sutter davis hospital - office of statewide health planning · xls file · web...

AB 1045 - List of 25 CommonOutpatient Procedures for 2012

AB 1045 (May 2012)

Hospital Name: Sutter Davis HospitalOSHPD Facility No: 106574010Effective Date of Charges: June 1, 2012Evaluation & Management Services (CPT Codes 99201-99499)

Emergency Room Visit, Level 2 99282 647.00Emergency Room Visit, Level 3 99283 1,078.00Emergency Room Visit, Level 4 99284 1,650.00Laboratory & Pathology Services (CPT Codes 80048-89356)

Basic Metabolic Panel 80048 187.00Comprehensive Metabolic Panel 80053 235.00Lipid Panel 80061 338.00Creatine Kinase (CK), (CPK), Total 82550 144.00Blood Gas Analysis, including 02 saturation 82805 87.00Thyroid Stimulating Hormone 84443 375.00Troponin, Quantitative 84484 219.00Complete Blood Count, with differential WBC, automated 85025 171.00Complete Blood Count, automated 85027 144.00Prothrombin Time 85610 86.00Partial Thromboplastin Time 85730 134.00Radiology Services (CPT Codes 70010-79999)

CT Scan, Head or Brain, without contrast 70450 2,975.00X-Ray, Chest, two views 71020 321.00X-Ray, Lumbo Sacral, four views 72110 635.00CT Scan, Pelvis, with contrast 72193 4,554.00CT Scan, Abdomen, with contrast 74160 5,212.00Ultrasound, Abdomen, Complete 76700 1,280.00Ultrasound, OB, 14 weeks or more, single fetus, transabdominal 76805 1,276.00Mammography, Screening, Bilateral 77057Medicine Services (CPT Codes 90281-99607)

Electrocardiogram 12 Lead Tracing Only 93005 215.00Echocardiography, complete 93307 2,526.00Inhalation Treatment, pressurized or nonpressurized 94640 300.00Surgery Services (CPT Codes 10021-69990)

Arthroscopy, Knee, with meniscectomy (medial or lateral) 29881 17,285.83Arthroscopy, Shoulder, with partial acromioplasty 29826 22,467.58Carpal Tunnel Surgery 64721 7,547.65Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984 9,971.36Colonoscopy, diagnostic 45378 3,895.02Colonoscopy, with biopsy 45380 7,559.58Colonoscopy, with lesion removal, by snare technique 45385 6,768.76Discission, secondary membranous cataract, laser surgery 66821Endoscopy, Upper GI, with biopsy 43239 7,301.64Endoscopy, Upper GI, diagnostic 43235 3,524.46Excision, Breast Lesion 19120 21,152.33Hernia Repair, Inguinal, 5 years and older 49505 15,746.33Injection, Diagnostic or Therapeutic substance, epidural, sacral 62311 7,229.34Injection, Anesthetic or Steroid, transforaminal epidural, sacral 64483 7,587.27Laparoscopic Cholecystectomy 47562 19,343.62Tympanostomy (insert ventilating tube, general anesthesia) 69436 8,509.18Tonsillectomy with Adenoidectomy, less than 12 years old 42820 14,724.84Count of Reported Procedures (minimum 25 required) 40

2012 CPT Code

Outpatient Charge Amount

2012 CPT Code

2012 CPT Code

2012 CPT Code

2012 CPT Code

Average Charge Amount

document.xls

of 196

BILLING DESCRIPTION DEPARTMENT DESCRIPTION

5410162 S STRL CATHETER IV 30.75 54 AMBULATORY CARE5410220 VENIPUNCTURE 15.75 54 AMBULATORY CARE5410154 LUMBAR PUNCTURE DX 631.00 54 AMBULATORY CARE5410071 BX LIVER 1772.00 54 AMBULATORY CARE5410030 INJ BLOOD PATCH 781.00 54 AMBULATORY CARE5410055 INJ SPINE LUMB/SCRL 1215.00 54 AMBULATORY CARE5410188 EKG 12 LEAD TRACING 221.00 54 AMBULATORY CARE5402235 REMV TUNN CV CATH W/O 501.45 54 AMBULATORY CARE9210352 CARDIOVERT ELECTIVE EXT 1468.00 92 CARDIOLOGY9210444 CARDIAC STRESS TEST 983.00 92 CARDIOLOGY9210071 CARDIAC STRESS TEST 983.00 92 CARDIOLOGY9210188 EKG SIGNAL AVERAGED 1419.00 92 CARDIOLOGY9210451 EKG SIGNAL AVERAGED 1419.00 92 CARDIOLOGY9210576 PAD REHAB PER SESSION 637.00 92 CARDIOLOGY9210006 CARDIAC REHAB W EKG 139.00 92 CARDIOLOGY9210477 MAINTENANCE CARDIAC REHAB 92 CARDIOLOGY9210147 RISK MOD PROGRAM 109.00 92 CARDIOLOGY9210469 AMB BP RECORDING ONLY 176.00 92 CARDIOLOGY9210378 PULMONARY STRESS SIMPLE 3462.00 92 CARDIOLOGY9210535 PULMONARY STRESS SIMPLE 3462.00 92 CARDIOLOGY9210386 PULMONARY STRESS COMPLEX 1918.00 92 CARDIOLOGY9210568 THER PROC STRNTH/ENDR 15M 90.00 92 CARDIOLOGY9210543 THER PROC RESP FNCTN 15M 90.00 92 CARDIOLOGY9210550 THER PROC RESP FNCTN GRP 244.00 92 CARDIOLOGY9210055 CA ECHO 2D CMP NO SPC/DOP 2526.00 92 CARDIOLOGY9210402 CA ECHO 2D CMP NO SPC/DOP 2526.00 92 CARDIOLOGY9210394 CA ECHO 2D LTD 1805.00 92 CARDIOLOGY9210196 CA ECHO 2D LTD 1805.00 92 CARDIOLOGY9210170 CA ECHO DPPLER CMPL 1120.00 92 CARDIOLOGY9210410 CA ECHO DPPLER CMPL 1120.00 92 CARDIOLOGY9210048 CA ECHO DPPLER COLOR FLOW 868.00 92 CARDIOLOGY9210428 CA ECHO DPPLER COLOR FLOW 868.00 92 CARDIOLOGY9210436 CA ECHO 2D W STRES 2464.00 92 CARDIOLOGY9210154 CA ECHO 2D W STRES 2464.00 92 CARDIOLOGY9210584 CA TTE DPLR CMPLT WO CON 4166.00 92 CARDIOLOGY2020477 S NSTRL SPIROMETER ADULT 40.45 20 CENTRAL SUPPLY2020436 S NSTRL NEBULIZER W/ TEE 9.60 20 CENTRAL SUPPLY

CHARGE CODE

SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

A1

[Microsoft JET Created Table]006101007071010

document.xls

of 196

BILLING DESCRIPTION DEPARTMENT DESCRIPTIONCHARGE CODE

SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2020402 S NSTRL CAN NASAL 02 7FT 5.35 20 CENTRAL SUPPLY2020493 S NSTRL MASK AEROSOL ADLT 4.25 20 CENTRAL SUPPLY2015147 S NSTRL SCD SLEEVE MED 84.00 20 CENTRAL SUPPLY2015139 S NSTRL SCD SLEEVE SM 128.25 20 CENTRAL SUPPLY2014777 S NSTRL URINE DRAIN BAG 35.15 20 CENTRAL SUPPLY2014793 S NSTRL URINE METER 85.20 20 CENTRAL SUPPLY2015170 S NSTRL PEDS PULSE OX REP 31.62 20 CENTRAL SUPPLY2020444 S NSTRL AEROCHAMBER 73.50 20 CENTRAL SUPPLY2020428 S NSTRL MASK O2 NREBREATH 12.80 20 CENTRAL SUPPLY2014405 S NSTRL TED HOSE KNEE 42.60 20 CENTRAL SUPPLY2020535 S NSTRL PROBE OXMTRY INF 159.75 20 CENTRAL SUPPLY2012094 S NSTRL LEG BAG 22.35 20 CENTRAL SUPPLY2015154 S NSTRL SCD SLEEVE LG 173.37 20 CENTRAL SUPPLY2013175 S NSTRL THORACIC RIB BELT 102.25 20 CENTRAL SUPPLY2020469 S NSTRL FLOWMETER PEAK 107.55 20 CENTRAL SUPPLY2020451 S NSTRL RESUSCITATOR MANL 124.60 20 CENTRAL SUPPLY2020360 S NSTRL CO2 DETECTOR 126.75 20 CENTRAL SUPPLY2014413 S NSTRL TED HOSE THIGH 41.55 20 CENTRAL SUPPLY2020154 S NSTRL BEAR HUGGER COVER 91.60 20 CENTRAL SUPPLY2020485 S NSTRL MASK O2 ADULT 6.40 20 CENTRAL SUPPLY2012995 S NSTRL POST OP SHOE 63.90 20 CENTRAL SUPPLY2014819 S NSTRL UROSTY SKIN BARR 20.25 20 CENTRAL SUPPLY2014801 S NSTRL UROSTOMY POUCH 93.70 20 CENTRAL SUPPLY2015055 S NSTRL BRIEF, STRETCH 6.40 20 CENTRAL SUPPLY2014785 S NSTRL URINE FTR SNGL 2.15 20 CENTRAL SUPPLY2013589 S NSTRL SPLINT 3 X 15 20 CENTRAL SUPPLY2013662 S NSTRL STAPLE REMOVER 23.45 20 CENTRAL SUPPLY2014306 S NSTRL SYN CAST TAPE 3IN 146.95 20 CENTRAL SUPPLY2013878 S NSTRL SUSPENSORY 181.05 20 CENTRAL SUPPLY2014728 S NSTRL UNDERPADS, 5PK 2.15 20 CENTRAL SUPPLY2014660 S NSTRL SLING TRIANGULAR 16.00 20 CENTRAL SUPPLY2013407 S NSTRL SITZ BATH DISP 17.05 20 CENTRAL SUPPLY2015188 S NSTRL OXYGEN MASK 23.97 20 CENTRAL SUPPLY2015162 S NSTRL ADULT PULSE OX RP 32.08 20 CENTRAL SUPPLY2020410 S NSTRL MASK 02 PEDS 9.60 20 CENTRAL SUPPLY2020527 S NSTRL PROBE OXMTRY ADLT 206.60 20 CENTRAL SUPPLY2020519 S NSTRL MASK BREATH INF 25.55 20 CENTRAL SUPPLY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2020501 S NSTRL MASK BREATH NEO 25.55 20 CENTRAL SUPPLY2020378 S NSTRL STOMA IRRIG DRAIN 55.40 20 CENTRAL SUPPLY2020345 S NSTRL STMA IR DRN W/FLG 68.15 20 CENTRAL SUPPLY2020584 S NSTRL ADPTR POWERPICC 37.00 20 CENTRAL SUPPLY2012540 S NSTRL OSTOMY BARRIER 4" 23.45 20 CENTRAL SUPPLY2011864 S NSTRL INCONT BARR 123.55 20 CENTRAL SUPPLY2011799 S NSTRL PILLOW HIP ABDUCT 263.05 20 CENTRAL SUPPLY2012680 S NSTRL URINE COL PEDS 4.25 20 CENTRAL SUPPLY2013316 S NSTRL SHRT ARMCAST ADLT 223.65 20 CENTRAL SUPPLY2013274 S NSTRL SEQ COMP. SLEEVE 1222.60 20 CENTRAL SUPPLY2013019 S NSTRL PREM PASTE/STOMA 75.60 20 CENTRAL SUPPLY2013001 S NSTRL POWDER 3.20 20 CENTRAL SUPPLY2012946 S NSTRL POSEY RESTR VEST 150.15 20 CENTRAL SUPPLY2012631 S NSTRL OSTY POUCH CLAMP 16.00 20 CENTRAL SUPPLY2012615 S NSTRL OSTY IRRIG DRN 83.05 20 CENTRAL SUPPLY2012607 S NSTRL OSTY DRN POUCH 14.90 20 CENTRAL SUPPLY2012599 S NSTRL OSTY BARR 2.5IN 77.75 20 CENTRAL SUPPLY2012565 S NSTRL MISC C/S 20 CENTRAL SUPPLY2010395 S NSTRL SLING ARM SMALL 42.60 20 CENTRAL SUPPLY2010387 S NSTRL SLING ARM MEDIUM 42.60 20 CENTRAL SUPPLY2010379 S NSTRL SLING ARM LARGE 42.60 20 CENTRAL SUPPLY2010353 S NSTRL ANOSCOPE DISP 11.70 20 CENTRAL SUPPLY2010155 S NSTRL ADMIT KIT/THERM 20 CENTRAL SUPPLY2010148 S NSTRL ADHV SPRAY 6 OZ 207.70 20 CENTRAL SUPPLY2011005 S NSTRL DEFIB PAD 113.95 20 CENTRAL SUPPLY2011633 S NSTRL HEEL/ELBOW PROT 43.65 20 CENTRAL SUPPLY2011625 S NSTRL HEATING PAD, DISP 141.65 20 CENTRAL SUPPLY2011443 S NSTRL FECAL INCONT COL 63.90 20 CENTRAL SUPPLY2011013 S NSTRL DEFIB PAD, AUTO 239.65 20 CENTRAL SUPPLY2010577 S NSTRL PAD BLANKETROL 603.85 20 CENTRAL SUPPLY2010700 S NSTRL CAST SHOES 62.85 20 CENTRAL SUPPLY2010676 S NSTRL BUCK TRACTN BOOT 136.30 20 CENTRAL SUPPLY2010619 S NSTRL BLD WARMER LINER 232.15 20 CENTRAL SUPPLY2013332 S NSTRL SHRT LEGCAST ADLT 628.35 20 CENTRAL SUPPLY2011096 S NSTRL DONUT AIR CUSHION 170.40 20 CENTRAL SUPPLY2011740 S STRL FOLWY CATHETER TRA 98.00 20 CENTRAL SUPPLY2014926 S STRL WATER IRRIG 3000CC 60.70 20 CENTRAL SUPPLY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2013837 S STRL SUCTION KIT SINGLE 31.95 20 CENTRAL SUPPLY2015022 S STRL YANKAUER SUCTION 13.85 20 CENTRAL SUPPLY2010320 S STRL CATHETER IV 22G X 29.80 20 CENTRAL SUPPLY2015006 S STRL XEROFLO GZE 2X2 52.20 20 CENTRAL SUPPLY2013811 S STRL TRAY STRAIGHT CATH 115.00 20 CENTRAL SUPPLY2013217 S STRL SALEM SUMP TUBE 16.00 20 CENTRAL SUPPLY2010361 S STRL ANTI REFLUX VALUE 60.70 20 CENTRAL SUPPLY2013829 S STRL SUC CATH SNGL 38.35 20 CENTRAL SUPPLY2010098 S STRL ADAPTIC 3X8 20.25 20 CENTRAL SUPPLY2015014 S STRL XEROFORM 5X9 9.60 20 CENTRAL SUPPLY2010346 S STRL CATHETER IV 24 G X 30.90 20 CENTRAL SUPPLY2010106 S STRL ADAPTIC 3X3 5.35 20 CENTRAL SUPPLY2010296 S STRL CATHETER IV 20B 1 28.75 20 CENTRAL SUPPLY2011302 S STRL ENDOTRACHEAL TUBE 116.10 20 CENTRAL SUPPLY2012573 S STRL MLUM CATH KIT 341.85 20 CENTRAL SUPPLY2014520 S STRL THORACENTESIS 454.75 20 CENTRAL SUPPLY2012466 S STRL NDL PORT A CATH 106.50 20 CENTRAL SUPPLY2010809 S STRL CHEST DRAIN ADULT 487.75 20 CENTRAL SUPPLY2013084 S STRL RADIAL ARTERY CATH 206.60 20 CENTRAL SUPPLY2014587 S STRL TRACH TUBE FENEST 714.60 20 CENTRAL SUPPLY2011435 S STRL FEMALE MINI CATH 22.35 20 CENTRAL SUPPLY2011765 S STRL CATHETER FOLWY 2W 44.75 20 CENTRAL SUPPLY2012219 S STRL LUMBAR PUNC ADULT 151.25 20 CENTRAL SUPPLY2010643 S STRL BONE MARROW TRAY 291.80 20 CENTRAL SUPPLY2013126 S STRL RESTORE CX 4X4 34.10 20 CENTRAL SUPPLY2013803 S STRL STOPCOCK W/TUBE 46.85 20 CENTRAL SUPPLY2014199 S STRL SUTURE 698 ETHILON 42.60 20 CENTRAL SUPPLY2014850 S STRL VASLINE GZE 6X36 20.25 20 CENTRAL SUPPLY2014835 S STRL VASLINE GZE 1/2X72 11.70 20 CENTRAL SUPPLY2014827 S STRL DRAINAGE 669.90 20 CENTRAL SUPPLY2014900 S STRL WATER IRRIG 1000CC 9.60 20 CENTRAL SUPPLY2015121 S STRL KIT CATH INFANT 5F 11.70 20 CENTRAL SUPPLY2015113 S STRL SUT S-PRO 3.0BL18 16.00 20 CENTRAL SUPPLY2015105 S STRL SUT S-PRO 3.0BL14 18.10 20 CENTRAL SUPPLY2015097 S STRL SUT S-PRO 4.0BL18 18.10 20 CENTRAL SUPPLY2015089 S STRL CATH SUC 14FR 146.95 20 CENTRAL SUPPLY2015071 S STRL DERMABOND 340.80 20 CENTRAL SUPPLY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2014975 S STRL WET DRESSING 44.75 20 CENTRAL SUPPLY2013704 S STRL STERILE FIELD 2.15 20 CENTRAL SUPPLY2013514 S STRL NEEDLE SPINAL 14.90 20 CENTRAL SUPPLY2015063 S STRL PIC CATHETER KIT 553.80 20 CENTRAL SUPPLY2014074 S STRL SUTURE 640 SILK 20.25 20 CENTRAL SUPPLY2014009 S STRL SUTURE SILK 680H 57.50 20 CENTRAL SUPPLY2014017 S STRL SUT 1604 PLN/GUT 100.10 20 CENTRAL SUPPLY2014025 S STRL SUT 1614 EHTILON 43.65 20 CENTRAL SUPPLY2014033 S STRL SUT 1615 ETHILON 43.65 20 CENTRAL SUPPLY2014207 S STRL SUTURE 699 ETHILON 42.60 20 CENTRAL SUPPLY2014058 S STRL SUT 1698 ETHILON 42.60 20 CENTRAL SUPPLY2014181 S STRL SUTURE 697 ETHILON 42.60 20 CENTRAL SUPPLY2014090 S STRL SUTURE 661 ETHILON 18.10 20 CENTRAL SUPPLY2014108 S STRL SUTURE 662 ETHILON 16.00 20 CENTRAL SUPPLY2014116 S STRL SUTURE 663 ETHILON 25.55 20 CENTRAL SUPPLY2014124 S STRL SUTURE 664 ETHILON 27.70 20 CENTRAL SUPPLY2014132 S STRL SUTURE 685 SILK 19.15 20 CENTRAL SUPPLY2014041 S STRL SUT 1644 PLN/GUT 46.85 20 CENTRAL SUPPLY2014595 S STRL TRACH TUBE LO PRES 831.75 20 CENTRAL SUPPLY2014140 S STRL SUTURE 687G 20.25 20 CENTRAL SUPPLY2013902 S STRL SUTURE A306 SILK 13.85 20 CENTRAL SUPPLY2013993 S STRL SUT R690 MERSILEN 60.70 20 CENTRAL SUPPLY2013928 S STRL SUT G 181H CHROMI 24.50 20 CENTRAL SUPPLY2013936 S STRL SUTURE J493 VICRYL 47.95 20 CENTRAL SUPPLY2013944 S STRL SUTURE J494 VICRYL 45.80 20 CENTRAL SUPPLY2013951 S STRL SUTURE J597 VICRYL 61.75 20 CENTRAL SUPPLY2014496 S STRL THERMODILTION CATH 1771.10 20 CENTRAL SUPPLY2013969 S STRL SUTURE J598 VICRYL 61.75 20 CENTRAL SUPPLY2013910 S STRL SUT B424 ETHIBOND 57.50 20 CENTRAL SUPPLY2020121 S STRL FEEDING TUBE 5 FR. 38.35 20 CENTRAL SUPPLY2020576 S STRL CATH 6 FR POWERPIC 870.00 20 CENTRAL SUPPLY2020212 S STRL GRSHNG PICC SL 775.30 20 CENTRAL SUPPLY2020139 S STRL FEEDING TUBE 8 FR. 5.35 20 CENTRAL SUPPLY2020105 S STRL LP INF 133.15 20 CENTRAL SUPPLY2020063 S STRL PROBE, BLANKETROL 146.95 20 CENTRAL SUPPLY2020246 S STRL CATHETER MID LINE 522.90 20 CENTRAL SUPPLY2019925 S STRL CATHETER TROCAR 340.80 20 CENTRAL SUPPLY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2019909 S STRL EPIDURAL TRAY 1105.45 20 CENTRAL SUPPLY2019891 S STRL TRACH TUBE EXCHANG 133.15 20 CENTRAL SUPPLY2020568 S STRL ATH 5FR POWERPICC 20 CENTRAL SUPPLY2020550 S STRL KIT INTDR MIC 5.0F 437.70 20 CENTRAL SUPPLY2020543 S STRL KIT INTDR MIC 3.5F 437.70 20 CENTRAL SUPPLY2012516 S STRL NUGAUZ, PLAIN 1" 33.00 20 CENTRAL SUPPLY2020220 S STRL GRSHNG PICC DL 781.70 20 CENTRAL SUPPLY2020394 S STRL TRAY THORACIC VENT 1578.35 20 CENTRAL SUPPLY2020352 S STRL SKIN STAPLER 35 W 85.20 20 CENTRAL SUPPLY2020303 S STRL CYSTOSCOPY/TRAY 46.85 20 CENTRAL SUPPLY2012284 S STRL MONTR KIT ART LINE 134.20 20 CENTRAL SUPPLY2012482 S STRL NUGAUZ IODO 1IN 37.30 20 CENTRAL SUPPLY2012474 S STRL NUGAUZ IODO 1/2IN 33.00 20 CENTRAL SUPPLY2012409 S STRL NASOSTAT 329.10 20 CENTRAL SUPPLY2012391 S STRL NASAL TAMPON 204.50 20 CENTRAL SUPPLY2012375 S STRL NASAL PAK POST 206.60 20 CENTRAL SUPPLY2012367 S STRL NASAL PACKING STAT 40.45 20 CENTRAL SUPPLY2012300 S STRL MORGAN THER. LENS 342.95 20 CENTRAL SUPPLY2012524 S STRL NUGAUZ, PLAIN 2" 44.75 20 CENTRAL SUPPLY2012243 S STRL MALCOT DRAIN 40 FR 139.50 20 CENTRAL SUPPLY2012003 S STRL SMALL VEIN SET IV 38.35 20 CENTRAL SUPPLY2011948 S STRL NEEDLE INTRAOSEOUS 375.95 20 CENTRAL SUPPLY2011872 S STRL INNER CAN DISP 39.40 20 CENTRAL SUPPLY2011773 S STRL CATHETER FOLEY 3 W 120.35 20 CENTRAL SUPPLY2013183 S STRL CATHETER ROBINSON 44.75 20 CENTRAL SUPPLY2013134 S STRL RESTORE CX 8X8 146.95 20 CENTRAL SUPPLY2012508 S STRL NUGAUZ, PLAIN 1/2" 28.75 20 CENTRAL SUPPLY2012789 S STRL PERITON LAVGE TRAY 580.45 20 CENTRAL SUPPLY2012557 S STRL MISC C/S STERILE 20 CENTRAL SUPPLY2011716 S STRL FILTER LEUKOCYTE 2.15 20 CENTRAL SUPPLY2012938 S STRL PNEUMOTHRAX KIT 10255.95 20 CENTRAL SUPPLY2010270 S STRL CATHETER IV 18G 1 29.80 20 CENTRAL SUPPLY2010544 S STRL BPLR PACING CATH 1743.40 20 CENTRAL SUPPLY2010411 S STRL ARTERIAL TUBING 86.25 20 CENTRAL SUPPLY2010403 S STRL ART LINE INJ KIT 286.50 20 CENTRAL SUPPLY2011757 S STRL CATHETER COUDE TIP 120.35 20 CENTRAL SUPPLY2010288 S STRL CATHETER IV 18G 2 58.60 20 CENTRAL SUPPLY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2010593 S STRL BLD COIL 109.70 20 CENTRAL SUPPLY2010254 S STRL CATHETER IV 16G 1 29.80 20 CENTRAL SUPPLY2010247 S STRL CATHETER IV 16G X3 90.55 20 CENTRAL SUPPLY2010213 S STRL CATHETR IV 14G 1/4 29.80 20 CENTRAL SUPPLY2010304 S STRL CATHETER IV 20G 2 44.75 20 CENTRAL SUPPLY2011708 S STRL FTR/ASPIR NDL 13.85 20 CENTRAL SUPPLY2011690 S STRL FDING TUBE ENT 8FR 5.35 20 CENTRAL SUPPLY2011641 S STRL HEIMLICH CHEST DRN 119.30 20 CENTRAL SUPPLY2011609 S STRL GUIDE WIRE, PERC. 115.00 20 CENTRAL SUPPLY2011500 S STRL GASTRIC LAVGE TRAY 689.05 20 CENTRAL SUPPLY2010569 S STRL BLAKMOR TUBE 20FR 1995.80 20 CENTRAL SUPPLY2010973 S STRL MANOMETER CVP 192.75 20 CENTRAL SUPPLY2010924 S STRL CATH COUCIL 321.65 20 CENTRAL SUPPLY2010635 S STRL BONANNO CATHETER 644.35 20 CENTRAL SUPPLY2013571 S ORTHO SPLINT, COCK UP 77.75 20 CENTRAL SUPPLY2014991 S ORTHO IMBLR WRIST/ANKLE 57.50 20 CENTRAL SUPPLY2011724 S ORTHO FINGER SPLINT 20 CENTRAL SUPPLY2010031 S ORTHO ABDOMINAL BINDER 94.80 20 CENTRAL SUPPLY2012227 S IMP MAHURKAR CATH 11.5 1303.55 20 CENTRAL SUPPLY2010668 S IMP BROV CATH INJ CAP 34.10 20 CENTRAL SUPPLY2010189 ALBUMIN 5%/250ML 326.95 20 CENTRAL SUPPLY2010775 CERVICAL FOAM COLLAR 42.60 20 CENTRAL SUPPLY2012060 S OT KO IMMOB CNVS LONG 176.80 20 CENTRAL SUPPLY2013381 S OT SO FIG 8 ABDC CNVS 201.30 20 CENTRAL SUPPLY2019982 S OT SO ACRO/CLAV CNVS PF 165.10 20 CENTRAL SUPPLY2013522 S OT SO ACRO/CLAV CNVS PF 47.95 20 CENTRAL SUPPLY2013530 S OT SO ACRO/CLAV CNVS PF 77.75 20 CENTRAL SUPPLY2013548 S OT SO ACRO/CLAV CNVS PF 77.75 20 CENTRAL SUPPLY2019966 S OT PNEUM WALKING BOOT 234.30 20 CENTRAL SUPPLY2012342 NA CL IRRIG 1000CC 8.50 20 CENTRAL SUPPLY2012359 NA CL IRRIG 3000CC 146.95 20 CENTRAL SUPPLY2210003 NA CL 0.45% 1000ML 85.88 22 CENTRAL SUPPLY IV2210375 S NSTRL NIPPLESHIELD 24MM 21.45 22 CENTRAL SUPPLY IV2210433 S STRL CATHETER 22GA. 27.15 22 CENTRAL SUPPLY IV2210441 S STRL CATHETER 20GA. 27.15 22 CENTRAL SUPPLY IV2210425 S STRL CATHETER 24GA. 27.15 22 CENTRAL SUPPLY IV2210094 S STRL EVACUATED CONTAINE 91.90 22 CENTRAL SUPPLY IV

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2210458 S STRL CATHETER 218GA. 27.15 22 CENTRAL SUPPLY IV2210342 S STRL KIT MNTR 24IN. 87.15 22 CENTRAL SUPPLY IV2210334 S STRL SENSOR FLOTRAC ADL 850.00 22 CENTRAL SUPPLY IV2210326 S STRL SWAN CATH 8FR 837.25 22 CENTRAL SUPPLY IV2210318 S STRL CATHCNTRLKITVENOUS 956.25 22 CENTRAL SUPPLY IV2210367 S STRL GRSHNG CATH PICC 4 459.00 22 CENTRAL SUPPLY IV2210102 S STRL EVACUATED FLSK 250 140.60 22 CENTRAL SUPPLY IV2210466 S STRL KIT CVC OXI CATH 8 935.00 22 CENTRAL SUPPLY IV2210359 S STRL CATHPOWERPICCW/TRY 658.75 22 CENTRAL SUPPLY IV2210417 S STRL ACTIFLO BOWEL CATH 513.75 22 CENTRAL SUPPLY IV2210409 S STRL TRIPLE LUMENT PICC 22 CENTRAL SUPPLY IV2210391 S STRL GRSHNG CATH PICC 5 22 CENTRAL SUPPLY IV2210383 S STRL CATH GRSHNG PICC 4 22 CENTRAL SUPPLY IV2210045 D51/4NS 1000ML 83.66 22 CENTRAL SUPPLY IV2210078 D5NS 1000ML 83.80 22 CENTRAL SUPPLY IV2210086 D5NS 500ML 146.00 22 CENTRAL SUPPLY IV2210144 MANNITOL 40% 500CC 197.00 22 CENTRAL SUPPLY IV2210201 NORMOSOL M/D5W 1000ML 86.04 22 CENTRAL SUPPLY IV2210177 NA CL 0.9% 50ML 84.54 22 CENTRAL SUPPLY IV2210193 NA CL 0.9% 100ML 84.44 22 CENTRAL SUPPLY IV2210037 D5LR 500 ML 146.00 22 CENTRAL SUPPLY IV2210300 D10W 500ML 83.48 22 CENTRAL SUPPLY IV2210060 D51/2NS 500ML 146.00 22 CENTRAL SUPPLY IV2210243 D5W 250ML 83.52 22 CENTRAL SUPPLY IV2210227 D10W 1000ML 84.14 22 CENTRAL SUPPLY IV2210250 D5W 50ML 84.62 22 CENTRAL SUPPLY IV2210276 D5W 100ML 83.48 22 CENTRAL SUPPLY IV2210219 WATER IJ 1000ML 83.98 22 CENTRAL SUPPLY IV2210284 TPN 1000ML 146.00 22 CENTRAL SUPPLY IV2210110 HEPARIN 1000U IJ 230.00 22 CENTRAL SUPPLY IV2210052 D51/2NS 1000ML 83.94 22 CENTRAL SUPPLY IV2210029 D5LR 1000ML 83.50 22 CENTRAL SUPPLY IV2210235 D5W 1000 CC 83.72 22 CENTRAL SUPPLY IV2210268 5% DEXTROSE/WATER 500 ML 83.52 22 CENTRAL SUPPLY IV2210136 LACTATE RINGERS TO 1000CC 83.50 22 CENTRAL SUPPLY IV2210292 LACTATE RINGERS TO 1000CC 83.42 22 CENTRAL SUPPLY IV2210151 NA CL 0.9% 1000CC 83.66 22 CENTRAL SUPPLY IV

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

2210169 NA CL 0.9% 250CC 83.80 22 CENTRAL SUPPLY IV2210185 NA CL 0.9% 500ML 83.52 22 CENTRAL SUPPLY IV8569063 RP TC99M RBC/TAG DX 30MCI 21.00 85 DIETARY6210025 EEG AWAKE AND DROWSY 1183.00 62 EEG6210009 EEG AWAKE AND ASLEEP 1614.00 62 EEG9010257 ED LEVEL 1 420.00 90 EMERGENCY ROOM9010109 ED LEVEL 2 647.00 90 EMERGENCY ROOM9010117 ED LEVEL 3 1078.00 90 EMERGENCY ROOM9010083 ED LEVEL 4 1650.00 90 EMERGENCY ROOM9010091 ED LEVEL 5 1978.00 90 EMERGENCY ROOM9010703 ED CC 1ST 30-74 MN 2382.00 90 EMERGENCY ROOM9010711 ED CC EA ADD 30 MN 791.00 90 EMERGENCY ROOM9010760 ED PROC MINOR 388.00 90 EMERGENCY ROOM9010786 ED PROC MAJOR 932.00 90 EMERGENCY ROOM9011362 DRG SCRN MULTI PPE 76.00 90 EMERGENCY ROOM9011370 URNALYSIS MAN W/O MICRO 25.00 90 EMERGENCY ROOM9011388 PREGNANCY SCRN UR 59.00 90 EMERGENCY ROOM9011396 ALCOHOL (ETHANOL) BREATH 116.00 90 EMERGENCY ROOM9010737 GLUCOSE 25.00 90 EMERGENCY ROOM9011024 VENIPUNCTURE 14.00 90 EMERGENCY ROOM9010935 INJ IVP SNGL/INIT DRG 178.00 90 EMERGENCY ROOM9010950 INJECTION IM/SQ EA 223.00 90 EMERGENCY ROOM9011081 OPHTHALMOLOGY EXAM 91.00 90 EMERGENCY ROOM9010745 CPR 326.00 90 EMERGENCY ROOM9010802 TEMP TRANSCUTANEOUS PACE 514.00 90 EMERGENCY ROOM9010752 CARDIOVERT ELECTIVE EXT 985.00 90 EMERGENCY ROOM9011040 THROMBOLYSIS CORO IV 2067.00 90 EMERGENCY ROOM9010729 EKG 12 LEAD TRACING ONLY 215.00 90 EMERGENCY ROOM9011412 PHLEBOTOMY THERAPEUTIC 516.00 90 EMERGENCY ROOM9011438 SART EXAM 500.00 90 EMERGENCY ROOM9010299 BLOOD TRANSFUSN LT 2 HR 881.00 90 EMERGENCY ROOM9010430 BLOOD TRANSFUSN 2-4 HR 1540.00 90 EMERGENCY ROOM9010448 BLOOD TRANSFUSN 4-6 HR 2421.00 90 EMERGENCY ROOM9010919 BLOOD TRANSFUSN GT 6HR 2978.00 90 EMERGENCY ROOM9011107 AEROSOL TX SUBSQ 133.00 90 EMERGENCY ROOM9011032 ADMIN IMMUN SGL VACC 86.00 90 EMERGENCY ROOM9011289 ADMIN IMMUN EA ADD VACC 90.00 90 EMERGENCY ROOM

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9011057 ARTERIAL PUNCTURE 126.00 90 EMERGENCY ROOM9011164 HYDRATN INFSN INIT 31-60M 506.00 90 EMERGENCY ROOM9011172 HYDRATN INFSN EA ADD HR 354.00 90 EMERGENCY ROOM9011180 INFUSION W/MED 16-60MN 506.00 90 EMERGENCY ROOM9011206 INFSN W/MED EA ADD HR 354.00 90 EMERGENCY ROOM9011198 INFSN W/MED ADD SEQ 16-60 347.00 90 EMERGENCY ROOM9011214 CS SAME MD LT5YR 0-30M 154.00 90 EMERGENCY ROOM9011222 CS SAME MD GT5YR 0-30M 144.00 90 EMERGENCY ROOM9011230 CS SAME MD ADD 15M 74.00 90 EMERGENCY ROOM9011248 CS DIFF MD LT5YR 0-30M 223.00 90 EMERGENCY ROOM9011255 CS DIFF MD GT5YR 0-30M 184.00 90 EMERGENCY ROOM9011263 CS DIFF MD ADD 15M 82.00 90 EMERGENCY ROOM9011271 INJ IVP ADDL SEQ NEW DRG 153.00 90 EMERGENCY ROOM9011420 INFSN W/MED CONCURRENT 301.00 90 EMERGENCY ROOM9011305 CATH SPECIMEN COLL SGL PT 92.00 90 EMERGENCY ROOM9011313 COLL BLD PICC/CNTRL LN 25.00 90 EMERGENCY ROOM9011321 INJ IVP SAME DRG EA >30M 63.00 90 EMERGENCY ROOM9011537 COLL BLD IMP VEN ACCS DEV 321.00 90 EMERGENCY ROOM9011446 INFLUENZA H1N1 VACC ADMIN 24.00 90 EMERGENCY ROOM9011453 ED LEVEL 1 W/PROC 420.00 90 EMERGENCY ROOM9011461 ED LEVEL 2 W/PROC 647.00 90 EMERGENCY ROOM9011479 ED LEVEL 3 W/PROC 1078.00 90 EMERGENCY ROOM9011487 ED LEVEL 4 W/PROC 1650.00 90 EMERGENCY ROOM9011495 ED LEVEL 5 W/PROC 1978.00 90 EMERGENCY ROOM9011529 HYDRATN INFSN INIT 31-60M 506.00 90 EMERGENCY ROOM9011511 INJ IVP SNGL/INIT DRG 178.00 90 EMERGENCY ROOM9011503 ED CC 1ST 30-74 MN W/PROC 2382.00 90 EMERGENCY ROOM9011545 VENI <3YR SCALP VEIN MD 115.00 90 EMERGENCY ROOM9011552 VENI <3YRS AGE MD SKILL 134.00 90 EMERGENCY ROOM9011560 INFUSION W/MED 16-60MN 504.00 90 EMERGENCY ROOM9011578 INJ IVP ADL SQ NEW DRG 151.00 90 EMERGENCY ROOM9011347 TUBERCULN SKIN TEST INTRA 62.00 90 EMERGENCY ROOM8810111 DIALYS EMER ESRD HOSP OP 157.00 88 HEMODIALYSIS8810004 DIALYS HEMO IP 3070.00 88 HEMODIALYSIS8810103 DIALYS CCPD IP 1850.00 88 HEMODIALYSIS8810053 DIALYS CCPD IP 1850.00 88 HEMODIALYSIS1210327 LABOR LEVEL 2 / HR-IP 630.00 12 LABOR AND DELIVERY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1213859 OXYGEN 1063.95 12 LABOR AND DELIVERY1210319 LABOR LEVEL 1 / HR-IP 503.00 12 LABOR AND DELIVERY1210558 DELIVERY VAGINAL LEVEL 2 4335.00 12 LABOR AND DELIVERY1213982 S NSTRL FETAL MONITOR BLT 10.65 12 LABOR AND DELIVERY1210541 DELIVERY VAGINAL LEVEL 1 3793.00 12 LABOR AND DELIVERY1213685 S NSTRL BREAST PUMP KIT 838.15 12 LABOR AND DELIVERY1214253 S NSTRL SITZ BATH 10.33 12 LABOR AND DELIVERY1213834 S NSTRL OXYGEN FACE MASK 67.10 12 LABOR AND DELIVERY1213693 S NSTRL BILI MASK 64.95 12 LABOR AND DELIVERY1214188 S NSTRL BRSTFEED STRT SYS 48.41 12 LABOR AND DELIVERY1214295 S NSTRL DEFIB PADS ADULT 92.29 12 LABOR AND DELIVERY1214311 S NSTRL INNER CANNULA 21.87 12 LABOR AND DELIVERY1214154 S NSTRL KIWI VACUUM 138.00 12 LABOR AND DELIVERY1214329 S NSTRL INNER CANNULA 21.87 12 LABOR AND DELIVERY1213701 S NSTRL NURSING SYS SUPP 99.05 12 LABOR AND DELIVERY1212034 S NSTRL NASAL CANNULA 5.35 12 LABOR AND DELIVERY1213651 S NSTRL BLE PAD & SHELLS 7.45 12 LABOR AND DELIVERY1213552 S NSTRL URINARY BAG INF 20.25 12 LABOR AND DELIVERY1213438 S NSTRL MITYVAC 567.65 12 LABOR AND DELIVERY1213388 S NSTRL URINE DRNG BAG 76.70 12 LABOR AND DELIVERY1214287 S NSTRL DEFIB PEDIATRIC 102.79 12 LABOR AND DELIVERY1214303 S NSTRL INNER CANNULA SZ4 21.87 12 LABOR AND DELIVERY1213198 S STRL SUTURE, REGULAR 4.25 12 LABOR AND DELIVERY1213990 S STRL IV CATHETER 37.30 12 LABOR AND DELIVERY1213867 S STRL EPIDURAL TRAY 281.15 12 LABOR AND DELIVERY1213503 S STRL AMNIHOOK 1.05 12 LABOR AND DELIVERY1213925 S STRL NORMAL SALINE IRRI 256.65 12 LABOR AND DELIVERY1213891 S STRL PAD - GROUNDING 22.35 12 LABOR AND DELIVERY1213180 S STRL SKIN STAPLE 35 198.10 12 LABOR AND DELIVERY1213933 S STRL YANKAUR SUCTION 12.80 12 LABOR AND DELIVERY1210194 S STRL ELECT FETAL SCALP 177.85 12 LABOR AND DELIVERY1213511 S STRL IUPC KIT 377.00 12 LABOR AND DELIVERY1214196 S STRL CERV RIPENING BALN 218.50 12 LABOR AND DELIVERY1213743 S STRL UAC TRAY DISP 713.55 12 LABOR AND DELIVERY1214204 S STRL POSTPARTUM BALLOON 935.00 12 LABOR AND DELIVERY1213578 S STRL UMBILICAL CATHETER 10.65 12 LABOR AND DELIVERY1214147 S STRL SURGICEL 520.00 12 LABOR AND DELIVERY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1213222 S STRL CATH FOLEY TRAY 201.30 12 LABOR AND DELIVERY1213214 S STRL CATH FOLEY 101.20 12 LABOR AND DELIVERY1213206 S STRL SUTURE, PDS 11.70 12 LABOR AND DELIVERY1213008 S STRL ANGIOCATH 23.45 12 LABOR AND DELIVERY1212075 S STRL SPINAL NEEDLE 36.20 12 LABOR AND DELIVERY1212026 S STRL LMA TUBE 63.90 12 LABOR AND DELIVERY1213321 S STRL SUCTION, BOVIE 141.65 12 LABOR AND DELIVERY1214261 S STRL SUTURE POP OFF 25.55 12 LABOR AND DELIVERY1213669 S STRL HULKA CLIPS 685.85 12 LABOR AND DELIVERY1213966 S STRL FILTER PALL/LEUKOC 329.10 12 LABOR AND DELIVERY1213958 S STRL TRANSF PUMP TUBE 43.65 12 LABOR AND DELIVERY1213941 S STRL THERMAL BLANKET 158.70 12 LABOR AND DELIVERY1213917 S STRL AUTO SUTURE 174.65 12 LABOR AND DELIVERY1213909 S STRL PENCIL - BOVIE 17.05 12 LABOR AND DELIVERY1213230 S STRL CATH ROBINSON 94.80 12 LABOR AND DELIVERY1213826 S STRL TRAY PERCERVICAL 3.20 12 LABOR AND DELIVERY1213313 S STRL SUC KIT SNGL 26.65 12 LABOR AND DELIVERY1213487 S STRL AMNIOCENTESIS TRAY 318.45 12 LABOR AND DELIVERY1213412 S STRL BLOOD COIL DUOCOIL 256.65 12 LABOR AND DELIVERY1213396 S STRL VACURETTE 63.90 12 LABOR AND DELIVERY1213883 S STRL SCRATCH PAD BOVIE 3.20 12 LABOR AND DELIVERY1214337 S STRL CATHETER 9.88 12 LABOR AND DELIVERY1210053 CST (CONTRAC STRESS TEST) 654.00 12 LABOR AND DELIVERY1210079 OCT (OXYTOCIN CHLNG TEST) 654.00 12 LABOR AND DELIVERY1210061 NST (NON-STRESS TEST) 386.00 12 LABOR AND DELIVERY1210103 EXTERNAL VERSION 1117.00 12 LABOR AND DELIVERY1214212 INJ BLOOD PATCH 467.00 12 LABOR AND DELIVERY1213529 US OB LTD 1/MORE FETUSES 233.00 12 LABOR AND DELIVERY1214006 US BIO PROFILE W NONSTRES 275.00 12 LABOR AND DELIVERY1211085 INJECTION IM/SQ EA 153.00 12 LABOR AND DELIVERY1211093 INJ IVP SNGL/INIT DRG 122.00 12 LABOR AND DELIVERY1200054 LEVEL 1 NEW PATIENT 415.00 12 LABOR AND DELIVERY1200070 LEVEL 2 NEW PATIENT 530.00 12 LABOR AND DELIVERY1200096 LEVEL 3 NEW PATIENT 557.00 12 LABOR AND DELIVERY1200112 LEVEL 4 NEW PATIENT 738.00 12 LABOR AND DELIVERY1200138 LEVEL 5 NEW PATIENT 965.00 12 LABOR AND DELIVERY1200062 LEVEL 1 EST PATIENT 415.00 12 LABOR AND DELIVERY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1200088 LEVEL 2 EST PATIENT 530.00 12 LABOR AND DELIVERY1200104 LEVEL 3 EST PATIENT 557.00 12 LABOR AND DELIVERY1200120 LEVEL 4 EST PATIENT 738.00 12 LABOR AND DELIVERY1200146 LEVEL 5 EST PATIENT 965.00 12 LABOR AND DELIVERY1214220 OB OBSERVATION / HR-OP 176.00 12 LABOR AND DELIVERY1210350 SURG LVL 1 FIRST 30M 1134.00 12 LABOR AND DELIVERY1210483 SURG LVL 2 FIRST 30M 1701.00 12 LABOR AND DELIVERY1211028 SURG LVL 3 FIRST 30M 2731.00 12 LABOR AND DELIVERY1210368 SURG LVL 1 ADD 15M 450.00 12 LABOR AND DELIVERY1210509 SURG LVL 2 ADD 15M 565.00 12 LABOR AND DELIVERY1210442 SURG LVL 3 ADD 15M 655.00 12 LABOR AND DELIVERY1200195 STND GENRL ANES FIRST 30M 848.00 12 LABOR AND DELIVERY1200203 STND GENRL ANES ADD 15M 420.00 12 LABOR AND DELIVERY1214139 IMP MESH 1172.00 12 LABOR AND DELIVERY1200179 MAC/REG FIRST 30M NONOR 758.00 12 LABOR AND DELIVERY1200187 MAC/REG ADD 15M NONOR 367.00 12 LABOR AND DELIVERY1214055 OTOACOUSTC SCREEN INIT IP 290.00 12 LABOR AND DELIVERY1214170 OTOACOUSTC RESCREEN 164.00 12 LABOR AND DELIVERY1211143 NST MULTI GEST 386.00 12 LABOR AND DELIVERY1211135 CST MULTI GEST 654.00 12 LABOR AND DELIVERY1211150 OCT MULTI GEST 654.00 12 LABOR AND DELIVERY1214063 HYDRATN INFSN INIT 31-60M 348.00 12 LABOR AND DELIVERY1214071 HYDRATN INFSN EA ADD HR 243.00 12 LABOR AND DELIVERY1214089 INFUSION W/MED 16-60MN 348.00 12 LABOR AND DELIVERY1214097 INFSN W/MED EA ADD HR 243.00 12 LABOR AND DELIVERY1214105 INFSN W/MED ADD SEQ 16-60 238.00 12 LABOR AND DELIVERY1214238 SURG LVL 4 FIRST 30M 8057.00 12 LABOR AND DELIVERY1214246 SURG LVL 4 ADD 15M 2120.00 12 LABOR AND DELIVERY1214121 INJ IVP SAME DRG EA >30M 43.00 12 LABOR AND DELIVERY1214162 INSRT BAKRI POSTPARTM BLN 867.00 12 LABOR AND DELIVERY1214279 DELIVERY NON-LDR 4150.00 12 LABOR AND DELIVERY1210038 GLUCOSE 17.00 12 LABOR AND DELIVERY1214030 NA CL 83.00 12 LABOR AND DELIVERY1214048 LACTATE RINGERS TO 1000CC 83.00 12 LABOR AND DELIVERY3012119 VENIPUNCTURE 47.00 30 LABORATORY3010337 BASIC METBLC PNL TOTAL CA 187.00 235.00 30 LABORATORY3014792 BASIC METBLC PNL TOTAL CA 223.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3011996 ELECTROLYTE PNL FLD 155.00 30 LABORATORY3010592 ELECTROLYTE PNL 155.00 192.00 30 LABORATORY3014172 ELECTROLYTE PNL 183.00 30 LABORATORY3010345 COMPR MET PNL 235.00 30 LABORATORY3013984 COMPR MET PNL 281.00 30 LABORATORY3014875 PRENATAL PNL 931.00 30 LABORATORY3014867 PRENATAL PNL 931.00 30 LABORATORY3014883 LIPID PNL 338.00 30 LABORATORY3015054 LIPID PNL 438.00 30 LABORATORY3015302 LIPID PNL 18.85 30 LABORATORY3014974 RENAL FUNCTION PNL 193.00 30 LABORATORY3014982 RENAL FUNCTION PNL 229.00 30 LABORATORY3010956 HEPATIC FUNCTION PNL 182.00 30 LABORATORY3014487 HEPATIC FUNCTION PNL 216.00 30 LABORATORY3014719 AMPHETAMINE SCRN 79.00 30 LABORATORY3014727 BARBITURATES SCRN 79.00 30 LABORATORY3014735 BENZODIAZEPINE SCRN 79.00 30 LABORATORY3014776 CANNABINOID SCRN 79.00 30 LABORATORY3014743 COCAINE SCRN 79.00 30 LABORATORY3014768 OPIATES SCRN 79.00 30 LABORATORY3014750 PCP SCRN 79.00 30 LABORATORY3014784 TRICYCLIC SCRN 79.00 30 LABORATORY3015005 CARBAMAZEPINE TOTAL 321.00 30 LABORATORY3010576 DIGOXIN 294.00 30 LABORATORY3015021 VALPROIC ACID 300.00 30 LABORATORY3013935 GENTAMICIN 432.00 30 LABORATORY3010691 GENTAMICIN PK 364.00 30 LABORATORY3010709 GENTAMICIN TR 364.00 30 LABORATORY3011087 PHENYTOIN TOTAL 294.00 30 LABORATORY3011269 SALICYLATE 155.00 30 LABORATORY3014370 SALICYLATE 197.00 30 LABORATORY3011442 THEOPHYLLINE 316.00 30 LABORATORY3011491 TOBRAMYCIN PK 358.00 30 LABORATORY3011509 TOBRAMYCIN TR 358.00 30 LABORATORY3011699 VANCOMYCIN PK 607.00 30 LABORATORY3011707 VANCOMYCIN TR 607.00 30 LABORATORY3014966 URNALYSIS AUTO W/ MICRO 70.00 85.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3011657 URNALYSIS AUTO W/O MICRO 48.00 30 LABORATORY3014016 URNALYSIS AUTO W/O MICRO 59.00 3.00 30 LABORATORY3011673 MICRO EXAM UR 70.00 30 LABORATORY3010857 PREGNANCY SCRN UR 139.00 30 LABORATORY3014503 PREGNANCY SCRN UR 170.00 30 LABORATORY3010014 ACETAMINOPHEN 449.00 30 LABORATORY3010022 KETONES QL 102.00 30 LABORATORY3010048 ALBUMIN SERUM/PLASMA/BLD 107.00 30 LABORATORY3015542 MICROALBUMIN UR 24HR 148.00 30 LABORATORY3010600 ALCOHOL (ETHANOL) 241.00 30 LABORATORY3013950 ALCOHOL (ETHANOL) 288.00 30 LABORATORY3010063 AMMONIA 321.00 30 LABORATORY3010071 AMYLASE 384.00 501.00 30 LABORATORY3014339 AMYLASE 170.00 30 LABORATORY3010089 AMYLASE FLD 384.00 30 LABORATORY3010105 AMYLASE UR RAN 384.00 30 LABORATORY3010097 AMYLASE UR TIM 384.00 30 LABORATORY3010170 BILIRUBIN TOTAL 112.00 135.00 30 LABORATORY3014396 BILIRUBIN TOTAL 109.00 30 LABORATORY3015450 BILIRUBIN TOTAL 33.16 30 LABORATORY3010188 BILIRUBIN DIRECT 112.00 30 LABORATORY3014354 BILIRUBIN DIRECT 131.00 30 LABORATORY3015039 OCCLT BLD STL QL MULT SPC 70.00 30 LABORATORY3015047 OCCULT BLD GASTRIC QL 70.00 30 LABORATORY3010279 CALCIUM 112.00 142.00 30 LABORATORY3014289 CALCIUM 137.00 30 LABORATORY3011541 CO2 (BICARBONATE) 107.00 135.00 30 LABORATORY3010378 CHLORIDE 102.00 128.00 30 LABORATORY3014271 CHLORIDE 124.00 30 LABORATORY3010394 CHLORIDE UR 24HR 112.00 30 LABORATORY3010386 CHLORIDE UR 112.00 30 LABORATORY3012077 CHLORIDE FLD 107.00 30 LABORATORY3014263 CHOLESTEROL 118.00 30 LABORATORY3010402 CHOLESTEROL 96.00 30 LABORATORY3010477 CK TOTAL 144.00 30 LABORATORY3014255 CK TOTAL 170.00 30 LABORATORY3010410 CK MB FRACTION 257.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3010527 CREATININE 112.00 142.00 30 LABORATORY3014230 CREATININE 137.00 30 LABORATORY3010519 CREATININE UR RAN 112.00 30 LABORATORY3015559 CREATININE UR RAN 130.00 30 LABORATORY3010493 CREATININE UR 24HR 112.00 30 LABORATORY3010501 CREATININE CLEARANCE 209.00 30 LABORATORY3014248 CREATININE CLEARANCE 249.00 30 LABORATORY3011061 PH BLD 187.00 30 LABORATORY3013695 BLD GAS CORD ART 428.00 30 LABORATORY3013703 BLD GAS CORD VEN 428.00 30 LABORATORY3010162 BLD GAS ART 428.00 30 LABORATORY3010782 GLUCOSE FLD 86.00 30 LABORATORY3010774 GLUCOSE CSF 86.00 30 LABORATORY3015252 GLUCOSE 30 LABORATORY3010717 GLUCOSE 86.00 107.00 30 LABORATORY3013919 GLUCOSE 105.00 30 LABORATORY3010808 GLUC PRENAT 50 GM SCRN 107.00 30 LABORATORY3010733 GLUCOSE 1HR PP 102.00 30 LABORATORY3010725 GLUCOSE 2HR PP 117.00 30 LABORATORY3014958 GTT 2HR 1ST 3 SPEC 284.00 30 LABORATORY3015427 GTT 2HR 1ST 3 SPEC 84.62 30 LABORATORY3010766 GTT 3HR 1ST 3 SPEC 284.00 30 LABORATORY3013687 GTT 3HR 1ST 3 SPEC 284.00 30 LABORATORY3015401 GTT 3HR 1ST 3 SPEC 84.62 30 LABORATORY3013927 GTT 3HR 1ST 3 SPEC 351.00 30 LABORATORY3014941 GTT 4HR 1ST 3 SPEC 284.00 30 LABORATORY3015419 GTT ADDED SAMPLE 25.73 30 LABORATORY3010824 GTT ADDED SAMPLE 86.00 30 LABORATORY3010675 GGT 161.00 30 LABORATORY3014594 GGT 190.00 30 LABORATORY3012218 HEMOGLOBIN F (APT) 134.00 30 LABORATORY3013471 HEMOGLOBIN GLYCOSYLTD A1C 214.00 30 LABORATORY3013828 IRON 144.00 30 LABORATORY3014628 LACTIC ACID 235.00 30 LABORATORY3010923 LDH 134.00 30 LABORATORY3014495 LDH 157.00 30 LABORATORY3010915 LDH FLD 134.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3010907 LDH CSF 168.00 30 LABORATORY3015278 LIPASE 133.00 30 LABORATORY3010865 HDL CHOLESTEROL 182.00 30 LABORATORY3014529 HDL CHOLESTEROL 227.00 30 LABORATORY3010964 MAGNESIUM 150.00 30 LABORATORY3014461 MAGNESIUM 177.00 30 LABORATORY3011079 BODY FLUID PH NOS 80.00 30 LABORATORY3010055 ALK PHOSPHATASE 112.00 30 LABORATORY3011095 PHOSPHORUS (PO4) 107.00 30 LABORATORY3011137 POTASSIUM 102.00 128.00 30 LABORATORY3014446 POTASSIUM 124.00 30 LABORATORY3012069 POTASSIUM FLD 102.00 30 LABORATORY3011152 POTASSIUM UR 24 HR 96.00 30 LABORATORY3011145 POTASSIUM UR RAN 96.00 30 LABORATORY3011525 PROTEIN TOTAL FLD 80.00 30 LABORATORY3011517 PROTEIN TOTAL CSF 80.00 30 LABORATORY3011566 PROTEIN TOTAL BLOOD 80.00 30 LABORATORY3014586 PROTEIN TOTAL BLOOD 98.00 30 LABORATORY3011558 PROTEIN UR QN 24 HR 80.00 30 LABORATORY3011350 SODIUM 107.00 135.00 30 LABORATORY3012051 SODIUM FLD 107.00 30 LABORATORY3011368 SODIUM UR 24HR 107.00 30 LABORATORY3011376 SODIUM UR RAN 107.00 30 LABORATORY3011384 SPEC GRAVITY FLD 54.00 30 LABORATORY3015294 TESTOSTERONE TOTAL 108.99 30 LABORATORY3012275 FREE T4 198.00 30 LABORATORY3014040 FREE T4 236.00 30 LABORATORY3012200 TSH 375.00 30 LABORATORY3014057 TSH 445.00 30 LABORATORY3011319 AST (SGOT) 112.00 30 LABORATORY3011327 ALT (SGPT) 118.00 30 LABORATORY3011590 TRIGLYCERIDE 128.00 30 LABORATORY3015013 TROPONIN I QN 219.00 30 LABORATORY3010261 BUN 86.00 107.00 30 LABORATORY3014297 BUN 105.00 30 LABORATORY3011624 URIC ACID 102.00 30 LABORATORY3014362 URIC ACID 118.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3012283 BETA HCG QN 332.00 30 LABORATORY3014537 BETA HCG QN 410.00 30 LABORATORY3010840 PREGNANCY TEST SER QL 166.00 206.00 30 LABORATORY3014511 PREGNANCY TEST SER QL 196.00 30 LABORATORY3013786 MISC CHEM TEST 72.00 30 LABORATORY3010998 MISC CHEM TEST 30 LABORATORY3014305 BLEEDING TIME TEST 118.00 30 LABORATORY3010212 BLEEDING TIME TEST 769.00 30 LABORATORY3012010 BLD SMR EXAM W MAN DIFF 75.00 93.00 30 LABORATORY3014693 BLD SMR EXAM WO MAN DIFF 74.00 30 LABORATORY3012093 HEMATOCRIT SPUN 54.00 30 LABORATORY3015161 HEMATOCRIT 54.00 64.00 30 LABORATORY3012101 HEMOGLOBIN 54.00 30 LABORATORY3015153 HEMOGLOBIN 54.00 64.00 30 LABORATORY3010311 CBC AUTO W AUTO DIFF WBC 171.00 214.00 30 LABORATORY3013992 CBC AUTO W AUTO DIFF WBC 203.00 30 LABORATORY3010220 CBC AUTO 144.00 178.00 30 LABORATORY3013968 CBC AUTO 170.00 30 LABORATORY3011236 RETICULOCYTE MAN 96.00 30 LABORATORY3014412 RETICULOCYTE MAN 111.00 30 LABORATORY3015237 RETICULOCYTE AUTO 91.00 30 LABORATORY3014933 WBC CNT AUTO 59.00 30 LABORATORY3010428 CLOT RETRACTION 80.00 30 LABORATORY3010642 FIBRIN DEGRAD PROD 155.00 30 LABORATORY3015138 D DIMER QN 225.00 30 LABORATORY3010659 FIBRINOGEN 187.00 30 LABORATORY3012176 FETAL RBC SMR (K B) 171.00 30 LABORATORY3013489 FETAL RBC SCRN ROSETTE 144.00 30 LABORATORY3015203 PLT AGGREGATION EA AGENT 508.00 30 LABORATORY3011103 PLT CNT AUTO 102.00 121.00 30 LABORATORY3014453 PLT CNT AUTO 118.00 30 LABORATORY3011178 PROTHROMBIN TIME 86.00 107.00 30 LABORATORY3013976 PROTHROMBIN TIME 105.00 30 LABORATORY3011277 SEDIMENTATION RATE MAN 80.00 100.00 30 LABORATORY3014149 SEDIMENTATION RATE MAN 92.00 30 LABORATORY3015245 SEDIMENTATION RATE AUTO 59.00 30 LABORATORY3011186 PTT PLAS OR WB 134.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3014438 PTT PLAS OR WB 157.00 30 LABORATORY3014685 PTT SUBSTITUTION EA 144.00 30 LABORATORY3011574 TRNSFUS RXN INVESTIGATE 257.00 30 LABORATORY3010436 COLD AGGLUTININ TTR 177.00 30 LABORATORY3010873 HETEROPHILE AB SCRN 112.00 142.00 30 LABORATORY3014552 HETEROPHILE AB SCRN 137.00 30 LABORATORY3014818 BACTERIAL AG EA AG 225.00 30 LABORATORY3012168 RPR NON-TREPNML AB QL 96.00 30 LABORATORY3014388 RPR NON-TREPNML AB QL 111.00 30 LABORATORY3015260 HIV 1/HIV 2 AB 305.00 30 LABORATORY3012259 RUBELLA AB 321.00 30 LABORATORY3010139 AB SCRN 257.00 30 LABORATORY3014321 AB SCRN 275.00 30 LABORATORY3015195 AB ELUTION 314.00 30 LABORATORY3010121 AB ID 455.00 30 LABORATORY3010451 COOMBS DIRECT IG 118.00 30 LABORATORY3010006 ABO TYP 64.00 30 LABORATORY3014347 ABO TYP 79.00 30 LABORATORY3011244 RH TYP 64.00 30 LABORATORY3014404 RH TYP 79.00 30 LABORATORY3010154 AG SCRN PER UNIT PT SPEC 209.00 30 LABORATORY3011939 COMPATIBILITY TEST IS 369.00 30 LABORATORY3015385 COMPATIBILITY TEST IS 44.00 30 LABORATORY3011863 COMPATIBILITY TEST AHG 387.00 30 LABORATORY3010634 THAWING PROD PER UNIT 166.00 30 LABORATORY3014990 MISC TS PROC 284.00 30 LABORATORY3011228 CULT SPUTUM/BRONCH WASH 193.00 30 LABORATORY3014065 CULT THROAT 68.00 30 LABORATORY3011467 CULT THROAT 193.00 30 LABORATORY3010246 CULT BODY FLUID 193.00 30 LABORATORY3010303 CULT CATHETER TIP 193.00 30 LABORATORY3010550 CULT CSF 193.00 30 LABORATORY3010584 CULT EAR 193.00 30 LABORATORY3010618 CULT EYE 193.00 30 LABORATORY3010980 CULT MISC 193.00 30 LABORATORY3014214 CULT MISC 68.00 30 LABORATORY3011681 CULT UROGENITAL 193.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3014206 CULT UROGENITAL 68.00 30 LABORATORY3014602 CULT WOUND 68.00 30 LABORATORY3011723 CULT WOUND 193.00 30 LABORATORY3014610 CULT BACT ANAEROBIC 74.00 30 LABORATORY3010113 CULT BACT ANAEROBIC 209.00 30 LABORATORY3014891 CULT BACT AEROBIC ID 177.00 30 LABORATORY3014917 CULT BACT AEROBIC ID 177.00 30 LABORATORY3014081 CULT BETA STREP A ONLY 53.00 30 LABORATORY3013638 CULT BETA STREP A ONLY 144.00 30 LABORATORY3015351 CULT GRP B STREP SCRN 41.47 30 LABORATORY3015393 CULT GRP B STREP SCRN 41.47 30 LABORATORY3013620 CULT GRP B STREP SCRN 144.00 30 LABORATORY3010683 CULT GC SCRN 144.00 30 LABORATORY3014222 CULT GC SCRN 53.00 30 LABORATORY3014032 CULT UR ID EACH ISOLATE 64.00 30 LABORATORY3011640 CULT UR ID EACH ISOLATE 182.00 30 LABORATORY3015435 CULT FUNG SKIN HAIR NAIL 50.72 30 LABORATORY3015468 MACRO EXAM PARASITE 19.30 30 LABORATORY3012044 SUSCEPT MIC PER PLATE 193.00 30 LABORATORY3015369 SUSCEPT MIC PER PLATE 40.00 30 LABORATORY3010816 SMR GRAM STAIN 96.00 30 LABORATORY3014545 SMR GRAM STAIN 117.00 30 LABORATORY3010626 STL FOR WBC'S 96.00 30 LABORATORY3010972 SMR MALARIA 191.00 30 LABORATORY3010881 INDIA INK PREP CSF 96.00 30 LABORATORY3011715 SMR WET MOUNT 96.00 30 LABORATORY3015443 KOH PREP SKIN HAIR NAIL 28.07 30 LABORATORY3010899 KOH PREP SKIN HAIR NAIL 96.00 30 LABORATORY3011483 CULT VIRUS TISS CULT CPE 578.00 30 LABORATORY3015062 ADENOVIRUS DFA 268.00 30 LABORATORY3015088 INFLUENZA B DFA 268.00 30 LABORATORY3015070 INFLUENZA A DFA 268.00 30 LABORATORY3015096 PARAINFLUENZA DFA 268.00 30 LABORATORY3012127 RSV DFA 268.00 327.00 30 LABORATORY3015104 INFECT AGENT POLYVAL DFA 268.00 30 LABORATORY3013646 C DIFFICILE TOXIN EIA 268.00 30 LABORATORY3012192 HBs AG 230.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3015229 INFLUENZA AG A OR B EACH 268.00 30 LABORATORY3015211 RSV AG EIA 268.00 30 LABORATORY3011194 STREP GRP A AG EIA 268.00 30 LABORATORY3014024 STREP GRP A AG EIA 268.00 30 LABORATORY3015377 AG DETECT EIA MULT STEP 45.75 30 LABORATORY3015476 CHLAMYDIA TRACH DIR PRB 432.00 30 LABORATORY3013877 CHLAMYDIA TRACH DIR PRB 444.00 30 LABORATORY3015484 GC DIR PRB 432.00 30 LABORATORY3013885 GC DIR PRB 444.00 30 LABORATORY3010667 CYTP EVL FNA 1ST EVL EA 272.00 30 LABORATORY3013711 CELL CNT FLD W/O DIFF 107.00 30 LABORATORY3010568 CELL CNT FLD W/ DIFF 123.00 30 LABORATORY3011426 CELL CNT FLD W/ DIFF 123.00 30 LABORATORY3011301 CELL CNT FLD W/ DIFF 123.00 30 LABORATORY3010543 CRYSTAL ID TISS/FLD NO UR 216.00 30 LABORATORY3015500 EOSINOPHILS SMR NASAL 30.57 30 LABORATORY3010238 CULT BLD BACTERIA 230.00 30 LABORATORY3014073 CULT BLD BACTERIA 275.00 30 LABORATORY3014198 CULT STL SALM & SHIG 74.00 30 LABORATORY3011418 CULT STL SALM & SHIG 209.00 30 LABORATORY3011392 SPECIFIC GRAVITY UR 59.00 30 LABORATORY3015146 BLD CNT RBC AUTO 64.00 85.00 30 LABORATORY3015492 C-REACTIVE PROTEIN HS 85.75 30 LABORATORY3015187 B-TYP NATRIURETIC PEPTIDE 754.00 30 LABORATORY3015112 MAN CELL CT EA 96.00 30 LABORATORY3015120 AUTO DIFF WBC COUNT 144.00 30 LABORATORY3015179 CYTOLOGY SEL CELL ENHANCE 272.00 30 LABORATORY3015526 CANDIDA DNA DIR PROBE 132.63 30 LABORATORY3015534 GARDNER VAG DNA DIR PROBE 132.63 30 LABORATORY3015518 TRICHOMONAS VAG DRCT DNA 132.63 30 LABORATORY3015567 LEVETIRACETAM 32.62 30 LABORATORY3010147 BLOOD TYPE ANTGN DONOR EA 191.00 30 LABORATORY3015336 PAMG-1 C/V QUAL 271.92 30 LABORATORY3015344 B/P-PERTUSSIS DNA QUL PCR 148.17 30 LABORATORY3015310 ASSAY OF LIPOPROTEIN(A) 18.82 30 LABORATORY3015328 LIPOPROTEIN BLD BY NMR 44.40 30 LABORATORY3015286 INFLUENZA DNA AMP PROBE 298.00 30 LABORATORY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3210176 MISC TS PROC 265.00 32 LABORATORY BLOOD3210507 MISC TS PROC 235.00 32 LABORATORY BLOOD3210465 WB PS 229.00 32 LABORATORY BLOOD3210051 CRYO PS 185.00 32 LABORATORY BLOOD3210010 CRYO PS 185.00 32 LABORATORY BLOOD3210028 CRYO PS 185.00 32 LABORATORY BLOOD3210044 CRYO PS 185.00 32 LABORATORY BLOOD3210069 CRYO PS 185.00 32 LABORATORY BLOOD3210077 CRYO PS 185.00 32 LABORATORY BLOOD3210085 CRYO PS 185.00 32 LABORATORY BLOOD3210093 CRYO PS 185.00 32 LABORATORY BLOOD3210101 CRYO PS 185.00 32 LABORATORY BLOOD3210036 CRYO PS 185.00 32 LABORATORY BLOOD3210432 RBC L/D PS 275.00 32 LABORATORY BLOOD3210440 RBC L/D PS 275.00 32 LABORATORY BLOOD3210457 RBC L/D PS 275.00 32 LABORATORY BLOOD3210317 RBC L/D PS 263.00 32 LABORATORY BLOOD3210333 RBC L/D PS 200.00 32 LABORATORY BLOOD3210119 FFP PS 134.00 32 LABORATORY BLOOD3210481 FFP PS 628.00 32 LABORATORY BLOOD3210127 FFP PS 134.00 32 LABORATORY BLOOD3210499 FFP PS 210.00 32 LABORATORY BLOOD3210135 FFP PS 134.00 32 LABORATORY BLOOD3210143 FFP PS 134.00 32 LABORATORY BLOOD3210275 PLTC PS 134.00 32 LABORATORY BLOOD3210192 PLTC PS 134.00 32 LABORATORY BLOOD3210200 PLTC PS 134.00 32 LABORATORY BLOOD3210218 PLTC PS 134.00 32 LABORATORY BLOOD3210226 PLTC PS 134.00 32 LABORATORY BLOOD3210234 PLTC PS 134.00 32 LABORATORY BLOOD3210242 PLTC PS 134.00 32 LABORATORY BLOOD3210267 PLTC PS 134.00 32 LABORATORY BLOOD3210283 PLTC PS 134.00 32 LABORATORY BLOOD3210259 PLTC PS 134.00 32 LABORATORY BLOOD3210358 RBC PS 200.00 32 LABORATORY BLOOD3210416 RBC PS 275.00 32 LABORATORY BLOOD3210408 RBC PS 200.00 32 LABORATORY BLOOD

