Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 42000001 (TRANSCUTAN) NEUROSTIM 420 64550 $ 299.94 ACTIVE 0.45% NS 1000ML W/20MEQ (1/2 25000680 258 J7030 $ 30.00 ACTIVE NS-20MEQ POT CHL 1000ML) 0.9% SODIUM CHLORIDE 3ML 25000258 PREFILLED SALINE FLUSH 250 A4216 $ 14.00 ACTIVE SYRINGE 30100129 1 25-DIHYDROXYVITAMIN D 301 82652 $ 513.36 ACTIVE 27200001 10 FRENCH SHEATH 15-716B 272 C1894 $ 212.80 ACTIVE 10% LMD IN 5% DEXTROSE 25800005 500ML / DEXTRAN 40 IN 258 J7060 $ 280.00 ACTIVE DEXTROSE INJ 500ML 10% LMD IN 5%DEXTROSE 25800006 258 J7060 $ 322.00 ACTIVE 500ML/DE 30100216 17-KETOSTEROIDS TOTAL 301 83586 $ 170.64 ACTIVE 4.0MM ACROMIOBLASTER 27200199 272 A4649 $ 140.00 ACTIVE 7205668 4FR INT KIT MINI GW- 27200887 272 A4649 $ 112.00 ACTIVE POUCH/SHEATH 5.5MM PEDIPORT W/ LOCKING 27200845 272 C1751 $ 1,376.88 ACTIVE TROCAR 27200180 5FR POLLACK CATHETER 272 A4649 $ 32.46 ACTIVE 30100201 5-HYDROXYINDOLEACETIC ACID 301 83497 $ 171.96 ACTIVE 25901724 A&D ONINTMENT 2OZ 270 A6250 $ 64.00 ACTIVE 63600003 ABBOKINASE 5MU VIAL 636 J3365 $ 15,755.60 ACTIVE 32000001 ABD AORTAGRAM 320 75625 $ 6,708.00 ACTIVE ABD AORTAGRAM - NON 48100087 481 75625 $ 6,708.00 ACTIVE SELECTIVE ABD AORTAGRAM W/ BILATERAL 48100086 481 75630 $ 8,306.00 ACTIVE RUNOFF 32000002 ABD W/RUN OFFS 320 75630 $ 8,306.00 ACTIVE 27000561 ABDOMINAL BINDER UNIV 270 L0625 $ 500.00 ACTIVE 27000524 ABDOMINAL PAD 270 A4649 $ 3.10 ACTIVE ABDOMINAL PARACENTESIS 36000190 (DIAGNOSTIC OR THERAPEUTIC); 360 49083 $ 3,403.00 ACTIVE WITH IMAGING GUIDANCE

ABDOMINAL PARACENTESIS 36000189 (DIAGNOSTIC OR THERAPEUTIC); 360 49082 $ 3,403.00 ACTIVE WITHOUT IMAGING GUIDANCE ABLATION OF ADDITIONAL 48100114 481 93655 $ 48,028.75 ACTIVE MECHANISM OF SVT OR VT 32000053 ABSCSS FIST SIN TRACT 320 76080 $ 2,656.50 ACTIVE 27000756 ACE WRAP 6" 270 A6449 $ 34.10 ACTIVE 25000011 ACETADOTE 20% INJECTION 250 J0132 $ 28.00 ACTIVE 25900029 ACETAMINOPH 160MG/5ML LIQ 259 J3490 $ 30.00 ACTIVE 25000029 ACETAMINOPHEN 1000MG IV 250 J0131 $ 59.00 ACTIVE 25900031 ACETAMINOPHEN 120MG SUPP. 250 J8498 45 ACTIVE

25900032 ACETAMINOPHEN 325MG SUPP. 250 J8498 45 ACTIVE 25900033 ACETAMINOPHEN 325MG TAB 250 A9150 $ 30.00 ACTIVE 25900030 ACETAMINOPHEN 500 MG TAB 250 J0131 $ 30.00 ACTIVE ACETAMINOPHEN 500MG TAB 25700002 250 A9150 $ 30.00 ACTIVE (MAPAP ES) 25900034 ACETAMINOPHEN 650MG SUPP 250 J8498 $ 45.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ACETAMINOPHEN SUSP. 25700001 250 A9150 $ 30.00 ACTIVE 160MG/5ML PRECISIONDOSE 25900036 ACETAMINOPHEN W/COD #4 250 J8499 $ 14.00 ACTIVE ACETAMINOPHEN/CODEINE 120- 25901937 250 J3490 $ 45.00 ACTIVE 12MG/5ML ORAL SOL 30100003 ACETONE BLOOD 301 82010 $ 108.96 ACTIVE 30100004 ACETONE SERUM QUALITATIVE 301 82009 $ 60.24 ACTIVE 30700001 ACETONE URINE NON AUTO 307 81002 $ 41.76 ACTIVE ACETYLCHOLINE RECEPTOR 30100005 301 84238 $ 341.32 ACTIVE ANTIBODY ACETYLCYSTEINE (MUCOMYST) 25901933 250 J7608 $ 112.00 ACTIVE 10% INH 100MG 30ML VIAL 25900041 ACETYLCYSTEINE 10PC 250 J7608 $ 202.00 ACTIVE 25900773 ACETYLCYSTEINE 20% 30ML 250 J7608 $ 184.50 ACTIVE 30100296 ACID PHOSPHATASE (TOTAL) 301 84060 $ 98.52 ACTIVE ACID-FAST BACILLUS SMEAR & 30600085 306 87206 $ 71.88 ACTIVE FUNGAL STAIN ACID-FAST BACILLUS SMEAR 30600001 306 87116 $ 144.00 ACTIVE AND CULTURE ACROMIOCLAVICULAR AC 32000054 320 73050 $ 818.52 ACTIVE JOINTS W/WO WEIGHTS - 2 VIEW ACTIDOSE WITH SORBITAL 50GM 25901306 250 J3490 $ 338.00 ACTIVE 240ML 30500002 ACTIVATED CLOTTING TIME 305 85347 $ 56.76 ACTIVE 30100007 ACUTE HEPATITIS PANEL 301 80074 $ 635.16 ACTIVE 27200883 ACUTRAK2 7.5 LONG DRILL 270 C1713 $ 9,315.00 ACTIVE 27000584 ADAPTER CATHETER 270 A4300 $ 52.00 ACTIVE 27000637 ADAPTER VALVE LL 270 A4649 $ 132.00 ACTIVE 32000003 ADD PERIPH S&I ADD FAMILY 320 75964 $ 4,945.92 ACTIVE 32000004 ADD VIS S&I 320 75968 $ 4,945.92 ACTIVE 48100112 ADDITIONAL A FIB ABLATIONS 481 93657 $ 41,671.40 ACTIVE 25400001 ADENOSINE 90MG/30ML VIAL 636 J0153 $ 710.10 ACTIVE 30200005 ADENOVIRUS ANTIBODY 302 86603 $ 171.60 ACTIVE ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY 36000366 360 14301 $ 45,499.50 ACTIVE AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM 42000004 ADL TRAIN EA 15 450 97535 $ 251.16 ACTIVE 77100001 ADMIN HEPATITIS B VACCNE 771 G0010 $ 144.90 ACTIVE 77100002 ADMIN INFLUENZA VACCINE 771 G0008 $ 411.96 ACTIVE ADMIN PNEUMOCOCCAL 77100003 771 G0009 $ 277.88 ACTIVE VACCNE ADRENOCORTICOTROPIC 30100006 301 82024 $ 363.86 ACTIVE HORMONE 25900058 ADVAIR DISKUS 250/50 250 J3535 $ 2,040.00 ACTIVE 25900059 ADVAIR DISKUS 500/50 250 J3535 $ 2,680.00 ACTIVE 25900061 ADVIL 200MG TABLET 250 A9150 $ 30.00 ACTIVE 25901316 ADVIL SUSP. 100MG/5ML 4 OZ 250 A9150 $ 30.00 ACTIVE 27000761 AERO CHAMBER 270 A4627 $ 13.50 ACTIVE 25900064 AFRIN 0.05 PC SPRY 15ML 250 J3490 $ 46.00 ACTIVE 30900019 AG DETECT NOS IA MULT 306 87449 $ 44.40 ACTIVE 30600064 AGENT NOS ASSAY W/OPTIC 306 87899 $ 192.84 ACTIVE 27000015 AIRWAY NASAL 28FR (11267) 270 A7034 $ 100.00 ACTIVE 27000016 AIRWAY NASAL 30FR (11268) 270 A7034 $ 92.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000017 AIRWAY NASAL 32FR (11269) 270 A7034 $ 100.00 ACTIVE 27200813 AIRWAYS NASAL (ALL) 272 A7034 $ 336.00 ACTIVE 27200812 AIRWAYS ORAL (ALL) 272 A7044 $ 204.00 ACTIVE 30100022 ALANINE AMINOTRANSFERASE 301 84460 $ 70.68 ACTIVE 30100011 ALBUMIN (SERUM) 301 82040 $ 66.00 ACTIVE 30100010 ALBUMIN (URINE) 301 82042 $ 93.36 ACTIVE ALBUTEROL (MCR) INHALER 25900071 250 J7609 $ 446.00 ACTIVE UNIT DOSE 1MG ALBUTEROL (VENTOLIN) INHALR 25901201 250 J7613 $ 592.50 ACTIVE 90MCG/ACT INH ALBUTEROL INH 0.5% 2.5MG 25000032 250 J7613 $ 32.50 ACTIVE 0.5ML VIAL ALBUTEROL SULFATE 0.083% 25900072 250 J7613 $ 30.00 ACTIVE 3ML-NEBULIZER ALBUTEROL UP TO 2.5MG & 25901774 IPRATROPIUM BROMIDE UP TO 259 J7620 $ 24.00 ACTIVE 0.5MG ALBUTEROL/IPRABROMIDE 0.5- 25901319 250 J7620 $ 82.50 ACTIVE 3MG/3ML 30100632 ALCOHOL (ETHANOL) 301 80320 $ 112.80 ACTIVE ALCOHOL ISOPROPYL 70% 4OZ 27000754 250 A4244 $ 5.25 ACTIVE BTL ALCOHOL, ISOPROPYL 70% 16OZ 27000755 250 A4244 $ 5.25 ACTIVE (473ML) BTL 30000013 ALDOLASE 301 82085 $ 129.48 ACTIVE 30100015 ALDOSTERONE 301 82088 $ 392.84 ACTIVE 30100017 ALKALINE PHOSPHATASE 301 84075 $ 69.00 ACTIVE ALKALINE PHOSPHATASE 30100016 301 84080 $ 197.16 ACTIVE ISOENZYMES ALL POTASSIUM HYDROXIDE 30600002 306 Q0112 $ 69.78 ACTIVE (KOH) PREPARATIONS ALLERGEN SPECIFIC IGE 30200174 QUANTITATIVE/SEMIQUANTITATI 302 86003 $ 69.60 ACTIVE VE 30100574 ALLERGY SKIN TEST 301 95028 $ 222.74 ACTIVE 25900083 ALLOPURINOL 100MG TAB 250 J8499 $ 16.00 ACTIVE 30100019 ALPHA-1-ANTITRYPSIN (TOTAL) 301 82103 $ 179.16 ACTIVE ALPHA-FETOPROTEIN AMNIOTIC 30000041 301 82106 $ 223.68 ACTIVE FLUID ALPHA-FETOPROTEIN TUMOR 30100009 301 82105 $ 223.68 ACTIVE MARKER ALPRAZOLAM (XANAX) 0.5MG 25901234 250 J8499 $ 30.00 ACTIVE TAB 25900086 ALPRAZOLAM .25MG TAB 250 J8499 $ 24.00 ACTIVE 25900087 ALPRAZOLAM 0.5MG TAB 250 J8499 $ 44.00 ACTIVE 25901854 ALPRAZOLAM 1MG TAB 250 J8499 $ 45.00 ACTIVE 30100021 ALPRAZOLMAM-XANAX 301 80299 $ 223.68 ACTIVE ALTEPLASE (CATHFLO 63600025 636 J2997 $ 813.80 ACTIVE ACTIVASE) 2MG VIAL 25900094 AMBIEN 10 MG TAB 250 J8499 $ 57.00 ACTIVE 25900095 AMBIEN 5MG TAB 250 J8499 $ 57.00 ACTIVE 27000587 AMBU BAG 270 S8999 $ 400.00 ACTIVE 30100023 AMIKACIN 301 80150 $ 201.00 ACTIVE AMINO ACIDS MX QUALITATE 30100024 301 82128 $ 184.92 ACTIVE EACH SPECIMEN AMINOLEVULINIC ACID DELTA 30100025 301 82135 $ 219.36 ACTIVE (ALA) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS AMIODARONE 150MG (50MG/3ML) 25000875 636 J0282 $ 70.00 ACTIVE 3ML SDVIAL 63600149 AMIODARONE 360MG/200ML IV 636 J0282 $ 93.36 ACTIVE 63600150 AMIODARONE 450MG/9ML VIAL 636 J0282 $ 9.66 ACTIVE 63600151 AMIODARONE 900MG/18ML 636 J0282 $ 34.00 ACTIVE AMIODARONE CORDARONE 25900306 250 J8499 $ 54.00 ACTIVE 200MG TABLET AMITRIPTYLINE (ELAVIL) 10MG 25901419 250 J8499 $ 18.40 ACTIVE TABS AMITRIPTYLINE (ELAVIL) 25MG 25901420 250 J8499 $ 30.00 ACTIVE TABS AMLODIPINE (NORVASC) 5 MG 25900843 250 J8499 $ 52.00 ACTIVE TAB 25900105 AMLODIPINE 10MG TAB 250 J8499 $ 68.00 ACTIVE 30100028 AMMONIA 301 82140 $ 194.28 ACTIVE 25900107 AMMONIA INHALANT 250 J7699 $ 32.00 ACTIVE 27000696 AMNIOFIX PARTICULATE 40MG 250 C1762 $ 2,902.00 ACTIVE AMOXICILLIN (AMOXIL) 25901323 259 J8499 $ 96.60 ACTIVE 125MG/5ML OS AMOXICILLIN + CLAVULANATE 25900145 POTASSIUM (AUGMENTIN) 875 259 J8499 $ 94.50 ACTIVE MG TAB AMOXICILLIN +CLAVULANATE 25901946 250 J3490 $ 24.00 ACTIVE 400MG 5ML OS 25901322 AMOXICILLIN 250 MG. CAP. 250 J8499 $ 24.00 ACTIVE 25901855 AMOXICILLIN 250MG/5ML 150ML 250 J8499 $ 24.00 ACTIVE

25901856 AMOXICILLIN 400MG/5ML 50ML 250 J8499 $ 24.00 ACTIVE

25901857 AMOXICILLIN 400MG/5ML 80ML 250 J8499 $ 24.00 ACTIVE 25100039 AMOXICILLIN 500MG CAP 259 J8499 $ 24.00 ACTIVE AMOXICILLIN+CLAV POTAS 25900143 250 J8499 $ 76.50 ACTIVE (AUGMENTIN) 500/125MG TAB 25901324 AMOXIL 250MG/5ML 100ML 250 J8499 $ 228.00 ACTIVE 30100029 AMPHETAMINE 301 82145 $ 183.54 ACTIVE 63600185 AMPICILLIN 250MG VIAL 636 J0290 $ 33.68 ACTIVE 63600190 AMPICILLIN/SULBACTAM 1.5GM 636 J0290 $ 33.68 ACTIVE 63600191 AMPICILLIN/SULBACTAM 3GM 636 J0290 $ 33.68 ACTIVE AMPLICATION OF PATIENT 30100031 301 83900 $ 379.96 ACTIVE NUCLEIC ACID AMPUTATION FINGER/THUMB ANY JOINT/PHALAN SINGLE 36000238 360 26951 $ 33,190.50 ACTIVE INCLUDING NEURECTOMIES W/DIRECT CLOSURE AMPUTATION, TOE; 36000298 360 28825 $ 18,346.50 ACTIVE INTERPHALANGEAL JOINT 30100032 AMYLASE 301 82150 $ 86.40 ACTIVE 30100071 ANABOLIC STEROIDS; 1 OR 2 301 80327 $ 40.20 ACTIVE 30100059 ANALGESICS NON-OPIOID 1-2 301 80329 $ 221.28 ACTIVE 30100114 ANALGESICS, NON-OPIOID; 3-5 301 80330 $ 221.28 ACTIVE 25000003 ANCEF 1GRM 50ML IV 636 J0690 $ 12.24 ACTIVE 30100038 ANDROSTENEDIONE 301 82157 $ 267.26 ACTIVE ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING 37100001 371 1920 $ 3,814.48 ACTIVE CORONARY ANGIOGRAPHY AND VENTRICULOGRAPHY Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ANESTHESIA FOR NERVES/MUSCLES/TENDONS/FA 37000008 370 1716 $ 2,416.00 ACTIVE SCIA/BURSAE OF UPPER ARM/ELBOW; TENODESIS 32000006 ANGIO BI-LAT CAROTID 320 75680 $ 14,808.78 ACTIVE ANGIO BI-LAT 32000007 320 75671 $ 14,808.78 ACTIVE CAROTID/CEREBRAL 27200007 ANGIO CATH 3.5 X 20MM 272 C1725 $ 21.50 ACTIVE 27200660 ANGIO JET 150ML 272 C1757 $ 339.00 ACTIVE ANGIO JET A-V GRAFT 36000016 360 36870 $ 1,287.00 ACTIVE THROMBECTO ANGIO THROUGH EXISTING 32300014 323 75898 $ 3,794.08 ACTIVE CATHETER 32000008 ANGIO UNI-LAT CAROTID 320 75676 $ 14,808.78 ACTIVE ANGIO UNI-LAT 32000009 320 75665 $ 14,808.78 ACTIVE CAROTID/CEREBRAL 32300010 ANGIOG PUMONARY BIL SEL 323 75743 $ 18,890.70 ACTIVE ANGIOPLASTY HEMOSTASIS 27200702 272 A4649 $ 282.50 ACTIVE VALVE ANGIOTENSIN I CONVERTING 30100039 301 82164 $ 194.64 ACTIVE ENZYME 32000056 ANKLE 2 VIEWS 320 73600 $ 1,300.00 ACTIVE 32000055 ANKLE 3V OR MORE 320 73610 $ 1,505.00 ACTIVE 32200001 ANKLE ARTHROGRAPHY 322 73615 $ 2,618.56 ACTIVE ANKLE WALKER, MAXTRAX 27400007 270 L4360 $ 596.10 ACTIVE W/AIR LG 27800030 ANS CHARGING SYSTEM 270 C1820 $ 8,553.02 ACTIVE 27800799 ANS PATIENT PROGRAMMER 270 L8681 $ 21.50 ACTIVE ANS STIMULATOR CHARGING 27800797 270 L8689 $ 35.95 ACTIVE SYSTEM ANTI MITOCHONDRIAL 30200013 302 86256 $ 160.68 ACTIVE ANTIBODY 30200017 ANTI PLATELET ANTIBODIES 302 86023 $ 166.08 ACTIVE ANTIBIOTIC SENSITIVE 30600003 MICROTITER MINIMUM 306 87186 $ 115.32 ACTIVE INHIBITORY CONCENTRATION ANTIBODY HERPES SIMPLEX 30000001 302 86694 $ 191.88 ACTIVE NON SPECIFIC TYPE TEST 30200004 ANTIBODY IDENTIFICATION 302 86870 $ 260.82 ACTIVE ANTIBODY IDENTIFICATION; 30200008 302 86021 $ 55.77 ACTIVE LEUKOCYTE ANTIBODIES ANTIBODY LYMPHOCYTIC 30000002 300 86727 $ 171.60 ACTIVE CHORIOMENINGITIS VIRUS ANTIBODY SCREEN RED BLOOD 30200026 302 86850 $ 117.24 ACTIVE CELLS EACH SERUM TECHNIQUE 30000003 ANTIBODY WEST NILE VIRUS 302 86789 $ 191.88 ACTIVE ANTIBODY WEST NILE VIRUS 30000004 302 86788 $ 224.64 ACTIVE (IMMUNOGLOBIN-M) 30100547 ANTIBODY; ACTINOMYCES 302 86602 $ 37.68 ACTIVE ANTIGEN SCREEN WITH 30200006 302 86905 $ 51.00 ACTIVE REAGENT SERUM/UNIT 30100040 ANTI-HISTONE ANTIBODY 301 83516 $ 153.72 ACTIVE ANTIHUMAN GLOBULIN TEST 30200027 (COOMBS TEST) DIRECT EACH 302 86880 $ 71.88 ACTIVE ANTISERUM ANTINUCLEAR ANTIBODY TEST 30200014 302 86038 $ 161.16 ACTIVE (ANA) 30200015 ANTINUCLEAR ANTIBODY TITER 302 86039 $ 148.80 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ANTI-SACCHAROMYCES CEREVISIAE ANTIBODIES 30200029 302 86671 $ 163.44 ACTIVE IMMUNOGLOBIN- G/IMMUNOGLOBIN-A (FUNGAL 30200028 ANTISTREPTOLYSIN-O SCREEN 302 86063 $ 76.92 ACTIVE 30200032 ANTISTREPTOLYSIN-O TITER 302 86060 $ 97.32 ACTIVE 30500003 ANTITHROMBIN III ANTIGEN 305 85301 $ 144.12 ACTIVE ANUCORT (HEMORR W/ HC 25900112 250 J8498 $ 49.50 ACTIVE SUPP) R/S 27200183 ANVIL GRASPER 10AG 272 A4649 $ 2,389.86 ACTIVE 27200856 AO DRILL BIT 3.5 272 A4649 $ 1,946.00 ACTIVE 32000010 AORTIC ARCH 320 75650 $ 14,808.78 ACTIVE 27200189 AORTIC CANNULA 24FR L211024 272 A4649 $ 64.00 ACTIVE 48100061 AORTIC ROOT INJECTION 481 93567 $ 1,600.34 ACTIVE 44000001 APHASIA ASSESSMENT 1 HOUR 440 96105 $ 1,062.60 ACTIVE APLIGRAF APPL OF PRODUCT 76100002 761 15341 $ 3,620.74 ACTIVE ADDL 25 SQ CM APLIGRAF APPLICATION OF 76100003 761 15340 $ 3,620.74 ACTIVE PRODUCT INITIAL 42000005 APLY FINGER SPLNT STAT 450 29130 $ 769.78 ACTIVE 42000007 APLY SHRT ARM SPLT DYN 450 29126 $ 769.78 ACTIVE 30100042 APOLIPOPROTEIN A 301 82172 $ 253.08 ACTIVE APP OF SKIN SUBSTITUTE GRAFT, TOTAL WOUND 36000333 SURFACE AREA UP TO 100SQCM; 360 15275 $ 4,950.00 ACTIVE FIRST 25SQCM OR < WOUND SURFACE AREA APPENDECTOMY RUPTURED 36000063 APPENDIX W/ ABSCESS OR 360 44960 $ 27,417.90 ACTIVE GENERALIZED PERITONITIS APPLICATION OF SHORT ARM 45000133 SPLINT (FOREARM TO 450 29125 $ 2,052.00 ACTIVE HAND)STATIC APPLICATION OF SHORT LEG 36000293 360 29405 $ 1,405.90 ACTIVE CAST (BELOW KNEE TO TOES) APPLICATION, FINGER SPLINT; 45000141 450 29130 $ 550.00 ACTIVE STATIC APPLICATION, LONG LEG SPLINT 45000142 450 29505 $ 500.00 ACTIVE (THIGH TO ANKLE/TOES) 27200691 APPLICATOR MALLEABLE 272 A4649 $ 847.50 ACTIVE APPLIER CLIP SURGICLIP M-9.75 27200744 272 A4649 $ 565.00 ACTIVE AUTO BLUE 42000008 APPLY DENIS-BROWNE SPL 450 29590 $ 769.78 ACTIVE 42000009 APPLY FINGER SPLNT DYN 450 29131 $ 769.78 ACTIVE 42000010 APPLY LONG ARM SPLINT 450 29105 $ 769.78 ACTIVE 42000011 APPLY LONG LEG SPLINT 450 29505 $ 769.78 ACTIVE 42000012 APPLY SHORT LEG SPLINT 450 29515 $ 769.78 ACTIVE 27000020 AQUACEL RIBBON 3/4 X 18 270 A6197 $ 280.00 ACTIVE 27000769 AQUAGEL 270 A6196 $ 12.50 ACTIVE 42000013 AQUATIC EXERCISE EA 15 450 97113 $ 206.08 ACTIVE 25900118 ARICEPT 5 MG TAB 250 J8499 $ 136.50 ACTIVE 30100044 ARSENIC 301 82175 $ 252.96 ACTIVE 30100427 ART PUNC WITHDRAW BLD DX 410 36600 $ 904.50 ACTIVE 92100001 ARTERIAL 1-LEV/BI-LATERAL 921 93922 $ 1,200.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ARTHERECTOMY SILVERHAWK 27200008 272 C1714 $ 16,223.90 ACTIVE DS ARTHREX ARTHROSCOPY PUMP 27200615 272 A7002 $ 662.00 ACTIVE TUBING 27200673 ARTHREX CANNULA 272 C1713 $ 1,695.00 ACTIVE ARTHROCENTESIS ASPIRATION INJ INTERMEDIATE JOINT/BURSA 45000086 (TEMPOROMANDIBULAR/ACROMI 450 20605 $ 1,944.00 ACTIVE OCLAVICULAR/WRIST/ELBOW/AN KLE) W/O US GUID

ARTHROCENTESIS ASPIRATION/INJECTION MAJOR 36100015 JOINT/BURSA (SHOULDER HIP 361 20610 $ 2,410.00 ACTIVE KNEE SUBACROMIAL BURSA) W/O US GUIDANCE

ARTHROCENTESIS ASPIRATION/INJECTION SMALL 45000087 450 20600 $ 1,836.00 ACTIVE JOINT/BURSA (FINGERS/TOES) W/O US GUIDANCE ARTHROCENTESIS, ASPIRATION/INJECTION, MAJOR 45000131 JOINT/BURSA 450 20610 $ 2,394.00 ACTIVE (SHOULDER/HIP/KNEE/SUBAC BURSA); W/O US GUIDE ARTHRODESIS, ANKLE, OPEN 36000329 360 27870 $ 53,351.50 ACTIVE PROCEDURE ARTHRODESIS, GREAT TOE; 36000347 360 28750 $ 29,201.00 ACTIVE METATARSOPHALANGEAL JOINT ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE 36000354 OR TRANSVERSE; WITH 360 28735 $ 40,553.50 ACTIVE OSTEOTOMY (EG, FLATFOOT CORRECTION) ARTHRODESIS, TIBIOFIBULAR 36000307 360 27871 $ 33,695.00 ACTIVE JOINT, PROXIMAL OR DISTAL 36000353 ARTHRODESIS; SUBTALAR 360 28725 $ 40,373.50 ACTIVE ARTHROPLASTY ACETABULAR AND PROXIMAL FEMORAL 36000017 PROSTHETIC REPLACE(TOTAL 360 27130 $ 14,112.80 ACTIVE HIP ARTHROPLASTY) W/OR W/O AUTOGRAFT OR ALLOGRAFT

ARTHROPLASTY KNEE CONDYLE, PLATEAU MEDIAL, & 36000050 LATERAL COMPARTMENTS W/OR 360 27447 $ 70,730.50 ACTIVE W/O PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)

ARTHROSCOPY KNEE REMOVAL OF FB (OSTEOCHONDRITIS 36000092 360 29874 $ 27,957.00 ACTIVE DISSECANS FRAGMENTATION CHONDRAL FRAGMENTA ARTHROSCOPY KNEE W/ MENISCECTOMY (MEDIAL & 36000231 LATERAL)INC 360 29880 $ 29,260.00 ACTIVE SHAVING/DEBRID/CHONDROPLA STY Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ARTHROSCOPY SHOULDER 36000061 360 29827 $ 54,989.00 ACTIVE W/ROTATOR CUFF REPAIR ARTHROSCOPY SHOULDER; 36100011 361 29807 $ 53,946.50 ACTIVE REPAIR OF SLAP LESION ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR 36000375 360 29895 $ 23,343.00 ACTIVE JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL ARTHROSCOPY, ANKLE (TIBIOTALAR/FIBULOTALAR 36000320 360 29898 $ 29,159.50 ACTIVE JOINTS), SURG; DEBRIDEMENT, EXTENSIVE ARTHROSCOPY, ANKLE, EXCISION OF OSTEOCHONDRAL 36000321 360 29891 $ 34,793.50 ACTIVE DEFECT OF TALUS/TIBIA, INCL DRILLING OF THE DEFECT ARTHROSCOPY, KNEE W/MENIS (MED OR LAT) INC DEB 36000271 360 29881 $ 25,381.00 ACTIVE SHAVING/ARTICULAR (CHONDROP) ARTHROSCOPY, KNEE, DEBRIDEMENT/SHAVING OF 36000186 360 29877 $ 32,336.00 ACTIVE ARTICULAR CARTILAGE (CHONDROPLASTY) ARTHROSCOPY, SHOULDER DECOMP OF SUBACROMIAL 36000256 360 29826 $ 9,226.50 ACTIVE W/PARTIAL ACROMIOPLASTY & CORACOACROMIAL LIGAMENT ARTHROSCOPY, SHOULDER DISTAL CLAVICULECTOMY INC 36000255 360 29824 $ 34,681.50 ACTIVE ARTICULAR SURFACE (MUMFORD PROCEDURE) ARTHROSCOPY, SHOULDER, 36000261 SURGICAL; DEBRIDEMENT, 360 29822 $ 29,499.50 ACTIVE LIMITED ARTHROSCOPY, SUBTALAR 36000326 JOINT, SURGICAL; 360 29906 $ 36,071.50 ACTIVE W/DEBRIDEMENT ARTHROTOMY ANKLE, INC 36000292 EXPLORATION, DRAINAGE, OR 360 27610 $ 15,528.80 ACTIVE REMOVAL OF FB ARTHROTOMY W/EXPLORATION,DRAINAGE,REM 36000291 OVAL OF LOOSE OR 360 28020 $ 18,698.00 ACTIVE FB;INTERTARSAL OR TARSOMETATARSAL JOINT ARTHROTOMY W/EXPLORATION/DRAINAGE/REM 36000327 360 26080 $ 20,178.00 ACTIVE OVAL OF FB; INTERPHALANGEAL JOINT, EA. ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR 36000373 360 26075 $ 16,464.50 ACTIVE FOREIGN BODY; METACARPOPHALANGEAL JOINT, EACH ASCORBIC ACID OR VITAMIN C 30100046 301 82180 $ 131.76 ACTIVE (BLOOD) 36000105 ASP/INJ THYROID CYST 360 60300 $ 2,830.36 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ASPARTATE 30100047 301 84450 $ 69.00 ACTIVE AMINOTRANSFERASE 30200033 ASPERGILLUS ANTIBODY 302 86606 $ 200.76 ACTIVE ASPIRATION CATHETER 27000001 270 C1887 $ 2,674.00 ACTIVE (MEDTRONIC VASCULAR) 25900128 ASPIRIN 325MG TAB 250 G8598 $ 24.00 ACTIVE 25900130 ASPIRIN 81 MG COATED 250 A9150 $ 8.00 ACTIVE 25901334 ASPIRIN BABY 81MG TAB 250 A9150 $ 24.00 ACTIVE 30100440 ASSAY OF SELENIUM 301 84255 $ 94.56 ACTIVE 30100623 ASSAY OF SIALIC ACID 301 84275 $ 179.16 ACTIVE 30100206 ASSAY OF SOMATOMEDIN 301 84305 $ 78.75 ACTIVE 30600100 ASSAY TEST FOR BLOOD FECAL 300 82274 $ 56.00 ACTIVE 25000055 ATROPINE 0.4MG/ML AMP 636 J0461 $ 70.00 ACTIVE 25900139 ATROPINE 1% OPHTH SOL 15 ML 250 J7636 $ 92.00 ACTIVE ATROVENT 0.02% 2.5ML UNIT 25900140 250 J7644 $ 20.00 ACTIVE DOSE VIAL 25901346 AURALGAN OTIC GTTS 10ML 250 J3490 $ 280.50 ACTIVE AUTOLOGOUS BLOOD OR 30200034 302 86890 $ 689.08 ACTIVE COMPONENT AUTOMATED COMPLETE BLOOD 30500017 305 85027 $ 86.16 ACTIVE COUNT (CBC) 30100438 AUTOMATED SEDIMENT RATE 305 85652 $ 36.00 ACTIVE 25900155 AVITENE 1GM JAR 250 J8499 $ 1,881.40 ACTIVE AVULSION OF NAIL PLATE 45000044 PARTIAL OR COMPLETE SIMPLE 450 11730 $ 2,862.00 ACTIVE SINGLE 25000872 AZITHROMYCIN 250 Q0144 $ 62.78 ACTIVE 25000004 AZITHROMYCIN 200MG/5ML 15ML 250 J0456 $ 62.78 ACTIVE 30100048 B TYPE NATRIURETIC PEPTIDE 301 83880 $ 471.12 ACTIVE 25900161 BACITRACIN 500U/GM 3.5GM 250 J3490 $ 69.00 ACTIVE BACITRACIN 500UN 14GM TOP 25901953 250 J3490 $ 24.00 ACTIVE OINTMENT BACITRACIN ZINC +POLYMYXIN 25901957 250 J3490 $ 12.50 ACTIVE B OPHTH OINMT BACLOFEN (LIORESAL) 10MG 25900672 259 J8499 $ 24.00 ACTIVE TABLET BACTERIAL VAGINOSIS 30100600 306 87905 $ 45.24 ACTIVE SIGLIDASE 25900165 BACTERIOSTATC H2O 30ML VL 250 A4216 $ 14.00 ACTIVE 25900166 BACTROBAN 2% 15GM CREAM 250 A4216 $ 360.00 ACTIVE 25900169 BACTROBAN NASL2% 1GM OINT 250 A6250 $ 92.00 ACTIVE 27000023 BAG BEDI URINE (16398) 270 A4357 $ 16.00 ACTIVE 27000477 BAG COLOSTOMY 270 A5061 $ 508.00 ACTIVE 27000632 BAG DECANTER 270 A4649 $ 116.00 ACTIVE 27200013 BAG DECANTERS 272 A4649 $ 16.00 ACTIVE BAG DISPOSABLE 1400 ML 27200635 272 A4357 $ 447.00 ACTIVE RELIEF VALVE/SPIKE 27000024 BAG DRAINAGE URINE 270 A4357 $ 22.00 ACTIVE 27000025 BAG FOLEY DRAIN 270 A4358 $ 500.00 ACTIVE 27200773 BAG ICE LARGE 272 A9270 $ 35.40 ACTIVE 27000026 BAG URINEMETER W FOLEY 270 A4358 $ 428.00 ACTIVE 27000027 BAG URINEMETER W/O FOLEY 270 A4358 $ 232.00 ACTIVE BAG UROLOGY COLLECTION 27000029 270 A4358 $ 570.00 ACTIVE CF505406 Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000028 BAG UROLOGY DRAIN CF507505 270 A4358 $ 428.00 ACTIVE BAG, BANDED W/RUBBER BAND 27200914 272 A4649 $ 28.80 ACTIVE & TAPE 101CMX101CM BAG, PAT DRWSTRNG 20X20X4 27000746 270 A9270 $ 2.40 ACTIVE WHT 27000030 BANDAGE ACE 2 270 A6448 $ 21.90 ACTIVE 27000031 BANDAGE ACE 3 270 A6449 $ 33.60 ACTIVE 27000032 BANDAGE ACE 4 270 A6449 $ 21.60 ACTIVE 27000033 BANDAGE ACE 6 270 A6450 $ 76.00 ACTIVE 27000530 BANDAGE COBAN 6'' 270 A6455 $ 116.00 ACTIVE 27000036 BANDAGE ELASTIC 2 270 A6448 $ 20.00 ACTIVE 27000522 BANDAGE ESMARK ALL 270 A6413 $ 120.00 ACTIVE 27000037 BANDAGE KERLIX 270 A6446 $ 72.00 ACTIVE 27000038 BANDAGE KLING 2IN (10572) 270 A6446 $ 16.00 ACTIVE 27000039 BANDAGE KLING 3" 270 A6446 $ 48.00 ACTIVE 27000040 BANDAGE KLING 4"""" 270 A6446 $ 28.00 ACTIVE 27000041 BANDAGE KLING ALL 270 A6446 $ 24.00 ACTIVE 27900050 BANDAGE REG ALL SIZES 272 A6413 $ 9.60 ACTIVE 27000042 BANDAGE STERI STRIP 1/2X4 270 A4450 $ 44.00 ACTIVE 27000770 BANDAGE STRECH 3X75 270 A6446 $ 9.00 ACTIVE 27200899 BANDAGE, COBAN ELAS TAN 1 272 A6453 $ 9.00 ACTIVE 30100049 BARBITURATES (NESDONAL) 301 82205 $ 170.66 ACTIVE 32000057 BARIUM ENEMA W/WO KUB 320 74270 $ 7,187.00 ACTIVE BARIUM SULFATE BERRY 25901858 SMOOTHIE 2.1%/2.0% CONTRAST 250 J8499 $ 8.08 ACTIVE 450ML OS BARTONELLA HENSELAE 30200035 302 86611 $ 135.72 ACTIVE ANTIBODY (IMMUNOGLOBIN-G) 30100602 B-CELL TOTAL COUNT 302 86355 $ 139.74 ACTIVE 27000558 BEDPANS, FRACTURE 271 E0276 $ 382.32 ACTIVE BEHAVIORAL WEIGHT LOSS-3 51000009 510 G0447 $ 1,320.00 ACTIVE MONTHS BEHAVIORAL WEIGHT LOSS-6 51000010 510 G0447 $ 3,080.00 ACTIVE MONTHS BELLADONNA EARACHE DROPS 25901956 250 J3490 $ 12.50 ACTIVE 10ML OTIC SOLN BELT STRAP SLEEVE GARMENT 27000771 270 A4467 $ 28.25 ACTIVE OR COVERING ANY TYPE 25900174 BENADRYL 12.5MG/5ML ELIX 250 Q0163 $ 14.00 ACTIVE 25900175 BENADRYL 25MG CAPSULE 250 Q0163 $ 24.00 ACTIVE 25900179 BENICAR 20MG TAB 250 J8499 $ 27.00 ACTIVE 25000579 BENTYL 20MG/2ML 636 J0500 $ 14.26 ACTIVE 25901859 BENZOCAINE 20% SPRAY 250 J8499 $ 5.15 ACTIVE 25901948 BENZOCAINE 6MG LOZENGE 250 J8499 $ 5.25 ACTIVE BETA 2 GLYCOPROTEIN I 30000005 302 86146 $ 64.24 ACTIVE ANTIBODY (IMMUNOGLOBIN-A) 30100054 BETA-2 MICROGLOBULIN 301 82232 $ 215.64 ACTIVE 25900187 BETADINE ANTSPT SOL 10%24 259 A4246 $ 30.00 ACTIVE 25901355 BICITRA 30ML 250 J3490 $ 24.00 ACTIVE 25900197 BICITRA SUGAR FREE SOL 15 ML 250 J8499 $ 14.50 ACTIVE 32000011 BI-LAT EXTREMITY U/L S&I 320 75716 $ 8,984.00 ACTIVE 30100055 BILE ACIDS (TOTAL) 301 82239 $ 228.36 ACTIVE 32000058 BILE STONE EXTRACTION 320 74327 $ 2,701.74 ACTIVE 36000142 BILI DCT STNE REM PRQ 360 47544 $ 18,766.04 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 32000059 BILI DRN PRC 320 75980 $ 4,303.60 ACTIVE BILI ENDOSCOP PERQ T TUBE 36000018 360 47556 $ 12,793.98 ACTIVE W/DIL STRICT W/ST 30100056 BILIRUBIN DIRECT 301 82248 $ 66.84 ACTIVE 30100058 BILIRUBIN TOTAL 301 82247 $ 66.84 ACTIVE 27000043 BINDER ABDOMINAL LG (16241) 270 L0625 $ 176.00 ACTIVE

27000044 BINDER ABDOMINAL MED (16242) 270 L0625 $ 176.00 ACTIVE

27000045 BINDER ABDOMINAL XLG (16273) 270 L0625 $ 336.00 ACTIVE BINDER ABDOMINAL XXLG 27000046 270 L0625 $ 336.00 ACTIVE (16274) BIOFLEXOR PAIN REL TOP GEL 25901860 250 J8499 $ 5.25 ACTIVE 2.25OZ JAR BIOPSY ABDOMINAL OR 36000126 RETROPERITONEAL MASS, 360 49180 $ 4,318.02 ACTIVE PERCUTANEOUS NEEDLE BIOPSY BREAST PERCUT 36000127 NEEDLE CORE NOT USING 360 19100 $ 3,316.60 ACTIVE IMAGING GUIDANCE 36000108 BIOPSY LIVR NDL W/MJR PRO 360 47001 $ 5,600.00 ACTIVE 36000109 BIOPSY LUNG MEDIASTNM 360 32405 $ 6,106.58 ACTIVE BIOPSY OF LIVER, NEEDLE; 36000107 360 47000 $ 6,106.58 ACTIVE PERCUTANEOUS BIOPSY OR EXCISION OF LYMPH 40200055 360 38505 $ 5,203.17 ACTIVE NODES BIOPSY PROSTATE 36000102 360 55700 $ 6,880.00 ACTIVE NEEDL/PUNCH SIN/MUTIPLE 36000149 BIOPSY SOFT TISS NEC THOR 360 21550 $ 6,229.66 ACTIVE BIOPSY SOFT TISSUE OF LEG/ANKLE AREA; DEEP 36000308 360 27614 $ 20,195.00 ACTIVE (SUBFASCIAL OR INTRAMUSCULAR) 36000110 BIOPSY SPIN CORD PERQ NDL 360 62269 $ 6,106.52 ACTIVE BIOPSY, BONE, OPEN; DEEP (EG, 36000356 HUMERAL SHAFT, ISCHIUM, 360 20245 $ 18,306.00 ACTIVE FEMORAL SHAFT) 25900198 BISACODYL 10MG SUPP 250 J8498 $ 8.00 ACTIVE 25900199 BISACODYL 5MG TAB 250 J8499 $ 8.00 ACTIVE 27200196 BIT DRILL 2.5MM 310.25 272 C1713 $ 888.00 ACTIVE 27000739 BIT DRILL 2.6MMX70MM 270 C1713 $ 3,190.00 ACTIVE 27200625 BIT DRILL HELIX NUVASIVE 272 C1713 $ 6,090.00 ACTIVE 27200558 BITE BLOCK 272 A4649 $ 128.00 ACTIVE 25400003 BIVALIRUDIN 250MG VIAL 636 J0583 $ 162.08 ACTIVE BLADE 4.0 AGGRESSIVE PLUS 27200200 272 A4649 $ 684.00 ACTIVE 375-544-000 27000641 BLADE CLIPPER SURG DISP 272 A4649 $ 128.00 ACTIVE 27200649 BLADE FULL RADIUS 5.5MM 272 A4550 $ 3,129.00 ACTIVE 27200648 BLADE INCISOR 4.5MM 272 A4649 $ 140.00 ACTIVE 27200911 BLADE MICRO DUAL CUT 272 A4649 $ 824.70 ACTIVE 27200688 BLADE MYRINGOTOMY 272 A4649 $ 847.50 ACTIVE 27200826 BLADE SURGICAL (#10 15 & 20) 272 A4649 $ 72.00 ACTIVE 27200647 BLADE TWINFIX 5.0 272 A4649 $ 6,126.00 ACTIVE BLANKET BAER HUGGER 27000640 270 A4467 $ 368.00 ACTIVE UPPER/LOWER BODY 30200040 BLASTOMYCES ANTIBODY 302 86612 $ 172.08 ACTIVE 30100428 BLD GASES W/02 SAT 301 82805 $ 945.24 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30500006 BLEEDING TIME 305 85002 $ 60.12 ACTIVE BLOOD BANK SERUM 31000002 302 86078 $ 328.92 ACTIVE TRANSFUSION REACTION BLOOD COLLECTION BLUE TUBE 27000744 270 A4649 $ 31.00 ACTIVE BLD VAC 4.5ML LT BLU BLOOD COLLECTION GREEN 27000442 TUBE VAC/HEMOGARD PLUS 270 A4649 $ 27.00 ACTIVE GRN 4ML BLOOD COLLECTION LAVENDER 27000438 TUBE VAC/HEMOGARD+EDTA 270 A4649 $ 37.00 ACTIVE LAV 4ML BLOOD COLLECTION TIGER TOP 27000440 270 A4649 $ 57.00 ACTIVE TUBE 8.5ML BLOOD COUNT; AUTOMATED 30000039 300 85004 $ 86.16 ACTIVE DIFFERENTIAL WBC COUNT 30600004 BLOOD CULTURE BACTERIAL 306 87040 $ 137.64 ACTIVE BLOOD SMEAR MICROSCOPIC 30500005 EXAMINATION WITHOUT MANUAL 305 85008 $ 45.84 ACTIVE WBC DIFFERENTIAL BLOOD SMEAR WITH MANUAL 30500004 WHITE BLOOD CELL 305 85007 $ 45.84 ACTIVE DIFFERENTIAL 39000007 BLOOD SPLIT UNIT SPEC AMT 390 P9011 $ 4,356.00 ACTIVE BLOOD TYPE ANTIGEN 30200042 302 86904 $ 196.08 ACTIVE SERUM/UNIT 30200044 BLOOD TYPING ABO 302 86900 $ 39.84 ACTIVE BLOOD TYPING- RH 30200051 302 86906 $ 103.22 ACTIVE PHENOTYPING COMPLETE 30200049 BLOOD TYPING RH-D 302 86901 $ 39.84 ACTIVE BLOOD TYPING; ANTIGEN TESTING OF DONOR BLOOD 30000037 302 86902 $ 76.20 ACTIVE USING REAGENT SERUM, EACH ANTIGEN TEST 30100060 BLOOD UREA NITROGEN 301 84520 $ 52.68 ACTIVE BLOOD UREA NITROGEN RANGE 30100398 301 84540 $ 66.72 ACTIVE (URINE) BLOOD, OCCULT; FECES, CONSECUTIVE COLLECTED 30100001 301 82270 $ 52.56 ACTIVE SPECIMENS FOR COLORECTAL CANCER SCREEN 30900016 BODY FLUID PROTEIN 309 84157 $ 48.84 ACTIVE 32000060 BONE AGE STUDIES 320 77072 $ 1,113.00 ACTIVE BONE GRAFT, ANY DONOR 36000306 360 20902 $ 28,934.84 ACTIVE AREA; MAJOR OR LARGE BONE GRAFT, ANY DONOR 36000305 AREA; MINOR OR SMALL (EG, 360 20900 $ 21,639.82 ACTIVE DOWEL OR BUTTON) 32000061 BONE LENGTH STUDIES 320 77073 $ 1,745.00 ACTIVE BONE MARROW BIOPSY 36000101 360 38220 $ 5,203.17 ACTIVE ASPIRATION BONE MARROW SMEAR 31000003 305 85097 $ 579.60 ACTIVE INTERPRETATION 27000048 BOOT CALF GARMENT SM-REG 270 L3260 $ 358.00 ACTIVE 27100021 BOOT PODOUS UNIV 271 L4396 $ 1,844.00 ACTIVE 27200906 BOWL, SOLUTION STR 32OZ 272 A4649 $ 21.45 ACTIVE 27000049 BRACE ANKLE LARGE 274 L4350 $ 314.85 ACTIVE 27000050 BRACE ANKLE MEDIUM 274 L4350 $ 304.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000051 BRACE ANKLE SMALL 274 L4350 $ 304.00 ACTIVE 27000052 BRACE ANKLE SUPPORT XLG 274 L4350 $ 517.00 ACTIVE 27000053 BRACE CLAVICLE LARGE 270 L3650 $ 56.00 ACTIVE 27000054 BRACE CLAVICLE MEDIUM 270 L3650 $ 56.00 ACTIVE 27000055 BRACE CLAVICLE SMALL 270 L3650 $ 56.00 ACTIVE 27000056 BRACE CLAVICLE X LARGE 270 L3650 $ 56.00 ACTIVE 27000057 BRACE CLAVICLE XSMALL 270 L3650 $ 50.00 ACTIVE 32000012 BRACH S&I 320 75962 $ 4,945.92 ACTIVE BRCA1 GENE FULL DUP/DEL 31200020 312 81166 $ 2,260.13 ACTIVE ALYS 31200019 BRCA1 GENE FULL SEQ ALYS 312 81165 $ 2,121.60 ACTIVE BRCA2 GENE FULL DUP/DEL 31200022 312 81167 $ 2,121.60 ACTIVE ALYS 31200021 BRCA2 GENE FULL SEQ ALYS 312 81216 $ 2,221.44 ACTIVE 36000106 BREAST CYST ASPIRATION 360 19000 $ 2,824.30 ACTIVE 25901357 BRETHINE 2.5MG TAB 250 J8499 $ 29.00 ACTIVE BREVITAL SODIUM 25000675 250 J3490 $ 716.00 ACTIVE (METHOHEXITAL) 500MG VIAL 27000583 BRIEF ADULT 270 A4520 $ 52.00 ACTIVE 27000582 BRIEF INFANT/PEDI 270 A4520 $ 52.00 ACTIVE BRONCHODILATION RESPONSIVENESS SPIROMETRY 46000010 460 94060 $ 318.24 ACTIVE PRE&POST-BRONCHODILATOR ADMIN BRUCELLA ABORTUS 30200053 302 86000 $ 93.12 ACTIVE AGGLUTININS 30200052 BRUCELLA ANTIBODY 302 86622 $ 119.04 ACTIVE 27000007 BUBBLE HUMIDIFIER 270 E0555 $ 38.10 ACTIVE 25901829 BUDESONIDE 0.5MG/2ML SUSP 250 J7634 $ 116.48 ACTIVE 25901929 BUMETANIDE 0.5MG TAB 250 J8499 $ 10.50 ACTIVE 25000005 BUMETANIDE 1MG 250 J3490 $ 8.10 ACTIVE 25200001 BUMEX 1MG TAB 250 J8499 $ 16.00 ACTIVE BUPIVACAINE (MARCAINE) 0.5% + 25000646 250 J3490 $ 68.00 ACTIVE EPI 50ML BUPIVACAINE (SENSORCAINE) 25000006 250 J3490 $ 66.00 ACTIVE MPF 0.5% 10ML SDVIAL BUPIVACAINE/DW 0.75% SPINAL 25901960 250 J3490 $ 68.00 ACTIVE 2ML AMP BUPROPION (WELLBUTRIN) ER 25901230 250 J8499 $ 78.00 ACTIVE SR 100MG TAB BUR 4.0MM BARREL 6-FLUTE 375- 27200559 272 A4649 $ 724.00 ACTIVE 941-000 BURR 4.0MM OVAL SOLID 27200910 272 A4649 $ 180.00 ACTIVE CARBIDE MEDIUM 27200666 BURR/BLADE 272 A4649 $ 678.00 ACTIVE 25900206 BUSPAR 10MG TABLET 250 J8499 $ 37.50 ACTIVE 63600153 BUTORPHANOL 1MG/1ML VIAL 636 J0595 $ 11.98 ACTIVE 36000104 C OR T ADD LEVEL 360 64472 $ 3,986.36 ACTIVE 30100061 C- PEPTIDE 301 84681 $ 277.56 ACTIVE 32000064 CA SCREEN BARIUM ENEMA 320 G0120 $ 5,209.96 ACTIVE 32000065 CALCANEOUS 2V OR MORE 320 73650 $ 888.00 ACTIVE 30100063 CALCITONIN (SERUM) 301 82308 $ 357.24 ACTIVE 30100065 CALCIUM (SERUM) 301 82310 $ 67.76 ACTIVE CALCIUM CARBONATE (TUMS) 25901167 250 J8499 $ 16.00 ACTIVE CHEW ES 750MG TAB CALCIUM CHLORIDE 10% 1G 25800096 250 J3490 $ 72.70 ACTIVE (100MG/ML) 10ML ABJT SYG Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CALCIUM GLUCONATE 10% 25800097 258 J0610 $ 25.23 ACTIVE (100MG/ML) 10ML SDVIAL 30100064 CALCIUM IONIZED 301 82330 $ 182.40 ACTIVE CALIFORNIA EQUINE 30200099 302 86651 $ 48.84 ACTIVE ENCEPHALITIS 30200061 CANCER ANTIGEN 125 302 86304 $ 277.56 ACTIVE 30200059 CANCER ANTIGEN 15-3 302 86300 $ 277.56 ACTIVE 30200062 CANCER ANTIGEN 19.9 302 86301 $ 277.56 ACTIVE 30200064 CANDIDA ANTIBODY 302 86628 $ 160.08 ACTIVE 31000004 CANDIDA DNA DIR PROBE 310 87480 $ 111.40 ACTIVE 27100020 CANNISTER SUCTION 271 A7000 $ 76.00 ACTIVE 27000635 CANNULA DISP INNER 270 A4623 $ 188.00 ACTIVE 27000692 CANNULA DISP THRD 8.5X72MM 270 A4550 $ 480.00 ACTIVE

