CPT4 Code Descripon Charge Amount NICARDIPINE HCL 20MG/200ML PRE-MIXED IV $ 419.00 A9270GY TRAVATAN $ 354.00 BAYHEP B PFS $ 653.00 J1645 FRAGMIN 18000U $ 423.00 AMMONIA AROMATIC INH $ 4.00 A4340 CATH FOLEY COUDE LTX 5CC 22 FR $ 31.00 CLIP RESOLUTION $ 844.00 A4351 CATHETER URETHRAL BARDIA 14 FR $ 27.00 64832 REPAIR NERVE ADD ON $ 417.00 C1726 BALLOON HERCULES 15-16.5-18MM $ 663.00 C1726 DILATOR BAL CRE SGL USE FIXED $ 855.00 C1726 DILATOR BAL CRE SGL USE FIXED $ 855.00 C1726 DILATOR BAL CRE SGL USE FIXED $ 855.00 C1726 DILATOR CRE FIXED WIRE BALLOON $ 855.00 C1726 DILATOR COLONIC BAL CRE WIRE GU $ 986.00 27705 INCISION OF TIBIA $ 17,350.00 28270 RELEASE OF FOOT CONTRACTURE $ 8,186.00 28296 CORRECTION OF BUNION $ 8,186.00 28315 REMOVAL OF SESAMOID BONE $ 8,186.00 28405 TREATMENT OF HEEL FRACTURE $ 665.00 28725 FUSION OF FOOT BONES $ 31,327.00 29820 ARTHROSCOPY SHLDRR SYNOVEC PAR $ 17,350.00 29824 SHOULDER ARTHROSCOPY MUMFORD $ 8,186.00 29826 SHOULDER ARTHROSCOPY/SURGERY $ 1,440.00 29827 ARTHROSCOP ROTATOR CUFF REPR $ 17,350.00 29894 ANKLE ARTHROSCOPY/SURGERY $ 8,186.00 31254 REVISION OF ETHMOID SINUS $ 15,053.00 31295 SINUS ENDO W/BALLON DIL MAX $ 15,053.00 31297 SINUS ENDO W/BALLON DIL SPHENOID $ 15,053.00 36907 TRANSLUMINAL BALLOON ANGIOPLAST $ 235.00 38220 BONE MARROW ASPIRATION $ 4,172.00 46260 REMOVE IN/EX HEM GROUPS 2+ $ 7,166.00 47379 LAPAROSCOPE PROCEDURE LIVER $ 13,891.00 47600 REMOVAL OF GALLBLADDER $ 1,944.00 52235 CYSTOSCOPY AND TREATMENT $ 8,346.00 56501 DESTROY VULVA LESIONS SIM $ 4,854.00 58140 MYOMECTOMY ABDOM METHOD $ 2,156.00 58301 REMOVE INTRAUTERINE DEVICE $ 497.00 58350 REOPEN FALLOPIAN TUBE $ 12,725.00 59409 OBSTETRICAL CARE $ 7,034.00 64491 INJ PARAVERT F JNT C/T 2 LEV $ 107.00 64494 INJ PARAVERT F JNT L/S 2 LEV $ 91.00 77001 FLUOROGUIDE FOR VEIN DEVICE $ 114.00 G0460 AUTOLOGOUS PRP FOR ULCERS $ 4,854.00 64718 REVISE ULNAR NERVE AT ELBOW $ 4,984.00 64787 IMPLANT NERVE END $ 374.00 42900 REPAIR THROAT WOUND $ 3,522.00 27825 TREAT LOWER LEG FRACTURE $ 4,178.00 12053 INTMD WND RPR FACE MM 5.1-7.5 CM $ 962.00

1 12041 INTMD WND RPR N-HF-GEN=<2.5 CM $ 962.00 CLIP HEMO-LOK LARGE $ 158.00 27618 EXC LEG/ANKLE TUM < 3 CM $ 4,172.00 25248 REMOVE FOREARM FOREIGN BODY $ 4,178.00 46258 REMOVE IN/EX HEM GRP W/FISTU $ 7,166.00 27752 CLOSD TX TIBIAL SHAFT W/MANIP $ 4,178.00 36558 INSERT TUNNELED CVC W/O PORT/PUMP AGE>5 $ 7,714.00 36569 INS PICC AGE 5 YRS/> $ 3,042.00 STAPLE ENDO GIA RR 60MM MED THICK $ 1,262.00 BAG BILE $ 30.00 SUTURE TI CRON 5-0 $ 13.00 ELECTRODE LOOP 2 X 1 $ 68.00 WIRE FIBER $ 66.00 SUTURE MAXON 4-0 $ 8.00 BAG BILE 9 1/2" $ 30.00 58150 TOTAL HYSTERECTOMY $ 15,304.00 15271 SKIN SUB GRAFT TRNK/ARM/LEG $ 4,854.00 82009 ACETONE-BLOOD $ 46.00 82150 AMYLASE-FLUID $ 59.00 82570 CREATININE-FLUID $ 36.00 80051 ELECTROLYTES-ST $ 68.00 82438 CHLORIDE-FLUID $ 36.00 80299 MEXILETINE-SERUM $ 245.00 83615 LDH-FLUID $ 36.00 82945 GLUCOSE-FLUID $ 36.00 83935 OSMOLALITY-FECES $ 107.00 84302 SODIUM-FLUID $ 36.00 84110 PORPHOBIL/QUANT $ 41.00 80320 ALCOHOL-BLOOD $ 125.00 84157 PROTEIN-CSF $ 52.00 82085 ALDOLASE $ 52.00 80192 PROCAIN/NAPA $ 132.00 80299 DISOPYRAMIDE SE $ 83.00 80150 AMIK-TROUGH $ 118.00 84075 ALKALINE PHOSPTSE $ 36.00 80299 DIGITOXIN-SERUM $ 83.00 82805 GASES-BLD BASE EX $ 227.00 82985 GLYCOSYLATED ALBUMIN $ 85.00 82128 AMINO ACID SC-BL $ 67.00 80061 LIPID PANEL $ 93.00 82330 CA IONIZED MEAS $ 81.00 82128 AMINO ACID SC-UR $ 67.00 82108 ALUMINUM-PLASMA $ 121.00 82150 AMYLASE-2HR URINE $ 59.00 82150 AMYLASE-RANDOM UR $ 59.00 82438 CHLORIDE-CSF $ 36.00 82436 CHLORIDE-RAND UR $ 36.00 82465 CHOLESTEROL-FLUID $ 36.00 82139 AMINO ACID QNT-UR $ 929.00 82570 CREATININE-RAN UR $ 36.00 82575 CREATININE CL-2HR $ 114.00 80299 DYPHYLLINE-SERUM $ 83.00 82140 AMMONIA-BLOOD $ 114.00 80051 ELECTROLYTES-RA U $ 68.00 80176 LIDOCAINE-SERUM $ 83.00 85549 LYSOZYME-URINE $ 87.00

2 83785 MANGANESE-BLOOD $ 290.00 83661 L/S-PG AMN FLD $ 134.00 80299 MEPHENYTOIN-SERUM $ 83.00 80299 METHOTREXATE-SER $ 125.00 83935 OSMOLALITY-RAN UR $ 107.00 83986 PH-FLUID $ 35.00 84133 POTASSIUM-RAND UR $ 36.00 82150 AMYLASE-BLOOD $ 59.00 84300 SODIUM-RANDOM UR $ 36.00 84430 THIOCYANATE-SERUM $ 56.00 84478 TRIGLYCERIDES-FL $ 36.00 84540 UUN-12HR URINE $ 36.00 84540 UUN-RANDOM URINE $ 36.00 83880 BNP $ 160.00 80164 VALPROIC ACID TOTAL-SER $ 126.00 80202 VANCO-TROUGH $ 132.00 82652 VIT D 1,25-DI-OH $ 176.00 86235 ANTIEXTRACTABLE NUCLEAR AG $ 295.00 80299 ANTIBIOTIC LEVEL $ 83.00 87529 HSV I/II DNA BY PCR $ 556.00 80188 PRIMIDONE-SERUM $ 132.00 80184 PHENOBARBITAL-SER $ 132.00 80185 PHENYTOIN-SERUM $ 132.00 80156 CARBAMAZEP.SER. $ 132.00 81050 VOLUME MEAS. $ 15.00 82040 ALBUMIN-SERUM $ 36.00 82175 ARSENIC - URINE $ 332.00 80299 TOCAINIDE-SERUM $ 317.00 82951 GLUCOSE TOL 3SP $ 108.00 80299 FLECAINIDE-SERUM $ 83.00 80299 AMOXAPINE-SERUM $ 293.00 82150 AMYLASE-24HR UR $ 59.00 80162 DIGOXIN TOTAL $ 126.00 80200 TOBRA-TROUGH $ 126.00 80170 GENTA-TROUGH $ 132.00 83088 HISTAMINE-BLOOD $ 134.00 83670 LAP-LEUC AMIN PEP $ 125.00 83050 METHEMOGLOBIN $ 125.00 84132 POTASSIUM-SERUM $ 36.00 83550 IRON-TIBC $ 93.00 82962 GLUCOSE-BLOOD-BEDSIDE $ 35.00 84520 BUN-UREA N $ 36.00 82175 ARSENIC-BLOOD $ 87.00 82495 CHROMIUM $ 239.00 82952 GLU TOL. 6TH HR $ 36.00 82340 CALCIUM - URINE $ 36.00 82131 CYSTINE QUANT $ 185.00 82310 CALCIUM-TOTAL-BLOOD $ 36.00 82382 CATECHOLAMINES-UR $ 79.00 82435 CHLORIDE-SERUM $ 36.00 82465 CHOLESTEROL $ 36.00 82480 CHOLINESTERASE $ 52.00 82375 CO/ CARBON MONOXIDE $ 29.00 82525 COPPER - URINE $ 58.00 82525 COPPER-SERUM $ 58.00 82374 CO2 CONTENT $ 36.00

3 82550 CPK TOTAL $ 36.00 82570 CREAT-24HR URINE $ 36.00 82575 CREAT CLEAR-24HR $ 114.00 82565 CREATININE-BLOOD $ 36.00 82507 CITRIC ACID-URINE $ 344.00 82553 CKMB $ 111.00 80150 AMIKACIN-PEAK $ 118.00 80170 GENTAMICIN-PEAK $ 132.00 80200 TOBRAMYCIN-PEAK $ 126.00 82952 GLU TOL 5TH HR $ 36.00 84156 RAND UR PROTEIN $ 52.00 80051 ELECTROLYTE PL $ 68.00 80051 LYTES,24HR URINE $ 68.00 82668 ERYTHROPOIETIN $ 135.00 82710 FECAL FATS QUANT $ 239.00 82977 GGTP $ 36.00 84080 ALK PHOS ISOENZ $ 71.00 84134 PREALBUMIN-SERUM $ 71.00 82805 GASES-BLOOD $ 227.00 83491 GLUCORTICOID 170H $ 83.00 83655 LEAD-BLOOD/OCH $ 94.00 82947 GLUCOSE-FBS $ 36.00 83036 GLYCOHEMOGLOBIN $ 85.00 87899 HIV AG RAPID $ 90.00 82533 CORTISOL POST DEXAMETHASONE $ 185.00 83718 HDL CHOLESTEROL $ 108.00 83015 HEAVY METALS-UR $ 465.00 83090 HOMOCYSTEINE-SE $ 185.00 83540 IRON-SERUM $ 59.00 83605 LACTIC ACID $ 114.00 83615 LDH TOTAL-SERUM $ 36.00 83655 LEAD - URINE $ 94.00 83655 LEAD-BLOOD $ 94.00 83690 LIPASE $ 93.00 80178 LITHIUM $ 114.00 83735 MAGNESIUM-SERUM $ 59.00 83735 MAGNESIUM-URINE $ 59.00 83825 MERCURY BLOOD $ 73.00 83825 MERCURY-URINE $ 73.00 82131 METH. MALON SER $ 185.00 82131 METH. MALOMIC-UR $ 185.00 83874 MYOGLOBIN - SERUM $ 59.00 83874 MYOGLOBIN QNT-UR $ 59.00 83930 OSMOLALITY-SERUM $ 107.00 83935 OSMOLAL-24HR UR $ 107.00 83945 OXALATE URINE $ 60.00 82810 OXYGEN SAT-BLOOD $ 87.00 82800 PH-BLOOD $ 35.00 84105 PHOSPHORUS -URINE $ 36.00 84100 PHOSPHORUS-BLOOD $ 36.00 84106 PORPHOBIL-QUAL $ 37.00 84119 PORPHYRINS QU-UR $ 41.00 84133 POTASSIUM-24HR UR $ 36.00 84138 PREGNANETRIOL $ 290.00 84155 PROT TOTAL-W-CA $ 52.00 84220 PYRUVATE KINASE $ 129.00

4 80194 QUINIDINE $ 132.00 84300 SODIUM-24HR URINE $ 36.00 84295 SODIUM-SERUM $ 36.00 80198 THEOPHYLLINE $ 132.00 84450 TRNSMNSE SGOT AST $ 36.00 84460 TRANSAMINASE SGPT $ 36.00 84478 TRIGLYCERIDES $ 36.00 84560 URIC ACID - URINE $ 36.00 84550 URIC ACID-BLOOD $ 36.00 84540 UUN-24HR URINE $ 36.00 84425 VITAMIN B1 $ 104.00 82180 VITAMIN C $ 41.00 82306 VITAMIN D (25-OH) $ 136.00 84620 XYLOSE TOLERANCE $ 66.00 83915 5'-NUCLEOTIDASE $ 180.00 82950 GLUCOSE PP W DOSE $ 50.00 80173 HALOPERIDOL-SER $ 83.00 84081 PG AMNIOTIC FL QUAL $ 77.00 80299 FLUPHENAZINE-SE $ 144.00 82247 BILIR-CORD BLD $ 36.00 86255 ACETYLCHOLINE RECEPTOR AB $ 176.00 84600 ALCOHOL METHYL, BLOOD $ 77.00 82105 ALPHA FETOPROTEIN, MATERN $ 140.00 80299 AMIODARONE, SERUM $ 83.00 82248 BILIRUBIN DIRECT, SERUM $ 36.00 82247 BILIRUBIN TOTAL, SERUM $ 36.00 82340 CALCIUM, RANDOM URINE $ 36.00 80048 BASIC MET PNL $ 79.00 80158 CYCLOSPORINE FPIA, SERUM $ 126.00 82955 G6PD QUANT. BLOOD $ 160.00 82947 GLUCOSE 1HR POST PRANDIAL $ 50.00 82947 GLUCOSE-SPINAL FLUID $ 36.00 87522 HCV RNA, QUANTITATIVE $ 211.00 86692 HEP B DELTA AB $ 180.00 87515 HEPATITIS B VIRUS DNA $ 374.00 86804 HEPATITIS C BY RIBA, SERU $ 316.00 83835 METANEPHRINES FRAC, URINE $ 140.00 82043 MICROALBUMIN, 24HR URINE $ 63.00 84311 PHOSPHOLIPIDS, SERUM $ 41.00 82951 3 HR GLUCOSE TOLERANCE, S $ 176.00 84066 ACID PHOSPHATASE PROSTATI $ 167.00 82024 ADRENOCORTICOTROPHIC HORM $ 254.00 82088 ALDOSTERONE, SERUM $ 254.00 82088 ALDOSTERONE, URINE $ 254.00 82164 ANGIOTENSIN CONV ENZYME,S $ 126.00 84703 BHCG QUALITATIVE, SERUM $ 47.00 84681 C-PEPTIDE, SERUM $ 98.00 86301 CARBOHYDRATE ANTIGEN 19-9 $ 100.00 88262 CHROMOSOME ANALYSIS,BLOOD $ 604.00 82533 CORTISOL, SERUM $ 185.00 82670 ESTRADIOL, SERUM $ 52.00 82677 ESTRIOL TOTAL, SERUM $ 71.00 82672 ESTROGENS TOTAL, SERUM $ 200.00 82728 FERRITIN, SERUM $ 125.00 82746 FOLATE, SERUM $ 125.00 83001 FOLLICLE STIMULATING HORM $ 125.00

5 84439 FREE T4, SERUM $ 83.00 82941 GASTRIN, SERUM $ 83.00 84702 HCG MICRO DILUTION, SERUM $ 227.00 86709 HEPATITIS A AB IGM $ 136.00 86704 HEPATITIS B CORE ANTIBODY $ 136.00 86705 HEPATITIS B CORE IGM ANTI $ 136.00 86706 HEPATITIS B SURFACE ANTIB $ 93.00 87340 HEPATITIS B SURFACE ANTIG $ 93.00 86707 HEPATITIS BE ANTIBODY $ 125.00 87350 HEPATITIS BE ANTIGEN $ 176.00 83498 HYDROXYPROGESTERONE 17-AL $ 125.00 83525 INSULIN, SERUM $ 41.00 86337 INSULINE ANTIBODIES, SERU $ 373.00 86340 INTRINSIC FACTOR BLK AB $ 254.00 83002 LUTEINIZING HORMONE, SERU $ 125.00 83970 PARATHYRIOID HORMONE, INT $ 247.00 83970 PARATHYROID HORMONE C-TER $ 247.00 84030 PKU SCREENING $ 203.00 84144 PROGESTERONE, SERUM $ 98.00 84146 PROLACTIN, SERUM $ 125.00 82747 RBC FOLATE $ 125.00 84244 RENIN ACTIVITY, PLASMA $ 100.00 84479 T-3 UPTAKE, SERUM $ 67.00 84436 T-4 (THYROXINE) TOTAL, SE $ 67.00 84402 TESTOST FREE & WEAKLY BOU $ 271.00 84403 TESTOSTERONE TOTAL, SERUM $ 135.00 84443 THYROID STIMULATING HORMO $ 81.00 84442 THYROXINE BINDING GLOBULI $ 68.00 84481 TRIIODOTHYRONINE FREE, SE $ 72.00 84482 TRIIODOTHYRONINE REVERSE, $ 72.00 84480 TRIIODOTHYRONINE TOTAL, S $ 72.00 82607 VITAMIN B12, SERUM $ 185.00 86803 HEPATITIS C $ 186.00 82232 BETA-2 MICROGLOBULIN, SER $ 83.00 82627 DEHYDROEPIANDROSTERONE SU $ 110.00 80186 DILANTIN,FREE $ 132.00 82693 ETHYLENE GLYCOL, SERUM $ 81.00 82960 G-6-PD QUALITATIVE, BLOOD $ 162.00 83986 PH, STOOL $ 35.00 85303 PROT C ACT $ 342.00 85306 PROTEIN S ACTIVITY $ 342.00 84157 PROTEIN, BODY FLUID $ 52.00 84156 PROTEIN, 24 HOUR URINE $ 52.00 36415 VENIPUNCTURE ROUTINE $ 22.00 82378 CARCINOEMBRYONIC ANTIGEN $ 144.00 87389 HIV AG/AB COMBO, 4TH GENERATION $ 125.00 84153 PROSTATE SPECIFIC ANTIGEN $ 135.00 84155 TOTAL PROTEIN, SERUM $ 52.00 82105 TRIPLE TEST, MATERNAL SER $ 140.00 82436 CHLORIDE,24HOUR URINE $ 36.00 80307 DRUGS OF ABUSE, URINE $ 664.00 82951 3HR GLU. TOL. PREG.WOMAN $ 171.00 84703 PREG TEST-P OP $ 47.00 82608 VIT B12 BNDNG CAP $ 245.00 84305 SOMATOMEDIN-C $ 98.00 84586 VIP-VASOINT POLY $ 162.00

6 84703 HCG-INTACT $ 47.00 84588 ANTIDIUR HORM-BL $ 132.00 83525 INSULIN ASSY F. $ 41.00 83525 INSULIN ASY H 1/2 $ 41.00 83525 INSULIN ASSY H 1 $ 41.00 83525 INSULIN ASY HR 2 $ 41.00 83525 INSULIN ASSY 3H $ 41.00 83525 INSULIN ASY HR 4 $ 41.00 82240 BILE ACID TOTAL $ 331.00 83003 HUMAN GROWTH HORM $ 153.00 84620 XYLOSE ABSORP FASTING, SE $ 66.00 84620 XYLOSE ABSORP 1 HOUR, SER $ 66.00 84620 XYLOSE ABSORPTION, URINE $ 66.00 84484 TROPONIN I QUANT $ 121.00 82247 NEONATAL BILIRUBIN TOTAL $ 36.00 86300 CANCER ANTIGEN 15-3 $ 100.00 84105 PHOS RAND UR $ 36.00 82040 ALBUMIN-FLUID $ 36.00 86304 CA 125 $ 100.00 80157 CARBAMAZE.FREE $ 139.00 80197 TACROLIMUS, SE $ 252.00 86003 ALLERGY PANEL REGION 4, TREES $ 63.00 86003 ALLERGY PANEL REGION 4, WEEDS $ 63.00 86003 ALLERGY PANEL, ANIMAL GRO $ 63.00 86003 ALLERGY PANEL, CEREAL GRO $ 63.00 86003 ALLERGY PANEL, MOLD GROUP $ 63.00 86003 ALLERGY PANEL, NUT GROUP $ 63.00 86003 ALLERGY PANEL, PEDS GROUP $ 63.00 86003 ALLERGY PANEL, SALAD GROU $ 63.00 86003 ALLERGY PANEL, SEAFOOD GR $ 63.00 86003 ALLERGY PANEL, STING INSECT $ 63.00 86003 ALLERGY PANEL, VEGATABLE GR $ 63.00 86005 ALLERGY SCREEN, ANIMAL $ 41.00 86005 ALLERGY SCREEN, GRASSES # 1 $ 41.00 86005 ALLERGY SCREEN, HOUSE DUS $ 41.00 86005 ALLERGY SCREEN, MOLDS $ 41.00 86005 ALLERGY SCREEN, TREES # 1 $ 41.00 86005 ALLERGY SCREEN, TREES # 2 $ 41.00 86005 ALLERGY SCREEN, TREES # 3 $ 41.00 86005 ALLERGY SCREEN, TREES # 4 $ 41.00 86005 ALLERGY SCREEN, WEEDS # 1 $ 41.00 86005 ALLERGY SCREEN, WEEDS # 2 $ 41.00 82157 ANDROSTENEDIONE, SERUM $ 141.00 86141 C-REACTIVE PROTEIN $ 125.00 82495 CHROMIUM, SERUM $ 239.00 80299 CLOMIPRAMINE, SERUM $ 180.00 82600 CYANIDE, BLOOD $ 94.00 84165 ELECTROPH-PROTEIN-CSF $ 104.00 82677 ESTRIOL UNCONJUGATED $ 71.00 82943 GLUCAGON, PLASMA $ 83.00 82945 GLUCOSE-RANDOM URINE $ 36.00 83088 HISTAMIN, 24 HOUR URINE $ 134.00 80299 ISONIAZID, SERUM $ 147.00 83655 LEAD (MEDICAID),BLOOD $ 94.00 83690 LIPASE, BODY FLUID $ 93.00 83519 NEUROTENSIN, PLASMA $ 185.00

7 86255 PANCREATIC ISLET CELL AB, $ 238.00 84155 PROTEIN-CSF $ 52.00 83080 TAY SACHS CARRIER SCREEN $ 135.00 84270 TESTOSTERONE BINDING GLOB $ 125.00 80299 THIOPENTAL, SERUM $ 121.00 82131 TRYPTOPHAN, SERUM $ 185.00 84545 UREA NITROGEN CLEARANCE $ 104.00 84560 URIC ACID, 24 HOUR URINE $ 36.00 84999 A-SUNUNIT-PITUITARY HORMONE $ 144.00 82664 BETA-2-TRANSFERRIN $ 737.00 83021 HEMOGLOBIN A2 BY COLUMN $ 167.00 82105 ALPHA-FETOPROTEIN TUMOR $ 140.00 82103 A-1-ANTITRYPSIN $ 66.00 82390 CERULOPLASMIN $ 52.00 86162 CH 50 $ 125.00 82595 CRYOGLOBULIN,QUAL $ 72.00 83010 HAPTOGLOBULIN LEVEL $ 125.00 82785 IG E LEVEL $ 135.00 84466 TRANSFERRIN $ 125.00 85810 VISCOSITY SERUM $ 221.00 86431 RHEUMATOID FACTOR $ 125.00 86689 HIV, WESTERN BLOT $ 167.00 86003 ALLERGY PANEL REGION INHALANTS $ 63.00 86005 ALLERGY SCREEN, GRASSES # 2 $ 41.00 82784 IGM-CORD BLOOD $ 125.00 83992 PHENCYCLIDINE (PCP), SERU $ 87.00 80069 RENAL FUNCT PN $ 94.00 80299 PROTRITYL SER $ 46.00 80150 AMIKACIN-RAND. $ 118.00 80170 GENTAMICIN-RAN $ 132.00 80200 TOBRAMYCIN-RAN $ 126.00 80202 VANCOMYCIN-RAN $ 132.00 G0479 BENZODIAZEPINES POC $ 31.00 G0479 COCAINE POC $ 31.00 G0479 BARBITURATES POC $ 31.00 G0479 METHADONE POC $ 31.00 G0479 OPIATES POC $ 31.00 G0479 PHENCYCLIDINE POC $ 31.00 G0479 THC POC $ 31.00 G0479 TRICYCLIC ANTIDEPRESSANTS POC $ 31.00 84484 TROPONIN POC $ 118.00 83874 MYOGLOBIN POC $ 56.00 82553 CKMB POC $ 111.00 83880 BNP $ 160.00 G0479 ACETAMINOPHEN/PARACETAMOL POC $ 31.00 G0479 AMPHETAMINES POC $ 31.00 G0479 METHAMPHETAMINES POC $ 31.00 84560 URIC ACID FLD $ 36.00 82731 FETAL FIBRONECTIN $ 315.00 82705 FECAL FAT QUALITATIVE $ 167.00 80048 ECL BASIC METABOLIC PANEL $ 8.00 80053 ECL COMP METABOLIC PANEL $ 16.00 83036 ECL GLYCOHEMOGLOBIN(A1C) $ 16.00 86703 ECL HIV1/HIV2 AB $ 8.00 83655 ECL LEAD-URINE $ 42.00 80061 ECL LIPID PANEL $ 26.00

8 84153 ECL PROSTATE SPECIFIC ANTIGEN $ 35.00 84443 ECL THYROID STIMULATING HORMO $ 8.00 82043 ECL URINE MICROALBUMIN $ 26.00 82491 CAFFEINE LEVEL, SERUM $ 191.00 84402 TESTOSTERONE, FREE, DIRECT $ 81.00 G0479 DRUG OF ABUSE (POC) $ 300.00 82570 CREATININE, RANDOM URINE $ 36.00 86703 HIV AB RAPID $ 90.00 80076 LIVER FUNC PNL $ 77.00 80053 COMP METAB PNL $ 114.00 80053 COMP METAB FLD $ 114.00 80074 HEPATIT-ACU PN $ 584.00 86708 HEP A AB TOTAL $ 136.00 82805 CORD GASES-VEN $ 227.00 82805 CORD GASES-ART $ 227.00 82043 MICROALB RA UR $ 63.00 80155 CAFFEINE $ 39.00 80159 CLOZAPINE $ 33.00 80169 EVEROLIMUS $ 37.00 80171 GABAPENTIN WHOLE BLOOD $ 36.00 80175 LAMOTRIGINE $ 36.00 80177 LEVETIRACETAM $ 36.00 80180 MYCOPHENOLATE (MYCOPHENOIC ACID) $ 49.00 80183 OXCARBAZEPINE $ 36.00 80199 TIAGABINE $ 49.00 80203 ZONISAMIDE $ 36.00 87661 TRICHOMONAS VAGINALIS AMPLIF $ 96.00 88342 IMMUNOHISTO/CYTO CHEM 1ST ST $ 206.00 88343 IMMUNOHISTOCHEM PER SPECIMEN $ 206.00 80335 ANTIDEPRESS TRICYCLICS 1 OR 2 $ 29.00 80329 ANALGESICS NON-OPIOD 1 OR 2 $ 125.00 80320 ALCOHOLS $ 125.00 80327 ANABOLIC STEROIDS 1 OR 2 $ 125.00 80361 OPIATES 1 OR MORE $ 87.00 80345 BARBITURATES $ 58.00 80353 COCAINE $ 225.00 80163 DIGOXIN; FREE $ 126.00 80165 VALPROIC ACID FREE $ 126.00 80323 ALKALOIDS NOS $ 36.00 80324 AMPHETAMINES; 1 OR 2 $ 83.00 80332 ANTIDEPRESSANTS SRTNRGC 1 OR 2 $ 31.00 80346 BENZODIAZEPINES; 1-12 $ 83.00 80348 BUPRENORPHINE $ 87.00 80349 CANNABINOIDS, NATURAL $ 83.00 80350 CANNABINOIDS, SYNTHETIC; 1-3 $ 83.00 80354 FENTANYL $ 83.00 80355 GABAPENTIN, NON-BLOOD $ 36.00 80356 HEROIN METABOLITE $ 83.00 80357 KETAMINE AND NORKETAMINE $ 83.00 80358 METHADONE $ 83.00 80359 METHYLENEDIOXYAMPHETAMINES $ 83.00 80360 METHYLPHENIDATE $ 83.00 80363 OPIOIDS & OPIATE ANALGS 3 OR 4 $ 83.00 80365 OXYCODONE $ 83.00 80366 PREGABALIN $ 83.00 80367 PROPOXYPHENE $ 83.00

9 80375 DRUG DEF QUAL OR QUANT NOS 1-3 $ 83.00 87116 ACID FAST-CULTURE $ 211.00 87070 CULTURE-GENITAL $ 184.00 87070 CULTURE UPPER RESPIRATORY $ 184.00 87088 CULTURE-URINE $ 184.00 87186 MIC-SENSITIVITY $ 162.00 87880 STREP SCREEN $ 108.00 88312 BACT. VAG. SCR $ 147.00 87206 ACID FAST-SMEAR $ 104.00 87220 KOH PREP $ 114.00 87045 CULTURE -STOOL $ 184.00 87070 CULT-GRP B STRP $ 184.00 87040 CULTURE-BLOOD $ 332.00 87184 SENS.-AN02 #1 $ 165.00 87070 CULTURE-DIPTHERIA $ 184.00 87101 CULTURE-FUNGUS $ 176.00 87274 HERP.SMEAR DFA $ 68.00 87081 GC SCREEN $ 184.00 87205 GRAM STAIN $ 108.00 87210 INDIA INK-CSF $ 104.00 87272 CRYTOSP-ST.-STL $ 238.00 87425 ROTAVIRUS-STOOL $ 176.00 87280 RSV SCREEN $ 81.00 87070 LEGIONELLA CULT $ 184.00 87254 HERPES VIR CULT $ 144.00 87070 PERTUSSIS CULT $ 83.00 87265 PERTUSSIS SMR $ 143.00 87190 ISONIAZ 0.2TEST $ 52.00 87190 ISONIAZ 1.0TEST $ 52.00 87190 RIFAMPIN-TEST $ 52.00 87190 ETHAMBUTOL-TEST $ 52.00 87324 CLOSTRIDIUM DIFF CYTOTOXIN TST $ 203.00 87190 STREPTOMYC-TEST $ 52.00 87190 PYRAZINAM-TEST $ 52.00 82270 OCCULT BLOOD-STL $ 41.00 87177 OVA AND PARASITES $ 278.00 82270 OCC BLD BEDSIDE $ 41.00 87197 SER BACTERICIDAL $ 79.00 87253 VIRUS DETECTION $ 141.00 87252 VIRUS CULTURE $ 144.00 88313 TRICHROME STAIN $ 85.00 87252 TISSUE CULT 2 $ 144.00 87252 TISSUE CUL 1 $ 144.00 87081 MRSA CULTURE SUSCEPTIBILITY $ 31.00 87190 AFB SENSITIVITY $ 227.00 87075 ANAEROBIC CULTURE $ 215.00 87070 BODY FLUID CULTURE $ 184.00 87070 CULTURE LOWER RESPIRATORY $ 184.00 87490 CHLAMYDIA DNA PROBE $ 98.00 87070 AEROBIC CULTURE $ 184.00 87590 GC DNA PROBE $ 98.00 87081 STAPH SCREEN $ 184.00 87110 CHLAMYDIA CULTURE $ 192.00 87103 FUNGUS CULTURE FOR BLOOD $ 176.00 89050 STOOL WBC $ 93.00 87172 PINWORM STOOL $ 94.00

10 SPOR/STER $ 94.00 87550 AFB PROBE $ 126.00 87184 K/B SENSITIVITY $ 165.00 87804 INFLUENZA-RAP $ 155.00 87015 ACID FAST-CONC $ 35.00 87077 AEROBIC IDENT. $ 35.00 87076 ANAEROBIC IDEE $ 35.00 87185 BETA LACT SUSC $ 35.00 87254 SHELL VIAL $ 35.00 87046 STL-ADD-CAMPYL $ 16.00 8704691 STL-E-COLIO157 $ 16.00 8704691 STL-ADD-YERSIN $ 16.00 87207 MICROSPOR-STL $ 126.00 87590 ECL GC DNA PROBE $ 16.00 87491 CHLAMYDIA AMPLIFICATION $ 145.00 87591 GONOCOCCUS AMPLIFICATION $ 145.00 87045 STOOL CULTURE AEROMONAS $ 184.00 87181 SUSCEPTIBILITY STUDY EACH AGENT (E TEST) $ 28.00 87427 SHIGA TOXIN 1 $ 81.00 87427 SHIGA TOXIN 2 $ 81.00 87116 AFB BLOOD CULTURE $ 211.00 87116 AFB CSF CULTURE & SMEAR $ 211.00 87147 STREPTOCOCCUS GROUP B $ 28.00 87147 HAEMOPHILUS INFLUENZAE $ 28.00 87147 NEISSERIA MENINGITIDIS GROUPS A/Y $ 28.00 87147 NEISSERIA MENINGITIDIS GROUPS C/W135 $ 28.00 87147 NEISSERIA MENINGITIDIS GROUPS B/E. COLI $ 28.00 87147 STREPTOCOCCUS PNEUMONIA $ 28.00 87071 BRONCHIAL WASH CULTURE & GRAM STAIN $ 184.00 87075 CLOSTRIDIUM DIFFICILE CULTURE $ 215.00 87070 CSF CULTURE & GRAM STAIN $ 184.00 87081 CLO TEST $ 184.00 87252 CMV ISOLATION $ 191.00 87207 CYCLOSPORA STAIN $ 126.00 87207 ISOSPORA STAIN $ 126.00 87207 MICROSPORIDIUM STAIN $ 126.00 87070 EAR CULTURE & GRAM STAIN $ 184.00 87070 EYE CULTURE & GRAM STAIN $ 184.00 87102 FUNGUS CSF CULTURE AND INDIA INK $ 176.00 87101 FUNGUS CULTURE & KOH-SKIN, HAIR,NAILS $ 176.00 87102 FUNGUS CULTURE & KOH- OTHER SOURCE $ 176.00 87070 GALL BLADDER CULTURE $ 184.00 87081 GONORRHEA CULTURE $ 184.00 87255 HERPES VIRUS ISOLATION AND TYPING $ 165.00 87168 INSECT IDENTIFICATION $ 163.00 87070 LEGIONELLA DFA & CULTURE $ 184.00 87081 MRSA SCREENING, NASAL $ 163.00 87329 GIARDIA SPECIAL STAIN $ 126.00 87328 CRYPTOSPORIDIUM SPECIAL STAIN $ 126.00 87801 PERTUSSIS PCR $ 175.00 87070 PLACENTA CULTURE AND GRAM STAIN $ 184.00 87281 PNEUMOCYTOSIS DFA $ 208.00 87070 SPUTUM CULTURE & GRAM STAIN $ 184.00 83630 FECAL LACTOFERRIN STOOL WBC $ 163.00 87449 STREP PNEUMO URINARY ANTIGEN $ 317.00 87070 THROAT CULTURE $ 184.00

11 87070 TISSUE CULTURE & GRAM STAIN $ 184.00 87176 TISSUE HOMOGENIZATION (GRINDING CHARGE) $ 56.00 87045 STOOL CULTURE VIBRIO $ 184.00 87252 VIRUS ISOLATION $ 191.00 87252 VIRUS RESPIRATORY ISOLATION $ 191.00 87169 WORM IDENTIFICATION $ 158.00 87070 WOUND DEEP/ABSCESS CULTURE & GRAM STAIN $ 184.00 87070 WOUND/SUPERFICIAL CULTURE & GRAM STAIN $ 184.00 87045 STOOL CULTURE PLESIOMONAS $ 184.00 87046 STOOL CULTURE CAMPYLOBACTER $ 56.00 87081 STREP A CULTURE SCREEN $ 184.00 87045 STOOL CULTURE YERSINIA $ 184.00 87253 HERPES VIRUS ADDITIONAL STAIN $ 56.00 87278 LEGIONELLA DFA STAIN $ 28.00 PENICILLIN BINDING PROTEIN (PBP) $ 109.00 87103 FUNGUS BLOOD CULTURE $ 184.00 87147 CRYPTOCOCCAL ANTIGEN TEST $ 56.00 87329 GIARDIA $ 99.00 87328 CRYPTOSPORIDIUM $ 99.00 87040 BLOOD CULTURE, ED #1 $ 332.00 8704091 BLOOD CULTURE, ED #2 - MOD 91 $ 332.00 87591 OH GONOCOCCUS AMPLIFICATION $ 22.50 85048 WBC ONLY $ 33.00 89190 EOSINOPHILS-SMEAR $ 33.00 86022 PLATELET ANTIBODY HEPARIN $ 290.00 36415 BLOOD COLLECTION FEE-SPECIAL $ 22.00 85280 FACTOR XII $ 213.00 85291 FACTOR XIII $ 118.00 85002 SIMP BLD TIME $ 94.00 85420 PLASMINOGEN $ 186.00 85245 VON WILLEBRANDS FACTOR $ 604.00 89050 CELL COUNT $ 58.00 89050 CELL COUNT $ 58.00 89050 CELL COUNT $ 58.00 89050 CELL COUNT $ 58.00 85635 REPTILASE TIME $ 222.00 85025 CBC $ 123.00 85300 LUPUS TYPE ANTICO $ 365.00 P9604 TRAVEL-MED-OP-1-WAY $ 14.00 89051 CELL COUNT $ 58.00 85732 PTT MIXING STUD $ 180.00 85611 P.T. M I X I N G S T U D I ES $ 126.00 85018 HEMOGLOB-BEDSID $ 33.00 83872 MUCIN CLOT TEST $ 71.00 89060 CRYSTALS-SYN FL $ 46.00 85048 EOS COUNT $ 33.00 85250 FACTOR IX $ 206.00 85651 SED RATE-WEST $ 60.00 85384 FIBRINOGEN-QUANT $ 121.00 87493 C DIFF MOLECULAR $ 125.00 81003 URINALYSIS/OCH $ 33.00 81003 URINE STICK/OCH $ 33.00 85025 CBC/OCH $ 39.00 85246 VON W. FACTORANT $ 221.00 85247 VON W MULTIMERS $ 604.00 85220 FACTOR V $ 118.00

12 85230 FACTOR VII $ 118.00 85240 FACTOR VIII $ 206.00 85270 FACTOR XI $ 236.00 85362 FIBRIN SPLIT PROD $ 200.00 83051 HEMOGLOB,FREE-SER $ 58.00 85540 LEUKOCYTE ALKSMR $ 167.00 87207 MALARIA PREP $ 140.00 85730 PARTIAL THROMBO $ 167.00 85049 PLATELET COUNT $ 52.00 84703 PREGNANCY IMNO UR $ 47.00 84703 PREG-UR-BEDSIDE $ 47.00 85307 PROT C RESISTAN $ 221.00 85610 PROTHROMBIN TIME $ 108.00 85025 CBC-COMPLETE BLOOD COUNT $ 26.00 81003 ECL URINALYSIS $ 8.00 81015 ECL URINE MICROSCOPIC $ 26.00 85044 RETIC. COUNT $ 94.00 85245 RISTOCETIN COFA $ 362.00 85660 SICKLE CELL SCN $ 63.00 85670 THROMBIN TIME $ 167.00 81003 URINALYSIS $ 33.00 81001 URINALYSIS AUTOMATED W/MICROSCOPIC $ 57.00 81002 UR STICK-BEDSID $ 16.00 81002 UR STICK-PAR-BE $ 16.00 85004 WBC-DIFFERENTIAL $ 94.00 82955 G6PD-CELL AGE SEPARATED TEST $ 160.00 85301 ANTITHROMBIN III ANTIGEN $ 271.00 82376 CARBON MONOXIDE QUAL $ 36.00 85014 HEMATOCRIT $ 33.00 85018 HEMOGLOBIN $ 33.00 85025 HEMOGRAM $ 63.00 86022 PLATELET ANTIBODY-NON-SPE $ 380.00 81015 URINE MICROSCOPIC $ 26.00 87210 TRICHO (TRICHOMONAS WET MOUNT) $ 91.00 82010 ACETONE URINE $ 16.00 89051 CSF CELL COUNT $ 58.00 85576 ADP FOR PLATELET AGGREGAT $ 153.00 85576 COLLAGEN FOR PLT,AGGREGA $ 153.00 85576 EPINEPHRINE FOR PLT AGGRE $ 153.00 85576 RISTOCETIN FOR PLT AGGREG $ 153.00 85576 THROMBIN FOR PLT.AGGREGA $ 153.00 85041 RED BLOOD CELL COUNT $ 33.00 83986 PH FLUID $ 35.00 85379 D-DIMER POC $ 239.00 85300 ANTITHR 3 ACT $ 365.00 88319 ACETATE ESTERASE $ 141.00 G0123 THINPREP PAP $ 125.00 88313 IRON STAIN $ 85.00 88313 TRICHOME STAIN $ 85.00 88313 ELASTIC STAIN $ 85.00 88313 RETICULUM STAIN $ 85.00 88313 CONGO RED STAIN $ 85.00 88313 MUCICARMINE STAIN $ 85.00 88313 ALCIAN BLUE STAIN $ 85.00 85097 BONE MARROW $ 317.00 88312 GRAM STAIN $ 147.00

13 88312 ACID FAST STAIN $ 147.00 88312 GIEMSA STAIN $ 147.00 88313 MYELIN STAIN $ 85.00 88358 DNA PLOIDY ANALYSIS $ 539.00 82370 CALCULUS ANALYSIS $ 126.00 88313 CRYS VIOLET STAIN $ 85.00 88108 CYTO-CSF $ 266.00 88108 CYTOLOGY-WASHINGS $ 266.00 88104 CYTOLOGY NON-GYN SMEARS $ 141.00 88312 METH SILVER STAIN $ 147.00 88313 OIL RED O STAIN $ 85.00 88313 PAS W DIAT STAIN $ 85.00 88307 SURGICAL PATH E $ 426.00 88172 FNA W ASSIST $ 307.00 88313 SPEC. HIST STAIN $ 85.00 76098 FAXITRON XRAY $ 94.00 88313 AMMONIACAL SILVER STAIN $ 85.00 88311 BONE DECALCIFICAT $ 103.00 88348 EM PREP $ 362.00 88332 FROZEN SECR. MULT $ 490.00 88319 ACID PHOS- HISTO $ 141.00 88331 FROZEN SECT. 1 SP $ 449.00 88319 PEROXIDASE $ 141.00 88305 HISTOCHEM PROC $ 361.00 88262 CHROMOSOMES ANAL 15 - 20 BLD $ 604.00 88230 TISS CULT LYMPH $ 584.00 88314 HISTOCHEM PREP $ 541.00 83080 TAY SACHS-AMNIOTIC FLUID $ 247.00 82013 ACETYLCHOLINESTERASE-AMN. FLD $ 287.00 82106 ALPHA F/PR AMFL $ 140.00 88237 TISS.CULT.BON M $ 862.00 88262 CHROMOSOMES-B M $ 604.00 88235 TISSUE CULT AMN $ 862.00 88267 CHROMOSOMES AMN $ 858.00 88346 IMMUNO HISTOLOGY $ 254.00 88319 NON-SPEC EST $ 141.00 88313 PAS PERDC ACD SHF $ 85.00 88302 SURGICAL PATH A $ 186.00 88302 SURGICAL PATH 0 $ 186.00 88304 SURGICAL PATH B $ 228.00 88305 SURGICAL PATH C $ 361.00 88365 HPV-I STAIN $ 176.00 88365 HPV-II STAIN $ 176.00 88300 TISSUE EXAM GEN $ 66.00 88312 STEINER-STEINER STAIN $ 147.00 88365 HPV-III STAIN $ 176.00 88108 CYTO-BODY FLUID $ 266.00 88319 SUDAN BLK STN $ 141.00 G0123 ECL THIN PREP PAP $ 50.00 88104 BRONCHIAL LAVAGE - CYTOLOGY $ 141.00 88312 CYTOLOGY SPECIAL STAIN I $ 147.00 88271 CHROMOMOS-FISH $ 332.00 88358 IMAGE ANALYSIS $ 184.00 87899 CLOTEST $ 81.00 88184 CD3 $ 72.00 88184 CD4 $ 72.00

14 88184 CD56 CELL MARK $ 72.00 CD19 $ 72.00 CD4 CELL MARK $ 72.00 88184 CD8 CELL MARK $ 72.00 88173 FNA IMM INT/EVALUATION $ 372.00 86945 BLOOD IRRADIATION FEE $ 153.00 86850 ANTIBODY SCREEN $ 126.00 86920 CROSSMATCH-ORD $ 132.00 86850 FETAL SCREEN TEST $ 149.00 86901 RH(D) TYPE SEROLOGIC $ 79.00 85460 FETO MATER BLEED $ 172.00 85660 HB S DONOR TEST $ 63.00 86900 ABO TYPE-CORD BLOOD SEROLOGIC $ 79.00 86900 ABO TYPING SEROLOGIC $ 79.00 86870 ANTIBODY IDENTITY $ 439.00 80055 OBSTETRIC PNL $ 227.00 36430 BLD PROD ADM $ 1,161.00 86922 EXT.AHG XM-ORD $ 271.00 P9021 RBC EACH UNIT $ 670.00 J2790 RHOGAM PRODUCT $ 422.00 P9010 DIRECTED WHOLE BLOOD FEE $ 439.00 86078 INTRE TRAN RXN $ 625.00 86927 THAWING OF BLOOD PRODUCT $ 25.00 86902 UNIT ANTIGEN TYPE SEROLOGIC $ 46.00 86880 DIRECT COOMBS TEST FEE $ 85.00 87899 HIV AG RAPID $ 90.00 PROC CHG GR APHER $ 1,335.00 86965 PLATELET POOLING FEE $ 103.00 P9012 PROC CHG CRYO PPT $ 320.00 P9039 FROZ DEGLY RBC $ 879.00 P9017 FFP EACH UNIT $ 377.00 P9019 PLATELETS EACH UNIT $ 320.00 P9022 RBC WASHED EACH UNIT $ 589.00 J2790 RHOGAM PRODUCT $ 570.00 LEUCOCYTE REM. FILTER $ 88.00 LEUCOCYTE REMOVAL FILTER $ 129.00 PROC CHG REC WB $ 691.00 PLATELET LEUCOCYTE REM. FILTER $ 228.00 P9035 PLAT PHERES LR EA UNIT $ 1,704.00 PED SATELLITE $ 83.00 DD/AA SHPNG CHG $ 56.00 HLA DONOR SEARCH $ 83.00 86890 AUTOLOGOUS DONATION FEE $ 399.00 P9010 AUTOLOGOUS WHOLE BLOOD FE $ 259.00 PALL FILT RBC $ 88.00 PALL FILT-NEON $ 52.00 P9010 WHOLE BLD-CPD $ 414.00 P9044 PLAS CRYO POOR $ 324.00 NSY PACKAGE $ 717.00 P9023 PROCCHG JU FFP $ 332.00 78452 NM MULTI SPECT W EF AND WM $ 3,746.00 78070 NM PARA THYROID SCAN $ 1,628.00 78580 PULM PERFUSION IMAGING, PARTICULATE $ 1,761.00 78579 PULM VENT IMAGING, AERO/GAS $ 1,761.00 78582 PULM VENT_AER/GAS & PERF IMAGING $ 1,761.00 78226 NM HEPAT IMAG, INCLD GALLBLDR $ 1,632.00

15 78227 NM HEPAT IMAG, INCLD GLBR PHAR $ 1,632.00 A9502 NM MYOVIEW, DX, PSD $ 441.00 78278 NM G.I. BLEED $ 1,483.00 A9560 NM PYP DX PSD UT 30 MCI'S $ 293.00 78306 NM BONE &/OR JOINT SCAN-WB $ 2,287.00 A9503 NM MDP up to 30 mCi's $ 167.00 A9508 NM I-131 MIBG DX PER 0.5 MCI $ 33.00 78610 NM BRAIN SCAN VASC ONLY $ 1,611.00 78707 NM KIDNEY VASCULAR FLOW & FUNC $ 1,662.00 78708 NM KIDNEY FORM FLOW FUNC W DIURETC 78708 $ 1,662.00 A9562 NM MAG3 DX PSD UT 15 MCI'S $ 1,703.00 78804 NM WB TUMOR LOC MULTI DAYS $ 1,969.00 A9540 NM MAA DX PSD UT 10 MCI'S $ 135.00 A9512 NM STRAIGHT TECH DX PER MCI $ 2.00 A9516 NM I-123 DX PER 100 MCI CAPS $ 108.00 A9556 NM GALLIUM DX PER MCI $ 135.00 A9537 NM CHOLETEC DX PSD UT 15 MCI'S $ 221.00 78012 NM THYROID UPTAKE $ 540.00 78014 NM THYROID UPTAKE/SCAN $ 2,267.00 78071 NM PARATHYROID PLANAR W/SPECT $ 2,635.00 78803 NM TUMOR IMAGING TOMO (SPECT) $ 1,061.00 78215 NM LIVER & SPLEEN; STATIC $ 1,619.00 A9510 NM HEPATOL DX PSD UT15 MCI'S $ 68.00 78580 NM LUNG SCAN-PERFUS; PARTICUL $ 1,401.00 78290 NM MECKEL'S DIVERTIC $ 1,483.00 78761 NM TESTICULAR SCAN $ 1,523.00 78013 NM THYROID SCAN $ 1,727.00 A9548 NM DTPA DX PER 0.5 MCI $ 15.00 78806 NM WBC LOC; WHOLE BODY $ 2,115.00 78305 NM BONE &/OR JOINT SCAN-MULTI $ 2,287.00 78458 NM BILATERAL VENOGRAM $ 1,395.00 78805 NM WBC LOC LIMITED $ 2,044.00 78185 NM SPLEEN SCAN $ 983.00 A9521 NM CERETEC DX PSD UP TO 25 MCI $ 2,912.00 A9541 NM SULFUR CLLD DX PSD UT20 MCI $ 262.00 78195 NM LYMPHOSCINTIGRAPHY $ 1,672.00 78264 NM GASTRIC SCAN $ 1,167.00 A9500 SESTAMIBI 1-30MCI $ 138.00 A9539 NM TC99 DTPA DX PSD UT 25MCI $ 50.00 J2805 NM KINEVAC 5MCG INJ $ 62.00 A9560 NM ULTRATAG DX PSD UT 30MCI $ 662.00 J1642 NM HEPARIN 10U INJ 500U $ 3.00 7706752 MA SCR MAMM INCL CAD LT $ 135.00 70140 XR FACIAL BONES < 3 V $ 216.00 7706752 MA SCR MAMM INCL CAD RT $ 135.00 73050 XR ACROM CLAV JOINTS, BIL $ 562.00 72100 XR LUMBAR 2 OR 3V $ 588.00 71010 XR CHEST - AP PORTABLE $ 456.00 70150 XR FACIAL BONES MIN 3V $ 483.00 73060LT XR HUMERUS LT MIN 2V $ 344.00 73060RT XR HUMERUS RT MIN 2V $ 344.00 73562LT XR KNEE-ONLY LEFT(3 VIEWS) $ 344.00 73562RT XR KNEE-ONLY RIGHT(3 VIEWS) $ 344.00 77067 MA SCR MAMMO INCL CAD BI $ 190.00 77066 MA DX MAMMO INCL CAD BI $ 562.00 77065 MA DX MAMMO INCL CAD UNI $ 562.00

16 73560LT XR KNEE LT 1 OR 2V $ 216.00 73560RT XR KNEE RT 1 OR 2V $ 216.00 73564LT XR KNEE 4 OR > VIEWS LEFT $ 406.00 73564RT XR KNEE 4 OR > VIEWS RIGHT $ 406.00 76098 MA SPECIMEN RAD EXAM $ 925.00 74000 XR ABDOMEN OR KUB $ 313.00 71035 XR CHEST LORDOTIC VIEW ONLY $ 185.00 73610LT XR ANKLE LT MIN 3V $ 383.00 73610RT XR ANKLE RT MIN 3V $ 383.00 77072 XR BONE AGE $ 240.00 72050 XR CERV SPINE MIN 4V $ 510.00 71023 XR CHEST 2V WITH FLUORO $ 529.00 74300 XR OPERATIVE CHOLANGIOGRAM $ 897.00 74305 XR CHOLANGIO T-TUBE $ 679.00 73000LT XR CLAVICLE LEFT $ 279.00 73000RT XR CLAVICLE RIGHT $ 279.00 74270 XR COLON BARIUM/LGI $ 759.00 74280 XR COLON AIR CONTRAST W/BARIUM $ 829.00 74455 XR VOIDING CYSTO URETHROGRAM $ 961.00 74430 XR CYSTOGRAM MIN 3V $ 759.00 74022 XR ACUTE ABD SERIES INCL/CHEST $ 456.00 73080LT XR ELBOW LT MIN 3V $ 313.00 73080RT XR ELBOW RT MIN 3V $ 313.00 74220 XR ESOPHAGUS $ 642.00 73552RT XR FEMUR RT 2V $ 313.00 73552LT XR FEMUR LT 2V $ 313.00 73140LT XR FINGERS LT MIN 2V $ 280.00 73140RT XR FINGERS RT MIN 2V $ 280.00 76001 XR FLUOROSCOPY >1HR $ 678.00 73630LT XR FOOT LT MIN 3V $ 213.00 73630RT XR FOOT RT MIN 3V $ 213.00 73090LT XR FOREARM LT 2V $ 279.00 73090RT XR FOREARM RT 2V $ 279.00 73130LT XR HAND LT MIN 3V $ 280.00 73130RT XR HAND RT MIN 3V $ 280.00 73521 XR HIP BILAT W/ PELVIS $ 497.00 73502LT XR HIP AP-LAT LT 2-3V $ 287.00 73502RT XR HIP AP-LAT RT MIN 2-3V $ 287.00 73530LT XR HIP PINNING LEFT $ 922.00 73530RT XR HIP PINNING RIGHT $ 922.00 74400 XR UROGRAPHY $ 1,172.00 72110 XR LUMBOSACRAL W/OBL MIN 4V $ 338.00 77055GG MA DX MAMM LT SAME DAY AS SCRN $ 245.00 77055GG MA DX MAMM RT SAME DAY AS SCRN $ 245.00 70110 XR MANDIBLE MIN 4V $ 456.00 70160 XR NASAL BONES MIN 3V $ 180.00 70360 XR NECK SOFT TISSUE $ 313.00 70200 XR ORBITS MIN 4V $ 338.00 73650LT XR OS CALCIS LT MIN 2V $ 313.00 73650RT XR OS CALCIS RT MIN 2V $ 313.00 72170 XR PELVIS 1 OR 2V $ 338.00 74420 XR UROGRAPHY RETROGRADE $ 833.00 71101LT XR RIBS 2V LT W / PA CHEST $ 890.00 71101RT XR RIBS 2V RT W / PA CHEST $ 890.00 70260 XR SKULL MIN 4V $ 338.00 72202 XR SI JNTS 3 OR >V $ 338.00

17 72220 XR SACRUM & COCCYX MIN 2V $ 344.00 73010RT XR SCAPULA RT $ 180.00 72081 XR SCOLIOSIS XRAY 1 VIEW $ 347.00 72082 XR SCOLIOSIS XRAY 2-3 VIEWS $ 384.00 72083 XR SCOLIOSIS XRAY 4-5 VIEWS $ 425.00 72084 XR SCOLIOSIS XRAY MIN 6 VIEWS $ 532.00 73030LT XR SHOULDER MIN 2V LT $ 313.00 73030RT XR SHOULDER MIN 2V RT $ 313.00 70220 XR SINUS MIN 3V $ 483.00 77074 XR SKEL/BONE SURVEY $ 1,255.00 74250 XR SMALL BOWEL $ 897.00 72040 XR SPINE CERVICAL; 2-3 VIEWS $ 615.00 71120 XR STERNUM MIN 2V $ 180.00 72072 XR THORACIC SPINE 3V $ 377.00 73590RT XR TIB FIB RT 2V $ 344.00 73590LT XR TIB FIB LT 2V $ 344.00 73660LT XR TOES LT MIN 2V $ 180.00 73660RT XR TOES RT MIN 2V $ 180.00 74245 XR UP GI SML BOWEL $ 1,231.00 74240 XR UPP GI/STOMAC BARIUM WO KUB $ 758.00 75820LT XR VENOGRAM EXTREMITY LEFT $ 1,369.00 75820RT XR VENOGRAM EXTREMITY RIGHT $ 1,369.00 74246 XR UGI WITH AIR W/O KUB $ 909.00 73110LT XR WRIST LT MIN 3V $ 197.00 73110RT XR WRIST RT MIN 3V $ 197.00 49440 IR PERC G-TUBE PLC $ 843.00 58340 XR INJ HYSTEROSLPNGRM $ 290.00 68850 XR INJ DCRYCYSTGRM $ 847.00 77076 XR BONE SURVEY - INFANT JNTS $ 221.00 71130 XR STERNOCLAV JNT(S) RT MIN 3V $ 290.00 73592LT XR LOWER EXT INF LT MIN 2V $ 313.00 73592RT XR LOWER EXT INF RT MIN 2V $ 313.00 71100LT XR RIBS 2V LT $ 640.00 71100RT XR RIBS 2V RT $ 640.00 19281LT MA NDL LOC BREAST W/MAMM GD LT $ 1,230.00

18 19281RT MA NDL LOC BREAST W/MAMM GD RT $ 1,230.00 19282LT MA NDL LOC EA ADDL W/MAMM LT $ 1,077.00 19282RT MA NDL LOC EA ADDL W/MAMM RT $ 1,077.00 19285LT MA NDL LOC BREAST W/US GD LT $ 2,126.00 19285RT MA NDL LOC BREAST W/US GD RT $ 2,126.00 19286LT MA NDL LOC EA ADDL LSN W/US LT $ 1,973.00 19286RT MA NDL LOC EA ADDL LSN W/US RT $ 1,973.00 19287LT MA NDL LOC BREAST W/MRI GD LT $ 1,306.00 19287RT MA NDL LOC BREAST W/MRI GD RT $ 1,306.00 19288LT MA NDL LOC EA ADD LSN W/MRI LT $ 1,153.00 19288RT MA NDL LOC EA ADD LSN W/MRI RT $ 1,153.00 73562LT XR PATELLA LT 3V $ 180.00 73562RT XR PATELLA RT 3V $ 171.00 74283 XR BARIUM ENEMA THERAPEUTIC $ 781.00 74300 XR CHOLANGIOGRAM IN OR $ 605.00 74301 XR CHOLANGIOGRAM IN OR ADD'L $ 166.00 74330 XR ENDO CATH BILI/PANC DUCTS $ 556.00 74329 XR ENDO CATH PANCR DUCT SYST $ 556.00 76010 XR FB LOC CHILD NOSE RECTUM 1V $ 68.00 76496 XR FLUOROSCOPY UNLISTED PROC $ 232.00 72240 XR MYELOGRAPHY C-SPINE $ 1,258.00 72270 XR MYELOGRAPHY ENTIRE SPINE $ 1,906.00 72265 XR MYELOGRAPHY L-SPINE $ 1,383.00 72255 XR MYELOGRAPHY T-SPINE $ 1,142.00 70371 XR SPEECH EVAL DYNAMIC PHARYNX $ 232.00 72120 XR SPINE LUMBAR BEND 2 OR 3VIEW $ 424.00 72052 XR SPN CERVICAL C FLEX/EXT $ 436.00 74241 XR UPPER GI & KUB $ 1,034.00 74249 XR UPPER GI C AIR &SMALL BOWEL $ 1,288.00 74247 XR UPPER GI C AIR CONTRAST&KUB $ 984.00 74410 XR UROGRAPHY W/INFUSION $ 925.00 74450 XR URETHROCYSTOGRAPHY RETROGRD $ 482.00 Q9965 XR LOCM 100-199 MG/ML $ 6.00 Q9966 XR LOCM 200-299 MG/ML $ 6.00 Q9967 XR LOCM 300-399 MG/ML $ 6.00 Q9951 XR LOCM 400 OR > MG/ML $ 6.00 77081 XR DXA BONE DENSITY APEND $ 232.00 73600LT XR ANKLE LT 2V $ 383.00 73600RT XR ANKLE RT 2V $ 383.00 73070LT XR ELBOW LT 2V $ 314.00 73070RT XR ELBOW RT 2V $ 314.00 73620LT XR FOOT LT 2V $ 213.00 73620RT XR FOOT RT 2V $ 213.00 70030 XR FOREIGN BODY EYE $ 180.00 73120LT XR HAND LT 2V $ 338.00 73120RT XR HAND RT 2V $ 338.00 73501LT XR HIP LT 1V $ 215.00 73501RT XR HIP RT 1V $ 215.00 73502 XR INFANT/CH PEL/HIPS 2-3V $ 287.00 70100 XR MANDIBILE < 4V $ 341.00 71110 XR RIBS BILAT 3V $ 671.00 71111 XR RIBS BILAT, PA 4V MIN $ 890.00 73010LT XR SCAPULA LT $ 180.00 73020LT XR SHOULDER 1V LT $ 234.00 73020RT XR SHOULDER 1V RT $ 234.00 70250 XR SKULL < 4V $ 338.00