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3210390 RBC PS 200.00 32 LABORATORY BLOOD3210382 RBC PS 200.00 32 LABORATORY BLOOD3210366 RBC PS 200.00 32 LABORATORY BLOOD3210341 RBC PS 200.00 32 LABORATORY BLOOD3210325 RBC PS 200.00 32 LABORATORY BLOOD3210374 RBC PS 200.00 32 LABORATORY BLOOD3210473 FFP SD PS 238.00 32 LABORATORY BLOOD3210184 PHER PS 1191.00 32 LABORATORY BLOOD3210309 RHO D MINI 50MCG IJ 61.00 32 LABORATORY BLOOD3210291 RHO D FULL 300MCG IJ 152.00 32 LABORATORY BLOOD3310018 EKG 12 LEAD TRACING 301.00 33 LABORATORY EKG3410396 CALC ANALYSIS CHEM QN 112.00 34 LABORATORY PATHOLOGY3410677 IRON 88.00 34 LABORATORY PATHOLOGY3410131 CYTOLOGY FLD 589.00 34 LABORATORY PATHOLOGY3410107 CYTOPATH SIMPLE FILTER 79.00 34 LABORATORY PATHOLOGY3410040 CYTOLOGY CONCENTRATION 380.00 34 LABORATORY PATHOLOGY3410081 CYTOLOGY OTHER SOURCE 321.00 34 LABORATORY PATHOLOGY3410123 CYTOLOGY PREP & INTERP 428.00 34 LABORATORY PATHOLOGY3410099 CYTOLOGY EXTENDED STUDY 72.00 34 LABORATORY PATHOLOGY3410206 CYTP EVL FNA 1ST EVL EA 272.00 34 LABORATORY PATHOLOGY3410214 CYTP EVL FNA 1ST EVL EA 272.00 34 LABORATORY PATHOLOGY3410198 FNA INTERP & RPT 272.00 34 LABORATORY PATHOLOGY3410172 DNA CL CYCLE 266.00 34 LABORATORY PATHOLOGY3410784 DNA CL CYCLE 84.21 34 LABORATORY PATHOLOGY3410552 DNA CL CYCLE 266.00 34 LABORATORY PATHOLOGY3410834 DNA CL CYCLE 84.21 34 LABORATORY PATHOLOGY3410628 CHRMOSOM CNT/KARY 2683.00 34 LABORATORY PATHOLOGY3410719 CHRMOSOM CNT/KARY 2683.00 34 LABORATORY PATHOLOGY3410610 CHRMOSOM CNT/KARY 2683.00 34 LABORATORY PATHOLOGY3410602 CHRMOSOM CNT/KARY 2683.00 34 LABORATORY PATHOLOGY3410636 CHRMOSOM CNT/KARY 1489.00 34 LABORATORY PATHOLOGY3410594 CHRMOSOM CNT/KARY 1489.00 34 LABORATORY PATHOLOGY3410644 CHRMOSOM CNT/KARY 1489.00 34 LABORATORY PATHOLOGY3410305 SURG PATH LVL I 338.00 34 LABORATORY PATHOLOGY3410255 SURG PATH LVL II 730.00 34 LABORATORY PATHOLOGY3410263 SURG PATH LVL III 808.00 34 LABORATORY PATHOLOGY3410271 SURG PATH LVL IV 1091.00 34 LABORATORY PATHOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3410297 SURG PATH LVL V 1787.00 34 LABORATORY PATHOLOGY3410289 SURG PATH LVL V 1787.00 34 LABORATORY PATHOLOGY3410362 SPEC STAIN GRP I MICR I/R 132.00 34 LABORATORY PATHOLOGY3410388 SPEC STAIN GRP II INTRP/R 140.00 34 LABORATORY PATHOLOGY3410313 SPEC STAIN GRP II INTRP/R 140.00 34 LABORATORY PATHOLOGY3410321 HISTO STAIN FRZN SECT I/R 153.00 34 LABORATORY PATHOLOGY3410164 SPC STN GRP II ENZYM I&R 396.00 34 LABORATORY PATHOLOGY3410057 OUTSD SLIDE CONSULT PREP 338.00 34 LABORATORY PATHOLOGY3410404 PATH CONSULT INTRAOP 149.00 34 LABORATORY PATHOLOGY3410248 PATH FRZN SECTION 1 BLK 371.00 34 LABORATORY PATHOLOGY3410230 PATH FRZN SECTION ADD 171.00 34 LABORATORY PATHOLOGY3410354 IMMUNOHISTOCHEMISTRY 288.00 34 LABORATORY PATHOLOGY3410776 IMMUNOHISTOCHEMISTRY 84.17 34 LABORATORY PATHOLOGY3410842 IMMUNOHISTOCHEMISTRY 116.95 34 LABORATORY PATHOLOGY3410826 IMMUNOHISTOCHEMISTRY 84.17 34 LABORATORY PATHOLOGY3410818 IMMUNOHISTOCHEMISTRY 84.17 34 LABORATORY PATHOLOGY3410792 IMMUNOHISTOCHEMISTRY 116.95 34 LABORATORY PATHOLOGY3410768 IMMUNOHISTOCHEMISTRY 84.17 34 LABORATORY PATHOLOGY3410735 IMMUNOHISTOCHEMISTRY 219.00 34 LABORATORY PATHOLOGY3410727 IMMUNOHISTOCHEMISTRY 98.00 34 LABORATORY PATHOLOGY3410347 IMMUNOFL STDY DRCT EA ANT 380.00 34 LABORATORY PATHOLOGY3410339 IMMUNOFL STUDY INDIRECT 618.00 34 LABORATORY PATHOLOGY3410024 ANALYSIS SKELETAL MUSCLE 383.00 34 LABORATORY PATHOLOGY3410016 ANALYSIS TUMOR 32.00 34 LABORATORY PATHOLOGY3410370 SURG PATH UNLISTED 34 LABORATORY PATHOLOGY3410149 DECALCIFICATION 149.00 34 LABORATORY PATHOLOGY3410800 IN SITU HYBRIDIZ EA PROBE 330.00 34 LABORATORY PATHOLOGY3410859 IN SITU HYBRIDIZ EA PROBE 330.00 34 LABORATORY PATHOLOGY3410743 INTRAOP CYTOPATH CON INIT 643.00 34 LABORATORY PATHOLOGY3410750 INTRAOP CYTOPATH CON ADDL 392.00 34 LABORATORY PATHOLOGY3114378 HEPATITIS PNL ACUTE 1014.00 31 LABORATORY REFERRALS3112513 HEPATITIS PNL ACUTE 1014.00 31 LABORATORY REFERRALS3112497 DRG SCRN QL CHROM EA 263.00 31 LABORATORY REFERRALS3114162 DRG SCRN QL CHROM EA 130.00 31 LABORATORY REFERRALS3112760 DRG CONF 58.00 31 LABORATORY REFERRALS3112646 AMIKACIN 30.00 31 LABORATORY REFERRALS3114071 BENZODIAZEPINES 68.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3112844 CARBAMAZEPINE TOTAL 39.00 31 LABORATORY REFERRALS3113040 CYCLOSPORINE 46.00 31 LABORATORY REFERRALS3113065 DESIPRAMINE 18.25 31 LABORATORY REFERRALS3114055 VALPROIC ACID 10.50 31 LABORATORY REFERRALS3113073 DOXEPIN 22.00 31 LABORATORY REFERRALS3114295 IMIPRAMINE 31.00 31 LABORATORY REFERRALS3113511 LITHIUM 12.00 31 LABORATORY REFERRALS3113594 NORTRIPTYLINE 30.00 31 LABORATORY REFERRALS3113669 PHENOBARBITAL 25.00 31 LABORATORY REFERRALS3116118 PHENYTOIN FREE 57.69 31 LABORATORY REFERRALS3113677 PRIMIDONE 26.00 31 LABORATORY REFERRALS3113685 PROCAINAMIDE 27.00 31 LABORATORY REFERRALS3115755 QUINIDINE 312.00 31 LABORATORY REFERRALS3113768 QUINIDINE 27.00 31 LABORATORY REFERRALS3114121 AMIODARONE 47.00 31 LABORATORY REFERRALS3114618 MICROALBUMIN UR 24HR 125.00 31 LABORATORY REFERRALS3114600 MICROALBUMIN UR RAN 125.00 31 LABORATORY REFERRALS3113602 ALPHA 1 ANTITRYPSIN 18.00 31 LABORATORY REFERRALS3112430 ALPHA 1 ANTITRYP PHENO 38.00 31 LABORATORY REFERRALS3114451 AFP TUMOR MARKER 359.00 31 LABORATORY REFERRALS3112638 AFP TUMOR MARKER 11.00 31 LABORATORY REFERRALS3113362 AMINO ACIDS SGL QN 33.00 31 LABORATORY REFERRALS3114006 DELTA ALA 49.00 31 LABORATORY REFERRALS3112802 BETA2 MICROGLOBULIN 26.00 31 LABORATORY REFERRALS3115714 CALCIUM IONIZED 296.00 31 LABORATORY REFERRALS3112836 CALCIUM IONIZED 20.00 31 LABORATORY REFERRALS3113818 CALC ANALYSIS INFRARED 25.00 31 LABORATORY REFERRALS3110160 CARBOXYHEMOGLOBIN QN 7.00 31 LABORATORY REFERRALS3114485 CEA 411.00 31 LABORATORY REFERRALS3112885 CEA 9.75 31 LABORATORY REFERRALS3112778 CAROTENE 15.00 31 LABORATORY REFERRALS3112869 CATECHOL FRAC PLAS 27.50 31 LABORATORY REFERRALS3112877 CATECHOL FRAC UR 45.00 31 LABORATORY REFERRALS3115722 CERULOPLASMIN 234.00 31 LABORATORY REFERRALS3112901 CERULOPLASMIN 9.75 31 LABORATORY REFERRALS3112927 CHOLINESTERASE SER 25.00 31 LABORATORY REFERRALS3112919 CHOLINESTERASE RBC 32.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3115391 COPPER 76.20 31 LABORATORY REFERRALS3112976 COPPER 22.00 31 LABORATORY REFERRALS3114493 CORTISOL TOTAL 354.00 31 LABORATORY REFERRALS3112984 CORTISOL TOTAL 13.00 31 LABORATORY REFERRALS3114501 CORTISOL (AM DRAW) 354.00 31 LABORATORY REFERRALS3114519 CORTISOL (PM DRAW) 354.00 31 LABORATORY REFERRALS3115730 CRYOGLOB QL OR SEMI QL 28.00 31 LABORATORY REFERRALS3113008 CRYOGLOB QL OR SEMI QL 10.00 31 LABORATORY REFERRALS3114469 VITAMIN B12 322.00 31 LABORATORY REFERRALS3113974 VITAMIN B12 5.70 31 LABORATORY REFERRALS3113099 ERYTHROPOIETIN 22.00 31 LABORATORY REFERRALS3114709 ESTRADIOL (E2) 603.00 31 LABORATORY REFERRALS3113107 ESTRADIOL (E2) 24.00 31 LABORATORY REFERRALS3113115 FAT STL QL 20.00 31 LABORATORY REFERRALS3114527 FERRITIN 291.00 31 LABORATORY REFERRALS3113123 FERRITIN 8.25 31 LABORATORY REFERRALS3114303 FETAL FIBRONECTIN 1388.00 31 LABORATORY REFERRALS3114535 FOLATE 317.00 31 LABORATORY REFERRALS3113149 FOLATE 9.00 31 LABORATORY REFERRALS3113131 FOLATE RBC 26.00 31 LABORATORY REFERRALS3114667 NB GENETIC SCR GALACT 15.95 31 LABORATORY REFERRALS3113404 IGA 8.00 31 LABORATORY REFERRALS3115920 IGA 203.00 31 LABORATORY REFERRALS3115938 IGG 203.00 31 LABORATORY REFERRALS3113412 IGG 9.00 31 LABORATORY REFERRALS3115946 IGM 203.00 31 LABORATORY REFERRALS3113420 IGM 8.00 31 LABORATORY REFERRALS3116597 IGE 31 LABORATORY REFERRALS3113396 IGE 9.00 31 LABORATORY REFERRALS3113164 GASTRIN 20.00 31 LABORATORY REFERRALS3113180 G6PD QN 22.00 31 LABORATORY REFERRALS3114543 FSH 400.00 31 LABORATORY REFERRALS3114113 FSH 14.00 31 LABORATORY REFERRALS3114550 LH 400.00 31 LABORATORY REFERRALS3113495 LH 34.00 31 LABORATORY REFERRALS3115748 HAPTOGLOBIN QN 270.00 31 LABORATORY REFERRALS3113206 HAPTOGLOBIN QN 10.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3114147 HEAVY METAL SCRN UR 65.00 31 LABORATORY REFERRALS3113339 HGB ELECTRO 18.00 31 LABORATORY REFERRALS3114576 HEMOGLOBIN GLYCOSYLTD A1C 208.00 31 LABORATORY REFERRALS3113370 5 HIAA UR 32.00 31 LABORATORY REFERRALS3100302 17 OH PROGESTRONE 15.95 31 LABORATORY REFERRALS3116613 IMMUNOASSAY NOT SPEC 65.00 31 LABORATORY REFERRALS3113446 IRON 27.00 31 LABORATORY REFERRALS3113883 IRON BINDING CAPACITY 10.00 31 LABORATORY REFERRALS3113453 KETOGENIC STEROIDS FX 24.00 31 LABORATORY REFERRALS3113461 LDH ISOENZYMES 14.00 31 LABORATORY REFERRALS3113479 LEAD BLD 12.00 31 LABORATORY REFERRALS3112083 L/S RATIO 43.00 31 LABORATORY REFERRALS3114766 LIPASE 151.00 31 LABORATORY REFERRALS3113503 LIPASE 8.00 31 LABORATORY REFERRALS3114030 METANEPHRINES UR 38.00 31 LABORATORY REFERRALS3113578 MYOGLOBIN 35.00 31 LABORATORY REFERRALS3116472 MYOGLOBIN 75.44 31 LABORATORY REFERRALS3113586 MYOGLOBIN UR 28.00 31 LABORATORY REFERRALS3116670 PROTEIN NEPHELOMET 5.00 31 LABORATORY REFERRALS3116662 PROTEIN NEPHELOMET 5.00 31 LABORATORY REFERRALS3116076 MOL DX ENZ DIG EA ENZ TX 88.00 31 LABORATORY REFERRALS3116084 MOL DX NUC ACID PRB 14.00 31 LABORATORY REFERRALS3115904 MOL DX NUC ACID PRB 9.37 31 LABORATORY REFERRALS3116100 MOL DX INTERP & RPT 14.00 31 LABORATORY REFERRALS3113628 OLIGOCLONAL BANDS CSF 24.00 31 LABORATORY REFERRALS3113610 OSMOLALITY SER 12.00 31 LABORATORY REFERRALS3113636 OSMOLALITY UR 12.00 31 LABORATORY REFERRALS3113743 PTH C TERMINAL 19.00 31 LABORATORY REFERRALS3115912 PTH INTACT 889.00 31 LABORATORY REFERRALS3114642 PHENYLALANINE BLOOD 15.40 31 LABORATORY REFERRALS3114188 ACID PHOS PROSTATIC 14.00 31 LABORATORY REFERRALS3112620 ALK PHOS ISOENZYMES 17.00 31 LABORATORY REFERRALS3114220 PORPHYRINS UR QN&FX 55.00 31 LABORATORY REFERRALS3116589 PREALBUMIN 85.20 31 LABORATORY REFERRALS3113693 PROGESTERONE 19.00 31 LABORATORY REFERRALS3114717 PROLACTIN 416.00 31 LABORATORY REFERRALS3113701 PROLACTIN 23.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3114568 PSA TOTAL 395.00 31 LABORATORY REFERRALS3113719 PSA TOTAL DIAG 13.30 31 LABORATORY REFERRALS3116399 PSA TOTAL 107.40 31 LABORATORY REFERRALS3115458 PSA FREE 6.89 31 LABORATORY REFERRALS3115698 PSA FREE 126.00 31 LABORATORY REFERRALS3116654 PROTEIN TOTAL BLOOD 2.00 31 LABORATORY REFERRALS3114105 PROTEIN ELECTRO CSF 39.00 31 LABORATORY REFERRALS3113388 PROTEIN ELECTRO SER 10.25 31 LABORATORY REFERRALS3116647 PROTEIN ELECTRO SER 10.25 31 LABORATORY REFERRALS3114170 PROTEIN ELECTRO UR 64.00 31 LABORATORY REFERRALS3112554 RECEPT ASSAY ESTROGEN 93.00 31 LABORATORY REFERRALS3112612 ACETYLCHOLINE RECEPT AB 45.00 31 LABORATORY REFERRALS3113842 TESTOSTERONE FREE 61.00 31 LABORATORY REFERRALS3113859 TESTOSTERONE TOTAL 16.00 31 LABORATORY REFERRALS3114725 TESTOSTERONE TOTAL 556.00 31 LABORATORY REFERRALS3115466 THYROXINE (T4) 146.00 31 LABORATORY REFERRALS3113834 FREE T4 9.00 31 LABORATORY REFERRALS3114634 TSH 15.95 31 LABORATORY REFERRALS3113867 THYR STIM IG 34.00 31 LABORATORY REFERRALS3115771 TRANSFERRIN 276.00 31 LABORATORY REFERRALS3113917 TRANSFERRIN 16.00 31 LABORATORY REFERRALS3115763 T3 TOTAL 307.00 31 LABORATORY REFERRALS3113826 T3 TOTAL 12.00 31 LABORATORY REFERRALS3115805 T3 FREE 69.00 31 LABORATORY REFERRALS3113925 VMA UR 24HR 26.00 31 LABORATORY REFERRALS3113982 ZINC 23.00 31 LABORATORY REFERRALS3113214 BETA HCG QN 31.00 31 LABORATORY REFERRALS3116332 BETA HCG QN 87.92 31 LABORATORY REFERRALS3111135 MISC CHEM TEST 31 LABORATORY REFERRALS3100294 FCTR II 78.00 31 LABORATORY REFERRALS3100104 FCTR V 49.00 31 LABORATORY REFERRALS3100112 FCTR VII 59.00 31 LABORATORY REFERRALS3100120 FCTR VIII 45.00 31 LABORATORY REFERRALS3100278 FCTR VIII VW AG 59.00 31 LABORATORY REFERRALS3100286 FCTR VIII VW MULTIMER 69.00 31 LABORATORY REFERRALS3100138 FCTR IX 67.50 31 LABORATORY REFERRALS3100146 FCTR X 59.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3100153 FCTR XI 49.00 31 LABORATORY REFERRALS3100161 FCTR XII 49.00 31 LABORATORY REFERRALS3100179 FCTR XIII 40.00 31 LABORATORY REFERRALS3112026 AT3 ACTIVITY 255.00 31 LABORATORY REFERRALS3100013 AT3 AG IMMUNOLOGIC 26.00 31 LABORATORY REFERRALS3112034 AT3 AG IMMUNOLOGIC 44.00 31 LABORATORY REFERRALS3113727 PROTEIN C AG 43.00 31 LABORATORY REFERRALS3100237 PROTEIN C AG 35.00 31 LABORATORY REFERRALS3111176 PROTEIN C ACTIVITY 296.00 31 LABORATORY REFERRALS3111168 PROTEIN S AG TOTAL 250.00 31 LABORATORY REFERRALS3100245 PROTEIN S AG TOTAL 35.00 31 LABORATORY REFERRALS3100203 FCTR INHIBITOR TEST 117.00 31 LABORATORY REFERRALS3100195 FCTR INHIBITOR TEST 110.00 31 LABORATORY REFERRALS3100088 EUGLOBULIN LYSIS 41.40 31 LABORATORY REFERRALS3110392 D DIMER SEMI QN/QL 156.00 31 LABORATORY REFERRALS3114774 D DIMER QN 218.00 31 LABORATORY REFERRALS3100187 FIBRINOGEN QN 15.00 31 LABORATORY REFERRALS3100005 ALPHA 2 ANTIPLASMIN 50.50 31 LABORATORY REFERRALS3115425 FETAL RBC SMR (K B) 166.00 31 LABORATORY REFERRALS3100021 HEPARIN ASSAY 76.50 31 LABORATORY REFERRALS3110822 PHOSPHLPD NUTRLZTN PLTLT 74.00 31 LABORATORY REFERRALS3112174 RUSSELL VIPER VENOM DILU 208.00 31 LABORATORY REFERRALS3113529 RUSSELL VIPER VENOM DILU 43.00 31 LABORATORY REFERRALS3113800 SICKLE CL SCRN 8.00 31 LABORATORY REFERRALS3116480 SICKLE CL SCRN 32.24 31 LABORATORY REFERRALS3115433 ALLERGEN SPECIFIC IGE QN 7.35 31 LABORATORY REFERRALS3116415 ALLERGEN SPECIFIC IGE QN 30.48 31 LABORATORY REFERRALS3116712 ALLERGEN SPECIFIC IGE QN 7.35 31 LABORATORY REFERRALS3112679 PLT AB DRG INDUCED 71.00 31 LABORATORY REFERRALS3112737 PLT AB INDIRECT 94.00 31 LABORATORY REFERRALS3115961 ANA (ANTI NUCLEAR AB) 260.00 31 LABORATORY REFERRALS3112729 ANA (ANTI NUCLEAR AB) 7.27 31 LABORATORY REFERRALS3115706 ASO TTR 156.00 31 LABORATORY REFERRALS3112687 ASO SCRN 9.75 31 LABORATORY REFERRALS3114758 C REACTIVE PROTEIN 109.00 31 LABORATORY REFERRALS3112992 C REACTIVE PROTEIN 9.74 31 LABORATORY REFERRALS3112695 CARDIOLIPIN AB 23.50 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3100070 CARDIOLIPIN IGA AB 23.14 31 LABORATORY REFERRALS3100054 CARDIOLIPIN IGG AB 23.14 31 LABORATORY REFERRALS3100062 CARDIOLIPIN IGM AB 23.14 31 LABORATORY REFERRALS3100047 PHOSPHOLIPID AB 23.14 31 LABORATORY REFERRALS3114733 COMPLEMENT C3 260.00 31 LABORATORY REFERRALS3114246 COMPLEMENT C3 12.00 31 LABORATORY REFERRALS3114741 COMPLEMENT C4 260.00 31 LABORATORY REFERRALS3114261 COMPLEMENT C4 9.00 31 LABORATORY REFERRALS3114279 COMPLEMENT C5 36.00 31 LABORATORY REFERRALS3112968 COMPLEMENT TOT (CH50) 11.00 31 LABORATORY REFERRALS3115979 ANTI DNA DBL STRAND 296.00 31 LABORATORY REFERRALS3112653 ANTI DNA DBL STRAND 20.00 31 LABORATORY REFERRALS3112661 ANTI DNA DBL STRAND 26.00 31 LABORATORY REFERRALS3116027 JO 1 AB 385.00 31 LABORATORY REFERRALS3116001 LA (SS B) AB 385.00 31 LABORATORY REFERRALS3115995 RO(SS A) AB 385.00 31 LABORATORY REFERRALS3116019 SCL 70 AB 385.00 31 LABORATORY REFERRALS3112711 MITOCHONDRIAL AB SCRN 18.00 31 LABORATORY REFERRALS3112745 STRIATED MUSCLE AB SCRN 33.00 31 LABORATORY REFERRALS3115821 THYROID PEROXIDASE AB 126.00 31 LABORATORY REFERRALS3116548 THYROID PEROXIDASE AB 85.00 31 LABORATORY REFERRALS3114592 NEURONAL AB (HU AB) TTR 67.00 31 LABORATORY REFERRALS3115797 CA 15 3 (27.29) 447.00 31 LABORATORY REFERRALS3116381 CA 15 3 (27.29) 116.28 31 LABORATORY REFERRALS3116373 CA 19 9 121.52 31 LABORATORY REFERRALS3114477 CA 125 447.00 31 LABORATORY REFERRALS3112828 IMMUNOASSAY TUM AG EA 19.00 31 LABORATORY REFERRALS3112810 IMMUNOASSAY TUM AG EA 15.25 31 LABORATORY REFERRALS3112794 IMMUNOFIX UR 38.00 31 LABORATORY REFERRALS3112786 IMMUNOFIX SER 25.00 31 LABORATORY REFERRALS3115664 T LMPH TOT CNT 70.00 31 LABORATORY REFERRALS3115656 T LYMPH CD4/8 CNT&RATIO 105.00 31 LABORATORY REFERRALS3115649 T LYMPH CD4 (HELPER) CNT 70.00 31 LABORATORY REFERRALS3115094 BACTERIAL AG EA AG 130.00 31 LABORATORY REFERRALS3112422 CRYPTOCOCCAL AG AGGL 42.00 31 LABORATORY REFERRALS3114972 CRYPTOCOCCAL AG AGGL 113.00 31 LABORATORY REFERRALS3114584 RHEUMATOID FCTR QL 120.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3114063 RHEUMATOID FCTR QL 9.00 31 LABORATORY REFERRALS3113941 VDRL CSF NON-TREPML AB QL 6.00 31 LABORATORY REFERRALS3113537 LYME DISEASE AB 56.00 31 LABORATORY REFERRALS3114212 CHLAMYDIA AB 31.00 31 LABORATORY REFERRALS3114287 CHLAMYDIA AB 90.00 31 LABORATORY REFERRALS3114014 COCCIDIOIDES AB CSF 30.00 31 LABORATORY REFERRALS3111440 Q FEVER AB 18.00 31 LABORATORY REFERRALS3113750 Q FEVER AB 27.00 31 LABORATORY REFERRALS3112943 CMV AB IGG 19.00 31 LABORATORY REFERRALS3112950 CMV AB IGM 19.00 31 LABORATORY REFERRALS3114089 CMV AB IGM 37.00 31 LABORATORY REFERRALS3111952 COXSACKIE AB TYP A 36.00 31 LABORATORY REFERRALS3114097 COXSACKIE AB TYP A 56.00 31 LABORATORY REFERRALS3116159 EBV AB EARLY AG 45.82 31 LABORATORY REFERRALS3116167 EBV AB EBNA 53.45 31 LABORATORY REFERRALS3116134 EBV VCA AB IGG 63.38 31 LABORATORY REFERRALS3116142 EBV VCA AB IGM 63.38 31 LABORATORY REFERRALS3113081 EBV AB VCA 25.00 31 LABORATORY REFERRALS3113198 H PYLORI AB IGA 10.00 31 LABORATORY REFERRALS3115045 H PYLORI AB TOTAL 312.00 31 LABORATORY REFERRALS3110632 HIV 1 AB 37.00 31 LABORATORY REFERRALS3114386 HIV 1/HIV 2 AB 296.00 31 LABORATORY REFERRALS3113347 HIV 1/HIV 2 AB 16.00 31 LABORATORY REFERRALS3113297 HB CORE AB TOTAL 15.00 31 LABORATORY REFERRALS3116282 HB CORE AB TOTAL 70.40 31 LABORATORY REFERRALS3114352 HB CORE AB IGM 255.00 31 LABORATORY REFERRALS3113289 HB CORE AB IGM 15.00 31 LABORATORY REFERRALS3114345 HBS AB 234.00 31 LABORATORY REFERRALS3113313 HBS AB 7.60 31 LABORATORY REFERRALS3113255 HBS AB 22.00 31 LABORATORY REFERRALS3113230 HBE AB 20.00 31 LABORATORY REFERRALS3114329 HAV AB TOTAL 265.00 31 LABORATORY REFERRALS3113263 HAV AB TOTAL 12.00 31 LABORATORY REFERRALS3113271 HAV AB IGM 19.00 31 LABORATORY REFERRALS3114311 HAV AB IGM 244.00 31 LABORATORY REFERRALS3113438 INFLUENZA A AB 28.00 31 LABORATORY REFERRALS3113487 LEGIONELLA AB 15.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3113552 MYCOPLAS AB IGM 54.00 31 LABORATORY REFERRALS3113784 RUBELLA AB IGG 12.00 31 LABORATORY REFERRALS3113792 RUBEOLA AB IGG 8.08 31 LABORATORY REFERRALS3115847 TOXOPLAS AB IGG 312.00 31 LABORATORY REFERRALS3113891 TOXOPLAS AB IGG 13.00 31 LABORATORY REFERRALS3115854 TOXOPLAS AB IGM 312.00 31 LABORATORY REFERRALS3113156 FTA ABS (TPPA) 12.00 31 LABORATORY REFERRALS3116498 VZV AB 75.24 31 LABORATORY REFERRALS3115441 VZV AB 21.25 31 LABORATORY REFERRALS3113933 VZV AB 43.00 31 LABORATORY REFERRALS3115789 VZV AB 276.00 31 LABORATORY REFERRALS3115813 VIRUS AB NOT SPEC 276.00 31 LABORATORY REFERRALS3115839 THYROGLOBULIN AB 66.00 31 LABORATORY REFERRALS3114360 HCV AB 307.00 31 LABORATORY REFERRALS3113321 HCV AB 9.74 31 LABORATORY REFERRALS3116639 HCV AB CONF 14.42 31 LABORATORY REFERRALS3113354 HLA B27 31.00 31 LABORATORY REFERRALS3115417 IRRADIATION BLD PROD EA 50.00 31 LABORATORY REFERRALS3114956 CULT BACT ANAEROBIC 203.00 31 LABORATORY REFERRALS3114782 CULT BACT ANAEROBIC 203.00 31 LABORATORY REFERRALS3114923 CULT BACT ANAEROBIC 203.00 31 LABORATORY REFERRALS3115359 CULT BACT ANAEROBIC 203.00 31 LABORATORY REFERRALS3115292 CULT BACT ANAEROBIC ID 172.00 31 LABORATORY REFERRALS3115144 CULT BACT AEROBIC ID 172.00 31 LABORATORY REFERRALS3115151 CULT BACT AEROBIC ID 172.00 31 LABORATORY REFERRALS3115110 CULT BETA STREP A ONLY 140.00 31 LABORATORY REFERRALS3115193 CULT GRP B STREP SCRN 140.00 31 LABORATORY REFERRALS3114899 CULT SCRN B PERTUSSUS 140.00 31 LABORATORY REFERRALS3115177 CULT MRSA SCRN 140.00 31 LABORATORY REFERRALS3115185 CULT VRE SCRN 140.00 31 LABORATORY REFERRALS3115342 CULT GC SCRN 140.00 31 LABORATORY REFERRALS3116563 CULT LEGIONELLA 50.28 31 LABORATORY REFERRALS3116738 CULT LEGIONELLA 50.28 31 LABORATORY REFERRALS3115136 CULT UR ID EACH ISOLATE 177.00 31 LABORATORY REFERRALS3114428 CULT FUNGUS OTHER SOURCE 182.00 31 LABORATORY REFERRALS3112356 CULT FUNGUS OTHER SOURCE 21.00 31 LABORATORY REFERRALS3114410 CULT FUNGUS BLD 192.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3115169 CULT FUNGUS YEAST ID 224.00 31 LABORATORY REFERRALS3115300 CULT FUNGUS MOLD ID 48.00 31 LABORATORY REFERRALS3113560 MYCOPLAS CULT 32.00 31 LABORATORY REFERRALS3115052 MYCOPLAS CULT 44.00 31 LABORATORY REFERRALS3114394 AFB CULT 234.00 31 LABORATORY REFERRALS3112570 AFB CULT 31.00 31 LABORATORY REFERRALS3112562 AFB CULT 23.00 31 LABORATORY REFERRALS3114998 AFB CULT BLD 234.00 31 LABORATORY REFERRALS3115318 CULT TYP AGGL 120.00 31 LABORATORY REFERRALS3114980 CULT TYP BY NA PRB DPT EA 432.00 31 LABORATORY REFERRALS3114048 PINWORM CELLOPHANE TAPE 42.00 31 LABORATORY REFERRALS3115060 PINWORM CELLOPHANE TAPE 38.00 31 LABORATORY REFERRALS3115284 TISSUE HOMOGENIZATION 48.00 31 LABORATORY REFERRALS3115334 OVA & PARASITES W CONC 192.00 31 LABORATORY REFERRALS3113644 OVA & PARASITES W CONC 24.00 31 LABORATORY REFERRALS3115086 SUSCEPT KB DISK <=12 151.00 31 LABORATORY REFERRALS3115227 SUSCEPT BY ENZYME DETECT 104.00 31 LABORATORY REFERRALS3115078 SUSCEPT MIC PER PLATE 187.00 31 LABORATORY REFERRALS3114964 SER BACTERICIDAL TTR 209.00 31 LABORATORY REFERRALS3112521 SMR GIEMSA 55.00 31 LABORATORY REFERRALS3115029 SMR GRAM STAIN 94.00 31 LABORATORY REFERRALS3114402 SMR AFB STAIN 114.00 31 LABORATORY REFERRALS3115235 SMR AFB STAIN 114.00 31 LABORATORY REFERRALS3114139 SMR INCL BODIES PARASITE 19.00 31 LABORATORY REFERRALS3114436 INDIA INK PREP CSF 94.00 31 LABORATORY REFERRALS3114444 KOH PREP SKIN HAIR NAIL 94.00 31 LABORATORY REFERRALS3116423 CULT HERPES 152.24 31 LABORATORY REFERRALS3113966 VIRUS CULT ID 41.00 31 LABORATORY REFERRALS3115474 ADENOVIRUS DFA 260.00 31 LABORATORY REFERRALS3114832 CHLAMYDIA AG DFA 260.00 31 LABORATORY REFERRALS3114840 CRYPTO AG DFA 260.00 31 LABORATORY REFERRALS3112539 HSV TYP 2 DFA 37.00 31 LABORATORY REFERRALS3115490 INFLUENZA B DFA 260.00 31 LABORATORY REFERRALS3115482 INFLUENZA A DFA 260.00 31 LABORATORY REFERRALS3115508 PARAINFLUENZA TYP 1 FA 260.00 31 LABORATORY REFERRALS3115516 PARAINFLUENZA TYP 2 FA 260.00 31 LABORATORY REFERRALS3115524 PARAINFLUENZA TYP 3 FA 260.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3115532 RSV DFA 260.00 31 LABORATORY REFERRALS3115201 C DIFFICILE TOXIN EIA 260.00 31 LABORATORY REFERRALS3110236 C DIFFICILE TOXIN EIA 21.00 31 LABORATORY REFERRALS3113016 CRYPTO NEOFORMANS EIA 34.00 31 LABORATORY REFERRALS3113172 CRYPTOSPORIDIUM 31.00 31 LABORATORY REFERRALS3112596 CRYPTOSPORIDIUM 38.00 31 LABORATORY REFERRALS3115383 CRYPTOSPORIDIUM AG EIA 260.00 31 LABORATORY REFERRALS3113024 CRYPTOSPORIDIUM AG EIA 20.00 31 LABORATORY REFERRALS3115375 GIARDIA AG EIA 260.00 31 LABORATORY REFERRALS3115409 CYTOMEGALOVIRUS AG EIA 35.00 31 LABORATORY REFERRALS3114337 HBS AG 224.00 31 LABORATORY REFERRALS3113305 HBs AG 13.90 31 LABORATORY REFERRALS3115367 ROTAVIRUS AG EIA 260.00 31 LABORATORY REFERRALS3113776 ROTAVIRUS AG EIA 20.00 31 LABORATORY REFERRALS3114683 CHLAMYDIA TRACH DIR PRB 432.00 31 LABORATORY REFERRALS3114691 GC DIR PRB 432.00 31 LABORATORY REFERRALS3116126 HPV AMP PRB 754.00 31 LABORATORY REFERRALS3116225 HPV AMP PRB 754.00 31 LABORATORY REFERRALS3115631 DNA CL CYCLE 133.50 31 LABORATORY REFERRALS3112190 CHRMOSOM CNT/KARY 2683.00 31 LABORATORY REFERRALS3112588 CHRMOSOM CNT/KARY 2683.00 31 LABORATORY REFERRALS3112208 CHRMOSOM CNT/KARY 769.00 31 LABORATORY REFERRALS3115276 SPEC STAIN GRP II INTRP/R 1009.00 31 LABORATORY REFERRALS3112547 IMMUNOHISTOCHEMISTRY 119.00 31 LABORATORY REFERRALS3115219 SPEC CONCENTRATION 48.00 31 LABORATORY REFERRALS3115003 CULT BLD BACTERIA 224.00 31 LABORATORY REFERRALS3114931 CULT BLD BACTERIA 224.00 31 LABORATORY REFERRALS3115243 CULT STL SALM & SHIG 203.00 31 LABORATORY REFERRALS3115102 CULT STL SALM & SHIG 203.00 31 LABORATORY REFERRALS3115268 CULT STL E COLI EA PLATE 203.00 31 LABORATORY REFERRALS3115250 CULT STL CAMPHYLOB EA PLT 203.00 31 LABORATORY REFERRALS3114808 CULT CAPD 187.00 31 LABORATORY REFERRALS3115037 CULT H2O 44.00 31 LABORATORY REFERRALS3114907 CULT LOWER RESPIRATORY 187.00 31 LABORATORY REFERRALS3115326 CULT LOWER RESPIRATORY 187.00 31 LABORATORY REFERRALS3115128 CULT NOSE/THROAT 187.00 31 LABORATORY REFERRALS3114949 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3114790 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114816 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114915 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114873 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114824 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114865 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114857 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114881 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3115011 CULT OTHER SOURCE AEROBIC 187.00 31 LABORATORY REFERRALS3114626 TYROSINE 15.40 31 LABORATORY REFERRALS3115987 SMITH AB 385.00 31 LABORATORY REFERRALS3116183 IMMUNOASSAY NONINFECT 15.95 31 LABORATORY REFERRALS3116068 MOL DX ISO/EXT PRFD EA NA 14.00 31 LABORATORY REFERRALS3115896 MOL DX ISO/EXT PRFD EA NA 19.60 31 LABORATORY REFERRALS3115953 AG DETECT NOS DNA AMP 292.50 31 LABORATORY REFERRALS3115888 ML DX AMP TR NA EA SQ GT2 81.97 31 LABORATORY REFERRALS3114659 HEMOGLOBIN FRACTION QN 15.95 31 LABORATORY REFERRALS3100039 BETA 2 GLYCOPROTN I AB EA 23.15 31 LABORATORY REFERRALS3116092 MOL DX MUT SCN 1 SEG EA 359.00 31 LABORATORY REFERRALS3113735 NATRIURETIC PEPTIDE 76.00 31 LABORATORY REFERRALS3114675 NATRIURETIC PEPTIDE 733.00 31 LABORATORY REFERRALS3100310 MASS SPECT/TANDEM QN NES 16.00 31 LABORATORY REFERRALS3100252 PROTEIN S FREE 91.00 31 LABORATORY REFERRALS3112067 NEWBORN SCRN PANEL 6.00 31 LABORATORY REFERRALS3111788 CELL MARKR TECH ONLY 1ST 48.00 31 LABORATORY REFERRALS3115615 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3112893 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115581 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115599 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115573 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115557 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115540 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115607 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115565 CELL MARKR TECH ONLY 1ST 1263.00 31 LABORATORY REFERRALS3115623 CELL MARKR TECH EA ADDL 35.00 31 LABORATORY REFERRALS3116035 ANTI RNP AB 385.00 31 LABORATORY REFERRALS3116043 CENTROMERE AB 385.00 31 LABORATORY REFERRALS

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

3116050 HISTONE AB 385.00 31 LABORATORY REFERRALS3100260 RISTOCETIN COFACTOR 108.00 31 LABORATORY REFERRALS3116175 BIOTINIDASE ASSAY 15.95 31 LABORATORY REFERRALS3116274 ASSAY OF LIPOPROTEIN(A) 75.64 31 LABORATORY REFERRALS3116720 TB TEST CELL IMMUNE MEAS 409.98 31 LABORATORY REFERRALS3116555 TREPONEMA PALLIDUM AB 77.36 31 LABORATORY REFERRALS3116233 ALPHA 1 ANTITRYPSIN 78.44 31 LABORATORY REFERRALS3116241 APOLIPOPROTEIN A1 82.32 31 LABORATORY REFERRALS3116258 APOLIPOPROTEIN B 82.32 31 LABORATORY REFERRALS3116266 BETA2 MICROGLOBULIN 94.48 31 LABORATORY REFERRALS3116506 VZV AB IGG 75.24 31 LABORATORY REFERRALS3116514 VZV AB IGM 75.24 31 LABORATORY REFERRALS3116522 RUBEOLA AB IGG 75.24 31 LABORATORY REFERRALS3116530 RUBEOLA AB IGM 75.24 31 LABORATORY REFERRALS3116191 DNA PRB CYTGNTC >100 863.00 31 LABORATORY REFERRALS3116209 DNA PRB CYTGNTC EA 463.00 31 LABORATORY REFERRALS3116571 LDL BY DIRECT MEASURE 55.72 31 LABORATORY REFERRALS3116464 CARDIOLIPIN IGA AB 148.56 31 LABORATORY REFERRALS3116456 CARDIOLIPIN IGG AB 148.56 31 LABORATORY REFERRALS3116449 CARDIOLIPIN IGM AB 148.56 31 LABORATORY REFERRALS3116357 C-PEPTIDE 121.52 31 LABORATORY REFERRALS3116290 DHEA SULFATE 129.84 31 LABORATORY REFERRALS3116340 ERYTHROPOIETIN 109.80 31 LABORATORY REFERRALS3116324 GROWTH HORMONE 97.36 31 LABORATORY REFERRALS3116316 IGFBP 3 78.92 31 LABORATORY REFERRALS3116308 IGF-1 124.16 31 LABORATORY REFERRALS3116365 INSULIN 66.76 31 LABORATORY REFERRALS3116407 THYROGLOBULIN 93.80 31 LABORATORY REFERRALS3116605 VITAMIN D 25HYDROXY 640.00 130.00 31 LABORATORY REFERRALS3116621 HEP C VIRUS PCR QN 180.84 31 LABORATORY REFERRALS3116431 DRG SCRN MULTI CLASS IMM 77.00 31 LABORATORY REFERRALS3116688 C DIFF AMPLIFIED PROBE 172.87 31 LABORATORY REFERRALS3116696 PHAGOCYTOPHILUM AB IGG 16.25 31 LABORATORY REFERRALS3116704 PHAGOCYTOPHILUM AB IGM 16.25 31 LABORATORY REFERRALS5510110 LITHO ESWL UNILAT 20106.00 55 LITHOTRIPSY5510615 LITHO ESWL BILAT 25230.00 55 LITHOTRIPSY9518002 HYDROMORPHONE 2MG LIQ 95 MONTHLY INTEREST CHARGE T

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

1100361 S NSTRL BLANKET BILIBED 133.15 11 NURSERY ANCILLARY CHARGES1100395 S NSTRL OXYHOOD 86.25 80.95 11 NURSERY ANCILLARY CHARGES1100353 S NSTRL MANMTER PRESSR 59.65 11 NURSERY ANCILLARY CHARGES1100338 S NSTRL SUPPLEMENTAL NURS 5684.95 11 NURSERY ANCILLARY CHARGES1100247 S NSTRL URINARY BAG INF 20.25 11 NURSERY ANCILLARY CHARGES1100379 S STRL VESSEL CATH INSERT 299.25 11 NURSERY ANCILLARY CHARGES1100270 S STRL UMBILICAL CATH 167.20 11 NURSERY ANCILLARY CHARGES1100015 CIRCUMCISION 267.00 11 NURSERY ANCILLARY CHARGES1100403 OBS BONE MARROW ASP W/BX 439.00 11 NURSERY ANCILLARY CHARGES1100023 GLUCOSE 17.00 11 NURSERY ANCILLARY CHARGES0284208 S STRL IR NDL 18GA THIN 30.00 02 OBSERVATION0263004 S STRL IR INTRO 5FR 100.00 02 OBSERVATION0252346 S STRL NR STENT/NEURO 4.0 7113.15 02 OBSERVATION0243394 S STRL EMBOLIC LIQUID 5237.50 02 OBSERVATION0252049 S STRL NR WIRE 300 FLOPPY 1511.25 02 OBSERVATION0252122 S STRL NE STENT/NEURO 3.5 7113.15 02 OBSERVATION0261347 S STRL IR DITR 7FR 30.00 02 OBSERVATION0261321 S STRL IR DITR 6FR 30.00 02 OBSERVATION0252361 S STRL NR STENT/NEURO 4.5 7113.15 02 OBSERVATION0252163 S STRL NR STENT/NEURO 4.5 7113.15 02 OBSERVATION0252320 S STRL NR STENT/NEURO 3.5 7113.15 02 OBSERVATION0252148 S STRL NR STENT/NEURO 4.0 7113.15 02 OBSERVATION0264523 S STRL RF PROBE 3.5CMX15C 1168.30 02 OBSERVATION0264481 S STRL RF PROBE 3CMX15CM 996.85 02 OBSERVATION0264465 S STRL RF PROBE 2CMX15CM 768.95 02 OBSERVATION0286302 S STRL IR TY THORA 204.00 02 OBSERVATION0264549 S STRL RF PROBE 4CMX15CM 02 OBSERVATION0241026 S STRL TUBE 60.00 02 OBSERVATION0242503 S STRL EMBLOIC LIQUID 16250.00 02 OBSERVATION0211235 CARDIOVERT ELECTIVE EXT 1138.00 02 OBSERVATION0200188 OBS INJECTION IM/SQ EA 258.00 02 OBSERVATION0200170 OBS INJ IVP SNGL/INIT DRG 205.00 02 OBSERVATION0281956 CATH DRAINAGE 373.00 02 OBSERVATION0234328 CATH GUIDING 496.00 02 OBSERVATION0234526 CATH GUIDING 471.00 02 OBSERVATION0234542 CATH GUIDING 471.00 02 OBSERVATION0234690 CATH GUIDING 1284.00 02 OBSERVATION

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0234344 CATH GUIDING 495.00 02 OBSERVATION0234401 CATH GUIDING 344.00 02 OBSERVATION0234443 CATH GUIDING 447.00 02 OBSERVATION0285155 IMP CATH HD/PRTNL LNG TRM 1600.00 02 OBSERVATION0232546 CATH INF PER CEN MID NOHD 793.00 02 OBSERVATION0232520 CATH INF PER CEN MID NOHD 1719.00 02 OBSERVATION0231209 CATH OCCLUSION 496.00 02 OBSERVATION0234427 CATH THROMB/EMBOLCTMY 115.00 02 OBSERVATION0268540 CATH TRNSML ANGIO NOLASR 660.00 02 OBSERVATION0268565 CATH TRNSML ANGIO NOLASR 297.00 02 OBSERVATION0232884 CATH TRNSML ANGIO NOLASR 1022.00 02 OBSERVATION0232843 CATH TRNSML ANGIO NOLASR 961.00 02 OBSERVATION0232801 CATH TRNSML ANGIO NOLASR 1022.00 02 OBSERVATION0232140 CATH TRNSML ANGIO NOLASR 1635.00 02 OBSERVATION0232041 CATH TRNSML ANGIO NOLASR 1635.50 02 OBSERVATION0232066 CATH TRNSML ANGIO NOLASR 1635.50 02 OBSERVATION0232108 CATH TRNSML ANGIO NOLASR 1733.00 02 OBSERVATION0232124 CATH TRNSML ANGIO NOLASR 1635.00 02 OBSERVATION0232769 CATH TRNSML ANGIO NOLASR 1022.00 02 OBSERVATION0232165 CATH TRNSML ANGIO NOLASR 1635.00 02 OBSERVATION0232686 CATH TRNSML ANGIO NOLASR 1022.00 02 OBSERVATION0232728 CATH TRNSML ANGIO NOLASR 961.00 02 OBSERVATION0232645 CATH TRNSML ANGIO NOLASR 961.00 02 OBSERVATION0200006 OBS BLADDER IRRIG SMPL 155.00 02 OBSERVATION0200014 OBS BLOOD TRANSFSN 2-4 HR 1780.00 02 OBSERVATION0234013 CATH TRNSLML ATHR ROT 8225.00 02 OBSERVATION0200022 OBS BLOOD TRANSFSN 4-6 HR 2798.00 02 OBSERVATION0200030 OBS BLOOD TRANSFSN GT 6HR 3442.00 02 OBSERVATION0200048 OBS BLOOD TRANSFSN LT 2HR 1018.00 02 OBSERVATION0200097 OBS EKG 12 LEAD TRACING 248.00 02 OBSERVATION0200212 OBS INSERT CATH TMP SMPL 412.00 02 OBSERVATION0200196 OBS INS NON-TUN CV CATH5+ 912.00 02 OBSERVATION0268060 GUIDEWIRE 156.00 02 OBSERVATION0268847 GUIDEWIRE 599.00 02 OBSERVATION0267708 GUIDEWIRE 88.00 02 OBSERVATION0267807 GUIDEWIRE 77.00 02 OBSERVATION0268003 GUIDEWIRE 169.00 02 OBSERVATION

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0268029 GUIDEWIRE 169.00 02 OBSERVATION0268045 GUIDEWIRE 169.00 02 OBSERVATION0267500 GUIDEWIRE COONS BENS 102.10 02 OBSERVATION0268086 GUIDEWIRE 156.00 02 OBSERVATION0268102 GUIDEWIRE 253.00 02 OBSERVATION0268128 GUIDEWIRE 247.00 02 OBSERVATION0268144 GUIDEWIRE 262.00 02 OBSERVATION0268169 GUIDEWIRE 818.00 02 OBSERVATION0268227 GUIDEWIRE 788.00 02 OBSERVATION0268508 GUIDEWIRE 570.00 02 OBSERVATION0268524 GUIDEWIRE 570.00 02 OBSERVATION0268649 GUIDEWIRE 57.00 02 OBSERVATION0268805 GUIDEWIRE 639.00 02 OBSERVATION0268706 GUIDEWIRE 112.00 02 OBSERVATION0200261 OBS VENIPUNCTURE 16.00 02 OBSERVATION0200089 OBS DECLOT VASC DEVICE 176.00 02 OBSERVATION0200253 OBS PULSE-OX OVRNITE CONT 324.00 02 OBSERVATION0200246 OBS PULSE OX MULTIPLE 235.00 02 OBSERVATION0200238 OBS PLACE NEEDLE IN VEIN 119.00 02 OBSERVATION0200063 OBS COLL BLD VNS ACCS DVC 371.00 02 OBSERVATION0200055 OBS INSRT BLADDER CATH 10.00 02 OBSERVATION0200220 OBS INSRT BLADDER CATH 192.00 02 OBSERVATION0200113 OBS HYDRTN INF INIT 31-60 585.00 02 OBSERVATION0200105 OBS HYDRAT INF EA ADD HR 409.00 02 OBSERVATION0200162 OBS INFSN W/MED 16-60MN 585.00 02 OBSERVATION0200147 OBS INF W/MED EA ADD HR 409.00 02 OBSERVATION0200139 OBS INF W/MED ADDSQ 16-60 401.00 02 OBSERVATION0276642 STENT NO-COR TMP W/DL SYS 3600.00 02 OBSERVATION0276667 STENT NON-COR TMP W/O DEL 3200.00 02 OBSERVATION0276204 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276246 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276048 STENT NOCOAT W DEL SYS 4170.00 02 OBSERVATION0276063 STENT NOCOAT W DEL SYS 3134.00 02 OBSERVATION0276089 STENT NOCOAT W DEL SYS 3134.00 02 OBSERVATION0276105 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276121 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276147 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0276022 STENT NOCOAT W DEL SYS 4061.00 02 OBSERVATION0276220 STENT NOCOAT W DEL SYS 3134.00 02 OBSERVATION0276006 STENT NOCOAT W DEL SYS 4061.00 02 OBSERVATION0276261 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276287 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276303 STENT NOCOAT W DEL SYS 3913.00 02 OBSERVATION0276329 STENT NOCOAT W DEL SYS 3913.00 02 OBSERVATION0276345 STENT NOCOAT W DEL SYS 3913.00 02 OBSERVATION0276360 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276188 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0276162 STENT NOCOAT W DEL SYS 3691.00 02 OBSERVATION0274845 STENT NO-COAT/COV W/O DEL 3795.00 02 OBSERVATION0274803 STENT NO-COAT/COV W/O DEL 4023.00 02 OBSERVATION0274902 STENT NO-COAT/COV W/O DEL 3876.00 02 OBSERVATION0274829 STENT NO-COAT/COV W/O DEL 3795.00 02 OBSERVATION0274860 STENT NO-COAT/COV W/O DEL 3522.00 02 OBSERVATION0274886 STENT NO-COAT/COV W/O DEL 2630.00 02 OBSERVATION0200121 OBS IJ IVP ADL SQ NEW DRG 177.00 02 OBSERVATION0200154 OBS INFSN W/MED CONCURRNT 312.00 02 OBSERVATION0200071 OBS CPR 262.00 02 OBSERVATION0200204 OBS INS PICC AGE 5 YRS/> 1548.00 02 OBSERVATION0201996 OBS IVP SME DRG EA >30M 41.00 02 OBSERVATION0200329 OBS COL BLD PICC/CNTRL LN 27.00 02 OBSERVATION0200287 OBS INFUSN CHEMO 0-60 MN 893.00 02 OBSERVATION0200295 OBS INFUSN CHEM EA ADD HR 775.00 02 OBSERVATION0200279 OBS CARDIOVERT ELECT EXT 947.00 02 OBSERVATION0200303 OBS ADMIN INFLUENZA VACC 89.00 02 OBSERVATION0200311 OBS ADMIN PNEUMOCOCAL VAC 40.00 02 OBSERVATION0200337 OBS INFLU H1N1 VACC ADMIN 24.00 02 OBSERVATION0202002 OBS APPLY LONG ARM SPLINT 626.00 02 OBSERVATION0202010 OBS INSERT CATH TMP CMPLX 411.89 02 OBSERVATION0200345 INC ST ABSC DEEP 400.00 02 OBSERVATION0202028 OBS ASP BLADDER SP CATH 1035.00 02 OBSERVATION8230740 S NSTRL GEL PAD 4X4 44.75 82 OCCUPATIONAL THERAPY8230534 S NSTRL THERAPUTTY 5 OZ 10.65 82 OCCUPATIONAL THERAPY8230542 S NSTRL COBAN 1 IN 1 ROLL 1.05 82 OCCUPATIONAL THERAPY8230559 S NSTRL COBAN 2IN 1 ROLL 6.40 82 OCCUPATIONAL THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

8230609 S NSTRL EDEMA GLOVE FULL 11.70 82 OCCUPATIONAL THERAPY8230617 S NSTRL ELBOW STRAP 23.45 82 OCCUPATIONAL THERAPY8230625 S NSTRL FINGER DIGITAL GE 4.25 82 OCCUPATIONAL THERAPY8230633 S NSTRL FINGER JOINT CINC 4.25 82 OCCUPATIONAL THERAPY8230658 S NSTRL KINESIO TAPE 1 RL 22.35 82 OCCUPATIONAL THERAPY8230757 S NSTRL GEL PAD 1X1 11.70 82 OCCUPATIONAL THERAPY8230765 S NSTRL ELASTMER PTY 1TBL 2.15 82 OCCUPATIONAL THERAPY8230773 S NSTRL EDEMA GLV 3/4 FIN 11.70 82 OCCUPATIONAL THERAPY8230781 S NSTRL EDEMA GLV ISOTONE 17.05 82 OCCUPATIONAL THERAPY8230641 S NSTRL FINGER BUDDY STRA 22.35 82 OCCUPATIONAL THERAPY8230849 S OT SO ACRO/CLAV CNVS PF 804.10 82 OCCUPATIONAL THERAPY8230229 S OT EO EL W/MTL JT PF 127.80 82 OCCUPATIONAL THERAPY8230856 S OT EO DBL F/A EXT/FLEX 1108.65 82 OCCUPATIONAL THERAPY8230245 S OT WHFO RIGID W/O JNTS 385.55 82 OCCUPATIONAL THERAPY8230294 S OT WHFO RIGID W/O JNTS 625.15 82 OCCUPATIONAL THERAPY8230237 S OT WHFO RIGID W/O JNTS 246.00 82 OCCUPATIONAL THERAPY8230815 S OT WHF W/O JT PREFAB 222.60 82 OCCUPATIONAL THERAPY8230864 S OT WHF DYN HNG WRST/FGR 1463.30 82 OCCUPATIONAL THERAPY8230872 S OT WHF DYN HNG W/F CBL 1800.90 82 OCCUPATIONAL THERAPY8230823 WHFO PREFAB WRIST COCK-UP 72.40 82 OCCUPATIONAL THERAPY8230831 S OT WO EL PREFAB 61.75 82 OCCUPATIONAL THERAPY8230302 S OT HFO FLEX GLV EL FGR 116.10 82 OCCUPATIONAL THERAPY8230435 WHFO NONTORSN JNT PREFAB 1517.65 82 OCCUPATIONAL THERAPY8230401 WHFO NONTORSN JNT PREFAB 66.05 82 OCCUPATIONAL THERAPY8230443 WHFO NONTORSN JNT PREFAB 108.65 82 OCCUPATIONAL THERAPY8230450 WHFO NONTORSN JNT PREFAB 1517.65 82 OCCUPATIONAL THERAPY8230518 WHFO NONTORSN JNT PREFAB 182.10 82 OCCUPATIONAL THERAPY8230328 WHFO NONTORSN JNT PREFAB 143.80 82 OCCUPATIONAL THERAPY8230385 WHFO NONTORSN JNT PREFAB 99.05 82 OCCUPATIONAL THERAPY8230377 WHFO NONTORSN JNT PREFAB 120.35 82 OCCUPATIONAL THERAPY8230500 WHFO NONTORSN JNT PREFAB 183.20 82 OCCUPATIONAL THERAPY8230468 HFO NONTORSION JNT PREFAB 550.60 82 OCCUPATIONAL THERAPY8230476 HFO NONTORSION JNT PREFAB 119.30 82 OCCUPATIONAL THERAPY8230344 HFO NONTORSION JNT PREFAB 1517.65 82 OCCUPATIONAL THERAPY8230484 HFO NONTORSION JNT PREFAB 106.50 82 OCCUPATIONAL THERAPY8230351 HFO NONTORSION JNT PREFAB 119.30 82 OCCUPATIONAL THERAPY8230393 HFO NONTORSION JNT PREFAB 69.25 82 OCCUPATIONAL THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

8230336 HFO NONTORSION JNT PREFAB 95.85 82 OCCUPATIONAL THERAPY8230369 HFO W/O JOINTS PF 44.75 82 OCCUPATIONAL THERAPY8230419 FO PIP/DIP W/JOINT/SPRING 49.00 82 OCCUPATIONAL THERAPY8031338 S NSTRL CPM PADS 129.95 80 PHYSICAL THERAPY8030330 S NSTRL SUPPLIES 80 PHYSICAL THERAPY8030538 S NSTRL SUPPLIES 80 PHYSICAL THERAPY8031221 PT E-STIM SUPERVISED 15 141.00 80 PHYSICAL THERAPY8030272 PT E-STIM SUPERVISED 15 141.00 80 PHYSICAL THERAPY8030546 PT EVAL BRIEF 153.00 80 PHYSICAL THERAPY8030579 PT EVAL COMPREHENSIVE 459.00 80 PHYSICAL THERAPY8030868 PT EVAL EXTENDED 612.00 80 PHYSICAL THERAPY8030561 PT EVAL INTERMEDIATE 306.00 80 PHYSICAL THERAPY8030553 PT EVAL LTD 286.00 80 PHYSICAL THERAPY8030603 PT RE-EVAL COMPREHENSIVE 275.00 80 PHYSICAL THERAPY8030876 PT RE-EVAL EXTENDED 551.00 80 PHYSICAL THERAPY8030595 PT RE-EVAL INTERMEDIATE 275.00 80 PHYSICAL THERAPY8030587 PT RE-EVAL LTD 233.00 80 PHYSICAL THERAPY8031049 PT ADL TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030819 PT ADL TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030801 PT COMMUNITY REINT EA 15 141.00 80 PHYSICAL THERAPY8030744 PT CONTRAST BATH INIT 30 141.00 80 PHYSICAL THERAPY8031320 PT DEBRIDE SKIN/TISSUE 183.00 80 PHYSICAL THERAPY8031189 PT E-STIM EA 15 120.00 80 PHYSICAL THERAPY8030223 PT E-STIM EA 15 120.00 80 PHYSICAL THERAPY8030702 PT E-STIM MANUAL INIT 30 234.00 80 PHYSICAL THERAPY8030975 PT EVAL 15 130.00 80 PHYSICAL THERAPY8030025 PT EVAL 15 130.00 80 PHYSICAL THERAPY8031551 PT EVAL 30 306.00 80 PHYSICAL THERAPY8030884 PT EVAL 30 306.00 80 PHYSICAL THERAPY8031569 PT EVAL 45 459.00 80 PHYSICAL THERAPY8031577 PT EVAL 60 612.00 80 PHYSICAL THERAPY8031585 PT EVAL 75 765.00 80 PHYSICAL THERAPY8031593 PT EVAL 90 918.00 80 PHYSICAL THERAPY8030934 PT EVAL ADD 15 153.00 80 PHYSICAL THERAPY8030926 PT EVAL INIT 30 306.00 80 PHYSICAL THERAPY8030439 PT EXER GP ADD 15 106.00 80 PHYSICAL THERAPY8030421 PT EXER GP INIT 30 212.00 80 PHYSICAL THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

8030686 PT FNX ACT INIT 30 282.00 80 PHYSICAL THERAPY8031098 PT GAIT TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030066 PT GAIT TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030694 PT GAIT TRAIN INIT 30 282.00 80 PHYSICAL THERAPY8030447 PT GP ED PER SESSION 142.00 80 PHYSICAL THERAPY8030215 PT IONTOPHORESIS EA 15 156.00 80 PHYSICAL THERAPY8030710 PT IONTOPHORESIS INIT 30 259.00 80 PHYSICAL THERAPY8030405 PT JOINT MOB INIT 30 302.00 80 PHYSICAL THERAPY8031148 PT MANUAL THER EA 15 151.00 80 PHYSICAL THERAPY8030900 PT MANUAL THER EA 15 151.00 80 PHYSICAL THERAPY8030728 PT MANUAL TRACT INIT 30 302.00 80 PHYSICAL THERAPY8031205 PT MECH TRACT 15 121.00 80 PHYSICAL THERAPY8030264 PT MECH TRACT 15 121.00 80 PHYSICAL THERAPY8030371 PT MYOFAC/SOFT MOB 30 302.00 80 PHYSICAL THERAPY8031064 PT NEUROMUSC REED EA 15 151.00 80 PHYSICAL THERAPY8030041 PT NEUROMUSC REED EA 15 151.00 80 PHYSICAL THERAPY8030678 PT NEUROMUSC REED INIT 30 302.00 80 PHYSICAL THERAPY8030397 PT ORTHOTIC FAB INIT 30 282.00 80 PHYSICAL THERAPY8030793 PT ORTHOTIC TRAIN ADD 15 141.00 80 PHYSICAL THERAPY8031114 PT ORTHOTIC TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030835 PT ORTHOTIC TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030785 PT ORTHOTIC TRAIN INIT 30 282.00 80 PHYSICAL THERAPY8030181 PT PROC THER GP 15 106.00 80 PHYSICAL THERAPY8030355 PT PROSTH TRAIN ADD 15 141.00 80 PHYSICAL THERAPY8031122 PT PROSTH TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030843 PT PROSTH TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030348 PT PROSTH TRAIN INIT 30 282.00 80 PHYSICAL THERAPY8031015 PT RE-EVAL 30 275.00 80 PHYSICAL THERAPY8030892 PT RE-EVAL 30 275.00 80 PHYSICAL THERAPY8031296 PT STRAP UNNA BOOT 204.00 80 PHYSICAL THERAPY8030413 PT TAPING EA VISIT 71.00 80 PHYSICAL THERAPY8031072 PT THER ACT EA 15 141.00 80 PHYSICAL THERAPY8030389 PT THER ACT EA 15 141.00 80 PHYSICAL THERAPY8030157 PT THER ACT EA 15 141.00 80 PHYSICAL THERAPY8010712 PT THER ACT EA 15 141.00 80 PHYSICAL THERAPY8031031 PT THER EX EA 15 141.00 80 PHYSICAL THERAPY8030033 PT THER EX EA 15 141.00 80 PHYSICAL THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

8030660 PT THER EX INIT 30 282.00 80 PHYSICAL THERAPY8030082 PT THER MASSAGE EA 15 151.00 80 PHYSICAL THERAPY8031130 PT THER MASSAGE EA 15 151.00 80 PHYSICAL THERAPY8030736 PT THER MASSAGE INIT 30 302.00 80 PHYSICAL THERAPY8030959 PT TREAT COMBO ADD 15 141.00 80 PHYSICAL THERAPY8030942 PT TREAT COMBO INIT 30 282.00 80 PHYSICAL THERAPY8031171 PT ULTRASOUND EA 15 120.00 80 PHYSICAL THERAPY8030207 PT ULTRASOUND EA 15 120.00 80 PHYSICAL THERAPY8030751 PT ULTRASOUND INIT 30 240.00 80 PHYSICAL THERAPY8031239 PT VASOPNEUMATIC 15 73.00 80 PHYSICAL THERAPY8031106 PT WHLCHR MNG/TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030918 PT WHLCHR MNG/TRAIN EA 15 141.00 80 PHYSICAL THERAPY8030306 PT WHIRLPOOL 30 141.00 80 PHYSICAL THERAPY8031197 PT WHIRLPOOL 30 141.00 80 PHYSICAL THERAPY8030462 PT PROC/MOD ADD 15 141.00 80 PHYSICAL THERAPY8031411 PT NP WOUND TX <=50 CM 15 126.00 80 PHYSICAL THERAPY8031429 PT NP WOUND TX >50 CM 15 120.00 80 PHYSICAL THERAPY8031437 PT NP WOUND TX <=50 CM 30 225.00 80 PHYSICAL THERAPY8031445 PT NP WOUND TX >50 CM 30 268.00 80 PHYSICAL THERAPY8031452 PT NP WOUND TX <=50 CM 45 414.00 80 PHYSICAL THERAPY8031460 PT NP WOUND TX >50 CM 45 457.00 80 PHYSICAL THERAPY8031478 PT NP WOUND TX <=50 CM 60 533.00 80 PHYSICAL THERAPY8031486 PT NP WOUND TX >50 CM 60 584.00 80 PHYSICAL THERAPY8031494 PT NP WOUND TX <=50 CM 90 683.00 80 PHYSICAL THERAPY8031502 PT NP WOUND TX >50 CM 90 737.00 80 PHYSICAL THERAPY8031510 PT NP WOUND TX <=50CM 105 816.00 80 PHYSICAL THERAPY8031528 PT NP WOUND TX >50 CM 105 866.00 80 PHYSICAL THERAPY8031536 PT NP WOUND TX <=50CM 120 945.00 80 PHYSICAL THERAPY8031544 PT NP WOUND TX >50 CM 120 999.00 80 PHYSICAL THERAPY8031619 PT DEBRIDE <=1ST 20 SQ/CM 298.00 141.00 80 PHYSICAL THERAPY8031627 PT DEBRIDE EA ADD 20 SQ/M 298.00 141.00 80 PHYSICAL THERAPY6110209 VITAL CAPACITY 296.00 61 PULMONARY REHAB0858001 RP TL-201 DX PER MCI 110.00 08 RADIOLOGICAL PHARMACEUTIC0852541 RP TX I-131 CAP PER MCI 2099.00 08 RADIOLOGICAL PHARMACEUTIC0852509 RP DX I-131 CAP PER MCI 523.00 08 RADIOLOGICAL PHARMACEUTIC0882001 S NSTRL BAG DRNG URINARY 118.20 08 RADIOLOGICAL PHARMACEUTIC0859009 S STRL NM AEROSOL KIT 75.60 08 RADIOLOGICAL PHARMACEUTIC

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0888016 S STRL US TRAY BIOPSY 1646.50 08 RADIOLOGICAL PHARMACEUTIC0820050 S STRL BREAST BIOPSY CLIP 599.00 08 RADIOLOGICAL PHARMACEUTIC0883827 S STRL NDL BIOP ASAP 18GA 223.65 08 RADIOLOGICAL PHARMACEUTIC0883801 S STRL NDL BIOP ASAP 15GA 318.45 08 RADIOLOGICAL PHARMACEUTIC0883843 S STRL NDL BIOP ASAP 18GA 318.45 08 RADIOLOGICAL PHARMACEUTIC0888008 S STRL CT TRAY BIOPSY 113.95 08 RADIOLOGICAL PHARMACEUTIC0883868 S STRL NDL BIOP ASAP 20GA 318.45 08 RADIOLOGICAL PHARMACEUTIC0884023 S STRL NDL BIOP S-CUT 17C 171.45 08 RADIOLOGICAL PHARMACEUTIC0892505 S STRL TRAY THORACENTISIS 274.75 08 RADIOLOGICAL PHARMACEUTIC0888503 S STRL US AMINO TRAY 96.90 08 RADIOLOGICAL PHARMACEUTIC0820068 S STRL BREAST BX CLIP 186.00 08 RADIOLOGICAL PHARMACEUTIC0884049 S STRL NDL BIOP S-CUT 18C 176.80 08 RADIOLOGICAL PHARMACEUTIC0884007 S STRL NDL BIOP S-CUT 16C 169.35 08 RADIOLOGICAL PHARMACEUTIC0883892 S STRL CT NDL BIOP GEREM 635.80 08 RADIOLOGICAL PHARMACEUTIC0883884 S STRL NDL BIOP ASAP 18GA 370.60 08 RADIOLOGICAL PHARMACEUTIC0883520 S STRL CT NDL 21GA 150MM 182.10 08 RADIOLOGICAL PHARMACEUTIC0883504 S STRL CT NDL 18GA 150MM 144.85 08 RADIOLOGICAL PHARMACEUTIC0882506 S STRL BIOP GUN ADV13MM 205.55 08 RADIOLOGICAL PHARMACEUTIC0893891 S STRL BAL UT 9MM4CM75CM 1211.95 08 RADIOLOGICAL PHARMACEUTIC0858753 S STRL NM CYSTO IRRIG 27.70 08 RADIOLOGICAL PHARMACEUTIC0884320 S STRL NDL CHIB 19GA/20CM 68.15 08 RADIOLOGICAL PHARMACEUTIC0885400 S STRL CT NEEDLE TLA 160.80 08 RADIOLOGICAL PHARMACEUTIC0888404 S STRL TRAY ST CATH 20.25 08 RADIOLOGICAL PHARMACEUTIC0888354 S STRL TRAY PNEUMOTHORAX 275.85 08 RADIOLOGICAL PHARMACEUTIC0888206 S STRL TRAY FOLEY CATH 1646.50 08 RADIOLOGICAL PHARMACEUTIC0888107 S STRL TRAY CONT EPI 183.20 08 RADIOLOGICAL PHARMACEUTIC0887455 S STRL DRN CATH NEPH 8FR 563.40 08 RADIOLOGICAL PHARMACEUTIC0887406 S STRL DRN CATH NEPH 10FR 563.40 08 RADIOLOGICAL PHARMACEUTIC0886507 S STRL CATH FOLWY 10FR 10.65 08 RADIOLOGICAL PHARMACEUTIC0886044 S STRL ENTEROCLYSIS KIT 433.45 08 RADIOLOGICAL PHARMACEUTIC0884064 S STRL NDL SURECUT 21CM 165.10 08 RADIOLOGICAL PHARMACEUTIC0885608 S STRL CT NEEDLE OSTYCUT 357.85 08 RADIOLOGICAL PHARMACEUTIC0884304 S STRL NDL CHIB 19GA/15CM 64.95 08 RADIOLOGICAL PHARMACEUTIC0885202 S STRL NDL HVL SPNL 22GA 104.35 08 RADIOLOGICAL PHARMACEUTIC0885004 S STRL CT NDL COAXL BIOP 132.05 08 RADIOLOGICAL PHARMACEUTIC0884601 S STRL CATH INTIMA 22GA 20.25 08 RADIOLOGICAL PHARMACEUTIC0884403 S STRL CT NDL CHIB 22GA 64.95 08 RADIOLOGICAL PHARMACEUTIC

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0884387 S STRL CT NDL CHIB 22GA 64.95 08 RADIOLOGICAL PHARMACEUTIC0884361 S STRL CT NDL CHIB 22GA 52.20 08 RADIOLOGICAL PHARMACEUTIC0884346 S STRL NDL CHIB 20GA/15CM 77.75 08 RADIOLOGICAL PHARMACEUTIC0885806 S STRL NDL PERCU CUT BIOP 171.45 08 RADIOLOGICAL PHARMACEUTIC0851709 RP GALLIUM GA-67 DX 1 MCI 96.00 08 RADIOLOGICAL PHARMACEUTIC0852525 RP DX I131 SOD SOL/MCI 08 RADIOLOGICAL PHARMACEUTIC0852574 RP TX I131 SOD SOL/MCI 08 RADIOLOGICAL PHARMACEUTIC0851485 RP C14 UREA/TEST 102.00 08 RADIOLOGICAL PHARMACEUTIC0852012 RP I123 MIBG 225.00 08 RADIOLOGICAL PHARMACEUTIC0852368 RP I123 MIBG 2549.00 08 RADIOLOGICAL PHARMACEUTIC0852004 RP I123 DX 100UCI TO 999 88.00 08 RADIOLOGICAL PHARMACEUTIC0852020 RP I123 DX 100UCI TO 999 1.00 08 RADIOLOGICAL PHARMACEUTIC0855007 RP TC99M PERTEC DX EA MCI 66.00 08 RADIOLOGICAL PHARMACEUTIC0853002 RP IN111 ONCSCNT DX 6MCI 5852.00 08 RADIOLOGICAL PHARMACEUTIC0855304 RP TC99M SESTMBI DX 40MCI 781.00 08 RADIOLOGICAL PHARMACEUTIC0856609 RP TC99M MYOVIEW DX 40MCI 326.00 08 RADIOLOGICAL PHARMACEUTIC0856500 RP TC99M MDP 1-30MCI 88.00 08 RADIOLOGICAL PHARMACEUTIC0855056 RP TC99M ACUTECT DX 20MCI 1729.00 08 RADIOLOGICAL PHARMACEUTIC0853309 RP IN111 PRSTSCN DX 10MCI 3628.00 08 RADIOLOGICAL PHARMACEUTIC0855601 RP TC99M CERETEC DX 25MCI 1133.00 08 RADIOLOGICAL PHARMACEUTIC0854109 RP SR89 TX PER MCI 7645.00 08 RADIOLOGICAL PHARMACEUTIC0852467 RP I131 TOSITUMOMAB DX DS 4785.00 08 RADIOLOGICAL PHARMACEUTIC0852475 RP I131 TOSITUMOMAB RX DS 41470.00 08 RADIOLOGICAL PHARMACEUTIC0853408 RP IN111 OXYQIN DX 0.5MCI 2332.00 08 RADIOLOGICAL PHARMACEUTIC0853200 RP IN111 DTPA/0.5MCI 2420.00 08 RADIOLOGICAL PHARMACEUTIC0858225 RP XE133 DX 10MCI 08 RADIOLOGICAL PHARMACEUTIC0854026 RP P32 SODIUM PHO RX 1MCI 633.00 08 RADIOLOGICAL PHARMACEUTIC0854018 RP P32 CHROMIC RX 1MCI 1865.00 08 RADIOLOGICAL PHARMACEUTIC0851519 RP CO57 CYANO DX PO 1UCI 08 RADIOLOGICAL PHARMACEUTIC0856005 RP TC99M PENTETA DX 25MCI 110.00 08 RADIOLOGICAL PHARMACEUTIC0855908 RP TC99M PENTETA DX 25MCI 88.00 08 RADIOLOGICAL PHARMACEUTIC0857102 RP TC99M SULFR/C DX 20MCI 286.00 08 RADIOLOGICAL PHARMACEUTIC0857003 RP TC99M SULFR/C DX 20MCI 88.00 08 RADIOLOGICAL PHARMACEUTIC0856302 RP TC99M MAA DX 10MCI 140.00 08 RADIOLOGICAL PHARMACEUTIC0856104 RP TC99M GLUCEPT DX 25MCI 83.00 08 RADIOLOGICAL PHARMACEUTIC0856807 RP TC99M PYROPHO DX 25MCI 155.00 08 RADIOLOGICAL PHARMACEUTIC0856401 RP TC99M MERTIAT DX 15MCI 2130.00 08 RADIOLOGICAL PHARMACEUTIC

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0855700 RP TC99M MEBROFN DX 15MCI 133.00 08 RADIOLOGICAL PHARMACEUTIC0856906 RP TC99M RBC/TAG DX 30MCI 177.00 08 RADIOLOGICAL PHARMACEUTIC0857607 RP Y90 IBRITUM RX 40MCI 33287.00 08 RADIOLOGICAL PHARMACEUTIC0855551 RP TC99M SC FLT DX 20MCI 460.00 08 RADIOLOGICAL PHARMACEUTIC0852814 RP I131 DX 1UCI MAX 100 356.00 08 RADIOLOGICAL PHARMACEUTIC0855486 RP DX TC99M ARCTMMB 45MCI 2335.00 08 RADIOLOGICAL PHARMACEUTIC0853648 RP IN111 OCTREOSC DX 6MCI 2800.00 08 RADIOLOGICAL PHARMACEUTIC0854059 SM 153 LEXIDRONAM 150MCI 4852.00 08 RADIOLOGICAL PHARMACEUTIC0851014 DIPYRIDAMOLE/10MG IJ 69.00 08 RADIOLOGICAL PHARMACEUTIC0824300 CON HOCM <=149MG/ML 1ML 105.00 08 RADIOLOGICAL PHARMACEUTIC0824102 CON LOCM <= 149S I 1ML 174.00 08 RADIOLOGICAL PHARMACEUTIC0823351 CON LOCM 300-349S I 1ML 174.00 08 RADIOLOGICAL PHARMACEUTIC0823856 CON LOCM 350-399S I 1ML 174.00 08 RADIOLOGICAL PHARMACEUTIC0859132 CON GAD-BASE MR 1ML IJ 5.80 08 RADIOLOGICAL PHARMACEUTIC0851444 SINCALIDE 5MCG IJ 110.00 08 RADIOLOGICAL PHARMACEUTIC0898619 REGADENOSON 0.1MG IJ 225.00 08 RADIOLOGICAL PHARMACEUTIC6010375 OXYGEN 481.40 60 RESPIRATORY SERVICES6010797 OXYGEN 481.40 60 RESPIRATORY SERVICES6011068 OXYGEN 481.40 60 RESPIRATORY SERVICES6011050 OXYGEN 481.40 60 RESPIRATORY SERVICES6012397 OXYGEN 207.00 60 RESPIRATORY SERVICES6012405 OXYGEN 240.00 60 RESPIRATORY SERVICES6012413 OXYGEN 202.00 60 RESPIRATORY SERVICES6011852 OXYGEN 481.40 60 RESPIRATORY SERVICES6011894 OXYGEN 481.40 60 RESPIRATORY SERVICES6010854 INTUBATION ET EMERGENCY 323.00 60 RESPIRATORY SERVICES6011431 CAPILLARY PUNCTURE 60 RESPIRATORY SERVICES6011076 CARDIOVERT ELECTIVE EXT 1400.00 60 RESPIRATORY SERVICES6010896 S NSTRL BIPAP CIRC 337.60 60 RESPIRATORY SERVICES6010904 S NSTRL BIPAP FULL MASK 490.95 60 RESPIRATORY SERVICES6010938 S NSTRL MIST CIRC 64.95 60 RESPIRATORY SERVICES6010912 S NSTRL BIPAP NASAL MASK 332.30 60 RESPIRATORY SERVICES6010821 S NSTRL MASK OXYGEN 2.15 60 RESPIRATORY SERVICES6010839 S NSTRL MASK AEROSOL 40.45 60 RESPIRATORY SERVICES6010847 S NSTRL CANNULA OXYGEN 3.20 60 RESPIRATORY SERVICES6010888 S NSTRL PEAK FLOW METER 276.90 60 RESPIRATORY SERVICES6010920 S NSTRL FLUTER VALVE 706.10 60 RESPIRATORY SERVICES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

6010813 S NSTRL MASK VENTURI 74.55 60 RESPIRATORY SERVICES6010102 S NSTRL DISP RESUC BAG 1156.60 60 RESPIRATORY SERVICES6010433 S NSTRL PEAK FLOW METER 600.65 60 RESPIRATORY SERVICES6010342 S STRL OXIMETRY PROBE 123.05 60 RESPIRATORY SERVICES6010573 S STRL VENTILATOR CIRCUIT 386.60 60 RESPIRATORY SERVICES6010052 S STRL CLOSED TRACHEAL S 252.40 60 RESPIRATORY SERVICES6010946 S STRL WATER 760 ML 76.70 60 RESPIRATORY SERVICES6010953 S STRL WATER 1070 ML 91.60 60 RESPIRATORY SERVICES6010250 S STRL MDI SPACER 755.10 60 RESPIRATORY SERVICES6010037 ARTERIAL PUNCTURE 249.00 60 RESPIRATORY SERVICES6012165 ARTERIAL PUNCTURE 249.00 60 RESPIRATORY SERVICES6012389 EXT ECG EVNT RCRD/MNTR 749.00 60 RESPIRATORY SERVICES6010680 CPR 723.00 60 RESPIRATORY SERVICES6012280 SPIROMETRY 680.00 60 RESPIRATORY SERVICES6010490 SPIROMETRY PRE/POST BD 1279.00 60 RESPIRATORY SERVICES6012256 SPIROMETRY PRE/POST BD 1279.00 60 RESPIRATORY SERVICES6012264 VITAL CAPACITY 297.00 60 RESPIRATORY SERVICES6011175 THORACIC GAS VOLUME 1120.00 60 RESPIRATORY SERVICES6011183 AIRWAY RESISTANCE 225.00 60 RESPIRATORY SERVICES6010771 RESP FLOW VOLUME LOOP 678.00 60 RESPIRATORY SERVICES6010730 IPPB DEMO/EVAL 636.00 60 RESPIRATORY SERVICES6010185 IPPB TX SUBSEQUENT 296.00 60 RESPIRATORY SERVICES6010607 VENT MGMNT INITIAL 4057.00 60 RESPIRATORY SERVICES6012504 VENT MGMNT INITIAL 4057.00 60 RESPIRATORY SERVICES6011589 VENT MGMNT INIT NEO/PEDS 4057.00 60 RESPIRATORY SERVICES6010581 VENT MGMNT SUBSEQUENT 3309.00 60 RESPIRATORY SERVICES6012512 VENT MGMNT SUBSEQUENT 3309.00 60 RESPIRATORY SERVICES6011597 VENT MGMNT SUBSQ NEO/PEDS 3309.00 60 RESPIRATORY SERVICES6010631 AEROSOL TX DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011688 AEROSOL TX DEMO/EVAL 200.00 60 RESPIRATORY SERVICES6012488 AEROSOL TX DEMO/EVAL 636.00 60 RESPIRATORY SERVICES6010235 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011035 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011605 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011654 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011662 MDI/NEB DEMO/EVAL 445.00 60 RESPIRATORY SERVICES6011670 MDI/NEB DEMO/EVAL 445.00 60 RESPIRATORY SERVICES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

6011647 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011639 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011613 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6011621 MDI/NEB DEMO/EVAL 330.00 60 RESPIRATORY SERVICES6010011 AEROSOL TX SUBSQ 300.00 60 RESPIRATORY SERVICES6011753 AEROSOL TX SUBSQ 300.00 60 RESPIRATORY SERVICES6012496 AEROSOL TX SUBSQ 296.00 60 RESPIRATORY SERVICES6011043 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6010243 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011720 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011704 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011746 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011738 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011696 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6011712 MDI/NEB SUBSQ 300.00 60 RESPIRATORY SERVICES6010177 CPT INITIAL 504.00 60 RESPIRATORY SERVICES6012462 CPT INITIAL 504.00 60 RESPIRATORY SERVICES6012447 CPT INITIAL 504.00 60 RESPIRATORY SERVICES6011761 CPT INITIAL 504.00 60 RESPIRATORY SERVICES6012421 CPT INITIAL 504.00 60 RESPIRATORY SERVICES6010417 CPT SUBSEQUENT 286.00 60 RESPIRATORY SERVICES6012470 CPT SUBSEQUENT 286.00 60 RESPIRATORY SERVICES6012454 CPT SUBSEQUENT 286.00 60 RESPIRATORY SERVICES6011779 CPT SUBSEQUENT 286.00 60 RESPIRATORY SERVICES6012439 CPT SUBSEQUENT 286.00 60 RESPIRATORY SERVICES6010094 CO DIFFUSING CAPACITY 618.00 60 RESPIRATORY SERVICES6010482 PULMONARY COMPLIANCE 1592.00 60 RESPIRATORY SERVICES6010334 PULSE OXIMETRY SINGLE 174.00 60 RESPIRATORY SERVICES6012223 PULSE OXIMETRY SINGLE 174.00 60 RESPIRATORY SERVICES6010326 PULSE OXIMETRY MULTIPLE 451.00 60 RESPIRATORY SERVICES6012231 PULSE OXIMETRY MULTIPLE 452.00 60 RESPIRATORY SERVICES6011324 PULSE OX-OVERNIGHT CONT 622.00 60 RESPIRATORY SERVICES6012249 PULSE OX-OVERNIGHT CONT 624.00 60 RESPIRATORY SERVICES6010961 ETCO2 INIT DAY 974.00 60 RESPIRATORY SERVICES6012173 ETCO2 INIT DAY 976.00 60 RESPIRATORY SERVICES6010110 ETCO2 SUBSQ DAY 974.00 60 RESPIRATORY SERVICES6012348 EXT ECG CONT RCRD/STR 48H 1093.00 60 RESPIRATORY SERVICES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

