AB 1045 - List of 25 CommonOutpatient Procedures for 2017

Office of Statewide Health Planning and Development AB 1045 (May 2008)

Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017

Evaluation & Management Services (CPT Codes 99201-99499) 2017 CPT Code Average ChargeEmergency Room Visit, Level 2 (low to moderate severity) 99282 $1,297.00Emergency Room Visit, Level 3 (moderate severity) 99283 $2,093.00Emergency Room Visit, Level 4 (high severity) 99284 $3,248.00Outpatient Visit, established patient, 15 minutes 99213 $473.00

Laboratory & Pathology Services (CPT Codes 80047-89398) 2017 CPT Code Average ChargeBasic Metabolic Panel 80048 $61.00

82805 $887.00Complete Blood Count, automated 85027 $41.00Complete Blood Count, with differential WBC, automated 85025 $41.00Comprehensive Metabolic Panel 80053 $76.00Creatine Kinase (CK), (CPK), Total 82550Lipid Panel 80061 $79.00Partial Thromboplastin Time 85730 $43.00Prothrombin Time 85610 $28.00Thyroid Stimulating Hormone 84443 $108.00Troponin, Quantitative 84484 $120.00Urinalysis, without microscopy 81002 $17.00Urinalysis, with microscopy 81001 $30.00

Radiology Services (CPT Codes 70010-79999) 2017 CPT Code Average ChargeCT Scan, Abdomen, with contrast 74160 $4,724.00CT Scan, Head or Brain, without contrast 70450 $3,651.00CT Scan, Pelvis, with contrast 72193 $7,884.00Mammography, Screening, Bilateral 77057MRI, Head or Brain, without contrast, followed by contrast 70553 $7,230.00Ultrasound, Abdomen, Complete 76700 $2,433.00Ultrasound, OB, 14 weeks or more, transabdominal 76805 $755.00X-Ray, Lower Back, four views 72110 $1,443.00X-Ray, Chest, two views 71020 $1,087.00

Medicine Services (CPT Codes 90281-99607) 2017 CPT Code Average ChargeCardiac Catheterization, Left Heart, percutaneous 93452 $18,861.00Echocardiography, complete 93307 $1,642.00Electrocardiogram, routine, with interpretation and report 93000Inhalation Treatment, pressurized or nonpressurized 94640 $93.00Physical Therapy, Evaluation 97001Physical Therapy, Gait Training 97116 $115.00Physical Therapy, Therapeutic Exercise 97110 $129.00

In response to requests from hospitals and the public, OSHPD has developed this form to assist hospitals in collecting and submitting the average charge for 25 common outpatient procedures performed by hospitals, as required by AB 1045 (Chapter 532, Statutes of 2005). Use of the OSHPD form is voluntary, but highly encouraged, as it allows hospitals to report and the public to compare uniform information regarding common outpatient procedures.

Blood Gas Analysis, including 02 saturation

AB 1045 - List of 25 CommonOutpatient Procedures for 2017

Office of Statewide Health Planning and Development AB 1045 (May 2008)

Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017

Surgery Services (CPT Codes 10021-69990) 2017 CPT Code Average ChargeArthroscopy, Knee, with meniscectomy (medial or lateral) 29881Arthroscopy, Shoulder, with partial acromioplasty 29826Carpal Tunnel Surgery 64721Cataract Removal with Insertion of Intraocular Lens, 1 Stage 66984Colonoscopy, diagnostic 45378Colonoscopy, with biopsy 45380Colonoscopy, with lesion removal, by snare technique 45385Discission, secondary membranous cataract, laser surgery 66821Endoscopy, Upper GI, with biopsy 43239Endoscopy, Upper GI, diagnostic 43235Excision, Breast Lesion 19120Hernia Repair, Inguinal, 5 years and older 49505

62311Injection, Anesthetic or Steroid, transforaminal epidural, lumbar 64483Laparoscopic Cholecystectomy 47562Tympanostomy (insert ventilating tube, general anesthesia) 69436Tonsillectomy with Adenoidectomy, less than 12 years old 42820

Other Common Outpatient Procedures (list as needed) 2017 CPT Code Average Charge

Count of Reported Procedures (minimum 25 required) 29Instructions for Completing AB 1045 Common Outpatient Procedure Form1. Enter Hospital Name and OSHPD Facility Number. Revise Effective Date of Charges, if necessary.2. Enter Average Charge for at least 25 commonly performed outpatient procedures. For Evaluation & Management Services, do not include related ancillary charges. For all other procedures, include related ancillary charges.

(e.g., supplies, drugs, lab, use of operating room, etc.) should be included in the average charge for that procedure.3. Do not change procedure descriptions or CPT code references. Use "Other Common Outpatient Procedures" (rows 62-71) if you are unable to select procedures from list.4. Submit completed form as Excel (.xls) file, along with chargemaster and percent change in gross revenue calculation, by e-mail to chargemaster@oshpd.ca.gov or by standard mail on CD.

Injection, Diagnostic or Therapeutic substance, epidural, lumbar

NOTE: The CPT codes are included on this form to help identify the listed procedures based on the frequencies across hospital-based ambulatory surgery data. The average charge for all related services and procedures

Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017

Billing Description (25 char) Price

2204 ROOM SEMI M/S/GYN 34372402 ROOM SEMI M/S/GYN 34372600 ROOM SEMI M/S/GYN 3437

11007 ROOM ICU TRAUMA 901011205 ROOM ICU TRAUMA 901011403 ROOM ICU TRAUMA 901012807 NEWBORN I ON PEDS 234713003 NEWBORN LEVEL I 234721006 ROOM CCU GENERAL 901021204 ROOM CCU GENERAL 901021402 ROOM CCU GENERAL 901021808 ROOM CCU GENERAL 901022806 NEWBORN II ON PEDS 808523002 NEWBORN II ON NURSY 808523010 NEWBORN II COUPLET 808531906 ROOM INTER CCU/TELE 524432805 NEWBORN NICU III 901033506 NEWBORN NICU III 901039008 ROOM SEMI M/S/GYN 343742804 ROOM SEMI PVT PED 343743505 NEWBORN NICU IV 1081249007 ROOM SEMI PVT PED 343750021 OUTPT IN A BED NC 0 251102 ROOM SEMI M/S/GYN 343751110 ROOM SEMI M/S/GYN 343751201 ROOM SEMI M/S/GYN 343751409 ROOM SEMI M/S/GYN 343751508 ROOM SEMI M/S/GYN 343751607 ROOM SEMI M/S/GYN 343751904 ROOM SEMI M/S/GYN 343752001 ROOM SEMI M/S/GYN 343752209 ROOM SEMI M/S/GYN 343752407 ROOM SEMI M/S/GYN 343752605 ROOM SEMI M/S/GYN 343752803 ROOM SEMI M/S/GYN 343754007 ROOM SEMI M/S/G OB 343759006 ROOM SEMI M/S/GYN 343761002 ROOM ICU GENERAL 901061200 ROOM ICU GENERAL 901061408 ROOM ICU GENERAL 901062802 ROOM ICU PEDIATRIC 524469005 ROOM ICU GENERAL 9010

CDMNumber

Zero Price indicator

71001 ROOM INTER ICU/TELE 524471100 ROOM INTER ICU/TELE 524471118 ROOM INTER ICU/TELE 524471209 ROOM INTER ICU/TELE 524471407 ROOM INTER ICU/TELE 524471506 ROOM INTER ICU/TELE 524471605 ROOM INTER ICU/TELE 524479004 ROOM INTER ICU/TELE 524482800 ROOM SEMI OB OFF UNIT 343784004 ROOM SEMI PVT OB 343791116 ROOM ACUTE ADMINISTRATIVE 343791504 ROOM ACUTE ADMINISTRATIVE 343791603 ROOM ACUTE ADMINISTRATIVE 343791801 ROOM ACUTE ADMINISTRATIVE 343791900 ROOM ACUTE ADMINISTRATIVE 343792007 ROOM ACUTE ADMINISTRATIVE 343792205 ROOM ACUTE ADMINISTRATIVE 343792403 ROOM ACUTE ADMINISTRATIVE 343792601 ROOM ACUTE ADMINISTRATIVE 343792809 ROOM ACUTE ADMINISTRATIVE 343794003 ROOM SEMI OB HI RSK 343799002 ROOM ACUTE ADMINISTRATIVE 3437

100490 CATH DIALYSIS ST 115X-150 464100500 CATH INFUSION 195X-254 786100510 CATH OTHER 17X-23 70100520 CLOSURE IMPLNT 30X-39 121100530 GUIDEWIRE 331X-431 1334100540 INST/SUPP NONST 51X-67 207100550 INST/SUPP STERL 13X-17 53100560 INST/SUPP STERL 17X-23 70100570 INST/SUPP STERL 23X-30 93100580 INST/SUPP STERL 30X-39 121100693 ADMIN HEP B VACCINE 364100701 ADMIN INFLUENZA VACCINE 364100719 ADMIN PNEUMO VACCINE 364100727 DIRECT ADMISSION FOR OBSV 652100735 OBSERVATION PER HOUR 143100743 TRANSFUS BLD/BLD COMP 861100926 ADMIN OTHER IMMUN VAC ADD 364100927 ADMIN OTHER IMMUN VAC ONE 364200030 SPECIFIC GRAVITY UR POC 24200070 TRANSFUS BLD/BLD COMP 941200090 CATH INFUSION 23X-30 93200100 CATH OTHER 10-13 40200110 INST/SUPP STERL 10-13 40200120 INST/SUPP STERL 39X-51 158200130 KIT/PACK DISP 88X-115 355

200140 ADMIN HEP B VACCINE 364200150 ADMIN INFLUENZA VACCINE 364200160 ADMIN PNEUMO VACCINE 364200161 ADMIN OTHER IMMUN VAC ADD 364200162 ADMIN OTHER IMMUN VAC ONE 364200163 CAR SEAT/BED TEST 60MIN 90200164 CAR SEAT/BED TEST ADD 30 45300030 OBSERVATION PER HOUR 143300080 TRANSFUS BLD/BLD COMP 861300090 DIRECT ADMISSION FOR OBSV 652300150 ADMIN HEP B VACCINE 364300160 ADMIN INFLUENZA VACCINE 364300170 ADMIN PNEUMO VACCINE 364300172 NON OBV OIB HR NC 0 1300180 ADMIN OTHER IMMUN VAC ADD 364300181 ADMIN OTHER IMMUN VAC ONE 364300182 MINOR PROCEDURE 937400080 INJ TX/DX/PROPH SUBQ/IM 382400100 OBSERVATION PER HOUR 143400110 OBSERVATION PER HOUR 143400120 OBSERVATION PER HOUR 143400140 OBSERVATION PER HOUR 143400160 TRANSFUS BLD/BLD COMP 861400170 TRANSFUS BLD/BLD COMP 595400180 TRANSFUS BLD/BLD COMP 861400200 CIRCUMCISION 812400210 INF IV HYDRA INIT 31-60MN 2170400220 INF IV HYDRAT EA ADD HR 570400230 INF TX/DX/PRO INIT 1ST HR 2577400240 INF TX/DX/PRO EA ADD HR 705400250 INJ TX/DX/PRO IVPUSH INIT 382400260 INJ TX/DX/PRO IV PUSH SEQ 382400270 CHEMO IV PUSH INITIAL 1171400280 CHEMO IV PUSH EA ADD 654400290 CHEMO INF INIT 1ST HR 2091400300 CHEMO INF EA ADD HR 439400320 BLOOD COLLECTION VAD 339400330 IRRIG IMPLANTED VEN ACCES 323400350 VENIPUNCTURE NON LAB 22400360 MINOR PROCEDURE 937400450 DIRECT ADMISSION FOR OBSV 652400460 DIRECT ADMISSION FOR OBSV 652400480 DIRECT ADMISSION FOR OBSV 652400490 DIRECT ADMISSION FOR OBSV 652400500 INS/REPL/DECL NONTUN/PIC 2035400540 ADMIN INFLUENZA VACCINE 364400550 ADMIN PNEUMO VACCINE 364

400580 INF IV HYDRA INIT 31-60MN 2170400590 INF TX/DX/PRO INIT 1ST HR 2577400600 INF TX/DX/PRO SEQ 1HR 1112400610 INF IV HYDRAT EA ADD HR 570400620 INF TX/DX/PRO EA ADD HR 705400630 INJ TX/DX/PROPH SUBQ/IM 382400640 INJ TX/DX/PRO IVPUSH INIT 382400650 INJ TX/DX/PRO IV PUSH SEQ 382400660 CARDIOVERSION ELCTIVE EXT 2491400670 GLUCOSE BLD BY DEVICE POC 17400680 VENIPUNCTURE NON LAB 22400690 CATH FOR SPECIMEN COLLECT 125400700 INSERT CATH BLADDER 319400710 INJ TX/PRO/DX IVP SME DRG 382400730 LUMBAR PUNCTURE DIAGNOSTC 1677400740 ADMIN HEP B VACCINE 364400750 ADMIN HEP B VACCINE 364400760 ADMIN INFLUENZA VACCINE 364400770 ADMIN PNEUMO VACCINE 364400780 TRANSFUS BLD/BLD COMP 595400790 ADMIN HEP B VACCINE 364400800 ADMIN INFLUENZA VACCINE 364400810 ADMIN PNEUMO VACCINE 364400820 ADMIN HEP B VACCINE 364400830 ADMIN INFLUENZA VACCINE 364400840 ADMIN PNEUMO VACCINE 364400850 ADMIN HEP B VACCINE 364400860 ADMIN INFLUENZA VACCINE 364400870 ADMIN OTHER IMMUN VAC ADD 182400880 ADMIN OTHER IMMUN VAC ONE 364400890 ADMIN PNEUMO VACCINE 364400900 CATH FOR SPECIMEN COLLECT 379400910 CHEMO INF EA ADD HR 439400920 CHEMO INF EA SEQ 1ST HR 2091400930 CHEMO INF INIT 1ST HR 2091400940 CHEMO SQ/IM HORMONAL 410400950 CHEMO SQ/IM NONHORMONAL 950400960 GLUCOSE BLD BY DEVICE POC 17400970 INF IV HYDRA INIT 31-60MN 2170400980 INF IV HYDRAT EA ADD HR 570400990 INF IV TX/DX PUMP PROLONG 401401000 INF TX/DX CONCURRENT 1547401010 INF TX/DX/PRO EA ADD HR 705401020 INF TX/DX/PRO INIT 1ST HR 2577401030 INF TX/DX/PRO SEQ 1HR 1112401040 INJ TX/DX/PRO INTRA-ARTER 382401050 INJ TX/DX/PRO IV PUSH SEQ 382

401060 INJ TX/DX/PRO IVPUSH INIT 382401070 INJ TX/DX/PROPH SUBQ/IM 382401080 INJ TX/PRO/DX IVP SME DRG 382401090 INS/REPL/DECL NONTUN/PIC 2035401100 INSERT CATH BLADDER 319401110 IRRIG IMPLANTED VEN ACCES 323401120 MINOR PROCEDURE 937401130 OBSERVATION PER HOUR 143401140 DIRECT ADMISSION FOR OBSV 652401150 PACU COMPLEX 1ST 30MIN 1028401160 PACU COMPLEX ADDL 15MIN 359401170 PACU STANDARD 1ST 30MIN 791401180 PACU STANDARD ADDL 15MIN 277401190 PHLEBOTOMY THERAPEUT 341401200 PUMP IMPLANTD REFIL/MAINT 544401210 PUMP PORTABL REFILL/MAINT 544401211 BLOOD COLLECTION PICC 376401220 TRANSFUS BLD/BLD COMP 861412305 INF IV TX/DX PUMP PROLONG 401412306 APHERESIS PLASM THERAPEUT 3033412307 CHEMO INF EA SEQ 1ST HR 2091412312 INTRO SHTH OTH 30X-39 121412320 CATH INFUSION 150X-195 604412321 ADMIN HEP B VACCINE 364412322 ADMIN INFLUENZA VACCINE 364412323 ADMIN OTHER IMMUN VAC ADD 182412324 ADMIN OTHER IMMUN VAC ONE 364412325 ADMIN PNEUMO VACCINE 364412326 CATH FOR SPECIMEN COLLECT 125412327 CHEMO INF EA ADD HR 439412328 CHEMO INF EA SEQ 1ST HR 2091412329 CHEMO INF INIT 1ST HR 2091412330 CHEMO SQ/IM HORMONAL 410412331 CHEMO SQ/IM NONHORMONAL 950412332 DIRECT ADMISSION FOR OBSV 652412333 GLUCOSE BLD BY DEVICE POC 17412334 INF IV HYDRA INIT 31-60MN 2170412335 INF IV HYDRAT EA ADD HR 570412336 INF IV TX/DX PUMP PROLONG 401412337 INF TX/DX CONCURRENT 1547412338 INF TX/DX/PRO EA ADD HR 705412339 INF TX/DX/PRO INIT 1ST HR 2577412340 INF TX/DX/PRO SEQ 1HR 1112412341 INJ TX/DX/PRO INTRA-ARTER 382412342 INJ TX/DX/PRO IV PUSH SEQ 382412343 INJ TX/DX/PRO IVPUSH INIT 382412344 INJ TX/DX/PROPH SUBQ/IM 382

412345 INJ TX/PRO/DX IVP SME DRG 382412346 INS/REPL/DECL NONTUN/PIC 2035412347 INSERT CATH BLADDER 319412348 IRRIG IMPLANTED VEN ACCES 323412349 MINOR PROCEDURE 937412350 NON OBV OIB HR NC 0 1412351 OBSERVATION PER HOUR 143412352 OUTPT IN A BED NC 0 2412353 PACU COMPLEX 1ST 30MIN 1028412354 PACU COMPLEX ADDL 15MIN 359412355 PACU STANDARD 1ST 30MIN 791412356 PACU STANDARD ADDL 15MIN 277412357 PHLEBOTOMY THERAPEUT 341412358 PUMP IMPLANTD REFIL/MAINT 544412359 PUMP PORTABL REFILL/MAINT 544412360 TRANSFUS BLD/BLD COMP 1003412361 VENIPUNCTURE NON LAB 22412362 ADMIN OTHER IMMUN VAC ONE 364412363 ADMIN OTHER IMMUN VAC ADD 182412364 CHEMO SQ/IM NONHORMONAL 950412365 CHEMO SQ/IM HORMONAL 410412366 CHEMO INF INIT 1ST HR 2091412367 CHEMO INF EA ADD HR 439412368 PUMP PORTABL REFILL/MAINT 544412369 PUMP IMPLANTD REFIL/MAINT 544412370 IRRIG IMPLANTED VEN ACCES 323412371 INF TX/DX CONCURRENT 1547412372 BLOOD COLLECTION VAD 339412373 INS/REPL/DECL NONTUN/PIC 2035412374 NON OBV OIB HR NC 0 1412375 NON OBV OIB HR NC 0 1412376 ADMIN OTHER IMMUN VAC ADD 364412377 ADMIN OTHER IMMUN VAC ONE 364412378 NON OBV OIB HR NC 0 1412379 ADMIN OTHER IMMUN VAC ADD 364412380 ADMIN OTHER IMMUN VAC ONE 364412381 NON OBV OIB HR NC 0 1412382 ADMIN OTHER IMMUN VAC ADD 364412383 ADMIN OTHER IMMUN VAC ONE 364412384 NON OBV OIB HR NC 0 1412385 NACL 0.9% 1000ML INJ 194412386 NACL 0.9% 500ML INJ 78412387 LACTATED RINGERS 1L INJ 78412388 CAR SEAT/BED TEST 60MIN 90412389 CAR SEAT/BED TEST ADD 30 45600000 C-SECT L&D CT EA ADD BABY 0 1600001 DELIVERY C-SECT L&D NC 0 1

