Brooks Rehabilitation Charge Master 12.28.18

Mnemonic Name Charge Category Category Description Amount

200020 4 Rehab/Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00

200021 4 Rehab/Semi Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00

210020 2 Rehab/Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00

210050 2 Rehab Peds/Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00

220020 3 Rehab/Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00 230020 2 E Rehab/Private 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00 239020 3 East Rehab 118 Rehabilitation - Room and Board- Private (Medical or General) $1,400.00 220021 3 Rehab/Semi Private 128 Rehabilitation - Room and Board-Semi-Private Two Bed (Medical or General) $1,400.00 219999 LOA Charge 180 General Leave of Absence $- 149900 Legal Billing 229 Other Special Charges $- 208031 Specialty Bed 229 Other Special Charges $- 218031 Specialty Bed 229 Other Special Charges $-

228031 Specialty Bed 229 Other Special Charges $-

238031 Specialty Bed 229 Other Special Charges $-

239031 Specialty Bed 229 Other Special Charges $-

309369 Misc Charges 229 Other Special Charges $-

NONTAX Non Tax Client Rev 229 Other Special Charges $-

TAXSUP Taxable Supplies 229 Other Special Charges $-

147557 Physical Perf Test/Measure FCE 240 General - All Inclusive Ancillary $135.00

149712 Neuro Program 1/2 Day 240 General - All Inclusive Ancillary $550.00 149715 Neuro Program Per Day 240 General - All Inclusive Ancillary $950.00 149721 Pain Program Per Day 240 General - All Inclusive Ancillary $950.00 149722 Pain Program 1/2 Day 240 General - All Inclusive Ancillary $550.00 149736 SelfPay Half Day Stepdown 240 General - All Inclusive Ancillary $250.00 149917 Self Pay Full Day Complete 240 General - All Inclusive Ancillary $450.00 149918 Self Pay Half Day Complete 240 General - All Inclusive Ancillary $250.00

149919 Selfpay Full Day Stepdown 240 General - All Inclusive Ancillary $300.00

159712 SCI 1/2 Day Treatment 240 General - All Inclusive Ancillary $550.00

159715 SCI Full Day Treatment 240 General - All Inclusive Ancillary $950.00

99232AC Hospital Follow Up Level 2 AC 240 General - All Inclusive Ancillary $142.00

71226 Metronidazole 50 mg SU 250 General Pharmacy $9.00

71260 Morphine PF 200mg/20ml 250 General Pharmacy $432.00

71288 Exp Cabergoline 0.5mg 250 General Pharmacy $609.00

71293 Cyclophosphamide 100MG 250 General Pharmacy $69.00 71294 Melphalan 2mg 250 General Pharmacy $37.00 71295 Pralidoxime Cl up to 1g 250 General Pharmacy $523.00 71301 Exp Memropenem 100mg 250 General Pharmacy $113.00 71303 Exp Meropenem 100mg 250 General Pharmacy $367.00 71308 Ergonovine Mal Upto .2 250 General Pharmacy $88.00 71312 Exp Acetlycysteine 100 250 General Pharmacy $19.00

71318 Fondaparinux 7.5mg Inj 250 General Pharmacy $329.00

71323 Ibuprofen Lysine PF 20 250 General Pharmacy $2,122.00

71325 Micafungin 50mg Inj 250 General Pharmacy $260.00

71340 Doripenem 500mg Inj 250 General Pharmacy $113.00

71341 Doripenem 500mg/NS 10 250 General Pharmacy $436.00

71342 Heparin 1 Unit/ml 3 ml 250 General Pharmacy $17.00

71343 Heparin 10 Unit/ml 10 250 General Pharmacy $20.00

71369 Hydroxycobol 2.5gm Inj 250 General Pharmacy $1,237.00

1 71370 Nicard 0.2mg/ml 200ml 250 General Pharmacy $916.00 71371 Fentanyl 75mcg Patch 250 General Pharmacy $211.00 71388 Melphalan 2mg 250 General Pharmacy $37.00 71451 Octreotide Depo 1M 20M 250 General Pharmacy $8,955.00

71494 Morphine 1mg/ml PCA 250 General Pharmacy $319.00

71495 Fentanyl 20mcg/ml PCA 250 General Pharmacy $319.00

71496 Hydromorph 0.2 mg/ml P 250 General Pharmacy $319.00

71516 Hydromorph 2mg Inj 250 General Pharmacy $164.00

71571 Phenobarb 130mg Inj 250 General Pharmacy $164.00

71579 Haldol Dec 100mg Inj 250 General Pharmacy $104.00

71582 Metformin 500mg Udl 250 General Pharmacy $17.00

71592 Zanamivr Inh-10 Dose 250 General Pharmacy $296.00 71608 D5NS/Potass Chlor 20meq/1000ml 250 General Pharmacy $441.00 71609 D50.45NACL/POT CHL.10MEQ 1000 250 General Pharmacy $507.00 71614 Sodium Citrate 3ml Syringe 250 General Pharmacy $23.00 71615 Oxymorphone 40mg Srtab 250 General Pharmacy $113.00 71616 Nilotinib HCL 200mg 250 General Pharmacy $305.00 71617 KCL 25 Meq/250 ml 250 General Pharmacy $341.00

71618 KCL 25 Meq/500ml 250 General Pharmacy $341.00

71619 Heparin 30000Unit/1000ml 250 General Pharmacy $517.00

71620 Oxymorphone 5mg Tab 250 General Pharmacy $77.00

71626 Ziconotide 500mcg/20ml 250 General Pharmacy $11,115.00

71650 Celecoxib 200mg Cap 250 General Pharmacy $33.00

71653 Famotidine 20mg Chewtab 250 General Pharmacy $17.00

71659 Cabazitaxel 60mg Inj 250 General Pharmacy $25,852.00

71669 Fluticasone 100 Inh 250 General Pharmacy $378.00 71670 Fluticasone 250 Inh 250 General Pharmacy $474.00 71677 Ceftriaxone 100mg/ml 250 General Pharmacy $88.00 71688 Dabigatran Etexilate 150mg Cap 250 General Pharmacy $38.00 71695 Interf Beta1A 30Mcg Inj 250 General Pharmacy $2,018.00 71907 Exp Derm Nonhm Ts Sq C 250 General Pharmacy $202.00 71909 Exp Derm Nonhm Ts Sq S 250 General Pharmacy $404.00

74400 Perflutren Lipd Mcrs 250 General Pharmacy $565.00

75052 Fentanyl 12Mcg per hr Patch 250 General Pharmacy $211.00

75062 Hyaluronidase Up to 15 250 General Pharmacy $167.00

75438 Ropivacaine 0.2% 20ml 250 General Pharmacy $78.00

75439 Ropivacaine 0.5% 30ml 250 General Pharmacy $121.00

75440 Levetiracetam 500mg Inj 250 General Pharmacy $151.00

75444 Conivaptan 20mg Inj 250 General Pharmacy $1,448.00

79430 Vzig 125 Unit/1.25ml 250 General Pharmacy $238.00

79431 Acyclovir 40mg/ml Udl 250 General Pharmacy $12.00 171202 Oseltamivir 25ml Susp 250 General Pharmacy $207.00 171275 Roflumilast 500mcg Tab 250 General Pharmacy $56.00 171282 Lidocaine 2% 5ml Inj 250 General Pharmacy $44.00 171285 Lidocaine 1% 10ml 250 General Pharmacy $152.00 171287 Valganciclovir 100ml 250 General Pharmacy $2,142.00 171290 Aripiprazole 9.75mg Inj 250 General Pharmacy $106.00

171311 Hydromorphone 2mg Inj 250 General Pharmacy $152.00

193045 Glucose Tolerance Bev 250 General Pharmacy $41.00

301031 Teds Thigh Xxlarge/Reg (351) 250 General Pharmacy $35.00

2 301263 Tube Gastrostomy 22Fr 250 General Pharmacy $80.00 301264 Tube Gastrostomy 24Fr 250 General Pharmacy $80.00 305112 Trach Tube 6.0 250 General Pharmacy $150.00 305117 Drsg Mepilex Ag 4X4 250 General Pharmacy $23.00

314245 Adhesion Barrier 250 General Pharmacy $2,999.00

314506 Collagen Instat 3x4in 250 General Pharmacy $313.00

314995 Adcon Adhesion Barrier 250 General Pharmacy $4,177.00

378706 CPD Anticoagulant 250 General Pharmacy $251.00

423966 Pyrophosphate Vial 250 General Pharmacy $117.00

425354 Midazolam Syrup 250 General Pharmacy $88.00

425358 Rivaroxaban 10 Mg Tablet 250 General Pharmacy $63.00

425396 Ceftaroline Fosamil 600Mg Vial 250 General Pharmacy $488.00 425435 Hepa Imag Incl Gb 250 General Pharmacy $1,744.00 425436 Hepa Imag Incl Gb w ph 250 General Pharmacy $1,744.00 425453 Ceftaroline Fosamil 400Mg Vial 250 General Pharmacy $488.00 425640 Clotrimazole Crm 1% 45gm 250 General Pharmacy $51.00 434134 EYE IRRIGATION BLINK 8 250 General Pharmacy $73.00 436431 LACRILUBE 250 General Pharmacy $61.00

438110 BLINX 250 General Pharmacy $62.00

439620 VISCOAT INJ 250 General Pharmacy $1,318.00

476101 SADDLE BLOCK TRAYS ABB 250 General Pharmacy $337.00

476108 SPINAL TRAYS 22G PHARM 250 General Pharmacy $304.00

476118 TRAY SPINOCAN BURRON 2 250 General Pharmacy $117.00

476191 KITS L.T.A. 25/CS 250 General Pharmacy $248.00

477532 TRAY SPINAL BURRON 26G 250 General Pharmacy $117.00

477533 TRAY SPINAL SPINOCAN B 250 General Pharmacy $117.00 477534 TRAY SPINAL SPINOCAN B 250 General Pharmacy $117.00 477603 TRAY LUMBAR SYMPATHETI 250 General Pharmacy $333.00 480947 Dilator Jcd 14-0-0-38-2 250 General Pharmacy $218.00 482135 Dilator 9.0X38X20 250 General Pharmacy $201.00 485878 Dilator Vssl 4F 035 250 General Pharmacy $107.00 686832 Rhogam, 50Mg Dose 250 General Pharmacy $77.00

735167 Lidocaine/Epi 1.5% Sdv 250 General Pharmacy $111.00

750005 Pentazocine 30mg Amp 250 General Pharmacy $167.00

750008 Tetanus Toxiod 250 General Pharmacy $102.00

750030 Meperidine 10mg/ml 50m 250 General Pharmacy $717.00

750083 Morphine 500mg/20ml Inj 250 General Pharmacy $218.00

750300 Misoprostol 25mcg Tab 250 General Pharmacy $30.00

750355 Meperidine 25mg/ml Inj 250 General Pharmacy $110.00

750357 Sufentanil 100mcg 1ml 250 General Pharmacy $506.00

750358 Sufentanil 5ml Inj 250 General Pharmacy $1,222.00 750364 Fentanyl 1000mcg/20ml 250 General Pharmacy $409.00 750476 Didanosine 125mg 250 General Pharmacy $53.00 750971 Gen Code (250) 250 General Pharmacy $- 751635 Tramadol HCL 50 MG Tab 250 General Pharmacy $20.00 751900 ACETYLCYSTEINE 6GM INJ 250 General Pharmacy $493.00 752004 Bivalirudin 250mg Inj 250 General Pharmacy $1,264.00

752005 Acth Gel 80U/ml UDI 250 General Pharmacy $67.00

752029 Alcohol 95%ml 250 General Pharmacy $75.00

752035 Methyldopa 250mg 5ml Vial 250 General Pharmacy $104.00

3 752047 Aminophylline 10mg Ud 250 General Pharmacy $69.00 752065 Physostigmine 2mg Amp 250 General Pharmacy $76.00 752071 Antivenin Crotal/Crofa 250 General Pharmacy $3,951.00 752072 Antivenom Blck Wid(Lact 250 General Pharmacy $321.00

752087 Asparaginase 10000U/10 250 General Pharmacy $533.00

752111 Amikacin 500mg Inj 250 General Pharmacy $62.00

752115 Atropine 0.4 MG/ML 20 250 General Pharmacy $125.00

752184 Calcitonin 100mcg Udi 250 General Pharmacy $75.00

752185 Calcitonin 200mcg Udi 250 General Pharmacy $166.00

752187 Calcitonin 400mcg/2ml 250 General Pharmacy $198.00

752191 Candida S Test 250 General Pharmacy $153.00

752192 Mepivicaine 2% 50ml Vial 250 General Pharmacy $159.00 752200 Interferon Alfa 2A 3mu 250 General Pharmacy $559.00 752210 Chloropro 3% PF 250 General Pharmacy $227.00 752219 Cefotaxime 100mg Ud Inj 250 General Pharmacy $69.00 752242 Clonidine 1000mg/10ml 250 General Pharmacy $397.00 752259 Dexameth 24mg/ml 5ml Inj 250 General Pharmacy $754.00 752260 Cosyntropin 25 Units Vial 250 General Pharmacy $344.00

752264 Cyclophosphamide 100mg 250 General Pharmacy $62.00

752278 Dexamethasone 8mg/ml L 250 General Pharmacy $462.00

752279 Dexameth-Xyloc Susp 5m 250 General Pharmacy $711.00

752287 PROPOFOL 10MG/ML 50ML 250 General Pharmacy $415.00

752295 ERGONOVINE INJ 0.2 MG/ 250 General Pharmacy $81.00

752303 Estradiol Valer 40mg/M 250 General Pharmacy $223.00

752309 ESTRADIOL CYPRION 5MG/ 250 General Pharmacy $94.00

752339 DIHYDROERGOTAM 1MG 1ML 250 General Pharmacy $171.00 752357 DIP TET TOX PED 0.5 ML 250 General Pharmacy $121.00 752359 ADENOSINE 6MG/2ML INJ 250 General Pharmacy $133.00 752361 DOPAMIN 400 MG INJ 250 General Pharmacy $114.00 752410 EDTA 150MG/ML 20ML 250 General Pharmacy $173.00 752413 SOD ACET 40MEQ/20 ML I 250 General Pharmacy $36.00 752416 SOD CL TUBEX 2.5 ML 250 General Pharmacy $111.00

752424 FLOXURIDINE 500MG. VIA 250 General Pharmacy $590.00

752436 GLYCOPYRROLATE 20 250 General Pharmacy $201.00

752449 HISTOPLASMIN 250 General Pharmacy $44.00

752454 HEPATITIS A VACCINE 250 General Pharmacy $388.00

752467 HEPARIN 5000 UNITS/1ML 250 General Pharmacy $64.00

752469 RHO IMMUNE GLOBULIN 10 250 General Pharmacy $2,989.00

752475 FONDAPARINOX 2.5MG INJ 250 General Pharmacy $250.00

752509 DIAZOXIDE 80MG 20ML AM 250 General Pharmacy $215.00

752512 CEFOTETAN 1GM INJ 250 General Pharmacy $357.00 752513 CEFOTETAN 2GM INJ 250 General Pharmacy $626.00 752522 DEXPANHENL 500 MG SYRI 250 General Pharmacy $111.00 752525 DEXTRAN-1 150MG/ML 20M 250 General Pharmacy $317.00 752534 DROPERIDOL 2.5MG/1ML A 250 General Pharmacy $423.00 752554 INTERFERON B-1A 22 MCG 250 General Pharmacy $642.00 752567 INSULIN 75/25 10ML 250 General Pharmacy $376.00

752575 KANAMYCIN 1 G 3 ML VIA 250 General Pharmacy $150.00

752590 SINCALIDE 5MCG/ML INJ 250 General Pharmacy $535.00

752595 LANSOPRAZOLE 30 MG INJ 250 General Pharmacy $71.00

4 752600 LABETALOL 5MG/ML 20ML 250 General Pharmacy $63.00 752601 CAFFEINE CIT INJ 60MG/ 250 General Pharmacy $261.00 752610 LEVCOVERIN 350MG INJ 250 General Pharmacy $767.00 752632 LIDOCAINE 5%/DEX 2ML I 250 General Pharmacy $223.00

752633 LIDOCAINE 2% 10ML SDV 250 General Pharmacy $316.00

752634 LIDOCAINE 0.5% 50ML SD 250 General Pharmacy $331.00

752670 BUPIVACINE 0.75/DEX 8. 250 General Pharmacy $35.00

752674 METRONIDAZOLE 500MG IN 250 General Pharmacy $118.00

752680 AMIKACIN 20MG UD INJ 250 General Pharmacy $43.00

752683 FUROSEMIDE 20 MG UDI 250 General Pharmacy $19.00

752687 LYMPHOCYTE IMMUNE GLOB 250 General Pharmacy $953.00

752688 SPIRONOLAC 5MG/ML 50 S 250 General Pharmacy $141.00 752694 METHOTREXATE 200V 250 General Pharmacy $268.00 752700 METHYLENE BLUE 250 General Pharmacy $178.00 752708 METHOHEXITOL 500MG VIA 250 General Pharmacy $353.00 752713 METUBINE 20ML 250 General Pharmacy $218.00 752714 MIDAZOLAM 50MG/10ML VI 250 General Pharmacy $211.00 752721 MIVACURIUM 10MG/5ML IN 250 General Pharmacy $329.00

752730 MUMPS SKIN TES 250 General Pharmacy $126.00

752741 MULTIVITAMIN PED 10ML 250 General Pharmacy $206.00

752747 NAFCILLIN 50MG UD INJ 250 General Pharmacy $69.00

752772 PENTOBARBITAL 100MG 2M 250 General Pharmacy $64.00

752776 NALMEFENE 1 MG/ML 2 ML 250 General Pharmacy $423.00

752792 NITR 25MG INJ 250 General Pharmacy $219.00

752794 L-CYSTEINE 50MG/ML INJ 250 General Pharmacy $141.00

752798 OFLOXACIN 400MG INJ 250 General Pharmacy $471.00 752799 OPRELVEKIN INJ 5MG 250 General Pharmacy $833.00 752837 PEN G POT 1 MILL U UDI 250 General Pharmacy $138.00 752838 PENICILLIN POT. G 1 MU 250 General Pharmacy $104.00 752848 PEN PRO 0.6 TX 250 General Pharmacy $99.00 752849 PEN G PROC 1.2MU 250 General Pharmacy $51.00 752856 PHENOL 6% INJ 250 General Pharmacy $197.00

752865 DIPYRIDAMOLE 10MG/2ML 250 General Pharmacy $77.00

752870 PIPERACILLIN 4G VIAL 250 General Pharmacy $133.00

752888 TETRACAINE 1% 2ML AMP 250 General Pharmacy $174.00

752891 THIOPENTAL 500MG/20ML 250 General Pharmacy $409.00

752914 NEOSTIGMINE 0.5MG 1ML 250 General Pharmacy $140.00

752955 HEPATITIS B IMM GLOB 0 250 General Pharmacy $531.00

752985 RUBELLA VIRUS 250 General Pharmacy $183.00

752998 SECRETIN 75CU INJ 250 General Pharmacy $955.00

753006 SODIUM BICARB 1-5ML 250 General Pharmacy $64.00 753009 SODIUM CL 0.9% 30 ML M 250 General Pharmacy $- 753032 PROMAZINE 100MG 2ML VI 250 General Pharmacy $69.00 753038 ALFENTANIL 2ML 250 General Pharmacy $240.00 753042 STREPYOMYGIN INJ 400MG 250 General Pharmacy $100.00 753048 SUCCINYLCHO 1000MG FLO 250 General Pharmacy $458.00 753049 SUMATRIPTAN 6MG/.5ML I 250 General Pharmacy $767.00

753053 MORPHINE 5MG/ML 50 ML 250 General Pharmacy $645.00

753122 THIOTEPA 15MG 250 General Pharmacy $691.00

753130 TIMENTIN 3.1 GM INJ 250 General Pharmacy $140.00

5 753142 TOLAZOLINE 25MG/ML 1ML 250 General Pharmacy $108.00 753150 TUBERCULIN PPD TEST/5T 250 General Pharmacy $153.00 753155 HEPB VAC PED 10MCG/0.5 250 General Pharmacy $108.00 753212 PIP/TAZOBACT 4.5 GM 250 General Pharmacy $121.00

753230 Vitamin A 50,000 IU/ML 250 General Pharmacy $260.00

753240 HYALURONIDASE 150UN VI 250 General Pharmacy $207.00

753266 LIDOCAINE VISC 2% 100M 250 General Pharmacy $205.00

753611 CHERRY SYR/30 250 General Pharmacy $34.00

753693 DIAZEPAM RECTAL GEL 10 250 General Pharmacy $597.00

753702 DIGOXIN 0.1MG/ML 1ML A 250 General Pharmacy $36.00

753951 MULTIVITAMIN THERA 5ML 250 General Pharmacy $13.00

754102 Cyclosp 50 ml 250 General Pharmacy $1,309.00 754151 Sorb 70% 250 General Pharmacy $150.00 754211 Water Irrig 1000ml Bt 250 General Pharmacy $110.00 754229 Multi 50ml 250 General Pharmacy $50.00 754371 EMETROL 90ML 250 General Pharmacy $21.00 754534 CASTELLANI PAINT 1OZ. 250 General Pharmacy $62.00 754720 BUPIV/DEX 0.75% 2ML I 250 General Pharmacy $116.00

754735 AMMONIUM ALUM IRRG 100 250 General Pharmacy $315.00

754755 PENTAMIDIN INH/SOL 300 250 General Pharmacy $673.00

754782 APRACLONIDINE 250 General Pharmacy $159.00

754797 DIPIVEFRIN 0.1% OPH SO 250 General Pharmacy $72.00

754808 SCOPOLAMINE .25% OPSOL 250 General Pharmacy $201.00

754809 CORTISPORI O O 250 General Pharmacy $436.00

754832 LACRILUBE OPOI 0.7G 250 General Pharmacy $20.00

754834 Acetylcysteine 10% 4ml 250 General Pharmacy $25.00 754841 MYDRAPRED OP S 250 General Pharmacy $121.00 754844 PHENYLEPHRINE 0.5% NA 250 General Pharmacy $25.00 754850 FLURIBROFEN OPSO 2.5ML 250 General Pharmacy $250.00 754853 POLY-PRED OP S 250 General Pharmacy $141.00 754857 PROPARACAINE 0.5% OPSO 250 General Pharmacy $294.00 754869 PILO 4% 2 250 General Pharmacy $104.00

754874 SULFACET 10% ONT 250 General Pharmacy $123.00

754877 SULFACET 10% TEARS NAT 250 General Pharmacy $47.00

754907 MAG SOX 120GM 250 General Pharmacy $120.00

754916 NEOMYCIN E 250 General Pharmacy $153.00

754925 PODOPHYLLUM 25% 15ML 250 General Pharmacy $317.00

754934 PILOCARP 4% 250 General Pharmacy $448.00

754951 HYDROCHLORIC ACID 30ML 250 General Pharmacy $36.00

754962 N POLISH REMOVE 250 General Pharmacy $13.00

755032 MORPHINE PF 10MG/10ML 250 General Pharmacy $133.00 755033 MORRHUATE 50 MG/ML 30 250 General Pharmacy $414.00 755034 MORPHINE PF 200MG/20ML 250 General Pharmacy $1,366.00 755035 MORPHINE PF 500MG/20ML 250 General Pharmacy $1,366.00 755037 MORPHINE PF 500MG/10ML 250 General Pharmacy $1,222.00 755055 STRONG IODINE SOLN DOS 250 General Pharmacy $48.00 755056 BISMUTH SUBGAL PWDR DS 250 General Pharmacy $100.00

756005 DARBEPOETIN 150 MCG IN 250 General Pharmacy $1,758.00

756006 DARBEPOETIN 200 MCG IN 250 General Pharmacy $2,339.00

756007 DARBEPOTEIN 300 MCG IN 250 General Pharmacy $3,504.00

6 756999 NON-FORMULARIES 250 General Pharmacy $- 757001 VARICELLA VIRUS LIVE S 250 General Pharmacy $359.00 757005 CYTARABINE LIPOSOMAL 5 250 General Pharmacy $5,939.00 757006 STREPTOZOCIN 1 GM INJ 250 General Pharmacy $794.00

757912 AZTREONAM 500MG/NS 100 250 General Pharmacy $386.00

758010 CEFOTETAN 1 GM/NS 100 250 General Pharmacy $658.00

758011 CEFOTETAN 2 GM/NS 100 250 General Pharmacy $954.00

758014 CEFIPIME 500MG/NS 100M 250 General Pharmacy $418.00

758020 IMEPENEM 500 MG/NS 100 250 General Pharmacy $507.00

758024 Pipracillin 3gm/Ns 10ml 250 General Pharmacy $434.00

758025 PIPRACILLIN 4 GM/NS 10 250 General Pharmacy $436.00

758026 PIPRACILLIN 2 GM/NS 10 250 General Pharmacy $431.00 758027 PIP/TAZO 4.5 G/NS 100M 250 General Pharmacy $478.00 758032 VANCOMYCIN 1 GM INJ 250 General Pharmacy $347.00 758046 CLINDAMYCIN 900 MG/D5W 250 General Pharmacy $1,250.00 758056 RANITIDINE 50 MG/ 1/2 250 General Pharmacy $660.00 758062 CEFTAZIDIME OPHTH SOL 250 General Pharmacy $282.00 758073 TETANUS IMM GL 250 U 250 General Pharmacy $282.00

758078 QUINAPRISTIN/DALFO 500 250 General Pharmacy $653.00

758080 DROTRECOGIN ALFA 20 MG 250 General Pharmacy $3,976.00

758085 CYCLOSPORINE 250 MG/5 250 General Pharmacy $305.00

758088 CARMUSTINE 100 MG VIAL 250 General Pharmacy $658.00

758089 DACTINOMYCIN 0.5 MG VI 250 General Pharmacy $183.00

758091 MECHLORETHAMINE 10 MG 250 General Pharmacy $201.00

758092 RENACIDIN 10% SOL 500 250 General Pharmacy $218.00

758105 HEPARIN 5000UNIT/NS500 250 General Pharmacy $133.00 758111 OXYTOCIN 30 UN/NS 500 250 General Pharmacy $493.00 775026 Pot Inf Add 250 General Pharmacy $21.00 786105 TOTAL VOLUME 250 General Pharmacy $- 799093 EXP IRON SUCR CPX 1 MG 250 General Pharmacy $250.00 833679 INTERLINK INJECTION SI 250 General Pharmacy $11.00 900610 Ketamine Hcl 500 Mg/5 Ml Vial 250 General Pharmacy $160.00

900617 Labetal Hydrochlor 20Mg/4MlInj 250 General Pharmacy $47.00

900632 Morphine Sulfate 4 Mg/Ml Inj 250 General Pharmacy $117.00

900633 Morphine Sulfate 2 Mg/Ml Inj 250 General Pharmacy $105.00

900637 Amiodarone Hcl 450 Mg/9Ml Vl 250 General Pharmacy $295.00

900675 Tramadol Hcl 50 Mg Tab 250 General Pharmacy $21.00

900688 Actylcystn6000Mg/30Ml20%OrlSln 250 General Pharmacy $117.00

900737 LOCM 300 TO 399 PER ML 250 General Pharmacy $6.00

900746 Carbachol .01% Intraoc 250 General Pharmacy $605.00

900762 Piperaclln/TazbctmSod3.375GmVl 250 General Pharmacy $93.00 900766 PIP SOD/TAZ 3.375 G BA 250 General Pharmacy $404.00 900768 Heparin Sod(Porcn)1000Un/MlVl 250 General Pharmacy $50.00 900769 Acetaminophen 325 Mg Tab 250 General Pharmacy $5.00 900806 Sodium Acetazolamide 500 Mg Vl 250 General Pharmacy $369.00 900810 Paricalcitol 5 Mcg/Ml Vial 250 General Pharmacy $221.00 900931 Cefazolin Sodium 1 Gm Vial 250 General Pharmacy $526.00

900940 Diltiazem Hcl 25 Mg/5 Ml Vial 250 General Pharmacy $62.00

900946 Amikacin Sulfate 500 Mg/2Ml Vl 250 General Pharmacy $62.00

900968 Aminophylline 500Mg/20 Ml Vial 250 General Pharmacy $50.00

7 901034 Ampiclln Sod/Sulbactm Na 3GmVl 250 General Pharmacy $529.00 901035 AmpicllnSod/SulbactamNa1.5GmVl 250 General Pharmacy $391.00 901041 Ampicillin Sodium 125 Mg Vial 250 General Pharmacy $25.00 901047 Ampicillin Sodium 250 Mg Vial 250 General Pharmacy $32.00

901048 Ampicillin Sodium 500 Mg Vial 250 General Pharmacy $60.00

901049 Ampicillin Sodium 1 Gm Vial 250 General Pharmacy $58.00

901050 Ampicillin Sodium 2 Gm Vial 250 General Pharmacy $94.00

901061 Amphotericin B 50 Mg Vial 250 General Pharmacy $123.00

901097 Sumatriptan Succinate 50Mg Tab 250 General Pharmacy $22.00

901133 Fomepizole 1500 Mg/1.5 Ml Vl 250 General Pharmacy $4,952.00

901162 Atropine 1 Mg/10 Ml Syringe 250 General Pharmacy $174.00

901163 Atropine Sulfate 0.4Mg/Ml Vial 250 General Pharmacy $118.00 901180 "Bacitracin 50,000 Unit Vial" 250 General Pharmacy $62.00 901181 Azithromycin 500 Mg Vial 250 General Pharmacy $247.00 901201 Ceftriaxone Sodium 1 Gm Vial 250 General Pharmacy $272.00 901202 Ceftriaxone Sodium 2 Gm Vial 250 General Pharmacy $304.00 901203 CEFTRIAXONE 500 VL 250 General Pharmacy $266.00 901206 Ceftriaxone Sodium 250 Mg Vial 250 General Pharmacy $266.00

901211 BENZOCAINE 2 OZ TOPICA 250 General Pharmacy $51.00

901220 Benztropine Mesylat 2Mg/2MlAmp 250 General Pharmacy $192.00

901224 BetmtAcet/BetmtNaPh12Mg/2MlInj 250 General Pharmacy $152.00

901238 PencllnGBenzthn600000Un/MlSyr 250 General Pharmacy $250.00

901239 PencllnGBenzthn1.2MilUn/2MlPfs 250 General Pharmacy $432.00

901247 Activated Charcl 25Gm/120MlSus 250 General Pharmacy $78.00

901260 Cisatracurm Besylt 20Mg/10MlVl 250 General Pharmacy $605.00

901263 Bleomycin Sulfate 15 Unit Vial 250 General Pharmacy $904.00 901272 Fosfomycin Tromethamine 3G/Pkt 250 General Pharmacy $210.00 901273 Bss Opl 15Ml 250 General Pharmacy $233.00 901275 Magnesium Sulfate 1 Gm/2 Ml Vl 250 General Pharmacy $45.00 901277 MagSulfate/H2o/Ns2Gm/50MlIvbag 250 General Pharmacy $81.00 901278 Mag Sulfate/D5W1Gm/100Ml Ivbag 250 General Pharmacy $81.00 901280 Magn Sulf/H2O 20Gm/500Ml Ivbg 250 General Pharmacy $160.00

901281 Magn Sulf/H2O/Ns 4Gm/100MlIvbg 250 General Pharmacy $81.00

901288 Bumetanide 1 Mg/4 Ml Vial 250 General Pharmacy $19.00

901299 Bupivacaine Hcl 0.25% 30Ml Sdv 250 General Pharmacy $59.00

901303 Bupivacn Hcl/Epi 0.25% 30MlSdv 250 General Pharmacy $50.00

901312 Bupivacan Hcl/Epi 0.5% 30MlSdv 250 General Pharmacy $59.00

901316 Bupivacaine Hcl 0.5% 30 Ml Sdv 250 General Pharmacy $53.00

901320 Bupivacaine Hcl 0.75% 10Ml Sdv 250 General Pharmacy $205.00

901338 Calcitriol 1 Mcg/Ml Amp 250 General Pharmacy $130.00

901341 Calcium Chloride 1Gm/10Ml Syrg 250 General Pharmacy $134.00 901342 Calcium Chlor 1000Mg/10Ml Vl 250 General Pharmacy $52.00 901344 RabsVacChk-EmbCell2.5IntUnMlVl 250 General Pharmacy $951.00 901347 Calcium Glucon 1000Mg/10MlVl 250 General Pharmacy $34.00 901375 Cefazolin Sodium 1 Gm Vial 250 General Pharmacy $487.00 901378 Cefotaxime 1Gm Inj 250 General Pharmacy $143.00 901386 Ethyl Chloride 1 -/Dose Spry 250 General Pharmacy $83.00

901390 Cefuroxime Sodium 750 Mg Vial 250 General Pharmacy $152.00

901393 Cefuroxime Sodium 1.5 Gm Vial 250 General Pharmacy $412.00

901408 Celecoxib 200 Mg Cap 250 General Pharmacy $36.00

8 901411 Insulin Asprt 100Un/Ml 10Mlbot 250 General Pharmacy $323.00 901413 Chloramphenicol Na Succ 1Gm Vl 250 General Pharmacy $62.00 901461 Carboplatin 50 Mg/5 Ml 250 General Pharmacy $395.00 901486 Clindamycin 600Mg Amp 250 General Pharmacy $315.00

901487 Clindamycn Phospht 900Mg/6MlVl 250 General Pharmacy $705.00

901488 CLEOCIN 600MG RTU 250 General Pharmacy $732.00

901489 CLEOCIN 900MG RTU 250 General Pharmacy $823.00

901561 Cyanocobalamin 1000 Mcg/Ml Vl 250 General Pharmacy $83.00

901593 Deferoxamine Mesylate 500Mg Vl 250 General Pharmacy $83.00

901598 Valproate Sodium 500 Mg/5Ml Vl 250 General Pharmacy $126.00

901608 Tolterodine Tartrate 2 Mg Tab 250 General Pharmacy $23.00

901610 Dexamethsn Sod Phspht 4Mg/MlVl 250 General Pharmacy $97.00 901611 Verapamil Hcl 5 Mg/2 Ml Vial 250 General Pharmacy $70.00 901613 Dexamthsn Sod Phospht10Mg/MlVl 250 General Pharmacy $204.00 901638 DIAZEPAM 2.5 MG RECTAL 250 General Pharmacy $559.00 901644 Diazepam 5 Mg Tab 250 General Pharmacy $37.00 901645 Diazepam 10 Mg/2 Ml Inj 250 General Pharmacy $350.00 901656 Dicyclomine Hcl 20 Mg/2 Ml Amp 250 General Pharmacy $346.00

901660 Digoxin 0.5 Mg/2 Ml Amp 250 General Pharmacy $26.00

901666 Diltiazem Hcl 125Mg/25 Ml Vial 250 General Pharmacy $76.00

901697 Diphenhydramin Hcl 50Mg/Ml Vl 250 General Pharmacy $103.00

901701 Diphenhydramine Hcl 25 Mg Cap 250 General Pharmacy $4.00

901706 Diph,Prtss(Acll)TetPed0.5MlVl 250 General Pharmacy $143.00

901710 Vancomycin Hcl 500Mg/100Ml Btl 250 General Pharmacy $175.00

901713 PROPOFOL 100ML 250 General Pharmacy $415.00

901719 Chlorothiazide Sodium 500Mg Vl 250 General Pharmacy $694.00 901725 Sitagliptin Phoshate 25 Mg Tab 250 General Pharmacy $79.00 901730 Dobtmn Hcl/D5W 500Mg/250MlIvbg 250 General Pharmacy $534.00 901732 Meperidine Hcl 50 Mg Tab 250 General Pharmacy $63.00 901746 Dopamine Hcl 200 Mg/5 Ml Vial 250 General Pharmacy $57.00 901765 Doxycycline Hyclate 100Mg Vial 250 General Pharmacy $596.00 901767 Dihydroergotam Mesyl 1Mg/MlAmp 250 General Pharmacy $414.00

901775 Dacarbazine 200 Mg Vial 250 General Pharmacy $93.00

901782 Enoxaparin Sodim 40Mg/0.4MlSyr 250 General Pharmacy $169.00

901783 Enoxaparin Sodim 60Mg/0.6MlSyr 250 General Pharmacy $223.00

901785 Enoxaparin Sodim 30Mg/0.3MlSyr 250 General Pharmacy $147.00

901786 Enoxaparin Sod 120Mg/0.8Ml Syr 250 General Pharmacy $422.00

901788 Enoxaparin Sodim 80Mg/0.8MlSyr 250 General Pharmacy $222.00

901809 Enalaprilat 1.25 Mg/Ml Vial 250 General Pharmacy $105.00

901816 Ephedrine Sulfate 50 Mg/Ml Amp 250 General Pharmacy $134.00

901817 Epinephrine 1 Mg/10 Ml Syringe 250 General Pharmacy $448.00 901858 Esmolol Hydrochlor100Mg/10MlVl 250 General Pharmacy $378.00 901871 Etomidate 40 Mg/20 Ml Vial 250 General Pharmacy $134.00 901897 Tobramycn Fortfd 1.4% 5MlOpsol 250 General Pharmacy $339.00 901899 Tapentadol Hydrochlord 50MgTab 250 General Pharmacy $50.00 901900 Fentyl Citrate 250Mcg/5 Ml Amp 250 General Pharmacy $327.00 901903 Fentanyl Citrate100Mcg/2Ml Amp 250 General Pharmacy $215.00

901907 Fentanyl 75 Mcg Patch 250 General Pharmacy $228.00

901919 Tamsulosin Hcl 0.4 Mg Cap 250 General Pharmacy $23.00

901924 Ivermectin 3 Mg Tablet 250 General Pharmacy $59.00

9 901930 Fluconzl/SodCl 100Mg/50MlIvbag 250 General Pharmacy $399.00 901935 Posaconazole 200 Mg/5Ml 250 General Pharmacy $239.00 901939 Voriconazole 200 Mg Tab 250 General Pharmacy $292.00 901941 Flucnzl/Sod Cl 400Mg/200MlIvbg 250 General Pharmacy $588.00

901943 Flumazenil 0.5 Mg/5 Ml Vial 250 General Pharmacy $780.00

901951 Fluorescein Sodium 5 Ml Amp 250 General Pharmacy $56.00

901952 Fluorescein Sodium 1 Ea Strip 250 General Pharmacy $12.00

901954 Fluorouracil 500 Mg/10 Ml Vial 250 General Pharmacy $60.00

901971 Folic Acid 5 Mg/Ml Udi 250 General Pharmacy $62.00

901973 Furosemide 20 Mg/2 Ml Vial 250 General Pharmacy $17.00

901975 Furosemide 40 Mg/4 Ml Vial 250 General Pharmacy $20.00

901978 Furosemide 100 Mg/10 Ml Vial 250 General Pharmacy $42.00 902031 Gentamicin Sulf 0.3% 3.5Gm Opn 250 General Pharmacy $139.00 902034 Gentamicin Sulfate 20Mg/2Ml Vl 250 General Pharmacy $83.00 902035 Gentamicin Sulfate 80 Mg/2MlVl 250 General Pharmacy $232.00 902036 Mannitl(OsmtcDir)12.5Gm/50MlVl 250 General Pharmacy $36.00 902047 Dextrose 50%-H2O 25Gm/50MlSyrg 250 General Pharmacy $330.00 902065 Glycopyrrolate 0.2 Mg/Ml Vial 250 General Pharmacy $59.00

902066 GLYCOPYRROLATE 4 MG/20 250 General Pharmacy $80.00

902088 Haloperidol Lactate 5Mg/Ml Amp 250 General Pharmacy $35.00

902100 Lidocaine Hcl 2% 10 Ml Jelly 250 General Pharmacy $243.00

902101 HydrocrtSodSuccint100 Mg/2MlVl 250 General Pharmacy $30.00

902108 Heptitis B Vrs Vacc 20Mcg/MlVl 250 General Pharmacy $301.00

902109 Lidocaine 0.5% W/Epin 50Ml Mdv 250 General Pharmacy $194.00

902110 Lidocaine 2% W/Epin 20 Ml Sdv 250 General Pharmacy $263.00

902117 HepSod(Porcine)1000Un/Ml10MlVl 250 General Pharmacy $44.00 902119 Heparin SodPorcn 5000Un/MlVl 250 General Pharmacy $37.00 902122 Heparin 500 u lock 250 General Pharmacy $7.00 902127 Lidocaine 1% Mpf 5 Ml Inj 250 General Pharmacy $30.00 902149 Hydralazine Hcl 20 Mg/Ml Vial 250 General Pharmacy $137.00 902166 Hydromorphone Hcl 1 Mg/Ml Inj 250 General Pharmacy $114.00 902199 Ertapenem Sodium 1 Gm Vial 250 General Pharmacy $316.00

902223 Indigo-Carmine 250 General Pharmacy $318.00

902241 InsRegHumRec/Ns100Un/100MlIvbg 250 General Pharmacy $160.00

902261 ISOPROTERENOL AMP 250 General Pharmacy $2,583.00

902284 LABETALOL INJ 250 General Pharmacy $66.00

902295 Terbinafine Hcl 250 Mg Tab 250 General Pharmacy $134.00

902302 Leucovorin Calcium 50 Mg Vial 250 General Pharmacy $107.00

902340 Lidocaine 2% Jelly 5 Ml Tube 250 General Pharmacy $20.00

902341 Lidocaine Hcl 4% 50Ml Tpcl Sln 250 General Pharmacy $262.00

902343 Lidocaine 0.5% 50 Ml Sdv 250 General Pharmacy $273.00 902351 Lidocaine Hcl 4% 5 Ml Pf Amp 250 General Pharmacy $151.00 902354 LidocnHcl(Antrr)2% 50Mg/5MlSyg 250 General Pharmacy $53.00 902355 LIDOCAIN VISC .20ML 250 General Pharmacy $110.00 902356 Lidocaine Hcl/Epi 1% 20 Ml Mdv 250 General Pharmacy $170.00 902357 LIDOCAINE 1% 250 General Pharmacy $39.00 902362 Lidocaine Hcl 2% 20 Ml Mdv 250 General Pharmacy $345.00

902366 Lidocaine Hcl 1% 20 Ml Mdv 250 General Pharmacy $313.00

902381 Levofloxacin 500 MG Soln 250 General Pharmacy $54.00

902382 LEVOFLOXACIN 750 MG BA 250 General Pharmacy $886.00

10 902384 LEVOFLOXACIN 500 MG BA 250 General Pharmacy $734.00 902385 Fat Emul 20% 20Gm/100Ml Iv.Sln 250 General Pharmacy $88.00 902392 Lorazepam 2 Mg/Ml Vial 250 General Pharmacy $348.00 902421 POTASSIUM 10 MEQ/100 B 250 General Pharmacy $124.00

902422 Potassm Chlor 20Meq/100Ml Ivbg 250 General Pharmacy $124.00

902428 Colistimethate Sodium 150Mg Vl 250 General Pharmacy $297.00

902438 Dexacidin Oph Susp 5Ml 250 General Pharmacy $483.00

902451 LEVOFLOXACIN 250 MG BA 250 General Pharmacy $660.00

902456 Meperidine Hcl 50 Mg/Ml Pfs 250 General Pharmacy $159.00

902463 MinerlOil (Lax) 133Ml/Btl Enma 250 General Pharmacy $13.00

902464 Fleets Ped 250 General Pharmacy $11.00

902467 Mesalamine 4 Gm/60 Ml Enma 250 General Pharmacy $52.00 902476 Metoprolol Tartrat 5Mg/5Ml Amp 250 General Pharmacy $102.00 902481 Methylene Blue 100 Mg/10Ml Amp 250 General Pharmacy $384.00 902483 Methylergonovn Malt0.2Mg/MlAmp 250 General Pharmacy $126.00 902492 Metronidazole/Sod Chl 250 General Pharmacy $571.00 902493 METRONIDAZOLE DILUTION 250 General Pharmacy $20.00 902498 Methocarbamol 1000 Mg/10Ml Vl 250 General Pharmacy $255.00

902502 Polyvinyl Alchl 15Ml/Btl Opsol 250 General Pharmacy $47.00

902509 Pramipexole Di-Hcl 0.25 Mg Tab 250 General Pharmacy $43.00

902513 Methylprednsoln SodSucc125MgVl 250 General Pharmacy $239.00

902516 Methylprednisln SodSucc500MgVl 250 General Pharmacy $313.00

902517 Methylprdnsln Sod Succ 40Mg Vl 250 General Pharmacy $132.00

902520 Methylprednsoln Acet 80Mg/MlVl 250 General Pharmacy $264.00

902536 Metoclopramide Hcl 10Mg/2Ml Vl 250 General Pharmacy $224.00

902555 MIDAZOLAM 5MG INJ 250 General Pharmacy $159.00 902566 Mitomycin 5 Mg Vial 250 General Pharmacy $147.00 902567 Tobrmn/0.25NrSal300Mg/5MlAmNeb 250 General Pharmacy $356.00 902582 Morphine Sulfate 10 Mg/Ml Pfs 250 General Pharmacy $147.00 902599 Multivitamins 10 Ml Vial 250 General Pharmacy $64.00 902604 Nafcillin Sodium 1 Gm Vial 250 General Pharmacy $126.00 902606 NAFCILLIN DILUTION 250 General Pharmacy $73.00

902607 NAFCILLIN 2 GM VIAL 250 General Pharmacy $148.00

902608 Nalbuphine Hcl 10 Mg/Ml Vial 250 General Pharmacy $142.00

902614 Naloxone Hcl 0.4 Mg/Ml Inj 250 General Pharmacy $53.00

902639 Mycophenolt MofetlHcl500Mg/Vl 250 General Pharmacy $215.00

902651 Pregabalin 100 Mg Cap 250 General Pharmacy $40.00

902653 Neostgmn Mthylsulf10Mg/10MlMdv 250 General Pharmacy $181.00

902654 Nicardipine Hcl 25 Mg/10Ml Amp 250 General Pharmacy $248.00

902680 Norepinphr Bitartrt 4Mg/4MlAmp 250 General Pharmacy $110.00

902682 Methotrexate Sod 100Mg/4MlSdv 250 General Pharmacy $211.00 902711 Nitroglycrn/D5W 25Mg/250Ml Btl 250 General Pharmacy $142.00 902730 TetnsDphthr Txd Adlt 0.5MlInj 250 General Pharmacy $135.00 902733 DiphPrtss(Acll)TetVac0.5MlVl 250 General Pharmacy $179.00 902781 Cefepime Hcl 2 Gm Vial 250 General Pharmacy $195.00 902782 Cefepime Hcl 1 Gm Vial 250 General Pharmacy $123.00 902783 Oxytocin 10 Unit/Ml Vial 250 General Pharmacy $71.00

902792 Pancuronium Bromid 10Mg/10MlVl 250 General Pharmacy $683.00

902802 Pantoprazole Sodium 40 Mg Vial 250 General Pharmacy $131.00

902808 Penicillin G Potass 5MilluntVl 250 General Pharmacy $221.00

11 902838 Phenylphrn Hcl 0.25% 15MlNasol 250 General Pharmacy $73.00 902845 Phenylephrine Hcl 10Mg/Ml Vial 250 General Pharmacy $181.00 902851 Phenytoin Sodium 100 Mg/2Ml Vl 250 General Pharmacy $127.00 902854 Phenytoin Sodium 250 Mg/5Ml Vl 250 General Pharmacy $159.00

902860 Phytonadione 1 Mg/0.5 Ml Inj 250 General Pharmacy $65.00

902861 Phytonadione 10 Mg/Ml Amp 250 General Pharmacy $116.00

902866 Pilocarpine Hcl 2% 15 Ml Opsol 250 General Pharmacy $270.00

902899 Pneumococcal Vaccine 0.5 Ml Vl 250 General Pharmacy $271.00

902904 Bacitrcn/PolymyxnBSulf3.5GmOpn 250 General Pharmacy $152.00

902910 NeomySulf/Gramcd/Plymy10MlOpsl 250 General Pharmacy $398.00

902920 Sod Cl Irrg Sln 1000Ml/BtlIrri 250 General Pharmacy $158.00

902924 Poliomyelts VacKill 0.5Ml Inj 250 General Pharmacy $170.00 902927 Multivitamins 1 Ml Udl 250 General Pharmacy $11.00 902961 Prednisolon Acet 1% 5Ml Opsusp 250 General Pharmacy $83.00 902963 Gentmcn/SodChlr120Mg/100MlIvbg 250 General Pharmacy $491.00 903004 Progesterone 50 Mg/Ml Udi 250 General Pharmacy $54.00 903009 Promethazine Hcl 25 Mg/Ml Inj 250 General Pharmacy $116.00 903033 Propranol Hydrchlor 1Mg/MlAmp 250 General Pharmacy $62.00

903044 Protamine Sulfate 50 Mg/5Ml Vl 250 General Pharmacy $92.00

903058 Succinylcholine 100 MG 250 General Pharmacy $368.00

903059 SuccinylcholChlor200Mg/10MlVl 250 General Pharmacy $368.00

903073 Ranitidin Hydrochlor50Mg/2MlVl 250 General Pharmacy $232.00

903119 MeasleMumpRubella Vac 0.5MlVl 250 General Pharmacy $221.00

903129 Salsalate 500 Mg Tablet 250 General Pharmacy $13.00

903178 Sod Bicrbnt 8.4% 10Meq/10MlPfs 250 General Pharmacy $135.00

903179 Sodim Bicarbonat 50Meq/50MlPfs 250 General Pharmacy $186.00 903180 Sodium Bicarbonate 5 Ml Vial 250 General Pharmacy $32.00 903181 Sod Bicarbnt 4.2% 5Meq/10MlPfs 250 General Pharmacy $135.00 903182 Sodium Bicarbont 50Meq/50Ml Vl 250 General Pharmacy $88.00 903220 Sulfamethoxzl/Trimthprm 10MlVl 250 General Pharmacy $339.00 903236 Palivizumab 50 Mg Vial 250 General Pharmacy $5,369.00 903241 OSELTAMIVIR ORAL SUSP 250 General Pharmacy $33.00

903265 Terbutaline Sulfate 1Mg/Ml Amp 250 General Pharmacy $88.00

903269 Sildenafil Citrate 20Mg Tablet 250 General Pharmacy $108.00

903272 Epoprostenol Na 0.5 Mg Vial 250 General Pharmacy $221.00

903278 Tetracan Hcl 0.5% 2Ml/4MlOpsol 250 General Pharmacy $100.00

903307 Thrombin 5000 Unit/Vial Pwdr 250 General Pharmacy $341.00

903323 Tobramycin Sulf 0.3% 5 MlOpsol 250 General Pharmacy $372.00

903331 Ketorolc Tromethamn 60Mg/2MlVl 250 General Pharmacy $373.00

903334 Ketorolac Trometham 30Mg/Ml Vl 250 General Pharmacy $268.00

903339 Triamcinoln Acetond 40Mg/MlVl 250 General Pharmacy $129.00 903354 Triamterene 50 MG 250 General Pharmacy $46.00 903366 Trimethobnzmd Hcl 200Mg/2MlAmp 250 General Pharmacy $129.00 903374 Tropicamide 1% Opsol 250 General Pharmacy $518.00 903377 Hydrocod Psx/Chlor-Poli 5MlUdl 250 General Pharmacy $36.00 903391 Racepinephrine 2.25% IH 250 General Pharmacy $11.00 903392 Vasopressin 20 Unit/Ml Amp 250 General Pharmacy $347.00

903393 Vecuronium Bromide 10Mg/10MlVl 250 General Pharmacy $151.00

903408 Vincristine Sulfate 2Mg/2MlVl 250 General Pharmacy $208.00

903426 Dabigatran Etexilate 75 Mg Cap 250 General Pharmacy $42.00

12 903433 Bupropion Hcl 150Mg Tab.Sr.24H 250 General Pharmacy $56.00 903447 Paricalcitol 2 Mcg/Ml Vial 250 General Pharmacy $84.00 903448 Vinblastine Sulfate 10 Mg Vial 250 General Pharmacy $663.00 903455 Rocuronium Bromd 100Mg/10Ml Vl 250 General Pharmacy $594.00

903486 Entecavir 1 Mg Tab 250 General Pharmacy $166.00

903489 Ibandronate Sodium 150 Mg Tab 250 General Pharmacy $360.00

903493 Ceftazidime 1 Gm Vial 250 General Pharmacy $204.00

903494 Ceftazidime 2 Gm Vial 250 General Pharmacy $292.00

903509 Vancomycin Hcl 500 Mg Vial 250 General Pharmacy $100.00

903527 Asenapine 5 Mg Tab.Subl 250 General Pharmacy $79.00

903528 Rocuronium 5 ML INJ 250 General Pharmacy $292.00

903549 Bss Irrig Sol 500Ml 250 General Pharmacy $768.00 903560 Gabapentin 300 Mg/6 Ml Udl 250 General Pharmacy $47.00 903563 Potassium Chlor 40Meq/20MlVl 250 General Pharmacy $59.00 903571 Enoxaparin Sodium 150Mg/Ml Syr 250 General Pharmacy $631.00 903612 Hydrocortison 100Mg/60Ml Enema 250 General Pharmacy $61.00 903616 Phenobarbital 30Mg/7.5Ml Udcup 250 General Pharmacy $27.00 903623 Lacosamide 200 Mg/100 Ml Ivbag 250 General Pharmacy $199.00

903711 D5W/PotChlor20Meq/1000MlIvSln 250 General Pharmacy $508.00

903712 D5Lr/PotChlor20Meq/1000MlIvSln 250 General Pharmacy $505.00

903730 Meperidine Hcl 100 Mg/Ml Pfs 250 General Pharmacy $216.00

903731 HEPARIN 5000UNIT/NS500 250 General Pharmacy $131.00

903735 Ketorolac Trometham 15Mg/Ml Vl 250 General Pharmacy $196.00

903741 Ceftazidime 22.5 Mg/Ml Udi 250 General Pharmacy $305.00

903743 Vancomycin Hcl 20 Mg/2 Ml Udi 250 General Pharmacy $20.00

903746 Potassium Chlor 20Meq/10Ml Vl 250 General Pharmacy $52.00 903752 D5Ns/PotChlor20Meq/1000MlIvSln 250 General Pharmacy $477.00 903753 SodCl0.9%PtChl20Meq1000MlIvSln 250 General Pharmacy $387.00 903754 SodCl0.9%PtChl40Meq1000MlIvSln 250 General Pharmacy $387.00 903755 Sodium Biphospht 60Meq/15Ml Vl 250 General Pharmacy $21.00 903758 Gentamicin/Ns 80 Mg/1000Ml Btl 250 General Pharmacy $305.00 903759 D50.45Ncl/PtCh20Meq/1000MlIvSn 250 General Pharmacy $542.00

903769 Fat Emul 20% 50Gm/250Ml Iv.Sln 250 General Pharmacy $120.00

903787 Potassium Acetate 40Meq/20MlVl 250 General Pharmacy $62.00

903788 Potassium Phosph 45Mm/15Ml Vl 250 General Pharmacy $27.00

903790 Papaverine Hcl 60 Mg/2 Ml Vial 250 General Pharmacy $40.00

903793 Ethyl Alcohol 1 Ml Amp 250 General Pharmacy $186.00

903811 Dabigatran Etexilate 150Mg Cap 250 General Pharmacy $42.00

903815 Phenobarbital Drip 250 General Pharmacy $693.00

903816 Phenobarbital Sodim 65Mg/Ml Vl 250 General Pharmacy $88.00

903818 Octreotide Acetat 500Mcg/Ml Vl 250 General Pharmacy $434.00 903843 Dexameths Sod Phos0.1% 5MlOpsl 250 General Pharmacy $96.00 903855 Quinine Sulfate 324 Mg Cap 250 General Pharmacy $50.00 903858 Hypromellose 15 Ml Opsol 250 General Pharmacy $242.00 903860 Sodim Chlor(Ophth) 2% 15MlOpsl 250 General Pharmacy $212.00 903890 Fentyl 12Mcg.Per.Hr Patch.Td72 250 General Pharmacy $228.00 903896 Paliperidone 3 Mg Tab.Osm.24 250 General Pharmacy $111.00

903898 Tapentadol Hydrochlord 75MgTab 250 General Pharmacy $59.00

903941 Rifaximin 550 Mg Tab 250 General Pharmacy $150.00

903948 HYDROMORPH UP TO 4MG 250 General Pharmacy $152.00

13 903949 Hydromorphone Hcl 10 Mg/Ml Amp 250 General Pharmacy $117.00 903972 Pilocarpine Hcl 1% 15 Ml Opsol 250 General Pharmacy $110.00 903978 Methotrexate Sodim 50Mg/2MlSdv 250 General Pharmacy $215.00 903992 Fluphenazine Hcl 2.5 Mg/Ml Inj 250 General Pharmacy $327.00

903994 Polymyxin B Sulf 500000UnitVl 250 General Pharmacy $305.00

904094 BUPIV/EPI 0.5% PF 250 General Pharmacy $59.00

904095 Procainamide Hcl 1 Gm/2Ml Vial 250 General Pharmacy $168.00

904128 Pyridostigmin Brom 10Mg/2MlAmp 250 General Pharmacy $151.00

904215 Olanzapine 10 Mg/Vial Sdv 250 General Pharmacy $213.00

904232 Propranolol 20 MG/5ML 250 General Pharmacy $22.00

904298 SodCl0.45%PtChl20Meq1000MlIvSl 250 General Pharmacy $357.00

904310 Midazolam Hcl 2 Mg/2 Ml Vial 250 General Pharmacy $147.00 904311 Midazolam Hcl 5 Mg/5 Ml Vial 250 General Pharmacy $348.00 904417 Cilostazol 50 Mg Tab 250 General Pharmacy $23.00 904433 LIDOCAINE 1% EPI 50ML 250 General Pharmacy $43.00 904435 Lidocaine Hcl 2% Pf 10 Ml Inj 250 General Pharmacy $165.00 904446 EDROPHONIUM 10 MG AMP 250 General Pharmacy $172.00 904633 Gentamcn/SodChlor80Mg/50MlIvbg 250 General Pharmacy $642.00

904664 Aminocaproic Acid 5 Gm/20Ml Vl 250 General Pharmacy $256.00

904678 Oxycodone Hcl 5 Mg Irtab 250 General Pharmacy $26.00

904698 SODIUM CHLORIDE 250 General Pharmacy $459.00

904914 Quinidine Glucont 800Mg/10MIVl 250 General Pharmacy $170.00

904919 Prasugrel Hydrochlorid 5Mg Tab 250 General Pharmacy $59.00

904922 Insuln Reg U-500 500Unts/Ml Ml 250 General Pharmacy $48.00

904926 Aztreonam 1 Gm Vial 250 General Pharmacy $137.00

904928 Aztreonam 2 Gm Vial 250 General Pharmacy $360.00 904939 Methylnltrx Brmd 12Mg/0.6 MlVl 250 General Pharmacy $301.00 904940 HydrocrtSodSuccint 250Mg/2MlVl 250 General Pharmacy $54.00 904955 Voriconazole 50 Mg Tab 250 General Pharmacy $119.00 904974 LEVOTHYROXINE 100MCG I 250 General Pharmacy $248.00 904975 Famotidine 20 Mg/2 Ml Vial 250 General Pharmacy $267.00 905025 Heparin 50 u lock 250 General Pharmacy $6.00

905030 RIVAROXABAN 15 MG TAB 250 General Pharmacy $63.00

905031 GLYCERIN STERILE PF IN 250 General Pharmacy $205.00

905034 DIAZEPAM 20 MG RECTAL 250 General Pharmacy $594.00

905044 D51/2NS+K30 1000 ML 250 General Pharmacy $432.00

905045 D51/2NS+K40 1000 ML 250 General Pharmacy $470.00

905127 AMPICILLIN 30MG/ML 250 General Pharmacy $37.00

905167 Ticagrelor 90 Mg Tab 250 General Pharmacy $47.00

905168 HydrcdnBit/App2.5/108Per5MlUdl 250 General Pharmacy $21.00

905180 VILAZODONE 10 MG TAB 250 General Pharmacy $47.00 905181 POTASSIUM 40 MEQ/100 B 250 General Pharmacy $124.00 905182 VILAZODONE 20 MG TAB 250 General Pharmacy $44.00 905183 NEBIVOLOL 10 MG TAB 250 General Pharmacy $36.00 905188 Cyclopentloate 1% 5Ml 250 General Pharmacy $144.00 905190 Cytarabine 100 Mg Vial 250 General Pharmacy $32.00 905192 Doxorbcn Hydrchlrd 10Mg/5Ml Vl 250 General Pharmacy $304.00

905215 Chlorpromazine Hcl25 Mg/Ml Amp 250 General Pharmacy $75.00

905252 Dantrolene Sodium 20 Mg Vial 250 General Pharmacy $262.00

905253 Dext 25%-H2O 2.5Gm/10 Ml Pfs 250 General Pharmacy $127.00

14 905274 D5Ns/PotChlor40Meq/1000MlIvSln 250 General Pharmacy $517.00 905276 Cefotaxime Sod 1Gm/100Mlns Bg 250 General Pharmacy $454.00 905293 Vancomycin Hcl 10 Mg/Ml Udi 250 General Pharmacy $305.00 905294 Vancomycn Hcl 25Mg/Ml 5Ml Opsl 250 General Pharmacy $305.00

905295 Chondrtn/SodHyaluront0.75MlSyr 250 General Pharmacy $313.00

905305 Tacrolimus 0.1% 30 Gm Oint 250 General Pharmacy $510.00

905312 Cisplatin 10 Mg Vial 250 General Pharmacy $101.00

905318 Sevelmr Carbont 2.4Gm Pwd.Pack 250 General Pharmacy $59.00

905321 Acyclovir Sodim 5Mg/Ml Inj Neo 250 General Pharmacy $73.00

905327 CalcGluc/D10W 1500Mg/500MlIvbg 250 General Pharmacy $142.00

905336 Sod Chlor 23.4% 120Meq/30MlVl 250 General Pharmacy $120.00

905339 Buprenorphine Hcl 2Mg Tab.Subl 250 General Pharmacy $93.00 905341 Mesna 200 Mg/2 Ml Vial 250 General Pharmacy $76.00 905349 Fluconzl/SodCl 200Mg/100MlIvbg 250 General Pharmacy $482.00 905392 DOXIL 20 MG 250 General Pharmacy $2,824.00 905424 LidocainHcl(Antrr)100Mg/5MlSyr 250 General Pharmacy $124.00 905427 SODIUM CHLORIDE 100 ME 250 General Pharmacy $111.00 905428 LINEZOLID 2 MG/ML INJ 250 General Pharmacy $125.00

905429 MEROPENEM 50 MG/ML INJ 250 General Pharmacy $69.00

905430 PIP/TAZO 60 MG/ML INJ 250 General Pharmacy $73.00

905431 RANITIDINE 1 MG/ML INJ 250 General Pharmacy $6.00

905432 VANCOMYCIN 10 MG/ML IN 250 General Pharmacy $13.00

905455 Gentamicin Sulfate 10Mg/Ml Udi 250 General Pharmacy $54.00

905463 Leech 1 - Each 250 General Pharmacy $76.00

905472 Fluorometholone 0.1% 5Ml Opsus 250 General Pharmacy $77.00

905483 Ethiodized Oil 10 Ml Amp 250 General Pharmacy $476.00 905533 RISPERDAL CON 12.5 MG 250 General Pharmacy $411.00 905534 PENICILLIN G 5000 UNIT 250 General Pharmacy $20.00 905669 FENTANYL 10 MCG/ML PCA 250 General Pharmacy $308.00 905688 DEXMEDETOMID 200 MCG B 250 General Pharmacy $735.00 905699 APREPITANT 40 MG PO 250 General Pharmacy $234.00 905769 FERROUS SULF 1ML PO 250 General Pharmacy $20.00

905800 MEROPENEN 20 MG/ML INJ 250 General Pharmacy $4.00

905938 KETAMINE 200MG/20ML 250 General Pharmacy $106.00

905951 Opium Tnc 5 Mg 250 General Pharmacy $63.00

905964 CHOLECALCIFEROL 400 UN 250 General Pharmacy $3.00

905977 NICARDIPINE 2500MCG/10 250 General Pharmacy $231.00

905995 GENT/CLINDA/POLY 30ML 250 General Pharmacy $13.00

906091 Mepivacaine Hcl 30 Ml 1% Sdv 250 General Pharmacy $119.00

906092 MEPIVACAINE 2% VIAL 250 General Pharmacy $119.00

906097 Ganciclovir Sod 500Mg/10MlVl 250 General Pharmacy $401.00 906105 Cocaine/EPI 8.16 ML Spray 250 General Pharmacy $1,041.00 906118 MORPHINE EPD/IT PF 10M 250 General Pharmacy $100.00 906150 Lidocaine Hcl 15 Ml Udl 250 General Pharmacy $22.00 906496 Clindamycin 150 MG/10 ML 250 General Pharmacy $23.00 906501 HYDROMORPH UP TO 4MG 250 General Pharmacy $124.00 906505 CEFTRIAXONE 40MG/ML PE 250 General Pharmacy $9.00

906516 Albendazole 200 MG Po 250 General Pharmacy $391.00

906556 Calfactant 3 Ml Vial 250 General Pharmacy $963.00

906557 Calfactant 6 Ml Vial 250 General Pharmacy $1,703.00

15 906558 Carbprst Tromthmn 250Mcg/MlAmp 250 General Pharmacy $214.00 906567 CisatrcrmBesylat200Mg/20MlVial 250 General Pharmacy $735.00 906574 Cocaine Hcl 4% 4 Ml Topsol 250 General Pharmacy $508.00 906578 Collagenase 30 Gm Tube 250 General Pharmacy $295.00

906604 Diazepam 2.5 Mg Gel 250 General Pharmacy $389.00

906606 Diazepam 10 Mg Gel 250 General Pharmacy $469.00

906607 Diazepam 20 Mg Gel 250 General Pharmacy $594.00

906617 Dinoprostone 10 Mg Supp.Vag 250 General Pharmacy $614.00

906638 Ethacrynate Sodium 50 Mg Vial 250 General Pharmacy $426.00

906645 Fidaxomicin 200 Mg Tab 250 General Pharmacy $492.00

906682 Indomethacn Sod Trihydrt 1MgVl 250 General Pharmacy $1,429.00

906687 Isoproterenol Hcl 1 Mg/5Ml Amp 250 General Pharmacy $6,426.00 906688 Isoproterenol Hcl 0.2Mg/Ml Syr 250 General Pharmacy $2,172.00 906689 Levothyroxine 100 Mcg Vial 250 General Pharmacy $228.00 906691 Levothyroxine 200 Mcg Vial 250 General Pharmacy $391.00 906715 Neo/PlyBSulf/Dexnth3.5Gm/TubOp 250 General Pharmacy $267.00 906734 Nitroprusside Sodium 50Mg Vial 250 General Pharmacy $3,259.00 906757 Rifampin 600 Mg Vial 250 General Pharmacy $498.00

906769 SodThiosulf(Atd)12.5Gm/50MlVl 250 General Pharmacy $306.00

906774 Talc 4 Gm Aero.Powd 250 General Pharmacy $536.00

906775 Talc 5 Gm Vial 250 General Pharmacy $495.00

906781 Tiotropium 18 Mcg Cap.W.Dev 250 General Pharmacy $210.00

906790 Tolvaptan 30 Mg Tab 250 General Pharmacy $875.00

906804 ENTRESTO 49MG-51MG TAB 250 General Pharmacy $36.00

906805 ENTRESTO 24MG-26MG TAB 250 General Pharmacy $36.00

906806 ENTRESTO 97MG-103MG TA 250 General Pharmacy $36.00 906809 DEXMETH SOD PHOS 0.1MG/ML UDI 250 General Pharmacy $33.00 906811 VORTIOXETINE 10 MG TAB 250 General Pharmacy $45.00 906869 Isosulfan Blue 1% 5 Ml Sdv 250 General Pharmacy $1,523.00 906900 BRIDION INJ 250 General Pharmacy $626.00 906902 CANGRELOR 50 MG INJ 250 General Pharmacy $2,688.00 906906 CEFOTAXIME 40MG/ML PED 250 General Pharmacy $37.00

906920 Canagliflozin 100 MG Tab 250 General Pharmacy $56.00

906921 Canagliflozoin 300 MG Tab 250 General Pharmacy $56.00

906928 Fluvacc 4val 6-35 Mo Im 250 General Pharmacy $65.00

906958 Oxandrolone 2.5MG 250 General Pharmacy $46.00

906966 Pentamidine Isethiont 300MgVl 250 General Pharmacy $616.00

907366 Succinylchol 200 MG Inj 250 General Pharmacy $368.00

907367 Heparin 5 U lock 250 General Pharmacy $9.00

925813 Handle Sx/Irr Interpulse 250 General Pharmacy $229.00

936008 Lacosamide 50 MG/100 ML IV 250 General Pharmacy $199.00 936009 Lacosamide 100 MG/100 ML IV 250 General Pharmacy $199.00 939804 Ticagrelor 60 Mg Tab 250 General Pharmacy $43.00 940127 Odefsey Tab 250 General Pharmacy $222.00 940128 Epzicom 600-300 Tab 250 General Pharmacy $25.00 940129 Evotaz 300-150 250 General Pharmacy $187.00 940130 Maraviroc 150 MG Tab 250 General Pharmacy $54.00

946987 Solution IRR 0.9% NACL 1L 250 General Pharmacy $46.00

968730 Renografin 50ml 250 General Pharmacy $219.00

968989 Nontonic Contrast/cc 250 General Pharmacy $1,732.00

16 969498 Hypaque 50ml 250 General Pharmacy $158.00 969499 Hypaque 100ml 250 General Pharmacy $408.00 752060 Amrinone 5mg/ml 20ml A 252 Pharmacy Non-generic Drugs $691.00 752074 Antivenom Corlsnk (Micf 252 Pharmacy Non-generic Drugs $5,762.00

752076 Aprotinin 10000 Kiu/ml 252 Pharmacy Non-generic Drugs $1,577.00

752396 FILGRASTIM 300MCG/ML I 252 Pharmacy Non-generic Drugs $692.00

752399 FILGRASTIM 480MCG/1.6M 252 Pharmacy Non-generic Drugs $987.00

752987 OCTREOTIDE 0.1 MG/ML I 252 Pharmacy Non-generic Drugs $69.00

752988 OCTREOTIDE 0.05MG/ML I 252 Pharmacy Non-generic Drugs $38.00

753143 TOBRAMYCIN 1.2GM POW 252 Pharmacy Non-generic Drugs $1,578.00

900674 Abciximab 10 Mg/5 Ml Vial 252 Pharmacy Non-generic Drugs $3,978.00

901141 Pamidronate Disodium 30Mg Vial 252 Pharmacy Non-generic Drugs $804.00 901787 Enoxaparin Sodium 100Mg/Ml Syr 252 Pharmacy Non-generic Drugs $251.00 901814 Etanercept 25 Mg Vial 252 Pharmacy Non-generic Drugs $1,982.00 902461 Atovaquone 750 Mg/5 Ml Udl 252 Pharmacy Non-generic Drugs $102.00 903042 Alprostadil 500 Mcg/Ml Amp 252 Pharmacy Non-generic Drugs $787.00 903320 Tobramycin Sulfate 80Mg/2Ml Vl 252 Pharmacy Non-generic Drugs $471.00 905689 Cyclsprn,Modfd 100Mg/Ml50Mlbt 252 Pharmacy Non-generic Drugs $736.00

906593 DesmprssnAcet10Mcg/Spry5MlNasp 252 Pharmacy Non-generic Drugs $799.00

72405 Locm 300 to 399 Per Ml 255 Pharmacy Drugs incidental to Radiology $11.00

72752 Locm 300 to 399 Per ml 255 Pharmacy Drugs incidental to Radiology $11.00

72755 Rplc Gast Or Ceco Tube 255 Pharmacy Drugs incidental to Radiology $1,560.00

72811 Locm 200 to 299 Per Ml 255 Pharmacy Drugs incidental to Radiology $10.00

72812 Locm 200 to 299 Ml 255 Pharmacy Drugs incidental to Radiology $12.00

72813 Locm 300 to 399ml 255 Pharmacy Drugs incidental to Radiology $11.00

72814 Locm 100 to 100 Per ml 255 Pharmacy Drugs incidental to Radiology $10.00 73402 Gadolinium Based Mr Ml 255 Pharmacy Drugs incidental to Radiology $26.00 74633 Locm 200 to 299 Per ml 255 Pharmacy Drugs incidental to Radiology $12.00 74634 Locm 300 to 399 per ml 255 Pharmacy Drugs incidental to Radiology $11.00 74635 Locm 300 to 399 Per ml 255 Pharmacy Drugs incidental to Radiology $10.00 76216 Locm 300 to 399 Per ml 255 Pharmacy Drugs incidental to Radiology $11.00 76217 Locm 300 to 399 per ml 255 Pharmacy Drugs incidental to Radiology $10.00

77228 Gadolinium Based Mr ml 255 Pharmacy Drugs incidental to Radiology $26.00

77229 Locm 300 to 399 per ml 255 Pharmacy Drugs incidental to Radiology $10.00

77279 LOCM 300 TO 399 PER ML 255 Pharmacy Drugs incidental to Radiology $11.00

77280 Locm 300 to 399 Per ml 255 Pharmacy Drugs incidental to Radiology $10.00

77281 Locm 100 to 199 per ml 255 Pharmacy Drugs incidental to Radiology $10.00

78217 Locm 300 to 399 Per ml 255 Pharmacy Drugs incidental to Radiology $11.00

79764 Locm 300 to 399 per ml 255 Pharmacy Drugs incidental to Radiology $11.00

423617 Locm 300 To 399 Per Ml 255 Pharmacy Drugs incidental to Radiology $10.00

423800 Gad Base Mr Cont Nos 1 255 Pharmacy Drugs incidental to Radiology $25.00 727555 Locm 300/50 Ml 255 Pharmacy Drugs incidental to Radiology $2,045.00 727586 Gastrografin 255 Pharmacy Drugs incidental to Radiology $253.00 728392 Locm 300/100 Ml 255 Pharmacy Drugs incidental to Radiology $2,940.00 900731 Gad Mr Cont Nos/ 10 Ml 255 Pharmacy Drugs incidental to Radiology $193.00 900732 Gad Mr Cont Nos/ 15 Ml 255 Pharmacy Drugs incidental to Radiology $270.00 900733 Gad Mr Cont Nos/ 20 Ml 255 Pharmacy Drugs incidental to Radiology $360.00

900741 Locm 200 To 299 20 Ml 255 Pharmacy Drugs incidental to Radiology $31.00

928004 Octafluoropropane 3ml 255 Pharmacy Drugs incidental to Radiology $625.00

959175 Locm 300/50 Ml 255 Pharmacy Drugs incidental to Radiology $2,105.00

17 959724 Locm 300-399 Mg 255 Pharmacy Drugs incidental to Radiology $2,105.00 959726 Locm 300/100 Ml 255 Pharmacy Drugs incidental to Radiology $2,805.00 959727 Gadolinium (Magnevist) 255 Pharmacy Drugs incidental to Radiology $2,231.00 300329 Drsg Auacel Silver 258 IV Solutions $28.00

300418 Vac Drg Asy Lg 258 IV Solutions $96.00

300432 Vac Drsg Assy Med 258 IV Solutions $77.00

301165 Irr Saline 1000Cc Btl 258 IV Solutions $5.00

301166 Irr Sodium Chl 3000 258 IV Solutions $24.00

301167 Irr Water 1000 Cc Btl 258 IV Solutions $5.00

301330 Tray Incision/Drainage 258 IV Solutions $14.00

305048 Tray Cath 258 IV Solutions $311.00

305050 Interlink Heplock 258 IV Solutions $58.00 378716 Trocar 5mm 35LDA 258 IV Solutions $226.00 378717 Trocar 35LNA 258 IV Solutions $229.00 378718 Trocar 355HR 258 IV Solutions $86.00 378721 Trocar 512DA 258 IV Solutions $276.00 378724 Trocar 512NA 258 IV Solutions $276.00 378743 1000cc IV Fluid 258 IV Solutions $386.00

378744 500cc IV Fluid 258 IV Solutions $408.00

378745 Defibrillator and Lead 258 IV Solutions $-

476048 EXTENSION MINI-VOL 6 258 IV Solutions $108.00

476059 HIGH FLOW SET HARVARD 258 IV Solutions $127.00

476206 SET Y-TYPE W/XL BLD FI 258 IV Solutions $169.00

476215 T-CONNECTOR EXTENSION 258 IV Solutions $17.00

476222 Y-SITE 258 IV Solutions $25.00

476500 GEN CODE 258 IV Solutions $- 478414 NOVEX STOPCOCK 258 IV Solutions $38.00 479823 I.V. MANIFOLD SET 258 IV Solutions $25.00 501162 IRR SALINE 1000CCBAG 258 IV Solutions $394.00 501165 IRR SALINE 1000CCBTL 258 IV Solutions $248.00 501166 IRR SALINE 1500CCBTL 258 IV Solutions $292.00 501167 IRR WATER 1000CCBTL 258 IV Solutions $233.00

501168 IRR WATER 1500CCBTL 258 IV Solutions $209.00

501169 IRR WATER 1000CCBAG 258 IV Solutions $372.00

501181 IRR SALINE 3000CC BAG 258 IV Solutions $455.00

502300 Gen Code (258) 258 IV Solutions $-

755046 LATEX PRECAUTIONS 1-DOSE 258 IV Solutions $-

756886 GEN CODE 258 IV Solutions $-

759020 Needle Angio 22g x 1.5 258 IV Solutions $34.00

782463 GEN CODE I.V.T 258 IV Solutions $-

782515 D10W* 1000 ML 258 IV Solutions $- 785011 NACL 0.9% 250 ML BOTTL 258 IV Solutions $368.00 786030 Heparin 25,000U/D5 500 258 IV Solutions $517.00 786041 WATER IRRIG BAG 1000ML 258 IV Solutions $213.00 786050 DEXTRAN 40/D5 500 ML 258 IV Solutions $389.00 786100 DEXTROSE 50% 500ML 258 IV Solutions $462.00 786101 DEXTROSE 70% 500ML 258 IV Solutions $544.00

786106 TROMETHAMINE 3.6% 500M 258 IV Solutions $903.00

786764 DEX 5%/ELEC-LYT56 1000 258 IV Solutions $550.00

786765 PLASMALYTE A 1000ML 258 IV Solutions $141.00

18 786788 HETASTARCH IN NS 500ML 258 IV Solutions $714.00 786839 SODIUM Cl 100 ML MINIB 258 IV Solutions $280.00 795024 IV TUBING T PORT CON 258 IV Solutions $51.00 795048 CATH SCLAV 3 LUM YG/15 258 IV Solutions $425.00

795050 INTERLNK HEPLOCK INJSI 258 IV Solutions $75.00

795062 NEEDLE ANGSET 22X1 258 IV Solutions $108.00

795063 NEEDLE ANGSET 20X1 258 IV Solutions $106.00

795064 NEEDLE ANGSET 18X1.25 258 IV Solutions $75.00

795072 NEEDLE B'FLY 25GX3/4 258 IV Solutions $57.00

795074 NEEDLE B'FLY 23X3/4 258 IV Solutions $52.00

795075 NEEDLE B'FLY 21X3/4 258 IV Solutions $64.00

795076 NEEDLE B'FLY 17GX3/8 258 IV Solutions $50.00 795089 TUBING CENTRAL VENOUS 258 IV Solutions $237.00 795090 NEEDLE INTIMA SAF T 22 258 IV Solutions $- 795092 NEEDLE INTIMA SAF T 20 258 IV Solutions $- 795097 CATH SCLAV 3LUM 7F/30C 258 IV Solutions $1,006.00 795098 EXT SET W/O FILTER 258 IV Solutions $36.00 795099 IV SET START-UP 258 IV Solutions $-

796010 Adm Set, Ext Tube 20" 258 IV Solutions $85.00

796014 ADM SET PRIMARY-VENT 258 IV Solutions $30.00

796018 T-CONNECTOR 258 IV Solutions $36.00

796036 BURETROL 150ML IN-LINE 258 IV Solutions $279.00

796039 SODIUM CL 0.45% 500 ML 258 IV Solutions $363.00

796055 DEXTROSE 10% 1000ML 258 IV Solutions $458.00

796056 DEXTROSE 10% 500ML 258 IV Solutions $357.00

796070 DEXTROSE 5% 100ML 258 IV Solutions $458.00 796071 DEXTROSE 5% 1000ML 258 IV Solutions $549.00 796072 DEXTROSE 5% 250ML 258 IV Solutions $530.00 796073 DEXTROSE 5% 50ML 258 IV Solutions $434.00 796074 DEXTROSE 5% 500ML 258 IV Solutions $533.00 796082 DEX 5%/NACL 0.2% 1000 258 IV Solutions $432.00 796083 DEX 5%/NACL 0.2% 500 M 258 IV Solutions $501.00

796085 DEX 5%/NACL 0.45% 500M 258 IV Solutions $501.00

796086 DEX 5%/NACL 0.45% 1000 258 IV Solutions $501.00

796088 DEX 5%/NACL 0.9% 1000 258 IV Solutions $434.00

796090 DEX 5%/NACL 0.9% 500 M 258 IV Solutions $432.00

796098 DEX 5%/LACT RING 1000 258 IV Solutions $465.00

796764 DEX 5%/ELECLYT-56 1000 258 IV Solutions $550.00

796790 LACTATED RINGERS 1000M 258 IV Solutions $501.00

796836 SODIUM CL 0.45% 1000 M 258 IV Solutions $317.00

796838 SODIUM CL 0.9% 100 ML 258 IV Solutions $363.00 796839 SODIUM Cl 100 ML MINIB 258 IV Solutions $- 796840 SODIUM CL 0.9% 1000 ML 258 IV Solutions $363.00 796842 SODIUM CL 0.9% 250 ML 258 IV Solutions $465.00 796844 SODIUM CL 0.9% 50 ML 258 IV Solutions $363.00 796846 SODIUM CL 0.9% 500 ML 258 IV Solutions $363.00 796850 SODIUM CL 0.9% 250 ML 258 IV Solutions $465.00

796885 Water Sterile 1000ml 258 IV Solutions $173.00

900606 SOD CHL 0.9% 100 ML AD 258 IV Solutions $312.00

900607 Sodium Cl 0.9% 250 Ml Ivbag 258 IV Solutions $353.00

19 901295 Sod Cl 0.9% Irr Bag 1L 258 IV Solutions $260.00 901376 Dextrose 10%-Water 1000 Ml Bg 258 IV Solutions $390.00 901379 Dext 5%-0.25% Salin 1000Ml Bg 258 IV Solutions $369.00 902135 Dext 40/Na Chlr 0.9% 500Ml Btl 258 IV Solutions $319.00

903191 Hypochlor 1 App 258 IV Solutions $124.00

903518 HEPARIN 25000 UNIT 1/2 258 IV Solutions $394.00

903550 Bal Salt Soln Plus 500 258 IV Solutions $417.00

903678 Sodium Chlor 0.45% 1000Ml Bag 258 IV Solutions $269.00

903688 Water Inject Strl 1000 Ml Bag 258 IV Solutions $77.00

903689 Dextrose 5%-Water 250 Ml Btl 258 IV Solutions $211.00

903690 Dextrose 5%-Water 250 Ml Bag 258 IV Solutions $452.00

903691 Dext 5%-H2O 500 Ml Excelbag 258 IV Solutions $408.00 903692 Dextrose 5%-H2O 1000 Ml Ivbag 258 IV Solutions $420.00 903693 Dextrose 5%-Water 50 Ml Bag 258 IV Solutions $371.00 903694 Dextrose 5%-Water 100 Ml Bag 258 IV Solutions $390.00 903697 Sodium Chloride 0.45% 500Ml Bg 258 IV Solutions $312.00 903699 Sodium Cl 0.9% 150 Ml Ivbag 258 IV Solutions $229.00 903700 Sodium Cl 0.9% 500 Ml Ivbag 258 IV Solutions $277.00

903701 Sodium Cl 0.9% 1000 Ml Ivbag 258 IV Solutions $263.00

903702 Sodium Cl 0.9% 50 Ml Ivbag 258 IV Solutions $312.00

903703 Sodium Cl 0.9% 100 Ml Ivbag 258 IV Solutions $312.00

903705 Sodium Chloride 3% 500 Ml Bag 258 IV Solutions $327.00

903707 Dext 5%-0.45%Saline 1000Ml Bg 258 IV Solutions $426.00

903708 "Dextrose 5%-Ns 1,000 Ml Bag" 258 IV Solutions $331.00

903709 Dext 5%-Lact Riners 1000Ml Bg 258 IV Solutions $396.00

903756 Total Parent Nutri/100 258 IV Solutions $288.00 903760 Dextrose 5%-Water 150 Ml Bag 258 IV Solutions $331.00 903761 LidoHcl/D5W 0.4% 2Gm/500MlIvbg 258 IV Solutions $523.00 903764 Ringers Sltn Lact 1000Ml Ivbg 258 IV Solutions $351.00 904489 Dextrose 10%-Water 500 Ml Bag 258 IV Solutions $385.00 904761 FLD D5/.45NS 10K 1000M 258 IV Solutions $505.00 904763 FLD MINI-BAG PLUS NS50 258 IV Solutions $312.00

904765 FLD-MINI-BG PLUS NS100 258 IV Solutions $312.00

904889 Sodium Cl 0.9% 250 Ml Excelbag 258 IV Solutions $354.00

905120 NS 250ML AD-VANT 258 IV Solutions $396.00

905672 MANNITOL 20% 250ML 258 IV Solutions $324.00

905975 DSW MINI-BG PLUS 50ML 258 IV Solutions $371.00

905976 DSW MINI-BG PLUS 100ML 258 IV Solutions $390.00

932305 Needle Echotip Procore 258 IV Solutions $1,755.00

940452 Needle Endo 4MM 27GA 258 IV Solutions $1,969.00

71222 Dasatinib 70 mg tab 259 Other Pharmacy $415.00 71227 Darifenancin 7.5mg Tab 259 Other Pharmacy $27.00 71234 Cromolyn Sodium Inh 259 Other Pharmacy $343.00 71235 Cromolyn Sod Naspry 259 Other Pharmacy $84.00 71239 Clonidine 100mcg Susp 259 Other Pharmacy $18.00 71240 Pantoprazole 20mc Tab 259 Other Pharmacy $13.00 71241 Ispradipine 2.5mg Cap 259 Other Pharmacy $35.00

71245 Erlontinib 25mg Tab 259 Other Pharmacy $160.00

71249 Darunavir 300mg Cap 259 Other Pharmacy $84.00

71251 Imatinib 400mg Tab 259 Other Pharmacy $517.00

20 71253 levETIRAcetam 500mg/5ml UDL 259 Other Pharmacy $48.00 71259 Valsartan 160mg Tab 259 Other Pharmacy $46.00 71262 Quinapril 20Mg Tab 259 Other Pharmacy $32.00 71263 Diazepam 1mg Udl 259 Other Pharmacy $18.00

71264 Carvedilol Cr 10mg 259 Other Pharmacy $57.00

71265 Carvedilol Cr 20mg 259 Other Pharmacy $57.00

71266 Minocycline 50mg 259 Other Pharmacy $12.00

71267 Nicardipine Sr 30mg 259 Other Pharmacy $30.00

71268 Nicardipine Sr 45mg 259 Other Pharmacy $38.00

71289 Polyethylene Gly 4.1 0 259 Other Pharmacy $64.00

71320 Moxifloxacin 0.5% Opsol 259 Other Pharmacy $337.00

71322 Levocarnitine 500mg U 259 Other Pharmacy $26.00 71324 Cipro Hc Otic Susp 259 Other Pharmacy $485.00 71337 Omeprazole 10mg Cap 259 Other Pharmacy $56.00 71338 Mirtazipine 15mg Solt 259 Other Pharmacy $25.00 71344 Oxycodone HCL/Acetaminophen 10 259 Other Pharmacy $56.00 71346 Cipro/Dex OT Susp 259 Other Pharmacy $443.00 71347 Morphine PF 500 mg/20 ml 259 Other Pharmacy $407.00

71349 Nebivolol 5mg Tab 259 Other Pharmacy $33.00

71352 Escitalopram 10mg UDL 259 Other Pharmacy $67.00

71359 Pot/Sod Acid Phos Tab 259 Other Pharmacy $12.00

71360 Indinavir 200mg Cap 259 Other Pharmacy $21.00

71362 Tobramycin 10mg/ml in 259 Other Pharmacy $6.00

71365 Levetiracetam 500mg SR 259 Other Pharmacy $57.00

71367 Fentanyl 100mcg Patch 259 Other Pharmacy $211.00

71400 Darunavir 400mg Tab 259 Other Pharmacy $120.00 71402 Magnesium Oxide 400mg 259 Other Pharmacy $13.00 71409 Brimid/Timolol Opsol 259 Other Pharmacy $291.00 71411 Budesonide/Formot 160 259 Other Pharmacy $447.00 71412 Budesonide/Formot 80/4 259 Other Pharmacy $447.00 71499 Insulin Aspart Dose 259 Other Pharmacy $44.00 71570 Aripiprazole 2mg Tab 259 Other Pharmacy $110.00

71575 Cyanocobalamin 1000 MCG Tab 259 Other Pharmacy $10.00

71576 VIT D 1000 unit 259 Other Pharmacy $11.00

71583 Prasugrel Hydrochloride 10mg 259 Other Pharmacy $62.00

71585 Ibandronate 2.5mg Tab 259 Other Pharmacy $51.00

71634 Fenofibric Acid 135mg 259 Other Pharmacy $50.00

71637 Donepezil HCL 10mg Tab 259 Other Pharmacy $54.00

71640 Irbesartan 300mg Tab 259 Other Pharmacy $26.00

71648 Memantine HCL 10mg Tab 259 Other Pharmacy $43.00

71656 Aminophylline 100mg Tab 259 Other Pharmacy $12.00 71661 Mycophenolate Sodium 360mg Tab 259 Other Pharmacy $37.00 71662 Levonorgestrel 1.5mg Tab 259 Other Pharmacy $175.00 71666 Febuxostat 40mg Tablet 259 Other Pharmacy $51.00 71671 Pancrelipase 10 259 Other Pharmacy $36.00 71672 Pancrelipase 20 259 Other Pharmacy $33.00 71673 Pancrelipase 16 259 Other Pharmacy $29.00

71674 Pancrelipase 4 259 Other Pharmacy $13.00

71685 Risedronate 150mg Tab 259 Other Pharmacy $450.00

71691 HC Acetate/Pramoxine HCL 4gm C 259 Other Pharmacy $71.00

21 72422 Zolpidem Cr 12.5 Tab 259 Other Pharmacy $104.00 75004 Pantoprazole Bicarb So 259 Other Pharmacy $291.00 75006 Simvastatin 10mg Tab 259 Other Pharmacy $46.00 75008 Atorvastatin 40mg Tab 259 Other Pharmacy $62.00

75020 Sodium Cl 1 Meq Udl 259 Other Pharmacy $12.00

75021 Propranolol 10mg Udl 259 Other Pharmacy $7.00

75022 Baclofen Susp 10mg/10ml UDL 259 Other Pharmacy $12.00

75023 Baclofen Susp 1mg Udl 259 Other Pharmacy $7.00

75024 Sodium Cl 2.5 Meq Udl 259 Other Pharmacy $12.00

75026 Levetriacetam 250 mg u 259 Other Pharmacy $30.00

75034 Estradiol Val 10mg/ml 259 Other Pharmacy $64.00

75036 Levocarnitine 100mg U 259 Other Pharmacy $17.00 75042 Fluvastatin 20mg Tab 259 Other Pharmacy $39.00 75044 Ipratropium Bromide 12.9gm 259 Other Pharmacy $376.00 75051 Morphine 1 mg/ml Udl 259 Other Pharmacy $30.00 75053 Albuterol Sulfate 1 Puff Aer 259 Other Pharmacy $126.00 75063 Cyclosporine Oral 25 M 259 Other Pharmacy $35.00 75066 Dexamethasone 2mg Tab 259 Other Pharmacy $17.00

75067 Dexamethasone 4mg 259 Other Pharmacy $13.00

75413 Timolol/Dorzol 0.5/2 0psol 259 Other Pharmacy $359.00

75418 Nitofur 25mg/5 120ml 259 Other Pharmacy $700.00

75428 Enalapril 1mg Udl 259 Other Pharmacy $18.00

75429 Azelastine 0.05% Opso 259 Other Pharmacy $456.00

75430 Oxcarbazepine 60mg Udl 259 Other Pharmacy $9.00

75431 Labetalol 40mg Udl 259 Other Pharmacy $18.00

75432 Insulin Detemir 10ml 259 Other Pharmacy $343.00 79432 Ondansetron 1mg Udl 259 Other Pharmacy $69.00 79433 Ondansetron HCL 2mg/2.5ml Udl 259 Other Pharmacy $102.00 79434 Ondansetron 3mg Udl 259 Other Pharmacy $133.00 79438 Methenamine Hippurate 1gm Tab 259 Other Pharmacy $29.00 79439 Tacrolimus 0.5mg Udl 259 Other Pharmacy $13.00 79440 Tacrolimus 1mg Udl 259 Other Pharmacy $21.00

79441 Tacrolimus 5mg Cap 259 Other Pharmacy $124.00

79459 Bentropine Mesylate 0.5mg Tab 259 Other Pharmacy $12.00

171210 Saccharomyces Boul Pkt 259 Other Pharmacy $19.00

171211 Benz Perox/Eryth Gel Pkt 259 Other Pharmacy $30.00

171213 Ondansetron 4mg ODT 259 Other Pharmacy $13.00

171219 Zenpep 5000 Unit Cap 259 Other Pharmacy $20.00

171220 Zenpep 10000 Unit Cap 259 Other Pharmacy $37.00

171249 Chlorothiazide 500mg Udl 259 Other Pharmacy $50.00

171250 Wheat Dextrin 3.5gm 259 Other Pharmacy $9.00 171251 Os Cal 500+D Tab 259 Other Pharmacy $8.00 171264 Guanfacine 1mg SrTab 259 Other Pharmacy $54.00 171294 Iloperidone 4mg Tab 259 Other Pharmacy $72.00 171295 Iloperidone 6mg Tab 259 Other Pharmacy $72.00 171296 Iloperidone 8mg Tab 259 Other Pharmacy $72.00 171299 Armodafanil 150mg Tab 259 Other Pharmacy $110.00

171300 Armodafanil 250mg Tab 259 Other Pharmacy $110.00

171302 Haloperidol 1mg Udl 259 Other Pharmacy $11.00

171303 Haloperidol 2mg Udl 259 Other Pharmacy $11.00

22 171304 Haloperidol 5mg Udl 259 Other Pharmacy $11.00 171305 Haloperidol 0.5mg Udl 259 Other Pharmacy $11.00 171307 Nicotine 2mg Gum 259 Other Pharmacy $9.00 171308 Guaifenesin 200mg Udl 259 Other Pharmacy $9.00

171309 Guaifenesin 300mg Udl 259 Other Pharmacy $9.00

171310 Alprazolam 1mg Tab 259 Other Pharmacy $34.00

171312 Clonazepam 1mg tab 259 Other Pharmacy $34.00

171314 Methadone 10mg Tab 259 Other Pharmacy $34.00

171315 Paliperidone 3mg Tab 259 Other Pharmacy $106.00

171316 Paliperidone 6mg Tab 259 Other Pharmacy $106.00

171319 Selegiline 12mg Patch 259 Other Pharmacy $123.00

171321 Risperdal 2mg Udl 259 Other Pharmacy $64.00 171322 Oxycodone 20 SrTab 259 Other Pharmacy $71.00 300340 Dressing Fibracol Plus 4X8 3/4 259 Other Pharmacy $30.00 425345 Acetazol-500MG Cap 259 Other Pharmacy $27.00 425349 Effexor 37.5 MG SA 259 Other Pharmacy $36.00 425351 Linagliptin 5 Mg Tablet 259 Other Pharmacy $62.00 750028 Meperidine/Phenergan Cap 259 Other Pharmacy $72.00

750044 HYDROCODONE BIT/ACET 10/325 TB 259 Other Pharmacy $35.00

750045 Acetamino E.S. 500MG Tab 259 Other Pharmacy $4.00

750048 Actifed Tab 259 Other Pharmacy $8.00

750052 Adderal Xr 30mg 259 Other Pharmacy $54.00

750062 Acyclovir 200 MG Cap 259 Other Pharmacy $26.00

750063 Fexofen/P-ephed Tab 259 Other Pharmacy $36.00

750067 Alendronate 10mg Tab 259 Other Pharmacy $56.00

750068 Alendronate 40mg Tab 259 Other Pharmacy $63.00 750070 Alendronate 70mg Tab 259 Other Pharmacy $159.00 750081 Amoxicillin Trihydrate 250mg C 259 Other Pharmacy $57.00 750082 ATOMOXETINE HCL 25 MG CAP 259 Other Pharmacy $57.00 750094 Clonazepam 0.1mg/ml Udl 259 Other Pharmacy $18.00 750096 Alumin Hydrox 500mg Tab 259 Other Pharmacy $- 750123 Tacrine 10mg Cap 259 Other Pharmacy $36.00

750128 Auranofin 3mg Cap 259 Other Pharmacy $23.00

750167 Buproprion 100 MG Tab 259 Other Pharmacy $21.00

750169 Bellergal SP Tab 259 Other Pharmacy $72.00

750200 Disopyramide CR 100mg 259 Other Pharmacy $7.00

750201 Disopyramide CR 150mg 259 Other Pharmacy $26.00

750204 Timolol 10mg Tab 259 Other Pharmacy $20.00

750209 Betaxolol 10mg Tab 259 Other Pharmacy $36.00

750230 Busulfam 2mg Fan 259 Other Pharmacy $8.00

750260 Captopril 6.25mg Tab 259 Other Pharmacy $13.00 750262 Capecitabine 500mg 259 Other Pharmacy $121.00 750285 Fluoxymesterone 10mg Tab 259 Other Pharmacy $23.00 750287 Chlor Hydr 500 259 Other Pharmacy $13.00 750325 Docusate Sod 100MG Cap 259 Other Pharmacy $5.00 750350 Procarbazine 50mg Tab 259 Other Pharmacy $20.00 750398 Hyoscyamine -L 0.15mg Tab 259 Other Pharmacy $25.00

750411 Cyclosporine/San 25mg 259 Other Pharmacy $21.00

750413 Cyclosporine/Neo 25mg 259 Other Pharmacy $84.00

750454 cycloSPORINE,Modified 100mg Cp 259 Other Pharmacy $61.00

23 750455 Deconamine SRRx 259 Other Pharmacy $23.00 750460 Dexametha 0.5 259 Other Pharmacy $30.00 750466 Delavirdine 100mg Tab 259 Other Pharmacy $23.00 750470 Chlorpropamide 250mg Tab 259 Other Pharmacy $19.00

750471 Chlorpropamide 100mg Tab 259 Other Pharmacy $12.00

750474 Etidronate 200mg Tab 259 Other Pharmacy $23.00

750500 Digitoxin 0.1 259 Other Pharmacy $19.00

750508 Digoxin 0.05 MG/ML UDL 259 Other Pharmacy $10.00

750525 Disopyramide 100mg Cap 259 Other Pharmacy $12.00

750529 Divalproex Er 500mg Tab 259 Other Pharmacy $48.00

750545 Divalproex Sodium 125mg EcTab 259 Other Pharmacy $54.00

750578 Cetrizine 5mg Tab 259 Other Pharmacy $50.00 750580 Esomeprazole 40mg 259 Other Pharmacy $97.00 750581 Feosol 259 Other Pharmacy $19.00 750585 Fluvastatin 80mg SrTab 259 Other Pharmacy $50.00 750662 Fioricet Tab 259 Other Pharmacy $23.00 750670 Estropipate 3mg Tab 259 Other Pharmacy $19.00 750671 Est Estrogen 0.3mg Tab 259 Other Pharmacy $19.00

750676 Felodipine 2.5mg Tabs 259 Other Pharmacy $57.00

750677 Est Estrogen 1.25mg Tab 259 Other Pharmacy $21.00

750679 Piroxicam 20mg Cap 259 Other Pharmacy $50.00

750682 Etodolac Xr 400mg Tab 259 Other Pharmacy $21.00

750683 Polysac Iron 150mg Cap 259 Other Pharmacy $12.00

750684 Ferrous Gluco 320mg Tab 259 Other Pharmacy $8.00

750694 Fexofenadine 60mg Tab 259 Other Pharmacy $35.00

750695 Eprosartan 400mg Tab 259 Other Pharmacy $34.00 750699 Fenprofen 600mg Cap 259 Other Pharmacy $10.00 750702 Folix Tab 259 Other Pharmacy $19.00 750723 Fosinopril 10mg Tab 259 Other Pharmacy $36.00 750725 Gabapentin 400 MG Cap 259 Other Pharmacy $48.00 750747 Mesalamine 400mg Tab 259 Other Pharmacy $20.00 750748 Mesalamine 250mg Cap 259 Other Pharmacy $20.00

750765 Glucose Tab #10 259 Other Pharmacy $8.00

750769 Griseofulvin Micro 500 259 Other Pharmacy $21.00

750780 Gefitinib 250mg Tab 259 Other Pharmacy $391.00

750791 Hydergine Or Tab 259 Other Pharmacy $12.00

750801 Doxecalciferol 2.5mcg 259 Other Pharmacy $133.00

750808 Hydroxyzine 10MG Tab 259 Other Pharmacy $32.00

750834 Irbesartan 75mg Tab 259 Other Pharmacy $21.00

750836 Irbesartan 150mg Tab 259 Other Pharmacy $21.00

750837 Veraqamil SR 120mg tab 259 Other Pharmacy $12.00 750838 Guanethidine 10mg tab 259 Other Pharmacy $21.00 750849 Verapamil ER 180mg 259 Other Pharmacy $36.00 750869 Larodopa 250mg Tab 259 Other Pharmacy $12.00 750882 Lansoprazole 15mg 259 Other Pharmacy $54.00 750883 Lansoprazole 30mg 259 Other Pharmacy $56.00 750890 Loteprenolol 0.5% Opso 259 Other Pharmacy $237.00

750893 Lexocarnitine 330mg Tab 259 Other Pharmacy $20.00

750896 Levetiracetam 500 MG Tab 259 Other Pharmacy $52.00

750915 Loratadine 10MG Tab 259 Other Pharmacy $63.00

24 750921 Loxapine 25mg Cap 259 Other Pharmacy $19.00 750927 Nitrofurantoin 100MG 259 Other Pharmacy $52.00 750936 Meprobamate 400mg Tab 259 Other Pharmacy $21.00 750937 Mebendazole 100mg Tab 259 Other Pharmacy $114.00

750939 Methylpred 4mg Dosepa 259 Other Pharmacy $371.00

750956 Metaproternol 10mg Tab 259 Other Pharmacy $20.00

750957 Guaifenesin 200mg Tab 259 Other Pharmacy $8.00

750968 METHOTREXATE 2.5 MG TAB 259 Other Pharmacy $42.00

750972 Midrin Cap 259 Other Pharmacy $71.00

750990 Multivitamin/Iron Tab 259 Other Pharmacy $8.00

750994 Nefazodine 150mg Tab 259 Other Pharmacy $34.00

750998 Mesoridazine 25mg Tab 259 Other Pharmacy $20.00 751005 METHENAMINE MANDEL 1GM 259 Other Pharmacy $13.00 751006 MIRTAZZPINE 7.5 MG TAB 259 Other Pharmacy $23.00 751015 ACETOHEXAMIDE 250MG TA 259 Other Pharmacy $12.00 751049 NITROGLYCERIN CAP 6.5M 259 Other Pharmacy $15.00 751050 NITROGLYCERIN CAP 9MG 259 Other Pharmacy $21.00 751066 Tacrolimus 10 MG/5 ML UDL 259 Other Pharmacy $115.00

751075 CLOFAZIMINE 50MG CAP 259 Other Pharmacy $12.00

751086 OCUVITE TAB 259 Other Pharmacy $12.00

751105 OSCAL 250/D TAB 259 Other Pharmacy $8.00

751109 OXTRIPHYLLINE 400 MG T 259 Other Pharmacy $20.00

751170 PENICILLAMINE 250MG CA 259 Other Pharmacy $34.00

751201 PIMOZIDINE 2MG TAB 259 Other Pharmacy $20.00

751202 PINDOLOL 5MG TAB 259 Other Pharmacy $12.00

751208 PERINDOPRIL 4MG TAB 259 Other Pharmacy $35.00 751210 PAROMYCIN 250 MG CAP 259 Other Pharmacy $62.00 751219 PHENOXYBENZAMINE 10MG 259 Other Pharmacy $12.00 751227 PIROXICAM 10MG C 259 Other Pharmacy $25.00 751232 PLACEBO CAPS 259 Other Pharmacy $21.00 751243 POTASSIUM BICAR 25 MEQ 259 Other Pharmacy $12.00 751270 PROPANTHELINE 15 MG TA 259 Other Pharmacy $12.00

751289 Propranolol ER 80mg Capsule 259 Other Pharmacy $39.00

751290 PROCAINAMIDE SR 1000MG 259 Other Pharmacy $12.00

751291 PROPRANOLOL ER 60MG CA 259 Other Pharmacy $25.00

751298 Pantoprazole 40MG Tab 259 Other Pharmacy $13.00

751339 QUINAPRIL 5MG TAB 259 Other Pharmacy $35.00

751340 QUINIDINE SUL ER 300MG 259 Other Pharmacy $23.00

751343 QUINIDIN 200 T 259 Other Pharmacy $9.00

751347 RABEPRAZOLE 20 MG TAB 259 Other Pharmacy $54.00

751348 QUININE 325MG CAP 259 Other Pharmacy $13.00 751359 RAMIPRIL 1.25MG CAP 259 Other Pharmacy $20.00 751383 RESERPINE 0.25 259 Other Pharmacy $12.00 751390 RIMATEDINE 100MG TAB 259 Other Pharmacy $51.00 751401 ROSIGLITAZONE 4 MG TAB 259 Other Pharmacy $64.00 751403 RU-TUSS TAB 259 Other Pharmacy $20.00 751405 ROSIGLITAZONE 2 MG TAB 259 Other Pharmacy $50.00

751420 SAQUINAVIR 259 Other Pharmacy $64.00

751425 Senocot S Tab 259 Other Pharmacy $5.00

751427 SEVELAMER 403 MG TAB 259 Other Pharmacy $34.00

25 751463 SALSALATE 750 MG TAB 259 Other Pharmacy $11.00 751477 STAVUDINE 15MG CAP 259 Other Pharmacy $50.00 751479 STRESSTAB W/ZINC TAB 259 Other Pharmacy $8.00 751550 TALWIN NX TAB 259 Other Pharmacy $44.00

751570 CARBAMAZEPINE 200 MG S 259 Other Pharmacy $26.00

751571 CARBAMAZEPINE 200MG CA 259 Other Pharmacy $23.00

751575 CHLORPHENIRAMINE ER 8 259 Other Pharmacy $12.00

751600 THALIDOMIDE 50 MG CAP 259 Other Pharmacy $159.00

751610 ESTRADIOL 0.0375 MG PT 259 Other Pharmacy $93.00

751638 TRIMEPRAMINE 25MG CAP 259 Other Pharmacy $34.00

751641 TRIMETHOBENZAM 250MG C 259 Other Pharmacy $26.00

751650 TOLAZAMIDE 250 MG TAB 259 Other Pharmacy $9.00 751653 TOLMETIN 400MG CAP 259 Other Pharmacy $11.00 751666 TROVAFLOXACIN 100MG TA 259 Other Pharmacy $75.00 751667 TROVAFLOXACIN 200MG TA 259 Other Pharmacy $81.00 751708 UREA 15GM CRYSTALS 259 Other Pharmacy $10.00 751754 CHOLECALCIFEROL 400 INT.TAB 259 Other Pharmacy $20.00 751766 ZALCITABINE 0.75MG TAB 259 Other Pharmacy $38.00