6010524 SUCTION NASOTRACHEAL 190.00 60 RESPIRATORY SERVICES6010516 SPUTUM INDCTN VIA AEROSOL 806.00 60 RESPIRATORY SERVICES6011787 SPUTUM INDCTN VIA AEROSOL 806.00 60 RESPIRATORY SERVICES6011472 CBT 1ST HOUR 200.00 60 RESPIRATORY SERVICES6011480 CBT EACH ADDL HOUR 165.00 60 RESPIRATORY SERVICES6010227 CPAP/BIPAP INITIAL DAY 2489.00 60 RESPIRATORY SERVICES6011498 CPAP/BIPAP INITIAL DAY 2489.00 60 RESPIRATORY SERVICES6011951 CPAP/BIPAP INITIAL DAY 2489.00 60 RESPIRATORY SERVICES6011944 CPAP/BIPAP INITIAL DAY 2489.00 60 RESPIRATORY SERVICES6010201 CPAP/BIPAP SUBSEQUENT DAY 2489.00 60 RESPIRATORY SERVICES6011506 CPAP/BIPAP SUBSEQUENT DAY 2489.00 60 RESPIRATORY SERVICES6012355 EXT ECG CONT SCAN/RPT 48H 667.00 60 RESPIRATORY SERVICES6011449 PH BLD 201.00 60 RESPIRATORY SERVICES6012363 PLETHYSMOGRAPHY LUNG VOL 1120.00 60 RESPIRATORY SERVICES6012371 PULM FUNC BY OSCILLOMETRY 225.00 60 RESPIRATORY SERVICES6011464 BLD GAS ART 457.00 60 RESPIRATORY SERVICES6010045 BLD GASES W/O2 SAT 87.00 60 RESPIRATORY SERVICES6011456 BODY FLUID PH NOS 55.00 60 RESPIRATORY SERVICES0011007 ROOM MED/SURG/GYN 3384.00 00 ROOM & BED0010017 ROOM MED/SURG/GYN 3027.00 00 ROOM & BED0044008 ROOM OB/MATERNAL 3162.00 00 ROOM & BED0004002 ROOM OB/MATERNAL 1.00 00 ROOM & BED0041004 ROOM OB/MATERNAL 3162.00 00 ROOM & BED0040014 ROOM OB/MATERNAL 3162.00 00 ROOM & BED0095000 ROOM PEDIATRIC 1119.00 00 ROOM & BED0075002 NEWBORN BOARDER BABY 1523.00 00 ROOM & BED0071001 NEWBORN BOARDER BABY 1523.00 00 ROOM & BED0055004 NEWBORN LEVEL I 1250.00 00 ROOM & BED0051003 NEWBORN LEVEL I 1250.00 00 ROOM & BED0021006 NEWBORN LEVEL II 4500.00 00 ROOM & BED0025007 NEWBORN LEVEL II 4500.00 00 ROOM & BED0035006 NEWBORN LEVEL III 6500.00 00 ROOM & BED0045005 NEWBORN LEVEL IV 11400.00 00 ROOM & BED0020016 ROOM ICU 7903.00 00 ROOM & BED0091009 ROOM TELEMETRY/SPEC CARE 3674.00 00 ROOM & BED0090019 ROOM TELEMETRY/SPEC CARE 3287.00 00 ROOM & BED0031005 OBSERVATION PER HOUR 173.00 00 ROOM & BED

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0064006 OBSERVATION PER HOUR 173.00 00 ROOM & BED0030015 OBSERVATION PER HOUR 173.00 00 ROOM & BED0010025 ROOM NO CHARGE 00 ROOM & BED9490210 NA CL 0.45% 1000ML 94 SDH IV INFUSION THERAPY9433202 NA CL 0.45% 1000ML 94 SDH IV INFUSION THERAPY9432618 NA CL 0.45% 500ML 94 SDH IV INFUSION THERAPY9431073 S NSTRL MEDTRONIC REFILL 170.79 94 SDH IV INFUSION THERAPY9430331 S STRL DRSG BIOPATCH 1IN 27.37 94 SDH IV INFUSION THERAPY9431123 S STRL NDL GRIPPR 22GX3/4 34.62 94 SDH IV INFUSION THERAPY9430216 S STRL CATH INSYTE W 24G 11.62 94 SDH IV INFUSION THERAPY9430083 S STRL BLOOD SET Y-TYPE 10.68 94 SDH IV INFUSION THERAPY9431420 S STRL SET PHLEBTYM 500C 33.63 94 SDH IV INFUSION THERAPY9431651 S STRL SET IV SEC BLD TU 8.69 94 SDH IV INFUSION THERAPY9430778 S STRL GRSHNG PICC DL 549.16 94 SDH IV INFUSION THERAPY9431891 S STRL COVER PROBE SHEATH 53.34 94 SDH IV INFUSION THERAPY9431842 S STRL COBE BLOOD WARMER 46.75 94 SDH IV INFUSION THERAPY9439886 S STRL GROSHONG POWER PIC 2501.00 94 SDH IV INFUSION THERAPY9430463 S STRL EPI ANESTH TRAY 77.50 94 SDH IV INFUSION THERAPY9431099 S STRL MIDLINE CATHETER 3 234.83 94 SDH IV INFUSION THERAPY9431065 S STRL LP TRAY W.20 74.40 94 SDH IV INFUSION THERAPY9430844 S STRL INTRODUCER NEEDLE 94.53 94 SDH IV INFUSION THERAPY9430836 S STRL INTRODUCER NEEDLE 96.66 94 SDH IV INFUSION THERAPY9430828 S STRL INTRODUCER NEEDLE 93.42 94 SDH IV INFUSION THERAPY9430794 S STRL GRSHNG PICC SL 343.82 94 SDH IV INFUSION THERAPY9430786 S STRL GROSHONG PICC 3FR 382.02 94 SDH IV INFUSION THERAPY9430760 S STRL GRSHNG CATH RP 9.5 496.63 94 SDH IV INFUSION THERAPY9431115 S STRL NDL GRIPPR 20GX3/4 23.46 94 SDH IV INFUSION THERAPY9430745 S STRL GRSHNG REP KIT DL 290.25 94 SDH IV INFUSION THERAPY9430349 S STRL DRSG BIOPTCH 3/4IN 26.33 94 SDH IV INFUSION THERAPY9430315 S STRL TRAY,MAHURKAR OL 1 428.96 94 SDH IV INFUSION THERAPY9430273 S STRL CATH SAF-T-INTIMA 20.29 94 SDH IV INFUSION THERAPY9430265 S STRL CATH SAF-T-INTIMA 20.29 94 SDH IV INFUSION THERAPY9430257 S STRL CATH SAF-T-INTIMA 20.29 94 SDH IV INFUSION THERAPY9430240 S STRL CATH SAF-T-INTIMA 20.29 94 SDH IV INFUSION THERAPY9430232 S STRL GRSHNG REP CON 9.5 62.53 94 SDH IV INFUSION THERAPY9430224 S STRL GRSHNG REP CON 8FR 62.53 94 SDH IV INFUSION THERAPY9430752 S STRL GRSHNG CATH REP 8 496.63 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9431743 S STRL TRAY FULL GROSHONG 821.35 94 SDH IV INFUSION THERAPY9431867 S STRL STERILE EVAC BOTTL 303.20 94 SDH IV INFUSION THERAPY9431859 S STRL THORACENTESIS TRAY 612.70 94 SDH IV INFUSION THERAPY9432030 S STRL CATH FOLEY 3WAY 109.15 94 SDH IV INFUSION THERAPY9431834 S STRL SPICC 4 FR REPLACE 90.88 94 SDH IV INFUSION THERAPY9431818 S STRL TRANSDUCER COVERS 43.54 94 SDH IV INFUSION THERAPY9431800 S STRL MINI-STICK KIT 5FR 198.71 94 SDH IV INFUSION THERAPY9431107 S STRL MIDLINE CATHETER 4 213.48 94 SDH IV INFUSION THERAPY9431750 S STRL APPL CHL SWABSTICK 6.39 94 SDH IV INFUSION THERAPY9431735 S STRL TRAY FULL GROSHONG 618.88 94 SDH IV INFUSION THERAPY9431727 S STRL TRAY FULL GROSHONG 618.88 94 SDH IV INFUSION THERAPY9431628 S STRL CATH J&J PROTECTIV 13.12 94 SDH IV INFUSION THERAPY9431610 S STRL CATH J&J PROTECTIV 13.12 94 SDH IV INFUSION THERAPY9431602 S STRL CATH J&J PROTECTIV 13.12 94 SDH IV INFUSION THERAPY9431594 S STRL CATH INSYTE AUTOGU 11.62 94 SDH IV INFUSION THERAPY9431578 S STRL MICR INTRD KIT 5FR 229.50 94 SDH IV INFUSION THERAPY9431560 S STRL MICR INTRD KIT 4FR 235.90 94 SDH IV INFUSION THERAPY9431552 S STRL MICR INTRD KIT 3FR 253.66 94 SDH IV INFUSION THERAPY9431545 S STRL THORACENTESIS TRAY 113.94 94 SDH IV INFUSION THERAPY9431438 S STRL SPNL TRAY 25G 39.45 94 SDH IV INFUSION THERAPY9431792 S STRL SURGIFOAM J&J 28.56 94 SDH IV INFUSION THERAPY9430208 S STRL CATH INSYTE 22 G 1 11.62 94 SDH IV INFUSION THERAPY9430190 S STRL CATH INSYTE 20 X 1 11.62 94 SDH IV INFUSION THERAPY9430182 S STRL CATH INSYTE 18 X 1 11.62 94 SDH IV INFUSION THERAPY9430109 S STRL TRAY BONE MARR ASP 115.06 94 SDH IV INFUSION THERAPY9430091 S STRL NDL BONE MARR ASP 12.75 94 SDH IV INFUSION THERAPY9430042 S STRL ARROW TL CATH KT 146.95 94 SDH IV INFUSION THERAPY9430034 S STRL ARROW SL CATH KT 59.35 94 SDH IV INFUSION THERAPY9490889 ACYCLOVIR 5 MG IJ 94 SDH IV INFUSION THERAPY9450404 ASPIRATION BONE MARROW 1018.00 94 SDH IV INFUSION THERAPY9461252 ALBUMIN 5%/250ML 94 SDH IV INFUSION THERAPY9433459 ALBUMIN 25%/50ML 94 SDH IV INFUSION THERAPY9483165 ALBUMIN 25%/50ML 94 SDH IV INFUSION THERAPY9489741 ALDESLEUKIN/SGL DOSE IJ 94 SDH IV INFUSION THERAPY9432857 ALPRAZOLAM 94 SDH IV INFUSION THERAPY9483520 ALTEPLASE 1MG IJ 94 SDH IV INFUSION THERAPY9450420 LUMBAR PUNCTURE DX 578.00 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470592 AMIFOSTINE 500MG IJ 94 SDH IV INFUSION THERAPY9489592 ARSENIC TRIOXIDE 1MG IJ 94 SDH IV INFUSION THERAPY9431883 GUIDEWIRE 293.25 94 SDH IV INFUSION THERAPY9431875 GUIDEWIRE 199.50 94 SDH IV INFUSION THERAPY9431909 EP STEER GUID INTRO/SHTH 95.50 94 SDH IV INFUSION THERAPY9450685 IMMUN ADMIN SGL VACCNE 88.00 94 SDH IV INFUSION THERAPY9450693 IMMUN ADMIN EA ADD VACCNE 75.00 94 SDH IV INFUSION THERAPY9450198 INJECTION IM/SQ EA 186.00 94 SDH IV INFUSION THERAPY9450453 INJ IVP SNGL/INIT DRG 182.00 94 SDH IV INFUSION THERAPY9433624 FACTOR 8 RECM/IU IJ 94 SDH IV INFUSION THERAPY9432287 FACTOR 8 RECM/IU IJ 94 SDH IV INFUSION THERAPY9433616 FACTOR 8 RECM/IU IJ 94 SDH IV INFUSION THERAPY9490418 FACTOR 8 RECM/IU IJ 94 SDH IV INFUSION THERAPY9432840 APAP/COD 94 SDH IV INFUSION THERAPY9491366 APAP/OXYCOD 94 SDH IV INFUSION THERAPY9491051 ARGININE 94 SDH IV INFUSION THERAPY9489675 ASCORBIC ACID 500MG/ML 94 SDH IV INFUSION THERAPY9490103 ASPARAGINASE 10000U IJ 94 SDH IV INFUSION THERAPY9450529 LEVEL 1 NEW PATIENT 549.00 94 SDH IV INFUSION THERAPY9450537 LEVEL 2 NEW PATIENT 610.00 94 SDH IV INFUSION THERAPY9450545 LEVEL 3 NEW PATIENT 671.00 94 SDH IV INFUSION THERAPY9450552 LEVEL 4 NEW PATIENT 733.00 94 SDH IV INFUSION THERAPY9450560 LEVEL 5 NEW PATIENT 794.00 94 SDH IV INFUSION THERAPY9450164 LEVEL 1 EST PATIENT 549.00 94 SDH IV INFUSION THERAPY9450461 LEVEL 2 EST PATIENT 610.00 94 SDH IV INFUSION THERAPY9450479 LEVEL 3 EST PATIENT 671.00 94 SDH IV INFUSION THERAPY9450487 LEVEL 4 EST PATIENT 733.00 94 SDH IV INFUSION THERAPY9450495 LEVEL 5 EST PATIENT 794.00 94 SDH IV INFUSION THERAPY9450248 VENIPUNCTURE 14.00 94 SDH IV INFUSION THERAPY9450875 ADMIN INFLUENZA VACC 90.00 94 SDH IV INFUSION THERAPY9450883 ADMIN PNEUMOCOCCAL VACC 156.00 94 SDH IV INFUSION THERAPY9450073 INFUSN CHEMO 0-60 MN 982.00 94 SDH IV INFUSION THERAPY9450503 INFUSN CHEMO EA ADD HR 698.00 94 SDH IV INFUSION THERAPY9450131 INF CHMO INTRA ART 16-60M 1506.00 94 SDH IV INFUSION THERAPY9450123 INF CHEM IA EA ADDL HR 668.00 94 SDH IV INFUSION THERAPY9470022 BLEOMYCIN 15U IJ 94 SDH IV INFUSION THERAPY9432352 BLEOMYCIN 15U IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9432071 BLEOMYCIN 15U IJ 94 SDH IV INFUSION THERAPY9431972 BLEOMYCIN 15U IJ 94 SDH IV INFUSION THERAPY9470725 BLEOMYCIN 15U IJ 94 SDH IV INFUSION THERAPY9460270 CAPTOPRIL 25MG TAB 94 SDH IV INFUSION THERAPY9431973 CARBOPLATIN 50MG IJ 94 SDH IV INFUSION THERAPY9433863 CARBOPLATIN 50MG IJ 94 SDH IV INFUSION THERAPY9431975 CARBOPLATIN 50MG IJ 94 SDH IV INFUSION THERAPY9432873 CARBOPLATIN 50MG IJ 94 SDH IV INFUSION THERAPY9470048 CARBOPLATIN 50MG IJ 94 SDH IV INFUSION THERAPY9470011 CARMUSTINE 100MG IJ 94 SDH IV INFUSION THERAPY9483132 CASPOFUNGIN/5MG IJ 94 SDH IV INFUSION THERAPY9451006 CETIRIZINE 94 SDH IV INFUSION THERAPY9490400 CIDOFOVIR 375 MG IJ 94 SDH IV INFUSION THERAPY9490038 CIMETIDINE ORAL TABLET 94 SDH IV INFUSION THERAPY9470063 CISPLATIN 10MG IJ 94 SDH IV INFUSION THERAPY9431976 CISPLATIN 10MG IJ 94 SDH IV INFUSION THERAPY9432048 CISPLATIN 10MG IJ 94 SDH IV INFUSION THERAPY9431977 CISPLATIN 10MG IJ 94 SDH IV INFUSION THERAPY9470733 CLADRIBINE/1MG IJ 94 SDH IV INFUSION THERAPY9483181 IG CYTOMEGALOVIRUS VIAL 94 SDH IV INFUSION THERAPY9491002 CYCLOPHOSPHAMID 100MG IJ 94 SDH IV INFUSION THERAPY9470089 CYCLOPHOSPHAMID 100MG IJ 94 SDH IV INFUSION THERAPY9470873 CYTARABINE 100MG IJ 94 SDH IV INFUSION THERAPY9490251 D51/4NS 1000ML 94 SDH IV INFUSION THERAPY9410150 D5NS 1000ML 94 SDH IV INFUSION THERAPY9433178 D5NS 1000ML 94 SDH IV INFUSION THERAPY9470013 D5NS 500ML 94 SDH IV INFUSION THERAPY9470568 DACARBAZINE 100MG IJ 94 SDH IV INFUSION THERAPY9482548 DACLIZUMAB 25MG IJ 94 SDH IV INFUSION THERAPY9470170 DAUNORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9480468 DEFEROXAMINE 500MG IJ 94 SDH IV INFUSION THERAPY9432345 DENILEUKIN 300MCG IJ 94 SDH IV INFUSION THERAPY9450024 BLOOD TRANSFUSN 2-4 HR 1284.00 94 SDH IV INFUSION THERAPY9450511 BLOOD TRANSFUSN 4-6 HR 2020.00 94 SDH IV INFUSION THERAPY9480500 DESMOPRESSIN ACET 1MCG IJ 94 SDH IV INFUSION THERAPY9450032 BLOOD TRANSFUSN GT 6HR 2484.00 94 SDH IV INFUSION THERAPY9450016 BLOOD TRANSFUSN LT 2 HR 735.00 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470758 DEXRAZOXANE/250MG IJ 94 SDH IV INFUSION THERAPY9433582 DEXRAZOXANE/250MG IJ 94 SDH IV INFUSION THERAPY9483918 DMSO 50% INJ 94 SDH IV INFUSION THERAPY9483892 DOLASETRON MESYLT 10MG IJ 94 SDH IV INFUSION THERAPY9483470 DOPAMINE HCL 40 MG IJ 94 SDH IV INFUSION THERAPY9433020 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9433277 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9433285 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9432220 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9470717 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9470196 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9432212 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9432238 DOXORUBICIN 10MG IJ 94 SDH IV INFUSION THERAPY9480575 DOXYCYCLINE HYCLATE 100MG 94 SDH IV INFUSION THERAPY9431996 EPIRUBICIN 2MG IJ 94 SDH IV INFUSION THERAPY9432055 EPIRUBICIN 2MG IJ 94 SDH IV INFUSION THERAPY9470808 EPIRUBICIN 2MG IJ 94 SDH IV INFUSION THERAPY9490673 EPOETIN NON-ESRD/1000U IJ 94 SDH IV INFUSION THERAPY9490657 EPOETIN NON-ESRD/1000U IJ 94 SDH IV INFUSION THERAPY9490665 EPOETIN NON-ESRD/1000U IJ 94 SDH IV INFUSION THERAPY9432410 ETOPOSIDE 10MG IJ 94 SDH IV INFUSION THERAPY9491234 ETOPOSIDE 10MG IJ 94 SDH IV INFUSION THERAPY9491036 ETOPOSIDE 10MG IJ 94 SDH IV INFUSION THERAPY9432760 ETOPOSIDE 10MG IJ 94 SDH IV INFUSION THERAPY9491242 ETOPOSIDE 10MG IJ 94 SDH IV INFUSION THERAPY9483959 FAMOTIDINE 94 SDH IV INFUSION THERAPY9481839 FILGRASTIM 300MCG IJ 94 SDH IV INFUSION THERAPY9481821 FILGRASTIM 480MCG IJ 94 SDH IV INFUSION THERAPY9491226 FLUDARABINE 50MG IJ 94 SDH IV INFUSION THERAPY9490913 FLUDARABINE 50MG IJ 94 SDH IV INFUSION THERAPY9432246 FLUDARABINE 50MG IJ 94 SDH IV INFUSION THERAPY9491218 FLUDARABINE 50MG IJ 94 SDH IV INFUSION THERAPY9490822 FOLIC ACID 94 SDH IV INFUSION THERAPY9450396 COLLECT BLD VNS ACCES DVC 268.00 94 SDH IV INFUSION THERAPY9450446 DECLOT VASC DEVICE 155.00 94 SDH IV INFUSION THERAPY9490293 FOSCARNET SOD 1000 MG IJ 94 SDH IV INFUSION THERAPY9480963 FUROSEMIDE 20MG TAB 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9450255 PHLEBOTOMY THERAPEUTIC 553.00 94 SDH IV INFUSION THERAPY9450297 REFILL/MAINT PORTABL PUMP 682.00 94 SDH IV INFUSION THERAPY9490681 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9432451 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9433244 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9470253 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9433251 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9433046 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9432790 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9433269 GEMCITABINE 200MG IJ 94 SDH IV INFUSION THERAPY9450891 THORACENTESIS 575.00 94 SDH IV INFUSION THERAPY9490947 GOSERELIN/3.6MG IMPLNT 94 SDH IV INFUSION THERAPY9483264 GOSERELIN/3.6MG IMPLNT 94 SDH IV INFUSION THERAPY9432303 GRANISETRON 100MCG IJ 94 SDH IV INFUSION THERAPY9460064 GRANISETRON 1MG PO 94 SDH IV INFUSION THERAPY9450677 REMV TUNN CV CATH W/O PT 459.00 94 SDH IV INFUSION THERAPY9450628 CHEMO IV PMP INFSN GT 8HR 1467.00 94 SDH IV INFUSION THERAPY9450602 CHEMO INJ BRAIN/HEART SQ 1368.00 94 SDH IV INFUSION THERAPY9450594 CHEMO CNS W/SPINAL PUNC 909.00 94 SDH IV INFUSION THERAPY9450578 CHEMO PLURAL CAV W/THOR 2847.00 94 SDH IV INFUSION THERAPY9460288 HCTZ 25MG PO 94 SDH IV INFUSION THERAPY9483694 HEMIN/1MG IJ 94 SDH IV INFUSION THERAPY9489584 VX HEP A ADULT IM 94 SDH IV INFUSION THERAPY9481144 HEP B IG HUMAN IM 94 SDH IV INFUSION THERAPY9483371 VX HEP B ADULT IM 94 SDH IV INFUSION THERAPY9483942 HETASTARCH 500ML 94 SDH IV INFUSION THERAPY9432402 HYDROCOD/APAP 94 SDH IV INFUSION THERAPY9433707 HYDROCOD/APAP 94 SDH IV INFUSION THERAPY9433699 HYDROCOD/APAP 94 SDH IV INFUSION THERAPY9460072 HYDROCODONE 5MG PO 94 SDH IV INFUSION THERAPY9431994 HYDROMORPHONE 94 SDH IV INFUSION THERAPY9431995 HYDROMORPHONE 94 SDH IV INFUSION THERAPY9470001 IBUPROFEN 94 SDH IV INFUSION THERAPY9490483 IDARUBICIN/5MG IJ 94 SDH IV INFUSION THERAPY9460320 IFOSFAMIDE/1GM IJ 94 SDH IV INFUSION THERAPY9433715 IFOSFAMIDE/1GM IJ 94 SDH IV INFUSION THERAPY9482118 INFLIXIMAB 10MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9483553 INTERFERON A-2B 1000KU IJ 94 SDH IV INFUSION THERAPY9431974 IRINOTECAN 20MG IJ 94 SDH IV INFUSION THERAPY9490864 IRINOTECAN 20MG IJ 94 SDH IV INFUSION THERAPY9490865 IRINOTECAN 20MG IJ 94 SDH IV INFUSION THERAPY9470030 IRINOTECAN 20MG IJ 1381.35 94 SDH IV INFUSION THERAPY9490863 IRINOTECAN 20MG IJ 94 SDH IV INFUSION THERAPY9483827 ITRACONAZOLE 50 MG IJ 94 SDH IV INFUSION THERAPY9470018 K ACET 94 SDH IV INFUSION THERAPY9490327 K PHOS 94 SDH IV INFUSION THERAPY9432907 K CL 94 SDH IV INFUSION THERAPY9459744 INJ MAJOR JNT BURSA 531.00 94 SDH IV INFUSION THERAPY9433871 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9490939 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9491077 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9481474 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9432204 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9432196 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9481476 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9432188 LEUCOVORIN/50MG IJ 94 SDH IV INFUSION THERAPY9470956 LEUPROLIDE/3.75MG IJ 94 SDH IV INFUSION THERAPY9490897 LEUPROLIDE 7.5MG IJ 94 SDH IV INFUSION THERAPY9483207 LEUPROLIDE 7.5MG IJ 94 SDH IV INFUSION THERAPY9432725 LEUPROLIDE 7.5MG IJ 94 SDH IV INFUSION THERAPY9481524 LEVOTHYROXINE 94 SDH IV INFUSION THERAPY9480393 LIDOCAINE 94 SDH IV INFUSION THERAPY9433236 LIDOCAINE 94 SDH IV INFUSION THERAPY9489865 LINEZOLID/200MG IJ 94 SDH IV INFUSION THERAPY9470015 LOPERAMIDE 94 SDH IV INFUSION THERAPY9470016 LORATADINE 94 SDH IV INFUSION THERAPY9481558 LORAZEPAM 94 SDH IV INFUSION THERAPY9482845 MAG SO4/500MG INJ 94 SDH IV INFUSION THERAPY9470003 MANNITOL 94 SDH IV INFUSION THERAPY9483041 MANNITOL 25% IJ 94 SDH IV INFUSION THERAPY9489766 MEDROXYPROGESTER 50MG IJ 94 SDH IV INFUSION THERAPY9483777 VX MENINGOCOCCAL POLYSACC 94 SDH IV INFUSION THERAPY9433814 VX MENINGOCOCCAL POLYSACC 94 SDH IV INFUSION THERAPY9433822 MEPERIDINE 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470005 MEPERIDINE 94 SDH IV INFUSION THERAPY9481565 MEPERIDINE HCL /100MG 94 SDH IV INFUSION THERAPY9483512 MEROPENEM 100 MG IJ 94 SDH IV INFUSION THERAPY9432964 MESNA 200MG IJ 94 SDH IV INFUSION THERAPY9432956 MESNA 200MG IJ 94 SDH IV INFUSION THERAPY9470857 MESNA 200MG IJ 94 SDH IV INFUSION THERAPY9450651 INSRT NON-TUNN CV CATH<5 983.00 94 SDH IV INFUSION THERAPY9483231 MILRINONE/5MG IJ 94 SDH IV INFUSION THERAPY9450735 INSRT NON-TUNN CV CATH 5+ 94 SDH IV INFUSION THERAPY9450636 INS PICC W/O PORT 5+ YR 1141.00 94 SDH IV INFUSION THERAPY9450644 RPLC COMP NON-TUN CV CATH 1043.00 94 SDH IV INFUSION THERAPY9450669 RPLC COMP PICC W/O 1034.00 94 SDH IV INFUSION THERAPY9470394 MITOMYCIN 5MG IJ 94 SDH IV INFUSION THERAPY9470402 MITOXANTRONE/5MG IJ 94 SDH IV INFUSION THERAPY9481755 TRACE ELEM-5 10ML IV 94 SDH IV INFUSION THERAPY9483025 FERRIC GLUC 62.5MG 94 SDH IV INFUSION THERAPY9483710 NA THIOSULFATE 94 SDH IV INFUSION THERAPY9432550 NTG 94 SDH IV INFUSION THERAPY9483728 NTG 94 SDH IV INFUSION THERAPY9410226 NORMOSOL R 1000ML 94 SDH IV INFUSION THERAPY9432501 NA CL 0.9% 150ML 94 SDH IV INFUSION THERAPY9489808 NA CL 0.9% 50ML 94 SDH IV INFUSION THERAPY9433061 NA CL 0.9% 50ML 94 SDH IV INFUSION THERAPY9490806 OCTREOTIDE DEPO 1MG IJ 94 SDH IV INFUSION THERAPY9490814 OCTREOTIDE DEPO 1MG IJ 94 SDH IV INFUSION THERAPY9483397 OCTREOTIDE DEPO 1MG IJ 94 SDH IV INFUSION THERAPY9432007 OLANZAPINE 94 SDH IV INFUSION THERAPY9481888 ONDANSETRON/1MG IJ 94 SDH IV INFUSION THERAPY9432584 ONDANSETRON/1MG IJ 94 SDH IV INFUSION THERAPY9432592 ONDANSETRON/1MG IJ 94 SDH IV INFUSION THERAPY9432576 ONDANSETRON/1MG IJ 94 SDH IV INFUSION THERAPY9432568 ONDANSETRON/1MG IJ 94 SDH IV INFUSION THERAPY9481870 ONDANSETRON 8MG PO 94 SDH IV INFUSION THERAPY9490780 OPRELVEKIN 5MG IJ 94 SDH IV INFUSION THERAPY9433350 OXYCODONE 94 SDH IV INFUSION THERAPY9432113 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9470428 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9432105 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9431983 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9431981 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9432915 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9433038 PACLITAXEL 30MG IJ 94 SDH IV INFUSION THERAPY9481896 PAMIDRONATE/30MG IJ 94 SDH IV INFUSION THERAPY9432311 PAMIDRONATE/30MG IJ 94 SDH IV INFUSION THERAPY9431989 PAMIDRONATE/30MG IJ 94 SDH IV INFUSION THERAPY9483991 PANTOPRAZOLE/VIAL IJ 94 SDH IV INFUSION THERAPY9491069 PENTOSTATIN/10MG IJ 94 SDH IV INFUSION THERAPY9483561 VX PNMOCOCCL PLYSAC GT 2Y 94 SDH IV INFUSION THERAPY9491358 PROBENECID 94 SDH IV INFUSION THERAPY9482019 PROTEINASE INHB 10MG IJ 94 SDH IV INFUSION THERAPY9490152 PYRIDOXINE HCL 100 MG IJ 94 SDH IV INFUSION THERAPY9432394 QUINAPRIL 94 SDH IV INFUSION THERAPY9490095 IG RABIES IM/SUBCU 94 SDH IV INFUSION THERAPY9482084 VX RABIES INTRAMUSCULAR 94 SDH IV INFUSION THERAPY9490749 RITUXIMAB 100MG IJ 94 SDH IV INFUSION THERAPY9470436 RITUXIMAB 100MG IJ 94 SDH IV INFUSION THERAPY9483462 SARGRAMOSTIM 50MCG IJ 94 SDH IV INFUSION THERAPY9483744 NA BICARBONATE 94 SDH IV INFUSION THERAPY9490301 NA BIPHOSPHATE 94 SDH IV INFUSION THERAPY9490111 POLYSTYRENE 94 SDH IV INFUSION THERAPY9460312 SORBITOL 94 SDH IV INFUSION THERAPY9489881 THIAMINE HCL 100 MG IJ 94 SDH IV INFUSION THERAPY9489642 THYROTROPIN 1.1MG VL IJ 94 SDH IV INFUSION THERAPY9491200 TRASTUZUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9433343 TRIAMCINOLONE 94 SDH IV INFUSION THERAPY9489832 TUBERCULN SKIN TEST INTRA 60.22 94 SDH IV INFUSION THERAPY9491309 VALACYCLOVIR 94 SDH IV INFUSION THERAPY9489980 VALPROIC ACID 94 SDH IV INFUSION THERAPY9489659 VX VARICELLA VIRUS LIVE 94 SDH IV INFUSION THERAPY9470410 VINORELBINE 10MG IJ 94 SDH IV INFUSION THERAPY9432253 VINORELBINE 10MG IJ 94 SDH IV INFUSION THERAPY9490921 VINORELBINE 10MG IJ 94 SDH IV INFUSION THERAPY9470020 WATER 94 SDH IV INFUSION THERAPY9460304 MISC ORAL SOLID 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9490871 MISC ORAL LIQUID 94 SDH IV INFUSION THERAPY9490442 MISC TOPICAL/RECTAL 94 SDH IV INFUSION THERAPY9491150 MISC INJECTION 94 SDH IV INFUSION THERAPY9433889 MISC OTHER DRUG 94 SDH IV INFUSION THERAPY9490459 NA CL 0.9% 100ML 94 SDH IV INFUSION THERAPY9432642 NA CL 0.9% 100ML 94 SDH IV INFUSION THERAPY9432659 NA CL 0.9% 100ML 94 SDH IV INFUSION THERAPY9432667 NA CL 0.9% 100ML 94 SDH IV INFUSION THERAPY9433079 NA CL 0.9% 100ML 94 SDH IV INFUSION THERAPY9460171 PROCHLORPERAZINE 10MG TAB 94 SDH IV INFUSION THERAPY9483900 MVI-12 94 SDH IV INFUSION THERAPY9470010 D10W 500ML 94 SDH IV INFUSION THERAPY9489824 D51/2NS 500ML 94 SDH IV INFUSION THERAPY9470940 D50W 50 ML 94 SDH IV INFUSION THERAPY9410069 D5W 250ML 94 SDH IV INFUSION THERAPY9431971 D5W 250ML 94 SDH IV INFUSION THERAPY9433137 D5W 250ML 94 SDH IV INFUSION THERAPY9470004 MORPHINE 94 SDH IV INFUSION THERAPY9432766 NA CL 3% 500ML 94 SDH IV INFUSION THERAPY9410341 D10W 1000ML 94 SDH IV INFUSION THERAPY9470923 D5W 50ML 94 SDH IV INFUSION THERAPY9433111 D5W 50ML 94 SDH IV INFUSION THERAPY9470931 D5W 100ML 94 SDH IV INFUSION THERAPY9433129 D5W 100ML 94 SDH IV INFUSION THERAPY9433418 IG LYMPHOCYTE 250MG 94 SDH IV INFUSION THERAPY9433483 ANTITHYMOCYT GLOBULN 25MG 94 SDH IV INFUSION THERAPY9432386 ANTITHYMOCYT GLOBULN 25MG 94 SDH IV INFUSION THERAPY9470019 WATER IJ 1000ML 94 SDH IV INFUSION THERAPY9490624 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9490608 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9490632 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9483074 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9491192 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9483082 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9433012 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9490616 DARBEPOETIN 1MCG NON-ESRD 94 SDH IV INFUSION THERAPY9459769 REPR CV CATH W/O PORT 1517.00 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9490475 CYTARABINE LIPO 10MG IJ 94 SDH IV INFUSION THERAPY9433897 DOXORUBICIN LIPID 10MG IJ 94 SDH IV INFUSION THERAPY9432782 DOXORUBICIN LIPID 10MG IJ 94 SDH IV INFUSION THERAPY9470205 DOXORUBICIN LIPID 10MG IJ 94 SDH IV INFUSION THERAPY9432774 DOXORUBICIN LIPID 10MG IJ 94 SDH IV INFUSION THERAPY9470204 DOXORUBICIN LIPID 10MG IJ 94 SDH IV INFUSION THERAPY9483157 PEGFILGRASTIM 6MG IJ 94 SDH IV INFUSION THERAPY9432337 VORICONAZOLE 10 MG IJ 94 SDH IV INFUSION THERAPY9470816 NM ADM/SUPPLY BEXXAR450MG 2833.00 94 SDH IV INFUSION THERAPY9483173 AMPHO B LPD CMPLX 10MG IJ 94 SDH IV INFUSION THERAPY9483249 ZOLEDRONIC ZOMETA 1MG IJ 94 SDH IV INFUSION THERAPY9433384 ZOLEDRONIC ZOMETA 1MG IJ 94 SDH IV INFUSION THERAPY9483439 INTERFERON B-1A 11MCG IM 94 SDH IV INFUSION THERAPY9431826 SURGICELL DRESSING 113.15 94 SDH IV INFUSION THERAPY9470683 APREPITANT ORAL 5MG 94 SDH IV INFUSION THERAPY9433491 APREPITANT ORAL 5MG 94 SDH IV INFUSION THERAPY9470002 LEUPROLIDE PER 1 MG 94 SDH IV INFUSION THERAPY9490772 MOXIFLOXACIN 100 MG IJ 94 SDH IV INFUSION THERAPY9489998 AGALSIDASE BETA 1 MG IJ 94 SDH IV INFUSION THERAPY9490582 AGALSIDASE BETA 1 MG IJ 94 SDH IV INFUSION THERAPY9483421 DAPTOMYCIN 1MG IJ 94 SDH IV INFUSION THERAPY9470667 FULVESTRANT 25MG IJ 94 SDH IV INFUSION THERAPY9483405 OCTREOTIDE NON DEPO 25MCG 94 SDH IV INFUSION THERAPY9491176 PALONOSETRON INJ 25 MCG 94 SDH IV INFUSION THERAPY9483579 PALONOSETRON INJ 25 MCG 94 SDH IV INFUSION THERAPY9470691 BEVACIZUMAB PER 10MG IJ 94 SDH IV INFUSION THERAPY9470618 BEVACIZUMAB PER 10MG IJ 94 SDH IV INFUSION THERAPY9470584 CETUXIMAB PER 10MG IJ 94 SDH IV INFUSION THERAPY9490798 CETUXIMAB PER 10MG IJ 94 SDH IV INFUSION THERAPY9470642 PEMETREXED PER 10MG IJ 94 SDH IV INFUSION THERAPY9489774 OMALIZUMAB PER 5MG IJ 94 SDH IV INFUSION THERAPY9491168 AZACITIDINE 1 MG IJ 94 SDH IV INFUSION THERAPY9433509 AZACITIDINE 1 MG IJ 94 SDH IV INFUSION THERAPY9470675 AZACITIDINE 1 MG IJ 94 SDH IV INFUSION THERAPY9470634 BORTEZOMIB PER 0.1MG IJ 94 SDH IV INFUSION THERAPY9489725 NATALIZUMAB 1MG INJ 94 SDH IV INFUSION THERAPY9470782 PACLTXL PROTN PART 1MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9470766 CLOFARABINE 1MG IJ 94 SDH IV INFUSION THERAPY9450818 CHEM IVP SNGL/INIT DRG 865.00 94 SDH IV INFUSION THERAPY9450768 INFUSION W/MED 16-60MN 372.00 94 SDH IV INFUSION THERAPY9450776 INFSN W/MED EA ADD HR 273.00 94 SDH IV INFUSION THERAPY9483835 CORTICORELN OVINE 1MCG IJ 94 SDH IV INFUSION THERAPY9450784 INFSN W/MED ADD SEQ 16-60 277.00 94 SDH IV INFUSION THERAPY9470824 OXALIPLATIN 0.5MG IJ 94 SDH IV INFUSION THERAPY9490731 OXALIPLATIN 0.5MG IJ 94 SDH IV INFUSION THERAPY9491119 OXALIPLATIN 0.5MG IJ 94 SDH IV INFUSION THERAPY9490996 OXALIPLATIN 0.5MG IJ 94 SDH IV INFUSION THERAPY9490988 OXALIPLATIN 0.5MG IJ 94 SDH IV INFUSION THERAPY9431997 ANTI CITRATE DEXTROSE A 94 SDH IV INFUSION THERAPY9450792 CHEM NO-HORM ANTNEO SQ/IM 315.00 94 SDH IV INFUSION THERAPY9432535 IVIG LYOPHILIZD 500MG NOS 94 SDH IV INFUSION THERAPY9483850 IVIG LYOPHILIZD 500MG NOS 94 SDH IV INFUSION THERAPY9483843 IVIG LYOPHILIZD 500MG NOS 94 SDH IV INFUSION THERAPY9432600 NA CL 0.45% 50ML 94 SDH IV INFUSION THERAPY9450743 HYDRATN INFSN INIT 31-60M 384.00 94 SDH IV INFUSION THERAPY9470832 TIGECYCLINE 1MG IJ 94 SDH IV INFUSION THERAPY9450750 HYDRATN INFSN EA ADD HR 276.00 94 SDH IV INFUSION THERAPY9490053 GAMMA GLOBULIN IM IJ 1 CC 94 SDH IV INFUSION THERAPY9482530 RHO D H SD 100 IU IJ 94 SDH IV INFUSION THERAPY9491010 RHO D H SD 100 IU IJ 94 SDH IV INFUSION THERAPY9483869 VX DTP DIP/TETTOX/PERTUS 94 SDH IV INFUSION THERAPY9450800 CHEM HORMON ANTINEO SQ/IM 315.00 94 SDH IV INFUSION THERAPY9483868 VX HEMOPH FLU B PRP-T 94 SDH IV INFUSION THERAPY9450826 CHEM IVP EA ADDL DRG 664.00 94 SDH IV INFUSION THERAPY9450834 INJ IVP ADDL SEQ NEW DRG 163.00 94 SDH IV INFUSION THERAPY9489667 VX MMR 94 SDH IV INFUSION THERAPY9433434 VX MMR 94 SDH IV INFUSION THERAPY9481979 VX IPV POLIOVIRUS SC/IM 94 SDH IV INFUSION THERAPY9490145 VX IPV POLIOVIRUS SC/IM 94 SDH IV INFUSION THERAPY9450859 IRRIG IMPLNTD VNS ACC DVC 265.00 94 SDH IV INFUSION THERAPY9489600 VX TD PF GT 7Y IM 94 SDH IV INFUSION THERAPY9483645 VX TETANUS TOXOID 94 SDH IV INFUSION THERAPY9489691 VX TETANUS TOXOID 94 SDH IV INFUSION THERAPY9450412 BX BM NDL/TROCAR 677.00 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9450909 INFSN W/MED CONCURRENT 422.00 94 SDH IV INFUSION THERAPY9450842 CHEM ADDL SEQ INF 0-60MN 725.00 94 SDH IV INFUSION THERAPY9489782 AMIKACIN 100MG IJ 94 SDH IV INFUSION THERAPY9480070 AMPICILLIN 500MG IJ 94 SDH IV INFUSION THERAPY9433475 AMPICILLIN 500MG IJ 94 SDH IV INFUSION THERAPY9433467 AMPICILLIN 500MG IJ 94 SDH IV INFUSION THERAPY9461245 AMPICILLIN/SULB 1.5GM IJ 94 SDH IV INFUSION THERAPY9489915 COLL BLD PICC/CNTRL LN 237.00 94 SDH IV INFUSION THERAPY9489923 SC THER INFSN 16-60 MN 357.00 94 SDH IV INFUSION THERAPY9482241 AUROTHIOGLUCOSE 50MG IJ 94 SDH IV INFUSION THERAPY9489931 SC THER INFSN ADDL HR 320.00 94 SDH IV INFUSION THERAPY9489949 SC THER INFSN ADDL PMP SU 1385.00 94 SDH IV INFUSION THERAPY9489956 INJ IVP SAME DRG EA >30M 88.00 94 SDH IV INFUSION THERAPY9483884 AZITHROMYCIN 500MG IJ 94 SDH IV INFUSION THERAPY9489840 AZTREONAM 500MG IJ 94 SDH IV INFUSION THERAPY9433319 AZTREONAM 500MG IJ 94 SDH IV INFUSION THERAPY9490830 SMZ/TMP 10ML IJ 94 SDH IV INFUSION THERAPY9483488 BUMETANIDE 0.5MG IJ 94 SDH IV INFUSION THERAPY9483322 CA GLUCONATE 10ML IJ 94 SDH IV INFUSION THERAPY9480203 CEFAZOLIN 500MG IJ 94 SDH IV INFUSION THERAPY9433004 CEFAZOLIN 500MG IJ 94 SDH IV INFUSION THERAPY9483496 CEFEPIME HCL 500MG IJ 94 SDH IV INFUSION THERAPY9432865 CEFEPIME HCL 500MG IJ 94 SDH IV INFUSION THERAPY9480252 CEFOTAXIME 1GM IJ 94 SDH IV INFUSION THERAPY9480260 CEFOTETAN 500MG IJ 94 SDH IV INFUSION THERAPY9433327 CEFOXITIN SOD 1GM IJ 94 SDH IV INFUSION THERAPY9480278 CEFTAZIDIME 500MG IJ 94 SDH IV INFUSION THERAPY9480286 CEFTIZOXIME NA 500MG IJ 94 SDH IV INFUSION THERAPY9433368 CEFTRIAXONE 250MG IJ 94 SDH IV INFUSION THERAPY9480294 CEFTRIAXONE 250MG IJ 94 SDH IV INFUSION THERAPY9432899 CEFTRIAXONE 250MG IJ 94 SDH IV INFUSION THERAPY9432881 CEFTRIAXONE 250MG IJ 94 SDH IV INFUSION THERAPY9480302 CEFUROXIME NA 750MG IJ 94 SDH IV INFUSION THERAPY9483454 CHLOROTHIAZIDE 500MG IJ 94 SDH IV INFUSION THERAPY9480336 CIMETIDINE 300MG IJ 94 SDH IV INFUSION THERAPY9480328 CIPROFLOXACIN 200MG IJ 94 SDH IV INFUSION THERAPY9480351 CLINDAMYCIN 300MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9480435 CYANOCOBALAMIN 1000MCG IJ 94 SDH IV INFUSION THERAPY9491143 CYCLOSPORINE 25MG PO 94 SDH IV INFUSION THERAPY9433517 CYCLOSPORINE 25MG PO 94 SDH IV INFUSION THERAPY9490467 CYCLOSPORINE 250MG IJ 94 SDH IV INFUSION THERAPY9480518 DEXAMETHASONE PHOS 1MG IJ 94 SDH IV INFUSION THERAPY9470012 DEXAMETHASONE 0.25MG PO 94 SDH IV INFUSION THERAPY9460247 DIAZEPAM 5MG IJ 94 SDH IV INFUSION THERAPY9480534 DIHYDROERGOTAMINE 1MG IJ 94 SDH IV INFUSION THERAPY9480559 DIPHENHYDRAMINE 50MG IJ 94 SDH IV INFUSION THERAPY9432758 DIPHENHYDRAMINE 50MG PO 94 SDH IV INFUSION THERAPY9432121 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9482951 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9432139 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9432147 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9432154 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9432170 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9432162 ENOXAPARIN 10MG IJ 94 SDH IV INFUSION THERAPY9491259 ERTAPENEM 500MG IJ 94 SDH IV INFUSION THERAPY9483348 ERTAPENEM 500MG IJ 94 SDH IV INFUSION THERAPY9483603 ETANERCEPT 25MG IJ 94 SDH IV INFUSION THERAPY9480898 FAMOTIDINE 20MG IJ 94 SDH IV INFUSION THERAPY9470246 FLUOROURACIL 500MG IJ 94 SDH IV INFUSION THERAPY9432089 FLUOROURACIL 500MG IJ 94 SDH IV INFUSION THERAPY9432097 FLUOROURACIL 500MG IJ 94 SDH IV INFUSION THERAPY9433335 FLUOROURACIL 500MG IJ 94 SDH IV INFUSION THERAPY9490004 FONDAPARINUX 0.5MG IJ 94 SDH IV INFUSION THERAPY9433640 FUROSEMIDE 20MG IJ 94 SDH IV INFUSION THERAPY9480971 FUROSEMIDE 20MG IJ 94 SDH IV INFUSION THERAPY9433632 FUROSEMIDE 20MG IJ 94 SDH IV INFUSION THERAPY9481102 GENTAMICIN 80MG IJ 94 SDH IV INFUSION THERAPY9491044 GLUCAGON HCL 1MG IJ 94 SDH IV INFUSION THERAPY9483223 GOLD NA THIOMAL 50MG IJ 94 SDH IV INFUSION THERAPY9490228 HALOPERIDOL 5MG IJ 94 SDH IV INFUSION THERAPY9480369 HEPARIN 1000U IJ 94 SDH IV INFUSION THERAPY9432279 HYDRALAZINE 20MG IJ 94 SDH IV INFUSION THERAPY9481276 HYDROCORT NA SUC 100MG IJ 94 SDH IV INFUSION THERAPY9483975 HYDROMORPHONE 4MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9451014 HYDROXYUREA 500MG PO 94 SDH IV INFUSION THERAPY9490426 HYDROXYZINE HCL 25MG IJ 94 SDH IV INFUSION THERAPY9433731 IMIPENEM/CILAST 250MG IJ 94 SDH IV INFUSION THERAPY9481292 IMIPENEM/CILAST 250MG IJ 94 SDH IV INFUSION THERAPY9433723 IMIPENEM/CILAST 250MG IJ 94 SDH IV INFUSION THERAPY9433749 IMIPENEM/CILAST 250MG IJ 94 SDH IV INFUSION THERAPY9470907 INSULIN 5 UNITS IJ 94 SDH IV INFUSION THERAPY9481425 INTERFERON B-1B 0.25MG IJ 94 SDH IV INFUSION THERAPY9483140 IRON SUCROSE 1MG IJ 94 SDH IV INFUSION THERAPY9490350 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433764 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433756 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433566 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433210 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9481987 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433525 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433558 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433533 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9433541 K CL/2MEQ INJ 94 SDH IV INFUSION THERAPY9489816 KETOROLAC 15MG IJ 94 SDH IV INFUSION THERAPY9490384 LEVOFLOXACIN 250MG IJ 94 SDH IV INFUSION THERAPY9432709 LEVOFLOXACIN 250MG IJ 94 SDH IV INFUSION THERAPY9432717 LEVOFLOXACIN 250MG IJ 94 SDH IV INFUSION THERAPY9490236 MAGNESIUM SO4 500MG IJ 94 SDH IV INFUSION THERAPY9433806 MAGNESIUM SO4 500MG IJ 94 SDH IV INFUSION THERAPY9490137 MAGNESIUM SO4 500MG IJ 94 SDH IV INFUSION THERAPY9433798 MAGNESIUM SO4 500MG IJ 94 SDH IV INFUSION THERAPY9489964 MANNITOL 25% 50ML IJ 94 SDH IV INFUSION THERAPY9470017 MEPERIDINE 100MG IJ 94 SDH IV INFUSION THERAPY9433855 METHADONE 5MG PO 94 SDH IV INFUSION THERAPY9489626 METHOTREXATE 5MG IJ 94 SDH IV INFUSION THERAPY9481649 METHYLPRED ACET 40MG IJ 94 SDH IV INFUSION THERAPY9481623 METHYLPRED ACET 80MG IJ 94 SDH IV INFUSION THERAPY9410390 METHYLPRED SUCC 40MG IJ 94 SDH IV INFUSION THERAPY9410382 METHYLPRED SUCC 125MG IJ 94 SDH IV INFUSION THERAPY9433830 METHYLPRED SUCC 125MG IJ 94 SDH IV INFUSION THERAPY9433848 METHYLPRED SUCC 125MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9481672 METOCLOPRAMIDE 10MG IJ 94 SDH IV INFUSION THERAPY9490392 METRONIDAZOLE 500MG IJ 94 SDH IV INFUSION THERAPY9482035 MIDAZOLAM 1MG IJ 94 SDH IV INFUSION THERAPY9489907 MORPHINE 10MG IJ 94 SDH IV INFUSION THERAPY9490061 NAFCILLIN 2GM IJ 94 SDH IV INFUSION THERAPY9490434 NALBUPHINE 10MG IJ 94 SDH IV INFUSION THERAPY9432543 NALOXONE 1MG IJ 94 SDH IV INFUSION THERAPY9433228 PCN G K 600,000U IJ 94 SDH IV INFUSION THERAPY9490244 PCN G K 600,000U IJ 94 SDH IV INFUSION THERAPY9410374 PEG INTER ALFA 2-A 180MCG 94 SDH IV INFUSION THERAPY9489873 PENTAMIDINE 300MG IJ 94 SDH IV INFUSION THERAPY9481938 PHYTONADIONE 1MG IJ 94 SDH IV INFUSION THERAPY9460155 PREDNISONE 5MG PO 94 SDH IV INFUSION THERAPY9483819 PROCHLORPERAZINE 10MG IJ 94 SDH IV INFUSION THERAPY9490905 RANITIDINE 25MG IJ 94 SDH IV INFUSION THERAPY9483751 TESTOSTERONE CYP 100MG IJ 94 SDH IV INFUSION THERAPY9490335 TICAR/CLAV 3.1GM IJ 94 SDH IV INFUSION THERAPY9470485 VINBLASTINE 1MG IJ 94 SDH IV INFUSION THERAPY9470881 VINCRISTINE 1MG IJ 94 SDH IV INFUSION THERAPY9432063 VINCRISTINE 1MG IJ 94 SDH IV INFUSION THERAPY9432980 ZOSYN 1GM / 0.125GM IJ 94 SDH IV INFUSION THERAPY9432972 ZOSYN 1GM / 0.125GM IJ 94 SDH IV INFUSION THERAPY9490160 ZOSYN 1GM / 0.125GM IJ 94 SDH IV INFUSION THERAPY9410408 PROMETHAZINE 50 MG IJ 94 SDH IV INFUSION THERAPY9482365 TOBRAMYCIN 80MG IJ 94 SDH IV INFUSION THERAPY9490855 HYALURONIDASE 150U IJ 94 SDH IV INFUSION THERAPY9483686 ADALIMUMAB 20MG IJ 94 SDH IV INFUSION THERAPY9490368 DOBUTAMINE 250MG IJ 94 SDH IV INFUSION THERAPY9480583 DROPERIDOL 5MG IJ 94 SDH IV INFUSION THERAPY9483355 FE GLUCONATE 12.5MG IJ 94 SDH IV INFUSION THERAPY9490376 FLUCONAZOLE 200MG IJ 94 SDH IV INFUSION THERAPY9481557 LORAZEPAM 2MG IJ 94 SDH IV INFUSION THERAPY9482415 VANCOMYCIN 500MG IJ 94 SDH IV INFUSION THERAPY9432998 VANCOMYCIN 500MG IJ 94 SDH IV INFUSION THERAPY9483983 IBANDRONATE 1MG IJ 94 SDH IV INFUSION THERAPY9489683 ABATACEPT 10MG IJ 94 SDH IV INFUSION THERAPY9433681 HEP LOCK FLUSH 10U IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9480377 HEP LOCK FLUSH 10U IJ 94 SDH IV INFUSION THERAPY9489709 VX ZOSTER SC IJ 94 SDH IV INFUSION THERAPY9491184 DECITABINE 1MG IJ 94 SDH IV INFUSION THERAPY9470899 DECITABINE 1MG IJ 94 SDH IV INFUSION THERAPY9489857 PANITUMUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9490277 GANCICLOVIR SOD 500 MG IJ 94 SDH IV INFUSION THERAPY9489758 HYALGAN PER DOSE IA 94 SDH IV INFUSION THERAPY9431979 IMM GLOB/VIVAGLB 100MG IJ 94 SDH IV INFUSION THERAPY9431978 IMM GLOB/VIVAGLB 100MG IJ 94 SDH IV INFUSION THERAPY9490129 IMM GLOB/VIVAGLB 100MG IJ 94 SDH IV INFUSION THERAPY9490020 H PAPILLOMA VX 3 DOSE IM 94 SDH IV INFUSION THERAPY9491283 IVIG OCTOGAM 500MG IJ 94 SDH IV INFUSION THERAPY9433657 IVIG GAMMAGARD L 500MG IJ 94 SDH IV INFUSION THERAPY9433673 IVIG GAMMAGARD L 500MG IJ 94 SDH IV INFUSION THERAPY9433665 IVIG GAMMAGARD L 500MG IJ 94 SDH IV INFUSION THERAPY9491085 IVIG GAMMAGARD L 500MG IJ 94 SDH IV INFUSION THERAPY9431991 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9490012 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9490764 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9431992 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9431993 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9490574 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9490566 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9490558 IVIG FLEBOGAMMA 500MG IJ 94 SDH IV INFUSION THERAPY9431986 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490525 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9431985 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490533 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490517 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9431987 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9431984 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490186 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490541 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9431988 IVIG GAMNX/GMMKD 500MG IJ 94 SDH IV INFUSION THERAPY9490046 ZOLEDRONIC RECLAST 1MG IJ 94 SDH IV INFUSION THERAPY9431980 ONDANSETRON 4MG PO 94 SDH IV INFUSION THERAPY9432261 HEPAGAM B 0.5ML IV IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9490756 IXABEPILONE 1MG IJ 94 SDH IV INFUSION THERAPY9490491 IVIG PRIVIGEN 500 MG IJ 94 SDH IV INFUSION THERAPY9490509 IVIG PRIVIGEN 500 MG IJ 94 SDH IV INFUSION THERAPY9490087 IVIG PRIVIGEN 500 MG IJ 94 SDH IV INFUSION THERAPY9432519 FOSAPREPITANT 1MG IJ 94 SDH IV INFUSION THERAPY9490079 FOSAPREPITANT 1MG IJ 94 SDH IV INFUSION THERAPY9491093 TEMSIROLIMUS 1MG IJ 94 SDH IV INFUSION THERAPY9432295 METHYLNLTRXN 12MG/.6ML IJ 94 SDH IV INFUSION THERAPY9490970 BENDAMUSTINE HCL 1MG IJ 94 SDH IV INFUSION THERAPY9433442 ROMIPLOSTIM 10MCG IJ 94 SDH IV INFUSION THERAPY9491267 CERTOLIZUMAB PEGOL 1MG IJ 94 SDH IV INFUSION THERAPY9410101 D51/2NS 1000ML 94 SDH IV INFUSION THERAPY9433590 D51/2NS 1000ML 94 SDH IV INFUSION THERAPY9433160 D51/2NS 1000ML 94 SDH IV INFUSION THERAPY9410184 D5LR 1000ML 94 SDH IV INFUSION THERAPY9433186 D5LR 1000ML 94 SDH IV INFUSION THERAPY9410028 D5W 1000 CC 94 SDH IV INFUSION THERAPY9433152 D5W 1000 CC 94 SDH IV INFUSION THERAPY9470949 5% DEXTROSE/WATER 500 ML 94 SDH IV INFUSION THERAPY9433145 5% DEXTROSE/WATER 500 ML 94 SDH IV INFUSION THERAPY9431970 5% DEXTROSE/WATER 500 ML 94 SDH IV INFUSION THERAPY9410218 LACTATE RINGERS TO 1000CC 94 SDH IV INFUSION THERAPY9433772 LACTATE RINGERS TO 1000CC 94 SDH IV INFUSION THERAPY9433194 LACTATE RINGERS TO 1000CC 94 SDH IV INFUSION THERAPY9433780 LACTATE RINGERS TO 1000CC 94 SDH IV INFUSION THERAPY9410333 NA CL 0.9% 1000CC 94 SDH IV INFUSION THERAPY9432675 NA CL 0.9% 1000CC 94 SDH IV INFUSION THERAPY9433103 NA CL 0.9% 1000CC 94 SDH IV INFUSION THERAPY9410283 NA CL 0.9% 250CC 94 SDH IV INFUSION THERAPY9432626 NA CL 0.9% 250CC 94 SDH IV INFUSION THERAPY9433087 NA CL 0.9% 250CC 94 SDH IV INFUSION THERAPY9432634 NA CL 0.9% 250CC 94 SDH IV INFUSION THERAPY9433392 NA CL 0.9% 250CC 94 SDH IV INFUSION THERAPY9410291 NA CL 0.9% 500ML 94 SDH IV INFUSION THERAPY9432683 NA CL 0.9% 500ML 94 SDH IV INFUSION THERAPY9433095 NA CL 0.9% 500ML 94 SDH IV INFUSION THERAPY9490962 PLERIXAFOR 1MG IJ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9490848 TRIPTORELIN PA 3.75 MG IJ 94 SDH IV INFUSION THERAPY9481441 IRON DEXTRAN 50 MG IJ 94 SDH IV INFUSION THERAPY9491275 ATROPINE SO4 0.01MG IJ 94 SDH IV INFUSION THERAPY9491317 CORTROSYN 0.25MG IJ 94 SDH IV INFUSION THERAPY9432008 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9491135 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9491127 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9432949 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9432378 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9432931 DOCETAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9431982 FERUMXYTL 1MG IJ NON-ESRD 94 SDH IV INFUSION THERAPY9432691 METHOTREXATE 50MG IJ 94 SDH IV INFUSION THERAPY9491291 METHOTREXATE 50MG IJ 94 SDH IV INFUSION THERAPY9433376 OFATUMUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9433293 OFATUMUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9491333 PRALATREXATE 1MG IJ 94 SDH IV INFUSION THERAPY9491341 PRALATREXATE 1MG IJ 94 SDH IV INFUSION THERAPY9431990 TOCILIZUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432006 TOCILIZUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432014 TOCILIZUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432527 DENOSUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432329 DENOSUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9433608 EPINEPHRINE ADRL 0.1MG IJ 94 SDH IV INFUSION THERAPY9432493 EPINEPHRINE ADRL 0.1MG IJ 94 SDH IV INFUSION THERAPY9432485 IMIGLUCERASE 10UNITS IJ 94 SDH IV INFUSION THERAPY9483314 VX FLUZONE >=3 YRS, IM 94 SDH IV INFUSION THERAPY9432469 VELAGLUCERASE ALFA 100U 94 SDH IV INFUSION THERAPY9432477 CABAZITAXEL 1MG IJ 94 SDH IV INFUSION THERAPY9432436 DEGARELIX 1MG IJ 94 SDH IV INFUSION THERAPY9432428 DEGARELIX 1MG IJ 94 SDH IV INFUSION THERAPY9432923 TOPOTECAN 0.1MG IJ 94 SDH IV INFUSION THERAPY9432444 TOPOTECAN 0.1MG IJ 94 SDH IV INFUSION THERAPY9431998 TOPOTECAN 0.1MG IJ 94 SDH IV INFUSION THERAPY9432741 TELAVANCIN IJ 10 MG 94 SDH IV INFUSION THERAPY9433053 ERIBULIN MESYL 1MG/2ML IJ 94 SDH IV INFUSION THERAPY9433301 CEFTAROLINE 10MG IJ 94 SDH IV INFUSION THERAPY9470006 SIPULEUCEL-T AUTO CD54+ 94 SDH IV INFUSION THERAPY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