27000693 CANNULA DISP THRD 8.5X72MM 270 A4550 $ 480.00 ACTIVE CANNULA ETCO2 ADULT 7' O2 2 27100026 271 A4615 $ 14.50 ACTIVE CO2 TUBING F 27000668 CANNULA OXYGEN NASAL 7FT 271 A4615 $ 24.00 ACTIVE 27000059 CANNULA TRACH INNER 10 270 A4623 $ 76.00 ACTIVE 27000060 CANNULA TRACH INNER 4 270 A4623 $ 76.00 ACTIVE 27000466 CANNULA TRACH INNER 6 270 A4623 $ 40.00 ACTIVE 27000061 CANNULA TRACH INNER 8 270 A4623 $ 76.00 ACTIVE 27000749 CAP, BOUF LF SB 24" BLU 270 A9270 $ 1.05 ACTIVE 25900224 CARAFATE 1 GM TABLET 250 J8499 $ 24.00 ACTIVE 30100074 CARBAMAZEPINE TOTAL 301 80156 $ 194.16 ACTIVE CARBOXYHEMOGLOBIN 30100075 301 82375 $ 164.28 ACTIVE (QUANTITATIVE) 30100080 CARCINOEMBRYONIC ANTIGEN 301 82378 $ 252.84 ACTIVE 30200065 CARDIOLIPIN ANTIBODY 302 86147 $ 128.80 ACTIVE 34100001 CARDIOLITE 1 DAY PROTOCOL 341 78461 $ 7,752.30 ACTIVE CARDIOPULMONARY 36000004 360 92950 $ 1,931.90 ACTIVE RESUSCITATION CARDIOPULMONARY 45000146 450 92950 $ 1,931.90 ACTIVE RESUSCITATION CARDIOVERSION, ELECTRICAL 48100081 CONVERSION OF ARRHYTHMIA; 481 92960 $ 3,838.12 ACTIVE EXTERNAL 25900232 CARDIZEM 30MG TABLET 250 J8499 $ 24.00 ACTIVE 25900238 CARDIZEM CD 300MG CAP 250 J8499 $ 55.20 ACTIVE 25900244 CARISOPRODOL 350MG TABLET 250 J8499 $ 14.00 ACTIVE 27200909 C-ARM DRAPE 41 X 74 INCH 272 A4649 $ 2,442.30 ACTIVE 25900245 CARMEX LIP OINT 7GM 250 A9150 $ 6.00 ACTIVE 30100076 CARNITINE 301 82379 $ 224.88 ACTIVE 30100077 CAROTENE (SERUM) 301 82380 $ 123.00 ACTIVE CAROTID ANGIOGRAM - 48100084 481 36222 $ 19,621.53 ACTIVE UNILATERAL CARPAL TUNNEL RELEASE 36000086 360 64721 $ 22,128.50 ACTIVE MEDIAN NERVE CARVEDILOL (COREG) 12.5MG 25900307 259 J8499 $ 40.00 ACTIVE TAB 27000062 CAST ARM LONG 270 Q4005 $ 140.00 ACTIVE 27000063 CAST ARM SHORT 270 Q4009 $ 68.00 ACTIVE 27000479 CAST BOOT 274 L3260 $ 1,520.00 ACTIVE 27000064 CAST LEG LONG 270 Q4041 $ 143.20 ACTIVE 27000065 CAST LEG SHORT 270 Q4045 $ 60.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000480 CAST SHOE 274 L3260 $ 500.00 ACTIVE 27000544 CAST SHOE LG 270 L3260 $ 272.00 ACTIVE CAST SPLINT ONESTP 27000066 270 A4649 $ 16.00 ACTIVE 3""""X12""" 27000067 CASTING TAPE 2IN 270 A4649 $ 14.00 ACTIVE 27000068 CASTING TAPE 3IN 270 A4649 $ 14.00 ACTIVE 27000069 CASTING TAPE 4IN 270 A4649 $ 14.00 ACTIVE 27000070 CASTING TAPE 5IN 270 A4649 $ 14.00 ACTIVE CATECHOLAMINES BLOOD 30100078 301 82384 $ 193.20 ACTIVE FRACTION CATECHOLAMINES TOTAL 30100079 301 82382 $ 327.60 ACTIVE (URINE) CATH 1.5 MM 120MM 150CM 014 27200739 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 1.5 MM 40MM 150CM 014 27200718 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 1.5MM 20MM 150CM 014 27200717 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2 MM 120MM 150CM 014 27200719 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2 MM 150MM 150CM 014 27200720 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2 MM 220MM 150CM 014 27200721 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2 MM 40MM 150CM 014 PTA 27200722 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 2 MM 80MM 150CM 014 PTA 27200723 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 2.5 MM 120MM 150CM 014 27200724 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2.5 MM 150MM 150CM 014 27200725 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2.5 MM 150MM 220CM 014 27200726 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2.5 MM 40MM 220CM 014 27200727 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 2.5 MM 80MM 220CM 014 27200728 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3 MM 120MM 220CM 014 27200729 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3 MM 150MM 220CM 014 27200730 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3 MM 220MM 220CM 014 27200731 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3 MM 40MM 220CM 014 PTA 27200732 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 3 MM 80MM 220CM 014 PTA 27200733 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 3.5 MM 120MM 220CM 014 27200734 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3.5 MM 40MM 220CM 014 27200735 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 3.5 MM 80MM 220CM 014 27200736 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION CATH 4 MM 40MM 120CM 014 PTA 27200738 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 4 MM 80MM 120CM 014 PTA 27200737 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 4 MM 80MM 120CM 014 PTA 27200740 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 5 MM 120MM 120CM 014 27200741 272 C1726 $ 1,890.00 ACTIVE PTA DILATATION Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CATH 5 MM 40MM 120CM 014 PTA 27200742 272 C1726 $ 1,890.00 ACTIVE DILATATION CATH 5 MM 80MM 120CM 014 PTA 27200743 272 C1726 $ 1,890.00 ACTIVE DILATATION 27000074 CATH ALL PURPOSE 16FR 272 A4338 $ 16.00 ACTIVE 27000071 CATH ALL PURPOSE 8FR 272 A4351 $ 16.00 ACTIVE 27000072 CATH ALL PURPOSE-10FR 272 A4351 $ 16.00 ACTIVE 27000073 CATH ALL PURPOSE-12FR 272 A4351 $ 16.00 ACTIVE 27000126 CATH ALL PURPOSE-14FR 272 A4351 $ 112.00 ACTIVE 27000075 CATH ALL PURPOSE-18FR 272 A4351 $ 16.00 ACTIVE 27000076 CATH ALL PURPOSE-20FR 272 A4351 $ 16.00 ACTIVE 27000077 CATH ALL PURPOSE-22FR 272 A4351 $ 16.00 ACTIVE 27000078 CATH ALL PURPOSE-24FR 272 A4351 $ 16.00 ACTIVE 27000079 CATH ALL PURPOSE-26FR 272 A4351 $ 16.00 ACTIVE 27000080 CATH ALL PURPOSE-28FR 272 A4351 $ 16.00 ACTIVE 27000081 CATH ALL PURPOSE-30FR 272 A4351 $ 16.00 ACTIVE 27000082 CATH ALL PURPOSE-32FR 272 A4351 $ 16.00 ACTIVE 27200675 CATH ARMADA 14 272 C1726 $ 1,804.00 ACTIVE 27200697 CATH ARTERIAL 272 A4301 $ 152.00 ACTIVE 27900023 CATH ASPIRATION 272 C1757 $ 1,450.00 ACTIVE 27800035 CATH BALLOON PEG 272 C1726 $ 650.00 ACTIVE 27900030 CATH BERN 272 C1725 $ 1,356.00 ACTIVE 27200588 CATH BRONCHO ANY SIZE 272 C1725 $ 608.00 ACTIVE 27000481 CATH CHOLANGIGRAM 272 C1726 $ 550.00 ACTIVE 27000083 CATH CHOLANGIO LAP 272 A4338 $ 30.00 ACTIVE 27900036 CATH CROSSER 272 C1725 $ 1,400.00 ACTIVE 27900014 CATH DIAGNOSTIC 272 C1887 $ 678.00 ACTIVE CATH EMBOLECTOMY WITH 27900048 272 C1757 $ 837.00 ACTIVE INFLATION PORT 5.5FR 80CM T 27000523 CATH EXTERNAL MALE ALL 270 A4326 $ 52.00 ACTIVE 27200897 CATH F4 INF 3DRC 100CM 272 A4351 $ 57.00 ACTIVE 27200896 CATH F4 INF IM 100CM 272 A4351 $ 57.00 ACTIVE 27200895 CATH F4 INF JL 4 100CM 272 A4351 $ 57.00 ACTIVE 27200889 CATH F4 INF JR 4 100CM 272 A4351 $ 57.00 ACTIVE 27000084 CATH FEMALE KIT 272 A4311 $ 34.00 ACTIVE 27000482 CATH FEMALE SPEED 272 A4353 $ 100.00 ACTIVE 27000085 CATH FILIFORM 272 A4351 $ 30.00 ACTIVE 27000086 CATH FOLEY 18FR 5CC COUDE 272 A4338 $ 42.00 ACTIVE 27000087 CATH FOLEY 2 W 10FR 272 A4338 $ 56.00 ACTIVE 27000095 CATH FOLEY 2 W 18FR 30CC 272 A4338 $ 56.00 ACTIVE 27000099 CATH FOLEY 2 W 22FR 30CC 272 A4338 $ 56.00 ACTIVE 27000110 CATH FOLEY 22FR 30CC COUDE 272 A4338 $ 62.00 ACTIVE 27000088 CATH FOLEY 2-W-12FR 270 A4338 $ 16.00 ACTIVE 27000089 CATH FOLEY 2-W-12FR30CC 272 A4338 $ 62.00 ACTIVE 27000091 CATH FOLEY 2-W-14FR30CC 272 A4338 $ 56.00 ACTIVE 27000093 CATH FOLEY 2-W-16FR30CC 272 A4338 $ 56.00 ACTIVE 27000097 CATH FOLEY 2-W-20FR30CC 272 A4338 $ 56.00 ACTIVE 27000101 CATH FOLEY 2-W-24FR30CC 272 A4338 $ 56.00 ACTIVE 27000103 CATH FOLEY 2-W-26FR30CC 272 A4338 $ 56.00 ACTIVE 27000105 CATH FOLEY 2-W-28FR30CC 272 A4338 $ 56.00 ACTIVE 27000107 CATH FOLEY 2-W-30FR30CC 272 A4338 $ 56.00 ACTIVE 27000109 CATH FOLEY 2-W-32FR30CC 272 A4338 $ 56.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000115 CATH FOLEY 3 W 24FR 30CC 272 A4346 $ 96.00 ACTIVE 27000111 CATH FOLEY 3-W-16FR30CC 272 A4346 $ 96.00 ACTIVE 27000112 CATH FOLEY 3-W-18FR30CC 272 A4346 $ 96.00 ACTIVE 27000113 CATH FOLEY 3-W-20FR30CC 272 A4346 $ 96.00 ACTIVE 27000114 CATH FOLEY 3-W-22FR30CC 272 A4346 $ 96.00 ACTIVE 27000116 CATH FOLEY 3-W-26FR30CC 272 A4346 $ 96.00 ACTIVE 27000117 CATH FOLEY COUDE 24-5 272 A4346 $ 86.00 ACTIVE 27000118 CATH FOLEY TRAY 16FR 272 A4311 $ 63.00 ACTIVE 27000119 CATH FOLEY TRAY 18FR 272 A4311 $ 64.00 ACTIVE 27200027 CATH FRONTRUNNER XP 272 C2628 $ 8,982.82 ACTIVE 27000120 CATH INFANT KIT 270 A4311 $ 52.00 ACTIVE 27000121 CATH KIT FLEX-TIP EPI 270 A4649 $ 72.00 ACTIVE 27200219 CATH LIBERTE MONORAIL ALL 272 C1725 $ 1,890.00 ACTIVE 27200028 CATH MICROGUIDE XP 272 C1887 $ 674.00 ACTIVE 27200685 CATH MPA ALL SIZES 272 A4340 $ 186.50 ACTIVE 27200029 CATH PACK 272 A4649 $ 430.00 ACTIVE 27200225 CATH PERITONEAL DIAL 272 C1752 $ 312.34 ACTIVE CATH PLACEMENT IN MAMERY 48100094 481 36216 $ 63,246.86 ACTIVE (FOR IM ANGIO) CATH PLACEMENT IN 48100095 481 36215 $ 53,874.98 ACTIVE SUBCLAVIAN 48100001 CATH PLACEMENT W/O LHC 481 93508 $ 24,040.52 ACTIVE CATH PLACMENT NOS SEL 48100096 AORTA - 481 36221 $ 19,623.53 ACTIVE CAROTID,VERTEBRAL,ANGIO 27200226 CATH PROTECTIVE 8.0MM 272 A4649 $ 16.00 ACTIVE 27000483 CATH RACZ KIT& NEEDLE 270 A4649 $ 300.00 ACTIVE 27000124 CATH RED LATEX 22FR 272 A4351 $ 92.00 ACTIVE 27000125 CATH RED LATEX 24FR 272 A4351 $ 92.00 ACTIVE 27900016 CATH SLIP BEACON 272 A4351 $ 69.00 ACTIVE 27000484 CATH STRAIGHT 270 A4649 $ 484.00 ACTIVE 27000559 CATH SUCTION 270 A4628 $ 52.00 ACTIVE 27200228 CATH SUPRA PUBIC 272 C2627 $ 225.40 ACTIVE 27200659 CATH TERUMO 272 C1887 $ 1,674.00 ACTIVE 27000129 CATH VENOUS 272 A4301 $ 152.00 ACTIVE 27000130 CATH WHISTLE TIP 26FR 272 A4351 $ 106.00 ACTIVE 27000131 CATH WHISTLE TIP 28FR 272 A4351 $ 106.00 ACTIVE 27000132 CATH WHISTLE TIP 30FR 272 A4351 $ 106.00 ACTIVE 27000133 CATH WHISTLE TIP 32FR 272 A4351 $ 106.00 ACTIVE 27000128 CATH, PVC W/TROCAR 14FR 270 A4338 $ 428.00 ACTIVE 27200888 CATH4F INF PIG 145 MOD 110CM 272 A4351 $ 147.00 ACTIVE CATHETER ASPIRATION (SEPARATE PROCEDURE); 36000195 360 31720 $ 719.38 ACTIVE NASOTRACHEAL CLEARANCE OF AIRWAYS 27200250 CATHETER BALLOON 5837 272 C1726 $ 2,080.00 ACTIVE 27200791 CATHETER DIALYSIS 272 C1752 $ 8,372.00 ACTIVE 27000486 CATHETER EPIDURL SET 272 A4550 $ 75.00 ACTIVE CATHETER FLEX SINUS GUIDE 27800741 272 C1887 $ 1,266.00 ACTIVE GC000 CATHETER FLEX SINUS GUIDE 27800742 272 C1887 $ 1,266.00 ACTIVE GC070 CATHETER FLEX SINUS GUIDE 27800740 272 C1887 $ 1,266.00 ACTIVE GC110RF Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CATHETER FOLEY (NO LATEX) 27000134 272 A4351 $ 106.00 ACTIVE 16FR CATHETER GASTRIC BALLOON 27200251 272 C1726 $ 1,443.96 ACTIVE SUCTION B2020 CATHETER GUIDE-6F GUIDING 27200918 272 C1887 $ 1,485.00 ACTIVE CATHETER 100CM, XBLAD3.5 SH CATHETER IV PROTECT PLUS 27200916 272 C1725 $ 29.85 ACTIVE 20GX1IN 27200249 CATHETER MULTILUMEN 272 A4649 $ 56.00 ACTIVE CATHETER PLACEMENT - 48100088 481 36245 $ 78,551.82 ACTIVE ABDOMINAL AORTAGRAM CATHETER SOLO PRO SINUS 27800739 272 C1887 $ 1,748.00 ACTIVE BALLOON BC0516SP 27000762 CATHETER SUCTION 10FR 272 A4624 $ 14.00 ACTIVE 27000465 CATHETER SUCTION 12FR 272 A4624 $ 14.00 ACTIVE CATHETER SUCTION 18FR 27000136 272 A4624 $ 16.00 ACTIVE (10846) 27000660 CATHETER SUCTION INLINE 272 A4624 $ 15.00 ACTIVE 27200833 CATHETER SUCTION PEDI 272 A4624 $ 24.00 ACTIVE CATHETER URETETAL WHISTEL 27000579 270 A4353 $ 360.00 ACTIVE TIP CATHETER, ELECTROPHYSIOLOGY, 27200847 272 C1732 $ 39,660.00 ACTIVE DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING CATHETER, TRANSLUMINAL 27200050 272 C1724 $ 69,000.00 ACTIVE ATHERECTOMY, ROTATIONAL 27000743 CAUTERY TUBE PEN 270 A4649 $ 135.00 ACTIVE 30500085 CD 4 COUNT 302 86361 $ 99.18 ACTIVE 30100625 C-DIFF DNA (CDIFF BY PCR) 306 87493 $ 129.99 ACTIVE 25000873 CEFOTETAN 2 GRAM 250 S0074 $ 172.00 ACTIVE 25900253 CEFTIN 250MG TABLET 250 J8499 $ 46.00 ACTIVE 25900259 CELEXA 20MG TAB 250 J8499 $ 45.00 ACTIVE CELL COUNT MISCELLANEOUS 30900001 309 89051 $ 73.44 ACTIVE FLUID (NO BLOOD) 30900021 CELL SEPARATION 302 86972 $ 79.50 ACTIVE 25901947 CEPHALEXIN 125MG 5ML OS 250 J3490 $ 18.00 ACTIVE 25900262 CEPHALEXIN 250MG CAPSULE 259 J8499 $ 18.00 ACTIVE 25900263 CEPHALEXIN 500MG CAP 259 J8499 $ 54.00 ACTIVE 32000066 CEPHALOGRAM ORTHODONTIC 320 70350 $ 478.80 ACTIVE 30100082 CERULOPLASMIN 301 82390 $ 143.16 ACTIVE 32000063 CERV SPINE (6+V) 4V & FLEX/EXT 320 72052 $ 2,687.00 ACTIVE 32000186 CERV SPINE 2-3 VIEWS 320 72040 $ 1,591.50 ACTIVE 32000062 CERV SPINE 4-5 VIEWS 320 72050 $ 2,140.00 ACTIVE 27000137 CERVICAL COLLAR (MED) (16244) 274 L0120 $ 66.00 ACTIVE 27000138 CERVICAL COLLAR LG 274 L0120 $ 152.00 ACTIVE 27400001 CERVICAL COLLAR SM 270 L0120 $ 12.44 ACTIVE 27000139 CERVICAL COLLAR XL 274 L0120 $ 176.00 ACTIVE 27000140 CERVICAL COLLAR XTR SMALL 274 L0120 $ 124.00 ACTIVE

CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP 27000778 270 L0150 $ 294.21 ACTIVE (PLASTIC COLLAR WITH MANDIBULAR/OCCIPITAL PIECE) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CHANGE PRQ TUBE/DRG CATH 32000014 320 75984 $ 1,070.36 ACTIVE C+MNTR RS&I 25900268 CHAR. W/SORBITOL 25GM L 250 J3490 $ 280.00 ACTIVE 25900269 CHARCOAL ACTIVATED 25GM 250 J3490 $ 156.00 ACTIVE 42000014 CHECKOUT ORTHOTIC 15M 450 97762 $ 218.40 ACTIVE 30100083 CHEMILUMINESCENT 301 82397 $ 188.28 ACTIVE 32400010 CHEST 1 VIEW 320 71045 $ 1,078.50 ACTIVE 32000234 CHEST 2 VIEW 320 71046 $ 1,471.50 ACTIVE 32400011 CHEST 2V W AP LORDOTIC 324 71047 $ 1,882.00 ACTIVE CHEST 2V W 32400012 324 71048 $ 2,004.00 ACTIVE OBLIQUES(TOTAL4V) CHEST TUBE EVACUATION 27000141 270 A7041 $ 424.00 ACTIVE SYSTEM (THORACLEX) 27000142 CHEST TUBE STRAIGHT 24FR 270 A7041 $ 70.00 ACTIVE 27000143 CHEST TUBE STRAIGHT 28FR 270 A7041 $ 70.00 ACTIVE 27000144 CHEST TUBE STRAIGHT 32FR 270 A7041 $ 70.00 ACTIVE 27000145 CHEST TUBE STRAIGHT 36FR 270 A7041 $ 70.00 ACTIVE CHLAMYDIA IMMUNOGLOBIN-G 30200072 302 86631 $ 157.68 ACTIVE ANTIBODY CHLAMYDIA IMMUNOGLOBIN-M 30200073 302 86632 $ 169.08 ACTIVE ANTIBODY CHLAMYDIA TRACHOMATIS 30600007 306 87491 $ 126.00 ACTIVE DIRECT DNA PROBE 27200863 CHLORAPREP 3ML WITH TINT 272 A4248 $ 16.05 ACTIVE 25900271 CHLORASEPTIC SPRAY 45ML 250 J3490 $ 54.00 ACTIVE CHLORDIAZ/CLIDIN.BROMIDE 25901373 250 J8499 $ 30.00 ACTIVE CAP 25900275 CHLORDIAZEPOXIDE10MG CAPS 250 J8499 $ 8.00 ACTIVE 30100085 CHLORIDE 301 82435 $ 61.32 ACTIVE 30100084 CHLORIDE 24HR URINE 301 82436 $ 69.00 ACTIVE 30100086 CHLORIDE BODY FLUID 301 82438 $ 65.16 ACTIVE 25000018 CHLORPROMAZINE 25MG/1ML 636 J3230 $ 70.95 ACTIVE 36000019 CHNG PRQ BILIARY DRG CATH 360 47525 $ 7,676.48 ACTIVE CHOLANGIO&/OR 32000068 320 74300 $ 2,242.00 ACTIVE PANCREATGRM 32000069 CHOLANGIOGRAM T-TUBE 320 74305 $ 2,638.00 ACTIVE CHOLANGIOGRAPHY PERQ 32000015 320 74320 $ 4,468.00 ACTIVE TRANSHEPA 32000071 CHOLECYSTOGRAPHY ORAL 320 74290 $ 1,121.82 ACTIVE CHOLESCINITRAPHY 34100003 341 78223 $ 3,769.78 ACTIVE W/KENEVAC DEL 30100092 CHOLINESTERASE SERUM 301 82480 $ 105.00 ACTIVE 30100093 CHOLYLGLYCINE 301 82240 $ 354.36 ACTIVE CHROMATOGRAPHY 30100094 301 82491 $ 209.30 ACTIVE QUANTITATIVE COLUMN CHROMOSOME ANALYSIS 20-25 31100001 311 88264 $ 1,062.60 ACTIVE CELLS 31100002 CHROMOSOME COUNT 5 CELLS 311 88261 $ 2,221.80 ACTIVE 30600102 CHYLMD TRACH DNA QUANT 306 87492 $ 160.41 ACTIVE 30600111 CHYLMD TRCH DIR PROBE DNA 306 87490 $ 74.28 ACTIVE 32000072 CINE/VIDEO 320 76120 $ 1,402.10 ACTIVE 32000073 CINE/VIDEO COMPLEMENT 320 76125 $ 680.40 ACTIVE 25900281 CIPRODEX 0.3%/1% 7.5ML OTIC 250 J7342 $ 928.00 ACTIVE 25900282 CIPROFLOXACIN 250MG TAB 250 J8499 $ 102.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CIPROFLOXACIN 400MG 200ML 25000277 636 J0744 $ 3,826.00 ACTIVE IVFL 25900283 CIPROFLOXACIN 500MG TAB 259 J8499 $ 96.00 ACTIVE 25900493 CIPROFLOXACIN OTIC 0.3%/5ML 250 J3490 $ 68.13 ACTIVE 27000653 CIRCUIT BIPAP 270 A4618 $ 372.00 ACTIVE CIRCUITS ANESTHESIA 27200814 272 A4618 $ 468.00 ACTIVE BREATHING CIRCUMCISION SURG EXCISION OTHER THAN CLAMP DEVICE OR 36000072 360 54161 $ 10,306.50 ACTIVE DORSAL SLIT > THAN 28 DAYS OLD CITALOPRAM (ESCITALOPRAM) 25900664 259 J8499 $ 56.00 ACTIVE 10MG TAB 30100095 CITRATE 301 82507 $ 370.68 ACTIVE 25900286 CITRATE OF MAGNESIA 300ML 250 J3490 $ 69.00 ACTIVE 25900289 CLARITIN 10MG TABLET 250 J8499 $ 60.00 ACTIVE CLARITIN ELIXIR 5MG/5ML PER 25901379 250 J3490 $ 16.00 ACTIVE 5ML 32000074 CLAVICLE COMPLETE 320 73000 $ 1,334.00 ACTIVE CLEANSER WOUND/SKIN 27000595 270 A6260 $ 156.00 ACTIVE CARRAKLENZ 25901938 CLEOCIN 600MG/50ML IV 250 J3490 $ 30.00 ACTIVE 25000019 CLEOCIN 900MG 50ML IV 250 J3490 $ 32.55 ACTIVE 25000020 CLEOCIN 900MG 6ML SDVIAL 250 J3490 $ 10.50 ACTIVE CLEOCIN ADDV 900MG 6ML 25000021 250 J3490 $ 10.50 ACTIVE SDVIAL CLINDAMYCIN (CLEOCIN) 150MG 25900292 259 J8499 $ 60.00 ACTIVE CAP CLINDAMYCIN (CLEOCIN) ADDV 25000022 250 J3490 $ 15.80 ACTIVE 600MG 4ML SDVIAL 25000023 CLINDAMYCIN 300MG/2ML VIAL 250 J3490 $ 28.50 ACTIVE

25901945 CLINDAMYCIN 600MG 50ML IV FL 259 J3490 $ 34.88 ACTIVE 25000024 CLINDAMYCIN 600MG/4ML 250 J3490 $ 19.20 ACTIVE 25000025 CLINDAMYCIN 900MG/6ML 250 J3490 $ 32.55 ACTIVE CLONAZEPAM (KLONOPIN) 25900626 259 J8499 $ 24.00 ACTIVE 0.5MG TAB CLONAZEPAM (KLONOPIN) 1MG 25900627 250 J8499 $ 24.00 ACTIVE TAB 25900297 CLONIDINE 0.1MG TAB 259 J8499 $ 50.48 ACTIVE CLOPIDOGREL (PLAVIX) 75MG 25900917 250 G9531 $ 99.00 ACTIVE TAB CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, 45000154 450 26755 $ 13,363.50 ACTIVE FINGER OR THUMB; WITH MANIPULATION, EACH CLOSED TREATMENT OF FX, PHALANX/GES, OTHER THAN 36000316 360 28510 $ 6,192.00 ACTIVE GREAT TOE; W/O MANIPULATION, EA CLOSED TREATMENT OF 45000062 PATELLAR DISLOCATION 450 27560 $ 17,401.50 ACTIVE WITHOUT ANESTHESIA CLOSED TREATMENT OF RADIAL 45000090 450 25500 $ 4,233.60 ACTIVE SHAFT FX; W/O MANIPULATION Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CLOSED TREATMENT, 45000140 METACARPAL FX, SINGLE; W/ 450 26605 $ 8,217.00 ACTIVE MANIPULATION, EACH BONE CLOSED TX OF DISTAL ANKLE 45000094 450 27788 $ 19,764.00 ACTIVE FX; W/ MANIPULATION CLOSED TX OF DISTAL ANKLE 45000095 450 27786 $ 14,688.00 ACTIVE FX; W/O MANIPULATION CLOSED TX OF FINGER 45000126 DISLOCATION, SINGLE, W/ MANIP 450 26775 $ 17,766.00 ACTIVE W/ ANES CLOSED TX OF FINGER JOINT 45000102 DISLOCATION SINGLE W/MANP & 450 26770 $ 13,086.00 ACTIVE W/O ANESTHESIA CLOSED TX OF FX, PHALANX/PHALANGES, OTHER 45000091 450 28510 $ 9,192.00 ACTIVE THAN GREAT TOE; W/O MANIP, EA CLOSED TX OF RADIAL SHAFT 45000134 450 25505 $ 23,399.50 ACTIVE FRACTURE; W/MANIPULATION CLOSED TX PHALANGEAL SHAFT FX PROXIMAL/MIDDLE PHALANX, 45000093 FINGER/THUMB; W/MAN W/OR 450 26725 $ 15,588.00 ACTIVE W/O SKIN/SKELETAL TRACTION; EA CLOSED TX SHOULDER 45000103 DISLOCATION W/MANP W 450 23655 $ 20,736.00 ACTIVE ANESTHESIA CLOSED TX SHOULDER 45000104 DISLOCATION W/MANP W/O 450 23650 $ 14,832.00 ACTIVE ANESTHESIA CLOSED TXOF FX, PHALANX/PHALANGES, OTHER 45000114 450 28515 $ 7,344.00 ACTIVE THAN GREAT TOE; W/ MANIPULATION, EACH CLOSTRIDIUM DIFFICILE TOXIN 30600005 306 87324 $ 159.84 ACTIVE ENZYME IMMUNOASSAY CLOSURE DEVICE VASCULAR 27200031 272 C1760 $ 10,000.00 ACTIVE ALL CLOT INHIBING PROTEIN C 30500013 305 85303 $ 184.44 ACTIVE ACTIVITY CLOT INHIBITING ANTITHROMBIN 30500012 305 85300 $ 158.04 ACTIVE III CLOTH, SURGICAL SCRUB 2% 27000758 270 A4248 $ 38.70 ACTIVE CHLORAHEXADINE 30500014 CLOTTING FACTOR V 305 85220 $ 235.32 ACTIVE 30500015 CLOTTING FACTOR VII 305 85230 $ 238.68 ACTIVE 30500009 CLOTTING FACTOR VIII 305 85245 $ 305.88 ACTIVE 30500016 CLOTTING FACTOR VIII ANTIGEN 305 85244 $ 272.28 ACTIVE

CLOTTING FACTOR VIII VON 30500019 305 85246 $ 305.88 ACTIVE WILLEBRAND FACTOR ANTIGEN CLOTTING FACTOR VIII VON 30500010 305 85247 $ 305.88 ACTIVE WILLEBRAND FACTOR MX 30500011 CLOTTING FACTOR XIII 305 85290 $ 217.80 ACTIVE 30100585 CMV QUANT DNA PCR (PLASMA) 306 87497 $ 158.64 ACTIVE 46000003 CO DIFFUSING CAPACITY 460 94720 $ 676.20 ACTIVE 30100100 CO2 (BICARBONATE) 301 82374 $ 65.16 ACTIVE 30500082 COAG TIME OTHER METHODS 305 85348 $ 53.88 ACTIVE 30100101 COCAINE QUANTITATIVE 301 80353 $ 201.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30200074 COCCIDIOIDES ANTIBODY 302 86635 $ 153.00 ACTIVE COCKUP WRIST/FOREARM 27000146 270 L3908 $ 348.00 ACTIVE LARGE 42000015 COGN SKILLS DEV 420 97127 $ 247.66 ACTIVE 27000002 COIL PUSHER 16 270 A4649 $ 42.00 ACTIVE COL CHROMOTOGRAPHY 30100220 301 82542 $ 289.08 ACTIVE QUAL/QUAN 30200075 COLD AGGLUTININS TITER 302 86157 $ 107.52 ACTIVE 27000147 COLLAR CERV MED 270 L0120 $ 28.00 ACTIVE 27000148 COLLAR CERVCL LG SERPENT 270 L0120 $ 92.00 ACTIVE 27000149 COLLAR PLASTIC LG 270 L0120 $ 86.00 ACTIVE 27000150 COLLAR PLASTIC MED 270 L0120 $ 86.00 ACTIVE 27000488 COLLAR SOFTIZE 274 L0120 $ 98.85 ACTIVE COLLECTION BLOOD SPECIMEN 30000048 300 36416 $ 30.00 ACTIVE (EG,FINGER,HEEL,EAR STICK) COLLECTOR, SPECIMEN 27000752 270 A4649 $ 8.70 ACTIVE COMMODE WHT 27OZ COLLECTOR, SPECIMEN 27000751 270 A4649 $ 53.25 ACTIVE POLP/STONE 27000151 COLLR CERV MED SERPENTINE 270 L0120 $ 92.00 ACTIVE 32000075 COLON BARIUM ENEMA W/AIR 320 74280 $ 9,652.00 ACTIVE COLONOSCOPY FLEX; W/REM OF 36000295 TUMOR/POLYP/LESION BY 360 45385 $ 7,128.90 ACTIVE SNARE TECHNIQUE COLONOSCOPY FLEXIBLE DIAGNOSTIC INC COLLECTION 45000060 360 45378 $ 9,861.00 ACTIVE OF SPECIMEN BY BRUSHING/WASHING 75000004 COLONOSCOPY WITH BIOPSY 360 45380 $ 10,698.50 ACTIVE COLONOSCOPY, FLEX; 36000303 W/DIRECTED SUBMUCOSAL INJ 360 45381 $ 10,189.00 ACTIVE ANY SUBSTANCE COLORECTAL CANCER SCREEN 36000344 ON INDIVIDUAL NOT MEETING 360 G0121 $ 9,428.50 ACTIVE CRITERIA FOR HIGH RISK COLORECTAL CANCER 36000350 SCREENING; COLONOSCOPY ON 360 G0105 $ 9,414.00 ACTIVE INDIVIDUAL AT HIGH RISK COLORECTAL CANCER 36000351 SCREENING; FLEXIBLE 360 G0104 $ 2,832.00 ACTIVE SIGMOIDOSCOPY 32000076 COMB ENDO CATH BILI/PANC 320 74330 $ 2,809.60 ACTIVE COMPATABILITY TEST EACH 30200077 UNIT USING THE ANTIGLOBULIN 302 86922 $ 219.96 ACTIVE TECHNIQUE COMPATIBILITY TEST EACH 30200281 302 86923 $ 2,270.00 ACTIVE UNIT; ELECTRONIC 25900304 COMPAZINE 10MG TAB 250 J8499 $ 41.40 ACTIVE COMPLEMENT COMPONENT 30100433 302 86162 $ 193.20 ACTIVE TOTAL (CH50) COMPLEMENT; ANTIGEN, EACH 30200058 COMPONENT, C 2-5 OR FACTOR 302 86160 $ 159.96 ACTIVE B COMPLETE ACUTE ABDOMEN SERIES, INC SUPINE, ERECT, 32000050 320 74022 $ 2,106.50 ACTIVE AND/OR DECUBITUS VIEWS, SINGLE VIEW CHEST Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS COMPLETE BLOOD COUNT WITH 30500008 AUTOMATED DIFFERENTIAL 305 85025 $ 103.56 ACTIVE (CBC) 30200076 COMPLETE EACH INCUBATION 302 86921 $ 149.96 ACTIVE COMPREHENSIVE METABOLIC 30100104 301 80053 $ 140.88 ACTIVE PANEL (CMP) 27000573 COMPRES HOT/COLD 270 A9273 $ 12.45 ACTIVE COMPUTER MAMMOGRAM 40100001 401 77052 $ 426.50 ACTIVE COMPUTER A CONCENTRATION (ANY TYPE) OF 30600008 306 87015 $ 89.04 ACTIVE INFECTIOUS AGENTS 27000152 CONNECTING TUBE NEPH DRAIN 270 A7048 $ 74.00 ACTIVE CONNECTOR 5 IN 1 TUBING 27000153 270 A4649 $ 16.00 ACTIVE (10806) 27200256 CONNECTOR FLEX 272 A4649 $ 56.00 ACTIVE 27200257 CONNECTOR OXY SUPPLY TU 272 A4649 $ 56.00 ACTIVE CONTAINER SPECIMEN 27000154 270 A4649 $ 16.00 ACTIVE MUSCOUS 40C (15426) CONTINUOUS BREATHING 41000026 410 94644 $ 506.80 ACTIVE TREATMENT 1ST HOUR CONTINUOUS BREATHING 41000027 410 94645 $ 304.08 ACTIVE TREATMENT EACH ADD'L HOUR 42000016 CONTRAST BATHS EA 15 450 97034 $ 201.62 ACTIVE CONTROL NASAL HEMORRHAGE 45000151 ANTERIOR COMPLEX ANY 450 30903 $ 810.96 ACTIVE METHOD CONTROL NASAL HEMORRHAGE POSTERIOR W/NASAL PACKS 45000065 450 30905 $ 300.00 ACTIVE AND/OR CAUTERY ANY METHOD INITIAL

CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED 45000105 450 30901 $ 2,916.00 ACTIVE CAUTERY AND/OR PACKING) ANY METHOD CONVERTORS UNDER- 27000759 270 A4649 $ 13.00 ACTIVE BUTTOCKS DRAPES 30100105 COPPER 301 82525 $ 165.48 ACTIVE CORDIS CYPHER STENT 27200040 COATED/COVERED W/DELIVERY 272 C1874 $ 32,000.00 ACTIVE SYST 3.0 X 18 CXS18300 25900308 COREG 25MG TABLETS 250 J8499 $ 40.00 ACTIVE 25900309 COREG 3.125 MG TAB 259 J8499 $ 37.50 ACTIVE 25900311 COREG 6.25MG TAB 250 J8499 $ 27.00 ACTIVE CORONARY ANGIOGRAM ONLY 48100066 481 93454 $ 74,005.50 ACTIVE (NO VALVE CROSS) CORONARY SVG (BYPASS 48100067 481 93455 $ 81,353.50 ACTIVE GRAFT) W IMA ANGIO CORRECTION HALLUX VALGUS(BUNIONECTOMY) 36000150 W/SESAMOIDECTOMY/RESECTIO 360 28292 $ 25,273.50 ACTIVE N OF PROXIMAL PHALANX BASE WHEN PERFORMED CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, 36000311 360 28285 $ 18,864.00 ACTIVE PARTIAL OR TOTAL PHALANGECTOMY) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30100106 CORTISOL FREE (URINE) 301 82530 $ 222.84 ACTIVE 30100107 CORTISOL TOTAL 301 82533 $ 217.32 ACTIVE 25900324 COUMADIN 1MG TABLET 250 J8499 $ 24.00 ACTIVE COVER, MAYO STAND REINF 23" 27200893 272 A4649 $ 13.00 ACTIVE X54" COVER, TABLE STD RE-INF STR 27200894 272 A4649 $ 19.00 ACTIVE 44X90 30200089 COXSACKIE TYPE A ANTIBODY 302 86658 $ 173.64 ACTIVE 25200076 COZAAR 100MG TAB 252 J8499 $ 32.00 ACTIVE 25901391 COZAAR 25MG TAB 250 J8499 $ 30.00 ACTIVE 25900331 COZAAR 50MG TAB 250 J8499 $ 40.00 ACTIVE CPAP/BIPAP INITIATION AND 41000003 410 94660 $ 969.10 ACTIVE MANAGEMENT 41000005 CPT INITIAL 410 94667 $ 750.00 ACTIVE 41000020 CPT SUBQ 410 94668 $ 506.80 ACTIVE 27200699 CRADLE ARM LAMINECTOMY 272 E0190 $ 226.00 ACTIVE CRE ESOPHAGEAL DILATATION 27200642 272 C1726 $ 6,435.00 ACTIVE BALLOON 30200054 C-REACTIVE PROTEIN 302 86140 $ 69.00 ACTIVE C-REACTIVE PROTEIN HIGH 30200056 302 86141 $ 172.68 ACTIVE SENSITIVITY 30100111 CREATINE 301 82540 $ 61.80 ACTIVE 30100112 CREATINE CLEARANCE 301 82575 $ 126.12 ACTIVE 30100096 CREATINE KINASE TOTAL 301 82550 $ 86.76 ACTIVE 30100097 CREATINE KINASE-MB TRIAGE 301 82553 $ 153.96 ACTIVE CREATINE PHOSPHOKINASE 30100109 301 82552 $ 178.56 ACTIVE ISOENZYME (CK MB) 30100116 CREATININE (FLUID) 301 82570 $ 69.00 ACTIVE 30100113 CREATININE BLOOD 301 82565 $ 68.28 ACTIVE CRITICAL CARE E/M FIRST 30- 45000081 450 99291 $ 5,152.44 ACTIVE 74MINS 30200091 CROSS MATCH EACH UNIT (SPIN) 302 86920 $ 219.96 ACTIVE CRUTCHES LARGE UNDERARM 27000324 OTHER THAN WOOD 271 E0114 $ 285.00 ACTIVE ADJUSTABLE CRUTCHES PEDI (CHILD) 27000326 271 E0114 $ 285.00 ACTIVE STANDARD CRUTCHES SMALL UNDERARM 27000325 OTHER THAN WOOD 271 E0114 $ 285.00 ACTIVE ADJUSTABLE CRUTCHES STANDARD MEDIUM 27300001 271 E0114 $ 350.00 ACTIVE SIZE PAIR 30100120 CRYOGLOBULIN (QUALITATIVE) 301 82595 $ 86.16 ACTIVE 39000002 CRYOPRECIPITATE EACH UNIT 390 P9012 $ 547.40 ACTIVE 30600010 CRYPTOSPORIDIUM ANTIGEN 306 87272 $ 159.84 ACTIVE CRYSTAL IDENTIFICATION ANY 30900003 309 89060 $ 95.40 ACTIVE FLUID (NO URINALYSIS) CT 3D RENDER W/O POST 35000002 350 76377 $ 3,088.50 ACTIVE PROCESS CT 3D RENDER W/POST 35000003 350 76376 $ 1,096.50 ACTIVE PROCESS CT ABD & PELVIS W AND W/O 35200034 352 74178 $ 16,931.50 ACTIVE CONTRAST 35200033 CT ABD & PELVIS W/CONTRAST 352 74177 $ 14,962.50 ACTIVE 35200002 CT ABD W/O - W/CONTRAST 352 74170 $ 12,582.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 35200031 CT ABD/PELVIS W/O CONTRAST 352 74176 $ 9,631.00 ACTIVE 35200004 CT ABDOMEN W/CONTRAST 352 74160 $ 11,059.00 ACTIVE 35200003 CT ABDOMEN W/O CONT 352 74150 $ 7,196.50 ACTIVE 35000004 CT BONE DENSITY STUDY AXIAL 350 77078 $ 3,438.00 ACTIVE 35100003 CT BRAIN W W/O CONTR 351 70470 $ 9,197.00 ACTIVE 35100001 CT BRAIN W/CONTRAST 351 70460 $ 7,771.00 ACTIVE 35100002 CT BRAIN W/O CONTRAST 351 70450 $ 5,567.00 ACTIVE 35200005 CT CER SPINE W/CONTRAST 352 72126 $ 10,989.00 ACTIVE 35200006 CT CERV SPINE W/O CONT 352 72125 $ 8,356.00 ACTIVE 35200007 CT CERV SPINE WO- W/CONTR 352 72127 $ 9,355.50 ACTIVE 35200008 CT CHEST W/CONTRAST 352 71260 $ 10,990.00 ACTIVE 35200009 CT CHEST W/O CONTRAST 352 71250 $ 8,235.50 ACTIVE 35200010 CT CHEST W/O THEN W/CON 352 71270 $ 13,179.50 ACTIVE 35000001 CT DRAIN W/CATH PLACEMT 350 75989 $ 5,844.00 ACTIVE 35000005 CT ELECTRON BEAM TOMO 350 S8092 $ 1,259.02 ACTIVE 35000006 CT GUIDANCE TISS ABLATION 350 77013 $ 3,055.52 ACTIVE 35000007 CT GUIDE NDL PLACEMENT 350 77012 $ 5,999.50 ACTIVE 35200011 CT LOWER EXTREM W/O CON 352 73700 $ 8,184.00 ACTIVE 35200012 CT LOWER EXTREM WO- W/CON 352 73702 $ 13,092.00 ACTIVE 35200013 CT LUMB SPINE W/CONTRAST 352 72132 $ 10,954.50 ACTIVE 35200014 CT LUMB SPINE W/O CONTR 352 72131 $ 8,184.00 ACTIVE 35200015 CT LUMB SPINE W/O- W/CON 352 72133 $ 12,972.50 ACTIVE 35200016 CT LWR EXTREM W/CONTRAST 352 73701 $ 10,817.50 ACTIVE 35100005 CT MAXILLOFACIAL W/CON 351 70487 $ 8,083.00 ACTIVE 35100004 CT MAXILLOFACIAL W-W/O 351 70488 $ 9,829.00 ACTIVE 35100006 CT MAXILLOFACIALW/O CONT 351 70486 $ 6,712.00 ACTIVE 35100007 CT NECK W CONTRAST 351 70491 $ 11,300.00 ACTIVE 35100008 CT NECK W- W/O CONTRAST 351 70492 $ 13,317.50 ACTIVE 35100009 CT NECK W/O CONTRAST 351 70490 $ 8,872.50 ACTIVE 35100011 CT ORBIT/SELLA/IAC W 351 70481 $ 13,213.50 ACTIVE 35100012 CT ORBIT/SELLA/IAC WO 351 70480 $ 8,872.50 ACTIVE 35100010 CT ORBIT/SELLA/IAC W-WO 351 70482 $ 14,462.50 ACTIVE 35200017 CT PELVIS W/CONTRAST 352 72193 $ 10,817.50 ACTIVE 35200018 CT PELVIS W/O CONTRAST 352 72192 $ 7,024.00 ACTIVE 35200019 CT PELVIS WO- W/CONT 352 72194 $ 12,476.50 ACTIVE 35000009 CT RECONST AORTA 350 G0288 $ 4,246.96 ACTIVE 35000008 CT SINUS LTD/LO F/U STUDY 350 76380 $ 5,227.50 ACTIVE 35000010 CT STEREOTACTIC LOC 350 77011 $ 3,487.26 ACTIVE 35200020 CT THOR SPINE W/CONTRAST 352 72129 $ 10,989.50 ACTIVE 35200021 CT THOR SPINE W/O CONT 352 72128 $ 8,184.00 ACTIVE 35200022 CT THOR SPINEW/O- W/CON 352 72130 $ 12,972.50 ACTIVE 35000011 CT UNLISTED PROCEDURE 350 76497 $ 3,004.40 ACTIVE 35200023 CT UPPER EXTREM W/CONT 352 73201 $ 10,664.00 ACTIVE 35200024 CT UPPER EXTREM W/O CON 352 73200 $ 8,169.00 ACTIVE 35200025 CT UPPER EXTREMWO-W CON 352 73202 $ 5,115.60 ACTIVE 35200001 CT VERTEBROPLASTY 352 72292 $ 2,415.00 ACTIVE 35200026 CTA ABD AW RUNOFF WO/W 352 75635 $ 18,235.00 ACTIVE CTA ABD/PELVIS WITH CONTRAST INCLUDING NON 35200036 352 74174 $ 18,674.00 ACTIVE CONTRAST IF PERFORMED AND POST PROCESING Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CTA ABDOMEN W/O W 35200027 352 74175 $ 14,723.00 ACTIVE CONTRAST CTA CHEST (NONCORONARY) 35200028 W/CONTRAST; INC W/O 352 71275 $ 14,398.50 ACTIVE CONTRAST IF PERFORMED 35100016 CTA HEAD W-W/O CONTRAST 351 70496 $ 14,175.00 ACTIVE CTA HEART,WITHOUT CONTRAST MATERIAL,WITH 35200037 352 75571 $ 4,816.50 ACTIVE QUANTITATIVE EVALUATION OF CORONARY CALCIUM 35900001 CTA LWR EXTR WO/W CON-W 359 73706 $ 16,845.00 ACTIVE 35100017 CTA NECK W/O & W CONTRAST 351 70498 $ 14,089.50 ACTIVE 35200029 CTA PELVIS WO-W CONTRAST 352 72191 $ 14,603.50 ACTIVE 35200030 CTA UP EXTREM WO/W CONTR 352 73206 $ 5,670.00 ACTIVE CUBITAL TUNNEL RELEASE/NEUROPLASTY/TRANS 36000122 360 64718 $ 30,723.00 ACTIVE POSITION ULNAR NERVE AT ELBOW 27200806 CUFF BLOOD PRESSURE (ALL) 272 A4663 $ 168.00 ACTIVE CUICK COMBO REDI PAK 11996- 27200259 272 A4649 $ 632.00 ACTIVE 000017 30600019 CULTURE ANAEROBIC BACTERIA 306 87075 $ 126.24 ACTIVE CULTURE BACTERIAL ANY 30600022 306 87070 $ 114.84 ACTIVE OTHER SOURCE CULTURE BACTERIAL 30600104 306 87071 $ 34.98 ACTIVE QUANTITATIVE AEROBIC 30600020 CULTURE CAMPYLOBACTER 306 87046 $ 125.88 ACTIVE CULTURE CHLAMYDIA, ANY 30600045 306 87110 $ 261.24 ACTIVE SOURCE 30600012 CULTURE EPIDERMAL FUNGUS 306 87101 $ 102.72 ACTIVE CULTURE FUNGI ISOLATION 30600025 306 87103 $ 245.52 ACTIVE (BLOOD) CULTURE FUNGI ISOLATION 30600011 306 87102 $ 102.72 ACTIVE (NOT BLOOD) CULTURE PRESUMPTIVE 30600105 PATHOGENIC ORGANISMS 306 87081 $ 88.32 ACTIVE SCREENING ONLY 30600013 CULTURE TYPE SALMONELLA 306 87147 $ 69.00 ACTIVE CULTURE URINE BACTERIA 30600015 306 87088 $ 107.88 ACTIVE ISOLATION 27000753 CUP, MED GRAD 1OZ 270 A9270 $ 12.00 ACTIVE 27000622 CUSHION DONUT O RING 270 E0190 $ 230.00 ACTIVE 27200260 CUTTER 45MM LINEAR 6TB45 272 A4649 $ 2,908.00 ACTIVE CUTTING LOOP 27FR EXTENDED 27200907 272 A4649 $ 625.05 ACTIVE LENGTH 48200001 CV STRESS W/ECG TRACE 482 93017 $ 1,912.68 ACTIVE 30100121 CYANIDE 301 82600 $ 258.60 ACTIVE CYCLIC CITRULLINATED 30200094 302 86200 $ 172.68 ACTIVE PEPTIDE CYCLOBENZAPHRINE (FLEXERIL) 25900339 250 J8499 $ 22.00 ACTIVE 10MG TAB CYCLOPENTOLATE 40MG/2ML 25901864 250 J3490 $ 68.48 ACTIVE OPTH 30600041 CYCLOSPORA STAIN 306 87207 $ 79.92 ACTIVE 30100122 CYLOSPORINE LEVEL 301 80158 $ 240.72 ACTIVE 25200113 CYMBALTA 60MG CAP 250 J8499 $ 56.00 ACTIVE 30100072 CYSTATIN C 301 82610 $ 222.24 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 36000242 CYSTECTOMY PARTIAL SIMPLE 360 51550 $ 5,015.40 ACTIVE 32000077 CYSTOGRAM 3V OR MORE 320 74430 $ 1,782.00 ACTIVE CYSTOPLASTY OR CYSTOURETHROPLASTY, PLASTIC OPERATION ON 36000358 BLADDER AND/OR VESICAL 360 51800 $ 52,486.50 ACTIVE NECK (ANTERIOR Y-PLASTY, VESICAL FUNDUS RESECTION), ANY CYSTOURETHROSCOPY (INCLUDING URETERAL 36000380 CATHETERIZATION); WITH 360 52320 $ 12,848.00 ACTIVE REMOVAL OF URETERAL CALCULUS CYSTOURETHROSCOPY 36100013 361 52000 $ 2,183.11 ACTIVE (SEPARATE PROCEDURE) CYSTOURETHROSCOPY W/ 36100012 361 52204 $ 7,441.50 ACTIVE BIOPSY(S) CYSTOURETHROSCOPY W/ URETEROSCOPY/PYELOSCOPY; 36000278 360 52352 $ 18,393.00 ACTIVE W/REMOVAL OR MANIPULATION OF CALCULUS CYSTOURETHROSCOPY W/CALIBRATION AND/OR DILATION OF URETHRAL 36000264 360 52281 $ 8,004.00 ACTIVE STRICTURE/STENOSIS, W/W/O MEATOTOMY, W/W/O INJECTION FOR CYSTOGRAPHY CYSTOURETHROSCOPY 36000263 W/DIRECT VISION INTERNAL 360 52276 $ 13,922.50 ACTIVE URETHROTOMY CYSTOURETHROSCOPY W/FULGURATION (INC CRYOSURGERY/LASER 36000253 360 52234 $ 12,942.00 ACTIVE SURGERY) &/OR RESECTION OF; SMALL BLADDER TUMOR(S) 0.5- 2.0CM CYSTOURETHROSCOPY W/FULGURATION (INCLUDING 36000054 CRYOSURGERY/LASER 360 52224 $ 10,729.50 ACTIVE SURGERY) TX OF MINOR (<0.5 CM) LESION(S) W/OR W/O BX CYSTOURETHROSCOPY W/REMOVAL OF 36000313 FB/CALCULUS/URETERAL STENT 360 52310 $ 7,902.00 ACTIVE FROM URETHRA/BLADDER; SIMPLE CYSTOURETHROSCOPY W/URETERAL CATH W/OR W/O 36000276 360 52005 $ 6,926.50 ACTIVE IRRIGA/INSTILLATION/URETEROP YELOGRAPHY CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING 36000360 CRYOSURGERY OR LASER 360 52240 $ 20,484.00 ACTIVE SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER 36000379 360 52235 $ 15,028.50 ACTIVE SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 C CYSTOURETHROSCOPY, WITH 36000312 INTERNAL URETHROTOMY; 360 52275 $ 12,583.66 ACTIVE MALE CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR 36000288 PYELOSCOPY; WITH 360 52353 $ 19,697.50 ACTIVE LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED) CYTOGENETICS & MOLECULAR 30100549 CYTOGENETICS, 311 88291 $ 151.68 ACTIVE INTERPRETATION & REPORT 31100003 CYTOLOGY BRUSHINGS 311 88104 $ 257.60 ACTIVE 30200095 CYTOMEGALOVIRUS ANTIBODY 302 86644 $ 191.88 ACTIVE CYTOMEGALOVIRUS 30200096 302 86645 $ 224.64 ACTIVE IMMUNOGLOBIN-M ANTIBODY CYTOPATH C/V AUTO FLUID 31100017 311 88175 $ 98.13 ACTIVE REDO CYTOPATHOLOGY SMEARS 31100004 311 88160 $ 193.20 ACTIVE (OTHER SOURCE) CYTOPATHOLOGY, CERVICAL/VAGINAL, 30200277 PRESERVATIVE FLUID, AUTO 311 88142 $ 75.03 ACTIVE THIN LAYER PREP; MANUAL SCREEN 25800016 D5 1/2NS 30MEQ 1000ML 258 J3480 $ 2,676.00 ACTIVE 25800027 D5W 250ML IV SOLN. 258 J7060 $ 146.00 ACTIVE DANTRIUM 20MG VIAL 25000139 250 J3490 $ 1,168.00 ACTIVE (DANTROLENE SOD) D-DIMERS AND FIBRIN 30500023 DEGRADATION PRODUCTS 305 85379 $ 150.42 ACTIVE QUANTITATIVE DE STENT EACH ADDITIONAL 48100068 481 G0291 $ 1,600.34 ACTIVE VESSEL DEBRDMNT/NON-SEL STERL 15 42000002 420 97602 $ 1,027.82 ACTIVE MIN 42000017 DEBRIDE SELECT W/O ANES <=2 450 97597 $ 1,027.82 ACTIVE