752110 Ascor AC 500 A 259 Other Pharmacy $34.00

752277 Fenoldopam 20mg/ml 2ml 259 Other Pharmacy $1,954.00

752531 INSULIN GLARGINE DOSE 259 Other Pharmacy $104.00

753241 Abacavir Liq 120ml 259 Other Pharmacy $369.00

753242 AMANTADINE 50 MG/5ML U 259 Other Pharmacy $21.00

753245 BELLADONNA ALK/PB 0.5U 259 Other Pharmacy $13.00

753248 CARBAMAZ 50 MG UDL 259 Other Pharmacy $13.00

753253 AUGMENTIN 250MG/ML 75M 259 Other Pharmacy $234.00 753267 METOCLOPR 0.1 MG/ML UD 259 Other Pharmacy $13.00 753269 CAPTOPRIL 1 MG/ML UDL 259 Other Pharmacy $13.00 753270 GLYCOPYROLATE 1 MG UDL 259 Other Pharmacy $13.00 753271 GLYCOPYROL 0.1 MG/ML U 259 Other Pharmacy $13.00 753272 FOLIC ACID 1MG/ML UDL 259 Other Pharmacy $12.00 753273 FORMOTEROL FUM #12 259 Other Pharmacy $189.00

753300 FLUTIC/SALMET 100/50 I 259 Other Pharmacy $389.00

753301 FLUTIC/SALMET 250/50 I 259 Other Pharmacy $389.00

753302 FLUTIC/SALMET 500/50 I 259 Other Pharmacy $572.00

753529 DOCUSATE LIQ 50MG/5ML 259 Other Pharmacy $8.00

753533 HYDROXYZINE 10MG UDL 259 Other Pharmacy $20.00

753534 IBUPROFEN 50 MG UDL 259 Other Pharmacy $8.00

753545 OXYBUTYNIN 5 MG UDL 259 Other Pharmacy $21.00

753546 PEN G 250 MG UDL 259 Other Pharmacy $26.00

753548 PREDNISONE 1 MG UDL 259 Other Pharmacy $13.00 753553 ZIDOVUDINE 300 MG UDL 259 Other Pharmacy $50.00 753554 METOCLOPRAMIDE 1 MG UD 259 Other Pharmacy $13.00 753557 Acet/Cod 1 ml 259 Other Pharmacy $13.00 753564 DIPHENHYDRAMINE 120 ML 259 Other Pharmacy $26.00 753566 CHLOROTH 50 MG UDL 259 Other Pharmacy $13.00 753596 CLARITHROMY 250/5 100M 259 Other Pharmacy $376.00

753605 CETIRIZINE SYRP 5ML 259 Other Pharmacy $34.00

753620 CISAPRIDE 1MG/ML 120ML 259 Other Pharmacy $120.00

753621 CHLORPH 120 ML 259 Other Pharmacy $13.00

26 753627 SPIRONOLACTONE 1MG/ML 259 Other Pharmacy $30.00 753628 SPIRONOLACTONE 5MG/ML 259 Other Pharmacy $30.00 753639 HYDRALAZIN SOL 20MG/20 259 Other Pharmacy $178.00 753692 DIAZEPAM 5/5 259 Other Pharmacy $35.00

753694 CLINDAMYCIN SOLN 75MG/ 259 Other Pharmacy $211.00

753695 DICYCLOMINE 5YR 10MG/5 259 Other Pharmacy $128.00

753714 DIMETAPP ELIXIR 5 ML U 259 Other Pharmacy $20.00

753731 DOXEPIN 5% CRM 30GM 259 Other Pharmacy $93.00

753732 THEOPHYLLINE 100MG/18. 259 Other Pharmacy $12.00

753734 THEOPHYLLINE 10MG UDL 259 Other Pharmacy $19.00

753834 MCT OIL DOSE 259 Other Pharmacy $19.00

753866 BISMUTH SUBSALICY 30 ML UDL 259 Other Pharmacy $11.00 753871 LEVORPHANOL 5/5 UDL 259 Other Pharmacy $44.00 753873 LACTULOSE SYRUP 100 ML 259 Other Pharmacy $35.00 753898 PRIMIDONE 250/5 120 ML 259 Other Pharmacy $100.00 753923 METHYLDOPA 250MG/5ML U 259 Other Pharmacy $25.00 753929 SIMETHICONE DOSE 259 Other Pharmacy $- 753931 Acetamin 15ml Drop 259 Other Pharmacy $39.00

753933 NEOMYCIN 120ML 259 Other Pharmacy $175.00

753943 GAVISCON SUSP 360ML BO 259 Other Pharmacy $36.00

753950 MULTIVITAMIN/IRON 240M 259 Other Pharmacy $205.00

753954 PHENYTOIN 50 MG/2ML UD 259 Other Pharmacy $20.00

753983 LANSOPRAZOLE BICARB SO 259 Other Pharmacy $290.00

753990 Nystatin 100,UN/ML 60M 259 Other Pharmacy $78.00

753996 NITROFURANTOIN 5 ML UD 259 Other Pharmacy $20.00

754021 Pen V K 125 S 259 Other Pharmacy $108.00 754022 Pen VK 250/5 259 Other Pharmacy $196.00 754038 Procainamide ER 750mg 259 Other Pharmacy $21.00 754095 Guaifenesin 100mg/sml 259 Other Pharmacy $19.00 754098 Guiafenesin Dm Syr 120 259 Other Pharmacy $25.00 754169 Thioridazine 25mg/5ml 259 Other Pharmacy $377.00 754205 Acetam 100mg/ml Udl Dr 259 Other Pharmacy $13.00

754210 Valproic Acid 250/5 12 259 Other Pharmacy $35.00

754326 Desonide 0.05% Oint 15 259 Other Pharmacy $121.00

754373 GEN CODE (259) 259 Other Pharmacy $-

754412 METHYLPREDNISO ENEMA R 259 Other Pharmacy $102.00

754422 MICONAZOLE 100MG VAG T 259 Other Pharmacy $20.00

754484 NEO-CORTEF 1% CR 20GM 259 Other Pharmacy $170.00

754498 ERYTHROMYCIN 2% TSOL 6 259 Other Pharmacy $141.00

754513 AQUAPH 1PD JAR 259 Other Pharmacy $219.00

754516 SALICYLIC ACID POW 10G 259 Other Pharmacy $20.00 754526 POVIDONE-IODINE OINT 3 259 Other Pharmacy $23.00 754537 NAPHAZLINE 0.5% OPSOL 259 Other Pharmacy $50.00 754539 CROTAMITON 60G TUBE 259 Other Pharmacy $97.00 754557 FLUOCINONIDE .05% 30G 259 Other Pharmacy $34.00 754558 FLUOCINONIDE 0.5% 30G 259 Other Pharmacy $75.00 754559 FLUOCINOLON 0.025% O 1 259 Other Pharmacy $110.00

754564 HYDROCORTISONE POW 1GM 259 Other Pharmacy $20.00

754565 GENTAMICIN 0.1% 15G O 259 Other Pharmacy $104.00

754578 CLINDAMYCIN VAG CRM 40 259 Other Pharmacy $501.00

27 754579 MICONAZOLE 2% VAG CR 4 259 Other Pharmacy $78.00 754580 MYCOLOG O 15G 259 Other Pharmacy $369.00 754588 POLYSPORIN TOP POW 35 259 Other Pharmacy $213.00 754591 NIVEA CREAM 259 Other Pharmacy $19.00

754603 FLUOCINOLONE 0.025% C 259 Other Pharmacy $72.00

754604 TERBINAFINE 1% CRM 259 Other Pharmacy $295.00

754606 TESTOSTERONE 5 MG PATC 259 Other Pharmacy $88.00

754609 TRIAMCIN AC 0.1% CR 60 259 Other Pharmacy $240.00

754623 LOTRISONE CR 15GM 259 Other Pharmacy $159.00

754639 ACYCLOVIR 30 GM OINT 259 Other Pharmacy $1,530.00

754664 BENZOIN TINCTURE 60ML 259 Other Pharmacy $34.00

754669 ALPHA KERI MOISTURE BA 259 Other Pharmacy $21.00 754693 BETAMETH DIP .05% LOT 259 Other Pharmacy $401.00 754694 BETAMETH DIP CRM 15 259 Other Pharmacy $331.00 754695 GRANULEX SPRAY 259 Other Pharmacy $88.00 754696 NITROLINGUAL SPRY 13.8 259 Other Pharmacy $185.00 754701 MERCUROCHR 10Z 259 Other Pharmacy $69.00 754704 LINDANE 1% LOTION 60ML 259 Other Pharmacy $562.00

754706 BABY SHAMPOO 3.5OZ 259 Other Pharmacy $12.00

754723 PHENOL LIQ 30ML 259 Other Pharmacy $100.00

754729 MONOOCTANOIN 120 ML 259 Other Pharmacy $573.00

754730 SALINE/GLYC/ALC CPD 259 Other Pharmacy $75.00

754733 PIRBUTEROL .2MG/P INH 259 Other Pharmacy $141.00

754736 FLUOCINOLONE 0.01% SOL 259 Other Pharmacy $151.00

754737 FLUNISOLID/AERO 7GM IN 259 Other Pharmacy $432.00

754741 NITROGLYCERIN SPRY 1DO 259 Other Pharmacy $23.00 754757 CIPROFLOXACIN OPSO 2.5 259 Other Pharmacy $108.00 754759 CITAPHIL LOT/HC 1% 480 259 Other Pharmacy $48.00 754760 BETAXOLOL .5% OPSO 2.5 259 Other Pharmacy $104.00 754761 BITOLTEROL 15ML INH 259 Other Pharmacy $626.00 754764 BENZOCAINE SPRAY DOSE 259 Other Pharmacy $20.00 754774 BETOXOLOL 0.25% 10 ML 259 Other Pharmacy $471.00

754783 APRACLONIDINE .5% OPSO 259 Other Pharmacy $432.00

754785 PHYSOSTIGMINE OPH OINT 259 Other Pharmacy $226.00

754793 BLEPHAMIDE O S 259 Other Pharmacy $78.00

754795 BUDESONIDE INHALER 259 Other Pharmacy $594.00

754796 BRIMONIDINE 15ML 0.2% 259 Other Pharmacy $299.00

754804 BIMATOPROST 0.03% OPSO 259 Other Pharmacy $578.00

754813 BETAXOLOL 0.5% OPSOL 259 Other Pharmacy $165.00

754815 CARBAMIDE PEROX ORAL 6 259 Other Pharmacy $64.00

754817 BLEPHAMIDE OPOI 3.5GM 259 Other Pharmacy $72.00 754825 ACETIC ACID SOLN 259 Other Pharmacy $25.00 754829 ACETYCHOL-E 1% OP 2ML 259 Other Pharmacy $545.00 754835 Loteprednol 0.2% OPSO 259 Other Pharmacy $291.00 754843 AQUAPHOR/HYDRCORT 1% C 259 Other Pharmacy $146.00 754883 FLUNISOLIDE NASAL SPR 259 Other Pharmacy $391.00 754891 SUMATRIPTAN NASAL SPRA 259 Other Pharmacy $369.00

754896 CHLORAMPEN 1% 00 259 Other Pharmacy $142.00

754900 TRAVAPROST 0.004% 259 Other Pharmacy $386.00

754912 HYDROCORT PD 25 GM 259 Other Pharmacy $428.00

28 754919 EUCER/HYDRCORT 1% C 45 259 Other Pharmacy $96.00 754920 CLORCORTOLONE 0.1% CRM 259 Other Pharmacy $171.00 754922 SILVER NITRATE 259 Other Pharmacy $- 754927 SEBULEX SHAMPO 259 Other Pharmacy $100.00

754931 EPIFOAM 10GM 259 Other Pharmacy $133.00

754933 CHLORHEX GLUC .12% 16O 259 Other Pharmacy $100.00

754950 AMMO ARO VAPOR 259 Other Pharmacy $-

754957 DOCUSATE SOD MINI ENEM 259 Other Pharmacy $51.00

754960 POLYSTYRENE SULFONAT 1 259 Other Pharmacy $57.00

755024 METHADONE 1MG/1ML UDL 259 Other Pharmacy $34.00

755031 MIDAZOLAM 10MG/5ML UDL 259 Other Pharmacy $283.00

755040 ACETAMINOPHEN/COD 5ML 259 Other Pharmacy $- 755051 EUCALYPTUS OIL DOSE 259 Other Pharmacy $48.00 758086 CYCLOPHOSPHAMIDE 25 MG 259 Other Pharmacy $17.00 758087 MELPHALAN 2 MG TAB 259 Other Pharmacy $33.00 758113 RALTEGRAVIR 100 MG TAB 259 Other Pharmacy $904.00 900596 Levetiracetam 100 Mg/Ml Ml 259 Other Pharmacy $19.00 900613 Ritonavir 100 Mg Tablet 259 Other Pharmacy $26.00

900615 Levothyroxine 88 Mcg Tablet 259 Other Pharmacy $12.00

900618 Glipizide Sa 5 Mg Srtab 259 Other Pharmacy $23.00

900619 Glipizide Sa 10 Mg Srtab 259 Other Pharmacy $22.00

900626 Atenolol 25 Mg Tab 259 Other Pharmacy $15.00

900631 Terazosin Hcl 1 Mg Cap 259 Other Pharmacy $19.00

900644 Biaxin Susp 250 MG/5ML 259 Other Pharmacy $42.00

900648 Cefpodoxime Proxetil 200Mg Tab 259 Other Pharmacy $47.00

900650 Cefpodoxime Proxetil 100Mg Tab 259 Other Pharmacy $37.00 900651 Azithromycin 200Mg/5Ml 30Mlbot 259 Other Pharmacy $346.00 900654 Ketorolac Tromethamn 0.5%Opsol 259 Other Pharmacy $277.00 900658 Fosamprenavir Calcm 700 Mg Tab 259 Other Pharmacy $111.00 900659 Acebutolol Hydrochlrd 200MgCap 259 Other Pharmacy $19.00 900660 Lamivudine 150 Mg Tab 259 Other Pharmacy $93.00 900661 Lopinavir/Ritonvr 5Ml/Udl Soln 259 Other Pharmacy $151.00

900662 TRUVADA 259 Other Pharmacy $159.00

900664 Lopinavr/Ritonvr 1Unt.Dose Tab 259 Other Pharmacy $83.00

900665 Enalapril Maleate 10 Mg Tab 259 Other Pharmacy $19.00

900680 P-Ephed Sul/Loratadn 1Ea Srtab 259 Other Pharmacy $52.00

900681 Risperidone 1 Mg/Ml Soln 259 Other Pharmacy $67.00

900689 Acetylcyst 20% 4ML RT 259 Other Pharmacy $32.00

900690 Olanzapine 5 Mg Tab 259 Other Pharmacy $63.00

900691 Olanzapine 2.5 Mg Tab 259 Other Pharmacy $52.00

900693 Capsaicin 0.1% 60 Gm Crm 259 Other Pharmacy $117.00 900696 Carvedilol 3.125 Mg Tab 259 Other Pharmacy $35.00 900697 Carvedilol 12.5 Mg Tab 259 Other Pharmacy $35.00 900699 Neutra Phos Pkt 259 Other Pharmacy $13.00 900702 Carvedilol 6.25 Mg Tab 259 Other Pharmacy $35.00 900705 Vesanoid 10MG Capsule 259 Other Pharmacy $91.00 900706 Carvedilol 25 Mg Tab 259 Other Pharmacy $38.00

900711 Dofetilide 125 Mcg Capsule 259 Other Pharmacy $47.00

900712 Dofetilide 250 Mcg Capsule 259 Other Pharmacy $47.00

900713 Aspirin 81 Mg Ectab 259 Other Pharmacy $4.00

29 900714 Acetaminophen 650Mg/20.3Ml Udl 259 Other Pharmacy $7.00 900716 Acetaminophen 160 Mg/5 Ml Udl 259 Other Pharmacy $15.00 900720 Divalproex Sodim 125MgSprinkle 259 Other Pharmacy $10.00 900721 Methadone Hcl 5 Mg/5 Ml Elix 259 Other Pharmacy $36.00

900722 Amx Tr/Potass Clavlnt 875MgTab 259 Other Pharmacy $134.00

900723 METHADONE HCL 10 MG TA 259 Other Pharmacy $26.00

900734 Amyls/Lips/Prots 30-6-19Cap.Dr 259 Other Pharmacy $21.00

900736 Codeine Phosphate 30 Mg Tab 259 Other Pharmacy $36.00

900738 MIACALCIN NASAL SPRAY 259 Other Pharmacy $226.00

900747 Rifampin 150 Mg Cap 259 Other Pharmacy $62.00

900773 Pulmicort Respule 0.5 MG 259 Other Pharmacy $48.00

900774 Acetaminophen 500 Mg Cap 259 Other Pharmacy $4.00 900782 Acetaminophen 120 Mg Supp.Rect 259 Other Pharmacy $5.00 900783 Acetamin 325 mg Supp 259 Other Pharmacy $5.00 900784 Acetaminophen 650 Mg Supp.Rect 259 Other Pharmacy $5.00 900789 Acetamino W/Codeine #3 259 Other Pharmacy $42.00 900791 Butlb/Acetmnphn/Caffn1UnDseTab 259 Other Pharmacy $23.00 900792 Mirtazapine 15 Mg Tab 259 Other Pharmacy $20.00

900794 Coden/Act 30/300Per 12.5MlSoln 259 Other Pharmacy $21.00

900798 Losartan Potassium 25 Mg Tab 259 Other Pharmacy $36.00

900799 Losartan Potassium 50 Mg Tab 259 Other Pharmacy $32.00

900804 Theophyllin Anhydrs 600MgSrtab 259 Other Pharmacy $21.00

900805 Acetazolamide 250 Mg Tab 259 Other Pharmacy $26.00

900812 Abacavir 300 Mg Tab 259 Other Pharmacy $134.00

900816 Ursodiol 300 Mg Cap 259 Other Pharmacy $37.00

900817 Nelfinavir Mesylate 250 Mg Tab 259 Other Pharmacy $42.00 900818 Nevirapine 200 Mg Tab 259 Other Pharmacy $61.00 900823 Stavudine 20 Mg Cap 259 Other Pharmacy $56.00 900826 Pioglitazone 15 Mg Tab 259 Other Pharmacy $83.00 900827 Acyclovir 200 Mg/5 Ml Susp 259 Other Pharmacy $22.00 900828 Pioglitazone 30 Mg Tab 259 Other Pharmacy $107.00 900829 Acyclovir 200 Mg Cap 259 Other Pharmacy $26.00

900839 Metformin Hcl 500Mg Tab.Sr.24H 259 Other Pharmacy $36.00

900841 Metformin Hcl 500 Mg Tab 259 Other Pharmacy $32.00

900842 Fluvoxamine Maleate 50 Mg Tab 259 Other Pharmacy $73.00

900844 ACYCLOVIR OINT 15G 259 Other Pharmacy $555.00

900846 Nifedipine 30 Mg Srtab 259 Other Pharmacy $26.00

900855 Albuterol Sulf 2Mg/5Ml SyrUdl 259 Other Pharmacy $26.00

900858 Anagrelide Hcl 0.5 Mg Cap 259 Other Pharmacy $79.00

900860 Paroxetine Hcl 10 Mg Tab 259 Other Pharmacy $67.00

900862 EsomeprzlMagTrihydrt20MgCap.Ec 259 Other Pharmacy $73.00 900863 Aluminum Hydroxide 30 Ml Udl 259 Other Pharmacy $9.00 900873 Albuterol Sulf 1Puff Aer.W.Adp 259 Other Pharmacy $137.00 900874 ALBUTEROL INH DOSE 259 Other Pharmacy $5.00 900875 Arformoterol 15 MCG IHN 259 Other Pharmacy $29.00 900878 Albuterol Sulfate 4 Mg Tab 259 Other Pharmacy $27.00 900881 Albuterol Sulfate 4 Mg Srtab 259 Other Pharmacy $36.00

900897 Allopurinol 100 Mg Tab 259 Other Pharmacy $27.00

900898 Allopurinol 300 Mg Tab 259 Other Pharmacy $27.00

900902 Alprazolam 0.25 Mg Tab 259 Other Pharmacy $36.00

30 900903 BRIMONIDINE 0.2% OPHTH 259 Other Pharmacy $37.00 900904 Alprazolam 0.5 Mg Tab 259 Other Pharmacy $36.00 900906 Glimepiride 4 Mg Tab 259 Other Pharmacy $23.00 900909 Anastrozole 1 Mg Tab 259 Other Pharmacy $134.00

900910 Lovastatin 10 Mg Tab 259 Other Pharmacy $19.00

900925 Ondansetron Hcl 4 Mg/5 Ml Udl 259 Other Pharmacy $173.00

900926 Ondansetron 4 Mg Tab.Rapdis 259 Other Pharmacy $13.00

900937 Mag Hydr/AlHydr/Simeth 30MlUdl 259 Other Pharmacy $10.00

900943 Domeboro Soln 259 Other Pharmacy $51.00

900945 Amantadine Hcl 100 Mg Tab 259 Other Pharmacy $19.00

900950 Aminocaproic Acid 500 Mg Tab 259 Other Pharmacy $88.00

900963 InsGlrgHumRecAnlg100UnMl10Mlbt 259 Other Pharmacy $345.00 900969 Amiodarone Hcl 200 Mg Tab 259 Other Pharmacy $24.00 900973 Amitriptyline Hcl 10 Mg Tab 259 Other Pharmacy $19.00 900976 Amitriptyline Hcl 25 Mg Tab 259 Other Pharmacy $19.00 900980 Risedronate Sodium 5 Mg Tab 259 Other Pharmacy $52.00 900981 Amitriptyline Hcl 50 Mg Tab 259 Other Pharmacy $19.00 900982 Danazol 200 Mg Cap 259 Other Pharmacy $26.00

900984 Amitriptyline Hcl 75 Mg Tab 259 Other Pharmacy $27.00

900986 Dorzolamide Hcl 2% 10 Ml Opsol 259 Other Pharmacy $148.00

900988 Metoprolol Succinat 25Mg Srtab 259 Other Pharmacy $23.00

900992 TOPROL XL 100MG 259 Other Pharmacy $26.00

900994 Metoprolol Succinat 50Mg Srtab 259 Other Pharmacy $23.00

900995 Ammonium Lactate 12% 8 Oz 259 Other Pharmacy $414.00

900996 Metformin Hcl 850 Mg Tab 259 Other Pharmacy $40.00

901004 CEFDINIR 125MG/5ML SUS 259 Other Pharmacy $15.00 901005 Cefdinir 300 Mg Capsule 259 Other Pharmacy $61.00 901006 Amoxicillin Trihydrt 250Mg Cap 259 Other Pharmacy $67.00 901007 Amoxicillin Trihydrt 500Mg Cap 259 Other Pharmacy $42.00 901014 Ezetimibe 10 Mg Tab 259 Other Pharmacy $56.00 901028 Amx Tr/Potass Clavlnt 500MgTab 259 Other Pharmacy $66.00 901036 Disopyramide Phosphat 150MgCap 259 Other Pharmacy $13.00

901058 Glyburide 1.25 Mg Tab 259 Other Pharmacy $13.00

901060 Clarithromycin 500 Mg Tab 259 Other Pharmacy $56.00

901068 ANCOBON 500 MG CAP 259 Other Pharmacy $347.00

901083 Simvastatin 10 Mg Tab 259 Other Pharmacy $50.00

901084 Simvastatin 5 Mg Tab 259 Other Pharmacy $38.00

901085 Simvastatin 40 Mg Tab 259 Other Pharmacy $57.00

901086 Simvastatin 80 Mg Tab 259 Other Pharmacy $62.00

901087 Simvastatin 20 Mg Tab 259 Other Pharmacy $46.00

901088 Estradiol 0.1 Mg Ptch 259 Other Pharmacy $99.00 901089 Methyl Salicylt/Menthl 3Oz Crm 259 Other Pharmacy $21.00 901108 Hc Acet/Pramxn Hcl 4GmCrm.Appl 259 Other Pharmacy $77.00 901119 Hydrocortisone Acett 25Mg Supp 259 Other Pharmacy $38.00 901120 Donepezil Hcl 5 Mg Tab 259 Other Pharmacy $59.00 901121 Isoniazid 100 Mg Tab 259 Other Pharmacy $26.00 901130 Memantine Hcl 10 Mg Tab 259 Other Pharmacy $47.00

901135 AURALGAN OTIC 259 Other Pharmacy $44.00

901143 Ascorbic Acid 500 Mg Tab 259 Other Pharmacy $7.00

901146 Ascorbic Acid 500 Mg/5 Ml Udl 259 Other Pharmacy $12.00

31 901149 Aspirin 81 Mg Chwt 259 Other Pharmacy $4.00 901151 Aspirin 300 Mg Supp 259 Other Pharmacy $5.00 901153 Aspirin 325 Mg Ectab 259 Other Pharmacy $4.00 901157 Candesartan Cilexetil 16Mg Tab 259 Other Pharmacy $38.00

901158 Atenolol 50 Mg Tab 259 Other Pharmacy $27.00

901168 Ipratropm Bromd 0.03% 30Ml Nsp 259 Other Pharmacy $346.00

901169 Atropine Sulfate 1% Opsol 259 Other Pharmacy $212.00

901174 Permethrin 1 Appl Btl 259 Other Pharmacy $79.00

901175 Azathioprine 50 Mg Tab 259 Other Pharmacy $56.00

901178 Azithromycin 600 Mg Tab 259 Other Pharmacy $340.00

901182 Prenatal Vitamin/Irn/Fa1 - Tab 259 Other Pharmacy $5.00

901183 Bacitracin 1Appl 0.9Gm Ud.Oint 259 Other Pharmacy $5.00 901186 Bacitracin 3.5 Gm Opoin 259 Other Pharmacy $166.00 901189 BACLOFEN 5MG/5ML 259 Other Pharmacy $12.00 901191 Baclofen 10 Mg Tab 259 Other Pharmacy $27.00 901193 Baclofen 20 Mg Tab 259 Other Pharmacy $40.00 901194 Beclomethason Dipropnt 30MlBtl 259 Other Pharmacy $224.00 901195 Belladnn Alkald/Phenbarb 1-Tab 259 Other Pharmacy $27.00

901196 Belladnn Alklds/Phenobrb5MlUdl 259 Other Pharmacy $38.00

901207 Benazepril Hcl 10 Mg Tab 259 Other Pharmacy $21.00

901208 Benazepril Hcl 5 Mg Tab 259 Other Pharmacy $19.00

901209 Benazepril Hcl 20 Mg Tab 259 Other Pharmacy $21.00

901212 Benzonatate 100 Mg Cap 259 Other Pharmacy $13.00

901213 Sotalol Hcl 80 Mg Tab 259 Other Pharmacy $35.00

901214 Sotalol Hcl 120 Mg Tab 259 Other Pharmacy $62.00

901215 Tetracn/Benzocn/Butmbn 1 - Spy 259 Other Pharmacy $129.00 901219 Zafirlukast 20 Mg Tab 259 Other Pharmacy $26.00 901221 Benztropine Mesylate 0.5Mg Tab 259 Other Pharmacy $13.00 901222 Benztropine Mesylate 1 Mg Tab 259 Other Pharmacy $26.00 901223 Benztropine Mesylate 2 Mg Tab 259 Other Pharmacy $26.00 901231 Bethanechol Chloride 10 Mg Tab 259 Other Pharmacy $13.00 901232 Bethanechol Chloride 25 Mg Tab 259 Other Pharmacy $20.00

901242 Bisacodyl 5 Mg Tab 259 Other Pharmacy $5.00

901243 Bisacodyl 10 Mg Supp 259 Other Pharmacy $10.00

901255 Prednisolone 15 Mg/5 Ml Udl 259 Other Pharmacy $38.00

901264 Camphr/Phnl/PetHy-Phl6Gm/TubOt 259 Other Pharmacy $13.00

901270 Bromocriptine Mesylt 2.5Mg Tab 259 Other Pharmacy $23.00

901284 BUMETANIDE .5MG TAB 259 Other Pharmacy $11.00

901286 Bumetanide 1 Mg Tab 259 Other Pharmacy $19.00

901323 Buspirone Hcl 5 Mg Tab 259 Other Pharmacy $10.00

901333 Caffeine Citrated 20 Mg/Ml Ml 259 Other Pharmacy $229.00 901335 CARB 600MG/VIT D3 400 259 Other Pharmacy $4.00 901336 Calcium Acetate 667 Mg Tab 259 Other Pharmacy $15.00 901339 Calc Carbnt (Alk) 500MgChewtab 259 Other Pharmacy $5.00 901352 Captopril 12.5 Mg Tab 259 Other Pharmacy $13.00 901355 Quetipn Fumrt 200Mg Tab.Sr.24H 259 Other Pharmacy $83.00 901356 Carbamazepine 200 Mg Tab 259 Other Pharmacy $13.00

901357 Carbamazepine 200Mg/10 Ml Susp 259 Other Pharmacy $22.00

901358 TEGRETOL XR 200MG TAB 259 Other Pharmacy $22.00

901359 Carbamazepine 100Mg Tab.Er.12H 259 Other Pharmacy $19.00

32 901361 Carbamd Prxd 6.5% 15Ml/BtlOtsl 259 Other Pharmacy $73.00 901362 Carbidopa/Levodopa 25/100 Tab 259 Other Pharmacy $13.00 901363 Carbidopa/Levdp Cr 25/100Srtab 259 Other Pharmacy $23.00 901364 Carbidopa/Levodopa 10/100 Tab 259 Other Pharmacy $13.00

901365 Carbidopa/Levodopa 25/250 Tab 259 Other Pharmacy $13.00

901367 Carbidopa/Levdp Cr 50/200Srtab 259 Other Pharmacy $23.00

901368 Carisoprodol 350 Mg Tab 259 Other Pharmacy $38.00

901387 Urea Crystals 30 Gm Jar 259 Other Pharmacy $20.00

901389 CEFUROX AXET 250MG 259 Other Pharmacy $10.00

901391 Imipramine Pamoate 75 Mg Cap 259 Other Pharmacy $19.00

901394 Cephalexin 250 Mg Cap 259 Other Pharmacy $37.00

901395 Citalopram Hydrobromid 20MgTab 259 Other Pharmacy $21.00 901396 Citalopram Hydrobromid 10MgTab 259 Other Pharmacy $20.00 901397 Escitalopram 10 Mg Tab 259 Other Pharmacy $50.00 901400 Cephalexin 500 Mg Cap 259 Other Pharmacy $66.00 901407 Celecoxib 100 Mg Cap 259 Other Pharmacy $36.00 901414 Clorazepat Dipotassm 3.75MgTab 259 Other Pharmacy $36.00 901415 Chlordiazepoxide Hcl 5 Mg Cap 259 Other Pharmacy $36.00

901416 Chlordiazepoxide Hcl 25 Mg Cap 259 Other Pharmacy $66.00

901428 Chlorpromazine Hcl 10 Mg Tab 259 Other Pharmacy $21.00

901430 Chlorpromazine Hcl 25 Mg Tab 259 Other Pharmacy $23.00

901431 Chlorpromazine Hcl 50 Mg Tab 259 Other Pharmacy $26.00

901433 Chlorthalidone 25 Mg Tab 259 Other Pharmacy $20.00

901439 Cholestyramin/Aspartm 4 Gm Pkt 259 Other Pharmacy $50.00

901446 Ciprofloxcn Hydrochlr 250MgTab 259 Other Pharmacy $36.00

901447 Moxifloxacin Hcl 400 Mg Tab 259 Other Pharmacy $124.00 901452 CIPROFLOXACI 500MG 259 Other Pharmacy $33.00 901453 CIPROFLOXACIN 750MG 259 Other Pharmacy $33.00 901454 CIPROFLO 0.3% OP SO 259 Other Pharmacy $47.00 901466 Magnesium Citrate 300 Ml Soln 259 Other Pharmacy $13.00 901471 Bicalutamide 50 Mg Tab 259 Other Pharmacy $117.00 901476 Loratadine 10 Mg Tab 259 Other Pharmacy $63.00

901479 Chlordiazepox/ClidinmBr1 - Cap 259 Other Pharmacy $27.00

901480 Estradiol 0.075 Mg Ptch 259 Other Pharmacy $99.00

901492 Clindamycin Hcl 150 Mg Cap 259 Other Pharmacy $77.00

901498 Clonazepam 0.5 Mg Tab 259 Other Pharmacy $36.00

901502 Clonidine Hcl 0.2Mg Patch.Tdwk 259 Other Pharmacy $91.00

901505 Clonidine Hcl 0.1Mg Patch.Tdwk 259 Other Pharmacy $63.00

901506 Clonidine Hcl 0.3Mg Patch.Tdwk 259 Other Pharmacy $124.00

901507 Clonidine Hcl 0.1 Mg Tab 259 Other Pharmacy $12.00

901511 Clozapine 25 Mg Tab 259 Other Pharmacy $21.00 901512 Clozapine 100 Mg Tab 259 Other Pharmacy $59.00 901515 CLOTRIMAZOLE CRM 1% 30 259 Other Pharmacy $22.00 901517 Clotrimazole 10 Mg Troche 259 Other Pharmacy $26.00 901531 Temazepam 7.5 Mg Cap 259 Other Pharmacy $79.00 901532 Colchicine 0.6 Mg Tab 259 Other Pharmacy $26.00 901535 Electrolyte Sol/Peg 4000MlSoln 259 Other Pharmacy $372.00

901544 Duoneb INH Solution 259 Other Pharmacy $5.00

901545 Sodium Chloride 3% INH 259 Other Pharmacy $6.00

901546 Zidovudine/Lamivudine Tab 259 Other Pharmacy $140.00

33 901548 EstrogensConjugatd 0.625MgTab 259 Other Pharmacy $37.00 901549 EstrogensConjugatd 1.25Mg Tab 259 Other Pharmacy $52.00 901550 EstrogensConjugated 0.3Mg Tab 259 Other Pharmacy $47.00 901567 Cyclobenzaprine Hcl 10 Mg Tab 259 Other Pharmacy $71.00

901569 Cyclophosphamide 25 Mg Tab/Cap 259 Other Pharmacy $21.00

901571 Liothyronine Sodium 25 Mcg Tab 259 Other Pharmacy $26.00

901576 Cyproheptadn Hydrochlor 4MgTab 259 Other Pharmacy $13.00

901579 Dantrolene Sodium 25 Mg Cap 259 Other Pharmacy $13.00

901580 Pyrimethamine 25 Mg Tab 259 Other Pharmacy $3,013.00

901582 Dapsone 25 Mg Tab 259 Other Pharmacy $13.00

901590 Etravirine 100 Mg Tablet 259 Other Pharmacy $71.00

901591 Darunavir Ethanolat 600Mg Tab 259 Other Pharmacy $126.00 901594 Torsemide 20 Mg Tab 259 Other Pharmacy $13.00 901597 Demeclocycline Hcl 150 Mg Tab 259 Other Pharmacy $77.00 901600 Desipramine Hcl 25 Mg Tab 259 Other Pharmacy $13.00 901605 Trazodone Hcl 50 Mg Tab 259 Other Pharmacy $32.00 901606 Tolterodn Tartrt 4MgCap.Sr.24H 259 Other Pharmacy $63.00 901609 Tolterodin Tartrt 2MgCap.Sr24H 259 Other Pharmacy $61.00

901616 Dexamethasone 0.5 Mg Tab 259 Other Pharmacy $11.00

901618 Dexamethasone 2 Mg Tab 259 Other Pharmacy $19.00

901619 Dexamethasone 4 Mg Tab 259 Other Pharmacy $13.00

901623 Dexamethasone 30 Mg/30 Ml Soln 259 Other Pharmacy $93.00

901633 Doxycycline Monohydrt 100MgCap 259 Other Pharmacy $83.00

901640 Diazepam 2 Mg Tab 259 Other Pharmacy $37.00

901641 VANCOMYCI HCL 125MG 259 Other Pharmacy $34.00

901647 Diclofenac Sodium 25 Mg Ectab 259 Other Pharmacy $38.00 901648 Dibucaine 1% 30 Gm Oint 259 Other Pharmacy $61.00 901649 Diclofenac Sodium 75 Mg Ectab 259 Other Pharmacy $50.00 901650 Diclofenac Sodium 1% 100Gm Gel 259 Other Pharmacy $157.00 901653 Dicloxacillin Sodium 250Mg Cap 259 Other Pharmacy $23.00 901654 Dicyclomine Hcl 10 Mg Cap 259 Other Pharmacy $26.00 901655 Dicyclomine Hcl 20 Mg Tab 259 Other Pharmacy $36.00

901658 Digoxin 0.125 Mg Tab 259 Other Pharmacy $10.00

901659 Digoxin 0.25 Mg Tab 259 Other Pharmacy $13.00

901661 Digoxin 0.125 Mg/2.5 Ml Udl 259 Other Pharmacy $19.00

901665 Diltiazem Hcl 30 Mg Tab 259 Other Pharmacy $12.00

901668 Diltiazem Hcl 60 Mg Tab 259 Other Pharmacy $21.00

901669 Diltiazem Hcl 90 Mg Srcap 259 Other Pharmacy $38.00

901671 Diltiazem Hcl 180 Mg Cdcap 259 Other Pharmacy $37.00

901672 Diltiazem Hcl 240 Mg Cdcap 259 Other Pharmacy $40.00

901673 Diltiazem Hcl 60 Mg Srcap 259 Other Pharmacy $22.00 901676 Diltiazem Hcl 120 Mg Cdcap 259 Other Pharmacy $23.00 901678 Diltiazem Hcl 300 Mg Cdcap 259 Other Pharmacy $59.00 901680 Aliskiren Hemifumart 150Mg Tab 259 Other Pharmacy $43.00 901688 Oxybutynn Chlor 10MgTab.Osm.24 259 Other Pharmacy $67.00 901689 Oxybutynin Chloride 5Mg Tab.Sa 259 Other Pharmacy $67.00 901690 Dimenhydrinate 50 Mg Tab 259 Other Pharmacy $5.00

901693 Valsartan 80 Mg Tab 259 Other Pharmacy $47.00

901695 Valsartan 320 Mg Tab 259 Other Pharmacy $56.00

901702 Diphnxylt/AtropSulf1Unt.DseTab 259 Other Pharmacy $20.00

34 901711 Dipyridamole 25 Mg Tab 259 Other Pharmacy $19.00 901712 Dipyridamole 50 Mg Tab 259 Other Pharmacy $19.00 901717 Aspirin/Dipyridamole 1Ea Srcap 259 Other Pharmacy $56.00 901727 Acamprosate Calcm 333Mg tab.Dr 259 Other Pharmacy $26.00

901754 Doxazosin Mesylate 1 Mg Tab 259 Other Pharmacy $21.00

901755 Doxazosin Mesylate 4 Mg Tab 259 Other Pharmacy $36.00

901756 Doxepin Hcl 10 Mg Cap 259 Other Pharmacy $19.00

901757 Doxepin Hcl 25 Mg Cap 259 Other Pharmacy $13.00

901758 Doxepin Hcl 50 Mg Cap 259 Other Pharmacy $22.00

901759 Doxepin Hcl 100 Mg Cap 259 Other Pharmacy $22.00

901763 Entacapone 200 Mg Tab 259 Other Pharmacy $50.00

901769 Dronabinol 2.5 Mg Cap 259 Other Pharmacy $77.00 901774 Docusate Sodium 100 Mg Cap 259 Other Pharmacy $5.00 901776 Docusate Sodium 100Mg/10Ml Udl 259 Other Pharmacy $7.00 901794 Venlafaxine Hcl 25 Mg Tab 259 Other Pharmacy $32.00 901795 Venlafaxine Hcl 37.5 Mg Tab 259 Other Pharmacy $32.00 901797 Venlafaxine Hcl 75MgTab.Sr.24H 259 Other Pharmacy $73.00 901804 Permethrin 5% 60 Gm Crm 259 Other Pharmacy $186.00

901812 Enalapril Maleate 2.5 Mg Tab 259 Other Pharmacy $10.00

901813 Enalapril Maleate 5 Mg Tab 259 Other Pharmacy $13.00

901852 ERYTHROMYCIN BASE 1 GM 259 Other Pharmacy $36.00

901862 Estradiol 1 Mg Tab 259 Other Pharmacy $37.00

901865 Ethambutol Hcl 400 Mg Tab 259 Other Pharmacy $36.00

901872 Etoposide 50 Mg Cap 259 Other Pharmacy $264.00

901873 EUCERIN CREAM 4 OZ 259 Other Pharmacy $36.00

901874 Eucerin 1-Lb 259 Other Pharmacy $78.00 901881 Raloxifene Hcl 60 Mg Tab 259 Other Pharmacy $36.00 901887 Famotidine 20 Mg Tab 259 Other Pharmacy $15.00 901890 Famciclovir 125 Mg Tab 259 Other Pharmacy $36.00 901891 Famciclovir 500 Mg Tab 259 Other Pharmacy $84.00 901894 Letrozole 2.5 Mg Tab 259 Other Pharmacy $107.00 901901 Psyllium 1 Unit.Dose Pkt 259 Other Pharmacy $13.00

901904 Fentanyl 100 Mcg Patch 259 Other Pharmacy $228.00

901905 Fentyl 50Mcg.Per.Hr Patch.Td72 259 Other Pharmacy $228.00

901906 Fentyl 25Mcg.Per.Hr Patch.Td72 259 Other Pharmacy $226.00

901912 Menthol/Aloe Vera Gel 4 Oz Btl 259 Other Pharmacy $152.00

901916 Ferrous Sulfate 300 Mg Udcup 259 Other Pharmacy $5.00

901917 Ferrous Sulfate 325 Mg Tab 259 Other Pharmacy $4.00

901920 Dutasteride 0.5 Mg Cap 259 Other Pharmacy $50.00

901921 Fluticsn Propint 16Gm0.05 %Nsp 259 Other Pharmacy $318.00

901925 Dantrolene Sodium 50 Mg Cap 259 Other Pharmacy $32.00 901931 Fluconazole 100 Mg Tab 259 Other Pharmacy $104.00 901932 Fluconazole 150 Mg Tab 259 Other Pharmacy $135.00 901934 Fluconazole 200 Mg Tab 259 Other Pharmacy $151.00 901936 Fluconazole 100 Mg/2.5 Ml Udl 259 Other Pharmacy $104.00 901942 Fludrocortison Acetat 0.1MgTab 259 Other Pharmacy $13.00 901958 Fluoxetine Hcl 20 Mg Cap 259 Other Pharmacy $40.00

901959 Fluoxetine Hcl 20 Mg/5 Ml Udl 259 Other Pharmacy $78.00

901960 Fluoxetine Hcl 10 Mg Cap 259 Other Pharmacy $50.00

901961 Duloxetine Hcl 30Mg Capsule.Dr 259 Other Pharmacy $59.00

35 901962 Duloxetine Hcl 20Mg Capsule.Dr 259 Other Pharmacy $52.00 901963 Duloxetine Hcl 60Mg Capsule.Dr 259 Other Pharmacy $59.00 901964 Fluphenazine Hcl 2.5 Mg Tab 259 Other Pharmacy $20.00 901967 Folic Acid 1 Mg Tab 259 Other Pharmacy $15.00

901972 Pentosn Polysulft Sod 100MgCap 259 Other Pharmacy $52.00

901974 Thphylln Anhydrs 100MgCp.Sr24H 259 Other Pharmacy $13.00

901979 Furosemide 20 Mg Tab 259 Other Pharmacy $11.00

901980 Furosemide 40 Mg Tab 259 Other Pharmacy $11.00

901981 Furosemide 80 Mg Tab 259 Other Pharmacy $13.00

901982 Furosemide 40 Mg/5 Ml Udl 259 Other Pharmacy $15.00

901992 Valganciclvr Hydrochlor450MgTb 259 Other Pharmacy $295.00

901999 Gemfibrozil 600 Mg Tab 259 Other Pharmacy $26.00 902018 AUGMENTIN 500 MG TAB 259 Other Pharmacy $63.00 902027 Gentamicin Sulf 0.1% 15Gm Crm 259 Other Pharmacy $306.00 902028 GENTAMICIN OINT 259 Other Pharmacy $104.00 902038 Sulfasalazine 500 Mg Tab 259 Other Pharmacy $19.00 902040 Glipizide 5 Mg Tab 259 Other Pharmacy $13.00 902042 Glipizide 10 Mg Tab 259 Other Pharmacy $22.00

902058 Glyburide 2.5 Mg Tab 259 Other Pharmacy $13.00

902059 Glyburide 5 Mg Tab 259 Other Pharmacy $13.00

902064 Promethazine Hcl 25 Mg Supp 259 Other Pharmacy $105.00

902073 Guanfacine Hcl 1 Mg Tab 259 Other Pharmacy $19.00

902074 GUAIFENESI SYP 10 ML 259 Other Pharmacy $5.00

902075 GUAIFENESIN DM 10 ML 259 Other Pharmacy $9.00

902079 Guaifenesin 600 Mg Srtab 259 Other Pharmacy $10.00

902081 Guaifnsn/CodnPhosphat5Ml/UdlSy 259 Other Pharmacy $20.00 902082 Raltegravir Potassim 400Mg Tab 259 Other Pharmacy $125.00 902083 Haloperidol 0.5 Mg Tab 259 Other Pharmacy $13.00 902084 Haloperidol 1 Mg Tab 259 Other Pharmacy $13.00 902085 Haloperidol 2 Mg Tab 259 Other Pharmacy $13.00 902086 Haloperidol 5 Mg Tab 259 Other Pharmacy $13.00 902090 HALOPERIDOL CONC 259 Other Pharmacy $23.00

902095 Hydrocortisone 1% 30 Gm Crm 259 Other Pharmacy $22.00

902097 Hydrocortisone 1% 30 Gm Oint 259 Other Pharmacy $22.00

902105 Vitamin - Renal Form T 259 Other Pharmacy $5.00

902143 Hydralazine Hcl 10 Mg Tab 259 Other Pharmacy $26.00

902145 Ranolazine 500 Mg Tab.Sr.12H 259 Other Pharmacy $46.00

902146 Hydralazine Hcl 25 Mg Tab 259 Other Pharmacy $21.00

902148 Hydralazine Hcl 50 Mg Tab 259 Other Pharmacy $23.00

902152 Hydrochlorothiazide 25 Mg Tab 259 Other Pharmacy $20.00

902154 Hydrochlorothiazide 12.5Mg Tab 259 Other Pharmacy $20.00 902155 Hydrcd Bit/Homatrp 5 Mg/5MlLiq 259 Other Pharmacy $38.00 902160 Hydrocortisone 10 Mg Tab 259 Other Pharmacy $13.00 902165 Hydromorphone Hcl 2 Mg Tab 259 Other Pharmacy $63.00 902170 Hydroxychloroqun Sulf 200MgTab 259 Other Pharmacy $36.00 902172 LEFLUNOMIDE 10MG TAB 259 Other Pharmacy $37.00 902173 Hydroxyurea 500 Mg Cap 259 Other Pharmacy $38.00

902174 Hydroxyzine Hcl 10 Mg Tab 259 Other Pharmacy $32.00

902178 Hydroxyzine Hcl 10 Mg/5 Ml Udl 259 Other Pharmacy $19.00

902180 Dronedarn Hydrochlor 400Mg Tab 259 Other Pharmacy $56.00

36 902181 Hyoscyamine Sulfat 0.125Mg Tab 259 Other Pharmacy $21.00 902182 Hyoscyamine Sulf 0.375Mg Srcap 259 Other Pharmacy $21.00 902186 Ibuprofen 400 Mg Tab 259 Other Pharmacy $23.00 902187 Ibuprofen 200 Mg Tab 259 Other Pharmacy $5.00

902188 Ibuprofen 100 Mg/5 Ml Udl 259 Other Pharmacy $5.00

902189 Meloxicam 7.5 Mg Tab 259 Other Pharmacy $56.00

902191 Ibuprofen 600 Mg Tab 259 Other Pharmacy $40.00

902192 Ibuprofen 800 Mg Tab 259 Other Pharmacy $37.00

902193 Glipizide Sa 2.5 Mg Srtab 259 Other Pharmacy $23.00

902194 Primaquine Phosphat 26.3Mg Tab 259 Other Pharmacy $27.00

902206 Imipramine Hcl 10 Mg Tab 259 Other Pharmacy $13.00

902207 Isosorbid Mononitrt 30Mg Srtab 259 Other Pharmacy $33.00 902208 Imipramine Hcl 25 Mg Tab 259 Other Pharmacy $13.00 902219 Indapamide 2.5 Mg Tab 259 Other Pharmacy $30.00 902225 Indomethacin 25 Mg Cap 259 Other Pharmacy $59.00 902227 Indomethacin 75 Mg Srcap 259 Other Pharmacy $63.00 902232 Insul Nph Hum Rcm 100Unt/MlInj 259 Other Pharmacy $23.00 902233 Insuln Detmr 100Unt/Ml Inj 259 Other Pharmacy $50.00

902237 Insuln Rg Hum Rc 100Unt/Ml Inj 259 Other Pharmacy $12.00

902244 InsAspPrt70/InsAs30 100Un/MlIj 259 Other Pharmacy $47.00

902260 Isoniazid 300 Mg Tab 259 Other Pharmacy $27.00

902263 Isosorbide Dinitrate 20 Mg Tab 259 Other Pharmacy $11.00

902264 Isosorbide Mononitrat 20Mg Tab 259 Other Pharmacy $12.00

902265 Isosorbide Dinitrat 40Mg Srtab 259 Other Pharmacy $13.00

902269 Levetiracetam 500 Mg Tab 259 Other Pharmacy $57.00

902273 Ketoconazole 2% 15 Gm Crm 259 Other Pharmacy $152.00 902276 Ketoconazole 200 Mg Tab 259 Other Pharmacy $43.00 902285 Labetalol Hydrochlrd 100Mg Tab 259 Other Pharmacy $29.00 902287 Labetalol Hydrochlrd 200Mg Tab 259 Other Pharmacy $37.00 902288 Labetalol Hydrochlrd 300Mg Tab 259 Other Pharmacy $47.00 902289 Lactase 3000 Unit Tab 259 Other Pharmacy $10.00 902293 Lactobacills(Acidph Blg)1GmPkt 259 Other Pharmacy $15.00

902294 LACTULOSE SYRP 259 Other Pharmacy $27.00

902299 Leucovorin Calcium 5 Mg Tab 259 Other Pharmacy $36.00

902300 Leucovorin Calcium 25 Mg Tab 259 Other Pharmacy $171.00

902310 Oxycdn Hcl/Acetmnphn 10/325Tab 259 Other Pharmacy $61.00

902313 Lamotrigine 100 Mg Tab 259 Other Pharmacy $61.00

902314 Lamotrigine 25 Mg Tab 259 Other Pharmacy $67.00

902315 Levothyroxine 125 Mcg Tablet 259 Other Pharmacy $13.00

902319 Levothyroxine 25 Mcg Tablet 259 Other Pharmacy $13.00

902320 Levothyroxine 75 Mcg Tablet 259 Other Pharmacy $13.00 902322 Levothyroxine 50 Mcg Tablet 259 Other Pharmacy $13.00 902323 Levothyroxine 112 Mcg Tablet 259 Other Pharmacy $10.00 902325 Levothyroxine 150 Mcg Tablet 259 Other Pharmacy $13.00 902326 Levothyroxine 100 Mcg Tablet 259 Other Pharmacy $13.00 902332 Lithium Carbonate 300 Mg Cap 259 Other Pharmacy $21.00 902334 Lithium Carbonate 300 Mg Srtab 259 Other Pharmacy $22.00

902337 Lithium Carbonate 450 Mg Srtab 259 Other Pharmacy $22.00

902338 Lithium Citrate 300Mg/5 Ml Udl 259 Other Pharmacy $23.00

902345 Lidocaine Hcl 5% 35 Gm Oint 259 Other Pharmacy $306.00

37 902348 Lidocaine 1 Ea Ptch 259 Other Pharmacy $79.00 902368 Lisinopril 2.5 Mg Tab 259 Other Pharmacy $13.00 902369 Fish Oil/Dha/Epa 1000 Mg Cap 259 Other Pharmacy $20.00 902370 Lisinopril 5 Mg Tab 259 Other Pharmacy $13.00

902371 Atorvastatin Calcium 80 Mg Tab 259 Other Pharmacy $62.00

902372 Lisinopril 10 Mg Tab 259 Other Pharmacy $15.00

902374 Lisinopril 20 Mg Tab 259 Other Pharmacy $23.00

902375 Atorvastatin Calcium 40 Mg Tab 259 Other Pharmacy $62.00

902376 Atorvastatin Calcium 10 Mg Tab 259 Other Pharmacy $50.00

902377 Atorvastatin Calcium 20 Mg Tab 259 Other Pharmacy $62.00

902378 Levofloxacin 500 Mg Tab 259 Other Pharmacy $248.00

902379 Levofloxacin 750 Mg Tab 259 Other Pharmacy $274.00 902380 Levofloxacin 250 Mg Tab 259 Other Pharmacy $93.00 902386 Rosuvastatin Calcium 5 Mg Tab 259 Other Pharmacy $50.00 902387 Rosuvastatin Calcium 10 Mg Tab 259 Other Pharmacy $50.00 902388 Rosuvastatin Calcium 20 Mg Tab 259 Other Pharmacy $50.00 902390 Loperamide Hcl 2 Mg Cap 259 Other Pharmacy $38.00 902397 AmphtAsp/Ampht/D-Ampht 10MgTab 259 Other Pharmacy $47.00

902398 Lorazepam 0.5 Mg Tab 259 Other Pharmacy $36.00

902399 Lorazepam 1 Mg Tab 259 Other Pharmacy $77.00

902400 LORAZEPAM 2MG/ML ORAL 259 Other Pharmacy $77.00

902401 Hydrocodone Bit/Acet 5/325 Tab 259 Other Pharmacy $38.00

902402 Hydrocodone Bit/Act 7.5/325Tab 259 Other Pharmacy $37.00

902403 Hydrocodone Bit/Acet 10/325Tab 259 Other Pharmacy $27.00

902404 Lovastatin 20 Mg Tab 259 Other Pharmacy $19.00

902405 Hydrcdn Bit/Act7.5/325 15MlSln 259 Other Pharmacy $83.00 902407 Loxapine Succinate 5 Mg Cap 259 Other Pharmacy $19.00 902410 Lubriderm Lotion 300Ml 259 Other Pharmacy $38.00 902416 Milk Of Mag 30Ml 259 Other Pharmacy $4.00 902417 Magnesium Chloride 64 Mg Tab 259 Other Pharmacy $5.00 902418 Magnesium Oxide 400 Mg Tablet 259 Other Pharmacy $13.00 902420 Pioglitazone 45 Mg Tab 259 Other Pharmacy $117.00

902431 MAXITROL-OPTH OINT 259 Other Pharmacy $291.00

902444 Meclizine Hydrochlrd 12.5MgTab 259 Other Pharmacy $26.00

902446 Medroxyprogestern Acet 10MgTab 259 Other Pharmacy $19.00

902449 Medroxyprogester Acet 2.5MgTab 259 Other Pharmacy $13.00

902450 Norethindrone Ac(Prog) 5Mg Tab 259 Other Pharmacy $43.00

902452 Megestrol Acetate 40 Mg Tab 259 Other Pharmacy $21.00

902453 Megestrol Acet 400Mg/10Ml Udl 259 Other Pharmacy $120.00

902462 Fleets 259 Other Pharmacy $13.00

902469 Mesalamine 1000 Mg Supp.Rect 259 Other Pharmacy $91.00 902479 Methazolamide 50 Mg Tab 259 Other Pharmacy $19.00 902482 Methylergonovine Malt 0.2MgTab 259 Other Pharmacy $38.00 902488 Methylphenidate Hcl 5 Mg Tab 259 Other Pharmacy $36.00 902490 Metronidz 70Gm/Tube0.75% Vggel 259 Other Pharmacy $459.00 902495 Methocarbamol 500 Mg Tab 259 Other Pharmacy $36.00 902497 Methocarbamol 750 Mg Tab 259 Other Pharmacy $62.00

902500 Methotrexate 2.5 Mg Tab 259 Other Pharmacy $42.00

902504 Cyclosporine. 0.05% Droperette 259 Other Pharmacy $21.00

902505 Mexiletine Hcl 200 Mg Cap 259 Other Pharmacy $119.00

38 902507 Mexiletine Hcl 150 Mg Cap 259 Other Pharmacy $90.00 902508 Pramipexole Di-Hcl 0.125Mg Tab 259 Other Pharmacy $43.00 902510 Pramipexole Di-Hcl 1 Mg Tab 259 Other Pharmacy $46.00 902511 Pramipexole Di-Hcl 0.5 Mg Tab 259 Other Pharmacy $46.00

902512 Polyethyln Glycl 3350 17Gm Pkt 259 Other Pharmacy $66.00

902514 Lansoprazole 30 Mg Tab.Rap.Dr 259 Other Pharmacy $59.00

902515 Metoprolol 100MG Tab 259 Other Pharmacy $589.00

902521 Methyldopa 250 Mg Tab 259 Other Pharmacy $19.00

902523 Methylprednisolone 4 Mg Tab 259 Other Pharmacy $38.00

902524 Methylprednisolone 16 Mg Tab 259 Other Pharmacy $83.00

902525 Tamoxifen Citrate 10 Mg Tab 259 Other Pharmacy $37.00

902528 Exemestane 25 Mg Tablet 259 Other Pharmacy $104.00 902529 Metoclopramide Hcl 10 Mg Tab 259 Other Pharmacy $27.00 902535 Metoclopram Hcl 10Mg/10MlUdcup 259 Other Pharmacy $38.00 902537 Febuxostat 40 Mg Tablet 259 Other Pharmacy $56.00 902538 Metoclopramide Hcl 5 Mg Tab 259 Other Pharmacy $27.00 902539 Metolazone 2.5 Mg Tab 259 Other Pharmacy $13.00 902540 Metolazone 5 Mg Tab 259 Other Pharmacy $13.00

902542 Metoprolol 25 Mg Tab 259 Other Pharmacy $21.00

902543 Metoprolol 25 MG Tab 259 Other Pharmacy $21.00

902544 Metoprolol Tartrate 50 Mg Tab 259 Other Pharmacy $21.00

902545 Metoprolol Tartrate 100 Mg Tab 259 Other Pharmacy $21.00

902546 Metronidazole 500 Mg Tab 259 Other Pharmacy $22.00

902547 Metronidazole 250 Mg Tab 259 Other Pharmacy $15.00

902548 METRONIDAZOLE ORAL SUS 259 Other Pharmacy $37.00

902549 Nitazoxanide 500 Mg Tab 259 Other Pharmacy $153.00 902558 Mineral Oil (Lax) 30 Ml Udl 259 Other Pharmacy $5.00 902559 MinrlOil (AsSolvn) 25Ml/BtlLiq 259 Other Pharmacy $56.00 902564 Minoxidil 2.5 Mg Tab 259 Other Pharmacy $21.00 902565 Minoxidil 10 Mg Tab 259 Other Pharmacy $21.00 902568 Misoprostol 100 Mcg Tab 259 Other Pharmacy $36.00 902578 Morphine Sulfate 15 Mg Irtab 259 Other Pharmacy $36.00

902579 Morphine Sulfate 15 Mg Srtab 259 Other Pharmacy $37.00

902580 Morphine Sulfate 30 Mg Srtab 259 Other Pharmacy $62.00

902581 Morphine Sulfate 100 Mg Srtab 259 Other Pharmacy $73.00

902590 Morphine Sulfat 10Mg/0.5Ml Udl 259 Other Pharmacy $38.00

902591 Morphine Sulfate 10 Mg/5Ml Udl 259 Other Pharmacy $40.00

902598 Sodim Chlor (Ophth) 5% 15Mlbot 259 Other Pharmacy $347.00

902617 Naproxen 250 Mg Tab 259 Other Pharmacy $50.00

902624 Tacrolimus Anhydrous 0.5Mg Cap 259 Other Pharmacy $34.00

902625 Tacrolimus Anhydrous 1 Mg Cap 259 Other Pharmacy $26.00 902626 Neomycin Sulfate 500 Mg Tab 259 Other Pharmacy $21.00 902640 Zonisamide 100 Mg Cap 259 Other Pharmacy $52.00 902641 Gabapentin 300 Mg Cap 259 Other Pharmacy $23.00 902642 Gabapentin 400 Mg Cap 259 Other Pharmacy $48.00 902643 Gabapentin 100 Mg Cap 259 Other Pharmacy $15.00 902646 Lubiprostone 8 Mcg Capsule 259 Other Pharmacy $50.00

902647 Lubiprostone 24 Mcg Capsule 259 Other Pharmacy $52.00

902648 Pregabalin 25 Mg Cap 259 Other Pharmacy $40.00

902649 Pregabalin 50 Mg Cap 259 Other Pharmacy $40.00

39 902650 Pregabalin 75 Mg Cap 259 Other Pharmacy $40.00 902652 PREGABALIN 150 MG CAP 259 Other Pharmacy $40.00 902656 Nicotine 7 Mg Ptch 259 Other Pharmacy $108.00 902657 Nicotine 21 Mg Ptch 259 Other Pharmacy $117.00

902659 Nicotine 14 Mg Ptch 259 Other Pharmacy $119.00

902664 Niacin 50 Mg Tab 259 Other Pharmacy $13.00

902666 Niacin 500 Mg Cap.Sa 259 Other Pharmacy $35.00

902670 Nifedipine 10 Mg Cap 259 Other Pharmacy $27.00

902672 Nifedipine 60 Mg Srtab 259 Other Pharmacy $83.00

902673 Nifedipine 90 Mg Srtab 259 Other Pharmacy $83.00

902674 Nimodipine 30 Mg Cap 259 Other Pharmacy $167.00

902675 Nitrofurant Macrcrystl 50MgCap 259 Other Pharmacy $37.00 902676 Nitrofrntn/Ntrfrn Mc 100Mg Cap 259 Other Pharmacy $21.00 902677 NITROFURANTOIN SUSP 259 Other Pharmacy $38.00 902679 Ketoconazole 2% 120 Ml Shmp 259 Other Pharmacy $139.00 902687 Nortriptyline Hcl 10 Mg Cap 259 Other Pharmacy $19.00 902688 Nortriptyline Hcl 25 Mg Cap 259 Other Pharmacy $19.00 902689 Amlodipine Besylate 5 Mg Tab 259 Other Pharmacy $19.00

902690 Amlodipine Besylate 2.5 Mg Tab 259 Other Pharmacy $19.00

902691 Amlodipine Besylate 10 Mg Tab 259 Other Pharmacy $19.00

902693 Nitroglycerin 2.5 Mg Srcap 259 Other Pharmacy $26.00

902696 Nitroglycerin 0.1 Mg/Hr Ptch 259 Other Pharmacy $37.00

902697 Nitroglycerin 0.2 Mg/Hr Ptch 259 Other Pharmacy $40.00

902698 Nitroglycerin 0.4 Mg/Hr Ptch 259 Other Pharmacy $47.00

902703 Nitroglycerin 1 In/Udtube Oint 259 Other Pharmacy $37.00

902704 Nitroglycerin 0.6 Mg/Hr Ptch 259 Other Pharmacy $63.00 902706 Nitroglycerin 0.4 Mg Tab.Sl 259 Other Pharmacy $22.00 902717 Nystatn 500000 Un/5Ml Orl.Sus 259 Other Pharmacy $21.00 902719 "Nystatin 100,000 Unit/Ml Udl" 259 Other Pharmacy $7.00 902721 Nystatin 15 Gm/Tube Oint 259 Other Pharmacy $84.00 902723 Nystatin 15 Gm Crm 259 Other Pharmacy $129.00 902726 Nystatin 15 Gm Pwdr 259 Other Pharmacy $243.00

902736 Opium/Belldnn Alkalds 30MgSupp 259 Other Pharmacy $77.00

902752 Oxazepam 10 Mg Cap 259 Other Pharmacy $36.00

902753 Oxazepam 15 Mg Cap 259 Other Pharmacy $36.00

902757 Oxybutynin Chloride 5 Mg Tab 259 Other Pharmacy $21.00

902759 Cinacalcet Hcl 30 Mg Tab 259 Other Pharmacy $98.00

902760 Oxcarbazepine 150 Mg Tab 259 Other Pharmacy $37.00

902761 Oxcarbazepine 300 Mg Tab 259 Other Pharmacy $52.00

902763 Oxycodon Hcl Sr 10MgTab.Er.12H 259 Other Pharmacy $59.00

902764 Oxycodn Hcl Sr 40Mg Tab.Er.12H 259 Other Pharmacy $93.00 902766 Oxycodon Hcl Sr 80MgTab.Er.12H 259 Other Pharmacy $140.00 902771 Paroxetine Hcl 20 Mg Tab 259 Other Pharmacy $67.00 902772 Paroxetin Hcl 12.5MgTab.Sr.24H 259 Other Pharmacy $62.00 902779 Oxycodn Hcl/Acetamin 5/325Tab 259 Other Pharmacy $61.00 902780 Oxymetazol Hydrochlr 0.05%Nasp 259 Other Pharmacy $36.00 902794 Amylase/Lipase/Protes 1EaCapDr 259 Other Pharmacy $26.00

902796 PANCRELIPASE EX CAP 259 Other Pharmacy $15.00

902798 Pantoprazole 40Mg Tab 259 Other Pharmacy $13.00

902801 Pantoprzl Sod 40Mg/Pkt Grn.Pck 259 Other Pharmacy $40.00

40 902805 Penicillin V Potassim 500MgTab 259 Other Pharmacy $36.00 902815 Pentoxifylline 400 Mg Tab 259 Other Pharmacy $13.00 902816 Chlorhexidn Gluconat 15Ml Mwsh 259 Other Pharmacy $21.00 902818 Perphenazine 2 Mg Tab 259 Other Pharmacy $13.00

902821 Phenazopyridine Hcl 100 Mg Tab 259 Other Pharmacy $38.00

902822 Phenazopyridine Hcl 200 Mg Tab 259 Other Pharmacy $38.00

902823 Chloraseptic Liquid 6O 259 Other Pharmacy $26.00

902824 Menthol/Phenol 1 - Loz 259 Other Pharmacy $4.00

902825 Phenobarbital 32.4 Mg Tablet 259 Other Pharmacy $36.00

902826 Phenobarbital 97.2 Mg Tablet 259 Other Pharmacy $25.00

902829 Hydrocortis Acet 2.5%Rectalcrm 259 Other Pharmacy $295.00

902835 Calamine 177 Ml/Btl Lot 259 Other Pharmacy $13.00 902837 Bosentan 62.5 Mg Tab 259 Other Pharmacy $457.00 902841 Phenylephrn Hcl 0.5% 15Ml Nasp 259 Other Pharmacy $26.00 902842 Phenylephrine Hcl 1% 15Ml Nasp 259 Other Pharmacy $27.00 902849 Phenytoin 50 Mg Chwt 259 Other Pharmacy $32.00 902853 Oxycodone Hcl 30 Mg Irtab 259 Other Pharmacy $67.00 902855 Phenytoin Sodium Extnd 30MgCap 259 Other Pharmacy $19.00

902856 Phenytoin Sod Extend 100MgCap 259 Other Pharmacy $15.00

902859 Phytonadione 5 Mg Tab 259 Other Pharmacy $248.00

902863 Varenicline Tartrate 0.5Mg Tab 259 Other Pharmacy $42.00

902893 Clopidogrel Bisulfate 75Mg Tab 259 Other Pharmacy $37.00

902896 Clopidogrel Bisulfat 300Mg Tab 259 Other Pharmacy $148.00

902897 Prasugrel Hydrochlorid 10MgTab 259 Other Pharmacy $67.00

902898 Cilostazol 100 Mg Tab 259 Other Pharmacy $23.00

902901 Bacitrcn/Polymyxn B Sulf15GmOn 259 Other Pharmacy $259.00 902918 Calcium Polycarbophl 625Mg Tab 259 Other Pharmacy $5.00 902926 Polymyxin B Sulf/Tmp 10MlOpsol 259 Other Pharmacy $277.00 902928 Multivit/Iron Drops 259 Other Pharmacy $11.00 902929 MULTIVIT ORAL LIQ 259 Other Pharmacy $4.00 902931 Potassium Chloride 10Meq Srcap 259 Other Pharmacy $15.00 902932 Potassium Chloride 20Meq Srtab 259 Other Pharmacy $15.00

902937 Potass Chlor 10% 20Meq/15MlUdl 259 Other Pharmacy $20.00

902944 Acarbose 50 Mg Tab 259 Other Pharmacy $20.00

902946 Repaglinide 1 Mg Tab 259 Other Pharmacy $37.00

902950 Nateglinide 60 Mg Tab 259 Other Pharmacy $37.00

902951 Pravastatin Sodium 10 Mg Tab 259 Other Pharmacy $61.00

902952 Pravastatin Sodium 40 Mg Tab 259 Other Pharmacy $69.00

902954 Alfuzosin Hcl 10 Mg Tab.Sr.24H 259 Other Pharmacy $40.00

902956 Prazosin Hcl 1 Mg Cap 259 Other Pharmacy $13.00

902957 Prazosin Hcl 5 Mg Cap 259 Other Pharmacy $19.00 902971 Prednisone 1 Mg Tab 259 Other Pharmacy $13.00 902972 Prednisone 2.5 Mg Tab 259 Other Pharmacy $20.00 902973 Prednisone 5 Mg Tab 259 Other Pharmacy $20.00 902974 Prednisone 10 Mg Tab 259 Other Pharmacy $19.00 902976 Budesonide 3 Mg Cap.Sr.24H 259 Other Pharmacy $47.00 902977 Prednisone 20 Mg Tab 259 Other Pharmacy $32.00

902978 Midodrine Hcl 2.5 Mg Tab 259 Other Pharmacy $47.00

902989 Omeprazole 20 Mg Cap 259 Other Pharmacy $117.00

902990 Primidone 250 Mg Tab 259 Other Pharmacy $13.00

41 902992 Primidone 50 Mg Tab 259 Other Pharmacy $13.00 902993 Midodrine Hcl 5 Mg Tab 259 Other Pharmacy $59.00 902996 Probenecid 500 Mg Tab 259 Other Pharmacy $15.00 902998 Prochlorperazn Malte 25Mg Supp 259 Other Pharmacy $104.00

903000 Prochlorperazine Maleat 5MgTab 259 Other Pharmacy $27.00

903007 Promethazine Hcl 12.5 Mg Tab 259 Other Pharmacy $37.00

903008 Promethazine Hcl 25 Mg Tab 259 Other Pharmacy $36.00

903010 Promethazine Hcl 12.5 Mg Supp 259 Other Pharmacy $99.00

903020 Propafenone Hcl 150 Mg Tab 259 Other Pharmacy $21.00

903021 Propafenn Hcl 225Mg Cap.Sr.12H 259 Other Pharmacy $67.00

903022 Propafenn Hcl 325Mg Cap.Sr.12H 259 Other Pharmacy $83.00

903027 Propranolol Hydrochlrd 10MgTab 259 Other Pharmacy $15.00 903028 Propranolol Hydrochlor 20MgTab 259 Other Pharmacy $20.00 903029 Propranolol Hydrochlrd 40MgTab 259 Other Pharmacy $22.00 903036 Propylthiouracil 50 Mg Tab 259 Other Pharmacy $21.00 903037 Finasteride 5 Mg Tab 259 Other Pharmacy $23.00 903045 Modafinil 100 Mg Tab 259 Other Pharmacy $134.00 903048 Pseudoephedrine Hcl 30 Mg Tab 259 Other Pharmacy $5.00

903051 Mercaptopurine 50 Mg Tab 259 Other Pharmacy $21.00

903053 Pyrazinamide 500 Mg Tab 259 Other Pharmacy $38.00

903054 Pyridostigmine Bromide 60MgTab 259 Other Pharmacy $15.00

903055 Pyridoxine Hcl 50 Mg Tab 259 Other Pharmacy $11.00

903057 Pyridostigmn Bromd 180Mgtab.Sa 259 Other Pharmacy $32.00

903061 Quinidine Sulfate 300 Mg Tab 259 Other Pharmacy $19.00

903062 Quinidine Gluconate 324MgSrtab 259 Other Pharmacy $19.00

903067 Ramipril 1.25 Mg Cap 259 Other Pharmacy $20.00 903068 Ramipril 2.5 Mg Cap 259 Other Pharmacy $26.00 903069 Ramipril 10 Mg Cap 259 Other Pharmacy $43.00 903070 Rifaximin 200 Mg Tab 259 Other Pharmacy $51.00 903074 Ranitidine Hydrochlor 150MgTab 259 Other Pharmacy $19.00 903075 Tizanidine Hcl 4 Mg Tab 259 Other Pharmacy $47.00 903076 Tizanidine Hcl 2 Mg Tab 259 Other Pharmacy $39.00

903087 SEVELAMER CARB 800MG P 259 Other Pharmacy $59.00

903089 Sevelamer Carbonate 800 Mg Tab 259 Other Pharmacy $40.00

903091 Ropinirole Hcl 0.25 Mg Tab 259 Other Pharmacy $40.00

903092 Ropinirole Hcl 1 Mg Tab 259 Other Pharmacy $40.00

903093 Ropinirole Hcl 2 Mg Tab 259 Other Pharmacy $40.00

903095 Nabumetone 500 Mg Tab 259 Other Pharmacy $22.00

903096 Rifampin 300 Mg Cap 259 Other Pharmacy $50.00

903100 Rifabutin 150 Mg Cap 259 Other Pharmacy $102.00

903108 Risperidone 0.25 Mg Tab 259 Other Pharmacy $43.00 903109 Risperidone 0.5 Mg Tab 259 Other Pharmacy $43.00 903111 Risperidone 1 Mg Tab 259 Other Pharmacy $43.00 903116 Glycopyrrolate 1 Mg Tab 259 Other Pharmacy $38.00 903117 Oxycodone Hcl 5 Mg/5 Ml Soln 259 Other Pharmacy $61.00 903121 Calcitriol 0.25 Mcg Cap 259 Other Pharmacy $19.00 903124 Sodium Chloride 1 Spray Nasp 259 Other Pharmacy $73.00

903131 Scopolamine Hydrobrm 1.5MgPtch 259 Other Pharmacy $181.00

903137 Pilocarpine Hcl 5 Mg Tab 259 Other Pharmacy $21.00

903138 Galantamine Hydrobromd 4Mg Tab 259 Other Pharmacy $64.00

42 903140 GALANTAMINE 8 MG TAB 259 Other Pharmacy $64.00 903144 Senna/Docusate Sodium 1 Ea Tab 259 Other Pharmacy $5.00 903149 Sertraline Hcl 50 Mg Tab 259 Other Pharmacy $59.00 903150 Sertraline Hcl 25 Mg Tab 259 Other Pharmacy $48.00

903151 Ziprasidone Hcl 20 Mg Cap 259 Other Pharmacy $78.00

903155 Aripiprazole 5 Mg Tab 259 Other Pharmacy $126.00

903157 ZIPRASIDONE 40 MG CAP 259 Other Pharmacy $78.00

903158 Aripiprazole 10 Mg Tab 259 Other Pharmacy $126.00

903164 Silver Sulfadiazine 1% Gm Crm 259 Other Pharmacy $228.00

903167 Silver Sulfadiazn 1% 400Gm Jar 259 Other Pharmacy $281.00

903168 Simethicone 80 Mg Chewtab 259 Other Pharmacy $4.00

903169 Simethicone 40Mg/0.6Ml 30Mlbot 259 Other Pharmacy $67.00 903172 Montelukast Sodim 5Mg Tab.Chew 259 Other Pharmacy $38.00 903174 Montelukast Sodium 10 Mg Tab 259 Other Pharmacy $36.00 903176 Sodium Bicarbont(Alk) 325MgTab 259 Other Pharmacy $7.00 903177 Sodium Bicarbont(Alk) 650MgTab 259 Other Pharmacy $7.00 903188 Dakn(1/2StrSln)16Oz/Btl0.25%Ir 259 Other Pharmacy $124.00 903190 DAKINS SOL 0.5 480 ML 259 Other Pharmacy $124.00

903195 Sorbitol Solution 30 Ml Udcup 259 Other Pharmacy $26.00

903196 Itraconazole 100 Mg Cap 259 Other Pharmacy $77.00

903201 Spironolactone 25 Mg Tab 259 Other Pharmacy $20.00

903204 Spironolactone 100 Mg Tab 259 Other Pharmacy $26.00

903207 SodPolystyrnSulfnt15Gm/60MlBtl 259 Other Pharmacy $57.00

903210 Sucralfate 1 Gm Tab 259 Other Pharmacy $22.00

903211 Sucralfate 1 Gm/10 Ml Udl 259 Other Pharmacy $38.00

903213 Nisoldipine 8.5 Mg Tab.Sr.24H 259 Other Pharmacy $27.00 903217 Sulfamethxzl/Trimethprm20MlUdl 259 Other Pharmacy $40.00 903222 Sulfasalazine 500 Mg Ectab 259 Other Pharmacy $22.00 903223 Balsalazide 750 Mg Cap 259 Other Pharmacy $37.00 903224 Sulfadiazine 500 Mg Tab 259 Other Pharmacy $26.00 903225 Sulindac 150 Mg Tab 259 Other Pharmacy $37.00 903226 Sulindac 200 Mg Tab 259 Other Pharmacy $37.00

903230 Efavirenz 200 Mg Capsule 259 Other Pharmacy $67.00

903231 Atazanavir Sulfate 200 Mg Cap 259 Other Pharmacy $152.00

903232 Atazanavir Sulfate 150 Mg Cap 259 Other Pharmacy $152.00

903242 Flecainide Acetate 100 Mg Tab 259 Other Pharmacy $32.00

903243 Flecainide Acetate 50 Mg Tab 259 Other Pharmacy $26.00

903244 Oseltamivir Phosphate 75Mg Cap 259 Other Pharmacy $104.00

903246 Methimazole 5 Mg Tab 259 Other Pharmacy $22.00

903250 Temazepam 15 Mg Cap 259 Other Pharmacy $38.00

903253 Propyln Glycol/Mo 90Ml/Btl Lot 259 Other Pharmacy $186.00 903263 Terbutaline Sulfate 2.5 Mg Tab 259 Other Pharmacy $27.00 903276 Rasagiline Mesylate 1 Mg Tab 259 Other Pharmacy $79.00 903282 Tetracycline Hcl 250 Mg Cap 259 Other Pharmacy $19.00 903283 Chlorprocaine 30 Ml Inj 259 Other Pharmacy $173.00 903286 Tetrhydrzln Hcl 0.05% 15MlOpsl 259 Other Pharmacy $21.00 903287 Theophyllin Anhydrs 100MgSrtab 259 Other Pharmacy $13.00

903288 Theophyllin Anhydrs 200MgSrtab 259 Other Pharmacy $13.00

903289 Theophyllin Anhydrs 300MgSrtab 259 Other Pharmacy $10.00

903292 ThphyllnAnhydr200Mg Cap.Sr.24H 259 Other Pharmacy $26.00

43 903299 Thioridazine Hcl 10 Mg Tab 259 Other Pharmacy $32.00 903302 Thioridazine Hcl 50 Mg Tab 259 Other Pharmacy $37.00 903303 Thiothixene 2 Mg Cap 259 Other Pharmacy $19.00 903304 Thiothixene 5 Mg Cap 259 Other Pharmacy $19.00

903314 Timolol Maleate 0.5% 5Ml Opsol 259 Other Pharmacy $120.00

903316 Timolol Maleate 0.25% 5Ml Opsl 259 Other Pharmacy $83.00

903329 Topiramate 100 Mg Tab 259 Other Pharmacy $87.00

903330 Topiramate 25 Mg Tab 259 Other Pharmacy $56.00

903332 Ketorolac Tromethamin 10Mg Tab 259 Other Pharmacy $27.00

903343 Triamcinolone Acetond 5Gm Pste 259 Other Pharmacy $73.00

903345 Triamcinln Aceton 0.1% 15GmCrm 259 Other Pharmacy $129.00

903346 TRIAMCINOLONE 80 GM CR 259 Other Pharmacy $259.00 903348 Triamcinln Actnd 0.1% 454GmCrm 259 Other Pharmacy $105.00 903352 Nystatin/Triamcn 15Gm/Tube Crm 259 Other Pharmacy $371.00 903355 Hctz/Triamterene 25/37 259 Other Pharmacy $21.00 903356 Fenofibrate 54 Mg Tab 259 Other Pharmacy $32.00 903357 Fenofibrate 160 Mg Tab 259 Other Pharmacy $77.00 903362 Colesevelam 625 Mg Tab 259 Other Pharmacy $37.00

903363 Trifluoperazine Hcl 1 Mg Tab 259 Other Pharmacy $37.00

903364 Trihexyphenidyl Hcl 2 Mg Tab 259 Other Pharmacy $25.00

903367 Trimethoprim 100 Mg Tab 259 Other Pharmacy $13.00

903368 Sulfamethxzl/Trimethprm 1EaTab 259 Other Pharmacy $26.00

903369 Sulfamethoxazl/TrimethprmDsTab 259 Other Pharmacy $37.00

903370 Quetiapine Fumarate 25 Mg Tab 259 Other Pharmacy $52.00

903371 Quetiapine Fumarate 100 Mg Tab 259 Other Pharmacy $67.00

903372 Trinsicon Cap 259 Other Pharmacy $21.00 903378 Theophyllin Anhydrs 400MgSrtab 259 Other Pharmacy $10.00 903379 Moexipril Hcl 7.5 Mg Tab 259 Other Pharmacy $20.00 903382 URSODIOL 250 MG TAB 259 Other Pharmacy $37.00 903383 Valproic Acid 250 Mg/5 Ml Udl 259 Other Pharmacy $21.00 903384 Divalproex Sodium 500 Mg Ectab 259 Other Pharmacy $21.00 903386 Divalproex Sod 250MgTab.Sr.24H 259 Other Pharmacy $25.00

903388 Valacyclovir Hcl 500 Mg Tab 259 Other Pharmacy $40.00

903396 Verapamil Hcl 180 Mg Srtab 259 Other Pharmacy $19.00

903397 Verapamil Hcl 240 Mg Srtab 259 Other Pharmacy $19.00

903398 Verapamil Hcl 40 Mg Tab 259 Other Pharmacy $10.00

903399 Verapamil Hcl 80 Mg Tab 259 Other Pharmacy $13.00

903400 Verapamil Hcl 120 Mg Tab 259 Other Pharmacy $13.00

903407 Latanoprost 0.005% 2.5Ml Opsl 259 Other Pharmacy $383.00

903412 "Cyanocobalamin 1,000 Mcg Tab" 259 Other Pharmacy $11.00

903416 Rivastigmine Tartrate 1.5MgCap 259 Other Pharmacy $56.00 903419 Warfarin Sodium 1 Mg Tab 259 Other Pharmacy $21.00 903420 Warfarin Sodium 2 Mg Tab 259 Other Pharmacy $21.00 903421 Warfarin Sodium 3 Mg Tab 259 Other Pharmacy $21.00 903424 Warfarin Sodium 2.5 Mg Tab 259 Other Pharmacy $21.00 903427 Warfarin Sodium 5 Mg Tab 259 Other Pharmacy $12.00 903428 Warfarin Sodium 7.5 Mg Tab 259 Other Pharmacy $20.00

903429 Warfarin Sodium 10 Mg Tab 259 Other Pharmacy $20.00

903430 Bupropion Hcl 75 Mg Tab 259 Other Pharmacy $19.00

903431 Bupropion Hcl 150Mg Tab.Sr.12H 259 Other Pharmacy $36.00

44 903432 Bupropion Hcl 100 Mg Tab 259 Other Pharmacy $21.00 903434 Bupropion Hcl 100Mg Tab.Sr.12H 259 Other Pharmacy $43.00 903444 PetrolatumWhite 30Gm/Tub Oint 259 Other Pharmacy $13.00 903446 Paricalcitol 1 Mcg Capsule 259 Other Pharmacy $84.00

903454 RanitidnHydrchlor150Mg/10MlUdl 259 Other Pharmacy $64.00

903463 Ramelteon 8 Mg Tablet 259 Other Pharmacy $50.00

903464 Eszopiclone 1 Mg Tablet 259 Other Pharmacy $59.00

903466 Zolpidem Tartrate 5 Mg Tab 259 Other Pharmacy $63.00

903467 Capsaicin 0.03% 60 Gm Crm 259 Other Pharmacy $107.00

903470 Zinc Sulfate 220 Mg Cap 259 Other Pharmacy $13.00

903476 Tenofvr Disprxl Fumrt 300MgTab 259 Other Pharmacy $170.00

903477 Zidovudine 100 Mg Cap 259 Other Pharmacy $66.00 903485 Teriparatd 20Mcg/Dse Disp.Syrg 259 Other Pharmacy $2,787.00 903487 Miconazole Nitrate 2 Oz Oint 259 Other Pharmacy $91.00 903488 Naproxen 125 Mg/5 Ml Susp 259 Other Pharmacy $15.00 903495 Cholecalciferol 400 IntUnt Tab 259 Other Pharmacy $21.00 903497 Cholecalcifrl 1000Intunit Tab 259 Other Pharmacy $11.00 903500 Desvnlfxn Succnt50MgTab.Sr.24H 259 Other Pharmacy $50.00

903501 Non-Formulary Med 259 Other Pharmacy $-

903512 METRONIDAZOLE 50MG SUS 259 Other Pharmacy $11.00

903516 Torsemide 10 Mg Tab 259 Other Pharmacy $13.00

903521 Amiloride Hcl 5 Mg Tablet 259 Other Pharmacy $21.00

903525 Estradiol 0.05 Mg Ptch 259 Other Pharmacy $99.00

903526 Testosterone 5 Gm Gel 259 Other Pharmacy $93.00

903529 Prednisone 50 Mg Tab 259 Other Pharmacy $38.00

903530 Ondansetron Hcl 2 Mg/2.5Ml Udl 259 Other Pharmacy $111.00 903533 Levetiracetam 500 Mg/5 Ml Udl 259 Other Pharmacy $52.00 903534 Morphine Sulfate 0.1 Mg/Ml Ml 259 Other Pharmacy $32.00 903538 Methadone Hcl 10 Mg/Ml Udl 259 Other Pharmacy $36.00 903539 Prednisone 5 Mg/Ml 30Mlbot 259 Other Pharmacy $292.00 903540 Methadone Hcl 5 Mg Tab 259 Other Pharmacy $36.00 903541 Dexamethasone 1.5 Mg Tab 259 Other Pharmacy $11.00

903542 Diazepam 5 Mg/5 Ml Udl 259 Other Pharmacy $37.00

903547 Dextran 70/Hp-M-Cell 1Drp Opsl 259 Other Pharmacy $21.00

903551 MOXIFLOXACIN 0.5% OPSO 259 Other Pharmacy $363.00

903554 Methenamine Hippurate 1 Gm Tab 259 Other Pharmacy $32.00

903556 Fesoterod Fumart 4MgTab.Sr.24H 259 Other Pharmacy $47.00

903557 Azithromycin 200 Mg/5 Ml Udl 259 Other Pharmacy $90.00

903558 Dofetilide 500 Mcg Capsule 259 Other Pharmacy $47.00

903559 Gabapentin 100 Mg/2 Ml Udl 259 Other Pharmacy $22.00

903561 Phenytoin 25 Mg/Ml Susp 259 Other Pharmacy $22.00 903567 Adalimumab 40 Mg/0.8 Ml Inj 259 Other Pharmacy $4,797.00 903568 Erythromycin Base 250 Mg Ectab 259 Other Pharmacy $23.00 903569 ErythrmycEthylscnt200Mg/5MlUdl 259 Other Pharmacy $13.00 903572 Riluzole 50 Mg Tablet 259 Other Pharmacy $126.00 903574 Oxcarbazepine 300 Mg/5 Ml Udl 259 Other Pharmacy $47.00 903575 Valsartan 160 Mg Tab 259 Other Pharmacy $50.00

903576 Mycophenolate Sod 180Mg tab.Dr 259 Other Pharmacy $40.00

903577 Mycophenolate Sod 360Mg tab.Dr 259 Other Pharmacy $40.00

903578 Imatinib Mesylate 100 Mg Tab 259 Other Pharmacy $215.00

45 903580 Valsartan 40 Mg Tab 259 Other Pharmacy $35.00 903581 Diclofenac Sodium 100 Mg Srtab 259 Other Pharmacy $91.00 903582 Deferasirox 500 Mg Tab.Disper 259 Other Pharmacy $282.00 903583 Rivastigmine 4.6 Mg Patch.Td24 259 Other Pharmacy $78.00

903584 Rivastigmine 9.5 Mg Patch.Td24 259 Other Pharmacy $78.00

903585 MOMETASONE 220 INH 259 Other Pharmacy $369.00

903586 Ribavirin 200 Mg Cap 259 Other Pharmacy $93.00

903587 Mometasn Furoat 110Mcg/PuffInh 259 Other Pharmacy $550.00

903590 Didanosine 200 Mg Capsule.Dr 259 Other Pharmacy $77.00

903596 Diflunisal 500 Mg Tab 259 Other Pharmacy $62.00

903603 Torsemide 5 Mg Tab 259 Other Pharmacy $22.00

903608 Desmopressin Acetate 0.1Mg Tab 259 Other Pharmacy $67.00 903609 Divalproex Sodium 125 Mg Ectab 259 Other Pharmacy $13.00 903615 Phenobarbital 10 Mg/2.5 Ml Ml 259 Other Pharmacy $32.00 903619 Sod Citrt (Alk)/Ca(Ir) 15MlUdl 259 Other Pharmacy $36.00 903620 Ranitidn Hydrochlor 15Mg/MlUdl 259 Other Pharmacy $20.00 903624 Lacosamide 50 Mg Tab 259 Other Pharmacy $63.00 903625 Lacosamide 100 Mg Tab 259 Other Pharmacy $83.00

903628 Isosorbide Dinitrate 5 Mg Tab 259 Other Pharmacy $11.00

903630 Risedronate Sodium 30 Mg Tab 259 Other Pharmacy $166.00

903632 Triamcinln Acetnd 0.1% 15GmOnt 259 Other Pharmacy $84.00

903633 Bacitracin 28 Gm/Tube Oint 259 Other Pharmacy $35.00

903634 Lanolin (Emoll) 1 Appl Tube 259 Other Pharmacy $47.00

903638 ERYTHROMYCIN 0.5% OPH 259 Other Pharmacy $42.00

903643 Repaglinide 0.5 Mg Tab 259 Other Pharmacy $37.00

903646 Famotidine 10 Mg Tab 259 Other Pharmacy $19.00 903647 Buspirone Hcl 10 Mg Tab 259 Other Pharmacy $19.00 903650 Lamivudine 100 Mg Tab 259 Other Pharmacy $84.00 903654 Propafenn Hcl 425Mg Cap.Sr.12H 259 Other Pharmacy $83.00 903655 Propafenone Hcl 225 Mg Tab 259 Other Pharmacy $37.00 903658 Aspirin/Buffers 325 Mg Tab 259 Other Pharmacy $4.00 903662 Reserpine 0.1 Mg Tab 259 Other Pharmacy $13.00

903663 Naltrexone Hcl 50 Mg Tab 259 Other Pharmacy $84.00

903665 Flutamide 125 Mg Cap 259 Other Pharmacy $21.00

903666 Candesartan Cilexetil 4 Mg Tab 259 Other Pharmacy $38.00

903675 Niacin 250 Mg Tab.Sa 259 Other Pharmacy $7.00

903679 Nitroglycerin 2% Oint 259 Other Pharmacy $67.00

903680 Benzocaine 0.5 ML Spray 259 Other Pharmacy $51.00

903681 Cetaphil Lotion 480Ml 259 Other Pharmacy $20.00

903682 Quetiapine Fumarate 200 Mg Tab 259 Other Pharmacy $67.00

903683 Quetiapn Fumart 50MgTab.Sr.24H 259 Other Pharmacy $52.00 903685 Quetipn Fumrt 300Mg Tab.Sr.24H 259 Other Pharmacy $96.00 903686 Rosuvastatin Calcium 40 Mg Tab 259 Other Pharmacy $50.00 903704 Sodium Chloride 3% 30 Ml Nasol 259 Other Pharmacy $79.00 903715 Nicardipine Hcl 20 Mg Cap 259 Other Pharmacy $19.00 903716 Nicardipine Hcl 30 Mg Cap 259 Other Pharmacy $19.00 903717 ESTRADIOL 0.0375 MG PT 259 Other Pharmacy $70.00

903718 Nitrofrntn Macrcrystl 100MgCap 259 Other Pharmacy $52.00

903720 Levetiracetam 250 Mg Tab 259 Other Pharmacy $43.00

903744 Vancomycin 500 Mg/5 Ml Udl 259 Other Pharmacy $83.00

46 903745 Vancomycin 250 Mg/2.5 Ml Udl 259 Other Pharmacy $50.00 903747 Sodium Chloride 1Gm Ta 259 Other Pharmacy $33.00 903772 Thyroid 30 Mg Tab 259 Other Pharmacy $19.00 903774 Nebivolol 5 Mg Tab 259 Other Pharmacy $36.00

903775 Milnacipran Hcl 25 Mg Tab 259 Other Pharmacy $32.00

903777 Memantine Hcl 5 Mg Tab 259 Other Pharmacy $47.00

903781 Hc Acetate/Lidocan Hcl 7GmCrm 259 Other Pharmacy $90.00

903795 MULTIVITAMIN W-IRON TA 259 Other Pharmacy $4.00

903802 Danazol 50 Mg Cap 259 Other Pharmacy $26.00

903804 Flavoxate Hcl 100 Mg Tab 259 Other Pharmacy $50.00

903808 Galntm Hydrbrmd 8Mg Cap24H.Pel 259 Other Pharmacy $83.00

903814 Perphenazine 8 Mg Tab 259 Other Pharmacy $13.00 903817 Bismuth Subsalicylate 30Ml Udl 259 Other Pharmacy $10.00 903820 Promethazine Hcl 50 Mg Supp 259 Other Pharmacy $139.00 903823 Mg Trslct/Alh/Nahc3/Aa1-Chwtab 259 Other Pharmacy $5.00 903827 Bethanechol Chloride 50 Mg Tab 259 Other Pharmacy $19.00 903829 Loperamide Hcl 1 Mg/7.5 Ml Udl 259 Other Pharmacy $15.00 903833 MultivitaminsTherapeutic Tab 259 Other Pharmacy $4.00

903836 Multivitamins 1 Each Chewtab 259 Other Pharmacy $5.00

903841 SIMETHICONE DOSE 259 Other Pharmacy $5.00

903842 Cholecalciferol 5000IntUnt Cap 259 Other Pharmacy $13.00

903844 SACCHAROMYCES BOUL PKT 259 Other Pharmacy $12.00

903845 Zinc Oxide/Panthenol/Vit E Crm 259 Other Pharmacy $26.00

903847 Lidocn/Epinephrn/Tetracn2MlTop 259 Other Pharmacy $73.00

903854 Silver Nitrate Appl. 1 Ea Stck 259 Other Pharmacy $12.00

903857 Efvrnz/EmtrctbTnfvr 1Unt.DsTab 259 Other Pharmacy $288.00 903865 Calcitriol 15 Mcg/15 Ml Soln 259 Other Pharmacy $828.00 903868 Torsemide 100 Mg Tab 259 Other Pharmacy $13.00 903871 Selegiline Hcl 5 Mg Tab 259 Other Pharmacy $67.00 903874 Zenpep 5000 Unit Cap 259 Other Pharmacy $13.00 903875 Zenpep 20000 Unit Cap 259 Other Pharmacy $35.00 903880 Ferric Subsulfate 30 Ml Soln 259 Other Pharmacy $54.00

903883 Bethanechol Chloride 5 Mg Tab 259 Other Pharmacy $10.00

903891 Pancrelipase 4 259 Other Pharmacy $13.00

903892 PANCRELIPASE 10 259 Other Pharmacy $23.00

903893 Pancrelipase 16 259 Other Pharmacy $29.00

903894 PANCRELIPASE 20 259 Other Pharmacy $43.00

903895 GalntmHydrbrmd 24Mg Cap24H.Pel 259 Other Pharmacy $83.00

903897 Topiramate 15 Mg Cap.Sprink 259 Other Pharmacy $37.00

903901 MiscElctrlytRplcmts60MlSpryBtl 259 Other Pharmacy $126.00

903902 Hydroxyzine Pamoate 25 Mg Cap 259 Other Pharmacy $37.00 903905 Chlordiazepoxide Hcl 10 Mg Cap 259 Other Pharmacy $36.00 903906 Megestrol Acetate 20 Mg Tab 259 Other Pharmacy $19.00 903907 Fluphenazine Hcl 1 Mg Tab 259 Other Pharmacy $13.00 903908 Trifluoperazine Hcl 5 Mg Tab 259 Other Pharmacy $22.00 903909 Prazosin Hcl 2 Mg Cap 259 Other Pharmacy $13.00 903910 Doxepin Hcl 75 Mg Cap 259 Other Pharmacy $22.00

903911 Baclofen 10 Mg/10 Ml Udl 259 Other Pharmacy $13.00

903912 Carbamazepine 100 Mg Chwt 259 Other Pharmacy $10.00

903918 Ergocalciferol 50000IntUntCap 259 Other Pharmacy $13.00

47 903920 Oxybutynin 3.9 Mg Patch.Tdbw 259 Other Pharmacy $120.00 903924 Mesalamine 500 Mg Capsule.Sa 259 Other Pharmacy $- 903925 Lanthanum Carb 500 Mg Tab.Chew 259 Other Pharmacy $47.00 903926 Mesalamine 1.2 Gm Tablet.Dr 259 Other Pharmacy $63.00

903929 Terazosin Hcl 5 Mg Cap 259 Other Pharmacy $19.00

903931 Glimepiride 1 Mg Tab 259 Other Pharmacy $13.00

903944 Doxercalciferol 0.5 Mcg Cap 259 Other Pharmacy $54.00

903945 Doxercalciferol 4 Mcg/2 Ml Amp 259 Other Pharmacy $186.00

903954 Colestipol Hcl 1 Gm Tab 259 Other Pharmacy $22.00

903955 AmxTr/PotssClavlnt400Mg/5MlUdl 259 Other Pharmacy $91.00

903956 Eplerenone 25 Mg Tab 259 Other Pharmacy $64.00

903959 Magnesium Gluconate 500 Mg Tab 259 Other Pharmacy $9.00 903962 Acetc Acd (A-Bac) 15Ml/BtlOtsl 259 Other Pharmacy $78.00 903967 Trazodone Hcl 100 Mg Tab 259 Other Pharmacy $87.00 903968 Cromolyn Sodium INH 259 Other Pharmacy $72.00 903969 Liothyronine Sodium 5 Mcg Tab 259 Other Pharmacy $22.00 903971 Diclofnc Epolmn 1Ptch Adh.Ptch 259 Other Pharmacy $276.00 903977 Ramipril 5 Mg Cap 259 Other Pharmacy $26.00

903982 Emtricitabine 200 Mg Cap 259 Other Pharmacy $119.00

903984 Donepezil Hcl 10 Mg Tab 259 Other Pharmacy $59.00

903987 Nelfinavir Mesylate 625 Mg Tab 259 Other Pharmacy $67.00

904068 Captopril 25 Mg Tab 259 Other Pharmacy $13.00

904109 Lactulose 200 GM/300ML 259 Other Pharmacy $102.00

904158 Hydroxyzine Pamoate 50 Mg Cap 259 Other Pharmacy $37.00

904161 Dornas Alfa2.5Mg/2.5Ml Inh.Sol 259 Other Pharmacy $309.00

904198 Cephalexin 250 Mg/5 Ml Udl 259 Other Pharmacy $20.00 904229 ZIPRASIDONE 80MG CAP 259 Other Pharmacy $78.00 904233 LITHIUM CARB CAP 150 M 259 Other Pharmacy $21.00 904249 DISOPYRAMIDE CAP 100 M 259 Other Pharmacy $10.00 904329 D5-0.2%NS KCL 20 MEQ 1L 259 Other Pharmacy $477.00 904348 Guaifnsn/D-MethrphnHb5Ml/UdSyr 259 Other Pharmacy $8.00 904399 Risperidone 2 Mg Tab 259 Other Pharmacy $43.00

904402 Valproic Acid 250 Mg Cap 259 Other Pharmacy $22.00

904404 FLUPHENAZINE TAB 5MG 259 Other Pharmacy $20.00

904405 Albuterol Sulfate 2 Mg Tab 259 Other Pharmacy $23.00

904480 CHLOPROMAZINE 100MG TA 259 Other Pharmacy $26.00

904492 Oxaprozin 600 Mg Tab 259 Other Pharmacy $61.00

904503 Lidocn(Anst)/PrilcHcl5Gm/TubCr 259 Other Pharmacy $84.00

904526 LOXAPINE 10MG CAP 259 Other Pharmacy $19.00

904605 ACETMN COD ELIXIR 259 Other Pharmacy $10.00

904613 Epinephrn 30Ml/Btl 1:1000 Soln 259 Other Pharmacy $262.00 904622 Ibuprofen 100Mg/5Ml 120Ml Susp 259 Other Pharmacy $56.00 904640 Vitamin A And D 2OzGm/Tub Oint 259 Other Pharmacy $21.00 904658 Albuterol Sulfater 5%20M 259 Other Pharmacy $51.00 904682 LANTHANUM CAR 1000MG T 259 Other Pharmacy $47.00 904699 GUAIFENESIN 300MG/15ML 259 Other Pharmacy $8.00 904771 Albuterol Neb UD 259 Other Pharmacy $5.00

904822 Polythyln Glycl 3350 238Gm Pwd 259 Other Pharmacy $99.00

904840 RISPERIDONE 3 MG TAB 259 Other Pharmacy $43.00

904863 ACETAMINOPHEN RS 259 Other Pharmacy $5.00

48 904876 Compound Oral/Topical 259 Other Pharmacy $339.00 904915 Atomoxetine Hcl 10 Mg Cap 259 Other Pharmacy $62.00 904916 Atomoxetine Hcl 18 Mg Cap 259 Other Pharmacy $62.00 904917 Olanzapine 10 Mg Tab 259 Other Pharmacy $67.00

904918 Olanzapine 5 Mg Tab.Disper 259 Other Pharmacy $102.00

904920 Insulin Lispro 100 Unts/Ml Inj 259 Other Pharmacy $47.00

904936 Tranylcypromine Sulfat 10MgTab 259 Other Pharmacy $26.00

904944 Diphenoxylat/Atrp Sulf 5Ml Liq 259 Other Pharmacy $15.00

904953 EstrogensConjugatd 0.45Mg Tab 259 Other Pharmacy $32.00

904956 Ziprasidone Hcl 60 Mg Cap 259 Other Pharmacy $73.00

904969 DILTIAZEM 100MG IV 259 Other Pharmacy $126.00

904982 CLOBETASOL 0.05% CRM 1 259 Other Pharmacy $33.00 904984 DOCOSANOL 10% CR 2GM 259 Other Pharmacy $102.00 904995 ZONISAMIDE 25 MG 259 Other Pharmacy $19.00 904996 OLANZAPINE/FLUOXET 3/2 259 Other Pharmacy $83.00 904997 OLANZAPINE/FLUOXET 6/2 259 Other Pharmacy $102.00 904998 OLANZAPINE/FLUOXET 12/ 259 Other Pharmacy $133.00 905035 RIVAROXABAN 20MG TAB 259 Other Pharmacy $63.00

905039 METFORMIN 750 MG SRTAB 259 Other Pharmacy $40.00

905040 FLUOCINONIDE .05% 15 G 259 Other Pharmacy $76.00

905041 FLUOCINONIDE.05% 15 G 259 Other Pharmacy $98.00

905042 FLUOCINONIDE .05% 60 G 259 Other Pharmacy $124.00

905043 VITAMIN B COMPLEX TAB 259 Other Pharmacy $7.00

905046 ROFLUMILASY 500 MCG TA 259 Other Pharmacy $61.00

905047 FELBAMATE 400 MG TAB 259 Other Pharmacy $44.00

905048 CLOBAZAM 10 MG TAB 259 Other Pharmacy $64.00 905049 CLOBAZAM 5 MG TAB 259 Other Pharmacy $44.00 905051 RIVASTIGMINE 3 MG CAP 259 Other Pharmacy $73.00 905052 VERAPAMIL 120 MG SRTAB 259 Other Pharmacy $13.00 905063 LEVETIRACETA 500MG/100 259 Other Pharmacy $383.00 905126 Mexiletine Hcl 250 Mg Cap 259 Other Pharmacy $129.00 905135 RILPIVIRINE 25MG TAB 259 Other Pharmacy $96.00

905154 KETOTIFEN OPTH 259 Other Pharmacy $63.00

905189 CyproheptdnHydrchlor2Mg/5MlSyr 259 Other Pharmacy $22.00

905191 Divalproex Sodium 250 Mg Ectab 259 Other Pharmacy $20.00

905201 Loratadine 5 Mg/5 Ml Udl 259 Other Pharmacy $15.00

905203 Misoprostol 200 Mcg Tab 259 Other Pharmacy $38.00

905206 Opium/Belladnn Alkalds 60MgSup 259 Other Pharmacy $79.00

905211 WARFARIN 0.5 MG TAB 259 Other Pharmacy $21.00

905232 THEOPHYLLINE 15ML ELIX 259 Other Pharmacy $13.00

905237 Zidovudine 10 Mg/Ml Udl 259 Other Pharmacy $13.00 905266 METOPROLOL 6.25MG SUS 259 Other Pharmacy $21.00 905282 Hypromellose 3.5 Gm Gel 259 Other Pharmacy $56.00 905285 Phenytoin 100 Mg/4 Ml Udl 259 Other Pharmacy $36.00 905291 Estradiol 0.025 Mg Ptch 259 Other Pharmacy $99.00 905296 Amoxapine 50 Mg Tab 259 Other Pharmacy $23.00 905298 DoxycycMonohyd25Mg/5Ml60MlSsp 259 Other Pharmacy $246.00

905300 Montelukast Sodim 4Mg Tab.Chew 259 Other Pharmacy $43.00

905304 Prednisolone 3 Mg/Ml Udl 259 Other Pharmacy $15.00

905308 Selegiline 6 Mg Patch 259 Other Pharmacy $130.00

49 905309 Carbidopa 25 Mg Tab 259 Other Pharmacy $42.00 905315 Rifampin 100Mg/10Ml 120Ml Susp 259 Other Pharmacy $324.00 905320 Atomoxetine Hcl 25 Mg Cap 259 Other Pharmacy $62.00 905323 Lamivudine 100 Mg/10 Ml Udl 259 Other Pharmacy $129.00

905324 Lurasidone Hcl 40 Mg Tab 259 Other Pharmacy $107.00

905326 Amoxicillin 250Mg/3.125 Ml Udl 259 Other Pharmacy $26.00

905328 Mycophnt Moftl 500Mg/2.5MlSusp 259 Other Pharmacy $47.00

905329 Armodafinil 50 Mg Tab 259 Other Pharmacy $66.00

905330 Silodosin 8 Mg Capsule 259 Other Pharmacy $57.00

905334 Lamotrigine 150 Mg Tab 259 Other Pharmacy $61.00

905337 Saxagliptin Hydrochlord 5MgTab 259 Other Pharmacy $66.00

905338 Prednisone 5 Mg/5 Ml Udl 259 Other Pharmacy $38.00 905340 Diphenhydram Hcl 12.5Mg/5MlUdl 259 Other Pharmacy $20.00 905343 Mupirocin 2% 22 Gm Oint 259 Other Pharmacy $326.00 905346 Clonidine Hcl 10 Mcg/Ml Udl 259 Other Pharmacy $19.00 905348 Cyclobenzaprine Hcl 5 Mg Tab 259 Other Pharmacy $36.00 905350 Thiamine Hcl 100 Mg Tab 259 Other Pharmacy $4.00 905400 LANSOPRAZOLE ODT 15MG 259 Other Pharmacy $59.00

