River Hospital River Hosp CDM All CDM Line Items

12/19/2018 10:32 AM iver_Hospital_River_Hosp_CDM_All_CDM_Line_ItemsAll CDM Items

Price Eff CDM Name Description CPT Price Date River Hosp CDM MOBILITY CURRENT STATUS $0.05 10/1/2018 River Hosp CDM MOBILITY GOAL STATUS $0.05 10/1/2018 River Hosp CDM MOBILITY D/C STATUS $0.05 10/1/2018 River Hosp CDM BODY POS CURRENT STATUS $0.05 10/1/2018 River Hosp CDM BODY POS GOAL STATUS $0.05 10/1/2018 River Hosp CDM BODY POS D/C STATUS $0.05 10/1/2018 River Hosp CDM CARRY CURRENT STATUS $0.05 10/1/2018 River Hosp CDM CARRY GOAL STATUS $0.05 10/1/2018 River Hosp CDM CARRY D/C STATUS $0.05 10/1/2018 River Hosp CDM SELF CARE CURRENT STATUS $0.05 10/1/2018 River Hosp CDM SELF CARE GOAL STATUS $0.05 10/1/2018 River Hosp CDM SELF CARE D/C STATUS $0.05 10/1/2018 River Hosp CDM OTHER PT/OT GOAL STATUS $0.05 10/1/2018 River Hosp CDM OTHER PT/OT GOAL STATUS $0.05 10/1/2018 River Hosp CDM OTHER PT/OT D/C STATUS $0.05 10/1/2018 River Hosp CDM SUB PT/OT CURRENT STATUS $0.05 10/1/2018 River Hosp CDM SUB PT/OT GOAL STATUS $0.05 10/1/2018 River Hosp CDM SUB PT/OT D/C STATUS $0.05 10/1/2018 River Hosp CDM VFC ROTAVIRUS VACCINE 90680 $0.05 10/1/2018 River Hosp CDM OMALIZUMAB -RESP DEPT USE ONLY $0.05 10/1/2018 River Hosp CDM INSULIN HUMAN REG 1U/ML $0.05 10/1/2018 River Hosp CDM INSULIN HUMAN ISOPHANE 1U/ML $0.05 10/1/2018 River Hosp CDM NYS HEMOPHILUS FLU B VACCINE 90648 $0.05 10/1/2018 River Hosp CDM NYS INFLUENZA VAC 6-35MO PRESV 90685 $0.05 10/1/2018 River Hosp CDM NYS DTAP IPV&HIB COMBO VACCINE 90698 $0.05 10/1/2018 River Hosp CDM NYS VFC FLU QUAD VACC60mcg/0.5 90686 $0.05 10/1/2018 River Hosp CDM NYS VFC ActHIB 90648 $0.05 10/1/2018 River Hosp CDM NYS VFC TDAP 7+YRS 90715 $0.05 10/1/2018 River Hosp CDM NYS VFC DT 7+YRS 90714 $0.05 10/1/2018 River Hosp CDM NYS VFC FLUZONE 3+YRS PRES FRE 90686 $0.05 10/1/2018 River Hosp CDM NYS VFC GARDISIL (HPV) 90651 $0.05 10/1/2018 River Hosp CDM NYS VFC POLIO (IPV) 90713 $0.05 10/1/2018 River Hosp CDM NYS VFC DTAP < 7 YEARS OLD 90700 $0.05 10/1/2018 River Hosp CDM NYS VFC KINRIX (DTAP&IPV) 90696 $0.05 10/1/2018 River Hosp CDM NYS VFC MMR II 90707 $0.05 10/1/2018 River Hosp CDM NYS VFC MENACTRA 90733 $0.05 10/1/2018 River Hosp CDM NYS VFC PEDIATIX DTAP/IPV/HEPB 90723 $0.05 10/1/2018 River Hosp CDM NYS VFC PREVNAR 13 PNEUMONIA 90670 $0.05 10/1/2018 River Hosp CDM NYS VFC RECOMBIVAX (HEPB) 90744 $0.05 10/1/2018 River Hosp CDM NYS VFC VARIVAX (VARICELLA) 90716 $0.05 10/1/2018 River Hosp CDM NYS VFC FLUMIST 90660 $0.05 10/1/2018 River Hosp CDM NYS VFC FLU 6-35 MO 90655 $0.05 10/1/2018 River Hosp CDM NYS VFC MENINGOCOCCAL MCV4 90734 $0.05 10/1/2018 River Hosp CDM ROTAVIRUS VACCINE STATE SUPPLY 90681 $0.05 10/1/2018 River Hosp CDM NYS INFLUENZA VACCINE 3+ YEARS 90658 $0.05 10/1/2018

River Hosp CDM NYS SUPPLIED PROQUAD MMRV VAC 90710 $0.05 10/1/2018 River Hosp CDM NYS VFC HEP B CHILD 90744 $0.05 10/1/2018 River Hosp CDM NYS VFC HEP A CHILD 90634 $0.05 10/1/2018 River Hosp CDM NYS VFC HEP A 90633 $0.05 10/1/2018 River Hosp CDM NYS HIB VACCINE 4 DOSE SCHEDUL 90648 $0.05 10/1/2018 River Hosp CDM NYS VFC TDAP 7+YEARS CLN2 $0.05 10/1/2018 River Hosp CDM NYS VFC TDAP 7+ YRS 90715 $0.05 10/1/2018 River Hosp CDM NYS VFC MMR $0.05 10/1/2018 River Hosp CDM NYS VFC VARIVAX (VARICELLA) 90716 $0.05 10/1/2018 River Hosp CDM ASPIRIN 81 MG TABLET EC $0.10 10/1/2018 River Hosp CDM LIDOCAINE 2% 10mg/0.5ml VIAL J2001 $0.15 10/1/2018 River Hosp CDM MELATONIN 3 MG TABLET $0.15 10/1/2018 River Hosp CDM MELATONIN 5 MG TABLET $0.15 10/1/2018 River Hosp CDM SIMVASTATIN 10 MG TAB $0.15 10/1/2018 River Hosp CDM LEVETIRACETAM 10mg/0.1 ml VIAL $0.20 10/1/2018 River Hosp CDM MAGNESIUM OXIDE 400MG TABLET $0.20 10/1/2018 River Hosp CDM BUSPIRONE 5 MG TABLET $0.20 10/1/2018 River Hosp CDM ROPINIROLE 0.5mg TABLET $0.25 10/1/2018 River Hosp CDM IBUPROFEN TAB 800MG $0.25 10/1/2018 River Hosp CDM SIMVASTATIN 5 MG TAB $0.25 10/1/2018 River Hosp CDM HumuLIN 70/30 PER UNIT.ML $0.30 10/1/2018 River Hosp CDM HumuLIN 70/30 PER UNIT/ML $0.30 10/1/2018 River Hosp CDM ATORVASTATIN 40mg TABLETS $0.30 10/1/2018 River Hosp CDM AMPICILLIN 250MG CAP $0.30 10/1/2018 River Hosp CDM NOVOLOG $0.35 10/1/2018 River Hosp CDM NCS GENASYME 80MG CHEW TAB $0.35 10/1/2018 River Hosp CDM NCS THERA-PLUS LIQ $0.35 10/1/2018 River Hosp CDM LEVOFLOXACIN 250mg TAB $0.35 10/1/2018 River Hosp CDM NCS ASPIRIN 325MG TAB $0.40 10/1/2018 River Hosp CDM CEETIRIZINE HCL (ZYRTEC) 10MG $0.45 10/1/2018 River Hosp CDM NCS ACETAMIN PM 500/25MG TAB $0.45 10/1/2018 River Hosp CDM NCS VITAMIN B-12 250MCG TAB $0.45 10/1/2018 River Hosp CDM DEXAMETHASONE 20MG/5ML VIAL J1100 $0.45 10/1/2018 River Hosp CDM SERTRALINE HCL 50MG TAB $0.45 10/1/2018 River Hosp CDM HUMULIN 70/30 PER UNIT $0.50 10/1/2018 River Hosp CDM LEVOTHYROXINE 88 mcg $0.50 10/1/2018 River Hosp CDM NCS VITAMIN E 400 UNIT CAP $0.50 10/1/2018 River Hosp CDM TERAZOSIN 5 MG CAPS $0.50 10/1/2018 River Hosp CDM BUPROPROIN 100MG $0.55 10/1/2018 River Hosp CDM LEVOTHYROXINE 137 mcg $0.55 10/1/2018 River Hosp CDM HYDROXYZINE 25MG PO $0.55 10/1/2018 River Hosp CDM CALCIUM CARB 500mg TAB CHEW $0.55 10/1/2018 River Hosp CDM TRANDOLAPRIL 1MG $0.60 10/1/2018 River Hosp CDM NCS FIBER-LAX 625MG TAB $0.60 10/1/2018 River Hosp CDM LORATADINE 10mg $0.60 10/1/2018 River Hosp CDM LORATADINE 10 MG TABLET $0.60 10/1/2018 River Hosp CDM QUETIAPINE FUMARATE 25 MG TAB $0.65 10/1/2018

River Hosp CDM GLYBURIDE 1.25 MG $0.65 10/1/2018 River Hosp CDM ADULT GLYCERIN SUPP. $0.65 10/1/2018 River Hosp CDM LEVOTHYROXINE 150MG $0.65 10/1/2018 River Hosp CDM BENZOIN TINCTURE 0.6 ML $0.65 10/1/2018 River Hosp CDM LISSAMINE GREEN 1.5mg OPTHSTRP $0.65 10/1/2018 River Hosp CDM NCS MAG 64 ENTERIC COATED TAB $0.65 10/1/2018 River Hosp CDM TRIPLE ANTIBIOTIC OINT PKT $0.70 10/1/2018 River Hosp CDM ADDIPAK 0.9% NS 5ML $0.70 10/1/2018 River Hosp CDM SODIUM CHLORIDE $0.70 10/1/2018 River Hosp CDM AMITRIPTYLINE HCL 50MG TABLET $0.70 10/1/2018 River Hosp CDM FISH OIL 1000MG $0.70 10/1/2018 River Hosp CDM CHILDRENS CHEW IRON W/MIN $0.70 10/1/2018 River Hosp CDM CALCIUM W/VIT D EFF W/M $0.70 10/1/2018 River Hosp CDM CITALOPRAM 10 MG TAB $0.70 10/1/2018 River Hosp CDM LEVOTHYROXINE 112MCG $0.70 10/1/2018 River Hosp CDM LISINOPRIL 20MG TAB $0.70 10/1/2018 River Hosp CDM ACYCLOVIR 200MG CAP $0.70 10/1/2018 River Hosp CDM MIRTAZAPINE 30MG $0.70 10/1/2018 River Hosp CDM ZOLPIDEM TARTRATE 5MG $0.70 10/1/2018 River Hosp CDM ZOLPIDEM TARTRATE 10MG $0.70 10/1/2018 River Hosp CDM SILVER NITRATE STICK $0.70 10/1/2018 River Hosp CDM KNY METFORMIN HYDRCHL 500MG TB $0.70 10/1/2018 River Hosp CDM LEVOTHYROZINE SODIUM 125MG $0.70 10/1/2018 River Hosp CDM DIAZEPAM 2MG TAB $0.70 10/1/2018 River Hosp CDM FOSINOPRIL SODIUM TAB 20MG $0.70 10/1/2018 River Hosp CDM ETODOLAC 400MG CAP $0.70 10/1/2018 River Hosp CDM LEVOTHYROXINE SODIUM 75MG TAB $0.70 10/1/2018 River Hosp CDM VERAPAMIL 240MG $0.70 10/1/2018 River Hosp CDM POTASSIUM CL 20 MEQ/15ML LIQ $0.70 10/1/2018 River Hosp CDM FERROUS GLUCONATE $0.70 10/1/2018 River Hosp CDM KETOROLAC TROME 15MG/1ML VIAL $0.70 10/1/2018 River Hosp CDM FLUOXETINE 10MG TAB $0.70 10/1/2018 River Hosp CDM NORTRIPTYLINE HCL 75MG $0.70 10/1/2018 River Hosp CDM CARISOPRODOL 350MG $0.70 10/1/2018 River Hosp CDM ACET/CODE 120MG-12MG/5ML $0.70 10/1/2018 River Hosp CDM GLYCERIN SUPP PEDS $0.70 10/1/2018 River Hosp CDM ACTIVATED CHARC 250MG TAB $0.70 10/1/2018 River Hosp CDM PILOCARPINE 1% (DROP) $0.70 10/1/2018 River Hosp CDM PROPARACAINE 0.5% (DROP) $0.70 10/1/2018 River Hosp CDM TYLENOL PM $0.70 10/1/2018 River Hosp CDM CRANBERRY CAP $0.70 10/1/2018 River Hosp CDM PHENYLEPHRINE 2.5% PER DROP $0.70 10/1/2018 River Hosp CDM TROPICAMIDE 1% PER DROP $0.70 10/1/2018 River Hosp CDM COGENTIN 1MG TAB $0.70 10/1/2018 River Hosp CDM NCS ACETAMINOPHEN 500MG TAB $0.70 10/1/2018 River Hosp CDM NCS ASPIRIN CHEWABLE 81MG $0.70 10/1/2018 River Hosp CDM NCS BISACODYL 5MG TAB $0.70 10/1/2018

River Hosp CDM NCS CALCIUM CARB 600MG TAB $0.70 10/1/2018 River Hosp CDM NCS CHILD CHEW +IRON TAB $0.70 10/1/2018 River Hosp CDM NCS DAILY VIT TAB $0.70 10/1/2018 River Hosp CDM DIGOXIN 0.125MG TAB $0.70 10/1/2018 River Hosp CDM NCS DIPHENHYDRAMINE 25MG TAB $0.70 10/1/2018 River Hosp CDM NCS DOCUSATE SODIUM 100MG TAB $0.70 10/1/2018 River Hosp CDM NCS EFFRV CAL W/VIT D 500MG TB $0.70 10/1/2018 River Hosp CDM NCS ENEMA DISPOS 19G-7G/118 FL $0.70 10/1/2018 River Hosp CDM NCS ENTERIC COATED ASPIRIN 325 $0.70 10/1/2018 River Hosp CDM NCS ENTERIC COATED ASPIRIN 81 $0.70 10/1/2018 River Hosp CDM NCS FERROUS SULFATE 325MG $0.70 10/1/2018 River Hosp CDM NCS FIBER LAX 500CT 325MG TAB $0.70 10/1/2018 River Hosp CDM NCS FOLIC ACID 1MG TAB $0.70 10/1/2018 River Hosp CDM NCS FUROSENIDE 20MG TAB $0.70 10/1/2018 River Hosp CDM NCS GENAPAP GEL-COAT 500MG TAB $0.70 10/1/2018 River Hosp CDM NCS ISOSORBIDE DINITR 20MG TAB $0.70 10/1/2018 River Hosp CDM NCS LISINOPRIL 20MG TAB $0.70 10/1/2018 River Hosp CDM NCS METOPROLOL TRATRATE 25MG $0.70 10/1/2018 River Hosp CDM NCS OPTI GEN TAB $0.70 10/1/2018 River Hosp CDM NCS OYST-CAL-D 500 $0.70 10/1/2018 River Hosp CDM NCS PINK BISMUTH 262MG TAB $0.70 10/1/2018 River Hosp CDM NCS PREDNISONE 10MG TAB $0.70 10/1/2018 River Hosp CDM NCS SENNA GEN 8.6MG TAB $0.70 10/1/2018 River Hosp CDM NCS SENNA-S 8.6-50MG TAB $0.70 10/1/2018 River Hosp CDM NCS SIMETHICONE 80MG TAB CHEW $0.70 10/1/2018 River Hosp CDM NCS SODIUM CHLORIDE 1MG TAB $0.70 10/1/2018 River Hosp CDM NCS THERA-GESIC MAX STR CREAM $0.70 10/1/2018 River Hosp CDM NCS THERA-M W/BETA CARO $0.70 10/1/2018 River Hosp CDM NCS THERAPEUTIC-M $0.70 10/1/2018 River Hosp CDM NCS VITAMIN C 500MG TAB $0.70 10/1/2018 River Hosp CDM PROPOXYPHENE/APAP 100mg/650TB $0.70 10/1/2018 River Hosp CDM TETRACYCLINE HCL 250 MG CAP $0.70 10/1/2018 River Hosp CDM FUROSEMIDE 40MG TABLET $0.70 10/1/2018 River Hosp CDM INDOMETHACIN 25MG CAPSULE $0.70 10/1/2018 River Hosp CDM DEXTROAMPHETAMINE 5mg TAB $0.70 10/1/2018 River Hosp CDM ASPIRIN 125MG SUPPOS $0.70 10/1/2018 River Hosp CDM DIPHENHYDRAMINE/BENADRYL 25mg $0.70 10/1/2018 River Hosp CDM PSYLLIUM 3.7gm $0.70 10/1/2018 River Hosp CDM MAALOX 3ml $0.70 10/1/2018 River Hosp CDM NITROSTAT 0.3mg $0.70 10/1/2018 River Hosp CDM OXAZEPAM 10mg CAP $0.70 10/1/2018 River Hosp CDM ACETAMINOPHEN 100MG/ML BTL $0.70 10/1/2018 River Hosp CDM HEMORRHOIDAL SUPP $0.70 10/1/2018 River Hosp CDM TEMAZEPAM 15mg TAB $0.70 10/1/2018 River Hosp CDM ACETAMINOPHEN 120 ML BTL $0.70 10/1/2018 River Hosp CDM FLUORESCEIN SODIUM 9MG STRIP $0.70 10/1/2018 River Hosp CDM MAALOX 30ml $0.70 10/1/2018

River Hosp CDM AMOXICILLIN 500 TAB $0.70 10/1/2018 River Hosp CDM MYLANTA II SUSP 30ML $0.70 10/1/2018 River Hosp CDM FERROUS SULFATE 300MG/5ML UD $0.70 10/1/2018 River Hosp CDM LISINOPRIL 40mg $0.70 10/1/2018 River Hosp CDM NITRAZINE PAPER $0.70 10/1/2018 River Hosp CDM AL HY/ALGIN/SO BIC/MGTRI 360ml $0.70 10/1/2018 River Hosp CDM MEDROXYPROGESTERONE ACET 2.5mg $0.70 10/1/2018 River Hosp CDM AMOXICILLIN 250MG TAB $0.70 10/1/2018 River Hosp CDM DICLOXACILLIN SODIUM 250MG CAP $0.70 10/1/2018 River Hosp CDM GAUIFENESIN 100MG/ 5ML UD $0.70 10/1/2018 River Hosp CDM DOC LIQ 150mg/5ml $0.70 10/1/2018 River Hosp CDM GAUIFENESIN 5ml $0.70 10/1/2018 River Hosp CDM HYDROCODONE/APAP5/500 TAB $0.70 10/1/2018 River Hosp CDM PSYLLIUM PER DOSE $0.70 10/1/2018 River Hosp CDM IBUPROFEN 100MG/5ML BTL $0.70 10/1/2018 River Hosp CDM TUMS CHW 500mg $0.70 10/1/2018 River Hosp CDM ACETAMINOPHEN 80mg/0.5ml DROPS $0.70 10/1/2018 River Hosp CDM AMPHOGEL HYDROX SUSP 5ml $0.70 10/1/2018 River Hosp CDM CALCIUM CARB 600mg $0.70 10/1/2018 River Hosp CDM CALCIUM CARBW/VIT D 500MG TAB $0.70 10/1/2018 River Hosp CDM E.E.S TAB 400MG $0.70 10/1/2018 River Hosp CDM FAMOTIDINE 20mg TAB $0.70 10/1/2018 River Hosp CDM ALPRAZOLAM 0.5mg TAB $0.70 10/1/2018 River Hosp CDM ECONAZOLE NITRATE 15 GM TUBE $0.70 10/1/2018 River Hosp CDM GUAIFENESIN AC/LIQUOR 5ml $0.70 10/1/2018 River Hosp CDM MAGNESIUM SULFATE 1gm/2ml VIAL $0.70 10/1/2018 River Hosp CDM BACLOFEN 10MG TAB $0.75 10/1/2018 River Hosp CDM METHADONE 10MG TAB $0.75 10/1/2018 River Hosp CDM ATENOLOL 25MG TAB $0.75 10/1/2018 River Hosp CDM LEVOTHYROXINE 0.025mg $0.75 10/1/2018 River Hosp CDM LEVOTHYROXINE 100MCG TAB $0.75 10/1/2018 River Hosp CDM CARBIDOPA/LEVODOPA 25/100 $0.75 10/1/2018 River Hosp CDM GABAPENTIN 300MG $0.75 10/1/2018 River Hosp CDM MIRTAZAPINE 15MG $0.75 10/1/2018 River Hosp CDM FLUOXETINE 20MG TAB $0.75 10/1/2018 River Hosp CDM ACETAMINOPHEN 650MG SUPP $0.75 10/1/2018 River Hosp CDM SIMETHICONE 80MG TAB $0.75 10/1/2018 River Hosp CDM HYDRALAZINE HCL 25MG $0.75 10/1/2018 River Hosp CDM PROBIOTIC CAP $0.75 10/1/2018 River Hosp CDM CETIRIZINE 10MG (ZYRTEC) $0.75 10/1/2018 River Hosp CDM CARBAMAZEPINE 200MG $0.75 10/1/2018 River Hosp CDM CEPHALEXIN 250MG $0.75 10/1/2018 River Hosp CDM GLIMEPIRIDE 2MG TAB $0.75 10/1/2018 River Hosp CDM GLYCERIN SUPP PEDS $0.75 10/1/2018 River Hosp CDM FML-FLUOROMETH 0.1% PER DROP $0.75 10/1/2018 River Hosp CDM NCS ALLOPURINOL 100MG TAB $0.75 10/1/2018 River Hosp CDM DIAZEPAM 5mg TAB $0.75 10/1/2018

River Hosp CDM BISACODYL 10MG SUPP $0.75 10/1/2018 River Hosp CDM QUININE SULFATE 260MG TAB $0.75 10/1/2018 River Hosp CDM PHENOBARBITAL 32.4 mg TAB $0.75 10/1/2018 River Hosp CDM IBUPROFEN 400MG TABLET $0.75 10/1/2018 River Hosp CDM FERROUS SULFATE 325MG TAB .EC $0.75 10/1/2018 River Hosp CDM MULTIVITAMIN $0.75 10/1/2018 River Hosp CDM ACETAMINOPHEN 325mg TABLET $0.75 10/1/2018 River Hosp CDM AMOXICILLIN 250 MG CAPSULE $0.75 10/1/2018 River Hosp CDM METOPROLOL TARTRATE 50mg TAB $0.75 10/1/2018 River Hosp CDM MILK OF MAGNESIA 5ML $0.75 10/1/2018 River Hosp CDM CALCIUM CARB/ VIT D 250 MG TAB $0.75 10/1/2018 River Hosp CDM PREDNISONE 5MG TAB $0.75 10/1/2018 River Hosp CDM PREDNISONE 10MG TAB $0.75 10/1/2018 River Hosp CDM PREDNISONE 20MG TAB $0.75 10/1/2018 River Hosp CDM PHENAZOPYRIDINE HCL 100mg TAB $0.75 10/1/2018 River Hosp CDM ACETAMINOPHEN 160MG/5ML ELIXIR $0.75 10/1/2018 River Hosp CDM MAGNESIUM CITRATE $0.75 10/1/2018 River Hosp CDM THIAMINE HCL 100mg TAB $0.75 10/1/2018 River Hosp CDM MYLANTA SUSP 30ML $0.75 10/1/2018 River Hosp CDM GLYCERIN SUPPOSITORY (ADULT) $0.75 10/1/2018 River Hosp CDM NYSTATIN ORAL SUSP $0.75 10/1/2018 River Hosp CDM CIPROFLOXACIN 500mg TAB $0.75 10/1/2018 River Hosp CDM NITROSTAT 0.4MG SL 656/25 $0.75 10/1/2018 River Hosp CDM DIPHENHYDRAMINE HCL 25MG CAP $0.75 10/1/2018 River Hosp CDM DOCUSATE SODIUM 100MG CAPSULE $0.75 10/1/2018 River Hosp CDM METOCLOPRAMIDE HCL 10MG TAB $0.75 10/1/2018 River Hosp CDM IBUPROFEN 200MG TAB $0.75 10/1/2018 River Hosp CDM IBUPROFEN 600 MG TABLET $0.75 10/1/2018 River Hosp CDM DILTIAZEM HCD 180 MG CAPS $0.75 10/1/2018 River Hosp CDM AMBIEN 5mg TAB $0.75 10/1/2018 River Hosp CDM ASPIRIN 81 MG TAB.CHEW $0.75 10/1/2018 River Hosp CDM ASPIRIN 325MG TABLET $0.75 10/1/2018 River Hosp CDM CIPROFLOXACIN 250mg TAB $0.75 10/1/2018 River Hosp CDM LISINOPRIL 10mg TAB $0.75 10/1/2018 River Hosp CDM AMLODIPINE BESYLATE 5MG TABLET $0.75 10/1/2018 River Hosp CDM BENZONATATE 100mg CAPS $0.75 10/1/2018 River Hosp CDM FLUCONAZOLE 150mg TAB $0.75 10/1/2018 River Hosp CDM AMITRIPTYLINE HCL 25MG TABLET $0.75 10/1/2018 River Hosp CDM CLONAZEPAM 0.5 MG TAB $0.75 10/1/2018 River Hosp CDM ATENOLOL 50MG TAB $0.75 10/1/2018 River Hosp CDM CITALOPRAM 20mg TAB $0.75 10/1/2018 River Hosp CDM TRAMADOL HCL 50MG TAB $0.75 10/1/2018 River Hosp CDM LISINOPRIL 5mg $0.75 10/1/2018 River Hosp CDM SENNA TAB $0.75 10/1/2018 River Hosp CDM O2 SUPPLY TUBING A4616 $0.80 10/1/2018 River Hosp CDM ALOE VERA CREAM $0.80 10/1/2018 River Hosp CDM NCS FERREX 150 U-D 150MG CAP $0.80 10/1/2018

River Hosp CDM NCS METOCLOPRAMIDE 5MG $0.80 10/1/2018 River Hosp CDM METOPOLOL XL 50 TAB $0.80 10/1/2018 River Hosp CDM KEPPRA 500MG $0.85 10/1/2018 River Hosp CDM LEVOTHYROXINE 50MCG TAB $0.85 10/1/2018 River Hosp CDM THERM M PLUS $0.85 10/1/2018 River Hosp CDM HALOPERIDOL 2MG $0.85 10/1/2018 River Hosp CDM GLIPIZIDE 2.5MG $0.85 10/1/2018 River Hosp CDM TORADOL INJ 15MG EA $0.85 10/1/2018 River Hosp CDM PEN VK 250MG TAB $0.85 10/1/2018 River Hosp CDM GUAIFEN/DEXTROM200mg-20mg/10ml $0.85 10/1/2018 River Hosp CDM AMOXICILLIN 875mg TAB $0.85 10/1/2018 River Hosp CDM FENTANYL 50MCG/1ML 2ML AMP. $0.90 10/1/2018 River Hosp CDM ALBUTEROL 2.5 MG/0.5 ML $0.93 10/1/2018 River Hosp CDM NASAL CANNULA (ADULT) $0.95 10/1/2018 River Hosp CDM AEROSOL MASK (ADULT) $0.95 10/1/2018 River Hosp CDM POTASSIUM BICARBONATE 25MEQ $0.95 10/1/2018 River Hosp CDM NCS DIGITEX 125MCG TAB $0.95 10/1/2018 River Hosp CDM MEPERDINE 50MG TAB $0.95 10/1/2018 River Hosp CDM EPHEDRINE 50MG/1ML $1.00 10/1/2018 River Hosp CDM PLAQUENIL $1.00 10/1/2018 River Hosp CDM METHIMAZOLE 5MG TAB $1.00 10/1/2018 River Hosp CDM ROPINIROLE 5MG $1.00 10/1/2018 River Hosp CDM PSEUDOEPHEDRINE HCL 30MG/5ML $1.00 10/1/2018 River Hosp CDM NCS PHENYTOIN SODIUM 100MG CAP $1.00 10/1/2018 River Hosp CDM CEFUROXIME 250mg TAB $1.00 10/1/2018 River Hosp CDM MULTIVITAMIN W/MIN $1.00 10/1/2018 River Hosp CDM ERTHROM ES 2000mg/5ml SUSP $1.00 10/1/2018 River Hosp CDM NORMAL SALINE FLUSH SYRING $1.05 10/1/2018 River Hosp CDM TORSEMIDE 20 MG $1.05 10/1/2018 River Hosp CDM CYCLOBENZAPRINE 5mg $1.05 10/1/2018 River Hosp CDM FLUORESCEIN OPHTHLMIC STRP 1mg $1.05 10/1/2018 River Hosp CDM NCS BISAC-EVAC 10MG SUPP RECT $1.05 10/1/2018 River Hosp CDM ISOSORBIDE DINITRATE 10MG TAB $1.05 10/1/2018 River Hosp CDM ASPIRIN 300MG SUPP.RECT $1.05 10/1/2018 River Hosp CDM PENICILLIN VK 250mg/5mlORALSYR $1.05 10/1/2018 River Hosp CDM METHYLPHENIDATE 5mg $1.05 10/1/2018 River Hosp CDM NTG 0.4MG (1/150 GR) $1.05 10/1/2018 River Hosp CDM SODIUM BICARB 650mg TAB $1.05 10/1/2018 River Hosp CDM GLYCOPYRROLATE 0.4MG/1ML $1.10 10/1/2018 River Hosp CDM ONDANSETRON HYDRAC 4MG TAB $1.10 10/1/2018 River Hosp CDM ONDANSETRON HYDRO 4MG/2ML VIAL $1.10 10/1/2018 River Hosp CDM ACE BANDAGE 2" $1.15 10/1/2018 River Hosp CDM HYDROCODONE/APAP 5mg/325mg TAB $1.15 10/1/2018 River Hosp CDM METOLAZONE 2.5mg TABLET $1.15 10/1/2018 River Hosp CDM CHOLECALCIFEROL(VitD)1000unTAB $1.15 10/1/2018 River Hosp CDM PANTOPRAZOLE 20mg TAB $1.15 10/1/2018 River Hosp CDM NCS HALOPERIDOL 1MG TAB $1.15 10/1/2018

River Hosp CDM ASPIRIN 325 MG TABLET.EC $1.15 10/1/2018 River Hosp CDM METOCLOPRAMIDE HCL 5MG/ML VIAL $1.15 10/1/2018 River Hosp CDM OMEPRAZOLE 20 MG CAPSULE $1.15 10/1/2018 River Hosp CDM AMOXICILLIN 250MG/5ML ORAL SYR $1.15 10/1/2018 River Hosp CDM CYANOCOBALMIN(VITB12)250mcgTab $1.15 10/1/2018 River Hosp CDM AMARYL 1MG TAB $1.15 10/1/2018 River Hosp CDM NAPROXEN 500MG TAB $1.15 10/1/2018 River Hosp CDM BACTERIOSTATIC WATER INJ $1.20 10/1/2018 River Hosp CDM NITROGLYCERIN .4 MG/HR PATCH $1.20 10/1/2018 River Hosp CDM COENMZYNE Q10 100MG $1.20 10/1/2018 River Hosp CDM NCS LEVOTHYROXINE SOD 100MCG $1.20 10/1/2018 River Hosp CDM NCS MUCINEX ER 600MG TAB $1.20 10/1/2018 River Hosp CDM HEP.100U/ML 10ml $1.20 10/1/2018 River Hosp CDM CEPACOL LOZENGE $1.20 10/1/2018 River Hosp CDM ACE BANDAGE 3" $1.25 10/1/2018 River Hosp CDM LIDOCAINE 1% 20ML VIAL J2001 $1.25 10/1/2018 River Hosp CDM NCS FUROSEMIDE 80MG TAB $1.25 10/1/2018 River Hosp CDM METHADONE 5mg TAB $1.25 10/1/2018 River Hosp CDM ACETAMINOPHEN W/CODIENE #3 TAB $1.25 10/1/2018 River Hosp CDM NEOSTIGMINE 1 MG/ML VIAL $1.25 10/1/2018 River Hosp CDM ROXICODONE $1.25 10/1/2018 River Hosp CDM EZ GAS GRANUALES $1.28 10/1/2018 River Hosp CDM JEVITY 237ML CAN $1.30 10/1/2018 River Hosp CDM HYDROXYUREA 500MG TAB $1.30 10/1/2018 River Hosp CDM DONNATAL ELIXIR 5ml $1.30 10/1/2018 River Hosp CDM SYNTHROID 0.075MG TAB $1.30 10/1/2018 River Hosp CDM GLUCERNA CAN $1.35 10/1/2018 River Hosp CDM PHENYLEPHRINE 10MG/ML $1.35 10/1/2018 River Hosp CDM DIGOXIN 250 MCG TABLET $1.35 10/1/2018 River Hosp CDM NIFEDIPINE XL30MG TAB $1.35 10/1/2018 River Hosp CDM DEXT 5% WATER 100ml $1.40 10/1/2018 River Hosp CDM MUCINEX 600MG $1.40 10/1/2018 River Hosp CDM MORPHINE 20mg/5ml UDC $1.40 10/1/2018 River Hosp CDM NCS GLYBURIDE 2.5MG $1.40 10/1/2018 River Hosp CDM NCS LISINOPRIL 40MG TAB $1.40 10/1/2018 River Hosp CDM MORPHINE 10mg/5ml UDC $1.40 10/1/2018 River Hosp CDM DEXAMETHASONE 1MG/ML $1.40 10/1/2018 River Hosp CDM BUPIVICAINE .5% 30ml $1.40 10/1/2018 River Hosp CDM AMOXICILLIN 125mg/5ml 7.5ml $1.40 10/1/2018 River Hosp CDM CALCIUM CARBONATE 500mg TAB $1.40 10/1/2018 River Hosp CDM BUPIVACAINE HCL 0.5mg $1.40 10/1/2018 River Hosp CDM CARBAMAZEPINE 100mg TAB CHEW $1.40 10/1/2018 River Hosp CDM BUPRICAINE 0.5ml $1.40 10/1/2018 River Hosp CDM DEXAMETHASONE SODPHOSPH 1MG/ML $1.40 10/1/2018 River Hosp CDM CHLORTHALIDONE 25 MG TABLET $1.45 10/1/2018 River Hosp CDM ACE BANDAGE 4" $1.45 10/1/2018 River Hosp CDM LOSARTAN 100 MG $1.45 10/1/2018

River Hosp CDM OXYCODONE 5MG TAB $1.45 10/1/2018 River Hosp CDM NCS HALOPERIDOL 2MG TAB $1.45 10/1/2018 River Hosp CDM NCS KLOR-CON M20 20MEQ TAB $1.45 10/1/2018 River Hosp CDM HYDROCORTISONE ACETATE 25 SUPP $1.45 10/1/2018 River Hosp CDM LORAZEPAM 2mg/ml 1 ml VIAL $1.45 10/1/2018 River Hosp CDM GLYBURIDE MIC 3mg TAB $1.45 10/1/2018 River Hosp CDM ACETAMINOPHEN 160MG/5ML U/D $1.50 10/1/2018 River Hosp CDM PROMETHAZINE HCL 25MG/ML AMP $1.50 10/1/2018 River Hosp CDM ACETAMINOPHEN 325MG SUPP/RECT $1.50 10/1/2018 River Hosp CDM BISACODYL 5MG TAB.EC $1.50 10/1/2018 River Hosp CDM ISOSORBIDE DINITRATE 20mg TAB $1.50 10/1/2018 River Hosp CDM VICODIN ORAL 5/500 $1.50 10/1/2018 River Hosp CDM DIPHENHYDRAMINE 50MG CAP Q0163 $1.50 10/1/2018 River Hosp CDM CHOLCHICINE 0.6MB TAB $1.50 10/1/2018 River Hosp CDM VENLAFAXINE HCL 37.5MG $1.55 10/1/2018 River Hosp CDM MULTIVITE SUSP PER 5ML $1.55 10/1/2018 River Hosp CDM VITAMIN E CAP $1.55 10/1/2018 River Hosp CDM MUCINEX DM 600MG/30MG $1.55 10/1/2018 River Hosp CDM BENEFIBER $1.55 10/1/2018 River Hosp CDM VIT D 500mg $1.55 10/1/2018 River Hosp CDM VIT D 1000MU $1.55 10/1/2018 River Hosp CDM VIT B12 $1.55 10/1/2018 River Hosp CDM MEGESTROL ACETATE 40MG/1ML SUS $1.55 10/1/2018 River Hosp CDM PERCOCET 5/325 $1.55 10/1/2018 River Hosp CDM KD-BISOPROLOL 10MG $1.55 10/1/2018 River Hosp CDM SODIUM BICARB 8.4%VIAL/50ML $1.55 10/1/2018 River Hosp CDM CHLOROTHIAZIDE 250mg TABLET $1.55 10/1/2018 River Hosp CDM HEMORRHOIDAL UNISERT $1.55 10/1/2018 River Hosp CDM NITROGLYCERINE 30 GM TUBE 2% $1.55 10/1/2018 River Hosp CDM ACETYLCYSTEINE 100mg/0.5ml $1.55 10/1/2018 River Hosp CDM PREDNISOLONE 5MG/5ML $1.55 10/1/2018 River Hosp CDM DEXT 5% WATER 500ml $1.60 10/1/2018 River Hosp CDM LIFESHIELD MACROBORE EXTENSION $1.60 10/1/2018 River Hosp CDM HEPARIN 10000U/ML1ML J1644 $1.60 10/1/2018 River Hosp CDM PHENYTOIN SOD 100mg CAP $1.60 10/1/2018 River Hosp CDM TRAZODONE HCL 50mg TAB $1.60 10/1/2018 River Hosp CDM ACETAMINOPHEN 160mg/5ml $1.60 10/1/2018 River Hosp CDM ACETAMINOPHEN 500mg TABLET $1.60 10/1/2018 River Hosp CDM HEPARIN SODIUM,PORCINE 5000U $1.65 10/1/2018 River Hosp CDM FOLIC ACID 1 MG TABLET $1.65 10/1/2018 River Hosp CDM VENLAFAXINE HCL 75mg TAB $1.65 10/1/2018 River Hosp CDM NORM SALINE 0.45% 500cc $1.70 10/1/2018 River Hosp CDM LIDOCAINE 2% PF 2ml VIAL $1.70 10/1/2018 River Hosp CDM CEFUROXIME 500MG TAB $1.70 10/1/2018 River Hosp CDM NCS BREATHE RIGHT LG CLEAR $1.70 10/1/2018 River Hosp CDM ACETAMINOPHEN 650mg TAB $1.70 10/1/2018 River Hosp CDM ERYTHROCIN 250 MG TAB $1.75 10/1/2018

River Hosp CDM IBUPROFEN 100MG/5ML INDIV UD $1.75 10/1/2018 River Hosp CDM NCS K TAB 10MEQ $1.75 10/1/2018 River Hosp CDM ALBUTEROL 3cc UD (0.83%) J7620 $1.75 10/1/2018 River Hosp CDM TOLBUTAMIDE 500 TAB $1.75 10/1/2018 River Hosp CDM CLONIDINE HCL 0.1MG TAB $1.80 10/1/2018 River Hosp CDM ASCORBIC ACID 500mg TAB $1.80 10/1/2018 River Hosp CDM AMMONIA AROM INH $1.80 10/1/2018 River Hosp CDM RACEM EPI .5cc UD (2.25%) J7699 $1.80 10/1/2018 River Hosp CDM FACE TENT $1.85 10/1/2018 River Hosp CDM ANTI REFLUX VALVE $1.85 10/1/2018 River Hosp CDM MIDAZOLAM 5MG/ML INJ. $1.85 10/1/2018 River Hosp CDM DICYCLOMINE HCL 10MG CAPSULE $1.85 10/1/2018 River Hosp CDM ROXANAL LIQUID 20mg/ml $1.85 10/1/2018 River Hosp CDM COMPRESSION BANDAGE ROLL $1.90 10/1/2018 River Hosp CDM LIDOCAINE VISCOUS 15ML UD $1.90 10/1/2018 River Hosp CDM NCS CAPTOPRIL 12.5MG TAB $1.90 10/1/2018 River Hosp CDM NCS METOPROLOL SUCCINATE 50MG $1.90 10/1/2018 River Hosp CDM PROPRANOLOL 20MG TAB $1.90 10/1/2018 River Hosp CDM 0.09% NACL-3cc "SHRIMP" J7051 $1.90 10/1/2018 River Hosp CDM ELIXOPHYLLIN ELIXIR ML $1.90 10/1/2018 River Hosp CDM BENAZEPRIL 10mg TAB $1.90 10/1/2018 River Hosp CDM NEBULIZER KIT A7007 $1.95 10/1/2018 River Hosp CDM SPECIMAN COLLECTOR $1.95 10/1/2018 River Hosp CDM RAMIPRIL 2.5MG CAP $1.95 10/1/2018 River Hosp CDM FENXOFENADINE CAP 180MG $1.95 10/1/2018 River Hosp CDM TRIAMCINOLONE ACET 15GM 1%CRM $1.95 10/1/2018 River Hosp CDM PROCHLORPER 5MG $1.95 10/1/2018 River Hosp CDM HEPARIN 1000U/ML 1ML $1.95 10/1/2018 River Hosp CDM FLEX TUBING 10FT $2.00 10/1/2018 River Hosp CDM MED CONC O2 MASK (PEDS) $2.00 10/1/2018 River Hosp CDM NORMAL SALINE 250ml INJ $2.00 10/1/2018 River Hosp CDM BLOOD GAS KIT $2.00 10/1/2018 River Hosp CDM ATROPINE 1 MG/ML $2.00 10/1/2018 River Hosp CDM MAG 64 $2.00 10/1/2018 River Hosp CDM AMPICILLIN 500MG CAP $2.00 10/1/2018 River Hosp CDM AMITRIPTYLINE 25mg TAB $2.00 10/1/2018 River Hosp CDM DEXAMETHASONE 0.5mg/5ml $2.00 10/1/2018 River Hosp CDM METOCLOPRAM 5mg TAB $2.00 10/1/2018 River Hosp CDM BENAZEPRIL HCL 10mgTAB $2.00 10/1/2018 River Hosp CDM LIDOCAINE HCL 10MG/ML VIAL $2.00 10/1/2018 River Hosp CDM DEXAMETHASONE .5mg/5ml ELIXIR $2.00 10/1/2018 River Hosp CDM CEFDINIR 300 MG $2.05 10/1/2018 River Hosp CDM AEROSOL MASK PEDS (NIC) $2.05 10/1/2018 River Hosp CDM CONTROL SYRINGE 10CC $2.05 10/1/2018 River Hosp CDM YANKAUR SUCTION TIP REG $2.10 10/1/2018 River Hosp CDM NORMAL SALINE 500ml INJ $2.10 10/1/2018 River Hosp CDM DEXT 5% WATER 250ml $2.10 10/1/2018

River Hosp CDM AUGMENTIN200-28.5mg/5mlORALSYR $2.10 10/1/2018 River Hosp CDM PRIMIDONE 250MG $2.10 10/1/2018 River Hosp CDM METHIMAZOLE 10 mg TAB $2.10 10/1/2018 River Hosp CDM KETOROLAC 15mg/ml VIAL $2.10 10/1/2018 River Hosp CDM ATROPINE SULFATE .4 MG/ML VIAL $2.10 10/1/2018 River Hosp CDM ACETAMINOPHEN 325mg/10.15mlUDC $2.10 10/1/2018 River Hosp CDM RECREO POWDER $2.10 10/1/2018 River Hosp CDM HALUPERIDOL 1mg TAB $2.10 10/1/2018 River Hosp CDM CEFAZOLIN 1gm $2.10 10/1/2018 River Hosp CDM ACE BANDAGE 6" $2.15 10/1/2018 River Hosp CDM LACTULOSE 20g/30ml $2.15 10/1/2018 River Hosp CDM INJ CEFAZOLIN SODIUM 500MG $2.15 10/1/2018 River Hosp CDM ACETAMINOPHEN 120MG SUPP RECT $2.15 10/1/2018 River Hosp CDM COLCHICINE .6MG TABLET $2.15 10/1/2018 River Hosp CDM THEOPHYLLINE 100mg ER $2.15 10/1/2018 River Hosp CDM MORPHINE 5MG/1 ML $2.20 10/1/2018 River Hosp CDM TRACHEOSTOMY MASK A4621 $2.25 10/1/2018 River Hosp CDM ALOE VISTA CONDITIONER $2.25 10/1/2018 River Hosp CDM SILVER NITRATE APPLICATORS 1ea $2.25 10/1/2018 River Hosp CDM MIDAZOLAM 5mg/5ml VIAL $2.25 10/1/2018 River Hosp CDM LEVETIRACETTAM 750MG TAB $2.25 10/1/2018 River Hosp CDM SODIUMCHLORIDE 0.65% NASALSPRY $2.25 10/1/2018 River Hosp CDM HEPARINFLUSH 10unts/ml 3ml SYR $2.25 10/1/2018 River Hosp CDM HEPARIN 100 units/ml 3ml SYR $2.25 10/1/2018 River Hosp CDM MORPHINE ORAL SYR 10mg/0.5ml $2.25 10/1/2018 River Hosp CDM MORPHINE ER 15mg TABLET $2.25 10/1/2018 River Hosp CDM METRONIDAZOLE 250mg TAB $2.25 10/1/2018 River Hosp CDM PREDNISOLONE 15MG/5ML SYRUP $2.25 10/1/2018 River Hosp CDM TENORMIN 25mg TAB $2.25 10/1/2018 River Hosp CDM IV SET,SECONDARY $2.30 10/1/2018 River Hosp CDM NORMAL SALINE 0.9% 1000cc INJ $2.35 10/1/2018 River Hosp CDM LOVASTATIN TAB 25MG $2.35 10/1/2018 River Hosp CDM MEROPENEM 100mg/DOSE J2185 $2.35 10/1/2018 River Hosp CDM GLIPIZIDE 5MG TABLET $2.35 10/1/2018 River Hosp CDM ALBUTEROL 3cc UD (0.83%) $2.35 10/1/2018 River Hosp CDM EZ PAQUE 96% BARIUM SULFATE $2.38 10/1/2018 River Hosp CDM MAYO STAND COVER $2.40 10/1/2018 River Hosp CDM METOCLOPRAMIDE HCL 5MG TAB $2.40 10/1/2018 River Hosp CDM NCS LORATADINE 10MG TAB $2.40 10/1/2018 River Hosp CDM DOPAMINE 200MG/5ML $2.40 10/1/2018 River Hosp CDM LORAZEPAM 0.5MG TAB $2.40 10/1/2018 River Hosp CDM TRIAMT/HCTZ CAP $2.40 10/1/2018 River Hosp CDM LEVOTHYROXINE SODIUM 100 MCG $2.40 10/1/2018 River Hosp CDM METRONIDAZOLE 250 MG TAB $2.40 10/1/2018 River Hosp CDM NORMAL SALINE IRRIG 500cc $2.45 10/1/2018 River Hosp CDM STERILE WATER IRRIG 250ML $2.45 10/1/2018 River Hosp CDM NCS ATENOLOL 25MG TAB $2.45 10/1/2018

River Hosp CDM SUCTION TRAY 14FR $2.50 10/1/2018 River Hosp CDM ALOE VISTA PERI WASH $2.50 10/1/2018 River Hosp CDM VICSCOUS LIDOCAINE UD CUP $2.50 10/1/2018 River Hosp CDM ERYTHROMYCIN BASE 250MG TABLET $2.50 10/1/2018 River Hosp CDM ALPRAZOLAM 0.25mg TAB $2.50 10/1/2018 River Hosp CDM MECLIZINE HCL 25MG TAB $2.50 10/1/2018 River Hosp CDM IRRIGATION TRAY $2.55 10/1/2018 River Hosp CDM DEXT 5% NS 45% 1000ml INJ $2.55 10/1/2018 River Hosp CDM NORMAL SALINE 250ML IRRIG $2.55 10/1/2018 River Hosp CDM SUCTION KIT 10FR $2.55 10/1/2018 River Hosp CDM MORPHINE 10mg/ml VIAL $2.55 10/1/2018 River Hosp CDM MS CONTIN 15mg TAB $2.55 10/1/2018 River Hosp CDM FINGER SPLINT $2.60 10/1/2018 River Hosp CDM LACTATED RINGERS 1000cc $2.60 10/1/2018 River Hosp CDM AMILORIDE HCL 5MG TAB $2.60 10/1/2018 River Hosp CDM CALCIUM GLUCONATE 100 MG/ML VL $2.60 10/1/2018 River Hosp CDM NORMAL SALINE IRRIG 1000ml $2.65 10/1/2018 River Hosp CDM SAFSITE CAPPED VALVE SYSTEM $2.65 10/1/2018 River Hosp CDM ACE WRAP W/VELCRO $2.65 10/1/2018 River Hosp CDM LACTATED RINGERS 500CC $2.65 10/1/2018 River Hosp CDM SUCTION KIT 8FR $2.65 10/1/2018 River Hosp CDM SURGICAL STRIPS $2.65 10/1/2018 River Hosp CDM NICOTINE PATCH 7MG $2.65 10/1/2018 River Hosp CDM LIDOCAINE - MPF 1% 2ml VIAL $2.65 10/1/2018 River Hosp CDM DUO-NEB 3cc UD J7699 $2.65 10/1/2018 River Hosp CDM NEUTRA PHOS $2.65 10/1/2018 River Hosp CDM STERILE WATER IRRIG 1000ml $2.70 10/1/2018 River Hosp CDM SUCTION TRAY 12FR $2.70 10/1/2018 River Hosp CDM 3" EXTRAFAST PLASTER $2.70 10/1/2018 River Hosp CDM LUBRICANT 2 OZ TUBE $2.70 10/1/2018 River Hosp CDM SURGICAL STRIPS 1/4" X 6" $2.70 10/1/2018 River Hosp CDM FEEDING TUBE 5FR $2.70 10/1/2018 River Hosp CDM NCS LISINOPRIL 10MG TAB $2.70 10/1/2018 River Hosp CDM MORPHINE 2mg/ml INJ $2.70 10/1/2018 River Hosp CDM CALAMINE LOTION 4 OZ $2.70 10/1/2018 River Hosp CDM LABETALOL HCL 100mg TAB $2.70 10/1/2018 River Hosp CDM DILTIAZEM HCL 30 MG TABLET $2.70 10/1/2018 River Hosp CDM KCL201/2NS $2.75 10/1/2018 River Hosp CDM AUGMENTIN 875MG/125MG TAB $2.75 10/1/2018 River Hosp CDM KETOROLAC TROMETHAMINE60mg/2ml J1885 $2.75 10/1/2018 River Hosp CDM MORPHINE 4mg/ml INJ $2.75 10/1/2018 River Hosp CDM NON-REBREATHER O2 MASK (ADULT) $2.80 10/1/2018 River Hosp CDM DEX 5% NS 1000cc $2.80 10/1/2018 River Hosp CDM LACTATED RINGERS 500ml $2.80 10/1/2018 River Hosp CDM DEXT 5% NS 25% 1000ml $2.80 10/1/2018 River Hosp CDM NORM SALINE 45% 1000cc $2.80 10/1/2018 River Hosp CDM PENROSE DRAIN 1/4 x 18 $2.80 10/1/2018

River Hosp CDM METOPROLOL TARTRATE 25MG $2.80 10/1/2018 River Hosp CDM MORPHINE 20mg/5ml UDC $2.80 10/1/2018 River Hosp CDM DONNATAL TABLET $2.80 10/1/2018 River Hosp CDM SYMMETRYL HCL 100mg CAPSULE $2.80 10/1/2018 River Hosp CDM FUROSEMIDE 40MG/4ML VIAL $2.80 10/1/2018 River Hosp CDM NORMAL SALINE 45% 100ml $2.80 10/1/2018 River Hosp CDM SURGICAL STRIPS 1/2" X 6" $2.85 10/1/2018 River Hosp CDM 5% DEXTROSE/LACT RING 1000cc $2.85 10/1/2018 River Hosp CDM ALENDRONATE SODIUM 70MG $2.85 10/1/2018 River Hosp CDM NIFEDIPINE 10MG CAPSULE $2.85 10/1/2018 River Hosp CDM IV ADM SET $2.90 10/1/2018 River Hosp CDM STERI DRAPE 11X17 $2.90 10/1/2018 River Hosp CDM MANNITOL 25% 250MG/ML $2.90 10/1/2018 River Hosp CDM TRACH HOLDER $2.95 10/1/2018 River Hosp CDM SUCTION TUBING 6FT $2.95 10/1/2018 River Hosp CDM NYSTATIN OINT 15GM TUBE $2.95 10/1/2018 River Hosp CDM LORAZEPAM 4mg/ml VIAL $2.95 10/1/2018 River Hosp CDM ALLOPURINOL 100mg TABLET $2.95 10/1/2018 River Hosp CDM INTAL UD (CROMOLYN) J7631 $2.95 10/1/2018 River Hosp CDM SENNA $2.95 10/1/2018 River Hosp CDM STAPLE REMOVER $3.00 10/1/2018 River Hosp CDM MARKER SURGICAL SKIN STERILE $3.00 10/1/2018 River Hosp CDM VIAL MATE ADAPTER BAXTER $3.00 10/1/2018 River Hosp CDM OXYBUTYNIN CHLORICDE 5MG TAB $3.00 10/1/2018 River Hosp CDM ENEMA PHOSPHATE $3.05 10/1/2018 River Hosp CDM INSULIN GLARGINE(LANTUS) 1U/ML $3.05 10/1/2018 River Hosp CDM NCS HYDROXYCHLOR 200MG TAB $3.05 10/1/2018 River Hosp CDM STAPLE REMOVER ER $3.10 10/1/2018 River Hosp CDM SLIPPERS $3.10 10/1/2018 River Hosp CDM SODIUM CHLORIDE 0.45% $3.10 10/1/2018 River Hosp CDM COLASTIC 1" (OR) SENSI-WRAP 1" $3.10 10/1/2018 River Hosp CDM GUAI-AC UDC $3.10 10/1/2018 River Hosp CDM LIDOCAINE 1%/EPI 20ML VIAL $3.10 10/1/2018 River Hosp CDM UNASYN 1.5GM $3.10 10/1/2018 River Hosp CDM CARBAMIDE PEROXIDE OTIC $3.10 10/1/2018 River Hosp CDM NCS NAMENDA 5MG TAB $3.10 10/1/2018 River Hosp CDM SALINE NASAL SPRAY 45ml $3.10 10/1/2018 River Hosp CDM ALBUTEROL 2MG TAB $3.10 10/1/2018 River Hosp CDM DOXEPIN HCL 25MG CAPSULE $3.10 10/1/2018 River Hosp CDM PENTOXIFYLLINE 400mg TAB $3.10 10/1/2018 River Hosp CDM DILTIAZEM HCL 30mg TABLET $3.10 10/1/2018 River Hosp CDM MEDROXYPROGESTRONE ACET 10mgTB $3.10 10/1/2018 River Hosp CDM PREFILL O2 NEBULIZER $3.15 10/1/2018 River Hosp CDM DISPOSABLE ANASCOPE $3.15 10/1/2018 River Hosp CDM MIDAZOLAM 10mg/2ml VIAL $3.15 10/1/2018 River Hosp CDM GUAIFENESIN 60mg/1200mg TAB $3.15 10/1/2018 River Hosp CDM LOVASTATIN 10mg $3.15 10/1/2018

River Hosp CDM RIFAMPIN 300mg CAPSULE $3.15 10/1/2018 River Hosp CDM DONNATOL 10cc $3.15 10/1/2018 River Hosp CDM CHLORPROMAZNE 25mg TAB $3.15 10/1/2018 River Hosp CDM WARFARIN SODIUM 1mg TAB $3.15 10/1/2018 River Hosp CDM FUROSEMIDE 100MG 10ML VIAL $3.15 10/1/2018 River Hosp CDM WARFARIN 3mg $3.15 10/1/2018 River Hosp CDM STERILE MEDICATION LABEL $3.20 10/1/2018 River Hosp CDM NORM SAL 500CC DEX/0.225% $3.20 10/1/2018 River Hosp CDM NALOXONE HCL .4 MG/ML AMP $3.20 10/1/2018 River Hosp CDM MEPERIDINE HCL 25mg/ml VIAL $3.20 10/1/2018 River Hosp CDM ATROVENT UD (.02%) J7644 $3.20 10/1/2018 River Hosp CDM AMOXICILLIN 125mg 5mlBTL $3.20 10/1/2018 River Hosp CDM ALCOHOL SOL 70% 150P $3.20 10/1/2018 River Hosp CDM GABAPENTIN 100 MG CAPSULE $3.20 10/1/2018 River Hosp CDM SCAPEL #11 $3.25 10/1/2018 River Hosp CDM NEEDLE COUNTER FOAM/MAGNET ST $3.25 10/1/2018 River Hosp CDM IOPIDINE 0.5% PER DROP $3.25 10/1/2018 River Hosp CDM NCS ARICEPT 5MG TABLET $3.25 10/1/2018 River Hosp CDM MEPERIDINE HCL 75mg/ml VIAL $3.25 10/1/2018 River Hosp CDM MECLIZINE HCL 12.5 MG TAB $3.25 10/1/2018 River Hosp CDM SINEMET TAB $3.25 10/1/2018 River Hosp CDM MICRONASE 5MG $3.25 10/1/2018 River Hosp CDM GLYBURIDE 5MG TABLET $3.25 10/1/2018 River Hosp CDM DIVALPROEX SODIUM 250MG TAB $3.25 10/1/2018 River Hosp CDM LEVALBUTEROL HCL 0.63 MG/3ML $3.25 10/1/2018 River Hosp CDM SUTURE REMOVAL TRAY $3.30 10/1/2018 River Hosp CDM MASK PED AERESOL $3.30 10/1/2018 River Hosp CDM SNAP COVER $3.30 10/1/2018 River Hosp CDM 3M REMOVER LOTION $3.30 10/1/2018 River Hosp CDM ELECTRODE NEEDLE POINT $3.30 10/1/2018 River Hosp CDM LIDOCAINE 2% 20ML VIAL $3.30 10/1/2018 River Hosp CDM MEPERIDINE HCL 50mg/ml VIAL $3.30 10/1/2018 River Hosp CDM MEPERIDINE 100mg/ml VIAL $3.30 10/1/2018 River Hosp CDM FUROSEMIDE 20MG TAB $3.30 10/1/2018 River Hosp CDM DIPHENHYDRANINE/BENADRYL 50mg $3.30 10/1/2018 River Hosp CDM WARFARIN SODIUM 2mg TAB $3.30 10/1/2018 River Hosp CDM DIPYRIDAMOLE 50MG TABLET $3.30 10/1/2018 River Hosp CDM METHOCARBAMAL 500g TAB $3.30 10/1/2018 River Hosp CDM POTASIUM CHLORIDE 10MEQ CAP $3.30 10/1/2018 River Hosp CDM STERI STRIPS $3.35 10/1/2018 River Hosp CDM SMALLBORE EXTENSION SET ASU $3.35 10/1/2018 River Hosp CDM ATROPINE SULFATE/DIPHEN 1 TAB $3.35 10/1/2018 River Hosp CDM HALOPERIDOL .5MG TAB $3.35 10/1/2018 River Hosp CDM EZM BARIUM SULFATE 98% HD $3.40 10/1/2018 River Hosp CDM URINARY LEG BAG $3.40 10/1/2018 River Hosp CDM WOUND IRRIGATOR IGLOO $3.40 10/1/2018 River Hosp CDM STERILE WATER IRRG 100ml $3.40 10/1/2018

River Hosp CDM SENSORCAINE 0.5% $3.40 10/1/2018 River Hosp CDM AUGMENTIN 200MG/5ML $3.40 10/1/2018 River Hosp CDM KCL 40MEQD51/2NS $3.40 10/1/2018 River Hosp CDM PROCHLORPERAZINE 5mg TAB $3.40 10/1/2018 River Hosp CDM HYDROXYZINE HCL 10MG TABLET $3.40 10/1/2018 River Hosp CDM SPECIMAN TRAP $3.45 10/1/2018 River Hosp CDM EMPTY VAC 1000cc $3.45 10/1/2018 River Hosp CDM D5W/KCL 20 MEQ/L BAG $3.45 10/1/2018 River Hosp CDM DERMABLADE $3.45 10/1/2018 River Hosp CDM 2-0 SILK K833H $3.45 10/1/2018 River Hosp CDM WELCHOL 625MG TAB $3.45 10/1/2018 River Hosp CDM VENALFAZINE 75XR TAB $3.45 10/1/2018 River Hosp CDM VALIUM 5MG 1ML $3.45 10/1/2018 River Hosp CDM FENTANYL 100MCG/2ML $3.45 10/1/2018 River Hosp CDM IV START KIT SUPPLY $3.50 10/1/2018 River Hosp CDM LOTION HAND $3.50 10/1/2018 River Hosp CDM 02 MASK,MED CONCENTRATION $3.50 10/1/2018 River Hosp CDM 4" EXTRAFAST PLASTER $3.50 10/1/2018 River Hosp CDM KEPPRA 1000MG TAB $3.50 10/1/2018 River Hosp CDM PROCAINAMIDE 250MG CAP $3.50 10/1/2018 River Hosp CDM GLUCOPHAGE 500mg TAB $3.50 10/1/2018 River Hosp CDM KERLIX ROLL 4" $3.55 10/1/2018 River Hosp CDM AQUAPAK 340ML $3.55 10/1/2018 River Hosp CDM STAX FINGER SPLINT $3.55 10/1/2018 River Hosp CDM MARKER UF, STERILE $3.55 10/1/2018 River Hosp CDM XYLOCAINE MPF $3.55 10/1/2018 River Hosp CDM ASU SMALLBORE EXTENSION SET $3.55 10/1/2018 River Hosp CDM BEAVER KNIFE BLADE 6400 $3.55 10/1/2018 River Hosp CDM FENTANYL 250mcg/ml $3.55 10/1/2018 River Hosp CDM NALBUPHINE 20mg/ml AMP $3.55 10/1/2018 River Hosp CDM GLYBURIDE 2.5 MG $3.55 10/1/2018 River Hosp CDM GLYBURIDE 2.5 MG TABLET $3.55 10/1/2018 River Hosp CDM MONOPRIL 10MG TAB $3.55 10/1/2018 River Hosp CDM STERILE ACE BANDAGE $3.60 10/1/2018 River Hosp CDM 2-0 SILK LIGAPAK LA55G $3.60 10/1/2018 River Hosp CDM POTASS CHL 10MEQ/5ML $3.60 10/1/2018 River Hosp CDM SODIUM CHLORIDE 0.65% BTL $3.60 10/1/2018 River Hosp CDM ISOSORBIDE MONONITRATE 30MG TB $3.60 10/1/2018 River Hosp CDM GLYBURIDE 3mg TAB $3.60 10/1/2018 River Hosp CDM MESH PANT XXXL $3.65 10/1/2018 River Hosp CDM DUODERM THIN 4x4 $3.65 10/1/2018 River Hosp CDM NON-REBREATHER O2 MASK (PEDS) $3.70 10/1/2018 River Hosp CDM NORMAL SALINE .9% 1200ml $3.70 10/1/2018 River Hosp CDM DEXTROSE 5%/W 1000CC $3.70 10/1/2018 River Hosp CDM DEXTROSE 5% WATER 100cc $3.70 10/1/2018 River Hosp CDM SUCTION TUBING 12' $3.70 10/1/2018 River Hosp CDM HYDROMORPHONE 2 MG $3.70 10/1/2018

River Hosp CDM LABETOLOL HCL 200MG $3.70 10/1/2018 River Hosp CDM POTAS20MEQ1/2NS/D5W $3.70 10/1/2018 River Hosp CDM VERAPAMIL HCL 80mg TAB $3.70 10/1/2018 River Hosp CDM PHYTONADIONE 5mg TAB $3.70 10/1/2018 River Hosp CDM BAC/NEOPOLY OIN 30G $3.70 10/1/2018 River Hosp CDM MIDAZOLAM HCL 2MG/2ML $3.70 10/1/2018 River Hosp CDM MASK, ENTRAINMENT $3.75 10/1/2018 River Hosp CDM BACK TABLE COVERS $3.75 10/1/2018 River Hosp CDM PROPOFOL 200MG/ML VIAL $3.75 10/1/2018 River Hosp CDM BUPIVACAINE 0.25% $3.75 10/1/2018 River Hosp CDM IPRATROPIUM BROMIDE .2 MG VIAL $3.75 10/1/2018 River Hosp CDM LEVALBUTEROL HCL 1.25MG/3ML $3.75 10/1/2018 River Hosp CDM AZITHROMYCIN 250mg TAB $3.75 10/1/2018 River Hosp CDM SPUTUM TRAP $3.80 10/1/2018 River Hosp CDM GAUZE VASELINE 6X36 $3.80 10/1/2018 River Hosp CDM TRACH CARE KIT $3.80 10/1/2018 River Hosp CDM NG TUBE HOLDER $3.80 10/1/2018 River Hosp CDM PANCRELIPASE 10000 UNIT TAB $3.80 10/1/2018 River Hosp CDM TOLTERODINE 2mg TAB $3.80 10/1/2018 River Hosp CDM PEDIALYTE 8.5 GM PACKET $3.80 10/1/2018 River Hosp CDM NCS DEPAKOTE 500MG TAB $3.80 10/1/2018 River Hosp CDM SPECIPANS $3.85 10/1/2018 River Hosp CDM OXYGEN (O2) PER HOUR $3.85 10/1/2018 River Hosp CDM SUTURE, ETHILON 3-0 1663G $3.85 10/1/2018 River Hosp CDM EYE SHEILD $3.85 10/1/2018 River Hosp CDM RAMIPRIL 5MG CAP $3.85 10/1/2018 River Hosp CDM CARVEDILOL 12.5 MG TAB $3.85 10/1/2018 River Hosp CDM DROPERIDOL 2.5MG/1ML $3.85 10/1/2018 River Hosp CDM ASPIRIN 600MG SUPP.RECT $3.85 10/1/2018 River Hosp CDM DOXAZOSIN MESYLATE 2mg TAB $3.85 10/1/2018 River Hosp CDM ICE PACK EYE BLUE $3.90 10/1/2018 River Hosp CDM AMOXICILLIN 200/5ml SUSP $3.90 10/1/2018 River Hosp CDM FINASTERIDE 5MG TABLET $3.90 10/1/2018 River Hosp CDM STYLETTE INTUBATING 14fr $3.95 10/1/2018 River Hosp CDM TEXAS CATHETER $3.95 10/1/2018 River Hosp CDM BAXTER CONNECTOR EXT. ST. ASU $3.95 10/1/2018 River Hosp CDM AMOXICILLIN 400mg SUSP/75ml $3.95 10/1/2018 River Hosp CDM SUCRALFATE 1gm TAB $3.95 10/1/2018 River Hosp CDM DICLOXACILLIN 125mg $3.95 10/1/2018 River Hosp CDM THEOPHYLLINE ANHYDROUS 200MGER $3.95 10/1/2018 River Hosp CDM QUINAPRIL HCL 5mg TAB $3.95 10/1/2018 River Hosp CDM TIMOLOL 0.3% $4.00 10/1/2018 River Hosp CDM PENICILLIN VK 500mg TAB $4.00 10/1/2018 River Hosp CDM NORMAL SALINE 0.9 100CC $4.05 10/1/2018 River Hosp CDM TONSIL SPONGES $4.05 10/1/2018 River Hosp CDM GEMFIBROZIL 600MG TAB $4.05 10/1/2018 River Hosp CDM BUPIVACAINE 0.5% $4.05 10/1/2018