9432816 IPILIMUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432808 IPILIMUMAB 1MG IJ 94 SDH IV INFUSION THERAPY9432832 BELIMUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9432824 BELIMUMAB 10MG IJ 94 SDH IV INFUSION THERAPY9433426 BRENTUXIMAB VEDOTIN IJ 94 SDH IV INFUSION THERAPY9433905 PEGLOTICASE 1 MG IJ 94 SDH IV INFUSION THERAPY9490954 INFLUENZA H1N1 VACC ADMIN 24.00 94 SDH IV INFUSION THERAPY9450586 CHEMOTX ADMN PRTL CAVITY 2635.00 94 SDH IV INFUSION THERAPY9450867 PROLONGED IV INF REQ PUMP 2003.00 94 SDH IV INFUSION THERAPY9432022 BLADDER INSTILATION CHEMO 301.00 94 SDH IV INFUSION THERAPY9450115 INF CHEM INTRA ART PROLNG 1374.00 94 SDH IV INFUSION THERAPY9431966 US GUIDE VASCULAR ACCESS 124.00 94 SDH IV INFUSION THERAPY8110298 SP EVAL FNX SWALL 15 136.00 81 SPEECH THERAPY8110306 SP EVAL FNX SWALL 30 272.00 81 SPEECH THERAPY8110314 SP EVAL FNX SWALL 45 408.00 81 SPEECH THERAPY8110157 SP EVAL FNX SWALL 60 544.00 81 SPEECH THERAPY8110322 SP EVAL MTN FLUOR SWA 120 1306.00 81 SPEECH THERAPY8110025 SP EVAL MTN FLUOR SWAL 60 653.00 81 SPEECH THERAPY8110330 SP EVAL MTN FLUOR SWAL 90 980.00 81 SPEECH THERAPY8110348 SP EVAL SP/LNG/COM/AUD 30 272.00 81 SPEECH THERAPY8110355 SP EVAL SP/LNG/COM/AUD 45 408.00 81 SPEECH THERAPY8110033 SP EVAL SP/LNG/COM/AUD 60 544.00 81 SPEECH THERAPY8110363 SP TX SP/LANG/COM IND 30 251.00 81 SPEECH THERAPY8110371 SP TX SP/LANG/COM IND 45 377.00 81 SPEECH THERAPY8110108 SP TX SP/LANG/COM IND 60 502.00 81 SPEECH THERAPY8110389 SP TX SWALL/ORAL FNX 30 251.00 81 SPEECH THERAPY8110397 SP TX SWALL/ORAL FNX 45 377.00 81 SPEECH THERAPY8110249 SP TX SWALL/ORAL FNX 60 502.00 81 SPEECH THERAPY0664227 IRC ASP BREAST CYST 371.00 06 SUNQUEST RADIOLOGY0672055 USC ASP BREAST CYST 347.00 06 SUNQUEST RADIOLOGY0642454 CTC ASP BREAST CYST 371.00 06 SUNQUEST RADIOLOGY0622001 XRC ASP BREAST CYST 371.00 06 SUNQUEST RADIOLOGY0669242 VENIPUNCTURE 47.00 06 SUNQUEST RADIOLOGY0664235 IRC ASP BREAST ADD 144.00 06 SUNQUEST RADIOLOGY0622043 XRC ASP BREAST ADD 51.00 06 SUNQUEST RADIOLOGY0642462 CTC ASP BREAST ADD 144.00 06 SUNQUEST RADIOLOGY0672063 USC ASP BREAST ADD 51.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0679803 USC BX BREAST W IMAG 428.00 06 SUNQUEST RADIOLOGY0624452 S STRL RF TALON PROBE 2295.00 06 SUNQUEST RADIOLOGY0623041 XRC BREAST NDL WIRE 544.00 06 SUNQUEST RADIOLOGY0677666 USC BREAST NDL WIRE 628.00 06 SUNQUEST RADIOLOGY0623082 XRC BREAST NDL WIRE ADD 216.00 06 SUNQUEST RADIOLOGY0672535 USC BX MUSCLE 1065.00 06 SUNQUEST RADIOLOGY0622621 XRC BX MUSCLE 3175.00 06 SUNQUEST RADIOLOGY0662627 IRC BX MUSCLE 1019.00 06 SUNQUEST RADIOLOGY0662528 IRC BX BONE SUPER 561.00 06 SUNQUEST RADIOLOGY0648105 CTC BX BONE SUPER 598.00 06 SUNQUEST RADIOLOGY0672600 USC BX BONE SUPER 561.00 06 SUNQUEST RADIOLOGY0661363 IRC BX BONE DEEP 2819.00 06 SUNQUEST RADIOLOGY0671107 USC INJ SINOGRAM 554.00 06 SUNQUEST RADIOLOGY0662023 IRC INJ SINOGRAM 481.00 06 SUNQUEST RADIOLOGY0626440 XRC INJ MAJOR JNT BURSA 223.00 06 SUNQUEST RADIOLOGY0625988 XRC INJ ARTHRO SHOULDER 538.00 06 SUNQUEST RADIOLOGY0625921 XRC INJ ARTHRO ELBOW 546.00 06 SUNQUEST RADIOLOGY0626002 XRC INJ ARTHRO WRIST 533.00 06 SUNQUEST RADIOLOGY0625947 XRC INJ ARTHRO HIP 681.00 06 SUNQUEST RADIOLOGY0625962 XRC INJ ARTHRO KNEE 633.00 06 SUNQUEST RADIOLOGY0626408 XRC BRNCH W CON SEG BRNCH 1107.00 06 SUNQUEST RADIOLOGY0674879 XRC THORACENTESIS 546.00 06 SUNQUEST RADIOLOGY0629568 XRC THORACENTESIS 546.00 06 SUNQUEST RADIOLOGY0669564 IRC THORACENTESIS 477.00 06 SUNQUEST RADIOLOGY0649566 XRC THORACENTESIS 546.00 06 SUNQUEST RADIOLOGY0672717 USC THORACENTESIS W TUBE 557.00 06 SUNQUEST RADIOLOGY0663484 XRC THORACENTESIS W TUBE 557.00 06 SUNQUEST RADIOLOGY0648196 CTC BX PLEURA 1044.00 06 SUNQUEST RADIOLOGY0664250 IRC BX PLEURA 409.00 06 SUNQUEST RADIOLOGY0648154 CTC BX LUNG MEDIASTNM 143.00 06 SUNQUEST RADIOLOGY0622589 XRC BX LUNG MEDIASTNM 2061.00 06 SUNQUEST RADIOLOGY0662114 IRC BX LUNG MEDIASTNM 139.27 137.27 06 SUNQUEST RADIOLOGY0661173 IRC PTA BRACHIOCEPH EA 9456.00 06 SUNQUEST RADIOLOGY0661165 IRC PTA VEN 7384.00 06 SUNQUEST RADIOLOGY0666305 IRC INTRO CATH IVC/SVC 3887.00 06 SUNQUEST RADIOLOGY0626697 XRC INTRO CATH IVC /SVC 2297.00 06 SUNQUEST RADIOLOGY0643312 CTC INTRO CATH IVC SVC 680.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0624650 XRC ESOPH DILATE BLN >30M 1309.00 06 SUNQUEST RADIOLOGY0666602 IRC INTRO G TUBE LONG 33.00 06 SUNQUEST RADIOLOGY0648147 CTC BX LIVER 1181.00 06 SUNQUEST RADIOLOGY0622480 XRC BX LIVER 1181.00 06 SUNQUEST RADIOLOGY0664086 IRC BX LIVER 1181.00 06 SUNQUEST RADIOLOGY0672584 USC BX LIVER 1181.00 06 SUNQUEST RADIOLOGY0663054 IRC ABSCSS CYST LIVER PRC 254.00 06 SUNQUEST RADIOLOGY0647560 CTC ABSCSS CYST LIVER PRC 266.80 06 SUNQUEST RADIOLOGY0663856 IRC BILI ENDO W STENT 587.00 365.00 06 SUNQUEST RADIOLOGY0664201 IRC BX PANCREAS 1776.00 06 SUNQUEST RADIOLOGY0673335 USC ABSCSS DRN PERITNL 5953.00 06 SUNQUEST RADIOLOGY0663104 IRC ABSCSS DRN PERITNL 6618.00 06 SUNQUEST RADIOLOGY0673350 USC ABSCSS DRN SUBDIAP 3334.00 06 SUNQUEST RADIOLOGY0673384 USC ABSCSS DRN RETROPE 3067.00 06 SUNQUEST RADIOLOGY0663187 IRC ABSCSS DRN RETROPE 5876.00 06 SUNQUEST RADIOLOGY0667105 IRC PARACNT ABD INI NO IM 551.00 06 SUNQUEST RADIOLOGY0647453 CTC PARACNT ABD INI NO IM 551.00 06 SUNQUEST RADIOLOGY0671628 USC PARACNT ABD INI NO IM 551.00 06 SUNQUEST RADIOLOGY0627802 XRC PARACNT ABD INI NO IM 551.00 06 SUNQUEST RADIOLOGY0647461 CTC PARACT ABD SUBQ NO IM 559.00 06 SUNQUEST RADIOLOGY0667113 IRC PARACNT ABD SUB NO IM 559.00 06 SUNQUEST RADIOLOGY0627828 XRC PARACNT ABD SUB NO IM 559.00 06 SUNQUEST RADIOLOGY0671644 USC PARACNT ABD SUB NO IM 559.00 06 SUNQUEST RADIOLOGY0622555 XRC BX ABD RETROPE 485.00 06 SUNQUEST RADIOLOGY0648139 CTC BX ABD RETROPE 485.00 06 SUNQUEST RADIOLOGY0672758 USC BX ABD RETROPE 485.00 06 SUNQUEST RADIOLOGY0664052 IRC BX ABD RETROPE 485.00 06 SUNQUEST RADIOLOGY0633834 NMC INJ VP SHUNT 152.00 06 SUNQUEST RADIOLOGY0663153 IRC ABSCSS DRN RENL 5906.00 06 SUNQUEST RADIOLOGY0647669 CTC ABSCSS DRN RENL 4091.00 06 SUNQUEST RADIOLOGY0672949 USC ABSCSS DRN RENL 248.00 06 SUNQUEST RADIOLOGY0622670 XRC BX RENL 2325.00 06 SUNQUEST RADIOLOGY0648204 CTC BX RENL 2325.00 06 SUNQUEST RADIOLOGY0664300 IRC BX RENL 2325.00 06 SUNQUEST RADIOLOGY0672675 USC BX RENL 2325.00 06 SUNQUEST RADIOLOGY0673228 USC ASP RENL CYST 134.00 06 SUNQUEST RADIOLOGY0622068 XRC ASP RENL CYST 134.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0667659 IRC ASP RENL CYST 134.00 06 SUNQUEST RADIOLOGY0667253 CTC ASP RENL CYST 134.00 06 SUNQUEST RADIOLOGY0665851 IRC INJ NEPHROGRAM 373.00 06 SUNQUEST RADIOLOGY0626218 XRC INJ ILEAL CONDUIT 280.00 06 SUNQUEST RADIOLOGY0626069 XRC INJ CYSTO VCUG 793.00 06 SUNQUEST RADIOLOGY0666107 IRC INJ CYSTO RETRO 356.00 06 SUNQUEST RADIOLOGY0626630 XRC INJ CYSTO RETRO 356.00 06 SUNQUEST RADIOLOGY0664276 IRC BX PROSTATE 791.00 06 SUNQUEST RADIOLOGY0642645 CTC BX PROSTATE 665.00 06 SUNQUEST RADIOLOGY0626200 XRC SAL INFN SONOHYSTER 432.00 06 SUNQUEST RADIOLOGY0666297 IRC INTRO CATH FALLOPN 468.00 06 SUNQUEST RADIOLOGY0663062 IRC ABSCSS DRN PELV PRC 5015.00 06 SUNQUEST RADIOLOGY0673376 USC ABSCSS DRN PELV PRC 3777.00 06 SUNQUEST RADIOLOGY0622696 XRC BX THYROID 261.00 06 SUNQUEST RADIOLOGY0672790 USC BX THYROID 261.00 06 SUNQUEST RADIOLOGY0664409 IRC BX THYROID 261.00 06 SUNQUEST RADIOLOGY0642694 CTC BX THYROID 261.00 06 SUNQUEST RADIOLOGY0665372 IRC INJ C1 C2 MYELOGRAM 265.00 06 SUNQUEST RADIOLOGY0633842 NMC INJ ASP SHUNT 224.00 06 SUNQUEST RADIOLOGY0626242 XRC LUMBAR PUNCTURE DX 550.00 06 SUNQUEST RADIOLOGY0627026 XRC LP THRP 658.00 06 SUNQUEST RADIOLOGY0665737 IRC INJ MYELOGRAM 754.00 06 SUNQUEST RADIOLOGY0626226 XRC INJ MYELOGRAM 754.00 06 SUNQUEST RADIOLOGY0626267 XRC INJ MYELOGRAM 754.00 06 SUNQUEST RADIOLOGY0665331 IRC INJ DACROCYSTOGRAM 2006.00 06 SUNQUEST RADIOLOGY0623710 XR CISTERNOGRAM 1390.00 06 SUNQUEST RADIOLOGY0662437 IR CISTERNOGRAM 304.00 06 SUNQUEST RADIOLOGY0624809 XR FB IN EYE 321.00 06 SUNQUEST RADIOLOGY0627224 XR MANDIBLE LES 4V 362.00 148.00 06 SUNQUEST RADIOLOGY0627208 XR MANDIBLE 4V OR MORE 435.00 06 SUNQUEST RADIOLOGY0627265 XR MASTOIDS LES 3V 374.00 06 SUNQUEST RADIOLOGY0627240 XR MASTOIDS 3V OR MORE 594.00 06 SUNQUEST RADIOLOGY0624841 XR FACIAL BONE LES 3V 326.00 174.00 06 SUNQUEST RADIOLOGY0624825 XR FACIAL BONE 3V OR MORE 479.00 219.00 06 SUNQUEST RADIOLOGY0627406 XR NASAL BONES 3V OR MORE 387.00 148.00 06 SUNQUEST RADIOLOGY0627547 XR OPTIC FORAMINA 402.00 06 SUNQUEST RADIOLOGY0627562 XR ORBITS 4V OR MORE 484.00 222.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0627661 XR SIN PARA LES 3V 349.00 174.00 06 SUNQUEST RADIOLOGY0627646 XR SIN PARA 3V OR MORE 424.00 219.00 06 SUNQUEST RADIOLOGY0628966 XR SKULL LES 4V 394.00 06 SUNQUEST RADIOLOGY0628941 XR SKULL LES 4V 394.00 06 SUNQUEST RADIOLOGY0628909 XR SKULL 4V OR MORE 489.00 255.00 06 SUNQUEST RADIOLOGY0628925 XR SKULL 4V OR MORE 489.00 06 SUNQUEST RADIOLOGY0629543 XR TMJ UNI 348.00 06 SUNQUEST RADIOLOGY0629527 XR TMJ BIL 571.00 06 SUNQUEST RADIOLOGY0653956 MRI OF TMJ(S) 3238.00 06 SUNQUEST RADIOLOGY0623165 XR CEPHALOGRAM ORDO 185.00 06 SUNQUEST RADIOLOGY0627448 XR NEC SOFT TISSUE 305.00 123.00 06 SUNQUEST RADIOLOGY0627869 XR PHARYNXLARYNX W FLUORO 1003.00 06 SUNQUEST RADIOLOGY0627844 XR PHARYNGEAL SPEECH EVAL 854.00 06 SUNQUEST RADIOLOGY0668939 IR SIALOGRAM 255.00 06 SUNQUEST RADIOLOGY0628198 XR SIALOGRAM 1321.00 06 SUNQUEST RADIOLOGY0641555 CT BRAIN W/O CON 2975.00 06 SUNQUEST RADIOLOGY0641563 CT BRAIN W/O CON 2975.00 06 SUNQUEST RADIOLOGY0641605 CT BRAIN W CON 3856.00 06 SUNQUEST RADIOLOGY0641506 CT BRAIN W-W/O CON 4749.00 06 SUNQUEST RADIOLOGY0644856 CT ORBIT/SELLA/FOSSA W/O 4834.00 06 SUNQUEST RADIOLOGY0643858 CT MAXILLOFACIAL W/O CON 3960.00 06 SUNQUEST RADIOLOGY0643700 CT MAXILLOFACIAL W/O CON 3960.00 06 SUNQUEST RADIOLOGY0644203 CT ORBIT SELLA FOSSA W 5715.00 06 SUNQUEST RADIOLOGY0644807 CT ORBIT SELLA FOSSA W 5715.00 06 SUNQUEST RADIOLOGY0643908 CT MAXILLOFACIAL W CON 4841.00 06 SUNQUEST RADIOLOGY0643759 CT MAXILLOFACIAL W CON 4841.00 06 SUNQUEST RADIOLOGY0644104 CT ORBIT SELLA FOSA W-W/O 6563.00 06 SUNQUEST RADIOLOGY0644757 CT ORBIT SELLA FOSA W-W/O 6563.00 06 SUNQUEST RADIOLOGY0643650 CT MAXILLOFACIAL W-W/O 6041.00 06 SUNQUEST RADIOLOGY0644005 CT NEC W/O CON 3725.00 06 SUNQUEST RADIOLOGY0644054 CT NEC W CON 4645.00 06 SUNQUEST RADIOLOGY0643957 CT NEC W-W/O CON 5819.00 06 SUNQUEST RADIOLOGY0653204 MR ORBIT FACE NEC W/O CON 3712.00 06 SUNQUEST RADIOLOGY0653105 MR ORBIT FACE NEC W/O CON 3712.00 06 SUNQUEST RADIOLOGY0655506 MRA HEAD W/O CON 4177.00 06 SUNQUEST RADIOLOGY0655522 MRA HEAD W CON 4147.00 06 SUNQUEST RADIOLOGY0655548 MRA HEAD W-W/O CON 4939.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0652750 MR BRAIN W STEM W/O CON 3805.00 06 SUNQUEST RADIOLOGY0652800 MR BRAIN W STEM W CON 4185.00 06 SUNQUEST RADIOLOGY0652701 MR BRAIN W STEM W-W/O CON 5210.00 06 SUNQUEST RADIOLOGY0623223 XR CHEST 1V 234.00 135.00 06 SUNQUEST RADIOLOGY0623249 XR CHEST 1V 234.00 135.00 06 SUNQUEST RADIOLOGY0623355 XR CHEST 2V 321.00 176.00 06 SUNQUEST RADIOLOGY0623280 XR CHEST 2V 321.00 06 SUNQUEST RADIOLOGY0623389 XR CHEST 2V W AP LORDOTIC 397.00 209.00 06 SUNQUEST RADIOLOGY0623348 XR CHEST 2V W OBLIQUES 500.00 06 SUNQUEST RADIOLOGY0623405 XR CHEST 2V W OBLIQUES 500.00 212.00 06 SUNQUEST RADIOLOGY0623413 XR CHEST 4V CMPL 495.00 06 SUNQUEST RADIOLOGY0623421 XR CHEST 4V MORE W FLUORO 1050.00 06 SUNQUEST RADIOLOGY0623058 XR CHEST SPECIAL V EA 365.00 06 SUNQUEST RADIOLOGY0627943 XR RIBS UNI 2V 343.00 163.00 06 SUNQUEST RADIOLOGY0627968 XR RIBS UNI 2V 343.00 06 SUNQUEST RADIOLOGY0627950 XR RIBS UNI & PA CHEST 419.00 06 SUNQUEST RADIOLOGY0627901 XR RIBS BIL 3V 441.00 222.00 06 SUNQUEST RADIOLOGY0629444 XR STERNUM 2V OR MORE 354.00 184.00 06 SUNQUEST RADIOLOGY0629428 XR STERNOCLAVIC 3V MORE 424.00 199.00 06 SUNQUEST RADIOLOGY0643551 CT THORAX W/O CON 3849.00 06 SUNQUEST RADIOLOGY0643601 CT THORAX W CON 4795.00 06 SUNQUEST RADIOLOGY0643569 CT THORAX W CON 4795.00 06 SUNQUEST RADIOLOGY0643502 CT THORAX W-W/O 6034.00 06 SUNQUEST RADIOLOGY0652206 MR CHEST W/O CON 4226.00 06 SUNQUEST RADIOLOGY0652404 MRA CHEST W-W/O CON 2766.00 06 SUNQUEST RADIOLOGY0629303 XR SPINE SURVEY ENTIRE 800.00 06 SUNQUEST RADIOLOGY0629022 XR SPINE SNGL V CERV 256.00 06 SUNQUEST RADIOLOGY0629097 XR SPINE CERV 2-3V 426.00 171.00 06 SUNQUEST RADIOLOGY0629105 XR SPINE CERV 2-3V 426.00 06 SUNQUEST RADIOLOGY0629089 XR SPINE CERV 2-3V 426.00 06 SUNQUEST RADIOLOGY0629048 XR SPINE CERV 4V OR MORE 593.00 253.00 06 SUNQUEST RADIOLOGY0629063 XR SPINE C 4V & FLEX/EXT 781.00 319.00 06 SUNQUEST RADIOLOGY0629261 XR SPINE SCOLIOSIS STNDNG 400.00 145.00 06 SUNQUEST RADIOLOGY0629329 XR SPINE THOR 2V 364.00 184.00 06 SUNQUEST RADIOLOGY0629352 XR SPINE THOR 2V 364.00 06 SUNQUEST RADIOLOGY0629345 XR SPINE THOR 3V 430.00 204.00 06 SUNQUEST RADIOLOGY0629360 XR SPINE THOR 4V OR MORE 538.00 250.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0629402 XR SPINE THOR LUMB 2V 394.00 189.00 06 SUNQUEST RADIOLOGY0629287 XR SPINE SCOLIOSIS SUP ER 540.00 194.00 06 SUNQUEST RADIOLOGY0629246 XR SPINE LUMB 2-3V 458.00 06 SUNQUEST RADIOLOGY0629253 XR SPINE LUMB 2-3V 458.00 189.00 06 SUNQUEST RADIOLOGY0629204 XR SPINE LUMB 2-3V 458.00 06 SUNQUEST RADIOLOGY0629220 XR SPINE LUMB 2-3V 458.00 06 SUNQUEST RADIOLOGY0629162 XR SPINE LUMB 4V OR MORE 635.00 258.00 06 SUNQUEST RADIOLOGY0629188 XR SPINE L/S W BEND MIN 6 882.00 334.00 06 SUNQUEST RADIOLOGY0629147 XR L/SCRL BEND ONLY 2/3V 623.00 06 SUNQUEST RADIOLOGY0646406 CT SPINE CERV W/O CON 3875.00 06 SUNQUEST RADIOLOGY0646455 CT SPINE CERV W CON 4808.00 06 SUNQUEST RADIOLOGY0646356 CT SPINE CERV W-W/O CON 6028.00 06 SUNQUEST RADIOLOGY0646703 CT SPINE THOR W/O CON 3869.00 06 SUNQUEST RADIOLOGY0646752 CT SPINE THOR W CON 4814.00 06 SUNQUEST RADIOLOGY0646653 CT SPINE THOR W-W/O 6034.00 06 SUNQUEST RADIOLOGY0646554 CT SPINE LUMB W/O CON 3856.00 06 SUNQUEST RADIOLOGY0646604 CT SPINE LUMB W CON 4801.00 06 SUNQUEST RADIOLOGY0646307 CT SPINE LUMB W CON 4801.00 06 SUNQUEST RADIOLOGY0646505 CT SPINE LUMB W-W/O CON 6028.00 06 SUNQUEST RADIOLOGY0653451 MR SPINE CERV W/O CON 3317.00 06 SUNQUEST RADIOLOGY0653501 MR SPINE CERV W CON 4188.00 06 SUNQUEST RADIOLOGY0653857 MR SPINE THOR W/O CON 3375.00 06 SUNQUEST RADIOLOGY0653907 MR SPINE THOR W CON 3694.00 06 SUNQUEST RADIOLOGY0653659 MR SPINE LUMB W/O CON 3369.00 06 SUNQUEST RADIOLOGY0653709 MR SPINE LUMB W CON 4162.00 06 SUNQUEST RADIOLOGY0653600 MR SPINE CERV W-W/O CON 5120.00 06 SUNQUEST RADIOLOGY0653808 MR SPINE THOR W-W/O 4752.00 06 SUNQUEST RADIOLOGY0653758 MR SPINE LUMB W-W/O 5109.00 06 SUNQUEST RADIOLOGY0627752 XR PELV 1 OR 2V 283.00 148.00 06 SUNQUEST RADIOLOGY0627760 XR PELV 1 OR 2V 283.00 06 SUNQUEST RADIOLOGY0627786 XR PELV 1 OR 2V 283.00 06 SUNQUEST RADIOLOGY0627745 XR PELV 1 OR 2V 283.00 06 SUNQUEST RADIOLOGY0627703 XR PELV 3V OR MORE 476.00 189.00 06 SUNQUEST RADIOLOGY0644658 CT PELV W/O CON 3640.00 06 SUNQUEST RADIOLOGY0644708 CT PELV W CON 4554.00 06 SUNQUEST RADIOLOGY0644609 CT PELV W-W/O CON 6093.00 06 SUNQUEST RADIOLOGY0653303 MR PELV W CON 4145.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0628107 XR SI JNT 1 OR 2V 337.00 06 SUNQUEST RADIOLOGY0628008 XR SI JNT 3V OR MORE 402.00 174.00 06 SUNQUEST RADIOLOGY0628123 XR SACRUM COCCYX 2 V MORE 332.00 161.00 06 SUNQUEST RADIOLOGY0627307 XR MYELOGRAM CERV 1594.00 06 SUNQUEST RADIOLOGY0627364 XR MYELOGRAM THOR 1463.00 06 SUNQUEST RADIOLOGY0627349 XR MYELOGRAM LUMB 1550.00 06 SUNQUEST RADIOLOGY0627323 XR MYELOGRM 1 OR MORE REG 2388.00 06 SUNQUEST RADIOLOGY0627075 XR DISKOGRAM CERV THOR 2000.00 06 SUNQUEST RADIOLOGY0627083 XR DISKOGRAM LUMB 1409.00 06 SUNQUEST RADIOLOGY0623769 XR CLAVICLE CMPL 323.00 145.00 06 SUNQUEST RADIOLOGY0623785 XR CLAVICLE CMPL 323.00 06 SUNQUEST RADIOLOGY0628206 XR SCAPULA CMPL 330.00 06 SUNQUEST RADIOLOGY0628958 XR SHOULDER 1V 256.00 133.00 06 SUNQUEST RADIOLOGY0628289 XR SHOULDER 1V 256.00 06 SUNQUEST RADIOLOGY0628321 XR SHOULDER 1V 256.00 06 SUNQUEST RADIOLOGY0628305 XR SHOULDER 1V 256.00 06 SUNQUEST RADIOLOGY0628263 XR SHOULDER 2V OR MORE 330.00 161.00 06 SUNQUEST RADIOLOGY0622183 XR ARTHRO SHOULDER 1289.00 06 SUNQUEST RADIOLOGY0621862 XR AC JNT 426.00 189.00 06 SUNQUEST RADIOLOGY0625814 XR HUMERUS 2V OR MORE 326.00 161.00 06 SUNQUEST RADIOLOGY0624049 XR ELBOW 2V 323.00 145.00 06 SUNQUEST RADIOLOGY0624007 XR ELBOW 3V OR MORE 408.00 161.00 06 SUNQUEST RADIOLOGY0622126 XR ARTHRO ELBOW 1126.00 06 SUNQUEST RADIOLOGY0625400 XR FOREARM 2V 315.00 145.00 06 SUNQUEST RADIOLOGY0626762 XR EXT INF UPP LES 1YR 337.00 06 SUNQUEST RADIOLOGY0629980 XR WRIST 2V 343.00 138.00 06 SUNQUEST RADIOLOGY0629956 XR WRIST 2V 343.00 06 SUNQUEST RADIOLOGY0629949 XR WRIST 3V OR MORE 431.00 151.00 06 SUNQUEST RADIOLOGY0622225 XR ARTHRO WRIST 1264.00 06 SUNQUEST RADIOLOGY0625616 XR HAND 2V 310.00 138.00 06 SUNQUEST RADIOLOGY0625608 XR HAND 3V OR MORE 375.00 151.00 06 SUNQUEST RADIOLOGY0625020 XR FINGER(S) 2V OR MORE 381.00 06 SUNQUEST RADIOLOGY0642926 CT EXT UPP W/O CON 3745.00 06 SUNQUEST RADIOLOGY0642934 CT EXT UPP W CON 4651.00 06 SUNQUEST RADIOLOGY0642918 CT EXT UPP W-W/O CON 6211.00 06 SUNQUEST RADIOLOGY0652602 MR EXT UPP NO JNT W-W/O 5428.00 06 SUNQUEST RADIOLOGY0652651 MR EXT UPP JNT W/O CON 3596.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0625707 XR HIP UNI 1V 273.00 06 SUNQUEST RADIOLOGY0625715 XR HIP UNI 1V 273.00 06 SUNQUEST RADIOLOGY0625673 XR HIP UNI 2V OR MORE 426.00 163.00 06 SUNQUEST RADIOLOGY0625665 XR HIPS BIL 2V W PELV 431.00 194.00 06 SUNQUEST RADIOLOGY0622142 XR ARTHRO HIP 1041.00 06 SUNQUEST RADIOLOGY0625699 XR HIP OR 299.00 06 SUNQUEST RADIOLOGY0624908 XR FEMUR 2V 310.00 161.00 06 SUNQUEST RADIOLOGY0626937 XR KNEE 1 OR 2V 330.00 148.00 06 SUNQUEST RADIOLOGY0626911 XR KNEE 1 OR 2V 330.00 06 SUNQUEST RADIOLOGY0626887 XR KNEE 3V 413.00 161.00 06 SUNQUEST RADIOLOGY0626903 XR KNEE 4V OR MORE 476.00 176.00 06 SUNQUEST RADIOLOGY0626960 XR KNEES STANDING AP 369.00 140.00 06 SUNQUEST RADIOLOGY0626978 XR KNEES STANDING AP 06 SUNQUEST RADIOLOGY0622167 XR ARTHRO KNEE 1581.00 06 SUNQUEST RADIOLOGY0629600 XR TIBIA FIBULA 2V 305.00 148.00 06 SUNQUEST RADIOLOGY0626747 XR EXT INF LOW LES 1YR 343.00 06 SUNQUEST RADIOLOGY0621912 XR ANKLE 2V 318.00 138.00 06 SUNQUEST RADIOLOGY0621920 XR ANKLE 2V 318.00 06 SUNQUEST RADIOLOGY0621904 XR ANKLE 3V OR MORE 375.00 151.00 06 SUNQUEST RADIOLOGY0622100 XR ARTHRO ANKLE 1200.00 06 SUNQUEST RADIOLOGY0625335 XR FOOT 2V 305.00 138.00 06 SUNQUEST RADIOLOGY0625327 XR FOOT 2V 305.00 06 SUNQUEST RADIOLOGY0625301 XR FOOT 3V OR MORE 369.00 151.00 06 SUNQUEST RADIOLOGY0627604 XR CALCANEOUS 2V OR MORE 311.00 133.00 06 SUNQUEST RADIOLOGY0629667 XR TOE(S) 2V OR MORE 355.00 117.00 06 SUNQUEST RADIOLOGY0642827 CT EXT LOW W/O CON 3751.00 06 SUNQUEST RADIOLOGY0642835 CT EXT LOW W CON 4704.00 06 SUNQUEST RADIOLOGY0642819 CT EXT LOW W-W/O CON 6243.00 06 SUNQUEST RADIOLOGY0652453 MR EXT LOW W-W/O CON 5437.00 06 SUNQUEST RADIOLOGY0652503 MR EXT LOW JT W/O CON 3677.00 06 SUNQUEST RADIOLOGY0652552 MRA EXT LOW W-W/O CON 3443.00 06 SUNQUEST RADIOLOGY0621698 XR ABD 1V AP 256.00 148.00 06 SUNQUEST RADIOLOGY0621722 XR ABD 1V AP 256.00 06 SUNQUEST RADIOLOGY0621706 XR ABD 1V AP 256.00 06 SUNQUEST RADIOLOGY0621771 XR ABD 1V AP 256.00 06 SUNQUEST RADIOLOGY0621797 XR ABD W OBLIQUES CONE 426.00 06 SUNQUEST RADIOLOGY0621763 XR ABD CMPL DECUB ERECT 430.00 181.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0621714 XR ABD CMPL DECUB ERECT 430.00 06 SUNQUEST RADIOLOGY0621789 XR ABD CMPL W 1V CHEST 522.00 06 SUNQUEST RADIOLOGY0646158 CT ABD W/O CON 3614.00 06 SUNQUEST RADIOLOGY0641159 CT ABD W/O CON 3614.00 06 SUNQUEST RADIOLOGY0646208 CT ABD W/CON 5212.00 06 SUNQUEST RADIOLOGY0641209 CT ABD W/CON 5212.00 06 SUNQUEST RADIOLOGY0646109 CT ABD W-W/O CON 7157.00 06 SUNQUEST RADIOLOGY0641100 CT ABD W-W/O CON 7157.00 06 SUNQUEST RADIOLOGY0652107 MR ABD W/O CON 3326.00 06 SUNQUEST RADIOLOGY0652123 MRA ABD W-W/O CON 2785.00 06 SUNQUEST RADIOLOGY0622365 XR PHARYNX OR ESOPH CERV 965.00 06 SUNQUEST RADIOLOGY0624429 XR ESOPH 1073.00 06 SUNQUEST RADIOLOGY0624460 XR SWALLOWING FNCTN 1042.00 06 SUNQUEST RADIOLOGY0629808 XR UGI W/O KUB 1212.00 06 SUNQUEST RADIOLOGY0629832 XR UGI W KUB 1346.00 06 SUNQUEST RADIOLOGY0629840 XR UGI W SM BOWEL 2108.00 06 SUNQUEST RADIOLOGY0629790 XR UGI W AIR CON 06 SUNQUEST RADIOLOGY0629816 XR UGI W AIR CON KUB 1689.00 06 SUNQUEST RADIOLOGY0629824 XR UGI W AIR CON SM BOWEL 2324.00 06 SUNQUEST RADIOLOGY0628982 XR SM BOWEL SERIES 1315.00 06 SUNQUEST RADIOLOGY0622324 XR CONTRAST ENEMA 1873.00 06 SUNQUEST RADIOLOGY0622340 XR BE W AIR CON 2572.00 06 SUNQUEST RADIOLOGY0622308 XR BE THRP 1708.00 06 SUNQUEST RADIOLOGY0623603 XR CHOLECYSTOGRAM ORAL 825.00 06 SUNQUEST RADIOLOGY0623629 XR CHOLECYSTOGRAM ORAL FU 222.00 06 SUNQUEST RADIOLOGY0623520 XR CHOL IN OR 517.00 06 SUNQUEST RADIOLOGY0623546 XR CHOL IN OR ADD SET 315.00 06 SUNQUEST RADIOLOGY0662429 IR CHOL EXISTING CATH 436.00 06 SUNQUEST RADIOLOGY0623561 XR CHOL EXISTING CATH 604.00 06 SUNQUEST RADIOLOGY0623587 XR CHOL TRANSHEPAT PRC 1300.00 06 SUNQUEST RADIOLOGY0662635 IR ENDO BILI DUCT 1415.00 06 SUNQUEST RADIOLOGY0624304 XR ERCP PANC DUCT 1017.00 06 SUNQUEST RADIOLOGY0624320 XR ERCP BILI PANC DUCT 1904.00 06 SUNQUEST RADIOLOGY0623827 XR GI TUBE INSERT LONG 1256.00 06 SUNQUEST RADIOLOGY0624403 XR INTRALUMINAL DILATE 1403.00 06 SUNQUEST RADIOLOGY0662064 IR BILI DUCT DILATE PRC 806.00 06 SUNQUEST RADIOLOGY0626861 XR IVP W-W/O TOMOGRAM 1403.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0626804 XR IVP W-W/O TOMOGRAM 1403.00 06 SUNQUEST RADIOLOGY0629881 XR UROGRAM RETRO 1583.00 06 SUNQUEST RADIOLOGY0627505 XR UROGRAM ANTEGRADE 756.00 06 SUNQUEST RADIOLOGY0623868 XR CYSTOGRAM 3V OR MORE 852.00 06 SUNQUEST RADIOLOGY0629865 XR URETHROCYSTOGRAM 865.00 06 SUNQUEST RADIOLOGY0629873 XR URETHROCYSTOGRAM VOID 1175.00 06 SUNQUEST RADIOLOGY0666115 IR URETHROCYSTOGRAM VOID 838.00 06 SUNQUEST RADIOLOGY0669101 IR URETERAL STENT PRC 986.00 06 SUNQUEST RADIOLOGY0667139 PLT AGGREGATION EA AGENT 508.00 06 SUNQUEST RADIOLOGY0623181 XR HYSTEROSALPINGOGRAM 968.00 06 SUNQUEST RADIOLOGY0662684 IR HYSTEROSALPINGOGRAM 679.00 06 SUNQUEST RADIOLOGY0629915 XR SHUNTOGRAM NONVASC 1118.00 06 SUNQUEST RADIOLOGY0669408 IR VENOGRAM EXT BIL 1109.00 06 SUNQUEST RADIOLOGY0646224 CT DRN W CATH PLACE PRC 1481.00 06 SUNQUEST RADIOLOGY0661108 IR DRN W CATH PLACE PRC 744.00 06 SUNQUEST RADIOLOGY0672931 US DRN W CATH PLACE PRC 885.00 06 SUNQUEST RADIOLOGY0625228 XR FLUORO 1HR OR LES 1327.00 06 SUNQUEST RADIOLOGY0625251 XR FLUORO 1HR OR LES 1327.00 06 SUNQUEST RADIOLOGY0625202 XR FLUORO 1HR OR LES 1327.00 06 SUNQUEST RADIOLOGY0662668 IR FLUORO 1HR OR LES 886.00 06 SUNQUEST RADIOLOGY0622746 XR FLUORO NDL PLACE 743.00 06 SUNQUEST RADIOLOGY0662536 IR FLUORO NDL PLACE 519.00 06 SUNQUEST RADIOLOGY0620153 XR FLUORO NDL PLACE 664.00 06 SUNQUEST RADIOLOGY0625467 XR FB LOC CHLD 294.00 06 SUNQUEST RADIOLOGY0622803 XR BONE AGE STDY 222.00 148.00 06 SUNQUEST RADIOLOGY0641423 CT BONE LENGTH STDY 457.00 06 SUNQUEST RADIOLOGY0622845 XR BONE LENGTH STDY 386.00 222.00 06 SUNQUEST RADIOLOGY0622902 XR BONE SURVEY LTD 756.00 06 SUNQUEST RADIOLOGY0622886 XR BONE SURVEY CMPL 1218.00 06 SUNQUEST RADIOLOGY0622811 XR BONE SURVEY INF 889.00 06 SUNQUEST RADIOLOGY0641431 CT BONE DENSTY STDY AXIAL 2792.00 06 SUNQUEST RADIOLOGY0621466 XR DEXA AXIAL SKELETON 902.00 06 SUNQUEST RADIOLOGY0631705 XR DEXA AXIAL SKELETON 902.00 06 SUNQUEST RADIOLOGY0631655 XR DEXA AXIAL SKELETON 902.00 06 SUNQUEST RADIOLOGY0636977 XR DEXA AXIAL SKELETON 902.00 06 SUNQUEST RADIOLOGY0631606 XR DEXA AXIAL SKELETON 902.00 06 SUNQUEST RADIOLOGY0625103 XR ABSCSS FIST SIN TRACT 626.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0668806 IR GALACTOGRAM 1 DUCT 371.00 06 SUNQUEST RADIOLOGY0623009 XR MAMMO GDE NDL EA LES 446.00 06 SUNQUEST RADIOLOGY0627257 XR SPECIMEN SURGICAL 192.00 06 SUNQUEST RADIOLOGY0629501 XR SPECIMEN SURGICAL 174.00 06 SUNQUEST RADIOLOGY0629741 XR TOMOGRAM 1474.00 06 SUNQUEST RADIOLOGY0629725 XR TOMOGRAM CMPLX UNI 2295.00 06 SUNQUEST RADIOLOGY0667733 IR CINE/VIDEO COMPLEMENT 112.00 06 SUNQUEST RADIOLOGY0641407 CT GUIDE NDL PLACEMENT 2042.00 06 SUNQUEST RADIOLOGY0674143 US ENCEPHALOGRAM 1134.00 06 SUNQUEST RADIOLOGY0674903 US HEAD & NEC SFT TISSUE 1151.00 06 SUNQUEST RADIOLOGY0674358 US HEAD & NEC SFT TISSUE 1151.00 06 SUNQUEST RADIOLOGY0673608 US CHEST 772.00 06 SUNQUEST RADIOLOGY0673558 US BREAST UNI OR BIL 875.00 06 SUNQUEST RADIOLOGY0673509 US BREAST UNI OR BIL 875.00 06 SUNQUEST RADIOLOGY0672253 US ABD CMPL 1280.00 06 SUNQUEST RADIOLOGY0672303 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672402 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672907 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672352 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672204 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672451 US ECHO ABD LTD 987.00 06 SUNQUEST RADIOLOGY0672808 US RETROPE CMPL 1233.00 06 SUNQUEST RADIOLOGY0674820 US SPINAL CANAL 972.00 06 SUNQUEST RADIOLOGY0674630 US OB AFTR 1ST TRI 1 GEST 1276.00 06 SUNQUEST RADIOLOGY0674721 US OB AFTR 1ST TRI EA GES 629.00 06 SUNQUEST RADIOLOGY0674697 US OB LTD 1/MORE FETUSES 759.00 06 SUNQUEST RADIOLOGY0674663 US OB FU/REEVAL EA FETUS 953.00 06 SUNQUEST RADIOLOGY0674606 US BIO PROFILE W NONSTRES 897.00 06 SUNQUEST RADIOLOGY0674127 US ECHO FETAL 1724.00 06 SUNQUEST RADIOLOGY0673756 US DPPLER ECHO FETAL 483.00 06 SUNQUEST RADIOLOGY0673905 US TRANSVAGINAL 250.00 06 SUNQUEST RADIOLOGY0674507 US PELV CMPL NONOB 1151.00 06 SUNQUEST RADIOLOGY0674523 US PELV LTD FU NONOB 1039.00 06 SUNQUEST RADIOLOGY0674846 US TESTICULAR SCROTUM 1168.00 06 SUNQUEST RADIOLOGY0674937 US INTRO INTERSTITIAL TX 752.00 06 SUNQUEST RADIOLOGY0636258 NM THYROID UPTAKE SNGL 797.00 06 SUNQUEST RADIOLOGY0636209 NM THYROID UPTAKE MULTI 1007.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0635979 NM THYROID IMAG UPT SNGL 2697.00 06 SUNQUEST RADIOLOGY0635953 NM THYROID IMAG UPT MULTI 1637.00 06 SUNQUEST RADIOLOGY0636001 NM THYROID IMAG ONLY 1835.00 06 SUNQUEST RADIOLOGY0635839 NM THYROID METS LTD 2327.00 06 SUNQUEST RADIOLOGY0636100 NM THYROID METS WB 3538.00 06 SUNQUEST RADIOLOGY0634600 NM PARATHYROID 1619.00 06 SUNQUEST RADIOLOGY0634501 NM LYMPHATIC PATHWAY 3748.00 06 SUNQUEST RADIOLOGY0634055 NM LIVER STATIC 2092.00 06 SUNQUEST RADIOLOGY0634105 NM LIVER W VASCULAR FLOW 2279.00 06 SUNQUEST RADIOLOGY0634154 NM LIVER W SPECT 2478.00 06 SUNQUEST RADIOLOGY0634253 NM LIVER SPLEEN STATIC 2140.00 06 SUNQUEST RADIOLOGY0634303 NM LIVER SPLEEN W FLOW 1335.00 06 SUNQUEST RADIOLOGY0634006 NM LIVER FNCTN STDY 1659.00 06 SUNQUEST RADIOLOGY0633800 NM HEPATOBILIARY DUCTAL 3700.00 06 SUNQUEST RADIOLOGY0632851 NM GASTRIC EMPTYING 3159.00 06 SUNQUEST RADIOLOGY0623843 NM GASTRIC EMPTYING 2143.00 06 SUNQUEST RADIOLOGY0634675 NM UREA TEST C14 ANALYSIS 1339.00 06 SUNQUEST RADIOLOGY0633008 NM GI BLEEDING SCAN 3791.00 06 SUNQUEST RADIOLOGY0634550 NM BOWEL (MECKELS) 3673.00 06 SUNQUEST RADIOLOGY0631408 NM BONE SCAN LTD 1852.00 06 SUNQUEST RADIOLOGY0631358 NM BONE SCAN LTD 1852.00 06 SUNQUEST RADIOLOGY0631804 NM BONE SCAN MULTI AREAS 2449.00 06 SUNQUEST RADIOLOGY0631952 NM BONE SCAN WB 2693.00 06 SUNQUEST RADIOLOGY0631853 NM BONE THREE PHASE 3769.00 06 SUNQUEST RADIOLOGY0631903 NM BONE SCAN W SPECT 2473.00 06 SUNQUEST RADIOLOGY0632802 NM VASCULAR FLOW NCARDIO 1882.00 06 SUNQUEST RADIOLOGY0633354 NM HEART MP MULTI PLANAR 2021.00 06 SUNQUEST RADIOLOGY0636852 NM HEART MP SNGL W SPEC 2578.00 06 SUNQUEST RADIOLOGY0638379 NM HEART MP MULTI W SPECT 4990.00 06 SUNQUEST RADIOLOGY0633057 NM HEART MP MULTI W SPECT 4990.00 06 SUNQUEST RADIOLOGY0633750 NM HEART MP MULTI W SPECT 4990.00 06 SUNQUEST RADIOLOGY0633552 NM HEART MI PLANAR 1420.00 06 SUNQUEST RADIOLOGY0633156 NM HEART GATED MULTIVIEW 3395.00 06 SUNQUEST RADIOLOGY0634352 NM LUNG PERF 2249.00 06 SUNQUEST RADIOLOGY0634451 NM LUNG VENTI1V 1409.00 06 SUNQUEST RADIOLOGY0634477 NM LUNG PERF VENT 3691.00 06 SUNQUEST RADIOLOGY0634493 NM LUNG QUAN DIFF FNCTN 3987.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0632356 NM BRAIN LT4 STAT V W/FLW 2401.00 06 SUNQUEST RADIOLOGY0632158 NM BRAIN GT3 STAT V W/FLW 3743.00 06 SUNQUEST RADIOLOGY0632208 NM BRAIN W TOMO SPECT 3878.00 06 SUNQUEST RADIOLOGY0632257 NM BRAIN FLOW ONLY 2070.00 06 SUNQUEST RADIOLOGY0632059 NM BRAIN CISTERNOGRAM 3870.00 06 SUNQUEST RADIOLOGY0632075 NM CSF FLOW W SPECT 815.00 06 SUNQUEST RADIOLOGY0635052 NM KIDNEY IMAGING W/FLOW 2405.00 06 SUNQUEST RADIOLOGY0635219 NM K FLOW/FUNCT W/O DRG 2436.00 06 SUNQUEST RADIOLOGY0634808 NM K FLOW/FUNCT W/DRUG 1580.00 06 SUNQUEST RADIOLOGY0634816 NM K FLOW/FUNCT W/DRUG 1580.00 06 SUNQUEST RADIOLOGY0634857 NM RENL FNCTN NONIMAG 1068.00 06 SUNQUEST RADIOLOGY0636308 NM TUMOR LOC LTD W RP 1970.00 06 SUNQUEST RADIOLOGY0636407 NM TUMOR LOC MULTI W RP 2728.00 06 SUNQUEST RADIOLOGY0636506 NM TUMOR LOC WB SNGL DAY 3639.00 06 SUNQUEST RADIOLOGY0631002 NM ABSCSS LOC LTD 1891.00 06 SUNQUEST RADIOLOGY0631101 NM ABSCSS LOC WB 3787.00 06 SUNQUEST RADIOLOGY0637140 CA CARDIAC STRES TEST 2235.00 06 SUNQUEST RADIOLOGY0675611 CA ECHO 2D CMP NO SPC/DOP 2526.00 06 SUNQUEST RADIOLOGY0675678 CA ECHO 2D LTD 1805.00 06 SUNQUEST RADIOLOGY0675884 CA ECHO TRANSESOPHAGEAL 4749.00 06 SUNQUEST RADIOLOGY0675645 CA ECHO DPPLER CMPL 1120.00 06 SUNQUEST RADIOLOGY0675637 CA ECHO DPPLER COLOR FLOW 868.00 06 SUNQUEST RADIOLOGY0675694 CA ECHO 2D W STRES 2464.00 1081.00 06 SUNQUEST RADIOLOGY0675942 NI DPPLER EXTRACRAN BIL 538.00 06 SUNQUEST RADIOLOGY0675850 NI DUPLEX EXTRACRAN BIL 2207.00 06 SUNQUEST RADIOLOGY0675843 NI DUPLEX EXTRACRAN UNI 1535.00 06 SUNQUEST RADIOLOGY0676304 NI INTRACRAN LTD 1292.00 06 SUNQUEST RADIOLOGY0675413 NI EXT ART LTD BIL 1-2 LV 983.00 06 SUNQUEST RADIOLOGY0675462 NI DUPLEX EXT LOW BIL 2880.00 06 SUNQUEST RADIOLOGY0675801 NI DUPLEX EXT UPP BIL 2269.00 06 SUNQUEST RADIOLOGY0676379 NI DPPLER EXT VEINS BIL 1092.00 06 SUNQUEST RADIOLOGY0676403 NI DUPLEX EXT VEINS BIL 2242.00 06 SUNQUEST RADIOLOGY0676452 NI DUPLEX EXT VEINS UNI 1471.00 06 SUNQUEST RADIOLOGY0675108 NI DUPLEX ABD PELV CMPL 2897.00 06 SUNQUEST RADIOLOGY0675157 NI DUPLEX ABD PELV LTD 1573.00 06 SUNQUEST RADIOLOGY0675207 NI AORTA IVC IL CMPL 2102.00 06 SUNQUEST RADIOLOGY0675215 NI AORTA IVC IL LTD 1464.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0647487 CTC PUNCTURE DRN LESION 373.00 06 SUNQUEST RADIOLOGY0672683 USC PUNCTURE DRN LESION 363.00 363.00 06 SUNQUEST RADIOLOGY0622548 XRC BX BREAST PRC W/O 437.00 06 SUNQUEST RADIOLOGY0666263 IRC INTRO AORTA 1024.00 06 SUNQUEST RADIOLOGY0667642 IRC CATH PORTAL VEIN PRC 3121.00 06 SUNQUEST RADIOLOGY0627976 XRC REPS PREV PLC CV CATH 397.00 06 SUNQUEST RADIOLOGY0667428 IRC REPS PREV PLC CV CATH 397.00 06 SUNQUEST RADIOLOGY0627893 XRC REMV TUNN CV CATH W/O 479.00 06 SUNQUEST RADIOLOGY0669580 IRC REMV TUNN CV CATH W/O 388.00 06 SUNQUEST RADIOLOGY0644385 CTC REMV TUNN CV CATH W/O 479.00 06 SUNQUEST RADIOLOGY0664425 IRC BX TRANSCATHETER 330.00 06 SUNQUEST RADIOLOGY0664771 IRC EXCHNGE INTRAVAS CATH 155.00 06 SUNQUEST RADIOLOGY0648261 CTC BX EXCSN LYMPH NODE 801.00 06 SUNQUEST RADIOLOGY0624312 XRC ERCP DX W/WO SPEC 516.00 06 SUNQUEST RADIOLOGY0666172 IRC CHNG G TUBE WO IMG/GD 1492.00 06 SUNQUEST RADIOLOGY0621326 XRC CHNG G TUBE WO IMG/GD 369.00 06 SUNQUEST RADIOLOGY0666610 IRC CHNG G TUBE WO IMG/GD 1492.00 06 SUNQUEST RADIOLOGY0621334 XRC REPO NASO/ORO G TUBE 214.00 06 SUNQUEST RADIOLOGY0662973 IRC DRN APPNCL ABSCSS PRC 3964.00 06 SUNQUEST RADIOLOGY0661389 IRC INCSN GBLDR PRC W S&I 1065.00 06 SUNQUEST RADIOLOGY0660456 IRC REINSERT BILE TUBE 5073.00 06 SUNQUEST RADIOLOGY0673343 USC DRN PANC PSEUDOCYST 3334.00 06 SUNQUEST RADIOLOGY0673368 USC DRN ABD ABSCSS OPN 2309.00 06 SUNQUEST RADIOLOGY0664573 IRC EXCHANGE DRN CATH 1358.00 06 SUNQUEST RADIOLOGY0674036 USC EXCHANGE DRN CATH 150.00 06 SUNQUEST RADIOLOGY0642991 CTC EXCHANGE DRN CATH 3978.00 06 SUNQUEST RADIOLOGY0665638 IRC INJ CON ABSCSS 602.00 06 SUNQUEST RADIOLOGY0679001 USC INJ CON ABSCSS 98.00 06 SUNQUEST RADIOLOGY0643056 CTC INJ CON ABSCSS 602.00 06 SUNQUEST RADIOLOGY0666180 IRC ASP BLADDER SP CATH 661.00 06 SUNQUEST RADIOLOGY0665448 IRC INJ SPINE CERV/THOR 726.00 06 SUNQUEST RADIOLOGY0627984 XR RIBS BIL W PA CXR 591.00 06 SUNQUEST RADIOLOGY0625749 XR PELV HIP 2V INF CHLD 458.00 06 SUNQUEST RADIOLOGY0661983 IR BILE STONE EXTRACTION 1008.00 06 SUNQUEST RADIOLOGY0625582 XR BILE STONE EXTRACTION 265.00 06 SUNQUEST RADIOLOGY0627794 XR PELVIMETRY 364.00 06 SUNQUEST RADIOLOGY0661397 IR ANGIO INT MAMMARY 2054.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0669473 IR VENOGRAM SIN JUGULAR 1791.00 06 SUNQUEST RADIOLOGY0669382 IR VENOGRAM HEP W EVAL 1771.00 06 SUNQUEST RADIOLOGY0669390 IR VENOGRAM HEP W/O EVAL 1775.00 06 SUNQUEST RADIOLOGY0668673 IR EXCHNGE INTRAVAS CATH 1563.00 06 SUNQUEST RADIOLOGY0625194 XR FLUORO GUIDE SPINE INJ 508.00 06 SUNQUEST RADIOLOGY0622951 XR DEXA APPEN 298.00 06 SUNQUEST RADIOLOGY0652180 MR BREAST BIL W-W/O CON 4142.00 06 SUNQUEST RADIOLOGY0646851 CT GUIDE RAD TX FIELDS 2864.00 06 SUNQUEST RADIOLOGY0654947 MR SPECTROSCOPY 3459.00 06 SUNQUEST RADIOLOGY0672154 US ECHO RETROPE LTD 1048.00 06 SUNQUEST RADIOLOGY0674044 US ECHO INF HIPS 1379.00 06 SUNQUEST RADIOLOGY0626952 US ECHO INF HIPS 1379.00 06 SUNQUEST RADIOLOGY0672733 US NDL PLACE 2082.00 06 SUNQUEST RADIOLOGY0662338 CA NDL PLACE 3228.00 06 SUNQUEST RADIOLOGY0673103 US NDL PLACE 1470.00 06 SUNQUEST RADIOLOGY0674192 US GUIDE ART PSEUDOANEUR 2651.00 06 SUNQUEST RADIOLOGY0699702 RO SIMULATION SMPL 791.00 06 SUNQUEST RADIOLOGY0699744 RO SIMULATION CMPLX 5312.00 06 SUNQUEST RADIOLOGY0633149 NM HEART GATED SNGL 2600.00 06 SUNQUEST RADIOLOGY0634378 NM VENT/PER REBRTH/WASHOU 3830.00 06 SUNQUEST RADIOLOGY0635185 NM K FLOW/FUNCT MULTIPLE 3800.00 06 SUNQUEST RADIOLOGY0671909 USC BX BREAST VAC ASSIST 2770.00 06 SUNQUEST RADIOLOGY0623033 XRC IMAG LOC CLIP W BX 454.00 06 SUNQUEST RADIOLOGY0641621 CTA HEAD W-W/O CON 6687.00 06 SUNQUEST RADIOLOGY0644070 CTA NEC W-W/O CON 4793.00 06 SUNQUEST RADIOLOGY0653147 MR ORBIT FACE NEC W-W/O 5350.00 06 SUNQUEST RADIOLOGY0657502 MRA NEC W/O CON 4168.00 06 SUNQUEST RADIOLOGY0657528 MRA NEC W CON 4400.00 06 SUNQUEST RADIOLOGY0657544 MRA NEC W-W/O CON 6576.00 06 SUNQUEST RADIOLOGY0662072 IR BRONCHOGRAM UNI 207.00 06 SUNQUEST RADIOLOGY0662080 IR BRONCHOGRAM BIL 314.00 06 SUNQUEST RADIOLOGY0643627 CTA CHST NOCORO W-W/O CON 6032.00 06 SUNQUEST RADIOLOGY0652388 MR CHEST W-W/O CON 6075.04 06 SUNQUEST RADIOLOGY0644724 CTA PELV W-W/O CON 5418.00 06 SUNQUEST RADIOLOGY0653295 MR PELV W/O CON 3784.00 06 SUNQUEST RADIOLOGY0653311 MR PELV W-W/O CON 5405.00 06 SUNQUEST RADIOLOGY0652644 MR EXT UPP JNT W CON 3863.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0642850 CTA EXT LOW W-W/O CON 5599.00 06 SUNQUEST RADIOLOGY0652438 MR EXT LOW W/O CON 3773.00 06 SUNQUEST RADIOLOGY0652511 MR EXT LOW JNT W CON 3863.00 06 SUNQUEST RADIOLOGY0652529 MR EXT LOW JNT W-W/O CON 5097.00 06 SUNQUEST RADIOLOGY0646216 CTA ABD W-W/O CON 5599.00 06 SUNQUEST RADIOLOGY0652115 MR ABD W-W/O CON 5417.00 06 SUNQUEST RADIOLOGY0662445 IR CORPORA CAVERNOSOGRAM 487.00 06 SUNQUEST RADIOLOGY0629899 XR CORPORA CAVERNOSOGRAM 160.00 06 SUNQUEST RADIOLOGY0662585 IR FALLOPN TUBE TRANSCERV 449.00 06 SUNQUEST RADIOLOGY0625137 XR FALLOPN TUBE TRANSCERV 1406.00 06 SUNQUEST RADIOLOGY0668269 IR LYMPHANGIO ABD UNI 867.00 06 SUNQUEST RADIOLOGY0669283 IR VENOGRAM ADRENAL UNI 1736.00 06 SUNQUEST RADIOLOGY0669275 IR VENOGRAM ADRENAL BIL 1786.00 06 SUNQUEST RADIOLOGY0668376 IR PORTOGRAM W/O HEM EVAL 1799.00 06 SUNQUEST RADIOLOGY0667923 IR IVUS NONCO INI 648.00 06 SUNQUEST RADIOLOGY0667931 IR IVUS NONCO ADD 327.00 06 SUNQUEST RADIOLOGY0654962 MR GUIDE NDL PLACE 3061.00 06 SUNQUEST RADIOLOGY0652172 MR BREAST UNI W-W/O CON 3371.00 06 SUNQUEST RADIOLOGY0626879 XR MAN APP STRS ANY JNT 43.00 06 SUNQUEST RADIOLOGY0641332 CTA ABD W RUNOFF W-W/O 6133.00 06 SUNQUEST RADIOLOGY0674150 US BIO PROFILE WO NOSTRES 681.00 06 SUNQUEST RADIOLOGY0674200 US FETAL TRANSFUSION IUT 679.00 06 SUNQUEST RADIOLOGY0674218 US VILLUS SAMPLING 729.00 06 SUNQUEST RADIOLOGY0642686 CTC BX HIP 1054.00 06 SUNQUEST RADIOLOGY0666685 IRC CYSTO TUBE CHNG SMPL 361.00 06 SUNQUEST RADIOLOGY0666693 IRC CYSTO TUBE CHNG CMPLX 493.00 06 SUNQUEST RADIOLOGY0661314 IRC INJ NRV ILIOINGUINAL 312.00 06 SUNQUEST RADIOLOGY0626135 XR EPIDUROGRAM 1118.00 06 SUNQUEST RADIOLOGY0662577 IR EPIDUROGRAM 781.00 06 SUNQUEST RADIOLOGY0628164 XR SELLA TURCICA 321.00 06 SUNQUEST RADIOLOGY0669374 IR VENOGRAM EPID 1786.00 06 SUNQUEST RADIOLOGY0622779 XRC BX SOFT TISS NEC THOR 839.00 06 SUNQUEST RADIOLOGY0633875 NMC RA TRCR SENTINEL NODE 97.00 06 SUNQUEST RADIOLOGY0661348 IRC INJ CELIAC PLEX LYTIC 846.00 06 SUNQUEST RADIOLOGY0624106 XR EXAM OF MIDDLE EAR 402.00 06 SUNQUEST RADIOLOGY0669481 IR VENOGRAM SAG SINUS 1775.00 06 SUNQUEST RADIOLOGY0664441 IRC BRONCH W BX 1245.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0669465 IR VENOGRAM ORBITAL 135.00 06 SUNQUEST RADIOLOGY0663666 IRC DECLOT XTL CAN W BLN 267.00 06 SUNQUEST RADIOLOGY0663815 IRC ENDO RENL W URET CATH 843.00 524.00 06 SUNQUEST RADIOLOGY0661975 IR ARTHRO SI JNT 581.00 06 SUNQUEST RADIOLOGY0634774 NM WB VOL DETERMINATION 1231.00 06 SUNQUEST RADIOLOGY0634782 NM PLATELET SURVIVAL STDY 1865.00 06 SUNQUEST RADIOLOGY0667584 IRC RVSN AVS FIST OPN W/O 1027.00 06 SUNQUEST RADIOLOGY0627695 XR PERITONEOGRAM 186.00 06 SUNQUEST RADIOLOGY0672980 USC VILLUS SAMPLING 302.00 06 SUNQUEST RADIOLOGY0672527 USC BX LYMPH NODE SUPER 412.00 412.00 06 SUNQUEST RADIOLOGY0642603 CTC BX LYMPH NODE SUPER 402.00 06 SUNQUEST RADIOLOGY0648113 CTC BX BRAIN W BURR HOLE 2212.00 06 SUNQUEST RADIOLOGY0652586 MR EXT UPP NO JNT W/O CON 3863.00 06 SUNQUEST RADIOLOGY0652594 MR EXT UPP NO JNT W/CON 4110.00 06 SUNQUEST RADIOLOGY0622597 MR EXT UPP NO JNT W/CON 4110.00 06 SUNQUEST RADIOLOGY0652669 MR EXT UPP JNT W-W/O CON 5109.00 06 SUNQUEST RADIOLOGY0674069 US ECHO INF HIPS LTD 705.00 06 SUNQUEST RADIOLOGY0643478 CTC PNMNSTOMY W DRN PRC 3765.00 06 SUNQUEST RADIOLOGY0667840 IRC PNMNSTOMY W DRN PRC 728.00 06 SUNQUEST RADIOLOGY0662734 IRC RMVL KDY STN PRC/LES2 1522.00 06 SUNQUEST RADIOLOGY0665430 IRC INJ SPINE W CATH L/S 582.00 06 SUNQUEST RADIOLOGY0668517 IRC RMVL INTHCL/EPID CATH 494.00 06 SUNQUEST RADIOLOGY0629139 XR SPINE SNGL V LUMB 256.00 06 SUNQUEST RADIOLOGY0629030 XR SPINE SNGL V LUMB 256.00 06 SUNQUEST RADIOLOGY0629311 XR SPINE SNGL V THOR 256.00 06 SUNQUEST RADIOLOGY0667725 IRC DECLOT VASC DEVICE 139.00 06 SUNQUEST RADIOLOGY0667865 IRC INJ NRV INTCOSTL MULT 833.00 06 SUNQUEST RADIOLOGY0664516 IRC INJ NRV INTCOSTL SNGL 476.00 06 SUNQUEST RADIOLOGY0660415 IRC INJ SPINE W CATH C/TH 787.00 06 SUNQUEST RADIOLOGY0665687 IRC INJ TND SHEATH/LG 06 SUNQUEST RADIOLOGY0664219 IRC FNA W IMAG GUIDANCE 430.00 06 SUNQUEST RADIOLOGY0622761 IRC FNA W IMAG GUIDANCE 430.00 06 SUNQUEST RADIOLOGY0642405 CTC FNA W IMAG GUIDANCE 430.00 06 SUNQUEST RADIOLOGY0672485 USC FNA W IMAG GUIDANCE 430.00 06 SUNQUEST RADIOLOGY0654988 MR GUIDE VISCL TISS ABLTN 1948.00 06 SUNQUEST RADIOLOGY0670851 US GDE PRNCHYML TISS ABLN 780.00 06 SUNQUEST RADIOLOGY0667857 US GDE PRNCHYML TISS ABLN 780.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0627182 XR MAMMO SCRN CAD ADD-ON 32.00 06 SUNQUEST RADIOLOGY0642736 CTC ABLTN RENAL RF PRC 2701.00 06 SUNQUEST RADIOLOGY0670828 USC ABLTN RENAL RF PRC 3835.00 06 SUNQUEST RADIOLOGY0660829 IRC ABLTN RENAL RF PRC 3835.00 06 SUNQUEST RADIOLOGY0661058 IR ENDOVAS REPR ABD AO 630.00 06 SUNQUEST RADIOLOGY0661066 IR PLACE PROS REPR AAA 190.00 06 SUNQUEST RADIOLOGY0699108 RO RADIAT DOSIMETRY CALC 329.00 06 SUNQUEST RADIOLOGY0699603 RO RADIATION PHYSICS CNSL 749.00 06 SUNQUEST RADIOLOGY0699850 RO INTRSTIT RADIAT CMPLX 3500.00 06 SUNQUEST RADIOLOGY0665661 IRC INJ TRG PT 1 OR 2 MCL 129.00 06 SUNQUEST RADIOLOGY0665679 IRC INJ TRIG PT GT 2 MCL 143.00 06 SUNQUEST RADIOLOGY0661371 IRC RVSN AV FST WO THROM 849.00 06 SUNQUEST RADIOLOGY0627174 XR MAMMO DX CAD ADD-ON 32.00 06 SUNQUEST RADIOLOGY0699900 RO DVCS CONSTRUCT SMPL 323.00 06 SUNQUEST RADIOLOGY0699421 RO IMRT DLVR EA SESSION 2543.00 06 SUNQUEST RADIOLOGY0699868 RO IMRT PLAN 4496.00 06 SUNQUEST RADIOLOGY0699579 RO ISODOSE PLAN CMPLX 678.00 06 SUNQUEST RADIOLOGY0699645 RO RAD PORT FILM(S) 126.00 06 SUNQUEST RADIOLOGY0699272 RO RAD TX 2 AREA 11-19MEV 449.00 06 SUNQUEST RADIOLOGY0699256 RO RAD TX 2 AREA 1-5MEV 449.00 06 SUNQUEST RADIOLOGY0699264 RO RAD TX 2 AREA 6-10MEV 449.00 06 SUNQUEST RADIOLOGY0699280 RO RAD TX 2 AREA GT 19MEV 449.00 06 SUNQUEST RADIOLOGY0699322 RO RAD TX 3/MORE 11-19MEV 500.00 06 SUNQUEST RADIOLOGY0699306 RO RAD TX 3/MORE 1-5MEV 500.00 06 SUNQUEST RADIOLOGY0699314 RO RAD TX 3/MORE 6-10MEV 500.00 06 SUNQUEST RADIOLOGY0699330 RO RAD TX 3/MORE GT 19MEV 500.00 06 SUNQUEST RADIOLOGY0699223 RO RAD TX SNGL 11-19MEV 381.00 06 SUNQUEST RADIOLOGY0699207 RO RAD TX SNGL 1-5MEV 381.00 06 SUNQUEST RADIOLOGY0699215 RO RAD TX SNGL 6-10MEV 381.00 06 SUNQUEST RADIOLOGY0699231 RO RAD TX SNGL GT 19MEV 381.00 06 SUNQUEST RADIOLOGY0699355 RO RAD TX SUPERFICIAL 381.00 06 SUNQUEST RADIOLOGY0699660 RO SIMULATION 3D 6306.00 06 SUNQUEST RADIOLOGY0699728 RO SIMULATION INTRM 1150.00 1150.00 06 SUNQUEST RADIOLOGY0699926 RO DVCS CONSTRUCT CMPLX 4 783.00 06 SUNQUEST RADIOLOGY0626473 XRC IJ SI JNT ARTH W/GUID 3840.00 06 SUNQUEST RADIOLOGY0660118 IRC IJ SI JT ANES/ST W/GD 5054.64 06 SUNQUEST RADIOLOGY0640110 CAC IJ SI JT ANES/ST W/GD 8522.60 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0620138 XRC IJ SI JT ANES/ST W/GD 7234.10 06 SUNQUEST RADIOLOGY0667832 IRC PSEUDOANEURYSM INJ 445.00 06 SUNQUEST RADIOLOGY0676585 USC PSEUDOANEURYSM INJ 445.00 06 SUNQUEST RADIOLOGY0674564 US OB 1ST TRI 1 GEST 1035.00 06 SUNQUEST RADIOLOGY0674572 US OB 1ST TRI EA GEST 366.00 06 SUNQUEST RADIOLOGY0674580 US OB DTLD FTL EXAM 1 GES 1267.00 06 SUNQUEST RADIOLOGY0674598 US OB DTLD FTL EXM EA GES 1492.00 06 SUNQUEST RADIOLOGY0674747 US OB TRANSVAGINAL 275.00 06 SUNQUEST RADIOLOGY0666677 IRC NG TUBE PLC W FLUORO 54.00 54.00 06 SUNQUEST RADIOLOGY0668749 IR CV CATH MECH CLEAR 585.00 06 SUNQUEST RADIOLOGY0662049 IRC MECH REMOVE INTRACATH 789.00 486.00 06 SUNQUEST RADIOLOGY0662098 IRC MECH REMOVE PERICATH 789.00 486.00 06 SUNQUEST RADIOLOGY0668731 IR RMVL CVA DEV OBSTRCTN 1391.00 06 SUNQUEST RADIOLOGY0641472 CT PERFUSION W/CON CBF 8816.00 06 SUNQUEST RADIOLOGY0652776 MR VENOGRAM BRAIN 5968.00 06 SUNQUEST RADIOLOGY0660852 IR PLACE OCC DEV VEIN ART 1053.00 327.00 06 SUNQUEST RADIOLOGY0664292 IRC BX SALIVARY GLAND NDL 381.00 06 SUNQUEST RADIOLOGY0661041 IRC DRAIN PELV HIP JT ABS 421.00 06 SUNQUEST RADIOLOGY0673251 USC ASP THYROID CYST 359.00 06 SUNQUEST RADIOLOGY0662015 IRC DRAIN HEMATOMA/FLUID 368.00 06 SUNQUEST RADIOLOGY0664243 IRC INJ/ASP GANGLION CYST 150.00 06 SUNQUEST RADIOLOGY0646315 CT VERTPLASTY EA BDY CT 1019.00 06 SUNQUEST RADIOLOGY0665612 IR INJ IVP SNGL/INIT DRG 290.00 06 SUNQUEST RADIOLOGY0648758 CT LUNG SCREENING 3849.00 06 SUNQUEST RADIOLOGY0648725 CT CARDIAC SCORING 1447.00 06 SUNQUEST RADIOLOGY0663773 IRC TEMP BAL ARTERIAL OCC 772.00 06 SUNQUEST RADIOLOGY0672972 USC CORDOCENTESIS IUT 285.00 06 SUNQUEST RADIOLOGY0621409 XRC INSERT CATH TMP SMPL 284.00 06 SUNQUEST RADIOLOGY0633891 NMC INSERT CATH TMP SMPL 284.00 06 SUNQUEST RADIOLOGY0621417 XRC INSERT CATH TMP CMPLX 303.00 06 SUNQUEST RADIOLOGY0636464 NM WHOLE BODY 2+ DAYS 6754.00 06 SUNQUEST RADIOLOGY0635615 NM MONOCLONAL AB IV INFSN 1241.00 06 SUNQUEST RADIOLOGY0667782 IRC INS NON-TUN CV CATH<5 836.00 06 SUNQUEST RADIOLOGY0621524 XRC INS NON-TUN CV CATH<5 1096.00 06 SUNQUEST RADIOLOGY0621532 XRC INS NON-TUN CV CATH5+ 1068.00 06 SUNQUEST RADIOLOGY0667790 IRC INS NON-TUN CV CATH5+ 625.00 06 SUNQUEST RADIOLOGY0667808 IRC INS TUN CV NO PRT LT5 4593.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0621540 XRC INS TUN CV NO PRT LT5 3027.00 06 SUNQUEST RADIOLOGY0621557 XRC INS TUNN CV NO PORT5+ 3002.00 06 SUNQUEST RADIOLOGY0667816 IRC INS TUNN CV NO PORT5+ 4133.00 06 SUNQUEST RADIOLOGY0621607 XRC INS TUNN CV DEV LT 5 5332.00 06 SUNQUEST RADIOLOGY0667675 IRC INS TUNN CV DEV LT 5 7127.00 06 SUNQUEST RADIOLOGY0621615 XRC INS TUNN CV DEV 5+ 6395.00 06 SUNQUEST RADIOLOGY0667667 IRC INS TUNN CV DEV 5+ 8267.00 06 SUNQUEST RADIOLOGY0621649 XRC INS PICC W/O PORT LT5 1110.00 06 SUNQUEST RADIOLOGY0674317 USC INS PICC W/O PORT LT5 1496.00 06 SUNQUEST RADIOLOGY0666370 IRC INS PICC W/O PORT LT5 1110.00 06 SUNQUEST RADIOLOGY0666362 IRC INS PICC W/O PORT 5+ 932.00 06 SUNQUEST RADIOLOGY0621656 XRC INS PICC W/O PORT 5+ 932.00 06 SUNQUEST RADIOLOGY0674325 USC INS PICC W/O PORT 5+ 1350.00 06 SUNQUEST RADIOLOGY0621664 XRC INS PICC W/PORT LT 5 6803.00 06 SUNQUEST RADIOLOGY0666396 IRC INS PICC W/PORT LT 5 4545.00 06 SUNQUEST RADIOLOGY0621672 XRC INS PICC W/PORT 5+YRS 6510.00 06 SUNQUEST RADIOLOGY0666388 IRC INS PICC W/PORT 5+YRS 5175.00 06 SUNQUEST RADIOLOGY0668566 IRC REPR CV CATH W/O PORT 666.00 06 SUNQUEST RADIOLOGY0627877 XRC RPLC COMP NON-TUNN CV 851.00 06 SUNQUEST RADIOLOGY0667691 IRC RPLC COMP NON-TUNN CV 851.00 06 SUNQUEST RADIOLOGY0667683 IRC RPLC COMP TUN CV CATH 4593.00 06 SUNQUEST RADIOLOGY0667717 IRC RPLC COMP TUN CV W/PT 8749.00 06 SUNQUEST RADIOLOGY0627935 XRC RPLC CMP PICC W/O 833.00 06 SUNQUEST RADIOLOGY0625186 XR FLUOR CVAD PLC/RMV/RPR 1486.00 06 SUNQUEST RADIOLOGY0667741 IR FLUOR CVAD PLC/RMV/RPR 1038.00 06 SUNQUEST RADIOLOGY0674432 IR US VASC ACCESS ADD ON 299.00 06 SUNQUEST RADIOLOGY0627430 XR DACRYOCYSTOGRAPHY 515.00 06 SUNQUEST RADIOLOGY0667378 IRC OPN INTRVAS STENT ADD 234.00 06 SUNQUEST RADIOLOGY0667360 IRC OPN INTRVS STENT INIT 538.00 06 SUNQUEST RADIOLOGY0663518 IRC OPN TRANS ANGIO RENAL 738.00 06 SUNQUEST RADIOLOGY0668723 IRC REM TUNN CVA DEV W PT 745.00 06 SUNQUEST RADIOLOGY0672592 USC BX BM NDL/TROCAR 566.00 06 SUNQUEST RADIOLOGY0664029 IRC BX BM NDL/TROCAR 554.00 06 SUNQUEST RADIOLOGY0642538 CTC BX BM NDL/TROCAR 554.00 06 SUNQUEST RADIOLOGY0622514 XRC BX BM NDL/TROCAR 566.00 06 SUNQUEST RADIOLOGY0664763 IRC PNMNSTOMY W DRN OPN 2765.00 06 SUNQUEST RADIOLOGY0666198 IRC INS INTRA ART PUMP 1725.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0666164 IRC RVSN INTRA ART PUMP 1047.00 06 SUNQUEST RADIOLOGY0663542 IRC RMVL INTRA ART PUMP 786.00 06 SUNQUEST RADIOLOGY0664961 IRC UP GI ENDO W/TUBE PLC 687.00 06 SUNQUEST RADIOLOGY0669879 IRC ERCP W/BIOPSY 977.00 06 SUNQUEST RADIOLOGY0624338 XRC ERCP W/BIOPSY 977.00 06 SUNQUEST RADIOLOGY0624346 XRC ERCP W/SPHINC/PAPIL 1148.00 06 SUNQUEST RADIOLOGY0669853 IRC ERCP RMVL CALC 1379.00 06 SUNQUEST RADIOLOGY0624353 XRC ERCP RMVL CALC 1379.00 06 SUNQUEST RADIOLOGY0624361 XRC ERCP RETRO DESTRUCTN 1543.00 06 SUNQUEST RADIOLOGY0624155 XRC ERCP INS NASO TUBE 1147.00 06 SUNQUEST RADIOLOGY0624163 XRC ERCP INS BIL/PAN TUBE 754.00 06 SUNQUEST RADIOLOGY0624171 XRC ERCP RMVL FB/CHNG 1264.00 06 SUNQUEST RADIOLOGY0626150 XRC ERCP BLN DILATION 1147.00 06 SUNQUEST RADIOLOGY0624379 XRC ERCP W/ABLATION 1148.00 06 SUNQUEST RADIOLOGY0665166 IRC DRN APPNCL ABSCSS OPN 1708.00 06 SUNQUEST RADIOLOGY0664979 IRC PROCTOSIGMOIDOSCPY DX 256.00 06 SUNQUEST RADIOLOGY0664987 IRC PROCTOSIGMOID W/DIL 2661.00 06 SUNQUEST RADIOLOGY0674788 USC LAP ABLATION RF LIVER 3130.00 06 SUNQUEST RADIOLOGY0674796 USC LAP ABLTN CRYO LIVER 3131.00 06 SUNQUEST RADIOLOGY0670836 USC ABLTN CRYO OPN LIVER 3683.00 06 SUNQUEST RADIOLOGY0642744 CTC ABLTN CRYO OPN LIVER 3683.00 06 SUNQUEST RADIOLOGY0626374 XRC INJ PANCREAT INTRAOP 293.00 06 SUNQUEST RADIOLOGY0665968 IRC INJ PANCREAT INTRAOP 293.00 06 SUNQUEST RADIOLOGY0662726 IRC RMVL KDY STN PRC GT 2 3644.00 06 SUNQUEST RADIOLOGY0626622 XRC INJ URETHROCYST CHAIN 1278.00 06 SUNQUEST RADIOLOGY0666099 IRC INJ URETHROCYST CHAIN 1278.00 06 SUNQUEST RADIOLOGY0674945 USC PLC NDL PROSTATE INST 2088.00 06 SUNQUEST RADIOLOGY0670844 USC ABLTN PROSTATE CRYO 3930.00 06 SUNQUEST RADIOLOGY0642470 CTC BX STEREO ASPIR HEAD 3466.00 06 SUNQUEST RADIOLOGY0652693 MRC BX STEREO ASPIR HEAD 3466.00 06 SUNQUEST RADIOLOGY0627687 XR PERINEOGRAM 207.00 06 SUNQUEST RADIOLOGY0641449 CT BONE DENSITY STDY APPN 408.00 06 SUNQUEST RADIOLOGY0621821 XR RADIO ABSORPTIOMETRY 109.00 06 SUNQUEST RADIOLOGY0627133 XR MAMMO SCRN DIG BILAT 378.00 06 SUNQUEST RADIOLOGY0627166 XR MAMMO DX DIG BILAT 444.00 06 SUNQUEST RADIOLOGY0627190 XR MAMMO DX DIG UNILAT 348.00 06 SUNQUEST RADIOLOGY0625053 XR FLUORO 1-2 HRS 1534.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0625061 XR FLUORO 2-3 HRS 1791.00 06 SUNQUEST RADIOLOGY0625079 XR FLUORO 3-4 HRS 1791.00 06 SUNQUEST RADIOLOGY0625087 XR FLUORO 4-5 HRS 1791.00 06 SUNQUEST RADIOLOGY0625095 XR FLUORO 5-6 HRS 1791.00 06 SUNQUEST RADIOLOGY0622076 XRC ASP SPINAL CYST PRC 1609.00 06 SUNQUEST RADIOLOGY0663682 IRC ASP SPINAL CYST PRC 1609.00 06 SUNQUEST RADIOLOGY0642488 CTC ASP SPINAL CYST PRC 1609.00 06 SUNQUEST RADIOLOGY0672493 USC ASP SPINAL CYST PRC 1609.00 06 SUNQUEST RADIOLOGY0648659 CTC ENDO SB W JEJ TUB PRC 653.00 06 SUNQUEST RADIOLOGY0667873 IRC ENDO SB W JEJ TUB PRC 425.00 06 SUNQUEST RADIOLOGY0673921 USC ENDO SB W JEJ TUB PRC 653.00 06 SUNQUEST RADIOLOGY0625558 XRC ENDO SB W JEJ TUB PRC 653.00 06 SUNQUEST RADIOLOGY0673301 USC DRN ABSCESS COMP/MULT 268.00 06 SUNQUEST RADIOLOGY0663021 IRC DRN ABSCESS COMP/MULT 268.00 06 SUNQUEST RADIOLOGY0699439 RO STER XR GD LOC TRGT 1063.00 06 SUNQUEST RADIOLOGY0629857 XRC CYSTOMETROGRAM CMPLX 1213.00 06 SUNQUEST RADIOLOGY0623884 XRC UROFLOWMETRY COMPLEX 197.00 06 SUNQUEST RADIOLOGY0622787 XRC BX SKIN LESION SNGL 310.00 06 SUNQUEST RADIOLOGY0622795 XRC BX SKIN LESION EA ADD 84.00 06 SUNQUEST RADIOLOGY0666982 IRC PERC VERT AUG ADD VRT 386.00 06 SUNQUEST RADIOLOGY0648774 CT COLONOSCOPY SCRN 890.00 06 SUNQUEST RADIOLOGY0669598 IRC RMV TNLD INPRTNL CATH 595.00 06 SUNQUEST RADIOLOGY0622969 XR DXA BONE DENS VRT FRAC 321.00 06 SUNQUEST RADIOLOGY0665646 IR INJECTION IM/SQ EA 64.00 06 SUNQUEST RADIOLOGY0674960 USC URINE CAPACITY MEASUR 157.00 06 SUNQUEST RADIOLOGY0684050 PS HEART METBLC EVAL 1150.00 06 SUNQUEST RADIOLOGY0681056 PS BRAIN METBLC EVAL 1150.00 06 SUNQUEST RADIOLOGY0681155 PS BRAIN PERF EVAL 1150.00 06 SUNQUEST RADIOLOGY0684829 PS LIMITED AREA 1150.00 06 SUNQUEST RADIOLOGY0684845 PS SKULL TO MID THIGH 1150.00 06 SUNQUEST RADIOLOGY0684662 PS FULL BODY 1150.00 06 SUNQUEST RADIOLOGY0683714 PS FULL BODY 1150.00 06 SUNQUEST RADIOLOGY0682179 PS FULL BODY 1150.00 06 SUNQUEST RADIOLOGY0682161 PS FULL BODY 1150.00 06 SUNQUEST RADIOLOGY0698514 RO DSIGN MLC DEV FOR IMRT 800.00 06 SUNQUEST RADIOLOGY0684159 PS HEART PERF SNGL 1150.00 06 SUNQUEST RADIOLOGY0684100 PS HEART PERF MULTI 1150.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0684860 PS/CT ATT ANAT LOC LTD 1150.00 06 SUNQUEST RADIOLOGY0684886 PS/CT SKULL-THGH 1150.00 06 SUNQUEST RADIOLOGY0684902 PS/CT WHOLE BODY 1150.00 06 SUNQUEST RADIOLOGY0665109 CAC NONTHROMBOLYSIS IV 1354.00 06 SUNQUEST RADIOLOGY0698522 RO IO RAD TX DLR BY X-RAY 06 SUNQUEST RADIOLOGY0698530 RO IO RAD TX DLR BY ELECT 06 SUNQUEST RADIOLOGY0666966 IRC PRC VRT AUG THOR 1VRT 1022.00 06 SUNQUEST RADIOLOGY0666974 IRC PRC VRT AUG LUMB 1VRT 991.00 06 SUNQUEST RADIOLOGY0646901 CT CS SAME MD LT5YR 0-30M 400.00 06 SUNQUEST RADIOLOGY0662809 IR CS SAME MD LT5YR 0-30M 429.00 06 SUNQUEST RADIOLOGY0651323 MR CS SAME MD LT5YR 0-30M 317.00 06 SUNQUEST RADIOLOGY0671347 US CS SAME MD LT5YR 0-30M 471.00 06 SUNQUEST RADIOLOGY0624700 XR CS SAME MD LT5YR 0-30M 594.00 06 SUNQUEST RADIOLOGY0635912 NM CS SAME MD LT5YR 0-30M 536.00 06 SUNQUEST RADIOLOGY0646919 CT CS SAME MD GT5YR 0-30M 600.00 06 SUNQUEST RADIOLOGY0651331 MR CS SAME MD GT5YR 0-30M 267.00 06 SUNQUEST RADIOLOGY0662817 IR CS SAME MD GT5YR 0-30M 361.00 06 SUNQUEST RADIOLOGY0671297 US CS SAME MD GT5YR 0-30M 397.00 06 SUNQUEST RADIOLOGY0624718 XR CS SAME MD GT5YR 0-30M 500.00 06 SUNQUEST RADIOLOGY0635920 NM CS SAME MD GT5YR 0-30M 451.00 06 SUNQUEST RADIOLOGY0624726 XR CS SAME MD ADD 15M 200.00 06 SUNQUEST RADIOLOGY0644930 CT 3D RENDER W/O POSTPROS 1181.00 06 SUNQUEST RADIOLOGY0654939 MR 3D RENDER W/O POSTPROS 526.00 06 SUNQUEST RADIOLOGY0635946 NM CS DIFF MD LT5YR 0-30M 372.00 06 SUNQUEST RADIOLOGY0654921 MR 3D RENDER W/POSTPROCES 462.00 06 SUNQUEST RADIOLOGY0644914 CT 3D RENDER W/POSTPROCES 1037.00 06 SUNQUEST RADIOLOGY0662825 IR CS SAME MD ADD 15M 145.00 06 SUNQUEST RADIOLOGY0646927 CT CS SAME MD ADD 15M 240.00 06 SUNQUEST RADIOLOGY0624734 XR CS DIFF MD LT5YR 0-30M 544.00 06 SUNQUEST RADIOLOGY0635961 NM CS DIFF MD GT5YR 0-30M 308.00 06 SUNQUEST RADIOLOGY0651372 MR CS DIFF MD ADD 15M 107.00 06 SUNQUEST RADIOLOGY0662833 IR CS DIFF MD LT5YR 0-30M 393.00 06 SUNQUEST RADIOLOGY0646935 CT CS DIFF MD LT5YR 0-30M 653.00 06 SUNQUEST RADIOLOGY0671313 US CS DIFF MD LT5YR 0-30M 06 SUNQUEST RADIOLOGY0624742 XR CS DIFF MD GT5YR 0-30M 450.00 06 SUNQUEST RADIOLOGY0662841 IR CS DIFF MD GT5YR 0-30M 325.00 06 SUNQUEST RADIOLOGY0646943 CT CS DIFF MD GT5YR 0-30M 540.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0651380 MR CS DIFF MD LT5YR 0-30M 291.00 06 SUNQUEST RADIOLOGY0624767 XR CS DIFF MD ADD 15M 200.00 06 SUNQUEST RADIOLOGY0646950 CT CS DIFF MD ADD 15M 240.00 06 SUNQUEST RADIOLOGY0671339 US CS DIFF MD ADD 15M 159.00 06 SUNQUEST RADIOLOGY0652214 MR BREAST CAD MRI ADD-ON 56.00 06 SUNQUEST RADIOLOGY0677641 VESSEL MAP HEMO ACCESS 2432.00 06 SUNQUEST RADIOLOGY0672881 US TRANSPLNT KDNY W/DPPLR 1448.00 06 SUNQUEST RADIOLOGY0654012 MR CARD MRI MORPH WO CON 2820.00 06 SUNQUEST RADIOLOGY0633826 NM IV IJ RA DRUG DX STUDY 486.00 464.00 06 SUNQUEST RADIOLOGY0627497 XRC REMV RNL TUBE W/FLUOR 1405.00 06 SUNQUEST RADIOLOGY0654038 MR CARD MRI W/STRESS IMG 4258.00 06 SUNQUEST RADIOLOGY0654061 MR CARD MRI MORPH W-W/O 4069.00 06 SUNQUEST RADIOLOGY0662387 IR CHEMO IA PUSH 1162.00 06 SUNQUEST RADIOLOGY0662379 IR CHEMO IA PUSH 1162.00 06 SUNQUEST RADIOLOGY0660423 IRC PRM ART MTHROM/GUIDE 10059.00 10059.00 06 SUNQUEST RADIOLOGY0672634 USC BX OF OVARY(S) 816.00 06 SUNQUEST RADIOLOGY0654087 MR CARD MRI W/STRSS W-W/O 4998.00 06 SUNQUEST RADIOLOGY0633818 NM RP DACRYOCYSTOGRAM 444.00 06 SUNQUEST RADIOLOGY0660431 IRC PRM ART MTHROM ADD-ON 3234.00 06 SUNQUEST RADIOLOGY0630905 NM HEPATOBILIRY SYS IMAGE 1370.00 06 SUNQUEST RADIOLOGY0663716 IRC VENOUS M-THROMBECTOMY 6572.00 06 SUNQUEST RADIOLOGY0630939 NM HEPATO SYS IMAG W/DRUG 1370.00 06 SUNQUEST RADIOLOGY0663724 IRC VENOUS M-THROM ADD-ON 8061.00 06 SUNQUEST RADIOLOGY0630947 NM LUNG VENTILATION IMAGE 945.00 06 SUNQUEST RADIOLOGY0630962 NM LUNG VENT&PERFUS IMAGE 1477.00 06 SUNQUEST RADIOLOGY0630970 NM LUNG PERFUSION DIFFERL 945.00 06 SUNQUEST RADIOLOGY0630988 NM LUNG PERF&VENT DIFFERL 1477.00 06 SUNQUEST RADIOLOGY0630608 NM INTRA-ART RPHARM RX 06 SUNQUEST RADIOLOGY0665992 IRC IJ W/FLUOR EVAL CVAD 421.00 06 SUNQUEST RADIOLOGY0642702 CTC BX SOFT TISS HIP DEEP 1283.00 06 SUNQUEST RADIOLOGY0667014 IRC REMV RNL TUBE W/FLUOR 1405.00 06 SUNQUEST RADIOLOGY0642637 CTC BX OF OVARY(S) 816.00 06 SUNQUEST RADIOLOGY0673962 US XTR NON-VASC COMPLETE 981.00 06 SUNQUEST RADIOLOGY0667618 IRC REMOVE URET STNT INT 10392.00 06 SUNQUEST RADIOLOGY0673970 US XTR NON-VASC LMTD 614.00 06 SUNQUEST RADIOLOGY0647750 USC BX LYMPH NODE OPEN 2853.00 06 SUNQUEST RADIOLOGY0663039 IRC DRN ABSCESS SMPL/SNGL 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0671602 USC ABD PARACENTS W/IMAGE 2697.00 06 SUNQUEST RADIOLOGY0671610 PERITONEAL LAVAGE 2697.00 06 SUNQUEST RADIOLOGY0667287 SREP S/N/A/G/TR/E 2.5CM/< 338.00 06 SUNQUEST RADIOLOGY0665711 IRC LAP REV ADJ GAST DVC 1910.00 06 SUNQUEST RADIOLOGY0662031 IRC INJ SINUS TRACT TX 304.00 06 SUNQUEST RADIOLOGY0666024 CTC I&D ABSC/HEMA NK/THOR 1125.00 06 SUNQUEST RADIOLOGY0661330 IRC INSTL AGT PLEURODESIS 1026.00 06 SUNQUEST RADIOLOGY0666412 IRC PLACE G-TUBE PERC 1174.00 06 SUNQUEST RADIOLOGY0666438 IRC PLC DUD/JEJ TUBE PERC 2464.00 06 SUNQUEST RADIOLOGY0666420 IRC REPLACE G/C TUBE PERC 5120.00 06 SUNQUEST RADIOLOGY0666446 IRC RPLC DUD/JEJ TUBE PRC 5424.00 06 SUNQUEST RADIOLOGY0666487 IRC REPLACE G-J TUBE PERC 3877.00 06 SUNQUEST RADIOLOGY0668277 IRC RM G/COLON TUBE W/DVC 3898.00 06 SUNQUEST RADIOLOGY0668285 IRC CON IJ G/COLON TUBE 729.00 444.00 06 SUNQUEST RADIOLOGY0666479 IRC PLC CECSTMY TUBE PERC 7145.00 06 SUNQUEST RADIOLOGY0654079 MR CARD MRI VEL FLW MAP 602.00 06 SUNQUEST RADIOLOGY0654046 MR CARD MRI VEL FLW MAP 602.00 06 SUNQUEST RADIOLOGY0654095 MR CARD MRI VEL FLW MAP 602.00 06 SUNQUEST RADIOLOGY0654020 MR CARD MRI VEL FLW MAP 602.00 06 SUNQUEST RADIOLOGY0650812 MRA SPINAL CANAL W/CON 4200.00 06 SUNQUEST RADIOLOGY0650820 MRA SPINAL CANAL W/O CON 4200.00 06 SUNQUEST RADIOLOGY0650838 MRA SPINAL CANAL W-WO CON 4565.00 06 SUNQUEST RADIOLOGY0650861 MRA UPPER EXT W/CON 4400.00 06 SUNQUEST RADIOLOGY0650895 MRA UPPER EXT W/CON LT 4400.00 06 SUNQUEST RADIOLOGY0650911 MRA UPPER EXT W/CON RT 4400.00 06 SUNQUEST RADIOLOGY0650879 MRA UPPER EXT W/O CON 4565.00 06 SUNQUEST RADIOLOGY0650937 MRA UPPER EXT W/O CON LT 4565.00 06 SUNQUEST RADIOLOGY0650929 MRA UPPER EXT W/O CON RT 4565.00 06 SUNQUEST RADIOLOGY0643015 CTC ASPIRATON BONE MARROW 2159.00 06 SUNQUEST RADIOLOGY0650887 MRA UPPER EXT W-WO CON 4600.00 06 SUNQUEST RADIOLOGY0650960 MRA UPPER EXT W-WO CON LT 4600.00 06 SUNQUEST RADIOLOGY0643023 CTC BONE MARROW ASP W/BX 2631.00 06 SUNQUEST RADIOLOGY0650945 MRA UPPER EXT W-WO CON RT 4600.00 06 SUNQUEST RADIOLOGY0653113 MRI BRAIN FUNC BY TECH 3805.00 06 SUNQUEST RADIOLOGY0665760 IRC LAP BAND ADJ/INJ/ASP 2646.00 06 SUNQUEST RADIOLOGY0646166 CT ABD & PELVIS W/O CON 5441.00 06 SUNQUEST RADIOLOGY0646174 CT ABD & PELVIS W/CON 7253.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0667907 IRC SYNOVIAL BX IP JOINT 806.00 06 SUNQUEST RADIOLOGY0650010 MRI BRAIN FUNC MD/PSYC BI 3805.00 06 SUNQUEST RADIOLOGY0646182 CT ABD & PELVIS 1+ REGION 9813.00 06 SUNQUEST RADIOLOGY0667915 IRC SYNOVIAL BX MCP JOINT 826.00 06 SUNQUEST RADIOLOGY0667949 IRC CYST W/INS URTL STENT 1961.00 06 SUNQUEST RADIOLOGY0667980 IRC CYSTO W/TX UR STRICTR 493.00 06 SUNQUEST RADIOLOGY0650028 MR FUNCTNAL BRAIN MAPPING 06 SUNQUEST RADIOLOGY0662148 CTC BX LYMPH NODE OPEN 4128.00 06 SUNQUEST RADIOLOGY0648410 CTC BX GALLBLADDER FOSSA 1252.00 06 SUNQUEST RADIOLOGY0642611 CTC BX THIGH/KNE SFT TISS 775.00 06 SUNQUEST RADIOLOGY0641118 CTC ABD PARACENTS W/IMAGE 2697.00 06 SUNQUEST RADIOLOGY0641126 PERITONEAL LAVAGE 2697.00 06 SUNQUEST RADIOLOGY0641134 CT ANG ABD&PELV W/O&W/DYE 7156.00 06 SUNQUEST RADIOLOGY0625004 XR FINGER(S) 2V OR MOR BI 209.00 117.00 06 SUNQUEST RADIOLOGY0661322 IRC BILI ENDO PERC W BX 453.00 06 SUNQUEST RADIOLOGY0660951 IRC CHG STENT VIA TRNSURL 220.00 06 SUNQUEST RADIOLOGY0662478 IRC ASPIRATON BONE MARROW 600.00 06 SUNQUEST RADIOLOGY0660498 IRC INSR TUN IP CATH PERC 1359.00 06 SUNQUEST RADIOLOGY0621391 CYSTOMETROGRAM W/VP 1054.00 06 SUNQUEST RADIOLOGY0622373 XRC ASPIRATON BONE MARROW 526.00 06 SUNQUEST RADIOLOGY0662122 IRC BX LYMPH NODE SUPER 778.82 778.82 06 SUNQUEST RADIOLOGY0622449 XRC BX LYMPH NODE OPEN 3504.00 06 SUNQUEST RADIOLOGY0621342 XRC CON IJ G/COLON TUBE 753.00 06 SUNQUEST RADIOLOGY0672519 IRC BX LYMPH NODE OPEN 2448.00 06 SUNQUEST RADIOLOGY0661033 ESOPH W INS OF STENT/TUBE 2488.00 06 SUNQUEST RADIOLOGY0661025 IRC REV INTRATHCL P/P RES 395.00 06 SUNQUEST RADIOLOGY0601716 XRC ABD PARACENTS W/IMAGE 2246.00 06 SUNQUEST RADIOLOGY0662163 IRC BX SKIN LESION SNGL 434.00 06 SUNQUEST RADIOLOGY0601724 PERITONEAL LAVAGE 2246.00 06 SUNQUEST RADIOLOGY0601732 XRC INS ENDOVAS VC FILTER 18040.00 06 SUNQUEST RADIOLOGY0601740 XRC REDO ENDOVAS VC FILTR 12380.00 06 SUNQUEST RADIOLOGY0601757 XRC RML ENDOVAS VC FILTER 12380.00 06 SUNQUEST RADIOLOGY0660316 IRC PHLEB VEINS XTR 10-20 06 SUNQUEST RADIOLOGY0660399 IRC INC & REM FB SQ COMPL 06 SUNQUEST RADIOLOGY0660365 IRC REMVL FORGN BODY ABDM 06 SUNQUEST RADIOLOGY0660373 IRC CANNULATION THOR DUCT 06 SUNQUEST RADIOLOGY0660381 IRC CHEM CAUT GRAN TISSUE 693.00 06 SUNQUEST RADIOLOGY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