905436 CHLOROTHIAZIDE 250 MG 259 Other Pharmacy $11.00

905458 Iloperidone 1 Mg Tab 259 Other Pharmacy $59.00

905459 Iloperidone 2 Mg Tab 259 Other Pharmacy $54.00

905478 Dextromethrphn Hbr/Quindn1EaCp 259 Other Pharmacy $50.00

905481 PHENOXYBENZAMINE 10MG 259 Other Pharmacy $299.00

905489 Cipro 400 Mg Inj 259 Other Pharmacy $462.00

905532 TESTOSTERONE 2 MG PATC 259 Other Pharmacy $50.00

905535 AMIODARONE 100 MG TAB 259 Other Pharmacy $23.00 905667 Itraconazole 10 Mg/Ml 150Mlbot 259 Other Pharmacy $652.00 905668 DARUNAVIR 800 MG TAB 259 Other Pharmacy $97.00 905674 NEVIRAPINE 50 MG/5ML 259 Other Pharmacy $32.00 905693 APIXABAN 5 MG TAB 259 Other Pharmacy $31.00 905726 APIXABAN 2.5MG TAB 259 Other Pharmacy $31.00 905803 Phenytoin 5MG/ML INJ 259 Other Pharmacy $6.00

905889 Zidovudine 4 Mg/Ml Udi 259 Other Pharmacy $59.00

905969 LUBRIFRESH 3.5 GM OPHT 259 Other Pharmacy $42.00

905990 QUETIAPINE 300 MG TAB 259 Other Pharmacy $50.00

906086 Selegiline 9 Mg Patch 259 Other Pharmacy $85.00

906109 MAGNESIUM SULF 40MG/ML 259 Other Pharmacy $5.00

906188 TOPIRAMATE 25MG SPRNK 259 Other Pharmacy $21.00

906198 AMANTADINE 100MG/10ML 259 Other Pharmacy $11.00

906502 COMPLERA TAB 259 Other Pharmacy $189.00

906509 IVABRADINE 5 MG TAB 259 Other Pharmacy $35.00 906510 NALOXEGOL 12.5 MG TAB 259 Other Pharmacy $42.00 906511 NALOXEGOL 25 MG TAB 259 Other Pharmacy $42.00 906512 EDOXABAN 30 MG TAB 259 Other Pharmacy $46.00 906514 Acyclovir 5% 15 Gm Oint 259 Other Pharmacy $511.00 906517 Nitazoxanide 100Mg/5Ml 60Mlbot 259 Other Pharmacy $448.00 906520 Alvimopan 12 Mg Capsule 259 Other Pharmacy $323.00

906529 BeclmthDiprnt40McgPuffAerWAdp 259 Other Pharmacy $304.00

906545 Brinzolamide 1% 10 Ml Opsusp 259 Other Pharmacy $208.00

906555 Calcitonin-Salmon 1 Spray Nasp 259 Other Pharmacy $693.00

50 906565 Ciprofloxacin Hcl 3.5 Gm Opoin 259 Other Pharmacy $297.00 906569 Clobetsl Propnt 0.05% 30GmOint 259 Other Pharmacy $337.00 906625 Erlotinib Hcl 100 Mg Tablet 259 Other Pharmacy $468.00 906627 Erlotinib Hcl 150 Mg Tablet 259 Other Pharmacy $519.00

906635 EstrogensConjugated 30Gm Vgcr 259 Other Pharmacy $1,053.00

906639 Exenatd 10Mcg/0.04MlPen.Injctr 259 Other Pharmacy $823.00

906640 Exenatd 5Mcg/0.02Ml Pen.Injctr 259 Other Pharmacy $721.00

906646 Flucytosine 500 Mg Cap 259 Other Pharmacy $321.00

906650 Fluocinonide 0.05% 60 Gm Crm 259 Other Pharmacy $157.00

906686 Ipratrpm Brmd 12.9GmAer.W.Adap 259 Other Pharmacy $376.00

906693 Linezolid 100 Mg/5 Ml 150Mlbot 259 Other Pharmacy $357.00

906694 Linezolid 600 Mg Tab 259 Other Pharmacy $470.00 906719 Mometasn Furat 220Mcg/PuffInh 259 Other Pharmacy $341.00 906722 Moxifloxcn Hcl 0.5% 3Ml Opsol 259 Other Pharmacy $49.00 906735 Ofloxacin 0.3% 5 Ml Otic Soln 259 Other Pharmacy $296.00 906764 Salmeterol 50 Mcg/Disk 259 Other Pharmacy $302.00 906768 Selenium Sulfide 207 Ml Shmp 259 Other Pharmacy $31.00 906789 Tolvaptan 15 Mg Tab 259 Other Pharmacy $875.00

906891 Phenelzine Sulfate 15 Mg Tab 259 Other Pharmacy $11.00

906898 RIVASTIGMINE 13.3 MG P 259 Other Pharmacy $66.00

906903 SAQUINAVIR 500 MG TAB 259 Other Pharmacy $40.00

906904 CALCITRIOL 1 MCG/ML SO 259 Other Pharmacy $47.00

906929 Triumeq Tab 259 Other Pharmacy $267.00

907275 Hydroxyurea 200 Mg Cap 259 Other Pharmacy $35.00

907276 Multivitamin W/Iron Chew 259 Other Pharmacy $7.00

907286 Lidocaine 4% Patch 259 Other Pharmacy $73.00 907350 Lacosamide 200 MG Tab 259 Other Pharmacy $70.00 418639 Iv Hydrat Init Up To 1 260 IV Therapy - General $1,048.00 418640 Iv Hydrat Ea Add Hr 260 IV Therapy - General $232.00 418641 Iv Initial Up To 1 Hou 260 IV Therapy - General $534.00 418642 Iv Each Add Hour 260 IV Therapy - General $534.00 418643 Iv Addl Seq Inf Up To 260 IV Therapy - General $199.00

418644 Iv Concurrent Infusion 260 IV Therapy - General $232.00

428074 Iv Therapy/Antibiotics 260 IV Therapy - General $521.00

520194 Iv Therapy 260 IV Therapy - General $494.00

436686 HI FLOW SET HARVARD MI 264 IV Therapy/Supplies $38.00

438008 BLOOD ADMINISTRATION S 264 IV Therapy/Supplies $115.00

17851 Bioglue 1 Tube 270 Medical/Surgical Supplies and Devices - General $1,944.00

71219 Microfib Collagen 1gm 270 Medical/Surgical Supplies and Devices - General $484.00

71850 Gelatin Pwd Absorb 1g 270 Medical/Surgical Supplies and Devices - General $391.00

71852 Microfib Collagen 1gm 270 Medical/Surgical Supplies and Devices - General $484.00 71853 Microfib Coll Sheet 270 Medical/Surgical Supplies and Devices - General $397.00 71854 Hemostat Absorb 2x4 270 Medical/Surgical Supplies and Devices - General $517.00 149369 Gen Code 270 Medical/Surgical Supplies and Devices - General $- 300021 Suppository Inserter 270 Medical/Surgical Supplies and Devices - General $108.00 300023 Magnifier Syringe Ins 270 Medical/Surgical Supplies and Devices - General $15.00 300025 Pt Alarm Pad 270 Medical/Surgical Supplies and Devices - General $36.00

300100 Seal Eakin Lg 270 Medical/Surgical Supplies and Devices - General $11.00

300110 Dressing Island 4X14 270 Medical/Surgical Supplies and Devices - General $5.00

300135 Stomahesive Powder 270 Medical/Surgical Supplies and Devices - General $12.00

51 300153 Wafer 1.25 270 Medical/Surgical Supplies and Devices - General $6.00 300154 Wafer Sur Fit Natural 1 3/4 270 Medical/Surgical Supplies and Devices - General $9.00 300155 Wafer Sur Fit Natural 2 1/4 Wh 270 Medical/Surgical Supplies and Devices - General $9.00 300156 Water Sur Fit Natural 2 3/4 270 Medical/Surgical Supplies and Devices - General $9.00

300157 Wafer Stomahesive W/Flange 4X4 270 Medical/Surgical Supplies and Devices - General $9.00

300162 Pouch Drain Surfit 12 1 3/4 270 Medical/Surgical Supplies and Devices - General $6.00

300163 Pouch Drain 3/4X2 1/2 270 Medical/Surgical Supplies and Devices - General $9.00

300164 Pouch Surfit Drain 12 2 3/4 270 Medical/Surgical Supplies and Devices - General $6.00

300165 Pouch Drain Natural 270 Medical/Surgical Supplies and Devices - General $8.00

300166 Pouch 1.25 270 Medical/Surgical Supplies and Devices - General $6.00

300167 Flexi-Seal Bag 270 Medical/Surgical Supplies and Devices - General $16.00

300175 Sensi-Care Cream 270 Medical/Surgical Supplies and Devices - General $15.00 300200 Pouch Surfit Drain 12 2 1/4 270 Medical/Surgical Supplies and Devices - General $6.00 300260 Dressing Biopatch 2150 270 Medical/Surgical Supplies and Devices - General $18.00 300265 Statlock Device 270 Medical/Surgical Supplies and Devices - General $17.00 300274 Strips Iodf 1/4 270 Medical/Surgical Supplies and Devices - General $6.00 300298 Drsg Duoderm X-Thin 270 Medical/Surgical Supplies and Devices - General $16.00 300312 Dressing Xeroform 4X4 270 Medical/Surgical Supplies and Devices - General $5.00

300313 Dressing Xeroform 5X9 270 Medical/Surgical Supplies and Devices - General $5.00

300315 Drsg Duoderm 4X4 270 Medical/Surgical Supplies and Devices - General $9.00

300325 Dressing Elasto-Gel 270 Medical/Surgical Supplies and Devices - General $9.00

300337 Drsg Aquacel Rope 270 Medical/Surgical Supplies and Devices - General $15.00

300338 Drsg Aquacel Ag Surg 270 Medical/Surgical Supplies and Devices - General $89.00

300339 Drsg Fibracol 4X4 270 Medical/Surgical Supplies and Devices - General $21.00

300350 Drsg Prisma Sm 2X2 270 Medical/Surgical Supplies and Devices - General $32.00

300355 Drsg Prisma Lg 4X4 270 Medical/Surgical Supplies and Devices - General $80.00 300375 Hme Filter Trach Vent 270 Medical/Surgical Supplies and Devices - General $6.00 300397 Trach Bivona 4.0 Ped 270 Medical/Surgical Supplies and Devices - General $137.00 300398 Trach Bivona 5.0 Ped 270 Medical/Surgical Supplies and Devices - General $137.00 300399 Trach Tube Cuffless Pediatric 270 Medical/Surgical Supplies and Devices - General $137.00 300400 Tube Trach #4 Dic 270 Medical/Surgical Supplies and Devices - General $106.00 300401 Cannula #10 Disp Inner 270 Medical/Surgical Supplies and Devices - General $12.00

300403 Cannula #8 Dic 270 Medical/Surgical Supplies and Devices - General $12.00

300405 Trach Tube #4 Dct 270 Medical/Surgical Supplies and Devices - General $92.00

300406 Trach Tube #6 Dct 270 Medical/Surgical Supplies and Devices - General $92.00

300407 Vac Connector 270 Medical/Surgical Supplies and Devices - General $12.00

300408 Trach Tube #8 Dct 270 Medical/Surgical Supplies and Devices - General $92.00

300409 Vac Can W/Gel 270 Medical/Surgical Supplies and Devices - General $76.00

300410 Trach Tube #10 Dct 270 Medical/Surgical Supplies and Devices - General $92.00

300411 Trach Tube #8 270 Medical/Surgical Supplies and Devices - General $100.00

300412 Trach Tube #4 Dfen 270 Medical/Surgical Supplies and Devices - General $92.00 300413 Vac Soft Foam Sm 270 Medical/Surgical Supplies and Devices - General $18.00 300414 Trach Tube #6 Dfen 270 Medical/Surgical Supplies and Devices - General $92.00 300416 Trach Tube #8 Dfen 270 Medical/Surgical Supplies and Devices - General $124.00 300419 Trach Tube #10 Dfen 270 Medical/Surgical Supplies and Devices - General $92.00 300423 Suction Cath 12Fr 270 Medical/Surgical Supplies and Devices - General $212.00 300426 Trach Tube #6 270 Medical/Surgical Supplies and Devices - General $94.00

300427 Trach Tube #8 Cfs 270 Medical/Surgical Supplies and Devices - General $129.00

300430 Vac Drape 270 Medical/Surgical Supplies and Devices - General $16.00

300433 Trach Tube #6 Cfn 270 Medical/Surgical Supplies and Devices - General $100.00

52 300434 Trach Tube #4 Dcfs 270 Medical/Surgical Supplies and Devices - General $92.00 300436 Tube Trach #6 Dcfs 270 Medical/Surgical Supplies and Devices - General $113.00 300437 Tube Rectal 20 270 Medical/Surgical Supplies and Devices - General $41.00 300438 Trach Tube #8 Dcfs 270 Medical/Surgical Supplies and Devices - General $92.00

300440 Trach Tube #10 Dcfs 270 Medical/Surgical Supplies and Devices - General $92.00

300441 Trach Tube #8 Fen 270 Medical/Surgical Supplies and Devices - General $154.00

300444 Trach Tube #4 Dcfn 270 Medical/Surgical Supplies and Devices - General $118.00

300446 Trach Tube #6 Dcfn 270 Medical/Surgical Supplies and Devices - General $92.00

300447 Drsg Granufoam Silver Lg 270 Medical/Surgical Supplies and Devices - General $152.00

300448 Trach Tube #8 Dcfn 270 Medical/Surgical Supplies and Devices - General $92.00

300449 Trach Tube #10 Dcfn 270 Medical/Surgical Supplies and Devices - General $92.00

300461 Scd Sleeve Exp Thigh Sm 270 Medical/Surgical Supplies and Devices - General $147.00 300462 Scd Sleeve Exp Thigh Med 270 Medical/Surgical Supplies and Devices - General $122.00 300463 Scd Sleeve Exp Thigh Lg 270 Medical/Surgical Supplies and Devices - General $186.00 300464 T.R.A.C. Pad 270 Medical/Surgical Supplies and Devices - General $35.00 300466 Plexi Boot Reg 270 Medical/Surgical Supplies and Devices - General $186.00 300467 Plexi Boot Lg 270 Medical/Surgical Supplies and Devices - General $196.00 300468 Scd Sleeve Knee Md Dvt10 270 Medical/Surgical Supplies and Devices - General $38.00

300469 Scd Sleeve Knee Lg Dvt20 270 Medical/Surgical Supplies and Devices - General $54.00

300470 Scd Sleeve Knee Xl Dvt60 270 Medical/Surgical Supplies and Devices - General $71.00

300471 Scd Sleeve Thi Med Dvt30 270 Medical/Surgical Supplies and Devices - General $65.00

300472 Scd Sleeve Thigh Lg Dvt40 270 Medical/Surgical Supplies and Devices - General $88.00

300493 Tubing 72"" Suct Lnr 270 Medical/Surgical Supplies and Devices - General $6.00

300496 Liner Suction 1500 Ml 270 Medical/Surgical Supplies and Devices - General $9.00

300497 Suction Can Portable 270 Medical/Surgical Supplies and Devices - General $26.00

300499 Trach Bivona Ad 270 Medical/Surgical Supplies and Devices - General $256.00 300510 Sling Disp Lift 270 Medical/Surgical Supplies and Devices - General $68.00 300525 Scd Sleeve Thigh Sm 270 Medical/Surgical Supplies and Devices - General $164.00 300528 Scd Sleeve Exp Knee 270 Medical/Surgical Supplies and Devices - General $106.00 300530 Scd Sleeve Knee Lg 270 Medical/Surgical Supplies and Devices - General $134.00 300541 Pillow Adbuction 270 Medical/Surgical Supplies and Devices - General $53.00 300665 Vac Sof Foam Lg 270 Medical/Surgical Supplies and Devices - General $30.00

300728 Shoe Cast Lg Female 270 Medical/Surgical Supplies and Devices - General $15.00

300730 Shoe Cast Mens Lg 270 Medical/Surgical Supplies and Devices - General $16.00

300832 Foot Positioner 270 Medical/Surgical Supplies and Devices - General $35.00

300833 Forearm Supp Rt 270 Medical/Surgical Supplies and Devices - General $24.00

300834 Foot Foam Block 270 Medical/Surgical Supplies and Devices - General $70.00

300842 Support Comfort Form Wrist XL 270 Medical/Surgical Supplies and Devices - General $66.00

300843 Support Lumbosacral XL 40-44 270 Medical/Surgical Supplies and Devices - General $66.00

300844 Support lumbosacral XXL 44-48 270 Medical/Surgical Supplies and Devices - General $66.00

300848 Support Lumbosacral Sm 28-32 270 Medical/Surgical Supplies and Devices - General $66.00 300849 Support Lumbosacral Med 32-36 270 Medical/Surgical Supplies and Devices - General $66.00 300850 Support Lumbosacral Lg-36-40 270 Medical/Surgical Supplies and Devices - General $66.00 300851 Support Lumbosacral XXXL 48-51 270 Medical/Surgical Supplies and Devices - General $66.00 300853 Finger Contract Cush 270 Medical/Surgical Supplies and Devices - General $8.00 300864 Collar Cervical Sm 270 Medical/Surgical Supplies and Devices - General $15.00 300865 Collar Phil Lg 270 Medical/Surgical Supplies and Devices - General $53.00

300867 Collar Cervical Small 270 Medical/Surgical Supplies and Devices - General $11.00

300869 Collar Cervical Lg 270 Medical/Surgical Supplies and Devices - General $12.00

300870 Collar Cervical Xl 270 Medical/Surgical Supplies and Devices - General $14.00

53 300871 Collar Aspen 270 Medical/Surgical Supplies and Devices - General $135.00 300896 Collar Phil Xlg 270 Medical/Surgical Supplies and Devices - General $53.00 300898 Helmet Small 270 Medical/Surgical Supplies and Devices - General $215.00 300899 Helmet Medium 270 Medical/Surgical Supplies and Devices - General $215.00

300900 Helmet Large 270 Medical/Surgical Supplies and Devices - General $215.00

300901 Pad Miami J 270 Medical/Surgical Supplies and Devices - General $56.00

300954 Immob Knee Lg 270 Medical/Surgical Supplies and Devices - General $36.00

300955 Knee Immob Ped 9 270 Medical/Surgical Supplies and Devices - General $35.00

300956 Knee Immob Ped 12 Inch 270 Medical/Surgical Supplies and Devices - General $54.00

300957 Knee Immob Xxl 270 Medical/Surgical Supplies and Devices - General $50.00

300958 Immob Knee Xlg 270 Medical/Surgical Supplies and Devices - General $46.00

300995 Binder Abd Ped 6 Inches 270 Medical/Surgical Supplies and Devices - General $22.00 301022 Teds Knee Sm/Reg 270 Medical/Surgical Supplies and Devices - General $12.00 301026 Teds Knee Large/Reg 270 Medical/Surgical Supplies and Devices - General $12.00 301028 Teds Knee Xl/Reg 270 Medical/Surgical Supplies and Devices - General $14.00 301030 Teds Knee Xxlg/Reg 270 Medical/Surgical Supplies and Devices - General $33.00 301032 Teds Thigh Xxlarge/Long 270 Medical/Surgical Supplies and Devices - General $35.00 301036 Collar Cervical Ped 270 Medical/Surgical Supplies and Devices - General $21.00

301250 Tube Gastrostomy 20Fr 270 Medical/Surgical Supplies and Devices - General $99.00

301254 Tube Sump 12Fr 270 Medical/Surgical Supplies and Devices - General $15.00

301256 Tube Declogger 270 Medical/Surgical Supplies and Devices - General $15.00

301323 Enema Bucket W/Soap 270 Medical/Surgical Supplies and Devices - General $6.00

301326 Drsg Acticoat 4X4 270 Medical/Surgical Supplies and Devices - General $22.00

301327 Drsg Wound Veil 270 Medical/Surgical Supplies and Devices - General $24.00

301329 Drsg Silvasorb 270 Medical/Surgical Supplies and Devices - General $28.00

301331 Silvasorb/Hydrogel 270 Medical/Surgical Supplies and Devices - General $44.00 301342 Lumber Puncture Tray 270 Medical/Surgical Supplies and Devices - General $32.00 301394 Catheter Foley Coude 14Fr 270 Medical/Surgical Supplies and Devices - General $56.00 301395 Catheter Foley Coude 16Fr 5Cc 270 Medical/Surgical Supplies and Devices - General $56.00 301455 Cath Strap Leg 270 Medical/Surgical Supplies and Devices - General $8.00 301462 Cath Irr 3-Way 18F 30Cc 270 Medical/Surgical Supplies and Devices - General $17.00 301463 Cath Irr 3-Way 20F 30Cc 270 Medical/Surgical Supplies and Devices - General $17.00

301464 Cath Fol 18F 30C 2 Way 270 Medical/Surgical Supplies and Devices - General $26.00

301469 Self Catheter Adolscnt 10Fr 270 Medical/Surgical Supplies and Devices - General $4.00

301470 Cath Coude Lf (614) 270 Medical/Surgical Supplies and Devices - General $5.00

301575 Mirror Gooseneck 270 Medical/Surgical Supplies and Devices - General $68.00

301847 Valve Spkng Passymuir 270 Medical/Surgical Supplies and Devices - General $123.00

301848 Valve Spkng Passymuir 270 Medical/Surgical Supplies and Devices - General $123.00

301849 Valve Spkng Passymuir 270 Medical/Surgical Supplies and Devices - General $123.00

301881 Boot Walking Pneumatic/Vacuum 270 Medical/Surgical Supplies and Devices - General $677.00

302081 Liner F/Miami J Collar 270 Medical/Surgical Supplies and Devices - General $48.00 305000 Skin Barrier Cut To Fit 270 Medical/Surgical Supplies and Devices - General $11.00 305001 Vented Bag 18142 270 Medical/Surgical Supplies and Devices - General $8.00 305005 Sur-Fit Inserts 270 Medical/Surgical Supplies and Devices - General $8.00 305007 Tube Levin 1 8Fr 270 Medical/Surgical Supplies and Devices - General $6.00 305008 Pouch Urostomy 270 Medical/Surgical Supplies and Devices - General $8.00 305009 Ostomy Sys 2 Piece 270 Medical/Surgical Supplies and Devices - General $9.00

305010 Tube Decompress 18F 270 Medical/Surgical Supplies and Devices - General $32.00

305012 Feeding Adapter 18F 270 Medical/Surgical Supplies and Devices - General $17.00

305018 Drain Pch Ultra 270 Medical/Surgical Supplies and Devices - General $18.00

54 305019 Promogran Dressing 270 Medical/Surgical Supplies and Devices - General $27.00 305020 Pouch Drain Filter 270 Medical/Surgical Supplies and Devices - General $6.00 305021 Suppository Inserter 270 Medical/Surgical Supplies and Devices - General $108.00 305022 Stimulator Bowel 270 Medical/Surgical Supplies and Devices - General $101.00

305023 Cast Air Splint 270 Medical/Surgical Supplies and Devices - General $206.00

305026 Tape Medipore 2 270 Medical/Surgical Supplies and Devices - General $12.00

305028 Rectal Catheter 30Fr 270 Medical/Surgical Supplies and Devices - General $26.00

305029 Condom Cath Med 270 Medical/Surgical Supplies and Devices - General $6.00

305031 Idoform Strips 1/4 270 Medical/Surgical Supplies and Devices - General $9.00

305033 Urostomy Wafer 270 Medical/Surgical Supplies and Devices - General $42.00

305034 Dressing Prisma Matrix Ma028 270 Medical/Surgical Supplies and Devices - General $32.00

305035 Prisma Large 270 Medical/Surgical Supplies and Devices - General $80.00 305036 Drsg Mepilex Lite 6X6 270 Medical/Surgical Supplies and Devices - General $16.00 305037 Drsg Flexigel 2X2 270 Medical/Surgical Supplies and Devices - General $9.00 305038 Pouch Urostomy 1 270 Medical/Surgical Supplies and Devices - General $18.00 305039 Pouch Colos. Closed 270 Medical/Surgical Supplies and Devices - General $6.00 305040 Wafer Stoma 270 Medical/Surgical Supplies and Devices - General $14.00 305041 Peri Wash Coloplast 270 Medical/Surgical Supplies and Devices - General $14.00

305042 Drsg Flexifel 2X2 270 Medical/Surgical Supplies and Devices - General $11.00

305043 Pouch Surfit 270 Medical/Surgical Supplies and Devices - General $11.00

305044 Tube Trach Portex 270 Medical/Surgical Supplies and Devices - General $162.00

305045 Trach Portex 270 Medical/Surgical Supplies and Devices - General $14.00

305046 Tube Rectcal Flexi-Seal 270 Medical/Surgical Supplies and Devices - General $767.00

305047 Bags Flexi-Seal 270 Medical/Surgical Supplies and Devices - General $16.00

305049 Trach #4 Fen 270 Medical/Surgical Supplies and Devices - General $14.00

305051 Cath Self Female 6Fr 270 Medical/Surgical Supplies and Devices - General $4.00 305052 Trac Pad Tubing 270 Medical/Surgical Supplies and Devices - General $80.00 305053 Tube Mickey G 20F 270 Medical/Surgical Supplies and Devices - General $244.00 305054 Trach Ext 8.0 Proximal 270 Medical/Surgical Supplies and Devices - General $192.00 305055 Trach Ext 8.0 Distal 270 Medical/Surgical Supplies and Devices - General $192.00 305056 Trach Long 6 Proximal 270 Medical/Surgical Supplies and Devices - General $160.00 305057 Trach Inner Cann 6.0 270 Medical/Surgical Supplies and Devices - General $12.00

305058 Barrier Sur-Fit Flexible 270 Medical/Surgical Supplies and Devices - General $8.00

305059 Barrier Surfit 270 Medical/Surgical Supplies and Devices - General $22.00

305060 Pouch Urostomy 270 Medical/Surgical Supplies and Devices - General $16.00

305061 Pouch Surfit Uro 270 Medical/Surgical Supplies and Devices - General $6.00

305062 Gel Saf-Gel Hydr 270 Medical/Surgical Supplies and Devices - General $26.00

305063 Belt Hernia Med 270 Medical/Surgical Supplies and Devices - General $56.00

305064 Drain Bag W/Reflux Vlv 270 Medical/Surgical Supplies and Devices - General $94.00

305065 Red Cap 270 Medical/Surgical Supplies and Devices - General $28.00

305066 Chloraprep Sepp 270 Medical/Surgical Supplies and Devices - General $180.00 305067 Pouch Lil Ones 270 Medical/Surgical Supplies and Devices - General $4.00 305072 Immobilizer Knee 16In Small 270 Medical/Surgical Supplies and Devices - General $32.00 305073 Kit Cone Irrigator 7721 270 Medical/Surgical Supplies and Devices - General $36.00 305074 Irr Visi Flow 270 Medical/Surgical Supplies and Devices - General $26.00 305076 Colostomy Wafer Flange 270 Medical/Surgical Supplies and Devices - General $9.00 305077 Colostomy Barrier Ring 270 Medical/Surgical Supplies and Devices - General $8.00

305078 Colostomy Flange Pouch 270 Medical/Surgical Supplies and Devices - General $6.00

305079 Cath Self 8Fr Peds 270 Medical/Surgical Supplies and Devices - General $3.00

305080 Barrier Ring Ostomy 270 Medical/Surgical Supplies and Devices - General $12.00

55 305082 Tube Trach Flextend 4.5 270 Medical/Surgical Supplies and Devices - General $326.00 305084 Pouch Drain 1 3/4 270 Medical/Surgical Supplies and Devices - General $4.00 305085 Ted Knee Hi Sm Reg 270 Medical/Surgical Supplies and Devices - General $52.00 305086 Trach Long 6 Cuf/Dist 270 Medical/Surgical Supplies and Devices - General $115.00

305100 Pouch Urostomy 1-3/4 270 Medical/Surgical Supplies and Devices - General $5.00

305101 Wafer Skin Barrier 270 Medical/Surgical Supplies and Devices - General $9.00

305102 Kit Pleurx Drainage 100Oml 270 Medical/Surgical Supplies and Devices - General $160.00

305103 Drsg Silvasorb 270 Medical/Surgical Supplies and Devices - General $81.00

305104 Drsg Silvasorb 270 Medical/Surgical Supplies and Devices - General $173.00

305105 Vent Osto-Ez-Air Release 270 Medical/Surgical Supplies and Devices - General $4.00

305107 Immobilizer Knee 15 270 Medical/Surgical Supplies and Devices - General $54.00

305108 Seals Eakin Cohesive Small 270 Medical/Surgical Supplies and Devices - General $126.00 305109 Trach 8.0 Xltin 270 Medical/Surgical Supplies and Devices - General $16.00 305110 Pouch Drainable 1-Pc 270 Medical/Surgical Supplies and Devices - General $6.00 305111 Drsg Puracol Plus Ag 270 Medical/Surgical Supplies and Devices - General $53.00 305114 Pouch Drain W/Tap 1-3/4 270 Medical/Surgical Supplies and Devices - General $39.00 305115 Wafer Durahesive 1 3/4 270 Medical/Surgical Supplies and Devices - General $40.00 305116 Drsg Optifoam Non-Adhesive 270 Medical/Surgical Supplies and Devices - General $14.00

305118 Drsg Mepilex Ag 8X20 270 Medical/Surgical Supplies and Devices - General $196.00

305119 Drsg Adaptic 3X16 270 Medical/Surgical Supplies and Devices - General $5.00

305132 Wafer Convatec Bx/10 270 Medical/Surgical Supplies and Devices - General $14.00

305139 Trach Long #6 Distal 270 Medical/Surgical Supplies and Devices - General $196.00

305140 Drsg Tegaderm 4X12 270 Medical/Surgical Supplies and Devices - General $6.00

305160 Kit Pleurx Dressing 500Ml 270 Medical/Surgical Supplies and Devices - General $136.00

305175 Mirror Gooseneck 270 Medical/Surgical Supplies and Devices - General $68.00

306731 Tru-Close Drain 270 Medical/Surgical Supplies and Devices - General $60.00 311050 No Charge Item 270 Medical/Surgical Supplies and Devices - General $- 314633 Heel Cups Universal 949 270 Medical/Surgical Supplies and Devices - General $140.00 314795 Suction Liners 270 Medical/Surgical Supplies and Devices - General $106.00 314854 Depuy Rt Ankle System 270 Medical/Surgical Supplies and Devices - General $6,216.00 314963 Suction Cannisters 1200cc 40/c 270 Medical/Surgical Supplies and Devices - General $158.00 317702 Supporter 270 Medical/Surgical Supplies and Devices - General $96.00

378704 Press Separator 270 Medical/Surgical Supplies and Devices - General $146.00

378705 Suct Assembly 270 Medical/Surgical Supplies and Devices - General $70.00

378784 Sequestration Supplies 270 Medical/Surgical Supplies and Devices - General $779.00

424198 TRAY FOL 18FR I/C 270 Medical/Surgical Supplies and Devices - General $173.00

424200 Kit Cath Lub Std 16F 270 Medical/Surgical Supplies and Devices - General $171.00

424438 Set XTN .3ML 6IN IV Ndls 270 Medical/Surgical Supplies and Devices - General $29.00

424745 Sut Silk 2-0 A305H 270 Medical/Surgical Supplies and Devices - General $42.00

424794 STEN ESO 18F W/TEMP 270 Medical/Surgical Supplies and Devices - General $34.00

424834 SUT PDS #5 CCS MB47G 270 Medical/Surgical Supplies and Devices - General $211.00 424842 Sut Moncryl 4.0 Y426H 270 Medical/Surgical Supplies and Devices - General $89.00 424852 Sut Chrmc ABS 4-0 1654G 270 Medical/Surgical Supplies and Devices - General $104.00 424879 Sut Nyl 4-0 PS-2 662H 270 Medical/Surgical Supplies and Devices - General $26.00 424913 Sut Silk Nabs 3-0 A1854H 270 Medical/Surgical Supplies and Devices - General $27.00 424914 Sut Silk 0 A186H 270 Medical/Surgical Supplies and Devices - General $13.00 424916 SUT SILK NABS 2-0 A185 270 Medical/Surgical Supplies and Devices - General $25.00

424937 SUT CHRMC ABS 4-0 G121 270 Medical/Surgical Supplies and Devices - General $53.00

425031 Sut Vcryl Sz 3-0 J316H 270 Medical/Surgical Supplies and Devices - General $29.00

427045 PROBE BICAP 270 Medical/Surgical Supplies and Devices - General $843.00

56 428412 STENT SET 270 Medical/Surgical Supplies and Devices - General $698.00 428567 PROCALCITONIN PCT 270 Medical/Surgical Supplies and Devices - General $15.00 434735 SUCTION CANNISTERS 120 270 Medical/Surgical Supplies and Devices - General $158.00 436422 SUPPORT SHOULDER ABDUC 270 Medical/Surgical Supplies and Devices - General $951.00

447002 BAG DRAIN ANTIRFL 2000 270 Medical/Surgical Supplies and Devices - General $45.00

462292 Binder ABD XLG 9IN 3PNL 270 Medical/Surgical Supplies and Devices - General $113.00

477838 Hemovac Kit L SUI30-404D 270 Medical/Surgical Supplies and Devices - General $177.00

477898 Suture 4-0 Ethilon 1667 270 Medical/Surgical Supplies and Devices - General $58.00

481927 Valve Smartsite 1 Ml 270 Medical/Surgical Supplies and Devices - General $15.00

482476 Dilator 270 Medical/Surgical Supplies and Devices - General $186.00

485091 SUT VCRYL 4-0 J422H 270 Medical/Surgical Supplies and Devices - General $38.00

485541 Dressing 4X4In Abs Nwvn 270 Medical/Surgical Supplies and Devices - General $10.00 499285 CELLULOSE OXD 4X2IN HM 270 Medical/Surgical Supplies and Devices - General $488.00 500001 Strap Montgomery 270 Medical/Surgical Supplies and Devices - General $61.00 500120 OST ADHES REMOVE 6OZ 270 Medical/Surgical Supplies and Devices - General $104.00 500121 OST DEODORANT 1.25OZ 270 Medical/Surgical Supplies and Devices - General $43.00 500122 OST DEODORANT SPRAY 270 Medical/Surgical Supplies and Devices - General $42.00 500130 OST BELT MD 270 Medical/Surgical Supplies and Devices - General $133.00

500131 OST PREP SKIN 50/BX 270 Medical/Surgical Supplies and Devices - General $73.00

500132 OST ADHES SKIN BOND 270 Medical/Surgical Supplies and Devices - General $83.00

500133 OST Tail Closure/Clamp 270 Medical/Surgical Supplies and Devices - General $25.00

500134 OST Bag Clamp Squibb 270 Medical/Surgical Supplies and Devices - General $25.00

500136 OST Stomachesive Paste 270 Medical/Surgical Supplies and Devices - General $83.00

500139 OST IRRIGATION SET 270 Medical/Surgical Supplies and Devices - General $170.00

500181 OST IRR SLEEVE 1.50I 270 Medical/Surgical Supplies and Devices - General $57.00

500182 OST IRR SLEEVE 1.75I 270 Medical/Surgical Supplies and Devices - General $57.00 500183 OST IRR SLEEVE 2.25I 270 Medical/Surgical Supplies and Devices - General $57.00 500184 OST IRR SLEEVE 2.75I 270 Medical/Surgical Supplies and Devices - General $57.00 500232 CHEST DRAIN STAND 270 Medical/Surgical Supplies and Devices - General $56.00 500354 EYE T'MENT TRAY 270 Medical/Surgical Supplies and Devices - General $431.00 500454 SEQUENTIAL MED THIGH S 270 Medical/Surgical Supplies and Devices - General $2,338.00 500455 SEQUENTIAL THIGH XLG S 270 Medical/Surgical Supplies and Devices - General $2,338.00

500465 SEQUENTIAL SMALL KNEE 270 Medical/Surgical Supplies and Devices - General $2,338.00

500468 BED KEANE/DAY 270 Medical/Surgical Supplies and Devices - General $2,164.00

500469 BED CLENSICAIR/DAY 270 Medical/Surgical Supplies and Devices - General $1,045.00

500480 SEQUENTIAL THIGH EX SM 270 Medical/Surgical Supplies and Devices - General $2,338.00

500495 SUCTION ORAL /DAY 270 Medical/Surgical Supplies and Devices - General $227.00

500496 SUCTION C'STOR W/TUB 270 Medical/Surgical Supplies and Devices - General $362.00

500498 SUCTION IN'MIT /DAY 270 Medical/Surgical Supplies and Devices - General $227.00

500502 PACEMAKER EXT /DAY 270 Medical/Surgical Supplies and Devices - General $558.00

500527 SEQUENTIAL THIGH SMALL 270 Medical/Surgical Supplies and Devices - General $2,338.00 500548 DOUCHE SET 270 Medical/Surgical Supplies and Devices - General $64.00 500563 PAP SMEAR SET 270 Medical/Surgical Supplies and Devices - General $133.00 500592 BREAST PUMP MANUAL/ELE 270 Medical/Surgical Supplies and Devices - General $184.00 500695 SUPPORT ABD 270 Medical/Surgical Supplies and Devices - General $314.00 501171 MOLASSES 4OZ 270 Medical/Surgical Supplies and Devices - General $67.00 501258 TUBE BAKER DUODENAL 16 270 Medical/Surgical Supplies and Devices - General $240.00

501302 PERITONEAL LAVAG SET 270 Medical/Surgical Supplies and Devices - General $108.00

501323 ENEMA BUCKET W/SOAP 270 Medical/Surgical Supplies and Devices - General $27.00

501455 CATH STRAP LEG 270 Medical/Surgical Supplies and Devices - General $113.00

57 501570 RE HEAD CRADLE 270 Medical/Surgical Supplies and Devices - General $681.00 501571 LUMBAR SUPPORT 270 Medical/Surgical Supplies and Devices - General $661.00 501575 GOOSE NECK MIRRON 270 Medical/Surgical Supplies and Devices - General $- 501847 Mirror Laryngeal 270 Medical/Surgical Supplies and Devices - General $92.00

501956 SCALE, DIALYSIS SPRING 270 Medical/Surgical Supplies and Devices - General $88.00

502424 Spirometer, Incentive Adult 270 Medical/Surgical Supplies and Devices - General $266.00

502453 Gen-Code/C S 270 Medical/Surgical Supplies and Devices - General $-

502501 Foot Wrap Pair 270 Medical/Surgical Supplies and Devices - General $576.00

502502 Foot Wrap Combo Pair 270 Medical/Surgical Supplies and Devices - General $764.00

502871 Dressing Teg 2-3/8x2 270 Medical/Surgical Supplies and Devices - General $10.00

506736 SUCTION CANNISTER ACCU 270 Medical/Surgical Supplies and Devices - General $158.00

658732 E-Z WRAP 270 Medical/Surgical Supplies and Devices - General $27.00 658733 EASY CAP 270 Medical/Surgical Supplies and Devices - General $158.00 658734 FLUTTER DEVICE 270 Medical/Surgical Supplies and Devices - General $567.00 667909 Ambu Bag 270 Medical/Surgical Supplies and Devices - General $481.00 667996 Nasal Trumpet Placement 270 Medical/Surgical Supplies and Devices - General $124.00 689325 Fibrin Sealant 270 Medical/Surgical Supplies and Devices - General $2,649.00 689893 Leuko Reduction Filter 270 Medical/Surgical Supplies and Devices - General $428.00

718022 Emg Disposable Needle 270 Medical/Surgical Supplies and Devices - General $100.00

728792 Pneumothorax Set 270 Medical/Surgical Supplies and Devices - General $1,936.00

776933 Fld Bar Da 46 270 Medical/Surgical Supplies and Devices - General $33.00

776938 K/H-Di/Blu/Cp 270 Medical/Surgical Supplies and Devices - General $38.00

909073 Shur-Clens 270 Medical/Surgical Supplies and Devices - General $100.00

909521 Shur Clens 20Ml 270 Medical/Surgical Supplies and Devices - General $43.00

909537 E.R. Pertrach 270 Medical/Surgical Supplies and Devices - General $1,078.00

926855 Dressing Biopatch 4mm 270 Medical/Surgical Supplies and Devices - General $36.00 928887 Dressing Foam Brdr 4x4 270 Medical/Surgical Supplies and Devices - General $55.00 968558 Interlink Y-Extension 270 Medical/Surgical Supplies and Devices - General $73.00 969553 Pressure Monitoring Kit 270 Medical/Surgical Supplies and Devices - General $256.00

GEN SUPPL Y FLAT RATE SUPPLY CHARGE 270 Medical/Surgical Supplies and Devices - General $28.00

OT6889 Gen Code 270 Medical/Surgical Supplies and Devices - General $- 300097 Binder Surg Md 9 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $224.00

300998 Binder Surg Lg 9 Inches 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $22.00

301451 Cath Condom Med 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $16.00

301537 Cath Condom Sm 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $16.00

304000 Mesalt Dressing 8 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $6.00

310748 Cast Splint-Fiberglass 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $268.00

310749 Cast Splint - Plaster 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $227.00

311003 Suspensary 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $310.00

314724 Splint Denver Nasal 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $470.00

314725 Splint Doyle II Airway 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $557.00 314726 Splint External Nasal 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $240.00 314729 Splint Nasal Large 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $145.00 314730 Splint Nasal Small 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $140.00 315805 Halter Cervical Head 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $36.00 316102 Cast Leg - Plaster 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $924.00 316104 Cast Leg - Fiberglass 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,100.00

427905 AMBU DISP 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $196.00

428073 OXYGEN W/NASAL CANNULA 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $209.00

432100 SPLINT NASAL SIMPLE 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $140.00

58 436390 SPLINT MAGNE 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $169.00 439357 SPLINT NASAL BROWN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $140.00 462305 BNDR ABD 12 IN 45-62 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $177.00 476176 ECG ELECTRODES 50/PK 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $51.00

500137 OST STOMADESIVE 4X4 EA 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00

500145 OST BAG AD/KA 1.75IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $21.00

500146 OST BAG AD/KA 2.00IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $21.00

500153 OST WAFER 1.50IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $61.00

500154 OST WAFER 1.75IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $61.00

500155 OST WAFER 2.25IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $61.00

500156 OST WAFER 2.75IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $61.00

500360 EYE SHIELD FOX 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $62.00 500476 HEAT PAD DISP 24X60 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $375.00 500478 M'RESS HYPO PROBE 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $85.00 500538 PERI PAD, DOUBLE PLUS 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $43.00 500552 OL-FATHER'S GOWN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $81.00 500594 BELT FETAL LEG DISP 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $76.00 500595 BELT FETAL ABD DISP 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $76.00

500691 CAST BOOT MED 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $246.00

500694 TUCKS PADS 40/BT 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $27.00

500706 BLADE ASSEMBLE PREP 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $287.00

500716 CAST PADDINGT 6X4 YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $61.00

500722 CAST BOOT LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $245.00

500723 CAST BOOT SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $246.00

500724 CAST BOOT MED 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $245.00

500726 CAST PADDING 3X4YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $75.00 500736 CAST LEG SHORT ADULT 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $674.00 500739 CAST LEG LONG ADULT 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $700.00 500740 CAST ARM LONG CHILD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $467.00 500742 CAST PLASTER ARM LONG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $548.00 500745 CAST PL BANDGE 2X5 YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $38.00 500746 CAST PL BANDGE 3X5 YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $27.00

500747 CAST PL BANDGE 4X5 YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $38.00

500748 CAST PL BANDGE 6X5 YD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $57.00

500749 CAST PL SPL 3X15 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $169.00

500750 CAST PL SPL 4X15 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $170.00

500751 CAST PL SPL 5X3OIN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $170.00

500752 SUPPORT LEG/SPAN AID 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $685.00

500754 CAST FIBER TAPE 3 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $240.00

500755 CAST FIBER TAPE 4 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $256.00

500756 CAST FIBER TAPE 2 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $233.00 500757 CAST FIBER ARM SHT CHI 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $512.00 500759 CAST FIBER TAPE 5 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $281.00 500760 CAST FIBER ARM LG ADUL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,062.00 500764 CAST FIBER LEG ADULT 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,046.00 500765 CAST FIBER LEG LG ADUL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,485.00 500766 CAST FIBER LEG LG CHIL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,046.00

500768 CAST FIBER PAD 3IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $123.00

500769 CAST FIBER PAD 4 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $127.00

500770 CAST FIBER PAD 6IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $193.00

59 500771 CAST PL SPL OCL 2X24 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $255.00 500772 CAST PL SPL OCL 3X36 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $259.00 500773 CAST PL SPL OCL 4X36 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $255.00 500774 CAST PL SPL OCL 5X36 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $255.00

500775 CAST PL SPL OCL 6X36 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $255.00

500852 CAST FIBER PAD 2IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $90.00

500888 IMMOB SHOUL'R RAY SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $389.00

500889 IMMOB SHOUL'R RAY MD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $389.00

500890 IMMOB SHOUL'R RAY LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $389.00

500891 IMMOB SHOUL'R RAY XL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $389.00

500915 CAST PAD STER 4 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $81.00

500916 CAST PAD STER 6 IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $81.00 500987 RESTRAINTS LIMB PR 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 500989 RESTRAINT MITTEN, UNIV 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 500990 RESTRAINT VEST SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 500991 RESTRAINT VEST MD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 500992 RESTRAINT VEST LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 500996 SHEEPSKIN 24X30IN 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $-

500997 BINDER SURG MD 9 IN. 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $314.00

500998 BINDER SURG LG 9 IN. 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $314.00

500999 BINDER SURG LG 12 IN. 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $314.00

501001 SUSPENSARIE SMALL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $304.00

501002 SUSPENSARIE MEDIUM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $304.00

501003 SUSPENSARIE LARGE 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $304.00

501004 SUSPENSARIE X-LARGE0 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $304.00

501005 SUPPORTER ATHLETE SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $193.00 501006 SUPPORTER ATHLETE MD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $193.00 501007 SUPPORTER ATHLETE LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $193.00 501008 BINDER RIB UNIV MALE 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $170.00 501451 CATH CONDOM MD 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00 501452 CATH CONDOM LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00 501453 CATH CONDOM 25/BX 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $470.00

501481 DIAPER ADULT MED 6/PK 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $-

501537 CATH CONDON SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00

501556 CATH CONDOM NON LATEX 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00

501557 CATH CONDOM NON LATEX 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00

501558 CATH CONDOM NON LATEX 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $25.00

501572 RE LUBE JELLY 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $38.00

501631 BINDER SURG XLG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $354.00

501643 SAGE MOUTHCARE AND SUC 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $123.00

501902 Binder Surg 9" Xlg 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $314.00 501972 GEN CODE (271) 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $- 502065 Airplane Splint Small 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,776.00 502066 Airplane Splint Med-Lg 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $1,775.00 520078 MIDSTREAM SPECIMEN COL 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $27.00 520126 SLING ARM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $229.00 520144 SUPPORTER ADULT LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $210.00

520146 SUPPORTER ADULT SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $210.00

520152 SUSPENSORY LG 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $248.00

520153 SUSPENSORY MED 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $248.00

60 520154 SUSPENSORY SM 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $248.00 908010 Ecg - Electrodes 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $56.00 909021 Physto Pacemaker Pads 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $422.00 909117 Paceaid Ext Electrodes 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $383.00

968660 Recording Paper 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $467.00

969536 Misc Plastics Piece 271 Medical/Surgical Supplies and Devices - Non-Sterile Supply $234.00

71835 Pleurx Catherer 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,949.00

71873 Forcep Cold Biopsy 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

72761 CVRT Gastr to Gsjej TU 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,205.00

72771 Cath 2nd OD Low Art Bi 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,550.00

193047 Pediatric Press Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $14.00

201056 Thoracostomy Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,777.00 274863 CATHTR CV DUAL LUMEN C 272 Medical/Surgical Supplies and Devices - Sterile Supply $524.00 300079 Tube Feed Lopez Valve 272 Medical/Surgical Supplies and Devices - Sterile Supply $22.00 300251 Bandage Ace 2 272 Medical/Surgical Supplies and Devices - Sterile Supply $4.00 300252 Bandage Ace 3 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 300253 Bandage Ace 4 Inch 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 300254 Bandage Ace 6 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00

300262 Bandaid Coverlet 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00

300270 Drsg Cvp Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

300271 Nuguaze Iodo 2 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00

300272 Nugauze Iodo 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00

300300 Drsg Transparent Lg 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00

300310 Drsg Vaseline Gauze Pk 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00

300317 Drsg Adhesive 7X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $22.00

300318 Drsg Duoderm 6X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $18.00 300319 Drsg Duoderm 6X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $33.00 300320 Drsg Duoderm 6X6 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 300328 Drsg Cavity 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00 300330 Drsg Transparent Med 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00 300332 Drsg Vigilon 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00 300333 Drsg Vigilon 6X8 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00

300334 Drsg Duoderm Thin 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $14.00

300335 Drsg Transparent Sm 272 Medical/Surgical Supplies and Devices - Sterile Supply $4.00

300345 Drsg Sorbaview 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

300402 Tube Trach 6 Dic 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00

300420 Cath Suction Set 6Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

300421 Cath Suction Set 8Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

300422 Cath Suction Set 10F 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

300424 Cath Suction Set 14Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

300425 Trach Tube #4 Cfs 272 Medical/Surgical Supplies and Devices - Sterile Supply $94.00 300428 Trach Tube #6 Fen 272 Medical/Surgical Supplies and Devices - Sterile Supply $138.00 300429 Tube Suction Yankauer 272 Medical/Surgical Supplies and Devices - Sterile Supply $4.00 300431 Vac Drg Asy Sm 272 Medical/Surgical Supplies and Devices - Sterile Supply $53.00 300439 Trach Tube #4 Cfn 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 300442 Trach Tube #4 Fen 272 Medical/Surgical Supplies and Devices - Sterile Supply $138.00 300451 Tube Trach Ped 3.0 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00

300452 Tube Trach Ped 3.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $99.00

300453 Tube Trach Ped 4.0 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00

300454 Sequential Med Thigh Sleeve 272 Medical/Surgical Supplies and Devices - Sterile Supply $95.00

61 300455 Sequential Thigh Xlg Sleeve 272 Medical/Surgical Supplies and Devices - Sterile Supply $183.00 300456 Tube Trach Ped 4.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00 300457 Tube Trach Ped 5.0X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00 300458 Tube Trach Ped 5.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00

300465 Sequential Small Knee Sleeve 272 Medical/Surgical Supplies and Devices - Sterile Supply $95.00

300487 K-Pad 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00

300498 Trach Bivona 6.0 Ad 272 Medical/Surgical Supplies and Devices - Sterile Supply $134.00

300527 Sequential Thigh Small Sleeve 272 Medical/Surgical Supplies and Devices - Sterile Supply $136.00

300835 Support Comfort Form Wrist Sm 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00

300837 Support Comfort Form Wrist Llg 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00

300838 Support Comfort Form Wrist Xl 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00

300839 Support Comfort Form Wrist Sm 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00 300997 Binder Abd 9 Inches 272 Medical/Surgical Supplies and Devices - Sterile Supply $18.00 301253 Tube Sump 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00 301268 Tube Feed 5Fr X 36"" (Neo) 272 Medical/Surgical Supplies and Devices - Sterile Supply $22.00 301269 Tube Feed 8Frx42 272 Medical/Surgical Supplies and Devices - Sterile Supply $22.00 301271 Tube Feed Container 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00 301274 Tube Feed 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

301275 Tube Feed 14Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

301276 Tube Feed 16Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

301277 Tube Gi Levine 18Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00

301288 Iv Continous-Flow Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00

301299 Avi Secondary Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

301334 Tray Minor Laceration 272 Medical/Surgical Supplies and Devices - Sterile Supply $16.00

301351 Staple Remover 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00

301361 Tray Cutdown 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00 301393 Cath Coude Lf 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $6.00 301402 Cath Foley 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 301403 Cath Foley 14Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 301404 Cath Foley 16Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 301405 Cath Foley 2W/18Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 301406 Cath Foley 20Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00

301407 Cath Foley 22Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00

301408 Cath Foley 24Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $26.00

301438 Cath Urethral Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00

301439 Cath Foley 16Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

301440 Cath Foley 18Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

301443 Cath Foley Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $22.00

301445 Drain Bag Urinary 272 Medical/Surgical Supplies and Devices - Sterile Supply $17.00

301452 Cath Condom Lg 272 Medical/Surgical Supplies and Devices - Sterile Supply $16.00

301456 Cath Ureth 8Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301457 Cath Ureth 10Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301458 Cath Ureth 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301459 Cath Ureth 14Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301460 Cath Ureth 16Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301461 Cath Ureth 18Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00 301465 Cath Extension Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

301468 Cath Female Intermit 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00

301551 Touchless Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

302110 AFO Ankle Support 272 Medical/Surgical Supplies and Devices - Sterile Supply $290.00

62 305002 Cath Touchless 12Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00 305003 Cannula Fen 272 Medical/Surgical Supplies and Devices - Sterile Supply $14.00 305004 Urostomy Pouch 272 Medical/Surgical Supplies and Devices - Sterile Supply $16.00 305006 Cath Foley #8Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

305015 Wafer Dura Flex 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00

305027 Fecal Bags 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

305157 Brunswick Burn Dressing 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00

310096 Drain Chest Ats Bag 272 Medical/Surgical Supplies and Devices - Sterile Supply $982.00

310100 Staple Valtrac 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,697.00

310102 Penile Assembly Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,376.00

310430 Suction Frazier 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00

311046 Tubing Suction Proctor 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 311235 Transvaginal Sling Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,289.00 311401 Cath Urethral Foley 2-Way 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00 311457 Cath Urethral Straight 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 311580 Suture Bridge Ret 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00 312501 Shunt Drain Bag External 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00 312526 Cap Protective Fixation 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

312527 Shunt Cath Distal Peritoneal 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

312529 Cath Intraventricular Monitor 272 Medical/Surgical Supplies and Devices - Sterile Supply $589.00

312584 Drain External System 821687 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,132.00

312681 Infusion Pump Refill Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

312682 Kit Cranioplastic 272 Medical/Surgical Supplies and Devices - Sterile Supply $951.00

312885 Periotoneal Introducer 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00

313737 Sut Cardiovascular E-Pack 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,654.00

313738 Endoclip 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,905.00 313762 Stapler Automatic Purse String 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,382.00 313764 Stapler Circular 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,797.00 313771 Stapler Gia Multifire 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,467.00 313772 Stapler Gia 90 Premium 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,771.00 313773 Stapler Lds Powered Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,603.00 313774 Stapler TA55 Loading Unit 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,517.00

313775 Stapler Roticulator Poly 55 272 Medical/Surgical Supplies and Devices - Sterile Supply $934.00

313783 Stapler Surgiclip 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,975.00

313789 Stapler TA 30 Reload 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,528.00

313795 Stapler TA 55 Inst 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,251.00

313797 Stapler TA90 Inst 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,755.00

313798 Stapler TA90 Reload 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,637.00

313800 Endo Veres 150MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $667.00

313804 Endo Convertor/Reducer 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

313805 Endo Trocar/Sheath Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,825.00 313812 Sut Chromic 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00 313824 Sut Chromic 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00 313831 Sut Chromic 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $36.00 313841 Sut Chromic 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00 313846 Sut Chromic 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00 313854 Sut Chromic 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00

313857 Sut Chromic 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00

313858 Sut Chromic 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

313859 Sut Chromic 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

63 313888 Sut Dexon 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 313891 Sut Ethibond 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 313896 Sut Ethibond 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 313909 Sut Ethibond 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

313910 Sut Ethibond 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

313911 Sut Ethibond 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

313915 Sut Ethibond/Ct-1 B425H 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

313922 Sut Ethilon 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

313926 Sut Ethilon 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

313927 Sut Ethilon 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

313931 Sut Ethilon 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

313932 Sut Ethilon 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 313933 Sut Ethilon 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 313939 Sut Ethilon 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $654.00 313944 Sut Maxon 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00 313946 Sut Maxon 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00 313949 Sut Mersilene 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00 313951 Sut Mersilene 5MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00

313952 Sut Mersilene 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00

313975 Sut Novafil 0/T-12 30in. 4455 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00

313981 Sut Nurolon 1/Cut OS-8 C595T 272 Medical/Surgical Supplies and Devices - Sterile Supply $251.00

313990 Sut PDS 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

313993 Sut PDS 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

313994 Sut PDS 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

314001 Sut Plain 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $83.00

314002 Sut Plain 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $240.00 314003 Sut Plain 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 314004 Sut Plain Gut 0/Reel L104G 2dz 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 314005 Sut Plain O/CT1 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 314008 Sut Plain 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 314012 Sut Plain 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $83.00 314013 Sut Plain 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00

314019 Sut Plain 10-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $383.00

314030 Sut Prolene 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314031 Sut Prolene 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314035 Sut Prolene 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314036 Sut Prolene 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314037 Sut Prolene 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314038 Sut Prolene 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314058 Sut Prolene 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

314068 Sut Prolene 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 314075 Sut Prolene 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $246.00 314076 Sut Retention Bolster 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314077 Sut Silk 0 18In A186H 3Dz/Bx 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314078 Sut Silk 0 30in SA86B 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314079 Sut Silk O/FSL 68OH 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 314080 Sut Silk O/MO-7 C0416 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

314081 Sut Silk 1 18IN A187H 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314082 Sut Silk 1 30IN A307H 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314083 Sut Silk 2-0 I8IN A185 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

64 314084 Sut Silk 2-0 30in A305 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314085 Sut Silk 2-0/Cut FSL 6 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 314086 Sut Silk 2-0/Cut KS 623H 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 314087 Sut Silk 2-0/Sh C012T P/O 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

314088 Sut Silk 2-0/Taper SH K833h 3D 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

314093 Sut Silk 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

314096 Sut Silk 4-0 30In A303h 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314098 Sut Silk 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

314099 Sut Silk 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

314108 Sut Silk 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00

314111 Sut Silk 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00

314112 Sut Silk 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00 314117 Sut Steel #6 M654g 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00 314118 Sut Steel Ds26 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00 314120 Sut Steel 2 DS24 272 Medical/Surgical Supplies and Devices - Sterile Supply $152.00 314122 Sut Steel 2-0 DS28 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00 314124 Sut Steel 3-0 18in SS-30g 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 314125 Sut Steel 3-0 DS30 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

314127 Sut Steel 4 DS22 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00

314128 Sut Steel 4-0 DS32 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00

314131 Sut Steel 4-0/TS 554g 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00

314132 Sut Steel #5/MyoWire 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

314133 Sut Steel 7 DS18 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

314134 Sut Steel DS20 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

314135 Sut Tevdek 0 18in 7915 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

314136 Sut Tevdek O 30in 7935 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314137 Sut Tevdek 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314138 Sut Tevdek 1 18in 7946 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314148 Sut Tevdek 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314149 Sut Tevdek 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314151 Sut Tevdek 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 314154 Sut Ticron 0 18in 3008-61 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

314155 Sut Ticron 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

314157 Sut Ticron 2 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

314159 Sut Ticron 5/C-20 3027 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

314160 Sut Vicryl 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314167 Sut Vicryl O/Taper Ctx 3370H 3 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314169 Sut Vicryl 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314174 Sut Vicryl 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314175 Hemolok Clip 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314187 Sut Vicryl 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00 314189 Sut Vicryl 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00 314194 Horizon Clip 272 Medical/Surgical Supplies and Devices - Sterile Supply $36.00 314202 Sut Vicryl 5-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 314204 Sut Vicryl 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 314205 Sut Vicryl 7-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 314206 Sut Vicryl 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

314210 U-11 Umbil Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00

314223 Pack Basic 272 Medical/Surgical Supplies and Devices - Sterile Supply $477.00

314240 Pack Open Heart Custom 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,583.00

65 314243 Adapter Ureteral Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314248 Argon Coag Handswitch 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00 314249 Bag Decanter 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00 314250 Drain Bag Ureteral 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

314256 Stone Basket 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,679.00

314257 Stone Basket Segura 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,828.00

314258 Stone Basket Gemeni 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,028.00

314265 Stone Basket Rutner 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,790.00

314268 Biopsy Needle 272 Medical/Surgical Supplies and Devices - Sterile Supply $862.00

314283 Blade Beaver 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00

314294 Blade Cranio 272 Medical/Surgical Supplies and Devices - Sterile Supply $383.00

314296 Blade Eschman Skin Knife 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 314310 Blade Saw 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 314336 Blades Sternal Saw 272 Medical/Surgical Supplies and Devices - Sterile Supply $844.00 314337 Booties Suture Aid 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314339 Ostomy Bridge 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 314344 Brush Biopsy Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $843.00 314346 Brush Femoral Canal 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

314347 Bulldog Vascu-stat 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

314372 Cannula Vessel 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

314376 Tube Baker Jejunostomy 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,145.00

314393 Cath Ureteral Flexi Tip 272 Medical/Surgical Supplies and Devices - Sterile Supply $592.00

314395 Cath Fogarty Embolectomy 272 Medical/Surgical Supplies and Devices - Sterile Supply $744.00

314403 Cath Fogarty Biliary 272 Medical/Surgical Supplies and Devices - Sterile Supply $349.00

314405 Cath Fogarty Irrig 272 Medical/Surgical Supplies and Devices - Sterile Supply $551.00

314408 Nasal Balloon Fox 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00 314409 Cath Malecot 272 Medical/Surgical Supplies and Devices - Sterile Supply $402.00 314423 Cath Monatherm Foley 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00 314433 Cath Pezzar 272 Medical/Surgical Supplies and Devices - Sterile Supply $323.00 314440 Cath Suprapubic 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,200.00 314442 Cath Ureteral 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 314446 Cath Thoracic Rt Angle 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

314450 Cath Thoracic Straight 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

314454 Cath Tip Trol Stent Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00

314483 Cautery Biopolar Cord 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

314488 Cautery Tip Blade 6 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

314491 Cautery Suction Bovie 272 Medical/Surgical Supplies and Devices - Sterile Supply $457.00

314493 Cautery Tip Needle 1 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $130.00

314494 Cautery Tip Needle 6 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $130.00

314498 Cautery Tip Cleaner 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

314503 Cement Cartridge Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 314505 Clips Leroy/Raney 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00 314510 Berkley Specimen Convertor 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00 314513 Berkley Specimen Convertor 272 Medical/Surgical Supplies and Devices - Sterile Supply $158.00 314522 Drain T-Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 314524 Endoscissors 272 Medical/Surgical Supplies and Devices - Sterile Supply $934.00 314530 Drain Flat 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00

314537 Drain Blake 272 Medical/Surgical Supplies and Devices - Sterile Supply $524.00

314557 Drsg Selopor 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00

314562 Dura Hook Retractors 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

66 314563 Electrode Bugbee Ball 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,793.00 314564 Electrode Jeltrode 272 Medical/Surgical Supplies and Devices - Sterile Supply $917.00 314565 Electrode Cysto Loop 272 Medical/Surgical Supplies and Devices - Sterile Supply $685.00 314570 Esmark Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $509.00

314575 Cath urethrograf Davis 272 Medical/Surgical Supplies and Devices - Sterile Supply $377.00

314576 Cath Urethrograp Tratn 272 Medical/Surgical Supplies and Devices - Sterile Supply $377.00

314583 Filiform 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

314588 Vessel Occluder 272 Medical/Surgical Supplies and Devices - Sterile Supply $426.00

314590 Viscera Retainer 272 Medical/Surgical Supplies and Devices - Sterile Supply $167.00

314592 Filiform Follower 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

314593 Balloon Structural 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,125.00

314594 Endo Hernia Custom Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,655.00 314595 Endo Dissector/Kittner 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00 314613 Fred Anti Fog Device 272 Medical/Surgical Supplies and Devices - Sterile Supply $246.00 314614 Gelfoam 12x7mm 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 314615 Gelfoam 80x125mm 6/bx 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00 314624 Guide Valve Suture 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00 314627 Guide Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00

314637 Hydragrip Fogarty 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

314641 Introducer Split Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $409.00

314642 Introducer Implant Aid 272 Medical/Surgical Supplies and Devices - Sterile Supply $999.00

314648 Tubing Tur Series Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

314649 Tubing Irri-simpulse 272 Medical/Surgical Supplies and Devices - Sterile Supply $924.00

314650 Irrigator Femoral Tip 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00

314651 Irrigator Cone Tip 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

314655 Knife Microsurgical 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00 314662 Light Flexi-luminator 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00 314667 Basin Set Major Custom 272 Medical/Surgical Supplies and Devices - Sterile Supply $557.00 314668 Marker Vascular 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 314670 Dermacarrier 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00 314678 Nerve Lacator/Stimu 272 Medical/Surgical Supplies and Devices - Sterile Supply $768.00 314683 Magnetic Pad Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $355.00

314686 Pen Skinscribe 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

314687 Perforator Dispo 272 Medical/Surgical Supplies and Devices - Sterile Supply $766.00

314690 Probe Electrohydraulic Litho 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,104.00

314692 Probe Solid Wire Dispo 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,887.00

314706 Perfusion Set Multiple 272 Medical/Surgical Supplies and Devices - Sterile Supply $265.00

314710 Shunt Gott Aneurysm 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,349.00

314712 Shunt Carotid Bard 272 Medical/Surgical Supplies and Devices - Sterile Supply $364.00

314713 Shunt Carotid Brenner 272 Medical/Surgical Supplies and Devices - Sterile Supply $582.00

314714 Shunt Carotid Argyle 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00 314715 Shunt Carotid Pruitt 272 Medical/Surgical Supplies and Devices - Sterile Supply $732.00 314719 Skull Pin Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $567.00 314790 Vein Stripper 272 Medical/Surgical Supplies and Devices - Sterile Supply $374.00 314791 Strips Ear Canal 0.25x2.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $464.00 314794 Suction Flexible Intracardiac 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00 314796 Suction Poole 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

314797 Endo Veres 120mm 272 Medical/Surgical Supplies and Devices - Sterile Supply $667.00

314798 Surgicel 272 Medical/Surgical Supplies and Devices - Sterile Supply $637.00

314813 Berkley Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

67 314816 Tunneler Vascular Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $399.00 314818 Ureteral Dilation Ball 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,467.00 314819 Uro-Vac Bladder Evacul 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00 314823 Urody Luer Cath Adapter 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

314824 Urody Tubing Set Apt 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

314827 Uterine Manipulator 272 Medical/Surgical Supplies and Devices - Sterile Supply $965.00

314829 Vessel Loop Blue Maxi 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

314830 Vessel Loop Red Mini 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

314834 Blade Gigli Saw 272 Medical/Surgical Supplies and Devices - Sterile Supply $478.00

314837 Pacing Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $251.00

314840 Myowire Temp. Pacer Le 272 Medical/Surgical Supplies and Devices - Sterile Supply $832.00

314848 Tubing Buretrol/Burett 2C2422 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00 314858 Bag Drain Bile 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00 314859 Blade Surgical 272 Medical/Surgical Supplies and Devices - Sterile Supply $64.00 314870 Cath Coude 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 314874 Cath Urethral Foley 3-Way 272 Medical/Surgical Supplies and Devices - Sterile Supply $356.00 314890 Cath Suprapubic Bonanno 272 Medical/Surgical Supplies and Devices - Sterile Supply $895.00 314926 Irr-gycene 3000ML 287317 272 Medical/Surgical Supplies and Devices - Sterile Supply $280.00

314940 Gauze Packing Iodoform 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

314952 Cystomanometer Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

314956 Sigmoidoscope Sheath Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

314961 Stockinette Sterile 272 Medical/Surgical Supplies and Devices - Sterile Supply $187.00

314990 Tubing Cysto 2c4040 48/bx 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

314991 Tubing Extension Set 20in Veno 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

314992 Tubing Extension Set 30in Veno 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

314993 Tubing P.E. 272 Medical/Surgical Supplies and Devices - Sterile Supply $324.00 314994 Endo Coag Shears 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,178.00 314996 Protractor 272 Medical/Surgical Supplies and Devices - Sterile Supply $966.00 315000 Tubing Suction 1/4inx20ft 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 315001 Tubing Tur Type 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00 315009 Choledoschoscope 272 Medical/Surgical Supplies and Devices - Sterile Supply $426.00 315010 Dermabrader 272 Medical/Surgical Supplies and Devices - Sterile Supply $211.00

315018 Drill Bit Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00

315022 Laser C02 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,332.00

315038 Drain Chest Bottle 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

315068 Stapler Gia Reload 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,467.00

315074 Sut Mersilene 5mm RS20 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00

315081 Cath Passer Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

315082 Cath Passer Disp 55cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $167.00

315086 Drain Saratoga Sump 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

315088 Electrode Knife 272 Medical/Surgical Supplies and Devices - Sterile Supply $842.00 315089 Electrode Ball 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,629.00 315091 Stays Retract Dsip 272 Medical/Surgical Supplies and Devices - Sterile Supply $713.00 315092 Prostate Seeding Needles 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 315108 Drill Bit Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $212.00 315158 Endo Gastrostomy Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,692.00 315159 Endo Jejunostomy Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,692.00

315180 Permacath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,281.00

315190 Heart Access System 272 Medical/Surgical Supplies and Devices - Sterile Supply $6,403.00

315222 Sut Vicryl 0 ct J958h 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

68 315226 Sut Goretex CV-2 Thx-2 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 315227 Drain/Reinfusion System 272 Medical/Surgical Supplies and Devices - Sterile Supply $945.00 315238 Drain Shirley Sump 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 315274 Endoloop/Sut 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

315281 Set Ureteroscopy Intro 272 Medical/Surgical Supplies and Devices - Sterile Supply $813.00

315289 Shunt Carotid Javid 272 Medical/Surgical Supplies and Devices - Sterile Supply $320.00

315290 Perc Entry Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

315299 Endo Laparos Custom Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,770.00

315315 Tubing Irr/Asp Nezhat 272 Medical/Surgical Supplies and Devices - Sterile Supply $813.00

315345 Set Asif Basic 272 Medical/Surgical Supplies and Devices - Sterile Supply $402.00

315353 Set Bougie Dilators 272 Medical/Surgical Supplies and Devices - Sterile Supply $442.00

315356 Set Casper Instrument 272 Medical/Surgical Supplies and Devices - Sterile Supply $266.00 315366 Set Esphagela Dilator 272 Medical/Surgical Supplies and Devices - Sterile Supply $304.00 315450 Electrode Side Effect 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,190.00 315467 Endo Gia Staples 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,002.00 315468 Endo Gia Reload 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,275.00 315486 Set Drill Bits 272 Medical/Surgical Supplies and Devices - Sterile Supply $337.00 315513 Sut Deklene 8-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $640.00

315515 Adhesive Mastisol 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

315523 Retriever Suture 272 Medical/Surgical Supplies and Devices - Sterile Supply $667.00

315534 Laser Fiber 272 Medical/Surgical Supplies and Devices - Sterile Supply $901.00

315535 Vapor Sheath Sterile Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00

315536 Probe Doppler Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,038.00

315539 Cath Fogarty Acc Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,144.00

315540 Clipper Head Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00

315541 Blade Saw St Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 315544 Applicator Tip Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 315545 Retractotape Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 315557 Guidewire SS 260cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $364.00 315558 Guidewire SS 180cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $409.00 315559 Pinnacle Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00 315561 Inflation Device Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00

315562 Lemaitre Stent Guidewire 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

315563 Aorto-Iliac Guidewire 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00

315564 Optalp Balloon 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,332.00

315565 Sheath CV 6Frx23cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

315566 Cath CV Multiside 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

315567 Cath CV Mpa Guide 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00

315568 Jaquire 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,079.00

315569 Injection Gold Probe 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,473.00

315570 Fast Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $364.00 315571 Expandable Sheath 25Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,318.00 315572 Iliac Balloon Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,079.00 315573 Torque Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $602.00 315574 Angioscale Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $158.00 315575 Zmed Balloon Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,729.00 315576 Amplatz Snare 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,982.00

315577 Cath CV Cobra 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00

315578 Guidewire CV Benison 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

315579 Guidewire CV J-Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

69 315630 Endo Babcock 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,395.00 315633 Endo Hernia Staples 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,190.00 315645 Sut Steel 5-0 M645 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 315661 Penrose Drain 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00

315666 Crock Cutters 272 Medical/Surgical Supplies and Devices - Sterile Supply $548.00

315671 Endo Retractor 272 Medical/Surgical Supplies and Devices - Sterile Supply $843.00

315703 Stapler Roticulator 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,034.00

315710 Blade Dermatome 272 Medical/Surgical Supplies and Devices - Sterile Supply $398.00

315729 Stapler Hernia Short V 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,355.00

315772 Cath Aortic Irr Occl 12Fr-10 5 272 Medical/Surgical Supplies and Devices - Sterile Supply $253.00

315781 Laser Fiber Prolase 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,163.00

315783 Tubing Irri-Flo 272 Medical/Surgical Supplies and Devices - Sterile Supply $374.00 315803 Ureteral Baloon Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,158.00 315807 Endo Catch 272 Medical/Surgical Supplies and Devices - Sterile Supply $469.00 315808 Sut Ethlion 11-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00 315810 Sut PDS 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 315820 Balloon Dissector 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,755.00 315821 Cath Ureteral Tandem Balloon 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,302.00

315822 Drsg Jobst Facio Plast 272 Medical/Surgical Supplies and Devices - Sterile Supply $246.00

315823 Electrode Wedge 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,198.00

315824 Forceps Ureteroscopic 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,050.00

315827 Sut PDS 6-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

315828 Sut Monocryl 4-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00

315844 Endo Optiview 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,157.00

316100 Retract System Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $618.00

316183 Laser Yag 272 Medical/Surgical Supplies and Devices - Sterile Supply $6,555.00 316617 Sut PDS 4-0/PS2 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00 316622 Introducer 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00 316624 Endothoracoport 272 Medical/Surgical Supplies and Devices - Sterile Supply $210.00 316626 Wire Guide Cord 1.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00 316751 Endo Clinch 272 Medical/Surgical Supplies and Devices - Sterile Supply $810.00 316752 Surgiview I 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,752.00

316754 Cusa Pack 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,485.00

316874 Endo Bluntport/Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,857.00

316878 Endo Hernia Loading Unit 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,100.00

316904 Shunt Flo-Coil 272 Medical/Surgical Supplies and Devices - Sterile Supply $618.00

316905 Syvek Patch 272 Medical/Surgical Supplies and Devices - Sterile Supply $374.00

317064 Cath Rectal Pressure 272 Medical/Surgical Supplies and Devices - Sterile Supply $130.00

317200 Cath Endopyelotomy 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,147.00

317201 Endoscopic Vein Harves 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,917.00

317376 Rod Tunneling Medtronic 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,358.00 317452 Cutter Anspach Burr 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,927.00 317539 Midcab System 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,358.00 317540 Midcab System II 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,472.00 317566 Cath Kit Lg Bore 272 Medical/Surgical Supplies and Devices - Sterile Supply $735.00 317570 Kit Refil Synchromed 8551 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00 317606 Stapler TA 30 Inst 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,310.00

317625 Wire Tonsil Snare 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00

317639 Sut Ethilon 10-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $681.00

317640 Sut PDS 5-0 249G 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00

70 317662 Burr Elan-E 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00 317666 Cath Dual Lumen Vasc 272 Medical/Surgical Supplies and Devices - Sterile Supply $815.00 317669 Shunt Cath Peritoneal 272 Medical/Surgical Supplies and Devices - Sterile Supply $687.00 317681 Electrode Loop 272 Medical/Surgical Supplies and Devices - Sterile Supply $985.00

317685 Kit Guide Ghajar 80-1185 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,013.00

317689 Aortic Punch 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00

317694 Cautery Tip E-Z Clean 272 Medical/Surgical Supplies and Devices - Sterile Supply $171.00

317700 Cath Thoracic Str 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

317714 Shunt Drain Bag 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

317715 Shunt Drain Collection 272 Medical/Surgical Supplies and Devices - Sterile Supply $950.00

317716 Endo Stapler/Tacker 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,321.00

317718 Sut Ethilon 9-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $557.00 317761 Screw Head Sterotatic 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,467.00 317781 Shunt Drain Ext System 272 Medical/Surgical Supplies and Devices - Sterile Supply $588.00 317784 Cement Breakaway Nozzle 272 Medical/Surgical Supplies and Devices - Sterile Supply $399.00 317800 Dialator Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $346.00 317805 Cement Bowl MixVac II 272 Medical/Surgical Supplies and Devices - Sterile Supply $318.00 317806 Cement Bowl High Vac/N 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

317807 Cement Femoral Pressure 272 Medical/Surgical Supplies and Devices - Sterile Supply $698.00

317812 Sut Surgitie Loop 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

317826 Sut Nurolon 4-0 5654H 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00

317827 Sut Nurolon 2-0/C5420 272 Medical/Surgical Supplies and Devices - Sterile Supply $266.00

317900 Uro Tubing Pump Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

317950 Rasp Bone Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

317951 Doppler Probe Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $572.00

317952 Stealth System 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,570.00 318114 Collagen Inj Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $117.00 318122 Urody Transducer Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 318295 Sponge Collagen Bicol 80-1460 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 318298 Sut Goretex 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 318309 Endo Pneumo Sleeve Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,440.00 318310 Omni Retractor System 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

318313 Endo Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

318314 Harmonic Dissecting Hook 272 Medical/Surgical Supplies and Devices - Sterile Supply $900.00

318315 Endo Blunt Dissector 272 Medical/Surgical Supplies and Devices - Sterile Supply $356.00

318316 Therma, Uterine Balloon 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,171.00

318317 Nerve Monitor Electrode 272 Medical/Surgical Supplies and Devices - Sterile Supply $451.00

318318 Nerve Monitor Probe 272 Medical/Surgical Supplies and Devices - Sterile Supply $447.00

319489 Electrode Double Rollerball 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,793.00

319800 Cath Ureteral Angled 272 Medical/Surgical Supplies and Devices - Sterile Supply $251.00

319834 Endo Stitch 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00 319865 Promusdrug Eluting 272 Medical/Surgical Supplies and Devices - Sterile Supply $9,337.00 319878 Sut Monocryl 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00 319879 Sut Monocryl 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 319883 Surgicel 6x9 272 Medical/Surgical Supplies and Devices - Sterile Supply $746.00 319895 Dilator Vasc 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00 319897 Cath Central Access Tray 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

319898 Cath Subclavian Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,254.00

319899 Cath Dbl Lumen Subclavian/Fem 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00

332503 Cath Word Barth 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00

71 332517 Drain Hysterectomy 272 Medical/Surgical Supplies and Devices - Sterile Supply $372.00 332520 Flounder Dispo 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00 332540 Tube Falcon 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00 332557 Set Follicle Aspiration 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,068.00

332580 Pack C-Section Custom 272 Medical/Surgical Supplies and Devices - Sterile Supply $684.00

332864 Cautery Corson Needle 272 Medical/Surgical Supplies and Devices - Sterile Supply $863.00

332868 USA Active Cord Sterile 272 Medical/Surgical Supplies and Devices - Sterile Supply $374.00

332869 USA Cutting Loop Elect 272 Medical/Surgical Supplies and Devices - Sterile Supply $967.00

332870 USA Roll Bar Electrode 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,732.00

332871 USA Roller Ball 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,732.00

332896 Endo Shears 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,313.00

332910 Cautery Footswitching E2 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 332920 Cautery LLezt Loop 272 Medical/Surgical Supplies and Devices - Sterile Supply $917.00 332921 Cautery Lletz Ball 272 Medical/Surgical Supplies and Devices - Sterile Supply $372.00 332922 Hystoflow Pump/Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $698.00 332923 Endo Grasp 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,307.00 332959 Shears Mini Endo 272 Medical/Surgical Supplies and Devices - Sterile Supply $588.00 333006 Device Retrieval 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,339.00

333009 Endopouch Specimen Ret 272 Medical/Surgical Supplies and Devices - Sterile Supply $455.00

333014 Grasper 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,100.00

372003 Drsg Oil Emulsions 3x8 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00

378703 Filt Cardiotomy 272 Medical/Surgical Supplies and Devices - Sterile Supply $869.00

378719 Autotran Disp Supply 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,401.00

378720 Pacer Program 272 Medical/Surgical Supplies and Devices - Sterile Supply $436.00

378723 Cannula 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

378731 Perfus Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,167.00 378746 Cook Intnrodcr 272 Medical/Surgical Supplies and Devices - Sterile Supply $253.00 378753 Percor Balloon 272 Medical/Surgical Supplies and Devices - Sterile Supply $8,503.00 378757 Membrane Oxygenator 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,141.00 378758 Fe Venous Cannula 272 Medical/Surgical Supplies and Devices - Sterile Supply $478.00 378759 Op Ht Pk 8618 272 Medical/Surgical Supplies and Devices - Sterile Supply $696.00 378760 Disp Transduce 272 Medical/Surgical Supplies and Devices - Sterile Supply $349.00

378762 Cardioplegia Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $592.00

378763 Hemoconcentrator 272 Medical/Surgical Supplies and Devices - Sterile Supply $980.00

378764 Retrograde Cannula 272 Medical/Surgical Supplies and Devices - Sterile Supply $804.00

378776 Disp External Defib PDS 272 Medical/Surgical Supplies and Devices - Sterile Supply $210.00

378781 Pacing Block Cable 272 Medical/Surgical Supplies and Devices - Sterile Supply $67.00

378782 Sat/Hct Sensor 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

378783 Blood Analysis Sensor 272 Medical/Surgical Supplies and Devices - Sterile Supply $364.00

379832 8.5 Fr. Introducer Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $575.00

379833 Centrif Pump/Flow Prob 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,936.00 413188 Sp Chg Tube/Drn W/C 272 Medical/Surgical Supplies and Devices - Sterile Supply $936.00 414442 Rem/Adj Dev/Cath Only 272 Medical/Surgical Supplies and Devices - Sterile Supply $847.00 417776 Emergent Dialysis Esrd 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,080.00 418635 Immuniz Admin Ea Addtl 272 Medical/Surgical Supplies and Devices - Sterile Supply $551.00 418666 Admin Influenza Vaccin 272 Medical/Surgical Supplies and Devices - Sterile Supply $141.00 418667 Admin Pneumococcal Vac 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00

420225 Vacuum Bottle 2 Liter 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

420226 Vaccum Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

420242 Immuniz Admin Sgl 272 Medical/Surgical Supplies and Devices - Sterile Supply $553.00

72 420243 Immuniz Admin Ea Addtl 272 Medical/Surgical Supplies and Devices - Sterile Supply $553.00 420271 Immuniz Admin Sgl 272 Medical/Surgical Supplies and Devices - Sterile Supply $551.00 420291 Sponge, Sterile 4x4 2/Pk 272 Medical/Surgical Supplies and Devices - Sterile Supply $33.00 420429 CATHETER TONSIL SUCTIO 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

420496 CANNISTER SUCTION 272 Medical/Surgical Supplies and Devices - Sterile Supply $158.00

420692 TUBE LUKENS 272 Medical/Surgical Supplies and Devices - Sterile Supply $64.00

421041 ANOSCOPE DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

421062 Cath Renal Pelvis 272 Medical/Surgical Supplies and Devices - Sterile Supply $10,543.00

421080 SUTURE, SILK 272 Medical/Surgical Supplies and Devices - Sterile Supply $46.00

421248 TUBING IV SOLUTION SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

421250 TUBE FEEDING ENTRIFLEX 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

421260 DOBB-HOFF FEEDING TUBE 272 Medical/Surgical Supplies and Devices - Sterile Supply $194.00 421273 TUBE LAVACUATOR - EWAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 421290 TUBING IV PUSH 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00 421313 BASIC BIOPSY TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $640.00 421314 TRAY TRAVENOL W/NEEDLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $590.00 421332 TRAY IRRIGATION 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 421371 TRAY SOFT TISSUE BIOPS 272 Medical/Surgical Supplies and Devices - Sterile Supply $617.00

421438 TRAY CATH STRAIGHT SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

421439 TRAY CATH FOLEY 16FR. 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

424028 DRSNG GERMCDL 1X4 NTMC 272 Medical/Surgical Supplies and Devices - Sterile Supply $128.00

424102 SUT ETHLN 3-0 PS2 1669 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00

424128 Gwire Vasc 180cm 6cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

424178 EVACUATOR WND DRN 100C 272 Medical/Surgical Supplies and Devices - Sterile Supply $85.00

424202 CTH URET PLLK 5F 272 Medical/Surgical Supplies and Devices - Sterile Supply $210.00

424212 Sut Cr 3-0 Absrb 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00 424260 DILATOR VSC 12F 038X20 272 Medical/Surgical Supplies and Devices - Sterile Supply $218.00 424261 DILATOR VSC 8F 038X20 272 Medical/Surgical Supplies and Devices - Sterile Supply $218.00 424262 DILATOR VSC 6F 038X20 272 Medical/Surgical Supplies and Devices - Sterile Supply $218.00 424263 DILATOR VSC 10F 038X20 272 Medical/Surgical Supplies and Devices - Sterile Supply $217.00 424295 DRSNG TGDRM DBL 4X4 3/ 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00 424316 SYRINGE INFL ALN 2 INT 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

424330 STOPCOCK IV ALR 3W HFL 272 Medical/Surgical Supplies and Devices - Sterile Supply $17.00

424353 GAUZE CURAD IMPREGNATE 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00

424361 Plug AU 7F 300 272 Medical/Surgical Supplies and Devices - Sterile Supply $875.00

424444 IV SET 30 SECONDARY 272 Medical/Surgical Supplies and Devices - Sterile Supply $17.00

424699 SHTH 7F HLS1007M 272 Medical/Surgical Supplies and Devices - Sterile Supply $297.00

424757 SNARE PLPCTM OVL 2.4X1 272 Medical/Surgical Supplies and Devices - Sterile Supply $196.00

424800 PACKING WOUND IFORM .5 272 Medical/Surgical Supplies and Devices - Sterile Supply $37.00

424815 Sut ABS 3-0 SH J416H 272 Medical/Surgical Supplies and Devices - Sterile Supply $29.00

424821 SUT NY 3-0 FSL 1671G 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 424841 SUT NYL 3-0 FSL 1671G 272 Medical/Surgical Supplies and Devices - Sterile Supply $31.00 424851 SUT CHRMC 0 812H 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00 424855 SUT VCRYL 00 BR SH J31 272 Medical/Surgical Supplies and Devices - Sterile Supply $29.00 424860 SUT NYL MONO 3-0 663H 272 Medical/Surgical Supplies and Devices - Sterile Supply $30.00 424862 SUT NYL #2 NABS 49OT 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00 424885 SUT CR 2-0 ABSRB 272 Medical/Surgical Supplies and Devices - Sterile Supply $50.00

425003 Drain Incs .25IN 18IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00

427012 TUBE JEJUNAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $747.00

427013 TUBE LUKI 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00

73 427017 TUBE GASTROSTOMY REPLA 272 Medical/Surgical Supplies and Devices - Sterile Supply $722.00 427024 TUBE FLEXIFLO FDG 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00 427025 FORCEP GRASPING 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,198.00 427027 FORCEP BIOPSY 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,276.00

427028 BUTTON PEG 272 Medical/Surgical Supplies and Devices - Sterile Supply $728.00

427034 ENDOTUBE 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

427035 BRUSH CYTOL PEDIATRIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

427036 BRUSH CYTOLOGY 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

427040 PEG W/GUIDEWIRE 20FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,382.00

427043 STOMATE 272 Medical/Surgical Supplies and Devices - Sterile Supply $766.00

427047 BASKET LITHOTRIPTOR 7F 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,974.00

427048 CATH BILIARY DRAINAGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,249.00 427053 PAPILLOTOME WIRE-GUIDE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,410.00 427054 ADAPTER, UNIVERSAL 14F 272 Medical/Surgical Supplies and Devices - Sterile Supply $36.00 427055 ADAPTER, UNIVERSAL 18F 272 Medical/Surgical Supplies and Devices - Sterile Supply $36.00 427057 BALLOON STONE EXT 2LUM 272 Medical/Surgical Supplies and Devices - Sterile Supply $543.00 427059 TUBE COLON DECOMPRESSI 272 Medical/Surgical Supplies and Devices - Sterile Supply $523.00 427060 CONNECTOR Y-PORT 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00

427063 TUBE SUMP 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

427064 TUBE SUMP PUMP AN42 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

427065 BRUSH CYTOLOGY BILIARY 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,131.00

427067 BASKET STONE EXTRACTOR 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,413.00

427068 CUTTERS ENOSCOPE SUTUR 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

427823 SNARE POLYP DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $742.00

428103 TRAP POLYP SUCTION 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

428107 TRAY THORACENTESIS 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00 428109 RETRIEVAL NET 272 Medical/Surgical Supplies and Devices - Sterile Supply $712.00 428110 FORCEP RAT TOOTH 272 Medical/Surgical Supplies and Devices - Sterile Supply $456.00 428196 CANNULA VIAL ACCESS 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00 428201 ENDOTUBE JEJUNAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,019.00 428204 WIREGUIDE NON-COATED 272 Medical/Surgical Supplies and Devices - Sterile Supply $324.00 428414 SNARE, SMALL OVAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $494.00

428785 Egd With Ablation 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,576.00

429530 BALLOON/PNUEMATIC DILA 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,855.00

429573 BASKET GASTRO/COLON 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,925.00

429574 BALLOON ACHALASIA 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,941.00

429575 FORCEP DISP HOT BX 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,082.00

429578 CATH VILIARY DILITATIO 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,682.00

429579 TRACERWIRE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,099.00

429581 STENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $324.00

429582 BALLOON ACHIEVER 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,388.00 429583 BALLOON STONE EXT ILUM 272 Medical/Surgical Supplies and Devices - Sterile Supply $766.00 429598 SYRINGE GUN ASSEMBLY 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 429599 BILLARY CYTOLOGY BRUSH 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 429600 CATH BILIARY CYTOLOGY 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 429601 ADAPTER SIDE ARM 272 Medical/Surgical Supplies and Devices - Sterile Supply $46.00 429602 CATHETER WASH 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

429605 CANNULA LEVER LOCK 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00

429606 CATHETER ERCP 272 Medical/Surgical Supplies and Devices - Sterile Supply $602.00

429651 STONETOME 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,477.00

74 429652 CATH BILIARY DRAIN NAS 272 Medical/Surgical Supplies and Devices - Sterile Supply $723.00 429653 WIREGUIDE COATED 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,230.00 429701 LIGATOR MULTIBAND 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,898.00 429979 Egd W/Endo Us Esoph 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,968.00

430034 Egd W/Transmural Drn 272 Medical/Surgical Supplies and Devices - Sterile Supply $8,934.00

432003 CANNULA THREADED CANNU 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

432005 BLADE ENDO CURVED INCI 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,608.00

432073 SET BANKHART SHOULDER 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00

432080 SET ASIF MINI FRAGMENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

432082 SET ASIF SMALL FRAGMEN 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

432092 PACK SHOULDER ARTH. 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,265.00

432107 ROD TUNNELING DISP. 272 Medical/Surgical Supplies and Devices - Sterile Supply $502.00 432111 KNIFE OPHTHALMIC SLIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $455.00 434023 SUCTION YANKAUER 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 434058 SURGICAL 4X8 IN. 272 Medical/Surgical Supplies and Devices - Sterile Supply $449.00 434157 CATH URETHRAL FOLEY SE 272 Medical/Surgical Supplies and Devices - Sterile Supply $374.00 434273 SUT DEXON S 4-0/CS1 79 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 434288 Sut Silk 2-0/Cut Fsl 6 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00

434300 SUT DACRON 5-0/DO-S 29 272 Medical/Surgical Supplies and Devices - Sterile Supply $256.00

434301 SUT DEXON 0/T-25 7286- 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

434302 SUT DEXON 2-0/T-19 724 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

434306 SUT DEXON PLUS O/T-12 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

434308 SUT DEXON PLUS 4-0/CS- 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

434309 SUT ENDOLOOP 272 Medical/Surgical Supplies and Devices - Sterile Supply $436.00

434347 SUT MAXON 4-0/PRE-2 65 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

434356 SUT NYLON 9-0/C-3 1931 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00 434361 SUT NYLON 10-0/AU-5 69 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00 434405 SUT POLYDEK SILKY 0/KH 272 Medical/Surgical Supplies and Devices - Sterile Supply $288.00 434418 SUT PROLENE 9-0/BIF-4 272 Medical/Surgical Supplies and Devices - Sterile Supply $246.00 434421 SUT PROLENE 10-0/BIF-4 272 Medical/Surgical Supplies and Devices - Sterile Supply $579.00 434447 SUT SILK 9-0/TG175-8 7 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 434455 SUT TEVDEK 6-0/KT-1 79 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

434458 SUT TI-CRON 0/3008-61 272 Medical/Surgical Supplies and Devices - Sterile Supply $219.00

434572 CANNULA NASAL W/TUBING 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

434596 BANDAGE ACE STER 2 IN. 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

434600 BLADE ABRADER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,795.00

434602 KNIFE GRISHABER MICROS 272 Medical/Surgical Supplies and Devices - Sterile Supply $746.00

434603 KNIFE MICROSURGERY 681 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

434615 OXYCEL GAUZE OXIDIZED 272 Medical/Surgical Supplies and Devices - Sterile Supply $357.00

434673 THORACENTESIS WITH CAT 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

434703 FOGARTY SOFTJAW SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 434717 SUT CABLE 3-0 2GS-1-30 272 Medical/Surgical Supplies and Devices - Sterile Supply $23.00 434755 GELFOAM 80X125MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00 434773 GLIDE LENS 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 434778 MICRO WIPES 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00 434797 Sheet Head Drape 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00 434800 BLADE ACROMIZER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,562.00

434801 BLADE STONECUTTER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,575.00

434872 BLADE ENDO FULL 272 Medical/Surgical Supplies and Devices - Sterile Supply $712.00

434873 BLADE ENDO TURBO 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,443.00

75 434900 CANNULA HYDRODISSECT 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 435126 SPEARS SURGICAL 180/BX 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00 435145 SUT SILK 0 18IN. A186H 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 435183 NASAL TAMPON 272 Medical/Surgical Supplies and Devices - Sterile Supply $356.00

435193 TUBING IRRIGATION HALL 272 Medical/Surgical Supplies and Devices - Sterile Supply $637.00

435194 NAVIGATOR GRASPER/CUTT 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

435196 BLADE MAMMOPLASTY 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

435211 PACK EYE CUSTOM 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,437.00

435217 DRAIN EYE WICK 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

435220 ERASER HEMOSTATIC STRA 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

435221 ERASER HEMOSTATIC TAPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

435222 ERASER WETFIELD STRAIG 272 Medical/Surgical Supplies and Devices - Sterile Supply $303.00 435224 FILTER CONNECTOR 5 MIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 435231 CYSTOTOME KELMAN 22G 272 Medical/Surgical Supplies and Devices - Sterile Supply $399.00 435233 PACK RETINA 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,437.00 435236 TIP ULTRASONIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $659.00 435299 KIT CANNULA CONCEPT 97 272 Medical/Surgical Supplies and Devices - Sterile Supply $152.00 435300 KIT NUCLEOTONE 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,572.00

435301 KIT MENISCECTOMY MINI 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

435302 KIT SHOULDER SUSPENSIO 272 Medical/Surgical Supplies and Devices - Sterile Supply $815.00

435303 LEADER TENDON 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

435304 PACK ARTHROSCOPY CUSTO 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,642.00

435376 ELECTRODE LATERAAL REL 272 Medical/Surgical Supplies and Devices - Sterile Supply $567.00

435385 CANNULA ARTHROSCOPIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

435402 BLADE ARTHRO - LOK 272 Medical/Surgical Supplies and Devices - Sterile Supply $403.00

435407 OCUTOME PROBE IRRIGATI 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,974.00 435408 PACK I & A 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00 435460 SUT DEXON S 0/T12 7266 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00 435463 SUT DEXON S 3-0/CE-4 7 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 435939 CYSTOTOME IRRIGATING 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00 435952 INFUSION CANNULA 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00 435954 CORNEAL LIGHT SHIELD 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

435955 CORNEAL PROTECTOR CROU 272 Medical/Surgical Supplies and Devices - Sterile Supply $62.00

435956 TUBE SUMP N/G 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

435974 SUCTION SET WOUND LG 8 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

436026 PACK ARTHROSCOPY 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,642.00

436034 SUCTION SET WOUND SM 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

436044 BLADE VACUUM TREPHINE 272 Medical/Surgical Supplies and Devices - Sterile Supply $621.00

436049 PACK VITRECTOMY 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,331.00

436053 GELFILM 1X2 IN. 272 Medical/Surgical Supplies and Devices - Sterile Supply $422.00

436096 BLADE MYRINGOTOMY KNIF 272 Medical/Surgical Supplies and Devices - Sterile Supply $529.00 436127 SPINAL ANESTHESIA TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $227.00 436186 FOX POST NASAL W/SYRIN 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 436189 Drsg Vaseline Gauze 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00 436211 AIRWAY OROPHARYNGEAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 436225 ENDO-OCULAR PROBE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,973.00 436226 CANNULA ANTERIOR CHAMB 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

436304 SUCTION SIGMOIDOSCOPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $46.00

436313 BLADE BEAVER SLIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00

436317 BLADE BEAVER NEEDLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00

76 436323 BLADE BEAVER STAPEDECT 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00 436325 BLADE MICRO FEATHER 71 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00 436326 BLADE SUPERBLADE TREPH 272 Medical/Surgical Supplies and Devices - Sterile Supply $621.00 436379 BAGS SCOPE ADJUSTMENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $179.00

436384 UNIPAK I/A 10511F 272 Medical/Surgical Supplies and Devices - Sterile Supply $863.00

436505 SUT VICRYL 9-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00

436613 BLADE AGGRESSIVE MENIS 272 Medical/Surgical Supplies and Devices - Sterile Supply $772.00

436620 STOCKINETTE IMPERVIOUS 272 Medical/Surgical Supplies and Devices - Sterile Supply $232.00

436651 BLADE ENDO INCISOR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,608.00

436653 CANNULA ACUFEX 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00

436670 DRSG - VIGILON 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

436672 KNIFE SLIT CRESCENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $494.00 436695 BLADE MICRO EDGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $214.00 436702 CANNULA IRRIGATING J-H 272 Medical/Surgical Supplies and Devices - Sterile Supply $158.00 436710 UNIPACK PARTS KIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $747.00 436782 BLADE ENDO CUTTER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,319.00 436783 BLADE ENDO TRU END 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,042.00 436784 BLADE ENDO ROUND 272 Medical/Surgical Supplies and Devices - Sterile Supply $661.00

436786 BLADE ENDO BURR 3.5-6. 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,021.00

436789 BLADE ENDO BURR PEAR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,613.00

436812 SMOOTHER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,190.00

436853 SUT DACRON 4-O/DO-5 29 272 Medical/Surgical Supplies and Devices - Sterile Supply $253.00

436859 SUT NYLON 5-0/S24 7731 272 Medical/Surgical Supplies and Devices - Sterile Supply $194.00

436860 SUT DACRON 5-0/D-1 282 272 Medical/Surgical Supplies and Devices - Sterile Supply $253.00

436866 SUT POLYPROPYLENE 10-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $515.00

436873 VICRYL 4-0/SH J-415H 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00 436881 VACUUM BOTTLE TUBING 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 436940 SUT SURGICAL STEEL 3-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 436953 SUT SURGIGUT 4-0/P112 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00 436955 BLADE NOTCHBLASTER 5.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $898.00 436960 CANNULA INFUSION 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00 436962 CANNULA U-SHAPED 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

436967 SHEATH ENDO SCRUB 272 Medical/Surgical Supplies and Devices - Sterile Supply $557.00

436971 TUBING INTELL JECT 272 Medical/Surgical Supplies and Devices - Sterile Supply $802.00

436984 SUCKER KAM 272 Medical/Surgical Supplies and Devices - Sterile Supply $337.00

436986 LATEX FREE CASE KIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,034.00

436987 ENDOILLUMINATOR DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $303.00

436995 BLADE ENDO STRAIGHT SH 272 Medical/Surgical Supplies and Devices - Sterile Supply $917.00

438114 I&A PACK 272 Medical/Surgical Supplies and Devices - Sterile Supply $859.00

438390 CATH KIT STRAIGHT 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

438425 LASER ARGON 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,261.00 438605 EAR CANAL STRIPS 272 Medical/Surgical Supplies and Devices - Sterile Supply $548.00 439094 BLADE ENDO BURR 272 Medical/Surgical Supplies and Devices - Sterile Supply $901.00 439098 DRSG GLASSCOCK PADS 272 Medical/Surgical Supplies and Devices - Sterile Supply $485.00 439321 ARTHRO FLO IRRIGATOR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,020.00 439353 SHIELD CORNEAL SURGILE 272 Medical/Surgical Supplies and Devices - Sterile Supply $304.00 439500 BURR SURGICAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $901.00

439503 BLADE ARTHROSCOPY CUTT 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,242.00

439509 IRIS RETRACTORS DISP. 272 Medical/Surgical Supplies and Devices - Sterile Supply $791.00

439510 MICRODEBRIDER SUCTION 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

77 439515 STAPLER VERSATACK 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,855.00 439521 KERATO PROSTHESIS 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,190.00 439552 CANNULA PEYMAN HIGH VI 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00 439600 SINUS PACK 272 Medical/Surgical Supplies and Devices - Sterile Supply $214.00

439603 BLADE ENDO JAGUAR 272 Medical/Surgical Supplies and Devices - Sterile Supply $795.00

439607 GUIDE PIN W/EYE 272 Medical/Surgical Supplies and Devices - Sterile Supply $575.00

439609 IRR-SET BIFURCATED 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00

439611 Booties Suture Aid 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00

439612 CARPAL TUNNEL RELEASE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,597.00

439613 DAM ARTHROSCOPIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

439623 IV-LACT RINGERS 500CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

439652 DRSG DUODERM 272 Medical/Surgical Supplies and Devices - Sterile Supply $62.00 439655 INJECTOR ACCESSORY PAK 272 Medical/Surgical Supplies and Devices - Sterile Supply $436.00 444840 LEAD DXTRUS 4136 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,488.00 445186 DEVICE CLSRE ANGIOSL 6 272 Medical/Surgical Supplies and Devices - Sterile Supply $988.00 446213 BLN OPTPR 6F 7X8X80 272 Medical/Surgical Supplies and Devices - Sterile Supply $772.00 446386 CATH PICC 2375355 272 Medical/Surgical Supplies and Devices - Sterile Supply $503.00 448343 Stnt Bil Panc Gnn7X5X170 272 Medical/Surgical Supplies and Devices - Sterile Supply $475.00

448800 BOTTLE DRAINAGE PLEURX 272 Medical/Surgical Supplies and Devices - Sterile Supply $263.00

449399 BLN AVTR RX 5X1.5X135 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,321.00

449430 BLN OPTPR 5F 10X4X110 272 Medical/Surgical Supplies and Devices - Sterile Supply $779.00

449432 BLN OPTPR 7F 12X4X80 272 Medical/Surgical Supplies and Devices - Sterile Supply $714.00

449436 BLN OPTPR 5F 6X4X80 272 Medical/Surgical Supplies and Devices - Sterile Supply $772.00

449438 BLN OPTPR 5F 7X4X80 272 Medical/Surgical Supplies and Devices - Sterile Supply $772.00

449637 Bln Optpr 5F 6x2x80 272 Medical/Surgical Supplies and Devices - Sterile Supply $697.00

449640 Bln Optpr 5F 7x2x80 272 Medical/Surgical Supplies and Devices - Sterile Supply $805.00 450147 BANDGE UNNABOOT 10X43 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 451706 Bln Savy 2X2X150 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,712.00 451708 BLN SAVY 2.5X2X150 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,684.00 451994 Cath Embl 80X5.5R Fgtrty 272 Medical/Surgical Supplies and Devices - Sterile Supply $410.00 454288 BNDG ESMK 4IN STERL 272 Medical/Surgical Supplies and Devices - Sterile Supply $32.00 454289 BNDG ESMK 6IN STERL 272 Medical/Surgical Supplies and Devices - Sterile Supply $39.00

454291 Bndg Esmk Strl Le 6IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $54.00

455130 Cath EP QPLR 20-5-2MM 5FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $455.00

455298 CATH ANGIO CRD353691 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

455320 Cathx Angi JL4 F4 100 272 Medical/Surgical Supplies and Devices - Sterile Supply $225.00

455335 CATH FOL 16FR 5CC LF 272 Medical/Surgical Supplies and Devices - Sterile Supply $168.00

455336 CATH FOLEY 18FR 5CC LF 272 Medical/Surgical Supplies and Devices - Sterile Supply $168.00

455398 BOLSTER SUT RTNT 2.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $54.00

455484 CATH PLUG DRN TUBE OVE 272 Medical/Surgical Supplies and Devices - Sterile Supply $5.00

455488 BNDG COBAN 6X5 ST 272 Medical/Surgical Supplies and Devices - Sterile Supply $66.00 455495 BNDG CBN 4 IN STRL 3M 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 455500 Cath Foley 22Fr 30Cc Ic 272 Medical/Surgical Supplies and Devices - Sterile Supply $159.00 455530 CATH URET CONE TIP 5X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $160.00 455535 CATH FOL 14FR ALL SIL 272 Medical/Surgical Supplies and Devices - Sterile Supply $69.00 455564 Cath Fol 18FR 5CC 2 Way 272 Medical/Surgical Supplies and Devices - Sterile Supply $139.00 455566 Cath Foley 22F 5CC IC 272 Medical/Surgical Supplies and Devices - Sterile Supply $144.00

455572 CATH RED CONT 22FR 30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $213.00

455614 CATH IV SFSHLD YLW 18G 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

455615 CATH IV SFSHLD YLW 20G 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

78 455835 Surgicel Abs 4X8In 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00 457881 Saw Blade 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 458003 CATH ABL C TEMP SNS 8M 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,715.00 458071 CATH SLCTV 100CM 4F BR 272 Medical/Surgical Supplies and Devices - Sterile Supply $457.00

458585 CATH URET 4FR OP-END 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

459449 CATH MAHURKA 3LM 12F 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $406.00

459450 CATH MAHURKA 12F 20 272 Medical/Surgical Supplies and Devices - Sterile Supply $327.00

464251 CATH BLN 21FR7X4X75 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,371.00

464260 BSKT RTRV 4WR 2X20X120 272 Medical/Surgical Supplies and Devices - Sterile Supply $885.00

464478 BLN CRE 6-8X5.5X240 272 Medical/Surgical Supplies and Devices - Sterile Supply $967.00

464482 BLN ORE 15-18X5.5X240 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,139.00

464483 BLN CRE 18-20X5.5X240 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,139.00 464860 LEAD FNLN2 4469 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,268.00 464871 CATH OMNI FLUSH 4FR 65 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00 465024 Cath Bln 6.5 14mm Lum 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,512.00 465078 Cath Blndil .035IN 8FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,125.00 465083 BLN CONQ 4X5.5X75 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,199.00 465084 BLN CATH CQ CQ7584 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,125.00