River Hosp CDM CLAVE CONNECTOR $4.10 10/1/2018 River Hosp CDM MOHAWK FLEXI TRAK $4.10 10/1/2018 River Hosp CDM PROCHLORPERAZINE MAL 10mg TAB $4.10 10/1/2018 River Hosp CDM CAPTOPRIL 12.5mg TAB $4.10 10/1/2018 River Hosp CDM MATHOCARBAMOL 500mg TAB $4.10 10/1/2018 River Hosp CDM SUTURE, VICRYL 2-0 J417H $4.15 10/1/2018 River Hosp CDM 2-0 VICRYL J317H $4.15 10/1/2018 River Hosp CDM SPINAL NEEDLE PEDS 22gax2.5" $4.15 10/1/2018 River Hosp CDM INFANT SPIN NEEDLE 22gax1-1/2" $4.15 10/1/2018 River Hosp CDM NICOTINE PATCH 14MG $4.15 10/1/2018 River Hosp CDM POLYSTYRENE SOD 15g/60ml $4.15 10/1/2018 River Hosp CDM CATHETER TRAY STRAIGHT 14FR $4.20 10/1/2018 River Hosp CDM NEBULIZER, AEROMIST $4.20 10/1/2018 River Hosp CDM BENADRYL CREAM 28GM $4.20 10/1/2018 River Hosp CDM DENTURE ADHESIVE $4.20 10/1/2018 River Hosp CDM 5" EXTRAFAST PLASTER $4.20 10/1/2018 River Hosp CDM INTUBATING STYLET 10 FR $4.20 10/1/2018 River Hosp CDM MELOXICAM 7.5MG $4.20 10/1/2018 River Hosp CDM TOBRAMYCIN 80mg/2ml 2ml VIAL $4.20 10/1/2018 River Hosp CDM NITRO-BID 2% PKT $4.20 10/1/2018 River Hosp CDM PHENYTOIN SODIUM 250mg/5mlVIAL $4.20 10/1/2018 River Hosp CDM PURIFIED WATER 30ML $4.25 10/1/2018 River Hosp CDM DEXAMETHASONE SOD PHOS PF $4.25 10/1/2018 River Hosp CDM J507G $4.30 10/1/2018 River Hosp CDM AMOXICILLIN 250/5ml SUSP $4.30 10/1/2018 River Hosp CDM TENORMIN 50mg TAB $4.30 10/1/2018 River Hosp CDM SIMETHICONE DROPS $4.30 10/1/2018 River Hosp CDM ATROVEN US (.02%) $4.30 10/1/2018 River Hosp CDM ATROVEN UD (.02%) J7644 $4.30 10/1/2018 River Hosp CDM CORNEAL LIGHT SHIELD $4.35 10/1/2018 River Hosp CDM SUTURE, VICRYL 3-0 J944H $4.40 10/1/2018 River Hosp CDM SUTURE, J416H $4.40 10/1/2018 River Hosp CDM 3-0 VICRYL J316H $4.40 10/1/2018 River Hosp CDM ESTRONGEN (PREMARIN 0.3MG) $4.40 10/1/2018 River Hosp CDM NICOTINE PATCH 21MG $4.45 10/1/2018 River Hosp CDM POTASSIUM CHLORIDE $4.45 10/1/2018 River Hosp CDM KEFLEX 250MG CAPS $4.45 10/1/2018 River Hosp CDM LIQUITEARS $4.45 10/1/2018 River Hosp CDM BUPIVACAINE 0.5%(PF) 30ml VIAL $4.45 10/1/2018 River Hosp CDM SODIUM POLYSTYRENE 15G/60MLBTL $4.45 10/1/2018 River Hosp CDM LIDOCAIN/EPI 2% 30ML VIAL $4.45 10/1/2018 River Hosp CDM WARFARIN 10mg $4.45 10/1/2018 River Hosp CDM PROMAZINE TAB 25MG $4.45 10/1/2018 River Hosp CDM BABY SHAMPOO $4.50 10/1/2018 River Hosp CDM ENDO TUBE CUFFED 3.5 $4.50 10/1/2018 River Hosp CDM ENDO TUBE CUFFED 4.0 $4.50 10/1/2018 River Hosp CDM ENDO TUBE CUFFED 4.5 $4.50 10/1/2018

River Hosp CDM VESSELL LOOPS $4.50 10/1/2018 River Hosp CDM FACE MASK, VENTI MASKII $4.50 10/1/2018 River Hosp CDM CHOLESTYRAMINE QUEST 4GM/5.5 $4.50 10/1/2018 River Hosp CDM FOLIC ACID 5MG/ML 10ML VIAL $4.50 10/1/2018 River Hosp CDM LIDOCAINE 2% 20MG/ML SYR $4.50 10/1/2018 River Hosp CDM ASU SPIN NEEDLE 25gaX3.5"ORANG $4.55 10/1/2018 River Hosp CDM LIDOCAIN/EPI 1% 30ML $4.55 10/1/2018 River Hosp CDM AMPICILLIN SODIUM 500mg VIAL $4.55 10/1/2018 River Hosp CDM LOVASTATIN TAB 50MG $4.60 10/1/2018 River Hosp CDM WARFARIN SODIUM 2.5mg TAB $4.60 10/1/2018 River Hosp CDM AMINOPHYLLINE 250mg/10ml $4.60 10/1/2018 River Hosp CDM SUCCINYLCHOLINE 200mg/10ML $4.60 10/1/2018 River Hosp CDM NORMAL SALINE 50mL $4.60 10/1/2018 River Hosp CDM CREON 12,000 UNITS TAB $4.65 10/1/2018 River Hosp CDM NCS AMLODIPINE BESYLATE 5MGTAB $4.65 10/1/2018 River Hosp CDM NCS FAMOTIDINE 20MG TAB $4.65 10/1/2018 River Hosp CDM HYDROYZINE HCL 25 MG TABLET $4.65 10/1/2018 River Hosp CDM POT CHLORIDE 25meq EFF $4.65 10/1/2018 River Hosp CDM TAGAMET 300mg TAB $4.70 10/1/2018 River Hosp CDM DIGOXIN 125 MCG TABLET $4.70 10/1/2018 River Hosp CDM FUROSEMIDE 40MG TAB $4.70 10/1/2018 River Hosp CDM RACEPINEPHRINE 2.25% INJ $4.70 10/1/2018 River Hosp CDM BUTTERFLY 25ga x 3/8 $4.75 10/1/2018 River Hosp CDM SUTURE, ETHILON 3-0 663G $4.75 10/1/2018 River Hosp CDM IRBESARTAN 150MG TAB $4.75 10/1/2018 River Hosp CDM DICYCLOMINE 10MG TAB $4.75 10/1/2018 River Hosp CDM KETOROLAC TROMETHAMINE 30MG VL $4.75 10/1/2018 River Hosp CDM IV CATHETER 18 x 1 1/4 $4.80 10/1/2018 River Hosp CDM IV CATHETER 16 x 1 1/2 $4.80 10/1/2018 River Hosp CDM GAUZE IODOFORM 1/4" $4.80 10/1/2018 River Hosp CDM COLASTIC 4" $4.80 10/1/2018 River Hosp CDM VAGINAL SPECULUM SM-MED $4.80 10/1/2018 River Hosp CDM NCS NYSTATIN 100000 U/G POWDER $4.80 10/1/2018 River Hosp CDM ENALAPRIL MALEATE 10mg TAB $4.80 10/1/2018 River Hosp CDM ESTROGEN .625mg TAB $4.80 10/1/2018 River Hosp CDM SUTURE, VICRYL 4-0 REEL J284G $4.85 10/1/2018 River Hosp CDM SUTURE, VICRYL 3-0 REEL J285G $4.85 10/1/2018 River Hosp CDM SAFE-T-TRAY $4.85 10/1/2018 River Hosp CDM COBAN WRAP 3" X 5YD $4.85 10/1/2018 River Hosp CDM DILTIAZEM XL 240MG CAP $4.85 10/1/2018 River Hosp CDM LASIX 4ML SYR IM IV J1940 $4.85 10/1/2018 River Hosp CDM DRESSING, COBAN 6" NS $4.90 10/1/2018 River Hosp CDM VAGINAL SPEC. LG FOR LIGHT $4.90 10/1/2018 River Hosp CDM 3-0 VICRYL LIGAPAK J205G $4.90 10/1/2018 River Hosp CDM ENDOTRACH TUBE, UNCUFFED $4.90 10/1/2018 River Hosp CDM BACLOFEN 20mg TAB $4.90 10/1/2018 River Hosp CDM LIDOCAINE 2% 30mg/ml VIAL $4.90 10/1/2018

River Hosp CDM WARFARIN 4mg $4.90 10/1/2018 River Hosp CDM INFANT FEEDING TUBE 5FR $4.95 10/1/2018 River Hosp CDM MEDIPORE TAPE 4" $4.95 10/1/2018 River Hosp CDM WECK-CEL SURG POINT & STRIPS $4.95 10/1/2018 River Hosp CDM LAP SPONGE PKG $4.95 10/1/2018 River Hosp CDM DRAPE, MED W/TAPE $4.95 10/1/2018 River Hosp CDM SUTURE, VICRYL 2-0 VR417 $5.00 10/1/2018 River Hosp CDM EASY COVER, LG $5.00 10/1/2018 River Hosp CDM OMEPRAZOLE 40mg CAP $5.00 10/1/2018 River Hosp CDM PENICILLIN VK 250mg TAB $5.00 10/1/2018 River Hosp CDM INDAPAMIDE 2.5MG TABLET $5.00 10/1/2018 River Hosp CDM CHLORASEPIC SPRAY6OZ $5.00 10/1/2018 River Hosp CDM MINIBAG PLUS 5% DEXTROSE 50CC $5.05 10/1/2018 River Hosp CDM MINIBAG PLUS 5% DEXTROSE 100CC $5.05 10/1/2018 River Hosp CDM DICYCLOMINE HCL 10MG VIAL $5.05 10/1/2018 River Hosp CDM OXYCONTIN 10mg TAB $5.05 10/1/2018 River Hosp CDM IV CATHETER 22 GAGE $5.10 10/1/2018 River Hosp CDM IV CATHETER 24 GAGE $5.10 10/1/2018 River Hosp CDM IV CATHETER 20 x 1 1/4 $5.10 10/1/2018 River Hosp CDM WEBRIL 4" STERILE $5.10 10/1/2018 River Hosp CDM COUDE CLEAN CATHETER $5.10 10/1/2018 River Hosp CDM QUETIAPINE FUMARATE $5.10 10/1/2018 River Hosp CDM NALBUPHINE HCL 10MG/ML AMP $5.10 10/1/2018 River Hosp CDM SODIUM BICARB 8.4% MEQ/ML SYR $5.10 10/1/2018 River Hosp CDM MAGNESIUM SULFATE 20gm/500mlBG $5.10 10/1/2018 River Hosp CDM AMOXICILLIN 500 MG CAPSULE $5.10 10/1/2018 River Hosp CDM OXYMETAZOLINE HCL 15ML .5% BTL $5.10 10/1/2018 River Hosp CDM NCS C-TRIAM 0.1% 600MG CREAM $5.15 10/1/2018 River Hosp CDM RMS 10mg RECTAL SUPP $5.15 10/1/2018 River Hosp CDM SUCCINYLCHOLINE 20mg/1ml SYRNG J0330 $5.15 10/1/2018 River Hosp CDM VECURONIUM 10MG $5.15 10/1/2018 River Hosp CDM DRAPE IMPERVIOUS, SPLIT SHEET $5.20 10/1/2018 River Hosp CDM STOPCOCK 3-WAY $5.20 10/1/2018 River Hosp CDM ATROPINE SULFATE 1MG/ML SYR $5.20 10/1/2018 River Hosp CDM AUGMENTIN 500MG/125MG TAB $5.20 10/1/2018 River Hosp CDM SULFAMETH/TMP 800/160 TAB $5.20 10/1/2018 River Hosp CDM AMLODIPINE 5mg $5.20 10/1/2018 River Hosp CDM NADOLO 20mg TAB $5.20 10/1/2018 River Hosp CDM DUODERM XTHIN 3X3 $5.25 10/1/2018 River Hosp CDM BUPIVACAINE 0.5% EPI 10ML $5.25 10/1/2018 River Hosp CDM HYPERTONIC SALINE 3% $5.25 10/1/2018 River Hosp CDM Simethicone OralSusp40mg/0.6ml $5.25 10/1/2018 River Hosp CDM Simethicone OralSusp40mg/0.6ml $5.25 10/1/2018 River Hosp CDM ABILIFY MAINTENA PER MG $5.25 10/1/2018 River Hosp CDM POTSSIUM CHLRIDE 25MEQ PWDRPKT $5.25 10/1/2018 River Hosp CDM SUTURE, VICRYL J218H $5.30 10/1/2018 River Hosp CDM PEN V POT 125MG/5ML $5.30 10/1/2018

River Hosp CDM LIQUID BANDAGES 30ML BOTTLE $5.30 10/1/2018 River Hosp CDM MORPHINE 2mg/ml SYRINGE $5.30 10/1/2018 River Hosp CDM MORPHINE 4mg/ml SYRINGE $5.30 10/1/2018 River Hosp CDM MORPHINE 5mg/ml SYRINGE $5.30 10/1/2018 River Hosp CDM AKWU OPTHAL LUBRICANT $5.30 10/1/2018 River Hosp CDM GAUZE,IOD 1/2" $5.35 10/1/2018 River Hosp CDM NG TUBE, SALEM SUMP $5.35 10/1/2018 River Hosp CDM SUTURE SILK CT-1 NEEDLE 424H $5.35 10/1/2018 River Hosp CDM BANDAGE ELASTIC 6" STERILE $5.35 10/1/2018 River Hosp CDM CANDESARTAN CILEXITIL 8MG $5.35 10/1/2018 River Hosp CDM DIPHENHYDRAMINE HCL 12.5MG 5ML $5.35 10/1/2018 River Hosp CDM BISOPROLOL 5MG TAB $5.35 10/1/2018 River Hosp CDM MINIBAG PLUS N/S 0.9% 50CC $5.40 10/1/2018 River Hosp CDM MINIBAG PLUS N/S 0.9% 100CC $5.40 10/1/2018 River Hosp CDM MASK ANESTH SM $5.40 10/1/2018 River Hosp CDM MASK ANESTH MED $5.40 10/1/2018 River Hosp CDM MASK ANESTH LRG $5.40 10/1/2018 River Hosp CDM ROSIGLITAZONE TAB 2MG $5.40 10/1/2018 River Hosp CDM CYANOCOB 100MCG INJ $5.40 10/1/2018 River Hosp CDM THIAMINE HCL 100MG/ML VIAL $5.40 10/1/2018 River Hosp CDM PORPARACAINE 0.5% 15ML $5.40 10/1/2018 River Hosp CDM BENZOIN TINC 1OZ $5.40 10/1/2018 River Hosp CDM ESTROGENS,CONJUGATED .625mgTAB $5.40 10/1/2018 River Hosp CDM DACRIOSE $5.40 10/1/2018 River Hosp CDM CIPROFLOXACIN 200mg 20ml VIAL $5.40 10/1/2018 River Hosp CDM CLAVE EXTENSION 8" (MACRO) $5.45 10/1/2018 River Hosp CDM MASK, PEDIATRIC W/NEB $5.45 10/1/2018 River Hosp CDM DUODERM SIGNAL 8X9 $5.45 10/1/2018 River Hosp CDM RED MAXI VESSEL LOOP $5.45 10/1/2018 River Hosp CDM SUTURE, 0 PROLENE 8412H $5.45 10/1/2018 River Hosp CDM WIPE, INSTRUMENT W/ DRAIN $5.45 10/1/2018 River Hosp CDM BACITRCN/PMIXIN B 30GM TUBE $5.45 10/1/2018 River Hosp CDM SIMVASTATIN 20 MG TAB $5.45 10/1/2018 River Hosp CDM XOPENEX 0.63 UD J7619 $5.45 10/1/2018 River Hosp CDM XOPENEX 1.25 UD J7614 $5.45 10/1/2018 River Hosp CDM MGC DIAG KIT MOUTHPIECE $5.50 10/1/2018 River Hosp CDM ELECTROSURGICAL PT PLATE $5.50 10/1/2018 River Hosp CDM BENZOIN COMPOUND 60 ML BTL $5.50 10/1/2018 River Hosp CDM POST MORTEM BAG $5.55 10/1/2018 River Hosp CDM SYRINGE W/NEEDLE 5cc & GREATER $5.55 10/1/2018 River Hosp CDM SNARE $5.55 10/1/2018 River Hosp CDM SUTURE, CHROMIC 3-0 G122H $5.55 10/1/2018 River Hosp CDM HYDROMRPHONE 1mg/ml 1mlSYRINGE $5.55 10/1/2018 River Hosp CDM GI COCKTAIL 30ML PO $5.55 10/1/2018 River Hosp CDM VALPROATE SODIUM IV 500 mg $5.55 10/1/2018 River Hosp CDM NCS CARVEDILOL 6.25MG TAB $5.55 10/1/2018 River Hosp CDM PROBENECID 500MG TAB $5.55 10/1/2018

River Hosp CDM DOXAZOSIN MESYLATE 1mg TAB $5.55 10/1/2018 River Hosp CDM CLINDAMYCIN HCL 150mg CAPS $5.55 10/1/2018 River Hosp CDM 801H $5.60 10/1/2018 River Hosp CDM ALIBAG 36X28 $5.60 10/1/2018 River Hosp CDM RED ROBINSON CATHETER 12FR $5.60 10/1/2018 River Hosp CDM ALCON SMPTS KIT/INTR ULTRA SLV $5.60 10/1/2018 River Hosp CDM METHYLPREDNISOLONE 125mg/2ml $5.60 10/1/2018 River Hosp CDM NITROGLYCERIN 50mg/10ml VIAL $5.60 10/1/2018 River Hosp CDM FUROSEMIDE 80MG TABLET $5.60 10/1/2018 River Hosp CDM VERAPAMIL HCL 120mg TAB $5.60 10/1/2018 River Hosp CDM DUODERM 5.5 x 5.5 $5.65 10/1/2018 River Hosp CDM PRAVASTATIN 20MG $5.65 10/1/2018 River Hosp CDM LIDOCAIN/EPI 2% 20ML J2001 $5.65 10/1/2018 River Hosp CDM NAPROXEN 250 MG TABLET $5.65 10/1/2018 River Hosp CDM POTASSIUM 20MCQ $5.65 10/1/2018 River Hosp CDM POTASSIUM CHLORIDE 20MEQ TAB $5.65 10/1/2018 River Hosp CDM PHENOBARBITOL 65mg/ml $5.65 10/1/2018 River Hosp CDM SUTURE, VICRYL 2-0 J269G $5.70 10/1/2018 River Hosp CDM OLMESARTAN TAB 40MG $5.70 10/1/2018 River Hosp CDM TERBUTALINE 1ML AMP(BRETHINE) J7680 $5.70 10/1/2018 River Hosp CDM NISOLDIPINE 10mg TAB $5.70 10/1/2018 River Hosp CDM EPIENEPHRINE 1MG/ML AMP PRESER $5.70 10/1/2018 River Hosp CDM LASIX 2ML SYR 1M IV $5.70 10/1/2018 River Hosp CDM NADOLOL 40mg TAB $5.70 10/1/2018 River Hosp CDM DIGOXIN 0.25 MG/1ML AMP J1160 $5.70 10/1/2018 River Hosp CDM METHYLPREDNISOLONE 4MG TAB $5.70 10/1/2018 River Hosp CDM PILOCARPINE HCL 1% 15ML BTL $5.70 10/1/2018 River Hosp CDM NITRIK 0.4MG/HR 10MG ADH PATCH $5.70 10/1/2018 River Hosp CDM DILTIAZEM SR 120 MG $5.70 10/1/2018 River Hosp CDM CARVEDILOL 25mg $5.70 10/1/2018 River Hosp CDM SOLUMEDROL $5.80 10/1/2018 River Hosp CDM SUTURE, CHROMIC 811H $5.80 10/1/2018 River Hosp CDM SUTURE, PLAIN 4-0 H821H $5.80 10/1/2018 River Hosp CDM SUTURE, PROLENE 2-0 8411H $5.80 10/1/2018 River Hosp CDM H821H $5.80 10/1/2018 River Hosp CDM CHROMIC SUTURE G124H $5.80 10/1/2018 River Hosp CDM SUTURE, 0 VICRYL J352H $5.80 10/1/2018 River Hosp CDM NEB TX MEDICATION $5.80 10/1/2018 River Hosp CDM EYE STREAM $5.80 10/1/2018 River Hosp CDM DILTIAZEM HCL 120 EP CAPS $5.80 10/1/2018 River Hosp CDM ENEMA MINERAL OIL $5.85 10/1/2018 River Hosp CDM B-12 INJECTION J3420 $5.85 10/1/2018 River Hosp CDM FEILCHENFELD FORCEP $5.85 10/1/2018 River Hosp CDM SUTURE VICRYL-0, J418H $5.85 10/1/2018 River Hosp CDM SUTURE, CHROMIC 2-0 G123H $5.85 10/1/2018 River Hosp CDM SUTURE U203H $5.85 10/1/2018 River Hosp CDM EXTENSION, BRAUN T-PORT $5.85 10/1/2018

River Hosp CDM BENICAR 40MG $5.85 10/1/2018 River Hosp CDM NCS GENASAL LA 0.05% SPRAY BTL $5.85 10/1/2018 River Hosp CDM CYANOCOBALAMIN 1mg/ml VIAL J3420 $5.85 10/1/2018 River Hosp CDM BOTOX (1 UNIT ONLY) $5.90 10/1/2018 River Hosp CDM VIBRAMYCIN 100mg CAP $5.90 10/1/2018 River Hosp CDM ACETYLCYSTEINE 200mg/ml VIAL $5.90 10/1/2018 River Hosp CDM AMPICILLIN SOD/SULBACTAM 1.5G J0295 $5.90 10/1/2018 River Hosp CDM NABUMETONE 500MG TAB $5.90 10/1/2018 River Hosp CDM SUCTION LINER $5.95 10/1/2018 River Hosp CDM EXTENSION SET 3-4 $5.95 10/1/2018 River Hosp CDM ETCO2 ADULT CANNULA $5.95 10/1/2018 River Hosp CDM BAC NEO POLY OPH OIN $5.95 10/1/2018 River Hosp CDM PROMETHAZINE HCL 25mg TAB $5.95 10/1/2018 River Hosp CDM DIPHENHYDRAMINE HCL 50MG VIAL $5.95 10/1/2018 River Hosp CDM SOD BICARB 4.2 % PED SYRINGE $5.95 10/1/2018 River Hosp CDM BUSPIRONE 10MG TAB $5.95 10/1/2018 River Hosp CDM TRIMETHOBENZAMIDE 100mg SUPP $5.95 10/1/2018 River Hosp CDM SILVER SULFADIAZINE 50GM CREAM $5.95 10/1/2018 River Hosp CDM POTASSIUM CHLORIDE 10MEQ BAG $5.95 10/1/2018 River Hosp CDM DEFIB PAD, ADULT $6.00 10/1/2018 River Hosp CDM BEAVER EAR BLADE $6.05 10/1/2018 River Hosp CDM FUROSEMIDE 20MG/2ML VIAL J1940 $6.05 10/1/2018 River Hosp CDM VANCOMYCIN HCl 500mg VIAL $6.15 10/1/2018 River Hosp CDM I.V. EXTENSION SET $6.20 10/1/2018 River Hosp CDM MASK,INFANT MED CONC $6.20 10/1/2018 River Hosp CDM PRIMARY SET BAXTER $6.20 10/1/2018 River Hosp CDM L113G $6.20 10/1/2018 River Hosp CDM ANCHOR NEEDLE MAYO GUT 1/2 cir $6.20 10/1/2018 River Hosp CDM SODIUM BICARB 8.4% 1ml SYRINGE $6.20 10/1/2018 River Hosp CDM PHENYLEPHRINE 10% 5ML DROP $6.25 10/1/2018 River Hosp CDM HYDROXYZINE 10 MG TAB $6.25 10/1/2018 River Hosp CDM DOXYCYCLINE HYCLATE 100MG CAP $6.25 10/1/2018 River Hosp CDM BASIC PACK 1 $6.30 10/1/2018 River Hosp CDM NORMODYNE 100MG/20ML $6.30 10/1/2018 River Hosp CDM CEFAZOLIN 500MG INJ $6.30 10/1/2018 River Hosp CDM SODIUM CHLORIDE 3% 500ml IVBAG $6.30 10/1/2018 River Hosp CDM PROCAINAMIDE 1 gm/2 ml VIAL $6.30 10/1/2018 River Hosp CDM LOPERAMIDE HCL 2MG CAPSULE $6.30 10/1/2018 River Hosp CDM AZITHROMYCIN 500mg TAB $6.30 10/1/2018 River Hosp CDM VASELINE GAUZE 3"-18" $6.35 10/1/2018 River Hosp CDM ENEMA SETS $6.35 10/1/2018 River Hosp CDM ULTRASOUND KEYBRD COVER $6.35 10/1/2018 River Hosp CDM LORTABELIXIR 7.5-325mg/15mlUDC $6.35 10/1/2018 River Hosp CDM GASTROCCULT SLIDE $6.40 10/1/2018 River Hosp CDM NEEDLE ANCHOR MAYO 1/2" #6 $6.40 10/1/2018 River Hosp CDM LIDO 4% VIAL $6.40 10/1/2018 River Hosp CDM NCS JUVEN PACKET $6.40 10/1/2018

River Hosp CDM HYDROCORTISONE SOD SUCC 100VIA J1720 $6.40 10/1/2018 River Hosp CDM TRIMETHOBENZAMIDE 200mg SUPP $6.40 10/1/2018 River Hosp CDM METOLAZONE 5mg ORAL $6.40 10/1/2018 River Hosp CDM METOLAZONE 5MG TAB $6.40 10/1/2018 River Hosp CDM ZONE 1 ALLERGY (86003 X29) 86003 $6.44 10/1/2018 River Hosp CDM FILM DUPLICATING $6.45 10/1/2018 River Hosp CDM MEMANTINE $6.45 10/1/2018 River Hosp CDM DILAUDID INJECTION $6.50 10/1/2018 River Hosp CDM LEGGING, SURGICAL $6.50 10/1/2018 River Hosp CDM LEGGINS $6.50 10/1/2018 River Hosp CDM DEXAMETHASONE SOD PHOS 4MG VL $6.50 10/1/2018 River Hosp CDM DRESSING,TOPPER 4X4 BX $6.55 10/1/2018 River Hosp CDM SPECIMEN CLIP $6.55 10/1/2018 River Hosp CDM DRAPE SHEET 3/4 STERILE $6.60 10/1/2018 River Hosp CDM CONCHAPAK 1650 $6.60 10/1/2018 River Hosp CDM TRIAMCINOLONE ACETENIDE 40mg/V J3301 $6.60 10/1/2018 River Hosp CDM OXYTOCIN 100 UNITS/10ml VIAL $6.60 10/1/2018 River Hosp CDM CLONIDINE 0.2MG TAB $6.60 10/1/2018 River Hosp CDM HYDROXYZINE HCL 25MG/ML VIAL $6.60 10/1/2018 River Hosp CDM LACTULOSE 10g/15ml BTL 480ml $6.60 10/1/2018 River Hosp CDM BLOOD SECONDARY SET $6.65 10/1/2018 River Hosp CDM AQUAPAK 440 ml W/ ADAPTOR $6.65 10/1/2018 River Hosp CDM HYDROMORPHONE 2MG/ML INJ $6.65 10/1/2018 River Hosp CDM AMIODARONE HCL 100MG $6.65 10/1/2018 River Hosp CDM POTASSIUMCHLORIDE10meq100ml IV $6.65 10/1/2018 River Hosp CDM DIVALPROEX ER 250 mg TAB $6.65 10/1/2018 River Hosp CDM NITROFURANTOIN MONO/MAC 100mg $6.65 10/1/2018 River Hosp CDM BOUDREAUX'S BUTT PASTE $6.65 10/1/2018 River Hosp CDM XIBROM 0.9% PER DROP $6.65 10/1/2018 River Hosp CDM RACEPINEPHRINE 2/25% 0.5ml NEB $6.65 10/1/2018 River Hosp CDM AMIODARONE 450mg VIAL $6.70 10/1/2018 River Hosp CDM PREGABALIN 75MG $6.70 10/1/2018 River Hosp CDM MASK ANESTHESIA SMALL $6.80 10/1/2018 River Hosp CDM FEIL-SPLINTER FORCEP DISP. $6.80 10/1/2018 River Hosp CDM TIZANIDINE 4MG TAB $6.80 10/1/2018 River Hosp CDM GROUNDING PAD $6.85 10/1/2018 River Hosp CDM SHAMPOO CAP $6.85 10/1/2018 River Hosp CDM EPIDURAL SYRINGE $6.85 10/1/2018 River Hosp CDM PHEBOTOMY SET $6.85 10/1/2018 River Hosp CDM SUTURE VICRYL 2 J195H $6.85 10/1/2018 River Hosp CDM DRESSING OPTIFOAM GENTLE WHITE $6.85 10/1/2018 River Hosp CDM CIMETIDINE 300 2ml INJ $6.85 10/1/2018 River Hosp CDM NCS DIAL SOAP GOLD 3.5 OZ BAR $6.85 10/1/2018 River Hosp CDM KETO OPTHAMOLIC SOLUTION $6.90 10/1/2018 River Hosp CDM CATHETER LEG STRAP $6.90 10/1/2018 River Hosp CDM EXTENSION SET 32" $6.90 10/1/2018 River Hosp CDM OXYCONTIN $6.90 10/1/2018

River Hosp CDM HYDROMORPHONE INJ $6.95 10/1/2018 River Hosp CDM MALYUGIN RING 6.25 mm $6.95 10/1/2018 River Hosp CDM RANITIDINE 150mg TAB $6.95 10/1/2018 River Hosp CDM QUINAPRIL HCL 20MG TAB $6.95 10/1/2018 River Hosp CDM POOLER SUCTION INSTRUMENT $7.00 10/1/2018 River Hosp CDM MATERNITY PADS STERILE $7.00 10/1/2018 River Hosp CDM OSMOLITE 1.2 $7.00 10/1/2018 River Hosp CDM TED STOCKING KNEE, XXLARGE $7.00 10/1/2018 River Hosp CDM SUTURE J603H $7.00 10/1/2018 River Hosp CDM TAMSULOSIN HCL 0.4MG $7.00 10/1/2018 River Hosp CDM OFLOXACIN $7.00 10/1/2018 River Hosp CDM LIDOCAIN/EPI 1% 30ML VIAL $7.05 10/1/2018 River Hosp CDM CLOTRIMAZOLE TROCHE $7.05 10/1/2018 River Hosp CDM HYDROXYZINE 50MG/ML VIAL J3410 $7.05 10/1/2018 River Hosp CDM CLOTRIMAZOLE 10mg TROCHE $7.05 10/1/2018 River Hosp CDM CALCIUM CHL 10% 10mL SYR $7.10 10/1/2018 River Hosp CDM TOURNIQUET CUFF 8" $7.15 10/1/2018 River Hosp CDM ELASTIC TAPE 2" $7.15 10/1/2018 River Hosp CDM LYOFOAM DRESSING 2X2 $7.20 10/1/2018 River Hosp CDM SPEARS, EYE MICROSPONGE $7.20 10/1/2018 River Hosp CDM LOSARTAN POTASSIUM 25MG TABLET $7.20 10/1/2018 River Hosp CDM WOUND CARE KIT NON DRESS ER $7.25 10/1/2018 River Hosp CDM DUODERM $7.25 10/1/2018 River Hosp CDM TERAZOSIN HCL 1 MG CAPS $7.25 10/1/2018 River Hosp CDM PAXIL CR 12.5MG TAB $7.30 10/1/2018 River Hosp CDM NCS URSODIOL 300MG TAB $7.30 10/1/2018 River Hosp CDM TRIMETHOBENZAMIDE 100mg1ml VL $7.30 10/1/2018 River Hosp CDM COBAN STERILE 4" LATEX FREE $7.35 10/1/2018 River Hosp CDM HYDROCERIN 120 gm JAR $7.35 10/1/2018 River Hosp CDM BRIMONIDINE TARTRATE 0.2% $7.35 10/1/2018 River Hosp CDM TIMOLOL OPHTHALMIC 0.5% 5ml $7.35 10/1/2018 River Hosp CDM TIMOLOL OPHTHALMIC 0.25% 5ml $7.35 10/1/2018 River Hosp CDM GENTAMICIN 80mg/2ml VIAL $7.35 10/1/2018 River Hosp CDM ADENOSINE 6mg/2m VIAL $7.35 10/1/2018 River Hosp CDM OXYBUTYMIN XL 10mg $7.35 10/1/2018 River Hosp CDM ARM SLING ALL SIZES $7.40 10/1/2018 River Hosp CDM DRAPE, UNDER BUTTOCK, KENDALL $7.40 10/1/2018 River Hosp CDM SURGICAL GOWN LARGE $7.40 10/1/2018 River Hosp CDM PREP TRAY PVI SOL $7.40 10/1/2018 River Hosp CDM BITE BLOCK, DISPOSABLE $7.40 10/1/2018 River Hosp CDM VALSARTAN 160 MG $7.40 10/1/2018 River Hosp CDM HYPERGEL 0.5 OZ $7.45 10/1/2018 River Hosp CDM FORMFIT MASK INFANT $7.45 10/1/2018 River Hosp CDM AMINOPHYLLINE 500mg/20ml VIAL $7.45 10/1/2018 River Hosp CDM PREGABLIN 50MG $7.45 10/1/2018 River Hosp CDM LNA FLEX INTRODUCER PEDIATRIC $7.50 10/1/2018 River Hosp CDM SURG STERILE GOWN - XXL $7.50 10/1/2018

River Hosp CDM LMA FLEXIBLE INTRODUCER ADULT $7.50 10/1/2018 River Hosp CDM FERROUS SULFATE ELIXIR BTL $7.50 10/1/2018 River Hosp CDM BUPIVCAINE-MPF 0.75% 10ML VIAL $7.50 10/1/2018 River Hosp CDM VACUTAINER BOTTLE 1000CC $7.55 10/1/2018 River Hosp CDM KEFLEX 500mg CAPS $7.55 10/1/2018 River Hosp CDM LIDOCAINE 2gm/500ml IV $7.60 10/1/2018 River Hosp CDM CLAVE EXTENSION 7" (MICRO) $7.65 10/1/2018 River Hosp CDM STYLET INTUBATING 5FR SMALL $7.65 10/1/2018 River Hosp CDM DRAIN BAG 2000ML $7.65 10/1/2018 River Hosp CDM OCTREOTIDE ACEATATE 100MG $7.65 10/1/2018 River Hosp CDM UNDER BUTTOCK DRAPE $7.65 10/1/2018 River Hosp CDM CANNULA, BIFLO $7.65 10/1/2018 River Hosp CDM TROPICAMIDE 1% 15ML $7.65 10/1/2018 River Hosp CDM CALAN 5MG IV 2ML $7.65 10/1/2018 River Hosp CDM LIDEX 15GM CR $7.65 10/1/2018 River Hosp CDM VERAPAMIL HCL 2.5MG/ML AMP $7.65 10/1/2018 River Hosp CDM FLUOCINONIDE 15 GM TUBE $7.65 10/1/2018 River Hosp CDM PAROXETINE 40MG TAB $7.65 10/1/2018 River Hosp CDM AMIODARONE HCL 200mg TABLET $7.65 10/1/2018 River Hosp CDM SURGICAL GOWN XL $7.70 10/1/2018 River Hosp CDM INCENTIVE SPIROMETER $7.70 10/1/2018 River Hosp CDM DOCUSATE SODIUM 10MG/5ML $7.70 10/1/2018 River Hosp CDM SURGICAL GOWN X-LARGE $7.70 10/1/2018 River Hosp CDM TEGADERM DRESSING 6"X8" $7.75 10/1/2018 River Hosp CDM UNASYN 3gm VIAL $7.75 10/1/2018 River Hosp CDM NCS CETIRIZINE HCL 10MG TAB $7.75 10/1/2018 River Hosp CDM NCS CLARINEX 5MG TAB $7.75 10/1/2018 River Hosp CDM TRIPLE ANTIBIOTIC OINT .5gm $7.75 10/1/2018 River Hosp CDM AQUACELL FOAM DRESSING 4X4 $7.80 10/1/2018 River Hosp CDM ROCURONIUM 50mg/5 ml 5 ml VIAL $7.80 10/1/2018 River Hosp CDM PROPOFOL 200mg/10ml $7.80 10/1/2018 River Hosp CDM GENTRAMICIN 80mg/100ml IV $7.80 10/1/2018 River Hosp CDM PREFIL O2 ADAPTER $7.85 10/1/2018 River Hosp CDM ENDO TRACH TUBE HOLDER $7.85 10/1/2018 River Hosp CDM SUTURE, PROLENE 2-0 8833H $7.85 10/1/2018 River Hosp CDM LITTAUER STITCHSCISSORS W/HOOK $7.85 10/1/2018 River Hosp CDM ANESTHESIA CIRCUIT,ADULT $7.85 10/1/2018 River Hosp CDM HYDROCHLOROTHIAZIDE 25mg $7.85 10/1/2018 River Hosp CDM STERILE SPONGES $7.90 10/1/2018 River Hosp CDM ADM SET Y-TYPE BLOOD SET $7.95 10/1/2018 River Hosp CDM SPINAL NEEDLE 22gax3.5 $7.95 10/1/2018 River Hosp CDM ERYTHRMYCN 0.5%OPTHOINT1gmTUBE $7.95 10/1/2018 River Hosp CDM BUPVACAINE WITH EPI 0.5% $7.95 10/1/2018 River Hosp CDM DUODERM SIGNAL 4x4 $8.00 10/1/2018 River Hosp CDM 735G $8.00 10/1/2018 River Hosp CDM SURGICAL GOWN SMALL $8.00 10/1/2018 River Hosp CDM CLIPPER BLADE ASSEMBLY $8.00 10/1/2018

River Hosp CDM GROUND PAD $8.00 10/1/2018 River Hosp CDM SOLUSET 150 $8.00 10/1/2018 River Hosp CDM DRESSING, COBAN 6" STERILE ROL $8.00 10/1/2018 River Hosp CDM TORSEMIDE 100MG TAB $8.00 10/1/2018 River Hosp CDM NORMAL SALINE 0.9 50CC $8.05 10/1/2018 River Hosp CDM DIAZEPAM INJ 10mg/2ml $8.05 10/1/2018 River Hosp CDM GRADUATE $8.10 10/1/2018 River Hosp CDM SULFAMETH/TRIME 800/160MG SUSP $8.10 10/1/2018 River Hosp CDM SODIUM BICARB 4% VIAL $8.10 10/1/2018 River Hosp CDM EFFEXOR 37.5 MG $8.15 10/1/2018 River Hosp CDM BENADRYL CREAM $8.15 10/1/2018 River Hosp CDM CYCLOBENZAPRINE HCL 10MG TAB $8.15 10/1/2018 River Hosp CDM STERILE TOWELS (2) $8.20 10/1/2018 River Hosp CDM INSTRUMENT PAD $8.20 10/1/2018 River Hosp CDM STERILE EYE SHEET $8.20 10/1/2018 River Hosp CDM STERILE PILLOW CASE $8.20 10/1/2018 River Hosp CDM TISSUES $8.20 10/1/2018 River Hosp CDM SPUTUM CUP $8.20 10/1/2018 River Hosp CDM VERSIVA 3.5 X 3.5 $8.20 10/1/2018 River Hosp CDM SENSORCAINE/EPI 0.5% $8.20 10/1/2018 River Hosp CDM DOPAMINE 400MG/10ML $8.20 10/1/2018 River Hosp CDM ZINC OXIDE PASTE $8.25 10/1/2018 River Hosp CDM SIEMANS NEEDLE GUIDE $8.25 10/1/2018 River Hosp CDM URINARY CATHETER $8.25 10/1/2018 River Hosp CDM AQUACEL 4x4 DRESSING $8.25 10/1/2018 River Hosp CDM PROCHLORPERAZINE 5mg SUPP $8.25 10/1/2018 River Hosp CDM PSEUDOEPHEDRINE HCL 30MG TAB $8.25 10/1/2018 River Hosp CDM NASOPHARYNGEL AIRWAY $8.30 10/1/2018 River Hosp CDM LOVASTATIN 20MG $8.30 10/1/2018 River Hosp CDM NCS CYANOCOBALAMIN 1000MCG VIA $8.30 10/1/2018 River Hosp CDM NITROFURANTOIN MACRO 50MG CAP $8.30 10/1/2018 River Hosp CDM HYDROCHLOROTHIAZIDE 25mg TAB $8.30 10/1/2018 River Hosp CDM RECTAL THERMOMETER $8.35 10/1/2018 River Hosp CDM DRESSING COBAN 4" $8.35 10/1/2018 River Hosp CDM TOURNIQUET CUFF 12" $8.35 10/1/2018 River Hosp CDM CAUTERY, HANDCONTROL PENCIL $8.35 10/1/2018 River Hosp CDM SPINAL NEEDLE,QUINCKE $8.35 10/1/2018 River Hosp CDM BUPIVACAINE W/EPI-MPF0.75%30ml $8.35 10/1/2018 River Hosp CDM LOSARTAN/GCTZ 50/12. $8.35 10/1/2018 River Hosp CDM CELECOXIB $8.35 10/1/2018 River Hosp CDM STYLET INTUBATING 10FR ADULT $8.40 10/1/2018 River Hosp CDM VENTURI MASK A4620 $8.40 10/1/2018 River Hosp CDM STERILE OR TOWELS $8.40 10/1/2018 River Hosp CDM SUTURE PROLENE ETHICON 8424H $8.40 10/1/2018 River Hosp CDM SUTURE VICRYL COAT+ 0 vcp376h $8.40 10/1/2018 River Hosp CDM TIGAN INJECTION 200MG $8.40 10/1/2018 River Hosp CDM SOD CHLORID .9% 100ml MINIBAG+ $8.40 10/1/2018

River Hosp CDM ESMOLOL 100mg/10ml VIAL $8.40 10/1/2018 River Hosp CDM HYDROCDN/APAP 2.5-167mg/5mlUDC $8.40 10/1/2018 River Hosp CDM CEFDINIR 250mg/5ml ORAL SYRING $8.40 10/1/2018 River Hosp CDM MITOMYCIN 0.3mg/ml. $8.40 10/1/2018 River Hosp CDM ACE BANDAGE ER $8.45 10/1/2018 River Hosp CDM ULTRASITE VALVE NEEDLE FREE $8.45 10/1/2018 River Hosp CDM FLAT BLD ELEC W HEX 6" $8.45 10/1/2018 River Hosp CDM SUTURE 3-0 PROLENE $8.45 10/1/2018 River Hosp CDM SUTURE, ETHILON 4-0 1662G $8.55 10/1/2018 River Hosp CDM TAMOXIFEN CITRATE 10mg TAB $8.55 10/1/2018 River Hosp CDM TAMOXIFEN 20mg $8.55 10/1/2018 River Hosp CDM EYE WICK 8" WITH BAG $8.60 10/1/2018 River Hosp CDM VASELINE GAUZE 5"-36" $8.65 10/1/2018 River Hosp CDM VASELINE GAUZE 1/2"-72" $8.65 10/1/2018 River Hosp CDM GAUZE,PLAIN $8.65 10/1/2018 River Hosp CDM TACOLIMUS 1mg ORAL $8.65 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 14 FR $8.70 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 18 FR $8.70 10/1/2018 River Hosp CDM CATH #18 FOLEY FR $8.70 10/1/2018 River Hosp CDM BAXTER CONTIU-FLO SET ASU $8.70 10/1/2018 River Hosp CDM FENTANYL 25MCG PATCH $8.70 10/1/2018 River Hosp CDM POLYVINYL ALCOHOL 15ml BTL $8.70 10/1/2018 River Hosp CDM PHENYTOIN 2ml 50mg/ml $8.70 10/1/2018 River Hosp CDM ELECTRODE PENCIL $8.75 10/1/2018 River Hosp CDM MEDICAL ELECTRODE 1/16" $8.75 10/1/2018 River Hosp CDM MEDICAL ELECTRODE ASST 1/16 $8.75 10/1/2018 River Hosp CDM VENLAFAXINE ExtRel 37.5MG $8.75 10/1/2018 River Hosp CDM RANITIDINE INJ 50mg 2ml $8.75 10/1/2018 River Hosp CDM NCS ACETAMINOPHEN 160MG/ML ELX $8.80 10/1/2018 River Hosp CDM SUCCINYLCHOLINE 20MG/ML VIAL $8.80 10/1/2018 River Hosp CDM MOUTH WASH $8.85 10/1/2018 River Hosp CDM ENDO TRACH TUBE,CUFFED $8.85 10/1/2018 River Hosp CDM 1696G $8.85 10/1/2018 River Hosp CDM MEROCEL POPE EAR WICK $8.85 10/1/2018 River Hosp CDM DIAMOX 500MG $8.85 10/1/2018 River Hosp CDM DEXAMETHASONE 4mg TAB $8.85 10/1/2018 River Hosp CDM CELECOXIB 100 MG CAPSULE $8.85 10/1/2018 River Hosp CDM ALFENTANIL 500MCG/ML 2ML VIAL $8.90 10/1/2018 River Hosp CDM LAMOTRIGINE 100MG TABLET $8.95 10/1/2018 River Hosp CDM NCS VIT D SOFT GEL 50000 CAP $8.95 10/1/2018 River Hosp CDM SUTURE, ETHILON 6-0 697G $9.00 10/1/2018 River Hosp CDM CHLORAPREPP 10.5ML $9.00 10/1/2018 River Hosp CDM VALTREX 1000 MG $9.00 10/1/2018 River Hosp CDM IPECAC SYRUP 30 ML $9.00 10/1/2018 River Hosp CDM NASAL CANNULA (INFANT) A4615 $9.10 10/1/2018 River Hosp CDM NASAL CANNULA (PEDIATRIC) A4615 $9.10 10/1/2018 River Hosp CDM GAUZE PACKING, IODOFORM 1" $9.10 10/1/2018

River Hosp CDM MIDAZOLAM UDC 2MG/ML $9.10 10/1/2018 River Hosp CDM NCS OMEPRAZOLE 20MG TAB $9.10 10/1/2018 River Hosp CDM NCS OMEPRAZOLE 20MG TAB $9.10 10/1/2018 River Hosp CDM PRIMARY IV TUBING STRAIGHT $9.15 10/1/2018 River Hosp CDM NYSTATIN 15GM CREAM $9.15 10/1/2018 River Hosp CDM METHYLINE BLUE 1% 10MG/ML $9.20 10/1/2018 River Hosp CDM CEFOXITEN INJ 1gm J0694 $9.20 10/1/2018 River Hosp CDM LINDANE 1% LOTION 60ML BTL $9.20 10/1/2018 River Hosp CDM PHENYTOIN SODIUM 50mg/5ML $9.20 10/1/2018 River Hosp CDM PRIMARY SET $9.25 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 16FR $9.25 10/1/2018 River Hosp CDM MASK, ANESTHESIA ALL SIZES $9.25 10/1/2018 River Hosp CDM MASK ANESTHESIA,LRG $9.25 10/1/2018 River Hosp CDM 585H $9.25 10/1/2018 River Hosp CDM FOG OUT SOLUTION $9.25 10/1/2018 River Hosp CDM DEPAKOTE 250MG TAB $9.25 10/1/2018 River Hosp CDM AMBIEN 10mg TAB $9.25 10/1/2018 River Hosp CDM ABD DRESSING 1 BOX $9.30 10/1/2018 River Hosp CDM J494H $9.30 10/1/2018 River Hosp CDM FIXATION TAPE $9.30 10/1/2018 River Hosp CDM CEFACLOR 250mg CAPS $9.30 10/1/2018 River Hosp CDM BSS 18ML DROPS $9.30 10/1/2018 River Hosp CDM HYDROCODONE 325/7.5 $9.30 10/1/2018 River Hosp CDM ENALAPRILATE 2.5MG/2ML $9.35 10/1/2018 River Hosp CDM SUTURE, VICRYL 5-0 J500G $9.35 10/1/2018 River Hosp CDM ALIGATOR FORCEPS SER JAW3 $9.40 10/1/2018 River Hosp CDM ATTENDS MEDIUM-EACH $9.40 10/1/2018 River Hosp CDM MAGNESIUM SULFATE 5GM/10ML SYR $9.40 10/1/2018 River Hosp CDM NEOSYNEPHRINE 1/2% SPRAY $9.40 10/1/2018 River Hosp CDM NYSTATIN CREAM 30G $9.40 10/1/2018 River Hosp CDM GASTROGRAFIN 120 ML $9.45 10/1/2018 River Hosp CDM STERILE TOWELS (4) $9.45 10/1/2018 River Hosp CDM FINE EXCISION TRAY $9.45 10/1/2018 River Hosp CDM IRRIGA. WATER 500ML $9.45 10/1/2018 River Hosp CDM PACIFIER NUK $9.45 10/1/2018 River Hosp CDM SPLINT MAT-FIBERGLAS $9.45 10/1/2018 River Hosp CDM SODIUM CHLORIDE 0.45% 500mlBAG $9.45 10/1/2018 River Hosp CDM FLU VACCINE SWG (ADMIN) RN G0128 $9.50 10/1/2018 River Hosp CDM KETAMINE 50MG/10ML $9.50 10/1/2018 River Hosp CDM ESMOLOL 10MG/ML VIAL $9.50 10/1/2018 River Hosp CDM XYLOCAINE 4% 5ML INJ $9.50 10/1/2018 River Hosp CDM BRIEF, MEDIUM PKG $9.55 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 20 FR $9.55 10/1/2018 River Hosp CDM CATHETER,FOLEY 30cc $9.55 10/1/2018 River Hosp CDM SUTURE, VICRYL 5-0 J943G $9.55 10/1/2018 River Hosp CDM SPIRONOLACTONE 25MG TAB $9.55 10/1/2018 River Hosp CDM ATORVASTATIN 10mg TAB $9.55 10/1/2018

River Hosp CDM ANESTHESIA-GENERAL PER MINUTE $9.60 10/1/2018 River Hosp CDM Philips Gas Sampling Tubing $9.60 10/1/2018 River Hosp CDM MISQUITO FORCEPS CURVED 5"DISP $9.60 10/1/2018 River Hosp CDM SCOTCH CAST TAPE 2BL $9.60 10/1/2018 River Hosp CDM CHLORAPREPP 1 STEP CLEAR APPLI $9.65 10/1/2018 River Hosp CDM DIVALPROEX SODIUM 500MG $9.65 10/1/2018 River Hosp CDM AMPICILLIN SODIUM 1G VIAL $9.65 10/1/2018 River Hosp CDM BUDESONIDE 0.2mg/2ml $9.65 10/1/2018 River Hosp CDM NELFINAYIR MESYLATE 250g $9.65 10/1/2018 River Hosp CDM SLIDE REVIEW W/O DIFF 85008 $9.65 10/1/2018 River Hosp CDM PREP TRAY, EXIDINE $9.70 10/1/2018 River Hosp CDM AMLODIPINE BESYLATE 10mg TAB $9.70 10/1/2018 River Hosp CDM GENTAMICIN 0.3% 5ML BTL $9.80 10/1/2018 River Hosp CDM NASAL TRUMPET (ALL SIZES) $9.85 10/1/2018 River Hosp CDM ENDO TRACH TUBE HOLDER, PED $9.85 10/1/2018 River Hosp CDM LIFESHIELD GENIVIAL ACCESS DEV $9.90 10/1/2018 River Hosp CDM LIPITOR 20MG TAB $9.95 10/1/2018 River Hosp CDM ESCITALOPRAM 10MG $9.95 10/1/2018 River Hosp CDM GLUCOSE GEL $10.00 10/1/2018 River Hosp CDM CATHETER KIT FEMALE $10.05 10/1/2018 River Hosp CDM IRRIGA. WATER 1000ML $10.05 10/1/2018 River Hosp CDM VENLAFAXINE ExtRel HCL 150MG $10.10 10/1/2018 River Hosp CDM ROSUVASTATIN CALCIUM 10MG $10.10 10/1/2018 River Hosp CDM OFLOXACIN OPTH SOL 0.3%5ml BTL $10.15 10/1/2018 River Hosp CDM OXYCONTIN 20mg TAB $10.15 10/1/2018 River Hosp CDM PROMETHAZINE HCL 25mg SUPP $10.15 10/1/2018 River Hosp CDM AUGMENTIN 250MG/125MG TAB $10.20 10/1/2018 River Hosp CDM NCS CLINDAMYCIN HCL 300MG CAP $10.20 10/1/2018 River Hosp CDM AIRWAY SUCTION STERILE ER $10.25 10/1/2018 River Hosp CDM MORHPINE 100MG VIAL $10.25 10/1/2018 River Hosp CDM TOLTERODINE TARTRATE $10.25 10/1/2018 River Hosp CDM CEFEPIME 1 gm $10.25 10/1/2018 River Hosp CDM PULMACORT $10.25 10/1/2018 River Hosp CDM SUTURE, PROLENE 2-0 8523H $10.30 10/1/2018 River Hosp CDM CAPTOPRIL 25mg TAB $10.30 10/1/2018 River Hosp CDM URINALYSIS W/MICRO 81003 $10.30 10/1/2018 River Hosp CDM ALOE VISTA PROTECTIVE OINTMENT $10.35 10/1/2018 River Hosp CDM KD-AVODART 0.5 MG $10.35 10/1/2018 River Hosp CDM ETT HOLDER $10.40 10/1/2018 River Hosp CDM MACROBID 100 MG CAP $10.40 10/1/2018 River Hosp CDM PROLENE 3-0 8522H $10.45 10/1/2018 River Hosp CDM CATHETER ROBINSON 28FR $10.45 10/1/2018 River Hosp CDM ACIPHEX 20MG TAB $10.45 10/1/2018 River Hosp CDM ADENOSINE 6mg/2ml Syringe $10.45 10/1/2018 River Hosp CDM Humulin N (NPH) 3ml vial $10.45 10/1/2018 River Hosp CDM RABEPORAZOLE 20mg TABLET $10.45 10/1/2018 River Hosp CDM ESMARK TAPE 6" $10.55 10/1/2018

River Hosp CDM TAPE ESMARK 6X9 $10.55 10/1/2018 River Hosp CDM SUTURE, ETHILON 5-0 7731G $10.55 10/1/2018 River Hosp CDM ESOMEPRAZOLE SODIUM CAP 20MG $10.55 10/1/2018 River Hosp CDM BROMOCRIPTINE 2.5mg TAB $10.55 10/1/2018 River Hosp CDM ASU EPIDURAL NEEDLE 17ga x3.5" $10.60 10/1/2018 River Hosp CDM WARFARIN SODIUM 5mg TAB $10.60 10/1/2018 River Hosp CDM ESOMEPRAZOLE CAP 40MG $10.65 10/1/2018 River Hosp CDM KEFLEX SUSP. 125MG/5ML $10.65 10/1/2018 River Hosp CDM VALSARTAN 160MG $10.65 10/1/2018 River Hosp CDM FEEDING TUBE SET UP $10.70 10/1/2018 River Hosp CDM MOHAWK TURN-COT MED $10.70 10/1/2018 River Hosp CDM STAT LCOK FOR PICC LINES $10.70 10/1/2018 River Hosp CDM PROPOFOL 500MG/50ML $10.70 10/1/2018 River Hosp CDM CARVEDILOL 3.125MG $10.70 10/1/2018 River Hosp CDM ZOSYN 2.25 gm IV VIAL $10.75 10/1/2018 River Hosp CDM SUTURE, VICRYL 5-0 VR493 $10.80 10/1/2018 River Hosp CDM PPD-TUBERSOL 5TUL 0.1ML $10.80 10/1/2018 River Hosp CDM GABPINTIN 600mg $10.80 10/1/2018 River Hosp CDM DRESSING WET SALINE $10.85 10/1/2018 River Hosp CDM KIDNEY STONE FILTER $10.85 10/1/2018 River Hosp CDM SHAMPOO BABY $10.85 10/1/2018 River Hosp CDM BETADINE SOLUTION $10.85 10/1/2018 River Hosp CDM ROCEPHIN INJECTION J0696 $10.90 10/1/2018 River Hosp CDM CEFTRIAXONE SODIUM 500mg VIAL J0696 $10.90 10/1/2018 River Hosp CDM ROCEPHIN INJECTION PER 250MG J0696 $10.90 10/1/2018 River Hosp CDM TOURNIQUET CUFF 18" $10.95 10/1/2018 River Hosp CDM MONTELUKAST SODIUM CAP 10MG $10.95 10/1/2018 River Hosp CDM POLYETHYLENE GLYCOL 17GM/DOSE $10.95 10/1/2018 River Hosp CDM IV START KIT $11.00 10/1/2018 River Hosp CDM KETOROLAC 10mg TAB $11.00 10/1/2018 River Hosp CDM LEVETIRACETAM 500MG TABLET $11.05 10/1/2018 River Hosp CDM ASU EPIDURAL NEEDLE 20ga x3.5" $11.05 10/1/2018 River Hosp CDM 1 SEAL $11.05 10/1/2018 River Hosp CDM ZEGERID 20MG POWDER PKT $11.05 10/1/2018 River Hosp CDM XOPENEX 0.31MG PER AMP $11.10 10/1/2018 River Hosp CDM Humulin 70/30 3ml vial $11.10 10/1/2018 River Hosp CDM NCS ALLERGY CREAM 2% BENADRYL $11.10 10/1/2018 River Hosp CDM SUTURE, PROLENE 5-0 8681G $11.15 10/1/2018 River Hosp CDM ESMARK TAPE, 4" $11.15 10/1/2018 River Hosp CDM METHYLPREDNISOLONE SOD 40MG VL $11.15 10/1/2018 River Hosp CDM FLURBIPROPHEN $11.20 10/1/2018 River Hosp CDM THEOPHYLL/ANHYDROUS 80MG/15ML $11.20 10/1/2018 River Hosp CDM MICROSCOPIC URINALY 81015 $11.20 10/1/2018 River Hosp CDM AIRWAY SUCTION NON STERILE $11.25 10/1/2018 River Hosp CDM CEFTAZIDIME 1gm $11.25 10/1/2018 River Hosp CDM VASOTEC 5mg $11.25 10/1/2018 River Hosp CDM PAROXETINE HCL 20mg TAB $11.25 10/1/2018

River Hosp CDM TIGAN INJECTION 200MG CLN J3250 $11.35 10/1/2018 River Hosp CDM PED CATH KIT 5 FR $11.35 10/1/2018 River Hosp CDM TETRACAINE 0.5% OPTH SLN 2ML $11.35 10/1/2018 River Hosp CDM CEFTRIAXONE SODIUM 1g VIAL $11.35 10/1/2018 River Hosp CDM NCS EAR WAX TREATMENT DROPS $11.40 10/1/2018 River Hosp CDM FEXOFENADINE 180mg $11.40 10/1/2018 River Hosp CDM DILTOZEN 125MG/25 ML VIAL $11.45 10/1/2018 River Hosp CDM NAIL TRAY $11.45 10/1/2018 River Hosp CDM IRRIGA. WATER 1500ML $11.45 10/1/2018 River Hosp CDM FRACTURED BED PAN $11.45 10/1/2018 River Hosp CDM BABY BOTTLE $11.45 10/1/2018 River Hosp CDM TOURNIQUET CUFF 24" $11.45 10/1/2018 River Hosp CDM PREDNISOLONE ACET 1% 5ML $11.45 10/1/2018 River Hosp CDM TUBERSOL .1 ML TB TEST $11.45 10/1/2018 River Hosp CDM HEMORRHOIDAL OINTMT $11.45 10/1/2018 River Hosp CDM LIMB HOLDER (WRIST/ANKLE) $11.50 10/1/2018 River Hosp CDM LENS GUIDE,GLDE 36 $11.50 10/1/2018 River Hosp CDM ROOM TURNOVER SYSTEM $11.60 10/1/2018 River Hosp CDM WEBRIL 6" STERILE $11.60 10/1/2018 River Hosp CDM SPLINT, FOREARM PADDED R/LG $11.60 10/1/2018 River Hosp CDM SPLINT, FOREARM NONPAD $11.60 10/1/2018 River Hosp CDM ISO NEB SUPPLY $11.65 10/1/2018 River Hosp CDM PRAVACHOL 40MG TAB $11.65 10/1/2018 River Hosp CDM CLOPIDOGREL BISULFATE 75mg TAB $11.65 10/1/2018 River Hosp CDM POST OP SHOE FEMALE SMALL $11.70 10/1/2018 River Hosp CDM POST OP SHOE FEMALE MED $11.70 10/1/2018 River Hosp CDM POST OP SHOE FEMALE LARGE $11.70 10/1/2018 River Hosp CDM POST OP SHIE MALE SMALL $11.70 10/1/2018 River Hosp CDM POST OP SHOE MALE MED $11.70 10/1/2018 River Hosp CDM POST OP SHOE MALE LG $11.70 10/1/2018 River Hosp CDM POST OP SHOE MALE EX LG $11.70 10/1/2018 River Hosp CDM SURGICAL GOWN, KC400 X LG $11.70 10/1/2018 River Hosp CDM SUTURE 802h CHROMIC O $11.75 10/1/2018 River Hosp CDM SPINAL/WHITCARE NEEDLE 22ga X5 $11.75 10/1/2018 River Hosp CDM PHENOL $11.75 10/1/2018 River Hosp CDM NASO-AIRWAY 20FR $11.75 10/1/2018 River Hosp CDM NITROGLYCERIN 0.2mg PATCH $11.75 10/1/2018 River Hosp CDM CEFEPIME 2GRAM VIAL $11.80 10/1/2018 River Hosp CDM SIMPLE CATH KIT ER $11.80 10/1/2018 River Hosp CDM SUTURE U204H $11.80 10/1/2018 River Hosp CDM SUTURE ETHILON 5-0 698G $11.80 10/1/2018 River Hosp CDM PIOGLAITAZONE HCL 15MG $11.80 10/1/2018 River Hosp CDM 1666G $11.85 10/1/2018 River Hosp CDM TETRACAINE 0.5% OPTH SOL 4ml $11.85 10/1/2018 River Hosp CDM CHAMBER, POCKET $11.90 10/1/2018 River Hosp CDM FLURBIPOFEN 0.03% 2.5ML $11.90 10/1/2018 River Hosp CDM D/S/B PROD #1 83893 $11.90 10/1/2018

River Hosp CDM D/S/B PROD #2 83893 $11.90 10/1/2018 River Hosp CDM O2-HEATED AEROSOL PER HOUR $11.95 10/1/2018 River Hosp CDM AUGMENTIN 250MG/5ML $11.95 10/1/2018 River Hosp CDM ENALAPRIL MALEATE 5 MG TAB $11.95 10/1/2018 River Hosp CDM LTA KIT $12.00 10/1/2018 River Hosp CDM TICAGRELOR 90 mg TABLETS $12.05 10/1/2018 River Hosp CDM 1669H $12.10 10/1/2018 River Hosp CDM 1667G $12.10 10/1/2018 River Hosp CDM NYSTATIN SUSP (BTL) $12.10 10/1/2018 River Hosp CDM METRONIDAZOLE 500mg/100ml $12.10 10/1/2018 River Hosp CDM ROSIGLITAZONE MALEATE 4mg TAB $12.10 10/1/2018 River Hosp CDM SPLINT FINGER $12.15 10/1/2018 River Hosp CDM WALLACH ENDOCELL STER $12.15 10/1/2018 River Hosp CDM YANKAUR SUCTION TIP FINE $12.20 10/1/2018 River Hosp CDM VARI TIP ELECTRODE $12.20 10/1/2018 River Hosp CDM NCS CIPROFLOXACIN 250MG TAB $12.20 10/1/2018 River Hosp CDM FAMOTIDINE 20 mg/50ml IV BAG $12.20 10/1/2018 River Hosp CDM MUPIROCIN 2% 15G TUBE $12.20 10/1/2018 River Hosp CDM BEAVER BLADE 6900 $12.25 10/1/2018 River Hosp CDM SCOTCH CAST TAPE 3BL $12.25 10/1/2018 River Hosp CDM VERSIVA 4x4 $12.25 10/1/2018 River Hosp CDM FLUMAZENIL 0.5MG/5ML $12.25 10/1/2018 River Hosp CDM SPLINT, FOREARM PADDED R/SM $12.30 10/1/2018 River Hosp CDM SPLINT, FOREARM PADDED R/MED $12.30 10/1/2018 River Hosp CDM SPLINT, FOREARM PADDED L/MED $12.30 10/1/2018 River Hosp CDM SPLINT, FOREARM PADDED L/LG $12.30 10/1/2018 River Hosp CDM DULOXETINE HCL (CYMBALTA) $12.30 10/1/2018 River Hosp CDM SERTALINE 50mg TAB $12.30 10/1/2018 River Hosp CDM INTERACTIVE COMPLEXITY PHP 90785 $12.30 10/1/2018 River Hosp CDM LEAD WIRE $12.35 10/1/2018 River Hosp CDM PHYSOSTIMINE SAL. VIAL $12.35 10/1/2018 River Hosp CDM ACYCLOVIR IV 500MG/10ML VIAL $12.35 10/1/2018 River Hosp CDM CALAMINE LOTION $12.35 10/1/2018 River Hosp CDM NIFEDIPINE XL60mg TAB $12.35 10/1/2018 River Hosp CDM SCREENING VISUAL AQUITY 99173 $12.35 10/1/2018 River Hosp CDM VANCOMYCIN 125 MG CAPSULE $12.50 10/1/2018 River Hosp CDM NCS PLAVIX 75MG $12.50 10/1/2018 River Hosp CDM NCS TEARGEN 1.4% DROPS BTL $12.50 10/1/2018 River Hosp CDM ARM SLING ANY SIZE ER $12.55 10/1/2018 River Hosp CDM DURA PREP 26ML $12.55 10/1/2018 River Hosp CDM SUTURE, ETHILON 4-0 699G $12.55 10/1/2018 River Hosp CDM DEXTROSE 5% 250ml BAG $12.55 10/1/2018 River Hosp CDM NCS PROTONIX 40MG TAB $12.55 10/1/2018 River Hosp CDM BUPIVACAINE HCL 0.25 $12.55 10/1/2018 River Hosp CDM TETRACAINE SOL 0.5% $12.55 10/1/2018 River Hosp CDM TED STOCKINGS BK $12.60 10/1/2018 River Hosp CDM SUTURE, 4-0 MONOCRYL Y823G $12.60 10/1/2018