42000018 DEBRIDE SELECT W/O ANES 20+ 450 97598 $ 1,027.82 ACTIVE DEBRIDEMENT BONE (EPIDERMIS/DERMIS/SUBCUT 36000083 360 11044 $ 3,608.85 ACTIVE TISSUE/MUSCLE/FASCIA) FIRST 20 SQ CM OR LESS DEBRIDEMENT SKIN - FULL 76100005 761 11041 $ 1,118.10 ACTIVE THICKNESS DEBRIDEMENT SKIN - 76100007 761 11042 $ 1,841.50 ACTIVE SUBCUTANEOUS DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, 36000367 DERMIS, AND SUBCUTANEOUS 360 11043 $ 8,018.50 ACTIVE TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25000141 DEBROX EAR WAX 6.5% 0.5 OZ 250 A9150 $ 54.00 ACTIVE 31200001 DECALCIFICATION PROCEDURE 312 88311 $ 161.42 ACTIVE

DECLOTTING BY THROMBOLYTIC AGENT OF 36100009 361 36593 $ 1,148.55 ACTIVE IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER 25900366 DEPAKOTE 250MG EC TABLET 250 J8499 $ 24.00 ACTIVE 25900367 DEPAKOTE 500MG 250 J8499 $ 54.00 ACTIVE 27200698 DERMACARRIER 272 C1781 $ 395.50 ACTIVE 36000335 DERMAPURE, PER SQ CM 360 Q4152 $ 50.00 ACTIVE DESFLURANE (SUPRANE) INH LIQ 25000716 250 J3490 $ 76.00 ACTIVE 240ML DETECT AGNT MULT DNA 30100544 306 87801 $ 150.00 ACTIVE AMPLIFIED TECHNIQUE 42000019 DEV TESTING EXT W/I&R 450 96111 $ 4,385.64 ACTIVE 42000020 DEV TESTING LTD W/I&R 450 96110 $ 1,116.16 ACTIVE 27200662 DEVICE EVERCROSS 272 C1725 $ 4,212.00 ACTIVE DEXA APPENDICULAR 32000078 320 77081 $ 378.44 ACTIVE (PERIPHERAL) SKELETON 32000079 DEXA AXIAL SKELETON 320 77080 $ 1,984.50 ACTIVE DEXA VERTEBRAL FRACTURE 32000080 320 77082 $ 488.32 ACTIVE ASSESS DEXAMETHASONE (DECADRON) 63600195 INHALATION SOLUTION PER 636 J7638 $ 13.50 ACTIVE MILLIGRAM 25000033 DEXAMETHASONE 1MG 30ML OS 250 J8540 $ 42.08 ACTIVE DEXAMETHASONE 1MG TAB PER 25900375 259 J8540 $ 24.00 ACTIVE .25MG 25800031 DEXTROSE 10% 500ML IV 250 J3490 $ 20.00 ACTIVE 25800033 DEXTROSE 25% 10ML 250 J3490 $ 54.00 ACTIVE DEXTROSE 5%/LACTATED 25800036 258 J7121 $ 434.00 ACTIVE RINGERS/2 25901958 DEXTROSW 50% 10ML SYRINGE 250 J3490 $ 85.00 ACTIVE 30100124 DHEA 301 82626 $ 336.96 ACTIVE 30100125 DHEA-SULFATE 301 82627 $ 296.52 ACTIVE 94200001 DIAB O/P SELF-MGT GRP 30M 942 G0109 $ 81.20 ACTIVE 94200002 DIAB O/P SELF-MGT IND 30M 942 G0108 $ 394.80 ACTIVE 44000003 DIAGNOSTIC LARYNGOSCOPY 440 31575 $ 1,020.74 ACTIVE 25900382 DIAZEPAM 5MG TAB 259 J8499 $ 30.00 ACTIVE DICLOFENAC (VOLTAREN) 75MG 25901220 250 J8499 $ 28.00 ACTIVE TABLET 25901866 DICLOFENAC 100MG TAB 250 J8499 $ 8.30 ACTIVE 25900385 DICYCLOMINE 10MG CAPSULE 250 J8499 $ 8.00 ACTIVE 25900386 DICYCLOMINE HCL 20MG TAB 250 J8499 $ 8.00 ACTIVE 51000007 DIETARY CONSULT 510 97802 $ 220.00 ACTIVE 25900387 DIFLUCAN 100MG TABLET 250 J8499 $ 96.00 ACTIVE 25900388 DIFLUCAN 150 MG TABLET 250 J8499 $ 340.00 ACTIVE 25900389 DIFLUCAN 50 MG TAB 250 J8499 $ 138.00 ACTIVE 30100127 DIGOXIN 301 80162 $ 177.00 ACTIVE DIGOXIN (DIGITEX) 250MCG 25901931 250 J8499 $ 10.50 ACTIVE (0.25MG) TABLET 30100128 DIHYDROCODEINONE 301 82646 $ 492.66 ACTIVE 25900390 DILANTIN 100MG CAPSULE 250 J8499 $ 24.00 ACTIVE 32000081 DILATION NEPHROSTOMY 320 74485 $ 2,552.90 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS DIPHENHYDRAMINE 2% TOP 25901954 250 J3490 $ 24.00 ACTIVE CREAM DIPHENOXELATE/ATROPINE 25901867 250 J8499 $ 24.00 ACTIVE 2.5MG TAB 25900399 DIPYRIDAMOLE 50MG TABLET 250 J8499 $ 10.00 ACTIVE DIRECT ADMISSION PATIENT 76200002 762 G0379 $ 2,403.45 ACTIVE FOR HOSPITAL OBS 32000082 DISKOGRAM CERV THOR 320 72285 $ 5,503.00 ACTIVE 32000083 DISKOGRAM LUMBAR 320 72295 $ 4,713.50 ACTIVE 31100005 DNA ANALYSIS 311 88182 $ 463.68 ACTIVE DNA ANTIBODY/NATIVE/DOUBLE 30200097 302 86225 $ 183.24 ACTIVE STRAND

DNA ANTIBODY/NATIVE/SINGLE 30200098 302 86226 $ 161.40 ACTIVE STRAND 63600154 DOBUTAMINE 250MG/20ML 636 J1250 $ 57.08 ACTIVE 63600184 DOBUTAMINE 250MG/250ML IV 636 J1250 $ 64.12 ACTIVE 25900405 DOCUSATE SODIUM 100MG CAP 250 J8499 $ 8.00 ACTIVE 25900410 DONNATAL 16.2MG ELIXIR 259 J8499 $ 264.00 ACTIVE DOP ECHO COLOR FLO VEL 48000003 480 93325 $ 1,159.20 ACTIVE MAPG DOP ECHO FTL PLSD SPECTRAL 40200001 402 76828 $ 1,159.20 ACTIVE DIS DOP ECHO FTL SPECTRAL 40200002 402 76827 $ 1,288.00 ACTIVE DISPLAY DOP ECHO P-W&/OR CONT 48000005 480 93321 $ 1,159.20 ACTIVE W/SPECTR 25000030 DOPAMINE 200MG 5ML VIAL 250 J1265 $ 45.00 ACTIVE 25000176 DOPAMINE 800MG/250ML D5W 250 J1265 $ 234.00 ACTIVE 92100014 DOPPLER INTCRAN ARTS COMP 921 93886 $ 1,754.90 ACTIVE DOPPLER VELOCIMETRY, FETAL; 40200062 402 76820 $ 2,466.00 ACTIVE UMBILICAL ARTERY DOUBLE DRY SUCTION CHEST 27200263 272 C1729 $ 196.40 ACTIVE DRAIN 25900414 DOXEPIN 10MG CAPSULE 250 J8499 $ 8.00 ACTIVE 25000180 DOXYCYCLINE 100MG VIAL 250 J3490 $ 198.00 ACTIVE 25900417 DOXYCYCLINE100MG TABL 250 J8499 $ 190.00 ACTIVE 27200654 DRAIN BLAKE 19FR 272 A7048 $ 1,305.00 ACTIVE 27000156 DRAIN BLAKE 19FR 270 A7048 $ 600.00 ACTIVE 27000157 DRAIN JACK PRATT 10MM 270 A7048 $ 550.00 ACTIVE 27000158 DRAIN JACK PRATT 7MM 270 A7048 $ 550.00 ACTIVE 27000160 DRAIN PENROSE 12 X 1 270 A7048 $ 28.00 ACTIVE 27000161 DRAIN PENROSE 12 X 1/2 270 A7048 $ 28.00 ACTIVE 27000162 DRAIN PENROSE 12 X 1/4 270 A7048 $ 28.00 ACTIVE 27000163 DRAIN PENROSE 12 X 3/4 270 A7048 $ 28.00 ACTIVE 27000164 DRAIN PENROSE 18 X 1 270 A7048 $ 28.00 ACTIVE 27000165 DRAIN PENROSE 18 X 1/2 270 A7048 $ 28.00 ACTIVE 27000166 DRAIN PENROSE 18 X 1/4 270 A7048 $ 28.00 ACTIVE 27000167 DRAIN PENROSE 18 X 3/4 270 A7048 $ 28.00 ACTIVE 27000168 DRAIN PLEUR-EVAC 270 A7041 $ 50.00 ACTIVE DRAINAGE OF OVARIAN CYST(S), 36000257 UNILATERAL/BILATERAL; 360 58805 $ 20,880.50 ACTIVE ABDOMINAL APPROACH Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS DRAINAGE, LYMPH NODE 36000132 ABSCESS/LYMPHADENITIS; 360 38300 $ 14,209.86 ACTIVE SIMPLE DRAINAGE, 36000130 PERIVESICAL/PREVESICAL 360 51080 $ 11,983.44 ACTIVE SPACE ABSCESS DRAPE ABDOMINAL LAPARO 27200627 272 A4467 $ 102.00 ACTIVE STERILE 27200667 DRAPE CLEARVIEW 272 A4467 $ 678.00 ACTIVE 27200665 DRAPE EXTREMITY 272 A4467 $ 678.00 ACTIVE 27200701 DRAPE MICROSCOPE 272 A4467 $ 452.00 ACTIVE 27200678 DRAPE PROBE COVER 272 A4649 $ 1,017.00 ACTIVE 27000633 DRAPE SURG STERI DRAPE 270 A4467 $ 124.00 ACTIVE 27000634 DRAPE SURG STERI DRAPE 1010 270 A4467 $ 108.00 ACTIVE 27000173 DRESSING 2X2 STERILE 272 A6402 $ 8.00 ACTIVE 27000177 DRESSING ADAPTIC 3X3 272 A6223 $ 9.25 ACTIVE 27000178 DRESSING ADAPTIC 3X8 272 A6223 $ 23.85 ACTIVE 27000019 DRESSING AQUACEL 4X4 270 A6197 $ 70.00 ACTIVE 27200776 DRESSING AQUACEL AG 4X4 272 A6209 $ 174.90 ACTIVE DRESSING AQUACEL 62300001 623 A6197 $ 270.00 ACTIVE W/HYDROFIBER .75X18 DRESSING AQUACEL 62300002 623 A6197 $ 242.00 ACTIVE W/HYDROFIBER 9.5X 11.5 27100022 DRESSING BIO PATCH 271 A6219 $ 212.00 ACTIVE 27000034 DRESSING COBAN 2" 272 A6453 $ 18.74 ACTIVE 27000035 DRESSING COBAN 3" 272 A6454 $ 4.95 ACTIVE 27000180 DRESSING DRAIN SPONGE 270 A4649 $ 120.00 ACTIVE DRESSING DUODERM EXTRA 62300003 623 A6234 $ 84.00 ACTIVE THIN 2X8 DRESSING DUODERM EXTRA 62300004 623 A6234 $ 82.00 ACTIVE THIN 4X6 DRESSING FOAM ADHESIVE 27000592 272 A6212 $ 188.00 ACTIVE OPTIFOAN 4 X 4 DRESSING FOAM EXUDER 27000591 272 A6209 $ 272.00 ACTIVE ODORSHIELD 27000182 DRESSING GAUZE TUBE P-APP 270 A6457 $ 8.45 ACTIVE 27000169 DRESSING GELFOAM 270 A6212 $ 92.00 ACTIVE DRESSING GRANUFORM ALL 62300006 623 A6550 $ 508.50 ACTIVE SIZES DRESSING HYDOCLLOID 4.5 X 7.5 27000170 270 A6235 $ 146.00 ACTIVE OVAL 27000495 DRESSING KERLIX ROLL 272 A6445 $ 384.00 ACTIVE 27000185 DRESSING OPSITE 2X3 272 A6258 $ 0.90 ACTIVE 27200797 DRESSING SPANDEX (ALL) 272 A6210 $ 204.00 ACTIVE DRESSING SURESITE/TEGADERM 27200808 272 A6259 $ 172.00 ACTIVE TRANSPARENT 6 X 8 DRESSING SURGICAL ISLAND 4 X 27000171 270 A6235 $ 22.00 ACTIVE 8 27000172 DRESSING TAGADERM 10X12 C 272 A6204 $ 132.00 ACTIVE 27000195 DRESSING TEGADERM 4X4 272 A6203 $ 12.60 ACTIVE 27000197 DRESSING TELFA 2X3 272 A6219 $ 16.00 ACTIVE 27000198 DRESSING TELFA 3X4 272 A6222 $ 17.00 ACTIVE 27000199 DRESSING TELFA 3X8 272 A6223 $ 18.00 ACTIVE 27200771 DRESSING UNNA 4" 270 A6456 $ 108.45 ACTIVE 62300005 DRESSING VASELINE 623 A6222 $ 190.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000205 DRESSING XEROFORM 1/8 272 A6222 $ 15.00 ACTIVE 27000206 DRESSING XEROFORM 5X9 272 A6223 $ 18.10 ACTIVE DRESSING/DEBRIDEMENT PART- 45000084 THICKNESS APPLICATION 450 16020 $ 2,826.00 ACTIVE BURNS-LESS 5% BODY DRILL 2.0MM X 102MM WL 50MM 27800584 272 C1713 $ 4,170.00 ACTIVE AO-SHAFT DRILL BONE GRAFT 10MM PART# 27000435 272 A4649 $ 7,560.00 ACTIVE BG-8020-5 DRILL BONE GRAFT 8MM 27000738 272 C1713 $ 7,520.00 ACTIVE PART#BG8010S 36000111 DRN OF RETROPER ABCS 360 49060 $ 6,858.60 ACTIVE 36000133 DRN PAN PSUDOCYST PRQ 360 48511 $ 8,880.82 ACTIVE 27000174 DRSNG 4X4 10S 270 A6413 $ 52.00 ACTIVE 27000175 DRSNG 4X4 2S 270 A6413 $ 48.00 ACTIVE 27000176 DRSNG 4X4 NON STERILE LF 270 A6216 $ 5.40 ACTIVE 27000179 DRSNG AEROFORM STRIP 5X9 270 A6212 $ 28.00 ACTIVE 27000181 DRSNG GZ IODINE 270 A6224 $ 112.00 ACTIVE 27000183 DRSNG KERLIX FLUFF 270 A6403 $ 32.20 ACTIVE 27000184 DRSNG NASAL PK VASE 270 A6223 $ 66.00 ACTIVE 27000186 DRSNG OPSITE 5X7 272 A6259 $ 120.00 ACTIVE 27000187 DRSNG SPAND SZ 1-2 272 A6243 $ 52.00 ACTIVE 27000188 DRSNG SPAND SZ 3-4 272 A6243 $ 86.00 ACTIVE 27000189 DRSNG SPAND SZ 5-8 272 A6244 $ 146.00 ACTIVE 27000190 DRSNG SPAND SZ 9-10 272 A6244 $ 684.00 ACTIVE 27000191 DRSNG SPANDAG P/40 272 A6244 $ 90.00 ACTIVE 27000192 DRSNG SURGICEL 2X3 272 A6203 $ 550.00 ACTIVE 27000193 DRSNG SURGICEL 4X8 272 A6204 $ 550.00 ACTIVE 27000194 DRSNG SURGIPAD EA 272 A6203 $ 16.00 ACTIVE 27000196 DRSNG TELFA 1.5X2 272 A6219 $ 32.00 ACTIVE 27000200 DRSNG VAS GZ 1/2 272 A6223 $ 28.00 ACTIVE 27000201 DRSNG VAS GZ 1/36 272 A6224 $ 28.00 ACTIVE 27000202 DRSNG VAS GZ 3X18 272 A6224 $ 28.00 ACTIVE 27000203 DRSNG VAS GZ 3X9 272 A6224 $ 28.00 ACTIVE 27000204 DRSNG VAS GZ 6X36 272 A6224 $ 34.00 ACTIVE DRUG SCREEN 30100132 METHYLXANTHINE CLASS 301 G0434 $ 502.32 ACTIVE (EACH) 30000045 DRUG SCREEN PANEL 301 80305 $ 151.20 ACTIVE DRUG SCRN QUANT 30000007 300 80183 $ 176.76 ACTIVE OXCARBAZEPIN DRUG TEST PRESUMPTIVE 30100098 301 80307 $ 287.32 ACTIVE CHEMISTRY ANLYZR DRUG TEST PRESUMPTIVE, ANY NUMBER DRUG CLASSES; ANY 30000044 DEVICES OR 300 G0477 $ 4,472.00 ACTIVE PROC(IMMUNOASSAY), CAPABLE OF BEING READ BY DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG 30100110 IDENTIFICATION METHODS ABLE 301 G0481 $ 164.42 ACTIVE TO IDENTIFY INDIVIDUAL DRUGS AND Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS DRUG TEST(S), DEFINITIVE, UTILIZING DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY 30100115 301 G0659 $ 323.25 ACTIVE INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL IS 27200646 DUET TRS 60 272 A4649 $ 16,485.00 ACTIVE DULOXETINE DR (CYMBALTA) 25901707 250 J8499 $ 54.00 ACTIVE 30MG CAPSULE 27000207 DUODERM 4 X 4 272 A6212 $ 146.00 ACTIVE 27000012 DUODERM CGF 4X4 DRESSING 270 A6212 $ 64.00 ACTIVE DUODERM EXTRA THIN CGF 27000013 270 A6212 $ 60.00 ACTIVE SPOTS 92100004 DUP ABD/PELVIC/RETRO PERI 921 93975 $ 9,070.50 ACTIVE 92100016 DUP SCN EXTCRANI ARTS LTD 921 93882 $ 5,022.00 ACTIVE 92100006 DUPLEX ABD/PELV/RETRO LTD 921 93976 $ 1,780.66 ACTIVE DUPLEX DOPP L EXT ARTERIAL 92100008 921 93925 $ 9,070.50 ACTIVE BILATERAL DUPLEX DOPP L EXT ARTERIAL 92100005 921 93926 $ 6,201.00 ACTIVE UNILA DUPLEX DOPP VENOUS IMAG 92100011 921 93970 $ 9,070.50 ACTIVE UPP/LOW EXT BILATERAL DUPLEX DOPP VENOUS IMAG UPP/LOW EXT UNILAT INC 92100013 921 93971 $ 4,765.50 ACTIVE RESPONSES TO COMPRESSION/ MANEUVERS 92100009 DUPLEX UPPER EXTREM BILAT 921 93930 $ 2,470.44 ACTIVE 92100010 DUPLEX(UPPER)EXTR UNILAT 921 93931 $ 1,702.40 ACTIVE 25900421 DURAGESIC 25 MCG/HR PATCH 250 J3490 $ 357.00 ACTIVE 25900420 DURAGESIC 75MCG PATCH 250 J3490 $ 606.00 ACTIVE 27100013 DURAPREP 26ML 271 A4245 $ 340.00 ACTIVE 27100012 DURAPREP 6ML 271 A4649 $ 176.00 ACTIVE EACH ADDITIONAL STENT 36000020 360 37206 $ 881.00 ACTIVE VESSEL 25901868 EARACHE DROPS 10ML 250 J3490 $ 14.00 ACTIVE 30200063 EASTERN EQUINE ENCEPHALITIS 302 86652 $ 48.84 ACTIVE 73000001 ECG 12 LEAD TRACE ONLY 730 93005 $ 676.20 ACTIVE 73100001 ECG 24H W/VIS SCN ANA RPT 731 93226 $ 730.94 ACTIVE 73100002 ECG MON-24 HRS RECORDING 731 93225 $ 1,355.62 ACTIVE 48000024 ECHO C/2D 483 93306 $ 3,083.50 ACTIVE 40200003 ECHO FTL CV SYS R-T REC 402 76825 $ 1,288.00 ACTIVE ECHO FTL CV SYS R-T REC 40200004 402 76826 $ 1,159.20 ACTIVE REPEAT ECHO TRANSESOPHAGEAL 2D 48000021 W/PROBE IMAGE ACQUISITION 480 93312 $ 4,553.08 ACTIVE INTERPRETATION & REPORT ECHO TRANSESOPHAGEAL CONGENITAL ANOMALIES 48000017 480 93315 $ 4,553.08 ACTIVE W/PROBE IMAGE INTEPRETATION & REPORT ECHO TRANSTHORACIC 2D 48000020 480 93308 $ 1,159.20 ACTIVE FOLLOW-UP/LIMITED STUDY ECHO TRANSTHORACIC REAL- TIME 2D CARDIOVASCULAR 48000018 480 93350 $ 2,437.54 ACTIVE STRESS TEST INTERPRETATION & REPORT Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ECHOCARDIOGRAPHY, TRANSTHORACIC(2D), INC M- MODE REC, WHEN PERFORMED, 48300001 483 93351 $ 11,952.00 ACTIVE DURING REST/CARDIO STRESS TEST; W/INT AND REP; INC MONITORING W/SU ECHOCARDIOGRAPHY, 48000019 TRANSTHORACIC, 2D; 480 93307 $ 2,437.54 ACTIVE COMPLETE 74000001 EEG ROUTINE 740 95816 $ 1,700.16 ACTIVE 74000002 EEG UP TO 1 HR 740 95812 $ 1,812.86 ACTIVE 25900430 EFFEXOR XR 75MG CAP 250 J8499 $ 76.00 ACTIVE EGD DIAGNOSTIC; FLEXIBLE 75000005 361 43235 $ 6,544.50 ACTIVE TRANSORAL EGD FLEX TRANSORAL W/FUNDOPLASTY 36000067 360 43210 $ 22,871.50 ACTIVE PARTIAL/COMPLETE INC DUODENOSCOPY EGD FLEXIBLE TRANSORAL 36000232 360 43239 $ 7,398.00 ACTIVE W/BX SINGLE OR MULTIPLE EGD FLEXIBLE, TRANSORAL W/REMOVAL OF 36000270 360 43251 $ 10,445.50 ACTIVE TUMOR/POLYP/LESION BY SNARE TECHNIQUE 73000003 EKG HOLTER MONITOR FOR 24 730 93224 $ 602.14 ACTIVE 32000085 ELBOW 2 VIEWS 320 73070 $ 1,316.00 ACTIVE 32000084 ELBOW 3V OR MORE 320 73080 $ 1,505.00 ACTIVE 32200002 ELBOW ARTHROGRAPHY 322 73085 $ 4,724.00 ACTIVE ELEC ALYS PACG CVDFB 2 48000006 480 93289 $ 431.48 ACTIVE CHMBR W 42000022 ELECTRIC STIM(UNATT) 450 97014 $ 226.82 ACTIVE ELECTROCARDIOGRAM, 73000004 ROUTINE ECG W/12 LEADS; 730 93000 $ 976.00 ACTIVE W/INTERPRETATION & REPORT

45000004 ELECTROCONVERSION HRT EXT 450 92960 $ 3,838.12 ACTIVE ELECTRODE BLADE 5.1 COATED 27200710 272 A4556 $ 68.48 ACTIVE INSULATED HEXLOC 27200709 ELECTRODE BLADE LONG 40 272 A4556 $ 65.08 ACTIVE ELECTRODE BLADE PTFE- 27200711 272 A4556 $ 107.36 ACTIVE COATED 6.5" ELECTRODE ELECTROSURGICAL 27000671 270 A4556 $ 140.00 ACTIVE PATIENT RETURN 27200708 ELECTRODE NEEDLE STD 40 272 A4556 $ 20.12 ACTIVE 27200784 ELECTRODES 270 A4556 $ 52.00 ACTIVE 27000709 ELECTRODES RESTING EKG TAB 270 A4556 $ 17.00 ACTIVE 25901949 ELECTROLYTE PEDI 1QT BTL 250 B4103 $ 15.22 ACTIVE ELECTRONIS ANALYSIS OF 92000005 IMPLANTED NEUROSTIMULATOR 920 95972 $ 1,092.00 ACTIVE PULSE GENERATOR ELECTROPHYSIOLOGIC 48100060 COMPHSV EVAL-SVT- W/ 481 93653 $ 55,432.55 ACTIVE ABLATION 27200782 ELECTROSURGICAL PENCIL 272 A4649 $ 184.00 ACTIVE 27000763 END TITAL CO2 DETECTOR 270 A4649 $ 10.15 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 32000086 ENDO BILI DUCT 320 74328 $ 2,380.00 ACTIVE 32000087 ENDO CATH PANCRETIC DUCT 320 74329 $ 2,338.00 ACTIVE 48100014 ENDOMYOCARDIAL BX 481 93505 $ 9,587.98 ACTIVE ENDOSCOPY SWALLOW TEST 44000004 440 92612 $ 4,623.92 ACTIVE (FEES) ENDOSCOPY, WRIST, W/ 36000287 RELEASE OF TRANSVERSE 360 29848 $ 9,988.30 ACTIVE CARPAL LIGAMENT ENDOVASC EXTEN PROSTH 36000023 360 34711 $ 2,870.00 ACTIVE ADD'L ENDOVASC EXTEND PROSTH 36000024 360 34709 $ 9,268.00 ACTIVE INIT 25000187 ENOXAPARIN 60MG/0.6ML SRG 636 J1650 $ 102.00 ACTIVE ENTEROLYSIS (FREEING OF 36000056 INTESTINAL ADHESION) 360 44005 $ 45,746.40 ACTIVE (SEPARATE PROCEDURE) 27200285 EON PATIENT PROGRAMMER 272 C1787 $ 11,014.92 ACTIVE 48100111 EP STUDY -SVT - NO ABLATION 481 93620 $ 76,921.20 ACTIVE EP STUDY/ TRASPTL, A FIB, 48100071 481 93656 $ 82,943.52 ACTIVE PULM VEIN ABLT 27200548 E-PACK PROCEDURE KIT #7836E 272 33512 $ 2,609.06 ACTIVE 32000088 EPIDUROGRAM 320 72275 $ 5,548.00 ACTIVE EPSTEIN-BARR NUCLEAR 30200003 302 86664 $ 203.88 ACTIVE ANTIGEN ANTIBODY EPSTEIN-BARR VIRAL CAPSID 30200100 ANTIGEN ANTIBODY 302 86665 $ 128.80 ACTIVE IMMUNOGLOBIN-G EPSTEIN-BARR VIRUS EARLY 30200105 302 86663 $ 174.96 ACTIVE ANTIGEN 27000208 EQUALIZER WALKER LG (16218) 270 L4386 $ 688.00 ACTIVE EQUALIZER WALKER MED 27000209 270 L4386 $ 688.00 ACTIVE (16216) ER TEMP FOLEY CATHETER 45000143 450 51702 $ 1,343.00 ACTIVE INSERTION 75000007 ERCP 750 43260 $ 8,384.00 ACTIVE ERCP W/BIOPSY SINGLE OR 75000008 750 43261 $ 12,576.00 ACTIVE MULTIPLE ERCP 75000013 W/SPHINCTEROTOMY/PAPILLOT 750 43262 $ 11,482.19 ACTIVE OMY 25901428 ERTHYROMYCIN 250MG TAB 250 J8499 $ 16.00 ACTIVE 25900447 ERYTHROMYCIN 500MG TAB 250 J8499 $ 30.00 ACTIVE 25900446 ERYTHROMYCIN 5MG/GM OINT 250 A6250 $ 124.00 ACTIVE 30100136 ERYTHROPOIETIN (EPO) 301 82668 $ 250.56 ACTIVE 25000198 ESMOLOL HCI 10MG/1ML 10ML 250 J3490 $ 326.00 ACTIVE 25901861 ESOMEPRAZOLE 20MG CAP 250 J8499 $ 7.07 ACTIVE ESOPHAGOSCOPY, FLEXIBLE, 36000337 360 43215 $ 7,162.50 ACTIVE TRANSORAL; W/REMOVAL OF FB 32000089 ESOPHAGUS 320 74220 $ 4,243.50 ACTIVE 42000021 E-STIM EA 15 450 97032 $ 251.92 ACTIVE 30100137 ESTRADIOL (E2) 301 82670 $ 372.48 ACTIVE 30100138 ESTRIOL 301 82677 $ 322.44 ACTIVE 30100139 ESTROGEN FRACTIONATED 301 82671 $ 430.68 ACTIVE 30100140 ESTROGENS (TOTAL) 301 82672 $ 289.32 ACTIVE 30100141 ESTRONE 301 82679 $ 186.76 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25900458 ETHYL CHLORIDE 250 J3490 $ 324.00 ACTIVE 30100142 ETHYLENE GLYCOL 301 82693 $ 198.72 ACTIVE 25901940 ETOMIDATE 40MG/20ML VIAL 250 J3490 $ 13.84 ACTIVE 30000052 EUGLOBULIN LYSIS 300 85360 $ 112.08 ACTIVE EVACUATION OF SUBUNGUAL 45000106 450 11740 $ 1,692.00 ACTIVE HEMATOMA 44400002 EVAL FNX SWALL 120 450 92610 $ 6,877.92 ACTIVE 44400006 EVAL MTN FLUOR SWA 120 450 92611 $ 6,877.92 ACTIVE 44400009 EVAL SP/COM DVC 1ST HR 450 92607 $ 1,597.12 ACTIVE 44400010 EVAL SP/COM DVC ADL 30 450 92608 $ 360.64 ACTIVE 44400011 EVAL SP/LANG/COM 120 450 92506 $ 2,588.88 ACTIVE 27900039 EVICEL APPLICATOR 270 A4649 $ 1,950.00 ACTIVE 27200676 EVICEL KIT W/PRESSURE 272 C9250 $ 10,395.00 ACTIVE 44000012 EXAM NEUROBEHAVIOR HR 450 96116 $ 1,610.00 ACTIVE 32000090 EXAM OF MIDDLE EAR 320 70134 $ 734.38 ACTIVE EXCH PREV PLCD ABSC/CYST 36000025 360 49423 $ 7,676.48 ACTIVE DRAIN CATH W/GDE EXCISION OF CHEST WALL 36100014 361 19260 $ 12,505.80 ACTIVE TUMOR INCLUDING RIBS EXCISION OF HYDROCELE 36000239 360 55041 $ 26,726.50 ACTIVE BILATERAL EXCISION OF HYDROCELE; 36000260 360 55040 $ 17,705.50 ACTIVE UNILATERAL EXCISION OF LESION OF 36000348 SPERMATIC CORD (SEPARATE 360 55520 $ 23,561.50 ACTIVE PROCEDURE) EXCISION OF SPERMATOCELE 36100016 361 54840 $ 15,475.00 ACTIVE W/ OR W/O EPIDIDYMECTOMY EXCISION OF VARICOCELE/LIGATION OF 36000267 SPERMATIC VEINS FOR 360 55530 $ 18,416.50 ACTIVE VARICOCELE; SEPERATE PROCEDURE EXCISION OTHER BENIGN 45000049 LESION INCLUDING MARGINS 450 11440 $ 600.00 ACTIVE EXCEPT SKIN TAG EXCISION TUMOR SOFT TISSUE 36000302 NECK/ANTERIOR THORAX, 360 21555 $ 14,990.00 ACTIVE SUBCUT; <3CM EXCISION TUMOR SOFT TISSUE 36000272 OF UPPER ARM/ELBOW AREA, 360 24075 $ 15,437.50 ACTIVE SUBCUT <3CM EXCISION TUMOR SOFT TISSUE 36100022 PELVIS/HIP AREA, SUBCUT; 361 27047 $ 17,748.00 ACTIVE <3CM EXCISION, BENIGN LESION INC MARGINS, EXCEPT SKIN TAG, 36000315 360 11404 $ 8,388.00 ACTIVE TRUNK/ARMS/LEGS; DIAM 3.1- 4.0CM EXCISION, BENIGN LESION INC MARGINS, EXCEPT SKIN TAG, 36100025 361 11400 $ 4,176.00 ACTIVE TRUNK/ARMS/LEGS; EXCISED DIAMETER 0.5CM OR < EXCISION, BENIGN LESION INC MARGINS, EXCEPT SKIN TAG, 36100026 361 11401 $ 5,384.00 ACTIVE TRUNK/ARMS/LEGS; EXCISED DIAMETER 0.6 TO 1.0CM Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS EXCISION, BENIGN LESION INC MARGINS, EXCEPT SKIN TAG, 36100027 361 11402 $ 5,922.00 ACTIVE TRUNK/ARMS/LEGS; EXCISED DIAMETER 1.1 TO 2.0CM EXCISION, BENIGN LESION INCL MARGINS, EXCEPT SKIN TAG, 36000341 360 11426 $ 14,274.00 ACTIVE SCALP/NECK/HANDS/FEET/GENIT ALIA; EXCISED DIAM >4CM EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED 36000372 360 11421 $ 600.00 ACTIVE ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAM EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT 36000339 360 11406 $ 12,218.50 ACTIVE SKIN TAG, TRUNK, EXTREM; DIAMETER >4.0CM EXCISION, LESION INC MARGINS 36100024 EXCEPT SKIN TAG 361 11403 $ 7,285.00 ACTIVE TRUNK/ARMS/LEGS; 2.1-3.0CM 36000370 EXCISION, OLECRANON BURSA 360 24105 $ 17,335.50 ACTIVE

EXCISION, OTHER BENIGN 36000338 LESION INCLUDING MARGINS, 360 11444 $ 11,219.50 ACTIVE EXCEPT SKIN TAG, FACE 3.1-4CM EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, 36000369 360 28043 $ 13,128.50 ACTIVE SUBCUTANEOUS; LESS THAN 1.5 CM EXCISION, TUMOR, SOFT TISSUE 36000309 OF PELVIS/HIP AREA, SUBC 3 CM 360 27043 $ 23,279.50 ACTIVE OR> EXCISION/CURETTAGE OF BONE CYST/BENIGN TUMOR OF 36000273 360 24120 $ 24,749.50 ACTIVE HEAD/NECK OF RADIUS/OLECRANON PROCESS EXCSN BREAST LESION; OPEN; 36000154 360 19125 $ 13,791.26 ACTIVE SINGLE LESION EXCSN NAIL/NAIL MATRIX 45000077 450 11750 $ 350.00 ACTIVE PART/COMP PERM RMV EXERCISE/PHARMACOLOGICAL 48200002 482 93015 $ 4,989.00 ACTIVE STRESS WITHOUT TRANSPORT 25000871 EXPAREL 1.3% 200MG/20ML 250 J3490 $ 62.00 ACTIVE EXPLORATION OF EPIDIDYMIS, 36000280 360 54865 $ 18,590.50 ACTIVE W/ WO BX EXPLORATION OF PENETRATING 36000323 WOUND (SEPARATE 360 20103 $ 18,072.00 ACTIVE PROCEDURE); EXTREMITY EXPLORATORY LAPAROTOMY EXPLORATORY CELIOTOMY W/ 36000059 360 49000 $ 32,212.00 ACTIVE OR W/OUT BX (SEPARATE PROCEDURE) 32000017 EXT CAROTID BI-LAT 320 75662 $ 14,808.78 ACTIVE 32000018 EXT CAROTID UNI-LAT 320 75660 $ 4,945.92 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH 27200003 CONNECTOR/ADAPTOR, FOR 272 A4331 $ 10.74 ACTIVE USE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH EXTENSION SET CARESITE 35 27000765 270 S1015 $ 10.26 ACTIVE INCH T EXTRACTABLE NUCLEAR 30200018 ANTIGEN, ANTIBODY TO, ANY 302 86235 $ 239.16 ACTIVE METHOD 25901862 EYE WASH 118ML 250 J3490 $ 5.00 ACTIVE 32000092 EYE XRAY FOR FB 320 70030 $ 905.00 ACTIVE EZ BENT TIP RETRIEVAL SHEATH 27000003 272 C1884 $ 18,000.00 ACTIVE 6 FRENCH 76100008 F/U VISIT LEVEL 1 761 99211 $ 567.40 ACTIVE 76100009 F/U VISIT LEVEL 2 761 99212 $ 677.38 ACTIVE 76100010 F/U VISIT LEVEL 3 761 99213 $ 677.38 ACTIVE 76100011 F/U VISIT LEVEL 4 761 99214 $ 939.56 ACTIVE 76100012 F/U VISIT LEVEL 5 761 99215 $ 1,177.00 ACTIVE F5 (COAGULATION FACTOR V) (EG, HEREDITARY 31000009 310 81241 $ 366.85 ACTIVE HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT 45000148 FAC FEE FOLLOW UP 450 99024 $ 1,000.00 ACTIVE 45000005 FAC FEE LEVEL I 450 99281 $ 2,400.00 ACTIVE 45000007 FAC FEE LEVEL II 450 99282 $ 5,000.00 ACTIVE 45000009 FAC FEE LEVEL III 450 99283 $ 13,000.00 ACTIVE 45000011 FAC FEE LEVEL IV 450 99284 $ 15,000.00 ACTIVE 45000013 FAC FEE LEVEL V 450 99285 $ 18,000.00 ACTIVE 32000093 FACIAL BONE 3V OR MORE 320 70150 $ 1,986.00 ACTIVE 32000094 FACIAL BONES <3 VIEWS 320 70140 $ 1,420.50 ACTIVE 30100255 FACTOR V LEIDEN MUTATION 1 301 83891 $ 238.00 ACTIVE

30100258 FACTOR V LEIDEN MUTATION 2 301 83894 $ 238.00 ACTIVE

30100261 FACTOR V LEIDEN MUTATION 3 301 83912 $ 238.00 ACTIVE

30100256 FACTOR V LEIDEN MUTATION 4 301 83898 $ 238.00 ACTIVE FACTOR VIII (ANTIHEMOPHILIC 45000057 450 J7190 $ 100.00 ACTIVE FACTOR HUMAN) PER IU 25900466 FAMOTIDINE 20MG TAB 259 J8499 $ 46.00 ACTIVE 25000026 FAMOTIDINE 20MG/50ML IV 250 S0028 $ 13.80 ACTIVE 30100591 FAT GLOBULES URINE 300 89125 $ 17.64 ACTIVE FATS/LIPIDS FECES 30100144 301 82705 $ 67.92 ACTIVE QUALITATIVE 30100088 FATTY ACIDS, NONESTERIFIED 301 82725 $ 225.24 ACTIVE 30100057 FECAL BILIRUBIN (QUALITATIVE) 301 82252 $ 60.72 ACTIVE FECAL FATS/LIPIDS 30100143 301 82710 $ 224.04 ACTIVE QUANTITATIVE 27100023 FECAL MGMNT KIT 271 A4649 $ 6,552.00 ACTIVE 27100024 FECAL MGMNT POUCH 271 A4330 $ 452.00 ACTIVE FEES W/LARYNGEAL SENSE 44000005 440 92616 $ 7,753.76 ACTIVE TEST FEM/POP REVASC ANGIOPLASTY 48100039 481 37224 $ 29,627.23 ACTIVE UNILATERAL Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 48100042 FEM/POP REVASC STENT/ATHER 481 37227 $ 71,835.92 ACTIVE FEM/POP REVASC W/ 48100040 481 37225 $ 51,568.52 ACTIVE ATHERE/ANGIO 48100041 FEM/POP REVASC W/STENT 481 37226 $ 51,568.52 ACTIVE 36000026 FEM-POP ATHERECTOMY 360 35493 $ 29,141.00 ACTIVE 25900470 FENTANYL 100MCG/HR PATCH 250 J3490 $ 684.00 ACTIVE 25900471 FENTANYL 50MCG/HR. P 250 J3490 $ 402.00 ACTIVE 30100146 FERRITIN 301 82728 $ 181.80 ACTIVE 25900475 FERROUS SULFATE TAB 325 250 J8499 $ 30.00 ACTIVE FIBRIN DEGRADATION 30500022 PRODUCTS AND D-DIMERS 305 85378 $ 116.64 ACTIVE QUALITATIVE 30500020 FIBRINOGEN ACTIVITY 305 85384 $ 116.64 ACTIVE 30200245 FIBRINOGEN ANTIGEN 305 85385 $ 173.52 ACTIVE FIBRINOGEN DEGRADATION 30500021 305 85362 $ 91.80 ACTIVE SPLIT PRODUCTS FIBRINOLYTIC FACTORS AND 30000053 INHIBITORS; ALPHA-2 305 85410 $ 102.72 ACTIVE ANTIPLASMIN FIBRINOLYTIC FACTORS AND 30000054 INHIBITORS; PLASMINOGEN, 305 85420 $ 87.12 ACTIVE EXCEPT ANTIGENIC ASSAY 27000666 FILTER ANTI-REFLUX 270 A7013 $ 250.00 ACTIVE 27000659 FILTER BACTERIA 270 A7013 $ 104.00 ACTIVE 27000767 FINGER STICK LANCET 270 A4259 $ 8.00 ACTIVE 32000096 FINGER(S) 2V OR MORE 320 73140 $ 1,487.50 ACTIVE 25901301 FIORICET TAB 250 J8499 $ 24.00 ACTIVE 25900478 FLAGYL 250MG TABLET 250 J8499 $ 69.00 ACTIVE 25900479 FLAGYL 500MG TABLET 250 J8499 $ 84.00 ACTIVE 25900481 FLECAINIDE 50MG TABLET 250 J8499 $ 18.00 ACTIVE 25900482 FLEET ENEMA 250 J3490 $ 205.50 ACTIVE 25900486 FLOMAX 0.4MG CAPSULE 250 J8499 $ 45.00 ACTIVE 25900487 FLONASE 0.05% NASAL SPRAY 250 J3490 $ 960.00 ACTIVE 25900488 FLORINEF 0.1MG TABLET 250 J8499 $ 22.00 ACTIVE FLOW CYTOMETRY CELL 31100006 311 88185 $ 135.52 ACTIVE SURFACE MARKER FLOW CYTOMETRY FIRST 31100008 311 88184 $ 866.18 ACTIVE MARKER FLOW CYTOMETRY 31100009 311 88187 $ 501.20 ACTIVE INTERPERTATION 25901939 FLUCAINE OPTH SOL 5ML 250 J3490 $ 74.56 ACTIVE FLUID MANAGEMENT PACK, 27200890 272 A4649 $ 342.60 ACTIVE ENDOSCOPY 25901941 FLUMAZENIL 1MG/10ML 250 J3490 $ 12.08 ACTIVE FLUOR GUIDE NDL 32000097 320 77002 $ 1,255.80 ACTIVE PLACE/ASP/BX FLUORESCEIN +BENOXINATE 25901942 250 J3490 $ 24.00 ACTIVE OPHTH 0.25% SOLN 27000691 FLUORESCEIN DROPS 5ML 270 J3490 $ 20.00 ACTIVE FLUORESCENT NONINFECTIOUS 30200016 AGENT ANTIBODY; SCREEN, 302 86255 $ 160.68 ACTIVE EACH ANTIBODY 25000207 FLUOR-I-STRIP 9MG STRIP 250 A9150 $ 24.00 ACTIVE 32000019 FLUORO <1 HOUR 320 76000 $ 2,257.50 ACTIVE 32000020 FLUORO >1 HOUR 320 76001 $ 7,134.00 ACTIVE 32000098 FLUORO GUIDE CVA DEVICE 320 77001 $ 1,092.68 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 32000099 FLUOROSCOPIC GUIDEI 320 77003 $ 1,552.88 ACTIVE 30100148 FOLATE RED BLOOD CELL 301 82747 $ 231.00 ACTIVE FOLEY CATH 22FR 75CC RIB 27000211 270 L4386 $ 1,712.00 ACTIVE BALLOON 25900500 FOLIC ACID 1MG TABLET 250 J8499 $ 30.00 ACTIVE 30100150 FOLIC ACID SERUM 301 82746 $ 196.08 ACTIVE FOLLICLE STIMULATING 30100153 HORMONE (FSH)- 301 83001 $ 247.80 ACTIVE GONADOTROPIN 45000147 FOLLOW UP VISIT 450 99027 $ 150.00 ACTIVE 32000102 FOOT 2 VIEW 320 73620 $ 1,232.00 ACTIVE 32000104 FOOT 3V OR MORE 320 73630 $ 1,386.00 ACTIVE FOOT DROP SPLINT, 27400008 RECUMBENT POSITIONING 274 L4398 $ 226.14 ACTIVE DEVICE, PREFABRICATED 27200668 FORCEPS PULMONARY 272 A4649 $ 2,511.00 ACTIVE 32000105 FOREARM 2 VIEWS 320 73090 $ 1,232.00 ACTIVE 25000211 FORTAZ 1GM VIAL 250 J0713 $ 156.00 ACTIVE 30200109 FRESH FROZEN PLASMA (450ML) 302 86927 $ 383.18 ACTIVE FRESH FROZEN PLASMA 1 39000004 390 P9017 $ 817.88 ACTIVE DONOR (EACH UNIT) 30200239 FROZEN BLOOD FREEZING EA 302 86930 $ 519.70 ACTIVE FRUCTOSAMINE/GLYCATED 30100152 301 82985 $ 201.12 ACTIVE PROTEIN 32000106 FULL BODY 1 VIEW CHILD 320 76010 $ 851.20 ACTIVE FULL THICKNESS GRAFT, FREE, 36000332 INC DIRECT CLOSURE OF 360 15240 $ 41,471.50 ACTIVE DONOR SITE; 20 SQ CM OR <