19 73092LT XR UPPER EXT INF LT MIN 2V $ 338.00 73100LT XR WRIST LT 2V $ 180.00 73100RT XR WRIST RT 2V $ 180.00 49406 IR ABCESS DRAIN SUBDIAPH $ 2,506.00 49406 IR ABSCESS DRAIN RETROPE $ 2,506.00 49406 IR ABSCESS DRAIN PERITO $ 3,030.00 32551 IR TUBE THORACOSTOMY $ 2,005.00 47000 IR BIOP LIVER PERC SEP PR $ 628.00 47001 IR BIOP LIVER PERC W/OTH $ 628.00 20206 IR BIOPSY MUSCLE PERCUT $ 373.00 48102 IR BIOPSY PANCREAS PERCU $ 999.00 32400 IR BIOPSY PLEURA PERCUT $ 986.00 43760 IR CHG GASTRO TBE W/O IMAGE $ 710.00 75984 IR CHG PERC TUBE/DRN CATH/CONT $ 1,234.00 43215 IR ESOPH FOREIGN BY REMO $ 1,314.00 36000 IR INTRO NEED/INTRACATH VEIN $ 589.00 58340 IR INJ HYSTEROSLPNGRM $ 290.00 47500 IR INJ PERC TRANHEP CHOLA $ 986.00 51600 IR INJECTION CYSTOGRAM $ 399.00 50690 IR INJECTION LOOPOGRAM $ 399.00 42550 IR INJECTION SIALOGRAM $ 217.00 50390 IR SP PERC ANTEGR PYELOGRAM $ 986.00 47510 IR PERC BIL DRAIN (EXT) $ 2,190.00 50392 IR PERC DRAIN OR INJ PELV $ 2,254.00 50393 IR PERC DRAIN STENT PL UR $ 2,769.00 50390 IR PERC RENAL CYST ASP $ 986.00 33010 IR PERICARDIOCENTESIS INIT $ 878.00 77001 IR CVC & PICC GUIDANCE $ 2,513.00 Q9965 IR LOCM 100-199 MG/ML $ 6.00 Q9966 IR LOCM 200-299 MG/ML $ 6.00 Q9967 IR LOCM 300-399 MG/ML $ 6.00 Q9951 IR LOCM 400 OR > MG/ML $ 6.00 74328 IR ENDO CATH BILIARY DUCT SYST $ 590.00 74740 IR X RAY HYSTEROSALPINGOGRAM $ 575.00 75989 IR GUIDE PERC DRN W/CATH PLCMT $ 1,234.00 61055 IR INJ BRAIN CAN C1- W/IN $ 506.00 62284 IR INJ FOR MYELOGRAM $ 768.00 74475 IR INTRO CATH RNL/PLVS DRN/INJ $ 1,453.00 50398 IR NEPHROSTOMY TUBE CHGE $ 688.00 47511 IR PERC INT & EXT DRAIN $ 2,549.00 44015 IR PERC PLCMT ENTERC TUBE $ 1,646.00 74320 IR PERC TRANSHEPATIC CHOL $ 852.00 49440 IR PERCUT PLCMT GAST TUBE $ 1,753.00 76000 XR FLUOROSCOPY <1HR $ 678.00 43761 IR REPOS GASTRO TUBE NUTRITION $ 562.00 62270 IR SPINAL TAP; DIAGNOSTIC $ 1,159.00 75822 IR VENOGRAM EXTREMITY BIL $ 1,615.00 73085LT IR ARTHROGRAM ELBOW LEFT $ 594.00 73085RT IR ARTHROGRAM ELBOW RIGHT $ 594.00 73525 IR ARTHROGRAM HIP LEFT $ 656.00 73525 IR ARTHROGRAM HIP RIGHT $ 656.00 73580LT IR ARTHROGRAM KNEE LEFT $ 656.00 73580RT IR ARTHROGRAM KNEE RIGHT $ 656.00 73040LT IR ARTHROGRAM SHOULDER LEFT $ 656.00 73040RT IR ARTHROGRAM SHOULDER RIGHT $ 656.00 73115LT IR ARTHROGRAM WRIST LEFT $ 656.00

20 73115RT IR ARTHROGRAM WRIST RIGHT $ 656.00 50200LT IR BIOPSY RENAL PERCUT LEFT $ 878.00 50200RT IR BIOPSY RENAL PERCUT RIGHT $ 878.00 73615LT IR INJ ANKLE ARTHROGRAM LEFT $ 399.00 73615RT IR INJ ANKLE ARTHROGRAM RIGHT $ 399.00 19030LT IR INJ BREAST DUCT SING LEFT $ 278.00 19030RT IR INJ BREAST DUCT SING RIGHT $ 278.00 24220LT IR INJ ELBOW ARTHROGRAM LEFT $ 399.00 24220RT IR INJ ELBOW ARTHROGRAM RIGHT $ 399.00 27093LT IR INJ HIP ARTHROGM; WO ANES-LT $ 399.00 27093RT IR INJ HIP ARTHROGM; WO ANES-RT $ 399.00 27370LT IR INJ KNEE ARTHROGRAM LEFT $ 399.00 27370RT IR INJ KNEE ARTHROGRAM RIGHT $ 399.00 77002 IR FLUORO NDL GUIDE BX OR ASP $ 824.00 23350LT IR INJ SHOULDER ARTHRO LT $ 399.00 23350RT IR INJ SHOULDER ARTHRO RT $ 399.00 25246LT IR INJ WRIST ARTHROGRAM LEFT $ 399.00 25246RT IR INJ WRIST ARTHROGRAM RIGHT $ 399.00 75820LT IR VENOGRAM EXTREMITY LEFT $ 977.00 75820RT IR VENOGRAM EXTREMITY RIGHT $ 977.00 73615LT IR ARTHROGRAM ANKLE LEFT $ 594.00 73615RT IR ARTHROGRAM ANKLE RIGHT $ 594.00 32405LT IR BIOPSY LUNG PERCUTAN LT $ 986.00 32405RT IR BIOPSY LUNG PERCUTAN RT $ 986.00 36568 IR PICC W/O PORT < 5 YRS $ 904.00 36569 IR PICC W/O PORT 5 YRS OR > $ 904.00 36584 IR PICC REPLC WO PORT, SAME ACC $ 904.00 75980 IR PERC TRANSHEP BIL DRN W/CON $ 1,376.00 61050 IR C1-C2 PUNCT W/O INJ/CONT $ 1,376.00 36598 IR CV ACCESS DEV EVAL C FLUORO $ 232.00 49423 IR EXCH PREV DRAIN C GUIDANCE $ 1,132.00 43752 IR NASO GASTRIC TUBE PLACEMENT $ 377.00 50389RT IR NEPH TUBE REMOVAL FLUORO RT $ 1,234.00 50389LT IR NEPH TUBE REMOVAL FLUORO LT $ 1,234.00 36597 IR PICC LINE REPOSITION $ 852.00 77003 IR FLUORO GUIDE SPINEPARSPINE $ 824.00 49450 IR FLUORO GUIDE G-TUBE EXCH $ 510.00 10022 IR FINE NDL ASPIR W/IMAG $ 788.00 47531 IR INJ T-TUBE CHOLANGIOGRAM $ 986.00 50394 IR PERC ANTEGR PYELOGRAM $ 530.00 75710 IR ANGIO EXTREMITY UNILATERAL $ 4,523.00 36245 IR SEL CATH PLC ART 1ST AB EXT $ 1,234.00 35474 IR ANGIOPLASTY PERC FEM POPITE $ 7,420.00 72040 XR CERV SP 3 VIEWS $ 447.00 49083 IR ABD PARACENTESIS W/IMAGING $ 1,139.00 32555 IR THORACENTESIS W/CT $ 3,280.00 32555 IR THORACENTESIS W/US $ 1,987.00 32555 IR THORACENTESIS W/FLUORO $ 1,300.00 37236 IR TRNSCTH INTRV STNT 1ST ART $ 18,514.00 37237 IR TRNSC INTRV STNT EA ADD ART $ 8,954.00 10030 IR GUIDE CATHET FLUID DRAINAGE $ 324.00 37238 IR TRNSC INTRV STNT 1ST VEIN $ 18,514.00 37239 IR TRNSC INTRV STNT ADDL VEINS $ 8,954.00 37241 IR VASC EMBOLIZE/OCCLUD VENOUS $ 17,952.00 37242 IR VASC EMBOLIZE/OCCLUD ARTERY $ 17,952.00 37243 IR VASC EMBOLIZE/OCCLUD ORGAN $ 17,952.00

21 37244 IR VASC EMBOLIZE/OCCLUD BLEED $ 17,952.00 43191 IR ESOPHAGOSCP RIGI TRANSO DX $ 1,361.00 43192 IR ESOPHAGOSCP RIGI TRANSO INJCT $ 2,057.00 43193 IR ESOPHAGOSCP RIGI TRANSO BPSY $ 2,057.00 43194 IR ESOPHAGOSCP RIGI TRANSO REM F $ 2,057.00 43195 IR ESOPHAGOSCOPY RIGID BALLOON $ 2,057.00 43196 IR ESOPHAGOSCP GUIDE WIRE DLAT $ 2,057.00 43197 IR ESOPHAGOSCOPY FLEX DX BRUSH $ 1,361.00 43198 IR ESOPHAGOSC FLEX TRNSN BIOPY $ 1,361.00 43211 IR ESOPHAGOSCOP MUCOSAL RESECT $ 1,361.00 43212 IR ESOPHAGOSCOP STENT PLACEMNT $ 4,814.00 43213 IR ESOPHAGOSCOPY RETRO BALLOON $ 2,057.00 43214 IR ESOPHAGOSC DILATE BALLN 30 $ 2,057.00 43229 IR ESOPHAGOSC LESION ABLATE $ 3,997.00 43274 IR ERCP DUCT STENT PLACEMENT $ 3,926.00 43233 IR EGD BALLN DIL ESOPH30 MM/> $ 2,057.00 43253 IR EGD US TRANSMURL INJXN/MARK $ 2,057.00 43254 IR EGD ENDO MUCOSAL RESECTION $ 1,361.00 43266 IR EGD ENDOSCOPIC STENT PLACE $ 4,814.00 43270 IR EGD LESION ABLATION $ 2,057.00 43275 IR ERCP REMOVE FORGN BODY DUCT $ 3,926.00 43276 IR ERCP STENT EXCHNGE W/DILATE $ 3,926.00 43277 IR ERCP EA DUCT/AMPULLA DILATE $ 3,926.00 43278 IR ERCP LESION ABLATE W/DILATE $ 3,926.00 49405 IR IMAGE CATH FLUID COLXN VISC $ 2,483.00 49406 IR IMAGE CATH FLUID PERI/RETRO $ 2,483.00 49407 IR IMAGE CATH FLUID TRNS/VGNL $ 1,538.00 52356 IR CYSTO/URETERO W/LITHOTRIPSY $ 6,708.00 66183 IR INSERT ANT DRAINAGE DEVICE $ 6,166.00 93582 IR PERQ TRANSCATH CLOSURE PDA $ 25,960.00 93583 IR PERQ TRANSCATH SEPTAL REDXN $ 25,960.00 97610 IR LOW FREQUENCY NON-THERNL US $ 170.00 0319T IR INSERT SUBQ DEFIB W/ELTRD $ 50,790.00 0320T IR INSERT SUBQ DEFIB ELECTRODE $ 9,343.00 0321T IR INSERT SUBQ DEFIB PLS GEN $ 50,790.00 0322T IR RMBL SUBQ DEFIB PLS GEN $ 4,705.00 0323T IR RMVL & REPLC SUBQ PLS GEN $ 50,790.00 0324T IR RMVL SUBQ DEFIB ELECTRODE $ 4,705.00 0325T IR REPOS SUBQ DEFIB ELTRD &/GN $ 4,705.00 0331T IR HEART SYMP IMAGE PLNR $ 2,342.00 0332T IR HEART SYMP IMAGE PLNR SPECT $ 2,342.00 0336T IR LAP ABLAT UTERINE FIBROIDS $ 17,446.00 0338T IR TRNSCTH RENAL SYMP DNRV UNL $ 5,230.00 0339T IR TRNSCTH RENAL SYMP DNRV BIL $ 5,230.00 22510 IR PERC VERTEBRO INJ CERVICTHR $ 5,305.00 22511 IR PERC VERTEBRO INJ LUMBOSCRL $ 5,305.00 22512 IR PERC VERT EA ADDL CERV/LUMB $ 377.00 22513 IR PERC VERTEBRAL AUG THORACIC $ 12,890.00 22514 IR PERC VERTERAL AUG LUMBAR $ 12,890.00 22515 IR PRC VRT AUG EA ADD THR/LMBR $ 377.00 50693 IR URET STENT PLACMT VIA EXS NEPH TRACT $ 734.61 52334 IR NEPH INSERT GW PERCUTANEOUS $ 869.25 10160 PUNCT ASPIR ABSCESS/CYST $ 798.15 20220 BONE BIOSPY, SUPERFICIAL, PRQ $ 609.30 20225 IR BONE BIOSPY, DEEP, PRQ $ 913.95 20500 THER INJ SINUS TRACT $ 698.33

22 20604 ASPIR/INJ SMALL JOINT/BURSA W/ GUIDANCE $ 312.00 20606 ASPIR/INJ MED JOINT/BURSA W/ GUIDANCE $ 312.00 20611 ASPIR/INJ LARGE JOINT/BURSA W/ GUIDANCE $ 528.90 32550 PLMT TUNNELED PLEURAL CATH $ 1,933.20 32557 PLEURAL DRAINAGE PRQ $ 1,298.03 35475 NATIVE BRACHIAL ARTERY ANGIO $ 2,920.43 35476 VENOUS ANGIO PRQ, INITIAL VESSEL $ 2,349.98 35476 VENOUS ANGIO, PRQ, EACH ADD'L VESSEL $ 2,349.98 36010 PLACE CATH IN SVC/IVC $ 1,085.93 36011 PLACE CATH IN VEIN, 1ST ORDER BRANCH $ 1,381.65 36012 PLACE CATH IN VEIN, =>2ND ORDER BRANCH $ 1,526.70 36140 PLACE CATH IN ARTERY, EXT $ 932.33 36147 AV SHUNTOGRAM $ 1,628.25 36148 AV SHUNTOGRAM ADD'L $ 426.83 36200 PLACE CATH IN AORTA, OTHER APPROACH $ 1,399.28 50386 INDWELLING URET STENT REMOVE TRANSURET $ 1,496.48 36215 ADV CATH FROM AV SHUNT TO UPPER EXT $ 2,065.73 36215 EACH 1ST ORDER ABOVE DIAPHRAGM $ 2,065.73 36216 INITAL 2ND ORDER ABOVE DIAPHRAGM $ 2,480.78 36217 INITIAL 3RD OR HIGHER ABOVE DIAPHRAGM $ 2,945.78 36218 EACH ADD'L 2ND OR HIGHER ABOVE DIAPHRAGM $ 476.03 36221 NON-SELECTIVE CERVIOCEREBRAL ARCH $ 1,954.80 36222 CAROTID, EXTRACRANIAL, UNILATERAL $ 2,680.35 36223 CAROTID, INTRACRANIAL, UNILATERAL $ 2,926.88 36224 CAROTID, INTRACRANIAL, UNILATERAL, ICA $ 3,272.10 36225 VERT, UNILATERAL, INNOMINATE/SUBCLAVIAN $ 2,872.05 36226 VERT, UNILATERAL, VERTEBRAL CATH POS $ 3,285.75 36227 EXTERNAL CAROTID, SELECTIVE, UNILATERAL $ 1,034.03 36228 EACH ADD'L INTRACRANIAL CAROTID/VERT $ 2,117.33 36246 INITIAL 2ND ORDER ARTERY BRANCH $ 2,427.98 36247 INITIAL 3RD ORDER OR HIGHER ARTERY BRANC $ 2,844.23 36248 EACH ADD'L => 2ND ORDER ARTERY BRANCH $ 429.75 36251 RENAL SELECTIVE, UNILATERAL W.WO AORTA $ 2,541.00 36252 RENAL SELECTIVE, BILATERAL, W/WO AORTA $ 3,418.58 36253 RENAL SUPERSELECTIVE, UNILAT, W/WO AORTA $ 3,271.20 36254 RENAL SUPERSELECTIVE, BILAT, W/WO AORTA $ 3,968.18 36481 PLACE CATH INTO PORTAL VEIN $ 2,961.00 36556 INSERT NON0TUNNELED CVC $ 1,034.25 36558 INSERT TUNNELED CVC W/O PORT/PUMP AGE >5$ 7,714.00 36561 INSERT TUNNELED CVC W/ PORT AGE >5 $ 3,110.93 36566 INSERT TUNNELED CVC W/2 CATHS W/PORT $ 3,427.43 36571 INSERT PICC W/ PORT $ 3,257.00 36575 REPAIR (NON)TUNNELED PICC W/O PORT/PUMP $ 303.98 36576 REPAIR (NON)TUNNELED PICC W/ PORT/PUMP $ 1,746.45 36578 REPLACE CATH ONLY PICC W/ PORT/PUMP $ 1,873.88 36580 REPLACE NON-TUNNELED PICC W/O PORT/PUMP $ 572.40 36581 REPLACE TUNNELED CVC W/O PORT/PUMP $ 1,678.43 36585 REPLACE PICC W/ PORT THRU SAME ACCESS $ 1,954.00 36589 REMOVE TUNNELED CVC W/O PORT/PUMP $ 1,185.23 36590 REMOVE TUNNELED CVC W/ PORT/PUMP $ 1,896.00 36595 REMOVE FIBRIN SHEATH SEPARATE ACCESS $ 1,572.38 36870 PRQ THROMB, AV FISTULA $ 2,578.35 37182 TIPS INSERTION $ 7,047.45 37183 TIPS REVISION $ 3,327.98 37184 PRIMARY ATERIAL THROMB, INITIAL VESSEL $ 4,171.65 37185 PRIMARY ARTERIAL THROMB, SUBSEQ VESSELS $ 1,536.15

23 37186 SECONDARY ARTERIAL THROMB $ 2,268.90 37187 PRQ THROMB, VENOUS $ 3,619.50 37188 PRQ THROMB, VENOUS, REPEAT SUBSEQ DAY $ 2,570.48 37191 INSERT VENA CAVA FILTER $ 2,093.70 37192 REPOSITION VENA CAVA FILTER $ 3,284.18 37193 REMOVE VENA CAVA FILTER $ 3,209.63 37211 INFUSION THROMBOLYSIS ATERIAL, 1ST DAY $ 3,571.43 37213 INFUSION THROMBOLYSIS, SUBSEQ DAY $ 2,172.23 37214 INFUSION THROMBOLYSIS, SUBSEQ/FINAL DAY $ 1,192.73 37220 ANGIO ONLY, ILIAC ARTERY, INITIAL $ 3,815.78 37221 STENT PLMT, W/WO ANGIO, ILIAC ARTERY $ 4,682.63 37222 ANGIO ONLY, ILIAC ARTERY, ADD'L IPSILAT $ 1,726.95 37223 STENT PLMT, W/WO ANGIO, ILIAC, ADD'L IPL $ 1,975.95 37224 ANGIO ONLY, FEM/POP ARTERY UNILATERAL $ 4,179.83 37225 FEM/POP ATHERECTOMY ARTICULAR ANASTOM $ 5,702.48 37226 STENT PLMT, W/WO ANGIO FEM/POP ART UNI $ 4,179.83 37227 STENT PLMT/ATHERECTOMY, FEM/POP ARTERY $ 6,858.30 37228 ANGIO ONLY, TIB/PERON ARTERY, UNILATERAL $ 5,122.35 37232 ANGIO ONLY, TIB/PERON ARTERY, EACH ADD'L $ 1,861.43 38220 BONE MARROW ASPIRATION $ 523.73 38221 BONE MARROW BIOSPY $ 614.70 38505 LYMPH NODE BIOSPY, SUPERFICIAL $ 596.25 42400 SALIVARY GLAND BIOSPY $ 464.85 47490 CHOLECYSTOSTOMY PRQ $ 2,757.23 47531 PTC VIA EXISTING ACCESS $ 808.80 47532 INJECTION FOR CHOLANGIOGRAM $ 1,838.03 47533 EXTERNAL BILIARY DRAINAGE CATH PLMT $ 2,626.20 47534 INT/EXT BILIARY DRAINAGE CATH PLMT $ 3,482.93 47535 CONVERSION OF BILIARY DRAINAGE CATH $ 2,015.55 47536 EXCHANGE OF BILIARY CATH $ 1,244.18 47537 REMOVAL OF BILIARY DRAINAGE CATH $ 857.78 47538 STENT PLMT BILE DUCTS VIA EXISTING ACCES $ 2,775.08 47539 STENT PLMT BILE DUCTS VIA NEW ACCESS $ 3,752.63 47540 STENT PLMT BD NEW ACCESS W/ SEP DRAIN $ 4,478.48 47541 ASSIST ENDO BILIARY INTERVENTION NEW ACC $ 2,407.50 47542 CHOLANEIOPLASTY (MAX OF 2) $ 1,221.98 47543 BILIARY BIOSPY, ENDOLUMINAL, PRQ $ 1,534.13 47543 BIOPSY, ENDOLUMINAL, PRQ $ 1,534.13 47544 STONE REMOVAL GALLBLADDER/BILE DUCTS $ 1,861.28 49180 ABD/RETROPERITONEUM BIOPSY, PRQ NEEDLE $ 720.38 49418 INS TUNNELED INTRAPERITONEAL CATH $ 1,857.75 49424 ABSCESS/CYST CATH INJ $ 323.25 49446 PLACE INITIAL GASTROJEJUNOSTOMY TUBE $ 1,374.83 49465 GASTROINTESTINAL TUBE CHECK $ 260.33 50382 INDWELLING URET STENT REMOVE/REPLMT PRQ $ 2,284.05 50384 INDWELLING URET STENT REMOVAL PRQ $ 2,075.78 50385 INDWELLING URET STNT REMOVE/REPLMT TRANS $ 1,962.15 50387 NEPHROURETERAL STENT REMOVE/REPLMT $ 818.85 50391 INSTALL THERA DRUG THRU NEPHROSTOMY $ 826.95 36160 PLACE CATH IN AORTA, TRANSLUMBAR $ 1,064.78 50430 NEPHROSTOGRAM VIA NEW ACCESS NEEDLE/CATH $ 1,403.85 50431 NEPHROSTOGRAM VIA EXISTING ACCESS $ 554.85 50432 PLMT OF NEPHROSTOMY TUBE $ 1,855.80 50434 PLMT OF NEPHROURETERAL CATH $ 1,757.10 50435 NEPHROSTOMY TUBE CHANGE $ 850.65 50593 RENAL TISSUE CRYOABLATION PRQ $ 4,027.13

24 50606 BIOSPY, ENDOLUMINAL, RENAL/PELVIS/UTER $ 1,344.30 50694 URET STENT PLMT NEW ACCESS W/O NEPH TUBE $ 2,376.08 50695 URET STENT PLMT NEW ACCESS W/ SEP NEPHR $ 3,014.25 50705 URET EMBOLIZATION/OCCLUSION, ANY ACCESS $ 1,727.48 50706 URETEROPLASTY, ANY ACCESS $ 1,585.58 55700 PROSTATE BIOPSY, TRANSRECTAL $ 4,934.00 60100 THYROID BIOSPY, PRQ $ 1,312.00 61055 CERVICAL MYELOGRAM VIA CERVICAL PUNCT $ 424.00 61055 THORACIC MYELOGRAM VIA CERVICAL PUNCT $ 424.00 61055 LUMBAR MYELOGRAM VIA CERVICAL PUNCT $ 424.00 61055 COMPLETE MYELOGRAM VIA CERVICAL PUNCT $ 424.00 62267 INTERVERT DISC/ PARAVERT SOFT TISS ASPIR $ 1,383.00 62302 CERVICAL MYELOGRAM $ 1,028.25 62303 THORACIC MYELOGRAM $ 1,044.98 62304 LUMBOSACRAL MYELOGRAM $ 1,014.53 62305 COMPLETE MYELOGRAM $ 1,055.78 75600 DESC THORACIC AORTOGRAM SINGLE $ 1,564.13 75605 DESC THORACIC AORTOGRAM MULTIPLE $ 1,114.20 75625 ABDOMINAL AORTOGRAM $ 648.68 75630 ABDOMINAL AORTOGRAM BILATERAL RUNOFF $ 1,385.03 75658 RETROGRADE BRACHIAL $ 1,354.58 75705 SPINAL SELECTIVE $ 1,018.88 75716 BILATERAL EXTREMITY IMAGING $ 1,516.13 75791 AV SHUNTOGRAM W/O DIR ACCESS INTO SHUNT $ 1,873.95 75825 INFERIOR VENOCAVOGRAM $ 1,703.00 75827 SUPERIOR VENOCAVOGRAM $ 1,703.00 75831 RENAL VENOGRAM UNILATERAL SELECTIVE $ 1,703.00 75833 RENAL VENOGRAM BILATERAL SELECTIVE $ 1,794.00 75840 ADRENAL VENOGRAM UNILATERAL SELECTIVE $ 2,532.00 75842 ADRENAL VENOGRAM BILATERAL SELECTIVE $ 2,935.00 75860 JUGULAR VENOGRAM $ 1,147.73 75870 SUPERIOR SAGITTAL SINUS VENOGRAM $ 4,485.00 75872 EPIDURAL VENOGRAM $ 1,122.83 75880 ORBITALVENOGRAM $ 1,131.45 75893 SAMPLE VENOUS BLOOD, PER ORGAN $ 4,027.50 75962 ANGIO ANASTOMOSIS UPPER EXTREMITY $ 1,123.58 75978 VENOPLASTY, PERIPHREAL ZONE $ 885.23 75978 ADD'L CENTRAL VENOPLASTY $ 885.23 76937 US GUIDANCE FOR VASCULAR ACCESS $ 399.00 76942 ULTRASOUND GUIDANCE $ 271.35 77003 SPINAL PUNCTURE LUMBAR $ 243.98 77012 CT GUIDANCE $ 994.73 A5200 IR STAYFIX FIXATION DEVICE $ 66.24 A7048 IR TRU-CLOSE SUCTION DRAIN W/PORT $ 84.39 C1729 IR FLEXIMA APDL DRAIN CATH 8F/25CM $ 366.00 C1769 IR MICROPUNCT NITINOL GWIRE 18G/.8CM $ 51.03 C1769 IR AMPLATZ SUPER STIFF GWIRE.35/145 $ 117.60 C1769 IR V-18 CONTROL WIRE 110CM $ 369.00 C1769 IR ZIPWIRE STIFF SHAFT ANGLED TIP GWIRE $ 219.00 C1769 IR GLIDE WIRE TERUMO ANGLED STIFF SHAFT $ 163.77 C1887 IR GLIDE CATHETER TERUMO 4F/65CM $ 165.36 C1887 IR GLIDE CATHETER TERUMO 4F/120CM $ 165.36 C1894 IR PEEL AWAY SHEATH INTRO 4F/.38CM $ 145.26 C1894 IR PEEL AWAY SHEATH INTRO 10F/.38CM $ 145.26 C1894 IR PEEL AWAY SHEATH INTRO 12F/.38CM $ 145.26 C2617 IR FLEXIMA URETERAL STENT KIT $ 813.00

25 C2617 IR FLEXIMA URETERAL STENT $ 510.00 77053 MA DUCTOGRAM SINGLE $ 755.00 77054 MA DUCTOGRAM MULTIPLE DUCTS $ 755.00 86255 STRIAT MUSCLE AB $ 238.00 84143 17 HYDROXYPREGNENONE $ 125.00 82103 A-1-ANTITRYPSIN $ 66.00 86812 HLA-B27 TYPING $ 172.00 87899 CRYPTOCOCCAL AG $ 87.00 86329 A-2 MACROGLOBULIN $ 136.00 86665 EB VIRUS AB $ 83.00 86780 TREP.PALL.-MHA $ 144.00 86631 CHLAMYDIA ANTIBODY $ 245.00 86147 CARDIOLIPIN ANTIBODY $ 115.00 86039 ANA $ 244.00 83883 ALBUMIN-QNT-FL $ 58.00 86255 GLOM BASEM MEM AB $ 238.00 86332 IMM COMP:RAJI CEL $ 295.00 86720 LEPTOSPIRA AB $ 73.00 86060 ANTISTREP O TITER $ 56.00 86765 MEASLES-RUB TITER $ 172.00 86331 PM-1 AB POLYMYOS $ 298.00 87270 CHLAMYDIA SMEAR-DFA $ 58.00 86157 COLD AGGLUTININS $ 140.00 83080 TAY-SACHS SCREEN $ 247.00 86162 CH50 HEMO COMP FL $ 125.00 87899 CRYPTOC. AG-CSF $ 144.00 86663 EBV-EARLY AGIGG $ 184.00 86747 PARUDVIRUS B-19 $ 87.00 86160 C3-COMPLEMENT $ 125.00 86682 CYSTICERCUS AB $ 213.00 86682 SCHISTOSOMA AB $ 213.00 86664 EBV-NUCL.AGIGG $ 200.00 86160 C3 LEVEL-FLUIDS $ 125.00 84466 TRANSFERRIN $ 125.00 86160 C4 COMPLEMENT $ 125.00 86160 C4 LEVEL-FLUIDS $ 125.00 86787 VZV-IGM AB $ 114.00 86777 TOXO-IGG AB $ 141.00 82784 IGM-CORD BLOOD $ 125.00 86777 TOXOPL IGG AB $ 141.00 82390 CERULOPLASMIN $ 52.00 83873 CSF MYELIN BASIC $ 155.00 83010 HAPTOGLOBIN LEVEL $ 125.00 86778 TOXOPLASMA IGM AB $ 141.00 86645 CMV-IGM ANTIBODY TITER $ 114.00 84160 PROTEIN TOTAL-FL $ 63.00 87536 HIV I RNA QNTPCR $ 340.00 86325 LIGHT CHAINS-QUANT 24 HR URINE $ 342.00 86777 TOXOPLASMOSIS $ 141.00 86334 IFE-IMMUNOFIX EL $ 299.00 86592 VDRL SPINAL FLUID $ 104.00 85810 VISCOSITY SERUM $ 221.00 86255 MITOCHROND. AB $ 238.00 86255 PARIETAL CELL AB $ 238.00 86255 SMOOTH MUS AB $ 238.00 86606 ASPERGILLUS AB $ 72.00

26 82784 CSF-IGG $ 125.00 83883 ALBUMIN-CSF $ 63.00 83883 ALBUMIN-SERUM $ 63.00 82172 APOLIPOPROTEINA $ 172.00 82172 LIPOPROT. B $ 172.00 86403 BACT AB ST GP B $ 99.00 86658 COXSAC B TYPE 5 $ 71.00 86658 COXSAC B TYPE 6 $ 71.00 86694 HERP SIMP2 IGG $ 103.00 86695 HERPES SIMPLEX I/II IGG ANTBDY $ 103.00 86632 C. PSITTACI IGM $ 59.00 86632 C. TRACH. IGM $ 59.00 86631 C. TRACH. IGG $ 103.00 86632 TWAR IGM $ 103.00 86631 TWAR IGG $ 103.00 86738 MYCOPL PNEUMON $ 71.00 86756 RESP. SYNCY VIR. $ 71.00 82785 IGE LEVEL $ 135.00 86332 IMM COMP.-CIQ BIN $ 295.00 86644 CMV-ANTIBODY TITER $ 110.00 86162 CH 50 $ 125.00 86774 TETANUS AB $ 94.00 86618 LYME ANTIBODY $ 81.00 87420 RSV TEST $ 114.00 84165 PROT.ELECTROPH $ 104.00 86000 TULAREMIA AGGL $ 39.00 84432 THYROGLOBULIN ASSAY $ 135.00 82232 BETA-2 MICROGLOBULIN-SERUM $ 83.00 82232 BETA-2 MICROGLOBULIN-URINE $ 83.00 87390 HIV P24 ANTIGEN $ 245.00 86765 MEASLES,IGM AB $ 172.00 86709 RETINOL BIND PR $ 125.00 84134 PREALBUMIN $ 71.00 82523 N-TELOPT. ASSAY $ 176.00 86000 AMEBIASIS IGG ANTIBODY $ 39.00 86215 ANTI-DNASE-B TITER $ 71.00 86021 CYTOPLASMIC NEUTROPHIL AN $ 347.00 86677 HELICOBACTER PYLORI, IGG $ 144.00 86695 HERPES SIMPLEX I/II IGM ANTBDY $ 125.00 86694 HERPES SIMPLEX 2 IGM ANTI $ 125.00 86308 MONO SCREEN $ 114.00 86762 RUBELLA IGG/IGM ANTIBODIES $ 172.00 86256 VARICELLA-ZOSTER IGG ANTI $ 103.00 86225 ANTI-DNA $ 141.00 82105 ALPHA-FETOPROTEIN, TUMOR $ 140.00 83020 HEMOGLOBINOPATHIES PROFIL $ 317.00 86684 HAEMOPHILUS INFLUENZAE TY $ 98.00 86403 NEISSERIA MENINGITIDIS G. $ 87.00 86403 NEISSERIA MENINGITIDIS GR $ 87.00 86403 STREPTOCOCCUS PNEUMONIAE $ 87.00 86665 EBV-VCA IGG ANTIBODY $ 83.00 86000 FEBRILE PROTE US OX19 $ 39.00 86000 FEBRILE SAL PARATHYPOID $ 39.00 86000 FEBRILE SAL PARATHYPOID B $ 39.00 86000 FEBRILE THYPHOID H $ 39.00 86000 FEBRILE THYPHOID O $ 39.00

27 86320 IMMUNO PROTEINELECTROPHORESIS $ 342.00 86603 ADENOVIR ABCSF $ 114.00 86603 ADENOVIRUS IGG, BY IFA $ 114.00 82040 ALBUMIN,SERUM $ 36.00 86658 COXSACKIE B1 ANTIBODY,CS $ 71.00 86658 COXSACKIE B2 ANTIBODY,CS $ 71.00 86658 COXS B3 AB,CS $ 71.00 86658 COXS B4 AB,CS $ 71.00 86658 COXS B5 AB,CS $ 71.00 86658 COXS B6 AB,CS $ 71.00 86665 EBV-VCA IGM ANTIBODY $ 83.00 86658 ECHOVIRUS SCREEN IGG, BY I $ 71.00 86658 ECHOVIRUS SCREEN IGM, BY I $ 71.00 83030 FETAL HEMOGLOBIN $ 151.00 86695 HERP SIMP1 IGG $ 125.00 86695 HERPES SIMPLEX 1, IGM,CS $ 125.00 86694 HERP SIMP2 IGG $ 125.00 86694 HERP SIMP2 IGM $ 125.00 82784 IGG, SERUM $ 125.00 82784 IMMUNOGLOBULIN G,CSF $ 125.00 86735 MUMPS IGG, BY IFA $ 143.00 86735 MUMPS IGM, BY IFA $ 143.00 83916 OLIGOCLONAL BANDS IN CSF $ 107.00 86235 RNP (RIBONUCLEOPROTEIN) A $ 200.00 86800 THYROGLOBULIN ANTIBODIES $ 125.00 86376 THYROID MICROSOMAL ANTIBO $ 71.00 83068 UNSTABLE HEMOGLOB $ 203.00 85660 SICKLE CELL SCREENING TES $ 63.00 82595 CRYOGLOBULIN,QUALITATIVE $ 72.00 82784 IMMUNOGLOBULIN A $ 125.00 82784 IMMUNOGLOBULIN G $ 125.00 82784 IMMUNOGLOBULIN M $ 125.00 84165 PROTEIN ELECTROPH.SERUM $ 104.00 83020 HEMOGLOBIN ELECT $ 317.00 86698 HISTOPLASMA ANTIBODIES $ 60.00 86592 RPR QUALITATIVE $ 104.00 86593 RPR QUANTITATIVE $ 126.00 86710 INFLUENZA A IGG $ 71.00 86710 INFLUENZA A IGM $ 71.00 86710 INFLUENZA B IGG $ 71.00 86710 INFLUENZA B IGM $ 71.00 86756 RESP.SYN VIR, IGM $ 114.00 84155 TOTAL PROTEIN, URINE $ 52.00 86663 EB VIRUS EARLY ANTIGEN $ 184.00 87449 LEGIONELLA ANTIGEN-URINE $ 254.00 83520 HISTONE ANTIBODY $ 176.00 87385 HISTOPLASMA AG $ 206.00 87904 HIV PHEN 1-5AD $ 294.00 83520 GLIADIN ABS $ 211.00 86039 ECL ANA $ 8.00 86021 ANTI-MYELOPEROXIDASE IGG AB $ 137.00 86255 ENDOMYSIAL ANTIBODY IGA $ 76.00 87338 H. PYLORI STOOL AG, EIA $ 180.00 86235 SSA AUTOANTIBODY $ 119.00 86235 SSB AUTOANTIBODY $ 119.00 86003 BEEF IGE ALLERGEN $ 63.00

28 86003 CHOCOLATE IGE ALLERGEN $ 63.00 86003 CORN IGE ALLERGEN $ 63.00 86003 EGG WHOLE IGE ALLERGEN $ 63.00 86003 COW MILK IGG ALLERGEN $ 63.00 86003 PEANUT IGE ALLERGEN $ 63.00 86003 PORK IGE ALLERGEN $ 63.00 86003 SOYBEAN IGE ALLERGEN $ 63.00 86003 WHEAT IGE ALLERGEN $ 63.00 86612 BLASTOMYCES ABS, QN, DID $ 56.00 86635 COCCIDIOIDES ABS, QN, DID $ 56.00 86698 HISTOPLASMA ABS, QN, DID $ 56.00 86606 ASPERGILLUS FLAVUS $ 56.00 86606 ASPERGILLUS NIGER $ 56.00 86003 ALTERNARIA TENUIS $ 63.00 86003 BERMUDA GRASS IGE ALLERGEN $ 63.00 86003 CAT HAIR/DANDER IGE ALLERGEN $ 63.00 86003 D FARINAE MITE $ 63.00 86003 DPTRONYSNUS IGE $ 63.00 86003 ELM IGE ALLERGEN $ 63.00 86003 ENGLISH PLANTAIN IGE ALLER $ 63.00 86003 KENTUCKY BLUEGRASS IGE A $ 63.00 86003 OAK IGE ALLERGEN $ 63.00 86003 SHORT RAGWEED IGE ALLERG $ 63.00 86003 DOG HAIR/DANDER $ 63.00 86003 WILLOW IGE ALLERGEN $ 63.00 86003 COTTONWOOD IGE ALLERGEN $ 63.00 86003 PECAN/HICKORY IGE $ 63.00 86003 MTN CEDAR IGE ALLERGEN $ 63.00 86003 BIRCH IGE ALLERGEN $ 63.00 86003 AM. BEECH TREE IGE ALLERGEN $ 63.00 86003 GREY ALDER IGE ALLERGEN $ 63.00 86003 MAPLE BOX ELDER IGE $ 63.00 86003 WALNUT IGE ALLERGEN $ 63.00 86003 TIMOTHY GRASS IGE ALLERGEN $ 63.00 86003 EGG WHITE IGE ALLERGEN $ 63.00 86003 CODFISH IGE ALLERGEN $ 63.00 86003 SHRIMP IGE ALLERGEN $ 63.00 86003 BLUE MUSSEL IGE ALLERGEN $ 63.00 86003 COCKROACH, AM. ALLERGEN IGE $ 63.00 86003 PENICILLUM NOTATUM $ 63.00 86003 CLADOSPORIUM HERBARUM IGE ALLERGEN $ 63.00 86698 HISTOPLASMA YEAST AB $ 56.00 86606 ASPERGILLUS FUMIGATUS $ 56.00 86480 QUANTIFERON TB GOLD $ 300.00 86003 ALTERNARIA ALTERNATA IGE $ 63.00 86003 WHITE ASH IGE $ 63.00 86003 MULBERRY IGE $ 63.00 86003 COMMON RAGWEED IGE $ 63.00 86003 RUSSIAN THISTLE IGE $ 63.00 86003 ROUGH PIGWEED IGE $ 63.00 86003 ROUGH MARSH ELDER W16 $ 63.00 86003 CLAM IGE $ 63.00 86003 SCALLOP IGE $ 63.00 86003 SESAME SEED IGE $ 63.00 86003 MAPLE LEAF SYCAMORE IGE $ 63.00 86003 WALNUT TREE IGE $ 63.00

29 86140 CRP-C REACTIVE PROTEIN $ 125.00 86431 RHEUMATOID FACTOR $ 125.00 86777 TOXOIGG AB CSF $ 141.00 AMBULATORY INFUSION PUMP $ 45.00 71250 CT CHEST WO/CONTRAST $ 1,818.00 72125 CT SERVICAL SPINE WO/CONTRAST $ 1,931.00 71260 CT CHEST W/CONTRAST $ 2,046.00 70486 CT FACIAL BONES W/O CONTR $ 2,156.00 70487 CT FACIAL BONES W/CONTR $ 2,383.00 70490 CT NECK W/O CONTR $ 2,156.00 70491 CT NECK W/CONTRAST $ 2,383.00 70480 CT ORB/EAR/FOSSA W/O CONTR $ 1,818.00 70481 CT ORB/EAR/FOSSA W/CONTR $ 2,046.00 70460 CT HEAD/BRAIN W/CONTR $ 1,818.00 70450 CT HEAD/BRAIN SCAN W/O CONTR $ 1,589.00 70470 CT HEAD/BRAIN W/ & WO CONTR $ 2,046.00 72194 CT PELVIS W & WO $ 2,613.00 72193 CT PELVIS W/CONTRAST $ 2,383.00 72192 CT PELVIS WO CONTRAST $ 2,156.00 74170 CT ABD W & W/O $ 2,156.00 48102 CT BX PANCREAS PERC $ 3,064.00 49180 CT BX ABD OR RETRO MASS $ 3,064.00 50200 CT RENAL BX NEEDLE $ 3,064.00 70486 CT SINUSES W/O CONTRAST $ 2,156.00 72132 CT SPINE LUMBAR W/CONTRAST $ 3,064.00 72129 CT SPINE THORACIC W CONTRAST $ 2,046.00 72128 CT THORACIC SPINE WO CONTRAST $ 1,931.00 77012 CT GUID NE BIOP $ 2,722.00 72127 CT CERV W & W/O $ 2,383.00 73202 CT EXT W & W/O RT $ 2,501.00 72133 CT LUMBAR W & W/O $ 2,383.00 70488 CT MAXILLOFACIAL W & W/O $ 2,613.00 70482 CT ORBIT/EAR/FOSSA W & W/O $ 2,501.00 70492 CT ST NEC W & W/O $ 2,613.00 71270 CT THORAX W & W/O $ 2,270.00 72126 CT CERVICAL SPINE W CONTRAST $ 1,278.00 77012 CT CYST ASPIRATION $ 2,613.00 73702 CT LOW EXT W & WO RT $ 1,364.00 77078 CT BONE DENSITY AXIAL $ 570.00 77011 CT STERIOTACTIC LOCALIZATION $ 2,954.00 73700LT CT LWR EXTLT WO CONTRAST $ 2,046.00 73700RT CT LWR EXT RT WO CONTRAST $ 2,046.00 73701LT CT LOWER EXTREMITY CONTR LEFT $ 2,270.00 73701RT CT LOWER EXTREMITY CONTR RIGHT $ 2,270.00 73201LT CT UPPER EXTREMITY LT W CONT $ 2,270.00 73201RT CT UPPER EXTREMITY RT W CONT $ 2,270.00 73200LT CT UPPER EXTREMITY LT WO CONT $ 2,046.00 73200RT CT UPPER EXTREMITY RT WO CONT $ 2,046.00 76377 CT 3D RECON INDEP WORKSTATION $ 570.00 71275 CT CTA CHEST NON COR W CONTRAST $ 2,412.00 72131 CT SPINE LUMBAR WO CONTRAST $ 1,931.00 74150 CT ABDOMEN WO CONTRAST $ 1,931.00 74160 CT ABDOMEN W CONTRAST $ 2,156.00 73206LT CT CTA ANGIO UP EXT LT W CONT $ 2,412.00 73206RT CT CTA ANGIO UP EXT RT W CONT $ 2,412.00 73706LT CT CTA ANGIO LOW EXT LT W CONT $ 2,412.00

30 73706RT CT CTA ANGIO LOW EXT RT W CONT $ 2,412.00 47000 CT Liver BX $ 3,064.00 0042T CT PERFUSION W, CBF $ 2,046.00 70496 CT CTA, HEAD $ 2,412.00 70498 CT CTA, NECK $ 2,412.00 72130 CT THORACIC W & W/O $ 2,383.00 72191 CT CTA PELVIS W & WO CONTRAST $ 2,412.00 74175 CT CTA ABD W CONT $ 2,412.00 75635 CT CTA ABD AOR/ILIOFEM W CONT $ 2,412.00 75989 CT GUID PERC DRAIN W/CTH PLCMT $ 1,234.00 76380 CT LIMITED OR FOLLOW UP SCAN $ 2,046.00 Q9965 CT LOCM 100-199 MG/ML $ 6.00 Q9966 CT LOCM 200-299 MG/ML $ 6.00 Q9967 CT LOCM 300-399 MG/ML $ 6.00 Q9951 CT LOCM 400 OR > MG/ML $ 6.00 73202 CT UP EXT W & W/O LT $ 2,501.00 73702 CT LOW EXT W & W/O LT $ 1,364.00 77073 CT BONE LENGTH $ 110.00 75571 CT HEART WO CONTRAST ST $ 2,270.00 75572 CT HEART W CONTRAST $ 2,405.00 75574 CT HEART CORONARY $ 2,751.00 75573 CT HEART CONTRAST CONG HRT $ 2,270.00 77078 CT BONE DENSITY 1 OR > SITES AXIAL $ 399.00 74176 CT ABDOMEN AND PELVIS WITHOUT CONTRAST $ 4,087.00 74177 CT ABDOMEN AND PELVIS WITH CONTRAST $ 4,540.00 74178 CT ABDOMEN AND PELVIS W & W/O CONTRAST $ 4,568.00 32405 CT BX LUNG NEEDLE $ 1,399.00 74174 CT CTA ANGIO ABDOMEN/PELVIS $ 4,825.00 70551 MR MRI BRAIN $ 2,067.00 72141 MR MRI CERVICAL SPINE $ 737.00 72148 MR MRI LUMBAR SPINE $ 2,067.00 72146 MR MRI THORACIC SPINE $ 2,067.00 70553 MR MRI BRAIN COMBO $ 2,840.00 A9579 MR GAD PER ML $ 20.00 73220 MR CREDIT AUDIT ADJ 729 $ 399.00 C8901 MR MRA, ABDOMEN $ 737.00 C8910 MR MRA, CHEST $ 737.00 70544 MR MRA, HEAD $ 1,234.00 70547 MR MRA, NECK $ 1,943.00 C8919 MR MRA, PELVIS $ 737.00 74181 MR MRI ABDOMEN $ 2,067.00 70552 MR MRI BRAIN W/GAD. - ONLY $ 2,294.00 72142 MR MRI C-SPINE W/GAD. -ONLY $ 2,305.00 72156 MR MRI C-SPINE, COMBO $ 4,080.00 72149 MR MRI L-SPINE W/GAD. -ONLY $ 2,294.00 72158 MR MRI L-SPINE, COMBO $ 4,043.00 71550 MR MRI MEDIASTINUM $ 2,067.00 70540 MR MRI ORBIT/FACE/NECK $ 2,067.00 72196 MR PELVIS W/DYE $ 1,931.00 72147 MR MRI T-SPINE W/GAD. -ONLY $ 2,304.00 72157 MR MRI T-SPINE, COMBO $ 4,080.00 73720LT MR LOWER EXT LT NON JNT W & W0 $ 2,067.00 73720RT MR LOWER EXT RT NON JNT W & W0 $ 2,067.00 C8913LT MR MRA LOWER EXTREMITIES LEFT $ 1,943.00 C8913RT MR MRA LOWER EXTREMITIES RIGHT $ 1,943.00 73220LT MR UP LT EXT NON JT W & W/0 $ 2,067.00

31 73220RT MR UP RT EXT NON JT W & W/0 $ 2,067.00 73221LT MR MRI UPPER EXTREMITY JNT LT $ 2,067.00 73221RT MR MRI UPPER EXTREMITY JNT RT $ 2,067.00 73721LT MR MRI LOWER EXTREMITY JNT LT $ 2,067.00 73721RT MR MRI LOWER EXTREMITY JNT RT $ 2,067.00 74182 MR ABDOMEN C CONT $ 2,200.00 76498 MR UNLISTED PROCEDURE $ 399.00 C8912RT MR MRA LOW EXT W/RT $ 1,943.00 C8912LT MR MRA LOWER EXTREMITY W/ LEFT $ 1,943.00 C8900 MR MRA ABD WITH $ 743.00 C8902 MR MRA ABD WITH & W/O $ 743.00 77058 MR BREAST UNI W $ 2,067.00 77058 MR BREAST UNI W/O $ 2,067.00 77058 MR BREAST UNI W & W/O $ 2,067.00 77059 MR BREAST BILAT W $ 2,067.00 77059 MR BREAST BILAT W/O $ 2,067.00 77059 MR BREAST BILAT W & W/O $ 2,067.00 C8909 MR MRA CHEST W $ 737.00 C8911 MR MRA CHEST W/ & W/O $ 737.00 C8918 MR MRA PELVIS W $ 737.00 C8920 MR MRA PELVIS W/ & W/O $ 737.00 73718RT MR LOWER EXT RT NON JNT W/O $ 2,067.00 73718LT MR LOWER EXT LT NON JNT W/O $ 2,067.00 73719RT MR LOWER EXT RIGHT NON JNT W $ 2,067.00 73719LT MR LOWER EXT LEFT NON JNT W $ 2,067.00 70542 MR ORBIT, FACE, &/OR NECK W $ 2,067.00 70543 MR ORBIT, FACE, &/OR NECK W&WO $ 2,067.00 70545 MR MRA HEAD W/ $ 1,234.00 70546 MR MRA HEAD W/ & W/O $ 1,234.00 70548 MR MRA NECK W/ $ 1,943.00 70549 MR MRA NECK W/ & W/O $ 1,943.00 71551 MR CHEST W/ $ 2,067.00 71552 MR CHEST W/ & W/O $ 2,067.00 72195 MR PELVIS W/O $ 1,931.00 72197 MR PELVIS W & W/O $ 1,931.00 73218RT MR UP EXT NON-JT W/O RT $ 2,067.00 73219RT MR UP EXT NON-JT W/ RT $ 2,067.00 73219LT MR UP EXT NON-JT W/ LT $ 2,067.00 73222RT MR UP EXT JT W/ RT $ 2,067.00 73222LT MR UP EXT JT W/ LT $ 2,067.00 73223RT MR UP EXT JT W/ & W/O RT $ 2,067.00 73223LT MR UP EXT JT W/ & W/O LT $ 2,067.00 73722RT MR LOW EXT JT W/ RT $ 2,067.00 73722LT MR LOW EXT JT W/ LT $ 2,067.00 73723RT MR LOW EXT JT W/ & W/O RT $ 2,067.00 73723LT MR LOW EXT JT W/ & W/O LT $ 2,067.00 74183 MR ABD W/ & W/O $ 2,067.00 73218LT MR UP EXT NON-JT W/O LT $ 2,067.00 75557 MR CARD MORPH & FUNC W/O $ 1,873.00 75559 MR CARD M&F W/ STRESS $ 2,067.00 75561 MR CARD M&F W&W/O $ 1,873.00 75563 MR CARD M&F W&W/O STRESS $ 2,067.00 77021 MR GUIDE FOR NEEDLE PLACEMENT $ 691.00 72159 MR MRA SPINAL CANAL W/CONTRAST $ 716.00 72159 MR MRA SPINAL CANAL W/O CONTRAST $ 716.00 72159 MR MRA SPINAL CANAL W & W/O CONTRAST $ 716.00

32 73225 MR MRA UP EXT LT W/CONTRAST $ 716.00 73225 MR MRA UP EXT LT W/O CONTRAST $ 716.00 73225 MR MRA UP EXT LT W & W/O CONTRAST $ 716.00 73225 MR MRA UP EXT RT W/CONTRAST $ 716.00 73225 MR MRA UP EXT RT W/O CONTRAST $ 716.00 73225 MR MRA UP EXT RT W & W/O CONTRAST $ 716.00 19285LT US BRST LOC CLIP GD 1ST LSN LT $ 2,126.00 19285RT US BRST LOC CLIP GD 1ST LSN RT $ 2,126.00 19286LT US BRST LOC CLIP EA ADD LT $ 1,973.00 19286RT US BRST LOC CLIP EA ADD RT $ 1,973.00 19285LT US BRST WIRE LOC GD 1ST LSN LT $ 2,126.00 76946 US AMNIOCENTESIS $ 534.00 19285RT US BRST WIRE LOC GD 1ST LSN RT $ 2,126.00 19286LT US BRST WIRE LOC EA ADD LT $ 1,973.00 19286RT US BRST WIRE LOC EA ADD RT $ 1,973.00 76942 US GUIDE NDL PLCMT BX $ 1,511.00 93975 US DPLX ABD/PLVC/SCR/RTR CMPLT $ 387.00 93976 US DPLX ABD/PLVC/SCR/RTR LIMTD $ 387.00 76819 US OB FETAL PROF WO NON-STRESS $ 914.00 76506 US HEAD $ 567.00 76856 US PELVIC COMPLETE $ 784.00 76805 US OB >OR=14 WKS; SNGL FETUS $ 1,028.00 76816 US PREGNANCY F/U, PER FETUS $ 274.00 76872 US PROSTATE-TRANSRECT $ 757.00 76870 US TESTICULAR ULTRASOUND $ 569.00 76536 US SOFT TISSUE HEAD OR NECK $ 453.00 76830 US TRANSVAGINAL ULTRASOUN $ 757.00 76999 US UNLISTED US PROCEDURE $ 695.00 93922 US DUP ART SINGLE LEVEL BILAT $ 1,062.00 76816 US FETAL MTR F/UP $ 274.00 76856 US ECOTOPIC PREG-NON-OB $ 784.00 76816 US FETAL AGE $ 759.00 76815 US FETAL DTH $ 342.00 76816 US FETAL GROW $ 546.00 76942 US GUIDE NDL PLCMT CYST ASP $ 1,511.00 76998 US INTRA OPERATIVE ST $ 828.00 76815 US PLACENTAL LOCAL $ 570.00 93880 US DUP EXTRACRANIAL ART BILAT $ 990.00 76882LT US EXTREMITY LEFT LIMITED $ 624.00 76882RT US EXTREMITY RIGHT LIMITED $ 624.00 76815 US OB AFI OR LIMITED $ 533.00 93970 US DUP EXT VEINS UP BILAT $ 864.00 93923 US DUP ART UP EXT MULT LVL BIL $ 864.00 93923 US DUP ART LOW EXT MULT LVL BI $ 864.00 93970 US DUP EXT VEINS LOW BILAT $ 864.00 93971LT US LE VENOUS DUPLEX LT $ 486.00 93971LT US UE VENOUS DUPLEX LT $ 486.00 93971RT US LE VENOUS DUPLEX RT $ 486.00 93971RT US UE VENOUS DUPLEX RT $ 486.00 93978 US AORTA IVC ILIAC DUPLX COMPL $ 232.00 G0365 US DUPLX HEMODIALYSIS GRAFT $ 232.00 76604 US EXAM, CHEST $ 232.00 76800 US EXAM, SPINAL CANAL $ 232.00 76801 US OB US < 14 WKS,SINGLE FETUS $ 648.00 76802 US OB US < 14 WKS, ADD'L FETUS $ 232.00 76810 US OB US >/= 14 WKS,ADDL FETUS $ 232.00

33 76811 US OB US, DETAILED, SNGL FETUS $ 253.00 76812 US OB US, DETAILED, ADDL FETUS $ 232.00 76813 US OB US NUCHAL MEAS, 1 GEST $ 232.00 76814 US OB US NUCHAL MEAS, ADL FETUS $ 232.00 76817 US OB TRANS VAG $ 232.00 76818 US FETAL BIOPHYS PROFILE $ 232.00 76825 US ECHO EXAM OF FETAL HEART $ 138.00 76826 US ECHO EXAM FETAL HEART F/U $ 138.00 76827 US DOPP ECHO EXAM FETAL HEART $ 138.00 76828 US DOP ECHO EXAM FETAL HRT F/U $ 138.00 76831 US SONOHYSTEROGRAPHY $ 253.00 76857 US LIMITED PELVIS NON-OB $ 232.00 76885 US EXAM INFANT HIPS, DYNAMIC $ 232.00 76936 US ECHO GUID FOR ARTERY REPAIR $ 399.00 76937 US GUIDE, VASCULAR ACCESS $ 399.00 76945 US ECHO GUIDE, VILLUS SAMPLING $ 232.00 76948 US ECHO GUIDE, OVA ASPIRATION $ 216.00 76775 US RETROPERITIONAL LIMITED $ 633.00 76705 US ABDOMEN LIMITED $ 951.00 76700 US ABDOMEN COMPLETE $ 1,235.00 76770 US RETROPERITONEAL COMPLETE $ 951.00 93925 US LE DUPLEX ART/GRAFT BIL $ 375.00 93926 US LE DUPLEX ART/GRAFT UNI/LIM'D $ 239.00 93930 US UE DUPLEX ART/GRAFT BIL $ 375.00 93931 US UE DUPL ART/GRAFT UNI/LIM'D $ 239.00 76820 US DOPP VEL FETAL UMB $ 399.00 76821 US DOPP VEL FETAL MID CERE $ 399.00 10022 US FNA W/IMAGE GUIDANCE $ 788.00 60100 US BX THYROID NEEDLE $ 1,312.00 76886 US INFANT HIP STATIC $ 232.00 93924 US LE ART STRESS BIL $ 250.00 93979 US AORTA IVC ILIAC LTD $ 224.00 19083 US BX BRST 1ST LESN US IMAG $ 1,425.00 19084 US BX BRST ADD LESN US IMAG $ 1,425.00 76641LT US BREAST COMPLT INCLD AXL LT $ 732.00 76642LT US BREAST LIMITED INCLD AXL LT $ 622.00 76641RT US BREAST COMPLT INCLD AXL RT $ 732.00 76642RT US BREAST LIMITED INCLD AXL RT $ 622.00 7664150 US BREAST COMPLT INCLD AXL BIL $ 842.00 7664250 US BREAST LIMITED INCLD AXL BIL $ 716.00 20611 US ARTHRO MJR JNT/BURS W/US GD $ 528.90 97161GP PT EVALUATION LOW $ 289.00 97164GP PT RE-EVAL EST PC $ 289.00 97150GP PT GROUP $ 67.00 97110GP PT THER EXERCISE - 15 MIN $ 161.00 97112GP PT NEURO RE-ED - 15 MIN $ 161.00 97116GP PT GAIT TRAINING - 15 MIN $ 161.00 97760GP PT ORTHO FIT/TRAIN - 15 MIN $ 161.00 97542GP PT WC TRAINING - 15 MIN $ 161.00 97537GP PT COMM/WORK - 15 min $ 161.00 97530GP PT THER ACT - 15 MIN $ 161.00 97140GP PT MANUAL THERAPY - 15 MIN $ 161.00 97032GP PT E-STIM SUPERVISED - 15 MIN $ 135.00 97012GP PT TRACTION LUMBAR $ 135.00 97012GP PT TRACTION CERVICAL $ 135.00 97033GP PT IONTOPHORESIS -15 MIN $ 150.00

34 97035GP PT ULTRASOUND - 15 MIN $ 135.00 97022GP PT WHIRLPOOL $ 135.00 97602GP NON SELECTIVE DEBRID PER SESS $ 377.00 97533GP PT SENS INTEG EA 15 MINS $ 161.00 97010GP PT HOT/COLD PACKS $ 150.00 97597GP DEBRIDE OPEN WOUNDS 1ST 20 SQ CM OR LESS $ 325.00 97598GP DEBRIDE OPEN WOUNDS EACH ADDL 20 SQ CM $ 341.00 L1902 ANKLE FOOT ORTHOSIS, PREFAB $ 102.00 L3931 WHFO W/JOINTS $ 144.00 L3923 HAND FINGER ORTHOSIS $ 47.00 L1830 KNEE ORTHOSIS, PREFABRICATED $ 112.00 L0220 THORACIC, RIB BELT $ 66.00 L0172 CERVICAL COLLAR SEMI-RIGID $ 193.00 L0460 TLSO PREFABRICATED $ 1,357.00 29125GP FOREARM SPLINT $ 150.00 29240GP STRAPPING OF SHOULDER $ 110.00 97750GP PHYS PERF TEST PER 15 MINS $ 150.00 97124GP MASSAGE $ 40.00 97606GP NEG PRESS WOUND > 50SQ CM $ 178.00 97605GP NEG PRESS WOUND <=50 SQ CM $ 178.00 97761GP PROSTHETIC TRAINING EA 15 MINS $ 150.00 97161GPKX PT EVAL LOW-KX $ 289.00 97164GPKX PT RE-EVAL EST PC-KX $ 289.00 97150GPKX PT GROUP-KX $ 67.00 97110GPKX PT THER EXERCISE - 15 MIN-KX $ 161.00 97112GPKX PT NEURO RE-ED - 15 MIN-KX $ 161.00 97116GPKX PT GAIT TRAINING - 15 MIN-KX $ 161.00 97760GPKX PT ORTHO FIT/TRAIN - 15 MIN-KX $ 161.00 97542GPKX PT WC TRAINING - 15 MIN-KX $ 161.00 97537GPKX PT COMM/WORK - 15 MIN-KX $ 161.00 97530GPKX PT THER ACT - 15 MIN-KX $ 161.00 97140GPKX PT MANUAL THERAPY- 15 MIN-KX $ 161.00 97032GPKX PT E-STIM SUPERVISED - 15 MIN-KX $ 135.00 97012GPKX PT TRACTION LUMBAR-KX $ 135.00 97012GPKX PT TRACTION CERVICAL-KX $ 135.00 97033GPKX PT IONTOPHORESIS - 15 MIN-KX $ 150.00 97035GPKX PT ULTRASOUND - 15 MIN-KX $ 135.00 97022GPKX PT WHIRLPOOL-KX $ 135.00 97602GPKX NON SELECTIVE DEBRID PER SESS-KX $ 377.00 97533GPKX PT SENS INTEG EA 15 MINS-KX $ 161.00 97010GPKX PT HOT/COLD PACKS-KX $ 150.00 97597GPKX DBBR OPN WD1ST 20SQ CM/LESS-KX $ 325.00 97598GPKX DEBR OPN WD EA ADDL 20SQ CM-KX $ 341.00 29125GPKX FOREARM SPLINT-KX $ 150.00 29240GPKX STRAPPING OF SHOULDER-KX $ 110.00 97750GPKX PHYS PERF TEST PER 15 MINS-KX $ 150.00 97124GPKX MASSAGE-KX $ 40.00 97606GPKX NEG PRESS WOUND > 50SQ CM-KX $ 178.00 97605GPKX NEG PRESS WOUND <=50 SQ CM-KX $ 178.00 97761GPKX PROSTHETIC TRAINING EA 15 MINS-KX $ 150.00 97014GP PT E-STIM UNATTENDED $ 135.00 97014GPKX PT E-STIM UNATTENDED-KX $ 135.00 97602GO NON SELECTIVE DEBRID WO ANES $ 377.00 97022GO WHIRLPOOL OT $ 135.00 97165GO OT EVAL LOW $ 289.00 97168GO OT RE-EVAL EST PC $ 289.00