600002 OUTPATIENT PROCEDURE NC 0 1600003 DELIVERY C-SECT IN OR NC 0 1600004 C-SECT OR CT EA ADD BABY 0 1600005 INPATIENT SURG L&D OR NC 0 1600006 INJ TX/DX/PROPH SUBQ/IM 382600007 INF IV HYDRA INIT 31-60MN 2170600008 INF IV HYDRAT EA ADD HR 570600009 INF TX/DX/PRO INIT 1ST HR 2577600010 INF TX/DX/PRO EA ADD HR 705600011 INJ TX/DX/PRO IVPUSH INIT 382600012 INJ TX/DX/PRO IV PUSH SEQ 382600013 INF TX/DX CONCURRENT 1547600014 INJ TX/PRO/DX IVP SME DRG 382600015 CATH FOR SPECIMEN COLLECT 379600016 VENIPUNCTURE NON LAB 22600017 BILIRUBIN TOT TRANSCUT 39600018 GLUCOSE BLD BY DEVICE POC 17600019 SURGERY LEVEL 1 1ST 30MIN 3975600020 SURGERY LEVEL 1 ADD 15MIN 1385600021 SURGERY LEVEL 2 1ST 30MIN 4818600022 SURGERY LEVEL 2 ADD 15MIN 1679600023 SURGERY LEVEL 3 1ST 30MIN 5839600024 SURGERY LEVEL 3 ADD 15MIN 2034600025 EPIDURAL PLACE VAG DELIV 1446600026 EPIDURAL BLOOD PATCH 1619600027 INSERT CATH BLADDER 313600028 AMNIOINFUS TRANSAB WWO US 509600029 AMNIOCENTESIS 1524600030 MINOR PROCEDURE 937600031 ANESTH GENERAL 1ST 30MIN 1154600032 ANESTH GENERAL ADDL 15MIN 404600033 ANESTH MAC/REG 1ST 30MIN 888600034 ANESTH MAC/REG ADDL 15MIN 404600035 LOCAL ANESTHESIA 404600036 TRANSFUS BLD/BLD COMP 941600037 US PREG 1 OR >FETUSES LTD 1967600041 PACU STANDARD 1ST 30MIN 791600042 PACU STANDARD ADDL 15MIN 277600043 FETAL CONTRAC STRESS TEST 283600044 FETAL NON STRESS TEST 702600045 EXTERNAL VERSION 1385600046 CERCLAGE PLACEMENT 5210600047 INSERT CERVICAL DILATOR 338600048 FETAL DEMISE <23WK NEW PT 1844600049 FETAL DEMISE <23WK EST PT 1844600051 FETAL DEM <23 NEW W PROC 1844600052 FETAL DEM <23 EST W PROC 1844

600054 DELIVERY OF PLACENTA 5354600055 FETAL NS TEST ADDL FETUS 702600056 DELIVERY VAGINAL ROUTINE 6256600057 DELIVERY VAGINAL HIGH RSK 7823600058 CIRCUMCISION 186600059 OB VISIT/FETAL MONITR NEW 250600060 CATH OTHER 13X-17 53600061 OB VISIT/FETAL MONITR EST 90600062 OB OBSERV PER HOUR 166600063 DIRECT ADMISSION FOR OBSV 652600064 ADMIN HEP B VACCINE 364600065 ADMIN INFLUENZA VACCINE 364600066 ADMIN PNEUMO VACCINE 364600070 CATH OTHER 17X-23 70600080 CLOSURE EXTERN 17X-23 70600090 CLOSURE EXTERN 23X-30 93600100 INST/SUPP NONST 13X-17 53600150 CATH INFUSION 51X-67 207600160 CLOSURE EXTERN 10-13 40600170 CLOSURE EXTERN 13X-17 53600180 CLOSURE IMPLNT 115X-150 464600190 CLOSURE IMPLNT 17X-23 70600200 CLOSURE IMPLNT 39X-51 158600210 CLOSURE IMPLNT 51X-67 207600220 CLOSURE IMPLNT 88X-115 355600230 GUIDEWIRE <10 18600240 INST/SUPP STERL 10-13 40600250 INST/SUPP STERL 13X-17 53600260 INST/SUPP STERL 17X-23 70600270 INST/SUPP STERL 23X-30 93600290 NACL 0.9% 500ML INJ 78600300 LACTATED RINGERS 500MLINJ 78600310 ADHESION BARR 254X-331 1024600450 LACTATED RINGERS 1L INJ 78600480 CLOSURE IMPLNT 30X-39 121600490 INST/SUPP STERL 30X-39 121600528 PACU COMPLEX 1ST 30MIN 1028600536 PACU COMPLEX ADDL 15MIN 359600544 INF TX/DX/PRO SEQ 1HR 1112600545 SURGERY LEVEL 4 1ST 30MIN 7077600546 SURGERY LEVEL 4 ADD 15MIN 2465600547 ANES PUDENDAL NRV INJ 297600548 CLOSURE IMPLNT 195X-254 786600549 CLOSURE IMPLNT 67X-88 271600550 NON OBV GYN OIB HR NC 0 1600551 DELIVERY VAG EA ADD BABY 7823600560 VISIT LEVEL 1 EST PT 97

600561 ADMIN OTHER IMMUN VAC ADD 364600562 ADMIN OTHER IMMUN VAC ONE 364600563 OB VST/FTL MON EST W/PROC 90600564 OB VST/FTL MON NEW W/PROC 250600565 OB OBSERV PER HR NO HCPCS 166600566 D5% W ELECTROL 148 1000ML 78600567 MOD SEDAT =>5YRS 1ST 15M 554600568 MODERATE SEDAT ADD 15MIN 465600569 PUMP PORTABL REFILL/MAINT 544600570 PUMP IMPLANTD REFIL/MAINT 544600571 INF IV TX/DX PUMP PROLONG 401600572 BLOOD COLLECTION PICC 376600573 AMNIOTIC FLUID REDUC W/US 875600574 CERCLAGE REMOVAL 6618600575 INF TX/PROPH SUBQ 1ST HR 570600576 INF TX/PROPH SUBQ ADD HR 110

2000020 PT MANUAL THERAPY EA 15 1282000070 PT THR ACTIVITY EA 15 1152000080 PT THERAPY GROUP 15 3132000090 PT WHIRLPOOL ONE EXTRMITY 2302000100 PT ULTRASOUND EA 15 752000150 PT THERAPY GROUP 30 3222000160 PT THERAPY GROUP 45 3742000170 PT THERAPY GROUP 60 4202000180 PT THERAPY GROUP 75 4672000190 PT THERAPY GROUP 90 5182000230 PT E-STIM ATTEND EA 15 592000240 PT EXERCISE THR EA 15 1292000250 PT GAIT TRAINING EA 15 1152000270 PT NEUROMSCL RE-ED EA 15 1072000290 PT SELF CARE/HOME EA 15 1122000300 PT WHEELCHAIR TRN EA 15 1272000320 PT NON-CPT CLNT SRV 15 NC 0 12000330 PT STUDENT PRODUCT/DAY NC 0 12000340 PT DEBR SL SESSION 1ST 20 5652000350 PT DEBR SL SESSION ADD 20 2712000360 PT DEBR SL SESS EA 15 NC 0 12000560 PT PHYS PRF TEST EA 15 622000570 PT MC THERAPY COMBO ADD15 702000580 PT ORTHOTIC FIT/TRN EA 15 742000590 PT E-STIM UNATTENDED OTHR 502000600 PT PARAFFIN BATH THERAPY 502000610 PT TRACTION MECHANICAL 702000630 PT IONTOPHORESIS EA 15 622000640 PT MC EVALUATION INI 30 2842000660 PT PROSTHETIC TRN EA 15 742000690 PT NON-CPT CLNT SRV 15 NC 0 1

2000710 PT MC THERAPY COMBO INI30 1382000720 PT STRAPPING UNNA BOOT 3452001260 PT E-STIM UNATTENDED ULCR 952001270 PT MC EXERCISE THR INI 30 902001290 PT MC MANUAL THR INI 30 1282001300 PT MC MANUAL THR ADD 15 1282001640 PT NON-CPT INSTRUCT 15 NC 0 12001650 PT NON-CPT INSTRUCT 15 NC 0 12001670 PT DEBR SL SESS EA 15 NC 0 12001750 PT MC EVALUATION ADD 15 1422001760 PT MASSAGE EA 15 452001770 PT MOBILITY CURRENT CH 0.012001780 PT MOBILITY CURRENT CI 0.012001790 PT MOBILITY CURRENT CJ 0.012001800 PT MOBILITY CURRENT CK 0.012001810 PT MOBILITY CURRENT CL 0.012001820 PT MOBILITY CURRENT CM 0.012001830 PT MOBILITY CURRENT CN 0.012001840 PT MOBILITY GOAL CH 0.012001850 PT MOBILITY GOAL CI 0.012001860 PT MOBILITY GOAL CJ 0.012001870 PT MOBILITY GOAL CK 0.012001880 PT MOBILITY GOAL CL 0.012001890 PT MOBILITY GOAL CM 0.012001900 PT MOBILITY GOAL CN 0.012001910 PT MOBILITY D/C STATUS CH 0.012001920 PT MOBILITY D/C STATUS CI 0.012001930 PT MOBILITY D/C STATUS CJ 0.012001940 PT MOBILITY D/C STATUS CK 0.012001950 PT MOBILITY D/C STATUS CL 0.012001960 PT MOBILITY D/C STATUS CM 0.012001970 PT MOBILITY D/C STATUS CN 0.012001980 PT BODY POS CURRENT CH 0.012001990 PT BODY POS CURRENT CI 0.012002000 PT BODY POS CURRENT CJ 0.012002010 PT BODY POS CURRENT CK 0.012002020 PT BODY POS CURRENT CL 0.012002030 PT BODY POS CURRENT CM 0.012002040 PT BODY POS CURRENT CN 0.012002050 PT BODY POS GOAL CH 0.012002060 PT BODY POS GOAL CI 0.012002070 PT BODY POS GOAL CJ 0.012002080 PT BODY POS GOAL CK 0.012002090 PT BODY POS GOAL CL 0.012002100 PT BODY POS GOAL CM 0.012002110 PT BODY POS GOAL CN 0.012002120 PT BODY POS D/C STATUS CH 0.01

2002130 PT BODY POS D/C STATUS CI 0.012002140 PT BODY POS D/C STATUS CJ 0.012002150 PT BODY POS D/C STATUS CK 0.012002160 PT BODY POS D/C STATUS CL 0.012002170 PT BODY POS D/C STATUS CM 0.012002180 PT BODY POS D/C STATUS CN 0.012002190 PT CARRY CURRENT CH 0.012002200 PT CARRY CURRENT CI 0.012002210 PT CARRY CURRENT CJ 0.012002220 PT CARRY CURRENT CK 0.012002230 PT CARRY CURRENT CL 0.012002240 PT CARRY CURRENT CM 0.012002250 PT CARRY CURRENT CN 0.012002260 PT CARRY GOAL STATUS CH 0.012002270 PT CARRY GOAL STATUS CI 0.012002280 PT CARRY GOAL STATUS CJ 0.012002290 PT CARRY GOAL STATUS CK 0.012002300 PT CARRY GOAL STATUS CL 0.012002310 PT CARRY GOAL STATUS CM 0.012002320 PT CARRY GOAL STATUS CN 0.012002330 PT CARRY D/C STATUS CH 0.012002340 PT CARRY D/C STATUS CI 0.012002350 PT CARRY D/C STATUS CJ 0.012002360 PT CARRY D/C STATUS CK 0.012002370 PT CARRY D/C STATUS CL 0.012002380 PT CARRY D/C STATUS CM 0.012002390 PT CARRY D/C STATUS CN 0.012002400 PT SELF CARE CURRENT CH 0.012002410 PT SELF CARE CURRENT CI 0.012002420 PT SELF CARE CURRENT CJ 0.012002430 PT SELF CARE CURRENT CK 0.012002440 PT SELF CARE CURRENT CL 0.012002450 PT SELF CARE CURRENT CM 0.012002460 PT SELF CARE CURRENT CN 0.012002470 PT SELF CARE GOAL CH 0.012002480 PT SELF CARE GOAL CI 0.012002490 PT SELF CARE GOAL CJ 0.012002500 PT SELF CARE GOAL CK 0.012002510 PT SELF CARE GOAL CL 0.012002520 PT SELF CARE GOAL CM 0.012002530 PT SELF CARE GOAL CN 0.012002540 PT SELF CARE D/C CH 0.012002550 PT SELF CARE D/C CI 0.012002560 PT SELF CARE D/C CJ 0.012002570 PT SELF CARE D/C CK 0.012002580 PT SELF CARE D/C CL 0.012002590 PT SELF CARE D/C CM 0.01

2002600 PT SELF CARE D/C CN 0.012002610 PT OTHER PT/OT CURRENT CH 0.012002620 PT OTHER PT/OT CURRENT CI 0.012002630 PT OTHER PT/OT CURRENT CJ 0.012002640 PT OTHER PT/OT CURRENT CK 0.012002650 PT OTHER PT/OT CURRENT CL 0.012002660 PT OTHER PT/OT CURRENT CM 0.012002670 PT OTHER PT/OT CURRENT CN 0.012002680 PT OTHER PT/OT GOAL CH 0.012002690 PT OTHER PT/OT GOAL CI 0.012002700 PT OTHER PT/OT GOAL CJ 0.012002710 PT OTHER PT/OT GOAL CK 0.012002720 PT OTHER PT/OT GOAL CL 0.012002730 PT OTHER PT/OT GOAL CM 0.012002740 PT OTHER PT/OT GOAL CN 0.012002750 PT OTHER PT/OT D/C CH 0.012002760 PT OTHER PT/OT D/C CI 0.012002770 PT OTHER PT/OT D/C CJ 0.012002780 PT OTHER PT/OT D/C CK 0.012002790 PT OTHER PT/OT D/C CL 0.012002800 PT OTHER PT/OT D/C CM 0.012002810 PT OTHER PT/OT D/C CN 0.012002820 PT SUB PT/OT CURRENT CH 0.012002830 PT SUB PT/OT CURRENT CI 0.012002840 PT SUB PT/OT CURRENT CJ 0.012002850 PT SUB PT/OT CURRENT CK 0.012002860 PT SUB PT/OT CURRENT CL 0.012002870 PT SUB PT/OT CURRENT CM 0.012002880 PT SUB PT/OT CURRENT CN 0.012002890 PT SUB PT/OT GOAL CH 0.012002900 PT SUB PT/OT GOAL CI 0.012002910 PT SUB PT/OT GOAL CJ 0.012002920 PT SUB PT/OT GOAL CK 0.012002930 PT SUB PT/OT GOAL CL 0.012002940 PT SUB PT/OT GOAL CM 0.012002950 PT SUB PT/OT GOAL CN 0.012002960 PT SUB PT/OT D/C CH 0.012002970 PT SUB PT/OT D/C CI 0.012002980 PT SUB PT/OT D/C CJ 0.012002990 PT SUB PT/OT D/C CK 0.012003000 PT SUB PT/OT D/C CL 0.012003010 PT SUB PT/OT D/C CM 0.012003020 PT SUB PT/OT D/C CN 0.012003030 PT ATTEN CURRENT CH 0.012003040 PT ATTEN CURRENT CI 0.012003050 PT ATTEN CURRENT CJ 0.012003060 PT ATTEN CURRENT CK 0.01

2003070 PT ATTEN CURRENT CL 0.012003080 PT ATTEN CURRENT CM 0.012003090 PT ATTEN CURRENT CN 0.012003100 PT ATTEN GOAL STATUS CH 0.012003110 PT ATTEN GOAL STATUS CI 0.012003120 PT ATTEN GOAL STATUS CJ 0.012003130 PT ATTEN GOAL STATUS CK 0.012003140 PT ATTEN GOAL STATUS CL 0.012003150 PT ATTEN GOAL STATUS CM 0.012003160 PT ATTEN GOAL STATUS CN 0.012003170 PT ATTEN D/C STATUS CH 0.012003180 PT ATTEN D/C STATUS CI 0.012003190 PT ATTEN D/C STATUS CJ 0.012003200 PT ATTEN D/C STATUS CK 0.012003210 PT ATTEN D/C STATUS CL 0.012003220 PT ATTEN D/C STATUS CM 0.012003230 PT ATTEN D/C STATUS CN 0.012003240 PT MEMORY CURRENT CH 0.012003250 PT MEMORY CURRENT CI 0.012003260 PT MEMORY CURRENT CJ 0.012003270 PT MEMORY CURRENT CK 0.012003280 PT MEMORY CURRENT CL 0.012003290 PT MEMORY CURRENT CM 0.012003300 PT MEMORY CURRENT CN 0.012003310 PT MEMORY GOAL STATUS CH 0.012003320 PT MEMORY GOAL STATUS CI 0.012003330 PT MEMORY GOAL STATUS CJ 0.012003340 PT MEMORY GOAL STATUS CK 0.012003350 PT MEMORY GOAL STATUS CL 0.012003360 PT MEMORY GOAL STATUS CM 0.012003370 PT MEMORY GOAL STATUS CN 0.012003380 PT MEMORY D/C STATUS CH 0.012003390 PT MEMORY D/C STATUS CI 0.012003400 PT MEMORY D/C STATUS CJ 0.012003410 PT MEMORY D/C STATUS CK 0.012003420 PT MEMORY D/C STATUS CL 0.012003430 PT MEMORY D/C STATUS CM 0.012003440 PT MEMORY D/C STATUS CN 0.012003450 PT MOBILITY CURRENT CH 0.012003460 PT MOBILITY CURRENT CI 0.012003470 PT MOBILITY CURRENT CJ 0.012003480 PT MOBILITY CURRENT CK 0.012003490 PT MOBILITY CURRENT CL 0.012003500 PT MOBILITY CURRENT CM 0.012003510 PT MOBILITY CURRENT CN 0.012003520 PT MOBILITY GOAL CH 0.012003530 PT MOBILITY GOAL CI 0.01

2003540 PT MOBILITY GOAL CJ 0.012003550 PT MOBILITY GOAL CK 0.012003560 PT MOBILITY GOAL CL 0.012003570 PT MOBILITY GOAL CM 0.012003580 PT MOBILITY GOAL CN 0.012003590 PT MOBILITY D/C STATUS CH 0.012003600 PT MOBILITY D/C STATUS CI 0.012003610 PT MOBILITY D/C STATUS CJ 0.012003620 PT MOBILITY D/C STATUS CK 0.012003630 PT MOBILITY D/C STATUS CL 0.012003640 PT MOBILITY D/C STATUS CM 0.012003650 PT MOBILITY D/C STATUS CN 0.012003660 PT BODY POS CURRENT CH 0.012003670 PT BODY POS CURRENT CI 0.012003680 PT BODY POS CURRENT CJ 0.012003690 PT BODY POS CURRENT CK 0.012003700 PT BODY POS CURRENT CL 0.012003710 PT BODY POS CURRENT CM 0.012003720 PT BODY POS CURRENT CN 0.012003730 PT BODY POS GOAL CH 0.012003740 PT BODY POS GOAL CI 0.012003750 PT BODY POS GOAL CJ 0.012003760 PT BODY POS GOAL CK 0.012003770 PT BODY POS GOAL CL 0.012003780 PT BODY POS GOAL CM 0.012003790 PT BODY POS GOAL CN 0.012003800 PT BODY POS D/C STATUS CH 0.012003810 PT BODY POS D/C STATUS CI 0.012003820 PT BODY POS D/C STATUS CJ 0.012003830 PT BODY POS D/C STATUS CK 0.012003840 PT BODY POS D/C STATUS CL 0.012003850 PT BODY POS D/C STATUS CM 0.012003860 PT BODY POS D/C STATUS CN 0.012003870 PT CARRY CURRENT CH 0.012003880 PT CARRY CURRENT CI 0.012003890 PT CARRY CURRENT CJ 0.012003900 PT CARRY CURRENT CK 0.012003910 PT CARRY CURRENT CL 0.012003920 PT CARRY CURRENT CM 0.012003930 PT CARRY CURRENT CN 0.012003940 PT CARRY GOAL STATUS CH 0.012003950 PT CARRY GOAL STATUS CI 0.012003960 PT CARRY GOAL STATUS CJ 0.012003970 PT CARRY GOAL STATUS CK 0.012003980 PT CARRY GOAL STATUS CL 0.012003990 PT CARRY GOAL STATUS CM 0.012004000 PT CARRY GOAL STATUS CN 0.01