River Hosp CDM BLADDER IRRIG SET $12.60 10/1/2018 River Hosp CDM NCS SIMVATATIN 40MG TAB $12.60 10/1/2018 River Hosp CDM ORTHOGLASS 12" EA $12.65 10/1/2018 River Hosp CDM BRIEFS, LARGE PKG $12.65 10/1/2018 River Hosp CDM CON MED GRAVITY TUBING 2 SPIKE $12.65 10/1/2018 River Hosp CDM NCS THERA-DERM LOTION BOTTLE $12.65 10/1/2018 River Hosp CDM EPINEPHRINE 1MG/ML AMP $12.65 10/1/2018 River Hosp CDM ATORVASTATIN 20mg TAB $12.65 10/1/2018 River Hosp CDM URIMETER $12.70 10/1/2018 River Hosp CDM URIMETER $12.70 10/1/2018 River Hosp CDM PROMETHAZINE HCL 50MG/ML AMP $12.70 10/1/2018 River Hosp CDM EPINEPHRINE PEDIATRIC KIT $12.70 10/1/2018 River Hosp CDM PORT FLUSH KIT $12.75 10/1/2018 River Hosp CDM OXYGEN MASK #7706 $12.80 10/1/2018 River Hosp CDM INSULIN INST. PAK $12.80 10/1/2018 River Hosp CDM IN-LINE FILTER $12.80 10/1/2018 River Hosp CDM MUCOSAL ATOMIZATION DEVICE $12.80 10/1/2018 River Hosp CDM IMPERIOUS STOCKINETTE 12X48 $12.80 10/1/2018 River Hosp CDM STERILE WATER FOR INJECT 100ML $12.80 10/1/2018 River Hosp CDM NG/OG SET UP $12.85 10/1/2018 River Hosp CDM GAIT BELTS $12.85 10/1/2018 River Hosp CDM CYSTOTOME IRR 27G $12.85 10/1/2018 River Hosp CDM PANTOPRAZOLE NA 20MG $12.85 10/1/2018 River Hosp CDM INFRARED 97026 $12.90 10/1/2018 River Hosp CDM ELASTOPLAST 3" $12.90 10/1/2018 River Hosp CDM NCS LUBRI-SKIN 24'S LOTION 480 $12.90 10/1/2018 River Hosp CDM PROCHLORPERAZINE MAL 25MG SUPP $12.90 10/1/2018 River Hosp CDM SKIN PREP TRAY $12.95 10/1/2018 River Hosp CDM BSS STERILE IRRIGATING $12.95 10/1/2018 River Hosp CDM IMMUNIZATION ADMIN EACH ADD'L 90472 $12.95 10/1/2018 River Hosp CDM CERV COLLAR SOFT ANY SIZE ER $13.00 10/1/2018 River Hosp CDM HYDRALAZINE 20MG/1ML $13.00 10/1/2018 River Hosp CDM ERYTHROMYCIN BASE 3.5 MG TUBE $13.00 10/1/2018 River Hosp CDM DEBROX 15ML $13.00 10/1/2018 River Hosp CDM PEN VK 250mg/5ml 100ml $13.00 10/1/2018 River Hosp CDM ANESTHESIA BAG 3 LITTER $13.05 10/1/2018 River Hosp CDM INTER COMPLEXITY CPSY NON PHYS 90785 $13.05 10/1/2018 River Hosp CDM INTER COMPLEXITY RCWP NON PHYS 90785 $13.05 10/1/2018 River Hosp CDM INTERACTIVE COMPLEXITY RCWP 90785 $13.05 10/1/2018 River Hosp CDM TOURNIQUET CUFF 30" $13.10 10/1/2018 River Hosp CDM CHANG HYDRODISSECT CANNULA27ga $13.10 10/1/2018 River Hosp CDM OVICRYK J340H $13.20 10/1/2018 River Hosp CDM STERI DRAPE 47X51 $13.30 10/1/2018 River Hosp CDM IOBAN 13X13 $13.30 10/1/2018 River Hosp CDM BAC/NEO/POLY 1/32 OZ $13.30 10/1/2018 River Hosp CDM EPINEPHRINE ADULT KIT $13.45 10/1/2018 River Hosp CDM NEEDLE SPINAL $13.50 10/1/2018

River Hosp CDM NCS CETAPHIL ANTIBACT BAR $13.50 10/1/2018 River Hosp CDM ANALGESIC BALM $13.50 10/1/2018 River Hosp CDM NYSTATIN POWDER $13.55 10/1/2018 River Hosp CDM KERLIX ROLL $13.60 10/1/2018 River Hosp CDM DECLOGGER-PEG TYPE (18-24FR) $13.60 10/1/2018 River Hosp CDM WEBSTER NEEDLEHOLDER 6" DISP. $13.60 10/1/2018 River Hosp CDM TICK NIPPER $13.60 10/1/2018 River Hosp CDM CHANNEL ADAPTER $13.60 10/1/2018 River Hosp CDM MEPHYTON 5MG $13.60 10/1/2018 River Hosp CDM INDIGO CARMINE 8mg/ml AMP $13.60 10/1/2018 River Hosp CDM SULFACETAMIDE SOD 15ML BTL 10% $13.60 10/1/2018 River Hosp CDM ANG REVERSE CUT 25G $13.65 10/1/2018 River Hosp CDM HYDROCERIN CREAM 60gm $13.65 10/1/2018 River Hosp CDM IMMUN ADMIN EACH ADD'L ER 90472 $13.70 10/1/2018 River Hosp CDM EPINEPHRINE 0.1 MG/ML SYRINGE $13.80 10/1/2018 River Hosp CDM ANOSCOPE, DISP X-LONG $13.85 10/1/2018 River Hosp CDM BAC NEO POLY OINT 15 $13.85 10/1/2018 River Hosp CDM PHACO TIPS $13.90 10/1/2018 River Hosp CDM NCS CIPROFLOXACIN 500MG TAB $13.90 10/1/2018 River Hosp CDM ADMISSION KIT ACUTE/SWG $13.95 10/1/2018 River Hosp CDM HUBER NEEDLE 19G X 1" $14.00 10/1/2018 River Hosp CDM HALOPERIDOL LACTATE 5MG/ML VL J1630 $14.05 10/1/2018 River Hosp CDM DEXTROSE 50% WATER 50ML SYRING $14.05 10/1/2018 River Hosp CDM BACITRACIN ZINC 500 U/G/UD PKT $14.10 10/1/2018 River Hosp CDM SAF-GEL $14.15 10/1/2018 River Hosp CDM MAR MED DERMA STENT $14.25 10/1/2018 River Hosp CDM ELASTIC TAPE 4" $14.25 10/1/2018 River Hosp CDM SALEM SUMP TUBE $14.30 10/1/2018 River Hosp CDM BAIRE BODY BLANKET $14.30 10/1/2018 River Hosp CDM GATIFLOXACIN INJECTION 10MG $14.30 10/1/2018 River Hosp CDM CAST BOOT, SMALL $14.35 10/1/2018 River Hosp CDM SUCRALFATE SUSP 1gm/10ml udc $14.35 10/1/2018 River Hosp CDM NITROPRUSSIDE SODIUM 25MG VIAL $14.35 10/1/2018 River Hosp CDM URINALYSIS, NO MICRO 81002 $14.40 10/1/2018 River Hosp CDM SPLINT, COLLES $14.45 10/1/2018 River Hosp CDM OCULAR OCCLUDER ADHESIVE DRAPE $14.45 10/1/2018 River Hosp CDM LIDOCAINE 2% URO-JET 1 KIT $14.45 10/1/2018 River Hosp CDM CYCLOPENTOLATE 1% $14.45 10/1/2018 River Hosp CDM URINALYSIS, NO MICRO CLN2 81002 $14.45 10/1/2018 River Hosp CDM ISOVUE 300/100ML CONTRAST $14.52 10/1/2018 River Hosp CDM RAE ENDO TRACH TUBE SZ 5.0 5.5 $14.60 10/1/2018 River Hosp CDM STERI DRAPE $14.60 10/1/2018 River Hosp CDM U-DRAPE $14.60 10/1/2018 River Hosp CDM DEPO MEDROL INJECTION 40MG J1030 $14.65 10/1/2018 River Hosp CDM TOLTERODINE ER 2mg CAP $14.65 10/1/2018 River Hosp CDM EPI SHUGARCAINE $14.70 10/1/2018 River Hosp CDM PULMICORT RESPULE 25mg/2cc UD J7626 $14.75 10/1/2018

River Hosp CDM SPINAL TAP TRAY $14.80 10/1/2018 River Hosp CDM BIPOLAR PENCIL $14.80 10/1/2018 River Hosp CDM HUMULIN N $14.80 10/1/2018 River Hosp CDM TED, THIGH (ALL SIZES) $14.80 10/1/2018 River Hosp CDM BUPIVACAINE HCL 5mg/ml VIAL $14.80 10/1/2018 River Hosp CDM PROMETHAZINE HCL 12.5mg $14.80 10/1/2018 River Hosp CDM PREGABALIN 25 mg CAPSULE $14.85 10/1/2018 River Hosp CDM AQUACEL AG 2X2 DRESSING $14.90 10/1/2018 River Hosp CDM SOLUSET, MICRODRI $14.90 10/1/2018 River Hosp CDM DERMAFUNGAL 4 OZ. $14.95 10/1/2018 River Hosp CDM ESOPHAGEAL/RECT 12 fr adult $14.95 10/1/2018 River Hosp CDM AZITHROMYCIN 500mg VIAL $14.95 10/1/2018 River Hosp CDM DUAL SYRINGE WITH SPIKEKITS $15.02 9/27/2018 River Hosp CDM CLAVICLE BRACE ER $15.05 10/1/2018 River Hosp CDM SCOTCH CAST TAPE 4 BL $15.10 10/1/2018 River Hosp CDM CORNEAL PROTECTOR $15.15 10/1/2018 River Hosp CDM VALACYCLOVIR (VALTREX) 500MG $15.20 10/1/2018 River Hosp CDM NCS SALINE NASAL SPRAY BTL $15.20 10/1/2018 River Hosp CDM FINGERSTICK CAPILLARY BLOOD 36416 $15.20 10/1/2018 River Hosp CDM LAPORATOMY PACK $15.25 10/1/2018 River Hosp CDM NCS MILK OF MAG 400MG/5ML BTL $15.25 10/1/2018 River Hosp CDM IMV MANIFOLD $15.50 10/1/2018 River Hosp CDM SMARTSITE NEEDLESS VALVE $15.50 10/1/2018 River Hosp CDM SKIN STAPLER ER $15.55 10/1/2018 River Hosp CDM NCS CALC ANTACID 500MG TAB BTL $15.60 10/1/2018 River Hosp CDM NCS NITROFURANTOIN MACR 100MG $15.60 10/1/2018 River Hosp CDM PANTOPRAZOLE 40mg TAB $15.65 10/1/2018 River Hosp CDM RAYTEX SPONGE $15.70 10/1/2018 River Hosp CDM BALANCED SALT SOL(BSS)500mlBTL $15.70 10/1/2018 River Hosp CDM PYRIDOXINE HCL 100MG/ML $15.70 10/1/2018 River Hosp CDM LEVOFLOXACIN 750 mg $15.70 10/1/2018 River Hosp CDM POWERLOCK INFUSION KTT 20GX1.5 $15.75 10/1/2018 River Hosp CDM HYDRODISSECTION CANNULA 30GA $15.75 10/1/2018 River Hosp CDM ELMA $15.75 10/1/2018 River Hosp CDM UNIVERSAL LWR EXTREMITY DRAPE $15.75 10/1/2018 River Hosp CDM PERI FECAL POUCH W/ADHESIVE $15.75 10/1/2018 River Hosp CDM CHLORAPREP 1-STEP 26 ml $15.80 10/1/2018 River Hosp CDM ESOPHAGEAL/RECT 9fr PEDS $15.85 10/1/2018 River Hosp CDM LIDODERM PATCH 5% $15.85 10/1/2018 River Hosp CDM MULTIVITAMINS 10ml VIAL $15.85 10/1/2018 River Hosp CDM GLUCOSE $15.85 10/1/2018 River Hosp CDM ALBUTEROL .5cc UD (.5%) $15.90 10/1/2018 River Hosp CDM NCS KERASAL 5-10% OINT $15.95 10/1/2018 River Hosp CDM WOUND IRRIGATION SYSTEM $16.00 10/1/2018 River Hosp CDM HOODED JUMPSUIT ALL IN ONE $16.00 10/1/2018 River Hosp CDM DRAPE EYE-PAC 18X22 CLEAR $16.05 10/1/2018 River Hosp CDM SPINAL NEEDLE 22ga X 3.5" $16.05 10/1/2018

River Hosp CDM SUTURE PROLENE 4-0 8682G $16.05 10/1/2018 River Hosp CDM OXYCONTIN 40mg TAB $16.05 10/1/2018 River Hosp CDM OXYMETAZOLINE NASAL SPRAY $16.05 10/1/2018 River Hosp CDM NYSTATIN/TRIAMCIN 15 GM CREAM $16.10 10/1/2018 River Hosp CDM FINGERSTK-CAPILLARY BLOOD DRAW 36416 $16.10 10/1/2018 River Hosp CDM CANNULA FLEXIBLE TIP 25GA $16.15 10/1/2018 River Hosp CDM ULTRASONIC NRB CIRCUIT $16.20 10/1/2018 River Hosp CDM INFUSAID NEEDLES $16.20 10/1/2018 River Hosp CDM READI-CATH $16.20 10/1/2018 River Hosp CDM 5" PLASTER BANDAGE $16.20 10/1/2018 River Hosp CDM MICROBE IV FILTER $16.25 10/1/2018 River Hosp CDM SURGICAL GOWN XXXL $16.25 10/1/2018 River Hosp CDM EYE DILATING SOLUTION (2%) $16.25 10/1/2018 River Hosp CDM METOPROLOL TARTRATE 1MG/ML AMP $16.30 10/1/2018 River Hosp CDM WRST SPLNT LFT/RGT UNIV COCKUP L3938 $16.35 10/1/2018 River Hosp CDM OPHTHAKMIC KNIFE 15 DEGREE $16.40 10/1/2018 River Hosp CDM TOURNIQUET CUFF 42" $16.45 10/1/2018 River Hosp CDM MICROSPONGE SURGICAL WECK CELL $16.50 10/1/2018 River Hosp CDM SKIN PREP TRAY W/ CHLORAPREP $16.55 10/1/2018 River Hosp CDM NALOXONE 1mg/1ml $16.55 10/1/2018 River Hosp CDM ACTIVATE CHARCOAL AQU. 25GRAM $16.60 10/1/2018 River Hosp CDM TED STOCKING THIGH, ALL SIZES $16.65 10/1/2018 River Hosp CDM CATHETER FOLEY 10FR $16.70 10/1/2018 River Hosp CDM MICONAZOLE CREAM 2% $16.80 10/1/2018 River Hosp CDM FENTANYL 50 MCG PATCH $16.85 10/1/2018 River Hosp CDM BOUGIE INTRODUCER TIP 15 FR $16.95 10/1/2018 River Hosp CDM ELASTOPLAST 4" $16.95 10/1/2018 River Hosp CDM FOLEY TRAY 16FR $17.00 10/1/2018 River Hosp CDM ALOE VISTA SENSI CREAM $17.05 10/1/2018 River Hosp CDM BICILLIN CR 1.2MU SYR $17.10 10/1/2018 River Hosp CDM VESICARE 10 MG TAB $17.15 10/1/2018 River Hosp CDM RISPERIDONE 1mg TAB $17.15 10/1/2018 River Hosp CDM SUCTION CANISTER 1200cc $17.20 10/1/2018 River Hosp CDM 8411H $17.25 10/1/2018 River Hosp CDM RAE ENDO TRACH TUBE SZ 6.0 $17.25 10/1/2018 River Hosp CDM PREVAIL SKIN PREP $17.25 10/1/2018 River Hosp CDM STERILE MARKER REG. TIP $17.30 10/1/2018 River Hosp CDM HEPARIN/D5W 25U/ML BAG $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG: DOT/SLOT BLOT 83893 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEI ACID PR1 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 2 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 3 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 4 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 5 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 6 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 7 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 8 83896 $17.30 10/1/2018

River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 9 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 10 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 11 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 12 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 13 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 14 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 15 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 16 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 17 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 18 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 19 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 20 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 21 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 22 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 23 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 24 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 25 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 24 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 28 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 28 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 29 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 30 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 31 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 32 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 33 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 34 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 35 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 36 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 37 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 38 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 39 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 40 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 41 83896 $17.30 10/1/2018 River Hosp CDM MOLECULAR DIAG;NUCLEIC ACID 42 83896 $17.30 10/1/2018 River Hosp CDM WRIST SPLINT COCKUP $17.35 10/1/2018 River Hosp CDM SERTALINE 100mg TAB $17.35 10/1/2018 River Hosp CDM SULFAMETH/TRIMETH 800mg160mgVL $17.35 10/1/2018 River Hosp CDM VOLUME MEASURE 81050 $17.45 10/1/2018 River Hosp CDM KEFLEX SUSP. 250MG/5ML $17.50 10/1/2018 River Hosp CDM NCS GENFIBER ORANGE W/POWDER $17.50 10/1/2018 River Hosp CDM GLASS L>O>R /SYRINGE 5cc $17.55 10/1/2018 River Hosp CDM PROCHLORPERAZINE 10mg/2ml $17.55 10/1/2018 River Hosp CDM JANUVIA 25MG TAB $17.55 10/1/2018 River Hosp CDM ADMINISTRATION HEPATITIS B $17.55 10/1/2018 River Hosp CDM CAPSASIN 0.0025%/60 GRM TUBE $17.65 10/1/2018 River Hosp CDM UNNA BOOT $17.70 10/1/2018 River Hosp CDM ECG 3 LEAD INTERP AND REPORT 93042 $17.75 10/1/2018

River Hosp CDM ECG 3 LEAD INTERP W/REPORT 93042 $17.75 10/1/2018 River Hosp CDM LIDOCAINE 1%/EPI 30ml MPF VIAL $17.75 10/1/2018 River Hosp CDM MAGNESIUM 1gm/100ml IVPB $17.75 10/1/2018 River Hosp CDM AZITHROMYCIN 100mg/5ml ORALSYR $17.75 10/1/2018 River Hosp CDM INJ DOPAMINE HCL, 40 MG J1265 $17.75 10/1/2018 River Hosp CDM CORTISPORIN 1% SOL 15ML DROP $17.80 10/1/2018 River Hosp CDM PHENYLEPHRINE 2.5% 15ML $17.80 10/1/2018 River Hosp CDM LIDOCAINE JELLY 60G/30ML TUBE $17.85 10/1/2018 River Hosp CDM CYCLOSPORINE 100MG $17.90 10/1/2018 River Hosp CDM MOHAWK DONUT RING $18.10 10/1/2018 River Hosp CDM BRIMONIDINE TARTRATE .02% $18.10 10/1/2018 River Hosp CDM BD NEXIVADIFFUSIC IVCATHTR22X1 $18.15 10/1/2018 River Hosp CDM CYSTOSCOPY/IRRIGATION SETS $18.15 10/1/2018 River Hosp CDM HIBCLEANSE $18.20 10/1/2018 River Hosp CDM LANSOPRAZOLE 15mg CAPS $18.20 10/1/2018 River Hosp CDM VALVE KIT, CHILD ISO $18.30 10/1/2018 River Hosp CDM NCS COMBIVENT 18-103MCG INHAL $18.35 10/1/2018 River Hosp CDM CORTISPOR OPHUNG 3.5gm $18.50 10/1/2018 River Hosp CDM IMMUNIZATION ADMIN EA ADDL 90472 $18.50 10/1/2018 River Hosp CDM CATHETER, FOLEY 22FR 30 $18.60 10/1/2018 River Hosp CDM FILTERLINE SET, ADULT/PEDI $18.60 10/1/2018 River Hosp CDM SCOTCH CAST TAPE 5BL $18.60 10/1/2018 River Hosp CDM SALINE NASAL GEL $18.65 10/1/2018 River Hosp CDM SYRINGE CT STERILE $18.70 10/1/2018 River Hosp CDM PANDA MASK $18.75 10/1/2018 River Hosp CDM AUGMENTIN 400-57MG/5ML $18.80 10/1/2018 River Hosp CDM GOLYTELY $18.80 10/1/2018 River Hosp CDM CLARITHROMYCIN 500mgTAB $18.80 10/1/2018 River Hosp CDM LANSOPRAZOLE 30mg CAPS $18.80 10/1/2018 River Hosp CDM KETAMINE 500mg/5ml VIAL $18.85 10/1/2018 River Hosp CDM SLFTRM PEDORALSUSP200-40mg/5ml $18.85 10/1/2018 River Hosp CDM PROTAMINE 50 MG/5 ML 5ML VIAL $18.85 10/1/2018 River Hosp CDM TROPICAMIDE 1% OPTH 15mlBOTTLE $18.85 10/1/2018 River Hosp CDM ACTIV CHRCOAL w SORBTL 50g BTL $18.85 10/1/2018 River Hosp CDM CLINDAMYCIN PHOSPHATE 300mg BG $18.90 10/1/2018 River Hosp CDM HYDRODISSECTION CANNULA $18.95 10/1/2018 River Hosp CDM MAGNESIUM SULFATE 100ml BAG $18.95 10/1/2018 River Hosp CDM AQUACEL 6x6 DRESSING $19.00 10/1/2018 River Hosp CDM AUGMENTIN 250MG/5ML SUSP $19.10 10/1/2018 River Hosp CDM REFRESH EYE DROPS $19.15 10/1/2018 River Hosp CDM BAG DECANTER $19.25 10/1/2018 River Hosp CDM POTASSIUMCHLRIDE 20meqPWDR PKT $19.25 10/1/2018 River Hosp CDM DRESSING,MEPILEX 6X8 EA $19.30 10/1/2018 River Hosp CDM INLINE MANOMETER $19.35 10/1/2018 River Hosp CDM VAGINAL PREP TRAY $19.35 10/1/2018 River Hosp CDM NITRO D5 100MCG/ML 250ML BOTT. $19.35 10/1/2018 River Hosp CDM SUTURE MONO 3-0, eth-497G $19.35 10/1/2018

River Hosp CDM GOLYTELY $19.50 10/1/2018 River Hosp CDM SCOTCH CAST $19.50 10/1/2018 River Hosp CDM KCI DRAPES CLEAR $19.55 10/1/2018 River Hosp CDM SPO2 FINGER SENSOR $19.65 10/1/2018 River Hosp CDM ACCUTARQ CURVED TIP SPINL 25A5 $19.70 10/1/2018 River Hosp CDM POWERLOC MAX NEEDLE 20gX1" $19.80 10/1/2018 River Hosp CDM POWERLOC MAX NEEDLE 20gaX .75" $19.80 10/1/2018 River Hosp CDM VFC ADMIN EA ADDITIONAL 90461 $19.80 10/1/2018 River Hosp CDM CLARITHROMYCIN 250mg TAB $19.85 10/1/2018 River Hosp CDM 2-0 NOVAFIL SUTURE $19.95 10/1/2018 River Hosp CDM IRIS SCISSRCRVD4"DELICATESTAIN $19.95 10/1/2018 River Hosp CDM REFRESH TEARS $20.00 10/1/2018 River Hosp CDM HYDRODISSECTIONCANNULA 27ga $20.05 10/1/2018 River Hosp CDM MAR MED TOURNICOT "UNI COT" $20.15 10/1/2018 River Hosp CDM NEEDLE, RETROBULBAR $20.15 10/1/2018 River Hosp CDM NAFCILLIN SODIUM 1G VIAL S0032 $20.15 10/1/2018 River Hosp CDM MICRODRIP NITRO TUBING $20.20 10/1/2018 River Hosp CDM DEXTROSE 5% 1/2NS KCL 10MEQ $20.20 10/1/2018 River Hosp CDM DEXTROSE 5% 1/2NS KCL 20MEQ $20.20 10/1/2018 River Hosp CDM DEXTROSE 5% 1/2NS KCL 40MEQ $20.20 10/1/2018 River Hosp CDM HYDROCORTISONE 1% 30 GM TUBE $20.20 10/1/2018 River Hosp CDM BLADE,TUNNEL,STRAIGHT,SHARP OR $20.30 10/1/2018 River Hosp CDM SPINAL NEEDLE,WHITACRE $20.30 10/1/2018 River Hosp CDM VALSARTAN 40MG $20.30 10/1/2018 River Hosp CDM BLOOD DRAWN 36415 $20.30 10/1/2018 River Hosp CDM PT FOCUSED HEALTH RISK ASSES 96160 $20.30 10/1/2018 River Hosp CDM CG FOCUSED HEALTH RISK ASSESS 96161 $20.30 10/1/2018 River Hosp CDM PT FOCUSED HEALTH RISK ASSE 96160 $20.30 10/1/2018 River Hosp CDM CG FOCUSED HEALTH RISK ASSESS 96161 $20.30 10/1/2018 River Hosp CDM TED STOCKING THIGH XXLARGE $20.35 10/1/2018 River Hosp CDM METOCLOPRAM 10MG/2ML $20.45 10/1/2018 River Hosp CDM SULFATE, URINE 84392 $20.45 10/1/2018 River Hosp CDM ISO VALVE KIT, CHILD $20.50 10/1/2018 River Hosp CDM LIDOCAINE JELLY 2% 30ML TUBE $20.50 10/1/2018 River Hosp CDM CATHETER, DOLEY 2-WAY 14 FR $20.60 10/1/2018 River Hosp CDM DOUBW/DEX $20.60 10/1/2018 River Hosp CDM DOBUTAME 250 MG BAG $20.60 10/1/2018 River Hosp CDM CELLCEPT 500 MG TAB $20.60 10/1/2018 River Hosp CDM CATHETER FOLEY COUDE 14FR $20.65 10/1/2018 River Hosp CDM NCS CEFUROXIME 500MG TAB $20.65 10/1/2018 River Hosp CDM RESTRAINT LIMBS SINGLE $20.75 10/1/2018 River Hosp CDM NORMAL SALINE IRRIG 3000ML $20.75 10/1/2018 River Hosp CDM FAMOTIDINE 20mg/2ml VIAL $20.75 10/1/2018 River Hosp CDM SUTURE,ETHILON 5-0 $20.80 10/1/2018 River Hosp CDM RECTA SUCTION TUBE $20.85 10/1/2018 River Hosp CDM NASAL AIRWAY 28FR $20.85 10/1/2018 River Hosp CDM ACCUTARQ CURVD TIPSPINL 22x3.5 $20.90 10/1/2018

River Hosp CDM BSS 500ML $20.95 10/1/2018 River Hosp CDM VFC ADMIN UP TO 18 EA ADD'L 90461 $20.95 10/1/2018 River Hosp CDM VAC ADMIN UP TO 18 EA ADD'L 90461 $20.95 10/1/2018 River Hosp CDM DONEPEZIL 10mg $21.00 10/1/2018 River Hosp CDM MASK ADULT W/TUBING $21.20 10/1/2018 River Hosp CDM AQUACELL FOAM DRESSING 7X7 $21.25 10/1/2018 River Hosp CDM XARELTO 10mg $21.25 10/1/2018 River Hosp CDM ECG 12 LEAD INTERPRET (PROF) 93010 $21.30 10/1/2018 River Hosp CDM ECG 12 LEAD INTERPRET(PROF)CLN 93010 $21.30 10/1/2018 River Hosp CDM ERYTHROMYCIN LACTOBIO 500MG VL $21.30 10/1/2018 River Hosp CDM CATHETERFOLEY 3WY 30ccLATEX/FR $21.35 10/1/2018 River Hosp CDM LOW-TEMPERATURE CAUTERY $21.35 10/1/2018 River Hosp CDM LUMBAR ROLL W/STRAP $21.40 10/1/2018 River Hosp CDM TED AK STOCKING $21.45 10/1/2018 River Hosp CDM NEOSPORIN OIN OP 3.5 $21.45 10/1/2018 River Hosp CDM SKIN SCRUB TRAY FOR VAG. $21.50 10/1/2018 River Hosp CDM HI TEMP SURGICAL LOOP CAUTERY $21.50 10/1/2018 River Hosp CDM ENUCLEATION/EXCISCERATION SIZE $21.50 10/1/2018 River Hosp CDM PERFORATED CONFORMER SM $21.50 10/1/2018 River Hosp CDM PERFORATED CONFORMER MED $21.50 10/1/2018 River Hosp CDM TISSUE EXAM BY KOH SLIDE 87220 $21.55 10/1/2018 River Hosp CDM GLUCOSE FINGER STICK SNF 82962 $21.60 10/1/2018 River Hosp CDM VANCOMYCIN 750mg VIAL $21.60 10/1/2018 River Hosp CDM NCS BETASEPT 4-4% LIQ $21.60 10/1/2018 River Hosp CDM GLUCOSE FINGER STICK 82962 $21.60 10/1/2018 River Hosp CDM NEO SYNEPHRINE 0.5% SPRAY $21.65 10/1/2018 River Hosp CDM FENTANYL 75MCG PATCH $21.75 10/1/2018 River Hosp CDM EYE TRAY ER $21.85 10/1/2018 River Hosp CDM BURN TRAY ER $21.85 10/1/2018 River Hosp CDM FENOFIBRATE (TRICOR) 145MG $21.85 10/1/2018 River Hosp CDM HALOBETASOL 5% OINT. 15GM TUB $21.85 10/1/2018 River Hosp CDM CATHETER FOLEY COUDE 16FR $21.90 10/1/2018 River Hosp CDM BACITRACIN 50,000 UNIT POWVIAL $21.90 10/1/2018 River Hosp CDM CEFAZOLIN2mg/50mlPREMADE IVBAG $21.95 10/1/2018 River Hosp CDM INVEGA SUSTENNA PER MG $21.95 10/1/2018 River Hosp CDM JACKS-PRATT DRAIN KIT $22.05 10/1/2018 River Hosp CDM NASAL AIRWAY 26FR $22.10 10/1/2018 River Hosp CDM STIFNECK BABY CERV COLLAR $22.10 10/1/2018 River Hosp CDM STIFNECK PEDI CERV COLLAR $22.10 10/1/2018 River Hosp CDM GENTAMICIN .3% 3.5GM TUBE OINT $22.15 10/1/2018 River Hosp CDM CATHETER ROUND TIP URETERAL $22.20 10/1/2018 River Hosp CDM EAR TRAY $22.25 10/1/2018 River Hosp CDM EYE TRAY $22.25 10/1/2018 River Hosp CDM NASAL TRAY $22.25 10/1/2018 River Hosp CDM BURN TRAY $22.25 10/1/2018 River Hosp CDM BABY KIT $22.25 10/1/2018 River Hosp CDM PYRIDOXINE 100mg/ml 1ml VIAL $22.25 10/1/2018

River Hosp CDM DEPO MEDROL INJECTION 20MG J1020 $22.35 10/1/2018 River Hosp CDM Muri-Lube STRL VIAL 10ml vial $22.35 10/1/2018 River Hosp CDM UPPER BODY BLANKET $22.40 10/1/2018 River Hosp CDM ANESTHESIA CIRCUIT, PED $22.45 10/1/2018 River Hosp CDM CAUTERY, HI-TEMP $22.55 10/1/2018 River Hosp CDM EDROPHONIUM 10MG/1ML $22.60 10/1/2018 River Hosp CDM NCS DUODERM DRESSINGS 4X4 EA $22.80 10/1/2018 River Hosp CDM CAUTERY BLADE $22.90 10/1/2018 River Hosp CDM NCS DML FORTE W/PANTHENOL CRM $22.95 10/1/2018 River Hosp CDM DEPO MEDROL INJECTION 20MG $23.00 10/1/2018 River Hosp CDM ADULT RESUSC BAG $23.00 10/1/2018 River Hosp CDM MASK RESUSCITATOR ADULT $23.00 10/1/2018 River Hosp CDM 6-0 PLAIN 1916G $23.00 10/1/2018 River Hosp CDM SODIUM BICARBONATE4.2%10ml SYR $23.00 10/1/2018 River Hosp CDM ACT CHARCL AQU PEDS 25gm/120ml $23.00 10/1/2018 River Hosp CDM OFFICE VISIT LVL ONE ESTAB PC 99211 $23.10 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 1 EST (PC) 99211 $23.10 10/1/2018 River Hosp CDM O/V LVL 1 EST CARDIO PC 99211 $23.10 10/1/2018 River Hosp CDM OFFICE VST LVL 1 EST PC (GYN) 99211 $23.10 10/1/2018 River Hosp CDM OFFICE VISIT LVL 1 EST PC OPTH 99211 $23.10 10/1/2018 River Hosp CDM OFFICE VST LVL 1 EST PC (ENT) 99211 $23.10 10/1/2018 River Hosp CDM OFFICE VISIT LVL 1 EST PC(GEN) 99211 $23.10 10/1/2018 River Hosp CDM O/V LVL 1 ESTAB PC CLN2 99211 $23.10 10/1/2018 River Hosp CDM DR OFF VISIT LVL1 EST PC CLN2 99211 $23.10 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 1 PC 99211 $23.10 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 1 PROF PHP 99211 $23.10 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 1 PROF RCWP 99211 $23.10 10/1/2018 River Hosp CDM DRAPE LAP/PELVIC $23.15 10/1/2018 River Hosp CDM GYM MEMBERSHIP MONTHLY $23.15 10/1/2018 River Hosp CDM ALOE VISTA 2/1 $23.30 10/1/2018 River Hosp CDM CAPTURA BEIPSY FORCEPS W/SPIKE $23.30 10/1/2018 River Hosp CDM RESTRAINT LIMBS DOUBLE $23.30 10/1/2018 River Hosp CDM ACTV CHRCL/AQUEOUSBS50GM/240ML $23.30 10/1/2018 River Hosp CDM SPINAL NEEDLE,WHITACRE $23.35 10/1/2018 River Hosp CDM CYCLOPETOLATE 2% 15ML $23.45 10/1/2018 River Hosp CDM V SHAPE PAD $23.50 10/1/2018 River Hosp CDM ISO VALVE KIT, ADULT $23.50 10/1/2018 River Hosp CDM FILTER FOR IV SOL. SET $23.50 10/1/2018 River Hosp CDM NCS FERROUS SULF 5/ML ELIX BTL $23.60 10/1/2018 River Hosp CDM TRANSDERM SCOP PATCH $23.60 10/1/2018 River Hosp CDM DONEPEZIL HCL 5mg TAB $23.60 10/1/2018 River Hosp CDM ESOMOL HCL $23.65 10/1/2018 River Hosp CDM BIO PATCH DRESSING $23.65 10/1/2018 River Hosp CDM DEXTROMETHORPAN (DELSYM) BTL $23.65 10/1/2018 River Hosp CDM NON ROUTINE BLD DRAW 3/>YRS 36410 $23.70 10/1/2018 River Hosp CDM I-KNIFE $23.75 10/1/2018 River Hosp CDM J671G $23.75 10/1/2018

River Hosp CDM DRAPE, OPHTHALMIC PLASTIC $23.80 10/1/2018 River Hosp CDM DIPHENHYDRAMINE 50MG/10ML $23.80 10/1/2018 River Hosp CDM CLINDAMYCIN 900MG A/V $23.85 10/1/2018 River Hosp CDM ATROPINE 1% EYE DROP $23.95 10/1/2018 River Hosp CDM PHYTONADIONE 2mg/ml $23.95 10/1/2018 River Hosp CDM NASAL PACKING,MEROCEL 4.5CM+ $24.00 10/1/2018 River Hosp CDM CATHETER 20 fr 30 cc 3-WAY $24.05 10/1/2018 River Hosp CDM NUCLEIC ACID PROBE 83896 $24.05 10/1/2018 River Hosp CDM NUCLEIC ACID PROBE 83896 $24.05 10/1/2018 River Hosp CDM NUCLEIC ACID PROBE 83896 $24.05 10/1/2018 River Hosp CDM NUCLEIC ACID PROBE 83896 $24.05 10/1/2018 River Hosp CDM CRYSTALS FL 89060 $24.10 10/1/2018 River Hosp CDM SUTURE, VICRYL 5-0 J571G $24.25 10/1/2018 River Hosp CDM EZETIMIBE/SIMVASTATIN 10MG TAB $24.25 10/1/2018 River Hosp CDM TUBING STERILE PLUME EVAC $24.50 10/1/2018 River Hosp CDM CEFUROXIME SODIUM 750mg VIAL $24.75 10/1/2018 River Hosp CDM CEFUROXIME INJ 750mg $24.75 10/1/2018 River Hosp CDM TORADOL INJECTION 60MG $24.85 10/1/2018 River Hosp CDM VASOPRESSIN 10u/0.5ml $24.85 10/1/2018 River Hosp CDM HEMATOCRIT AUTOMATED 85014 $24.95 10/1/2018 River Hosp CDM A-OK 15D FULL HANDLE $25.00 10/1/2018 River Hosp CDM NCS REFRESH TEARS 0.5% BTL $25.05 10/1/2018 River Hosp CDM AMOXICILLIN 250MG/5ML 150ML $25.05 10/1/2018 River Hosp CDM SUTURE TRAY ER $25.10 10/1/2018 River Hosp CDM LACERATION TRAY $25.20 10/1/2018 River Hosp CDM WBC INDICES W/MAN DF 85007 $25.20 10/1/2018 River Hosp CDM WBC INDICES W/MAN DF APG 85007 $25.20 10/1/2018 River Hosp CDM KATENA VECTIS 2 HOLE 4MM DISP $25.25 10/1/2018 River Hosp CDM SUCTION COAG FOR FOOT PEDAL $25.30 10/1/2018 River Hosp CDM SUCTION POLYP TRAY $25.30 10/1/2018 River Hosp CDM KENALOG VIAL $25.30 10/1/2018 River Hosp CDM SITAGLIPTIN 100 MG $25.50 10/1/2018 River Hosp CDM RIVAROXABAN 15mg $25.50 10/1/2018 River Hosp CDM METHYLPREDNISO ACET 40 MG $25.50 10/1/2018 River Hosp CDM ORGANISM ID URINE 87088 $25.50 10/1/2018 River Hosp CDM ORGANISM ID URINE APG 87088 $25.50 10/1/2018 River Hosp CDM INFED 100MG/2ML $25.60 10/1/2018 River Hosp CDM LENS GUIDE,GLDE 10 $25.75 10/1/2018 River Hosp CDM PLATELETS, AUTOMATIC 85049 $25.80 10/1/2018 River Hosp CDM IRRIGATING 27 g 4 mm BENT TIP $26.00 10/1/2018 River Hosp CDM CEFAZOLIN SODIUM 1G VIAL $26.05 10/1/2018 River Hosp CDM SUTURE, VICRYL 4-0 J507G $26.10 10/1/2018 River Hosp CDM J570G $26.10 10/1/2018 River Hosp CDM CERVICAL COLLAR (PED) $26.15 10/1/2018 River Hosp CDM TB TEST MANTOUX $26.15 10/1/2018 River Hosp CDM NCS DOCU LIQ 50MG/5ML LIQ 473 $26.20 10/1/2018 River Hosp CDM POCKET MASK STERILE $26.25 10/1/2018

River Hosp CDM VENTILATOR $26.25 10/1/2018 River Hosp CDM PREP RAZOR $26.40 10/1/2018 River Hosp CDM MURI-LUBE 10ml $26.40 10/1/2018 River Hosp CDM SOD SULFACETAMIDE 10%/15ml $26.40 10/1/2018 River Hosp CDM A-OK SATINSLIT FULL HANDLE $26.45 10/1/2018 River Hosp CDM CONSCIOUS SEDATION EA ADDL 15M 99153 $26.55 10/1/2018 River Hosp CDM NEOMYCIN $26.65 10/1/2018 River Hosp CDM RESP PT EDUCATION PER 30 MIN 98960 $26.76 10/1/2018 River Hosp CDM BLOOD PACK KITS $26.80 10/1/2018 River Hosp CDM END-TIDAL C02 DETECT (ADULT) $26.80 10/1/2018 River Hosp CDM SENSITIVITY MIC 87186 $26.80 10/1/2018 River Hosp CDM AFB BLOOD CULTURE 87206 $26.80 10/1/2018 River Hosp CDM URINE AT 5 HRS FOR GTT 81002 $26.80 10/1/2018 River Hosp CDM SENSITIVITY MIC APG 87186 $26.80 10/1/2018 River Hosp CDM MIOSTAT 0.01% 1.5ML $26.85 10/1/2018 River Hosp CDM SEPERATION & IDENTIF TECHNIQUE 83909 $26.85 10/1/2018 River Hosp CDM SPECIAL REPORTS-INS FORMS 99080 $26.90 10/1/2018 River Hosp CDM NALOXONE 1mg/1ml AMP $27.05 10/1/2018 River Hosp CDM ROPIVACAINE 0.5% 30ML $27.10 10/1/2018 River Hosp CDM DORZ0LAMIDE OPHTHLMC SOL2%10ml $27.20 10/1/2018 River Hosp CDM 4-0 MERSILENE 1778G $27.25 10/1/2018 River Hosp CDM NCS GUIATUSS DM 10/5ML SYR BTL $27.25 10/1/2018 River Hosp CDM DISPOS RESUSCIT BAG (PEDS) $27.30 10/1/2018 River Hosp CDM RESUSITATION BAG & MASK,PED $27.30 10/1/2018 River Hosp CDM KCI WHITE FOAM $27.40 10/1/2018 River Hosp CDM EYE DIALATING SOLUTION (3.5%) $27.45 10/1/2018 River Hosp CDM METER, PEAK FLOW $27.50 10/1/2018 River Hosp CDM OLANZAPINE 2.5 MG TAB $27.50 10/1/2018 River Hosp CDM PARAFIN BATH THERAPY 97018 $27.55 10/1/2018 River Hosp CDM SUTURE, 10-0 ETHILON 7770G $27.60 10/1/2018 River Hosp CDM IMMUNOELEC UR 86325 $27.61 11/1/2018 River Hosp CDM 6-0 PLAIN GUT G-1 770G $27.65 10/1/2018 River Hosp CDM PHYTONADIONE 1mg/0.5ml $27.65 10/1/2018 River Hosp CDM LABETALOL HCL 5MG/ML VIAL $27.70 10/1/2018 River Hosp CDM LMA UNIQUE AIREWAY 1.5 $27.75 10/1/2018 River Hosp CDM NEOSTIGMINE 1:1000 10 ml VIAL $27.75 10/1/2018 River Hosp CDM SINSKEY HOOK SINGLE USE $27.80 10/1/2018 River Hosp CDM ATTENDS,PULL-UP $27.85 10/1/2018 River Hosp CDM SPLINT, METAL SM $27.85 10/1/2018 River Hosp CDM NASAL PACKING,MEROCEL 8.0+ $27.85 10/1/2018 River Hosp CDM CSF/BD FL DIFF 89051 $27.85 10/1/2018 River Hosp CDM DEHYDRATED ALCOHOL 98% PER 1ML $27.90 10/1/2018 River Hosp CDM GENTAMICIN SULFATE 0.1%SUSP $27.90 10/1/2018 River Hosp CDM HURRICAINE SPRAY $27.95 10/1/2018 River Hosp CDM DANTROLENE SODIUM 20MG VIAL $27.95 10/1/2018 River Hosp CDM FLU VACCINE (SNF) 90658 $28.00 10/1/2018 River Hosp CDM FLU VACCINE (SWG) 90658 $28.00 10/1/2018

River Hosp CDM OVAL SNARE, MINI BRAIDED LOOP $28.00 10/1/2018 River Hosp CDM DUODERM SIGNAL 8X9 $28.10 10/1/2018 River Hosp CDM REDDIE KNEE BRACE $28.20 10/1/2018 River Hosp CDM TORRENT IRRIGATION TUBING $28.25 10/1/2018 River Hosp CDM CHLORIDE 82435 $28.25 10/1/2018 River Hosp CDM HANDLING AND/OR CONVEYANCE SPE 99000 $28.40 10/1/2018 River Hosp CDM URINALYSIS, WITH MICRO 81000 $28.60 10/1/2018 River Hosp CDM ENOXAPARIN SODIUM 40mg INJ $28.70 10/1/2018 River Hosp CDM AQUACEL AG 4X4 DRESSING $28.75 10/1/2018 River Hosp CDM BIOPSY NEEDLE MAG $28.91 10/1/2018 River Hosp CDM BLOOD SET RANGER WARMING $28.95 10/1/2018 River Hosp CDM SHOULDER IMMOBILIZER $28.95 10/1/2018 River Hosp CDM FECAL REDUCING SUBSTANCES 84377 $28.95 10/1/2018 River Hosp CDM REDUC SUB FEC 84377 $28.95 10/1/2018 River Hosp CDM AGGLUTININS AUTO SCREEN 86940 $29.00 10/1/2018 River Hosp CDM LORAZEPAM 2mg/1ml SYRINGE $29.05 10/1/2018 River Hosp CDM HEMOGLOBIN 85018 $29.05 10/1/2018 River Hosp CDM WBC 85048 $29.05 10/1/2018 River Hosp CDM CAPTURA HOT BIOPSY FORCEP $29.15 10/1/2018 River Hosp CDM TRIMTHOBENZAMIDE HCL 100mb AMP $29.15 10/1/2018 River Hosp CDM OCCULT BLOOD/ NEOPLASM SCREEN 82270 $29.25 10/1/2018 River Hosp CDM ROCURONIUM $29.30 10/1/2018 River Hosp CDM COLONSCOPY FEN SPIKED FORCEP $29.40 10/1/2018 River Hosp CDM CLOTRIMAZOLE CR 1% 15gm $29.40 10/1/2018 River Hosp CDM GAUZE IODOFORM 2" $29.45 10/1/2018 River Hosp CDM GAUZE IODOFORM 1/2" $29.45 10/1/2018 River Hosp CDM CHEST SEAL, ASHERMAN $29.45 10/1/2018 River Hosp CDM EA ADDL VACCINE 90472 $29.50 10/1/2018 River Hosp CDM HOLTER KIT $29.50 10/1/2018 River Hosp CDM ERTHROMYCIN 1gm VIAL $29.55 10/1/2018 River Hosp CDM APRESOLINE 10mg IV $29.85 10/1/2018 River Hosp CDM DUODERM CG7 6X6 DRESSING $30.30 10/1/2018 River Hosp CDM FLUID SAFE CANISTER 3000CC $30.30 10/1/2018 River Hosp CDM GASTROCCULT 82271 $30.30 10/1/2018 River Hosp CDM BEAVER BLADE 4mm $30.35 10/1/2018 River Hosp CDM NOVOLIN R 100cc $30.35 10/1/2018 River Hosp CDM AQUACEL AG 4X4.7 $30.40 10/1/2018 River Hosp CDM ERYTHROMYCIN LACTOBIONATE 1GM J1364 $30.40 10/1/2018 River Hosp CDM PHYTONADIONE 10MG/ML $30.40 10/1/2018 River Hosp CDM MASK FIT TESTING - CLIENT $30.45 10/1/2018 River Hosp CDM PEAK FLOW RATE $30.45 10/1/2018 River Hosp CDM RAPID STREP CLN2 87880 $30.45 10/1/2018 River Hosp CDM SUTURE, CHROMIC GUT 4-0 1798G $30.50 10/1/2018 River Hosp CDM FENTANYL 100MCG PATCH $30.50 10/1/2018 River Hosp CDM NCS DIABETIC TUSSIN DM LIQ BTL $30.50 10/1/2018 River Hosp CDM ANOSCOPE W/ LIGHT $30.55 10/1/2018 River Hosp CDM URINE COLLECTION, DRUG SCREENS 99001 $30.60 10/1/2018

River Hosp CDM ADD BEDSIDE REQUIREMENTS $30.65 10/1/2018 River Hosp CDM SITZ BATH $30.65 10/1/2018 River Hosp CDM ISUPREL HCL .02mg/ml J7658 $30.65 10/1/2018 River Hosp CDM DESTRUCT BENIGN LESION ADD'L 17003 $30.75 10/1/2018 River Hosp CDM DESTRUCT BENIGN LSN ADD'L(GEN) 17003 $30.75 10/1/2018 River Hosp CDM CX41D PER PACKAGE $30.90 10/1/2018 River Hosp CDM SPINAL TRAY OR $30.90 10/1/2018 River Hosp CDM DEBRIDEMENT EA ADDL 20 SQ CM 97598 $30.90 10/1/2018 River Hosp CDM MASK ADULT HARNESS $30.95 10/1/2018 River Hosp CDM BETADINE 5% OPTH SLN 30ML $31.00 10/1/2018 River Hosp CDM LATANOPRST 0.005% OP-SOL 2.5ml $31.05 10/1/2018 River Hosp CDM OLANZAPINE 5mg TAB $31.10 10/1/2018 River Hosp CDM GUIDEWIRE 025" 150CM $31.15 10/1/2018 River Hosp CDM CLOTRIMAZOLE 15GM TUBE $31.20 10/1/2018 River Hosp CDM DRESSING TRAY ER $31.25 10/1/2018 River Hosp CDM PEDIATRIC CATHETER $31.55 10/1/2018 River Hosp CDM SUTURE, VICRYL 7-0 J546G $31.65 10/1/2018 River Hosp CDM TUBING SET, VENOUS $31.65 10/1/2018 River Hosp CDM BREATH PATH PATIENT CIRCUIT $31.75 10/1/2018 River Hosp CDM LAP DRAPE $31.75 10/1/2018 River Hosp CDM URINE AT 1/2 HR FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM URINE AT 1 HR FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM URINE AT 2 HRS FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM URINE AT 3 HRS FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM URINE AT 4 HRS FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM URINALYSIS NON AUTO W/O MICRO 81002 $31.75 10/1/2018 River Hosp CDM URINE, FASTING FOR GTT 81002 $31.75 10/1/2018 River Hosp CDM RH PHENOTYPE 86906 $31.80 10/1/2018 River Hosp CDM BRIEF EMOTIONAL/BH ASSESMENT 96127 $31.80 10/1/2018 River Hosp CDM BRIEF EMOTIONAL BEH ASSESMENT 96127 $31.80 10/1/2018 River Hosp CDM BRIEF EMOTIONAL BEH ASSESMENT 96127 $31.80 10/1/2018 River Hosp CDM BRIEF EMOTIONAL BEH ASSESMENT 96127 $31.80 10/1/2018 River Hosp CDM SPECIAL STAIN GROUP II 88313 $31.80 10/1/2018 River Hosp CDM TRIAMCINOLONE 1% 80gm $31.90 10/1/2018 River Hosp CDM CEPHALEXIN 100ml $32.05 10/1/2018 River Hosp CDM J547G $32.10 10/1/2018 River Hosp CDM PILOCARPINE HCL 0.5% 15 ML BTL $32.10 10/1/2018 River Hosp CDM CSF/BDFL-CELL COUNT 89050 $32.10 10/1/2018 River Hosp CDM CATHETER, FOLEY 6FR $32.20 10/1/2018 River Hosp CDM AMIDATE 40MG 2MG/ML SDV $32.20 10/1/2018 River Hosp CDM LMA UNIQUE AIRWAY SIZE 2 $32.20 10/1/2018 River Hosp CDM SUTURE TRAY $32.30 10/1/2018 River Hosp CDM I/A TIP ANGLED 0.3MM POLYMER $32.30 10/1/2018 River Hosp CDM SUTURE, VICRYL 10-0 V960G $32.30 10/1/2018 River Hosp CDM ALCON I&A TIP ANGLED 0.3mm $32.30 10/1/2018 River Hosp CDM MEROCEL TANDARD DRESSING 8.0CM $32.35 10/1/2018 River Hosp CDM MIOSTAT 0.01% SOLN $32.40 10/1/2018

River Hosp CDM SMART CAPNOLINE O2 PLUS,ADULT $32.40 10/1/2018 River Hosp CDM L.E.T. $32.45 10/1/2018 River Hosp CDM SHORT ARM CASTING SUPPLIES $32.50 10/1/2018 River Hosp CDM CASTING SUPPLY/SHT ARM SPLINT $32.50 10/1/2018 River Hosp CDM FINGER SPLINT $32.55 10/1/2018 River Hosp CDM COMFORT WRIST SPLINT $32.60 10/1/2018 River Hosp CDM LMA UNIQUE-ALL SIZES $32.60 10/1/2018 River Hosp CDM PH BLOOD 82800 $32.60 10/1/2018 River Hosp CDM VENOUS,PH 82800 $32.60 10/1/2018 River Hosp CDM INFUSION TREATMENT ROOM/15 MIN $32.70 10/1/2018 River Hosp CDM NCS LEVAQUIN 500MG TAB $32.75 10/1/2018 River Hosp CDM SUCTION CANISTER 3000ml $32.80 10/1/2018 River Hosp CDM INFLUENZA VAC 6-35MO PRESV FR 90655 $32.90 10/1/2018 River Hosp CDM INFLUENZA VAC 3YRS+ 90658 $32.90 10/1/2018 River Hosp CDM CAPSAICIN 60gm TUBE $32.90 10/1/2018 River Hosp CDM ALCON CLEAR CUTSIDE PORT KNIF $33.00 10/1/2018 River Hosp CDM 1780G $33.05 10/1/2018 River Hosp CDM DUODERM SIGNAL 7.5 x 7.8 $33.15 10/1/2018 River Hosp CDM ABDOMINAL BINDER $33.30 10/1/2018 River Hosp CDM VENOFER 100MG/5ML $33.45 10/1/2018 River Hosp CDM PROCRIT NONESRD USE 1000 UNITS $33.45 10/1/2018 River Hosp CDM GELFOAM $33.55 10/1/2018 River Hosp CDM OMNIPAQUE(IOHEXOL)300mg/ml 1VL $33.65 10/1/2018 River Hosp CDM AZITHROMYCIN 200mg/5ml SUSP $33.70 10/1/2018 River Hosp CDM DRESSING TRAY $33.80 10/1/2018 River Hosp CDM METHYLDOPATE 250MG/5 $33.85 10/1/2018 River Hosp CDM AUGMENTIN 600-42.9MG/5ML 125ML $33.95 10/1/2018 River Hosp CDM DUODERM 8X9 SACRAL DRESSING $34.00 10/1/2018 River Hosp CDM AMOXICILLIN 250MG/5ML 150ML $34.00 10/1/2018 River Hosp CDM MANTOUX (SWG) 86580 $34.05 10/1/2018 River Hosp CDM MANTOUX - ER 86580 $34.05 10/1/2018 River Hosp CDM MANTOUX 86580 $34.05 10/1/2018 River Hosp CDM MANTOUX 86580 $34.05 10/1/2018 River Hosp CDM PPD RCWP 86580 $34.05 10/1/2018 River Hosp CDM OCCULT BLOOD DIAGNOSTIC CLN 82272 $34.10 10/1/2018 River Hosp CDM OCCULT BLOOD DIAGNOSTIC CLN 82272 $34.10 10/1/2018 River Hosp CDM OCCULT BLOOD DIAGNOSTIC 82272 $34.10 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 24FR $34.15 10/1/2018 River Hosp CDM CATHETER FOLEY 5cc 22FR $34.15 10/1/2018 River Hosp CDM COLONOSCOPY FORCEP, SPIKED $34.15 10/1/2018 River Hosp CDM NUTRITIONAL COUNSELING INIT RC 97802 $34.21 11/1/2018 River Hosp CDM STIFNECK PEDISELECT $34.35 10/1/2018 River Hosp CDM SMOKE/TOBACCO CESSATION 3-10 99406 $34.40 10/1/2018 River Hosp CDM SMOKE/TABACCO CESSATION 3-10 99406 $34.40 10/1/2018 River Hosp CDM SMOKING CESSATION 3-10 MIN 99406 $34.40 10/1/2018 River Hosp CDM SMOKE/TOBACCO CESSATION 3-10MN 99406 $34.40 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018

River Hosp CDM VISCOSITY SRM 85810 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $34.45 10/1/2018 River Hosp CDM UMBILICAL VESSEL CATHETER $34.60 10/1/2018 River Hosp CDM DISPOS RESUSCIT BAG (INFANT) $34.70 10/1/2018 River Hosp CDM TELEPHONE E&M BY PHY 5-10 MIN 99441 $34.80 10/1/2018 River Hosp CDM BARIUM ENEMA KIT $34.85 10/1/2018 River Hosp CDM LARYNGOSCOPE & BLADE, DISP. $34.95 10/1/2018 River Hosp CDM ALCON DUAL BLADE 1.0 mm $35.00 10/1/2018 River Hosp CDM URIC ACID, URINE 84560 $35.00 10/1/2018 River Hosp CDM OCCULT BLOOD, FECES 1-3 SCREEN 82270 $35.10 10/1/2018 River Hosp CDM REUTER BOBBIN $35.25 10/1/2018 River Hosp CDM METHYLERGONOVINE MALEATE .2mg J2210 $35.40 10/1/2018 River Hosp CDM SUCTION CANISTER DISPOSABLE $35.45 10/1/2018 River Hosp CDM RFHC NO SHOW CHG $35.55 10/1/2018 River Hosp CDM SPEC CLN CARD NO SHOW CHG $35.55 10/1/2018 River Hosp CDM SPEC CLN GYN NO SHOW CHG $35.55 10/1/2018 River Hosp CDM SPEC CLN OPTHM NO SHOW CHG $35.55 10/1/2018 River Hosp CDM SPEC CLN ENT NO SHOW CHG $35.55 10/1/2018 River Hosp CDM SPEC CLN GEN SURG NO SHOW CHG $35.55 10/1/2018 River Hosp CDM CONV CARE NO SHOW CHG $35.55 10/1/2018 River Hosp CDM GATIFLOXACIN 200mg TAB $35.80 10/1/2018

River Hosp CDM URINE/OTHER SOURCE QUANT 82042 $36.05 10/1/2018 River Hosp CDM PROCHLORPERA 10MG/2ML $36.20 10/1/2018 River Hosp CDM CLINDAMYCIN INJ 600MG D5W $36.20 10/1/2018 River Hosp CDM BREATHING CIRCUIT $36.25 10/1/2018 River Hosp CDM CONTRAST AGENT ISOVUE 100ML VL $36.25 10/1/2018 River Hosp CDM OPTHALMIC DRAPE ALCON NON-WOVE $36.30 10/1/2018 River Hosp CDM EPI-S/C O/S .025%epi/.75%LIDOC $36.35 10/1/2018 River Hosp CDM STIFNECK SELECT CERV COLLAR $36.40 10/1/2018 River Hosp CDM VERAPAMIL HCL 180MG $36.55 10/1/2018 River Hosp CDM ALLERGEN SPECF IGE, EA ALLERGE 86003 $36.55 10/1/2018 River Hosp CDM BORDETELLA AB IGG 86615 $36.60 10/1/2018 River Hosp CDM BORDETELLA AB IGM 86615 $36.60 10/1/2018 River Hosp CDM RCWP NO SHOW CHG $36.60 10/1/2018 River Hosp CDM OLONZAPINE 10mg $36.65 10/1/2018 River Hosp CDM RESUSITATION BAG & MASK,INFANT $36.70 10/1/2018 River Hosp CDM CLINDAMYCIN PHOSPHATE 600MG VL $36.70 10/1/2018 River Hosp CDM AC ADD PERSONAL REQ $36.75 10/1/2018 River Hosp CDM IV SET UP - SUPPLIES $36.75 10/1/2018 River Hosp CDM BEAVER LAMELLAR BLADE 6600 $36.75 10/1/2018 River Hosp CDM KNEE IMMOBILIZER 18" $36.80 10/1/2018 River Hosp CDM ACETONE SR, QUALITATIVE 82010 $36.80 10/1/2018 River Hosp CDM B-HYDROXYBUTURATE 82010 $36.80 10/1/2018 River Hosp CDM ADMINIST. HEPATITIS B VACCINE G0010 $37.03 10/1/2018 River Hosp CDM FLU VACCINE SWG (ADMIN) PHYS G0008 $37.03 10/1/2018 River Hosp CDM PNEUMO VACCINE SWG (ADMIN) G0009 $37.03 10/1/2018 River Hosp CDM INTRAVENOUS INFUSION EA ADDL 96361 $37.03 10/1/2018 River Hosp CDM FLU VACCINE (ADMIN) PHYSICIAN G0008 $37.03 10/1/2018 River Hosp CDM PNEUMOCOCCAL VACCINE (ADMIN)MC G0009 $37.03 10/1/2018 River Hosp CDM CRUTCHES ADULT 48"-60" $37.20 10/1/2018 River Hosp CDM CRUTCHES YOUTH 32"-42" $37.20 10/1/2018 River Hosp CDM CRUTCHES MEDIUM 42"-52" $37.20 10/1/2018 River Hosp CDM DERMABOND MINI $37.25 10/1/2018 River Hosp CDM CASTING SUPPLY/LONG ARM SPLINT $37.25 10/1/2018 River Hosp CDM RAPID STREP 87880 $37.35 10/1/2018 River Hosp CDM PHONO/US 97035 $37.45 10/1/2018 River Hosp CDM WHEELCHAIR MGMT PROPULSION TRN 97542 $37.50 10/1/2018 River Hosp CDM 300SURG PATH GR TECH 88300 $37.60 10/1/2018 River Hosp CDM SULFACETAMIDE SODIUM 3.5GM gm $37.65 10/1/2018 River Hosp CDM C02 82374 $37.65 10/1/2018 River Hosp CDM PUDDLEVAC $37.70 10/1/2018 River Hosp CDM FORNACH MANIFOLDS GREEN $37.70 10/1/2018 River Hosp CDM NEOMYCINE/POLYb/DXMETHSN OINT $37.70 10/1/2018 River Hosp CDM CLONIDINE HCL 0.2mg 24HR PATCH $37.70 10/1/2018 River Hosp CDM FLUCONAZOLE 100MG TABLET $37.70 10/1/2018 River Hosp CDM PHIL COLLAR HARD ER $37.75 10/1/2018 River Hosp CDM TERBUTALINE INJ 1MG $37.85 10/1/2018 River Hosp CDM REVERSE T3 84482 $37.85 10/1/2018

River Hosp CDM GLOUCOSE, BLOOD REAGENT STRIP 82948 $37.95 10/1/2018 River Hosp CDM GLOUCOSE, BLOOD REAGENT STRIP 82948 $37.95 10/1/2018 River Hosp CDM RHYTHM ECG INTERP&REPORT ONLY 93042 $38.00 10/1/2018 River Hosp CDM BETAXOLOL 0.5% 5ML $38.00 10/1/2018 River Hosp CDM GLUCOSE, BLOOD 82947 $38.05 10/1/2018 River Hosp CDM VFC ADMIN EA ADDITIONAL 90460 $38.10 10/1/2018 River Hosp CDM PAP SMEAR REVIEW BY PATHOLOGIS 88141 $38.20 10/1/2018 River Hosp CDM E. COLI TOXIN BY EIA 87427 $38.20 10/1/2018 River Hosp CDM HEEL PROTECTOR LARGE $38.25 10/1/2018 River Hosp CDM TAMIFLU 75MG CAP $38.40 10/1/2018 River Hosp CDM PULL-UP XX-LARGE $38.45 10/1/2018 River Hosp CDM VENAFLOW, DISP CALF FOAM CUFF $38.55 10/1/2018 River Hosp CDM NEOMYCINE/POLYb/DXMETHSONESUSP $38.70 10/1/2018 River Hosp CDM RETIC COUNT 85045 $38.75 10/1/2018 River Hosp CDM SUTURE, VICRYL 8-0 J974G $38.80 10/1/2018 River Hosp CDM 775G $38.85 10/1/2018 River Hosp CDM HYPO/HYPERTHERMIA BLANKET $38.95 10/1/2018 River Hosp CDM CEFTRIAXONE 250mg $38.95 10/1/2018 River Hosp CDM GATIFLOXACIN 400MG TAB $39.00 10/1/2018 River Hosp CDM SUTURE, VICRYL 6-0 J562G $39.05 10/1/2018 River Hosp CDM AUGMENTIN 200MG 50ML BOTTLE $39.10 10/1/2018 River Hosp CDM ALDOMET INJ 250mg $39.10 10/1/2018 River Hosp CDM DILTIAZEM HCL 50MG/10 ML VIAL $39.10 10/1/2018 River Hosp CDM END-TIDAL C02 DETECT (PED/INF) $39.20 10/1/2018 River Hosp CDM DOBUTAMINE/D5 5%mg/100ml 250ml $39.35 10/1/2018 River Hosp CDM OCCULT BLOOD, FECES SCREEN MC 82270 $39.45 10/1/2018 River Hosp CDM HYPAFIX DRESSING RETENTION $39.45 10/1/2018 River Hosp CDM HYPAFIX DRESSING $39.45 10/1/2018 River Hosp CDM NAROPIN 5mg/1ml $39.50 10/1/2018 River Hosp CDM PHENYLEPHRINE 2.5%/2ml BOTTLE $39.60 10/1/2018 River Hosp CDM IOPIDINE 0.1% UD DOSE PER AMP $39.60 10/1/2018 River Hosp CDM VFC ADMIN UP TO 18 ANY ROUTE 90460 $39.70 10/1/2018 River Hosp CDM VAC ADMIN UP TO 18 ANY ROUTE 90460 $39.70 10/1/2018 River Hosp CDM NEUROMUSCULAR REEDUCATION 97112 $39.75 10/1/2018 River Hosp CDM IONTOPHORESIS 97033 $39.75 10/1/2018 River Hosp CDM MASSAGE 97124 $39.75 10/1/2018 River Hosp CDM PNEUMO HYPER PANEL 86331 $39.85 10/1/2018 River Hosp CDM POTASSIUM 84132 $39.90 10/1/2018 River Hosp CDM RUSSELL'S VIPER VENOM 85612 $39.90 10/1/2018 River Hosp CDM POTASSIUM APG 84132 $39.90 10/1/2018 River Hosp CDM NUTRITIONAL COUNSELING INITIAL 97802 $39.97 11/1/2018 River Hosp CDM ALLIGATOR FORCEPT 5 1/2"STERIL $40.10 10/1/2018 River Hosp CDM SMEAR PRIMARY BACT 87205 $40.10 10/1/2018 River Hosp CDM PRANTOPRAZOLE IV $40.15 10/1/2018 River Hosp CDM EP PNEUMOPERITONEUM NDL 150CM $40.25 10/1/2018 River Hosp CDM CLEARCUT SLIT BLADE 2.75 mm $40.50 10/1/2018 River Hosp CDM ACTIVATED CHARC W/SORB 240ML $40.60 10/1/2018