35 97110GO OT THER EXERCISE - 15 MIN $ 129.00 97112GO OT NEURO RE-ED - 15 MIN $ 129.00 97535GO OT SELF CARE - 15 MIN $ 129.00 97150GO OT GROUP $ 67.00 97530GO OT THER ACTIVITY - 15 MIN $ 129.00 97760GO OT ORTHO FIT/TRAIN - 15 MIN $ 129.00 97542GO OT WC TRAINING - 15 MIN $ 129.00 97140GO OT MANUAL THERAPY - 15 MIN $ 129.00 97032GO OT E-STIM SUPERVISED - 15 MIN $ 129.00 97033GO OT IONTOPHORESIS - 15 min $ 129.00 97035GO OT ULTRASOUND - 15 MIN $ 129.00 97018GO OT PARAFFIN $ 150.00 97010GO OT HOT/COLD PACK $ 150.00 97597GO DEBRIDE OPEN WOUNDS 1ST 20 SQ CM OR LESS $ 325.00 97598GO DEBRIDE OPEN WOUNDS EACH ADDL 20 SQ CM $ 341.00 L1902 ANKLE FOOT ORTHOSIS, PREFAB $ 102.00 L3931 WHFO DORSAL WRIST PREFAB $ 144.00 L3923 HAND FINGER ORTHOSIS $ 47.00 L1830 KNEE ORTHOSIS, PREFABRICATED $ 112.00 L0220 THORACIC, RIB BELT $ 66.00 L0172 CERVICAL COLLAR SEMI RIGID $ 193.00 L0460 TLSO PREFABRICATED $ 1,357.00 29125GO FOREARM SPLINT $ 150.00 29240GO STRAPPING OF SHOULDER $ 110.00 29280GO STRAPPING HAND OR FINGER $ 110.00 29260GO STRAPPING ELBOW OR WRIST $ 110.00 97762GO CHECK OUT ORTH PROS EA 15 MIN $ 150.00 97761GO PROSTHETIC TRAINING EA 15 MIN $ 150.00 97602GOKX NON SELECTIVE DEBRID WO ANES-KX $ 377.00 97022GOKX WHIRLPOOL OT-KX $ 135.00 97165GOKX OT EVAL LOW-KX $ 289.00 97168GOKX OT RE-EVAL EST PC-KX $ 289.00 97110GOKX OT THER EXERCISE - 15 MIN-KX $ 129.00 97112GOKX OT NEURO RE-ED - 15 MIN-KX $ 129.00 97535GOKX OT SELF CARE - 15 MIN-KX $ 129.00 97150GOKX OT GROUP - 15 MIN-KX $ 67.00 97530GOKX OT THER ACTIVITY - 15 MIN-KX $ 129.00 97760GOKX OT ORTHO FIT/TRAIN - 15 MIN-KX $ 129.00 97542GOKX OT WC TRAINING - 15 MIN-KX $ 129.00 97140GOKX OT MANUAL THERAPY - 15 MIN-KX $ 129.00 97032GOKX OT E-STIM SUPERVISED - 15 MIN-KX $ 129.00 97033GOKX OT IONTOPHORESIS - 15 MIN-KX $ 129.00 97035GOKX OT ULTRASOUND- 15 MIN-KX $ 129.00 97018GOKX OT PARAFFIN-KX $ 150.00 97010GOKX OT HOT/COLD PACK-KX $ 150.00 97597GOKX DEBR OPN WD1ST 20SQ CM/LESS-KX $ 325.00 97598GOKX DEBR OPN WND EA ADDL 20SQCM-KX $ 341.00 29125GOKX FOREARM SPLINT-KX $ 150.00 29240GOKX STRAPPING OF SHOULDER-KX $ 110.00 29280GOKX STRAPPING HAND OR FINGER-KX $ 110.00 29260GOKX STRAPPING ELBOW OR WRIST-KX $ 110.00 97762GOKX CHECK OUT ORTH PROS EA 15 MIN-KX $ 150.00 97761GOKX PROSTHETIC TRAINING EA 15 MIN-KX $ 150.00 97014GO OT E-STIM UNATTENDED $ 135.00 97014GOKX OT E-STIM UNATTENDED-KX $ 135.00 92508GN SP GROUP $ 73.00

36 96105GN SP ASSESS OF APHASIA $ 546.00 92611GN SP VIDEO SWALLOW $ 546.00 92610GN SP DYSPHAGIA EXAM $ 302.00 92526 DYSPH TREATMENT $ 422.00 92507GN SLP TREATMENT $ 422.00 97533 SENS ITEG EA 15 MIN $ 150.00 92508GNKX SP GROUP-KX $ 73.00 96105GNKX SP ASSESS OF APHASIA-KX $ 546.00 92611GNKX SP VIDEO SWALLOW-KX $ 546.00 92610GNKX SP SYSPHAGIA EXAM-KX $ 302.00 92507GNKX SLP TREATMENT-KX $ 422.00 92521GN SP EVALUATN-SPEECH FLUENCY $ 546.00 92522GN SP EVALUATE SPEECH PRODUCTN $ 546.00 92523GN SP SPEECH SOUND LANG COMPRE $ 546.00 92524GN SP BHVRL QUALT ANALYS VOICE $ 546.00 92521GNKX SP EVALUATN-SPEECH FLUENCY-KX $ 546.00 92522GNKX SP EVALUATE SPEECH PRODUCTN-KX $ 546.00 92523GNKX SP SPEECH SOUND LANG COMPRE-KX $ 546.00 92524GNKX SP BHVRL QUALT ANALYS VOICE-KX $ 546.00 92567 AUD TYMPANOMETRY $ 93.00 92568 AUD ACOUS REFLEX TS $ 85.00 92570 AUD ACOUS REF DECAY $ 59.00 92582 AUD COND PLAY AUDIO $ 239.00 92583 AUD SELECT PIC AUDIO $ 399.00 92591 AUD HR AID EXAM BI $ 305.00 92592 AUD HR AID CHECK MO $ 305.00 92594 AUD HR ELEC ACOUS MONO $ 125.00 92557 AUD COMP AUDIO EXAM $ 253.00 92588 COMPREHENSIVE AUD $ 399.00 92593 AUD HR CHECK BIN $ 171.00 92595 AUD HR AID ELECT BIN $ 147.00 92563 AUD TONE DECAY $ 85.00 92565 AUD STENGER TONE $ 87.00 92577 AUD STENGER SPEECH $ 93.00 92579 AUD VRA $ 206.00 69210 AUD REMOVAL IMPACTED CERUM $ 114.00 V5264 AUD EAR MOLD $ 217.00 92590 AUD HR aid consult $ 79.00 V5014 AUD HR AID REPAIR $ 553.00 92587 AUD SCREEN $ 399.00 92585 ABR SCREEN $ 399.00 V5160 DISPENS FEE BIN $ 426.00 V5241 DISPENS FEE MON $ 426.00 AID REPLACEMNT $ 1,375.00 V5140 BINAURAL AID $ 3,376.00 V5060 MONAURAL AID $ 1,688.00 V5060 SECOND AID $ 1,375.00 93041 RHYTHM ST W/O ECG $ 77.00 93307 2D ECHOCARDIOGRAM (W/M-MODE) $ 1,279.00 C8925 TRANSESOPH ECHO $ 1,255.00 93017 TREADMILL STRESS $ 980.00 93225 HOLTER RECORDING (EXTERNAL UP TO 48 HRS) $ 479.00 93320 CARDIAC DOPPLER $ 399.00 93005 EKG-CARD $ 196.00 93308 ECHO FOLLOW UP-CARD $ 443.00 93017 STRESS TEST W/ADENO/REGADENO $ 909.00

37 93017 STRESS TEST DIPYRIDAMOL $ 909.00 93350 STRESS-ECHO $ 2,087.00 93325 COLOR DOPPLER $ 335.00 93226 HOLTER SCAN (EXTERNAL UP TO 48 HRS) $ 426.00 93017 DOBUTAMINESTRESS $ 2,087.00 93017 STRESS TEST W/DOBUTAMINE $ 909.00 C8923 2D ECHOCARDIOGRAM W CONTRAST $ 1,207.00 Q9957 DEFINITY PERFLUTREN PER ML $ 114.00 C8924 TTE 2D FU/LIMITED W/CONTRAST $ 1,212.00 C8928 TTE 2D STRESS TEST W/CONTRAST $ 2,087.00 C8930 TTE 2D STRESS W/EKG W/CONTRAST $ 3,065.00 93351 TTE 2D STRESS W/EKG W/O CNTRST $ 3,065.00 C8929 TTE 2D W/DOPPLER W/CONTRAST $ 1,875.00 93306 TTE 2D W/DOPPLER W/O CONTRAST $ 1,875.00 93306 PEDIATRIC TTE 2D W/DOPPLER W/O CONTRAST $ 1,875.00 97802 MNT INITIAL ASSESS EA 15 MIN $ 103.00 97803 MNT REASSESSMENT EA 15 MIN $ 59.00 97804 MNT GROUP EA 30 MINS $ 29.00 G0270 MNT 2ND REFERRAL EA 15 MIN $ 48.00 G0271 MNT GRP 2ND REFER EA 30 MIN $ 27.00 0377T ANOSCPY INJ AGENT FOR INCONT $ 5,303.00 EYE TRAY $ 33.00 82270 HEMOCCULT/GASTROCCULT $ 37.00 OB PACKS $ 62.00 PACING KIT T/V $ 317.00 MORGAN LENS $ 136.00 10060 I&D SIMPLE SKIN ABSCESS $ 333.00 10061 I&D COMPLICATED SKIN ABSCESS $ 333.00 10080 I&D PILONIDAL CYST SIMPLE $ 1,100.00 10081 I&D PILONIDAL CYST COMPLICATED $ 1,955.00 10120 F B REMOVAL TISSUE SIMPLE $ 962.00 10121 F B REMOVAL TISSUE COMPLEX $ 2,485.00 10140 I&D HEMA, SEROMA, FLUID COLL $ 1,955.00 10160 I&D PUNCTURE ASPIRATION $ 377.00 10180 I&D POST-OP WOUND INFECTION $ 2,691.00 11000 DEBR ECZE OR INFEC SKIN<10% $ 377.00 11001 DEBR ECZE / INF SKIN ADD'L 10% $ 377.00 11042 DEBR SUBQ TISSUE 1ST 20 SQ CM OR LESS $ 962.00 11043 DEBR MUSCLE/FASCIA 1ST 20 SQ CM OR LESS $ 493.00 11044 DEBR BONE 1ST 20 SQ CM OR LESS $ 4,172.00 11200 SKIN TAG REMOVAL 1-15 $ 261.00 11201 SKIN TAG REMOVAL EACH ADD 10 $ 354.00 11719 TRIM NAILS $ 119.00 11720 DEBRIDEMENT OF NAIL(S) 1-5 $ 212.00 11721 DEBRIDEMENT OF 6 OR >NAILS $ 212.00 11730 AVULSION OF SINGLE NAIL PLATE $ 261.00 11732 AVULSION OF ADD'L NAIL PLATE $ 228.00 11750 REMOVAL NAILBED AND MATRIX $ 755.00 11752 REM NAIL W/AMP DIST.PHLX TUFT $ 3,216.00 11760 REPAIR NAILBED $ 340.00 11765 EXCISION SKIN EDGE TOENAIL $ 354.00 12001 SIMPLE REP SCALP ETC. <2.5CM $ 500.00 12002 SIMPL REP SCALP ETC. 2.6-7.5CM $ 500.00 12004 SMPL REP SCALP ETC. 7.6-12.5CM $ 500.00 12005 SMPL REP SCALP ETC. 12.6-20CM $ 500.00 12006 SIMPL REP SCALP ETC. 20.1-30CM $ 500.00

38 12007 SIMPLE REP SCALP ETC.>30CM $ 500.00 12011 SIMPLE REPAIR FACE <2.5CM $ 500.00 12013 SIMPLE REPAIR FACE 2.6-5CM $ 500.00 12014 SIMPLE REPAIR FACE 5.1-7.5CM $ 500.00 12015 SIMPLE REPAIR FACE 7.6-12.5CM $ 500.00 12016 SIMPLE REPAIR FACE 12.6-20CM $ 500.00 12017 SIMPLE REPAIR FACE 20.1-30CM $ 986.00 12018 SIMPLE REPAIR FACE>30CM $ 986.00 12020 SIMPLE WOUND DEHISCENCE REPAIR $ 500.00 12021 S WOUND DEHISC REP W/PACKING $ 986.00 12031 IM REPAIR SC/TRK/EXT <2.5CM $ 500.00 12032 IM REP SCALP/TRK/EXT 2.6-7.5CM $ 500.00 12034 IM REP SCLP/TRK/EXT 7.6-12.5CM $ 986.00 12035 IM REP SCALP/TRK/EXT 12.6-20CM $ 986.00 12036 IM REP SCALP/TRK/EXT 20.1-30CM $ 986.00 12037 IM REP SCALP/TRK/EXT>30CM $ 1,098.00 12041 IM REP HAND/FT/NECK/GEN <2.5CM $ 962.00 12042 IM REPR HD/FT/N/GEN 2.6-7.5CM $ 500.00 12044 IM REP HD/FT/N/GEN 7.6-12.5CM $ 500.00 12045 IM REP HD/FT/NK/GEN 12.6-20CM $ 986.00 12046 IM REP HD/FT/N/GEN 20.1-30 $ 986.00 12047 IM REP HD/FT/NECK/GEN >30CM $ 1,098.00 12051 IM REPAIR FACE <2.5CM $ 500.00 12052 IM REPAIR FACE 2.6-5CM $ 500.00 12053 IM REPAIR FACE 5.1-7.5CM $ 962.00 12054 IM REPAIR FACE 7.6-12.5CM $ 986.00 12055 IM REPAIR FACE 12.6-20CM $ 986.00 12056 IM REPAIR FACE 20.1-30CM $ 986.00 12057 IM REPAIR FACE > 30CM $ 1,098.00 13100 COMPL REPAIR TRUNK 1.1-2.5CM $ 1,098.00 13101 COMPLEX REPAIR TRUNK 2.6-7.5CM $ 1,098.00 13102 C REP TRNK >7.5CM EA ADD'L 5CM $ 500.00 13120 C REP SCALP/ARM/LEG 1.1-2.5CM $ 377.00 13121 C REP SCALP/ARM/LEG 2.6-7.5CM $ 500.00 13122 C REP SCA/A/L >7.5CM ADD'L 5CM $ 500.00 13131 COMPLEX REPAIR FACE 1.1-2.5CM $ 500.00 13132 COMPLEX REPAIR FACE 2.6-7.5CM $ 986.00 13133 COMP REP F >7.5CM EA ADD'L 5CM $ 986.00 13151 C REP EYELID/N/E/LIP 1.1-2.5CM $ 500.00 13152 C REP EYELID/N/E/LIP 2.6-7.5CM $ 1,098.00 13153 C REP ELID/N/E/LIP>7.5CM A/5CM $ 500.00 13160 EXTENS WOUND DEHISCENCE REPAIR $ 2,995.00 16035 ESCHAROTOMY INITIAL $ 1,341.00 16036 ESCHAROTOMY EACH ADDITIONAL $ 377.00 20005 INCISION DEEP TISSUE ABSCESS $ 3,348.00 20100 WOUND EXPLORATION NECK $ 852.00 20101 WOUND EXPLORATION CHEST $ 2,995.00 20102 WOUND EXPLORATION TRUNK $ 2,995.00 20103 WOUND EXPLORATION EXTREMITY $ 1,999.00 20520 F B REML MUSCLE/TENDON SIMPLE $ 755.00 20525 F B REML MUSCLE/TENDON DEEP $ 3,216.00 20550 TENDON SHEATH/LIGAMENT INJECT $ 362.00 20551 TENDON ORIGIN INSERTION $ 362.00 20552 S/ M TRIGR PT INJ 1 OR 2 MUSC $ 362.00 20553 S/M TRIGR PT INJ 3 > MUSCLES $ 362.00 20600 ARTHROCENTESIS SMALL JOINT $ 362.00

39 20605 ARTHROCENTESIS INTERMEDIATE JT $ 362.00 TRAY,ENT $ 99.00 OXYGEN MASK $ 105.00 81002 URINE DIP $ 33.00 RING REMOVAL $ 26.00 OXYGEN CANNULA $ 14.00 81025 PREG STAT (UCG) $ 94.00 87880 ER RAPID STREP SCREENING $ 108.00 G0480 WORK COMP BLOOD ALCOHOL $ 483.00 96376 OP IVP INJ EA ADD SEQ SAME MED $ 178.00 MOD SEDATION >5YRS 1ST 30 $ 350.00 MOD SED < 5YRS, 1ST 30 MIN $ 350.00 MOD SEDAT EA ADDL 15 MIN $ 174.00 94640 PRES OR NON-PRESS INHAL TX $ 499.00 94664 VENTILATION TREATMENT DEMO $ 83.00 21310 CLOSED TX NASAL FX W/O MANIP $ 332.00 21320 CLOSD TX N W/O M W/ STAB $ 6,805.00 21450 CLOSED TX MANDIBLE W/O MANIP $ 332.00 21451 CLOSED TX MANDIBLE W/ MANIP $ 1,293.00 21480 JAW REDUCTION $ 332.00 21820 CLOSED TX STERNUM W/O MANIP $ 377.00 23030 I&D SHOULDER ABSCES $ 2,691.00 23330 FOREIGN BODY REMOVAL SHOULDER $ 1,174.00 23505 CLOSED TX CLAVICLE W/ MANIP $ 2,919.00 23570 CLOSED TX SCAPULA W/O MANIP $ 377.00 23575 CLOSED TX SCAPULA W/ MANIP $ 776.00 23600 CLOSD TX PROX.HUMERUS W/O MAN $ 276.00 23605 CLOSD TX PROX. HUMERUS W/ MANP $ 2,919.00 23620 CLOSD TX GRTER HUM TUB W/O MAN $ 377.00 23625 CLOSD TX GRTER HUM TUB W/ MAN $ 2,919.00 23650 SHOULDER REDUCTION W/MAN $ 377.00 23665 C TX GTR HUM TUB FX W/ S D W/M $ 986.00 24200 F BODY REMOVAL ARM/ELBOW SQ $ 755.00 24201 F BODY REMOVAL ARM/ELBOW DEEP $ 2,485.00 24500 CLOSD TX HUMERAL SHAFT W/O MAN $ 377.00 24505 CLOSED TX HUMERAL SHAFT W/ MAN $ 377.00 24530 C TX SPRA/TRNSCNDAR FX W/O M $ 377.00 24535 CLOSD TX SPRA/TRNSCDAR FX W/M $ 776.00 24600 POSTERIOR ELBOW REDUCTION $ 276.00 24640 REDUCTION NURSEMAIDS ELBOW $ 377.00 24650 CLOSD TX RAD HEAD/NECK W/O M $ 276.00 24655 CLOSD TX RAD HEAD/NECK W/ MP $ 776.00 24670 CLOSD TX OLECR PROC FX W/O M $ 377.00 24675 CLOSD TX OLECR PROC FX W/M $ 377.00 25500 CLOSD TX RAD SHAFT FX W/O M $ 276.00 25505 CLOSD TX RAD SHAFT FX W/ M $ 776.00 25530 CLOSD TX ULN SHAFT W/O MANIP $ 276.00 25535 CLOSED TX ULNAR SHAFT W/ MANIP $ 377.00 25560 CLOSD TX RAD/ULNR SHAFT W/O M $ 377.00 25565 CLOSD TX RAD/ULN SHAFT W/ M $ 4,178.00 25600 CLOSED TX COLLES FX W/O MANIP $ 276.00 25605 CLOSED TX COLLES FX W/ MANIP $ 4,178.00 25622 CLOSD TX NAVICULAR FX W/O MANP $ 377.00 25624 CLOSD TX NAVICULAR FX W/ MANIP $ 776.00 25630 CLOSED TX CARPAL FX W/O MANIP $ 276.00 25635 CLOSED TX CARPAL FX W/ MANIP $ 377.00

40 25660 WRIST REDUCTION W/MAN $ 377.00 25680 C TX TRANS-SCAPILUNAR FX W/O M $ 377.00 26010 I&D SIMPLE FINGER ABSCESS $ 333.00 26011 I&D COMPLICATED FINGER ABSCESS $ 1,955.00 26350 FINGER FLEXOR TENDON REPAIR $ 4,104.00 26418 FINGER EXTENSOR TENDON REPAIR $ 2,587.00 26600 C TX METACARPAL FX W/O M $ 276.00 26605 C TX METACARPAL FX W/ M $ 377.00 26641 THUMB REDUCTION W/MAN $ 276.00 26645 CLOSED TX BENNET FX $ 776.00 26670 HAND REDUCTION W/MAN $ 377.00 26700 FINGER MP REDUCTION W/MAN $ 276.00 26720 C TX PRO\MD PHA FGER/THU W/O M $ 276.00 26725 C TX PR/MID PHAL FNGR/THU W/M $ 377.00 26740 CLOSD TX ARTICULAR FX W/O M $ 276.00 26742 CLOSD TX ARTICULAR FX W/MANIP $ 377.00 26750 CLSD TX DIS PHAL FR THMB W/O M $ 276.00 26755 CLSD TX DS PHAL FR THUMB W/M $ 377.00 26770 REDUCTION FINGER IP W/MAN $ 276.00 27086 F B REMOVAL HIP/PELVIS SQ $ 3,913.00 27087 F B REMOVAL HIP/PELVIS DEEP $ 3,363.00 27250 REDUCTION HIP TRAUMA $ 377.00 27500 CLSD TX FEM SHAFT W/O MANIP $ 776.00 27502 CLSD TX FEM SHAFT W/MANIP $ 2,919.00 27508 C TX DIST F F/L CONDYLE W/O M $ 377.00 27510 CLSED TX D FEM M/L CONDYLE W/M $ 986.00 27520 CLOSD TX PATELLA W/O MANIP $ 377.00 27530 CLOSD TX TIBIAL PLAT W/O MANIP $ 377.00 27550 REDUCTION KNEE $ 377.00 27560 REDUCTION KNEE PATELLA $ 377.00 27750 CLOSD TX TIB SHAFT W/O MANIP $ 377.00 27752 CLOSD TX TIBIAL SHAFT W/MANIP $ 4,178.00 27760 CLOSD TX MED MALL W/O MANIP $ 276.00 27762 CLOSD TX MED MALEOLUS W/MP $ 2,919.00 27780 CLOS TX PRX FIB OR SHAFT W/O M $ 276.00 27781 CLOSD TX PRO FIB OR SHAFT W/M $ 2,919.00 27786 CLOSD TX LAT MALEOLUS W/O MANP $ 276.00 27788 CLOSD TX LAT MALEOLUS W/MANIP $ 377.00 27808 CLOSD TX BIMALLEOLAR W/O MANIP $ 377.00 27810 CLOSED TX BIMALLEOLAR W/MANIP $ 377.00 27816 CLOSD TX TRIMALEOLAR W/O MANIP $ 986.00 27818 CLOSD TX TRIMALLEOLAR W/MANIP $ 776.00 27840 REDUCTION ANKLE $ 377.00 27899 OTHER LEG OR ANKLE PROCEDURE $ 276.00 28190 FOREIGN BODY REMOVAL SQ FOOT $ 755.00 28400 CLOSED TX CALCANEUS W/O MANIP $ 377.00 28405 CLOSED TX CALCANEUS W/MANIP $ 2,919.00 28430 CLOSED TX TALUS W/O MANIP $ 377.00 28435 CLOSED TX TALUS W/MANIP $ 377.00 28450 CLOSD TX TARSAL BONE W/O MANIP $ 377.00 28455 CLOSED TX TARSAL BONE W/MANIP $ 377.00 28470 CLOSED TX METATARSAL W/O MANIP $ 377.00 28475 CLOSED TX METATARSAL W/MANIP $ 377.00 28490 CLOSED TX GREAT TOE W/O MANIP $ 276.00 28495 CLOSED TX GREAT TOE W/MANIP $ 377.00 28510 CLOSED TX OTHER TOE W/O MANIP $ 276.00

41 28515 CLOSED TX OTHER TOE W/MANIP $ 377.00 28540 REDUCTION FOOT $ 377.00 28630 REDUCTION TOE MP $ 377.00 28660 REDUCTION TO IP $ 276.00 29055 SHOULDER SPICA CAST $ 355.00 29058 SHOULDER VELPEAU CAST $ 174.00 29065 LONG ARM CAST $ 355.00 29075 SHORT ARM CAST $ 355.00 29085 HAND/WRIST CAST $ 174.00 29126 SHORT ARM SPLINT DYNAMIC $ 174.00 29131 FINGER SPLINT DYNAMIC $ 174.00 29200 CHEST STRAPPING $ 174.00 29799 LOW BACK STRAPPING $ 174.00 29240 SHOULDER VELPEAU STRAPPING $ 174.00 29260 ELBOW/WRIST STRAPPING $ 174.00 29280 HAND/FINGER STRAPPING $ 174.00 29345 LONG LEG CAST $ 355.00 29405 SHORT LEG CAST $ 355.00 29425 WALKING CAST $ 355.00 29435 PTB CAST $ 355.00 29440 ADD WALKER CAST $ 174.00 29450 CLUBFOOT CAST $ 174.00 29520 HIP STRAPPING $ 174.00 29530 KNEE STRAPPING $ 174.00 29540 ANKLE/FOOT STRAPPING $ 174.00 29550 TOES STRAPPING $ 174.00 29580 UNNA BOOT STRAPPING $ 174.00 29700 REM/REV GAIMT ET BT/BODY CAST $ 174.00 29705 REML/REVION LONG ARM/LEG CAST $ 174.00 29710 REM/REV SHLDER/HIP SPICA CAST $ 390.00 29730 WINDOW CAST $ 174.00 29740 WEDGE CAST $ 174.00 29799 UNLISTED CASTING/STRAPING PROC $ 174.00 30903 ANT NASAL PACKING COMPLEX $ 377.00 30906 POST NASAL PACKING SUBSEQUENT $ 986.00 31502 TRACHEOSTOMY TUBE REPLACE $ 357.00 31511 F B REMOVAL LARYNX INDIRECT $ 986.00 31577 F B REMOVAL LARYNX W/SCOPE $ 986.00 31603 EMERGENT TRACHEOTOMY $ 1,293.00 32554 THORACENTESIS W/O IMAGING $ 1,896.00 32110 THORA CNTRL TRAUM HEM/REP L TR $ 2,412.00 32160 THORA INTERNAL CARDIAC MASSAGE $ 3,218.00 33011 PERICARDIOCENTESIS SUBSEQUENT $ 986.00 36400 VENIP FEM/JUGULAR <3YRS BY MD $ 1,072.00 36405 VENIPUNTURE SCALP VEIN BY MD $ 377.00 36410 VENIPUNTURE >3YRS AGE MD SKILL $ 107.00 36600 ABG DRAW $ 135.00 36620 ART LINE INSERTPERCUTANEOUS $ 804.00 36625 ARTRIAL LINE INSERTION CUTDOWN $ 1,072.00 40650 COMP REP LIP VERMILLION ONLY $ 1,385.00 40652 COMP REP LIP UP TO 1/2 VERT HT $ 1,385.00 40654 COMP REP LIP > 1/2 VERT HT $ 1,385.00 40804 FB REMVAL MOUTH EMBEDDED SIMPL $ 377.00 40805 F B REMOVL MOUTH EMBEDDED COMP $ 1,385.00 40830 CMPLX REP VESTIBULE 2.5CM OR < $ 424.00 40831 COMPLEX REP VESTIBULE >2.5 CM $ 1,385.00

42 41250 C REP 2.5CM FL MTH &/OR A2/3 $ 424.00 41251 COMPLEX REPAIR POST 1/3 TONGUE $ 424.00 41252 COMP RE>2.5CM TONG/FL MOUTH $ 1,385.00 41800 I&D DENTAL ABSCESS $ 332.00 42700 I&D TONSIL ABSCESS $ 332.00 42809 FOREIGN BODY REMOVAL PHARYNX $ 377.00 43460 SENGS-BLAKEMORE TUBE INSRTION $ 2,412.00 45005 I&D PERIRECTAL ABSCESS $ 2,638.00 46050 I&D PERIANAL ABCESS $ 652.00 46083 I&D THROMBOSED HEMORRHOID $ 652.00 46221 SIMPLE LIGATION HEMORRHOID $ 652.00 46320 EXC EXT THROMBOTIC HMORRHOID $ 3,717.00 51102 INSERTION SUPRAPUBIC CATHETER $ 2,639.00 54700 I&D SCROTAL SPACE $ 3,818.00 56405 I&D VULVA/PERINEUM $ 472.00 56420 I&D BARTHOLIN'S GLAND $ 472.00 57020 COLPOCENTESIS $ 986.00 57160 INSERTION PESSARY DEVICE $ 203.00 57200 SUTURE VAGINAL INJURY $ 3,297.00 58120 D&C NON-OBSTETRICAL $ 2,713.00 58301 REMOVAL IUD $ 380.00 59160 CURETTAGE POSTPARTUM $ 2,713.00 59414 DELIVERY PLACENTA ONLY $ 2,336.00 59514 CESAREAN DELIVERY $ 3,211.00 64450 DIGITAL BLOCK $ 1,682.00 65205 REM SUPERF SUBCONJ FB $ 198.00 65210 REML EMBEDDED SUBCONJ FB $ 198.00 67700 I&D EYELID ABSCESS $ 986.00 69000 I&D EAR ABSCESS SIMPL $ 333.00 69005 I&D EAR ABSCESS COMPLICATED $ 2,691.00 69200 FB REMOVAL EAR $ 306.00 69210 CERUMEN REMOVAL $ 99.00 96360 IV INF, HYDRATION, 1ST HOUR $ 285.00 96361 IV INF HYDRATION ADDL HOURS $ 178.00 96365 INF MED INITIAL, UP TO 1HR $ 285.00 96366 INFUSION THERA EA ADDL HOUR $ 178.00 96367 INF MED ADDL SEQ INF<1HR $ 175.00 96368 INF MED CONCURRENT INFUSION $ 178.00 96372 IM/SC INJECTION $ 160.00 96374 IVP INJ SINGLE OR INITIAL SUBS $ 554.00 96375 IVP INJ EACH ADD SEQ NEW MED $ 178.00 92953 TRANSCUTANEOUS PACING $ 1,234.00 92961 INTERNAL DEFIBRILLATION $ 1,376.00 29105 LONG ARM POSTERIOR MOLD $ 505.00 29505 LONG LEG POSTERIOR MOLD $ 492.00 29125 SHORT ARM POSTERIOR MOLD $ 448.00 29515 SHORT LEG POSTERIOR MOLD $ 435.00 BLADDER CATHETERIZATION(BY RN) $ 198.00 CONCEPT CAUTERY $ 58.00 HOT PACK $ 16.00 ENDOTRACHEAL TUBE $ 130.00 MIC GASTRO TUBE $ 213.00 SUTURES $ 33.00 YANKAUR TUBE $ 6.00 TRAY, CHEST TUBE $ 356.00 NEEDLE, INTRAOSSEOUS $ 141.00

43 SUTURE TRAY $ 110.00 20610 ARTHRO/APIR JNT MAJOR $ 757.00 EYE IRRIG-ONE $ 294.00 30300 REM FB NAS/EAR $ 262.00 30901 NOSEBLEED ANT. $ 343.00 30905 NOSEBLEED POST $ 986.00 31730 TRACH T INSERT $ 777.00 32551 CHEST T INSERT $ 1,218.00 33010 PERICARDIOCENT $ 986.00 33210 TEMP INT PACEMA $ 7,562.00 36556 CATH INSERT VEIN CNTRL>5YRS $ 986.00 36555 CATH INSERT VEIN CNTRL<5YRS $ 986.00 36680 NEEDLE INSERT. $ 518.00 43760 CHG GAST.TUBE $ 710.00 51700 BLAD.IRRIGAT. $ 281.00 51702 CATHETER BLADDER FOLEY $ 281.00 57415 REM FB VAGINAL W/ANESTH $ 2,513.00 67938 REM FB EYE LID $ 389.00 45915 REM FECAL IMP $ 2,356.00 92960 CARDIO ELE EXT $ 1,234.00 51703 CATH BLADDER FOLEY COMPLEX $ 350.00 EXTERNAL CATHETER $ 50.00 16000 BURN TREATMENT NO DEBRIDEMENT $ 458.00 16020 BURN TX SMALL DEBRIDE <5% $ 505.00 MULTI-LUMENT CV CATHETER KIT $ 204.00 36420 CUTDOWN<1YEAR $ 759.00 36425 CUTDOWN >1 YEAR $ 759.00 31605 CRICOTHYRECTOMY $ 1,686.00 36415 BLOOD DRAW $ 21.00 36416 BLOOD DRAW HEEL,FINGER STICK $ 21.00 29130 APPLY FINGER SPLIT STATIC $ 210.00 23500 FRACTURE CLAVICLE W/O MAN $ 294.00 96372 INJECTION ANTIBIOTIC $ 160.00 11740 NAIL EVACUATION OF HEMATOMA $ 254.00 EAR WICK POPP $ 22.00 EPISTAT $ 59.00 RHINO ROCKETS $ 67.00 NON-REBREATHER $ 105.00 PERICARDIOCENTESIS TRAY $ 180.00 46608 REM FB ANAL $ 949.00 65222 REM FB CORNEA WITH SLIT LAMP $ 386.00 65220 REM FB CORNEA W/O SLIT LAMP $ 386.00 36440 PUSH TRANSFUSION <2 YEARS $ 1,097.00 49083 ABDOMINAL PARACENTESIS $ 815.00 49084 PERITONEAL LAVAGE $ 815.00 CULTURE COLLECTION $ 21.00 90471 IMMUNIZATION INJECT 1ST $ 160.00 AIRWAY, AMBU ADULT & PEDS $ 114.00 C1729 PERITO LAV TRAY $ 216.00 99282 LEVEL II LIMITED $ 453.00 99283 LEVEL III INTERMEDIATE $ 708.00 99284 LEVEL IV EXTENDED $ 903.00 99285 LEVEL V COMP $ 1,394.00 99291 LVL VI CRTCL 1ST 30-74 MIN $ 2,011.00 99292 EA ADD'L 30 MIN CRITICAL CARE $ 664.00 NU-TRAKE CRICO KIT $ 73.00

44 TRAY,PLACTIC(GENERAL) $ 282.00 EYE PATCH $ 6.00 CENTRAL VENOUS CATH KIT PEDS $ 204.00 43753 GASTRIC LAVAGE $ 900.00 97597 DEBRIDE OPEN WOUNDS 1ST 20 SQ CM OR LESS $ 376.00 97598 DEBRIDE OPEN WOUNDS EA ADDL 20 SQ CM $ 376.00 11045 DEBRIDE TISSUE SUBQ EA ADDL 20 SQ CM $ 423.00 11046 DEBRIDE MUSCLE/FASCIA EA ADDL 20 SQ CM $ 424.00 11047 DEBRIDE BONE EA ADDL 20 SQ CM $ 1,316.00 82962 ACCU-CHEK-ER $ 45.00 31899 AIRWAY, NASOPHARYNGEAL-ER $ 1,180.00 ANGIOCATH $ 39.00 ANGIOCATH G. 18/20 $ 35.00 AUTOTRANSFUSION DRAINAGE $ 365.00 BAG, U PEDIATRIC-ER $ 21.00 BAG, URINARY DRAINAGE-ER $ 23.00 16030 BURN TX LARGE >10% $ 986.00 16025 BURN TX MED DEBIRDE 5%-10% $ 398.00 92950 CARDIOPULMINARY RESUSTION $ 1,516.00 CAST SHOE-ER $ 43.00 CATHETER, COUDE-ER $ 72.00 CATHETER, FOLEY 2-WAY-ER $ 114.00 CATHETER, SUCTION (EA)-ER $ 6.00 CATHETER, TRIPLE LUMEN-ER $ 173.00 CATHETER, TROCAR-ER $ 112.00 L0150 COLLAR, HARD CERVICAL-ER $ 186.00 L0120 COLLAR, SOFT CERVICAL-ER $ 59.00 DIAPER, INFANT (EA)-ER $ 9.00 80307 DRUG SCREEN, URINE-ER $ 126.00 EAR CURRETTES, DISP-ER $ 6.00 99281 ER TRIAGE - LWBS $ 135.00 99281 ER TRIAGE $ 135.00 99281 ER- DCFS INITIAL HEALTH S $ 364.00 FOLEY CATH 30CC $ 31.00 FOLEY CATH 5CC $ 29.00 G TUBE REPLACEMENT $ 171.00 GELFOAM-ER $ 41.00 IMMOB SHOULDER-ER $ 239.00 31500 INTUBATION $ 1,241.00 IV BURETROL, PEDIATRIC-ER $ 99.00 KIT, PORT-A-CATH DRSG-ER $ 43.00 KIT, STR CATH FRMALE-ER $ 25.00 L1830 KNEE IMMOBILIZER-ER $ 99.00 LIMB RESTRAINTS $ 37.00 BAG,CADAVER $ 73.00 NEEDLE, PORT A CATH-ER $ 37.00 OXYGEN ADMINISTRATION-ER $ 103.00 PENROSE DRAIN $ 12.00 PLEURAVAC-ER $ 287.00 SCALPEL, DISP-ER $ 6.00 SLING, ARM-ER $ 16.00 62270 SPINAL TAP-ER $ 462.00 SPLINT, COCK-UP-ER $ 72.00 L3908 SPLINT, WRIST ELASTIC-ER $ 66.00 STRAINER, FILTER FUNNEL-E $ 71.00 STYLET, (INTUBATING)-ER $ 29.00

45 TRAUMA KIT $ 166.00 TRAY THORACOTOMY $ 136.00 TRAY, CUT DOWN-ER $ 324.00 TRAY, FOLEY CATHETER-ER $ 67.00 TRAY, LUMBAR PUNTTURE-ER $ 71.00 TRAY,THORACENTESIS-DISP. $ 135.00 TRIPLE LUMEN-ER $ 459.00 TUBE, SALEM SUMP-ER $ 47.00 TUBE, TRACH (SHILEY)-ER $ 393.00 TUBIGRIP 1 1/2 YD-ER $ 46.00 URIMETER, DISP-ER $ 37.00 URINARY LEG BAG $ 52.00 99281 WND CHECKUP/FOLLOW/UP EXA $ 114.00 32554 THORACENTESIS $ 1,896.00 GRADUATE DISP-ER $ 6.00 32556 INSERT CHEST TUBE PNEUMOTHORAX $ 880.00 TRAY, TRACHEOSTOMY-ER $ 136.00 59409 EMERGENCY CHILDBIRTH-ER $ 3,181.00 51701 ED CATH HFOR URINE SPEC $ 306.00 11201 REMOVE SKIN TAGS ADD ON $ 354.00 20600 DRAIN/INJ JOINT/BURSA W/O US $ 362.00 20606 DRAIN/INJ JOINT/BURSA W/US $ 431.00 20615 TREATMENT OF BONE CYST $ 1,773.00 20680 REMOVAL OF SUPPORT IMPLANT $ 7,195.00 21820 TREATMENT OF STERNUM FRACTURE $ 377.00 29075 APPLY FOREARM CAST $ 355.00 29425 APPLY SHORT LEG CAST $ 355.00 29700 REMOVAL/REVISION OF CAST $ 174.00 36589 REMOVAL TUNNELED CV CATH $ 250.00 36590 REMOVAL TUNNELED CV CATH $ 1,896.00 57160 INSERT PESSARY/OTHER DEVICE $ 203.00 58100 BIOSPY OF UTERUS LINING $ 200.00 68801 DILATE TEAR DUCT OPENING $ 200.00 69200 CLEAR OUTER EAR CANAL $ 306.00 69210 REMOVE IMPACTED EAR WAX UNI $ 99.00 88160 CYTOPATH SMEAR $ 99.00 92511 NASOPHARYNGOSCOPY $ 250.00 94760 MEASURE BLOOD OXYGEN LEVEL $ 97.00 11200 SKIN TAG REMOVAL $ 261.00 11730 REMOVAL OF NAIL PLATE $ 261.00 30300 REMOVE FOREIGN BODY $ 262.00 59000 AMNIOCENTESIS DIAGNOSTIC $ 514.00 88387 TISS EXAM MOLECULAR STUDY $ 50.00 11100 BIOPSY SKIN, SINGLE LESION $ 962.00 57510 CRYOCAUTERY $ 324.00 96372 INJECTION/THERAPEUTIC; IM/SUBQ $ 160.00 10060 I & D OF SKIN ABCESS, SIMPLE $ 377.00 96365 IV INFUSION THERAPEUTIC 1ST HR $ 399.00 90471 IMMUNIZATION INJECT 1ST $ 160.00 96523 IRRIG VENOUS ACCESS DEVICE $ 168.00 99201 LEVEL I NEW E&M $ 94.00 99202 LEVEL II NEW E&M $ 104.00 99203 LEVEL III NEW E&M $ 114.00 99204 LEVEL IV NEW E&M $ 174.00 99205 LEVEL V NEW E&M $ 204.00 99211 LEVEL I EST E&M $ 94.00

46 99212 LEVELII EST E&M $ 104.00 99213 LEVEL III EST E&M $ 114.00 99214 LEVEL IV EST E&M $ 154.00 99215 LEVEL V EST E&M $ 184.00 96374 INITIAL THER IV PUSH $ 554.00 96375 ADD'L SEQ PUSH, NEW DRUG $ 178.00 57420 COLP VAG W CERVIX IF PRESENT $ 317.00 57421 COLP VAG&CERV IF PRES W/BX(S) $ 317.00 57452 COLP CERVIX & VAGINA $ 141.00 96376 IVP INJ EA ADD SEQ SAME MED>30MIN $ 178.00 17000 DESTRUCT PREMALG LESION $ 75.00 17003 DESTRUCT PREMALG LESION 2-14 $ 7.00 17004 DESTRUCT PREMALG LESION 15> $ 167.00 20526 THER INJ CARP TUNNEL $ 362.00 20550 ING TENDON SHEATH/LIGAMENT $ 362.00 20605 INJ SMALL JOINT $ 362.00 20610 INJ MAJOR JOINT $ 757.00 23500 TX CLAVICLE FRACTURE $ 294.00 23540 TX CLAVICLE DISLOCATION $ 317.00 23600 CLOSED TX PROX HUMERUS W/O MANIP $ 276.00 23620 CLOSED TX GREATER HUM TUB W/MANIP $ 377.00 24500 CLOSED TX HUMERUS SHAFT W/MANIP $ 377.00 24530 CLOSED TX SPRA/THRNSCNDAR FX W/MANIP $ 377.00 24560 TX HUMERUS FRACTURE $ 377.00 24576 TX CONDYLE HUMERUS FRACTURE $ 377.00 24650 TX RADIUS FRACTURE $ 276.00 24670 TX ULNAR FRACTURE $ 377.00 25500 TX RADIUS SHAFT FRACTURE $ 276.00 25530 TX ULNAR SHAFT FRACTURE $ 276.00 25560 TX RADIUS/ULNAR FRACTURE $ 377.00 25600 TX RADIUS/ULNAR SHAFT FRACTURE $ 276.00 25622 CLOSED TX NAVICULAR FX W/O MANIP $ 377.00 25630 CLOSED TX CARPAL FX W/O MANIP $ 276.00 26600 WRIST RECUTION W/MANIP $ 377.00 26720 CLOSED TX PRO/MD PHAL FINGER W/O MANIP $ 276.00 26750 CLOSED TX DIS PHAL FR THUMB W/O MANIP $ 276.00 27245 TX THIGH FRACTURE $ 276.00 27520 CLOSED TX PATELLA W/O MANIP $ 377.00 27530 CLOSED TX TIBIAL PLAT W/O MANIP $ 377.00 27538 TX KNEE FRACTURE(S) $ 377.00 27750 CLOSED TX TIBIAL SHAFT W/O MANIP $ 377.00 27760 CLOSED TX MEDIAL ANKLE FRACTURE $ 276.00 27780 CLOSED TX FIB OR SHAFT W/O MANIP $ 276.00 27786 CLOSED TX LAT MALEOLUS W/O MANIP $ 276.00 27808 CLOSED TX BIMALLEOLAR W/O MANIP $ 377.00 27824 TX LOWER LEG FRACTURE $ 276.00 28400 CLOSED TX CALCANEUS W/O MANIP $ 377.00 28430 CLOSED TX TALUS W/O MANIP $ 377.00 28450 TX MIDFOOT FRACTURE $ 377.00 28470 CLOSED TX METATARSAL W/O MANIP $ 377.00 28490 CLOSED TX GREAT TOE W/O MAINP $ 276.00 28510 CLOSED TX OTHER TOE W/O MANIP $ 276.00 29065 APPLY LONG ARM CAST $ 355.00 29085 APPLY HAND/WRIST CAST $ 174.00 29105 APPLY LONG ARM SPLINT $ 505.00 29125 APPLY FOREARM SPLINT $ 448.00

47 29130 APPLY FINGER SPLINT $ 210.00 29345 APPLY LONG LEG CAST NW/B $ 355.00 29355 APPLY LONG LEG CAST W/B $ 355.00 29365 APPLY LONG LEG CAST CYLINDRICAL $ 355.00 29405 APPLY SHORT LEG CAST $ 355.00 29505 APPLY LONG LEG SPLINT $ 492.00 29515 APPLY LOWER LEG SPLINT $ 435.00 56405 I&D OF VULVA/PERIENUM $ 472.00 56420 DRAINAGE OF GLAND ABSCESS $ 472.00 56501 DESTRUCT VULVA LESIONS SIM $ 141.00 56605 BIOSPY VULVA/PERINEUM 1 LESION $ 91.00 56606 BIOSPY VULVA/PERINEUM ADD'L LESION $ 35.00 56820 EXAM VULVA W/SCOPE $ 141.00 56821 EXAM/BIOSPY VULVA W/SCOPE $ 276.00 57061 DESTRUCT VAG LESIONS SIMPLE $ 125.00 57100 BIOSPY OF VAGINA $ 99.00 57105 BIOPSY OF VAGINA W/SUTURE $ 120.00 57455 BIOSPY OF CERVIX W/SCOPE $ 317.00 57456 COLP VAG W/ECC $ 317.00 57460 BIOSPY OF CERVIX W/SCOPE LEEP $ 6,256.00 57500 BIOSPY OF CERVIX $ 317.00 57505 ENDOCERVICAL CURETTAGE $ 1,781.00 57511 CRYOCAUTERY OF CERVIX $ 324.00 57800 DILATION OF CERVICAL CANAL $ 65.00 59430 CARE AFTER DELIVERY $ 220.00 76805 OB US >/= 14 WKS SNGL FETUS $ 1,028.00 76815 OB US LIMITED FETS(S) $ 342.00 76817 TRANSVAGINAL US OBSTETRIC $ 232.00 76830 TRANSVAGINAL US NON-OB $ 757.00 76856 US EXAM PELVIC COMPLETE $ 784.00 76857 US EXAM PELVIC LIMITED $ 232.00 56740 EXC/BARTH GLAND CYST 56740 $ 350.00 57700 CERCLAGE/CERVIX 57700 $ 7,034.00 58110 ENDOMETRIAL CURETTAGE 58110 $ 200.00 58600 TUBAL LIGATION ABDOMINAL 58600 $ 401.00 58605 TUBAL LIGATION POSTPARTUM 58605 $ 355.00 59136 TX ETOPIC PREGNANCY 59136 $ 1,200.00 82948 GLUCOSE FINGER STICK 82948 $ 31.00 88150 PAP SMEAR 88150 $ 99.00 90460 VAC ADMIN 1ST COMP 90460 $ 50.00 90461 VAC ADMIN ADD'L COMP 90461 $ 30.00 90633 HEP A VACCINE 90633 $ 32.21 90648 HIB TX 90648 $ 10.00 90655 INF VAC <3 YRS ADMIN 90655 $ 40.00 90656 INF VAC >3 YRS ADMIN 90656 $ 40.00 90658 INFLUENZA VAC ADMIN 90658 $ 40.00 90707 MMR 90707 $ 61.00 90713 IPV 90713 $ 30.17 90716 VZV 90716 $ 116.00 90715 TD ADULT 90715 $ 75.00 90723 PEDIATRIX 90723 $ 100.00 90743 HEP B VAC >12 YRS 90743 $ 70.00 90744 HEP B VAC ADOL ADMIN 90744 $ 16.00 92004 EYE EXAM NEW PT 92004 $ 200.00 92012 EYE EXAM EST PT 92012 $ 125.00 92014 EYE EXAM & TX EST PT 92014 $ 150.00

48 92587 HEARING TEST 92587 $ 399.00 94640 NEB TX 94640 $ 499.00 96110 AUTISM SCREENING 96110 $ 20.00 97802 NUTRI/ACTIVITY COUNSEL 15 MIN 97802 $ 103.00 99024 POST OP FOLLOW UP VISIT 99024 $ 100.00 99173 VISION TEST 99173 $ 7.45 99244 LEVEL IV OFFICE CONSULT 99244 $ 150.00 99381 PREVENTIVE VISIT <1 YR NEW 99381 $ 130.25 99382 PREVENTIVE VISIT 1-4 YRS NEW 99382 $ 135.12 99383 PREVENTIVE VISIT 5-11 YRS NEW 99383 $ 141.19 99384 PREVENTIVE VISIT 12-17 YRS NEW 99384 $ 159.83 99385 PREVENTIVE VISIT 18-39 YRS NEW 99385 $ 155.37 99386 PREVENTIVE VISIT 40-64 YRS NEW 99386 $ 179.27 99387 PREVENTIVE VISIT >65 YRS NEW 99387 $ 195.15 99391 PREVENTIVE VISIT <1 YR EST 99391 $ 117.20 99392 PREVENTIVE VISIT 1-4 YRS EST 99392 $ 125.31 99393 PREVENTIVE VISIT 5-11 YRS EST 99393 $ 124.90 99394 PREVENTIVE VISIT 12-17 YRS EST 99394 $ 136.25 99395 PREVENTIVE VISIT 18-39 YRS EST 99395 $ 139.09 99396 PREVENTIVE VISIT 40-64 YRS EST 99396 $ 148.41 99397 PREVENTIVE VISIT >65 YRS EST 99397 $ 159.83 99420 EDINBURGH DEPRESSION SCREEN 99420 $ 50.00 G0101 WELL WOMAN/GYNE EXAM G0101 $ 65.00 J1050 DEPO PROVERA J1050 $ 50.00 20553 INJ TRIGGER POINT 3> MUSCLES 20553 $ 362.00 G0463 HOSP OP CLINIC VISIT G0463 $ 150.00 92002 EYE EXAM NEW PT 92002 $ 175.00 92567 TYMPANOMETRY 92567 $ 93.00 20552 INJ TRIGGER POINT 1/2 MUSCLES 20552 $ 362.00 20551 INJ TENDON OROGIN 20551 $ 362.00 25000 INCISION TENDON SHEATH 25000 $ 450.00 26725 CLOSED TX PR/MID PHAL W/MANIP 26725 $ 377.00 43999 STOMACH SURGERY PROCEDURE 43999 $ 200.00 90649 HPV VACCINE 90649 $ 186.00 97810 ACUPUNCT W/O STIM 15 MIN 97810 $ 110.00 99406 INTERMED SMOKING CESS CONSUL 99406 $ 30.00 10160 PUNCT ASPIR ABCESS/CYST $ 377.00 57454 COLP CERV/VAG W/BX(S) CERV/CUR $ 827.00 11900 INJECT INTRALESIONAL UP TO 7 $ 108.00 86580 TUBERCULOSIS INTRADERMAL $ 39.00 81002 URINE GLUCOSE/PROTEIN NON-AUTO $ 14.00 11042 DEBRIDE SKIN/SUBQ TISSUE $ 962.00 11421 EXCISION BENIGN .6-1 CM $ 235.00 11420 EXCISION, BENIGN .5 CM $ 224.00 16025 BURN TX MED DEBRIDE 5% - 10% $ 377.00 92950 CPR $ 773.00 82271 HEMOCULT/GASTRO-OPD $ 21.00 Q2039 INFLUENZA VACCINE 3YRS+; IM $ 37.00 10021 FINE NEEDLE ASPIR WO IMAGE $ 236.00 10080 INC DRAIN PILONIDAL CYST SIMPLE $ 333.00 11101 BX SKIN SQ TISSUE SIMPLE EA ADDL $ 377.00 44500 INTRA LONG GASTROINTEST TUBE $ 991.00 51700 IRRIGATION OF BLADDER $ 281.00 51701 INSERT BLADDER CATH NON INDWEL $ 306.00 51702 INSERT BLADDER CATH SIMPLE $ 281.00 51703 INSERT BLADDER CATH COMPLEX $ 350.00

49 58301 REMOVAL IUD $ 380.00 62270 LUMBAR SPINE PUNCTURE DX $ 462.00 82962 ACCUCHECK PHYSICIAN CENTER $ 31.00 81025 URINE PREG PHYSICIAN CENTER $ 94.00 81002 URINE DIP PHYSICIAN CENTER $ 33.00 54150 OP CIRCUMCISION $ 4,934.00 90472 ADMIN VACCINE EACH ADDL $ 61.00 82962 ACCUCHECK $ 16.00 96375 ADDITIONAL SEQ IV PUSH, NEW DR $ 178.00 96367 ADDITIONAL TX SEQ INFUS, UP TO $ 178.00 96376 ADDITIONAL SEQ IV PUSH SAME DR $ 178.00 11100 BIOPSY,SKIN LESION, SINGLE LES $ 962.00 96368 CONCURRENT TX INFUSIION $ 178.00 92950 CPR $ 773.00 82271 HEMOCULT/GASTRO $ 21.00 96372 INJECTIONS/THERAPEUTIC $ 160.00 96360 IV INFUSION HYDRATION 1ST HR $ 399.00 96365 IV INFUSIION THERAPEUTIC 1ST H $ 399.00 96366 IV INFUSION, TX EA ADDL HR $ 178.00 99203 LEVEL III NEW E&M $ 122.00 99211 LEVEL 1 EST E&M $ 91.00 99201 LEVEL 1 NEW E&M $ 91.00 99212 LEVEL II EST E&M $ 107.00 99202 LEVEL II NEW E&M $ 107.00 99213 LEVEL III EST E&M $ 122.00 99214 LEVEL IV EST E&M $ 151.00 99204 LEVEL IV NEW E&M $ 185.00 99215 LEVEL V EST E&M $ 185.00 99205 LEVEL V NEW E&M $ 240.00 36415 VENIPUNCTURE $ 6.00 96361 IV INFUSION HYDRATION EA ADDL $ 178.00 36430 BLOOD TRANSFUSION OPD $ 1,161.00 38220 BONE MARROW ASPIRATION $ 370.00 96402 CHEMO HORMONAL $ 87.00 96411 CHEMO IVP ADDL DRUG $ 175.00 96413 CHEMO IV INFUSION 1ST HR $ 876.00 96415 CHEMO IV INF ADDL EA HR $ 87.00 96417 CHEMO IV INF ADDL SEQ UP TO 1H $ 87.00 96416 CHEMO IV INF >8HRS W PUMP $ 274.00 96409 CHEMO IV PUSH SNGL OR INI $ 252.00 96401 CHEMO NON HORMONAL IM $ 87.00 96523 IRRIG VENOUS ACCESS DEVICE $ 168.00 99195 THER PHLEBOTOMY $ 114.00 96374 IV PUSH INITIAL $ 554.00 90471 IMMUNIZATION ADMIN 1 VACCINE $ 160.00 90746 EHS HEP B VAC $ 53.00 86580 EHS PPD 5TU $ 10.00 90707 EHS MMR VAC $ 82.00 90715 EHS TDAP VAC $ 42.00 90471 EHS VAC ADMIN 1ST $ 36.00 90472 EHS VAC ADM EA ADD $ 24.00 90716 EHS VARIVAX $ 147.00 80307 EHS URINE DRUG $ 27.00 G0109 DIABETES TRAIN GRP/30 MIN $ 42.00 G0108 DIABETES TRAIN IND/30 MIN $ 73.00 97804 MNT GRP EACH 30 MIN $ 35.00

50 97802 MNT INDIV INT EA 15 MIN $ 68.00 97803 MNT INDIV REASS EA 15 MIN $ 62.00 G0271 MNT REASSESS GRP 30 MIN $ 35.00 G0270 MNT REASSESS IND 30 MIN $ 62.00 11042 DEBRIDE TISSUE SUBQ 1ST 20 SQ CM OR < $ 962.00 11043 DEBRIDE TISSUE THRU MUSCLE 1ST 20SQ CM $ 420.00 11044 DEBRIDE TISSUE THRU BONE 1ST 20SQ CM $ 4,172.00 11100 BIOPSY OF SKIN LESION - SINGLE $ 962.00 11101 BIOPSY SKIN LESION, EACH ADDL $ 377.00 15004 SURG/WOUND PREP 1ST 100 SQ CM $ 986.00 15005 SURG/WOUND PREP ADDL 100 SQ CM $ 986.00 15115 EPIDRM A-GRFT 1ST 100 SQ CM $ 986.00 15116 EPIDRM A-GRFT ADDL 100 SQ CM $ 986.00 15120 SKN SPLT A-GRFT 1ST 100 SQ CM $ 3,250.00 15121 SKN SPLT A-GRFT ADDL 100 SQ CM $ 3,250.00 15135 DERM AUTOGRAFT 1ST 100 SQ CM $ 2,550.00 15136 DERM AUTOGRAFT ADDL 100 SQ CM $ 2,550.00 97597 DEBRIDE OPEN WOUNDS 1ST 20 SQ CM OR LESS $ 376.00 97598 DEBRIDE OPEN WOUNDS EACH ADDL 20 SQ CM $ 376.00 97602 NON SEL DEBRID PER SESSION $ 377.00 97605 NEG PRESS WND TX <=50CM DME $ 201.00 97606 NEG PRESS WND TX > 50CM DME $ 298.00 99201 NEW PT-BRIEF $ 126.00 99202 NEW PT-LIMITED $ 158.00 99203 NEW PT-INTERMEDIATE $ 207.00 99204 NEW PT-EXTENDED $ 284.00 99205 NEW PT-COMPREHENSIVE $ 384.00 99211 EST PT-BRIEF $ 126.00 99212 EST PT-LIMITED $ 158.00 99213 EST PT-INTERMEDIATE $ 158.00 99214 EST PT-EXTENDED $ 207.00 99215 EST PT-COMPREHENSIVE $ 284.00 A6010 COLLAGEN BASED WOUND FILLER $ 73.00 A6011 COLLAGEN GEL/PASTE WOUND FIL $ 6.00 A6021 COLLAGEN DRESSING <=16 SQ IN $ 49.00 COLLAGEN DSG WND FILL PER 6 IN $ 14.00 A6196 ALGINATE DRESSING <=16 SQ IN $ 16.00 ALGINATE DRSG WOUND FILLER $ 12.00 A6212 FOAM DRG <=16 SQ IN W/BORDER $ 24.00 HYDROGEL DSG<=16 SQ IN $ 11.00 A6254 ABSORPT DRG <=16 SQ IN W/BDR $ 4.00 Q4100 TISSUEMEND, PER SQ CM $ 2.00 Q4112 ALLOGRAFT, CYMETRA, INJ, 1CC $ 723.00 Q4113 ALLOGRAFT, GRAFTJACKET INJ 1CC $ 723.00 Q4114 ALLOGRAFT INTEGRA FLOW INJ 1CC $ 2,221.00 11045 DEBRIDE TISSUE SUBQ EA ADDL 20 SQ CM $ 423.00 Q4118 MATRISTEM MICROMATRIX 1MG $ 14.00 11000 DEBR ECZE INFEC SKIN<10% $ 420.00 11001 DEBR ECZE/INF SKIN ADD'L 10% $ 377.00 HONEYCOLLOID DRESSING<=16 SQ IN A6196 $ 80.00 A6209 AG FOAM DRESSG<=16SQ IN W/O BORDER A6209 $ 101.00 15272 APP SKN SUB/AREA<100/ADL 25CM (T/A/L) $ 986.00 15273 APP SKN SUB/AREA>100/1ST 100CM (T/A/L) $ 986.00 15274 APP SKN SUB/AREA>100/ADL 100CM (T/A/L) $ 986.00 15275 APP SKN SUB/AREA<100/1ST 25CM (H/H/F) $ 986.00 15276 APP SKN SUB/AREA<100/ADL 25CM (H/H/F) $ 986.00

51 15277 APP SKN SUB/AREA>100/1ST 100CM (H/H/F) $ 986.00 10061 I & D ABSCESS; CMPLCTD OR MULT $ 333.00 17250 CHEM CAUT GRAN TISS SNS/FSTLA $ 228.00 29580 STRAPPING; UNNA BOOT $ 174.00 29581 APP MULT COMP-LEG INDG ANKL/FT $ 174.00 96372 THER, PROP OR DX INJ SUB/INTRA $ 160.00 99195 PHLEBOTOMY; THERAPEUTIC $ 114.00 10060 INCISION AND DRAINAGE OF ABSCESS $ 377.00 AG BURN DRESSING <=32INCHEES $ 54.00 15777 ACELLULAR DERM MATRIX IMPLT $ 2,740.00 13160 LATE CLOSURE OF WOUND $ 3,090.00 COLLAGEN PRP MATRIX $ 1,854.00 LIDO 2.5/PRILO 2.5CREAM 30GM $ 87.00 MUPIROCIN OINTMENT 2% 22GM $ 65.00 COLLAGENASE 250 UNITS/GM 30GM $ 428.00 IODOSORB GEL 40GM $ 315.00 SODIUM HYPOCHLOR 0.5% SOL473ML $ 75.00 HYDROFIBER DRESS (AQUACELL) 4X4 $ 50.00 HYDROBERA BLUE BACTERIOSTATIC $ 59.00 BUPIVACAINE 0.25% 10ML VIAL $ 45.00 LIDOCAINE 1% WITH EPINEPHRINE $ 39.00 BUPIVACAINE 0.5% W/EPI 10ML VL $ 47.00 LIDOCAINE 1% MDV 20ML VIAL $ 37.00 IODOFORM P/S 1/2 X 5 YD $ 48.00 97607 NEG PRESS WND TX <=50CM DISPBL $ 298.00 97608 NEG PRESS WND TX > 50CM DISPBL $ 298.00 Q4133 GRAFIX PRIME PER SQ CM $ 367.40 Q4132 GRAFIX CORE PER SQ CM $ 367.40 59025 NON STRESS TEST $ 462.00 59020 O C T STRESS TEST $ 313.00 86703 OB RAPID HIV $ 139.00 TUBAL LIGATION $ 1,308.00 C-SECTION 1 - 1 1/2 HRS $ 7,613.00 VAG DELIVERY HIGH RISK $ 4,291.00 DEL RM RC OVER 5 $ 1,687.00 DEL RM RC 1 1/2-2 $ 992.00 DEL RM RC 1-1 1/2 $ 868.00 DEL RM RC 1/2 TO 1 $ 743.00 DEL RM RC 2 TO 3 $ 1,114.00 DEL RM RC 3 TO 4 $ 1,237.00 DEL RM RC 4 TO 5 $ 1,478.00 VAG DELIVERY LOW RISK $ 3,641.00 99211TH OB TRIAGE LEVEL 1 $ 737.00 81002 POC URINE DIP $ 5.00 82962 ACCUCHEK LABOR & DELIVERY $ 31.00 96375 OBV ADDL IV PUSH DIFFERENT DRU $ 178.00 96367 OBV ADDL SEQ INFUS THER TO 1HR $ 178.00 96368 OBV CONCURRENT THERAPEUTIC INF $ 178.00 96374 OBV INITIAL IV PUSH $ 554.00 96360 OBV IV INFUS HYDRATION 1ST HR $ 355.00 96361 OBV IV INFUS HYDRA EA ADDL HR $ 178.00 96366 OBV IV INFUS THER EA ADDL HR $ 178.00 96376 OBV IVP INJ EA ADD SEQ SAME ME $ 178.00 96365 OBV IV INFUS THERA 1ST HR $ 355.00 96372 OBV INJ THERA SUBQ OR IM $ 160.00 C-SECTION EA ADDL 30 MINUTES $ 1,308.00