0660357 IRC PHLEB VEINS XTR <10 06 SUNQUEST RADIOLOGY0660225 IRC INS ENDOVAS VC FILTER 13027.00 06 SUNQUEST RADIOLOGY0660233 LIGATION OF INF VENA CAVA 13027.00 06 SUNQUEST RADIOLOGY0660241 IRC ABD PARACENTS W/IMAGE 1622.00 06 SUNQUEST RADIOLOGY0660258 PERITONEAL LAVAGE 1622.00 06 SUNQUEST RADIOLOGY0660266 IRC DES CERV/THOR FAC JNT 2195.00 06 SUNQUEST RADIOLOGY0660274 IRC DES C/TH FACT JNT ADD 767.00 06 SUNQUEST RADIOLOGY0660282 IRC DES LUMB/SAC FACT JNT 3770.00 06 SUNQUEST RADIOLOGY0660290 DESTR L/S FACET JNT ADDL 2195.00 06 SUNQUEST RADIOLOGY0660308 IRC CATH REN ART 1ST BI 8754.00 06 SUNQUEST RADIOLOGY0660324 IRC CATH REN ART 1ST UNI 8754.00 06 SUNQUEST RADIOLOGY0660332 IRC CATH RN AR 1ST UNI LT 8754.00 06 SUNQUEST RADIOLOGY0660340 IRC CATH RN AR 1ST UNI RT 8754.00 06 SUNQUEST RADIOLOGY0660159 IRC CATH REN ART 2ND+ BI 8754.00 06 SUNQUEST RADIOLOGY0660167 IRC REDO ENDOVAS VC FILTR 8940.00 06 SUNQUEST RADIOLOGY0660175 IRC RML ENDOVAS VC FILTER 8940.00 06 SUNQUEST RADIOLOGY0660183 IRC CATH REN ART 2+ UNI 8754.00 06 SUNQUEST RADIOLOGY0660191 IRC CATH RN ART 2+ UNI LT 8754.00 06 SUNQUEST RADIOLOGY0660209 IRC CATH RN ART 2+ UNI RT 8754.00 06 SUNQUEST RADIOLOGY0660217 IRC IJ SI JNT ARTH WO/GD 06 SUNQUEST RADIOLOGY0660449 IRC INSERT PACER TMP SNGL 2768.00 3343.00 06 SUNQUEST RADIOLOGY5010665 S NSTRL BITE BLOCK ENDO 26.65 50 SURGERY AND RECOVERY5010673 S STRL CAUT PROBE GOLD 752.10 50 SURGERY AND RECOVERY5010657 S STRL CAUTERY ERBE APC 1222.15 50 SURGERY AND RECOVERY5010491 CPLX PACU FIRST 30M 3277.00 50 SURGERY AND RECOVERY5010509 CPLX PACU ADD 15M 1627.00 50 SURGERY AND RECOVERY5010210 SURG LVL 1 FIRST 30M 2051.00 50 SURGERY AND RECOVERY5010400 SURG LVL 1 ADD 15M 875.00 50 SURGERY AND RECOVERY5010434 SURG LVL 2 FIRST 30M 2583.00 50 SURGERY AND RECOVERY5010442 SURG LVL 2 ADD 15M 1037.00 50 SURGERY AND RECOVERY5010079 SURG LVL 3 FIRST 30M 3132.00 50 SURGERY AND RECOVERY5010087 SURG LVL 3 ADD 15M 1175.00 50 SURGERY AND RECOVERY5010459 SURG LVL 4 FIRST 30M 3672.00 50 SURGERY AND RECOVERY5010467 SURG LVL 4 ADD 15M 1246.00 50 SURGERY AND RECOVERY5010475 SURG LVL 5 FIRST 30M 3838.00 50 SURGERY AND RECOVERY5010483 SURG LVL 5 ADD 15M 1561.00 50 SURGERY AND RECOVERY5010418 BLOOD TRANSFUSN LT 2 HR 1048.00 50 SURGERY AND RECOVERY

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5010632 CX CASE OR 1113.00 50 SURGERY AND RECOVERY5010756 FNA W/O IMAG GUIDANCE 549.00 50 SURGERY AND RECOVERY5010269 STND PACU LVL 1 FIRST 30M 1018.80 50 SURGERY AND RECOVERY5010111 STND PACU LVL 1 ADD 15M 500.37 50 SURGERY AND RECOVERY5010822 CHNG G TUBE WO IMAG/GD 2239.00 50 SURGERY AND RECOVERY5010731 STND PACU LVL 2 FIRST 30M 1515.00 50 SURGERY AND RECOVERY5010749 STND PACU LVL 2 ADD 15M 572.00 50 SURGERY AND RECOVERY5010772 GLUCOSE 28.00 50 SURGERY AND RECOVERY5010848 CX CASE ENDO 440.00 50 SURGERY AND RECOVERY5010855 ENDOSCOPY GI DX 2984.00 50 SURGERY AND RECOVERY5010863 ENDOSCOPY GI DX +1 INTRVN 3509.00 50 SURGERY AND RECOVERY5010871 ENDOSCOPY GI DX +2 INTRVN 3640.00 50 SURGERY AND RECOVERY5010889 ENDOSCOPY GI DX >=3 INTRV 3771.00 50 SURGERY AND RECOVERY5010004 ENDOSCOPY RESPIRATORY DX 1500.00 50 SURGERY AND RECOVERY5010384 ENDOSCOPY RSP DX +1 INTRV 1700.00 50 SURGERY AND RECOVERY5010897 ENDOSCOPY RSP DX +2 INTRV 1809.00 50 SURGERY AND RECOVERY5010905 ENDOSCOPY RSP DX >=3INTRV 1877.00 50 SURGERY AND RECOVERY5010764 REPO NASO/ORO G TUBE 297.00 50 SURGERY AND RECOVERY5310024 STND GENRL ANES FIRST 30M 904.00 53 SURGERY ANESTHESIA5310420 STND GENRL ANES ADD 15M 448.00 53 SURGERY ANESTHESIA5310404 CPLX GENRL ANES FIRST 30M 1038.00 53 SURGERY ANESTHESIA5310412 CPLX GENRL ANES ADD 15M 556.00 53 SURGERY ANESTHESIA5310453 S NSTRL LEAD EEG 104.35 53 SURGERY ANESTHESIA5310545 S NSTRL ELEC BIS MONITOR 239.30 53 SURGERY ANESTHESIA5310594 S NSTRL SENSOR T-LINE 667.38 53 SURGERY ANESTHESIA5310354 MAC/REG FIRST 30M 875.00 53 SURGERY ANESTHESIA5310438 S STRL TRAY SPINAL 209.10 53 SURGERY ANESTHESIA5310529 S STRL HAND NEBULZER DISP 8.90 53 SURGERY ANESTHESIA5310123 S STRL BRONCHOCATH TUBE 883.95 53 SURGERY ANESTHESIA5310446 S STRL TRAY EPIDURAL 336.55 53 SURGERY ANESTHESIA5310537 S STRL TUBING BLOOD ADMIN 44.45 53 SURGERY ANESTHESIA5310198 S STRL LTA KIT 57.50 53 SURGERY ANESTHESIA5310644 S STRL ATOMIZER 37.50 53 SURGERY ANESTHESIA5310297 S STRL UNIVENT TUBE 862.65 53 SURGERY ANESTHESIA5310511 S STRL SLTR BLOOD PALL 90.65 53 SURGERY ANESTHESIA5310602 S STRL TUBE ET RAE 23.25 53 SURGERY ANESTHESIA5310610 S STRL TUBE ET HI-LO 7.75 53 SURGERY ANESTHESIA

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5310636 S STRL TUBE ET BRONCH HOO 308.00 53 SURGERY ANESTHESIA5310115 S STRL ANTI-REFLUX VALVE 51.10 53 SURGERY ANESTHESIA5310628 S STRL TUBE ET BRONCH 282.75 53 SURGERY ANESTHESIA5310362 MAC/REG ADD 15M 423.00 53 SURGERY ANESTHESIA5310552 CS SAME MD GT5YR 0-30M 399.00 53 SURGERY ANESTHESIA5310560 CS SAME MD ADD 15M 393.00 53 SURGERY ANESTHESIA5310578 CS DIFF MD GT5YR 0-30M 359.00 53 SURGERY ANESTHESIA5310586 CS DIFF MD ADD 15M 160.00 53 SURGERY ANESTHESIA5113931 S NSTRL SLEEVE COMPRE DEV 584.70 51 SURGERY SUPPLIES5113949 S NSTRL TED HOSE 79.90 51 SURGERY SUPPLIES5158472 S NSTRL SPLNT PLASTR XFST 5.05 51 SURGERY SUPPLIES5153994 S NSTRL BLANKET WARMING 95.85 51 SURGERY SUPPLIES5158506 S NSTRL CAST RL PLASTER 20.65 51 SURGERY SUPPLIES5158316 S NSTRL SLING DISPOSABLE 42.10 51 SURGERY SUPPLIES5152426 S NSTRL CRYO CUFF 977.65 51 SURGERY SUPPLIES5154216 S NSTRL URINE DRNG BAG 35.15 51 SURGERY SUPPLIES5158456 S NSTRL SPLNT DELTA LITE 68.65 51 SURGERY SUPPLIES5158464 S NSTRL SPLINT OCL 69.60 51 SURGERY SUPPLIES5159124 S NSTRL ARTHRO PUDDLE VAC 355.55 51 SURGERY SUPPLIES5159025 S NSTRL BAG AMBU ADULT 124.45 51 SURGERY SUPPLIES5158563 S NSTRL SPLINT WRIST 84.80 51 SURGERY SUPPLIES5158449 S NSTRL CAST RL FIBERGLAS 59.60 51 SURGERY SUPPLIES5110283 S NSTRL BONE WAX 19.25 51 SURGERY SUPPLIES5124649 S NSTRL CLAMP BAG OSTOMY 15.45 51 SURGERY SUPPLIES5159421 S NSTRL BAG AMBU PED 372.51 51 SURGERY SUPPLIES5159363 S NSTRL BAG LEG URINE 21.90 51 SURGERY SUPPLIES5159561 S NSTRL CHG SYS NEUROSTIM 5430.98 51 SURGERY SUPPLIES5124623 S NSTRL KIT BRST PMP UNIV 396.30 51 SURGERY SUPPLIES5110077 S NSTRL ANDREWS TBL PDG 457.95 51 SURGERY SUPPLIES5113808 S NSTRL DRESSING BRST BIN 273.70 51 SURGERY SUPPLIES5157854 S STRL SUT L1 $1-5,00 12.75 51 SURGERY SUPPLIES5158365 S STRL SOL IV LR 10.25 51 SURGERY SUPPLIES5158282 S STRL WTR IRRIG SOL 3.75 51 SURGERY SUPPLIES5158290 S STRL IRRIGATION SOL SAL 3.80 51 SURGERY SUPPLIES5158423 S STRL FX ENDO BX (DISP) 888.85 51 SURGERY SUPPLIES5158571 S STRL KNIFE SURG DISP 8.05 51 SURGERY SUPPLIES5157870 S STRL SUT L3 10.01-15.00 63.25 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5157920 S STRL PD GRND DUAL ADULT 17.05 51 SURGERY SUPPLIES5158514 S STRL DRSG ADAPTIC 19.85 51 SURGERY SUPPLIES5157896 S STRL SUT L5 20.01-25.00 113.75 51 SURGERY SUPPLIES5110838 S STRL CATH FOLEY TRAY 99.05 51 SURGERY SUPPLIES5110606 S STRL STAPLER SKIN 87.35 51 SURGERY SUPPLIES5157722 S STRL ENDO DNARE OVAL 210.85 51 SURGERY SUPPLIES5158613 S STRL SUCTION YANKAUER 5.45 51 SURGERY SUPPLIES5159082 S STRL SKN ADHES DERMABND 113.25 51 SURGERY SUPPLIES5154489 S STRL STAPLES-GIA REFILL 904.50 51 SURGERY SUPPLIES5158027 S STRL PAD GROUND ADULT 10.65 51 SURGERY SUPPLIES5157862 S STRL SUT L2 5.01-10.00 38.00 51 SURGERY SUPPLIES5154364 S STRL HEMOCLIP SM/MED 7.45 51 SURGERY SUPPLIES5158555 S STRL DRSG XEROFORM 9.30 51 SURGERY SUPPLIES5158332 S STRL SOL IV NACL 46.50 51 SURGERY SUPPLIES5114764 S STRL SUPPLY MISC 176.75 51 SURGERY SUPPLIES5113121 S STRL ORTHO HOOD 299.25 51 SURGERY SUPPLIES5152343 S STRL CYSTO/TUR TUBG 73.50 51 SURGERY SUPPLIES5111513 S STRL MISC CODE OR 51 SURGERY SUPPLIES5112859 S STRL BLADE-BEAVER 64 72.40 51 SURGERY SUPPLIES5158001 S STRL CAUT TIP TEFLON 27.70 51 SURGERY SUPPLIES5152418 S STRL ENDO CLIP APPLIER 276.00 51 SURGERY SUPPLIES5115373 S STRL PORT 190.00 51 SURGERY SUPPLIES5159298 S STRL LAP ENDOCATCH GOLD 385.25 51 SURGERY SUPPLIES5113188 S STRL CAUTERY PENCIL 14.90 51 SURGERY SUPPLIES5113972 S STRL STAPLES A ENDO GIA 610.50 51 SURGERY SUPPLIES5158159 S STRL SNARE MINI OVAL 224.70 51 SURGERY SUPPLIES5159496 S STRL CLIP HEMOSTASIS 967.59 51 SURGERY SUPPLIES5155411 S STRL ARTHRO BURR/CUTTER 924.40 51 SURGERY SUPPLIES5111927 S STRL RANFAC CATHETER 615.55 51 SURGERY SUPPLIES5154471 S STRL STAPLES-GIA 1127.85 51 SURGERY SUPPLIES5114475 S STRL NEEDLE QUINCKE 98.00 51 SURGERY SUPPLIES5157979 S STRL CAUT TIP NDL 6.40 51 SURGERY SUPPLIES5153721 S STRL PHACO KIT 383.40 51 SURGERY SUPPLIES5158084 S STRL SPI NDL 1.5 & 3.5I 8.50 51 SURGERY SUPPLIES5159322 S STRL BLADE EYE KERATOME 206.34 51 SURGERY SUPPLIES5153523 S STRL GRENADE RESERVOIR 73.50 51 SURGERY SUPPLIES5152475 S STRL SHOULDER CANNULA 281.15 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5110382 S STRL CATH FOLEY 2WY 5ML 45.70 51 SURGERY SUPPLIES5155510 S STRL ARTHRO SUTURE RETR 939.35 51 SURGERY SUPPLIES5159090 S STRL DRAIN PENROSE 4.65 51 SURGERY SUPPLIES5158977 S STRL BLDE DUAL CUT 267.75 51 SURGERY SUPPLIES5159520 S STRL BAG EXTRACTION 1157.70 51 SURGERY SUPPLIES5111174 S STRL KAM SUCTION 184.25 51 SURGERY SUPPLIES5153515 S STRL DRAINAGE 369.55 51 SURGERY SUPPLIES5111083 S STRL INSUFFLATOR TUBING 50.05 51 SURGERY SUPPLIES5154208 S STRL CATH ROBINSON 44.75 51 SURGERY SUPPLIES5157169 S STRL TUBING LEVEL 1 IRR 283.30 51 SURGERY SUPPLIES5156914 S STRL FORCEP BIPLR CUTNG 2085.00 51 SURGERY SUPPLIES5110960 S STRL HEMOVAC MED & LG 391.50 51 SURGERY SUPPLIES5112735 S STRL TUBING ARTHROSCOPY 583.60 51 SURGERY SUPPLIES5158233 S STRL ELEC VAPR 3.5 640.30 51 SURGERY SUPPLIES5153457 S STRL GELFOAM 134.20 51 SURGERY SUPPLIES5114772 S STRL SUPPLY MISC 378.76 51 SURGERY SUPPLIES5157953 S STRL CAUTERY TIP EXT 28.75 51 SURGERY SUPPLIES5157987 S STRL CAUT TIP NDL INSUL 26.65 51 SURGERY SUPPLIES5115381 S STRL PORT 226.25 51 SURGERY SUPPLIES5156716 S STRL UTERINE MANIPULATO 377.00 51 SURGERY SUPPLIES5113899 S STRL TOURNIQUET STERILE 244.95 51 SURGERY SUPPLIES5154299 S STRL ENDO PEANUTS 101.50 51 SURGERY SUPPLIES5159215 S STRL BLDE OSC LVL 4 176.75 51 SURGERY SUPPLIES5114780 S STRL SUPPLY MISC 450.00 51 SURGERY SUPPLIES5159181 S STRL CAUT URO COAG LP 814.80 51 SURGERY SUPPLIES5155189 S STRL HERNIA TACKER 1542.00 51 SURGERY SUPPLIES5159280 S STRL CAUT CRD BPLR DISP 50.30 51 SURGERY SUPPLIES5155387 S STRL IMPL CEMENT SINGLE 1242.85 51 SURGERY SUPPLIES5114806 S STRL SUPPLY MISC 810.00 51 SURGERY SUPPLIES5112610 S STRL VESSELOOPS 33.00 51 SURGERY SUPPLIES5155478 S STRL ORTHO VAPOR TRODE 1072.45 51 SURGERY SUPPLIES5113105 S STRL SURGICEL 519.70 51 SURGERY SUPPLIES5158837 S STRL CAUT CUT 5MM 1848.95 51 SURGERY SUPPLIES5157300 S STRL LASER FIBER HOLMIU 1723.15 51 SURGERY SUPPLIES5154158 S STRL BERKLEY CONTAINER 90.55 51 SURGERY SUPPLIES5115316 S STRL SEALANT 576.00 51 SURGERY SUPPLIES5158894 S STRL BLDE RECIP 1 126.25 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5112560 S STRL TRU CUT BS NEEDLE 150.15 51 SURGERY SUPPLIES5113089 S STRL SEQUARA BASKET 1969.20 51 SURGERY SUPPLIES5114350 S STRL CATH BALLOON ESOPH 1472.85 51 SURGERY SUPPLIES5115134 S STRL CLIP APPLIER 420.50 51 SURGERY SUPPLIES5154992 S STRL OCCUCOAT 478.20 51 SURGERY SUPPLIES5113980 S STRL IRRIGATOR PULSEVAC 1300.35 51 SURGERY SUPPLIES5157235 S STRL ENDO INFLATION DEV 615.55 51 SURGERY SUPPLIES5157821 S STRL SYRINGE LOR 7ML 51.10 51 SURGERY SUPPLIES5112602 S STRL VACURETTE 23.45 51 SURGERY SUPPLIES5157888 S STRL SUT L4 15.01-20.00 88.50 51 SURGERY SUPPLIES5114608 S STRL CANNULA RADIOFREQU 603.85 51 SURGERY SUPPLIES5112909 S STRL KIT PEG TUBE 1360.00 51 SURGERY SUPPLIES5154521 S STRL STAPLES-TA REF 3.5 734.75 51 SURGERY SUPPLIES5115241 S STRL BURR 252.50 51 SURGERY SUPPLIES5115324 S STRL APPLICATOR 73.25 51 SURGERY SUPPLIES5157961 S STRL CAUT TIP EXT INSUL 26.65 51 SURGERY SUPPLIES5114749 S STRL SUPPLY MISC 25.25 51 SURGERY SUPPLIES5114491 S STRL NEEDLE TOUCHY 98.00 51 SURGERY SUPPLIES5115472 S STRL TUBING 187.00 51 SURGERY SUPPLIES5114541 S STRL SUTURE ENDOSTITCH 264.10 51 SURGERY SUPPLIES5115357 S STRL CAUTERY 163.25 51 SURGERY SUPPLIES5158944 S STRL BLADE HIP/SHOULDER 769.20 51 SURGERY SUPPLIES5115126 S STRL STAPLER 373.50 51 SURGERY SUPPLIES5158605 S STRL SET EPI CATH RPAQ 153.70 51 SURGERY SUPPLIES5115209 S STRL ENDOSTITCH 213.50 51 SURGERY SUPPLIES5111075 S STRL INSTRUMENT MAGNET 58.60 51 SURGERY SUPPLIES5110291 S STRL BOVIE SUCTION 109.70 51 SURGERY SUPPLIES5159223 S STRL BLDE MICOSC LVL 1 75.75 51 SURGERY SUPPLIES5159157 S STRL CAUT LOOP ANG/RESE 2187.35 51 SURGERY SUPPLIES5115308 S STRL SEALANT 479.75 51 SURGERY SUPPLIES5114848 S STRL SUPPLY MISC 1530.00 51 SURGERY SUPPLIES5152558 S STRL CORNEAL SHIELDS 683.75 51 SURGERY SUPPLIES5113840 S STRL BLADE INSTRUTEK 1353.60 51 SURGERY SUPPLIES5113857 S STRL KIT SHOULDER SUSP 608.10 51 SURGERY SUPPLIES5114756 S STRL SUPPLY MISC 75.75 51 SURGERY SUPPLIES5110267 S STRL IMPL CEMENT DOUBLE 1140.60 51 SURGERY SUPPLIES5115225 S STRL CLIP APPLIER 622.50 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5158068 S STRL ENDO NDL INJ 123.05 51 SURGERY SUPPLIES5155213 S STRL BLUNT TROCAR 504.50 51 SURGERY SUPPLIES5115407 S STRL PORT 271.50 51 SURGERY SUPPLIES5158126 S STRL ROTH NET ENDO 431.35 51 SURGERY SUPPLIES5110424 S STRL CHEST TUBE 169.35 51 SURGERY SUPPLIES5154455 S STRL STAPLES-CEEA 977.75 51 SURGERY SUPPLIES5114053 S STRL KIT ACL TRANSTIBAL 1038.40 51 SURGERY SUPPLIES5158118 S STRL BAND DEVICE ENDO 574.05 51 SURGERY SUPPLIES5157243 S STRL ENDO LOCKING DEVI 164.00 51 SURGERY SUPPLIES5157912 S STRL SUT L7 35.00-40.00 189.50 51 SURGERY SUPPLIES5115217 S STRL ENDOSTITCH 96.00 51 SURGERY SUPPLIES5155379 S STRL BURRS 75.75 51 SURGERY SUPPLIES5115266 S STRL SAW BLADE 75.75 51 SURGERY SUPPLIES5155643 S STRL STAPLES-ENDO GIA 632.60 51 SURGERY SUPPLIES5158209 S STRL SEALANT FLOSEAL MA 613.45 51 SURGERY SUPPLIES5153184 S STRL PKING NAGAUZ IODOF 35.15 51 SURGERY SUPPLIES5113345 S STRL ELECT S-PLAST COAG 863.70 51 SURGERY SUPPLIES5115423 S STRL STAPLER 70.75 51 SURGERY SUPPLIES5157227 S STRL ENDO STONE REMOVAL 1698.70 51 SURGERY SUPPLIES5157219 S STRL GUIDEWIRE JAG 800.90 51 SURGERY SUPPLIES5111612 S STRL OPHTHALMIC CAUTERY 98.00 51 SURGERY SUPPLIES5114871 S STRL SUPPLY MISC 2070.00 51 SURGERY SUPPLIES5159116 S STRL PIN CAP 41.70 51 SURGERY SUPPLIES5158217 S STRL NDL PORTACATH 30.95 51 SURGERY SUPPLIES5158597 S STRL TRAY SM JNT&CNULA 645.55 51 SURGERY SUPPLIES5113824 S STRL RETRACTOR STAYS 391.90 51 SURGERY SUPPLIES5159249 S STRL BLDE MICOSC LVL 3 176.75 51 SURGERY SUPPLIES5159637 S STRL DILATOR URETERAL 243.80 51 SURGERY SUPPLIES5152996 S STRL NEEDLE-WHITACRE 60.70 51 SURGERY SUPPLIES5155254 S STRL PROBE-NIMM MONITOR 1112.95 51 SURGERY SUPPLIES5158399 S STRL FING TRAP DISP 177.75 51 SURGERY SUPPLIES5158019 S STRL CAUT TIP TEF INSUL 38.35 51 SURGERY SUPPLIES5114822 S STRL SUPPLY MISC 1170.00 51 SURGERY SUPPLIES5157045 S STRL NEEDLE TARGETING 1253.50 51 SURGERY SUPPLIES5111158 S STRL WIRE J 80.95 51 SURGERY SUPPLIES5159538 S STRL CLOSE WND SURGIFIS 408.60 51 SURGERY SUPPLIES5159512 S STRL LIGATOR 7 BAND 1716.69 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5110275 S STRL MIXING/INJ SYS 643.25 51 SURGERY SUPPLIES5113907 S STRL DRAIN THORACIC 486.70 51 SURGERY SUPPLIES5114863 S STRL SUPPLY MISC 1890.00 51 SURGERY SUPPLIES5158860 S STRL BLDE MIC SAG 1 232.45 51 SURGERY SUPPLIES5158191 S STRL FORCEP BRONCH BIOP 188.25 51 SURGERY SUPPLIES5158043 S STRL SPI NDL 2.5IN 6.40 51 SURGERY SUPPLIES5159546 S STRL TUBNG PAIN PUMP 605.82 51 SURGERY SUPPLIES5156039 S STRL LIGASURE 1004.30 51 SURGERY SUPPLIES5158274 S STRL ELEC VAPR SUCT 90 628.80 51 SURGERY SUPPLIES5158092 S STRL BRUSH ENDO CYTO 57.50 51 SURGERY SUPPLIES5111943 S STRL RETROBULAR NEEDLE 30.90 51 SURGERY SUPPLIES5115415 S STRL PORT 72.25 51 SURGERY SUPPLIES5157177 S STRL KIT SM JOINT SUTUR 864.80 51 SURGERY SUPPLIES5115043 S STRL SUPPLY MISC 4900.00 51 SURGERY SUPPLIES5111000 S STRL SUTURE PASSER HEWS 358.90 51 SURGERY SUPPLIES5114830 S STRL SUPPLY MISC 1350.00 51 SURGERY SUPPLIES5112891 S STRL VEIN STRIPPER 246.00 51 SURGERY SUPPLIES5156195 S STRL FALLOPE RING 522.80 51 SURGERY SUPPLIES5113964 S STRL TUBING TPS 372.51 51 SURGERY SUPPLIES5112826 S STRL STAPLE ROTIC TA 693.50 51 SURGERY SUPPLIES5110911 S STRL GLYCIN 3000CC 69.25 51 SURGERY SUPPLIES5112818 S STRL INT STAP PURSTRING 424.25 51 SURGERY SUPPLIES5115100 S STRL SUT 333.75 51 SURGERY SUPPLIES5114376 S STRL INTRODUCER 615.55 51 SURGERY SUPPLIES5154323 S STRL ENDO GIA 666.70 51 SURGERY SUPPLIES5157151 S STRL LEVEL 1 FLUID WARM 339.75 51 SURGERY SUPPLIES5154463 S STRL STAPLES-DFS/FASCIA 187.00 51 SURGERY SUPPLIES5158670 S STRL DRILL BIT LVL 2 496.10 51 SURGERY SUPPLIES5115050 S STRL SUPPLY MISC 5180.00 51 SURGERY SUPPLIES5158050 S STRL SPI NDL 5 & 7IN 19.15 51 SURGERY SUPPLIES5154307 S STRL LAP HERNIA BAL 735.90 51 SURGERY SUPPLIES5155270 S STRL CYSTO CAUTERY CORD 266.25 51 SURGERY SUPPLIES5155197 S STRL ENDO STITCH 790.25 51 SURGERY SUPPLIES5153192 S STRL NUGAUZ PLAIN 34.10 51 SURGERY SUPPLIES5120142 S STRL CAPSULE PH 1404.56 51 SURGERY SUPPLIES5115092 S STRL SUT BRIDGE 31.50 51 SURGERY SUPPLIES5115183 S STRL BALLOON 839.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5159173 S STRL CAUT URO CT LP ANG 1047.20 51 SURGERY SUPPLIES5157276 S STRL ENDO BALLOON RETRI 1247.10 51 SURGERY SUPPLIES5110796 S STRL FEMORAL WICKS 375.95 51 SURGERY SUPPLIES5114632 S STRL RADIOLUCENT TARGET 799.80 51 SURGERY SUPPLIES5159447 S STRL BLADE HELICAL 3062.32 51 SURGERY SUPPLIES5159470 S STRL MIXER CEMENT 967.59 51 SURGERY SUPPLIES5157193 S STRL CANNULA ERCP 788.10 51 SURGERY SUPPLIES5157102 S STRL CATH BALLOON THERM 4556.05 51 SURGERY SUPPLIES5114814 S STRL SUPPLY MISC 990.00 51 SURGERY SUPPLIES5114798 S STRL SUPPLY MISC 630.00 51 SURGERY SUPPLIES5114921 S STRL SUPPLY MISC 2970.00 51 SURGERY SUPPLIES5158951 S STRL BLDE MIC RSP 2 998.25 51 SURGERY SUPPLIES5114988 S STRL SUPPLY MISC 3500.00 51 SURGERY SUPPLIES5111141 S STRL DRAINAGE 703.95 51 SURGERY SUPPLIES5159074 S STRL CATH BALLOON COLON 1629.55 51 SURGERY SUPPLIES5158621 S STRL CATH FOLY CDE 2W/5 115.30 51 SURGERY SUPPLIES5157250 S STRL ENDO BASKET TRAPEZ 1226.90 51 SURGERY SUPPLIES5157268 S STRL ENDO BALLOON RETRI 1247.10 51 SURGERY SUPPLIES5158340 S STRL SOL IV D5LR 11.20 51 SURGERY SUPPLIES5156054 S STRL HUMMER MICRODEBRID 1220.50 51 SURGERY SUPPLIES5111448 S STRL MENSICAL NEEDLES 341.85 51 SURGERY SUPPLIES5158266 S STRL ELEC VAPR 2.3MM 674.80 51 SURGERY SUPPLIES5158076 S STRL NDL INSULATED 54.30 51 SURGERY SUPPLIES5110770 S STRL FEML CANAL BRUSH 227.90 51 SURGERY SUPPLIES5110135 S STRL ARTERIAL LINE 118.20 51 SURGERY SUPPLIES5155726 S STRL DOPPLER PROBE 845.60 51 SURGERY SUPPLIES5155684 S STRL SAW BLE-TOL KNEE 710.35 51 SURGERY SUPPLIES5112511 S STRL TRACH TUBE 619.85 51 SURGERY SUPPLIES5115340 S STRL WAND 574.25 51 SURGERY SUPPLIES5115431 S STRL TACKER 1944.00 51 SURGERY SUPPLIES5113956 S STRL TUBE NG 86.25 51 SURGERY SUPPLIES5115399 S STRL PORT 248.00 51 SURGERY SUPPLIES5115365 S STRL PORT 135.75 51 SURGERY SUPPLIES5158878 S STRL BLDE MIC SAG 2 326.15 51 SURGERY SUPPLIES5114343 S STRL CATH MALECOT 64.95 51 SURGERY SUPPLIES5113865 S STRL CAUTERY BIPOLAR CU 592.15 51 SURGERY SUPPLIES5115456 S STRL CATH 98.25 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5115084 S STRL UMB TAPE 8.75 51 SURGERY SUPPLIES5115035 S STRL SUPPLY MISC 4620.00 51 SURGERY SUPPLIES5114970 S STRL SUPPLY MISC 3220.00 51 SURGERY SUPPLIES5154356 S STRL BAKER GASTRO TUBE 531.45 51 SURGERY SUPPLIES5113170 S STRL DRILL BIT LVL 1 369.20 51 SURGERY SUPPLIES5115068 S STRL SUPPLY MISC 5460.00 51 SURGERY SUPPLIES5114855 S STRL SUPPLY MISC 1710.00 51 SURGERY SUPPLIES5115142 S STRL STAPLER 450.75 51 SURGERY SUPPLIES5159231 S STRL BLDE MICOSC LVL 2 126.25 51 SURGERY SUPPLIES5155031 S STRL HUMMER TUBING 398.30 51 SURGERY SUPPLIES5159264 S STRL BLDE MICOSC LVL 5 277.75 51 SURGERY SUPPLIES5159256 S STRL BLDE MICOSC LVL 4 227.25 51 SURGERY SUPPLIES5159348 S STRL KIT CATH URET CONN 190.60 51 SURGERY SUPPLIES5159330 S STRL BLADE EYE UNITOME 49.80 51 SURGERY SUPPLIES5158100 S STRL CORD CAUTERY ENDO 217.25 51 SURGERY SUPPLIES5159272 S STRL TUBG IRRIG ORTH XL 1139.90 51 SURGERY SUPPLIES5157938 S STRL PAD GRND PEDS 13.85 51 SURGERY SUPPLIES5157904 S STRL SUT L6 25.01-30.00 139.00 51 SURGERY SUPPLIES5159207 S STRL BLDE OSC LVL 3 227.25 51 SURGERY SUPPLIES5159611 S STRL SIZER BREAST PROS 1716.69 51 SURGERY SUPPLIES5159645 S STRL BSKT STONE EXTRCTR 1092.44 51 SURGERY SUPPLIES5159652 S STRL SET NEPH TAMPONADE 1150.49 51 SURGERY SUPPLIES5157995 S STRL CAUT TIP REPLACE 6.40 51 SURGERY SUPPLIES5158811 S STRL DRILL BIT CANN 2.7 2124.70 51 SURGERY SUPPLIES5158407 S STRL LSR FIBER FLOW 205.10 51 SURGERY SUPPLIES5158522 S STRL PROBE PERC LUMBAR 5982.10 51 SURGERY SUPPLIES5158803 S STRL DRILL BIT LVL 15 1190.85 51 SURGERY SUPPLIES5158498 S STRL BANDAGE ESMARK 144.15 51 SURGERY SUPPLIES5158530 S STRL DRSG SCARLET RED 11.10 51 SURGERY SUPPLIES5158548 S STRL DRSG VASELINE GZ 51 SURGERY SUPPLIES5158431 S STRL CANNULA ANT CHAMB 45.10 51 SURGERY SUPPLIES5158415 S STRL TIP PHACO 30 DEG 170.95 51 SURGERY SUPPLIES5158761 S STRL DRILL BIT LVL 11 846.10 51 SURGERY SUPPLIES5158696 S STRL DRILL BIT LVL 4 788.75 51 SURGERY SUPPLIES5158704 S STRL DRILL BIT LVL 5 861.50 51 SURGERY SUPPLIES5158712 S STRL DRILL BIT LVL 6 1162.35 51 SURGERY SUPPLIES5158639 S STRL CATH FOLY 2 WY30ML 218.95 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5158720 S STRL DRILL BIT LVL 7 626.75 51 SURGERY SUPPLIES5158738 S STRL DRILL BIT LVL 8 693.60 51 SURGERY SUPPLIES5158746 S STRL DRILL BIT LVL 9 756.50 51 SURGERY SUPPLIES5158795 S STRL DRILL BIT LVL 14 1128.15 51 SURGERY SUPPLIES5158753 S STRL DRILL BIT LVL 10 758.35 51 SURGERY SUPPLIES5158845 S STRL CAUT CUT 10MM 1748.65 51 SURGERY SUPPLIES5158589 S STRL TRAY PUDENDAL 88.45 51 SURGERY SUPPLIES5158779 S STRL DRILL BIT LVL 12 908.80 51 SURGERY SUPPLIES5158787 S STRL DRILL BIT LVL 13 1065.50 51 SURGERY SUPPLIES5158829 S STRL CAUT CUT OPEN 5MM 1159.50 51 SURGERY SUPPLIES5158241 S STRL ELEC VPR HK 90 617.25 51 SURGERY SUPPLIES5159108 S STRL NDL ASPIRATION 358.80 51 SURGERY SUPPLIES5158225 S STRL ELEC VAPR HNDPIECE 1468.40 51 SURGERY SUPPLIES5159140 S STRL CHEST TUBE ANG/STR 73.70 51 SURGERY SUPPLIES5158183 S STRL DILATOR SPINAL 575.10 51 SURGERY SUPPLIES5158175 S STRL FX STONE RETRIEVE 679.45 51 SURGERY SUPPLIES5158688 S STRL DRILL BIT LVL 3 647.90 51 SURGERY SUPPLIES5158258 S STRL ELEC VAPR SHRK 2.3 805.15 51 SURGERY SUPPLIES5158886 S STRL BLDE MIC SAG 3 533.30 51 SURGERY SUPPLIES5159165 S STRL CAUT COAGLP WTEETH 977.75 51 SURGERY SUPPLIES5158142 S STRL SNARE NDL TIP ENDO 83.05 51 SURGERY SUPPLIES5158134 S STRL SNARE ASSY ENDO 101.20 51 SURGERY SUPPLIES5159199 S STRL BLDE OSC LVL 2 126.25 51 SURGERY SUPPLIES5158167 S STRL FX BIOPSY BRONCH 943.60 51 SURGERY SUPPLIES5158936 S STRL BLDE SAG FANNED 728.05 51 SURGERY SUPPLIES5158852 S STRL BLADE SAW RAYHACK 341.85 51 SURGERY SUPPLIES5158381 S STRL KIT LIORESAL REFIL 382.90 51 SURGERY SUPPLIES5158902 S STRL BLDE RECIP 2 378.75 51 SURGERY SUPPLIES5158373 S STRL CLIPS HULK 444.40 51 SURGERY SUPPLIES5159009 S STRL ELECT PLASMA RESEC 2187.35 51 SURGERY SUPPLIES5158928 S STRL BLDE MIC RSP 1 711.10 51 SURGERY SUPPLIES5158357 S STRL SOL IV D5W 30.75 51 SURGERY SUPPLIES5158324 S STRL BAG BILE 123.35 51 SURGERY SUPPLIES5158969 S STRL BLDE RASP XCUT S/L 483.75 51 SURGERY SUPPLIES5158308 S STRL ELEC VPR WEDGE 971.45 51 SURGERY SUPPLIES5158985 S STRL CANNULA ACL BLUE 259.80 51 SURGERY SUPPLIES5158993 S STRL ELECT ROLL BALL 1 1065.50 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5158910 S STRL BLDE RASP XCUT 14X 622.20 51 SURGERY SUPPLIES5115274 S STRL SAW BLADE 126.25 51 SURGERY SUPPLIES5115027 S STRL SUPPLY MISC 4340.00 51 SURGERY SUPPLIES5115076 S STRL BUTTON 11.75 51 SURGERY SUPPLIES5115118 S STRL SUT 158.50 51 SURGERY SUPPLIES5115159 S STRL STAPLER 480.50 51 SURGERY SUPPLIES5115167 S STRL STAPLE 240.50 51 SURGERY SUPPLIES5115175 S STRL STAPLE 351.50 51 SURGERY SUPPLIES5115191 S STRL ENDOSTITCH 117.00 51 SURGERY SUPPLIES5114996 S STRL SUPPLY MISC 3780.00 51 SURGERY SUPPLIES5115258 S STRL BURR 353.50 51 SURGERY SUPPLIES5114962 S STRL SUPPLY MISC 2940.00 51 SURGERY SUPPLIES5115282 S STRL BURR 50.50 51 SURGERY SUPPLIES5115290 S STRL BURR 129.25 51 SURGERY SUPPLIES5115332 S STRL STIM 45.75 51 SURGERY SUPPLIES5115449 S STRL CATH 59.75 51 SURGERY SUPPLIES5115464 S STRL CANNULA 40.75 51 SURGERY SUPPLIES5115480 S STRL VENT TUBE 82.25 51 SURGERY SUPPLIES5124607 S STRL TUBE FEEDING SILK 188.05 51 SURGERY SUPPLIES5124615 S STRL TUBE FEEDING 5.05 51 SURGERY SUPPLIES5115233 S STRL BURR 151.50 51 SURGERY SUPPLIES5114723 S STRL SUTURE LASSO 1310.93 51 SURGERY SUPPLIES5114566 S STRL LASER FIBER GREENL 3675.05 51 SURGERY SUPPLIES5114574 S STRL TRAY BONE MARROW 290.75 51 SURGERY SUPPLIES5114616 S STRL ELECTRODE RADIOFRE 63.90 51 SURGERY SUPPLIES5114640 S STRL DRILL BIT 4.2MM RA 574.05 51 SURGERY SUPPLIES5114657 S STRL KIRSCHNER WIRE-GAM 546.35 51 SURGERY SUPPLIES5114673 S STRL CANNISTER GEL (WOU 398.30 51 SURGERY SUPPLIES5114681 S STRL WASHER SUTURE 624.25 51 SURGERY SUPPLIES5114699 S STRL STAPLE OS 1872.75 51 SURGERY SUPPLIES5115019 S STRL SUPPLY MISC 4060.00 51 SURGERY SUPPLIES5114889 S STRL SUPPLY MISC 2250.00 51 SURGERY SUPPLIES5114897 S STRL SUPPLY MISC 2430.00 51 SURGERY SUPPLIES5114905 S STRL SUPPLY MISC 2610.00 51 SURGERY SUPPLIES5114913 S STRL SUPPLY MISC 2790.00 51 SURGERY SUPPLIES5114939 S STRL SUPPLY MISC 3150.00 51 SURGERY SUPPLIES5114947 S STRL SUPPLY MISC 3330.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5114954 S STRL SUPPLY MISC 3510.00 51 SURGERY SUPPLIES5114459 S STRL BK WAIST BELT WEBB 893.55 51 SURGERY SUPPLIES5124631 S STRL NDL STIM EPIDURAL 1230.70 51 SURGERY SUPPLIES5112966 S STRL CORSON DISP SUC 1174.70 51 SURGERY SUPPLIES5111877 S STRL PROBE EHL 1678.45 51 SURGERY SUPPLIES5111919 S STRL RADIAL ARTERY CATH 149.10 51 SURGERY SUPPLIES5112289 S STRL BLADE OPHTH SUPER 152.30 51 SURGERY SUPPLIES5112453 S STRL TAUT CHOLNGIO CATH 316.30 51 SURGERY SUPPLIES5112917 S STRL DRAINAGE 611.30 51 SURGERY SUPPLIES5111430 S STRL MEDULARY VENT TUBE 54.30 51 SURGERY SUPPLIES5112990 S STRL ENDOLOOPS 301.00 51 SURGERY SUPPLIES5113022 S STRL HYPAQUE DYE 31.95 51 SURGERY SUPPLIES5113055 S STRL BLN DILATE NONVSC 709.30 51 SURGERY SUPPLIES5113097 S STRL IMPL SHEET SILAS 371.70 51 SURGERY SUPPLIES5113337 S STRL ELECT S-PLAST COAG 1935.10 51 SURGERY SUPPLIES5114558 S STRL TUBE T 46.85 51 SURGERY SUPPLIES5112685 S STRL WIRE SUTURE 340.80 51 SURGERY SUPPLIES5110085 S STRL ANGIOCATH 1 1/4/2 31.95 51 SURGERY SUPPLIES5111828 S STRL PLEATMAN SAC 536.75 51 SURGERY SUPPLIES5110259 S STRL BIPOLAR BOVIE 50.05 51 SURGERY SUPPLIES5110531 S STRL CAUT URO CUT LOOP 1276.25 51 SURGERY SUPPLIES5110564 S STRL DRAINAGE 380.20 51 SURGERY SUPPLIES5110572 S STRL DEXTRAN 241.75 51 SURGERY SUPPLIES5110622 S STRL NASAL SINUS ENDO S 481.40 51 SURGERY SUPPLIES5110788 S STRL FEMORAL RESTRICTOR 192.75 51 SURGERY SUPPLIES5111307 S STRL BLADE OSCILLATING 50.50 51 SURGERY SUPPLIES5111356 S STRL LIGHTED YANKAUER 810.45 51 SURGERY SUPPLIES5110150 S STRL CHEST TUBE TROCAR 305.65 51 SURGERY SUPPLIES5114301 S STRL ELECTRODE ROLLER B 1299.10 51 SURGERY SUPPLIES5114152 S STRL KYPHOPLASTY BONE F 689.05 51 SURGERY SUPPLIES5114186 S STRL DRESSING OWENS 40.45 51 SURGERY SUPPLIES5114269 S STRL GUIDE WIRE TIBIAL 886.10 51 SURGERY SUPPLIES5114293 S STRL CATH FILIFORM 234.30 51 SURGERY SUPPLIES5114129 S STRL KYPHOPLASTY SYR IN 743.35 51 SURGERY SUPPLIES5114335 S STRL TUBE BAKER JEJYNOS 1356.80 51 SURGERY SUPPLIES5114418 S STRL SHEATH GAMMA PROBE 205.55 51 SURGERY SUPPLIES5114426 S STRL KYPHOPLASTY EXPAND 12134.60 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5114442 S STRL POSTOP DRESS & 1 C 3987.35 51 SURGERY SUPPLIES5114285 S STRL CATH FOLLOWER PHIL 340.80 51 SURGERY SUPPLIES5113923 S STRL DRILL REAMER 962.75 51 SURGERY SUPPLIES5114145 S STRL KYPHOPLASTY INTROD 3537.95 51 SURGERY SUPPLIES5113915 S STRL DRILL WIRE PASS 817.90 51 SURGERY SUPPLIES5114137 S STRL KYPHOPLASTY BONE T 3737.10 51 SURGERY SUPPLIES5114020 S STRL ELECT ARTHRO TEMP 983.00 51 SURGERY SUPPLIES5114038 S STRL TUBE CHEST HEMILIC 603.85 51 SURGERY SUPPLIES5114061 S STRL KIT TRANSFIX WIRE 567.65 51 SURGERY SUPPLIES5114079 S STRL CANNULA TIBIAL BON 240.70 51 SURGERY SUPPLIES5114087 S STRL CANNULA TIBIAL TUN 553.80 51 SURGERY SUPPLIES5114095 S STRL DRILL REAMER CORIN 1284.85 51 SURGERY SUPPLIES5114103 S STRL BLADE PARALLEL GRA 642.70 51 SURGERY SUPPLIES5114111 S STRL KYPHOPLASTY NEEDLE 287.55 51 SURGERY SUPPLIES5114467 S STRL VAC CL LATIS 221.50 51 SURGERY SUPPLIES5113873 S STRL CAUT BIPOL CUT LON 1974.30 51 SURGERY SUPPLIES5156724 S STRL PACKING NASAL POPE 172.55 51 SURGERY SUPPLIES5156591 S STRL STRAP CHIN 177.85 51 SURGERY SUPPLIES5156609 S STRL KIT CVP LINE 183.20 51 SURGERY SUPPLIES5156617 S STRL TREPHINE LACRIMAL 670.95 51 SURGERY SUPPLIES5156708 S STRL APPL LIQUID 473.95 51 SURGERY SUPPLIES5156559 S STRL CATH TUNNELER 1339.75 51 SURGERY SUPPLIES5156757 S STRL KYPHOPLASTY INTRO 1573.00 51 SURGERY SUPPLIES5156773 S STRL BONE SYRINGE SYMPH 1729.55 51 SURGERY SUPPLIES5156781 S STRL BONE GRAFT DELIVER 1101.20 51 SURGERY SUPPLIES5156377 S STRL APPLIER MENISCAL 435.60 51 SURGERY SUPPLIES5156906 S STRL LAP FORCEP BIPOLAR 1034.10 51 SURGERY SUPPLIES5156435 S STRL VAC DRESSING ASSEM 955.30 51 SURGERY SUPPLIES5156443 S STRL VAC GEL CANNISTER 812.60 51 SURGERY SUPPLIES5156518 S STRL HARVESTER BONE 1235.40 51 SURGERY SUPPLIES5156542 S STRL CATH INFUSION 3541.15 51 SURGERY SUPPLIES5157326 S STRL CATHETER STRETTA K 3286.60 51 SURGERY SUPPLIES5157334 S STRL GUIDE WIRE STRETTA 345.05 51 SURGERY SUPPLIES5157342 S STRL PRESSURE VALVE STR 115.00 51 SURGERY SUPPLIES5157359 S STRL SPINE WAND NUCLEOP 4148.20 51 SURGERY SUPPLIES5157367 S STRL NUCLEOPLASTY KIT 46.85 51 SURGERY SUPPLIES5157383 S STRL KIT CATH EPIDURAL 70.30 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5157391 S STRL CATH EPI NAVICATH 1560.25 51 SURGERY SUPPLIES5157573 S STRL NUCLEOPLASTY SYRIN 406.85 51 SURGERY SUPPLIES5157284 S STRL ENDO BALLOON DILAT 1685.90 51 SURGERY SUPPLIES5157748 S STRL DRILL LG FEMORAL 5 759.35 51 SURGERY SUPPLIES5157755 S STRL BLADE DISC DIAMOND 463.30 51 SURGERY SUPPLIES5157763 S STRL KIT SYRINGE DISCOG 569.80 51 SURGERY SUPPLIES5157771 S STRL CURRETTE KYPHOSPLA 799.80 51 SURGERY SUPPLIES5157789 S STRL STAPLE CIRCULAR 29 1845.65 51 SURGERY SUPPLIES5157797 S STRL STAPLE RT ANGLE CU 1486.75 51 SURGERY SUPPLIES5157805 S STRL STAPLE STRAIGHT CU 1308.90 51 SURGERY SUPPLIES5157813 S STRL STAPLE RELOAD STRA 738.05 51 SURGERY SUPPLIES5157599 S STRL BONE HARVEST DOWEL 1620.95 51 SURGERY SUPPLIES5157052 S STRL DRILL TWIST 1.1 738.05 51 SURGERY SUPPLIES5156963 S STRL PIN DISTRACTOR 516.55 51 SURGERY SUPPLIES5156971 S STRL WIRE SCISSORS 78.80 51 SURGERY SUPPLIES5156989 S STRL LIORESAL 10 MGM 730.60 51 SURGERY SUPPLIES5157003 S STRL NEEDLE NORIAN DELI 220.45 51 SURGERY SUPPLIES5157011 S STRL KIT BIOPSY TRANSPO 2223.70 51 SURGERY SUPPLIES5157037 S STRL RET ILL LIGHTMAT 536.75 51 SURGERY SUPPLIES5157292 S STRL LASER FIBER BENDAB 799.80 51 SURGERY SUPPLIES5157060 S STRL DRILL TWIST 1.5 1025.60 51 SURGERY SUPPLIES5157078 S STRL DRILL BIT BONE GRA 751.90 51 SURGERY SUPPLIES5157094 S STRL PLATE POSTERIOR CA 341.85 51 SURGERY SUPPLIES5157110 S STRL SUTURE DEVICE ENDO 315.25 51 SURGERY SUPPLIES5157128 S STRL TMPLATE RECONST4.5 451.55 51 SURGERY SUPPLIES5157201 S STRL CANNULA ERCP AUTOT 1560.25 51 SURGERY SUPPLIES5153853 S STRL CATH PICC KIT 934.00 51 SURGERY SUPPLIES5152780 S STRL CELLULOSE BARRIER 283.30 51 SURGERY SUPPLIES5152848 S STRL KIT CVP 345.05 51 SURGERY SUPPLIES5153085 S STRL STRL H2O 3000CC 60.70 51 SURGERY SUPPLIES5153218 S STRL DRESSING FULLER SH 144.85 51 SURGERY SUPPLIES5153465 S STRL GELFILM 193.85 51 SURGERY SUPPLIES5153697 S STRL DERMATOME BLADE 427.05 51 SURGERY SUPPLIES5153705 S STRL DERMAL CARRIER 311.00 51 SURGERY SUPPLIES5154984 S STRL IRR CYSTOTOME 42.60 51 SURGERY SUPPLIES5154224 S STRL URIMETER 85.20 51 SURGERY SUPPLIES5154232 S STRL ALLEN-STIRRUP CLE 166.15 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5154497 S STRL STAPLES-LDS/FASCIA 509.75 51 SURGERY SUPPLIES5154513 S STRL STAPLES-TA 444.00 51 SURGERY SUPPLIES5154539 S STRL STAPLE CARTRIDGE T 208.00 51 SURGERY SUPPLIES5153747 S STRL CYSTO BASKET PARAC 1125.70 51 SURGERY SUPPLIES5152194 S STRL EHL ELECTRODE 984.05 51 SURGERY SUPPLIES5152269 S STRL MENISCAL CAUTERY 908.45 51 SURGERY SUPPLIES5152459 S STRL NASAL TAMPON 96.90 51 SURGERY SUPPLIES5152590 S STRL VAPOR-TRODE 705.05 51 SURGERY SUPPLIES5155023 S STRL DRILL CUTTER 482.45 51 SURGERY SUPPLIES5155700 S STRL MILLING BLADE-KNEE 764.65 51 SURGERY SUPPLIES5155783 S STRL WORD BARTHLIN CATH 148.05 51 SURGERY SUPPLIES5154950 S STRL CATH HICKMAN INTRO 437.70 51 SURGERY SUPPLIES5155627 S STRL PUDDLE VAC 160.80 51 SURGERY SUPPLIES5157839 S STRL SYRINGE NORIAN DEL 615.55 51 SURGERY SUPPLIES5155361 S STRL ZIMMER ANKLE STRAP 160.80 51 SURGERY SUPPLIES5155049 S STRL ELECTRODES 1243.90 51 SURGERY SUPPLIES5155064 S STRL HEP NACL 500CC 21.30 51 SURGERY SUPPLIES5155171 S STRL ENDO CLIP CTG 1134.25 51 SURGERY SUPPLIES5155205 S STRL ENDO SUTURE 559.15 51 SURGERY SUPPLIES5155221 S STRL TROCAR 11MM 273.70 51 SURGERY SUPPLIES5155288 S STRL CYSTO BUGBEE 932.95 51 SURGERY SUPPLIES5155296 S STRL CYSTO ROLLER BALL 1312.10 51 SURGERY SUPPLIES5155304 S STRL GLIDEWIRE 19.40 51 SURGERY SUPPLIES5155692 S STRL PATELLA REAMER 1109.75 51 SURGERY SUPPLIES5155338 S STRL URETHROTOMY KNIFE 839.20 51 SURGERY SUPPLIES5155445 S STRL LIGAMENT CHISEL 1016.00 51 SURGERY SUPPLIES5155460 S STRL OATS HARVESTER 4115.15 51 SURGERY SUPPLIES5155486 S STRL FEMORAL TIP 78.80 51 SURGERY SUPPLIES5155536 S STRL INSULATED NEEDLE 88.40 51 SURGERY SUPPLIES5155577 S STRL AVETINE 928.70 51 SURGERY SUPPLIES5155585 S STRL AVETINE ENDO 762.55 51 SURGERY SUPPLIES5152525 S ORTHO DONALDSON EAR TUB 300.35 51 SURGERY SUPPLIES5114046 S ORTHO IMMOB SHLDR D-J 738.45 51 SURGERY SUPPLIES5154133 S ORTHO POST-OP SHOES 60.70 51 SURGERY SUPPLIES5153812 S ORTHO IMBLR KNEE REG 182.10 51 SURGERY SUPPLIES5155247 S ORTHO ET TUBE 1390.90 51 SURGERY SUPPLIES5152442 S ORTHO MOSS GASTRO TUBE 1472.85 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5110804 S ORTHO FINGER SPLINT 55.40 51 SURGERY SUPPLIES5151709 S ORTHO STAPES MCGEE 362.10 51 SURGERY SUPPLIES5152517 S ORTHO GOODE-T EAR TUBE 149.10 51 SURGERY SUPPLIES5152756 S ORTHO BRACE ELS 1046.10 51 SURGERY SUPPLIES5153820 S ORTHO IMBLR SHOULDER/AR 130.30 51 SURGERY SUPPLIES5152715 S ORTHO STAPES APPLEBAUM 1774.30 51 SURGERY SUPPLIES5152731 S ORTHO MOD GOODE-T E-TUB 535.70 51 SURGERY SUPPLIES5152723 S ORTHO MODIF T-TUBE 375.95 51 SURGERY SUPPLIES5152699 S ORTHO STAPES BLACK 821.10 51 SURGERY SUPPLIES5159603 S IOL TORIC 2465.79 51 SURGERY SUPPLIES5151311 S IMP ORTHO 270.00 51 SURGERY SUPPLIES5151329 S IMP ORTHO 450.00 51 SURGERY SUPPLIES5151337 S IMP ORTHO 630.00 51 SURGERY SUPPLIES5113469 S IMP IMPL SCREW 51 SURGERY SUPPLIES5156203 S IMP IMPL ANCHOR MITEK 1137.40 51 SURGERY SUPPLIES5151923 S IMP JOINT 270.00 51 SURGERY SUPPLIES5151907 S IMP MISC 5460.00 51 SURGERY SUPPLIES5122841 S IMP Z-WIRE 100.10 51 SURGERY SUPPLIES5151303 S IMP ORTHO 90.00 51 SURGERY SUPPLIES5151618 S IMP MISC 270.00 51 SURGERY SUPPLIES5151881 S IMP MISC 4900.00 51 SURGERY SUPPLIES5160999 S IMP HIP STEM 7700.00 51 SURGERY SUPPLIES5151931 S IMP JOINT 450.00 51 SURGERY SUPPLIES5113659 S IMP PIN BIONX 850.95 51 SURGERY SUPPLIES5151691 S IMP MISC 1710.00 51 SURGERY SUPPLIES5151345 S IMP ORTHO 810.00 51 SURGERY SUPPLIES5151915 S IMP JOINT 90.00 51 SURGERY SUPPLIES5161534 S IMP HIP LINER 4900.00 51 SURGERY SUPPLIES5159439 S IMP ANCHOR BIOKNOTLESS 1935.18 51 SURGERY SUPPLIES5122783 S IMP WIRE K PLAIN 83.05 51 SURGERY SUPPLIES5161229 S IMP HIP CUP 3780.00 51 SURGERY SUPPLIES5113154 S IMP IMPL BONE DRIED/FRO 4733.95 51 SURGERY SUPPLIES5159397 S IMP STENT SINUS TARSI 4409.48 51 SURGERY SUPPLIES5111042 S IMP IMPLANTS 51 SURGERY SUPPLIES5151352 S IMP ORTHO 990.00 51 SURGERY SUPPLIES5151600 S IMP MISC 90.00 51 SURGERY SUPPLIES5151543 S IMP ORTHO 4060.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5161831 S IMP HIP HEAD 4620.00 51 SURGERY SUPPLIES5159413 S IMP ACCESSRY KIT SCS 2028.82 51 SURGERY SUPPLIES5160411 S IMP KNEE TIB TRAY 7420.00 51 SURGERY SUPPLIES5160460 S IMP KNEE TIB INSERT 2700.00 51 SURGERY SUPPLIES5151642 S IMP MISC 810.00 51 SURGERY SUPPLIES5160742 S IMP KNEE PATELLA 1980.00 51 SURGERY SUPPLIES5155981 S IMP KNEE FEML CMPT 51 SURGERY SUPPLIES5151451 S IMP ORTHO 2790.00 51 SURGERY SUPPLIES5151550 S IMP ORTHO 4340.00 51 SURGERY SUPPLIES5161898 S IMP HIP HEAD 8260.00 51 SURGERY SUPPLIES5155965 S IMP KNWW TIBIAL CMPT 51 SURGERY SUPPLIES5155957 S IMP IMPL HIP TOTAL STEM 51 SURGERY SUPPLIES5151634 S IMP MISC 630.00 51 SURGERY SUPPLIES5151519 S IMP ORTHO 3220.00 51 SURGERY SUPPLIES5156062 S IMP SPLINT NASAL DOYLE 201.30 51 SURGERY SUPPLIES5160114 S IMP KNEE FEM COMP 6860.00 51 SURGERY SUPPLIES5151873 S IMP MISC 4620.00 51 SURGERY SUPPLIES5151378 S IMP ORTHO 1350.00 51 SURGERY SUPPLIES5151659 S IMP MISC 990.00 51 SURGERY SUPPLIES5156476 S IMP IMPL ROD 51 SURGERY SUPPLIES5151998 S IMP JOINT 1530.00 51 SURGERY SUPPLIES5151527 S IMP ORTHO 3500.00 51 SURGERY SUPPLIES5151626 S IMP MISC 450.00 51 SURGERY SUPPLIES5156252 S IMP FIBRIN SEALANT 2050.15 51 SURGERY SUPPLIES5160098 S IMP KNEE FEM COMP 6300.00 51 SURGERY SUPPLIES5161716 S IMP HIP HEAD 1620.00 51 SURGERY SUPPLIES5113477 S IMP IMPL PLATE 51 SURGERY SUPPLIES5151782 S IMP MISC 3150.00 51 SURGERY SUPPLIES5151824 S IMP MISC 3220.00 51 SURGERY SUPPLIES5151949 S IMP JOINT 630.00 51 SURGERY SUPPLIES5151592 S IMP ORTHO 5460.00 51 SURGERY SUPPLIES5152111 S IMP JOINT 2940.00 51 SURGERY SUPPLIES5155999 S IMP IMPL KNEE PATELLA 51 SURGERY SUPPLIES5160536 S IMP KNEE TIB INSERT 4060.00 51 SURGERY SUPPLIES5151865 S IMP MISC 4340.00 51 SURGERY SUPPLIES5151535 S IMP ORTHO 3780.00 51 SURGERY SUPPLIES5114202 S IMP CABLE 1316.35 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5155866 S IMP HIP SHELL SCREW 51 SURGERY SUPPLIES5162003 S IMP SHOULDER STEM 7700.00 51 SURGERY SUPPLIES5160023 S IMP KNEE FEM COMP 4340.00 51 SURGERY SUPPLIES5160296 S IMP KNEE TIB TRAY 4060.00 51 SURGERY SUPPLIES5157185 S IMP STENT BILIARY 463.30 51 SURGERY SUPPLIES5160122 S IMP KNEE FEM COMP 7140.00 51 SURGERY SUPPLIES5151469 S IMP ORTHO 2970.00 51 SURGERY SUPPLIES5156450 S IMP NAIL 51 SURGERY SUPPLIES5151402 S IMP ORTHO 1890.00 51 SURGERY SUPPLIES5151386 S IMP ORTHO 1530.00 51 SURGERY SUPPLIES5162029 S IMP SHOULDER STEM 8260.00 51 SURGERY SUPPLIES5160866 S IMP HIP STEM 4060.00 51 SURGERY SUPPLIES5154786 S IMP IMPL ANC MTEK MINI 1225.80 51 SURGERY SUPPLIES5155403 S IMP ANCHOR CORKSCREW 1460.10 51 SURGERY SUPPLIES5155916 S IMP IMPL HIP TOTAL PLUG 575.10 51 SURGERY SUPPLIES5113360 S IMP IMPL CORT 51 SURGERY SUPPLIES5161559 S IMP HIP LINER 5460.00 51 SURGERY SUPPLIES5151972 S IMP JOINT 1170.00 51 SURGERY SUPPLIES5155890 S IMP HIP TOL ACETAB SHE 51 SURGERY SUPPLIES5160825 S IMP HIP STEM 2940.00 51 SURGERY SUPPLIES5156104 S IMP PUTTY/GEL 5CC 5047.06 51 SURGERY SUPPLIES5161708 S IMP HIP HEAD 1260.00 51 SURGERY SUPPLIES5156815 S IMP JOINT 3220.00 51 SURGERY SUPPLIES5160031 S IMP KNEE FEM COMP 4620.00 51 SURGERY SUPPLIES5114327 S IMP PUTTY/GEL 1CC 1207.92 51 SURGERY SUPPLIES5160270 S IMP KNEE TIB TRAY 3500.00 51 SURGERY SUPPLIES5160304 S IMP KNEE TIB TRAY 4340.00 51 SURGERY SUPPLIES5160247 S IMP KNEE TIB TRAY 3420.00 51 SURGERY SUPPLIES5151717 S IMP MISC 1890.00 51 SURGERY SUPPLIES5162060 S IMP SHOULDER HEAD 3780.00 51 SURGERY SUPPLIES5160841 S IMP HIP STEM 3500.00 51 SURGERY SUPPLIES5162094 S IMP SHOULDER GLENOID 3220.00 51 SURGERY SUPPLIES5162136 S IMP SHOULDER GLENOID 3875.00 51 SURGERY SUPPLIES5151733 S IMP MISC 2250.00 51 SURGERY SUPPLIES5151675 S IMP MISC 1350.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5160494 S IMP KNEE TIB INSERT 2940.00 51 SURGERY SUPPLIES5151394 S IMP ORTHO 1710.00 51 SURGERY SUPPLIES5162144 S IMP SHOULDER GLENOID 4125.00 51 SURGERY SUPPLIES5151485 S IMP ORTHO 3330.00 51 SURGERY SUPPLIES5151683 S IMP MISC 1530.00 51 SURGERY SUPPLIES5157615 S IMP WASHER 343.50 51 SURGERY SUPPLIES5157581 S IMP GRAFT AMNIO 1620.95 51 SURGERY SUPPLIES5155841 S IMP HIP HEAD ADPTR BI/ 51 SURGERY SUPPLIES5156088 S IMP STENT NASAL MEROGEL 416.40 51 SURGERY SUPPLIES5156070 S IMP SPLINT NASAL THERMA 55.40 51 SURGERY SUPPLIES5161245 S IMP HIP CUP 4340.00 51 SURGERY SUPPLIES5161237 S IMP HIP CUP 4060.00 51 SURGERY SUPPLIES5155973 S IMP KNEE ARTCLR SURFACE 51 SURGERY SUPPLIES5156351 S IMP IMPL ARTHRO ARTHRE 667.75 51 SURGERY SUPPLIES5156468 S IMP IMPL PIN GUIDE 51 SURGERY SUPPLIES5156823 S IMP JOINT 3500.00 51 SURGERY SUPPLIES5156831 S IMP JOINT 3780.00 51 SURGERY SUPPLIES5156849 S IMP JOINT 4060.00 51 SURGERY SUPPLIES5156856 S IMP JOINT 4340.00 51 SURGERY SUPPLIES5160940 S IMP HIP STEM 6300.00 51 SURGERY SUPPLIES5160585 S IMP KNEE TIB INSERT 5460.00 51 SURGERY SUPPLIES5151410 S IMP ORTHO 2070.00 51 SURGERY SUPPLIES5160528 S IMP KNEE TIB INSERT 3780.00 51 SURGERY SUPPLIES5151576 S IMP ORTHO 4900.00 51 SURGERY SUPPLIES5151840 S IMP MISC 3780.00 51 SURGERY SUPPLIES5151501 S IMP ORTHO 2940.00 51 SURGERY SUPPLIES5151444 S IMP ORTHO 2610.00 51 SURGERY SUPPLIES5151436 S IMP ORTHO 2430.00 51 SURGERY SUPPLIES5160288 S IMP KNEE TIB TRAY 3780.00 51 SURGERY SUPPLIES5152020 S IMP JOINT 2070.00 51 SURGERY SUPPLIES5151899 S IMP MISC 5180.00 51 SURGERY SUPPLIES5151022 S IMP SPINE 450.00 51 SURGERY SUPPLIES5151964 S IMP JOINT 990.00 51 SURGERY SUPPLIES5151758 S IMP MISC 2610.00 51 SURGERY SUPPLIES5151816 S IMP MISC 2940.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5152046 S IMP JOINT 2430.00 51 SURGERY SUPPLIES5160312 S IMP KNEE TIB TRAY 4620.00 51 SURGERY SUPPLIES5152053 S IMP JOINT 2610.00 51 SURGERY SUPPLIES5152061 S IMP JOINT 2790.00 51 SURGERY SUPPLIES5151766 S IMP MISC 2790.00 51 SURGERY SUPPLIES5160015 S IMP KNEE FEM COMP 4060.00 51 SURGERY SUPPLIES5152004 S IMP JOINT 1710.00 51 SURGERY SUPPLIES5162086 S IMP SHOULDER GLENOID 2940.00 51 SURGERY SUPPLIES5161765 S IMP HIP HEAD 3420.00 51 SURGERY SUPPLIES5161633 S IMP HIP LINER 7700.00 51 SURGERY SUPPLIES5162151 S IMP SHOULDER GLENOID 4900.00 51 SURGERY SUPPLIES5161773 S IMP HIP HEAD 2940.00 51 SURGERY SUPPLIES5160650 S IMP KNEE TIB INSERT 7420.00 51 SURGERY SUPPLIES5160734 S IMP KNEE PATELLA 1620.00 51 SURGERY SUPPLIES5160064 S IMP KNEE FEM COMP 5460.00 51 SURGERY SUPPLIES5160346 S IMP KNEE TIB TRAY 5460.00 51 SURGERY SUPPLIES5160916 S IMP HIP STEM 5460.00 51 SURGERY SUPPLIES5160429 S IMP KNEE TIB TRAY 9380.00 51 SURGERY SUPPLIES5160353 S IMP KNEE TIB TRAY 5740.00 51 SURGERY SUPPLIES5160882 S IMP HIP STEM 4620.00 51 SURGERY SUPPLIES5160890 S IMP HIP STEM 4900.00 51 SURGERY SUPPLIES5160387 S IMP KNEE TIB TRAY 6580.00 51 SURGERY SUPPLIES5160361 S IMP KNEE TIB TRAY 6020.00 51 SURGERY SUPPLIES5159314 S IMP PIN STEINMAN 166.70 51 SURGERY SUPPLIES5159306 S IMP STPLE LIGAMENT 20MM 1080.30 51 SURGERY SUPPLIES5160403 S IMP KNEE TIB TRAY 7140.00 51 SURGERY SUPPLIES5159405 S IMP ACCESSRY KIT NEUROS 771.80 51 SURGERY SUPPLIES5160395 S IMP KNEE TIB TRAY 6860.00 51 SURGERY SUPPLIES5160379 S IMP KNEE TIB TRAY 6300.00 51 SURGERY SUPPLIES5160908 S IMP HIP STEM 5180.00 51 SURGERY SUPPLIES5160213 S IMP KNEE FEM COMP 12600.00 51 SURGERY SUPPLIES5160205 S IMP KNEE FEM COMP 9380.00 51 SURGERY SUPPLIES5160072 S IMP KNEE FEM COMP 5740.00 51 SURGERY SUPPLIES5161005 S IMP HIP STEM 7980.00 51 SURGERY SUPPLIES5160106 S IMP KNEE FEM COMP 6580.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5160197 S IMP KNEE FEM COMP 9100.00 51 SURGERY SUPPLIES5161013 S IMP HIP STEM 8260.00 51 SURGERY SUPPLIES5160932 S IMP HIP STEM 6020.00 51 SURGERY SUPPLIES5161021 S IMP HIP STEM 8540.00 51 SURGERY SUPPLIES5160049 S IMP KNEE FEM COMP 4900.00 51 SURGERY SUPPLIES5160189 S IMP KNEE FEM COMP 8820.00 51 SURGERY SUPPLIES5160130 S IMP KNEE FEM COMP 7420.00 51 SURGERY SUPPLIES5160148 S IMP KNEE FEM COMP 7700.00 51 SURGERY SUPPLIES5160155 S IMP KNEE FEM COMP 7980.00 51 SURGERY SUPPLIES5160163 S IMP KNEE FEM COMP 8260.00 51 SURGERY SUPPLIES5160171 S IMP KNEE FEM COMP 8540.00 51 SURGERY SUPPLIES5157946 S IMP STAPLE BONE 635.80 51 SURGERY SUPPLIES5160965 S IMP HIP STEM 6860.00 51 SURGERY SUPPLIES5160338 S IMP KNEE TIB TRAY 5180.00 51 SURGERY SUPPLIES5159579 S IMP AUTOL CHONDRYOCYTE 51 SURGERY SUPPLIES5160320 S IMP KNEE TIB TRAY 4900.00 51 SURGERY SUPPLIES5160221 S IMP KNEE FEM COMP 18200.00 51 SURGERY SUPPLIES5160056 S IMP KNEE FEM COMP 5180.00 51 SURGERY SUPPLIES5160973 S IMP HIP STEM 7140.00 51 SURGERY SUPPLIES5160981 S IMP HIP STEM 7420.00 51 SURGERY SUPPLIES5160262 S IMP KNEE TIB TRAY 3220.00 51 SURGERY SUPPLIES5160254 S IMP KNEE TIB TRAY 2940.00 51 SURGERY SUPPLIES5160007 S IMP KNEE FEM COMP 3780.00 51 SURGERY SUPPLIES5160239 S IMP KNEE FEM COMP 26600.00 51 SURGERY SUPPLIES5160924 S IMP HIP STEM 5740.00 51 SURGERY SUPPLIES5160957 S IMP HIP STEM 6580.00 51 SURGERY SUPPLIES5160759 S IMP KNEE PATELLA 2340.00 51 SURGERY SUPPLIES5160767 S IMP KNEE PATELLA 2700.00 51 SURGERY SUPPLIES5160643 S IMP KNEE TIB INSERT 7140.00 51 SURGERY SUPPLIES5160775 S IMP KNEE PATELLA 3060.00 51 SURGERY SUPPLIES5160783 S IMP KNEE PATELLA 3420.00 51 SURGERY SUPPLIES5160627 S IMP KNEE TIB INSERT 6580.00 51 SURGERY SUPPLIES5160619 S IMP KNEE TIB INSERT 6300.00 51 SURGERY SUPPLIES5160601 S IMP KNEE TIB INSERT 6020.00 51 SURGERY SUPPLIES5160791 S IMP KNEE PATELLA 2940.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5160809 S IMP KNEE PATELLA 3220.00 51 SURGERY SUPPLIES5160593 S IMP KNEE TIB INSERT 5740.00 51 SURGERY SUPPLIES5160510 S IMP KNEE TIB INSERT 3500.00 51 SURGERY SUPPLIES5160635 S IMP KNEE TIB INSERT 6860.00 51 SURGERY SUPPLIES5158662 S IMP WASHER WASHLOC 2350.30 51 SURGERY SUPPLIES5160718 S IMP KNEE ALL POLY 6020.00 51 SURGERY SUPPLIES5160700 S IMP KNEE ALL POLY 5740.00 51 SURGERY SUPPLIES5160692 S IMP KNEE ALL POLY 5460.00 51 SURGERY SUPPLIES5160684 S IMP KNEE ALL POLY 5180.00 51 SURGERY SUPPLIES5160676 S IMP KNEE TIB INSERT 10780.00 51 SURGERY SUPPLIES5160668 S IMP KNEE TIB INSERT 7700.00 51 SURGERY SUPPLIES5160726 S IMP KNEE PATELLA 1260.00 51 SURGERY SUPPLIES5160502 S IMP KNEE TIB INSERT 3220.00 51 SURGERY SUPPLIES5160874 S IMP HIP STEM 4340.00 51 SURGERY SUPPLIES5160486 S IMP KNEE TIB INSERT 3420.00 51 SURGERY SUPPLIES5160478 S IMP KNEE TIB INSERT 3060.00 51 SURGERY SUPPLIES5160452 S IMP KNEE TIB INSERT 2340.00 51 SURGERY SUPPLIES5160445 S IMP KNEE TIB INSERT 1980.00 51 SURGERY SUPPLIES5160437 S IMP KNEE TIB TRAY 9660.00 51 SURGERY SUPPLIES5160817 S IMP HIP STEM 3420.00 51 SURGERY SUPPLIES5160577 S IMP KNEE TIB INSERT 5180.00 51 SURGERY SUPPLIES5160569 S IMP KNEE TIB INSERT 4900.00 51 SURGERY SUPPLIES5160833 S IMP HIP STEM 3220.00 51 SURGERY SUPPLIES5160551 S IMP KNEE TIB INSERT 4620.00 51 SURGERY SUPPLIES5160544 S IMP KNEE TIB INSERT 4340.00 51 SURGERY SUPPLIES5151741 S IMP MISC 2430.00 51 SURGERY SUPPLIES5114715 S IMP POST 51 SURGERY SUPPLIES5150081 S IMP KNEE FEM COMP 6020.00 51 SURGERY SUPPLIES5114731 S IMP PEG 1116.84 51 SURGERY SUPPLIES5114707 S IMP KNEE PEG 953.40 51 SURGERY SUPPLIES5151360 S IMP ORTHO 1170.00 51 SURGERY SUPPLIES5151204 S IMP SPINE 2940.00 51 SURGERY SUPPLIES5151212 S IMP SPINE 3220.00 51 SURGERY SUPPLIES5151220 S IMP SPINE 3500.00 51 SURGERY SUPPLIES5151238 S IMP SPINE 3780.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5151246 S IMP SPINE 4060.00 51 SURGERY SUPPLIES5151253 S IMP SPINE 4340.00 51 SURGERY SUPPLIES5151261 S IMP SPINE 4620.00 51 SURGERY SUPPLIES5151279 S IMP SPINE 4900.00 51 SURGERY SUPPLIES5151295 S IMP SPINE 5460.00 51 SURGERY SUPPLIES5151170 S IMP SPINE 3150.00 51 SURGERY SUPPLIES5151428 S IMP ORTHO 2250.00 51 SURGERY SUPPLIES5151477 S IMP ORTHO 3150.00 51 SURGERY SUPPLIES5151493 S IMP ORTHO 3510.00 51 SURGERY SUPPLIES5151568 S IMP ORTHO 4620.00 51 SURGERY SUPPLIES5151584 S IMP ORTHO 5180.00 51 SURGERY SUPPLIES5151667 S IMP MISC 1170.00 51 SURGERY SUPPLIES5151287 S IMP SPINE 5180.00 51 SURGERY SUPPLIES5151089 S IMP SPINE 1530.00 51 SURGERY SUPPLIES5150156 S IMP KNEE FEM COMP 7980.00 51 SURGERY SUPPLIES5150164 S IMP KNEE FEM COMP 51 SURGERY SUPPLIES5151006 S IMP SPINE 90.00 51 SURGERY SUPPLIES5151014 S IMP SPINE 270.00 51 SURGERY SUPPLIES5151030 S IMP SPINE 630.00 51 SURGERY SUPPLIES5151048 S IMP SPINE 810.00 51 SURGERY SUPPLIES5151055 S IMP SPINE 990.00 51 SURGERY SUPPLIES5151196 S IMP SPINE 3510.00 51 SURGERY SUPPLIES5151071 S IMP SPINE 1350.00 51 SURGERY SUPPLIES5151188 S IMP SPINE 3330.00 51 SURGERY SUPPLIES5151097 S IMP SPINE 1710.00 51 SURGERY SUPPLIES5151105 S IMP SPINE 1890.00 51 SURGERY SUPPLIES5151113 S IMP SPINE 2070.00 51 SURGERY SUPPLIES5151121 S IMP SPINE 2250.00 51 SURGERY SUPPLIES5151139 S IMP SPINE 2430.00 51 SURGERY SUPPLIES5151147 S IMP SPINE 2610.00 51 SURGERY SUPPLIES5151154 S IMP SPINE 2790.00 51 SURGERY SUPPLIES5151162 S IMP SPINE 2970.00 51 SURGERY SUPPLIES5151063 S IMP SPINE 1170.00 51 SURGERY SUPPLIES5112065 S IMP WASHER SPIKE 1032.07 51 SURGERY SUPPLIES5112115 S IMP IMPL STAPLE SERRAT 155.50 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5112123 S IMP STAPLE SPIKED 857.70 51 SURGERY SUPPLIES5112149 S IMP PIN STEINMAN 77.55 51 SURGERY SUPPLIES5113402 S IMP KNEE TOL COMPLETE 51 SURGERY SUPPLIES5113352 S IMP IMPL SCREW 20MM 51 SURGERY SUPPLIES5113378 S IMP IMPL CANC LAG 51 SURGERY SUPPLIES5101308 S IMP POUCH MESH PUMP 488.85 51 SURGERY SUPPLIES5111646 S IMP ORTHO SRB PIN 2720.00 51 SURGERY SUPPLIES5111166 S IMP WIRE K THREADED 162.95 51 SURGERY SUPPLIES5113485 S IMP ALLOGRAFT TENDON 51 SURGERY SUPPLIES5114160 S IMP DISTRACTION PIN/PO 1295.05 51 SURGERY SUPPLIES5114210 S IMP CABLE BUTTON 334.40 51 SURGERY SUPPLIES5114228 S IMP CABLE 4-HOLE PLATE 9902.35 51 SURGERY SUPPLIES5114236 S IMP CABLE PLATE DISTAL 916.95 51 SURGERY SUPPLIES5114277 S IMP APLIGRAF 4070.45 51 SURGERY SUPPLIES5113394 S IMP ALLOGRAFT 51 SURGERY SUPPLIES5114319 S IMP SPINAL SPACER 51 SURGERY SUPPLIES5114400 S IMP KNEE TIBIAL INSERT 51 SURGERY SUPPLIES5114434 S IMP BIOTRACE 6 GMS 456.90 51 SURGERY SUPPLIES5151774 S IMP MISC 2970.00 51 SURGERY SUPPLIES5113543 S IMP BREAST 51 SURGERY SUPPLIES5113600 S IMP EAR TUBE ARMSTRONG 243.90 51 SURGERY SUPPLIES5113634 S IMP SCREW PLATE ANCHOR 51 SURGERY SUPPLIES5113642 S IMP SHUNT CAROTID 575.10 51 SURGERY SUPPLIES5113667 S IMP CABLE PIN ASSEMBLY 2608.20 51 SURGERY SUPPLIES5113790 S IMP SPLINT NASAL MEROG 483.50 51 SURGERY SUPPLIES5113816 S IMP GRAFTON FLEX 4550.20 51 SURGERY SUPPLIES5151725 S IMP MISC 2070.00 51 SURGERY SUPPLIES5156625 S IMP STAPLE UNICLIP 1280.15 51 SURGERY SUPPLIES5156633 S IMP EAR 51 SURGERY SUPPLIES5156641 S IMP BONE PUTTY ALLOMATR 3595.68 51 SURGERY SUPPLIES5156658 S IMP OSTEOSET MINI BEAD 2102.30 51 SURGERY SUPPLIES5156567 S IMP NUT 51 SURGERY SUPPLIES5156765 S IMP BONE GRAFT IC 10CC 3369.65 51 SURGERY SUPPLIES5156799 S IMP KNEE EXTENDER 51 SURGERY SUPPLIES5156807 S IMP KNEE HALF BLOCK 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5156864 S IMP JOINT 4620.00 51 SURGERY SUPPLIES5156872 S IMP JOINT 4900.00 51 SURGERY SUPPLIES5156666 S IMP OSTEOSET REG BEAD 3615.70 51 SURGERY SUPPLIES5156211 S IMP SPINAL LOCKIGN CAP 51 SURGERY SUPPLIES5156229 S IMP SPINAL SCREW 51 SURGERY SUPPLIES5156237 S IMP SPINAL ROD 51 SURGERY SUPPLIES5156245 S IMP SPINAL HEAD 51 SURGERY SUPPLIES5156260 S IMP SHOULDER GLEN COMP 51 SURGERY SUPPLIES5156278 S IMP SHOULDER HUM HEAD 51 SURGERY SUPPLIES5156286 S IMP SHOULDER HUM STEM 51 SURGERY SUPPLIES5156294 S IMP PROSTEON 2100.20 51 SURGERY SUPPLIES5156583 S IMP SHUNT DENVER 3475.10 51 SURGERY SUPPLIES5156369 S IMP ANCHOR MITEK RAPIDL 672.00 51 SURGERY SUPPLIES5156419 S IMP METATARSAL STEM 3558.15 51 SURGERY SUPPLIES5156427 S IMP GUIDE PIN METATARS 132.05 51 SURGERY SUPPLIES5156500 S IMP SPINAL CAGE 51 SURGERY SUPPLIES5156526 S IMP IMPL NAIL CAP END 661.35 51 SURGERY SUPPLIES5156302 S IMP TRANSFIX ACL 673.10 51 SURGERY SUPPLIES5157664 S IMP QUAD EXTENSION KIT 2441.00 51 SURGERY SUPPLIES5156880 S IMP JOINT 5180.00 51 SURGERY SUPPLIES5157607 S IMPL DERMAGRAFT 2194.95 51 SURGERY SUPPLIES5156138 S IMP BONE COLLAGRAFT LAR 4600.80 51 SURGERY SUPPLIES5156922 S IMP BONE COLLAPRO 3682.75 51 SURGERY SUPPLIES5156930 S IMP PIN 51 SURGERY SUPPLIES5157318 S IMP TOTAL HIP SPACER 51 SURGERY SUPPLIES5157086 S IMP SCREW CAP 432.40 51 SURGERY SUPPLIES5157136 S IMP STENT ESOPHAGEAL 5230.20 51 SURGERY SUPPLIES5156898 S IMP JOINT 5460.00 51 SURGERY SUPPLIES5157029 S IMP CEMENT BONE NORIAN 3843.60 51 SURGERY SUPPLIES5154794 S IMP IMPL ANC MTEK RG 1024.55 51 SURGERY SUPPLIES5154802 S IMP IMPL ANC MTEK SUP 1436.70 51 SURGERY SUPPLIES5156187 S IMP EXTERNAL FIXATOR 51 SURGERY SUPPLIES5152095 S IMP JOINT 3330.00 51 SURGERY SUPPLIES5151790 S IMP MISC 3330.00 51 SURGERY SUPPLIES5151808 S IMP MISC 3510.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5151832 S IMP MISC 3500.00 51 SURGERY SUPPLIES5151857 S IMP MISC 4060.00 51 SURGERY SUPPLIES5151956 S IMP JOINT 810.00 51 SURGERY SUPPLIES5151980 S IMP JOINT 1350.00 51 SURGERY SUPPLIES5152012 S IMP JOINT 1890.00 51 SURGERY SUPPLIES5152038 S IMP JOINT 2250.00 51 SURGERY SUPPLIES5152087 S IMP JOINT 3150.00 51 SURGERY SUPPLIES5152103 S IMP JOINT 3510.00 51 SURGERY SUPPLIES5152277 S IMP IMPL ENDOBUTTON 1038.40 51 SURGERY SUPPLIES5161039 S IMP HIP STEM 8820.00 51 SURGERY SUPPLIES5152079 S IMP JOINT 2970.00 51 SURGERY SUPPLIES5155924 S IMP HIP TOTAL FEM RESTR 51 SURGERY SUPPLIES5155734 S IMP IMPL SCREW INT 1328.05 51 SURGERY SUPPLIES5155742 S IMP IMPL ENISCAL DART 889.30 51 SURGERY SUPPLIES5155825 S IMP HIP BPLR CUP 51 SURGERY SUPPLIES5155833 S IMP HIP HEAD BPLR/UNI 51 SURGERY SUPPLIES5155858 S IMP HIP STEM BPLR/UNI 51 SURGERY SUPPLIES5155874 S IMP HIP BPLR CEMENTLESS 51 SURGERY SUPPLIES5155908 S IMP HIP TOL ACETAB LIN 51 SURGERY SUPPLIES5155932 S IMP HIP TOL CENTRALIZE 51 SURGERY SUPPLIES5155940 S IMP HIP TOL FEML HEAD 51 SURGERY SUPPLIES5156021 S IMP HIP TOL COMPLETE 51 SURGERY SUPPLIES5156047 S IMP IMPL PIN INTRAMEDU 51 SURGERY SUPPLIES5156096 S IMP PUTTY/GEL 10CC 3971.69 51 SURGERY SUPPLIES5156112 S IMP BONE COLLAGRAFT SIN 1432.45 51 SURGERY SUPPLIES5156120 S IMP BONE COLLAGRAFT SMA 2747.70 51 SURGERY SUPPLIES5155882 S IMP HIP BPLR CEMENTED 51 SURGERY SUPPLIES5155676 S IMP MENISCAL ARROW 723.15 51 SURGERY SUPPLIES5155429 S IMP IMPL BONE SYNTH 2976.70 51 SURGERY SUPPLIES5155452 S IMP MENISCAL STAPLER 2349.40 51 SURGERY SUPPLIES5156179 S IMP IMPL TIBIAL SHEATH 577.25 51 SURGERY SUPPLIES5155312 S IMP ZEBRA WIRE 371.70 51 SURGERY SUPPLIES5161047 S IMP HIP STEM 9100.00 51 SURGERY SUPPLIES5160858 S IMP HIP STEM 3780.00 51 SURGERY SUPPLIES5161146 S IMP HIP STEM 16100.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5161294 S IMP HIP CUP 5740.00 51 SURGERY SUPPLIES5161286 S IMP HIP CUP 5460.00 51 SURGERY SUPPLIES5161278 S IMP HIP CUP 5180.00 51 SURGERY SUPPLIES5161260 S IMP HIP CUP 4900.00 51 SURGERY SUPPLIES5161252 S IMP HIP CUP 4620.00 51 SURGERY SUPPLIES5161211 S IMP HIP CUP 3500.00 51 SURGERY SUPPLIES5161203 S IMP HIP CUP 3220.00 51 SURGERY SUPPLIES5161195 S IMP HIP CUP 2940.00 51 SURGERY SUPPLIES5161187 S IMP HIP CUP 3420.00 51 SURGERY SUPPLIES5161575 S IMP HIP LINER 6020.00 51 SURGERY SUPPLIES5161161 S IMP HIP STEM 16660.00 51 SURGERY SUPPLIES5161328 S IMP HIP CUP 6580.00 51 SURGERY SUPPLIES5161120 S IMP HIP STEM 15540.00 51 SURGERY SUPPLIES5161112 S IMP HIP STEM 15260.00 51 SURGERY SUPPLIES5161104 S IMP HIP STEM 14980.00 51 SURGERY SUPPLIES5161096 S IMP HIP STEM 14700.00 51 SURGERY SUPPLIES5161088 S IMP HIP STEM 14420.00 51 SURGERY SUPPLIES5161070 S IMP HIP STEM 14140.00 51 SURGERY SUPPLIES5161062 S IMP HIP STEM 13860.00 51 SURGERY SUPPLIES5161054 S IMP HIP STEM 9380.00 51 SURGERY SUPPLIES5162615 S IMP PLUG 3132.00 51 SURGERY SUPPLIES5162656 S IMP JOINT COMP 637.50 51 SURGERY SUPPLIES5161179 S IMP HIP CUP 3060.00 51 SURGERY SUPPLIES5161427 S IMP HIP LINER 2340.00 51 SURGERY SUPPLIES5161567 S IMP HIP LINER 5740.00 51 SURGERY SUPPLIES5161542 S IMP HIP LINER 5180.00 51 SURGERY SUPPLIES5161526 S IMP HIP LINER 4620.00 51 SURGERY SUPPLIES5161518 S IMP HIP LINER 4340.00 51 SURGERY SUPPLIES5161500 S IMP HIP LINER 4060.00 51 SURGERY SUPPLIES5161492 S IMP HIP LINER 3780.00 51 SURGERY SUPPLIES5161484 S IMP HIP LINER 3500.00 51 SURGERY SUPPLIES5161476 S IMP HIP LINER 3220.00 51 SURGERY SUPPLIES5161468 S IMP HIP LINER 2940.00 51 SURGERY SUPPLIES5161450 S IMP HIP LINER 3420.00 51 SURGERY SUPPLIES5161302 S IMP HIP CUP 6020.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5161435 S IMP HIP LINER 2700.00 51 SURGERY SUPPLIES5161310 S IMP HIP CUP 6300.00 51 SURGERY SUPPLIES5161419 S IMP HIP CUP 14420.00 51 SURGERY SUPPLIES5161401 S IMP HIP CUP 8820.00 51 SURGERY SUPPLIES5161393 S IMP HIP CUP 8540.00 51 SURGERY SUPPLIES5161385 S IMP HIP CUP 8260.00 51 SURGERY SUPPLIES5161377 S IMP HIP CUP 7980.00 51 SURGERY SUPPLIES5161369 S IMP HIP CUP 7700.00 51 SURGERY SUPPLIES5161351 S IMP HIP CUP 7420.00 51 SURGERY SUPPLIES5161344 S IMP HIP CUP 7140.00 51 SURGERY SUPPLIES5161336 S IMP HIP CUP 6860.00 51 SURGERY SUPPLIES5161443 S IMP HIP LINER 3060.00 51 SURGERY SUPPLIES5162664 S IMP JOINT COMP 1062.50 51 SURGERY SUPPLIES5162672 S IMP JOINT COMP 1700.00 51 SURGERY SUPPLIES5162128 S IMP SHOULDER GLENOID 4060.00 51 SURGERY SUPPLIES5161153 S IMP HIP STEM 16380.00 51 SURGERY SUPPLIES5161690 S IMP HIP HEAD 900.00 51 SURGERY SUPPLIES5161807 S IMP HIP HEAD 3780.00 51 SURGERY SUPPLIES5161799 S IMP HIP HEAD 3500.00 51 SURGERY SUPPLIES5161781 S IMP HIP HEAD 3220.00 51 SURGERY SUPPLIES5162045 S IMP SHOULDER HEAD 3220.00 51 SURGERY SUPPLIES5161740 S IMP HIP HEAD 2700.00 51 SURGERY SUPPLIES5162110 S IMP SHOULDER GLENOID 3780.00 51 SURGERY SUPPLIES5161724 S IMP HIP HEAD 1980.00 51 SURGERY SUPPLIES5161682 S IMP HIP LINER 9100.00 51 SURGERY SUPPLIES5161674 S IMP HIP LINER 8820.00 51 SURGERY SUPPLIES5162052 S IMP SHOULDER HEAD 3500.00 51 SURGERY SUPPLIES5161666 S IMP HIP LINER 8540.00 51 SURGERY SUPPLIES5161658 S IMP HIP LINER 8260.00 51 SURGERY SUPPLIES5161641 S IMP HIP LINER 7980.00 51 SURGERY SUPPLIES5162078 S IMP SHOULDER HEAD 4060.00 51 SURGERY SUPPLIES5162102 S IMP SHOULDER GLENOID 3500.00 51 SURGERY SUPPLIES5161625 S IMP HIP LINER 7420.00 51 SURGERY SUPPLIES5161732 S IMP HIP HEAD 2340.00 51 SURGERY SUPPLIES5161948 S IMP SHOULDER STEM 6020.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5161914 S IMP HIP HEAD 8820.00 51 SURGERY SUPPLIES5161906 S IMP HIP HEAD 8540.00 51 SURGERY SUPPLIES5161880 S IMP HIP HEAD 6020.00 51 SURGERY SUPPLIES5161872 S IMP HIP HEAD 5740.00 51 SURGERY SUPPLIES5161864 S IMP HIP HEAD 5460.00 51 SURGERY SUPPLIES5161856 S IMP HIP HEAD 5180.00 51 SURGERY SUPPLIES5161849 S IMP HIP HEAD 4900.00 51 SURGERY SUPPLIES5161823 S IMP HIP HEAD 4340.00 51 SURGERY SUPPLIES5161815 S IMP HIP HEAD 4060.00 51 SURGERY SUPPLIES5162037 S IMP SHOULDER HEAD 2940.00 51 SURGERY SUPPLIES5161930 S IMP SHOULDER STEM 5740.00 51 SURGERY SUPPLIES5161955 S IMP SHOULDER STEM 6300.00 51 SURGERY SUPPLIES5161963 S IMP SHOULDER STEM 6580.00 51 SURGERY SUPPLIES5161971 S IMP SHOULDER STEM 6860.00 51 SURGERY SUPPLIES5161989 S IMP SHOULDER STEM 7140.00 51 SURGERY SUPPLIES5161997 S IMP SHOULDER STEM 7420.00 51 SURGERY SUPPLIES5162011 S IMP SHOULDER STEM 7980.00 51 SURGERY SUPPLIES5161138 S IMP HIP STEM 15820.00 51 SURGERY SUPPLIES5161757 S IMP HIP HEAD 3060.00 51 SURGERY SUPPLIES5161922 S IMP HIP HEAD 9100.00 51 SURGERY SUPPLIES5161583 S IMP HIP LINER 6300.00 51 SURGERY SUPPLIES5161591 S IMP HIP LINER 6580.00 51 SURGERY SUPPLIES5161609 S IMP HIP LINER 6860.00 51 SURGERY SUPPLIES5161617 S IMP HIP LINER 7140.00 51 SURGERY SUPPLIES5162433 LEAD EXT PACING/NEUROSTIM 3420.00 51 SURGERY SUPPLIES5162425 LEAD EXT PACING/NEUROSTIM 3060.00 51 SURGERY SUPPLIES5162409 LEAD EXT PACING/NEUROSTIM 2340.00 51 SURGERY SUPPLIES5162441 LEAD EXT PACING/NEUROSTIM 4452.00 51 SURGERY SUPPLIES5162417 LEAD EXT PACING/NEUROSTIM 2700.00 51 SURGERY SUPPLIES5112958 CATH BLN DILATE NOVSC 3002.25 51 SURGERY SUPPLIES5155635 CATH BLN TIS DSCT NOVSC 1663.55 51 SURGERY SUPPLIES5111836 CATH DRAINAGE 119.30 51 SURGERY SUPPLIES5114665 CATH DRAINAGE 357.85 51 SURGERY SUPPLIES5152681 IMP CATH HD/PRTNL LNG TRM 1317.40 51 SURGERY SUPPLIES5154943 IMP CATH HD/PRTNL LNG TRM 604.90 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5156948 CATH HD SHORT TERM 689.05 51 SURGERY SUPPLIES5154935 CATH INF PER CEN MID NOHD 1053.30 51 SURGERY SUPPLIES5154901 CATH INF PER CEN MID NOHD 3318.55 51 SURGERY SUPPLIES5156997 CATH INF PER CEN MID NOHD 341.85 51 SURGERY SUPPLIES5154927 CATH INF PER CEN MID NOHD 1481.40 51 SURGERY SUPPLIES5154919 CATH INF PER CEN MID NOHD 4045.95 51 SURGERY SUPPLIES5156492 CATH INF PER CEN MID NOHD 125.65 51 SURGERY SUPPLIES5110325 CATH INF PER CEN MID NOHD 1351.50 51 SURGERY SUPPLIES5156690 CATH INTRASPINAL 2672.10 51 SURGERY SUPPLIES5113014 CATH OCCLUSION 313.00 51 SURGERY SUPPLIES5114251 CATH SP/CYSTOSCOPIC 304.60 51 SURGERY SUPPLIES5156682 CATH SP/CYSTOSCOPIC 297.15 51 SURGERY SUPPLIES5112586 CATH URETERAL 117.85 51 SURGERY SUPPLIES5159355 CATH URETERAL 545.50 51 SURGERY SUPPLIES5162607 CONN TISS NON-HUMAN 20698.00 51 SURGERY SUPPLIES5162680 CONN TISS NON-HUMAN 44240.00 51 SURGERY SUPPLIES5159991 CONN TISS NON-HUMAN 10349.00 51 SURGERY SUPPLIES5157714 CONN TISS NON-HUMAN 3590.10 51 SURGERY SUPPLIES5157706 CONN TISS NON-HUMAN 3462.30 51 SURGERY SUPPLIES5162169 GENERATOR NEURO NO-RECHRG 23800.00 51 SURGERY SUPPLIES5156955 GENERATOR NEURO NO-RECHRG 250.30 51 SURGERY SUPPLIES5162185 GENERATOR NEURO NO-RECHRG 29400.00 51 SURGERY SUPPLIES5162235 GENERATOR NEURO NO-RECHRG 49000.00 51 SURGERY SUPPLIES5162201 GENERATOR NEURO NO-RECHRG 35000.00 51 SURGERY SUPPLIES5162193 GENERATOR NEURO NO-RECHRG 32200.00 51 SURGERY SUPPLIES5157672 GENERATOR NEURO NO-RECHRG 37698.85 51 SURGERY SUPPLIES5162581 GENERATOR NEURO NO-RECHRG 37800.00 51 SURGERY SUPPLIES5162599 GENERATOR NEURO NO-RECHRG 43400.00 51 SURGERY SUPPLIES5162219 GENERATOR NEURO NO-RECHRG 40600.00 51 SURGERY SUPPLIES5162227 GENERATOR NEURO NO-RECHRG 46200.00 51 SURGERY SUPPLIES5162177 GENERATOR NEURO NO-RECHRG 26600.00 51 SURGERY SUPPLIES5113527 IMP GRAFT VASCULAR 51 SURGERY SUPPLIES5114194 IMP GRAFT VASCULAR 1793.45 51 SURGERY SUPPLIES5113519 IMP GRAFT VASCULAR 51 SURGERY SUPPLIES5152202 GUIDEWIRE 364.25 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5114244 GUIDEWIRE 248.15 51 SURGERY SUPPLIES5114590 GUIDEWIRE 1498.45 51 SURGERY SUPPLIES5157730 GUIDEWIRE 373.80 51 SURGERY SUPPLIES5155502 INFUSN PUMP NON-PROG TEMP 1131.05 51 SURGERY SUPPLIES5155759 INFUSN PUMP NON-PROG TEMP 1127.85 51 SURGERY SUPPLIES5156534 INFUSN PUMP PROGRAMMABLE 33628.45 51 SURGERY SUPPLIES5114392 S DEVICE JNT 51 SURGERY SUPPLIES5156575 S DEVICE JNT 4507.10 51 SURGERY SUPPLIES5156393 S DEVICE JNT 4121.55 51 SURGERY SUPPLIES5156385 S DEVICE JNT 51 SURGERY SUPPLIES5156310 S DEVICE JNT 51 SURGERY SUPPLIES5113444 S DEVICE JNT 483.50 51 SURGERY SUPPLIES5162334 LEAD NEUROSTIMULATOR 7700.00 51 SURGERY SUPPLIES5162342 LEAD NEUROSTIMULATOR 8260.00 51 SURGERY SUPPLIES5162284 LEAD NEUROSTIMULATOR 3780.00 51 SURGERY SUPPLIES5162292 LEAD NEUROSTIMULATOR 5460.00 51 SURGERY SUPPLIES5157656 LEAD NEUROSTIMULATOR 6809.32 51 SURGERY SUPPLIES5162300 LEAD NEUROSTIMULATOR 5740.00 51 SURGERY SUPPLIES5162367 LEAD NEUROSTIMULATOR 9940.00 51 SURGERY SUPPLIES5162359 LEAD NEUROSTIMULATOR 8540.00 51 SURGERY SUPPLIES5162391 LEAD NEUROSTIMULATOR 17220.00 51 SURGERY SUPPLIES5162326 LEAD NEUROSTIMULATOR 7420.00 51 SURGERY SUPPLIES5162383 LEAD NEUROSTIMULATOR 16660.00 51 SURGERY SUPPLIES5162318 LEAD NEUROSTIMULATOR 6580.00 51 SURGERY SUPPLIES5162375 LEAD NEUROSTIMULATOR 10780.00 51 SURGERY SUPPLIES5162458 NEUROSTIM LEAD TEST KIT 3780.00 51 SURGERY SUPPLIES5162466 NEUROSTIM LEAD TEST KIT 4060.00 51 SURGERY SUPPLIES5110119 IOL NEW TECHNOLOGY 840.30 51 SURGERY SUPPLIES5154976 IOL NEW TECHNOLOGY 840.30 51 SURGERY SUPPLIES5111091 IOL NEW TECHNOLOGY 1361.05 51 SURGERY SUPPLIES5156013 IOL NEW TECHNOLOGY 826.45 51 SURGERY SUPPLIES5113626 IMP MESH 1172.55 51 SURGERY SUPPLIES5156344 IMP MESH 609.75 51 SURGERY SUPPLIES5159595 IMP MESH 51 SURGERY SUPPLIES5162623 IMP MESH 155.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5159801 IMP MESH 1350.00 51 SURGERY SUPPLIES5159819 IMP MESH 1616.00 51 SURGERY SUPPLIES5113535 IMP MESH 689.50 51 SURGERY SUPPLIES5159058 IMP MESH 136.75 51 SURGERY SUPPLIES5159850 IMP MESH 2196.00 51 SURGERY SUPPLIES5159777 IMP MESH 154.75 51 SURGERY SUPPLIES5156161 IMP MESH 1350.00 51 SURGERY SUPPLIES5159827 IMP MESH 2117.00 51 SURGERY SUPPLIES5159728 IMP MESH 2117.00 51 SURGERY SUPPLIES5159736 IMP MESH 1876.00 51 SURGERY SUPPLIES5156153 IMP MESH 3472.00 51 SURGERY SUPPLIES5159835 IMP MESH 1836.00 51 SURGERY SUPPLIES5159843 IMP MESH 2520.00 51 SURGERY SUPPLIES5159876 IMP MESH 3290.00 51 SURGERY SUPPLIES5159892 IMP MESH 5124.00 51 SURGERY SUPPLIES5159884 IMP MESH 4340.00 51 SURGERY SUPPLIES5159942 IMP MESH 3472.00 51 SURGERY SUPPLIES5114517 IMP MESH 1616.50 51 SURGERY SUPPLIES5154380 IMP MESH 591.10 51 SURGERY SUPPLIES5154398 IMP MESH 890.35 51 SURGERY SUPPLIES5157649 IMP MESH 1792.40 51 SURGERY SUPPLIES5159918 IMP MESH 1620.00 51 SURGERY SUPPLIES5159926 IMP MESH 1170.00 51 SURGERY SUPPLIES5157698 IMP MESH 3539.00 51 SURGERY SUPPLIES5159793 IMP MESH 486.00 51 SURGERY SUPPLIES5113576 IMP MESH 1166.20 51 SURGERY SUPPLIES5113410 IMP MESH 2676.35 51 SURGERY SUPPLIES5159785 IMP MESH 237.50 51 SURGERY SUPPLIES5155106 IMP MESH 542.10 51 SURGERY SUPPLIES5155114 IMP MESH 937.20 51 SURGERY SUPPLIES5159934 IMP MESH 3906.00 51 SURGERY SUPPLIES5157623 IMP MESH 1674.00 51 SURGERY SUPPLIES5113550 IMP MESH 601.75 51 SURGERY SUPPLIES5113584 IMP MESH 1839.25 51 SURGERY SUPPLIES5159868 IMP MESH 3240.00 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5113592 IMP MESH 3458.05 51 SURGERY SUPPLIES5159975 IMP MESH 1379.00 51 SURGERY SUPPLIES5157631 IMP MESH 1862.70 51 SURGERY SUPPLIES5159967 IMP MESH 5012.00 51 SURGERY SUPPLIES5159983 IMP MESH 2570.00 51 SURGERY SUPPLIES5159959 IMP MESH 4270.00 51 SURGERY SUPPLIES5159769 IMP MESH 518.50 51 SURGERY SUPPLIES5156146 IMP MESH 3434.00 51 SURGERY SUPPLIES5159900 IMP MESH 6412.00 51 SURGERY SUPPLIES5114533 IMP MESH 1511.25 51 SURGERY SUPPLIES5159751 IMP MESH 2768.00 51 SURGERY SUPPLIES5162631 IMP MESH 750.00 51 SURGERY SUPPLIES5114525 IMP MESH 1249.25 51 SURGERY SUPPLIES5162649 IMP MESH 2500.00 51 SURGERY SUPPLIES5114509 IMP MESH 4133.25 51 SURGERY SUPPLIES5114483 IMP MESH 7411.35 51 SURGERY SUPPLIES5159041 IMP MESH 325.05 51 SURGERY SUPPLIES5159033 IMP MESH 320.50 51 SURGERY SUPPLIES5159744 IMP MESH 3506.00 51 SURGERY SUPPLIES5159066 IMP MESH 187.25 51 SURGERY SUPPLIES5156674 MORCELLATOR 3102.35 51 SURGERY SUPPLIES5114384 DUAL CHAMB RR PACEMAKER 51 SURGERY SUPPLIES5162540 PT PROGR NEUROSTIM 3780.00 51 SURGERY SUPPLIES5162557 PT PROGR NEUROSTIM 4060.00 51 SURGERY SUPPLIES5162532 PT PROGR NEUROSTIM 3500.00 51 SURGERY SUPPLIES5162565 PT PROGR NEUROSTIM 6580.00 51 SURGERY SUPPLIES5162573 PT PROGR NEUROSTIM 6860.00 51 SURGERY SUPPLIES5162524 PT PROGR NEUROSTIM 3220.00 51 SURGERY SUPPLIES5162516 PT PROGR NEUROSTIM 2940.00 51 SURGERY SUPPLIES5159371 PT PROGR NEUROSTIM 51057.98 51 SURGERY SUPPLIES5162490 PT PROGR NEUROSTIM 3060.00 51 SURGERY SUPPLIES5162474 PT PROGR NEUROSTIM 2340.00 51 SURGERY SUPPLIES5162482 PT PROGR NEUROSTIM 2700.00 51 SURGERY SUPPLIES5162508 PT PROGR NEUROSTIM 3420.00 51 SURGERY SUPPLIES5157680 PT PROGR NEUROSTIM 6211.29 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5156005 IMP PORT INDWELLING 1596.45 51 SURGERY SUPPLIES5153689 IMP PORT INDWELLING 2135.35 51 SURGERY SUPPLIES5159660 PROBE CRYOABLATION 13262.48 51 SURGERY SUPPLIES5159678 PROBE CRYOABLATION 2809.13 51 SURGERY SUPPLIES5156328 PENILE PROST INFLAT 51 SURGERY SUPPLIES5156336 PENILE PROSTH NO INFLAT 51 SURGERY SUPPLIES5113428 REP DEV URINARY W/SLING 4543.95 51 SURGERY SUPPLIES5113162 STENT NON-COR TMP W/O DEL 2414.35 51 SURGERY SUPPLIES5114582 STENT NON-COR TMP W/O DEL 51 SURGERY SUPPLIES5114624 STENT NON-COR TMP W/O DEL 5200.40 51 SURGERY SUPPLIES5159629 IMP TISSUE MARKER 271.72 51 SURGERY SUPPLIES5110416 CELL SAVER SERVICE 3106.00 51 SURGERY SUPPLIES5157847 S PR IRRIGATION SYRINGE 6.40 51 SURGERY SUPPLIES5159132 S PR CATH IND FY 2WY LSCN 62.65 51 SURGERY SUPPLIES5158647 S PR CATH IND FOLEY 3 WAY 113.65 51 SURGERY SUPPLIES5110390 S PR CATH IND FOLEY 3 WAY 143.30 51 SURGERY SUPPLIES5124599 S PR SKIN BAR W/FLANGE 47.30 51 SURGERY SUPPLIES5124573 S PR OST PCH DRN W/O BAR 25.05 51 SURGERY SUPPLIES5124581 S PR OST PCH URN W/O BAR 25.55 51 SURGERY SUPPLIES5158480 CERVICAL FOAM COLLAR 58.65 51 SURGERY SUPPLIES5159686 IMP COLLAGEN URINARY TRCT 11954.96 51 SURGERY SUPPLIES5159710 SYNTHETIC IMP URINARY 1ML 1030.61 51 SURGERY SUPPLIES5159462 IMP,BONE CEMENT 1954.78 51 SURGERY SUPPLIES5159454 IMP,BONE CEMENT 735.05 51 SURGERY SUPPLIES5159504 IMP,BONE CEMENT 4239.23 51 SURGERY SUPPLIES5159389 IMP,BONE CEMENT 1092.44 51 SURGERY SUPPLIES5159488 IMP,BONE CEMENT 2434.58 51 SURGERY SUPPLIES5162250 GEN NRSTIM RECHG BAT SY 46200.00 51 SURGERY SUPPLIES5162276 GEN NRSTIM RECHG BAT SY 51800.00 51 SURGERY SUPPLIES5159553 GEN NRSTIM RECHG BAT SY 50325.90 51 SURGERY SUPPLIES5162268 GEN NRSTIM RECHG BAT SY 49000.00 51 SURGERY SUPPLIES5162243 GEN NRSTIM RECHG BAT SY 43400.00 51 SURGERY SUPPLIES5159587 IOL POSTERIOR CHAMBER 5618.25 51 SURGERY SUPPLIES5159702 IMP JNT ELBOW CONSTRUCT 51 SURGERY SUPPLIES5159694 IMP JNT ELBOW COMPONENT 51 SURGERY SUPPLIES