River Hosp CDM THROMBIN TIME 85670 $40.60 10/1/2018 River Hosp CDM VENIPUNCTURE/NONROUTINE 36410 $40.65 10/1/2018 River Hosp CDM INFLUENZA QUAD VACC60mcg/0.5ml 90686 $40.80 10/1/2018 River Hosp CDM INFLUENZA VAC 3 YR+ PRESERV FR 90685 $40.80 10/1/2018 River Hosp CDM ANES. EPIDERMAL TRAY $40.90 10/1/2018 River Hosp CDM FOLEY CATHETER 3WAY 18FR $40.95 10/1/2018 River Hosp CDM BILIRUBIN,DIRECT 82248 $40.95 10/1/2018 River Hosp CDM CAT SCRATCH FEVER 86611 $41.05 10/1/2018 River Hosp CDM CAT SCRATCH FEVER 86611 $41.05 10/1/2018 River Hosp CDM CAT SCRATCH FEVER 86611 $41.05 10/1/2018 River Hosp CDM CAT SCRATCH FEVER 86611 $41.05 10/1/2018 River Hosp CDM ALK PHOSPHATASE 84075 $41.10 10/1/2018 River Hosp CDM APTT 85730 $41.10 10/1/2018 River Hosp CDM MORGAN LENS $41.20 10/1/2018 River Hosp CDM EP PNEUMOPERITONEUM NDL 120CM $41.25 10/1/2018 River Hosp CDM 6-0 MERSILENE 1722G $41.25 10/1/2018 River Hosp CDM SODIUM 84295 $41.30 10/1/2018 River Hosp CDM TOLERANCE TEST,EA ADD'L SPEC 82952 $41.40 10/1/2018 River Hosp CDM GLUCOSE AT 4 HRS FOR GTT 82952 $41.40 10/1/2018 River Hosp CDM GLUCOSE AT 5 HRS FOR GTT 82952 $41.40 10/1/2018 River Hosp CDM DOPAMINE 800mg PreMix BAG $41.45 10/1/2018 River Hosp CDM INFLU SAN QUAD VACC60mcg/0.5ml 90686 $41.60 10/1/2018 River Hosp CDM #57 CRESENT BLADE SURG $41.65 10/1/2018 River Hosp CDM HEX PHASE PHOSPHOLIPID 85597 $41.65 10/1/2018 River Hosp CDM TELEPHONE ASSESSMENT 5-10 MIN 98966 $41.65 10/1/2018 River Hosp CDM ANA TITER 86039 $41.75 10/1/2018 River Hosp CDM ALDOLASE 82085 $41.75 10/1/2018 River Hosp CDM IMA EMERG KIT $41.85 10/1/2018 River Hosp CDM METHEMOGLOBIN QUANT 83050 $41.95 10/1/2018 River Hosp CDM BUN 84520 $42.00 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 1 PHP 99211 $42.00 10/1/2018 River Hosp CDM KNEE IMMOBILIZER $42.05 10/1/2018 River Hosp CDM ANNUAL DEPRESS SCREEN MCR ONLY $42.05 10/1/2018 River Hosp CDM ACTINOMYCES Ab 86602 $42.05 10/1/2018 River Hosp CDM ACTINOMYCES AB-ADDTL 86602 $42.05 10/1/2018 River Hosp CDM MEDIHONEY 44ml TUBE $42.15 10/1/2018 River Hosp CDM INFLUENZA NASAL SPRAY .2ML EA 90660 $42.35 10/1/2018 River Hosp CDM INFLUENZA NASAL SPRAY .2ML EA 90660 $42.35 10/1/2018 River Hosp CDM LUMBAR TRAY ER $42.55 10/1/2018 River Hosp CDM LUMBAR-PUNCTURE TRAY PED $42.70 10/1/2018 River Hosp CDM GLUCOSE BODY FLUID 82945 $42.75 10/1/2018 River Hosp CDM BASIC CASTING SUPPLIES $42.85 10/1/2018 River Hosp CDM CULTURE STTOL ADD+ PATHOGENS 87046 $42.85 10/1/2018 River Hosp CDM ASSAY OF BARBITUATES 82205 $42.90 10/1/2018 River Hosp CDM LEGIONELLA PNEUMO URIN ANTIGEN 87449 $42.90 10/1/2018 River Hosp CDM DERMARITE SEARA COMFORT FOAM $42.95 10/1/2018 River Hosp CDM ANTI DNASE B 86215 $43.05 10/1/2018

River Hosp CDM SAFETY KNIFE XSTAR BLADE $43.15 10/1/2018 River Hosp CDM LOOP EXCISION ELECTRODE 12X8 $43.25 10/1/2018 River Hosp CDM LOOP EXCISION ELECTRODE 15X10 $43.25 10/1/2018 River Hosp CDM LOOP EXCISION ELECTRODE 20X10 $43.25 10/1/2018 River Hosp CDM PROSTHETIC TRAINING 97761 $43.33 11/1/2018 River Hosp CDM VENTILATOR CIRCUITRY $43.35 10/1/2018 River Hosp CDM EGG CREATE MATTRESS $43.75 10/1/2018 River Hosp CDM BETAXOLOL HCL .25% 5ML BTL $43.80 10/1/2018 River Hosp CDM LAMIVUDINE 150MG TAB $43.80 10/1/2018 River Hosp CDM GLUCOSE AT 1/2 HR FOR GTT 82952 $43.90 10/1/2018 River Hosp CDM GLUCOSE AT 1 HR FOR GTT 82952 $43.90 10/1/2018 River Hosp CDM GLUCOSE AT 2 HRS FOR GTT 82952 $43.90 10/1/2018 River Hosp CDM GLUCOSE AT 3 HRS FOR GTT 82952 $43.90 10/1/2018 River Hosp CDM PINWORM SL PR 87172 $43.95 10/1/2018 River Hosp CDM COAXIAL CANULA 14 GAUGE $44.00 10/1/2018 River Hosp CDM SUTURE, AR-7200 $44.00 10/1/2018 River Hosp CDM CLINDAMYCIN 900 MG IV $44.00 10/1/2018 River Hosp CDM DOBUTAMINE HCL 250mg/20ml VIAL $44.25 10/1/2018 River Hosp CDM ALBUMIN 82040 $44.25 10/1/2018 River Hosp CDM ZOYSN 4.5 gm VIAL $44.30 10/1/2018 River Hosp CDM ASPERGILLUS AB BY CF 86606 $44.30 10/1/2018 River Hosp CDM ASPERGILUS AB BY CF-ADDTL 86606 $44.30 10/1/2018 River Hosp CDM MASK, NEONATE RES $44.35 10/1/2018 River Hosp CDM SEMEN,POST VAS 89321 $44.40 10/1/2018 River Hosp CDM PULSE OXIMETER ADHESIVE PED $44.45 10/1/2018 River Hosp CDM PROCAINAMIDE INJ 100ml $44.45 10/1/2018 River Hosp CDM BRIMONIDINE TART 15% 5ml $44.45 10/1/2018 River Hosp CDM INFLUENZA VAC 3YRS 90658 $44.45 10/1/2018 River Hosp CDM INFLUENZA VACCINE PRESERV FREE 90656 $44.45 10/1/2018 River Hosp CDM DRAPE, KNEE ARTHRISCOPY $44.65 10/1/2018 River Hosp CDM HEMORRHOIDL LIGATR DISPSUCTPWR $44.80 10/1/2018 River Hosp CDM TUOHY NEEDLE 20gax3.5" $44.80 10/1/2018 River Hosp CDM DRAPE OPH APERT 65X100 $44.80 10/1/2018 River Hosp CDM AZITHROMYCIN 100mg/5ml SUSP $44.85 10/1/2018 River Hosp CDM MAYO DOSSECTING SCISSORS $44.90 10/1/2018 River Hosp CDM ADENOSINE 3mg/ml VIAL $45.00 10/1/2018 River Hosp CDM LEVOFLOXACIN 500mg TAB $45.00 10/1/2018 River Hosp CDM INFUSION SYRING W/STOPCPCK $45.05 10/1/2018 River Hosp CDM SPINAL NEEDLE 22ga X 5" $45.05 10/1/2018 River Hosp CDM ANCA 86256 $45.10 10/1/2018 River Hosp CDM LMB ACUSPRING FINGER EXTENSION $45.15 10/1/2018 River Hosp CDM IV CATHETER 14gax3.25" $45.30 10/1/2018 River Hosp CDM ANIT PNEUMOCCAL AB 86317 $45.45 10/1/2018 River Hosp CDM ANTI PNEUMOCCAL AB 86317 $45.45 10/1/2018 River Hosp CDM NOREPINEPHRINE BIT 1MG/ML AMP $45.50 10/1/2018 River Hosp CDM CEFOXITIN 1G VIAL $45.55 10/1/2018 River Hosp CDM FLOWTRON SLEEVE STANDARD SIZE $45.65 10/1/2018

River Hosp CDM 2808G $45.75 10/1/2018 River Hosp CDM ENOXAPARIN 60 MG INJ $45.75 10/1/2018 River Hosp CDM PHYSICAL THERAPIST PROF $45.75 10/1/2018 River Hosp CDM ALLERGY INJECTION 95115 $45.80 10/1/2018 River Hosp CDM O/T RE-EVAL 97168 $45.90 10/1/2018 River Hosp CDM RPR, QUANT 86593 $45.90 10/1/2018 River Hosp CDM BRIEF, XXLARGE $46.00 10/1/2018 River Hosp CDM TERAZOL VAGINAL CREAM $46.00 10/1/2018 River Hosp CDM ALLERGY INJECTION (MULTIPLE) 95117 $46.05 10/1/2018 River Hosp CDM CLONIDINE HCL 0.1mg 24HR PATCH $46.05 10/1/2018 River Hosp CDM PREALBUMIN 84134 $46.05 10/1/2018 River Hosp CDM BILIRUBIN TOTAL 82247 $46.10 10/1/2018 River Hosp CDM INTRODUCER $46.15 10/1/2018 River Hosp CDM CHEST TUBE 28FR $46.20 10/1/2018 River Hosp CDM ULTRA BRAID SUTURE ASU $46.20 10/1/2018 River Hosp CDM CHEST TUBE ALL SIZES $46.20 10/1/2018 River Hosp CDM SUTURE, AR-7242 $46.40 10/1/2018 River Hosp CDM ENDOSCOPY TUBING/CAP GI $46.40 10/1/2018 River Hosp CDM HPYLORI AG 87339 $46.40 10/1/2018 River Hosp CDM SPIRIVA 18MCG $46.50 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L NEW DRUG $46.65 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L SAME DRUG $46.65 10/1/2018 River Hosp CDM CREATININE, OTHER SOURCE 82570 $46.65 10/1/2018 River Hosp CDM Doxy 100 100 MG SOLR $46.90 10/1/2018 River Hosp CDM MORGAN LENS IRRIGATION $46.90 10/1/2018 River Hosp CDM ACCUTARQ QUICKE SPINL 20x3.5 $46.95 10/1/2018 River Hosp CDM GASTROSTOMY FEEDING TUBE $46.95 10/1/2018 River Hosp CDM CEFTRIAXONE 1gm A/V $47.00 10/1/2018 River Hosp CDM PULSE OXIMETER ADHESIVE ADULT $47.10 10/1/2018 River Hosp CDM PROTHROMBIN TIME 85610 $47.20 10/1/2018 River Hosp CDM PROTHROMBIN TIME APG 85610 $47.20 10/1/2018 River Hosp CDM SPLINT WRIST/THUMB $47.35 10/1/2018 River Hosp CDM TUOHY NEEDLES 17 GA X 17" $47.35 10/1/2018 River Hosp CDM URINE, MICRO 81000 $47.35 10/1/2018 River Hosp CDM DISP ENDOSCOPY MASK 5 $47.40 10/1/2018 River Hosp CDM SUTURE, ETHILON 9-0 2890G $47.55 10/1/2018 River Hosp CDM SULFATRIM SUS 200-40mg/5ml $47.65 10/1/2018 River Hosp CDM COMPLEMENT C1Q 86160 $47.65 10/1/2018 River Hosp CDM LEVONORGESTREL 1.5 MG TABLET $47.80 10/1/2018 River Hosp CDM RPR, QUAL 86592 $47.90 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L SAME DRUG 96376 $47.95 10/1/2018 River Hosp CDM IV CATHETER 14GA 5.25 NEEDLE $48.00 10/1/2018 River Hosp CDM LAB SHIPPING CHARGE $48.05 10/1/2018 River Hosp CDM 02 LOW FLOW 12 HOURS $48.15 10/1/2018 River Hosp CDM TOTAL PROTEIN 84155 $48.15 10/1/2018 River Hosp CDM CHOLESTEROL 82465 $48.15 10/1/2018 River Hosp CDM TRIGLYCERIDES 84478 $48.15 10/1/2018

River Hosp CDM IRON,TOTAL BINDING CAPACITY 83550 $48.15 10/1/2018 River Hosp CDM IRON TOTAL 83540 $48.15 10/1/2018 River Hosp CDM VICODIN TEST 80375 $48.35 10/1/2018 River Hosp CDM HYDROCORTISONE 2.5% 30 GM TUBE $48.50 10/1/2018 River Hosp CDM SMOKE/TOBACCO CESSATION >10MIN 99407 $48.65 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 2 PC 99212 $48.65 10/1/2018 River Hosp CDM URIC ACID 84550 $48.75 10/1/2018 River Hosp CDM VANCOMYCIN HCL 125 TAB $48.85 10/1/2018 River Hosp CDM KCI VAC 300ML CANISTER $48.95 10/1/2018 River Hosp CDM PILOCARPINE HCL 4% 15 ML BTL $48.95 10/1/2018 River Hosp CDM BASIC CARDIAC MONITOR SETUP $49.00 10/1/2018 River Hosp CDM SMALL CORNEAL SHIELD WITH HAND $49.00 10/1/2018 River Hosp CDM SURGISEAL TOPICAL ADHESIVE $49.00 10/1/2018 River Hosp CDM WET MOUNT 87210 $49.15 10/1/2018 River Hosp CDM DURAGESIC 25mg PATCH $49.15 10/1/2018 River Hosp CDM WET MOUNT 87210 $49.15 10/1/2018 River Hosp CDM KOH PREP 87210 $49.15 10/1/2018 River Hosp CDM WET PREP 87210 $49.15 10/1/2018 River Hosp CDM QUICKCLOT 4X4 HEM DRESSING $49.20 10/1/2018 River Hosp CDM PHOSPHORUS 84100 $49.25 10/1/2018 River Hosp CDM DEPO MEDROL INJECTION 40MG $49.35 10/1/2018 River Hosp CDM GALECTIN - 3 LEVEL 83520 $49.35 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L NEW DRUG OB 96375 $49.45 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L NEW DRUG 96375 $49.45 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L SAME DRUG 96376 $49.45 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L NEW DRUG 96375 $49.45 10/1/2018 River Hosp CDM IV MEDS/PUSH/ADD'L SAME DRUG 96376 $49.45 10/1/2018 River Hosp CDM WELL WOMAN W/PAP 40-64 MCR PC Q0091 $49.45 10/1/2018 River Hosp CDM WELL WOMAN W/PAP +65 MCR (PC) Q0091 $49.45 10/1/2018 River Hosp CDM WELL WOMAN W/PAP 18-39 MCR GYN Q0091 $49.45 10/1/2018 River Hosp CDM WATER BUG $49.50 10/1/2018 River Hosp CDM LINDANE 1% SHAMPOO 60ML BTL $49.55 10/1/2018 River Hosp CDM DRAINABLE POUCH W/4" $49.60 10/1/2018 River Hosp CDM LUMBAR TRAY INFANT $49.60 10/1/2018 River Hosp CDM CONCHAPAK W/COLUMN $49.60 10/1/2018 River Hosp CDM MONSEL PASTE $49.80 10/1/2018 River Hosp CDM CREATININE 82565 $49.80 10/1/2018 River Hosp CDM COOMBS TEST 86880 $49.95 10/1/2018 River Hosp CDM SITZ MARKERS $50.05 10/1/2018 River Hosp CDM GATIFLOXACIN/D5W 400MG $50.05 10/1/2018 River Hosp CDM REVERSE TRANSCRIPTION 83902 $50.05 10/1/2018 River Hosp CDM CATHETER BARTHOLIN GLAND $50.15 10/1/2018 River Hosp CDM AMO IRRIGATION SLEEVE $50.15 10/1/2018 River Hosp CDM ALBUTERAL INHALER $50.15 10/1/2018 River Hosp CDM TUOHY NEEDLES 20GA X 6" $50.20 10/1/2018 River Hosp CDM FOAM ANKLE SUPPORT $50.20 10/1/2018 River Hosp CDM RHEUMATOID FACTOR QUAL 86430 $50.20 10/1/2018

River Hosp CDM SUTURE VICRYL 7-0 ETH J566G $50.25 10/1/2018 River Hosp CDM METHYLPREDISOLONE SOD 2gm VIAL $50.35 10/1/2018 River Hosp CDM VENAFLOW, XL DISP CALF CUFF $50.45 10/1/2018 River Hosp CDM MIACALCIN TWIN/PK 200U SPR/PMP $50.50 10/1/2018 River Hosp CDM HEPATITIS A VACCINE ADULT 90632 $50.55 10/1/2018 River Hosp CDM HEPATITIS A VACCINE (CHILD) 90633 $50.55 10/1/2018 River Hosp CDM SED RATE 85651 $50.60 10/1/2018 River Hosp CDM LDH 83615 $50.65 10/1/2018 River Hosp CDM ANTIBODY SCREEN 86850 $50.80 10/1/2018 River Hosp CDM HETEROPHILE AB 86308 $50.80 10/1/2018 River Hosp CDM CAD DIAGNOSTIC 77051 $50.95 10/1/2018 River Hosp CDM CAD SCREENING 77067 $50.95 10/1/2018 River Hosp CDM CONCENTRATION FOR INFECT AGENT 87015 $50.95 10/1/2018 River Hosp CDM EACH ADDL NAIL PLATE 11732 $51.10 10/1/2018 River Hosp CDM RALTEGRAVIR 400mg $51.25 10/1/2018 River Hosp CDM CALCIUM 82310 $51.30 10/1/2018 River Hosp CDM RH 86901 $51.30 10/1/2018 River Hosp CDM PILOCARPINE HCL 2% 15 ML BTL $51.40 10/1/2018 River Hosp CDM ICA 512AB 86341 $51.45 10/1/2018 River Hosp CDM MONARCH II CARTRIDGE B $51.50 10/1/2018 River Hosp CDM PARTS KIT,MICROSMOOTH $51.50 10/1/2018 River Hosp CDM GAMMA GLUTAMYLTRANSFERASE 82977 $51.50 10/1/2018 River Hosp CDM CLO TEST 87081 $51.60 10/1/2018 River Hosp CDM VRE CULTURE 87081 $51.60 10/1/2018 River Hosp CDM CULT BACT SCR SINGLE/THROAT 87081 $51.60 10/1/2018 River Hosp CDM ASU SPOT MARKER $51.65 10/1/2018 River Hosp CDM NCS AQUACEL AG 4X4.7 $51.70 10/1/2018 River Hosp CDM PHOSPHORUS UR 84105 $51.70 10/1/2018 River Hosp CDM ENDOMYSIVE AB 86255 $52.15 10/1/2018 River Hosp CDM DEXAMETHASONE30mg/30mlINTENSOL $52.30 10/1/2018 River Hosp CDM DRUG SCREEN QUANT CAFFEINE 80155 $52.30 10/1/2018 River Hosp CDM BLEEDING TIME 85002 $52.50 10/1/2018 River Hosp CDM TET/DIPTHERIA PED $52.80 10/1/2018 River Hosp CDM AMYLASE 82150 $52.90 10/1/2018 River Hosp CDM CRYOGLOBULINS SERUM 82595 $53.00 10/1/2018 River Hosp CDM CLEAR CUT SAFETY SIDE PORT DB $53.15 10/1/2018 River Hosp CDM V-LANCE KNIFE $53.30 10/1/2018 River Hosp CDM SAFETY SIDE PORT KNIFE $53.30 10/1/2018 River Hosp CDM PREGNANCY, URINE 81025 $53.55 10/1/2018 River Hosp CDM INSUFFLATOR TUBING $53.70 10/1/2018 River Hosp CDM LDH ISOENZYMES 83625 $53.70 10/1/2018 River Hosp CDM STREPTOCOCCUS A ANTIGEN 87880 $53.70 10/1/2018 River Hosp CDM STREPTOCOCCUS GROUP 87880 $53.70 10/1/2018 River Hosp CDM MOXIFLOXCN OPTHSOL 0.8mg/mlSYR $53.75 10/1/2018 River Hosp CDM CEFUROXIME OPTHSOL3mg/0.3mlSYR $53.75 10/1/2018 River Hosp CDM PEAK FLOW METER ER $53.90 10/1/2018 River Hosp CDM COTTONOIDS $53.95 10/1/2018

River Hosp CDM HIP KIT $54.00 10/1/2018 River Hosp CDM SPLINT/STRAPPING/IMMOBILIZE $54.10 10/1/2018 River Hosp CDM FINE NEEDLE ASPIRATION ER $54.10 10/1/2018 River Hosp CDM INJ INTERMEDIATE/SMALL JT ER $54.10 10/1/2018 River Hosp CDM EYE EXAM ER $54.10 10/1/2018 River Hosp CDM CLINDAMYCIN 900MG AV $54.25 10/1/2018 River Hosp CDM CUSTOM EYE PAK $54.30 10/1/2018 River Hosp CDM GLUTATHIONE 82978 $54.40 10/1/2018 River Hosp CDM BRIMONIDINE TART 5ml BTL 270 $54.65 10/1/2018 River Hosp CDM POTASSIUM,URINE 84133 $54.80 10/1/2018 River Hosp CDM CALCIUM UR 82340 $54.80 10/1/2018 River Hosp CDM CALCIUM, RANDOM URINE 82340 $54.80 10/1/2018 River Hosp CDM CEFTAZIDIME 500MG $54.85 10/1/2018 River Hosp CDM INTRODUCER SHEATH, 7F, 11cm $54.90 10/1/2018 River Hosp CDM MEASLES,MUMPS.RUBELLA 1 VIAL $54.90 10/1/2018 River Hosp CDM MUMPS/RUBELLA INJ LV $54.90 10/1/2018 River Hosp CDM BALL ELECTRODE 10X10 ROUND $54.95 10/1/2018 River Hosp CDM TEAM CONF NO PT/FAM 30M NONPHY 99368 $55.00 10/1/2018 River Hosp CDM TEAM CONF NO PT/FAM 30M NONPHY 99368 $55.00 10/1/2018 River Hosp CDM PERSONAL CARE ITEMS $55.15 10/1/2018 River Hosp CDM BICILLIN CR 900/300 $55.25 10/1/2018 River Hosp CDM PH BODY FLUID EXCEPT BLOOD 83986 $55.25 10/1/2018 River Hosp CDM SUTURE J574G V. $55.45 10/1/2018 River Hosp CDM GROWTH HORMONE TEST 86277 $55.50 10/1/2018 River Hosp CDM LIDOCAINE 2% 10ml $55.55 10/1/2018 River Hosp CDM EPIDURAL TRAY $55.80 10/1/2018 River Hosp CDM BETA GLUCAN 87449 $55.80 10/1/2018 River Hosp CDM NEB TX SUBSEQ CONT HR 94645 $55.85 10/1/2018 River Hosp CDM RECOVERY ROOM 0-30 MINUTES $55.85 10/1/2018 River Hosp CDM HIV TEST 87389 $55.95 10/1/2018 River Hosp CDM RHYTHM ECG 1-3 LEADS W/O INTP 93041 $55.96 10/1/2018 River Hosp CDM REM IMPACTED CERUMEN W/IRR 69209 $55.96 10/1/2018 River Hosp CDM REM IMPACTED CERUMEN IRR/LAV 69209 $55.96 10/1/2018 River Hosp CDM REM IMPACTED CERUMEN W/IRR/LAV 69209 $55.96 10/1/2018 River Hosp CDM REM IMPACTED CERUMEN W/IRR/LAV 69209 $55.96 10/1/2018 River Hosp CDM LIVER BIOPSY TRAY $56.20 10/1/2018 River Hosp CDM CEFACLOR 125mg/5ml 75ml $56.40 10/1/2018 River Hosp CDM ALCON 0.3mm POLYMER i/a $56.50 10/1/2018 River Hosp CDM BALL ELECTRODE 12X20 ROUND $56.60 10/1/2018 River Hosp CDM SODIUM URN 84300 $56.80 10/1/2018 River Hosp CDM AKTEN 3.5% /5ml vial $56.95 10/1/2018 River Hosp CDM LIDO PREMIX 500ML2GM $57.00 10/1/2018 River Hosp CDM LIDOCAINE HCL/D5W 4MG/ML BAG $57.00 10/1/2018 River Hosp CDM CLEARCUT HP2 DB SILT 2.6mm ANG $57.10 10/1/2018 River Hosp CDM PEAK FLOW METER SUPPLY $57.15 10/1/2018 River Hosp CDM CPK ISOENZYMES SERUM 82552 $57.20 10/1/2018 River Hosp CDM ABDOMINAL BINDER $57.25 10/1/2018

River Hosp CDM HDL 83718 $57.35 10/1/2018 River Hosp CDM CRYPTOSPORIDIUM ANTIGEN 87328 $57.35 10/1/2018 River Hosp CDM LEVOFLOXACIN 250mg BAG $57.65 10/1/2018 River Hosp CDM ACYLCARNITINE PROFILE 82017 $57.65 10/1/2018 River Hosp CDM PHENYLALANINE, PKU BLOOD 84030 $57.70 10/1/2018 River Hosp CDM SAW BLD 9.4MMX25.5MMX0.04MM $58.00 10/1/2018 River Hosp CDM XALANTAN OPHTH .005% SOLUTION $58.10 10/1/2018 River Hosp CDM PULSE OX BRIEF 94760 $58.15 10/1/2018 River Hosp CDM ER PULSE OXIMETRY BRIEF 94760 $58.15 10/1/2018 River Hosp CDM PULSE OXIMETRY CLINIC 94760 $58.15 10/1/2018 River Hosp CDM PULSE OXIMETRY-SPOTCHECK 94760 $58.15 10/1/2018 River Hosp CDM PULSE OXIMETRY 94760 $58.15 10/1/2018 River Hosp CDM PULSE OXIMETRY CLN2 94760 $58.15 10/1/2018 River Hosp CDM IM INJECTION SUBCU 96372 $58.20 10/1/2018 River Hosp CDM IMMUNIZATION (ADMIN) ACUTE 90471 $58.20 10/1/2018 River Hosp CDM IM INJECTION SUBCU 96372 $58.20 10/1/2018 River Hosp CDM IM INJ OF VACCINE ONLY (OBS) 90471 $58.20 10/1/2018 River Hosp CDM THERA INJ (ADMIN) CLINIC 96372 $58.20 10/1/2018 River Hosp CDM IM ANTIBIOTIC 96372 $58.20 10/1/2018 River Hosp CDM IM THERAPEUTIC INJ ADMIN (ER) 96372 $58.20 10/1/2018 River Hosp CDM INJ THERA 96372 $58.20 10/1/2018 River Hosp CDM FLU VACCINE (ADMIN) RN 90471 $58.20 10/1/2018 River Hosp CDM IM INJECTION OF VACCINE ONLY 90471 $58.20 10/1/2018 River Hosp CDM IMMUNATION ADMIN 90471 $58.20 10/1/2018 River Hosp CDM IM INJECTION SUBCU 96372 $58.20 10/1/2018 River Hosp CDM IM INJ THERA/PROPHY/DIAG ADMIN 96372 $58.20 10/1/2018 River Hosp CDM FLU VACCINE (ADMIN) RN 90471 $58.20 10/1/2018 River Hosp CDM ANTIBIOTICS (ADMIN) 96372 $58.20 10/1/2018 River Hosp CDM HEPATITIS B VACCINE (ADMIN) MC 90471 $58.20 10/1/2018 River Hosp CDM IM INJECTION SUBCU 96372 $58.20 10/1/2018 River Hosp CDM INJECTION THERA 96372 $58.20 10/1/2018 River Hosp CDM IM INJECTION CLN 96372 $58.20 10/1/2018 River Hosp CDM INTRANASAL ADMIN (RCC) 90473 $58.20 10/1/2018 River Hosp CDM IMMUNIZATION ADMIN 90471 $58.20 10/1/2018 River Hosp CDM THERA INJ (ADMIN) CLN2 96372 $58.20 10/1/2018 River Hosp CDM IMMUNIZATION ADMIN FLU RN 90471 $58.20 10/1/2018 River Hosp CDM INTRANASAL ADMIN (CLN2) 90473 $58.20 10/1/2018 River Hosp CDM IMMUNIZATION ADMIN 90471 $58.20 10/1/2018 River Hosp CDM ELECTRIC STIM, UNATTENDED 97014 $58.25 10/1/2018 River Hosp CDM BALL ELECTRODE 10X8 SQ $58.25 10/1/2018 River Hosp CDM LLETA BALL ELECTRODE 5MM $58.25 10/1/2018 River Hosp CDM PROTEIN TOT 24HR UR 84156 $58.40 10/1/2018 River Hosp CDM DOXYCYCLINE HYCLATE 100MG VIAL $58.60 10/1/2018 River Hosp CDM NCS FOSAMAX U-U 70MG TAB $58.70 10/1/2018 River Hosp CDM ATHLETIC TRAINING RE-EVAL 97172 $58.80 10/1/2018 River Hosp CDM SEPERATION & IDENTIF TECHNIQUE 83909 $59.00 10/1/2018 River Hosp CDM NEB TX CONTINUOUS-EA SUBS HOUR 94645 $59.15 10/1/2018

River Hosp CDM BETADEXAMETHASONE 0.1% $59.55 10/1/2018 River Hosp CDM APRESOLINE 20MG/ML VIAL J0360 $59.60 10/1/2018 River Hosp CDM SUTURE 7756G ETHICON 10-0 $59.75 10/1/2018 River Hosp CDM GUIDE WR 1.2MMX12 STERILE $59.80 10/1/2018 River Hosp CDM U/S EVAL OF POTENTIAL ACC SITE 76937 $59.80 10/1/2018 River Hosp CDM PROPRANOLOL HCL 1MG/ML AMP $59.85 10/1/2018 River Hosp CDM PHLEBOTOMY BAD W/NEEDLE $59.95 10/1/2018 River Hosp CDM BALL ELECTRODE 15X12 ROUND $60.00 10/1/2018 River Hosp CDM NCS SENNA 8.8MG/5ML SYRUP BTL $60.05 10/1/2018 River Hosp CDM EYE IRRIGATION SET UP ER $60.05 10/1/2018 River Hosp CDM *LEUKOFILTER RC 100 $60.05 10/1/2018 River Hosp CDM ENZYME ACTIVITY IN BLOOD CELLS 82657 $60.05 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 1 PHP 99201 $60.05 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 2 PHP 99212 $60.05 10/1/2018 River Hosp CDM URINE DRUG SCREEN, AFTER HOURS 99001 $60.05 10/1/2018 River Hosp CDM OFFICE VISIT LVL1 (ESTAB PT) 99211 $60.15 10/1/2018 River Hosp CDM O/V LVL1 ESTAB FAC CLN2 99211 $60.15 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 1 RCWP 99211 $60.15 10/1/2018 River Hosp CDM CATH FOGARTY IRRIGA $60.20 10/1/2018 River Hosp CDM PERCUTANEOUS SHEATH KIT, ARROW $60.35 10/1/2018 River Hosp CDM LIGHT CHAINS, URINE 83883 $60.35 10/1/2018 River Hosp CDM EHRILICHIA AB 86666 $60.35 10/1/2018 River Hosp CDM EHRILICHIA AB 86666 $60.35 10/1/2018 River Hosp CDM EHRILICHIA AB 86666 $60.35 10/1/2018 River Hosp CDM EHRILICHIA AB 86666 $60.35 10/1/2018 River Hosp CDM CIPROFLOXACIN/D5WMG 200ML BAG $60.60 10/1/2018 River Hosp CDM OXACILLIN 2 MG INJ. $60.65 10/1/2018 River Hosp CDM WHIRLPOOL 97022 $60.70 10/1/2018 River Hosp CDM LMA SUPREME SIZE 2.5 $60.80 10/1/2018 River Hosp CDM OUTPT AMBULANCE PER MILE $60.90 10/1/2018 River Hosp CDM CORTISPORIN SUS OTIC $61.00 10/1/2018 River Hosp CDM HEMOPHILUS INFLUENZA B VACCINE 90648 $61.10 10/1/2018 River Hosp CDM TRUE CUSTOM ENDO PACK $61.15 10/1/2018 River Hosp CDM SPECIAL PT CONDITIONS $61.25 10/1/2018 River Hosp CDM RAPID RHINO 5.5 ANTERIOR $61.50 10/1/2018 River Hosp CDM A-OK SATIN CRESCENT FULL $61.60 10/1/2018 River Hosp CDM PREG ASSOC PLASMA PROTEIN 84163 $61.65 10/1/2018 River Hosp CDM BRACE, AIR CAST $61.90 10/1/2018 River Hosp CDM BRACE,AIR CAST RIGHT ANKLE L4350 $61.90 10/1/2018 River Hosp CDM ROCKY MNTN SPOTTED FEVER 86757 $61.95 10/1/2018 River Hosp CDM SGOT (AST) 84450 $62.05 10/1/2018 River Hosp CDM TOPIRAMATE 80201 $62.10 10/1/2018 River Hosp CDM SPINE ENTIRE 1 VIEW 72081 $62.12 10/1/2018 River Hosp CDM CT HEART W/O CONT EVAL COR CAL 75571 $62.12 10/1/2018 River Hosp CDM HOT/COLD PACKS 97010 $62.25 10/1/2018 River Hosp CDM CORTISPORIN OTIC 10ML SOL $62.25 10/1/2018 River Hosp CDM PROCTOSOL HC CREAM 2.5% $62.30 10/1/2018

River Hosp CDM INFLUENZA VAC 6-35MO PRESV FR 90685 $62.35 10/1/2018 River Hosp CDM TELEMEDICINE ENCOUNTER SPOKE $62.50 10/1/2018 River Hosp CDM COLONOSCOPY ACU SNARE $62.50 10/1/2018 River Hosp CDM BIOPSY SKIN,EA ADD'L LSN (GEN) 11101 $62.65 10/1/2018 River Hosp CDM PREVENTATIVE MEDICINE COUNSEL 99401 $62.75 10/1/2018 River Hosp CDM AUDIOMETRY 92551 $62.85 10/1/2018 River Hosp CDM CHLORIDE,URINE 82436 $62.95 10/1/2018 River Hosp CDM TYMPANOMETRY (ENT) 92567 $63.05 10/1/2018 River Hosp CDM TDAP 7YRS+ VACCINE 90715 $63.15 10/1/2018 River Hosp CDM Tdap (ADACEL) 0.5ml VIAL 90715 $63.15 10/1/2018 River Hosp CDM TDAP 7+ YEARS 90715 $63.15 10/1/2018 River Hosp CDM SUTURE 770G ETHICON $63.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL TWO ESTAB PC 99212 $63.45 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 2 EST (PC) 99212 $63.45 10/1/2018 River Hosp CDM O/V LVL 2 EST CARDIO PC 99212 $63.45 10/1/2018 River Hosp CDM OFFICE VST LVL 2 EST PC (GYN) 99212 $63.45 10/1/2018 River Hosp CDM OFFICE VISIT LVL 2 EST PC OPTH 99212 $63.45 10/1/2018 River Hosp CDM OFFICE VST LVL 2 EST PC(ORTHO) 99212 $63.45 10/1/2018 River Hosp CDM OFFICE VST LVL 2 EST PC (ENT) 99212 $63.45 10/1/2018 River Hosp CDM OFFICE VISIT LVL 2 EST PC(GEN) 99212 $63.45 10/1/2018 River Hosp CDM O/V LVL 2 ESTAB PC CLN2 99212 $63.45 10/1/2018 River Hosp CDM DR OFF VISIT LVL 2 EST PC CLN2 99212 $63.45 10/1/2018 River Hosp CDM NEW PAT LEVEL 1 PROF PHP 99201 $63.45 10/1/2018 River Hosp CDM PHP LEVEL 2 PC 99212 $63.45 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 2 PC RCWP 99212 $63.45 10/1/2018 River Hosp CDM TELE ESTAB PAT LVL 2 PC RCWP 99212 $63.45 10/1/2018 River Hosp CDM TELE EST PAT LVL 2 CPSY 99212 $63.45 10/1/2018 River Hosp CDM SUTURE ETHILON 9000g $63.60 10/1/2018 River Hosp CDM IV INFUSION SET UP $63.65 10/1/2018 River Hosp CDM PROTAMINE SULFATE250mg/25ml VL $63.80 10/1/2018 River Hosp CDM INHIBIN A 86336 $63.80 10/1/2018 River Hosp CDM PHONE E/M PHY/QHP 11-20 MIN 99442 $63.80 10/1/2018 River Hosp CDM TELEPHONE E&M BY PHY 11-20 MIN 99442 $64.05 10/1/2018 River Hosp CDM KOH (PHYS REVEIW & INTERP) 93272 $64.15 10/1/2018 River Hosp CDM FRUCTOSAMINE 82985 $64.30 10/1/2018 River Hosp CDM STOOL FOR LEUKOCYTES 89055 $64.40 10/1/2018 River Hosp CDM RAPID INTUBATION MED KIT $64.45 10/1/2018 River Hosp CDM EZ PAP SYSTEM $64.70 10/1/2018 River Hosp CDM DIX HALLPIKE (ENT) 92532 $64.85 10/1/2018 River Hosp CDM BACT ID EACH ORGANISM 87077 $64.95 10/1/2018 River Hosp CDM VANCOMYCIN HCL 1gm VIAL $65.00 10/1/2018 River Hosp CDM CPK 82550 $65.00 10/1/2018 River Hosp CDM TEAM CONF NO PT/FAM 30M PHY 99367 $65.00 10/1/2018 River Hosp CDM TEAM CONF NO PT/FAM 30M PHYSIC 99367 $65.00 10/1/2018 River Hosp CDM TETANUS/DIPTH 0.5 PER VIAL 90714 $65.15 10/1/2018 River Hosp CDM TETANUS/DIPTH/PERT 90714 $65.15 10/1/2018 River Hosp CDM TET/DIPTH/PERT 90714 $65.15 10/1/2018

River Hosp CDM ALCON INTRPID 0.3MM TRANS I/A $65.30 10/1/2018 River Hosp CDM DRESSING OPTIFOAM AG + SILVER $65.70 10/1/2018 River Hosp CDM SGPT (ALT) 84460 $65.80 10/1/2018 River Hosp CDM BROSLOW o2 DELIVERY MODULE $66.00 10/1/2018 River Hosp CDM EPISTAXIS SET UP ER $66.05 10/1/2018 River Hosp CDM PROSTHETIC TRAINING, EA 15 MIN 97761 $66.05 10/1/2018 River Hosp CDM PROCTOSOL HC 2.57gm $66.05 10/1/2018 River Hosp CDM CATHETER COUDE 14 FR W/BALLOON $66.15 10/1/2018 River Hosp CDM TELEMEDICINE GENERAL $66.30 10/1/2018 River Hosp CDM RAPID FLU A AND B, EACH 87400 $66.35 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL ONE NEW(PC) 99201 $66.70 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 1 NEW (PC) 99201 $66.70 10/1/2018 River Hosp CDM O/V LVL 1 NEW CARDIO PC 99201 $66.70 10/1/2018 River Hosp CDM OFFICE VST LVL 1 NEW PC (GYN) 99201 $66.70 10/1/2018 River Hosp CDM OFFICE VISIT LVL 1 NEW PC OPTH 99201 $66.70 10/1/2018 River Hosp CDM OFFICE VST LVL 1 NEW PC (ENT) 99201 $66.70 10/1/2018 River Hosp CDM OFFICE VST LVL 1 NEW PC (GEN) 99201 $66.70 10/1/2018 River Hosp CDM O/V LEVEL 1 NEW PC CLN2 99201 $66.70 10/1/2018 River Hosp CDM DR OFF VISIT LVL 1 NEW PC CLN2 99201 $66.70 10/1/2018 River Hosp CDM NEW PAT LEVEL 1 PROF RCWP 99201 $66.70 10/1/2018 River Hosp CDM IV INJ/PUSH/ADD'L NEW DRUG CLN 96375 $66.75 10/1/2018 River Hosp CDM EA ADDL SEQUENTIAL IV PUSH NEW 96375 $66.75 10/1/2018 River Hosp CDM ADL TRAINING 97535 $66.80 10/1/2018 River Hosp CDM THERAP ACTIV DIRECT PT CONTACT 97530 $66.80 10/1/2018 River Hosp CDM 1 HR POST GLUCOLA 82950 $66.80 10/1/2018 River Hosp CDM CBC W/O DIFF 85027 $66.80 10/1/2018 River Hosp CDM CBC W/O DIFF APG 85027 $66.80 10/1/2018 River Hosp CDM BACLOFEN 83789 $66.95 10/1/2018 River Hosp CDM PNEUMOCOCCAL VACCINE 2.5ml VL 90732 $67.10 10/1/2018 River Hosp CDM TOBRAMYCIN SULFATE 0.3% 5MLBTL $67.15 10/1/2018 River Hosp CDM SUMATRIPTAN SUCC 6mg/0.5 SYRNG $67.20 10/1/2018 River Hosp CDM FACE MASKS, VARIOUS SIZES RESP $67.30 10/1/2018 River Hosp CDM KNIFE, 3.0MM CLEARCUT DB SLIT $67.35 10/1/2018 River Hosp CDM MUTATION ID BY SEQ SINGLE EA 83904 $67.45 10/1/2018 River Hosp CDM MUTATION ID BY SEQ SINGLE EA 83904 $67.45 10/1/2018 River Hosp CDM ALCON CRES KNIFE SANTIN STRAIT $67.55 10/1/2018 River Hosp CDM TENOFOVIR 300 MG PER TAB $67.60 10/1/2018 River Hosp CDM HOLTER MONITOR PHYS REV/INTRP 93227 $67.60 10/1/2018 River Hosp CDM GRAPSING FORCEP $67.95 10/1/2018 River Hosp CDM PHENYLEPHRINE OPHTH 10% 5mlBTL $67.95 10/1/2018 River Hosp CDM ATIVAN ASSAY OF BENZODIAZEPINE 80346 $67.95 10/1/2018 River Hosp CDM ISO VITAL SIGNS KIT ADULT $68.00 10/1/2018 River Hosp CDM TYMPANOMETRY 92567 $68.15 10/1/2018 River Hosp CDM THERAPEUTIC/DIAG INJECTION 96372 $68.15 10/1/2018 River Hosp CDM NASAL PACK 5.5 ANTERIOR $68.20 10/1/2018 River Hosp CDM RAPID RHINO 550-5.5MM $68.20 10/1/2018 River Hosp CDM AQUACEL AG 6X6 DRESSING $68.45 10/1/2018

River Hosp CDM OSMOLALITY SR 83930 $68.45 10/1/2018 River Hosp CDM KETOCONAZOLE 15gm TUBE $68.70 10/1/2018 River Hosp CDM CEFTRIAXONE 250mg VIAL $68.90 10/1/2018 River Hosp CDM T4 (THYROXINE TOTAL) 84436 $68.90 10/1/2018 River Hosp CDM CULTURE, FUNGUS & STAIN 87101 $69.00 10/1/2018 River Hosp CDM CULT FUNGUS NOT SKIN 87102 $69.00 10/1/2018 River Hosp CDM GAIT/CRUTCH TRAINING 97116 $69.20 10/1/2018 River Hosp CDM CLEAR VAC W SMOKE EVACUATION $69.25 10/1/2018 River Hosp CDM CLEARCUT SLIT BLADE 2.6mm $69.30 10/1/2018 River Hosp CDM METIPRANOLOL .3% DROPS $69.30 10/1/2018 River Hosp CDM LMA SUPREME SIZE 3 $69.35 10/1/2018 River Hosp CDM AMP NUC ACID PCR $69.35 10/1/2018 River Hosp CDM AMP NUC ACID PCR $69.35 10/1/2018 River Hosp CDM AMP NUC ACID PCR $69.35 10/1/2018 River Hosp CDM AMP NUC ACID PCR $69.35 10/1/2018 River Hosp CDM DTAP (CHILD) < 7 YEARS OLD 90700 $69.45 10/1/2018 River Hosp CDM EXCEL STABILITY SLEEVE 5MM $69.60 10/1/2018 River Hosp CDM IV INFUS/CONCURRENT 96368 $69.65 10/1/2018 River Hosp CDM CONCURRENT INFUSION 96368 $69.65 10/1/2018 River Hosp CDM CONCURRENT INFUSION 96368 $69.65 10/1/2018 River Hosp CDM IV INFUS/CONCURRENT 96368 $69.65 10/1/2018 River Hosp CDM PIPERACILLIN/TAZOB SOD 3.375GM $69.65 10/1/2018 River Hosp CDM CONCURRENT INFUSION CLN 96368 $69.65 10/1/2018 River Hosp CDM CLEAR CUT SLIT KNIFE DUAL 2.75 $69.80 10/1/2018 River Hosp CDM DEBRIDEMENT EA ADDL 20 SQ CM 11045 $69.95 10/1/2018 River Hosp CDM OSMOLALITY UR 83935 $70.00 10/1/2018 River Hosp CDM STOOL CULTURE FOR YERSINIA 87046 $70.00 10/1/2018 River Hosp CDM #5 ETHICON NYLON SUTURE $70.15 10/1/2018 River Hosp CDM PHIL CERVICAL COLLARS $70.35 10/1/2018 River Hosp CDM SOFT SHIELD COLLOGEN EYE $70.45 10/1/2018 River Hosp CDM LIPASE SERUM 83690 $70.60 10/1/2018 River Hosp CDM GATIFLOXAN 200MG BAG $70.75 10/1/2018 River Hosp CDM ANAEROBE ID 87076 $70.90 10/1/2018 River Hosp CDM LUMBAR TRAY ADULT $71.00 10/1/2018 River Hosp CDM HEPATITIS B VACCINE (CHILD) 90744 $71.05 10/1/2018 River Hosp CDM 5X76 BLUE CANULA BOX OF 10 $71.20 10/1/2018 River Hosp CDM MICROSMOOTH CIROTIP PARTS KIT $71.35 10/1/2018 River Hosp CDM FINGER SPLINT APPLICATION 29130 $71.45 10/1/2018 River Hosp CDM FINGER SPLINT APPLICATION' 29130 $71.45 10/1/2018 River Hosp CDM PED AMBU BAG $71.55 10/1/2018 River Hosp CDM COMPARISON VIEWS $71.70 10/1/2018 River Hosp CDM 302 SURG GR& MICRO TECH 88302 $71.70 10/1/2018 River Hosp CDM NASAL PACK ANTER/POST 7.5 $71.75 10/1/2018 River Hosp CDM RAPID RHINO 750-7.5MM $71.75 10/1/2018 River Hosp CDM PAP/BREAST EXAM (MC ONLY) G0101 $71.94 10/1/2018 River Hosp CDM INTERACTIVE GRP PSYCHOTH PHP 90853 $71.94 10/1/2018 River Hosp CDM INTERACTIVE GRP PSYCHOTH RCWP 90853 $71.94 10/1/2018

River Hosp CDM SPLINT PREFAB WRIST/ANKLE $72.00 10/1/2018 River Hosp CDM LACTOFERRIN;FECAL;QUAL 83630 $72.00 10/1/2018 River Hosp CDM MOLECULAR DIAG;AMPLIFIC, TA $72.00 10/1/2018 River Hosp CDM THER INJ 96372 $72.00 10/1/2018 River Hosp CDM NORBUPRENORPHINE 80348 $72.15 10/1/2018 River Hosp CDM MORPHINE - ASSAY OF OPIATES 80361 $72.15 10/1/2018 River Hosp CDM LATANOPROST %0.005% BTL $72.50 10/1/2018 River Hosp CDM AMINO ACIDS: SINGLE,QUANT EA 82131 $72.55 10/1/2018 River Hosp CDM CETACAINE SPRAY 56G $72.70 10/1/2018 River Hosp CDM MICROINTRODUCER SHEATH SET 7cm $72.80 10/1/2018 River Hosp CDM FINE NEEDLE ASPIRATION $73.00 10/1/2018 River Hosp CDM CALCIUM HYDROXIDE DENTAL PASTE $73.00 10/1/2018 River Hosp CDM ARTHROSCOPY TUBING $73.20 10/1/2018 River Hosp CDM LMA SUPREME SIZE 5 $73.50 10/1/2018 River Hosp CDM ASO 86063 $73.55 10/1/2018 River Hosp CDM DTAP (CHILD) < 7 YEARS OLD 90700 $73.60 10/1/2018 River Hosp CDM AIRWAY SET UP PED $73.60 10/1/2018 River Hosp CDM LUGOL'S STRONG IODINE 5% $73.65 10/1/2018 River Hosp CDM THERAPEUTIC EXERCISE 97110 $73.70 10/1/2018 River Hosp CDM PLUME PEN SMOKE EVAC. ELECSURG $73.75 10/1/2018 River Hosp CDM 8X72 THREADEDCANNULA GRN BOX10 $74.00 10/1/2018 River Hosp CDM CASTING SUPPLIES,SHORT LEG $74.10 10/1/2018 River Hosp CDM ENTEOVIRUS 86658 $74.10 10/1/2018 River Hosp CDM ENTEOVIRUS COXSACKIE-ADDTL 86658 $74.10 10/1/2018 River Hosp CDM ENTEOIRUS COXSACKIE-ADDTL 86658 $74.10 10/1/2018 River Hosp CDM ENTEOVIRUS COXSACKIE-ADDTL 86658 $74.10 10/1/2018 River Hosp CDM CATHETERIZATION, SIMPLE $74.70 10/1/2018 River Hosp CDM IRRIGATOR KIT CNE/TB $75.00 10/1/2018 River Hosp CDM SUTURE, ETHILON 10-0 7707G $75.00 10/1/2018 River Hosp CDM MICRO INDROTUCER SHEATH 7 FR $75.00 10/1/2018 River Hosp CDM ELECTROLYTES PANEL 80051 $75.00 10/1/2018 River Hosp CDM TEAM CONF FTF PT/FAM 30M NONPH 99366 $75.00 10/1/2018 River Hosp CDM TEAM CONF FTF PT/FAM 30M NONPH 99366 $75.00 10/1/2018 River Hosp CDM ASSAY OF ACETIMINOPHEN 82003 $75.30 10/1/2018 River Hosp CDM TENS 64550 $75.50 10/1/2018 River Hosp CDM IV INITIATION $75.60 10/1/2018 River Hosp CDM NEEDLE BIOPSY $75.60 10/1/2018 River Hosp CDM MYRINGOTOMY T-TUBE $75.60 10/1/2018 River Hosp CDM FLOWTRON SLEEVE LARGE SIZE $76.10 10/1/2018 River Hosp CDM RECOVERY ROOM 31-60 MINUTES $76.15 10/1/2018 River Hosp CDM MOXIFLOXACN BSS INTRV 0.1mg/ML $76.15 10/1/2018 River Hosp CDM FECAL ELASTASE 82656 $76.15 10/1/2018 River Hosp CDM OTHER HOURS ADD ON CODE 99050 $76.15 10/1/2018 River Hosp CDM ALBUMIN 5%-250ML $76.25 10/1/2018 River Hosp CDM ALBUMIN 25%-50ML $76.25 10/1/2018 River Hosp CDM TUBING GRAVITY 2/SET $76.30 10/1/2018 River Hosp CDM GARDNERELLA DIRECT PROBE 87510 $76.35 10/1/2018

River Hosp CDM TRICHOMONAS VAGINALIS DIR PRB 87660 $76.35 10/1/2018 River Hosp CDM CANDIDA SP. DIRECT PROBE 87480 $76.35 10/1/2018 River Hosp CDM BUPRENORPHINE 80348 $76.50 10/1/2018 River Hosp CDM ELECTRIC STIM,CONSTANT ATTEND 97032 $76.80 10/1/2018 River Hosp CDM URINE CULTURE W/CC 87086 $77.10 10/1/2018 River Hosp CDM EXC NAILPLAT P OR C ADD'L(GEN) 11732 $77.25 10/1/2018 River Hosp CDM AFTER HOURS CODE 99051 $77.25 10/1/2018 River Hosp CDM ECG 12 LEAD INTERPR(PROF) CLN2 93010 $77.40 10/1/2018 River Hosp CDM ERYTHROMY W/SULFISOC SUS150ml $77.65 10/1/2018 River Hosp CDM ATROPINE OPTHALMIC 1% 2ml $78.00 10/1/2018 River Hosp CDM ATROPINE 1% 2ml OPHTHALMIC CHR $78.00 10/1/2018 River Hosp CDM DEBRIDE SKIN PART THICK (SWG) $78.05 10/1/2018 River Hosp CDM ECG 3 LEAD W/ INTER 93040 $78.05 10/1/2018 River Hosp CDM PELVIC EXAM ER, SIMPLE $78.05 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 3 PHP 99213 $78.05 10/1/2018 River Hosp CDM TELEPHONE ASSESSMENT 11-20 MIN 98967 $78.25 10/1/2018 River Hosp CDM APPT AFTER HOURS 99051 $78.45 10/1/2018 River Hosp CDM APPT AFTER HOURS CPSY 99051 $78.45 10/1/2018 River Hosp CDM CEFUROXIMEINTRAVTRL10mg1mlVIAL $78.70 10/1/2018 River Hosp CDM LITHIUM 80178 $78.70 10/1/2018 River Hosp CDM INFLUENZA A AG DIRECT 87804 $78.85 10/1/2018 River Hosp CDM ZUMI-UTERINE MANIPULATOR $78.95 10/1/2018 River Hosp CDM MAGNESIUM 83735 $79.05 10/1/2018 River Hosp CDM HAND PACK CARPAL TUNNEL $79.10 10/1/2018 River Hosp CDM DIAZEPAM 5MG/1 ML 10ML VIAL $79.25 10/1/2018 River Hosp CDM MECHANICAL TRACTION 97012 $79.30 10/1/2018 River Hosp CDM ANOSCOPY, DIAGNOSTIC $79.40 10/1/2018 River Hosp CDM PHP CARE MGMT SVC 20 MIN 99484 $79.75 10/1/2018 River Hosp CDM RCWP CARE MGMT SVC 20 MIN 99484 $79.75 10/1/2018 River Hosp CDM C-REACTIVE PROTEIN QUANT 86140 $79.95 10/1/2018 River Hosp CDM LINEAR RELOAD 60mm TR60B $80.00 10/1/2018 River Hosp CDM HEMOGLOBIN ELECTROPHORESIS 83020 $80.05 10/1/2018 River Hosp CDM SICKLE CELL SC 83020 $80.05 10/1/2018 River Hosp CDM APRACLONIDINE 17.5ml $80.10 10/1/2018 River Hosp CDM APRACLONIDNE 1% 5ml BTL $80.10 10/1/2018 River Hosp CDM HANDSWITCH SUCTION COAGULATOR $80.40 10/1/2018 River Hosp CDM ENDOCOAT SYRINGE $80.45 10/1/2018 River Hosp CDM CHRONIC CARE MANAGEMENT 99490 $80.50 10/1/2018 River Hosp CDM O/V LVL1 NEW PT FAC CLN2 99201 $80.60 10/1/2018 River Hosp CDM ECHO VIRUS ANTIBODY 86790 $80.65 10/1/2018 River Hosp CDM OFFICE VISIT LVL1 (NEW PT) 99201 $81.05 10/1/2018 River Hosp CDM CLINIC EXAM - MAMMO GRANT $81.05 10/1/2018 River Hosp CDM OSTEOPATHIC MANIPULATION 98925 $81.05 10/1/2018 River Hosp CDM NEW PT FAC LEVEL 1 RCWP 99201 $81.05 10/1/2018 River Hosp CDM ALBUTEROL/IPRATRO INH 14.7G $81.10 10/1/2018 River Hosp CDM CONSULTATION LEVEL ONE (PC) 99241 $81.50 10/1/2018 River Hosp CDM PAIM MGMT CONSULT LEVEL 1 99241 $81.50 10/1/2018

River Hosp CDM CBC W/AUTO DIF INDIC 85025 $81.65 10/1/2018 River Hosp CDM BIOPSY LESION, EA ADD'L (GEN) 11101 $81.90 10/1/2018 River Hosp CDM CATHERIZATION,SIMPLE ER $81.95 10/1/2018 River Hosp CDM ECG 3 LEAD TRACING ONLY 93041 $82.05 10/1/2018 River Hosp CDM CO2 INLINE TUBING SET $82.05 10/1/2018 River Hosp CDM THIPURINE METHLYTRANSFERASE 80373 $82.25 10/1/2018 River Hosp CDM CERUMEN REMOVAL BY PHYS (ENT) 69210 $82.35 10/1/2018 River Hosp CDM CERUM REMOVAL BY PHYS - CLN2 69210 $82.35 10/1/2018 River Hosp CDM ROTAVIRUS DET 87425 $82.40 10/1/2018 River Hosp CDM ECG 3 LEAD W/O INTER 93041 $82.70 10/1/2018 River Hosp CDM HEIMLICK CHEST DRAIN TUBE $82.75 10/1/2018 River Hosp CDM EXCEL STABILITY SLEEVE 11MM $82.85 10/1/2018 River Hosp CDM NG TUBE 10 FR 99070 $82.95 10/1/2018 River Hosp CDM NG TUBE 14 FR $82.95 10/1/2018 River Hosp CDM NG TUBE 18 FR $82.95 10/1/2018 River Hosp CDM 60 cc SYRINGE FOR DILATION $83.20 10/1/2018 River Hosp CDM PHACO PACK $83.20 10/1/2018 River Hosp CDM CHLORIDE, OTHER SOURCE 82438 $83.20 10/1/2018 River Hosp CDM REMOV IMPACTED CERUMEN $83.25 10/1/2018 River Hosp CDM PHP SBIRT 99408 $83.30 10/1/2018 River Hosp CDM VITRASE 1.2ML (HYALURONIDASE) $83.60 10/1/2018 River Hosp CDM MED SER 10PM-8AM 24HR FAC 1 UN 99053 $83.65 10/1/2018 River Hosp CDM SPEC ANESTH SERVICE 1 UNIT 99100 $83.65 10/1/2018 River Hosp CDM KCI VAC GRANUFOAM MED DRESSING $83.80 10/1/2018 River Hosp CDM HEPATITIS B SURFACE ANTIGEN 87340 $83.95 10/1/2018 River Hosp CDM FINGER 29130 $84.05 10/1/2018 River Hosp CDM VANCO 250 CAPS $84.05 10/1/2018 River Hosp CDM PATHOLOGY REVIEW OF SLIDE 85060 $84.05 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 2 PHP 99202 $84.05 10/1/2018 River Hosp CDM PNEUMO NEEDLE 120MM $84.30 10/1/2018 River Hosp CDM AIRWAY SETUP ADULT $84.35 10/1/2018 River Hosp CDM SCRN DIG MAMMO BILAT/ADD ON 77063 $84.40 10/1/2018 River Hosp CDM PODUS BOOT LINER $84.60 10/1/2018 River Hosp CDM MEGACE SUSPENSION 240ML BTL $84.60 10/1/2018 River Hosp CDM ALCONCLEARCUT SD PORTKNF 1.0MM $84.75 10/1/2018 River Hosp CDM IV INFUS/SEQUENT INIT 1HR OBS 96367 $84.80 10/1/2018 River Hosp CDM PULSE OXIMETRY EXTENDED ER 94761 $84.80 10/1/2018 River Hosp CDM IV INFUS/SEQUENT INIT TO 1HR 96367 $84.80 10/1/2018 River Hosp CDM IV INFUS/SEQENTIAL INIT TO 1HR 96367 $84.80 10/1/2018 River Hosp CDM PULSE OX W/ EXERCISE 94761 $84.80 10/1/2018 River Hosp CDM TISSUE CULTURE 87070 $84.80 10/1/2018 River Hosp CDM CATHETER TIP CULTURE 87070 $84.80 10/1/2018 River Hosp CDM SPUTUM CULTURE 87070 $84.80 10/1/2018 River Hosp CDM AEROBIC CULTURE 87070 $84.80 10/1/2018 River Hosp CDM EAR CULTURE 87070 $84.80 10/1/2018 River Hosp CDM EYE CULTURE 87070 $84.80 10/1/2018 River Hosp CDM NASOPHARYNGEAL CULTURE 87070 $84.80 10/1/2018

River Hosp CDM GENITAL CULTURE 87070 $84.80 10/1/2018 River Hosp CDM WOUND CULTURE 87070 $84.80 10/1/2018 River Hosp CDM BODY FLUIDS CULTURE 87070 $84.80 10/1/2018 River Hosp CDM PERTUSSIS CULTURE 87070 $84.80 10/1/2018 River Hosp CDM FLOW CYTOMETRY EA CELL SURFACE 88182 $84.80 10/1/2018 River Hosp CDM OBTAIN/PREP/CONVEY PAP TO LAB $85.00 10/1/2018 River Hosp CDM ALA 82135 $85.20 10/1/2018 River Hosp CDM DIAMOX IV $85.55 10/1/2018 River Hosp CDM RUBELLA ANTIBODIES ISG 86762 $85.60 10/1/2018 River Hosp CDM OFFICE VISIT LVL2 (ESTAB PT) 99212 $85.90 10/1/2018 River Hosp CDM O/V LVL2 ESTAB FAC CLN2 99212 $85.90 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 2 RCWP 99212 $85.90 10/1/2018 River Hosp CDM OVA AND PARASITES 87177 $85.90 10/1/2018 River Hosp CDM UR MICRO ALBUMIN, QNT 82043 $86.10 10/1/2018 River Hosp CDM UR MICRO ALBUMIN, QNT APG 82043 $86.10 10/1/2018 River Hosp CDM PHENTOLAMINE INJ 5mg $86.45 10/1/2018 River Hosp CDM PAP SMEAR,SCREENING 88143 $86.45 10/1/2018 River Hosp CDM ADRENALIN CHLOR 1MG $86.60 10/1/2018 River Hosp CDM ULTRA CLIP BREAST DUAL TRIGGER $86.68 10/1/2018 River Hosp CDM REM IMPACTED CERUMEN 69210 $86.70 10/1/2018 River Hosp CDM PULSA VAC WOUND DEBRID DEVICE $86.90 10/1/2018 River Hosp CDM VITRASE 1.2 ML VIAL $86.90 10/1/2018 River Hosp CDM ANTI CCP IGG 86200 $86.95 10/1/2018 River Hosp CDM RA QUANT 86431 $87.20 10/1/2018 River Hosp CDM IV START 36000 $87.30 10/1/2018 River Hosp CDM IV START (OBS) 36000 $87.30 10/1/2018 River Hosp CDM IV START ER 36000 $87.30 10/1/2018 River Hosp CDM IV INITIATION ONLY 36000 $87.30 10/1/2018 River Hosp CDM IV START CLN 36000 $87.30 10/1/2018 River Hosp CDM BASIC METABOLIC PNL 80048 $87.65 10/1/2018 River Hosp CDM CKMB 82553 $87.75 10/1/2018 River Hosp CDM DRAIN SUBUNGUAL HEMATOMA $87.95 10/1/2018 River Hosp CDM FUNGAL CULTURE BLOOD 87103 $88.25 10/1/2018 River Hosp CDM ALC/SUBABUSE SCRN, 15-30 MIN 99408 $88.50 10/1/2018 River Hosp CDM CELERO SECURE SITE MARKER $88.83 10/1/2018 River Hosp CDM PREGNANACY TEST, URINE 84703 $88.90 10/1/2018 River Hosp CDM HCG,QUAL 84703 $88.90 10/1/2018 River Hosp CDM PREGNANCY TEST, URINE CLN2 84703 $88.90 10/1/2018 River Hosp CDM SHAVING EPIDERMAL/DERMAL LES 11300 $88.95 10/1/2018 River Hosp CDM PORT FLUSH 96523 $89.10 10/1/2018 River Hosp CDM PORT FLUSH BY NURSE (OBS) 96523 $89.10 10/1/2018 River Hosp CDM PORT FLUSH BY NURSE 96523 $89.10 10/1/2018 River Hosp CDM APPL FINGER SPLINT 29130 $89.10 10/1/2018 River Hosp CDM CERULOPLASMIN 82390 $89.10 10/1/2018 River Hosp CDM ORTHOTIC MGMT&TRAIN, EA 15 MIN 97760 $89.35 10/1/2018 River Hosp CDM SMALL JOINT: FINGER TOE 20600 $89.50 10/1/2018 River Hosp CDM SMALL JOINT INJ 20600 $89.50 10/1/2018

River Hosp CDM ANAEROBES 87075 $89.50 10/1/2018 River Hosp CDM ONE ANTIGEN EQUIVALENT EACH 81374 $89.81 11/1/2018 River Hosp CDM CAST WINDOWING, BI-VALVE $90.05 10/1/2018 River Hosp CDM EYE EXAM ER W/SLIT LAMP $90.05 10/1/2018 River Hosp CDM WOUND CLOSURE (ADHESIVE) $90.05 10/1/2018 River Hosp CDM UNLISTED ER MINOR PROC(IN ABS) $90.05 10/1/2018 River Hosp CDM UNLISTED EYE SURG PROC MINOR 67399 $90.05 10/1/2018 River Hosp CDM KCI VAC SURPLICE DRESS, SMALL $90.10 10/1/2018 River Hosp CDM TOURNIQUET MAT $90.10 10/1/2018 River Hosp CDM SENSE NERVE CONDUCTION TEST 95904 $90.40 10/1/2018 River Hosp CDM MOTOR NERVE CONDUCTION TEST 95903 $90.40 10/1/2018 River Hosp CDM CARDIAC MONITOR EVENT 93270 $90.40 10/1/2018 River Hosp CDM FOAM REPLACEMENT PAD $90.60 10/1/2018 River Hosp CDM PRED-G $90.90 10/1/2018 River Hosp CDM CULTURE/TYPING DNA OR RNA 87150 $90.95 10/1/2018 River Hosp CDM ENOXAPARIN 80MG $91.35 10/1/2018 River Hosp CDM RSV AG, NOS 87807 $91.80 10/1/2018 River Hosp CDM ECG W INTER/RPT MCR IPPE ONLY $92.00 10/1/2018 River Hosp CDM Tdap (BOOSTRIX) 0.5ml SYRINGE 90715 $92.15 10/1/2018 River Hosp CDM URINE TOX SINGLE DRUG CLASS 80307 $92.20 10/1/2018 River Hosp CDM THOROCENTESIS TRAY $92.35 10/1/2018 River Hosp CDM NG INSERT/GASTRIC LAVAGE 43753 $92.40 10/1/2018 River Hosp CDM CANNULA THREADED CLEARTRAC 7.0 $92.40 10/1/2018 River Hosp CDM URINARY BLADDER U/S VOL+PVR 51798 $92.85 10/1/2018 River Hosp CDM DIG MAMMO UNI/BI DIAG ADD ON $92.85 10/1/2018 River Hosp CDM IGA SUBCLASSES 82784 $93.20 10/1/2018 River Hosp CDM IGA SALIVA 82784 $93.20 10/1/2018 River Hosp CDM IGM SERUM 82784 $93.20 10/1/2018 River Hosp CDM IGA SERUM 82784 $93.20 10/1/2018 River Hosp CDM IGG SERUM 82784 $93.20 10/1/2018 River Hosp CDM IGD SERUM 82784 $93.20 10/1/2018 River Hosp CDM FIBRINOGEN 85384 $93.55 10/1/2018 River Hosp CDM CLARITHR/BIAXIN 250mg/5ml SUSP $93.60 10/1/2018 River Hosp CDM CHEMO ADMIN SUBCUT/INTRAMUS 96402 $93.60 10/1/2018 River Hosp CDM MED JOINT INJ 20605 $93.65 10/1/2018 River Hosp CDM PHOSPATATASE,ACID,PROSTATIC 84066 $93.65 10/1/2018 River Hosp CDM MED JOINT: ANKLE/WRIST/AC 20605 $93.65 10/1/2018 River Hosp CDM HEP A AB TOT 86708 $93.70 10/1/2018 River Hosp CDM CEFTRIAXONE 2gm A/V $93.85 10/1/2018 River Hosp CDM CALIF. CERVICAL COLLAR XLG $93.95 10/1/2018 River Hosp CDM AQUACEL AG 8X12 $94.25 10/1/2018 River Hosp CDM EYE PACK $94.30 10/1/2018 River Hosp CDM INTRAOSSEOUS NEEDLE $94.55 10/1/2018 River Hosp CDM ALK PHOS ISOENZYME 84080 $94.55 10/1/2018 River Hosp CDM IPV VACCINE (CHILD) 90713 $94.65 10/1/2018 River Hosp CDM LEAD SCREENING 83655 $94.85 10/1/2018 River Hosp CDM CALCULUS RENAL 82360 $94.85 10/1/2018