30600042 FUNGUS IDENTIFICATION (MOLD) 306 87107 $ 196.42 ACTIVE

30600043 FUNGUS/YEAST IDENTIFICATION 306 87106 $ 137.64 ACTIVE 25900507 FUROSEMIDE 20MG TAB 259 J8499 $ 8.00 ACTIVE 25900508 FUROSEMIDE 40MG TABLET 259 J8499 $ 24.00 ACTIVE GABAPENTIN 100MG CAPSULE 25901540 259 J8499 $ 30.00 ACTIVE (NEURONTIN) GADODIAMIDE (OMNISCAN) 25901869 250 A9579 $ 221.90 ACTIVE 287MG 15ML BTL GADODIAMIDE (OMNISCAN) 25901870 250 A9579 $ 257.35 ACTIVE 287MG 20ML VIAL 42000023 GAIT TRAINI EA 15MIN 450 97116 $ 246.40 ACTIVE 32000107 GALACTOGRAM 1 DUCT 403 77053 $ 1,358.84 ACTIVE 30000049 GALECTIN-3 301 82777 $ 301.70 ACTIVE GAMMAGLOBULIN SUBUNITS 30100156 301 82787 $ 106.92 ACTIVE IMMUNOGLOBIN-G1 2 3 4 GAMMA-GLUTAMYL 30100170 TRANSPEPTIDASE/TRANSFERAS 301 82977 $ 96.00 ACTIVE E 25901442 GARAMYCIN OPHTH OINT 3.5 GM 250 J3490 $ 193.20 ACTIVE GARAMYCN GENTAMICIN TO 25000294 636 J1580 $ 1,836.00 ACTIVE 80MG GARDNERELLA VAGINALIS, DNA 31000006 310 87510 $ 111.40 ACTIVE DIR PROBE 30600044 GAS LIQUID CHROMATOGRAPHY 306 87143 $ 167.04 ACTIVE GAS SAMPLING LINE W/M/M/ 27200902 272 A4649 $ 722.30 ACTIVE CONN 10' Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30100628 GASES BLOOD PH ONLY 301 82800 $ 132.00 ACTIVE 30100163 GASTRIC ACID FREE & TOTAL 301 82930 $ 80.52 ACTIVE 30900004 GASTRIC INTUBATION ANALYSIS 309 89130 $ 268.64 ACTIVE 75900001 GASTRIC LAVAGE 759 91105 $ 1,079.56 ACTIVE 30100164 GASTRIC OCCULT BLOOD 301 82271 $ 63.84 ACTIVE 30100165 GASTRIN 301 82941 $ 235.08 ACTIVE 25800095 GASTROVIEW 30ML 250 J3490 $ 115.50 ACTIVE 27200002 GAUZE >16 <=48 SQ IN W/BORDR 272 A6220 $ 28.00 ACTIVE 27000574 GAUZE 2X2 NONSTERILE; EA 270 A6216 $ 2.10 ACTIVE 30100166 GENERAL HEALTH PANEL 301 80050 $ 531.00 ACTIVE GENETIC VIRUS ISOLATE 30600096 306 87255 $ 125.43 ACTIVE HERPES SIMPLEX VIRUS GENTAMICIN (GARAMYCIN) PEDI 25000009 636 J1580 $ 77.25 ACTIVE 20MG 2ML SDVIAL GENTAMICIN 0.3% OPTH DROPS 25901863 250 J3490 $ 40.93 ACTIVE 5ML 25000012 GENTAMICIN 80MG 50ML IV 636 J1580 $ 57.33 ACTIVE GENTAMICIN 80MG/100ML 0.9% 25000013 636 J1580 $ 77.25 ACTIVE NACL 25000010 GENTAMICIN 80MG/20ML IV 636 J1580 $ 57.33 ACTIVE 30100167 GENTAMICIN PEAK 301 80170 $ 218.40 ACTIVE 30200112 GIARDIA ANTIBODY 302 86674 $ 196.20 ACTIVE 30600046 GIARDIA ANTIGEN 306 87329 $ 81.76 ACTIVE 30100171 GLIADIN ANTIBODY 301 83520 $ 207.24 ACTIVE GLOVE SURGICAL ESTEEM PI PF 27200886 272 A4930 $ 75.00 ACTIVE ANY SZ D-STAT SUB GLOVE, SURGICAL, LTX, 27200885 272 A4930 $ 15.90 ACTIVE ENCORE, ACCLAIM, PF, 7 27000610 GLOVES BIOGEL (ALL) 272 A4930 $ 108.00 ACTIVE 27000768 GLOVES NON STERILE 270 A4927 $ 8.00 ACTIVE 27000577 GLOVES STERILE (ALL SZS) 272 A4930 $ 8.00 ACTIVE 25900526 GLUCOPHAGE 500MG TAB 250 J8499 $ 24.00 ACTIVE 30100174 GLUCOSE 2HR POSTPRANDIAL 301 82950 $ 63.24 ACTIVE GLUCOSE BLOOD REAGENT 30100175 301 82948 $ 60.48 ACTIVE STRIP-FINGER STICK GLUCOSE CEREBROSPINAL 30100177 301 82945 $ 52.44 ACTIVE FLUID GLUCOSE QUANTITATIVE; 30100179 301 82947 $ 52.44 ACTIVE VENOUS BLOOD GLUCOSE TOLERANCE TEST 30100184 301 82951 $ 171.60 ACTIVE 3HR 1ST 3 SPEC GLUCOSE TOLERANCE TEST 30100185 301 82952 $ 52.32 ACTIVE ADDED SAMPLE GLUCOSE, BLOOD BY GLUCOSE 30900022 MONITORING DEVICE(S) FOR 301 82962 $ 39.36 ACTIVE HOME USE GLUCOSE-6-PHOSPHATE 30100178 301 82955 $ 129.24 ACTIVE DEHYDROGENASE 25900529 GLUCOTROL 10MG TABLET 250 J8499 $ 16.00 ACTIVE 25900530 GLUCOTROL 5MG TABLET 250 J8499 $ 24.00 ACTIVE 25901871 GLUTOSE 15 O/GEL 37.5GM TUBE 250 A9150 $ 8.75 ACTIVE GLYBURIDE (MICRONASE) 5MG 25901516 250 J8499 $ 30.00 ACTIVE TAB 25900535 GLYCERIN ADULT SUPP 250 J8498 $ 37.50 ACTIVE 25900004 GLYCERIN PEDI SUPP 250 J8498 $ 37.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25800071 GLYCINE 1.5% 3000ML 258 J3490 $ 104.48 ACTIVE 25901872 GOLYTELY 4,000ML SOLN 250 J3490 $ 47.68 ACTIVE 27100014 GOWNS ISOLATION 271 A4649 $ 48.00 ACTIVE 27000626 GOWNS SURGICAL 270 A4467 $ 120.00 ACTIVE 27000627 GOWNS SURGICAL XL (KC) 270 A4467 $ 224.00 ACTIVE 30600047 GRAM STAIN 306 87205 $ 57.00 ACTIVE 25901448 GRANULEX SPRAY 2 OZ 250 J3490 $ 391.00 ACTIVE 27200664 GRASPER REPOSABLE 272 A4649 $ 2,790.00 ACTIVE 91500001 GROUP PSYCHOTHERAPY 915 90853 $ 277.69 ACTIVE GUAIFENESIN 25901873 +DEXTROMETHORPHAN 250 J3490 $ 5.50 ACTIVE (ROBITUSSIN DM) OS 100/10MG 25900541 GUAIFENESIN 100MG/5ML SYR 259 J3490 $ 64.00 ACTIVE GUAIFENESIN DM 25000222 250 J3490 $ 14.00 ACTIVE 200MG/20MG/10ML 10ML UD GUAIFENESIN+DEXTROMETH 25901874 250 J8499 $ 5.50 ACTIVE 600/30MG TAB 27000212 GUIDE WIRE 3.2MM 270 C1769 $ 1,012.00 ACTIVE GUIDE WIRE HI-TORQUE BALANCE MIDDLEWIGHT 27200901 272 C1769 $ 150.00 ACTIVE UNIVERSAL .014 STRAIGHT TIP 3.0CM X 190CM GUIDEWIRE .021 SWANZ 27000213 270 C1769 $ 150.00 ACTIVE STRAIGHT F (CA10053) 27000214 GUIDEWIRE THREADED 1.1MM 270 C1769 $ 392.00 ACTIVE GUIDING CATHETER 6F .070 XB 27200900 272 C1714 $ 720.00 ACTIVE LAD 3.5 100CM 30100569 H PYLORI BREATH TESTING 301 83013 $ 898.08 ACTIVE 30100570 H PYLORI DRUG ADMIN 301 83014 $ 104.76 ACTIVE 30200115 HAEMOPHILUS INFLUENZA 302 86684 $ 211.20 ACTIVE 25900546 HALDOL 0.5MG TAB 250 J8499 $ 24.00 ACTIVE 25000746 HALDOL 1MG TAB 250 J8499 $ 24.00 ACTIVE

HALLUX RIGIDUS CORRECTION W/CHEILECTOMY, DEBRID & 36000297 CAPSULAR RELEASE OF FIRST 360 28291 $ 11,831.00 ACTIVE METATARSOPHALANGEAL JOINT; W/IMPLANT

25900551 HALOPERIDOL 5MG TABLET 250 J8499 $ 30.00 ACTIVE 32000109 HAND 2 VIEWS 320 73120 $ 1,249.50 ACTIVE 32000108 HAND 3V OR MORE 320 73130 $ 1,454.50 ACTIVE HANDLE EXTRA LONG ENDO 61A 27200651 272 A4649 $ 4,812.00 ACTIVE ULTRA HANDLE SPECIMEN IN OTHER 30000008 300 99001 $ 280.00 ACTIVE FACILITY-LAB HANDLING/CONVEYANCE OF 30000050 SPECIMEN FOR TRANSFER TO A 300 99000 $ 20.00 ACTIVE LABORATORY 30100186 HAPTOGLOBIN 301 83010 $ 167.64 ACTIVE 30100181 HBA1C GLYCOHEMOGLOBIN 301 83036 $ 129.48 ACTIVE 41300001 HBO 413 99183 $ 1,072.62 ACTIVE 41300002 HBO PER 30 MINUTE 413 C1300 $ 1,072.62 ACTIVE 30100525 HBV DNA 306 87517 $ 158.64 ACTIVE HCG - BETA HUMAN CHORIONIC 30100053 GONADOTROPHIN 301 84702 $ 200.76 ACTIVE QUANTITATIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30500079 HCT SPUN 305 85013 $ 84.00 ACTIVE HDL CHOLESTEROL DIRECT 30100187 301 83718 $ 109.20 ACTIVE MEASURE HEALTH AND BEHAVIORAL 91400005 914 96152 $ 277.69 ACTIVE INTERVENTION EA 15 MIN HEAVY METAL QUANTITATIVE 30100188 301 83015 $ 251.28 ACTIVE (BLOOD) HELICOBACTER PYLORIC 30600049 306 87338 $ 191.76 ACTIVE ANTIGEN HELICOBACTOR PYLORI 30200116 302 86677 $ 132.28 ACTIVE ANTIBODY 30500024 HEMATOCRIT 305 85014 $ 31.56 ACTIVE HEMIPHALANGECTOMY/INTERPH ALANGEAL JOINT 36000286 360 28160 $ 13,322.00 ACTIVE EXCISION,TOE,PROXIMAL END PHALANX, EACH 80100001 HEMODIALYSIS TREATMENT 801 90935 $ 4,171.80 ACTIVE 30500026 HEMOGLOBIN 305 85018 $ 31.56 ACTIVE 30100190 HEMOGLOBIN (PLASMA) 301 83051 $ 97.44 ACTIVE HEMOGLOBIN 30100194 301 83021 $ 240.72 ACTIVE ELECTROPHORESIS HEMOLYSINS AND AGGLUTININS 30200117 302 86941 $ 161.40 ACTIVE (INCUBATED) HEMORRHOIDECTOMY 45000066 INTERNAL AND EXTERNAL 450 46255 $ 3,682.20 ACTIVE SINGLE COLUMN/GROUP 30100191 HEMOSIDERIN (QUALITATIVE) 301 83070 $ 63.24 ACTIVE 27200329 HEMOSPLIT CATHETER 19CM 272 C1750 $ 4,272.04 ACTIVE 25901852 HEPARIN 1000 UNIT/ML 1ML VIAL 636 J1644 $ 9.20 ACTIVE 25000230 HEPARIN 25 000U/500ML D5W 636 J1644 $ 262.00 ACTIVE 63600183 HEPARIN 25,000/250ML IV 636 J1644 $ 35.40 ACTIVE 63600192 HEPARIN FLUSH 30U 3ML 636 J1642 $ 14.00 ACTIVE 63600156 HEPARIN FLUSH 500UNITS/5ML 636 J1642 $ 5.50 ACTIVE 27000217 HEPARIN LOCK 270 J1642 $ 60.00 ACTIVE HEPARIN LOCK FLUSH 100 U/ML 25000233 636 J1642 $ 14.00 ACTIVE 1ML VIAL HEPARIN LOCK FLUSH 500U/5ML 25000235 636 J1642 $ 10.00 ACTIVE SYR 32000111 HEPATIC VENOGRAM 320 75889 $ 6,955.00 ACTIVE 30200119 HEPATITIS A ANTIBODY TOTAL 302 86708 $ 165.12 ACTIVE HEPATITIS A IMMUNOGLOBIN-M 30200120 302 86709 $ 150.12 ACTIVE ANTIBODY 30200125 HEPATITIS B ANTIBODY TEST 302 86707 $ 154.20 ACTIVE 30200121 HEPATITIS B CORE ABIGM 302 86705 $ 156.96 ACTIVE HEPATITIS B CORE ANTIBODY 30200122 302 86704 $ 143.16 ACTIVE (TOTAL) HEPATITIS B E-ANTIGEN ENZYME 30600055 306 87350 $ 153.72 ACTIVE IMMUNOASSAY HEPATITIS B NUCLEIC ACID 30600052 306 87516 $ 467.88 ACTIVE AMPLIFICATION PROBE HEPATITIS B SURFACE 30200128 302 86706 $ 143.16 ACTIVE ANTIBODY HEPATITIS B SURFACE ANTIGEN 30600053 306 87340 $ 137.76 ACTIVE ENZYME IMMUNOASSAY 63600045 HEPATITIS B VACCINE 636 90746 $ 794.00 ACTIVE 30200126 HEPATITIS C ANTIBODY 302 86803 $ 190.20 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30600057 HEPATITIS C GENOTYPE 306 87902 $ 953.52 ACTIVE HEPATITIS C NUCLEIC ACID 30600056 306 87521 $ 467.88 ACTIVE AMPLIFICATION PROBE HEPATITIS C VIRUS B-DNA RNA 30600050 306 87522 $ 571.20 ACTIVE QUANTIFICATION HEPATOBILIARY SYSTEM IMAGING, INC GALLBLADDER WHEN PRESENT; 34000001 340 78227 $ 22,294.00 ACTIVE W/PHARMACOLOGIC INTERVENTION, INC QUANT MEAS; WHEN PERFORMED HERPES SIMPLEX TYPE 2 30200130 302 86696 $ 193.20 ACTIVE ANTIBODY HERPES SIMPLEX TYPE I 30200131 302 86695 $ 175.80 ACTIVE ANTIBODY HERPES SIMPLEX VIRUS 30200244 306 87529 $ 129.99 ACTIVE AMPLIFIED PROBE TECHNIQUE HERPES SIMPLEX VIRUS 30100199 301 84182 $ 350.52 ACTIVE WESTERN BLOT ANALYSIS HERPS SIMPLEX VIRUS 30600136 306 87530 $ 158.64 ACTIVE QUANTIFICATION 25800039 HESPAN 6% 500ML 250 J3490 $ 516.00 ACTIVE HETEROPHILE ANTIBODIES; 30200153 302 86308 $ 69.00 ACTIVE SCREENING 30200132 HETEROPHILE ANTIBODY TITER 302 86309 $ 86.16 ACTIVE 30100193 HGB ELECTROPHORESIS 301 83020 $ 171.60 ACTIVE 25900556 HIBICLENS 4% TOPICAL 259 A4248 $ 57.45 ACTIVE HIGH RESOLULTION 30100195 LIPOPROTEIN FRACTIONATION 301 83701 $ 235.20 ACTIVE AND QUANTIFICATION 32000113 HIP DURING SURGERY 320 73530 $ 1,391.60 ACTIVE 32000225 HIP UNI W/PELVIS 2-3 VIEWS 320 73502 $ 2,092.50 ACTIVE HIP UNILAT W/PELVIS 1VIEW 32000228 320 73501 $ 1,265.50 ACTIVE RADIOLOGICAL 32000115 HIPS BIL 2V W PELV 320 73521 $ 1,898.50 ACTIVE 32000118 HIPS BIL 3-4 V W PELV 320 73522 $ 2,191.50 ACTIVE 30200133 HISTOPLASMA ANTIBODY 302 86698 $ 166.56 ACTIVE 30700015 HISTOPLASMA CAPSULATUM 306 87385 $ 44.40 ACTIVE 30200134 HIV 1 ANTIBODY 302 86701 $ 118.44 ACTIVE HIV 1 B-DNA RNA 30600059 306 87536 $ 1,134.60 ACTIVE QUANTIFICATION HIV-1 DNA PCR AMPLIFIED 30600060 306 87535 $ 467.88 ACTIVE PROBE HIV-1/HIV-2 ANTIBODY SINGLE 30200135 302 86703 $ 182.76 ACTIVE ASSAY 27200500 HME FILTER 272 A7507 $ 16.00 ACTIVE 30100196 HOMOCYSTEINE 301 83090 $ 224.88 ACTIVE 30100198 HOMOVANILLIC ACID (HVA) 301 83150 $ 268.92 ACTIVE 27000218 HOSE AE IMPER LRG 270 A6533 $ 624.00 ACTIVE 27000219 HOSE AE IMPERV MED 270 A6533 $ 158.00 ACTIVE 27000220 HOSE AE IMPERV SM 270 A6533 $ 158.00 ACTIVE 27000221 HOSE AE IMPERV WS-MD-LN 270 A6533 $ 286.00 ACTIVE 27000222 HOSE AE TED TH-LG-LN 270 A6533 $ 396.00 ACTIVE 27000223 HOSE AE TED TH-LG-RG 270 A6533 $ 396.00 ACTIVE 27000224 HOSE AE TED TH-LG-SH 270 A6533 $ 90.00 ACTIVE 27000225 HOSE AE TED TH-MD-LN 270 A6533 $ 396.00 ACTIVE 27000226 HOSE AE TED TH-MD-RG 270 A6533 $ 396.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000227 HOSE AE TED TH-MD-SH 270 A6533 $ 396.00 ACTIVE 27000228 HOSE AE TED TH-SM-LN 270 A6533 $ 396.00 ACTIVE 27000229 HOSE AE TED TH-SM-RG 270 A6533 $ 90.00 ACTIVE 27000230 HOSE AE TED TH-SM-SH 270 A6533 $ 90.00 ACTIVE 27000231 HOSE AE TED WS-LG-LN 270 A6530 $ 224.00 ACTIVE 27000232 HOSE AE TED WS-LG-RG 270 A6530 $ 130.00 ACTIVE 27000233 HOSE AE TED WS-SM-LN 270 A6530 $ 130.00 ACTIVE 27000234 HOSE AE TED WS-SM-RG 270 A6530 $ 130.00 ACTIVE 27000235 HOSE AE TED WS-XLG-LN 270 A6530 $ 130.00 ACTIVE 27000236 HOSE AE TED WS-XLG-RG 270 A6530 $ 224.00 ACTIVE 27000237 HOSE KNEE HI/LARGE LONG 270 A6530 $ 28.00 ACTIVE 27000238 HOSE KNEE HI/LARGE REG 270 A6530 $ 28.00 ACTIVE 27000239 HOSE KNEE HI/MEDIUM LONG 270 A6530 $ 28.00 ACTIVE 27000240 HOSE KNEE HI/MEDIUM REG 270 A6530 $ 28.00 ACTIVE 27000241 HOSE KNEE HI/SMALL LONG 270 A6530 $ 28.00 ACTIVE 27000242 HOSE KNEE HI/SMALL REG 270 A6530 $ 28.00 ACTIVE 27000243 HOSE KNEE HI/X-LARGE LONG 270 A6530 $ 28.00 ACTIVE 27000244 HOSE KNEE HI/X-LARGE REG 270 A6530 $ 28.00 ACTIVE 27000603 HOSE TED KNEE HIGH (ALL) 270 A6533 $ 244.00 ACTIVE HOSE TED THIGH LENGTH X- 27000601 270 A6533 $ 196.00 ACTIVE LARGE BARIATRIC HOSE TED THIGH LENGTH XX- 27000602 270 A6533 $ 648.00 ACTIVE LARGE BARIATRIC 27000245 HOSE THIGH LG LNG WBLT 270 A6533 $ 202.00 ACTIVE 27000246 HOSE THIGH LG REG WBLT 270 A6533 $ 202.00 ACTIVE 27000247 HOSE THIGH MED LNG WBLT 270 A6533 $ 202.00 ACTIVE 27000248 HOSE THIGH MED REG WBLT 270 A6533 $ 202.00 ACTIVE 27000249 HOSE THIGH SM LNG WBLT 270 A6533 $ 202.00 ACTIVE 27000250 HOSE THIGH XLG LNG WBLT 270 A6533 $ 202.00 ACTIVE 27000251 HOSE THIGH XLG REG WBLT 270 A6533 $ 202.00 ACTIVE HOSPITAL DISCHARGE DAY 98700007 987 99238 $ 1,781.75 ACTIVE MANAGEMENT; UP TO 30 MIN 42000024 HOT/COLD PACKS 450 97010 $ 165.40 ACTIVE 25900559 HUMALOG 30UNITS/3ML 250 J3490 $ 802.00 ACTIVE HUMAN GROWTH HORMONE 30200114 302 86277 $ 209.88 ACTIVE ANTIBODY (HGH) HUMAN GROWTH HORMONE 30100516 301 83003 $ 61.74 ACTIVE HGH HUMAN LEUKOCYTE ANTIGEN 30200136 302 86812 $ 199.64 ACTIVE B27 HUMAN T-LYMPHOTROPHIC VIRUS/HUMAN 30200137 302 86689 $ 258.12 ACTIVE IMMUNODEFICIENCY VIRUS CONFIRMATORY ANTIBODY 32000116 HUMERUS 2V OR MORE 320 73060 $ 1,282.50 ACTIVE HUMULIN R (REGULAR) INSULIN 25200012 250 J1815 $ 780.00 ACTIVE 10ML HURRICAINE (CETACAINE) 25900264 250 J3490 $ 854.00 ACTIVE SPRAY PER DOSE HYDRALAZINE (APRESOLINE) 25000721 250 J8499 $ 24.00 ACTIVE 10MG TAB HYDRALAZINE (APRESOLINE) 25901875 250 J8499 $ 24.00 ACTIVE 50MG TAB 63600152 HYDRALAZINE 20MG/1ML SDVIAL 636 J0360 $ 23.94 ACTIVE 25900567 HYDRALAZINE HCL 25MG TAB 250 J8499 $ 24.00 ACTIVE 25900568 HYDRALAZINE HCL 50MG TAB 250 J8499 $ 24.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS HYDRATION IV INFUS INIT 31MINS- 45000018 450 96360 $ 1,267.50 ACTIVE 1HR HYDRATION IV INFUSION ADD TO 45000017 450 96361 $ 277.88 ACTIVE 8 HYDROCHLOROTHIAZIDE HCTZ 25900553 259 J8499 $ 10.00 ACTIVE 12.5MG CAP HYDROCHLORTHIAZIDE 25MG 25901453 250 J8499 $ 24.00 ACTIVE TAB 25900573 HYDROCODONE/APAP 10/500MG 250 J8499 $ 10.00 ACTIVE HYDROCODONE/APAP 25901963 250 J8499 $ 12.00 ACTIVE 7.5MG/325MG 15ML ORAL SOL 25900575 HYDROCORTISNE 1% 30GM CRM 250 A6250 $ 78.00 ACTIVE HYDROCORTISONE 1% CREAM 25901454 250 A6250 $ 48.00 ACTIVE 1OZ HYDROCORTISONE CREAM 25901876 250 A6250 $ 5.25 ACTIVE 0.9GM PACKET 25901456 HYDROGEN PEROXIDE 40Z LIQ 250 J3490 $ 60.00 ACTIVE HYDROMORPHONE (DILAUDID) 25000243 636 J1170 $ 414.00 ACTIVE 2MG/1ML SDVIAL UP TO 4MG HYDROMORPHONE 1MG/ML 63600181 636 J1170 $ 212.00 ACTIVE SYRINGE HYDRO-SURG WOUND 27000750 270 A4649 $ 4,799.70 ACTIVE IRRIGATOR 30100200 HYDROXYCORTICOSTEROID 301 83491 $ 233.64 ACTIVE HYDROXYZINE 10MG/5ML ORAL 25000034 250 J8499 $ 85.56 ACTIVE SYRUP 25901877 HYDROXYZINE 25MG TAB 250 J8499 $ 30.00 ACTIVE 25900579 HYDROXYZINE PAM 25MG PO 250 J8499 $ 30.00 ACTIVE HYOSCYAMINE (LEVSIN) 0.125MG 25900661 250 J8499 $ 30.00 ACTIVE TABLET HYPERTONIC SALINE 3% 500ML 25000031 250 J7131 $ 13.78 ACTIVE IV FL 32000117 HYSTEROSALPINGOGRAM 320 74740 $ 2,648.80 ACTIVE

HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION 36000368 (EG, ENDOMETRIAL RESECTION, 360 58563 $ 12,704.00 ACTIVE ELECTROSURGICAL ABLATION, THERMOABLATION)

I&D COMPLEX POST OP 76100013 761 10180 $ 12,053.66 ACTIVE INFECTION I&D OF EPIDIDYMIS, TESTIS, 36000265 SCROTAL SPACE 360 54700 $ 11,190.00 ACTIVE (ABSCESS/HEMATOMA) I&D OF HEMATOMA SEROMA OR 76100016 761 10140 $ 7,678.50 ACTIVE FLUID I&D OF ISCHIORECTAL/PERIRECAL 36000299 360 46040 $ 20,460.00 ACTIVE ABSCESS (SEPARATE PROCEDURE) 27000252 IAB LINEAR 7.5 34CC (C10433) 272 A4301 $ 10,550.00 ACTIVE 27000253 IAB LINEAR 7.5 40CC (C10434) 272 A4301 $ 10,550.00 ACTIVE 27000254 IAB STATLOCK 272 A4301 $ 5,294.00 ACTIVE 25901459 IBUPROFEN 400MG TAB 259 J8499 $ 24.00 ACTIVE 25901950 IBUPROFEN 50MG 1.25ML OS 259 J3490 $ 24.00 ACTIVE 25400002 IBUTILIDE 1MG/10ML VIAL 636 J1742 $ 482.60 ACTIVE 63600048 IBUTILIDE FUMARATE 1MG 636 J1742 $ 482.72 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ICAR CATHETER ABLATION 48100072 481 93650 $ 73,900.26 ACTIVE ATRIOVENTR NODE FUNCTION ICD EVAL S/D ICD LEADS AT 48000034 480 93640 $ 14,381.36 ACTIVE INITIAL IMPLANT ICD PULSE GENERATOR 48000035 480 93641 $ 27,559.98 ACTIVE TESTING S/D ICD 27000255 ICE PACK STAY DRY LG (16256) 270 A9273 $ 52.00 ACTIVE IDENTIFY CULTURED AEROBIC 30600018 306 87077 $ 107.64 ACTIVE BACTERIA IDENTIFY EACH ANAEROBIC 30600061 306 87076 $ 107.64 ACTIVE ORGANISM ILIAC ANGIO WITH LEFT HEART 48100018 481 G0278 $ 53,830.57 ACTIVE CATH (NON-SELECTIVE) 48100056 ILIAC REVASC W /STENT ADD ON 481 37223 $ 2,567.00 ACTIVE 48100054 ILIAC REVASC W/STENT 481 37221 $ 48,600.00 ACTIVE 48100055 ILIAC REVASC. ADD ON 481 37222 $ 3,336.00 ACTIVE IMAGE CATH FLUID COLXN VISC; 36000138 360 49405 $ 8,880.82 ACTIVE PERCUTANEOUS 36000135 IMAGE CATH FLUID PERI/RETRO 360 49406 $ 8,880.82 ACTIVE 30100202 IMIPRAMINE 301 80174 $ 202.86 ACTIVE 27000257 IMMOB ARM LARGE 270 L3702 $ 38.00 ACTIVE 27000258 IMMOB ARM MEDIUM 270 L3702 $ 46.00 ACTIVE 27000259 IMMOB ARM SMALL 270 L3702 $ 260.00 ACTIVE 27000260 IMMOB ARM XLG 270 L3702 $ 50.00 ACTIVE 27000261 IMMOB KNEE POST/OP LGE 274 L1830 $ 650.00 ACTIVE 27000262 IMMOB KNEE POST/OP MED 274 L1830 $ 650.00 ACTIVE 27000263 IMMOB KNEE POST/OP SML 274 L1830 $ 650.00 ACTIVE 27000264 IMMOB KNEE POST/OP XLRG 274 L1830 $ 114.00 ACTIVE 27000256 IMMOB KNEE POST/OP XXL 2 270 L1830 $ 114.00 ACTIVE 27000265 IMMOB KNEE POST/OP XXLG 274 L1830 $ 112.00 ACTIVE 27000266 IMMOB SHLDR MED 270 L3660 $ 650.00 ACTIVE 27000267 IMMOB SHLDR SM 270 L3660 $ 650.00 ACTIVE 27000268 IMMOB SHLDR X- LRG 270 L3660 $ 650.00 ACTIVE 27000269 IMMOB SHLDR XL 270 L3660 $ 650.00 ACTIVE 27000270 IMMOB ULTRASLING LARGE 270 L3670 $ 52.00 ACTIVE 27000271 IMMOB ULTRASLING MEDIUM 270 L3670 $ 366.00 ACTIVE 27000272 IMMOB ULTRASLING SMALL 270 L3670 $ 50.00 ACTIVE 27400005 IMMOBILIZER KNEE LG 274 L1830 $ 430.00 ACTIVE IMMOBILIZER SHOULDER 27000273 270 L3660 $ 80.00 ACTIVE ELASTIC (16227) IMMOBILIZER SHOULDER LG 27000274 270 L3660 $ 80.00 ACTIVE (16228) IMMOBILIZER SHOULDER MED 27000275 270 L3660 $ 150.00 ACTIVE FEMALE (16230) IMMOBILIZER SHOULDER MED 27000276 270 L3660 $ 176.00 ACTIVE MALE (16229) IMMOBILIZER SHOULDER XLG 27000277 270 L3660 $ 204.00 ACTIVE FEMALE (16302) IMMOBILIZER SHOULDER XLG 27000278 270 L3660 $ 204.00 ACTIVE MALE (16301) IMMOBILIZER SLINE & SWATHE 27000279 270 L3671 $ 86.00 ACTIVE AR 30200138 IMMUNE COMPLEX ASSAY 302 86332 $ 324.96 ACTIVE IMMUNIZ ADMIN 1 VACC 77100006 771 90471 $ 277.88 ACTIVE SINGL/COMBO Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS IMMUNOASSAY 30200139 IMMUNOELECTROPHORESIS 302 86320 $ 359.04 ACTIVE (SERUM) IMMUNOASSAY 30200140 IMMUNOELECTROPHORESIS 302 86325 $ 298.20 ACTIVE (URINE) IMMUNOASSAY, INFECTIOUS AGENT ANTIBODY, 30200209 302 86317 $ 55.55 ACTIVE QUANTITATIVE, NOT OTHERWISE SPECIFIED IMMUNOCYTHOCHEMISTRY 31200004 312 88342 $ 336.34 ACTIVE EACH ANTIBODY IMMUNOFIXATION 30200141 302 86334 $ 297.96 ACTIVE ELECTROPHORESIS (SERUM) 30100553 IMMUNOFIXATION URINE 302 86335 $ 108.69 ACTIVE IMMUNOFLUORESCENT STUDY, 31000001 EACH ANTIBODY; DIRECT 312 88346 $ 492.66 ACTIVE METHOD 30100159 IMMUNOGLOBIN-E 301 82785 $ 219.48 ACTIVE 30100157 IMMUNOGLOBULINS IGA IGG IGM 301 82784 $ 124.08 ACTIVE 27200333 IMP 1.8MM PIN 22MM 201.972 272 C1713 $ 616.06 ACTIVE IMP BARD FIRM LUBRISTENT 27200362 272 C2617 $ 1,698.08 ACTIVE 030724 27600001 IMP RESTOR CATARACT LENS 276 V2632 $ 7,693.42 ACTIVE IMPED CONT ENDOMETRIAL 27000280 270 A4264 $ 10,344.00 ACTIVE ABLATION DISP DEVICE KIT IMPLANTATION OF MESH FOR 36000234 HERNIA REPAIR OR FOR 360 49568 $ 14,018.50 ACTIVE CLOSURE 41000006 INCENT SPIRO INITIAL 410 G0237 $ 276.92 ACTIVE 41000030 INCENTIVE SPIROMETRY INITIAL 410 94664 $ 539.53 ACTIVE INCENTIVE SPIROMETRY 41000031 410 94799 $ 263.08 ACTIVE INSTRUCTION INCISION & DRAINAGE DEEP 36000192 ABSCESS, BURSA/HEMATOMA 360 27301 $ 26,064.00 ACTIVE THIGH/KNEE REGION INCISION & DRAINAGE, 36000251 LEG/ANKLE; DEEP 360 27603 $ 20,139.50 ACTIVE ABSCESS/HEMATOMA INCISION & REMOVAL OF FB 51000024 361 10120 $ 5,349.50 ACTIVE SKIN SIMPLE SUB TISSUE INCISION AND DRAINAGE OF 45000108 ABSCESS COMPLICATED/ 450 10061 $ 9,252.00 ACTIVE MULTIPLE INCISION AND DRAINAGE OF 45000080 450 10060 $ 5,022.00 ACTIVE ABSCESS SIMPLE/ SINGLE INCISION AND DRAINAGE OF 45000107 450 10081 $ 8,766.00 ACTIVE PILONIDAL CYST COMPLICATED INCISION AND REMOVAL OF FB, 36100028 SUBCUTANEOUS TISSUES; 361 10121 $ 9,558.00 ACTIVE COMPLICATED INCISION, EXTENSOR TENDON 36000296 SHEATH, WRIST (EG, 360 25000 $ 5,210.52 ACTIVE DEQUERVAINS DISEASE) INDERAL (PROPRANOLOL) 10MG 25900596 250 J8499 $ 24.00 ACTIVE TAB INDERAL (PROPRANOLOL) 20MG 25900597 250 J8499 $ 30.00 ACTIVE TABS Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INDERAL (PROPRANOLOL) 40MG 25900598 250 J8499 $ 18.40 ACTIVE TAB 30600062 INDIA INK PREP 306 87210 $ 151.34 ACTIVE 25000255 INDIGO CARMINE 0.8PC AMP 250 J3490 $ 932.00 ACTIVE INDIVIDUAL PSYCHOTHERAPY 30 91400001 914 90832 $ 1,159.20 ACTIVE MINUTES 25900602 INDOCIN 25MG CAPS 250 J8499 $ 24.00 ACTIVE 32000021 INF VENA CAVA GRAM 320 75825 $ 6,607.50 ACTIVE INFECTIOUS AGENT ANTIGEN 30000006 DETECTION BY IMMUNOASSAY 300 87427 $ 740.00 ACTIVE TECHNIQUE,[EIA], [ELISA], [IMCA]

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), 30000020 NOT OTHERWISE SPECIFIED; 300 87799 $ 238.00 ACTIVE QUANTIFICATION, EACH ORGANISM

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); 30000017 300 87481 $ 194.50 ACTIVE CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); 30000018 300 87512 $ 232.00 ACTIVE GARDNERELLA VAGINALIS, QUANTIFICATION INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); 30000019 300 87661 $ 194.95 ACTIVE TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECHNIQUE

INFECTIOUS AGENT DETECTION 30600065 306 87798 $ 467.88 ACTIVE BY NUCLEIC ACID DNA INFLATION DEVICE. 27200917 BASIXCOMPAK .30ATM/BAR 272 A4649 $ 175.05 ACTIVE .20ML INFUSION PUMP, IMPLANTABLE, 27000774 270 E0782 $ 12,932.31 ACTIVE NON-PROGRAMMABLE INFUSION SET 3 NDL FREE 27200915 272 S1015 $ 161.10 ACTIVE VALVE INITIAL HOSP CARE,COMPREHENSIVE HX; 98700002 987 99222 $ 3,369.25 ACTIVE COMPREHENSIVE EXAM; MED DECISION MOD COMPLEX INITIAL HOSP CARE,COMPREHENSIVE 98700003 987 99223 $ 4,990.75 ACTIVE HX;COMPREHENSIVE EXAM;MED DECISION HIGH COMPLEX

INITIAL HOSPITAL CARE, DETAIL/COMPREHENSV 98700001 987 99221 $ 2,494.00 ACTIVE HX;DETAIL/COMPREHENSV EXAM;MED DEC STRTFWD/LOW

INITIAL TX, FIRST DEGREE BURN, 45000129 WHEN NO MORE THAN LOCAL 450 16000 $ 2,394.00 ACTIVE TREATMENT IS REQUIRED Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INJ ADENOSINE 6MG/2ML VIAL 63600007 636 J0153 $ 540.00 ACTIVE PER 1MG 36000159 INJ AIR/CON PERIT CAV 360 49400 $ 1,986.10 ACTIVE 25000225 INJ AMIDATE 20MG/10 ML VIAL 250 J3490 $ 273.84 ACTIVE 25100031 INJ AMPICILLIN 1GM VIAL 636 J0290 $ 131.00 ACTIVE INJ AORTOGRAPHY DURING 48100002 481 93544 $ 1,600.34 ACTIVE HEART C 36000160 INJ ARTHRO ANKLE 360 27648 $ 1,779.46 ACTIVE 36000161 INJ ARTHRO ELBOW 360 24220 $ 1,888.20 ACTIVE 36000162 INJ ARTHRO HIP 360 27093 $ 2,193.64 ACTIVE 36000163 INJ ARTHRO KNEE 360 27370 $ 1,847.78 ACTIVE 36000164 INJ ARTHRO SHOULDER 360 23350 $ 1,738.58 ACTIVE 36000165 INJ ARTHRO TMJ 360 21116 $ 1,801.64 ACTIVE 36000166 INJ ARTHRO WRIST 360 25246 $ 1,924.50 ACTIVE INJ ATARAX (HYDROXYZINE) TO 25000297 250 J3410 $ 114.00 ACTIVE 25MG 25000722 INJ ATROPINE 0.4 MG VIAL 636 J0461 $ 136.50 ACTIVE INJ ATROPINE 1MG/10ML 25000723 636 J0461 $ 456.00 ACTIVE ABBOJECT 25000262 INJ AZITHROMYCIN 500MG 636 J0456 $ 417.00 ACTIVE INJ BICILLIN LA PER 100 000 25901820 636 J0561 $ 285.00 ACTIVE UNITS 25000726 INJ BUMEX 1MG 4ML VIAL 250 J3490 $ 106.50 ACTIVE INJ BUPIVACAINE 0.25% 30ML 25100006 250 J3490 $ 76.50 ACTIVE VIAL INJ BUPIVACAINE 0.5% (150MG) 25100007 250 J3490 $ 154.50 ACTIVE +EPI 30ML VIAL 36000168 INJ C1 C2 MYELOGRAM 360 61055 $ 5,577.26 ACTIVE 30200280 INJ CANDIDA SKIN TEST 302 86485 $ 48.65 ACTIVE 25000728 INJ CARDIZEM 25MG/5ML VIAL 250 J3490 $ 402.00 ACTIVE INJ CEFAZOLIN 1 GM VIAL PER 25100014 636 J0690 $ 227.00 ACTIVE 500MG 25000270 INJ CEFEPIME HCL 500MG VIAL 636 J0692 $ 195.00 ACTIVE 25000389 INJ CEFOXITIN 2 MG VIAL 636 J0694 $ 342.00 ACTIVE 25000271 INJ CEFOXITIN SODIUM 1GM VIAL 636 J0694 $ 205.50 ACTIVE INJ CEFTRIAXONE (ROCEPHIN) 25200126 636 J0696 $ 141.50 ACTIVE ADDV 1GM 20ML SDVIAL 63600186 INJ CEFTRIAXONE 2GM VIAL 636 J0696 $ 126.27 ACTIVE 25000730 INJ CEFTRIAXONE 500MG VIAL 636 J0696 $ 270.00 ACTIVE INJ CELESTONE 6MG/1ML 25200015 636 J0702 $ 320.00 ACTIVE 30MG/5ML VIAL INJ CERVICAL/THORACIC 36000167 TRANSFORAMINAL EPIDURAL, 360 64479 $ 4,614.74 ACTIVE WITH IMAGING GUIDANCE 25200026 INJ CLAFORAN 500MG VIAL 636 J0698 $ 144.00 ACTIVE INJ CLINDAMYCIN PHOSPHATE 25000863 250 S0027 $ 131.00 ACTIVE 300 MG INJ CLINDAMYCIN PHOSPHATE 25000864 250 S0077 $ 131.00 ACTIVE 300MG-NOT COV BY MCR 63600130 INJ CLONIDINE HCL 1MG VIAL 636 J0735 $ 609.50 ACTIVE 25000494 INJ COMPAZINE 10MG/2ML VIAL 636 J0780 $ 112.50 ACTIVE 48100003 INJ CORONARIES 481 93545 $ 1,600.34 ACTIVE 48100004 INJ CORONARIES S&I 481 93555 $ 1,020.74 ACTIVE 25000136 INJ D50W 50ML SYRINGE 250 J3490 $ 585.00 ACTIVE 36000156 INJ DACRYOCYSTOGRAM 360 68850 $ 985.60 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INJ DECADRON 10MG/ML PER 25000142 636 J1100 $ 388.00 ACTIVE 1MG INJ DECADRON 4MG/1ML (PER 25000844 250 J1100 $ 28.50 ACTIVE 1MG)VIAL INJ DEPO MEDROL 40MG/ML 25000153 636 J1030 $ 114.00 ACTIVE VIAL INJ DEPO MEDROL 80MG/ML 25901812 636 J1040 $ 93.75 ACTIVE VIAL INJ DEXAMETHASONE 4MG VIAL 25000158 636 J1100 $ 28.00 ACTIVE PER 1MG INJ DIAG/THERAP NOT INC NEUROLYTIC SUBST. INCL 45000136 NEEDLE/CATH PLACEMENT; 450 62323 $ 4,972.00 ACTIVE LUMBAR/SACRAL W/IMAGING GUIDANCE

INJ DIAGNOSTIC/THERAPEAUTIC AGENT PARAVERT FACET JOINT 36100019 361 64494 $ 2,592.00 ACTIVE W/IMAG GUID;LUMBAR/SACRAL; SECOND LEVEL

INJ DIAGNOSTIC/THERAPEAUTIC AGENT PARAVERT FACET JOINT 36100018 361 64493 $ 4,500.00 ACTIVE W/IMAG GUID;LUMBAR/SACRAL; SINGLE LEVEL

INJ DIAZEPAM/VALIUM UP TO 25000162 250 J3360 $ 181.50 ACTIVE 5MG 25000283 INJ DIGOXIN TO 0.5MG AMP 636 J1160 $ 60.00 ACTIVE 25000286 INJ DIPHENHYDRAM UP TO 50MG 636 J1200 $ 114.00 ACTIVE 36000169 INJ DISKOGRAM CERV 360 62291 $ 4,411.20 ACTIVE 36000170 INJ DISKOGRAM LUMB 360 62290 $ 4,995.20 ACTIVE 36000171 INJ DUCT GALACTOGRAM 360 19030 $ 1,818.20 ACTIVE 25000186 INJ ENOXAPARIN 100MG/1.0 ML 636 J1650 $ 871.50 ACTIVE 25000190 INJ EPHEDRINE 50MG/ML AMP 250 J3490 $ 959.00 ACTIVE 25000191 INJ EPINEPHRINE 0.1MG/ML 250 J0171 $ 550.00 ACTIVE INJ EPINEPHRINE 1MG/ML 30 ML 25000192 250 J0171 $ 207.00 ACTIVE VIAL 25100019 INJ ETOMIDATE 20MG/20ML 250 J3490 $ 273.84 ACTIVE 36000173 INJ FACET LS ADDL LVL 360 64476 $ 3,986.36 ACTIVE INJ FENTANYL 0.05MG/ML 2ML 25000205 250 J3010 $ 304.00 ACTIVE AMP INJ FLUCONAZOLE 200MG 100ML 25000290 250 J1450 $ 804.00 ACTIVE IV INJ FUROSEMIDE 40MG VIAL PER 25000216 250 J1940 $ 159.00 ACTIVE 20MG 25000215 INJ FUROSEMIDE UP TO 20MG 250 J1940 $ 194.00 ACTIVE 63600043 INJ GLUCAGON 1MG VIAL 636 J1610 $ 1,233.00 ACTIVE 25000226 INJ HALOPERIDOL 5MG/ML VIAL 250 J1630 $ 136.50 ACTIVE

25000231 INJ HEPARIN 5000 UNITS/ML VIAL 636 J1644 $ 96.00 ACTIVE

25901600 INJ HUMULIN 70/30 INSULIN VIAL 636 J1815 $ 780.00 ACTIVE

25901452 INJ HUMULIN NPH INSULIN VIAL 636 J1815 $ 819.00 ACTIVE INJ INSULIN NOVOLOG (PLAIN) 25100073 636 J1815 $ 60.00 ACTIVE PER DOSE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 48100005 INJ INTERNAL MAMMARY 481 93564 $ 1,600.34 ACTIVE 25000783 INJ ISOPTIN 2.5MG/ML 2ML 250 J3490 $ 85.00 ACTIVE 25000784 INJ ISUPREL 1ML AMP 250 J3490 $ 114.00 ACTIVE 25000342 INJ KENALOG 40MG/ML 1ML VIAL 636 J3301 $ 270.00 ACTIVE

25901305 INJ KETAMINE 500MG /10ML VIAL 250 J3490 $ 229.50 ACTIVE

25000347 INJ KETOROLAC 30MG PER 15MG 636 J1885 $ 90.00 ACTIVE INJ KETOROLAC 60MG/2ML PER 25200114 636 J1885 $ 48.00 ACTIVE 15MG VIAL INJ LABETALOL NORMODYNE 25000806 250 J3490 $ 570.40 ACTIVE 100MG/20ML 25000356 INJ LEVOFLOXACIN 250MG 50ML 636 J1956 $ 357.00 ACTIVE 25000358 INJ LEVOPHED 4MG/4ML VIAL 250 J3490 $ 320.00 ACTIVE INJ LIDOCAINE (XYLOCAINE) 1% 63600159 636 J2001 $ 8.63 ACTIVE 10MG 30ML SDVIAL INJ LIDOCAINE (XYLOCAINE) 1% 63600160 636 J2001 $ 8.63 ACTIVE 10MG 5ML SDAMPUL INJ LIDOCAINE (XYLOCAINE) 2% 63600161 636 J2001 $ 10.80 ACTIVE 20MG/ML 50ML MDVIAL INJ LIDOCAINE (XYLOCAINE) MPF 25000842 636 J2001 $ 198.00 ACTIVE 1% 10MG/ML 5ML SDVIAL INJ LIDOCAINE +D5 (XYLOCAINE) 25000364 636 J2001 $ 70.00 ACTIVE 2GM/500ML IV 63600162 INJ LIDOCAINE 1% + EPI 10ML 636 J2001 $ 5.60 ACTIVE INJ LIDOCAINE 1% + EPI 20ML 25000639 636 J2001 $ 159.00 ACTIVE VIAL 25000361 INJ LIDOCAINE 1% 10ML VIAL 636 J2001 $ 180.00 ACTIVE 63600163 INJ LIDOCAINE 1% 20ML VIAL 636 J2001 $ 6.15 ACTIVE INJ LIDOCAINE 2% 100MG/5ML 25000645 636 J2001 $ 32.00 ACTIVE SYRINGE 63600164 INJ LIDOCAINE 2% 20ML 636 J2001 $ 6.15 ACTIVE 25000372 INJ LINCOCIN 300MG/ML VIAL 636 J2010 $ 165.60 ACTIVE 25901772 INJ LOVENOX 120MG/1.2ML 636 J1650 $ 976.00 ACTIVE 25100020 INJ LOVENOX 30 MG/0.3ML 636 J1650 $ 244.00 ACTIVE 25000378 INJ LOVENOX 40MG/0.4ML 636 J1650 $ 325.00 ACTIVE 48100006 INJ LT VENT OR ATRIAL ANGIO 481 93543 $ 1,600.34 ACTIVE INJ LUMBAR/SACRAL 36000174 TRANSFORAMINAL EPIDURAL, 360 64483 $ 4,614.74 ACTIVE WITH IMAGING GUIDANCE 25800042 INJ MANNITOL 25% IN 50ML 636 J2150 $ 114.00 ACTIVE INJ MARCAINE 0.25%/EPI 20ML 25000845 250 J3490 $ 99.00 ACTIVE VIAL 25000384 INJ MARCAINE 0.5% 30ML 250 J3490 $ 96.00 ACTIVE 25000390 INJ MEPERIDINE 50MG 636 J2175 $ 48.00 ACTIVE 25200059 INJ MERREM 1 GM VIAL 636 J2185 $ 644.00 ACTIVE INJ METHYLPREDNISOLONE 25000308 (SOLUMEDROL) SOD SUCCINATE 636 J2930 $ 114.00 ACTIVE 125MG VIAL INJ METHYLPREDNISOLONE 25000307 (SOLUMEDROL) SOD SUCCINATE 636 J2920 $ 114.00 ACTIVE 40MG INJ METOCLOPRAMIDE UP TO 25000401 636 J2765 $ 472.00 ACTIVE 10MG/ML 25901511 INJ METOPROLOL 5MG/5ML VIAL 259 J3490 $ 166.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INJ MIDAZOLAM 2MG/2ML VIAL 25000800 636 J2250 $ 295.50 ACTIVE PER 1MG 25000311 INJ MORPHINE SULF TO 10MG 636 J2270 $ 114.00 ACTIVE 36000176 INJ MYELOGRAM 360 62284 $ 2,532.32 ACTIVE INJ NALOXONE 0.4MG/ML PER 25000430 636 J2310 $ 387.00 ACTIVE 1MG 36000177 INJ NEPHROGRAM 360 50394 $ 1,811.60 ACTIVE 25000448 INJ NORCURON 10MG VIAL 250 J3490 $ 81.00 ACTIVE INJ OF ANESTHETIC AGENT 76000035 PARAVERTEBRAL FACET JOINT 760 64490 $ 1,463.22 ACTIVE W/IMAGE GUID; FIRST LEVEL INJ ONDANSETRON PER 1MG 25901294 636 J2405 $ 97.88 ACTIVE VIAL INJ ORPHENADRINE (NORFLEX) 25000450 636 J2360 $ 869.00 ACTIVE UP TO 60MG/2ML 25000810 INJ OXYTOCIN 10 UNIT VIAL 636 J2590 $ 322.00 ACTIVE 36000178 INJ PARAVERT C/T JNT 360 64470 $ 4,614.74 ACTIVE 36000179 INJ PARAVRT L/S 1 LVL 360 64475 $ 4,614.74 ACTIVE 25000466 INJ PEPCID 20MG VIAL 250 S0028 $ 136.50 ACTIVE INJ PIPERACILLIN/TAZOBACTAM 25000659 636 J2543 $ 258.00 ACTIVE 3.375GM

63600102 INJ PNEUMOVAX 23 0.5ML VIAL 250 J3490 $ 486.00 ACTIVE 30200208 INJ PPD SKIN TEST APLISOL 302 86580 $ 96.00 ACTIVE 25000489 INJ PRIMAXIN PER 250MG IV VIAL 636 J0743 $ 265.50 ACTIVE 25000770 INJ PROCAINAMIDE TO 1GM 636 J2690 $ 324.00 ACTIVE INJ PROMETHAZINE UP TO 50 MG 25000498 636 J2550 $ 66.00 ACTIVE VIAL INJ PROPOFOL 10MG/ML 20ML 25000500 636 J2704 $ 273.00 ACTIVE VIAL 25000505 INJ PROTONIX 40 MG VIAL 636 C9113 $ 382.50 ACTIVE 25000510 INJ RANITIDINE 50MG/2ML VIAL 636 J2780 $ 60.00 ACTIVE