A1


document.xls

of 196


SEQ 999 AMOUNT

SEQ 200 AMOUNT

SEQ 100 AMOUNT

SEQ 300 AMOUNT

DEPARTMENT CODE

5162706 IMP JNT HIP CONSTRUCT 19600.00 51 SURGERY SUPPLIES5162698 IMP JNT HIP CONSTRUCT 16240.00 51 SURGERY SUPPLIES5162714 IMP JNT HIP CONSTRUCT 20580.00 51 SURGERY SUPPLIES5162748 IMP JNT HIP CONSTRUCT 12600.00 51 SURGERY SUPPLIES5162730 IMP JNT HIP CONSTRUCT 13160.00 51 SURGERY SUPPLIES5162722 IMP JNT HIP CONSTRUCT 15680.00 51 SURGERY SUPPLIES5162755 IMP JNT HIP HEMI 5040.00 51 SURGERY SUPPLIES5162789 IMP JNT HIP HEMI 1800.00 51 SURGERY SUPPLIES5162771 IMP JNT HIP HEMI 2800.00 51 SURGERY SUPPLIES5162763 IMP JNT HIP HEMI 8400.00 51 SURGERY SUPPLIES5162813 IMP JNT KNEE CONSTRUCT 11760.00 51 SURGERY SUPPLIES5162821 IMP JNT KNEE CONSTRUCT 10080.00 51 SURGERY SUPPLIES5162854 IMP JNT KNEE CONSTRUCT 11760.00 51 SURGERY SUPPLIES5162839 IMP JNT KNEE CONSTRUCT 7000.00 51 SURGERY SUPPLIES5162805 IMP JNT KNEE CONSTRUCT 9660.00 51 SURGERY SUPPLIES5162797 IMP JNT KNEE CONSTRUCT 8960.00 51 SURGERY SUPPLIES5162847 IMP JNT KNEE CONSTRUCT 8400.00 51 SURGERY SUPPLIES5162888 IMP JNT SHOULDER CONSTRCT 8400.00 51 SURGERY SUPPLIES5162870 IMP JNT SHOULDER CONSTRCT 11200.00 51 SURGERY SUPPLIES5162896 IMP JNT SHOULDER CONSTRCT 11200.00 51 SURGERY SUPPLIES5162862 IMP JNT SHOULDER CONSTRCT 21000.00 51 SURGERY SUPPLIES5111554 NA CL 3000CC 54.30 51 SURGERY SUPPLIES5111380 LACTATED RINGER IRRIG 64.95 51 SURGERY SUPPLIES0100040 BLOOD TRANSFUSN 2-4 HR 1780.00 01 TELEMETRY0100032 BLOOD TRANSFUSN 4-6 HR 2798.00 01 TELEMETRY0100024 BLOOD TRANSFUSN GT 6HR 3442.00 01 TELEMETRY0100057 BLOOD TRANSFUSN LT 2 HR 1018.00 01 TELEMETRY2139715 S STRL DELEE, MUCOUS TRAP 56.45 210341586 CA ANGIO IL W HC 105.00 03

A1


Sutter Davis Hospital Pharmacy Charge Master

of 196

DRUG NAME

9197385 ABACAVIR 300MG TABLET 38.849190562 ABATACEPT 250MG INJ 1,551.639189200 ABCIXIMAB 10MG/5ML VIAL 2,026.729107426 ACARBOSE 50MG TABLET 19.439107798 ACEBUTOLOL 200MG CAPSULE 19.569179698 ACETAMIN 100MG/ML DROP 15ML 0.009191420 ACETAMINOPHEN 1000 MG/100ML IJ 131.509128281 ACETAMINOPHEN 120MG SUPPOS. 0.009112871 ACETAMINOPHEN 160MG/5ML UDCUP 0.009128299 ACETAMINOPHEN 325MG SUPPOS. 0.009100124 ACETAMINOPHEN 325MG TABLET 0.009137001 ACETAMINOPHEN 325MG/10.15ML UD 0.009100025 ACETAMINOPHEN 500MG TABLET 0.009128307 ACETAMINOPHEN 650MG SUPPOS. 0.009158650 ACETAMINOPHEN 650MG/20.3ML UD 0.009100082 ACETAMINOPHEN 80MG CHEW TAB 0.009112871 ACETAMINOPHEN 80MG LIQ UD 0.009155011 ACETAMINOPHEN/COD #3 TABLET 35.749155029 ACETAMINOPHEN/COD #4 TABLET 36.379112871 ACETAMINOPHEN/COD LIQ 12.5ML 37.779159047 ACETAMINOPHEN/COD LIQ 5ML UD 37.379130105 ACETAMINOPHEN/COD#3 6PK 0.009112871 acetaZOLAMIDE 100MG/ML in D5W 229.429100132 acetaZOLAMIDE 125MG TABLET 18.669100140 acetaZOLAMIDE 250MG TABLET 19.099112871 acetaZOLAMIDE 25MG/ML ORAL LIQ 17.689310012 acetaZOLAMIDE 500MG INJ 159.249100157 acetaZOLAMIDE SR 500MG CAPSULE 30.739170101 ACETIC ACID 0.25% IRRIG 1000ML 61.719173923 ACETIC ACID 2% OTIC SOLN 15ML 115.099173865 ACETYLCHOLINE 1% OPHT SOL 2ML 106.599187543 ACETYLCYSTEINE 10% SOLN 4ML 28.159302019 ACETYLCYSTEINE 10% VIAL 30ML 31.759187568 ACETYLCYSTEINE 20% 30ML 47.179187550 ACETYLCYSTEINE 20% 4ML VIAL 30.659190224 ACETYLCYSTEINE IV 6GM/30ML INJ 555.769100033 ACYCLOVIR 200MG CAPSULE 20.619132275 ACYCLOVIR 400 MG TABLET 21.449179714 ACYCLOVIR 40MG/ML SUSP 120ML 104.999172081 ACYCLOVIR 5% OINT 30GM 1,058.479169012 ACYCLOVIR 5% OINTMENT 15GM 443.309306549 ACYCLOVIR 500MG/10ML VIAL 69.259306549 ACYCLOVIR 5MG/ML D5W PED SYRIN 35.439100165 ACYCLOVIR 800MG TABLET 24.659190497 ADALIMUMAB 40MG/0.8ML IJ 2,408.189187519 ADENOSINE 6MG/2ML INJ 92.389187519 ADENOSINE 90MG/30ML VIAL 867.089174269 ADVAIR 100-50 DISKUS #14 227.59

CHARGE CODE

CALCULATED PRICE


of 196

DRUG NAMECHARGE CODE

CALCULATED PRICE

9174277 ADVAIR 250/50 DISKUS #14 227.599174285 ADVAIR 500/50 DISKUS #14 348.879130089 AEROCHAMBER 143.729190588 AGALSIDASE BETA 5 MG INJ 1,767.039107855 ALBENDAZOLE 200MG TABLET 23.489195017 ALBUMIN 25% 100ML INJ 725.919195017 ALBUMIN 25% INJ 50ML 466.919195009 ALBUMIN 5% 500ML 655.919191073 ALBUMIN 5% 50ML 430.919132002 ALBUTEROL 0.083% 2.5MG/ML 3ML 19.159179417 ALBUTEROL 0.4MG/ML LIQ 120ML 50.719132234 ALBUTEROL 1.25 MG/3 ML INH 20.879132184 ALBUTEROL 2.5MG/0.5ML INHAL 18.459100199 ALBUTEROL 2MG TAB 18.199100199 ALBUTEROL 2MG/5ML UDCUP 18.209100207 ALBUTEROL 4MG TABLET 18.499173055 ALBUTEROL 5 MG/ML SOLN 20ML 69.099175431 ALBUTEROL HFA 90MCG INH 8.5GM 132.699112871 ALBUTEROL HFA INHLER (TAKEHOME 0.009310533 ALCOHOL (ETHYL) DEHYD.98% 1ML 165.369151093 ALCOHOL 10%/DEXTROSE 5% 152.799316266 ALDESLEUKIN 22MILLION UNIT INJ 2,492.289316753 ALEMTUZUMAB 30MG/ML 1ML INJ 4,920.689107319 ALENDRONATE 10MG TABLET 24.349100710 ALENDRONATE 35MG TABLET 65.059108754 ALENDRONATE 5MG TABLET 24.349108762 ALENDRONATE 70MG TABLET 73.029163486 ALFENTANIL 1000MCG/2ML AMP 113.919163577 ALFENTANIL 2500MCG/5ML AMP 121.799128497 ALISKIREN 150 MG TABLET 24.229103268 ALKA-SELTZER GOLD EFF TAB 0.009112871 ALLANDERM-T OINTMENT 30GM 146.299100231 ALLOPURINOL 100MG TABLET 18.009100249 ALLOPURINOL 300MG TABLET 18.779311135 ALLOPURINOL NA 500 MG VIAL 1,326.089137282 AL-MAG HYDROX-SIMETH 30ML 0.009170200 ALOE VESTA/MICONAZOL OINT 56GM 41.219190547 ALPHA-1 PROTEINASE INHIBITOR 351.969190547 ALPHA-1-PROTEINASE INHIBITOR 351.779155052 ALPRAZolam 0.25MG TABLET 36.369155045 ALPRAZolam 0.5MG TABLET 36.619155037 ALPRAZolam 1MG TABLET 37.129311184 ALPROSTADIL 500MCG/ML AMPUL 320.189193012 ALTEPLAS (TPA)100MG VIAL 12,062.799193012 ALTEPLASE (TPA) 1MG/ML INJ 258.709193012 ALTEPLASE (TPA) 50MG VIAL 6,101.579193012 ALTEPLASE 2 MG INJ 322.509178245 ALUMINUM HYDROX SUSP 355ML 0.00


of 196


CALCULATED PRICE

9100264 AMANTADINE 100MG CAPSULE 19.049137399 AMANTADINE 100MG/10ML UD CUP 21.459168964 AMERICAINE OINTMENT 30GM 0.009189218 AMIFOSTINE 500MG INJ 1,372.319306879 AMIKACIN 500MG/2ML INJ 44.129306879 AMIKACIN 5MG/ML D5W SYRG 35.799300898 aMILoride 1MG/ML LIQ PEDIPOD 17.759100272 aMILoride 5MG TABLET 20.139178013 AMINOCAPROIC 25% SYRUP 120ML 445.029112871 AMINOCAPROIC ACID 20MG/ML SYR 140.509100280 AMINOCAPROIC ACID 500MG TAB 23.349310020 AMINOCAPROIC ACID 5GM/20ML INJ 145.749112871 AMINOGLYCOSIDE PER PHARMACY 0.009310038 AMINOPHYLLINE 250MG/10ML VL 142.099310038 AMINOPHYLLINE 500MG/20ML VL 142.149112871 AMINOPHYLLINE 5MG/ML D5W SYRG 140.529192048 AMINOSYN M 3.5% IV SOLN 1L 128.779311143 AMIODARONE 150 MG/3 ML SYRINGE 92.149311143 AMIODARONE 150MG/3ML INJ 142.789100215 AMIODARONE 200MG TABLET 24.139112871 AMIODARONE 5MG/ML ORAL LIQ 17.719311143 AMIODARONE 900 MG/18 ML VIAL 140.369311143 AMIODARONE-D5W 150 MG/100 ML 169.329311143 AMIODARONE-D5W 450 MG/250 ML 199.829311143 AMIODARONE-D5W 900 MG/500 ML 248.699118399 AMITRIPTYLINE 100 MG TAB 19.779100298 AMITRIPTYLINE 10MG TAB 17.919100306 AMITRIPTYLINE 25MG TABLET 18.289100314 AMITRIPTYLINE 50MG TABLET 18.859105040 amLODipine 5MG TABLET 23.439174095 AMMONIA AROMATIC AMPUL 17.759170846 AMMONIUM LAC 12% CRM 140GM 73.399168246 AMMONIUM LACTATE 12% LOT 400GM 183.099180795 AMOX/CLAUV 40MG/ML LIQ 100ML 107.439112871 AMOXICILLIN 125MG/5ML 80ML TKH 0.009181108 AMOXICILLIN 25 MG/ML 80ml 41.299100330 AMOXICILLIN 250MG CAPSULE 18.089112871 AMOXICILLIN 500MG #2 (TKHM) 0.009100348 AMOXICILLIN 500MG CAPSULE 18.539181116 AMOXICILLIN 50MG/ML LIQ 80ML 45.719300310 AMOXICILLIN 50MG/ML ORAL LIQ 17.759180787 AMOXICILLIN 50MG/ML SUSP 100ML 47.359182205 AMOXICILLIN 50MG/ML SUSP 150ML 49.259112871 AMPHO B 0.1MG/ML D5W SYRINGE 140.439306887 AMPHO B LIPOS (AMBISOME) 50MG 517.169306887 AMPHO B LIPOSOME 1MG/ML SYRG 147.889305939 AMPHOTERICIN (FUNGIZONE) 50MG 75.999306317 AMPHPO B LIPID (ABELCET) 10MG 83.09


of 196


CALCULATED PRICE

9305368 AMPICILLIN 1 GM ADD-VAN VIAL 125.999305368 AMPICILLIN 125MG VIAL 115.719305368 AMPICILLIN 1GM VIAL 122.559305368 AMPICILLIN 1GM/100ML NS MB+ 122.559305368 AMPICILLIN 2 GM ADD-VAN VIAL 145.499100363 AMPICILLIN 250MG CAPSULE 18.029305046 AMPICILLIN 250MG VIAL 110.769305368 AMPICILLIN 25mg/ml NS syringe 59.899305368 AMPICILLIN 2GM VIAL 138.779305368 AMPICILLIN 2GM/100ML NS MB+ 138.779100371 AMPICILLIN 500 MG CAPSULE 18.369305368 AMPICILLIN 500MG VIAL 111.279179656 AMPICILLIN 50MG/ML SUSP 100ML 63.259305947 AMPICILLIN/SULB 1.5g/100mL Mb+ 113.819305947 AMPICILLIN/SULB 3GM/100ML NSmb 120.769305947 AMPICILLIN/SULBACTAM 3 GM INJ 120.769305947 AMPICILLIN-SULBACTAM 1.5 GM VL 118.429174087 AMYL NITRITE AMPUL 17.939108598 ANAGRELIDE 0.5MG CAPSULE 34.539168055 ANALGESIC BALM OINT 30GM 0.009107285 ANASTROZOLE 1MG TABLET 51.179310780 ANTITHROMBIN III INJ 355.219186107 ANTIVENIN(LATRODECTUS) VIAL 137.799186123 ANTIVENIN,CROTALIDAE (SNAKE) 3,937.189128018 ANUSOL HC 25MG SUPPOS 19.439128315 ANUSOL SUPPOSITORY 0.009174301 APRACLONIDINE 0.5% OP SOL 5ML 279.099173030 APRACLONIDINE 1% OP SOL 0.1ML 75.669117219 APREPITANT 125MG CAPSULE 345.609117219 APREPITANT 40 MG CAPSULE 147.639117219 APREPITANT 80MG CAPSULE 230.389170176 AQUAPHOR OINTMENT 50GM 50.099132317 ARFORMOTEROL 15MCG/2ML SOLN 34.199190067 ARGATROBAN 250MG/2.5ML IJ 3,345.309148016 ARGININE 10% INJ 300ML 161.109116336 ARIPIPAZOLE 5MG TABLET 62.059316829 ARSENIC TRIOXIDE 10MG/10ML AMP 719.379173048 ARTIFICIAL TEARS OPHT SOL 15ML 52.579178047 ASCORBIC AC 90MG/ML SOLN 50ML 82.339100389 ASCORBIC ACID 500MG TABLET 0.009310053 ASCORBIC ACID 500MG/ML VIAL 141.369316118 ASPARAGINASE 10,000 UNIT INJ 745.909128265 ASPIRIN 300MG SUPPOSITORY 0.009109414 ASPIRIN 325MG TABLET 0.009128273 ASPIRIN 600MG SUPPOSITORY 0.009100058 ASPIRIN 81MG CHEW TABLET 0.009100652 ASPIRIN BUFFERED 325MG TAB 0.009102468 ASPIRIN EC 325MG TABLET 0.00


of 196


CALCULATED PRICE

9113291 ASPIRIN EC 81MG TABLET 0.009120056 ATAZANAVIR 100 MG CAP 57.419118191 ATAZANAVIR 150MG CAPSULE 57.419120064 ATAZANAVIR 200 MG CAP 57.419100413 ATENOLOL 100 MG TABLET 19.939100405 ATENOLOL 25MG TABLET 19.499100397 ATENOLOL 50MG TABLET 19.339106071 ATORVASTATIN 10MG TABLET 26.699108580 ATORVASTATIN 20MG TABLET 31.259118092 ATORVASTATIN 40MG TABLET 31.259179813 ATOVAQUONE 750MG/5ML LIQ 120ML 1,507.199183591 ATRACURIUM 100MG/10ML VIAL 101.909191099 ATRACURIUM 50MG/5ML VIAL 90.319190844 ATROPINE 0.4MG/1ML VIAL 74.569190844 ATROPINE 0.5MG/5ML SYRINGE 86.949173071 ATROPINE 1% EYE OINT 3.5GM 40.219173063 ATROPINE 1% OPHTH SOL 15ML 110.799190844 ATROPINE 1MG/10ML SYRINGE 75.449190844 ATROPINE 1MG/1ML VIAL 75.189107715 AUGMENTIN 875MG TAB 34.119100462 AUGMENTIN 250MG TABLET 25.989137449 AUGMENTIN 25MG/ML ORAL LIQ 1ML 18.639178716 AUGMENTIN 400MG/5ML SUSP 100ML 175.599100447 AUGMENTIN 500MG TAB 29.969178062 AUGMENTIN 50MG/ML SUSP 150ML 336.389180753 AUGMENTIN 50MG/ML SUSP 75MGL 188.669118381 AUGMENTIN XR 1,000-62.5 TAB 25.969173709 AURALGAN OTIC SOLN 15ML 41.259100421 AURANOFIN 3MG CAPSULE 46.719118290 AVANDAMET 4 MG/500 MG TABLET 27.049170077 AVITENE 1GM POWDER 383.609170903 AVITENE SHEET 70MMX35MM 387.679316639 azaCITIDine 1MG INJ 625.549100470 azaTHIOprine 50MG TABLET 20.439175586 AZELASTINE 0.05% OPSOL 6ML 351.799174608 AZELASTINE 137MCG NASAL 30ML 328.179176041 AZITHROMYCIN 1% EYE DROP 2.5ML 242.129182197 AZITHROMYCIN 20MG/ML SUSP 15ML 100.959113820 AZITHROMYCIN 250MG TABLET 45.509112871 AZITHROMYCIN 250MG#6 ZPK 0.009112871 AZITHROMYCIN 2MG/ML D5W SYR 140.579180332 AZITHROMYCIN 40MG/ML SUSP 15ML 100.959178732 AZITHROMYCIN 40MG/ML SUSP 30ML 153.439305913 AZITHROMYCIN 500MG (ADV)/250ML 5,650.279305913 AZITHROMYCIN 500MG VIAL 94.999305913 AZITHROMYCIN 500MG VIAL MATE 165.179138108 AZITHROMYICN 900MG/22.5ML UDCU 83.419112871 AZTREONAM 10MG/ML D5W SYR 140.80


of 196


CALCULATED PRICE

9306895 AZTREONAM 1G/50ML ISO DEX 186.459306895 AZTREONAM 1GM INJ 223.279306895 AZTREONAM 2GM INJ 200.609306895 AZTREONAM 2GM/50ML D5W PMX 267.859107111 B COMPLEX TABLET 17.639113325 B COMPLEX W/VITAMIN C TABLET 17.689173584 BACIT/POLYMYX B OP OINT 3.5GM 97.619305053 BACITRACIN 50,000 UNITS INJ 62.159173097 BACITRACIN 500U/GM OPHT 3.5GM 151.929169855 BACITRACIN 500UN/GM OINT 30GM 46.349172032 BACITRACIN OINT PKT 17.829112871 BACITRACIN/POLYMYXIN B POWDER 57.499169947 BACITRACIN/POLYMYXIN OINT 30GM 58.339100512 BACLOFEN 10MG TABLET 19.009112871 BACTRIM 20ML UDCUP#2 (TAKEHOME 0.009168980 BAG BALM OINTMENT 300GM 44.799117110 BALSALAZIDE 750MG CAP 20.749190232 BBATROPINE 0.4MG/ML 20ML VIAL 141.559112871 BBBIVALIRUDIN 250MG/50ML 0.009183815 BBGLYCOPYRROLATE 0.2MG/ML 20ML 82.669183088 BBINSULIN HumaLOG 100UN/ML 0.009183732 BBINSULIN NPH HUMAN 100UN/ML 0.009183948 BBINSULIN REG HUMAN 100UN/ML 0.009112871 BBNACL 0.9% 10ML VIAL #25 0.009112871 BCG VACCINE (TICE STRAIN) VIAL 414.029170713 BECAPLERMIN 0.01% GEL 15GM 1,109.939173113 BECLOMETH AQ 0.042% NASAL 25GM 364.769175050 BECLOMETHASONE 40MCG INH 7.3GM 211.979176116 BECLOMETHASONE 40MCG INH 8.7GM 297.859175068 BECLOMETHASONE 80MCG INH 7.3GM 271.949191289 BELIMUMAB 120 MG VIAL 1,221.729160003 BELLADONNA & OPIUM 60MG SUPP 81.429100538 BENAZEPRIL 10MG TABLET 19.459100546 BENAZEPRIL 20MG TABLET 19.459118068 BENAZEPRIL 40 MG TABLET 19.899100520 BENAZEPRIL 5MG TABLET 19.579316795 BENDAMUSTINE 100 MG IJ 5,445.289316795 BENDAMUSTINE 1MG (100MG VIAL) 658.049170440 BENGAY OINTMENT 57GM 42.179168956 BENZALKON CHL 1:750 SOL 236ML 83.529182114 BENZOCAIN 10% DENTAL GEL 5.3GM 40.489170010 BENZOCAINE 20% GEL 5.25GM 48.339170697 BENZOCAINE 20% LIQ 30ML 54.019170002 BENZOCAINE 20% METER SPRAY 2OZ 105.099112871 BENZOCAINE 20% ORAL LIQ 13.3ML 37.459175076 BENZOCAINE 20% OTIC DROPS 15ML 59.879100587 BENZONATATE 100MG CAPSULE 19.019100579 BENZTROPINE 2 MG TABLET 18.15


of 196


CALCULATED PRICE

9100561 BENZTROPINE 1MG TABLET 18.319190240 BENZTROPINE 2MG/2ML INJ 220.189132127 BERACTANT 25MG/ML VIAL 8ML 1,671.589132135 BERACTANT 25MG/ML VL 4ML 952.079168543 BETAMETHA DP 0.05% OINT 15GM 135.999169053 BETAMETHAS VA 0.1% OINT 15GM 69.889169079 BETAMETHASONE 0.05% CRM 15GM 118.299183955 BETAMETHASONE SOLU 30MG/5ML IJ 156.319168972 BETAMETHASONE VA 0.1% CRM 15GM 68.379169061 BETAMETHASONE VA 0.1% LOT 60ML 181.499174327 BETAXOLOL 0.5% EYE DROP 5ML 167.639176082 BETAXOLOL-S 0.25% OPSOL 10ML 393.049100603 BETHANECHOL 10MG TABLET 20.549100611 BETHANECHOL 25MG TABLET 21.129100595 BETHANECHOL 5MG TABLET 18.989316654 BEVACIZUMAB 400MG/16ML 6,438.659169244 BIAFINE TOPICAL EMULSION 45GM 129.309197104 BICALUTAMIDE 50MG TABLET 75.349112871 BICILLIN C-R 1.2MILLUN/2ML SYR 170.079112871 BICILLIN CR 600,000UNIT/ML INJ 104.969137019 BICITRA 30ML UD CUP 18.859175357 BIMATOPROST 0.03% OP SOL 2.5ML 254.209113457 BIRTH CONTROL PILL 20.699112871 BIRTH CONTROL PILLS (PT OWN) 0.009128323 BISACODYL 10MG SUPPOS. 0.009100637 BISACODYL EC 5MG TABLET 0.009178534 BISMUTH SUBSALICY SUSP 240ML 0.009100629 BISMUTH SUBSALICYLATE CHEW TAB 0.009109612 BISOPROLOL 5MG TAB 19.999103623 BISOPROLOL/HCTZ 10/6.25 TAB 19.839113341 BISOPROLOL/HCTZ 2.5/6.25 TAB 19.839108440 BISOPROLOL/HCTZ 5/625MG TAB 19.839190117 BIVALIRUDIN 250MG INJ 1,609.169316027 BLEOMYCIN 15 UNITS INJ 780.009173139 BLEPHAMIDE 0.2% OPH 5ML 186.619112871 BLOOD GLUCOSE CHECK 0.009112871 BMX MOUTHWASH 100ML 47.779316647 BORTEZOMIB 0.1MG INJ 703.789189507 BOTULINUM TOXIN 100 UNITS INJ 1,351.189170879 BOUDREAUXS BUTT PASTE 48.029120643 BRILINTA 90 MG TABLET 26.929175498 BRIMONIDINE 0.1% EYE DROPS 5ML 206.139174616 BRIMONIDINE 0.15% OP SOLN 5ML 221.169138009 BRINZOLAMIDE 1% OP SOL 10ML 298.129112871 BROMFENAC 0.09% EYE DROP 2.5ML 345.099100645 BROMOCRIPTINE 2.5MG TABLET 31.149175233 BSS EYE SOLN 15ML 50.099173196 BSS EYE SOLUTION 500ML 92.11


of 196


CALCULATED PRICE

9174947 BSS OPHTH SOLN 30ML 59.229132077 BUDESONIDE 0.25MG/2ML RESPULE 36.149132085 BUDESONIDE 0.5MG/2ML RESP 39.419174723 BUDESONIDE 180MCG/PUFF INHALER 393.879175464 BUDESONIDE 90MCG FLEXHALER 303.039175225 BUDESONIDE AQUA NAS SPRY 299.299112871 BUMETANIDE 0.125MG/ML SYR 140.789187089 BUMETANIDE 0.5MG/2ML INJ 73.479107020 BUMETANIDE 1MG TABLET 18.379187089 BUMETANIDE 1MG/4ML VIAL 73.689187089 BUMETANIDE 2.5MG/10ML INJ 82.689187659 BUPIVA/DEXTROSE 0.75% PF 2ML 73.969189663 BUPIVACAINE (PRESERVATIVE FREE 42.499183807 BUPIVACAINE 0.25% INJ 10ML 75.609183054 BUPIVACAINE 0.25%/EPI INJ 30ML 76.049191313 BUPIVACAINE 0.25%/EPI PF 10ML 74.029183559 BUPIVACAINE 0.5% 10ML INJ 74.259183476 BUPIVACAINE 0.5%w/EPI INJ 30ML 82.849189408 BUPIVACAINE 0.75% w/EPI 30ML 89.119183567 BUPIVACAINE MPF 0.5% 30ML 88.299183526 BUPIVACAINE PF 0.25% 30ML INJ 73.459183567 BUPIVACAINE PF 0.5% VIAL 30ML 73.799183047 BUPIVACAINE PF 0.75% VIAL 30ML 77.069112871 BUPIVACAINE-EPI 0.25% PF 10ML 74.089190257 BUPRENORPHINE 0.3MG/ML INJ 90.689113853 buPROPion 100MG TABLET 19.499101916 buPROPion 75MG TABLET 19.019107681 buPROPion SR 100MG TABLET 25.909107699 buPROPion SR 150MG TABLET 26.509117078 buPROPion XL 150 MG TABLET 30.929100678 busPIRone 10 MG TABLET 20.289100660 busPIRone 5MG TABLET 19.099310558 BUTORPHANOL 1MG/1ML INJ 121.499310558 BUTORPHANOL 2MG/1ML INJ 115.559182189 BUTORPHANOL NS 10MG/ML 2.5ML 230.619170648 BUTT PASTE(ZINC)16% OINT 30GM 39.909316837 CABAZITAXEL 60 MG/1.5 ML KT 20,725.569108606 CABERGOLINE 0.5MG TABLET 90.879168527 CADEXOMER GEL 40GM 307.059187576 CAFF/SOD BENZOATE 500MG INJ 95.189302118 CAFFEINE CIT 20MG/ML PEDIPOD 50.909112871 CAFFEINE CIT 20MG/ML SYRINGE 157.459190919 CAL DISOD VERSENAT 1GM INJ 258.969169863 CALADRYL LOTION 44.619169871 CALAMINE LOTION 120ML 0.009182106 CALC CARB 500MG CHEW TAB#12 0.009175340 CALCITONIN 200UN/NASAL 3.7ML 240.879189853 CALCITONIN 400 UNITS/2ML INJ 221.12


of 196


CALCULATED PRICE

9101973 CALCITRIOL 0.25MCG CAPSULE 19.979101973 CALCITRIOL 0.5MCG CAPSULE 21.429190448 CALCITRIOL 1MCG/ML AMPUL 100.079103771 CALCIUM ACETATE 667MG TABLET 17.849112871 CALCIUM CARB 1250 MG/5ML 120ML 41.039182106 CALCIUM CARB 500MG CHEW TABLET 0.009106626 CALCIUM CARB/VIT D 250/125 TAB 17.679101924 CALCIUM CARBONATE 500MG TAB 0.009113630 CALCIUM CARBONATE 600MG TABLET 17.679104514 CALCIUM CARBONATE 650MG TAB 17.589187766 CALCIUM CHLOR 10% SYRINGE 10ML 89.319112871 CALCIUM CHLOR 25MG/ML in D5W 60.099310079 CALCIUM CHLORIDE 10% VIAL 10ML 75.189118084 CALCIUM CIT/VIT D3 CAPLET 17.879300054 CALCIUM GLUB 360MG/ML LIQ 17.639310087 CALCIUM GLUC 1000MG/10ML INJ 36.879112871 CALCIUM GLUC 100MG/ML ORAL LIQ 17.739112871 CALCIUM GLUC 50MG/ML in D5W 43.999310087 CALCIUM GLUCONATE 4.65MEQ/10ML 36.879113861 CALCIUM LACTATE 10GR TABLET 17.619116351 CALCIUM/MAG 426/246MG TABLET 17.669112871 CALCIUM/PHOS ORAL COMBO 30ML 32.759113689 CALCIUM/VIT D 500MG/200IU TAB 17.669168550 CALMOSEPTINE OINTMENT 113GM 45.099109273 CANDESARTAN 16MG TABLET 23.769187980 CANDIN SKIN TEST 93.189116286 CANESARTAN 8MG TAB 23.769197542 CAPECITABINE 150 MG TABLET 54.969100835 CAPECITABINE 500MG TABLET 56.629312034 CAPREOMYCIN 1GM VIAL 192.289168170 CAPSAICIN 0.025% CREAM 60GM 68.099112871 CAPTOPRIL 1MG/ML ORAL LIQ 17.619113895 CAPTOPRIL 25MG TABLET 19.989113903 CAPTOPRIL 50 MG TABLET 20.159113218 CAPTOPRIL/HCTZ 25/15 TABLET 19.109190992 CARBACHOL 0.01% IO SOL 1.5ML 104.979173758 CARBACHOL 1.5% DROPS 15ML 163.809173766 CARBACHOL 3% OPHTH SOLN 15ML 182.349178476 carBAMazepin 20MG/ML LIQ 120ML 74.979102021 carBAMazepine 100MG CHEW TAB 18.159113929 carBAMazepine 200MG TABLET 18.469138140 carBAMazepine 200MG/10ML UDCUP 24.099107863 carBAMazepine XR 100MG TAB 18.909107871 carBAMazepine XR 200MG TAB 20.259105859 CARBIDOPA/LEVO 10/100 TAB 18.999106790 CARBIDOPA/LEVO 25/100 TAB 20.219105867 CARBIDOPA/LEVO 25/250 TABLET 19.709108549 CARBIDOPA/LEVO CR 25/100 TAB 19.41


of 196


CALCULATED PRICE

9106808 CARBIDOPA/LEVO CR 50/200 TAB 20.699316183 CARBOplatin 50MG INJ 955.409310095 CARBOPROST 250MCG/ML INJ 352.689174954 CARBOXYMETHYLCELL 1% OPHTH 3ML 37.329105891 CARISOPRODOL 350MG TABLET 18.759170507 CARMEX LIP OINT 7.5GM 37.479316019 CARMUSTINE 100MG INJ 1,042.609317017 CARMUSTINE/POLIFEPROS WAFER #8 46,877.319317017 CARMUSTINE/POLIFEPROS WAFER #8 47,140.489174350 CARTEOLOL 1% OP SOL 5ML 74.379100041 CARVEDILOL 12.5MG TABLET 23.249109422 CARVEDILOL 25 MG TABLET 21.829107491 CARVEDILOL 3.125MG TABLET 23.249109430 CARVEDILOL 6.25MG TABLET 23.249118225 CARVEDILOL CR 40MG CAP 28.239305822 CASPOFUNGIN 0.5MG/ML in NS SYR 8,380.489305822 CASPOFUNGIN 5MG INC (50MG) 224.469179466 CASTOR OIL 120ML 53.399180191 CASTOR OIL 60ML 37.579102039 CEFACLOR 250MG CAPSULE 21.539178054 CEFACLOR 50MG/ML SUSP 75ML 93.159116377 CEFADROXIL 500MG CAPSULE 28.519305475 ceFAZolin 1 GM ADD-VAN VIAL 110.619305475 ceFAZolin 1GM VIAL 118.199305475 ceFAZolin 1GM/100ML NS MB+ 118.199305475 ceFAZolin 1GM/10ML SW SYRINGE 118.199307125 ceFAZolin 1GM/50ML D5W PB 119.279305475 ceFAZolin 2GM/100 ML NS 161.279305475 ceFAZolin 500MG INJ 111.599112871 ceFAZolin 50MG/ML IN D5W 35.359180852 CEFDINIR 125 MG/5 ML SUSP 196.659120486 CEFDINIR 300 MG CAPSULE 27.789306903 CEFEPIME 1 GM/50ML D-ISO PMX 170.089306903 CEFEPIME 1G/100ML NS MB+ 145.939306903 CEFEPIME 1GM VIAL 149.399306903 CEFEPIME 2 GM /100ML D-ISO PMX 209.179306903 CEFEPIME 2GM INJ 192.799306903 CEFEPIME 2GM/100MLNS MB+ 185.999112871 CEFEPIME 50MG/ML IN D5W 37.359113945 CEFIXIME 400MG TAB 56.619305525 CEFOTAXIME 1G/50ML D5W PMX 130.799305525 CEFOTAXIME 1GM INJ 108.569305525 CEFOTAXIME 1GM/100ML NS mb+ 108.569305525 CEFOTAXIME 2GM INJ 114.0593006630 CEFOTAXIME 2GM/100ML NS mb+ 114.059305525 CEFOTAXIME 2GM/50ML D5W PMX 148.139305525 CEFOTAXIME 500MG INJ 119.429112871 CEFOTAXIME 50MG/ML in D5W 36.54


of 196


CALCULATED PRICE

9306655 CEFOXITIN 1GM /100ML NS MB+ 127.739305517 CEFOXITIN 1GM VIAL 127.779306655 CEFOXITIN 1GM/50ML D5W 129.879305517 CEFOXITIN 2GM VIAL 150.279306655 CEFOXITIN 2GM/100ML NS MB+ 150.279306630 CEFOXITIN 2GM/50ML D5W 127.779112871 CEFOXITIN 50MG/ML SYRG 106.409178781 CEFPROZIL 50MG/ML SUSP 100ML 180.819112871 CEFTAROLINE 600 MG INJ 141.139306440 CEFTAZIDIME 1GM INJ 126.199305525 CEFTAZIDIME 1GM/100ML mb+ 126.199306440 CEFTAZIDIME 1GM/50ML D-IS PMX 139.139306440 CEFTAZIDIME 2GM INJ 127.189306440 CEFTAZIDIME 2MG/50ML D-ISO PMX 167.579306440 CEFTAZIDIME 500MG INJ 119.509112871 CEFTAZIDIME 50MG/ML in D5W 38.599306929 CEFTIZOXIME 1000MG INJ 58.819305442 cefTRIAXone 1 GM /50ml DEX ISO 210.199305442 cefTRIAXone 1GM INJ 121.279305442 cefTRIAXone 1GM/100ML NS MB+ 120.639305442 cefTRIAXone 2 GM/50ML D5W 288.989305442 cefTRIAXone 250MG INJ 134.939305442 cefTRIAXone 2GM INJ 288.099305442 cefTRIAXone 2GM/100ML NS MB+ 288.099112871 cefTRIAXone 40MG/ML in D5W 40.369305442 cefTRIAXone 500MG INJ 159.039305343 CEFUROXIME 1.5GM INJ 124.799305343 CEFUROXIME 1.5GM/100ML NS MB+ 124.799305343 CEFUROXIME 1.5GM/50ML D5W PMX 1,855.279102088 CEFUROXIME 250MG TABLET 26.359179474 CEFUROXIME 25MG/ML SUSP 100ML 116.679113960 CEFUROXIME 500MG TABLET 32.719180803 CEFUROXIME 50MG/ML LIQ 50ML 171.249305343 CEFUROXIME 750MG INJ 143.709305343 CEFUROXIME 750MG/100ML MB+ 118.07