52 96372 RHOGAM/BETAMETHASONE INJECTION $ 160.00 DELIVERY PLACENTA $ 3,022.00 59412 EXTERNAL VERSION CEPHALIC $ 6,256.00 59000 AMNIOCENTESIS - DIAGNOSTIC $ 514.00 D & C $ 3,022.00 VAGINAL DELIVERY OUTSIDE HOSPITAL $ 3,022.00 G0257 HEMODIALYSIS $ 1,478.00 90945 PERITONEAL DIALYSIS $ 1,478.00 36514 APHERESIS $ 2,007.00 92960 ELECTIVE CARDIOVERSION $ 1,234.00 99195 THER PHLEBOTOM $ 211.00 96360 IV INFUSION,HYDRATION 1ST HR $ 377.00 96361 IV INFUSION HYDRATION EA AD HR $ 178.00 96366 IV INFUS THERA EA ADL HOUR $ 178.00 96367 ADD THER SEQ INFUS UP TO 1HR $ 178.00 96368 CONCURRENT THERAPEUTIC INFUS $ 178.00 96372 INJECTION THER SUBQ OR IM $ 160.00 96374 INITIAL THER IV PUSH $ 554.00 96375 ADL SEQ PUSH, DIFF DRUG $ 178.00 MISC SURGICAL PROCEDURE $ 67.00 96376 OP IVP INJ EA ADD SEQ SAME MED $ 178.00 96365 OBV IV INFUSION THERA 1ST HR $ 355.00 82962 GLUCOSE POINT OF CARE $ 31.00 C1776 DO NOT USE $ 12,342.00 OR LEVEL 1 $ 62.00 OR LEVEL 2 $ 78.00 OR LEVEL 3 $ 82.00 OR LEVEL 4 $ 106.00 OR LEVEL 5 $ 129.00 TROCAR,BLUNT $ 210.00 C1881 FILTER,GRN FEM $ 3,353.00 C1768 GRAFT,VASCULAR $ 1,175.00 C1768 GRAFT,VASC STD $ 1,207.00 C1730 KIT,INTRO PERC $ 335.00 NEEDL,CONTRAST $ 282.00 PAD,DEFIB $ 955.00 PADDING,CAST $ 98.00 PLUG,PERFIX $ 855.00 REDUCER CAP $ 37.00 C2617 STENT,URET PER $ 657.00 BLADE,RAZRCUT $ 335.00 BASKET,GEMINI $ 887.00 CANNULA,AC $ 256.00 CORD,BIPOLAR $ 29.00 COVER,CLAMP $ 16.00 CYSTOTOME,IRR $ 33.00 DISSCTR,BLUNT $ 119.00 DRAPE,RETRACTR $ 6.00 ELECTRODE,LEEP $ 434.00 KNIFE,30DEGREE $ 47.00 KNIFE,COLD STR $ 483.00 KNIFE,KEROTOME $ 95.00 C1781 MESH,ATRIUM $ 236.00 MICROTIP $ 335.00 MICROTIP,20000 $ 940.00 PAD,LEG HOLDER $ 341.00

53 PATCH,CARDIOVA $ 516.00 PILLOW,ABDUCT $ 236.00 C1713 SCREWS HIP CAN $ 811.00 C1713 PIN,RUSH ROD $ 259.00 SHOE,POST-OP $ 46.00 SPLINT,J $ 500.00 SUCT.FRAIZER $ 121.00 TIP,PHACO FLAR $ 242.00 C1729 TUBE,T $ 98.00 B4087 TUBE,N-G $ 196.00 ENDO POUCH BAG $ 112.50 ADAPTER,SWIVEL $ 77.00 BAG,LEG URI $ 12.00 CATH,RADIAL $ 26.00 CLAMP,BABCOCK $ 394.00 DRAIN,AC SINGL $ 297.00 A7041 DRAIN,AC DOUBL $ 335.00 HOLDER,TUBE $ 6.00 NEEDLE,BRONCHI $ 325.00 NEEDLE,HUBER $ 26.00 NEEDLE,PNEUMOP $ 143.00 SET,TUR4 $ 33.00 C1769 WIRE,GLIDE TIP $ 114.00 C1769 WIRE,GUIDE J $ 64.00 C1757 CATH,FOGARTY $ 331.00 FORCEP,ENDO $ 365.00 BLADE,RECIPROC $ 270.00 BLADE,OSCILLAT $ 236.00 INTERPULSE,HND $ 703.00 INTERPULSE,TIP $ 453.00 GLOVES,KEVLAR $ 115.00 C1758 CATH,URE OPEN $ 67.00 CATH,ART IRRIG $ 143.00 BLADE,EYE,SLIT $ 149.00 CANN HYDRO DI $ 35.00 CATH,THROMBECT $ 1,296.00 ERASER,HEMOSTA $ 335.00 ERASER,WETFLD $ 60.00 IOL $ 504.00 PHACO IOL $ 1,252.00 GIGLI SAW BLAD $ 102.00 C1768 GRAFT,VAS TAPER $ 3,811.00 C1768 GRAFT,VASC Y $ 3,922.00 INST WIPE,CORN $ 42.00 C1894 KIT,INTRODUCER $ 335.00 KNIFE,ANG SLIT $ 248.00 KNIFE,CRESCENT $ 181.00 KNIFE,OPTHAL $ 181.00 NEEDLE,SELF RET $ 208.00 NEEDLE,RETRIBU $ 110.00 KIT-IA 20,000 $ 973.00 POLISH,CAPSUL $ 208.00 STAPLER,GIA $ 943.00 STAPLES,ENDO $ 1,375.00 STAPLES,LDS $ 657.00 SUTURE,0-4 $ 22.00

54 SUTURE,5-6 $ 35.00 SUTURE,7-8 $ 56.00 SUTURE,9-10 $ 60.00 V-LANCE $ 248.00 ACMI KNIFE ELE $ 562.00 ACMI TUR CABLE $ 176.00 ARROW TLC HEMO $ 355.00 ARTHOSC SHAVER $ 335.00 BURR-ALL $ 59.00 C1750 CATH,TENC. PER $ 297.00 CMG KIT $ 141.00 DAVOL DRAIN $ 135.00 C1726 DILATOR-URETER. $ 1,049.00 C1726 DILATOR-UROMAX $ 1,049.00 DRILL BIT CANN $ 1,049.00 ELECT.HY PROBE $ 630.00 ELLICK EVACUAT $ 88.00 ENDO AVITENE $ 1,049.00 ENDO HOOK $ 42.00 ENDO RETRACT/F $ 347.00 ENDO SURGPRT LG $ 335.00 C1881 FILTER,GRN JUG $ 3,353.00 GLASSMAN VISCE $ 110.00 GRASP,FORCEPS $ 840.00 C1769 GUIDE WIRE $ 141.00 C1769 GUIDE WIRE-ALL $ 162.00 C1769 GUIDE WIRE-MIC $ 335.00 KEITH NEEDLE $ 35.00 C1713 KNOWLES PIN $ 335.00 LENS GLIDE $ 9.00 C1781 MESH 1 X 8 $ 345.00 C1781 MESH 3 X 6 $ 335.00 C1781 MESH 6 X 6 $ 423.00 C1729 NEPHROST DRNG CATH $ 444.00 PEG KIT $ 414.00 POSITIONERS $ 16.00 PURSESTRING $ 414.00 L3908 SPLINT WRIST $ 121.00 ST BASKET-PFIS $ 742.00 STEEL SUTURE $ 100.00 ST. BASKET-MIC. $ 887.00 SUTURE RET BOL $ 27.00 TA VASC REFILL $ 470.00 TA VASC STAPLR $ 470.00 THERM BALL CAU $ 2,513.00 TORQUE VISES $ 56.00 A7521 TRACH - TUBE $ 299.00 URETH. BLADE $ 657.00 VAP. BAR ELECTR $ 753.00 C1713 WASHERS-SPIKED $ 203.00 C1713 WASHERS-ALL $ 102.00 WIRE SPOOL $ 12.00 CONE BIOPSY EXCISOR $ 61.00 TROCAR, 5MM KII OPTICAL $ 117.00 TROCAR, 12MM KII OPTICAL $ 121.00 GELPOINT $ 939.00

55 TROCAR, VERSAPORT $ 197.00 NEEDLE, VERES INSUFFLATION $ 33.00 SUTURE, FIBERWIRE $ 66.00 CLAMP CLOVER, RADIOPAQUE $ 26.00 SUTURE BOOTIES $ 8.00 MAX-CORE BIOPSY, 18X16 $ 84.00 MAX-CORE BIOPSY, 18X20 $ 85.00 A4322 SYRINGE, TOOMEY $ 15.00 A4340 CATHETER, 26FR 30CC, 3 WAY $ 29.00 C1771 ALIGN URETHRAL - HOOK + HALO $ 1,795.00 FLOSEAL HEMOSTATIC MATRIX $ 401.00 C1713 KIT, COLLES WRISTLOC FRACTURE $ 1,964.00 CATHETER, ANGIOGRAPHIC 5FR $ 34.00 C1768 GRAFT, VASCULAR 6 X 80 W/RINGS $ 1,215.00 C1880 FILTER, GREENFIELD 12FR TITAN $ 1,801.00 C1788 CATHETER, PORT, 8FR $ 852.00 A4338 CATHETER, FOLEY 28FR 30CC $ 15.00 CATHETER, URETERAL ADAPTERS $ 6.00 CATHETER, BAKER JEJUNOSTOMY $ 742.00 BONE WAX $ 41.00 C1758 CATHETER, URETHRAL, 8FR CONE TIP $ 37.00 NERVE LOCATOR (STIMULATOR) $ 112.00 KIT, JP SUCTION RESERVOIR 100CC $ 40.00 TUBE, BLAKEMORE X-R 20 FR.(19925) $ 719.00 C1894 BRITE TIP SHEATH 6F $ 68.00 SUTURE, V-LOC 180, $ 251.00 ELECTRODE, SPATULA TIP $ 99.00 ELECTRODE, J-HOOK $ 99.00 C1751 CATHETER, 7F SWAN GANZ PACING $ 524.00 C1892 INTRODUCER, PEEL AWAY, 8FR $ 109.00 ELECTRODE, CUTTING LOOP $ 132.00 C1781 GRAFT, ATRIUM MESH 3X6 $ 131.00 C1781 GRAFT, ATRIUM MESH 6X6 $ 138.00 C1768 GRAFT, VASCULAR, 6MM X 30CM $ 627.00 C1768 GRAFT, VASCULAR, 6MM X 50CM $ 699.00 C1768 GRAFT, VASCULAR, 4-7MM X 40CM $ 847.00 C1768 GRAFT, VASCULAR 6 X 80 $ 1,233.00 KIT, COLD BLUE EASI-LAVAGE $ 144.00 C1751 CATHETER, SWANZ THERMO-DILUT $ 332.00 A4351 CATHETER, 12 FR WHISTLE TIP STRAIGHT PAC $ 6.00 CAUTERY, DISPOSABLE $ 28.00 ELECTRODE, BALL, STERNE, 5LONG, EZ CLEAN $ 24.00 SUTURE, BIOSYN 4-0 $ 30.00 SUTURE, SURGIPRO 1, CP-425 $ 14.00 SUTURE, CHROMIC 5-0 $ 15.00 SUTURE, TI-CRON O $ 103.00 SUTURE, MAXON 3-0 V-20 TAPER $ 14.00 LIGASURE ADVANCE, STANDARD, 5MM BX/6 $ 1,311.00 STAPLER, SINGLE USE RELOADABLE $ 861.00 PREMIUM SURGICLIP S-9.0 TITANIUM BX/6 $ 389.00 ENDO PEANUT 5MM DEVICE (PK/3) BX/4 $ 176.00 SUTURE, CHROMIC GUT, 2.0 CG811 $ 14.00 SUTURE, SURGIPRO II, 4-0 $ 35.00 SHEARS, ENDO $ 141.00 SURGICLIP L-13.0 $ 389.00 PERI-STRIPS $ 339.00

56 NEEDLE, ELECTRODE $ 9.00 SHOE, ORTHO $ 16.00 SUCTION COAGULATOR, HAND SWITCH $ 29.00 LIGASURE, 5MM INSTRUMENT $ 852.00 STAPLER, SURG POWERED DISP LDS $ 555.00 ENDO, CLIP APPLIER 5MM $ 1,307.00 DEVICE, ARTICULATING SUTURING $ 1,083.00 NEEDLE, RETROBULBAR/ATKINSON $ 12.00 RING, SELF RETAINING ACM BX/3 $ 80.00 C1768 GRAFT, PROPATEN 4-7MM 45CM $ 1,933.00 C1768 GRAFT, PROPATEN 6X40 STNDRD $ 1,627.00 SUTURE,GORE $ 60.00 ELECTRODE, HYSTER 21 FR. $ 229.00 ZIMMER K WIRES, STYLE 7,1.6MM $ 48.00 ZIMMER GIGLI SAW BLADES, $ 114.00 C1771 CALDERA DESARA SLING $ 1,303.00 FORCEP, SERRATED LARGE $ 30.00 FORCEP, HOT BIOPSY $ 251.00 B4087 SET, ENDO. GASTROST. $ 185.00 ACUSNARE $ 36.00 PROBE, QUICKSILVER BIPOLAR $ 350.00 CATHETER, PIGTAIL 5FR 90CM NYLON $ 67.00 C2617 STENT, LEVEL 2 $ 138.00 C2625 STENT, LEVEL 3 $ 232.00 GUIDEWIRE, GI LEVEL 1 $ 135.00 C1769 GUIDEWIRE, GI LEVEL 2 $ 274.00 BALLOON, LEVEL 1 $ 235.00 BALLOON, LEVEL 2 $ 345.00 C1726 BALLOON, LEVEL 3 $ 523.00 CYTOMAX II DOUBLE LUMEN $ 186.00 BASKET, LEVEL 1 $ 323.00 BASKET, LEVEL 2 $ 572.00 BASKET, LEVEL 3 $ 645.00 MULTI-BAND 6 SHOOTER $ 372.00 NEEDLE, DISP VARICES INJECTOR $ 105.00 CATHETER, GLO-TIP ERCP $ 134.00 C1769 ROADRUNNER EXTRA SUPPORT $ 258.00 C1769 TRACER METRO DIRECT WIRE $ 251.00 C1894 SHEATH, 5 FR FLEXER ANSEL GUIDING $ 131.00 C1769 DIRECT ACCESS, HOW. DASH 6.0 F $ 503.00 ARTHRSCPY, SHAVER BLADE $ 134.00 ARTHRSCPY, BURR $ 144.00 ENT, SHAVER BLADE $ 229.00 HANDPIECE, INTERPULSE SET $ 110.00 GRASPER, DISPOSABLE $ 137.00 GRAPSER, GATOR $ 658.00 SET, INTERPULSE HANDPIECE $ 115.00 C1713 NAIL OSTEOTOMY $ 1,368.00 C1713 PLATE 4 HOLE $ 1,669.00 C1713 PLATE 5 HOLE $ 1,669.00 C1713 PLATE 6 HOLE $ 1,669.00 C1713 PLATE 8 HOLE $ 1,911.00 C1713 PLATE HIND/MIDFOOT $ 908.00 C1713 PLATE FRAGMENT $ 259.00 C1713 PLATE VISE $ 13,230.00 C1713 PLATE, CONDYLAR- LEVEL 1 $ 888.00

57 C1713 PLATE, CONDYLAR- LEVEL 2 $ 951.00 C1713 PLATE, CONDYLAR- LEVEL 3 $ 1,042.00 C1713 PLATE, CONDYLAR- LEVEL 4 $ 1,095.00 C1713 PLATE, CONDYLAR- LEVEL 5 $ 1,147.00 C1713 PLATE, CONDYLAR- LEVEL 6 $ 1,266.00 C1713 PLATE, CONDYLAR- LEVEL 7 $ 1,835.00 C1713 PLATE, CONDYLAR- LEVEL 8 $ 1,921.00 C1713 PLATE, CONDYLAR- LEVEL 9 $ 2,000.00 C1713 PLATE, CONDYLAR- LEVEL 10 $ 2,085.00 C1713 PLATE, CONDYLAR- LEVEL 11 $ 2,115.00 C1713 PLATE, CONDYLAR- LEVEL 12 $ 2,190.00 C1713 PLATE, CONDYLAR- LEVEL 13 $ 2,289.00 C1713 PLATE, CONDYLAR- LEVEL 14 $ 2,358.00 C1713 PLATE, CONDYLAR- LEVEL 15 $ 2,436.00 C1713 PLATE, CONDYLAR- LEVEL 16 $ 2,563.00 C1713 PLATE, CONDYLAR- LEVEL 17 $ 2,819.00 C1713 PLATE, CONDYLAR- LEVEL 18 $ 2,930.00 C1713 PLATE, CONDYLAR- LEVEL 19 $ 3,465.00 C1713 PLATE, CONDYLAR- LEVEL 20 $ 3,630.00 C1713 PLATE, CONDYLAR- LEVEL 21 $ 3,829.00 C1713 PLATE, CONDYLAR- LEVEL 22 $ 4,058.00 C1713 PLATE, CONDYLAR- LEVEL 23 $ 4,222.00 C1713 PLATE, CONDYLAR- LEVEL 24 $ 4,543.00 C1713 PLATE, CONDYLAR- LEVEL 25 $ 5,805.00 C1713 PLATE, CONDYLAR- LEVEL 26 $ 5,916.00 C1713 PLATE, CONDYLAR- LEVEL 27 $ 6,081.00 C1713 PLATE, CONDYLAR- LEVEL 28 $ 6,195.00 C1713 PLATE, CONDYLAR- LEVEL 29 $ 6,261.00 C1713 PLATE, CONDYLAR- LEVEL 30 $ 6,327.00 C1713 PLATE, CONDYLAR- LEVEL 31 $ 6,425.00 C1713 PLATE, CONDYLAR- LEVEL 32 $ 6,491.00 C1713 PLATE, CONDYLAR- LEVEL 33 $ 6,550.00 C1713 PLATE, CONDYLAR- LEVEL 34 $ 6,622.00 C1713 PLATE, CONDYLAR- LEVEL 35 $ 6,721.00 C1713 PLATE, CONDYLAR- LEVEL 36 $ 6,809.00 C1713 PLATE, CONDYLAR- LEVEL 37 $ 6,885.00 C1713 PLATE, CONDYLAR- LEVEL 38 $ 7,015.00 C1713 PLATE, CONDYLAR- LEVEL 39 $ 7,128.00 OSTEOTOMY ENDCAP $ 790.00 C1713 SCREW, STEPPED LEVEL 1 $ 367.00 C1713 SCREW, STEPPED LEVEL 2 $ 531.00 C1713 PLATE, SP LEVEL 1 $ 2,891.00 C1713 PLATE, SP LEVEL 2 $ 3,173.00 C1713 PLATE, SP LEVEL 3 $ 3,486.00 C1713 PLATE, NAV LEVEL 1 $ 2,865.00 C1713 PLATE, NAV LEVEL 2 $ 3,029.00 C1713 PLATE, HUMERUS LEVEL 1 $ 211.00 C1713 PLATE, HUMERUS LEVEL 2 $ 3,501.00 C1713 PLATE, HUMERUS LEVEL 3 $ 3,666.00 C1713 PLATE, HUMERUS LEVEL 4 $ 3,885.00 C1713 PLATE, HUMERUS LEVEL 5 $ 4,016.00 C1713 PLATE, HUMERUS LEVEL 6 $ 4,180.00 C1713 PLATE, HUMERUS LEVEL 7 $ 4,275.00 C1713 PLATE, HUMERUS LEVEL 8 $ 4,380.00 C1713 PLATE, HUMERUS LEVEL 9 $ 4,439.00 C1713 PLATE, HUMERUS LEVEL 10 $ 4,543.00

58 C1713 PLATE, HUMERUS LEVEL 11 $ 4,616.00 C1713 PLATE, HUMERUS LEVEL 12 $ 4,749.00 C1713 PLATE, HUMERUS LEVEL 13 $ 4,914.00 C1713 PLATE, HUMERUS LEVEL 14 $ 5,019.00 C1713 PLATE, HUMERUS LEVEL 15 $ 5,143.00 C1713 PLATE, HUMERUS LEVEL 16 $ 5,308.00 C1713 PLATE, HUMERUS LEVEL 17 $ 5,461.00 C1713 PLATE, HUMERUS LEVEL 18 $ 5,625.00 C1713 PLATE, HUMERUS LEVEL 19 $ 5,779.00 C1713 PLATE, HUMERUS LEVEL 20 $ 5,943.00 C1713 PLATE, HUMERUS LEVEL 21 $ 6,021.00 C1713 PLATE, HUMERUS LEVEL 22 $ 6,186.00 C1713 PLATE, HUMERUS LEVEL 23 $ 6,261.00 C1713 PLATE, HUMERUS LEVEL 24 $ 6,425.00 C1713 PLATE, HUMERUS LEVEL 25 $ 6,504.00 C1713 PLATE, HUMERUS LEVEL 26 $ 6,589.00 C1713 PLATE, HUMERUS LEVEL 27 $ 6,668.00 C1713 PLATE, HUMERUS LEVEL 28 $ 6,747.00 C1713 PLATE, HUMERUS LEVEL 29 $ 6,910.00 C1713 PLATE, HUMERUS LEVEL 30 $ 6,982.00 C1713 PLATE, HUMERUS LEVEL 31 $ 7,071.00 C1713 PLATE, HUMERUS LEVEL 32 $ 7,146.00 C1713 PLATE, HUMERUS LEVEL 33 $ 7,236.00 C1713 PLATE, ANK ART LEVEL 1 $ 3,825.00 C1713 PLATE, ANK ART LEVEL 2 $ 3,934.00 C1713 PLATE, PED HIP LEVEL 1 $ 1,967.00 C1713 PLATE, PED HIP LEVEL 2 $ 2,046.00 C1713 PLATE, PED HIP LEVEL 3 $ 2,131.00 C1713 PLATE, PED HIP LEVEL 4 $ 2,209.00 C1713 PLATE, WRIST FUS LEVEL 1 $ 6,156.00 C1713 PLATE, WRIST FUS LEVEL 2 $ 6,321.00 C1713 PLATE, TIBIA LEVEL 1 $ 970.00 C1713 PLATE, TIBIA LEVEL 2 $ 1,035.00 C1713 PLATE, TIBIA LEVEL 3 $ 1,098.00 C1713 PLATE, TIBIA LEVEL 4 $ 1,167.00 C1713 PLATE, TIBIA LEVEL 5 $ 1,236.00 C1713 PLATE, TIBIA LEVEL 6 $ 1,360.00 C1713 PLATE, TIBIA LEVEL 7 $ 1,479.00 C1713 PLATE, TIBIA LEVEL 8 $ 1,583.00 C1713 PLATE, TIBIA LEVEL 9 $ 1,691.00 C1713 PLATE, TIBIA LEVEL 10 $ 1,787.00 C1713 PLATE, TIBIA LEVEL 11 $ 1,901.00 C1713 PLATE, TIBIA LEVEL 12 $ 2,003.00 C1713 PLATE, TIBIA LEVEL 13 $ 2,246.00 C1713 PLATE, TIBIA LEVEL 14 $ 2,397.00 C1713 PLATE, TIBIA LEVEL 15 $ 2,619.00 C1713 PLATE, TIBIA LEVEL 16 $ 2,740.00 C1713 PLATE, TIBIA LEVEL 17 $ 2,986.00 C1713 PLATE, TIBIA LEVEL 18 $ 3,058.00 C1713 PLATE, TIBIA LEVEL 19 $ 3,337.00 C1713 PLATE, TIBIA LEVEL 20 $ 3,413.00 C1713 PLATE, TIBIA LEVEL 21 $ 3,468.00 C1713 PLATE, TIBIA LEVEL 22 $ 3,540.00 C1713 PLATE, TIBIA LEVEL 23 $ 3,615.00 C1713 PLATE, TIBIA LEVEL 24 $ 3,705.00 C1713 PLATE, TIBIA LEVEL 25 $ 3,780.00

59 C1713 PLATE, TIBIA LEVEL 26 $ 4,094.00 C1713 PLATE, TIBIA LEVEL 27 $ 4,216.00 C1713 PLATE, TIBIA LEVEL 28 $ 4,380.00 C1713 PLATE, TIBIA LEVEL 29 $ 4,547.00 C1713 PLATE, TIBIA LEVEL 30 $ 4,671.00 C1713 PLATE, TIBIA LEVEL 30.5 $ 4,737.00 C1713 PLATE, TIBIA LEVEL 31 $ 4,836.00 C1713 PLATE, TIBIA LEVEL 32 $ 5,268.00 C1713 PLATE, TIBIA LEVEL 33 $ 5,363.00 C1713 PLATE, TIBIA LEVEL 34 $ 5,429.00 C1713 PLATE, TIBIA LEVEL 35 $ 5,491.00 C1713 PLATE, TIBIA LEVEL 36 $ 5,550.00 C1713 PLATE, TIBIA LEVEL 37 $ 5,612.00 C1713 PLATE, TIBIA LEVEL 38 $ 5,674.00 C1713 PLATE, TIBIA LEVEL 39 $ 5,737.00 C1713 PLATE, TIBIA LEVEL 40 $ 5,630.00 C1713 PLATE, TIBIA LEVEL 41 $ 5,691.00 C1713 PLATE, TIBIA LEVEL 42 $ 5,752.00 C1713 PLATE, TIBIA LEVEL 43 $ 5,818.00 C1713 PLATE, TIBIA LEVEL 44 $ 5,889.00 C1713 PLATE, TIBIA LEVEL 45 $ 5,948.00 C1713 PLATE, TIBIA LEVEL 46 $ 5,997.00 C1713 PLATE, TIBIA LEVEL 47 $ 6,050.00 C1713 PLATE, TIBIA LEVEL 48 $ 6,130.00 C1713 PLATE, TIBIA LEVEL 49 $ 6,196.00 C1713 PLATE, TIBIA LEVEL 50 $ 6,289.00 C1713 PLATE, FEMUR LEVEL 1 $ 5,137.00 C1713 PLATE, FEMUR LEVEL 2 $ 5,239.00 C1713 PLATE, FEMUR LEVEL 3 $ 5,296.00 C1713 PLATE, FEMUR LEVEL 4 $ 5,398.00 C1713 PLATE, FEMUR LEVEL 5 $ 5,496.00 C1713 PLATE, FEMUR LEVEL 6 $ 5,604.00 C1713 PLATE, FEMUR LEVEL 7 $ 5,700.00 C1713 PLATE, FEMUR LEVEL 8 $ 5,764.00 C1713 PLATE, FEMUR LEVEL 9 $ 5,860.00 C1713 PLATE, FEMUR LEVEL 10 $ 5,936.00 C1713 PLATE, FEMUR LEVEL 11 $ 6,003.00 C1713 PLATE, FEMUR LEVEL 12 $ 6,095.00 C1713 PLATE, FEMUR LEVEL 13 $ 6,161.00 C1713 PLATE, FEMUR LEVEL 14 $ 6,213.00 C1713 PLATE, FEMUR LEVEL 15 $ 6,286.00 C1713 PLATE, FEMUR LEVEL 16 $ 6,356.00 C1713 PLATE, FEMUR LEVEL 17 $ 6,518.00 C1713 PLATE, FEMUR LEVEL 18 $ 6,681.00 C1713 PLATE, FEMUR LEVEL 19 $ 6,839.00 C1713 PLATE, FEMUR LEVEL 20 $ 6,897.00 C1713 PLATE, FEMUR LEVEL 21 $ 6,976.00 C1713 PLATE, FEMUR LEVEL 22 $ 7,028.00 C1713 PLATE, FEMUR LEVEL 23 $ 7,136.00 C1713 PLATE, FEMUR LEVEL 24 $ 7,209.00 C1713 PLATE, FEMUR LEVEL 25 $ 7,368.00 C1713 PLATE, FEMUR LEVEL 26 $ 7,441.00 C1713 PLATE, FEMUR LEVEL 27 $ 7,600.00 C1713 PLATE, METAP. LEVEL 1 $ 3,177.00 C1713 PLATE, METAP. LEVEL 2 $ 3,237.00 C1713 PLATE, METAP. LEVEL 3 $ 3,342.00

60 C1713 PLATE, METAP. LEVEL 4 $ 3,451.00 C1713 PLATE, METAP. LEVEL 5 $ 4,456.00 C1713 PLATE, METAP. LEVEL 6 $ 4,602.00 C1713 PLATE, METAP. LEVEL 7 $ 4,701.00 C1713 PLATE, METAP. LEVEL 8 $ 4,790.00 C1713 PLATE, METAP. LEVEL 9 $ 5,007.00 C1713 PLATE, LCP LEVEL 1 $ 777.00 C1713 PLATE, LCP LEVEL 2 $ 900.00 C1713 PLATE, LCP LEVEL 3 $ 955.00 C1713 PLATE, LCP LEVEL 4 $ 1,034.00 C1713 PLATE, LCP LEVEL 5 $ 1,092.00 C1713 PLATE, LCP LEVEL 6 $ 1,145.00 C1713 PLATE, LCP LEVEL 7 $ 1,223.00 C1713 PLATE, LCP LEVEL 8 $ 1,273.00 C1713 PLATE, LCP LEVEL 9 $ 1,337.00 C1713 PLATE, LCP LEVEL 10 $ 1,433.00 C1713 PLATE, LCP LEVEL 11 $ 1,515.00 C1713 PLATE, LCP LEVEL 12 $ 1,633.00 C1713 PLATE, LCP LEVEL 13 $ 1,751.00 C1713 PLATE, LCP LEVEL 14 $ 1,849.00 C1713 PLATE, LCP LEVEL 15 $ 1,942.00 C1713 PLATE, LCP LEVEL 16 $ 1,999.00 C1713 PLATE, LCP LEVEL 17 $ 2,100.00 C1713 PLATE, LCP LEVEL 18 $ 2,164.00 C1713 PLATE, LCP LEVEL 19 $ 2,275.00 C1713 PLATE, LCP LEVEL 20 $ 2,365.00 C1713 PLATE, LCP LEVEL 21 $ 2,476.00 C1713 PLATE, LCP LEVEL 22 $ 2,610.00 C1713 PLATE, LCP LEVEL 23 $ 2,775.00 C1713 PLATE, LCP LEVEL 24 $ 2,839.00 C1713 PLATE, LCP LEVEL 25 $ 2,928.00 C1713 PLATE, LCP LEVEL 26 $ 3,049.00 C1713 PLATE, LCP LEVEL 27 $ 3,259.00 C1713 PLATE, LCP LEVEL 28 $ 3,419.00 C1713 PLATE, LCP LEVEL 29 $ 3,478.00 C1713 PLATE, LCP LEVEL 30 $ 3,565.00 C1713 PLATE, LCP LEVEL 31 $ 3,727.00 C1713 PLATE, LCP LEVEL 32 $ 3,825.00 C1713 PLATE, LCP LEVEL 33 $ 3,985.00 C1713 PLATE, LCP LEVEL 34 $ 4,061.00 C1713 PLATE, LCP LEVEL 35 $ 4,227.00 C1713 PLATE, LCP LEVEL 36 $ 4,421.00 C1713 PLATE, LCP LEVEL 37 $ 4,555.00 C1713 PLATE, LCP LEVEL 38 $ 4,666.00 C1713 PLATE, LCP LEVEL 39 $ 4,829.00 C1713 PLATE, LCP LEVEL 40 $ 4,993.00 C1713 PLATE, LCP LEVEL 41 $ 5,083.00 C1713 PLATE, LCP LEVEL 42 $ 5,519.00 C1713 PLATE, LCP LEVEL 43 $ 5,958.00 C1713 PLATE, OLECRAN. LEVEL 1 $ 3,291.00 C1713 PLATE, OLECRAN. LEVEL 2 $ 3,434.00 C1713 PLATE, OLECRAN. LEVEL 3 $ 3,542.00 C1713 PLATE, OLECRAN. LEVEL 4 $ 3,657.00 C1713 PLATE, OLECRAN. LEVEL 5 $ 3,752.00 C1713 PLATE, OLECRAN. LEVEL 6 $ 3,816.00 C1713 PLATE, OLECRAN. LEVEL 7 $ 3,822.00

61 C1713 PLATE, OLECRAN. LEVEL 8 $ 3,912.00 C1713 PLATE, OLECRAN. LEVEL 9 $ 3,982.00 C1713 PLATE, RAD HD. LEVEL 1 $ 2,251.00 C1713 PLATE, RAD HD. LEVEL 2 $ 2,310.00 C1713 PLATE, RAD HD. LEVEL 3 $ 2,356.00 C1713 PLATE, PILON LEVEL 1 $ 6,047.00 C1713 PLATE, PILON LEVEL 2 $ 6,365.00 C1713 PLATE, DHHS LEVEL 1 $ 2,094.00 C1713 PLATE, DHHS LEVEL 2 $ 2,254.00 C1713 PLATE, DHHS LEVEL 3 $ 2,671.00 C1713 PLATE, DHHS LEVEL 4 $ 3,128.00 C1713 PLATE, DISTAL RAD LEVEL 1 $ 1,677.00 C1713 PLATE, DISTAL RAD LEVEL 2 $ 2,944.00 C1713 PLATE, DISTAL RAD LEVEL 3 $ 3,090.00 C1713 PLATE, DISTAL RAD LEVEL 4 $ 3,189.00 C1713 PLATE, DISTAL RAD LEVEL 5 $ 3,282.00 C1713 PLATE, DISTAL RAD LEVEL 6 $ 3,425.00 C1713 PLATE, DISTAL RAD LEVEL 7 $ 3,562.00 C1713 PLATE, DISTAL RAD LEVEL 8 $ 3,695.00 C1713 PLATE, DISTAL RAD LEVEL 9 $ 3,832.00 C1713 PLATE, DISTAL RAD LEVEL 10 $ 3,991.00 C1713 PLATE, DISTAL RAD LEVEL 11 $ 5,604.00 C1713 PLATE, DISTAL RAD LEVEL 12 $ 5,875.00 C1713 PLATE, DISTAL RAD LEVEL 13 $ 6,009.00 C1713 PLATE, DISTAL RAD LEVEL 14 $ 6,168.00 C1713 PLATE, DISTAL RAD LEVEL 15 $ 6,273.00 C1713 PLATE, DISTAL RAD LEVEL 16 $ 6,477.00 C1713 PLATE, CLAVICLE LEVEL 1 $ 2,566.00 C1713 PLATE, CLAVICLE LEVEL 2 $ 2,750.00 C1713 PLATE, CLAVICLE LEVEL 3 $ 2,797.00 C1713 PLATE, CLAVICLE LEVEL 4 $ 2,928.00 C1713 PLATE, CLAVICLE LEVEL 5 $ 3,011.00 C1713 PLATE, CLAVICLE LEVEL 6 $ 3,138.00 C1713 PLATE, CLAVICLE LEVEL 7 $ 3,192.00 C1713 PLATE, CLAVICLE LEVEL 8 $ 3,247.00 C1713 PLATE, CLAVICLE LEVEL 9 $ 3,300.00 C1713 PLATE, CLAVICLE LEVEL 10 $ 3,352.00 C1713 PLATE, CLAVICLE LEVEL 11 $ 3,405.00 C1713 PLATE, CLAVICLE LEVEL 12 $ 3,460.00 C1713 PLATE, CLAVICLE LEVEL 13 $ 3,513.00 C1713 PLATE, CLAVICLE LEVEL 14 $ 3,583.00 C1713 PLATE, CLAVICLE LEVEL 15 $ 3,673.00 C1713 PLATE, FIBULA LEVEL 1 $ 2,254.00 C1713 PLATE, FIBULA LEVEL 2 $ 2,289.00 C1713 PLATE, FIBULA LEVEL 3 $ 2,356.00 C1713 PLATE, FIBULA LEVEL 4 $ 2,447.00 C1713 PLATE, FIBULA LEVEL 5 $ 2,514.00 C1713 PLATE, FIBULA LEVEL 6 $ 2,584.00 C1713 PLATE, ULNA $ 2,966.00 C1713 PLATE, DCP LEVEL 1 $ 449.00 C1713 PLATE, DCP LEVEL 2 $ 509.00 C1713 PLATE, DCP LEVEL 3 $ 567.00 C1713 PLATE, DCP LEVEL 4 $ 627.00 C1713 PLATE, DCP LEVEL 5 $ 681.00 C1713 PLATE, DCP LEVEL 6 $ 745.00 C1713 PLATE, DCP LEVEL 7 $ 799.00

62 C1713 PLATE, DCP LEVEL 8 $ 862.00 C1713 PLATE, DCP LEVEL 9 $ 917.00 C1713 PLATE, DCP LEVEL 10 $ 974.00 C1713 PLATE, DCP LEVEL 11 $ 1,034.00 C1713 PLATE, DCP LEVEL 12 $ 1,098.00 C1713 PLATE, DCP LEVEL 13 $ 1,197.00 C1713 PLATE, DCP LEVEL 14 $ 1,314.00 C1713 PLATE, DCP LEVEL 15 $ 1,384.00 C1713 PLATE, DCP LEVEL 16 $ 1,448.00 C1713 PLATE, DCP LEVEL 17 $ 1,518.00 C1713 PLATE, DCP LEVEL 18 $ 1,594.00 C1713 PLATE, DCP LEVEL 19 $ 1,690.00 C1713 PLATE, DCP LEVEL 20 $ 1,840.00 C1713 PLATE, DCP LEVEL 21 $ 2,030.00 C1713 PLATE, DCP LEVEL 22 $ 2,135.00 C1713 PLATE, DCP LEVEL 23 $ 2,301.00 C1713 PLATE, DCP LEVEL 24 $ 2,464.00 C1713 PLATE, OSTEOT. LEVEL 1 $ 1,576.00 C1713 PLATE, OSTEOT. LEVEL 2 $ 1,735.00 C1713 PLATE, OSTEOT. LEVEL 3 $ 1,836.00 C1713 PLATE, OSTEOT. LEVEL 4 $ 1,916.00 C1713 PLATE, OSTEOT. LEVEL 5 $ 1,995.00 C1713 PLATE, OSTEOT. LEVEL 6 $ 2,075.00 C1713 PLATE, CUBOID LEVEL 1 $ 1,355.00 C1713 PLATE, CUBOID LEVEL 2 $ 2,709.00 C1713 PLATE, CUBOID LEVEL 3 $ 2,868.00 C1713 PLATE, TALUS LEVEL 1 $ 2,674.00 C1713 PLATE, TALUS LEVEL 2 $ 2,833.00 C1713 PLATE, ANKLE ARTH. LEVEL 1 $ 3,682.00 C1713 PLATE, ANKLE ARTH. LEVEL 2 $ 3,784.00 C1713 PLATE, RECON LEVEL 1 $ 1,148.00 C1713 PLATE, RECON LEVEL 2 $ 1,203.00 C1713 PLATE, RECON LEVEL 3 $ 1,273.00 C1713 PLATE, RECON LEVEL 4 $ 1,328.00 C1713 PLATE, RECON LEVEL 5 $ 1,391.00 C1713 PLATE, RECON LEVEL 6 $ 1,461.00 C1713 PLATE, RECON LEVEL 7 $ 1,518.00 C1713 PLATE, RECON LEVEL 8 $ 1,572.00 C1713 PLATE, RECON LEVEL 9 $ 1,623.00 C1713 PLATE, RECON LEVEL 10 $ 1,687.00 C1713 PLATE, RECON LEVEL 11 $ 1,757.00 C1713 PLATE, RECON LEVEL 12 $ 1,808.00 C1713 PLATE, RECON LEVEL 13 $ 1,868.00 C1713 PLATE, RECON LEVEL 14 $ 1,954.00 C1713 PLATE, RECON LEVEL 15 $ 2,034.00 C1713 PLATE, RECON LEVEL 16 $ 2,132.00 C1713 PLATE, RECON LEVEL 17 $ 2,187.00 C1713 PLATE, RECON LEVEL 18 $ 2,240.00 C1713 PLATE, RECON LEVEL 19 $ 2,304.00 C1713 PLATE, RECON LEVEL 20 $ 2,388.00 C1713 PLATE, RECON LEVEL 21 $ 2,444.00 C1713 PLATE, RECON LEVEL 22 $ 2,531.00 C1713 PLATE, RECON LEVEL 23 $ 2,587.00 C1713 PLATE, RECON LEVEL 24 $ 2,660.00 C1713 PLATE, RECON LEVEL 25 $ 2,718.00 C1713 PLATE, RECON LEVEL 26 $ 2,791.00

63 C1713 PLATE, RECON LEVEL 27 $ 2,871.00 C1713 PLATE, RECON LEVEL 28 $ 2,941.00 C1713 PLATE, RECON LEVEL 29 $ 3,078.00 C1713 PLATE, RECON LEVEL 30 $ 3,154.00 C1713 PLATE, RECON LEVEL 31 $ 3,460.00 C1713 PLATE, RECON LEVEL 32 $ 3,621.00 C1713 PLATE, RECON LEVEL 33 $ 3,985.00 C1713 PLATE, SPRING, LEVEL 1 $ 805.00 C1713 PLATE, SPRING, LEVEL 2 $ 964.00 C1713 PLATE, SPRING, LEVEL 3 $ 1,118.00 C1713 PLATE, J LEVEL 1 $ 1,808.00 C1713 PLATE, J LEVEL 2 $ 1,954.00 C1713 PLATE, J LEVEL 3 $ 2,100.00 C1713 PLATE, J LEVEL 4 $ 2,247.00 C1713 PLATE, J LEVEL 5 $ 2,575.00 C1713 PLATE, J LEVEL 6 $ 2,718.00 C1713 PLATE, J LEVEL 7 $ 2,864.00 C1713 PLATE, J LEVEL 8 $ 3,030.00 C1713 PLATE, LOCKING LEVEL 1 $ 1,773.00 C1713 PLATE, LOCKING LEVEL 2 $ 1,932.00 C1713 PLATE, LOCKING LEVEL 3 $ 2,100.00 C1713 SCREW, CONNECT LEVEL 1 $ 598.00 C1713 SCREW, CONNECT LEVEL 2 $ 757.00 C1713 PLATE, STRAIGHT LEVEL 1 $ 205.00 C1713 PLATE, STRAIGHT LEVEL 2 $ 266.00 C1713 PLATE, STRAIGHT LEVEL 3 $ 716.00 C1713 PLATE, STRAIGHT LEVEL 4 $ 786.00 C1713 PLATE, STRAIGHT LEVEL 5 $ 862.00 C1713 PLATE, STRAIGHT LEVEL 6 $ 926.00 C1713 PLATE, STRAIGHT LEVEL 7 $ 1,019.00 C1713 PLATE, H LEVEL 1 $ 764.00 C1713 PLATE, H LEVEL 2 $ 862.00 C1713 PLATE, H LEVEL 3 $ 1,506.00 C1713 PLATE, Y LEVEL 1 $ 827.00 C1713 PLATE, Y LEVEL 2 $ 942.00 C1713 PLATE, Y LEVEL 3 $ 999.00 C1713 PLATE, Y LEVEL 4 $ 1,506.00 C1713 PLATE, Y LEVEL 5 $ 1,594.00 C1713 PLATE, Y LEVEL 6 $ 1,980.00 C1713 PLATE, Y LEVEL 7 $ 2,190.00 C1713 PLATE, Y LEVEL 8 $ 2,654.00 C1713 PLATE, T LEVEL 1 $ 205.00 C1713 PLATE, T LEVEL 2 $ 295.00 C1713 PLATE, T LEVEL 3 $ 458.00 C1713 PLATE, T LEVEL 4 $ 519.00 C1713 PLATE, T LEVEL 5 $ 592.00 C1713 PLATE, T LEVEL 6 $ 646.00 C1713 PLATE, T LEVEL 7 $ 764.00 C1713 PLATE, T LEVEL 8 $ 827.00 C1713 PLATE, T LEVEL 9 $ 888.00 C1713 PLATE, T LEVEL 10 $ 958.00 C1713 PLATE, T LEVEL 11 $ 1,031.00 C1713 PLATE, T LEVEL 12 $ 1,174.00 C1713 PLATE, T LEVEL 13 $ 1,247.00 C1713 PLATE, T LEVEL 14 $ 1,331.00 C1713 PLATE, T LEVEL 15 $ 1,391.00

64 C1713 PLATE, T LEVEL 16 $ 1,451.00 C1713 PLATE, T LEVEL 17 $ 1,506.00 C1713 PLATE, T LEVEL 18 $ 1,563.00 C1713 PLATE, T LEVEL 19 $ 1,646.00 C1713 PLATE, T LEVEL 20 $ 1,751.00 C1713 PLATE, T LEVEL 21 $ 1,957.00 C1713 PLATE, T LEVEL 22 $ 2,231.00 C1713 PLATE, T LEVEL 23 $ 2,559.00 C1713 PLATE, T LEVEL 24 $ 2,654.00 C1713 PLATE, T LEVEL 25 $ 2,788.00 C1713 PLATE, T LEVEL 26 $ 2,954.00 C1713 PLATE, T LEVEL 27 $ 4,555.00 C1713 PLATE, T LEVEL 28 $ 4,713.00 C1713 PLATE, T LEVEL 29 $ 4,730.00 C1713 PLATE, T LEVEL 30 $ 4,888.00 C1713 PLATE, T LEVEL 31 $ 5,063.00 C1713 PLATE, L LEVEL 1 $ 205.00 C1713 PLATE, L LEVEL 2 $ 1,448.00 C1713 PLATE, L LEVEL 3 $ 1,591.00 C1713 PLATE, L LEVEL 4 $ 1,706.00 C1713 PLATE, X LEVEL 1 $ 2,734.00 C1713 PLATE, X LEVEL 2 $ 2,804.00 C1713 PLATE, X LEVEL 3 $ 2,893.00 C1713 PLATE, X LEVEL 4 $ 2,963.00 C1713 PLATE, COBRA HD. LEVEL 1 $ 2,079.00 C1713 PLATE, COBRA HD. LEVEL 2 $ 2,212.00 C1713 PLATE, COBRA HD. LEVEL 3 $ 2,330.00 C1713 PLATE, COBRA HD. LEVEL 4 $ 2,457.00 C1713 PLATE, CALCANEAL LEVEL 1 $ 703.00 C1713 PLATE, CALCANEAL LEVEL 2 $ 1,938.00 C1713 PLATE, CALCANEAL LEVEL 3 $ 2,190.00 C1713 PLATE, CALCANEAL LEVEL 4 $ 2,263.00 C1713 PLATE, CALCANEAL LEVEL 5 $ 2,534.00 C1713 PLATE, CALCANEAL LEVEL 6 $ 2,706.00 C1713 PLATE, COLVERLF LEVEL 1 $ 1,188.00 C1713 PLATE, TUBULAR LEVEL 1 $ 233.00 C1713 PLATE, TUBULAR LEVEL 2 $ 286.00 C1713 PLATE, TUBULAR LEVEL 3 $ 347.00 C1713 PLATE, TUBULAR LEVEL 4 $ 420.00 C1713 PLATE, TUBULAR LEVEL 5 $ 547.00 C1713 PLATE, TUBULAR LEVEL 6 $ 633.00 C1713 PLATE, TUBULAR LEVEL 7 $ 5,570.00 PLATE, CONNECT. LEVEL 1 $ 281.00 PLATE, CONNECT. LEVEL 2 $ 366.00 C1713 ARCH, FEMORAL LEVEL 1 $ 3,402.00 C1713 ARCH, FEMORAL LEVEL 2 $ 3,513.00 C1713 ARCH, FEMORAL LEVEL 3 $ 3,618.00 C1713 ARCH, FEMORAL LEVEL 4 $ 3,829.00 C1713 ARCH, FEMORAL LEVEL 5 $ 3,934.00 C1713 ARCH, FEMORAL LEVEL 6 $ 4,150.00 C1713 ARCH, FEMORAL LEVEL 7 $ 4,252.00 C1713 PLATE, ADAPT LEVEL 1 $ 844.00 C1713 PLATE, ADAPT LEVEL 2 $ 1,436.00 C1713 PLATE, ADAPT LEVEL 3 $ 1,527.00 C1713 PLATE, ADAPT LEVEL 4 $ 1,594.00 C1713 PLATE, ADAPT LEVEL 5 $ 1,681.00

65 C1713 PLATE, LOCKING LEVEL 1 $ 1,331.00 C1713 PLATE, LOCKING LEVEL 2 $ 1,489.00 C1713 PLATE, LOCKING LEVEL 3 $ 2,849.00 C1713 PLATE, LOCKING LEVEL 4 $ 3,008.00 C1713 PLATE, TROC. STAB LEVEL 1 $ 2,037.00 C1713 PLATE, TROC. STAB LEVEL 2 $ 2,196.00 C1713 PLATE, LENGTH LEVEL 1 $ 981.00 C1713 PLATE, LENGTH LEVEL 2 $ 1,317.00 C1713 PLATE, LENGTH LEVEL 3 $ 1,521.00 C1713 PLATE, BLADE LEVEL 1 $ 1,620.00 C1713 PLATE, BLADE LEVEL 2 $ 1,741.00 C1713 PLATE, BLADE LEVEL 3 $ 1,836.00 C1713 PLATE, BLADE LEVEL 4 $ 1,900.00 C1713 PLATE, BLADE LEVEL 5 $ 1,995.00 C1713 PLATE, BLADE LEVEL 6 $ 2,075.00 C1713 PLATE, BLADE LEVEL 7 $ 2,208.00 C1713 PLATE, BLADE LEVEL 8 $ 2,368.00 C1713 PLATE, BLADE LEVEL 9 $ 2,432.00 C1713 PLATE, BLADE LEVEL 10 $ 3,017.00 C1713 PLATE, BLADE LEVEL 11 $ 3,186.00 C1713 PLATE, BLADE LEVEL 12 $ 3,285.00 C1713 PLATE, BLADE LEVEL 13 $ 3,568.00 C1713 PLATE, BLADE LEVEL 14 $ 3,784.00 C1713 PLATE, BLADE LEVEL 15 $ 4,287.00 C1713 PLATE, BLADE LEVEL 16 $ 5,293.00 C1713 PLATE, BUTTRESS LEVEL 1 $ 1,433.00 C1713 PLATE, BUTTRESS LEVEL 2 $ 1,594.00 C1713 PLATE, BUTTRESS LEVEL 3 $ 1,677.00 C1713 PLATE, BUTTRESS LEVEL 4 $ 1,925.00 C1713 PLATE, BUTTRESS LEVEL 5 $ 2,072.00 C1713 PLATE, BUTTRESS LEVEL 6 $ 2,212.00 C1713 PLATE, BUTTRESS LEVEL 7 $ 2,304.00 C1713 PLATE, BUTTRESS LEVEL 8 $ 2,394.00 C1713 PLATE, BUTTRESS LEVEL 9 $ 2,485.00 C1713 PLATE, BUTTRESS LEVEL 10 $ 2,578.00 C1713 PLATE, BUTTRESS LEVEL 11 $ 2,731.00 C1713 PLATE, BUTTRESS LEVEL 12 $ 2,791.00 C1713 PLATE, BUTTRESS LEVEL 13 $ 2,925.00 C1713 PLATE, BUTTRESS LEVEL 14 $ 3,011.00 C1713 PLATE, BUTTRESS LEVEL 15 $ 3,100.00 C1713 PLATE, BUTTRESS LEVEL 16 $ 3,183.00 C1713 PLATE, BUTTRESS LEVEL 17 $ 3,317.00 C1713 PLATE, BUTTRESS LEVEL 18 $ 3,399.00 C1713 PLATE, BUTTRESS LEVEL 19 $ 3,475.00 C1713 PLATE, BUTTRESS LEVEL 20 $ 3,653.00 C1713 PLATE, WRIST FUS. LEVEL 1 $ 3,600.00 C1713 PLATE, WRIST FUS. LEVEL 2 $ 3,860.00 C1713 PLATE, BIFURCAT. LEVEL 1 $ 1,051.00 C1713 PLATE, BIFURCAT. LEVEL 2 $ 1,209.00 C1713 PLATE, BARREL LEVEL 1 $ 1,620.00 C1713 PLATE, BARREL LEVEL 2 $ 1,855.00 C1713 PLATE, BARREL LEVEL 3 $ 2,024.00 C1713 PLATE, BARREL LEVEL 4 $ 2,479.00 C1713 PLATE, BARREL LEVEL 5 $ 2,639.00 C1713 PLATE, BARREL LEVEL 6 $ 3,297.00 C1713 PLATE, BARREL LEVEL 7 $ 3,396.00

66 C1713 PLATE, BARREL LEVEL 8 $ 3,457.00 C1713 PLATE, BARREL LEVEL 9 $ 3,556.00 C1713 PLATE, DCS LEVEL 1 $ 3,460.00 C1713 PLATE, DCS LEVEL 2 $ 3,618.00 C1713 PLATE, DCS LEVEL 3 $ 3,909.00 C1713 PLATE, DCS LEVEL 4 $ 4,166.00 C1713 PLATE, DCS LEVEL 5 $ 4,325.00 C1713 PLATE, DCS LEVEL 6 $ 5,315.00 C1713 PLATE, DCS LEVEL 7 $ 5,474.00 C1713 PLATE, DCS LEVEL 8 $ 5,650.00 C1713 PLATE, DCS LEVEL 9 $ 5,735.00 C1713 PLATE, DCS LEVEL 10 $ 5,895.00 C1713 PLATE, DISTAL FEM. LEVEL 1 $ 4,646.00 C1713 PLATE, DISTAL FEM. LEVEL 2 $ 4,806.00 C1713 PLATE, SPOON $ 1,206.00 C1713 3.5 LOCKING COMP. PLATE 5 HOLE $ 710.00 C1713 3.5 LOCKING COMP. PLATE 6 HOLE $ 710.00 C1713 3.5 LOCKING COMP. PLATE 7 HOLE $ 745.00 C1713 3.5 LOCKING COMP. PLATE 8 HOLE $ 777.00 C1713 3.5 LOCKING COMP. PLATE 9 HOLE $ 777.00 C1713 3.5 LOCKING COMP. PLATE 10 HOLE $ 844.00 C1713 3.5 LOCKING COMP. PLATE 12 HOLE $ 946.00 C1713 3.5 LOCKING COMP. PLATE 14 HOLE $ 1,012.00 C1713 SPIDER PLATE SMALL 16MM $ 338.00 C1713 SPIDER PLATE LARGE 20MM $ 338.00 C1713 SPIDER PLATE LARGE OFFSET $ 338.00 C1713 SCREW, CORTEX LEVEL 1 $ 69.00 C1713 SCREW, CORTEX LEVEL 2 $ 107.00 C1713 SCREW, CORTEX LEVEL 3 $ 160.00 C1713 SCREW, CORTEX LEVEL 4 $ 221.00 C1713 SCREW, CORTEX LEVEL 5 $ 277.00 C1713 SCREW, CORTEX LEVEL 6 $ 324.00 C1713 SCREW, LOCKING LEVEL 1 $ 388.00 C1713 SCREW, LOCKING LEVEL 2 $ 439.00 C1713 SCREW, LOCKING LEVEL 3 $ 525.00 C1713 SCREW, LOCKING LEVEL 4 $ 649.00 C1713 SCREW, LOCKING LEVEL 5 $ 700.00 C1713 SCREW, LOCKING LEVEL 6 $ 783.00 C1713 SCREW, LOCKING LEVEL 7 $ 869.00 C1713 SCREW, LOCKING LEVEL 8 $ 946.00 C1713 SCREW, LOCKING LEVEL 9 $ 1,083.00 C1713 SCREW, CONICAL LEVEL 1 $ 500.00 C1713 SCREW, CONICAL LEVEL 2 $ 614.00 C1713 SCREW, CONICAL LEVEL 3 $ 964.00 C1713 SCREW SHAFT LEVEL 1 $ 68.00 C1713 SCREW SHAFT LEVEL 2 $ 830.00 C1713 SCREW SHAFT LEVEL 3 $ 990.00 C1713 SCREW, CANNULATED LEVEL 1 $ 722.00 C1713 SCREW, CANNULATED LEVEL 2 $ 761.00 C1713 SCREW, CANNULATED LEVEL 3 $ 993.00 C1713 SCREW, CANNULATED LEVEL 4 $ 1,016.00 C1713 SCREW, CANCELLOUS LEVEL 1 $ 75.00 C1713 SCREW, CANCELLOUS LEVEL 2 $ 137.00 C1713 SCREW, CANCELLOUS LEVEL 3 $ 191.00 C1713 SCREW, CANCELLOUS LEVEL 4 $ 535.00 C1713 SCREW, CANCELLOUS LEVEL 5 $ 592.00

67 C1713 SCREW, CANCELLOUS LEVEL 6 $ 697.00 C1713 SCREW, CANCELLOUS LEVEL 7 $ 751.00 C1713 SCREW, COMPRESSION LEVEL 1 $ 151.00 C1713 SCREW, COMPRESSION LEVEL 2 $ 310.00 C1713 SCREW, COMPRESSION LEVEL 3 $ 987.00 C1713 SCREW, COMPRESSION LEVEL 4 $ 1,145.00 C1713 SCREW, COMPRESSION LEVEL 5 $ 1,279.00 C1713 SCREW, COMPRESSION LEVEL 6 $ 1,454.00 C1713 SCREW, SCHANZ LEVEL 1 $ 283.00 C1713 SCREW, SCHANZ LEVEL 2 $ 344.00 C1713 SCREW, SCHANZ LEVEL 3 $ 452.00 C1713 SCREW, SCHANZ LEVEL 4 $ 528.00 C1713 SCREW, SCHANZ LEVEL 5 $ 598.00 C1713 SCREW, SCHANZ LEVEL 6 $ 675.00 C1713 SCREW, SCHANZ LEVEL 7 $ 9,207.00 C1713 SCREW, SCHANZ LEVEL 8 $ 9,516.00 C1713 SCREW, RECON LEVEL 1 $ 611.00 C1713 SCREW, RECON LEVEL 2 $ 668.00 C1713 SCREW, RECON LEVEL 3 $ 770.00 C1713 SCREW, RECON LEVEL 4 $ 827.00 C1713 SCREW, LAG LEVEL 1 $ 946.00 C1713 SCREW, LAG LEVEL 2 $ 1,048.00 C1713 SCREW, LAG LEVEL 3 $ 1,188.00 C1713 SCREW, LAG LEVEL 4 $ 1,299.00 C1713 SCREW, LAG LEVEL 5 $ 1,457.00 C1713 SCREW, MALLEOLAR $ 133.00 C1713 SCREW, CON. EXTRACTION LEVEL 1 $ 254.00 C1713 SCREW, CORTICAL LEVEL 1 $ 102.00 C1713 SCREW, CORTICAL LEVEL 2 $ 169.00 C1713 SCREW, BONE $ 105.00 C1713 BOLT, LOCKING LEVEL 1 $ 506.00 C1713 BOLT, LOCKING LEVEL 2 $ 602.00 C1713 BOLT, LOCKING LEVEL 3 $ 805.00 C1713 BOLT, MDFT FUSION LEVEL 1 $ 1,919.00 C1713 BOLT, MDFT FUSION LEVEL 2 $ 1,989.00 C1713 BOLT, MDFT FUSION LEVEL 3 $ 2,079.00 C1713 BOLT, MDFT FUSION LEVEL 4 $ 2,149.00 BOLT, WIRE LEVEL 1 $ 170.00 BOLT, CONNECTION $ 43.00 BOLT, SCHANZ SCREW LEVEL 1 $ 840.00 BOLT, SCHANZ SCREW LEVEL 2 $ 961.00 BOLT, EYE $ 411.00 C1713 NAIL, HUMERAL $ 6,792.00 C1713 NAIL, FIXATION LEVEL 1 $ 4,930.00 C1713 NAIL, FIXATION LEVEL 2 $ 6,490.00 C1713 NAIL, FEMORAL LEVEL 1 $ 4,122.00 C1713 NAIL, FEMORAL LEVEL 2 $ 4,281.00 C1713 NAIL, FEMORAL LEVEL 3 $ 4,605.00 C1713 NAIL, FEMORAL LEVEL 4 $ 5,341.00 C1713 NAIL, FEMORAL LEVEL 5 $ 5,825.00 C1713 NAIL, FEMORAL LEVEL 6 $ 5,936.00 C1713 NAIL, FEMORAL LEVEL 7 $ 6,076.00 C1713 NAIL, TIBIAL LEVEL 1 $ 4,316.00 C1713 NAIL, TIBIAL LEVEL 2 $ 5,321.00 C1713 NAIL, HNDFT ARTHR $ 5,662.00 C1713 NAIL, ELASTIC LEVEL 1 $ 911.00