2004010 PT CARRY D/C STATUS CH 0.012004020 PT CARRY D/C STATUS CI 0.012004030 PT CARRY D/C STATUS CJ 0.012004040 PT CARRY D/C STATUS CK 0.012004050 PT CARRY D/C STATUS CL 0.012004060 PT CARRY D/C STATUS CM 0.012004070 PT CARRY D/C STATUS CN 0.012004080 PT SELF CARE CURRENT CH 0.012004090 PT SELF CARE CURRENT CI 0.012004100 PT SELF CARE CURRENT CJ 0.012004110 PT SELF CARE CURRENT CK 0.012004120 PT SELF CARE CURRENT CL 0.012004130 PT SELF CARE CURRENT CM 0.012004140 PT SELF CARE CURRENT CN 0.012004150 PT SELF CARE GOAL CH 0.012004160 PT SELF CARE GOAL CI 0.012004170 PT SELF CARE GOAL CJ 0.012004180 PT SELF CARE GOAL CK 0.012004190 PT SELF CARE GOAL CL 0.012004200 PT SELF CARE GOAL CM 0.012004210 PT SELF CARE GOAL CN 0.012004220 PT SELF CARE D/C CH 0.012004230 PT SELF CARE D/C CI 0.012004240 PT SELF CARE D/C CJ 0.012004250 PT SELF CARE D/C CK 0.012004260 PT SELF CARE D/C CL 0.012004270 PT SELF CARE D/C CM 0.012004280 PT SELF CARE D/C CN 0.012004290 PT OTHER PT/OT CURRENT CH 0.012004300 PT OTHER PT/OT CURRENT CI 0.012004310 PT OTHER PT/OT CURRENT CJ 0.012004320 PT OTHER PT/OT CURRENT CK 0.012004330 PT OTHER PT/OT CURRENT CL 0.012004340 PT OTHER PT/OT CURRENT CM 0.012004350 PT OTHER PT/OT CURRENT CN 0.012004360 PT OTHER PT/OT GOAL CH 0.012004370 PT OTHER PT/OT GOAL CI 0.012004380 PT OTHER PT/OT GOAL CJ 0.012004390 PT OTHER PT/OT GOAL CK 0.012004400 PT OTHER PT/OT GOAL CL 0.012004410 PT OTHER PT/OT GOAL CM 0.012004420 PT OTHER PT/OT GOAL CN 0.012004430 PT OTHER PT/OT D/C CH 0.012004440 PT OTHER PT/OT D/C CI 0.012004450 PT OTHER PT/OT D/C CJ 0.012004460 PT OTHER PT/OT D/C CK 0.012004470 PT OTHER PT/OT D/C CL 0.01

2004480 PT OTHER PT/OT D/C CM 0.012004490 PT OTHER PT/OT D/C CN 0.012004500 PT SUB PT/OT CURRENT CH 0.012004510 PT SUB PT/OT CURRENT CI 0.012004520 PT SUB PT/OT CURRENT CJ 0.012004530 PT SUB PT/OT CURRENT CK 0.012004540 PT SUB PT/OT CURRENT CL 0.012004550 PT SUB PT/OT CURRENT CM 0.012004560 PT SUB PT/OT CURRENT CN 0.012004570 PT SUB PT/OT GOAL CH 0.012004580 PT SUB PT/OT GOAL CI 0.012004590 PT SUB PT/OT GOAL CJ 0.012004600 PT SUB PT/OT GOAL CK 0.012004610 PT SUB PT/OT GOAL CL 0.012004620 PT SUB PT/OT GOAL CM 0.012004630 PT SUB PT/OT GOAL CN 0.012004640 PT SUB PT/OT D/C CH 0.012004650 PT SUB PT/OT D/C CI 0.012004660 PT SUB PT/OT D/C CJ 0.012004670 PT SUB PT/OT D/C CK 0.012004680 PT SUB PT/OT D/C CL 0.012004690 PT SUB PT/OT D/C CM 0.012004700 PT SUB PT/OT D/C CN 0.012004710 PT ATTEN CURRENT CH 0.012004720 PT ATTEN CURRENT CI 0.012004730 PT ATTEN CURRENT CJ 0.012004740 PT ATTEN CURRENT CK 0.012004750 PT ATTEN CURRENT CL 0.012004760 PT ATTEN CURRENT CM 0.012004770 PT ATTEN CURRENT CN 0.012004780 PT ATTEN GOAL STATUS CH 0.012004790 PT ATTEN GOAL STATUS CI 0.012004800 PT ATTEN GOAL STATUS CJ 0.012004810 PT ATTEN GOAL STATUS CK 0.012004820 PT ATTEN GOAL STATUS CL 0.012004830 PT ATTEN GOAL STATUS CM 0.012004840 PT ATTEN GOAL STATUS CN 0.012004850 PT ATTEN D/C STATUS CH 0.012004860 PT ATTEN D/C STATUS CI 0.012004870 PT ATTEN D/C STATUS CJ 0.012004880 PT ATTEN D/C STATUS CK 0.012004890 PT ATTEN D/C STATUS CL 0.012004900 PT ATTEN D/C STATUS CM 0.012004910 PT ATTEN D/C STATUS CN 0.012004920 PT MEMORY CURRENT CH 0.012004930 PT MEMORY CURRENT CI 0.012004940 PT MEMORY CURRENT CJ 0.01

2004950 PT MEMORY CURRENT CK 0.012004960 PT MEMORY CURRENT CL 0.012004970 PT MEMORY CURRENT CM 0.012004980 PT MEMORY CURRENT CN 0.012004990 PT MEMORY GOAL STATUS CH 0.012005000 PT MEMORY GOAL STATUS CI 0.012005010 PT MEMORY GOAL STATUS CJ 0.012005020 PT MEMORY GOAL STATUS CK 0.012005030 PT MEMORY GOAL STATUS CL 0.012005040 PT MEMORY GOAL STATUS CM 0.012005050 PT MEMORY GOAL STATUS CN 0.012005060 PT MEMORY D/C STATUS CH 0.012005070 PT MEMORY D/C STATUS CI 0.012005080 PT MEMORY D/C STATUS CJ 0.012005090 PT MEMORY D/C STATUS CK 0.012005100 PT MEMORY D/C STATUS CL 0.012005110 PT MEMORY D/C STATUS CM 0.012005120 PT MEMORY D/C STATUS CN 0.012005130 PT DEBRIDE NONSEL W/POC 2542005164 PT MC RE-EVAL INI 30 2902005165 PT MC RE-EVAL ADD 15 2632005166 PT MC CASE CONSULT W RPT 2712005167 PT MC COM/WK REINT ADD 15 1172005168 PT MC COM/WK REINT INI 30 2712005169 PT MC CONFERENCE ADD 15 1172005170 PT MC CONFERENCE INI 30 2712005171 PT MC CONTRST BATH ADD 15 1172005172 PT MC CONTRST BATH INI 30 2712005173 PT MC DEBR WO ANES ADD 15 1172005174 PT MC DEBR WO ANES INI 30 2712005175 PT MC DIATH/MICRO ADD 15 1172005176 PT MC DIATH/MICRO INI 30 2712005177 PT MC DVL COGNT ADD 15 1172005178 PT MC DVL COGNT INI 30 2712005179 PT MC E-STIM ATTND ADD 15 1172005180 PT MC E-STIM ATTND INI 30 2712005181 PT MC E-STIM UNATT ADD 15 1172005182 PT MC E-STIM UNATT INI 30 2712005183 PT MC EVAL ATH TRN ADD 15 1172005184 PT MC EVAL ATH TRN INI 30 2712005185 PT MC EXERCISE THR ADD 15 1172005186 PT MC GAIT TRAIN ADD 15 1172005187 PT MC GAIT TRAIN INI 30 2712005188 PT MC HOT/COLD PCK ADD 15 1172005189 PT MC HOT/COLD PCK INI 30 2712005190 PT MC HUBBARD TANK ADD 15 1172005191 PT MC HUBBARD TANK INI 30 271

2005192 PT MC INFRARED THR ADD 15 1172005193 PT MC INFRARED THR INI 30 2712005194 PT MC IONTOPHORES ADD 15 1172005195 PT MC IONTOPHORES INI 30 2712005196 PT MC MASSAGE ADD 15 1172005197 PT MC MASSAGE INI 30 2712005198 PT MC MMT BODY ADD 15 1172005199 PT MC MMT BODY INITIAL 30 2712005200 PT MC MOT VID 3D ADD 15 1172005201 PT MC MOT VIDEO 3D INI 30 2712005202 PT MC NEUROMSCL ED ADD 15 1172005203 PT MC NEUROMSCL ED INI 30 2712005204 PT MC ORTH FIT/TRN ADD 15 1172005205 PT MC ORTH FIT/TRN INI 30 2712005206 PT MC ORTH/PROS CK ADD 15 1172005207 PT MC ORTH/PROS CK INI 30 2712005208 PT MC PARAFFIN THR ADD 15 1172005209 PT MC PARAFFIN THR INI 30 2712005210 PT MC PHYS PRF TST ADD 15 1172005211 PT MC PHYS PRF TST INI 30 2712005212 PT MC PREL EVAL SNF ICF 2712005213 PT MC PROSTHTC TRN ADD 15 1172005214 PT MC PROSTHTC TRN INI 30 2712005215 PT MC RE-EVAL ATH ADD 15 1172005216 PT MC RE-EVAL ATH INI 30 2712005217 PT MC SENSORY TECH ADD 15 1172005218 PT MC SENSORY TECH INI 30 2712005219 PT MC SLF CARE/HME ADD 15 1172005220 PT MC SLF CARE/HME INI 30 2712005221 PT MC THR ACTIVITY ADD 15 1172005222 PT MC THR ACTVTY INI 30 2712005223 PT MC TRACTION MEC ADD 15 1172005224 PT MC TRACTION MEC INI 30 2712005225 PT MC ULTRASOUND ADD 15 1172005226 PT MC ULTRASOUND INI 30 2712005227 PT MC UV THERAPY ADD 15 1172005228 PT MC UV THERAPY INI 30 2712005229 PT MC VASOPN TX ADD 15 1172005230 PT MC VASOPN TX INI 30 2712005231 PT MC WHEELCHR TRN ADD 15 1172005232 PT MC WHEELCHR TRN INI 30 2712005233 PT MC WHRLPL THR ADD 15 1172005234 PT MC WHRLPL THR INI 30 2712005235 PT MC WOUNDVAC ADD 15 1172005236 PT MC WOUNDVAC INI 30 2712005264 PT THPY CAP KX REVIEW NC 0 22005265 PT THPY CAP KX REVIEW NC 0 2

2005281 PT EVAL MOD COMPLEX 30 MN 3282005282 PT EVAL HIGH COMPLEX 45MN 4902005288 PT EVAL LOW COMPLEX 15 MN 1422005289 PT EVAL LOW COMPLEX 30 MN 3282005290 PT EVAL LOW COMPLEX 45 MN 4902005291 PT EVAL MOD COMPLEX 45 MN 4902005292 PT EVAL MOD COMPLEX 60 MN 6522005293 PT EVAL HIGH COMPLEX 60MN 6522005294 PT EVAL HIGH COMPLEX 75MN 8522005295 PT EVAL HIGH COMPLEX 90MN 10142005296 PT RE-EVAL EST CARE PL 15 3192005297 PT RE-EVAL EST CARE PL 30 3532005298 PT RE-EVAL EST CARE PL 45 3872005299 PT RE-EVAL EST CARE PL 60 4312100010 ST EVAL SWAL VID/FLR 30 7932100030 ST TREATMENT SWALLOW 30 2142100070 ST EVAL SWALLOWING 15 4492100080 ST TREATMENT SPEECH 30 2402100090 ST TREATMENT SPEECH 45 3262100100 ST TREATMENT SPEECH 60 4132100110 ST TREATMENT SWALLOW 60 4282100130 ST DEVLOPMENTAL SCREENING 4812100180 ST EVAL SWALLOWING 30 5862100190 ST EVAL SWALLOWING 45 7812100200 ST EVAL SWALLOWING 60 9762100210 ST EVAL SWAL VID/FLR 45 10172100220 ST EVAL SWAL VID/FLR 60 13622100230 ST EVAL SWAL VID/FLR 90 20332100250 ST TREATMENT SWALLOW 15 942100260 ST TREATMENT SWALLOW 45 2822100470 ST COGNT PERF TEST EA HR 3482100490 ST STUDENT PRODUCT/DAY NC 0 12100500 ST TREATMENT SPEECH 15 1152100510 ST SWALLOW CURRENT CH 0.012100520 ST SWALLOW CURRENT CI 0.012100530 ST SWALLOW CURRENT CJ 0.012100540 ST SWALLOW CURRENT CK 0.012100550 ST SWALLOW CURRENT CL 0.012100560 ST SWALLOW CURRENT CM 0.012100570 ST SWALLOW CURRENT CN 0.012100580 ST SWALLOW GOAL STATUS CH 0.012100590 ST SWALLOW GOAL STATUS CI 0.012100600 ST SWALLOW GOAL STATUS CJ 0.012100610 ST SWALLOW GOAL STATUS CK 0.012100620 ST SWALLOW GOAL STATUS CL 0.012100630 ST SWALLOW GOAL STATUS CM 0.012100640 ST SWALLOW GOAL STATUS CN 0.01

2100650 ST SWALLOW D/C STATUS CH 0.012100660 ST SWALLOW D/C STATUS CI 0.012100670 ST SWALLOW D/C STATUS CJ 0.012100680 ST SWALLOW D/C STATUS CK 0.012100690 ST SWALLOW D/C STATUS CL 0.012100700 ST SWALLOW D/C STATUS CM 0.012100710 ST SWALLOW D/C STATUS CN 0.012100720 ST MOT SPEECH CURRENT CH 0.012100730 ST MOT SPEECH CURRENT CI 0.012100740 ST MOT SPEECH CURRENT CJ 0.012100750 ST MOT SPEECH CURRENT CK 0.012100760 ST MOT SPEECH CURRENT CL 0.012100770 ST MOT SPEECH CURRENT CM 0.012100780 ST MOT SPEECH CURRENT CN 0.012100790 ST MOTOR SPEECH D/C CH 0.012100800 ST MOTOR SPEECH D/C CI 0.012100810 ST MOTOR SPEECH D/C CJ 0.012100820 ST MOTOR SPEECH D/C CK 0.012100830 ST MOTOR SPEECH D/C CL 0.012100840 ST MOTOR SPEECH D/C CM 0.012100850 ST MOTOR SPEECH D/C CN 0.012100860 ST LANG COMP CURRENT CH 0.012100870 ST LANG COMP CURRENT CI 0.012100880 ST LANG COMP CURRENT CJ 0.012100890 ST LANG COMP CURRENT CK 0.012100900 ST LANG COMP CURRENT CL 0.012100910 ST LANG COMP CURRENT CM 0.012100920 ST LANG COMP CURRENT CN 0.012100930 ST LANG COMP GOAL CH 0.012100940 ST LANG COMP GOAL CI 0.012100950 ST LANG COMP GOAL CJ 0.012100960 ST LANG COMP GOAL CK 0.012100970 ST LANG COMP GOAL CL 0.012100980 ST LANG COMP GOAL CM 0.012100990 ST LANG COMP GOAL CN 0.012101000 ST LANG COMP D/C CH 0.012101010 ST LANG COMP D/C CI 0.012101020 ST LANG COMP D/C CJ 0.012101030 ST LANG COMP D/C CK 0.012101040 ST LANG COMP D/C CL 0.012101050 ST LANG COMP D/C CM 0.012101060 ST LANG COMP D/C CN 0.012101070 ST LANG EXPR CURRENT CH 0.012101080 ST LANG EXPR CURRENT CI 0.012101090 ST LANG EXPR CURRENT CJ 0.012101100 ST LANG EXPR CURRENT CK 0.012101110 ST LANG EXPR CURRENT CL 0.01

2101120 ST LANG EXPR CURRENT CM 0.012101130 ST LANG EXPR CURRENT CN 0.012101140 ST LANG EXPRESS GOAL CH 0.012101150 ST LANG EXPRESS GOAL CI 0.012101160 ST LANG EXPRESS GOAL CJ 0.012101170 ST LANG EXPRESS GOAL CK 0.012101180 ST LANG EXPRESS GOAL CL 0.012101190 ST LANG EXPRESS GOAL CM 0.012101200 ST LANG EXPRESS GOAL CN 0.012101210 ST LANG EXPRESS D/C CH 0.012101220 ST LANG EXPRESS D/C CI 0.012101230 ST LANG EXPRESS D/C CJ 0.012101240 ST LANG EXPRESS D/C CK 0.012101250 ST LANG EXPRESS D/C CL 0.012101260 ST LANG EXPRESS D/C CM 0.012101270 ST LANG EXPRESS D/C CN 0.012101280 ST ATTEN CURRENT CH 0.012101290 ST ATTEN CURRENT CI 0.012101300 ST ATTEN CURRENT CJ 0.012101310 ST ATTEN CURRENT CK 0.012101320 ST ATTEN CURRENT CL 0.012101330 ST ATTEN CURRENT CM 0.012101340 ST ATTEN CURRENT CN 0.012101350 ST ATTEN GOAL STATUS CH 0.012101360 ST ATTEN GOAL STATUS CI 0.012101370 ST ATTEN GOAL STATUS CJ 0.012101380 ST ATTEN GOAL STATUS CK 0.012101390 ST ATTEN GOAL STATUS CL 0.012101400 ST ATTEN GOAL STATUS CM 0.012101410 ST ATTEN GOAL STATUS CN 0.012101420 ST ATTEN D/C STATUS CH 0.012101430 ST ATTEN D/C STATUS CI 0.012101440 ST ATTEN D/C STATUS CJ 0.012101450 ST ATTEN D/C STATUS CK 0.012101460 ST ATTEN D/C STATUS CL 0.012101470 ST ATTEN D/C STATUS CM 0.012101480 ST ATTEN D/C STATUS CN 0.012101490 ST MEMORY CURRENT CH 0.012101500 ST MEMORY CURRENT CI 0.012101510 ST MEMORY CURRENT CJ 0.012101520 ST MEMORY CURRENT CK 0.012101530 ST MEMORY CURRENT CL 0.012101540 ST MEMORY CURRENT CM 0.012101550 ST MEMORY CURRENT CN 0.012101560 ST MEMORY GOAL STATUS CH 0.012101570 ST MEMORY GOAL STATUS CI 0.012101580 ST MEMORY GOAL STATUS CJ 0.01