CEFUROXIME 75MG/ML SWFI 48.289108622 CELECOXIB 100MG CAP 24.089113978 CELECOXIB 200MG CAPSULE 28.259113374 CENTRUM SILVER TABLET 0.009113382 CENTRUM TABLET 0.009109448 CEPACOL LOZ#1 0.009182072 CEPACOL THROAT LOZ #18 0.009102062 CEPHALEXIN 250MG CAPSULE 20.959112871 CEPHALEXIN 250MG/5ML 200ML TKH 0.009102070 CEPHALEXIN 500MG CAPSULE 24.529112871 CEPHALEXIN 500MG#2 TAKHM 0.009112871 CEPHALEXIN 50MG/ML ORAL SYR 17.939179482 CEPHALEXIN 50MG/ML SUSP 100ML 72.89


of 196


CALCULATED PRICE

9180761 CEPHALEXIN 50MG/ML SUSP 200ML 98.099169095 CETACAINE SPRAY 56ML 193.099170747 CETAPHIL MOIST LOTION 480ML 55.899107897 CETIRIZINE 10MG TABLET 22.549316670 CETUXIMAB 100MG/50ML INJ 1,820.689178559 CHARCOAL w/SORB 50GM LIQ 240ML 82.399178559 CHARCOAL-AQUA 50GM LIQ 240ML 82.399112871 CHERRY SYRUP 0.009159070 CHLORAL HYDRATE 500MG/5ML CUP 37.099197047 CHLORAMBUCIL 2MG TABLET 46.419305087 CHLORAMPHEN NA SUCC 1GM VL 213.419112871 CHLORAMPHENICOL 50MG/ML SYR 140.989112871 CHLORASEPTIC SORE THROAT SPRAY 38.879168824 CHLORASEPTIC SPRAY 180ML 0.009155102 chlordiazePOXIDE 10MG CAP 35.819155110 chlordiazePOXIDE 25MG CAP 35.869155094 chlordiazePOXIDE 5MG CAPSULE 35.729137498 CHLORHEXIDINE 0.12% LIQ 15ML 18.309178112 CHLORHEXIDINE 0.12% LIQ 473ML 55.899190778 CHLOROPROCAINE 3% INJ 30ML 90.909183450 CHLOROPROCAINE MPF 3% 20ML INJ 124.799190760 CHLOROPROCAINE PF 2% 20 ML 102.519102120 CHLOROQUINE 250MG TABLET 22.539113317 CHLOROQUINE 500MG TABLET 28.159102146 CHLOROTHIAZIDE 250MG TABLET 17.859112871 CHLOROTHIAZIDE 25MG/ML SYR 141.469310756 CHLOROTHIAZIDE 500MG INJ 1,126.759300302 CHLOROTHIAZIDE 50MG/ML LIQ 17.669102161 CHLORPHENIRAMINE 4MG TABLET 0.009183443 CHLORPROCAINE 1% INJ 30ML 114.209102203 chlorproMAZINE 10MG TABLET 19.699102179 chlorproMAZINE 25MG TABLET 20.479189499 chlorproMAZINE 25MG/1ML INJ 109.229102195 chlorproMAZINE 50MG TABLET 21.699189499 chlorproMAZINE 50MG/2ML INJ 114.819102229 chlorproPAMIDE 250MG TABLET 19.879102237 CHLORTHALIDONE 25MG TABLET 18.549113408 CHOLECALCIFEROL (D3) 400IU TAB 17.659109455 CHOLESTYRAMINE LIGHT PACKET 24.259105685 CHOLESTYRAMINE PACKET 22.299106360 CHOLINE/MAG SALIC 500MG TABLET 18.479106378 CHOLINE/MAG SALIC 750MG TAB 19.019168584 CICLOPIROX 0.77% CREAM 15GM 79.319312018 CIDOFOVIR 75MG/ML 5ML INJ 1,916.369109752 CILOSTAZOL 100MG TABLET 21.909118464 CILOSTAZOL 50 MG TABLET 21.209310715 CIMETIDINE 300MG/2ML INJ 147.129100009 CIMETIDINE 400MG TABLET 20.64


of 196


CALCULATED PRICE

9112871 CIMETIDINE 6MG/ML in NS SYRG 140.509191388 CIMZIA 200 MG/ML SYRINGE KIT#2 4,873.179112954 CINACALCET 30 MG TABLET 51.499112871 CIPRO 2MG/ML SYRINGE 105.589306937 CIPRO 400MG/40ML INJ 162.899175472 CIPRODEX OTIC SUSP 7.5ML 361.209174590 CIPROFLOX 0.3% OPHT OINT 3.5GM 277.879179722 CIPROFLOX 100MG/ML SUSP 100ML 253.859176025 CIPROFLOXACIN 0.3% OP SOL 2.5M 85.159173733 CIPROFLOXACIN 0.3% OP SOL 5ML 212.609306325 CIPROFLOXACIN 200MG/100ML D5W 136.499102245 CIPROFLOXACIN 250MG TABLET 27.239306325 CIPROFLOXACIN 400MG/200ML D5W 165.299102252 CIPROFLOXACIN 500MG TABLET 28.179102260 CIPROFLOXACIN 750MG TABLET 29.069175126 CIPROFLOXACIN HC OTIC 10ML 391.579112871 CISATRACURIUM 10MG/5ML VIAL 105.979190653 CISATRACURIUM 200MG/20ML IJ 748.099316035 CISplatin 1mg/ml 50ML (10MGBi 623.119108523 CITALOPRAM 20MG TABLET 27.169316282 CLADRIBINE 1MG/ML VIAL 683.629178823 CLARITHROMY 50MG/ML SUSP 100ML 281.299104068 CLARITHROMYCIN 250MG TABLET 31.919104076 CLARITHROMYCIN 500MG TABLET 33.339117037 CLARITHROMYCIN XL 500MG TAB 33.539112871 CLEVIDIPINE 25MG/50ML PREMIX 467.779114984 CLIDINIUM/CHLORDIAZEPOXIDE CAP 33.849169103 CLINDAMYCIN 1% LOTION 60ML 113.059102286 CLINDAMYCIN 150MG CAPSULE 26.669178138 CLINDAMYCIN 15MG/ML SUSP 100ML 176.819305095 CLINDAMYCIN 300MG/2ML VIAL 45.079305095 CLINDAMYCIN 300MG/50ML D5 PMX 126.309305095 CLINDAMYCIN 600MG/4ML INJ 126.039305095 CLINDAMYCIN 600MG/50ML D5 PMX 137.459112871 CLINDAMYCIN 6MG/ML in D5W 38.599305095 CLINDAMYCIN 900MG/6ML VIAL 132.489305095 CLINDMYCIN 900MG/50ML D5W PMX 144.589169152 CLOBETASOL 0.05% CREAM 30GM 71.699170051 CLOBETASOL 0.05% CREAM 60GM 108.299168592 CLOBETASOL 0.05% OINTMENT 15GM 92.659170515 CLOBETASOL 0.05% TOP SOL 50ML 114.299155128 clonazePAM 0.5MG TABLET 36.699155136 clonazePAM 1MG TABLET 36.909102310 cloNIDine 0.1MG TABLET 18.029112871 cloNIDine 0.1MG/ML ORAL SUSP 18.029114059 cloNIDine 0.2MG TAB 18.309188806 cloNIDine 1,000MCG/ML 10ML INJ 250.369171000 cloNIDine-TTS 1 PATCH 75.17


of 196


CALCULATED PRICE

9171018 cloNIDine-TTS 2 PATCH 114.559171026 cloNIDine-TTS 3 PATCH 229.269117417 CLOPIDOGREL 300MG TABLET 60.169107608 CLOPIDOGREL 75MG TABLET 33.289155144 CLORAZEPATE 3.75MG TABLET 37.979169707 CLORPACTIN WCS-90 POWDER 2GM 46.579170119 CLOTRIMAZOLE 1% CREAM 15GM 52.099169111 CLOTRIMAZOLE 1% CREAM 30GM 104.799169137 CLOTRIMAZOLE 1% LOTION 30ML 97.219169137 CLOTRIMAZOLE 1% TOP SOLN 30ML 66.139169145 CLOTRIMAZOLE 1% VAG CRM 45GM 49.499104738 CLOTRIMAZOLE 10MG TROCHE 21.439169459 CLOTRIMAZOLE/BETAMETH CRM 15GM 96.539170218 CLOTRIMAZOLE/BETAMETH LOT 30ML 227.569114083 CLOZAPINE ODT 100MG TAB 32.339168931 COAL TAR 0.5% SHAMPOO 240ML 52.839170390 COAL TAR SOLUTION 473ML 90.239159062 COCAINE 10% SOLUTION 4ML 104.699158692 COCAINE 4% 10ML BOTTLE 160.099159088 COCAINE 4% SOLUTION 4ML 75.839118126 COD LIVER OIL CAPSULE 17.629155169 CODEINE SULFATE 30MG TABLET 36.129113143 COENZYME Q10 30MG SOFTGEL 18.329102369 COLCHICINE 0.6MG TABLET 19.349109703 COLESEVELAM 625MG TABLET 20.829170192 COLLAGENASE 250UN/GM OINT 15GM 165.219170192 COLLAGENASE 250UN/GM OINT 30GM 164.919174293 COMBIVENT MDI 14.7GM 523.809197252 COMBIVIR TABLET 51.209311218 CONIVAPTAN 20MG/4 ML INJ 1,196.889117177 CORTISONE ACETATE 25MG TABLET 18.479173238 CORTISPORIN EAR SOLN 10ML 96.719169558 CORTISPORIN OINTMENT 206.069174921 CORTISPORIN OPHTH OINT 3.5GM 114.079174202 CORTISPORIN OPHTH SUSP 7.5ML 264.399173238 CORTISPORIN OTIC SUSP 10ML 96.719112871 CORTISPORIN OTIC SUSP 10ML TAK 0.009187121 CORTROSYN 0.25MG INJ 105.459112871 COSYNTROPIN 250MCG/ML SYRG 175.629173824 CROMOLYN 4% NASAL SPRAY 13ML 50.039175480 CROMOLYN MDI 14.2GM 299.059173816 CROMOLYN MDI 8GM 200.999132028 CROMOLYN NEBULIZER SOLUTION 18.959175084 CROMOLYN SOD 4% OPHT SOL 10ML 109.499169186 CROTAMITON 10% CREAM 60GM 67.679191107 CUPRIC SULFATE 4 MG/10 ML VL 40.079170226 CURASOL GEL 30GM 51.159187006 CYANIDE ANTIDOTE PACKAGE 928.76


of 196


CALCULATED PRICE

9187147 CYANOCOBALAMIN 1000MCG/ML INJ 72.689107921 CYANOCOBALAMIN 250MCG TABLET 17.629102377 CYCLOBENZAPRINE 10MG TABLET 19.499176033 CYCLOMYDRIL EYE DROP 5ML 118.299173832 CYCLOPENTOLATE 0.5% OPHT 15ML 164.789173246 CYCLOPENTOLATE 1% OP SOL 2ML 80.359175043 CYCLOPENTOLATE 2% OPSOL 2ML 94.509317041 CYCLOPHOSPHAM 100mg(500mg vl) 673.489197054 CYCLOPHOSPHAMIDE 25MG TABLET 39.619317041 CYCLOPHOSPHAMIDE 500 MG VIAL 916.019103243 CYCLOPHOSPHAMIDE 50MG TAB 42.779180456 cycloSPORIN (NEORAL) 100MG CAP 30.609180456 cycloSPORINE (GENGRAF) 50ML 701.319107269 cycloSPORINE (NEORAL) 25MG CAP 20.819180456 cycloSPORINE (NEORAL) 50ML 746.119176058 cycloSPORINE 0.05% EYE EMUL 46.089180456 cycloSPORINE 100MG CAP 39.939180456 cycloSPORINE 100MG/ML LIQ 50ML 1,121.709189119 cycloSPORINE 250MG/5ML VIAL 194.049103243 cycloSPORINE 25MG CAPSULE 23.169107269 cycloSPORINE(GENGRAF) 25MG CAP 20.509102401 CYPROHEPTADINE 4MG TABLET 18.509316050 CYTARABINE 100MG VIAL 623.849316365 CYTARABINE LIPOSOME 10MG INJ 1,396.089194028 CYTOMEGALOVIRUS IG 2.5GM IJ 2,465.939147331 D10NS 1000ML 119.919147042 D10W 1000ML (FS) 123.219147042 D10W 1000ML IV SOLN. 123.219147190 D10W 250ML 120.529147190 D10W 250ML IV SOLN. 120.529147034 D10W 500ML (FS) 120.279147034 D10W 500ML IV SOLN 120.279192022 D10W/AA3%/HEPA 125UNITS 250ML 959.679112871 D12.5% 500ML 113.279147026 D5W 1000ML 121.339147026 D5W 1000ML (FS) 121.339134016 D5W 100ML 16.409147000 D5W 250ML 118.819147000 D5W 250ML 18.969147018 D5W 500ML 118.819147018 D5W 500ML (FS) 118.819134008 D5W 50ML 16.409112871 D5W FOR NICU SYRINGE 0.009147513 D5W w/ KCL 20MEQ 1000ML 129.439147521 D5W w/KCL 30MEQ 1000ML 138.859147539 D5W w/KCL 40MEQ 1000ML 111.719147448 D5W/0.22%NACL w/10MEQ KCL 112.059147455 D5W/0.22%NACL w/20MEQ KCL 129.43


of 196


CALCULATED PRICE

9147463 D5W/0.22%NACL w/30MEQ KCL 111.999147471 D5W/0.22%NACL w/40MEQ KCL 129.439147240 D5W/0.225% NACL 1000ML 122.539147232 D5W/0.225% NACL 500ML 119.629147281 D5W/0.45% NACL w/ KCL 10MEQ 129.439147729 D5W/0.45% NACL 1000ML 122.539147257 D5W/0.45% NACL 250ML 119.629147265 D5W/0.45% NACL 500ML 119.629147299 D5W/0.45% NACL w/KCL 20MEQ 129.439147422 D5W/0.45%NACL W/30MEQ KCL 129.439147430 D5W/0.45%NACL w/40MEQ KCL 129.439147315 D5W/0.9% NACL 1000ML 122.539147307 D5W/0.9% NACL 500ML 119.629147109 D5W/0.9% NACL w/40MEQ KCL 129.439147091 D5W/0.9%NACL w/20MEQ KCL 129.439192022 D5W/AA 2%/HEP PF 125UNIT 250ML 959.679147117 D5W/LACT RINGERS w/20MEQ KCL 133.079147216 D5W/LACTATED RINGERS 1000ML 125.259147208 D5W/LACTATED RINGERS 500ML 121.189112871 DABIGATRAN 150MG CAP 26.989128497 DABIGATRAN 75 MG CAP 26.449316068 DACARBAZINE 100MG VIAL 637.149316076 DACTINomycin 0.5MG VIAL 2,005.619169202 DAKINS 0.25% (HALF STR) 480ML 57.319169194 DAKIN'S 0.5% (FULL STR) 480ML 57.319187584 DANTROLENE 20MG INJ 291.789102419 DANTROLENE 25MG CAPSULE 20.189104696 DAPSONE 25MG TABLET 19.719306820 DAPTOmycin 500 MG INJ 800.119306820 DAPTOmycin 50MG/ML in NS 637.049190505 DARBEPOETIN 100MCG/0.5ML IJ 1,530.769190505 DARBEPOETIN 100MCG/1ML VL 1,530.769190505 DARBEPOETIN 150MCG/0.3ML IJ 2,261.069190505 DARBEPOETIN 200MCG/0.4ML IJ 2,991.359190505 DARBEPOETIN 25MCG/0.42ML IJ 435.339190505 DARBEPOETIN 300MCG/0.6ML IJ 4,451.939190505 DARBEPOETIN 40MCG/0.4ML IJ 654.449190505 DARBEPOETIN 500MCG/1ML IJ 7,373.109190505 DARBEPOETIN 60MCG/0.3ML IJ 946.519112962 DARUNAVIR 400MG TAB 59.249118548 DARUNAVIR 600MG TAB 59.249316290 DAUNOribicin 10MG/2ML INJ 671.249173303 DDAVP 0.01% NASAL SPRAY 5ML 647.589173261 DEBROX 6.5% OTIC SOLN 15ML 40.059316712 DECITABINE 1MG IJ (50MG VIAL) 685.089316712 DECITABINE 50 MG VIAL 4,222.849310400 DEFEROXAMINE 500MG INJ 162.789317066 DEGARELIX 1MG (120MG VIAL) 626.22


of 196


CALCULATED PRICE

9317074 DEGARELIX 1MG (80MG VIAL) 626.229317074 DEGARELIX 80 MG VIAL 1,600.949102534 DEMECLOCYCLINE 150MG TABLET 38.819191024 DENOSUMAB 60 MG/ML INJ 2,083.189163346 DEPO-TESTOSTERONE 200 MG/ML 163.499170184 DERMOPLAST SPRAY 0.009102443 DESIPRAMINE 10MG TABLET 19.809102450 DESIPRAMINE 25MG TABLET 20.259169897 DESITIN OINTMENT 120GM 41.679118142 DESLORATATINE 5MG TAB 29.019107939 DESMOPRESSIN 0.1MG TAB 23.599117185 DESMOPRESSIN 0.2MG TABLET 33.089190265 DESMOPRESSIN 4MCG/ML INJ 10ML 179.059190265 DESMOPRESSIN 4MCG/ML INJ 1ML 117.329173717 DESONIDE 0.05% CREAM 15GM 68.659169004 DESONIDE 0.05% LOTION 59ML 332.099168618 DESONIDE 0.05% OINTMENT 15GM 59.999170234 DESOXIMETASONE 0.25% CRM 15GM 150.359178856 DEXAMETH INT 1MG/ML SOLN 30ML 74.339178146 DEXAMETHASO 0.1MG/1ML 120ML 61.689190273 DEXAMETHASONE 0.1MG/ML D5W SYR 141.059112871 DEXAMETHASONE 0.2MG/ML PO LIQ 19.209102484 DEXAMETHASONE 0.5MG TABLET 18.049102492 DEXAMETHASONE 0.75MG TABLET 18.219190273 DEXAMETHASONE 10MG/ML INJ 73.359190273 DEXAMETHASONE 120MG/30ML VL 89.569190273 DEXAMETHASONE 20MG/5ML VIAL 74.569102518 DEXAMETHASONE 2MG TABLET 18.859102526 DEXAMETHASONE 4MG TABLET 18.799190273 DEXAMETHASONE 4MG/1ML INJ 72.869173279 DEXAMTHASONE 0.1% OP SOL 5ML 156.369190182 DEXMEDETOMIDINE 200MCG/2ML INJ 249.289112871 DEXMEDETOMIDINE/NS 4MCG/ML IJ 0.009188137 DEXRAZOXANE 250MG VIAL 657.549147075 DEXTRAN 40 10%/D5W IV SOLN 171.919147083 DEXTRAN 40/NS IV SOLN. 378.639155912 dextroAMPHETAMINE 5MG TAB 35.869189457 DEXTROSE 10% INJ 5ML 72.969112871 DEXTROSE 10%/0.225% NACL 250ML 14.409147331 DEXTROSE 10%-NS IV SOLN 1000ML 119.919112871 DEXTROSE 15% 500ML 113.279147620 DEXTROSE 20%/WATER IV SOLN. 112.079187188 DEXTROSE 25% SYRINGE 10ML 81.269189259 DEXTROSE 50%/WATER 50ML VIAL 72.469189267 DEXTROSE 50%/WATER SYR 50ML 84.829147646 DIANEAL W/1.5% DEXTROSE 5000ML 189.279148065 DIANEAL W/1.5% DEXTROSE 5000ML 189.279147653 DIANEAL W/2.5% DEXTROSE 5000ML 191.47


of 196


CALCULATED PRICE

9147661 DIANEAL W/4.25% DEXTROSE 5L 193.579112871 DIATRIZOATE 50% 50ML VIAL 87.449160045 DIAZEPAM 10MG RECTAL GEL 617.799155235 DIAZEPAM 10MG TABLET 35.949163650 DIAZEPAM 10MG/2ML INJ 108.999155201 DIAZEPAM 2MG TABLET 35.579155227 DIAZEPAM 5MG TABLET 35.739159104 DIAZEPAM 5MG/5ML UD CUP 39.539155227 DIAZEPAM INT 5MG/ML ORAL CONC 36.969137423 DIAZOXIDE 50MG/ML ORAL SUSP 33.129168030 DIBUCAINE 1% RECTAL OINT 47.959102914 DICLOFENAC 75 MG TAB DR 19.849174632 DICLOFENAC 0.1% OPH SOL 2.5ML 117.959120478 DICLOFENAC 1.3% PATCH 31.829114216 DICLOFENAC EC 25MG DR TAB 20.399114208 DICLOFENAC SOD 50 MG TAB EC 19.449102542 DICLOXACILLIN 250MG CAPSULE 18.879102559 DICLOXACILLIN 500MG CAPSULE 19.959114232 DICYCLOMINE 10MG CAPSULE 18.089102567 DICYCLOMINE 20MG TABLET 18.259188814 DICYCLOMINE 20MG/2ML INJ 140.409180464 DIDANOSINE 10MG/ML 200ML 276.319168253 DIFLORASONE 0.05% OINT 60GM 315.399189150 DIGIFAB IMMUNE FAB 40MG IJ 1,340.369102583 DIGOXIN 0.125MG TAB 18.679102591 DIGOXIN 0.25MG TABLET 18.679187204 DIGOXIN 0.5MG/2ML INJ 75.699179649 DIGOXIN 50 MCG/ML PO LIQ 60ML 104.679300237 DIGOXIN 50MCG/ML ORAL LIQ 1ML 18.949112871 DIGOXIN IMM FAB 1MG/ML in NS 1,550.919187204 DIGOXIN PED 100MCG/ML INJ 84.829188145 DIHYDROERGOTAMINE 1MG/ML INJ 136.609103953 DILTAZEM CD 300MG CAPSUL 23.899310319 DILTIAZEM 25MG/5ML VIAL 110.649309006 DILTIAZEM 100MG ADV VIAL 124.679151515 DILTIAZEM 125 MG/125 ML D5W 208.799312307 DILTIAZEM 125MG/25ML VIAL 162.329102633 DILTIAZEM 30MG TABLET 18.459102633 DILTIAZEM 60MG TABLET 18.969102658 DILTIAZEM 90MG TABLET 19.269109471 DILTIAZEM CD 120MG CAPSULE 20.439103938 DILTIAZEM CD 180MG CAPSULE 21.019103946 DILTIAZEM CD 240MG CAPSULE 22.479102690 DILTIAZEM SR 120MG CAPSULE 20.039102187 DILTIAZEM SR 60MG CAPSULE 19.749102682 DILTIAZEM SR 90MG CAPSULE 19.989113655 DILTIAZEM XR 120MG CAP 22.869113663 DILTIAZEM XR 180MG CAP 23.80


of 196


CALCULATED PRICE

9113671 DILTIAZEM XR 240MG CAP 25.819112871 DILTIAZEM-D5W 100 MG/100 ML 204.279190208 DIMERCAPROL 300MG/3ML AMP 275.829168626 DINOPROST0NE 0.5MG/3GM GEL 773.789128364 DINOPROSTONE 10MG VAG SUPP 538.349190695 DIP/PERTUSS/TET ADULT VX 0.5ML 162.129186255 DIP/PERTUSS/TET PEDI VX .5ML 126.409186032 DIP/TET ADULT 0.5ML 118.139186230 DIP/TETANUS(PEDIATRIC) 0.5ML 89.209186255 DIPH/PERTUSS(ACELL)/TET PF(PED 122.449179862 diphenhydrA LIQ DF,AF,SF 118ML 44.839137266 diphenhydrAMIN 12.5MG/5ML UDCP 18.719168493 diphenhydrAMINE 1% CRM 28.3GM 42.709170242 diphenhydrAMINE 2% CRM 15GM 41.419102716 diphenhydrAMINE 25MG TABLET 0.009112871 diphenhydrAMINE 25MG tb#2 TKHM 0.009138058 diphenhydrAMINE 25MG/10ML UDCU 18.819102724 diphenhydrAMINE 50MG CAP 17.829187774 diphenhydrAMINE 50MG/1ML VIAL 72.189159120 DIPHENOXYLATE/ATROPINE LIQ 1ML 35.369155276 DIPHENOXYLATE/ATROPINE TABLET 36.059138017 DIPIVEFRIN 0.1% EYE DROPS 10ML 89.499108796 DIPYRIDAMOL/ASA 25/200 SR CAP 26.619187139 DIPYRIDAMOLE 10MG/2ML VIAL 84.979102732 DIPYRIDAMOLE 25MG TABLET 18.309187139 DIPYRIDAMOLE 50MG/10ML VL 97.029102773 DISOPYRAMIDE 100MG CAPSULE 18.949102781 DISOPYRAMIDE 150MG CAPSULE 19.199102740 DISOPYRAMIDE CR 100MG CAP 22.109102757 DISOPYRAMIDE CR 150MG CAP 22.929107061 DIVALPROEX EC 125MG TABLET 19.869107079 DIVALPROEX EC 250MG TABLET 23.119107087 DIVALPROEX EC 500MG TABLET 27.769118043 DIVALPROEX ER 250MG 24HR TAB 22.619107095 DIVALVROEX SPRINKLE 125MG CAP 20.269310111 DOBUTamine 1000MG/D5W 250ML 353.669310111 DOBUTamine 250MG/20ML INJ 114.039151481 DOBUTamine 250MG/250ML D5W PMX 190.189151481 DOBUTamine 500MG/D5W 250ML 252.289317025 DOCETAXEL 20MG/0.5ML INJ 1,619.029317025 DOCETAXEL 80 MG/8 ML VIAL* 652.679170457 DOCOSANOL 10% CREAM 2GM 65.889114315 DOCUSATE CAL 240 MG CAPSULE 0.009137258 DOCUSATE SOD 100MG/10ML CUP 0.009138066 DOCUSATE SOD 250MG/25ML UDCUP 18.759170895 DOCUSATE SOD 283MG ENEMA 22.029102674 DOCUSATE SODIUM 100MG CAPSULE 0.009113283 DOCUSATE SODIUM 250MG CAPSULE 0.00


of 196


CALCULATED PRICE

9108804 DOFETILIDE 0.125MG CAPSULE 27.199108812 DOFETILIDE 0.25MG CAPSULE 27.199113390 DOLASETRON 100MG TABLET 172.579190281 DOLASETRON 100MG/5ML VIAL 165.349190281 DOLASETRON 12.5MG/0.625ML INJ 107.589174822 DOMEBORO OTIC SOLN 60ML 179.099172073 DOMEBORO PACKET 19.559107509 DONEPEZIL 5MG TABLET 40.579112871 DONNATAL LIQ 30ML 42.839178583 DONNATAL LIQUID 120ML 64.259311192 DOPamine 200MG/5ML VIAL 109.659311192 DOPamine 400MG/10ML VIAL 107.449311192 DOPamine 400MG/250ML D5W PMX 153.369311192 DOPamine 400MG/5ML INJ 113.459311192 DOPamine 800MG/250ML D5W 176.379312331 DORIPENEM 500MG IJ 233.899128513 DORNASE 1MG/ML INHAL PILLOW 197.679138025 DORZOLAMIDE 2% OPHT SOL 10ML 205.389174152 DORZOLAMIDE 2% OPHTH SOLN 5ML 88.979163163 DOXAPRAM 400MG/20ML INJ 264.949102872 DOXAZOSIN 1MG TAB 19.409102898 DOXAZOSIN 2MG TAB 19.409102831 DOXEPIN 10MG CAPSULE 18.289114364 DOXEPIN 25MG CAPSULE 18.419170259 DOXEPIN 5% CREAM 45GM 454.919102856 DOXEPIN 50MG CAPSULE 18.699316084 DOXOrubicin 10MG/5ML INJ 637.759316381 DOXOrubicin LIP 10MG/5ML 1,929.129305111 DOXYCYCLINE 100MG INJ 64.619102880 DOXYCYCLINE 100MG TABLET 18.599112871 DOXYCYCLINE 100MG TB#2 TKHM 0.009155243 DRONABINOL 2.5MG CAPSULE 54.229112939 DRONEDARONE 400 MG TABLET 28.199187253 DROPERIDOL 5MG/2ML INJ 78.689190927 DTaP/HEPB/IPV COMB 0.5 ML IJ 233.599117235 DULoxetine DR 30 MG CAP 31.079100801 DULoxetine SR 20 MG CAP 29.609132150 DUONEB 2.5-0.5MG/3ML SOLN 23.049189606 DUOVISC VISCOELASTIC SYSTEM 438.849100819 DUTASTERIDE 0.5 MG CAPSULE 26.849168105 ECONAZOLE 1% CREAM 30GM 96.959312265 ECULIZUMAB 300MG/30ML IJ 13,848.999187964 EDROPHONIUM 10MG/ML 15ML INJ 166.189112871 EDTA 2% EYE DROPS 10ML 150.799112947 EFFIENT 10 MG TABLET 33.129117318 ELETRIPTAN 40 MG TABLET 83.249306812 ELITEK 1.5 MG VIAL 1,605.349170069 EMLA CREAM 5GM 52.97


of 196


CALCULATED PRICE

9120197 EMTRICITABINE 200 MG CAP 37.789102948 ENALAPRIL 10MG TAB 19.699112871 ENALAPRIL 1MG/ML ORAL SUSP 19.599116922 ENALAPRIL 20MG TAB 20.609102955 ENALAPRIL 5MG TAB 19.599188830 ENALAPRILAT 1.25 MG/ML VIAL 70.189190901 ENALAPRILAT 2.5MG/2ML INJ 76.919112871 ENALAPRILAT 25MCG/ML in NS SYR 152.129190299 ENOXAPARIN 100MG/1ML INJ 253.819190299 ENOXAPARIN 120MG/0.8ML INJ 290.619190299 ENOXAPARIN 150MG/ML 1ML SYRG 345.739190299 ENOXAPARIN 30MG/0.3ML INJ 125.209190299 ENOXAPARIN 40MG/0.4ML INJ 143.559190299 ENOXAPARIN 60MG/0.6ML INJ 180.379190299 ENOXAPARIN 80MG/0.8ML INJ 217.099109778 ENTACAPONE 200MG TABLET 26.069310145 ePHEDrine 50MG/ML INJ 71.189112871 ePHEDrine/NS 5 MG/ML SYR 10ML 99.789191123 ePHEDrine-NS 100 MG/10 ML SYR 112.279180100 EPINEPHrine 1MG/10ML SYRINGE 75.469180100 EPINEPHrine 1MG/ML AMPUL PF 78.949180100 EPINEPHrine 1MG/ML INJ 73.409180100 EPINEPHrine 1MG/ML INJ 30ML 88.689132119 EPINEPHrine 2.25% INH 0.5ML 18.809180092 EPIPEN 0.3 MG AUTO-INJECTOR 271.469316522 EPIRUBICIN 2MG/ML INJ 625.019117094 EPLERENONE 25 MG TABLET 29.019188020 EPOETIN 10000U/ML INJ 390.439188020 EPOETIN 2,000 UNITS/ML INJ 155.909188020 EPOETIN 20,000UNITS/ML INJ 710.689188020 EPOETIN 3000UNITS/ML INJ 166.279188020 EPOETIN 40,000 UNITS/ML INJ 1,784.779188020 EPOETIN 4000U/ML INJ 198.289190307 EPTIFBATIDE 20MG/10ML INJ 402.979190307 EPTIFIBATIDE 75MG/100ML PREMIX 1,036.969311143 ER-AMIODARONE 300MG/20ML D5W 567.229316670 ERBITUX 200 MG/100 ML VIAL 3,027.299102963 ERGOCALCIFEROL 50,000 UNIT CAP 18.279303009 ERGOCALCIFEROL 8,000UNIT/ML 22.819118480 ERGOLOID MESYLATES 1 MG TAB 26.889112871 ERIBULIN 1MG/ 2 ML INJ 2,751.529197567 ERLOTINIB 150 MG TABLET 443.749306614 ERTAPENEM 1GM INJ 189.019112871 ERTAPENEM 20MG/ML in NS syr 62.619180746 ERYTHMYC/SULFISOX 150ML 109.299178435 ERYTHMYC/SULFISOX100ML 66.259305137 ERYTHROMYCIN 1GM INJ 120.579113192 ERYTHROMYCIN 400MG TABLET 18.06


of 196


CALCULATED PRICE

9112871 ERYTHROMYCIN 40MG/ML LIQ 1ML 17.639302050 ERYTHROMYCIN 40MG/ML LIQ 1ML 17.639305137 ERYTHROMYCIN 500MG INJ 137.559112871 ERYTHROMYCIN 5MG/ML in NS 42.499102997 ERYTHROMYCIN EC 250MG TABLET 20.569114422 ERYTHROMYCIN EC 333MG TABLET 20.659102989 ERYTHROMYCIN EC 500MG TABLET 20.799112871 ERYTHROMYCIN ETH 400MG/100ML 64.679120528 ERYTHROMYCIN EYE OINT 1GM 42.379173311 ERYTHROMYCIN OP OINT 3.5GM 73.099305137 ERYTHROMYICN 500MG/250ML NS AV 179.359116385 ESCITALOPRAM 10MG TAB 27.529310137 ESMOLOL 100MG/10ML INJ 151.259152042 ESMOLOL 2000MG/100ML NS 452.689151283 ESMOLOL 2500MG/250ML NS 452.689113051 ESOMEPRAZOLE 20MG CAPSULE 32.409116401 ESOMEPRAZOLE 40MG CAPSULE 32.409169269 ESTRADIOL 0.01% VAG CRM 42.5GM 302.019171232 ESTRADIOL 0.025MG/HR 2XWK PTCH 36.889171158 ESTRADIOL 0.05MG ptch 2xwk 34.799171158 ESTRADIOL 0.05MG/24HR PATCH 67.549171174 ESTRADIOL 0.075MG/DAY PATCH 67.549171042 ESTRADIOL 0.1MG BI-WEEK PATCH 30.829171042 ESTRADIOL 0.1MG/DAY PATCH 67.549107962 ESTRADIOL 0.5MG TABLET 18.069109505 ESTRADIOL 1MG TABLET 18.249103029 ESTRADIOL 2MG TABLET 19.429190638 ESTRADIOL CYP 25MG/5ML INJ 150.389183013 ESTRADIOL VAL 100MG/5ML VL 284.929107350 ESTRATEST 1.25MG/2.5MG TABLET 25.469169251 ESTROGEN,CONJ VAG CREAM 42.5GM 388.119103037 ESTROGENS,CON 0.3MG TABLET 22.869114448 ESTROGENS,CON 0.625MG TABLET 22.869103045 ESTROGENS,CON 0.9MG TABLET 22.869103052 ESTROGENS,CON 1.25MG TABLET 19.829188152 ESTROGENS,CONJ 25MG INJ 364.699107970 ESTROPIPATE 0.75MG TABLET 18.419105008 ESTROPIPATE 1.5MG TABLET 21.069156043 ESZOPICLONE 1MG TAB 51.059188749 ETANERCEPT 50MG/ML IJ 1,250.319112871 ETHACRYNATE 1MG/ML NS SYRG 141.289188160 ETHACRYNATE SOD 50MG INJ 1,690.839117326 ETHACRYNIC ACID 25 MG TAB 23.479103086 ETHAMBUTOL 100MG TABLET 18.749103094 ETHAMBUTOL 400MG TABLET 21.529188756 ETHANOLAMINE 5% INJ 2ML 205.149190729 ETHIODOL AMPUL 316.889103110 ETHOSUXIMIDE 250MG CAPSULE 21.54


of 196


CALCULATED PRICE

9168022 ETHYL CHLORIDE SPRAY 102.199114471 ETODOLAC 300 MG CAPSULE 20.789107988 ETODOLAC 400MG TABLET 20.499188848 ETOMIDATE 20MG/10ML INJ 87.999189424 ETOMIDATE 40MG/20ML INJ 134.649316167 ETOPOSIDE 100MG/5ML INJ 616.119197393 ETOPOSIDE 50MG CAPSULE 130.379169905 EUCERIN CREAM 120GM 44.019168261 EUCERIN LOTION 240ML 0.009106105 EXCEDRIN MIGRAINE TABLET 0.009109935 EXEMESTANE 25MG TABLET 52.739190737 EXENATIDE 5MCG PEN 1.2ML 782.429174830 EYE WASH OPHTH SOLN 120ML 42.679173188 EYE-STREAM SOLUTION 30ml 69.749100736 EZETIMIBE 10MG TABLET 28.449100785 EZETIMIBE/SIMVASTATIN 10/20 TB 28.599100793 EZETIMIBE/SIMVASTATIN 10/40 TB 28.599196205 FACTOR 8 (HUMATE P) 1 UNIT 353.419192071 FACTOR 9 (PROFILNINE) 1 UNIT 352.419196114 FACTOR VIIA 1MCG INJ 354.259109281 FAMCICLOVIR 500MG TABLET 38.219116930 FAMOTIDINE 10 MG TABLET 17.869112871 FAMOTIDINE 20 MG /50ML PMX 118.579103144 FAMOTIDINE 20MG TABLET 21.039188178 FAMOTIDINE 20MG/2ML VIAL 73.089191487 FAMOTIDINE 2MG/ML in NS SYR 141.819116948 FAMOTIDINE 40 MG TABLET 24.249181025 FAMOTIDINE 40MG/5ML LIQ 50ML 308.619112871 FAMOTIDINE 8MG/ML liq 434.869112871 FAST ACTING CARBOHYDRATE 0.009151291 FAT EMULSIONS 10% 250ML 157.909151234 FAT EMULSIONS 10% IV SOLUTION 137.219152018 FAT EMULSIONS 20% 250ML 139.039151226 FAT EMULSIONS 20% IV SOLUTION 239.259108853 FELODIPINE SR 2.5MG TABLET 20.579100074 FELODIPINE SR 5MG TABLET 20.579117243 FENOFIBRATE 145 MG TABLET 30.499117250 FENOFIBRATE 48 MG TABLET 21.869109398 FENOFIBRATE,MICR 160MG TAB 22.829189085 FENOLDOPAM 10MG/ML INJ 590.189163056 fentaNYL 100MCG/2ML INJ 106.979163056 fentaNYL 100MCG/2ML SYRINGE 108.349161035 fentaNYL 100MCG/HR PATCH 141.929161043 fentaNYL 12 MCG/HR PATCH 74.899163056 fentaNYL 1250MCG/250ML NS DRIP 204.659166265 fentaNYL 1250MCG/BUP 0.1%/NS 189.319156001 fentaNYL 1600 MCG LOZENGE 145.979155854 fentaNYL 200MCG LOZENGE 72.70


of 196


CALCULATED PRICE

9166240 fentaNYL 200MCG/BUPV 0.1% DRIP 257.339163056 fentaNYL 2500MCG/250ML NS 208.959163056 fentaNYL 250MCG/5ML INJ 107.909161001 fentaNYL 25MCG/HR PATCH 63.969163056 fentaNYL 300MCG/30ML NS PCA 270.009155755 fentaNYL 400MCG LOZENGE 82.749163056 fentaNYL 500MCG/10ML VL 111.549161019 fentaNYL 50MCG/HR PATCH 87.869112871 fentaNYL 600MCG LOZENGE 93.459161027 fentaNYL 75MCG/HR PATCH 115.589166265 fentaNYL1250mcg/BUP0.0625%/NS 182.639166240 fentaNYL200MCG/BUPV 0.125% PMX 187.079190851 FERAHEME 510MG/17ML VIAL 1,022.459310806 FERRIC GLU CMPLX 62.5MG/ML 5ML 226.369170911 FERRIC SUBSULFATE SOLN 8GM 63.839103177 FERROUS GLUCONATE 324MG TAB 17.779103193 FERROUS GLUCONATE 325 MG TAB 17.699179664 FERROUS SULF 300MG/5ML LIQ 18.719114497 FERROUS SULF 325 MG TAB EC 18.159112871 FERROUS SULFATE 15 MG/ML DROPS 35.459114505 FERROUS SULFATE 160MG SR TAB 0.009103193 FERROUS SULFATE 324MG EC TAB 0.009113416 FEXOFENADINE 180MG TABLET 23.319107590 FEXOFENADINE 60MG TABLET 20.879112871 FILGRASTIM 20MCG/ML PED SYR 168.029188087 FILGRASTIM 300MCG/ML INJ 697.269188095 FILGRASTIM 480MCG/1.6ML INJ 1,068.639112871 FILGRASTIM 50MCG/ML PED SYR 209.529100066 FINASTERIDE 5MG TABLET 22.889103011 FIORICET TABLET 19.229155268 FIORINAL CAPSULE 36.769155284 FIORINAL/CODEINE #3 CAPSULE 38.599112871 FIRST-MOUTHWASH BLM 10ml ud 20.599116419 FISH OIL 1000MG CAPSULE 17.699103227 FLAVOXATE 100MG TABLET 21.069103219 FLECAINIDE 100MG TABLET 23.019112871 FLECAINIDE 20MG/ML ORAL SUSP 23.619109521 FLECAINIDE 50MG TABLET 21.039128166 FLEET ENEMA 133ML 37.369128158 FLEET MINERAL OIL ENEMA 39.149316092 FLOXURIDINE 500MG INJ 904.449186081 FLUARIX 2011-2012 SYRINGE (PF) 95.149181041 FLUCONAZOLE 10 MG/ML SUSP 35ML 106.699104647 FLUCONAZOLE 100MG TABLET 50.889118027 FLUCONAZOLE 200MG TABLET 72.089305848 FLUCONAZOLE 200MG/100ML NS 216.249305848 FLUCONAZOLE 2mg/mL (Variable) 216.249191495 FLUCONAZOLE 2MG/ML NS SYRINGE 141.47


of 196


CALCULATED PRICE

9112871 FLUCONAZOLE 40MG/ML ORAL SYR 28.659178963 FLUCONAZOLE 40MG/ML SUSP 35ML 528.999191206 FLUCONAZOLE-NS 100 MG/50 ML 129.679305848 FLUCONAZOLE-NS 400 MG/200 ML 269.809112871 FLUCYTOSINE 10MG/ML ORAL SUSP 25.629114554 FLUCYTOSINE 500MG CAPSULE 208.129316191 FLUDARABINE 50MG INJ 1,360.359103276 FLUDROCORTISONE 0.1MG TABLET 19.229186263 FLULAVAL 2011-12 0.5ML 87.469112871 FLUMAZENIL 0.5MG/5ML VIAL 88.949187907 FLUMAZENIL 1MG/10ML INJ 553.189173469 FLUNISOLIDE 0.025% NASAL 25ML 172.599173519 FLUNISOLIDE MDI 7GM 234.419170408 FLUOCINOLONE 0.01% SOL 60ML 218.099169285 FLUOCINOLONE 0.025% CRM 15GM 103.759168998 FLUOCINOLONE 0.025% OINT 60GM 154.359168295 FLUOCINONIDE 0.05% CREAM 15GM 66.979170572 FLUOCINONIDE 0.05% OINT 15GM 59.499168683 FLUOCINONIDE 0.05% SOL 60ML 83.399175332 FLUORESCEIN 0.6MG EYE STRIP 35.349188186 FLUORESCEIN 10% INJ 5ML 131.069173683 FLUOROMETHO 0.25% OPHT SOL 5ML 94.979174442 FLUOROMETHOL 0.1% OP SOL 15ML 105.459170267 FLUOROURACIL 5% CREAM 25GM 245.479316100 FLUOROURACIL 500MG/10ML INJ 621.409107996 FLUoxetine 10MG CAPSULE 22.759114570 FLUoxetine 20MG CAPSULE 22.899178971 FLUoxetine 4MG/ML LIQ 120ML 271.099109539 FLUOXYMESTERONE 10MG TABLET 41.439106493 FLUPHENAZINE 1MG TABLET 18.559183351 FLUPHENAZINE 25MG/10ML INJ 268.899103292 FLUPHENAZINE 5MG TABLET 20.209155292 FLURAZEPAM 15MG CAPSULE 35.739173170 FLURBIPROFEN 0.03% OPHT 2.5ML 84.189113044 FLURBIPROFEN 50MG TABLET 19.139197062 FLUTAMIDE 125MG CAPSULE 21.739173998 FLUTICASONE 0.05% NASAL 16GM 205.619175399 FLUTICASONE HFA 110 MCG MDI 285.179175407 FLUTICASONE HFA 220 MCG MDI 423.519175415 FLUTICASONE HFA 44 MCG MDI 221.879107301 FLUVASTATIN 20MG CAPSULE 26.089116427 FLUVASTATIN XL 80MG SR TAB 28.499107459 FLUVOXAMINE 50MG TABLET 24.219187048 FLUZONE 2011-2012 VIAL 97.139112871 FOLGARD RX TABLET 18.829108655 FOLIC ACID 0.4MG TABLET 17.599114612 FOLIC ACID 1MG TABLET 17.879112871 FOLIC ACID 50MCG/ML ORAL LIQ 17.60


of 196


CALCULATED PRICE

9310590 FOLIC ACID 5MG/ML INJ 40.309191180 FOMEPIZOLE 1.5 GM/1.5 ML VIAL 2,764.369190315 FONDAPARINUX 10 MG/0.8 ML INJ 375.309190315 FONDAPARINUX 2.5 MG/0.5 ML INJ 193.649190315 FONDAPARINUX 7.5 MG/0.6 ML INJ 360.769174624 FORMOTEROL AEROLZ 12MCG CP #12 38.799312299 FOSAPREPITANT 115MG VIAL 627.979312299 FOSAPREPITANT 150 MG INJ 765.009100090 FOSINOPRIL 10MG TABLET 20.909100108 FOSINOPRIL 20 MG TAB 19.939189713 FOSPHENYTOIN 100MG/2ML INJ 127.749112871 FOSPHENYTOIN 25MG/ML in NS SYR 45.449189713 FOSPHENYTOIN 500MG/10ML INJ 194.449190471 FULVESTRANT 125MG/2.5ML IJ 1,049.559190471 FULVESTRANT 250MG/5ML INJ 2,088.069178203 FUROSEMIDE 10 MG/ML LIQ 60ML 55.899187808 FUROSEMIDE 100MG/10ML INJ 75.809112871 FUROSEMIDE 10MG/ML LIQ 1ML 17.909158379 FUROSEMIDE 10MG/ML LIQ 1ML 17.909112871 FUROSEMIDE 1MG D5 SYRG 140.469103318 FUROSEMIDE 20MG TABLET 17.869187808 FUROSEMIDE 20MG/2ML INJ 79.829103326 FUROSEMIDE 40MG TABLET 17.909187808 FUROSEMIDE 40MG/4ML INJ 74.569137175 FUROSEMIDE 40MG/5ML LIQ UD CUP 20.799103342 FUROSEMIDE 80MG TABLET 18.459137217 G.I. COCKTAIL 40ML 23.559107194 GABAPENTIN 100MG CAPSULE 18.729107186 GABAPENTIN 300MG CAPSULE 23.159107673 GABAPENTIN 400MG CAPSULE 24.069179888 GABAPENTIN 50MG/ML LIQ 120ML 132.689109786 GALANTAMINE 4MG TABLET 22.279194143 GAMUNEX 10% 10GM/100ML 2,757.979194143 GAMUNEX 10% 20GM/200ML 5,165.039194143 GAMUNEX 10%5GM/50ML 1,559.169112871 GANCICLOVIR 100MG/ML ORAL SUSP 27.199197245 GANCICLOVIR 250MG CAPSULE 44.739305632 GANCICLOVIR 500MG INJ 809.919112871 GANCICLOVIR 5MG/ML in D5W 217.659103334 GAVISCON FOAMTAB 0.009178211 GAVISCON LIQUID 360ML 0.009169319 GELATIN POWDER 1GM 219.859169327 GELFILM OPHTH DRESSING 1 EA 97.839169343 GELFOAM 12/7MM SPONGE 52.829169335 GELFOAM SIZE 100 SPONGE 136.739316415 GEMCITABINE 200MG INJ 975.669103409 GEMFIBROZIL 600MG TABLET 19.849316464 GEMTUZUMAB 5MG INJ 6,927.21


of 196


CALCULATED PRICE

9170135 GENTAMICIN 0.1% CREAM 15GM 42.419169350 GENTAMICIN 0.1% OINTMENT 15GM 42.419173329 GENTAMICIN 0.3% OP OINT 3.5GM 74.439173337 GENTAMICIN 0.3% OPHTH SOL 5ML 74.599306754 GENTAMICIN 100MG/100ML PMX 122.969306754 GENTAMICIN 120MG/100ML NS PMX 123.779306101 GENTAMICIN 4mg/mL in D5W syr 141.019306754 GENTAMICIN 80 MG/NS 100 ML PB 121.989305145 GENTAMICIN 80MG/2ML INJ 40.129306754 GENTAMICIN 80MG/50ML NS PMX 121.989306754 GENTAMICIN 80MG/8ML ADD-VANT 38.739305160 GENTAMICIN PED 20MG/2ML VIAL 44.859306101 GENTAMICIN PEDI SYRINGE IN NS 36.279316449 GLATIRAMER 20MG INJ KIT 2,829.469108002 GLIMEPIRIDE 2MG TABLET 18.559109299 GLIMEPIRIDE 4MG TABLET 19.459103375 glipiZIDE 10MG TABLET 18.899114620 glipiZIDE 5MG TABLET 18.309108564 glipiZIDE XL 10MG TABLET 20.699113077 glipiZIDE XL 2.5MG TABLET 19.179107343 glipiZIDE XL 5MG TABLET 19.179188202 GLUCAGON 1MG INJ 314.189113705 GLUCOSA/CHONDROIT 500/400 CAP 18.389108887 GLUCOSAMINE 500MG CAPSULE 17.959182148 GLUCOSE 40% GEL 37.5GM 38.259100827 GLUCOSE 5GM CHEW TABLET 17.919118357 GLUCOVANCE 2.5-500 MG TABLET 20.549113275 GLUTAMINE 10GM PACKET 20.849103359 glyBURIDE 2.5MG TABLET 18.169114638 glyBURIDE 5MG TABLET 18.609103425 glyBURIDE, MICRON 3MG TABLET 20.749128026 GLYCERIN ADULT SUPPOS. 17.919178997 GLYCERIN LIQUID 480ML 45.339128034 GLYCERIN PEDIATRIC SUPPOS. 17.849188210 GLYCOPYRROLATE 0.2MG/1ML VL 73.309190885 GLYCOPYRROLATE 0.2MG/ML 5ML IJ 76.469190877 GLYCOPYRROLATE 0.4MG/2ML INJ 73.929112871 GLYCOPYRROLATE 100MCG/ML SUSP 18.879103367 GLYCOPYRROLATE 1MG TABLET 31.969178229 GOLYTELY SOLUTION 4000ML 81.899187246 GOSERELIN 10.8MG IMPLANT SYR 3,366.359187246 GOSERELIN 3.6MG IMPLANT INJ 1,554.069310772 GRANISETRON 0.1 MG/ML VIAL 77.999114646 GRANISETRON 1MG TABLET 145.539310772 GRANISETRON 1MG/ML INJ 116.549179896 guaiFENesi(AF,SF,DF) LIQ 118ML 48.079138124 guaiFENesin /DM 5 ML UDCUP 18.399138074 guaiFENesin 100MG/5ML UDCUP 18.39


of 196


CALCULATED PRICE

9137068 guaiFENesin 200MG/10ML UDCUP 18.399137159 GUAIFENESIN DM 10ML UD CUP 19.019106634 guaiFENesin LA 600MG TAB 18.139159112 guaiFENesin W/COD 10ML CUP 37.219138090 guaiFENesin/COD 5ML UDCUP 18.619112871 guaiFENesin/CODEINE SYRUP 4OZ 40.659103391 guanFACINE 1MG TABLET 19.299186099 HAEMOPHILUS B CONJ VACC 0.5ML 100.349103466 HALOPERIDOL 0.5MG TABLET 18.149103474 HALOPERIDOL 1MG TABLET 18.469178260 HALOPERIDOL 2MG/ML LIQ 120ML 119.699103482 HALOPERIDOL 5MG TABLET 19.509188228 HALOPERIDOL 5MG/1ML VIAL 72.869189523 HALOPERIDOL DECAN 50MG/ML INJ 160.069112871 HEALON 10 MG/ML SYRG 0.85ML 382.689190711 HEALON GV 14 MG/ML SYRG 0.85 420.189112871 HEALON5 23 MG/ML DISP SYRINGE 257.689191131 HEMIN 313 MG VIAL 5,347.799145152 HEPARIN 100 UNIT/ML 5ML SYRG 74.699145152 HEPARIN 10 UNIT/1ML INJ 39.119145152 HEPARIN 10 UNIT/ML 30ML VIAL 72.189145152 HEPARIN 10 UNITS/ML INJ 10ML 36.779183997 HEPARIN 10,000 UNITS/ 1ML INJ 87.269145152 HEPARIN 100 UNITS/ML INJ 10ML 71.819145046 HEPARIN 100 UNITS/ML PF 36.499151069 HEPARIN 1000 UNITS/500ML NS 118.409151044 HEPARIN 25,000 UNIT/250ML D5W 125.489151044 HEPARIN 25000U-1/2NS 250ML 121.899183997 HEPARIN 5,000 UNITS/0.5 ML INJ 77.119183997 HEPARIN 5,000 UNITS/ML INJ 72.069183997 HEPARIN NA 1,000U/ML 10ML VIAL 87.929183997 HEPARIN NA 1000 UNITS/ML 30ML 39.489145152 HEPARIN PF 10 UNIT/1ML SYR 40.319145152 HEPARIN PF 100 UNIT/ML 5ML SYR 77.609183997 HEPARIN PF 2000 UNIT/2ML INJ 102.369112871 HEPARIN PF 250UNITS/250ML D10W 118.279112871 HEPARIN PF 250UNITS/NS 250ML 117.399145046 HEPARIN PF 2UNITS/2ML SYRINGE 6.509145046 HEPARIN PF 30UNITS/3ML SYRINGE 41.239186180 HEPATITIS A VACC PF 1ML 223.839186180 HEPATITIS A VIRUS VACCINE 1ML 201.189194002 HEPATITIS B IMM GLOB 0.5ML 547.119112871 HEPATITIS B IMM GLOB 5ML 1,959.799194002 HEPATITIS B IMMUNE GLOB IJ 1ML 685.919186198 HEPATITIS B VACC 5MCG/.5ML INJ 131.149147182 HETASTARCH 6%/NS 500ML BAG 162.879305053 HIP IRRG SOLN 500ML 165.279173352 HOMATROPINE 5% OPHT SOL 5ML 61.55


of 196


CALCULATED PRICE

9186222 HUMAN PAPILLOMAVIRUS VAC 0.5ML 371.689170002 HURRICAINE 20% AEROSOL 60ML 109.499190984 HYALUDRONIDAS 240 UN/1.2ML VL 215.149189531 HYALURONATE 10MG/ML OPH 0.55ML 307.689190620 HYALURONIDASE 150UNITS/ML IJ 118.989158700 HYCODAN 5ML UD CUP 25.059158148 HYCODAN SYRUP 1ML 17.929158155 HYCOTUSS SYRUP 1ML 17.739114737 hydrALAZINE 10MG TABLET 17.999112871 hydrALAZINE 1MG/ML LIQ 1ML 17.589112871 hydrALAZINE 1MG/ML NS SYRG 143.029188277 hydrALAZINE 20MG/ML INJ 99.469103540 hydrALAZINE 25MG TABLET 18.269112871 hydrALAZINE 4MG/ML ORAL LIQ 17.589103557 hydrALAZINE 50MG TABLET 18.439112871 HYDROCHLOROTHIAZIDE 10MG/ML PO 17.859114711 HYDROCHLOROTHIAZIDE 25MG TB 17.859114729 HYDROCHLOROTHIAZIDE 50 MG TB 17.909112871 HYDROcod/APAP 10/325 #2 (TKHM) 0.009112871 HYDROcod/APAP LIQ 30ML (TKHOME 0.009112871 HYDROcodone 5/325 #2 TKHM 0.009159013 HYDROcodone W/APAP LIQ 15ML UD 41.299112871 HYDROcodone/APAP #6 TAKEHOME 33.759155664 HYDROcodone/APAP 10/325 TABLET 39.899155839 HYDROcodone/APAP 5/325 TAB 36.399155920 HYDROcodone/APAP 7.5/325 TAB 38.569155763 HYDROcodone/IBU 7.5/200 TAB 37.759128414 HYDROCORT 1% RECTAL CRM 30GM 128.179128448 HYDROCORT 2.5% RECTAL CRM 30GM 109.359169301 HYDROCORTISONE 0.2% CRM 45GM 107.799169392 HYDROCORTISONE 0.5% CRM 30GM 0.009169376 HYDROCORTISONE 1% CREAM 30GM 48.769169400 HYDROCORTISONE 1% OINT 28GM 49.739170465 HYDROCORTISONE 10% RECTAL 15GM 315.739128141 HYDROCORTISONE 100MG ENEMA 59.339103599 HYDROCORTISONE 10MG TABLET 18.059169418 HYDROCORTISONE 2.5% CRM 30GM 43.149169806 HYDROCORTISONE 2.5% LOT 118ML 188.079168725 HYDROCORTISONE 2.5% OINT 30GM 43.149112871 HYDROCORTISONE 2MG/ML ORAL LIQ 18.059188285 HYDROCORTISONE SS 100MG VIAL 79.889188285 HYDROCORTISONE SS 100MG/2ML IJ 74.669163395 HYDROCORTISONE SS 1MG/ML in D5 144.849189796 HYDROCORTISONE SS 250MG VIAL 87.639189796 HYDROCORTISONE SS 250MG/2ML VL 105.079188293 HYDROCORTISONE SS 500MG INJ 108.909169590 HYDROGEN PEROXIDE 3% SOL 120ML 36.559163130 HYDROmorphone 1 - 4MG INJ 115.91


of 196


CALCULATED PRICE

9163130 HYDROmorphone 10MG/ML INJ 112.359163130 HYDROmorphone 1-2MG INJ 107.939163395 HYDROmorphone 1MG/ML INJ 107.359155334 HYDROmorphone 2MG TABLET 36.349163130 HYDROmorphone 2MG/ML INJ 109.179163130 HYDROmorphone 30MG/30ML NS PCA 226.459128042 HYDROmorphone 3MG SUPPOS 59.629163395 HYDROmorphone 4 MG/ML SYRIN 108.349155342 HYDROmorphone 4MG TABLET 36.999163130 HYDROmorphone 4MG/ML INJ 108.989163130 HYDROmorphone 50MG/100ML NS 228.379163130 HYDROmorphone 50MG/5ML INJ 138.859166257 HYDROmorphone 6MG/30ML PCA 190.459103615 HYDROXYCHLOROQUINE 200MG TB 20.019197070 HYDROXYUREA 500MG CAPSULE 37.749179680 hydrOXYzi HCL 2MG/ML LIQ 120ML 47.849190455 hydrOXYzine 100MG/2ML INJ 80.189190455 hydrOXYzine 25 MG/1ML VL 77.689103649 hydrOXYzine HCL 10MG TABLET 18.809114752 hydrOXYzine HCL 25MG TABLET 19.389114760 hydrOXYzine HCL 50 MG TABLET 19.789187832 hydrOXYzine HCL 50MG INJ 73.749108465 hydrOXYzine PAM 25MG CAPSULE 18.159108465 hydrOXYzine PAM 50MG #4 TKHM 0.009108465 hydrOXYzine PAM 50MG CAPSULE 18.199180340 HYOSCYAMINE 0.125 MG/ML DROP 119.079191065 HYOSCYAMINE 0.5MG/1ML INJ 146.589113713 HYOSCYAMINE SL 0.125MG TABLET 19.279102435 HYOSCYAMINE SR 0.375MG CAP 19.899175365 HYPROMELLOSE 2.5% OP SOL 15ML 57.479147638 HYSKON IRRIG SOLN 100ML 90.289190554 IBANDRONATE 3MG/3 ML SYR INJ 1,141.739137340 IBUPROFEN 100MG/5ML UD CUP 0.009103664 IBUPROFEN 200MG TABLET 0.009112871 IBUPROFEN 20MG/ML ORAL LIQ 1ML 17.699303664 IBUPROFEN 20MG/ML ORAL LIQ 1ML 17.699114778 IBUPROFEN 400MG TABLET 17.989103680 IBUPROFEN 600MG TABLET 18.169114786 IBUPROFEN 800MG TABLET 18.169190158 IBUPROFEN LYSIN/PF 20MG/2ML IJ 1,308.489190158 IBUPROFEN LYSIN/PF 20MG/2ML IJ 1,378.669189366 IBUTILIDE 1MG/10ML INJ 1,173.729316258 IDArubicin 5MG/5ML INJ 906.889316225 IFOSFAMIDE 1GM INJ 953.769112871 ILEX SKIN PROTECTANT PASTE 60G 44.199197310 IMATINIB 100MG TABLET 82.379197559 IMATINIB 400 MG TABLET 508.379191305 IMIGLUCERASE 400 UNITS VIAL 4,010.20


of 196


CALCULATED PRICE

9305723 IMIPENEM/CILAS 250MG/100ML MB+ 146.919305723 IMIPENEM/CILAS 500MG MB+ 185.639305723 IMIPENEM/CILASTATIN 250 MG IJ 79.899112871 IMIPENEM/CILASTATIN 5MG/ML SYR 35.899305723 IMIPENEM/CLIASTATIN 500MG INJ 184.949103730 IMIPRAMINE 10MG TABLET 18.419103748 IMIPRAMINE 25MG TABLET 19.309194119 IMMUNE GLOB (HUMAN) 10% INJ 3,196.939194168 IMMUNE GLOB 10% 100ML 3,059.319194218 IMMUNE GLOB 10% 200ML 6,042.949194218 IMMUNE GLOB 10% 50ML 1,773.929112871 IMMUNE GLOB GAMMA IVIG 10ML 925.269194119 IMMUNE GLOB HUMAN 5% IJ 200ML 2,318.539194119 IMMUNE GLOB HUMAN 5% IJ 400ML 4,382.919194119 IMMUNE GLOB HUMAN 5% IJ 5GM 1,334.729194119 IMMUNE GLOB HUMAN 5% INJ 449.299194119 IMMUNE GLOB,HUMAN 10% (IVIG) 1,334.729194150 IMMUNE GLOB,HUMAN 6GM VIAL 1,562.919194168 IMMUNE GLOBULIN 10% 50ML 1,682.919194184 IMMUNE GLOBULIN,GAMMA(IGG)2ML 476.629112871 INAMRINONE 100 MG/20 ML VIAL 396.569103722 INDAPAMIDE 2.5MG TABLET 19.269188327 INDIGO CARMINE 0.8% INJ 86.889197138 INDINAVIR 400MG CAPSULE 23.749190133 INDOMETHACIN 1MG/ML in D5W 205.179114828 INDOMETHACIN 25MG CAPSULE 18.359180076 INDOMETHACIN 25MG/5ML 120ML 86.389103821 INDOMETHACIN 50MG CAPSULE 18.919190133 INDOMETHACIN I.V. 1MG INJ 134.999189358 inFLIXimab 10MG INCREMENT INJ 297.159112871 INFLUENZA VIRUS VACCINE 87.689145160 INSULIN ASPART 100UNIT/ML VIAL 369.309145160 INSULIN HumaLOG INJ PER DOSE 9.079183278 INSULIN HUMAN 70/30 100UN/ML 0.009145202 INSULIN LISPRO 100UNIT/ML 10ML 369.329145343 INSULIN LISPRO 100unit/mL 3mL 159.929145160 INSULIN NPH 70/30 10ML 229.279112871 INSULIN NPH HUMAN 100 UN/ML VL 229.279145160 INSULIN NPH HUMAN PER DOSE 8.939145160 INSULIN REG HUMAN 100UN/ML PD 8.939190703 INSULIN REG HUMAN 10ML VIAL 168.799190703 INSULIN REG HUMAN 3ML VIAL 117.919145160 INSULIN REG*DILUTE*1UN/ML 10ML 71.219145160 INSULIN, GLARGINE VIAL 10ML 348.719145160 INSULIN,GLARG 100UNITS/ML 3ML 170.429145160 INSULIN,HUMAN 70/30 MIX PD 8.939145160 INSULN HumaLMIX 75/25 INJ 10ML 369.329199076 INTERFERON ALFA2B 10MUNITS IJ 553.72


of 196


CALCULATED PRICE

9199076 INTERFERON ALFA2B 50 MILLUNIT 2,207.459190539 INTERFERON BETA-1A 30 MCG IJ 2,229.589190323 INTERFERON BETA-1B 0.3MG INJ 230.389179011 IODINE MILD TINCTURE 480ML 89.899112871 IOHEXOL 300 MG/ML 50ML VIAL 161.989137076 IPECAC SYRUP 30ML UD CUP 26.959191297 IPILIMUMAB 50 MG/10 ML VIAL 15,254.089132051 IPRATROPIUM 0.02% SOLN 2.5ML 21.079174756 IPRATROPIUM 0.03% SPRAY 30ML 264.459174764 IPRATROPIUM 0.06% SPRAY 15ML 231.669173162 IPRATROPIUM HFA MDI 12.9GM 521.249108515 IRBESARTAN 150MG TABLET 24.499114844 IRBESARTAN 75MG TABLET 24.149316506 IRINOTECAN 20MG/ML INJ 687.289190331 IRON DEXTRAN 100MG/2ML VIAL 215.769112871 IRON DEXTRAN 10MG/ML in NS 178.069112871 IRON DEXTRAN 25MG/ML in NS 178.069190349 IRON SUCROSE CMPLX 100MG/5ML 190.189182080 ISOFLURANE 100ML 118.989114851 ISONIAZID 100 MG TABLET 17.759179730 ISONIAZID 10MG/ML SYRUP 120ML 68.129103847 ISONIAZID 300MG TABLET 17.859169848 ISOPROPYL ALCOHOL 70% 480ML 37.579310707 ISOPROTERENOL 1MG/5ML INJ 181.149103862 ISOSORBIDE DN 10MG TABLET 17.919103870 ISOSORBIDE DN 20MG TABLET 18.009116443 ISOSORBIDE DN 40MG SR TAB 19.249116443 ISOSORBIDE DN 40MG TAB 22.259103854 ISOSORBIDE DN 5MG TABLET 17.879103888 ISOSORBIDE DN SL 5MG TABLET 17.969107152 ISOSORBIDE MON 20MG TABLET 19.649108424 ISOSORBIDE MON SR 60MG TABLET 20.289107160 ISOSORBIDE MONO SR 30MG TABLET 21.519188889 ISOSULFAN BLUE 1% 5ML VIAL 1,579.849190802 ISOVUE-300 61% VIAL 180.159112871 ISOVUE-M 200 41% VIAL 286.229114877 ISRADIPINE 2.5MG CAPSULE 20.249103672 ITRACONAZOLE 100MG CAPSULE 53.129179441 ITRACONAZOLE 10MG/ML LIQ 150ML 543.719109943 IVERMECTIN 3MG TABLET 28.909316738 IXABEPILONE 1MG (15MG VIAL) 763.80991 K (for Neonatal TPN) 70.189310160 K ACET 40MEQ/20ML INJ 38.299112871 K ACETATE 0.05MEQ/ML in D5W 39.099112871 K ACETATE 0.1MEQ/ML in D5W 41.099109588 K BICARB EFF 25MEQ TAB 18.609178377 K IODIDE 1GM/ML SOLN 30ML 76.139312257 K PHOS 10MMOL/250ML NS PMX 108.12


of 196


CALCULATED PRICE

9301888 K PHOS 3MMOL/ML ORAL LIQ 1ML 17.749120247 KALETRA 100-25 MG TABLET 24.939118274 KALETRA 200/50 MG TABLET 32.319312315 KANAMYCIN 1GM/3ML INJ 48.959179524 KAOPECTATE SUSP 240ML 41.559178278 KAYEXYLATE 15 GM/60 ML 51.899112871 KCL 0.05MEQ/ML in D5W 36.099112871 KCL 0.1MEQ/ML in D5W 36.099137134 KCL 10% 20MEQ/15ML UCUP 18.679137142 KCL 10% 40MEQ/30ML UD 19.119190646 KCL 10MEQ/100ML SW PMX 130.069190646 KCL 10MEQ/20ML SW SRYG 107.439190646 KCL 20MEQ/10ML VIAL 36.179158619 KCL 2MEQ/ML ORAL LIQ 1ML 17.669147562 KCL 40MEQ IN D5W & LACT RINGER 113.379105289 KCL SR 10MEQ CAP 19.229118183 KCL SR 10MEQ TAB 18.229312273 KCL10MEQ/LIDOC 10MG/100ML NS 110.999163361 KETAMINE 10 MG/ML 20ML VL 144.879163387 KETAMINE 100MG/ML VIAL 129.439112871 KETAMINE 2MG/ML in D5W 141.779163379 KETAMINE 500MG/10ML INJ 121.379169582 KETOCONAZOLE 2% CREAM 15GM 68.019170093 KETOCONAZOLE 2% SHAMPOO 120ML 86.939114919 KETOCONAZOLE 200MG TABLET 23.879173444 KETOROLAC 0.5% OPHTH SOLN 5ML 326.049103714 KETOROLAC 10MG TABLET 19.419188079 KETOROLAC 15 MG/1ML VL 77.509188079 KETOROLAC 30MG/ML INJ 73.849188079 KETOROLAC 60MG/2ML INJ 82.389175522 KETOTIFEN 0.025% OP 5ML 58.889103987 LABETALOL 100MG TABLET 18.519183112 LABETALOL 100MG/20ML INJ 82.389112871 LABETALOL 10MG/ML ORAL SUSP 18.519103961 LABETALOL 200MG TABLET 18.919194176 LABETALOL 20MG/4ML INJ 79.709156175 LACOSAMIDE 50 MG TABLET 46.539173378 LACRI-LUBE OPHTH OINT 48.319147141 LACTATED RINGERS 1000ML 122.999147141 LACTATED RINGERS INJECTION 122.999113259 LACTOBACILLUS ACIDOPH PACKET 18.939103979 LACTOBACILLUS CHEW TABLET 17.869137092 LACTULOSE 20GM/30ML UDCUP 23.519180431 lamiVUDine 10MG/ML LIQ 240ML 283.439197211 lamiVUDine 150MG TABLET 33.079108028 lamoTRIgine 100MG TABLET 31.529112871 lamoTRIgine 1MG/ML ORAL SUSP 23.279108036 lamoTRIgine 25MG TABLET 29.78


of 196


CALCULATED PRICE

9171208 LANOLIN OINTMENT 0.009191370 LANREOTIDE 120 MG/0.5 ML SYRGE 9,944.869107434 LANSOPRAZOLE 15MG SR CAP 29.559108044 LANSOPRAZOLE 30MG CAPSULE 29.559117227 LANSOPRAZOLE 30MG ODT DR TAB 24.439112871 LANSOPRAZOLE 3MG/ML ORAL SUSP 19.079301995 LANSOPRAZOLE 3MG/ML ORAL SUSP 19.079118498 LANSOPRAZOLE ODT 15MG DR TAB 33.679118076 LANTHANUM 500 MG CHEWTAB 35.499174715 LATANOPROST 0.005% OPHT 2.5ML 268.049116450 LEFLUNOMIDE 10MG TABLET 79.109108929 LEFLUNOMIDE 20MG TABLET 79.109188632 LEPIRUDIN 50MG INJ 1,383.509170937 LET GEL (sterile) 3ML 57.579170481 LET SOLUTION 5ML 25.859109984 LETROZOLE 2.5MG TABLET 58.529101957 LEUCOVORIN CALCIUM 25MG TAB 44.939189226 LEUCOVORIN CALCIUM 50MG INJ 150.109101940 LEUCOVORIN CALCIUM 5MG TAB 24.059316431 LEUPROLIDE ACET 22.5MG 3MO IJ 5,073.409316431 LEUPROLIDE ACET 30MG-4 MON IJ 7,285.069316530 LEUPROLIDE ACETATE 3.75MG IJ 1,469.699316431 LEUPROLIDE DEPOT 7.5MG KIT 2,191.399132267 LEVABUTEROL 1.25MG/3ML IH SOLN 32.709132069 LEVALBUTEROL 0.63MG/3ML SOLN 32.709132267 LEVALBUTEROL 1.25MG/0.5ML INH 25.139175563 LEVALBUTEROL HFA INHALER 152.219180084 LEVETIRACETAM 100MG/ML 120ML 329.799112871 LEVETIRACETAM 100MG/ML 30ML 108.779132291 LEVETIRACETAM 10MG/2ML SYRG 143.639108945 LEVETIRACETAM 500MG TABLET 21.599112871 LEVETIRACETAM 500MG TB#2 TKHM 0.009132291 LEVETIRACETAM 500MG/5ML IJ 178.889138165 LEVETIRACETAM 500MG/5ML UD CUP 36.259173402 LEVOBUNOLOL 0.25% OPHT SOL 5ML 66.739173386 LEVOBUNOLOL 0.5% OPHT SOL 5ML 83.459310467 LEVOCARNITINE 1000MG/5ML VIAL 191.609300724 LEVOCARNITINE 100MG/ML LIQ 18.149175571 LEVOFLOXACIN 1.5% DROPS 5ML 222.129108051 LEVOFLOXACIN 250MG TABLET 36.259305806 LEVOFLOXACIN 250MG/50ML D5W 149.099107822 LEVOFLOXACIN 500MG TABLET 38.849306960 LEVOFLOXACIN 500MG/100ML D5W 192.919306960 LEVOFLOXACIN 500MG/20ML INJ 192.919112871 LEVOFLOXACIN 5MG/ML in D5W syr 35.959117300 LEVOFLOXACIN 750 MG TABLET 57.699306960 LEVOFLOXACIN 750MG/150ML D5W 221.599109653 LEVONORGESTROL 0.75MG TAB #2 74.74


of 196


CALCULATED PRICE

9155326 LEVORPHANOL 2MG TABLET 19.699114976 LEVOTHROID 200 MCG TABLET 18.379103995 LEVOTHYROXINE 0.025MG TABLET 18.209114943 LEVOTHYROXINE 0.05MG TABLET 18.039104001 LEVOTHYROXINE 0.075MG TABLET 18.219104043 LEVOTHYROXINE 0.088MG TABLET 18.109104027 LEVOTHYROXINE 0.112MG TABLET 18.159104035 LEVOTHYROXINE 0.125MG TABLET 18.199114950 LEVOTHYROXINE 0.15MG TABLET 18.219109547 LEVOTHYROXINE 0.175MG TABLET 18.299104019 LEVOTHYROXINE 100MCG TABLET 18.109112871 LEVOTHYROXINE 100MCG VIAL 204.389118159 LEVOTHYROXINE 137 MCG TAB 18.459188343 LEVOTHYROXINE 200MCG INJ 118.989188343 LEVOTHYROXINE 200MCG/5ML INJ 314.189301797 LEVOTHYROXINE 25MCG/ML LIQ 18.209188350 LEVOTHYROXINE 500MCG VIAL 182.889183187 LIDO 0.5%/EPI 1:200000 50ML 77.189189432 LIDO 1.5%/EPI 1:200000 10ML 87.149170630 LIDOCAINE 2% JELLY UROJET 50.739183120 LIDOCAINE 0.5% 50ML INJ 77.169183138 LIDOCAINE 1% INJ 20ML 76.189183195 LIDOCAINE 1%/EPI 1:100000 20ML 74.829190828 LIDOCAINE 1%-EPI 1:200,000 30M 79.099183229 LIDOCAINE 1.5% EPI 1:200 30ML 86.779190943 LIDOCAINE 2% - EPI 1:100 1.7ML 71.149187857 LIDOCAINE 2% 100MG/5ML SYRINGE 86.589183161 LIDOCAINE 2% INJ 20ML 70.969170168 LIDOCAINE 2% JELLY 30ML 76.579168816 LIDOCAINE 2% JELLY 5ML 20.679137290 LIDOCAINE 2% VISC 20ML UDCUP 20.919183203 LIDOCAINE 2%/EPI 1:100000 20ML 73.409151390 LIDOCAINE 2GM/250ML D5W PREMIX 138.169132309 LIDOCAINE 2GM/500ML D5W 138.169171240 LIDOCAINE 4% TOP 20ML 47.719169442 LIDOCAINE 4% TOPICAL SOLN 50ML 66.659189465 LIDOCAINE 5% IN D7.5W INJ 2ML 75.589169434 LIDOCAINE 5% OINTMENT 35.44GM 181.499171190 LIDOCAINE 5% PATCH 34.909190810 LIDOCAINE MPF 1% 10ML 78.189188368 LIDOCAINE MPF 1% 2ML INJ 72.259183146 LIDOCAINE MPF 1% 30ML 83.309189614 LIDOCAINE MPF 1% INJ 5ML 75.699189622 LIDOCAINE MPF 2% 10ML VIAL 76.269190752 LIDOCAINE MPF 2% 2ML VIAL 76.439188897 LIDOCAINE MPF 2% 5ML 75.969189630 LIDOCAINE MPF 2%/EPI 10ML 88.339183872 LIDOCAINE MPF 2%EPI 1:200 20ML 102.94


of 196


CALCULATED PRICE

9188384 LIDOCAINE MPF 4% INJ 5ML 74.809179789 LIDOCAINE VISCOUS 2% 100ML 41.939188400 LIDOCAINE-MPF 1.5% INJ 20ML 99.269170838 LIDOCAINE-PRILOCAINE CREAM 115.029180415 LINEZOLID 100MG/5ML SUSP 150ML 1,223.869191255 LINEZOLID 2MG/ML in SWFI 141.159109257 LINEZOLID 600MG TABLET 255.299306978 LINEZOLID 600MG/300ML SW IV 384.899104092 LIOTHYRONINE 25MCG TABLET 18.819104084 LIOTHYRONINE 5MCG TABLET 18.609104126 LIOTRIX 120MG TABLET 19.379104134 LIOTRIX 180MG TABLET 19.779104118 LIOTRIX 60MG TABLET 19.109103805 LISINOPRIL 10MG TABLET 19.789103813 LISINOPRIL 20MG TABLET 19.579116989 LISINOPRIL 40 MG TABLET 20.399103797 LISINOPRIL 5MG TABLET 19.719113424 LISINOPRIL/HCTZ 20/12.5 TABLET 21.419109976 LISINOPRIL/HCTZ 20/25 TABLET 21.469179037 LITHIUM 1.6MEQ/ML LIQ 120ML 68.649104167 LITHIUM CARB SR 300MG TABLET 18.449104159 LITHIUM CARB SR 450MG TABLET 18.699104175 LITHIUM CARBONATE 150MG CAP 17.939115007 LITHIUM CARBONATE 300MG CAP 17.979174996 LODOXAMIDE 0.1% OPHTH SOL 10ML 285.439103763 LOPERAMIDE 2MG CAPSULE 18.969137191 LOPERAMIDE 2MG/10ML UDCUP 20.299104209 LORATADINE 10MG TABLET 19.269163254 LORazepam 20MG/10ML INJ 224.599163254 LORazepam 2MG/ML INJ 122.039155060 LORazepam 0.5MG TABLET 36.489112871 LORazepam 0.5mg TB#2 TKHM 0.009155078 LORazepam 1MG TABLET 36.909155086 LORazepam 2MG TABLET 37.469158080 LORazepam INT 2MG/ML LIQ 1ML 20.759180720 LORazepam INT 2MG/ML LIQ 30ML 201.339163254 LORazepam-NS 100 MG/100 ML BAG 175.459108085 LOSARTAN 25MG TAB 20.919107327 LOSARTAN 50MG TABLET 22.089175001 LOTEPREDNOL 0.2% OPHTH SOL 5ML 303.059175019 LOTEPREDNOL 0.5% OPHTH SOL 5ML 292.759108093 LOVASTATIN 10 MG TABLET 20.249104233 LOVASTATIN 20MG TABLET 22.929118167 LUBIPROSTONE 24MCG CAP 26.769194010 LYMPHOCYTE IMMUNE GLOB 250MG 1,982.469168329 MAFENIDE 8.5% CREAM 453.6GM 343.539307109 MAG SULF 1GM/100ML D5 PMX 119.479112871 MAG SULF 20GM/500ML PREMIX 118.54