68 C1713 NAIL, ELASTIC LEVEL 2 $ 974.00 C1713 NAIL, ELASTIC LEVEL 3 $ 1,044.00 C1713 NAIL, ELASTIC LEVEL 4 $ 1,107.00 C1713 NAIL, ELASTIC LEVEL 5 $ 1,171.00 C1713 NAIL, ELASTIC LEVEL 6 $ 1,258.00 NAIL, PELVIC $ 1,900.00 C1713 PIN, BUTTRESS LEVEL 1 $ 228.00 C1713 PIN, BUTTRESS LEVEL 2 $ 417.00 C1713 PIN, STEINMAN LEVEL 1 $ 148.00 C1713 PIN, STEINMAN LEVEL 2 $ 277.00 C1713 PIN, STEINMAN LEVEL 3 $ 471.00 PIN, CENTERING LEVEL 1 $ 324.00 PIN, CENTERING LEVEL 2 $ 414.00 C1713 PIN, CERCLAGE LEVEL 1 $ 586.00 C1713 PIN, CERCLAGE LEVEL 2 $ 977.00 PIN, FIXATION $ 474.00 ENDCAP LEVEL 1 $ 280.00 ENDCAP LEVEL 2 $ 478.00 ENDCAP LEVEL 3 $ 554.00 ENDCAP LEVEL 4 $ 627.00 ENDCAP LEVEL 5 $ 707.00 ENDCAP LEVEL 6 $ 757.00 ENDCAP LEVEL 7 $ 865.00 ENDCAP LEVEL 8 $ 929.00 ENDCAP LEVEL 9 $ 1,054.00 BLADE, SAW LEVEL 1 $ 169.00 BLADE, SAW LEVEL 2 $ 275.00 BLADE, SAW LEVEL 3 $ 420.00 BLADE, SAW LEVEL 4 $ 487.00 BLADE, SAW LEVEL 5 $ 1,279.00 BLADE, SAW LEVEL 6 $ 1,576.00 BLADE, SPIRAL LEVEL 1 $ 2,015.00 BLADE, SPIRAL LEVEL 2 $ 2,173.00 BLADE, SPIRAL LEVEL 3 $ 2,457.00 BLADE, SPIRAL LEVEL 4 $ 2,616.00 C1713 BLADE, HELICAL LEVEL 1 $ 2,184.00 C1713 BLADE, HELICAL LEVEL 2 $ 2,342.00 BLADE, HELIX LEVEL 1 $ 1,188.00 BLADE, HELIX LEVEL 2 $ 1,261.00 BLADE, HELIX LEVEL 3 $ 1,346.00 BLADE, HELIX LEVEL 4 $ 1,419.00 BURR LEVEL 1 $ 205.00 BURR LEVEL 2 $ 275.00 BURR LEVEL 3 $ 341.00 WIRE, K LEVEL 1 $ 99.00 WIRE, K LEVEL 2 $ 280.00 WIRE, K LEVEL 3 $ 334.00 WIRE, K LEVEL 4 $ 401.00 WIRE, K LEVEL 5 $ 608.00 WIRE, K LEVEL 6 $ 668.00 WIRE, K LEVEL 7 $ 1,687.00 WIRE, CERCLAGE LEVEL 1 $ 222.00 WIRE, CERCLAGE LEVEL 2 $ 280.00 WIRE, CERCLAGE LEVEL 3 $ 366.00 WIRE, CERCLAGE LEVEL 4 $ 449.00 WIRE, GUIDE LEVEL 1 $ 102.00

69 WIRE, GUIDE LEVEL 2 $ 156.00 WIRE, GUIDE LEVEL 3 $ 216.00 WIRE, GUIDE LEVEL 4 $ 350.00 C1769 WIRE, GUIDE LEVEL 5 $ 433.00 WIRE, GUIDE LEVEL 6 $ 551.00 WIRE, SPADE PT. LEVEL 1 $ 286.00 WIRE, SPADE PT. LEVEL 2 $ 888.00 WIRE, SMOOTH $ 285.00 WIRE, REDUCTION $ 888.00 WIRE POST SHORT $ 751.00 WIRE POST TALL $ 856.00 WIRE MOUNT $ 586.00 ROD, CARB FIB LEVEL 1 $ 152.00 ROD, CARB FIB LEVEL 2 $ 602.00 ROD, CARB FIB LEVEL 3 $ 716.00 C1713 ROD, CARB FIB LEVEL 4 $ 767.00 ROD, CARB FIB LEVEL 5 $ 894.00 ROD, CARB FIB LEVEL 6 $ 958.00 ROD, CARB FIB LEVEL 7 $ 1,054.00 ROD, CARB FIB LEVEL 8 $ 1,139.00 ROD, CARB FIB LEVEL 9 $ 1,426.00 ROD, CARB FIB LEVEL 10 $ 2,359.00 ROD, CARB FIB LEVEL 11 $ 2,594.00 ROD, CARB FIB LEVEL 12 $ 2,833.00 ROD, CARB FIB LEVEL 13 $ 3,055.00 ROD, THREADED LEVEL 1 $ 258.00 ROD, THREADED LEVEL 2 $ 321.00 ROD, THREADED LEVEL 3 $ 411.00 RING, LEVEL 1 $ 1,387.00 RING, LEVEL 2 $ 1,457.00 RING, LEVEL 3 $ 1,534.00 RING, LEVEL 4 $ 1,598.00 RING, LEVEL 5 $ 1,703.00 RING, LEVEL 6 $ 1,814.00 RING, LEVEL 7 $ 1,919.00 RING, LEVEL 8 $ 1,995.00 RING, LEVEL 9 $ 2,231.00 RING, LEVEL 10 $ 2,298.00 RING, LEVEL 11 $ 2,447.00 RING, LEVEL 12 $ 2,555.00 RING, LEVEL 13 $ 2,657.00 RING, LEVEL 14 $ 3,189.00 RING, LEVEL 15 $ 3,402.00 RING, LEVEL 16 $ 3,829.00 RING, LEVEL 17 $ 3,956.00 RING, LEVEL 18 $ 4,252.00 RING, LEVEL 19 $ 4,678.00 RING, LEVEL 20 $ 5,102.00 RING, FOOT LEVEL 1 $ 2,657.00 RING, FOOT LEVEL 2 $ 2,766.00 RING, FOOT LEVEL 3 $ 2,874.00 RING, FOOT LEVEL 4 $ 2,979.00 RING, FOOT LEVEL 5 $ 3,498.00 RING, FOOT LEVEL 6 $ 3,641.00 RING, FOOT LEVEL 7 $ 3,784.00 RING, FOOT LEVEL 8 $ 3,927.00

70 RING, FOOT LEVEL 9 $ 4,071.00 WASHER LEVEL 1 $ 15.00 WASHER LEVEL 2 $ 79.00 WASHER LEVEL 3 $ 133.00 WASHER LEVEL 4 $ 254.00 WASHER LEVEL 5 $ 345.00 WASHER LEVEL 6 $ 430.00 WASHER LEVEL 7 $ 503.00 BAR, CONNECTION LEVEL 1 $ 113.00 BAR, CONNECTING LEVEL 2 $ 187.00 IMPACTOR, LEVEL 1 $ 458.00 IMPACTOR, LEVEL 2 $ 611.00 SLEEVE, LOCKING LEVEL 1 $ 1,324.00 SLEEVE, LOCKING LEVEL 2 $ 1,483.00 SLEEVE, HOLDING LEVEL 1 $ 1,130.00 SLEEVE, HOLDING LEVEL 2 $ 1,299.00 SLEEVE, PROTECTION LEVEL 1 $ 920.00 SLEEVE, PROTECTION LEVEL 2 $ 2,030.00 SLEEVE, PROTECTION LEVEL 3 $ 2,327.00 SLEEVE, PROTECTION LEVEL 4 $ 2,915.00 CAPS, PROTECTIVE LEVEL 1 $ 15.00 CAPS, PROTECTIVE LEVEL 2 $ 152.00 BUTTON, CERCLAGE $ 586.00 DRILL BIT LEVEL 1 $ 275.00 DRILL BIT LEVEL 2 $ 338.00 DRILL BIT LEVEL 3 $ 789.00 DRILL BIT LEVEL 4 $ 879.00 DISTRACTOR LEVEL 1 $ 1,066.00 DISTRACTOR LEVEL 2 $ 2,406.00 DISTRACTOR LEVEL 3 $ 2,657.00 DISTRACTOR LEVEL 4 $ 2,979.00 DISTRACTOR LEVEL 5 $ 3,618.00 DISTRACTOR LEVEL 6 $ 3,877.00 BAR, SACRAL $ 2,298.00 WIRE, TROCAR LEVEL 1 $ 350.00 WIRE, TROCAR LEVEL 2 $ 382.00 CLAMP, LEVEL 1 $ 777.00 CLAMP, LEVEL 2 $ 958.00 CLAMP, LEVEL 3 $ 1,218.00 CLAMP, LEVEL 4 $ 1,305.00 CLAMP, LEVEL 5 $ 1,614.00 CLAMP, LEVEL 6 $ 2,342.00 CLAMP, LEVEL 7 $ 2,632.00 CLAMP, LEVEL 8 $ 2,642.00 CLAMP, LEVEL 9 $ 2,702.00 CLAMP, LEVEL 10 $ 2,833.00 CLAMP, LEVEL 11 $ 3,170.00 CLAMP, LEVEL 12 $ 3,475.00 CLAMP, LEVEL 13 $ 19,475.00 SIDE STRUT $ 4,331.00 CLAMP, HOLDER $ 777.00 NUT, LEVEL 1 $ 15.00 NUT, LEVEL 2 $ 156.00 NUT, LEVEL 3 $ 275.00 NUT, LEVEL 4 $ 404.00 NUT, LEVEL 5 $ 598.00

71 NUT, SPRING LOADED $ 1,218.00 STANDOFF, LEVEL 1 $ 173.00 STANDOFF, LEVEL 2 $ 280.00 LENGTHENING APP LEVEL 1 $ 11,184.00 LENGTHENING APP LEVEL 2 $ 12,845.00 LENGTHENING APP LEVEL 3 $ 17,123.00 CABLE $ 1,747.00 ARM, PERC. $ 8,494.00 ARM, PELVIC $ 9,443.00 ARM, HOHMAN $ 14,170.00 BROACH $ 999.00 KIT, SACRAL $ 4,208.00 C1713 BONE STAPLE $ 503.00 SPINDLE, THREADED LEVEL 1 $ 1,541.00 SPINDLE, THREADED LEVEL 2 $ 1,903.00 PLUG, THREADED $ 398.00 REAMER $ 275.00 SUPPORT, OBLIQUE $ 2,126.00 C1776 JOINT, UNIVERSAL $ 2,941.00 COMPRESSOR, OPEN $ 2,164.00 FIXATOR, ADJ. DISTAL $ 7,533.00 COVER, WRIST $ 3.00 FIXATOR, ELBOW $ 5,755.00 CARRIAGE, SLIDING $ 1,903.00 BAR, CONNECTING $ 207.00 C1713 NAIL, ELONGATION $ 1,218.00 TUBE, THREADED $ 458.00 DISK, SPIKED $ 745.00 SPACER $ 356.00 INSERT, SCREW HOLE $ 359.00 C1776 STEM, FEMORAL LEVEL 1 $ 3,800.00 C1776 STEM, FEMORAL LEVEL 2 $ 3,870.00 C1776 STEM, FEMORAL LEVEL 3 $ 6,222.00 C1776 STEM, FEMORAL LEVEL 4 $ 6,955.00 C1776 STEM, FEMORAL LEVEL 5 $ 15,268.00 C1776 STEM, FEMORAL LEVEL 6 $ 20,955.00 C1776 STEM, FEMORAL LEVEL 7 $ 22,973.00 C1776 CUP, ACETAB. LEVEL 1 $ 563.00 C1776 CUP, ACETAB. LEVEL 2 $ 8,476.00 C1713 CUP, ACETAB. LEVEL 3 $ 9,393.00 C1776 CUP, ACETAB. LEVEL 4 $ 9,568.00 C1776 CUP, ACETAB. LEVEL 5 $ 11,155.00 C1776 CUP, ACETAB. LEVEL 6 $ 11,308.00 C1776 CUP, ACETAB. LEVEL 7 $ 11,741.00 C1776 CUP, ACETAB. LEVEL 8 $ 12,012.00 C1776 CUP, ACETAB. LEVEL 9 $ 12,288.00 C1776 CUP, ACETAB. LEVEL 10 $ 12,820.00 C1776 CUP, ACETAB. LEVEL 11 $ 14,946.00 C1776 CUP, ACETAB. LEVEL 12 $ 15,723.00 C1776 LINER, ACETAB. LEVEL 1 $ 4,026.00 C1776 LINER, ACETAB. LEVEL 2 $ 4,131.00 C1776 LINER, ACETAB. LEVEL 3 $ 4,622.00 C1776 LINER, ACETAB. LEVEL 4 $ 4,201.00 C1776 LINER, ACETAB. LEVEL 5 $ 4,622.00 C1776 LINER, ACETAB. LEVEL 6 $ 4,727.00 C1776 LINER, ACETAB. LEVEL 7 $ 5,264.00

72 C1776 LINER, ACETAB. LEVEL 8 $ 5,468.00 C1776 LINER, ACETAB. LEVEL 9 $ 5,535.00 C1776 LINER, ACETAB. LEVEL 10 $ 5,604.00 C1776 LINER, ACETAB. LEVEL 11 $ 5,793.00 C1776 LINER, ACETAB. LEVEL 12 $ 5,913.00 C1776 LINER, ACETAB. LEVEL 13 $ 5,983.00 C1776 LINER, ACETAB. LEVEL 14 $ 6,120.00 C1776 LINER, ACETAB. LEVEL 15 $ 6,257.00 C1776 LINER, ACETAB. LEVEL 16 $ 6,324.00 C1776 LINER, ACETAB. LEVEL 17 $ 6,423.00 C1776 LINER, ACETAB. LEVEL 18 $ 6,566.00 C1776 LINER, ACETAB. LEVEL 19 $ 6,754.00 C1776 LINER, ACETAB. LEVEL 20 $ 6,843.00 C1776 LINER, ACETAB. LEVEL 21 $ 6,986.00 C1776 LINER, ACETAB. LEVEL 22 $ 7,288.00 C1776 LINER, ACETAB. LEVEL 23 $ 7,530.00 C1776 LINER, ACETAB. LEVEL 24 $ 7,814.00 C1776 LINER, ACETAB. LEVEL 25 $ 7,976.00 C1776 LINER, ACETAB. LEVEL 26 $ 8,606.00 C1776 LINER, ACETAB. LEVEL 27 $ 9,662.00 C1776 LINER, ACETAB. LEVEL 28 $ 10,153.00 C1776 LINER, ACETAB. LEVEL 29 $ 10,223.00 C1776 LINER, ACETAB. LEVEL 30 $ 10,596.00 C1776 LINER, ACETAB. LEVEL 31 $ 10,643.00 C1776 LINER, ACETAB. LEVEL 32 $ 10,862.00 C1776 LINER, ACETAB. LEVEL 33 $ 11,770.00 C1776 LINER, ACETAB. LEVEL 34 $ 14,953.00 C1776 LINER, ACETAB. LEVEL 35 $ 15,675.00 C1776 LINER, ACETAB. LEVEL 36 $ 16,913.00 C1776 LINER, ACETAB. LEVEL 37 $ 16,913.00 C1776 LINER, ACETAB. LEVEL 38 $ 18,151.00 C1776 INSERT, ACETAB. LEVEL 1 $ 8,421.00 C1776 INSERT, ACETAB. LEVEL 2 $ 8,564.00 C1776 INSERT, ACETAB. LEVEL 3 $ 9,058.00 C1776 INSERT, ACETAB. LEVEL 4 $ 11,197.00 C1776 INSERT, ACETAB. LEVEL 5 $ 13,603.00 C1776 INSERT, ACETAB. LEVEL 6 $ 14,370.00 C1776 HEAD, FEMORAL LEVEL 1 $ 1,789.00 C1776 HEAD, FEMORAL LEVEL 2 $ 3,542.00 C1776 HEAD, FEMORAL LEVEL 3 $ 4,313.00 C1776 HEAD, FEMORAL LEVEL 4 $ 4,812.00 C1776 HEAD, FEMORAL LEVEL 5 $ 7,151.00 C1776 HEAD, FEMORAL LEVEL 6 $ 7,715.00 C1776 HEAD, FEMORAL LEVEL 7 $ 7,861.00 C1776 HEAD, FEMORAL LEVEL 8 $ 8,011.00 C1776 HEAD, FEMORAL LEVEL 9 $ 8,240.00 C1776 HEAD, FEMORAL LEVEL 10 $ 8,476.00 C1776 HEAD, FEMORAL LEVEL 11 $ 8,644.00 C1776 HEAD, FEMORAL LEVEL 12 $ 8,838.00 C1776 HEAD, FEMORAL LEVEL 13 $ 9,122.00 C1776 HEAD, FEMORAL LEVEL 14 $ 9,303.00 C1776 HEAD, FEMORAL LEVEL 15 $ 9,749.00 C1776 HEAD, FEMORAL LEVEL 16 $ 10,255.00 C1776 HEAD, FEMORAL LEVEL 17 $ 10,760.00 C1776 HEAD, FEMORAL LEVEL 18 $ 11,916.00 C1776 HEAD, FEMORAL LEVEL 19 $ 12,827.00

73 C1776 CEMENTRALIZER $ 535.00 C1776 COMPONENT, FEMORAL LEVEL 1 $ 12,365.00 C1776 COMPONENT, FEMORAL LEVEL 2 $ 13,803.00 C1776 COMPONENT, FEMORAL LEVEL 3 $ 14,644.00 C1776 COMPONENT, FEMORAL LEVEL 4 $ 18,017.00 C1776 COMPONENT, FEMORAL LEVEL 5 $ 18,555.00 C1776 COMPONENT, FEMORAL LEVEL 6 $ 20,446.00 C1776 COMPONENT, FEMORAL LEVEL 7 $ 20,951.00 C1776 COMPONENT, FEMORAL LEVEL 8 $ 24,526.00 C1776 TRAY, TIBIAL LEVEL 1 $ 10,865.00 C1776 TRAY, TIBIAL LEVEL 2 $ 10,981.00 C1776 TRAY, TIBIAL LEVEL 3 $ 11,764.00 C1776 TRAY, TIBIAL LEVEL 4 $ 12,050.00 C1776 TRAY, TIBIAL LEVEL 5 $ 13,297.00 C1776 TRAY, TIBIAL LEVEL 6 $ 13,546.00 C1776 INSERT, TIBIAL LEVEL 1 $ 4,955.00 C1776 INSERT, TIBIAL LEVEL 2 $ 5,169.00 C1776 INSERT, TIBIAL LEVEL 3 $ 5,717.00 C1776 INSERT, TIBIAL LEVEL 4 $ 5,805.00 C1776 INSERT, TIBIAL LEVEL 5 $ 5,919.00 C1776 INSERT, TIBIAL LEVEL 6 $ 6,216.00 C1776 INSERT, TIBIAL LEVEL 7 $ 6,451.00 C1776 INSERT, TIBIAL LEVEL 8 $ 6,636.00 C1776 INSERT, TIBIAL LEVEL 9 $ 6,986.00 C1776 INSERT, TIBIAL LEVEL 10 $ 7,323.00 C1776 INSERT, TIBIAL LEVEL 11 $ 7,381.00 C1776 INSERT, TIBIAL LEVEL 12 $ 7,693.00 C1776 INSERT, TIBIAL LEVEL 13 $ 7,766.00 C1776 INSERT, TIBIAL LEVEL 14 $ 8,097.00 C1776 INSERT, TIBIAL LEVEL 15 $ 8,167.00 C1776 INSERT, TIBIAL LEVEL 16 $ 8,237.00 C1776 INSERT, TIBIAL LEVEL 17 $ 8,342.00 C1776 INSERT, TIBIAL LEVEL 18 $ 8,940.00 C1776 INSERT, TIBIAL LEVEL 19 $ 10,410.00 C1776 INSERT, TIBIAL LEVEL 20 $ 13,867.00 C1776 WEDGE, TIBIAL LEVEL 1 $ 6,773.00 C1776 WEDGE, TIBIAL LEVEL 2 $ 7,381.00 C1776 WEDGE, TIBIAL LEVEL 3 $ 8,266.00 C1776 ROD, TIBIAL LEVEL 1 $ 5,063.00 C1776 ROD, TIBIAL LEVEL 2 $ 5,169.00 C1776 ROD, TIBIAL LEVEL 3 $ 5,312.00 C1776 ROD, TIBIAL LEVEL 4 $ 7,381.00 C1776 TIBIAL STEM $ 4,173.00 C1776 BOLT, FEMORAL $ 1,212.00 C1776 ROD FEMORAL FLT, LEVEL 1 $ 6,633.00 C1776 ROD FEMORAL FLT, LEVEL 2 $ 6,773.00 C1776 FEMORAL INSERT $ 6,238.00 C1776 FEMORAL ADAPTER $ 8,663.00 C1776 FEMORAL ADAPTER BOLT $ 1,212.00 C1776 FEMORAL POST $ 4,208.00 C1776 PATELLAR COMPONENT, LEVEL 1 $ 3,342.00 C1776 PATELLAR COMPONENT, LEVEL 2 $ 4,208.00 C1713 SCREW, SIGMA 6.5 $ 821.00 C1776 STEM, HUMERAL LEVEL 1 $ 11,470.00 C1776 STEM, HUMERAL LEVEL 2 $ 13,282.00 C1776 STEM, HUMERAL LEVEL 3 $ 14,475.00

74 C1776 STEM, HUMERAL LEVEL 4 $ 18,083.00 C1776 STEM, HUMERAL LEVEL 5 $ 19,567.00 C1776 STEM, HUMERAL LEVEL 6 $ 25,220.00 C1776 HEAD, HUMERAL LEVEL 1 $ 6,311.00 C1776 HEAD, HUMERAL LEVEL 2 $ 7,084.00 C1776 HEAD, HUMERAL LEVEL 3 $ 8,807.00 C1776 GLENOID PROSTHESIS, LEVEL 1 $ 5,162.00 C1776 GLENOID PROSTHESIS, LEVEL 2 $ 7,480.00 C1776 GLENOID PROSTHESIS, LEVEL 3 $ 8,126.00 BUTTON/SPRING REPLACE $ 408.00 EASY OUT $ 1,083.00 APEX HOLE ELIM POSITIVE STOP $ 911.00 TAPERED SPACER $ 961.00 C1713 SCREW, ROOF PILE $ 805.00 C1713 SCREW, TAPERED HD LEVEL 1 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 2 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 3 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 4 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 5 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 6 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 7 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 8 $ 805.00 C1713 SCREW, TAPERED HD LEVEL 9 $ 805.00 C1776 SLEEVE, FEMORAL LEVEL 1 $ 10,375.00 C1776 SLEEVE, FEMORAL LEVEL 2 $ 12,228.00 C1776 STEM, UNIVERSAL FLUTED $ 6,098.00 CEMENT, BONE LEVEL 1 $ 318.00 CEMENT, BONE LEVEL 2 $ 481.00 CEMENT, BONE LEVEL 3 $ 570.00 CEMENT, BONE LEVEL 4 $ 656.00 CEMENT, BONE LEVEL 5 $ 914.00 CEMENT, BONE LEVEL 6 $ 1,384.00 CEMENT, BONE LEVEL 7 $ 1,477.00 CEMENT, BONE LEVEL 8 $ 1,559.00 CEMENT, BONE LEVEL 9 $ 3,132.00 CEMENT, BONE LEVEL 10 $ 3,224.00 C1769 KIT, VASCULAR ACCESS $ 32.00 C1750 KIT, HEMOSPLIT 14.5FR 19 CM $ 815.00 C1788 CATHETER, GROS TITANIUM 8FR POR $ 705.00 C1788 PORT, TITANIUM POWER 6FR. $ 1,019.00 C1788 PORT, MRI W/8FR. GROSHONG $ 864.00 C1788 TITANIUM LOW-PROFILE SINGLE LUMEN 6.0FR $ 530.00 ELLIK BLADDER EVACUATOR $ 79.00 C1729 PLEUREX PLURAL CATHETER $ 1,044.00 PUDDLE VAC FLOOR SUCTION $ 177.00 STENT, RETRIEVER $ 225.00 TAP, LEVEL 1 $ 576.00 C1713 TAP, LEVEL 2 $ 821.00 TAP, LEVEL 3 $ 888.00 TAP, LEVEL 4 $ 1,051.00 TAP, LEVEL 5 $ 1,384.00 ENDPIECE,DBL JOINT $ 2,569.00 RAIL, EXT. ROD $ 3,122.00 FIXATOR, RAIL $ 3,208.00 CRYOCUFF-MEDIUM $ 170.00 CRYOCUFF-LARGE $ 181.00

75 C1750 CATHETER, TENCKOFF PERITONEAL 42CM $ 122.00 A7521 TUBE, TRACH 6FR, 60 XLTCP $ 132.00 ADHESIVE, INDERMIL $ 70.00 LIGASURE, SMALL JAW INSTRUMENT $ 3,958.42 STAPLE, TRI RELOAD 60MM PURPLE $ 3,164.18 STAPLE TRI RELOAD 45MM PURPLE $ 738.27 STAPLE TRI RELOAD 60MM TAN $ 3,054.43 ENDO GIA ULTRA XL HANDLE $ 1,424.68 FORCEP RD 180 $ 1,417.50 ENDO GIA ULTRA HANDLE $ 1,198.89 FORCEP TK 5MM DEVICE $ 1,102.50 DRAPE WARMER 66X44 $ 155.00 VCARE $ 784.22 SUTURE, 2.0 SOFSILK $ 774.90 SUTURE VICRYL 9.0 $ 534.41 PACK LAPAROSCOPY CDS $ 177.42 CLEARIFY $ 68.40 C1750 KIT SPLIT CATH 14V28CM ST 23CM TIP $ 399.00 C1757 BAG, UROLOGY DRAIN $ 48.75 BLADE, COATED INSULATED $ 273.00 SHEET, PATIENT TRANSFER 36X84 $ 262.50 PERIOSTEAL ELEVATOR 6MM CURVED BLADE $ 250.95 CONTAINER, DISPOSAL NEEDLE 8GAL $ 231.00 SUTURE 2.0 POLYSORB V-20 $ 227.72 TUBING, T-U-R-Y CYSTO $ 223.44 SUTURE 2.0 POLYSORB V-20 GLS322 $ 203.61 APPLICATOR, CHLORAPREP 26 ML $ 23.00 TROCAR KII SHIELDED BLADED $ 189.00 TROCAR KII OPTICAL 11X100MM $ 189.00 TROCAR KII OPTICAL 12X100MM $ 189.00 COUNTERSINK FOR 2.0MM/2.4MM SCREWS $ 189.00 ELECTRODE BLADE LONG CS/40 $ 186.38 ELECTRODE NEEDLE STANDARD LENGTH $ 184.28 COVER CASE CART 34X24X36 RL 100 $ 178.50 TRAY, FLOEY URIMETER SURESTEP 16FR $ 163.28 A4314 TRAY, FOLEY URIMETER SURESTEP 18FR $ 163.28 SUTURE MAXON 0, 36X90 CM GS 21 $ 162.34 BRUSH SURG SCRUB W/POVIDONE-IODINE $ 153.97 STRIPS CIDEX OPA TEST $ 153.39 ELECTRODE L-HOOK 5MMX32CM LAPAROSCOPIC $ 153.09 DRAPE SURG U-DRAPE $ 152.15 CIRCUIT BREATHING ANESTHESIA ADULT 60 $ 140.49 CLIPPER DISPOSABLE FIXED HEAD $ 134.40 TROCAR SHIELDED BLADE ASSESS SYSTEM $ 132.30 3.0 SUTURE POLYSORB CL842 $ 129.81 TUBING CYSTO IRRIG $ 129.15 DRAPE SHOULDER SPLIT W/POUCH ORTHO $ 128.95 TROCAR KII OPTICAL 5X100MM $ 126.00 SUTURE 2.0 POLYSORB CL955 $ 123.98 TUBING INSUFFLATION $ 120.20 SET EXTENSION 7 MACRO $ 117.08 SOAP SURG SCRUB TRISEPTIN 32OZ $ 114.07 5-N-CONNECTOR $ 113.40 C1771 T-SLING $ 1,428.00 RELOADS RADIAL PURPLE $ 883.50 STAPLE TRIRELOAD 45MM TAN CVD $ 812.19

76 RELOAD 45MM TAN $ 709.56 STAPLE TRI RELOAD 45MM GRAY $ 657.05 ENDO GIA ULTRA SHORT HANDLE $ 513.81 VERSAPORT $ 228.93 VERSAPORT $ 228.47 CDS KNEE ARTHROSCOPY $ 146.16 5M ENDO CATCH $ 112.50 PERMCATH 55CM ST $ 99.00 WALKER SHORT PNEUMATIC MED $ 85.86 WALKER SHORT PNEUMATIC LG $ 85.86 J HOOK TIP $ 75.99 CDS SET UP $ 63.00 CDS EXTREMITY $ 62.88 ABRAMSON TRIPLE LUMEN SUMP DRAIN $ 49.56 GLYCINE 3000 $ 11.85 .9% SALINE 3000 $ 28.00 WATER 3000 $ 9.32 A4461 SUPPORT,AB $ 100.00 A4565 SLING,ARM $ 27.00 NEEDL,ASAP $ 270.00 BAG A JET $ 14.00 C1713 CEMENT,BONE $ 403.00 C1713 BONE CEMENT KNEE $ 114.00 BOVIE TIP $ 94.00 BOVIE TIP SHORT $ 68.00 BOVIE TIP 10MG $ 35.00 BRUSH,BRONCHIA $ 63.00 CAST,FIBERGLAS $ 52.00 C1729 CATHETER HICKMAN DBL $ 624.00 CATHETER JAVID BYPASS $ 335.00 C1729 CATH,JEJUBAKER $ 984.00 C1729 CATHETER MALECOT NEP $ 155.00 A4338 CATHETER PORT-A-CATH $ 1,676.00 C1788 PORT-A-CATH 8F PROFUSE PLASTIC $ 500.00 C1752 CATHETER QUINTON 40D $ 829.00 C1751 CATHETER TRIPLE LUMN $ 344.00 CHOLANGIOGM CATH $ 330.00 IRRIGATOR,SUCT $ 74.27 TUBING,CO2 $ 73.00 CYTOLOGY MICRO BRUSH $ 35.00 DISPOSABLE CLEANING BRUSH $ 16.00 STRIPPER,VEIN $ 115.00 BAG,URIN DRAIN $ 42.00 J PRATT DRAIN $ 15.00 C1729 DRAIN,HEMOW/TR $ 206.00 DRAPE CRANIAL $ 37.00 DRAPE,ISOLATION $ 83.00 DRAPE VI DRAPE $ 63.00 DRILL BITS $ 335.00 93005 EKG-OPERATING ROOM $ 129.00 ENDO DISSECT $ 403.00 LOOP,ENDO $ 335.00 SHEARS,ENDO $ 511.00 ENDO SURGI-TIE LOOP $ 287.00 SURGIPORT,ENDO $ 57.00 CLIP,ENDO $ 1,110.87

77 DISSCTR,ENDO $ 505.00 ACCU-TEMP $ 42.00 FILLIFORM DISP $ 29.00 FLEXI-FLO 18 $ 182.00 FLEXI-FLO 20 $ 182.00 A4338 CATH,FOLEY $ 68.00 A4346 CATH,FOLEY3WAY $ 79.00 A4314 BAG,CATH FOLEY $ 15.69 A4338 FRENCH CATHETER $ 42.00 DRESS GELFOAM $ 192.00 GELFOAM SIZE 12 $ 6.00 GIA 80 3.8 $ 578.00 C1768 GOR TX GRAFTS 8X75 $ 2,513.00 HEMOCLIP-ALL $ 316.00 KIT,HEMOVAC $ 247.00 DRAPE,IOBAN $ 60.00 INGRAM SUPRAPUBLIC $ 335.00 DRESS IODOFORM $ 37.00 KIT,LAP CHOLE $ 1,858.00 LOADING UNIT GIA 80 $ 307.00 LUKI TUBE $ 37.00 C1729 MALCOTT CATHETER $ 47.00 MICRO SUTURE $ 87.00 FORCEP,BIOPSY $ 299.00 C1768 MOORE PROST REG $ 1,848.00 NEOLOOP $ 33.00 PAPILLOTOME-MICROVAS $ 456.00 PENROSE 12 IN DR $ 12.00 DRAIN,PENROSE $ 12.00 C1729 CATH,PEZER $ 149.00 C1713 PLEXIPULSE/FLOW TRON $ 424.00 SUCTION POOLE $ 29.00 REGULAR SUTURE $ 40.00 C1713 RESECTOSCOPE LOOP $ 335.00 BLADE,SAGITTAL $ 236.00 B4082 TUBE,SALEM $ 43.00 C1713 SCREWS ALL - ANCHORS $ 95.00 C1713 SCREWS BUNION. $ 135.00 C1713 SCREWS SCHANZ $ 335.00 C1713 SCREWS SELF TAP $ 460.00 C1713 SCREWS TITIAM - ANCHOR $ 169.00 SUPPORT,SCROTL $ 46.00 L3650 SPLINT,SHOULDR $ 167.00 SKIN STAPLES $ 19.00 STAPLE REMOVER $ 22.00 STAPLE-GIA DLU REFIL $ 506.00 STAPLE-ROTICULATOR $ 945.00 STAPLE-TA DLU 30 3.5 $ 182.00 STAPLE-TA DLU55 3.5 $ 335.00 STAPLE-TA 55 3.5 $ 526.00 STAPLE-TA 90 3.5&4.8 $ 526.00 STAPLES O LDS $ 409.00 STAPLER,ENDO $ 1,449.00 STAPLES-GIA-60 $ 374.00 STAPLES-HEMOCLIP WEC $ 59.00 C1713 STEIMAN PIN $ 335.00

78 C1874 STENT-HYDRO PLUS $ 283.00 C1874 STENT,DBL J $ 414.00 STONE EXTRCTN-BASKET $ 541.00 DRESS,SURGICEL $ 114.00 SURGICEL 4 X 8 $ 62.00 SUTURE BOOT $ 31.00 TEGADERM SMALL $ 37.00 CATH,THORACIC $ 43.00 C1729 THOR W/TROCHAR CA $ 41.00 C1713 K WIRE ALL $ 56.00 TRACHEOSTOMY CJP BIV $ 114.00 TUBES-POLYETHY LENE $ 23.00 TUBE,CYSTO IRR $ 31.00 C1758 URET CONETIP CATH $ 68.00 ADAPTER,URETER $ 9.00 URETRAL DRAIN BAG $ 33.00 URIMETER DRAIN BAG $ 115.00 BOVIE PAD $ 56.00 MANIP,UTERINE $ 166.00 VACURET TUBING $ 77.00 VACURET TIP $ 52.00 VACURET FILTER $ 126.00 A6199 DRESS VASELINE $ 23.00 XERFORM 1X8 $ 12.00 DRESS XEROFORM $ 21.00 SUCTION YANKAU $ 33.00 CAST ARM LONG ALL $ 37.00 ARM POST MOLD $ 37.00 CAST ARM SHORT ALL $ 37.00 AST LEG LONG ALL $ 37.00 LEG POST MOLD $ 37.00 CAST LEG SHORT ALL $ 37.00 BAG,BILE $ 73.00 BONE WAX $ 9.00 BOVIE CORD $ 73.00 A6454 DRESS COBAN $ 16.00 A4340 CATH,FLEY COUD $ 78.00 SET,CYSTOMANOM $ 52.00 CANNISTER,SUCT $ 16.00 NEEDLE,TRUCUT $ 105.00 C2627 DRAINS CYSTO SUPRA P $ 93.00 ELASTOPLAST 4 IN $ 14.00 ENDO PATH LAP KIT AC $ 1,259.00 EXTRNL FIXATOR CLAMP $ 317.00 EXTRNL FIXATOR CON B $ 59.00 K WIRE THREAD $ 68.00 SHIELD,EYE $ 9.00 C1751 CATH,GROSHONG $ 1,423.00 LAVEEN PERITON SHNT $ 456.00 LIVER BIOP NEEDLE $ 126.00 NASAL SPLINT $ 22.00 L1830 SPLINT,KNEE $ 181.00 STAPLES-LDS REFILL $ 275.00 C1768 TAP GORE TEX GRFT $ 2,192.00 SCREWS ALL-NON ANCHORS $ 571.00 SCREWS TITIAM - NON ANCHOR $ 854.00

79 APPLIER, ENDOSCOPIC CLIP 5M $ 262.00 C1788 CANNULA, 5MM SILS PORT BX/6 $ 1,070.00 CAUTERY, J TIPS BOX/10 $ 44.00 CLIP CART DISP 10 K2 MED/LG $ 142.00 DEVICE, CARTER THMPSN CLOS STN $ 244.00 DEVICE CARTER THMPSN CLOS, XLN $ 344.00 DEVICE, ENDO CLOSE SUTURING $ 103.79 DISSECTOR, ROTICULAR ENDO 5MM $ 214.00 ENDO GIA II 45-4.8 SULU BOX/6 $ 132.00 ENDO GIA II 60-4.8 SULU BOX/6 $ 216.00 ENDO LP LIGAT COATD VYCRIL $ 225.00 ENDO LP, ZERO LIGASURE PDS11 $ 225.00 ENDOGRASP, ROTICULAR 5MM BOX $ 602.00 C1763 GRFT, SRGSS BIODSGN 13X22 8 L $ 8,523.00 C1763 GRFT, SRGSS BIODSGN TISS 20X20 $ 11,802.00 GRSPER FRCPS, SUPER ATRAU TIP $ 132.00 C1781 GYNECARE PROLIFT ANTR RPR KIT $ 2,582.00 KIT, ENDOMTRL ABLTN DISP CS/3 $ 1,845.00 XXXXXXXXXXXXXXXXXXXXXXXX $ 27.00 C1782 LAPAROSCOPIC TISSUE MORCELATOR $ 1,073.00 LIGSUR ATLS 20CM HND SWTCH SLR $ 1,016.00 LIGSUR ATLS HNED SWTCH LAP SEAL $ 1,009.00 LIGSUR AXS SNAP ELECTRODE $ 469.00 LIGSUR IMPACT INSTRMNT 18CM $ 1,461.00 LIGSUR MAX SNAP ELECTRODE $ 492.00 LIGSUR PRECISE INSTRUMENT $ 254.00 LIGSUR V 5MM SEALER/DIVIDER $ 934.00 PATCH, WITTMAN 20CM X 40CM $ 2,607.00 PENCIL, ELECTROSURGICAL 10F $ 99.00 PROBE, ELECTRHDRLIC LIPTOTRPTR $ 289.00 PROTRAK 5MM INSTRUMENT $ 465.00 RELOAD, CURVED/CUTTER GREEN $ 542.00 RING, RETRCTR 14.1X14.1CM STRL $ 133.00 STAPLER, CNTR LINR STNARD BLUE $ 542.00 STAPLER, CURVD CTTR W/GRN RLDS $ 991.00 STAPLER,CURVD CTTR,BLUE RLDS $ 991.00 STAPL ROTICU 30-3.5 TITAN17617 $ 433.00 STAPL ROTICU 30-3.5 TITANL7615 $ 448.00 SYSTEM, LPRSCPC GLPRT 120MM $ 934.00 TIP, SCISSOR ENDO CUT,DISP $ 127.00 28 FR RT ANGLE THORACIC CATH $ 15.00 C1750 14.5 FR HEMOSPLIT CATH $ 984.00 C1750 14.5 FR HEMOSPLIT CATH 28 CM $ 984.00 C1750 14.5 FR SILVER 27 CM $ 1,023.00 C1750 14.5 FR HEMOSPLIT 27 CM $ 852.00 2.5 MM AGGRESSIVE UCTTER $ 94.00 20 FR RT ANGLE THORACIC CATH $ 27.00 24 FR RT ANGLE THORACIC CATH $ 15.00 24 FR RT ANGLE THORACIC CATH $ 27.00 28 FR RT ANGLE THORACIC CATH $ 27.00 3.5 MM FULL RADIUS BLADE $ 131.00 3.5 MM INCISOR BLADE $ 131.00 3.5MM AGGRESSIVE MENISCUS $ 127.00 32 FR RT ANGLE THORACIC CATH $ 15.00 32 FR RT THORACIC CATH $ 27.00 36 FR RT ANGLE THORACIC CATH $ 20.00

80 4 ML COSEAL $ 892.00 4.0 MM ACROMIONIZER BURR $ 131.00 4.0 MM ELITE ABRADER BURR $ 212.00 4.0 ELITE ACROMOBLASTER BURR $ 212.00 4.0MM BARREL BUR $ 135.00 4.0MM SHARPEDGE MICRO DEBRIDER $ 229.00 4.0MM SLOTTED WHISKER $ 131.00 4.5 INCISION PLUS BLAD $ 132.00 4.5 CURVED SYNOVATOR CON BLADE $ 140.00 4.5 MM FULL RADIUS BLADE $ 131.00 4.5 ORBIT INCISOR PLUS BLADE $ 136.00 5.0MM VLTRA BAREL BUR $ 127.00 5.5 MM ACROMIOBLASTER ELITE $ 212.00 5.5MM ACROMIONIZER BURR $ 131.00 5.5 MM ELITE ABRADER BURR $ 212.00 5.5 MM RADIUS BONECUTTER BLADE $ 212.00 5.5 MM AGGRESSIVE PLUS $ 127.00 5.5 MM BARREL BUR $ 135.00 C1751 9.5 DUAL LUMEN $ 824.00 AGGRASSIVE PLUS 5.5 $ 127.00 C1894 AIR GUARDF $ 229.00 ANGLED APPRASSIVE PLUS 4.5 $ 110.00 ANTHROWAND-SUPER MULTIVAL 50 $ 549.00 ARTHRO ELECTRODE, HOOK 90 $ 30.00 C1781 BARD COMPOSIX MESH $ 3,404.00 C1781 BARD MESH 112640 $ 107.00 C1781 BARD MESH 112680 $ 130.00 BISU-LOC $ 251.00 BOVIE $ 24.00 C1894 BRITE TIP SHEATH 7F $ 99.00 C1894 BRITE TIP SHEATH 8F $ 99.00 CAROTID SHUNT $ 2,134.00 CHOLAGIOGRRAM $ 88.00 CLOSED WOUND SUCTION KIT $ 27.00 CUT REST SURGICAL GLOVES $ 119.00 CUTTING ELECTRODE $ 786.00 C1768 DBL VASCULAR GRAFT 20X10 $ 1,140.00 C1768 DBL VASCULAR GRAFT 24X12 $ 1,140.00 DENVER SPLINT LARGE $ 114.00 DISPOSABLE DEVICE $ 1,845.00 C1781 DUALMESH $ 313.00 ELECTRODES T COND $ 469.00 ELECTROSURGICAL DEVICE $ 99.00 C1781 ENDO GIA DRY $ 310.00 ENDO MICRO DEBRID IRRIG CASSET $ 100.00 ENT EVAC 70EXTRA $ 492.00 C1781 FERI STRIPS $ 321.00 C1757 FOGARTY 5F 80CM $ 94.00 C1757 FORGARTY 6F 80 CM $ 94.00 C1757 FOGARTY 2 FR 50 CM $ 152.00 C1757 FOGARTY 3FR 80 CM $ 94.00 C1757 FOGARTY 3FR 40 CM $ 152.00 C1757 FOGARTY 4F 40 CM $ 94.00 GASTROSTOMY FEEDING TUBE 14FR $ 130.00 GASTROSTOMY FEEDING TUBE 16FR $ 103.00 C1768 GORTEX STRECH VAS GRAFTV06040L $ 673.00

81 C1768 GORTEX STRECH VAS GRAFTS47045 $ 1,173.00 GORTEX SUTURE $ 62.00 C1768 GRAFT 20X30 $ 1,080.00 GRAFT SIZER $ 35.00 C1769 GUIDE WIRE $ 35.00 C1750 HEMOGLIDE P.C. CATH 5663260 $ 915.00 C1750 HEMOSPLIT 19 CM $ 984.00 C1750 HEMOSPLIT $ 839.00 C1750 HEMOSPLIT 35MM $ 984.00 C1750 HEMOSTAR CATH 16FR $ 863.00 INTRADUCER $ 65.00 LEEP RADIUS ELECTRODE $ 55.00 LEG BAG $ 23.00 C1750 MAHURKAR $ 454.00 C1781 MOTIFMESH PTSF0611 $ 305.00 C1781 MOTIFMESH PTSF0715 $ 470.00 C1781 MOTIFMESH PTSF1515 $ 907.00 C1781 MOTIFMESH PTSE2030 $ 2,943.00 NERVE LOCATOR $ 134.00 C1771 OBTURATOR SYSTEM $ 1,533.00 OPTHALAMICS SELF THREAD MONOKA $ 202.00 ORBIT 4.5 INCISION BLADE $ 146.00 PAPARELLA-VENT TUBE 1.02MM $ 81.00 PAPARELLA-VENT TUBE 1.14MM $ 77.00 C1781 PERFIX PLUG LRG $ 484.00 C1781 PERFIX PLUG MED $ 480.00 C1781 PERFIX PLUG SMALL $ 475.00 C1781 PERFIX PLUG X-L $ 563.00 PRECISE INSTR $ 509.00 C1768 PROPATEN VASC GRAFT H060040A $ 1,615.00 C1768 PROPATEN VASC GRAFT HTO84050A $ 2,700.00 QUICK PRESSURE MONITOR SET $ 191.00 C1750 QUINTON $ 114.00 C1768 REINFORCE VASCULAR GRAFT 6X80 $ 1,461.00 RHINO ROCKET LARGE $ 34.00 RHINO ROCKET MEDIUM $ 30.00 RHINO ROCKET SMALL $ 29.00 RHINO ROCKET X-LARGE $ 39.00 SHORT BEVEL 35 $ 549.00 SPRAY SET COSEAL $ 130.00 SPRAY SET TISSEL 0600013 $ 130.00 STEEL CONV CUTTING $ 64.00 C1768 STR VASCULAR GRAFT 8MM $ 714.00 C1768 STR VASCULAR GRAFT 10MM 6MM $ 238.00 C1768 STR VASCULAR GRAFT 20MM X6MM $ 380.00 SUPER TURBO VAC $ 559.00 SURGICAL PATTIES 80-1407 $ 1.50 SURGICAL PATTIES 80-1404 $ 27.00 C1763 SURGISIS $ 8,523.00 THERMA CHOICE $ 1,441.00 C1782 TISSUE MORCELLATOR $ 1,073.00 TRACH CANNULA $ 15.00 C1769 TRACH INTRODUCER TRAY $ 574.00 TRACH TUBE PTX520000 $ 7.00 A7521 TRACH TUBE 60XLTCD $ 136.00 A7520 TRACH TUBE 5.5 PED $ 70.00

82 TRACH TUBE 10 DCT $ 91.00 TRACH TUBE 6CFS $ 92.00 A7521 TRACH TUBE 6DCT $ 95.00 A7520 TRACH TUBE 6 CFN $ 97.00 A7521 TRACH TUBE 8LPC $ 114.00 A7521 TRACH TUBE 8 FEN $ 123.00 STEEL CONV CUTTING $ 136.00 B4087 TRANSGASTRIC JEJUNAL FEED TUBE $ 700.00 C1781 TRELEX NATURAL MESH 1 X 4 $ 418.00 T-TUBE DEAVER 14FR $ 37.00 T-TUBE DEAVER 10 FR $ 37.00 T-TUBE DEAVER 12FR $ 37.00 T-TUBE DEAVER 16 FR $ 37.00 20 FR RT ANGLE THORACIC CATH $ 15.00 3.5MM RESECTOR $ 127.00 4.0M AGGRESSIVE PLUS $ 127.00 C1751 5 FR DUAL LULMEN BASIC TRAY $ 185.00 C1751 9 FR DUAL LUMEN BASIC TRAY $ 202.00 C1768 BARD LOW POROSITY FELT $ 46.00 CATH ADAPTOR $ 40.00 DENVER SPLINT SMALL $ 114.00 ENT TRAY DISPOSABLE $ 114.00 C1757 FOGARTY 4F 80 CM $ 94.00 C1768 GRAFT 22X30 $ 1,080.00 INFANT ELECTRODE $ 23.00 C1781 MOTIFMESH PTSE1522 $ 1,467.00 PAPARELLA-VENT TUBE 1.27 $ 60.00 C1768 PROPATEN VASC GRAFT HT067090A $ 4,390.00 C1765 SEPRAFILM ADHESION BARRIER $ 524.00 T-TUBE DEAVER 8FR $ 37.00 C1894 SUPER SHEATH $ 32.00 C1771 TVT DEVICE $ 1,334.00 ULTRAWAX DBL VELOUR 24X30MM $ 1,080.00 VACULAR PATCH 10MM $ 688.00 C1768 VASCULAR CORETEX $ 673.00 C1768 VASVULAR GRAFT 18X9 $ 1,521.00 C1769 VASCULAR KIT $ 492.00 VASCULAR PATCH 20 MM $ 732.00 C1768 VASVULAR PROPATEN $ 1,933.00 A4623 TRACH CANNULA $ 15.00 C1768 VASCULAR RINGED $ 1,666.00 C1768 VASCULAR STRECH $ 878.00 VEIN STRIPPER $ 75.00 A7520 TRACH TUBE 4 CFN $ 97.00 T-TUBE DEAVER 18FR $ 37.00 C1713 SCREW, CORTICAL, SELF DRILLING $ 324.00 C1713 OSTEO TITE, STERILE $ 408.00 C1713 SHAFT, SCREW, 50MM, 6.0MM $ 324.00 STERILIZATION, SCREWS TRAY $ 855.00 COVERS, SCREW, PK OF 20 $ 125.00 C1713 TITANIUM CORTICAL SCREW $ 408.00 C1713 SCREW, XCALIBER SDRILL STERILE $ 408.00 BONE SCREW RACK $ 408.00 C1713 SCREW, XCALIBER, SELF-DRILLING $ 384.00 BONE SCREW CUTTER $ 3,611.00 HAND DRILL $ 1,054.00

83 BONE SCREW SIZE RULER $ 242.00 SCREW CONNECTOR $ 904.00 UNIVERSL T-WRENECH $ 1,085.00 STERILIZATION TRAY $ 1,505.00 C1713 SCREW, DISTAL RAD VOLAR $ 227.00 C1713 PLATE, VOLAR DIS RAD C2 STD $ 1,880.00 C1713 PLATE, VOLAR DIS RAD LONG $ 2,124.00 ASSEMBLY, 3.0MM HEX DRIVER $ 472.00 BENDER, STRAIGHT PLATE $ 319.00 BENDER, THREADED PLATE $ 286.00 K-WIRE, 1.1MM X 150MM $ 96.00 HEX KEY 1.5MM L-PATTERN LONG S $ 96.00 DEPTH GAUGE, DISTAL $ 945.00 DEPTH GAUGE, PROXIMAL $ 974.00 HEX DRCR QUCK KCONNCT TIP 1.5MM $ 413.00 1.5MM HEX DRVER ASSEMBLY $ 1,550.00 GUIDE, 1.6MM - 2.0MM DRILL $ 560.00 GUIDE, 2.5MM DRILL $ 573.00 DRILL BIT, QUICK CONNECT $ 240.00 KIT, DRILL BIT 1 $ 41.00 DRILL BIT 180 $ 284.00 KIT, DRILL BIT CANNULATED $ 555.00 DRILL BIT, CANNULATED 1 $ 420.00 DRILL BIT, CANNULATED 2 $ 458.00 K-WIRE, 1.5MM X 250MM $ 150.00 DRILL BIT, CALIBRATED $ 420.00 K-WIRE, 2 X 150MM $ 96.00 KIT, DRILL BIT 2 $ 428.00 DRILL BIT 140MM $ 302.00 KIT, DRILL BIT 3 $ 437.00 KIT, DRILL BIT 24 $ 443.00 DRILL BIT $ 289.00 KIT ASSEMB TEMPLATE SM FIXATOR $ 4,602.00 TEMPLATE, SMALL FIXATOR ASSEMB $ 2,095.00 GUIDE, SCREW, 32MM $ 153.00 GUIDE, DRILL, 20MM, 3.2MM $ 153.00 TEMPLATE, ARTICUL BDY SML FIXTR $ 576.00 KIT, FIXATOR, SMALL $ 4,662.00 CAM, 5MM, SMALL FIXATOR $ 251.00 BUSH, SMALL FIXATOR $ 192.00 CLAMP, STRAIGHT, SMALL FIXATOR $ 842.00 CLAMP, T, SMALL FIXATOR $ 1,144.00 COMPRSSN/DISTRCTN UNT SML FXTR $ 1,068.00 SCREW, CLAMP, M6 X 14 $ 88.00 NUT, LOCKING, BODY, SMALL $ 107.00 WRENCH, ALLEN, 5MM $ 196.00 BODY, MALE, SMALL $ 272.00 BODY, CENTRAL, SMALL $ 272.00 BODY, ARTICULATING HIP $ 3,363.00 TORQUE WRENCH 5MM $ 1,234.00 O-RING, SILICONE, (10 EACH) $ 20.00 BODY ARTICL SLF ALGNG SML FXTR $ 3,363.00 KIT, FIXATOR, PEDIATRIC $ 4,662.00 FIXATOR, PEDIATRIC $ 3,363.00 BLUE SMALL CENTRAL BODY $ 1,668.00 SMALL BLUE BUSH $ 192.00

84 SMALL BLUE STRAIGHT CLAMP $ 1,136.00 T-CLAMP, PEDIATRIC FIXATOR $ 1,144.00 CAM, 6MM $ 331.00 COMPRESSION/DISTRACTION UNIT $ 1,152.00 DYNAMIZATION COLLAR, DYNARING $ 458.00 SCREW, CLAMP, M8 X 17 $ 121.00 NUT, BODY LOCKING, 6MM $ 150.00 CLAMP, DOUBLE-COUPLING $ 2,465.00 CLAMP COVER $ 620.00 COMPRSSN/DISTRCTION UNIT SHORT $ 1,152.00 O-RING $ 22.00 SUPPLMNT SCRW HLDER W/OUTRGGER $ 2,465.00 SUPLMNT SCRW HLDER-OUTRG 150MM $ 121.00 CLAMP, ANGLED SCREW $ 2,465.00 ASSEMBLY TEMPLATE, SHORT $ 1,505.00 GUIDE, SCREW, 160MM $ 231.00 GUIDE, DRILL, 140MM, 4.8MM $ 231.00 TEMPLATE, GARCHES LENGTHENER $ 2,715.00 TEMPLTE ARTCLTG BDY10022/10036 $ 900.00 C1713 EIGHT-PLATE GUIDE GROWTH SCREW $ 461.00 C1713 EIGHT-PLATE GUIDED GROWTH PLATE $ 821.00 TEMPLATE, METAPHYSEAL CLAMP $ 1,505.00 WIRE GUIDE, 2MM $ 302.00 TEMPLATE TORBAY GARCHES RALCNT $ 1,505.00 MANIPULATION FORCEPS $ 1,963.00 ALIGNMENT GRID $ 753.00 ANKLE PIN GUIDE RADIOLCNT CLMP $ 753.00 X-RAY OVERLAY, SCREW MAGNIFICA $ 231.00 ISKD NAIL FEMORAL $ 29,503.00 ISKD NAIL TIBIA $ 29,503.00 C1713 SCREWS STANDARD NON-STERILE $ 384.00 C1713 SCREW- REVISION (NON STERILE) $ 413.00 C1713 X-WIRE WITH CENTRAL OLIVE $ 387.00 C1713 POST, 50MM - 100MM $ 369.00 BALL JNTD CONNCTNG ROD SHEFFLD $ 2,172.00 COUPLING, BALL JOINT $ 1,449.00 PROCALLUS, WITH BALL JOINT $ 7,239.00 ISKD, LENGTHENER TEMPL MARKING $ 454.00 X-WIRE WITH OLIVE $ 452.00 X-WIRE, NO OLIVE $ 243.00 K-WIRE COVERS (20 EACH) $ 112.00 C1713 SCREW, RING CONNECTING $ 177.00 TRANSLATION/ROTATION HINGE $ 1,799.00 HINGE CLAMP $ 1,272.00 C1713 EXTENSION PLATE $ 644.00 TEMPLATE, SWIVEL CLAMP, LRS $ 1,992.00 35MM BOLT KIT $ 276.00 NUTS AND WASHERS (20 EACH) $ 243.00 SLOTTED WASHERS (10 EACH) $ 900.00 BOLTS 25MM (10 EACH) $ 276.00 COUNTER NUT $ 145.00 SPEED WRENCH, 10MM $ 276.00 OPEN END WRENCH, 10MM $ 192.00 THREADED BARS (3 EACH) $ 354.00 THREADED BAR $ 131.00 300MM RADIOLUCENT BAR $ 467.00

85 RADIOLUCENT RING, 2/3 $ 2,830.00 RADIOLUCENT RING, 1/3 $ 1,062.00 GUIDE, DRILL, 8.0/4.8MM DIA $ 147.00 2 HOLE K-WIRE CLAMP KIT $ 579.00 SUPP SCRW HOLD 150MM RADLU BAR $ 210.00 WRENCH, ALLEN, 3MM POLYHEDRAL $ 54.00 WRENCH, ALLEN, 6MM POLYHEDRAL $ 207.00 WRENCH, TORQUE 6MM $ 1,209.00 STOP, DRILL BIT $ 101.00 DEPTH GAUGE $ 959.00 TEMPLATE CENTRAL BODY STD LONG $ 1,505.00 C1713 GUIDE, SCREW $ 153.00 GUIUDE, DRILL, 40MM, 4.8MM $ 153.00 HAMMER $ 842.00 NUT, LOCKING, HAMMER HEAD $ 82.00 ATTACHMNT TGARCHES TMPLATE LRS $ 1,032.00 TEMPLATEK SANDWICH CLAMP $ 1,992.00 TMPLT STRGHT CLMPLRS PEDIATRIC $ 989.00 TEMPLATE T-CLAMP LRS PEDIATRIC $ 989.00 TEMPLATE SWVL CLMP LRS PEDTRIC $ 1,328.00 TMPLT BALL JNT CPLNGLRS PDTRIC $ 915.00 SCRW LCKNG TMPLT LRS PEDIATRIC $ 82.00 COMPR/DISTR UNIT GARCHES EXT $ 1,490.00 KIT LIMB LENTHNER STD GARCHES $ 9,087.00 KIT, T-CLAMP, STD GARCHES $ 6,299.00 MALE LIM LENGTHENER T-GARCHES $ 2,448.00 CLMP KIT LIMB LGTHR TGARCHS LG $ 6,638.00 CLAMP, T-GARCHES $ 3,320.00 CMPRS/DSTRN UNT STD/LNG CLICKR $ 1,490.00 CLAMP MICMTRC SWVL ADULT ONLY $ 3,630.00 CLAMP, T, LRS $ 3,320.00 CLAMP, END, LRS $ 1,992.00 STOP, DYNAMIZATION, LRS $ 664.00 DYNARING W/CMPRSS/DSTRCT ATTMT $ 826.00 CLAMP, CENTRAL, LRS $ 2,154.00 COUPLING, BALL JOINT, LRS $ 2,154.00 T-GARCHES RAIL ATTACHMENT, LRS $ 2,154.00 RAIL, 120MM, LRS $ 3,025.00 RAIL, 230MM, LRS $ 3,320.00 TCLMP GARCHES ASSY-20070/50542 $ 5,458.00 SANDWICH CLAMP, LRS $ 2,818.00 RAIL, 300MM, LRS $ 3,983.00 RAIL, 400MM, LRS $ 4,278.00 WASHER, LRS $ 266.00 CLAMP, MULTI-PLANAR $ 4,956.00 COUPLER HINGED RAIL-RAIL ADULT $ 3,320.00 COMPRSS/DSTRCT UNT EXT6.2CMLRS $ 1,254.00 CLAMP, T, LRS, REDIATRIC $ 1,652.00 CLAM, T-GARCHES, PEDIATRIC $ 4,632.00 DYNAMIZATION STOP LRS PEDIATRC $ 576.00 DYNARNG-CMPRSS/DSTRCT LRS DTRC $ 915.00 COUPLING BALL JNT LRS PEDIATRC $ 1,652.00 CLAMP, CENTRAL, LRS, PEDIATRIC $ 1,328.00 RAIL, 100MM, LRS, PEDIATRIC $ 2,986.00 RAIL, 150MM, LRS, PEDIATRIC $ 3,320.00 RAIL, 200MM, LRS, PEDIATRIC $ 3,644.00

86 RAIL, 250MM, LRS, PEDIATRIC $ 3,983.00 LOCKING SCREW, LRS, PEDIATRIC $ 134.00 CLAMP, SWIVEL, LRS, PEDIATRIC $ 2,154.00 COUPLR HNGD RAIL-RAIL PEDIATRIC $ 3,320.00 CALCANEAL FIXATOR STERILE KIT $ 11,447.00 MINIRAIL LENGTHENER $ 3,196.00 MINIRAIL LENGTHNR SHORT 32/5MM $ 3,196.00 T-CLAMP USED-2MM/3//MM DMTR PINS $ 626.00 MINIRAIL, ARTICULATED $ 3,196.00 SCREW, CLAMP, M4X8 MINIFIXATOR $ 121.00 COVER, CLALMP, MINIFIXATOR $ 260.00 MINIFIXATOR, CALCANEAL $ 3,205.00 CALCANEAL FIXATOR $ 9,471.00 STERILIZTN TRAYMINIFXTRS EMPTY $ 1,593.00 NON-SWIVEL MINIRAIL CLAMP COVR $ 284.00 WRENCH, T $ 316.00 DRIVER FOR 3MM SHAFT SCREWS $ 349.00 FORCEPS, SCREW (PAIR) $ 853.00 MINIRAIL TEMPLATE KIT-SET OF 4 $ 631.00 MINIRAIL CALCANEAL OSTEOTMY FIXTR $ 4,420.00 C1713 SHORT MINIRAIL $ 3,246.00 M2 GEARED MINIRAIL FIXATOR $ 10,262.00 ARTD MINIRL FXTR HRZN AXS2SIDE $ 10,262.00 GUIDE, DRILL, 2.7MM $ 243.00 GUIDE, PILOT WIRE, 1.6MM $ 243.00 TROCAR, PENNIG $ 243.00 KIT, SMALL METACARPAL $ 1,411.00 WRENCH, T FOR CLAMP SCREWS $ 243.00 DOUBLE BALL JOINT, PENNING I $ 788.00 C1713 SCREW, CLAMP/SLIDE, PENNIG I $ 101.00 FIXATOR, WRIST, PENNIG II $ 4,834.00 FXTR WRST WDSTRCTN MDLE PNG II $ 5,158.00 FXTR WRST EXTRA ARTCLR PNNIG II $ 5,405.00 CAM, PENNIG II $ 243.00 BUSH, PENNIG II $ 180.00 MODULE SHRT-STRGHT CLMP PENG II $ 2,039.00 MODULE SHRT W/TCLAMP PENNIG II $ 1,997.00 MDL LNG W/STRGHT CLMP PNNIG II $ 2,060.00 DOUBLE BALL JOINT, PENNIG II $ 758.00 CLAMP, STRAIGHT, PENNIG II $ 573.00 CLAMP, ULNA OUTRIGGER PENNIG II $ 2,340.00 MODULE, DISTRACTION, PENNIG II $ 2,356.00 CLAMP EXTRA ARTICULR RADIOLCNT $ 1,612.00 C1713 SCRW RDLCNT CLMPCVR XARCLR 3PK $ 305.00 SCREW, CLAMP COVER, PENNIG II $ 101.00 CLAMP, T, PENNIG II $ 490.00 K-WIRE, 1.5 X 150MM, (2 EACH) $ 218.00 STERILZTN TRAY PENNIG II EMPTY $ 2,140.00 BODY, SHORT, PMF $ 1,951.00 BODY, STD, PMF $ 2,036.00 BODY, LONG, PMF $ 2,140.00 KIT, SHORT, PMF $ 3,552.00 KIT, STANDARD, PMF $ 3,633.00 KIT, LONG, PMF $ 3,717.00 BODY, EXTRA LONG, PMF $ 2,211.00 CLAMPS, L, LEFT/RIGHT $ 1,769.00