2101590 ST MEMORY GOAL STATUS CK 0.012101600 ST MEMORY GOAL STATUS CL 0.012101610 ST MEMORY GOAL STATUS CM 0.012101620 ST MEMORY GOAL STATUS CN 0.012101630 ST MEMORY D/C STATUS CH 0.012101640 ST MEMORY D/C STATUS CI 0.012101650 ST MEMORY D/C STATUS CJ 0.012101660 ST MEMORY D/C STATUS CK 0.012101670 ST MEMORY D/C STATUS CL 0.012101680 ST MEMORY D/C STATUS CM 0.012101690 ST MEMORY D/C STATUS CN 0.012101700 ST VOICE CURRENT CH 0.012101710 ST VOICE CURRENT CI 0.012101720 ST VOICE CURRENT CJ 0.012101730 ST VOICE CURRENT CK 0.012101740 ST VOICE CURRENT CL 0.012101750 ST VOICE CURRENT CM 0.012101760 ST VOICE CURRENT CN 0.012101770 ST VOICE GOAL STATUS CH 0.012101780 ST VOICE GOAL STATUS CI 0.012101790 ST VOICE GOAL STATUS CJ 0.012101800 ST VOICE GOAL STATUS CK 0.012101810 ST VOICE GOAL STATUS CL 0.012101820 ST VOICE GOAL STATUS CM 0.012101830 ST VOICE GOAL STATUS CN 0.012101840 ST VOICE D/C STATUS CH 0.012101850 ST VOICE D/C STATUS CI 0.012101860 ST VOICE D/C STATUS CJ 0.012101870 ST VOICE D/C STATUS CK 0.012101880 ST VOICE D/C STATUS CL 0.012101890 ST VOICE D/C STATUS CM 0.012101900 ST VOICE D/C STATUS CN 0.012101910 ST OTH SP LANG CURRENT CH 0.012101920 ST OTH SP LANG CURRENT CI 0.012101930 ST OTH SP LANG CURRENT CJ 0.012101940 ST OTH SP LANG CURRENT CK 0.012101950 ST OTH SP LANG CURRENT CL 0.012101960 ST OTH SP LANG CURRENT CM 0.012101970 ST OTH SP LANG CURRENT CN 0.012101980 ST OTHER SP LANG GOAL CH 0.012101990 ST OTHER SP LANG GOAL CI 0.012102000 ST OTHER SP LANG GOAL CJ 0.012102010 ST OTHER SP LANG GOAL CK 0.012102020 ST OTHER SP LANG GOAL CL 0.012102030 ST OTHER SP LANG GOAL CM 0.012102040 ST OTHER SP LANG GOAL CN 0.012102050 ST OTHER SP LANG D/C CH 0.01

2102060 ST OTHER SP LANG D/C CI 0.012102070 ST OTHER SP LANG D/C CJ 0.012102080 ST OTHER SP LANG D/C CK 0.012102090 ST OTHER SP LANG D/C CL 0.012102100 ST OTHER SP LANG D/C CM 0.012102110 ST OTHER SP LANG D/C CN 0.012102120 ST MOTOR SPEECH GOAL CH 0.012102130 ST MOTOR SPEECH GOAL CI 0.012102140 ST MOTOR SPEECH GOAL CJ 0.012102150 ST MOTOR SPEECH GOAL CK 0.012102160 ST MOTOR SPEECH GOAL CL 0.012102170 ST MOTOR SPEECH GOAL CM 0.012102180 ST MOTOR SPEECH GOAL CN 0.012102181 ST EVAL SPEECH FLUENCY 15 1372102182 ST EVAL SPEECH FLUENCY 30 2402102183 ST EVAL SPEECH FLUENCY 45 3552102184 ST EVAL SPEECH FLUENCY 60 5722102185 ST EVAL SPEECH FLUENCY 75 6352102186 ST EVAL SPEECH FLUENCY 90 7722102187 ST EVAL SPEECH FLUENC 105 9552102188 ST EVAL SPEECH FLUENC 120 11442102189 ST EVAL SPEECH PRODUCT 15 1662102190 ST EVAL SPEECH PRODUCT 30 2912102191 ST EVAL SPEECH PRODUCT 45 4302102192 ST EVAL SPEECH PRODUCT 60 6932102193 ST EVAL SPEECH PRODUCT 75 7692102194 ST EVAL SPEECH PRODUCT 90 9362102195 ST EVAL SPEECH PRODUC 105 11572102196 ST EVAL SPEECH PRODUC 120 13862102197 ST EVAL SP SOUND COMP 15 1852102198 ST EVAL SP SOUND COMP 30 3182102199 ST EVAL SP SOUND COMP 45 4722102200 ST EVAL SP SOUND COMP 60 7602102201 ST EVAL SP SOUND COMP 75 8422102202 ST EVAL SP SOUND COMP 90 10272102203 ST EVAL SP SOUND COMP 105 12732102204 ST EVAL SP SOUND COMP 120 15202102205 ST VOICE BEHAV ANALY 15 1392102206 ST VOICE BEHAV ANALY 30 2402102207 ST VOICE BEHAV ANALY 45 3552102208 ST VOICE BEHAV ANALY 60 5722102209 ST VOICE BEHAV ANALY 75 6332102210 ST VOICE BEHAV ANALY 90 7712102211 ST VOICE BEHAV ANALY 105 9572102212 ST VOICE BEHAV ANALY 120 11432102213 ST TREATMENT SPEECH 75 5022102214 ST TREATMENT SPEECH 90 588

2102215 ST TREATMENT SWALLOW 75 5142102216 ST TREATMENT SWALLOW 90 5652102217 ST THPY CAP KX REVIEW NC 0 22102218 ST EVAL VOICE PROS 30 2402102219 ST EVAL VOICE PROS 45 3552102220 ST EVAL VOICE PROS 60 5722102221 ST EVAL VOICE PROS 75 6332200050 OT THR ACTIVITY EA 15 1152200100 OT EXERCISE THR EA 15 1292200120 OT SELF CARE/HOME EA 15 1122200210 OT NON-CPT CLNT SRV 15 NC 0 12200220 OT STUDENT PRODUCT/DAY NC 0 12200240 OT SENSORY TECH EA 15 772200250 OT MC EVALUATION INI 30 1942200260 OT MC EVALUATION ADD 15 1562200270 OT COM/WORK REINT EA 15 522200280 OT MC THR ACTIVITY INI 30 1802200290 OT MC THR ACTIVITY ADD 15 902200300 OT NEUROMSCL RE-ED EA 15 772200340 OT MC NEUROMSCL ED INI 30 1562200350 OT MC NEUROMSCL ED ADD 15 772200360 OT MC SLF CARE/HME INI 30 2252200370 OT MC SLF CARE/HME ADD 15 1122200380 OT MOBILITY CURRENT CH 0.012200390 OT MOBILITY CURRENT CI 0.012200400 OT MOBILITY CURRENT CJ 0.012200410 OT MOBILITY CURRENT CK 0.012200420 OT MOBILITY CURRENT CL 0.012200430 OT MOBILITY CURRENT CM 0.012200440 OT MOBILITY CURRENT CN 0.012200450 OT MOBILITY GOAL CH 0.012200460 OT MOBILITY GOAL CI 0.012200470 OT MOBILITY GOAL CJ 0.012200480 OT MOBILITY GOAL CK 0.012200490 OT MOBILITY GOAL CL 0.012200500 OT MOBILITY GOAL CM 0.012200510 OT MOBILITY GOAL CN 0.012200520 OT MOBILITY D/C STATUS CH 0.012200530 OT MOBILITY D/C STATUS CI 0.012200540 OT MOBILITY D/C STATUS CJ 0.012200550 OT MOBILITY D/C STATUS CK 0.012200560 OT MOBILITY D/C STATUS CL 0.012200570 OT MOBILITY D/C STATUS CM 0.012200580 OT MOBILITY D/C STATUS CN 0.012200590 OT BODY POS CURRENT CH 0.012200600 OT BODY POS CURRENT CI 0.012200610 OT BODY POS CURRENT CJ 0.01

2200620 OT BODY POS CURRENT CK 0.012200630 OT BODY POS CURRENT CL 0.012200640 OT BODY POS CURRENT CM 0.012200650 OT BODY POS CURRENT CN 0.012200660 OT BODY POS GOAL CH 0.012200670 OT BODY POS GOAL CI 0.012200680 OT BODY POS GOAL CJ 0.012200690 OT BODY POS GOAL CK 0.012200700 OT BODY POS GOAL CL 0.012200710 OT BODY POS GOAL CM 0.012200720 OT BODY POS GOAL CN 0.012200730 OT BODY POS D/C STATUS CH 0.012200740 OT BODY POS D/C STATUS CI 0.012200750 OT BODY POS D/C STATUS CJ 0.012200760 OT BODY POS D/C STATUS CK 0.012200770 OT BODY POS D/C STATUS CL 0.012200780 OT BODY POS D/C STATUS CM 0.012200790 OT BODY POS D/C STATUS CN 0.012200800 OT CARRY CURRENT CH 0.012200810 OT CARRY CURRENT CI 0.012200820 OT CARRY CURRENT CJ 0.012200830 OT CARRY CURRENT CK 0.012200840 OT CARRY CURRENT CL 0.012200850 OT CARRY CURRENT CM 0.012200860 OT CARRY CURRENT CN 0.012200870 OT CARRY GOAL STATUS CH 0.012200880 OT CARRY GOAL STATUS CI 0.012200890 OT CARRY GOAL STATUS CJ 0.012200900 OT CARRY GOAL STATUS CK 0.012200910 OT CARRY GOAL STATUS CL 0.012200920 OT CARRY GOAL STATUS CM 0.012200930 OT CARRY GOAL STATUS CN 0.012200940 OT CARRY D/C STATUS CH 0.012200950 OT CARRY D/C STATUS CI 0.012200960 OT CARRY D/C STATUS CJ 0.012200970 OT CARRY D/C STATUS CK 0.012200980 OT CARRY D/C STATUS CL 0.012200990 OT CARRY D/C STATUS CM 0.012201000 OT CARRY D/C STATUS CN 0.012201010 OT SELF CARE CURRENT CH 0.012201020 OT SELF CARE CURRENT CI 0.012201030 OT SELF CARE CURRENT CJ 0.012201040 OT SELF CARE CURRENT CK 0.012201050 OT SELF CARE CURRENT CL 0.012201060 OT SELF CARE CURRENT CM 0.012201070 OT SELF CARE CURRENT CN 0.012201080 OT SELF CARE GOAL CH 0.01

2201090 OT SELF CARE GOAL CI 0.012201100 OT SELF CARE GOAL CJ 0.012201110 OT SELF CARE GOAL CK 0.012201120 OT SELF CARE GOAL CL 0.012201130 OT SELF CARE GOAL CM 0.012201140 OT SELF CARE GOAL CN 0.012201150 OT SELF CARE D/C CH 0.012201160 OT SELF CARE D/C CI 0.012201170 OT SELF CARE D/C CJ 0.012201180 OT SELF CARE D/C CK 0.012201190 OT SELF CARE D/C CL 0.012201200 OT SELF CARE D/C CM 0.012201210 OT SELF CARE D/C CN 0.012201220 OT OTHER PT/OT CURRENT CH 0.012201230 OT OTHER PT/OT CURRENT CI 0.012201240 OT OTHER PT/OT CURRENT CJ 0.012201250 OT OTHER PT/OT CURRENT CK 0.012201260 OT OTHER PT/OT CURRENT CL 0.012201270 OT OTHER PT/OT CURRENT CM 0.012201280 OT OTHER PT/OT CURRENT CN 0.012201290 OT OTHER PT/OT GOAL CH 0.012201300 OT OTHER PT/OT GOAL CI 0.012201310 OT OTHER PT/OT GOAL CJ 0.012201320 OT OTHER PT/OT GOAL CK 0.012201330 OT OTHER PT/OT GOAL CL 0.012201340 OT OTHER PT/OT GOAL CM 0.012201350 OT OTHER PT/OT GOAL CN 0.012201360 OT OTHER PT/OT D/C CH 0.012201370 OT OTHER PT/OT D/C CI 0.012201380 OT OTHER PT/OT D/C CJ 0.012201390 OT OTHER PT/OT D/C CK 0.012201400 OT OTHER PT/OT D/C CL 0.012201410 OT OTHER PT/OT D/C CM 0.012201420 OT OTHER PT/OT D/C CN 0.012201430 OT SUB PT/OT CURRENT CH 0.012201440 OT SUB PT/OT CURRENT CI 0.012201450 OT SUB PT/OT CURRENT CJ 0.012201460 OT SUB PT/OT CURRENT CK 0.012201470 OT SUB PT/OT CURRENT CL 0.012201480 OT SUB PT/OT CURRENT CM 0.012201490 OT SUB PT/OT CURRENT CN 0.012201500 OT SUB PT/OT GOAL CH 0.012201510 OT SUB PT/OT GOAL CI 0.012201520 OT SUB PT/OT GOAL CJ 0.012201530 OT SUB PT/OT GOAL CK 0.012201540 OT SUB PT/OT GOAL CL 0.012201550 OT SUB PT/OT GOAL CM 0.01

2201560 OT SUB PT/OT GOAL CN 0.012201570 OT SUB PT/OT D/C CH 0.012201580 OT SUB PT/OT D/C CI 0.012201590 OT SUB PT/OT D/C CJ 0.012201600 OT SUB PT/OT D/C CK 0.012201610 OT SUB PT/OT D/C CL 0.012201620 OT SUB PT/OT D/C CM 0.012201630 OT SUB PT/OT D/C CN 0.012201640 OT SWALLOW CURRENT CH 0.012201650 OT SWALLOW CURRENT CI 0.012201660 OT SWALLOW CURRENT CJ 0.012201670 OT SWALLOW CURRENT CK 0.012201680 OT SWALLOW CURRENT CL 0.012201690 OT SWALLOW CURRENT CM 0.012201700 OT SWALLOW CURRENT CN 0.012201710 OT SWALLOW GOAL STATUS CH 0.012201720 OT SWALLOW GOAL STATUS CI 0.012201730 OT SWALLOW GOAL STATUS CJ 0.012201740 OT SWALLOW GOAL STATUS CK 0.012201750 OT SWALLOW GOAL STATUS CL 0.012201760 OT SWALLOW GOAL STATUS CM 0.012201770 OT SWALLOW GOAL STATUS CN 0.012201780 OT SWALLOW D/C STATUS CH 0.012201790 OT SWALLOW D/C STATUS CI 0.012201800 OT SWALLOW D/C STATUS CJ 0.012201810 OT SWALLOW D/C STATUS CK 0.012201820 OT SWALLOW D/C STATUS CL 0.012201830 OT SWALLOW D/C STATUS CM 0.012201840 OT SWALLOW D/C STATUS CN 0.012201850 OT ATTEN CURRENT CH 0.012201860 OT ATTEN CURRENT CI 0.012201870 OT ATTEN CURRENT CJ 0.012201880 OT ATTEN CURRENT CK 0.012201890 OT ATTEN CURRENT CL 0.012201900 OT ATTEN CURRENT CM 0.012201910 OT ATTEN CURRENT CN 0.012201920 OT ATTEN GOAL STATUS CH 0.012201930 OT ATTEN GOAL STATUS CI 0.012201940 OT ATTEN GOAL STATUS CJ 0.012201950 OT ATTEN GOAL STATUS CK 0.012201960 OT ATTEN GOAL STATUS CL 0.012201970 OT ATTEN GOAL STATUS CM 0.012201980 OT ATTEN GOAL STATUS CN 0.012201990 OT ATTEN D/C STATUS CH 0.012202000 OT ATTEN D/C STATUS CI 0.012202010 OT ATTEN D/C STATUS CJ 0.012202020 OT ATTEN D/C STATUS CK 0.01

2202030 OT ATTEN D/C STATUS CL 0.012202040 OT ATTEN D/C STATUS CM 0.012202050 OT ATTEN D/C STATUS CN 0.012202060 OT MEMORY CURRENT CH 0.012202070 OT MEMORY CURRENT CI 0.012202080 OT MEMORY CURRENT CJ 0.012202090 OT MEMORY CURRENT CK 0.012202100 OT MEMORY CURRENT CL 0.012202110 OT MEMORY CURRENT CM 0.012202120 OT MEMORY CURRENT CN 0.012202130 OT MEMORY GOAL STATUS CH 0.012202140 OT MEMORY GOAL STATUS CI 0.012202150 OT MEMORY GOAL STATUS CJ 0.012202160 OT MEMORY GOAL STATUS CK 0.012202170 OT MEMORY GOAL STATUS CL 0.012202180 OT MEMORY GOAL STATUS CM 0.012202190 OT MEMORY GOAL STATUS CN 0.012202200 OT MEMORY D/C STATUS CH 0.012202210 OT MEMORY D/C STATUS CI 0.012202220 OT MEMORY D/C STATUS CJ 0.012202230 OT MEMORY D/C STATUS CK 0.012202240 OT MEMORY D/C STATUS CL 0.012202250 OT MEMORY D/C STATUS CM 0.012202260 OT MEMORY D/C STATUS CN 0.012202261 OT MC COM/WK REINT ADD 15 902202262 OT MC COM/WK REINT INI 30 1802202263 OT MC CONFERENCE ADD 15 902202264 OT MC CONFERENCE INI 30 1802202265 OT MC DIATH/MICRO ADD 15 902202266 OT MC DIATH/MICRO INI 30 1802202267 OT MC DVL COGNT ADD 15 902202268 OT MC DVL COGNT INI 30 1802202269 OT MC E-STIM ATTND ADD 15 902202270 OT MC E-STIM ATTND INI 30 1802202271 OT MC E-STIM UNATT ADD 15 902202272 OT MC E-STIM UNATT INI 30 1802202273 OT MC EXERCISE THR ADD 15 902202274 OT MC EXERCISE THR INI 30 1802202275 OT MC FAB SPLINT ADD 15 902202276 OT MC FAB SPLINT INI 30 1802202277 OT MC GAIT TRAIN ADD 15 902202278 OT MC GAIT TRAIN INI 30 1802202279 OT MC INFRARED THR ADD 15 902202280 OT MC INFRARED THR INI 30 1802202281 OT MC IONTOPHORES ADD 15 902202282 OT MC IONTOPHORES INI 30 1802202283 OT MC MANUAL THR ADD 15 90