of 196


CALCULATED PRICE

9137282 MAG-AL SUSP 30ML UDCUP 0.009199035 MAGIC MOUTHWASH 120ML 53.099307109 MAGN SULF 4GM/50ML SW PMX 120.429115122 MAGNESIUM GLUC 500MG TAB 17.909311168 MAGNESIUM 2GM/SWFI 50ML 125.099151408 MAGNESIUM 40GM/1000ML PREMIX 124.979311176 MAGNESIUM 4GM/100ML SWFI 121.039115114 MAGNESIUM CHLORIDE SR 64MG TAB 17.799178120 MAGNESIUM CITRATE SOLN 300ML 38.299104290 MAGNESIUM OXIDE 400MG TABLET 18.049112871 MAGNESIUM PROTOCOL 0.009112871 MAGNESIUM SULF 25MG/ML in D5W 140.529308016 MAGNESIUM SULF 3GM/50ML NS 131.509112871 MAGNESIUM SULF 500MG/ML LIQ 18.149307109 MAGNESIUM SULFATE 1GM/2ML VIAL 108.159307109 MAGNESIUM SULFATE 8MEQ/2ML INJ 106.459307109 MAGNESIUM-D5W 1 GRAM/50 ML 125.099130121 MAGNEVIST VIAL 175.109151010 MANNITOL 20% IV SOLN 500ML 255.049310509 MANNITOL 25% 50ML VIAL 77.139173394 MAXITROL OPHTH OINT 3.5GM 252.139186024 MEASLES,MUMPS&RUBELLA VACCINE 130.969115171 MEBENDAZOLE 100MG CHEW TABLET 30.319316423 MECHLORETHAMINE 10MG INJ 639.369104365 MECLIZINE 12.5MG TABLET 18.989104373 MECLIZINE 25MG TABLET 19.289178328 MEDIUM CHAIN TRIGLYCERIDE 30ML 38.549190190 medroxyPROGESTE 400MG/ML 2.5ML 522.399187931 medroxyPROGESTERo 150MG/ML INJ 182.409115205 medroxyPROGESTERone 10MG TB 18.499104399 medroxyPROGESTERone 2.5MG 18.159108101 medroxyPROGESTERone 5MG TAB 18.459117383 MEGESTROL 400MG/10ML CUP 26.019117383 MEGESTROL 40MG TABLET 19.699113481 MELATONIN 3MG TABLET 17.679109802 MELOXICAM 7.5MG TABLET 23.899104415 MELPHALAN 2MG TABLET 28.919316217 MELPHALAN 50 MG VIAL 4,305.289100777 MEMANTINE 10MG TABLET 26.699118407 MEMANTINE 5MG TAB 26.699190950 MENINGOCOCCAL POLYSACC VAC 346.369186248 MENNINGOCCAL VAC 335.929163197 MEPERIDINE 100MG/ML INJ 107.939158452 MEPERIDINE 10MG/ML SYRUP 1ML 17.939163155 MEPERIDINE 25 - 50MG INJ 107.939163171 MEPERIDINE 25 - 75MG INJ 107.939163148 MEPERIDINE 25MG/1ML INJ 107.179163197 MEPERIDINE 300MG/30ML NS PCA 199.05


of 196


CALCULATED PRICE

9163171 MEPERIDINE 50 - 75MG INJ 107.939163197 MEPERIDINE 50 -100MG INJ 107.939155359 MEPERIDINE 50MG TABLET 36.489163155 MEPERIDINE 50MG/1ML INJ 106.639163197 MEPERIDINE 75 - 100MG INJ 107.939163171 MEPERIDINE 75MG/ML INJ 107.339184003 MEPIVACAINE 1% INJ 30ML 86.779184003 MEPIVACAINE 1.5% INJ 30ML 92.689184003 MEPIVACAINE 2% INJ 20ML 88.609106840 MEPROBAMATE 400MG TABLET 38.759197120 MERCAPTOPURINE 50MG TABLET 43.079306986 MEROPENEM 1GM INJ 198.849312026 MEROPENEM 20MG/ML in NS 38.219128455 MESALAMINE 1000 MG SUPP 61.009107392 MESALAMINE 250MG SR CAP 18.759128067 MESALAMINE 4GM/60ML ENEMA 65.579104894 MESALAMINE CR 400MG TABLET 19.439316233 MESNA 200MG/2ML INJ 225.969112871 MESSAGE 0.009104423 METAPROTERENOL 10MG TABLET 19.559174939 METAPROTERENOL 650MCG INH 14GM 125.139117268 METAXALONE 800 MG TABLET 28.099107467 metFORMIN 500MG TABLET 18.969107293 metFORMIN 850MG TABLET 19.949109315 metFORMIN XR 500MG TABLET 19.879138033 METHACHOLINE 100 MG VIAL 123.099155367 METHADONE 0.5MG/ML ORAL SOLN 35.219155367 METHADONE 10MG TABLET 35.969163106 METHADONE 10MG/ML INJ 106.869155367 METHADONE 40MG DISPERS TAB 35.759155367 METHADONE 5MG TABLET 35.869155367 METHADONE INT 10MG/1ML PO SYR 36.789155367 METHADONE INT 10MG/ML LIQ 1ML 19.249113473 METHAZOLAMIDE 25MG TABLET 18.519104431 METHAZOLAMIDE 50MG TABLET 23.309104449 METHENAMINE HIP 1GM TABLET 23.169104456 METHENAMINE MAN 1GM TABLET 18.619104464 METHENAMINE MD 500MG EC TAB 18.219106501 METHIMAZOLE 10MG TABLET 19.099104472 METHIMAZOLE 5MG TABLET 18.449183542 METHOCARBAMOL 1000MG/10ML INJ 101.289115239 METHOCARBAMOL 500MG TABLET 18.579104480 METHOCARBAMOL 750MG TABLET 18.549163098 METHOHEXITAL 500MG INJ 170.099197088 METHOTREXATE 2.5MG TABLET 42.539316688 METHOTREXATE 50MG/2ML PF INJ 623.849109463 METHYCELLULOSE PACKET 18.109104522 methylDOPA 250MG TABLET 18.29


of 196


CALCULATED PRICE

9104530 methylDOPA 500MG TABLET 18.909310731 methylDOPATE 250MG/5ML INJ 165.369188426 METHYLENE BLUE 1% VIAL 84.189104548 methylERGONOVINE 0.2MG TABLET 21.039187691 methylERGONOVINE 0.2MG/ML INJ 89.389190661 METHYLNALTREXONE 12MG/0.6ML IJ 182.429155417 METHYLPHENIDATE 10MG TABLET 36.419155409 METHYLPHENIDATE 5MG TABLET 36.039187154 methylPREDNIS ACET 40MG/ML INJ 88.559187162 methylPREDNIS ACET 80MG/ML INJ 102.059112871 methylPREDNIS SS 10MG/ML IN NS 140.789183294 methylPREDNISolon SS 500MG INJ 97.739104555 methylPREDNISolone 4MG TAB 20.419183294 methylPREDNISolone SS 125MG IJ 81.859183294 methylPREDNISolone SS 125MG VL 81.789183294 methylPREDNISolone SS 1GM INJ 136.469187881 methylPREDNISolone SS 40MG INJ 77.429187881 methylPREDNISolone SS 40MG/ML 74.389174657 METIPRANOLOL 0.3% OPHT SOL 5ML 84.659188434 METOCLOPRAMIDE 0.5MG/ML in NS 142.719104571 METOCLOPRAMIDE 10MG TABLET 18.189137167 METOCLOPRAMIDE 10MG/10ML CUP 19.719188434 METOCLOPRAMIDE 10MG/2ML INJ 145.069104563 METOCLOPRAMIDE 5MG TABLET 18.369112871 METOLAZONE 1MG/ML ORAL SUSP 20.029104589 METOLAZONE 2.5MG TABLET 20.029104597 METOLAZONE 5MG TABLET 20.299115288 METOPROLOL 100MG TAB 19.209116666 METOPROLOL 25 MG TABLET 18.049104605 METOPROLOL 50MG TABLET 18.699188442 METOPROLOL 5MG/5ML INJ 77.069116955 METOPROLOL XL 100MG SR TAB 20.269109901 METOPROLOL XL 25MG SR TAB 20.339115296 METOPROLOL XL 50MG TABLET 20.339170796 metroNIDAZOLE GEL 0.75% 45GM 368.599170788 metroNIDAZOLE 0.75% CRM 45GM 895.439170036 metroNIDAZOLE 0.75% VAG 70GM 124.739112871 metroNIDAZOLE 15MG/ML ORAL LIQ 18.139104639 metroNIDAZOLE 250MG TABLET 18.709104621 metroNIDAZOLE 500MG TABLET 19.219305541 metroNIDAZOLE 500MG/100ML 124.429305541 metroNIDAZOLE 5mg/ml variable 124.119170820 metroNIDAZOLE TOP GEL 1% 60GM 532.979104498 MEXILETINE 150MG CAPSULE 18.939168345 MICONAZOLE 2% CREAM 15GM 74.379170853 MICONAZOLE 2% CRM 142GM 61.379169475 MICONAZOLE 2% CRM 28GM 41.699168410 MICONAZOLE 2% EX THICK CRM 92G 64.35


of 196


CALCULATED PRICE

9170150 MICONAZOLE 2% POWDER 45GM 42.859169491 MICONAZOLE 2% VAG CRM 45GM 54.619128356 MICONAZOLE 3 200MG VAG SUPP #3 70.149128349 MICONAZOLE 7 100MG VAG SUPP #7 38.409158668 MIDAZOLAM 10 MG/5 ML SYRUP 35.099163668 MIDAZOLAM 10MG/10ML INJ 114.039163668 MIDAZOLAM 10MG/2ML VIAL 119.039158668 MIDAZOLAM 10MG/5ML LIQ UD 46.069163668 MIDAZOLAM 25MG/5ML VIAL 124.039163668 MIDAZOLAM 2MG/2ML VIAL 106.659158221 MIDAZOLAM 2MG/ML SYRUP 1ML 19.749163668 MIDAZOLAM 50MG/10ML INJ 142.799163668 MIDAZOLAM 5MG/5ML VIAL 109.899107533 MIDODRINE 2.5MG TABLET 20.619108408 MIDODRINE 5MG TABLET 23.719104654 MIDRIN CAPSULE 18.539180811 MILES SOLN 30ML 80.099112871 MILK OF MAGNESIA CONC. 10ML 0.009137100 MILK OF MAGNESIUM 30ML UDCUP 0.009310525 MILRINONE 10MG/10ML VIAL 154.489310525 MILRINONE 20MG/100ML D5W 400.499310525 MILRINONE 20MG/20ML INJ 129.119137126 MINERAL OIL 30ML UD CUP 18.799174780 MINERAL OIL LIGHT SOLN 10ML 37.799117011 MINOCYCLINE 100MG CAPSULE 24.349107004 MINOCYCLINE PELLETIZ 50MG CAP 20.959104688 MINOXIDIL 10MG TABLET 20.139104670 MINOXIDIL 2.5MG TABLET 18.739199035 MIRACLE MOUTHWASH 120ML 53.099116468 MIRALAX 17GM PACKET 21.539170770 MIRALAX POWDER 119GM 53.559107566 MIRTAZAPINE 15MG TABLET 23.099107574 MIRTAZAPINE 30MG TABLET 23.099113432 MIRTAZAPINE SOL 15MG TABLET 24.979113440 MIRTAZAPINE SOL 30MG TABLET 25.209108127 MISOPROSTOL 100MCG TABLET 21.369104274 MISOPROSTOL 200MCG TABLET 23.379109562 MISOPROSTOL 25MCG DOSE 20.359316134 MITOMYCIN 5MG INJ 750.729316324 MITOXANTRONE 20mg/10ml (5mg ) 827.589155888 MODAFINIL 100MG TABLET 43.479168808 MOMETASONE 0.1% CREAM 15GM 127.039170317 MOMETASONE 0.1% OINTMENT 15GM 127.039175548 MOMETASONE 220MCG INHL #14 78.409174483 MOMETASONE 50MCG NASAL 17GM 169.999107558 MONTELUKAST 10MG TABLET 30.339120551 MONTELUKAST 4 MG GRANULES 30.339108952 MONTELUKAST 4MG CHEW TAB 30.33


of 196


CALCULATED PRICE

9163445 morphine 1 - 10MG INJ 107.679163445 morphine 1 - 5MG INJ 107.679160060 morphine 10 MG SUPP 47.599163445 morphine 10 MG/1ML SYRINGE 108.479163445 MORPHINE 10 MG/ML AMPUL 107.569163684 morphine 100MG/100ML NS DRIP 227.539163445 morphine 10MG/ML INJ 106.999163445 morphine 15 MG/ML CARPUJET 108.259163445 morphine 15MG/ML 20ML VIAL 130.039163445 morphine 2 - 10MG INJ 107.679163445 morphine 2 - 4MG INJ 107.679163445 morphine 2 - 5MG INJ 107.679163445 morphine 2 - 6MG INJ 107.679163445 morphine 2 - 8MG INJ 107.679158023 morphine 20MG/ML LIQ 1ML (PYX) 18.799158676 morphine 20MG/ML PO LIQ 30ML 142.519158023 morphine 20MG/ML PO UD REPACK 19.239163445 morphine 2MG/ML INJ 107.479163445 morphine 30MG/30ML NS PCA 200.579163445 morphine 3-8MG INJ 107.679163445 morphine 4 - 8MG INJ 107.679163445 morphine 4MG/ML INJ 107.539163684 morphine 50MG/ML INJ 20ML 283.319163445 MORPHINE 8 MG/ML SYRINGE 108.479156068 morphine ER 30MG PELLET CAP 45.259163429 morphine PF 10MG/10ML INJ 123.739163445 morphine PF 1MG/2ML INJ 125.359163429 morphine PF 200MG/20ML INJ 417.279163692 morphine PF 2MG/2ML AMPUL 127.039163429 morphine PF 500MG/20ML AMP 667.279163429 morphine PF 5MG/10ML INJ 131.919155391 morphine SR 100MG TABLET 46.039155383 morphine SR 15MG TABLET 37.089155433 morphine SR 30MG CAP (24HR) 45.229155433 morphine SR 30MG TABLET 38.889155300 morphine SR 60MG TABLET 42.489158684 morphine SULF 10MG/5ML LIQ UD 36.639158742 morpine 0.2MG/0.5ML ORAL SOLN 35.409183419 MORRHUATE 50MG/ML INJ 30ML 245.189175373 MOXIFLOXACIN 0.5% OPH SOL 3ML 242.739115379 MOXIFLOXACIN 400MG TABLET 36.409307117 MOXIFLOXACIN 400MG/250ML PMX 225.769310301 MULTI-TRACE ELEMENTS INJ 37.589138181 MULTIVITAMIN LIQ 5ML UDCUP 19.559112871 MULTI-VITAMIN DROPS 1ML 17.989191156 MULTI-VITAMIN DROPS 1ML 17.989178427 MULTIVITAMIN LIQ 120ML 45.959100702 MULTIVITAMIN TABLET 0.00


of 196


CALCULATED PRICE

9310335 MULTIVITAMIN W/VIT K INJ 10ML 54.459109570 MULTIVITAMIN,THER W/MIN TABLET 0.009310640 MULTIVITS PEDI INJ 1ML 40.349191156 MULTIVITS W/ IRON DROPS 1ML 17.869170804 MUPIROCIN 2% CRM 15GM 162.219169574 MUPIROCIN 2% OINTMENT 22GM 210.659138041 MURO-128 5% EYE OINT 3.5GM 71.419174673 MURO-128 5% OPHTH SOL 15ML 71.419181132 MUTLIVIT W/MIN/FE LIQ 237ML 47.699106600 MYCOPHENOLATE 200MG/ML 175ML 2,260.329188673 MYCOPHENOLATE 500MG VIAL 227.279106600 MYCOPHENOLATE MOF 250MG CAP 29.909151556 NA BICARB 150MEQ/1L D5W 137.979151549 NA BICARB 75MEQ/1L 1/2 NS 137.239112871 NA CL 0.5MEQ/ML in D5W 36.509148032 NA PHOS 10MMOL/250ML IVPB 117.279106667 NABUMETONE 500MG TABLET 20.559190745 NACL 0.45%/KCL 10MEQ RX PMX 135.279151101 NACL 0.45%/KCL 20MEQ 1000ML 130.659310269 NACL 0.9% FLUSH (sterile field 43.899310269 NACL 0.9% FLUSH SYRG 10ML 39.499108150 NADOLOL 20MG TABLET 19.409104746 NADOLOL 40MG TABLET 19.719306771 NAFCILLIN 1 GM/ 50 ML D5W PMX 149.349305590 NAFCILLIN 1GM VIAL 134.479305590 NAFCILLIN 1GM/100ML NS MB+ 134.479305590 NAFCILLIN 2 GM INJ 161.919307059 NAFCILLIN 20MG/ML in D5W 35.989306770 NAFCILLIN 2GM/100ML D5 PMX 168.6993006770 NAFCILLIN 2GM/100ML NS MB+ 161.919187709 NALBUPHINE 10MG/ML INJ 72.469187709 NALBUPHINE 20 MG/ML AMPUL 76.899187709 NALBUPHINE 200 MG/10 ML VIAL 116.429190356 NALOXONE 0.4MG/ML INJ 72.989190356 NALOXONE 2MG/2ML INJ 80.169106576 NALTREXONE 50MG TABLET 26.109163619 NANDROLONE DE 200MG/2ML INJ 134.339173915 NAPHAZOL/ANTAZOL OPHT SOL 15ML 51.359174665 NAPHAZOLINE 0.1% OPHT SOL 15ML 49.359173873 NAPHAZOLINE/PHENIR OPHT 15ML 53.029108481 NAPROXEN 220MG TABLET 0.009104753 NAPROXEN 250MG TABLET 19.159104761 NAPROXEN 275MG TAB 19.249104779 NAPROXEN 375MG TABLET 19.749104787 NAPROXEN 500MG TABLET 20.239108499 NAPROXEN 550MG TAB 20.149190596 NATALIZUMAB 300MG/15ML IJ 9,112.229118209 NATEGLINIDE 60MG TAB 22.34


of 196


CALCULATED PRICE

9173980 NEDOCROMIL MDI 16.2GM 120.539103631 NEFAZODONE 100MG TABLET 20.599108168 NEFAZODONE 150MG TABLET 20.659316852 NELARABINE 250 MG/50ML IJ 2,073.019197005 NELFINAVIR 60MG TAB 23.789179136 NEOMYCIN 25MG/ML SOLN 120ML 62.749104795 NEOMYCIN 500MG TABLET 21.509173410 NEO-POLY-DEXAMTH OPSOL 5ML 216.879173485 NEOPSPORIN OPHTH OINT 3.5GM 148.999170127 NEOSPORIN G.U. IRRIGANT AMP 195.659172024 NEOSPORIN OINT PACKET 18.199169558 NEOSPORIN OINTMENT 30GM 50.279173477 NEOSPORIN OPHTH SOLN 10ML 163.049188467 NEOSTIGMINE 10MG/10ML VIAL 92.489175555 NEPAFENAC 0.1% OPSOL 3ML 347.659107335 NEPHROCAPS CAPSULE 0.009107111 NEPHRO-VITE TABLET 17.879190166 NESIRATIDE 1.5MG VIAL 478.369190166 NESIRITIDE 0.1 mg INJ 162.899190893 NEUT 4% VIAL 5ML 45.269112871 NEUTRA-PHOS 10MG/ML ORAL SUSP 18.429105644 NEUTRA-PHOS PACKET 18.609180423 NEVIRAPINE 10MG/ML ORAL SUSP 353.489197377 NEVIRAPINE 200MG TABLET 29.779170291 NEW SKIN LIQUID 2.55GM 0.009109372 NIACIN 250MG SR CAPSULE 17.679104837 NIACIN 500MG TABLET 17.649104829 NIACIN 50MG TABLET 17.599104837 NIACIN SR 500MG TABLET 17.679104852 niCARDipine 20MG CAPSULE 18.349148057 niCARDipine 20MG/200ML NS 379.069310913 niCARDipine 25MG/10ML INJ 641.639104845 niCARDipine 30MG CAPSULE 18.809152034 niCARDipine 40 MG/200 ML NS 652.859109992 niCARDipine SR 30MG CAPSULE 19.379107103 niCARDipine SR 45MG CAPSULE 20.439171067 NICOTINE 14MG PATCH 24.299171075 NICOTINE 21MG PATCH 25.829118456 NICOTINE 2MG GUM #1 18.739182098 NICOTINE 2MG GUM #12 36.279182098 NICOTINE 4MG GUM #10 36.059104860 NIFEdipine 10MG CAPSULE 18.889113721 NIFEdipine SR 30MG TABLET 19.869113739 NIFEdipine SR 60MG TABLET 22.819117003 NIFEdipine SR 90MG TAB 22.689115445 NIFEdipine XL 30MG SA TABLET 23.289104878 NIFEdipine XL 60MG SA TABLET 26.559113754 NIFEdipine XL 90MG SA TABLET 24.30


of 196


CALCULATED PRICE

9104902 niMODipine 30MG CAPSULE 35.849118217 NITAZOXANIDE 500MG TAB 71.399108689 NITROFURANTOIN MACRO 100MG CAP 26.119115452 NITROFURANTOIN MCR 100 MG CAP 21.289104910 NITROFURANTOIN MCR 50MG CAP 21.539179912 NITROFURATOIN 25MG/5ML 60ML 66.939171083 NITROGLYCERIN 0.1MG/HR PATCH 25.309171091 NITROGLYCERIN 0.2MG/HR PATCH 21.359112871 NITROGLYCERIN 0.3MG TAB#1 17.729182064 NITROGLYCERIN 0.4MG SPRAY 12GM 662.719120569 NITROGLYCERIN 0.4MG TAB 17.919171109 NITROGLYCERIN 0.4MG/HR PATCH 21.909112871 NITROGLYCERIN 0.6MG TAB#1 17.729171117 NITROGLYCERIN 0.6MG/HR PATCH 22.349172016 NITROGLYCERIN 2% OINT UD PKT 18.839170309 NITROGLYCERIN 2% OINT30GM 46.399310517 NITROGLYCERIN 50MG VIAL 133.399151085 NITROGLYCERIN 50MG/250ML D5W 127.899182015 NITROGLYCERIN SL 0.3MG TABLET 35.269182049 NITROGLYCERIN SL 0.4MG TABLET 44.219182007 NITROGLYCERIN SL 0.6MG TABLET 35.269104928 NITROGLYCERIN SR 2.5MG CAP 17.859104936 NITROGLYCERIN SR 6.5MG CAP 17.909118449 NITROGLYCERIN SR 9MG CAP 19.549171125 NITROLGYCERIN 0.3MG PATCH 26.379170887 NITROLINGUAL 0.4 MG SPRAY 4.9G 400.619310152 NITROPRUSSIDE 50MG/2ML VIAL 143.869115460 NIZATIDINE 150MG CAPSULE 23.849310434 norEPINEPHrine 4MG/4ML INJ 153.549152059 norEPINEPHrine-D5W 8 MG/250 ML 230.329148024 NORMOSOL-M/DEXTROSE 5% 1L 111.959147323 NORMOSOL-R 1000ML 111.419147323 NORMOSOL-R 1000ML 111.419147489 NORMOSOL-R/DEXTROSE 5% 1L 111.579147489 NORMOSOL-R/DEXTROSE 5% 1000ML 111.579104951 NORTRIPTYLINE 10MG CAP 18.449104969 NORTRIPTYLINE 25MG CAPSULE 19.329196098 NOVOSEVEN RT 1,000 MCG VIAL 3,562.679196114 NOVOSEVEN RT 2,000 MCG VIAL 6,790.919112871 NS w / KCL 10MEQ 1,000ML 135.279147554 NS w/20MEQ KCL 129.439147547 NS w/40MEQ KCL 1000ml 122.499148040 NTG 25MG/250ML D5W (CATH LAB) 121.389170812 NYSTATIN 100,000 UN/G CRM 15GM 38.029168352 NYSTATIN 100,000 UN/GM CRM 30G 87.599169616 NYSTATIN 100,000U/GM POW 15GM 90.019168444 NYSTATIN 100000UN/GM OINT 15GM 70.099300534 NYSTATIN 100000UN/ML ORAL SUS 18.10


of 196


CALCULATED PRICE

9137365 NYSTATIN 500000UNITS/5ML CUP 20.899128059 NYSTATIN VAGINAL TABLET 21.649169525 NYSTATIN/TRIAMCINO CREAM 30GM 41.689194200 OCTOGAM 10GM/200ML VIAL 2,510.919189945 OCTREOTIDE 0.05MG/ML INJ 89.009189945 OCTREOTIDE 1000MCG/5ML INJ 554.699189945 OCTREOTIDE 500MCG/ML INJ 246.389189945 OCTREOTIDE ACET 100 MCG/ML AMP 113.529190521 OCTREOTIDE LAR 10MG IJ 4,616.929190521 OCTREOTIDE LAR 20MG INJ 6,027.179190521 OCTREOTIDE LAR 30MG INJ 8,990.369113465 OCUVITE TABLET 17.839173691 OFLOXACIN 0.3% EAR DROPS 5ML 143.559174699 OFLOXACIN 0.3% OPHTH SOLN 5ML 166.149190679 OLANZapine 10MG VIAL 165.499109885 OLANZapine 2.5MG TAB 42.859103698 OLANZapine 5MG TABLET 47.419109216 OLANZapine ODT 10MG TAB 64.939109208 OLANZapine ODT 5 MG TABLET 49.809100728 OLMESARTAN 20MG TABLET 24.589100744 OLMESARTAN 5MG TABLET 23.289175092 OLOPATADINE 0.1% OP SOL 5ML 321.069105206 OLSALAZINE 250MG CAPSULE 20.039190489 OMALIZUMAB 150MG INJ 2,299.519102328 OMEPRAZOLE 20MG SR CAPSULE 26.789112871 OMEPRAZOLE 2MG/ML ORAL SUSP 26.789102336 OMEPRAZOLE 40MG SR CAPSULE 30.799188012 ONDANSETRON 32MG/50ML D5W PMX 136.809103441 ONDANSETRON 4MG TABLET 64.819188723 ONDANSETRON 4MG/2ML VIAL 106.259112871 ONDANSETRON ODT 4MG #2 TKHM 0.009106832 ONDANSETRON ODT 4MG TABLET 68.539158239 OPIUM TINCTURE 10MG/ML 19.449189275 OPRELVEKIN 5MG INJ 948.229180068 ORAL BALANCE GEL 42GM 45.039189911 ORPHENADRINE 60MG/2ML INJ 128.379105016 ORPHENADRINE SR 100MG TAB 21.909302308 OSELTAMIVIR 6 MG/ML SUSP 21.349112871 OSELTAMIVIR 6MG/ML LIQ 60ML 262.309118175 OSELTAMIVIR 75MG CAP 0.009118175 OSELTAMIVIR 75MG CAP 40.279112871 OSELTAMIVIR 75MG CAP #10 0.009112871 OWN DILUENT 0.009316662 OXALIPLATIN 50MG/10ML INJ 2,071.819117375 OXANDROLONE 10 MG TABLET 89.229108986 OXANDROLONE 2.5MG TABLET 51.059104704 OXAPROZIN 600MG TABLET 22.669155441 OXAZEPAM 10MG CAPSULE 37.18


of 196


CALCULATED PRICE

9155458 OXAZEPAM 15MG CAPSULE 37.739108994 OXcarbazepine 150 MG TABLET 20.579109000 OXcarbazepine 300MG TABLET 27.259178179 OXcarbazepine 300MG/5ML 250ML 502.829179771 OXYBUTYNIN 1MG/ML SYRUP 120ML 61.729105032 OXYBUTYNIN 5MG TABLET 18.449109265 OXYBUTYNIN XL 5MG TABLET 24.319112871 oxyCOD/APAP 5/325MG #2 (TKHOME 0.009155557 OXYCODONE 5 MG CAPSULE 37.029158098 oxyCODONE 20MG LIQ UD SYRG 24.219158098 oxyCODONE 20MG/ML LIQ 1ML PYX 24.219156019 oxyCODONE 30 MG TABLET 37.939155557 oxyCODONE 5MG TABLET 35.919155615 oxyCODONE SR 10MG TABLET 38.649155565 oxyCODONE SR 20MG TABLET 43.089155771 oxyCODONE SR 40MG TABLET 47.139156050 oxyCODONE SR 80MG TAB 57.749155664 oxyCODONE/APAP 10/325MG TAB 36.729155466 oxyCODONE/APAP 5/325 TABLET 38.099155474 oxyCODONE/ASA 5/325MG TAB 38.399174061 OXYMETAZOLINE 0.05% SPRAY 30ML 53.339310475 OXYTOCIN 10 UNITS/1ML INJ 79.339310475 OXYTOCIN 15 UNIT/250ML NS PMX 107.529310475 OXYTOCIN 15UNITS/250ML LR 107.529310475 OXYTOCIN 20UN/1000ML NS 149.369310475 OXYTOCIN 20UNITS/1000ML LR 120.899316209 PACLITAXEL 30MG/5ML INJ 959.529316696 PACLITAXEL PROTN-BD 1MG (100MG 636.709312323 PALIVIZUMAB 50MG/0.5 ML INJ 2,949.849190091 PALONOSETRON 0.25 MG/5 ML INJ 994.949188111 PAMIDRONATE 30MG INJ 700.089168519 PANAFIL OINTMENT 30GM 211.099170754 PANAFIL SE SPRAY EMUL 34ML 211.099108192 PANCREASE MT 10 EC CAPSULE 20.219108200 PANCREASE MT 4 CAPSULE EC 18.469120379 PANCREAZE 4,200 UNIT CAP DR 19.179183328 PANCURONIUM 10MG/10ML VIAL 78.949316720 PANITUMUMAB 200MG/10ML INJ 4,755.989310814 PANTOPRAZOLE 40MG INJ 190.369112871 PANTOPRAZOLE 4MG/ML in NS 147.399109018 PANTOPRAZOLE SR 40MG TABLET 31.829187279 PAPAVERINE 300MG/10ML INJ 82.689187279 PAPAVERINE 60MG/2ML INJ 76.909158247 PAREGORIC LIQ 1ML 18.159190364 PARICALCITOL 2MCG/ML IJ 84.979190364 PARICALCITOL 5MCG INJ 107.159113747 PARoxetine 10MG TABLET 22.779103508 PARoxetine 20MG TABLET 23.00


of 196


CALCULATED PRICE

9103516 PARoxetine 30MG TABLET 23.299113762 PARoxetine CR 12.5MG TABLET 24.789112871 PCA KEYS 0.009112871 PEDIALYTE SOLN 1000ML 46.519316407 PEGASPARGASE 750 UNIT/ML IJ 14,222.089189309 PEGFILGRASTIM 6MG/0.6ML INJ 9,439.569190034 PEGINTERFERON 180MCG/0.5ML 1,362.129316704 PEMETREXED 10mg (500mg VIAL) 742.269316704 PEMETREXED 500 MG INJ 7,316.769112871 PEN G BENZ 600,000 UNITS/ML IJ 142.559191339 PEN G BENZ LA 1.2 MUN/2ML INJ 195.509191339 PEN G BENZ LA 2.4 MUN/4ML INJ 326.999307067 PEN G K 2 MILL UN/50ML D5W PMX 132.099307067 PEN G K 2.5 MUNIT/100ML NS 113.609307067 PEN G K 2.5MILL UNIT/50ML NS 113.269307067 PEN G K 5 MILL UN/100ML NS 121.259307067 PEN G K 5 MILL UNIT VIAL MATE 52.499307067 PEN G POT 100,000UN/ML in D5W 41.989307067 PEN G PROCAINE 1.2 MILLUN/2ML 128.119307067 PEN GK 5 MILL UNITS/250ML NS 121.939168139 PENCICLOVIR 1% CREAM 1.5GM 117.689179748 PENICILL VK 50MG/ML LIQ 100ML 40.679105107 PENICILLAMINE 250MG CAPSULE 26.889307067 PENICILLIN G POT 5 MUNIT VL 52.789190786 PENICILLIN G PROC 600,000 UN 104.979305210 PENICILLIN G SODIUM 5MUNIT INJ 245.669105115 PENICILLIN VK 250MG TABLET 17.809180365 PENICILLIN VK 25MG/ML 100ML 40.059115585 PENICILLIN VK 500MG TABLET 19.119180324 PENICILLIN VK 50MG/ML LQ 200ML 30.019112871 PENTACEL VIAL 257.289306507 PENTAMIDINE 300MG INHALATION 227.859305855 PENTAMIDINE 300MG VIAL 129.499163411 PENTAZOCINE 30MG/1ML IJ 114.039155730 PENTAZOCINE/NALOXONE 38.899163676 PENTobarbital 1000MG/20ML VIAL 1,314.369163676 PENTobarbital 2500MG/50ML INJ 2,360.449109810 PENTOSAN 100MG CAPSULE 21.829316456 PENTOSTATIN 10MG INJ 3,270.249106675 PENTOXIFYLLINE SR 400MG TAB 18.869112871 PEPPERMINT SPIRIT 30ML 0.009181009 PEPTO-BISMOL SUSP 120ML 0.009169780 PERMETHRIN 1% LIQUID 60ML 48.069169798 PERMETHRIN 5% CREAM 60GM 91.179105131 PERPHENAZINE 2MG TABLET 19.519105149 PERPHENAZINE 4MG TABLET 20.249112871 PHENAZOPYRIDINE 100MG #4 TKHM 0.009105164 PHENAZOPYRIDINE 100MG TAB 18.56


of 196


CALCULATED PRICE

9105172 PHENAZOPYRIDINE 200MG TAB 19.229105180 PHENELZINE 15MG TABLET 18.639102807 PHENobarb/BELLADONNA SR TABLET 22.279158718 PHENobarbit LIQ 20MG/5ML UDCUP 36.399138173 PHENobarbit/BELLADONNA LIQ 5ML 19.139102815 PHENobarbita/BELLADONNA TABLET 20.339112871 PHENobarbital 10MG/ML in D5W 38.499163080 PHENobarbital 130MG/1ML VIAL 175.549163080 PHENobarbital 65MG/1ML VIAL 131.829155508 PHENobarbital 100MG TABLET 35.269155482 PHENobarbital 15MG TABLET 35.179155490 PHENobarbital 30MG TABLET 35.379112871 PHENobarbital 4MG/ML LIQ 30ML 108.529155847 PHENobarbital 60MG TABLET 35.219105248 PHENOXYBENZAMINE 10MG CAP 37.399187287 PHENTOLAMINE 5MG VIAL 325.779175043 PHENYLEPH/CYCLOPENT OP SOL 2ML 82.559174517 PHENYLEPHRINE 0.25% SPRAY 15ML 44.079174012 PHENYLEPHRINE 0.5% NASAL 15ML 48.079174541 PHENYLEPHRINE 1% NASAL 15ML 48.079176009 PHENYLEPHRINE 1% NASAL 30ML 42.279173501 PHENYLEPHRINE 10% OPHT SOL 5ML 48.499190372 PHENYLEPHRINE 10MG/100ML D5W 86.769190372 PHENYLEPHRINE 10MG/1ML VIAL 146.629190976 PHENYLEPHRINE 1mg/10ml NS syrg 94.589174863 PHENYLEPHRINE 2.5% OP SOL 5ML 117.939190380 PHENYTOIN 100MG/2ML INJ 72.999137274 PHENYTOIN 100MG/4ML UD CUP 18.669190380 PHENYTOIN 250MG/5ML INJ 74.689105230 PHENYTOIN 50MG CHEW TABLET 19.249105222 PHENYTOIN SR 100MG CAP 18.219105214 PHENYTOIN SR 30MG CAPSULE 18.339112871 PHOS REPLACE CENTRAL CRITICAL 0.009118271 PHOS REPLACEMENT NON CRITICAL 0.009112871 PHOS REPLACEMENT PERIPH CRITIC 0.009118365 PHOS-NAK PACKET 18.339112871 PHOSPHATE PROTOCOL 0.009179557 PHOSPHO-SODA SOLN 45ML 42.279187303 PHTONADIONE 5MG/ML in D5W 167.469187295 PHYSOSTIGMINE 2MG/2ML INJ 80.709187303 PHYTONADIONE 10MG/ML INJ 80.549187303 PHYTONADIONE 1MG/0.5ML INJ 75.609115668 PHYTONADIONE 5MG TABLET 27.289173527 PILOCARPINE 1% OPHTH SOLN 15ML 164.519173535 PILOCARPINE 2% OPHTH SOLN 15ML 167.399173543 PILOCARPINE 3% OPHTH SOLN 15ML 56.459173550 PILOCARPINE 4% OPHTH SOLN 15ML 173.839113119 PILOCARPINE 5MG TABLET 21.15


of 196


CALCULATED PRICE

9174137 PILOCARPINE HS 4% OPHT GEL 4GM 229.569171182 PIMECROLIMUS 1% CREAM 15GM 85.139105198 PIMOZIDE 2MG TABLET 21.779112871 PINK LADY ENEMA 220ML 60.179109026 PIOGLITAZONE 15MG TABLET 31.979118373 PIOGLITAZONE 30MG TAB 39.589307000 PIPERACILLIN 2GM VIAL 64.599307000 PIPERACILLIN 3GM INJ 79.339307000 PIPERACILLIN 4GM VIAL 94.079112871 PIPERACILLIN 80MG/ML D5W SYRG 141.569175035 PIRBUTEROL INHALER 14GM 162.659106717 PIROXICAM 10MG CAPSULE 20.379115684 PIROXICAM 20MG CAPSULE 22.999195025 PLASMA PROTEIN 5% IV SOLN 480.919191115 PNEUMOCOCCAL VACC ADULT 210.969170143 PODOFILOX 0.5% TOP SOLN 3.5ML 290.439108614 POLYCARBOPHIL CAL 625MG TABLET 17.829306341 POLYMYXIN B 50,000 UNITS 101.179174558 POLYMYXIN B/TMP OPHT SOLN 10ML 61.979174855 POLY-PRED OPHTH SOLN 5ML 100.909172057 POLYSPORIN OINT PACKET 18.039112871 POLYTRIM 10ML TAKEHOME 0.009132176 PORACTANT INTRATRACHEAL 3ML 2,030.879180829 POSACONAZOL 40MG/ML SUSP 105ML 2,042.729113002 POTASSIUM CIT SR 5MEQ TAB 19.169188996 POTASSIUM CL 10MEQ/50ML IVPB 130.069105305 POTASSIUM CL SR 20MEQ TAB 18.689114901 POTASSIUM CL SR 8MEQ CAP 19.279183336 POTASSIUM PHOS 45MMOL/15ML INJ 37.879183336 POTASSIUM PHOS 66MEQ/15ML INJ 37.879115643 POTASSIUM PHOSPHOR 250MG TAB 18.169168014 POVIDONE-IODINE 10% OINT 30GM 41.699168501 POVIDONE-IODINE 10% SOLN 237ML 41.299187329 PRALIDOXIME CHLORIDE 1 GM INJ 357.119107749 PRAMIPEXOLE 0.125MG TABLET 19.339107772 PRAMIPEXOLE 0.25MG TAB 27.709107764 PRAMIPEXOLE 1MG TABLET 22.019168071 PRAMOXINE 1% FOAM 15GM 121.759170333 PRAMOXINE 1% GEL 118GM 48.279106550 PRAVASTATIN 20MG TABLET 23.449105313 PRAZIQUANTEL 600MG TABLET 48.109115700 PRAZOSIN 1MG CAPSULE 18.149105321 PRAZOSIN 2MG CAPSULE 18.319115718 PRAZOSIN 5MG CAPSULE 18.869173899 PRED FORTE 1% EYE DROPS 10ML 93.099175506 PRED FORTE 1% EYE DROPS 5ML 115.029137332 prednisoLON 15MG/5ML UD LIQ/SY 21.409180449 prednisoLONE 3MG/ML LIQ 20ML 57.99


of 196


CALCULATED PRICE

9104555 prednisoLONE 3MG/ML ORAL LIQ 18.329115742 predniSONE 10MG TABLET 17.739105354 predniSONE 1MG TABLET 18.029137241 predniSONE 1MG/ML SOLN 120ML 74.709105347 predniSONE 2.5MG TABLET 17.769115742 predniSONE 20MG TABLET 17.819115742 predniSONE 5MG TABLET 17.799118324 PREGABALIN 100MG CAP 25.089118332 PREGABALIN 25MG CAP 24.409156027 PREGABALIN 50 MG CAPSULE 41.949156035 PREGABALIN 75 MG CAPSULE 41.949109513 PREMPRO 0.625/2.5MG TABLET 22.319105396 PRENATAL VIT/FE/FA TABLET 18.089128182 PREPARATION H OINTMENT 30GM 0.009128380 PREPARATION H SUPPOSITORY 18.729199092 PREVNAR 13 SYRINGE 363.479117045 PRIMAQUINE 26.3MG TABLET 21.199105404 primiDONE 250MG TABLET 20.789106709 primiDONE 50MG TABLET 18.569112871 PRISMASATE BKO/3.5 5000ML 185.279112871 PrismaSOL BGK 0/2.5 5000ML 219.579105412 PROBENECID 500MG TABLET 19.529183377 PROCAINAMIDE 1000MG/10ML VIAL 107.229183344 PROCAINAMIDE 1000MG/2ML VIAL 73.809112871 PROCAINAMIDE 20MG/ML in NS 140.629105420 PROCAINAMIDE 250MG CAPSULE 19.219112871 PROCAINAMIDE 2MG/ML in NS 140.609112871 PROCAINAMIDE 50MG/ML ORAL SUSP 19.219105453 PROCAINAMIDE SR 500MG TABLET 19.159105479 PROCAINAMIDE SR 750MG TAB 19.349189929 PROCAINE 10% 2ML INJ 78.269105487 PROCARBAZINE 50MG CAPSULE 134.679105495 PROCHLORPERAZINE 10MG TAB 19.399187337 PROCHLORPERAZINE 10MG/2ML VIAL 88.489128075 PROCHLORPERAZINE 25MG SUPP 26.489105495 PROCHLORPERAZINE 5MG TABLET 18.789169624 PROCTOFOAM-HC FOAM 10GM 170.439179672 PROMETH/PHENYLEPH SYRUP 120ML 55.679117409 PROMETHAZ 1.25MG/ML LIQ 120ML 46.359128091 PROMETHAZINE 12.5MG SUPPOS. 25.349112871 PROMETHAZINE 25MG SUPP#2 TKHM 0.009128083 PROMETHAZINE 25MG SUPPOS. 27.539117409 PROMETHAZINE 25MG TABLET 18.639187345 PROMETHAZINE 25MG/1ML INJ 73.409128109 PROMETHAZINE 50MG SUPPOS. 56.229187352 PROMETHAZINE 50MG/ML INJ 74.699159021 PROMETHAZINE w/COD 5ML UD CUP 36.899179235 PROMETHAZINE w/DM SYRUP 120ML 45.95


of 196


CALCULATED PRICE

9105438 PROPAFENONE 150MG TAB 20.829115833 PROPANTHELINE 15MG TABLET 18.839173592 PROPARACAINE 0.5% OPH SOL 15ML 69.999189101 PROPOFOL 1000MG/100ML VIAL 251.119187444 PROPOFOL 200MG/20ML INJ 119.679187469 PROPOFOL 500MG/50ML INJ 141.879155524 PROPOXY-N/APAP 100-650 TAB 36.219112871 PROPRANOLOL 0.1MG/ML NS SYRG 144.079105529 PROPRANOLOL 10MG TABLET 17.969310228 PROPRANOLOL 1MG/1ML INJ 107.309105537 PROPRANOLOL 20MG TABLET 18.099179375 PROPRANOLOL 20MG/5ML SOLN 54.379115841 PROPRANOLOL 40 MG TABLET 18.379115858 PROPRANOLOL LA 120MG CAP 28.269108226 PROPRANOLOL LA 60MG CAPSULE 25.259105552 PROPRANOLOL LA 80MG CAP 26.189105586 PROPYLTHIOURACIL 50MG TAB 19.049190398 PROTAMINE SULF 250MG/25ML INJ 122.889190398 PROTAMINE SULF 50MG/5ML INJ 87.759105602 PSEUDOEPHEDRINE 30MG TABLET 0.009116963 PSEUDOEPHEDRINE 60 MG TABLET 17.669105610 PSYLLIUM PACKET 0.009105628 PYRAZINAMIDE 500MG TABLET 19.939179250 PYRIDOSTIG 12MG/ML LIQ 120ML 143.479187294 PYRIDOSTIGMINE 10MG/2ML INJ 124.749105636 PYRIDOSTIGMINE 60MG TABLET 23.479107442 PYRIDOSTIGMINE SR 180MG TABLET 27.539105651 PYRIDOXINE 100MG TABLET 17.639310665 PYRIDOXINE 100MG/1ML VIAL 92.129115916 PYRIDOXINE 50MG TAB 17.609112871 PYRIDOXINE 50MG/ML ORAL SUSP 17.589115924 PYRIMETHAMINE 25MG TABLET 19.739107582 QUEtiapine 100MG TABLET 33.049107665 QUEtiapine 200MG TAB 46.789107616 QUEtiapine 25MG TABLET 26.589104340 QUINAPRIL 10MG TABLET 22.339104324 QUINAPRIL 20MG TABLET 22.339104332 QUINAPRIL 5MG TABLET 22.339183393 quiNIDine GLUC 800MG/10ML INJ 114.039105701 quiNIDine GLUC SR 324MG TAB 20.299105693 quiNIDine SULF SR 300MG TAB 19.669115940 quiNIDine SULFATE 200MG TAB 17.959105727 quiNIDine SULFATE 300MG TAB 18.329105743 quiNINE SULF 324 MG CAPSULE 30.989109042 RABEPRAZOLE DR 20MG TABLET 26.569194192 RABIES IMMUNE GLOB 10ML 5,611.999194069 RABIES IMMUNE GLOBULIN INJ 2ml 700.919186164 RABIES VACCINE (AVIAN, PF) 1ML 466.18


of 196


CALCULATED PRICE

9186164 RABIES VACCINE (HUMAN) 1ML 693.789108234 RALOXIFENE 60MG TABLET 28.779120593 RALTEGRAVIR 400 MG TABLET 59.199108242 RAMIPRIL 1.25MG CAPSULE 22.199108259 RAMIPRIL 10 MG CAPSULE 22.299107129 RAMIPRIL 2.5MG CAPSULE 20.989107137 RAMIPRIL 5 MG CAPSULE 23.299105750 RANITIDINE 150MG TABLET 20.579112871 RANITIDINE 15MG/ML ORAL SOLN 18.459179268 RANITIDINE 15MG/ML SYRUP 120ML 225.159311200 RANITIDINE 2.5MG/ML D5W SYRG 105.679311200 RANITIDINE 50MG/2ML INJ 113.259128489 RANOLAZINE SR 500MG TAB 26.759181033 READI-CAT 1.2% SUSPENSION 45.689186195 RECOMBIVAX HB 10 MCG/ML 1ML 212.539169822 RECOTHROM 5,000 UNITS VIAL 244.939112871 REGADENOSON 0.4MG /5ML INJ 604.619163643 REMIFENTAIL 1MG VIAL 168.179163635 REMIFENTANIL 2 MG INJ 189.369108051 REPAGLINIDE 0.5MG TABLET 23.799107723 REPAGLINIDE 2MG TABLET 23.799115957 RESERPINE 0.1MG TABLET 19.549117029 RIBOFLAVIN 25MG TABLET 17.629105792 rifaBUTin 150MG CAPSULE 48.869112871 rifAMPin 10MG/ML ORAL SUSP 17.859108267 rifAMPin 150MG CAPSULE 23.759105784 rifAMPin 300MG CAPSULE 23.639112871 rifAMPin 3MG/ML NS SYRG 141.139187238 rifAMPin 600MG INJ 423.409118258 rifaXIMin 200MG TAB 42.059118563 rifaXIMin 550MG TAB 65.389106766 RIMANTADINE 100MG TABLET 21.219174871 RIMEXOLONE 1% OPHTH SOLN 5ML 133.799112871 RIMSO-50 SOLUTION 50ML 252.899113614 RISEDRONATE 35MG TABLET 62.019109224 RISEDRONATE 5MG TABLET 23.909118266 RISPERIDONE 0.25MG TAB 21.659107202 RISPERIDONE 1MG TABLET 22.349179755 RISPERIDONE 1MG/ML SOLN 30ML 517.809197013 RITONAVIR 100 MG TABLET 38.479197013 RITONAVIR 100MG GEL CAP 38.479316498 riTUXimab 100MG/10ML INJ 2,157.319120445 RIVAROXABAN 10MG TAB 35.349120619 RIVAROXABAN 15 MG TAB 35.349120627 RIVAROXABAN 20 MG TAB 35.349179920 RIVASTIGMINE 2MG/ML LIQ 120ML 1,171.629118514 RIVASTIGMINE 4.6MG/24HR PATCH 38.449118522 RIVASTIGMINE 9.5MG/24HR PATCH 38.44


of 196


CALCULATED PRICE

9109638 RIVASTIGMINE1.5MG CAPSULE 28.099109059 RIZATRIPTAN ODT 10MG TAB 68.259183211 ROCURONIUM 100MG/10ML INJ 169.399183906 ROCURONIUM 50 MG/5 ML SYRINGE 141.879183906 ROCURONIUM 50MG/5ML VIAL 121.869113010 ROPINIROLE 0.25MG TABLET 24.819113028 ROPINIROLE 1MG TABLET 24.819190216 ROPIVACAINE 100MG/20ML VIAL 101.279190216 ROPIVACAINE 150MG/30ML INJ 108.969190216 ROPIVACAINE 2 MG/ML AMP 20ML 92.659190216 ROPIVACAINE 200MG/100ML INJ 159.599117144 ROSUVASTATIN 10MG TAB 29.039117151 ROSUVASTATIN 20MG TABLET 29.039117136 ROSUVASTATIN 5MG TAB 29.039190935 ROTAVIRUS VAC,LIVE ORAL 1ML 265.829112871 RT AEROSOL PROTOCOL 0.009186073 RUBELLA VACCINE W/DILUENT 92.639168428 SALICY (TROLAMINE)10% CRM 90GM 41.679178294 SALIVA SUBSTITUTE SOLN 120ML 44.739175118 SALMETEROL 50MCG DISKUS #28 143.599106774 SALSALATE 500MG TABLET 18.909311234 SARGRAMOSTIM 250MCG VIAL 607.869311234 SARGRAMOSTIM 500MCG/ML INJ 752.189168485 SARNA ANTI-ITCH LOTION 222ML 50.959173600 SCOPOLAMINE 0.25% OPH SOLN 5ML 109.149187402 SCOPOLAMINE 0.4MG/ML INJ 89.589171133 SCOPOLAMINE 1.5MG/72HR PATCH 27.969105800 SELEGILINE 5MG CAPSULE 22.419168840 SELENIUM SULF 1% SHAMPOO 207ML 44.239137407 SENNA 528MG/15ML UD CUP 21.359112871 SENNA SYRUP 120ML 45.899105818 SENNA/DSS TABLET 18.409113333 SENNOSIDES 187MG TABLET 0.009114455 SENNOSIDES,CAL 15MG CHEW TAB 18.039115981 SERTRALINE 100MG TAB 18.359105677 SERTRALINE 50MG TABLET 22.599113135 SEVELAMER 800MG TABLET 25.089112996 SEVELAMER CARB 800 MG TAB 23.589113127 SEVELMER 400MG TAB 21.329117391 SILDENAFIL 2.5MG/ML ORAL LIQ 18.699117391 SILDENAFIL 20MG TAB 59.489117391 SILDENAFIL 50MG TABLET 38.819169814 SILVASORB GEL 45ML 97.049112871 SILVER NITRATE 0.5% SOLN 960ML 81.469182171 SILVER NITRATE APPLICATOR 18.179168857 SILVER SULFADIAZINE 1% 400GM 105.239169640 SILVER SULFADIAZINE 1% CR 50GM 51.619178385 SIMETHICON 40MG/0.6ML SOL 30ML 49.09


of 196


CALCULATED PRICE

9105842 SIMETHICONE 80MG CHEW TABLET 0.009112871 SIMPLE SYRUP 0.009115999 SIMVASTATIN 10 MG TABLET 22.609106659 SIMVASTATIN 20MG TABLET 30.349113499 SIMVASTATIN 40MG TABLET 27.399108846 SIMVASTATIN 5MG TABLET 21.329187725 SINCALIDE 5MCG INJ 246.019108960 SINGULAIR 5MG TABLET CHEW 30.339118019 sitaGLIPtin 100 MG TABLET 34.889118118 sitaGLIPtin 25MG TABLET 34.899118431 sitaGLIPtin 50MG TAB 34.899302001 SOD CHL 4MEQ/ML ORAL LIQ 17.679128406 SOD POLYSTY 30GM/120ML ENEMA 74.439112871 SODIUM ACET 0.5MEQ/ML in D5W 47.049300575 SODIUM ACETATE 2MEQ/ML PEDIPOD 17.799310970 SODIUM ACETATE 40MEQ/20ML INJ 39.879112871 SODIUM BICARB 0.5MEQ/ML in D5W 102.569112871 SODIUM BICARB 1MEQ/ML ORAL LIQ 17.649310384 SODIUM BICARB 4.2% 10ML SYR 83.679105875 SODIUM BICARB 650MG TABLET 17.589310376 SODIUM BICARB 8.4% 10ML SYR 75.969310251 SODIUM BICARB 8.4% 50ML VIAL 39.699310251 SODIUM BICARB 8.4% SYR 50ML 77.009147570 SODIUM CHL 0.9% IRRIG 250ML 50.669147414 SODIUM CHL 0.9% IRRIG. 1000ML 53.379147414 SODIUM CHL 0.9% IRRIG.1000ML 53.379147919 SODIUM CHLO 0.9% IRRG 500ML 50.419145079 SODIUM CHLOR .9% 5ML SYRINGE 41.619147570 SODIUM CHLOR 0.9% IRRIG 250ML 50.669132218 SODIUM CHLOR 10% PILLOW 15ML 19.049310954 SODIUM CHLOR 120MEQ/30ML INJ 40.489147711 SODIUM CHLORIDE 0.45% 1000ML 121.499147166 SODIUM CHLORIDE 0.45% 500ML 119.599147364 SODIUM CHLORIDE 0.9% 1000ML 119.459134032 SODIUM CHLORIDE 0.9% 100ML 14.799310269 SODIUM CHLORIDE 0.9% 10ML VIAL 36.689147349 SODIUM CHLORIDE 0.9% 250ML 13.119147349 SODIUM CHLORIDE 0.9% 250ML 18.359147356 SODIUM CHLORIDE 0.9% 500ML 118.379134024 SODIUM CHLORIDE 0.9% 50ML 14.799132143 SODIUM CHLORIDE 0.9% INH 3ML 17.849147505 SODIUM CHLORIDE 0.9% IRRIG 3L 59.039112871 SODIUM CHLORIDE 1.7MEQ/ML ORAL 17.679106857 SODIUM CHLORIDE 1GM TABLET 17.689132283 SODIUM CHLORIDE 3% 15ML INHAL 19.049147679 SODIUM CHLORIDE 3% IV 500ML 119.099147505 SODIUM CHLRIDE 0.9% IRRG 3L FS 59.039174020 SODIUM CL 0.65% NASAL SPY 45ML 39.39


of 196


CALCULATED PRICE

9310947 SODIUM PHOSPHATE 45MM/15ML INJ 37.959310947 SODIUM PHOSPHATE 60MEQ/15ML IJ 37.959187733 SODIUM THIOSULFATE 10% 10ML VL 177.869310327 SODIUM THIOSULFATE 25% VIAL 140.369118340 SOLIFENACIN 5MG TAB 31.449190174 SOMATROPIN 0.6 MG/0.25ML INJ 181.539137308 SORBITOL 70% SOLN 30ML CUP 20.679302266 SOTALOL 5MG/ML ORAL SUSP 23.579104712 SOTALOL 80MG TABLET 23.579191354 SOTRADECOL 1% VIAL 162.419116005 SPIRONOLACTONE 100 MG TABLET 20.509105909 SPIRONOLACTONE 25MG TABLET 18.419302035 SPIRONOLACTONE 4MG/ML ORAL LQ 17.739116013 SPIRONOLACTONE 50MG TABLET 19.319112871 SPIRONOLACTONE/HCTC 5MG/ML LIQ 17.869107541 SPIRONOLACTONE/HCTZ 25/25 TAB 20.179112871 SPRAY AND STRETCH SPRAY 0.009179938 STAVUDINE 1MG/ML LIQ 200ML 221.419197237 STAVUDINE 40 MG CAPSULE 34.279310996 STERILE WATER FOR INJ 1000ML 120.279147398 STERILE WATER,IRRIG 1000ML 52.499147398 STERILE WATER,IRRIGAT 1000ML 52.499306259 STREPTOMYCIN 1GM INJ 64.399306259 STREPTOZOCIN 1GM INJ 901.889184011 SUCCINYLCHOLINE 200MG/10ML INJ 72.289184011 SUCCINYLCHOLINE 200MG/10ML NS 115.939105933 SUCRALFATE 1GM TABLET 19.099137373 SUCRALFATE 1GM/10ML CUP 21.719302027 SUCRALFATE 200MG/ML ORAL SUSP 17.749182122 SUCRETS LOZENGE #18 35.369163510 SUFentanil 100MCG/2ML INJ 127.699163114 SUFentanil 250MCG/5ML AMP 143.779168634 SULCONAZOLE 1% CREAM 30GM 225.799174889 SULFACET/PREDNIS 0.25% OP 10ML 89.019173626 SULFACETA 10% OPHTH OINT 3.5GM 51.299173618 SULFACETAMIDE 10% OP SOL 15ML 68.179106873 sulfADIAZINE 500MG TABLET 20.169138132 SULFAMETHOX/TMP 20ML UDCUP 25.559112871 SULFAMETHOX/TMP DS #2 TKHM 0.009179599 SULFAMETHOX/TMP SUSP 100ML 60.359105826 SULFAMETHOXAZOLE/TMP DS TAB 19.839306945 SULFAMETHOXAZOLE/TMP INJ 47.939113838 SULFAMETHOXAZOLE/TMP SS TAB 18.889105958 SULFASALAZINE 500MG TABLET 18.069105974 SULINDAC 150MG TABLET 19.579105982 SULINDAC 200MG TABLET 20.039182031 SUMAtriptan 20MG NASAL SPRAY 128.079107368 SUMAtriptan 25MG TABLET 55.78


of 196


CALCULATED PRICE

9108283 SUMAtriptan 50MG TAB 84.159174236 SUMAtriptan 5MG NASAL SPRAY 128.079187667 SUMAtriptan 6MG/0.5ML INJ 287.419170861 SURGICEL ADSORB HEMOSTAT 4X8 150.759118415 SWEET-EASE NATURAL SOLN 17.809118100 SYMBICORT 160-4.5 MCG INH 6GM 396.679175456 SYMBICORT 80-4.5 MCG INH 6.9GM 349.419112871 SYNERCID 141.259310962 SYNERCID 500MG VIAL 361.669103524 TACROLIMUS 0.5MG CAPSULE 22.099103524 TACROLIMUS 1MG CAPSULE 27.229189283 TACROLIMUS 5MG/ML INJ 473.719154055 TALC INTRAPLEURAL 0.4G/SEC 4GM 280.099154014 TALC POWDER-STERILE 5GM 140.809105990 TAMOXIFEN 10MG TABLET 21.349107525 TAMSULOSIN 0.4MG CAPSULE 29.089170358 TAZAROTENE 0.1% CREAM 30GM 582.029170358 TAZAROTENE 0.1% GEL 30GM 582.029117334 TEITHROMYCIN 400 MG TABLET 52.689191271 TELAVANCIN 250 MG VIAL 293.629109646 TELMISARTAN 40MG TABLET 20.569155532 TEMAZEPAM 15MG CAPSULE 36.529155961 TEMAZEPAM 30 MG CAPSULE 36.769155623 TEMAZEPAM 7.5MG CAPSULE 59.619197419 TEMOZOLOMIDE 100MG CAPSULE 376.099197419 TEMOZOLOMIDE 20MG CAPSULE 89.259197419 TEMOZOLOMIDE 5MG CAPSULE 36.849316761 TEMSIROLIMUS 25MG/ML IJ 3,518.279307042 TENECTEPLASE 50MG KIT 7,964.599197369 TENOFOVIR 300MG TAB 81.419105834 TERAZOSIN 1MG CAPSULE 20.769108317 TERAZOSIN 5MG CAPSULE 20.769168865 TERBINAFINE 1% CREAM 12GM 51.399104100 TERBINAFINE 250MG TABLET 58.929187428 TERBUTALINE 1MG/ML INJ 129.589116039 TERBUTALINE 2.5MG TABLET 18.519106006 TERBUTALINE 5MG TABLET 18.949169483 TERCONAZOLE 0.4% VAG CRM 45GM 122.499170416 TERCONAZOLE 0.8% VAG CRM 20GM 122.499128372 TERCONAZOLE 3 80MG SUPP #3 64.229163346 TESTOSTERONE 200MG/ML INJ 145.009171141 TESTOSTERONE 5MG/24HR PATCH 58.969193996 TETANUS IM GLOB 250 UNITS/ML 940.439186065 TETANUS TOXOID 0.5ML INJ 87.709176017 TETRACAINE 0.5% EYE DROP 15ML 56.179173634 TETRACAINE 0.5% OPHTH SOL 2ML 53.959189077 TETRACAINE 1% 20MG/2ML INJ 88.909175514 TETRACAINE 2% SOLN 30ML 73.79


of 196


CALCULATED PRICE

9106014 TETRACYCLINE 250MG CAPSULE 17.719179763 TETRACYCLINE 25MG/ML LIQ 120ML 70.029191578 TETRADECYL NS 3% INJ 166.189174046 TETRAHYDROZOLINE 0.05% OP 15ML 40.719179607 THEOPHYL 80MG/15ML LIQ 120ML 38.609112871 THEOPHYLLINE 5.33MG/ML ORAL LQ 17.589112871 THEOPHYLLINE 80 MG/15 ML UDCUP 42.599117292 THEOPHYLLINE SR 100MG CAP 19.959106030 THEOPHYLLINE SR 100MG TAB 17.969106048 THEOPHYLLINE SR 200MG TAB 18.289106063 THEOPHYLLINE SR 300MG TAB 18.179170325 THERA-GESIC ANALGES CRM 150GM 0.009106097 THIAMINE 100MG TABLET 0.009190414 THIAMINE 200MG/2ML INJ 94.469108648 THIAMINE 50MG TABLET 0.009197112 THIOGUANINE 40MG TABLET 56.399163312 THIOPENTAL 500MG INJ 113.199106113 THIORIDAZINE 10MG TABLET 18.239116096 THIORIDAZINE 25MG TABLET 18.519106121 THIORIDAZINE 50MG TABLET 18.759316175 THIOTEPA 15MG INJ 1,111.119106154 THIOTHIXENE 1MG CAPSULE 18.499300401 THIOTHIXENE 5MG CAPSULE 18.509169822 THROMBIN 5,000 UNITS PWDR 124.179106188 THYROID 30MG TABLET 17.849106196 THYROID 60MG TABLET 18.109190513 THYROTROPIN 1.1MG INJ 2,502.869113523 tiaGABine 2MG TABLET 32.609108325 tiaGABine 4MG TABLET 32.609112871 TICARCILL 30MG/ML NS SYR 140.679306333 TICARCILLIN/CLAV 3.1GM INJ 67.629105719 TICLOPIDINE 250MG TABLET 21.529311226 TIGECYCLINE 50 MG INJ 184.549173642 TIMOLOL 0.25% OPHTH SOLN 5ML 65.099173659 TIMOLOL 0.5% OPHTH SOLN 5ML 69.099174681 TIMOLOL XE 0.25% OPHT GEL 5ML 134.099174244 TIMOLOL/DORZOLAM OPHT SOL 5ML 127.079176074 TIMOLOL-XE 0.5% OPH GEL 5mL 152.099117342 TIOTROPIUM AEROLI 18 MCG CP #5 108.819151416 TIROFIBAN 6.25MG/25ML INJ 591.759107707 tiZANidine 4MG TABLET 20.819173790 TOBRAMY/DEXAMET OP OINT 3.5GM 383.039173808 TOBRAMY/DEXAMET OPHT SOL 2.5ML 170.029173964 TOBRAMYCIN 0.3% OPH OINT 3.5GM 234.199173956 TOBRAMYCIN 0.3% OPHTH SOLN 5ML 64.479305269 TOBRAMYCIN 1.2GM POWDER VIAL 710.149305277 TOBRAMYCIN 20MG/2ML INJ 41.149174731 TOBRAMYCIN 300MG/5ML INH SOLN 238.32


of 196


CALCULATED PRICE

9112871 TOBRAMYCIN 4MG/ML NS SYRG 141.099305269 TOBRAMYCIN 80 MG/100 ML NS 129.119305269 TOBRAMYCIN 80MG/2ML INJ 43.579307141 TOCILIZUMAB 80 MG/4 ML VIAL 814.349106253 TOLAZamide 100MG TABLET 18.489106261 TOLAZamide 250MG TABLET 20.179169962 TOLNAFTATE 1% CREAM 15GM 40.599169954 TOLNAFTATE 1% SOLUTION 44.299113531 TOLTERODIN LA 2MG CAPSULE 30.399108531 TOLTERODINE 2MG TABLET 25.229109836 TOLTERODINE LA 4MG CAP 30.269108390 TOPIRAMATE 100MG TAB 26.299113549 TOPIRAMATE 200MG TABLET 27.789113556 TOPIRAMATE 25MG SPRINKLE CAP 21.439109125 TOPIRAMATE 25MG TABLET 20.949317033 TOPOTECAN 4MG INJ 3,356.139317033 TOPOTECAN 4MG/4ML INJ 2,694.729108333 TORSEMIDE 20MG TABLET 19.399192006 TPN <= 2 LITERS 1,169.969192048 TPN <=1,000ML PERIPHERAL 877.479192048 TPN <1 LITER 877.479192055 TPN >= 3 LITERS 1,462.459192006 TPN 2L PERIPHERAL 1,169.969192055 TPN 3L PERIPHERAL 1,462.459192022 TPN, NEONATAL/INFANT 1000ML 877.479116203 traMADol 50MG TABLET 19.609112871 traMADol ODT 50MG TAB 24.189113564 traMADol/APAP 37.5/325 TABLET 19.829113572 TRANDOLAPRIL 2MG TABLET 19.479106287 TRANYLCYPROMINE 10MG TABLET 25.709316472 TRASTUZUMAB 10MG CHARGE 780.139175027 TRAVOPROST 0.004% OP SOL 2.5ML 221.639175027 TRAVOPROST Z 0.004% OP 2.5ML 252.749106303 traZODone 100MG TABLET 19.029106295 traZODone 50MG TABLET 18.409170721 TRETINOIN 0.025% CREAM 45GM 156.579175142 TRIAMCIN AQ 55MCG NASAL 16.5GM 312.259169657 TRIAMCINOLONE 0.025% CRM 15GM 44.179169673 TRIAMCINOLONE 0.1% CRM 15GM 46.449168873 TRIAMCINOLONE 0.1% CRM 80GM 45.299169764 TRIAMCINOLONE 0.1% OINT 15GM 46.449168881 TRIAMCINOLONE 0.1% OINT 80GM 47.599170374 TRIAMCINOLONE 0.1% PASTE 5GM 172.979168899 TRIAMCINOLONE 0.5% CREAM 15GM 57.669168949 TRIAMCINOLONE 0.5% OINT 15GM 55.299169756 TRIAMCINOLONE 1% LOTION 60ML 119.939190430 TRIAMCINOLONE 200MG/5ML VL 171.499190430 TRIAMCINOLONE ACET 40MG/ML 1ML 90.14


of 196


CALCULATED PRICE

9190430 TRIAMCINOLONE ACET 50MG/5ML VL 95.959174160 TRIAMCINOLONE MDI 20GM 172.259102930 TRIAMTERENE/HCTZ 37.5/25 CAP 18.699109489 TRIAMTERENE/HCTZ 50/25 CAP 18.729109554 TRIAMTERENE/HCTZ 75/50 TABLET 21.669155573 TRIAZOLAM 0.125MG TABLET 36.379106345 TRIFLUOPERAZINE 10MG TABLET 20.919106329 TRIFLUOPERAZINE 2MG TABLET 19.329106337 TRIFLUOPERAZINE 5MG TABLET 19.789173667 TRIFLURIDINE 1% OPH SOLN 7.5ML 244.999106352 TRIHEXYPHENIDYL 2MG TABLET 17.929116229 TRIHEXYPHENIDYL 5MG TABLET 18.289106311 TRIMATERENE 50MG CAPSULE 20.769187485 TRIMETHOBENZ 200MG/2ML INJ 81.149106923 TRIMETHOPRIM 100MG TABLET 18.929100181 TRIPROLIDINE/PSEUDOEPHED TAB 17.649190794 TRIPTORELIN PA DEPOT 3.75MG IJ 2,054.499302316 TRI-VI-SOL-IRON DROPS 1ML 17.839113598 TRIZIVIR TABLET 72.069151333 TROMETHAMINE IV SOLN 500ML 484.579174905 TROPICAMIDE 0.5% OPH SOLN 15ML 99.719174913 TROPICAMIDE 1% OPHTH SOLN 15ML 177.959118050 TRUVADA TABLET 111.869191008 TRYPAN BLUE 0.06% IO 0.5ML 168.589187998 TUBERCULIN,PURIF.PROT TEST 76.379112871 TUCKS MEDICATED PADS 0.009168097 TUCKS OINTMENT 30GM 0.009158288 TUSSIONEX PENNKIN SUSP 1ML 19.249186206 TYPHOID 25MCG/0.5ML VACCINE 165.569168790 UREACIN-20 CREAM 120GM 65.469113606 URISED TABLET 18.639112871 URSODIOL 25MG/ML ORAL SUSP 18.099105925 URSODIOL 300MG CAPSULE 22.189112871 USTEKINUMAB 45MG/0.5ML SYRG 14,109.949100116 valACYclovir 500MG TABLET 34.259197534 valGANCIclovir 450MG TABLET 152.849189028 VALPROATE 500MG/5ML INJ 188.049137381 VALPROIC ACID 250 MG/5 ML CUP 19.059106956 VALPROIC ACID 250MG CAPSULE 19.149118308 VALSARTAN 320MG TAB 27.829107814 VALSARTAN 80MG CAPSULE 25.109108911 VANCOCIN HCL 125 MG PULVULE 87.209305293 VANCOMYCIN 1G/250ML NS (ADV) 121.699305293 VANCOMYCIN 1GM INJ 119.409305293 VANCOMYCIN 1GM VIAL MATE 119.409305293 VANCOMYCIN 1GM/200ML D5W PMX 175.549305293 VANCOMYCIN 1GM/250 ML NS 148.959302043 VANCOMYCIN 20MG/ML ORAL SUSP 21.41


of 196


CALCULATED PRICE

9102625 VANCOMYCIN 250MG CAPSULE 45.809179615 VANCOMYCIN 25MG/ML SOLN 120ML 497.819305293 VANCOMYCIN 500MG MB+ 111.039305293 VANCOMYCIN 500MG VIAL 111.039181082 VANCOMYCIN 50MG/ML SUSP 100ML 125.099112871 VANCOMYCIN 5MG/ML D5W SYRG 140.569305293 VANCOMYCIN 750 MG VIAL 116.329305293 VANCOMYCIN 750 MG/150 ML BAG 136.629305293 VANCOMYCIN 750MG VIAL MATE 116.329112871 VANCOMYCIN PER PHARMACY 0.009118035 VARENICLINE 0.5 MG TABLET 24.449310483 VASOPRESSIN 20 UNITS/ML INJ 87.879307083 VASOPRESSIN 5UNITS/50ML D5W 154.869310426 VECURONIUM 10 MG/10 ML SYRINGE 118.089310426 VECURONIUM 10MG VIAL 84.829112871 VECURONIUM 25MG/50ML D5W 186.869112871 VECURONIUM 50MG/50ML D5W 217.869108341 VENLAFAXINE 100MG TAB 22.439108358 VENLAFAXINE 25MG TABLET 20.569107244 VENLAFAXINE 37.5MG TABLET 20.659107236 VENLAFAXINE 50MG TABLET 20.749107251 VENLAFAXINE 75MG TAB 22.959107632 VENLAFAXINE XR 37.5MG CAPSULE 29.149107640 VENLAFAXINE XR 75MG CAPSULE 30.549106972 VERAPAMIL 120MG TABLET 18.349106949 VERAPAMIL 40MG TABLET 18.109310491 VERAPAMIL 5MG/2ML INJ 75.069106964 VERAPAMIL 80MG TABLET 18.699108556 VERAPAMIL SR 120MG TABLET 19.429106998 VERAPAMIL SR 180MG TABLET 19.959106980 VERAPAMIL SR 240MG TABLET 20.829163700 VIMPAT 200 MG/20 ML VIAL 269.329316316 vinBLAStine 1MG INJ 620.559316142 vinCRIStine 1MG INJ 625.969316332 VINORELBINE 10MG/ML INJ 842.849189655 VISCOAT SYRINGE 0.5ML 377.429168923 VIT A&D OINT 60GM 0.009137415 VIT A, C, D INFANT DROP 1ML 17.989168923 VITAMIN A & D OINTMENT 45GM 0.009109679 VITAMIN A 10000IU CAP 17.619188947 VITAMIN A 50,000UNITS/ML 2ML 131.869100488 VITAMIN B COMPLEX CAPSULE 17.649187147 VITAMIN B-12 1,000 MCG TAB 17.679118506 VITAMIN B12 500 MCG TABLET 17.629109927 VITAMIN D 400 UNITS TABLET 17.609120114 VITAMIN D3 1000 IU TAB 17.619106410 VITAMIN E 200IU CAPSULE 17.659106428 VITAMIN E 400IU CAPSULE 17.68


of 196


CALCULATED PRICE

9112871 VITAMIN E 50UNITS/ML DROPS 22.329301631 VITAMIN E 50UNITS/ML DROPS 22.329307018 VORICONAZOLE 200MG INJ 471.309113093 VORICONAZOLE 200MG TAB 131.079181090 VORICONAZOLE 40MG/ML SUSP 75ML 1,984.149118316 VORICONAZOLE 50MG TAB 45.939307018 VORICONAZOLE 5MG/ML NS SYRG 145.669173931 VOSOL HC OTIC SOLN 10ML 441.959106436 WARFARIN 1MG TABLET 20.509106444 WARFARIN 2.5MG TABLET 20.729116252 WARFARIN 2MG TABLET 20.629108366 WARFARIN 3MG TABLET 20.739116260 WARFARIN 4MG TAB 20.749106451 WARFARIN 5MG TABLET 20.859108374 WARFARIN 6MG TAB 21.819106469 WARFARIN 7.5MG TABLET 21.959112871 WARFARIN PER PROTOCOL 0.009187527 WATER FOR INJECTION 10ML VIAL 0.009189564 WATER FOR INJECTION 20ML INJ 0.009189572 WATER FOR INJECTION 50ML INJ 0.009194135 WINRHO SDF 5000U VIAL 2,513.919170606 XENADERM OINTMENT 60GM 174.059191024 XGEVA 120 MG/1.7 ML VIAL 4,096.189107483 ZAFIRLUKAST 20MG TABLET 22.189197195 ZALCITABINE 0.375MG TABLET 22.099176066 ZANAMIVIR 5 MG DISKHALER #20 0.009170341 ZEASORB POWDER 70.90GM 42.039112988 ZENPEP DR 10,000 UNITS CAPSULE 21.669112970 ZENPEP DR 15,000 UNITS CAPSULE 23.499112798 ZENPEP DR 5,000 UNITS CAPSULE 19.759197203 ZIDOVUDINE 100MG CAPSULE 23.599307026 ZIDOVUDINE 200MG/20ML INJ 207.129307026 ZIDOVUDINE 4MG/ML D5W SYRG 141.249118472 ZINC GLUCONATE 50 MG TABLET 17.629169020 ZINC OXIDE 10% CREAMY OINT 60G 41.829169996 ZINC OXIDE OINTMENT 30GM 41.759310343 ZINC SULFATE 1MG/ML INJ 35.719106477 ZINC SULFATE 220MG CAPSULE 18.049109174 ZIPRASIDINE 40MG CAPSULE 37.809109166 ZIPRASIDONE 20MG CAPSULE 37.809190125 ZIPRASIDONE 20MG INJ 111.349109182 ZIPRASIDONE 80MG CAP 42.139310988 ZOLEDRONIC 4MG VIAL 2,210.189190570 ZOLEDRONIC RECLAST 5MG/100ML 2,749.829108739 ZOLMITRIPTAN 2.5MG TABLET 54.339155219 ZOLPIDEM 10 MG TABLET 44.389155821 ZOLPIDEM 5MG TABLET 44.349109141 ZONISAMIDE 100MG CAPSULE 21.53


of 196


CALCULATED PRICE

9186214 ZOSTER LIVE VACCINE 70.189307034 ZOSYN 2.25 GM/50ML PMX FRZ 142.509307034 ZOSYN 2.25GM VIAL 56.719307034 ZOSYN 2.25GM/100ML NS MB+ 136.179307034 ZOSYN 3.375 GM INJ 71.689307034 ZOSYN 3.375GM/100ML NS MB+ 151.659307034 ZOSYN 3.375GM/50ML D5W 78.049307034 ZOSYN 4.5/100ML PMX FRZ 176.059307034 ZOSYN 4.5GM VIAL 90.179307034 ZOSYN 4.5GM/100ML NS MB+ 163.999112871 ZOSYN 40MG/ML D5W SYR 144.56

Hospital Name: Sutter Davis Hospital

Column A Column B Column C Column D Column E

Estimated 2011 Revenue Estimated 2012 Revnue

$272,105,305 $276,243,022 ($3,818,030) $7,955,747 2.92%

Column A = 1/1/2011 to 5/31/2011 actual charges, annualized.Column B = 1/1/2012 to 5/31/2012 actual charges, annualized.Column C = Any changes due to volume variances including services provided in one year and not the other.Column D = Rate change only, based on analysis using 1/1/2012 - 5/31/2012 volumes.Column E = Rate Increase only for submission to OSHPD (Column D divided by Column A).

Adjustment for any change in volume or factor other than rate increase

Change in revenue due to rate increase(=B-A-C)

Percentage Change in Gross Charges due to rate

increase (Column D divided by Column A)

sutter davis hospital - office of statewide health planning · xls file · web...

Documents