87 CLAMPS, STD, 1 PAIR $ 1,612.00 NUT, COMPRESSION/DISTRACTION $ 54.00 CLAMP, LOCKING SCREW $ 54.00 BAR, STRAIGHT MINI PENNIG $ 1,057.00 C1713 SPACER, C/D NUT $ 227.00 WIRE, THREADED (4 EACH) $ 331.00 EXTRACTOR, THREADED WIRE $ 278.00 TRAY, STERILIZATION, PMF $ 1,057.00 PMF SPCL STR CLAMP 3MM SCRW PR $ 2,293.00 COVERS, PENNIG SCREWS PK OF 20 $ 134.00 KIT, FIXATOR PROCALLUS $ 7,287.00 BODY PROCALLUS $ 3,127.00 BUSH, PROCALLUS $ 281.00 CLAMP PROCALLUS $ 1,431.00 ACTUATOR PROCALLUS $ 1,269.00 NUT, LOCKING, M10, PROCALLUS $ 54.00 CENTRAL BODY LOCKING NUT $ 134.00 BODY, MALE PROCALLUS $ 930.00 BODY, FEMALE PROCALLUS $ 930.00 BODY ARTICLTD HIP FMLE PROCLLS $ 4,749.00 KIT, FIXATOR, SHORT, PROCALLUS $ 7,287.00 BODY, SHORT, PROCALLUS $ 3,127.00 ACT SHRT PROCLLS EXTNDS 2.75CM $ 1,269.00 BODY, MALE, SHORT, PROCALLUS $ 930.00 BODY, FEMALE, SHORT, PROCALLUS $ 930.00 FXTR SELFALGNG ARTCLTG PROCLLS $ 10,533.00 BODY SELFALIGN ARTCLTG PROCLLS $ 4,589.00 SUPPLMNTARY SCREW HOLDER CLAMP $ 791.00 CLMP RDLCNT ANKL NS[-DSTRCT SYS $ 4,130.00 ANKLE DISTRACTOR SHCEDID SRGRY $ 4,278.00 KIT, ANKLE DISTRACTOR RE-PACK $ 2,642.00 ALLEN WRENCH, 4MM $ 202.00 RADIOLCNT WRST BSC KIT W/O SCRW $ 2,650.00 RADIOLCNT WRST CMPKIT-SD SCRWS $ 3,983.00 XRAY OVRLY RADIOLCNT WRST SSTM $ 243.00 POLYHEDRAL ALLEN WRENCH, 6MM $ 207.00 DRILL BIT KIT, 4.0/310MM $ 399.00 SCREW T-WRENCH HEXAGONAL 3.5MM $ 243.00 LOCKING SCREW DEPTH GAGE $ 311.00 STRAIGHT TROCAR, 8MM $ 153.00 GRADUATED ANGLED TROCAR, 8/4MM $ 231.00 DRILL GUIDE, 4MM $ 153.00 COUNTERSINK HAND DRILL 8/4MM $ 231.00 T-HANDLED LOCKING SCREW EXTRCTR $ 231.00 HANDLE $ 606.00 SHORT GUIDE BAR140-220MM NAILS $ 311.00 SMOOTH SCREW GUIDE $ 153.00 REAMER GUIDE SLEEVE $ 153.00 K-WIRE, 3MM, 400MM LENGTH $ 153.00 CANNULATED HAND REAMER 12/10MM $ 1,209.00 STERI-TRAY, INSTRUMENTS $ 753.00 STERI-TRAY, IMPLANTS $ 1,054.00 C1713 STD LOCKING SCREW $ 311.00 C1713 REVISION LOCKING SCREW $ 384.00 WASHERS (PACK OF 4) $ 236.00 RETROGRADE NAIL $ 3,762.00

88 RETROGRADE NAIL END CAP $ 302.00 C1713 TL NUT PLASTIC SQURE DRV 10MM $ 66.00 C1713 TL LINEAR DITRCTR THREAD 115MM $ 436.00 C1713 TL LINR DSTRCTR TELESCPC 100MM $ 1,299.00 C1713 TL LINR DSTRCTR TELESCPC 150MM $ 1,443.00 C1713 TL LINR DSTRCTR TELESCPC 200MM $ 1,587.00 C1713 TL LINR DSTRCTR TELESCPC 70MM $ 1,155.00 TL HINGE TELSCOPIC EXTNDR 100MM $ 577.00 TL ROD THREAD W/BALL PROFL 60MM $ 132.00 TL ROD THREAD -BALL PROFL 200MM $ 171.00 TL HINGE, INLINE, 100MM $ 1,035.00 TL HINGE, OUTBOARD 100MM $ 1,691.00 C1713 TL, ANGULAR DISTRACTOR, 100MM $ 2,491.00 TL, ANGULAR DISTRACTOR, 150MM $ 2,754.00 C1713 TL ANGLR DSTRCTR EXTND BRACKET $ 905.00 TL ROD THREAD-BALL PRFLE 150MM $ 157.00 TL, HEX DRIVER, STRAIGHT, 1/8" $ 302.00 HEX DRICER, POWER, 1/8" $ 171.00 TL, WRENCH, PATIENT, 10MM $ 78.00 TL, WRENCH, DOUBLE, 10MM $ 197.00 TL, TRAY, DISTRACTORS & HINGES $ 1,744.00 TL, WRENCY, T-3MM $ 302.00 TL, NUT APPLICATOR $ 171.00 C1713 TLHALT PIN TAPAERED SELF THREAD $ 380.00 TL POST 1HOLD ASSMBLD 12MM BOLT $ 380.00 TL POST 2HOLDE ASSMBLD 12MM BOLT $ 420.00 TL POST 3HOLDE ASSMBLD 12MM BOLT $ 433.00 TL POST 4HOLDE ASSMBLD 12MM BOLT $ 446.00 TL, WASHER, THIN, 1MM $ 12.00 TL, WASHER, THICK, 2.5MM $ 27.00 STOPPER, RUBBER $ 12.00 TL TR DBL WIRE HLF PIN INSTMNT $ 1,744.00 C1713 TL BOLT HALF PIN FIXTN UNIVRSL $ 315.00 TL, WIRE, BAYONET 1.8MM X 370MM $ 315.00 TL, ROD THREADED W/HEX DRIVE $ 132.00 C1713 TL, PLATE, 2-HOLE $ 249.00 TL ROD THREADED-/HEXDRIVE 85MM $ 105.00 TL, SPACER, 10MM/30MM $ 93.00 TL, SPACER, 15MM/35MM $ 105.00 TL, SPACER, 20MM/40MM $ 117.00 TL, SPACER, 25MM/45MM $ 132.00 TL, SPACER, 30MM/50MM $ 144.00 C1713 TL ARCH 90MM-120MM SHORT/LONG $ 2,019.00 TL, PLATE, 3-HOLE $ 276.00 TL, PLATE, 4-HOLE $ 315.00 TL, PLATE, 5-HOLE $ 354.00 TL ROD THREADED-HEX DRICE 60MM $ 105.00 TL ROD THREADED-HEX DRIVE 200MM $ 144.00 TL ROD THREADED-HEX DRIVE 300MM $ 157.00 TL ROD THREADED-HEX DRIVE 400MM $ 171.00 TL, TRAY, ARCHES & PLATES $ 1,744.00 TL, RING, FULL, 800MM $ 1,639.00 TL, RING, FULL, 100MM $ 1,796.00 TL, RING, FULL, 120MM $ 2,085.00 TL, RING, FULL, 130MM $ 2,373.00 TL, RING, FULL, 140MM $ 2,517.00

89 TL, RING, FULL, 150MM $ 2,662.00 TL, RING, FULL, 160MM $ 2,688.00 TL, RING, FULL, 170MM $ 2,950.00 TL, RING, FULL, 200MM $ 3,213.00 TL, RING, FULL, 220MM $ 3,474.00 TL, RING, FULL, 240MM $ 3,999.00 TL, RING, HALF, 80MM $ 852.00 TL, RING, HALF, 100MM $ 891.00 TL, RING, HALF, 120MM $ 1,075.00 TL, RING, HALF, 130MM $ 1,218.00 TL, RING, HALF, 140MM $ 1,299.00 TL, RING, HALF, 150MM $ 1,364.00 TL, RING, HALF, 160MM $ 1,443.00 TL, RING, HALF, 170MM $ 1,508.00 TL, RING, HALF, 200MM $ 1,652.00 TL, RING, HALF, 220MM $ 1,796.00 TL, RING, HALF, 240MM $ 2,032.00 TL, RING, 5/8, 100MM $ 1,218.00 TL, RING, 5/8, 120MM $ 1,364.00 TL, RING, 5/8, 130MM $ 1,508.00 TL, RING, 5/8, 140MM $ 1,573.00 TL, RING, 5/8, 150MM $ 1,652.00 TL, RING, 5/8, 160MM $ 1,731.00 TL, RING, 5/8, 170MM - 180MM $ 1,796.00 TL, RING, 5/8, 200M $ 1,941.00 TL, FOOT PLATE, 100MM $ 1,115.00 TL, FOOT PLATE, 120MM $ 1,179.00 TL, FOOT PLATE, 130MM $ 1,245.00 TL, FOOT PLATE, 140MM $ 1,311.00 TL, FOOT PLATE, 150MM $ 1,377.00 TL, FOOT PLATE, 160MM $ 1,508.00 TL, FOOT PLATE, 170MM $ 1,573.00 TL, FOOT PLATE, 180MM $ 1,639.00 TL, FOOT PLATE, 200MM $ 1,705.00 TL, EXTENSION FOOT PLATE 3-HOLE $ 563.00 TL, EXTENSION FOOT PLATE 5-HOLE $ 708.00 TL, EXTENSION FOOT PLATE 7-HOLE $ 761.00 C1713 VERONAIL TITAN TROCHANTERI NAIL $ 3,655.00 VERONAIL TITANIUM NAIL END CAP $ 588.00 C1713 VERONAIL TITAN TROCHANT LGNAIL $ 5,281.00 C1713 VERONAIL TITAN FIX PROX SCREW $ 1,133.00 C1713 VERONAIL TITAN SLIDE SCREW KIT $ 1,133.00 C1713 TITANIUM LOCKING SCREW D.4.8MM $ 514.00 RADIOLUCENT HANDLE $ 2,950.00 INDERTION KNOW M8X1 $ 221.00 LOCKING ROD $ 221.00 LOCKING ROD $ 192.00 SCREW GUIDE $ 221.00 DRILL GUIDE $ 192.00 CEPHALIC WIRE GUIDE $ 221.00 CALCAR DIRLL STOP $ 134.00 TROCAR $ 221.00 CEPHALIC SCREWDRIVER $ 2,213.00 CEPHALIC DRILL BIT, 0 7.5MM $ 930.00 OPTIONL CLCR DRILL BIT 0 7.5MM $ 930.00 CANNULATED AWL $ 1,918.00

90 SCREW RULER $ 295.00 SCREW GUIDE LOCKING CAM $ 104.00 K-WIRE 0 2MM, L 220MM $ 131.00 CANNULATED SCREW DRIVER $ 1,032.00 GRADTD DRILL BIT 04.8MM L330MM $ 467.00 LOCKING SCREW EXTRACTOR $ 231.00 CEPHALIC WIRE, 0 4MM, L 400MM $ 373.00 GUIDE WIRE 0 2.5MM L 980MM W/OLIVE $ 373.00 GUIDE WIRE 0 3MM L 980MM W/OLIVE $ 434.00 UNIVERSAL CHUCK WITH T-HANDLE $ 1,179.00 THREADED WIRE 0 3MM, L 400MM $ 324.00 PROTECTION SLEEVE 200/16MM $ 369.00 WIRE GUIDE, 16MM/3MM, L125MM $ 147.00 3MM TROCAR, L 145MM $ 221.00 CANNLTD DRILL BIT 0 16MM L 300MM $ 974.00 6MM POLYHEDRAL T-HANDLE WRENCH $ 221.00 FR HD SHT GRD DRIL 0 4.8MM L 180MM $ 408.00 FREE HAND SHORT DRILL GUIDE $ 134.00 VERONAIL TRAY LID $ 737.00 VERONAIL TRAY BAE $ 737.00 KIT XCALBR METADIAPHYSL STRLE $ 9,294.00 KIT XCALBR METAPHYSL-INSTMT STER $ 9,943.00 US XCALIBR MTDIAPHYSL CMPLT KIT $ 13,425.00 STATC CMPRSS/DSTRCT XCLBR STER $ 989.00 DYNMC CMPRSS/DST UNTXCLBR STER $ 989.00 UNIVERSL ALLEN WRENCH 5MM/3MM $ 163.00 KIT SUP SCRW HLDR BAR CLAMP STER $ 1,668.00 KIT XCLBER ARTCLTD ANKLE STER $ 11,580.00 KIT XCLBER ARTD ANKL CMPL STER $ 15,696.00 KIT XCLBER ANKLE CMPLTKIT STER $ 16,228.00 CANN DRILL BIT 3.2X150MM WR SER $ 502.00 RADIOLUCNT ANKLE PIN GDE STRLE $ 826.00 MANIPULATION FORCEPS, XCALIBER $ 2,154.00 KIT, XCALIBER HYBRID, STERILE $ 9,264.00 1/3 RING INNER DIAMETER 175MM $ 885.00 180MM ADULT LRS RAIL $ 3,570.00 ARTICULTD MINIRAIL FXTR W/HINGE $ 5,828.00 ASSY, XCALIBER BONE SCREW RACK $ 295.00 ORIGEN DBM 2CC $ 885.00 ORIGEN DBM 5CC $ 2,213.00 ORIGEN DBM 10CC $ 3,983.00 BONE MRRW ASPRT NDL ORGN DLVRY $ 369.00 TRINITY EVOLUTION 1CC $ 1,623.00 TRINITY EVOLUTION 5CC $ 7,196.00 C1893 TRINITY EVOLUTION 10CC $ 13,096.00 C1893 TRINITY EVOLUTION 15CC $ 16,375.00 EMPTY INSTRUMENT TRAY $ 3,147.00 TL, 1/8" HEX DRIVER $ 499.00 TL, HEX DRIVER, 90-DEGREE 1/8" $ 105.00 TL+ AO 1/8"HEX PWR DRVR ATTMNT $ 247.00 WIRE CUTTER $ 2,610.00 TL PLUS WIRE TENSIONER W/TIP $ 4,590.00 TL, WRENCH, COMBO, 10MM $ 66.00 TL, WRENCH, HINGED COMBO, 10MM $ 171.00 TL, 90 DEGREE TUBULAR WRENCH $ 78.00 85MM THREADED ROD $ 117.00

91 NEEDLE NOSE PLIER STLESS STEEL $ 354.00 T-WRENCH WITH AO CONNECTOR $ 818.00 EMPTY EXTERNAL SUPPORTS TRAY $ 3,934.00 TL PLUS 90MM ARCH $ 2,019.00 TL PLUS FULL RING, 140MM $ 2,517.00 TL PLUS FULL RING, 160MM $ 2,688.00 TL PLUS FULL RING, 180MM $ 2,950.00 TL PLUS FULL RING, 200MM $ 3,213.00 TL PLUS HALF RING, 140MM $ 1,299.00 TL PLUS HALF RING, 160MM $ 1,443.00 TL PLUS HALF RING, 180MM $ 1,508.00 TL PLUS HALF RING, 200MM $ 1,652.00 TL PLUS 5/8" RING, 140MM $ 1,573.00 TL PLUS 5/8" RING, 160MM $ 1,731.00 TL PLUS 5/8" RING, 180MM $ 1,796.00 TL PLUS 5/8" RING, 200MM $ 1,941.00 TL+ FOOTPLATE 140MM $ 1,311.00 TL+ FOOTPLATE 160MM $ 1,508.00 TL+ FOOTPLATE 180MM $ 1,639.00 TL+ FOOTPLATE 200MM $ 1,705.00 TL+ FOOTPLATE EXTENSION 4 HOLE $ 563.00 TL+ FOOTPLATE EXTENSION 6 HOLE $ 708.00 EMPTY FIXATION ELEMENTS TRAY $ 3,934.00 TL, NUT, STAINLESS STEEL, 10MM $ 6.00 C1713 TL+ METAL DISTRACTI/CMPRSS NUT $ 105.00 TL+ EXTENDED NUT M6 X 1 $ 105.00 TL, BOLT, 16MM $ 6.00 TL, BOLT, 20MM $ 6.00 TL, BOLT, 12MM $ 6.00 TL, WASHER, SLOTTED $ 117.00 C1713 TL+ HALF PIN AO $ 380.00 C1713 TL+ UNIV HLF PIN FXTN BLT 4-6MM $ 315.00 TL+ ONE HOLE POST $ 380.00 C1713 TL+ TWO HOLE POST $ 420.00 C1713 TL+ THREE HOLE POST $ 433.00 C1713 TL+ FOUR HOLE POST $ 446.00 C1713 TL+ FIVE HOLE POST $ 459.00 TL WIRE W/STOPPER 1.8MM X 400MM $ 472.00 TL, WIRE, BAYONET 1.8MM X 400MM $ 315.00 TL, APPLICATOR RUBBER STOPPER $ 288.00 C1713 STAINLESS STEEL WASHER 2MM THICK $ 20.00 TL, WASHER, CONICAL PAIR $ 45.00 C1713 TL BOT WIRE FIXATION UNIVERSAL $ 222.00 EMPTY HINGES & DISTRACTORS TRAY $ 3,147.00 TL+ TELSCPC LINR DSTRCTR 100MM $ 1,299.00 TL+ TELSCPC LINR DSTRCTR 150MM $ 1,443.00 TL+ TELSCPC LINR DSTRCTR 200MM $ 1,587.00 TL+ TELSCPC LINR DSTRCTR 70MM $ 1,155.00 TL+ 100MM TELESCOPIC HNGE ENTNDR $ 577.00 TL+ THREADED HINGE ROD, 60MM $ 157.00 TL+ CANNLTD INLINE HNGE ASSMBLY $ 1,035.00 TL+ OUTBOARD HINGE ASSEMBLY $ 1,691.00 C1713 TL+ ANGL DSTRCTR ASSMBLY 100MM $ 2,491.00 C1713 TL+ ANGULAR DISTRACTOR 150MM $ 2,754.00 TL+ THREADED HINGE ROD 150MM $ 183.00 115MM - 165MM THREADED ROD $ 132.00

92 TL PLUS 20MM PLATE $ 249.00 85MM THREADED ROD $ 117.00 TL, OBLIQUE SUPPORT $ 918.00 TL+ 30MM PLATE $ 276.00 TL+ 40MM PLATE $ 315.00 TL+ 50MM PLATE $ 354.00 60MM THREADED ROG $ 117.00 TL+ HEX STANDOFF $ 249.00 TL PLUS HEX STANDOFF 30MM $ 276.00 TL, HINGE, UNIVERSAL $ 1,050.00 TL+ THREADED HEX END ROD 200MM $ 144.00 TL+ THREADED HEX END ROD 300MM $ 157.00 TL+ THREADED HEX END ROD 400MM $ 171.00 MCP DSPSBL PK HALL MICRO SYSTM $ 1,197.00 MCP DPS PK STRYKR CMMD II TPS $ 1,197.00 C1776 METACARPOPHALANGEAL JOINT DIST $ 3,868.00 C1776 METACARPOPHALANGEAL JOINT PROX $ 5,916.00 C1776 SILICONE MCP $ 3,275.00 PIP DISPOSABLE PACK $ 1,501.00 C1776 SILICONE PIP $ 3,275.00 C1776 PROXIMAL INTERPHALANGEAL $ 4,839.00 PHS DISPOSABLE PACK $ 1,314.00 C1776 PYRO HEMISPHERE $ 5,916.00 C1776 PCS PYROSHPERE $ 6,864.00 CMC DSPSBL PACK - HALL/STRYKER $ 1,314.00 C1776 CMC DISTAL HEMI $ 5,916.00 C1776 NUGRIP IMPLANT $ 6,213.00 NUGRIP AXIAL CANNULATED CUTTER $ 410.00 C1776 Stem $ 7,819.00 C1776 RADIAL HEAD STANDARD $ 6,832.00 C1776 RADIAL HEAD LONG $ 7,819.00 C1713 TI, LOCKING SCREW, 2.7 $ 541.00 C1713 TI, STD SCREW, 2.7 $ 354.00 C1713 TI, RH PLATE $ 2,460.00 DRILL BIT, 2.0MM (STAINLESS) $ 426.00 K-WIRE 0.9MM X 105,, STAINLESS $ 66.00 KWIRE PN BON 1.2X 100MM STNLS $ 66.00 C1713 TI, HI COMP SCREW, CANNULATED $ 1,230.00 C1713 TI, MINI COMP SCREW CANNULATED $ 1,230.00 ASCN MINI CNNLA DRILL-DPTH GUG $ 518.00 ASCENSION MICRO TISSUE PRTCTOR $ 312.00 KWIRE-CANNLTD SCRWS 0.9 X 105MM $ 66.00 KWIRE PIN BONE 1.2MM X 100MM $ 66.00 C1776 Head $ 4,728.00 C1776 STANDARD STEME $ 10,920.00 C1776 MEDIUM STEM $ 11,700.00 C1776 LONG STEM $ 12,481.00 ULNR HD DSPS PK HLL MCRO SYSTSM $ 1,075.00 ULNR HD DSPS PK STKER CMND II $ 1,075.00 C1776 FIRST CHOICE HEAD, STEM $ 16,348.00 C1776 PYROCARBON LUNATE $ 11,703.00 C1776 TITAN COMPONENT $ 15,942.00 C1776 TITAN SHAPER $ 888.00 C1713 STEINMANN UNTHREADED PIN $ 108.00 C1776 NEUROLAC - NERVE TUBE <10.0MM $ 3,426.00 C1776 NEUROLAC - NERVE TUBE >10.0MM $ 4,543.00

93 FLEXIGLIDE SHEET, 2 X 3CM $ 1,368.00 FLEXIGLIDE SHEET, 5 X 7CM $ 2,091.00 FLEXIGLIDE SHEET, 10 X 13CM $ 4,468.00 C1713 OPEN WEDGE PLATE $ 3,786.00 C1713 FOREFOOT UNIVERSAL PLATE $ 3,570.00 C1713 MPJ FUSION PLATE $ 4,573.00 DRILLBIT STRYKERFIT 2.7MM SCRW $ 426.00 CUP SPHERICAL REAMER $ 492.00 C1713 2.0MM X 150MM GUIDE PIN $ 66.00 C1713 LAPIDUS PLATE, WITHOUT STEP $ 4,186.00 C1713 LAPIDUS PLATE, STEP $ 4,186.00 C1713 INTERPOSITNING PLATE W/OUT STM $ 4,186.00 C1713 INTERPOSITNING PLATE STEM $ 4,186.00 C1713 REARFOOT UNIVERSAL PLATE $ 3,786.00 C1713 RRFT RCNSTRCT PIT 37MM - 6 HOLES $ 3,918.00 C1713 RRFT RCNSTRCT PIT 50MM - 6 HOLES $ 3,267.00 C1713 RRFT RCNSTRCT PIT 66MM - 4 HOLES $ 5,410.00 C1713 FLATLINE ARTHRODESIS PLATE $ 3,618.00 C1713 DWYER DISPLACEMENT PLATE $ 4,413.00 C1713 CALCANEUS PLATE $ 4,413.00 C1713 LOCKING SCREW, 2.5 $ 541.00 C1713 STD SCREW $ 354.00 SYNTHES STYLE TWIST DRILL $ 426.00 C1713 DRILL BIT STRYKE FIT 3.5MM SCRW $ 426.00 C1713 STRAIGHT PLATE $ 2,927.00 C1713 T-SHAPE PLATE $ 3,272.00 C1713 LOCKING SCREW, 2.7 $ 541.00 DRILL BIT AO FITTING $ 426.00 SCREW ON DRILL GUIDE $ 456.00 K-WIRE 100 X 1.1MM $ 66.00 CANNULATED SCREW $ 459.00 C1713 HEADLESS SCREW $ 557.00 C1713 QUICK SNAP SCREW $ 524.00 C1713 DIGITAL SCREW $ 640.00 TC OVERDRILL $ 508.00 SMOOTH K-WIRE $ 66.00 THREADED K-WIRE $ 66.00 TH CANNULATED RELIEF DRILL $ 541.00 TH SMOOTH K-WIRE $ 66.00 K-WIRE SMOSOTH - DOUBLE POINTED $ 66.00 C1776 METATARSAL IMPLANT $ 5,884.00 C1776 PROXIMAL PHALANX HEMI IMPLANT $ 4,573.00 METATARSAL SURFACE REAMER $ 492.00 PROXIMAL PHALANX SURFACE REAMER $ 492.00 C1713 2.0MM X 125MM GUIDE PIN $ 66.00 4.5MM CANNULATED DRILL $ 492.00 C1713 ACCELL EVO3 2.5CC $ 2,046.00 C1713 ACCELL EVO3 5CC $ 3,147.00 C1713 ACCELL EVO3 10CC $ 5,979.00 ASPIREX BONE MRRW ASPIRATE KIT $ 295.00 ASPRX PLS BONE MRRW ASPRTE KIT $ 872.00 C1713 ACCELL 100 1CC $ 842.00 C1713 ACCELL 100 5CC $ 2,391.00 C1713 ACCELL 100 10CC $ 475.00 C1713 ACCELL CONNEXUS 1.5CC $ 354.00 C1713 ACCELL CONNEXUS 1CC $ 620.00

94 C1713 ACCELL CONNEXUS 2.5CC $ 1,166.00 C1713 ACCELL CONNEXUS 5CC $ 2,051.00 C1713 ACCELL CONNEXUS 10CC $ 3,497.00 C1713 ACCELL TBM SQUARE 2 X 2 X 0.5CM $ 1,352.00 C1713 ACCELL TBM STRIP 5 X 2 X 0.5CM $ 2,582.00 C1713 ACCELL TBM SQUARE 5 X 5 X 0.5CM $ 5,458.00 C1713 ACCELL TBM ROUND, 7X 0.6CM $ 6,890.00 C1713 ORTH BLAST II PASTE, 0.5CC $ 295.00 C1713 ORTH BLAST II PASTE, 1CC $ 443.00 C1713 ORTH BLAST II PASTE, 3CC $ 1,106.00 C1713 ORTH BLAST II PASTE, 8CC $ 2,508.00 C1713 ORTH BLAST II PUTTY, 5CC $ 1,724.00 C1713 ORTH BLAST II PUTTY, 10CC $ 3,054.00 C1713 OSSATURA BCP 1-2MM, 1CC $ 458.00 C1713 OSSATURA BCP 1-2MM, 5CC $ 871.00 C1713 OSSATURA BCP 1-2MM, 10CC $ 1,608.00 C1713 OSSATURA BCP 1-5MM, 5CC $ 871.00 C1713 OSSATURA BCP 1-5MM, 10CC $ 1,608.00 C1713 OSSATURA BCP 1-5MM, 15CC $ 2,140.00 C1713 OSSATURA BCP 1-5MM, 30CC $ 3,231.00 C1713 OSSATURA TCP 3MM, 5CC $ 871.00 C1713 OSSATURA TCP 3MM, 10CC $ 1,608.00 C1713 OSSATURA TCP 3MM, 15CC $ 2,140.00 OSSATURA TCP 3MM, 30CC $ 3,231.00 C1713 CANNCELLOUS CRUSHED 1-4MM, 15CC $ 812.00 CANNCELLOUS CRUSHED 1-4MM, 30CC $ 1,283.00 CANNCELLOUS CRUSHED 4-10MM, 15CC $ 723.00 C1713 CANNCELLOUS CRUSHED 4-10MM, 30CC $ 1,196.00 C1713 DYNAGRAFT II GEL, 0.5CC $ 295.00 C1713 DYNAGRAFT II GEL, 1CC $ 443.00 C1713 DYNAGRAFT II GEL, 5CC $ 1,726.00 C1713 DYNAGRAFT II GEL, 10CC $ 3,054.00 C1713 DYNAGRAFT II PUTTY, 1CC $ 487.00 C1713 DYNAGRAFT II PUTTY, 2.5CC $ 974.00 C1713 DYNAGRAFT II PUTTY, 5CC $ 1,726.00 C1713 DYNAGRAFT PUTTY, 10CC $ 3,054.00 C9359 MOZAIK PUTTY 2.5CC $ 1,327.00 C9359 MOZAIK PUTTY 5CC $ 2,212.00 C9359 MOZAIK PUTTY 10CC $ 3,684.00 C9359 MOZAIK PUTTY 15CC $ 4,420.00 C9362 MOZAIK STRIP 10CC $ 3,684.00 C9362 MOZAIK STRIP 15CC $ 4,420.00 C1776 22MM COCR FEMORAL HEAD $ 3,720.00 C1776 PROFORM GA CEM. CAST COCR STEM $ 7,293.00 C1776 PS CEMENTED FEMUR, PROVEN $ 13,605.00 C1776 CEMENTED TIBIAL TRAY FEM $ 9,769.00 C1776 PS TIBIAL TRAY INSERT $ 5,557.00 C1776 3-PEG CEMENTED PATELLA $ 3,639.00 C1776 1-PEG CEMENTED PATELLA $ 3,639.00 C1776 BIARTICULAR CUP $ 5,196.00 C1776 CR CEMENTED FEMUR, PROVEN $ 14,343.00 C1776 CR CURVED TIBIAL TRAY INSERT $ 5,557.00 C1776 CR STANDARD TIBIAL TRAY INSERT $ 5,557.00 C1776 PROGENY LAT HIP STEM $ 16,473.00 C1776 PROGENY DISTAL CENTRAL $ 541.00 C1776 PROFORM POROUS BEAD SHELL 2725 $ 8,933.00

95 C1776 CR POROUS COAT FEMUR LEFT $ 19,014.00 C1776 PROFORM POROUS BEAD SHELL 3220 $ 10,556.00 C1776 SURPASS, CERAMIC HEAD $ 7,671.00 C1776 VALGUS BUSHING ASSY, REV KNEE $ 1,688.00 C1776 FEMORAL & TIBIAL STEM $ 4,884.00 C1776 FEMORAL COMPONENT REVISED KNEE $ 24,160.00 C1776 OFFSET, TIBIAL BUSHING ASY $ 1,688.00 C1776 REVISION KNEE TIBIAL TRAY $ 12,817.00 C1776 TIBIAL INSERT ASSY $ 7,622.00 C1776 COCR FEMORAL HEAD $ 3,720.00 C1776 HALF TIBIAL BLOCK W/SCREW $ 4,442.00 C1776 TIBIAL TRAY ASM, MODULAR $ 11,719.00 C1776 TIBIAL WEDGE 10 DEG W/O SCREW $ 4,016.00 C1776 DISTAL FEM SPACER ASM $ 4,426.00 C1776 POSTERIOR FEM SPACER ASM $ 4,426.00 C1776 FEMORAL COMP MODULAR PS $ 18,850.00 C1776 INLAY TIBIAL COMPONENT $ 5,065.00 C1776 LINERS, 32MM NON-HOODED $ 5,327.00 C1776 LINERS, 32MM HOODED $ 5,327.00 C1776 PROCLASS STEM, STD $ 21,555.00 C1776 FEMORAL COMPONENT $ 12,342.00 C1776 LINER, NON-HOOD 28ID PROAR $ 5,327.00 C1776 LINERS, HOODED 28ID PROAR $ 5,327.00 C1776 FEMORAL HEAD ZIRCONIA $ 7,359.00 C1776 SURPASS ACETABUL. SHELL LINER $ 9,769.00 C1776 SURPASS ACETABULAR SHELL $ 8,933.00 C1776 PROVIDENT STEM, STD $ 23,356.00 C1776 PROCLASS STEM, LAT $ 21,555.00 C1776 PROVIDENT STEM, LAT $ 23,356.00 C1776 PROTRACT STEM , LAT $ 23,356.00 C1776 PROTRACT STEM STD HA COAT $ 24,669.00 C1776 PROTRACT STEM, STD $ 23,356.00 C1713 PROTRACT STEM LAT HA COAT $ 24,669.00 C1776 ACETABULAR BONE SCREW $ 574.00 C1776 PROVEN KNEE - PS GENFELX FEMUR $ 14,343.00 C1773 CEMENTED FEM-TIB STEM $ 4,884.00 C1713 TITANIUM SUT ANCHOR 2MM X 1 $ 770.00 C1713 TITANIUM SUT ANCHOR 3MM X 1 $ 820.00 C1713 TINANIUM SUT ANCHOR 4.0MM X 2 $ 852.00 C1713 TITANIUM SUT ANCHOR 5.5MM X2 $ 934.00 ARTHRO TIT SUT ANCHR 5.5MM X2 $ 984.00 SHORT RETROGRADE KNIFE (N/S) $ 984.00 RETROGRADE LIGAMENT KNIFE $ 984.00 C1713 10X15/17.5X1.5 (37-TWO ARMED) $ 1,393.00 C1713 15X10X1.5 (37-TWO ARMED) $ 1,476.00 20X15X(3X2) (37-TWO ARMED) $ 1,557.00 C1713 20X12X12 (3X2) (37-FOUR ARMED) $ 2,787.00 C1713 10X10X1.52 (55-TWO ARMED) $ 902.00 C1713 10X15/17.5X1.5 (55-TWO ARMED) $ 1,065.00 C1713 15X10X1.5 (55-TWO ARMED) $ 984.00 C1713 12X6X12 (1.5X1.5) 55FOUR ARMED $ 2,787.00 C1713 15X7.5X12 (2X1.5) 55FOUR ARMED $ 2,787.00 C1713 TAC-TITE 5.5 TI $ 1,623.00 TISSUE REINFORCEMENT 3X4CM $ 6,294.00 TISSUE REINFORCEMENT 6X9CM $ 10,294.00 SUPLMNT SCRW HLDR-OUTRG 400MM $ 150.00

96 CLAMP, TRAUMA GARCHES $ 2,465.00 CLAMP, METAPHYSEAL $ 2,465.00 COVER, ANGLED SCREW CLAMP $ 620.00 CLAMP, TORBAY-GARCHES $ 2,465.00 TEMPLATE, ANGLED SCREW CLAMP $ 1,505.00 TEMPLATE, TRAUMA $ 1,505.00 CAMMULATED SCREWDRICER, 2.5MM $ 1,062.00 8PIT DRILL BIT CN 3.2MM QUK CNNCT $ 472.00 C1713 K-WIRE 1.6MM X 150MM $ 109.00 EIGHT-PLATE DRILL GUIDE $ 644.00 C1713 STERI-TRAY KIT, EIGHT-PLATE $ 39,830.00 STERI-TRAY KIT EIGHTPLATE EMPTY $ 3,039.00 WIRE TENSIONING DEVICE $ 3,184.00 C1769 GUIDE WIRE $ 531.00 C1713 2-HOLE K-WIRE SECURING PIN $ 546.00 3-HOLE WIRE CLAMP SLIDER UNIT $ 997.00 CLAMP, SHEFFIELD $ 2,172.00 CLAMP, FRAGMENT WIRE $ 546.00 CLAMP, SINGLE SCREW $ 900.00 C1713 HANDLE W/BAR LOCKING SCREW $ 2,465.00 GUIDE BAR PART A W/NYON SCRWS $ 1,660.00 WRENCH, T, SCREW HEX 3.5MM $ 243.00 DEPTH GAUGE FOR LOCKING SCREW $ 311.00 TROCAR, STRAIGHT, 8MM $ 153.00 T-WRENCH, 6MM W/UNIV JOINT $ 290.00 WRENCH, INSTRUMENT, 13MM $ 104.00 C1713 GUIDE, SCREW, TIBIAL NAIL $ 266.00 FEMORAL EXTRACTOR $ 307.00 HAMMER, SLIDING, TIBIAL NAIL $ 664.00 HANDLE, SUPPORT, TIBIAL NAIL $ 1,682.00 BAR, GUIDE, TIBIAL NAIL $ 847.00 EXT JG HANDL LCKG ROD TIBL NAIL $ 324.00 EXT JG PRXML OUTIGGR-TIBL NAIL $ 1,520.00 AWL, POINTED, TIBIAL NAIL $ 251.00 C1713 ADAPTERE, SCREW, TIBIAL NAIL $ 737.00 BLK HANDLE/BAYONET $ 184.00 STERI-TRAY ISKD INSTRMNT EMPTY $ 2,140.00 C1713 LOCKG ROD SCURNG NUT FMRL NAIL $ 295.00 C1713 LOCKING ROD, FEMORAL NAIL $ 177.00 FOOT RING, 150MM, ALUMINUM $ 3,538.00 C1713 K-WIRE CLAMP KIT $ 900.00 C1713 4 HOLE K-WIRE CLAMP KIT $ 677.00 TEMPLATE, STRAIGHT CLAMP $ 1,652.00 TEMPLATE, T-CLAMP, LRS $ 1,652.00 TEMPLATE MULTIPLANAR CLAMP LRS $ 1,652.00 C1713 LOCKING SCREW, TEMPLATE, LRS $ 99.00 TEMPLTE MICROMTRC SWVL CLMP LRS $ 1,992.00 C1713 TEMPLATE, BALL JOINT COUPLING $ 989.00 TEMPLTE BSE ACUTE CORRCTNS LRS $ 1,992.00 TMPLT GARCH END CLMP ACUTE LRS $ 1,992.00 TMPLT STR ENDCLMPACTE CRRCTLRS $ 1,992.00 TMPLT T-END CLMP ACT CRRCTLRS $ 1,992.00 C1713 LOCKG NUT ACUTE CRRTN TMPLTLRS $ 104.00 SCREW LOCKNG, ACUTE CRRCT TMPLT $ 163.00 CURVED RAIL, 100MM, LRS $ 664.00 CURVED RAIL, 130MM, LRS $ 797.00

97 GUIDE, DRILL, 2.0MM $ 243.00 TL, RING, FULL, 180MM $ 2,950.00 TL, RING, HALF, 180MM $ 1,508.00 TL PLUS 120MM ARCH $ 2,019.00 C1713 STEINMANN THREADED PIN $ 125.00 C1776 28MM COCR FEMORAL HEAD $ 3,720.00 C1776 28MM COCR FEMORAL HEAD SKIRT $ 3,720.00 C1713 CANCELLOUS BONE SCREW $ 574.00 C1776 LINERS, 28MM NON-HOODED $ 3,803.00 C1776 LINERS, 28MM HOODED $ 3,803.00 C1776 PROVIDENT SHELL $ 8,933.00 C1776 DISTAL CENTRALIZER $ 541.00 C1776 UNIPOLAR HEAD $ 2,983.00 C1776 CERAMIC FEMORAL HEAD $ 7,359.00 C1776 DTW STEM $ 16,047.00 C1713 TINANIUM SUT ANCHOR 4.0MM X 1 $ 820.00 C1713 10X10X1.5 (37-TWO ARMED) $ 1,311.00 C1713 15X15/17X1.5 (37-TWO ARMED) $ 1,476.00 C1713 20X20X(3X2) (37-TWO ARMED) $ 1,557.00 C1713 25X20X(3X2) (37-TWO ARMED) $ 1,557.00 C1713 30X20X(3X2) (37-TWO ARMED) $ 1,557.00 DRILL 2.0 MM $ 246.00 C1713 PIN 2.0 MM $ 246.00 DRILL 3.5 MMI $ 246.00 C1713 PIN 3.5 MM $ 246.00 C1713 15X15/17X1.5 (55-TWO ARMED) $ 1,065.00 TISSUE REINFORCEMENT 4X6CM $ 7,015.00 CYSTITOME $ 99.00 KNIFE, I $ 309.00 V2630 LENS, INTRAOCULAR $ 309.00 OCCUTOME $ 309.00 KNIFE, CRESCENT $ 302.00 V-LANCE $ 426.00 DRAPE, STERILE LEG $ 50.00 SPACER, CERVICAL $ 2,163.00 NEEDLE, FREE $ 37.00 C1769 LASER FIBER LEVEL 1 $ 793.00 C1888 LASER FIBER LEVEL 2 $ 1,030.00 C1887 CATHETER, OMNI FLUSH $ 340.00 C1750 CATHETER, PD $ 213.00 C1768 GRAFT, COLLEGEN $ 1,543.00 C1713 TIGHTROPE $ 1,530.00 STAPLER, TA90 $ 559.00 C1874 STENT, FLAIR LEVEL 2 $ 3,631.00 C1874 STENT, FLAIR LEVEL 1 $ 3,322.00 C1876 STENT, LIFESTENT LEVEL 1 $ 2,163.00 C1876 STENT, LIFESTENT LEVEL 2 $ 2,936.00 C1887 CATHETER, SEEKER $ 373.00 C1725 CATHETER, PTA RIVAL $ 386.00 C1725 CATHETER, PTA ULTRAVERSE $ 587.00 C1725 CATHETER, PTA CONQUEST $ 528.00 C1725 CATHETER, PTA DORADO $ 476.00 DEVICE, CALIBER $ 108.00 COLLES FRACTURE KIT $ 1,646.00 TORQUE VISE $ 386.00 C1769 PATHFINDER $ 386.00

98 C1769 JAGWIRE $ 386.00 SPHINCTERTOME, ULTRA XL $ 386.00 IOL GLIDE $ 386.00 WET FIELD ERASER $ 386.00 C1713 SCREW, DISTRACTION $ 124.00 LOOP, CUTTING $ 204.00 ROLLERBALL $ 204.00 EXTRACTOR, TIPLESS $ 586.00 EXTRACTOR, HELICAL $ 599.00 EXTRACTOR, NCOMPASS $ 438.00 C1773 GRASPER, THREE PRONG $ 407.00 C2627 CATHETER, SUPRAPUBIC SET $ 180.00 C1769 GUIDEWIRE, NITINOL LEVEL 1 $ 99.00 C1769 GUIDEWIRE, NITINOL LEVEL 2 $ 150.00 C1769 GUIDEWIRE, BENTSEN $ 48.00 C1769 GUIDEWIRE, ROADRUNNER $ 48.00 C2617 STENT, URETERAL SET $ 251.00 C1758 CATHETER, URETERAL LEVEL 1 $ 37.00 C1894 ACCESS SHEATH, URETERAL $ 387.00 C1894 INTRODUCER, CHECK FLO $ 368.00 CATHETER, HIGH FLOW $ 386.00 C1880 FILTER, VENA CAVA $ 1,906.00 INTRODUCER, PD LONG $ 417.00 C1894 SHEATH, VASCULAR $ 78.00 C1713 PIN, RESORBABLE $ 541.00 PATHSEEKER $ 386.00 C1713 ANCHOR, MINI QUICK $ 541.00 C1713 ANCHOR, ORTHOCORD $ 603.00 KNOT PUSHER $ 386.00 PATCH, VENTRAL $ 1,020.00 C1714 TURBOHAWK $ 5,021.00 CUTTER DRIVER $ 541.00 C1884 SPIDER $ 464.00 VIABAHN $ 3,858.00 ELECTRODE, BALL TIP $ 176.00 LOOP CUTTING $ 180.00 ELECTRODE, BALL TIP $ 176.00 ELECTRODE, ROLLER BALL $ 185.00 CORD, DISPOSABLE $ 59.00 CORDIS, 5FR. $ 154.00 C1725 CATHETER, BALLOON $ 464.00 C1725 CATHETER, DILATATION $ 464.00 CANNULA, HYDRO. $ 105.00 CYSTOTOME, 25G. $ 99.00 BLADE, MICRO $ 87.00 C1750 CATHETER, TENCKHOFF $ 386.00 BIOPLANT $ 1,082.00 ANASTOCLIP $ 1,224.00 INTRODUCER, NEEDLE $ 216.00 DRAPE, SHOULDER $ 386.00 MEDRAD INJECTION LINE $ 386.00 KIT, MARK V $ 464.00 WECK-CEL $ 24.00 SEPTAL SPLINT $ 80.00 PIN HEAD $ 12.00 BLADE, SAGITTAL DISPOSABLE $ 48.00

99 BLADE, OSCILLATING DISPOSABLE $ 48.00 BURR, CARBIDE $ 44.00 C1713 K-WIRE $ 56.00 BIO-COMPOSITE WEDGE $ 1,313.00 C1781 MESH LEVEL 1 $ 282.00 C1781 MESH LEVEL 2 $ 501.00 C1781 MESH LEVEL 3 $ 414.00 C1781 MESH LEVEL 4 $ 613.00 C1781 MESH LEVEL 5 $ 741.00 C1781 MESH LEVEL 6 $ 1,545.00 C1781 MESH LEVEL 7 $ 1,695.00 C1781 MESH LEVEL 8 $ 1,882.00 C1781 MESH LEVEL 9 $ 2,350.00 C1729 TRAY, THORACENTESIS DISP $ 130.00 C1769 GLIDEWIRE LEVEL 2 $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE $ 250.00 C1769 GLIDEWIRE LEVEL 3 $ 1,411.00 C1769 GLIDEWIRE $ 1,411.00 C1769 GLIDEWIRE LEVEL 1 $ 200.00 C1769 GLIDEWIRE $ 200.00 C1769 GLIDEWIRE $ 200.00 C1769 GLIDECATH LEVEL 1 $ 142.00 C1769 GLIDECATH LEVEL 2 $ 190.00 C1769 MICROINTRODUCER $ 386.00 BLADE, DERMATOME $ 587.00 CANNULA, TWIST $ 386.00 C1713 PIN, TRIM IT SYSTEM $ 1,468.00 00100 SALIVARY GLANDS INCL BIOPS NOS $ 1,872.00 00102 PLASTIC REPAIR OF CLEFT LIP $ 1,797.00 00103 EYE, BLEPHAROPLASTY $ 2,361.00 00104 ELECTROCONVULSIVE THERAPY $ 1,252.00 00120 EXTERNAL,MIDDLE,&INNER EAR NOS $ 2,378.00 00124 OTOSCOPY $ 1,245.00 00126 TYNPANOTOMY $ 1,245.00 00140 PROCEDURES ON EYE NOS $ 1,633.00 00142 LENS SURGERY $ 1,633.00 00147 IRIDECTOMY $ 2,304.00 00160 NOSE & SINUSES NOS $ 2,444.00 00162 RADICAL SURGERY OF NOSE $ 3,429.00 00164 BIOPSY, SOFT TISSUE OF NOSE $ 1,309.00 00170 INTRAORAL PROC INCLDNG BX NOS $ 1,567.00 00172 REPAIR OF CLEFT PALATE $ 1,797.00 00174 EXC OF RETROPHARYNGEAL TUMOR $ 1,797.00 00176 RADICAL SURGERY INTRAORAL $ 2,812.00 00190 FACIAL BONES NOS $ 2,444.00 00300 INTEG SYS MUS/NRV,HEAD/NECK PT $ 1,882.00 00320 ESOPH,THYR,LARYNX,TRACH,&LYMPH $ 2,187.00 00400 INTEG SYS EXTREM ANT TRUNK $ 1,882.00 00402 RECONSTRUCT BREAST RED/AUG MAM $ 2,600.00 00404 RADICAL/MODIFIED PROCED BREAST $ 3,448.00

100 00406 RAD/MOD PROC BREAST W/INT MAMM $ 3,512.00 00470 PARTIAL RIB RESECTION NOS $ 2,378.00 00500 ALL PROCEDURES ON ESOPHAGUS $ 1,624.00 00520 CLSD CHEST PROC(INC BRONCH)NOS $ 2,260.00 00522 NEEDLE BIOPSY OF PLEURA $ 1,789.00 00528 MEDIATINOSCOPY&DIAG THORACOSCO $ 2,591.00 00530 TRANSVENOUS PACEMAKER INSERTN $ 1,808.00 00532 ANES F/ACCESS CENT VENOUS CIRC $ 1,641.00 00534 TRANSV INS/REP CARDIOVRT/DEFIB $ 2,241.00 00540 THORACOTOMY:LNG,PLEURA,DIAPHRA $ 3,162.00 00542 DECORTICATION $ 3,596.00 00350 MAJOR VESSELS OF NECK NOS $ 2,324.00 00600 CERVICAL SPINE & CORD NOS $ 4,886.00 00604 CERVICL SPINE SITTING POSITION $ 7,189.00 00620 THORACIC SPINE & CORD NOS $ 5,952.00 00630 LUMBAR REGION NOS $ 3,199.00 00670 EXTENSIVE SPINE & SPINAL CORD $ 9,659.00 00700 UPPER ANT ABD WALL NOS $ 3,022.00 00702 PERCUTANEOUS LIVER BIOPSY $ 2,084.00 00750 HERNIA REPAIR IN UPPER ABD NOS $ 2,673.00 00752 LUMBAR/VENT(INCISIONAL)HERNIAS $ 2,212.00 00756 TRANSABD REP DIAPHRAGMATIC HER $ 3,319.00 00770 MAJOR ABD BLOOD VESSELS $ 3,596.00 00790 INTRAPERITONEAL PROC UPPER ABD $ 3,319.00 00792 PARTIAL HEPATECTOMY(EXC LIV B) $ 4,258.00 00794 PANCREATECTOMY PARTIAL/TOTAL $ 5,088.00 00800 LOWER ANT ABD WALL NOS $ 1,696.00 00802 PANNICULECTOMY $ 2,775.00 00810 LOWER INTESTINAL ENDOSCOPIC PR $ 1,771.00 00820 LOWER POSTERIOR ABD WALL $ 2,868.00 00830 HERNIA REPAIR LOWER ABD NOS $ 2,028.00 00832 VENTRAL & INCISIONAL HERNIAS $ 2,212.00 00840 INTRAPERITONEAL LOWER ABD NOS $ 3,319.00 00844 ABDOMINOPERINEAL RES $ 3,069.00 00846 RADICAL HYST $ 3,319.00 00848 PELVIC EXENTERATION $ 3,319.00 00860 EXTRAPERITONEAL LOWER ABD NOS $ 3,319.00 00864 TOTAL CYSTECTOMY $ 3,873.00 00865 RADICAL PROSTATECTOMY(SUP/RET) $ 3,319.00 00866 ADRENALECTOMY $ 5,530.00 00873 LITHOTRIPSY,EXT SHOCK NO WATER $ 1,973.00 00880 MAJOR LOWER ABD VESSELS NOS $ 4,517.00 00902 ANORECTAL, ENDOSCOPY BIOPSY $ 1,797.00 00904 RADICAL PERINEAL PROCEDURE $ 3,319.00 00910 TRANSURETHRAL PROCEDURES NOS $ 1,752.00 00912 TRANSURETHRAL RES BLADDER TUMR $ 2,610.00 00914 TRANSURETHRAL RESECT PROSTATE $ 2,610.00 00916 POST-TRANS RESECTION BLEEDING $ 2,610.00 00920 MALE EXTERNAL GENITALIA NOS $ 1,918.00 00922 SEMINAL VESICLES $ 2,304.00 00924 UNDESCENDED TESTIS, UNI/BILAT $ 1,935.00 00926 RADICAL ORCHIECTOMY, INGUINAL $ 2,121.00 00928 RADICAL ORCHIECTOMY, ABDOMINAL $ 2,537.00 00930 ORCHIECTOMY, UNILAT OR BILAT $ 1,935.00 00938 INS PENILE PROSTHESIS(PER APP) $ 2,979.00 00940 VAGINAL PROCEDURES NOS $ 1,245.00

101 00942 COLPOTOMY,COLPECTOMY,COLPORRHA $ 1,476.00 00944 VAGINAL HYSTERECTOMY $ 2,212.00 00948 CERVICAL CERCLAGE $ 1,771.00 00952 HYSTEROSCOPY/HYSTEROSALPINGOGR $ 2,028.00 01173 OPEN REP PELVIC ACETABULAR FX $ 2,488.00 01200 CLSD PROC INVOLVING HIP JOINT $ 2,507.00 01202 ARTHROSCOPIC HIP JOINT $ 2,361.00 01210 OPEN INVOLVING HIP JOINT NOS $ 2,507.00 01212 HIP DISARTICULATION $ 2,765.00 01214 TOTAL HIP ARTHROPLASTY $ 2,526.00 01215 REVISION TOTAL HIP ARTHOPLASTY $ 2,765.00 01220 ALL CLSD PROC: UPPER 2/3 FEMUR $ 2,545.00 01230 OPEN PROC: UPPER 2/3 FEMUR NOS $ 2,858.00 01232 AMPUTATION $ 2,138.00 01234 RADICAL RESECTION $ 2,398.00 01250 NERVE,MUSCL,TEND,FASCIA UP LEG $ 2,304.00 01260 INV VEINS UPPER LEG INC EXPLOR $ 2,166.00 01270 INV ARTER UP LEG INC BYPASS GR $ 2,488.00 01272 FEMORAL ARTERY LIGATION $ 2,074.00 01274 FEMORAL ARTERY EMBOLECTOMY $ 2,304.00 01320 NERV,MUSCL,TEND KNEE/POPLITEAL $ 3,181.00 01340 CLSD PROC LOWER 1/3 FEMUR $ 2,361.00 01360 OPEN PROC LOWER 1/3 FEMUR $ 2,691.00 01380 CLSD PROC ON KNEE JOINT $ 2,324.00 01382 ARTHROSCOPIC PROC KNEE JOINT $ 2,840.00 01390 CLSD PROC UPPEREND TIB/FIB/PAT $ 2,166.00 01392 OPEN PROC UPPEREND TIB/FIB/PAT $ 2,711.00 01400 OPEN PROC KNEE JOINT NOS $ 2,553.00 01402 TOTAL KNEE REPLACEMENT $ 3,409.00 01404 DISARTICULATION AT KNEE $ 2,212.00 01420 CAST APPL REM/REP INV KNEE JNT $ 1,845.00 01430 VEINS OF KNEE & POPLITEAL NOS $ 1,845.00 01432 ARTERIOVENOUS FISTULA $ 2,166.00 01440 ARTERIES KNEE/POPLITEAL NOS $ 2,488.00 01442 POPLITEAL THROMBOEND W/WO GRFT $ 2,858.00 01444 POPLITEAL EXC GRFT REP OCC/ANE $ 2,858.00 00862 RENAL INC UPPER 1/3 URETER $ 2,673.00 01462 CLSD PROC LOWER LEG ANKLE FOOT $ 2,304.00 01464 ARTHROSCOPIC ANKLE JOINT $ 2,341.00 01470 NER,MUS,TEN,FAS LOW LEG/FT NOS $ 2,212.00 01472 REP RUPTURED ACHILLES TENDON $ 2,488.00 01474 GASTROCNEMIUS RECESS(STRAYR P) $ 2,488.00 01480 OPEN BONES LOW LEG,ANKL,FT NOS $ 2,711.00 01484 OSTEOTOMY/OSTEOPLASTY TIB/FIB $ 2,727.00 01486 TOTAL ANKLE REPLACEMENT 01486 $ 3,098.00 01490 LOWER LEG CAST APPL REM/REP $ 2,166.00 01500 ARTER LOWR LEG INC BYPASS GRFT $ 2,488.00 01502 EMBOLECTOMY LOWER LEG $ 2,121.00 01520 VEINS LOWER LEG NOS $ 2,341.00 01522 VENOUS THROMBECTOMY DIR W/CATH $ 2,212.00 01620 CLSD STERNOCLAV/ACROMIOCLAV JT $ 2,488.00 01622 ARTHROSCOPIC SHOULDER JOINT $ 2,212.00 01630 OPEN STERNOCLAV/ACROMIOCLAV JT $ 3,539.00 01638 RADICAL RES SHOULDER/AXILLA $ 2,858.00 01636 INTERTHORACOSCAPULAR AMP $ 3,798.00 01652 AXILLARY-BRACHIAL ANEURYSM $ 4,056.00

102 01656 AXILLARY-FEMORAL BYPASS GRAFT $ 4,056.00 01670 VEINS OF SHOULDER/AXILLA $ 2,166.00 01710 NERV,MUSC,TEND UPPER ARM/ELBOW $ 1,845.00 01712 TENOTOMY,ELBOW-SHOULDER OPEN $ 2,488.00 01714 TENOPLASTY ELBOW TO SHOULDER $ 2,488.00 01716 TENODESIS,RUPTURE LNG TEND BIC $ 2,488.00 01730 CLSD HUMERUS & ELBOW $ 2,370.00 01732 ARTHROSCOPIC ELBOW JOINT $ 2,212.00 01740 OPEN HUMERUS & ELBOW NOS $ 2,545.00 01744 REP NONUNION/MALUNION HUMERUS $ 2,398.00 01758 EXC CYST OR TUMOR OF HUMERUS $ 2,212.00 01770 ARTERIES UPPER ARM & ELBOW NOS $ 2,673.00 01772 EMBOLECTOMY UPPER ARM/ELBOW $ 2,673.00 01780 VEINS UPPER ARM/ELBOW NOS $ 2,193.00 01810 NERV,MUSCL,TENDN FOREARM,WRIST $ 2,711.00 01820 CLSD RADIUS ULNA WRIST HANDBON $ 2,537.00 01830 OPEN RADIUS ULNA WRIST HANDBON $ 2,673.00 01840 ARTERIES FOREARM WRIST HND NOS $ 2,581.00 01842 EMBOLECTOMY FOREARM $ 2,581.00 01844 VASCULAR SHUNT,REV,ANY TYPE DI $ 2,398.00 01850 VEINS OF FOREARM WRIST HAND $ 2,304.00 01860 CAST APPL,REM,REP FOREARM WRST $ 1,935.00 01990 HARVESTING ORGANS BRAINDEAD PT $ 2,684.00 01961 CESAREAN SECTION $ 2,084.00 01967 EPID F/LABOR ENDING IN VAG DEL $ 412.00 01963 CESAREAN HYSTRO W/O LABOR ANAL $ 2,268.00 01968 CESAREAN DELV AFT LABOR ANAL $ 2,488.00 64486 TAP BLOCK UNILAT BY INJ $ 129.00 64487 TAP BLOCK UNILAT BY CONT INJ $ 149.00 82962 ACCU-CHEK $ 37.00 RECOVERY-ADULT 1ST 30 MINUTES $ 270.00 RECOVERY-PEDS 1ST 30 MINUTES $ 270.00 RECOVERY ADULT EA ADD'L 30 MIN $ 97.00 RECOV PEDS EA ADDL 30 MINS $ 97.00 RECOVERY RM 1ST 30 MINUTES $ 335.00 RECOVERY RM EA ADDL 30 MINS $ 97.00 82962 ACCU-CHEK-ASU $ 31.00 02 HEAD HOOD PER 8HRS $ 176.00 O2 THERAPY 8HR $ 165.00 94003 MECH VENT NEON $ 403.00 82803 ARTERIAL BLOOD GAS ANALYSIS $ 203.00 94726 DTR RESISTANCE TO AIRFLOW $ 697.00 94762 NOCT PULSE OX $ 855.00 94640 MDI TREATMENT $ 499.00 94760 PULSE OXIMETRY SINGLE STUDY $ 97.00 94002 VENT INITIAL DAY $ 1,588.00 94003 VENT EA SUBQ DAY $ 1,588.00 94640 AEROSOL TMT $ 499.00 94642 AEROSOL TMT-PENTAMIDINE $ 450.00 94668 CHEST PT TMT; SUBSEQUENT $ 168.00 94799 INCENTIVE BREATH $ 415.00 94640 IPPB TREATMENT $ 499.00 94640 RX NEBULZR TMT $ 499.00 94640 SPUTUM INDUCTION W TX $ 499.00 94664 DEMO/EVAL AEROSOL THERAPY $ 316.00 02 THERAPY HIGH FLOW $ 268.00

103 02 THERAPY HIGH-FLOW $ 267.00 HELIOX THERAPY $ 410.00 94667 CHEST PT TMT INITIAL $ 308.00 94761 PULSE OXIMETRY MULT STUDY $ 144.00 94660 MASK CPAP BIPAP PER DAY $ 1,891.00 36600 ABG BLOOD DRAW CHARGE $ 135.00 94645 CONT INHAL TRMT EA ADDL HOUR $ 117.00 82803 ART BLOOD GAS & CO-OXIMET $ 203.00 82375 CO OXIMETRY; QUANT $ 203.00 94644 CONT INHAL TRMT 1ST HOUR $ 169.00 94060 PFT COMPLETE/MEDS $ 303.00 REPLACE RESUS. BAG $ 97.00 92950 RESUSCITATION-RES $ 1,207.00 VENTILATOR CIRCUIT CHG X1 $ 197.00 82803 CAPILLARY BLOOD GAS $ 203.00 82800 EXER PH BLOOD GAS $ 141.00 94729 DIFFUSION STUDY $ 203.00 94060 PEAK FLOW NEB PRE & POST $ 276.00 94010 PFT SPIROMETRY $ 270.00 94375 FLOW VOLUME LOOP-RES $ 430.00 82803 VBG $ 203.00 82800 NON-EXER PH BLOOD GAS $ 141.00 82803 CORD ABG $ 203.00 82803 CORD VBG $ 203.00 99407 SMOKING & TOBACCO USE COUNSELING SESSION $ 44.00 94669 MECHANICAL CHEST WALL OSCILL $ 499.00 95937 REPETITIVE STIMULATION $ 232.00 95863 EMG 3 EXTREMIT $ 529.00 95864 EMG 4 EXTREMIT $ 605.00 95907 NERVE CONDUCT STUDIES; 1-2 $ 464.00 95908 NERVE CONDUCT STUDIES; 3-4 $ 927.00 95909 NERVE CONDUCT STUDIES; 5-6 $ 1,391.00 95910 NERVE CONDUCT STUDIES; 7-8 $ 1,854.00 95911 NERVE CONDUCT STUDIES; 9-10 $ 2,318.00 95912 NERVE CONDUCT STUDIES; 11-12 $ 2,666.00 95913 NERVE CONDUCT STUDIES; 13+ $ 3,013.00 95816 E.E.G. * $ 645.00 95861 EMG 2 EXTREMITIES $ 490.00 95860 EMG 1 EXTREMITY $ 490.00 95824 EEG CERE DEATH PROTOCAL-N $ 888.00 95885 EMG; EA EXT; AMP/LAT/VEL; LMTD $ 490.00 95886 EMG; EA EXT; AMP/LAT/VEL; CMPL $ 490.00 95887 EMG; NON-EXT AMP/LTNCY/VELCTY $ 490.00 43180 ESOPHAGOSCOPY W/ZENKER DVTCLM $ 3,968.00 44381 ILEOSCOPY STOMA W/TE BAL DIL $ 1,738.00 44384 ILEOSCOPY STOMA W/PL ENDO STNT $ 1,738.00 43241 DUODENOSCOPY&CANU $ 1,916.00 USE OF BICAP $ 365.00 PULSE MONITOR $ 176.00 PHOTOGRAPHY $ 215.00 O/P RECOVERY PERIOD $ 262.00 VARICES NEEDLE KIT $ 197.00 C1726 E.R.C.P. CATHETER $ 254.00 MIC G-J TUBE $ 998.00 ANGIOCATH, Y ADAPTER $ 41.00 ANESTHESIA EXTENSION SET $ 204.00