2202284 OT MC MANUAL THR INI 30 1802202285 OT MC MASSAGE ADD 15 902202286 OT MC MASSAGE INI 30 1802202287 OT MC ORTH FIT/TRN ADD 15 902202288 OT MC ORTH FIT/TRN INI 30 1802202289 OT MC ORTH/PROS CK ADD 15 902202290 OT MC ORTH/PROS CK INI 30 1802202291 OT MC PROSTHTC TRN ADD 15 902202292 OT MC PROSTHTC TRN INI 30 1802202293 OT MC RE-EVAL ADD 15 1562202294 OT MC RE-EVAL INI 30 1942202295 OT MC SENSORY TECH ADD 15 902202296 OT MC SENSORY TECH INI 30 1802202297 OT MC TRACTION MEC ADD 15 902202298 OT MC TRACTION MEC INI 30 1802202299 OT MC TST DVLPMNTL ADD 15 902202300 OT MC TST DVLPMNTL INI 30 1802202301 OT MC TST NEUROBVL ADD 15 902202302 OT MC TST NEUROBVL INI 30 1802202303 OT MC ULTRASOUND ADD 15 902202304 OT MC ULTRASOUND INI 30 1802202305 OT MC UV THERAPY ADD 15 902202306 OT MC UV THERAPY INI 30 1802202307 OT MC VASOPN TX ADD 15 902202308 OT MC VASOPN TX INI 30 1802202309 OT MC WHEELCHR TRN ADD 15 902202310 OT MC WHEELCHR TRN INI 30 1802202311 OT THPY CAP KX REVIEW NC 0 22202312 OT MC TREATMENT ADD 15 902202313 OT MC TREATMENT INI 30 1802202320 OT EVAL LOW COMPLEX 30 MN 2242202321 OT EVAL MOD COMPLEX 45 MN 3382202322 OT EVAL HIGH COMPLEX 60MN 5112202323 OT RE-EVAL EST CARE PL 30 2582202324 OT EVAL LOW COMPLEX 15 MN 1792202325 OT EVAL LOW COMPLEX 45 MN 3382202326 OT EVAL MOD COMPLEX 30 MN 2242202327 OT EVAL MOD COMPLEX 60 MN 5112202328 OT EVAL HIGH COMPLEX 45MN 3382202329 OT EVAL HIGH COMPLEX 75MN 6842202330 OT EVAL HIGH COMPLEX 90MN 8572202331 OT RE-EVAL EST CARE PL 15 2442202332 OT RE-EVAL EST CARE PL 45 3022202333 OT RE-EVAL EST CARE PL 60 3472700250 LACTATED RINGERS 1L INJ 42700260 NACL 0.9% 500ML INJ 22701220 ORTHO L0150 115X-150 464

2701230 ORTHO L0172 10-13 402701250 ORTHO L0172 17X-23 702701260 ORTHO L0172 23X-30 932701270 ORTHO L0172 30X-39 1212701280 ORTHO L0200 431X-561 17362701290 ORTHO L0450 150X-195 6042701300 ORTHO L0472 331X-431 13342701310 ORTHO L0630 115X-150 4642701320 ORTHO L0639 949X-1234 38202701330 ORTHO L0976 115X-150 4642701340 ORTHO L1620 39X-51 1582701360 ORTHO L1686 730X-949 29382701370 ORTHO L1832 431X-561 17362701380 ORTHO L1930 195X-254 7862701390 ORTHO L1970 431X-561 17362701400 ORTHO L3650 <10 182701410 ORTHO L3807 13X-17 532701420 ORTHO L3908 <10 182701430 ORTHO L3931 67X-88 2712701440 ORTHO L4386 51X-67 2072701450 ORTHO L8420 17X-23 702701460 CATH OCCLUSION 115X-150 4642701470 CATH INFUSION 88X-115 3552701480 CATH OTHER 13X-17 532701490 CATH OTHER 17X-23 702701500 CATH OTHER 30X-39 1212701510 INST/SUPP STERL 13X-17 532701530 KIT/PACK DISP 67X-88 2712701540 KIT/PACK DISP 195X-254 7862701550 INST/SUPP NONST 10-13 402701560 INST/SUPP NONST 13X-17 532701570 INST/SUPP NONST 23X-30 932701580 INST/SUPP NONST 30X-39 1212701590 INST/SUPP NONST 39X-51 1582701600 INST/SUPP NONST 51X-67 2072701610 INST/SUPP NONST 67X-88 2712701620 ORTHO L0460 730X-949 29382701630 ORTHO L1830 10-13 402701640 ORTHO L1830 13X-17 532701650 ORTHO L1832 115X-150 4642701660 ORTHO L1932 561X-730 22592701670 ORTHO L2116 67X-88 2712701680 ORTHO L3670 13X-17 532701690 ORTHO L3923 10-13 402701700 ORTHO L3961 88X-115 3552701720 NACL 0.9% 1000ML INJ 32701730 D5% W ELECTROL 148 500ML 78

2701740 D5% W ELECTROL 148 1000ML 782701770 CARD PLEG COR 16MEQ/1LSOL 1572701780 INST/SUPP STERL 30X-39 1212701790 CLOSURE EXTERN 17X-23 702701800 GASTRO IMP 150X-195 6042701820 CATH INFUSION 30X-39 1212701830 CATH INFUSION 51X-67 2072701840 CATH INFUSION 39X-51 1582701850 CATH INFUSION 67X-88 2712701860 INST/SUPP STERL 150X-195 6042701870 KIT/PACK DISP 50X-67 2072701890 CLOSURE IMPLNT 51X-67 2072701891 INST/SUPP STERL 23X-30 932701892 INST/SUPP STERL 51X-67 2072701893 INST/SUPP STERL 254X-331 10242701894 ORTHO L0625 <10 182701895 ORTHO L4350 10-13 402701900 CATH OTHER 51X-67 2072701910 ORTHO L0464 949X-1234 38202701928 ORTHO L5450 254X-331 10242701936 ORTHO L2830 88X-115 3552701944 ORTHO L2624 331X-431 13342701951 ORTHO L2820 88X-115 3552701969 ORTHO L0627 254X-331 10242701977 ORTHO L0637 949X-1234 38202701985 ORTHO L2622 254X-331 10242701993 ORTHO L2128 1605X-2087 64612702009 ORTHO L2192 331X-431 13342702017 ORTHO L1820 88X-115 3552702025 CAST 88X-115 3552702033 CAST 115X-150 4642702041 CAST 150X-195 6042702058 CAST 195X-254 7862702066 SPLINT 67X-88 2712702074 SPLINT 88X-115 3552702082 SPLINT 115X-150 4642702090 SPLINT 150X-195 6042702108 SPLINT 195X-254 7862702116 ORTHO L0810 4588X-5965 184682702124 PILLOW POST OP 67X-88 2712702132 SLNG 115X-150 4642702140 ORTHO L4360 39X-51 1582702157 ORTHO L1810 115X-150 4642702170 ORTHO L0190 431X-561 17362702180 ORTHO L0486 1605X-2087 64612702210 ORTHO L0482 1234X-1605 49682702220 ORTHO L0628 67X-88 271

2702230 ORTHO L0633 195X-254 7862702280 ORTHO L1932 730X-949 29382702300 ORTHO L2999 67X-88 2712702310 ORTHO L3961 115X-150 4642702320 ORTHO L3980 254X-331 10242702330 ORTHO L0462 730X-949 29382702348 COMP STOCKING TH 67X-88 2712702355 ORTHO L3807 150X-195 6042702363 SPLINT 254X-331 10242702371 SPLINT 331X-431 13342702389 SPLINT 431X-561 17362702397 SPLINT 561X-730 22592702405 CAST 254X-331 10242702413 CAST 331X-431 13342702421 CAST 431X-561 17362702439 CAST 561X-730 22592702440 ORTHO L1932 949X-1234 38202702441 ORTHO L2820 115X-150 4642702442 ORTHO L0972 88X-115 3552702447 LENS MORGAN 762702462 CATH INFUSION 10-13 402702471 ORTHO L0638 1234X-1605 49682702472 ORTHO L1686 431X-561 17362702473 ORTHO L5530 2714X-3529 109252702474 CATH OTHER 23X-30 932702475 INST/SUPP STERL 67X-88 2712702476 ORTHO L0456 730X-949 29382702477 ORTHO L4396 115X-150 4642702478 ORTHO L3982 331X-431 13342702480 ORTHO L1960 561X-730 22592702481 ORTHO L2405 88X-115 3552702482 ORTHO L2200 67X-88 2712702483 ORTHO L2036 2087X-2714 84022702484 ORTHO L0650 949X-1234 38202702485 ORTHO L4397 195X-254 7862702486 ORTHO L4386 115X-150 4642702487 ORTHO L3216 115X-150 4652702488 ORTHO L2220 88X-115 3552702489 ORTHO L2182 67X-88 2712702490 ORTHO L2785 30X-39 1212702492 ORTHO L3340 88X-115 3552702493 INST/SUPP STERL1605X-2087 64612702494 ORTHO L0174 254X-331 10242702495 ORTHO L0810 3529X-4588 182662702496 ORTHO L0650 1234X-1605 49683000001 MS-IMMUNO SHIGA I 293000002 MS-IMMUNO SHIGA II 29

3000004 RL-A-CAL EXON9PCR 2010673 2903000007 RL-A-MOLEC PATH PROC LVL4 503000008 RL-SR-LITHIUM 9.013000009 RL-SR-LIPASE FLUID 9.383000010 H-HEPATITIS B IGM 8213 1033000012 RL-A-NEPHELOMETRY EA 32.363000013 RL-A-AST/SGOT 32.363000014 RL-A-UREA NITROGEN BLD 32.373000015 RL-A-ADENOVIRUS QNT PCR 47.363000016 RL-A-LI-FRAUMENI(TP53)SEQ 6503000018 RL-A-ADENOVIRUS QUAL PCR 38.83000019 RL-A-LACTIC ACID 11.813000020 H-HEPATITIS A IGM 903000021 RL-A-HUNTINGTON DIS MUT 46.143000022 FECAL BLOOD ASSAY 78.733000023 OCCULT BLD CA SCREEN IA 633000024 RL-A-DESMOGLEIN 1 IGG 97.883000025 RL-A-DESMOGLEIN 3 IGG 97.873000026 RL-A-PARASIT MACR 2007361 4.723000027 RL-A-DIAZEPAM 90076 40.93000030 RL-M-HYDROXYCHLOROQUINE 1773000031 STREP B PROBE EXP 0 33000050 RL-A-AMINO ACD BL 2009389 18.653000060 H-BETA 2 MICROGLOB 7659 783000070 H-C PEPTIDE 7546 1013000080 RL-A-C1 ESTERASE IHB FNCT 13.273000090 H-EBV EARLY ANTIGEN 8295 653000100 RL-A-METHOTREXATE 2005405 15.143000110 RL-A-MYELN BSIC PRT 80515 19.023000120 PHOSPHATIDYLGLYCEROL 1723000130 THYROXINE FREE 883000140 H-DHEA SULFATE 7567 1553000150 RL-UD-COMP FIXATION COCCI 443000160 RL-A-VIRAL CULTURE 22.83000180 H-TRANSFERRIN 1183000190 RL-A-CLONAZEPAM 90055 20.453000200 H-IMMUNOGLOBULIN QUANT 443000202 RL-A-CULT SCRN SINGLE ORG 7.333000203 RL-A-HYALURONIC ACD 81138 14.313000204 RL-QD-JC VIRUS AB 13633000210 RL-A-ANG CONV ENZYM 80001 16.143000220 H-ROTOVIRUS 2660 513000230 RL-A-SSNDA IGG 99528 13.383000240 RL-A-ORGANIC ACD PL 99289 18.23000250 H-CENTROMERE AB 663000260 RL-A-COPPER SERUM 20096 13.723000270 RL-A-PM/SCL IGG 2003040 15.2

3000280 H-LYME TOTAL AB 8087 823000290 RL-A-SMOOTH MUSCLE IGG 10.273000300 RL-A-FLECAINIDE 90003 15.143000320 IF RSV AG 393000330 H-COMPLEMENT C4 8053 683000350 RL-A-LEAD BLD 99470 13.383000360 PSA SCRN 1113000370 H-ESTRADIOL 7583 1373000380 RL-A-GIARDIA AG 60048 10.383000390 CPK MB ONLY 633000400 UREA NITROGEN URINE 423000410 BASIC METABOLIC PANEL 613000420 VANCOMYCIN 2053000430 UA QL/SEMIQT RED SUB 173000440 H-CA 125 8051 1013000450 H-CA 19-9 8055 1013000460 H-CA 15-3 8046 1013000470 H-HEPATITIS C AB 8060 2473000480 PREALBUMIN 703000490 RL-SR-MYOGLOBIN SERUM 17.593000510 RL-A-MYCOPLSM IGG/M 50399 14.653000520 H-CARDIOLIPIN IGG/IGM 1173000550 H-CYCLOSPORINE 7553 883000560 RL-A-AT3 ENZYMATIC 13.13000580 RL-A-CAFFEINE 2011603 15.143000590 RL-A-T CELL CD4 CNT 95885 29.63000610 PH BODY FLUID NOS 223000620 RL-A-FETAL HGB APT 20156 6.593000630 H-GC AMD PROBE 1123000640 H-CHLAMYDIA AMD PROBE 1123000650 SPEC GRAV NON URINE 83000660 CHLORIDE URINE 393000670 CREATININE UR 343000680 AMYLASE UR 463000700 ALBUMIN FLUID OTHER 253000710 H-PARATHYROID HORM 8133 3293000720 RL-A-THYRX BND GLOB 70410 16.353000730 H-VARICELA ZOSTER AB 8153 923000740 RL-A-T PALLIDUM IGG 50477 153000750 RL-A-INSULIN ANTIBODY 23.673000760 RL-A-COMPLEMENT C6 99072 603000770 RL-A-COX B VIRUS AB 60055 14.413000780 H-FREE T-3 7843 1483000800 RL-A-STRIATED MUSCLE IGG 12.163000810 RL-A-MYOCARDIAL IGG 50742 12.163000820 RL-A-ANCA AB PANL 2002068 12.163000840 RL-A-DNASE-B AB 50220 14.66

3000841 RL-A-HIV 1/2 AG/AB ELISA 19.973000850 GTT ADD SPECIMEN 173000860 H-THYROGLOBULIN SERUM 783000870 SODIUM URINE 383000880 POTASSIUM UR 323000890 H-CMV IGM AB 8229 823000900 RL-A-ASPERGILLUS AB CF 16.643000910 RL-A-BLASTOMYCES AB 14.263000920 RL-A-RICKETTSIA IGG/IGM 21.43000940 RL-A-ZINC URINE 12.593000950 H-PROT C FUNCTIONAL 1338 673000960 H-PROT S FUNCTIONAL 1338 763000970 RL-A-FACTOR 8 MULTIMERIC 23.983000980 RL-A-PSEUDOCHOLINESTERASE 8.713000990 OSMOLALITY URINE 613001000 RL-DN-STONE ANALYSIS 25.233001010 RL-A-PROS ACID PHOS 70120 10.683001020 AMMONIA 713001030 RL-A-AMIOTIC BILI 80276 7.63001040 RL-A-CHOLINESTERASE RBC 8.53001060 ALBUMIN SERUM/PLASMA/BLD 233001070 RL-A-ALDOLASE 20012 10.743001090 ALCOHOLS 883001100 H-AFP SERUM 8003 803001110 RL-A-A1 ANTITRYPSIN 50001 14.853001120 AMYLASE FLD 463001130 H-THYROID PEROXIDASE AB 893001150 RL-A-ARSENIC QUANT URINE 20.983001160 H-DSDNA ANTIBODY 853001170 H-THYROGLOBULIN AB 763001200 BILIRUBIN TOTAL 903001210 H-CEA 8049 953001220 H-CERULOPLASMIN 8042 563001240 CORTISOL TOTAL 1693001250 H-COMPLEMENT C3 8052 683001260 CALCIUM TOT SER/FLD 263001270 RL-A-COMPLEMENT C5 50156 13.273001280 RL-A-ACTH 70010 42.73001300 CHLORIDE BLOOD 433001310 SWEAT COLL IONTOPHOR 1143001320 CALCIUM UR QN TIMED 443001330 CHOLESTEROL TOTAL 693001340 CPK TOTAL 453001350 CREATININE BLOOD 273001360 CREATININE CLEARANCE 753001370 RL-A-CRYOGLOBULIN 50185 5.323001380 DIGOXIN TOTAL 109

3001390 FIBRINOGEN ACTIVITY 403001400 PHENYTOIN TOTAL 963001410 H-FOLIC ACID 7579 783001420 H-FERRITIN 7577 933001430 H-VITAMIN B-12 7870 853001440 RL-A-ETHOSUXIMIDE 2010358 18.063001450 H-FSH 7582 1013001460 CHOLESTEROL HDL 1483001470 GLUCOSE POST DOSE 273001480 ELECTROLYTE PANEL 693001490 RL-A-ESTRIOL TOTAL 70051 26.743001500 RL-GD-G1PU TRANF (TRA) 18.253001510 CARBON DIOXIDE 473001520 RL-A-GASTRIN 70075 19.53001530 GLUCOSE BLOOD 653001540 GENTAMICIN 1023001550 H-GGT/GGTP 3124 323001560 RL-A-G6PD QNT 80135 10.723001570 RL-A-TOXOPLASMA IGG 16.583001580 H-HEMOGLBN ELCTRP 8240 883001590 H-GROWTH HORMONE 7622 803001600 H-GLYCOHEMOGLOBIN 7623 783001610 H-INSULIN LEVEL 543001620 RL-A-LEAD URINE 13.383001630 RL-A-LEUK ALK PHOS 49000 9.53001640 RL-A-VMA URINE 80470 17.143001650 H-LUTEINIZING HORMON 7649 1063001670 RL-A-VITAMIN A 80525 12.823001690 H-IRON TOTAL 393001700 RL-A-IRON BIND CAP 20420 7.963001710 RL-A-17-KETOSTEROID 80650 14.153001720 LDH FLD 253001730 RL-A-LDH ISOENZYME 20413 14.153001740 LACTATE/LACTIC ACID 443001750 CARBAMAZEPINE TOTAL 963001760 LIPASE 513001770 RL-A-LIPOPROT ELEC 80503 12.583001780 LIPID PANEL 793001790 LITHIUM 563001800 MAGNESIUM 393001820 RL-A-MERCURY BLOOD 99305 14.123001830 RL-A-PRIMIDONE 90202 18.343001840 OSMOLALITY BLOOD 613001850 RL-A-ALK PHOS TOTAL 21020 5.723001860 PHOSPHATASE ALKALINE 223001870 PHOSPHORUS 203001880 RL-A-PHOSPHORUS URINE 5.72

3001881 RL-A-PHOSPHOLIPID 20042 7.63001900 RL-A-PORPHYRN UR 2002181 16.263001910 H-PROLACTIN 7674 1173001920 RL-A-ALA URINE 80103 18.23001930 POTASSIUM SERUM/BLD/PLASM 263001940 RL-A-PARVO B19 G/M 65120 16.623001950 RL-A-FELBAMATE 94030 15.143001960 PROTEIN TOTAL SERUM 173001970 PROTEIN TOTAL URINE 543001980 H-PROGESTERONE 7667 1013001990 RL-A-PROCAIN/NAPA 90151 18.523002000 H-PROTEIN ELECTRO SER 593002010 RL-A-RENIN ACTIVITY 70105 24.323002020 LACTATE/LACTIC ACID FLD 443002030 RL-A-5-NUCLEOTIDASE 80235 12.333002040 H-BENCE JONES UR 8047 1423002050 RL-A-QUINIDINE 90245 15.23002060 SALICYLATE 1 OR 2 493002070 RL-A-5-HIAA URINE 80420 14.263002080 RL-A-SEROTONIN BLOOD 34.253002090 SODIUM SERUM/BLD/PLASMA 243002100 AST/SGOT 253002110 ALT/SGPT 823002120 H-TESTOSTERONE 1303002130 TRIGLYCERIDES 963002140 THEOPHYLLINE 963002160 SUSCPT DISK PER 1-12 283002170 CULTURE ENVIRONMENTAL NC 0 13002180 THYROID STIM HORMONE 1083002190 UREA NITROGEN BLOOD 243002200 URIC ACID BLOOD 263002210 URIC ACID UR 383002250 CBC W/AUTO DIFF 413002260 CBC AUTO W/O DIFF 413002270 HEMATOCRIT 193002280 PLATELET AUTO 483002290 ACETAMINOPHEN 1 OR 2 1133002300 PROTHROMBIN TIME 283002310 RL-A-RBC OSMO FRG 2002257 7.393002320 SED RATE RBC AUTO 393002330 PARTIAL THROMBO TIME 433002340 H-ANA 8005 653002350 RL-A-VW FACTOR AG 30125 25.383002360 RL-A-RISTOCTN COFAC 30125 25.383002390 H-HEP B SURFACE AG 8072 863002400 RL-A-HLA B27 95840 28.533002410 H-RHEUMATOID FACTOR 8120 27