465569 CHBA NDL DCHN-22GA-15 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

466517 LEAD FNLN2 4470 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,268.00

467709 Cath Ultrasound Pltn Egl 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,080.00

468664 CATH ASH SPLIT ASPC28- 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,798.00

468665 Cath Hmdial 14Fr L32cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,798.00

468912 Cath Hmdial 14Fx24 24-3 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,798.00

470040 AQCL AG RBN 4INX4.7 272 Medical/Surgical Supplies and Devices - Sterile Supply $124.00

471006 BLN Sinuplsty 20 ML 272 Medical/Surgical Supplies and Devices - Sterile Supply $426.00 472166 CATHETER DRN PLEURX VA 272 Medical/Surgical Supplies and Devices - Sterile Supply $337.00 472664 Cath Dlys Plnd 19Fx36 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,420.00 472680 Cath Dlys Plnd 23Fx40 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,570.00 472687 Cath Dialysis 88881284 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,669.00 472910 STNT SFA VBHN 7X5X120 272 Medical/Surgical Supplies and Devices - Sterile Supply $20,946.00 473560 CATH DRN PLEURX KIT PL 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,235.00

474397 Cath Foley Tray 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $223.00

476044 EPIDURAL MINI PACK 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

476045 EPIDURAL TRAY CONT 488 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

476046 EPIDURAL TRAY CONT POR 272 Medical/Surgical Supplies and Devices - Sterile Supply $158.00

476073 LASER 6.0MM FLEX ET TU 272 Medical/Surgical Supplies and Devices - Sterile Supply $951.00

476074 LASER SHIELD ET TUBE X 272 Medical/Surgical Supplies and Devices - Sterile Supply $620.00

476075 LASER SHIELD ET TUBE X 272 Medical/Surgical Supplies and Devices - Sterile Supply $620.00

476076 LASER SHIELD ET TUBE X 272 Medical/Surgical Supplies and Devices - Sterile Supply $620.00

476119 TUBE ARMOURED RUSCH 272 Medical/Surgical Supplies and Devices - Sterile Supply $464.00 476125 TUBE BRONCHOCATH CARLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,276.00 476126 TUBE BRONCHOCATH CARLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,276.00 476127 TUBE BRONCHOCATH CARLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,276.00 476128 TUBE BRONCHOCATH CARLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,276.00 476151 TUBE LARYNGECTOMY 7.0 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 476153 TUBE ET LASER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,186.00

476168 TUBE ENDOTRACHEAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $214.00

476179 CATH KIT MULTILUMEN 7F 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,230.00

476188 IV INFUSION SET AVI 23 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

79 476189 IV INFUSION SET AVI 42 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 476953 TRAY CATH BOX 16FR 350 272 Medical/Surgical Supplies and Devices - Sterile Supply $213.00 477038 CATH TRAY 5FR PICC 272 Medical/Surgical Supplies and Devices - Sterile Supply $492.00 477054 CTHGD GLD 4F ANG65 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

477237 Needle Proc 15cm 18ga 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

477313 STENT POLARIS ULTRA 272 Medical/Surgical Supplies and Devices - Sterile Supply $724.00

477352 INTRACATH 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

477521 TUBE SUCTION YANKAUER 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

477571 Sut Plain 3-0 Ct 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

477596 TUBE GASTRO 18FR EZRE 272 Medical/Surgical Supplies and Devices - Sterile Supply $141.00

477611 CATH ARROW RADIAL ARTE 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

477666 ELECTRODE RETURN ADULT 272 Medical/Surgical Supplies and Devices - Sterile Supply $39.00 477714 RAPID REFILL SYRINGE A 272 Medical/Surgical Supplies and Devices - Sterile Supply $211.00 477783 Brite Tip Sheath Long 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 477785 SHEATH INTRO GW 23CM 7FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 477873 Sut Coast Vic Bx/36 J259H 272 Medical/Surgical Supplies and Devices - Sterile Supply $29.00 477890 SUTURE 0 PROLENE C821G 272 Medical/Surgical Supplies and Devices - Sterile Supply $196.00 477916 Suture Prolene 2-0 8685H 272 Medical/Surgical Supplies and Devices - Sterile Supply $44.00

479822 EXTERNAL PACING ELECTR 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

479826 IV MANIFOLD SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00

479840 Level1-1St 30 Mins 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,336.00

479841 Level 1 Add'L 15 Mins 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,528.00

480109 TUBE TRANSGASTIC JEJUN 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,126.00

480246 Gwire Asahi Prowater 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $435.00

480538 Probe APC Circum Elcsu 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,255.00

480627 GLIDEWIRE ST .035/150C 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 480715 HT SPARTACORE 14 190 C 272 Medical/Surgical Supplies and Devices - Sterile Supply $445.00 480891 DUODERM EX-THIN CGF 4X 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00 480924 NEEDLE 7CM 19GA ULTHN 272 Medical/Surgical Supplies and Devices - Sterile Supply $103.00 480948 VALVE BLEEDBACK COPILO 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 481152 GWIRE VASC 150CM 3CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 481185 Cautery Electro Pencil 272 Medical/Surgical Supplies and Devices - Sterile Supply $110.00

481427 ENDOSCOPIC MARKERS 5ML 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

481502 Cath Guide 6Fr Jr4 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

481561 BENTSON STRAIGHT WIRE 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

481661 BILIARY LOCK/BX CAPS 272 Medical/Surgical Supplies and Devices - Sterile Supply $207.00

481691 DRESSING TELFA 3X8 272 Medical/Surgical Supplies and Devices - Sterile Supply $3.00

481728 Catheter 6Fr HS .070 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

481756 ENDO GLD PROBE W/NDL 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,020.00

481761 PEEL-AWAY PLVW-22-38 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

481765 SPONGE SUGIFOAM 100 272 Medical/Surgical Supplies and Devices - Sterile Supply $210.00 481834 WIRE EXCHANGE GLIDE 272 Medical/Surgical Supplies and Devices - Sterile Supply $263.00 481835 GWIRE VASC 300CM 4FR 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $483.00 481921 SHEATH FLEXOR CONTR 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00 481984 Glidewire SS 260CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $295.00 481993 SHEATH PINNACLE 6F 272 Medical/Surgical Supplies and Devices - Sterile Supply $208.00 482090 G/WIRE .018 180CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $310.00

482111 Suture Silk Co13D 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00

482403 Tube Trach 7 272 Medical/Surgical Supplies and Devices - Sterile Supply $212.00

482518 DRSNG TRANS 2.75X2.25 272 Medical/Surgical Supplies and Devices - Sterile Supply $3.00

80 482525 KIT MLT-LUM CVC 45703 272 Medical/Surgical Supplies and Devices - Sterile Supply $580.00 482563 BANDAGE ABS 10X8IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $3.00 482571 CATH 7FR 300CM BIP STD 272 Medical/Surgical Supplies and Devices - Sterile Supply $619.00 482572 GWIRE VASC 15D.018IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $327.00

482584 LUMEN 272 Medical/Surgical Supplies and Devices - Sterile Supply $413.00

482765 DERMABOND ADV 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

482842 Device Infl 33CM Syr 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

482857 SYS DRAINAGE URET 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

482954 STPCK 3-WAY HI PRSS 272 Medical/Surgical Supplies and Devices - Sterile Supply $31.00

482966 GW RSN TFE 03S 80 1.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

482995 NEEDLE INTJCT 4/25G 272 Medical/Surgical Supplies and Devices - Sterile Supply $828.00

483021 SET IV PRIM PIGBCK N/V 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 483075 Gwire CV Rsn.035x260x1 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 483279 DEVICE INFL 12FR ENCR 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00 483291 CATH DRN 10FR 25CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $417.00 483301 CTHGD GLD 4F C2 65 272 Medical/Surgical Supplies and Devices - Sterile Supply $290.00 483306 GW APMTZ 035 260 SS ST 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 483307 GWIRE APMTZ 035 260 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

483326 SHTH BRPT 6F 45 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

483365 Elctrd 0.35 GW OD2 272 Medical/Surgical Supplies and Devices - Sterile Supply $567.00

483487 GWIRE HT SPRTA 300 272 Medical/Surgical Supplies and Devices - Sterile Supply $340.00

483493 SHTH BRTP 6F 5.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

483497 Shth Avnt+5F 11 Wg 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00

483517 GW STRQ 035 300 ANG SF 272 Medical/Surgical Supplies and Devices - Sterile Supply $398.00

483528 Introducer Sht 4Fr 11c 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00

483538 Shth Avnt 6.5F 11 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 483587 CHTDX INFN 4F MPA2 125 272 Medical/Surgical Supplies and Devices - Sterile Supply $225.00 483591 CTHDX INFN 4F ALMOD 10 272 Medical/Surgical Supplies and Devices - Sterile Supply $225.00 483593 CTHDX INFN 4F PIG145 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $225.00 483594 CATHDX INFN 4F IM 100C 272 Medical/Surgical Supplies and Devices - Sterile Supply $225.00 483606 CTHGD VBT 6F 067 RDC 5 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00 483643 Dur Chrmc 2-0 Sg13T 272 Medical/Surgical Supplies and Devices - Sterile Supply $213.00

483672 SUT VCRYL 3-0J232H 272 Medical/Surgical Supplies and Devices - Sterile Supply $31.00

483717 SUT NYL NAB 3-0 L30 62 272 Medical/Surgical Supplies and Devices - Sterile Supply $31.00

483749 SUTURE CHRMC 2 CTI 923 272 Medical/Surgical Supplies and Devices - Sterile Supply $53.00

483753 SUT ABS 0 J946H 272 Medical/Surgical Supplies and Devices - Sterile Supply $30.00

483768 Sut Pln 4-0 1828H 272 Medical/Surgical Supplies and Devices - Sterile Supply $105.00

483793 Sut Prln 0 8690H 272 Medical/Surgical Supplies and Devices - Sterile Supply $53.00

483839 KIT LTA TOP ANES 272 Medical/Surgical Supplies and Devices - Sterile Supply $111.00

483936 STAPLER SKIN FXHD PXW3 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

483970 Dltr SrgiclRl A 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,306.00 484028 TUBE GST 20F PUL DOME 272 Medical/Surgical Supplies and Devices - Sterile Supply $409.00 484033 GW .035 TAD 2 TPS ELT 272 Medical/Surgical Supplies and Devices - Sterile Supply $373.00 484040 Gw Rsn Crv 025 260 1.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 484079 TUBE FD JUNO SIL14F 272 Medical/Surgical Supplies and Devices - Sterile Supply $877.00 484115 Gwire Ext 115 x 0.35L 272 Medical/Surgical Supplies and Devices - Sterile Supply $182.00 484165 TUBE FD G-J 18FX45 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,216.00

484239 SHEATH INTRO 90CM 6F . 272 Medical/Surgical Supplies and Devices - Sterile Supply $687.00

484244 VISE MULTI-TORQUE 014 272 Medical/Surgical Supplies and Devices - Sterile Supply $142.00

484279 SPHINCTERTOME HYDRATOM 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,225.00

81 484283 Splnt NSL SIL September 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 484396 STNT BIL HLNK 6X12X135 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,287.00 484524 Sut Vcryl 3-0 J215H 272 Medical/Surgical Supplies and Devices - Sterile Supply $33.00 484840 GWIRE VASC 260CM 3MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $429.00

484871 SHTH SET PLWY 20F 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

485019 Shth Avnt 4F 11 Wgw 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

485166 FORCEPS ENDO BX NDL 24 272 Medical/Surgical Supplies and Devices - Sterile Supply $168.00

485188 Cath Uret 5fr 70cm 20d 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

485338 Shth CTH Pedi 5F 10x40CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

485376 Probe Irr 300cm 2.3 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,404.00

485451 DRSG MPLX BRDR 3X3 272 Medical/Surgical Supplies and Devices - Sterile Supply $46.00

485465 Dressing Petro 9X3In 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00 485468 Shth Flxr 10F 40 272 Medical/Surgical Supplies and Devices - Sterile Supply $409.00 485509 SYRINGE 3CC W/CANNULA 272 Medical/Surgical Supplies and Devices - Sterile Supply $211.00 485657 KIT SURGILAV HANDPIECE 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 485688 DRESSING PTRO XROFRM 9 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00 485695 TUBING INJECTION MEDEX 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 485707 IV CONTINOUS-FLOW TUBI 272 Medical/Surgical Supplies and Devices - Sterile Supply $72.00

485708 URINE BAG SP'MEN NEO 272 Medical/Surgical Supplies and Devices - Sterile Supply $10.00

485709 Tube Drn 18IN Conn XTN L 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00

485720 CATH SHEP LCK 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

485872 GWIRE GLD 035 180 SS A 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00

485896 SHTH BRTP 8f 35 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

485903 Tubing Insufflate.25ID 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00

486019 SHTH AVNT 4F 11 WGW 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00

486020 SHTH AVNT 6F 11 WG 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 486021 SHTH AVNT 7F 11 WG 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 486022 SHT AVNT 8F 11 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 486023 CTHDX TMP+5 ST 65 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 486035 CATH NYLEX PIG 4FR 8SH 272 Medical/Surgical Supplies and Devices - Sterile Supply $211.00 486050 CANNULA ETCO2 LARGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $49.00 486075 SUT VCRYL 0 J260H 272 Medical/Surgical Supplies and Devices - Sterile Supply $29.00

486079 SUTURE VCL 2-0 CT 27IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

486084 Sut Vcyrl 0 J340H 272 Medical/Surgical Supplies and Devices - Sterile Supply $30.00

486091 SUT Vcryl 4-0 J422H 272 Medical/Surgical Supplies and Devices - Sterile Supply $39.00

486117 Sut Nyl Nabs 2-0 Fs 664G 272 Medical/Surgical Supplies and Devices - Sterile Supply $29.00

486119 Sut Silk 2-0 677G 272 Medical/Surgical Supplies and Devices - Sterile Supply $28.00

486174 Suture Prln 4-0 8682g 272 Medical/Surgical Supplies and Devices - Sterile Supply $84.00

486175 Suture Prln4-0 Fs2 8683H 272 Medical/Surgical Supplies and Devices - Sterile Supply $49.00

486188 SUT VCRYL 2-0 J839D 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

486236 IV SET ADMIN TUR LF 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 486240 IV EXT SET 6IN INJSITE 272 Medical/Surgical Supplies and Devices - Sterile Supply $48.00 486322 Drsg Ddrm Cgf Brdr 6X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $208.00 486324 KIT PROCDRL 20FR PEJ 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,057.00 486361 SNARE JMB OVAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $742.00 486362 TUBE GST 20F PSH DOME 272 Medical/Surgical Supplies and Devices - Sterile Supply $408.00 486383 SNARE ESCPC 20X200 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486406 DILATOR VSC 5F 038X20 272 Medical/Surgical Supplies and Devices - Sterile Supply $218.00

486413 GWIRE VASC BNTSN 260X2 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486433 POLYNET RETRIVAL 2.5MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $537.00

82 486477 GW RDRN XS 018 180 272 Medical/Surgical Supplies and Devices - Sterile Supply $543.00 486484 GW RDRN XS XCH 018 270 272 Medical/Surgical Supplies and Devices - Sterile Supply $543.00 486531 Cthgd Vbt 6F 070 IM 90 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 486572 DEC UROVIEW 2800 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486583 DRAIN 19FR RO FULLFLUT 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486624 GW H JGWR STR 035 260 272 Medical/Surgical Supplies and Devices - Sterile Supply $850.00

486671 CTHDX TORC NB 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486685 GWDX NTRX 018 180 INT 272 Medical/Surgical Supplies and Devices - Sterile Supply $458.00

486713 PATCH GLYKO SL 3CMX3CX 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

486736 Snare Optmz Trp M-Chmbr 272 Medical/Surgical Supplies and Devices - Sterile Supply $161.00

486738 INTRO SHTH 038 12F 10C 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

486762 Dressing Telfa 4X3 In 272 Medical/Surgical Supplies and Devices - Sterile Supply $2.00 486780 Shth Avnt 10F 11 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 486834 DRESSING DURODRM THIN 272 Medical/Surgical Supplies and Devices - Sterile Supply $72.00 486861 SET XTN L32IN 4.7ML PR 272 Medical/Surgical Supplies and Devices - Sterile Supply $24.00 486884 Introducer Shth 4Fr 10c 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 486915 DEVICE EMBOSHLD NAV6 L 272 Medical/Surgical Supplies and Devices - Sterile Supply $8,272.00 487081 SET XTN IV 3.9X33 2C5627 272 Medical/Surgical Supplies and Devices - Sterile Supply $14.00

487279 TUBE 20FR GSTRM EZFD 272 Medical/Surgical Supplies and Devices - Sterile Supply $141.00

487280 Tube 22FR Gstrm Ezfd 272 Medical/Surgical Supplies and Devices - Sterile Supply $141.00

487514 Cannula Inner 6.4MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

488213 FORCEPS ENDO NDL 240CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

489613 Set Cath 40cm 14Fr Tri 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,798.00

490789 TBG CYSTO Y SET SURG 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

491456 STENT VASC NTNL 80X125 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,763.00

491457 STENT VASC NTNL 80X125 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,763.00 491458 STENT VASC NTNL 40X125 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,763.00 491519 Stapler Skin Remover 272 Medical/Surgical Supplies and Devices - Sterile Supply $15.00 491986 CATH URTH LBRSLIC 20F 272 Medical/Surgical Supplies and Devices - Sterile Supply $182.00 492894 INTRO CATH 90CM 5IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $334.00 492908 STNT HLNK E 5.5X18X135 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,287.00 493559 Introducer Cath 16F 17CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $450.00

494913 SNARE 230CM 25GA 3MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $652.00

496129 Bandadge Elast 4In Ns 272 Medical/Surgical Supplies and Devices - Sterile Supply $8.00

496455 BANDAGE ELAST 6IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $11.00

497117 CATH BLNDIL 5X80X130 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,399.00

497301 NDL BX 22G 5.2F-8CM EC 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,755.00

499294 Tube Gastro 16F 20CC BLN 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

499295 TUBE GASTRO FEED PRT 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

499296 TUBE GSTRO FEED PRT 20 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

499297 Tube Gastro Feed Prt 22Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 500002 Coban Sterile 2 In 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 500003 Coban Sterile 3 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 500004 Coban Sterile 4 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 500005 Coban Sterile 6 in 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00 500050 Guide Spring J 68cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $266.00 500051 Guide Spring St 45cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00

500052 Guide Spring 30cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

500054 Cath Radial Artery 20G x 8 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

500055 Cath Artery 3Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

83 500056 Cath, Vessel Kit 20Gax 272 Medical/Surgical Supplies and Devices - Sterile Supply $557.00 500061 Cath Artrial Hickman 272 Medical/Surgical Supplies and Devices - Sterile Supply $844.00 500062 Cath Intraflo 3cc 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 500063 Percutaneous Tray 8F 272 Medical/Surgical Supplies and Devices - Sterile Supply $485.00

500064 Swan Ganz 02 Saturation 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,994.00

500066 Tubing Hipress MF06 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

500067 TUBING HIPRESS MF48 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

500068 TUBING HIPRESS MM06 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

500069 CATH THERMODILUTION SH 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

500075 SOLCOTRANS PLUS 272 Medical/Surgical Supplies and Devices - Sterile Supply $717.00

500077 CATH THERMODILUTION 7F 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,348.00

500078 CATH THERMODILUTION PA 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,775.00 500079 VALVE, LOPEZ 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 500080 CONNECTOR MM-01 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 500088 DRAIN ORTHO PRE-FILTER 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 500089 DRAIN ORTHO BACTERIAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $212.00 500090 DRAIN ACD ANTICOQULANT 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 500091 DRAIN VAC BULB 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00

500092 DRAIN ORTHO BLOOD TRAN 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

500096 PLEURVAC ATS BAG 272 Medical/Surgical Supplies and Devices - Sterile Supply $551.00

500098 CATH INTRO SHEATH 8F 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

500102 CATH ARTERIAL/VENOUS 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

500104 CATH PERCUTANEOUS SHEA 272 Medical/Surgical Supplies and Devices - Sterile Supply $227.00

500116 FECAL B/10 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00

500118 OST WOUND DRAINAGE POU 272 Medical/Surgical Supplies and Devices - Sterile Supply $17.00

500119 OST WOUND DRAINAGE POU 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00 500129 OST LOOP SET STERILE 2 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 500135 OST Stomachesive Powder 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 500148 OST Loop Ostomy 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $21.00 500167 OST LOOP SET STERILE 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 500180 OST COLOSTOMY/ILEUSTOM 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 500196 OST WOUND DRAINAGE POU 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

500197 OST URO STER SET 1.50 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00

500198 OST URO STER SET 1.75 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00

500201 CHEST HEIMLICK DRAIN V 272 Medical/Surgical Supplies and Devices - Sterile Supply $304.00

500202 CHEST DRAIN BOTTLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $435.00

500203 PLEUREVAC DOUBLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $296.00

500204 PLEUREVAC INFANT 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

500205 PLEUREVAC PNEUNEUOTOMY 272 Medical/Surgical Supplies and Devices - Sterile Supply $324.00

500206 PLEURVAC SINGLE/ATS 272 Medical/Surgical Supplies and Devices - Sterile Supply $579.00

500207 CHEST PIRAX W/TR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,453.00 500208 CHEST TUBE 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 500209 CHEST TUBE 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 500210 CHEST TUBE 20 FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 500211 CHEST TUBE 24FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 500212 CHEST TUBE 28FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 500213 CHEST TUBE 36FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

500215 CHEST TUBE W/TR 1OFR 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00

500216 CHEST TUBE W/TR 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00

500217 CHEST TUBE W/TR 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00

84 500219 CHEST TUBE W/TR 24FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00 500220 CHEST TUBE-W/TR 28FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00 500221 CHEST TUBE-W/TR 32FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $277.00 500222 CHEST TUBE RED 28FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

500223 CHEST TUBE RED 30FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

500224 CHEST TUBE RED 32FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

500225 VACUUM BOTTLE 2000CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

500226 VACUUM BOTTLE TUBING 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00

500229 THORACOTOMY SET 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $690.00

500230 THORACOTOMY SET 20FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $690.00

500231 THORACOTOMY SET 28FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $690.00

500234 THORACENTESIS SET W/CA 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 500235 CHEST TUBE 32 FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 500251 BANDAGE ACE 2IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00 500252 BANDAGE ACE 3IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00 500253 BANDAGE ACE 4IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00 500254 BANDAGE ACE 6IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00 500262 BANDAID 2X2IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $25.00

500270 DRESSING, CVP/SUBCLAVI 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

500271 NUGAUZE IODO 2IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

500272 NUGAUZE IODO 1IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

500273 NUGAUZE IODO 1/2IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

500274 NUGAUZE IODO 1/4IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00

500276 NUGAUZE PLAIN 1IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00

500277 NUGAUZE PLAIN 1/2IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00

500278 NUGAUZE PLAIN 1/4IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00 500284 DRESS OR LARGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 500285 DRESS OR MEDIUM 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00 500286 DRSG OWENS GAUZE 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00 500288 DRSG SCARLET RED 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 500289 DRESS W/ANTIBIOTIC 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00 500290 DRESS OR SMALL 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

500292 SURGICEL 4X8IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00

500293 SURGICEL 2X14IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00

500295 COMPRESS WET SALINE 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00

500298 DRSG DUODERM THIN 6X7 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

500299 DRSG DUODERM THIN 2X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

500300 DRSG TRANSPARENT LG 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

500309 DRSG VASELINE GAUZE 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

500310 DRSG VASELINE GAUZE PA 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

500311 DRSG XEROFORM 2X2 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 500312 DRSG XEROFORM 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 500313 DRSG XEROFORM 5X9 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 500317 DRSG DUODERM 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00 500318 DRSG DUODERM 6X7 W/BOR 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 500321 BANDAGE ACE STER 3 IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 500322 BANDAGE ACE STER 4 IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

500323 BANDAGE ACE STER 6 IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00

500325 DRESS, EPI-LOCK 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

500327 DRESS EPI LOCK 6X8 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

85 500329 DRESSING, KAITOSTAT 272 Medical/Surgical Supplies and Devices - Sterile Supply $127.00 500330 DRSG TRANSPARENT MED 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 500331 DRSG DUODERM CGF 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 500332 DRSG DUODERM CGF 6X6 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00

500333 DRSG DUODERM THIN 4X6 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00

500334 DRSG DUODERM THIN 4X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $90.00

500335 DRSG TRANSPARENT SM 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

500340 ASPIRATOR ADAMS 272 Medical/Surgical Supplies and Devices - Sterile Supply $512.00

500344 EAR TRAY IRRIGATION 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00

500347 EAR TRAY TREATMENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00

500349 EAR WICK POPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

500350 SINUS SET IRRIGATION 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00 500356 TUBE LARYN 11MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 500357 TUBE LARYN 8MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500358 TUBE LARYN 10MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 500359 TUBE LARYN 12MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 500363 CATH, NASAL POSTPAC 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 500365 TUBE TRACH STOP SS 00M 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500371 TUBE TRACH STOP 4MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00

500372 TUBE TRACH STOP 6MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00

500373 TUBE TRACH STOP 8MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00

500374 TUBE TRACH STOP 10MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00

500375 TUBE TRACH SHILEY #3 P 272 Medical/Surgical Supplies and Devices - Sterile Supply $280.00

500376 TUBE TRACH STOP SS 3WY 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500377 TUBE TRACH STOP SS4M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00

500378 TUBE TRACH STOP SS5M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500379 TUBE TRACH STOP SS6M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500380 TUBE TRACH STOP SS7M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500381 TUBE TRACH STOP SS8M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500382 TUBE TRACH STOP SS9M 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00 500383 TRACH TRAY DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $589.00 500384 TUBE TRACH STOP SS 2M 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500385 TUBE TRACH STOP SS 1M 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500386 TUBE TRACH 6 FEN (DFEN 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500387 TUBE TRACH 8 FEN (DFEN 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500388 TRACH CLEANING SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

500389 TUBE TRACH STOP SS OM 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500390 TUBE TRACH SS OOMM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500391 TUBE TRACH SS OMM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500392 TUBE TRACH SS1MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500393 TUBE TRACH SS 2MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00 500394 TUBE TRACH SS 3MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00 500395 TUBE TRACH SS 4MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00 500396 TUBE TRACH SS 5MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00 500397 TUBE TRACH SS 6MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00 500398 TUBE TRACH SS 7MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00 500399 TUBE TRACH SS 8MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500400 TUBE TRACH SS 9MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500401 TUBE TRACH SS 10MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

500402 TUBE TRACH 4 DIC SHILE 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00

86 500403 TUBE TRACH 6 DIC SHILE 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00 500404 TUBE TRACH 10 DIC SHIL 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00 500405 TUBE TRACH 4 DCT 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00 500406 TUBE TRACH 6 DCT 272 Medical/Surgical Supplies and Devices - Sterile Supply $523.00

500407 TUBE TRACH 8 DCT 272 Medical/Surgical Supplies and Devices - Sterile Supply $523.00

500408 TUBE TRACH 10 DCT 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00

500410 TUBE TRACH 6 FEN (CFN) 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500411 TUBE TRACH 8 FEN (CFN) 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500415 CATH SUCTION 10FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

500416 CATH SUCTION 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

500417 CATH SUCTION 14FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

500418 CATH SUCTION 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00 500419 CATH SUCTION 18FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00 500420 CATH SUCTION SET 6FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00 500421 CATH SUCTION SET 8FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00 500422 CATH SUCTION SET 10F 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00 500423 CATH SUCTION SET 12F 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00 500424 CATH SUCTION SET 14F 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

500425 TUBE TRACH 4 (CFS) CUF 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

500426 TUBE TRACH 6 (CFS) CUF 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

500427 TUBE TRACH 8 (CFS) CUF 272 Medical/Surgical Supplies and Devices - Sterile Supply $289.00

500428 TUBE TRACH 6 FEN CUFFE 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500429 TUBE SUCTION YANKAUER 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

500430 TUBE SUCTION FRZ 8FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00

500431 TUBE SUCTION FRZ 10FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00

500432 TUBE SUCTION FRZ 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00 500434 TUBE TRACH 8 DIC SHILE 272 Medical/Surgical Supplies and Devices - Sterile Supply $345.00 500435 TUBE TRACH 10 FEN (CFN 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00 500436 TUBE TRACH 8 SCT (LONG 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00 500437 TUBE TRACH 9 SCT (LONG 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00 500438 TUBE TRACH 10 SCT (LON 272 Medical/Surgical Supplies and Devices - Sterile Supply $874.00 500439 TUBE TRACH 4 FEN (CFN) 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500440 TUBE TRACH 6 FEN (DCFN 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500441 TUBE TRACH 8 FEN CUFFE 272 Medical/Surgical Supplies and Devices - Sterile Supply $378.00

500442 CATH SUCTION BRONCH 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00

500541 AMNIOCENTESIS SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $408.00

500550 CATH FILTERED SPECIMEN 272 Medical/Surgical Supplies and Devices - Sterile Supply $79.00

500551 VACUUM EXTRACTOR, DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

500561 TUBING H/PRESS NEONA 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

500567 ELECTRODE SPIRAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00

500569 CATH UMBILICAL 3.5FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00 500570 Cath Umbilical 5.0Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00 500581 PROBE OXYGEN NEONA 4FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,046.00 500582 PROBE OXYGEN NEONAT 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,745.00 500583 CATH UMBIL SET 3.5FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00 500584 CATH UNBIL SET 5.0FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00 500585 CATH UMBIL SET 8.0FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $212.00

500593 PRESSURE INTRAUTERINE 272 Medical/Surgical Supplies and Devices - Sterile Supply $523.00

500597 SUCTION CATH NEO-VAC 3 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00

500598 SUCTION CATH NEO-VAC 3 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00

87 500645 BASIN SET STERILE 272 Medical/Surgical Supplies and Devices - Sterile Supply $216.00 500656 CONNECTOR 5 IN 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00 500660 CONNECTOR Y 3/8 IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00 500661 CONNECTOR Y 1/4 IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00

500669 BLOOD WARMING BAG 272 Medical/Surgical Supplies and Devices - Sterile Supply $117.00

500670 SUCTION SET WOUND 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

500675 SUCTION SET WOUND SM 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

500696 BILE BAG DRAIN 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

500698 STAPLER SKIN 272 Medical/Surgical Supplies and Devices - Sterile Supply $467.00

500709 TUBE CONNECT 6FT 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00

500710 WOUND DRAIN STERILE BA 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

500843 SHOE POST-OP F'LE SM 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500844 SHOE POST-OP F'LE MD 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500845 SHOE POST-OP F'LE LG 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500846 SHOE POST-OP MALE SM 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500847 SHOE POST-OP MALE MD 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500848 SHOE POST-OP 272 Medical/Surgical Supplies and Devices - Sterile Supply $314.00 500920 P'MAKER ADAPT CBLW/CL 272 Medical/Surgical Supplies and Devices - Sterile Supply $184.00

500921 P'MAKER ADAPT CBLW/BK 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

500925 P'MAKER E'DE M 5F125 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,303.00

500927 P'MAKER E'DE U 5F125 272 Medical/Surgical Supplies and Devices - Sterile Supply $941.00

500928 P'MAKER E'DE U 7F125 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,457.00

500932 P'MAKER E'DE E 5F 110 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,862.00

500936 P'MAKER CH'LER V98-100 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,130.00

501056 8635G Prolene 5-0 PC3 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

501062 SUT PROLENE 4-0/CUT P- 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 501063 SUT PROLENE 4-0/PS-2 8 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 501064 SUT PROLENE 4-0/PS-4 8 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 501065 SUT PROLENE 5-0/CUT P- 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 501066 SUT PROLENE 5-0/CUT PS 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00 501068 SUT PROLENE 6-0/CUT P- 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 501069 SUT PROLENE 6-0/CUT P- 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

501071 SUT CHROM GUT 4-0/TAPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

501072 SUT CHROM GUT 3-0/TAPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

501073 SUT CHROM GUT 2-0/TAPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

501074 SUT PLAIN 0/CT-1 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

501075 SUT PLAIN 6-0/C-1 770G 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

501076 SUT PLAIN 5-0/P-3 686H 272 Medical/Surgical Supplies and Devices - Sterile Supply $75.00

501077 SUT PLAIN 4-0/PS-2 162 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00

501078 SUT PLAIN 3-0/PS-2 163 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00

501080 SUT SILK 2-0/FSL 677G 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 501085 SUT SILK 3-0/KS 622H 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00 501086 SUT SILK 0/FSL 680H 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 501087 SUT SILK 3-0/PS-2 1684 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00 501088 U-11 UMBIL DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 501089 SUT SILK 4-0/PS-2 1677 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 501090 SUT SILK 2-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

501091 SUT SILK 0 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

501093 SUT CHROM GUT 7-0/TG 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

501125 SUT VICRYL 2-0/TAPER C 272 Medical/Surgical Supplies and Devices - Sterile Supply $130.00

88 501126 SUT VICRYL 3-0/CUT PS- 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 501127 SUT VICRYL 4-0/CUT P-3 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501128 SUT VICRYL 5-0/CUT P-3 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 501129 SUT ETHILON 2-0/FS 664 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

501130 SUT ETHILON 3-0/PS-1 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501132 SUT ETHILON 4-0/PS-2 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501133 SUT ETHILON 5-0/PC3 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501134 SUT ETHILON 5-0/FS-2 6 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501135 SUT ETHILON 5-0/PS-2 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501137 SUT ETHILON 6-0/P3 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501138 SUT ETHILON 6-0/P-1 69 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

501139 SUT ETHILON 6-01 PS-3 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00 501141 7816 Tyvdek 2-0TE9 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 501144 SUT CHROM GUT 5-0/P-3 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501145 SUT CHROM GUT 0/TAPER 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501150 SUT CHROM GUT 2-0/TAPE 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501151 SUT CHROM GUT 4-0/FS-2 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501152 SUT CHROM GUT 3-0/FS-2 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

501163 ERR EYE BLINX 8OZ 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

501185 COMBO CATH DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $749.00

501186 GOLD PROBE DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,473.00

501187 FIDUCIARY MARKER DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00

501188 CAPTURING DEVICE DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,171.00

501189 SUT TICRON ETH 272 Medical/Surgical Supplies and Devices - Sterile Supply $117.00

501215 HUBER 20X1.5 272 Medical/Surgical Supplies and Devices - Sterile Supply $137.00

501247 TUBE FEEDING DOBBHOFF 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501249 VALVE ANTI-REFLUX 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501250 TUBE GASTRO KIT 20FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $354.00 501251 TUBE SUMP 10FR W/ANTI- 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 501252 TUBE SUMP PUMP AN42 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 501253 TUBE SUMP 12FR W/ANTI- 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 501254 DRAINAGE, J-VAC 300CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $274.00

501255 TUBE SUMP 14FR W/ANTI- 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

501256 TUBE GI CANTOR 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $209.00

501259 TUBE FEEDING ENTERFLEX 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

501260 TUBE FEEDING DOBBHOFF 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

501261 DRAINAGE JACKSON PRATT 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00

501263 TUBE GASTRO KIT 22FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $354.00

501264 TUBE GASTRO KIT 24FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $354.00

501265 TUBE FEED 3.5FRX15IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

501266 TUBE FEED 5FR X 16 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501267 TUBE FEED 8.0FRX15IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501268 TUBE FEED 5FR X 36 (N 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501269 TUBE FEED 8.0FRX42IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501270 TUBE FEED 10FRX42IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $38.00 501271 TUBE FEED CONTAINER 272 Medical/Surgical Supplies and Devices - Sterile Supply $59.00 501273 TUBE GASTRIC LAVAGE 32 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00

501274 TUBE GI LEVINE 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

501275 TUBE GI LEVINE 14FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

501276 TUBE GI LEVINE 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

89 501277 TUBE GI LEVINE 18FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 501278 TUBE FEEDING 8FR (PADA 272 Medical/Surgical Supplies and Devices - Sterile Supply $441.00 501279 TUBE PENROSE 0.25X12 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00 501280 TUBE PENROSE 0.50X12 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

501281 TUBE PENROSE 0.75X12 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

501282 TUBE PENROSE 1.00X12 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

501283 TUBE PENROSE 1.00X18 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

501284 TUBE SUMP 16FR/W ANTI- 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

501285 DRAINAGE HEMOVAC 400CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $115.00

501286 TUBE SUMP 18FR W/ANTI- 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

501288 IV CONTINOUS-FLOW TUBI 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00

501289 IV TUBING SEC AVI 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 501290 IV BASIC TUBING 272 Medical/Surgical Supplies and Devices - Sterile Supply $185.00 501291 IV NITROGLYCERIN TUBIN 272 Medical/Surgical Supplies and Devices - Sterile Supply $356.00 501292 IVINFUSION BUR AVI 272 Medical/Surgical Supplies and Devices - Sterile Supply $389.00 501293 IV INFUSION BL'D AVI 272 Medical/Surgical Supplies and Devices - Sterile Supply $232.00 501294 IV INFUSION SET 24HR 272 Medical/Surgical Supplies and Devices - Sterile Supply $162.00 501295 TUBE FEED 6FR NEO 36IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

501296 TUBE GASTROSTOMY MOSS 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,030.00

501298 TUBE GASTRIC LAVAGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00

501299 AVI SECONDARY TUBING 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501301 PARACENTESIS TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $804.00

501304 TUBE FEEDING W/GASTRO 272 Medical/Surgical Supplies and Devices - Sterile Supply $240.00

501306 ARTERIOGRAM TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $251.00

501309 ARTHOGRAM TRAY DISPO 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,313.00

501312 BIOPSY BONE TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,122.00 501313 BIOPSY BASIC TRAY - DI 272 Medical/Surgical Supplies and Devices - Sterile Supply $642.00 501327 VENTRICULOSTOMY EXT DR 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 501329 HYSTOGRAM TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $432.00 501330 INCISION/DRAIN TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $200.00 501334 TRAY MINOR LACERATION 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00 501336 MYLOGRAM SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $724.00

501338 DRAIN & VENTRICOLOSTOM 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,574.00

501342 SPINAL LUMBAR TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $515.00

501350 SUTURE REMOVAL TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00

501351 STAPLE REMOVER 272 Medical/Surgical Supplies and Devices - Sterile Supply $175.00

501353 SUTURE TRAY W/DORF 272 Medical/Surgical Supplies and Devices - Sterile Supply $525.00

501355 HEART TAMPONADE TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $372.00

501361 TRAY, CUTDOWN 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00

501362 KIT EXT. DRAINAGE COLL 272 Medical/Surgical Supplies and Devices - Sterile Supply $602.00

501363 PERICARDIOCENTESIS TRA 272 Medical/Surgical Supplies and Devices - Sterile Supply $722.00 501370 SPINAL LUMBAR TR NEO 272 Medical/Surgical Supplies and Devices - Sterile Supply $323.00 501379 SYSTEM II EXT DRAINAGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $611.00 501388 UROTRACK & COLLECTOR 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 501393 CATH COUDE 12FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 501394 CATH COUDE 14FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 501395 CATH COUDE 16FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

501396 CATH COUDE 18FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

501397 CATH COUDE 20FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

501398 CATH COUDE 22FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

90 501399 CATH COUDE 24FRX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00 501400 CATH FOLEY 2W/8FR/3CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00 501401 CATH FOLEY 2W/10FR/3CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $248.00 501402 CATH FOLEY 2W/12FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501403 CATH FOLEY 2W/14FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501404 CATH FOLEY 2W/16FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501405 CATH FOLEY 2W/18FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501406 CATH FOLEY 2W/20FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501407 CATH FOLEY 2W/22FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501408 CATH FOLEY 2W/24FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501409 CATH FOLEY 2W/26FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501416 CATH FOLEY 2W/28FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00 501417 CATH FOLEY 2W/30FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00 501418 CATH FOLEY 2W/16FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 501419 CATH FOLEY 2W/18FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 501420 CATH FOLEY 2W/28FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00 501421 CATH FOLEY 2W/20FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 501422 CATH FOLEY 2W/22FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

501423 CATH FOLEY 2W/24FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

501424 CATH FOLEY 2W/26FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

501425 CATH FOLEY 3W/16FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00

501426 CATH FOLEY 3W/18FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00

501427 CATH FOLEY 3W/20FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00

501428 CATH FOLEY 3W/22FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00

501429 CATH FOLEY 3W/24FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00

501430 CATH FOLEY 3W/26FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $370.00 501431 CATH FOLEY 3W/28FR/5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $372.00 501432 CATH FOLEY 3W/8FR/30CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501433 CATH FOLEY 3W/20FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501434 CATH FOLEY 3W/22FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501435 CATH FOLEY 3W/24FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501436 CATH FOLEY 3W/26FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

501437 CATH FOLEY 3W/24FR/75C 272 Medical/Surgical Supplies and Devices - Sterile Supply $255.00

501438 CATH URETHRAL SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

501439 CATH FOLEY 16FR TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00

501440 CATH FOLEY 18FR TRAY 272 Medical/Surgical Supplies and Devices - Sterile Supply $308.00

501441 URINE METER BAXTER 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

501442 URINEMETER, FOLEY 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

501443 CATH FOL SET W/O CAT 272 Medical/Surgical Supplies and Devices - Sterile Supply $245.00

501444 URINE BAG, TURP 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00

501445 URINE BAG PHARMASEAL 272 Medical/Surgical Supplies and Devices - Sterile Supply $313.00 501449 URINE BAG LEG 1000CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $83.00 501450 URINE BAG SP'MEN NEO 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00 501456 CATH URETH RED 8FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 501457 CATH URETH RED 10FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 501458 CATH URETH RED 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 501459 CATH URETH RED 14FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

501460 CATH URETH RED 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

501461 CATH URETH RED 18FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

501464 CATH ACCESS PORT 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,653.00

91 501465 CATH FOL TUBE EXT 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00 501466 IRR CYSTO SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $202.00 501467 CATH F'LE INT 25/BX 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,059.00 501468 CATH FEMALE INTERMIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

501469 CATH URETH COUDE 4F 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

501474 M'METER CYSTO 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00

501478 CATH INGRAM TROCAR 16F 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

501479 URINE BAG LEG DELUXE 272 Medical/Surgical Supplies and Devices - Sterile Supply $83.00

501484 DIL URETH SPIRAL #2 272 Medical/Surgical Supplies and Devices - Sterile Supply $398.00

501485 DIL URETH SPIRAL #3 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

501486 DIL URETH SPIRAL #4 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

501487 DIL URETH SPIRAL #5 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00 501488 DIL URETH SPIRAL #6 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00 501489 DIL URETH OLIVE #2 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00 501490 DIL URETH OLIVE #3 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00 501491 DIL URETH OLIVE #4 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00 501492 DIL URETH OLIVE #5 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00 501493 DIL URETH OLIVE #6 272 Medical/Surgical Supplies and Devices - Sterile Supply $226.00

501494 DIL CATH PHIL 12FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501495 DIL CATH PHIL 14FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501496 DIL CATH PHIL 16FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501497 DIL CATH PHIL 18FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501498 DIL CATH PHIL 20FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501499 DIL CATH PHIL 22FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501500 DIL CATH PHIL 24FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00

501501 DIL CATH PHIL 26FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 501502 DIL CATH PHIL 28FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00 501503 CATH, FEMALE 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 501504 DIL URETH STR'GHT 2FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $749.00 501505 ROTAGLIDE 272 Medical/Surgical Supplies and Devices - Sterile Supply $603.00 501506 ADVANCER 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,599.00 501507 BURR ROTOLINK 272 Medical/Surgical Supplies and Devices - Sterile Supply $-

501508 ROTAWIRE 272 Medical/Surgical Supplies and Devices - Sterile Supply $999.00

501530 CATH COUNCIL 18FX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00

501531 CATH COUNCIL 22FX5CC 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00

501532 DIL CATH PHIL 30FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $123.00

501533 CATH FOLEY 2W/30FR/30C 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00

501534 URINOMETER MIDGET 272 Medical/Surgical Supplies and Devices - Sterile Supply $73.00

501535 CATH GUIDE FOLEY 272 Medical/Surgical Supplies and Devices - Sterile Supply $52.00

501538 CATH COUNCIL 16FR X 5C 272 Medical/Surgical Supplies and Devices - Sterile Supply $281.00

501551 CATH MALE INTERMIT 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 501623 FILTER, IV 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 501627 TUBING, AVI 390 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 501640 SET, CATH EXTENSION 272 Medical/Surgical Supplies and Devices - Sterile Supply $86.00 501642 VIAL ADAPTER 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 501647 CATH FOL SIL 14FR X 5C 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00 501648 CATH FOL SIL 16FR X 5C 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00

501649 CATH FOL SIL 18FR X 5C 272 Medical/Surgical Supplies and Devices - Sterile Supply $259.00

501650 INCENTIVE SPIROMETER P 272 Medical/Surgical Supplies and Devices - Sterile Supply $265.00

501651 NASAL PACKING 272 Medical/Surgical Supplies and Devices - Sterile Supply $512.00

92 501652 SUT COTTONY II 272 Medical/Surgical Supplies and Devices - Sterile Supply $108.00 501653 TAPE HYPAFIX 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00 501654 OROTRACHEAL NEEDLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 501700 CATH 16FR ANTIBIOT 272 Medical/Surgical Supplies and Devices - Sterile Supply $117.00

501701 Cath 18Fr Antibiot 272 Medical/Surgical Supplies and Devices - Sterile Supply $117.00

501702 EPIDURAL PUMP SET 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

501703 RIB BELT XLG 272 Medical/Surgical Supplies and Devices - Sterile Supply $64.00

501750 SHEATH EXPANDABLE 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,273.00

501751 Cath Angioscale Diagnostic 272 Medical/Surgical Supplies and Devices - Sterile Supply $809.00

501752 CATH ILLIAC BALLOON 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,145.00

501753 CATH TORQUE 272 Medical/Surgical Supplies and Devices - Sterile Supply $642.00

501838 SENSOR VAGINAL FEMALE 272 Medical/Surgical Supplies and Devices - Sterile Supply $464.00 501839 CATH INTERPLEURAL-JAME 272 Medical/Surgical Supplies and Devices - Sterile Supply $194.00 501841 DUODERM GEL 1 OZ 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00 501842 Protective Ointment Aloe Vesta 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00 501843 Perineal Solution II Aloe Vest 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 501848 Valve, Speaking Trach-Passy Mu 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00 501849 Valve, Speaking Ventil 272 Medical/Surgical Supplies and Devices - Sterile Supply $423.00

501850 Valve, Speaking-Montgomery/Set 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,101.00

501856 UNISOLVE (BX) 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

501860 Tray, Picc Dual Lumen 6Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,762.00

501861 Tray, Picc Dual Lumen 6Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,762.00

501863 Introducer PICC 6Fr (13Ga) Ea 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

501864 Introducer, Picc 4Fr (7Ga) Ea 272 Medical/Surgical Supplies and Devices - Sterile Supply $140.00

501867 Kit, Ventricuiostomy (Ea) CCU 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,132.00

501868 Cup Manometer 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,207.00 501869 Kit Vertriculostomy (Ea) CODM 272 Medical/Surgical Supplies and Devices - Sterile Supply $931.00 501870 Set, Ventricular Cath-Ext Drai 272 Medical/Surgical Supplies and Devices - Sterile Supply $572.00 501872 Tubing Epidural Pump/Abbott 272 Medical/Surgical Supplies and Devices - Sterile Supply $157.00 501873 Cv Multilumen Cath/Guard 16cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 501874 Cv Multilumen Cath/Guard 30cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $96.00 501900 Tubing, IV - Pdi 272 Medical/Surgical Supplies and Devices - Sterile Supply $113.00

501901 Tubing, Iv Microbore Extension 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

501950 Drain, Single Chest Chamber 272 Medical/Surgical Supplies and Devices - Sterile Supply $566.00

501952 Cap, Dialysis Mini 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00

501953 SET, DIALYSIS TRANSFER 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00

501955 KIT, DIALYSIS ON/OFF 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

501957 SOLUTION, DIANEAL 1.50 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00

501958 SOLUTION, DIANEAL 2.50 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00

501959 SOLUTION, DIANEAL 4.25 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00

501960 Connector, Dialysis Universal 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00 501961 Cap, Dialysis Cath Sealing 272 Medical/Surgical Supplies and Devices - Sterile Supply $21.00 501962 GEN CODE (272) 272 Medical/Surgical Supplies and Devices - Sterile Supply $- 501973 LASER EQUIPMENT 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,131.00 501974 LASER FIBER DISP 272 Medical/Surgical Supplies and Devices - Sterile Supply $4,214.00 501975 SUT VICRYL 10-0 272 Medical/Surgical Supplies and Devices - Sterile Supply $219.00 501976 TROCAR BLUNT W/BALLOON 272 Medical/Surgical Supplies and Devices - Sterile Supply $842.00

501977 UROLOGY STAYS 272 Medical/Surgical Supplies and Devices - Sterile Supply $362.00

502038 Intra Compartment Pres 272 Medical/Surgical Supplies and Devices - Sterile Supply $478.00

502100 Drain w/Monitoring Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,775.00

93 502101 Laser Indigo 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,068.00 502102 Arthowand 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,056.00 502103 Arthrowand Turbo 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,313.00 502104 Electrode End Effect 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,228.00

502105 Endo Lap Chole Kit Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $791.00

502106 Endo Trocar Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00

502107 Endo Valve Reducer Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $148.00

502150 Nerve Impulse Tube 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,407.00

502151 Wire Terumo 272 Medical/Surgical Supplies and Devices - Sterile Supply $193.00

502152 Tuohy Borst Rotating Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $146.00

502153 Multitorque Vise Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00

502154 Lunderquist Ring Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 502200 Gen Code (272) 272 Medical/Surgical Supplies and Devices - Sterile Supply $- 502425 Kit Triple Lumen Cath Insertio 272 Medical/Surgical Supplies and Devices - Sterile Supply $525.00 502874 Dressing Teg Dbl 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $10.00 503010 Drsg Hydro/Aqua 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 503150 Vac Cannister Assembly 272 Medical/Surgical Supplies and Devices - Sterile Supply $181.00 503151 Small Dressing Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $165.00

503152 Medium Dressing Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $212.00

503153 Large Dressing Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $256.00

503154 V.A.C. Soft-Form 272 Medical/Surgical Supplies and Devices - Sterile Supply $202.00

503160 Kci V.A.C. Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $553.00

503175 Radiofreq Needleprobe 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00

503176 Oxytip Sensor 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

503177 Vaginal Sling Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,520.00

503179 Trocar Sta-Sharp Disp 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00 503180 Electrode Side Effect 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,144.00 503223 Subretinal Cannula 272 Medical/Surgical Supplies and Devices - Sterile Supply $64.00 503458 Path Glykosl 272 Medical/Surgical Supplies and Devices - Sterile Supply $88.00 506731 DRAINAGE SYSTEM, TRUE 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 506732 CATH RADIAL ARTERY 20G 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 506733 CATH RADIAL ARTERY 20G 272 Medical/Surgical Supplies and Devices - Sterile Supply $130.00

506750 PACKING, NASAL POST 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

506754 FEMSTOPS (EA) 272 Medical/Surgical Supplies and Devices - Sterile Supply $502.00

506755 CATH S'CLAV 4 LUMEN 16 272 Medical/Surgical Supplies and Devices - Sterile Supply $688.00

507202 CATH AVX 6FR 50CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,235.00

508011 CATH 1ST OD LOW ART 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,609.00

508012 CATH 2ND OD LOW ART 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,178.00

509482 SPONGE 4X4 12 PLY 272 Medical/Surgical Supplies and Devices - Sterile Supply $9.00

520045 DRAIN BAG LEG LG 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

520077 KIT REFILL INFUSAID 272 Medical/Surgical Supplies and Devices - Sterile Supply $227.00 520112 POST-OP BOOT/SHOE 272 Medical/Surgical Supplies and Devices - Sterile Supply $337.00 520174 TRAY OPHTHALMIC DRESSI 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 658725 Aeorchamber 272 Medical/Surgical Supplies and Devices - Sterile Supply $297.00 688650 Blood Product Filter 272 Medical/Surgical Supplies and Devices - Sterile Supply $154.00 689892 Leuko Reduction Filter 272 Medical/Surgical Supplies and Devices - Sterile Supply $173.00 690017 LAP/GAUZE SPONGE 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00

698625 DISP TEMP PROBE 272 Medical/Surgical Supplies and Devices - Sterile Supply $27.00

698853 B/P CUFF 272 Medical/Surgical Supplies and Devices - Sterile Supply $33.00

727675 Perclose Closure Devic 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,551.00

94 727722 All Purpose Drain 272 Medical/Surgical Supplies and Devices - Sterile Supply $402.00 727856 Trocar Needle 18G 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00 775002 Al-Fe Kidney 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,216.00 775003 Cavh Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $276.00

775004 Cavh Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $675.00

775009 Guide Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $214.00

775027 Quinton Permacath 272 Medical/Surgical Supplies and Devices - Sterile Supply $772.00

776917 K/H Subcl Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $414.00

776922 Kid Dialyz/Glp 272 Medical/Surgical Supplies and Devices - Sterile Supply $330.00

776935 K/H-Fem/Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $189.00

777152 Universal Tray 272 Medical/Surgical Supplies and Devices - Sterile Supply $477.00

777158 Crit-Line Blood Chambe 272 Medical/Surgical Supplies and Devices - Sterile Supply $100.00 778195 K/H Bath Sol G 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00 778483 Multi-Lumen Hemodialys 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,692.00 778637 P/D-Cu/Ca/Tenc 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,692.00 779533 P/D-Cath/Tenck 272 Medical/Surgical Supplies and Devices - Sterile Supply $372.00 779548 Subclavian Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $169.00 779701 Duolator 272 Medical/Surgical Supplies and Devices - Sterile Supply $81.00

779702 Silverguard Double Lum 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,637.00

779703 Tesio Twin Catheter W/ 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,467.00

815587 WIRE GUIDE 0.35 15OM S 272 Medical/Surgical Supplies and Devices - Sterile Supply $211.00

816500 WIRE GUIDE .035X150 AN 272 Medical/Surgical Supplies and Devices - Sterile Supply $175.00

816503 GUIDEWIRE GLIDE STR 272 Medical/Surgical Supplies and Devices - Sterile Supply $175.00

826443 BANDAGE ESMARK 4X9 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00

828260 HEMOVAC W/TRO 1/8 400M 272 Medical/Surgical Supplies and Devices - Sterile Supply $47.00

829443 INTRODUCER AVANTI 4F 1 272 Medical/Surgical Supplies and Devices - Sterile Supply $54.00 829708 CATH NYLEX PIG 4FR 8SH 272 Medical/Surgical Supplies and Devices - Sterile Supply $57.00 831216 SUTURE VICRYL 2-0 J259 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00 831217 SUTURE VICRYL 0-0 J26O 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00 833732 Interlink I.V. Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00 835019 Bandage Ace Sterile 4 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00 835020 Bandage Ace Velcro 6x5 272 Medical/Surgical Supplies and Devices - Sterile Supply $12.00

835189 Stapler Skin 35 Wide Dis 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00

848779 Tube Peg Dome 20F 272 Medical/Surgical Supplies and Devices - Sterile Supply $357.00

875027 Cath Opta Pro 7x4 80cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $856.00

896510 Electrode Adult Rem 272 Medical/Surgical Supplies and Devices - Sterile Supply $13.00

899481 BANDAGE KERLEX 4.5X4 272 Medical/Surgical Supplies and Devices - Sterile Supply $10.00

899497 Sponge 2X2 4Ply 2/pk 272 Medical/Surgical Supplies and Devices - Sterile Supply $7.00

900036 Cath Ultsnd 0.35IN 8.5FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,420.00

900333 Fiber Omniguide Beampath 272 Medical/Surgical Supplies and Devices - Sterile Supply $9,699.00

901612 Pediatric Cath Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $43.00 902007 Davol Female Cath Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $198.00 902013 Stapler,Skin (5) 272 Medical/Surgical Supplies and Devices - Sterile Supply $415.00 902019 Collection Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $106.00 902020 Gelfoam 12X7 Mm 272 Medical/Surgical Supplies and Devices - Sterile Supply $134.00 909015 Rapid Infusion Tubing 272 Medical/Surgical Supplies and Devices - Sterile Supply $125.00 909020 Davol Femal Cath Kit 272 Medical/Surgical Supplies and Devices - Sterile Supply $198.00

909522 Stapler Skin (5) 272 Medical/Surgical Supplies and Devices - Sterile Supply $421.00

921554 Set Puncture Micro 4Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $144.00

922358 Sol Irr NS 3000ml 272 Medical/Surgical Supplies and Devices - Sterile Supply $30.00

95 924159 Sol Irr H20 1000ml 272 Medical/Surgical Supplies and Devices - Sterile Supply $23.00 924802 Clip Int Hmclp Endo 272 Medical/Surgical Supplies and Devices - Sterile Supply $867.00 925211 Instrument Set End Omni 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,417.00 926605 Cath Hemo 24CM 14.5FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,683.00

927735 Blade Shvr 2.99MM 11CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,302.00

928321 Introducer SHTH 8FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $280.00

928348 Introducer Shth 7Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $280.00

928541 Fiber Laser Omnigrade Ent 272 Medical/Surgical Supplies and Devices - Sterile Supply $9,008.00

928794 Gwire Stiff 4Fr 21ga 7cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

928890 Dressing Foam 7.9X7.2 272 Medical/Surgical Supplies and Devices - Sterile Supply $126.00

929099 Dressing Opticell 4x4IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $61.00

929263 Cath Infl 40MM 14MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,965.00 929266 Cath Infl 40MM 16MM 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,965.00 929573 Cath Drain 8FR 20CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $258.00 929633 Pacemaker 4.45X5.2cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $12,860.00 930903 Guidewire Visi 2.2527cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $879.00 931055 Catheter Drn 14Fr 21Cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $265.00 931102 Knife Surg 3.7IN Lrnx 272 Medical/Surgical Supplies and Devices - Sterile Supply $373.00

931384 Catheter IV 20GA 1.25IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $35.00

931551 Pencil Cautery Coated SM 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00

931593 Gwire 0.35X180 Lund 272 Medical/Surgical Supplies and Devices - Sterile Supply $417.00

931863 Cath Bln Dorado 9x4x80 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,028.00

933907 STNT URET 4.5FR 26CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $326.00

933923 STNT URET 7FR 28CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $326.00

933946 Cath Thrmb 65CM 7FR 272 Medical/Surgical Supplies and Devices - Sterile Supply $3,139.00

933969 System Thrmb Zelantedvt 272 Medical/Surgical Supplies and Devices - Sterile Supply $16,059.00 936988 Needle Asp 22GA 3 Shot 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,598.00 937542 Cath Blndil 7MM 135CM 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,028.00 938864 Cath Blndil 4X20X80 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,190.00 940942 Adhesive Skn Exfn Tiss 1ML 272 Medical/Surgical Supplies and Devices - Sterile Supply $229.00 941722 Catheter IV 20GA 1IN 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00 945506 Guidewire Solo Flx 272 Medical/Surgical Supplies and Devices - Sterile Supply $242.00

946988 Solution IRR H20 1 Pls 272 Medical/Surgical Supplies and Devices - Sterile Supply $42.00

961324 Set Cysto Irrigation 272 Medical/Surgical Supplies and Devices - Sterile Supply $76.00

961847 Balloon 10X4 Dorado 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,028.00

961978 Cath Bln 6X80X130 PCP 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,199.00

962324 Tray Cath 16FR 350ML 272 Medical/Surgical Supplies and Devices - Sterile Supply $197.00

968537 Valv\Ather\Biopsy Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $236.00

968538 Exchange Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $607.00

968539 Wholey Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $592.00

968549 Valvuloplasty Balloon Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,423.00 968556 Embolectomy Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,709.00 968557 Temp Pacer Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $346.00 968661 Diagnostic Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $447.00 968663 Roent Tub 272 Medical/Surgical Supplies and Devices - Sterile Supply $62.00 968667 Standard Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $170.00 968671 Swan Monitoring Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,778.00

968672 Swan Thermodilution Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,589.00

968674 Atherectomy Guiding Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,105.00

968675 Atherectomy Motor Drive Unit 272 Medical/Surgical Supplies and Devices - Sterile Supply $722.00

96 968676 Atherectomy Rotating Valve 272 Medical/Surgical Supplies and Devices - Sterile Supply $233.00 968677 Low Pressure Inflation Device 272 Medical/Surgical Supplies and Devices - Sterile Supply $690.00 968679 Athrectomy Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $13,129.00 968682 Standard Sheath Introducer 272 Medical/Surgical Supplies and Devices - Sterile Supply $642.00

968685 Biopsy Forceps 272 Medical/Surgical Supplies and Devices - Sterile Supply $618.00

968692 Pacing Wedge Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,041.00

968729 PTCA Wire 175cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,577.00

968731 Vascular Closure 8F/10Fr 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,489.00

968732 Vascular Closure 6F 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,726.00

968980 Steer Connector - PTCA 272 Medical/Surgical Supplies and Devices - Sterile Supply $145.00

968983 Guiding Catheter - PTCA 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,858.00

968984 PTCA Balloon 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,499.00 968986 PTCA Wire 300cm 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,577.00 968987 Long Sheath 272 Medical/Surgical Supplies and Devices - Sterile Supply $205.00 968988 Indeflator - PTCA 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,169.00 969227 BI Zucker Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,574.00 969228 Quad Zucker Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,273.00 969307 Safe Sheath Peel Away 272 Medical/Surgical Supplies and Devices - Sterile Supply $394.00

969479 Dacron Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $509.00

969503 Fem Stop (Sterile) 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,755.00

969518 Tec Guidewire 272 Medical/Surgical Supplies and Devices - Sterile Supply $999.00

969519 Tec Insertion Tool 272 Medical/Surgical Supplies and Devices - Sterile Supply $56.00

969520 Tec Rear Extension 272 Medical/Surgical Supplies and Devices - Sterile Supply $175.00

969522 Tec Vacuum Bottles 272 Medical/Surgical Supplies and Devices - Sterile Supply $46.00

969523 Roubin Infusion Cath 272 Medical/Surgical Supplies and Devices - Sterile Supply $2,589.00

969534 Trapper 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,361.00 969535 Duostat Y-Connector 272 Medical/Surgical Supplies and Devices - Sterile Supply $51.00 969538 Dilator 272 Medical/Surgical Supplies and Devices - Sterile Supply $104.00 969545 Teck Power pak 272 Medical/Surgical Supplies and Devices - Sterile Supply $234.00 969550 Rope Wire 272 Medical/Surgical Supplies and Devices - Sterile Supply $268.00 969551 Extra Suture 272 Medical/Surgical Supplies and Devices - Sterile Supply $70.00 969552 Skin Stapler 272 Medical/Surgical Supplies and Devices - Sterile Supply $292.00

969558 Secondary Tech 272 Medical/Surgical Supplies and Devices - Sterile Supply $7,307.00

969561 Vasoseal 272 Medical/Surgical Supplies and Devices - Sterile Supply $1,428.00

969613 Coronary Ultrasound Catheter 272 Medical/Surgical Supplies and Devices - Sterile Supply $6,036.00

969630 K-Loc Securement Device 272 Medical/Surgical Supplies and Devices - Sterile Supply $17.00

969633 Wire Micro Snare 272 Medical/Surgical Supplies and Devices - Sterile Supply $5,160.00

969701 Sp Angio Renal Sel Bi 272 Medical/Surgical Supplies and Devices - Sterile Supply $10,806.00

300845 Strap Clavicle Sm 273 Medical/Surgical Supplies and Devices - Take Home Supplies $16.00

300846 Strap Clavicle Med 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00

300847 Strap Clavicle Lg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301010 Teds Thigh Sm/Sht 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301013 Teds Thigh Md/Sht 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301014 Teds Thigh Md/Reg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301015 Teds Thigh Md/Lng 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301017 Teds Thigh Lg/Reg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 301018 Ted Thigh Lg/Lng 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00

301019 Teds Thigh Xlg/Reg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $22.00

301020 Teds Thigh Xlg/Lng 273 Medical/Surgical Supplies and Devices - Take Home Supplies $22.00

301024 Teds Knee Med/Reg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $14.00

97 301033 Ted Hose Xxxl Sht 273 Medical/Surgical Supplies and Devices - Take Home Supplies $77.00 301034 Ted Hose Xxxl Reg 273 Medical/Surgical Supplies and Devices - Take Home Supplies $77.00 434124 SUSPENSORY LG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $248.00 434125 SUSPENSORY X-LG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $248.00

435335 STRAP CLAVICLE 273 Medical/Surgical Supplies and Devices - Take Home Supplies $545.00

435339 WRIST SUPPORT 273 Medical/Surgical Supplies and Devices - Take Home Supplies $96.00

435347 SPLINT ALUMAFOAM FINGE 273 Medical/Surgical Supplies and Devices - Take Home Supplies $108.00

436288 SUPPORT ATHLETIC 273 Medical/Surgical Supplies and Devices - Take Home Supplies $193.00

436796 SPT COCK-UP WRIST L XX 273 Medical/Surgical Supplies and Devices - Take Home Supplies $175.00

436797 SPT WRIST FORARM LT XX 273 Medical/Surgical Supplies and Devices - Take Home Supplies $158.00

500544 BREAST SHIELD SET 273 Medical/Surgical Supplies and Devices - Take Home Supplies $56.00

500833 BRACE/SPLINT, UNIVERSA 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00 500835 BRACE WRIST/ARM SM/L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00 500836 BRACE WRIST/ARM MD/L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00 500837 BRACE WRIST/ARM LG/L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00 500838 BRACE WRIST/ARM XL/L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $367.00 500839 BRACE WRIST/ARM SM/R 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00 500840 BRACE WRIST/ARM MD/R 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00

500841 BRACE WRIST/ARM LG/R 273 Medical/Surgical Supplies and Devices - Take Home Supplies $362.00

500842 BRACE WRIST/ARM XL/R 273 Medical/Surgical Supplies and Devices - Take Home Supplies $367.00

500851 CANE HARDWOOD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $73.00

500865 CERVICAL COLLAR PHILAD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $744.00

500867 CERVICAL COLLAR SOFT S 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00

500868 CERVICAL COLLAR SOFT M 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00

500869 CERVICAL COLLAR SOFT L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00

500870 CERVICAL COLLAR SOFT L 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00 500873 CLAVICAL STRAP X-SM 273 Medical/Surgical Supplies and Devices - Take Home Supplies $418.00 500874 CLAVICAL STRAP SM 273 Medical/Surgical Supplies and Devices - Take Home Supplies $418.00 500875 CLAVICAL STRAP MD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $418.00 500876 CLAVICAL STRAP LG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $418.00 500877 CLAVICAL STRAP X-LG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $418.00 500896 CERVICAL COLLAR PHILAD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $744.00

500898 CERVICAL COLLAR PHILAD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $744.00

500899 CERVICAL COLLAR PHILAD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $744.00

500900 CERVICAL COLLAR PHILAD 273 Medical/Surgical Supplies and Devices - Take Home Supplies $744.00

500905 BRACE ANKLE/ADULT UNIV 273 Medical/Surgical Supplies and Devices - Take Home Supplies $1,092.00

500907 BRACE ANKLE/SMALL UNIV 273 Medical/Surgical Supplies and Devices - Take Home Supplies $1,092.00

500919 BRACE WRIST RT LG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $367.00

500964 BOOTS SPAN-AID PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $398.00

500965 BOOT AIR SHOE 273 Medical/Surgical Supplies and Devices - Take Home Supplies $754.00

500966 BOOT AIR SHOE LINER 273 Medical/Surgical Supplies and Devices - Take Home Supplies $227.00 501010 TEDS THIGH SM/SHT PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00 501011 TEDS THIGH SM/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00 501012 TEDS THIGH SM/LNG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00 501013 TEDS THIGH MD/SHT PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00 501014 TEDS THIGH MD/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00 501015 TEDS THIGH MD/LNG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00

501016 TEDS THIGH LG/SHT PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00

501017 TEDS THIGH LG/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00

501018 TEDS THIGH LG/LNG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $259.00

98 501019 TEDS THIGH XLG/REG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00 501020 TEDS THIGH XLG/LNG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00 501021 TEDS KNEE XXLG/REG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $227.00 501022 TEDS KNEE SM/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501023 TEDS KNEE SM/LNG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501024 TEDS KNEE MD/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501025 TEDS KNEE MD/XLG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501026 TEDS KNEE LG/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501027 TEDS KNEE LG/LNG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501028 TEDS KNEE XL/REG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501029 TED KNEE XL/XLG PR 273 Medical/Surgical Supplies and Devices - Take Home Supplies $189.00

501035 TEDS KNEE XXLG/LNG 273 Medical/Surgical Supplies and Devices - Take Home Supplies $227.00 501036 CERVICAL COLLAR SOFT P 273 Medical/Surgical Supplies and Devices - Take Home Supplies $289.00 501389 URINE STRAINER 273 Medical/Surgical Supplies and Devices - Take Home Supplies $56.00 501561 RE DEODORANT ARM 273 Medical/Surgical Supplies and Devices - Take Home Supplies $21.00 501577 RE MUG T HANDLE 273 Medical/Surgical Supplies and Devices - Take Home Supplies $67.00 501595 RE W'CHAIR LAP TRAY 273 Medical/Surgical Supplies and Devices - Take Home Supplies $123.00 501624 GEN CODE (273) 273 Medical/Surgical Supplies and Devices - Take Home Supplies $-

501626 BREAST SHELL 273 Medical/Surgical Supplies and Devices - Take Home Supplies $51.00

501644 WIRECUTTERS 273 Medical/Surgical Supplies and Devices - Take Home Supplies $88.00

501970 GEN CODE (273) 273 Medical/Surgical Supplies and Devices - Take Home Supplies $-

506756 PAD POLAR COOLER 273 Medical/Surgical Supplies and Devices - Take Home Supplies $287.00

520044 DOUGHNUT PLASTIC AIR R 273 Medical/Surgical Supplies and Devices - Take Home Supplies $19.00

300331 Drsg Cutinova 4X4 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $9.00

300336 Drsg Allevyn 2X2 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $28.00

300481 Suction Diverter Tip 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $117.00 300511 Sling Disp Xl 100Lb 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $106.00 300722 Shoe Cast Large Men 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16.00 300723 Shoe Cast Small Men 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16.00 300724 Shoe Cast Med Men 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16.00 300725 Shoe Cast X-Large 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $28.00 300726 Shoe Cast Small Female 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16.00

300727 Shoe Cast Med Female 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16.00

300830 Boot Posey Heel Guard 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $58.00

300836 Wrist Support Sm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $22.00

300840 Wrist Support Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $22.00

300841 Wrist Supporter Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $22.00

300868 Cervical Collar Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $12.00

300875 Immob Shoulder Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $17.00

300951 Immob Knee Small 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $36.00

300952 Immob Knee Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $36.00 300969 Sling Arm Sm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $11.00 300970 Sling Arm Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $11.00 300971 Sling Arm Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $11.00 300978 Immob Shoulder Sm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $17.00 300980 Immob Shoulder Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $17.00 301005 Supporter Adult Sm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $15.00

301006 Suppporter Adult Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $15.00

301007 Supporter Adult Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $15.00

301800 Shoe Cast Ped (12Aa-S) 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $24.00

99 301876 Multipodus Boot Ped 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $188.00 301877 Multipodus Boot Small 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $188.00 301878 Multipodus Boot Large 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $119.00 301879 Multipodus Boot Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $119.00

301880 Mutlipodus Boot Xl 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $300.00

301971 Orthotic Spinal Orthosis Proc 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

302030 Ortho Add Lower Ext Orthosis 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

306730 Sling Arm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $11.00

306800 Orthotic Halo Cervical Jkt Ves 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

310914 Cast Padding 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $59.00

312474 Gen Code - Mor (274) 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

312587 Fabric-Vascular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $878.00 312588 Felt Cardio. Teflon 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,240.00 312621 Graft Goretex 6X40 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00 312634 Graft Bard Albumin Coa 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $4,083.00 312635 Graft Usci Dacron Fila 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $4,666.00 312638 Graft Velex Woven 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,924.00 312644 Graft Goretex 6X80 V06 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

312645 Graft Goretex 8X80 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

312646 Graft Goretex 6X30 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $4,264.00

312647 Graft Goretex 8X40 V08 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

312680 Infusion Pump Refill Kit 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $83.00

312791 Patch Carotid Intravas 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $647.00

312793 Patch Gortex Cardiovas 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,502.00

312794 Patch Soft Tissue 5X10 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,318.00

314475 Tube Jejunostomy Kit 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $483.00 314571 Patch Goretex Large 1M 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,044.00 314572 Patch Goretex Large 2M 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $4,584.00 314811 Tube Moss Gastrostomy 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $3,949.00 315005 Graft Goretex Vascular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $15,535.00 315094 Graft Seamguard 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,295.00 315124 Graft Hemashield 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $3,539.00

315151 Graft Intralum. Ringed 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,830.00

315225 Patch Goretex 5X 10Cm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,502.00

315245 Graft Medtronic 331-2 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,814.00

315254 Graft Medtronic 3300 S 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,988.00

315294 Tube Gastrostomy 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,141.00

315357 Felt Vascular Pledget 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $82.00

315451 Ossicula Prosthetic Im 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $878.00

315514 Felt, Cardiovascular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,240.00

315529 Graft Vascular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,733.00 315626 Fabric-Vascular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,593.00 315674 Graft Impra 6X40 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,235.00 315779 Graft Vascular Impra F 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $8,550.00 315780 Graft Vascular Impra F 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,257.00 315804 Graft Axillo-Bifemoral 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $16,063.00 315838 Graft Goretex 6X10 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,386.00

316101 Cast Arm - Plaster 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $747.00

316103 Cast Arm - Fiberglass 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $833.00

316612 Prosthesis Testicular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $3,900.00

100 316613 Graft Goretex Ringed 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $6,897.00 316614 Graft Goretex Ringed 8 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $6,897.00 317445 Graft Knitted Bifur 22 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,143.00 317512 Tube Stomate Flexiflo 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $677.00

317576 Graft Impra 4-7X45 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,235.00

317577 Graft Goretex 8X80 Rrt 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

317624 Graft Vascular Ptfe F7 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,344.00

317797 Graft Gortex 4-6 X 40 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

317798 Graft Goretex 6X80 R06 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

317799 Graft Vascular Impra 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $10,050.00

317810 Graft Goretex 10X80 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00

317811 Graft Goretex 8X40 S08 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $7,463.00 317875 Graft Goretex 6X20 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $6,611.00 317876 Graft Goretex 10X80Cm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $10,106.00 317877 Graft Goretex 4-7X45 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $9,327.00 317878 Graft Goretex 6X50 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $10,496.00 318300 Collagen Urinary Impla 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,558.00 318301 Mp Joint Prosthesis 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,336.00

318303 Interphalangeal Joint 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,601.00

319850 Patch Coretex Cv 2X9Cm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,044.00

319877 Patch Graft Cv 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $713.00

434553 IMMOBILIZER SHOULDER 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $389.00

435270 Implant Hinged Toe 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $3,579.00

435278 Implant Great Toe 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,531.00

435291 Implant Swanson Finger 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,179.00

435373 IMMOBILIZER KNEE 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 435383 BOOT CAST VELCRO LOOP 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $274.00 435478 Implant Testicular 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,281.00 436301 Ss Piston Teflon + Ss 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $746.00 436392 Ear Schuknecht Stapes 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $708.00 436506 SPLINT NASAL INTERNAL 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $175.00 439614 Ear Ossicular Implant 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,806.00

470198 Spln Cmnt Prlx W Trc 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $1,578.00

483893 IMMOBILIZER M/F SHLDR 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $102.00

500157 OST Wafer 4.00 6X6 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00

500158 OST WAFER FLEXIBLE 2.2 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00

500160 OST ACTIVE-LIFE POUCH 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00

500161 OST DRAINABLE POUCH 1- 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00

500162 OST DRAINABLE POUCH 1- 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00

500163 OST DRAINABLE POUCH 2- 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00

500164 OST DRAINABLE POUCH 2- 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00 500165 OST DRAINABLE POUCH 4 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00 500172 OST DURAHESIVE WAFER 1 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00 500175 ILEX SKIN PROTECTANT P 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $193.00 500185 OST WAFER FLEXIBLE 1.7 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00 500186 OST INSERT WAFER 1.25 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $25.00 500187 OST INSERT WAFER 1.30 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $25.00

500188 OST INSERT WAFER 1.50 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $25.00

500189 OST INSERT WAFER 1.60 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $25.00

500190 OST WAFER FLEXIBLE 1.5 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00

101 500193 OST ACTIVE LIFE POUCH 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $51.00 500194 OST DURAHESIVE WAFET 2 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00 500195 OST WAFER FLEXIBLE 2.7 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $61.00 500199 OST WAFER DURA'E 1.75 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $113.00

500200 OST WAFER DURA'E 2.25 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $113.00

500308 UNNA BOOT 4IN 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $113.00

500795 SPLINT ARM RT ADULT 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $394.00

500804 SPLINT LEG/AFO LT LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500805 SPLINT LEG/AFO RT LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500806 SPLINT LEG/AFO LT MD 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500807 SPLINT LEG/AFO RT MD 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500808 SPLINT LEG/AFO LT SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $335.00 500809 SPLINT LEG/AFO RT SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00 500824 SPLINT, F'GER B'BALL L 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $104.00 500830 SPLINT F'GER B'BAL SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $104.00 500832 SPLINT, FINGER FROG SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $157.00 500883 SPLINT F'GER B'BALL ME 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $104.00 500895 PHILLY COLLAR 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $251.00

500902 SPLINT F'GER VEL SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $193.00

500903 SPLINT F'GER VEL MD 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $193.00

500904 SPLINT F'GER VEL LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $193.00

500909 SPLINT LEG/AFO LT XL 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500910 SPLINT LEG/AFO RT XL 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $333.00

500950 SPLINT ANKLE AIR RT 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $579.00

500951 IMMOB KNEE (19) SM IM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00

500952 IMMOB KNEE (19) MED 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500953 IMMOB KNEE (19) LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500954 IMMOB KNEE (19) XLG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500955 IMMOB KNEE (24) SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500956 IMMOB KNEE (24) MED 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500957 IMMOB KNEE (24) LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00 500958 IMMOB KNEE (24) XLG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $867.00

500969 SLING ARM SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $216.00

500970 SLING ARM MD 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $216.00

500971 SLING ARM LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $216.00

500972 SUPPORT LUMBAR SM (28 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $807.00

500973 SUPPORT LUMBAR SM/MED 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $807.00

500974 SUPPORT LUMBAR MED (36 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $807.00

500975 SUPPORT LUMBAR MED/LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $807.00

500976 SUPPORT LUMBAR LG (44 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $807.00

500978 IMMOB SHOULDER SM 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $389.00 500979 IMMOB SHOULDER MD 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $389.00 500980 IMMOB SHOULDER LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $389.00 500981 IMMOB SHOULDER X-LG 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $389.00 500983 SPLINT FOOT COCK-UP 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $148.00 501628 Foot Orthotics 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $465.00 501704 Orthotic Knee Sleeve 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $951.00

501878 Orthotic Multipodus Afo Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $970.00

501879 Orthotic Multipodus Afo Md 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $917.00

501903 Splint Finger Toad Small 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $157.00

102 501904 Splint Finger Toad Med 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $157.00 501905 Splint Finger Toad Lg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $157.00 501971 ORTHOTIC SPINAL ORTHOS 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502000 Orthotic Tlso A/P/Lat 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502001 Orthotic Tlso A/P/Lat/Rotary 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502002 Orthotic Tlso A/P/Lat/Rotary C 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502003 Orthotic Tlso A/P/Lat/Rotary M 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502004 Orthotic Tlso A.P/Lat/Rotary H 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502005 Orthotic Tlso A/P/Lat/Rotary W 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502006 Orthotic Tlso A/P/Lat Molded 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502007 Orthotic Tlso A/P/Lat Molded W 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502008 Orthotic Afo Post Solid Ankle 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502009 Orthotic Add To Lower Ext V VC 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502010 Orthotic Cerv Multipost Collar 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502011 Orthotic Cerv Multipost Collar 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502012 Orthotic Cerv Multipost Clr/BA 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502013 Orthotic Thor Rib Belt 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502014 Orthotic Thor Rib Belt Custom 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502015 Orthotic Ilso Custom Fitted 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502016 Orthotic TLSO Custom Fabricate 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502017 Orthotic Tlso Elastic 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502018 Orthotic Tlso Hyperextension 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502019 Orthotic Tlso A/P Control 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502020 Orthotic Cerv Helmet Molded 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502021 Orthotic Cerv Helmet Non-mold 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502022 Orthotic Cerv Foam Collar 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502023 Orthotic Cerv Flex Plas Collar 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502024 Orthotic Cerv Semirigid Plas C 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502025 Orthotic Cerv Semirigid Adj Ch 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502026 Orthotic Cerv Semirigid Wire F 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502027 Orthotic Cerv Collar Molded 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502028 Orthotic Cerv Collar Semirigid 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502029 Orthotic Cerv Collar Thoracic 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502030 Orthotic Add To Lower Ext Orth 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502031 Orthotic Elastic Support Full 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502032 Orthotic Afo Molded W/Ankle Jo 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502033 Orthotic Elas Support 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502034 Orthotic Ho Abduction 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502035 Orthotic Add. Pelvic Control 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502036 Orthotic H0 Abduction 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502037 Orthotic Custom Repair 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502039 Orthotic Support B.K. Surgical 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502040 Orthotic Lift Heall & Sole Cor 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502041 Orthotic Lift Heel Tapered 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502042 Orthotic Lift Hell & Sole Neo 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502043 Orthotic Lift Metal Ext 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502044 Orthotic Heel Wedge 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502045 Orthotic Lso, Full Corset 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502046 Orthotic Foot-Ankle Socket 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502047 Orthotic Add. Test Socket 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

103 502048 Orthotic Add. Acrylic 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502049 Orthotic Add. Symes Socket B/K 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502050 Orthotic Add. Total Contact B 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502051 Orthotic Add Socket Insert Su 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502052 Orthotic Add Endo Alignable B 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502053 Orthotic Add Endo Ultralight B 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502054 Orthotic Prosthetic Sock Wool 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502055 Orthotic Kafo Femoral Fx Molde 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502056 Orthotic Upper Extremity Humer 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

502057 Orthotic Repair of Ort Dev 15 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $415.00

502058 Orthotic Sewho Airplane 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $5,015.00

502059 Orthotic Kafo Fx Ortho 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $10,025.00 502995 Orthotic Kafo Dbl Up Free Knee 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502996 Orthotic Add Low Ext Adj Mot 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502997 Orthotic Add Soft Interface A 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502998 Orthotic Add Soft Interface A 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 502999 Orthotic Add Sock Fracture OR 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503000 Orthotic Prosth. Shrinker BK 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503001 Orthotic Prosth. Shrinker AK 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503002 Orthotic Prosth. Shrinker Uppe 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503003 Orthotic Stump Sock Rk 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503004 Orthotic Stump Sock Ak 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503005 Orthotic Stump Sock Up 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503006 Orthotic AFO Moldd w/Ankle Jnt 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503007 Orthotic Add. Lower Ex 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503008 Orthotic Food Insert Molded 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503009 Orthotic TLSO Apl Two Piece Md 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503011 Orthotic Add. Lower Ext Bar-J 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503012 Orthotic Add. Pelvic Control 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503013 Orthotic Add Pelvic Contrl Hip 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503014 Orthotic Add Pelv Control Hip 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503015 Orthotic Add Pelvic Contrl Hip 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503025 Orthotic Compression Sleeve/GL 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503026 Orthotic Elastic Support Bk ME 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503027 Orthotic Elastic Support BK HE 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503028 Orthotic Elastic Support AK ME 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503029 Orthotic Elastic Support AK HE 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503030 Orthotic Elastic Support AK SU 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503031 Orthotic Add Lower Extrem Suc 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503032 Orthotic Add Knee Joint Disc/O 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503033 Orthotic Add Lower Extremity 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503034 Orthotic Ho Abduction Pelvic A 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503035 Orthotic LSO Flexible Custom F 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503131 Orthotic Femoral Fx Cast Semi 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503132 Orthotic Add Halo MRI Comp 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503133 Orthotic Sock Protective Body 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503134 Orthotic AFO Rigid Anterior Ti 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503135 Orthotic AFO Single Bar B/K 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503136 Orthotic HKafo Unilatel Torso 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503137 Orthotic Add Lower Extremity S 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

104 503138 Orthotic Femoral Fx Cast Rigid 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503139 Orthotic Add Lower Extrem Lm 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503140 Orthotic HO Abduction Pelvic A 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 503141 Orthotic Proc for Lower Extrem 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503142 Orthotic Foot Plastic Hell Str 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503143 Orthotic Add Lower Ext Pelvic 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503144 Orthotic Add Knee Joint Deop L 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503145 Orthotic Add Lower Extrem Nonc 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503146 Orthotic Add Lower Extrem Stra 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $-

503147 Orthotic Add Lower Ext 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $609.00

503148 Orthotic Foot Insert Long Arch 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $2,475.00

506730 Sling Arm Xlg 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $216.00 506800 ORTHOTIC HALO CERVICAL 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $- 520032 BOOT CAST VELCRO LOOP 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $280.00 906952 Cast Padding Cttn Strl 274 Medical/Surgical Supplies and Devices - Prosthetic/Orthotic Devices $11.00 378740 Misc Pacer Implant 275 Medical/Surgical Supplies and Devices - Pace Maker $- 378741 Pacemaker Lead 275 Medical/Surgical Supplies and Devices - Pace Maker $3,333.00 378742 Pacer Lead Adapter 275 Medical/Surgical Supplies and Devices - Pace Maker $1,463.00

378765 Pulse Generator I 275 Medical/Surgical Supplies and Devices - Pace Maker $29,087.00

378766 Pulse Generator Ii 275 Medical/Surgical Supplies and Devices - Pace Maker $25,605.00

378767 Pulse Generator Iii 275 Medical/Surgical Supplies and Devices - Pace Maker $21,939.00

378768 Pulse Generator Iv 275 Medical/Surgical Supplies and Devices - Pace Maker $21,287.00

378769 Pulse Generator V 275 Medical/Surgical Supplies and Devices - Pace Maker $16,947.00

378809 Xr Fluoro Pacemak Ins 275 Medical/Surgical Supplies and Devices - Pace Maker $1,166.00

491517 Pacemaker Singl Chmbr 275 Medical/Surgical Supplies and Devices - Pace Maker $15,126.00

938444 Pacemkr MRI 2CH PM2272 275 Medical/Surgical Supplies and Devices - Pace Maker $12,096.00 938483 Lead PCNG 52CM 8FR 275 Medical/Surgical Supplies and Devices - Pace Maker $1,512.00 938484 Lead PCNG 58CM 8FR 275 Medical/Surgical Supplies and Devices - Pace Maker $1,512.00 434953 Intraoccular Lens Iola 276 Medical/Surgical Supplies and Devices - Intraocular Lens $1,521.00 435079 Intraoccular Lens Amo 276 Medical/Surgical Supplies and Devices - Intraocular Lens $1,521.00 435572 Intraoccular Lens Alco 276 Medical/Surgical Supplies and Devices - Intraocular Lens $1,521.00 436423 Intraoccular Lens Chir 276 Medical/Surgical Supplies and Devices - Intraocular Lens $1,521.00

438087 Intraoccular Lens-Post 276 Medical/Surgical Supplies and Devices - Intraocular Lens $-

438146 Intraoccular Lens-Ant. 276 Medical/Surgical Supplies and Devices - Intraocular Lens $-

439367 Intraoccular Lens-Alco 276 Medical/Surgical Supplies and Devices - Intraocular Lens $1,208.00

439624 Intraoccular Lens Staa 276 Medical/Surgical Supplies and Devices - Intraocular Lens $810.00

301260 Tube Declogger Per 12-16 278 Medical/Surgical Supplies and Devices - Other Implants $15.00

305032 Pouch Closed 1-3/4 278 Medical/Surgical Supplies and Devices - Other Implants $390.00

312472 Gen Code - Mor (278) 278 Medical/Surgical Supplies and Devices - Other Implants $19.00

312502 Fallope Ring 278 Medical/Surgical Supplies and Devices - Other Implants $829.00

312506 Connecting Bar 278 Medical/Surgical Supplies and Devices - Other Implants $96.00 312518 Cable 1.6Mm 278 Medical/Surgical Supplies and Devices - Other Implants $3,986.00 312519 Cable 2.0Mm 278 Medical/Surgical Supplies and Devices - Other Implants $3,986.00 312520 Cable Crimp Sleeve 278 Medical/Surgical Supplies and Devices - Other Implants $3,233.00 312524 Cable Grip 278 Medical/Surgical Supplies and Devices - Other Implants $5,257.00 312530 Shunt Ventricular Cath 278 Medical/Surgical Supplies and Devices - Other Implants $696.00 312531 Clamp 4.0Mm 2.5Mm 395. 278 Medical/Surgical Supplies and Devices - Other Implants $1,306.00

312532 Clamp 4.0Mm 4.0Mm 395. 278 Medical/Surgical Supplies and Devices - Other Implants $1,306.00

312535 Clamp Tube To Tube 278 Medical/Surgical Supplies and Devices - Other Implants $2,901.00

312536 Clamp Single Adjustabl 278 Medical/Surgical Supplies and Devices - Other Implants $1,331.00

105 312537 Clamp Single Pin 393.6 278 Medical/Surgical Supplies and Devices - Other Implants $614.00 312541 Clamp Universal 393.75 278 Medical/Surgical Supplies and Devices - Other Implants $1,807.00 312542 Clip Aneurysm Sugita 278 Medical/Surgical Supplies and Devices - Other Implants $1,745.00 312581 Compressor Open 393.76 278 Medical/Surgical Supplies and Devices - Other Implants $1,518.00

312582 Shunt Connector 278 Medical/Surgical Supplies and Devices - Other Implants $213.00

312583 Convertible Ommaya Flu 278 Medical/Surgical Supplies and Devices - Other Implants $996.00

312589 Fixator Colles 278 Medical/Surgical Supplies and Devices - Other Implants $5,549.00

312632 Graft Umbilical Vein 278 Medical/Surgical Supplies and Devices - Other Implants $17,682.00

312648 Filter Vena Cava 278 Medical/Surgical Supplies and Devices - Other Implants $8,851.00

312679 Infusion Pump 278 Medical/Surgical Supplies and Devices - Other Implants $44,486.00

312692 Mesh Marlex 10X14 278 Medical/Surgical Supplies and Devices - Other Implants $4,949.00

312696 Mesh Mersilene 278 Medical/Surgical Supplies and Devices - Other Implants $569.00 312701 Shunt Valve Ventricula 278 Medical/Surgical Supplies and Devices - Other Implants $4,426.00 312702 Loop Recorder Implant 278 Medical/Surgical Supplies and Devices - Other Implants $25,464.00 312783 Nut 4.5Mm 278 Medical/Surgical Supplies and Devices - Other Implants $88.00 312784 Nut Springloaded 278 Medical/Surgical Supplies and Devices - Other Implants $162.00 312787 Shunt Vent. Reservoir 278 Medical/Surgical Supplies and Devices - Other Implants $1,421.00 312886 Pin Steinman Central T 278 Medical/Surgical Supplies and Devices - Other Implants $402.00

312891 Pin Ext Fix Colles 278 Medical/Surgical Supplies and Devices - Other Implants $348.00

312894 Pin Knowles 278 Medical/Surgical Supplies and Devices - Other Implants $323.00

312909 Pin Steinman 278 Medical/Surgical Supplies and Devices - Other Implants $224.00

312915 Pin Steinman Ext Fix 278 Medical/Surgical Supplies and Devices - Other Implants $224.00

312945 Plate Ambi 278 Medical/Surgical Supplies and Devices - Other Implants $2,623.00

312987 Plate Ambi Sc 278 Medical/Surgical Supplies and Devices - Other Implants $2,856.00

313002 Plate Broad Dcp 278 Medical/Surgical Supplies and Devices - Other Implants $808.00

313008 Plate Cloverleaf 278 Medical/Surgical Supplies and Devices - Other Implants $829.00 313013 Plate Condylar Buttres 278 Medical/Surgical Supplies and Devices - Other Implants $2,512.00 313015 Plate Condylar Dcp Lg. 278 Medical/Surgical Supplies and Devices - Other Implants $3,035.00 313016 Plate Condylar Dcp 278 Medical/Surgical Supplies and Devices - Other Implants $1,778.00 313032 Plate Narrow Dcp 10-16 278 Medical/Surgical Supplies and Devices - Other Implants $1,119.00 313040 Plate Dcp 3.5Mm 278 Medical/Surgical Supplies and Devices - Other Implants $569.00 313051 Plate Narrow Dcp 2-9 H 278 Medical/Surgical Supplies and Devices - Other Implants $1,119.00

313061 Plate Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,662.00

313062 Plate L Buttress 4-Hol 278 Medical/Surgical Supplies and Devices - Other Implants $3,304.00

313064 Plate Mini 278 Medical/Surgical Supplies and Devices - Other Implants $238.00

313066 Plate Small 278 Medical/Surgical Supplies and Devices - Other Implants $318.00

313072 Plate Semi-Tubular 278 Medical/Surgical Supplies and Devices - Other Implants $318.00

313082 Plate Spoon 278 Medical/Surgical Supplies and Devices - Other Implants $833.00

313088 Plate Small T 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00

313090 Plate T 3-Hole 240.13 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00

313091 Plate T 4-Hole 240.14 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00 313092 Plate T 5-Hole 240.15 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00 313093 Plate T 6-Hole 240.16 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00 313094 Plate T 8-Hole 240.18 278 Medical/Surgical Supplies and Devices - Other Implants $1,465.00 313095 Plate T Buttress 4-Hol 278 Medical/Surgical Supplies and Devices - Other Implants $2,116.00 313096 Plate T Buttress 5-Hol 278 Medical/Surgical Supplies and Devices - Other Implants $2,116.00 313097 Plate T 278 Medical/Surgical Supplies and Devices - Other Implants $1,687.00

313108 Plate Tubular 278 Medical/Surgical Supplies and Devices - Other Implants $348.00

313110 Plate Y 278 Medical/Surgical Supplies and Devices - Other Implants $927.00

313122 Plate Cobra 278 Medical/Surgical Supplies and Devices - Other Implants $2,045.00

106 313128 Port Vasc Access Arter 278 Medical/Surgical Supplies and Devices - Other Implants $5,851.00 313129 Port Vasc. Access Dual 278 Medical/Surgical Supplies and Devices - Other Implants $5,851.00 313130 Port Vasc. Access 278 Medical/Surgical Supplies and Devices - Other Implants $5,024.00 313150 Bovine Pericardial Pat 278 Medical/Surgical Supplies and Devices - Other Implants $1,745.00

313151 Graft Goretex Spinal 278 Medical/Surgical Supplies and Devices - Other Implants $2,601.00

313152 Graft Goretex Dura 278 Medical/Surgical Supplies and Devices - Other Implants $732.00

313188 Pudenz Barium Ventricu 278 Medical/Surgical Supplies and Devices - Other Implants $665.00

313195 Pudenz Flushing Valve 278 Medical/Surgical Supplies and Devices - Other Implants $2,928.00

313198 Pudenz Peritoneal Cath 278 Medical/Surgical Supplies and Devices - Other Implants $503.00

313199 Pudenz Peritoneal Cath 278 Medical/Surgical Supplies and Devices - Other Implants $503.00

313200 Pudenz Peritoneal Cath 278 Medical/Surgical Supplies and Devices - Other Implants $503.00

313201 Pudenz Ventricular Cat 278 Medical/Surgical Supplies and Devices - Other Implants $1,072.00 313206 Ring Mitral Prosthetic 278 Medical/Surgical Supplies and Devices - Other Implants $7,312.00 313273 Rush Rod 278 Medical/Surgical Supplies and Devices - Other Implants $789.00 313334 Screw Compression 278 Medical/Surgical Supplies and Devices - Other Implants $170.00 313335 Screw Cancellous 278 Medical/Surgical Supplies and Devices - Other Implants $390.00 313355 Ambi Hip Clip 278 Medical/Surgical Supplies and Devices - Other Implants $348.00 313356 Stent Wall 10Mm 278 Medical/Surgical Supplies and Devices - Other Implants $8,851.00

313357 Stent Wall 12Mm 278 Medical/Surgical Supplies and Devices - Other Implants $9,932.00

313372 Screw Compression Lag 278 Medical/Surgical Supplies and Devices - Other Implants $675.00

313373 Craniofix Clamp 278 Medical/Surgical Supplies and Devices - Other Implants $701.00

313374 Craniofix Cover 278 Medical/Surgical Supplies and Devices - Other Implants $878.00

313395 Apligraf Skin 44 Sqcm 278 Medical/Surgical Supplies and Devices - Other Implants $6,331.00

313477 Screw Cannulated 278 Medical/Surgical Supplies and Devices - Other Implants $1,044.00

313497 Screw Colles Set 11-01 278 Medical/Surgical Supplies and Devices - Other Implants $31.00

313515 Screw Cortex 278 Medical/Surgical Supplies and Devices - Other Implants $286.00 313567 Screw Cortical 278 Medical/Surgical Supplies and Devices - Other Implants $286.00 313575 Screw Malleolar 278 Medical/Surgical Supplies and Devices - Other Implants $420.00 313593 Screw Schanz 278 Medical/Surgical Supplies and Devices - Other Implants $288.00 313609 Shunt Denver Distal Ca 278 Medical/Surgical Supplies and Devices - Other Implants $290.00 313610 Shunt Denver 278 Medical/Surgical Supplies and Devices - Other Implants $2,687.00 313617 Shunt Denver Proximal 278 Medical/Surgical Supplies and Devices - Other Implants $317.00

313618 Shunt Denver Perit Cat 278 Medical/Surgical Supplies and Devices - Other Implants $559.00

313620 Shunt Denver Leuro Com 278 Medical/Surgical Supplies and Devices - Other Implants $336.00

313622 Shunt Ventricular 278 Medical/Surgical Supplies and Devices - Other Implants $1,044.00

313627 Stimulator Spinal Fusi 278 Medical/Surgical Supplies and Devices - Other Implants $43,064.00

313636 Shunt Standard Valve S 278 Medical/Surgical Supplies and Devices - Other Implants $3,981.00

313675 External Fixator Tube 278 Medical/Surgical Supplies and Devices - Other Implants $390.00

313705 Shunt Valve 278 Medical/Surgical Supplies and Devices - Other Implants $7,280.00

313719 Washer 278 Medical/Surgical Supplies and Devices - Other Implants $559.00

313721 Wire Cerclage 278 Medical/Surgical Supplies and Devices - Other Implants $96.00 313728 Kirschner Wire 278 Medical/Surgical Supplies and Devices - Other Implants $208.00 313739 Hemoclips Md-Lg 278 Medical/Surgical Supplies and Devices - Other Implants $810.00 313741 Hemoclips Lg 278 Medical/Surgical Supplies and Devices - Other Implants $810.00 313742 Hemoclips Md 278 Medical/Surgical Supplies and Devices - Other Implants $810.00 313743 Hemoclips Sm 278 Medical/Surgical Supplies and Devices - Other Implants $810.00 313744 Mesh Dexon Dg 7979-00 278 Medical/Surgical Supplies and Devices - Other Implants $1,083.00

313811 Bone Wax 278 Medical/Surgical Supplies and Devices - Other Implants $104.00

314246 Aneuroplastic Kit 278 Medical/Surgical Supplies and Devices - Other Implants $1,286.00

314247 Arch Bars 278 Medical/Surgical Supplies and Devices - Other Implants $288.00

107 314501 Cement Simplex 278 Medical/Surgical Supplies and Devices - Other Implants $1,093.00 314596 Duraguard 278 Medical/Surgical Supplies and Devices - Other Implants $2,843.00 314597 Peritoneal Membrane 278 Medical/Surgical Supplies and Devices - Other Implants $855.00 314768 Stent Ureteral 90Cm 278 Medical/Surgical Supplies and Devices - Other Implants $1,564.00

314842 Peri-Strips Implant 278 Medical/Surgical Supplies and Devices - Other Implants $1,181.00

314844 Graft Duraguard 278 Medical/Surgical Supplies and Devices - Other Implants $2,986.00

315061 Shunt Accu-Flo Hydroce 278 Medical/Surgical Supplies and Devices - Other Implants $877.00

315093 Patch Pericardial 278 Medical/Surgical Supplies and Devices - Other Implants $927.00

315152 Spinelink Cervical Tra 278 Medical/Surgical Supplies and Devices - Other Implants $1,664.00

315153 Spinelink Cervical Top 278 Medical/Surgical Supplies and Devices - Other Implants $1,664.00

315154 Spinelink Cervical Bot 278 Medical/Surgical Supplies and Devices - Other Implants $1,664.00

315155 Spinelink Cervical Scr 278 Medical/Surgical Supplies and Devices - Other Implants $1,069.00 315156 Spinelink Cer. End Cap 278 Medical/Surgical Supplies and Devices - Other Implants $563.00 315157 Spinelink Cer. Lock Nu 278 Medical/Surgical Supplies and Devices - Other Implants $242.00 315177 Clamp Univ Joint 2 Tub 278 Medical/Surgical Supplies and Devices - Other Implants $3,122.00 315178 Mesh Dualmesh Med. 278 Medical/Surgical Supplies and Devices - Other Implants $4,873.00 315179 Mesh Dualmesh Lg. 278 Medical/Surgical Supplies and Devices - Other Implants $10,481.00 315241 Shunt Leveen Peritonea 278 Medical/Surgical Supplies and Devices - Other Implants $2,775.00

315276 Mesh Vicryl 278 Medical/Surgical Supplies and Devices - Other Implants $1,858.00

315288 Stent Ureteral 278 Medical/Surgical Supplies and Devices - Other Implants $3,485.00

315301 Valve Aortic 278 Medical/Surgical Supplies and Devices - Other Implants $26,838.00

315303 Filter Vena Cava Jug 5 278 Medical/Surgical Supplies and Devices - Other Implants $7,152.00

315304 Filter Vena Cava Fem 5 278 Medical/Surgical Supplies and Devices - Other Implants $7,152.00

315310 Clip Aneurysm Yasergil 278 Medical/Surgical Supplies and Devices - Other Implants $1,524.00

315316 Spinelink Standard Lin 278 Medical/Surgical Supplies and Devices - Other Implants $1,469.00

315317 Spinelink Revrese Link 278 Medical/Surgical Supplies and Devices - Other Implants $1,469.00 315318 Spinelink Locknut 278 Medical/Surgical Supplies and Devices - Other Implants $258.00 315319 Spinelink Cap 278 Medical/Surgical Supplies and Devices - Other Implants $448.00 315320 Spinelink Spacer Washe 278 Medical/Surgical Supplies and Devices - Other Implants $448.00 315321 Spinelink Polydirectio 278 Medical/Surgical Supplies and Devices - Other Implants $5,586.00 315350 Stent Smart 80Mm 278 Medical/Surgical Supplies and Devices - Other Implants $14,725.00 315351 Stent Wall 278 Medical/Surgical Supplies and Devices - Other Implants $9,755.00

315352 Graft Endovascular Aaa 278 Medical/Surgical Supplies and Devices - Other Implants $85,833.00

315355 Stent Palmas Md 278 Medical/Surgical Supplies and Devices - Other Implants $6,484.00

315360 Stent Palmaz Lg 278 Medical/Surgical Supplies and Devices - Other Implants $5,839.00

315361 Stent Palmaz Ps424 278 Medical/Surgical Supplies and Devices - Other Implants $9,067.00

315362 Stent Palmaz Ps564 278 Medical/Surgical Supplies and Devices - Other Implants $9,809.00

315363 Stent Palmaz Ps784 278 Medical/Surgical Supplies and Devices - Other Implants $13,814.00

315364 Stent Palmaz Corinth I 278 Medical/Surgical Supplies and Devices - Other Implants $7,252.00

315365 Stent Palmaz 40/60 Mm 278 Medical/Surgical Supplies and Devices - Other Implants $8,981.00

315367 Stent Palmaz 60/80/100 278 Medical/Surgical Supplies and Devices - Other Implants $11,442.00 315368 Stent Smart 20Mm 278 Medical/Surgical Supplies and Devices - Other Implants $11,076.00 315369 Stent Smart 40/60 Mm 278 Medical/Surgical Supplies and Devices - Other Implants $12,261.00 315452 Ear Tube 278 Medical/Surgical Supplies and Devices - Other Implants $229.00 315537 Clips Hulka 278 Medical/Surgical Supplies and Devices - Other Implants $780.00 315538 Cannula Scott 278 Medical/Surgical Supplies and Devices - Other Implants $323.00 315542 Shunt Pudenz Ventric C 278 Medical/Surgical Supplies and Devices - Other Implants $322.00

315546 Clip Aneurysm 278 Medical/Surgical Supplies and Devices - Other Implants $1,278.00

315713 Ring Tricuspid Prosthe 278 Medical/Surgical Supplies and Devices - Other Implants $14,248.00

315718 Plate Angle 90 Deg 60M 278 Medical/Surgical Supplies and Devices - Other Implants $1,781.00

108 315734 Plate Reconstruction 278 Medical/Surgical Supplies and Devices - Other Implants $1,602.00 315799 Skin Stretching System 278 Medical/Surgical Supplies and Devices - Other Implants $2,601.00 315800 Rogo Sacral Screw 278 Medical/Surgical Supplies and Devices - Other Implants $2,601.00 315802 Cement Plug 278 Medical/Surgical Supplies and Devices - Other Implants $919.00

315806 Lead Implantable Spina 278 Medical/Surgical Supplies and Devices - Other Implants $11,801.00

315812 Valve Mitral 278 Medical/Surgical Supplies and Devices - Other Implants $40,122.00

315819 Osteoset 278 Medical/Surgical Supplies and Devices - Other Implants $4,375.00

315825 Spinelink Link Tie 278 Medical/Surgical Supplies and Devices - Other Implants $448.00

315826 Spinelink Fixed Screw 278 Medical/Surgical Supplies and Devices - Other Implants $3,648.00

315829 Mesh Marlex Plug 278 Medical/Surgical Supplies and Devices - Other Implants $1,480.00

315830 Screw Centre-Drive 278 Medical/Surgical Supplies and Devices - Other Implants $357.00

315831 Plate Micro Short 278 Medical/Surgical Supplies and Devices - Other Implants $502.00 315832 Plate Micro Straight 278 Medical/Surgical Supplies and Devices - Other Implants $1,316.00 315833 Plate Micro Square 278 Medical/Surgical Supplies and Devices - Other Implants $1,452.00 315834 Plate Micro Curved 278 Medical/Surgical Supplies and Devices - Other Implants $1,710.00 315835 Burr Hole Cover Metal 278 Medical/Surgical Supplies and Devices - Other Implants $1,278.00 315836 Mesh Panel Titanium 278 Medical/Surgical Supplies and Devices - Other Implants $4,320.00 315839 Cath Tenckhoff Cvd. Di 278 Medical/Surgical Supplies and Devices - Other Implants $652.00

316000 Patch Periguard Graft 278 Medical/Surgical Supplies and Devices - Other Implants $1,437.00

316001 Patch Periguard Cv 278 Medical/Surgical Supplies and Devices - Other Implants $2,302.00

316589 Shunt Lumbar Drain Kit 278 Medical/Surgical Supplies and Devices - Other Implants $1,245.00

316606 Plate Short Barrel 278 Medical/Surgical Supplies and Devices - Other Implants $2,732.00

316607 Level 1 - 1St 30 Minut 278 Medical/Surgical Supplies and Devices - Other Implants $8,910.00

316608 Level 1 Add'L 15 Minut 278 Medical/Surgical Supplies and Devices - Other Implants $4,288.00

316609 Level 2-1St 30 Mins 278 Medical/Surgical Supplies and Devices - Other Implants $11,839.00

316618 Level 2-Addl 15 Minute 278 Medical/Surgical Supplies and Devices - Other Implants $4,457.00 316650 Rogo Sacral Screw Offs 278 Medical/Surgical Supplies and Devices - Other Implants $2,336.00 316654 Rogo Spinal Rod 278 Medical/Surgical Supplies and Devices - Other Implants $3,908.00 316666 Rogo Crossbar 278 Medical/Surgical Supplies and Devices - Other Implants $3,996.00 316678 Rogo Downward Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,750.00 316680 Rogo Upward Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,928.00 316682 Rogo Neutral Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,750.00