25000523 INJ ROBINUL 0.2MG/ML 1ML VIAL 636 J7643 $ 151.50 ACTIVE 25200024 INJ ROCEPHIN 1GM PER250MG 636 J0696 $ 138.50 ACTIVE 25000528 INJ ROMAZICON 5MLVIAL 250 J3490 $ 964.50 ACTIVE 36000157 INJ RTRO URETHCYSTOG 360 51610 $ 2,035.60 ACTIVE 36000158 INJ SACROILIAC JT 360 27096 $ 2,588.38 ACTIVE INJ SENSORCAINE 0.25% WITH 25000843 250 J3490 $ 195.00 ACTIVE EP 20ML VIAL INJ SODIUM BICARB 50MEQ 50ML 25000546 250 J3490 $ 714.00 ACTIVE VIAL 25000559 INJ SOLU-CORTEF 100MG 2ML 636 J1720 $ 96.00 ACTIVE 36000115 INJ STELLATE GANGLION 360 64510 $ 4,614.74 ACTIVE INJ SUCCINYLCHOLINE 25901735 636 J0330 $ 64.00 ACTIVE CHLORIDE 10ML 25000578 INJ TDAP 0.5ML 636 90715 $ 751.50 ACTIVE 25200052 INJ TEFLARO 600MG VIAL 636 J0712 $ 394.00 ACTIVE 25000581 INJ THROMBINAR 5000 UNITS 250 J3490 $ 1,161.00 ACTIVE 25000605 INJ VANCOMYCIN 1GM VIAL 636 J3370 $ 540.00 ACTIVE 25000335 INJ VANCOMYCIN 500MG VIAL 636 J3370 $ 315.00 ACTIVE 25000612 INJ VASOPRESSIN 20 UNITS 250 J3490 $ 80.00 ACTIVE 25000613 INJ VASOTEC IV 1.25MG/ML VIAL 250 J3490 $ 95.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 48100007 INJ VEIN GRAFT VISUALIZATION 481 93540 $ 1,600.34 ACTIVE 25000617 INJ VERAPAMIL 5MG/2ML VIAL 250 J3490 $ 79.50 ACTIVE 25000830 INJ VERCURONIUM 10MG/ML 250 J3490 $ 95.60 ACTIVE 25900007 INJ VITAMIN K 10MG/ML AMP 250 J3430 $ 159.00 ACTIVE INJ XYLOCAINE 2% W/EPI 20 ML 25000833 636 J2001 $ 159.00 ACTIVE VIAL INJ, ANESTH AGENT; OTH 36100017 361 64450 $ 2,247.50 ACTIVE PERIPHERAL NERVE/BRANCH INJ, ANESTHETIC AGENT; 36000246 360 64445 $ 3,720.00 ACTIVE SCIATIC NERVE, SINGLE INJ. PROPOFOL 10MG/ML 50ML 25100053 636 J2704 $ 576.00 ACTIVE VIAL 48100051 INJ. VENT/ATRIAL ANGIO 481 93565 $ 1,600.34 ACTIVE 36000184 INJ-CONTRAST VENOGRAM 360 36005 $ 3,833.64 ACTIVE INJECTION OF ANESTHETIC 76000034 AGENT GREATER OCCIPITAL 760 64405 $ 748.58 ACTIVE NERVE INJECTION PROC, 36000183 CYSTOGRAPHY/VOIDING 360 51600 $ 2,348.52 ACTIVE URETHROCYSTOGRAPHY INJECTION PROC, URETEROGRAPHY/URETEROPYE 36000182 360 50684 $ 2,227.00 ACTIVE LOGRAPHY THROUGH URETEROSTOMY/CATHETER INJECTION PROCEDURE FOR CHOLANGIOGRAPHY, PERCUTANEOUS, COMPLETE 36000374 360 47532 $ 10,818.00 ACTIVE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR INJECTION SALIVARY; 36000180 360 42550 $ 1,690.08 ACTIVE SIALOGRAPHY INJECTION SINGLE TENDON 45000096 SHEATH,OR 450 20550 $ 2,034.00 ACTIVE LIGAMENT(PLANTAR"FASCIA") INJECTION SINGLE/MULTIPLE 45000128 TRIGGER POINT 3> MORE 450 20553 $ 2,232.00 ACTIVE MUSCLES INJECTION SINUS TRACT; 36000181 360 20501 $ 1,439.98 ACTIVE DIAGNOSTIC (SINOGRAM) INJECTION TRIGGER POINT- 51000001 510 20552 $ 138.00 ACTIVE TECH INJECTION(S),DIAGNOSTIC OR 36100021 THERAPEUTIC 361 64495 $ 2,625.00 ACTIVE AGENT,PARAVERTEBRAL FACET INJECTION, ANESTHETIC AGENT; 36000371 360 64417 $ 3,544.50 ACTIVE AXILLARY NERVE INJECTION, ANESTHETIC AGENT; 36000244 360 64415 $ 3,383.50 ACTIVE BRACHIAL PLEXUS, SINGLE INJECTION, ANESTHETIC AGENT; 36000318 ILIOINGUINAL, 360 64425 $ 4,842.00 ACTIVE ILIOHYPOGASTRIC NERVES INJECTION, DX/THERAPEUTIC SUBSTANCE, 36000172 360 62322 $ 4,614.74 ACTIVE EPIDURAL/SUBARACHNOID; LUMBAR/SACRAL Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INJECTION, VITAMIN B-12 63600196 CYANOCOBALAMIN, UP TO 1000 636 J3420 $ 56.25 ACTIVE MCG INS OR REPL OF SPINAL 36000116 360 63685 $ 79,680.51 ACTIVE NEUROSTI INS/REPLC PPM DUAL W/VENT & 36000027 481 33208 $ 69,356.09 ACTIVE AT INS/REPLC PPM GENERATOR 36000028 360 33213 $ 71,185.22 ACTIVE ONLY D INS/REPLC PPM GENERATOR 36000029 360 33212 $ 62,051.62 ACTIVE ONLY S INS/REPLC PPM SGL W/VENT 36000030 481 33207 $ 63,662.08 ACTIVE ELECT INSER OF INTRA-AORTIC BALL 36000031 360 33967 $ 1,020.74 ACTIVE ASS INSERT 1 CHMBR PACING 36000033 481 33206 $ 58,442.58 ACTIVE CARDIO D INSERT 2 CHMBR PACING 36000034 360 33240 $ 64,067.82 ACTIVE CARDIO D 36000035 INSERT LEAD PACE-DEFIB DUAL 481 33217 $ 27,370.44 ACTIVE 36000036 INSERT LOOP RECORDER 481 33282 $ 42,302.16 ACTIVE 36000037 INSERT LV PACING LEAD 481 33224 $ 57,193.06 ACTIVE INSERT OR REPOS OF ELEC 36000038 480 33249 $ 1,20,508.40 ACTIVE LEAD F INSERT PACEMAKER FLUOR AND 32000023 320 71090 $ 1,020.74 ACTIVE RA 48100008 INSERT SWAN-GANZ 481 93503 $ 10,249.66 ACTIVE INSERTION OF CENTRAL 48100036 360 36561 $ 17,236.50 ACTIVE VENOUS LINE SURGERY INSERTION OF HEART 36000039 481 33210 $ 28,450.74 ACTIVE ELECTRODE INSERTION OF INDWELLING 36100001 TUNNELED PLEURAL CATHETER 361 32550 $ 11,236.57 ACTIVE WITH CUFF INSERTION OF NON TUNNELED 48100069 481 36556 $ 6,317.00 ACTIVE CENTRAL VENOUS LINE INSERTION OF NON-INDWELLING 45000152 450 51701 $ 1,520.55 ACTIVE BLADDER CATHETER INSERTION TUNNELED CENTRALLY; CENTRAL VENOUS 45000082 450 36561 $ 2,767.50 ACTIVE ACCESS DEVICE, W/SUBC PORT; AGE 5OR> INSJ ELTRD 1 CHMBR 1 ELTRD 36000040 360 33216 $ 50,232.00 ACTIVE PRM INSJ ELTRD CAR VEN SYS TM 36000041 481 33225 $ 53,753.49 ACTIVE INSJ INSJ IPR CANNULA/CATH 36000042 360 49420 $ 22,511.02 ACTIVE F/DRG/DIAL TEMP INSRT INTRAPERITL CANN/CATH 36000044 360 49421 $ 18,647.58 ACTIVE DRAIN/DIALY 36000185 INSRT URET STNT DRN 360 50393 $ 16,206.06 ACTIVE INSTRUMENT BIOPSY MAXCORE 27200644 272 A4215 $ 1,899.00 ACTIVE 18G X 20CM 30100205 INSULIN 301 83525 $ 152.40 ACTIVE 30200146 INSULIN ANTIBODIES 302 86337 $ 285.48 ACTIVE INTERNAL MAMMARY 48100093 481 75756 $ 3,440.40 ACTIVE ARTERIOGRAM INTRA CARDIAC ECHO 27200921 272 C1759 $ 22,000.00 ACTIVE CATHETER 48100113 INTRACARDIAC ECG (ICE) 481 93662 $ 12,581.47 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS INTRACARDIAC ELECTROPHYSIOLOGIC 3- DIMENSIONAL MAPPING (LIST 48100064 481 93613 $ 14,456.02 ACTIVE SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) INTRACUTANEOUS 92000001 (INTRADERMAL) TESTS WITH 920 95024 $ 195.22 ACTIVE ALLERGENIC EXTRACTS 32000120 INTRALUMINAL DILATE 320 74360 $ 1,841.62 ACTIVE INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RSV 48100083 481 93572 $ 1,697.76 ACTIVE MEASUREMENT CORONARY VESSEL OR GRAFT - ADDL VESSEL INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RSV 48100082 481 93571 $ 4,283.42 ACTIVE MEASUREMENT CORONARY VESSEL OR GRAFT DURING CORONARY ANGIOGRA INTRAVASCULAR STENT (EA 48100098 481 37239 $ 25,419.12 ACTIVE ADDITIONAL VEIN) INTRAVASCULAR STENT (INITIAL 48100097 481 37238 $ 51,568.52 ACTIVE VEIN) INTRINSIC FACTOR BLOCKING 30200147 302 86340 $ 201.00 ACTIVE ANTIBODY 36000187 INTRO LONG GI TUBE 360 44500 $ 2,118.26 ACTIVE INTRO OF CATH RIGHT HEART 36000046 360 36013 $ 1,513.40 ACTIVE OR INTRO OF NEEDLE OR 36000047 360 36140 $ 1,239.70 ACTIVE INTRACATH INTRO PERQ TRANSHEP STENT 36000048 360 47511 $ 12,793.98 ACTIVE INT/EXT BILI INTRO PRQ TRANSHEPATC CATH 36000049 360 47510 $ 13,981.24 ACTIVE BILIARY DRG INTRODUCER 6FR-8FR - 27000282 270 C1894 $ 510.00 ACTIVE PERIPHERAL 27000283 INTRODUCER LEAD 270 C1892 $ 444.00 ACTIVE 27200110 INTRODUCER/SHEATH CAROTID 272 C1766 $ 1,583.52 ACTIVE INTRODUCTION OF NEEDLE OR 45000132 450 36000 $ 486.00 ACTIVE INTRACATHETER, VEIN INTUBATION ENDOTRACHEAL 41000022 410 31500 $ 861.20 ACTIVE ASSIST BY RT INTUBATION ENDOTRACHEAL 45000052 450 31500 $ 750.00 ACTIVE EMERGENCY PROCEDURE 25000340 INVANZ 1GM VIALS 636 J1335 $ 556.00 ACTIVE 25200077 IODOSORB GEL TOPICAL 1.4 OZ 250 J3490 $ 88.00 ACTIVE 42000025 IONTOPHORESIS EA 15 450 97033 $ 276.44 ACTIVE IOPAMIDOL (ISOVUE M200) 41% 63600157 636 Q9966 $ 221.35 ACTIVE 200MG 20ML IOPAMIDOL (ISOVUE M300) 61% 25000007 636 Q9967 $ 162.06 ACTIVE 300MG 100ML IOPAMIDOL (ISOVUE M300) 61% 63600158 636 Q9967 $ 214.68 ACTIVE 300MG 15ML 63600189 IOPAMIDOL 300MG 150ML BTL IV 636 Q9967 $ 382.20 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS IP CONSULT 96000011 COMPREHENSIVE/HIGH 960 99255 $ 5,112.00 ACTIVE COMPLEX 110MINS IP CONSULT 96000010 COMPREHENSIVE/MOD 960 99254 $ 4,248.00 ACTIVE COMPLEX 80MINS IP CONSULT DETAILED/LOW 96000009 960 99253 $ 2,925.00 ACTIVE COMPLEX 55MINS IP CONSULT EXPANDED 96000008 FOCUS/STRAIGHTFORWARD 960 99252 $ 1,899.00 ACTIVE 40MINS IP CONSULT PROBLEM 96000007 FOCUS/STRAIGHTFORWARD 960 99251 $ 1,242.00 ACTIVE 20MINS IRBESARTAN (AVAPRO) 75MG 25901347 250 J8499 $ 36.00 ACTIVE TAB IRBESARTAN +HCTZ 150/12.5MG 25901878 250 J8499 $ 5.25 ACTIVE TAB IRBESARTAN +HCTZ 300/12.5MG 25901879 250 J8499 $ 5.25 ACTIVE TAB IRBESARTAN 150MG TABLET 25901930 250 J8499 $ 24.00 ACTIVE (AVAPRO) 30100208 IRON 301 83540 $ 86.28 ACTIVE 30100209 IRON BINDING CAPACITY TEST 301 83550 $ 116.52 ACTIVE IRRADIATION OF BLOOD 30900018 302 86945 $ 78.51 ACTIVE PRODUCT EACH UNIT 25900589 ISOSORBIDE (IMDUR) 30MG TAB 250 J8499 $ 30.00 ACTIVE 63600193 ISOVUE 370-100ML 636 Q9967 $ 238.25 ACTIVE 25300001 ISOVUE 61% 50ML 636 Q9967 $ 450.70 ACTIVE 30100210 I-STAT BLOOD GASES 301 82803 $ 312.84 ACTIVE I-STAT PANEL CRITICAL BLOOD 30500060 305 85041 $ 40.20 ACTIVE ANALYSIS 30100212 I-STAT POTASSIUM 301 84132 $ 61.32 ACTIVE 30100213 I-STAT SODIUM 301 84295 $ 64.20 ACTIVE 25800003 IV 1/2 NS 1000ML BAG 258 J7030 $ 615.00 ACTIVE 25800004 IV 1/2 NS 500ML BAG 258 J7040 $ 585.00 ACTIVE 27000284 IV CATH PROTECTIV 16G X 1 1/4 272 A4649 $ 40.00 ACTIVE

27000285 IV CATH PROTECTIV 18G X 1 1/4 272 A4649 $ 40.00 ACTIVE 27000286 IV CATH PROTECTIV 20G X 1 272 A4649 $ 84.00 ACTIVE 27000287 IV CATH PROTECTIV 20G X 1 1/4 272 A4649 $ 24.00 ACTIVE 27000288 IV CATH PROTECTIV 22G X 1 272 A4649 $ 44.00 ACTIVE 27000289 IV CATH PROTECTIV 24G X 3/4 272 A4649 $ 44.00 ACTIVE 25800020 IV D5 LR 1000ML BAG 258 J7121 $ 480.00 ACTIVE 25800022 IV D5NS 1000 ML BAG 258 J7030 $ 675.00 ACTIVE 25800025 IV D5W 1000ML BAG 258 J7070 $ 440.00 ACTIVE 25800026 IV D5W 100ML BAG 258 J7060 $ 622.50 ACTIVE 25800028 IV D5W 500ML BAG 258 J7060 $ 577.50 ACTIVE IV DOBUTAMINE 500MG/250ML 25000738 258 J3490 $ 690.00 ACTIVE D5W BAG 25000175 IV DOPAMINE 400MG/250ML 250 J1265 $ 544.50 ACTIVE 25800049 IV LACT RINGERS 1000 ML BAG 258 J7120 $ 520.00 ACTIVE IV LACTATED RINGERS 500ML 25800081 258 J7120 $ 290.00 ACTIVE BAG 25800052 IV NS 1000ML BAG 258 J7030 $ 607.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25800054 IV NS 100ML BAG 258 J7050 $ 622.50 ACTIVE 25800055 IV NS 250ML BAG 258 J7050 $ 538.50 ACTIVE 25800091 IV NS 500ML BAG 258 J7040 $ 585.00 ACTIVE 25800056 IV NS 50ML BAG 258 J7050 $ 630.00 ACTIVE 25800057 IV NS MINI BAG PLUS 50 ML 258 J7050 $ 622.50 ACTIVE 48100099 IVC FILTER INSERTION 481 37191 $ 23,461.99 ACTIVE 32000123 IVP W NEPHROTOMOGRAM 320 74415 $ 2,462.60 ACTIVE 32000124 IVP W-W/O TOMOGRAM 320 74400 $ 5,236.50 ACTIVE IVPB DRIP INF ADD SEQUENTIAL 45000026 INF OF NEW DRUG/SUBS UP TO 1 450 96367 $ 277.88 ACTIVE HR IVPB DRIP INF CONCURRENT 45000028 450 96368 $ 447.30 ACTIVE INFUSION 45000027 IVPB DRIP INF EACH ADD HR 450 96366 $ 464.52 ACTIVE 45000029 IVPB DRIP INF INIT 1HR 450 96365 $ 1,267.50 ACTIVE 27200113 IVUS ATLANTIS PV CATHETER 272 C1753 $ 20,500.00 ACTIVE 48000008 IVUS -CORO-EA ADDL VESSEL 480 92979 $ 1,406.24 ACTIVE 48000009 IVUS -CORO-INITIAL VESSEL 480 92978 $ 6,583.68 ACTIVE IVUS RADILOGIC S & I 48100106 481 75946 $ 292.68 ACTIVE ADDITIONAL VESSEL IVUS RADILOGIC S & I INITIAL 48100105 481 75945 $ 472.12 ACTIVE VESSEL IVUS, NON CORONARY, DX OR 48100103 481 37250 $ 1,661.98 ACTIVE INTV (VENEOUS) IVUS, NON CORONARY,DX OR 48100104 481 37251 $ 1,035.16 ACTIVE INTV ADDITIONAL VESSEL 32000125 JNT ANY STRES V 320 77071 $ 454.84 ACTIVE JUGS OMNI SUCTION CANISTER 27100001 271 A7002 $ 259.90 ACTIVE 16000CC KAPPA/ LAMBDA FLC FREE 30100502 301 83883 $ 181.32 ACTIVE LIGHT CHAINN SERUM 25900619 K-DUR 10MEQ SA TAB 250 J8499 $ 24.00 ACTIVE 25900620 K-DUR 20MEQ SA TAB 250 J8499 $ 30.00 ACTIVE 25900624 KEPPRA 250MG TABLETS 250 J8499 $ 46.00 ACTIVE 25900625 KEPPRA 500 MG TAB 250 J8499 $ 37.50 ACTIVE KEPPRA 500MG/5ML 5ML 25000345 636 J1953 $ 430.00 ACTIVE (LEVETIRACETAM) KEPPRA/LEVETIRACETAM LEVEL 30000047 301 80177 $ 176.76 ACTIVE TEST KETOCONAZOLE 2% CREAM 25901880 250 J3490 $ 112.58 ACTIVE 30GM TUBE KETOGENIC STEROIDS 30100215 301 83582 $ 189.00 ACTIVE FRACTION KIDNEY IMAGING W/ VASCULAR FLOW FUNCTION AND W/O 34100089 341 78707 $ 11,513.50 ACTIVE PHARMACOLOGICAL INTERVENTION 27000614 KIT ABG 270 A4649 $ 96.00 ACTIVE 27200674 KIT ANGIO JET 272 A4649 $ 4,212.00 ACTIVE KIT CATH 6FR D LUMEN CT PICC 27200634 272 A4649 $ 2,940.00 ACTIVE FULL SW 27200795 KIT ENEMA 270 A4458 $ 52.00 ACTIVE 27200626 KIT ESOPHYX 2 272 A4649 $ 25,000.00 ACTIVE 27200789 KIT EYE IRRIGATION 270 A4649 $ 80.00 ACTIVE KIT GRAFT ACCESSORY 27200679 272 A4649 $ 17,955.00 ACTIVE OUTFLOW 27200633 KIT INTRODUCER 272 A4649 $ 819.00 ACTIVE 27200775 KIT IRRIGATION PISTON 270 A4322 $ 52.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27200759 KIT IV START 272 A4649 $ 28.00 ACTIVE 27200774 KIT LACERATION 272 A4550 $ 160.00 ACTIVE 27100016 KIT LTA 271 A4649 $ 224.00 ACTIVE 27000563 KIT MIDSTREAM COLLECTION 270 A4649 $ 52.00 ACTIVE KIT MIDSTREAM COLLECTOR 27000293 272 A4649 $ 16.00 ACTIVE (16496) 27000615 KIT NEBULIZER INC MASK 270 A7015 $ 44.00 ACTIVE 27200778 KIT PARACENTESIS 272 A4649 $ 72.00 ACTIVE 27200788 KIT PELVIC EXAM 272 A4649 $ 404.00 ACTIVE KIT SUCTION CATHETER (ALL 27000475 272 A4624 $ 40.50 ACTIVE SIZES) 27200779 KIT SUTURE REMOVAL 272 A4550 $ 84.00 ACTIVE 27200777 KIT THORACENTESIS 272 A4550 $ 924.00 ACTIVE 27200800 KIT TRACH CARE 272 A4629 $ 52.00 ACTIVE 32000126 KNEE 1 OR 2V 320 73560 $ 1,133.50 ACTIVE 32000127 KNEE 3 VIEWS 320 73562 $ 1,641.50 ACTIVE 32000128 KNEE 4V OR MORE 320 73564 $ 1,914.50 ACTIVE 32200003 KNEE ARTHROGRAPHY 322 73580 $ 5,510.00 ACTIVE 27000519 KNEE BRACES,HINGED 274 L1810 $ 479.12 ACTIVE 32000129 KNEES STANDING AP 320 73565 $ 1,573.00 ACTIVE KYHOPLASTY RADIOLOGICAL 32000024 320 72291 $ 1,514.92 ACTIVE S&I 36000051 KYPHOPLASTY LUMBAR 360 22514 $ 48,811.84 ACTIVE KYPHOPLASTY LUMBAR TRAY 27200426 272 A4550 $ 10,990.00 ACTIVE KPT1505 36000052 KYPHOPLASTY THORACIC 360 22513 $ 48,811.84 ACTIVE 34100004 LABELED RED CELL SEQUESTR 341 78140 $ 3,723.32 ACTIVE 25901881 LABETALOL 100MG TAB 250 J8499 $ 5.25 ACTIVE LACRI LUBE (REFRESH) OINTMT 25901882 250 J3490 $ 46.50 ACTIVE 3.5GM TUBE 30100218 LACTATE (LACTIC ACID) 301 83605 $ 142.44 ACTIVE 30100221 LACTATE DEHYDROGENASE 301 83615 $ 156.36 ACTIVE LACTATE DEHYDROGENASE 30100223 301 83625 $ 170.64 ACTIVE ISOENZYME 30100219 LACTOGEN PLACENTAL (HPL) 301 83632 $ 269.64 ACTIVE 25900633 LACTULOSE 10G/15ML 250 J8499 $ 280.00 ACTIVE LACTULOSE ORAL SOLUTION 25901936 250 J3490 $ 56.00 ACTIVE 20GM/30ML 25901883 LAMOTRIGINE 200MG TAB 250 J8499 $ 5.25 ACTIVE LAMOTRIGINE SERUM 30000014 300 80175 $ 73.65 ACTIVE (LAMICTAL)IMMUNOASSAY 25900640 LANOXIN 0.125MG TABLET 250 J8499 $ 24.00 ACTIVE 25000352 LANTUS INSULIN 1 UNIT/10ML 636 J1815 $ 14.00 ACTIVE 27800840 LAP BAND 270 A4649 $ 24,000.00 ACTIVE 36100004 LAP BAND ADJUSTMENT 361 S2083 $ 880.00 ACTIVE LAP, ESOPHAGOGASTRIC 36000275 360 43280 $ 56,219.50 ACTIVE FUNDOPLASTY LAPAROSCOPIC INGUINAL 36000342 360 49650 $ 18,325.54 ACTIVE HERNIA REPAIR LAPAROSCOPY 36000237 360 47562 $ 34,384.00 ACTIVE CHOLECYSTECTOMY LAPAROSCOPY PROCEDURE, 36000343 HERNIOPLASTY, 360 49659 $ 17,325.54 ACTIVE HERNIORRHAPHY, HERNIOTOMY Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS LAPAROSCOPY SURG 36000229 CHOLECYSTECTOMY 360 47564 $ 58,162.00 ACTIVE W/COMMON DUCT EXPLORE LAPAROSCOPY SURGICAL 36000235 360 44970 $ 31,404.50 ACTIVE APPENDECTOMY LAPAROSCOPY SURGICAL 36000236 CHOLECYSTECTOMY 360 47563 $ 37,315.50 ACTIVE W/CHOLANGIOGRAPHY LAPAROSCOPY, ABDOMEN, PERITONEUM & OMENTUM, DX, 36000259 W/ W/O SPECIMEN COLLECTION 360 49320 $ 17,021.50 ACTIVE BY BRUSHING OR WASHING (SEPARATE PROC) LAPAROSCOPY, COLECTOMY, 36000304 360 44204 $ 76,336.50 ACTIVE PARTIAL, W/ANASTOMOSIS LAPAROSCOPY, W/FULGURATION OR EXCISION 36000258 OF LESIONS OF OVARY, PELVIC 360 49322 $ 36,679.00 ACTIVE VISCERA/PERITONEAL SURFACE METHOD 27200881 LARGE ROCKER SHOE - LONG 274 L4386 $ 10,107.75 ACTIVE 44400001 LARYNGEAL FUNCTION STUDY 444 92520 $ 912.82 ACTIVE LARYNGOSCOPIC SENSORY 44000006 440 92614 $ 3,979.92 ACTIVE TEST LARYNGOSCOPY WITH 44000007 440 31579 $ 3,039.68 ACTIVE STROBOSCOPY LDL CHOLESTEROL DIRECT 30100225 301 83721 $ 127.20 ACTIVE MEASURE 30100226 LEAD 301 83655 $ 161.40 ACTIVE LEFT HEART / RIGHT HEART 48100062 481 93460 $ 73,557.50 ACTIVE CATH W/ CORONARIES LEFT HEART CATH LEFT 48100059 VENTRICULOGRAPHY ART/GRFT 481 93459 $ 61,860.36 ACTIVE ANGIO LEFT HEART CATH W/ 48100058 481 93458 $ 50,382.50 ACTIVE CORONARIES

LEFT HEART CATHETERIZATION; 48100074 LEFT VENTRICULOGRAPHY, 481 93452 $ 42,353.50 ACTIVE IMAGING SUPERVISION & INTERP

27000686 LEG BAG LG. 32OZ 270 A4649 $ 10.56 ACTIVE 30200148 LEGIONELLA ANTIBODY 302 86713 $ 204.00 ACTIVE LEGIONELLA PNEUMOPHILA 30600071 ANTIGEN DIRECT FLUORESCENT 306 87278 $ 187.20 ACTIVE ANTIBODY 30900014 LEPTOSPIRA 302 86720 $ 48.84 ACTIVE LESION BIOPSY EACH ADD'L- 51000027 510 11101 $ 780.60 ACTIVE TECH LESION BIOPSY SUBCUTANEOUS 51000026 510 11100 $ 1,518.00 ACTIVE TISS/MUCUOUS MEM SINGLE 30100227 LEUCINE AMINOPEPTIDASE 301 83670 $ 122.16 ACTIVE LEUKOCYTE ALKALINE 30500029 305 85540 $ 114.72 ACTIVE PHOSPHATASE WITH CT 30900005 LEUKOCYTE COUNT (FECAL) 309 89055 $ 57.00 ACTIVE LEUKOCYTE COUNT 30100436 305 85048 $ 33.84 ACTIVE AUTOMATED Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS LEUKOCYTE POOR RED BLOOD 39000003 390 P9016 $ 1,893.36 ACTIVE CELL (EACH UNIT) LEVALBUTEROL (XOPENEX) 25901239 250 J7614 $ 36.00 ACTIVE 0.63MG 0.63MG SOL 25901240 LEVALBUTEROL 1.25MG/3ML INH 250 J7614 $ 36.00 ACTIVE 25900647 LEVAQUIN 250 MG TABLET 250 J8499 $ 214.00 ACTIVE 25900650 LEVAQUIN 500MG TABLET 250 J8499 $ 171.00 ACTIVE 25900648 LEVAQUIN 750MG TAB 250 J8499 $ 52.00 ACTIVE 25000355 LEVAQUIN 750MG/150ML 636 J1956 $ 772.00 ACTIVE LEVOFLOXACIN (LEVAQUIN) 25000357 636 J1956 $ 481.50 ACTIVE 500MG 100ML IV LEVOTHYROXINE 25901755 (SYNTHROID)75MCG (0.075MG) 259 J8499 $ 24.00 ACTIVE TAB LEXISCAN 0.4MG/5ML (PER 25901295 636 J2785 $ 1,890.00 ACTIVE 0.1MG) 30100228 LIDOCAINE 301 80176 $ 195.84 ACTIVE 25000362 LIDOCAINE 1% 2ML 636 J2001 $ 210.00 ACTIVE 25000365 LIDOCAINE 2% 20MG/ML 636 J2001 $ 214.00 ACTIVE 25901487 LIDOCAINE 4% TOP APP 250 J3490 $ 192.00 ACTIVE LIDOCAINE HCL ORAL 2% 25900668 259 J3490 $ 184.00 ACTIVE VISCOUS 25901935 LIDOCAINE VISCOUS 2% 15ML 250 J3490 $ 69.00 ACTIVE LIDOCAINE/PRILOCAINE CREAM 25901884 250 J3490 $ 127.50 ACTIVE 30GM LIDOCAINE/PRILOCAINE CREAM 25901885 250 J3490 $ 16.43 ACTIVE 5GM 30100229 LIPASE 301 83690 $ 91.80 ACTIVE 25900673 LIPITOR 10 MG TABLET 250 J8499 $ 60.00 ACTIVE 25900674 LIPITOR 20MG TABS 259 J8499 $ 86.00 ACTIVE 30100231 LIPOPROTEIN 301 83695 $ 172.68 ACTIVE LIPOPROTEIN,BLOOD;ELECTROP 30100081 HORETIC SEPARATION AND 301 83700 $ 150.12 ACTIVE QUANTITATION LIPOPROTEIN-ASSOCIATED 30100066 301 83698 $ 555.72 ACTIVE PHOSPHOLIPASE A2 (LP-PLA2 LISINOPRIL (PRINVIL, ZESTRIL) 25901257 259 J8499 $ 24.00 ACTIVE 5MG TAB 25901256 LISINOPRIL (ZESTRIL) 20MG TAB 259 J8499 $ 28.00 ACTIVE LISINOPRIL 25901886 +HYDROCHLOROTHIAZIDE 250 J8499 $ 5.25 ACTIVE 20/12.5MG TAB 25901887 LISINOPRIL 2.5MG TAB 250 J8499 $ 7.59 ACTIVE 30100233 LITHIUM 301 80178 $ 88.20 ACTIVE 27000731 LITHO MACHINE RENTAL 271 E1399 $ 21,000.00 ACTIVE LITHOLAPAXY OF CALCULUS BY ANY MEANS IN 36000148 BLADDER/REMOVAL OF 360 52318 $ 24,890.00 ACTIVE FRAGMENTS COMPLICATED/LARGE >2.5CM LITHOTOMY DRAPES 27200920 272 A4649 $ 25.00 ACTIVE LITHOTOMY SHT LITHOTRIPSY 45000058 EXTRACORPOREAL SHOCK 790 50590 $ 29,746.00 ACTIVE WAVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS LITHOTRIPSY EXTRACORPOREAT SHOCK 79000001 790 50590 $ 50,746.00 ACTIVE WAVE AND LITHO MACHINE RENTAL 34100005 LIVER & SPLEEN IMAGE/FLOW 341 78216 $ 6,226.50 ACTIVE 30100301 LONG CHAIN FATTY ACIDS 301 82726 $ 240.72 ACTIVE 27200706 LOOP VESSEL MINI WHITE 272 A4649 $ 19.66 ACTIVE 27200707 LOOP VESSEL MINI WHITE 2 PK 272 A4649 $ 19.54 ACTIVE

27200712 LOOPS BLUE MICRO MINI 2 PACK 272 A4649 $ 22.60 ACTIVE LOPERAMIDE 1MG/5ML ORAL 25901934 250 J3490 $ 24.00 ACTIVE SOL 120ML 25900684 LOPERAMIDE 2MG CAP 250 J8499 $ 16.00 ACTIVE 25900686 LOPID 600MG TABLET 250 J8499 $ 24.00 ACTIVE 25000376 LOPRESSOR 1MG/ML AMPUL 250 J3490 $ 176.00 ACTIVE 25900688 LOPRESSOR 50MG TABLET 250 J8499 $ 24.00 ACTIVE LORAZEPAM (ATIVAN) 2MG 1ML 63600165 636 J2060 $ 24.00 ACTIVE SDVIAL 25900690 LORAZEPAM .5MG TAB 250 J8499 $ 16.00 ACTIVE 25900691 LORAZEPAM 1MG TAB 250 J8499 $ 22.00 ACTIVE 25901944 LORAZEPAM 2MG 30ML OS 250 J3490 $ 24.00 ACTIVE LOSARTAN + 25900583 HYDROCHLOROTHIAZIDE 250 J8499 $ 40.00 ACTIVE (HYZAAR) 50/12.5MG TAB LOSARTAN + 25901888 HYDROCHLORROTHIAZIDE 250 J8499 $ 7.59 ACTIVE (HYZAAR) 100/25MG TAB LOTENSIN 20MG TAB 25900697 250 J8499 $ 28.00 ACTIVE (BENAZEPRIL) 25900703 LOTRIMIN 1% LOTION 30ML 250 J3490 $ 326.60 ACTIVE 25900705 LOTRISONE CREAM 15GM 250 J3490 $ 424.50 ACTIVE LOVASTATIN (ZOCOR) 20MG 25901269 250 J8499 $ 76.50 ACTIVE TABLET LOWER EXTREM INFANT 2OR 32000091 320 73592 $ 638.40 ACTIVE MORE V <1YR LT AND RT HEART CATH - W/ 48100063 481 93461 $ 75,145.00 ACTIVE CORONORIES & GRAFTS LT HEART CATH - TRANSEPTAL 48100076 481 93462 $ 44,550.95 ACTIVE PUNTURE THROUGH SEPTUM 32000026 LT PULMONARY ANGIO 320 75741 $ 6,468.98 ACTIVE LTA 360 KIT (LIDOCAINE 25000379 HYDROCHLORIDE TOPICAL SOL 250 J3490 $ 64.00 ACTIVE USP 4%) 27200755 LUBRICATING JELLY 272 A4332 $ 52.00 ACTIVE 32000130 LUMB SPINE 2 OR 3 VIEWS 320 72100 $ 1,677.00 ACTIVE 32000131 LUMB SPINE 4+ VIEWS 320 72110 $ 2,344.00 ACTIVE 32000132 LUMB SPINE BEND VW ONLY 320 72120 $ 1,932.00 ACTIVE LUMB SPINE COMP W/BEND V 32000133 320 72114 $ 2,993.00 ACTIVE 6+VIEWS 30100234 LUTHERIZING HORMONE ( LH) 301 83002 $ 246.84 ACTIVE 30200150 LYME DISEASE ANTIBODY 302 86618 $ 227.04 ACTIVE LYME DISEASE PCR 30600072 306 87476 $ 467.88 ACTIVE AMPLIFICATION PROBE 32000134 LYMPHANGIO PELV/ABD BIL 320 75807 $ 3,507.72 ACTIVE 32000135 LYMPHANGIO PELV/ABD UNIL 320 75805 $ 3,507.72 ACTIVE 32000136 LYMPHANGIOGRAPHY EXT BIL 320 75803 $ 3,507.72 ACTIVE 32000137 LYMPHANGIOGRAPHY EXT UNI 320 75801 $ 2,511.60 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25901502 MAALOX 30ML 250 J3490 $ 30.00 ACTIVE MAG-AL-SIMETHICONE RS 200- 25901889 250 J3490 $ 5.70 ACTIVE 200-20MG 30100236 MAGNESIUM 301 83735 $ 89.28 ACTIVE 63600166 MAGNESIUM 500MG/2ML VIAL 636 J3475 $ 5.70 ACTIVE 25900720 MAGNESIUM OXIDE 400MG TAB 250 J8499 $ 24.00 ACTIVE

25000382 MAGNESIUM SULFATE 2GM/50ML 636 J3475 $ 174.00 ACTIVE MAHURKAR TRIPLE LUMEN 27200754 272 C1752 $ 360.00 ACTIVE CATHETER 12FR / CH X 16CM 40100002 MAMMO SCREEN CONVERT DIAG 401 77055 $ 1,152.76 ACTIVE MAMMO SCREEN CONVERT 40100003 401 77056 $ 1,152.76 ACTIVE DIAGN BIL 40300001 MAMMO SCRN DIG W COMP 403 77051 $ 427.50 ACTIVE 32000138 MAMMOGRAPHY BREAST LOC 320 77032 $ 1,152.76 ACTIVE 30500078 MAN DIFF WBC CNT BUFFY CT 305 85009 $ 60.84 ACTIVE 32000139 MANDIBLE 4V OR MORE 320 70110 $ 1,815.00 ACTIVE 32000140 MANDIBLE PARTIAL <4 VIEWS 320 70100 $ 3,500.00 ACTIVE 41000010 MANIP CW LUNG FUNC SUBSEQ 410 94668 $ 222.62 ACTIVE 63600167 MANNITOL 20% 250ML IV 636 J2150 $ 53.88 ACTIVE 63600168 MANNITOL 20% 500ML 636 J2150 $ 47.35 ACTIVE 30500030 MANUAL PLATELET COUNT 305 85032 $ 57.48 ACTIVE 42000026 MANUAL TECH EA 15M 450 97140 $ 266.00 ACTIVE 27000652 MASK BIPAP 272 A7034 $ 132.00 ACTIVE 27000616 MASK FACE TENT W/TUBING 270 A7030 $ 132.00 ACTIVE MASK NON-REBREATHABLE 27000650 270 A4620 $ 52.00 ACTIVE (NRB) 27000651 MASK OXYGEN 271 A4620 $ 15.00 ACTIVE 27000649 MASK VENTI 270 A4620 $ 76.00 ACTIVE 27100025 MASK, FOG FREE W/EAR LOOP 271 A4620 $ 4.35 ACTIVE

27000757 MASK, LARYNGEAL DISP CLEAR 270 A7521 $ 137.10 ACTIVE

MASS SPECTROMETRY AND 30200270 301 83789 $ 124.25 ACTIVE TANDEM MASS SPECTROMETRY 27000554 MASTISOL LIQUID ADHESIVE 272 A4364 $ 120.00 ACTIVE 32000141 MASTOIDS COMP 3V OR > 320 70130 $ 938.00 ACTIVE 32000142 MASTOIDS LESS THAN 3V 320 70120 $ 800.80 ACTIVE MAXORB EXTRA CALCIUM 27000593 270 A6196 $ 250.00 ACTIVE ALGINATE MAXORB EXTRA CMC/ALGINATE 27000594 270 A6197 $ 356.00 ACTIVE 4 X 8 30100103 MC DRUG TEST 301 G0480 $ 287.32 ACTIVE 41000028 MDI TREATMENT INITIAL 410 94640 $ 449.61 ACTIVE 41000029 MDI TREATMENT SUBQ 410 94640 $ 224.80 ACTIVE 42000027 MECH TRACT 15 450 97012 $ 252.76 ACTIVE MECHANICAL REMOVAL OF OBSTRUCTIVE MATERIAL FROM GASTROSTOMY, 36000349 750 49460 $ 10,761.50 ACTIVE DUODENOSTOMY, JEJUNOSTOMY, GASTRO- JEJUNOSTOMY 25900727 MECLIZINE HCL 25MG TABLET 259 J8499 $ 8.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS MED NUTRITION INDIVIDUAL RE- 94200006 942 97803 $ 280.00 ACTIVE ASSESSMENT EA 15 MINUTES

MED NUTRITION THERAPY INTIAL 94200007 942 97802 $ 308.00 ACTIVE ASSESSMENT EA 15 MINUTES 94200008 MED NUTRTION GROUP 30MIN 942 97804 $ 156.46 ACTIVE 25900728 MEDROL DOS PAK 4MG TAB 250 J8499 $ 523.50 ACTIVE MEDTRONIC REVEAL LOOP 27200118 272 C1764 $ 46,950.00 ACTIVE RECORDER 63600169 MEFOXIN 2GM 50ML IV 636 J0694 $ 57.18 ACTIVE 25901890 MELATONIN 1MG CAP 250 J8499 $ 5.05 ACTIVE 46000004 MEMBRANE DIFFUS CAPAC 460 94725 $ 737.38 ACTIVE MEPERIDINE (DEMEROL) 25MG 25000798 636 J2175 $ 48.00 ACTIVE 1ML MEPERIDINE HCL (DEMEROL) 25000392 636 J2175 $ 316.00 ACTIVE 75MG/1.5ML VIAL (50MG/1ML) MEPIVACAINE (CARBOCAINE) 2% 63600170 636 J0670 $ 15.60 ACTIVE 20ML SDVIAL 30100239 MEPROBAMATE 301 83805 $ 183.54 ACTIVE 30100240 MERCURY 301 83825 $ 135.24 ACTIVE 27200645 MESH COMPOSITE 7X9 272 C1781 $ 16,000.00 ACTIVE 30100089 METABOLIC PANEL IONIZED CA 301 80047 $ 164.76 ACTIVE 30100241 METANEPHRINES (BLOOD) 301 83835 $ 157.78 ACTIVE 25901891 METAXOLONE 800MG TABLET 250 J8499 $ 5.25 ACTIVE 30100244 METHADONE 301 80358 $ 140.88 ACTIVE METHEMOGLOBIN 30100247 301 83050 $ 98.40 ACTIVE QUANTITATIVE METHERGINE 0.2MG/ML 25000394 636 J2210 $ 56.00 ACTIVE INJECTION METHOCARBAMOL (ROBAXIN) 25901029 250 J8499 $ 10.00 ACTIVE 500MG TABLET METHOCARBAMOL (ROBAXIN) 25901030 250 J8499 $ 24.00 ACTIVE 750MG TAB METHYL ACETATE (DEPO- 25000155 636 J1040 $ 26.43 ACTIVE MEDROL) 80 MG 25000395 METHYLENE BLUE 1% 10ML 636 Q9968 $ 110.00 ACTIVE METHYLENEDIOXYAMPHETAMIN 30100099 301 80359 $ 4,470.00 ACTIVE ES (MDA, MDEA, MDMA) 30100248 METHYLMALONIC ACID 301 83921 $ 254.52 ACTIVE 25900740 METOCLOPRAMIDE 10MG TAB 250 J8499 $ 24.00 ACTIVE 25100024 METOPROLOL 25MG TAB 250 J8499 $ 16.00 ACTIVE METOPROLOL SUCCINATE ER 25900182 259 J8499 $ 22.00 ACTIVE 25MG TABLET 25000403 METRONIDAZ 500MG/NS 100ML 250 S0030 $ 244.00 ACTIVE MICRO T WAVE ALTERATIONS 48200004 482 93025 $ 1,170.40 ACTIVE WITHOUT TRANSPORTATION 30500001 MICROALBUMIN (URINE) 301 82043 $ 77.04 ACTIVE MICROSOMAL ANTIBODIES 30200151 302 86376 $ 135.24 ACTIVE (EACH) MIDAZOLAM (VERSED) 5MG/5ML 63600171 636 J2250 $ 15.32 ACTIVE VIAL MIDAZOLAM (VERSED) 5MG/ML 25000621 250 J3490 $ 2,914.00 ACTIVE 10ML OS 25900751 MILK MAGNESIA ORAL 20ML 250 J3490 $ 16.00 ACTIVE 25901517 MILK OF MAGNESIA 30ML 250 J3490 $ 24.00 ACTIVE MIRALAX POWDER UNIT DOSE 25900756 250 J3490 $ 44.00 ACTIVE PKG Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25900759 MIRAPEX 1MG TAB 250 J8499 $ 54.00 ACTIVE MMR II, MEASLES MUMPS 63600172 636 90707 $ 384.25 ACTIVE RUBELLA VACC 0.5ML MDVIAL 25900761 MOBIC 7.5 MG TABS 250 J8499 $ 37.50 ACTIVE MODERATE SEDATION 5YRS OR 37000010 370 99152 $ 628.00 ACTIVE OLDER 1ST 15M MODERATE SEDATION EACH 37000011 370 99153 $ 556.50 ACTIVE ADDT'L 15MIN MODERATE SEDATION UNDER 37000009 370 99151 $ 1,202.50 ACTIVE 5YRS 1ST 15M MODERATE SEDATION; 5+YRS, 36000153 360 99157 $ 590.00 ACTIVE EA ADDTNL 15MINS MODERATE SEDATION; 5+YRS, 36000151 360 99156 $ 1,200.00 ACTIVE FIRST 15MINS 30100262 MOLECULAR DIAGNOSTICS 301 83902 $ 154.56 ACTIVE MOLECULAR DX AMPLIFICATION 30100264 PATIENT NUCLEIC ACID EACH 301 83901 $ 193.20 ACTIVE MULTIPLEX REACTION MOLECULAR DX ENZYMATIC 30100263 301 83892 $ 96.60 ACTIVE DIGESTION 30100251 MOLECULAR DX EXTRACTION 301 83890 $ 305.90 ACTIVE MOLECULAR DX MUTATION IDENTIFICATION SEQUENCING 30100259 301 83904 $ 309.12 ACTIVE SINGLE SEGMENT EACH SEGMENT MOLECULAR DX NUCEIC ACID 30100260 301 83896 $ 96.60 ACTIVE PROBE (EACH) 30200230 MONO SPOT TEST 302 86723 $ 48.84 ACTIVE MONTELUKAST (SINGULAIR) 25901063 250 J8499 $ 69.00 ACTIVE 10MG TAB 27600003 MORGAN LENS 276 V2797 $ 51.95 ACTIVE 25000414 MORPHINE 15MG 1ML SDVIAL 636 J2270 $ 100.00 ACTIVE 25000415 MORPHINE 2MG/ML 1ML CARP 636 J2270 $ 42.00 ACTIVE 25000416 MORPHINE 4MG/1ML VIAL 636 J2270 $ 380.00 ACTIVE 63600182 MORPHINE 5MG SYRINGE 636 J2270 $ 42.00 ACTIVE 25000420 MORPHINE SULFATE (PF) 10MG 636 J2270 $ 135.00 ACTIVE 31200017 MORPHOMETRIC ANALYSIS 312 88360 $ 623.64 ACTIVE 27200879 MOTOR STRUT -SHORT 272 A4649 $ 28,034.10 ACTIVE 25900767 MOTRIN 400MG TABLET 259 J8499 $ 22.50 ACTIVE 25900768 MOTRIN 600MG TABLET 259 J8499 $ 30.00 ACTIVE 25900769 MOTRIN 800MG TABLET 259 J8499 $ 30.00 ACTIVE 61800001 MRA ABD W CON 618 C8900 $ 4,482.24 ACTIVE 61800003 MRA ABD W/O CON 618 C8901 $ 4,211.76 ACTIVE 61800002 MRA ABD W-W/O CON 618 C8902 $ 6,053.60 ACTIVE 61800004 MRA CHEST W CON 618 C8909 $ 4,482.24 ACTIVE 61800006 MRA CHEST W/O CON 618 C8910 $ 4,173.12 ACTIVE 61800005 MRA CHEST W-W/O CON 618 C8911 $ 6,053.60 ACTIVE 61600001 MRA EXT LOW W CON 616 C8912 $ 4,482.24 ACTIVE 61600003 MRA EXT LOW W/O CON 616 C8913 $ 4,173.12 ACTIVE 61600002 MRA EXT LOW W-W/O CON 616 C8914 $ 6,053.60 ACTIVE 61500004 MRA HEAD W CONTRAST 615 70545 $ 2,981.50 ACTIVE 61500001 MRA HEAD W/O CONTRAST 615 70544 $ 16,626.00 ACTIVE 61500003 MRA NECK W/O CON 615 70547 $ 16,610.50 ACTIVE 61500002 MRA NECK W-W/O CONTRACT 615 70549 $ 27,502.50 ACTIVE 61800007 MRA PELV W CON 618 C8918 $ 4,482.24 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 61800009 MRA PELV W/O CON 618 C8919 $ 4,173.12 ACTIVE 61800008 MRA PELV W-W/O CON 618 C8920 $ 6,053.60 ACTIVE MRA PELVIS; W OR W/O 61800010 618 72198 $ 4,173.12 ACTIVE CONTRAST 61500006 MRA, NECK W/CONTRAST 615 70548 $ 3,730.50 ACTIVE MRA,HEAD W AND W/O 61500005 615 70546 $ 3,663.50 ACTIVE CONTRAST 61000022 MRI- ABD W/O CONTRAST 610 74181 $ 15,949.00 ACTIVE 61000004 MRI ABDOMEN W/CONTRAST 610 74182 $ 21,811.50 ACTIVE 61000005 MRI ABDOMEN W/WO CONTRAST 610 74183 $ 24,331.50 ACTIVE 61000006 MRI BONE MARROW 610 77084 $ 4,440.38 ACTIVE 61100001 MRI BRAIN WITH CONTRAST 611 70552 $ 15,354.50 ACTIVE 61000027 MRI CHEST W CONTRAST 610 71551 $ 18,266.50 ACTIVE 61000007 MRI CHEST W/O CON 610 71550 $ 17,247.50 ACTIVE 61000008 MRI CHEST W/WO CONTRAST 610 71552 $ 27,917.50 ACTIVE MRI EXP UPPER OTHER THAN JT 61000009 610 73220 $ 23,954.50 ACTIVE W/WO CONTRAST 61000010 MRI EXT LOW JNT W/CON 610 73722 $ 18,307.50 ACTIVE 61000011 MRI EXT LOW NO JNT W/CON 610 73719 $ 19,401.00 ACTIVE 61000012 MRI EXT UPP JNT W/CON 610 73222 $ 18,154.50 ACTIVE 61000013 MRI EXT UPP JNT W/O CON 610 73221 $ 11,299.50 ACTIVE 61000014 MRI EXT UPP NO JNT W/CON 610 73219 $ 19,365.50 ACTIVE 61000015 MRI EXT UPP NO JNT W/O 610 73218 $ 16,972.00 ACTIVE 61000016 MRI GUIDE VISCL TISS ABLT 610 77022 $ 4,440.38 ACTIVE 61000018 MRI JOINT LOWER EXT W/WO 610 73723 $ 22,605.50 ACTIVE MRI LOWER EXT OTHER THAN 61000017 610 73720 $ 24,109.00 ACTIVE JOINT W/WO CONTRAST 61000001 MRI ORBIT FACE NEC W/O 610 70540 $ 16,954.50 ACTIVE 61000019 MRI ORBIT FACE NECK W/WO 610 70543 $ 23,597.00 ACTIVE 61200001 MRI PELVIS W/WO CONTRAST 610 72197 $ 24,280.00 ACTIVE MRI UPPER EXT JOINT W/WO 61000020 610 73223 $ 22,502.50 ACTIVE CONTRAST MRI, HEAD + NECK + ORBITS, W/ 61000026 610 70542 $ 4,029.00 ACTIVE CONTRAST 61100002 MRI-BRAIN W/O & W CONT 611 70553 $ 18,114.50 ACTIVE 61100003 MRI-BRAIN W/O CONTRAST 611 70551 $ 11,028.50 ACTIVE MRI-EXT LOWER JOINT WO 61000023 610 73721 $ 11,282.00 ACTIVE CONTRAST MRI-LOWER EXT OTHER THAN 61000024 610 73718 $ 16,972.00 ACTIVE JOINT WO CONTRAST 61200002 MRI-PELVIS W/CONTRAST 610 72196 $ 19,727.00 ACTIVE 61200003 MRI-PELVIS W/O CONTRAST 610 72195 $ 17,263.50 ACTIVE 61200004 MRI-SPINE CERV W/O & W C 612 72156 $ 18,217.00 ACTIVE MRI-SPINE CERVICAL W 61200005 612 72142 $ 15,526.50 ACTIVE CONTRAST 61200006 MRI-SPINE CERVICAL W/O 612 72141 $ 10,704.00 ACTIVE 61200007 MRI-SPINE LUMB W/O&W C 612 72158 $ 18,164.50 ACTIVE 61200008 MRI-SPINE LUMBAR W CONT 612 72149 $ 15,339.00 ACTIVE 61200009 MRI-SPINE LUMBER W/O CONT 612 72148 $ 10,653.00 ACTIVE 61200010 MRI-SPINE THORACIC W CONT 612 72147 $ 15,423.50 ACTIVE 61200011 MRI-SPINE THORACIC W/O 612 72146 $ 10,704.00 ACTIVE 61000025 MRI-TEMPORAL MANDBLR TMJ 610 70336 $ 15,351.50 ACTIVE 61200012 MRI-THORACIC W/O&W CONT 612 72157 $ 18,266.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS MTHFR (5,10- METHYLENETETRAHYDROFOLAT E REDUCTASE) (EG, 31000008 HEREDITARY 310 81291 $ 206.02 ACTIVE HYPERCOAGULABILITY) GENE ANALYSIS, COMMON VARIANTS (EG, 677T, 1298C) MUCINEX 600MG EXTENDED 25900771 250 J8499 $ 10.00 ACTIVE RELEAS 92000002 MULT SLEEP LATENCY TEST 920 95805 $ 21,276.50 ACTIVE MULTAQ 400MG TABLET 25000681 250 J8499 $ 48.00 ACTIVE (DRONEDARONE) 25901892 MULTI VITAMIN 250 J8499 $ 5.25 ACTIVE 30200154 MUMPS ANTIBODY 302 86735 $ 174.00 ACTIVE MUPIROCIN (BACTROBAN) 2% 25901893 250 A6250 $ 24.30 ACTIVE OINTMT 22GM TUBE MUTATION IDENTIFICATION BY 30100267 301 83914 $ 189.98 ACTIVE ENZYMATIC LIGATION 25901943 MVI ADULT INJ 5ML VIAL 250 J3490 $ 32.20 ACTIVE MYCOBACTERIAL 30000010 306 87118 $ 175.32 ACTIVE IDENTIFICATION (EACH ISOLATE) MYCOBACTERIUM 30600073 TUBERCULOSIS NUCLEIC ACID 306 87556 $ 500.16 ACTIVE AMPLIFICATION TEST (NAAT) 30200156 MYCOPLASMA ANTIBODY 302 86738 $ 176.52 ACTIVE 30100268 MYELIN BASIC PROTEIN 301 83873 $ 141.68 ACTIVE 32000144 MYELOGRAPHY 2+ REGIONS 320 72270 $ 6,122.00 ACTIVE 32000145 MYELOGRAPHY CERVICAL 320 72240 $ 4,729.50 ACTIVE 32000146 MYELOGRAPHY LUMBOSACRAL 320 72265 $ 4,421.50 ACTIVE 32000143 MYELOGRAPHY POST FOSSA 320 70010 $ 4,944.58 ACTIVE 32000147 MYELOGRAPHY THORACIC 320 72255 $ 4,697.50 ACTIVE 30100069 MYELOPEROXIDASE (MPO) 301 83876 $ 610.32 ACTIVE MYOCARDIAL PERFUSION IMAGING W/SPECT EJECTION 34100088 341 78452 $ 23,450.50 ACTIVE FRACTION REST AND/OR STRESS 30100269 MYOGLOBIN 301 83874 $ 172.20 ACTIVE 30600103 N.GONORRHOEAE DNA QUANT 306 87592 $ 158.64 ACTIVE 34100006 N/M THYROID UPTAKE W/ SCAN 341 78006 $ 2,514.20 ACTIVE NALBUPHINE 10MG/ML 10ML 25200007 636 J2300 $ 74.26 ACTIVE MDV 63600173 NALOXONE 2MG/2ML SYRINGE 636 J2310 $ 57.57 ACTIVE 25901531 NAPROSYN EC 500MG TAB 250 J8499 $ 37.50 ACTIVE NAROPIN (ROPIVACAINE HCL) 25000434 636 J2795 $ 192.00 ACTIVE 5MG MG/ML 0.5% 30ML SDV 32000148 NASAL BONES MIN 3 VI 320 70160 $ 1,556.50 ACTIVE 30900006 NASAL SMEAR EOSINOPHILS 309 89190 $ 69.48 ACTIVE NASAL/OROGASTRIC W/TUBE 36000188 360 43752 $ 1,273.79 ACTIVE PLMT 47100001 NASOPHARYNGOSCOPY 471 92511 $ 4,456.48 ACTIVE NEBULIZER ADMINISTRATION 27000772 270 A7003 $ 24.00 ACTIVE SET 41000001 NEBULIZER TREATMENT INITIAL 410 94640 $ 539.53 ACTIVE