104 C1726 BILIARY STONE EXTRACTOR SET $ 648.00 ULTRATOME TRIPLE LUMEN $ 804.00 C1729 BILIARY DRAIN KIT $ 648.00 C1874 BILIARY STENT KIT 7FR 10CM $ 423.00 C1769 WIRE GEENAN J STYLE .035 $ 1,058.00 ESOPHOGEAL PROSTHESIS $ 888.00 DISPOSABLE POLYP SNARE $ 173.00 CANNULA SHORT TAPERED $ 161.00 CANNULA PRECURVED FLUORO STAND $ 161.00 DISPOSABLE HOT BIOPSY FORCEPS $ 444.00 CANNULA PRECURVED SHORT TAPERD $ 161.00 CANNULA ULTRA TAPERED .025 FLU $ 161.00 KNIFE PAPILLOTOME .035 WIRE $ 522.00 C1874 PANCREATIC STENT $ 417.00 CANNULA PRECURVED WILTEK STAND $ 161.00 CANNULA TAPERED FLUORO MICROV $ 239.00 CANNULA FLUORO STRAIGHT MICROV $ 239.00 TRIPLE LUMEN SPHINCTEROTOME $ 1,012.00 NON DISPOSABLE PAPILLOTOME $ 262.00 NET POLYP RETRIEVER $ 155.00 OPTHPC-1 PRECUT PADILLOTOME $ 505.00 ZIMMON PAPILLOTOME PT-20 $ 505.00 XYLOCAINE ORAL SPRAY $ 41.00 C1726 ACHIEVER BALLOON DILATOR $ 717.00 PERCUTANEOUS GASTRO KIT $ 708.00 C1726 BILIARY BALLOON DILATOR $ 1,088.00 BALLOON STONE TRIPLE LMN 11.5 $ 610.00 BALLOON STONE EXT 8.5 MM $ 610.00 BALLOON STONE EXT 3 LUMEN 15MM $ 610.00 BICAP PROBE $ 1,176.00 BILLIARY CATHETER $ 208.00 CANNULA METAL TIP MICROVASIVE $ 239.00 C1769 GEENAN GUIDEWIRE $ 529.00 C1769 GUIDEWIRE ERCP $ 556.00 C1769 GLIDE WIRE $ 585.00 C1769 GUIDEWIRE .025 $ 227.00 DOUBLE LUMEN SPHINCTEROTOME $ 823.00 TRI POD GRASPER $ 625.00 C1726 MAX FORCE BALLOON DILATORS $ 775.00 MIC TUBE $ 206.00 LIVER BIOPSY TRAY $ 330.00 C1769 WIRE ZEBRA $ 585.00 ZIMMON PT30 PAPILLOTOME $ 505.00 TOURHY BORST ADAPTER $ 41.00 SOEHENDRA PAPIL PRE CUT PTPC15 $ 505.00 C1726 BALLOON DILTRS $ 909.00 STONE EXTRACTR $ 578.00 C1726 BALLOON DILATOR $ 753.00 J TUBE $ 432.00 ENDOSCOPY 1ST 30 MINS $ 1,139.00 ENDOSCOPY EA ADDL 30 MINUTES $ 671.00 STONETOME $ 1,444.00 FRENCH BIPOLAR $ 568.00 FORCEP PRECISOR BRONCO PULMON $ 97.00 C1726 CATH ESOPHAG BALL DIL FR 24-30 $ 426.00 ENDO-IRRIGATOR $ 459.00

105 C2617 STENT, ZIMMON PANCREATIC 3FR, 4CM $ 115.00 C1726 CATH ESOPHAG BALL DIL FR 30-36 $ 499.00 BOTTLE, LARGE IRRIGATION 100ML $ 173.00 CATHETER, GLO-TIP ERCP 5.5-3FR $ 109.00 C1726 CATH ESOPHAG BALL DIL FR36-45 $ 437.00 FOOTSWITCH PNEUMAT DUAL FUNCT $ 536.00 C1769 GUIDEWIRE TRACER DIRECT 021-480 $ 305.00 C1726 CATH ESOPHAG BALL DIL FR45-54 $ 437.00 TUBING ENDO-IRRIGATOR CONN L/L $ 115.00 C2625 CATHETER, REPLACEMENT FOR ERCP $ 250.00 C1726 CATH ESOPHAG BALL DIL FR54-60 $ 492.00 PRINT PACK SUPPLY FOR PROCESSR $ 171.00 CATHETER, ERCP $ 376.00 C1726 CATH ESOPH WIRE BALL FR24-30 $ 602.00 TUBING AIR/WATER JET CONN CAP $ 93.00 C2625 COTTON-LEUNG BILIARY STENT 7-7 $ 250.00 C1726 CATH ESOPH WIRE BALL FR36-45 $ 602.00 CAP SOAK PENTAX VIDEO SCOPES $ 144.00 C2625 COTTON-LEUNG BILIARY STENT 7-8 $ 250.00 C1726 CATH ESPHAG/PYLORIC/COLONIC $ 602.00 VALVE PLASTIC SUCTION $ 260.00 C2625 COTTON-LEUNG BILIARY STENT 7-9 $ 250.00 TUBE, MIC TRANSGASTRIC JEJUNAL FEEDING K $ 461.00 ADAPTER, WATER JET BUBING $ 144.00 C2625 COTTON-LEUNG BILIARY STENT 7-10 $ 250.00 ALLIANCE 60ML SYRINGE GAUGE ASSEMBLY $ 383.00 SEALS, RUBBER INLET $ 119.00 CATH EXTRACT-RETRIEV BALL 12MM $ 393.00 NEEDLES, WANG CYTOLOGY $ 130.00 CATH TRANSGASTRIC JEJUNAL FEED $ 461.00 C1769 HYDRATOME RX 44 CANNUL SPHINCT $ 1,056.00 BOTTLE, PENTAX WATER FOR SCOPE $ 464.00 C1726 CATH ESOPHAG BALL DIL FR18-24 $ 426.00 C1900 MICROVAS RX BILARY LOCK DEVI $ 274.00 XENON LIGHT SOURCE $ 975.00 ANOSCOPY $ 132.00 91030 BERNSTEIN TEST $ 776.00 GASTRO BIOPSY2 $ 682.00 COLONOSCOPY GILAB $ 1,401.00 SPECIMEN COLLCTN GI LAB $ 77.00 ESOPH GSTRO DUODE $ 1,063.00 GOLYTLY ADMINISTRATION $ 100.00 POLYPECTOMY $ 440.00 PROCTOSCOPY $ 353.00 SOLOPASS BILIARY STENT $ 1,058.00 BEDSIDE ASSIST-GI LAB $ 283.00 CAUTERY GI LAB $ 303.00 GI LAB SET-UP3 $ 297.00 OXYGEN APPLICATION $ 99.00 STENT REPLACEMENT $ 830.00 PH STUDY 24 HR $ 792.00 BIOPSY W/ CAUTERY $ 345.00 91034 AMBULATORY PH MONITORING $ 1,616.00 ENDOSCOPIC BAND $ 589.00 43760 REPLCMNT OF G TUBE $ 710.00 43212 ESOPH STNT PLA $ 7,477.00

106 J1745 REMICADE INF $ 83.00 VARICEAL BANDIG WITH EGD $ 4,417.00 G0176 ACTIVITY THER. 45+MIN $ 129.00 90846 FAM THER NO PT $ 167.00 90847 FAM THER W PT $ 167.00 90853 GROUP THERAPY $ 211.00 G0177 EDUCATION TRAINING 45+MIN $ 129.00 90791 PSYCHIATRIC DIAGNOSTIC EVAL $ 167.00 90832 PSYCHOTHERAPY 30 MIN $ 64.00 90834 PSYCHOTHERAPY 45 MIN $ 167.00 90837 PSYCHOTHERAPY 60 MIN $ 206.00 90785 INTERACTIVE COMPLEXITY $ 41.00 82962 ACCU-CHEK $ 31.00 96360 IV INFUSION,HYDRATION 1ST HOUR $ 377.00 96361 IV INFUSION HYDRATION EA ADDL $ 178.00 96365 IV INFUSION THERAPEUTIC 1ST HR $ 377.00 96366 IV INFUSION THERA EA ADDL HR $ 178.00 96367 ADDL THER SEQ INFUS UP TO 1HR $ 178.00 96368 CONCURRENT THER INFUSION $ 178.00 96372 INJECTION THER SUBQ OR IM $ 160.00 96374 INITIAL THER IV PUSH $ 554.00 96375 ADDL SEQ PUSH, DIFF DRUG $ 178.00 96376 OP IVP INJ EACH SEQ SAME MED $ 178.00 82962 GLUCOSE POINT OF CARE $ 31.00 82962 ACCU-CHEK-6 WEST $ 31.00 96360 IV INFUSION HYDRA 1ST HOUR $ 377.00 96361 IV INFUSION HYDRA EA ADDL HR $ 178.00 96365 IV INFUSION THERA 1ST HOUR $ 377.00 96367 ADDL THERP SEQ INFUS UP TO 1HR $ 178.00 96368 CONCURRENT THERP INFUSION $ 178.00 96372 INJECTION IM SUBQ OR IM $ 160.00 96374 INITIAL THER IV PUSH $ 554.00 96375 ADDL SEQ PUSH DIFF DRUG $ 178.00 MISC SURGICAL PROCEDURE $ 67.00 96376 OP IVP INJ EA ADD SEQ SAME MED $ 178.00 96366 OBV IV INFUS THERA EA ADDL HR $ 178.00 82962 ACCU-CHEK-PEDS $ 31.00 94772 PNEUMOGRAM $ 1,552.00 62270 SPINAL LUMBAR PUNCTURE $ 459.00 36620 ARTERIAL LINE $ 142.00 31500 INTUBATION $ 186.00 36680 INTRA-OSSEOUS $ 232.00 96375 OBV ADDL IV PUSH DIFF DRUG $ 178.00 96360 OBV IV INFUS HYDRATION 1ST HR $ 355.00 96365 OBV IV INFUS THERA 1ST HR $ 355.00 96366 OBV IV INFUS THERA EA ADDL HR $ 178.00 96367 OBV ADDL SEQ INFUS THER TO 1HR $ 178.00 96368 OBV CONCURRENT THERA INFUSION $ 178.00 96374 OBV INTITAL IV PUSH $ 554.00 96372 OBV INJ THERA SUBQ OR IM $ 160.00 96376 OBV IVP INJ EA ADD SEQ SAME MD $ 178.00 96361 OBV IV INFUS HYDRA EA ADDL HR $ 178.00 MOD SED W/INVASIVE PROC >5YRS 1ST 30MIN $ 349.00 MOD SED W/INVASIVE PROC <5YRS 1ST 30MIN $ 349.00 MOD SED W/INVASIVE PROC EA ADDL 15MIN $ 349.00 82948 ACCUCHEK 4PSY NON-EXEMPT $ 31.00

107 HALL SEMI-PRIV ROOM $ 1,600.00 G0378 HALL OBSERVATION PER HOUR $ 59.00 99220 NURSERY OBSERVATION PER HR $ 53.00 NEWBORN BORDER $ 1,331.00 NURSERY $ 1,295.00 NEWBORN INTERMEDIATE $ 2,622.00 G0378 PEDS OBSERVATION PER HOUR $ 59.00 PEDIATRICS PRIVATE $ 1,667.00 PEDIATRICS SEMI PRIVATE $ 1,610.00 INTERMEDIATE BD $ 2,254.00 G0378 PSY OBSERVATION PER HR $ 59.00 PSYCH DISCHARGE CONSULT $ 25.00 82962 ACCUCHEK 4 EAST $ 31.00 82962 ACCUCHEK 7 PSY $ 31.00 4PSY SEMI PRIVATE $ 1,595.00 7 PSY SEMI PRIVATE $ 1,595.00 99220 7PSY OBSERVATION PER HR $ 51.00 4PSY SEMI PRIVATE NON-EXEMPT $ 1,595.00 3 EAST MED/SURG PRIVATE $ 1,655.00 3 EMS TELEMETRY $ 2,470.00 3 EAST MED/SUR SEMI PRIVATE $ 1,600.00 G0378 3EMS OBSERVATION PER HOUR $ 59.00 G0378 ICU OBSERVATION PER HOUR $ 33.00 MED SURG OVERFLOW $ 1,600.00 INTENSIVE CARE $ 3,436.00 TELEMETRY OVERFLOW $ 2,470.00 82962 ACCU-CHEK $ 31.00 G0378 LABOR OBSERVATION PER HOUR $ 59.00 ANTEPARTUM INPATIENT $ 1,563.00 5WCS PRIVATE $ 1,563.00 5WCS SEMI-PRIVATE $ 1,563.00 G0378 MB OBSERVATION PER HOUR $ 14.00 82962 ACCUCHEK 5WMS $ 31.00 MED SURG OVERFLOW $ 1,600.00 STEPDOWN SEMI PRIVATE $ 2,470.00 STEPDOWN PRIVATE $ 2,530.00 G0378 6WMS OBSERVATION PER HR $ 59.00 54150 CIRCUMCISION $ 4,934.00 92551 OAE HEARING SCREENING $ 175.00 92587 ALGO HEARING SCREEN $ 399.00 82962 ACCUCHEK NURSERY $ 31.00 OB/GYN OBSERVATION $ 14.00 OB/GYN SEMI PRIVATE $ 1,563.00 99401 ASTHMA ACTION PLAN; EA 15 MIN $ 90.00 90471 IMMUNIZATION/VACCINATION $ 160.00 51702 INS TEMP BLADDER CATH SIMPLE $ 300.00 51703 INS BLADDER CATH COMPLEX $ 381.00 49082 ABD PARACENTESIS $ 2,099.00 36591 COLLECTION BLD VAD $ 308.00 36592 COLLECTION BLD CVP $ 308.00 90471 IMMUNIZATION/VACCINATION $ 160.00 51702 INS TEMP BLADDER CATH SIMPLE $ 300.00 51703 INS BLADDER CATH COMPLEX $ 380.00 36415 VENIPUNCTURE $ 22.00 36591 COLLECTION BLD VAD $ 308.00 36592 COLLECTION BLD CVP $ 308.00

108 90471 IMMUNIZATION/VACCINATION $ 160.00 51702 INS TEMP BLADDER CATH SIMPLE $ 300.00 51703 INS BLADDER CATH COMPLEX $ 380.00 36415 VENIPUNCTURE $ 22.00 36591 COLLECTION BLD VAD $ 308.00 36592 COLLECTION BLD CVP $ 308.00 96523 IRRIGATION VENOUS DEVICE $ 168.00 94667 CHEST PT - INIT OR EVAL $ 308.00 94668 CHEST PT - SUBSEQUENT $ 168.00 94669 MECHANICAL CHEST W/OSCILL $ 499.00 31720 CATHETER ASPI,NASOTRACHEAL $ 499.00 94640 NEBULIZER TREATEMENT $ 499.00 36569 INS PICC AGE 5 YRS/> $ 3,042.00 90471 IMMUNIZATION/VACCINATION $ 160.00 51702 INS TEMP BLADDER CATH SIMPLE $ 300.00 51703 INS BLADDER CATH COMPLEX $ 381.00 36415 VENIPUNCTURE $ 22.00 36591 COLLECTION BLD VAD $ 308.00 36592 COLLECTION BLD CVP $ 308.00 31500 ENDOTRACHEAL INTUBATION $ 552.00 94002 VENT MANAGEMENT INITIAL DAY $ 1,426.00 94003 VENT MANAGEMENT SUBQ DAY $ 1,426.00 94004 VENT MANAGEMENT NF PER DAY $ 1,426.00 94375 BEDSIDE PULMONARY FUNCTION TEST $ 257.00 94610 SURFACTANT ADMINISTRATION $ 577.00 94660 CONT POS AIRWAY PRESSURE CPAP $ 577.00 94780 CAR SEAT EVALUATION 60 MIN $ 98.00 94781 CAR SEAT EVALUATION + 30 MIN $ 98.00 36430 TRANSFUSION OF BLOOD COMPONENT $ 1,161.00 36440 TRANSFUSION OF BLOOD COMP 2 YRS < $ 1,161.00 43752 ORAL OR NASOGASTRIC TUBE PLMT $ 1,021.00 51100 SUPRAPUBIC BLADDER ASPIRATION $ 1,750.00 51701 BLADDER CATHETERIZATION $ 325.00 51702 INS TEMP BLADDER CATH $ 325.00 62270 LUMBAR PUNCTURE $ 1,682.00 90792 PSYCH DIAG EVAL W/MED SRVCS $ 381.00 90838 PSYTX PT&/FAM W/E&M 60 MIN $ 195.00 99203 OP VISIT NEW LVL 3 $ 208.00 99205 OP VISIT NEW LVL 5 $ 354.00 99211 OP VISIT EST LVL 1 $ 105.00 99212 OP VISIT EST LVL 2 $ 125.00 99213 OP VISIT EST LVL 3 $ 145.00 99214 OP VISIT EST LVL 4 $ 165.00 99215 OP VISIT EST LVL 5 $ 185.00 99212TH OB TRIAGE LEVEL 2 $ 125.00 99213TH OB TRIAGE LEVEL 3 $ 145.00 99214TH OB TRIAGE LEVEL 4 $ 165.00 99215TH OB TRIAGE LEVEL 5 $ 185.00 90471 IMMUNIZATION/VACCINATION $ 160.00 51702 INS TEMP BLADDER CATH SIMPLE $ 300.00 51703 INS BLADDER CATH COMPLEX $ 380.00 36415 VENIPUNCTURE $ 22.00 36591 COLLECTION BLD VAD $ 308.00 36592 COLLECTION BLD CVP $ 308.00 A9272 PICO DRESSING 4X12 $ 695.00 A9272 PICO DRESSING 4X16 $ 695.00

109 NITROUS OXIDE BREATHING CIRCUIT W M $ 51.00 COOKS BALLOON CERVICAL RIPENING $ 153.00 59899 BAKARI BALLOON $ 497.31 TROCAR 12MMX100MM BLADED $ 108.00 DRAPE 1000 $ 9.00 ELECTRODE LEEP RADIOUS 1.0 CM $ 61.00 TROCAR 11MMX100MM BLADELESS $ 123.00 TROCAR 11MMX100MM SHIELDED BLD $ 108.00 PACK EXTREMITY $ 17.00 PACK D&C CDS $ 86.00 TROCAR UNIV 5MM STD FIX CANN $ 41.00 ELECT L HOOK 5MM STD FIX CANN $ 78.00 INSTRUMENT POUCH 1018 $ 4.00 TROCAR 5MMX100MM FIOS (Z-THRE) $ 98.00 PACK T&A CDS $ 86.00 DRAPE STERI W/INCISE FILM $ 17.00 STOCKINETTE IMPERVIOUS 14X48 $ 11.00 LOOP DEV-O-LOOP MINI WHITE $ 3.00 CATHETER,ANGIOGRAPHIC $ 33.00 KIT,VASCULAR $ 31.00 PATCH,CARDIOVASCULAR .3X3 $ 441.00 CATHETER,ULTRAVERSE $ 675.00 KIT,CWS 400 CLSD WOUND SUCTION $ 50.00 ELLIK BLADDER EVACUATOR $ 90.00 DEVICE,CALIBER INFLATION $ 17.00 ARISTA AH FLEXI TIP XL APPL 38CM $ 75.00 ARISTA $ 390.00 KIT, NEEDLE GUIDE $ 34.00 A6209 DRESNG,BIOPATCH,1"DSK,CHG,7MM $ 17.00 A6209 DRESNG,BIOPATCH,1"DSK 4MM $ 18.00 GUIDEWIRE,AMPLATZ SUPER STIFF $ 127.00 ACT CO-AXIAL BPSY SYS 18GX15C $ 137.00 C1894 BRITE TIP SHEATH 8F $ 36.00 C1894 5F SHEATH BRITE TIP $ 36.00 C1894 7F SHEATH BRITE TIP $ 36.00 C1894 6F SHEATH BRITE TIP $ 36.00 C1880 TRAP EASE PERM VENA CAVA FILT $ 2,085.00 C1887 TRAILBLAZER 014 150CM $ 1,875.00 C1887 TRAILBLAZER 035 90CM $ 1,875.00 C1887 TRAILBLAZER 035 65CM $ 1,875.00 C1884 SPIDER FX 6MM FILT X 190/320CM $ 3,450.00 C1884 SPIDER FX 5MM FILT X 190/320CM $ 3,450.00 C1884 SPIDER FX 6MM FILT X 190/320CM $ 3,450.00 C1769 NITREX .018 WIRE 300CM LENGTH $ 1,014.00 C1725 NANOCROSS.014 2.0MMX20MMX150CM $ 660.00 C1725 NANOCROS.014 2.0MMX120MMX150CM $ 660.00 C1725 NANOCROS.014 2.0MMX150MMX150CM $ 660.00 C1725 NANOCROS.014 3.0MMX120MMX150CM $ 660.00 C1725 EVERCROSS .035 6MMX40MMX135CM $ 255.00 C1725 EVERCROSS .035 6MMX150MMX135CM $ 255.00 C1725 EVERCROSS .035 6MMX100MMX135CM $ 255.00 C1725 EVERCROSS .035 4MMX150MMX135CM $ 255.00 C1725 EVERCROSS .035 4MMX100MMX135CM $ 255.00 C1725 EVERCROSS .035 4MMX60MMX135CM $ 255.00 C1725 EVERCROSS .035 5MMX40MMX135CM $ 255.00 C1725 EVERCROSS .035 5MMX80MMX135CM $ 255.00

110 C1725 EVERCROSS .035 5MMX100MMX135CM $ 255.00 C1725 EVERCROSS .035 5MMX150MMX135CM $ 255.00 C1725 EVERCROSS .035 7MMX60MMX135CM $ 255.00 C1725 EVERCROSS .035 7MMX40MMX135CM $ 255.00 C1876 PRO E/F 6FR.035"5MMX100MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"5MMX60MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"6MMX60MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"6MMX100MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"6MMX150MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"7MMX40MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"7MMX60MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"8MMX40MM120CM $ 2,085.00 C1876 PRO E/F 6FR.035"8MMX60MM120CM $ 2,085.00 C1714 TURBOHAWK TH LS-C SURG $ 9,750.00 C1714 TURBOHAWK SS-CL $ 9,750.00 C1714 TURBOHAWK TH LX-M ENDO $ 9,750.00 C1714 TURBOHAWK TH LS-M ENDO $ 9,750.00 C1874 VIABAHN ENDOPROSTHESIS 7MMX5CM $ 9,525.00 VESSEL CLOSURE SYSTEM $ 1,602.00 VESSEL CLOSURE SYSTEM $ 1,602.00 ANASTOCLIP UNIVERSAL CLIP REM $ 402.00 ANASTOCLIP UNIVERSAL CLIP REM $ 402.00 VESSEL CLOSURE SYSTEM $ 1,602.00 CO-AXIAL INTRODUCER NEEDLE $ 42.00 C1760 DEVICE,ANGIOSEAL 6F $ 1,500.00 C1760 DEVICE,ANGIOSEAL 8F $ 1,500.00 C1760 GLIDEWIRE,RADIFOCUS $ 164.00 C1769 GLIDEWIRE,RADIFOCUS ANGLED $ 214.00 C1769 GLIDEWIRE,EXT FLOPPY COR 300CM $ 397.00 C1769 GLIDEWIRE,EXT FLOPPY COR 180CM $ 397.00 C1769 GLIDEWIRE,ADVANTAG.035"X180CM $ 645.00 C1769 GLIDEWIRE,ADVANTAGE.035"X260CM $ 720.00 GLIDECATH,LG,STRG TIP SHAPE $ 184.00 C1887 GUIDEWIRE,LG,ANGEL TAPER $ 165.00 KIT,INTRODUCER MICRO $ 114.00 KIT,INTRODUCER MICRO 5F $ 114.00 NITINOL TIPLESS STONE EXTRACT $ 627.00 EXTRACTOR,NCOMPASS NITIN STONE $ 697.00 EXTRACTOR,NCIRCLE NITI STONE $ 697.00 C1758 CATHETER,WHISTLE TIP (RIGHT) $ 311.00 C1758 CATHETER,WHISTLE TIP (LEFT) $ 311.00 C1758 ADAPTER,OPEN END CATHETER $ 31.00 C1758 CATHETER,OPEN-END URETERAL $ 31.00 C1758 CATHETER,OPEN-END URETERAL $ 32.00 C1758 CATHETER,URETERAL CONE TIP $ 37.00 C1758 CATHETER,OPEN-ENDED URETERAL $ 32.00 C1894 SHEATH,FLEXOR ACCESS $ 412.00 C1894 SHEATH,FLEXOR URETERAL ACCESS $ 412.00 C2625 SET,URETERAL STENT 22CM $ 444.00 C1892 INTRODUCER,DESILETS HOFFMAN $ 152.00 C1769 WIRE GUIDE,NITINOL CORE $ 54.00 C1769 GLIDEWIRE,HIWIRE .035 ANGLED $ 54.00 C1769 GLIDEWIRE,HIWIRE .035 STRAIGHT $ 79.00 C1769 WIDE GUIDE,NITINOL CORE HIWIRE $ 79.00 C1769 WIDE GUIDE,ANGLED STIFF .038 $ 79.00 C1769 ITINOL TIPLESS STONE EXTRACTOR $ 50.00

111 C2617 POSITIONER,FIRM URETERAL STENT $ 323.00 C2617 POSITIONER,FIRM URETERAL STENT $ 323.00 C2617 POSITIONER,FIRM URETERAL STENT $ 323.00 C2617 STENT,FIRM URETERAL $ 323.00 C2617 STENT,UNIVERSA FIRM $ 323.00 C2617 STENT,UNIVERSA FIRM $ 323.00 C2617 POSITIONER,FIRM URETERAL STENT $ 323.00 C2617 STENT,FIRM URETERAL 5X22 $ 323.00 C2617 STENT,FIRM URETERAL 5X24 $ 323.00 C2617 STENT,FIRM URETERAL 5X26 $ 323.00 C1769 SET,INTRODUCER TUBE SP $ 275.00 C1769 SET,BALLOON URETRAL DILATOR $ 541.00 C1769 BALLOON URETERAL DILATOR $ 467.00 C1769 BALLOON URETERAL DILATOR $ 467.00 C1769 BALLOON URETERAL DILATOR $ 541.00 SET,CYSTOMANOMETER $ 10.00 ADAPTER,CATH ADD TO $ 2.00 BIPLANE BIOPSY GUIDE $ 36.00 COVERS,LATEX FREE ST TRAND 2X $ 10.00 APP/CLIP HEMO-LOK A/ENDO 5ML $ 390.00 SURGISLEEVE LG $ 280.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 CUFF TOURNIQUET 24 IN X 4IN $ 65.00 CUFF TOURNIQUET 30 IN $ 70.00 CUFF TOURNIQUET 34 IN X 4IN $ 74.00 CUFF TOURNIQUET 44 IN X 4IN $ 81.00 CUFF TOURNIQUET 18 IN X 4IN $ 58.00 KIT CWS 400 CLSD WOUND SUCTION $ 49.00 SET F/ARTHROSCOPY PUMP TUBE $ 169.00 S/LIG 13MM MARYLAND JAW 37CM $ 724.28 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00

112 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 C1713 SCREW 4.0MM CANC BONE SCREW $ 110.00 ENDO CATH II 15MM SPECMN PCH $ 335.00 C1769 GUIDEWIRE,AMPLATZ SUP STIFF $ 127.00 C1725 PTA BALLOON 2X80X150 $ 1,110.00 STRIPS,GLOW N TELL 55CM TAPE $ 244.00 C1894 DILATOR, 8/10 SHEATH SET $ 156.00 C1887 GLIDECATH: 100CM 4FR ANGLED $ 165.00 CATHETER, ANGIOGRAPHIC 5F $ 184.00 VISE, TORQUE $ 24.00 C1725 CATH,ULTRAVERSE BDC PTA $ 675.00 C1769 AMPLATZ SUPER STIFF GUIDEWIRE $ 606.00 C1769 HYDROPHILIC COATED GUIDEWIRE $ 46.00 C1769 NITREX .018 WIRE 300CM LENGTH $ 1,014.00 C1769 G/WIRE,ADVANTAGE 035"X260CM $ 720.00 DEV,CALIBER INFLA #CL3030 $ 17.00 C1894 5F SHEATH BRITE TIP $ 36.00 C1894 BRITE TIP SHEATH 8F $ 36.00 C1894 6F BRITE TIP SHEATH $ 36.00 KIT,NDL GD 21G ANGLES W/PBR $ 33.00 C1894 KIT, INTRODUCER MICRO $ 114.00 C1894 KIT, INTRODUCER MICRO 5F $ 114.00 BIOPSY NEEDLE, GREEN $ 172.00 C1769 GLIDEWIRE, RADIFOCUS $ 164.00 C1769 GWIRE:260CM 035 STRT STIFF $ 214.00 C1874 STENT GRAFT, FLAIR ENDO VAS $ 7,050.00 C1887 GLIDECATH, 4FR, 65CM, STRT $ 165.00 C1887 GUIDEWIRE, LONG, ANGEL TAPER $ 165.00 WOUND PROTECTOR SMALL $ 169.00 CANISTER SUCTION 12,000CC $ 57.00 CANNULA STEP 12MM W/DILATOR $ 289.00 VERSAPORT V2 BLDELES OPT 15STD $ 937.00 STAPLE ENDO GIA RR 60MM E/T $ 1,197.00 STAPLE TRI RELOAD 60MM $ 945.90 SUTURE 1" LOOP MAXON $ 29.00 SUTURE POLYSORB 2-0 $ 6.00 DRAPE SPL SHOULD PCH STERILE $ 54.00 DRAIN RND SILICONE TROCAR 10" $ 25.00 SAGITTAL BLADE 25MM $ 181.00 SAGITAL BLADE WIDE $ 88.00 RECIPROCATING BLADE $ 139.00 RECIPROCATING BLDE DBL $ 122.00 STERNUM BLADE $ 69.00 SAG BLDE THICK LNG NO OFFSET $ 30.00 AGGRESSIVE PLUS CUTTER 4.0 $ 166.00 BUR, BARREL 4.0MM RED $ 176.00 AGGRESSIVE PLUS 5.5MM $ 166.00 BARREL BUR 12 FLUTE 5.5MM $ 166.00 DISP ARTHROSCOPY BLADE $ 166.00 DISP ARTHROSCOPY BLADE $ 176.00 ROUND BUR 6FLUTE 4.0MM $ 176.00 ROUND BUR 6FLUTE 3.5MM $ 176.00 PROBE,SUCT 90-S ACCELERATOR $ 495.00

113 HOOK, 3.5MM $ 495.00 ABSORBATACK FIX DEVICE $ 2,146.00 C1781 VENTRALIGHT 4X6 $ 1,097.00 C1781 HERNIA PATCH 3.2 X 3.2 $ 1,730.00 C1781 VENTRALEX ST HERNIA PATCH $ 1,660.00 C1781 VENTRALEX HERNIA PATCH 1.7 $ 1,128.00 C1781 VENTRIO HERNIA PTCH 13.8X17.8 $ 3,090.00 C1781 VENTRIO HERNIA PTCH 4.3X5.5 $ 2,441.00 C1781 VENTRIO HERNIA PATCH 11.4 $ 1,854.00 C1781 MESH, RT MEDIUM 3D MAX $ 485.00 C1781 MESH, LT MEDIUM 3D MAX $ 485.00 C1781 MESH, RT 3D MAX $ 527.00 C1781 3D LIGHT, LARGE, LEFT $ 599.00 C1781 3DMAX MESH XL LEFT $ 584.00 C1781 3DMAX MESH XL RIGHT $ 584.00 C1781 MESH, POLYPROPYLENE 3"X6" $ 352.00 C1781 MESH, POLYPROPYENE 26CM $ 299.00 C1781 MESH, MARLEX 6X6 $ 523.00 C1781 EXTRA LARGE PERFIX PLUG $ 556.00 C1781 LARGE PERFIX PLUG $ 440.00 C1781 FASTENERS, CAPSURE FIX SYS $ 870.00 MESH PLUG MEDIUM $ 434.00 C1781 MESH PERFIX PLUG SMALL $ 345.00 C1781 PHASIX 10X15CM $ 6,180.00 C1781 GRAFT, ATRIUM MESH 3X6 $ 210.00 STOCKINETTE TUBULAR 6 X 72 $ 9.00 TUB CROSSFLOW INFLOW CAS $ 75.00 L4360 WALKER EXT PNEUMATIC LRG $ 289.00 CUFF TOURNIQUET 18 IN X 4 IN $ 58.00 HYSTEROSCOPY DC $ 960.00 DEVICE INCISOR $ 1,797.00 S/TUB FLO/CTRL ARTHROSCOPY $ 169.00 SAGITTAL BLADE 25MM $ 181.00 SAGITAL BLADE WIDE $ 87.00 RECIPROCATING BLADE $ 139.00 RECIPRO BLADE DOUBLE SIDED $ 122.00 STERNUM BLADE $ 69.00 SAGITTAL BLD THICK LNG N/OFFSET $ 30.00 18G SPINAL NEEDLE $ 5.00 AGGRESSIVE PLUS CUTTER 4.0 $ 166.00 AGGRESSIVE PLUS 5.5MM $ 166.00 BARREL BUR 12 FLUTE 5.5MM $ 166.00 DISP ARTHROSCOPY BLADE $ 166.00 DISP ARTHROSCOPY BLADE $ 176.00 ROUND BUR 6FLUTE 4.0MM $ 176.00 ROUND BUR 6FLUTE 3.5MM $ 176.00 RF-CANNULA 10MM X 18G $ 118.00 SURGICAL BLADES $ 17.00 3M IOBAN 2 DRAPE $ 127.00 KIT,CWS 400 CLSD WOULD SUCT $ 28.00 BLADE, SHORT NARROW $ 201.00 BUR, EGG 4.0 $ 394.00 STRY BLDE, LONG NARROW $ 102.00 SHORT NARROW BLADE $ 130.00 BUR, EGG 4.0 $ 395.00 SHORT NARROW BLADE $ 130.00

114 THIN OFFSET BLADE $ 108.00 BLDE, SHORT MED CUT 9.0MM $ 108.00 CAST CUTTER BLADE $ 180.00 STRY 6.0 ROUND DIAMOND BUR $ 373.00 BLADE, SHORT NARROW $ 201.00 NEURO DRILL SOFT TOUCH $ 395.00 BUGBEE FULGURATING ELECTRODE $ 214.00 KNIFE ELECTRODE $ 2,680.00 COLLINGS KNIFE 24FR $ 218.00 A4351 CATH, URETHRAL 18FR $ 9.00 A4351 16FR RED CATHETER $ 9.00 KIT, INFANT CATH 5 FR CS/50 $ 9.00 A4340 CATH, FOLEY, LUBRICATH, 2-WAY $ 20.00 A4344 CATH, LUBRI-SIL 8FR $ 11.00 A4344 CATH, SILICONE UNCOATED 3CC $ 10.00 A4344 10 FR FOLEY CATHETER $ 11.00 A4344 CATH,FOLEY 100% SILICONE 14FR 10ML $ 14.00 A4346 CATH, 16FR 3-WAY FOLEY I.C. $ 36.00 C1758 CATHE, FOLEY EDELMANN 16FR $ 59.00 A4338 CATHETER, LUBRICATH 16FR $ 100.00 A4346 CATH,CONTINUOUS IRRIGATION 18FR $ 36.00 A4338 CATHR, 2-WAY FOLEY 18FR $ 30.00 C1758 CATH, 2-WAY FOLEY 18FR 5CC $ 35.00 A4338 CATH, 2-WAY FOLEY $ 30.00 A4338 CATH, FOLEY 22FR 5CC $ 1.00 A4346 CATH, 22FR 30CC 3-WAY $ 26.00 A4346 CATH, CONTINUOUS IRRIGATION 24FR $ 26.00 A4340 CATH, 26FR 30CC, 3 WAY $ 26.00 A4338 CATH, FOLEY 24FR 3/WAY $ 10.00 A4338 CATH, LUBRI-SIL 24FR 30CC $ 10.00 A4338 CATH, LUBRICATH 20FR 30CC $ 26.00 WOVEN FILIFORM STRAIGHT TIP $ 156.00 DIL/CATH,FILIFORMS, WOVEN, SP $ 156.00 FILIFORM,WOVEN 2FR 12.5 NYLON $ 156.00 DIL/CATH, FILIFORMS, WOVEN, SP $ 156.00 OLIVE TIP FILLAFORM 4 FRENCH $ 156.00 CATH, WOVEN PHILIPS $ 156.00 CUFF TOURNIQUET 12 IN $ 52.00 PACK GENERAL ORTHOPEDIC $ 70.00 A6457 STOCKINETTE TUBULAR 6X72 $ 10.00 MARYLAND JAW $ 1,698.00 C1894 FLEXOR URETERAL ACCESS SHEATH $ 412.00 C1758 FLEXI-TEP 2LUM URET ACC CATH 6F $ 116.00 C1758 FLEXI-TEP 2LUM URET ACC CATH 6F $ 117.00 C1758 DUAL LUMEN URETERAL CATHETER $ 104.00 C2627 WHISTLE TIP URETERAL CATHR LT $ 107.00 C2627 WHISTLE TIP URETERAL CATH RT $ 190.00 C2617 UNIVERSA FIRM STENTS $ 353.00 C2617 UNIVERSA FIRM STENTS $ 353.00 C2617 UNIVERSA FIRM STENTS $ 353.00 C2617 UNIVERSA FIRM STENTS $ 353.00 ENCORE 26 INFLATION DEVICE $ 174.00 B/WVN FILIFORM SPIRAL TIP 5 FR $ 156.00 B/WVN FILIFORM FOLLOWER 10 FR $ 234.00 B/WVN PHILLIPS FOLLOWER 12FR $ 234.00 B/WVN PHILLIPS FOLLOWER 14 FR $ 234.00

115 B/WVN PHILLIPS FOLLOWER 16 FR $ 234.00 B/WVN PHILLIPS FOLLOWER 18 FR $ 234.00 B/WVN PHILLIPS FOLLOWER 20 FR $ 234.00 B/WVN PHILLIPS FOLLOWER 22 FR $ 234.00 B/WVN PHILLIPS FOLLOWER 24 FR $ 234.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST PTA B/DILAT CATH $ 795.00 C1725 CONQUEST 40 PTA B/DILAT CATH $ 795.00 C1725 DORADO PTA DILATATION CATHETER $ 735.00 C1894 COOK MED FLEX-FLOR CK FLO INTRO $ 229.00 C1894 COOK MED FLEX-FLOR CK FLO INTRO $ 229.00 C1888 65CM VENACURE EVLT PROC KIT $ 1,500.00 C1880 TRAPEASE PERM VENA-CAVA FILTER $ 2,085.00 C1894 COOK MED PEEL AWAY INTRO 8F $ 148.00 C1894 COOK MED PEEL AWAY INTRO 10F $ 148.00 C1894 COOK MED PEEL AWAY INTRO 12F $ 148.00 COOK MEDICAL DILATOR 10 F $ 28.00 COOK MEDICAL DILATOR 12 F $ 28.00 C1874 FLAIR ENDOVASCULAR STENT GRAFT $ 12,753.00 C1750 ARGYLE PERITONEL DIALYSIS CATH $ 232.00 COVIDIEN STEEL SZ 5 SUTURE $ 21.00 EV3 EVERFLEX $ 2,085.00 INVISISHIELD PROCOVER KIT $ 23.00 C1769 COOK MEDICAL MICROWIRE GUIDE $ 51.00 ARGON ARTERIAL NEEDLE $ 8.00 BAXTER SPRAY KIT $ 163.00 A6209 BIOPATCH $ 18.00 TERUMO MULTI TORQUE KIT $ 165.00 SURG CARDIO VASC VEIN GRFT CANN $ 12.00 CORDIS DIAGNOSTIC CATH $ 25.00 BLDE SAW MICRO LNG MD 25MM X 9MM $ 108.00 SUT ETHB RPR V37 $ 193.00 MICROAIRE K-WIRE $ 19.00 STRYKE PERFORMANCE SAGITTAL BLADE $ 181.00 INSTINCT ENDOSCOPIC HEMOCLIP $ 693.00 UNDERBUTTOCKS DRAPE $ 7.00 A6457 STOCKINETTE 6 X 72 $ 9.60 TRADITIONAL MARYLAND DISSECTOR DISP $ 63.00 STRYKER SAGITTAL BLADE $ 181.00 STRYR BLDE SAW MICRO LNG MD 25MM X 9MM $ 108.00 VALLEYLAB SMOKE EVACUATION PENCIL $ 389.00 MINERVA DISPOSABLE HANDPIECE $ 3,480.00 C1713 ORTHOSORB RESORBABLE PIN $ 241.00 MICROAIRE K-WIRE 1.6 MM $ 54.00 MICRO OSCILLATOR BLADE FINE $ 6.00 MICRO SAGITTAL SAW BLADE $ 63.00 CARBIDE BUR OVAL CUTTING MED LEN $ 85.00 CARBIDE BUR OVAL CUTTING 5.5MM $ 85.00 GENADYNE FOAM KIT LARGE $ 128.00 C1882 INSERTION OF ICD $ 51,120.00 BLADE SHORT MEDIUM CUT 9.0MM $ 108.00

116 KIT XLR8 FOAM MEDIUM $ 113.00 FORCEP BIPOLAR 7MM $ 90.00 SUTURE MAXON GRN $ 23.00 C1769 HI WIRE NITINOL CORE WIRE GUIDE $ 107.00 WOVEN FILAFORM 5 FR. REUSABLE SPIRAL $ 146.00 A4340 COUDE TIP 14 FR. 30CC FOLEY CATHETER $ 29.00 A4340 COUDE TIP 12 FR. 5 CC FOLEY CATHETER $ 29.00 RIBBED BALLOON 2 WAY FOLEY CATHETER 26 F $ 26.00 C1758 WHISTLE TIP URETERAL CATHETER 5 FR. (Lef $ 116.00 C1758 WHISTLE TIP URETERAL CATHETER (RIGHT) $ 311.00 A4340 COUNCIL 20 FR. 5CC RIBBED BALLOON FOLEY $ 37.00 C1781 3D MESH LARGE LEFT $ 527.00 C1781 VENTRALIGHT MESH 6 X 8 ELLIPSE $ 2,163.00 C1781 VENTRALIGHT MESH 8 X 10 ELLIPSE $ 1,277.20 MINI STEP DILATOR & CANNULA 7MM-8MM $ 183.00 B4087 MIC GASTROSTOMY FEEDING TUBE 16 FR $ 110.00 C1729 THORACIC PVC CATHETER RIGHT ANGLE 32 FR $ 28.00 C1729 THOACIC PVC CATHETER RIGHT ANGLE 28 FR $ 28.00 3000cc HI FLOW CANISTER SMITH & NEPHEW $ 9.00 K-WIRE 1.6MM X 102MM $ 113.00 SUTURE MONOSOF 6-0 NYLON $ 3.60 DRAPE, C-ARM MOBILE XRAY $ 9.00 BRUSH CYTOLOGY FOR BRONCHOSCOPY $ 55.20 C1750 PRE CURVED PDROME CATH 23 CM $ 1,655.00 E0114 CRUTCH ADULT REGULAR $ 30.00 SPECIMAN TRAP 40 ML $ 4.00 L4360 WALKER EXTRA PNEUMATIC SMALL $ 291.00 K-WIRE 1.1MM X 102MM $ 19.00 SUTURE NOVAFIL $ 19.00 TROCAR K-WIRE 0.035 X 4 $ 19.00 GEISTLICH BIO OSS PEN 0.25 1MM 0.25G $ 291.00 GRAFT BONE DENTAL $ 1,409.00 SPLINT DENVER NASAL 1500 SMALL KIT $ 143.00 A7521 TUBE TRACH SZ 8 W DISP INNER CANNULA $ 137.00 A7521 TUBE TRACH CUFFED FENESTRATED SZ 6 $ 184.00 OPMI DRAPES $ 29.00 A4340 CATH FOLEY COUDE 2WAY 30CC 14 FR $ 29.00 A4340 CATH FOLEY COUDE LTX 12 FR 10 ML $ 29.00 A4340 CATH FOLEY COUNCIL 20 FR 5 ML $ 37.00 A4344 CATH FOLEY SILICONE 18 FR 10 ML $ 14.00 CATH FOLEY 18 FR COATED LATEX $ 9.00 A4338 CATH FOLEY 22 FR 30 ML LUBRICIOUS STR $ 14.00 C1713 MICRO SCREWS ACUTRAK 20MM $ 1,680.00 C1713 MICRO SCREWS ACUTRAK 22MM $ 1,680.00 C1713 MICRO SCREWS ACUTRAK 14MM $ 1,680.00 C1713 MICRO SCREWS ACUTRAK 12MM $ 1,680.00 FLEX HINGE TOE IMPLANT SZ 0S $ 3,510.00 FLEX HINGE TOE IMPLANT SZ 4S $ 3,210.00 FLEX HINGE TOE IMPLANT SZ 2S $ 3,510.00 FLEX HINGE TOE IMPLANT SZ 3S $ 3,510.00 FLEX HINGE TOE IMPLANT SZ 5S $ 3,510.00 C1713 MINI SCREWS ACUTRAK 26MM $ 1,680.00 C1713 22.0MM MINI ACUTRAK 2 BONE SCREW $ 1,680.00 C1713 MINI SCREWS ACUTRAK 30MM $ 1,680.00 C1713 MINI SCREWS ACUTRAK 18MM $ 1,680.00 C1713 MINI SCREWS ACUTRAK 28MM $ 1,680.00

117 C1713 STANDARD SCREWS ACUTRAK 16MM $ 1,680.00 C1713 STANDARD SCREWS ACUTRAK 22MM $ 1,680.00 C1713 STANDARD SCREWS ACUTRAK 26MM $ 1,680.00 C1713 STANDARD SCREWS ACUTRAK 28MM $ 1,680.00 C1713 STANDARD ACUTRAK 30MM $ 1,680.00 K WIRE 1.1MM X 102MM $ 54.00 TROCAR K WIRE 0.035X4 PTS BOTH END $ 19.00 PIN PROTECTOR 9MM $ 3.00 BLADE SAW OSC 9.6MM X20MMX0.7MM $ 87.00 SST BUR SHANNON 44 2.3MM $ 98.00 BLADE BEAVER 6400 $ 5.00 DISPENSER GYPONSA 5 PLY 15CM X 20M $ 179.00 DISPENSE GYPONSA SLAB 5 PLY 10CM X 2CM $ 143.00 SAGITTAL BLADE 18MM $ 181.00 FLYTE HOOD $ 90.00 CUFF TOURNIQUET CUFF 12 IN $ 52.00 IOBAN 2 DRAPE $ 127.00 CLOSED WOUND SUCTION $ 30.00 18 G SPINAL NEEDLE $ 5.00 LINERS GLOVE CUT REST SURGICAL $ 210.00 SURGICAL STEEL 6 4 X18 $ 125.00 SURGICAL STEEL 7 4 X 18 $ 128.00 PILLOW ABDUCTION SMALL $ 53.00 HIP ABDUCTION PILLOW MED $ 142.00 PILLOW ABDUCTION LARGE $ 157.00 PAD GROUNDING ADULT UNCORDED $ 3.00 NEEDLE PORT A CATH 22 GA X 11 SAFETY $ 14.00 CANNULA DILATOR MINI STEP MM SL $ 183.00 B4087 TUBE FEEDING GASTRO SILICONE MIC $ 111.00 A4414 WAFER FLAT MOLDABLE 2 $ 43.00 ADAPTER LOW PRESSURE 2 $ 11.00 WAFER FLAT MOLDABLE 1 $ 44.00 A4421 ADAPTER LOW PRESSURE 1 $ 1.00 LOOP OSTOMY BRIDGE $ 3.00 A5063 POUCH INVISICLOSE 1 $ 3.00 A5063 POUCH INVISICLOSE 2 $ 3.00 A4363 CLOSURE CURVED TAIL DUOLOCK $ 3.00 C1769 CAP LISS BARCODE 10 X 11.5 $ 107.00 C1758 WHISTLE TIP LT $ 311.00 C1758 CATH DUAL LMN FLEX TIP URETH 22610 $ 116.00 C1758 WHISTLE TIP RT $ 311.00 DILATION CATH FILIFORMS WOVEN SP $ 146.00 A4338 CATH LUBRICATH 20 FR 30 CC $ 26.00 C1729 CATH THORACIC SFT PVC RT ANG 32F $ 28.00 C1729 CATH THORACIC SFT PVC RT ANGLE 28F $ 28.00 TRADITIONAL MARYLAND 18.8MM $ 63.00 LAP CLINCH GRASPER $ 63.00 TIP SCISSOR ENDO CUT $ 116.00 MODIFIED MARYLAND 22.6MM $ 63.00 RIGHT ANGLE 10MM TIP LENGTH 17.3MM $ 63.00 KIT PORT ACCESS POWERLOC 20 GA $ 51.00 NDL PORTACATH 19GA X 1 1/4 GRIP $ 14.00 DRAINAGE PLEURAVAC INF CHEST $ 137.00 NEEDLE PORT A CATH 19G $ 6.00 INS BIOPSY MAXC PRPL SW 16 GA $ 123.00 INS BIOPSY MAXCORE PINK SWITCH $ 113.00

118 INS BIOPSY MAXC PINK SW 18 GA $ 113.00 TRU-CLOSE SUCTION DRAINAGE SYS $ 86.00 BAG DRAINAGE SUCTION $ 176.00 CELLEBRITY ENDOSCOPIC BRUSH $ 50.00 ALLIANCE SGL INFL SYS SYR $ 29.00 CAPTURA BIOPSY JUMBO SERRATED $ 50.00 C1876 ROTH NET RETRIEVER 2.5MM $ 330.00 INTERJECT NEEDLE $ 184.00 STANDARD DUAL AXIS SWIVEL $ 8.00 SHILEY DECANNULATION PLUG $ 15.00 TRACHEOSTOMY TUBE HOLDER $ 9.00 MICROBEDRIDER IRRIGATION CASS $ 414.00 ROBINSON BUCKET $ 738.00 LARGE DENVER SPLINT $ 58.00 4.5 MM X 0.6MM STAPES $ 607.00 5MM X 0.6MM STAPES $ 711.00 44970 LAPAROSCOPY APPENDECTOMY $ 13,891.00 47562 LAPAROSCOPY CHOLECYSTECTOMY $ 13,891.00 64483 EPIDURAL STEROID INJECTION $ 2,080.00 42826 TONSILLECTOMY $ 6,805.00 52000 CYSTOSCOPY $ 1,750.00 58562 HYSTEROSCOPY W REM IMPACTED FB $ 7,034.00 42820 TONSILLECTOMY AND ADENOIDECTOMY $ 13,427.00 49505 INGUINAL HERNIORRHAPHY $ 9,009.00 58662 OPERATIVE LAPAROSCOPY $ 13,891.00 54161 CIRCUMCISION 28 DAYS OR OLDER $ 5,248.00 11406 EXCISION OF MASS $ 4,172.00 31624 BRONCHOSCOPY $ 4,096.00 49650 LAP INGUINAL HERNIORRHAPHY $ 13,891.00 49585 UMBILICAL HERNIORRHAPHY $ 9,009.00 20692 APPLY OF EXTERNAL FIXATOR $ 31,327.00 28810 AMPUTATE METATARSAL W TOE SINGLE $ 8,186.00 93313 TRANSESOPHAGEAL ECHOCARDIOGRAM $ 1,506.00 30130 EXCISE INFERIOR TURBINATE $ 6,805.00 58552 TOTAL LAPAROSCOPIC HYSTERECTOMY $ 23,505.00 29840 ARTHROSCOPY WRIST $ 8,186.00 29874 ARTHROSCOPY KNEE REM LOOSE OR FB $ 8,186.00 27447 TOTAL KNEE ARTHROPLASTY $ 31,326.00 29880 KNEE ARTHROSCOPY MEDIAL AND LATERAL $ 8,186.00 29881 KNEE ARTHROSCOPY MEDIAL OR LATERAL $ 8,186.00 20610 DRAIN INJ MAJOR JOINT BURSA WO US $ 757.00 DILATOR BAL COLONIC PYLORIC $ 986.00 MINNESOTA TUBE 4 LUMEN $ 1,424.00 DILATOR BAL PYLORIC COLONIC $ 986.00 SET TUBE FLOCTRLARTHROS PMP $ 169.00 A4340 CATHETER FOLEY COUDE 22 FR 5CC $ 32.00 C1726 DILAT COLONIC BAL CRE WIREGUID $ 986.00 CATHETER URETHRAL 14 FR $ 27.00 DRAPE IOBAN2 INCISE ANTIMCRBL $ 14.00 C2625 STENT URETERAL OPTIMA 6 FR 28C $ 424.00 C1771 SLING CALDERA MEDICAL $ 1,677.00 C1726 DILAT CRE FIX WIRE BAL 6 FR 8 CM $ 855.00 A4340 FOLEY CATHETER 18 FR 5CC $ 46.00 A4346 CATH FOL 16 FR 30 ML SIL-E-LAST $ 26.00 A4340 FOLEY CATHETER COUDE 22 FR 5 CC $ 46.00 A4340 FOLEY CATHETER 16 FR 5 ML $ 46.00

119 31628 BRONCHOSCOPY LUNG BX EACH $ 8,097.45 27792 TREATMENT OF ANKLE FRACTURE DIS $ 17,350.00 27814 TREATMENT OF ANKLE FRACTURE BIM $ 17,350.00 28110 PART REMOVAL OF METATARSAL 5TH $ 8,186.00 28288 PART REMOVAL OF METATARSAL $ 8,186.00 28292 CORRECTION OF BUNION $ 8,186.00 10021 FNA WITHOUT IMAGE $ 962.00 42825 REMOVAL OF TONSILS $ 13,427.16 10060 DRAINAGE OF SKIN ABSCESS $ 523.00 11403 EXC TR EXT B9 MARG 2.1 3CM $ 1,773.00 26055 INCISE FINGER TENDON SHEATH $ 4,178.00 63650 IMPLANT NEUROELECTRODES $ 18,740.00 29891 ANKLE ARTHROSCOPY SURGERY $ 8,186.00 29895 ANKLE ARTHROSCOPY SURGERY $ 8,186.00 21930 EXC BACK LES SC < 3 CM $ 4,172.00 11402 EXC TR-EXT B9 MARG 1.1-2 CM $ 1,773.00 36821 AV FUSION DIRECT ANY SITE $ 7,714.00 26320 REMOVAL OF IMPLANT FROM HAND $ 4,172.00 57135 REMOVE VAGINA LESION $ 7,034.00 57461 CONZ OF XERVIX W/SCOPE LEEP $ 7,034.00 27610 EXPLORE/TREAT ANKLE JOINT $ 8,186.00 11400 EXC TR-EXT B9 MARG 0.5 CM< $ 1,773.00 11443 EXC FACE MM B9 MARG 2.1-3 CM $ 4,172.00 33262 REMVL & REPLC PULSE GEN 1 LEAD $ 68,425.00 64635 DESTROY LUMB/SAC FACET JNT $ 4,984.00 64636 DESTROY L/S FACET JNT ADDL $ 109.05 52356 CYSTO/URETERO W/LITHOTRIPSY $ 11,469.00 36818 AV FUSE UPPR ARM CEPHALIC $ 13,199.00 11423 EXC H-F-NK=SP B9 MARG 2.1-3 $ 4,172.00 11900 INJECT SKIN LESIONS

120 TAPE CAST 3 X 4 YDS STANDARD 3IN $ 6.00 PIN PROTECTOR 0.45"(1.1MM) WHITE $ 8.00 BARREL BURR 12-FLUTE $ 177.00 TAPE CASTING SCOTHCAST 5 IN $ 2.00 CASSETTE TUBING STRYK CROSSFLW $ 208.00 BLADE SAW OSC SMALL 5.2MM X20MM $ 87.00 FEMORAL CNL PRESSU W/OUT HUB $ 48.00 REVOLUTION CEMENT MIX SYSTEM $ 383.00 TROCAR WIRE 0.06X4" POINTS BOTH $ 19.00 CUTTER WHISKER SLOT 4 $ 168.00 TAPE CASTING SCOTCH CAST 2 IN $ 6.00 28820 AMPUTATION OF TOE $ 4,178.00 40812 EXCISE/REPAIR MOUTH LESION $ 6,805.00 58571 TLH W/T/O 250 G OR LESS $ 23,505.00 49652 LAP VENT/ABD HERNIA REPAIR $ 13,891.00 25111 REMOVE WRIST TENDON LESION $ 4,178.00 28415 TREAT HEEL FRACTURE $ 17,350.00 60220 TOTAL THYROID LOBECTOMY UNILATERAL $ 13,891.00 11200 REMOVAL OF SKIN TAGS $ 523.00 11401 EXC TR-EXT B9-MARG 0.6-1 CM $ 962.00 11422 EXC-H-F-NK-SP B9+MARG 1.1-2 $ 4,172.00 11442 EXC FACE-MM B9+MARG 1.1-2 CM $ 1,773.00 11603 EXC TR-EXT MAL+MARG 2.1-3 CM $ 1,773.00 13160 LATE CLOSURE OF WOUND $ 4,854.00 14020 TIS TRNFR S/A/L 10 SQ CM/< $ 4,854.00 14040 TIS TRNFR F/C/C/M/N/A/G/H/F $ 4,854.00 15002 WOUND PREP TRK/ARM/LEG $ 4,854.00 15738 MUSCLE-SKIN GRAFT LEG $ 8,388.00 19301 PARTIAL MASTECTOMY $ 8,442.00 19307 MAST MOD RAD $ 14,891.00 20552 INJ TRIGGER POINT 1/2 MUSCL $ 757.00 20670 REMOVAL OF SUPPORT IMPLANT $ 4,172.00 20680 REMOVAL OF SUPPORT IMPLANT DP $ 7,195.00 23650 TREAT SHOULDER DISLOCATION $ 665.00 25000 INCISION OF TENDON SHEATH $ 4,178.00 26115 EXC HAND LES SC < 1.5 CM $ 4,172.00 26160 REMOVE TENDON SHEATH LESION $ 4,178.00 26418 REPAIR FINGER TENDON $ 4,178.00 26615 TREAT METACARPAL FRACTURE $ 8,186.00 26727 TREAT FINGER FRACTURE EACH $ 8,186.00 27043 EXC HIP PELVIS LES SC 3 CM/> $ 7,195.00 27096 INJECT SACROILIAC JOINT $ 518.00 27602 DECOMPRESSION OF LOWER LEG $ 8,186.00 27650 REPAIR ACHILLES TENDON $ 8,186.00 28008 INCISION OF FOOT FASCIA $ 8,186.00 28060 PARTIAL REMOVAL FOOT FASCIA $ 8,186.00 28108 REMOVAL OF TOE LESIONS $ 4,178.00 28289 REPAIR HALLUX RIGIDUS $ 8,186.00 28308 INCISION OF METATARSAL $ 8,186.00 29823 SHOULDER ARTHROSCOPY/SURGERY $ 8,186.00 29873 KNEE ARTHROSCOPY/SURGERY $ 8,186.00 DEVICE TRU CLEAR INCISOR ULTRA PLUS $ 2,427.00 BLADE TRUCLEAR ULTRA MINI DEVICE $ 2,961.00 ADHESIVE TOPICAL SKIN SWIFTSET $ 101.00 HANDPIECES MINERVA DISPOSABLE $ 3,480.00 29882 KNEE ARTHROSCOPY/SURGERY $ 8,186.00

121 30140 RESECT INFERIOR TURBINATE $ 6,805.00 31541 LARYNSCOP W/TUMR EXC + SCOPE $ 8,097.00 32554 ASPIRATE PLEURA W/O IMAGING $ 1,896.00 33249 INSJ/RPLCMT DEFIB W/LEAD(S) $ 95,818.00 36215 PLACE CATHETER IN ARTERY $ 598.00 36561 INSERT TUNNELED CV CATH $ 7,714.00 36582 REPLACE TUNNELED CV CATH $ 7,714.00 36590 REMOVAL TUNNELED CV CATH $ 1,896.00 36901 INTRO NDL/CATH DIALYSIS CIRCU $ 1,896.00 36906 WITH TRANSCATHETER PLACEMENT $ 49,578.00 37722 LIGATE/STRIP LONG LEG VEIN $ 7,714.00 37799 VASCULAR SURGERY PROCEDURE $ 1,896.00 41112 EXCISION OF TONGUE LESION $ 6,805.00 46040 INCISION OF RECTAL ABSCESS $ 2,898.00 46922 EXCISION OF ANAL LESION(S) $ 7,166.00 49322 LAPAROSCOPY ASPIRATION $ 13,891.00 49329 LAPARO PROC ABDM/PER/OMENT $ 13,891.00 49560 RPR VENTRAL HERN INIT REDUC $ 9,009.00 49587 RPR UMBIL HERN BLOCK > 5 YR $ 9,009.00 49653 LAP VENT/ABD HERN PROC COMP $ 13,891.00 49654 LAP INC HERNIA REPAIR $ 23,505.00 49656 LAP INC HERNIA REPAIR RECUR $ 23,505.00 50561 KIDNEY ENDOSCOPY & TREATMENT $ 11,469.00 25609 TREAT FX RADIAL 3+ FRAG $ 11,871.00 36825 AV FUSION/FORARM VEIN $ 13,199.00 52005 CYSTOSCOPY & URETER CATHETER $ 5,248.00 52204 CYSTOSCOPY W/BIOPSY(S) $ 5,248.00 52310 CYSTOSCOPY AND TREATMENT $ 5,248.00 52332 CYSTOSCOPY AND TREATMENT $ 8,346.00 52353 CYSTOURETERO W/LITHOTRIPSY $ 11,469.00 52630 REMOVE PROSTATE REGROWTH $ 11,469.00 52648 LASER SURGERY OF PROSTATE $ 11,469.00 54065 DESTRUCTION PENIS LESION(S) $ 4,854.00 57505 ENDOCERVICAL CURETTAGE $ 1,781.00 57700 REVISION OF CERVIX $ 7,034.00 58661 LAPAROSCOPY REMOVE ADNEXA $ 13,891.00 59320 REVISION OF CERVIX $ 7,034.00 59514 CESAREAN DELIVERY ONLY $ 3,211.00 59820 CARE OF MISCARRIAGE $ 7,034.00 62321 WITH IMAGING GUIDANCE $ 1,682.00 62323 WITH IMAGING GUIDANCE $ 1,682.00 64490 INJ PARAVERT F JNT C/T 1 LEV $ 2,080.00 64493 INJ PARAVERT F JNT L/S 1 LEV $ 2,080.00 64633 DESTROY CERV/THOR FACET JNT $ 4,984.00 64721 CARPAL TUNNEL SURGERY $ 4,984.00 67700 DRAINAGE OF EYELID ABSCESS $ 828.00 69205 CLEAR OUTER EAR CANAL $ 4,172.00 69631 REPAIR EARDRUM STRUCTURES $ 13,427.00 C9745 NASAL ENDO EUSTACHIAN TUBE $ 13,427.00 G0260 INJ FOR SACROILIAC JT ANESTH $ 1,682.00 36830 ARTERY-VEIN NONAUTOGRAFT $ 13,199.00 52281 CYSTOSCOPY & TREATMENT $ 5,248.00 55520 REMOVAL OF SPERM CORD LESION $ 8,346.00 24075 EXC ARM/ELBOW LES SC < 3CM $ 4,172.00 10120 REMOVAL FOREIGN BODY $ 962.00 11012 DEB SKIN BONE AT FX SITE $ 7,195.00