River Hosp CDM LEAD 83655 $94.85 10/1/2018 River Hosp CDM CULTURE & SENSITIVITY SITE 87184 $94.90 10/1/2018 River Hosp CDM ZONISAMIDE LEVEL 82542 $94.95 10/1/2018 River Hosp CDM DUALWAVE OUTFLOW TUBING SET $95.10 10/1/2018 River Hosp CDM MANIPULATION 97140 $95.45 10/1/2018 River Hosp CDM TRIGGER POINT INJ 1 OR 2 20552 $95.55 10/1/2018 River Hosp CDM TRIGGER POINT INJ 1 OR 2 20552 $95.55 10/1/2018 River Hosp CDM O/T EVAL 97168 $95.75 10/1/2018 River Hosp CDM PHONE E/M PHYS/QHP 21-30 MIN 99443 $95.85 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 4 PHP 99214 $96.00 10/1/2018 River Hosp CDM TRACH TUBE 3, 3.5, 4 $96.15 10/1/2018 River Hosp CDM TRACH TUBE PED ALL SIZES $96.15 10/1/2018 River Hosp CDM ISOPTO HEMATROPINE 5% $96.30 10/1/2018 River Hosp CDM RENAL FUNCTION PNL 80069 $96.35 10/1/2018 River Hosp CDM RECOVERY ROOM 61-90 MINUTES $96.45 10/1/2018 River Hosp CDM ACAPELA DH S8185 $96.60 10/1/2018 River Hosp CDM PORT FLUSH (GEN) 96523 $96.80 10/1/2018 River Hosp CDM TELEPHONE E&M BY PHY 21-30 MIN 99443 $96.90 10/1/2018 River Hosp CDM ORBITAL IMPLANT #14 SILICONE $97.05 10/1/2018 River Hosp CDM ORBITAL IMPLANT #16 SILICONE $97.05 10/1/2018 River Hosp CDM ORBITAL IMPLANT #18 SILICONE $97.05 10/1/2018 River Hosp CDM CREAT CLEAR 82575 $97.35 10/1/2018 River Hosp CDM CEFDINIR 250mg/5ml 60ml BOTTLE $97.55 10/1/2018 River Hosp CDM PRIMAXIN 500 MG IV $97.85 10/1/2018 River Hosp CDM SPECIAL STAIN GROUP 1 88312 $98.05 10/1/2018 River Hosp CDM FAT OR LIPIDS QUAL FECES 82705 $98.15 10/1/2018 River Hosp CDM SHORT ARM SPLINT APPLICATION' 29125 $98.25 10/1/2018 River Hosp CDM AUGMENTIN 125MG/5ML PO $98.30 10/1/2018 River Hosp CDM FIB DEG PRO 85362 $98.35 10/1/2018 River Hosp CDM ALTERNATING PRESSURE PAD $98.55 10/1/2018 River Hosp CDM TENDON SHEATH/LIGAMENT CYST 20550 $98.90 10/1/2018 River Hosp CDM INJECT SINGLE TENDON 20550 $98.90 10/1/2018 River Hosp CDM Tendon Shealth/Ligament Cyst 20550 $98.90 10/1/2018 River Hosp CDM TOTAL T CELLS 86359 $98.90 10/1/2018 River Hosp CDM ASU PUMP TUBING $99.00 10/1/2018 River Hosp CDM HEAVY METAL,QUAN. 83015 $99.00 10/1/2018 River Hosp CDM INTAOSSEOUS NEEDLE 18 GA $99.15 10/1/2018 River Hosp CDM BICILLIN L-A $99.60 10/1/2018 River Hosp CDM DEOXYCORTISOL 11 82634 $99.65 10/1/2018 River Hosp CDM BILE ACIDS, TOTAL 82239 $99.65 10/1/2018 River Hosp CDM BASIC II EYE PACKS $99.70 10/1/2018 River Hosp CDM PHILIP HEARTSTART SMART PADSII $99.75 10/1/2018 River Hosp CDM NICOTINE SER 80323 $99.85 10/1/2018 River Hosp CDM HEPATIC FUNCTION PNL 80076 $100.00 10/1/2018 River Hosp CDM CEFACLOR/ 250mg/5ml 75mL $100.15 10/1/2018 River Hosp CDM TOBRAMYCIN/DEXAMETHASONE SUSP $100.40 10/1/2018 River Hosp CDM PERFORMANCE TEST OR EVAL 15MIN 97750 $100.50 10/1/2018

River Hosp CDM POTASSIUM CHLOR SOD 20MEQ BAG $100.75 10/1/2018 River Hosp CDM SHOULDER 1 VIEW 73020 $100.80 10/1/2018 River Hosp CDM FACTOR X 85260 $101.15 10/1/2018 River Hosp CDM SUTURE 1731G CHROMIC $101.35 10/1/2018 River Hosp CDM FACTOR V ACTIVITY 85220 $101.50 10/1/2018 River Hosp CDM FACTOR V INHIBITOR 85335 $101.50 10/1/2018 River Hosp CDM CLIENT HOURLY PSYCH CHARGE $101.50 10/1/2018 River Hosp CDM EDTA 3% MIXTURE 10ML BOTTLE $102.05 10/1/2018 River Hosp CDM SCS REPROGRAMMING 95971 $102.15 10/1/2018 River Hosp CDM SCS REPROGRAMMING 95971 $102.15 10/1/2018 River Hosp CDM LEVAQUIN 500MG BAG $102.30 10/1/2018 River Hosp CDM ANOSCOPY,DIAG INCLUDE COLLECT 46600 $102.30 10/1/2018 River Hosp CDM RHINO, BILATERAL 5CM $102.40 10/1/2018 River Hosp CDM C1 Q 86160 $102.40 10/1/2018 River Hosp CDM C2 86160 $102.40 10/1/2018 River Hosp CDM COMPLEMENT C3 86160 $102.40 10/1/2018 River Hosp CDM COMPLEMENT C4 86160 $102.40 10/1/2018 River Hosp CDM COMPLEMENT C1 ESTERASE INHIB 86160 $102.40 10/1/2018 River Hosp CDM PRESOURCE UNIV. BLOCK TRAY $102.75 10/1/2018 River Hosp CDM COLOSTOMY BAGS $103.10 10/1/2018 River Hosp CDM ER CLINIC LEVEL FACILITY 99281 $103.20 10/1/2018 River Hosp CDM TRIAGE - FACILITY 99281 $103.20 10/1/2018 River Hosp CDM 17-KETOGENIC 83586 $103.40 10/1/2018 River Hosp CDM HEPATITIS B CORE AB 86704 $103.50 10/1/2018 River Hosp CDM ACUJECT VARIABLE INJECTION 23G $103.55 10/1/2018 River Hosp CDM BLOOD CULTURE 87040 $103.55 10/1/2018 River Hosp CDM MIN SURG BIPOLAR CABLE $103.70 10/1/2018 River Hosp CDM NASAL/OROGASTRIC WITH TUBE PLA 43752 $103.75 10/1/2018 River Hosp CDM REMOVE SUTURE W/ANESTHESIA 15850 $103.75 10/1/2018 River Hosp CDM ABS TIP 30 ROUND 0.9mm $103.80 10/1/2018 River Hosp CDM VAP/LIPOPROTEIN SUBFRACT 83701 $104.10 10/1/2018 River Hosp CDM GC,DNA PB 87590 $104.25 10/1/2018 River Hosp CDM Phytonadione Oral Dilution Kit $104.45 10/1/2018 River Hosp CDM KYDEX-PRO BOOT INSERT ORTHOSIS $104.55 10/1/2018 River Hosp CDM FLONASE 110MCG 13GM AER/AD $104.60 10/1/2018 River Hosp CDM SURGICAL PATHOLOGY LEVEL III 88304 $104.65 10/1/2018 River Hosp CDM GANGLION CYST INJECTION 20612 $104.70 10/1/2018 River Hosp CDM GANGLION CYST INJECTION 20612 $104.70 10/1/2018 River Hosp CDM ATERIAL PUNCTURE 36600 $105.04 10/1/2018 River Hosp CDM CATHERIZATION, SIMPLE OBS 51701 $105.04 10/1/2018 River Hosp CDM FOLLEY CATH 51702 $105.04 10/1/2018 River Hosp CDM NEB TX CONTINUOUS 94644 $105.04 10/1/2018 River Hosp CDM ARTERIAL PUNCTURE 36600 $105.04 10/1/2018 River Hosp CDM CATHERIZATION, SIMPLE ER 51701 $105.04 10/1/2018 River Hosp CDM SUBUNGAL HEMATOMA 11740 $105.04 10/1/2018 River Hosp CDM CATH SIMPLE FOLEY 51702 $105.04 10/1/2018 River Hosp CDM EVACUATION SUBUNGUAL HEMATOMA 11740 $105.04 10/1/2018

River Hosp CDM ARTERIAL PUNCTURE DRAW BLOOD 36600 $105.04 10/1/2018 River Hosp CDM INS NON-DWELLING BLADDER CATH 51701 $105.04 10/1/2018 River Hosp CDM INS TEMP INDWELL BLADDER CATH 51702 $105.04 10/1/2018 River Hosp CDM PHLEBOTOMY THERAPEUTIC 99195 $105.04 10/1/2018 River Hosp CDM BLOOD COLL EST CENT/PERIF CATH 36592 $105.04 10/1/2018 River Hosp CDM FOLEY CATH 51702 $105.04 10/1/2018 River Hosp CDM ARTERIAL BLOOD PUNCTURE 36600 $105.04 10/1/2018 River Hosp CDM CHEST PHYSIO (SUBSQ) 94668 $105.04 10/1/2018 River Hosp CDM NEB TX CONTINUOUS-INIT HOUR 94644 $105.04 10/1/2018 River Hosp CDM CHEST PHYSIO INITIAL 94667 $105.04 10/1/2018 River Hosp CDM PULM STRESS TEST - 6 MIN WALK 94618 $105.04 10/1/2018 River Hosp CDM ABO 86900 $105.04 10/1/2018 River Hosp CDM PLEBOTOMY THERAPEUTIC CLN 99195 $105.04 10/1/2018 River Hosp CDM DIABETIC EYE EXAM 92250 $105.04 10/1/2018 River Hosp CDM FUNDUS PHOTO W/INTER & RPT 92250 $105.04 10/1/2018 River Hosp CDM IOL MULTIFOCAL ASCAN 92136 $105.04 10/1/2018 River Hosp CDM INSERTION TEMP INDWELLING BLAD 51702 $105.04 10/1/2018 River Hosp CDM NON-INDWELLING BLADDER CATH 51701 $105.04 10/1/2018 River Hosp CDM BLOOD COLL VENOUS ACCESS DEVIC 36591 $105.04 10/1/2018 River Hosp CDM MUPIROCIN 2% OINT 15G $105.10 10/1/2018 River Hosp CDM KCI VAC SURPLICE DRES,SMALL $105.40 10/1/2018 River Hosp CDM LMA KIT 3,4,5 $105.45 10/1/2018 River Hosp CDM WEST NILE VIRUS IGM 86788 $105.60 10/1/2018 River Hosp CDM WEST NILE VIRUS IGG 86789 $105.60 10/1/2018 River Hosp CDM HERNIA/BREAST PACK $105.95 10/1/2018 River Hosp CDM TRANSFERRIN 84466 $105.95 10/1/2018 River Hosp CDM PAP SMEAR, DIAGNOSTIC 88142 $106.00 10/1/2018 River Hosp CDM INITIAL/SUBSQ PCCM ADDL 30MIN 99494 $106.20 10/1/2018 River Hosp CDM INITIAL/SUBSQ PCCM ADDL 30MIN 99494 $106.20 10/1/2018 River Hosp CDM COMBITUBE 37FR $106.60 10/1/2018 River Hosp CDM LIGAMENT INJ: ORG/INS 20551 $106.90 10/1/2018 River Hosp CDM Ligament Inject/ Org/Ins. 20551 $106.90 10/1/2018 River Hosp CDM INJECT TENDON ORIGIN/INSERT 20551 $106.95 10/1/2018 River Hosp CDM OSTOMY SUPPLIES (FLANGE) $107.50 10/1/2018 River Hosp CDM CLONIDINE HCL 0.3MG/24HR/PATCH $107.55 10/1/2018 River Hosp CDM ZIKA VIRUS, URINE 87798 $107.60 10/1/2018 River Hosp CDM ZIKA VIRUS, BLOOD 87798 $107.60 10/1/2018 River Hosp CDM VITAMIN B5 84591 $107.70 10/1/2018 River Hosp CDM IV INJ/PUSH/ADD'L SAME DRUG CN 96376 $107.70 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 3 PHP 99203 $108.05 10/1/2018 River Hosp CDM GAD-65AB 83519 $108.20 10/1/2018 River Hosp CDM ECG 12 LEAD (TECH) 93005 $108.25 10/1/2018 River Hosp CDM ECG 12 LEAD (TECH) -CLINIC 93005 $108.25 10/1/2018 River Hosp CDM T3UPTAKE 84479 $108.25 10/1/2018 River Hosp CDM ECG 12 LEAD (TECH) CLN2 93005 $108.25 10/1/2018 River Hosp CDM IGE 82785 $108.40 10/1/2018 River Hosp CDM EMERGENCY DELIVERY KIT $108.45 10/1/2018

River Hosp CDM HEP B SURF AB 86706 $108.50 10/1/2018 River Hosp CDM TRIGGER POINT INJ 3+ 20553 $108.65 10/1/2018 River Hosp CDM TRIGGER POINT INJ 3+ 20553 $108.65 10/1/2018 River Hosp CDM HEEL PROTECTOR $108.70 10/1/2018 River Hosp CDM S/M SMOKE EVACUATION TUBING $109.05 10/1/2018 River Hosp CDM NCS NOVOLIN R 100UNIT/1ML VIAL $109.05 10/1/2018 River Hosp CDM IV INFUS/MEDS ADD'S HRS (OBS) 96366 $109.10 10/1/2018 River Hosp CDM IV INFUS/MEDS ADD'L HRS 96366 $109.10 10/1/2018 River Hosp CDM IV INFUS/MEDS ADD'L HRS 96366 $109.10 10/1/2018 River Hosp CDM IV INFUS/MEDS ADD'L HRS CLN 96366 $109.10 10/1/2018 River Hosp CDM CHLAMYDIA TRACH DNA PROBE 87490 $109.15 10/1/2018 River Hosp CDM HSP70 ANTIBODY 84181 $109.20 10/1/2018 River Hosp CDM 5 HIAA URINE 83497 $109.20 10/1/2018 River Hosp CDM CALCITONIN 200ml SPRAY $109.40 10/1/2018 River Hosp CDM CLINIC EXAM - MAMMO GRANT $109.40 10/1/2018 River Hosp CDM CRP CARDIAC 86141 $109.75 10/1/2018 River Hosp CDM LINEAR CUTTER RELOAD TCR55 $109.85 10/1/2018 River Hosp CDM CERUMEN REMOVAL UNILATERAL 69210 $110.00 10/1/2018 River Hosp CDM PRELUDE SHORT SHEATH INTRODUCR $110.05 10/1/2018 River Hosp CDM DERMABOND PEN $110.35 10/1/2018 River Hosp CDM ACYCLOVIR 15gm TUBE $110.40 10/1/2018 River Hosp CDM CORTISPORIN OPHTHOINT3.5gmTUBE $110.85 10/1/2018 River Hosp CDM ADACELL 1 DOSE PER VIAL $111.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL3 (ESTAB PT) 99213 $111.65 10/1/2018 River Hosp CDM MENINGOCOCCAL VACCINE 90733 $111.65 10/1/2018 River Hosp CDM O/V LVL3 ESTAB FAC CLN2 99213 $111.65 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 3 RCWP 99213 $111.65 10/1/2018 River Hosp CDM WRIST SPLINT METAL ER $111.80 10/1/2018 River Hosp CDM SHOULDER SUSP KIT BOX OF 12 $111.80 10/1/2018 River Hosp CDM LIPID PANEL 80061 $111.95 10/1/2018 River Hosp CDM LIPID PANEL APG 80061 $111.95 10/1/2018 River Hosp CDM 9011G $112.35 10/1/2018 River Hosp CDM MENINGOCOCCAL MCV4 90734 $113.00 10/1/2018 River Hosp CDM ZOLL ELECTRODE PAD $113.10 10/1/2018 River Hosp CDM INFUS IMMUNOGLBLN-PREADMINISTR $113.20 10/1/2018 River Hosp CDM INFUS IMMUNOGLBLN-PREADMINISTR $113.20 10/1/2018 River Hosp CDM INFUS IMMUNOGLBLN-PREADMINISTR $113.20 10/1/2018 River Hosp CDM DEHYGRATED ALCOLOH PER VIAL $113.20 10/1/2018 River Hosp CDM DIRECT LDL 83721 $113.20 10/1/2018 River Hosp CDM IV INFUS/HYDRATION ADD'L HR(S) 96361 $113.30 10/1/2018 River Hosp CDM IV INFUS/HYDRAT ADD'L HRS OBS 96361 $113.30 10/1/2018 River Hosp CDM IV INFUS/HYDRATION ADD'L HRS 96361 $113.30 10/1/2018 River Hosp CDM LONE STAR DIAP RETRACTOR RING $113.45 10/1/2018 River Hosp CDM TELEMEDICINE ENCOUNTER SPOKE $113.95 10/1/2018 River Hosp CDM ENEMA ER $114.00 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 5 PHP 99215 $114.00 10/1/2018 River Hosp CDM TREPONEMA PALLIDUM AB 86780 $114.00 10/1/2018

River Hosp CDM PICC LINE TRAY $114.07 10/1/2018 River Hosp CDM OTHER PERIPHERAL NERVE BLOCK 64450 $114.10 10/1/2018 River Hosp CDM OTHER PERIPHERAL NERVE BLK 64450 $114.10 10/1/2018 River Hosp CDM INSULIN, FREE 83527 $114.15 10/1/2018 River Hosp CDM PYRUVATE 84210 $114.15 10/1/2018 River Hosp CDM MMR VACCINE 90707 $114.15 10/1/2018 River Hosp CDM BROSLOW INTRAOSSEUS MODULE $114.20 10/1/2018 River Hosp CDM GASTROINTEST ENDOSCO 00740 $114.45 10/1/2018 River Hosp CDM CHEST SPECIAL VIEWS 71048 $114.46 10/1/2018 River Hosp CDM HIP UNILATERAL MINIMUM 4 VIEWS 73503 $114.46 10/1/2018 River Hosp CDM HIPS BILATERAL 3-4 VIEWS 73522 $114.46 10/1/2018 River Hosp CDM POTASSIUM CL NA 40MEQ BAG $114.50 10/1/2018 River Hosp CDM CIPROFLOXCN 400mg 40ml VIAL $114.65 10/1/2018 River Hosp CDM ACID PHOSPHATASE 84060 $114.70 10/1/2018 River Hosp CDM COLD HEMAGGLUTINS 86157 $114.70 10/1/2018 River Hosp CDM OBTAIN/PREP/CONVEY PAP TO LAB $114.75 10/1/2018 River Hosp CDM CEFTRIAXONE 500mg $114.90 10/1/2018 River Hosp CDM PLATLET CONCENTRATE P9019 $114.95 10/1/2018 River Hosp CDM GASTRIN, SERUM 82941 $114.95 10/1/2018 River Hosp CDM COMVAX: HEPB,HIB VACCINE 90748 $115.20 10/1/2018 River Hosp CDM LIPOPROTEIN ELECTOPH 83700 $115.40 10/1/2018 River Hosp CDM GASTROSCOPY BIOPSY FORCEPS $115.75 10/1/2018 River Hosp CDM VITRECTOMY SLEEVE $115.75 10/1/2018 River Hosp CDM HEP A IGM AB 86709 $115.75 10/1/2018 River Hosp CDM EMTRICITABINE 200 mg/300 mg $116.05 10/1/2018 River Hosp CDM NEOMYCIN/POLYM/HC DROPS $116.55 10/1/2018 River Hosp CDM DNA,DS 86225 $116.55 10/1/2018 River Hosp CDM KNEE PACK $116.80 10/1/2018 River Hosp CDM ATHLETIC TRAINING EVALUATION 97169 $117.60 10/1/2018 River Hosp CDM PTT SUBSTITUTION PLASMA 85732 $117.60 10/1/2018 River Hosp CDM INSULIN 83525 $117.60 10/1/2018 River Hosp CDM ARROW THERCAT EPIURAL CATHETER $117.75 10/1/2018 River Hosp CDM HEMOGLOBIN A1C 83036 $117.85 10/1/2018 River Hosp CDM HEMOGLOBIN A1C APG 83036 $117.85 10/1/2018 River Hosp CDM RESTING HAND SPLINT RIGHT LARG $117.90 10/1/2018 River Hosp CDM AMPLIFIED NUCLEIC ACID 83900 $118.05 10/1/2018 River Hosp CDM CYTO PLEURAL FL 88104 $118.10 10/1/2018 River Hosp CDM AMMONIA 82140 $118.20 10/1/2018 River Hosp CDM TELEPHONE ASSESSMENT 21-30 MIN 98968 $118.20 10/1/2018 River Hosp CDM EYE PACK EWINGCHOW $118.25 10/1/2018 River Hosp CDM ALBUTEROL 17GM INH J7618 $118.30 10/1/2018 River Hosp CDM ENDOPATH BLUNT TP 5mm DISSECTR $118.55 10/1/2018 River Hosp CDM NEXTERONE 150/100ml $118.60 10/1/2018 River Hosp CDM 3D RENDERING ON INDEP WORK ST 76377 $118.60 10/1/2018 River Hosp CDM DRAIN SUBUNGUAL HEMATOMA CLN 11740 $118.70 10/1/2018 River Hosp CDM FB EAR REMOVAL $118.75 10/1/2018 River Hosp CDM LACTIC ACID 83605 $118.90 10/1/2018

River Hosp CDM FLUMAZENTIL 0.1MG/ML VIAL $119.05 10/1/2018 River Hosp CDM ENDOMETRIAL SAMPLING 58110 $119.20 10/1/2018 River Hosp CDM BICILLIN CR SYRINGE $119.25 10/1/2018 River Hosp CDM CIPROFLOXACIN 400mg 200ml BAG $119.25 10/1/2018 River Hosp CDM QUICKCLOT ZFOLD HEM,DRESSING $119.45 10/1/2018 River Hosp CDM KCI 300ML CANISTER $119.70 10/1/2018 River Hosp CDM PERCUTAN ENTRY TRAY $119.75 10/1/2018 River Hosp CDM PLERO VAC CHEST DRAIN $119.80 10/1/2018 River Hosp CDM CHANGE OF GASTROSTOMY TUBE ER $119.95 10/1/2018 River Hosp CDM CRAWFORD STENT INTUBATION $119.95 10/1/2018 River Hosp CDM REUTER BOBBINS,TITANIUM $119.95 10/1/2018 River Hosp CDM TROMNOJECT 3% VIAL $119.95 10/1/2018 River Hosp CDM LEPTOSPIRAL AB 86720 $119.95 10/1/2018 River Hosp CDM TRICHINELLA AB 86784 $119.95 10/1/2018 River Hosp CDM OXCARBAZEPINE (TRILEPTAL) 80183 $119.95 10/1/2018 River Hosp CDM OFFICE VISIT LVL2 (NEW PT) 99202 $120.30 10/1/2018 River Hosp CDM PORT FLUSH 96523 $120.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL2 NEW PT FAC 99202 $120.30 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 2 RCWP 99202 $120.30 10/1/2018 River Hosp CDM DLCO (W/INTERPRETATION) 94729 $120.50 10/1/2018 River Hosp CDM IV INFUS/HYDRATION ADD'L HR(S) 96361 $120.70 10/1/2018 River Hosp CDM KCI VAC GRANUFOAM MED DRESSING $120.70 10/1/2018 River Hosp CDM C-ANCA 86256 $120.85 10/1/2018 River Hosp CDM P-ANCA 86256 $120.85 10/1/2018 River Hosp CDM MMR VACCINE (CHILD) 90707 $121.00 10/1/2018 River Hosp CDM TOXOPLASMA AB 86777 $121.00 10/1/2018 River Hosp CDM INSULIN-LIKE GROWTH FACTOR BP1 83520 $121.10 10/1/2018 River Hosp CDM IGFBP-3 83519 $121.15 10/1/2018 River Hosp CDM NUTRITIONAL COUNSELING GROUP 97804 $121.20 10/1/2018 River Hosp CDM DILATION CERVICAL CANAL INSTRU 57800 $121.20 10/1/2018 River Hosp CDM HERPES SIMPLEX VIRUS 1-2 PCR 87529 $121.30 10/1/2018 River Hosp CDM CONSULTATION LVL1 (NEW/EST PT) 99241 $121.55 10/1/2018 River Hosp CDM SALICYLATE 80329 $121.60 10/1/2018 River Hosp CDM PHENOBARBITAL 80184 $121.60 10/1/2018 River Hosp CDM ZINC PLASMA 84630 $121.60 10/1/2018 River Hosp CDM CARBOXYHEMO 82375 $121.60 10/1/2018 River Hosp CDM INFLUENZA B,RAPID 87804 $121.60 10/1/2018 River Hosp CDM HEPATITIS B VACCINE (ADULT) 90746 $121.65 10/1/2018 River Hosp CDM HEP B VACCINE 90746 $121.65 10/1/2018 River Hosp CDM GIARDIA L AG 87329 $121.65 10/1/2018 River Hosp CDM ALPHA SUB PITUITARY TM 83520 $121.80 10/1/2018 River Hosp CDM PHLEBOTOMY, THERAPEUTIC 99195 $122.00 10/1/2018 River Hosp CDM PHLEBOTOMY, THERAPEUTIC 99195 $122.00 10/1/2018 River Hosp CDM HERPES SIMP ELISA TYPE I 86695 $122.15 10/1/2018 River Hosp CDM INPT CONSULT LEVEL ONE 99251 $122.45 10/1/2018 River Hosp CDM VENOFER INJ 100MG/5ML VIAL $122.45 10/1/2018 River Hosp CDM COLONOSCOPY BIOPSY FORCEPS $122.70 10/1/2018

River Hosp CDM PROTOPORPH TOTAL RBC 84202 $122.90 10/1/2018 River Hosp CDM BIOPSY OF SKIN, SNGL LSN (GEN) 11100 $122.90 10/1/2018 River Hosp CDM IG6 SUBCLASSES 82787 $123.40 10/1/2018 River Hosp CDM REM FB EYE CONJ SUPR 65205 $123.60 10/1/2018 River Hosp CDM VENT MGMT NF PER DAY 94004 $123.65 10/1/2018 River Hosp CDM PNEUMOCOCCAL VACCINE (ADULT) 90732 $123.70 10/1/2018 River Hosp CDM HEPATITIS E IgM 86790 $123.75 10/1/2018 River Hosp CDM HEPATITIS E IgG 86790 $123.75 10/1/2018 River Hosp CDM MIOCHOL-E $123.90 10/1/2018 River Hosp CDM APPL SHORT ARM SPLINT 29125 $124.25 10/1/2018 River Hosp CDM SHORT ARM FOREARM TO HAND 29125 $124.25 10/1/2018 River Hosp CDM IV INFUS/SEQUENT INIT TO 1HR 96367 $124.30 10/1/2018 River Hosp CDM SEQ INFUS/INITIAL UP TO 1HR C 96367 $124.30 10/1/2018 River Hosp CDM ETHI PNEUMONEEDLE 120 mm $124.35 10/1/2018 River Hosp CDM ALCON CLEAR CUT SLIT KNIFE $124.35 10/1/2018 River Hosp CDM PORT FLUSH 96523 $124.45 10/1/2018 River Hosp CDM LONG LEG SPLINT APPLICATION 29505 $124.55 10/1/2018 River Hosp CDM SHORT LEG JOINT APPLICATION 29515 $124.70 10/1/2018 River Hosp CDM ALK PHOS LEUKOCYTE 85540 $124.75 10/1/2018 River Hosp CDM ALCON STANDARD EYE PAK $125.10 10/1/2018 River Hosp CDM VARICES INJECTOR $125.35 10/1/2018 River Hosp CDM EPSTEIN BARR VIRUS, CAPSID VCA 86665 $125.85 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 2 NEW (PC) 99202 $125.90 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 2 NEW (PC) 99202 $125.90 10/1/2018 River Hosp CDM O/V LVL 2 NEW CARDIO PC 99202 $125.90 10/1/2018 River Hosp CDM OFFICE VST LVL 2 NEW PC (GYN) 99202 $125.90 10/1/2018 River Hosp CDM OFFICE VISIT LVL 2 NEW PC OPTH 99202 $125.90 10/1/2018 River Hosp CDM OFFICE VISIT LVL 2 NEW ORTHO 99202 $125.90 10/1/2018 River Hosp CDM OFFICE VST LVL 2 NEW PC (ENT) 99202 $125.90 10/1/2018 River Hosp CDM OFFICE VST LVL 2 NEW PC (GEN) 99202 $125.90 10/1/2018 River Hosp CDM O/V LEVEL 2 NEW PC CLN2 99202 $125.90 10/1/2018 River Hosp CDM DR OFF VISIT LVL2 NEW PC CLN2 99202 $125.90 10/1/2018 River Hosp CDM UNIVERSAL SET UP TRAY $125.95 10/1/2018 River Hosp CDM VENOFER INJ 200MG/10ML VIAL $126.00 10/1/2018 River Hosp CDM MAJOR JOINT OR BURSA INJ ER $126.05 10/1/2018 River Hosp CDM ANTI SOLUBLE LIVER ANTIGEN $126.05 10/1/2018 River Hosp CDM CARBAMAZEPINE 10,11 $126.05 10/1/2018 River Hosp CDM STOOL CULTURE 87045 $126.45 10/1/2018 River Hosp CDM IMMUNOFIX,URINE 86335 $126.50 10/1/2018 River Hosp CDM STENTUBE LACRIMAL INTUBATION $126.90 10/1/2018 River Hosp CDM OFFICE VISIT LVL 3 ESTAB PC 99213 $127.20 10/1/2018 River Hosp CDM AMIODARONE HCL 150mg/.3ml INJ $127.20 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 3 EST (PC) 99213 $127.20 10/1/2018 River Hosp CDM O/V LVL 3 EST CARDIO PC 99213 $127.20 10/1/2018 River Hosp CDM OFFICE VST LVL 3 EST PC (GYN) 99213 $127.20 10/1/2018 River Hosp CDM OFFICE VISIT LVL 3 EST PC OPTH 99213 $127.20 10/1/2018 River Hosp CDM OFFICE VISIT 3 EST PC (ORTHO) 99213 $127.20 10/1/2018

River Hosp CDM OFFICE VST LVL 3 EST PC (ENT) 99213 $127.20 10/1/2018 River Hosp CDM OFFICE VISIT LVL 3 EST PC(GEN) 99213 $127.20 10/1/2018 River Hosp CDM O/V LVL 3 ESTAB PC CLN2 99213 $127.20 10/1/2018 River Hosp CDM DR OFF VISIT LVL 3 EST PC CLN2 99213 $127.20 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 3 PC 99213 $127.20 10/1/2018 River Hosp CDM PHP LEVEL 3 PC 99213 $127.20 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 3 PC RCWP 99213 $127.20 10/1/2018 River Hosp CDM TELE ESTAB PAT LVL 3 PC RCWP 99213 $127.20 10/1/2018 River Hosp CDM TELE EST PAT LEVEL 3 PC CPSY 99213 $127.20 10/1/2018 River Hosp CDM NUTRITIONAL COUNSELING RE-ASMT 97803 $127.20 10/1/2018 River Hosp CDM PTH INTACT 83970 $127.80 10/1/2018 River Hosp CDM CAROTENE 82380 $128.45 10/1/2018 River Hosp CDM PARACENTESIS/THORA TRAY $128.60 10/1/2018 River Hosp CDM ANAPLASMA PHAGOCYTOPHILUM 87798 $128.60 10/1/2018 River Hosp CDM TRIHIBIT: DTAP,HIB VACCINE 90723 $128.65 10/1/2018 River Hosp CDM CROSSMATCH 86921 $129.18 10/1/2018 River Hosp CDM INCUBATION 86921 $129.18 10/1/2018 River Hosp CDM AGT PHASE 86922 $129.18 10/1/2018 River Hosp CDM BLOOD COMPATABILITY (AHG) 86922 $129.18 10/1/2018 River Hosp CDM INDIRECT COOMBS 86885 $129.18 10/1/2018 River Hosp CDM RECHECK, X-MATCH 86922 $129.18 10/1/2018 River Hosp CDM TOE 73660 $129.25 10/1/2018 River Hosp CDM O/V LVL4 ESTAB FAC CLN2 99214 $129.60 10/1/2018 River Hosp CDM BOPOLAR CABLE SINGLE USE $129.65 10/1/2018 River Hosp CDM INSERT CATHETER ARTERY 36620 $129.90 10/1/2018 River Hosp CDM G6PD 82955 $129.90 10/1/2018 River Hosp CDM STREP A DNA AMP PROBE 87651 $130.25 10/1/2018 River Hosp CDM RSV DETECT AGENT NOS DNA AMP 87798 $130.25 10/1/2018 River Hosp CDM ANOSCOPY, DIAG W/WO COLLECTION 46600 $130.50 10/1/2018 River Hosp CDM REM FOREIGN BODY EXT EYE;CORN 65222 $130.55 10/1/2018 River Hosp CDM 30 MIN PHYSCHOTHERAPY RCWP 90833 $130.70 10/1/2018 River Hosp CDM NEXTERONE 360mg/200 ml $130.80 10/1/2018 River Hosp CDM FREE T4 84439 $130.85 10/1/2018 River Hosp CDM DILANTIN LEVEL 80185 $130.90 10/1/2018 River Hosp CDM CORTISOL, TOTAL SERUM 82533 $130.90 10/1/2018 River Hosp CDM BABESIA, IGG 86753 $131.05 10/1/2018 River Hosp CDM FINGER 73140 $131.15 10/1/2018 River Hosp CDM INJ DIAG/THERAPEUTIC 2ND LEVEL 64494 $131.20 10/1/2018 River Hosp CDM THEOPHYLLINE 80198 $131.30 10/1/2018 River Hosp CDM EP EXCEL BLADELESS TROCAR 8MM $131.45 10/1/2018 River Hosp CDM SURGICAL PATHOLOGY LEVEL IV 88305 $132.00 10/1/2018 River Hosp CDM TRILEPTAL LEVEL 80342 $132.05 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 4 PHP 99204 $132.05 10/1/2018 River Hosp CDM AMIKACIN 80150 $132.05 10/1/2018 River Hosp CDM IMIPRAMINE SERUM 80335 $132.35 10/1/2018 River Hosp CDM DOXEPIN, SERUM 80335 $132.35 10/1/2018 River Hosp CDM LIDOCAINE 80176 $132.35 10/1/2018

River Hosp CDM NORTRIPTYLINE 80335 $132.35 10/1/2018 River Hosp CDM GASTROSTOMY TUBE -MAGNAPORT $132.90 10/1/2018 River Hosp CDM ALPHA 1 ANTI P 82104 $132.95 10/1/2018 River Hosp CDM SHOULDER ARTHRO INJ PROC 23350 $133.40 10/1/2018 River Hosp CDM DEXAMETHASONE 82542 $133.55 10/1/2018 River Hosp CDM KETONE PANEL, URINE 82542 $133.55 10/1/2018 River Hosp CDM EBV AB NUCLEAR AG 86664 $133.60 10/1/2018 River Hosp CDM EPSTEIN BARR VIRUS, EARLY ANTI 86663 $133.60 10/1/2018 River Hosp CDM ALBUTEROL INHALER 200PUFFS/INH $133.65 10/1/2018 River Hosp CDM 1 HOUR ER TREATMT RM $133.80 10/1/2018 River Hosp CDM IMMUNOFIXATION, SERUM 86334 $134.00 10/1/2018 River Hosp CDM COPPER, SER 82525 $134.10 10/1/2018 River Hosp CDM INSERTION INTRAUTERINE DEVICE 58300 $134.30 10/1/2018 River Hosp CDM BLADDER IRRIGATION ER $134.35 10/1/2018 River Hosp CDM SOFT TISSUE BUTTOCK 76499 $134.35 10/1/2018 River Hosp CDM BONE DENSITY (LVA) 77086 $134.40 10/1/2018 River Hosp CDM ANTI BETA2 GLYCOPROTEIN 86146 $134.50 10/1/2018 River Hosp CDM BETA 2 GLYCOPROTEIN AB 86146 $134.50 10/1/2018 River Hosp CDM BETA 2 GLYCOPROTEIN AB 86146 $134.50 10/1/2018 River Hosp CDM BETA 2 GLYCOPROTEIN 86146 $134.50 10/1/2018 River Hosp CDM ABS TIPS30 DEG FLARED $134.70 10/1/2018 River Hosp CDM HIV SCREEN 86703 $134.85 10/1/2018 River Hosp CDM RUSSELL VIPER VENOM DILUTED 85613 $135.20 10/1/2018 River Hosp CDM SHORT LEG CALF TO FOOT RM 29515 $135.42 10/1/2018 River Hosp CDM LONG LEG THIGH TO ANKLE 29505 $135.42 10/1/2018 River Hosp CDM WINDOW CAST 29730 $135.42 10/1/2018 River Hosp CDM APPL LONG LEG SPLINT 29505 $135.42 10/1/2018 River Hosp CDM P/T RE-EVAL 97164 $135.65 10/1/2018 River Hosp CDM NASAL CLOSED/OPEN 21310 $135.70 10/1/2018 River Hosp CDM HEEL BONE DENSITY 77083 $135.70 10/1/2018 River Hosp CDM HEP C ANTIBODY 86803 $135.75 10/1/2018 River Hosp CDM NCS COLOSTOMY BAG SUR-FIT BX $135.95 10/1/2018 River Hosp CDM HEP BE AB 86707 $136.15 10/1/2018 River Hosp CDM PORPHOBILINOGEN, 24 HR URINE 84110 $136.30 10/1/2018 River Hosp CDM ANGIOTEN-1-CON 82164 $136.30 10/1/2018 River Hosp CDM VITAL CAPACITY SCREENING 94150 $136.32 10/1/2018 River Hosp CDM SPIROMETRY 94010 $136.32 10/1/2018 River Hosp CDM TYMPAN & REFLEX THR MSMT CLN2 92550 $136.32 10/1/2018 River Hosp CDM MISC RESPIRATORY PROCEDURE 94799 $136.32 10/1/2018 River Hosp CDM AZTREONAM 2GM $136.60 10/1/2018 River Hosp CDM P/T INITIAL EVAL 97161 $136.65 10/1/2018 River Hosp CDM IGF-1 84305 $136.75 10/1/2018 River Hosp CDM MANGANESE 83785 $136.75 10/1/2018 River Hosp CDM Hgb FRACTIONATION,CHROMATOGRAP 83021 $136.75 10/1/2018 River Hosp CDM MOLECULAR PATHOLOGY LEVEL 2 81401 $137.00 11/1/2018 River Hosp CDM OFFICE VISIT LVL4 (ESTAB PT) 99214 $137.40 10/1/2018 River Hosp CDM WELL VISIT EST 65+YRS 99397 $137.40 10/1/2018

River Hosp CDM DR WELL VISIT EST 65+ YEARS 99397 $137.40 10/1/2018 River Hosp CDM WELL VISIT EST 65+ YRS (GYN) 99397 $137.40 10/1/2018 River Hosp CDM WELL VISIT EST 65+YRS (CLN2) 99397 $137.40 10/1/2018 River Hosp CDM DR WELL VISIT EST +65 YRS CLN2 99397 $137.40 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 4 RCWP 99214 $137.40 10/1/2018 River Hosp CDM HOME VISIT 15MIN 99347 $137.70 10/1/2018 River Hosp CDM EACH ADDITIONAL LESION 11101 $137.80 10/1/2018 River Hosp CDM ECG ROUTINE MCR IPPE ONLY $137.80 10/1/2018 River Hosp CDM ECG TRACING ONLY MCR IPPE ONLY $137.80 10/1/2018 River Hosp CDM DIGOXIN 80162 $137.90 10/1/2018 River Hosp CDM FB EYE REMOVAL $138.00 10/1/2018 River Hosp CDM SIROLIMUS 80195 $138.15 10/1/2018 River Hosp CDM RAPAMYCIN 80195 $138.15 10/1/2018 River Hosp CDM PAP/BREAST EXAM (MC ONLY) $138.15 10/1/2018 River Hosp CDM VMA URINE 84585 $138.65 10/1/2018 River Hosp CDM APRACLONIDINE 0.5% 5ml OPTHSOL $138.90 10/1/2018 River Hosp CDM CUSTOM EYE PACK PLASTICS $139.00 10/1/2018 River Hosp CDM 5' NUCLEOTIDASE 83915 $139.20 10/1/2018 River Hosp CDM ENA AB'S 86235 $139.25 10/1/2018 River Hosp CDM ANTI SCLERODERMA-70 ABS 86235 $139.25 10/1/2018 River Hosp CDM ANA 86038 $139.35 10/1/2018 River Hosp CDM ULTRASOUND UNILATERAL LIMITED 76642 $139.80 10/1/2018 River Hosp CDM AMITRIPTYLINE 80335 $139.95 10/1/2018 River Hosp CDM ALBUMIN 5% 250 ML $140.15 10/1/2018 River Hosp CDM DEBRIDEMENT EA ADDL 20 SQ CM 11046 $140.20 10/1/2018 River Hosp CDM EXCALIBUR 3.8mm $140.20 10/1/2018 River Hosp CDM EXCALIBUR 4.0mm $140.20 10/1/2018 River Hosp CDM FREE CARBAMAZEPINE 80157 $140.30 10/1/2018 River Hosp CDM ALCOHOL,SERUM 80320 $140.30 10/1/2018 River Hosp CDM PRIMIDONE 80188 $140.30 10/1/2018 River Hosp CDM GENTAMICIN 80170 $140.30 10/1/2018 River Hosp CDM CEA 82378 $140.40 10/1/2018 River Hosp CDM OXALATE 83945 $140.40 10/1/2018 River Hosp CDM OSTOMY BOX $140.50 10/1/2018 River Hosp CDM PTOSIS SLING SET $140.75 10/1/2018 River Hosp CDM COMBITUBE 41FR $140.90 10/1/2018 River Hosp CDM RAD EXAM KNEE 1/2 VIEWS 73560 $140.95 10/1/2018 River Hosp CDM PEANUT DISSECTOR $141.55 10/1/2018 River Hosp CDM VITAMIN B2 84252 $141.55 10/1/2018 River Hosp CDM HYD-CORTST-24 HR UR 83491 $141.60 10/1/2018 River Hosp CDM TSH HIGH SENSITIVITY 84443 $141.70 10/1/2018 River Hosp CDM TSH HIGH SENSITIVITY APG 84443 $141.70 10/1/2018 River Hosp CDM HEP B CORE AB IGM 86705 $141.75 10/1/2018 River Hosp CDM PROT ELEC SR 84165 $141.85 10/1/2018 River Hosp CDM TRIAMCINOLONE DENTAL 0.1% OINT $142.05 10/1/2018 River Hosp CDM RECOVERY ROOM 91-120 MINUTES $142.10 10/1/2018 River Hosp CDM MULLERIAN INHIBITORY SUBSTANCE 82397 $142.10 10/1/2018

River Hosp CDM CALCIUM IONIZED 82330 $142.15 10/1/2018 River Hosp CDM MOLECULAR DIAGNOST: MOLEC ISOL 81241 $142.20 10/1/2018 River Hosp CDM SELLA TURCICA 70240 $142.40 10/1/2018 River Hosp CDM SOFT TISSUE NECK 70360 $142.40 10/1/2018 River Hosp CDM BONE AGE STUDIES 77072 $142.40 10/1/2018 River Hosp CDM SINUSES LIMITED 70210 $142.40 10/1/2018 River Hosp CDM NCS ACCUZYME OINTMENT TUBE $142.50 10/1/2018 River Hosp CDM ADENOVIRUS AG/DFA 86603 $142.50 10/1/2018 River Hosp CDM SIGMOIDOSCOPY,FLEXIBLE DX 45330 $142.65 10/1/2018 River Hosp CDM STERNUM 71120 $142.75 10/1/2018 River Hosp CDM PROPOXYPHENE(DARVOCET) 125 $142.85 10/1/2018 River Hosp CDM PAROXETINE (PAXIL) 80375 $142.85 10/1/2018 River Hosp CDM ACETAZOLAMIDE LEVEL 80375 $142.85 10/1/2018 River Hosp CDM LYME IGM WB 86617 $143.20 10/1/2018 River Hosp CDM PROVISC 0.55 ML $143.60 10/1/2018 River Hosp CDM PROCAINAMIDE with Metabolites 80192 $143.65 10/1/2018 River Hosp CDM V ZOST IGG 86787 $143.80 10/1/2018 River Hosp CDM CARPEL TUNNEL INJ 20526 $143.85 10/1/2018 River Hosp CDM CARPEL TUNNEL INJECTION 20526 $143.85 10/1/2018 River Hosp CDM BURN 1ST DEGREE $144.00 10/1/2018 River Hosp CDM CYTOLOGY, LIQUID BASE 88112 $144.10 10/1/2018 River Hosp CDM EP EXCEL BLADELESS TROCAR 11MM $144.30 10/1/2018 River Hosp CDM HCG QUANTITATIVE 84702 $144.30 10/1/2018 River Hosp CDM FEMUR I VIEW 73551 $144.60 10/1/2018 River Hosp CDM BURR 5.5x 180mm ABLATOR ASU $144.65 10/1/2018 River Hosp CDM CULTURE, M PNEUMO 87109 $144.85 10/1/2018 River Hosp CDM VITAMIN B12 SR 82607 $144.90 10/1/2018 River Hosp CDM INJ PENICILIN BENZATHINE J0561 $144.95 10/1/2018 River Hosp CDM MOLECULAR PROBE 88271 $145.00 10/1/2018 River Hosp CDM ANTI RETICULIN AB 86255 $145.35 10/1/2018 River Hosp CDM ANTI CENTROMERE AB 86255 $145.35 10/1/2018 River Hosp CDM ANTI MYELIN AB 86255 $145.35 10/1/2018 River Hosp CDM NMO AB 86255 $145.35 10/1/2018 River Hosp CDM STRIATIONAL ABS 86255 $145.35 10/1/2018 River Hosp CDM PSA DIAGNOSTIC 84153 $145.50 10/1/2018 River Hosp CDM PSA SCREENING G0103 $145.50 10/1/2018 River Hosp CDM ACID FAST SUSC 87190 $145.50 10/1/2018 River Hosp CDM MASTOIDS MIN 3V 70130 $145.55 10/1/2018 River Hosp CDM SHOULDER PACK $145.65 10/1/2018 River Hosp CDM MYOGLOBIN 83874 $145.90 10/1/2018 River Hosp CDM ANESTHESIA-MAC SUPPLIES $146.30 10/1/2018 River Hosp CDM PTOSE_UP 2MM $146.55 10/1/2018 River Hosp CDM INFLATION DEVICE 10CC $146.55 10/1/2018 River Hosp CDM CHEST ULTRASOUND BEDSIDE 76604 $146.75 10/1/2018 River Hosp CDM URINE PROTEIN ELECTROPHORESIS 84166 $146.80 10/1/2018 River Hosp CDM HAPTOGLOBIN 83010 $146.95 10/1/2018 River Hosp CDM FLOURIDE VARNISH APPLICATION 99188 $147.10 10/1/2018

River Hosp CDM 4.5INCISR+ELITE CRVD BOX/6KNEE $147.20 10/1/2018 River Hosp CDM MICRHOGAM 50 MCG $147.30 10/1/2018 River Hosp CDM GC URINE BY AMP. 87591 $147.30 10/1/2018 River Hosp CDM HUMAN GROWTH HORMONE 83003 $147.45 10/1/2018 River Hosp CDM TOBRAMYCIN 80200 $147.45 10/1/2018 River Hosp CDM STERNOCLAV JTS 71130 $147.75 10/1/2018 River Hosp CDM 4.5INCISR+ELITE STRT BOX/6 SHL $147.95 10/1/2018 River Hosp CDM HIB VACCINE 4 DOSE SCHEDULE 90648 $148.20 10/1/2018 River Hosp CDM FERRITIN 82728 $148.40 10/1/2018 River Hosp CDM T CELLS TOT CNT 86359 $148.50 10/1/2018 River Hosp CDM EVACUATION SUBUNGUAL HEMATOMA 11740 $148.50 10/1/2018 River Hosp CDM ASCORBIC ACID 82180 $148.55 10/1/2018 River Hosp CDM ACTIVATED PROTEIN C RESISTANCE 85307 $148.55 10/1/2018 River Hosp CDM PERIACTIN $148.55 10/1/2018 River Hosp CDM LONG ARM SPLINT APPLICATION 29105 $148.55 10/1/2018 River Hosp CDM APPL LING ARM SPLINT ADULT 29105 $148.55 10/1/2018 River Hosp CDM EP EXCEL BLADELESS TROCAR 12MM $148.70 10/1/2018 River Hosp CDM SKULL LIMITED > 4 VIEWS 70250 $148.70 10/1/2018 River Hosp CDM RISPERDONE 80342 $148.70 10/1/2018 River Hosp CDM GABAPENTIN 80375 $148.70 10/1/2018 River Hosp CDM ARSENIC,BLOOD 82175 $148.80 10/1/2018 River Hosp CDM RHINO, ANT/BILAT 5.5 CM $148.85 10/1/2018 River Hosp CDM SKIN TAG REMOVAL EACH ADDL 10 11201 $149.05 10/1/2018 River Hosp CDM VISION BLUE 0.06% $149.50 10/1/2018 River Hosp CDM ZARONTIN (Ethosuximide) 80168 $149.65 10/1/2018 River Hosp CDM CMV IGG AB, EIA 86644 $149.65 10/1/2018 River Hosp CDM HEP BE AG 87350 $149.80 10/1/2018 River Hosp CDM IND PSYCHOTHERAPY ~20-30MIN 90816 $150.00 10/1/2018 River Hosp CDM CARDIAC MONITORING W/INTERP ER 93040 $150.00 10/1/2018 River Hosp CDM UNLISTED IOL PROCEDURE 66999 $150.00 10/1/2018 River Hosp CDM MUMPS AB IGG, EIA 86735 $150.10 10/1/2018 River Hosp CDM PORPHYRINS,URINE,QUAN & FRAC 84120 $150.10 10/1/2018 River Hosp CDM AFP 82105 $150.25 10/1/2018 River Hosp CDM INHIBIN B 83520 $150.65 10/1/2018 River Hosp CDM DIPTHERIA TOXOID AB 86317 $150.65 10/1/2018 River Hosp CDM FOLIC ACID, RBC 82747 $150.65 10/1/2018 River Hosp CDM T-3 TOTAL 84480 $150.90 10/1/2018 River Hosp CDM CYTOLOGY URINE SMEAR 88108 $150.90 10/1/2018 River Hosp CDM RUBEOLA,AB 86765 $150.95 10/1/2018 River Hosp CDM BIOPLY VULVA OR PERINEUM 1 LSN 56605 $151.15 10/1/2018 River Hosp CDM TREPHINE BLD SGL USE 8.0 $151.35 10/1/2018 River Hosp CDM TREPHINE BLD SGL USE 8.25 $151.35 10/1/2018 River Hosp CDM TREPHONE BLD SGL USE 8.5 $151.35 10/1/2018 River Hosp CDM MYOGLOBIN, URINE 83874 $151.40 10/1/2018 River Hosp CDM VITAMIN D OH (CALCIDEDIOL) 82306 $151.80 10/1/2018 River Hosp CDM PERTUSSIS SM 87265 $151.85 10/1/2018 River Hosp CDM GLAUKOS SINGLE USE PRISM $152.25 10/1/2018

River Hosp CDM OBSERVATION 0-1 HR $152.25 10/1/2018 River Hosp CDM IPRISM CLIP VIEW STABILIZER $152.25 10/1/2018 River Hosp CDM CARBOHYDRTE DEFICIENT TRANSFRN 82373 $152.25 10/1/2018 River Hosp CDM GAMMA HYDROXYBUTYRIC ACID 80307 $152.25 10/1/2018 River Hosp CDM ZNT8 ANTIBODIES 86341 $152.25 10/1/2018 River Hosp CDM LIPOPROTEIN A2 83698 $152.40 10/1/2018 River Hosp CDM SPLINT TIB/FIB LEG 99070 $152.45 10/1/2018 River Hosp CDM NEURON SPECIFIC ENOLASE 86316 $152.65 10/1/2018 River Hosp CDM CAST REMOVAL $152.80 10/1/2018 River Hosp CDM IV INFUS/HYDRATION ADD'L HRS C 96361 $152.95 10/1/2018 River Hosp CDM FOLIC ACID 82746 $153.00 10/1/2018 River Hosp CDM PULSE OXIMETRY (CONTIN/OVRNT) 94762 $153.25 10/1/2018 River Hosp CDM HIP UNILATERAL 1 VIEW 73501 $153.30 10/1/2018 River Hosp CDM HERP SIM IGG/M 86694 $153.45 10/1/2018 River Hosp CDM CULT, TUBERCLE, AFB PRES ISOL 87116 $153.55 10/1/2018 River Hosp CDM SEX HORMONE BINDING GLOBULIN 84270 $153.55 10/1/2018 River Hosp CDM PESSARY, RING MILTES SIZE 4 $153.60 10/1/2018 River Hosp CDM CA 15-3 AG 86300 $153.60 10/1/2018 River Hosp CDM CA 19-9 AG 86301 $153.60 10/1/2018 River Hosp CDM ULTRASOUND PREGNANT UTERUS BED 76815 $153.65 10/1/2018 River Hosp CDM ANTI LIVER/KIDNEY MICRO AB 86376 $153.85 10/1/2018 River Hosp CDM THY PEROXIDASE ABS 86376 $153.85 10/1/2018 River Hosp CDM OFFICE VISIT LVL5 (ESTAB PT) 99215 $153.90 10/1/2018 River Hosp CDM O/V LVL5 ESTAB FAC CLN2 99215 $153.90 10/1/2018 River Hosp CDM EST PT FACILITY LEVEL 5 RCWP 99215 $153.90 10/1/2018 River Hosp CDM H PAPILLOMA VIRUS 87624 $153.90 10/1/2018 River Hosp CDM ANOSCOPY DIAG W OR W/O COLLECT 46600 $154.10 10/1/2018 River Hosp CDM FOREIGN BODY VIEW, CHILD 76010 $154.20 10/1/2018 River Hosp CDM PELVIS & HIPS CHILD 73502 $154.30 10/1/2018 River Hosp CDM CLAVICLE 73000 $154.30 10/1/2018 River Hosp CDM AC JTS 73050 $154.30 10/1/2018 River Hosp CDM UPPER EXTREMITY INFANT 73092 $154.30 10/1/2018 River Hosp CDM LOWER EXT (INFANT) 73592 $154.30 10/1/2018 River Hosp CDM GLUCAGON 1 MG VIAL $154.30 10/1/2018 River Hosp CDM FIBERWALL MINISCAL NEEDLE 2-0 $154.45 10/1/2018 River Hosp CDM OFFICE VISIT LVL3 (NEW PT) 99203 $154.55 10/1/2018 River Hosp CDM OFFICE VISIT LVL3 NEW PT FAC 99203 $154.55 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 3 RCWP 99203 $154.55 10/1/2018 River Hosp CDM DEBRIDE SKIN, SUBCUT TISSUE 11042 $154.65 10/1/2018 River Hosp CDM VENTILATING TUBE REM W/ANESTHE 69424 $154.75 10/1/2018 River Hosp CDM VENTILATING TUBE REM W/ANESTHE 69424 $154.75 10/1/2018 River Hosp CDM CHLAMYD, AB 86631 $154.90 10/1/2018 River Hosp CDM COMPRESSION STANDARD GARMENT $155.10 10/1/2018 River Hosp CDM COMPASS LUMBAR PUNCTURE $155.20 10/1/2018 River Hosp CDM RN TRANS W-TOWN $155.40 10/1/2018 River Hosp CDM RN TRANS OGDENS $155.40 10/1/2018 River Hosp CDM RN TRANS POTSDAM $155.40 10/1/2018

River Hosp CDM RN TRANS GOUV $155.40 10/1/2018 River Hosp CDM STAT PADZ, PEDIATRIC $155.45 10/1/2018 River Hosp CDM NEO/BACITR/POLYM OINT $155.55 10/1/2018 River Hosp CDM BONE DENS STUDY APPENDICULAR 77081 $156.00 10/1/2018 River Hosp CDM CLOZAPINE (Benzodiazipens) 80346 $156.00 10/1/2018 River Hosp CDM 5.5 ELITE STONECUTTER BURR $156.05 10/1/2018 River Hosp CDM NASAL BONES 70160 $156.05 10/1/2018 River Hosp CDM GREATER OCCIPITAL NERVE BLOCK 64405 $156.05 10/1/2018 River Hosp CDM GREATER OCIPIAL NERVE BLOCK 64405 $156.05 10/1/2018 River Hosp CDM PROVENTIL $156.25 10/1/2018 River Hosp CDM VANCOMYCIN LAB TEST 80202 $156.25 10/1/2018 River Hosp CDM URINE TOXICOLOGY RIVER HOSP 80307 $156.30 10/1/2018 River Hosp CDM TRACH TUBE FEN ALL SIZES $156.60 10/1/2018 River Hosp CDM CEFUROXIME 250 MG/50ml $156.60 10/1/2018 River Hosp CDM SABRETOOTH CURVED 4.0mm $156.85 10/1/2018 River Hosp CDM ALPRAZOLAM (XANAX) 80346 $156.85 10/1/2018 River Hosp CDM FOOT AP & LAT 73620 $156.95 10/1/2018 River Hosp CDM LARYNGOSCOPY 31505 $157.08 10/1/2018 River Hosp CDM FECAL 1 ANTITRYPSIN 82103 $157.45 10/1/2018 River Hosp CDM ALPHA 1 ANTITRIPSIN,TOTAL 82103 $157.45 10/1/2018 River Hosp CDM LAMOTRIGINE 80299 $157.60 10/1/2018 River Hosp CDM TRACHTUBE SIZE 6 FEN UNCUFFED $157.75 10/1/2018 River Hosp CDM DIHYDROTESTOSTERONE 80327 $157.75 10/1/2018 River Hosp CDM CILOXIN DROPS $158.00 10/1/2018 River Hosp CDM THYROGLOBULIN AB,QNT 86800 $158.05 10/1/2018 River Hosp CDM AUDIOMETRY 92552 $158.25 10/1/2018 River Hosp CDM TRACH TUBE LPC ALL SIZES $158.35 10/1/2018 River Hosp CDM Phenytoin,Free 80186 $158.40 10/1/2018 River Hosp CDM VALPROIC ACID FREE 80165 $158.40 10/1/2018 River Hosp CDM SKIN STAPLER SIGNET $158.50 10/1/2018 River Hosp CDM LONG ARM SHOULDER TO HAND 29105 $158.65 10/1/2018 River Hosp CDM KEPPRA DRUG LEVEL 80177 $158.65 10/1/2018 River Hosp CDM PSYCOTH W/PT&ORFAM 45NONP RCWP 90834 $158.65 10/1/2018 River Hosp CDM KEPPRA DRUG LEVEL 80177 $158.65 10/1/2018 River Hosp CDM PSYCOTH W/PT&ORFAM 45NONP CPSY 90834 $158.65 10/1/2018 River Hosp CDM INDIV PSYCH 30MIN PHYS RCWP 90832 $158.70 10/1/2018 River Hosp CDM INDIV PSYCHOTHERAPY 30MIN PHYS 90832 $158.70 10/1/2018 River Hosp CDM INDIV PSYCHOTHERAPY 30MIN NPHY 90832 $158.70 10/1/2018 River Hosp CDM INDIV PSYCH 30MIN PHYS RCWP 90832 $158.70 10/1/2018 River Hosp CDM INDIV PSYCH 30MIN NPHY RCWP 90832 $158.70 10/1/2018 River Hosp CDM INDIV PSYCH 30MIN NPHY CPSY 90832 $158.70 10/1/2018 River Hosp CDM APPL LONG ARM SPLINT 29105 $158.85 10/1/2018 River Hosp CDM MERCURY,QUAN 83825 $159.00 10/1/2018 River Hosp CDM FELBAMATE 80299 $159.35 10/1/2018 River Hosp CDM SERTRALINE TEST 80299 $159.35 10/1/2018 River Hosp CDM BUPROPION TEST 80299 $159.35 10/1/2018 River Hosp CDM IBUPROFEN 80299 $159.35 10/1/2018

River Hosp CDM SEROQUEL LEVEL 80299 $159.35 10/1/2018 River Hosp CDM FLECAINIDE 80299 $159.35 10/1/2018 River Hosp CDM METHOTREXATE 80299 $159.35 10/1/2018 River Hosp CDM LOXAPINE 80299 $159.35 10/1/2018 River Hosp CDM DTAP-IVP 90696 $159.50 10/1/2018 River Hosp CDM AFFIRM TEST 87800 $160.00 10/1/2018 River Hosp CDM BETA-2-MICROGLOBULIN 82232 $160.05 10/1/2018 River Hosp CDM LYME C6 PEPTIDE 86618 $160.20 10/1/2018 River Hosp CDM LYME DIS AB 86618 $160.20 10/1/2018 River Hosp CDM APOLIPOPROTEIN 82172 $160.30 10/1/2018 River Hosp CDM LUTEINIZING HORMONE 83002 $160.35 10/1/2018 River Hosp CDM XCEL DILATING TIP TROCAR 5mm $160.55 10/1/2018 River Hosp CDM PEDIARICKS: DTAP,IPV,HEPB VAC 90723 $160.55 10/1/2018 River Hosp CDM IUD REMOVAL 58301 $160.70 10/1/2018 River Hosp CDM BLOOD GASES ARTERIAL 82803 $160.85 10/1/2018 River Hosp CDM BLOOD GASES VENOUS 82803 $160.85 10/1/2018 River Hosp CDM TOTAL CARBAMAZEPINE 80156 $161.10 10/1/2018 River Hosp CDM CARBAMAZEPINE 10,11 80156 $161.10 10/1/2018 River Hosp CDM IODINE 83789 $161.40 10/1/2018 River Hosp CDM HPV HIGH RISK 87624 $161.40 10/1/2018 River Hosp CDM HPV LOW RISK 87623 $161.40 10/1/2018 River Hosp CDM LIPOPROTEIN A 83695 $161.55 10/1/2018 River Hosp CDM LMA $161.70 10/1/2018 River Hosp CDM SELENIUM BLD 84255 $161.80 10/1/2018 River Hosp CDM WELL VISIT NEW 12-17 YR (GYN) 99384 $161.95 10/1/2018 River Hosp CDM WELL VISIT NEW 65+ YRS (GYN) 99387 $161.95 10/1/2018 River Hosp CDM CMV AB, IGM 86645 $161.95 10/1/2018 River Hosp CDM VIT D 1,25 DIHYDROXY 82652 $162.00 10/1/2018 River Hosp CDM NASAL ENDOSCOPY DIAGNOSTIC 31231 $162.10 10/1/2018 River Hosp CDM C- DIFFICILE TOXIN B 87230 $162.55 10/1/2018 River Hosp CDM CLOSTR DIFFCILE TOXIN A 1 UNIT 87324 $162.80 10/1/2018 River Hosp CDM THYROXINE BINDING GLOBULINE 84442 $162.80 10/1/2018 River Hosp CDM PSYCHOTHERAPY W/MED EVAL&MGMNT90817 $163.20 10/1/2018 River Hosp CDM BOTH KNEES STANDING AP 73565 $163.45 10/1/2018 River Hosp CDM CT GUIDANCE FOR NEEDLE BIOPSY 77012 $163.55 10/1/2018 River Hosp CDM SHV EPI/DERMAL LESION 1.1-2.0 11307 $163.95 10/1/2018 River Hosp CDM WRIST AP& LAT 73100 $164.05 10/1/2018 River Hosp CDM 30 MIN PSYCHOTHERAPY PHP 90833 $164.25 10/1/2018 River Hosp CDM 30 MIN PHYSCHOTHERAPY RCWP 90833 $164.25 10/1/2018 River Hosp CDM H PYLORI AB 86677 $164.25 10/1/2018 River Hosp CDM H PYLORI AB APG 86677 $164.25 10/1/2018 River Hosp CDM WRIST COMP 73110 $164.95 10/1/2018 River Hosp CDM WELL CHILD EST <1YR (FAC+PC) 99391 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 1-4YRS (FAC+PC) 99392 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 5-11YR (FAC+PC) 99393 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 12-17YR(FAC+PC) 99394 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 18-39YR(FAC+PC) 99395 $165.00 11/1/2018