41000019 NEBULIZER TREATMENT SUBSQ 410 94640 $ 269.77 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 32000149 NECK SOFT TISSUE 320 70360 $ 1,335.00 ACTIVE NEDDLE, MERIT ADVANCE. ONE 27200898 WALL 18G. 7.0CM 2 3/4" . 272 A4215 $ 393.75 ACTIVE SELDINGER SHIELD SMOOTH 27200861 NEEDLE BONE MARROW VITOSS 272 C1830 $ 3,120.00 ACTIVE 92200001 NEEDLE EMG 1 EXTREM 922 95860 $ 805.00 ACTIVE 92200002 NEEDLE EMG 2 EXTREM 922 95861 $ 866.18 ACTIVE 92200003 NEEDLE EMG 3 EXTREM 922 95863 $ 1,014.30 ACTIVE 92200004 NEEDLE EMG 4 EXTREM 922 95864 $ 1,362.06 ACTIVE 27200785 NEEDLE HUBER/GRIPPER 272 A4649 $ 44.00 ACTIVE 27200823 NEEDLE HYPODERMIC (ALL) 272 A4215 $ 24.00 ACTIVE 27200652 NEEDLE INSULATED ALL SIZES 272 A4215 $ 1,119.00 ACTIVE NEEDLE PERCUTANEOUS ENTRY 27200700 272 A4215 $ 113.00 ACTIVE THINWALL 18GA/7CM NEEDLE PORT A CATH 20G X 1 27000302 270 A4301 $ 114.00 ACTIVE 1/4 (13914) NEEDLE PORT A CATH 20G X 3/4 27000303 270 A4301 $ 110.00 ACTIVE (13790) NEEDLE PORT A CATH 20G X 3/4 27000304 270 A4301 $ 100.00 ACTIVE (13790) 27200669 NEEDLE RADIAL JAW 272 A4215 $ 847.50 ACTIVE 27000608 NEEDLE SPINAL 18-19 GA X 3.5 272 A4215 $ 60.00 ACTIVE 27000606 NEEDLE SPINAL 18-20GA 6-8" 272 A4215 $ 344.00 ACTIVE 27000607 NEEDLE SPINAL 22 GA 5-7" 272 A4215 $ 488.00 ACTIVE 27000305 NEEDLE SPINAL 25G X 3.5 (10351) 270 A4215 $ 48.00 ACTIVE 27200824 NEEDLE SPINAL 25GA X 3.5 272 A4215 $ 140.00 ACTIVE 27200587 NEEDLE TRU CUT BIOPSY 272 A4215 $ 244.00 ACTIVE 27200794 NEEDLE W/SYRINGE 272 A4657 $ 52.00 ACTIVE 27200904 NEEDLE, BLUNT FILL 18GX1.5 272 A4215 $ 2.10 ACTIVE 42000029 NEG PRESS WOOUND TX > 50CM 450 97606 $ 1,027.82 ACTIVE NEG PRESSURE THERAPY UNIT 29100001 291 E2402 $ 744.00 ACTIVE DAILY RATE NEISSERIA GONORRHOEAE 30600074 306 87590 $ 126.00 ACTIVE DIRECT DNA PROBE NEISSERIA GONORRHOEAE, 30600101 306 87591 $ 129.99 ACTIVE AMPLIFIED PROBE TECHNIQUE NEO SYNEPHRINE 10MG/ML 5ML 25000437 636 J2370 $ 60.00 ACTIVE VIAL (PHENYLEPHRINE) 25900800 NEOMYCIN 500MG TAB 250 J8499 $ 52.50 ACTIVE 25901894 NEOMYCIN OTIC SOLN BTL 250 J3490 $ 408.10 ACTIVE 25000438 NEOMYCIN/POLYMYXIN/HC 10ML 250 J3490 $ 172.00 ACTIVE 25900802 NEOSPORIN OINTMENT .94GM 250 A6250 $ 36.00 ACTIVE 25900803 NEOSPORIN OINTMENT 15GM 250 A6250 $ 106.50 ACTIVE 25000439 NEOSTIGMIN 11000/ML INJ 636 J2710 $ 248.00 ACTIVE 25000440 NEOSTIGMINE 0.5MG INJ 636 J2710 $ 78.00 ACTIVE NEO-SYNEPHINE 1% NASAL 25900797 250 J3490 $ 28.00 ACTIVE SPRAY 42000031 NEUROMUSC RE-ED EA 15 450 97112 $ 260.40 ACTIVE 25900806 NEURONTIN 300 MG CAPS 250 J8499 $ 27.00 ACTIVE 25900807 NEURONTIN 400MG CAP 250 J8499 $ 30.00 ACTIVE 25901895 NEURONTIN 600MG CAP 250 J8499 $ 27.00 ACTIVE 25901896 NEURONTIN 800MG TAB 250 J8499 $ 27.00 ACTIVE NEUROPLASTY/TRANSPOSITION; 36000279 360 64719 $ 20,600.00 ACTIVE ULNAR NERVE WRIST Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 76100018 NEW PATIENT LEVEL 1 761 99201 $ 567.40 ACTIVE 76100019 NEW PATIENT LEVEL 2 761 99202 $ 677.38 ACTIVE 76100020 NEW PATIENT LEVEL 3 761 99203 $ 939.46 ACTIVE 76100021 NEW PATIENT LEVEL 4 761 99204 $ 1,177.00 ACTIVE 76100022 NEW PATIENT LEVEL 5 761 99205 $ 1,500.36 ACTIVE 25901951 NICARDIPINE 20MG 200ML IV FL 250 J3490 $ 201.50 ACTIVE 25901897 NICARDIPINE 25MG/10ML IV 250 J3490 $ 63.65 ACTIVE 25900820 NICOTINE 21MG PATCH 259 S4990 $ 230.00 ACTIVE NIFEDIPINE (PROCARDIA) 30MG 25900961 250 J8499 $ 45.00 ACTIVE TABLET 25200040 NITRO-BID 2% OINT U/D PKG 250 A6250 $ 16.00 ACTIVE 25901898 NITROBID OINT 30GM 250 A6250 $ 85.18 ACTIVE NITROFURANTOIN (MACROBID) 25900719 250 J8499 $ 24.00 ACTIVE 50MG CAP 46000005 NITROGEN WASHOUT 460 94350 $ 908.04 ACTIVE 25901899 NITROGLYCERIN 25MG/250ML IV 250 J3490 $ 50.50 ACTIVE

25901959 NITROGLYCERIN 50MG/250ML IV 250 J3490 $ 19.22 ACTIVE NITROSTAT 0.4MG S.L. TAB 25000691 250 J8499 $ 28.00 ACTIVE (NITROGLYCERIN) 30100603 NK CELL TOTAL COUNT 302 86357 $ 139.74 ACTIVE 34100008 NM ABSCSS LOC WB 341 78806 $ 27,338.00 ACTIVE 34100009 NM ADRENAL IMAGING 341 78075 $ 4,396.00 ACTIVE 34100011 NM BONE DENSITY 1+SITES 341 78350 $ 504.00 ACTIVE 34100012 NM BONE SCAN THREE PHASE 341 78315 $ 17,237.00 ACTIVE 34100013 NM BONE SCAN W SPEC 341 78320 $ 11,309.50 ACTIVE 34100014 NM BONE SCAN WHOLE BODY 341 78306 $ 12,502.50 ACTIVE 34100015 NM BONESCAN LIMITED 341 78300 $ 8,944.50 ACTIVE 34100016 NM BONESCAN MX AREAS 341 78305 $ 11,442.50 ACTIVE 34100017 NM BOWEL IMAGING-MECKELS 341 78290 $ 12,335.00 ACTIVE 34100018 NM BRAIN CISTERNOGRAM 341 78630 $ 16,854.50 ACTIVE 34100019 NM BRAIN CMPL STATIC 341 78605 $ 3,825.36 ACTIVE 34100020 NM BRAIN CMPL W FLOW 341 78606 $ 5,771.70 ACTIVE 34100021 NM BRAIN CMPL W SPECT 341 78607 $ 17,497.50 ACTIVE 34100022 NM BRAIN CSF SHUNT EVAL 341 78645 $ 2,758.00 ACTIVE 34100023 NM BRAIN FLOW ONLYY 341 78610 $ 5,771.70 ACTIVE 34100024 NM BRAIN LTD 341 78600 $ 3,825.36 ACTIVE 34100025 NM BRAIN LTD W FLOW 341 78601 $ 3,825.36 ACTIVE 34100026 NM CSF FLOW W SPECT 341 78647 $ 5,771.70 ACTIVE 34100027 NM CSF LEAKAGE DETECTION 341 78650 $ 5,771.70 ACTIVE 34100028 NM CSF VENTRICULOGRAPHY 341 78635 $ 5,771.70 ACTIVE 34100030 NM GALLIUM SCAN MULT 341 78801 $ 4,057.20 ACTIVE 34100031 NM GALLIUM SCAN SPEC 341 78803 $ 10,075.86 ACTIVE 34100029 NM GALLIUM TUMOR LOCLTD 341 78800 $ 3,326.26 ACTIVE 34100032 NM GASTRIC EMPTYING STDY 341 78264 $ 14,363.50 ACTIVE NM GASTROESOPHAGEAL 34100033 341 78262 $ 2,923.76 ACTIVE REFLX 34100034 NM GI BLEEDING SCAN 341 78278 $ 17,338.00 ACTIVE 34100035 NM GI PROTEIN LOSS 341 78282 $ 2,923.76 ACTIVE 34100036 NM HEART 1ST PASS ADD ON 341 78496 $ 2,343.60 ACTIVE 34100037 NM HEART 1ST PASS MULTI 341 78483 $ 4,522.00 ACTIVE 34100038 NM HEART 1ST PASS SINGLE 341 78481 $ 3,500.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 34100039 NM HEART BLOOD POOL SPECT 341 78494 $ 3,889.20 ACTIVE 34100040 NM HEART GATED MX STDY 341 78473 $ 4,831.40 ACTIVE 34100041 NM HEART GATED SINGLE 341 78472 $ 11,411.50 ACTIVE 34100042 NM HEART MI PLANAR 341 78466 $ 3,397.10 ACTIVE 34100043 NM HEART MI W EF 341 78468 $ 3,397.10 ACTIVE 34100044 NM HEART MI W SPECT 341 78469 $ 3,397.10 ACTIVE 34100045 NM HEART MP SNGLE PLANAR 341 78460 $ 7,752.30 ACTIVE 34100046 NM HEART MP W EF 341 78480 $ 1,763.38 ACTIVE 34100047 NM HEART MP WALL MOTION 341 78478 $ 1,778.00 ACTIVE 34100050 NM HRT MP MX W SPECT 341 78465 $ 7,752.30 ACTIVE 34100051 NM HRT MP SINGLE W SPEC 341 78464 $ 7,752.30 ACTIVE 25500014 NM I 123 IODINE 250 A9516 $ 540.96 ACTIVE 34100052 NM KIDNEY STUDY BIL 341 78708 $ 8,612.50 ACTIVE 34100054 NM LIVER & SPLEEN STATIC 341 78215 $ 9,625.50 ACTIVE 34100053 NM LIVER (SPECT) W FLOW 341 78206 $ 3,843.28 ACTIVE 34100057 NM LIVER IMAGING (SPECT) 341 78205 $ 10,432.50 ACTIVE 34100058 NM LIVER IMAGING STATIC 341 78201 $ 3,368.12 ACTIVE 34100059 NM LIVER W/VASCULAR FLOW 341 78202 $ 9,951.50 ACTIVE 34100060 NM LUNG PERF 341 78580 $ 11,835.00 ACTIVE NM LUNG PERFUSION AND 34100092 341 78582 $ 4,418.00 ACTIVE VENTILATION 34100091 NM LUNG VENTILATION ONLY 341 78579 $ 11,835.00 ACTIVE 34100066 NM OCTREOSCAN 341 78399 $ 3,102.40 ACTIVE 34100067 NM PARATHYROID IMAGING 341 78070 $ 14,910.50 ACTIVE 34100068 NM RENAL SCAN W/SPECT 341 78710 $ 3,404.80 ACTIVE 25500016 NM RP MYOVIEW 10MCI REST 255 A9502 $ 1,349.18 ACTIVE 34100073 NM SPLEEN IMAGING ONLY 341 78185 $ 3,075.10 ACTIVE 34100074 NM TESTIC IMG W/VASC FLW 341 78761 $ 9,625.50 ACTIVE 34100077 NM THYROID IMAGING ONLY 341 78010 $ 11,400.00 ACTIVE 34100076 NM THYROID METASTSS LTD 341 78015 $ 3,326.26 ACTIVE 34100078 NM THYROID METS W BODY 341 78018 $ 4,033.40 ACTIVE 34100079 NM THYROID UPTAKE MX 341 78001 $ 17,400.00 ACTIVE 34100080 NM THYROID UPTAKE SINGLE 341 78000 $ 1,307.32 ACTIVE 34100081 NM TUMOR LOC WB SNGL DAYG 341 78802 $ 5,506.26 ACTIVE 34200001 NM TX THYROID SUPPW/EVAL 342 79005 $ 3,044.72 ACTIVE 34100082 NM VENOGRAM BILAT 341 78458 $ 2,270.94 ACTIVE 34100007 NM VENOGRAM UNILAT 341 78457 $ 2,103.50 ACTIVE 34100083 NM VP SHUNT PATENCY TEST 341 78291 $ 2,923.76 ACTIVE NM WBC LABEL 34100084 341 78805 $ 22,338.00 ACTIVE LOCAL/ABSCESS/LTD 34100085 NM WHOLE BODY 2+ DAYS 341 78804 $ 10,075.86 ACTIVE NMR LIPOPROTEIN PROFILE 30100067 301 83704 $ 420.72 ACTIVE (LDL-P AND HDL-P) NON CORONARY STENT 36000053 360 37205 $ 881.00 ACTIVE PLACEMENT NON SEL COMMON ILLIAC 48100092 481 75710 $ 9,308.68 ACTIVE SUBCLAVIAN ANGIO 92100018 NONINVAS ART W/STRESS BIL 921 93924 $ 1,700.16 ACTIVE 92100017 NON-INVAS EXT ART MX BIL 921 93923 $ 1,597.12 ACTIVE 44000008 NONSPEECH GEN DEVICE EVAL 440 92605 $ 322.00 ACTIVE NONSPEECH GEN DEVICE 44000009 440 92606 $ 322.00 ACTIVE SERVICE 25900839 NORCO 10-325 TAB 250 J8499 $ 24.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25900840 NORCO 5-325 TAB 250 J8499 $ 16.00 ACTIVE 25900841 NORCO 7.5MG/325MG TABLET 250 J8499 $ 22.00 ACTIVE 30100275 NORTRIPTYLINE 301 80182 $ 228.62 ACTIVE NOVOLOG 100 UNITS/ML (1 25000669 250 J1815 $ 14.00 ACTIVE UNIT/.01 ML) 25900848 NOVOLOG MIX 100 UNITS/10ML 636 J1815 $ 14.00 ACTIVE NS 0.45% 1000ML W/POTASSIUM 25800050 258 J3480 $ 30.00 ACTIVE CHL 20MEQ 25800051 NS 0.9% 1000ML/KCL 20MEQ 258 J3480 $ 164.00 ACTIVE 30100276 N-TELOPEPTIDE (SERUM) 301 82523 $ 249.12 ACTIVE 30600076 NUCLEIC ACID PROBE 306 87149 $ 267.36 ACTIVE 30100524 NUCLEOTIDASE 5 301 83915 $ 148.68 ACTIVE 94200009 NUTRIT CNSL DIETICIAN 942 S9470 $ 460.46 ACTIVE 25900849 NYSTATIN CREAM 15GM TUBE 250 A6250 $ 54.00 ACTIVE NYSTATIN ORAL SUSP 25000455 250 J3490 $ 14.00 ACTIVE 5000U/5ML UD CUP 25900850 NYSTATIN PWD 100 000 U/1GM 250 J3490 $ 302.00 ACTIVE 25901965 NYSTATIN PWD 15GM 250 J3490 $ 302.00 ACTIVE 40200005 OB US DETAILED SNGL FETUS 402 76811 $ 8,841.50 ACTIVE 40200006 OB US LIMITED FETUS(S) 402 76815 $ 4,109.50 ACTIVE 76200003 OBSERVATION PER HOUR 762 G0378 $ 3,000.00 ACTIVE 76200025 OBSERVATION PER HOUR <8HRS 762 G0378 $ 3,000.00 ACTIVE OFLOXACIN 0.3% OPHTH SOLN 25900854 250 J3490 $ 496.80 ACTIVE 10ML BTL 30100277 OLIGOCLONAL BANDS 301 83916 $ 328.68 ACTIVE OMEPRAZOLE (PRILOSEC, 25901794 259 J8499 $ 24.00 ACTIVE NEXIUM) 20MG CAP OMNIPAQUE 240MG/10ML 25000015 636 Q9966 $ 266.00 ACTIVE (IOHEXOL) OMNIPAQUE 240MG/20ML 25000014 636 Q9966 $ 266.00 ACTIVE (IOHEXOL) OMNIPAQUE 240MG/50ML VIAL 25000457 636 Q9966 $ 298.00 ACTIVE (IOHEXOL) OMNIPAQUE 300MG/100ML VIAL 25000458 636 Q9967 $ 260.00 ACTIVE (IOHEXOL) OMNIPAQUE 300MG/10ML 25000016 636 Q9967 $ 266.00 ACTIVE (IOHEXOL) OMNIPAQUE 300MG/50ML 25000017 636 Q9967 $ 274.00 ACTIVE (IOHEXOL) ONDANSETRON (ZOFRAN) 4MG 25900858 250 S0119 $ 240.00 ACTIVE ODTAB 63600174 ONDANSETRON 40MG/20ML VIAL 636 J2405 $ 13.78 ACTIVE ONDANSETRON 4MG/5ML 50ML 25000572 250 S0119 $ 150.00 ACTIVE OS BTL 27000311 ON-Q 400ML PAIN PUMP 270 E0781 $ 1,925.28 ACTIVE OP CONSULT 96000006 COMPREHENSIVE/HIGH 960 99245 $ 5,661.00 ACTIVE COMPLEX 80MINS OP CONSULT 96000005 COMPREHENSIVE/MOD 960 99244 $ 4,644.00 ACTIVE COMPLEX 60MINS OP CONSULT DETAILED/LOW 96000004 960 99243 $ 3,105.00 ACTIVE COMPLEX 40MINS OP CONSULT EXPANDED 96000003 PROBLEM/STRAIGHTFORWARD 960 99242 $ 2,268.00 ACTIVE 30MIN Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS OP CONSULT PROBLEM 96000002 FOCUSED/STRAIGHTFORWARD 960 99241 $ 1,206.00 ACTIVE 15MIN OPEN ANGIOPLASTY - EACH 48100028 481 37208 $ 1,522.00 ACTIVE ADDITIONAL OPEN TREATMENT OF CALCANEAL FRACTURE, 36000361 360 28415 $ 57,995.50 ACTIVE INCLUDES INTERNAL FIXATION, WHEN PERFORMED; OPEN TREATMENT OF CLAVICULAR FX INCLUDES 36000123 360 23515 $ 21,639.82 ACTIVE INTERNAL FIXATION WHEN PERFORMED OPEN TREATMENT,DISTAL TIBIOFIBULAR JOINT 36000284 (SYNDESMOSIS) DISRUPTION, 360 27829 $ 84,831.80 ACTIVE INCLUDES INTERNAL FIXATION, WHEN PERFORMED OPEN TX OF FRACTURE,WT BEARING ARTICULAR 36000289 SURFACE/PORTION OF DISTAL 360 27827 $ 56,722.00 ACTIVE TIBIA (EG, PILON OR TIBIAL PLAFOND),WITH IF OPEN TX PROXIMAL HUMERAL (SURGICAL/ANATOMICAL NECK) 36000043 360 23615 $ 39,072.71 ACTIVE FX INCLUDES INTERNAL FIXATION TUBOROSITY REPAIR OPEN TX TRIMALLEOLAR ANKLE 11900001 FX WITH OR WITHOUT INTERNAL 360 27822 $ 44,268.50 ACTIVE FIXATION 32000150 OPTIC FORAMINA 320 70190 $ 890.40 ACTIVE OPTIMARK 330.9MG/ML 15ML 25901966 250 A9579 $ 99.82 ACTIVE VIAL 63600175 OPTIRAY 300/50ML 636 Q9967 $ 46.53 ACTIVE 27000312 OR COBAN DRESSING 4"" 270 A6454 $ 184.00 ACTIVE 41000034 ORAL CARE PROCEDURE BY RT 410 31720 $ 539.53 ACTIVE ORAL MAGNETIC RESONANCE 25500013 255 Q9954 $ 48.75 ACTIVE CONTRAST PER 100 ML ORAL SPEECH DEVICE 44000010 440 92597 $ 1,899.80 ACTIVE EVALUATION ORAVERSE, REGITINE 5MG 25000470 636 J2760 $ 712.00 ACTIVE SDVIAL 32000151 ORBITS 4V OR MORE 320 70200 $ 2,020.50 ACTIVE ORCHIECTOMY, SIMPLE; 36000277 SCROTAL OR INGUINAL 360 54520 $ 16,903.50 ACTIVE APPROACH ORCHIOPEXY INGUINAL 36000032 APPROACH W/OR W/O HERNIA 360 54640 $ 25,033.50 ACTIVE REPAIR ORGANIC ACIDS QUALITATIVE 30100280 301 83919 $ 219.36 ACTIVE (EACH) ORIF FINGER DISLOCATION, 36000268 360 26715 $ 29,650.50 ACTIVE SINGLE 36000274 ORIF OF BIMALL ANKLE FX 360 27814 $ 36,231.50 ACTIVE ORIF OF DISTAL FIBULA FX (LAT 36000245 360 27792 $ 33,914.50 ACTIVE MALLEOLUS) ORIF OF DISTAL RADIAL FX OR 36000262 360 25607 $ 38,148.00 ACTIVE EPIPHYSEAL SEPARATION Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS ORIF OF HUMERAL 36000269 SUPRACONDYLAR/TRANSCONDY 360 24545 $ 48,349.00 ACTIVE LAR FX ORIF OF METACARPAL FX, 36100020 361 26615 $ 28,106.00 ACTIVE SINGLE, EA BONE ORIF OF METATARSAL 36000310 FRACTURE, WHEN PERFORMED, 360 28485 $ 28,079.50 ACTIVE EA 42000032 ORTHO FIT/TRAIN EA 15 450 97760 $ 259.00 ACTIVE 25900218 OSCAL 600/400MG TAB 250 J8499 $ 8.00 ACTIVE OSELTAMIVIR (TAMIFLU) 30MG 25901900 250 J8499 $ 21.68 ACTIVE CAP 30100283 OSMOLALITY URINE 301 83935 $ 90.84 ACTIVE 32000152 OSSEOUS SURVEY 320 77075 $ 4,177.00 ACTIVE 32000153 OSSEOUS SURVEY INFANT 320 77076 $ 982.10 ACTIVE 32000154 OSSEOUS SURVEY LIMITED 320 77074 $ 3,065.50 ACTIVE OSTECTOMY OF STERNUM 36000240 360 21620 $ 7,873.80 ACTIVE PARTIAL OSTECTOMY, PARTIAL, EXOSTECTOMY/CONDYLECTOM 36000252 360 28288 $ 22,409.50 ACTIVE Y, MT HEAD, EA METATARSAL HEAD 27000314 OSTEOGENIC STIMULATOR 270 E0748 $ 36,225.00 ACTIVE OSTEOMED 2.3 CANNULATED 29000001 270 C1713 $ 2,400.00 ACTIVE DRILL OSTEOTOMY, TARSAL BONES, 36000364 OTHER THAN CALCANEUS OR 360 28304 $ 31,318.00 ACTIVE TALUS; OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, 36000355 360 28309 $ 46,331.50 ACTIVE METATARSAL; MULTIPLE (EG, SWANSON TYPE CAVUS FOOT PROCEDURE) OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE 36000362 360 28300 $ 33,732.50 ACTIVE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION OSTEOTOMY; MULTIPLE, WITH REALIGNMENT ON 36000357 360 27712 $ 57,455.50 ACTIVE INTRAMEDULLARY ROD (EG, SOFIELD TYPE PROCEDURE) 43400001 OT EVAL 15 MIN 434 97003 $ 302.68 ACTIVE 43400002 OT RE-EVAL 15 MIN 434 97004 $ 302.68 ACTIVE 30600079 OTHER METHOD IDENTIFICATION 306 87158 $ 92.88 ACTIVE OVA AND PARASITES DIRECT 30000038 SMEAR CONCENTRATION AND 306 87177 $ 118.68 ACTIVE IDENTIFICATION 27000657 OXIMETER PULSE DISP 270 E0445 $ 144.00 ACTIVE OXYBUTYNIN (DITROPAN) 5MG 25900401 250 J8499 $ 24.00 ACTIVE TAB OXYGEN PROBE FOR USE WITH 27000776 270 A4606 $ 46.15 ACTIVE OXIMETER DEVICE OXYGEN THERAPY INITIAL 41000035 410 94799 $ 506.80 ACTIVE SETUP 41000036 OXYGEN THERAPY PER DAY 410 94799 $ 304.08 ACTIVE 30100287 OXYLATE 301 83945 $ 173.40 ACTIVE 25901901 OXYMETAZOLINE 0.05% NS 30ML 250 J3490 $ 5.25 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000618 PACK ARTHROSCOPY 270 A4649 $ 1,044.00 ACTIVE 27000620 PACK BASIC SET-UP 270 A4649 $ 148.00 ACTIVE 27200714 PACK CATH LAB 272 A4301 $ 558.00 ACTIVE 27200686 PACK CYCTOSCOPY 272 A4649 $ 203.40 ACTIVE 27200628 PACK LAPAROTOMY T-SHEET 272 A4467 $ 186.00 ACTIVE PACK, HEAVY DUTY LOWER 27200903 272 A4649 $ 917.05 ACTIVE EXTREMITY 27200908 PACK, OBSTETRICAL 272 A4649 $ 237.00 ACTIVE 30000042 PACKED RBC 381 P9021 $ 460.00 ACTIVE 27000500 PACKING GAUZE IODOFORM 1 272 A6266 $ 464.00 ACTIVE 27000323 PACKING NUGZ 1"""" PL 270 A6407 $ 5.30 ACTIVE 27000327 PACKING NUGZ 2 270 A6402 $ 52.00 ACTIVE 27200793 PAD EYE PATCH STERILE 272 A6410 $ 62.00 ACTIVE 27000745 PAD, ALCOHOL PREP STR MED 270 A4245 $ 0.15 ACTIVE 27200891 PAD, FOAM DECUB 33X72X2" 272 A6213 $ 217.20 ACTIVE 27000329 PADDING CAST 2 N/S 270 A4580 $ 14.00 ACTIVE 27000330 PADDING CAST 4 STERILE 270 A4580 $ 24.00 ACTIVE 27000331 PADDING CAST 6 N/S 270 A4580 $ 28.00 ACTIVE 27200696 PAIN BLOCK TRAY 272 A4550 $ 169.50 ACTIVE 30100051 PANEL BASIC METABOLIC 301 80048 $ 112.80 ACTIVE 30100134 PANEL ELECTROLYTE 301 80051 $ 93.48 ACTIVE 30100192 PANEL HEPATIC FUNCTION 301 80076 $ 108.96 ACTIVE 30100230 PANEL LIPID 301 80061 $ 178.56 ACTIVE 30100349 PANEL RENAL FUNCTION 301 80069 $ 115.80 ACTIVE 42000033 PARAFFIN BATH 15 450 97018 $ 203.70 ACTIVE 30100338 PARATHYROID PTH INTACT 301 83970 $ 475.80 ACTIVE PARING/CUTTING BENIGN 45000092 HYPERKERATOTIC LESION (EG, 450 11055 $ 828.00 ACTIVE CORN/CALLUS); SINGLE LESION PARING/CUTTING BENIGN 76100023 761 11056 $ 580.50 ACTIVE LESION/2-4 LESIONS PARINT/CUTTING BENIGN 76100024 761 11057 $ 751.64 ACTIVE LESION/ > 4 LESIONS PARTIAL EXCISION BONE 36000121 360 28124 $ 17,272.00 ACTIVE PHALANX OF TOE PARTIAL THROMBOPLASTIN 30500037 305 85730 $ 80.04 ACTIVE TIME PARTIAL THROMBOPLASTIN 30500039 305 85732 $ 86.16 ACTIVE TIME (PLASMA/ WHOLE BLOOD) PARTICLE AGGLUTINATION; 30200092 302 86403 $ 138.48 ACTIVE SCREEN, EACH ANTIBODY PARVOVIRUS B19 ANTIBODY 30200165 302 86747 $ 200.40 ACTIVE IMMUNOGLOBIN-G 27000676 PASTE SKIN BARRIER 270 A4649 $ 56.50 ACTIVE 27000436 PATIENT SOCKS 270 A9270 $ 15.00 ACTIVE PCI ACUTE/SUBTOTAL OCCLUSION MYOCARDIAL 48100079 INFARCTION, CORONARY 481 92941 $ 40,568.52 ACTIVE ARTERY OR CORONARY ARTERY BYPASS GRAFT PEAK EXPIRATORY FLOW RATE 29400001 270 A4614 $ 267.60 ACTIVE METER, HAND HELD 46000006 PEAK FLOW STUDY 460 94010 $ 215.20 ACTIVE 32000027 PELVIC VESSEL 320 75736 $ 16,461.99 ACTIVE 32000157 PELVIS 1 OR 2 VIEWS 320 72170 $ 1,317.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PENICILLIN G POTASS 25000463 636 J2540 $ 90.00 ACTIVE 5,000,000UN VIAL PENICILLIN V POTASS 125MG 25000700 250 J3490 $ 24.00 ACTIVE 5ML ORAL SOL 25901712 PEPTO BISMOL 12 OZ 250 A9150 $ 36.00 ACTIVE 25900893 PEPTO-BISMOL 262MG CHEW 250 J8499 $ 8.00 ACTIVE PERC COR ATHERECTOMY W/WO 48000010 480 92995 $ 45,573.84 ACTIVE PTCA PERC COR ATHERECTOMY W/WO 48000011 480 92996 $ 45,573.84 ACTIVE PTCA 32000028 PERC PLACET OF IVC FILTER S&I 320 75940 $ 5,296.36 ACTIVE

PERC. CORONARY INTV 48100078 481 92937 $ 45,568.52 ACTIVE OF/THROUGH A BYPASS GRAFT PERCUT IMPL OF NEUROSTIM 36000118 360 63650 $ 41,724.92 ACTIVE ELECT PERCUTANEOUS CORONARY INTERVENTION - WITH DES - 48100108 481 C9601 $ 21,236.50 ACTIVE EACH ADDITIONAL BRANCH OF A MAJOR CORONARY ARTERY

PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT 36000314 360 28496 $ 13,993.00 ACTIVE TOE, PHALANX OR PHALANGES, WITH MANIPULATION PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING STENT(S) 48100038 481 C9600 $ 40,568.52 ACTIVE W/CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR COR PERCUTANEOUS TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), 48100077 481 92929 $ 40,568.52 ACTIVE WITH CORONARY ANGIOPLASTY WHEN PERFORMED; EACH ADDITIONAL

PERCUTANEOUS 48000012 TRANSLUMINAL CORONARY 480 92973 $ 7,298.14 ACTIVE THROMBECTOMY MECHANICAL PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF ACUTE 48100109 481 C9606 $ 71,835.92 ACTIVE TOTAL/SUBTOTAL OCCLUSION DURING ACUTE MYOCARDIAL INFA PERCUTANOUS TRANSCATHETER PLCMNT OF 48100037 INTRACORONARY STENT(S) W/ 481 92928 $ 57,276.00 ACTIVE ANGIOPLASTY WHEN PERFORMED EA ADDITIONAL 32000029 PERI ATHERECTOMY S&I 320 75992 $ 5,998.86 ACTIVE 48100035 PERICARDIAL WINDOW 481 33025 $ 3,319.82 ACTIVE 48100033 PERICARDIOCENTISIS 481 33010 $ 3,794.08 ACTIVE 30500007 PERIPHERAL BLOOD SMEAR 305 85060 $ 243.94 ACTIVE 32000158 PERITONEOGRAM 320 74190 $ 3,507.72 ACTIVE 25000468 PERMETHRIN CREAM 250 A6250 $ 316.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 32000030 PERQ BILIARY DRAINAGE S&I 320 75982 $ 3,909.08 ACTIVE 25901569 PERSANTINE 25MG TABS 250 J8499 $ 16.00 ACTIVE PHALANGECTOMY, TOE, EACH 36000376 360 28150 $ 13,962.50 ACTIVE TOE 32000160 PHARYNGEAL SPEECH EVAL 320 70371 $ 1,544.42 ACTIVE 32000161 PHARYNX OR ESOPH CERV 320 74210 $ 1,097.60 ACTIVE 32000162 PHARYNXLARYNX W FLUORO 320 70370 $ 1,128.40 ACTIVE PHENAZOPYRIDINE (PYRIDIUM, 25900900 250 J8499 $ 24.00 ACTIVE AZO) 95MG TAB 25901902 PHENAZOPYRIDINE 100MG TAB 250 J8499 $ 5.25 ACTIVE 25900903 PHENERGAN 12.5MG R/S 250 J8498 $ 45.00 ACTIVE PHENERGAN 6.25MG + CODEINE 25901572 250 J3490 $ 24.00 ACTIVE 10MG PER 5ML 30100292 PHENOBARBITAL 301 80184 $ 183.60 ACTIVE 25900907 PHENOBARBITAL 100MG TAB 250 J8499 $ 8.00 ACTIVE PHENOL EZ OTIC ANESTH 25200008 250 J3490 $ 176.00 ACTIVE COTTON SWAB 63600176 PHENYLEPHRINE 10MG/ML 636 J2370 $ 9.18 ACTIVE PHENYTOIN (DILANTIN) 100MG 25900391 250 J3490 $ 124.25 ACTIVE 2ML (50MG/ML) SDVIAL PHENYTOIN (DILANTIN) 250MG 25901964 250 J3490 $ 124.25 ACTIVE 5ML 30100294 PHENYTOIN (FREE) 301 80186 $ 183.48 ACTIVE 25900912 PHISOHEX 3% LIQUID 148ML 250 A6250 $ 216.00 ACTIVE 94000013 PHLEBOTOMY (THERAPEUTIC) 940 99195 $ 386.40 ACTIVE 30100298 PHOSPHORUS SERUM 301 84100 $ 63.24 ACTIVE 30100299 PHOSPHORUS URINE 301 84105 $ 69.36 ACTIVE 42000034 PHYS PERFORM TEST 15M 450 97750 $ 284.36 ACTIVE PHYSICAL THERAPY EVAL: HIGH 42400006 424 97163 $ 4,140.50 ACTIVE COMPLEXITY PHYSICAL THERAPY EVAL: LOW 42400004 424 97161 $ 828.10 ACTIVE COMPLEXITY PHYSICAL THERAPY EVAL: 42400005 424 97162 $ 2,070.25 ACTIVE MODERATE COMPLEXITY 36000201 PICC INSERT W/OUT SQ PORT 360 36569 $ 23,513.00 ACTIVE 36000202 PICC INSERT W/SQ PORT 5YRS> 360 36571 $ 12,060.50 ACTIVE 27100002 PILLOW ABDUCTION 271 E0190 $ 1,988.00 ACTIVE 27000734 PIN ANCHORAGE FIXATION 270 C1713 $ 1,976.00 ACTIVE 30600080 PINWORM EXAM 306 87172 $ 57.00 ACTIVE 30100302 PKU BLOOD 301 84030 $ 73.32 ACTIVE 36000055 PLACE CATHETER IN AORTA 360 36200 $ 4,520.88 ACTIVE 36000057 PLACE CATHETER IN VEIN 360 36010 $ 4,520.88 ACTIVE PLACEMENT NEPHROSTOMY 36000045 360 50432 $ 14,242.06 ACTIVE CATHETER PLACEMENT OF CATHETER 48100107 481 36011 $ 10,796.86 ACTIVE VENEOUS PLACEMENT OF OCCLUSIVE 48100119 DEVICE INTO EITHER A VENOUS 481 G0269 $ 25,412.65 ACTIVE OR ARTERIAL ACCESS SITE PLASBUMIN 25 (ALBUMIN, 63600011 636 P9047 $ 882.00 ACTIVE HUMAN) 25%USP 100ML PLASMINOGEN ACTIVATOR 30500086 305 85415 $ 229.20 ACTIVE INHIBITOR TYPE 1 (PAI-1) PLATELET AGGREGATION USING 30500031 305 85576 $ 298.92 ACTIVE ADP PLATELET ANTIBODY 30200012 302 86022 $ 244.92 ACTIVE IDENTIFICATION Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30500033 PLATELET NEUTRALIZATION 305 85597 $ 239.64 ACTIVE PLATELET PHERESIS (EACH 39000005 390 P9034 $ 4,651.28 ACTIVE UNIT) PLATELET RICH PLASMA (EACH 39000006 390 P9020 $ 3,220.00 ACTIVE UNIT) 30500050 PLATELETS 305 85049 $ 59.64 ACTIVE 31100012 PLEURAL FLUID CYTOLOGY 311 88108 $ 257.60 ACTIVE PLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 36000365 SQ CM OR LESS, OR 1% OF 360 15100 $ 36,994.00 ACTIVE BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050) PLUS 30 EACH ADDL CRITICAL 45600001 450 99292 $ 2,747.50 ACTIVE MIN W/99291 PNEUMOCOCCAL CONJUGATE 77100007 771 90670 $ 401.00 ACTIVE VACCINE 13 VALENT PCV13 PNEUMOCOCCAL VACCINE 23 77100005 771 90732 $ 462.00 ACTIVE VALENT PPSV23 ADMIN 92000003 POLYSOM GT 4 PARAM GT 6HR 920 95810 $ 30,165.00 ACTIVE 92000004 POLYSOM W/CPAP 920 95811 $ 33,099.00 ACTIVE PORPHOBILINOGEN 24HR 30100303 301 84110 $ 112.56 ACTIVE (URINE) 30100305 PORPHYRINS (PLASMA) 301 82492 $ 247.94 ACTIVE 30100304 PORPHYRINS FRACTION (URINE) 301 84120 $ 196.20 ACTIVE 27200656 PORT APPLIER 272 A4223 $ 5,406.00 ACTIVE 26000001 PORTACATH BLOOD DRAW 260 36591 $ 400.62 ACTIVE PORTACATH FLUSH/DRSG 94000004 940 96523 $ 1,267.00 ACTIVE CHANGE 27100003 POSITIONER SHOULDER 271 A4566 $ 2,456.00 ACTIVE 27400002 POST OP BRACE 270 L1832 $ 1,458.74 ACTIVE POTASSIUM (CEREBROSPINAL 30100308 301 84999 $ 128.80 ACTIVE FLUID) POTASSIUM 10 MEQ IN 100ML NS 25000479 258 J3480 $ 194.00 ACTIVE ( 30100307 POTASSIUM 24HR (URINE) 301 84133 $ 57.48 ACTIVE POTASSIUM 25MEQ 25901903 250 J8499 $ 15.25 ACTIVE EFFERVESCENT TABLET POTASSIUM CHL 10% 20MEQ 25901472 250 J3490 $ 24.00 ACTIVE 15ML OS POTASSIUM CHL 10% 40MEQ 25901904 250 J3490 $ 73.25 ACTIVE 30ML OS POTASSIUM CHLORIDE 25800058 258 J3480 $ 586.00 ACTIVE 20MEQ/100ML 100ML BAG POTASSIUM HYDROXIDE TISSUE 30600070 306 87220 $ 57.00 ACTIVE EXAM 25901853 PRASUGREL 10MG TAB 250 J8499 $ 120.20 ACTIVE 25900933 PRAVACHOL 20MG TAB 250 J8499 $ 76.50 ACTIVE PRAVASTATIN (PRAVACHOL) 25901905 250 J8499 $ 5.25 ACTIVE 40MG TAB 30100311 PREALBUMIN 301 84134 $ 194.52 ACTIVE PREDNISOLONE 1% 5ML 25900936 250 J3490 $ 176.00 ACTIVE OPHTHALMIC PREDNISOLONE SYRUP 25900938 250 J7510 $ 246.00 ACTIVE 15MG/5ML 5ML UNIT DOSE 25900941 PREDNISONE 5MG TAB 250 J8499 $ 24.00 ACTIVE PREDNISONE DELTASONE 20MG 25900359 250 J7512 $ 24.00 ACTIVE TAB Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30700004 PREGNANCY TEST (URINE) 307 81025 $ 103.32 ACTIVE PREGNANCY TEST SERUM 30100312 301 84703 $ 100.32 ACTIVE QUALITATIVE 30100313 PREGNANEDIOL 301 84135 $ 255.24 ACTIVE 30100314 PREGNANETRIOL 301 84138 $ 252.60 ACTIVE 30100087 PREGNENOLONE 301 84140 $ 275.64 ACTIVE 25900948 PREPARATION H OINT/APPL. 250 A6250 $ 106.00 ACTIVE PRETREATMENT OF RBCS FOR USE IN RBC ANTIBODY 30200167 302 86970 $ 560.00 ACTIVE DETECTION INCUBATION WITH CHEMOKIN PRETREATMENT OF SERUM FOR USE IN RED BLOOD CELL 30200168 302 86978 $ 1,120.00 ACTIVE ANTIBODY IDENTIFICATION BY RED C 30200240 PRETX SERUM RBC AB INHIB 302 86977 $ 311.62 ACTIVE PRIMAXIN 500MG IN 100ML NS 25000488 636 J0743 $ 630.00 ACTIVE (PR 30100315 PRIMIDONE LEVEL 301 80188 $ 221.28 ACTIVE 42000035 PROC THER GP 15 450 97150 $ 282.64 ACTIVE 30100316 PROCAINAMIDE W METABOLITES 301 80192 $ 223.32 ACTIVE 30100108 PROCALCITONIN 301 84145 $ 31.26 ACTIVE PROF APPLICATION SURGICAL 98100061 981 L3260 $ 500.00 ACTIVE BOOT/SHOE, EACH PROF ARTHROCENTESIS ASPIRATION INJ INTERMEDIATE JOINT/BURSA 98100023 981 20605 $ 256.60 ACTIVE (TEMPOROMANDIBULAR/ACROMI OCLAVICULAR/WRIST/ELBOW/AN KLE) W/O US GUID PROF ARTHROCENTESIS ASPIRATION/INJECTION MAJOR 98100038 JOINT/BURSA (SHOULDER HIP 981 20610 $ 928.80 ACTIVE KNEE SUBACROMIAL BURSA) W/O US GUIDANCE

PROF ARTHROCENTESIS ASPIRATION/INJECTION SMALL 98100039 981 20600 $ 244.05 ACTIVE JOINT/BURSA (FINGERS/TOES) W/O US GUIDANCE PROF AVULSION OF NAIL PLATE 98100075 PARTIAL OR COMPLETE SIMPLE 981 11730 $ 1,625.40 ACTIVE SINGLE PROF CARDIOPULMONARY 98100035 981 92950 $ 1,556.65 ACTIVE RESUSCITATION PROF CARDIOVASCULAR STRESS TEST USING 98500001 TREADMILL/BICYCLE 985 93018 $ 740.00 ACTIVE CONTINUOUS ECG MONITORING, INTER/REPORT ONLY PROF CLOSED TREATMENT OF 98100100 PATELLAR DISLOCATION 981 27560 $ 4,500.00 ACTIVE WITHOUT ANESTHESIA PROF CLOSED TREATMENT OF 98100074 RADIAL SHAFT FX; W/O 981 25500 $ 980.00 ACTIVE MANIPULATION PROF CLOSED TX OF DISTAL 98100059 981 27788 $ 5,900.10 ACTIVE ANKLE FX; W MANIPULATION Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PROF CLOSED TX OF DISTAL 98100060 981 27786 $ 4,387.35 ACTIVE ANKLE FX; W/O MANIPULATION PROF CLOSED TX OF FINGER 98100063 DISLOCATION, SINGLE, W/ MANIP 981 26775 $ 5,307.90 ACTIVE W/ ANES PROF CLOSED TX OF FX, PHALANX/PHALANGES, OTHER 98100076 981 28510 $ 6,426.00 ACTIVE THAN GREAT TOE; W/O MANIP, EA PROF CLOSED TX OF RADIAL 98100083 SHAFT FRACTURE; 981 25505 $ 7,689.45 ACTIVE W/MANIPULATION PROF CLOSED TX OF TEMPOROMANDIBULAR 96000012 960 21480 $ 2,538.00 ACTIVE DISLOCATION; INITIAL OR SUBSEQUENT PROF CLOSED TX PHALANGEAL SHAFT FX PROXIMAL/MIDDLE 98100065 PHALANX, FINGER/THUMB; 981 26725 $ 8,217.00 ACTIVE W/MANIPULATION W/OR W/O SKIN/SKELETAL TRACTION; EA PROF CONTROL NASAL 98100115 HEMORRHAGE ANTERIOR 981 30903 $ 304.08 ACTIVE COMPLEX ANY METHOD PROF CONTROL NASAL HEMORRHAGE POSTERIOR 98100104 981 30905 $ 175.00 ACTIVE W/NASAL PACKS AND/OR CAUTERY ANY METHOD INITIAL PROF CRITICAL CARE E/M FIRST 98100057 981 99291 $ 5,152.44 ACTIVE 30-74MINS PROF ECHO, TRANSTHORACIC, REAL-TIME W/IMAGE DOC INC M- 98100071 MODE, WHEN PERFORMED, 981 93306 $ 3,666.50 ACTIVE COMP W/SPEC DOPPLER/COLOR FLOW DOPPLETE, WITH SPE PROF ER TEMP FOLEY 98100109 981 51702 $ 575.00 ACTIVE CATHETER INSERTION PROF EXCISION OTHER BENIGN LESION 98100093 FACE/EARS/EYELIDS/NOSE/LIPS/ 981 11440 $ 248.00 ACTIVE MUCOUS MEMBRANE DIAMETER 0.5 CM/< PROF EXCSN NAIL/NAIL MATRIX 98100094 981 11750 $ 125.75 ACTIVE PART/COMP PERM RMV PROF FEE ER DEPT HI SEV 98100004 981 99284 $ 11,000.00 ACTIVE LEVEL IV PROF FEE ER DEPT HIGH SEV 98100005 981 99285 $ 12,000.00 ACTIVE LEVEL V PROF FEE ER DEPT LIMITED 98100001 981 99281 $ 8,000.00 ACTIVE LEVEL I PROF FEE ER DEPT MOD LEVEL 98100002 981 99282 $ 9,000.00 ACTIVE II PROF FEE ER DEPT MOD LEVEL 98100003 981 99283 $ 10,000.00 ACTIVE III PROF HEMORRHOIDECTOMY 98100108 INTERNAL AND EXTERNAL 981 46255 $ 1,050.00 ACTIVE SINGLE COLUMN/GROUP Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PROF INCISION & REMOVAL OF 98100112 981 10120 $ 2,248.65 ACTIVE FB SKIN SIMPLE SUB TISSUE PROF INITIAL OBS CARE LOW 76200015 982 99218 $ 2,481.75 ACTIVE SEVERITY/30MINS PROF INITIAL OBS CARE LOW 98100089 982 99218 $ 2,481.75 ACTIVE SEVERITY/30MINS PROF INITIAL OBS HIGH 98100091 982 99220 $ 4,577.00 ACTIVE SEVERITY/70MINS PROF INITIAL OBS MODERATE 76200020 982 99219 $ 3,347.00 ACTIVE SEVERITY/50MINS PROF INITIAL OBS MODERATE 98100090 982 99219 $ 3,347.00 ACTIVE SEVERITY/50MINS PROF INJ DIAG/THERAP NOT INC NEUROLYTIC SUBST. INCL 98100085 NEEDLE/CATH PLACEMENT; 981 62323 $ 6,264.00 ACTIVE LUMBAR/SACRAL W/IMAGING GUIDANCE PROF INJ, ANESTH AGENT; OTH 98100084 981 64450 $ 1,231.20 ACTIVE PERIPHERAL NERVE/BRANCH PROF INJECTION SINGLE 98100056 TENDON SHEATH,OR 981 20550 $ 283.65 ACTIVE LIGAMENT(PLANTAR"FASCIA") PROF INJECTION 98100040 SINGLE/MULTIPLE TRIGGER 981 20552 $ 283.65 ACTIVE POINT 1 OR 2 MUSCLE PROF INJECTION 98100041 SINGLE/MULTIPLE TRIGGER 981 20553 $ 327.00 ACTIVE POINT 3> MORE MUSCLES PROF INSERTION TUNNELED CENTRALLY; CENTRAL VENOUS 98100106 981 36561 $ 1,100.00 ACTIVE ACCESS DEVICE, W/SUBC PORT; AGE 5OR> PROF INTUBATION 98100105 ENDOTRACHEAL EMERGENCY 981 31500 $ 375.00 ACTIVE PROCEDURE PROF MOD SED <5YRS 1ST 98100048 981 99151 $ 1,202.50 ACTIVE 15MINS PROF MOD SED 5+YRS 1ST 98100049 981 99152 $ 628.00 ACTIVE 15MIN PROF MOD SED EACH ADDT'L 98100050 981 99153 $ 556.50 ACTIVE 15MIN PROF OBSERV & D/C SAME DAY 76200009 762 99234 $ 683.10 ACTIVE DISCHARGE LOW COMPLEX PROF OBSERV & D/C SAME DAY 76200012 762 99235 $ 4,182.75 ACTIVE MODERATE COMPLEXITY PROF OBSERVATION & D/C SAME 76200013 762 99236 $ 1,111.10 ACTIVE DAY HIGH COMPLEXITY PROF OBSERVATION CARE 98100088 982 99217 $ 1,789.00 ACTIVE DISCHARGE PROF PARING/CUTTING BENIGN 98100073 HYPERKERATOTIC LESION (EG, 981 11055 $ 2,466.00 ACTIVE CORN/CALLUS); SINGLE LESION PROF PLUS 30 EACH ADDL 98100066 981 99292 $ 3,009.00 ACTIVE CRITICAL MIN W/99291 PROF REMOVAL FB EXT EYE 98100036 981 65222 $ 1,020.30 ACTIVE CORNEAL W/SLIT LAMP PROF REMOVAL FB, 98100051 981 30300 $ 750.00 ACTIVE INTRANASAL; OFF TYPE PROC Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PROF REMOVAL FB; EXTERNAL 98100053 AUDITORY CANAL; W/O 981 69200 $ 2,430.00 ACTIVE GENERAL ANESTHESIA PROF REMOVAL IMPACTED 98100087 CARUMEN REQUIRING 981 69210 $ 107.60 ACTIVE INSTRUMENTAL PROF REMOVAL IMPACTED 98100044 CERUMEN IRRIGATION/LAVAGE 981 69209 $ 65.05 ACTIVE UNI PROF REMOVAL OF FB EXT EYE 98100110 981 65220 $ 217.05 ACTIVE CORNEAL W/O SLIT LAMP PROF REMOVAL OF FB 98100042 EXTERNAL EYE CONJUNCTIVAL 981 65205 $ 285.85 ACTIVE SUPERFICIAL PROF REMOVAL OF FB FOOT 98100043 981 28190 $ 350.00 ACTIVE SUBCUTANEOUS PROF REMOVAL OF FOREIGN 98100111 981 69205 $ 669.68 ACTIVE BODY EAR W/ANESTHESIA PROF REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, 96000014 960 36589 $ 10,945.25 ACTIVE WITHOUT SUBCUTANEOUS PORT OR PUMP PROF REPAIR COMPLEX 98100113 FACE/NECK/AXILLAE/GENITALIA/ 981 13132 $ 4,500.00 ACTIVE HANDS/FEET 2.6-7.5 CM PROF REPAIR COMPLEX 98100114 FACE/NECK/AXILLAE/GENITALIA/ 981 13133 $ 1,200.00 ACTIVE HANDS/FEET ADD ON PROF REPAIR COMPLEX FOREHEAD/CHEEKS/CHIN/MOUT 98100098 981 13131 $ 4,500.00 ACTIVE H/NECK/AXILLAE/GENITALIA/HAN DS/FEET 1.1-2.5 CM PROF REPAIR COMPLEX 98100046 981 13121 $ 4,202.10 ACTIVE SCALP/ARMS/LEGS; 2.6-7.5CM PROF REPAIR INTERM WOUNDS 98100072 SCALP/AXILLAE/TRUNK/EXTREMI 981 12032 $ 1,010.95 ACTIVE TIES 2.6-7.5CM