316692 Rogo Coupler 278 Medical/Surgical Supplies and Devices - Other Implants $1,846.00

316693 Rogo Spinal Set Screws 278 Medical/Surgical Supplies and Devices - Other Implants $750.00

316853 Clip Aneurysm Sundt 278 Medical/Surgical Supplies and Devices - Other Implants $2,087.00

316862 Mesh Prolene 278 Medical/Surgical Supplies and Devices - Other Implants $1,021.00

316865 Shunt Reservoir Holter 278 Medical/Surgical Supplies and Devices - Other Implants $882.00

316879 Rogo Cranial Hook 278 Medical/Surgical Supplies and Devices - Other Implants $1,920.00

316880 Rogo Wide Cranial Hook 278 Medical/Surgical Supplies and Devices - Other Implants $1,920.00

316882 Rogo Extended Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,750.00

316884 Rogo Lamina Hook 278 Medical/Surgical Supplies and Devices - Other Implants $2,750.00 316886 Rogo Hook Bar 278 Medical/Surgical Supplies and Devices - Other Implants $597.00 316889 Rogo Rod Bullet 278 Medical/Surgical Supplies and Devices - Other Implants $1,270.00 316902 Orbital Sheet 278 Medical/Surgical Supplies and Devices - Other Implants $5,977.00 317100 Plate Cervical Locking 278 Medical/Surgical Supplies and Devices - Other Implants $5,748.00 317108 Screw Cervical Locking 278 Medical/Surgical Supplies and Devices - Other Implants $197.00 317127 Screw Cancllous Cervic 278 Medical/Surgical Supplies and Devices - Other Implants $1,160.00

317128 Screw Cervical Exp Hea 278 Medical/Surgical Supplies and Devices - Other Implants $981.00

317375 Mesh Surgipro 3X5 278 Medical/Surgical Supplies and Devices - Other Implants $1,021.00

317382 Pouch Dacron Synchrome 278 Medical/Surgical Supplies and Devices - Other Implants $687.00

109 317385 Screw Casper Distracti 278 Medical/Surgical Supplies and Devices - Other Implants $1,549.00 317390 Cath Spinal Implantabl 278 Medical/Surgical Supplies and Devices - Other Implants $2,909.00 317432 Mesh Surgipro 14X9 278 Medical/Surgical Supplies and Devices - Other Implants $1,021.00 317433 Mesh Marlex 278 Medical/Surgical Supplies and Devices - Other Implants $2,116.00

317501 Mesh Surgical Implant 278 Medical/Surgical Supplies and Devices - Other Implants $1,180.00

317541 Infusion Pump Cath. Ki 278 Medical/Surgical Supplies and Devices - Other Implants $927.00

317556 Screw Herbert 278 Medical/Surgical Supplies and Devices - Other Implants $1,318.00

317578 Clip Adams Deweese 278 Medical/Surgical Supplies and Devices - Other Implants $1,742.00

317695 Cable Trocanteric Syst 278 Medical/Surgical Supplies and Devices - Other Implants $7,304.00

317785 Stimulator Spinal Cord 278 Medical/Surgical Supplies and Devices - Other Implants $27,808.00

317809 Cable W/Small Gripe 278 Medical/Surgical Supplies and Devices - Other Implants $5,257.00

317820 Cable W/Med Gripe 278 Medical/Surgical Supplies and Devices - Other Implants $5,257.00 317821 Cable W/Large Gripe 278 Medical/Surgical Supplies and Devices - Other Implants $5,257.00 317822 Cable 1.6Mm W/Sleeve 278 Medical/Surgical Supplies and Devices - Other Implants $3,233.00 317823 Cable 2.Omm W/Sleeve 278 Medical/Surgical Supplies and Devices - Other Implants $3,233.00 317872 Spinal Stimulator Exte 278 Medical/Surgical Supplies and Devices - Other Implants $5,527.00 317874 Cable 278 Medical/Surgical Supplies and Devices - Other Implants $3,986.00 318100 Osteosyn Plate 4-Hole 278 Medical/Surgical Supplies and Devices - Other Implants $1,886.00

318101 Osteosyn Plate 6-Hole 278 Medical/Surgical Supplies and Devices - Other Implants $1,886.00

318102 Osteosyn Plate 8-Hole 278 Medical/Surgical Supplies and Devices - Other Implants $1,886.00

318103 Osteosyn Plate 16-Hole 278 Medical/Surgical Supplies and Devices - Other Implants $1,886.00

318104 Osteosyn Plate Adaptio 278 Medical/Surgical Supplies and Devices - Other Implants $1,665.00

318105 Osteosyn Bur Hole Plat 278 Medical/Surgical Supplies and Devices - Other Implants $2,017.00

318106 Osteosyn Neuro Plate 278 Medical/Surgical Supplies and Devices - Other Implants $2,017.00

318107 Osteosyn Screw 1.0Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00

318108 Osteosyn Screw 1.2Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318109 Osteosyn Screw 1.5Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318110 Osteosyn Screw 2.0Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318111 Osteosyn Screw 2.0Mm L 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318112 Osteosyn Screw 1.8Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318113 Osteosyn Screw 2.3Mm 278 Medical/Surgical Supplies and Devices - Other Implants $436.00 318115 Osteosyn Orbit Plate 278 Medical/Surgical Supplies and Devices - Other Implants $2,799.00

318116 Osteosyn T-Plate 278 Medical/Surgical Supplies and Devices - Other Implants $2,090.00

318117 Osteosyn Y-Plate 278 Medical/Surgical Supplies and Devices - Other Implants $2,368.00

318118 Osteosyn L-Plate 278 Medical/Surgical Supplies and Devices - Other Implants $1,171.00

318119 Osteosyn Matrix Plate 278 Medical/Surgical Supplies and Devices - Other Implants $2,864.00

318297 Ring Annuloplasty 278 Medical/Surgical Supplies and Devices - Other Implants $18,128.00

318299 Implantable Neurostimu 278 Medical/Surgical Supplies and Devices - Other Implants $74,034.00

318305 Pro Oseton Implant Gra 278 Medical/Surgical Supplies and Devices - Other Implants $4,039.00

318306 Pro Osteon Implant Gra 278 Medical/Surgical Supplies and Devices - Other Implants $5,400.00

318307 Pro Osteon Implant Blo 278 Medical/Surgical Supplies and Devices - Other Implants $7,210.00 318308 Pro Osteon Implant Blo 278 Medical/Surgical Supplies and Devices - Other Implants $8,756.00 318312 Mesh Dualmesh 278 Medical/Surgical Supplies and Devices - Other Implants $2,753.00 319600 Infusion Pump 278 Medical/Surgical Supplies and Devices - Other Implants $68,068.00 319835 Portable Programmer 278 Medical/Surgical Supplies and Devices - Other Implants $1,855.00 319875 Graft Peri-Strips 2 Fi 278 Medical/Surgical Supplies and Devices - Other Implants $2,336.00 319876 Graft Peri-Strips 5 Fi 278 Medical/Surgical Supplies and Devices - Other Implants $5,257.00

319881 Rogo Pedicle Hook 278 Medical/Surgical Supplies and Devices - Other Implants $1,759.00

319882 Rogo Caudal Hook 278 Medical/Surgical Supplies and Devices - Other Implants $1,759.00

319890 Osteosyn Screw 2.7Mm 278 Medical/Surgical Supplies and Devices - Other Implants $483.00

110 319891 Osteosyn Screw 2.7 Eme 278 Medical/Surgical Supplies and Devices - Other Implants $625.00 319892 Osteosyn Plate 2.7 278 Medical/Surgical Supplies and Devices - Other Implants $1,359.00 319893 Osteosyn Plate 2.7 Lon 278 Medical/Surgical Supplies and Devices - Other Implants $1,692.00 319894 Osteosyn Plate Ang. 278 Medical/Surgical Supplies and Devices - Other Implants $1,846.00

319900 Cath Tenckhoff Dialysi 278 Medical/Surgical Supplies and Devices - Other Implants $323.00

319902 Plate Reconstruction 278 Medical/Surgical Supplies and Devices - Other Implants $2,175.00

337068 Vesica Sling Kit 278 Medical/Surgical Supplies and Devices - Other Implants $6,875.00

338579 Tutoplast 278 Medical/Surgical Supplies and Devices - Other Implants $4,158.00

339940 Mesh Polypro 278 Medical/Surgical Supplies and Devices - Other Implants $792.00

378770 Defibrillator Leads 278 Medical/Surgical Supplies and Devices - Other Implants $42,386.00

378771 Defibrillator Patches 278 Medical/Surgical Supplies and Devices - Other Implants $6,148.00

378773 Implantable Defib Eqpm 278 Medical/Surgical Supplies and Devices - Other Implants $1,920.00 378774 Implantable Defib I 278 Medical/Surgical Supplies and Devices - Other Implants $123,273.00 378775 Implantable Defib Ii 278 Medical/Surgical Supplies and Devices - Other Implants $123,273.00 378786 Drug Eluting Stent Sgl 278 Medical/Surgical Supplies and Devices - Other Implants $44,891.00 424434 Set Prim 3 Port 278 Medical/Surgical Supplies and Devices - Other Implants $76.00 424493 ELCTRD CUT LOOP 278 Medical/Surgical Supplies and Devices - Other Implants $567.00 428108 Prosthesis Esophageal 278 Medical/Surgical Supplies and Devices - Other Implants $1,540.00

432103 Anchor Snap Pack Gii 278 Medical/Surgical Supplies and Devices - Other Implants $1,622.00

432113 Kit Electrode Menisect 278 Medical/Surgical Supplies and Devices - Other Implants $1,075.00

434153 Cath Groshong Single L 278 Medical/Surgical Supplies and Devices - Other Implants $2,731.00

434439 Sut Sta-Tak Nonabsorba 278 Medical/Surgical Supplies and Devices - Other Implants $2,453.00

434650 Facial Graft-Gortex 278 Medical/Surgical Supplies and Devices - Other Implants $1,397.00

434664 EPIDURAL TRAYS CONT 48 278 Medical/Surgical Supplies and Devices - Other Implants $469.00

434665 EPIDURAL TRAYS PROTEX 278 Medical/Surgical Supplies and Devices - Other Implants $251.00

435187 Ear Tube Goode 278 Medical/Surgical Supplies and Devices - Other Implants $452.00 435189 Ear Tube Pope 278 Medical/Surgical Supplies and Devices - Other Implants $320.00 435207 Scleral Buckle Band 278 Medical/Surgical Supplies and Devices - Other Implants $549.00 435227 Lacrimal Intubation Se 278 Medical/Surgical Supplies and Devices - Other Implants $464.00 435253 Scleral Buckle Sleeve 278 Medical/Surgical Supplies and Devices - Other Implants $189.00 435256 Sphere Eye 278 Medical/Surgical Supplies and Devices - Other Implants $387.00 435261 Cornea 278 Medical/Surgical Supplies and Devices - Other Implants $8,855.00

435262 Scleral Buckle Pad 278 Medical/Surgical Supplies and Devices - Other Implants $474.00

435263 Scleral Buckle Implant 278 Medical/Surgical Supplies and Devices - Other Implants $474.00

435266 Scleral Buckle Strip 278 Medical/Surgical Supplies and Devices - Other Implants $397.00

435269 Scleral Buckle Tire 278 Medical/Surgical Supplies and Devices - Other Implants $397.00

435306 Plate Broad Dcn 278 Medical/Surgical Supplies and Devices - Other Implants $1,102.00

435332 Plate Tubular 278 Medical/Surgical Supplies and Devices - Other Implants $515.00

435393 Scleral Buckle Sponge 278 Medical/Surgical Supplies and Devices - Other Implants $928.00

435421 Cath Tesio 278 Medical/Surgical Supplies and Devices - Other Implants $2,121.00

435930 Screw Fixation Kurosak 278 Medical/Surgical Supplies and Devices - Other Implants $970.00 435949 Plate L Buttress 278 Medical/Surgical Supplies and Devices - Other Implants $1,791.00 436059 Ear Tube Vent 278 Medical/Surgical Supplies and Devices - Other Implants $57.00 436097 Bucket Handle Pros .6M 278 Medical/Surgical Supplies and Devices - Other Implants $590.00 436098 Bucket Handle Pros. .4 278 Medical/Surgical Supplies and Devices - Other Implants $590.00 436099 Bucket Handle Pros .88 278 Medical/Surgical Supplies and Devices - Other Implants $590.00 436100 Perfluoron 278 Medical/Surgical Supplies and Devices - Other Implants $2,546.00

436101 Icp Microsensor 278 Medical/Surgical Supplies and Devices - Other Implants $1,973.00

436102 Icp Cath 278 Medical/Surgical Supplies and Devices - Other Implants $2,036.00

436103 Imp Pain Pump System 278 Medical/Surgical Supplies and Devices - Other Implants $1,015.00

111 436252 Ear Tube Paparella 278 Medical/Surgical Supplies and Devices - Other Implants $400.00 436310 Ear Tube Shepard 278 Medical/Surgical Supplies and Devices - Other Implants $162.00 436337 Silastic Sheeting 278 Medical/Surgical Supplies and Devices - Other Implants $577.00 436373 Kit Intraspinal Infusa 278 Medical/Surgical Supplies and Devices - Other Implants $1,305.00

436701 Gas Ophthalmological/R 278 Medical/Surgical Supplies and Devices - Other Implants $502.00

436773 Scleral Plugs 19G Mvs 278 Medical/Surgical Supplies and Devices - Other Implants $1,181.00

436814 Spiked Washer 13.5X6 0 278 Medical/Surgical Supplies and Devices - Other Implants $199.00

436815 Pin Absorbable Orthoso 278 Medical/Surgical Supplies and Devices - Other Implants $1,816.00

436816 Pin Absorbable F/Dr Ya 278 Medical/Surgical Supplies and Devices - Other Implants $2,747.00

436826 Silastic Block 278 Medical/Surgical Supplies and Devices - Other Implants $684.00

436830 Tube Shep Gromet W/Tab 278 Medical/Surgical Supplies and Devices - Other Implants $162.00

436841 Paste Teflon Tube 7Ml 278 Medical/Surgical Supplies and Devices - Other Implants $2,567.00 436854 Anchor - Ligament 278 Medical/Surgical Supplies and Devices - Other Implants $1,464.00 436948 Ear Tube Duravent 278 Medical/Surgical Supplies and Devices - Other Implants $212.00 436950 Screw Interference 278 Medical/Surgical Supplies and Devices - Other Implants $2,564.00 436997 CATH TENCKHOFF CVD. DI 278 Medical/Surgical Supplies and Devices - Other Implants $432.00 438391 Pro Osteon Implant Blo 278 Medical/Surgical Supplies and Devices - Other Implants $3,867.00 438398 Pro Osteon Implant Gra 278 Medical/Surgical Supplies and Devices - Other Implants $3,664.00

438399 Pro Osteon Implant Gra 278 Medical/Surgical Supplies and Devices - Other Implants $1,598.00

438400 Pro Osteon Implant Blo 278 Medical/Surgical Supplies and Devices - Other Implants $1,215.00

438401 Pro Osteon Implant Blo 278 Medical/Surgical Supplies and Devices - Other Implants $2,412.00

438764 Screw Silk 278 Medical/Surgical Supplies and Devices - Other Implants $1,275.00

439502 Anchor 15Mm-Ligament 278 Medical/Surgical Supplies and Devices - Other Implants $1,836.00

439553 Silicone Oil Intraoc. 278 Medical/Surgical Supplies and Devices - Other Implants $528.00

439601 Staple Bone Coventry 278 Medical/Surgical Supplies and Devices - Other Implants $171.00

439602 Staple Bone Fixation 278 Medical/Surgical Supplies and Devices - Other Implants $653.00 439610 Cath Permacath 278 Medical/Surgical Supplies and Devices - Other Implants $901.00 446718 Filter Option Vena Cava 278 Medical/Surgical Supplies and Devices - Other Implants $3,675.00 455093 Stent Rx Preload 7Fr 7Cm 278 Medical/Surgical Supplies and Devices - Other Implants $489.00 458083 Filter Cv Navalign Cel 278 Medical/Surgical Supplies and Devices - Other Implants $6,937.00 459602 Fltr Vc Trpes 55-Fem-J 278 Medical/Surgical Supplies and Devices - Other Implants $5,067.00 464239 Tube Gstrm 24FR 278 Medical/Surgical Supplies and Devices - Other Implants $56.00

465206 Plate Reg F/1.5 SCRW 278 Medical/Surgical Supplies and Devices - Other Implants $344.00

467044 Clsre Prcls AT Sut 278 Medical/Surgical Supplies and Devices - Other Implants $1,003.00

468139 Filter Cv 65Cm Vc Jug 278 Medical/Surgical Supplies and Devices - Other Implants $6,937.00

468350 Clip Dev Rsl 2.8X11X23 278 Medical/Surgical Supplies and Devices - Other Implants $931.00

468588 Fltr Vc Opts 55 Fem-Ju 278 Medical/Surgical Supplies and Devices - Other Implants $6,080.00

469931 Stnt Ure Plrs 6X24 Wgw 278 Medical/Surgical Supplies and Devices - Other Implants $659.00

470231 Clsre Prcls Prgld 6F 278 Medical/Surgical Supplies and Devices - Other Implants $1,075.00

472434 STNT LIFEFLEX 7X40X80 278 Medical/Surgical Supplies and Devices - Other Implants $6,429.00

480213 LGTR ENDO SPEEDBAND SP 278 Medical/Surgical Supplies and Devices - Other Implants $786.00 481081 Icd Protecta Xt D314Tr 278 Medical/Surgical Supplies and Devices - Other Implants $93,876.00 484400 Stnt Bil Hlnk 7x18x135 278 Medical/Surgical Supplies and Devices - Other Implants $4,287.00 485612 Elctrd 28Fr Rlbl 278 Medical/Surgical Supplies and Devices - Other Implants $526.00 494658 Filter Cv Mrdn Juglr 278 Medical/Surgical Supplies and Devices - Other Implants $6,404.00 495577 Filter Mrdn Vc Fem 278 Medical/Surgical Supplies and Devices - Other Implants $6,404.00 497010 Stent Complete 8X40X13 278 Medical/Surgical Supplies and Devices - Other Implants $4,803.00

500101 Cath Groshong Cv Doubl 278 Medical/Surgical Supplies and Devices - Other Implants $3,772.00

502108 Endo 10mm Clips Disp 278 Medical/Surgical Supplies and Devices - Other Implants $722.00

503178 Fascia Lata Graft 278 Medical/Surgical Supplies and Devices - Other Implants $2,558.00

112 689070 Bone Cortical Chips Fd 278 Medical/Surgical Supplies and Devices - Other Implants $2,238.00 689071 Bone Cortical Chips Fd 278 Medical/Surgical Supplies and Devices - Other Implants $2,481.00 689072 Bone Femoral Head With 278 Medical/Surgical Supplies and Devices - Other Implants $4,979.00 689075 Bone Cortical-Cancello 278 Medical/Surgical Supplies and Devices - Other Implants $1,469.00

689076 Bone Cortical-Cancello 278 Medical/Surgical Supplies and Devices - Other Implants $2,073.00

689077 Bone Cancellous Chips 278 Medical/Surgical Supplies and Devices - Other Implants $3,512.00

689078 Bone Cancellous Chips 278 Medical/Surgical Supplies and Devices - Other Implants $1,836.00

689079 Bone Cancellous Chips 278 Medical/Surgical Supplies and Devices - Other Implants $1,836.00

689082 Grafton .5Cc 278 Medical/Surgical Supplies and Devices - Other Implants $314.00

689083 Grafton 1Cc 278 Medical/Surgical Supplies and Devices - Other Implants $561.00

689084 Grafton 10Cc 278 Medical/Surgical Supplies and Devices - Other Implants $3,517.00

689085 Grafton 25Cc 278 Medical/Surgical Supplies and Devices - Other Implants $6,242.00 689086 Grafton 5Cc 278 Medical/Surgical Supplies and Devices - Other Implants $2,276.00 689156 Bone Tendon Bone Hemi 278 Medical/Surgical Supplies and Devices - Other Implants $16,904.00 689160 Cancellous Chips 278 Medical/Surgical Supplies and Devices - Other Implants $2,804.00 689165 Cryopreserved Vein 278 Medical/Surgical Supplies and Devices - Other Implants $44,357.00 689171 Bone Tendon Bone, Whol 278 Medical/Surgical Supplies and Devices - Other Implants $12,620.00 689175 Femoral Shaft 22Mm 278 Medical/Surgical Supplies and Devices - Other Implants $1,410.00

689176 Femoral Shaft 67Mm 278 Medical/Surgical Supplies and Devices - Other Implants $1,530.00

689177 Femoral Shaft 120Mm 278 Medical/Surgical Supplies and Devices - Other Implants $1,992.00

689178 Femoral Shaft 170Mm 278 Medical/Surgical Supplies and Devices - Other Implants $7,764.00

689179 Right Proximal Femur W 278 Medical/Surgical Supplies and Devices - Other Implants $21,130.00

689180 Left Proximal Femur Wi 278 Medical/Surgical Supplies and Devices - Other Implants $21,130.00

689400 Fibula Wedge 278 Medical/Surgical Supplies and Devices - Other Implants $3,512.00

689401 Femoral Wedge 278 Medical/Surgical Supplies and Devices - Other Implants $5,334.00

689402 Femoral Ring 278 Medical/Surgical Supplies and Devices - Other Implants $2,655.00 689888 Bone Femoral Head 278 Medical/Surgical Supplies and Devices - Other Implants $6,069.00 727702 Cardio Defib Otr 278 Medical/Surgical Supplies and Devices - Other Implants $76,174.00 798999 CARMUSTINE WAFER BX 8 278 Medical/Surgical Supplies and Devices - Other Implants $50,095.00 845727 Opt Ease Filter 278 Medical/Surgical Supplies and Devices - Other Implants $7,785.00 931917 Stent Wall 9 F 60X16MM 278 Medical/Surgical Supplies and Devices - Other Implants $3,465.00 961844 Filter Denali Jugular 278 Medical/Surgical Supplies and Devices - Other Implants $5,682.00

969019 Long Term Dialysis Cat 278 Medical/Surgical Supplies and Devices - Other Implants $1,821.00

969067 Vaxcel Cath 278 Medical/Surgical Supplies and Devices - Other Implants $3,006.00

969502 Stent 278 Medical/Surgical Supplies and Devices - Other Implants $16,352.00

274043 Contrast VSPQ 150ml Btl 279 Medical/Surgical Supplies and Devices - Other Supplies/Devices $483.00

300326 Urology Procedure 279 Medical/Surgical Supplies and Devices - Other Supplies/Devices $-

501573 RE TISSUES 200/BOX 279 Medical/Surgical Supplies and Devices - Other Supplies/Devices $19.00

506757 COOLER POLAR PUMP 292 Purchase of New DME $1,735.00

418676 Urine Cath Coll Single 300 General Laboratory-Clinical $100.00

420056 Nasal Or Sputum Eos Sm 300 General Laboratory-Clinical $197.00 421122 Urine Cath Coll Single 300 General Laboratory-Clinical $98.00 423079 Misc Lab Test 300 General Laboratory-Clinical $- 557500 Tcsc Norse Noint 300 General Laboratory-Clinical $220.00 588223 Fat Stain 300 General Laboratory-Clinical $93.00 602450 Gen Code Lab 300 General Laboratory-Clinical $- 667906 Sputum Spec Coll Ind 300 General Laboratory-Clinical $347.00

689157 Ilium Tricortical Stri 300 General Laboratory-Clinical $3,896.00

689159 Acf Illium Wedge 300 General Laboratory-Clinical $2,829.00

689162 Fibular Shaft 300 General Laboratory-Clinical $2,662.00

113 689163 Tibia Shaft 300 General Laboratory-Clinical $2,073.00 689164 Transplant Tissue 300 General Laboratory-Clinical $4,320.00 689319 Tutoplast Dura Mater 300 General Laboratory-Clinical $3,078.00 902006 Urine Drug Screen 300 General Laboratory-Clinical $508.00

909014 W/C Drug Screen Fee 300 General Laboratory-Clinical $200.00

909016 Drug Comp Urine 300 General Laboratory-Clinical $517.00

909022 Ph Body Fluid 300 General Laboratory-Clinical $59.00

909600 Derma Bond Per Each 300 General Laboratory-Clinical $226.00

909872 Nonchemo Inf To 1 H 300 General Laboratory-Clinical $488.00

969485 Act Test 300 General Laboratory-Clinical $300.00

416361 5 Hiaa 301 Chemistry $8.00

416368 Acth Qn 301 Chemistry $15.00 416374 Aldolase 301 Chemistry $3.00 416375 Aldosterone Qn 301 Chemistry $6.00 416376 Aldosterone Ur Qn 301 Chemistry $38.00 416382 Aluminum 301 Chemistry $63.00 416385 Amino Acids Multiple Q 301 Chemistry $37.00 416397 Mercury Ur Quant 301 Chemistry $41.00

416410 Amitriptyline (Elavil) 301 Chemistry $36.00

416419 Desipramine (Norpramin 301 Chemistry $30.00

416420 Doxepin (Sineq Adapine 301 Chemistry $28.00

416421 Ethosuximide (Zarontin 301 Chemistry $13.00

416424 Imipramine (Tofranil) 301 Chemistry $30.00

416425 Lidocaine (Xylocaine) 301 Chemistry $14.00

416430 Phenytoin Dilantin Fr 301 Chemistry $9.00

416431 Primidone (Mysoline) Q 301 Chemistry $16.00 416435 Sirolimus Rapamune Qn 301 Chemistry $170.00 416450 Flecainide Tambocor Qn 301 Chemistry $15.00 416453 Gabapentin Neurontin Q 301 Chemistry $16.00 416455 Lamotrigine Lamictal Q 301 Chemistry $13.00 416456 Methotrexate Rheumat Q 301 Chemistry $16.00 416469 Metanephrines 301 Chemistry $19.00

416477 Myelin Basic Prot Csf 301 Chemistry $16.00

416478 Myoglobin Urine 301 Chemistry $17.00

416480 Alpha 2 Macro Nephelom 301 Chemistry $71.00

416485 Molecular Isolation 301 Chemistry $9.00

416486 Molecular Extract Hp 301 Chemistry $10.00

416487 Molecular Enz Digestio 301 Chemistry $10.00

416489 Molecular Gel Separati 301 Chemistry $9.00

416490 Molecular Nuc Acid Pro 301 Chemistry $10.00

416491 Md Target Amp Ea Na Se 301 Chemistry $63.00 416492 Md Target Amp Mult 1St 301 Chemistry $138.00 416502 Aminolevulinic Acid Al 301 Chemistry $8.00 416506 Androstenedione 301 Chemistry $16.00 416507 Angiotensin Conv Enz C 301 Chemistry $41.00 416508 Angiotensin I Conv Enz 301 Chemistry $6.00 416509 Apolipoprotein A1 301 Chemistry $13.00

416510 Apolipoprotein B 301 Chemistry $13.00

416511 Arsenic Bld 301 Chemistry $18.00

416512 Arsenic Ur 301 Chemistry $41.00

114 416513 Vit C Ascorbic Acid 301 Chemistry $8.00 416525 Cadmium 301 Chemistry $16.00 416526 Vitamin D3 25-Oh 301 Chemistry $11.00 416528 Calcitonin 301 Chemistry $17.00

416530 Stone Analysis Qn Chem 301 Chemistry $25.00

416534 Carotene 301 Chemistry $9.00

416537 Catechol Fraction Bld 301 Chemistry $28.00

416538 Catechol Fraction Ur 301 Chemistry $16.00

416539 Ceruloplasmin 301 Chemistry $6.00

416543 Pseudocholinesterase 301 Chemistry $14.00

416544 Cholinesterase Rbc 301 Chemistry $14.00

416604 Citrate 301 Chemistry $11.00 416608 Copper Bld 301 Chemistry $8.00 416609 Copper Urine 301 Chemistry $9.00 416612 Cortisol Free Urine 301 Chemistry $13.00 416616 Ck-Isoenzymes 301 Chemistry $11.00 416619 Cryoglobulins Ql Sqn 301 Chemistry $5.00 416624 Dhea 301 Chemistry $7.00

416628 Dibucaine Inhibitor 301 Chemistry $18.00

416631 Vitamin D 1-25 W/Wo Fr 301 Chemistry $14.00

416633 Amylase Isoenzymes Elp 301 Chemistry $68.00

416636 Estrogens Fract 301 Chemistry $22.00

416640 Estrone 301 Chemistry $35.00

416642 Ethylene Glycol 301 Chemistry $16.00

416649 Folate Rbc 301 Chemistry $7.00

416655 Igg Ea 301 Chemistry $4.00 416660 Igg Subclasses Ea 301 Chemistry $27.00 416662 Gastrin 301 Chemistry $7.00 416663 Glucagon 301 Chemistry $43.00 416665 G-6-Pd Quant 301 Chemistry $7.00 416682 Hemoglobin Fract Hplc 301 Chemistry $9.00 416690 Hemosiderin Qual 301 Chemistry $26.00

416692 Histamine Blood 301 Chemistry $95.00

416693 Histamine Urine 301 Chemistry $125.00

416695 Homovanillic Acid Ur 301 Chemistry $14.00

416697 Hydroxyprog 17D 301 Chemistry $15.00

416711 Acetylchol Rcpt Ab Bin 301 Chemistry $16.00

416712 Glut Acid Decarbox Ab 301 Chemistry $50.00

416733 Mag Ab Elisa Qn 301 Chemistry $193.00

416734 Sulfatide Ab Ia Qn 301 Chemistry $239.00

416743 Ldh Isoenzymes 301 Chemistry $11.00 416745 Lead Blood 301 Chemistry $5.00 416746 Lead Urine 301 Chemistry $41.00 416748 Leuc Aminopeptidase 301 Chemistry $5.00 416835 Mol Cap Elect Id Ea 301 Chemistry $31.00 416836 Molecular Interp Repor 301 Chemistry $9.00 416838 Nucleotidase 5 301 Chemistry $10.00

416849 Oxalate 301 Chemistry $15.00

416851 Pth C Terminal 301 Chemistry $16.00

416862 Newborn Screen (Pku) 301 Chemistry $25.00

115 416867 Alk Phos Isoenzymes 301 Chemistry $16.00 416870 Porphobilinogen Ur Qua 301 Chemistry $8.00 416871 Porphobilinogen Ur Qua 301 Chemistry $7.00 416873 Porphyrins Ur Qn + Fra 301 Chemistry $75.00

416889 Free Rbc Protoporphyri 301 Chemistry $9.00

416892 Pyridoxal 5 Phos Vit B 301 Chemistry $20.00

416893 Pyruvic Acid (Pyruvate 301 Chemistry $10.00

416898 Renin 301 Chemistry $11.00

416900 Selenium 301 Chemistry $39.00

416901 Serotonin 301 Chemistry $17.00

416907 Somatomedin C Igf-1 301 Chemistry $9.00

416910 Bromides Spect 301 Chemistry $63.00 416919 Vitamin B1 Thiamine 301 Chemistry $17.00 416921 Thyroglobulin 301 Chemistry $24.00 416923 Thyroxine Bg (Tbg) 301 Chemistry $10.00 416924 Thyroid Stim Immuno Ts 301 Chemistry $33.00 416927 T3 Reverse 301 Chemistry $28.00 416935 Vma Urine 301 Chemistry $20.00

416936 Vaso Intest Peptide 301 Chemistry $94.00

416938 Vitamin A 301 Chemistry $14.00

416944 Zinc Blood 301 Chemistry $6.00

417814 Abg With Meas O2 Sat 301 Chemistry $1,044.00

419002 Calcium Ionized 301 Chemistry $564.00

419003 Glucose Bld Qn 301 Chemistry $524.00

419004 Potassium Bld 301 Chemistry $466.00

419006 Sodium Bld 301 Chemistry $201.00 419297 Occ Bld Perox Oth Sour 301 Chemistry $129.00 419298 Occbld Perox 1 Spec Di 301 Chemistry $129.00 419299 Lactoferrin Stool Ia Q 301 Chemistry $187.00 419300 Ph Body Fluid 301 Chemistry $121.00 419301 Ph Gastric 301 Chemistry $65.00 419549 Procain With Napa 301 Chemistry $197.00

419550 Microalbumin Qn 301 Chemistry $24.00

419551 A-1-Antitrypsin Tot 301 Chemistry $160.00

419552 Alpha Fetoprot Serum 301 Chemistry $197.00

419553 Beta 2 Microglobulin 301 Chemistry $193.00

419554 Vitamin B12 301 Chemistry $180.00

419555 Dhea-S 301 Chemistry $261.00

419556 Erythropoietin Qn 301 Chemistry $218.00

419557 Estradiol 301 Chemistry $325.00

419558 Folate (Folic Acid) Se 301 Chemistry $174.00 419559 Iga Ea 301 Chemistry $112.00 419560 Igg Ea 301 Chemistry $112.00 419561 Igm Ea 301 Chemistry $112.00 419562 Ige 301 Chemistry $196.00 419563 Fsh 301 Chemistry $217.00 419564 Lh 301 Chemistry $217.00

419565 Growth Hormone (Hgh) 301 Chemistry $197.00

419566 Haptoglobin Quant 301 Chemistry $151.00

419567 Hemoglobin Electro 301 Chemistry $153.00

116 419568 Homocysteine Qn 301 Chemistry $197.00 419569 Insulin Total 301 Chemistry $138.00 419570 Myoglobin Bld 301 Chemistry $153.00 419571 Pth Intact 301 Chemistry $478.00

419572 Progesterone 301 Chemistry $245.00

419573 Prolactin 301 Chemistry $226.00

419574 Pros Spec Ag Free 301 Chemistry $216.00

419575 Protein Electro Ser 301 Chemistry $129.00

419576 Protein Electro Urine 301 Chemistry $211.00

419577 Protein Electro Csf 301 Chemistry $211.00

419578 Testosterone Total 301 Chemistry $300.00

419579 Transferrin 301 Chemistry $151.00 419580 T3 Uptake 301 Chemistry $82.00 419581 C-Peptide 301 Chemistry $225.00 419890 Iron 301 Chemistry $157.00 419918 Basic Metabolic Calc I 301 Chemistry $1,228.00 419919 Bmp Total Calcium 301 Chemistry $1,228.00 419920 Electrolyte Panel 301 Chemistry $566.00

419921 Comp Metabolic Panel 301 Chemistry $1,430.00

419922 Lipid Panel 301 Chemistry $1,008.00

419923 Renal Function Panel 301 Chemistry $640.00

419925 Hepatic Function Panel 301 Chemistry $640.00

419926 Drug Of Abuse Scr Chro 301 Chemistry $1,105.00

419927 Amikacin Quant 301 Chemistry $139.00

419928 Amikacin Peak Qn 301 Chemistry $139.00

419929 Amikacin Trough Qn 301 Chemistry $139.00 419930 Carbamazepine Tot Qn 301 Chemistry $1,047.00 419931 Digoxin (Lanoxin) Qn 301 Chemistry $157.00 419932 Valproic Acid (Depaken 301 Chemistry $798.00 419933 Gentamicin (Garamycin) 301 Chemistry $435.00 419934 Gentamicin Peak Qn 301 Chemistry $435.00 419935 Gentamicin Trough Qn 301 Chemistry $435.00

419936 Lithium (Eskalith) Qn 301 Chemistry $581.00

419937 Phenobarbital Luminal 301 Chemistry $891.00

419938 Phenytoin Dilant Tot Q 301 Chemistry $889.00

419939 Salicylate Quant 301 Chemistry $799.00

419940 Theophylline Quant 301 Chemistry $344.00

419941 Tobramycin Quant 301 Chemistry $344.00

419942 Tobramycin Peak 301 Chemistry $863.00

419943 Tobramycin Trough 301 Chemistry $863.00

419944 Vancomycin Quant 301 Chemistry $218.00 419945 Vancomycin Peak 301 Chemistry $218.00 419946 Vancomycin Trough 301 Chemistry $218.00 419954 Acetaminophen Qn 301 Chemistry $1,137.00 419955 Acetone Bld Ql 301 Chemistry $242.00 419956 Albumin Serum Qn 301 Chemistry $395.00 419957 Alcohol Qn Except Brea 301 Chemistry $85.00

419958 Ammonia 301 Chemistry $362.00

419959 Amylase Bld 301 Chemistry $721.00

419960 Amylase Ur 301 Chemistry $721.00

117 419961 Amylase Fl 301 Chemistry $721.00 419962 Bilirubin Tot 301 Chemistry $312.00 419963 Bilirubin Direct 301 Chemistry $218.00 419964 Calcium Total 301 Chemistry $549.00

419965 Calcium Ur Timed Qn 301 Chemistry $553.00

419966 Carbon Dioxide 301 Chemistry $339.00

419967 Carboxyhemoglobin Qn 301 Chemistry $488.00

419968 Cea 301 Chemistry $359.00

419969 Chloride Bld 301 Chemistry $181.00

419970 Chloride Ur 301 Chemistry $157.00

419971 Cholesterol Bld 301 Chemistry $590.00

419972 Cortisol Total 301 Chemistry $711.00 419973 Creat Kinase (Ck) Tota 301 Chemistry $769.00 419974 Ck Mb 301 Chemistry $769.00 419975 Creatinine Bld 301 Chemistry $516.00 419976 Creatinine Ur 301 Chemistry $444.00 419977 Creatinine Clearance 301 Chemistry $820.00 419978 Ferritin 301 Chemistry $94.00

419979 Fetal Fibronectin Sqn 301 Chemistry $614.00

419980 Glucose Body Fld Qn 301 Chemistry $524.00

419981 Glucose 2 Hr W Glucola 301 Chemistry $569.00

419982 Gtt 1St 3 Specimens 301 Chemistry $988.00

419983 Gtt Ea Addtl >3 Spec 301 Chemistry $464.00

419984 Gamma Gt 301 Chemistry $614.00

419985 Hemoglobin A1C 301 Chemistry $211.00

419987 Iron Binding (Tibc) 301 Chemistry $85.00 419988 Lactic Acid 301 Chemistry $102.00 419989 Ldh (Ld) 301 Chemistry $515.00 419990 Ldh (Ld) Body Fluid 301 Chemistry $515.00 419991 Lipase 301 Chemistry $751.00 419992 Hdl Cholesterol Dm 301 Chemistry $860.00 419993 Magnesium Bld 301 Chemistry $515.00

419994 Magnesium Urine 301 Chemistry $515.00

419995 Mucin Clot Synovial 301 Chemistry $127.00

419996 Natriuretic Peptide 301 Chemistry $1,017.00

419997 Osmolality Bld 301 Chemistry $146.00

419998 Osmolality Ur 301 Chemistry $129.00

419999 Alk Phos (Alp) 301 Chemistry $175.00

420000 Phosphorus Bld 301 Chemistry $241.00

420001 Phosphorus Ur 301 Chemistry $284.00

420002 Potassium Ur 301 Chemistry $332.00 420003 Prealbumin 301 Chemistry $129.00 420004 Pros Spec Ag (Psa) Tot 301 Chemistry $312.00 420005 Total Protein Bld 301 Chemistry $488.00 420006 Total Protein Urine Qn 301 Chemistry $488.00 420007 Tot Protein Body Flds 301 Chemistry $488.00 420009 Total Protein Csf Qn 301 Chemistry $488.00

420010 Sodium Ur 301 Chemistry $218.00

420011 Sp Grav Bdy Fluid Not 301 Chemistry $156.00

420012 T4 Total 301 Chemistry $351.00

118 420013 T4 Free 301 Chemistry $332.00 420014 Tsh 301 Chemistry $630.00 420015 Ast (Sgot) 301 Chemistry $675.00 420016 Alt (Sgpt) 301 Chemistry $745.00

420017 Triglycerides 301 Chemistry $339.00

420018 T3 Total 301 Chemistry $168.00

420019 T3 Free 301 Chemistry $359.00

420020 Troponin Quant 301 Chemistry $1,017.00

420021 Troponin Quant 301 Chemistry $1,017.00

420022 Bun 301 Chemistry $444.00

420023 Urine Urea Nitrogen 301 Chemistry $444.00

420024 Uric Acid Bld 301 Chemistry $578.00 420025 Uric Acid Ur 301 Chemistry $321.00 420026 Hcg Beta Quantitative 301 Chemistry $1,077.00 420027 Hcg Qualitative Serum 301 Chemistry $791.00 420028 Potassium Other 301 Chemistry $224.00 420344 Drug Scr Comp Chrom 301 Chemistry $173.00 420346 Lorazepam (Ativan) Qn 301 Chemistry $112.00

420347 Diazepam Quant 301 Chemistry $27.00

420348 Cyclosporine Quant 301 Chemistry $16.00

420356 Tacrolimus Quant 301 Chemistry $42.00

420357 Digitoxin Qn 301 Chemistry $39.00

420358 Amiodarone Cordarone Q 301 Chemistry $18.00

420363 Maprotiline Ludionil Q 301 Chemistry $140.00

420366 Albumin Ur Or Other Qn 301 Chemistry $22.00

420370 Alpha Fetoprot Serum M 301 Chemistry $44.00 420373 Cystine Qn 301 Chemistry $15.00 420392 Mhpg Qn Hplc 301 Chemistry $211.00 420408 Igd Ea 301 Chemistry $13.00 420409 Igg Csf Ea 301 Chemistry $33.00 420420 Endomysial Ab Iga Ql I 301 Chemistry $11.00 420421 Voltage Gated Ca Chan 301 Chemistry $286.00

420422 Pth Related Protein Ri 301 Chemistry $20.00

420426 Asialo-Gm1 Ab Ia Qn 301 Chemistry $282.00

420428 Trypsin Eia Quant Othe 301 Chemistry $63.00

420430 Tryptase Ia Qn 301 Chemistry $57.00

420434 Fetal Lung Mat Fluor P 301 Chemistry $61.00

420436 Ldl Cholesterol Dm 301 Chemistry $21.00

420443 Molecular Extract Hp 301 Chemistry $40.00

420449 Molec Amp Mult Ea Add' 301 Chemistry $31.00

420450 Molecular Rev Trans 301 Chemistry $24.00 420451 Molecular Id Mut Seq E 301 Chemistry $32.00 420454 Oligoclonal Bands 301 Chemistry $32.00 420455 Methylmalonic Acid Qn 301 Chemistry $14.00 420464 Yo Ab Wb Band Id 301 Chemistry $158.00 420465 Western Blot Probe B I 301 Chemistry $431.00 420673 Sugars Multi Ql 301 Chemistry $10.00

421178 Pros Spec Ag (Psa) Scr 301 Chemistry $312.00

421535 Cea 301 Chemistry $229.00

422920 Drug Scr Any # Mod Com 301 Chemistry $158.00

119 422967 Pamg-1 Cvs Ql 301 Chemistry $636.00 423083 Stool Reducing Substan 301 Chemistry $5.00 423545 Sodium Body Fluid 301 Chemistry $201.00 423802 Vitamin D3 25-Oh 301 Chemistry $24.00

423932 Lactic Acid 301 Chemistry $99.00

423954 Gc Ms Quantitative 301 Chemistry $18.00

423964 Magnesium Ionized 301 Chemistry $59.00

423997 Molecular Lysis Of Cel 301 Chemistry $28.00

425485 Light Chains Lambda Neph 301 Chemistry $22.00

429125 PTH Intact 301 Chemistry $314.00

429728 Def Drug Antidep Tri 1 301 Chemistry $17.00

429730 Def Drug Antidep Tri 6 301 Chemistry $11.00 432224 Drug Scr doo manual read 301 Chemistry $1,051.00 432236 Drug Scr Any Nbr Per DOS 301 Chemistry $105.00 447969 Angioset Sfty Intma 22 301 Chemistry $63.00 447970 Cath Angst Sfty Intma 301 Chemistry $70.00 449301 Cath Angjt Avx 6F 50 S 301 Chemistry $3,633.00 455618 CATH IV INFS RD 20GX1. 301 Chemistry $31.00

503221 Glucose Bld Strip 301 Chemistry $21.00

606518 Drug Scr Drugs Of Abus 301 Chemistry $1,105.00

606538 Acetaminophen 301 Chemistry $1,098.00

606558 Lactic Acid 301 Chemistry $99.00

606663 Pth Intact 301 Chemistry $75.00

607262 Copper Bld 301 Chemistry $43.00

607491 T3 Total 301 Chemistry $163.00

608209 Chloride Ur 301 Chemistry $153.00 608231 Igg 301 Chemistry $29.00 609157 Dhea-S 301 Chemistry $53.00 609605 Vitamin B12 301 Chemistry $27.00 609938 Gentamicin Trough Qn 301 Chemistry $421.00 610000 Total Protein Urine Qn 301 Chemistry $469.00 667961 Abg With Meas 02 Sat 301 Chemistry $1,044.00

902243 Insulin Regular 100 Units 301 Chemistry $11.00

909460 Occult Bld Stool 1-3 S 301 Chemistry $158.00

416553 Complement Tot Ch50 302 Immunology $18.00

416560 Anti-Ccp 302 Immunology $14.00

416566 Scleroderma 70 Ab 302 Immunology $14.00

416570 Histone Fa Ab Ql 302 Immunology $161.00

416573 Adrenal Fa Ab Ql 302 Immunology $55.00

416578 Gliadin Fa Ab Igg Scr 302 Immunology $6.00

416754 Parvovirus Igg 302 Immunology $13.00 416755 Parvovirus Igm 302 Immunology $13.00 416757 Amoebic Ab 302 Immunology $15.00 416761 Rickettsia Ab Ql 302 Immunology $69.00 416770 Rubella Igm 302 Immunology $9.00 416773 Rubeola Igm 302 Immunology $22.00 416776 Toxoplasma Igg Qual 302 Immunology $20.00

416777 Toxoplasma Igm Qual 302 Immunology $20.00

416781 Trichinella Ab Qual 302 Immunology $72.00

416784 Varic Zoster Igm 302 Immunology $14.00

120 416785 Enceph West Nile Ab Ig 302 Immunology $66.00 416794 Parainfluenza 1 Ab Ql 302 Immunology $7.00 416795 Parainfluenza 2 Ab Ql 302 Immunology $7.00 416796 Parainfluenza 3 Ab Ql 302 Immunology $7.00

416804 Hla B27 302 Immunology $21.00

417011 Allergen Ige Each 302 Immunology $8.00

417022 14C-Serotonin Release 302 Immunology $310.00

417038 Complement C2 302 Immunology $82.00

417040 Neuron Spec Enolase Qn 302 Immunology $33.00

417055 Teichoic Acid Ab Id 302 Immunology $9.00

417056 Aspergillus Flavus Gd 302 Immunology $6.00

417058 C1Q Binding Imm Comp 302 Immunology $13.00 417059 Raji Immune Comp 302 Immunology $29.00 417064 Insulin Ab 302 Immunology $28.00 417065 Intrinsic Fact Ab 302 Immunology $13.00 417066 Islet Cell Ab 302 Immunology $426.00 417069 T Cells Cd4 8 Ratio 302 Immunology $215.00 417089 Adenovirus Ab Ql 302 Immunology $10.00

417095 Strep Pneumo Ab Type 1 302 Immunology $24.00

417096 Bartonella H Igg 302 Immunology $19.00

417097 Bartonella H Igm 302 Immunology $19.00

417098 Bartonella Q Igg 302 Immunology $19.00

417099 Bartonella Q Igm 302 Immunology $19.00

417100 Blastomyces Ab Qual 302 Immunology $15.00

417106 Lyme Disease Ab Ql 302 Immunology $49.00

417110 Brucella Ab Qual 302 Immunology $4.00 417113 Candida Ab Qual 302 Immunology $7.00 417115 Chlamydia Pneumo Igg 302 Immunology $37.00 417116 Chlamydia Trach Igg 302 Immunology $36.00 417120 Chlamydia Pneumo Igm 302 Immunology $37.00 417121 Chlamydia Trach Igm 302 Immunology $37.00 417122 Coccidioid Ab Qual 302 Immunology $29.00

417127 Cmv Dna Qn 302 Immunology $6.00

417131 Enceph Lacrosse Ab Qua 302 Immunology $39.00

417134 Enceph E Equine Ab Qua 302 Immunology $39.00

417138 Enceph St Louis Ab Qua 302 Immunology $39.00

417140 Enceph W Equine Ab Qua 302 Immunology $39.00

417150 Coxsackie B1 Ab Qual 302 Immunology $6.00

417151 Coxsackie B2 Ab Qual 302 Immunology $6.00

417152 Coxsackie B3 Ab Qual 302 Immunology $6.00

417153 Coxsackie B4 Ab Qual 302 Immunology $6.00 417154 Coxsackie B5 Ab Qual 302 Immunology $6.00 417155 Coxsackie B6 Ab Qual 302 Immunology $6.00 417156 Echovirus Ab Qual 302 Immunology $55.00 417172 Ebv Early Ab Qual 302 Immunology $17.00 417175 Ebv Capsid Ab Qual 302 Immunology $17.00 417180 Fran Tularen Ab Qual 302 Immunology $79.00

417185 H Pylori Ab Qual 302 Immunology $19.00

417188 H Pylori Ab Ql Igm 302 Immunology $8.00

417193 Toxocara C Ab 302 Immunology $69.00

121 417196 Htlv 1 Ab Qual 302 Immunology $31.00 417198 Hiv Ab Western Blot 302 Immunology $27.00 417199 Hepatitis Delta Ab Qua 302 Immunology $200.00 417207 Herpes Simplex 2 Ab Ql 302 Immunology $20.00

417210 Histoplasma Yeast Ab Q 302 Immunology $9.00

417211 Hiv-1 Ab Qual 302 Immunology $6.00

417212 Hiv-2 Ab Qual 302 Immunology $24.00

417217 Influenza A Virus Ab 302 Immunology $38.00

417218 Influenza B Virus Ab 302 Immunology $38.00

417919 Antibody Screen Ea 302 Immunology $371.00

417920 Antibody Elution Ea 302 Immunology $177.00

417922 Antibody Id Ea 302 Immunology $760.00 417924 Direct Coombs Ahg Ea 302 Immunology $152.00 417925 Direct Coombs Comp Ea 302 Immunology $152.00 417926 Direct Coombs Igg Ea 302 Immunology $152.00 417928 Antibody Titer Ea Indi 302 Immunology $221.00 417931 Abo Type 302 Immunology $233.00 417933 Rh Type 302 Immunology $266.00

417941 Crossmatch Imm Spin 302 Immunology $354.00

417946 Ffp Thaw Ea Unit 302 Immunology $189.00

419302 Ana Qual Screen 302 Immunology $126.00

419303 Ana Quant Titer 302 Immunology $109.00

419304 Aso Qual Screen 302 Immunology $709.00

419305 Ds Dna Ab 302 Immunology $610.00

419306 Mono Scr (Heterophile) 302 Immunology $689.00

419307 Cryptococcal Ag Latex 302 Immunology $717.00 419308 Ra Factor Qual 302 Immunology $590.00 419309 Rpr Qual 302 Immunology $414.00 419595 Allergen Ige Each 302 Immunology $68.00 419596 Anca Cytoplasmic 302 Immunology $180.00 419597 Plt Ab Heparin Induced 302 Immunology $216.00 419598 Antistreptolysin O Qn 302 Immunology $70.00

419599 Cardiolipin Ab Iga 302 Immunology $196.00

419600 Cardiolipin Ab Igg 302 Immunology $196.00

419601 Cardiolipin Ab Igm 302 Immunology $196.00

419602 Complement C3 302 Immunology $143.00

419603 Complement C4 302 Immunology $143.00

419604 Jo-1 Antibody 302 Immunology $214.00

419605 Scleroderma 70 Ab 302 Immunology $214.00

419606 Sjogrens A Ab (Ssa) 302 Immunology $214.00

419607 Sjogrens B Ab (Ssb) 302 Immunology $214.00 419608 Extractable Nuc Ag Scr 302 Immunology $214.00 419609 Mitochondrial Fa Ab Ql 302 Immunology $143.00 419610 Ca 27-29 Qn 302 Immunology $241.00 419611 Ca 15-3 Qn 302 Immunology $241.00 419612 Ca 19-9 Qn 302 Immunology $241.00 419613 Ca 125 Qn 302 Immunology $241.00

419614 Human Gran Ehrl Igg Ia 302 Immunology $175.00

419615 Human Gran Ehrl Igm Ia 302 Immunology $175.00

419616 Immunofix Electro Ser 302 Immunology $261.00

122 419617 Immunofix Electro Ur 302 Immunology $344.00 419618 T Cells Cd4 Count 302 Immunology $153.00 419619 Thyroid Peroxidase Ab 302 Immunology $172.00 419620 Ra Factor Qual 302 Immunology $70.00

419621 Ra Qn 302 Immunology $70.00

419622 Tb Gamma Interferon Re 302 Immunology $156.00

419623 Vdrl Csf Qual 302 Immunology $53.00

419624 Chlamydia Pneumo Igg 302 Immunology $140.00

419625 Cmv Igg Qual 302 Immunology $170.00

419626 Cmv Igm Qual 302 Immunology $197.00

419627 Ebv Early Ab Qual 302 Immunology $156.00

419628 Ebv Capsid Igm Qual 302 Immunology $215.00 419629 H Pylori Ab Ql Igg 302 Immunology $139.00 419630 Herpes Simplex 1 Ab Ql 302 Immunology $157.00 419631 Herpes Simplex 2 Ab Ql 302 Immunology $226.00 419632 Hep B Core Ab Total 302 Immunology $143.00 419633 Hepatitis Be Ab Ql 302 Immunology $139.00 419634 Hep A Ab Total 302 Immunology $150.00

419635 Legionella Ab Qual 302 Immunology $181.00

419636 Mumps Ab Qual 302 Immunology $156.00

419637 Mycoplasma Ab Igg Ql 302 Immunology $157.00

419638 Mycoplasma Ab Igm Ql 302 Immunology $157.00

419639 Rubella Ab Qual 302 Immunology $170.00

419640 Rubeola Igg 302 Immunology $153.00

419641 Toxoplasma Igg Qual 302 Immunology $170.00

419642 Toxoplasma Igm Qual 302 Immunology $170.00 419643 Varic Zoster Ab Qual 302 Immunology $153.00 419644 Thyroglob Ab Ql 302 Immunology $190.00 419924 Acute Hepatitis Panel 302 Immunology $531.00 420044 C-Reactive Protein 302 Immunology $820.00 420045 Hiv 1&2 Ab Qual 302 Immunology $170.00 420046 Hep B Core Ab Igm Ql 302 Immunology $137.00

420047 Hb S Ab Qual 302 Immunology $125.00

420048 Hep A Ab Igm Qual 302 Immunology $129.00

420049 Hepatitis C Ab Qual 302 Immunology $164.00

420499 Anca Cytoplasmic 302 Immunology $51.00

420501 Platelet Antibodies 302 Immunology $36.00

420503 Complement C1 Est Act 302 Immunology $91.00

420507 Rnp Antibody 302 Immunology $17.00

420509 Reticulin Fa Ab Igg Sc 302 Immunology $26.00

420510 Striated Musc Fa Ab Sc 302 Immunology $135.00 420511 Gliadin Fa Ab Iga Scr 302 Immunology $6.00 420512 Fluorescent Ab Screen 302 Immunology $55.00 420514 Smooth Musc Fa Ab Ql 302 Immunology $8.00 420515 Glomerular Bm Fa Ab Ti 302 Immunology $10.00 420516 Neuronal Nuc Fa Ab Tit 302 Immunology $223.00 420518 Pigeon Serum Id 302 Immunology $40.00

420519 Thermoactinomyces Gd 302 Immunology $31.00

420520 Aspergillus Fumigatus 302 Immunology $6.00

420521 Aspergillus Niger Gd 302 Immunology $6.00

123 420536 Lyme Disease Ab Ql 302 Immunology $26.00 420542 Chlamydia Psittaci Igg 302 Immunology $36.00 420545 Chlamydia Psittaci Igm 302 Immunology $37.00 420548 Cmv Igm Qual 302 Immunology $15.00

420557 Ebv Nuclear Ab Qual 302 Immunology $17.00

420560 Micropolyspora Faeni A 302 Immunology $26.00

420564 Echinococcus Ab 302 Immunology $55.00

420565 Htlv 1 Ab Qual 302 Immunology $81.00

420571 Histoplasma Mycel Ab Q 302 Immunology $9.00

420581 Treponema Pallidum Ab 302 Immunology $10.00

420584 Enceph West Nile Ab Ig 302 Immunology $39.00

420585 Encph Wst Nil Ab Igm C 302 Immunology $39.00 420587 Encph Wst Nil Ab Igg C 302 Immunology $39.00 420591 Hepatitis C Confirm 302 Immunology $94.00 423019 Anti-Ri Ab Fa Ql 302 Immunology $43.00 536792 Plt Ab Heparin Induced 302 Immunology $466.00 567212 Ana Qual Screen 302 Immunology $121.00 567288 Cmv Igg Qual 302 Immunology $100.00

567453 Cryptococcal Ag Latex 302 Immunology $693.00

568539 Anca Cytoplasmic 302 Immunology $218.00

568601 Strep Group A Ag Qual 302 Immunology $783.00

568603 Fta Ab Confirm 302 Immunology $44.00

569155 Fluorescent Ab Screen 302 Immunology $471.00

569950 Legionella Ag, Ur 302 Immunology $733.00

587269 Platelet Antibodies 302 Immunology $117.00

607546 Heb B Core Ab Total 302 Immunology $48.00 608389 Hb S Ab Qual 302 Immunology $27.00 687174 Hla Phenotyping 302 Immunology $1,444.00 687183 Hla Dr/Dq Multiple 302 Immunology $2,219.00 689055 Thyroid Peroxidase Ab 302 Immunology $44.00 689081 Irradiation Bld Ea 302 Immunology $88.00 378733 Heparin Assay 305 Hematology $330.00

378761 Act Clot Time 305 Hematology $296.00

416957 Factor 8 Rel Ag 305 Hematology $27.00

416961 Factor 8 Vw Multimers 305 Hematology $175.00

416966 Factor 13 Solubility 305 Hematology $33.00

416969 Antithrombin 3 Act 305 Hematology $26.00

416983 Plasminogen 305 Hematology $62.00

416990 Leuko Alk Phos Stain 305 Hematology $5.00

416991 Muramidase Lysozyme 305 Hematology $17.00

416993 Osmotic Fragility Incu 305 Hematology $31.00 416994 Plt Aggregate Adp Atp 305 Hematology $33.00 416995 Plt Neutralization 305 Hematology $69.00 416998 Thrombin Time 305 Hematology $5.00 417001 Ptt Substitution Mixin 305 Hematology $209.00 417450 Act Clot Time 305 Hematology $61.00 417966 Fetal Screen (Rosette) 305 Hematology $105.00

419007 Hematocrit 305 Hematology $209.00

419008 Hemoglobin 305 Hematology $248.00

419582 Factor 2 Assay 305 Hematology $209.00

124 419583 Factor 5 Labile 305 Hematology $209.00 419584 Factor 7 Stable 305 Hematology $214.00 419585 Factor 8 Ahg 305 Hematology $214.00 419586 Factor 8 Ristocetin 305 Hematology $269.00

419587 Factor 8 Vw Ag 305 Hematology $269.00

419588 Factor 9 Assay 305 Hematology $224.00

419589 Factor 10 Assay 305 Hematology $214.00

419590 Factor 11 Assay 305 Hematology $214.00

419591 Factor 12 Assay 305 Hematology $226.00

419592 Protein C Activity 305 Hematology $167.00

419593 Protein S Free 305 Hematology $181.00

420029 Cbc Platelet Auto Diff 305 Hematology $901.00 420030 Cbc 305 Hematology $466.00 420031 Retic Count Auto 305 Hematology $156.00 420032 Eosinophil Count Bld A 305 Hematology $157.00 420033 Wbc Count Bld Auto 305 Hematology $156.00 420034 Platelet Automated 305 Hematology $541.00 420035 Fdp Semiquant 305 Hematology $620.00

420036 D-Dimer Semi 305 Hematology $585.00

420037 D-Dimer Quant 305 Hematology $948.00

420038 Fibrinogen Activity 305 Hematology $791.00

420039 Heparin Anti Xa 305 Hematology $875.00

420040 Protime 305 Hematology $549.00

420041 Sed Rate Manual 305 Hematology $590.00

420042 Sickle Cell Screen 305 Hematology $464.00

420043 Ptt 305 Hematology $682.00 420124 Kb Stain (Fetal Bleed) 305 Hematology $170.00 420274 Act Clot Time 305 Hematology $344.00 420494 Russell Viper Diluted 305 Hematology $47.00 420629 Heparin Assay 305 Hematology $384.00 423298 Antithrombin 3 Act 305 Hematology $63.00 423558 Plt Aggregate P2Y12 305 Hematology $2,475.00

423559 Plt Function-Aspirin A 305 Hematology $2,475.00

587384 Fdp Semiquant 305 Hematology $598.00

687448 K/B Stain (Fetal Bleed 305 Hematology $179.00

689135 Fetal Screen (Rosette) 305 Hematology $111.00

416259 Bordetell Parapertus Amp 306 Bacteriology & Microbiology $152.00

416362 Hep C Genotype 306 Bacteriology & Microbiology $110.00

417232 Yeast Id 306 Bacteriology & Microbiology $55.00

417245 Smear Microsporidium S 306 Bacteriology & Microbiology $32.00

417249 Cult Cmv 306 Bacteriology & Microbiology $49.00 417250 Cult Rsv 306 Bacteriology & Microbiology $69.00 417259 Aspergillus Ag Eia 306 Bacteriology & Microbiology $120.00 417280 Cmv Dna Qn 306 Bacteriology & Microbiology $483.00 417282 Hep B Dna Qn 306 Bacteriology & Microbiology $88.00 417284 Hep C Amp Probe Amp 306 Bacteriology & Microbiology $83.00 417302 Bord Pertussis Amp Pr 306 Bacteriology & Microbiology $44.00

417308 Strep Pneumo Ag Oia 306 Bacteriology & Microbiology $28.00

417312 Hiv 1 Genotype Rt & Pr 306 Bacteriology & Microbiology $321.00

419310 Afb Concentration 306 Bacteriology & Microbiology $371.00

125 419311 Inf Agent Concentratio 306 Bacteriology & Microbiology $371.00 419312 Culture Blood 306 Bacteriology & Microbiology $48.00 419313 Culture Stool 306 Bacteriology & Microbiology $1,390.00 419314 Cult Stl Add'L Pathoge 306 Bacteriology & Microbiology $349.00

419315 Culture Bronchial 306 Bacteriology & Microbiology $1,273.00

419316 Culture Eye 306 Bacteriology & Microbiology $1,214.00

419317 Culture Urogenital 306 Bacteriology & Microbiology $1,214.00

419318 Culture Ear 306 Bacteriology & Microbiology $1,214.00

419319 Cult Environ Epidemi 306 Bacteriology & Microbiology $1,214.00

419320 Culture Abscess 306 Bacteriology & Microbiology $1,214.00

419321 Culture Placenta 306 Bacteriology & Microbiology $1,214.00

419322 Culture Sinus 306 Bacteriology & Microbiology $1,214.00 419323 Culture Surgical Spec 306 Bacteriology & Microbiology $1,214.00 419324 Culture Drain 306 Bacteriology & Microbiology $1,214.00 419325 Culture Tissue 306 Bacteriology & Microbiology $1,273.00 419326 Cult Nose 306 Bacteriology & Microbiology $1,273.00 419327 Culture Csf 306 Bacteriology & Microbiology $1,273.00 419328 Culture Sputum 306 Bacteriology & Microbiology $1,273.00

419329 Cult Throat 306 Bacteriology & Microbiology $1,273.00

419330 Culture Bronch Wash 306 Bacteriology & Microbiology $1,273.00

419331 Culture Body Fluid 306 Bacteriology & Microbiology $1,273.00

419332 Culture Catheter Tip 306 Bacteriology & Microbiology $751.00

419333 Culture Wound 306 Bacteriology & Microbiology $1,273.00

419334 Culture Anaerobic 306 Bacteriology & Microbiology $1,240.00

419335 Aerobic Org Id 306 Bacteriology & Microbiology $640.00

419336 Cult Strep Group A Scr 306 Bacteriology & Microbiology $1,214.00 419337 Cult Vre Scr 306 Bacteriology & Microbiology $1,214.00 419338 Cult Gc Scr 306 Bacteriology & Microbiology $1,273.00 419339 Cult Legionella Scr 306 Bacteriology & Microbiology $566.00 419340 Cult Colony Count Ur 306 Bacteriology & Microbiology $922.00 419342 Cult Fungus Other Src 306 Bacteriology & Microbiology $1,158.00 419343 Cult Fungus Blood 306 Bacteriology & Microbiology $997.00

419344 Yeast Id 306 Bacteriology & Microbiology $312.00

419345 Mold Id 306 Bacteriology & Microbiology $299.00

419346 Cult Afb 306 Bacteriology & Microbiology $1,786.00

419347 Afb Identification 306 Bacteriology & Microbiology $312.00

419348 Cult Type Agglut 306 Bacteriology & Microbiology $94.00

419349 Macro Exam Parasite 306 Bacteriology & Microbiology $390.00

419350 Susc Agar Dil Each Age 306 Bacteriology & Microbiology $94.00

419351 Susc Beta Lactam 306 Bacteriology & Microbiology $94.00

419352 Susc Mic 306 Bacteriology & Microbiology $666.00 419353 Gram Stain Primary Src 306 Bacteriology & Microbiology $499.00 419354 Smear Afb 306 Bacteriology & Microbiology $545.00 419355 Smear Wet Mount 306 Bacteriology & Microbiology $25.00 419356 Virus Iso Add Studies 306 Bacteriology & Microbiology $117.00 419357 C Difficile Toxin Ag E 306 Bacteriology & Microbiology $1,061.00 419358 Cryptosporidium Ag Eia 306 Bacteriology & Microbiology $978.00

419359 Giardia Ag Eia 306 Bacteriology & Microbiology $492.00

419360 Rotavirus Ag Eia 306 Bacteriology & Microbiology $248.00

419361 Legionella Ag Eia 306 Bacteriology & Microbiology $758.00

126 419362 Chlamydia T Amp Probe 306 Bacteriology & Microbiology $904.00 419363 Gc Amp Probe 306 Bacteriology & Microbiology $904.00 419364 Influenza Virus Ag Oia 306 Bacteriology & Microbiology $811.00 419365 Strep A Optical Ia 306 Bacteriology & Microbiology $811.00

419524 Homogenization Tissue 306 Bacteriology & Microbiology $187.00

419645 Cult Chlamydia 306 Bacteriology & Microbiology $198.00

419646 O&P Smear Conc Id 306 Bacteriology & Microbiology $109.00

419647 Cult Virus Cpe 306 Bacteriology & Microbiology $301.00

419648 Pneumocystis Carinii I 306 Bacteriology & Microbiology $137.00

419649 H Pylori Ag Eia Stool 306 Bacteriology & Microbiology $146.00

419650 Hep Be Ag Eia 306 Bacteriology & Microbiology $138.00

419651 Hep C Rna Qn 306 Bacteriology & Microbiology $493.00 419652 Hiv 1 Dna Qn 306 Bacteriology & Microbiology $813.00 419654 Hsv Culture/Typing Elv 306 Bacteriology & Microbiology $392.00 420050 Smear Eosinophils Stai 306 Bacteriology & Microbiology $157.00 420051 Smear Malaria Stain 306 Bacteriology & Microbiology $359.00 420052 Hep B S Ag Eia 306 Bacteriology & Microbiology $121.00 420593 Serum Cidal Level 306 Bacteriology & Microbiology $84.00

420596 Resp Sync Virus Ag Eia 306 Bacteriology & Microbiology $19.00

423195 C Difficile AG EIA 306 Bacteriology & Microbiology $70.00

423196 Shiga Like Toxin Eia 306 Bacteriology & Microbiology $43.00

423818 Cmv Amp Probe 306 Bacteriology & Microbiology $102.00

423965 Cult Chlamydia 306 Bacteriology & Microbiology $174.00

423989 Strep Pneumo Ag Oia 306 Bacteriology & Microbiology $821.00

423992 C Diff Tox Gene Amp Pr 306 Bacteriology & Microbiology $85.00

423996 Bordetell Parapertus A 306 Bacteriology & Microbiology $44.00 428892 Resp Mplex RT Amp 12-25 306 Bacteriology & Microbiology $1,801.00 432356 Cult W Presumptive ID UR 306 Bacteriology & Microbiology $48.00 432359 Susc Mic 306 Bacteriology & Microbiology $666.00 432367 Leg Pneumophilia AG IFT 306 Bacteriology & Microbiology $70.00 432373 Infec Agent AG NOS OIA 306 Bacteriology & Microbiology $70.00 432899 Bordet Holmsii Amp Prob 306 Bacteriology & Microbiology $152.00

536786 Hep C Genotype 306 Bacteriology & Microbiology $236.00

566711 Mold Id 306 Bacteriology & Microbiology $288.00

568255 Smear Fecal Wbc 306 Bacteriology & Microbiology $457.00

568542 Influenza Virus Ag Dia 306 Bacteriology & Microbiology $783.00

589062 Smear Eosinophils 306 Bacteriology & Microbiology $153.00

416497 Melanin Melanogen Ur Q 307 Urology $5.00

419947 Ketones Ur Manual 307 Urology $359.00

419948 Protein Ur Qual Auto 307 Urology $349.00

419949 Ua W O Micro Auto 307 Urology $359.00 419950 Spec Grav Ur Auto 307 Urology $359.00 419951 Ph Ur Auto 307 Urology $371.00 419952 Ua Micro Only 307 Urology $424.00 419953 Preg Urine Qual 307 Urology $769.00 587235 Protein Ur Qual Auto 307 Urology $339.00 419366 Fecal Wbc Count Ql 309 Other Laboratory $146.00

419367 Fat Stain 309 Other Laboratory $94.00

420053 Cell Ct&Diff Body Fl 309 Other Laboratory $657.00

420054 Cell Ct & Diff Csf 309 Other Laboratory $657.00

127 420055 Crystals Body Fl 309 Other Laboratory $407.00 432846 Smear Fungus Stain 309 Other Laboratory $453.00 747080 Nuc Pharmaceutical Cer 309 Other Laboratory $4,365.00 414253 Surg Path Level 1 310 General Laboratory Anatomical $684.00

414254 Surg Path Level 2 310 General Laboratory Anatomical $710.00

414255 Surg Path Level 3 310 General Laboratory Anatomical $1,390.00

414256 Surg Path Level 4 310 General Laboratory Anatomical $3,036.00

414259 Surg Path Level 5 310 General Laboratory Anatomical $3,258.00

414260 Surg Path Level 6 310 General Laboratory Anatomical $3,497.00

414261 Path Decalcification 310 General Laboratory Anatomical $286.00

414267 Path Stain Group 1 310 General Laboratory Anatomical $581.00

414278 Path Stain Group 2 310 General Laboratory Anatomical $665.00 414295 Path Consult Fs 1 Spec 310 General Laboratory Anatomical $1,509.00 414296 Path Consult Fs Ea Add 310 General Laboratory Anatomical $684.00 414372 Immunohistochem Ea Ab 310 General Laboratory Anatomical $671.00 416917 Immunohistochem Ea Ab 310 General Laboratory Anatomical $64.00 417327 Immunofluor Dir Ea Ab 310 General Laboratory Anatomical $77.00 417330 Em Diagnostic 310 General Laboratory Anatomical $702.00

417336 In Situ Hybrid Ea Prob 310 General Laboratory Anatomical $105.00

417337 Insitu Hybrd Ea Prb Ma 310 General Laboratory Anatomical $119.00

420257 Surg Path Level 4 310 General Laboratory Anatomical $112.00

420258 Histology Cell Block 310 General Laboratory Anatomical $109.00

420260 Path Stain Group 2 310 General Laboratory Anatomical $84.00

420261 Histochem Stain & Fs 310 General Laboratory Anatomical $99.00

420262 Cytochem Enzyme Stain 310 General Laboratory Anatomical $154.00

420263 Immunohistochem Ea Ab 310 General Laboratory Anatomical $39.00 420264 Immunohistochem Ea Ab 310 General Laboratory Anatomical $112.00 420265 Immunofluor Dir Ea Ab 310 General Laboratory Anatomical $228.00 420266 Immunofluor Dir Ea Ab 310 General Laboratory Anatomical $112.00 420267 Em Diagnostic 310 General Laboratory Anatomical $519.00 420269 Ihc Qn/Sqn Ea Ab Comp 310 General Laboratory Anatomical $103.00 423198 Insitu Hybrd Ea Prb Co 310 General Laboratory Anatomical $148.00

429469 Ihc Ea Add Ab St Spec 310 General Laboratory Anatomical $671.00

414309 Cytology Conc & Interp 311 Cytology $136.00

414310 Cyto Liquid Base Non C/V 311 Cytology $209.00

414319 Fna Sample Adequacy 311 Cytology $332.00

414320 Fna Interp & Report 311 Cytology $882.00

416825 Tiss Cult Neoplas Bm B 311 Cytology $139.00

416826 Tiss Cult Neoplas Tumo 311 Cytology $161.00

416830 Philadelphia Chromosom 311 Cytology $136.00

420246 Cyto Fwb Smear & Inter 311 Cytology $29.00 420247 Cytology Conc & Interp 311 Cytology $49.00 420248 Cyto Liquid Base Non C 311 Cytology $36.00 420249 Dna Cell Cycle Fc 311 Cytology $53.00 420250 Fc 1St Mark 311 Cytology $63.00 420251 Fc Add 311 Cytology $28.00 420253 Chrom & Karyotype 5 Bm 311 Cytology $192.00

420255 Chrom Anal 20-25 Cells 311 Cytology $137.00

420256 Chrom Addtl Karyotype 311 Cytology $28.00

421468 Cytogen Dna Probe Each 311 Cytology $16.00

128 421469 Cytogen Ip 100-300 311 Cytology $75.00 423463 Tiss Cult Chrom Bx Nm 311 Cytology $153.00 423464 Chrom Anal Addtl Cells 311 Cytology $21.00 588804 Cd4 Helper Induc 1St M 311 Cytology $92.00

72779 Angio Maint Av Venous 320 General Radiology-Diagnostic $22,507.00

72809 Xr Joint Survey 1 View 320 General Radiology-Diagnostic $374.00

72826 Xr Knee 1 Or 2 View Bi 320 General Radiology-Diagnostic $2,065.00

201086 Xr T-L-Spine 2 Views 320 General Radiology-Diagnostic $415.00

413043 Sp Perc Drain 320 General Radiology-Diagnostic $3,462.00

413162 Xr Peritoneogram 320 General Radiology-Diagnostic $1,595.00

413165 Xr Cholang Perc/Trans 320 General Radiology-Diagnostic $1,672.00

413168 XR Intro Long GI tube 320 General Radiology-Diagnostic $389.00 413171 XR Urogram Antegrade 320 General Radiology-Diagnostic $1,351.00 413176 Xr Dilar Nephrostomy 320 General Radiology-Diagnostic $6,476.00 413201 Fluoro Guid Ctrl Acc D 320 General Radiology-Diagnostic $2,545.00 413203 XR Fluoro for Spine Inj 320 General Radiology-Diagnostic $2,229.00 413250 Venogram Ext Uni Upper 320 General Radiology-Diagnostic $3,350.00 413253 Venogram Ext Bi Upper 320 General Radiology-Diagnostic $3,350.00

413641 Xr Eye Foreign Body Rt 320 General Radiology-Diagnostic $698.00

413642 Xr Eye Foreign Body Lt 320 General Radiology-Diagnostic $698.00

413644 Xr Mandible < 4 V 320 General Radiology-Diagnostic $1,598.00

413645 Xr Mandible 4 + V 320 General Radiology-Diagnostic $1,833.00

413651 Xr Mastoids 3 + V Ps R 320 General Radiology-Diagnostic $1,210.00

413653 Xr Facial Bones < 3 V 320 General Radiology-Diagnostic $1,394.00

413654 Xr Facial Bones 3 + V 320 General Radiology-Diagnostic $1,952.00

413655 Xr Nasal Bones Comp 320 General Radiology-Diagnostic $1,129.00 413657 Xr Optic Foramina Rt 320 General Radiology-Diagnostic $825.00 413660 Xr Orbits 4 + V 320 General Radiology-Diagnostic $1,718.00 413661 Xr Sinuses < 3 V 320 General Radiology-Diagnostic $1,098.00 413662 Xr Sinuses 3 + V 320 General Radiology-Diagnostic $1,650.00 413664 Xr Skull < 4 V 320 General Radiology-Diagnostic $1,160.00 413665 Xr Skull 4 + V 320 General Radiology-Diagnostic $1,912.00

413666 Xr Tmj Uni Lt 320 General Radiology-Diagnostic $741.00

413667 XR TMJ UNI RT 320 General Radiology-Diagnostic $741.00

413668 Xr Tmj Bi 320 General Radiology-Diagnostic $1,342.00

413669 Xr Neck Soft Tissue 320 General Radiology-Diagnostic $1,332.00

413670 Xr Speech Ev Complex 320 General Radiology-Diagnostic $823.00

413686 Xr Ribs Uni 2 V Lt 320 General Radiology-Diagnostic $1,083.00

413687 Xr Ribs Uni 2 V Rt 320 General Radiology-Diagnostic $1,083.00

413688 Xr Ribs Uni W/Cxr 3+V 320 General Radiology-Diagnostic $1,546.00

413689 Xr Ribs Uni W/Cxr 3+V 320 General Radiology-Diagnostic $1,546.00 413691 Xr Ribs Bi W/Cxr 4 + V 320 General Radiology-Diagnostic $1,737.00 413692 Xr Sternum 2 + V 320 General Radiology-Diagnostic $1,030.00 413693 Xr Sc Joints 3 + V 320 General Radiology-Diagnostic $364.00 413694 Xr Spine Entire Ap & L 320 General Radiology-Diagnostic $3,899.00 413695 Xr Spine 1 V Spec Leve 320 General Radiology-Diagnostic $1,107.00 413696 Xr C-Spine 2/3 Views 320 General Radiology-Diagnostic $1,494.00

413697 Xr C-Spine 4 + V 320 General Radiology-Diagnostic $1,516.00

413698 Xr C-Spine W/Obliq F/E 320 General Radiology-Diagnostic $2,287.00

413699 Xr T-L-Spine Scoliosis 320 General Radiology-Diagnostic $1,212.00

129 413700 Xr T-Spine 2 Views 320 General Radiology-Diagnostic $1,107.00 413701 Xr T-Spine 3 Views 320 General Radiology-Diagnostic $1,639.00 413702 Xr T-Spine 4 + Views 320 General Radiology-Diagnostic $1,801.00 413703 Xr T-L-Spine 2 Views 320 General Radiology-Diagnostic $350.00

413704 Xr Spine Scoliosis 320 General Radiology-Diagnostic $1,883.00

413705 Xr L-Spine 2/3 Views 320 General Radiology-Diagnostic $1,231.00

413706 Xr L-Spine 4 + Views 320 General Radiology-Diagnostic $2,022.00

413707 Xr L-Spine W/Bend View 320 General Radiology-Diagnostic $2,822.00

413708 Xr L-Spine Bend Only 320 General Radiology-Diagnostic $1,120.00

413709 Xr Pelvis 1/2 Views 320 General Radiology-Diagnostic $1,093.00

413710 Xr Pelvis 3 + V 320 General Radiology-Diagnostic $960.00

413711 Xr Si Joints 3 + V 320 General Radiology-Diagnostic $975.00 413712 Xr Sacrum/Coccyx 2 + V 320 General Radiology-Diagnostic $1,481.00 413713 Xr Myelogram C-Spine 320 General Radiology-Diagnostic $4,915.00 413714 Xr Myelogram T-Spine 320 General Radiology-Diagnostic $4,915.00 413715 Xr Myelogram L-Spine 320 General Radiology-Diagnostic $4,915.00 413716 Xr Myelogr Spine 2/M R 320 General Radiology-Diagnostic $6,441.00 413720 Xr Clavicle Comp Lt 320 General Radiology-Diagnostic $1,281.00

413721 Xr Clavicle Comp Rt 320 General Radiology-Diagnostic $1,281.00

413723 Xr Scapula Comp Lt 320 General Radiology-Diagnostic $1,369.00

413724 Xr Scapula Comp Rt 320 General Radiology-Diagnostic $1,369.00

413726 Xr Shoulder 1 V Lt 320 General Radiology-Diagnostic $700.00

413727 Xr Shoulder 1 V Rt 320 General Radiology-Diagnostic $700.00

413729 Xr Shoulder 2 + V Lt 320 General Radiology-Diagnostic $1,488.00

413730 Xr Shoulder 2 + V Rt 320 General Radiology-Diagnostic $1,488.00

413731 Xr Shoulder 2 + V Bi 320 General Radiology-Diagnostic $2,765.00 413732 Xr Arthrogram Shldr Lt 320 General Radiology-Diagnostic $3,060.00 413733 Xr Arthrogram Shldr Rt 320 General Radiology-Diagnostic $3,060.00 413735 Xr Ac Jnts Bi W/Wo Wt 320 General Radiology-Diagnostic $1,144.00 413736 Xr Humerus 2 + V Lt 320 General Radiology-Diagnostic $1,310.00 413737 Xr Humerus 2 + V Rt 320 General Radiology-Diagnostic $1,310.00 413738 Xr Humerus 2 + V Bi 320 General Radiology-Diagnostic $2,639.00

413739 Xr Elbow 2 Views Lt 320 General Radiology-Diagnostic $958.00

413740 Xr Elbow 2 Views Rt 320 General Radiology-Diagnostic $958.00

413741 Xr Elbow 2 Views Bi 320 General Radiology-Diagnostic $1,767.00

413742 Xr Elbow 3 + V Lt 320 General Radiology-Diagnostic $879.00

413743 Xr Elbow 3 + V Rt 320 General Radiology-Diagnostic $879.00

413745 Xr Arthrogram Elbow Rt 320 General Radiology-Diagnostic $1,963.00

413746 Xr Arthrogram Elbow Lt 320 General Radiology-Diagnostic $1,963.00

413748 Xr Forearm 2 Views Rt 320 General Radiology-Diagnostic $1,102.00

413749 Xr Forearm 2 Views Lt 320 General Radiology-Diagnostic $1,102.00 413750 Xr Forearm 2 Views Bi 320 General Radiology-Diagnostic $2,045.00 413751 Xr Up Extrem Infant2V 320 General Radiology-Diagnostic $1,581.00 413752 Xr Up Extrem Infant2V 320 General Radiology-Diagnostic $1,581.00 413754 Xr Wrist 2 Views Lt 320 General Radiology-Diagnostic $1,004.00 413755 Xr Wrist 2 Views Rt 320 General Radiology-Diagnostic $1,004.00 413756 Xr Wrist 2 Views Bi 320 General Radiology-Diagnostic $2,005.00

413757 Xr Wrist 3 + V Lt 320 General Radiology-Diagnostic $1,338.00

413758 Xr Wrist 3 + V Rt 320 General Radiology-Diagnostic $1,338.00

413759 Xr Wrist 3 + V Bi 320 General Radiology-Diagnostic $2,638.00

130 413763 Xr Hand 2 V Lt 320 General Radiology-Diagnostic $834.00 413764 Xr Hand 2 V Rt 320 General Radiology-Diagnostic $834.00 413765 Xr Hand 2 V Bi 320 General Radiology-Diagnostic $1,555.00 413766 Xr Hand 3 + V Lt 320 General Radiology-Diagnostic $1,073.00

413767 Xr Hand 3 + V Rt 320 General Radiology-Diagnostic $1,073.00

413768 Xr Hand 3 + V Bi 320 General Radiology-Diagnostic $1,985.00

413769 Xr Finger(S) 2 + V Lt 320 General Radiology-Diagnostic $916.00

413770 Xr Finger(S) 2 + V Rt 320 General Radiology-Diagnostic $916.00

413772 Xr Hip Uni 1 V Lt 320 General Radiology-Diagnostic $1,069.00

413773 Xr Hip Uni 1 V Rt 320 General Radiology-Diagnostic $1,069.00

413774 Xr Hip Uni 2 + V Lt 320 General Radiology-Diagnostic $1,314.00

413775 Xr Hip Uni 2 + V Rt 320 General Radiology-Diagnostic $1,314.00 413776 Xr Hip Bi W/Pelvis 320 General Radiology-Diagnostic $1,389.00 413777 Xr Arthrogram Hip Rt 320 General Radiology-Diagnostic $2,647.00 413778 Xr Arthrogram Hip Lt 320 General Radiology-Diagnostic $2,647.00 413780 Xr Hip Intraop Lt 320 General Radiology-Diagnostic $1,595.00 413781 Xr Hip Intraop Rt 320 General Radiology-Diagnostic $1,595.00 413783 Xr Pelvis & Hips Inf/C 320 General Radiology-Diagnostic $1,329.00

413785 Xr Arthro Sacro Jnt Rt 320 General Radiology-Diagnostic $3,335.00

413786 Xr Femur 2 Views Lt 320 General Radiology-Diagnostic $1,464.00

413787 Xr Femur 2 Views Rt 320 General Radiology-Diagnostic $1,464.00

413788 Xr Femur 2 Views Bi 320 General Radiology-Diagnostic $2,627.00

413789 Xr Knee 1 Or 2 V Lt 320 General Radiology-Diagnostic $900.00

413790 Xr Knee 1 Or 2 V Rt 320 General Radiology-Diagnostic $900.00

413791 Xr Knee 1 Or 2 V Bi 320 General Radiology-Diagnostic $1,710.00

413795 Xr Knee 4 + V Lt 320 General Radiology-Diagnostic $1,075.00 413796 Xr Knee 4 + V Rt 320 General Radiology-Diagnostic $1,075.00 413797 Xr Knee 4 + V Bi 320 General Radiology-Diagnostic $1,983.00 413798 Xr Knee Ap Stand Bi 320 General Radiology-Diagnostic $1,196.00 413799 Xr Arthrogram Knee Rt 320 General Radiology-Diagnostic $2,109.00 413800 Xr Arthrogram Knee Lt 320 General Radiology-Diagnostic $2,109.00 413802 Xr Tibia/Fibula 2 V Lt 320 General Radiology-Diagnostic $1,076.00

413803 Xr Tibia/Fibula 2 V Rt 320 General Radiology-Diagnostic $1,076.00

413804 Xr Tibia/Fibula 2 V Bi 320 General Radiology-Diagnostic $2,083.00

413805 Xr Lower Ext Infnt 2V 320 General Radiology-Diagnostic $1,581.00

413806 Xr Lower Ext Infnt 2V 320 General Radiology-Diagnostic $1,581.00

413808 Xr Ankle 2 Views Lt 320 General Radiology-Diagnostic $852.00

413809 Xr Ankle 2 Views Rt 320 General Radiology-Diagnostic $852.00

413810 Xr Ankle 2 Views Bi 320 General Radiology-Diagnostic $1,635.00

413811 Xr Ankle 3 + V Lt 320 General Radiology-Diagnostic $1,093.00

413812 Xr Ankle 3 + V Rt 320 General Radiology-Diagnostic $1,093.00 413813 Xr Ankle 3 + V Bi 320 General Radiology-Diagnostic $2,036.00 413817 Xr Foot 2 Views Lt 320 General Radiology-Diagnostic $848.00 413818 Xr Foot 2 Views Rt 320 General Radiology-Diagnostic $848.00 413819 Xr Foot 2 Views Bi 320 General Radiology-Diagnostic $1,566.00 413820 Xr Foot 3 + V Lt 320 General Radiology-Diagnostic $1,077.00 413821 Xr Foot 3 + V Rt 320 General Radiology-Diagnostic $1,077.00

413823 Xr Calcaneus 2 + V Lt 320 General Radiology-Diagnostic $1,003.00

413824 Xr Calcaneus 2 + V Rt 320 General Radiology-Diagnostic $1,003.00

413825 Xr Calcaneus 2 + V Bi 320 General Radiology-Diagnostic $2,017.00

131 413826 Xr Toe(S) 2 + V Lt 320 General Radiology-Diagnostic $856.00 413827 Xr Toe(S) 2 + V Rt 320 General Radiology-Diagnostic $856.00 413828 Xr Toe(S) 2 + V Bi 320 General Radiology-Diagnostic $1,724.00 413829 Xr Abdomen Ap 1 V 320 General Radiology-Diagnostic $983.00

413831 Xr Abd Comp W Dec/Ere 320 General Radiology-Diagnostic $1,561.00

413832 Xr Abd Acute W/Chest 320 General Radiology-Diagnostic $1,844.00

413835 Xr Esophagus 320 General Radiology-Diagnostic $1,762.00

413836 Xr Swlw Func W/C&V 320 General Radiology-Diagnostic $2,388.00

413839 Xr Ugi W/Kub 320 General Radiology-Diagnostic $1,862.00

413840 Xr Ugi W/Small Intesti 320 General Radiology-Diagnostic $3,576.00

413842 Xr Ugi W/Air W/Kub 320 General Radiology-Diagnostic $1,638.00

413844 Xr Small Intestine 320 General Radiology-Diagnostic $1,855.00 413847 Xr Cont Enema W/Wo Kub 320 General Radiology-Diagnostic $2,152.00 413848 Xr Enema W/ Air 320 General Radiology-Diagnostic $2,437.00 413849 Ther Enema W/Cont Or A 320 General Radiology-Diagnostic $2,191.00 413852 Xr Cholang Intraop 320 General Radiology-Diagnostic $1,974.00 413853 Xr Cholang Intraop Adl 320 General Radiology-Diagnostic $1,974.00 413854 Xr Cholang Existing Ca 320 General Radiology-Diagnostic $1,784.00

413857 Xr Ercp Biliary Only 320 General Radiology-Diagnostic $2,388.00

413858 Xr Ercp Pancreas Only 320 General Radiology-Diagnostic $2,388.00

413859 Xr Ercp 320 General Radiology-Diagnostic $3,974.00

413860 Xr Intro Long Gi Tube 320 General Radiology-Diagnostic $389.00

413864 Xr Ivp W Or W/O Tomo 320 General Radiology-Diagnostic $2,533.00

413867 Xr Urogram Retro 320 General Radiology-Diagnostic $2,639.00

413868 Xr Urogram Antegrade 320 General Radiology-Diagnostic $1,351.00

413869 Xr Cystogram 3 + V 320 General Radiology-Diagnostic $1,434.00 413871 Xr Cystourethro Retro 320 General Radiology-Diagnostic $2,030.00 413872 Xr Cystourethro Vdng 320 General Radiology-Diagnostic $2,036.00 413879 Xr Hystrosalpngogram 320 General Radiology-Diagnostic $2,019.00 413884 Sp Pta Venous 320 General Radiology-Diagnostic $14,181.00 413888 Xr Fluoroscopy 0-60 Mi 320 General Radiology-Diagnostic $1,347.00 413889 Xr Fluoroscopy > 60 Mi 320 General Radiology-Diagnostic $574.00

413890 Xr Whole Body Fb 1 V 320 General Radiology-Diagnostic $722.00

413891 Xr Abscess/Fist/Sin 320 General Radiology-Diagnostic $1,848.00

413893 Xr Tomogram Sgl Plane 320 General Radiology-Diagnostic $2,670.00

413902 Fluoro Guid Ctrl Acc D 320 General Radiology-Diagnostic $2,378.00

413903 Xr Fluoro Ndl 320 General Radiology-Diagnostic $2,378.00

413904 Xr Fluoro For Spine In 320 General Radiology-Diagnostic $2,083.00

413912 Xr Bone Age Studies 320 General Radiology-Diagnostic $961.00

413913 Xr Bone Length Studies 320 General Radiology-Diagnostic $934.00

413914 Xr Bone Survey Ltd 320 General Radiology-Diagnostic $1,075.00 413915 Xr Bone Survey Comp 320 General Radiology-Diagnostic $2,463.00 413916 Xr Bone Survey Infant 320 General Radiology-Diagnostic $1,196.00 413917 Xr Joint Survey 1 V 320 General Radiology-Diagnostic $253.00 413937 Sp Venogram Ext Uni Rt 320 General Radiology-Diagnostic $3,350.00 413939 Sp Venogram Ext Bi 320 General Radiology-Diagnostic $3,350.00 417406 Sp Aortogm Th W/Film 320 General Radiology-Diagnostic $9,913.00

417407 Sp Pta Renal/Visceral 320 General Radiology-Diagnostic $20,565.00

417409 Sp Pta Visceral Addl 320 General Radiology-Diagnostic $3,314.00

417410 Sp Pta Venous 320 General Radiology-Diagnostic $14,314.00

132 417416 Sp Aortogm Abd W/Film 320 General Radiology-Diagnostic $9,913.00 417417 Sp Aortogm Abd W/Rnf 320 General Radiology-Diagnostic $9,913.00 417418 Sp Ang Cervcerebral 320 General Radiology-Diagnostic $9,913.00 417419 Sp Angio Brach Retro 320 General Radiology-Diagnostic $4,333.00

417421 Sp Angio Ex Carot Uni 320 General Radiology-Diagnostic $9,178.00

417423 Sp Angio It Carot Uni 320 General Radiology-Diagnostic $9,913.00

417424 Sp Angio Int Carot Bi 320 General Radiology-Diagnostic $9,913.00

417425 Sp Angio Cervical Uni 320 General Radiology-Diagnostic $9,913.00

417426 Sp Angio Cervical Bi 320 General Radiology-Diagnostic $9,913.00

417427 Sp Angio Vert/Cerv 320 General Radiology-Diagnostic $9,913.00

417428 Sp Angio Ext Uni Lt 320 General Radiology-Diagnostic $9,913.00

417429 Sp Angio Ext Uni Rt 320 General Radiology-Diagnostic $9,913.00 417430 Sp Angio Ext Bi 320 General Radiology-Diagnostic $9,913.00 417433 Sp Angio Renal Sel Bi 320 General Radiology-Diagnostic $9,913.00 417434 Sp Angio Pelvic 320 General Radiology-Diagnostic $9,913.00 417439 Sp Venogram Ext Uni Rt 320 General Radiology-Diagnostic $3,546.00 417440 Sp Venogram Ext Bi 320 General Radiology-Diagnostic $3,546.00 417441 Sp Venocavagm Inf 320 General Radiology-Diagnostic $4,333.00

417442 Sp Transcth Thpy Infus 320 General Radiology-Diagnostic $2,573.00

417443 Sp Ivc Filter Placemen 320 General Radiology-Diagnostic $1,898.00

417444 Us Intravasc Non Cor 320 General Radiology-Diagnostic $1,317.00

417445 Us Intravsc Non Cor Ad 320 General Radiology-Diagnostic $1,317.00

417447 Sp Transcth Intro Stnt 320 General Radiology-Diagnostic $3,314.00

417448 Sp Pta Periph 320 General Radiology-Diagnostic $20,565.00

417449 Sp Pta Priph Addl Ves 320 General Radiology-Diagnostic $3,314.00

420148 Sp Angio Renal Sel Uni 320 General Radiology-Diagnostic $9,913.00 420150 Sp Ang Visc Sel W/Wo F 320 General Radiology-Diagnostic $9,913.00 420156 Sp Venocavagm Sup 320 General Radiology-Diagnostic $4,333.00 420158 Sp Transcath Angio F/U 320 General Radiology-Diagnostic $917.00 420159 Sp Art Cth Exc Thrombo 320 General Radiology-Diagnostic $3,111.00 420171 Xr Fluoro Pacemak Ins 320 General Radiology-Diagnostic $1,060.00 420273 Sp Perc Drain 320 General Radiology-Diagnostic $3,429.00

420641 Xr Orthopantogram 320 General Radiology-Diagnostic $801.00

420650 Xr Si Joints < 3 V 320 General Radiology-Diagnostic $644.00

420663 Xr Stress View Joint 320 General Radiology-Diagnostic $801.00

421040 Ins Gastro Tube Perc 320 General Radiology-Diagnostic $5,448.00

421049 Cont Inj Gs/ Du/ Jj/ G 320 General Radiology-Diagnostic $728.00

421066 Est Nephrstmy Trct 320 General Radiology-Diagnostic $11,280.00

423070 Xr Stero Brst Biop Ea 320 General Radiology-Diagnostic $3,630.00

423128 Sp Venogram Ext Uni Lt 320 General Radiology-Diagnostic $3,830.00

423637 Xr Eye Foreign Body Lt 320 General Radiology-Diagnostic $700.00 423638 Xr Mandible 4 + V 320 General Radiology-Diagnostic $1,729.00 423639 Xr Mastoids 3 + V Ps R 320 General Radiology-Diagnostic $1,320.00 423640 Xr Facial Bones 3 + V 320 General Radiology-Diagnostic $1,830.00 423641 Xr Nasal Bones Comp 320 General Radiology-Diagnostic $1,063.00 423642 Xr Optic Foramina 320 General Radiology-Diagnostic $829.00 423643 Xr Orbits 4 + V 320 General Radiology-Diagnostic $1,730.00

423644 Xr Sinuses 3 + V 320 General Radiology-Diagnostic $1,763.00

423645 Xr Skull < 4 V 320 General Radiology-Diagnostic $1,111.00

423646 Xr Skull 4 + V 320 General Radiology-Diagnostic $1,845.00

133 423647 Xr Neck Soft Tissue 320 General Radiology-Diagnostic $1,242.00 423650 Xr Ribs Uni 2 V Rt 320 General Radiology-Diagnostic $1,023.00 423651 Xr Ribs Uni W/Cxr 3+V 320 General Radiology-Diagnostic $1,485.00 423652 Xr Ribs Bi W/Cxr 4 + V 320 General Radiology-Diagnostic $1,729.00

423653 Xr Sternum 2 + V 320 General Radiology-Diagnostic $1,021.00

423654 Xr Sc Joints 3 + V 320 General Radiology-Diagnostic $366.00

423655 Xr Spine Entire Ap & L 320 General Radiology-Diagnostic $3,463.00

423656 Xr Spine 1 V Spec Leve 320 General Radiology-Diagnostic $1,028.00

423657 Xr C-Spine 2/3 Views 320 General Radiology-Diagnostic $1,429.00

423658 Xr C-Spine 4 + V 320 General Radiology-Diagnostic $1,466.00

423659 Xr T-Spine 3 Views 320 General Radiology-Diagnostic $1,592.00

423660 Xr T-L-Spine 2 Views 320 General Radiology-Diagnostic $339.00 423661 Xr T-Spine Scoliosis 320 General Radiology-Diagnostic $1,877.00 423662 Xr L-Spine 2/3 Views 320 General Radiology-Diagnostic $1,215.00 423663 Xr L-Spine 4 + Views 320 General Radiology-Diagnostic $1,949.00 423664 Xr L-Spine W/Bend View 320 General Radiology-Diagnostic $2,727.00 423665 Xr L-Spine Bend Only 320 General Radiology-Diagnostic $1,149.00 423666 Xr Pelvis 1/2 Views 320 General Radiology-Diagnostic $1,028.00

423667 Xr Pelvis 3 + V 320 General Radiology-Diagnostic $1,028.00

423668 Xr Si Joints < 3 V 320 General Radiology-Diagnostic $650.00

423669 Xr Si Joints 3 + V 320 General Radiology-Diagnostic $1,021.00

423670 Xr Sacrum/Coccyx 2 + V 320 General Radiology-Diagnostic $1,414.00

423672 Xr Clavicle Comp Rt 320 General Radiology-Diagnostic $1,188.00

423673 Xr Scapula Comp Rt 320 General Radiology-Diagnostic $1,273.00

423674 Xr Shoulder 2 + V Rt 320 General Radiology-Diagnostic $1,414.00

423675 Xr Ac Jnts Bi W/Wo Wt 320 General Radiology-Diagnostic $1,149.00 423676 Xr Humerus 2 + V Rt 320 General Radiology-Diagnostic $1,229.00 423677 Xr Elbow 2 Views Rt 320 General Radiology-Diagnostic $892.00 423678 Xr Forearm 2 Views Rt 320 General Radiology-Diagnostic $1,028.00 423679 Xr Up Extrem Infant2V 320 General Radiology-Diagnostic $1,725.00 423680 Xr Wrist 2 Views Rt 320 General Radiology-Diagnostic $935.00 423681 Xr Wrist 3 + V Rt 320 General Radiology-Diagnostic $1,262.00

423682 Xr Hand 2 V Rt 320 General Radiology-Diagnostic $776.00

423683 Xr Hand 3 + V Rt 320 General Radiology-Diagnostic $1,008.00

423684 Xr Finger(S) 2 + V Rt 320 General Radiology-Diagnostic $863.00

423685 Xr Hip Uni 1 V 320 General Radiology-Diagnostic $947.00

423686 Xr Hip Uni 2 + V 320 General Radiology-Diagnostic $1,181.00

423687 Xr Femur 2 Views Rt 320 General Radiology-Diagnostic $1,312.00

423688 Xr Knee 1 Or 2 V Rt 320 General Radiology-Diagnostic $843.00

423689 Xr Knee 4 + V Rt 320 General Radiology-Diagnostic $1,021.00

423690 Xr Tibia/Fibula 2 View 320 General Radiology-Diagnostic $1,008.00 423691 Xr Lower Ext Infnt 2V 320 General Radiology-Diagnostic $1,725.00 423692 Xr Ankle 2 Views Rt 320 General Radiology-Diagnostic $794.00 423693 Xr Ankle 3 + V Rt 320 General Radiology-Diagnostic $1,029.00 423694 Xr Foot 2 Views Rt 320 General Radiology-Diagnostic $789.00 423695 Xr Foot 3 + V Rt 320 General Radiology-Diagnostic $1,021.00 423696 Xr Calcaneus 2 + V Rt 320 General Radiology-Diagnostic $940.00

423697 Xr Toes 2 + V 320 General Radiology-Diagnostic $805.00

423698 Xr Abdomen Ap 1 V 320 General Radiology-Diagnostic $881.00

423699 Xr Bone Length Studies 320 General Radiology-Diagnostic $-

134 423702 Xr Abd Flat & Upright 320 General Radiology-Diagnostic $1,504.00 423703 Xr Abd 3 View 320 General Radiology-Diagnostic $1,720.00 423704 Xr Elbow 3 + V Rt 320 General Radiology-Diagnostic $833.00 423705 Xr Bone Survey Ltd 320 General Radiology-Diagnostic $1,111.00

423707 Xr Bone Age Studies 320 General Radiology-Diagnostic $1,021.00

423709 Xr C-Spine 2/3 Views 320 General Radiology-Diagnostic $1,429.00

423710 Xr C-Spine W/Obliq F/E 320 General Radiology-Diagnostic $2,308.00

423711 Xr Hip Bi W/Pelvis 320 General Radiology-Diagnostic $1,349.00

423712 Xr Tmj Bi 320 General Radiology-Diagnostic $1,386.00

423713 Xr Tmj Uni Lt 320 General Radiology-Diagnostic $743.00

423714 Xr Tmj Uni Rt 320 General Radiology-Diagnostic $743.00

423715 Dxa Bone Density Axial 320 General Radiology-Diagnostic $1,366.00 423821 Xr T-L-Spine Scoliosis 320 General Radiology-Diagnostic $1,111.00 423823 Xr Forearm 2 Views Lt 320 General Radiology-Diagnostic $1,028.00 423835 Xr Shoulder 2 + V Bi 320 General Radiology-Diagnostic $2,820.00 423836 Xr Shoulder 2 + V Lt 320 General Radiology-Diagnostic $1,414.00 423837 Xr Humerus 2 + V Bi 320 General Radiology-Diagnostic $2,451.00 423838 Xr Humerus 2 + V Lt 320 General Radiology-Diagnostic $1,229.00

423841 Xr Elbow 3 + V Bi 320 General Radiology-Diagnostic $1,661.00

423842 Xr Elbow 3 + V Lt 320 General Radiology-Diagnostic $833.00

423843 Xr Forearm 2 Views Bi 320 General Radiology-Diagnostic $2,051.00

423848 Xr Wrist 3 + V Bi 320 General Radiology-Diagnostic $2,517.00

423849 Xr Wrist 3 + V Lt 320 General Radiology-Diagnostic $1,262.00

423852 Xr Hand 3 + V Bi 320 General Radiology-Diagnostic $2,010.00

423853 Xr Hand 3 + V Lt 320 General Radiology-Diagnostic $1,008.00

423880 Xr Knee 1 Or 2 V Bi 320 General Radiology-Diagnostic $1,677.00 423882 Xr Knee 4 + V Bi 320 General Radiology-Diagnostic $2,035.00 423883 Xr Knee 4 + V Lt 320 General Radiology-Diagnostic $1,021.00 429281 XR Myelogram C-Spine 320 General Radiology-Diagnostic $5,290.00 429282 XR Myelogram T-Spine 320 General Radiology-Diagnostic $5,290.00 429283 XR Myelogram L-Spine 320 General Radiology-Diagnostic $5,290.00 429284 XR Salivary Gland Calc 320 General Radiology-Diagnostic $5,290.00

430525 Neph Cath Exchange 320 General Radiology-Diagnostic $5,231.00

430527 Xr Spine 2 Or 3 Views 320 General Radiology-Diagnostic $1,795.00

430530 Xr Hip W Pel Uni 1 Vie 320 General Radiology-Diagnostic $1,020.00

430531 Xr Hip W Pel Un 2-3 Vi 320 General Radiology-Diagnostic $1,252.00

430533 Xr Hip W Pel Bi 2 View 320 General Radiology-Diagnostic $1,323.00

430534 Xr Hip W Pel Bi 3-4 Vi 320 General Radiology-Diagnostic $3,814.00

430537 Xr Femur Min 2 Views 320 General Radiology-Diagnostic $1,395.00

432254 XR Orthopantogram 320 General Radiology-Diagnostic $801.00

432555 ABD XR 1V 320 General Radiology-Diagnostic $937.00 482567 System Bone Cmnt Dlvry 320 General Radiology-Diagnostic $3,062.00 717826 Gen Code - Eeg (320) 320 General Radiology-Diagnostic $- 722459 Gen Code X-Ray 320 General Radiology-Diagnostic $- 726811 Sp Venogm Adrenal Uni 320 General Radiology-Diagnostic $4,811.00 726835 Xr Diskography Lumbar 320 General Radiology-Diagnostic $6,739.00 726954 Sp Angio Cervicocereor 320 General Radiology-Diagnostic $11,671.00

726980 Vertebral Angio Bilate 320 General Radiology-Diagnostic $7,356.00

727020 Sp Transcath Angio F/U 320 General Radiology-Diagnostic $1,079.00

727039 Sp Lymhang Pel/Abo Bi 320 General Radiology-Diagnostic $4,881.00

135 727094 Sp Angio Cervical Uni 320 General Radiology-Diagnostic $11,671.00 727224 Corpora Cavernosograph 320 General Radiology-Diagnostic $1,134.00 727272 Sp Angio Cervical Bi 320 General Radiology-Diagnostic $10,806.00 727400 Xr Ankle 3+V 320 General Radiology-Diagnostic $1,369.00