3002420 H-RUBELLA AB IGG 8145 693002430 H-RPR 8140 343002440 MONO TEST SCRN 403002460 H-C REACTIVE PROTEIN 3109 563002470 HCG PREG QL SERUM 443002480 CULT BLOOD 763002490 H-ASO TITER 8035 513002510 CULT AEROBIC ID 483002520 RL-HD-AFB DIR STN/ANY SCR 183002530 RL-HD-AFB CONCENTRATION 223002540 RL-HD-AFB CULTURE 253002550 CULTURE ANAEROBIC 713002560 RL-A-IMM COMPLX ASY 50667 26.943002570 H-RUBEOLA AB 8142 693002580 RL-A-CARISOP/META 2011450 34.633002590 RL-A-THIOCYANAT 2011575 12.863002600 RL-A-LYSOZYME 2012039 20.743002610 RL-A-AMITRIPTYLINE 90158 34.773002620 H-TOTAL T3 7830 913002630 RL-UD-IMMUNODIFF COCCI 363002640 RL-A-ECHOVIRUS AB 60053 14.413002650 H-CRYPTOCOCCAL AG 2621 463002660 RL-A-LYME IGG/IGM 55260 17.123002670 BILIRUBIN DIRECT 213002680 SE-H PYLORI AB 983002690 HOMOGENIZATION TISSUE 443002700 RL-A-OVA/PARASITE CONC ID 9.843002720 PINWORM EXAM TAPE PREP 503002750 SMEAR GRAM/GEIMSA 413002760 CELL CT FLUID W/DIFF 823002770 TISSUE EXAM FUNGUS 263002780 CRYSTAL ID LT MICROSC 493002790 PROTEIN TOTAL OTHER 453002800 RL-A-T. PALLIDM CSF 50206 4.563002810 CULT STOOL SALM/SHIG 513002820 CULTURE OTHER SOURCE 683002830 SUSCEPT MIC PER PLATE 603002840 UA AUTO W/O MICRO QW 163002850 ACETONE/KETONES QL 193002860 UA NONAUTO W/O MICRO 173002870 OCC BLD FEC QL 3 SPEC 203002880 RL-A-FAT FECAL QL 20385 5.633002890 SUGARS SINGLE QL 403002900 RL-A-HEMOSIDERIN UR 20222 5.253002920 CULT STOOL YERSINIA 403002940 SPECIFIC GRAVITY UR 173002960 D-DIMER QN 74

3002970 VALPROIC ACID TOTAL 1163002980 RL-A-AMIKACIN 14.173003010 RL-A-HSV 1/2 IGG/IGM 15.363003030 PHENOBARBITAL 793003050 RL-A-HEPAT BE AG 20094 12.743003060 H-HEP B CORE AB 8222 623003070 RL-A-HEPAT BE AB 20095 12.783003090 RL-A-IRON LIVER 28250 7.163003100 H-HEPATITS B SURF AB 8223 703003110 RL-A-HEP BS AB 20454 16.583003120 UA QL/SEMIQT 173003130 RL-A-CAROTENE 80055 10.23003140 RL-A-DISOPYRAMID 2011632 15.143003150 RL-A-HEP BS AG 20454 11.423003160 H-SMEAR MALARIA 2435 783003170 RL-A-AMOEBIASIS AB 13.73003180 RL-A-CATECHOLAMN PL 80216 27.923003190 HCG PREG QN 913003220 RL-A-COMPL TOT CH50 50198 22.463003226 CROSSMATCH ELECTRONIC 1393003230 CHLORIDE FLD 223003250 H-OLIGOCLONAL BAND 8188 1423003260 IMMUNOASSAY STREP A 463003261 RL-A-ERYTHROPOIETIN 50227 20.783003262 RL-A-C-PEPTIDE 70103 21.643003263 H-PT SUBSTITUTION 193003264 H-HEXAGONAL CONFIRM 263003265 RL-A-S PYOGENES GP A AB 11.263003270 GENERAL HEALTH PANEL 1253003280 RL-A-FAT FECAL QNT 18.573003290 GLUCOSE BLOOD BY DEVICE 253003300 CALCIUM IONIZED 683003310 BLOOD SMEAR MAN DIFF 233003320 RL-A-PENTOBARB 2011549 12.663003330 RL-A-ACETYLCHOLINE RECPT 14.943003340 TOBRAMYCIN 1053003350 RL-A-CHLAMYDIA CULT 60850 12.673003360 H-LEAD BLOOD 703003380 H-PROTEIN ELECTROPH UR 823003390 H-IMMUNOGLOBULIN IGE 8080 863003391 RL-A-CULTURE MISC SRC 9.523003392 RL-A-HOMOGEN TISSUE 6.53003393 RL-A-OXALATE QUANT BLD 1123003397 RL-A-FACTOR INHIBITOR 1503003400 H-HOMOCYSTEINE 7624 823003410 H-LIPOPROTEIN A 8064 643003420 RL-A-APC RESISTANCE 30127 16.94

3003450 RL-A-ALUMINUM LEVEL 99266 28.183003480 RL-A-HIT PF4 IGG 2012179 20.33003490 H-TACROLIMUS(FK-506) 7822 863003500 RL-A-DIPHTHERIA CUL 60360 7.333003520 H-HEP C RNA/PCR QNT 6610 2033003530 TROPONIN QN 1203003540 RL-A-PHOSPHATIDYLSERINE 17.763003560 H-MULT SCLER SER IGG 8188 443003570 URINE VOLUME MEASURE 183003590 H-HSV 1/2 DNA PCR 6620 633003610 H-EOSINOPHIL SMEAR 1270 183003620 GTT 1ST 3 SPEC 563003640 HEPATIC FUNC PANEL 613003650 COMP METABOLIC PANEL 763003660 UA AUTO W/MICRO 303003670 H-IMMUNOFIX ELEC SER 8077 1333003672 RL-Q-IMMUNOGLOBULIN E 103003673 RL-Q-RAST IGE QN OR SQ 103003674 RL-A-BCR-ABL1 MAJOR QNT 66.063003675 RL-A-C BRUNETTII TITER 13.43003680 H-IMMUNOFIX ELEC UR 8083 1423003681 RL-A-PMP22 DUP/DEL VAR 863.93003682 RL-A-PMP22 FULL SEQ ANALY 863.93003683 RL-A-BCRA 1/2 GENE ANALYS 20453003700 H-HEP B SURF AG CONF 8070 473003710 FETAL FIBRONECTIN 2693003720 CONCENTRATION ANY 383003730 RL-A-HELICOBCTR PYL 50994 16.043003760 SMEAR WET MOUNT INFECT 253003770 RBC WBC OR PLT MANL 253003780 H-CRYPTOSPORIDIUM 2049 513003790 RL-A-CPK TOTAL 20414 7.213003800 RL-A-INFLUENZA A AB 51069 14.993003810 HEMOGLOBIN 203003820 RL-A-CHLAMYDIA IGG 65100 13.563003840 RL-A-FUNGUS CULTURE 60149 9.123003850 RL-A-B HCG TUMOR MARKER 14.073003860 H-H PYLORI ANTIGEN 8022 1463003870 RL-A-MECONIUM SCRN 92516 78.43003890 RL-A-METHYLMALONIC ACID 18.23003900 RL-A-L PNEUMO AG UR 70322 10.273003910 RENAL FUNCTION PANEL 643003920 PLATELET AGG EA AGENT 893003930 RL-A-DRUG ANALYS UR 90500 23.43003960 PH UR 223003970 CULT STL E COLI 0157 403003980 H-HEPATITIS ACUT PNL 8216 261

3003990 RL-A-ANTITHROMB AG 30370 11.963004000 H-CMV IGG AB 8229 1003004010 H-LUPUS DRVVT CONFIR 1209 473004020 H-LUPUS ANT-COAG PTT 1235 433004030 RL-A-CMV RAPID CULT 65004 5.413004040 RL-A-COCCIDIOIDES AB CF 12.683004050 RL-A-HISTOPLASMA AB 13.823004090 H-EBV NUCLEAR AG 8295 743004100 H-EBV CAPSID IGG/IGM 8295 603004110 RL-A-OVA & PARASITE STAIN 20.093004120 RL-A-HVA UR 80470 11.43004130 RL-A-MERCURY 99470 14.123004140 RL-A-ARSENIC BLD 99470 20.983004150 RL-A-TOXOPLASMA IGM 15.363004160 RL-A-EPSTEN BAR PCR 50246 38.83004170 RL-A-CK ISOENZYME 20414 14.813004180 RL-A-ALK PHOS OTR % 21020 16.353004190 RL-A-PHENOBARBITAL 90202 12.663004210 RL-A-PORPHOBILIN UR 80260 9.123004220 RL-A-CHLAMYDIA TYP 60850 12.673004240 RL-A-ANCA REFLEX TITER 13.333004250 RL-A-IRON 7.163004260 CULT TYP SEROLOGICAL 213004270 SUSCEPT B-LACTAM EA 73004280 SUSCEPT AGAR 203004290 RETICULOCYTE AUTO 453004330 H-MULT SCLER CSF IGG 8188 443004340 H-MULT SCLER SER ALB 8188 663004350 H-MULT SCLER CSF ALB 8188 663004430 RL-A-SMTH MUS G TTR 51244 13.333004450 RL-A-CHLAMYDIA IGM 65100 13.563004460 RL-A-COCCI IGG/IGM 50137 12.683004500 RL-A-LDH TOTAL 6.683004550 RL-A-PLATELET AB 95614 13.773004560 RL-GD-17-OHP 18.253004570 RL-GD-TMS QUANT 19.743004580 RL-GD-TSH 18.253004590 RL-GD-HGB FRACT QNT CHRM 18.253004610 NATRIURETIC PEPTIDE 1413004630 RL-A-L PNEUMO IGG/IGM 16.923004660 H-HAPTOGLOBIN 8067 983004670 RL-A-L PNEUMO DFA 2004598 10.273004680 RL-A-RAST IGE QN OR SQ EA 5.783004700 RL-A-HEP BE AB 20454 12.783004720 H-VIT D 25-HYDROXY 7850 1233004730 CHOLEST LDL DIR MEAS 503004740 RL-A-VITD 125 DIHYD 80385 36.24

3004760 RL-A-LMWH 30144 14.473004780 MS-CRP HIGH SENSITIVITY 543004800 H-PTT SUBSTITUTION 303004810 H-CREATININE OTHER 343004820 H-ENA PANEL ADDL AB 243004840 COLLECT CAPILLAR BLOOD 133004850 CHLORIDE SWEAT 223004920 RL-A-REVERSE T-3 2007918 17.423004930 RL-A-HIV1 AB WBLT 20284 21.43004940 OCCULT BLOOD OTHER QL 143004970 RL-A-WESTNILE VIR CSF IGG 16.093004980 RL-A-WESTNILE VIR CSF IGM 18.833005010 H-SHB GLOBULIN 7708 1073005020 INFLUENZA IA OPTIC 393005060 H-F2 20210G>A VAR 8099 1513005080 H-CYCLIC CIT PEPTIDE 8056 643005100 RL-A-VITAMIN B6 80111 31.063005110 RL-A-VITAMIN B1 23.483005111 RL-T-IMMUNOHST SNG STN AD 253005120 RL-A-KEPPRA 98627 18.093005140 RL-A-RETICULIN IGA TITER 13.333005170 H-GLIADIN IGA/IGG 533005210 RL-A-VITAMIN E 80521 15.683005270 RL-A-INFLUENZA B AB 51069 14.993005280 H-TRANSGLUTAMINASE AB 533005290 RL-A-CMV IGM 50772 18.623005300 RL-A-RUBELLA IGM 15.363005310 RL-A-TESTOSTERONE 28.543005320 RL-A-FUNGUS (MOULD) SUSP 9.553005330 RL-A-HIV1 AB 2005375 9.823005360 RL-A-TESTO FREE 80159 28.153005370 RL-A-LAMOTRIGINE 90177 18.093005390 RL-A-FUNGAL BLD CUL 60070 9.973005400 RL-A-BILE ACID TOTL 70189 18.943005450 RL-A-AMIODARONE MTB 90161 15.143005460 H-SIROLIMUS 7552 643005490 RL-A-NICOTN/METB BL 92361 26.183005500 RL-A-CLOMIPRMN/METB 99336 15.143005510 RL-A-B HENSLE IGG/M 50108 11.253005530 RL-A-OXCARBAZPN MET 98834 18.093005550 RL-A-THC METABOLITE QT 19.973005570 RL-A-AMPHETAMINE QT 8.593005580 H-RIBOSOMAL P 713005590 RL-A-IGF 1 70125 21.923005600 RL-A-LIDOCAINE 90155 16.243005610 H-HEP C RNA GENOTYPE 6611 6973005620 H-HSV 1 GLYCOPROTEIN IGG 65

3005630 H-HSV 2 GLYCOPROTEIN IGG 933005640 H-RBC FOLATE 7578 1253005650 RL-A-MEPROBAMAT 2011521 17.313005680 RL-A-IGF 3 BND PROT 70060 15.623005700 H-BETA 2 GLYCOPROTEIN AB 1053005710 RL-A-OPIATE QT 10.763005730 RL-A-GLUCOSE FLUID 20503 4.343005740 RL-A-PROTEIN FLUID 20502 4.13005750 RL-A-NORO PCR 51281 30.153005760 RL-A-PTHRP 2010677 19.973005761 RL-A-BILL CAP ELECTROPH 13.743005762 RL-A-AMYLASE FLUID 7.173005763 RL-A-ZIKA IGM 2013942 14.253005764 RL-A-GASTR OCC BLD 60310 3.633005765 RL-A-FATTY ACD FREE 80120 14.723005770 RL-A-RABIES IGG 99132 14.253005800 RL-A-MPA/METAB 2010359 24.633005810 RL-A-TOPIRAMATE 70390 13.183005830 RL-GD-BIOTINIDASE 18.253005840 RL-GD-IMMUNOREAC TRYP 18.253005870 RL-A-CADMIUM 99675 25.583005880 RL-A-PORPHYRIN TL 2006593 152.243005900 RL-A-CARNITINE F/T 80068 18.653005910 RL-A-CALCITONIN 70006 29.613005920 RL-A-HEP C RNA QT 98268 47.363005930 RL-A-METANEPHRIN PL 50184 18.733005940 RL-A-ISOPROPANOL 90144 17.773005950 RL-A-OXALATE URN 20482 14.243005960 RL-A-CORT FREE UR 97222 18.483005999 RL-SR-CORTISOL 22.213006060 CULT SCREEN VRE 393006190 RL-A-HSV 1/2 IGG/IGM 15.363006191 H-FUNGUS CULTURE 983006192 H-QUANTIFERON 1953006200 RL-A-RUBELLA IGG 16.583006220 RL-A-LIPOPROTEIN HR FRACT 20.733006230 RL-A-TRIGLYCERIDES 30.053006270 OCCULT BLOOD FECES POC 213006290 ACT POC 783006300 FERN TEST 633006330 RL-A-IMMUNOGLOBULIN E 18.213006331 RL-A-FAT LIPIDS FECES 70.53006332 RL-A-MEAT FIBERS FECES 70.53006333 RL-A-LYMPHOCYTE TRANSF 53.753006334 RL-SR-PROTHROMBIN TIME 5.363006335 RL-SR-BILIRUBIN TOTAL 6.833006340 RL-A-PYRUVATE KINAS 80290 10.43

3006350 H-TOTAL PSA 1113006360 H-FREE PSA 8131 903006370 RL-A-BRUCELLA AB 50135 9.763006380 RL-A-HTLV I/II AB 51164 14.253006400 RL-A-IGG SUBCLASS EA 8.873006410 RL-A-ENTERIOVIR PCR 50249 39.233006420 RL-A-ACANTHAMOB CUL 60245 7.333006500 RL-A-LEPTOSPIRA ABS 12.433006510 RL-A-LEPTIN 70263 19.273006520 RL-A-P JIROVECI DFA 60052 10.213006530 RL-A-ADIPONECTIN 70262 14.313006540 RL-A-COCAINE METAB QT 16.753006550 RL-A-PSA ULTRASENST 98581 20.343006560 RL-A-HISTONE IGG 50860 10.273006580 RL-A-DRUG ANALYSIS UR 1ST 7.83006600 RL-A-HCG SERUM QUANT 14.073006610 RL-A-INHIBIN A 70137 17.543006620 RL-A-AFP MATERNAL 80434 12.033006650 RL-A-HISTOPLASMA AG 10.273006660 H-CMV DNA QT PCR 6622 1903006670 RL-A-EPSTEIN BARR VIRUS 47.363006680 RL-A-MONONUCL AG 93420 29.933006710 RL-A-NEURONAL ANTIBODIES 10.273006720 RL-A-N TELOPEPTD UR 70062 20.53006730 RL-A-FENTANYL/METAB 92570 21.513006740 RL-A-VITAMIN C 80380 10.933006750 RL-A-COENZYME Q10 81119 19.863006751 RL-A-NA PRB PCR 253006760 H-KAPPA/LAMBDA QT 8273 573006770 H-GBM IGG 8452 563006780 RL-A-GBM IGA AB 12.163006790 RL-A-PHENYTOIN FREE 90141 15.223006800 RL-A-PHENYTOIN TOTL 90141 14.663006810 RL-A-VW MULTIMER 30002 25.383006820 RL-A-FACTOR 8 ACTIVITY 19.83006830 RL-A-VW FACTOR AG 30002 25.383006840 RL-A-RISTOCTN COFCT 30002 25.383006850 H-T PALLIDUM IGG 8148 653006860 RL-A-ADAMTS 13 ACTV 30056 263006880 CREATININE BLOOD QW 233006890 METABOLC PANL IONZD CA QW 793006960 RL-A-CHROMOGRANIN A 23.013006970 VENIPUNCTURE OP 223006990 RL-A-GM1 AB PANEL EA 10.273007000 RL-A-ASPERGILLUS ANTIGEN 10.383007010 H-RPR TITER 8139 443007030 RL-A-INFLUENZ B DFA 60284 10.27