PROF REPAIR INTERMEDIATE OF 98100095 SCALP/AXILLAE/TRUNK/EXTREMI 981 12031 $ 682.40 ACTIVE TIES (EXC HANDS&FEET) 2.5CM<

PROF REPAIR INTERMEDIATE WOUNDS OF NECK/HANDS/FEET 98100097 981 12044 $ 980.00 ACTIVE AND/OR EXTERNAL GENITALIA 7.6 CM TO 12.5 CM PROF REPAIR INTERMEDIATE WOUNDS OF 98100096 981 12041 $ 980.00 ACTIVE NECK/HANDS/FEET/EXTERNAL GENITALIA 2.5< PROF REPAIR INTERMEDIETE OF SCALP/AXILLAE/TRUNK/OR 98100077 981 12034 $ 739.80 ACTIVE EXTREM (EXCL HANDS&FEET) 7.6-12.5 PROF REPAIR LACERATION 2.5CM<; FLOOR OF 98100107 981 41250 $ 1,125.00 ACTIVE MOUTH/ANTERIOR TWO-THIRDS OF TONGUE 98100116 PROF REPAIR OF NAIL BED 981 11760 $ 248.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PROF REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST 45000157 960 13122 $ 4,274.50 ACTIVE SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE PROF SERV APPLICATION OF 98100029 981 29130 $ 300.00 ACTIVE FINGER SPLINT STATIC PROF SERV APPLICATION OF 98100027 LONG ARM SPLINT (SHOULDER 981 29105 $ 300.00 ACTIVE TO HAND) PROF SERV APPLICATION OF 98100030 LONG LEG SPLINT (THIGH TO 981 29505 $ 312.00 ACTIVE ANKLE OR TOES) PROF SERV APPLICATION OF 98100028 SHORT ARM SPLINT (FOREARM 981 29125 $ 300.00 ACTIVE TO HAND)STATIC PROF SERV APPLICATION OF 98100031 SHORT LEG SPLINT (CALF TO 981 29515 $ 300.00 ACTIVE FOOT) PROF SERV CLOSED TREATMENT OF METACARPAL 98100082 981 26605 $ 7,166.00 ACTIVE FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE PROF SERV CLOSED TX OF FINGER JOINT DISLOCATION 98100025 981 26770 $ 1,888.00 ACTIVE SINGLE W/MANP & W/O ANESTHESIA PROF SERV CLOSED TX 98100062 SHOULDER DISLOCATION 981 23655 $ 980.00 ACTIVE W/MANP W ANES PROF SERV CLOSED TX 98100024 SHOULDER DISLOCATION 981 23650 $ 940.00 ACTIVE W/MANP W/O ANESTHESIA PROF SERV CONTROL OF NASAL 98100032 HEMORRHAGE SIMPLE ANY 981 30901 $ 225.00 ACTIVE METHOD PROF SERV DRESSING/DEBRIDEMENT PART- 98100022 981 16020 $ 840.00 ACTIVE THICKNESS BURNS-LESS 5% BODY PROF SERV ELECTROCARDIOGRAM(ECG) 98100033 985 93010 $ 300.00 ACTIVE 12LEADS INTERPRETATION & REPORT ONLY PROF SERV EVACUATION OF 98100010 981 11740 $ 518.50 ACTIVE SUBUNGUAL HEMATOMA PROF SERV INCISION AND 98100007 981 10061 $ 762.00 ACTIVE DRAINAGE (I & D) MULTIPLE PROF SERV INCISION AND 98100008 DRAINAGE OF PILONIDAL CYST 981 10081 $ 1,068.00 ACTIVE COMPLICATED PROF SERV INCISION AND 98100006 981 10060 $ 1,300.00 ACTIVE DRAINAGE SIMPLE/ SINGLE PROF SERV INITIAL TX 1ST 98100021 981 16000 $ 590.00 ACTIVE DEGREE BURN - LOCAL PROF SERV PUNCTURE 98100009 ASPIRATION OF ABSCESS 981 10160 $ 1,000.00 ACTIVE HEMATOMA, BULLA, OR CYST PROF SERV REPAIR INTEMD 98100018 981 12042 $ 980.00 ACTIVE NECK/HAND/FT/GENIT 2.6-7.5CM Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS PROF SERV REPAIR INTEMD 98100019 981 12051 $ 900.00 ACTIVE WOUND 2.5 CM OR LESS PROF SERV REPAIR INTEMD 98100020 981 12052 $ 1,200.00 ACTIVE WOUND 2.6 TO 5.0CM PROF SERV REPAIR INTERM 98100045 FACE/EARS/EYELIDS/NOSE/LIPS/ 981 12053 $ 1,137.90 ACTIVE MUCOUS MEMBRANES 5.1-7.5CM PROF SERV REPAIR INTERM FACE/EARS/EYELIDS/NOSE/LIPS/ 98100086 981 12054 $ 1,251.82 ACTIVE MUCOUS MEMBRANES 7.6-12.5 CM PROF SERV REPAIR INTERMEDIETE OF 98100037 SCALP/AXILLAE/TRUNK/OR 981 12035 $ 980.00 ACTIVE EXTREM (EXCL HANDS&FEET) 12.6-20CM PROF SERVICES PRVD 10PM-8AM 98100058 981 99053 $ 1,200.00 ACTIVE @ 24-HOUR FAC PROF SESRV CLOSED TX OF TOE 98100026 FX OTHER THAN GREAT TOE 981 28515 $ 288.00 ACTIVE W/MANP EACH PROF SIMPLE REPAIR FACE 98100014 981 12011 $ 557.60 ACTIVE AREA 2.5< PROF SIMPLE REPAIR FACE 98100015 981 12013 $ 583.00 ACTIVE AREA 2.6CM-5CM PROF SIMPLE REPAIR FACE 98100016 981 12014 $ 682.40 ACTIVE AREA 5.1-7.5CM PROF SIMPLE REPAIR FACE 98100017 981 12015 $ 826.90 ACTIVE AREA 7.6-12.5CM PROF SIMPLE REPAIR 98100011 SCALP/NECK/EXTREM 2.5CM OR 981 12001 $ 454.80 ACTIVE < PROF SIMPLE REPAIR 98100012 981 12002 $ 554.20 ACTIVE SCALP/NECK/EXTREM 2.6-7.5CM

PROF SIMPLE REPAIR 98100080 981 12006 $ 2,970.00 ACTIVE SCALP/NECK/EXTREM 20.1-30CM

PROF SIMPLE REPAIR 98100013 981 12004 $ 653.45 ACTIVE SCALP/NECK/EXTREM 7.6-12.5CM PROF SIMPLE REPAIR 98100034 SCALP/NECK/GEN/TRUNK/EXT 981 12005 $ 285.05 ACTIVE 12.6-20 PROF SPINAL PUNCTURE, 98100052 981 62270 $ 1,037.50 ACTIVE LUMBAR, DIAGNOSTIC PROF STRAPPING ELBOW OR 98100101 981 29260 $ 175.00 ACTIVE WRIST PROF STRAPPING; ANKLE 98100064 981 29540 $ 400.00 ACTIVE AND/OR FOOT 98100102 PROF STRAPPING; HAND/FINGER 981 29280 $ 150.00 ACTIVE 98100103 PROF STRAPPING; KNEE 981 29530 $ 240.00 ACTIVE PROF SUBS OBS CARE 76200024 982 99226 $ 2,589.00 ACTIVE HIGH/35MINS PROF SUBS OBS CARE 98200002 982 99226 $ 2,589.00 ACTIVE HIGH/35MINS PROF SUBS OBS CARE 76200022 982 99224 $ 983.75 ACTIVE LOW/15MINS PROF SUBS OBS CARE 98100092 982 99224 $ 983.75 ACTIVE LOW/15MINS Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 76200023 PROF SUBS OBS MOD/25MINS 982 99225 $ 1,796.00 ACTIVE 98200001 PROF SUBS OBS MOD/25MINS 982 99225 $ 1,796.00 ACTIVE PROF SUTURE REMOVAL BY PHYSICIAN OTHER THAN 98100055 981 S0630 $ 300.00 ACTIVE PHYSICIAN WHO ORIGINALLY CLOSED WOUND PROF TREATMENT, CLOSED 98100099 ELBOW DISLOCATION; W/O 981 24600 $ 687.00 ACTIVE ANESTHESIA PROF WOUND CLOSURE 98100081 UTILIZING TISSUE ADHESIVE(S) 981 G0168 $ 1,587.60 ACTIVE ONLY 30100317 PROGESTERONE 301 84144 $ 278.16 ACTIVE PROGRAMMED STIMULATION AND PACING AFTER 38100002 INTRAVENOUS DRUG INFUSION 481 93623 $ 3,876.00 ACTIVE (LIST SEPARATELY IN ADDT TO PRIMARY PROC) 30000032 PROINSULIN 301 84206 $ 80.07 ACTIVE 30100319 PROLACTIN 301 84146 $ 258.36 ACTIVE PROLONGED TX/PROPH/DX IV 45000032 450 C8957 $ 1,148.55 ACTIVE INF > 8 HOURS REQ PUMP 25901587 PROMETHAZINE 25MG SUPP. 250 J8498 $ 69.00 ACTIVE PROMETHAZINE DM 6.25 5ML 25901952 250 J3490 $ 24.00 ACTIVE ORAL SOL 120ML BOTTLE 25900971 PROMETHAZINE HCL 25MG TAB 250 J8499 $ 24.00 ACTIVE 25900972 PROPARACAINE OPTH. 0.5% 250 J3490 $ 122.00 ACTIVE 25901906 PROPOFOL 200MG/20ML VIAL 250 J3490 $ 53.17 ACTIVE 25900973 PROSCAR 5MG TABLET 250 J8499 $ 69.00 ACTIVE PROSTATE CANCER SCREENING 30100321 PROSTATE SPECIFIC ANTIGEN 301 84153 $ 245.28 ACTIVE (TOTAL) PROSTATE SPECIFIC ANTIGEN - 30100335 301 G0103 $ 245.28 ACTIVE MEDICARE PROSTATE SPECIFIC ANTIGEN 30000012 300 84154 $ 245.28 ACTIVE FREE PROSTATECTOMY (INC CONTROL OF POSTOP BLEEDVASECTOMY/MEATOTOM 36000300 360 55821 $ 21,890.00 ACTIVE Y/URETHRAL CALIBRATION/DILATION) 1-2 STAGES 30100295 PROSTATIC ACID PHOSPHATASE 301 84066 $ 128.76 ACTIVE 42000036 PROSTH TRAIN EA15MIN 450 97761 $ 239.40 ACTIVE 25000503 PROTAMINE 250 MG/25 ML VIAL 636 J2720 $ 216.00 ACTIVE 30100322 PROTEIN 24 HOUR (URINE) 301 84156 $ 48.84 ACTIVE 30100437 PROTEIN C ANTIGEN 305 85302 $ 160.20 ACTIVE PROTEIN ELECTROPHORESIS 30100323 301 84165 $ 143.16 ACTIVE SERUM 30500035 PROTEIN S (FREE) 305 85306 $ 204.36 ACTIVE 30000015 PROTEIN S (TOTAL) 305 85305 $ 154.80 ACTIVE 30100327 PROTEIN TOTAL 301 84155 $ 48.84 ACTIVE 30500036 PROTHROMBIN TIME 305 85610 $ 52.44 ACTIVE 25900974 PROTONIX 20MG TAB 250 J8499 $ 48.00 ACTIVE PROTONIX 40MG TAB 25200004 250 S0164 $ 76.00 ACTIVE (PANTOPRAZOLE SODIUM) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30200007 PROTOZOA ANTIBODIES 302 86753 $ 45.87 ACTIVE 25900980 PROZAC 10MG CAP 250 J8499 $ 98.00 ACTIVE 25900981 PROZAC 20MG CAPSULE 250 J8499 $ 60.00 ACTIVE PRQ CARD REVASC CHRONIC 48100080 TOTAL OCCLUSION - FIRST MAIN 481 92943 $ 50,568.52 ACTIVE VESSEL 48100075 PRQ CARD STENT/ATH/ANGIO 481 92933 $ 55,370.62 ACTIVE PRQ TRLUML CORONARY 48100085 481 92920 $ 29,627.23 ACTIVE ANGIOPLASTY ONE ART/BRANCH PSYCHIATRIC DIAGNOSTIC 91400004 EVALUATION WITH NO MEDICAL 914 90791 $ 478.41 ACTIVE SERVICES PSYCHOLOGICAL TESTING PER 91400002 914 96101 $ 804.32 ACTIVE HOUR PT NEG PRESS WOUND TX <50 42000030 420 97605 $ 558.44 ACTIVE CM 42000037 PT SENS INTEGRATIN EA 15M 420 97533 $ 235.20 ACTIVE 48100053 PTA - ILLIAC ARTERY REVASC 481 37220 $ 29,627.23 ACTIVE 36000058 PTA AORTA 360 35472 $ 27,102.58 ACTIVE 36000060 PTA BRACH ARTERY 360 35475 $ 27,102.58 ACTIVE 36000062 PTA FEM/POP ARTERIES 360 35474 $ 27,102.58 ACTIVE 36000064 PTA ILIAC ARTERY 360 35473 $ 27,102.58 ACTIVE 36000066 PTA RENAL & VISCERAL 360 35471 $ 27,102.58 ACTIVE PTCA 3.00MMX15MM DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY 48100073 ANGIOPLASTY WHEN 481 C9600 $ 14,000.00 ACTIVE PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH PTCA BALLOON CATHETER 27200919 272 C1726 $ 4,500.00 ACTIVE 3.00MMX15MM - MOZEC 48000013 PTCA EACH ADDL VESSEL 480 92944 $ 37,110.42 ACTIVE 48000014 PTCA SINGLE VESSEL 480 92982 $ 37,110.42 ACTIVE 48000015 PTCA W/STENT EA ADDL VESSEL 480 92938 $ 55,370.62 ACTIVE 48000016 PTCA W/STENT PLACEMENT 480 92980 $ 55,370.62 ACTIVE PULMONARY FUNTION TEST FVC 46000002 460 94010 $ 260.10 ACTIVE SPIROMETRY 41000018 PULMONARY REHABILITATION 410 G0424 $ 315.99 ACTIVE 46000008 PULSE OXIMETRY MULTIPLE 460 94761 $ 244.72 ACTIVE 46000009 PULSE OXIMETRY SINGLE 460 94760 $ 170.66 ACTIVE 46000007 PULSE OX-OVERNIGHT CONT 460 94762 $ 657.02 ACTIVE 27100008 PUMP INFUSION (IV) 271 A4224 $ 196.00 ACTIVE PUNCTURE ASPIRATION CYST 36000124 360 19001 $ 1,255.80 ACTIVE BREAST EACH ADDITIONAL PUNCTURE ASPIRATION OF 45000109 ABSCESS, HEMATOMA, BULLA, 450 10160 $ 4,914.00 ACTIVE OR CYST PYELOPLASTY (FOLEY Y- PYELOPLASTY) PLASTIC 45000059 360 50400 $ 60,297.00 ACTIVE OPERATION ON RENAL PELVIS SIMPLE 30100342 PYRUVATE 301 84210 $ 173.76 ACTIVE QUICK CROSS CATHETER LEVEL 27000006 270 C1751 $ 1,755.60 ACTIVE I QUIKCLOT, INTERVENTIONAL, 27200913 272 A6222 $ 1,266.30 ACTIVE WITHOUT SLIT GAUZE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 30100344 QUINIDINE (RANDOM) 301 80194 $ 194.64 ACTIVE RABIES IMMUNE GLOBULIN 63600187 636 90675 $ 1,462.00 ACTIVE (HUMAN) 150IU 1ML VIAL 63600148 RABIES VACCINE 636 90675 $ 1,462.00 ACTIVE 25900996 RACEPINEPHRINE 2.25% SOL 250 J7699 $ 48.00 ACTIVE RAD EXAM, ENTIRE SPINE 32000232 THO/LUM/CERV/SAC INC SKULL 320 72081 $ 981.00 ACTIVE IF PERF 1VIEW RAD EXAM, ENTIRE SPINE 32000231 THO/LUM/CERV/SAC INC SKULL 320 72082 $ 1,584.00 ACTIVE IF PERF 2-3VIEWS RAD EXAM, ENTIRE SPINE 33000001 THO/LUM/CERV/SAC INC SKULL 320 72083 $ 1,908.00 ACTIVE IF PERF 4-5VIEWS RAD EXAM, ENTIRE SPINE 33000002 THO/LUM/CERV/SAC INC SKULL 320 72084 $ 2,223.00 ACTIVE IF PERF MIN 6VIEWS RADIOLOGIC EXAMINATION 32000226 320 73551 $ 1,406.50 ACTIVE FEMUR 1 VIEW RADIOLOGIC EXAMINATION 32000227 320 73552 $ 1,641.00 ACTIVE FEMUR MINIMUM 2 VIEWS RADIOLOGIC EXAMINATION HIP 32200004 322 73525 $ 4,877.00 ACTIVE ARTHOGRAPHY RADIOLOGIC EXAMINATION, 32000233 320 74018 $ 1,130.00 ACTIVE ABDOMEN; 1 VIEW RADIOLOGIC EXAMINATION, 33000003 320 74019 $ 1,677.50 ACTIVE ABDOMEN; 2 VIEWS RADIOLOGIC EXAMINATION, 32000235 320 74021 $ 1,781.00 ACTIVE ABDOMEN; 3V OR MORE RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS 32000119 320 73503 $ 2,574.50 ACTIVE WHEN PERFORMED; MINIMUM OF 4 VIEWS RADIOLOGICAL EXAM PELVIS 32000230 320 72190 $ 1,930.00 ACTIVE COMPLETE MIN 3VIEWS 25900997 RAMIPRIL 5MG CAP 250 J8499 $ 36.00 ACTIVE RANITIDINE (ZANTAC) 300MG 25901907 250 J8499 $ 5.40 ACTIVE TAB 30000051 RAPID FLU SWAB TEST A&B 306 87502 $ 350.00 ACTIVE RAPID INFLUENZA SWAB ASSAY 30600067 306 87804 $ 198.60 ACTIVE W/OPTIC 30100346 RECEPTOR ASSAY ESTROGEN 301 84233 $ 447.58 ACTIVE 30500040 RED BLOOD CELL 305 85041 $ 40.20 ACTIVE RED BLOOD CELL ANTIBODY 30200002 302 86860 $ 228.62 ACTIVE ELUTION (EACH) RED BLOOD CELL PROCESSING 39200001 391 P9021 $ 10,437.00 ACTIVE & STORAGE 38100001 RED BLOOD CELLS, EACH UNIT 381 P9021 $ 10,437.00 ACTIVE REDUCTION OF TORSION OF TESTIS SURGICAL W/OR W/O 36000021 360 54600 $ 23,842.50 ACTIVE FIXATION OF CONTRALATERAL TESTIS 42400003 RE-EVAL 15 MIN 450 97002 $ 395.92 ACTIVE 37000005 REG/SPINAL ANES 60 MIN 370 1936 $ 4,832.00 ACTIVE 37000006 REG/SPINAL ANES ADD 30 MN 370 1936 $ 2,416.00 ACTIVE 25000513 RELISTOR 12MG/0.6ML VIAL 636 J2212 $ 540.00 ACTIVE 48100116 REM/REPLACE BI V PACEMAKER 481 33229 $ 56,564.26 ACTIVE REM/REPLACE ICD GENERATOR 48100117 481 33230 $ 71,118.96 ACTIVE ONLY Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS REM/REPLACE ICD/PPM (3+ 48100118 481 33231 $ 99,590.33 ACTIVE LEADS) REMERON (NOT SOLTAB) 15MG 25901005 250 J8499 $ 76.00 ACTIVE TAB 25901006 REMERON 30MG TAB 250 J8499 $ 84.00 ACTIVE 32000163 REMOVAL FB ESOPHI 320 74235 $ 993.30 ACTIVE REMOVAL FB FROM EXTERNAL 45000098 AUDITORY CANAL; W/O 450 69200 $ 4,225.00 ACTIVE GENERAL ANESTHESIA REMOVAL FB, INTRANASAL; 45000097 450 30300 $ 5,400.00 ACTIVE OFFICE TYPE PROCEDURE REMOVAL IMPACTED CERUMEN 45000122 REQUIRING INSTRUMENTATION, 450 69210 $ 1,692.00 ACTIVE UNILATERAL

REMOVAL IMPACTED CERUMEN 45000123 USING IRRIGATION/LAVAGE, 450 69209 $ 720.00 ACTIVE UNILATERAL 36000068 REMOVAL LOOP RECORDER 481 33284 $ 9,787.50 ACTIVE 36000281 REMOVAL OF ANKLE IMPLANT 361 27704 $ 29,626.00 ACTIVE REMOVAL OF FB EXT EYE 76000001 450 65220 $ 790.83 ACTIVE CORNEAL W/O SLIT LAMP REMOVAL OF FB EXTERNAL EYE 45000099 450 65205 $ 2,268.00 ACTIVE CONJUNCTIVAL SUPERFICIAL REMOVAL OF FB FOOT 45000100 450 28190 $ 6,948.00 ACTIVE SUBCUTANEOUS REMOVAL OF FB, EXTERNAL 45000121 450 65222 $ 2,682.00 ACTIVE EYE; CORNEAL, WITH SLIT LAMP REMOVAL OF FB, SHOULDER; 96000013 960 23330 $ 4,084.00 ACTIVE SUBCUTANEOUS REMOVAL OF FOREIGN BODY 36100008 361 69205 $ 5,289.50 ACTIVE EAR W/ANESTHESIA REMOVAL OF FOREIGN BODY 45000145 450 69205 $ 3,709.86 ACTIVE EAR W/ANESTHESIA REMOVAL OF IMPLANT; DEEP (EG, BURIED 36000345 360 20680 $ 20,959.50 ACTIVE WIRE/PIN/SCREW/METAL BAND/NAIL/ROD/PLATE) REMOVAL OF IMPLANT; SUPERFICIAL (BURIED 36000336 360 20670 $ 7,239.00 ACTIVE WIRE/PIN/ROD) (SEPARATE PROCEDURE) REMOVAL OF INFLATABLE 36000065 PENILE PROSTHESIS W/O 360 54406 $ 11,391.15 ACTIVE REPLACEMENT OF PROSTHESIS REMOVAL OF INTRA-AORTIC 36000069 BALLOON ASSIST INCLUDING 360 33971 $ 2,688.00 ACTIVE REPAIR OF FEMORAL ARTERY REMOVAL OF NEPHROSTOMY 36000120 360 50389 $ 4,875.36 ACTIVE TUBE WITH FLUOROSCOPY 36100023 REMOVAL OF PEG TUBE 361 49999 $ 1,200.00 ACTIVE REMOVAL OF PERMANENT 36000070 360 33233 $ 35,563.45 ACTIVE PACEMAKER REMOVAL OF SUTURES; BY PHYSICIAN OTHER THAN THE 45000124 450 S0630 $ 300.00 ACTIVE PHYSICIAN WHO ORIGINALLY CLOSED WOUND Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS REMOVAL OF TUNNELED 36100003 CENTRAL VENOUS DEVICE WITH 361 36590 $ 3,364.43 ACTIVE SUBCUTANEOUS PORT OR PUMP REMOVAL, SUBCUTANEOUS 36000378 360 33286 $ 9,787.50 ACTIVE CARDIAC RHYTHM MONITOR REMOVAL, UNDER ANESTHESIA, 36000290 360 20694 $ 17,406.00 ACTIVE OF EXTERNAL FIXATION SYSTEM

REMVL PERM PM PLS GEN 48100049 481 33228 $ 82,135.95 ACTIVE W/REPL PLSE GEN 2 LEAD SYS

REMVL PERM PM PLS GEN 48100110 481 33227 $ 68,450.74 ACTIVE W/REPL PLSE GEN SINGLE LEAD 32000034 RENAL AND VISC S AND I 320 75966 $ 4,446.82 ACTIVE RENAL ANGIO WITH LEFT HEART 48100017 481 G0275 $ 47,512.51 ACTIVE CATH (NON-SELECTIVE) 36000112 RENAL BIOPSY NEEDLE 360 50200 $ 6,106.58 ACTIVE 36000113 RENAL CYST ASPIRATION 360 50390 $ 6,106.58 ACTIVE 30100350 RENIN 301 84244 $ 183.54 ACTIVE REPAIR COMPLEX 45000073 FACE/NECK/AXILLAE/GENITALIA/ 450 13131 $ 13,900.75 ACTIVE HANDS AND/OR FEET 1.1-2.5CM

REPAIR COMPLEX 45000150 FACE/NECK/AXILLAE/GENITALIA/ 450 13133 $ 4,500.00 ACTIVE HANDS AND/OR FEET ADD ON REPAIR COMPLEX 45000101 450 13121 $ 13,878.00 ACTIVE SCALP/ARMS/LEGS; 2.6-7.5CM REPAIR INITIAL INCISIONAL OR 36000143 360 49560 $ 12,236.57 ACTIVE VENTRAL HERNIA REDUCIBLE REPAIR INITIAL INGUINAL 36100010 HERNIA AGE 5YRS OR > 360 49505 $ 27,177.00 ACTIVE REDUCIBLE REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR 36000359 360 49507 $ 30,491.50 ACTIVE OLDER; INCARCERATED OR STRANGULATED REPAIR INTEMD FACE/EARS/EYELIDS/NOSE/LIPS/ 45000139 450 12054 $ 11,850.00 ACTIVE MUCOUS MEMBRANES 7.6-12.5 CM REPAIR INTERM 35000012 FACE/EARS/EYELIDS/NOSE/LIPS/ 450 12053 $ 11,322.00 ACTIVE MUCOUS MEMBRANES 5.1-7.5CM

REPAIR INTERMEDIATE OF 45000070 SCALP/AXILLAE/TRUNK/EXTREMI 450 12031 $ 792.45 ACTIVE TIES (EXC HANDS&FEET) 2.5CM< REPAIR INTERMEDIATE OF SCALP/AXILLAE/TRUNK/EXTREMI 45000071 450 12032 $ 1,010.95 ACTIVE TIES (EXCL HANDS&FEET) 2.6- 7.5CM REPAIR INTERMEDIATE WOUNDS OF NECK/HANDS/FEET AND/OR 45000034 450 12044 $ 8,400.00 ACTIVE EXTERNAL GENITALIA 7.6 CM TO 12.5 CM Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS REPAIR INTERMEDIATE WOUNDS OF 45000063 450 12041 $ 7,800.50 ACTIVE NECK/HANDS/FEET/EXTERNAL GENITALIA 2.5< REPAIR INTERMEDIATE, WOUNDS OF 45000112 FACE/EAR/EYELID/NOSE/LIPS 450 12052 $ 10,584.00 ACTIVE /MUCOUS MEMBRANES; 2.6-5.0 CM REPAIR INTERMEDIATE, WOUNDS OF 45000111 450 12051 $ 8,892.00 ACTIVE FACE/EARS/EYELIDS/NOSE/LIPS/ MUCOUS MEMBRANES; 2.5 CM < REPAIR INTERMEDIETE OF SCALP/AXILLAE/TRUNK/OR 45000085 450 12035 $ 12,456.00 ACTIVE EXTREM (EXCL HANDS&FEET) 12.6-20CM REPAIR INTERMEDIETE OF SCALP/AXILLAE/TRUNK/OR 45000072 450 12034 $ 1,072.30 ACTIVE EXTREM (EXCL HANDS&FEET) 7.6-12.5 REPAIR LACERATION 2.5CM<; 45000083 FLOOR OF MOUTH/ANTERIOR 450 41250 $ 3,823.50 ACTIVE TWO-THIRDS OF TONGUE REPAIR OF COLLATERAL LIGAMENT, 36000324 360 26540 $ 33,515.50 ACTIVE METACARPOPHALANGEAL/INTER PHALANGEAL JOINT 45000155 REPAIR OF NAIL BED 450 11760 $ 280.94 ACTIVE REPAIR OF TUNICA VAGINALIS 36000089 360 55060 $ 19,938.50 ACTIVE HYDROCELE (BOTTLE TYPE) REPAIR RECURRENT INCISIONAL 36000233 OR VENTRAL HERNIA 360 49565 $ 40,122.50 ACTIVE REDUCIBLE REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; 36000317 360 49521 $ 37,277.50 ACTIVE INCARCERATED OR STRANGULATED REPAIR UMBILICAL HERNIA >5 36000129 360 49585 $ 11,236.57 ACTIVE YRS REDUCIBLE REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, 45000149 450 13132 $ 13,297.67 ACTIVE AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST 45000156 450 13122 $ 4,274.50 ACTIVE SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET 45000110 450 12042 $ 8,150.00 ACTIVE AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM REPAIR, PRIMARY, DISRUPTED 36000319 LIGAMENT, ANKLE; BOTH 360 27696 $ 28,943.50 ACTIVE COLLATERAL LIGAMENTS REPAIR, PRIMARY, DISRUPTED 36000285 360 27695 $ 83,870.80 ACTIVE LIGAMENT, ANKLE; COLLATERAL Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS REPAIR, PRIMARY, OPEN/PERCU; 36000330 360 27650 $ 34,055.50 ACTIVE RUPTURED ACHILLES TENDON

REPAIR, SECONDARY, ACHILLES 36000346 360 27654 $ 35,211.00 ACTIVE TENDON, W/ OR W/O GRAFT REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, 36000322 360 27698 $ 33,209.50 ACTIVE COLLATERAL (EG, WATSON- JONES PROCEDURE) REPAIR, TENDON/MUSCLE, UPPER ARM/ELBOW, EACH 36000243 360 24341 $ 38,744.00 ACTIVE TENDON/MUSCLE, PRIMARY/SECONDARY REPEAT COLLECTION OF BLOOD SPECIMEN USING ESTABLISHED 30000046 459 36592 $ 150.00 ACTIVE CENTRAL/PERIPHERAL CATHETER VENOUS

REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, 76100029 761 36578 $ 2,113.20 ACTIVE W/SUBCUTANEOUS PORT/PUMP, CENTRAL/PERIPHERAL INSERTION SITE REPOS/REPLC PPM OR AICD 36000073 481 33215 $ 19,062.24 ACTIVE LEAD 25901014 REQUIP 0.25MG TABS 250 J8499 $ 40.00 ACTIVE 25901016 REQUIP 2MG TABLET 250 J8499 $ 40.00 ACTIVE RESPIRATORY ASSESSMENT BY 41000024 410 94664 $ 899.20 ACTIVE RT RESPIRATORY EDUCATION BY 41000025 410 98960 $ 506.80 ACTIVE RT RESPIRATORY FLOW VOLUME 46000012 460 94375 $ 400.90 ACTIVE LOOP RESPIRATORY SYNCYTIAL VIRUS 30600081 ANTIGEN ENZYME 306 87420 $ 166.92 ACTIVE IMMUNOASSAY RESTING STRESS WITHOUT 34100095 341 78451 $ 11,725.26 ACTIVE TRANSPORTATION 25901018 RESTORIL 15MG CAPS 250 J8499 $ 24.00 ACTIVE 30500080 RETIC0 CT FLO CYTOMETRY 305 85045 $ 53.28 ACTIVE RETICULOCYTE CELLULAR 30100526 305 85046 $ 74.28 ACTIVE HEMOGLOBIN 30500042 RETICULOCYTE COUNT MANUAL 305 85044 $ 57.48 ACTIVE

27200694 RETRIEVAL OF STONE BASKET 272 A4649 $ 6,048.00 ACTIVE 27200892 RETRIEVER, ROTH POLYP 272 A4649 $ 5,500.00 ACTIVE REVIS &/OR REINSERT 36000074 360 47530 $ 7,358.56 ACTIVE TRANSHEPATIC TUBE REVJ SKN POCKET 1/2 CHMBR 36000075 360 33223 $ 13,527.42 ACTIVE PACG REVJ/RELOCATION SKN POCKET 36000076 360 33222 $ 13,527.42 ACTIVE PM RHEUMATOID FACTOR 30200179 302 86430 $ 75.60 ACTIVE QUALITATIVE RHEUMATOID FACTOR 30200181 302 86431 $ 75.60 ACTIVE QUANTITATIVE 73000002 RHYTHM EKG 1-3 LEAD TRACING 730 93041 $ 260.82 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS RHYTHM EKG 1-3 LEAD TRACING 73000005 730 93040 $ 285.95 ACTIVE WITH INTERPERTATION 32000165 RIBS BILAT 3 VIEWS 320 71110 $ 1,781.50 ACTIVE 32000164 RIBS BILAT W/PA CHEST 320 71111 $ 2,261.50 ACTIVE RIBS UNI & PA CHEST MIN 32000166 320 71101 $ 1,730.00 ACTIVE 3VIEWS 32000167 RIBS UNILAT 2 VIEWS 320 71100 $ 1,455.50 ACTIVE 30200182 RICKETTSIA ANTIBODIES 302 86757 $ 258.12 ACTIVE 25901022 RIFADIN 150MG CAP 250 J8499 $ 38.00 ACTIVE 25901023 RIFADIN 300MG CAP 250 J8499 $ 48.00 ACTIVE 48100065 RIGHT HEART CATH 481 93451 $ 30,430.48 ACTIVE 48100010 RIGHT HEART CATHETERIZATION 481 93501 $ 24,040.52 ACTIVE 27900008 RIGIFLEX II ABD 272 C1726 $ 425.00 ACTIVE 25901027 RISPERDOL 1MG TAB 250 J8499 $ 129.00 ACTIVE 25901961 RIZATRIPTAN ODT 10MG 250 J8499 $ 12.00 ACTIVE RMVL 1/2 CHMBR PACG CVDFB 36000077 360 33244 $ 16,168.46 ACTIVE ELTR 25000524 ROBINUL 0.4MG 2ML SDVIAL 636 J7643 $ 180.00 ACTIVE 25901607 ROBITUSSIN DAC 5ML 250 J8499 $ 16.00 ACTIVE ROCEPHIN (CEFTRIAXONE) 25000527 636 J0696 $ 177.18 ACTIVE 250MG VIAL ROCURONIUM (10MG/ML) 25901908 250 J3490 $ 13.50 ACTIVE 50MG/5ML VIAL ROTAVIRUS ANTIGEN ENZYME 30600082 306 87425 $ 159.84 ACTIVE IMMUNOASSAY 30000011 ROUTINE VENIPUNCTURE 300 36415 $ 36.00 ACTIVE RPR 1 ELTRDS 1 CHMBR PRM 36000078 360 33218 $ 53,130.00 ACTIVE PM/1 RPR 2 ELTRDS 2 CHMBR PRM 36000079 360 33220 $ 90,160.00 ACTIVE PM/2 RPSG PREV IMPLTED CAR VEN 36000080 481 33226 $ 53,769.48 ACTIVE SYS 30600114 RSV ASSAY W/OPTIC 306 87807 $ 159.84 ACTIVE 30600137 RSV CULTURE 306 87081 $ 88.32 ACTIVE 48100011 RT & LT HEART CATH 481 93526 $ 24,040.52 ACTIVE 32000036 RT PULMONARY ANGIO 320 75746 $ 6,468.98 ACTIVE 48100052 RT. & LF. HEART CATH 481 93453 $ 54,382.50 ACTIVE RUBELLA ANTIBODY 30200186 302 86762 $ 191.88 ACTIVE IMMUNOGLOBIN-G 30200187 RUBEOLA ANTIBODY 302 86765 $ 171.72 ACTIVE RUSSELL VIPER VENOM DILUTED 30500043 305 85613 $ 127.68 ACTIVE TEST 32200005 SACROILIAC JNT ARTHROGRAM 322 73542 $ 2,618.56 ACTIVE 32000170 SACROILIAC JNTS <3 VIEWS 320 72200 $ 1,352.00 ACTIVE 32000171 SACROILIAC JNTS >3 VIEWS 320 72202 $ 1,574.00 ACTIVE 32000172 SACRUM & COCCYX 2+ VIEWS 320 72220 $ 1,335.00 ACTIVE 30100351 SALICYLATE 301 80196 $ 150.42 ACTIVE 25901045 SANTYL OINTMENT 30GM 250 A6250 $ 684.00 ACTIVE 32000173 SCAPULA COMPLETE 320 73010 $ 1,436.50 ACTIVE 40300002 SCREENING MAMMOGRAM 403 77057 $ 1,152.76 ACTIVE SCREENING TEST FOR BLOOD 30600099 306 G0328 $ 56.00 ACTIVE FECAL 36000266 SCROTAL EXPLORATION 360 55110 $ 20,318.50 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS SECONDARY CLOSURE OF SURGICAL WOUND OR 36000377 360 13160 $ 39,613.00 ACTIVE DEHISCENCE, EXTENSIVE OR COMPLICATED 30500018 SEDIMENT RATE 305 85651 $ 51.24 ACTIVE 36000081 SELECT CATH 1ST ORDER 360 36215 $ 53,874.98 ACTIVE SELECT CATH 1ST ORDER ABD 36000082 360 36245 $ 78,551.82 ACTIVE ADD FAMILY 36000084 SELECT CATH 2ND ORDER 360 36216 $ 63,246.86 ACTIVE 36000085 SELECT CATH 2ND ORDER ABD 360 36246 $ 8,075.76 ACTIVE 36000087 SELECT CATH 3RD ORDER 360 36217 $ 8,075.76 ACTIVE 36000088 SELECT CATH 3RD ORDER ABD 360 36247 $ 8,075.76 ACTIVE 36000090 SELECT CATH ADD VESSEL 360 36218 $ 8,075.76 ACTIVE 36000091 SELECT CATH ADD VESSEL ABD 360 36248 $ 8,075.76 ACTIVE 32000037 SELECTED BI-LAT RENALS 320 75724 $ 14,808.78 ACTIVE 32000038 SELECTED UNI-LAT RENALS 320 75722 $ 14,808.78 ACTIVE SELECTIVE - UNILATERAL RENAL 48100090 481 36251 $ 15,418.84 ACTIVE ANGIO SELECTIVE BILATERAL RENAL 48100089 481 36252 $ 19,621.53 ACTIVE ANGIO SELECTIVE CATH PLACEMENT, 32000110 EXT CAROTID, UNI 320 36227 $ 5,809.50 ACTIVE W/ANGIOGRAPHY SELECTIVE COMMON ILLIAC 48100091 481 75736 $ 16,461.99 ACTIVE ANGIO SELECTIVE PELVIC VESSEL ADD 32000039 320 75774 $ 6,468.98 ACTIVE S&I 32000174 SELLA TURCICA 320 70240 $ 566.72 ACTIVE 30900009 SEMEN ANALYSIS MOT&CT 309 89310 $ 31.89 ACTIVE 25901048 SENOKOT S TABLET 250 J8499 $ 24.00 ACTIVE 30600084 SENSITIVITY 1-12 DISKS 306 87184 $ 91.92 ACTIVE 25000535 SENSORCAINE 0.25PC 10ML 250 J3490 $ 210.00 ACTIVE 25000539 SENSORCAINE 0.5PC VL 10ML 250 J3490 $ 230.00 ACTIVE 25000541 SENSORCAINE EPI .25% 50ML 250 J3490 $ 260.00 ACTIVE SENSORCAINE MPF 0.5% 30ML 25000537 250 J3490 $ 96.00 ACTIVE VIAL SENSORCAINE-MPF 0.75% 10ML 25000543 250 J3490 $ 486.00 ACTIVE VIAL SEPARATION AND 30100352 301 83909 $ 189.98 ACTIVE IDENTIFICATION 25901055 SEROQUEL 25MG TAB 250 J8499 $ 36.00 ACTIVE 30100353 SEROTONIN 301 84260 $ 413.16 ACTIVE SET ADD-ON BURETROL (ALARIS 27000336 270 S1015 $ 92.00 ACTIVE (10309) 27000343 SET INF BUTTERFLY 23G X 3/4 12 272 A4212 $ 17.85 ACTIVE 27200760 SET IV BLOOD TUBING Y 272 S1015 $ 580.00 ACTIVE 27200762 SET IV CONTINUE FLOW 272 S1015 $ 140.00 ACTIVE 27200764 SET IV PRIMARY 2 VALVE 272 S1015 $ 652.00 ACTIVE 27200766 SET IV PRIMARY 3 VALVE 272 S1015 $ 550.00 ACTIVE 27200763 SET IV SECONDARY 272 S1015 $ 96.00 ACTIVE 27200768 SET IV TUBING EXTENSION 272 S1015 $ 208.00 ACTIVE 27200761 SET IVE BURETTE 60 DROP 272 S1015 $ 1,864.00 ACTIVE 27200765 SET J LOOP 272 S1015 $ 244.00 ACTIVE 27200769 SET PCA TUBING 272 A4649 $ 212.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25000707 SEVOFORANE 90 MIN 250 J7699 $ 3,416.00 ACTIVE 27200716 SHEATH AVANTI 6FR 5.5CM 272 A4270 $ 101.70 ACTIVE 27200715 SHEATH AVANTI 6FR 7.5CM 272 A4270 $ 101.70 ACTIVE SHEATH PRELUDE 8 FR 4CM 27200637 272 A4270 $ 615.00 ACTIVE MARKER TIP 27200629 SHEET T THYROID STERILE 272 A4467 $ 207.00 ACTIVE 27000347 SHOE POST OP MEN-LG 270 L3260 $ 96.00 ACTIVE 27000348 SHOE POST OP MEN-MED 270 L3260 $ 96.00 ACTIVE 27000349 SHOE POST OP MEN-SM 270 L3260 $ 96.00 ACTIVE 27000766 SHOE POST OP PEDIATRIC 270 L3260 $ 96.00 ACTIVE 27000350 SHOE POST OP WOMEN -SM 270 L3260 $ 96.00 ACTIVE 27000351 SHOE POST OP WOMEN-LG 270 L3260 $ 96.00 ACTIVE 27000352 SHOE POST OP WOMEN-MED 270 L3260 $ 96.00 ACTIVE 27000353 SHOE POST OP XLG MALE 270 L3260 $ 96.00 ACTIVE SHOECOVER, LF N/SKID UNIV 27000748 270 A9270 $ 2.85 ACTIVE BLU EACH 32000176 SHOULDER 1 VIEW 320 73020 $ 1,111.50 ACTIVE 32000175 SHOULDER 2V OR MORE 320 73030 $ 1,385.00 ACTIVE 32200006 SHOULDER ARTHROGRAPHY 322 73040 $ 4,825.50 ACTIVE 27000502 SHOULDER PADDING OSI KIT 270 L3671 $ 628.00 ACTIVE SHOULDER SLING OR VEST DESIGN, ABDUCTION 27000777 RESTRAINER, WITH OR WITHOUT 270 A4566 $ 38.95 ACTIVE SWATHE CONTROL, PREFABRICATED 32000177 SIALOGRAPHY 320 70390 $ 1,755.60 ACTIVE 30500045 SICKLE CELL TEST 305 85660 $ 73.44 ACTIVE SIGMOIDOSCOPY FLEX W/ REMOVAL OF 75000011 750 45333 $ 5,278.00 ACTIVE TUMOR/POLYP/OTHER LESION BY HOT BX FORCEPS SIGMOIDOSCOPY FLEX; DIAGNOSTIC INC COLL OF 75000012 750 45330 $ 4,252.10 ACTIVE SPECIMEN BY BRUSHING/WASHING 27000476 SILVADENE CREAM 400GM 270 A6250 $ 432.00 ACTIVE SILVER GEL (ELTA) 25901909 ANTIMICROBIAL WOUND GEL 250 A6250 $ 64.25 ACTIVE 1.5OZ 45ML TUBE 25901056 SILVER NITRATE STICK EACH 250 J3490 $ 69.00 ACTIVE 25901910 SILVER NITRATE SWAB 250 J3490 $ 12.25 ACTIVE SILVER SULFADIAZENE CREAM 25901911 250 A6250 $ 61.28 ACTIVE 85 GM SILVER SULFADIAZINE 1% 25901057 250 A6250 $ 622.00 ACTIVE CREAM 20GM SILVER SULFADIAZINE, 25901912 THERMAZENE (SILVADENE) 1% 250 A6250 $ 20.40 ACTIVE CREAM 25GM TUBE SIMETHICONE INFANT DROPS 25901058 250 J3490 $ 68.00 ACTIVE 20MG/0.3ML 30ML BTL SIMPLE REPAIR FACE AREA 45000088 450 12011 $ 2,844.00 ACTIVE 2.5CM< SIMPLE REPAIR FACE AREA 2.6- 45000115 450 12013 $ 2,988.00 ACTIVE 5CM SIMPLE REPAIR FACE AREA 5.1- 45000116 450 12014 $ 3,852.00 ACTIVE 7.5CM SIMPLE REPAIR FACE AREA 7.6- 45000117 450 12015 $ 4,842.00 ACTIVE 12.5CM Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS SIMPLE REPAIR 45000125 SCALP/NECK/EXTREM 2.5CM OR 450 12001 $ 2,286.00 ACTIVE < SIMPLE REPAIR 45000118 450 12002 $ 3,024.00 ACTIVE SCALP/NECK/EXTREM 2.6-7.5CM