727401 Xr Ankle 2 Views 320 General Radiology-Diagnostic $1,055.00

727402 Xr Elbow 2 View 320 General Radiology-Diagnostic $1,181.00

727404 Xr Femur 2 Views 320 General Radiology-Diagnostic $1,743.00

727405 Xr Foot 3+V 320 General Radiology-Diagnostic $1,354.00

727406 Xr Foot 2 Views 320 General Radiology-Diagnostic $1,049.00

727407 Xr Forearm 2 Views 320 General Radiology-Diagnostic $1,366.00

727408 Xr Hand 2View 320 General Radiology-Diagnostic $1,031.00

727409 Xr Hand 3+V 320 General Radiology-Diagnostic $1,338.00 727411 Xr Hip Uni 2+V 320 General Radiology-Diagnostic $1,565.00 727412 Xr Humerus 2+V 320 General Radiology-Diagnostic $1,632.00 727413 Xr Knee 1-2View 320 General Radiology-Diagnostic $1,118.00 727414 Xr Knee 4+V 320 General Radiology-Diagnostic $1,354.00 727416 Xr Shoulder 2+V 320 General Radiology-Diagnostic $1,876.00 727418 Xr Wrist 3+V 320 General Radiology-Diagnostic $1,676.00

727521 Sp Lymphang Pel/Abd Un 320 General Radiology-Diagnostic $2,438.00

727525 Xr C-Spine 2/3 Views 320 General Radiology-Diagnostic $1,897.00

727526 Xr C-Spine 4+V 320 General Radiology-Diagnostic $1,946.00

727528 Xr T-Spine 3 Views 320 General Radiology-Diagnostic $2,112.00

727530 Xr L-Spine 2/3 Views 320 General Radiology-Diagnostic $1,613.00

727531 Xr L-Spine > 4V 320 General Radiology-Diagnostic $2,589.00

727532 Xr Sacrum/Coccyx 2+V 320 General Radiology-Diagnostic $1,876.00

727534 Xr Spine Scoliosis 320 General Radiology-Diagnostic $2,492.00 727535 Xr Pelvis 3+V 320 General Radiology-Diagnostic $1,366.00 727539 Xr Myelogram Spine 320 General Radiology-Diagnostic $6,065.00 727540 Xr Myelogram Spine All 320 General Radiology-Diagnostic $7,949.00 727541 Xr Hip Uni 2+V 320 General Radiology-Diagnostic $1,565.00 727544 Xr Femur 2 Views 320 General Radiology-Diagnostic $1,744.00 727545 Xr Knee 4+V 320 General Radiology-Diagnostic $1,354.00

727548 Xr Tibia/Fibula 2 View 320 General Radiology-Diagnostic $1,338.00

727549 Ankle 3 320 General Radiology-Diagnostic $1,382.00

727551 Xr Calcaneus 2V 320 General Radiology-Diagnostic $1,248.00

727552 Xr Foot 3+V 320 General Radiology-Diagnostic $1,354.00

727553 Xr Toes 2+V 320 General Radiology-Diagnostic $1,069.00

727558 Skel Survey 320 General Radiology-Diagnostic $1,345.00

727560 Fb Fluoro 320 General Radiology-Diagnostic $1,862.00

727562 A-C Jnts Bi W&W/O W 320 General Radiology-Diagnostic $1,538.00

727563 Xr Clavicle Comp 320 General Radiology-Diagnostic $1,581.00 727564 Xr Scapula Comp 320 General Radiology-Diagnostic $1,691.00 727565 Xr Humerus 2+V 320 General Radiology-Diagnostic $1,632.00 727567 Xr Elbow 2 Views 320 General Radiology-Diagnostic $1,181.00 727568 Xr Forearm 2 Views 320 General Radiology-Diagnostic $1,366.00 727569 Xr Wrist 3+V 320 General Radiology-Diagnostic $1,676.00 727571 Xr Hand 3+V 320 General Radiology-Diagnostic $1,338.00

727574 Xr Finger(5) 2+V 320 General Radiology-Diagnostic $1,154.00

727575 Xr Bone Age Studies 320 General Radiology-Diagnostic $1,354.00

727580 Xr Chest 1 320 General Radiology-Diagnostic $1,003.00

136 727582 Xr Ribs Bi W/Cxr 4+V 320 General Radiology-Diagnostic $2,297.00 727584 Chest Fluoro 320 General Radiology-Diagnostic $1,219.00 727587 Xr Sc Joints 3+V 320 General Radiology-Diagnostic $484.00 727588 Xr Sternum 2+V 320 General Radiology-Diagnostic $1,354.00

727591 Xr Tomogram Sgl Plane 320 General Radiology-Diagnostic $3,296.00

727593 Xr Skull 4+V 320 General Radiology-Diagnostic $2,450.00

727594 Xr Mastoids 3+V 320 General Radiology-Diagnostic $1,754.00

727598 Xr Facial Bones 3+V 320 General Radiology-Diagnostic $2,434.00

727599 Xr Sinuses 3+V 320 General Radiology-Diagnostic $2,343.00

727600 Xr Nasal Bones Comp 320 General Radiology-Diagnostic $1,413.00

727602 Xr Orbits 4+V 320 General Radiology-Diagnostic $2,302.00

727603 Xr Optic Foramina 320 General Radiology-Diagnostic $1,101.00 727604 Xr Cholang Perc Transh 320 General Radiology-Diagnostic $1,965.00 727606 Xr Eye Foreign Body 320 General Radiology-Diagnostic $930.00 727607 Xr Mandible 4+V 320 General Radiology-Diagnostic $2,297.00 727609 Venous Sampling - Rad 320 General Radiology-Diagnostic $1,802.00 727612 Xr Salivary Gland Calc 320 General Radiology-Diagnostic $523.00 727613 Xr Sialogram 320 General Radiology-Diagnostic $1,802.00

727614 Xr Neck Soft Tissue 320 General Radiology-Diagnostic $1,649.00

727615 Abd Acute W/Chest 320 General Radiology-Diagnostic $2,303.00

727616 Xr Abdomen Ap (Kub) 320 General Radiology-Diagnostic $1,174.00

727621 Xr Pelvimetry W/Local 320 General Radiology-Diagnostic $1,214.00

727622 Xr Hysterosalpingogram 320 General Radiology-Diagnostic $2,491.00

727624 Xr Ivp W/Tomo 320 General Radiology-Diagnostic $3,377.00

727625 Xr Urogram Retrograde 320 General Radiology-Diagnostic $3,257.00

727626 Xr Cystogram 3+V 320 General Radiology-Diagnostic $1,876.00 727627 Xr Cysto Urethro Voidi 320 General Radiology-Diagnostic $2,515.00 727631 Sp Transcath Thpy Infu 320 General Radiology-Diagnostic $3,028.00 727632 Xr Cholecyst Oral 320 General Radiology-Diagnostic $2,072.00 727635 Xr Cholang Intraop 320 General Radiology-Diagnostic $2,434.00 727636 Xr Cholang Post Op 320 General Radiology-Diagnostic $2,100.00 727637 Xr Esophagus 320 General Radiology-Diagnostic $2,290.00

727638 Xr Ugi W/Kub 320 General Radiology-Diagnostic $2,372.00

727639 Xr Dilat Intraum Esoph 320 General Radiology-Diagnostic $1,539.00

727640 Xr Small Bowel 320 General Radiology-Diagnostic $2,356.00

727642 Xr Barium Enema 320 General Radiology-Diagnostic $2,765.00

727643 Xr Barium Enema W/Air 320 General Radiology-Diagnostic $3,347.00

727644 Xr Whole Body Fb 1V 320 General Radiology-Diagnostic $889.00

727647 Sp Angio Pulm Sel Uni 320 General Radiology-Diagnostic $5,098.00

727649 Abd Aorta Sp Aortogm A 320 General Radiology-Diagnostic $11,671.00

727650 Xr Bone Length Studies 320 General Radiology-Diagnostic $1,354.00 727652 Xr Spine Iv Cervical 320 General Radiology-Diagnostic $1,366.00 727655 Joint Aspiration 320 General Radiology-Diagnostic $671.00 727657 Xr Small Bowel Entro 320 General Radiology-Diagnostic $2,016.00 727658 Sp Angio Pulm Sel Bi 320 General Radiology-Diagnostic $11,671.00 727670 Sp Angio Int Carot Bi 320 General Radiology-Diagnostic $11,671.00 727671 Sp Perc Drain 320 General Radiology-Diagnostic $3,045.00

727676 Xr Biopsy Intrathoraci 320 General Radiology-Diagnostic $2,437.00

727677 Sp Angio Pelvic Select 320 General Radiology-Diagnostic $11,671.00

727678 Sp Pta Fem-Pop 320 General Radiology-Diagnostic $9,303.00

137 727679 Sp Pta Iliac 320 General Radiology-Diagnostic $9,303.00 727680 Sp Pta Tibioper 320 General Radiology-Diagnostic $9,303.00 727681 Sp Pta Brachio 320 General Radiology-Diagnostic $9,303.00 727682 Sp Pta Renal 320 General Radiology-Diagnostic $9,303.00

727683 Sp Chg Gu Tube/Drn/ W/ 320 General Radiology-Diagnostic $1,079.00

727684 Xr Fl Loc Para Facet J 320 General Radiology-Diagnostic $2,570.00

727688 Tapease Filiter 320 General Radiology-Diagnostic $6,918.00

727692 R Lliac Stent 320 General Radiology-Diagnostic $7,319.00

727698 Bil Renal Art Stent 320 General Radiology-Diagnostic $4,406.00

727738 Avx 6Fr 50Cm 320 General Radiology-Diagnostic $2,109.00

727739 Berenstein 100 Cm 320 General Radiology-Diagnostic $417.00

727740 Cobra-1 Guide (32-142) 320 General Radiology-Diagnostic $274.00 727742 Diagnostic Catheter 320 General Radiology-Diagnostic $104.00 727749 H1H 320 General Radiology-Diagnostic $280.00 727758 Sim-2 5F 320 General Radiology-Diagnostic $107.00 727761 Vert Super Torque 4F 320 General Radiology-Diagnostic $146.00 727763 Xpeedior 6Fr 60Cm 320 General Radiology-Diagnostic $2,109.00 727764 Cath Hemo Shrt Term 320 General Radiology-Diagnostic $638.00

727770 Mahurka Tlc 320 General Radiology-Diagnostic $438.00

727790 Rosen 035X180 320 General Radiology-Diagnostic $81.00

727794 Tad Ii 320 General Radiology-Diagnostic $529.00

727806 Sheath Balkin 320 General Radiology-Diagnostic $246.00

727807 Sheath Brite Tip 320 General Radiology-Diagnostic $138.00

727808 Sheath Brite Top 6Fr 320 General Radiology-Diagnostic $194.00

727809 Sheath Brite Tip 7Fr 320 General Radiology-Diagnostic $246.00

727810 Stopcock 320 General Radiology-Diagnostic $12.00 727813 Bone Cement 320 General Radiology-Diagnostic $339.00 727817 Comfort Disc 320 General Radiology-Diagnostic $25.00 727819 G J Tube 320 General Radiology-Diagnostic $1,031.00 727821 G Tube 320 General Radiology-Diagnostic $194.00 727825 Pressure Inj Line 48 320 General Radiology-Diagnostic $17.00 727829 Coaxial Biopsy 320 General Radiology-Diagnostic $265.00

727834 Secour Acrylic Resin 320 General Radiology-Diagnostic $572.00

727844 Fogarty 320 General Radiology-Diagnostic $344.00

727846 Gastri Kit 320 General Radiology-Diagnostic $688.00

727855 Percutaneous 19G 320 General Radiology-Diagnostic $23.00

727857 Amplatz Super Stiff 320 General Radiology-Diagnostic $232.00

727871 J Wire 3Mm 320 General Radiology-Diagnostic $70.00

727872 Loc Guide Wire Ext 320 General Radiology-Diagnostic $237.00

727874 Bentson Exchange 320 General Radiology-Diagnostic $129.00

727876 Nitinol 018 80Cm 320 General Radiology-Diagnostic $349.00 728018 Reposition Gi Tube 320 General Radiology-Diagnostic $1,083.00 728073 Fluoro Guid Ctrl Acc D 320 General Radiology-Diagnostic $2,969.00 728393 Xr Uretero Retro 320 General Radiology-Diagnostic $2,505.00 728427 Sp Pta Priph Addl Ves 320 General Radiology-Diagnostic $3,900.00 728431 Xr Intro Renal Pelvis 320 General Radiology-Diagnostic $3,000.00 728433 Sp Transhep Bill Drn 320 General Radiology-Diagnostic $3,028.00

728434 Stent Placement Ureter 320 General Radiology-Diagnostic $1,404.00

728435 Stone Removal 320 General Radiology-Diagnostic $1,404.00

728436 Thoracic Angiograph 320 General Radiology-Diagnostic $11,671.00

138 728439 Urogram Antegrade 320 General Radiology-Diagnostic $1,683.00 728444 Xr Fluoroscopy 0-60 Mi 320 General Radiology-Diagnostic $2,214.00 728445 Sp Aortogm Abd W/Runof 320 General Radiology-Diagnostic $11,671.00 728448 Superior Vena Cavagram 320 General Radiology-Diagnostic $5,098.00

728449 Renal Venography Bilat 320 General Radiology-Diagnostic $5,098.00

728450 Sp Transcath Retrieve 320 General Radiology-Diagnostic $3,900.00

728453 Sp Angio A-V Shunt 320 General Radiology-Diagnostic $4,176.00

728454 Sp Place Bili Drn Sten 320 General Radiology-Diagnostic $3,028.00

728500 Xr Ugi W/Sm Bowel 320 General Radiology-Diagnostic $4,731.00

728502 Xr C-Spine W/Oblique F 320 General Radiology-Diagnostic $3,066.00

728503 Xr L-Spine W/Bend View 320 General Radiology-Diagnostic $3,623.00

728504 Xr Up Extreme Infant 2 320 General Radiology-Diagnostic $1,951.00 728505 Xr Hip Bi W/Pelvis 320 General Radiology-Diagnostic $1,786.00 728506 Xr Pelvis & Hips Infan 320 General Radiology-Diagnostic $1,565.00 728507 Xr Lower Ext Infant 2V 320 General Radiology-Diagnostic $1,951.00 728508 Xr Abdomen Decubitus 320 General Radiology-Diagnostic $983.00 728509 Xr Sinus Tract Study 320 General Radiology-Diagnostic $1,900.00 728795 Port-A-Cath Insertion 320 General Radiology-Diagnostic $1,862.00

729032 Sp Pta Visceral 320 General Radiology-Diagnostic $3,900.00

729034 Sp Pta Venous 320 General Radiology-Diagnostic $16,852.00

729042 Renal Cyst-Rad 320 General Radiology-Diagnostic $1,079.00

729044 Xr Bronchogram Uni 320 General Radiology-Diagnostic $1,070.00

729048 Perc Cholecystostomy- 320 General Radiology-Diagnostic $2,131.00

729064 Visceral Art- Selectiv 320 General Radiology-Diagnostic $11,671.00

729076 Xr Pacemak Insert 320 General Radiology-Diagnostic $1,248.00

729079 Xr Hip Intraop 320 General Radiology-Diagnostic $1,879.00 729080 Nm Laryngogram 320 General Radiology-Diagnostic $623.00 729081 Sp Ivc Filter Placemen 320 General Radiology-Diagnostic $2,067.00 729084 Sp Transcath Intro Ste 320 General Radiology-Diagnostic $3,900.00 729085 Xr Knee 2V 320 General Radiology-Diagnostic $1,035.00 729095 Xr Fistula Study 320 General Radiology-Diagnostic $2,286.00 729096 Xr Ercp 320 General Radiology-Diagnostic $4,905.00

729098 Xr Myelogram T-Spine 320 General Radiology-Diagnostic $6,065.00

729099 Angio Adren Sel Uni 320 General Radiology-Diagnostic $11,671.00

729103 Abdomen - Port 320 General Radiology-Diagnostic $1,910.00

729104 Kub Port 320 General Radiology-Diagnostic $432.00

729105 Hip Port 320 General Radiology-Diagnostic $1,359.00

729107 Sp Venogm Adrenal Bi 320 General Radiology-Diagnostic $4,811.00

729110 Xr Intro Long Gi Tube 320 General Radiology-Diagnostic $483.00

729112 Xr Ankle 2 Views 320 General Radiology-Diagnostic $1,055.00

729113 Xr Spine Entire Ap&Lat 320 General Radiology-Diagnostic $4,600.00 729114 Xr Spine Iv Lumbar 320 General Radiology-Diagnostic $1,147.00 729115 Thoracic Spine - Lat 320 General Radiology-Diagnostic $1,117.00 729116 Loopagram 320 General Radiology-Diagnostic $1,402.00 729117 Xr Hand 2V 320 General Radiology-Diagnostic $1,031.00 729118 Xr Foot 2 Views 320 General Radiology-Diagnostic $1,049.00 729119 Xr Wrist 2 Views 320 General Radiology-Diagnostic $1,240.00

729122 Renal Angiography Bila 320 General Radiology-Diagnostic $11,671.00

729124 Renal Venography Unila 320 General Radiology-Diagnostic $4,811.00

729125 Portacath Injection 320 General Radiology-Diagnostic $6,445.00

139 729127 Tube Change 320 General Radiology-Diagnostic $3,697.00 729132 Transcather Biopsy 320 General Radiology-Diagnostic $3,900.00 729194 Bead Chain 320 General Radiology-Diagnostic $883.00 729205 Renal Angiography Unil 320 General Radiology-Diagnostic $11,671.00

729206 Venography Unilateral 320 General Radiology-Diagnostic $4,176.00

729207 Sp Venogram Bilateral 320 General Radiology-Diagnostic $4,176.00

729208 Sp Venocauagm Inf 320 General Radiology-Diagnostic $5,098.00

729212 Sp Angio Low Extrem Un 320 General Radiology-Diagnostic $11,671.00

729213 Sp Angio Low Extrem Bi 320 General Radiology-Diagnostic $11,671.00

729216 Sp Angio Int Carot Uni 320 General Radiology-Diagnostic $11,671.00

729222 Metastatic Bone Survey 320 General Radiology-Diagnostic $3,354.00

729225 Xr Myelogram L-Spine 320 General Radiology-Diagnostic $6,065.00 729234 Xr Shoulder 2+V 320 General Radiology-Diagnostic $1,876.00 729236 Xr L-Spine Bend Only 320 General Radiology-Diagnostic $1,524.00 729255 Xr Fluoro Ndl Biopsy 320 General Radiology-Diagnostic $2,942.00 729256 Sp Pta Aortic 320 General Radiology-Diagnostic $3,900.00 729257 Sp Transcath Thrpy Emb 320 General Radiology-Diagnostic $3,028.00 729261 Xr Skull<4V 320 General Radiology-Diagnostic $1,479.00

729276 Track Dilatation 320 General Radiology-Diagnostic $1,438.00

729277 Nephrostomy Tract-Dili 320 General Radiology-Diagnostic $1,300.00

729278 Xr Place Gastro Tube 320 General Radiology-Diagnostic $1,070.00

729281 Xr Or Cholang Intraop 320 General Radiology-Diagnostic $2,434.00

729284 Spinal Angio - Rad 320 General Radiology-Diagnostic $3,611.00

729289 Sp Portogm W/Hemodyn 320 General Radiology-Diagnostic $10,806.00

729290 Sp Venogm Hep W/Dvn Fr 320 General Radiology-Diagnostic $10,806.00

729299 Sp Art Cath Exch Throm 320 General Radiology-Diagnostic $3,390.00 729301 Xr Si Joints 3+V 320 General Radiology-Diagnostic $1,356.00 729302 C Spine Lat Port 320 General Radiology-Diagnostic $1,974.00 729303 L Spine Lat Port 320 General Radiology-Diagnostic $1,063.00 729304 Knee Ap & Lat Port 320 General Radiology-Diagnostic $1,079.00 729305 Foot Port 320 General Radiology-Diagnostic $1,165.00 729306 Ankle Port 320 General Radiology-Diagnostic $1,206.00

729307 Hand Port 320 General Radiology-Diagnostic $1,132.00

729308 Finger Port 320 General Radiology-Diagnostic $1,044.00

729309 Femur Port 320 General Radiology-Diagnostic $1,537.00

729310 Lower Leg Port 320 General Radiology-Diagnostic $1,973.00

729311 Shoulder Port 320 General Radiology-Diagnostic $1,651.00

729312 Wrist Port 320 General Radiology-Diagnostic $1,637.00

729313 Elbow Port 320 General Radiology-Diagnostic $1,233.00

729318 Xr Speech E-Val Comple 320 General Radiology-Diagnostic $1,018.00

729323 Xr Sinuses <3 V 320 General Radiology-Diagnostic $1,356.00 729325 Xr Tmj Unit Lt 320 General Radiology-Diagnostic $989.00 729326 Xr Tmj Bil 320 General Radiology-Diagnostic $1,844.00 729334 Xr Ribs Uni W/Cxr 3+V 320 General Radiology-Diagnostic $1,971.00 729337 Xr Shoulder 1 V 320 General Radiology-Diagnostic $808.00 729338 Xr Elbow 3+Views 320 General Radiology-Diagnostic $1,044.00 729340 Xr Knee Ap Stand Bi 320 General Radiology-Diagnostic $1,479.00

729341 Xr Abd Comp W Dec/Ere 320 General Radiology-Diagnostic $1,844.00

729342 Xr Swlw Func W/C&V 320 General Radiology-Diagnostic $2,946.00

729353 Xr Orthopantogram 320 General Radiology-Diagnostic $989.00

140 729367 Xr Hip Uni 1V Rt 320 General Radiology-Diagnostic $1,258.00 729370 Xr Toe(S) 2+V Rt 320 General Radiology-Diagnostic $1,069.00 729500 Thoracentesis W/Tb 320 General Radiology-Diagnostic $2,689.00 729505 Per Vertebroplsty Thor 320 General Radiology-Diagnostic $14,224.00

729507 Per Vertebroplsty Ea A 320 General Radiology-Diagnostic $14,224.00

729508 Perc Vert W/Fluro Guid 320 General Radiology-Diagnostic $1,906.00

729530 Xr Finger(S) 2+ Vrt 320 General Radiology-Diagnostic $1,145.00

742462 Gen Code - Sonography 320 General Radiology-Diagnostic $-

748801 Usc Guided Absc Drain 320 General Radiology-Diagnostic $2,639.00

749484 Nm Cardiac Pl Sgl W/Ef 320 General Radiology-Diagnostic $721.00

928003 Asp Joint Major Bi 320 General Radiology-Diagnostic $1,266.00

928037 Flouro Guid Needle Pla 320 General Radiology-Diagnostic $2,965.00 928040 Paracentesis Subs 320 General Radiology-Diagnostic $1,606.00 928045 Sc Bx Prost 320 General Radiology-Diagnostic $2,559.00 928046 Bx Thyroid 320 General Radiology-Diagnostic $1,994.00 928053 Pine Needle Aspir W/Im 320 General Radiology-Diagnostic $2,312.00 928073 Fluoro Guid Ctrl Acc D 320 General Radiology-Diagnostic $2,965.00 969524 Cine For Lead Check In CathLab 320 General Radiology-Diagnostic $-

413760 Xr Arthrogram Wrist Rt 322 Arthrography $2,771.00

413761 Xr Arthrogram Wrist Lt 322 Arthrography $2,771.00

413814 Xr Arthrogram Ankle Rt 322 Arthrography $891.00

413815 Xr Arthrogram Ankle Lt 322 Arthrography $891.00

727556 Xr Arthrogram Knee 322 Arthrography $3,553.00

727654 Xr Arthrogram Hip 322 Arthrography $3,348.00

729224 Xr Arthrogram Shoulder 322 Arthrography $3,779.00

729240 Xr Arthrogram Elbow 322 Arthrography $2,426.00 729280 Xr Arthogram Ankle 322 Arthrography $1,102.00 729315 Xr Arthrogram Wrist 322 Arthrography $3,428.00 76307 Sulfur Colloid Dx 20 M 323 Arteriography $23.00 420152 Sp Angio Addl Vessel 323 Arteriography $4,333.00 727493 Vertebral Angio Unilat 323 Arteriography $8,260.00 729204 Aorta Trans L 323 Arteriography $4,406.00

729220 Tla W Runoff 323 Arteriography $4,987.00

729401 Sp Angio Addl Vessel 323 Arteriography $5,098.00

968691 S G Pul Angio 323 Arteriography $787.00

969481 Unilateral Renal Angio 323 Arteriography $10,806.00

969631 Bilateral Renal Angio 323 Arteriography $3,652.00

969652 Bilateral Carotid Angiogram 323 Arteriography $10,806.00

413674 Xr Chest 1 V 324 Chest X-ray $852.00

413675 Xr Chest 2 V 324 Chest X-ray $1,021.00

413676 Xr Chest 2 V W/Ap Lor 324 Chest X-ray $1,353.00 413677 Xr Chest 2 V W/Oblique 324 Chest X-ray $1,161.00 413678 Xr Chest 2 V W/Fluoro 324 Chest X-ray $1,228.00 413679 Xr Chest Comp 4 + V 324 Chest X-ray $1,427.00 413680 Xr Chest Comp W/Fluoro 324 Chest X-ray $3,335.00 413681 Xr Chest Special Views 324 Chest X-ray $1,673.00 413822 Xr Foot 3+V Bi 324 Chest X-ray $2,058.00

423648 Xr Chest 2 V W/Ap Lor 324 Chest X-ray $1,199.00

423649 Xr Chest 2 V W/Oblique 324 Chest X-ray $1,045.00

423700 Xr Chest 1 View 324 Chest X-ray $756.00

141 423701 Xr Chest 2 View 324 Chest X-ray $927.00 432551 CHEST X RAY 1 V 324 Chest X-ray $813.00 432552 Chest X-Ray 324 Chest X-ray $977.00 432554 Chest Xray 4+ 324 Chest X-ray $1,723.00

727419 Xr Wrist 2 Views 324 Chest X-ray $1,240.00

727581 Xr Chest 2 324 Chest X-ray $1,230.00

727585 Xr Chest 2V W/Fluord 324 Chest X-ray $1,444.00

727735 5F Quad Supreme Crd 2 324 Chest X-ray $507.00

727867 Guidewire Angle 018 324 Chest X-ray $310.00

727877 Diag Quad Connector 324 Chest X-ray $314.00

727879 Diag Decapolar 324 Chest X-ray $483.00

728501 Xr Chest 2V W/Ap Lor 324 Chest X-ray $1,591.00 729101 Chest Port-1 View 324 Chest X-ray $804.00 729102 Chest Port-2 View 324 Chest X-ray $1,291.00 729108 Research Chest Jcc 324 Chest X-ray $651.00 729109 Research Chest Jcc Glo 324 Chest X-ray $867.00 729230 Xr Chest 2V W/Obliques 324 Chest X-ray $1,392.00 729231 Xr Chest 2V W/Ar Lor 324 Chest X-ray $1,326.00

729314 Employee Chest 324 Chest X-ray $316.00

729317 Gen Code (324) 324 Chest X-ray $-

729332 Chest Decubitis 1 View 324 Chest X-ray $1,842.00

729363 Xr Ribs Uni 2 View Rt 324 Chest X-ray $1,356.00

729527 Elbow Ap/Lat/Obliques 324 Chest X-ray $1,117.00

73400 Gadolinium Based Mr Ml 340 General Nuclear Medicine $41.00

76300 I123 Sod Iod Cap 100 U 340 General Nuclear Medicine $152.00

76301 Pentetate Aersl Rx 75M 340 General Nuclear Medicine $451.00 76302 Pentetate Dx To 25 Mci 340 General Nuclear Medicine $115.00 76306 Macroagg Albmn Dx 10 M 340 General Nuclear Medicine $23.00 193020 Rubidium 82 Radionucli 340 General Nuclear Medicine $801.00 193039 Fdg-Radionuclide 340 General Nuclear Medicine $6,197.00 193041 Gen Code (340) 340 General Nuclear Medicine $- 193042 Gallium Radionuclide 340 General Nuclear Medicine $107.00

193053 Pet/Ct Tumor Limited A 340 General Nuclear Medicine $9,697.00

193113 Rubidium Rb82 Dx 60 Mc 340 General Nuclear Medicine $4,621.00

193115 Fdg Dx Up To 45 Mci 340 General Nuclear Medicine $3,780.00

422298 Penteate Aersl Dx 75 M 340 General Nuclear Medicine $124.00

742468 Gen Code Nuc 340 General Nuclear Medicine $-

749310 Radionuclide - Oncosin 340 General Nuclear Medicine $20,517.00

749346 Rad. Nuc-Phar- 15 Mci I-131 340 General Nuclear Medicine $3,112.00

749423 In 111 Pent Disodium 340 General Nuclear Medicine $1,874.00

749426 Radioelement-Iridium 1 340 General Nuclear Medicine $6,267.00 749451 Nuc-Phar Metastron Sr8 340 General Nuclear Medicine $9,386.00 749461 Gallium Ga67 1 Mci 340 General Nuclear Medicine $364.00 749481 Thallous Chloride 1 Mc 340 General Nuclear Medicine $127.00 193010 Pet Img Mel Noncover 341 Diagnostic Nuclear Medicine $18,134.00 193011 Pet - Resting Viabilit 341 Diagnostic Nuclear Medicine $9,296.00 193048 Pet-Lung Cancer Stagin 341 Diagnostic Nuclear Medicine $8,778.00

193049 Single Perfusion Study 341 Diagnostic Nuclear Medicine $3,391.00

193056 Pet Pulm Nodule Ring 341 Diagnostic Nuclear Medicine $18,134.00

418128 Nm Thyroid Scn W/Up M 341 Diagnostic Nuclear Medicine $4,791.00

142 418132 Nm Thyroid Mets W Bdy 341 Diagnostic Nuclear Medicine $6,370.00 418133 Nm Parathyroid 341 Diagnostic Nuclear Medicine $4,423.00 418139 Nm Lymphimag 341 Diagnostic Nuclear Medicine $6,726.00 418142 Nm Liver Spect 341 Diagnostic Nuclear Medicine $3,844.00

418144 Nm Liver & Spleen 341 Diagnostic Nuclear Medicine $5,016.00

418147 Nm Biliary Duct W/Wo R 341 Diagnostic Nuclear Medicine $6,268.00

418153 Nm Gastric Emptying 341 Diagnostic Nuclear Medicine $3,978.00

418156 Nm Acute Gi Blood Loss 341 Diagnostic Nuclear Medicine $1,697.00

418157 Nm Intestine Imaging 341 Diagnostic Nuclear Medicine $2,290.00

418158 Nm Shunt Patency 341 Diagnostic Nuclear Medicine $3,885.00

418159 Nm Bone Limited 341 Diagnostic Nuclear Medicine $3,610.00

418161 Nm Bone Whole Body 341 Diagnostic Nuclear Medicine $5,677.00 418162 Nm Bone 3 Phase 341 Diagnostic Nuclear Medicine $7,594.00 418163 Nm Bone Spect 341 Diagnostic Nuclear Medicine $5,997.00 418167 Nm Myocrd Spect R/S Sg 341 Diagnostic Nuclear Medicine $2,572.00 418177 Nm Muga R/S Single 341 Diagnostic Nuclear Medicine $4,374.00 418181 Nm Cardiac Pl Sgl W/Ef 341 Diagnostic Nuclear Medicine $710.00 418182 Nm Pulm Perf Partic 341 Diagnostic Nuclear Medicine $5,315.00

418183 Nm Perf Partic W/Vent 341 Diagnostic Nuclear Medicine $6,673.00

418189 Nm Pulm Qnt Diff Funct 341 Diagnostic Nuclear Medicine $3,374.00

418193 Nm Brain Min 4 Static 341 Diagnostic Nuclear Medicine $1,780.00

418194 Nm Brain Spect 341 Diagnostic Nuclear Medicine $4,378.00

418196 Nm Cisternogram 341 Diagnostic Nuclear Medicine $2,602.00

418197 Ventricular Shunt Study 341 Diagnostic Nuclear Medicine $2,614.00

418202 Nm Kdney Scan Flw&Fnc 341 Diagnostic Nuclear Medicine $5,949.00

418204 Nm Kidney Flw&Fnc Mul 341 Diagnostic Nuclear Medicine $6,471.00 418206 Nm Kidney Fnc Only 341 Diagnostic Nuclear Medicine $3,887.00 418211 Nm Tumor Local Mult 341 Diagnostic Nuclear Medicine $3,863.00 418214 Nm Tum Lc Wb 2/More Da 341 Diagnostic Nuclear Medicine $7,530.00 418215 Nm Local Infl Prcs Ltd 341 Diagnostic Nuclear Medicine $3,152.00 418216 Nm Abscess Lcl W Body 341 Diagnostic Nuclear Medicine $7,302.00 418244 Mebrofenin Dx To 15 Mc 341 Diagnostic Nuclear Medicine $135.00

420236 NM Gallium Scan LTD Area 341 Diagnostic Nuclear Medicine $3,152.00

420237 NM Scan Gallium 341 Diagnostic Nuclear Medicine $7,302.00

420669 Nm Dacryosystogram 341 Diagnostic Nuclear Medicine $2,726.00

421903 NM BONE WHOLE BODY 341 Diagnostic Nuclear Medicine $5,677.00

426384 Thyroid Scan 341 Diagnostic Nuclear Medicine $1,320.00

426386 NM THYROID SCAN W/FL 341 Diagnostic Nuclear Medicine $850.00

747076 Tumor Localization Spe 341 Diagnostic Nuclear Medicine $5,559.00

747077 Brain Perfusion Eval 341 Diagnostic Nuclear Medicine $732.00

747078 Brain Imaging With Vas 341 Diagnostic Nuclear Medicine $1,748.00 747079 Brain Tomography Spect 341 Diagnostic Nuclear Medicine $2,326.00 747082 Octreoscan Tumor Loc. 341 Diagnostic Nuclear Medicine $2,307.00 747083 Octreoscan Tumor Loc W 341 Diagnostic Nuclear Medicine $3,224.00 747522 Cisternography 341 Diagnostic Nuclear Medicine $2,558.00 747570 Gallium 341 Diagnostic Nuclear Medicine $10,844.00 747572 Ventilation Scan 341 Diagnostic Nuclear Medicine $2,866.00

747573 Meckels Scan 341 Diagnostic Nuclear Medicine $2,430.00

747576 Vent/Perf Lung 341 Diagnostic Nuclear Medicine $6,673.00

748722 Thallium Adenosine 341 Diagnostic Nuclear Medicine $10,141.00

143 748730 Schilling Metformin 341 Diagnostic Nuclear Medicine $1,279.00 748929 Indium 341 Diagnostic Nuclear Medicine $7,220.00 748930 Parathyroid Scan 341 Diagnostic Nuclear Medicine $4,762.00 748931 Thallium Scan Spect 341 Diagnostic Nuclear Medicine $6,834.00

748932 Thallium Persantine 341 Diagnostic Nuclear Medicine $9,042.00

748934 Organ Tomography 341 Diagnostic Nuclear Medicine $2,284.00

748935 Liver Hemangioma 341 Diagnostic Nuclear Medicine $4,728.00

748936 Bone Tomography 341 Diagnostic Nuclear Medicine $6,918.00

748937 Thallium Cardiolite 341 Diagnostic Nuclear Medicine $8,214.00

749187 Thallium Scan Resting 341 Diagnostic Nuclear Medicine $6,308.00

749188 Muga Scan 341 Diagnostic Nuclear Medicine $4,490.00

749200 Ceretec Lube Scan 341 Diagnostic Nuclear Medicine $4,473.00 749201 Ceretec Wbc Tagging 341 Diagnostic Nuclear Medicine $4,949.00 749241 Thyroid Scan 341 Diagnostic Nuclear Medicine $3,270.00 749279 Hepato/Bil Sc 341 Diagnostic Nuclear Medicine $6,268.00 749282 Rai/Thyroid 341 Diagnostic Nuclear Medicine $4,791.00 749286 Rai 341 Diagnostic Nuclear Medicine $596.00 749288 Pyp Myocardial 341 Diagnostic Nuclear Medicine $2,546.00

749291 Muga Rest/Stress 341 Diagnostic Nuclear Medicine $6,707.00

749292 1St Pass Card. 341 Diagnostic Nuclear Medicine $833.00

749293 Abd Shunt St 341 Diagnostic Nuclear Medicine $3,816.00

749294 Brainsc/Cbf 341 Diagnostic Nuclear Medicine $1,575.00

749295 Liver Scan 341 Diagnostic Nuclear Medicine $5,107.00

749296 Lung Scan 341 Diagnostic Nuclear Medicine $5,222.00

749297 Radio Venogram 341 Diagnostic Nuclear Medicine $1,484.00

749299 Renal Scan 341 Diagnostic Nuclear Medicine $4,155.00 749300 Hippuran 341 Diagnostic Nuclear Medicine $1,763.00 749301 Renal Flow 341 Diagnostic Nuclear Medicine $856.00 749302 Triple Renal 341 Diagnostic Nuclear Medicine $6,355.00 749303 Bone Scan 341 Diagnostic Nuclear Medicine $6,187.00 749306 Schillings Test 341 Diagnostic Nuclear Medicine $1,539.00 749307 Schillings Intrinsic 341 Diagnostic Nuclear Medicine $1,521.00

749308 I131 Body Scan 341 Diagnostic Nuclear Medicine $7,348.00

749309 Tumor Localization W/ 341 Diagnostic Nuclear Medicine $7,095.00

749312 Triple Renal W/Cap Tor 341 Diagnostic Nuclear Medicine $12,690.00

749314 Gfr Study 341 Diagnostic Nuclear Medicine $4,077.00

749336 Dacrocystogram 341 Diagnostic Nuclear Medicine $2,677.00

749391 Tri Phasic Bone Scan 341 Diagnostic Nuclear Medicine $7,653.00

749392 Radio Testicular Scan 341 Diagnostic Nuclear Medicine $4,382.00

749393 Radio Voiding Cysto 341 Diagnostic Nuclear Medicine $1,224.00

749394 G.I. Bleeding Scan 341 Diagnostic Nuclear Medicine $1,666.00 749395 Gastric Emptying Scan 341 Diagnostic Nuclear Medicine $4,217.00 749401 Resting Cardiolite Spe 341 Diagnostic Nuclear Medicine $7,228.00 749402 Hida Scan With Kinevac 341 Diagnostic Nuclear Medicine $6,361.00 749403 Nuc Pharmaceutical Met 341 Diagnostic Nuclear Medicine $2,461.00 749404 Ventricular Shunt Stud 341 Diagnostic Nuclear Medicine $452.00 749419 Cardiolite Cardiolie P 341 Diagnostic Nuclear Medicine $5,228.00

749420 Nm Schilling W&W/O F 341 Diagnostic Nuclear Medicine $2,967.00

749422 Gated Spect-Mvocardial 341 Diagnostic Nuclear Medicine $6,893.00

749429 Bone Scan Limited 341 Diagnostic Nuclear Medicine $3,990.00

144 749430 F/U Cardiolite Stress 341 Diagnostic Nuclear Medicine $2,529.00 749433 Lymph Gland Imaging Sc 341 Diagnostic Nuclear Medicine $2,545.00 749434 Mycardial Perf Study W 341 Diagnostic Nuclear Medicine $1,207.00 749444 Pertechnetate Dx Per M 341 Diagnostic Nuclear Medicine $15.00

749445 Mebrofenin Per Mci 341 Diagnostic Nuclear Medicine $39.00

749455 Cea Tumor Loc Whole Bo 341 Diagnostic Nuclear Medicine $2,881.00

749456 Cea Tumor Multiple Are 341 Diagnostic Nuclear Medicine $1,232.00

749457 Organ Tomography 341 Diagnostic Nuclear Medicine $2,289.00

749458 Tc 99 Red Blood Cells 341 Diagnostic Nuclear Medicine $29.00

749459 Tc 99M Mertiatide 1 Mc 341 Diagnostic Nuclear Medicine $91.00

749462 Labeled Rbc Dx To 30 M 341 Diagnostic Nuclear Medicine $26.00

749485 Exametazime Dx To 25 M 341 Diagnostic Nuclear Medicine $4,036.00 749495 First Pass Technique M 341 Diagnostic Nuclear Medicine $3,051.00 749500 Gen Code (341) 341 Diagnostic Nuclear Medicine $- 413061 Pl Dev Ot Ab/Pl/Pros/T 342 Therapeutic Nuclear Medicine $6,489.00 420670 Radioph Th Intracavt A 342 Therapeutic Nuclear Medicine $7,716.00 748799 Brach Sd Ima Med I-125 342 Therapeutic Nuclear Medicine $498.00 749337 Sod Iodid I-131 Per Mc 342 Therapeutic Nuclear Medicine $227.00

749338 Rad. Nuc-Phar- 7,Co I-131 342 Therapeutic Nuclear Medicine $1,815.00

749339 Rad. Nuc-Phar- 8Mci I-131 342 Therapeutic Nuclear Medicine $1,971.00

749340 Rad. Nuc-Phar- 9Mci I-131 342 Therapeutic Nuclear Medicine $2,136.00

749341 Rad. Nuc-Phar- 10Mci I-131 342 Therapeutic Nuclear Medicine $2,297.00

749342 Rad. Nuc-Phar- 11 Mci I-131 342 Therapeutic Nuclear Medicine $2,467.00

749343 Rad. Nuc-Phar 12Mci I-131 342 Therapeutic Nuclear Medicine $2,625.00

749344 Rad. Nuc-Phar 13Mci I-131 342 Therapeutic Nuclear Medicine $2,791.00

749345 Rad. Nuc-Phar 14Mci I-131 342 Therapeutic Nuclear Medicine $2,953.00 749347 Rad. Nuc-Phar 20Mci I-131 342 Therapeutic Nuclear Medicine $3,924.00 749348 Rad. Nuc-Phar- 25Mci I-131 342 Therapeutic Nuclear Medicine $4,746.00 749349 Rad. Nuc-Phar- 29 Mci I-131 342 Therapeutic Nuclear Medicine $5,389.00 749405 Rad. Nuc. Pharm-100 Mc 342 Therapeutic Nuclear Medicine $10,721.00 749406 Rad. Nuc. Phar-150 Mci 342 Therapeutic Nuclear Medicine $15,864.00 749407 Rad. Nuc. Phar-200 Mci 342 Therapeutic Nuclear Medicine $21,003.00

749450 Infusion Radiopharmacy 342 Therapeutic Nuclear Medicine $1,862.00

412992 Ct Chest W/O Contrast 350 General CT Scan $7,797.00

412993 Ct Chest W/Contrast 350 General CT Scan $10,635.00

412994 Ct Chest W&W/O Cont 350 General CT Scan $10,677.00

412995 Cta Chest 350 General CT Scan $11,100.00

412996 Ct C-Spine W/O Contras 350 General CT Scan $9,409.00

412997 CT C-Spine W/Contrast 350 General CT Scan $7,863.00

412999 Ct T-Spine W/O Contras 350 General CT Scan $9,229.00

413002 Ct L-Spine W/O Contras 350 General CT Scan $9,331.00 413003 Ct L-Spine W/Contrast 350 General CT Scan $8,557.00 413004 Ct L-Spine W&W/O Cont 350 General CT Scan $11,698.00 413005 Cta Pelvis 350 General CT Scan $10,103.00 413006 Ct Pelvis W/O Contrast 350 General CT Scan $8,353.00 413007 Ct Pelvis W/Contrast 350 General CT Scan $9,138.00 413008 Ct Pelvis W&W/O Cont 350 General CT Scan $7,186.00

413010 Ct Up Extrem W/O Cont Lt 350 General CT Scan $9,181.00

413011 Ct Up Extrem W/O Cont Rt 350 General CT Scan $9,181.00

413013 Ct Up Extrem W/Cont Lt 350 General CT Scan $9,490.00

145 413014 Ct Up Extrem W/Cont Rt 350 General CT Scan $9,490.00 413016 Ct Up Extrm W&W/O Con 350 General CT Scan $9,877.00 413017 Ct Up Extrm W&W/O Con 350 General CT Scan $9,877.00 413022 CT Lower Ext W/O Lt 350 General CT Scan $8,129.00

413024 Ct Lower Extrm W/O C R 350 General CT Scan $8,846.00

413026 Ct Lower Extrm W/Con R 350 General CT Scan $1,395.00

413029 Ct Lw Extrm W&W/O Con 350 General CT Scan $8,336.00

413031 CTA Lower Ext w/wo Contrast 350 General CT Scan $7,749.00

413034 Ct Abdomen W/O Cont 350 General CT Scan $8,780.00

413035 Ct Abdomen W/Cont 350 General CT Scan $10,004.00

413036 Ct Abdomen W&Wo Cont 350 General CT Scan $8,634.00

413037 Cta Abdomen 350 General CT Scan $10,121.00 413038 Ct Heart Wo Cn W Quan 350 General CT Scan $3,855.00 413039 Ctheart W Cn Str Mor F 350 General CT Scan $3,855.00 413040 Ctheart Congenitl Dise 350 General CT Scan $3,855.00 413041 Ct Heart W Cn Art/Graf 350 General CT Scan $3,855.00 413044 3D Ct/Mri/Us/Oth Not I 350 General CT Scan $308.00 413046 Ct Ltd/Loc 350 General CT Scan $1,665.00

413049 Ct Guid Ndl Plcmt 350 General CT Scan $7,438.00

413050 Ct Guidance Tissue Abl 350 General CT Scan $1,377.00

413051 Ct Place Rad Thpy Fld 350 General CT Scan $772.00

413055 Cta Abd Aorta If Lwex 350 General CT Scan $10,457.00

420612 Ct Abdomen W/Cont 350 General CT Scan $9,192.00

421765 Ct Lower Extrm W/O C B 350 General CT Scan $13,771.00

422915 Ct Abd&Pelvis W/O Cont 350 General CT Scan $8,585.00

422916 Ct Abd&Pelvis W/Cont 350 General CT Scan $9,010.00 423616 3D Ct/Mri/Us/Oth Ind 350 General CT Scan $5,731.00 423622 Cta Abd Aorta If Lwex 350 General CT Scan $8,906.00 423623 Cta Abdomen 350 General CT Scan $8,169.00 423624 Cta Chest 350 General CT Scan $8,975.00 423626 Cta Low Extremity Rt 350 General CT Scan $7,425.00 423630 Ct Neck W&W/O Cont 350 General CT Scan $8,413.00

423631 Ct Neck W&W/O Cont 350 General CT Scan $8,413.00

425670 3D CT/MRI/US/OTH IND 350 General CT Scan $545.00

430731 Ct Ab W/O Cont Xr29 350 General CT Scan $8,282.00

722469 Gen Code - 350 350 General CT Scan $-

957019 Reconst Ct/Mri/Other 350 General CT Scan $1,738.00

959163 Pituitary Without Cont 350 General CT Scan $6,127.00

959165 Ct Needle Biopsy 350 General CT Scan $8,823.00

959166 Ct Guided Abscess Drai 350 General CT Scan $4,627.00

959172 Pituitary W/Wo Contras 350 General CT Scan $7,826.00 959173 Pituitary With Contras 350 General CT Scan $6,640.00 959190 Gen Code - Ct. Scan 350 General CT Scan $- 959246 Ct Abdomen W/Contrast 350 General CT Scan $9,748.00 959248 Ct Abdomen Wo/Contrast 350 General CT Scan $9,404.00 959252 Abdomen W&W/O Contrast 350 General CT Scan $11,033.00 959262 Ct Pelvis W/O Contrast 350 General CT Scan $8,305.00

959265 Ct Pelvis W/Contrast 350 General CT Scan $8,834.00

959300 Ct Angio Head W&Wo Con 350 General CT Scan $10,188.00

959301 Ct Angio Neck W&Wo Con 350 General CT Scan $9,993.00

146 959302 Ct Angio Chest W&Wo C 350 General CT Scan $11,484.00 959303 Ct Pelvis W&Wo Cont 350 General CT Scan $10,937.00 959304 Ct Upper Ext W&Wo Cont 350 General CT Scan $9,502.00 959305 Ct Low Ext W&Wo Cont 350 General CT Scan $9,502.00

959306 Ct Abd W&Wo Cont 350 General CT Scan $10,455.00

959307 Sp Ang Abd W&Wo Cont 350 General CT Scan $11,396.00

959308 Reconst Ct/Mri/Other 350 General CT Scan $7,334.00

959735 Ct Cyst Aspiration 350 General CT Scan $4,214.00

959736 Ct Stero Localization 350 General CT Scan $10,344.00

959745 Ct Lower Extrm W.Contr 350 General CT Scan $1,523.00

412978 Ct Head/Brain W/O Cont 351 Head Scan $8,479.00

412979 Ct Head/Brain W/Cont 351 Head Scan $10,255.00 412980 Ct Hd/Br W&W/O Cont 351 Head Scan $10,775.00 412981 Ct Orbit/Sella/Iac Wo 351 Head Scan $7,257.00 412982 Ct Orbit/Sella/Iac W 351 Head Scan $9,705.00 412983 Ct Orbit/Sella/Iac W&W 351 Head Scan $9,061.00 412984 Ct Maxifac W/O Cnt 351 Head Scan $8,505.00 412985 Ct Maxifac W/Contrast 351 Head Scan $1,883.00

412986 Ct Maxifac W&W/O Cont 351 Head Scan $2,199.00

412987 Ct Neck W/O Contrast 351 Head Scan $7,617.00

412988 Ct Neck W/Contrast 351 Head Scan $9,713.00

412989 Ct Neck W&W/O Cont 351 Head Scan $8,901.00

412990 Cta Head 351 Head Scan $10,748.00

412991 Cta Neck 351 Head Scan $10,544.00

423587 Ct Head/Brain W/O Cont 351 Head Scan $6,867.00

423588 Ct Head/Brain W/Cont 351 Head Scan $7,595.00 423589 Ct Hd/Br W&W/O Cont 351 Head Scan $8,413.00 423590 Ct Orbit/Sella/Iac Wo 351 Head Scan $6,636.00 423591 Ct Orbit/Sella/Iac W 351 Head Scan $7,187.00 423592 Ct Orbit/Sella/Iac W&W 351 Head Scan $8,470.00 423593 Ct Maxifac W/O Cnt 351 Head Scan $7,258.00 423594 Ct Maxifac W/Contrast 351 Head Scan $1,611.00

423595 Ct Maxifac W&W/O Cont 351 Head Scan $2,028.00

423596 Ct Neck W/O Contrast 351 Head Scan $6,420.00

423597 Ct Neck W/Contrast 351 Head Scan $7,618.00

423625 Cta Head 351 Head Scan $7,959.00

423627 Cta Neck 351 Head Scan $7,806.00

425512 Cta Abd And Pelvis W/W 351 Head Scan $3,330.00

959161 Orbits With Contrast 351 Head Scan $6,640.00

959162 Iac W/O Contrast 351 Head Scan $8,495.00

959164 Orbits W& W/O Contrast 351 Head Scan $6,811.00 959170 Iac W& W/O Contrast 351 Head Scan $10,842.00 959171 Iac With Contrast 351 Head Scan $9,199.00 959174 Orbits W/Wo Contrast 351 Head Scan $8,690.00 959176 Ct Sinuses W/O Contras 351 Head Scan $9,289.00 959245 Ct Brain W/Contrast 351 Head Scan $9,717.00 959247 Ct Brain Wo/Contrast 351 Head Scan $8,787.00

959253 Ct Brain W&/Wo Contras 351 Head Scan $10,765.00

959260 Ct Neck W/O Contrast 351 Head Scan $8,217.00

959261 Ct Neck W/Contrast 351 Head Scan $9,747.00

147 959734 Ct Sinuses W/O Cont Lt 351 Head Scan $3,105.00 959759 Mri Spectroscopy 351 Head Scan $8,510.00 413020 Cta Upper Extremity w/wo Contr 352 Body Scan $8,721.00 413143 Vert/Sacroplsty W/Fluo 352 Body Scan $1,721.00

420609 Ct Chest W/O Contrast 352 Body Scan $7,797.00

420610 Ct Chest W/Contrast 352 Body Scan $10,635.00

420611 Ct Pelvis W/Contrast 352 Body Scan $8,397.00

420751 Vertebroplsty Thorac S 352 Body Scan $15,005.00

421764 Vert/Sacroplst W/Ct Gu 352 Body Scan $5,956.00

422917 Ct Abd&Pelvis W&Wo Con 352 Body Scan $10,360.00

423068 Cta Upper Extremity 352 Body Scan $8,721.00

423598 Ct Chest W/O Contrast 352 Body Scan $6,886.00 423599 Ct Chest W/Contrast 352 Body Scan $9,145.00 423600 Ct Chest W&W/O Cont 352 Body Scan $10,175.00 423601 Ct C-Spine W/O Contras 352 Body Scan $7,747.00 423602 Ct C-Spine W/Contrast 352 Body Scan $7,906.00 423603 Ct T-Spine W/O Contras 352 Body Scan $7,678.00 423604 Ct T-Spine W/Contrast 352 Body Scan $7,887.00

423605 Ct L-Spine W/O Contras 352 Body Scan $7,290.00

423606 Ct L-Spine W/Contrast 352 Body Scan $7,997.00

423607 Ct Pelvis W/O Contrast 352 Body Scan $6,489.00

423608 Ct Pelvis W/Contrast 352 Body Scan $6,904.00

423609 Ct Pelvis W&W/O Cont 352 Body Scan $6,652.00

423610 Ct Up Extrem W/O Cont 352 Body Scan $7,184.00

423611 Ct Up Extrem W/Cont Rt 352 Body Scan $8,078.00

423612 Ct Lower Extrm W/O C 352 Body Scan $6,804.00 423613 Ct Abdomen W/O Cont 352 Body Scan $7,349.00 423614 Ct Abdomen W/Cont 352 Body Scan $7,619.00 423615 Ct Abdomen W&Wo Cont 352 Body Scan $8,623.00 423618 Ct Up Extrm W&W/O Con 352 Body Scan $8,413.00 423619 Ct Lw Extrm W&W/O Con 352 Body Scan $7,099.00 423620 Ct Lower Extrm W/Con 352 Body Scan $1,188.00

423621 Ct T-Spine W&W/O Cont 352 Body Scan $11,080.00

423628 Cta Pelvis 352 Body Scan $8,544.00

423629 Cta Upper Extremity 352 Body Scan $7,425.00

423632 Ct L-Spine W&W/O Cont 352 Body Scan $11,080.00

423633 Ct C-Spine W&W/O Cont 352 Body Scan $11,080.00

423634 Ct Abd&Pelvis W/O Cont 352 Body Scan $9,344.00

423635 Ct Abd&Pelvis W/Cont 352 Body Scan $9,805.00

423636 Ct Abd&Pelvis W&Wo Con 352 Body Scan $11,275.00

959167 Ct Chest W/Contrast 352 Body Scan $11,700.00 959168 Ct Chest W&/Wo Contras 352 Body Scan $13,021.00 959251 Ct Chest W/O Contrast 352 Body Scan $8,811.00 959254 Ct C-Spine W/O Contras 352 Body Scan $9,912.00 959255 Ct T-Spine W/O Contras 352 Body Scan $9,824.00 959256 Ct L-Spine W/O Contras 352 Body Scan $9,331.00 959257 Ct C-Spine W/Contrast 352 Body Scan $10,121.00

959258 Ct T-Spine W/Contrast 352 Body Scan $10,100.00

959259 Ct L-Spine W/Contrast 352 Body Scan $10,240.00

959263 Ct Up Extrem W/O Cont 352 Body Scan $9,195.00

148 959264 Ct Lower Extrem W/O Co 352 Body Scan $8,702.00 959266 Ct Pelvis W-W/O Cont 352 Body Scan $8,510.00 959309 Ct Ltd/Loc 352 Body Scan $746.00 959733 Gen Code (352) 352 Body Scan $-

959751 Ct Lower Extrem W/O Co 352 Body Scan $8,712.00

959752 Ct Up Extrem W/O Cont 352 Body Scan $9,195.00

72712 Venous Mech Tromb 360 General Operating Room Services $19,374.00

201044 Repl Tunn Cv Cath 360 General Operating Room Services $980.00

201045 Repl Comp Picc 360 General Operating Room Services $2,067.00

201046 Remv Tunn Cath W/O Por 360 General Operating Room Services $4,029.00

201050 Repo Cvp W Fluoro 360 General Operating Room Services $2,067.00

201066 Exchg Cath Abs/Cys 360 General Operating Room Services $6,674.00 201068 Insert Non Tunn Cv Cat 360 General Operating Room Services $2,067.00 201076 Ins Perph Cvc W/O Port 360 General Operating Room Services $2,067.00 201078 Us Guidance Vasc Acces 360 General Operating Room Services $2,972.00 201083 Xr Subtraction W/O Std 360 General Operating Room Services $2,047.00 201088 Xr Abscess/Fist/Sin 360 General Operating Room Services $2,116.00 201092 Drn Absc Subdiaph 360 General Operating Room Services $4,837.00

201097 Bx Bone Deep 360 General Operating Room Services $3,785.00

312467 Gen-Code O.R. 360 General Operating Room Services $-

312475 Gen Code - Mor (360) 360 General Operating Room Services $-

315818 Bone Mill 360 General Operating Room Services $232.00

316619 Level 3 1St 30 Mins 360 General Operating Room Services $12,813.00

316620 Level 3 Addl 15 Mins 360 General Operating Room Services $4,628.00

316903 Twist Drill 360 General Operating Room Services $189.00

317007 Or Time Charge 0-30 360 General Operating Room Services $6,922.00 317359 O.H. Setup And Cancel 360 General Operating Room Services $9,642.00 319487 Surgical Assistant 360 General Operating Room Services $718.00 319836 Or Time Ea Addl 15 Min 360 General Operating Room Services $3,572.00 378711 CPB Equip 360 General Operating Room Services $5,407.00 378712 Iabp Monitoring 360 General Operating Room Services $9,185.00 378713 Pacemaker Analysis Equip 360 General Operating Room Services $212.00

379820 Cir Tech Mon Per 1/2 H 360 General Operating Room Services $227.00

379823 Cardio-Pulm Bypass 1/2 360 General Operating Room Services $8,815.00

379824 Acid Monitor Per 1/2 H 360 General Operating Room Services $576.00

379826 Auto Transfusion 1/2 H 360 General Operating Room Services $1,309.00

379829 Pacemkr Anal Per 1/2 H 360 General Operating Room Services $780.00

412765 Or Level 1 First 30 Mi 360 General Operating Room Services $9,502.00

412766 Or Level 1 Addl 15 Min 360 General Operating Room Services $4,573.00

412767 Or Level 2 First 30 Mi 360 General Operating Room Services $12,623.00

412768 Or Level 2 Addl 15 Min 360 General Operating Room Services $4,751.00 412769 Or Level 3 First 30 Mi 360 General Operating Room Services $13,661.00 412770 Or Level 3 Addl 15 Min 360 General Operating Room Services $4,939.00 412771 Or Level 4 First 30 Mi 360 General Operating Room Services $16,331.00 412772 Or Level 4 Addl 15 Min 360 General Operating Room Services $5,351.00 412773 Or Level 5 First 30 Mi 360 General Operating Room Services $29,927.00 412774 Or Level 5 Addl 15 Min 360 General Operating Room Services $13,185.00

420790 Insertion Vent Lead 360 General Operating Room Services $21,433.00

420792 Insert Pacemaker & Lea 360 General Operating Room Services $21,433.00

420793 Temp Pacer Insertion 360 General Operating Room Services $21,433.00

149 420794 Insert Sing Chamber Ge 360 General Operating Room Services $21,433.00 420795 Insert Dual Chamber Ge 360 General Operating Room Services $21,433.00 420799 Repair Pacemaker Elect 360 General Operating Room Services $21,145.00 420800 Revision Of Pacer Pock 360 General Operating Room Services $9,515.00

420801 Revision Of Aicd Pocke 360 General Operating Room Services $9,515.00

420809 Insert/Replace Aicd 360 General Operating Room Services $21,433.00

420810 Remove Pulse Generator 360 General Operating Room Services $12,169.00

420813 Insert Loop Recorder 360 General Operating Room Services $17,458.00

420814 Removal Loop Recorder 360 General Operating Room Services $4,747.00

420893 Remv Tunn Cath W Port 360 General Operating Room Services $2,433.00

420922 Transcath Stent Cca W/EP 360 General Operating Room Services $11,541.00

420969 Change Gi Tube 360 General Operating Room Services $1,195.00 421031 Paracentesis Subs 360 General Operating Room Services $1,647.00 421038 Rev Pert Venous Shunt 360 General Operating Room Services $15,294.00 421143 Level 1-1St 30 Minutes 360 General Operating Room Services $7,739.00 421144 Level 1-Addl 15 Minute 360 General Operating Room Services $3,724.00 421145 Level 2-1St 30 Minutes 360 General Operating Room Services $10,281.00 421146 Level 2-Addl 15 Minute 360 General Operating Room Services $3,870.00

421147 Level 3-1St 30 Minutes 360 General Operating Room Services $11,128.00

421148 Level 3-Addl 15 Minute 360 General Operating Room Services $4,018.00

421149 Level 4-1St 30 Minutes 360 General Operating Room Services $13,300.00

421150 Level 4-Addl 15 Minute 360 General Operating Room Services $4,358.00

421151 Davinci Surg 1St 30 Mi 360 General Operating Room Services $22,998.00

421152 Davinci Srg Addtnl15Mi 360 General Operating Room Services $2,297.00

421940 Inj Venogram 360 General Operating Room Services $1,241.00

421951 Venous Mech Thrmb Ea A 360 General Operating Room Services $19,647.00 422480 Gen Code Endoscopy 360 General Operating Room Services $- 425448 Rem/Repl Aicd Mult Ld 360 General Operating Room Services $143,461.00 428655 Transcath W/Im Vein Ini 360 General Operating Room Services $43,694.00 432017 TRAY SMALL BONE 360 General Operating Room Services $502.00 438795 Cancelled Surgery 360 General Operating Room Services $1,165.00 439491 Or Time Charge 0-30 360 General Operating Room Services $5,694.00

439492 Or Time Ea Addl 15 Min 360 General Operating Room Services $2,734.00

520192 Minor Treatment 360 General Operating Room Services $1,374.00

520193 Cryopexy 360 General Operating Room Services $2,303.00

520196 Gen Code - Sds Recover 360 General Operating Room Services $-

520198 Bone Marrow Biopsy 360 General Operating Room Services $2,561.00

520199 Thoracentesis 360 General Operating Room Services $2,000.00

722458 Gen Code (360) 360 General Operating Room Services $-

726812 Insertion Tesio Cath 360 General Operating Room Services $3,374.00

727661 Sc Inj Sinus Tract Dx 360 General Operating Room Services $1,220.00 727662 Sc Cath Hysterosalping 360 General Operating Room Services $1,665.00 728016 Sp Venogram Ext Uni 360 General Operating Room Services $4,178.00 728510 Sc Inj Myelogram L-Spi 360 General Operating Room Services $2,924.00 728511 Sc Inj Myelogram T-Spi 360 General Operating Room Services $2,924.00 733017 Rem/Adj Dev/Cath Only 360 General Operating Room Services $408.00 748731 Cisternography-Inj Pro 360 General Operating Room Services $1,524.00

748732 Dacrocystogram Inj Pro 360 General Operating Room Services $3,555.00

748733 Sc Thoracentesis 360 General Operating Room Services $1,764.00

748735 Sc Asp Cyst Breast Uni 360 General Operating Room Services $1,566.00

150 748756 Sc Paracentesis Inc 360 General Operating Room Services $1,374.00 749428 Breast Biopsy Perc Ndl 360 General Operating Room Services $4,729.00 968514 Pericardiocentesis 360 General Operating Room Services $1,777.00 968533 Temp Pacer Insertion 360 General Operating Room Services $20,128.00

968534 Insertion of Sgl Chamber Gene 360 General Operating Room Services $20,128.00

968535 Insertion of Dual Chamber Gene 360 General Operating Room Services $20,128.00

968550 Insertion Vent Lead 360 General Operating Room Services $20,128.00

968551 Upgrade Single Chamber to Dual 360 General Operating Room Services $20,128.00

968552 Revision Of Pacer Pocket 360 General Operating Room Services $9,017.00

969484 Insertion Atrial Lead 360 General Operating Room Services $20,128.00

969555 Insertion Dual Leads 360 General Operating Room Services $20,128.00

969605 Inser Or Replcmnt Aicd Gen & L 360 General Operating Room Services $20,128.00 969606 Replacement Aicd Gen. 360 General Operating Room Services $5,857.00 969608 Revision Of Aicd Pocket 360 General Operating Room Services $9,017.00 969609 Repair Pacemaker Electrodes AT 360 General Operating Room Services $19,855.00 72404 3D Ct/Mri/Us/Oth Not I 361 Minor Surgery $324.00 72407 Nm Wall Motion 361 Minor Surgery $6,561.00 72702 Inj W Fluor Eval Cvad 361 Minor Surgery $349.00

72703 Chng Ureter Stnt Percu 361 Minor Surgery $10,389.00

72704 Remv Ureter Stnt Percu 361 Minor Surgery $10,389.00

72705 Chng Ext/Int Urtr Stnt 361 Minor Surgery $3,873.00

72706 Remv Renal Tube W/Fluo 361 Minor Surgery $1,464.00

72721 Aspir Or Decomp Proc 361 Minor Surgery $17,364.00

72757 Rplc Gastrojejnsty Tub 361 Minor Surgery $1,603.00

72758 Ins Gastro Tube Perc 361 Minor Surgery $4,205.00

72773 Dx Perc Asp NP/Disc/Tissue 361 Minor Surgery $2,031.00 72789 AV Shunt Add'l Access Tx 361 Minor Surgery $1,191.00 72790 Inj Facet C/T> = 3Flu/C 361 Minor Surgery $3,041.00 72791 Inj Facet L/S>=3Flu/C 361 Minor Surgery $3,041.00 72835 Repl Comp Picc 361 Minor Surgery $2,067.00 72837 Gastrografn Po 367 120 361 Minor Surgery $39.00 72840 Inj Facet C/T> =3Flu/C 361 Minor Surgery $3,125.00

72841 Inj Facet L/S> =3Flu/C 361 Minor Surgery $3,125.00

72910 Dialysis Fistula 361 Minor Surgery $752.00

200135 Ul Dx Rad Proedure 361 Minor Surgery $346.00

201043 Replc Non Tunn Cv Cata 361 Minor Surgery $2,067.00

201077 Ins Tunneled Cvc W/O P 361 Minor Surgery $5,393.00

201109 Vess Inj Proc 361 Minor Surgery $1,222.00

413089 Sc Paracentesis Ini 361 Minor Surgery $2,624.00

413102 Sc Vertbrplsty Thor 361 Minor Surgery $13,770.00

413103 Sc Vertbrplsty Lumbar 361 Minor Surgery $13,770.00 413104 Sc Vertbrplsty Add Th/ 361 Minor Surgery $13,770.00 413122 Plc Devs Thor Radtx Gu 361 Minor Surgery $6,051.00 413127 Plc Dev Ab/Pl Radtx Gu 361 Minor Surgery $6,051.00 413326 Insert Bladder Catheter 361 Minor Surgery $369.00 413338 Insert Periph CV Cath 361 Minor Surgery $9,220.00 417542 Sc Pericardiocentesis 361 Minor Surgery $2,370.00

417549 Upgrade Pacer System 361 Minor Surgery $60,585.00

417552 Repair Lead Dual 361 Minor Surgery $9,914.00

417560 Sc Pta Aorta 361 Minor Surgery $24,149.00

151 417569 Occlusive Device Ven/A 361 Minor Surgery $2,730.00 417873 Intubation Endo Emerg 361 Minor Surgery $1,411.00 418977 Blood Transfusion 361 Minor Surgery $2,260.00 418978 Therapeutic Apheresi W 361 Minor Surgery $5,871.00

418979 Plasma Pheresis 361 Minor Surgery $5,871.00

418981 Puncture Lumbar Dx 361 Minor Surgery $1,463.00

420706 Fine Needle Aspir W/Im 361 Minor Surgery $2,332.00

420707 Fine Needle Aspir W/Im 361 Minor Surgery $2,726.00

420709 I&D Hemotm/Serma/Fld C 361 Minor Surgery $7,038.00

420711 Asp Abs/Cyst Skin 361 Minor Surgery $947.00

420713 Tatoo 361 Minor Surgery $1,221.00

420719 Bx Breast Perc Ndl 361 Minor Surgery $2,324.00 420721 Bx Breast Im Guid 361 Minor Surgery $3,490.00 420726 Plc Clip Breast Bx/Asp 361 Minor Surgery $668.00 420729 Bx Muscle Perc 361 Minor Surgery $2,183.00 420730 BX Muscle Perc 361 Minor Surgery $2,364.00 420731 Bx Muscle Perc 361 Minor Surgery $2,554.00 420732 Bx Bone Superficial 361 Minor Surgery $2,527.00

420734 Bx Bone Deep 361 Minor Surgery $3,903.00

420738 Inj Sinus Tract Dx 361 Minor Surgery $1,328.00

420740 Arthrocentesis Sml Bi 361 Minor Surgery $1,382.00

420742 Arthroctesis Inter Bi 361 Minor Surgery $1,382.00

420744 Asp Joint Major Bi 361 Minor Surgery $1,505.00

420745 Abl Bone Tu Pc 361 Minor Surgery $23,630.00

420749 Bx Soft Tis Neck/Thora 361 Minor Surgery $6,676.00

420750 Bx Soft Tis Neck/Thora 361 Minor Surgery $7,810.00 420755 Inj Arthro Shoulder 361 Minor Surgery $2,386.00 420756 Inj Arthro Elbow 361 Minor Surgery $2,064.00 420757 Inj Arthro Wrist 361 Minor Surgery $1,245.00 420758 Bx Sft Tiss Pelvis-Hip 361 Minor Surgery $4,671.00 420760 Inj Arthro Hip W/O An 361 Minor Surgery $1,529.00 420761 Inj Sacil Joint Arthro 361 Minor Surgery $1,175.00

420762 Inj Sacil Joint Arthro 361 Minor Surgery $1,098.00

420763 Inj Si Anes/Std/Th Ag 361 Minor Surgery $1,098.00

420764 Unlisted Proc Pelvis-H 361 Minor Surgery $968.00

420765 Bx Sft Tissue Thgh-Kne 361 Minor Surgery $10,141.00

420767 Inj Arthro Knee 361 Minor Surgery $1,568.00

420769 Bx Lower Leg Soft Tiss 361 Minor Surgery $4,940.00

420770 Inj Arthro Ankle 361 Minor Surgery $1,535.00

420775 Bx Pleura Perc 361 Minor Surgery $3,796.00

420776 Bx Lung Perc 361 Minor Surgery $4,774.00 420778 Thoracentesis 361 Minor Surgery $2,116.00 420782 Thoracentesis 361 Minor Surgery $2,155.00 420783 Thoracentesis 361 Minor Surgery $2,207.00 420785 Insindwltnlcath 361 Minor Surgery $2,310.00 420786 Thoracostomy Tube 361 Minor Surgery $2,097.00 420787 Remv Pleural Cath w/Cuff 361 Minor Surgery $736.00

420788 Abl 1/More Pulm Tu Pc 361 Minor Surgery $21,488.00

420789 Unl Proc Lung Pleura 361 Minor Surgery $2,074.00

420796 Reposition Electrode P 361 Minor Surgery $12,169.00

152 420797 Insert Electrode-Singl 361 Minor Surgery $21,433.00 420798 Replacement Aicd Gen 361 Minor Surgery $30,217.00 420802 Insert Lv Lead Exist A 361 Minor Surgery $21,433.00 420803 Insert Lv Lead New Aic 361 Minor Surgery $21,433.00

420805 Reposition Lv Lead 361 Minor Surgery $12,169.00

420806 Removal Pacemaker 361 Minor Surgery $12,169.00

420807 Remove Lead-Single 361 Minor Surgery $12,169.00

420808 Remove Lead-Dual 361 Minor Surgery $12,169.00

420811 Remove Leads - Icd 361 Minor Surgery $12,169.00

420816 Insertion Iabp Perc 361 Minor Surgery $9,178.00

420817 Unl Proc Cardiac 361 Minor Surgery $2,574.00

420821 Pta Renal/Visc 361 Minor Surgery $14,950.00 420828 Pta Brachiocephalic 361 Minor Surgery $14,950.00 420830 Pta Venous 361 Minor Surgery $14,950.00 420831 Atherectomy Iliac 361 Minor Surgery $3,247.00 420832 Atherectmy Fem/Pop 361 Minor Surgery $3,247.00 420833 Atherectomy Tibio 361 Minor Surgery $3,247.00 420834 Inj Perc Extrem Psean 361 Minor Surgery $1,376.00

420835 Inj Venogram 361 Minor Surgery $1,382.00

420836 Inj Venogram 361 Minor Surgery $1,382.00

420840 CATH IVC/SVC 361 Minor Surgery $4,204.00

420842 CATH 1ST ORDER VEN 361 Minor Surgery $3,944.00

420844 CATH 2ND ORDER VEN 361 Minor Surgery $4,805.00

420847 Njd/Ncath R Brch Art 361 Minor Surgery $2,017.00

420849 NDL/INCATH EXT ART 361 Minor Surgery $2,344.00

420850 Av Shunt Ini Access Ev 361 Minor Surgery $1,476.00 420853 CATH AORTA 361 Minor Surgery $4,351.00 420855 CATH 1ST ORD UP ART 361 Minor Surgery $3,944.00 420857 CATH 2ND ORD UP ART 361 Minor Surgery $4,805.00 420859 CATH 3RD ORD UP ART 361 Minor Surgery $5,675.00 420861 CATH EA ADDL UP ART 361 Minor Surgery $875.00 420864 CATH 1ST OD LOW ART 361 Minor Surgery $3,944.00

420867 CATH 2ND OD LOW ART BI 361 Minor Surgery $9,604.00

420868 CATH 2ND OD LOW ART 361 Minor Surgery $4,805.00

420871 CATH 3RD OD LOW ART BI 361 Minor Surgery $11,339.00

420872 CATH 3RD OD LOW ART 361 Minor Surgery $5,675.00

420874 CATH EA ADDL LOW ART 361 Minor Surgery $875.00

420878 Therapeutic Apheresis 361 Minor Surgery $5,871.00

420879 Thera Apheresis Platel 361 Minor Surgery $5,871.00

420880 Insert Non Tunn Cv Cat 361 Minor Surgery $2,677.00

420881 Tunnelled Cath w/o Port 361 Minor Surgery $6,043.00 420882 Insert Tunn CV Cath >5 361 Minor Surgery $12,902.00 420883 Ins Perph Cvc W/O Port 361 Minor Surgery $2,433.00 420884 Ins Perph Cvc W/O Port 361 Minor Surgery $2,433.00 420887 Repl Non Tunn CV Cath 361 Minor Surgery $2,433.00 420888 Repl Tunn CV Cath w/o Port 361 Minor Surgery $1,152.00 420890 Repl Comp Picc 361 Minor Surgery $2,433.00

420891 Repl Tunn CV Cath 361 Minor Surgery $3,588.00

420892 Remv Tunn Cath W/O Por 361 Minor Surgery $5,222.00

420894 Declot Vascular Device 361 Minor Surgery $1,616.00

153 420902 Prim Perc Mech Tromb 361 Minor Surgery $21,994.00 420904 Prm Prc Mch Trmb Ech A 361 Minor Surgery $8,878.00 420906 Sec Perc Thrmb Add On 361 Minor Surgery $8,878.00 420907 Venous Mech Thromb 361 Minor Surgery $24,550.00

420908 Venous Mech Tromb 361 Minor Surgery $21,994.00

420911 Trnscth Tx Thrombo 361 Minor Surgery $2,419.00

420915 Stent Peripheral Ini 361 Minor Surgery $25,130.00

420917 Stnt Peripheral Adl 361 Minor Surgery $25,130.00

420919 Exchange Intravsc Cath 361 Minor Surgery $7,420.00

420924 Intravasc Us Init Vess 361 Minor Surgery $2,730.00

420925 Intravasc Us Addl Vess 361 Minor Surgery $2,730.00

420927 Interrupt Ivc 361 Minor Surgery $16,756.00 420928 Bone Marrow Aspiration 361 Minor Surgery $1,737.00 420930 Sc Bx Lymph Node Perc 361 Minor Surgery $3,364.00 420932 Sc Bx Lymph Node Perc 361 Minor Surgery $3,933.00 420933 Identify Sentinel Node 361 Minor Surgery $1,068.00 420936 Biopsy Of Salivary Gla 361 Minor Surgery $1,788.00 420967 Place Ng/Og Tube Fluor 361 Minor Surgery $941.00

420968 Change GI Tube 361 Minor Surgery $1,449.00

420975 Intro Long Gi Tube 361 Minor Surgery $543.00

420978 Bx Anorectal Wall 361 Minor Surgery $12,695.00

420998 Bx Liver 361 Minor Surgery $3,463.00

421000 Bx Liver 361 Minor Surgery $3,495.00

421003 Drain Abscess Liver 361 Minor Surgery $4,654.00

421004 Abl 1/More Liv Tu Pc R 361 Minor Surgery $21,488.00

421005 Unlisted Proc Liver 361 Minor Surgery $1,185.00 421009 Inj Cholangio T-Tube 361 Minor Surgery $603.00 421021 Bx Pancreas 361 Minor Surgery $2,927.00 421022 Drn Pancreatic Cyst 361 Minor Surgery $4,603.00 421023 Drn Abscess Periton 361 Minor Surgery $5,341.00 421025 Drn Absc Subdiaph 361 Minor Surgery $5,281.00 421028 Paracentesis Ini 361 Minor Surgery $2,673.00

421029 Paracentesis Ini 361 Minor Surgery $2,724.00

421032 Bx Abd/Retroperito 361 Minor Surgery $3,903.00

421037 Inj Cath Abs/Cyst 361 Minor Surgery $1,372.00

421039 Inj Shuntogram 361 Minor Surgery $2,703.00

421042 Ins Duo/Jejstmt Tube 361 Minor Surgery $5,448.00

421044 CVRT GASTR TO GSJEJ TUBE 361 Minor Surgery $5,448.00

421045 Rplc Gast Ceco Tube 361 Minor Surgery $2,077.00

421046 Rplc Duo Or Jestmy Tub 361 Minor Surgery $2,077.00

421048 Cont INJ GS/du/JJ/GJ 361 Minor Surgery $891.00 421050 Unl Abdomen Proc 361 Minor Surgery $11,853.00 421051 Bx Renal 361 Minor Surgery $3,972.00 421053 Bx Renal 361 Minor Surgery $4,648.00 421060 Asp/Inj Cyst Ren/Pel 361 Minor Surgery $3,369.00 421065 Inj Pyelogr Thru Tb 361 Minor Surgery $1,544.00 421069 Abl 1/More Renl Tu Rf 361 Minor Surgery $21,488.00

421070 Inj Ileal Conduit 361 Minor Surgery $951.00

421071 Inj Cysto/Ureth 361 Minor Surgery $910.00

421073 Inj Urethrocyst Ret 361 Minor Surgery $1,183.00

154 421081 Inj Corpora Cavern 361 Minor Surgery $4,286.00 421082 Sc Bx Prost 361 Minor Surgery $3,013.00 421084 Pl Int Dev Rad Guid Pr 361 Minor Surgery $1,949.00 421085 Unlisted Proc Male 361 Minor Surgery $629.00

421086 Cath Hysterosalping 361 Minor Surgery $1,815.00

421089 Bx Thyroid 361 Minor Surgery $2,348.00

421096 Inj Myelogram Spine 361 Minor Surgery $3,850.00

421097 Inj Myelogram Spine 361 Minor Surgery $4,158.00

421101 Inj Epi L-Spine Sgl 361 Minor Surgery $3,041.00

421104 N Block Other Periphera 361 Minor Surgery $2,958.00

421115 Celiac Plexus Block 361 Minor Surgery $3,005.00

421289 SP TELE BED 361 Minor Surgery $2,234.00 422940 Pta Iliac Initial 361 Minor Surgery $26,081.00 422941 Pta Iliac Additional 361 Minor Surgery $26,081.00 422942 Iliac Stent Initial 361 Minor Surgery $26,081.00 422943 Iliac Stent Additional 361 Minor Surgery $26,081.00 422944 Pta Fem Pop 361 Minor Surgery $26,081.00 422945 Atherectomy Fem Pop 361 Minor Surgery $55,365.00

422946 Stent Fem Pop 361 Minor Surgery $55,365.00

422947 Stent Ather Fem Pop 361 Minor Surgery $95,879.00

422948 Atherectomy Tibia 361 Minor Surgery $55,365.00

422950 Ather Tibia Additional 361 Minor Surgery $55,365.00

422951 Pta Tibioperoneal 361 Minor Surgery $26,081.00

422952 Pta Tibioperoneal Add 361 Minor Surgery $26,081.00

422953 Stent Tibioperoneal 361 Minor Surgery $55,365.00

422954 Stent Tibioperoneal Ad 361 Minor Surgery $26,081.00 422955 Stent Ather Tibperonea 361 Minor Surgery $95,879.00 422956 Stent Ather Tibperon A 361 Minor Surgery $26,081.00 422962 Trluml Perip Athrc Ren 361 Minor Surgery $8,738.00 422963 Trluml Perip Athrc Vis 361 Minor Surgery $8,738.00 422964 Trluml Perip Athrc Ab 361 Minor Surgery $8,738.00 422965 Trluml Perip Athrc Brc 361 Minor Surgery $8,738.00

422966 Trluml Perip Athrc Ili 361 Minor Surgery $8,738.00

423066 Sc Transcath Retreive 361 Minor Surgery $14,496.00

423071 Infusion Non-Thromb 361 Minor Surgery $9,015.00

423129 Insertion Vent Lead 361 Minor Surgery $49,900.00

423471 Asp Joint Major 361 Minor Surgery $962.00

423804 Trig Nerve Block Inj 361 Minor Surgery $1,203.00

425427 Cath 1St Od Renal Bil 361 Minor Surgery $12,720.00

425504 DEST LUMB/SAC FACET JN 361 Minor Surgery $5,949.00

425506 DEST L/S FACET JNT ADD 361 Minor Surgery $3,466.00 425508 DEST CERV/THOR FACET J 361 Minor Surgery $3,466.00 425510 Redo Endo Vas VC Filter 361 Minor Surgery $13,177.00 425511 Rem Endo Vas VC Filter 361 Minor Surgery $13,177.00 425608 DESTR C/TH FACET JNT AD 361 Minor Surgery $1,210.00 426298 THORACENTESIS W/O IMAG 361 Minor Surgery $16,027.00 426300 Thoracentesis w/o Imaging 361 Minor Surgery $14,978.00

426324 Thoracentesis W/Imag 361 Minor Surgery $3,138.00

426542 Unl Proc Vasc Inj 361 Minor Surgery $1,622.00

426616 Puncture Shunt 361 Minor Surgery $2,309.00

155 428669 Fluid Drain Cath Visc 361 Minor Surgery $3,052.00 428670 Fluid Drain Cath Visc 361 Minor Surgery $3,226.00 428671 US Drain Abscess Liv w Imaging 361 Minor Surgery $2,932.00 428672 Fluid Drain Peri/Retro 361 Minor Surgery $5,471.00

428673 Fluid Drain Peri/Retro 361 Minor Surgery $3,138.00

429089 Anaerobic Org Id 361 Minor Surgery $581.00

430511 Intvsc US Noncorn Init 361 Minor Surgery $2,767.00

430517 Remove Biliary Cath 361 Minor Surgery $5,231.00

430538 Inj Cholangio T-Tube 361 Minor Surgery $1,408.00

430707 Inj Neph Exist Access 361 Minor Surgery $4,531.00

430709 INJ NEPH EXIST ACCESS BI 361 Minor Surgery $2,096.00

444440 Exam No Charge 361 Minor Surgery $- 444800 Cath Hmdial 33 Kit 361 Minor Surgery $2,776.00 448306 Cath CV Picc 6F 2LM 61 361 Minor Surgery $1,342.00 463097 Stent Esph Ascm 23/28M 361 Minor Surgery $10,715.00 477036 Cath CV Dual Lumen 361 Minor Surgery $593.00 482894 TERATOLA THRMBL CATH 361 Minor Surgery $3,285.00 483289 CTHDRN APD REG 8F 25 P 361 Minor Surgery $417.00

483292 CTHDRN APD REG 12F 25 361 Minor Surgery $417.00

484138 Ndl Bx Excp 25G Echotp 361 Minor Surgery $1,048.00

486325 CTHDX HDHNTR 4F 035 CI 361 Minor Surgery $229.00

486845 CTHDX INFN 5F C2 65 361 Minor Surgery $229.00

488616 CATH ANGIO 4FR 100CM 361 Minor Surgery $210.00

520013 Minor Surgery 361 Minor Surgery $3,121.00

520190 Laser - Argon 361 Minor Surgery $3,974.00

520191 Laser - Yag 361 Minor Surgery $3,980.00 724800 Gen Code (361) 361 Minor Surgery $- 726683 Stent Peripheral Ini 361 Minor Surgery $25,488.00 727040 Superior (Vanacava) Pr 361 Minor Surgery $698.00 727633 Inj Cysto/Ureth 361 Minor Surgery $921.00 727660 Sc Inj Diskogram L-Spi 361 Minor Surgery $2,186.00 727666 Sc Inj Ptch 361 Minor Surgery $1,141.00

727668 Tract Dilitation-Proc. 361 Minor Surgery $765.00

727669 Sc Est Nephrostomy Tra 361 Minor Surgery $10,341.00

727687 Ivc Filter Placement 361 Minor Surgery $6,600.00

727694 Acculink Carotid Stent 361 Minor Surgery $13,048.00

727737 Ash Split Cath Ii 361 Minor Surgery $2,240.00

727741 Cobra C-1 361 Minor Surgery $129.00

727754 New Blue Max Dilatatio 361 Minor Surgery $1,137.00

727765 Symmetry 361 Minor Surgery $1,876.00

727788 Roadrunner 035 361 Minor Surgery $171.00 727789 Roadrunner Xxxcm 361 Minor Surgery $532.00 727802 Sheaths 6Fr Short 361 Minor Surgery $138.00 727803 Sheath Advanti 035 361 Minor Surgery $56.00 727804 Sheath Ansel 361 Minor Surgery $320.00 727815 Co2 Fluid Bag 361 Minor Surgery $39.00 727816 Co2 Management Syst 361 Minor Surgery $368.00

727828 Bone Biopsy 16Gx15Cm 361 Minor Surgery $42.00

727853 Micro Ling Needle-Wire 361 Minor Surgery $158.00

727854 Needle Blunt 18G 15Cm 361 Minor Surgery $175.00

156 727859 Bentson 035X145 361 Minor Surgery $83.00 727864 Glidewire 018 361 Minor Surgery $1,537.00 727865 Glidewire 035 361 Minor Surgery $253.00 727866 Glidewire Stiff 361 Minor Surgery $266.00

728012 Sc Cath 2Nd Od Low Art 361 Minor Surgery $4,088.00

728452 Facet Block 361 Minor Surgery $2,605.00

729002 Sc Cath Biliary 361 Minor Surgery $4,293.00

729003 Embolization Body 361 Minor Surgery $6,827.00

729004 Cath/Stent Ureter 361 Minor Surgery $9,531.00

729005 Stone Removal-Extracti 361 Minor Surgery $7,208.00

729006 Sc Transcath Retrieve 361 Minor Surgery $7,596.00

729007 Arterial Inf Non-Throm 361 Minor Surgery $1,480.00 729008 Venacaua-Introduction 361 Minor Surgery $3,566.00 729010 Sc Inj Urethrocysto Re 361 Minor Surgery $1,087.00 729012 Inj Venogram 361 Minor Surgery $1,185.00 729013 Sc Inj Sialogram 361 Minor Surgery $873.00 729014 Sc Inj Myelogram 361 Minor Surgery $3,527.00 729015 Sc Inj Arthro Ankle 361 Minor Surgery $1,408.00

729016 Sc Inj Arthro Elbow 361 Minor Surgery $1,894.00

729017 Sc Inj Arthro-Hip-Inj 361 Minor Surgery $1,404.00

729018 Sc Inj Arthro Knee 361 Minor Surgery $1,438.00

729019 Sc Inj Arthro-Shoulder 361 Minor Surgery $2,186.00

729020 Thrombolysis 361 Minor Surgery $2,475.00

729021 Verteral Angio-(Lt) Se 361 Minor Surgery $3,327.00

729022 Vertebral Angio (Rt) S 361 Minor Surgery $3,598.00

729023 Tla W Runoff-Intro Pro 361 Minor Surgery $673.00 729024 Sc Change Bil Drn Cath 361 Minor Surgery $4,797.00 729025 Tube Change - Nephrost 361 Minor Surgery $4,797.00 729028 Sc Pte Venous 361 Minor Surgery $15,304.00 729029 Sc Ndl/Incath Av Shunt 361 Minor Surgery $1,320.00 729030 Angioplasty-(1St Order 361 Minor Surgery $2,864.00 729031 Sc Pte Iliac 361 Minor Surgery $15,304.00

729033 Sc Pta Renal Visc 361 Minor Surgery $15,304.00

729035 Drainage-Renal/Proc 361 Minor Surgery $1,845.00

729036 Sc Pta Tibioperoneal 361 Minor Surgery $15,304.00

729037 Angioplasty-Tibioperon 361 Minor Surgery $3,877.00

729038 Sc Pta Fem/Pop 361 Minor Surgery $15,304.00

729039 Sc Bx Lung Perc 361 Minor Surgery $3,406.00

729040 Sc Bx Bone Superficial 361 Minor Surgery $2,416.00

729041 Sc Bx Bone Deep 361 Minor Surgery $4,414.00

729043 Renal Cyst-Inj/Aspproc 361 Minor Surgery $3,329.00 729045 Sc Cath Bronchogram 361 Minor Surgery $2,308.00 729046 Stone Removal -0 Renal 361 Minor Surgery $20,860.00 729047 Stone Removal-Renal-Ex 361 Minor Surgery $3,280.00 729049 Sc Cholecystostomy Per 361 Minor Surgery $7,208.00 729050 Sc Stent Bil Prn Int/E 361 Minor Surgery $7,208.00 729051 Sc Cath 2Nd Ord Up Art 361 Minor Surgery $3,681.00

729052 Sc Cath 3Rd Ord Up Art 361 Minor Surgery $4,817.00

729053 Renal Venography Selec 361 Minor Surgery $3,350.00

729054 Spleenogram Selective 361 Minor Surgery $873.00

157 729055 Visceral Select. Proc. 361 Minor Surgery $2,624.00 729056 Sc Cath 1St Ord Up Art 361 Minor Surgery $3,350.00 729057 Sc Cath 2Nd Ord Up Art 361 Minor Surgery $4,079.00 729058 Sc Cath Aorta 361 Minor Surgery $3,692.00

729059 Sc Inj Lymphangiogram 361 Minor Surgery $3,271.00

729061 Sc Cath Renal Pelvis 361 Minor Surgery $9,282.00

729062 Portacath Check Intord 361 Minor Surgery $2,441.00

729063 Pulmonary Art- Selecti 361 Minor Surgery $2,799.00

729065 Visceral Hepatic Proc 361 Minor Surgery $3,599.00

729066 Visceral-Gda-Proc. 361 Minor Surgery $3,730.00

729067 Renal Angio-Selective 361 Minor Surgery $3,353.00

729068 Venous Sampling - Proc 361 Minor Surgery $2,798.00 729069 Sc Cath 1St Ord Low Ar 361 Minor Surgery $1,273.00 729070 Sc Ndl Ncath Vein 361 Minor Surgery $752.00 729071 Sc Ndl/Incath Ext Arj 361 Minor Surgery $1,990.00 729082 Sc Interrurt Ivc 361 Minor Surgery $17,152.00 729086 Stnt Peripheral Adl 361 Minor Surgery $25,488.00 729111 Xr Sc Intro Long Gi Tu 361 Minor Surgery $483.00

729128 Sc Change Gi Tube 361 Minor Surgery $1,331.00

729130 Sc Bx Liver 361 Minor Surgery $3,406.00

729131 Sc Bx Renal 361 Minor Surgery $3,406.00

729133 Revision,Reinsertion T 361 Minor Surgery $2,493.00

729134 Sc Drn Abscess Retrope 361 Minor Surgery $5,407.00

729135 Sc Inj Cath Abs/Cyst 361 Minor Surgery $1,260.00

729221 Percutaneous Discectom 361 Minor Surgery $15,246.00

729279 Sc Place Gi Tube 361 Minor Surgery $4,671.00 729282 Or Cholang Post Operat 361 Minor Surgery $567.00 729283 Sc Pta Brachiocepha Li 361 Minor Surgery $14,170.00 729285 Sc Cath 3Rd Ord Low Ar 361 Minor Surgery $4,470.00 729286 Second Order Abd Vesse 361 Minor Surgery $3,788.00 729287 Perc Drainage Peritone 361 Minor Surgery $3,998.00 729288 Sc Pta Aorta 361 Minor Surgery $14,170.00

729291 Perc Placement Central 361 Minor Surgery $6,180.00

729292 Sc Cath Portal Vn 361 Minor Surgery $11,755.00

729293 Shunt Anastomosis Port 361 Minor Surgery $23,232.00

729294 Biliary Bx (Brush) 361 Minor Surgery $1,132.00

729295 Liver Bx (Brush) Addit 361 Minor Surgery $2,216.00

729296 Facet Nerve Neurolysis 361 Minor Surgery $3,275.00

729297 Facet Ea Add Level 361 Minor Surgery $1,019.00

729298 Facet Neurolysis Ea Ad 361 Minor Surgery $492.00

729300 Sc Puncture Lumbar Dx 361 Minor Surgery $1,241.00 729316 Sc Inj Arthro Wrist 361 Minor Surgery $1,059.00 729320 Sc Stent Peripheral In 361 Minor Surgery $27,528.00 729459 Rem Venous Acc Device 361 Minor Surgery $3,974.00 729461 Per Thrombtmy Av Fistu 361 Minor Surgery $16,237.00 729468 Place Gi Tube Phys Sk 361 Minor Surgery $807.00 729506 Per Vertebroplsty Lumb 361 Minor Surgery $14,224.00

748734 Prostate Biopsy Sono-P 361 Minor Surgery $2,489.00

748750 Sc Aspcyst Renal/Pelvi 361 Minor Surgery $2,073.00

748751 Sc Bx Renal 361 Minor Surgery $3,837.00

158 748754 Sc Bx Liver 361 Minor Surgery $2,825.00 748919 Inj Perc Extrem Psean 361 Minor Surgery $1,170.00 749552 Sc Bx Lymph Node Perc 361 Minor Surgery $3,247.00 926247 Needle Asp Slmln 25Ga 361 Minor Surgery $1,030.00

968510 Removal Aicd 361 Minor Surgery $11,535.00

969600 Repair Of Gen Or Leads AICD 361 Minor Surgery $5,857.00

969607 Replacement Of Aicd Leads 361 Minor Surgery $5,857.00

969653 Selective Inj Left 361 Minor Surgery $10,806.00

969654 Selective Inj Right 361 Minor Surgery $10,806.00

70400 Pacu 1St Hr 370 General Anesthesia $3,936.00

70401 Pacu Addl 30 Mins 370 General Anesthesia $1,628.00

72200 Anesthesia 1St Hr 370 General Anesthesia $5,754.00 412915 Anesthesia First 60 Mi 370 General Anesthesia $7,453.00 412916 Anesthesia Addl 30 Min 370 General Anesthesia $4,179.00 432255 Mod Sed MD 1st 15>5 Yrs 370 General Anesthesia $1,608.00 432256 Mod SED MD ESDD 370 General Anesthesia $509.00 439493 Anes Gen/Mac 0-30 370 General Anesthesia $1,971.00 439494 Anes Gen/Mac Ea Add 15 370 General Anesthesia $1,061.00

477113 Anes Gen/Mac 0-30 370 General Anesthesia $3,496.00

479825 Anes Gen/Mac Ea Add 15 370 General Anesthesia $1,964.00

479842 Level 2 - 1St 30 Mins 370 General Anesthesia $11,839.00

479843 Level 2 - Add'L 15 Min 370 General Anesthesia $4,457.00

479844 Level 3-1St 30 Minutes 370 General Anesthesia $12,813.00

479845 Level 3-Addl 15 Minute 370 General Anesthesia $4,623.00

689891 Gen Code (370) 370 General Anesthesia $-

686833 Rh Immune Globulin 1Ml 387 Blood-Other Derivatives $810.00 689320 Gamma Globulin 1 Ml 387 Blood-Other Derivatives $697.00 417939 Antigen Typing Ea 390 General Blood Storage and Processing $146.00 417944 Crossmatch Ahg 390 General Blood Storage and Processing $615.00 417972 Prbc Lr Auto 390 General Blood Storage and Processing $402.00 417973 Prbc Lr Dd 390 General Blood Storage and Processing $470.00 417985 Cryoprecipitate 390 General Blood Storage and Processing $97.00

417987 Prbc Lr 390 General Blood Storage and Processing $354.00

417990 Ffp 390 General Blood Storage and Processing $111.00

417997 Prbc Auto 390 General Blood Storage and Processing $490.00

418005 Plts Ph Lr 390 General Blood Storage and Processing $1,056.00

418007 Plts Ph Lr Irr 390 General Blood Storage and Processing $1,115.00

418010 Prbc Ir 390 General Blood Storage and Processing $362.00

418012 Prbc Lr Irr 390 General Blood Storage and Processing $382.00

686789 Pretreat Serum Absorp 390 General Blood Storage and Processing $241.00

686791 Antibody Elution Ea 390 General Blood Storage and Processing $202.00 686831 Prbc Pedi 390 General Blood Storage and Processing $623.00 686900 Washed Rbc Unit Proc 390 General Blood Storage and Processing $683.00 686901 Leuk Poor Bld Unit Pro 390 General Blood Storage and Processing $401.00 687205 Abo Type 390 General Blood Storage and Processing $223.00 687438 Antibody Titer Ea 390 General Blood Storage and Processing $213.00 687439 Rh Phenotype 390 General Blood Storage and Processing $74.00

687442 Direct Coombs Ahg 390 General Blood Storage and Processing $147.00

687443 Antibody Screen Ea 390 General Blood Storage and Processing $357.00

687450 Whole Blood Unit Proc 390 General Blood Storage and Processing $600.00

159 687452 Platelet Pheresis Proc 390 General Blood Storage and Processing $1,431.00 687455 Packed Rbc Unit Proc 390 General Blood Storage and Processing $411.00 687456 Crossmatch Ahg 390 General Blood Storage and Processing $707.00 687458 Ffp Unit Proc 390 General Blood Storage and Processing $165.00

687459 Cryo Unit Proc 390 General Blood Storage and Processing $143.00

687462 Platelet Conc Unit Pro 390 General Blood Storage and Processing $105.00

687466 Antibody Id Ea 390 General Blood Storage and Processing $729.00

687488 Freeze Thaw Blood Unit 390 General Blood Storage and Processing $621.00

688292 Ffp Thaw Ea Unit 390 General Blood Storage and Processing $183.00

688295 Albumin Inf 5% 50Ml 390 General Blood Storage and Processing $58.00

688296 Albumin Inf 25% 50Ml 390 General Blood Storage and Processing $238.00

688305 Abo Type Cord Blood 390 General Blood Storage and Processing $232.00 688346 Rh Type 390 General Blood Storage and Processing $255.00 689014 Whole Blood Auto Proc 390 General Blood Storage and Processing $802.00 689018 Blood Unit Pooling 390 General Blood Storage and Processing $173.00 689029 Whole Blood Dd Proc 390 General Blood Storage and Processing $978.00 689030 Packed Rbc Auto Proc 390 General Blood Storage and Processing $720.00 689049 Packed Rbc Dd Proc 390 General Blood Storage and Processing $815.00

689132 Crossmatch Imm Spin 390 General Blood Storage and Processing $343.00

689136 Pretreat Serum Inhib E 390 General Blood Storage and Processing $188.00

689143 Direct Coombs Igg 390 General Blood Storage and Processing $147.00

689144 Direct Coombs Comp 390 General Blood Storage and Processing $147.00

689425 Packed Rbc Cmv Neg Pro 390 General Blood Storage and Processing $282.00

689426 Whole Blood Cmv Neg 390 General Blood Storage and Processing $699.00

689427 Ffp Unit Pedi 390 General Blood Storage and Processing $260.00

689428 Packed Rbc Dd Pedi 390 General Blood Storage and Processing $395.00 689430 Antibody Screen Cold 390 General Blood Storage and Processing $363.00 689431 Antibody Screen Prewar 390 General Blood Storage and Processing $363.00 689432 Antibody Id Prewarm Ea 390 General Blood Storage and Processing $697.00 689433 Pretreat Rbc'S Enz Ea 390 General Blood Storage and Processing $188.00 689434 Plasma Cryo Reduced 390 General Blood Storage and Processing $182.00 689435 Prbc Lr Irr 390 General Blood Storage and Processing $559.00

689436 Prbc Lr Irr Dd 390 General Blood Storage and Processing $1,025.00

689437 Plts Aph Lr Irr Dd 390 General Blood Storage and Processing $2,501.00

689438 Plts Aph Lr Irr 390 General Blood Storage and Processing $1,512.00

689439 Prbc Degly 390 General Blood Storage and Processing $779.00

689440 Prbc Ir 390 General Blood Storage and Processing $493.00

689441 Prbc Ir Cmv Neg 390 General Blood Storage and Processing $588.00

689442 Prbc Lr 390 General Blood Storage and Processing $480.00

689443 Plts Aph Lr Dd 390 General Blood Storage and Processing $2,420.00

689890 Antigen Typing Ea 390 General Blood Storage and Processing $184.00 689321 Blood Admin Fee Ea Unit 391 Blood Administration $273.00 689170 Alloderm 399 Other Blood Storage & Processing $2,487.00 423584 Mammo Diag Ddi Bi 401 Diagnostic Mammography $766.00 423585 Mammo Diag Ddi Uni 401 Diagnostic Mammography $766.00 423586 Comp Aid Detect Diag M 401 Diagnostic Mammography $58.00 413198 US Guidance Vasc Access 402 Ultrasound $2,624.00

414063 Us Encephalogram 402 Ultrasound $1,142.00

414064 Us Head And Neck 402 Ultrasound $1,941.00

414065 Us Chst W/Mediastinum 402 Ultrasound $1,593.00

160 414066 Us Breast Uni/Bi 402 Ultrasound $1,484.00 414067 Us Abdomen Complete 402 Ultrasound $2,771.00 414068 Us Abdomen Ltd 402 Ultrasound $2,247.00 414069 Us Retroperitoneal Com 402 Ultrasound $2,330.00

414070 Us Retro Ltd 402 Ultrasound $2,290.00

414072 Us Renal Transplant Rt 402 Ultrasound $659.00

414074 Us Preg 1St Trimtr 402 Ultrasound $426.00

414075 Us Prg 1St Tri Ea Add 402 Ultrasound $418.00

414076 Us Preg After 1St Tri 402 Ultrasound $2,870.00

414077 Us Prg Aft 1St Tri Ad 402 Ultrasound $1,174.00

414080 Us Pregnancy Ltd 402 Ultrasound $707.00

414082 Us Preg Ut Transvagina 402 Ultrasound $1,967.00 414091 Us Transvaginal 402 Ultrasound $1,862.00 414093 Us Pelvic Complete 402 Ultrasound $2,155.00 414094 Us Pelvic Ltd Or Fu 402 Ultrasound $830.00 414095 Us Scrotum And Cnts 402 Ultrasound $2,373.00 414096 Us Transrectal 402 Ultrasound $2,294.00 418226 Tc99M Sestamibi Dx Dos 402 Ultrasound $505.00

418227 Tetrofosmin Dx Per Dos 402 Ultrasound $297.00

418228 Medronate Dx Up To 30M 402 Ultrasound $78.00

418231 Thallous Chloride Mci 402 Ultrasound $129.00

418235 Pertechnetate Dx Per M 402 Ultrasound $15.00

418236 I123 Sod Iod Cap 100 U 402 Ultrasound $129.00

418238 Exametazime Dx To 25 M 402 Ultrasound $4,109.00

418240 I131 Sod Iod Cap Dx Mc 402 Ultrasound $140.00

418241 I131 Sod Iod Sol Tx Mc 402 Ultrasound $51.00 418246 Pentetate Dx To 25 Mci 402 Ultrasound $116.00 418247 Macroagg Albmn Dx 10 M 402 Ultrasound $90.00 418248 Sulfur Colloid Dx 20 M 402 Ultrasound $880.00 418249 Oxyquinoline Dx 0.5 Mc 402 Ultrasound $4,962.00 418254 Ga67 Citrate Dx Per Mc 402 Ultrasound $328.00 418258 Labeled Rbc Dx To 30 M 402 Ultrasound $545.00

418260 Mertiatide Dx To 15 Mc 402 Ultrasound $1,145.00

418265 Pentetreotide Dx 6 Mci 402 Ultrasound $8,868.00

420293 Usg Ndl Placement 402 Ultrasound $2,649.00

420660 Us Follow Up 402 Ultrasound $426.00

421130 Rubidium Rb82 Dx 60 Mc 402 Ultrasound $4,615.00

421132 Fdg Dx Up To 45 Mci 402 Ultrasound $3,776.00

422778 Us Extrem Non Vasc Com 402 Ultrasound $557.00

422779 Us Extrem Non Vasc Ltd 402 Ultrasound $361.00

423126 Sulfur Colloid Dx 20 M 402 Ultrasound $2,435.00 423716 Us Encephalogram 402 Ultrasound $967.00 423717 Us Head And Neck 402 Ultrasound $1,871.00 423718 Us Chst W/Mediastinum 402 Ultrasound $1,350.00 423719 Us Breast Uni/Bi 402 Ultrasound $1,456.00 423720 Us Abdomen Ltd 402 Ultrasound $1,929.00 423721 Us Retroperitoneal Com 402 Ultrasound $2,024.00

423723 Us Preg 1St Trimtr 402 Ultrasound $360.00

423725 Us Preg After 1St Tri 402 Ultrasound $2,425.00

423727 Us Pregnancy Flw Up 402 Ultrasound $702.00

161 423728 Us Preg Ut Transvagina 402 Ultrasound $1,661.00 423729 Us Transvaginal 402 Ultrasound $1,661.00 423730 Us Pelvic Complete 402 Ultrasound $1,925.00 423731 Us Scrotum And Cnts 402 Ultrasound $2,468.00

423732 Us Transrectal 402 Ultrasound $1,940.00

423733 Us Infant Hip Dynam 402 Ultrasound $2,403.00

423741 Us Fetal Biophys Prof 402 Ultrasound $2,425.00

423742 Us Retro Ltd 402 Ultrasound $2,024.00

423743 Us Abdomen Complete 402 Ultrasound $2,626.00

423746 Us Pelvic Ltd Or Fu 402 Ultrasound $702.00

423747 Us Extrem Non Vasc Com 402 Ultrasound $552.00

423748 Us Extrem Non Vasc Ltd 402 Ultrasound $359.00 423962 Ammonia N13 Dx To 40 M 402 Ultrasound $3,820.00 742469 Gen Code 402 Ultrasound $- 747072 Us Bile Ducts 402 Ultrasound $2,249.00 747073 Us Ascites 402 Ultrasound $2,872.00 747074 Usg Amniocentesis 402 Ultrasound $1,015.00 747140 Usg Cyst Asp Renal 402 Ultrasound $1,658.00

747141 Us Scrotum And Content 402 Ultrasound $2,581.00

747142 Us Low Extrem Non Vasc 402 Ultrasound $1,978.00

748603 Us Transrectal Prostat 402 Ultrasound $2,529.00

748604 Usg Biopsy Prostate 402 Ultrasound $2,791.00

748713 Us Infant Hipdynam Bi 402 Ultrasound $3,141.00

748714 Us Transvaginal 402 Ultrasound $2,167.00

748715 Us Chest W/Mediastinum 402 Ultrasound $1,758.00

748716 Neo-Natal Head Sono 402 Ultrasound $1,259.00 748718 Us Up Extrem Non Vasc 402 Ultrasound $881.00 748720 Pregnancy Follow-Up 402 Ultrasound $921.00 748724 Usg Cyst Asp Breast 402 Ultrasound $1,658.00 748753 Usg Ndl Placement 402 Ultrasound $3,123.00 748755 Usg Paracentesis 402 Ultrasound $2,366.00 748782 Us Liver 402 Ultrasound $2,249.00