River Hosp CDM WELL VISIT EST 40-64YR(FAC+PC) 99396 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST <1 YEAR 99391 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 1-4 YEARS 99392 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 5-11 YEARS 99393 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 12-17 YEARS 99394 $165.00 11/1/2018 River Hosp CDM DR WELL VISIT EST 40-64 YEARS 99396 $165.00 11/1/2018 River Hosp CDM DR WELL VISIT EST 18-39 YEARS 99395 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 12-17 YRS (GYN) 99394 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 18-39 YRS (GYN) 99395 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 40-64 YR (GYN) 99396 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST <1YR (CLN2) 99391 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 1-4YRS (CLN2) 99392 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 5-11YR (FAC+PC) 99393 $165.00 11/1/2018 River Hosp CDM WELL CHILD EST 12-17YR(CLN2) 99394 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 18-39YR(FAC+PC) 99395 $165.00 11/1/2018 River Hosp CDM WELL VISIT EST 40-64YR(CLN2) 99396 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST <1YR CLN2 99391 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 1-4YRS CLN2 99392 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 5-11YRS CLN2 99393 $165.00 11/1/2018 River Hosp CDM DR WELL CHILD EST 12-17YR CLN2 99394 $165.00 11/1/2018 River Hosp CDM DR WELL VISIT EST 18-39YR CLN2 99395 $165.00 11/1/2018 River Hosp CDM DR WELL VISIT EST 40-64YR CLN2 99396 $165.00 11/1/2018 River Hosp CDM VANCO 250mg $165.10 10/1/2018 River Hosp CDM TOXOPLASMA AB,IGM 86778 $165.10 10/1/2018 River Hosp CDM FB INTRANASAL REMOVAL $165.15 10/1/2018 River Hosp CDM ANTI RNA POLYMERASE 83520 $165.35 10/1/2018 River Hosp CDM FSH, SERUM 83001 $165.35 10/1/2018 River Hosp CDM GLOM. BASE. MEMB. AB 83520 $165.35 10/1/2018 River Hosp CDM GLOM BASE MEMB AB 83520 $165.35 10/1/2018 River Hosp CDM SHORT LEG CALF TO FOOT 29515 $165.70 10/1/2018 River Hosp CDM APPL SHORT LEG SPLINT 29515 $165.70 10/1/2018 River Hosp CDM CEFUROXIME 250MG/50ML $166.00 10/1/2018 River Hosp CDM VALPROIC ACID TOTAL 80164 $166.05 10/1/2018 River Hosp CDM 17 OH PROGESTERONE 83498 $166.35 10/1/2018 River Hosp CDM HOMOCYSTEINE SERUM 83090 $166.50 10/1/2018 River Hosp CDM DESIPRAMINE 80335 $166.85 10/1/2018 River Hosp CDM MUSCLE TEST, 2 LIMBS 95861 $167.05 10/1/2018 River Hosp CDM ALCOHOL/SUBABUSE SCRN, 30+ MIN 99409 $167.35 10/1/2018 River Hosp CDM RECOVERY ROOM 121-150 MINUTES $167.50 10/1/2018 River Hosp CDM COBALT 83018 $167.50 10/1/2018 River Hosp CDM THIAMINE, BL 84425 $167.50 10/1/2018 River Hosp CDM QUINIDINE 80194 $167.60 10/1/2018 River Hosp CDM VENT MGMT INPT SUBSQ DAY 94003 $167.85 10/1/2018 River Hosp CDM BURN RE-CHECK $168.00 10/1/2018 River Hosp CDM INSULIN AB 86337 $168.00 10/1/2018 River Hosp CDM COSYNTROPIN 0.25 MG $168.25 10/1/2018 River Hosp CDM MINI MONOKA IMPLANT $168.35 10/1/2018

River Hosp CDM THYROGLOBULIN QNT 84432 $168.60 10/1/2018 River Hosp CDM NEG PRESS WOUND THER

River Hosp CDM WELL VISIT NEW 18-39YR(FAC+PC) 99385 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW 40-64YR(FAC+PC) 99386 $171.70 10/1/2018 River Hosp CDM WELL NEW PAT VISIT 65+ YRS 99387 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW <1YR 99381 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 1-4 YEARS 99382 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 5-11 YEARS 99383 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 12-17 YEARS 99384 $171.70 10/1/2018 River Hosp CDM DR WELL VISIT NEW 18-39 YEARS 99385 $171.70 10/1/2018 River Hosp CDM DR WELL VISIT NEW 40-64 YEARS 99386 $171.70 10/1/2018 River Hosp CDM DR WELL VISIT NEW 65+ YEARS 99387 $171.70 10/1/2018 River Hosp CDM NUTRITIONAL COUNS RE-ASMT RCC 97803 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW 18-39 YR (GYN) 99385 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW 40-64 YR (GYN) 99386 $171.70 10/1/2018 River Hosp CDM WELL CHILD NEW <1YR (CLN2) 99381 $171.70 10/1/2018 River Hosp CDM WELL CHILD NEW 1-4YRS (CLN2) 99382 $171.70 10/1/2018 River Hosp CDM WELL CHILD NEW 5-11YRS (CLN2) 99383 $171.70 10/1/2018 River Hosp CDM WELL CHILD NEW 12-17YRS (CLN2) 99384 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW 18-39YRS (CLN2) 99385 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW 40-64YRS (CLN2) 99386 $171.70 10/1/2018 River Hosp CDM WELL VISIT NEW +65YRS (CLN2) 99387 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW <1YR (CLN2) 99381 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 1-4YRS CLN2 99382 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 5-11YRS CLN2 99383 $171.70 10/1/2018 River Hosp CDM DR WELL CHILD NEW 12-17YR CLN2 99384 $171.70 10/1/2018 River Hosp CDM DR WELL VISIT NEW 18-39YR CLN2 99385 $171.70 10/1/2018 River Hosp CDM DR WELL VISIT NEW 40-64YR CLN2 99386 $171.70 10/1/2018 River Hosp CDM DR WELL VIST NEW +65YRS CLN2 99387 $171.70 10/1/2018 River Hosp CDM INDIV PSYCHOTH W/MED EVAL-NPHY 90836 $171.95 10/1/2018 River Hosp CDM COMPR METABOLIC PNL 80053 $172.30 10/1/2018 River Hosp CDM COMPLETE PROFILE CPA APG 80053 $172.30 10/1/2018 River Hosp CDM ABS TAPERED MICROTIP 30 ROUND $172.45 10/1/2018 River Hosp CDM CARSON PERINEAL POST PAD $172.55 10/1/2018 River Hosp CDM UNA BOOT STRAPPING LOWER EXTR 29580 $173.70 10/1/2018 River Hosp CDM UNA BOOT STRAPPING LOWER EXTR 29580 $173.70 10/1/2018 River Hosp CDM DESTRUC BNGN LSN UP TO 14 17110 $173.80 10/1/2018 River Hosp CDM PERMETHRIN CREAM 5% $173.85 10/1/2018 River Hosp CDM CAPSULAR TENSION RING 11MM $173.85 10/1/2018 River Hosp CDM CYTOGENETICS INTERPRETATION 88291 $174.05 10/1/2018 River Hosp CDM COLLGEN CROSSLINK 82523 $174.05 10/1/2018 River Hosp CDM VIGAMOX 3ML $174.20 10/1/2018 River Hosp CDM M PNEUM IGG/IGM IFA 86738 $174.20 10/1/2018 River Hosp CDM APPLICATION LOWER LEG SPLINT 29505 $174.25 10/1/2018 River Hosp CDM DANTROLENE 20 MG VIAL $174.60 10/1/2018 River Hosp CDM PROGESTERONE SERUM 84144 $176.30 10/1/2018 River Hosp CDM COMPLEMENT CH50 86162 $176.30 10/1/2018 River Hosp CDM PROLACTIN 84146 $176.30 10/1/2018 River Hosp CDM PLURU-VAS CHEST DRAINAGE $177.10 10/1/2018

River Hosp CDM REMOV FB CORNEA WITH SLITLAMP 65222 $177.20 10/1/2018 River Hosp CDM TIOTROPIUM 18 mcg HANDIHANDLER $177.35 10/1/2018 River Hosp CDM PSA COMPLEXED 84152 $177.65 10/1/2018 River Hosp CDM ERYTHROPOIETIN 82668 $177.65 10/1/2018 River Hosp CDM HTLV I/II 86790 $178.20 10/1/2018 River Hosp CDM CONSULTATION LVL2 (NEW/EST PT) 99242 $178.25 10/1/2018 River Hosp CDM OFFICE VISIT LVL4 (NEW PT) 99204 $178.25 10/1/2018 River Hosp CDM OFFICE VISIT LVL4 NEW PT FAC 99204 $178.25 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 4 RCWP 99204 $178.25 10/1/2018 River Hosp CDM TRACH TUBE CHANGE 31502 $178.50 10/1/2018 River Hosp CDM C-PAP SYSTEM SIZE 5,6 $178.60 10/1/2018 River Hosp CDM OS CALCIS/HEEL 73650 $179.00 10/1/2018 River Hosp CDM INFECT AGENT DETECTION HEP B 87517 $179.05 10/1/2018 River Hosp CDM SPINE THOR AP,LAT,SWIM 72072 $179.40 10/1/2018 River Hosp CDM PILOCARPINE 1% OPTH SOLUTION $179.55 10/1/2018 River Hosp CDM D-DIMER 85379 $179.55 10/1/2018 River Hosp CDM CONTROL NASAL HEMORRHAGE SIMPL 30901 $179.85 10/1/2018 River Hosp CDM SIGMOIDOSCOPY $180.00 10/1/2018 River Hosp CDM NATURAL KILLER CELLS TOT CNT 86357 $180.00 10/1/2018 River Hosp CDM ANTIPANCREATIC ISLET CELLS 86341 $180.00 10/1/2018 River Hosp CDM RETROBULVAR INJECTION 67500 $180.25 10/1/2018 River Hosp CDM C-PEPTIDE, SRM 84681 $180.30 10/1/2018 River Hosp CDM FLUNISOLIDE AER 7G INH $180.40 10/1/2018 River Hosp CDM SURGICAL 4X8 $180.75 10/1/2018 River Hosp CDM HLA-B27 86812 $180.75 10/1/2018 River Hosp CDM CORTICOSTERONE 82528 $180.80 10/1/2018 River Hosp CDM FLUOR GUIDE FOR INJ PROC 77003 $180.90 10/1/2018 River Hosp CDM LYSOZYME 85549 $181.20 10/1/2018 River Hosp CDM ELBOW AP & LAT 73070 $181.35 10/1/2018 River Hosp CDM HERPEVIRUS 6 AB 86790 $181.65 10/1/2018 River Hosp CDM HERPEVIRUS 6 AB 86790 $181.65 10/1/2018 River Hosp CDM VITAMIN A 84590 $181.80 10/1/2018 River Hosp CDM SCIATIC NERVE BLOCK 64445 $182.05 10/1/2018 River Hosp CDM SCIATIC NERVE BLOCK 64445 $182.05 10/1/2018 River Hosp CDM FACIAL BONES MIN 3V 70150 $182.10 10/1/2018 River Hosp CDM SINUSES COMP, MIN 3V 70220 $182.10 10/1/2018 River Hosp CDM SPINE THORACOLUMBAR 72080 $182.10 10/1/2018 River Hosp CDM AMPHETAMIN(S) 82145 $182.35 10/1/2018 River Hosp CDM CDIFF PCR 87493 $182.60 10/1/2018 River Hosp CDM CANDIDA AB 86628 $182.70 10/1/2018 River Hosp CDM REM FOREIGN BODY EXT EYE 65205 $182.85 10/1/2018 River Hosp CDM RENIN PLS RIA 84244 $183.00 10/1/2018 River Hosp CDM TYSABRI AB 83516 $183.15 10/1/2018 River Hosp CDM ANTI PARIETAL CELL AB 83516 $183.15 10/1/2018 River Hosp CDM TTG, IGA 83516 $183.15 10/1/2018 River Hosp CDM ANTI ACTIN ANTIBODY 83516 $183.15 10/1/2018 River Hosp CDM HISTONE AB 83516 $183.15 10/1/2018

River Hosp CDM ANTI SMOOTH MUSCLE 83516 $183.15 10/1/2018 River Hosp CDM ANTI-GLIADIN AB 83516 $183.15 10/1/2018 River Hosp CDM ANTI-MITOCHONDRIAL 83516 $183.15 10/1/2018 River Hosp CDM MYELOPEROXIDASE AB 83516 $183.15 10/1/2018 River Hosp CDM TRANSGLUTAMINASE,TISSUE 83516 $183.15 10/1/2018 River Hosp CDM REMOVAL SKIN TAGS UP TO 15 11200 $183.35 10/1/2018 River Hosp CDM ANKLE AP&LAT 73600 $183.50 10/1/2018 River Hosp CDM SB ADD PERSONAL REQ BI WKLY $183.60 10/1/2018 River Hosp CDM SNF ADD PERSONAL REQ BI WKLY $183.60 10/1/2018 River Hosp CDM COMPRESSION LG CALF GARMENT $183.60 10/1/2018 River Hosp CDM SPLINT, TRACTION DISPOSABLE $183.60 10/1/2018 River Hosp CDM ESTRIOL 82677 $183.60 10/1/2018 River Hosp CDM SIGMOIDOSCOPY,FLEXIBLE DX 45331 $183.90 10/1/2018 River Hosp CDM REPAIR COMPLEX TRUNK EA ADDL 13102 $184.20 10/1/2018 River Hosp CDM BROSELOW IV MOD - RED $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - BLUE $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - WHITE $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - PURPLE $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - YELLOW $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - GREEN $184.50 10/1/2018 River Hosp CDM BROSELOW IV MOD - ORANGE $184.50 10/1/2018 River Hosp CDM CA 27-29 86300 $184.50 10/1/2018 River Hosp CDM FEMUR MINIMUM 2 VIEWS 73552 $184.60 10/1/2018 River Hosp CDM END OF LIFE ADD'L 30 MINUTES 99498 $185.75 10/1/2018 River Hosp CDM AMPHETAMINE CONFIRMATION 80325 $185.95 10/1/2018 River Hosp CDM BARBITURATE CONFIRMATION 80345 $185.95 10/1/2018 River Hosp CDM COCAINE CONFIRMATION 80353 $185.95 10/1/2018 River Hosp CDM MARIJUANA CONFIRMATION 80349 $185.95 10/1/2018 River Hosp CDM METHADONE CONFIRMATION 80358 $185.95 10/1/2018 River Hosp CDM OPIATE CONFIRMATION 80365 $185.95 10/1/2018 River Hosp CDM PHENCYCLIDINE CONFIRMATION 80375 $185.95 10/1/2018 River Hosp CDM PROPOXYPHENE CONFIRMATION 80367 $185.95 10/1/2018 River Hosp CDM CENTRAL LINE / TLC TRAY $186.00 10/1/2018 River Hosp CDM NEB TX SINGLE W/DRUG 94640 $186.37 10/1/2018 River Hosp CDM INHALATION THERAPY 94640 $186.37 10/1/2018 River Hosp CDM NEB TX SINGLE USE 94640 $186.37 10/1/2018 River Hosp CDM PRESSURIZED OR NON AIRWAY OBST 94640 $186.37 10/1/2018 River Hosp CDM BIPAP/CPAP-PER DAY 94660 $186.37 10/1/2018 River Hosp CDM ENT SUCTION PER SESSION 31720 $186.37 10/1/2018 River Hosp CDM PT. TEACH/INSTRUCT MDI 94664 $186.37 10/1/2018 River Hosp CDM NEB TX - EACH 94640 $186.37 10/1/2018 River Hosp CDM DEMO/UTIL AEROSOL GENERATOR 94664 $186.37 10/1/2018 River Hosp CDM DEMO AND/OR EVAL AEROSOL GENER 94664 $186.37 10/1/2018 River Hosp CDM GATIFLOXACIN 0.3% OPTH 5ML $186.40 10/1/2018 River Hosp CDM PHILIPS INFANT/CHILD FRX DEFIB $186.55 10/1/2018 River Hosp CDM INPT CONSULTATION LEVEL TWO 99252 $187.05 10/1/2018 River Hosp CDM DTAP,IPV&HIB COMBO VACCINE 90698 $187.30 10/1/2018

River Hosp CDM I&D ABSCESS SIMPLE(PARONYCHIA) 10060 $187.50 10/1/2018 River Hosp CDM ABDOMINAL PARACENTESIS W/O IMA 49082 $187.55 10/1/2018 River Hosp CDM ULTRASOUND BREAST UNILATERAL 76641 $188.00 10/1/2018 River Hosp CDM CHEST 1 VIEW 71045 $188.10 10/1/2018 River Hosp CDM DISSECTOR CVD/MONOPOLAR CAUTER $188.15 10/1/2018 River Hosp CDM MAXIMUM BREATHING CAPACITY 94200 $188.30 10/1/2018 River Hosp CDM CORTISOL, SALIVA 82530 $188.80 10/1/2018 River Hosp CDM APPLICATION SHORT LEG SPLINT 29515 $188.80 10/1/2018 River Hosp CDM INVANZ INJ $189.05 10/1/2018 River Hosp CDM CLOTTING FACTOR II PRO-SPECFIC 85210 $189.25 10/1/2018 River Hosp CDM BOUSSIGNAC CPAP S/U $189.35 10/1/2018 River Hosp CDM PROTEIN S, FREE 85306 $189.50 10/1/2018 River Hosp CDM AVULSION, SIMPLE 11730 $189.65 10/1/2018 River Hosp CDM PLEURA VAC $189.70 10/1/2018 River Hosp CDM TROCAR ENDOPATH B5XT $189.85 10/1/2018 River Hosp CDM LINEAR STAPLER 60mm TX60B $189.85 10/1/2018 River Hosp CDM RIBS BILAT 3 VIEWS 71110 $190.30 10/1/2018 River Hosp CDM VISCOAT 0.75ml SYR $190.30 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 3 NEW (PC) 99203 $190.40 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 3 NEW (PC) 99203 $190.40 10/1/2018 River Hosp CDM O/V LVL 3 NEW CARDIO PC 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VST LVL 3 NEW PC (GYN) 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VISIT LVL 3 NEW PC OPTH 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VISIT LVL 3 NEW ORTHO 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VST LVL 3 NEW PC (ENT) 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VST LVL 3 NEW PC (GEN) 99203 $190.40 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 3 NEW PC 99203 $190.40 10/1/2018 River Hosp CDM DR OFF VISIT LVL3 NEW PC CLN2 99203 $190.40 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 3 NEW PC 99203 $190.40 10/1/2018 River Hosp CDM TAMIFLU SUSPENSION $190.60 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL 96374 $191.09 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL OBS 96374 $191.09 10/1/2018 River Hosp CDM IV INJECTION CLINIC 96374 $191.09 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL 96374 $191.09 10/1/2018 River Hosp CDM INTRAVENOUS INFUSION 31MIN-1HR 96360 $191.09 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL 96374 $191.09 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL CLN 96374 $191.09 10/1/2018 River Hosp CDM IV INJ/MEDS/PUSH/INITIAL CLN 96374 $191.09 10/1/2018 River Hosp CDM AVULSION OF NAIL PLATE 11730 $191.40 10/1/2018 River Hosp CDM SINGLE DRUG TEST CONFIRMATION 80375 $191.55 10/1/2018 River Hosp CDM INJECTION < 7 LESIONS (ENT) 11900 $191.60 10/1/2018 River Hosp CDM SUPRACAPULAR NERVE BLOCK 64418 $191.90 10/1/2018 River Hosp CDM ENDOPATH 5MM CURVED SCISSORS $191.90 10/1/2018 River Hosp CDM SUPRACAPULAR NERVE BLOCK 64418 $191.90 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 1 99211 $191.95 10/1/2018 River Hosp CDM BURN 2ND DEGREE $191.95 10/1/2018 River Hosp CDM CD 4 86361 $191.95 10/1/2018

River Hosp CDM MANDIBLE COMP MIN 4V 70110 $192.05 10/1/2018 River Hosp CDM END OF LIFE E/M 99497 $192.25 10/1/2018 River Hosp CDM DELTA AMINOLEVULINIC ACID 82135 $194.10 10/1/2018 River Hosp CDM SIMPLE REPAIR 7.6CM TO 12.5CM 12004 $194.30 10/1/2018 River Hosp CDM SIMPLE REPAIR 7.6CM-12.5CM 12004 $194.30 10/1/2018 River Hosp CDM FOOT COMP 73630 $194.50 10/1/2018 River Hosp CDM SPINE LUMBAR AP/LAT 72100 $194.90 10/1/2018 River Hosp CDM HAND AP + LAT 73120 $195.40 10/1/2018 River Hosp CDM SNF SEMI BED HOLD $195.55 10/1/2018 River Hosp CDM EPI-PEN 0.3mg $195.60 10/1/2018 River Hosp CDM ULTRACLIP II TISSUE MAKER $195.80 10/1/2018 River Hosp CDM QUANTIFERON TB GOLD 86480 $195.90 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 ESTAB PC 99214 $196.30 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 4 EST (PC) 99214 $196.30 10/1/2018 River Hosp CDM O/V LVL 4 EST CARDIO PC 99214 $196.30 10/1/2018 River Hosp CDM OFFICE VST LVL 4 EST PC (GYN) 99214 $196.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 EST PC OPTH 99214 $196.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 EST(ORTHO) 99214 $196.30 10/1/2018 River Hosp CDM OFFICE VST LVL 4 EST PC (ENT) 99214 $196.30 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 EST PC(GEN) 99214 $196.30 10/1/2018 River Hosp CDM O/V LVL 4 ESTAB PC CLN2 99214 $196.30 10/1/2018 River Hosp CDM DR OFF VISIT LVL 4 EST PC CLN2 99214 $196.30 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 4 PC 99214 $196.30 10/1/2018 River Hosp CDM PHP E&M LVL 4 99214 $196.30 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 4 PC RCWP 99214 $196.30 10/1/2018 River Hosp CDM TELE ESTAB LVL 4 PC RCWP 99214 $196.30 10/1/2018 River Hosp CDM TELE EST LEVEL 4 PC CPSY 99214 $196.30 10/1/2018 River Hosp CDM SIMPLE REPAIR 5.1CM TO 7.5CM 12014 $196.75 10/1/2018 River Hosp CDM PELVIS IV 72170 $196.85 10/1/2018 River Hosp CDM FOREARM 73090 $196.95 10/1/2018 River Hosp CDM SACRUM & COCCYX 72220 $197.10 10/1/2018 River Hosp CDM AVULSION OF NAIL PLATE 11730 $197.20 10/1/2018 River Hosp CDM VISCOAT 0.5ML $197.55 10/1/2018 River Hosp CDM CORTISOL,FREE,URINE 82530 $197.75 10/1/2018 River Hosp CDM B-NATRIURETIC PEPTIDE 83880 $198.20 10/1/2018 River Hosp CDM CHEST TUBE SET UP $198.35 10/1/2018 River Hosp CDM SIGNOIDOSCOPY FLEX, DIAG W/DIL 45340 $198.35 10/1/2018 River Hosp CDM CONTROL NASAL HEMORRHAGE COMPL 30903 $198.40 10/1/2018 River Hosp CDM EMERGENCY ANESTHESIA 99140 $198.65 10/1/2018 River Hosp CDM RCWP PSYCH SUBSEQUENT CCM 60M 99493 $198.95 10/1/2018 River Hosp CDM SIMPLE REPAIR 2.5CM OR LESS 12011 $199.05 10/1/2018 River Hosp CDM PROTEIN S AG 85305 $199.05 10/1/2018 River Hosp CDM SCAPULA 73010 $199.20 10/1/2018 River Hosp CDM ORGANIC ACID ANLYS URINE QUAL 83919 $199.20 10/1/2018 River Hosp CDM ORGANIC ACIDS, URINE 83919 $199.20 10/1/2018 River Hosp CDM HERPES CULTURE 87255 $199.65 10/1/2018 River Hosp CDM AROMATIC SOLVENT EXPOSURE 84600 $200.00 10/1/2018

River Hosp CDM HALDOL 80173 $200.00 10/1/2018 River Hosp CDM CLOMIPRAMINE 80335 $200.00 10/1/2018 River Hosp CDM BACKBENCH PREP ENDOTHELIA GRFT 65757 $200.35 10/1/2018 River Hosp CDM TOBRAMYCIN OPHTH OINTMT $200.40 10/1/2018 River Hosp CDM ESTRONE 82679 $200.40 10/1/2018 River Hosp CDM EPITAXIS/CONTROL NOSEBLEED $200.65 10/1/2018 River Hosp CDM BIMATOPROSE .03% OPT DROPS BTL $201.35 10/1/2018 River Hosp CDM RIB UNILAT/PA CHEST 3 VIEWS 71101 $201.45 10/1/2018 River Hosp CDM SECUREMARK MARKERS $201.50 10/1/2018 River Hosp CDM PROZAC 80332 $201.55 10/1/2018 River Hosp CDM VITAMIN E 84446 $201.60 10/1/2018 River Hosp CDM SHAVE EPIDERMAL TRUNK .6MM-1CM 11301 $201.65 10/1/2018 River Hosp CDM SHAV EPIDERM/DERM LESION TRUNK 11301 $201.65 10/1/2018 River Hosp CDM RESURE SEALANT $201.75 10/1/2018 River Hosp CDM FLUTICASONE (Advair) 100/50 $201.75 10/1/2018 River Hosp CDM ASCA, IGG+IGA 86671 $201.95 10/1/2018 River Hosp CDM PHP PPSYCH CCM SUB MONTH 60MIN 99493 $202.00 10/1/2018 River Hosp CDM MAXCART ER ADULT $202.40 10/1/2018 River Hosp CDM GLUCAGON 82943 $202.80 10/1/2018 River Hosp CDM ER VISIT LEVEL 1 99281 $203.00 10/1/2018 River Hosp CDM RIVAROXABAN 80375 $203.00 10/1/2018 River Hosp CDM HEPARIN ANTI-XA 85520 $203.00 10/1/2018 River Hosp CDM APPL SHORT ARM SPLINT STATIC 29125 $203.15 10/1/2018 River Hosp CDM ANOSCOPY W/ REM TUMOR/POLYP 46610 $203.45 10/1/2018 River Hosp CDM NG INSERTION/LAVAGE OBS 91105 $203.85 10/1/2018 River Hosp CDM FINGER ABCESS SIMPLE 26010 $203.85 10/1/2018 River Hosp CDM EXC BENIGN LSN 0.5 CM OR LESS 11420 $203.95 10/1/2018 River Hosp CDM H INFLUENZA ABS 86684 $204.00 10/1/2018 River Hosp CDM REM FOREIGN BODY EXT AUDITORY 69200 $204.35 10/1/2018 River Hosp CDM INJ,ANES AGENT;TRIGEMINAL NERV 64430 $204.65 10/1/2018 River Hosp CDM PT EVALUATION 30 MIN 97162 $204.95 10/1/2018 River Hosp CDM SUTURE PROLINE 788g $205.10 10/1/2018 River Hosp CDM SNF PRIVATE BED HOLD $205.15 10/1/2018 River Hosp CDM CILOXIN OINTMENT $205.30 10/1/2018 River Hosp CDM HUMERUS 73060 $205.50 10/1/2018 River Hosp CDM CHEST 2 VIEWS 71046 $205.60 10/1/2018 River Hosp CDM CHEST 2 VIEWS APG 71046 $205.60 10/1/2018 River Hosp CDM NCS LOVENOX 60MG/0.6ML SYRIN $205.65 10/1/2018 River Hosp CDM LIPOPROTEIN QUANTITATION 83704 $205.85 10/1/2018 River Hosp CDM CARDIAC TROPONIN I 84484 $206.30 10/1/2018 River Hosp CDM INJECTION ANESTHE AGENT FACIAL 64402 $206.40 10/1/2018 River Hosp CDM BONE MINERAL DENSITY 77078 $206.40 10/1/2018 River Hosp CDM HIP ARTHROSCOPY PACK $207.10 10/1/2018 River Hosp CDM ANKLE COMP 73610 $207.65 10/1/2018 River Hosp CDM CATHERIZATION, COMPLEX OBS 51703 $207.70 10/1/2018 River Hosp CDM INDIV PSYCHOTHERAPY 45 MIN PHY 90836 $208.20 10/1/2018 River Hosp CDM PSYCH 45 MIN WHEN W/E&M RCWP 90836 $208.20 10/1/2018

River Hosp CDM ALDOSTERONE 82088 $209.30 10/1/2018 River Hosp CDM ELBOW COMP 73080 $209.65 10/1/2018 River Hosp CDM NG INSERTION/LAVAGE ER 43753 $210.00 10/1/2018 River Hosp CDM CHARCOAL/IPECAC ER ADMIN $210.00 10/1/2018 River Hosp CDM BONE DENS STUD VERT FRACT ASMT 77082 $210.00 10/1/2018 River Hosp CDM UNLISTED LACRIMAL SYSTEM PROC 68899 $210.00 10/1/2018 River Hosp CDM KNEE AP + LAT 73562 $210.15 10/1/2018 River Hosp CDM HOME VISIT 25MIN 99348 $210.20 10/1/2018 River Hosp CDM PSYCH W/PT&OR FAM 45 PHY RCWP 90834 $211.55 10/1/2018 River Hosp CDM PSYCHOTH W/PT &ORFAM 45 (PHYS) 90834 $211.55 10/1/2018 River Hosp CDM PSYCHOTH W/PT &ORFAM 45 NONPHY 90834 $211.55 10/1/2018 River Hosp CDM PSYCH W/PT&OR FAM 45 PHY RCWP 90834 $211.55 10/1/2018 River Hosp CDM PSYCH 45 MIN PHY RCWP VISIT 90834 $211.55 10/1/2018 River Hosp CDM NEEDLE LOCALIZATION 77032 $212.30 10/1/2018 River Hosp CDM DEPT OF TRANSPORTATION EXAM 99455 $212.75 10/1/2018 River Hosp CDM REPAIR COMPLEX SCALP EA ADDL 13122 $212.90 10/1/2018 River Hosp CDM REMICADE 10 MG DOSE $213.00 10/1/2018 River Hosp CDM GEUDER CANNULA CORNEAL IMPANT $213.15 10/1/2018 River Hosp CDM BLASTOMYCES ANTIBODY 86612 $213.15 10/1/2018 River Hosp CDM F2 GENE ANALYSIS 81240 $213.55 10/1/2018 River Hosp CDM FACTOR VIII RISTOCETIN COFACT 85245 $213.60 10/1/2018 River Hosp CDM FLUROSCOPY 76000 $213.75 10/1/2018 River Hosp CDM DESTRUC BENIGN LESN 15+ 17111 $213.80 10/1/2018 River Hosp CDM ALIMED MULTIBOOT STAN. W/LINER $214.20 10/1/2018 River Hosp CDM INFLUENZA AB 86710 $214.20 10/1/2018 River Hosp CDM CLOSUREFAST PROCEDURE PACK $214.80 10/1/2018 River Hosp CDM SURGICEL 4x8 $214.80 10/1/2018 River Hosp CDM ANTITHROMBIN III ACTIVITY 85300 $214.85 10/1/2018 River Hosp CDM TOE IP JOINT 28660 $214.90 10/1/2018 River Hosp CDM CLOSED TOE, OTHER THAN GREAT 28510 $214.90 10/1/2018 River Hosp CDM CLOSED GREAT TOE 28490 $214.90 10/1/2018 River Hosp CDM TM JOINT 21480 $214.90 10/1/2018 River Hosp CDM NURSEMAID ELBOW MANIP (CHILD) 24640 $214.90 10/1/2018 River Hosp CDM ESTRADIOL 82670 $214.95 10/1/2018 River Hosp CDM CBM BLADE $215.25 10/1/2018 River Hosp CDM BX BREAST W/PLACE LOCALIZATION 19084 $215.40 10/1/2018 River Hosp CDM ANTIBODY INDENTIFCA 86870 $215.43 10/1/2018 River Hosp CDM ARC PHEN(1-2)UNIT 86905 $215.43 10/1/2018 River Hosp CDM FFP THAWING 86927 $215.43 10/1/2018 River Hosp CDM ANTIGEN TYPING,RBC 86905 $215.43 10/1/2018 River Hosp CDM 307 COMPL DX EXAM P/C 88307 $215.43 10/1/2018 River Hosp CDM 5535IMMUNOPEROXITECH 88342 $215.43 10/1/2018 River Hosp CDM CLOSTR DIFFCILE TOXIN A 2 UNIT 87324 $215.65 10/1/2018 River Hosp CDM CLOSTR DIFFCILE TOXIN A 3 UNIT 87324 $215.65 10/1/2018 River Hosp CDM HEALON 0.85 ML SYRINGE $216.00 10/1/2018 River Hosp CDM FAT, LIPIDS, QUAN, FECES 82710 $216.95 10/1/2018 River Hosp CDM B. PERTUSSIS PCR 87798 $217.05 10/1/2018

River Hosp CDM SNF SEMI-PRIVATE $217.15 10/1/2018 River Hosp CDM CAPSULAR TENSION RING SIZE 10 $217.25 10/1/2018 River Hosp CDM ENDOPOUCH SPEC BAG $217.80 10/1/2018 River Hosp CDM MMRV VACCINE 90710 $217.95 10/1/2018 River Hosp CDM DNA AB-SS 86226 $217.95 10/1/2018 River Hosp CDM EP EXCEL BLADELESS TROCAR 5MM $218.10 10/1/2018 River Hosp CDM FISH HOOK REMOVAL $218.40 10/1/2018 River Hosp CDM FB REMOVAL TISSUE, SIMPLE $218.40 10/1/2018 River Hosp CDM ENDOMETRIAL SAMPLING BIOPSY 58100 $218.40 10/1/2018 River Hosp CDM AMIODARONE LEVEL 80299 $218.45 10/1/2018 River Hosp CDM RITALIN 80299 $218.45 10/1/2018 River Hosp CDM DRAIN/INJ JOINT/BURSA W/ US 20611 $218.55 10/1/2018 River Hosp CDM INJ ANESTHETIC AGENT FACIAL NE 64402 $218.80 10/1/2018 River Hosp CDM SCOLIOSIS ERECT&SUP 72090 $219.05 10/1/2018 River Hosp CDM PARVOVIRUS B19, IGG, IGM 86747 $219.25 10/1/2018 River Hosp CDM SIMPLE REPAIR TO 2.5 CM $219.45 10/1/2018 River Hosp CDM PELVIC LIMITED 76857 $219.50 10/1/2018 River Hosp CDM LINEAR CUTTER ETS 45MM TR45W $219.70 10/1/2018 River Hosp CDM LINEAR CUTTER RELOAD 3.5 TR45B $219.70 10/1/2018 River Hosp CDM LINEARCUTTER TES45mm GRN TR45G $219.70 10/1/2018 River Hosp CDM IV INFUS/MEDS 1HR (OBS) 96365 $219.95 10/1/2018 River Hosp CDM PHP PSYCH CCM FIRST 70 MIN 99492 $220.00 10/1/2018 River Hosp CDM RCWP PSYCH CCM FIRST 70 MIN 99492 $220.00 10/1/2018 River Hosp CDM TESTOSTERONE 84403 $220.00 10/1/2018 River Hosp CDM KNEE JOINT CASTS 01420 $220.80 10/1/2018 River Hosp CDM UPPER LEG VEINS 01260 $220.80 10/1/2018 River Hosp CDM L. LEG CASTS 01490 $220.80 10/1/2018 River Hosp CDM F, W, AND H BONES 01820 $220.80 10/1/2018 River Hosp CDM ARTH KNEE 01382 $220.80 10/1/2018 River Hosp CDM INTEGUMENTARY SYSTEM 00400 $220.80 10/1/2018 River Hosp CDM F, W, AND H VEINS 01850 $220.80 10/1/2018 River Hosp CDM L.LEG NER.MUS. TEN 01470 $220.80 10/1/2018 River Hosp CDM L. LEG VEINS 01520 $220.80 10/1/2018 River Hosp CDM FOREARM-WRIST-HAND 01810 $220.80 10/1/2018 River Hosp CDM ARM + ELBOW /UPPER 01710 $220.80 10/1/2018 River Hosp CDM OPEN REDUCTION/ANKLE 01484 $220.80 10/1/2018 River Hosp CDM MALE EXT GENTALIA 00920 $220.80 10/1/2018 River Hosp CDM VAGINAL PROC 00940 $220.80 10/1/2018 River Hosp CDM ARM CASTS 01860 $220.80 10/1/2018 River Hosp CDM HIP JOINT 01200 $220.80 10/1/2018 River Hosp CDM LOWER LEG BONES 01462 $220.80 10/1/2018 River Hosp CDM SHOULDER COMP 73030 $221.00 10/1/2018 River Hosp CDM SHOULDER COMPLETE APG 73030 $221.00 10/1/2018 River Hosp CDM NICARDIPINE 40mg/200ml IV $221.30 10/1/2018 River Hosp CDM CHROMOGRONIN A 86316 $221.30 10/1/2018 River Hosp CDM UNJECT SPINE LUMBAR/SACRAL 62322 $221.35 10/1/2018 River Hosp CDM TRYPTASE 83519 $221.60 10/1/2018

River Hosp CDM GROWTH HORMONE BINDING TEST 83519 $221.60 10/1/2018 River Hosp CDM PANCREATIC POLYPEPTIDE 83519 $221.60 10/1/2018 River Hosp CDM MUSK AB 83519 $221.60 10/1/2018 River Hosp CDM PELVIC EXAM ER, MODERATE $221.95 10/1/2018 River Hosp CDM DESTR OF LSN(S), SURG (GEN) 46922 $222.20 10/1/2018 River Hosp CDM EXTREMETY ARTERIAL 1 LVL,BILAT 93922 $222.55 10/1/2018 River Hosp CDM OMT 1-2 BODY REGIONS 98925 $223.25 10/1/2018 River Hosp CDM SEVOFLURANE 250 ml BOTTLE $223.75 10/1/2018 River Hosp CDM COCCIDIODES AB QNT 86635 $223.85 10/1/2018 River Hosp CDM HISTOPLASMA, AB BY CF 86698 $223.85 10/1/2018 River Hosp CDM CHEST 4V (OBL) 71048 $224.10 10/1/2018 River Hosp CDM ALUMINUM 82108 $224.10 10/1/2018 River Hosp CDM AERODYNAMIC & ACOUS TEST (ENT) 92520 $224.45 10/1/2018 River Hosp CDM AURALGAN BENZOCAINE 15ml $225.40 10/1/2018 River Hosp CDM REMOVAL ANAL SETON, OTH MARKER 46030 $225.65 10/1/2018 River Hosp CDM MST IRIS HOOKS $225.85 10/1/2018 River Hosp CDM ADH, ANTIDURETIC HORMONE 84588 $225.95 10/1/2018 River Hosp CDM CRYPTOCOCCUS ANTIBODY 86641 $225.95 10/1/2018 River Hosp CDM IRIS RETRACTOR, FLEXIBLE $226.15 10/1/2018 River Hosp CDM PROLONGED SVC EACH ADDL 30 MIN 99355 $226.45 10/1/2018 River Hosp CDM PROLONGED SVC EACH ADDL 30 MIN 99355 $226.45 10/1/2018 River Hosp CDM IV INFUS/MEDS 1 HR 96365 $226.60 10/1/2018 River Hosp CDM IV INFUS/HYDRATION 1HR (OPP) 96360 $226.60 10/1/2018 River Hosp CDM IV INFUS/HYDRATION 1HR 96360 $226.60 10/1/2018 River Hosp CDM IV INFUS/MEDS 1HR 96365 $226.60 10/1/2018 River Hosp CDM IV INFUS/HYDRATION 1HR 96360 $226.60 10/1/2018 River Hosp CDM IV INFUS/HYDRATION 1HR (OPP) 96360 $226.60 10/1/2018 River Hosp CDM PSYCHOTHERAPY CRISIS ADDL +30 90840 $227.15 10/1/2018 River Hosp CDM PSYCHOTHERAPY CRISIS +30 RCWP 90840 $227.15 10/1/2018 River Hosp CDM PSYCHOTHERAPY CRISIS +30 CPSY 90840 $227.15 10/1/2018 River Hosp CDM ENDOSCOPIC EVAL SM INTESTINE 44386 $227.30 10/1/2018 River Hosp CDM CHEST 2 VIEW & SPECIAL VIEW 71047 $227.50 10/1/2018 River Hosp CDM CHEST 3V (APICAL) 71047 $227.60 10/1/2018 River Hosp CDM SNF PRIVATE ROOM $228.00 10/1/2018 River Hosp CDM SACROILIAC JNT INJ W/GUIDE 27096 $228.05 10/1/2018 River Hosp CDM UNLISTED ULTRASOUND PROC BED 76999 $228.10 10/1/2018 River Hosp CDM FLUOROSCOPIC GUIDANCE NEEDLE 77002 $228.40 10/1/2018 River Hosp CDM INJ DIAG/THERAPEUTIC AGENT 64493 $228.50 10/1/2018 River Hosp CDM PSA FREE 84154 $228.70 10/1/2018 River Hosp CDM ULTRASOUND RETOPERIT BEDSIDE 76775 $228.75 10/1/2018 River Hosp CDM ULTRASOUND RETOPERITONEAL 76775 $228.75 10/1/2018 River Hosp CDM AORTA US SCREEN WELCOME MCR 76706 $228.75 10/1/2018 River Hosp CDM KOH (CONN/RECORD/DISCON) 93270 $229.20 10/1/2018 River Hosp CDM SHAVE TRUNK 1.1-2 CM 11302 $229.20 10/1/2018 River Hosp CDM SHAVE TRUNK 1.1-2 CM 11302 $229.20 10/1/2018 River Hosp CDM COLPOSCOPY ENTIRE VAG W/CERV 57420 $229.35 10/1/2018 River Hosp CDM FILSHIE CLIPS $229.40 10/1/2018

River Hosp CDM HAND COMP 73130 $229.40 10/1/2018 River Hosp CDM ANOSCOPY DIAG W/ REM MUL TUMOR 46612 $229.40 10/1/2018 River Hosp CDM BLADDER IRRIGATION SIMPLE 51700 $229.53 10/1/2018 River Hosp CDM BLADDDER IRRIGATION 51700 $229.53 10/1/2018 River Hosp CDM US TRANSVAGINAL PREG UTERUS TC 76817 $230.20 10/1/2018 River Hosp CDM INJECT SPINE W/CATH LMBR/SACR 62326 $230.35 10/1/2018 River Hosp CDM U/S F/U OB 76816 $231.25 10/1/2018 River Hosp CDM TROCAR ENDOPATH XCEL B12XT $231.40 10/1/2018 River Hosp CDM ADALIMUMAB 80299 $231.60 10/1/2018 River Hosp CDM MULTIPLE INTERCOSTAL BLOCK 64421 $231.60 10/1/2018 River Hosp CDM CARDIOLIP ANTIBODY 86147 $231.60 10/1/2018 River Hosp CDM ANOSCOPY W/ ABLATION OF TUMOR 46615 $231.60 10/1/2018 River Hosp CDM PERINEAL PAD ASU $231.85 10/1/2018 River Hosp CDM PROTEIN C ACTIVITY 85303 $232.00 10/1/2018 River Hosp CDM HARMONIC SCALPEL 5mm $232.30 10/1/2018 River Hosp CDM VENT MGMT INPT INIT DAY 94002 $232.55 10/1/2018 River Hosp CDM LPN TRANS SYR $232.75 10/1/2018 River Hosp CDM PROTEIN C, ANTIGEN 85302 $232.75 10/1/2018 River Hosp CDM CONSCIOUS SEDATION >5 1ST 15 M 99152 $233.00 10/1/2018 River Hosp CDM LYME PCR 87476 $233.45 10/1/2018 River Hosp CDM ENTEROVIRUS PCR 87498 $233.45 10/1/2018 River Hosp CDM LEGIONELLA PNEUM AB 86713 $233.45 10/1/2018 River Hosp CDM ZOSTER VACCINE 90736 $233.70 10/1/2018 River Hosp CDM ANTITHROM III ANTIGEN ASSA 85301 $233.75 10/1/2018 River Hosp CDM TOPICAL THROMBIN 5000 UNITS $233.95 10/1/2018 River Hosp CDM SKULL, FOUR VIEWS 70260 $234.10 10/1/2018 River Hosp CDM ACTIVASE 1mg IV $234.10 10/1/2018 River Hosp CDM INJECT SPINE W/CATH CRV/THRC 62324 $234.45 10/1/2018 River Hosp CDM HOLTER MONITOR UP TO 48HRS 93224 $234.70 10/1/2018 River Hosp CDM CONSULTATION LVL3 (NEW/EST PT) 99243 $234.95 10/1/2018 River Hosp CDM HEPATITIS B DNA, QUALITATIVE 87516 $235.20 10/1/2018 River Hosp CDM ILLOINGUAL/ILIOHYPOGASTRIC BLK 64425 $235.50 10/1/2018 River Hosp CDM Illoingunal/Iliohypogastric Ne 64425 $235.50 10/1/2018 River Hosp CDM REMOVE IMPLANT CONTRACEPT CAPS 11976 $236.40 10/1/2018 River Hosp CDM GRIESHABER FLEXIABE IRIS RETA $236.70 10/1/2018 River Hosp CDM PLASMINOGEN 85420 $236.70 10/1/2018 River Hosp CDM SIMPLE REP SUPERFICIAL WOUNDS 12001 $236.95 10/1/2018 River Hosp CDM REM BIV,GAUNLET BOOT/BODY CAST 29700 $237.28 10/1/2018 River Hosp CDM VONWILLEBRAND'S FACTOR AG 85246 $237.75 10/1/2018 River Hosp CDM DHEA SULFATE 82627 $237.85 10/1/2018 River Hosp CDM RIB UNILATERAL 2 VIEWS 71100 $238.10 10/1/2018 River Hosp CDM PHENOTHIAZINE 84022 $238.10 10/1/2018 River Hosp CDM METANEPHRINES 83835 $238.50 10/1/2018 River Hosp CDM PUNCUATE ABS/HEM.BL/CYST 10160 $238.55 10/1/2018 River Hosp CDM PUNCUTE ASP OF ABS/HEM/BL/CYST 10160 $238.55 10/1/2018 River Hosp CDM HLA CL II,LOWRES, ONE ANTIGEN 81377 $238.60 10/1/2018 River Hosp CDM ABDOMEN (KUB) 1 VIEW 74018 $239.10 10/1/2018

River Hosp CDM HOLTER MONITOR HOOK UP 93225 $239.10 10/1/2018 River Hosp CDM ESTROGENS TOTAL 82672 $239.10 10/1/2018 River Hosp CDM LUMBAR PUNCTURE (OBSV) $239.15 10/1/2018 River Hosp CDM CONSULTATION LEVEL 3 (PC) 99243 $239.30 10/1/2018 River Hosp CDM PAIN MGMT CONSULT LEVEL 3 99243 $239.30 10/1/2018 River Hosp CDM SIGMOIDOSCOPY;FORCEPS OR BIPOL 45333 $239.75 10/1/2018 River Hosp CDM EMPIRE MICROINCION ELECTRODE $239.80 10/1/2018 River Hosp CDM EMPIRE MCROINC. ELECTRODE 1/16 $239.80 10/1/2018 River Hosp CDM SPINE CERV AP/LAT 72040 $239.95 10/1/2018 River Hosp CDM CANNABINOIDS BLOOD 80307 $239.95 10/1/2018 River Hosp CDM MYCOPLASMA/UREAPLASMA PCR 87801 $239.95 10/1/2018 River Hosp CDM ACETOMINOPHEN LAB 80329 $240.35 10/1/2018 River Hosp CDM OMT 3 & 4 BODY REGIONS 98926 $240.40 10/1/2018 River Hosp CDM HEMOCHROMATOSIS 81256 $240.45 10/1/2018 River Hosp CDM SEVERING OF TARSORRHAOHY 67710 $240.55 10/1/2018 River Hosp CDM ALTEPLASE 2MG/2ML VIAL $240.65 10/1/2018 River Hosp CDM HANNA TREPHINE BLADE $241.65 10/1/2018 River Hosp CDM ORGANIC ACIDS, URINE, QNT. 83918 $241.75 10/1/2018 River Hosp CDM INDIV PSYCHOTH W/MED EVAL(PHY) 90836 $241.80 10/1/2018 River Hosp CDM METANEPHERINES PLASMA 83835 $242.25 10/1/2018 River Hosp CDM EZ-IO 25MM NEEDLE $242.30 10/1/2018 River Hosp CDM CA 125 AG 86304 $242.40 10/1/2018 River Hosp CDM SIMPLE REPAIR FACE TO 2.5cm $242.45 10/1/2018 River Hosp CDM THORACENTESIS $242.45 10/1/2018 River Hosp CDM I & D OF ABSCESS 10060 $242.60 10/1/2018 River Hosp CDM XIBROM 0.09% 2.5ML $242.70 10/1/2018 River Hosp CDM I&D PERIANAL ABSCESS,SPRFICIAL 46050 $242.85 10/1/2018 River Hosp CDM TEMP CLOSURE OF EYELIDS SUTURE 67875 $242.85 10/1/2018 River Hosp CDM ULTRASOUND EXTREM COMP BEDSIDE 76881 $243.35 10/1/2018 River Hosp CDM INJ TRIGGER 1 0R 2 MUSCLES OPP $243.55 10/1/2018 River Hosp CDM HEP D 86692 $243.55 10/1/2018 River Hosp CDM SCOLOSIS 2V 72082 $243.85 10/1/2018 River Hosp CDM ANAPHYLAXIS KIT $243.95 10/1/2018 River Hosp CDM TENDON SHEATH/LIGAMENT CYST TC 20550 $244.70 10/1/2018 River Hosp CDM TRIGGER POINT INJ 3+ 20553 $244.70 10/1/2018 River Hosp CDM BOTOX INJ FOR MIGRAINE TC 64615 $244.70 10/1/2018 River Hosp CDM SMALL JOINT: FINGER/TOE TC 20600 $244.70 10/1/2018 River Hosp CDM MED JOINT: ANKLE/WRIST/AC TC 20605 $244.70 10/1/2018 River Hosp CDM LARGE JOINT:HIP,KNEE, BURSA TC 20610 $244.70 10/1/2018 River Hosp CDM INJ TRIGGER 1 OR 2 MUSCLES OBS 20552 $244.70 10/1/2018 River Hosp CDM ARTHROCENTESIS MAJOR JOINT OBS 20610 $244.70 10/1/2018 River Hosp CDM TRIGGER POINT INJ SING OR MULT 20552 $244.70 10/1/2018 River Hosp CDM INJ PLANTAR DIGITAL NERVE 64455 $244.70 10/1/2018 River Hosp CDM NERVE BLOCK SPINAL ACCESS NRV 64999 $244.70 10/1/2018 River Hosp CDM INJ LIG/TRIG PT/TEND 20550 $244.70 10/1/2018 River Hosp CDM SMALL JOINT 20600 $244.70 10/1/2018 River Hosp CDM TRIGGER PT INJ SINGL OR MULTI 20552 $244.70 10/1/2018

River Hosp CDM SING/MULT TRIG PTS 3+ MUSCLE 20553 $244.70 10/1/2018 River Hosp CDM INJ TRIGGER POINT 1 OR 2 20552 $244.70 10/1/2018 River Hosp CDM SINGLE OR MULTI TRIGGER POINTS 20553 $244.70 10/1/2018 River Hosp CDM ARTHROCENTESIS SM JOINT BURSA 20600 $244.70 10/1/2018 River Hosp CDM INTERM JOINT OR BURSA 20605 $244.70 10/1/2018 River Hosp CDM MAJOR JOINT OR BURSA SHOULDER 20610 $244.70 10/1/2018 River Hosp CDM REM FOREIGN BODY EXT AUDITORY 69200 $244.70 10/1/2018 River Hosp CDM MAJOR JOINT INJECTION 20610 $244.70 10/1/2018 River Hosp CDM SMALL JOINT INJECTION 20600 $244.70 10/1/2018 River Hosp CDM INT JOINT INJECTION 20605 $244.70 10/1/2018 River Hosp CDM INJ INTERMEDIATE JOINTS CLN 20605 $244.70 10/1/2018 River Hosp CDM INJ SMALL JOINT CLN 20600 $244.70 10/1/2018 River Hosp CDM INJ TRIGGER POINT CLN 20553 $244.70 10/1/2018 River Hosp CDM INJECT INTO MAJOR JOINT/BURSA 20610 $244.70 10/1/2018 River Hosp CDM INJ TRIGGER TENDON SHEATH 20550 $244.70 10/1/2018 River Hosp CDM THERA INJ CARPAL TUNNEL 20526 $244.70 10/1/2018 River Hosp CDM INJ SINGLE TENDON/LIGAMENT 20550 $244.70 10/1/2018 River Hosp CDM INJ GANGLION CYST(S) 20612 $244.70 10/1/2018 River Hosp CDM SM JOINT INJ ORTHO 20600 $244.70 10/1/2018 River Hosp CDM MED JOINT INJ ORTHO 20605 $244.70 10/1/2018 River Hosp CDM LG JOINT INJECTION ORTHO 20610 $244.70 10/1/2018 River Hosp CDM ASPIRAT/INJECT GANG CYST (GEN) 20612 $244.70 10/1/2018 River Hosp CDM LARGE JOINT INJECTION 20610 $244.70 10/1/2018 River Hosp CDM ASPIRATION/INJECT INTER JOINT 20605 $244.70 10/1/2018 River Hosp CDM LARGE JOINT INJ 20610 $244.70 10/1/2018 River Hosp CDM ARTHROCENTESIS ASPIR/INJ MAJOR 20610 $244.70 10/1/2018 River Hosp CDM ARTHROCENTESIS ASPIRATION/INJ 20610 $244.70 10/1/2018 River Hosp CDM Incise Tear Duct Opening 68440 $244.70 10/1/2018 River Hosp CDM ASPIRATION/INJECT MED JT (GEN) 20605 $244.70 10/1/2018 River Hosp CDM FK 506 LEVEL,TACROLIMUS 80197 $245.05 10/1/2018 River Hosp CDM CATHERIZATION, COMPLEX ER 51703 $245.45 10/1/2018 River Hosp CDM INSERTION TEMP INDWELLING COMP 51703 $245.45 10/1/2018 River Hosp CDM ORBITS MIN 4 V 70200 $245.80 10/1/2018 River Hosp CDM TMJ'S 70330 $245.80 10/1/2018 River Hosp CDM DRESSING/DEBRIDE < 5% 16020 $245.90 10/1/2018 River Hosp CDM LUMBAR PUNCTURE $246.40 10/1/2018 River Hosp CDM BARTHOLIN'S ABSCESS 56420 $246.45 10/1/2018 River Hosp CDM PRALIDOXIME 1 gm VIAL J2730 $246.75 10/1/2018 River Hosp CDM TIBIA-FIBULA 73590 $248.05 10/1/2018 River Hosp CDM MAX CART ER PED $248.15 10/1/2018 River Hosp CDM CONTROL NASAL HEMOR, SIMPLE 30901 $248.75 10/1/2018 River Hosp CDM CARBON DIOXIDE ANALYZER 94770 $248.83 10/1/2018 River Hosp CDM CARBON DIOXIDE ANALYZER 94770 $248.83 10/1/2018 River Hosp CDM FLOW VOLUME LOOP 94375 $248.83 10/1/2018 River Hosp CDM TGV 94726 $248.83 10/1/2018 River Hosp CDM FRACTURE CARE - BOXER 26600 $249.40 10/1/2018 River Hosp CDM CALCITONIN SERUM 82308 $249.40 10/1/2018

River Hosp CDM PNEUMOVACC PREV13 .5ml PREFILL 90670 $249.45 10/1/2018 River Hosp CDM CHEST 4V (DECUB) 71048 $250.35 10/1/2018 River Hosp CDM FLONASE .05% 16GM BTL $250.55 10/1/2018 River Hosp CDM ROTAVIRUS VACCINE 90680 $250.75 10/1/2018 River Hosp CDM PELVIS COMP 72190 $251.60 10/1/2018 River Hosp CDM SPECIALTY BOOT $251.75 10/1/2018 River Hosp CDM SKIN TAG REMOVAL UP TO 15 11200 $251.85 10/1/2018 River Hosp CDM METHYLACID 83921 $252.40 10/1/2018 River Hosp CDM HOLTER MONITOR SCANNING/REPRT 93226 $252.70 10/1/2018 River Hosp CDM WRIST ARTHRO EXAM W/SPRV 73115 $252.74 10/1/2018 River Hosp CDM TOBRADEX OINT 3.5% $252.80 10/1/2018 River Hosp CDM HIP BILATERAL 73521 $252.85 10/1/2018 River Hosp CDM HIPS BILATERAL 2 VIEWS 73521 $252.85 10/1/2018 River Hosp CDM SPINE LUMBAR COMP APG 72110 $252.85 10/1/2018 River Hosp CDM INJ OF DIAG/THER SUBSTANCE 62323 $253.10 10/1/2018 River Hosp CDM I&D ABSCESS SIMPLE(PARONYCHIA) 10060 $253.15 10/1/2018 River Hosp CDM RECOVERY ROOM 151-180 MINUTES $253.75 10/1/2018 River Hosp CDM BOOT INSERT PAD $253.75 10/1/2018 River Hosp CDM ONCOPROTEIN HER-2/NEU 83950 $254.30 10/1/2018 River Hosp CDM ADVAIR 250/50 $254.60 10/1/2018 River Hosp CDM MITOMYCIN 0.4MG/ML $254.95 10/1/2018 River Hosp CDM DEBRIDE OPEN 1ST 20SQ CM OR < 97597 $255.30 10/1/2018 River Hosp CDM DEBRIDE OPEN 1ST 20SQ CM OR < 97597 $255.30 10/1/2018 River Hosp CDM DEBRIDEMENT OPEN WOUND 20SCMC< 97597 $255.30 10/1/2018 River Hosp CDM DEBRIDE EA ADDL 20 SQ CM 11046 $255.50 10/1/2018 River Hosp CDM EXC OTH BNGN LSN .5CM OR LESS 11440 $255.60 10/1/2018 River Hosp CDM CELERO BIOPSY DEVICE $256.03 10/1/2018 River Hosp CDM FAMILY THERAPY W/O PAT RCWP 90846 $256.10 10/1/2018 River Hosp CDM FAMILY THERAPY W/O PAT CPSY 90846 $256.10 10/1/2018 River Hosp CDM FAMILY PSYCHOTHERAPY PNP 90846 $256.25 10/1/2018 River Hosp CDM INTRINSIC FACTOR AB 86340 $257.95 10/1/2018 River Hosp CDM EXC CHALAZION SINGLE 67800 $258.05 10/1/2018 River Hosp CDM MTHFR 81291 $258.45 10/1/2018 River Hosp CDM FLUOROSCOPIC GUIDE PICC LINE 77001 $258.50 10/1/2018 River Hosp CDM COMPASS PRESSURE MONITORING KT $258.70 10/1/2018 River Hosp CDM EXC BENIGN LESION 0.6-1.0 CM 11401 $258.70 10/1/2018 River Hosp CDM DEBRIDEMENT 5-10% SURFACE 16025 $258.80 10/1/2018 River Hosp CDM INC & DRAINAGE OF ABSCESS 10060 $258.85 10/1/2018 River Hosp CDM CLIP PLACEMENT $259.00 10/1/2018 River Hosp CDM PROCTOSIGMOIDOSCOPY,RIGID DX 45320 $259.95 10/1/2018 River Hosp CDM HYSTEROSONOGRAPHY 76831 $260.35 10/1/2018 River Hosp CDM SURGICELL 14X2 DRESSING $261.45 10/1/2018 River Hosp CDM I&D ABSCESS - GYN 10060 $262.50 10/1/2018 River Hosp CDM U/S BREAST BILATERAL LIMITED 76642 $263.80 10/1/2018 River Hosp CDM LIGACLIP ENDO ROTATING MCA $265.00 10/1/2018 River Hosp CDM VARICELLA VIRUS VACCINE 90716 $265.35 10/1/2018 River Hosp CDM HYBRIDIZATION 88274 $265.35 10/1/2018

River Hosp CDM CONTROL NASAL HEMORRHAGE W/PAC 30905 $265.65 10/1/2018 River Hosp CDM DEBRIDE EA ADD'L 20SQ CM 97598 $265.80 10/1/2018 River Hosp CDM DEBRIDE EA ADD'L 20SQ CM 97598 $265.80 10/1/2018 River Hosp CDM INCISION THROM HEMMORHOID EXT 46083 $266.00 10/1/2018 River Hosp CDM FAMILY PSYCHOTHERAPY W/PT PCSY 90847 $266.00 10/1/2018 River Hosp CDM FAMILY PSYCHOTHERAPY W/PATIENT 90847 $266.00 10/1/2018 River Hosp CDM INJ WITH IMAGING GUIDANCE 62327 $266.00 10/1/2018 River Hosp CDM BLADE 4.5 x 180mm ASU $266.45 10/1/2018 River Hosp CDM SKIN TAG REMOVAL 15 OR LESS 11200 $267.00 10/1/2018 River Hosp CDM REMOVAL OF SKIN LESIONS 15LESS 11200 $267.00 10/1/2018 River Hosp CDM CARNITINE 82379 $267.10 10/1/2018 River Hosp CDM CANTHOTOMY SEPARATE PROCEDURE 67715 $267.90 10/1/2018 River Hosp CDM PELVIC EXAM UNDER ANESTHESIA 57410 $268.30 10/1/2018 River Hosp CDM I&D OF VULVA OR PERINEAL 56405 $268.35 10/1/2018 River Hosp CDM COLP CERVIX W/ENDO CUTTERAGE 57456 $268.35 10/1/2018 River Hosp CDM INC THROMBOSED HEMORRHOID EXT 46083 $269.15 10/1/2018 River Hosp CDM ULTRASOUND SOFT HEAD/NECK BEDS 76536 $269.15 10/1/2018 River Hosp CDM COMPLEX ANTERIOR 30903 $269.35 10/1/2018 River Hosp CDM INJ WITH IMAGING GUIDANCE 62325 $269.45 10/1/2018 River Hosp CDM PROSTATE 76872 $269.50 10/1/2018 River Hosp CDM HLA CLII, HIGHRES, ALLELES 81383 $269.50 10/1/2018 River Hosp CDM INCISION LINGUAL FRENUM 41010 $269.85 10/1/2018 River Hosp CDM INCISION LINGUAL FRENUM 41010 $269.85 10/1/2018 River Hosp CDM RESPITE SNF SEMI $269.95 10/1/2018 River Hosp CDM INJECT ANEST PERIPHERAL NERVE $269.95 10/1/2018 River Hosp CDM CASTING, ANY $269.95 10/1/2018 River Hosp CDM MULTIPLE INTERCOSTAL BLOCK 66421 $270.05 10/1/2018 River Hosp CDM MAMMO SCREEN 77067 $270.15 10/1/2018 River Hosp CDM BARTONELLA HENSALAE AB 87797 $270.70 10/1/2018 River Hosp CDM IRING OPTHAMOLIC SINGLE USE $270.75 10/1/2018 River Hosp CDM HIP COMPL 73502 $271.50 10/1/2018 River Hosp CDM INSERT NON TUNNEL CV CATH 36555 $271.90 10/1/2018 River Hosp CDM LINEAR CUTTER TLC55 $271.95 10/1/2018 River Hosp CDM DHEA 82626 $272.15 10/1/2018 River Hosp CDM DUOVISC KIT $272.20 10/1/2018 River Hosp CDM KNEE COMPLETE 73564 $272.40 10/1/2018 River Hosp CDM HPYLORI BREATH TEST 83013 $272.55 10/1/2018 River Hosp CDM CONTINUOUS POSITIVE CPAP 94660 $272.93 10/1/2018 River Hosp CDM PROTOPAM CHLORIDE VIAL $273.10 10/1/2018 River Hosp CDM ULTRASOUND ABD COMP BEDSIDE 76700 $273.85 10/1/2018 River Hosp CDM COLPOSCOPY CERVIX VAGINA (GYN) 57452 $274.55 10/1/2018 River Hosp CDM C1 EST INH FUNC 86161 $274.65 10/1/2018 River Hosp CDM EXC BGN LSN 0.6-1.0 (GEN) 11421 $274.85 10/1/2018 River Hosp CDM 60 PHYSHOTHERAPY SEP E/M PHP 90838 $275.05 10/1/2018 River Hosp CDM 60 MIN PSYCH W/ SEP E/M RCWP 90838 $275.05 10/1/2018 River Hosp CDM STOOL FOR H PYLORI 87338 $275.65 10/1/2018 River Hosp CDM REM FOREIGN BODY EXT AUDITORY 69200 $275.85 10/1/2018

River Hosp CDM COMPLEX REPAIR>7.5CM EYE,EAR+ 13153 $275.95 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 5 PHP 99205 $275.95 10/1/2018 River Hosp CDM TESTOSTERONE, FREE 84402 $276.10 10/1/2018 River Hosp CDM TCM MODERATE 99495 $276.15 10/1/2018 River Hosp CDM CLOSED DISTAL PHALANX 26750 $276.55 10/1/2018 River Hosp CDM REMOVAL SKIN TAG UP TO 15(GEN) 11200 $276.60 10/1/2018 River Hosp CDM EXC THROMBOSED HEMORRHOID EXT 46320 $276.70 10/1/2018 River Hosp CDM ABD PARACENTESIS W/IMAGING GUI 49083 $277.00 10/1/2018 River Hosp CDM NAIL BED PROCEDURE $277.15 10/1/2018 River Hosp CDM HYDROXYPROLINE URINE TOTAL 83505 $277.15 10/1/2018 River Hosp CDM OFFICE VISIT LVL 5 (ESTAB) PC 99215 $277.40 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 5 EST (PC) 99215 $277.40 10/1/2018 River Hosp CDM O/V LVL 5 EST CARDIO PC 99215 $277.40 10/1/2018 River Hosp CDM OFFICE VST LVL 5 EST PC (GYN) 99215 $277.40 10/1/2018 River Hosp CDM OFFICE VISIT LVL 5 EST PC OPTH 99215 $277.40 10/1/2018 River Hosp CDM OFFICE VST LVL 5 EST PC (ENT) 99215 $277.40 10/1/2018 River Hosp CDM OFFICE VISIT LVL 5 EST PC(GEN) 99215 $277.40 10/1/2018 River Hosp CDM O/V LVL 5 ESTAB PC CLN2 99215 $277.40 10/1/2018 River Hosp CDM DR OFF VISIT LVL 5 EST PC CLN2 99215 $277.40 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 5 PC 99215 $277.40 10/1/2018 River Hosp CDM ESTAB PAT LEVEL 5 PC RCWP 99215 $277.40 10/1/2018 River Hosp CDM TELE ESTAB PAT LVL 5 PC RCWP 99215 $277.40 10/1/2018 River Hosp CDM TELE EST PAT LEVEL 5 PC PSCY 99215 $277.40 10/1/2018 River Hosp CDM OMT 5-6 BODY REGIONS 98927 $278.20 10/1/2018 River Hosp CDM TNKASE 1MG/.2ML $278.70 10/1/2018 River Hosp CDM DEBRIDEMENT 5-10% SURFACE 16025 $279.15 10/1/2018 River Hosp CDM PROLONGED SERVICE W/O DPC 99358 $279.15 10/1/2018 River Hosp CDM MAMMO UNILAT DIAGNOSTIC 77065 $279.20 10/1/2018 River Hosp CDM CRITICAL CARE ADDITIONAL 30MIN 99292 $279.45 10/1/2018 River Hosp CDM SHAVE LESION 0.6-1.0 CM 11311 $279.85 10/1/2018 River Hosp CDM FREE T3 84481 $280.40 10/1/2018 River Hosp CDM SPINE THOR AP + LAT 72070 $280.90 10/1/2018 River Hosp CDM FIT/INSERT PESS/INTRAV DEV GYN 57160 $281.25 10/1/2018 River Hosp CDM CYCLOSPORINE 80158 $282.45 10/1/2018 River Hosp CDM EXC NAIL PLATE P OR C (GEN) 11730 $282.50 10/1/2018 River Hosp CDM EXC BENIGN LESION 1.1 TO 2.0CM 11402 $283.55 10/1/2018 River Hosp CDM INJECTION ANEST FACIAL NERVE $283.85 10/1/2018 River Hosp CDM LACOSSAMIDE 83789 $284.50 10/1/2018 River Hosp CDM INJ GREATER OCCIP NERVE (ER) 64405 $285.20 10/1/2018 River Hosp CDM PROTHROMBIN FRAGMENT 1.2 83520 $285.35 10/1/2018 River Hosp CDM FLUTICASONE FLOVENT .44mg INH $285.55 10/1/2018 River Hosp CDM TICK ID 87476 $285.65 10/1/2018 River Hosp CDM TICK ID 87476 $285.65 10/1/2018 River Hosp CDM DESTRUCT LESION VULVA SIMPLE 56501 $285.75 10/1/2018 River Hosp CDM BARD 14G BIOSPY PROBE $286.00 10/1/2018 River Hosp CDM SPINE THORACIC 4 VIEWS 72074 $286.15 10/1/2018 River Hosp CDM BROMFENAC 0.09% OPTH SOL 2.5ml $286.45 10/1/2018