3007040 RL-A-INFLUENZ A DFA 60284 10.273007050 RL-A-INFLU A/B CULT 60286 5.413007060 RL-A-THY STIM IMMGL 99430 56.223007080 RL-A-S.PNEUMO AG UR 60228 10.273007090 RL-A-APOLIPOPROTEIN 50029 15.343007100 RL-A-MYELOPEROX AB 50707 10.273007110 RL-A-SERINE PRT3 AB 50707 10.273007150 H-HIV 1 ULTRA SENSI 6600 3713007480 RL-A-BILI TOTAL FLD 20510 5.553007510 H-CALCIUM SERUM 8133 263007520 RL-A-UREA/MYCO CULT 65031 17.013007550 RL-A-T PALLIDUM AB 50777 153007554 SE-RSV AB 763007561 RL-A-MPL CODON 515 MUT QN 45.943007562 RL-A-CALIF ENCEPH AB CSF 14.583007563 RL-A-EAST EQUINE AB CSF 14.583007564 RL-A-WEST EQUINE AB CSF 14.583007570 RL-A-URINE VOLUME MEASURE 12.53007590 RL-A-MYOGLOBIN BLD 20224 14.273007600 RL-A-ACID PHOSPHAT 20544 7.63007610 RL-A-HTLV 1/2 WBLT 20642 21.43007620 RL-A-CRYOFIBRINOGEN 50190 9.483007630 RL-A-Q FEVER AB 2012625 13.43007640 RL-A-HGB S EVAL 50520 19.973007650 RL-A-SEX HORM BIND GLOB 24.023007660 RL-A-NORTRIPTYLINE 14.983007680 RL-A-DRUG ANALYSIS SERUM1 31.293007700 RL-A-ESTROGEN FRACT 93248 35.713007710 RL-A-ESTRONE TMS 93249 27.63007720 RL-A-T CEL CD4/8 RT 95853 46.823007740 RL-A-PCP QT 15.843007750 RL-A-BARBITURATE QT 12.663007760 RL-A-METHADONE QT 18.053007770 PTH-INTRAOP 3293007790 RL-HD-B PERTUSSIS BY PCR 603007800 RL-A-VIT D25 D2/3 2002348 24.793007810 RL-A-BENZODIAZEPINE QT 20.453007900 RL-A-ENDOMYSIAL AB 13.333007930 LEUKOCYTE ABSOL AUTO 143007940 RL-A-PROPOXYPHENE QT 21.513008060 RL-A-GAD65 AB 2002862 10.273008070 RL-A-IA2 ANTIBODY 50202 18.383008080 RL-A-5-A-DHT TMS 2002349 28.543008090 AMYLASE 463008160 RL-DV-METHOTREXATE 1243008170 RL-A-PYRUVIC ACID 80310 12.013008180 DRUG SCRN DEF 9+CL NONCHR 516

3008190 CLOS DIFF TOXIN AMP PROBE 1463008200 RL-A-TROPONIN T 98803 10.883008210 C-REACTIVE PROTEIN 563008220 RL-A-COBALT 22.373008230 RL-A-CHROMIUM 22.423008240 LAMELLAR BODY DENSITY 793008250 RL-A-17-OH PROGESTR 92332 30.033008260 RL-A-PREGNENOLONE 92334 22.863008330 RL-A-PORPH FRX BL 2006596 211.043008340 RL-A-B CELL TOTAL COUNT 40.083008350 RL-A-NK CELS TOT CT 95862 40.053008360 RL-A-T CELL TOT CNT 95862 40.053008370 RL-A-T CEL CD4/8 RT 95862 40.053008410 RL-A-LACTOFERRN STL 61164 21.943008430 RL-A-GLYCOMARK 81335 12.743008440 RL-A-ANA IGG IFA 50639 12.343008450 CULT NOSE/THROAT 683008460 CULT SCR MRSA 393008500 LACTATE DEHYDRO (LDH) 253008510 PARTICLE AGG SCRN EA AB 473008530 SMEAR WBC STOOL 413008560 RL-A-VORICONAZOLE 2001737 15.143008590 RL-A-HFE 3 MUTATION 55656 55.193008670 RL-A-H PYLORI IGM 16.043008680 COLLECT CAPILLAR BLOOD 63008720 RL-A-ALDOSTERONE SER 45.063008740 RL-A-UREA NITRO FLD 20183 4.363008750 RL-A-CREATININE FLD 20509 5.323008760 ASSAY OF PSA TOTAL 1113008770 RL-A-CANDIDA AB 55565 13.283008820 RL-A-IMMDIF GEL AB 50157 12.443008821 H-PROTHROMBIN TIME 1426 293008822 H-PARTIAL THROMB TIM 1430 443008826 RL-AD-APO GENOTYPE 625.43008827 H-CRYSTAL ID LT MICROSC 473008832 RL-QD-FIBROSURE 288.753008833 RL-A-ALPHA FODRIN AB IGA 753008834 RL-A-ALPHA FODRIN AB IGG 753008850 RL-A-CITRATE UR 20852 30.743008860 RL-A-LIPASE FLUID 20715 7.623008880 RL-A-MAGNESIUM UR 20477 7.413008890 RL-A-TRIGLYCERIDE FLUID 6.363008930 RL-A-ASPERGILLUS AB 50157 12.443008940 RL-BS-RH (D) BLOOD TYPING 323008941 RL-A-AST/SGOT 72.953008942 RL-PL-IMMUNO STN EA ADD 503008943 RL-SR-LACTIC ACID 14.55

3008950 RL-A-B-D-GLUCAN 2002434 1653008960 RL-A-A GALACTOMANNAN AG 10.383008970 H-SODIUM OTHER 3262 233008980 H-POTASSIUM FLUID 3217 323008990 H-MUMPS IGG 8138 743009010 H-C DIFF TOX AMP PRB 6615 1453009030 RL-A-CIRC TUMOR CNT 93399 4253009140 AMNIOTIC PROT QL AMNISURE 1683009220 RL-A-URIC ACID FLD 5.253009270 PROCALCITONIN 1003009300 DRUG SCR DEF 9+CL QL HIGH 5163009410 RL-A-COLD AGGLUTN 50175 8.913009540 BLOOD SMEAR AUTO DIFF 213009580 CELL COUNT CSF DIFF 823009620 COLLECT CAPILLAR BLOOD 153009650 COOMBS DIRECT 453009740 CULT FUNGUS ID YEAST 673009800 CULT UR W/COLONY CNT 363009820 CULT ANAEROBIC ID 513009940 IA MULTI AG QL 463009980 H-F5 LEIDEN VAR 8059 2253010070 GRANULOCYTES PHER EA 48353010140 IMMUNO SHIGA I 343010141 RL-A-DNA EXTRACTION SEQ 253010150 IMMUNO SHIGA II 343010151 RL-A-PENICILLIN BP2A SUSP 4.563010152 RL-A-HLA1 ABC SEQ 2011264 7803010153 RL-A-PLASMINOGEN ACTIV 6.123010154 OCCULT BLOOD FECES QL 203010240 H-MITOCHRONDRIAL AB 8013 803010380 PROTEIN CSF 453010460 MM-SUSCEPT AGAR 263010470 MM-SUSCEPT B-LACTAM EA 633010480 MM-SUSCEPT MIC PER PLATE 953010490 MM-SUSCPT DISK PER 1-12 593010600 H-URINE VOL MEASURE 183010640 VENIPUNCTURE OP 173010650 VENIPUNCTURE OP 123010690 WHOLE BLOOD EA L/R 7363010810 RL-A-CYCLIC AMP URINE 308.23010820 SP-CYTOPATH EXAM LEV 1 753010830 RL-BS-DIRECT ANTIGLOBULIN 323010980 RL-A-IA TUMOR AG QN 23.013011030 RL-A-STONE ANLYS 99460 14.263011060 RL-A-T GONDII PCR 55591 38.83011070 HGB F KLEIHAUER-BETKE 903011080 FETAL HGB ROSETTE 27

3011090 RBC AB SCR 753011100 RBC AB ELUTION 1393011110 AB ID RBC EACH PANEL 2463011130 COOMBS INDIRECT TITER 393011150 ABO 253011160 RH (D) 283011170 AG SCR PATIENT EA 173011180 AG RBC NON ABO/RH EA 193011190 CROSSMATCH IMMED SPIN 1393011200 CROSSMATCH AHG 1393011240 RL-BS-CMV AB 423011250 RL-BS-RED CELL AB SCRN EA 953011251 RL-A-GIVIRALPCR 2013577 232.363011260 RL-BS-ELUTION 1843011280 RL-BS-RED CELL AB PANL ID 1053011300 RL-BS-RARE RED CELL PANEL 3153011350 RL-BS-ANTIBODY TITER 2633011360 RL-BS-ABO TYPING 323011380 RL-BS-RED CELL TYPE 263011390 RL-BS-RH PHENOTYPE (5) 1313011400 RL-BS-RBC CROSSMATCH EACH 1053011410 RL-BS-PLT CROSSMATCH EACH 1583011420 RL-BS-IRRADIATION RBC/PLT 533011440 RL-BS-CHEMICAL TREATMNT 1053011441 RL-A-CULTURE C DIFF 60140 10.463011460 RL-BS-ENZYME TREATMENT 1053011480 RL-BS-SERUM INHIBITION 1053011490 RL-BS-ADSORPTION COLD/WRM 843011500 RL-BS-AUTOADSORPTION PANL 843011510 RL-BS-ALLOADSORPTION EA 893011520 RL-BS-RBC UNIT AG UNCONF 533011530 RL-BS-PLATELET XM FEE 1053011540 RL-BS-HLA MATCHING FEE 2633011550 AG TST REAGENT SERM EA AG 503011560 RL-BS-RBC UNIT AG CONFIRM 633011570 RL-US-MOLEC EGFR ANL LUNG 496.133011580 RL-US-MOLEC EGFR ANALYSIS 992.253011590 RL-US-MOLEC JAK2 QUAL 1513011600 RL-US-MOLEC JAK2 QUANT 1513011610 RL-US-MOLEC JAC2V617F MUT 1603011620 RL-US-MOLEC BCL/ABL MAJOR 1473011630 RL-US-MOLEC BCL/ABL MINOR 1473011640 RL-US-MOLEC BCL-2 GENE 903011650 RL-US-MOLEC BCL-1 GENE 903011660 RL-GD-T-CELL REC EXC CIRC 0.013011670 RL-A-DRVVT 1:1 MIX 10.583011680 RL-A-DRVVT CONFIRM 10.58

3011690 RL-A-HEX PHOS 20.243011700 RL-A-PLT NEUTRALIZATION 19.873011710 RL-A-PTT INHIBITOR 1:1 7.163011711 RL-A-FECAL FIBER 70.53011720 RL-A-PROCESSING FEE 7.383011730 RL-A-AFB ISOLATION 1753011740 RL-A-AFB/NOCARDIA SUSCPT 9.553011750 RL-A-AFB ID DNA SEQ 132.183011760 RL-A-AFB STAIN 5.943011770 RL-A-ANAEROBE MALDI-TOF 8.933011780 RL-A-ANAEROBE ID 8.933011790 RL-A-ANAEROBE BRTH DILU 9.553011800 RL-A-BROTH DILU AUTO 9.553011810 RL-A-BACT ID BACILLUS 8.933011820 RL-A-BACT ID DNA SEQ 130.713011830 RL-A-BACT IDENTIFICATION 8.933011840 RL-A-BETA LACTAM SUSCPT 2.493011850 RL-A-DISK DIFFUSE AUTO 7.623011870 RL-A-C.DIFFICILE BATTERY 8.933011880 RL-A-BACT ID CYSTIC PSEUD 8.933011890 RL-A-C.IMMITIS DNA PROBE 22.173011900 RL-A-DISK DIFFUSION SUSPT 7.623011910 RL-A-ETEST SUSCEPT 1.523011920 RL-A-FUNGAL DNA PROBE 22.173011930 RL-A-FUNG ID MALDI-TOF MS 5.783011940 RL-A-H.CAPSULATUM DNA PRB 22.173011941 RL-A-THYROXINE 7.63011942 RL-A-DESP/IMIPRM SP 90157 28.813011950 RL-A-KPC DISK DIFFUSION 7.623011960 RL-A-MAV DNA PROBE 22.173011970 RL-A-BACT ID MALDI-TOF 8.933011980 RL-A-MIC/MBC SUSCEPT 11.463012000 RL-A-MECA DET BY PCR 39.233012020 RL-A-BROTH DILU PANEL 9.553012030 RL-A-MTB DNA PROBE 22.173012040 RL-A-NONFERM BROTH DILU 9.553012050 RL-A-BACT ID GM NEG 8.933012060 RL-A-GM NEG ID & MIC 8.933012070 RL-A-BACT ID GM POS 8.933012080 RL-A-BACT ID PSEUDOMONAS 8.933012100 RL-A-SINGLE DRG BRTH DILU 9.553012120 RL-A-YEAST IDENT 11.423012130 RL-A-FUNGAL ID DNA SEQ 130.713012140 RL-A-17-CORTICOSTEROIDES 19.373012160 RL-A-ALDOSTERONE UR 70480 45.063012180 RL-A-AMINO ACD UR 2009419 18.653012190 RL-A-ARSENIC BLOOD 99045 20.98

3012200 RL-A-CARBOXYHGB 2005757 13.623012210 RL-A-CATECHOLAMN UR 80407 27.923012220 RL-A-CENTROMERE AB 17.973012230 H-CHLORIDE FLUID 3081 223012250 RL-A-COPPER URINE 20461 13.723012260 CPK MB ONLY POC 1313012350 RL-A-DRUG PANL 9 UR 92186 22.683012410 GLUCOSE BODY FLUID 763012420 HCG PREG QL URINE 443012440 LACTATE/LACTIC ACID POC 793012480 RL-A-MERCURY URINE 25050 14.123012490 RL-A-METANPHRN UR 2007996 18.733012500 H-MICROALBUMIN UR 403012510 RL-A-MYOGLOBIN URN 20223 14.273012520 RL-A-NICOTN/METB UR 92356 26.183012530 RL-A-COLLAGEN CROSS LINK 20.53012540 RL-A-ORGANIC ACD UR 98389 18.23012560 RL-A-PBG URN 2002181 9.123012580 RL-A-RENIN ACTIVITY 70073 24.323012590 RL-A-RIBOSOMAL P PROT AB 17.973012610 TROPONIN QN POC 1313012620 UA AUTO W/O MICRO 183012670 VENIPUNCTURE IP/ER 183012690 RL-A-ZINC BLOOD 20097 12.593012700 RL-A-ASPERGIL AB AD 50157 12.443012720 BLOOD SPLT UNIT 30 ML 7933012730 RL-A-T CELL TOT CNT 95853 46.823012740 RL-BS-CELL SEP AG TYPING 3683012750 RL-A-HEP BE AG 20454 12.743012760 RL-A-CMV IGG 50772 15.363012770 CRYOPRECIPITATE EA 7983012800 CULT SCRN SINGLE ORG 393012820 CULT SCRN STREP GRP B 393012830 CULT TYP SEROLOGICAL 213012860 SE-EIA QL MULTI AG 463012861 RL-AD-MUSK AB 9543012862 RL-A-LUTEINIZING HORM 20.483012880 RL-A-ENA IGG EA 51668 133012890 H-ENA ANTIBODY EA 793012930 RL-A-HERPES 1 & 2 AB IGM 16.183012961 RL-SR-CRYPTOSPORIDIUM 12.643012962 RL-SR-GIARDIA 12.643012963 RL-SR-E HISTOLYTICA 12.643012964 INFLUEN DNA/RNA AMP 1ST 2 2473012965 INFLUENZA DNA AMP EA>2TYP 613012980 H-LUPUS DRVVT SCREEN 1235 473013000 RL-A-MICROSOMAL ANTIBODY 15.2

3013020 RL-A-MONON CELPL6AG 95862 40.053013070 PLATELETS PHER L/R EA 14583013080 PLATELETS PHER L/R EA 13853013100 PLT PHERESIS L/R IRRAD 15113013110 PLT PHERESIS L/R IRRAD 14383013120 PROTHROMBIN TIME QW 263013130 RED CELLS EA AUTO 8753013140 RH (D) WEAK 283013150 RHO(D) IMMUNE GLOB 300MCG 1793013340 RL-A-DRUG ANLY EXP 90499 0 33013380 CULTURE ENVIRONMENTAL NC 0 13013430 PREG URINE VISUAL POC 263013500 RL-A-21-HYDROXYL AB 70265 14.943013510 RL-A-ALP1 ANTTR PHN 80500 15.413013520 RL-A-A1 ANTITRYPN 2011041 14.853013530 RL-A-A1 ANTITRYPSIN 80500 15.423013550 RL-A-ACE CSF 98974 16.143013560 RL-A-ACYLCARNITN QN 40033 18.653013580 RL-A-ADENO DEAMIN FLD 7.63013590 RL-A-ADENOVIRUS DFA 10.273013620 RL-A-AFB BLOOD CULT 9.123013630 RL-A-AFP TUMOR MARK 80428 12.033013650 RL-A-ALBUMIN SERUM 5.323013660 RL-A-ALBUMIN CSF 2.833013690 RL-A-ARTICHKE IGE 2007179 14.963013710 RL-A-BASS BLACK IGE 99692 14.963013720 RL-BLACK LOCUST IGE 92053 14.963013750 RL-A-CARAWAY IGE 2001903 21.533013770 RL-A-CHEDDAR IGG 2011817 21.733013780 RL-A-CURRANT IGE 2001909 34.413013790 RL-A-ETHYLEN OX IGE 98421 21.533013800 RL-A-E MAYNEI IGE 55087 21.533013811 RL-A-MLH1 FULL SEQ ANALY 424.23013812 RL-A-MLH1 DUP/DEL VAR 424.193013820 RL-A-FENNEL IGE 93490 34.413013830 RL-A-GROUNDSEL IGE 98871 21.533013850 RL-A-H SHAGBARK IGE 97934 21.533013880 RL-A-OAK RED IGE 97933 21.533013890 RL-A-ORRIS ROOT IGE 98862 14.963013900 RL-A-P ANHYDRDE IGE 98422 21.533013920 RL-A-PERCH IGE 99687 14.963013930 RL-A-POPLAR WHT IGE 98859 14.963013940 RL-A-PORCINE IGE 2001913 14.963013960 RL-A-ROSEMARY IGE 2001925 14.963013970 RL-A-S SOLANI IGE 99551 14.963013980 RL-A-SUMMR SQSH IGE 99122 14.963013990 RL-A-ALLERGEN SPEC IGG 5.78

3014000 RL-A-SUGAR BEET IGE 98645 14.963014010 RL-A-SUGAR CANE IGG 97911 133014020 RL-A-SUGAR CANE IGE 99736 14.963014030 RL-A-T PUTRECNT IGE 55183 21.533014040 RL-A-T RUBRUM IGG 90393 21.733014060 RL-A-YAM IGE 97325 21.533014070 RL-A-ZUCCHINI IGE 99134 14.963014090 RL-A-G CARAGN IGE 2001915 21.533014100 RL-A-ALT/SGPT 32.353014110 RL-A-ANA REFLEX IFA 13.363014120 RL-A-ANA RFLX IFA AENA 13.363014121 RL-A-EPO MUT DETECT SEQ 3953014130 RL-A-ANDRO GLUCURONIDE QN 1673014140 RL-A-ANDROSTENEDN 2001638 32.373014190 RL-A-APOLIPOPROTEIN 57.33014200 RL-A-ASPERGILLUS AB 16.643014210 RL-A-B CELL TOT CNT 95892 44.643014220 RL-A-NATRIURETIC PEPT 37.943014230 RL-A-B QUINT AB IGG IFA 11.253014240 RL-A-B QUINT AB IGM IFA 11.253014250 RL-A-B. BURGDORFERI AB 18.833014260 RL-A-B BURGDORFERI IGG 17.123014270 RL-A-BBURGDRF AB WB 50254 17.123014290 RL-A-B HERMSII AB 93170 92.13014300 RL-A-B PERTUSSIS IGA 14.583014310 RL-A-B PERTUSSIS IGA IBT 14.583014320 RL-A-B PERTUSSIS IGG 14.583014330 RL-A-B PERTUS IGG 2004327 14.583014340 RL-A-B PERTUSSIS IGM 14.583014350 RL-A-B PERTUS IGM 2004326 14.583014360 RL-A-B2 GLYCO PROT 1 IGG 24.233014370 RL-A-B2 GLYCO PROT 1 IGM 24.233014380 RL-A-BAKERS YEAST G 97706 5.783014390 RL-A-BARTONELLA SP PCR 38.83014410 RL-A-BETA2 GLYCOPRO 1 IGA 24.233014420 RL-A-BETA2 GLYCOPRO 1 IGG 24.233014430 RL-A-BETA2 GLYCOPRO 1 IGM 24.233014440 RL-A-B MICROGLOBULIN 17.713014441 RL-A-TCA QT UR 2007515 141.283014450 RL-A-BETA 2 TRANSFN 50047 32.83014460 RL-A-B-HEXOAMINDA 2008125 160.563014470 RL-A-B HYDROX BUTYR 80045 9.033014500 RL-A-BILIRUBIN TOTAL 47.293014510 RL-A-BJU IFE INTERPRET 32.83014520 RL-A-BJU TOTAL PROTEIN 4.13014521 CULT TYP ID DIRT PRBE ORG 1413014550 RL-A-BK VIRUS QT PCR 47.36