SIMPLE REPAIR 45000130 450 12006 $ 6,012.00 ACTIVE SCALP/NECK/EXTREM 20.1-30CM

SIMPLE REPAIR 45000113 450 12004 $ 3,762.00 ACTIVE SCALP/NECK/EXTREM 7.6-12.5CM SIMPLE REPAIR SUPERFICIAL WOUNDS 45000138 SCALP/NECK/AXILLAE/GENITALI 450 12005 $ 2,844.00 ACTIVE A/TRUNK/EXTREMITIES 12.6-20.0 CM 27200692 SIMPULSE SOLO SYSTEM 272 A4628 $ 1,186.50 ACTIVE SIMVASTATIN (ZOCOR) 10MG 25901268 259 J8499 $ 69.00 ACTIVE TAB SINGLE VIEW SPINE SPECIFY 32000178 320 72020 $ 1,043.50 ACTIVE LEVEL 32000179 SINUS PARANASAL <3 VIEW 320 70210 $ 1,420.50 ACTIVE 32000180 SINUS PARANASAL MIN 3V 320 70220 $ 1,781.00 ACTIVE 27000590 SKIN PASTE SOOTHE AND COOL 270 A6250 $ 136.00 ACTIVE 32000181 SKULL <4 VIEWS 320 70250 $ 1,712.00 ACTIVE 32000182 SKULL COMP > 4 VIEWS 320 70260 $ 2,158.50 ACTIVE 74000003 SLEEP EEG AWAKE/ASLEEP 740 95819 $ 1,700.16 ACTIVE 27000674 SLEEVES SCD ALL SIZES 270 A4649 $ 1,216.00 ACTIVE 27000503 SLING ARM LARGE 274 A4565 $ 41.25 ACTIVE 27000504 SLING ARM MEDIUM 274 A4565 $ 64.05 ACTIVE 27000505 SLING ARM SMALL 274 A4565 $ 53.70 ACTIVE 27000021 SLING ARM XLG 270 A4565 $ 93.20 ACTIVE SLIPPER, TERRY RYL BLU XLG 27000747 270 A9270 $ 11.90 ACTIVE ADLT 32000183 SM BOWEL SERIES 320 74250 $ 4,996.00 ACTIVE SMEARS OTHER EXTENDED 31100013 311 88162 $ 202.86 ACTIVE STUDY (>5) SMOKING/TOBACCO CESSATION 77000002 942 99406 $ 116.92 ACTIVE COUNSE 3-10MINS SMOKING/TOBACCO CESSATION 77000001 942 99407 $ 200.00 ACTIVE COUNSEL >10 MIN 27000008 SNARE SYSTEM 3920060- ALL 270 C1773 $ 3,819.20 ACTIVE 27000760 SO.CHL 0.9% IRR 500ML BTL 250 A4217 $ 9.73 ACTIVE SO.CHL 5% OPHTH OINTMT 25901913 250 A6250 $ 29.48 ACTIVE 3.5GM 1/8OZ TUBE SODIUM (CEREBROSPINAL 30100356 301 84302 $ 64.80 ACTIVE FLUID) 30100355 SODIUM 24HR (URINE) 301 84300 $ 64.80 ACTIVE SODIUM BICARBONATE 4.2% 25000545 250 J3490 $ 54.00 ACTIVE 10ML SODIUM BICARBONATE 8.4% 25000547 250 J3490 $ 456.00 ACTIVE PEDI S 25800062 SODIUM CHL 0.9% 25ML IV FL 258 J7050 $ 130.00 ACTIVE SODIUM CHLORIDE 0.45% 250ML 25000668 258 J2912 $ 18.00 ACTIVE BAG 25900010 SODIUM CHLORIDE 0.9% 10ML 250 A4216 $ 36.00 ACTIVE SODIUM CHLORIDE 0.9% 10ML 25000179 272 A4216 $ 16.00 ACTIVE FLUSH SYRINGE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 25901914 SODIUM CHLORIDE 0.9% 20ML 258 J7050 $ 36.00 ACTIVE 25000553 SODIUM CHLORIDE 3000ML 250 J3490 $ 100.00 ACTIVE SODIUM CHLORIDE 5% 25901932 258 J7042 $ 42.00 ACTIVE SOLUTION (0.5FL. OZ) 25000557 SODIUM NITROPRUSSIDE 50MG 250 J3490 $ 98.00 ACTIVE 25901070 SODIUM POLYSTYRENE 15GM 250 J3490 $ 64.00 ACTIVE SOLUMEDROL 1GM (8-125MG 25000027 636 J2930 $ 61.28 ACTIVE DOSES) MDVIAL SOLUMEDROL 500MG (4-125MG 25000028 636 J2930 $ 61.28 ACTIVE DOSES) MDVIAL SOLUTION SODIUM CHLORIDE 27000576 259 A4217 $ 88.00 ACTIVE IRRIGATION 1000ML SOLUTION SODIUM CHLORIDE 25901851 250 J7050 $ 50.00 ACTIVE IRRIGATION 250ML BTL 25901962 SOTALOL 120MG 250 J8499 $ 12.00 ACTIVE 31200010 SPECIAL STAINS GROUP I (EACH) 312 88312 $ 336.00 ACTIVE SPECIAL STAINS GROUP II 31200011 312 88313 $ 238.28 ACTIVE (EACH) SPECIMEN CONTAINERS 4 OZ 27000628 270 A4649 $ 24.00 ACTIVE STERILE 32000184 SPECIMEN SURGICAL 320 76098 $ 787.50 ACTIVE SPECTROPHOTOMETRY, 30100041 ANALYTE NOT ELSEWHERE 301 84311 $ 97.20 ACTIVE SPECIFIED SPECULUM SIGMOIDOSCOPE 27000474 270 A4649 $ 759.00 ACTIVE DISPOSABLE SPINAL PUNCTURE LUMBAR; 36000117 360 62270 $ 2,922.30 ACTIVE DIAGNOSTIC SPINAL PUNCTURE, LUMBAR, 45000144 450 62270 $ 2,430.00 ACTIVE DIAGNOSTIC 27200489 SPINE CATH 272 C1755 $ 13,106.80 ACTIVE 32000192 SPINE SURVEY ENTIRE 320 72010 $ 3,372.50 ACTIVE 25901072 SPIRIVA 18MCG INHALER 250 J7699 $ 888.00 ACTIVE 27000363 SPLINT ARM LONG 270 Q4018 $ 648.00 ACTIVE 27000506 SPLINT ARM SHORT 270 Q4022 $ 2,144.25 ACTIVE 27100010 SPLINT FINGER S/M 271 Q4049 $ 95.85 ACTIVE 27000370 SPLINT FINGER/TOE 270 L3927 $ 424.00 ACTIVE 27000371 SPLINT HAND 270 L3908 $ 1,052.00 ACTIVE 27000372 SPLINT LEG LONG 270 Q4042 $ 2,772.00 ACTIVE 27000373 SPLINT LEG SHORT 270 Q4046 $ 2,084.00 ACTIVE 27000375 SPLINT NASAL SEPTAL 270 Q4051 $ 478.00 ACTIVE 27000378 SPLINT WRIST LEFT SM 270 E1805 $ 46.00 ACTIVE 27000381 SPLINT WRIST RIGHT SML 270 A4570 $ 46.00 ACTIVE SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR 36000363 360 15101 $ 5,802.50 ACTIVE EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR SPLIT-THICKNESS AUTOGRAFT; FIRST 100SQCM OR <, OR 1% OF 36000334 360 15120 $ 36,017.50 ACTIVE BODY AREA OF INFANT/CHILD (EXCEPT 15050)

27000382 SPONGE GUAZE 4X4 2 PK (16436) 272 A6402 $ 8.45 ACTIVE 27000494 SPONGE LAPARATOMY 270 A6403 $ 24.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000642 SPONGE X-RAY DETECT 4X4 270 A4649 $ 52.00 ACTIVE SPONGE XRAY DETECTABLE 27000383 272 A6402 $ 2.80 ACTIVE 10/PK (10227) 27000638 SPUTUM COLLECT SYSTEM DISP 270 A4649 $ 56.00 ACTIVE 41000033 SPUTUM COLLECTION BY RT 410 31720 $ 719.38 ACTIVE 30900007 SPUTUM COLLECTION SIMPLE 309 89220 $ 328.92 ACTIVE 25901074 SSD AF 1% CREAM 50GM 250 A6250 $ 232.00 ACTIVE 30200191 ST LOUIS ENCEPHALITIS 302 86653 $ 175.80 ACTIVE 30100361 STADOL/BUTORPHANOL 301 83925 $ 1,542.38 ACTIVE STAPLE LOADING UNIT 45 2.5 27800923 272 A4649 $ 2,467.29 ACTIVE ENDO GIA RELOAD (TR45W) 27000385 STAPLE REMOVER SKIN (10843) 270 A4550 $ 32.00 ACTIVE 27200693 STAPLER HEMORRHOID 272 A4649 $ 7,560.00 ACTIVE 27200772 STAPLER SKIN PRECISION 272 A9270 $ 292.00 ACTIVE STATIONARY OXYGEN 27000773 270 E0441 $ 158.91 ACTIVE CONTENTS, GASEOUS 27200148 STENT ACCULINK STRAIGHT 272 C1876 $ 20,000.00 ACTIVE 27200643 STENT WALL ESOPH 28X155MM 272 A4649 $ 36,663.00 ACTIVE 32000193 STEREO LOCALIZ BREAST 320 77031 $ 3,152.38 ACTIVE 27000389 STERI STRIPS 272 A4450 $ 11.85 ACTIVE 27200703 STERILE TALC 4 GRAM 272 A4649 $ 1,092.00 ACTIVE 25000566 STERILE WATER 10ML VIAL 250 A4216 $ 154.00 ACTIVE 25901915 STERILE WATER 20ML 250 A4216 $ 5.70 ACTIVE 25800064 STERILE WATER 3000ML 258 A4217 $ 184.00 ACTIVE 25901916 STERILE WATER 500ML BOTTLE 250 A4217 $ 10.03 ACTIVE STERILE WATER IRRIGATION 25000634 250 A4217 $ 70.00 ACTIVE 500ML 32000194 STERNOCLAVIC 3V MORE 320 71130 $ 1,728.00 ACTIVE 32000195 STERNUM 2+ VIEWS 320 71120 $ 1,403.50 ACTIVE 27000507 STOCKINETTE 270 A6457 $ 568.00 ACTIVE 27000508 STOCKINETTE IMPREVIOUS 270 A4649 $ 1,476.00 ACTIVE STONE ANALYSIS - CALCULUS 30100362 301 82365 $ 171.96 ACTIVE INFRARED SPECTROSCOPY STOOL CULTURE BACTERIAL 30600091 306 87045 $ 125.88 ACTIVE ISOLATION 27200165 STOP COCKS 272 A4649 $ 24.00 ACTIVE 27800652 STPL ENDOCLIP 320 DISP 272 A4649 $ 3,000.00 ACTIVE 45000050 STRAPPING ELBOW OR WRIST 450 29260 $ 350.00 ACTIVE 45000046 STRAPPING HAND OR FINGER 450 29280 $ 300.00 ACTIVE 45000054 STRAPPING KNEE 450 29530 $ 450.00 ACTIVE 42000047 STRAPPING SHLDR (VELPEAU) 420 29240 $ 769.78 ACTIVE STRAPPING; ANKLE AND/OR 45000120 450 29540 $ 936.00 ACTIVE FOOT 30100542 STREP B ASSAY W/OPTIC 306 87802 $ 44.40 ACTIVE STREPTOCOCCUS-A ASSAY 30600092 306 87880 $ 198.36 ACTIVE WITH DIRECT OBSERVATION 27200787 STRIP ACCUCHECK TEST 272 A4253 $ 52.00 ACTIVE 40200054 SUBCLAVIAN VENOGRAM 402 76937 $ 1,558.00 ACTIVE SUBQ RMVL 1/2 CHMBR PACG 36000093 360 33241 $ 16,168.46 ACTIVE CVDFB Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS SUBSEQ HOSP CARE,DETAILED INTERVL HX; DETAILED 98700006 987 99233 $ 2,571.25 ACTIVE EXAM;MED DECISION HIGH COMPLEX SUBSEQ HOSP CARE,EXPAND PROB FOCUS INT HX;EXPAND 98700005 987 99232 $ 1,779.25 ACTIVE PROB EXAM;MED DEC MOD COMPLEX SUBSEQ HOSP CARE:PROB FOCUS INT HX;PROB FOCUS 98700004 987 99231 $ 967.25 ACTIVE EXAM;MED DEC STRTFWD/LOW COMPLEX SUCTION CATHETER 14/12FR 27200496 270 A4624 $ 16.00 ACTIVE DYND41902 41000021 SUCTION PROCEDURE BY RT 410 31720 $ 629.45 ACTIVE SUCTION RESERVOIR 100CC 27000159 270 A4649 $ 550.00 ACTIVE SILICONE SULFA/TRIM (BACTRIM) 25901084 250 S0039 $ 58.00 ACTIVE 800/160MG TAB 25901085 SULFASALAZINE 500MG TABLET 250 J8499 $ 14.00 ACTIVE 25901917 SUMATRIPTAN 100MG TAB 250 J8499 $ 10.15 ACTIVE 25900594 SUMATRIPTAN 25MG TAB 250 J8499 $ 10.25 ACTIVE 63600111 SUMATRIPTAN 6MG/0.5ML 636 J3030 $ 122.20 ACTIVE 32000040 SUP VENA CAVA GRAM 320 75827 $ 6,660.00 ACTIVE SURGICAL PATHOLOGY 31200008 CONSULTANT EACH ADDED 312 88332 $ 161.42 ACTIVE SECTION SURGICAL PATHOLOGY 31200009 CONSULTANT WITH 1 FROZEN 312 88331 $ 328.92 ACTIVE SECTION SURGICAL PATHOLOGY GROSS 31200012 312 88300 $ 161.42 ACTIVE AND MICROBIOLOGY LEVEL I

SURGICAL PATHOLOGY GROSS 31200005 312 88302 $ 228.62 ACTIVE AND MICROBIOLOGY LEVEL II

SURGICAL PATHOLOGY GROSS 31200003 312 88305 $ 470.12 ACTIVE AND MICROBIOLOGY LEVEL IV

SURGICAL PATHOLOGY GROSS 31200006 312 88307 $ 611.80 ACTIVE AND MICROBIOLOGY LEVEL V

SURGICAL PATHOLOGY GROSS 31200007 312 88309 $ 808.22 ACTIVE AND MICROBIOLOGY LEVEL VI SURGICAL PREPARATION/CREATION OF RECIPIENT SITE BY EXCISION OR 36000331 360 15004 $ 13,914.00 ACTIVE INCISIONAL RELEASE ; FIRST 100 SQ CM OR 1% OF BODY AREA OF INFANT/CHILD 27000516 SUSPENSORY ALL 270 A4649 $ 384.00 ACTIVE 27000735 SUTURE 0 PROLENE CT-1 270 A4649 $ 64.00 ACTIVE SUTURE 3-0 CHROMIC GUT SH 6 27000540 270 A4649 $ 2,848.00 ACTIVE PER BOX 27000727 SUTURE 3-0 ETHYLON CT1 272 A4649 $ 63.50 ACTIVE 27000543 SUTURE 4-0 ETHILON PS-2 272 A4649 $ 148.00 ACTIVE 27000711 SUTURE 4-0 NYLON 270 A4649 $ 498.90 ACTIVE 27000538 SUTURE 4-0 PROLENE PS-2 270 A4649 $ 176.00 ACTIVE 27000541 SUTURE 4-0 VICRYL PS-2 270 A4649 $ 164.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27000539 SUTURE 5-0 PROLENE PS-3 272 A4649 $ 60.00 ACTIVE 27200705 SUTURE BOOTIE YELLOW 270 A4649 $ 32.54 ACTIVE 27000404 SUTURE ER 270 A4649 $ 206.00 ACTIVE 27000707 SUTURE ETHILON 3-0 PS2 272 A4649 $ 70.35 ACTIVE SUTURE OF 1 NERVE; ULNAR 36000328 360 64836 $ 42,335.50 ACTIVE MOTOR SUTURE OF INFRAPATELLAR 36000282 360 27380 $ 30,505.50 ACTIVE TENDON; PRIMARY SUTURE OF 36000283 QUADRICEPS/HAMSTRING 360 27385 $ 28,012.50 ACTIVE MUSCLE RUPTURE; PRIMARY 27000405 SUTURE OR 270 A4649 $ 496.00 ACTIVE 27200851 SUTURE PASSER DISPOSABLE 272 A4550 $ 3,900.00 ACTIVE 27200713 SUTURE PROLENE BV BV 272 A4649 $ 158.20 ACTIVE 27200798 SWABSTICK BENZION 272 A5120 $ 32.00 ACTIVE 27200799 SWABSTICK POVIDINE/IODINE 272 A5120 $ 12.00 ACTIVE 32000196 SWALLOW FUNC W/CINE 320 74230 $ 1,390.62 ACTIVE SYMBICORT 160/4.5 MCG 25901828 250 J7699 $ 1,426.40 ACTIVE INHALER SYNOVECTOMY, TENDON SHEATH, RADICAL 36000250 (TENOSYNOVECTOMY), FLEXOR 360 26145 $ 26,570.50 ACTIVE TENDON, PALM/FINGER, EACH TENDON 30100266 SYNOVIAL MUCIN (FLUID) 301 83872 $ 78.12 ACTIVE 25901690 SYNTHROID 0.025MG TABS 250 J8499 $ 24.00 ACTIVE 25901633 SYNTHROID 0.05MG TAB 250 J8499 $ 24.00 ACTIVE 30200193 SYPHILIS TEST (QUANTITATIVE) 302 86593 $ 58.68 ACTIVE SYPHILIS TEST (RAPID PLASMA 30200185 302 86592 $ 57.00 ACTIVE REAGIN) 27000567 SYRINGE 10CC 272 A4209 $ 48.00 ACTIVE 27000568 SYRINGE 20CC 272 A4209 $ 48.00 ACTIVE 27200820 SYRINGE 22GA X 1.5 272 A4209 $ 24.00 ACTIVE 27000569 SYRINGE 30CC 272 A4209 $ 52.00 ACTIVE 27200767 SYRINGE 3CC 272 A4208 $ 48.00 ACTIVE 27000566 SYRINGE 5CC 272 A4209 $ 48.00 ACTIVE 27000570 SYRINGE 60CC 272 A4209 $ 48.00 ACTIVE 27000562 SYRINGE ASEPTO 272 A4320 $ 48.00 ACTIVE SYRINGE BONE MARROW 27200862 272 C1830 $ 3,656.00 ACTIVE ASPIRATION 20CC 27000417 SYRINGE BULB ASEPTO (10125) 270 A4322 $ 16.00 ACTIVE 27000565 SYRINGE INSULIN 272 A4657 $ 48.00 ACTIVE SYSTEM GASTRIC LAVGE 27000675 270 A4649 $ 3,032.00 ACTIVE CLOSED 34FR 30000036 T CELL ACTIVATION 302 86356 $ 99.18 ACTIVE 30100367 T3 (REVERSE) 301 84482 $ 210.12 ACTIVE 30100364 T3 FREE 301 84481 $ 225.84 ACTIVE 30100368 T3 TOTAL 301 84480 $ 189.00 ACTIVE 30100366 T3 UPTAKE 301 84479 $ 86.16 ACTIVE 30100370 T4 FREE 301 84439 $ 120.24 ACTIVE 30100371 T4 TOTAL 301 84436 $ 91.56 ACTIVE 30100372 TACROLIMUS 301 80197 $ 183.12 ACTIVE 25901097 TAM FLU 75MG CAP 250 J8499 $ 84.00 ACTIVE TAMIFLU 45MG CAP 25000571 250 J8499 $ 108.00 ACTIVE (OSELTAMIVIR PHOS) Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27100011 TAPE 4 INCHES MEDIPORE 271 A4452 $ 420.00 ACTIVE 30100571 TB QUANTIFERON GOLD 302 86480 $ 229.56 ACTIVE TC PLACEMENT 48100012 INTRACORONARY DRUG 481 G0290 $ 78,498.22 ACTIVE ELUTING STENT SINGLE VESSEL 30200194 T-CELLS CD4 & CD8 302 86360 $ 470.12 ACTIVE 30200195 T-CELLS TOTAL COUNT 302 86359 $ 470.12 ACTIVE TECHNETIUM TC-99 SESTAMIBI 34300001 DIAGNOSTIC PER STUDY DOSE 341 A9500 $ 515.20 ACTIVE GENERIC TEE F/CGEN CAR ANOMAL 48000022 480 93303 $ 2,437.54 ACTIVE COMPL TEE F/CGEN CAR ANOMAL F- 48000023 480 93304 $ 1,159.20 ACTIVE UP/LMT 25901105 TEGRETOL 200MG TABLET 250 J8499 $ 24.00 ACTIVE TEMP FOLEY CATHETER 36000200 450 51702 $ 1,343.00 ACTIVE INSERTION 45000021 TEMPORARY EXTERNAL PACING 450 92953 $ 1,806.00 ACTIVE TENDON SHEATH INCISION 45000074 361 26055 $ 16,036.50 ACTIVE (TRIGGER FINGER) 63600188 TENECTEPLASE 50MG VIAL IV 636 J3101 $ 11,860.00 ACTIVE TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG 36000352 AND/OR ANKLE; MULTIPLE 360 27681 $ 28,349.50 ACTIVE TENDONS (THROUGH SEPARATE INCISION[S]) 25901641 TENORMIN 50MG TABS 250 J8499 $ 24.00 ACTIVE TENOTOMY, PERCUTANEOUS, 36000340 360 28010 $ 10,782.00 ACTIVE TOE; SINGLE TENDON 63600123 TERBUTALINE 1MG/ML 636 J3105 $ 12.00 ACTIVE 25901114 TESSALON PERLE 100MG CAP 250 J8499 $ 24.00 ACTIVE 30100375 TESTOSTERONE (FREE) 301 84402 $ 244.72 ACTIVE TESTOSTERONE BINDING 30100374 301 84270 $ 289.80 ACTIVE GLOBULIN 30100376 TESTOSTERONE TOTAL 301 84403 $ 344.16 ACTIVE TETANUS (TD; TENIVAC) VACC 63600115 636 90714 $ 59.83 ACTIVE 0.5ML SDVIAL TETRACAINE 0.5% OPHTHALMIC 25901926 250 J3490 $ 100.00 ACTIVE SOLN 2ML TETRACAINE 0.5% OPTH DROPS 25901927 250 J3490 $ 100.00 ACTIVE 5ML TETRACAINE 035% OPTH SOL 25901928 250 J3490 $ 100.00 ACTIVE 4ML 25901116 TETRACAINE HCL 0.5% 15ML 250 J3490 $ 100.00 ACTIVE 25901645 TETRACYCLINE 250MG CAP 250 J8499 $ 24.00 ACTIVE 25901121 THEO-DUR 200MG TABLET SA 250 J8499 $ 8.00 ACTIVE 30100379 THEOPHYLLINE 301 80198 $ 188.52 ACTIVE 42000038 THER ACT 15MIN 450 97530 $ 261.96 ACTIVE THER MASSAGE EA 15 42000039 450 97124 $ 234.94 ACTIVE PERCUSSION THER PROPH/DX INJ INTRA 45000022 450 96373 $ 566.28 ACTIVE ARTICU 45000023 THER PROPH/DX INJ SUBQ/IM 450 96372 $ 355.60 ACTIVE 44000013 THER SVC SP DEV W/MOD 450 92609 $ 801.78 ACTIVE 42000040 THERAP EXE EA 15MIN 450 97110 $ 266.58 ACTIVE 27200884 THERMOMETER, ORAL AXILLARY 272 A4931 $ 547.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 63600177 THIAMINE 200MG/2ML VIAL 636 J3411 $ 24.83 ACTIVE 30100413 THIAMINE VITAMIN B-1 301 84425 $ 283.08 ACTIVE 32000199 THOR- SPINE 2 VIEWS 320 72070 $ 1,506.00 ACTIVE 32000200 THOR- SPINE 3 VIEWS 320 72072 $ 1,643.50 ACTIVE 32000201 THOR- SPINE 4+ VIEWS 320 72074 $ 1,865.50 ACTIVE THORACENTESIS W IMAGE 36000194 360 32555 $ 3,403.00 ACTIVE GUIDANCE THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE 36000139 360 32554 $ 2,434.32 ACTIVE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE 32000042 THORACIC AORTAGRAM 320 75605 $ 6,711.50 ACTIVE 32000202 THOR-LUMB SPINE 2 VIEWS 320 72080 $ 1,607.50 ACTIVE 27200170 THROMBECTOMY CATHETER 272 C1757 $ 1,868.20 ACTIVE 48000001 THROMBOLYSIS COR IV INF 480 92977 $ 2,135.00 ACTIVE 30900013 THROMBOPLASTIN INHIBITION 305 85705 $ 128.40 ACTIVE 30100382 THYROGLOBULIN 301 84432 $ 214.08 ACTIVE 30200200 THYROGLOBULIN ANTIBODY 302 86800 $ 212.04 ACTIVE THYROID BINDING GLOBULIN 30100381 301 84442 $ 197.16 ACTIVE (TBG) 36000114 THYROID BIOPSY NEEDLE 360 60100 $ 2,830.36 ACTIVE THYROID STIMULATING 30100383 301 84443 $ 224.04 ACTIVE HORMONE THYROID STIMULATING 30100396 301 84445 $ 678.12 ACTIVE IMMUNOGLOBIN 48100047 TIB/PERO REVAS ADD ON 481 37232 $ 1,150.50 ACTIVE TIB/PERO REVASC STENT & 48100050 481 37235 $ 1,086.50 ACTIVE ATHERO/ANGIO TIB/PERO REVASC W STENT & 48100046 481 37231 $ 75,835.92 ACTIVE ATHERO TIB/PERO REVASC 48100043 481 37228 $ 54,568.62 ACTIVE W/ANGIOPLASTY TIB/PERO REVASC 48100044 481 37229 $ 71,835.92 ACTIVE W/ATHER/ANGIO TIB/PERO REVASC W/ATHERO 48100048 481 37233 $ 775.00 ACTIVE ADD ON 48100045 TIB/PERO REVASC W/STENT 481 37230 $ 71,835.92 ACTIVE TIB/PERO REVASC W/STENT 48100057 481 37234 $ 1,086.50 ACTIVE W/STENT UNI EA. 32000203 TIBIA & FIBULA TWO VIEWS 320 73590 $ 1,266.50 ACTIVE 48100115 TILT TABLE EVALUATION 481 93660 $ 17,152.60 ACTIVE 25901918 TIMOLOL 0.5% OPTH SOL 250 J3490 $ 15.15 ACTIVE TISSUE CULTURE NEO-BLOOD 31100014 311 88237 $ 1,062.60 ACTIVE BONE MARROW TISSUE GRAFTS, OTHER (EG, 36000249 360 20926 $ 22,002.00 ACTIVE PARATENON, FAT, DERMIS) TISSUE IN SITU HYBRIDIZATION, 31200018 312 88365 $ 121.34 ACTIVE INTERPRETATION & REPORT 32000204 TMJ BILATERAL 320 70330 $ 2,258.00 ACTIVE 32000205 TMJ UNILATERAL 320 70328 $ 828.80 ACTIVE 30100386 TOBRAMYCIN 301 80200 $ 215.04 ACTIVE 25901136 TOBRAMYCIN 0.3% OPTH OIN 250 J3490 $ 564.00 ACTIVE 30100419 TOCOPHEROL ALPHA VITAMIN E 301 84446 $ 189.00 ACTIVE 32000206 TOE(S) 2V OR MORE 320 73660 $ 1,334.00 ACTIVE 32000207 TOMOGRAM 320 76100 $ 4,450.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 27100015 TONGUE DEPRESSOR (STERILE) 271 A4649 $ 24.00 ACTIVE 25901139 TOPAMAX 25 MG TAB 250 J8499 $ 36.00 ACTIVE 30100388 TOPIRAMATE 301 80201 $ 158.88 ACTIVE 25901143 TORADOL 10MG TABLET 250 J8499 $ 33.00 ACTIVE TOTAL CONTACT CAST 76100028 761 29445 $ 1,568.12 ACTIVE APPLICATION 30100293 TOTAL PHENYTOIN 301 80185 $ 176.76 ACTIVE 30100091 TOTAL SERUM CHOLESTEROL 301 82465 $ 58.08 ACTIVE 27200912 TOURNIQUETS LATEX 42" DISP 272 A4649 $ 4.10 ACTIVE TOXOPLASMA ANTIBODY 30100434 302 86777 $ 191.88 ACTIVE IMMUNOGLOBIN-G TOXOPLASMA ANTIBODY 30100435 302 86778 $ 192.12 ACTIVE IMMUNOGLOBIN-M 41000032 TRACH CARE PROCEDURE BY RT 410 31720 $ 899.22 ACTIVE TRACHEOSTOMY TUBE 27400006 270 A7526 $ 38.10 ACTIVE COLLAR/HOLDER, EACH 94200010 TRAIN & EDUCATE OPPS/PHP 942 G0177 $ 2,410.52 ACTIVE TRANEXAMIC ACID 1000 25800094 258 J3490 $ 285.60 ACTIVE MG/10ML 36000094 TRANSCATH IV STENT OPEN 360 37207 $ 1,525.00 ACTIVE TRANSCATH IV STENT S&I EACH 32000043 320 75960 $ 4,945.92 ACTIVE VE 36000095 TRANSCATH STENT CCA W/EPS 360 37215 $ 1,060.50 ACTIVE TRANSCATH STENT CCA W/O 36000096 360 37216 $ 1,177.50 ACTIVE EPS TRANSCATH TX EMBOLIATION 32000045 320 75894 $ 5,776.40 ACTIVE S&I TRANSCATH TX EMBOLIZATION 36000097 360 37204 $ 1,020.00 ACTIVE COILING 25901146 TRANSDERM SCOP.1.5MG/72HR 250 J3490 $ 163.50 ACTIVE 30100389 TRANSFERRIN 301 84466 $ 170.16 ACTIVE TRANSFUSION BLOOD OR 39100001 391 36430 $ 1,790.00 ACTIVE BLOOD COMPONENTS TRANSURETHRAL 36000241 ELECTROSURGICAL RESECTION 360 52601 $ 44,342.50 ACTIVE OF PROSTATE COMPLETE TRAVATAN 0.004% 2.5ML OPTH 25901149 250 J3490 $ 648.00 ACTIVE SOL TRAY ADULT LUMBAR 27000427 270 A4550 $ 444.00 ACTIVE PUNCTURE 27200677 TRAY CIAGLIA RHINO 272 A4550 $ 9,450.00 ACTIVE 27000578 TRAY DRESSING CVC 272 A4649 $ 204.00 ACTIVE 27000510 TRAY FOLEY CATHETER W/LUB 272 A4649 $ 3,340.00 ACTIVE TRAY LUMBAR PUNCTURE 27000428 272 A4550 $ 248.00 ACTIVE PEDI/INFANT (10809) 27000629 TRAY SHAVE PREP 270 A4550 $ 56.00 ACTIVE TRAY SPINAL ANESTHESIA 27200586 272 A4550 $ 190.00 ACTIVE BF405671 27000511 TRAY TRACH W/TUBE 272 A4550 $ 1,216.00 ACTIVE 27200780 TRAY URETHRAL CATH 14FR 272 A4550 $ 92.00 ACTIVE TRAY, FOLEY CATH, 14FR, LUBR, 27200905 272 A4315 $ 283.35 ACTIVE PVP, DRAIN BAG 25901152 TRAZODONE HCL 50MG TAB 259 J8499 $ 10.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS 42000045 TREATMENT WHIRLPOOL 15 MIN 420 97022 $ 308.00 ACTIVE TREPONEMA PALLIDUM 30200276 302 86780 $ 49.02 ACTIVE ANTIBODIES TRIAMCINOLONE ACETONIDE 25901955 250 J3490 $ 12.50 ACTIVE 0.025% TOP CREAM TRICHOMONAS VAGINALIS DIR 31000007 310 87660 $ 111.40 ACTIVE PROBE 45000127 TRIGGER POINT INJECTION 1-2 450 20552 $ 1,962.00 ACTIVE 30100392 TRIGLYCERIDES 301 84478 $ 76.56 ACTIVE 48100023 TRLUML PERIP ATHRC ILIAC ART 481 0238T $ 45,327.58 ACTIVE TROCAR BLADELESS 27200657 272 A4649 $ 1,842.00 ACTIVE OBTURATOR TROCAR ENDO ULTRA VERES 27200624 272 A4649 $ 223.00 ACTIVE NDL 120MM 27000646 TROCAR EXCEL 270 A4649 $ 2,264.00 ACTIVE TROCAR EXCEL 12MM LONG 27000643 270 A4649 $ 4,236.00 ACTIVE BLADELESS STABILITY SLEEV 27000645 TROCAR EXCEL 12MM SLEEVE 270 A4649 $ 1,720.00 ACTIVE TROCAR EXCEL/PISTONGRIP 27000644 270 A4649 $ 2,468.00 ACTIVE 12MM 27200680 TROCAR SEALANT TIP 272 A4649 $ 5,733.00 ACTIVE 27200704 TROCAR THORACOPORT 11.5MM 272 A4649 $ 169.50 ACTIVE TROPICAMIDE 1% OPTH SOL 25901919 250 J3490 $ 23.18 ACTIVE 15ML 30100394 TROPONIN 1 TRIAGE 301 84484 $ 149.64 ACTIVE 27000647 TUBE CALIBRATION GASTRIC 270 B4087 $ 4,788.00 ACTIVE 27000512 TUBE CHEST (ANY) 272 A4649 $ 548.00 ACTIVE 27200811 TUBE ENDOTRACHEAL 272 A7520 $ 80.00 ACTIVE 27200532 TUBE ENDOTRACHEAL ADAPTER 272 A7520 $ 597.65 ACTIVE 27000434 TUBE FEED ENTERNAL 10FR 270 B4082 $ 125.58 ACTIVE 27000437 TUBE FEED WEIGHTED 270 B4081 $ 125.58 ACTIVE 27000520 TUBE FEEDING INTERNAL 270 B4088 $ 268.00 ACTIVE 27000441 TUBE LEVIN 16FL 270 B4083 $ 41.86 ACTIVE 27200832 TUBE NASOGASTRIC W STYLET 272 B4081 $ 56.00 ACTIVE TUBE NASOGASTRIC WITHOUT 27000779 272 B4082 $ 48.00 ACTIVE STYLET 27000513 TUBE PULL PEG 270 B4082 $ 6,416.00 ACTIVE 27000528 TUBE SALEM SUMP 14 FR 270 B4082 $ 56.00 ACTIVE 27000527 TUBE SALEM SUMP 16 FR 270 B4082 $ 56.00 ACTIVE 27000549 TUBE SALEM SUMP 18 FR 270 B4082 $ 56.00 ACTIVE 27000636 TUBE TRACH (ALL SZ) 270 A4605 $ 2,240.00 ACTIVE 27000450 TUBE TRACH ANY SIZE 272 A7520 $ 452.00 ACTIVE TUBERSOL (TUBERCULIN 25000596 250 J3490 $ 68.00 ACTIVE PROTEIN) 27000560 TUBING DISPOSABLE 270 A4649 $ 52.00 ACTIVE 27000564 TUBING NASAL 7FT 270 A4615 $ 52.00 ACTIVE TUBING NON-CONNECTING 3/16 27000672 270 A7002 $ 40.00 ACTIVE X 6 27000656 TUBING OXYGEN 7FT 270 A4616 $ 10.00 ACTIVE 27000670 TUBING PUMP STRYKER 270 A7002 $ 2,188.00 ACTIVE TUBING SUCTION W/YANKAUER 27200756 272 A4628 $ 80.00 ACTIVE TIP TUSSIONEX 5ML ORAL SUSP PER 25901168 250 J3490 $ 24.00 ACTIVE 5ML Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS TX CLOSED ELBOW DISLOC; W/O 45000076 450 24600 $ 3,500.00 ACTIVE ANES 44000014 TX SP/LANG/COM 120 450 92507 $ 772.80 ACTIVE 44000021 TX SP/LANG/COM GP 120 450 92508 $ 1,545.60 ACTIVE 44000026 TX SWALL/ORAL FNX 120 450 92526 $ 3,091.20 ACTIVE 45000024 TX/PROPH/DX INJ IV PUSH ADD 450 96375 $ 566.28 ACTIVE TX/PROPH/DX INJ IV PUSH SAME 45000078 450 96376 $ 566.28 ACTIVE DRUG 45000025 TX/PROPH/DX INJ IV PUSH SGL/IN 450 96374 $ 821.80 ACTIVE TYLENOL MAPAP 650MG 20.3ML 25901920 250 J3490 $ 5.50 ACTIVE O/S 25901173 TYLENOL W/COD 30 MG #3 TAB 250 J8499 $ 36.00 ACTIVE 36100007 TYMPANOGRAM TEST 361 92567 $ 316.25 ACTIVE 40200007 U/S GUIDANCE PARENTESIS 402 76942 $ 2,915.00 ACTIVE 32000208 UGI W AIR CON 320 74246 $ 6,143.00 ACTIVE 32000209 UGI W AIR CON KUB 320 74247 $ 6,759.50 ACTIVE 32000210 UGI W AIR CON SM BOWEL 320 74249 $ 8,797.00 ACTIVE 32000211 UGI W KUB 320 74241 $ 5,633.00 ACTIVE 32000212 UGI W SM BOWEL 320 74245 $ 8,216.00 ACTIVE 32000214 UGI W/O KUB 320 74240 $ 5,460.00 ACTIVE 25901177 ULTRAM 50MG TAB 250 J8499 $ 60.00 ACTIVE 42000041 ULTRASOUND EA 15 450 97035 $ 234.10 ACTIVE ULTRASOUND,BREAST,UNILATE RAL,REAL TIME WITH IMAGE 40200060 DOCUMENTATION,INCLUDING 402 76641 $ 2,151.50 ACTIVE AXILLA WHEN PERFORMED;COMPLETE 63600178 ULTRAVIST 300/100ML 636 Q9967 $ 60.70 ACTIVE 63600179 ULTRAVIST 300/50ML 636 Q9967 $ 53.10 ACTIVE 27000571 UNDERPAD DISPOSABLE 270 A4554 $ 52.00 ACTIVE 32000046 UNI-LAT EXTREMITY U/L S&I 320 75710 $ 9,308.68 ACTIVE 32000213 UNLISTED DX X RAY PROC 320 76499 $ 1,425.20 ACTIVE 34100086 UNLISTED GU PROC DX NM 341 78799 $ 3,633.00 ACTIVE 42000050 UNLISTED MODALITY PT 450 97039 $ 259.00 ACTIVE UNLISTED PROCEDURE 36000098 360 37799 $ 10,374.00 ACTIVE VASCULAR S UNLISTED PROCEDURE, MALE 36000294 360 55899 $ 1,978.30 ACTIVE GENITAL SYSTEM 42000042 UNLISTED PT PROC 450 97799 $ 352.26 ACTIVE 42000048 UNNA BOOT APPLICATION 420 29580 $ 769.78 ACTIVE 41000014 UPDRAFT TRMT INITIAL 410 94640 $ 251.16 ACTIVE UPG PM SYS CONV 1 CHMBR SYS 36000099 360 33214 $ 96,350.80 ACTIVE 2 UPP EXT FX ORTHOSIS 27400003 270 L3980 $ 2,234.96 ACTIVE HUMERAL 32000215 UPPER EXTREM INF 2+VIEW 320 73092 $ 454.84 ACTIVE UREA 45% TOPICAL CREAM 25000874 250 A6250 $ 15.20 ACTIVE 255GM TUBE 30100493 UREA NITROGEN CLEARANCE 301 84545 $ 88.20 ACTIVE URECHOLINE (BETHANECHOL) 25900193 250 J8499 $ 37.50 ACTIVE 25MG TAB 25901667 URECHOLINE 10MG TAB 250 J8499 $ 24.00 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS URETERAL ENDOSCOPY THROUGH URETEROTOMY, W/W/OUT 36000247 360 50972 $ 6,545.04 ACTIVE IRRIGATION/INSTILLATION/URET EROPYELOGRAPHY W/W/OUT CATH & DILATION URETEROTOMY 36000248 W/EXPLORATION/DRAINAGE 360 50600 $ 8,004.00 ACTIVE (SEPARATE PROCEDURE) 32000217 URETHROCYSTOGRAM 320 74450 $ 3,784.50 ACTIVE 32000218 URETHROCYSTOGRAM VOID 320 74455 $ 3,901.00 ACTIVE URETHROPEXY (MARSHALL- 36000071 MARCHETTI-KRANTZ BURCH) 360 51840 $ 34,349.50 ACTIVE SIMPLE URETHROPLASTY, TRANSPUBIC OR PERINEAL, 1-STAGE, FOR 36000254 RECONSTRUCTION/REPAIR OF 360 53415 $ 59,265.50 ACTIVE PROSTATIC/MEMBRANOUS URETHRA 30100401 URIC ACID BLOOD 301 84550 $ 60.24 ACTIVE 30100402 URIC ACID URINE 301 84560 $ 63.24 ACTIVE 27000556 URINAL 271 E0325 $ 19.50 ACTIVE URINALYSIS MICROSCOPIC 30700014 307 81015 $ 40.68 ACTIVE ONLY URINALYSIS 30700006 QUALITATIVE/SEMIQUANTITATIV 307 81005 $ 28.92 ACTIVE E NOT IMMUNOASSAYS URINALYSIS, DIP STICK/TABLET 30700008 REAGENT; AUTOMATED WITH 307 81001 $ 42.24 ACTIVE MICROSCOPYURINALYSIS

URINALYSIS, DIP STICK/TABLET 30700003 REAGENT; AUTOMATED, W/O 307 81003 $ 29.88 ACTIVE MICROSCOPY 30600014 URINE COLONY COUNT 306 87086 $ 107.64 ACTIVE 31000005 URINE CYTOLOGY 311 88112 $ 322.50 ACTIVE 30100090 URINE DRUG SCREEN 301 80306 $ 205.68 ACTIVE 27000515 URINE METER W/BAG 270 A4358 $ 1,104.00 ACTIVE URINE VOLUME MEASURE (24 30700009 307 81050 $ 43.68 ACTIVE HR) UROBILINOGEN URINE 30100405 301 84578 $ 53.64 ACTIVE (QUALITATIVE) 32000219 UROGRAM RETRO 320 74420 $ 6,229.00 ACTIVE US ABD (SINGLE ORGAN) 40200011 402 76705 $ 4,434.50 ACTIVE LIMITED 40200016 US ABDOMEN COMPLETE 402 76700 $ 5,942.50 ACTIVE 40200017 US BIO PROFILE W NONSTRES 402 76818 $ 5,908.00 ACTIVE 40200018 US BIO PROFILE WO NOSTRES 402 76819 $ 1,366.40 ACTIVE US BREAST, UNI, REAL TIME 40200061 W/IMAGE DOC, INC AXILLA WHEN 402 76642 $ 1,600.00 ACTIVE PERFORMED; LIMITED 92100002 US CAROTID DOPPLER 921 93880 $ 7,840.50 ACTIVE 40200020 US CHEST 402 76604 $ 4,263.00 ACTIVE 40200024 US ECHO PROSTATE VOL STDY 402 76873 $ 8,042.00 ACTIVE 40200025 US ENCEPHALOGRAM 402 76506 $ 1,472.10 ACTIVE Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS US EXTREMITY NON-VASC 40200026 402 76881 $ 5,631.50 ACTIVE COMPLETE US EXTREMITY NON-VASC 40200059 402 76882 $ 1,475.60 ACTIVE LIMITED/ANATOMICAL SPECIFIC 40200027 US FU STDY 402 76970 $ 883.40 ACTIVE 40200028 US GUIDANCE INTRA-OP 402 76998 $ 1,097.60 ACTIVE 40200033 US OB AFTR 1ST TRI 1 GEST 402 76805 $ 6,915.50 ACTIVE 40200035 US OB FU/REEVAL EA FETUS 402 76816 $ 1,083.60 ACTIVE 40200036 US OB TRANSVAGINAL 402 76817 $ 4,726.50 ACTIVE 40200037 US PELV LTD FU NON OB 402 76857 $ 2,282.00 ACTIVE 40200049 US PELVIC COMPE NON OB 402 76856 $ 5,308.00 ACTIVE 40200038 US PERICARDIOCENT 402 76930 $ 1,232.00 ACTIVE US PREGANT UTERUS 1ST 40200039 402 76801 $ 6,027.50 ACTIVE TRIMEST 40200050 US- RETROPER KIDNEY CMPL 402 76770 $ 5,463.00 ACTIVE 40200041 US RETROPERIT (AORTA) LTD 402 76775 $ 2,778.50 ACTIVE US SOFT TISSUE HEAD AND 40200044 402 76536 $ 8,439.50 ACTIVE NECK 40200045 US TESTICULAR SCROTUM 402 76870 $ 3,223.50 ACTIVE 40200051 US- TRANSRECTAL PROSTATE 402 76872 $ 4,523.00 ACTIVE 40200047 US TRANSVAGINAL 402 76830 $ 5,921.50 ACTIVE VAGINAL DELIVERY ONLY (WITH 45000153 OR WITHOUT EPISIOTOMY 450 59409 $ 26,317.47 ACTIVE AND/OR FORCEPS) 30100123 VALPROIC ACID 301 80164 $ 180.60 ACTIVE 25901922 VALSARTAN (DIOVAN) 40MG TAB 250 J8499 $ 20.00 ACTIVE VALSARTAN + HCTZ (DIOVAN) 25900396 250 J8499 $ 30.00 ACTIVE 80/12.5MG TAB 25901194 VALTREX 500MG TAB 250 J8499 $ 84.00 ACTIVE 25000609 VANCOMYCIN 750MG VIAL 636 J3370 $ 70.00 ACTIVE 30100407 VANCOMYCIN PEAK 301 80202 $ 180.60 ACTIVE VANILLYLMANDELIC ACID 30100420 301 84585 $ 206.64 ACTIVE (RANDOM URINE) 30200203 VARICELLA ZOSTER ANTIBODIES 302 86787 $ 171.72 ACTIVE

VASECTOMY UNILATERAL OR 36000228 BILATERALINCLUDING POSTOP 360 55250 $ 19,669.00 ACTIVE SEMEN EXAMINATION(S) VASOACTIVE INTESTINAL 30100411 301 84586 $ 225.56 ACTIVE PEPTIDE 42000043 VASOPNEUMATIC DEVICE 450 97016 $ 252.20 ACTIVE 25901199 VASOTEC 5MG TABLET 250 J8499 $ 30.00 ACTIVE VASOVASOSTOMY, 36000301 360 55400 $ 24,962.50 ACTIVE VASOVASORRHAPHY 27200178 VENA CAVA FILTER G2 272 C1880 $ 28,000.00 ACTIVE VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE 30000009 SKILL OF A PHYSICIAN OR 300 36410 $ 175.00 ACTIVE OTHER QUALIFIED HEALTH CARE PROFESSIONAL ( 32000220 VENOGRAM EXT BIL 320 75822 $ 6,627.50 ACTIVE 32000221 VENOGRAM EXT UNI 320 75820 $ 5,561.50 ACTIVE VENOGRAPHY, CAVAL, INFERIOR 48100102 481 75825 $ 6,607.50 ACTIVE W SERIOLOGRAPHY Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS VENOGRAPHY, EXTREMITY, 48100101 481 75822 $ 6,627.50 ACTIVE BILATERAL S & I VENOGRAPHY, EXTREMITY, 48100100 481 75820 $ 5,561.50 ACTIVE UNILATERAL S & I 48100013 VENT & ATRIAL ANGIO S&I 481 93556 $ 1,020.74 ACTIVE 41000017 VENT MANAGEMENT 1ST DAY 410 94002 $ 7,801.00 ACTIVE 41000016 VENT MGMNT SUBSEQUENT 410 94003 $ 1,648.52 ACTIVE 27000764 VENTILATOR CIRCUIT 270 A4618 $ 72.00 ACTIVE 25900214 VERAPAMIL 80MG TAB 250 J8499 $ 24.00 ACTIVE 32000047 VERT HEAD&NECK 320 75685 $ 14,808.78 ACTIVE 40200058 VESSEL MAPPING 402 G0365 $ 2,500.00 ACTIVE 25901208 VIGAMOX 0.5% OPHTH SOL 250 J3490 $ 58.00 ACTIVE 30200205 VIRUS ANTIBODY NES 302 86790 $ 171.72 ACTIVE 30600028 VIRUS INOCULATION TISSUE 306 87252 $ 202.86 ACTIVE VIRUS ISOLATION ENHANCED 30600097 306 87254 $ 72.45 ACTIVE (SHELL VIAL) 32000048 VISCERAL W/FLUSH 320 75726 $ 7,242.00 ACTIVE 30500049 VISCOSITY 305 85810 $ 155.64 ACTIVE 92200005 VISUAL EVOKED POTENT TEST 922 95930 $ 1,738.80 ACTIVE 30100415 VITAMIN A 301 84590 $ 154.80 ACTIVE 25901213 VITAMIN A&D OINT. 2 OZ. TUBE 257 A6250 $ 64.00 ACTIVE VITAMIN B1 THIAMINE 100MG 25901127 250 J8499 $ 24.00 ACTIVE TAB 30100416 VITAMIN B-12 301 82607 $ 201.00 ACTIVE 25900814 VITAMIN B3 NIACIN 500MG CAP 250 J8499 $ 24.00 ACTIVE 30100414 VITAMIN B-6 301 84207 $ 374.64 ACTIVE VITAMIN C ASCORBIC ACID 25900125 250 J8499 $ 24.00 ACTIVE 500MG TAB 30100062 VITAMIN D 25 OH 301 82306 $ 394.68 ACTIVE VITAMIN D3 CHOLECALCIFEROL 25901923 250 J8499 $ 24.00 ACTIVE 400IU TAB 30000055 VITAMIN K 300 84597 $ 182.88 ACTIVE VITAMIN K1 PHYTONADIONE 25000473 250 J3430 $ 159.00 ACTIVE 1MG/0.5ML 30100421 VOLATILES 301 84600 $ 214.44 ACTIVE VORTX - 18 DIAMOND SHAPE 27000009 270 C1729 $ 370.00 ACTIVE FIBERED PLATINUM COILS 27000460 WALKER BOOT LOW TOP 274 L4387 $ 584.00 ACTIVE 27200672 WAND TURBO VAC 272 A4649 $ 1,696.00 ACTIVE 25901222 WARFARIN 5MG TAB 250 J8499 $ 24.00 ACTIVE 27000599 WASH PERINEAL 270 A4649 $ 72.00 ACTIVE 27000575 WATER STERILE 1000ML 272 A4217 $ 88.00 ACTIVE 25901921 WATER, STERILE 250ML IV 250 A4217 $ 6.20 ACTIVE 42000044 WC MGT TRAIN EA 15MIN 450 97542 $ 224.00 ACTIVE 41000023 WEANING / EXTUBATION 410 31500 $ 750.00 ACTIVE WEBRIL NONSTERILE CAST 27000461 270 A4649 $ 16.00 ACTIVE PADDING WEDGE EXCISION OF SKIN OF 96000001 960 11765 $ 484.65 ACTIVE NAIL FOLD (MATRIXECTOMY) 25901228 WELLBUTRIN SR 150MG 250 J8499 $ 37.50 ACTIVE 30100422 WESTERN BLOT (HU SCREEN) 301 84181 $ 227.04 ACTIVE WESTERN EQUINE 30200207 302 86654 $ 175.80 ACTIVE ENCEPHALITIS Charge Master List CPT/ Charge # Description Rev Code Charge Amt Status HCPCS WET MOUNTS INCLUDING 30600093 PREPARATIONS OF VAGINAL 306 Q0111 $ 69.78 ACTIVE CERVICAL OR SKIN SPECIMEN WHITE PETROLATUM/LIGHT 25901924 250 A6250 $ 11.25 ACTIVE MINERAL OIL O/O 3.5GM WHOLE OR RED BLOOD CELLS 39000001 LEUKOCYTES REDUCED FROZEN 390 P9054 $ 3,825.36 ACTIVE DEGLYCEROL WASHED EACH UN 27000609 WIPES ALOE VERA 270 A4649 $ 252.00 ACTIVE WIRE GUIDE HYDROPHYLIC 27200636 272 C1769 $ 747.00 ACTIVE 035DIA/180 CM WIRE WITH OLIVE DIA 2.0X450 27200869 272 C1713 $ 1,212.75 ACTIVE MM 42000046 WORK REINTG TRAIN 15 450 97537 $ 225.18 ACTIVE WOUND CLOSURE TISSUE 45000003 450 G0168 $ 798.00 ACTIVE ADHESIVE ONLY 32000223 WRIST 2 VIEWS 320 73100 $ 1,401.50 ACTIVE 32000222 WRIST 3V OR MORE 320 73110 $ 1,692.50 ACTIVE 32200007 WRIST ARTHROGRAPHY 322 73115 $ 2,618.56 ACTIVE WRIST HAND FINGER ORTHOSIS 27000775 (WHFO), WITHOUT JOINT(S), 270 L3809 $ 664.18 ACTIVE PREFABRICATED WRIST HAND FINGER ORTHOSIS 27400009 (WHFO), WITHOUT JOINT(S), 274 L3807 $ 664.18 ACTIVE PREFABRICATED 25901235 XANAX 1MG TAB 250 J8499 $ 30.00 ACTIVE XARELTO RIVAROXABAN 10MG 25000869 259 J8499 $ 54.80 ACTIVE TAB 25901675 XENADERM OINTMENT 30GM 250 A6250 $ 59.00 ACTIVE XPOSE FOR ENDOPROSTH 36000100 360 34812 $ 9,940.00 ACTIVE FEMORL BI-LAT 32000224 XR GB/PAN INTRAOP ADD SET 320 74301 $ 1,358.84 ACTIVE 25901244 XYLOCAINE 2% JELLY 30GM 250 A6250 $ 327.00 ACTIVE XYLOSE ABSORBTION TEST 30100423 301 84620 $ 157.92 ACTIVE BLOOD/URINE 30000043 Y SET TUBING 272 S1015 $ 30.00 ACTIVE 25901246 ZANAFLEX 4MG TABS 250 J8499 $ 37.50 ACTIVE 25901248 ZANTAC 150MG TABLET 250 J8499 $ 60.00 ACTIVE 25901255 ZESTRIL 10MG TABLET 250 J8499 $ 24.00 ACTIVE ZIDOVUDINE (RETROVIR) 300MG 25901696 250 J8499 $ 17.30 ACTIVE TAB 30100424 ZINC 301 84630 $ 151.80 ACTIVE 25901261 ZINC OXIDE OINTMENT 30GM 250 A6250 $ 14.00 ACTIVE 25901266 ZITHROMAX 250MG TAB 250 Q0144 $ 118.00 ACTIVE ZITHROMAX 500MG IN 250ML NS 25000654 250 Q0144 $ 484.00 ACTIVE (P ZITHROMAX ORAL 200MG/5ML 25901267 250 Q0144 $ 439.50 ACTIVE 30ML 25901925 ZOLMITRIPTAN 5MG ODT 250 J8499 $ 15.48 ACTIVE 25901272 ZOLOFT 100MG TABLET 250 J8499 $ 60.00 ACTIVE ZOSTER SHINGLES VACC 0.65ML 63600180 636 90736 $ 424.00 ACTIVE SDVIAL 25901278 ZOVIRAX 200MG CAPS 250 J8499 $ 45.00 ACTIVE 25901282 ZOVIRAX 400MG TAB 250 J8499 $ 121.50 ACTIVE 25901290 ZYRTEC-D 12HR TAB 250 J8499 $ 16.00 ACTIVE