River Hosp CDM PNEUMOTHORAX KIT ARROW $286.85 10/1/2018 River Hosp CDM INJECT EPIDURAL PATCH 62273 $286.95 10/1/2018 River Hosp CDM T-POD $287.15 10/1/2018 River Hosp CDM SIMPLE REPAIR 7.6CM TO 12.5CM 12015 $287.30 10/1/2018 River Hosp CDM INPT CONSULTATION LEVEL THREE 99253 $287.30 10/1/2018 River Hosp CDM TELEFLEX QUICK TRACH KIT $287.30 10/1/2018 River Hosp CDM ANNUAL WELL VISIT W/PPPS SUBSQ $287.80 10/1/2018 River Hosp CDM ULTRASOUND EXTREM LIM BEDSIDE 76882 $288.35 10/1/2018 River Hosp CDM ULTRASOUND EXTREM LIM BEDSIDE 76882 $288.35 10/1/2018 River Hosp CDM U/S EXTREMITY LIMITED 76882 $288.35 10/1/2018 River Hosp CDM BLEPHAROTOMY,DRN ABSC,EYELID 67700 $288.85 10/1/2018 River Hosp CDM PROB LACRIMAL CANALICULI 68840 $288.85 10/1/2018 River Hosp CDM REMOVAL EMBEDDED FB EYELID 67938 $289.25 10/1/2018 River Hosp CDM INSERT NON-BIO DRUG IMPLANT 11981 $289.35 10/1/2018 River Hosp CDM CITRATE, URINE 82507 $290.35 10/1/2018 River Hosp CDM ARTHROCENTESIS $291.20 10/1/2018 River Hosp CDM VERSATACK RE-LOADER $291.20 10/1/2018 River Hosp CDM OMT 7-8 BODY REGIONS 98928 $291.55 10/1/2018 River Hosp CDM FLOUR GUIDE FOR NEEDLE PLACMNT 77002 $291.55 10/1/2018 River Hosp CDM SURGWAND II 5MM $291.70 10/1/2018 River Hosp CDM XRAY ABDOMEN 2 VIEWS 74019 $291.95 10/1/2018 River Hosp CDM PROCRIT 10000 UNITS $292.90 10/1/2018 River Hosp CDM CALPROTECTIN 83993 $293.15 10/1/2018 River Hosp CDM SKIN TAF REMOVAL UP TO 15 11200 $293.20 10/1/2018 River Hosp CDM ORCHIECTOMY INGUINAL 00926 $294.25 10/1/2018 River Hosp CDM CERVICAL CERCLAGE 00948 $294.25 10/1/2018 River Hosp CDM CARDIOVERSION 00410 $294.25 10/1/2018 River Hosp CDM VENOUS CIRCULATION 00532 $294.25 10/1/2018 River Hosp CDM HYSTEROSCOPY 00952 $294.25 10/1/2018 River Hosp CDM HERNIA REP. U. AB 00750 $294.25 10/1/2018 River Hosp CDM ANORECTAL PROC 00902 $294.25 10/1/2018 River Hosp CDM HERNIA REP. L. AB 00830 $294.25 10/1/2018 River Hosp CDM UNDESCENDED TESTIS 00924 $294.25 10/1/2018 River Hosp CDM ORCHIOPEXY 00930 $294.25 10/1/2018 River Hosp CDM I&D DRAINAGE HEMATOMA, SEROMA 10140 $294.40 10/1/2018 River Hosp CDM INFLU DNA AMP PROBE QW 87502 $296.25 10/1/2018 River Hosp CDM LACERTATION REPAIR, SIMPLE ER 12001 $296.30 10/1/2018 River Hosp CDM MAMMO BILAT DIAGNOSTIC 77066 $297.15 10/1/2018 River Hosp CDM TMYPANOSTOMY INSERT VENT TUBE 69436 $297.45 10/1/2018 River Hosp CDM THROMBOLYSIS CORONARY BY IV 92977 $297.57 10/1/2018 River Hosp CDM THY STIMULATING IMMUNOGLOBULIN 84445 $298.85 10/1/2018 River Hosp CDM SIMPLE REPAIR 2.6-7.5cm 12002 $299.50 10/1/2018 River Hosp CDM SIMPLE REPAIR 2.6 CM-7.5 CM 12002 $299.50 10/1/2018 River Hosp CDM SIMPLE REPAIR 2.6-7.5 CM 12002 $299.50 10/1/2018 River Hosp CDM ENDROMETRIAL BIOPSY 58100 $299.90 10/1/2018 River Hosp CDM ARTHROCENTESIS $299.95 10/1/2018 River Hosp CDM THROMBOSED HEMMORRHOID $299.95 10/1/2018

River Hosp CDM ANIMAL BITE ER $299.95 10/1/2018 River Hosp CDM INCISION & DRAINAGE $299.95 10/1/2018 River Hosp CDM RECOVERY ROOM 271-300 MINUTES $299.95 10/1/2018 River Hosp CDM LARYNGOSCOPY,DIAGNOSTIC (ENT) 31505 $300.30 10/1/2018 River Hosp CDM B/A BRONCH PFT W/INTER 94060 $301.60 10/1/2018 River Hosp CDM BECLOMETHASON DIPRO INH $302.55 10/1/2018 River Hosp CDM SIMPLE RPR 2.5CM OR LESS (GEN) 12011 $302.70 10/1/2018 River Hosp CDM INTRAOSSEOUS INJ/INF OBS $302.80 10/1/2018 River Hosp CDM CIPRO HCL/HC OTIC SUSP 10ML $303.10 10/1/2018 River Hosp CDM FRACT NASAL INF TRUBINIT,THERA 30930 $303.10 10/1/2018 River Hosp CDM ANORECTAL EXAM,SURG W/ANES 45990 $303.10 10/1/2018 River Hosp CDM VITAMIN K 84597 $304.00 10/1/2018 River Hosp CDM CRITICAL CARE EA ADD'L 30MIN F 99292 $304.50 10/1/2018 River Hosp CDM RECOVERY ROOM 181-210 MINUTES $304.50 10/1/2018 River Hosp CDM CLOSED PHALANGEAL SHAFT 26720 $304.60 10/1/2018 River Hosp CDM PROLONGED SERVICE 1ST HOUR 99354 $304.95 10/1/2018 River Hosp CDM PROLONGED SERVICE 1ST HOUR 99354 $304.95 10/1/2018 River Hosp CDM PROLONGED SERV 1ST HOUR PHP 99354 $304.95 10/1/2018 River Hosp CDM INSERT NON TUNNEL CV CATH 36556 $305.15 10/1/2018 River Hosp CDM CENTRAL VENOUS CATHETER INSERT 36556 $305.15 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 2 99212 $305.25 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 2 99212 $305.25 10/1/2018 River Hosp CDM BOTOX INJ FOR MIGRAINES 64615 $305.55 10/1/2018 River Hosp CDM INSERTION NON-BIO DRUG DLV IMP 11981 $305.65 10/1/2018 River Hosp CDM EVALUTION SWALLOWING FUNCTION 92610 $305.95 10/1/2018 River Hosp CDM EVALUATE SWALLOWING FUNCTION 92610 $305.95 10/1/2018 River Hosp CDM RIBS BILAT INCL CHEST 4 VWS 71111 $307.20 10/1/2018 River Hosp CDM PT EVALUATION 45 MIN 97163 $307.40 10/1/2018 River Hosp CDM EPISTAT NASAL CATHER $308.00 10/1/2018 River Hosp CDM SIGMOIDOSCOPY;SNARE W/REMOVAL 45338 $308.20 10/1/2018 River Hosp CDM MALYUGIN RING 7.00 mm $308.65 10/1/2018 River Hosp CDM RN TRANS SYR $309.50 10/1/2018 River Hosp CDM ESOPHAGRAM 74220 $310.75 10/1/2018 River Hosp CDM REMV FB, SUBCUTANEOUS, SIMPLE 10120 $310.80 10/1/2018 River Hosp CDM INTERM REPAIR 2.6-7.5cm 12032 $310.80 10/1/2018 River Hosp CDM INTERM REPAIR NECK TO 2.5cm 12041 $310.80 10/1/2018 River Hosp CDM ASPIRATION OF ABSCESS 10160 $310.80 10/1/2018 River Hosp CDM INTERMED REPAIR TO 2.5cm 12031 $310.80 10/1/2018 River Hosp CDM DEBRID SKIN/SUBQ TIS 11042 $310.80 10/1/2018 River Hosp CDM LARGE >10% SURFACE 16030 $310.80 10/1/2018 River Hosp CDM I&R FOREIGN BODY SUBCUT 10120 $310.80 10/1/2018 River Hosp CDM WEDGE EXCISION SKIN NAIL FOLD 11765 $310.80 10/1/2018 River Hosp CDM SIMPLE REPAIR 12.6CM TO 20.0CM 12005 $310.80 10/1/2018 River Hosp CDM SIMPLE REPAIR 20.1 CM-30.0 CM 12006 $310.80 10/1/2018 River Hosp CDM SIMPLE REPAIR 12.6CM TO 20.0CM 12016 $310.80 10/1/2018 River Hosp CDM REPAIR WOUND 2.5 CM OR LESS 12031 $310.80 10/1/2018 River Hosp CDM REPAIR WOUND 2.6CM TO 7.5CM 12032 $310.80 10/1/2018

River Hosp CDM DEBRIDEMENT LARGE>10% SURFACE 16030 $310.80 10/1/2018 River Hosp CDM BIOPSY OF SKIN 11100 $310.80 10/1/2018 River Hosp CDM BIOPSY LESION 1, SIMPLE 11100 $310.80 10/1/2018 River Hosp CDM REMOV FB SUBCUTANEOUS, SIMPLE 10120 $310.80 10/1/2018 River Hosp CDM EXC WEDGE SKIN NAIL FOLD 11765 $310.80 10/1/2018 River Hosp CDM DESTRUCTION PENILE WARTS 54050 $310.80 10/1/2018 River Hosp CDM SHAV EPI/DERM LESION > 2.0CM 11303 $310.80 10/1/2018 River Hosp CDM REPAIR INTERMED 2.6-7.5CM 12032 $310.80 10/1/2018 River Hosp CDM BIOPSY LESION 1, SIMPLE (GEN) 11100 $310.80 10/1/2018 River Hosp CDM ASPIRATION OF ABSCESS (GEN) 10160 $310.80 10/1/2018 River Hosp CDM WEDGE EXC SKIN OF NAIL FOLD 11765 $310.80 10/1/2018 River Hosp CDM ASPIRATION OF CYST - GYN 10160 $310.80 10/1/2018 River Hosp CDM DEBRIDE SKIN/SUBSCUT TIS (GEN) 11042 $310.80 10/1/2018 River Hosp CDM BIOPSY SKIN LESION 11100 $310.80 10/1/2018 River Hosp CDM EXC MALG LSN 0.5 CM OR LESS 11640 $311.70 10/1/2018 River Hosp CDM INTRAOSSEOUS INJ/INF $311.90 10/1/2018 River Hosp CDM CUSTOM EYE PROCEDURE PACK $313.00 10/1/2018 River Hosp CDM CATHFLO $313.15 10/1/2018 River Hosp CDM ASPIRATION PHAR,ADN OR TONSILS 42999 $313.80 10/1/2018 River Hosp CDM VIT B6 84207 $313.85 10/1/2018 River Hosp CDM GRASPING 3 PRONG FORCEP $313.90 10/1/2018 River Hosp CDM SCREEN FOR HYPOGLYCEMIA X2 80305 $314.20 10/1/2018 River Hosp CDM VIRAL CULTURE 87252 $315.40 10/1/2018 River Hosp CDM ARTHREX COOLCUT ABLATOR 90 $316.75 10/1/2018 River Hosp CDM CAROTID DOPPLER UNILATERAL 93882 $317.15 10/1/2018 River Hosp CDM Probe Nasolacrimal Duct 68810 $317.15 10/1/2018 River Hosp CDM ABS CD4 AND CD8 COUNT 86360 $317.20 10/1/2018 River Hosp CDM HISTAMINE 83088 $317.90 10/1/2018 River Hosp CDM IND PSYCHOTH PT/FAM 60M PHY PH 90837 $317.95 10/1/2018 River Hosp CDM IND PSYCHOTH PT/FAM 60M RCWP 90837 $318.00 10/1/2018 River Hosp CDM DRUG SCREEN 80307 $318.00 10/1/2018 River Hosp CDM IND PSYHOTH PT/FAM 60MIN NONPH 90837 $318.00 10/1/2018 River Hosp CDM IND PSYCHOTH PT/FAM 60M RCWP 90837 $318.00 10/1/2018 River Hosp CDM IND PSYH PT/FAM 60M NONPH RCWP 90837 $318.00 10/1/2018 River Hosp CDM IND PSYH PT/FAM 60M NONPH CPSY 90837 $318.00 10/1/2018 River Hosp CDM IND PSYCH 60MIN PHY RCWP VISIT 90837 $318.00 10/1/2018 River Hosp CDM TOBRADEX OINTMENT $318.05 10/1/2018 River Hosp CDM WELCOME MCR INITIAL PREVENT $318.65 10/1/2018 River Hosp CDM PSYCH DIAG INTERVIEW EVL RCWP 90791 $318.85 10/1/2018 River Hosp CDM PSYCHIATRIC DIAG INTERVIEW EVL 90791 $318.85 10/1/2018 River Hosp CDM INITIAL PSYCH INTERVIEW NONPH 90791 $318.85 10/1/2018 River Hosp CDM VA IOP INITIAL EVAL 90791 $318.85 10/1/2018 River Hosp CDM PSYCH DIAG INTERVIEW EVL RCWP 90791 $318.85 10/1/2018 River Hosp CDM SACROILIAC JOINTS < 3V 72202 $319.40 10/1/2018 River Hosp CDM HOME VISIT 40 MIN FACE TO FACE 99349 $320.50 10/1/2018 River Hosp CDM KNOR PUSHER / SLOTTED CANNULA $320.80 10/1/2018 River Hosp CDM SMALL BOWEL (SM B) 74250 $321.00 10/1/2018

River Hosp CDM MIOSTAT 0.01% 1.5ML DROPS $321.25 10/1/2018 River Hosp CDM FLUID SAFE FMS, STRYKER $321.45 10/1/2018 River Hosp CDM ANOSCOPY DIAG INC COLLECTION 46607 $322.00 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 4 NEW (PC) 99204 $322.95 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 4 NEW (PC) 99204 $322.95 10/1/2018 River Hosp CDM O/V LVL 4 NEW CARDIO PC 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VST LVL 4 NEW PC (GYN) 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 NEW PC OPTH 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VISIT LVL 4 NEW ORHTO 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VST LVL 4 NEW PC (ENT) 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VST LVL 4 NEW PC (GEN) 99204 $322.95 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 4 NEW PC 99204 $322.95 10/1/2018 River Hosp CDM DR OFF VISIT LVL4 NEW PC CLN2 99204 $322.95 10/1/2018 River Hosp CDM PAIN MGMT O/V LEVEL 4 NEW PC 99204 $322.95 10/1/2018 River Hosp CDM INTEGRATED TUBING $323.75 10/1/2018 River Hosp CDM IV INFUS/HYDRATION 1HR CLN 96360 $325.45 10/1/2018 River Hosp CDM PRO-INSULIN 84206 $325.60 10/1/2018 River Hosp CDM EXC BNGN LSN 0.6 - 1.0 CM 11441 $325.60 10/1/2018 River Hosp CDM INSERT/PLACE HEART CATH 93503 $326.20 10/1/2018 River Hosp CDM SIGMOIDOSCOPY,FLEX W/ABLATION 45346 $326.65 10/1/2018 River Hosp CDM COMPLEX REPAIR FOREHEAD EA ADD 13133 $327.05 10/1/2018 River Hosp CDM BONIVA 150MG TAB $327.15 10/1/2018 River Hosp CDM DEST OF LSN PEN SIMPL SURG EXC 54060 $328.35 10/1/2018 River Hosp CDM SIMPLE REPAIR 7.6-12.5cm 12004 $328.90 10/1/2018 River Hosp CDM PRUDOXIN (ZONALON) 5% 30GM TUB $329.00 10/1/2018 River Hosp CDM REMOVAL FOREIGN BODY INTRANASA 30300 $329.45 10/1/2018 River Hosp CDM RECOVERY ROOM 301-330 MINUTES $329.95 10/1/2018 River Hosp CDM REMOV FB CORNEA W/O SLITLAMP 65220 $330.01 10/1/2018 River Hosp CDM REMOV FB EYE CONJUCT EMBEDDED 65210 $330.01 10/1/2018 River Hosp CDM REMOV FB PHARYNX 42809 $330.01 10/1/2018 River Hosp CDM NASO OR NOGASTRIC TUBE PLACE 43752 $330.01 10/1/2018 River Hosp CDM REM FB EYE CORNEAL W/O S LAMP 65220 $330.01 10/1/2018 River Hosp CDM REMOVE DRUG DEL IMPLANT (GEN) 11982 $330.01 10/1/2018 River Hosp CDM IOL, OTHER STD POSTERIOR MN60M V2632 $330.15 10/1/2018 River Hosp CDM DENTOALVEOLAR STRUCTURE 41899 $330.55 10/1/2018 River Hosp CDM PSYCHOTHERAPY FOR CRISIS 1-60 90839 $331.55 10/1/2018 River Hosp CDM PSYCHOTHERAPY FOR CRISIS RCWP 90839 $331.55 10/1/2018 River Hosp CDM PSYCHOTHERAPY FOR CRISIS CPSY 90839 $331.55 10/1/2018 River Hosp CDM CEFTAROLINE 600 MG IV VIAL $331.60 10/1/2018 River Hosp CDM CYANIDE ANTIDOTE PKG $331.85 10/1/2018 River Hosp CDM EXC CHALAZION; MULT SAME LID 67801 $331.95 10/1/2018 River Hosp CDM SPINE LUMBAR COMP 72110 $333.00 10/1/2018 River Hosp CDM DESTRUCT LSN ANUS SIMPLE ELECT 46910 $333.60 10/1/2018 River Hosp CDM HIP W/ PELVIS 2-3 VIEWS 73502 $333.85 10/1/2018 River Hosp CDM INCISION & DRAINAGE 10060 $335.45 10/1/2018 River Hosp CDM I&D OF ABSCESS (GEN) 10060 $335.45 10/1/2018 River Hosp CDM I&D ABSCESS SIMPLE 10060 $335.45 10/1/2018

River Hosp CDM XRAY ABD 3 OR MORE VIEWS 74021 $335.75 10/1/2018 River Hosp CDM CATECHOLAMINES, FRACT PLASMA 82384 $335.75 10/1/2018 River Hosp CDM CATECHOLAMINES, FRACTIONATED 82384 $335.75 10/1/2018 River Hosp CDM IV INFUS/MEDS 1 HR 96365 $336.25 10/1/2018 River Hosp CDM IV INFUS/MEDS 1HR CLN 96365 $336.25 10/1/2018 River Hosp CDM TOBRADEX DROPS $337.15 10/1/2018 River Hosp CDM ARTERIAL DOPPLER UNI LOW EXTRM 93926 $337.60 10/1/2018 River Hosp CDM EXC BNGN LSN 1.1-2 (GEN) 11422 $337.65 10/1/2018 River Hosp CDM EXC LSN BENIGN 1.1 - 2.0 (GYN) 11422 $337.65 10/1/2018 River Hosp CDM DESTRUCT LESION LID MARGIN<1CM 67850 $337.70 10/1/2018 River Hosp CDM VARICELLA VACCINE 90716 $337.95 10/1/2018 River Hosp CDM GARDASIL 90651 $338.30 10/1/2018 River Hosp CDM HIGH RESOLUTION HRA 46601 $338.85 10/1/2018 River Hosp CDM BESIVANCE 0.6% 5mlOPTH SUSPNSN $339.80 10/1/2018 River Hosp CDM ENDOMETRIAL W/WO ENDOCERV BIOP 58100 $341.70 10/1/2018 River Hosp CDM ARTERIAL DOPPLER UNI UPPER EXT 93931 $342.45 10/1/2018 River Hosp CDM ENDOSERTER CORNEAL IMPLANT $342.60 10/1/2018 River Hosp CDM CL TREATMENT FX TOE,PHALANX 28495 $344.40 10/1/2018 River Hosp CDM SPINE CERV 4 VIEW 72050 $344.45 10/1/2018 River Hosp CDM RECOVERY ROOM 211-240 MINUTES $345.10 10/1/2018 River Hosp CDM ENDOTRACHEAL INTUBATION $345.25 10/1/2018 River Hosp CDM HEPATITIS PANEL 80074 $345.40 10/1/2018 River Hosp CDM PLATELET AB 86022 $345.85 10/1/2018 River Hosp CDM IOL, TECNIS PCB00 AMO MONO V2630 $347.30 10/1/2018 River Hosp CDM IOL, TECNIS ZCB00 AMO MONO V2630 $347.30 10/1/2018 River Hosp CDM IOL, TECNIS ZA9003 AMO MONO V2630 $347.30 10/1/2018 River Hosp CDM MULTIFOCAL P-C IOL TECNIS COVD $347.30 10/1/2018 River Hosp CDM IOL COVD MULTIFOCAL REZOOM $347.30 10/1/2018 River Hosp CDM IOL,MTA4U0 ANTERIOR ALCON V2630 $347.30 10/1/2018 River Hosp CDM MULTIFOCAL P-C IOL RESTORE CVD $347.30 10/1/2018 River Hosp CDM TORIC A-C IOL COVERED $347.30 10/1/2018 River Hosp CDM SOFTSILK 2.0SCR 7x20 IN LTX FR $348.50 10/1/2018 River Hosp CDM HCV AB RIB 86804 $348.50 10/1/2018 River Hosp CDM INJ TRIGGER 1 OR 2 MUSCLES CLN 20552 $348.50 10/1/2018 River Hosp CDM I&D ABCESS COMPLICATED 10061 $349.30 10/1/2018 River Hosp CDM GASTRIC EMPTYING STUDY 78264 $349.44 10/1/2018 River Hosp CDM PROLONGED SERVICE RCWP 99354 $350.50 10/1/2018 River Hosp CDM REPAIR COMPLEX EYELID EA ADDL 13153 $352.00 10/1/2018 River Hosp CDM PSYCH EVAL - SNF 90801 $352.75 10/1/2018 River Hosp CDM U/S SCRN NUCHAL TRANSLUCENCY 76813 $353.05 10/1/2018 River Hosp CDM INTERM REPAIR FACE TO 2.5cm 12051 $353.15 10/1/2018 River Hosp CDM BLOOD TRANSFUSION $354.05 10/1/2018 River Hosp CDM BLOOD TRANSFUSION $354.05 10/1/2018 River Hosp CDM ACETYLCHOLINE RECEPTOR AB 84238 $355.10 10/1/2018 River Hosp CDM UPPER GI ENDOSCOPY W/BIOPSY 43239 $355.70 10/1/2018 River Hosp CDM CONSULTATION LVL4 (NEW/EST PT) 99244 $356.30 10/1/2018 River Hosp CDM INSERT EMERGENCY AIRWAY 31500 $356.75 10/1/2018

River Hosp CDM ENDOTRACHEAL INTUBATION PHYS 31500 $356.75 10/1/2018 River Hosp CDM ULTRASOUND ABD LIM BEDSIDE 76705 $357.50 10/1/2018 River Hosp CDM ABDOMEN LIMITED 76705 $357.50 10/1/2018 River Hosp CDM ABDOMEN LIMITED U/S APG 76705 $357.50 10/1/2018 River Hosp CDM PSYCH DIAG EVAL/MEDSVC RCWP 90792 $357.90 10/1/2018 River Hosp CDM PSYCHIATRIC DIAG EVAL W/MEDSVC 90792 $357.90 10/1/2018 River Hosp CDM PSYCH DIAG EVAL/MEDSVC RCWP 90792 $357.90 10/1/2018 River Hosp CDM INTUBATION, ENDOTRACHEAL 31500 $359.35 10/1/2018 River Hosp CDM INTUBATION ENDOTRACHAEL EMERG 31500 $359.35 10/1/2018 River Hosp CDM TOBRADEX OINTMENT $359.80 10/1/2018 River Hosp CDM RECOVERY ROOM 331-360 MINUTES $359.90 10/1/2018 River Hosp CDM EPI-PEN JR 0.15MG SYRINGE $359.90 10/1/2018 River Hosp CDM SEROTONIN BLOOD 84260 $361.15 10/1/2018 River Hosp CDM TREATMENT WOUND W/ PACKING 12021 $362.65 10/1/2018 River Hosp CDM OPEN PROCEDURE HIP JOINT 01210 $363.00 10/1/2018 River Hosp CDM INJ GREATER OCCIP NERVE 64405 $363.25 10/1/2018 River Hosp CDM ANDROSTENEDIONE 82157 $363.55 10/1/2018 River Hosp CDM INCISION & REMOVAL TISSUE 10120 $364.15 10/1/2018 River Hosp CDM BICILLAN L-A 200,000/2ML SYR J0561 $364.40 10/1/2018 River Hosp CDM CONTROL NASAL HEMOR ANTER(ENT) 30901 $364.70 10/1/2018 River Hosp CDM U/S BREAST BILATERAL COMPLETE 76641 $365.05 10/1/2018 River Hosp CDM EXC BNGN LSN 2.1-3 (GEN) 11403 $366.05 10/1/2018 River Hosp CDM CULDOSCOPY 00950 $366.30 10/1/2018 River Hosp CDM EAR 00120 $366.30 10/1/2018 River Hosp CDM NOSE 00160 $366.30 10/1/2018 River Hosp CDM PROCEDURE ON EYE 00140 $366.30 10/1/2018 River Hosp CDM INTEGUM HEAD&BIOPSY 00100 $366.30 10/1/2018 River Hosp CDM INTRAORAL 00170 $366.30 10/1/2018 River Hosp CDM NECK INTEGUMENTARY 00300 $366.30 10/1/2018 River Hosp CDM THYROID IMAGING 78010 $366.30 10/1/2018 River Hosp CDM FX/DISLOCATION REDUC/SIMPLE $366.90 10/1/2018 River Hosp CDM Excise Conjunctiva Lesion <1cm 68110 $368.90 10/1/2018 River Hosp CDM MYRINGOTOMY INCL ASPIRATION 69421 $369.05 10/1/2018 River Hosp CDM OMT 9-10 BODY REGIONS 98929 $369.25 10/1/2018 River Hosp CDM SIMP REPAIR FACE 2.6-5.0 CM 12013 $370.10 10/1/2018 River Hosp CDM FASTFIX 360 KNOTPUSHER/SUT CUT $370.35 10/1/2018 River Hosp CDM TRUEPASS NEEDLES BOX OF 5 $371.20 10/1/2018 River Hosp CDM INTERM REPAIR NECK 2.6-7.5cm 12042 $371.40 10/1/2018 River Hosp CDM OFFICE VISIT LVL5 (NEW PT) 99205 $372.55 10/1/2018 River Hosp CDM OFFICE VISIT LVL5 NEW PT FAC 99205 $372.55 10/1/2018 River Hosp CDM NEW PT FACILITY LEVEL 5 RCWP 99205 $372.55 10/1/2018 River Hosp CDM EYE SUTURE DURING SURGERY 67335 $372.55 10/1/2018 River Hosp CDM FLUOR GUIDE FOR DIAG/THER INJ 77003 $372.75 10/1/2018 River Hosp CDM VENOUS DOPPLER UNILATERAL 93971 $373.00 10/1/2018 River Hosp CDM CLOSED TREATMENT FX PHALANX 28515 $373.20 10/1/2018 River Hosp CDM FX GR TOE/PHALANX/ W/MANIPULAT 28495 $373.70 10/1/2018 River Hosp CDM SPINE ENTIRE AP/LAT 72082 $374.35 10/1/2018

River Hosp CDM SPINE ENTIRE 2 VIEWS 72082 $374.35 10/1/2018 River Hosp CDM PESSARY SIZE 5 $375.00 9/1/2018 River Hosp CDM CL TREATMEAT NASAL BONE FX 21315 $376.75 10/1/2018 River Hosp CDM SIMPLE REPAIR OVER 30.0 CM 12007 $376.85 10/1/2018 River Hosp CDM PSYCH INTERACTIVE EVAL - SNF 90802 $377.90 10/1/2018 River Hosp CDM FX/DISLOCATION RED.,SIMPLE $377.90 10/1/2018 River Hosp CDM IPRATROPIUM BROMIDE 14 GM AER $378.20 10/1/2018 River Hosp CDM SIMPLE REPAIR 20.1CM TO 30.0CM 12017 $378.90 10/1/2018 River Hosp CDM TRIESENSE 40MG/ML SUSPENSION $379.15 10/1/2018 River Hosp CDM SIMP REPAIR FACE 5.1-7.5 CM 12014 $380.00 10/1/2018 River Hosp CDM SING LAYER AMNIOTIC MEM SUTURE 65779 $380.40 10/1/2018 River Hosp CDM DESFLURANE BOTTLE $382.65 10/1/2018 River Hosp CDM COLPOSCOPY W/BIOPSY CERVIX 57455 $382.95 10/1/2018 River Hosp CDM REMOVAL FOREIGN BODY SHOULDER 23330 $383.10 10/1/2018 River Hosp CDM CONSULTATION LEVEL 4 PC (GEN) 99244 $384.55 10/1/2018 River Hosp CDM PAIN MGMT CONSULT LEVEL 4 99244 $384.55 10/1/2018 River Hosp CDM HYSTEROSCOPY DIAGNOSTIC 58555 $384.55 10/1/2018 River Hosp CDM RESPITE IP SEMI $385.75 10/1/2018 River Hosp CDM RESPITE SWG $385.75 10/1/2018 River Hosp CDM EXTENDED FLUOROSCOPY 76000 $387.50 10/1/2018 River Hosp CDM POSTERIOR 30905 $387.85 10/1/2018 River Hosp CDM PRIVIGEN 5 GM $389.05 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 3 99213 $389.90 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 3 99213 $389.90 10/1/2018 River Hosp CDM RECOVERY ROOM 361-390 MINUTES $389.90 10/1/2018 River Hosp CDM EXC BGN LSN 2.1-3.0 CM (GEN) 11423 $390.15 10/1/2018 River Hosp CDM KILLER CELL FUNCTION $392.30 10/1/2018 River Hosp CDM Remove Eyelid Lesion 67840 $393.60 10/1/2018 River Hosp CDM REMOVAL NONBIO DRUG DEL IMPLAN 11982 $393.65 10/1/2018 River Hosp CDM REPAIR WOUND 2.5CM OR LESS 12041 $394.55 10/1/2018 River Hosp CDM METHYLPREDN SOD SUCC 1GM INJ $394.75 10/1/2018 River Hosp CDM THORACENTESIS W/IMAGING GUIDE 32555 $395.95 10/1/2018 River Hosp CDM SPHINCTEROTOMY,ANAL SEP PROC 46080 $397.15 10/1/2018 River Hosp CDM TRAVOPROST EYE DROPS $398.50 10/1/2018 River Hosp CDM COLONOSCOPY THROUGH STOMA 44388 $398.60 10/1/2018 River Hosp CDM CHLORINATED PESTICIDE EXPOSURE 82441 $399.90 10/1/2018 River Hosp CDM TCM HIGH 99496 $400.00 10/1/2018 River Hosp CDM LARYNGOSCOPY,FLEXIBLE (ENT) 31575 $400.30 10/1/2018 River Hosp CDM NURSEMAID ELBOW - ER 24640 $400.60 10/1/2018 River Hosp CDM OB<14 WKS 76801 $400.60 10/1/2018 River Hosp CDM MONOFOCAL LENS $400.95 10/1/2018 River Hosp CDM NASAL/SINUS ENDOSCOPY W/BIOPSY 31237 $401.25 10/1/2018 River Hosp CDM IOL, SN60WF &SN60AT ALCON MONO V2632 $402.70 10/1/2018 River Hosp CDM IOL,MN60AC POSTERIOR ALCON V2632 $402.70 10/1/2018 River Hosp CDM IOL, SV25T0 MULTIFOCAL ALCON $402.70 10/1/2018 River Hosp CDM TORIC A-C IOL NON-COVERED $402.70 10/1/2018 River Hosp CDM EXC BGN LSN 3.1 - 4.0 CM 11404 $402.75 10/1/2018

River Hosp CDM PLACEMENT OF SETON 46020 $403.25 10/1/2018 River Hosp CDM IOL, AU00TO PRELOADED ALCON MO $403.50 10/1/2018 River Hosp CDM IGF-1 84305 $404.35 10/1/2018 River Hosp CDM FLUTICASONE FLOVENT .11MG INH $405.25 10/1/2018 River Hosp CDM TISSUE CULTURE;LYMPHOCYTE 88230 $405.50 10/1/2018 River Hosp CDM COLPOSCOPY OF CERVIX W/ LOOP 57460 $405.65 10/1/2018 River Hosp CDM COLPOSCOPY CERVIX WITH LOOP 57460 $405.65 10/1/2018 River Hosp CDM Probe NL Duct w/Balloon 68816 $405.75 10/1/2018 River Hosp CDM ER VISIT LEVEL 2 99282 $406.00 10/1/2018 River Hosp CDM RECOVERY ROOM 241-270 MINUTES $406.00 10/1/2018 River Hosp CDM FINGER IP JOINT 26770 $408.85 10/1/2018 River Hosp CDM CARDIOVERSION/DEFIBRILLATION $409.05 10/1/2018 River Hosp CDM EXC CHALAZION MULT DIFF LIDS 67805 $409.75 10/1/2018 River Hosp CDM REPAIR LAC 2.5CM OR LESS MOUTH 41250 $410.65 10/1/2018 River Hosp CDM REMOVAL FB AUDITORY CANAL(ENT) 69200 $410.75 10/1/2018 River Hosp CDM CLAVICLE, CLOSED 23500 $411.40 10/1/2018 River Hosp CDM I&D BARTHOLIN GLAND ABCESS 56420 $412.90 10/1/2018 River Hosp CDM IOL ROUTINE ASCAN 76519 $413.00 10/1/2018 River Hosp CDM CORRECTION OF EVERTED PUNCTUM 68705 $413.55 10/1/2018 River Hosp CDM ADVAIR 500/50 $414.80 10/1/2018 River Hosp CDM OPES ASPIRATING ABALATOR $415.80 10/1/2018 River Hosp CDM ANTREX COOL CUT 90* $415.80 10/1/2018 River Hosp CDM CUSTOM EYE PAK DR. KOLOMS $415.90 10/1/2018 River Hosp CDM GENERAL HEALTH PANEL 80050 $416.35 10/1/2018 River Hosp CDM INPT CONSULTATION LEVEL FOUR 99254 $417.55 10/1/2018 River Hosp CDM ANESTH W/HYPOTHERMIA 5 UNITS 99116 $418.20 10/1/2018 River Hosp CDM SPEC ANESTH PROC 5 UNITS 99135 $418.20 10/1/2018 River Hosp CDM LACERATION REPAIR, INTERMED $419.95 10/1/2018 River Hosp CDM RECOVERY ROOM 391-420 MINUTES $419.95 10/1/2018 River Hosp CDM PLASMA PORPHYRIN 84311 $419.95 10/1/2018 River Hosp CDM CMV PCR QUANT TEST 87497 $419.95 10/1/2018 River Hosp CDM CT ANGIO ABD/PEL W/CONT NO 3D 74174 $420.05 10/1/2018 River Hosp CDM NASAL/SINUS ENDOSCOPY SURG 31238 $420.40 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 5 NEW (PC) 99205 $420.60 10/1/2018 River Hosp CDM DR OFFICE VISIT LVL 5 NEW (PC) 99205 $420.60 10/1/2018 River Hosp CDM O/V LVL 5 NEW CARDIO PC 99205 $420.60 10/1/2018 River Hosp CDM OFFICE VST LVL 5 NEW PC (GYN) 99205 $420.60 10/1/2018 River Hosp CDM OFFICE VISIT LVL 5 NEW PC OPTH 99205 $420.60 10/1/2018 River Hosp CDM OFFICE VST LVL 5 NEW PC (ENT) 99205 $420.60 10/1/2018 River Hosp CDM OFFICE VST LVL 5 NEW PC (GEN) 99205 $420.60 10/1/2018 River Hosp CDM OFFICE VISIT LEVEL 5 NEW PC 99205 $420.60 10/1/2018 River Hosp CDM DR OFF VISIT LVL5 NEW PC CLN2 99205 $420.60 10/1/2018 River Hosp CDM DILATION ANAL SPHINCTER 45905 $420.75 10/1/2018 River Hosp CDM CARDIOVERSION/DEFIBRILLATION $421.35 10/1/2018 River Hosp CDM BOOTINSERT PAD ASU $423.65 10/1/2018 River Hosp CDM CARPEL TUNNEL INJECTION TC 20526 $423.75 10/1/2018 River Hosp CDM ANNUAL WELL VISIT W/PPPS INIT $425.70 10/1/2018

River Hosp CDM ROTAVIRUS VACCINE HUMAN 2 DOSE 90681 $426.45 10/1/2018 River Hosp CDM EXCISION CHALAZION SINGLE 67800 $427.60 10/1/2018 River Hosp CDM VIP LEVEL 84586 $428.25 10/1/2018 River Hosp CDM INTERM REPAIR FACE TO 2.5cm 12051 $428.95 10/1/2018 River Hosp CDM EXC MULT EXT PAP OR TAGS,ANUS 46230 $430.55 10/1/2018 River Hosp CDM INTERM REPAIR FACE 2.6-5.0cm 12052 $431.70 10/1/2018 River Hosp CDM REPAIR OF ANAL FISTULA/FIBRIN 46706 $432.45 10/1/2018 River Hosp CDM CARTER THOMASON LG $432.95 10/1/2018 River Hosp CDM INTERM REPAIR FACE 2.5 CM 12051 $433.15 10/1/2018 River Hosp CDM DRAINAGE ABSCESS CYST DENTOALV 41800 $433.30 10/1/2018 River Hosp CDM ACTH, EDTA PLAS 82024 $435.35 10/1/2018 River Hosp CDM ACYCLOVIR OIN 5%/15gm $435.50 10/1/2018 River Hosp CDM EXC BNGN LSN 1.1-2.0CM (GEN) 11402 $436.80 10/1/2018 River Hosp CDM ARTROSCOPIC PACK, CUSTOM $437.15 10/1/2018 River Hosp CDM VAG HYSTERECTOMY 00944 $438.95 10/1/2018 River Hosp CDM NECK 00320 $438.95 10/1/2018 River Hosp CDM CLOSED CHEST PROC 00520 $438.95 10/1/2018 River Hosp CDM HERNIA LUM/VENT 00752 $438.95 10/1/2018 River Hosp CDM HERNIA VENT/INCISION 00832 $438.95 10/1/2018 River Hosp CDM INTRAPERITIONEAL LOWER ABD 00840 $438.95 10/1/2018 River Hosp CDM EBV PCR QUANT TEST 87799 $439.35 10/1/2018 River Hosp CDM BK VIRUS 87799 $439.35 10/1/2018 River Hosp CDM COLONSCOPY THROUGH STOMA W/BX 44389 $439.45 10/1/2018 River Hosp CDM W/DECOMPRESSION SUBACROMIAL SP 29826 $440.00 10/1/2018 River Hosp CDM HCV PCR QUANT 87522 $440.40 10/1/2018 River Hosp CDM HEP C VIRUS RNA QNT 87522 $440.40 10/1/2018 River Hosp CDM TROCARES W/ SLEEVES 100mm $440.45 10/1/2018 River Hosp CDM I&D COMPLEX POST OP INFECTED 10180 $440.65 10/1/2018 River Hosp CDM ENDO CLIP 5MM $443.15 10/1/2018 River Hosp CDM EXC BNGN LSN 2.1-3.0CM FACE... 11443 $443.15 10/1/2018 River Hosp CDM HOME VISIT 60 MIN 99350 $444.15 10/1/2018 River Hosp CDM INTENSIVE OP TREATMENT $446.10 10/1/2018 River Hosp CDM MARSUP BARTHOLINS GLAND CYST 56440 $446.25 10/1/2018 River Hosp CDM BIOPSY OF LIP (ENT) 40490 $446.30 10/1/2018 River Hosp CDM I&D ABSCESS COMPLICATED 10061 $447.15 10/1/2018 River Hosp CDM INTERM REPAIR 7.6-12.5cm 12034 $447.45 10/1/2018 River Hosp CDM SPINE CERV COMP 72052 $447.60 10/1/2018 River Hosp CDM RECOVERY ROOM 421-450 MINUTES $449.90 10/1/2018 River Hosp CDM SIMPLE REPAIR 12.6-20cm 12005 $450.15 10/1/2018 River Hosp CDM ABDOMEN ACUTE COMPL W/CHEST 74022 $451.50 10/1/2018 River Hosp CDM ABDOMEN ACUTE 3V APG 74022 $451.50 10/1/2018 River Hosp CDM I & D OF ABSCESS COMPL/MULTI 10061 $451.85 10/1/2018 River Hosp CDM CORO/SAG RECONSTRUCT 76376 $452.00 10/1/2018 River Hosp CDM CLOSED TX DISTAL PHALANGEAL FX 26750 $453.40 10/1/2018 River Hosp CDM INC/REM FB SUBCUT 10120 $453.45 10/1/2018 River Hosp CDM REMOVAL FOREIGN BDY SMPL (GEN) 10120 $453.45 10/1/2018 River Hosp CDM INTERM REPAIR NECK 7.6-12.5cm 12044 $454.05 10/1/2018

River Hosp CDM HOME VISIT 60 MINUTES NEW PAT 99344 $455.85 10/1/2018 River Hosp CDM ARTHROGRAPHY SHOULDER W/SPRVSN 73040 $456.34 10/1/2018 River Hosp CDM SWG- SEMI PRIVATE $456.75 10/1/2018 River Hosp CDM EXC PILONIDAL CYST/SINUS; SIMP 11770 $457.00 10/1/2018 River Hosp CDM REM W/REINSERTION NON BIO DRUG 11983 $457.30 10/1/2018 River Hosp CDM PERITONEOCENTESIS, ABD OR LAV $457.75 10/1/2018 River Hosp CDM SPINE ENTIRE MINIMUN 6 VIEWS 72084 $458.00 10/1/2018 River Hosp CDM EXCISION NAIL & NAIL MATRIX 11750 $458.55 10/1/2018 River Hosp CDM EXCISION OF NAIL P OR C 11750 $458.55 10/1/2018 River Hosp CDM EXC TOENAIL PERMANENT (GEN) 11750 $458.55 10/1/2018 River Hosp CDM SPINE ENTIRE 4 OR 5 VIEWS 72083 $458.70 10/1/2018 River Hosp CDM PARITEX MESH 5.2 x 3.6 $458.80 10/1/2018 River Hosp CDM BIOPSY EXTERNAL EAR (ENT) 69100 $459.87 10/1/2018 River Hosp CDM PEDIATRIC HIPS 76885 $459.90 10/1/2018 River Hosp CDM EXC MALGN LSN 1.1-2.0 CM 11642 $460.05 10/1/2018 River Hosp CDM TESTICULAR 76870 $460.35 10/1/2018 River Hosp CDM TESTICULAR U/S APG 76870 $460.35 10/1/2018 River Hosp CDM DEBRIDE,MASTOIDECTOMY (ENT) 69220 $460.55 10/1/2018 River Hosp CDM PICC LINE SUPPLIES $460.75 10/1/2018 River Hosp CDM UNLISTED ULTRASOUND OTHER 76999 $461.30 10/1/2018 River Hosp CDM U/S EXTREMITY COMPLETE 76881 $461.30 10/1/2018 River Hosp CDM BARIUM ENEMA W/AIR 74280 $461.80 10/1/2018 River Hosp CDM L HEMO CHROM 81401 $462.85 10/1/2018 River Hosp CDM BALOON DILATOR 10-11-12 $463.30 10/1/2018 River Hosp CDM NEUPOGEN 300 MCG $465.35 10/1/2018 River Hosp CDM PARTIAL HYMENECTOMY OR REVIS 56700 $465.65 10/1/2018 River Hosp CDM ARTERIAL LINE INSERT/TLC OBS $465.85 10/1/2018 River Hosp CDM COLPOSCOPY CERVIX W/ LOOP 57461 $468.40 10/1/2018 River Hosp CDM CLOSED TREATMENT OF SHOULDER 23650 $468.45 10/1/2018 River Hosp CDM THROMBOLYSIS CEREBRAL IV INFUS 37195 $468.95 10/1/2018 River Hosp CDM CONSULTATION LVL5 (NEW/EST PT) 99245 $469.70 10/1/2018 River Hosp CDM COLONOSCOPY DIAGNOSITIC 45378 $473.55 10/1/2018 River Hosp CDM PELVIC EXAM ER, COMPLEX $473.85 10/1/2018 River Hosp CDM DUP ART/VN ABD/PLV C 93975 $474.70 10/1/2018 River Hosp CDM CHLOROTHIAZIDE 500mg $475.95 10/1/2018 River Hosp CDM CONSULTATION LEVEL 5 (PC) 99245 $476.05 10/1/2018 River Hosp CDM PAIN MGMT CONSULT LEVEL 5 99245 $476.05 10/1/2018 River Hosp CDM 2.8 Q-FIX DISPOSABLE KIT $476.10 10/1/2018 River Hosp CDM EXC BNGN LSN 0.6-1.0CM (GEN) 11401 $477.90 10/1/2018 River Hosp CDM REM TUNNEL CENTRAL VENOUS DEV 36590 $478.35 10/1/2018 River Hosp CDM ARTERIAL LINE INSERTION/TLC $479.85 10/1/2018 River Hosp CDM BURN 3RD DEGREE $479.85 10/1/2018 River Hosp CDM FB REMOVAL TISSUE, COMPLEX $479.85 10/1/2018 River Hosp CDM TENDON REPAIR $479.85 10/1/2018 River Hosp CDM RECOVERY ROOM 451-480 MINUTES $479.85 10/1/2018 River Hosp CDM FINE NEEDL ASPIR W/O IMAG GUID 10021 $480.85 10/1/2018 River Hosp CDM NEXPLANON REMOVAL 11982 $481.15 10/1/2018

River Hosp CDM SIMP REPAIR FACE 7.6-12.5 CM 12015 $481.50 10/1/2018 River Hosp CDM LIGAMENT INJECTION: ORG INS TC 20551 $482.15 10/1/2018 River Hosp CDM CONSCIOUS SEDATION < 5 YRS OLD 99151 $482.30 10/1/2018 River Hosp CDM UPPER G.I. W/AIR 74247 $485.40 10/1/2018 River Hosp CDM BONE/JOINT IMAGING LTD AREA 78300 $485.45 10/1/2018 River Hosp CDM EXCISION BENIGN LESION FACE 11310 $485.85 10/1/2018 River Hosp CDM BLOOD TRANSFUSION 36430 $486.60 10/1/2018 River Hosp CDM TRANSFUSION BLOOD 36430 $486.60 10/1/2018 River Hosp CDM BLOOD TRANSFUSION ADMINISTRAT 36430 $486.60 10/1/2018 River Hosp CDM COLPOSCOPY OF CERVIX W/BIOPSY 57454 $486.65 10/1/2018 River Hosp CDM ARTERIAL DOPPLER BIL UPPER EXT 93930 $486.80 10/1/2018 River Hosp CDM ANES DIAG ARTHRO KNEE 01382 $487.20 10/1/2018 River Hosp CDM ANES OPEN PROC BONE LOWER LEG 01480 $487.20 10/1/2018 River Hosp CDM ANES LOWER INTESTINAL ENDO 00812 $487.20 10/1/2018 River Hosp CDM ANES UPPER GASTRIC ENDO 00731 $487.20 10/1/2018 River Hosp CDM RPR,WOUND 2.6-7.5 CM INTERMED 12032 $487.80 10/1/2018 River Hosp CDM DEBRIDEMENT 1ST 20 SQ CM 11043 $488.20 10/1/2018 River Hosp CDM NAILBED REPAIR 11760 $488.20 10/1/2018 River Hosp CDM SIMP CLOSURE/DEHISCENCE 12020 $488.20 10/1/2018 River Hosp CDM COMPLEX REPAIR SCALP TO 2.5cm 13120 $488.20 10/1/2018 River Hosp CDM COMPLEX REPAIR TRUNK TO 2.5cm 13100 $488.20 10/1/2018 River Hosp CDM TREATMENT SUPERFICIAL WOUND 12020 $488.20 10/1/2018 River Hosp CDM REPAIR WOUND 7.6-12.5 CM 12044 $488.20 10/1/2018 River Hosp CDM COMPLEX REPAIR TRUNK 2.5 CM 13100 $488.20 10/1/2018 River Hosp CDM REPAIR OF NAIL BED 11760 $488.20 10/1/2018 River Hosp CDM VERSAPORT 5m-8m $488.20 10/1/2018 River Hosp CDM REMOVAL CONTRACEPTIVE IMPLANT 11982 $488.20 10/1/2018 River Hosp CDM DEBRIDE SKIN UP TO 10% (GEN) 11000 $488.20 10/1/2018 River Hosp CDM DEBRIDE INFECTED SKIN 11000 $488.20 10/1/2018 River Hosp CDM BIOPHYSICAL PROFILE 76819 $488.95 10/1/2018 River Hosp CDM OB LIMITED 76815 $488.95 10/1/2018 River Hosp CDM EXC MALIG LESION 2.1-3.0 CM 11603 $490.35 10/1/2018 River Hosp CDM CL TX PHALNGL SHFT FX W/O MNPL 26720 $492.20 10/1/2018 River Hosp CDM CARDIOPULMONARY RESUSCITATION 92950 $492.55 10/1/2018 River Hosp CDM PARTIAL HOSPITALIZATION PRGRM $493.80 10/1/2018 River Hosp CDM PATHOLOGY CONSULT 88321 $494.85 10/1/2018 River Hosp CDM INTERM REPAIR FACE 5.1-7.5cm 12053 $495.95 10/1/2018 River Hosp CDM SUMATRIPTAN 6MG/0.5 INJ J3030 $496.30 10/1/2018 River Hosp CDM CIRCUMCISION OVER 28 DAYS OLD 54161 $496.75 10/1/2018 River Hosp CDM TISSEAL 2ML $497.90 10/1/2018 River Hosp CDM FEMTO LASER NON CVD $500.00 10/1/2018 River Hosp CDM SIMPLE REPAIR OVER 30.0 CM 12018 $502.25 10/1/2018 River Hosp CDM COROTID DOPPLER BILATERAL 93880 $502.75 10/1/2018 River Hosp CDM ARTERIAL DOPPLER BIL LOW EXTR 93925 $502.75 10/1/2018 River Hosp CDM CHRONIC URTICARIA PANEL 86352 $502.90 10/1/2018 River Hosp CDM INPT CONSULTATION LEVEL FIVE 99255 $503.40 10/1/2018 River Hosp CDM REDUCTION PROCIDENTIA SEP PROC 45900 $504.70 10/1/2018

River Hosp CDM CAPSULAR TENSION RING $505.00 10/1/2018 River Hosp CDM POSTPARTUM CARE ONLY 59430 $505.55 10/1/2018 River Hosp CDM HIPS BILATERAL MIN 5 VIEWS 73523 $505.80 10/1/2018 River Hosp CDM EXCISE CYST 0.6-1.0 11401 $506.60 10/1/2018 River Hosp CDM EXC BENIGN .6 TO 1.0CM TRUNK 11401 $506.60 10/1/2018 River Hosp CDM CLOSED TX METATARSAL FX EACH 28470 $506.70 10/1/2018 River Hosp CDM CL TX PROX FIB/SHFT 27780 $507.70 10/1/2018 River Hosp CDM CLOSED TX OF PROXIMAL FIB FX 27780 $507.70 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 4 99214 $509.85 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 4 99214 $509.85 10/1/2018 River Hosp CDM RECOVERY ROOM 481-510 MINUTES $509.85 10/1/2018 River Hosp CDM CHROMOSONE AN 15-20 BANDING 88262 $509.95 10/1/2018 River Hosp CDM CONSCIOUS SEDATION 5&OLDER 99152 $511.20 10/1/2018 River Hosp CDM TEMP TRANSCU PACING 92953 $512.66 10/1/2018 River Hosp CDM TEMP TRANSCUTANEOUS PACING 92953 $512.66 10/1/2018 River Hosp CDM CARDIOVERSION ELECTIVE EXTERNA 92960 $512.66 10/1/2018 River Hosp CDM INTEST. ENDO. LOW AB 00810 $513.00 10/1/2018 River Hosp CDM INTRAPERITIONEAL UPPER ABD 00790 $513.00 10/1/2018 River Hosp CDM ABDOMINOPERIN RESECT 00844 $513.00 10/1/2018 River Hosp CDM INTERM REPAIR FACE 2.6-5.0 CM 12052 $513.25 10/1/2018 River Hosp CDM COLONOSCOPY W/BIOPSY SIN/MULT 45380 $514.45 10/1/2018 River Hosp CDM COLONSCOPY FLEX DIAG SUBM INJ 45381 $514.70 10/1/2018 River Hosp CDM ANES FOR ALL PROC NERVES,MUSC 01810 $516.45 10/1/2018 River Hosp CDM ANES DIAG ARTH PROC SHLDRJOINT 01622 $516.45 10/1/2018 River Hosp CDM ANES CLOSED PROC HIP JOINT 01622 $516.45 10/1/2018 River Hosp CDM ANES OPEN ARTHRO KNEE, UNSPEC 01400 $516.45 10/1/2018 River Hosp CDM EXCISIONAL BIOPSY OF EYELID 67810 $516.60 10/1/2018 River Hosp CDM RHO(D) IMMUNE GLOB 10ML 90384 $518.35 10/1/2018 River Hosp CDM ADENOIDECTOMY PRIME UNDER 12YR 42830 $518.60 10/1/2018 River Hosp CDM REPAIR WOUND 7.6CM TO 12.5CM 12034 $518.65 10/1/2018 River Hosp CDM CL TX RAD/ULN FX-M 25560 $519.50 10/1/2018 River Hosp CDM BARIUM ENEMA SINGLE 74270 $520.75 10/1/2018 River Hosp CDM PUNCTIPLASTY 68440 $521.45 10/1/2018 River Hosp CDM LIVER&SPLEEN IMAGING STATIC 78215 $522.15 10/1/2018 River Hosp CDM BALLOON DILATOR 12-13.5-15 $522.75 10/1/2018 River Hosp CDM BALLOON DILATOR 15-16.5-18 $522.75 10/1/2018 River Hosp CDM BX OF BREAST VACUUM W/IMAGE GD $526.75 10/1/2018 River Hosp CDM VERSATACK SKIN STAPLER $527.20 10/1/2018 River Hosp CDM EXC MALIG LESION SCALP 2.1-3.0 11623 $531.05 10/1/2018 River Hosp CDM SIMPLE REPAIR 20.1-30cm 12006 $533.85 10/1/2018 River Hosp CDM BOTOX INJ/ MIGRAINES 64615 $534.75 10/1/2018 River Hosp CDM REPAIR WOUND 2.6-7.5 CM 12042 $534.95 10/1/2018 River Hosp CDM EXC BENIGN LSN REMOVAL >4.0 11426 $535.45 10/1/2018 River Hosp CDM DESTRUCTION BENIGN LESION 15+ 17004 $535.70 10/1/2018 River Hosp CDM DESTRUCT BENIGN LSN 15+ (GEN) 17004 $535.70 10/1/2018 River Hosp CDM PERCUT NEEDLE CORE BIOPSY IG 19102 $537.30 10/1/2018 River Hosp CDM HLA A-29 81381 $539.85 10/1/2018

River Hosp CDM LACERATION REPAIR, COMPLEX $539.85 10/1/2018 River Hosp CDM RECOVERY ROOM 511-540 MINUTES $539.85 10/1/2018 River Hosp CDM 309COMP D MICR EXTCH 88309 $540.96 10/1/2018 River Hosp CDM INTESTINE IMAGING 78290 $541.65 10/1/2018 River Hosp CDM SPINAL PUNCTURE LUMBAR DIAG 62270 $543.38 10/1/2018 River Hosp CDM INJ ANESTHETIC AGENT FEMORAL N 64447 $543.38 10/1/2018 River Hosp CDM NERVE BLOCK PERIPHERAL NERVE 64450 $543.38 10/1/2018 River Hosp CDM SPINAL PUNCTURE, LUMBAR DIAG 62270 $543.38 10/1/2018 River Hosp CDM PERIPHERAL NERVE BLOCK 64450 $543.38 10/1/2018 River Hosp CDM ENDOMETRIAL ABLATION W/O GUIDE 58353 $543.45 10/1/2018 River Hosp CDM D&C DIAG/THER NONOBSTETR 58120 $543.95 10/1/2018 River Hosp CDM RPR INTERMED 5.1 - 7.5 CM 12053 $545.40 10/1/2018 River Hosp CDM INTERM REPAIR FACE 5.1-7.5 CM 12053 $545.80 10/1/2018 River Hosp CDM EXC BNGN LSN 0.6-1.0CM (GEN) 11441 $545.90 10/1/2018 River Hosp CDM SANTYL OINTMENT 30gm TUBE $546.35 10/1/2018 River Hosp CDM NCS CEFTRIAXONE 50ML 1GM PIGGY $546.70 10/1/2018 River Hosp CDM NASOPHARYNGOSCOPY (ENT) 92511 $546.90 10/1/2018 River Hosp CDM GATED BLOOD POOL IMAGE SINGLE 78472 $548.25 10/1/2018 River Hosp CDM VITRECTOMY CUTTER $549.20 10/1/2018 River Hosp CDM PROBING OF NASOLACRIMAL DUCT 68815 $550.65 10/1/2018 River Hosp CDM INTERM REPAIR 12.6-20cm 12035 $550.95 10/1/2018 River Hosp CDM NCS ADVAIR DISCUS 250/50MCG $551.70 10/1/2018 River Hosp CDM INTERM REPAIR NECK 12.6-20.0cm 12045 $552.85 10/1/2018 River Hosp CDM 1.8 Q-FIX DISPSBLE KIT HIP/SH $553.20 10/1/2018 River Hosp CDM SHOULDER SCOPE,BONE SHAVING 29826 $553.25 10/1/2018 River Hosp CDM CYSTIC FIBROSIS DNA SCREEN 81220 $556.60 11/1/2018 River Hosp CDM EXC LESION FLOOR MOUTH 41116 $556.60 10/1/2018 River Hosp CDM CRITICAL CARE FIRST HOUR 99291 $557.35 10/1/2018 River Hosp CDM RABIES IMMUNE GLOB 2ML VIAL 90375 $557.55 10/1/2018 River Hosp CDM VENOUS DOPPLER BILATERAL 93970 $557.65 10/1/2018 River Hosp CDM RABIES VACCINE INTRAMUSC USE 90675 $557.75 10/1/2018 River Hosp CDM COMPLEX REPAIR EYELID <1.0 CM $558.30 10/1/2018 River Hosp CDM ADNOIDECTOMY,PRIMARY 12+YRS 42831 $560.35 10/1/2018 River Hosp CDM HEMORRHOIDECTOMY INT 2 OR MORE 46946 $560.35 10/1/2018 River Hosp CDM HEMORRHOIDECTOMY INT BY LIG 46945 $561.55 10/1/2018 River Hosp CDM BIOPSY OF TONGUE ANT 2/3 (ENT) 41100 $563.40 10/1/2018 River Hosp CDM CT HEART W/ CONTRAST W/ 3D 75572 $563.50 10/1/2018 River Hosp CDM PARIETEX SURG MESH 20X20 CM $564.40 10/1/2018 River Hosp CDM AMBIENT COVAC 50 RF WAND $564.85 10/1/2018 River Hosp CDM LMS CLASSIC SIAE 2&2.5 $565.30 10/1/2018 River Hosp CDM CELERO BIOPSY DEVICE $566.65 10/1/2018 River Hosp CDM A/C SEPARATION W/O MANIPULA 23540 $566.85 10/1/2018 River Hosp CDM U/S SOFT TISSUE HEAD/NECK THY 76536 $568.35 10/1/2018 River Hosp CDM ANES FOR VAGINAL PROCEDURES 00952 $568.40 10/1/2018 River Hosp CDM ABDOMEN RETROPERITONEUM 76770 $568.45 10/1/2018 River Hosp CDM U/S RETROPERITONEAL BEDSIDE 76770 $568.50 10/1/2018 River Hosp CDM RECOVERY ROOM 541-570 MINUTES $569.85 10/1/2018

River Hosp CDM PATELLA (KNEE) 27560 $570.55 10/1/2018 River Hosp CDM PLASMA FR FROZEN HUM P9059 $572.20 10/1/2018 River Hosp CDM PUNCTURE ASPIRATION OF CYST 19000 $572.85 10/1/2018 River Hosp CDM EXCIS BENIGN LESION 1.1-2.0CM 11402 $572.85 10/1/2018 River Hosp CDM EXCISION BENIGN LESION <0.5 11400 $572.85 10/1/2018 River Hosp CDM EXCIS MALIG LESION 1.1-2.0CM 11622 $572.85 10/1/2018 River Hosp CDM I&D PILONDIAL CYST SIMPLE 10080 $572.85 10/1/2018 River Hosp CDM I&D PILONDIAL CYST COMPLICATED 10081 $572.85 10/1/2018 River Hosp CDM REM INPLANT CONTRACEPTIVE CAPS 11976 $572.85 10/1/2018 River Hosp CDM EXCISE CYST <0.5 PA 11400 $572.85 10/1/2018 River Hosp CDM REMOVAL IMPLANT CONTRA CAPSULE 11976 $572.85 10/1/2018 River Hosp CDM EXCIS MALIG LSN 0.5CM OR LESS 11600 $572.85 10/1/2018 River Hosp CDM EXC BENIGN LSN 0.6-1.0CM 11441 $572.85 10/1/2018 River Hosp CDM EXC BENIGN LES .6-1.0CM 11421 $572.85 10/1/2018 River Hosp CDM EXC BENIGN LES 0.5CM OR LESS 11440 $572.85 10/1/2018 River Hosp CDM EXC MALIG LSN 0.6-1.0 11601 $572.85 10/1/2018 River Hosp CDM EXC BENIGN LESION 0.5CM OR LES 11400 $572.85 10/1/2018 River Hosp CDM NEXPLAMNON REMOVAL 11976 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN 2.1 -3CM TR/AR/LG 11403 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN <.5CM (GYN) 11400 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN 0.6-1.0CM (GEN) 11421 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN <.5 (GEN) 11440 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN 1.1-2.0CM (GEN) 11442 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN <.5CM (GEN) 11400 $572.85 10/1/2018 River Hosp CDM EXC BNGN LSN 2.1-3.0CM (GEN) 11403 $572.85 10/1/2018 River Hosp CDM EXC BEGN LESION 2.1 - 3.0 CM 11403 $572.85 10/1/2018 River Hosp CDM I&D OF PILONIDAL CYST 10080 $572.85 10/1/2018 River Hosp CDM EXC MALIG LSN 2.1-3.0CM (GEN) 11603 $572.85 10/1/2018 River Hosp CDM EXC MALIGN LSN <.5 CM (GEN) 11640 $572.85 10/1/2018 River Hosp CDM INTERM REPAIR FACE 7.6-12.5 CM 12054 $574.05 10/1/2018 River Hosp CDM EYE PACK DR LITWICKI $574.25 10/1/2018 River Hosp CDM VASECTOMY W/POST OP SEMEN EXAM 55250 $574.45 10/1/2018 River Hosp CDM TRANSCUTANEOUS PACING $575.05 10/1/2018 River Hosp CDM BIOPSY CERVIX 57500 $575.60 10/1/2018 River Hosp CDM BIOPSY OF CERVIX 57500 $575.60 10/1/2018 River Hosp CDM BIOPSY VAGINAL MUCOSA 57100 $575.60 10/1/2018 River Hosp CDM COLPOSCOPY VAGINA W/ BX 57421 $575.60 10/1/2018 River Hosp CDM VULVAR BX (GYN) 56605 $575.60 10/1/2018 River Hosp CDM BIOPSY OF CERVIX 57500 $575.60 10/1/2018 River Hosp CDM PARITEX MESH 6x6 $577.60 10/1/2018 River Hosp CDM NASOLACRIMAL DUCT PROBE W/IRR 68810 $578.15 10/1/2018 River Hosp CDM PROLENE MESH 2.4 X 5.4 $578.30 10/1/2018 River Hosp CDM MORPHOMETRIC ANALYSIS 88361 $578.45 10/1/2018 River Hosp CDM PELVIC COMPLETE TRANS ABDOM 76856 $579.30 10/1/2018 River Hosp CDM 1ST HOUR CLINICAL STAFF DIRECT 99490 $580.15 10/1/2018 River Hosp CDM HYSTEROSCOPY W/ REM FOREIGN 58562 $580.15 10/1/2018 River Hosp CDM INCSN THROM HEMORRHOID EXT 46083 $581.15 10/1/2018