748783 Us Aorta 402 Ultrasound $2,639.00

748785 Us Gallbladder 402 Ultrasound $2,249.00

748786 Us Renal Bi 402 Ultrasound $2,366.00

748787 Us Pancreas 402 Ultrasound $2,249.00

748788 Us Spleen 402 Ultrasound $2,249.00

748789 Us Thyroid 402 Ultrasound $2,440.00

748794 Us Pregnancy Comp 402 Ultrasound $3,161.00

748798 Us Pelv Non Ob Comp 402 Ultrasound $2,513.00

748800 Us Fet Bio Ph Prof W/I 402 Ultrasound $3,164.00 748802 Us Abdomen Complete 402 Ultrasound $3,424.00 748803 Us Renal Uni 402 Ultrasound $1,842.00 748804 Us Fetal Heart Beat 402 Ultrasound $918.00 748805 Us Fetal Position 402 Ultrasound $918.00 748806 Us Urinary Bladder 402 Ultrasound $2,241.00 748807 Usg Cyst Asp 402 Ultrasound $1,683.00

748808 Usg Biopsy Breast 402 Ultrasound $2,791.00

748809 Usg Biopsy Renal 402 Ultrasound $2,791.00

748812 Us Retro Ltd 402 Ultrasound $2,639.00

162 748855 Us Breast Uni Lt 402 Ultrasound $1,562.00 748901 Usg Thoracentesis 402 Ultrasound $2,366.00 748903 Us Breast Uni 402 Ultrasound $1,898.00 748904 Us Breast Bi 402 Ultrasound $2,354.00

749435 Abcess Drainage W/Sono 402 Ultrasound $1,597.00

749501 Sono - Limited729278 402 Ultrasound $2,516.00

423583 Mammo Scr Ddi Bi 403 Screening Mammography $595.00

193008 Pet Brain Metabolic Ev 404 Positron Emission Tomography $10,759.00

193009 Pet Myocardial Met Ev 404 Positron Emission Tomography $10,566.00

193021 Pet Imaging Prev Singl 404 Positron Emission Tomography $7,074.00

193022 Pet Imaging Prev Mult 404 Positron Emission Tomography $7,074.00

193023 Pet Myo F/W Rst 78464 404 Positron Emission Tomography $7,074.00 193024 Pet Myo F/W Rst 78646 404 Positron Emission Tomography $7,074.00 193025 Pet Myo F/W Str 78465 404 Positron Emission Tomography $7,074.00 193026 Perfusion Pet Post Str 404 Positron Emission Tomography $7,074.00 193027 Pet Myo F/W Co Ang S 404 Positron Emission Tomography $7,074.00 193028 Pet Myo F/W Co Ang M 404 Positron Emission Tomography $7,074.00 193029 Pet Myo F/W 78460 Sgl 404 Positron Emission Tomography $7,074.00

193030 Pet Myo F/W 78460 Mul 404 Positron Emission Tomography $7,074.00

193031 Pet Myo F/W 93350 Sgl 404 Positron Emission Tomography $7,074.00

193032 Pet Myo F/W 93350 Mul 404 Positron Emission Tomography $7,074.00

193033 Pet Myo F/W Nuc Vent S 404 Positron Emission Tomography $7,074.00

193034 Pet Myo F/W Nuc Vent M 404 Positron Emission Tomography $7,074.00

193035 Pet Myo F/W 93000 Sgl 404 Positron Emission Tomography $7,074.00

193036 Pet Myo F/W 93000 Mul 404 Positron Emission Tomography $7,074.00

193037 Pet Myo F/W 93015 Sgl 404 Positron Emission Tomography $7,074.00 193038 Pet Myo F/W 93015 Mul 404 Positron Emission Tomography $7,074.00 193050 Pet Myo F/W 78460 Mul 404 Positron Emission Tomography $7,074.00 193054 Pet/Ct Tumor Sk Bs Mid 404 Positron Emission Tomography $9,697.00 193081 Macroaggregated Albumi 404 Positron Emission Tomography $27.00 193083 Tc 99M Exametazime 404 Positron Emission Tomography $4,446.00 193086 Locm 300-399 Mg 404 Positron Emission Tomography $2,180.00

420333 Pet Myocardial Met Ev 404 Positron Emission Tomography $9,331.00

420334 Pet Myocard Sgl R/S 404 Positron Emission Tomography $6,243.00

420335 Pet Myocard Multi R/S 404 Positron Emission Tomography $9,331.00

420336 Pet Brain Metabolic Su 404 Positron Emission Tomography $8,562.00

420337 Pet Brain Metabolic In 404 Positron Emission Tomography $8,562.00

420338 Pet/Ct Tumr Ltd Area S 404 Positron Emission Tomography $8,562.00

420339 Pet/Ct Tumr Ltd Area I 404 Positron Emission Tomography $8,562.00

420340 Pet/Ct Tm Sk Bs Midth 404 Positron Emission Tomography $8,562.00

420341 Pet/Ct Tm Sk Bs Midth 404 Positron Emission Tomography $8,562.00 420342 Pet/Ct Tumr Whol Bod S 404 Positron Emission Tomography $8,562.00 420343 Pet/Ct Tumr Whol Bod I 404 Positron Emission Tomography $8,562.00 423130 Pet Brain Perfusion Ev 404 Positron Emission Tomography $5,925.00 417824 Vent Mgmt Initial Ip/O 410 General Respiratory Services $2,068.00 417853 Subsq IPV/Flutter 410 General Respiratory Services $132.00 420183 Inh Tx Ac Awy Obst 410 General Respiratory Services $137.00

420184 Initial IPV/Flutter 410 General Respiratory Services $137.00

420244 Bipap/Cpap Vent Int&Mg 410 General Respiratory Services $509.00

425515 Pulm Vent & Perf Imag 410 General Respiratory Services $1,862.00

163 667901 Vent Mgmt Mech Vent Comp 410 General Respiratory Services $2,032.00 667910 Resp Neb Tx 410 General Respiratory Services $107.00 667911 O2, Nasal Cannula 410 General Respiratory Services $590.00 667964 Pulm Manipu Init Chest Phys 410 General Respiratory Services $136.00

668203 Pulm Manipulation Subs 410 General Respiratory Services $116.00

668204 PEP/IPV TH S 410 General Respiratory Services $87.00

668206 Pulm Manipulation Subs 410 General Respiratory Services $132.00

668268 Aer Or Vap Inh Subsq 410 General Respiratory Services $87.00

668270 Pulm Manipulation Subs 410 General Respiratory Services $128.00

669106 Vent Mgmt Subsequent D 410 General Respiratory Services $1,649.00

669114 Oxygen-Daily 410 General Respiratory Services $628.00

669118 O2,Aero/Trach/T-Piece 410 General Respiratory Services $910.00 669120 02, Mask/Non/Partial/V 410 General Respiratory Services $714.00 669754 RT Assess Sputum Production 410 General Respiratory Services $49.00 669755 Clinical Update 410 General Respiratory Services $97.00 669756 Cough Assist Initial 410 General Respiratory Services $126.00 669757 Cough Assist Subsequent 410 General Respiratory Services $107.00 669758 DPS Intake Assessment 410 General Respiratory Services $-

669761 Perform Suctioning 410 General Respiratory Services $49.00

669762 Respiratory Basic Assessment 410 General Respiratory Services $49.00

669763 Respiratory Evaluation 410 General Respiratory Services $97.00

669764 Respiratory Teaching Record 410 General Respiratory Services $97.00

669765 Tracheostomy Assessment 410 General Respiratory Services $97.00

667900 PEP/IPV TH I 412 Inhalation Services $103.00

669766 Metaneb 412 Inhalation Services $231.00

658294 Bedside Spiro Pre/Post Bronch 419 Other Respiratory Services $1,718.00 669759 DPS Wean/Clinical Read Record 419 Other Respiratory Services $465.00 669760 End Todal CO2 Checks/Non Vent 419 Other Respiratory Services $297.00 146887 Pt Therapy Activity 420 General Physical Therapy $140.00 146890 Pt Self Care/Home Mgmt 420 General Physical Therapy $131.00 147050 Neuromuscular Reeducation 420 General Physical Therapy $120.00 147533 Traction 420 General Physical Therapy $72.00

147538 Pt Therapeutic Exercise 420 General Physical Therapy $138.00

147690 PT Hot/Cold Therapy 420 General Physical Therapy $34.00

147691 Hot/Cold (Medicare Only) 420 General Physical Therapy $-

147710 Elec Stim-Unattended 420 General Physical Therapy $68.00

147792 Whirlpool/Fluidotherapy 420 General Physical Therapy $70.00

147801 Community/Work Re Integration 420 General Physical Therapy $104.00

147819 Paraffin 420 General Physical Therapy $30.00

147853 Pt Gait Training 420 General Physical Therapy $99.00

149000 Work Reintergration 420 General Physical Therapy $104.00 149091 Iontophoresis 420 General Physical Therapy $63.00 149126 Neuromuscualr Reeducation 420 General Physical Therapy $120.00 149134 PT Community/Work Re-Inte 420 General Physical Therapy $104.00 149335 Physical Recondition 1st Hr. 420 General Physical Therapy $243.00 149336 Physical Recondition Addl 30 m 420 General Physical Therapy $117.00 149337 Physical Recon Assess 1st Hr. 420 General Physical Therapy $243.00

149338 Physical Recond Asses Addl 30M 420 General Physical Therapy $117.00

149353 Elec Stim Manual 420 General Physical Therapy $75.00

149354 Work Hard 1st-2Hr 420 General Physical Therapy $495.00

164 149355 Work Hard Addl Hr. 420 General Physical Therapy $234.00 149723 Contrast Bath 420 General Physical Therapy $57.00 149724 Ultrasound 420 General Physical Therapy $61.00 149728 Workers Comp Test & Measure 420 General Physical Therapy $216.00

149760 Orthotic/Prosthetic Mgt PT 420 General Physical Therapy $216.00

149801 Manual Therapy 420 General Physical Therapy $129.00

149909 Electrical Stimulation 420 General Physical Therapy $68.00

149925 Aquatic Therapy 420 General Physical Therapy $169.00

29799GP Pt Application Splint 420 General Physical Therapy $57.00

422918 Us Extrem Non Vasc Ltd 420 General Physical Therapy $361.00

426632 PT Mobility Curr Stat 60 420 General Physical Therapy $1.00

426638 PT Mobility Goal Stat 40 420 General Physical Therapy $1.00 426646 PT Mobility DC Stat 60 420 General Physical Therapy $1.00 750000 Cyberdyne HAL 420 General Physical Therapy $400.00

750000GP Cyberdyne HAL 420 General Physical Therapy $400.00 90901GP Biofeedback Therapy 420 General Physical Therapy $147.00 90911GP Biofeedback Perineal 420 General Physical Therapy $170.00 95992GP Pt Canalith Repositioning 420 General Physical Therapy $92.00 97010GP Hot/Cold Therapy 420 General Physical Therapy $34.00

97010GPM Hot/Cold (Medicare Only) 420 General Physical Therapy $-

97012GP Traction 420 General Physical Therapy $72.00

97014GP Elec Stim - Unattended 420 General Physical Therapy $68.00

97018GP Paraffin 420 General Physical Therapy $41.00

9701MGP Hot/Cold (Medicare Only) 420 General Physical Therapy $-

9701MGPM Hot/Cold (Medicare Only) 420 General Physical Therapy $-

97022GP Whirlpool/Fluidotherapy 420 General Physical Therapy $86.00

97032GP Elec Stim-Manual 420 General Physical Therapy $75.00 97033GP Iontophoresis 420 General Physical Therapy $120.00 97034GP Contrast Bath PT 420 General Physical Therapy $25.00 97035GP Ultrasound 420 General Physical Therapy $61.00

97110GP Therapeutic Exercise 420 General Physical Therapy $138.00 97112GP Neuromuscular Reeducation 420 General Physical Therapy $144.00 97113GP Aquatic Therapy 420 General Physical Therapy $169.00

97116GP Gait Training 420 General Physical Therapy $122.00

97124GP Massage 420 General Physical Therapy $129.00

97140GP Manual Therapy 420 General Physical Therapy $129.00

97530GP Therapeutic Activity 420 General Physical Therapy $140.00

97533GP Sensory Integrative Treat 420 General Physical Therapy $104.00

97535GP Self Care/Home Mgmt 420 General Physical Therapy $147.00

97537GP Community/Work Re-Integr 420 General Physical Therapy $104.00

97542GP Wheelchair Management 420 General Physical Therapy $113.00 97545GP Pt Work Hard 1St-2Hr 420 General Physical Therapy $495.00 97546GP Pt Work Hard Add'L Hr 420 General Physical Therapy $234.00 97597GP Debridement Sel Less Or = 20 C 420 General Physical Therapy $270.00 97598GP Debridement Sel Greater 20 Cm 420 General Physical Therapy $342.00 97752GP W/C Tests & Measures 420 General Physical Therapy $216.00 97755GP PT Assistant Tech Assessment 420 General Physical Therapy $115.00

97760GP Orthotic Mgmt Training 420 General Physical Therapy $162.00

97761GP Prosthetic Training 420 General Physical Therapy $129.00

97762GP Checkout Orth/Prosthetic 420 General Physical Therapy $115.00

165 97763GP Orthotic/Prosthetic Management 420 General Physical Therapy $216.00 97777 Client Billing 420 General Physical Therapy $1.00

97850GP Physical Recond Assess 1St Hr 420 General Physical Therapy $243.00 97851GP Physical Recond Assess Ad'L 30 420 General Physical Therapy $117.00

97852GP Physical Recondition 1St Hr 420 General Physical Therapy $243.00

97853GP Physical Recondition Add'L 30 420 General Physical Therapy $117.00

99070PT Nh Misc Medical Pt 420 General Physical Therapy $120.00

99368GP Prof Consult Face,Fam,PSP 420 General Physical Therapy $12.50

99368PGP Prof Consult Phone 420 General Physical Therapy $6.25

99999GP Virtual Vera System 420 General Physical Therapy $-

A0160GP Travel Per Minute 420 General Physical Therapy $0.45

G0283GP Elec Stim Unattended 420 General Physical Therapy $68.00

GENCODE Gen Code 420 General Physical Therapy $- NESFGP Travel Natural Enviroment 420 General Physical Therapy $10.00 PT2810 *Aquatic Physical Therapy 420 General Physical Therapy $94.00 PT2830 *Aquatic Therapy Eval 420 General Physical Therapy $170.00 PT2857 *Individual Sup Exer. 15 Min 420 General Physical Therapy $72.00 PT2858 Individual Exercise Program 420 General Physical Therapy $- PT6740 Case Conference 15 Min 420 General Physical Therapy $-

PT6885 Rep Pt Evaluation 420 General Physical Therapy $108.00

PT6887 Therapeutic Activity 15 Min 420 General Physical Therapy $83.00

PT6950 Orthotic Fitting & Trng 15 min 420 General Physical Therapy $86.00

PT7708 Ultrasound 15 Min 420 General Physical Therapy $97.00

PT7710 Elec Stim-Unattended 420 General Physical Therapy $92.00

PT7807 *Tilt/Standing Table 15 Min 420 General Physical Therapy $80.00

PT7808 Ui Pt Eval 420 General Physical Therapy $187.00

PT7812 UI Therapeutic Activity 420 General Physical Therapy $82.00 PT7813 Ui Pelvic Floor Biofeedback 420 General Physical Therapy $148.00 PT9126 Neuromuscular Re-Ed 15 Min 420 General Physical Therapy $83.00 PT9132 Community Reintegration 15Min 420 General Physical Therapy $99.00

PT9134 Patient/Caregiver TR 15 Min 420 General Physical Therapy $84.00 PT9199 Cancellation 420 General Physical Therapy $- PT9201 Cancellation-Refused 420 General Physical Therapy $-

PT9203 Cancellation-Md 420 General Physical Therapy $-

PT9206 Cancellation-Nursing Care 420 General Physical Therapy $-

PT9332 Therapeutic Exercise 15 Min 420 General Physical Therapy $80.00

PT9335 Gait Training 15 Min 420 General Physical Therapy $92.00

PT9346 *Equip Order 420 General Physical Therapy $30.00

PT9352 Caregiver Instruction 420 General Physical Therapy $97.00

PT9371 Gen Code 420 General Physical Therapy $-

PT9372 Orthotics Fitting & Training 420 General Physical Therapy $86.00 PT9373 Casting 420 General Physical Therapy $104.00 PT9374 Wheelchair Mgmt/Propulsion 15 420 General Physical Therapy $75.00 PT9375 Rehab Conf Revisit 420 General Physical Therapy $173.00 PT9625 *Hot/Cold Therapy 420 General Physical Therapy $50.00 PT9628 *Tens Treatment 420 General Physical Therapy $86.00 PT9637 Wound Debridement 420 General Physical Therapy $96.00

PT9645 Orthotic Prosthetic Mgmt 420 General Physical Therapy $96.00

PTX9200 Cancellation-Sick 420 General Physical Therapy $-

PTX9204 Cancellation-Testing 420 General Physical Therapy $-

166 PTX9205 Cancellation-Unable To Parti 420 General Physical Therapy $- T1013GP Sign Lang/Oral Inter Svcs Pt 420 General Physical Therapy $100.00 T1027GP Eis Intervention Prof 420 General Physical Therapy $12.50 T2024GP Prof Consult Face to Face 420 General Physical Therapy $12.50

T2024PGP Professional Consult Phone 420 General Physical Therapy $6.25

VSCHEGP Hb Pt Virtual Eval 420 General Physical Therapy $275.00

VSCHTGP Hb Pt Virtual Treatment 420 General Physical Therapy $30.00

VSCPCGP 1 Hour Conference Call 420 General Physical Therapy $30.00

VSNSEVGP No Show/Cx Eval 420 General Physical Therapy $137.50

VSNSTXGP No Show/Cxl Treatment 420 General Physical Therapy $60.00

VSNSTXP No Show/Cxl Treatment 420 General Physical Therapy $60.00

WC9139 Pt Re-Evaluation 420 General Physical Therapy $92.00

WC9141 Pt Neuromuscular Re-Ed 15 Min 420 General Physical Therapy $70.00 WC9143 *Self Care Home Mgmt Tr 15 Min 420 General Physical Therapy $71.00 WC9145 Pt Community/Work Re-Integr 15 420 General Physical Therapy $85.00 WC9147 Pt Phy Perf Test/Measure 15Min 420 General Physical Therapy $72.00 WC9149 Pt Orthotic Mgmt Training 15Mi 420 General Physical Therapy $73.00 WC9151 Pt Check-Out Orth/Prosthe 15Mi 420 General Physical Therapy $68.00 WC9153 Pt Assist Tech Assessment 15Mi 420 General Physical Therapy $78.00

149727 Self Pay BBMPA PT Treatment 421 Physical Therapy Visit Charge $169.00

149905 Self Pay-Bbm Pt Treatment 421 Physical Therapy Visit Charge $169.00

410892 Ther Activ Dir 15 min PT 421 Physical Therapy Visit Charge $190.00

418092 Ther Act Dir 15 Min PT 421 Physical Therapy Visit Charge $190.00

146016 PT Group 423 Physical Therapy Group Rate $79.00

147573 5 Day Eval (Per Hour) 423 Physical Therapy Group Rate $183.00

PT2859 Group Therapy Procedure 423 Physical Therapy Group Rate $78.00

PT9068 Group Therapy 423 Physical Therapy Group Rate $86.00 146894 Pt Eval Low Compex 20 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00 146895 Pt Eval Mod Complex 30 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00 146896 Pt Eval High Complex 45 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00 146897 Pt Re-Eval Est Plan Care 424 Physical Therapy Evaluation or Re-evaluation $189.00 146898 Pt Eval 424 Physical Therapy Evaluation or Re-evaluation $360.00

147556 FCE Physical Perf Test/Measure 424 Physical Therapy Evaluation or Re-evaluation $135.00

149890 Pt Physical Perf Test/Measures 424 Physical Therapy Evaluation or Re-evaluation $135.00

432002 Eval PT High Complex 424 Physical Therapy Evaluation or Re-evaluation $614.00

829376 Misc Doc 424 Physical Therapy Evaluation or Re-evaluation $-

97001GP Pt Evaluation 424 Physical Therapy Evaluation or Re-evaluation $360.00

97002GP Pt Re-Eval 424 Physical Therapy Evaluation or Re-evaluation $189.00

97161GP Pt Eval Low Complex 20 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00

97162GP Pt Eval Mod Complex 30 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00

97163GP Pt Eval High Comlex 45 Min 424 Physical Therapy Evaluation or Re-evaluation $360.00 97164GP Pt Re-Eval Est Plan Care 424 Physical Therapy Evaluation or Re-evaluation $189.00 97750GP Physical Perf Test/Measure 424 Physical Therapy Evaluation or Re-evaluation $135.00 9775GP FCE PERFORMANCE TEST/MEASURES 424 Physical Therapy Evaluation or Re-evaluation $135.00 PT9367 Pt Eval 424 Physical Therapy Evaluation or Re-evaluation $187.00 PT9376 MISC DOC 424 Physical Therapy Evaluation or Re-evaluation $- PT9639 PT Eval Low Complex 20 Min 424 Physical Therapy Evaluation or Re-evaluation $176.00

PT9640 PT Eval Mod Complex 30 min 424 Physical Therapy Evaluation or Re-evaluation $176.00

PT9641 PT Eval High Complex 45 Min 424 Physical Therapy Evaluation or Re-evaluation $176.00

PT9642 PT Re-Eval est plan care 424 Physical Therapy Evaluation or Re-evaluation $93.00

167 PT9643 Physical Perf test/Measure 424 Physical Therapy Evaluation or Re-evaluation $60.00 SJCSBEGP St Johns County School Eval Pt 424 Physical Therapy Evaluation or Re-evaluation $55.01 SJCSBTGP St John County School Tx Pt 424 Physical Therapy Evaluation or Re-evaluation $17.86 WC9137 Pt Evaluation 424 Physical Therapy Evaluation or Re-evaluation $160.00

146730 Cognitive Rehab 430 General Occupational Therapy $156.00

146891 OT Self care/Home Mgmt 430 General Occupational Therapy $131.00

146893 OT Cognitive Rehab 430 General Occupational Therapy $156.00

147026 Driver Evaluation 430 General Occupational Therapy $57.00

147027 Driver Training 430 General Occupational Therapy $57.00

147108 OT Re-Eval Est Plan Care 430 General Occupational Therapy $214.00

147558 OT Sensory Integrative 430 General Occupational Therapy $104.00

147559 OT Manual Therapy 430 General Occupational Therapy $129.00 147561 OT Hot/Cold Therapy 430 General Occupational Therapy $34.00 149133 OT Community/Work Re-Inte 430 General Occupational Therapy $104.00 149729 OT Neuromuscular Reeducation 430 General Occupational Therapy $120.00 149755 Cognitive Rehab, Untimed OT 430 General Occupational Therapy $621.00 149756 Orthotic/Prosthetic Mgt OT 430 General Occupational Therapy $216.00 149757 Cognitive Rehab Mcr,Timed OT 430 General Occupational Therapy $156.00

149887 OT Therapeutic Activity 430 General Occupational Therapy $140.00

149888 OT Therapeutic Exercise 430 General Occupational Therapy $138.00

29799GO Ot Application Splint 430 General Occupational Therapy $57.00

29799HM Ota Application Splint 430 General Occupational Therapy $57.00

421165 Ther Activ Dir 15 min OT 430 General Occupational Therapy $190.00

819376 Misc Doc 430 General Occupational Therapy $-

899376 Misc Doc 430 General Occupational Therapy $-

95992GO Canalith Repositioning 430 General Occupational Therapy $92.00

97010GO Hot/Cold Therapy 430 General Occupational Therapy $34.00 97010GOM Hot/Cold (Medicare Only) 430 General Occupational Therapy $- 97014GO Elec Stim - Unattended 430 General Occupational Therapy $68.00 97018GO Paraffin 430 General Occupational Therapy $41.00

9701MGO Hot/Cold Therapy Medicare 430 General Occupational Therapy $- 9701MGOM Hot/Cold (Medicare Only) 430 General Occupational Therapy $- 97022GO Whirlpool/Fluidotherapy 430 General Occupational Therapy $86.00

97032GO Elec Stim-Manual 430 General Occupational Therapy $75.00

97033GO Iontophoresis 430 General Occupational Therapy $120.00

97034GO Contrast Bath OT 430 General Occupational Therapy $25.00

97035GO Ultrasound 430 General Occupational Therapy $61.00

97110GO Therapeutic Exercise 430 General Occupational Therapy $138.00

97112GO Neuromuscular Reeducation 430 General Occupational Therapy $144.00

97113GO Aquatic Therapy 430 General Occupational Therapy $169.00

97124GO Massage 430 General Occupational Therapy $129.00 97127GO Cognitive Rehab, Untimed 430 General Occupational Therapy $621.00 97140GO Manual Therapy 430 General Occupational Therapy $129.00 97168GO Ot Re-Eval Est Plan Care 430 General Occupational Therapy $214.00 97530GO Therapeutic Activity 430 General Occupational Therapy $140.00 97532GO Cognitive Rehab 430 General Occupational Therapy $156.00 97533GO Sensory Integrative Treat 430 General Occupational Therapy $104.00

97535GO Self Care/Home Mgmt 430 General Occupational Therapy $147.00

97535GOD Level I Driving 430 General Occupational Therapy $129.00

97537GO Community/Work Re-Integr 430 General Occupational Therapy $104.00

168 9753HMGO Ota Treatment 430 General Occupational Therapy $140.00 97542GO Wheelchair Management 430 General Occupational Therapy $113.00 97545GO Ot Work Hard 1St-2Hr 430 General Occupational Therapy $495.00 97546GO Ot Work Hard Add'L Hr 430 General Occupational Therapy $234.00

97597GO Debridement Sel Less Or = 20 C 430 General Occupational Therapy $270.00

97598GO Debridement Sel Greater 20 Cm 430 General Occupational Therapy $342.00

97752GO W/C Tests & Measures 430 General Occupational Therapy $216.00

97755GO Ot Assistive Tech Assessment 430 General Occupational Therapy $167.00

97760GO Orthotic Mgmt Training 430 General Occupational Therapy $162.00

97761GO Prosthetic Training 430 General Occupational Therapy $129.00

97762GO Checkout Orth/Prosthetic 430 General Occupational Therapy $113.00

97763GO Orthotic/Prosthetic Management 430 General Occupational Therapy $216.00

99070OT Misc Medical Ot 430 General Occupational Therapy $120.00 99368GO "Prof Consul Face,Fam,Psp" 430 General Occupational Therapy $12.50 99368PGO Prof Consul Phone 430 General Occupational Therapy $6.25 A0160GO Travel Per Minute 430 General Occupational Therapy $0.51 G0283GO Elec Stim Unattended 430 General Occupational Therapy $68.00 G0515GO Cognitive Rehab Medicare,Timed 430 General Occupational Therapy $156.00 OT2860 Aquatic Ot 15 Min 430 General Occupational Therapy $104.00

OT6740 Case Conference 15 Min 430 General Occupational Therapy $-

OT6885 Rep Ot Evaluation 430 General Occupational Therapy $120.00

OT6887 Therapeutic Activity 15 Min 430 General Occupational Therapy $82.00

OT6888 Therapeutic Exercise 15 Min 430 General Occupational Therapy $80.00

OT6893 Perceptual/Cognitive Tr 15 Mi 430 General Occupational Therapy $82.00

OT6950 Orthotics Fitting & Trng 15Mi 430 General Occupational Therapy $86.00

OT6951 Prosthetic Training 15 Min 430 General Occupational Therapy $92.00

OT7710 Electrical Stimulation 15Min 430 General Occupational Therapy $97.00 OT7808 Ui Ot Eval 430 General Occupational Therapy $180.00 OT7813 Ui Pelvic Floor Biofeedback 430 General Occupational Therapy $148.00 OT8952 Group Skills Act 1/4 Hr 430 General Occupational Therapy $37.00

OT8953 Indiv Skills Act 1/4 Hr 430 General Occupational Therapy $50.00 OT8954 Level 1 Grp Reentry 1/4 Hr 430 General Occupational Therapy $19.00 OT8956 Level 1 Ind Reentry 1/4 Hr 430 General Occupational Therapy $20.00

OT9126 Neuromuscular Re-Ed 15 Min 430 General Occupational Therapy $83.00

OT9127 Ultrasound 15 Min 430 General Occupational Therapy $97.00

OT9130 Fluidotherapy 430 General Occupational Therapy $116.00

OT9132 Community Reintegration 15 Mi 430 General Occupational Therapy $99.00

OT9134 Self Care Home Mgmt Tr 15 Min 430 General Occupational Therapy $84.00

OT9135 Wc Mgmt Propulsion Tr 15 Min 430 General Occupational Therapy $75.00

OT9156 Gen Code (430) 430 General Occupational Therapy $-

OT9199 Cancellation 430 General Occupational Therapy $- OT9201 Cancellation-Refused 430 General Occupational Therapy $- OT9202 Cancellation - Feed Group 430 General Occupational Therapy $- OT9203 Cancellation-Md 430 General Occupational Therapy $- OT9206 Cancellation-Nursing Care 430 General Occupational Therapy $- OT9352 Caregiver Instruction 430 General Occupational Therapy $97.00 OT9376 MISC DOC 430 General Occupational Therapy $-

OT9644 Untimed Cognitive Rehab 430 General Occupational Therapy $228.00

OT9645 Orthotic-Prosthetic Mgmt 430 General Occupational Therapy $96.00

OT9899 Cancellation 430 General Occupational Therapy $-

169 OTX9200 Cancellation -Sick 430 General Occupational Therapy $- OTX9204 Cancellation - Testing 430 General Occupational Therapy $- OTX9205 Cancellation-Unable Partcip 430 General Occupational Therapy $- REC9201 Cancellation-Refused 430 General Occupational Therapy $-

REC9203 Cancellation-MD 430 General Occupational Therapy $-

REC9206 Cancellation-Nursing Care 430 General Occupational Therapy $-

REC9899 Cancellation 430 General Occupational Therapy $-

RECX9200 Cancellation-Sick 430 General Occupational Therapy $-

RECX9205 Cancellation Unable participat 430 General Occupational Therapy $-

RT8952 GROUP SKILLS ACT 1/4 HR 430 General Occupational Therapy $33.00

RT8953 INDIV SKILLS ACT 1/4 430 General Occupational Therapy $45.00

RT8957 Music Therapy Ind 430 General Occupational Therapy $55.00

RT8958 Music Therapy Group 430 General Occupational Therapy $41.00 T1013GO Sign Lang/Oral Inter Svcs Ot 430 General Occupational Therapy $100.00 T1027GO Eis Intervention Prof 430 General Occupational Therapy $12.50 T2024GO Prof Consul Face To Face 430 General Occupational Therapy $12.50 T2024PGO Prof Consul Phone 430 General Occupational Therapy $6.25 VSCHEGO Hb Ot Virtual Eval 430 General Occupational Therapy $275.00 VSCHTGO Hb Ot Virtual Treament 430 General Occupational Therapy $30.00

VSCPCGO 1 Hour Conference Call 430 General Occupational Therapy $30.00

VSNSEVGO No Show/Cxl Eval 430 General Occupational Therapy $137.50

VSNSEVO No Show/Cxl Eval 430 General Occupational Therapy $137.50

VSNSTXGO No Show/Cxl Treatment 430 General Occupational Therapy $60.00

VSNSTXO No Show/Cxl Treatment 430 General Occupational Therapy $60.00

WC6887 Pt Therapeutic Activity 15 Min 430 General Occupational Therapy $69.00

WC6888 Ot Therapeutic Activity 15 Min 430 General Occupational Therapy $69.00

WC9135 Pt Wc Mgmt Propulsion Tr 15Min 430 General Occupational Therapy $63.00 WC9136 Ot Wc Mgmt Propulsion 15 Min 430 General Occupational Therapy $63.00 WC9142 Ot Neuromuscular Re-Ed 15 Min 430 General Occupational Therapy $70.00 WC9144 *Self Care Home Mgmt Tr 15 Min 430 General Occupational Therapy $71.00

WC9146 Ot Community/Work Re-Integr 15 430 General Occupational Therapy $85.00 WC9150 Ot Orthotic Mgmt Training 15Mi 430 General Occupational Therapy $73.00 WC9152 Ot Check-Out Orth/Prosthe 15Mi 430 General Occupational Therapy $68.00

WC9154 Ot Assist Tech Assessment 15Mi 430 General Occupational Therapy $78.00

WC9156 Gen Code (430) 430 General Occupational Therapy $-

WC9199 Cancellation 430 General Occupational Therapy $-

WC9200 Cancellation - Sick 430 General Occupational Therapy $-

WC9201 Cancellation - Refused 430 General Occupational Therapy $-

WC9202 Cancellation - Feed Group 430 General Occupational Therapy $-

WC9203 Cancellation - Md 430 General Occupational Therapy $-

WC9204 Cancellation - Testing 430 General Occupational Therapy $- WC9205 Cancellation - Unable Particip 430 General Occupational Therapy $- WC9206 Cancellation - Nursing Care 430 General Occupational Therapy $- WC9376 Misc Doc 430 General Occupational Therapy $- 149906 Self Pay-Bbm Ot Treatment 431 Occupational Therapy Visit Charge $169.00 149907 SelfPay BBM OT Treatment 431 Occupational Therapy Visit Charge $169.00 749447 I123 Sodium Iodide Cap 431 Occupational Therapy Visit Charge $167.00

147808 Visual Perceptual Tx Grp 433 Occupational Therapy Group Rate $79.00

149889 OT Group 433 Occupational Therapy Group Rate $169.00

OT6926 Group Ex/Activity 433 Occupational Therapy Group Rate $86.00

170 147105 OT Eval Low Complex 30 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00 147106 OT Eval Mod Complex 45 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00 147107 OT Eval High Complex 60 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00 149730 OT Physical Perf Test/Measure 434 Occupational Therapy Evaluation or Re-evaluation $135.00

432048 Eval OT High Complex 434 Occupational Therapy Evaluation or Re-evaluation $1.00

97003GO Ot Evaluation 434 Occupational Therapy Evaluation or Re-evaluation $383.00

97004GO Ot Re-Eval 434 Occupational Therapy Evaluation or Re-evaluation $214.00

97165GO Ot Eval Low Complex 30 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00

97166GO Ot Eval Mod Complex 45 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00

97167GO Ot Eval High Complex 60 Min 434 Occupational Therapy Evaluation or Re-evaluation $383.00

97750GO Physical Perf Test/Measure 434 Occupational Therapy Evaluation or Re-evaluation $135.00

9775GO FCE Performance Test/Measures 434 Occupational Therapy Evaluation or Re-evaluation $135.00

OT6886 Ot Evaluation 434 Occupational Therapy Evaluation or Re-evaluation $198.00 OT9377 OT Eval low Complex 30 min 434 Occupational Therapy Evaluation or Re-evaluation $187.00 OT9378 OT Eval Mod Complex 45 Min 434 Occupational Therapy Evaluation or Re-evaluation $187.00 OT9379 OT Eval High Complex 60 min 434 Occupational Therapy Evaluation or Re-evaluation $187.00 OT9380 OT Re-Eval est plan care 434 Occupational Therapy Evaluation or Re-evaluation $105.00 OT9643 Physical Perf Test/Measure 434 Occupational Therapy Evaluation or Re-evaluation $60.00 WC9138 Ot Evaluation 434 Occupational Therapy Evaluation or Re-evaluation $170.00

WC9140 Ot Re-Evaluation 434 Occupational Therapy Evaluation or Re-evaluation $102.00

WC9148 Ot Phy Perf Test/Measure 15Min 434 Occupational Therapy Evaluation or Re-evaluation $72.00

146802 ST Cognitive Rehab 440 General Speech-Language Pathology $156.00

147009 Swallow/Oral Treatment 440 General Speech-Language Pathology $381.00

147010 Speech/Language Treatment 440 General Speech-Language Pathology $324.00

147020 St Cognitive Rehab 440 General Speech-Language Pathology $156.00

149758 Cognitive Rehab Mcr,Timed ST 440 General Speech-Language Pathology $156.00 149759 Cognitive Rehab, Untimed ST 440 General Speech-Language Pathology $621.00

92507GN Speech/Language Treatment 440 General Speech-Language Pathology $324.00 92508GN Therapeutic Group 440 General Speech-Language Pathology $315.00 92520GN Laryngeal Function (Visipitch) 440 General Speech-Language Pathology $216.00

92526GN Swallow/Oral Treatment 440 General Speech-Language Pathology $381.00 92606GN Tx Non-Sp Aug Device 440 General Speech-Language Pathology $324.00 92609GN Tx Speech Gen Device 440 General Speech-Language Pathology $358.00

92612 Fiberoptic Endoscopic Eval 440 General Speech-Language Pathology $664.00

97127GN Cognitive Rehab, Untimed 440 General Speech-Language Pathology $621.00

97532GN Cognitive Rehab 440 General Speech-Language Pathology $129.00

99070GN Misc Medical St 440 General Speech-Language Pathology $120.00

99368GN "Prof Consul Face,Fam,Psp" 440 General Speech-Language Pathology $12.50

99368PGN Prof Consul Phone 440 General Speech-Language Pathology $6.25

A0160GN Travel Per Minute 440 General Speech-Language Pathology $0.51

COG6820 *Cog Rehab Individual Tx 15 Mi 440 General Speech-Language Pathology $82.00 COG6850 Cog Medicare Rehab 440 General Speech-Language Pathology $69.00 G0119GN Aug Device Re-Eval 1 Unit 440 General Speech-Language Pathology $212.00 G0515GN Cognitive Rehab Medicare,Timed 440 General Speech-Language Pathology $156.00 SJCSBTGN St John County School Tx St 440 General Speech-Language Pathology $17.86 ST6740 Case Conference 15 Min 440 General Speech-Language Pathology $- ST6800 Sp/Language Treatment 440 General Speech-Language Pathology $209.00

ST6811 Tx Speech Gen Device 440 General Speech-Language Pathology $196.00

ST6812 Hearing Screening Pure Tone 440 General Speech-Language Pathology $32.00

ST6813 Augmentative Comm Eval +30 Min 440 General Speech-Language Pathology $555.00

171 ST6820 *Cog Rehab Individual Tx 15 Mi 440 General Speech-Language Pathology $74.00 ST6830 Cog Rehab Sensory Int Tx 15M 440 General Speech-Language Pathology $79.00 ST6840 Cog Rehab Comm Reentry 15 Min 440 General Speech-Language Pathology $99.00 ST6845 Swallow Screening 440 General Speech-Language Pathology $-

ST6874 Swallow/Oral Function Treat 440 General Speech-Language Pathology $197.00

ST6875 Perceptual/Cognitive Rehab-15 440 General Speech-Language Pathology $82.00

ST6876 Community/Work Re-Integr -15 440 General Speech-Language Pathology $99.00

ST6885 ST Rep Evaluation 440 General Speech-Language Pathology $120.00

ST6899 Cancellation 440 General Speech-Language Pathology $-

ST9201 Cancellation-Refused 440 General Speech-Language Pathology $-

ST9202 Cancellation-Feed Group 440 General Speech-Language Pathology $-

ST9203 Cancellation-Md 440 General Speech-Language Pathology $-

ST9206 Cancellation-Nursing Care 440 General Speech-Language Pathology $- ST9352 Caregiver Instruction 440 General Speech-Language Pathology $97.00 ST9354 Cog Screening 440 General Speech-Language Pathology $- ST9644 Untimed Cognitive Rehab 440 General Speech-Language Pathology $228.00 ST9645 Orthotic-Prosthetic Mgmt 440 General Speech-Language Pathology $96.00 STX9200 Cancellation-Sick 440 General Speech-Language Pathology $- STX9204 Cancellation-Testing 440 General Speech-Language Pathology $-

STX9205 Cancellation-Unable To Parti 440 General Speech-Language Pathology $-

T1013GN Sign Lang/Oral Inter Svcs St 440 General Speech-Language Pathology $100.00

T1027GN Eis Intervention Prof 440 General Speech-Language Pathology $12.50

T2024GN Prof Consul Face To Face 440 General Speech-Language Pathology $12.50

T2024PGN Prof Consul Phone 440 General Speech-Language Pathology $6.25

VSCHEGN Hb St Virtual Eval 440 General Speech-Language Pathology $275.00

VSCHTGN Hb St Vitrual Treatment 440 General Speech-Language Pathology $30.00

VSCPCGN 1 Hour Conference Call 440 General Speech-Language Pathology $30.00 VSNSEVGN No Show/Cxl Eval 440 General Speech-Language Pathology $137.50 VSNSEVP No Show/Cxl Eval 440 General Speech-Language Pathology $137.50 VSNSEVS No Show/Cxl Eval 440 General Speech-Language Pathology $137.50

VSNSTXGN No Show/Cxl Treatment 440 General Speech-Language Pathology $60.00 VSNSTXS No Show/Cxl Treatment 440 General Speech-Language Pathology $60.00 149904 Self Pay-Bbm Speech Treatment 441 Speech-Language Pathology Visit Charge $169.00

ST6849 Speech Screening 441 Speech-Language Pathology Visit Charge $-

147015 Speech Therapeutic Group 443 Speech-Language Pathology Group Rate $147.00

839376 Misc Doc 443 Speech-Language Pathology Group Rate $-

859377 Misc Doc Cog 443 Speech-Language Pathology Group Rate $-

BC6810 Cog Rehab Group Tx 15 Min 443 Speech-Language Pathology Group Rate $190.00

COG6810 *Cog Rehab Group Tx 15 Min 443 Speech-Language Pathology Group Rate $172.00

ST6802 CLASS 443 Speech-Language Pathology Group Rate $190.00

ST6805 Gen Code (443) 443 Speech-Language Pathology Group Rate $- ST6806 * Group Therapy 443 Speech-Language Pathology Group Rate $172.00 ST9376 MISC DOC 443 Speech-Language Pathology Group Rate $- 146848 Pure Tone Hear Screen 444 Speech-Language Pathology Evaluation or Re-evaluation $70.00 147005 Speech/Language Evaluation 444 Speech-Language Pathology Evaluation or Re-evaluation $453.00 147008 Swallow Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $338.00 147702 Speech Cog Testing Per Hr 444 Speech-Language Pathology Evaluation or Re-evaluation $414.00

147802 Eval Of Speech Fluency 444 Speech-Language Pathology Evaluation or Re-evaluation $509.00

147803 Eval Of St Sound Production 444 Speech-Language Pathology Evaluation or Re-evaluation $414.00

147804 Eval St Sound Product Lc/Exp 444 Speech-Language Pathology Evaluation or Re-evaluation $860.00

172 147805 Behav & Qualative Analysis V/R 444 Speech-Language Pathology Evaluation or Re-evaluation $435.00 147807 Abbev Eval Speech Sound Mod 444 Speech-Language Pathology Evaluation or Re-evaluation $860.00 149719 Behav&Qualative Analysis V/R 444 Speech-Language Pathology Evaluation or Re-evaluation $435.00 149926 Standardized Cognitive Perform 444 Speech-Language Pathology Evaluation or Re-evaluation $513.00

420280 Eval Oral/Pharyng Swl SP 444 Speech-Language Pathology Evaluation or Re-evaluation $800.00

92506GN Speech/Language Evaluation 444 Speech-Language Pathology Evaluation or Re-evaluation $714.00

92521GN Eval Of Speech Fluency 444 Speech-Language Pathology Evaluation or Re-evaluation $509.00

92522GN Eval Of St Sound Production 444 Speech-Language Pathology Evaluation or Re-evaluation $414.00

92523GN Eval St Sound Product Lc/Exp 444 Speech-Language Pathology Evaluation or Re-evaluation $860.00

92524GN Behav & Qualative Analysis V/R 444 Speech-Language Pathology Evaluation or Re-evaluation $435.00

92552GN Pure Tone Hear Screen 444 Speech-Language Pathology Evaluation or Re-evaluation $70.00

92597GN Voice Prosth Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $1,013.00

92605GN Eval Non-Sp Aug Device 444 Speech-Language Pathology Evaluation or Re-evaluation $453.00 92607GN Eval Sp Gen Aug Dev 444 Speech-Language Pathology Evaluation or Re-evaluation $954.00 92608GN Eval Sp Gen Aug Add'L 30 444 Speech-Language Pathology Evaluation or Re-evaluation $1,013.00 92610GN Eval Oral/Swallow 444 Speech-Language Pathology Evaluation or Re-evaluation $338.00 92611GN Video Fluroscopic Evaluation 444 Speech-Language Pathology Evaluation or Re-evaluation $563.00 92612GN Flex Fiberoptic Endoscop Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $808.00 96105GN Aphasia Eval/Report 444 Speech-Language Pathology Evaluation or Re-evaluation $128.00

96110GN Developmental Eval-Limited 444 Speech-Language Pathology Evaluation or Re-evaluation $169.00

96125GN Standardized Cognitive Perform 444 Speech-Language Pathology Evaluation or Re-evaluation $228.00

BC6800 Cog Rehab Evaluation 15 Min 444 Speech-Language Pathology Evaluation or Re-evaluation $345.00

COG6800 *Cog Rehab Evaluation 15 Min 444 Speech-Language Pathology Evaluation or Re-evaluation $313.00

COG9352 Caregiver Instruction 444 Speech-Language Pathology Evaluation or Re-evaluation $88.00

ST6746 Ind Cog Densory Int TX 444 Speech-Language Pathology Evaluation or Re-evaluation $19.00

ST6801 Sp/Language Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $345.00

ST6803 Rep Evaluation 444 Speech-Language Pathology Evaluation or Re-evaluation $345.00 ST6807 Standard Aphasia Per Hr. 444 Speech-Language Pathology Evaluation or Re-evaluation $150.00 ST6808 *Developmental Eval Limited 444 Speech-Language Pathology Evaluation or Re-evaluation $179.00 ST6809 *Extended Developmental Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $308.00

ST6810 Augmentative Comm Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $523.00 ST6815 *Re-Eval Augmentative Comm 444 Speech-Language Pathology Evaluation or Re-evaluation $78.00 ST6842 Modified Barium Swallow Study 444 Speech-Language Pathology Evaluation or Re-evaluation $313.00

ST6846 Swallow Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $176.00

ST6851 Voice Prosthetic Eval 444 Speech-Language Pathology Evaluation or Re-evaluation $131.00

ST6853 Fees Laryngeal Sensory Testing 444 Speech-Language Pathology Evaluation or Re-evaluation $326.00

ST6854 Fees By Video Recording 444 Speech-Language Pathology Evaluation or Re-evaluation $345.00

ST9353 Evaluation of Speech Fluency 444 Speech-Language Pathology Evaluation or Re-evaluation $249.00

ST9355 Speech sound lang comprehend 444 Speech-Language Pathology Evaluation or Re-evaluation $421.00

ST9356 Behavral Quality Analys Voice 444 Speech-Language Pathology Evaluation or Re-evaluation $213.00

260073 Aquacel 4X4 450 General Emergency Room $38.00 260138 Op Visit Level 3 Est 450 General Emergency Room $1,038.00 357019 Monitor Overflow From 450 General Emergency Room $690.00 414637 Therp Prop Or Dx Inj I 450 General Emergency Room $505.00 418441 Op Visit Level 3 Np 450 General Emergency Room $2,070.00 418445 Op Visit Level 2 Est 450 General Emergency Room $733.00 418447 Op Visit Level 4 Est 450 General Emergency Room $1,129.00

418627 Ndl/Incath Vein 450 General Emergency Room $728.00

418637 Cpr 450 General Emergency Room $1,563.00

418648 Injection Im Or Sq 450 General Emergency Room $196.00

173 418650 Ivp Single/Initial Dru 450 General Emergency Room $605.00 418651 Ivp Ea Add Seq New Dru 450 General Emergency Room $484.00 418652 Ivp Ea Add Seq Same Dr 450 General Emergency Room $456.00 418654 Irrigation Of Vad 450 General Emergency Room $297.00

418658 Emer Dept Level 1 450 General Emergency Room $781.00

418660 Emer Dept Level 2 450 General Emergency Room $1,443.00

418661 Emer Dept Level 3 450 General Emergency Room $3,069.00

418662 Emer Dept Level 4 450 General Emergency Room $4,559.00

418663 Emer Dept Level 5 450 General Emergency Room $8,075.00

418664 Crit Care 1St 30-74 Mi 450 General Emergency Room $5,209.00

418677 Er Proc Level 1 450 General Emergency Room $1,106.00

418975 Ndl/Incath Vein 450 General Emergency Room $744.00 418982 Injection Im Or Sq 450 General Emergency Room $199.00 418983 Ivp Single/Initial Dru 450 General Emergency Room $553.00 418984 Ivp Ea Add Seq New Dru 450 General Emergency Room $466.00 419001 Ivp Ea Add Seq Same Dr 450 General Emergency Room $466.00 421124 Proce Category 1 450 General Emergency Room $1,127.00 421125 Proce Category 2 450 General Emergency Room $3,054.00

421126 Proce Category 3 450 General Emergency Room $3,910.00

421560 Proce Category 2 450 General Emergency Room $3,002.00

421561 Proce Category 3 450 General Emergency Room $3,845.00

423058 Gastric Intub By Phys 450 General Emergency Room $303.00

423067 Coll Blood Catheter No 450 General Emergency Room $289.00

423924 Emer Dept Level 1 450 General Emergency Room $795.00

423925 Emer Dept Level 2 450 General Emergency Room $1,469.00

423926 Emer Dept Level 3 450 General Emergency Room $3,123.00 423927 Emer Dept Level 4 450 General Emergency Room $4,637.00 423928 Emer Dept Level 5 450 General Emergency Room $8,212.00 423929 Crit Care 1St 30-74 Mi 450 General Emergency Room $5,299.00 902003 Er Chg Level Iii 450 General Emergency Room $2,547.00 902004 Er Chg Level Ii 450 General Emergency Room $1,203.00 902005 Er Chg Level I 450 General Emergency Room $651.00

902008 Suture/Staple Rem Np 450 General Emergency Room $312.00

902014 Er Chg Level Iv 450 General Emergency Room $3,785.00

902015 Er Chg Level V 450 General Emergency Room $6,700.00

909000 Er Chg Level Iii 450 General Emergency Room $2,547.00

909011 Er Chg Level Ii 450 General Emergency Room $1,203.00

909012 Er Chg Level I 450 General Emergency Room $651.00

909069 Suture/Staple Rem Np 450 General Emergency Room $312.00

909525 Proce Cat 1 450 General Emergency Room $1,026.00

909526 Proce Catagory 2 450 General Emergency Room $2,784.00 909527 Proce Catagory 3 450 General Emergency Room $3,564.00 909731 Er Chg Level Iv 450 General Emergency Room $3,785.00 909732 Er Chg Level V 450 General Emergency Room $6,700.00 909871 Critical Care 450 General Emergency Room $4,325.00 652458 Gen Code - Pulmonary 460 General Pulmonary Function $- 657947 Vital Capacity/NIF 460 General Pulmonary Function $524.00

658724 Noninv Ea Or Puls Ox C-Overnig 460 General Pulmonary Function $1,187.00

658729 Noninv Ea Or Puls Ox M-Cont 460 General Pulmonary Function $815.00

659304 Bedside Spiro 460 General Pulmonary Function $873.00

174 659322 Noninv Ear Or Puls Ox-Single 460 General Pulmonary Function $321.00 417734 Au Evo Po And/Or Cns C 471 Diagnostic Audiology $3,745.00 419679 Nasopharyngoscopy 471 Diagnostic Audiology $451.00 719729 Brainstem Audio Evor. 471 Diagnostic Audiology $3,901.00

74305 H-Reflex Gastro/Soleus 480 General Cardiology $1,138.00

74402 Echo 2D Comp W Cf Dop 480 General Cardiology $3,258.00

74403 Echo Stress W Cont Ecg 480 General Cardiology $2,963.00

74404 Tte2D w/wo CN W/Dop 480 General Cardiology $3,886.00

74405 Tte w/wo Strs Cont Ecg 480 General Cardiology $3,886.00

193040 Gen Code (480) 480 General Cardiology $-

417785 Cardioversion External 480 General Cardiology $2,886.00

417789 Echo2D Comp W Cf Dop 480 General Cardiology $3,556.00 417792 Tee 2D W/Wom Mode Comp 480 General Cardiology $5,873.00 417797 Echo Doppler Comp 480 General Cardiology $813.00 417799 Echo Color Flow Mapping 480 General Cardiology $1,827.00 417800 Echo Stress 480 General Cardiology $4,640.00 420177 Echo2D Comp W/O Cf Dop 480 General Cardiology $3,494.00 420179 Echo Doppler Comp 480 General Cardiology $813.00

420181 Echo Color Flow Mappin 480 General Cardiology $1,827.00

423953 Tilt Table W/Wo Rx 480 General Cardiology $4,446.00

520014 Cardioversion 480 General Cardiology $2,975.00

668002 Cpr 480 General Cardiology $1,354.00

678003 Echo Doppler Comp 480 General Cardiology $757.00

678004 Code 5 - Ekg 480 General Cardiology $227.00

678015 Echo 2D W/Wom Mode Com 480 General Cardiology $3,249.00

678016 Echo Color Flow Mappin 480 General Cardiology $1,699.00 678018 Tee 2D W/Wom Mode Comp 480 General Cardiology $5,380.00 678021 Echo Doppler Ltd 480 General Cardiology $1,598.00 679716 Tilt Table W/Wo Rx 480 General Cardiology $4,381.00 679717 Gen Code (480) 480 General Cardiology $- 679721 Cardioversion External 480 General Cardiology $2,845.00 928094 Transcath Stent Cca W/EP 480 General Cardiology $10,939.00

968505 Extended Proce 0-30min 480 General Cardiology $1,237.00

968507 Catheter Retrieval 480 General Cardiology $23,001.00

968512 Cardioversion 480 General Cardiology $3,001.00

968513 Cardio Pulmonary Resuscitation 480 General Cardiology $1,446.00

968520 Single Vessel Ptca-Lad 480 General Cardiology $26,263.00

968521 Additional Vessel Ptca-Lad 480 General Cardiology $26,263.00

968522 Mapping-Intravent Or Artial 480 General Cardiology $14,529.00

968523 Complex EP without Arrhythmia 480 General Cardiology $18,602.00

968524 Restim After Drugs/Initial Set 480 General Cardiology $14,529.00 968526 Ep Defib Eval 480 General Cardiology $5,697.00 968527 Bundle Of His Record 480 General Cardiology $14,529.00 968528 Intra-Atrial Record 480 General Cardiology $14,529.00 968530 Induction Ofarrythmia Without 480 General Cardiology $6,904.00 968536 Tempo Transcutaneous Pacer 480 General Cardiology $1,446.00 968554 Thrombolysis Intracoronary INF 480 General Cardiology $6,881.00

968555 Thrompolysis Iv 480 General Cardiology $2,867.00

968678 Single Vessel Atherectomy-Lad 480 General Cardiology $40,697.00

968720 Atherectomy Additional Lad 480 General Cardiology $1,668.00

175 968727 Drug Follow-Up After Initial $ 480 General Cardiology $5,697.00 969024 Pentetate Per Mci 480 General Cardiology $133.00 969043 Medronate 480 General Cardiology $100.00 969205 Quad Diagnostic Catheter 480 General Cardiology $1,056.00

969208 Decapolar Catheter Fixed 480 General Cardiology $708.00

969501 Single Vessel PTCA & Stent-Lad 480 General Cardiology $63,814.00

969521 Tec Procedure 480 General Cardiology $47,658.00

969532 Rt. Vent Pac/Rec 480 General Cardiology $14,529.00

969533 Complex & Ep With Arrhyth 480 General Cardiology $18,602.00

969540 Secondary Temp Pacer 480 General Cardiology $780.00

969541 Secondary Snrt/Atrial Pace 480 General Cardiology $6,740.00

969542 Secondary Ptca Lad 480 General Cardiology $5,507.00 969543 Secondary Atherectomy Lad 480 General Cardiology $9,705.00 969544 Add'Tnl Stented Vessel Lad 480 General Cardiology $10,708.00 969548 Secondary Cardioversion 480 General Cardiology $3,008.00 969549 Secondary His Bundle 480 General Cardiology $3,840.00 969554 Intra-Atrial Pace 480 General Cardiology $14,529.00 969559 Tec Cutter 480 General Cardiology $6,186.00

969560 Secondary Ptca & Stent lad 480 General Cardiology $16,035.00

969562 Secondary Atherectomy-RCA 480 General Cardiology $9,705.00

969563 Secondary Atherectomy-LCIRC 480 General Cardiology $9,705.00

969564 Add'Tnl Stented Vessel-RCA 480 General Cardiology $10,708.00

969565 Add'Tnl Stented Vessel-LCIRC 480 General Cardiology $36,972.00

969566 Additional Vessel Ptca-LCIRC 480 General Cardiology $6,720.00

969567 Single Vessel Atherectomy-RCA 480 General Cardiology $14,846.00

969568 Sgl Vessel Atherectomy LCIRC 480 General Cardiology $14,846.00 969569 Atherectomy Additional RCA 480 General Cardiology $1,668.00 969570 Atherectomy Additional LCIRC 480 General Cardiology $40,697.00 969571 Single Vessel Ptca-RCA 480 General Cardiology $43,933.00 969572 Single Vessel Ptca-LCIRC 480 General Cardiology $43,933.00 969573 Single Vessel Ptca&Stent-RCA 480 General Cardiology $70,328.00 969574 Single Vessel Ptca&Stent-LCIRC 480 General Cardiology $36,972.00

969575 Secondary Ptca - RCA 480 General Cardiology $5,507.00

969576 Secondary Ptca - LCIRC 480 General Cardiology $5,507.00

969577 Secondary Ptca & Stent-RCA 480 General Cardiology $16,035.00

969578 Secondary Ptca & Stent-LCIRC 480 General Cardiology $16,035.00

969579 Additional Vessel Ptca-RCA 480 General Cardiology $6,720.00

969601 Ep Test Of Aicd Intial Implant 480 General Cardiology $5,697.00

969602 Ablation Of Atrioventricular 480 General Cardiology $18,639.00

969603 Ablation of Svt, Access Pathwa 480 General Cardiology $18,639.00

969604 Ablation Of Vt 480 General Cardiology $13,495.00 969625 Additional Ultrasound Vessel 480 General Cardiology $2,586.00 969626 Coronary Ultrasound 480 General Cardiology $16,263.00 969632 Tilt Table 480 General Cardiology $4,513.00 417451 Cpr 481 Cardiac Cath Lab $1,446.00 417453 Cardioversion External 481 Cardiac Cath Lab $3,001.00 417454 Ivus Initial Vessel 481 Cardiac Cath Lab $16,263.00

417455 Ivus Ea Addl Vessel 481 Cardiac Cath Lab $2,586.00

417464 Interogation Eval Pm 481 Cardiac Cath Lab $165.00

417472 Insertion Flo Dr Cath 481 Cardiac Cath Lab $7,033.00

176 417473 Card Output Therm Dil 481 Cardiac Cath Lab $787.00 417475 Velocity Bld Flow Int 481 Cardiac Cath Lab $16,263.00 417476 Velocity Bld Flow Ea A 481 Cardiac Cath Lab $2,586.00 417477 Bundle Of His Recordin 481 Cardiac Cath Lab $14,529.00

417478 Intra Atrial Recording 481 Cardiac Cath Lab $14,529.00

417479 Rt Ventricular Recordi 481 Cardiac Cath Lab $14,529.00

417480 Iv/Ia Map Id Origin 481 Cardiac Cath Lab $14,529.00

417481 Ia Pacing 481 Cardiac Cath Lab $14,529.00

417482 Iv Pacing 481 Cardiac Cath Lab $14,529.00

417483 Intracard Ep 3D Mappin 481 Cardiac Cath Lab $14,239.00

417484 Arrhythmia Induce Elec 481 Cardiac Cath Lab $4,260.00

417485 Ep W/O Arrhythmia 481 Cardiac Cath Lab $18,602.00 417486 Ep W/Arrhythmia 481 Cardiac Cath Lab $18,602.00 417487 Ep W/La Rec W/Arrhythm 481 Cardiac Cath Lab $18,602.00 417488 Ep W/Lvrec W/Arrhythmi 481 Cardiac Cath Lab $18,602.00 417489 Stim & Pace After Iv I 481 Cardiac Cath Lab $14,529.00 417490 Ep Followup 481 Cardiac Cath Lab $5,697.00 417493 Aicd Lead/Gen Test Ini 481 Cardiac Cath Lab $5,697.00

417494 Aicd Eval & Reprogram 481 Cardiac Cath Lab $5,697.00

417495 Ablation Av Node W/Wo 481 Cardiac Cath Lab $18,639.00

417496 Ablation Svt 481 Cardiac Cath Lab $18,639.00

417497 Ablation Vt 481 Cardiac Cath Lab $13,495.00

417499 Intracardiac Echo 481 Cardiac Cath Lab $16,263.00

417597 Drug Eluting Stent Sgl 481 Cardiac Cath Lab $36,946.00

417598 Drug Elute Stent Ea Ad 481 Cardiac Cath Lab $36,946.00

417621 Renal Angio At Card Ca 481 Cardiac Cath Lab $2,704.00 417622 Ilc/Fem Art Ang At Cca 481 Cardiac Cath Lab $9,605.00 420678 Cardioversion Internal 481 Cardiac Cath Lab $3,008.00 420679 Perc Trans Coron Throm 481 Cardiac Cath Lab $2,291.00 420680 Trans Place Rad Del De 481 Cardiac Cath Lab $5,226.00 420681 Coronary Stent Initial 481 Cardiac Cath Lab $36,972.00 420682 Coronary Stent Ea Addl 481 Cardiac Cath Lab $36,972.00

420683 Ptca Initial Vessel 481 Cardiac Cath Lab $26,263.00

420684 Ptca Ea Addl Vessel 481 Cardiac Cath Lab $26,263.00

420685 Pb Valvuplsty Aortic V 481 Cardiac Cath Lab $27,758.00

420686 Atherectomy Sgl Vssl 481 Cardiac Cath Lab $40,697.00

420687 Cath Heart Right 481 Cardiac Cath Lab $22,186.00

420700 Per Cl Con Int Com W/I 481 Cardiac Cath Lab $22,748.00

420701 Per Cl Con Vt Sp Df W/ 481 Cardiac Cath Lab $21,137.00

420703 Unlisted Cardio Servic 481 Cardiac Cath Lab $544.00

420812 Insert/Repos Of Leads 481 Cardiac Cath Lab $20,128.00 422883 Cath Hrt Rt W Sat/Co 481 Cardiac Cath Lab $23,961.00 422884 Cath Hrt Lt/Inj L Vent 481 Cardiac Cath Lab $23,961.00 422885 Cath Hrt R&L/Inj L Ven 481 Cardiac Cath Lab $29,938.00 422886 Cath Plc/Inj Coronry A 481 Cardiac Cath Lab $23,961.00 422887 Cath Plc/Inj Bypas Gft 481 Cardiac Cath Lab $29,364.00 422888 Cth Plc/Inj Cr Art W R 481 Cardiac Cath Lab $32,591.00

422889 Cth Plc/Inj Graft W Rh 481 Cardiac Cath Lab $37,402.00

422890 Cth Plc/Inj Lhc & L Ve 481 Cardiac Cath Lab $39,189.00

422891 Cth Plc/Inj Lhc W Graf 481 Cardiac Cath Lab $41,172.00

177 422892 Cth Plc/Inj R&Lhc/L Ve 481 Cardiac Cath Lab $38,562.00 422893 Cth Plc/Inj R&Lhc/Graf 481 Cardiac Cath Lab $43,374.00 422894 Inj Select Lt Vent/Atr 481 Cardiac Cath Lab $3,536.00 422895 Inj Select Rt Vent/Atr 481 Cardiac Cath Lab $3,536.00

422896 Inj Supravalv Aortogrm 481 Cardiac Cath Lab $3,536.00

422897 Inj Pulmonary Angiogrm 481 Cardiac Cath Lab $3,536.00

422898 Lhc Trans Septal/Apica 481 Cardiac Cath Lab $23,961.00

432137 Intro Cath Dialysis Circ 481 Cardiac Cath Lab $30,596.00

968506 Endomyocardial Biopsy 481 Cardiac Cath Lab $7,033.00

968509 Insert Intra Aortic Balloon 481 Cardiac Cath Lab $8,699.00

968519 Swan Insertion 481 Cardiac Cath Lab $7,033.00

968532 Valvuloplasty 481 Cardiac Cath Lab $27,758.00 968542 Rt Heart Cath 481 Cardiac Cath Lab $22,186.00 968559 Lt Heart Cath 481 Cardiac Cath Lab $22,186.00 968688 Gen Code - Cardiac Cath Lab 481 Cardiac Cath Lab $- 968697 Cardiac Output 481 Cardiac Cath Lab $787.00 969496 Rt/Lt Cath 481 Cardiac Cath Lab $22,186.00 969525 Cutdown 481 Cardiac Cath Lab $5,416.00

969526 Inj Grafts 481 Cardiac Cath Lab $2,042.00

969527 Inkj Pulmonary Angio 481 Cardiac Cath Lab $1,915.00

969528 Inj Lima'S 481 Cardiac Cath Lab $2,420.00

969529 Inj Coros 481 Cardiac Cath Lab $5,028.00

969530 Inj Aortagram 481 Cardiac Cath Lab $2,171.00

969531 Inj Lv Angio 481 Cardiac Cath Lab $3,275.00

969539 Secondary RHC 481 Cardiac Cath Lab $2,401.00

969546 Secondary Lhc 481 Cardiac Cath Lab $5,492.00 969547 Secondary R & Lhc 481 Cardiac Cath Lab $7,360.00 969556 Supervision & Interepr 481 Cardiac Cath Lab $2,265.00 969557 S&I Palm, Aorta, Coronaries 481 Cardiac Cath Lab $2,969.00 417393 Stress Test 482 Stress Test $5,528.00 678005 Stress Test 482 Stress Test $5,138.00 678020 Gen Code Cv Sono Lab 482 Stress Test $-

678022 Echo Stress 482 Stress Test $4,575.00

417791 Echo 2D W/Wom Mode Ltd 483 Echocardiology $1,267.00

417796 Echocardiography Tee 483 Echocardiology $2,744.00

417798 Echo Doppler Ltd 483 Echocardiology $1,622.00

201028 N Block, Other Periphe 490 Ambulatory Surgical Care $1,172.00

520200 Urinary Catherization 490 Ambulatory Surgical Care $299.00

727629 Nerve Block 490 Ambulatory Surgical Care $1,913.00

727663 Sc Inj Cysto Exam 490 Ambulatory Surgical Care $873.00

727664 Sg Inj Pyelogr Thru Tu 490 Ambulatory Surgical Care $1,582.00 727665 Sc Inj Corpora Cavern 490 Ambulatory Surgical Care $3,930.00 727767 Conquest Balloon 490 Ambulatory Surgical Care $1,165.00 729009 Laryngogram-Proc 490 Ambulatory Surgical Care $2,394.00 729011 Bead Chain Inj Procedu 490 Ambulatory Surgical Care $386.00 749397 Tyroid Biopsy Sono Pro 490 Ambulatory Surgical Care $1,947.00 149927 Facility Fee 510 General Clinic $100.00

421330 Obs Per Hour W/Tele 510 General Clinic $178.00

520195 Injections 510 General Clinic $129.00

99199 Facility Fee 510 General Clinic $100.00

178 520003 Epidural Block 511 Chronic Pain Center $2,478.00 520005 Trigger Pt Injection 511 Chronic Pain Center $2,651.00 520006 Infusion Pump Refill 511 Chronic Pain Center $292.00 520007 Infusion Pump Reprogra 511 Chronic Pain Center $756.00

520009 Nerve Block 511 Chronic Pain Center $2,198.00

520012 Additional Block Proce 511 Chronic Pain Center $1,147.00

520210 Epidural Blood Patch 511 Chronic Pain Center $2,156.00

520215 Insert Neuro Electrode 511 Chronic Pain Center $945.00

520255 Morphine Test Dose 511 Chronic Pain Center $859.00

520265 Inj Anes Agent Trigemi 511 Chronic Pain Center $1,760.00

520266 Inj Anes Agent Facial 511 Chronic Pain Center $1,760.00

520267 Inj Anes Agent Vagus 511 Chronic Pain Center $1,760.00 520268 Inj Anes Agent Phrenic 511 Chronic Pain Center $1,760.00 520269 Inj Anes Agent Spin Ac 511 Chronic Pain Center $1,760.00 520270 Inj Anes Agent Cerv Pl 511 Chronic Pain Center $1,760.00 520271 Inj Anes Agent Brac Pl 511 Chronic Pain Center $1,760.00 520272 Inj Anes Agent Axillar 511 Chronic Pain Center $1,760.00 520273 Inj Anes Agent Suprasc 511 Chronic Pain Center $1,760.00

520274 Inj Anes Agent Interco 511 Chronic Pain Center $1,981.00

520275 Inj Anes Agent Ilioing 511 Chronic Pain Center $1,979.00

520276 Inj Anes Agent Sciatic 511 Chronic Pain Center $925.00

520277 Inj Anes Agent Other P 511 Chronic Pain Center $1,979.00

520278 Inj Anes Agent Interco 511 Chronic Pain Center $1,979.00

414610 Mri Tmj 610 General Magnetic Resonance Imaging (MRI) $7,532.00

414614 Mra Hd W/O Cont 610 General Magnetic Resonance Imaging (MRI) $6,383.00

414615 Mra Hd W/Contrast 610 General Magnetic Resonance Imaging (MRI) $6,630.00 414616 MRA Hd W&WO Contrast 610 General Magnetic Resonance Imaging (MRI) $6,394.00 414617 Mra Neck W/O Cont 610 General Magnetic Resonance Imaging (MRI) $6,360.00 414618 Mra Neck W/Contrast 610 General Magnetic Resonance Imaging (MRI) $7,135.00 414619 Mra Neck W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $7,437.00 414623 Mri Chest W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,852.00 414625 Mri Chest W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,170.00

414651 Mri Up W/Cont Lt 610 General Magnetic Resonance Imaging (MRI) $7,662.00

414654 Mri Up Jnt W&Wo Cont L 610 General Magnetic Resonance Imaging (MRI) $9,657.00

414655 Mri Up Jnt W&Wo Cont R 610 General Magnetic Resonance Imaging (MRI) $9,657.00

414659 Mra Up Ext Wwo Cont Rt 610 General Magnetic Resonance Imaging (MRI) $6,416.00

414660 Mri Low Ext W/O Cont L 610 General Magnetic Resonance Imaging (MRI) $8,610.00

414661 Mri Low Ext W/O Cont R 610 General Magnetic Resonance Imaging (MRI) $8,610.00

414663 MRI Low Ext W/Cont LT 610 General Magnetic Resonance Imaging (MRI) $7,455.00

414664 MRI Low Ext W/Cont RT 610 General Magnetic Resonance Imaging (MRI) $7,455.00

414666 Mri Low Ext W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,641.00 414667 Mri Low Ext W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,641.00 414669 Mri Lw Jnt W/O Cont Lt 610 General Magnetic Resonance Imaging (MRI) $7,925.00 414671 Mri Lw Jnt W/O Cont Rt 610 General Magnetic Resonance Imaging (MRI) $7,925.00 414673 Mri Lw Jnt W/Contrast 610 General Magnetic Resonance Imaging (MRI) $8,300.00 414675 Mri Lw Jnt W&Wo Cont L 610 General Magnetic Resonance Imaging (MRI) $9,588.00 414676 Mri Lw Jnt W&Wo Cont R 610 General Magnetic Resonance Imaging (MRI) $9,588.00

414679 MRCP 610 General Magnetic Resonance Imaging (MRI) $9,538.00

414680 Mri Abdomen W/Cont 610 General Magnetic Resonance Imaging (MRI) $10,040.00

414681 Mri Abdomen W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $10,593.00

179 414682 CAR MRI Morph Func WO CM 610 General Magnetic Resonance Imaging (MRI) $1,991.00 414687 3D Ct/Mri/Us/Oth Not I 610 General Magnetic Resonance Imaging (MRI) $293.00 414690 Mri Spectroscopy 610 General Magnetic Resonance Imaging (MRI) $7,447.00 414702 Mra W/Cont Abd 610 General Magnetic Resonance Imaging (MRI) $7,162.00

414703 Mra W/O Cont Abd 610 General Magnetic Resonance Imaging (MRI) $6,416.00

414704 Mra W/O Fol W/Cont Abd 610 General Magnetic Resonance Imaging (MRI) $5,940.00

420095 MRI Up Jnt W/Cont LT 610 General Magnetic Resonance Imaging (MRI) $6,961.00

420096 MRI Up Jnt W/Cont RT 610 General Magnetic Resonance Imaging (MRI) $6,691.00

420185 Mri Wo Fol Wcon Br Un 610 General Magnetic Resonance Imaging (MRI) $6,051.00

420186 Mri W/Cont Breast Uni 610 General Magnetic Resonance Imaging (MRI) $6,051.00

420187 Mri W/Cont Breast Uni 610 General Magnetic Resonance Imaging (MRI) $6,051.00

420643 Mra W/O Fol W/Cont Che 610 General Magnetic Resonance Imaging (MRI) $6,416.00 420644 Mra W/Cont Chest 610 General Magnetic Resonance Imaging (MRI) $7,162.00 420654 Mra Lower Extremity Lt/Rt 610 General Magnetic Resonance Imaging (MRI) $6,416.00 420661 Mri W/Cont Breast Bi 610 General Magnetic Resonance Imaging (MRI) $7,232.00 420662 Mri W/O Cont Breast Bi 610 General Magnetic Resonance Imaging (MRI) $7,232.00 421819 Mri Upper Ex W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,566.00 421820 Mri Upper Ex W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,566.00

421822 MRI Upper Ex W/Cont LT 610 General Magnetic Resonance Imaging (MRI) $7,160.00

421823 MRI Upper EX W/Cont RT 610 General Magnetic Resonance Imaging (MRI) $7,160.00

421825 Mri Up Ex W&Wo Cont Lt 610 General Magnetic Resonance Imaging (MRI) $9,866.00

421827 Mri Up Ex W&Wo Cont Rt 610 General Magnetic Resonance Imaging (MRI) $9,866.00

421828 MRI Up Jnt W/O Cont Lt 610 General Magnetic Resonance Imaging (MRI) $7,415.00

421829 Mri Up Jnt W/O Cont Bi 610 General Magnetic Resonance Imaging (MRI) $12,732.00

421830 Mri Up Jnt W/O Cont Rt 610 General Magnetic Resonance Imaging (MRI) $8,491.00

423749 Mri Tmj 610 General Magnetic Resonance Imaging (MRI) $9,308.00 423750 Mri Or/Fce/Nck W/O Con 610 General Magnetic Resonance Imaging (MRI) $8,560.00 423751 Mri Or/Fce/Nck W/Cont 610 General Magnetic Resonance Imaging (MRI) $7,222.00 423752 Mri Or/Fce/Nck W&Wo 610 General Magnetic Resonance Imaging (MRI) $7,997.00 423753 Mra Hd W/O Cont 610 General Magnetic Resonance Imaging (MRI) $5,731.00 423754 Mra Hd W&Wo Contrast 610 General Magnetic Resonance Imaging (MRI) $7,176.00 423755 Mra Neck W/O Cont 610 General Magnetic Resonance Imaging (MRI) $5,731.00

423756 Mra Neck W/Contrast 610 General Magnetic Resonance Imaging (MRI) $6,397.00

423757 Mra Neck W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $7,176.00

423761 Mri Chest W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,906.00

423762 Mri Chest W/Contrast 610 General Magnetic Resonance Imaging (MRI) $9,387.00

423763 Mri Chest W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,617.00

423764 Mra W/Cont Chest 610 General Magnetic Resonance Imaging (MRI) $6,397.00

423774 Mri Pelvis W/Contrast 610 General Magnetic Resonance Imaging (MRI) $7,400.00

423775 Mri Pelvis W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,617.00

423776 Mra W/Cont Pelvis 610 General Magnetic Resonance Imaging (MRI) $5,731.00 423777 Mri Upper Ex W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,649.00 423778 Mri Upper Ex W/Cont Rt 610 General Magnetic Resonance Imaging (MRI) $8,035.00 423779 Mri Up Ex W&Wo Cont Rt 610 General Magnetic Resonance Imaging (MRI) $8,810.00 423780 Mri Up Jnt W/O Cont Rt 610 General Magnetic Resonance Imaging (MRI) $7,583.00 423781 Mri Up Jnt W/Cont Rt 610 General Magnetic Resonance Imaging (MRI) $8,035.00 423782 Mri Up Jnt W&Wo Cont R 610 General Magnetic Resonance Imaging (MRI) $8,810.00

423783 Mri Low Ext W/O Cont R 610 General Magnetic Resonance Imaging (MRI) $7,906.00

423784 Mri Low Ext W/Cont Rt 610 General Magnetic Resonance Imaging (MRI) $8,035.00

423785 Mri Low Ext W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $8,810.00

180 423786 Mri Lw Jnt W/O Cont Rt 610 General Magnetic Resonance Imaging (MRI) $7,752.00 423787 Mri Lw Jnt W/Contrast 610 General Magnetic Resonance Imaging (MRI) $8,035.00 423788 Mri Lw Jnt W&Wo Cont R 610 General Magnetic Resonance Imaging (MRI) $8,810.00 423789 Mra Wo W Cont Lwr Ext 610 General Magnetic Resonance Imaging (MRI) $5,731.00

423790 Mri Abdomen W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,579.00

423791 Mri Abdomen W/Cont 610 General Magnetic Resonance Imaging (MRI) $8,970.00

423792 Mri Abdomen W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,745.00

423793 Mra W/Cont Abd 610 General Magnetic Resonance Imaging (MRI) $6,397.00

423794 Mri W/Cont Breast Uni 610 General Magnetic Resonance Imaging (MRI) $6,048.00

423795 Mri W/Cont Breast Uni 610 General Magnetic Resonance Imaging (MRI) $6,048.00

423796 Mri Wo Fol Wcon Brst U 610 General Magnetic Resonance Imaging (MRI) $6,048.00

423797 Mri W/Cont Breast Bi 610 General Magnetic Resonance Imaging (MRI) $6,459.00 423798 Mri W/O Cont Breast Bi 610 General Magnetic Resonance Imaging (MRI) $6,459.00 423799 Mri Wo Fol W/Con Brst 610 General Magnetic Resonance Imaging (MRI) $6,459.00 423801 Mri Pelvis W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,084.00 423900 Mri Low Ext W/O Cont B 610 General Magnetic Resonance Imaging (MRI) $11,857.00 425668 3D CT/MRI/US/OTH IND 610 General Magnetic Resonance Imaging (MRI) $5,466.00 957000 Mri Abdomen W/O Cont 610 General Magnetic Resonance Imaging (MRI) $10,980.00

957001 Mri Bone Marrow Blood 610 General Magnetic Resonance Imaging (MRI) $9,980.00

957004 Mri Cardiac Morph W/O 610 General Magnetic Resonance Imaging (MRI) $5,224.00

957005 Mri Chest W/O Cont 610 General Magnetic Resonance Imaging (MRI) $10,117.00

957006 Mri Low Extrem W/O Con 610 General Magnetic Resonance Imaging (MRI) $10,117.00

957007 Mri Upper Ex W/O Cont 610 General Magnetic Resonance Imaging (MRI) $9,790.00

957014 Mri Tmj W/O Contrast 610 General Magnetic Resonance Imaging (MRI) $7,841.00

957029 Mri Lw Jnt W/O Cont 610 General Magnetic Resonance Imaging (MRI) $9,924.00

957030 Mri Up Jnt W/O Cont 610 General Magnetic Resonance Imaging (MRI) $9,704.00 957050 Mri Elbow W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,001.00 957051 Mri Shoulder W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,001.00 957052 Mri Wrist W/O Cont 610 General Magnetic Resonance Imaging (MRI) $8,001.00 957053 Mri Ankle W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,916.00 957054 Mri Hip W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,916.00 957055 Mri Knee W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,916.00

957102 Mra Hd W/Contrast 610 General Magnetic Resonance Imaging (MRI) $8,186.00

957103 Mri Hd W&Wo Contrast 610 General Magnetic Resonance Imaging (MRI) $9,181.00

957104 Mri Neck W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,334.00

957105 Mri Neck W/Contrast 610 General Magnetic Resonance Imaging (MRI) $8,186.00

957106 Mri Neck W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $9,181.00

957107 Mri Chest W/Contrast 610 General Magnetic Resonance Imaging (MRI) $12,013.00

957108 Mri Chest W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $12,311.00

957111 Mri Upper Ex W/Cont 610 General Magnetic Resonance Imaging (MRI) $10,282.00

957112 Mri Upper Ex W/Cont 610 General Magnetic Resonance Imaging (MRI) $10,282.00 957113 Mri Up Ex W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00 957114 Mri Up Ex W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00 957115 Mri Up Jnt W/Cont 610 General Magnetic Resonance Imaging (MRI) $10,282.00 957116 Mri Up Jnt W/Cont 610 General Magnetic Resonance Imaging (MRI) $10,282.00 957117 Mri Up Jnt W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00 957118 Mri Up Jnt W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00

957119 Mri Low Ext W/Contrast 610 General Magnetic Resonance Imaging (MRI) $10,282.00

957120 Mri Low Ext W/Contrast 610 General Magnetic Resonance Imaging (MRI) $10,282.00

957121 Mri Low Ext W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00

181 957123 Mri Lw Jnt W/O Cont 610 General Magnetic Resonance Imaging (MRI) $9,924.00 957124 Mri Lw Jnt W/Contrast 610 General Magnetic Resonance Imaging (MRI) $10,282.00 957125 Mri Lw Jnt W/Contrast 610 General Magnetic Resonance Imaging (MRI) $10,282.00 957126 Mri Lw Jnt W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $11,276.00

957128 Mri Abdomen W/Cont 610 General Magnetic Resonance Imaging (MRI) $11,477.00

957129 Mri Abdomen W&Wo Cont 610 General Magnetic Resonance Imaging (MRI) $12,472.00

959270 Mra Hd W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,334.00

959271 Mra Chest W/O Contrast 610 General Magnetic Resonance Imaging (MRI) $7,334.00

959272 Mra Spine W/O Contrast 610 General Magnetic Resonance Imaging (MRI) $7,335.00

959274 Mra Up Extrem W/O Cont 610 General Magnetic Resonance Imaging (MRI) $7,334.00

959275 Mra Neck W/O Contrast 610 General Magnetic Resonance Imaging (MRI) $6,050.00

959276 Mra Low Extrem W/O Con 610 General Magnetic Resonance Imaging (MRI) $7,334.00 959277 Mra Abdomen W/O Contra 610 General Magnetic Resonance Imaging (MRI) $7,334.00 959283 Mri Lwr Extremity W/O 610 General Magnetic Resonance Imaging (MRI) $10,117.00 959285 Mra W/Cont Abd 610 General Magnetic Resonance Imaging (MRI) $8,186.00 959314 Mri Pelvis/Hip W/O Con 610 General Magnetic Resonance Imaging (MRI) $9,064.00 959731 Mri Breast Uni W/O &/O 610 General Magnetic Resonance Imaging (MRI) $7,740.00 959732 Mri Breast Bi Wo &/Or 610 General Magnetic Resonance Imaging (MRI) $8,266.00

414611 Mri Or/Fce/Nck W/O Con 611 Brain (including brain stem) $9,588.00

414612 Mri Or/Fce/Nck W/Cont 611 Brain (including brain stem) $8,090.00

414613 Mri Or/Fce/Nck W&Wo 611 Brain (including brain stem) $8,675.00

414620 Mri Brain W/O Contrast 611 Brain (including brain stem) $8,305.00

414621 Mri Brain W/Contrast 611 Brain (including brain stem) $10,510.00

414622 Mri Brain W&Wo Cont 611 Brain (including brain stem) $10,342.00

423758 Mri Brain W/O Contrast 611 Brain (including brain stem) $7,496.00

423759 Mri Brain W/Contrast 611 Brain (including brain stem) $9,387.00 423760 Mri Brain W&Wo Cont 611 Brain (including brain stem) $9,617.00 957002 Mri Brain W/O Cont 611 Brain (including brain stem) $9,593.00 957003 Brain Shunt Mri 611 Brain (including brain stem) $7,911.00 957008 Mri Neck W/O Contrast 611 Brain (including brain stem) $9,530.00 957009 Mri Or/Fce/Nck W/O Con 611 Brain (including brain stem) $10,955.00 957015 Mri Pituitary W/O Cont 611 Brain (including brain stem) $7,916.00

957016 Mri Iac W/O Contrast 611 Brain (including brain stem) $8,436.00

957021 Mri Brain W/Contrast 611 Brain (including brain stem) $12,013.00

957022 Mri Brain W/Wo Cont 611 Brain (including brain stem) $12,311.00

957100 Mri Or/Fce/Nck W/Cont 611 Brain (including brain stem) $9,243.00

957101 Mri Or/Fce/Nck W&Wo 611 Brain (including brain stem) $10,236.00

959729 Mri Pituitary W/Cont 611 Brain (including brain stem) $9,903.00

959730 Mri Pituitary W/Wo Con 611 Brain (including brain stem) $10,146.00

414626 Mri Brachial Plexus w/o Contra 612 Spinal Cord (including spine) $8,495.00

414627 MRI Brachial Plexus w/Contrast 612 Spinal Cord (including spine) $10,447.00 414628 Mri T-Spine W/O Cont 612 Spinal Cord (including spine) $7,959.00 414629 Mri T-Spine W/Contrast 612 Spinal Cord (including spine) $11,492.00 414630 Mri L-Spine W/O Cont 612 Spinal Cord (including spine) $7,892.00 414631 Mri L-Spine W/Cont 612 Spinal Cord (including spine) $11,783.00 414632 Mri C-Spine W&W/O Cont 612 Spinal Cord (including spine) $10,913.00 414633 Mri T-Spine W&W/O Cont 612 Spinal Cord (including spine) $12,431.00

420648 Mra Pelvis w/wo Contrast 612 Spinal Cord (including spine) $6,416.00

421106 Block C/T SPI ADL 612 Spinal Cord (including spine) $3,937.00

421107 Block L-Spine Sgl 612 Spinal Cord (including spine) $3,937.00

182 421814 Mri L-Spine W&W/O Cont 612 Spinal Cord (including spine) $11,420.00 421816 Mri Pelvis W/O Cont 612 Spinal Cord (including spine) $7,931.00 421817 MRI Pelvis W/Contrast 612 Spinal Cord (including spine) $6,594.00 421818 Mri Pelvis W&Wo Cont 612 Spinal Cord (including spine) $10,771.00

423765 Mri C-Spine W/O Cont 612 Spinal Cord (including spine) $8,099.00

423766 Mri C-Spine W/Contrast 612 Spinal Cord (including spine) $9,964.00

423767 Mri T-Spine W/O Cont 612 Spinal Cord (including spine) $7,549.00

423768 Mri T-Spine W/Contrast 612 Spinal Cord (including spine) $10,415.00

423769 Mri L-Spine W/O Cont 612 Spinal Cord (including spine) $7,649.00

423770 Mri L-Spine W/Cont 612 Spinal Cord (including spine) $10,683.00

423771 Mri C-Spine W&W/O Cont 612 Spinal Cord (including spine) $10,180.00

423772 Mri T-Spine W&W/O Cont 612 Spinal Cord (including spine) $11,415.00 423773 Mri L-Spine W&W/O Cont 612 Spinal Cord (including spine) $10,773.00 445142 Bln Optpr 6F 10X3X80 612 Spinal Cord (including spine) $764.00 446941 Bln Optpr 6F 8X3X80 612 Spinal Cord (including spine) $764.00 957010 Mri Pelvis W/Contrast 612 Spinal Cord (including spine) $9,470.00 957011 Mri C-Spine W/O Contra 612 Spinal Cord (including spine) $10,365.00 957012 Mri T-Spine W/O Contra 612 Spinal Cord (including spine) $9,663.00

957013 Mri L-Spine W/O Contra 612 Spinal Cord (including spine) $9,790.00

957023 Mri T-Spine W/Contrast 612 Spinal Cord (including spine) $13,333.00

957024 Mri T-Spine W/Wo Cont 612 Spinal Cord (including spine) $14,611.00

957025 Mri Spine W Contrast 612 Spinal Cord (including spine) $13,668.00

957026 Mri Spine W/Wo Contras 612 Spinal Cord (including spine) $13,785.00

957027 Mri Spine W/Contrast 612 Spinal Cord (including spine) $12,751.00

957028 Mri Cervical W/Wo Cont 612 Spinal Cord (including spine) $13,028.00

957036 Mri L-Spine W&W/O Cont 612 Spinal Cord (including spine) $13,785.00 957109 Mri Pelvis W/Contrast 612 Spinal Cord (including spine) $9,902.00 957110 Mri Pelvis W&Wo Cont 612 Spinal Cord (including spine) $12,311.00 959273 Mra Pelvis W/O Contras 612 Spinal Cord (including spine) $7,342.00 959762 Paramagnetic Cm 612 Spinal Cord (including spine) $2,231.00 314379 Cath Cholangio Cath 621 Supplies Incidental to Radiology $423.00 722457 Gen Code Xray Supplies 621 Supplies Incidental to Radiology $-

749400 Nuclear (Gen Code) Sup 622 Supplies Incidental to Other Diagnostic Services $-

71427 Epoetin Alfa 3000 U ES 634 Erythropoietin (EPO) less than 10,000 units $240.00

71428 Epoetin Alfa 2000 U Es 634 Erythropoietin (EPO) less than 10,000 units $164.00

71429 Epoetin Alfa 10000 U ES 634 Erythropoietin (EPO) less than 10,000 units $246.00

752464 GEN CODE (634) 634 Erythropoietin (EPO) less than 10,000 units $-

901834 Epoetin Alfa 2000Unt/Ml EsrdVl 634 Erythropoietin (EPO) less than 10,000 units $123.00

901843 "Epoetin Alfa 3,000 Unt/Ml Vl" 634 Erythropoietin (EPO) less than 10,000 units $174.00

71455 Epotn Alfa 20000 U Nes 635 Erythropoietin (EPO) more than 10,000 units $584.00

900760 Epoetin Alfa 40000 Unit/Ml Vl 635 Erythropoietin (EPO) more than 10,000 units $619.00 901846 Epoetin Alfa 10000Unt/Ml Vial 635 Erythropoietin (EPO) more than 10,000 units $456.00 71201 Varicella Live Sq 636 Drugs Requiring Detailed Coding $326.00 71202 Exp Methylene Blue M 636 Drugs Requiring Detailed Coding $159.00 71203 Methyldopate HCL 250M 636 Drugs Requiring Detailed Coding $93.00 71205 Calcitonin Salmon 400 636 Drugs Requiring Detailed Coding $179.00 71207 Corticot Ip to 40 Unit 636 Drugs Requiring Detailed Coding $359.00

71209 Dihydroeg Mes/1 mg 636 Drugs Requiring Detailed Coding $155.00

71212 Quinupristn/Dalfoprist 636 Drugs Requiring Detailed Coding $590.00

71214 Hyaluronidase Up to 15 636 Drugs Requiring Detailed Coding $187.00

183 71215 Cyclosporine Oral 25M 636 Drugs Requiring Detailed Coding $30.00 71220 VARICELLA VIRUS VACC LIVE-1 VI 636 Drugs Requiring Detailed Coding $398.00 71223 Treprostintl 1mg Inj 636 Drugs Requiring Detailed Coding $219.00 71254 Carmustine Wafer Bx 8 636 Drugs Requiring Detailed Coding $45,387.00

71292 Exp Fondaparinux Sod 636 Drugs Requiring Detailed Coding $210.00

71356 Regadenoson 0.4mg/5ml 636 Drugs Requiring Detailed Coding $671.00

71364 Regadenoson 0.1mg 636 Drugs Requiring Detailed Coding $619.00

71385 Micafungin 50mg Inj 636 Drugs Requiring Detailed Coding $234.00

71386 Pentobarbital 50mg In 636 Drugs Requiring Detailed Coding $57.00

71387 Cyclosporine 250mg/5 636 Drugs Requiring Detailed Coding $184.00

71430 Arsenic Trioxid 1mg 1 636 Drugs Requiring Detailed Coding $1,334.00

71431 Fondaparinux Sodium 2.5mg/.5ml 636 Drugs Requiring Detailed Coding $189.00 71432 Irinotecan 100mg Inj 636 Drugs Requiring Detailed Coding $251.00 71434 Regadenoson 0.4mg Inj 636 Drugs Requiring Detailed Coding $736.00 71435 Doripenem 500mg Inj 636 Drugs Requiring Detailed Coding $359.00 71438 Palonosetron 0.25mg Inj 636 Drugs Requiring Detailed Coding $679.00 71439 Aprepitant 125mg PO 636 Drugs Requiring Detailed Coding $492.00 71440 Aprepitant 80mg PO 636 Drugs Requiring Detailed Coding $316.00

71441 Oxytocin 30U/500ml NS 636 Drugs Requiring Detailed Coding $521.00

71442 Oxaliplatin 50mg inj 636 Drugs Requiring Detailed Coding $3,319.00

71443 Cladribine 10mg Inj 636 Drugs Requiring Detailed Coding $795.00

71444 Pemetrexed 500mg Inj 636 Drugs Requiring Detailed Coding $8,277.00

71445 Bevacizumab 100mg Inj 636 Drugs Requiring Detailed Coding $1,885.00

71447 Trastuzumab 440mg Inj 636 Drugs Requiring Detailed Coding $9,159.00

71449 Caspofungin 70mg Inj 636 Drugs Requiring Detailed Coding $522.00

71458 Tacrolimus Anhydrous 5mg Cap 636 Drugs Requiring Detailed Coding $115.00 71460 Caspofungin 50mg Inj 636 Drugs Requiring Detailed Coding $336.00 71465 Temozolomide 225mg PO 636 Drugs Requiring Detailed Coding $968.00 71466 Darbepotn Alfa 100mcg 636 Drugs Requiring Detailed Coding $1,531.00 71468 Sargramostim 250 mcg I 636 Drugs Requiring Detailed Coding $510.00 71469 Sargramostim 500mcg I 636 Drugs Requiring Detailed Coding $1,082.00 71473 Mycophenolate Mofetil 500mgTab 636 Drugs Requiring Detailed Coding $153.00

71474 Etoposide 100mg Inj 636 Drugs Requiring Detailed Coding $83.00

71477 Mitoxantrone 20mg Vial 636 Drugs Requiring Detailed Coding $903.00

71479 Zometa 4mg Inj 636 Drugs Requiring Detailed Coding $2,945.00

71480 Fulvestrant 125mg Inj 636 Drugs Requiring Detailed Coding $1,382.00

71484 IronSucrose Complex 100mg/5ml 636 Drugs Requiring Detailed Coding $182.00

71486 Ondansetron Hydrochloride 4mg 636 Drugs Requiring Detailed Coding $98.00

71504 Meropenem 500mg Vial 636 Drugs Requiring Detailed Coding $86.00

71509 Foscar Sod 600mg 636 Drugs Requiring Detailed Coding $414.00

71512 Micafungin 100mg/NS 636 Drugs Requiring Detailed Coding $714.00 71515 Secretin Syn Human 16m 636 Drugs Requiring Detailed Coding $988.00 71525 Cladribine 10mg Inj 636 Drugs Requiring Detailed Coding $1,035.00 71529 Anidulafungin 50mg In 636 Drugs Requiring Detailed Coding $359.00 71530 Sirolimus 1mg Liq 60 636 Drugs Requiring Detailed Coding $1,815.00 71531 Darbepotin Alfa 25 mcg 636 Drugs Requiring Detailed Coding $384.00 71532 Darbepotin Alfa 40mcg 636 Drugs Requiring Detailed Coding $613.00

71533 Darbepotin Alfa 60 mcg 636 Drugs Requiring Detailed Coding $922.00

71539 Leupro Depot 11.25mg Inj 636 Drugs Requiring Detailed Coding $5,912.00

71541 Cilastatin/Imipinm 500 636 Drugs Requiring Detailed Coding $458.00

184 71546 Dopamine 400mg Bag 636 Drugs Requiring Detailed Coding $476.00 71550 Darbepotn Alfa 200mcg 636 Drugs Requiring Detailed Coding $2,467.00 71551 Rho Imm Glob IV 5000 IV 636 Drugs Requiring Detailed Coding $1,780.00 71552 Darbepotn Alfa 150mcg 636 Drugs Requiring Detailed Coding $1,852.00

71553 Darbepotn Alfa 300mcg 636 Drugs Requiring Detailed Coding $3,698.00

71558 Cilastin/Imipinm 250mg/NS 636 Drugs Requiring Detailed Coding $360.00

71561 Thrombin(Bovine) 5000U/Vial 636 Drugs Requiring Detailed Coding $294.00

71562 Pralidoxime Cl up to 1g 636 Drugs Requiring Detailed Coding $474.00

71563 IVIG Gamunex 1gm 636 Drugs Requiring Detailed Coding $367.00

71587 Glatiramer Acetate 20mg Vial 636 Drugs Requiring Detailed Coding $1,610.00

71604 cycloSPORINE, Modified 25mg Ca 636 Drugs Requiring Detailed Coding $18.00

71623 Aprepitant 40mg PO 636 Drugs Requiring Detailed Coding $214.00 71632 Tigecycline 50mg Inj 636 Drugs Requiring Detailed Coding $552.00 71696 Cabazitaxel 60mg Inj 636 Drugs Requiring Detailed Coding $25,348.00 71699 Cyclophosphamide 100mg 636 Drugs Requiring Detailed Coding $69.00 71904 Tube Gastrostomy 636 Drugs Requiring Detailed Coding $708.00 72424 Exp Zoledronic Acid 1mg 636 Drugs Requiring Detailed Coding $3,650.00 72804 Locm Up To 149 Per Ml 636 Drugs Requiring Detailed Coding $12.00

72815 Cont Inj Gs/Du/Jj/Gj 636 Drugs Requiring Detailed Coding $737.00

75012 Mmr 1 Vial 636 Drugs Requiring Detailed Coding $146.00

76309 Tetrofosmin Dx to 40 mci 636 Drugs Requiring Detailed Coding $242.00

79406 Exp Baclofen 10mg 636 Drugs Requiring Detailed Coding $1,530.00

79407 Exp Nesiritide 0.1mg 636 Drugs Requiring Detailed Coding $106.00

79414 Exp Amikacin 100mg 636 Drugs Requiring Detailed Coding $57.00

79415 Sincalide 5mcg 636 Drugs Requiring Detailed Coding $484.00

79419 Exp Cabergoline 0.25m 636 Drugs Requiring Detailed Coding $57.00 79421 Exp Dexametha 0.25 636 Drugs Requiring Detailed Coding $25.00 79423 Exp Dexametha 0.25mg 636 Drugs Requiring Detailed Coding $25.00 79425 Exp Dexametha 0.25mg 636 Drugs Requiring Detailed Coding $25.00 79427 Exp Dexametha 0.25 636 Drugs Requiring Detailed Coding $12.00 79450 Exp Tigecycline Per 1mg 636 Drugs Requiring Detailed Coding $226.00 79478 Mechlorethamine 10mg 636 Drugs Requiring Detailed Coding $180.00

79479 Dactinomycin 0.5 MG Vial 636 Drugs Requiring Detailed Coding $164.00

79485 Exp Epotn Alfa 1000U 636 Drugs Requiring Detailed Coding $342.00

79487 Exp Epotn Alfa 1000 U 636 Drugs Requiring Detailed Coding $528.00

79489 Exp Epotn Alfa 1000U 636 Drugs Requiring Detailed Coding $855.00

79491 Exp Epotin Alfa 1000 U 636 Drugs Requiring Detailed Coding $186.00

171200 Fluvirin Vaccine 3y>1m 636 Drugs Requiring Detailed Coding $86.00

171204 Fulvestrant 250mh Inj 636 Drugs Requiring Detailed Coding $2,623.00

171206 Albumin Inf 5% 500ml 636 Drugs Requiring Detailed Coding $315.00

171215 Leupro Depot 45mg Inj 636 Drugs Requiring Detailed Coding $2,651.00 171281 Fac IX Complex 1 unit 636 Drugs Requiring Detailed Coding $7.00 171297 Naltrexone Depot 10mg 636 Drugs Requiring Detailed Coding $116.00 313363 Exp Derm/Epidrm Hm Sq 636 Drugs Requiring Detailed Coding $4,592.00 413064 Gastrografn Po 367 30M 636 Drugs Requiring Detailed Coding $39.00 413067 Omnipaque Po 240 50ml 636 Drugs Requiring Detailed Coding $31.00 413068 Locm 300 To 399 Per Ml 636 Drugs Requiring Detailed Coding $12.00

413957 Gastrografn Po 367 120 636 Drugs Requiring Detailed Coding $27.00

413959 Locm 100 To 199 Per Ml 636 Drugs Requiring Detailed Coding $4.00

413960 Locm 200 To 299 Per Ml 636 Drugs Requiring Detailed Coding $9.00

185 413962 Locm 300 To 399 Per Ml 636 Drugs Requiring Detailed Coding $6.00 413964 Locm 300 To 399/50 Ml 636 Drugs Requiring Detailed Coding $36.00 414699 Gad Base Mr Cont Nos 1 636 Drugs Requiring Detailed Coding $20.00 417511 Locm 200 To 299 Per Ml 636 Drugs Requiring Detailed Coding $12.00

417512 Locm 300 To 399 Per Ml 636 Drugs Requiring Detailed Coding $11.00

417978 Rhig Hmn Fulldose 300M 636 Drugs Requiring Detailed Coding $345.00

418168 Nm Myocrd Spect R/S Mu 636 Drugs Requiring Detailed Coding $3,923.00

421167 Omnipaque Po 240 50Ml 636 Drugs Requiring Detailed Coding $28.00

421363 Fac Viii Recomb 1U Nos 636 Drugs Requiring Detailed Coding $3.00

421364 Factor Viia 1 Microgra 636 Drugs Requiring Detailed Coding $3.00

421365 Albumin Inf 25% 20Ml 636 Drugs Requiring Detailed Coding $42.00

421366 Albumin Inf 5% 250Ml 636 Drugs Requiring Detailed Coding $115.00 421367 Albumin Inf 25% 50 Ml 636 Drugs Requiring Detailed Coding $116.00 421368 Fac Ix Pur Non Recom 636 Drugs Requiring Detailed Coding $3.00 423947 Perflutren Lipid Mcrs 636 Drugs Requiring Detailed Coding $394.00 425455 Acetaminophn Iv 1000Mg/100MlVl 636 Drugs Requiring Detailed Coding $137.00 686842 Albumin Inf 25% 20Ml 636 Drugs Requiring Detailed Coding $88.00 686843 Albumin Inf 5% 250Ml 636 Drugs Requiring Detailed Coding $237.00

686844 Albumin Inf 25% 50 Ml 636 Drugs Requiring Detailed Coding $238.00

687484 Albumin 25% 636 Drugs Requiring Detailed Coding $88.00

687489 Albumin 5% 636 Drugs Requiring Detailed Coding $237.00

689023 Factor 8 Human 100 Uni 636 Drugs Requiring Detailed Coding $17.00

689026 Factor 9 100 Units 636 Drugs Requiring Detailed Coding $17.00

747081 Radionuclide-Octreosca 636 Drugs Requiring Detailed Coding $5,594.00

749049 Ind 111 Oxyquinoline 636 Drugs Requiring Detailed Coding $5,928.00

749311 Radionucide - 5 Nici I 636 Drugs Requiring Detailed Coding $2,625.00 749408 Radionuclide-Gallium 636 Drugs Requiring Detailed Coding $115.00 749409 In 111 Oxyqui 636 Drugs Requiring Detailed Coding $5,554.00 749410 Sod Iodid I 131 636 Drugs Requiring Detailed Coding $3,610.00 749411 Radionuclide-Technetiu 636 Drugs Requiring Detailed Coding $604.00 749412 Radionuclide-Thallium-201,Per 636 Drugs Requiring Detailed Coding $154.00 749413 Sod Iod I-123 636 Drugs Requiring Detailed Coding $50.00

749414 Radionuclide Tetrofosm 636 Drugs Requiring Detailed Coding $2,190.00

749415 Radionuclide-Gallium-O 636 Drugs Requiring Detailed Coding $2,045.00

749417 Radiopharmeceutical Se 636 Drugs Requiring Detailed Coding $583.00

749418 I.V. Dipyridamole-10 M 636 Drugs Requiring Detailed Coding $517.00

749421 Co 57/58 Cyan Kit 636 Drugs Requiring Detailed Coding $2,042.00

749424 I.V. Adenosine 6Mg-Inj 636 Drugs Requiring Detailed Coding $98.00

749425 Radionuclide Technetiu 636 Drugs Requiring Detailed Coding $104.00

749440 Adenosine 30 Mg 636 Drugs Requiring Detailed Coding $421.00

749449 Sulfur Colloid Per Mci 636 Drugs Requiring Detailed Coding $25.00 749452 Therp Radiopharm 636 Drugs Requiring Detailed Coding $11,580.00 749454 Nuc Pharmaceutical Arc 636 Drugs Requiring Detailed Coding $8,699.00 749516 Nm Radiopharm Dx Img 636 Drugs Requiring Detailed Coding $4,909.00 749572 Nm Thyroid Scn W/Up S 636 Drugs Requiring Detailed Coding $2,892.00 749591 Adenosine 6mg Inj Dx 636 Drugs Requiring Detailed Coding $57.00 750575 Capecitabine 150mg Tab 636 Drugs Requiring Detailed Coding $29.00

751601 TEMOZOLAMIDE 5 MG CAP 636 Drugs Requiring Detailed Coding $49.00

752002 Aldesleukin 18 MIU Vial 636 Drugs Requiring Detailed Coding $1,493.00

752173 Ertapenem Sod 1gm Inj 636 Drugs Requiring Detailed Coding $232.00

186 752314 DAUNORUBICIN 10 MG 636 Drugs Requiring Detailed Coding $471.00 752315 Daunorubicin Cit Lip 5 636 Drugs Requiring Detailed Coding $3,438.00 752374 DYPYRID 10 MG DOSE-TES 636 Drugs Requiring Detailed Coding $70.00 752437 GEMTUZUMAB 5MG/20ML 636 Drugs Requiring Detailed Coding $7,295.00

752474 IMMUNE GLOBIN 1 GM INJ 636 Drugs Requiring Detailed Coding $294.00

752541 FLUZONE VACCINE 3Y> 1M 636 Drugs Requiring Detailed Coding $86.00

752609 LEUPROLIDE 3.75MG INJ 636 Drugs Requiring Detailed Coding $1,691.00

752614 LEUPROLIDE 7.5MG/1.5 M 636 Drugs Requiring Detailed Coding $1,880.00

752820 PACLITAXEL 30MG/5ML IN 636 Drugs Requiring Detailed Coding $722.00

752887 PNEUMOCCAL 7-VAL CONJ 636 Drugs Requiring Detailed Coding $431.00

752975 VINORELBINE 10 MG INJ 636 Drugs Requiring Detailed Coding $420.00

753149 TOPOTECAN 4 MG INJ 636 Drugs Requiring Detailed Coding $2,533.00 753164 TETANUS DIPHTHERIA INJ 636 Drugs Requiring Detailed Coding $124.00 753166 LIDOCAINE/EPI 1.5% SDV 636 Drugs Requiring Detailed Coding $683.00 799003 EXP PALIVIZUMAB PER 50 636 Drugs Requiring Detailed Coding $1,122.00 799015 EXP SIROLIMUS 1MG 636 Drugs Requiring Detailed Coding $2,667.00 799027 EXP DARBEPOETIN 1 MCG 636 Drugs Requiring Detailed Coding $2,044.00 799036 EXP LINEZOLID 200 MG 636 Drugs Requiring Detailed Coding $402.00