122 11042 DEB SUBQ TISSUE 20 SQ CM/< $ 962.00 11044 DEB BONE 20 SQ CM/< $ 4,172.00 11100 BIOPSY SKIN LESION $ 962.00 11404 EXC TR-EXT B9+MARG 3.1-4 CM $ 4,172.00 11420 EXC H-F-NK-SP B9+MARG 0.5/< $ 4,172.00 11421 EXC H-F-NK-SP B9+MARG 0.6-1 $ 1,773.00 11441 EXC FACE-MM B9+MARG 0.6-1 CM $ 1,773.00 11450 REMOVAL SWEAT GLAND LESION $ 7,195.00 11601 EXC TR-EXT MAL+MARG 0.6-1 CM $ 1,773.00 11604 EXC TR-EXT MAL+MARG 3.1-4 CM $ 1,773.00 11646 EXC F/E/E/N/L MAL+MRG >4 CM $ 7,195.00 11771 REMOVE PILONIDAL CYST EXTEN $ 7,195.00 11982 REMOVE DRUG IMPLANT DEVICE $ 1,022.00 12020 CLOSURE OF SPLIT WOUND $ 1,511.00 15770 DERMA-FAT-FASCIA GRAFT $ 8,388.00 15839 EXCISE EXCESS SKIN & TISSUE $ 7,195.00 17110 DESTRUCT B9 LESION 1-14 $ 523.00 19020 INCISION OF BREAST LESION $ 4,172.00 19120 REMOVAL OF BREAST LESION $ 8,442.00 19125 EXCISION BREAST LESION $ 8,442.00 19300 REMOVAL OF BREAST TISSUE $ 8,442.00 20615 TREATMENT OF BONE CYST $ 1,773.00 20693 ADJUST BONE FIXATION DEVICE $ 17,350.00 20926 REMOVAL OF TISSUE FOR GRAFT $ 8,388.00 21011 EXC FACE LES SC <2 CM $ 4,172.00 21012 EXC FACE LES SBQ 2 CM/> $ 4,172.00 21025 EXCISION OF BONE LOWER JAW $ 13,427.00 21048 REMOVE MAXILLA CYST COMPLEX $ 13,427.00 21320 CLOSED TX NOSE FX W/ STABLJ $ 6,805.00 21552 EXC NECK LES SC 3 CM/> $ 7,195.00 21555 EXC NECK LES SC < 3 CM $ 4,172.00 21931 EXC BACK LES SC 3 CM/> $ 4,172.00 21933 EXC BACK TUM DEEP 5 CM/> $ 7,195.00 22902 EXC ABD LES SC < 3 CM $ 4,172.00 23071 EXC SHOULDER LES SC 3 CM/> $ 4,172.00 23075 EXC SHOULDER LES SC < 3 CM $ 4,172.00 23655 TREAT SHOULDER DISLOCATION $ 4,178.00 24105 REMOVAL OF ELBOW BURSA $ 8,186.00 24340 REPAIR OF BICEPS TENDON $ 17,350.00 24342 REPAIR OF RUPTURED TENDON $ 17,350.00 24358 REPAIR ELBOW W/DEB OPEN $ 8,186.00 24359 REPAIR ELBOW DEB/ATTCH OPEN $ 8,183.00 24516 TREAT HUMERUS FRACTURE $ 31,327.00 24538 TREAT HUMERUS FRACTURE $ 17,350.00 25440 REPAIR/GRAFT WRIST BONE $ 17,350.00 25515 TREAT FRACTURE OF RADIUS $ 17,350.00 25526 TREAT FRACTURE OF RADIUS $ 17,350.00 25565 TREAT FRACTURE RADIUS & ULNA $ 4,178.00 25575 TREAT FRACTURE RADIUS/ULNA $ 17,350.00 25605 TREAT FRACTURE RADIUS/ULNA $ 4,178.00 25606 TREAT FX DISTAL RADIAL $ 8,186.00 25628 TREAT WRIST BONE FRACTURE $ 17,350.00 26210 REMOVAL OF FINGER LESION $ 4,178.00 26370 REPAIR FINGER/HAND TENDON $ 8,186.00 59151 LAP TX ECT PREG $ 13,891.00 26410 REPAIR HAND TENDON $ 4,178.00

123 26540 REPAIR HAND JOINT $ 8,186.00 26548 RECONSTRUCT FINGER JOINT $ 8,186.00 26608 TREAT METACARPAL FRACTURE $ 8,186.00 26665 TREAT THUMB FRACTURE $ 8,186.00 26685 TREAT HAND DISLOCATION $ 8,186.00 26735 TREAT FINGER FRACTURE EACH $ 8,186.00 27033 EXPLORATION OF HIP JOINT $ 8,186.00 27048 EXC HIP/PELV TUM DEEP < 5 CM $ 7,195.00 27130 TOTAL HIP ARTHROPLASTY $ 5,248.50 27327 EXC THIGH/KNEE LES SC < 3 CM $ 4,172.00 27337 EXC THIGH/KNEE LES SC 3 CM/> $ 7,195.00 27355 REMOVE FEMUR LESION $ 8,186.00 27372 REMOVAL OF FOREIGN BODY $ 7,195.00 27380 REPAIR OF KNEECAP TENDON $ 17,350.00 27385 REPAIR OF THIGH MUSCLE $ 17,350.00 27524 TREAT KNEECAP FRACTURE $ 17,350.00 27570 FIXATION OF KNEE JOINT $ 4,178.00 27619 EXC LEG/ANKLE TUM DEEP <5 CM $ 7,195.00 27632 EXC LEG/ANKLE LES SC 3 CM/> $ 7,195.00 27652 REPAIR/GRAFT ACHILLES TENDON $ 17,350.00 27685 REVISION OF LOWER LEG TENDON $ 8,186.00 27766 OPTX MEDIAL ANKLE FX $ 17,350.00 27822 TREATMENT OF ANKLE FRACTURE $ 17,350.00 27827 TREAT LOWER LEG FRACTURE $ 31,327.00 28010 INCISION OF TOE TENDON $ 4,178.00 28039 EXC FOOT/TOE TUM SC 1.5 CM/> $ 7,195.00 28043 EXC FOOT/TOE TUM SC < 1.5 CM $ 4,172.00 28045 EXC FOOT/TOE TUM DEEP <1.5CM $ 7,195.00 28090 REMOVAL OF FOOT LESION $ 4,178.00 28124 PARTIAL REMOVAL OF TOE $ 4,178.00 28192 REMOVAL OF FOOT FOREIGN BODY $ 4,172.00 22903 EXC ABD LES SC 3CM/> $ 7,195.00 28475 TREAT METATARSAL FRACTURE $ 665.00 36820 AV FUSION/FOREARM VEIN $ 13,199.00 11426 EXC BLES S/N/EX G >4CM $ 7,195.00 56440 SURGERY FOR VULVA LESION $ 7,034.00 12031 INTMD RER S/A/T/EXT 2.5 CM/< $ 962.00 24685 TREAT ULNAR FRACTURE $ 17,350.00 23515 TREAT CLAVICLE FRACTURE $ 17,350.00 27635 REMOVE LOWER LEG BONE LESION $ 8,186.00 57287 REVISE/REMOVE SLING REPAIR $ 7,034.00 49320 DIAG LAPRO SEPARATE PROC $ 13,891.00 52282 CYSTOSCOPY IMPLANT STENT $ 8,346.00 42310 DR ABSC SUBMAX/SUBLING INTRAORAL $ 1,423.00 41899 DENTAL SURGERY PROCEDURE $ 552.00 28112 PARTIAL REMOVAL OF METATARSAL $ 8,186.00 28122 PARTIAL REMOVAL OF FOOT BONE $ 8,186.00 28119 REMOVAL OF HEEL SPUR $ 8,186.00 27860 FIXATION OF ANKLE JOINT $ 4,178.00 57240 REPAIR BLADDER & VAGINA $ 12,725.00 28210 REPAIR/GRAFT OF FOOT TENDON $ 17,350.00 28250 REVISION OF FOOT FASCIA $ 8,186.00 28291 HALLUX RIG CORR W CHELLECTOMY $ 17,350.00 28485 TREAT METATARSAL FRACTURE $ 17,350.00 28495 TREAT BIG TOE FRACTURE $ 665.00 28496 TREAT BIG TOE FRACTURE $ 8,186.00

124 28675 REPAIR OF TOE DISLOCATION $ 8,186.00 28800 AMPUTATION OF MIDFOOT $ 8,186.00 28825 PARTIAL AMPUTATION OF TOE $ 4,178.00 29807 SHOULDER ARTHROSCOPY/SURGERY $ 17,350.00 29875 KNEE ARTHROSCOPY LIM SYNOVECTO $ 8,186.00 29877 KNEE ARTHROSCOPY DEBRID/SHV AC $ 8,186.00 29879 KNEE ARTHROSCOPY ABRAS ARTHROPL $ 8,186.00 29886 KNEE ARTHROSCOPY/SURGERY $ 8,186.00 29888 KNEE ARTHROSCOPY/SURGERY $ 17,350.00 30117 REMOVAL OF INTRANASAL LESION $ 6,805.00 30905 CONTROL OF NOSEBLEED $ 986.00 31237 NASAL/SINUS ENDOSCOPY SURG $ 4,096.00 31536 LARYNGOSCOPY W/BX & OP SCOPE $ 8,097.00 33264 REML & RPLCMT DFB GEN $ 95,818.00 36430 BLOOD TRANSFUSION SERVICE $ 1,161.00 38500 BIOPSY/REMOVAL LYMPH NODES SUP $ 8,442.00 38510 BIOPSY/REMOVAL LYMPH NODES DEEP $ 8,442.00 38525 BIOPSY/REMOVAL LYMPH NODES AXIL $ 8,442.00 40806 INCISION OF LIP FOLD $ 1,423.00 41010 INCISION OF TONGUE FOLD $ 3,522.00 41110 EXCISION OF TONGUE LESION $ 6,805.00 42182 REPAIR PALATE $ 13,427.00 42300 DRAINAGE OF SALIVARY GLAND $ 3,522.00 42415 EXCISE PAROTID GLAND/LESION $ 13,427.00 42821 REMOVE TONSILS AND ADENOIDS $ 6,805.00 42960 CONTROL THROAT BLEEDING $ 1,423.00 46020 PLACEMENT OF SETON $ 7,166.00 46230 REMOVAL OF ANAL TAGS $ 7,166.00 46910 DESTRUCTION ANAL LESION(S) $ 4,854.00 47000 NEEDLE BIOPSY OF LIVER $ 4,172.00 49321 LAPAROSCOPY BIOPSY $ 13,891.00 49507 PRP I/HERN INIT BLOCK >5 YR $ 9,009.00 49570 RPR EPIGASTRIC HERNIA REDUCE $ 9,009.00 50389 REMOVE RENAL TUBE W/FLUORO $ 1,750.00 50590 FRAGMENTING OF KIDNEY STONE $ 11,469.00 51600 INJECTION FOR BLADDER X-RAY $ 364.00 52276 CYSTOSCOPY AND TREATMENT $ 5,248.00 52318 REMOVE BLADDER STONE $ 11,469.00 52352 CYSTOURETERO W/STONE REMOVE $ 11,469.00 53230 REMOVAL OF URETHRA LESION $ 11,469.00 53450 REVISION OF URETHRA $ 5,248.00 54057 LASER SURG PENIS LESION(S $ 4,854.00 54405 INSERT MULTI-COMP PENIS PROS $ 48,579.72 54530 REMOVAL OF TESTIS $ 9,009.00 54640 SUSPENSION OF TESTIS $ 9,009.00 55060 REPAIR OF HYDROCELE $ 5,248.00 55535 REVISE SPERMATIC CORD VEINS $ 9,009.00 56515 DESTROY VULVA LESION/S COMPL $ 4,854.00 57250 REPAIR RECTUM & VAGINA $ 12,725.00 57260 REPAIR OF VAGINA $ 12,725.00 57288 REPAIR BLADDER DEFECT $ 12,725.00 57454 BX/CURETT OF CERVIX W/SCOPE $ 830.00 57522 CONIZATION OF CERVIX $ 7,034.00 58120 DILATION AND CURETTAGE $ 7,034.00 58260 VAGINAL HYSTERECTOMY $ 12,725.00 58353 ENDOMETR ABLATE THERMAL $ 12,725.00

125 58555 HYSTEROSCOPY DX SEP PROC $ 7,034.00 58561 HYSTEROSCOPY REMOVE MYOMA $ 12,725.00 58563 HYSTEROSCOPY ABLATION $ 12,725.00 58660 LAPAROSCOPY LYSIS $ 13,891.00 59870 EVACUATE MOLE OF UTERUS $ 7,034.00 64450 N BLOCK OTHER PERIPHERAL $ 1,682.00 64719 REVISE ULNAR NERVE AT WRIST $ 4,984.00 64784 REMOVE NERVE LESION $ 4,984.00 64831 REPAIR OF DIGIT NERVE $ 14,321.00 65420 REMOVAL OF EYE LESION $ 5,606.00 67801 REMOVE EYELID LESIONS $ 2,502.00 69436 CREATE EARDRUM OPENING $ 3,522.00 11920 REMOVAL OF BREAT LESION $ 8,442.00 24120 REMOVE ELBOW LESION $ 8,186.00 25075 EXC FOREARM LES SC<3 CM $ 4,172.00 27687 REVISION OF CALF TENDON $ 8,186.00 00731 UPPER GASTRO ENDOSCOPIC PROC $ 1,771.00 00811 LOWER INTESTINAL ENDOSCOPIC PR $ 1,771.00 00812 ANES LOWER INTESTINAL SCREEN COLSC $ 1,771.00 00813 ANES UPPER LOWER GI ENDOSCOPIC PX $ 1,771.00 ANES UPPER GI ENDOSCOPIC PX ERCP $ 1,771.00 84145 PROCALCITONIN $ 400.00 87481 CANDIDA SPECIES 1 BY NAA $ 145.00 87481 CANDIDA SPECIES 2 BY NAA $ 145.00 87661 TRICHOMONAS BY NAA $ 145.00 87798 BACTERIAL VAG MARKER 1 BY NAA $ 145.00 87798 BACTERIAL VAG MARKER 2 BY NAA $ 145.00 87798 BACTERIAL VAG MARKER 3 BY NAA $ 145.00 86787 VARICELLA ZOSTER IGM ANTI $ 103.00 93271 HOLTER MONITORING >48HRS $ 327.00 93303 TTE CONG ABN;COMPLETE $ 2,136.00 93315 TEE CONGENITAL;GLOBAL $ 2,136.00 36598 CONTRAST IINJ W/FLUOR EVAL CV DEVICE $ 611.00 C1725 INTRODUCER $ 456.00 C1750 GLIDEPATH CATHETER 5393150 $ 825.00 C1750 GLIDEPATH CATHETER 5393190 $ 750.00 C1750 GLIDEPATH CATHETER 5393230 $ 750.00 C1880 DENALI IVC FILTER DL 900F $ 2,775.00 C1880 DENALI IVC FILTER DL 900J $ 2,775.00 C1773 SNARE RETRIEVAL SRK30 $ 825.00 C1788 POWER PORT CLEARVUE 1668362 $ 3,294.00 C1788 POWER PORT CLEARVUE SLIM 1618000 $ 1,185.00 C1788 POWER PORT SLIM ARM POST 1716000 $ 1,035.00 C1725 CONQUEST 40 PTA CQF7584 $ 525.00 C1725 CONQUEST 40 PTA CQF7562 $ 525.00 C1725 CONQUEST 40 PTA CQF7564 $ 525.00 ATLAS GUIDE PTA ATG80124 $ 825.00 ATLAS GUIDE PTA ATG80204 $ 885.00 DORADO PTA DR8064 $ 480.00 27648 ANKLE ARTHROGRAPHY INJ $ 249.00 36005 EXTREM VENOGRAM INJ $ 411.00 36500 VENOUS SELECTIVE ORGAN BLOOD SAMPLING $ 213.00 36563 INS TUNNEL CVAD W SQ PUMP $ 11,607.00 36582 REPL TUNNELLED VAD W PORT $ 6,873.00 50080 PERC NEPHROSTOLITHOTOMY; TO 2 CM $ 22,719.00 50081 PERC NEPHROSTOLITHOTOMY; >2CM $ 22,719.00

126 50433 PLMT NEPHROURETERAL CATHETER $ 4,608.00 50684 INJ FOR URETEROGRAM THRU INDWELLING CATH $ 411.00 50688 CHANGE OF URETER TUBE/STENT $ 3,693.00 51610 RETRO INJ URETHRA $ 444.00 72190 X-RAY EXAM OF PELVIS 3+ VIEWS $ 309.00 74425 CONTRST X-RAY URINARY TRACT $ 1,077.00 74470 RENAL CYST STUDY $ 1,077.00 75964 REPAIR ARTERY BLOCKAGE EACH $ 249.00 77075 X-RAYS BONE SURVEY COMPLETE >12MOS $ 309.00 77080 DXA BONE DENSITY AXIAL 1+ SITES $ 309.00 73503LT X-RAY EXAM HIP 4/> VIEWS LT $ 309.00 73503RT X-RAY EXAM HIP 4/> VIEWS RT $ 309.00 C1874 STENT GRAFT, FLAIR ENDO VAS. $ 12,753.00 C1750 PRE-CURVED PADROME CATH 19CM $ 1,802.00 C1769 MICRO-INTRODUCER KIT $ 114.00 C1788 POWERPORT INTERMEDIATE KIT SLIM $ 2,310.00 C1788 POWERPORT INTERMEDIATE KIT ISP $ 1,911.00 C1751 MULTI-LUMEN CVC KIT $ 273.00 C1788 AIRGUARD VALVED SILICONE FILLED $ 2,352.00 C1729 10F DRAINAGE CATHETER SYSTEM $ 366.00 C1729 12F DRAINAGE CATHETER SYSTEM $ 366.00 C1729 14F DRAINAGE CATHETER SYSTEM $ 366.00 C1751 IR TRAY,POWER PICC 4FR $ 579.00 C1751 IR TRAY,POWER PICC 5FR $ 579.00 C1751 IR TRAY,POWER PICC 6FR $ 579.00 C1894 IR SHEATH INTRODUCER 7 FRENCH $ 36.00 C1894 IR SHEATH INTRODUCER 6 FRENCH $ 36.00 C1894 IR SHEATH INTRODUCER 5 FRENCH $ 36.00 C1725 IR PTA BALLOON DIL CATH 6F $ 795.00 IR TORCON ADV CATH HNB5.0-38-65 $ 67.00 C1769 IR ROSEN CRVD WIRE THSC35-1.45-1.5 $ 52.00 C1729 IR FLEXIMA APD JTIP 14FX25CM $ 366.00 IR DILATOR JCD10.0-38-20-COONS $ 49.00 IR DILATOR JCD9.0-38-20-COONS $ 49.00 IR DILATOR JCD7.0-38-20-COONS $ 49.00 IR CHIBA BX NEEDLE DCHN-18-20.0 $ 33.00 C1750 IR COVIDIEN CATH KIT 14.5FRX19 $ 1,803.00 IR LACERATION TRAY $ 11.00 C1769 IR AMPLATZ SUPER STIFF.035-75-7 $ 121.00 C1725 IR PTA DIL CATH 5.8F 8-40-75 $ 795.00 C1725 IR PTA DIL CATH 5.8F 6-40-75 $ 795.00 C1769 IR FXD CORWIRE GUIDE TSF35-180 $ 33.00 IR TORCON ADVCATH HNB5.0-38-40 $ 93.00 C1769 IR FXD CORWIREGUIDE TSF-35-180 $ 33.00 IR TORQUE VISE 0.025-0.038 $ 25.00 BIOPINCE FULLCORE BX INST 18GA $ 150.00 IR CHIBA BX NEEDLE DCHN21-15.0 $ 33.00 IR C-ARM XR DRAPE 104X188 $ 10.00 NDL GDE KIT SITE-RITE 21G $ 67.00 C1729 8F DRAINAGE CATHETER SYSTEM $ 402.00 IR COVIDIEN CHEST DRAINGE UNIT $ 301.00 IR COAXIAL TEMNO BX SYSTEM1820 $ 165.00 IR CO-AX INTRO NDL 17GA/11.8CM $ 51.00 IR COVIDIEN CATH KIT 14.5FRX23 $ 1,607.88 IR PRESTO INFLA DEV 40ATM/30CC $ 141.00 IR PTA BALLOON DIL CATH 5F $ 1,206.00

127 IR GLIDWIRE-TERUM ANGLD GR3506 $ 100.00 IR GLIDWIRE-TERUM ANGLD GR1804 $ 182.00 IR COAXIAL ACHIEVE 20GX15CM $ 157.68 IR ACCUSTICK II 21 GA X 15CM $ 357.00 C1894 MICROPUNCT INTRO STIFF G48088 $ 207.00 KUMPE CATH 5FR 40CM G47044 $ 66.00 KUMPE CATH 5FR 65CM G47185 $ 66.00 KUMPE CATH 5FR 100CM G47164 $ 66.00 MULT ANG CATH 5FR 65CM G47059 $ 66.00 MULT ANG CATH 5FR 100CM G08153 $ 66.00 COOK RC1 CATH 5FR 65CM G08078 $ 66.00 COOK RIM CATH 5FR 100CM G47167 $ 66.00 COOK RIM CATH 5FR 65CM G05979 $ 66.00 COOK DILATOR 7FRX20CM G00973 $ 22.00 COOK DILATOR 8FRX20CM G00980 $ 22.00 COOK DILATOR 9FRX20CM G00992 $ 22.00 C1729 COOK YUEH NDL 4FRX10CM G09646 $ 66.00 C1729 COOK YUEH NDL 5FRX7CM G09489 $ 66.00 C1729 COOK YUEH NDL 5FRX15CM G09492 $ 66.00 C1729 BILIARY DRAIN 8FRX40CM G09497 $ 300.00 C1729 BILIARY DRAIN 10FRX40CM G09498 $ 300.00 C1729 BILIARY DRAIN 12FRX40CM G09499 $ 300.00 C1769 BENSTN WREGDE.035 145CM G00691 $ 59.00 C1769 BENSTON WREGDE.035 80CM G00691 $ 72.00 C1769 COOK J-WIRE .035 80CM G00529 $ 38.00 CHIBA NDL 22GAX10CM G00852 $ 33.00 CHIBA NDL 22GAX15CM G00012 $ 33.00 C1769 GWIRE GLIDE.035X180CM GA3501 $ 647.00 C1769 GWIRE GLIDE.035X260CM GA3502 $ 720.00 C1769 GWIRE STIFSHFT.035X180CM GS3508 $ 158.00 C1769 GWIRE STIFSHFT.035X260CM GS3509 $ 169.00 C1769 GWIRE HYDRO.035X150CM GR3501 $ 100.00 C1769 GWIRE HYDRO.035X260CM GR3509 $ 150.00 GCATH 5FRX65CM ANGL RFZV9510GM $ 166.00 GCATH 5FRX100CM ANGL RFZV95110M $ 166.00 C1894 INTROSHEATH 5F,10CM RSS501 $ 36.00 C1894 INTROSHEATH 9F,10CM RSS901 $ 36.00 C1894 INTROSHEATH 6F,25CM RSS605 $ 78.00 C1894 INTROSHEATH 10F,10CM RSS003 $ 36.00 IR CO-AX INTRO NDL 17GA/6.8CM $ 51.00 IR CO-AX ACHIEVE 20GX20CM $ 158.00 74018 XR EXAM ABDOMEN 1 VIEW $ 192.00 74019 XR EXAM ABDOMEN 2 VIEWS $ 367.00 74021 XR EXAM ABDOMEN 3+ VIEWS $ 367.00 71045 XR EXAM CHEST 1 VIEW $ 192.00 71046 XR EXAM CHEST 2 VIEWS $ 192.00 X-RAY EXAM CHEST 3 VIEWS $ 192.00 71048 XR EXAM CHEST 4+ VIEWS $ 367.00 71047 XR EXAM CHEST 3 VIEWS $ 192.00 C1769 IR COOK BEN WIRE GUIDE G00691 $ 59.00 C1769 IR GLIDWIRE-TERUM ANGLD GR1805 $ 182.13 C1725 IR PTA DIL CATH 5F 5-20-75 $ 576.00 C1725 IR PTA DIL CATH 6F 8-40-75 $ 576.00 C1725 IR PTA DIL CATH 5F 7-40-75 $ 576.00 IR TORCON ADV CATH 5.0-38-100 $ 66.00 C1769 IR COOK BEN WIRE GUIDE G01315 $ 72.00

128 74018 XR ABDOMEN 1 VIEW PORTABLE $ 252.00 71045 XR CHEST AP PORTABLE $ 456.00 71046 XR CHEST LORDOTIC 2 VIEWS $ 192.00 71045 XR CHEST 1 VIEW AP PORTABLE $ 456.00 75710 RETROGRADE BRACHIAL $ 1,354.58 C1894 IR MICRO INTRODUCER KIT 5F $ 220.50 77013 CT GUIDE FOR TISSUE ABLATION $ 702.00 76881LT US XTR NON-VASC COMPLETE LT $ 471.00 76881RT US XTR NON-VASC COMPLETE-RT $ 471.00 31500 INTUBATION ET EMERGENT $ 396.00 94618 6 MINUTE WALK ASSESSMENT $ 132.00 98960 SELF-MGMT EDUC & TRAIN 1 PT $ 135.00 64550GP APPLY TENS UNIT $ 85.00 95832GO MUSCLE TEST;HAND $ 160.00 95851GP ROM; EA EXTREMTTRUNK (NOT HAND) $ 100.00 95852GO ROM MEASURE & REP; HAND $ 85.00 95992GP CANALITH REPOSITIONING PROC $ 230.00 97545GP WORK HARDENING INIT 2 HRS $ 644.00 97546GP WORK HARDENING EA ADDTL HR $ 322.00 V5266 BATTERY FOR HEARING DEVICE $ 15.00 97166GOKX OT EVAL MOD-KX $ 289.00 97167GOKX OT EVAL HIGH-KX $ 289.00 97166GO OT EVAL MODERATE $ 289.00 97167GO OT EVAL HIGH $ 289.00 97162GPKX PT EVAL MOD-KX $ 289.00 97163GPKX PT EVAL HIGH-KX $ 289.00 97162GP PT EVALUATION MOD $ 289.00 97163GP PT EVALUATION HIGH $ 289.00 97127GP PT COGNITIVE TRAIN 15 MIN $ 161.00 97127GPKX PT COGNITIVE TRAIN 15 MIN KX $ 161.00 97127GN COGNITIVE TRAIN EA 15 MIN $ 71.00 97127GNKX COGNITIVE TRAIN EA 15 MIN KX $ 71.00 92597 EVAL/FITTING OF SPEAKING VALVE $ 231.00 FACILITY FEE $ 105.27 46040 I&D PERIRECTAL/ISCHIAL ABSCESS $ 2,703.00 26705 TREAT KNUCKLE DISLOCATION $ 4,178.00 Q0091 OBTAINING SCREEN PAP SMEAR $ 39.00 29540 ANKLE/FOOT STRAPPING $ 385.00 87880QW STREP A ASSAY W/OPTIC $ 108.00 90698 PENTACEL VACCINE $ 245.00 29550 STRAPPING OF TOES $ 168.00 29280 STRAPPING, HAND OR FINGER $ 88.00 16020 BURN DEBRIDEMENT $ 472.00 11750 REMOVAL OF NAIL BED $ 900.00 11721 DEBRIDE NAIL 6 OR MORE $ 168.00 90715 TDAP BOOSTRIX $ 38.00 90732 PNEUMOVAX $ 85.00 99000 COLLECTION OF SPECIMEN $ 25.00 G0009 ADMIN PNEUMOCOCCAL ONLY $ 107.00 G0008 ADMIN FLU VIRUS VACCINE ONLY $ 107.00 56515 DESTROY VULVA LESIONS COMPL $ 4,854.00 27825 TREAT LOWER LEG FRACTURE $ 4,178.00 FACILITY FEE $ 105.27 51798 BLADDER SCAN $ 173.00 51705 CHANGE OF SUPRAPUBIC TUBE $ 710.00 64450 NERVE BLOCK $ 1,682.00

129 J2001 LIDOCAINE 10MG X 1 UNIT $ 6.27 J3301 KENALOG 10MG X 1 UNIT $ 5.63 S0020 MARCAINE 30ML X 1 UNIT $ 4.14 S0395 CASTING PROCEDURE $ 419.00 A4580 CASTING PLASTER $ 100.00 A4590 CASTING FIBERGLASS $ 100.00 97760 ORTHOTIC FITTING $ 149.00 E0114 CRUTCHES $ 65.00 L3260 SURGICAL BOOK/SHOE $ 35.00 G0127 TRIMMING DYSTOPHIC NAILS $ 173.00 11719 TRIMMING NONDYSTROPHIC NAILS $ 119.00 11720 DEBRIDEMENT 1-5 NAILS $ 212.00 97597 DEBRIDEMENT OPEN WOUND 20SQ CN $ 376.00 17110 DESTRUCT 1-14 B9 LESION WART REMOVL $ 523.00 17111 DESTRUCT 15+ B9 LESION WART REMOVAL $ 523.00 11732 NAIL AVULSION, EACH ADDITIONAL $ 228.00 11305 SHAVING LESION, FOOT<0.5CM $ 523.00 11306 SHAVING LESION, FOOT 0.6-1CM $ 523.00 29580 STRAPPING (UNNA BOOT) $ 174.00 68525 BIOPSY LACRIMAL SAC $ 5,606.00 68530 REMOVAL FOREIGN BODY LACRIMAL PASSAGES $ 828.00 58300 IUD INSERTION $ 264.00 93005 12 LEAD EKG TRACING ONLY $ 196.00 99211 MFM LEVEL I EST E&M 99211 $ 105.00 99212 MFM LEVEL II EST E&M 99212 $ 125.00 99213 MFM LEVEL III EST E&M 99213 $ 145.00 99214 MFM LEVEL IV EST E&M 99214 $ 165.00 99215 MFM LEVEL V EST E&M 99215 $ 185.00 99241 MFM CONSULTATION LVL I 99241 $ 161.00 99242 MFM CONSULTATION LVL II 99242 $ 201.00 99243 MFM CONSULTATION LVL III 99243 $ 256.00 99244 MFM CONSUTATION LVL IV 99244 $ 357.00 99245 MFM CONSULTATION LVL V 99245 $ 464.00 99201 MFM LEVEL I NEW E&M 99201 $ 94.00 99202 MFM LEVEL II NEW E&M 99202 $ 104.00 99203 MFM LEVEL III NEW E&M 99203 $ 114.00 99204 MFM LEVEL IV NEW E&M 99204 $ 174.00 99205 MFM LEVEL V NEW E&M 99205 $ 204.00 76801 USMFM OB<14 WKS, SINGLE FETUS $ 648.00 76802 USMFM OB<14 WKS,SINGLE FETUS,ADDL FETUS $ 232.00 76811 USMFM OB, DETAILED, SINGLE FETUS $ 253.00 76812 USMFM OB,DETAILED,SINGLE FETUS,ADDL FETU $ 232.00 76813 USMFM OB NUCHAL MEAS, 1 GEST $ 232.00 76814 USMFM OB NUCHAL MEAS,ADDL FETUS $ 232.00 76815 USMFM OB AFI OR LIMITED $ 533.00 76816 USMFM FETAL GROW $ 546.00 76817 USMFM OB TRANS VAG $ 232.00 76819 USMFM OB BIOPHYS PROFILE WO NST $ 914.00 76820 USMFM UMBILICAL ARTERY $ 399.00 76821 USMFM MIDCEREBRAL ARTERY $ 399.00 76830 USMFM TRANSVAGINAL ULTRASOUND $ 757.00 76856 USMFM US PELVIC $ 784.00 76946 USMFM AMNIOCENTESIS $ 534.00 76805 USMFM OB>OR=14 WKS; SNGL FETUS $ 1,028.00 76810 USMFM OB US>/= 14 WKS; ADDL FETUS $ 232.00 76831 USMFM SONOHYSTEROGRAPHY $ 253.00

130 EXTRA RX 9.0-12.0 RET BALLOON $ 540.00 SNARE POLYPECTOMY JUM OVAL $ 657.00 EXTRACT RX 9.0-12.0 RET BALLOON $ 540.00 SNARE POLYPECTOMY JUMBO OVAL $ 66.00 ENDOSCOPIC MARKER $ 91.00 ROTH NET FOREIGN BODY $ 272.00 TEST/CLO HP FAST $ 16.00 INSTINCT ENDOSCOPIC $ 693.00 C1769 AMSTERDAM STENT 7 FR. X 9CM $ 291.00 OMNI DASH $ 756.00 ACUSNARE 3 CM X 6 CM $ 69.00 SMALLEST DASH $ 354.00 C1769 ACROBAT 2 STRAIGHT 0.035 $ 525.00 C1769 ACROBAT 0.025 X 250 CM $ 668.00 C1769 ACROBAT 2 ANGLED 0.035 $ 525.00 TRIPLE LUMEN NEEDLE DEVICE $ 363.00 43450 DILATION WITH BOUGIE 43450 $ 2,301.00 45382 COLONOSCPY WITH BLEEDING 45382 $ 2,898.00 44388 COLONOSCOPY THRU STOMA 44388 $ 2,197.00 45384 COLONOSCOPY W LESION REMOVAL 45384 $ 2,716.00 43249 EGD W BAL DILATION ESOPH 43249 $ 4,417.00 46601 COLPOSCOPY 46601 $ 325.08 46924 ANAL CONDYLOMA 46924 $ 7,166.00 43261 ERCP W BX SINGLE MULTIPLE 43261 $ 8,490.00 43263 ERCP SPHINCTER PRESSURE MEAS 43263 $ 8,490.00 43266 END ENDOSCOPIC STENT PLACE 43266 $ 13,287.00 43270 EGD LESION ABLATION 43270 $ 4,417.00 43273 ENDOSCOPIC PANCREATOSCOPY 43273 $ 351.00 43275 ERCP REMOVE FORGN BODY DUCT 43275 $ 8,490.00 43276 ERCP STENT EXCHANGE W DILATE 43276 $ 13,287.00 43277 ERCP EA DUCT AMPULLA DILATE 43277 $ 8,490.00 43278 ERCP LESION ABLATE W DILATE 43278 $ 8,490.00 43236 EGD W/DIRECT INJECTION 43236 $ 2,301.00 43260 ERCP DIAGNOSTIC 43260 $ 8,490.00 43244 EGD VARICESBANDING 43244 $ 4,417.00 43246 EGD PLACE PEG 43246 $ 4,417.00 43248 EGD INS W DILATATION GW 43248 $ 2,301.00 43247 EGD FOREIGN BODY 43247 $ 2,301.00 45385 COLONOSCOPY WITH SNARE 45385 $ 2,898.00 43264 ERCP REMOVE CALCULI 43264 $ 8,490.00 43274 ERCP STENT PLACEMENT 43274 $ 13,287.00 43262 ERCP 43262 $ 8,490.00 45330 DIAGNOSTIC SIGMOIDOSCOPY 45330 $ 2,197.00 45378 DIAGONSTIC COLONSCOPY 45378 $ 2,197.00 43239 EGD BIOPSY SINGLE/MULTIPLE 43239 $ 2,301.00 43235 EGD DIAGNOSTIC BRUSH WASH 43235 $ 2,301.00 45380 COLONOSCOPY AND BIOPSY 45380 $ 2,898.00 43255 EGD CONTROL BLEEDING ANY 43255 $ 4,417.00 45381 COLONOSCOPY SUBMUCOUS NJX 45381 $ 2,898.00 C1769 STENT ZIMMON BILIARY $ 411.00 SPHINCTEROTOME ULT TAPER 5-4FR $ 354.00 JUMBO OVAL SNARE $ 69.00 C1769 GUIDEWIRE CALIB TIP 0.35 $ 525.00 C1769 COTTON LEUNG BILIARY STENT SET $ 291.00 C1769 WIRE GUIDE CALIBRATED TIP $ 668.00 C1769 GUIDEWIRE CALIB TIP 0.35 450C $ 525.00

131 FUSION OMNI-TOME $ 756.00 KNIFE NDL TRIPLE LUMEN ENDOSC $ 363.00 BALLOON EXTRACTOR PRO RX TRIPLE LUMEN $ 722.00 G0105 COLORECTAL SCRN HI RISK IND $ 2,197.00 G0121 COLON CA SCRN NOT HI RSK IND $ 2,197.00 QUICKSILVER BIPOLAR PROBE $ 414.00 43202 ESOPHAGOSCOPY FLEX BIOPSY $ 4,417.00 43250 EGD CAUTERY TUMOR POLYP $ 4,417.00 43251 EGD REMOVE LESION SNARE $ 4,417.00 45300 PROCTOSIGMOIDOSCOPY DX $ 2,197.00 46607 DIAGNOSTIC ANOSCOPY & BIOPSY $ 2,898.00 46610 ANOSCOPY REMOVE LESION $ 7,166.00 46615 ANOSCOPY $ 7,166.00 FORCEPS BIOPSY RAD JAW 240 CM $ 283.00 C1726 BAL HERCULES 3 STAGE 8 CM 2.8MM $ 519.00 44389 COLONOSCOPY THRU STOMA W/BX $ 2,898.00 90471 OH ADMIN 1ST IMMUNIZATION $ 10.00 90472 OH ADMIN VACCINE EA ADDL $ 10.00 90632 OH HEPATITIS A VACCINE W ADM $ 80.00 90658 OH INFLUENZA VACCINE W ADM $ 25.00 90715 OH TETANUS/DIPTH/PERT W ADM $ 50.00 90746 OH HEP B VACCINE SER 3 W ADM $ 70.00 99202-B OH PHYSICAL - NEW HIRE - BASIC $ 60.00 99203-D OH PHYSICAL - DOT $ 75.00 99205HZ OH HAZMAT EXAM $ 95.00 99203AH OH ANNUAL HEALTH REVIEW $ 35.00 99202-RQ OH OSHA RESPIRATORY QUESTIONNA $ 55.00 99204-WV OH INITIAL WELLNESS VISIT $ 95.00 99214-WV OH F/U WELLNESS VISIT $ 55.00 82075 OH BREATH ALCOHOL TEST - BAT $ 28.00 96372 OH INJECTION OF MEDICATION $ 10.00 92552 OH AUDIOGRAM W/INTERPRETATION $ 40.00 93000 OH EKG W/INTERPRETATION $ 57.00 94010 OH SPIROMETRY W/INTERPRETATION $ 55.00 86580 OH PPD TB SKIN TEST PLACED $ 25.00 OH VISIONOTEMER $ 25.00 84460 OH ALT $ 20.00 86706 OH ANTIHBS $ 40.00 82175 OH ARSENIC SERUM $ 40.00 80048 OH BASIC METABOLIC PANEL $ 25.00 82232 OH BETA 2 MICROGLOBULIN URINE $ 40.00 82947 OH BLOOD SUGAR FASTING $ 20.00 84520 OH BUN $ 20.00 82300 OH CADMIUM QUANTITATIVE SERUM $ 60.00 85027 OH CBC $ 30.00 80053 OH CHEM-14 PANEL $ 30.00 80053 OH COMPREHENSIVE METABOLIC PANEL $ 30.00 82565 OH CREATININE $ 20.00 87075 OH CULTURE-ANEROBIC $ 42.00 87071 OH CULTURE-THROAT STREP $ 30.00 87086 OH CULTURE-URINE $ 30.00 80051 OH ELECTROLYTE PANEL $ 20.00 82270 OH FECAL OCCULT BLOOD IMMUNO $ 15.00 82947 OH GLUCOSE SERUM $ 20.00 82948 OH GLUCOSE FINGER STICK/ACCU CHEK $ 15.00 83036 OH HGBAIC SERUM $ 19.00

132 87340 OH HBSAG $ 40.00 83015 OH HEAVY METAL FOR SERUM $ 90.00 83015 OH HEAVY METAL FOR URINE $ 80.00 82270 OH EMOCCULT $ 15.00 86708 OH HEPA IGG & IGM $ 40.00 86803 OH HEP C $ 40.00 86703 OH HIV $ 30.00 80076 OH HEPATIC FUNCTION PANEL $ 30.00 87350 OH HEPATITIS BEAG (HEPBEAG) $ 40.00 83625 OH LDH ISOENZYMES $ 40.00 83655 OH LEAD $ 18.50 80061 OH LIPID PANEL $ 30.00 86618 OH LYME DISEASE SCREEN $ 50.00 83825 OH MERCURY $ 40.00 86735 OH MUMPS TITER $ 120.00 84702 OH PREGNANCY TEST - HCG $ 25.00 84153 OH PSA $ 35.00 86480 OH QUANTIFERON GOLD (TB) $ 80.00 86382 OH RABIES TITER $ 120.00 87400 OH RAPID FLU TEST $ 42.00 86592 OH RPR (VDRL) $ 25.00 86762 OH RUBELLA SCREEN $ 80.00 86765 OH RUBEOLA ANTI IGG $ 70.00 88108 OH SPUTUM CYTOLOGY $ 100.00 84443 OH TSH $ 30.00 81002 OH URINE DIPSTICK $ 8.50 81005 OH URINE ANALYSIS $ 10.00 81025 OH URINE PREGNANCY TEST $ 15.00 86787 OH VARICELLA TITER $ 70.00 83655 OH LEAD ZPP WHOLE BLOOD $ 145.00 80307 OH JB DRUG SCREEN COLLECTION - DOT $ 16.00 80307 OH JB DRUG SCREEN COLLECTION - NON DOT $ 16.00 72110 OH LS SERIES MIN 4 VIEWS $ 338.00 97750 OH FUNCTIONAL CAPACITY EVALUATION $ 80.00 97545 OH WORK CONDITIONING INITIAL EVAL $ 240.00 97546 OH WORK CONDITIONING FOLLOW UP $ 120.00 90732 OH PNEUMOCOCCAL VACCINE INJ $ 310.00 92551 OH OAE HEARING SCREENING $ 170.00 36415 OH VENIPUNCTURE $ 10.00 OH HAIR COLLECTION (WITH KIT PROVIDED) $ 48.00 OH RESPIRATORY FIT TEST $ 70.00 OH OBSERVED COLLECTION FEE $ 20.00 OH PULM FUNCTION TEST $ 45.00 71010 OH CXR SINGLE VIEW $ 109.00 90471 OH ADMIN PNEUMOCOCCAL VACCINE $ 10.00 OH WEIGHT-BEARING PRE-EMP EVAL $ 33.00 99203 OH LEVEL 3 NEW VISIT JBHUNT $ 105.00 99213 OH LEVEL 3 EST VISIT JBHUNT $ 78.00 80307 OH DRUGSCR DOT PAN W/COL BACP $ 45.00 99203-D OH PHYSICAL - DOT BACP $ 65.00 86580 OH PPD TB SKIN PLACED BACP $ 25.00 OH OFF SITE VISIT 50 $ 50.00 OH OFF SITE VISIT 75 $ 75.00 OH OFF SITE VISIT 100 $ 100.00 OH OFF SITE VISIT 125 $ 125.00 OH OFF SITE VISIT 150 $ 150.00

133 OH OFF SITE VISIT 175 $ 175.00 OH OFF SITE VISIT 200 $ 200.00 99203-J OH PHYSICAL - DOT JB HUNT $ 60.00 OH TAXI 3 SERVICES $ 75.00 82491 OH PCB $ 160.00 80307 OH DRUG SCREEN URINE - DOT $ 48.00 80307 OH DRUG SCREEN URINE - NON DOT $ 45.00 OH-CIC PRE EMP PHYS EXAM $ 65.00 OH-CIC 5 PANEL HAIR FOLL DRUG TEST $ 55.00 OH-CIC PHYS EXAM RTW $ 60.00 PH-CIC MRO CHEM TEST REVIEW $ 25.00 OH-CIC BLOOD ALCOHOL TEST (INC COLLECT) $ 40.00 99201 WC LEVEL I NEW E&M $ 100.00 99202 WC LEVEL II NEW E&M $ 126.00 99203 WC LEVEL III NEW E&M $ 175.00 99204 WC LEVEL IV NEW E&M $ 265.00 99205 WC LEVEL V NEW E&M $ 285.00 99211 WC LEVEL I EST E&M $ 60.00 99212 WC LEVEL II EST E&M $ 85.00 99213 WC LEVEL III EST E&M $ 130.00 99214 WC LEVEL IV EST E&M $ 200.00 99215 WC LEVEL V EST E&M $ 250.00 99381 WC PREV VISIT <1 YRS NEW $ 200.00 99382 WC PREV VISIT 1-4 YRS NEW $ 225.00 99383 WC PREV VISIT 5-11 YRS NEW $ 275.00 99384 WC PREV VISIT 12-17 YRS NEW $ 300.00 99385 WC PREV VISIT 18-39 YRS NEW $ 325.00 99386 WC PREV VISIT 40-64 YRS NEW $ 350.00 99387 WC PREV VISIT 65+ YRS NEW $ 400.00 99391 WC PREV VISIT <1 YRS EST $ 175.00 99392 WC PREV VISIT 1-4 YRS EST $ 185.00 99393 WC PREV VISIT 5-11 YRS EST $ 200.00 99394 WC PREV VISIT 12-17 YRS EST $ 220.00 99395 WC VISIT PREV 18-39 YRS EST $ 260.00 99396 WC PREV VISIT 40-64 YRS EST $ 290.00 99397 WC PREV VISIT 65+ YRS EST $ 310.00 16000 WC BURN 1ST DEGREE $ 150.00 16020 WC BURN 2ND DEGREE $ 175.00 16025 WC BURN MED DEBRID 5-10% $ 350.00 16030 WC BURN TX LARGE >10% $ 450.00 90715 WC TETANUS/DIPTHERIA VAC $ 90.00 J0461 WC ATROPINE .01MG $ 10.00 J1200 WC BENAD .50MG $ 50.00 J0500 WC BENTYL SYRUP 20MG $ 30.00 J0561 WC BICILLIN LA 100K $ 55.00 J0595 WC BUTORPHANOL 1MG $ 25.00 J0690 WC CEFAZOLIN 500MG $ 10.00 J0696 WC CEFRIAXONE 250MG $ 45.00 J0702 WC CELESTONE 3MG $ 15.00 J0780 WC COMPAZINE 10MG $ 30.00 J1100 WC DECADRON 1MG $ 5.00 J1030 WC DEPO-MEDROL 40MG $ 20.00 J1094 WC DEX METH 1MG $ 5.00 J1100 WC DEXAMETHESONE 1MG $ 5.00 J0171 WC EPINEPHRINE .1MG $ 20.00 J1580 WC GENTAMYCIN 80MG $ 20.00

134 J3030 WC IMITREX 6MG $ 100.00 J1460 WC ISG PER 1CC $ 40.00 J2010 WC LINCOCIN 300MG $ 15.00 J1030 WC METH PRED 40MG $ 45.00 J2310 WC NARCAN 1MG $ 10.00 J2300 WC NUBAIN 10MG $ 5.00 J2550 WC PHEN UP 50MG $ 10.00 J7506 WC PREDNISONE 5MG $ 5.00 J0696 WC ROCEPHIN 250 MG $ 45.00 J2930 WC SOLUMEDROL 125MG $ 25.00 J2920 WC SOLUMEDROL 40MG $ 18.00 J1885 WC TORADOL 15MG $ 45.00 J3360 WC VALIUM $ 10.00 J3410 WC VISTARIL 25MG $ 5.00 A6448 WC ACE BANDAGE LT COMP <3 IN PER YARD $ 10.00 A6449 WC ACE BANDAGE LT COMP 3-5 IN PER YARD $ 10.00 A6450 WC ACE BANDAGE LT COMP >5 IN PER YARD $ 15.00 A6451 WC ACE BANDAGE MOD COMP 3-5 IN PER YARD $ 11.00 A4450 WC ADHESIVE TAPE $ 5.00 L4350 WC ANKLE BRACE, AIRCAST $ 150.00 A4466 WC ANKLE SLEEVE $ 25.00 L1906 WC ANKLE SPLINT $ 90.00 L3040 WC ARCH SUPPORT $ 65.00 L0627 WC BACK SUPPORT $ 500.00 A6254 WC BANDAID LARGE $ 10.00 E0100NU WC CANE $ 30.00 A4580 WC CAST SUPPLIES $ 100.00 L0120 WC CERVICAL COLLAR $ 35.00 L3650 WC CLAVICLE STRAP $ 75.00 A4570 WC COLLES SPLINT $ 30.00 E0114 WC CRUTCHES, OTHER THAN WOOD $ 65.00 Q4049 WC DIGIT SPLINT $ 40.00 A6402 WC DRESSING TELFA 2X3 $ 5.00 A6403 WC DRESSING TELFA 3X7 $ 5.00 A6222 WC DRESSING ADAPTIC 3X3 $ 5.00 A6223 WC DRESSING ADAPTIC 3X8 $ 10.00 A4466 WC ELBOW BRACE $ 25.00 A6410 WC EYE PATCH $ 10.00 99070 WC EYE PRESS PATCH $ 10.00 A4570 WC FINGER SPLINT $ 30.00 Q4049 WC FINGER SPLINT, STATIC $ 40.00 A6216 WC GAUZE 4X4 PADS $ 5.00 A6219 WC GAUZE 4X4 STERILE $ 5.00 A6443 WC GAUZE BANDAGE ROLL 3"/4" $ 10.00 L3485 WC HEEL CUP $ 45.00 E0191 WC HEEL PAD $ 25.00 A9273 WC HOT/COLD PACK $ 20.00 A6443 WC KLING WRAP, CONF BANDAGE $ 20.00 L1810 WC KNEE BRACE $ 125.00 L1820 WC KNEE-HINGED $ 150.00 A4570 WC OCL SPLINTS $ 30.00 L4360 WC ORTHO BOOT SHORT $ 350.00 L4360 WC ORTHO BOOT TALL $ 350.00 Q4051 WC PADDING- COTTON (SPLINT SUPPLIES) $ 10.00 Q4051 WC PADDING- GO RETEX (SPLINT SUPPLIES) $ 10.00 L0140 WC PHILLY COLLAR (CERVICAL PLASTIC) $ 100.00

135 L3250 WC POST OP SHOE, CUSTOM MOLDED $ 250.00 A4466 WC RIB BELT $ 45.00 L3650 WC SHOULDER IMMOBIL $ 80.00 A6250 WC SKIN SEALANT $ 15.00 A4565 WC SLING $ 20.00 L3650 WC SLING AND SWATH $ 80.00 L0120 WC SOFT C COLLAR (FLEXIBLE COLLAR) $ 35.00 A4570 WC SPLINTRITE BOOK $ 35.00 Q4049 WC STACK SPLINT $ 40.00 A4450 WC STERI STRIPS $ 10.00 L4350 WC STIRUP/AIR CAST $ 100.00 L3260 WC SURGICAL BOOT/SHOE $ 35.00 A4452 WC TAPE $ 5.00 L3649 WC ORTHOPOD SHOE $ 200.00 A4550 WC SURGICAL TRAY $ 100.00 A6231 WC TELFA/GAUZE $ 10.00 A6251 WC TUBE GAUZE $ 10.00 A4554 WC UNDER PADS $ 10.00 A4570 WC VELCRO SPLINTS $ 35.00 L4386 WC WALKER BOOT $ 300.00 L3908 WC WRIST & FOREARM $ 70.00 A4466 WC WRIST BAND $ 25.00 L3908 WC WRIST SPLINT $ 70.00 L3908 WC WRIST/HAND SPLINT $ 70.00 71045 OH CXR SINGLE VIEW $ 192.00 71046 OH CXR 2 VIEWS $ 192.00 99202 PHYSICAL EXAM W/PPD SKIN TEST $ 265.00 90707 MEASLES/MUMPS/RUBELLA VACCINE $ 61.10 90746 HEP B VACCINE $ 16.02 90716 VARICELLA VIRUS VACCINE $ 102.18 90715 TETANUS/DIPTHERIA/PERTUSSIS DTAP VACCINE $ 35.77 90732 PNEUMOCOCCAL VACCINE $ 67.99 90658 INFLUENZA VACCINE $ 12.34 90632 HEPATITIS A VACCINE $ 32.21 90734 MENINGOCOCCAL VACCINE $ 124.20 90713 POLIOVIRUS VACCINE INACTIVATED $ 30.17 90680 ROTAVIRUS VACCINE $ 119.39 90471 ADMINISTRATION 1ST IMMUNIZATION $ 12.00 90472 ADMINISTRATION VACCINE EACH ADDL $ 12.00 71010 CXR SINGLE VIEW $ 109.00 86592 RPR (VDRL) $ 25.00 36415 VENIPUNCTURE $ 7.00 90673 IM FLU VACC RIV3 NO PRESERV $ 12.34 90687 IM FLU VACC 4 VAL 6-35 MO IM $ 12.34 90688 IM FLU VACC 4 VAL 3YRS PLUS IM $ 12.34 71045 XR CHEST 1 VIEW $ 192.00 G0008 ADMIN FLU VIRUS VAC G0008 $ 104.00 G0009 ADMIN PNEMONIA VAC G0009 $ 104.00 G0010 ADMIN HEPATITIS B VAC G0010 $ 104.00 A4657 SYRINGE W/WO NDL $ 35.00 90999 UNLISTED DIALYSIS PROC $ 2,100.00 90937 HEMODIALYSIS REPEAT EVAL $ 2,100.00 Q4081 EPOETIN 20,000 UNITS/ML $ 4.86 J2997 ACTIVASE 2MG $ 405.00 90740 RECOMBIVAX 40MCG VIAL $ 425.00 90670 PREVNAR 13 (PCCV 13) $ 425.00

136 90732 PNEUMOVAX 23 $ 250.00 TUBERCULIN PPD $ 10.00 90658 FLU VACCINE 1 ML $ 95.00 J1644 HEPARIN 1000 U/ML $ 2.00 J2916 FERRLECIT INJ 12.5 MCG $ 18.60 J1756 VENOFER 1 MG $ 2.07 J2501 ZEMPLAR 1MCG/ML 2ML VIAL $ 59.00 J2501 ZEMPLAR 25MCG $ 143.00 DEXTROSE 50% 25MG 50ML $ 20.00 J1200 DIPHENHYDRAMINE INJ 50MG $ 6.00 J3370 VANCOMYCIN INJ 1000MG $ 41.00 A9270GY AMLODIPINE 5MG TABLET $ 2.00 A9270GY CLONIDINE HCL 0.1MG TAB $ 2.00 A9270GY NITROSTAT SL 0.4MG TAB $ 2.00 A9270GY ACETAMINOPHEN 325MG TAB $ 2.00 A9270GY METOCLOPROMIDE 5MG TAB $ 2.00 A9270GY CALCIUM CARBONATE 500MG $ 2.00 90960 ESRD SRV 4 VISITS P MO 20+ $ 2,100.00 COUMADIN 5MG TAB $ 2.00 ETHYL CHLORIDE SPRAY 3.5 OZ $ 95.00 RENVELA 800 MG TAB $ 16.00 90961 ESRD SRV 2-3 VSTS P MO 20+ $ 2,100.00 90962 ESRD SRV 1 VISIT P MO 20+ $ 2,100.00 90935 HEMODIALYSIS ONE EVAL $ 2,100.00 J0878 DAPTOMYCIN SDVINJ 500 MG VIAL $ 2.00 DIPHENHYDRAMINE 25 MG $ 1.00 J1580 GENTAMYCIN INJ 80 MG VIAL $ 3.00 J1270 HECTOROL 2 MCG/1 ML SDV $ 9.00 J1270 HECTOROL 4 MCG/2 ML SDV $ 12.00 J1270 INJ DOXERCALCIFEROL 2 MCG/1 ML SDV $ 9.00 J1270 INJ DOXERCALCIFEROL 4 MCG/2 ML SDV $ 12.00 J0606 INJ, ETELCALCETIDE, 0.1 MG $ 10.40 J0604 CINACALCET ORAL 1 MG ESRD DIALYSIS $ 2.68 CRIO PROMOTIONAL $ 1,200.00 CRIO PROMO MULTI TX $ 1,020.00 CRIO EMPLOYEE $ 1,000.00 CRIO EMPLOYEE MULTI TX $ 850.00 20526 THER INJ CARPAL TUNNEL $ 362.00 20550 THER INJ PLANTAR FASCIA $ 362.00 20600 INJ SMALL JOINT $ 362.00 20605 INJ INTERMED JOINT $ 362.00 20610 INJ MAJOR JOINT $ 757.00 23500 TX CLAVICLE FX $ 294.00 23540 TX A/C JOINT $ 317.00 23600 TX HUMERAL NECK FX $ 276.00 23620 TX GREATER TUBEROSITY FX $ 377.00 24500 TX HUMERAL SHAFT FX $ 377.00 24530 TX SPRA/TRNSCNDAR FX $ 377.00 24560 TX EPICONDYLAR FX $ 377.00 24576 TX CONDYLE ELBOW FX $ 377.00 24650 TX RADIAL HEAD FX $ 276.00 24670 TX OLECRANON FX $ 377.00 25500 TX RADIAL SHAFT FX $ 276.00 25530 TX ULNAR SHAFT FX $ 276.00 25560 TX BOTH RADIAL/ULNAR FX $ 377.00 25600 TX DISTAL RADIAL/ULNAR FX $ 276.00

137 25622 TX SCAPHOID FX $ 377.00 25630 TX CARPAL FX $ 276.00 26600 TX METACARPAL FX $ 377.00 26720 TX MID/PROX PHALANX FX $ 276.00 26750 TX DISTAL PHALANX FX $ 276.00 27245 TX GREATER TROCHANTER FX $ 276.00 27520 TX PATELLA FX $ 377.00 27530 TX TIBIAL PLATEAU FX $ 377.00 27538 TX TIBIAL TUBEROSITY FX $ 377.00 27750 TX TIBIAL SHAFT FX $ 377.00 27760 TX MEDIAL MALLEOLUS FX $ 276.00 27780 TX FIBULA FX $ 276.00 27786 TX LATERAL MALLEOLUS FX $ 276.00 27808 TX BIMALLEOLAR FX $ 377.00 27824 TX PILON/DISTAL TIBIA FX $ 276.00 28400 TX CALCANCUS FX $ 377.00 28430 TX TALUS FX $ 377.00 28450 TX TARSAL FX $ 377.00 28470 TX METATARSAL FX $ 377.00 28490 TX GREAT TOE FX $ 276.00 28510 TX PHALANGES FX $ 276.00 29065 APPLY LONG ARM CAST $ 355.00 29075 APPLY SHORT ARM CAST $ 355.00 29085 APPLY SHORT ARM THUMB SPICA CAST $ 174.00 29105 APPLY LONG ARM SPLINT $ 505.00 29125 APPLY SHORT ARM SPLINT $ 448.00 29130 APPLY FINGER SPLINT $ 210.00 29345 APPLY LONG LEG CAST NW/B $ 355.00 29355 APPLY LONG LEG CAST W/B $ 355.00 29365 APPLY CYLINDRICAL CAST $ 355.00 29405 APPLY SHORT LEG CAST NW/B $ 355.00 29425 APPLY SHORT LEG CAST W/B $ 355.00 29505 APPLY LONG LEG SPLINT $ 492.00 29515 APPLY SHORT LEG SPLINT $ 435.00 36415 VENIPUNCTURE/BLOOD DRAW $ 5.00 99201 LEVEL I NEW E&M $ 91.00 99202 LEVEL II NEW E&M $ 107.00 99203 LEVEL III NEW E&M $ 151.00 99204 LEVEL IV NEW E&M $ 185.00 99205 LEVEL V NEW E&M $ 240.00 99211 LEVEL I EST E&M $ 91.00 99212 LEVEL II EST E&M $ 107.00 99213 LEVEL II EST E&M $ 122.00 99214 LEVEL IV EST E&M $ 151.00 99215 LEVEL V EST E&M $ 185.00 .5% BUPIVACAINE HCL/EPH INJ 30ML $ 10.26 J1030 DEPO-MEDROL 40 MG/ML $ 13.29 J2001 LIDOCAINE HCL INJ 1% 10 MG/ML $ 6.27 S0020 SENSORCAINE-MPF .5% 10ML $ 4.14 J1885 KETOROLAC TROM 30 MG/ML $ 5.01 .5% BUPIVACAINE HCL $ 4.11 J1100 DEX SODIUM PHOSPHATE 4 MG/ML $ 1.89 J0702 BETA SODIUM PHOSPHATE/ACETATE 30ML $ 84.87 SSD 1% SILVER SULF CREAM 25 GM $ 18.15 SSD 1% SILVER SULF CREAM 50 GM $ 23.04 81025 PREGNANCY TEST $ 25.83

138 FACILITY FEE $ 105.27 FACILITY FEE $ 105.27 90686 EHS INFLUENZA VAC $ 20.00 99201 LEVEL I NEW E & M $ 69.00 99381 GH INITIAL EXAM 0-1 NEW $ 91.90 99382 GH INITIAL EXAM 1-4 NEW $ 98.65 99383 GH INITIAL EXAM 5-11 NEW $ 96.60 99391 GH INITIAL EXAM 0-1 EST $ 69.52 99392 GH INITIAL EXAM 1-4 EST $ 77.87 99393 GH INITIAL EXAM 5-11 EST $ 76.84 99212 GH INTERIM MED VISIT $ 25.65 96110 GH DEVELOPMENTAL SCR $ 16.07 85018 GH HEMOGLOBIN $ 2.32 85013 GH HEMATOCRIT $ 2.32 83655 GH LEAD SCR ANALYSIS $ 11.86 86580 GH MANTOUX TEST $ 4.00 81003 GH URINALYSIS $ 2.18 92551 GH HEARING SCR $ 15.20 99173 GH VISION SCREENING $ 7.45 99211 GH MAKE-UP VISIT $ 12.88 90713 GH IPV $ 6.40 90700 GH DTAP $ 6.40 90707 GH MMR $ 39.70 90647 GH HIB PRP-OMP CONJUGATE $ 6.40 90648 GH HIB PRP-T CONJUGATE $ 6.40 90744 GH HBV $ 6.40 90748 GH COMB HIB/HBV $ 6.40 90716 GH VARICELLA $ 6.40 90732 GH PCV AGE 5 AND UP $ 6.40 99078 GH HEALTH EDU $ 45.00

139