River Hosp CDM COLONOSCOPY TUM REM HOT FORCEP 45384 $583.35 10/1/2018 River Hosp CDM ANES INTEGUMENTARY SYSTEM $585.45 10/1/2018 River Hosp CDM Revision of Iris 66761 $586.40 10/1/2018 River Hosp CDM HYSTER W/BIOP ENDO W OR W0 DC 58558 $587.15 10/1/2018 River Hosp CDM TREATMENT FX RADIAL HEAD 24650 $590.55 10/1/2018 River Hosp CDM TRANSCUTANEOUS PACING $592.30 10/1/2018 River Hosp CDM HIV, QUANT 87536 $592.70 10/1/2018 River Hosp CDM HEP C GENOTYPING 87902 $592.85 10/1/2018 River Hosp CDM FLUTICASONE FLOVENT .22mg INH $593.75 10/1/2018 River Hosp CDM COMPLEX REPAIR SCALP TO 2.5 CM 13120 $594.80 10/1/2018 River Hosp CDM VITRECTOMY PACK $596.60 10/1/2018 River Hosp CDM LACERATION FACE SIMPLE REPAIR $597.05 10/1/2018 River Hosp CDM CL TX LAT MALL FX-M 27786 $598.15 10/1/2018 River Hosp CDM BIOPSY,VESTIBUL OF MOUTH (ENT) 40808 $598.50 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 5 99215 $599.80 10/1/2018 River Hosp CDM OPP FACILITY LEVEL 5 99215 $599.80 10/1/2018 River Hosp CDM UNLISTED ER COMPLEX PROC(ABS) $599.80 10/1/2018 River Hosp CDM RECOVERY ROOM 571-600 MINUTES $599.80 10/1/2018 River Hosp CDM UNLISTED PROC LESION REMOVAL 46999 $599.80 10/1/2018 River Hosp CDM ULTRASONIC GUIDE NEEDLE BEDSID 76942 $600.65 10/1/2018 River Hosp CDM SIMP REPAIR FACE 12.6-20.0CM 12016 $602.00 10/1/2018 River Hosp CDM BONE DENSITY (DXA) 77080 $602.90 10/1/2018 River Hosp CDM BONE DENSITY STUDY AXIAL SKEL 77080 $602.90 10/1/2018 River Hosp CDM LDCT LUNG CA SCREEN $603.30 10/1/2018 River Hosp CDM FX/DISLOCATION RED., COMPLEX $603.40 10/1/2018 River Hosp CDM SHOULDER W MANIPULATION 23650 $604.00 10/1/2018 River Hosp CDM DEBRIDEMENT 1ST 20 CM 11043 $605.40 10/1/2018 River Hosp CDM CUSTOM EYE PACK DR. DRUGER $605.90 10/1/2018 River Hosp CDM REPAIR WOUND 12.6CM TO 20.0CM 12035 $606.50 10/1/2018 River Hosp CDM ER VISIT LEVEL 3 99283 $609.00 10/1/2018 River Hosp CDM 1 UNIT PACKED RED CELLS P9016 $610.55 10/1/2018 River Hosp CDM U/S GUIDE FOR NEEDLE PLACEMENT 76942 $611.45 10/1/2018 River Hosp CDM EXC BNGN LSN OVER 4.0 (GEN) 11406 $611.60 10/1/2018 River Hosp CDM UNLISTED PROCEDURE RECTUM 45999 $611.60 10/1/2018 River Hosp CDM PACK,DR JOY $612.55 10/1/2018 River Hosp CDM CLOSED TREATMENT SHOULDER DIS 23675 $612.57 10/1/2018 River Hosp CDM REM INDWELLING PLEURAL CATHETE 32552 $612.57 10/1/2018 River Hosp CDM THORACENTESIS W/O IMAGING GUID 32554 $612.57 10/1/2018 River Hosp CDM THORACENTESIS ASPIRATION 32555 $612.57 10/1/2018 River Hosp CDM INJ DIAG/THERA SUBSTANCE PROF 62321 $612.85 10/1/2018 River Hosp CDM COMPLEX REPAIR FOREHEAD 2.5cm 13131 $613.15 10/1/2018 River Hosp CDM CLOSED TX RADIAL FX W/O MANIP 25500 $615.90 10/1/2018 River Hosp CDM GOLD WEIGHT IMPLANT $616.70 10/1/2018 River Hosp CDM TREATMENT OF HIP DISLOCATION 27256 $616.85 10/1/2018 River Hosp CDM REM W/REINSERTION NON BIO DRUG 11983 $617.35 10/1/2018 River Hosp CDM INTERM REPAIR FACE 7.6-12.5cm 12054 $618.95 10/1/2018 River Hosp CDM CL TX MED MALL FX 27760 $618.95 10/1/2018

River Hosp CDM BREAST $618.95 10/1/2018 River Hosp CDM ANES UPPER GI ENDO PROC $620.60 10/1/2018 River Hosp CDM ANES FOR VAGINAL PROC $620.60 10/1/2018 River Hosp CDM UPPER G.I. 74241 $623.50 10/1/2018 River Hosp CDM EXC BENIGN .6 TO 1.0 CM TRUNK 11401 $626.40 10/1/2018 River Hosp CDM OB<14 WK MULTIPLE GESTATION 76802 $628.00 10/1/2018 River Hosp CDM CPR 92950 $628.85 10/1/2018 River Hosp CDM CPR 92950 $628.85 10/1/2018 River Hosp CDM RESUSCITATION INPATIENT 92950 $628.85 10/1/2018 River Hosp CDM COMPLEX REPAIR FOREHEAD 2.5 CM 13131 $629.00 10/1/2018 River Hosp CDM FINGER MP JOINT 26700 $629.80 10/1/2018 River Hosp CDM RECOVERY ROOM 601-630 MINUTES $629.80 10/1/2018 River Hosp CDM TONSILLECTOMY AGE 12 AND OVER 42826 $629.95 10/1/2018 River Hosp CDM BX OR EXC LYMPH NODE OPEN 38500 $630.25 10/1/2018 River Hosp CDM EXCISION BIOPSY EYELID-BENIGN 11440 $633.65 10/1/2018 River Hosp CDM CLTX HUM SHFT NO MAN 24500 $636.75 10/1/2018 River Hosp CDM NASAL ENDOSCOPY (ENT) 31231 $636.95 10/1/2018 River Hosp CDM EXCISION BENIGN SM (CODE) $638.50 10/1/2018 River Hosp CDM TRIGGER POINT INJ 1 OR 2 TC 20552 $639.70 10/1/2018 River Hosp CDM COMPLEX REP TRUNK 2.6-7.5 CM 13101 $640.50 10/1/2018 River Hosp CDM MYRINGOTOMY (ENT) 69420 $641.10 10/1/2018 River Hosp CDM TRACHEOBRONCHOSCOPY (ENT) 31615 $642.00 10/1/2018 River Hosp CDM RECLAST 1MG $643.20 10/1/2018 River Hosp CDM INJ DIAG/THERA SUBSTANCE 62321 $643.55 10/1/2018 River Hosp CDM GANGLION CYST INJ TC 20612 $644.60 10/1/2018 River Hosp CDM CL TR INTERPHALANGEAL JOINT 26770 $647.05 10/1/2018 River Hosp CDM LASIK - PRK $647.80 10/1/2018 River Hosp CDM RESOLUTION CLIP BOSTON SCIENTI $648.25 10/1/2018 River Hosp CDM ANES FOR LOW INTEST-ENDO PROC 00811 $649.60 10/1/2018 River Hosp CDM ANES U/L GASTRO ENDO 00813 $649.60 10/1/2018 River Hosp CDM ANES NER/MUS UPPER ARM 01712 $649.60 10/1/2018 River Hosp CDM CLOSED TREAT RADIAL/ULNAR SHAF 25560 $649.80 10/1/2018 River Hosp CDM COLSCOPY W/TUM REM SNARE TECH 45385 $652.45 10/1/2018 River Hosp CDM HUMERUS, W/O MANIPULATION 23600 $653.10 10/1/2018 River Hosp CDM TONSILLECTOMY YOUNGER AGE 12 42825 $655.90 10/1/2018 River Hosp CDM EYELID WEIGHT, GOLD 1.0GRAM $657.70 10/1/2018 River Hosp CDM ABDOMINAL COMP BEDSIDE 76700 $658.95 10/1/2018 River Hosp CDM ABDOMINAL COMPLETE 76700 $658.95 10/1/2018 River Hosp CDM EYE PACK DR. WEINSTEIN $659.75 10/1/2018 River Hosp CDM RECOVERY ROOM 631-660 MINUTES $659.80 10/1/2018 River Hosp CDM S&N PIN AND WIRE PAC $660.80 10/1/2018 River Hosp CDM CL TX BIMLL ANKLE FX 27808 $661.75 10/1/2018 River Hosp CDM GUIDANCE FOR AMNIO 76946 $662.95 10/1/2018 River Hosp CDM CHEST COMPLETE 76604 $662.95 10/1/2018 River Hosp CDM INTERM REPAIR 20.1-30.0cm 12036 $663.60 10/1/2018 River Hosp CDM CENTRAL VENOUS LINE CLN 36558 $665.25 10/1/2018 River Hosp CDM IMPL MESH/PROSTH FOR HERNIA 49568 $665.30 10/1/2018

River Hosp CDM COLONSCOPY W/ ABLATION TUMOR 45388 $665.95 10/1/2018 River Hosp CDM COMPLEX REPAIR TRUNK 2.6-7.5cm 13101 $668.10 10/1/2018 River Hosp CDM TYMPANOSTOMY (ENT) 69433 $668.70 10/1/2018 River Hosp CDM ANES PROC: CORNEAL TRANSPLANT 00144 $669.10 10/1/2018 River Hosp CDM ANES PROC EYE OPTHALMOSCOPY 00148 $669.10 10/1/2018 River Hosp CDM COMPLEX REPAIR SCALP 2.6-7.5CM 13121 $672.05 10/1/2018 River Hosp CDM EYELID WEIGHT, GOLD 1.2GRAM $673.00 10/1/2018 River Hosp CDM ENDOVAGINAL/TRANSVAGINAL 76830 $673.90 10/1/2018 River Hosp CDM TISSEEL 4 ml KIT $677.10 10/1/2018 River Hosp CDM CLOSED TX METACARPAL FX 26600 $679.85 10/1/2018 River Hosp CDM OCCUPATIONAL HIV PEP KIT $681.65 10/1/2018 River Hosp CDM REPAIR WOUND 12.6-20.0 CM 12045 $682.25 10/1/2018 River Hosp CDM HYSTEROSCOPY W/ENDO ABLATION 58563 $683.30 10/1/2018 River Hosp CDM IUD - PARAGUARD $685.50 10/1/2018 River Hosp CDM FINE NEEDLE ASPIR W GUIDANCE 10022 $687.25 10/1/2018 River Hosp CDM RECOVERY ROOM 661-690 MINUTES $689.80 10/1/2018 River Hosp CDM COLONOSCOPY, FLEX W/ABLATION 45388 $693.35 10/1/2018 River Hosp CDM ANOSCOPY HRA WITH BIOPSY 46607 $698.35 10/1/2018 River Hosp CDM REPAIR WOUND 20.1CM TO 30.0CM 12036 $698.50 10/1/2018 River Hosp CDM INJ RhOd IMMUNE GLOBULIN FULL $699.75 10/1/2018 River Hosp CDM EXC MALIG LESION ASU 11643 $702.50 10/1/2018 River Hosp CDM OB>14 WEEKS 76805 $702.75 10/1/2018 River Hosp CDM LMA CLASSIC EXCEL 3,4&5 $703.60 10/1/2018 River Hosp CDM MESH PERFIX PLUG $703.85 10/1/2018 River Hosp CDM TX FX LATERAL MALLELUS 27786 $705.15 10/1/2018 River Hosp CDM DISP HIP PAC-JUIDE WIRE $706.10 10/1/2018 River Hosp CDM EXCISION TARSAL WEDGE 67916 $707.15 10/1/2018 River Hosp CDM CL TREAT DISTAL PHALANGEAL FX 26755 $707.85 10/1/2018 River Hosp CDM ANES LOWER INTESTINAL PROC 00810 $709.25 10/1/2018 River Hosp CDM ANES HERNIA LOWER ABD UNSPEC 00832 $709.25 10/1/2018 River Hosp CDM ANES VAGINAL PROC;HYSTER $709.25 10/1/2018 River Hosp CDM I/D PERIANAL ABSCESS 46050 $709.98 10/1/2018 River Hosp CDM ENDO EVAL SM INSTESTINE POUCH 44385 $709.98 10/1/2018 River Hosp CDM SIGMOIDOSCOPY 45330 $709.98 10/1/2018 River Hosp CDM HEMORRHOIDECTOMY BAND LIG(GEN) 46221 $709.98 10/1/2018 River Hosp CDM I&D PERIANAL ABSCESS SUPERFIC 46050 $709.98 10/1/2018 River Hosp CDM INFLECTRA 100 MG $710.50 10/1/2018 River Hosp CDM GREATER OCIPITAL NERVE BLK TC 64405 $719.25 10/1/2018 River Hosp CDM RECOVER ROOM 691-720 MINUTES $719.75 10/1/2018 River Hosp CDM RESP VIRUS PANEL 87633 $721.85 10/1/2018 River Hosp CDM TUBE THORACOSTOMY 32551 $723.05 10/1/2018 River Hosp CDM TONSIL&ADENOIDECTOMY UNDER 12 42820 $723.55 10/1/2018 River Hosp CDM ANESTHESIA OPEN ARTHROSCOPY 01400 $730.80 10/1/2018 River Hosp CDM CL/INTERM NECK 20.1-30. CM 12046 $731.05 10/1/2018 River Hosp CDM HARMONIC SYGERY $731.65 10/1/2018 River Hosp CDM CL TX TIBIAL SHFT FX 27750 $733.65 10/1/2018 River Hosp CDM EXC MALGN LSN OVER 4.O CM 11626 $735.75 10/1/2018

River Hosp CDM ARTICULATING CUTTER ATS45 $739.00 10/1/2018 River Hosp CDM EXC BGN LES INCLUDING MARGINS 11443 $739.65 10/1/2018 River Hosp CDM CT ANGIO PELVIS W/CONTRAST 72191 $740.20 10/1/2018 River Hosp CDM CT ANGIO UPP EXT W/ CONT NO 3D 73206 $740.20 10/1/2018 River Hosp CDM EXC MALIG LSN 0.6-1.0CM (GEN) 11601 $740.90 10/1/2018 River Hosp CDM NEUPOGEN 480 MCG $741.20 10/1/2018 River Hosp CDM CL TX DSTL RADFX+-FX 25600 $743.45 10/1/2018 River Hosp CDM ABD PARACENTESIS W/IMAGING GUI 49083 $743.49 10/1/2018 River Hosp CDM ABDOMINAL PARACENTESIS W/IMAG 49083 $743.49 10/1/2018 River Hosp CDM ABDM PARAC DIAG/THER W/O GUIDE 49082 $743.49 10/1/2018 River Hosp CDM ABDM PARAC DIAG/THER W/IMAGE 49083 $743.49 10/1/2018 River Hosp CDM PERITONEAL LAVAGE INCL GUIDE 49084 $743.49 10/1/2018 River Hosp CDM ISOLATION ROOM $743.75 10/1/2018 River Hosp CDM COMPLEX REPAIR SCALP 2.6-7.5CM 13121 $745.50 10/1/2018 River Hosp CDM BIOPSY OF ANORECTAL WALL, ANAL 45100 $746.15 10/1/2018 River Hosp CDM EXC MALIG LSN 0.6-1.0CM (GEN) 11621 $747.70 10/1/2018 River Hosp CDM RHO(D)IMM GLOBLN 1500 1.3 mlVL $748.55 10/1/2018 River Hosp CDM FX PHALANX FINGER W/MANIPULAT 26725 $748.95 10/1/2018 River Hosp CDM RECOVERY ROOM 721-750 MINUTES $749.75 10/1/2018 River Hosp CDM REMOVAL TUN CNTR VEN DEV (GEN) 36590 $749.90 10/1/2018 River Hosp CDM 4K PSA SCORE 81539 $750.00 11/1/2018 River Hosp CDM EXCIS BENIGN LESN FACE 1.1-2CM 11442 $750.95 10/1/2018 River Hosp CDM CLOSED TX DISTAL TIBIA W/O 27824 $751.40 10/1/2018 River Hosp CDM ANES PROC/SALV GLANDS W/BIOPSY 00103 $752.75 10/1/2018 River Hosp CDM ANESPROC/INNER EAR TYMPANOTOMY 00120 $752.75 10/1/2018 River Hosp CDM ANES PROC NOSE/SINUS UNSPEC 00160 $752.75 10/1/2018 River Hosp CDM ANES INTAORAL W/BIOPSY UNSPEC 00170 $752.75 10/1/2018 River Hosp CDM RABIES VACCINE INTRAMUSC USE 90675 $752.95 10/1/2018 River Hosp CDM TORIC LENS $753.65 10/1/2018 River Hosp CDM REPAIR INTERM FACE 12.6-20.0CM 12055 $754.00 10/1/2018 River Hosp CDM CL TREAT DISLOCATION W/O ANES 26670 $754.05 10/1/2018 River Hosp CDM TONSIL & ADENOIDECTOMY OVER 12 42821 $754.55 10/1/2018 River Hosp CDM CL TREATMENT METACARPAL FX 26605 $754.85 10/1/2018 River Hosp CDM CLOSED TX HMEAL FX W/O MAN 23600 $755.85 10/1/2018 River Hosp CDM IUD INSERTION 58300 $756.30 10/1/2018 River Hosp CDM DIGIBIND SOL 5DV $756.50 10/1/2018 River Hosp CDM EXC MAL LESION ARM 3.1-4.0 CM 11604 $756.50 10/1/2018 River Hosp CDM US BREAST BX 19102 $756.95 10/1/2018 River Hosp CDM LARYNGOSTROBOSCOPY,FLEX (ENT) 31579 $758.10 10/1/2018 River Hosp CDM MAMMOGRAPHIC BREAST GUIDANCE 77031 $758.55 10/1/2018 River Hosp CDM CHEST TUBE INSERTION $759.15 10/1/2018 River Hosp CDM SEMI PRIVATE 2-BED $761.25 10/1/2018 River Hosp CDM UC ACUFEX DIRECTOR ELITE DRILL $761.25 10/1/2018 River Hosp CDM DYONICS KEYLESS SAGITTAL SW $761.25 10/1/2018 River Hosp CDM TENDON SHEATH INCISION 26055 $765.15 10/1/2018 River Hosp CDM COMPLEX REP EYELID 1.1-2.5 CM 13151 $766.45 10/1/2018 River Hosp CDM CL TREAT METACARPOPHALANGEAL 26700 $766.50 10/1/2018

River Hosp CDM ACUTE GI BLOOD LOSS IMAGING 78278 $767.75 10/1/2018 River Hosp CDM SMALL INT ENDO W/OR W/O BIOPSY 44377 $768.80 10/1/2018 River Hosp CDM Post-Cataract Laser Surgery 66821 $770.65 10/1/2018 River Hosp CDM PEG TUBE #18 ROSS $770.85 10/1/2018 River Hosp CDM BONE/JOINT IMAGING 3 PHASE 78315 $772.80 10/1/2018 River Hosp CDM ANES HERNIA REPAIR UPPER ABD 00750 $774.65 10/1/2018 River Hosp CDM PRIVIGEN 10GM $778.05 10/1/2018 River Hosp CDM COMPLX REPAIR EYELDS 1.1-2.5cm 13151 $779.50 10/1/2018 River Hosp CDM RECOVERY ROOM 751-780 MINUTES $779.75 10/1/2018 River Hosp CDM IV THROMBOLYSIS $781.45 10/1/2018 River Hosp CDM THROMBOLYSIS THERAPY 92977 $781.45 10/1/2018 River Hosp CDM IV THROMBOLYSIS $781.45 10/1/2018 River Hosp CDM ORRHOIDECTOMY,EXT/COMPLT (GEN) 46250 $783.15 10/1/2018 River Hosp CDM CT ANGIO NECK W/CONTRAST NO 3D 70498 $784.60 10/1/2018 River Hosp CDM CTA AORTO-ILIOFEMORAL RUNOFF 75635 $784.60 10/1/2018 River Hosp CDM CT ANGIO-ABD W/WO CONT NO 3D 74175 $784.60 10/1/2018 River Hosp CDM EXCISION MALIGNANT LESION FACE 11641 $786.20 10/1/2018 River Hosp CDM EXC MALIG LSN 0.6-1.0CM (GEN) 11641 $786.20 10/1/2018 River Hosp CDM DOROPLASTY BALLOON $786.30 10/1/2018 River Hosp CDM SUTURE PASSER DIRECT ASU $786.65 10/1/2018 River Hosp CDM SIMP REPAIR FACE 20.1-30.0CM 12017 $790.00 10/1/2018 River Hosp CDM BONE/JOINT IMAGING WHOLE BODY 78306 $792.30 10/1/2018 River Hosp CDM ANES PROC EYE: LENS SURG 00142 $797.90 10/1/2018 River Hosp CDM ANES PROC INTEGUMENTARY UNSPEC 00300 $797.90 10/1/2018 River Hosp CDM ANES FOR NERVES,MUSCLES,TENDON $797.90 10/1/2018 River Hosp CDM KUGAL PATCH-ASU $798.20 10/1/2018 River Hosp CDM EXC MALGN LSN OVER 4.0 CM 11606 $799.35 10/1/2018 River Hosp CDM IUD INSERTION 58300 $801.70 10/1/2018 River Hosp CDM NON CARDIAC VASC FLOW IMAGING 78445 $803.10 10/1/2018 River Hosp CDM SCS LEAD PULL 63661 $805.45 10/1/2018 River Hosp CDM SCS LEAD PULL 63661 $805.45 10/1/2018 River Hosp CDM COMPLEX REPAIR EYELID 2.6-7.5 13152 $806.70 10/1/2018 River Hosp CDM EXCISION OF EYELID (CYST) 67840 $808.37 10/1/2018 River Hosp CDM BONE SURVEY SKELETAL 77075 $808.60 10/1/2018 River Hosp CDM RECOVERY ROOM 781-810 MINUTES $809.75 10/1/2018 River Hosp CDM LESION REMOVAL UNL/PROC (GEN) 46999 $809.75 10/1/2018 River Hosp CDM FISSURECTOMY 46200 $810.35 10/1/2018 River Hosp CDM LAP ABD,PERI AND OMENTUM DIAG 49320 $811.15 10/1/2018 River Hosp CDM LAPAROSCOPY ABDOMEN 49320 $811.15 10/1/2018 River Hosp CDM ER VISIT LEVEL 4 99284 $812.00 10/1/2018 River Hosp CDM UNLISTED LAPAROSCOPY PROC 58679 $812.60 10/1/2018 River Hosp CDM CL TX DSTL RADFX, W/O MANIPLTN 25600 $814.00 10/1/2018 River Hosp CDM EXC MALIG LSN 1.1-2.0CM (GEN) 11602 $814.45 10/1/2018 River Hosp CDM EXC MALIGN LESION 1.1-2.0 11602 $814.45 10/1/2018 River Hosp CDM ULTRA-FAST-FIX AB ASSEM-CURVED $814.95 10/1/2018 River Hosp CDM CLOSED TREATMENT HUMERAL SHAFT 24500 $820.95 10/1/2018 River Hosp CDM SUPRACAPULAR NERVE BLOCK TC 64418 $829.90 10/1/2018

River Hosp CDM STRABISMUS W/SCAR EXTRAOC MUSC 67332 $832.10 10/1/2018 River Hosp CDM ANES PROC EYE VITREORETINAL 00145 $836.40 10/1/2018 River Hosp CDM ANES FOR LOWER ABDOMINAL WALL $836.40 10/1/2018 River Hosp CDM COMPLEX REP FOREHEAD 2.6-7.5CM 13132 $838.05 10/1/2018 River Hosp CDM RECOVERY ROOM 811-840 MINUTES $839.70 10/1/2018 River Hosp CDM TREATMENT CLOSED ELBOW DISLOC 24600 $843.20 10/1/2018 River Hosp CDM EXC MALIGN LESION SCALP 11622 $846.95 10/1/2018 River Hosp CDM EXC MALIG LSN 1.1-2.0CM (GEN) 11622 $846.95 10/1/2018 River Hosp CDM REPAIR WOUND 20.1-30.0 CM 12046 $848.50 10/1/2018 River Hosp CDM CLOSED TR PATELLAR DISLOCATION 27560 $849.50 10/1/2018 River Hosp CDM COLONOSCOPY POLYP BASKET $853.10 10/1/2018 River Hosp CDM LAPAROSCOPY SURG W/ BIOPSY 49321 $858.25 10/1/2018 River Hosp CDM ANES RECONST PROC EYELID $860.75 10/1/2018 River Hosp CDM BONE/JOINT IMAGING SPECT 78320 $865.95 10/1/2018 River Hosp CDM RECOVERY ROOM 841-870 MINUTES $869.70 10/1/2018 River Hosp CDM MIRENA INTRAUTERINE SYSTEM $875.50 10/1/2018 River Hosp CDM EXCISION BIOPSY EYELID-MALIGN 11640 $879.35 10/1/2018 River Hosp CDM HEMORRHOIDECTOMY SING COL/GRP 46255 $879.75 10/1/2018 River Hosp CDM TRACHEOST, CRICOTH 31605 $885.55 10/1/2018 River Hosp CDM ANES PROC EYE UNSPECIFIED 00140 $886.55 10/1/2018 River Hosp CDM ANES HERNIA REPAIR 00830 $886.55 10/1/2018 River Hosp CDM ANES ANORECTAL PROC $886.55 10/1/2018 River Hosp CDM ANES FOR TUBAL LIG/TRANS $886.55 10/1/2018 River Hosp CDM IUD-SKYLA $888.15 10/1/2018 River Hosp CDM INFECTIOUS Agt Geno 87901 $896.15 10/1/2018 River Hosp CDM RECOVERY ROOM 871-900 MINUTES $899.70 10/1/2018 River Hosp CDM 1.8 Q-FIX ANCHOR $900.85 10/1/2018 River Hosp CDM LAP SURG OCCLUSION OVIDUCTS 58671 $902.20 10/1/2018 River Hosp CDM LAPAROSCOPY SURG W/ OCCLUSION 58671 $902.20 10/1/2018 River Hosp CDM UPPER GI W/ SM BOWEL 74249 $904.70 10/1/2018 River Hosp CDM SCW BIOSURE REGENSORB10mmx25mm $912.00 10/1/2018 River Hosp CDM AMINO ACID PROFILE QUANT PLASM 82139 $912.90 10/1/2018 River Hosp CDM MULTIFOCAL P-C IOL NC RESTORE V2788 $916.15 10/1/2018 River Hosp CDM CL TX KNEE DSLC-ANS 27550 $917.70 10/1/2018 River Hosp CDM EXC MALIG LSN 1.1-2.0CM (GEN) 11642 $918.70 10/1/2018 River Hosp CDM REMOVAL OF CORNE EPITH W/CHEL 65436 $924.20 10/1/2018 River Hosp CDM EXC RECTAL TUMOR 45172 $926.25 10/1/2018 River Hosp CDM RECOVERY ROOM 901-930 MINUTES $929.70 10/1/2018 River Hosp CDM BARD VENTRALEX ST LG CIRCLE $936.35 10/1/2018 River Hosp CDM THROMBOSED HEMORRHOID 46320 $936.39 10/1/2018 River Hosp CDM SIGMOIDSCOPY FLEX W/ BALLOON 45340 $936.39 10/1/2018 River Hosp CDM ANOSCOPY DIAG W/W/O SPECIMEN 46606 $936.39 10/1/2018 River Hosp CDM ANOSCOPY WITH BIOPSY 46606 $936.39 10/1/2018 River Hosp CDM EXCISE EXT THROMB HEMORRHOID 46320 $936.39 10/1/2018 River Hosp CDM EXC THROMBOSED HEM, EXT (GEN) 46320 $936.39 10/1/2018 River Hosp CDM Removal of Eye Lesion 65420 $936.55 10/1/2018 River Hosp CDM CLOSED TR ANKLE DISLOCATION 27840 $942.30 10/1/2018

River Hosp CDM ANES FOR OPEN ARTH DISTAL 01830 $946.80 10/1/2018 River Hosp CDM REPAIR INTERM FACE OVER 30.0CM 12057 $947.20 10/1/2018 River Hosp CDM THORACOTOMY PROC 00540 $948.50 10/1/2018 River Hosp CDM HEMORRHOIDOIDOPEXY;STPLE (GEN) 46947 $948.75 10/1/2018 River Hosp CDM REPAIR INTERM FACE 20.1-30.0CM 12056 $950.65 10/1/2018 River Hosp CDM PARITEX PROGRIP MESH (R&L) $952.85 10/1/2018 River Hosp CDM 2.8 Q-FIX SUTURE ANCHOR $954.90 10/1/2018 River Hosp CDM RECOVERY ROOM 931-960 MINUTES $959.70 10/1/2018 River Hosp CDM COPPER IUD $959.75 10/1/2018 River Hosp CDM CTA ABDOM AORTA W/&OR W/O CONT 75635 $962.75 10/1/2018 River Hosp CDM MITOSOL(MITOMYCN)OPTH 0.2mg/VL $965.65 10/1/2018 River Hosp CDM BLEPHAROPLASTY;UPPER EYELID 15822 $969.00 10/1/2018 River Hosp CDM SURGICAL TX ANAL FISTULA;SUBCT 46270 $971.90 10/1/2018 River Hosp CDM HYPERTET PER SYRINGE $972.40 10/1/2018 River Hosp CDM ANES INTEGUM SYS EXTREMETIES 00402 $974.40 10/1/2018 River Hosp CDM CENTRAL VENOUS CATH INS 5+YRS 36556 $982.97 10/1/2018 River Hosp CDM TUBE THORACOSTOMY 32551 $982.97 10/1/2018 River Hosp CDM INSERTION NONTUNNELED CATHETER 36555 $982.97 10/1/2018 River Hosp CDM PERICARDIOCENTESIS INITIAL 33010 $982.97 10/1/2018 River Hosp CDM INSERT PICC LINE OVER 5 YRS 36569 $982.97 10/1/2018 River Hosp CDM CENTRAL VEN CATH REPOS W/FLUOR 36597 $982.97 10/1/2018 River Hosp CDM ESOPHAGOGASTRODUODENOSCOPY 43235 $985.45 10/1/2018 River Hosp CDM RECOVERY ROOM 961-990 MINUTES $989.65 10/1/2018 River Hosp CDM COMPLX REPAIR FRHEAD 2.6-7.5CM 13132 $989.70 10/1/2018 River Hosp CDM EXC MALGN LESION OVER 4.0 CM 11646 $990.00 10/1/2018 River Hosp CDM INCONTINENCE SUPPLY,RECTAL INS $990.40 10/1/2018 River Hosp CDM AMPUTATION TOE METATARSOPHAL 28820 $992.20 10/1/2018 River Hosp CDM PARACENTESIS 49083 $1,002.10 10/1/2018 River Hosp CDM EXCISION MALIGNANT LESION TRNK 11603 $1,003.45 10/1/2018 River Hosp CDM EXCISION MALIGNANT LESION TRNK 11603 $1,003.45 10/1/2018 River Hosp CDM CLOSED TR HIP DISLOCATION 27250 $1,004.40 10/1/2018 River Hosp CDM RESECT LIP W/O RECONSTRUCT 40530 $1,006.95 10/1/2018 River Hosp CDM MULTIFOCAL P-C IOL TECNIS N/C $1,008.55 10/1/2018 River Hosp CDM IOL NONCVD MULTIFOCAL REZOOM $1,008.55 10/1/2018 River Hosp CDM CORNEAL CORRECT SURG ASTIGMAT 65772 $1,009.60 10/1/2018 River Hosp CDM M/F TECNIS LENS ZMBOO SPLIT $1,012.55 10/1/2018 River Hosp CDM M/F TECNIS LENS ZMB00 COVERED $1,012.55 10/1/2018 River Hosp CDM M/F TECNIS LENS ZMB00 N/C $1,012.55 10/1/2018 River Hosp CDM CSCOPY - STOMA W/POLYP REMOV 44394 $1,013.00 10/1/2018 River Hosp CDM ER VISIT LEVEL 5 99285 $1,015.00 10/1/2018 River Hosp CDM 4.75HEALICOIL REGNSORB SUTANCH $1,016.75 10/1/2018 River Hosp CDM 5.5 MULTIFIX-S ULTRA $1,016.75 10/1/2018 River Hosp CDM EXC OF CYST, 1 OR MORE (GEN) 19120 $1,019.50 10/1/2018 River Hosp CDM EXC MALIG LSN 3.1-4.0CM (GEN) 11604 $1,023.50 10/1/2018 River Hosp CDM CL TREAT RADIOCARPAL/INTERCARP 25660 $1,027.75 10/1/2018 River Hosp CDM I&D ISCHIORECTAL OR PERIRECTAL 46040 $1,028.70 10/1/2018 River Hosp CDM SURG TREAT ANAL FISTULA INTERS 46275 $1,030.40 10/1/2018

River Hosp CDM XOLAIR 150MG/5ML $1,037.85 10/1/2018 River Hosp CDM YAG LASER PERIPH IRID OD/OS 66761 $1,046.85 10/1/2018 River Hosp CDM CLOSED TX POST HIP ARTHRPLASTY 27265 $1,049.40 10/1/2018 River Hosp CDM 1 PROXIMATE PPH $1,049.45 10/1/2018 River Hosp CDM CARPAL TUNNEL RELEASE 64721 $1,054.80 10/1/2018 River Hosp CDM ANES DIAG ARTHRO SHLDR JOINT 01622 $1,055.60 10/1/2018 River Hosp CDM EXC NASAL POLYP, EXTENSIVE 30115 $1,061.15 10/1/2018 River Hosp CDM ANES LOWER ABD W/LAPROSCOPY 00840 $1,063.85 10/1/2018 River Hosp CDM IRIDECTOMY LES REM PERIPHERAL 66625 $1,065.35 10/1/2018 River Hosp CDM EXC PILONIDAL CYST EXTENSIVE 11771 $1,071.35 10/1/2018 River Hosp CDM CT COLONGRAPHY DIAG INC IMPAGE 74261 $1,078.15 10/1/2018 River Hosp CDM SUBMUCOUS RESECT INF TURBINE 30140 $1,079.85 10/1/2018 River Hosp CDM BIOPSY OPEN DEEP AXILLARY NODE 38525 $1,082.10 10/1/2018 River Hosp CDM ANES LOWER ABD W/RESECTION 00844 $1,087.30 10/1/2018 River Hosp CDM HYSTEROSCOPY SURGICAL 58561 $1,092.95 10/1/2018 River Hosp CDM TRACHEA BRONCHI REP 00548 $1,093.85 10/1/2018 River Hosp CDM OB>14WK MULTIPLE GESTATION 76810 $1,101.70 10/1/2018 River Hosp CDM REPAIR UMBILICAL HERNIA 5YR+ 49585 $1,102.75 10/1/2018 River Hosp CDM ANOSCOPY W/CAUTERY 46614 $1,113.50 10/1/2018 River Hosp CDM COLONOSCOPY, FLEX W/ABLATION 45388 $1,113.50 10/1/2018 River Hosp CDM GASTRO W BIOPSY 43239 $1,121.45 10/1/2018 River Hosp CDM Revision of Eyelid 67961 $1,131.25 10/1/2018 River Hosp CDM ANES, RADICAL PERINEAL PROC 00904 $1,136.80 10/1/2018 River Hosp CDM BIOPSY INTRANASAL (ENT) 30100 $1,138.08 10/1/2018 River Hosp CDM CAUTERIZ MUCOSA OF TURB (ENT) 30801 $1,138.08 10/1/2018 River Hosp CDM BIOPSY EXTERN AUDIT CANAL(ENT) 69105 $1,138.08 10/1/2018 River Hosp CDM Repair Eyelid Defect 67917 $1,139.10 10/1/2018 River Hosp CDM Repair Eyelid Defect 67924 $1,139.35 10/1/2018 River Hosp CDM KIDNEY STONE SATURATION $1,139.60 10/1/2018 River Hosp CDM HEMORROID/W/FISTULECTOMY ONE 46258 $1,147.00 10/1/2018 River Hosp CDM SCS REPROGRAMMING TC 95971 $1,148.35 10/1/2018 River Hosp CDM Revision of Eyelid 67950 $1,152.25 10/1/2018 River Hosp CDM OTHER PERIPHERAL NERVE BLK TC 64450 $1,162.85 10/1/2018 River Hosp CDM SURGICAL TREAT ANAL FISTULA 46280 $1,169.45 10/1/2018 River Hosp CDM REMOVE VITREIUS,ANTER LIMBAL 67005 $1,173.35 10/1/2018 River Hosp CDM ENDO ROOM 0-30 MINUTES $1,176.20 10/1/2018 River Hosp CDM REPAIR UMBILICAL HERNIA 5 > 49587 $1,177.20 10/1/2018 River Hosp CDM INTERCOSTAL NERVE BLOCK ONE 64420 $1,185.50 10/1/2018 River Hosp CDM YAG LASER PSTRIR CAPSUL OD/OS 66821 $1,187.80 10/1/2018 River Hosp CDM EXC OR TRANSP OF PTERYGIUM 65426 $1,189.40 10/1/2018 River Hosp CDM SIMP REPAIR FACE>30.0 CM 12018 $1,194.75 10/1/2018 River Hosp CDM LIVER IMAGING SPECT 78205 $1,202.68 10/1/2018 River Hosp CDM BRAIN IMAGING SPECT 78607 $1,202.68 10/1/2018 River Hosp CDM LIVER IMAGING WITH VASC FLOW 78202 $1,202.68 10/1/2018 River Hosp CDM FASTFIX 360 MENSCL RPR SYSTEM $1,204.30 10/1/2018 River Hosp CDM BIOCERAMIC OBRB. IMPLANT 20MM $1,211.35 10/1/2018 River Hosp CDM BIOCERAMIC ORBIT, IMPLANT 18MM $1,211.35 10/1/2018

River Hosp CDM PROXIMATE HEM STAPLER $1,212.50 10/1/2018 River Hosp CDM LAGOPTHALMOS W/ UP LID IMPLANT 67912 $1,215.30 10/1/2018 River Hosp CDM INTRAUTERINE DEVICE $1,228.90 10/1/2018 River Hosp CDM MULTIFOCAL LENS V2788 $1,231.70 10/1/2018 River Hosp CDM ORBITAL IMPLANT #16 UNWRAPPED $1,235.95 10/1/2018 River Hosp CDM ORBITAL IMPLANT #18 UNWRAPPED $1,235.95 10/1/2018 River Hosp CDM ENDO ROOM 31-60 MINUTES $1,239.75 10/1/2018 River Hosp CDM RHO(D)IMM GLOBLN 2500/2.2 mlVL $1,247.25 10/1/2018 River Hosp CDM PLATELET PHERESIS 1 UNIT $1,250.00 10/1/2018 River Hosp CDM ANES PROC NOSE/SINUS RADICAL 00162 $1,254.55 10/1/2018 River Hosp CDM RPR BLEPHAROPTOSIS,RECTUS W/SL 67906 $1,265.45 10/1/2018 River Hosp CDM REPAIR BROW PTOSIS,SUPRACIL 67900 $1,266.80 10/1/2018 River Hosp CDM RPR EPI HERNIA;INCAR OR STRANG 49572 $1,278.75 10/1/2018 River Hosp CDM CT COLONGRAPHY DIAG INC IMAGE 74261 $1,280.55 10/1/2018 River Hosp CDM RPR IRIS, CILIARY BODY 66680 $1,286.10 10/1/2018 River Hosp CDM REPR INIT INGN HERN 5+YR (GEN) 49505 $1,290.20 10/1/2018 River Hosp CDM BLEPHAROPLASTY LOWER EYELID 15820 $1,295.40 10/1/2018 River Hosp CDM EXCISION MALIGNANT LESION FACE 11622 $1,295.55 10/1/2018 River Hosp CDM CT ANGIO, CHEST W &/OR WO CONT 71275 $1,301.35 10/1/2018 River Hosp CDM COMPLX REPAIR EYELID 2.6-7.5cm 13152 $1,301.45 10/1/2018 River Hosp CDM ENDO ROOM 61-90 MINUTES $1,303.35 10/1/2018 River Hosp CDM CT ORBIT STELLA EAR W/O CONTR 70480 $1,311.55 10/1/2018 River Hosp CDM ORBIT W/O CONTR 70480 $1,311.55 10/1/2018 River Hosp CDM NASAL ENDOSCOP W/DEBRID (ENT) 31237 $1,323.70 10/1/2018 River Hosp CDM THINPROFILE PLAT EYELID IMPLAN $1,333.70 10/1/2018 River Hosp CDM EXC BEN LESION 3.1-4.0 CM 11404 $1,348.03 10/1/2018 River Hosp CDM NEG PRESS WOUND THER

River Hosp CDM BIOPSY SOFT TISSUE LEG/ANKLE 27613 $1,348.03 10/1/2018 River Hosp CDM BIOPSY SOFT TISSUE UPPER ARM 24065 $1,348.03 10/1/2018 River Hosp CDM BIOPSY SOFT TISSUE BACK FLANK 21920 $1,348.03 10/1/2018 River Hosp CDM EXC TUMOR SOFT TISSUE NECK<3CM 21555 $1,348.03 10/1/2018 River Hosp CDM EXC MALIGN LESION FACE 3.1-4.0 11644 $1,348.03 10/1/2018 River Hosp CDM BENIGN LESION REMOVAL 11420 $1,348.03 10/1/2018 River Hosp CDM EXC MALG LSN 3.1-4CM DIA (GEN) 11624 $1,348.03 10/1/2018 River Hosp CDM I&D HEMATOMA/SEROMA (GEN) 10140 $1,348.03 10/1/2018 River Hosp CDM EXC BNGN LSN 0.5CM OR LESS GEN 11420 $1,348.03 10/1/2018 River Hosp CDM EXC BNGN LSN 1.1-2.0CM (GEN) 11422 $1,348.03 10/1/2018 River Hosp CDM EXC BNGN LSN 2.1-3.0CM (GEN) 11443 $1,348.03 10/1/2018 River Hosp CDM EXC BGN LSN 3.1-4.0 CM (GEN) 11404 $1,348.03 10/1/2018 River Hosp CDM EXC BNGN LSN OVER 4.0CM (GEN) 11406 $1,348.03 10/1/2018 River Hosp CDM I&D SOFT TISS ABSC,SUBFASC GEN 20005 $1,348.03 10/1/2018 River Hosp CDM EXC BENIGN 2.1-3.0 CM SCALP 11423 $1,348.03 10/1/2018 River Hosp CDM BIOPSY SOFT TISSUE LEG OR ANKL 27613 $1,348.03 10/1/2018 River Hosp CDM I&D HEMATOMA 10140 $1,348.03 10/1/2018 River Hosp CDM REMOVE FOREIGN BODY SIMPLE 20520 $1,348.03 10/1/2018 River Hosp CDM EXC MALIGN LSN 2.1-3.0CM (GEN) 11623 $1,348.03 10/1/2018 River Hosp CDM EXC MALIGN LSN 2.1-3.0CM (GEN) 11643 $1,348.03 10/1/2018 River Hosp CDM EXC MALIG LSN 3.1-4.0CM (GEN) 11644 $1,348.03 10/1/2018 River Hosp CDM SCLERAL GRAFT-UNLISTED 67999 $1,349.20 10/1/2018 River Hosp CDM ENDO ROOM 121-150 MINUTES $1,349.50 10/1/2018 River Hosp CDM EXCIS OF GANGLOIN, WRIST 25111 $1,349.94 10/1/2018 River Hosp CDM EXCIS OF GANGLOIN, FOOT R 28090 $1,349.94 10/1/2018 River Hosp CDM CL TX RD/ULN FX+M 25565 $1,349.94 10/1/2018 River Hosp CDM CL TX HUM FX W/MAN 23605 $1,349.94 10/1/2018 River Hosp CDM CLOSED TREATMENT SHOULDER 23665 $1,349.94 10/1/2018 River Hosp CDM CLOSED TX DISTAL RADIAL FX 25605 $1,349.94 10/1/2018 River Hosp CDM CL TX TRIMALLEOLAR ANKLE /MANI 27818 $1,349.94 10/1/2018 River Hosp CDM CLOSED TX DISTAL RADIAL FX 25605 $1,349.94 10/1/2018 River Hosp CDM EXC GANGLION CYST WRIST 25111 $1,349.94 10/1/2018 River Hosp CDM Revision of Lower Eyelid 15821 $1,351.50 10/1/2018 River Hosp CDM BLEPHAROSPLASTY UPPER EXC SKIN 15823 $1,352.30 10/1/2018 River Hosp CDM COMBO TORIC/MULTIFOCAL LENS $1,362.65 10/1/2018 River Hosp CDM ENDO ROOM 91-120 MINUTES $1,366.95 10/1/2018 River Hosp CDM ANAL FISTULA CLOSE W/EMT FLAP 46288 $1,372.20 10/1/2018 River Hosp CDM HEMMOROID/W/FISTULECTOMY 2+ 46262 $1,379.70 10/1/2018 River Hosp CDM PELVIS W/O CONTRAST 72192 $1,383.80 10/1/2018 River Hosp CDM CT THORACIC W/O CONT. 72128 $1,383.80 10/1/2018 River Hosp CDM CER. SP W/O CONT. 72125 $1,383.80 10/1/2018 River Hosp CDM NECK W/O CONTRAST 70490 $1,383.80 10/1/2018 River Hosp CDM MAXFACE W/O CONT. 70486 $1,383.85 10/1/2018 River Hosp CDM REV/REP OPER WOUND OF ANTER SG 66250 $1,384.90 10/1/2018 River Hosp CDM AMNIOGRAFT PTERYGIUM SURG $1,395.65 10/1/2018 River Hosp CDM L SPINE WITHOUT CONT 72131 $1,397.55 10/1/2018 River Hosp CDM EXC TUMOR SOFT TISSUE > 5 CM 22900 $1,398.05 10/1/2018

River Hosp CDM Revise Eyelid Defect 67911 $1,399.15 10/1/2018 River Hosp CDM ARTHROSCOPY SHOULDER SURG W/DE 29822 $1,410.90 10/1/2018 River Hosp CDM XOLAIR $1,414.95 10/1/2018 River Hosp CDM CURVED SHEARS 36 CM $1,417.65 10/1/2018 River Hosp CDM EXC PILONIDAL CYST; COMPLICATE 11772 $1,420.10 10/1/2018 River Hosp CDM ORBIT W/CONT 70481 $1,427.20 10/1/2018 River Hosp CDM CERV SP W/CONTR 72126 $1,427.20 10/1/2018 River Hosp CDM CT UPPER EXT. W/CONT. 73201 $1,427.20 10/1/2018 River Hosp CDM BRAIN SCAN W/CONTRAST 70460 $1,427.55 10/1/2018 River Hosp CDM DEBRIDEMENT EXT GENITALIA 11004 $1,434.15 10/1/2018 River Hosp CDM RPR BLEPHAROPTOSIS;FRONT MUSCL 67901 $1,434.25 10/1/2018 River Hosp CDM ILLOINGUAL/ILIOHYPOGASTRIC BLK 64425 $1,450.15 10/1/2018 River Hosp CDM REPR ING HRN INCAR/STRAN (GEN) 49507 $1,450.55 10/1/2018 River Hosp CDM GI PANEL PCR 87507 $1,450.75 10/1/2018 River Hosp CDM CHEST W/O CONTRAST 71250 $1,452.50 10/1/2018 River Hosp CDM C-SPINE W/WO CONTRAST 72127 $1,454.10 10/1/2018 River Hosp CDM UMBILECTOMY 49250 $1,461.65 10/1/2018 River Hosp CDM NEUROPLASTY ULNAR NERVE ELBOW 64718 $1,464.65 10/1/2018 River Hosp CDM REPAIR RECUR ING HERNIA;REDUC 49520 $1,465.30 10/1/2018 River Hosp CDM PELVIS W/WO CONTRAST 72194 $1,484.85 10/1/2018 River Hosp CDM CT THORACIC W/WO CONT 72130 $1,484.85 10/1/2018 River Hosp CDM ORBIT W/WO CONTRAST 70482 $1,484.85 10/1/2018 River Hosp CDM L SPINE W/WO CONT. 72133 $1,484.85 10/1/2018 River Hosp CDM NECK W/WO CONTRAST 70492 $1,484.85 10/1/2018 River Hosp CDM CT UPPER EXT. W/WO CONTRAST 73202 $1,484.85 10/1/2018 River Hosp CDM MAXFACE W/WO CONTRAST 70488 $1,484.85 10/1/2018 River Hosp CDM LOWER EXT W/WO CONTRAST 73702 $1,484.85 10/1/2018 River Hosp CDM Revise Eye Muscle 67311 $1,485.25 10/1/2018 River Hosp CDM Repair Eyelid Defect 67904 $1,486.45 10/1/2018 River Hosp CDM HARMONIC 9 CM CURVED SHEAR $1,497.85 10/1/2018 River Hosp CDM EXC RECTAL TUMOR TRANSANAL APP 45171 $1,497.90 10/1/2018 River Hosp CDM EXC LSN,CORNEA EXC PTERYGUIM 65400 $1,498.30 10/1/2018 River Hosp CDM Repair Tear Duct 68700 $1,501.65 10/1/2018 River Hosp CDM EXC MALIG LSN > 4.0CM (GEN) 11606 $1,509.60 10/1/2018 River Hosp CDM CT ABD DRAINAGE 75989 $1,511.05 10/1/2018 River Hosp CDM PELVIS W CONTRAST 72193 $1,512.85 10/1/2018 River Hosp CDM L SPINE W CONTRAST 72132 $1,512.85 10/1/2018 River Hosp CDM LOWER EXTREM/W CONT. 73701 $1,512.85 10/1/2018 River Hosp CDM MAXFACE W/CONT 70487 $1,512.85 10/1/2018 River Hosp CDM BIOCERAMIC ORBIT IMPLANT 16MM $1,529.50 10/1/2018 River Hosp CDM ABDOMINAL W/CONTRAST 74160 $1,533.60 10/1/2018 River Hosp CDM NEEDLE BIOPSY S&I 77012 $1,548.20 10/1/2018 River Hosp CDM CT UPPER EXT. W/O CON. 73200 $1,549.30 10/1/2018 River Hosp CDM EVISCERATION OCULAR W/SYNC IMP 65093 $1,555.30 10/1/2018 River Hosp CDM PRIVIGEN 20GM $1,556.10 10/1/2018 River Hosp CDM SEVER ADHESIONS INCIS POST SYN 65875 $1,564.90 10/1/2018 River Hosp CDM INTERM REPAIR 30.1-39.0cm 12037 $1,568.43 10/1/2018

River Hosp CDM REPAIR WOUND OVER 30.0 CM 12037 $1,568.43 10/1/2018 River Hosp CDM REPAIR WOUND OVER 30.0 CM 12047 $1,568.43 10/1/2018 River Hosp CDM DESTRUCTION LESIONS VULVA 56501 $1,568.43 10/1/2018 River Hosp CDM SEC CLS OF SURG WOUND/DEHI EXT 13160 $1,568.43 10/1/2018 River Hosp CDM ABDOMIN W/WO CONT. 74170 $1,573.95 10/1/2018 River Hosp CDM CHEST W/WO CONTRAST 71270 $1,573.95 10/1/2018 River Hosp CDM MULTIPLE INTERCOSTAL BLOCK TC 66421 $1,574.85 10/1/2018 River Hosp CDM LOWER EXTREM-W/O CON 73700 $1,576.25 10/1/2018 River Hosp CDM SUTURE IRIS;RETRIEVE SUTURE 66682 $1,580.85 10/1/2018 River Hosp CDM AMPUT FING/THUMB SINGLE 26951 $1,588.85 10/1/2018 River Hosp CDM Cataract w/ IOL 66984 $1,591.45 10/1/2018 River Hosp CDM GATED BLOOD POOL IMAGE MULTI 78473 $1,594.25 10/1/2018 River Hosp CDM INFIXIMAB (REMICADE) 10MG $1,596.55 10/1/2018 River Hosp CDM Ciliary Endoscipic Ablation 66711 $1,596.55 10/1/2018 River Hosp CDM BRAIN W/WO CONT 70470 $1,599.90 10/1/2018 River Hosp CDM CHEST W CONTRAST 71260 $1,612.05 10/1/2018 River Hosp CDM HYPERRAB 300 UNITS/ML 90375 $1,624.90 10/1/2018 River Hosp CDM ANOPLASTY PLASTIC OP STRICTURE 46700 $1,634.85 10/1/2018 River Hosp CDM EXC/REP EYELID OVER 1/4 LID MG 67966 $1,636.25 10/1/2018 River Hosp CDM AMNIOTIC MEMBRANE/RECONSTR $1,649.40 10/1/2018 River Hosp CDM EXC TUMOR SOFT TISSUE 5CM OR > 22901 $1,651.50 10/1/2018 River Hosp CDM ARTHROSCOPY,SHOULDER,SURGICAL 29824 $1,659.15 10/1/2018 River Hosp CDM OPHTHALMIC PATCH GRAFTS $1,661.40 10/1/2018 River Hosp CDM STRAB REC/RESECT 1 VERT MUSCLE 67314 $1,671.40 10/1/2018 River Hosp CDM LAPAROSCOPY SURG WITH LYSIS 58660 $1,671.65 10/1/2018 River Hosp CDM Skin Tissue Rearrangement 14060 $1,684.90 10/1/2018 River Hosp CDM VASECTOMY UNILATERAL OR BILAT 55250 $1,695.68 10/1/2018 River Hosp CDM ABDOMINAL W/O CONT. 74150 $1,705.05 10/1/2018 River Hosp CDM SCIATIC NERVE BLOCK TC 64445 $1,714.75 10/1/2018 River Hosp CDM BRAIN SCAN W/O CONT. 70450 $1,722.25 10/1/2018 River Hosp CDM REM FORN BODY INTRA;ANT CHAMB 65235 $1,762.35 10/1/2018 River Hosp CDM OATS AUTOGRAFT 10mm $1,765.25 10/1/2018 River Hosp CDM OATS AUTOGRAFT 6mm $1,765.25 10/1/2018 River Hosp CDM OATS AUTOGRAFT 8mm $1,765.25 10/1/2018 River Hosp CDM STRABISMUS SURG-2 HORIZ MUSCLE 67312 $1,770.10 10/1/2018 River Hosp CDM CORRECT LAGOPHTHALMOS W/IMPLT 67912 $1,811.35 10/1/2018 River Hosp CDM OPEN TX DISTAL RAD FX 25607 $1,819.95 10/1/2018 River Hosp CDM REPAIR INIT INC/VEN HERNIA;RED 49560 $1,830.95 10/1/2018 River Hosp CDM NECK WITH CONTRAST 70491 $1,832.90 10/1/2018 River Hosp CDM TENODESIS LONG TENDON BICEPS 23430 $1,848.35 10/1/2018 River Hosp CDM COLONOSCOPY W/ BIOPSY 45380 $1,849.20 10/1/2018 River Hosp CDM Create Tear Sac Drain 68720 $1,881.20 10/1/2018 River Hosp CDM REPOS INTRAOC LENS PROS INCISN 66825 $1,884.35 10/1/2018 River Hosp CDM NDSC WRIST W/TRANS CARPAL LIG 29848 $1,902.40 10/1/2018 River Hosp CDM REPAIR INC/VENT HERNIA PROF 49565 $1,906.85 10/1/2018 River Hosp CDM INSERT IOL-NO CONCUR CAT REMOV 66985 $1,913.60 10/1/2018 River Hosp CDM ABDOMEN & PELVIS W/O CONTRAST 74176 $1,919.05 10/1/2018

River Hosp CDM SUBCHONDROPLASTY PROF FEE 29855 $1,941.85 10/1/2018 River Hosp CDM DEBRIDE SKIN TISSUE ABD WALL 11005 $1,945.90 10/1/2018 River Hosp CDM REMOVL IMPLANT MAT ANT SEG EYE 65920 $1,957.45 10/1/2018 River Hosp CDM CT THORACIC W CONTRAST 72129 $1,970.90 10/1/2018 River Hosp CDM Cataract Complex 66982 $1,979.00 10/1/2018 River Hosp CDM CT HEAD W/+OR W/O CONT ANGIO 70496 $1,979.95 10/1/2018 River Hosp CDM Treat Eye Socket Fracture 21390 $1,989.50 10/1/2018 River Hosp CDM BIO-A FISTULA PLUG $2,000.40 10/1/2018 River Hosp CDM ABDOMEN & PELVIS W CONTRAST 74177 $2,005.15 10/1/2018 River Hosp CDM DEBRIDEMENT SKIN ABD WALL 11005 $2,011.15 10/1/2018 River Hosp CDM TENDON SHEATH INCISION 26055 $2,020.75 10/1/2018 River Hosp CDM CRITICAL CARE (30-74MIN) FAC 99291 $2,030.00 10/1/2018 River Hosp CDM INJECTAAFER $2,052.00 10/1/2018 River Hosp CDM NEXPLANON IUD $2,075.20 10/1/2018 River Hosp CDM INJECTAFER 750 MG/ML $2,082.80 10/1/2018 River Hosp CDM MEGACE 625MG/5ML 150ML BOTTLE $2,088.50 10/1/2018 River Hosp CDM MRI LUMB SPIN CANL WO CON APG 72148 $2,089.10 10/1/2018 River Hosp CDM CLOSUREFAST 60 cm CATHETER $2,107.90 10/1/2018 River Hosp CDM CLOSUREFAST 3 cm CATHETER $2,107.90 10/1/2018 River Hosp CDM Explore/Treat Eye Socket 67412 $2,109.35 10/1/2018 River Hosp CDM ABDOMEN W CONTR/PELVIS W/O CON 74178 $2,112.15 10/1/2018 River Hosp CDM CT ABD&PELVIS 1+ SECT/REGION 74178 $2,112.15 10/1/2018 River Hosp CDM ABDOMEN/PELVIS W&W/O CONTRAST 74178 $2,112.15 10/1/2018 River Hosp CDM EMERGENCY VAGINAL DELIVERY 59410 $2,121.10 10/1/2018 River Hosp CDM MRI BRAIN W/STEM W/O CONT APG 70551 $2,122.15 10/1/2018 River Hosp CDM CYANOKIT 5 gm $2,122.30 10/1/2018 River Hosp CDM FULL THICK GRAFT,FREE,INC CLOS 15260 $2,152.65 10/1/2018 River Hosp CDM CLOSED TX NASAL SEPTAL FX 21337 $2,199.06 10/1/2018 River Hosp CDM EXC DESTRUC PHARYNX LESION 42808 $2,199.06 10/1/2018 River Hosp CDM REMOVAL OF NASAL LESION 30117 $2,199.06 10/1/2018 River Hosp CDM REMOVAL SALIVARY STONE 42330 $2,199.06 10/1/2018 River Hosp CDM CLOSUREFAST 100 cm CATHETER $2,234.40 10/1/2018 River Hosp CDM RPR INIT INC/VEN HERNIA INCARC 49561 $2,260.35 10/1/2018 River Hosp CDM EXCHANGE INTRAOCULAR LENS 66986 $2,260.35 10/1/2018 River Hosp CDM EXC CHALAZION;SINGLE GEN ANEST 66986 $2,260.35 10/1/2018 River Hosp CDM MARSUOIALIZATION BARTHOLIN CYS 56440 $2,272.77 10/1/2018 River Hosp CDM DESTRUCT VAGINAL LESION 57061 $2,272.77 10/1/2018 River Hosp CDM ARTHROSCOPY KNEE SURG W/MENISC 29881 $2,306.85 10/1/2018 River Hosp CDM DESTRUCTION LESION, ANUS 46924 $2,315.63 10/1/2018 River Hosp CDM PROCTOPLASTY PROLAPSE MUC MEB 45505 $2,315.63 10/1/2018 River Hosp CDM HEMORRHOIDECTOMY 46250 $2,315.63 10/1/2018 River Hosp CDM HEMORRHOIDECOMY,INT/EXT SINGLE 46255 $2,315.63 10/1/2018 River Hosp CDM CT ANGIO LOWER EXT W/CONTRAST 73706 $2,319.85 10/1/2018 River Hosp CDM PILONIDAL CYST 11770 $2,324.87 10/1/2018 River Hosp CDM REMOV FB MUSCLE DEEP/COMPLICA 20525 $2,324.87 10/1/2018 River Hosp CDM I&D COMPLEX POST OP INFECTION 10180 $2,324.87 10/1/2018 River Hosp CDM DEBRIDEMENT OPEN FRACTURE 11012 $2,324.87 10/1/2018

River Hosp CDM EXC PILONIDAL CYST SIMPLE 11770 $2,324.87 10/1/2018 River Hosp CDM OR ROOM 0-30 MINUTES $2,352.35 10/1/2018 River Hosp CDM SLT TRABECULOPLASTY LASER 1+ 65855 $2,445.30 10/1/2018 River Hosp CDM CLOSURE FAST CATH 60MM MICRO $2,449.95 10/1/2018 River Hosp CDM RETEPLASE $2,519.00 10/1/2018 River Hosp CDM EXC RECTAL TUMOR BY PROCTOMY 45160 $2,533.45 10/1/2018 River Hosp CDM GENTAMYCIN INJECTION (ENT) 69801 $2,593.70 10/1/2018 River Hosp CDM ARTHROSCOPY SHOULDER SURG ROTA 29827 $2,632.20 10/1/2018 River Hosp CDM OPEN DISTAL PHALANX 26765 $2,645.23 10/1/2018 River Hosp CDM DRAINAGE OF TENDON SHEATH 26020 $2,645.23 10/1/2018 River Hosp CDM ARTHROSCOPY KNEE W/DEBRID SHV 29877 $2,645.23 10/1/2018 River Hosp CDM ARTHROSCOPY KNEE W/MEDIS M&L 29880 $2,645.23 10/1/2018 River Hosp CDM CORRECTION HAMMERTOE 28285 $2,645.23 10/1/2018 River Hosp CDM ARTHROSCOPY SHLDR W/DEBRID EXT 29823 $2,645.23 10/1/2018 River Hosp CDM ARTHROSCOPY SHLDR DISTAL CLAV 29824 $2,645.23 10/1/2018 River Hosp CDM FISTULZATN,TRABU ABS PREV SURG 66170 $2,718.35 10/1/2018 River Hosp CDM BIOPSY BREAST OPEN, INCISIONAL 19101 $2,727.84 10/1/2018 River Hosp CDM OR ROOM 31-60 MINUTES $2,733.80 10/1/2018 River Hosp CDM RABIES IMMUNE GLOB 10ML VIAL 90375 $2,786.00 10/1/2018 River Hosp CDM P-50 EXPRESS SHUNT $2,801.85 10/1/2018 River Hosp CDM GLAUCOMA MINI EXPRESS SHUNT $2,813.55 10/1/2018 River Hosp CDM AQUEOS SHUNT EXTRAOCULAR RES 66180 $2,827.00 10/1/2018 River Hosp CDM NOVASURE NS2000 $2,881.80 10/1/2018 River Hosp CDM GOLD WEIGHT PLACEMENT (ENT) 67912 $2,890.50 10/1/2018 River Hosp CDM INSERTION INDWELLING TUNNEL CA 32550 $2,911.16 10/1/2018 River Hosp CDM SCS LEAD PULL TC 63661 $3,015.05 10/1/2018 River Hosp CDM ARTHROSCOPIC SYNOVECTOMY KNEE 29875 $3,093.65 10/1/2018 River Hosp CDM TENOTOMY ELBOW REPAIR RECONSTR 24359 $3,093.65 10/1/2018 River Hosp CDM ARTHRO KNEE W/MENISCECTOMY 29880 $3,093.65 10/1/2018 River Hosp CDM OR ROOM 61-90 MINUTES $3,178.75 10/1/2018 River Hosp CDM ARTHRO W/ALLOGRAFT PRO FEES 29867 $3,180.30 10/1/2018 River Hosp CDM CORNEA GEN WHOLE CORNEA $3,197.25 10/1/2018 River Hosp CDM RECLAST $3,215.85 10/1/2018 River Hosp CDM MRI LUMB SPIN CANL WO CONT APG 70553 $3,255.05 10/1/2018 River Hosp CDM STRATTICE MESH 15X25 CM $3,589.40 10/1/2018 River Hosp CDM KERATOPLASTY ENDOTHELIAL 65756 $3,608.69 10/1/2018 River Hosp CDM OR ROOM 91-120 MINUTES $3,623.80 10/1/2018 River Hosp CDM ROTATIONAL FLAP TRUNK 15734 $3,737.75 10/1/2018 River Hosp CDM OR ROOM 121-150 MINUTES $4,068.80 10/1/2018 River Hosp CDM CORNEA MICROKERATONE DSAEK $4,161.50 10/1/2018 River Hosp CDM OR ROOM 151-180 MINUTES $4,258.35 10/1/2018 River Hosp CDM INSERT ANT SEG AQUEOUS DRAIN C1783 $4,337.55 10/1/2018 River Hosp CDM CORNEA PRESTRIPPED FOR DMEK $4,466.00 10/1/2018 River Hosp CDM ASPIRATION OVARIAN CYST LAP 49322 $4,488.68 10/1/2018 River Hosp CDM GEUDER PRE LOADED CANNULA DMEK $4,669.00 10/1/2018 River Hosp CDM OR ROOM 181-210 MINUTES $4,678.10 10/1/2018 River Hosp CDM LASIK - STANDARD $4,858.05 10/1/2018

River Hosp CDM GAMMAGUARD 30MG $4,918.05 10/1/2018 River Hosp CDM ESSURE XZ $5,080.15 10/1/2018 River Hosp CDM REPAIR INC/VENT HERNIA FAC 49565 $5,327.70 10/1/2018 River Hosp CDM ARTHRSCOPY KNEE W/ MENS SHVG 29881 $5,494.15 10/1/2018 River Hosp CDM OR ROOM 211-240 MINUTES $5,512.70 10/1/2018 River Hosp CDM ARTHROSCOPY SHLDR ROTATOR REP 29827 $5,606.42 10/1/2018 River Hosp CDM NCS ARANESP 200MCG/0.4ML SYRI $5,834.00 10/1/2018 River Hosp CDM ENTYVIO 300 MG $5,951.00 10/1/2018 River Hosp CDM OR ROOM 241-270 MINUTES $6,201.75 10/1/2018 River Hosp CDM RABIES IMM GLOB 1500un10mlVIAL $6,400.25 10/1/2018 River Hosp CDM ARTHRO AIDED TIBAL FX 29855 $6,624.90 10/1/2018 River Hosp CDM ARTHRO AIDED AUG/RECONSTRUCT 29888 $6,624.90 10/1/2018 River Hosp CDM ARTHROSCOPY W/SUBCHONDROPLASTY 29855 $6,624.90 10/1/2018 River Hosp CDM OR ROOM 270-300 MINUTES $6,890.85 10/1/2018 River Hosp CDM LASIK - CUSTOM $7,125.15 10/1/2018 River Hosp CDM CORNEAL TISSUE $7,341.05 10/1/2018 River Hosp CDM PRAXBIND 2.5 GM/50 ML $8,706.25 10/1/2018 River Hosp CDM ARTHROSCOPY WITH ALLOGRAFT 29867 $12,130.85 10/1/2018