799051 ALTEPLASE 2MG/2ML INJ 636 Drugs Requiring Detailed Coding $167.00

799056 EXP FOSPHENYT 50 MG 636 Drugs Requiring Detailed Coding $127.00

799058 EXP FOSPHENYT 50 MG 636 Drugs Requiring Detailed Coding $273.00

799060 EXP MYCOPHENOLATE 250 636 Drugs Requiring Detailed Coding $69.00

799072 EXP MITOXANTRONE 5 MG 636 Drugs Requiring Detailed Coding $4,163.00

799089 DAPTOMYCIN 1 MG 636 Drugs Requiring Detailed Coding $7.00

799095 EXP BACLOFEN 500 MG 636 Drugs Requiring Detailed Coding $820.00

799097 EXP BACLOFEN PER 2000 636 Drugs Requiring Detailed Coding $1,530.00 799099 EXP BACLOFEN PER 2000 636 Drugs Requiring Detailed Coding $2,666.00 799102 AMPHOTERICIN B 50 MG I 636 Drugs Requiring Detailed Coding $334.00 799104 EXP CILAS SOD IMIP/250 636 Drugs Requiring Detailed Coding $422.00 799115 EXP IRON DEXTRAN 50 MG 636 Drugs Requiring Detailed Coding $83.00 799126 EXP ONDANSETRON HCL/1M 636 Drugs Requiring Detailed Coding $108.00 799128 EXP DESMOP ACE/1 MCG 636 Drugs Requiring Detailed Coding $50.00

799132 PHENTO MESY UP TO 5MG 636 Drugs Requiring Detailed Coding $151.00

799133 EXP NA FERRIC GLUC COM 636 Drugs Requiring Detailed Coding $142.00

799135 EXP THIAMINE HCL 100 M 636 Drugs Requiring Detailed Coding $36.00

799140 AZATHIOPRINE 100 MG VI 636 Drugs Requiring Detailed Coding $294.00

799141 EXP EPOETIN ALPHA/1000 636 Drugs Requiring Detailed Coding $137.00

799144 EXP INTERFERON BETA1A 636 Drugs Requiring Detailed Coding $888.00

799150 RABIES IMMUNE GLOBULIN 300 IN 636 Drugs Requiring Detailed Coding $1,043.00

799152 EXP DOPAMINE HCL 40 MG 636 Drugs Requiring Detailed Coding $38.00

799161 ADENOSINE 6 MG INJ TX 636 Drugs Requiring Detailed Coding $57.00 799162 ADENOSINE 6 MG INJ DX 636 Drugs Requiring Detailed Coding $57.00 799163 IMMUNE GLOB LYOPH 1G 636 Drugs Requiring Detailed Coding $223.00 799164 IMMUNE GLOB NONLYOPH 1 636 Drugs Requiring Detailed Coding $291.00 900611 Tigecycline 50 Mg Vial 636 Drugs Requiring Detailed Coding $455.00 900635 Ibutilide Fumarate 1Mg/10Ml Vl 636 Drugs Requiring Detailed Coding $756.00 900636 Amiodarone Hcl 150 Mg/3 Ml Vl 636 Drugs Requiring Detailed Coding $47.00

900676 Digoxn Immun Fab 40Mg/4Ml Vl 636 Drugs Requiring Detailed Coding $9,809.00

900687 Acetylcysteine 6000Mg/30MlVl 636 Drugs Requiring Detailed Coding $452.00

900692 Capecitabine 500 Mg Tab 636 Drugs Requiring Detailed Coding $109.00

187 900719 METHADONE 50 MG 636 Drugs Requiring Detailed Coding $148.00 900729 Multihance 20 ML 636 Drugs Requiring Detailed Coding $360.00 900735 Locm 300 To 399/ 100 M 636 Drugs Requiring Detailed Coding $600.00 900742 MICAFUNGIN 100 MG INJ 636 Drugs Requiring Detailed Coding $324.00

900745 LOM 300 to 399/50 ML 636 Drugs Requiring Detailed Coding $39.00

900786 Pyridoxine Hcl 100 Mg/Ml Vial 636 Drugs Requiring Detailed Coding $32.00

900814 HaemphBPolyscV-MenngPrt0.5MlVl 636 Drugs Requiring Detailed Coding $289.00

900837 Acyclovir Sodium 500Mg/10Ml Vl 636 Drugs Requiring Detailed Coding $77.00

900865 Albumin Hum 25% 12.5Gm/50MlBtl 636 Drugs Requiring Detailed Coding $299.00

900867 Albumin Human 25 Gm/100 Ml Inj 636 Drugs Requiring Detailed Coding $258.00

900913 Alteplase. 100 Mg Vial 636 Drugs Requiring Detailed Coding $29,343.00

900922 Desmopressin Acett 4Mcg/Ml Amp 636 Drugs Requiring Detailed Coding $45.00 900932 Cefoxitin Sodium 2 Gm Vial 636 Drugs Requiring Detailed Coding $108.00 900933 Cefoxitin Sodium 1 Gm Vial 636 Drugs Requiring Detailed Coding $79.00 900958 Fosphenytoin Sod 100Mg/2Ml Vl 636 Drugs Requiring Detailed Coding $106.00 900959 Fosphenytoin Sod 500Mg/10MlVl 636 Drugs Requiring Detailed Coding $227.00 901064 Amphotericin B Liposom 50Mg Vl 636 Drugs Requiring Detailed Coding $227.00 901177 Azithromycin 250 Mg Tab 636 Drugs Requiring Detailed Coding $180.00

901187 Baclofen 50 Mcg/Ml Amp 636 Drugs Requiring Detailed Coding $324.00

901188 Baclofen 10 Mg Kit 636 Drugs Requiring Detailed Coding $871.00

901268 Botulinum Toxin A 100 Unit Vl 636 Drugs Requiring Detailed Coding $2,092.50

901290 Albumin Human 5% 250Ml Iv.Soln 636 Drugs Requiring Detailed Coding $156.00

901343 Rabie ImmGlbln 300Intnt/2Ml Vl 636 Drugs Requiring Detailed Coding $831.00

901345 Caffeine Citrated 60Mg/3Ml Inj 636 Drugs Requiring Detailed Coding $200.00

901349 Calcitonin-Salmn 400Unt/2Ml Vl 636 Drugs Requiring Detailed Coding $7,663.00

901427 CHLORPROMAZINE 50 MG I 636 Drugs Requiring Detailed Coding $47.00 901456 CIPROFLOXACIN 200 MG B 636 Drugs Requiring Detailed Coding $290.00 901551 EstrogensConjugated 25Mg Vial 636 Drugs Requiring Detailed Coding $594.00 901556 Cosyntropin 0.25 Mg Vial 636 Drugs Requiring Detailed Coding $262.00 901572 Rituximab 100 Mg/10 Ml 636 Drugs Requiring Detailed Coding $2,934.00 901620 Rasburicase 1.5 Mg Vial 636 Drugs Requiring Detailed Coding $2,620.00 901741 Abatacept 250 mg Inj 636 Drugs Requiring Detailed Coding $3,050.00

901745 Cetuximab 100 Mg/50 Ml 636 Drugs Requiring Detailed Coding $1,521.00

901747 Dopamine Hcl 400 Mg Vial 636 Drugs Requiring Detailed Coding $32.00

901806 FondprnxSod2.5Mg/0.5MlDispSyrg 636 Drugs Requiring Detailed Coding $189.00

901808 FondprnxSod7.5Mg/0.6MlDispSyrg 636 Drugs Requiring Detailed Coding $249.00

901818 Epinephrine 1 Mg/Ml Amp 636 Drugs Requiring Detailed Coding $127.00

901829 Eptifibatide 20 Mg/10 Ml Vial 636 Drugs Requiring Detailed Coding $531.00

901844 Epoetin Alfa 2000Unt/Ml NsrdVl 636 Drugs Requiring Detailed Coding $123.00

901848 EPOTN ALFA 1000 U NESR 636 Drugs Requiring Detailed Coding $30.00

901850 ERYTHRO LACTO 500 MG V 636 Drugs Requiring Detailed Coding $315.00 901866 ETHANOLAMINE OLEAT 100 636 Drugs Requiring Detailed Coding $872.00 901938 Voriconazole 200 Mg/20 Ml Vial 636 Drugs Requiring Detailed Coding $332.00 901955 Fludarabine Phosphate 50 Mg Vl 636 Drugs Requiring Detailed Coding $1,114.00 901965 Fluphenazine Decant 25Mg/MlUdi 636 Drugs Requiring Detailed Coding $165.00 901994 Decitabine 50 Mg/20 Ml Vial 636 Drugs Requiring Detailed Coding $4,627.00 901997 Gemcitabine Hcl 200 Mg/5.26 Ml 636 Drugs Requiring Detailed Coding $423.00

901998 Bortezomib 3.5 Mg/Vial Ml 636 Drugs Requiring Detailed Coding $6,493.00

902043 GlucgnHumn Recombnt 1Mg/Ml Vl 636 Drugs Requiring Detailed Coding $607.97

902128 Bivalirudin 250 Mg Vial 636 Drugs Requiring Detailed Coding $3,685.00

188 902129 HepatitBImmn Globulin1MlAdtUdi 636 Drugs Requiring Detailed Coding $565.00 902195 Imipenem/Cilasttn Sod 250Mg Vl 636 Drugs Requiring Detailed Coding $193.00 902197 Imipenem/Cilastn Sod 500Mg Inj 636 Drugs Requiring Detailed Coding $277.00 902198 Meropenem 500 Mg Vial 636 Drugs Requiring Detailed Coding $86.00

902200 Meropenem 1 Gm Vial 636 Drugs Requiring Detailed Coding $169.00

902203 Idarubicin Hcl 5 Mg/5 Ml Vial 636 Drugs Requiring Detailed Coding $967.00

902204 Ifosfamide 1 Gm Vial 636 Drugs Requiring Detailed Coding $672.00

902220 Immune Globulin 6Gm/100Ml Inj 636 Drugs Requiring Detailed Coding $1,167.00

902245 Levetiracetam 500 Mg/5 Ml Vial 636 Drugs Requiring Detailed Coding $152.00

902256 Iron Sucrs Cmplx 100Mg/5Ml Inj 636 Drugs Requiring Detailed Coding $182.00

902305 Leuprld Acet 22.5Mg/SyrDispSyr 636 Drugs Requiring Detailed Coding $5,931.00

902307 Leuprld Act 7.5Mg/Syr DispSyrg 636 Drugs Requiring Detailed Coding $2,044.00 902331 Linezolid/D5W 600 Mg/300 Ml Bg 636 Drugs Requiring Detailed Coding $616.00 902396 Albumin Human 5 Gm/20 Ml Btl 636 Drugs Requiring Detailed Coding $43.00 902477 Metaxalone 800 Mg Tab 636 Drugs Requiring Detailed Coding $47.00 902519 Methylprednsoln Acet 40Mg/MlVl 636 Drugs Requiring Detailed Coding $59.00 902627 Cyclosporine Modifid 25Mg Cap 636 Drugs Requiring Detailed Coding $18.00 902628 Tacrolimus Anhydros 5Mg/Ml Amp 636 Drugs Requiring Detailed Coding $579.00

902630 Sirolimus 1 Mg Tab 636 Drugs Requiring Detailed Coding $58.00

902636 Mycophenolate Mofetil 250MgCap 636 Drugs Requiring Detailed Coding $31.00

902637 Mycophenolate Mofetl 500Mg Tab 636 Drugs Requiring Detailed Coding $153.00

902727 Octreotide Acett 0.05Mg/Ml Amp 636 Drugs Requiring Detailed Coding $64.00

902729 Octreotide Acetat 0.1Mg/Ml Amp 636 Drugs Requiring Detailed Coding $126.00

902740 PERFLUTRN LIPID MCRS 2 636 Drugs Requiring Detailed Coding $432.00

902777 Pemetrexed Disodium 500 Mg Vl 636 Drugs Requiring Detailed Coding $11,602.00

902966 Azacitidine 100 Mg/Vial Vial 636 Drugs Requiring Detailed Coding $1,257.00 902967 Interfrn Beta-1B 0.3Mg/1.2MlVl 636 Drugs Requiring Detailed Coding $663.00 903084 Infliximab 100 Mg Vial 636 Drugs Requiring Detailed Coding $3,856.00 903126 Cyclosporin(Sandimmn)100MgCap 636 Drugs Requiring Detailed Coding $38.00 903159 Ziprasidone Hcl 20 Mg Vial 636 Drugs Requiring Detailed Coding $128.00 903171 Sincalide 5 Mcg Vial 636 Drugs Requiring Detailed Coding $338.00 903228 Sumatrip Succ 6 Mg/0.5 Ml Vial 636 Drugs Requiring Detailed Coding $749.00

903249 Daptomycin 500 Mg Vial 636 Drugs Requiring Detailed Coding $3.00

903251 Docetaxel 20 Mg/2 Ml 636 Drugs Requiring Detailed Coding $875.00

903255 Temozolomide 100 Mg Cap 636 Drugs Requiring Detailed Coding $447.00

903256 Temozolomide 20 Mg Cap 636 Drugs Requiring Detailed Coding $146.00

903273 Tetanus Imm Glob 250 Unit Inj 636 Drugs Requiring Detailed Coding $850.00

903277 LOCM 100-199 Per ML 636 Drugs Requiring Detailed Coding $5.00

903296 Thiamine Hcl 200 Mg/2 Ml Vial 636 Drugs Requiring Detailed Coding $33.00

903478 Ondanstrn Hydrchlor 4Mg/2Ml Vl 636 Drugs Requiring Detailed Coding $98.00

903496 Varicll Virus Vac Lve 1/Ea Vil 636 Drugs Requiring Detailed Coding $476.00 903505 VANCOMYCIN 750 MG VL 636 Drugs Requiring Detailed Coding $108.00 903507 VANCOMYCIN 1 GM ADV 636 Drugs Requiring Detailed Coding $108.00 903520 HEPARIN 2000 U BAG 636 Drugs Requiring Detailed Coding $283.00 903523 Nesiritide 1.5 Mg Vial 636 Drugs Requiring Detailed Coding $4,082.00 903588 Moxlx Hcl/Ncl 0.8% 400Mg/250Ml 636 Drugs Requiring Detailed Coding $164.00 903856 Rho(D) Imm Globul50McgDispSyrg 636 Drugs Requiring Detailed Coding $192.00

903878 Rho(D)ImmGlob300Mcg/2MlDispSyg 636 Drugs Requiring Detailed Coding $349.00

903921 SodFrrcGlcCmplx/Sc62.5Mg/5MlVl 636 Drugs Requiring Detailed Coding $130.00

903970 Thrombin (Bovine) 5000 Unit/Vl 636 Drugs Requiring Detailed Coding $350.00

189 904030 Glatiramer Acetate 20 Mg Vial 636 Drugs Requiring Detailed Coding $1,610.00 905019 Eptifibatide 75Mg/100Ml Iv.Btl 636 Drugs Requiring Detailed Coding $1,661.00 905137 Pneumo Conj vac 13 Val IM 636 Drugs Requiring Detailed Coding $587.00 905142 TREPROSTINIL 1 MG INJ 636 Drugs Requiring Detailed Coding $330.00

905174 Baclofen 40 Mg Kit 636 Drugs Requiring Detailed Coding $3,483.00

905197 Factor VIIA 2 MG Inj 636 Drugs Requiring Detailed Coding $8,270.00

905273 FACTOR VIIA 1 MG INJ 636 Drugs Requiring Detailed Coding $4,137.00

905299 Mngcl Vac A C Y W-135 0.5MlInj 636 Drugs Requiring Detailed Coding $357.00

905316 Tacrolimus Anhydrous 5 Mg Cap 636 Drugs Requiring Detailed Coding $115.00

905319 Milrin Lact/D5W 40Mg/200MlIvbg 636 Drugs Requiring Detailed Coding $543.00

905325 Iron Dextrn Cmplx 100Mg/2Ml Vl 636 Drugs Requiring Detailed Coding $58.00

905433 IVIG PRIVIGEN 5G/50 ML 636 Drugs Requiring Detailed Coding $1,489.00 905434 ARGATROBAN 50 MG INJ 636 Drugs Requiring Detailed Coding $561.00 905449 ALTEPLASE RECOMB 1MG 636 Drugs Requiring Detailed Coding $293.00 905457 FAC IX RECOMB 636 Drugs Requiring Detailed Coding $5.00 905462 Haloperidol Decanoat100Mg/MlVl 636 Drugs Requiring Detailed Coding $170.00 905477 FLU VACCINE PF ID 636 Drugs Requiring Detailed Coding $98.00 905493 Brentuximab 50mg Inj 636 Drugs Requiring Detailed Coding $22,851.00

905494 Medrxyprgstrn Acet 150Mg/Ml Vl 636 Drugs Requiring Detailed Coding $305.00

905498 FLUTICASONE 50 INH 636 Drugs Requiring Detailed Coding $327.00

905499 ATOVAQUONE/PROGUANIL T 636 Drugs Requiring Detailed Coding $13.00

905536 LOCM 200 TO 299/ 50 ML 636 Drugs Requiring Detailed Coding $76.00

905778 FLU VAC FLUBLOK 636 Drugs Requiring Detailed Coding $158.00

905787 AMPIC/SULB 30MG INJ PE 636 Drugs Requiring Detailed Coding $6.00

905830 Octreotide Acetate 10Mg/kt Ml 636 Drugs Requiring Detailed Coding $6,107.00

905905 TBO-FILGRASTM 300MCG I 636 Drugs Requiring Detailed Coding $904.00 905906 TBO-FILGRASTM 480MCG I 636 Drugs Requiring Detailed Coding $1,446.00 905916 ADENOSINE DIAG 60 MG 636 Drugs Requiring Detailed Coding $418.00 905917 ADENOSINE DIAG 90 MG 636 Drugs Requiring Detailed Coding $577.00 905922 FILGRASTIM 300 MCG INJ 636 Drugs Requiring Detailed Coding $1,162.00 905923 FILGRASTIM 480 MCG INJ 636 Drugs Requiring Detailed Coding $1,960.00 905926 ZOLEDRONIC ACID 4MG IN 636 Drugs Requiring Detailed Coding $231.00

905930 BETA INTRFRN 1A IM 30M 636 Drugs Requiring Detailed Coding $2,032.00

905937 INFLUENZA TRI RIV3 PF 636 Drugs Requiring Detailed Coding $133.00

905939 Dexamethasone 1MG/ML UDL 636 Drugs Requiring Detailed Coding $8.00

906088 FLU Vacc Quad PF 0.25ML 636 Drugs Requiring Detailed Coding $65.00

906125 Propofol 200 MG Inj 636 Drugs Requiring Detailed Coding $75.00

906138 TESTOSTERONE CYP 1MG I 636 Drugs Requiring Detailed Coding $2.00

906160 PEDS-AZTREONAM 20MG/ML 636 Drugs Requiring Detailed Coding $6.00

906412 Cmpd Ketmn 50mg 5s 636 Drugs Requiring Detailed Coding $33.00

906844 CARMUSTINE WAFERS 8/BO 636 Drugs Requiring Detailed Coding $120,726.00 906845 PRAXBIND INJ 636 Drugs Requiring Detailed Coding $6,615.00 907194 Daptomycin 1 Mg Inj 636 Drugs Requiring Detailed Coding $3.00 907357 Bridion Inj 636 Drugs Requiring Detailed Coding $307.00 905072 INSULIN 5 U INJ 637 Self-administrable drugs $10.00 905694 Melatonin 3mg Tab 637 Self-administrable drugs $6.00 905779 MESALAMINE 400MG CAP 637 Self-administrable drugs $20.00

905857 Lacosamide 150mg 637 Self-administrable drugs $76.00

905891 PALIPERIDONE 9MG TAB 637 Self-administrable drugs $113.00

905898 OSELTAMIVIR 75 MG/12.5 637 Self-administrable drugs $65.00

190 905934 COMBIVENT RESPIM INH 637 Self-administrable drugs $645.00 905998 Stribild Tablet 637 Self-administrable drugs $215.00 906047 Lurasidone HCL 20 MG Tab 637 Self-administrable drugs $107.00 906071 Memantine 14 MG Cap.SPR.24 637 Self-administrable drugs $52.00

906081 MEMANTINE XR 7MG CAP 637 Self-administrable drugs $52.00

906084 MEMANTINE XR 21MG CAP 637 Self-administrable drugs $52.00

906085 MEMANTINE XR 28MG CAP 637 Self-administrable drugs $52.00

906093 GUAIFENESIN DM600-30 T 637 Self-administrable drugs $7.00

906140 FLU Vac Quad IIV4 PF ID 637 Self-administrable drugs $65.00

906145 BURPRENOR.HCL NALOX HCL 2MG TA 637 Self-administrable drugs $44.00

906147 BURPRENORPHINE HCL/NALOX 8MG T 637 Self-administrable drugs $44.00

906149 OSELTAMIVIR 30MG CAP 637 Self-administrable drugs $52.00 906159 VANCOMYCIN 125MG UDL 637 Self-administrable drugs $27.00 906176 Dolutegravie 50 MG Tab 637 Self-administrable drugs $113.00 906186 MICONAZOLE POWDER 71G 637 Self-administrable drugs $27.00 906191 SENNA 8.8 MG/5ML 637 Self-administrable drugs $6.00 906195 LINACLOTIDE 145 MCG CA 637 Self-administrable drugs $39.00 906196 LINACLOTIDE 290 MCG CA 637 Self-administrable drugs $39.00

906204 DULERA 100/5MCG INH 637 Self-administrable drugs $266.00

906205 DULERA 200/5MCG INH 637 Self-administrable drugs $266.00

906803 PANCRELIPASE 5000 CAP 637 Self-administrable drugs $13.00

906841 SULFAMETH/TRIM 5ML SUS 637 Self-administrable drugs $34.00

906846 Oseltamivir 30 MG/5ML 637 Self-administrable drugs $30.00

906857 Ipratrop 0.5MG NEB Sol 637 Self-administrable drugs $3.00

906863 Ciproflox Otic Sol .25ML 637 Self-administrable drugs $37.00

906908 VORAPAXAR 2.08 MG TAB 637 Self-administrable drugs $47.00 906909 GLUCOSE 0.8 GM/2ML 637 Self-administrable drugs $6.00 906917 DESCOVY 200/25 TAB 637 Self-administrable drugs $126.00 906918 Genvoya 150/200mg 637 Self-administrable drugs $221.00 906960 Mult/Iron 15 ML 637 Self-administrable drugs $4.00 906979 Trizivir Tab 637 Self-administrable drugs $81.00 907349 FLU VACC RIV4 PF AF IM 637 Self-administrable drugs $133.00

907352 Celecoxib 400MG Cap 637 Self-administrable drugs $36.00

907423 Perampanel 8MG Tab 637 Self-administrable drugs $96.00

907480 Phenazopyridine 95MG Tab 637 Self-administrable drugs $22.00

907486 Biktarvy Tab 637 Self-administrable drugs $250.00

938919 Darunav/Cobici 800/150 MG Tab 637 Self-administrable drugs $206.00

357008 Recovery Room 1st 1/2 Hour 710 General Recovery Room $2,287.00

357009 Recovery Room Add 1/2 Hour 710 General Recovery Room $1,892.00

412803 Pacu First 60 Min 710 General Recovery Room $4,232.00

412804 Pacu Addl 30 Min 710 General Recovery Room $1,752.00 418814 Pacu First 60 Min 710 General Recovery Room $5,005.00 418815 Pacu Addl 30 Min 710 General Recovery Room $2,071.00 427826 Rec Rm 30 Min 710 General Recovery Room $873.00 428402 Rec Rm Add 15 Min 710 General Recovery Room $1,061.00 429676 Gen Code (710) 710 General Recovery Room $- 520018 Recovery Room 1St 1/2 710 General Recovery Room $2,006.00

520019 Recovery Room Addl 1/2 710 General Recovery Room $1,659.00

520204 Recovery Room Phase 2 710 General Recovery Room $216.00

417558 Request for Service 727 Other $-

191 432139 THRMBC/NFS DIALYSIS CIRC 727 Other $17,710.00 432142 BAL ANGIO CTR DIALYSIS SEG 727 Other $16,689.00 417392 Ekg Tracing Only 730 General EKG/ECG (Electrocardiogram) $777.00 417394 Rhythm Strip Trace 730 General EKG/ECG (Electrocardiogram) $533.00

417395 Holter Record Visual 730 General EKG/ECG (Electrocardiogram) $2,266.00

423949 Ekg Tracing Only 730 General EKG/ECG (Electrocardiogram) $739.00

678000 Ekg Tracing Only 730 General EKG/ECG (Electrocardiogram) $540.00

678001 Ekg - Standard/Ecg 730 General EKG/ECG (Electrocardiogram) $787.00

678008 Holter Record Mini P/O 730 General EKG/ECG (Electrocardiogram) $1,274.00

678017 Gen Code Cv Sono 730 General EKG/ECG (Electrocardiogram) $-

679714 Ekg Signal Averaged 730 General EKG/ECG (Electrocardiogram) $1,522.00

417396 Holter Scan Visual 731 Holter Monitor $759.00 678009 Holter Record Mini P/O 731 Holter Monitor $2,290.00 678100 Holter Anaysis P/O 731 Holter Monitor $768.00 74304 Eeg Monitor Video 24 H 740 General EEG (Electroencephalogram) $6,317.00 147001 Eeg Digital Analysis 740 General EEG (Electroencephalogram) $120.00 147045 Eeg 740 General EEG (Electroencephalogram) $247.00 147047 Eeg Awake/Drosey 740 General EEG (Electroencephalogram) $321.00

147048 Eeg Greater 1 Hour 740 General EEG (Electroencephalogram) $337.00

417739 Eeg Up To 1 Hr 740 General EEG (Electroencephalogram) $1,169.00

417740 Eeg Greater Than 1 Hr 740 General EEG (Electroencephalogram) $1,092.00

417742 Eeg Rec Aw & Asleep 740 General EEG (Electroencephalogram) $3,052.00

417743 Eeg Coma Or Sleep Only 740 General EEG (Electroencephalogram) $3,735.00

417762 Eeg Monitor Video 24 H 740 General EEG (Electroencephalogram) $6,250.00

417767 Digital Analysis Eeg 740 General EEG (Electroencephalogram) $1,169.00

422919 Eeg Monitor Cbl/Rad At 740 General EEG (Electroencephalogram) $4,640.00 425502 Ndl Elec Para Vel 5 Or 740 General EEG (Electroencephalogram) $464.00 717825 Gen Code - Eeg 740 General EEG (Electroencephalogram) $- 718018 Sleep Eeg 740 General EEG (Electroencephalogram) $3,774.00 718020 EEG 740 General EEG (Electroencephalogram) $2,881.00 719820 Eeg Up To 1 Hr 740 General EEG (Electroencephalogram) $1,210.00 719822 Digital Analysis 740 General EEG (Electroencephalogram) $1,103.00

97597 Eeg Digital Analysis 740 General EEG (Electroencephalogram) $120.00

97597SP Sp Eeg Digital Analysis 740 General EEG (Electroencephalogram) $270.00

414419 Gastroesophag Reflx Test 750 General Gastro-Intestinal Services $1,614.00

414424 Capsule Endoscopy Ileu 750 General Gastro-Intestinal Services $4,145.00

414461 Ercp W/Chg Stent/Tu/Fb 750 General Gastro-Intestinal Services $7,102.00

414462 Colonoscopy Dx 750 General Gastro-Intestinal Services $6,888.00

414463 Col W/Biopsy 750 General Gastro-Intestinal Services $7,205.00

414464 Colonoscopy W/Rem Fb 750 General Gastro-Intestinal Services $9,101.00

414465 Colon W/Snare Tech 750 General Gastro-Intestinal Services $7,205.00 414466 Colon W/Hbf Or Bc 750 General Gastro-Intestinal Services $7,205.00 414467 Colonoscopy Other 750 General Gastro-Intestinal Services $9,101.00 414468 Col W/Cntrl Bld 750 General Gastro-Intestinal Services $8,260.00 414469 Colonoscopy Stoma Dx 750 General Gastro-Intestinal Services $6,888.00 414475 Proc W/Dilation 750 General Gastro-Intestinal Services $2,483.00 414480 Sigmoid Dx 750 General Gastro-Intestinal Services $3,648.00

414497 Ercp W/Rem Stone 750 General Gastro-Intestinal Services $9,185.00

414498 Upper Gi Endo W/Biopsy 750 General Gastro-Intestinal Services $4,830.00

414505 Upper Gi Endo W/Hbf/Bc 750 General Gastro-Intestinal Services $4,830.00

192 414506 Upper Gi Endo Other 750 General Gastro-Intestinal Services $4,490.00 414507 Upper Gi Endo W/Gd Wir 750 General Gastro-Intestinal Services $6,206.00 414510 Dil Esop W/Balloon 750 General Gastro-Intestinal Services $1,889.00 414511 Ercp W/Biopsy 750 General Gastro-Intestinal Services $7,418.00

414512 Ercp W/Sphinc/Papil 750 General Gastro-Intestinal Services $8,894.00

414515 Ercp W/Place Stent 750 General Gastro-Intestinal Services $8,539.00

414517 Esophagoscopy W/Bal Di 750 General Gastro-Intestinal Services $3,708.00

414518 Esophagoscopy W/Biopsy 750 General Gastro-Intestinal Services $2,843.00

414520 Esophagoscopy W/Band L 750 General Gastro-Intestinal Services $3,709.00

414522 Esophagoscopy W/In Tb 750 General Gastro-Intestinal Services $3,964.00

414525 Upper Gi Endo W/Us Ex 750 General Gastro-Intestinal Services $4,885.00

414527 Colon Submucosal Injec 750 General Gastro-Intestinal Services $4,093.00 414589 Bx Liver 750 General Gastro-Intestinal Services $3,097.00 420674 Esophagus Motility Std 750 General Gastro-Intestinal Services $2,097.00 420939 Esophagoscopy W/Rm Fb 750 General Gastro-Intestinal Services $4,751.00 420943 Esophagoscopy W/Gd Wir 750 General Gastro-Intestinal Services $4,214.00 420944 Esophagoscopy Other 750 General Gastro-Intestinal Services $10,014.00 420945 Upper Gi Endo Dx 750 General Gastro-Intestinal Services $4,517.00

420946 Upper Gi Endo W/Submu 750 General Gastro-Intestinal Services $3,849.00

420947 Upper GI Endo W/Biopsy 750 General Gastro-Intestinal Services $3,128.00

420948 Upper Gi Endo W/Inj Sc 750 General Gastro-Intestinal Services $5,663.00

420951 Upper Gi Endo W/Place 750 General Gastro-Intestinal Services $11,610.00

420952 Upper Gi Endo W/Rem Fb 750 General Gastro-Intestinal Services $6,736.00

420954 Upper Gi Endo W/Bal Di 750 General Gastro-Intestinal Services $5,948.00

420956 Upper Gi Endo W/Snare 750 General Gastro-Intestinal Services $4,830.00

420957 Upper Gi Endo W/Cntr B 750 General Gastro-Intestinal Services $7,391.00 420959 Ercp Dx 750 General Gastro-Intestinal Services $7,101.00 420965 Ercp W/Abablation 750 General Gastro-Intestinal Services $8,479.00 420973 Colonoscopy Stoma Othe 750 General Gastro-Intestinal Services $9,101.00 420977 Unlisted Proc Intestin 750 General Gastro-Intestinal Services $4,333.00 420979 Proctosigmoidoscopy Dx 750 General Gastro-Intestinal Services $2,483.00 420982 Sig W/Biopsy 750 General Gastro-Intestinal Services $3,966.00

420983 Sig W/Hbf Or Bc 750 General Gastro-Intestinal Services $3,966.00

420984 Sig W/Cntl Bld 750 General Gastro-Intestinal Services $4,795.00

420985 Sigmoid W/ Tat00 750 General Gastro-Intestinal Services $3,825.00

420986 Sig W/Decomp Volvulus 750 General Gastro-Intestinal Services $8,445.00

420987 Sig W/Snare Tech 750 General Gastro-Intestinal Services $3,966.00

420991 Col W/Submuc Inj 750 General Gastro-Intestinal Services $3,159.00

420996 Colonoscopy W/Ballon D 750 General Gastro-Intestinal Services $4,084.00

420997 Colonoscopy W/Wall Ste 750 General Gastro-Intestinal Services $8,329.00

421047 Rplc Gastrojejnsty Tub 750 General Gastro-Intestinal Services $2,077.00 421161 Proce Catagory 1 750 General Gastro-Intestinal Services $1,175.00 421813 Upper Gi Endo W/Band L 750 General Gastro-Intestinal Services $5,696.00 423049 Bronch w Alveolar Lavage 750 General Gastro-Intestinal Services $13,429.00 423456 Esoph Tamponade 750 General Gastro-Intestinal Services $5,835.00 425404 Ins Endovas Vc Filter 750 General Gastro-Intestinal Services $21,126.00 425418 Paracentesis w/Image 750 General Gastro-Intestinal Services $2,588.00

426325 Thoracentesis W/O Imag 750 General Gastro-Intestinal Services $14,623.00

427003 Ercp Dx 750 General Gastro-Intestinal Services $6,598.00

427004 Proc Dx 750 General Gastro-Intestinal Services $2,307.00

193 427009 Esophagoscopy Dx 750 General Gastro-Intestinal Services $2,353.00 427070 Tatoo 750 General Gastro-Intestinal Services $1,008.00 427828 Irradium Implant 750 General Gastro-Intestinal Services $1,675.00 428066 Liver Biopsy 750 General Gastro-Intestinal Services $2,880.00

428069 Outside Proc In Dept 750 General Gastro-Intestinal Services $2,633.00

428076 Ileoscopy Dx 750 General Gastro-Intestinal Services $5,190.00

428081 Paracentesis 750 General Gastro-Intestinal Services $2,605.00

428082 Thoracentesis 750 General Gastro-Intestinal Services $2,089.00

428093 Sigmoid Dx 750 General Gastro-Intestinal Services $3,392.00

428099 Colonoscopy Stoma Dx 750 General Gastro-Intestinal Services $6,402.00

428100 Anoscopy Dx 750 General Gastro-Intestinal Services $989.00

428101 Anoscopy Sgl W/Hbf Or 750 General Gastro-Intestinal Services $1,291.00 428102 Anoscopy Sgl W/Sn Tech 750 General Gastro-Intestinal Services $992.00 428104 Anoscopy W/Biop 750 General Gastro-Intestinal Services $1,291.00 428105 Anoscopy W/Cntl Bld 750 General Gastro-Intestinal Services $2,055.00 428106 Anoscopy W/Dil 750 General Gastro-Intestinal Services $1,237.00 428300 Rectal Manometry 750 General Gastro-Intestinal Services $2,960.00 428546 Unlisted Proc Stomach 750 General Gastro-Intestinal Services $3,441.00

428547 Unlisted Proc Anus 750 General Gastro-Intestinal Services $2,425.00

428706 Anoscopy W/Rem Fb 750 General Gastro-Intestinal Services $3,059.00

428707 Col W/Biopsy 750 General Gastro-Intestinal Services $6,697.00

428708 Col W/Cntrl Bld 750 General Gastro-Intestinal Services $7,677.00

428709 Colon Stoma W/Hbf Or B 750 General Gastro-Intestinal Services $6,697.00

428710 Colon W/Hbf Or Bc 750 General Gastro-Intestinal Services $6,697.00

428711 Colon W/Snare Tech 750 General Gastro-Intestinal Services $6,697.00

428712 Colonoscopy Dx 750 General Gastro-Intestinal Services $6,402.00 428713 Colonoscopy Stoma W/Bi 750 General Gastro-Intestinal Services $6,697.00 428714 Colonoscopy Stoma W/Cn 750 General Gastro-Intestinal Services $7,461.00 428715 Colonoscopy Stoma W/Rm 750 General Gastro-Intestinal Services $8,470.00 428716 Colonoscopy Stoma W/Sn 750 General Gastro-Intestinal Services $5,181.00 428717 Colonoscopy Transab 750 General Gastro-Intestinal Services $6,402.00 428718 Colonoscopy W/Rem Fb 750 General Gastro-Intestinal Services $8,459.00

428719 Dil Esop W/Balloon 750 General Gastro-Intestinal Services $1,757.00

428720 Ercp W/Biopsy 750 General Gastro-Intestinal Services $6,895.00

428721 Ercp W/Chg Stent/Tu/Fb 750 General Gastro-Intestinal Services $7,102.00

428722 Ercp W/Dilate Balloon 750 General Gastro-Intestinal Services $9,610.00

428723 Ercp W/In Drain Tube 750 General Gastro-Intestinal Services $7,935.00

428724 Ercp W/Lithotripsy 750 General Gastro-Intestinal Services $9,901.00

428725 Ercp W/Place Stent 750 General Gastro-Intestinal Services $7,935.00

428726 Ercp W/Rem Stone 750 General Gastro-Intestinal Services $9,185.00

428727 Ercp W/Sphinc/Papil 750 General Gastro-Intestinal Services $8,267.00 428728 Esoph Tamponade 750 General Gastro-Intestinal Services $5,423.00 428729 Esophagoscopy Other 750 General Gastro-Intestinal Services $2,353.00 428730 Esophagoscopy W/Bal Di 750 General Gastro-Intestinal Services $3,708.00 428731 Esophagoscopy W/Band L 750 General Gastro-Intestinal Services $3,448.00 428732 Esophagoscopy W/Biopsy 750 General Gastro-Intestinal Services $2,643.00 428733 Esophagoscopy W/Gd Wir 750 General Gastro-Intestinal Services $3,919.00

428734 Esophagoscopy W/Hbf/Bc 750 General Gastro-Intestinal Services $2,379.00

428735 Esophagoscopy W/In Tb 750 General Gastro-Intestinal Services $3,686.00

428736 Esophagoscopy W/Inj Sc 750 General Gastro-Intestinal Services $3,414.00

194 428737 Esophagoscopy W/Rm Fb 750 General Gastro-Intestinal Services $4,415.00 428738 Gt Removal 750 General Gastro-Intestinal Services $499.00 428739 Gt Replacement 750 General Gastro-Intestinal Services $989.00 428740 Gt Reposition 750 General Gastro-Intestinal Services $989.00

428741 Ileoscopy W/Biop 750 General Gastro-Intestinal Services $5,485.00

428742 Proc Mul W/Hbf/Bc/St 750 General Gastro-Intestinal Services $3,221.00

428743 Proc Sgl W/Hbf Or Bc 750 General Gastro-Intestinal Services $2,604.00

428744 Proc Sgl W/Snare Tech 750 General Gastro-Intestinal Services $2,606.00

428745 Proc W/Biopsy 750 General Gastro-Intestinal Services $2,604.00

428746 Proc W/Cntl Bld 750 General Gastro-Intestinal Services $3,376.00

428747 Proc W/Decomp Volvulus 750 General Gastro-Intestinal Services $2,929.00

428748 Proc W/Dilation 750 General Gastro-Intestinal Services $2,560.00 428749 Proc W/Rem Fb 750 General Gastro-Intestinal Services $4,374.00 428750 Sig W/Biopsy 750 General Gastro-Intestinal Services $3,688.00 428751 Sig W/Cntl Bld 750 General Gastro-Intestinal Services $4,457.00 428752 Sig W/Decomp Volvulus 750 General Gastro-Intestinal Services $7,850.00 428753 Sig W/Hbf Or Bc 750 General Gastro-Intestinal Services $3,688.00 428754 Sig W/Removal Fb 750 General Gastro-Intestinal Services $3,478.00

428755 Sig W/Snare Tech 750 General Gastro-Intestinal Services $3,688.00

428756 Dil Esop Ung Snd/Boug 750 General Gastro-Intestinal Services $2,050.00

428758 Upper Gi Endo Other 750 General Gastro-Intestinal Services $4,490.00

428759 Upper Gi Endo W/Band L 750 General Gastro-Intestinal Services $5,295.00

428760 Upper Gi Endo W/Biopsy 750 General Gastro-Intestinal Services $4,490.00

428761 Upper Gi Endo W/Dil Ga 750 General Gastro-Intestinal Services $5,124.00

428762 Upper Gi Endo W/Gd Wir 750 General Gastro-Intestinal Services $3,938.00

428763 Upper Gi Endo W/Hbf/Bc 750 General Gastro-Intestinal Services $4,490.00 428764 Upper Gi Endo W/Inj Sc 750 General Gastro-Intestinal Services $5,265.00 428765 Upper Gi Endo W/Place 750 General Gastro-Intestinal Services $10,788.00 428766 Upper Gi Endo W/Rem Fb 750 General Gastro-Intestinal Services $6,261.00 428767 Upper Gi Endo W/Snare 750 General Gastro-Intestinal Services $4,490.00 428768 Upper Gi Endo W/Tb Or 750 General Gastro-Intestinal Services $5,581.00 428786 Ercp W/Endo Stnt Bil/P 750 General Gastro-Intestinal Services $9,735.00

429042 Sm Bwl Cntrl Bleed 750 General Gastro-Intestinal Services $6,641.00

429569 Upper Gi Endo Dx 750 General Gastro-Intestinal Services $4,199.00

429703 Upper Gi Endo W/Bal Di 750 General Gastro-Intestinal Services $5,528.00

429704 Upper Gi Endo W/Cntr B 750 General Gastro-Intestinal Services $6,870.00

417557 Gen Code (760) 760 General Treatment/Observation Room $-

422289 Rem/Adj Dev/Cath Only 760 General Treatment/Observation Room $855.00

520211 GEN CODE (760) 760 General Treatment/Observation Room $-

421562 Procedure Category 1 761 Treatment Room $947.00

412404 OBS W/TELE PER HOUR 762 Observation Room $165.00 421307 Direct Referral To Obs 762 Observation Room $976.00 421333 Obs Per Hour 762 Observation Room $93.00 421334 Obs Per Hour W/Tele 762 Observation Room $166.00 208051 Acute Dialysis Treative 801 Inpatient Hemodialysis $416.00 218051 Acute Dialysis Treatment 801 Inpatient Hemodialysis $416.00 228051 Acute Dialysis Treatment 801 Inpatient Hemodialysis $416.00

238051 Acute Dialysis Treatment 801 Inpatient Hemodialysis $416.00

239051 ACUTE DIALYSIS TREATMENT 801 Inpatient Hemodialysis $416.00

417778 Hemodialysis In 801 Inpatient Hemodialysis $1,080.00

195 776906 Hemodialysis Treatment 801 Inpatient Hemodialysis $1,063.00 777154 Charcoal Kidney 801 Inpatient Hemodialysis $2,416.00 777157 Cavh Treatment 801 Inpatient Hemodialysis $375.00 779700 Gen Code Dialysis 801 Inpatient Hemodialysis $-

779815 Al-Fe Kidney 801 Inpatient Hemodialysis $3,408.00

775008 Gen Code Dialysis 820 General Hemodialysis- Outpatient or Home $-

520205 Ect Tx 901 Electroshock Treatment $1,975.00

146735 Psychotherapy Group 911 Rehabilitation Psychiatric/Psychological Services $75.00

147510 Psychotherapy Family 911 Rehabilitation Psychiatric/Psychological Services $212.00

147518 Health Behavior Intervent 911 Rehabilitation Psychiatric/Psychological Services $48.00

147519 Health Behavior Int Group 911 Rehabilitation Psychiatric/Psychological Services $11.00

147520 Health/ Behavior Int Fam W/Pt 911 Rehabilitation Psychiatric/Psychological Services $47.00 147521 Health Behavior Int Fam 911 Rehabilitation Psychiatric/Psychological Services $45.00 147522 Physical Activity Group 911 Rehabilitation Psychiatric/Psychological Services $67.00 147523 Stress Reduction/Relax Group 911 Rehabilitation Psychiatric/Psychological Services $67.00 147530 Psyc Test By Psychologist 911 Rehabilitation Psychiatric/Psychological Services $182.00 147535 Psyc Test By Technician 911 Rehabilitation Psychiatric/Psychological Services $90.00 147536 Psyc Test by Technician 911 Rehabilitation Psychiatric/Psychological Services $90.00

147540 Psyc Test By Computer 911 Rehabilitation Psychiatric/Psychological Services $50.00

147706 Psych Diag Eval 911 Rehabilitation Psychiatric/Psychological Services $338.00

147707 Psytx 30 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $126.00

147708 Psytx 45 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $162.00

147709 Psytx 60 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $236.00

147711 Inter Complex Add-On 911 Rehabilitation Psychiatric/Psychological Services $10.00

147712 Inter Complex Add-On 911 Rehabilitation Psychiatric/Psychological Services $10.00

147713 Psytx 60 Min Pat and/or Fam 911 Rehabilitation Psychiatric/Psychological Services $236.00 147715 Psych Crisis First 60 M 911 Rehabilitation Psychiatric/Psychological Services $302.00 147716 Psych Crisis Add 30 M 911 Rehabilitation Psychiatric/Psychological Services $162.00 147717 Psych Crisis Add 30 M 911 Rehabilitation Psychiatric/Psychological Services $162.00 147718 Psych Crisis Addl 30 min 911 Rehabilitation Psychiatric/Psychological Services $162.00 147858 Psych Test/Eval CP 1st hr 911 Rehabilitation Psychiatric/Psychological Services $182.00 147859 Psych Test/Eval CP add hr 911 Rehabilitation Psychiatric/Psychological Services $182.00

147860 Prof TestScore 1st 30mins 911 Rehabilitation Psychiatric/Psychological Services $182.00

147861 Prof TestScore add 30mins 911 Rehabilitation Psychiatric/Psychological Services $182.00

147868 Tech 2+ Test/Score 30mins 911 Rehabilitation Psychiatric/Psychological Services $90.00

147869 Tech 2+ Test/Score add 30 911 Rehabilitation Psychiatric/Psychological Services $90.00

147870 Single E-Platform Auto 911 Rehabilitation Psychiatric/Psychological Services $110.00

149860 Psychotherapy Group 911 Rehabilitation Psychiatric/Psychological Services $75.00

149908 Multi Family Group Medical Psy 911 Rehabilitation Psychiatric/Psychological Services $212.00

149916 Interact Group Psychotherapy 911 Rehabilitation Psychiatric/Psychological Services $75.00

90847 Psychotherapy Family 911 Rehabilitation Psychiatric/Psychological Services $212.00 90853 Psychotherapy Group 911 Rehabilitation Psychiatric/Psychological Services $75.00

COG6740 Misc 911 Rehabilitation Psychiatric/Psychological Services $- COG6741 Case Conference 911 Rehabilitation Psychiatric/Psychological Services $- COG6799 Misc 911 Rehabilitation Psychiatric/Psychological Services $- COG9201 Cancellation-Refused 911 Rehabilitation Psychiatric/Psychological Services $- COG9203 Cancellation-Md 911 Rehabilitation Psychiatric/Psychological Services $-

COG9206 Cancellation-Nursing Care 911 Rehabilitation Psychiatric/Psychological Services $-

COG9371 Gen Code 911 Rehabilitation Psychiatric/Psychological Services $-

COG9899 Cancellation 911 Rehabilitation Psychiatric/Psychological Services $-

196 COGX9200 Cancellation-Sick 911 Rehabilitation Psychiatric/Psychological Services $- COGX9204 Cancellation-Testing 911 Rehabilitation Psychiatric/Psychological Services $- COGX9205 Cancellation Unable Participat 911 Rehabilitation Psychiatric/Psychological Services $- PSY5020 Health-Behavior Ind Tx 15 Min 911 Rehabilitation Psychiatric/Psychological Services $59.00

PSY5030 Health-Behavior Grp Tx 15 Min 911 Rehabilitation Psychiatric/Psychological Services $49.00

PSY5040 Health-Behavior Fam W/Pt 15 Mi 911 Rehabilitation Psychiatric/Psychological Services $59.00

PSY5041 Psych Diag Eval 911 Rehabilitation Psychiatric/Psychological Services $225.00

PSY5042 Psytx 30 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $93.00

PSY5043 Psytx 45 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $121.00

PSY5044 Psytx 60 Min P And/Or Fa 911 Rehabilitation Psychiatric/Psychological Services $177.00

PSY5045 Inter Complex Add-On 911 Rehabilitation Psychiatric/Psychological Services $11.00

PSY5046 Psych Crisis First 60 M 911 Rehabilitation Psychiatric/Psychological Services $309.00

PSY5047 Psych Crisis Add 30 M 911 Rehabilitation Psychiatric/Psychological Services $166.00 PSY6718 Psychotherapy Family W/Pt 911 Rehabilitation Psychiatric/Psychological Services $238.00 PSY6740 Case Conference 911 Rehabilitation Psychiatric/Psychological Services $- PSY6749 Health-Behavior Fam W/O Pt 15M 911 Rehabilitation Psychiatric/Psychological Services $59.00 PSY6756 Psychotherapy Fam W/O Pt 911 Rehabilitation Psychiatric/Psychological Services $209.00 PSY6758 Psychotherapy Group 911 Rehabilitation Psychiatric/Psychological Services $124.00 PSY6763 Diagnostic Record Review 15Min 911 Rehabilitation Psychiatric/Psychological Services $64.00

PSY7530 Psy Test Psychologist Per Hr 911 Rehabilitation Psychiatric/Psychological Services $212.00

PSY7535 Psy Test Technician Per Hour 911 Rehabilitation Psychiatric/Psychological Services $96.00

PSY7540 Psy Test Computer 911 Rehabilitation Psychiatric/Psychological Services $54.00

PSY7550 Neuropsy Test/ Rpt Tech Per Hr 911 Rehabilitation Psychiatric/Psychological Services $160.00

PSY7560 Interact Group Psychotherapy 911 Rehabilitation Psychiatric/Psychological Services $75.00

PSY9200 Cancellation - Sick 911 Rehabilitation Psychiatric/Psychological Services $-

PSY9201 Cancellation - Refused 911 Rehabilitation Psychiatric/Psychological Services $-

PSY9812 Psych Test/Eval CP 1st hr 911 Rehabilitation Psychiatric/Psychological Services $182.00 PSY9813 Psych Test/Eval CP add hr 911 Rehabilitation Psychiatric/Psychological Services $182.00 PSY9814 Prof TestScore 1st 30mins 911 Rehabilitation Psychiatric/Psychological Services $182.00 PSY9815 Prof TestScore add 30mins 911 Rehabilitation Psychiatric/Psychological Services $182.00

PSY9822 Tech 2+ Test/Score 30mins 911 Rehabilitation Psychiatric/Psychological Services $90.00 PSY9823 Tech 2+ Test/Score add 30 911 Rehabilitation Psychiatric/Psychological Services $90.00 PSY9824 Single E-Platform Auto 911 Rehabilitation Psychiatric/Psychological Services $110.00

859376 Misc Doc Psych 914 Individual Therapy Psychiatric/Psychological Services $-

COG6746 Ind Cog Sensory Integ Tx 15 Mn 914 Individual Therapy Psychiatric/Psychological Services $19.00

PSY6743 Interactive/Play Psy 20-30 Min 914 Individual Therapy Psychiatric/Psychological Services $59.00

PSY6744 Interactive/Play Psy 45-50 Min 914 Individual Therapy Psychiatric/Psychological Services $86.00

147701 Psychotherapy Family-No Pt 916 Family Therapy Psychiatric/Psychological Services $186.00

146813 Biofeedback Anor/Vag 917 Bio Feedback - Psychiatric/Psychological Services $126.00

147043 Biofeedback Therapy 917 Bio Feedback - Psychiatric/Psychological Services $147.00

149805 Computer Data Analysis 917 Bio Feedback - Psychiatric/Psychological Services $41.00 428301 Biofeedback 917 Bio Feedback - Psychiatric/Psychological Services $1,189.00 90901 Biofeedback Therapy 917 Bio Feedback - Psychiatric/Psychological Services $147.00

90901SP Sp Biofeedback Therapy 917 Bio Feedback - Psychiatric/Psychological Services $147.00 90911 Biofeedback An/Vag 917 Bio Feedback - Psychiatric/Psychological Services $126.00

90911SP Sp Biofeedback An/Vag 917 Bio Feedback - Psychiatric/Psychological Services $126.00 14-1036F Non Tobacco User 918 Testing - Psychiatric/Psychological Services $0.01

14-107 Adult w MDD+Suicide Risk Assmt 918 Testing - Psychiatric/Psychological Services $0.01

14-131 Adult Pain Assmt+F/U 918 Testing - Psychiatric/Psychological Services $0.01

14-134 Depression Screen+F/U 918 Testing - Psychiatric/Psychological Services $0.01

197 14-181 Elder Maltmt Screen+F/U 918 Testing - Psychiatric/Psychological Services $0.01 14-226 Tobacco Use Screen+Intrvntn 918 Testing - Psychiatric/Psychological Services $0.01 14-281 Dementia Cog Assmt 918 Testing - Psychiatric/Psychological Services $0.01 14-282 Dementia Functional Assmt 918 Testing - Psychiatric/Psychological Services $0.01

14-283 Dementia Beh Psy Screen+Mgmt 918 Testing - Psychiatric/Psychological Services $0.01

14-286 Dementia Safety Screen+Recs 918 Testing - Psychiatric/Psychological Services $0.01

14-288 Dementia Caregiver Ed+Referral 918 Testing - Psychiatric/Psychological Services $0.01

14-290 Parkinsons Psych Assmt 918 Testing - Psychiatric/Psychological Services $0.01

14-291 Parkinsons Cog Assmt 918 Testing - Psychiatric/Psychological Services $0.01

14-293 Parkinsons Rehab Tx Options 918 Testing - Psychiatric/Psychological Services $0.01

14-30161P Prv Care/Scr:Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

14-3016F Prv Care/Scr:Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

14-3016F8 P Prv Care/Scr:Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01 14-325 Adult w MDD+Comorbid Care Comm 918 Testing - Psychiatric/Psychological Services $0.01 14-371 Depression PHQ9 918 Testing - Psychiatric/Psychological Services $0.01 14-374 Specialist Report to Referral 918 Testing - Psychiatric/Psychological Services $0.01 14-382 Pedi w MDD+Suicide Risk Assmt 918 Testing - Psychiatric/Psychological Services $0.01 14-4004F Screen Tobacco-W Counseling 918 Testing - Psychiatric/Psychological Services $0.01 14-4004F1 P No Screen-Doc Reasons Why 918 Testing - Psychiatric/Psychological Services $0.01

14-4004F8 P No Screen-Reason Not Spec 918 Testing - Psychiatric/Psychological Services $0.01

14-411 Depression 6mos Remission 918 Testing - Psychiatric/Psychological Services $0.01

14-414 Opioid Misuse Risk Eval 918 Testing - Psychiatric/Psychological Services $0.01

14-431 Unhealthy ETOH Screen+Intrvntn 918 Testing - Psychiatric/Psychological Services $0.01

14-4320F Counseled Substance Tx Options 918 Testing - Psychiatric/Psychological Services $0.01

14-G8417 BMI Above Normal W FU 918 Testing - Psychiatric/Psychological Services $0.01

14-G8418 BMI Below Normal W FU 918 Testing - Psychiatric/Psychological Services $0.01

14-G8419 BMI Abnormal No FU,No Reason 918 Testing - Psychiatric/Psychological Services $0.01 14-G8420 BMI WNL 918 Testing - Psychiatric/Psychological Services $0.01 14-G8421 BMI Not Documented no Reason 918 Testing - Psychiatric/Psychological Services $0.01 14-G8422 BMI Not Documented Not Eligib 918 Testing - Psychiatric/Psychological Services $0.01

14-G8427 Meds Reviewed 918 Testing - Psychiatric/Psychological Services $0.01 14-G8428 Meds Not Reviewed - No Reason 918 Testing - Psychiatric/Psychological Services $0.01 14-G8430 Meds Not Reviewed-No Eligible 918 Testing - Psychiatric/Psychological Services $0.01

14-G8431 Scrn Depression Pos W-Fu 918 Testing - Psychiatric/Psychological Services $0.01

14-G8432 Scrn Depression Not Doc-No Rea 918 Testing - Psychiatric/Psychological Services $0.01

14-G8433 Scrn Depression Not Doc-Inelg 918 Testing - Psychiatric/Psychological Services $0.01

14-G8442 Pain Assmnt Not Doc-Ineligible 918 Testing - Psychiatric/Psychological Services $0.01

14-G8482 Influenza Inmunization Adm 918 Testing - Psychiatric/Psychological Services $0.01

14-G8509 Pain Assmnt Pos No Fu No Reaso 918 Testing - Psychiatric/Psychological Services $0.01

14-G8510 Scrn Depression Neg 918 Testing - Psychiatric/Psychological Services $0.01

14-G8511 Scrn Depr Pos-No Fu No Reason 918 Testing - Psychiatric/Psychological Services $0.01 14-G8535 Elder Maltreat Assess-Not Elig 918 Testing - Psychiatric/Psychological Services $0.01 14-G8536 Elder Maltreat Assess-Not Done 918 Testing - Psychiatric/Psychological Services $0.01 14-G8730 Pain Assmnt Pos W-Fu 918 Testing - Psychiatric/Psychological Services $0.01 14-G8731 Pain Assmnt Neg 918 Testing - Psychiatric/Psychological Services $0.01 14-G8732 Pain Assmnt Not Done 918 Testing - Psychiatric/Psychological Services $0.01 14-G8733 Elder Maltreat Assess Pos W Fu 918 Testing - Psychiatric/Psychological Services $0.01

14-G8734 Elder Maltreat Assess Neg 918 Testing - Psychiatric/Psychological Services $0.01

14-G8735 Elder Maltreat Asess Pos No Fu 918 Testing - Psychiatric/Psychological Services $0.01

14-G8783 Prv care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

198 14-G8784 Prv Care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01 14-G8785 Prv care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01 14-G8938 Prev care/Scr & FU Plan 918 Testing - Psychiatric/Psychological Services $0.01 14-G8939 Pain Assmnt Pos No Fu Ineligib 918 Testing - Psychiatric/Psychological Services $0.01

14-G8940 Scrn Depression Pos-No Fu Inel 918 Testing - Psychiatric/Psychological Services $0.01

14-G8941 Elder Maltreat Asess Pos No Fu 918 Testing - Psychiatric/Psychological Services $0.01

14-G8950 Prv care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

14-G8951 Prv care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

14-G8952 Prv care/Scr Unhealthy Alc Use 918 Testing - Psychiatric/Psychological Services $0.01

14-G8959 Adlt Mdd:Cord Care/Comorbd Cnd 918 Testing - Psychiatric/Psychological Services $0.01

14-G9232 Adlt Mdd:Cord Care/Comorbd Cnd 918 Testing - Psychiatric/Psychological Services $0.01

14-G9621 Pt Screen Identified Alcohol 918 Testing - Psychiatric/Psychological Services $0.01

14-G9622 Pt Screen Unidentified Alcohol 918 Testing - Psychiatric/Psychological Services $0.01 14-G9623 Doc Med Reason Unhealthy Alco 918 Testing - Psychiatric/Psychological Services $0.01 14-G9624 Pt Not Screen Unhealthy Alco 918 Testing - Psychiatric/Psychological Services $0.01 146721 Ext Develop Eval/Report 918 Testing - Psychiatric/Psychological Services $290.00 146725 Neurobehav Exam Report 918 Testing - Psychiatric/Psychological Services $208.00 147516 Health Behavior Assess 918 Testing - Psychiatric/Psychological Services $51.00

147517 Health Behavior Reassess 918 Testing - Psychiatric/Psychological Services $50.00

147527 Day Treatment Program Full Day 918 Testing - Psychiatric/Psychological Services $950.00

147541 Aphasia Exam W/Report (Per Hr) 918 Testing - Psychiatric/Psychological Services $128.00

147545 Neuropsy Test/Rpt Psychologist 918 Testing - Psychiatric/Psychological Services $230.00

147550 Neuropsy Test/Rpt Technician 918 Testing - Psychiatric/Psychological Services $150.00

147555 Neuropsy Test/Rpt Computer 918 Testing - Psychiatric/Psychological Services $110.00

147854 Developmental Screen 918 Testing - Psychiatric/Psychological Services $213.00

147855 Developmental Test 1st hr 918 Testing - Psychiatric/Psychological Services $276.00 147856 NBSE w Report 1st hour 918 Testing - Psychiatric/Psychological Services $208.00 147857 NBSE w Report add hour 918 Testing - Psychiatric/Psychological Services $208.00 147862 NeuroPsy Test/Eval CP 1st 918 Testing - Psychiatric/Psychological Services $230.00 147863 NeuroPsy Test/Eval CP add 918 Testing - Psychiatric/Psychological Services $230.00 147864 Prof TestScore 1st 30mins 918 Testing - Psychiatric/Psychological Services $230.00 147865 Prof TestScore add 30mins 918 Testing - Psychiatric/Psychological Services $230.00

147866 Tech 2+ Test/Score 30mins 918 Testing - Psychiatric/Psychological Services $150.00

147867 Tech 2+ Test/Score add 30 918 Testing - Psychiatric/Psychological Services $150.00

147871 Developmental Test add 30 918 Testing - Psychiatric/Psychological Services $124.00

149356 Legal Forensic Activity Per Hr 918 Testing - Psychiatric/Psychological Services $550.00

149720 Comprehensive Pain Eval 918 Testing - Psychiatric/Psychological Services $1,500.00

149726 Comprenhensive Pain Evaluation 918 Testing - Psychiatric/Psychological Services $1,500.00

149809 Forensic Neuropsych Eval Wc 918 Testing - Psychiatric/Psychological Services $4,500.00

149810 Neuropsych Eval Case Rate 918 Testing - Psychiatric/Psychological Services $2,600.00

149812 Neuropsych Eval <6 Years Old 918 Testing - Psychiatric/Psychological Services $1,200.00 149813 Neuropsych Eval 6-25 Years Old 918 Testing - Psychiatric/Psychological Services $1,700.00 149814 Neuropsych Eval 26-70 Year Old 918 Testing - Psychiatric/Psychological Services $1,500.00 149815 Neuropsych Eval >70 Years Old 918 Testing - Psychiatric/Psychological Services $750.00

PEDNPE Neuro Psych Eval <6 Yrs Old 918 Testing - Psychiatric/Psychological Services $1,200.00 PEDNPE6 Neuro Psych Eval 6-25 Yrs Old 918 Testing - Psychiatric/Psychological Services $1,700.00 PSY1036F Non Tobacco User 918 Testing - Psychiatric/Psychological Services $0.01

PSY107 Adult w MDD+Suicide Risk Assmt 918 Testing - Psychiatric/Psychological Services $0.01

PSY131 Adult Pain Assmt+F/U 918 Testing - Psychiatric/Psychological Services $0.01

PSY134 Depression Screen+F/U 918 Testing - Psychiatric/Psychological Services $0.01

199 PSY181 Elder Maltmt Screen+F/U 918 Testing - Psychiatric/Psychological Services $0.01 PSY226 Tobacco Use Screen+Intrvntn 918 Testing - Psychiatric/Psychological Services $0.01 PSY281 Dementia Cog Assmt 918 Testing - Psychiatric/Psychological Services $0.01 PSY282 Dementia Functional Assmt 918 Testing - Psychiatric/Psychological Services $0.01

PSY283 Dementia Beh Psy Screen+Mgmt 918 Testing - Psychiatric/Psychological Services $0.01

PSY286 Dementia Safety Screen+Recs 918 Testing - Psychiatric/Psychological Services $0.01

PSY288 Dementia Caregiver Ed+Referral 918 Testing - Psychiatric/Psychological Services $0.01

PSY290 Parkinsons Psych Assmt 918 Testing - Psychiatric/Psychological Services $0.01

PSY291 Parkinsons Cog Assmt 918 Testing - Psychiatric/Psychological Services $0.01

PSY293 Parkinsons Rehab Tx Options 918 Testing - Psychiatric/Psychological Services $0.01

PSY325 Adult w MDD+Comorbid Care Comm 918 Testing - Psychiatric/Psychological Services $0.01

PSY371 Depression PHQ9 918 Testing - Psychiatric/Psychological Services $0.01

PSY374 Specialist Report to Referral 918 Testing - Psychiatric/Psychological Services $0.01 PSY382 Pedi w MDD+Suicide Risk Assmt 918 Testing - Psychiatric/Psychological Services $0.01 PSY4004F Screen Tobacco-W Counseling 918 Testing - Psychiatric/Psychological Services $0.01 PSY4004F1 P No Screen-Doc Reasons Why 918 Testing - Psychiatric/Psychological Services $0.01 PSY4004F8 P No Screen-Reason Not Spec 918 Testing - Psychiatric/Psychological Services $0.01 PSY411 Depression 6mos Remission 918 Testing - Psychiatric/Psychological Services $0.01 PSY414 Opioid Misuse Risk Eval 918 Testing - Psychiatric/Psychological Services $0.01

PSY431 Unhealthy ETOH Screen+Intrvntn 918 Testing - Psychiatric/Psychological Services $0.01

PSY5000 Health-Behavior Assess 15 Min 918 Testing - Psychiatric/Psychological Services $73.00

PSY5010 Health-Behavior Reassess 15Min 918 Testing - Psychiatric/Psychological Services $61.00

PSY6717 Neurobehavioral Exam/Report 918 Testing - Psychiatric/Psychological Services $213.00

PSY6721 Ext Developmental Test/Report 918 Testing - Psychiatric/Psychological Services $308.00

PSY6722 Aphasia Examination Per Hr 918 Testing - Psychiatric/Psychological Services $136.00

PSY7545 Neuropsy Test/Rpt Psyc Per Hr 918 Testing - Psychiatric/Psychological Services $235.00

PSY7555 Neuropsy Test/ Rpt Computer 918 Testing - Psychiatric/Psychological Services $125.00 PSY7556 Neuropsych Eval <6 Years Old 918 Testing - Psychiatric/Psychological Services $1,200.00 PSY7557 Neuropsych Eval 6-25 Years Old 918 Testing - Psychiatric/Psychological Services $1,700.00 PSY7558 Neuropsych Eval 26-70 Year Old 918 Testing - Psychiatric/Psychological Services $1,500.00

PSY7559 Neuropsych Eval > 70 Years Old 918 Testing - Psychiatric/Psychological Services $750.00 PSY7563 Legal Forensic Activity Per Hr 918 Testing - Psychiatric/Psychological Services $550.00 PSY7564 Forensic Neuropsych Eval Wc 918 Testing - Psychiatric/Psychological Services $4,400.00

PSY7565 Neuropsych Eval Case Rate 918 Testing - Psychiatric/Psychological Services $2,500.00

PSY7700 Developmental Eval Limited 918 Testing - Psychiatric/Psychological Services $213.00

PSY9808 Developmental Test 1st hr 918 Testing - Psychiatric/Psychological Services $276.00

PSY9809 Developmental Test add 30 918 Testing - Psychiatric/Psychological Services $124.00

PSY9810 NBSE w Report 1st hour 918 Testing - Psychiatric/Psychological Services $208.00

PSY9811 NBSE w Report add hour 918 Testing - Psychiatric/Psychological Services $208.00

PSY9816 NeuroPsy Test/Eval CP 1st 918 Testing - Psychiatric/Psychological Services $230.00

PSY9817 NeuroPsy Test/Eval CP add 918 Testing - Psychiatric/Psychological Services $230.00 PSY9818 Prof TestScore 1st 30mins 918 Testing - Psychiatric/Psychological Services $230.00 PSY9819 Prof TestScore add 30mins 918 Testing - Psychiatric/Psychological Services $230.00 PSY9820 Tech 2+ Test/Score 30mins 918 Testing - Psychiatric/Psychological Services $150.00 PSY9821 Tech 2+ Test/Score add 30 918 Testing - Psychiatric/Psychological Services $150.00 PSYG8427 Meds Reviewed 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8428 Meds Not Reviewed-No Reason 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8430 Meds Not Reviewed-Not Eligible 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8431 Scrn Depression Pos W-Fu 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8432 Scrn Depression Not Doc-No Rea 918 Testing - Psychiatric/Psychological Services $0.01

200 PSYG8433 Scrn Depression Not Doc-Inelig 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8442 Pain Assmnt Not Doc-Ineligible 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8509 Pain Assmnt Pos No Fu No Reaso 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8510 Scrn Depression Neg 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8511 Scrn Depr Pos-No Fu No Reason 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8535 Elder Matreat Assess-Not Eligi 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8536 Elder Maltreat Assess-Not Done 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8730 Pain Assmnt Pos W-Fu 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8731 Pain Assmnt Neg 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8732 Pain Assmnt Not Done 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8733 Elder Maltreat Assess Pos W Fu 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8734 Elder Matreat Assess Neg 918 Testing - Psychiatric/Psychological Services $0.01

PSYG8735 Elder Maltreat Assess Pos Fu 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8939 Pain Assmnt Pos No Fu Ineligib 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8940 Scrn Depression Pos-No Fu Inel 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8941 Elder Maltreat Assess Pos Not 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8959 Adlt Mdd:Cord Care/Comorbd 918 Testing - Psychiatric/Psychological Services $0.01 PSYG8960 Adlt Mdd:Cord Care/Comorbd 918 Testing - Psychiatric/Psychological Services $0.01 PSYG9232 Adlt Mdd:Cord Care/Comorbd 918 Testing - Psychiatric/Psychological Services $0.01

PSYG9621 Pt Screen Identified Alcohol 918 Testing - Psychiatric/Psychological Services $0.01

PSYG9622 Pt Screen Unidentified Alcohol 918 Testing - Psychiatric/Psychological Services $0.01

PSYG9623 Doc Med Reason Unhealthy Alco 918 Testing - Psychiatric/Psychological Services $0.01

PSYG9624 Pt Not Screen Unhealthy Alco 918 Testing - Psychiatric/Psychological Services $0.01

14-G8960 Adlt Mdd:Cord Care/Comorbd Cnd 919 Other - Psychiatric/Psychological Services $0.01

146731 Cog Therapeutic Group 919 Other - Psychiatric/Psychological Services $67.00

147733 Case Management Intermediate 919 Other - Psychiatric/Psychological Services $34.00 147806 Learning & Memory Tx 919 Other - Psychiatric/Psychological Services $67.00 149135 Case Management Brief 919 Other - Psychiatric/Psychological Services $24.00 149136 Case Managment Intermed 919 Other - Psychiatric/Psychological Services $34.00 149137 Case Management Complex 919 Other - Psychiatric/Psychological Services $44.00 149138 Team Conf W/O Pt (30 Min) 919 Other - Psychiatric/Psychological Services $75.00 149139 Team Conf W/O Pt (60 Min) 919 Other - Psychiatric/Psychological Services $150.00

149725 Functional Skills Tx Group 919 Other - Psychiatric/Psychological Services $35.00

149731 Additonal Skills Group 919 Other - Psychiatric/Psychological Services $67.00

149732 Community Skills Group 919 Other - Psychiatric/Psychological Services $67.00

149733 Functional Skills Tx Group 919 Other - Psychiatric/Psychological Services $67.00

149734 Executive Skills Tx Group 919 Other - Psychiatric/Psychological Services $67.00

149735 Social Skills Tx Group 919 Other - Psychiatric/Psychological Services $67.00

149806 Psych Feedback 919 Other - Psychiatric/Psychological Services $169.00

149807 Agency Report 919 Other - Psychiatric/Psychological Services $125.00

90889 Agency Report 919 Other - Psychiatric/Psychological Services $125.00 99371 Case Management Brief 919 Other - Psychiatric/Psychological Services $24.00 99373 Case Management Complex 919 Other - Psychiatric/Psychological Services $44.00

PSY7561 Psych Feedback 919 Other - Psychiatric/Psychological Services $169.00 PSY9807 Agency Report Prep 919 Other - Psychiatric/Psychological Services $141.00 414130 Dup Extracranial Bil 921 Peripheral Vascular Lab $3,749.00 414134 Dop Art 1-2 Levels Bil 921 Peripheral Vascular Lab $5,478.00

414136 Dop Le Art W/Exer Bil 921 Peripheral Vascular Lab $592.00

414137 Dup Le Art Bil 921 Peripheral Vascular Lab $2,943.00

414140 US Art Dup Col Flow up Ext Bil 921 Peripheral Vascular Lab $2,943.00

201 414143 Dup Vein Bil 921 Peripheral Vascular Lab $5,952.00 414147 Dup Ab/Pel/Sc Ltd 921 Peripheral Vascular Lab $2,895.00 414152 Dup A/V Study 921 Peripheral Vascular Lab $804.00 420603 Dup Le Art Uni/Ltd 921 Peripheral Vascular Lab $2,943.00

420604 Dup Ue Art Uni/Ltd 921 Peripheral Vascular Lab $2,943.00

420606 Dup Vein Uni/Ltd 921 Peripheral Vascular Lab $2,864.00

420704 Dop Vein Bil 921 Peripheral Vascular Lab $768.00

421804 Dop Art >3 Levels Bil 921 Peripheral Vascular Lab $5,478.00

423735 Dup Vein Bil 921 Peripheral Vascular Lab $4,897.00

423736 Dup Vein Uni/Ltd 921 Peripheral Vascular Lab $2,362.00

423738 Dup Extracranial Bil 921 Peripheral Vascular Lab $3,618.00

423745 Dup Ab/Pel/Sc Ltd 921 Peripheral Vascular Lab $2,415.00 689138 Therapeutic Phleb 921 Peripheral Vascular Lab $265.00 717827 Gen Code (921) 921 Peripheral Vascular Lab $- 718100 Nerve Cond Sens Mxd 921 Peripheral Vascular Lab $910.00 718750 Arterial Eval Of Lwr E 921 Peripheral Vascular Lab $3,147.00 718752 Arterial Duplex Limite 921 Peripheral Vascular Lab $925.00 718753 Doppler-Venous-Extrem- 921 Peripheral Vascular Lab $2,235.00

718754 Venous Duplex Limited 921 Peripheral Vascular Lab $2,313.00

718755 Dup Extracranial B/L 921 Peripheral Vascular Lab $3,518.00

719730 Doppler-Venous-Extrem- 921 Peripheral Vascular Lab $4,605.00

719731 Dup Ue Art Bil 921 Peripheral Vascular Lab $4,529.00

719732 Dop Le Art Sgl Level B 921 Peripheral Vascular Lab $5,130.00

719819 Dop Abdominal Comp 921 Peripheral Vascular Lab $2,016.00

747143 Dup Le Vein Bil 921 Peripheral Vascular Lab $5,857.00

747144 Doppler-Art-Upper Extr 921 Peripheral Vascular Lab $4,243.00 747145 Doppler-Art-Lower Extr 921 Peripheral Vascular Lab $5,375.00 748608 Dup Le Vein Uni/Ltd 921 Peripheral Vascular Lab $2,825.00 748810 Dupue Vein Bil 921 Peripheral Vascular Lab $5,224.00 748811 Dupue Vein Uni/Ltd 921 Peripheral Vascular Lab $2,532.00 748905 Us Renal Transplant 921 Peripheral Vascular Lab $727.00 748912 Carotid Imaging W/Spec 921 Peripheral Vascular Lab $3,685.00

748913 Dop Art Sgl Level Bil 921 Peripheral Vascular Lab $5,383.00

749453 Dup Abdominal Comp 921 Peripheral Vascular Lab $2,284.00

749464 Sestamibi 921 Peripheral Vascular Lab $496.00

749474 Oxyquinoline Dx 0.5 Mc 921 Peripheral Vascular Lab $5,079.00

749494 Gen Code (921) 921 Peripheral Vascular Lab $-

749529 Ny Local Infl Pros Ltd 921 Peripheral Vascular Lab $3,374.00

749555 Doppler Abd/Pel/Scrotu 921 Peripheral Vascular Lab $2,892.00

749561 Dup Le Art Uni/Ltd 921 Peripheral Vascular Lab $2,892.00

749564 Dup Vein Uni/Ltd 921 Peripheral Vascular Lab $2,896.00 74300 Ndl Elec Larynx 922 Electromyelogram $630.00 74301 Ndl Elec Hemidiaphragm 922 Electromyelogram $630.00 74302 Estim Guide Chemodener 922 Electromyelogram $345.00 74303 Ndl El Guide Chemodene 922 Electromyelogram $345.00 417746 Ndl Elec 1 Ext W/Wo Pa 922 Electromyelogram $1,460.00 417747 Ndl Elec 2 Ext W/Wo Pa 922 Electromyelogram $1,757.00

417748 Ndl Elec 3 Ext W/Wo Pa 922 Electromyelogram $2,111.00

417749 Ndl Elec 4 Ext W/Wo Pa 922 Electromyelogram $2,469.00

417751 Nerve Cond W/O F-Wave 922 Electromyelogram $910.00

202 417752 Nerve Cond W F-Wave 922 Electromyelogram $910.00 417753 Nerve Cond Sens Or Mxd 922 Electromyelogram $910.00 417755 Shrt Latency Soma Up L 922 Electromyelogram $1,733.00 417756 Shrt Latency Soma Lw L 922 Electromyelogram $757.00

417758 Vep 922 Electromyelogram $1,092.00

417760 H-Rflex Gastro/Soleus 922 Electromyelogram $533.00

417761 Neuro Junction Test 922 Electromyelogram $460.00

425501 Ndl Elec Para Vel Ltd 922 Electromyelogram $464.00

426406 Nerve Cond 5-6 Studies 922 Electromyelogram $221.00

426407 Nerve Cond 3-4 Studies 922 Electromyelogram $221.00

426409 Nerve Cond7-8 Stds 922 Electromyelogram $221.00

426410 Nerve Cond 9-10 Stds 922 Electromyelogram $408.00 428557 Sciatic Nerve Block 922 Electromyelogram $2,712.00 520206 Ischemic Limb Test 922 Electromyelogram $1,026.00 718019 Ncs Or Ncv Per Stim 922 Electromyelogram $910.00 718021 Emg Per Extremity 922 Electromyelogram $1,478.00 718025 F Wave Nerve Cond 922 Electromyelogram $910.00 718026 Emg-2 Extremities 922 Electromyelogram $1,776.00

718027 Emg-3 Extremities 922 Electromyelogram $2,133.00

718028 Emg-4 Extremities 922 Electromyelogram $2,496.00

718045 H Wave Nerve Cond 922 Electromyelogram $533.00

718101 Neuro Junction Test 922 Electromyelogram $466.00

719706 Visual Evoked Response 922 Electromyelogram $1,103.00

719707 Gen Code (922) 922 Electromyelogram $-

719818 Somatosens Evoked Resp 922 Electromyelogram $1,753.00

520250 Tensilon Test 929 Other Diagnostic Services $1,374.00 97799 Clubhouse Daily Rate 932 Medical rehab day program – full-day $150.00 147746 Meals Per Day 940 General Other Therapeutic Services $21.00 147748 Hotel Per Day 940 General Other Therapeutic Services $170.00 417970 Therapeutic Phleb 940 General Other Therapeutic Services $5,555.00 317357 O.H. Ptca Standby 975 Operating Room Professional Fee $- 672457 Gen Code - Pro Fee 985 EKG Professional Fee $-

300652 Tooth Brush 990 General - Patient Convenience Items Professional Fee $4.00

500651 COMB 990 General - Patient Convenience Items Professional Fee $17.00

500652 TOOTH BRUSH 990 General - Patient Convenience Items Professional Fee $21.00

500653 TOOTH PASTE 990 General - Patient Convenience Items Professional Fee $21.00

500655 TOOTH SWABS 1/PACK 990 General - Patient Convenience Items Professional Fee $19.00

500666 DENTURE CUP W/COVER 990 General - Patient Convenience Items Professional Fee $19.00

501337 SHAVE KIT 990 General - Patient Convenience Items Professional Fee $33.00

501605 GEN CODE - CSD 990 General - Patient Convenience Items Professional Fee $-

149899 No Show/Cancel 997 Admission kits $-

NOSHOW No Show Cancel 997 Admission kits $- 71216 Exp Methylene Blue 10 999 Other Patient Convenience Items $- 71311 Exp Acetlycysteine 6 G 999 Other Patient Convenience Items $- 71906 Exp Derm/Non Ts 21 Sq 999 Other Patient Convenience Items $- 71908 Exp Derm/Non Ts 70 Sq 999 Other Patient Convenience Items $- 72425 Exp Zoledronic Acid 5mg 999 Other Patient Convenience Items $-

79413 Exp Amikacin 500mg 999 Other Patient Convenience Items $-

79418 Exp Cabergoline 0.5mg 999 Other Patient Convenience Items $-

79420 Exp Dexametha 0.5mg 999 Other Patient Convenience Items $-

203 79422 Exp Dexametha 1.5mg 999 Other Patient Convenience Items $- 79424 Exp Dexametha 2mg 999 Other Patient Convenience Items $- 79426 Exp Dexametha 4mg 999 Other Patient Convenience Items $- 260081 Exp Drm/Epdm TS 44 Sq 999 Other Patient Convenience Items $-

799014 EXP SIROLIMUS 1MG.ML 6 999 Other Patient Convenience Items $-

799029 EXP DARBEPOETIN 200 MC 999 Other Patient Convenience Items $-

799055 EXP FOSPHENYT 100 MG 999 Other Patient Convenience Items $-

799057 EXP FOSPHENYT 500 MG 999 Other Patient Convenience Items $-

799088 EXP DAPTOMYCIN 500 MG 999 Other Patient Convenience Items $-

799092 EXP IRON SUCR CPX 100 999 Other Patient Convenience Items $-

799094 Exp Baclofen 10,000 mc 999 Other Patient Convenience Items $-

799096 EXP BACLOFEN 20000 MCG 999 Other Patient Convenience Items $- 799098 EXP BACLOFEN 40000 MCG 999 Other Patient Convenience Items $- 799116 EXP IRON DEXTRAN 100 M 999 Other Patient Convenience Items $- 889904 Medical Records Copying 999 Other Patient Convenience Items $-

14-G988HG P Goal Impaired 0% 420A General Physical Therapy $0.01 14-G988IG P Sc-Goal Imp 1<20% 420A General Physical Therapy $0.01 14-G988JG P Sc-Goal Imp 20<40% 420A General Physical Therapy $0.01 14-G988KG P Sc-Goal Imp 40<60% 420A General Physical Therapy $0.01

14-G988LG P Sc-Goal Imp 60<80% 420A General Physical Therapy $0.01

14-G988MG P Sc- Goal Imp 80<100% 420A General Physical Therapy $0.01

14-G988NG P Sc-Goal Imp 100% 420A General Physical Therapy $0.01

14-G989HG P D/C Impaired 0% 420A General Physical Therapy $0.01

14-G989IG P Sc- D/C Imp 1<20% 420A General Physical Therapy $0.01

14-G989JG P Sc-D/C Imp 20<40% 420A General Physical Therapy $0.01

14-G989KG P Sc-D/C Imp 40<60% 420A General Physical Therapy $0.01

14-G989LG P Sc-D/C Imp 60<80% 420A General Physical Therapy $0.01 14-G989MG P Sc-D/C Imp 80<100% 420A General Physical Therapy $0.01 14-G989NG P Sc- D/C Imp 100% 420A General Physical Therapy $0.01 G8988HGP Goal Impaired 0% 420A General Physical Therapy $0.01

G8988IGP SC-Goal Imp 1<20% 420A General Physical Therapy $0.01 G8988JGP SC-Goal Imp 20<40% 420A General Physical Therapy $0.01 G8988KGP SC-Goal Imp 40<60% 420A General Physical Therapy $0.01

G8988LGP SC-Goal Imp 60<80% 420A General Physical Therapy $0.01

G8988MGP SC- Goal Imp 80<100% 420A General Physical Therapy $0.01

G8988NGP SC-Goal Imp 100% 420A General Physical Therapy $0.01

G8989HGP D/C Impaired 0% 420A General Physical Therapy $0.01

G8989IGP SC- D/C Imp 1<20% 420A General Physical Therapy $0.01

G8989JGP SC-D/C Imp 20<40% 420A General Physical Therapy $0.01

G8989KGP SC-D/C Imp 40<60% 420A General Physical Therapy $0.01

G8989LGP SC-D/C Imp 60<80% 420A General Physical Therapy $0.01 G8989MGP SC-D/C Imp 80<100% 420A General Physical Therapy $0.01 G8989NGP SC- D/C Imp 100% 420A General Physical Therapy $0.01 14-G987HG P Sc- Eval/Pn Imp 0%/ 424A Physical Therapy Evaluation or Re-evaluation $0.01 14-G987IG P Sc-Eva/Pn Imp 1<20% 424A Physical Therapy Evaluation or Re-evaluation $0.01 14-G987JG P Sc-Eva/Pn Imp 20<40% 424A Physical Therapy Evaluation or Re-evaluation $0.01 14-G987KG P Sc-Eva/Pn Imp 40<60% 424A Physical Therapy Evaluation or Re-evaluation $0.01

14-G987LG P Sc-Eva/Pn Imp 60<80% 424A Physical Therapy Evaluation or Re-evaluation $0.01

14-G987MG P Sc-Eva/Pn Imp80<100% 424A Physical Therapy Evaluation or Re-evaluation $0.01

14-G987NG P Sc- Eva/Pn Imp 100% 424A Physical Therapy Evaluation or Re-evaluation $0.01

204 G8987HGP SC- Eval/PN Imp 0% 424A Physical Therapy Evaluation or Re-evaluation $0.01 G8987IGP SC-Eva/PN Imp 1<20% 424A Physical Therapy Evaluation or Re-evaluation $0.01 G8987JGP SC-Eva/PN Imp 20<40% 424A Physical Therapy Evaluation or Re-evaluation $0.01 G8987KGP SC-Eva/PN Imp 40<60% 424A Physical Therapy Evaluation or Re-evaluation $0.01

G8987LGP SC-Eva/PN Imp 60<80% 424A Physical Therapy Evaluation or Re-evaluation $0.01

G8987MGP SC-Eva/PN Imp80<100% 424A Physical Therapy Evaluation or Re-evaluation $0.01

G8987NGP SC- Eva/PN Imp 100% 424A Physical Therapy Evaluation or Re-evaluation $0.01

14-G988HG O Goal Impaired 0% 430A General Occupational Therapy $0.01

14-G988IG O Sc-Goal Imp 1<20% 430A General Occupational Therapy $0.01

14-G988JG O Sc-Goal Imp 20<40% 430A General Occupational Therapy $0.01

14-G988KG O Sc-Goal Imp 40<60% 430A General Occupational Therapy $0.01

14-G988LG O Sc-Goal Imp 60<80% 430A General Occupational Therapy $0.01

14-G988MG O Sc- Goal Imp 80<100% 430A General Occupational Therapy $0.01 14-G988NG O Sc-Goal Imp 100% 430A General Occupational Therapy $0.01 14-G989HG O D/C Impaired 0% 430A General Occupational Therapy $0.01 14-G989IG O Sc- D/C Imp 1<20% 430A General Occupational Therapy $0.01 14-G989JG O Sc-D/C Imp 20<40% 430A General Occupational Therapy $0.01 14-G989KG O Sc-D/C Imp 40<60% 430A General Occupational Therapy $0.01 14-G989LG O Sc-D/C Imp 60<80% 430A General Occupational Therapy $0.01

14-G989MG O Sc-D/C Imp 80<100% 430A General Occupational Therapy $0.01

14-G989NG O Sc- D/C Imp 100% 430A General Occupational Therapy $0.01

G8988HGO Goal Impaired 0% 430A General Occupational Therapy $0.01

G8988IGO SC-Goal Imp 1<20% 430A General Occupational Therapy $0.01

G8988JGO SC-Goal Imp 20<40% 430A General Occupational Therapy $0.01

G8988KGO SC-Goal Imp 40<60% 430A General Occupational Therapy $0.01

G8988LGO SC-Goal Imp 60<80% 430A General Occupational Therapy $0.01

G8988MGO SC- Goal Imp 80<100% 430A General Occupational Therapy $0.01 G8988NGO SC-Goal Imp 100% 430A General Occupational Therapy $0.01 G8989HGO D/C Impaired 0% 430A General Occupational Therapy $0.01 G8989IGO SC- D/C Imp 1<20% 430A General Occupational Therapy $0.01

G8989JGO SC-D/C Imp 20<40% 430A General Occupational Therapy $0.01 G8989KGO SC-D/C Imp 40<60% 430A General Occupational Therapy $0.01 G8989LGO SC-D/C Imp 60<80% 430A General Occupational Therapy $0.01

G8989MGO SC-D/C Imp 80<100% 430A General Occupational Therapy $0.01

G8989NGO SC- D/C Imp 100% 430A General Occupational Therapy $0.01

14-G987HG O Sc- Eval/Pn Imp 0% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G987IG O Sc-Eva/Pn Imp 1<20% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G987JG O Sc-Eva/Pn Imp 20<40% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G987KG O Sc-Eva/Pn Imp 40<60% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G987LG O Sc-Eva/Pn Imp 60<80% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G987MG O Sc-Eva/Pn Imp80<100% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 14-G987NG O Sc- Eva/Pn Imp 100% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 G8987HGO SC- Eval/PN Imp 0% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 G8987IGO SC-Eva/PN Imp 1<20% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 G8987JGO SC-Eva/PN Imp 20<40% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 G8987KGO SC-Eva/PN Imp 40<60% 434A Occupational Therapy Evaluation or Re-evaluation $0.01 G8987LGO SC-Eva/PN Imp 60<80% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

G8987MGO SC-Eva/PN Imp80<100% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

G8987NGO SC- Eva/PN Imp 100% 434A Occupational Therapy Evaluation or Re-evaluation $0.01

14-G157HG N Ms- G Imp 0% 440A General Speech-Language Pathology $0.01

205 14-G157IG N Ms- G Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G157JG N Ms- G Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G157KG N Ms- G Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G157LG N Ms- G Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G157MG N Ms- G Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G157NG N Ms- G Imp 100% 440A General Speech-Language Pathology $0.01

14-G158HG N Ms-D/C Imp 0% 440A General Speech-Language Pathology $0.01

14-G158IG N Ms-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G158JG N Ms-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G158KG N Ms- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G158LG N Ms-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G158MG N Ms-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G158NG N Ms- D/C Imp 100% 440A General Speech-Language Pathology $0.01 14-G160HG N Lc- G Imp 0% 440A General Speech-Language Pathology $0.01 14-G160IG N Lc- G Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G160JG N Lc- G Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G160KG N Lc- G Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G160LG N Lc- G Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G160MG N Lc- G Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G160NG N Lc- G Imp 100% 440A General Speech-Language Pathology $0.01

14-G161HG N Lc- D/C Imp 0% 440A General Speech-Language Pathology $0.01

14-G161IG N Lc- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G161JG N Lc- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G161KG N Lc- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G161LG N Lc- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G161MG N Lc- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G161NG N Lc- D/C Imp 100% 440A General Speech-Language Pathology $0.01 14-G163HG N Le- G Imp 0% 440A General Speech-Language Pathology $0.01 14-G163IG N Le- G Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G163JG N Le- G Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G163KG N Le- G Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G163LG N Le- G Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G163MG N Le- G Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G163NG N Le- G Imp 100% 440A General Speech-Language Pathology $0.01

14-G164HG N Le- D/C Imp 0% 440A General Speech-Language Pathology $0.01

14-G164IG N Le- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G164JG N Le- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G164KG N Le- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G164LG N Le- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G164MG N Le-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G164NG N Le- D/C Imp 100% 440A General Speech-Language Pathology $0.01 14-G166HG N Attn- G Imp 0% 440A General Speech-Language Pathology $0.01 14-G166IG N Attn- G Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G166JG N Attn- G Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G166KG N Attn- G Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G166LG N Attn- G Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G166MG N Attn- G Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G166NG N Attn- G Imp 100% 440A General Speech-Language Pathology $0.01

14-G167HG N Attn- D/C Imp 0% 440A General Speech-Language Pathology $0.01

14-G167IG N Attn- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

206 14-G167JG N Attn- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G167KG N Attn- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G167LG N Attn- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G167MG N Attn-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G167NG N Attn- D/C Imp 100% 440A General Speech-Language Pathology $0.01

14-G169HG N Mem- G Imp 0% 440A General Speech-Language Pathology $0.01

14-G169IG N Mem- G Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G169JG N Mem- G Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G169KG N Mem- G Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G169LG N Mem- G Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G169MG N Mem- G Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G169NG N Mem- G Imp 100% 440A General Speech-Language Pathology $0.01

14-G170HG N Mem- D/C Imp 0% 440A General Speech-Language Pathology $0.01 14-G170IG N Mem- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G170JG N Mem- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G170KG N Mem- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G170LG N Mem- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G170MG N Mem- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01 14-G170NG N Mem- D/C Imp 100% 440A General Speech-Language Pathology $0.01

14-G171HG N Voi- Ev/Pn Imp 0% 440A General Speech-Language Pathology $0.01

14-G171IG N Voi- Ev/Pn Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G172HG N Voi- G Imp 0% 440A General Speech-Language Pathology $0.01

14-G172IG N Voi- G Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G172JG N Voi- G Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G172KG N Voi- G Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G172LG N Voi- G Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G172MG N Voi- G Imp 80<100% 440A General Speech-Language Pathology $0.01 14-G172NG N Voi- G Imp 100% 440A General Speech-Language Pathology $0.01 14-G173HG N Voi- D/C Imp 0% 440A General Speech-Language Pathology $0.01 14-G173IG N Voi- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G173JG N Voi- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G173KG N Voi- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G173LG N Voi- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G173MG N Voi- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G173NG N Voi- D/C Imp 100% 440A General Speech-Language Pathology $0.01

14-G175HG N Slp- Goal Imp 0% 440A General Speech-Language Pathology $0.01

14-G175IG N Slp- G Imp 1 To <20% 440A General Speech-Language Pathology $0.01

14-G175JG N Slp-G Imp 20 To <40% 440A General Speech-Language Pathology $0.01

14-G175KG N Slp-G Imp 40 To <60% 440A General Speech-Language Pathology $0.01

14-G175LG N Slp-G Imp 60 To <80% 440A General Speech-Language Pathology $0.01

14-G175MG N Slp-G Imp 80 To <100% 440A General Speech-Language Pathology $0.01 14-G175NG N Slp- G Impaired 100% 440A General Speech-Language Pathology $0.01 14-G176HG N Slp- D/C Impaired 0% 440A General Speech-Language Pathology $0.01 14-G176IG N Slp-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G176JG N Slp-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G176KG N Slp-D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G176LG N Slp-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G176MG N Slp-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G176NG N Slp-D/C Imp 100% 440A General Speech-Language Pathology $0.01

14-G997HG N Swal-Goal Imp 0% 440A General Speech-Language Pathology $0.01

207 14-G997IG N Swal-Goal Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G997JG N Swal-Goal Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G997KG N Swal-Goal Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G997LG N Swal-Goal Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G997MG N Swa-Goal Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G997NG N Swal- Goal Imp 100% 440A General Speech-Language Pathology $0.01

14-G998HG N Swal- D/C Imp 0% 440A General Speech-Language Pathology $0.01

14-G998IG N Swal-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

14-G998JG N Swal-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

14-G998KG N Swal-D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

14-G998LG N Swal-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

14-G998MG N Swal-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G998NG N Swal-D/C Imp 100% 440A General Speech-Language Pathology $0.01 14-G999HG N Ms-Ev/Pn Imp 0% 440A General Speech-Language Pathology $0.01 14-G999IG N Ms-Ev/Pn Imp 1<20% 440A General Speech-Language Pathology $0.01 14-G999JG N Ms-Ev/Pn Imp 20<40% 440A General Speech-Language Pathology $0.01 14-G999KG N Ms- Ev/Pn Imp 40<60% 440A General Speech-Language Pathology $0.01 14-G999LG N Ms-Ev/Pn Imp 60<80% 440A General Speech-Language Pathology $0.01 14-G999MG N Ms-Ev/Pn Imp 80<100% 440A General Speech-Language Pathology $0.01

14-G999NG N Ms-Ev/Pn Imp 100% 440A General Speech-Language Pathology $0.01

G8997HGN Swal-Goal Imp 0% 440A General Speech-Language Pathology $0.01

G8997IGN Swal-Goal Imp 1<20% 440A General Speech-Language Pathology $0.01

G8997JGN Swal-Goal Imp 20<40% 440A General Speech-Language Pathology $0.01

G8997KGN Swal-Goal Imp 40<60% 440A General Speech-Language Pathology $0.01

G8997LGN Swal-Goal Imp 60<80% 440A General Speech-Language Pathology $0.01

G8997MGN Swa-Goal Imp 80<100% 440A General Speech-Language Pathology $0.01

G8997NGN Swal- Goal Imp 100% 440A General Speech-Language Pathology $0.01 G8998HGN Swal- D/C Imp 0% 440A General Speech-Language Pathology $0.01 G8998IGN Swal-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01 G8998JGN Swal-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G8998KGN Swal-D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 G8998LGN Swal-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01 G8998MGN Swal-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G8998NGN Swal-D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9157HGN Ms- G Imp 0% 440A General Speech-Language Pathology $0.01

G9157IGN Ms- G Imp 1<20% 440A General Speech-Language Pathology $0.01

G9157JGN Ms- G Imp 20<40% 440A General Speech-Language Pathology $0.01

G9157KGN Ms- G Imp 40<60% 440A General Speech-Language Pathology $0.01

G9157LGN Ms- G Imp 60<80% 440A General Speech-Language Pathology $0.01

G9157MGN Ms- G Imp 80<100% 440A General Speech-Language Pathology $0.01

G9157NGN Ms- G Imp 100% 440A General Speech-Language Pathology $0.01 G9158HGN Ms-D/C Imp 0% 440A General Speech-Language Pathology $0.01 G9158IGN Ms-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01 G9158JGN Ms-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01 G9158KGN Ms- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 G9158LGN Ms-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01 G9158MGN Ms-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9158NGN Ms- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9160HGN LC- G Imp 0% 440A General Speech-Language Pathology $0.01

G9160IGN LC- G Imp 1<20% 440A General Speech-Language Pathology $0.01

208 G9160JGN LC- G Imp 20<40% 440A General Speech-Language Pathology $0.01 G9160KGN LC- G Imp 40<60% 440A General Speech-Language Pathology $0.01 G9160LGN LC- G Imp 60<80% 440A General Speech-Language Pathology $0.01 G9160MGN LC- G Imp 80<100% 440A General Speech-Language Pathology $0.01

G9160NGN LC- G Imp 100% 440A General Speech-Language Pathology $0.01

G9161HGN LC- D/C Imp 0% 440A General Speech-Language Pathology $0.01

G9161IGN LC- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9161JGN LC- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G9161KGN LC- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

G9161LGN LC- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

G9161MGN LC- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9161NGN LC- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9163HGN LE- G Imp 0% 440A General Speech-Language Pathology $0.01 G9163IGN LE- G Imp 1<20% 440A General Speech-Language Pathology $0.01 G9163JGN LE- G Imp 20<40% 440A General Speech-Language Pathology $0.01 G9163KGN LE- G Imp 40<60% 440A General Speech-Language Pathology $0.01 G9163LGN LE- G Imp 60<80% 440A General Speech-Language Pathology $0.01 G9163MGN LE- G Imp 80<100% 440A General Speech-Language Pathology $0.01 G9163NGN LE- G Imp 100% 440A General Speech-Language Pathology $0.01

G9164HGN LE- D/C Imp 0% 440A General Speech-Language Pathology $0.01

G9164IGN LE- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9164JGN LE- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G9164KGN LE- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

G9164LGN LE- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

G9164MGN LE-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9164NGN LE- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9166HGN Attn- G Imp 0% 440A General Speech-Language Pathology $0.01 G9166IGN Attn- G Imp 1<20% 440A General Speech-Language Pathology $0.01 G9166JGN Attn- G Imp 20<40% 440A General Speech-Language Pathology $0.01 G9166KGN Attn- G Imp 40<60% 440A General Speech-Language Pathology $0.01

G9166LGN Attn- G Imp 60<80% 440A General Speech-Language Pathology $0.01 G9166MGN Attn- G Imp 80<100% 440A General Speech-Language Pathology $0.01 G9166NGN Attn- G Imp 100% 440A General Speech-Language Pathology $0.01

G9167HGN Attn- D/C Imp 0% 440A General Speech-Language Pathology $0.01

G9167IGN Attn- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9167JGN Attn- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G9167KGN Attn- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

G9167LGN Attn- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

G9167MGN Attn-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9167NGN Attn- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9169HGN Mem- G Imp 0% 440A General Speech-Language Pathology $0.01 G9169IGN Mem- G Imp 1<20% 440A General Speech-Language Pathology $0.01 G9169JGN Mem- G Imp 20<40% 440A General Speech-Language Pathology $0.01 G9169KGN Mem- G Imp 40<60% 440A General Speech-Language Pathology $0.01 G9169LGN Mem- G Imp 60<80% 440A General Speech-Language Pathology $0.01 G9169MGN Mem- G Imp 80<100% 440A General Speech-Language Pathology $0.01 G9169NGN Mem- G Imp 100% 440A General Speech-Language Pathology $0.01

G9170HGN Mem- D/C Imp 0% 440A General Speech-Language Pathology $0.01

G9170IGN Mem- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9170JGN Mem- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

209 G9170KGN Mem- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01 G9170LGN Mem- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01 G9170MGN Mem- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01 G9170NGN Mem- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9171HGN Voi- Ev/Pn Imp 0% 440A General Speech-Language Pathology $0.01

G9171IGN Voi- Ev/Pn Imp 1<20% 440A General Speech-Language Pathology $0.01

G9171JGN Voi-Ev/Pn Imp 20<40% 440A General Speech-Language Pathology $0.01

G9171KGN Voi-Ev/Pn Imp 40<60% 440A General Speech-Language Pathology $0.01

G9171LGN Voi-Ev/Pn Imp 60<80% 440A General Speech-Language Pathology $0.01

G9171MGN Voi-Ev/Pn Ip 80<100% 440A General Speech-Language Pathology $0.01

G9171NGN Voi- Ev/Pn Imp 100% 440A General Speech-Language Pathology $0.01

G9172HGN Voi- G Imp 0% 440A General Speech-Language Pathology $0.01

G9172IGN Voi- G Imp 1<20% 440A General Speech-Language Pathology $0.01 G9172JGN Voi- G Imp 20<40% 440A General Speech-Language Pathology $0.01 G9172KGN Voi- G Imp 40<60% 440A General Speech-Language Pathology $0.01 G9172LGN Voi- G Imp 60<80% 440A General Speech-Language Pathology $0.01 G9172MGN Voi- G Imp 80<100% 440A General Speech-Language Pathology $0.01 G9172NGN Voi- G Imp 100% 440A General Speech-Language Pathology $0.01 G9173HGN Voi- D/C Imp 0% 440A General Speech-Language Pathology $0.01

G9173IGN Voi- D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9173JGN Voi- D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G9173KGN Voi- D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

G9173LGN Voi- D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

G9173MGN Voi- D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9173NGN Voi- D/C Imp 100% 440A General Speech-Language Pathology $0.01

G9175HGN Slp- Goal Imp 0% 440A General Speech-Language Pathology $0.01

G9175IGN Slp- G Imp 1 To <20% 440A General Speech-Language Pathology $0.01 G9175JGN Slp-G Imp 20 To <40% 440A General Speech-Language Pathology $0.01 G9175KGN Slp-G Imp 40 To <60% 440A General Speech-Language Pathology $0.01 G9175LGN Slp-G Imp 60 To <80% 440A General Speech-Language Pathology $0.01

G9175MGN Slp-G Imp 80 To <100% 440A General Speech-Language Pathology $0.01 G9175NGN Slp- G Impaired 100% 440A General Speech-Language Pathology $0.01 G9176HGN Slp- D/C Impaired 0% 440A General Speech-Language Pathology $0.01

G9176IGN Slp-D/C Imp 1<20% 440A General Speech-Language Pathology $0.01

G9176JGN Slp-D/C Imp 20<40% 440A General Speech-Language Pathology $0.01

G9176KGN Slp-D/C Imp 40<60% 440A General Speech-Language Pathology $0.01

G9176LGN Slp-D/C Imp 60<80% 440A General Speech-Language Pathology $0.01

G9176MGN Slp-D/C Imp 80<100% 440A General Speech-Language Pathology $0.01

G9176NGN Slp-D/C Imp 100% 440A General Speech-Language Pathology $0.01

14-G159HG N Lc- Ev/Np Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G159IG N Lc- Ev/Np Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G159JG N Lc- Ev/Np Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G159KG N Lc- Ev/Np Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G159LG N Lc- Ev/Np Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G159MG N Lc-Ev/Np Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G159NG N Lc- Ev/Np Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G162HG N Le- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G162IG N Le- Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G162JG N Le- Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G162KG N Le- Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

210 14-G162LG N Le- Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G162MG N Le-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G162NG N Le- Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G165HG N Atn- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165IG N Atn-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165JG N Atn-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165KG N Atn-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165LG N Atn-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165MG N Atn-Ev/Pn Ip 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G165NG N Atn- Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G168HG N Mem- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G168IG N Mem- Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G168JG N Mem-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G168KG N Mem-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G168LG N Mem-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G168MG N Mem-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G168NG N Mem-Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G171JG N Voi-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G171KG N Voi-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G171LG N Voi-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G171MG N Voi-Ev/Pn Ip 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G171NG N Voi- Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G174HG N Slp- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G174IG N Slp-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G174JG N Slp-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G174KG N Slp-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G174LG N Slp-Ev/Pn Imp 60 <80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G174MG N Slp-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G174NG N Slp-Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G996HG N Swal- Eva/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G996IG N Swal-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G996JG N Swa-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 14-G996KG N Swa-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G996LG N Swa-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G996MG N Sw-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

14-G996NG N Swal-Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8996HGN Swal- Eva/PN Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8996IGN Swal-Ev/PN Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8996JGN Swa-Ev/PN Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8996KGN Swa-Ev/PN Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8996LGN Swa-Ev/PN Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8996MGN Sw-Ev/PN Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8996NGN Swal-Ev/PN Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8999HGN Ms-Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8999IGN Ms-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8999JGN Ms-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G8999KGN Ms- Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8999LGN Ms-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8999MGN Ms-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G8999NGN Ms-Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

211 G9159HGN LC- Ev/NP Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9159IGN LC- Ev/NP Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9159JGN LC- Ev/NP Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9159KGN LC- Ev/NP Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9159LGN LC- Ev/NP Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9159MGN LC-Ev/NP Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9159NGN LC- Ev/Np Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162HGN LE- Ev/PN Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162IGN LE- Ev/PN Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162JGN LE- Ev/PN Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162KGN LE- Ev/PN Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162LGN LE- Ev/PN Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9162MGN LE-Ev/PN Imp 880<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9162NGN LE- Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9165HGN Atn- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9165IGN Atn-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9165JGN Atn-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9165KGN Atn-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9165LGN Atn-Ev/Pn Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9165MGN Atn-Ev/Pn Ip 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9165NGN Atn- Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168HGN Mem- Ev/PN Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168IGN Mem- Ev/PN Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168JGN Mem-Ev/PN Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168KGN Mem-Ev/PN Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168LGN Mem-Ev/PN Imp 60<80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9168MGN Mem-Ev/PN Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9168NGN Mem-Ev/PN Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9174HGN Slp- Ev/Pn Imp 0% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9174IGN Slp-Ev/Pn Imp 1<20% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9174JGN Slp-Ev/Pn Imp 20<40% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9174KGN Slp-Ev/Pn Imp 40<60% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01 G9174LGN Slp-Ev/Pn Imp 60 <80% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9174MGN Slp-Ev/Pn Imp 80<100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

G9174NGN Slp-Ev/Pn Imp 100% 444A Speech-Language Pathology Evaluation or Re-evaluation $0.01

212