3014560 RL-A-BLSTOMYC AB CF 50626 14.263014570 RL-A-B.DERMATITIDIS AB 14.263014590 RL-A-BONE SPEC ALP 70053 16.353014600 RL-A-BORRELA SP PCR 55570 38.83014610 RL-A-BORRELIA SP PCR TICK 251.33014630 RL-A-BUPRENORPHILE QNT UR 21.513014650 RL-A-C DIFF CYTOTOX ASSY 21.823014660 RL-A-C DIFF TOXIN B PCR 39.773014690 RL-A-C PNEUMON IGG 65139 13.083014700 RL-A-C PNEUMON IGM 65105 14.043014710 RL-A-C.PSITTACI IGG 65139 13.083014720 RL-A-C PSITTACI IGM 65105 14.043014730 RL-A-C TRACHOMATIS AMP 38.83014740 RL-A-C TRACHO IGG 65139 13.083014750 RL-A-C TRACHO IGM 65015 14.043014760 RL-A-C TRACHOMATIS SP ID 6.653014780 RL-A-C1 ESTERASE INHIB 13.273014790 RL-A-C1Q BIND ASSY 50301 26.943014800 RL-A-CALCIUM 5.73014810 RL-A-CALPROTECTIN FECAL 21.943014820 RL-A-CAMPYLOBACT STL CULT 2.613014830 RL-A-CARDIOLIPN IGA 98358 24.233014840 RL-A-CARDIOLIPIN IGG 24.233014850 RL-A-CARDIOLIPIN IGM 24.233014860 RL-A-CARNITINE TOTAL UR 19.973014870 RL-A-CBG 1073014880 RL-A-CCP ANTIBODY 7.13014890 RL-A-CEA FLUID 20742 20.983014900 RL-A-CELL-MED IMM FCT SRN 191.193014920 RL-A-CFTR 32 MUT 1803014930 RL-A-CHLORIDE FLD 5.323014940 RL-A-CHOLEST LDL DIRECT 10.543014950 RL-A-CHOLESTERL FLD 20714 7.63014970 RL-A-CHYLOMICRON FLD 24.013014980 RL-A-CLORAZEPATE 90196 20.453014990 RL-A-CLOZAPINE 2013433 25.233015030 RL-A-CMV PCR 38.83015040 RL-A-CMV QUANT PCR 47.363015050 RL-A-COMPLEMENT C3A 603015060 RL-A-COMPLEMENT C4 13.273015080 RL-A-CONCENTRATION ANY 73015090 RL-A-CORT FREE BL 2012697 18.483015100 RL-A-CORTISOL BLD/FLD 18.023015110 RL-A-CREATININE UR 5.863015120 RL-A-CRYPTO AG BLD 50196 10.273015130 RL-A-CRYPTO AG CSF 50196 10.273015140 RL-A-CRYPTOSPORIDIUM EIA 10.27

3015170 RL-A-CYANIDE 90060 21.453015180 RL-A-CYP2C19 9 MUT 2103015190 RL-A-CYP2D6 14 MUT 382.453015200 RL-A-CYSTATIN C 15.23015210 RL-A-CYSTIC RESP CULT 9.523015220 RL-A-CYSTICERCO AB 55284 14.383015230 RL-A-CYSTINE QNT UR 18.653015240 RL-A-DENGUE FEV IGG 93096 14.253015250 RL-A-DENGUE FEV IGM 93096 14.253015260 RL-A-DEOXYPRD XL UR 70212 20.53015280 RL-A-DEXAMETHASON 2003248 15.143015290 RL-A-DIBUCAINE NUMB 20159 13.543015310 RL-A-DIPHTHERIA IGG 50595 16.583015340 RL-A-DRVVT 10.583015350 RL-A-DSDNA IGG IFA 13.333015360 RL-A-DSDNA IGG RFLX 15.193015370 RL-A-E CHAFENS IGG 51002 11.253015380 RL-A-E CHAFENS IGM 51002 11.253015390 RL-A-E COLI SHIGA TOXIN 10.273015400 RL-A-E HISTOLYTICA AG EIA 10.273015410 RL-A-ECHINOCOC G 2007220 14.383015420 RL-A-EHRL/ANAPLSM SP PCR 38.83015440 RL-A-ENA AB IGG 10.93015450 RL-A-ERYTHROC PORPH 20610 15.863015460 RL-A-ESTRADIOL FREE 30.93015470 RL-A-ESTRADIOL TMS 30.93015500 RL-A-ETHYLENE GLYCL 90110 16.473015510 RL-A-ETOH CONFIRM 11.943015520 RL-A-F2 G20210A MUT 56060 31.833015530 RL-A-F5LM R506Q 31.833015540 RL-A-F8 DEL/DUPLICATION 60.453015550 RL-A-F8 SEQUENCING 1283.893015560 RL-A-FACTOR 2 ACTIV 30007 14.363015570 RL-A-FACTOR 9 ACTIV 30100 21.053015580 RL-A-FACTOR 5 ACTIV 30075 19.513015590 RL-A-FACTOR 7 ACTIV 30080 19.83015600 RL-A-FACTOR X ACTIV 30105 19.83015610 RL-A-FACTOR XI ACT 30110 19.83015620 RL-A-FACTOR 8 ACT 2006182 18.063015630 RL-A-FATTY ACID PROFILE 382.963015640 RL-A-FECAL PH 3.963015650 RL-A-FLUNITRAZEPAM 1553015660 RL-A-FLUNITRAZEPAM METAB 1873015670 RL-A-FLUOR AB SCREEN 12.163015680 RL-A-FREE KAPPA LT CHN UR 15.033015690 RL-A-FREE LAMBDA LT CH UR 15.033015700 RL-A-FRUCTOSAMINE 99012 16.66

3015730 RL-A-FUNGAL STAIN 5.943015750 RL-A-G6PD 2 MUTATIONS 36.263015757 RL-A-FUNGAL AB 2013270 13.083015760 RL-A-GABAPENTIN 90057 18.093015765 RL-A-FLUOR AB 2013270 13.123015770 RL-A-GALATOSE TRANSF QN 23.293015773 RL-A-FACTOR 8 ACTIV 30095 19.83015780 RL-A-GFR ESTIMATED 5.323015790 RL-A-GGT/GGTP 48.963015800 RL-A-GHB SP 91193 1653015810 RL-A-GROWTH HORMONE 18.433015820 RL-A-H PYLORI AB 50995 16.043015840 RL-A-HANTAVIR AB 2001540 47.53015850 RL-A-HAPTOGLOBIN 47.293015860 RL-A-HBA1/2 DELETIONS 199.083015870 RL-A-HBA1/2 SEQUENCING 175.923015880 RL-A-HBB GENE SEQ 161.813015890 RL-A-HBB MUTATIONS 59.233015900 RL-A-HBSAG CONFIRM 11.423015910 RL-A-HBV CORE AB IGM 13.023015920 RL-A-HEP B CORE AB 20091 13.333015930 RL-A-HEP B DNA PCR 56025 47.363015940 RL-A-HBV GENOTYPING 353.883015950 RL-A-HCV AB BY CIA 15.783015960 RL-A-HCV GENOTYPE 284.623015970 RL-A-HELMINTH AB 14.383015980 RL-A-HEMOPHILIA A (F8) 78.173015990 RL-A-HEP PANEL ACUTE 52.663016010 RL-A-HEPATITIS D AB 20799 18.983016020 RL-A-HEPATITIS E IGG 52.63016030 RL-A-HEPATITIS E IGM 55.93016031 RL-BS-SERUM ADSORPTN FEE 1003016032 RL-QD-ESTROGEN TLT SE 22.983016033 H-CULT SCRN GC 433016034 RL-QD-LYMPH SUBSET PANEL 38.83016035 RL-QD-C TRACHOMATIS IGM 11.893016036 RL-QD-C TRACHOMATIS PNE 11.893016037 RL-QD-C TRACHOMATIS PSI 11.893016040 RL-A-HEROIN CONFIRM 2323016050 RL-A-HEROIN URN 91586 1053016060 RL-A-HSV CULTURE 65065 22.83016080 RL-A-HGB FRACTION CHROM 19.973016090 RL-A-HGB PLASMA 20058 8.083016100 RL-A-HGB URINE 20221 4.363016110 RL-A-HHV 6 QT PCR 60071 46.153016120 RL-A-HHV 6 IGG 2013423 14.253016140 RL-A-HISTAMINE PL 70036 32.65

3016150 RL-A-H GALACTO AG 2009418 10.273016160 RL-A-HIV DGRES TISS CLT 434.643016170 RL-A-HIV DRGRES TIS 92050 6133016180 RL-A-HIV1 DRUG CULT ADDL 51.973016190 RL-A-HIV1 DRUG CULT 51.993016200 RL-A-HIV1 GENOTYPE 55670 284.623016210 RL-A-HIV1 DNA QL 93061 38.83016220 RL-A-HIV1 RNA QT 55598 94.073016230 RL-A-HIV1 SEQ DRG RESIST 144.913016240 RL-A-HLA II HR 1 ALLEL EA 96.663016250 RL-A-HLA II LR ONE AG EA 96.673016260 RL-A-HLA B5701 2002429 36.263016290 RL-A-HSV1 GLYCP IGG 50292 14.583016300 RL-A-HSV1 IGG CSF 50379 14.583016330 RL-A-HSV 1/2 IGG CSF 15.363016340 RL-A-HSV 1/2 IGM CSF 15.363016360 RL-A-HSV2 GLYCOPROT IGG 21.43016380 RL-A-HSV PCR 60041 38.83016390 RL-A-HSV TYPING 6.083016400 RL-A-HE4 PROTEIN 2003020 23.583016410 RL-A-HUM METAPNEUMOVIRUS 10.273016420 RL-A-IA QL/SQ MULTI 10.273016430 RL-A-IG CRYOPRECIPITINS 6.083016440 RL-A-IGF-2 1153016450 RL-A-IGHV MUT ANALYSIS 401.793016480 RL-A-IMM CELL FNCT ASSAY 191.193016490 RL-A-IMMUNOFIXATION 20.733016491 H-AMYLASE FLUID 483016492 H-GLUCOSE BODY FLD 673016500 RL-A-IMMUNOGLOBULIN A 6.083016510 RL-A-IMMUNOGLOB D 99200 6.083016511 RL-A-IA QNT RIA 14.943016520 RL-A-IMMUNOGLOB G CSF 6.083016521 RL-A-VIT B12 BND CP 70260 15.843016530 RL-A-IMMUNOGLOB G SERUM 6.083016540 RL-A-IMMUNOGLOBULIN M 6.083016543 RL-A-PSEUDOEPHEDRINE UR 993016570 RL-A-INFX AG PTYP HIV 434.663016580 RL-A-INFX AG PHTYP HIV 145.693016590 RL-A-INHIBIN B 70413 14.313016600 RL-A-INSULIN FREE 70155 14.323016610 RL-A-INSULIN TOTAL 70155 12.653016620 RL-A-INTFRN B NEUT AB BIL 191.193016630 RL-A-INTRFN B NEU 2003390 191.193016640 RL-A-INTERLEUKIN 1 BETA 14.313016650 RL-A-INTERLEUKIN 2 14.313016660 RL-A-INTERLK 28B 2004680 64.05

3016670 RL-A-INTERLEUKIN 6 14.313016680 RL-A-INTRINS FCT AB 70210 16.663016690 RL-A-IODINE 22.373016700 RL-A-ISLET CELL AB 50138 18.383016710 RL-A-JC VIRUS PCR 99169 38.83016720 RL-A-LCM VIRUS IGG CSF 14.233016730 RL-A-LCM VIRUS IGG SER 14.233016740 RL-A-LCM VIRUS IGM CSF 14.233016750 RL-A-LCM VIRUS IGM SER 14.233016760 RL-A-LEFLUNOMIDE METAB 15.143016770 RL-A-LIPID PANEL 13.883016780 RL-A- M PNEUMO PCR 60256 38.83016790 RL-A-MTB AMP PROBE CSF 38.83016810 RL-A-MAGNESIUM RBC 7.413016820 RL-A-MANGANESE 99265 27.183016840 RL-A-METHANOL 90165 17.773016850 RL-A-MICROALBUMIN UR 5.863016860 RL-A-MICROSPR DFA 2003111 10.273016880 RL-A-MOULD BROTH DILU 9.553016890 RL-A-MOULD IDENT 11.423016900 RL-A-MTB CMPLX PROBE 39.773016910 RL-A-MTHFR 2 MUTAT 55655 64.053016920 RL-A-AMH 2002656 14.313016930 RL-A-MUMPS VIRUS AB IGG 14.423016940 RL-A-MUMPS IGM TITR 99589 14.423016950 RL-A-MUMPS VIRUS IGG CSF 14.423016960 RL-A-MUMPS VIRUS IGM CSF 14.423016980 RL-A-MYOSITIS ENA AB 93.923016990 RL-A-NA PRB AMP INF AGNT 38.83017000 RL-A-NEPHELOMETRY EA 48.963017010 RL-A-NEURN SPC ENLS 98198 23.013017020 RL-A-NEURONAL NUCLEAR IGG 13.333017030 RL-A-NEUT OX BURST 96657 191.193017040 RL-A-NEUT ASSOC AB 55506 15.883017050 RL-A-NICKEL SERUM 27.093017060 RL-A-NK CELLS ENUMERATION 42.163017070 RL-A-NK CELLS TL CT 95892 44.643017080 RL-A-NK MONONUCLEAR AG 29.933017090 RL-A-OLIGO BAND CSF 80440 22.233017100 RL-A-OSMO FECAL 98122 22.43017110 RL-A-OXYGEN DISSOC HEMOX 11.063017130 RL-A-PANC ELAST FEC 80526 14.313017140 RL-A-PARAINFLNZ TYP 1 DFA 10.273017150 RL-A-PARAINFLNZ TYP 2 DFA 10.273017160 RL-A-PARAINFLNZ TYP 3 DFA 10.273017170 RL-A-PARASITE EXAM TICK 4.723017180 RL-A-PARASITE SMEAR BLOOD 6.62

3017190 RL-A-PARATHYROID HORMONE 45.633017200 RL-A-PAROXETINE QN 90786 1013017210 RL-A-PAROXY NCT HGBUR RBC 29.933017220 RL-A-PAROXY NCT HGBUR WBC 29.933017230 RL-A-PARTIAL THROMB TIME 6.643017240 RL-A-PARVO B19 PCR 60043 38.83017270 RL-A-PHENYTOIN 14.663017280 RL-A-PHSETHANOLAMINE IGA 14.313017290 RL-A-PHSETHANOLAMINE IGG 14.313017300 RL-A-PHSETHANOLAMINE IGM 14.313017310 RL-A-PHOSPHAT GLYC IGA 14.313017320 RL-A-PHOSPHAT GLYC IGG 14.313017330 RL-A-PHOSPHAT GLYC IGM 14.313017340 RL-A-PHOSPH INOSITOL IGA 14.313017350 RL-A-PHOSPH INOSITOL IGG 14.313017360 RL-A-PHOSPHAT SERINE IGA 17.763017400 RL-A-PLATELET ANTIBODY 20.33017410 RL-A-POLIOVIRUS AB 60054 14.413017420 RL-A-PORPH FRX/QT 2002058 16.263017430 RL-A-PRO-BNP NT 50083 37.943017440 RL-A-PROGESTERONE 23.063017450 RL-A-PROINSULIN 70112 19.73017460 RL-A-PROPAFENONE 15.143017470 RL-A-PROT C FUNCT 30177 15.293017480 RL-A-PROTEIN C AG 30111 13.293017490 RL-A-PROT ELECT CSF 50590 19.943017500 RL-A-PROT S FREE AG 30177 16.943017510 RL-A-PROTEIN S FUNCTIONAL 16.943017520 RL-A-PROTEIN S TOTAL AG 12.823017530 RL-A-PROTHROMBIN TIME 4.343017540 RL-A-PSA FREE 80206 20.343017550 RL-A-PSA TOTAL 80206 20.343017560 RL-A-PTT D-HEPARIN 10.273017570 RL-A-PARTIAL THROMB TIME 6.643017580 RL-A-PYRIDINIUM CRSLNK UR 20.53017600 RL-A-PARROT DRP IGE 99635 21.533017640 RL-A-REPTILASE TIME 10.893017680 RL-A-RHEUMATOID FACT IGM 6.283017690 RL-A-RHEUMATOID FACTOR 6.283017700 RL-A-RPR 4.563017710 RL-A-RPR TITER 4.873017730 RL-A-RSV DFA 10.273017750 RL-A-RUBEOLA IGG 14.253017760 RL-A-RUBEOLA IGM 14.253017770 RL-A-SCEREVISIAE AB 50564 13.563017780 RL-A-PNEUM SERO IGG 50725 16.583017790 RL-A-SALMONELLA AB 14.58

3017800 RL-A-SCHISTOSOMA G 99411 14.383017810 RL-A-SELENIUM 25023 28.223017820 RL-A-SRA UNFR HEP 2005631 20.33017840 RL-A-SICKLE CELL RBC 5.83017850 RL-A-SIN NOMBRE VIRUS IGG 503017860 RL-A-SMEAR OTHER 73017870 RL-A-SOL FIBRIN MONOMER 8.573017880 RL-A-SOL TRNSF RCPT 70283 40.423017890 RL-A-SPECIMEN ID TESTING 1503017900 RL-A-SPOROTHRIX AB 1643017910 RL-A-SQ CELL CARCINOMA AG 23.013017930 RL-A-STLOUIS ENCP 2008916 14.583017940 RL-A-STRIATED MUSC AB TTR 13.333017950 RL-A-REDUC SBST STL 20373 6.093017970 RL-A-T CEL CD4/8 RT 95892 44.623017980 RL-A-T CELL TOT CNT 95892 44.643018010 RL-A-FTA CSF 55273 15.183018030 RL-A-T VAGINALIS AMP DET 38.83018040 RL-A-T3 UPTAKE 7.163018050 RL-A-TAY-SACHS 7 MUT 260.733018070 RL-A-TETANUS IGG 16.583018080 RL-A-THIO METHYLTRNSF RBC 19.973018090 RL-A-THROMBIN TIME 6.383018100 RL-A-THYROGLOBULIN AB 14.973018110 RL-A-THYROGLOBULIN 17.763018120 RL-A-THYROGLOBULIN 17.763018130 RL-A-THY PEROXIDASE AB 15.23018140 RL-A-THYROID STIM HORMONE 18.573018150 RL-A-THYROXINE FREE 9.973018160 RL-A-PROTEIN CSF 50590 4.13018170 RL-A-TOXOCARA IGG ELISA 14.383018190 RL-A-TRAZODONE 90316 15.143018220 RL-A-TRICHINELLA AB 50787 13.893018230 RL-A-FREE T3 17.713018250 RL-A-TRYPTASE 99173 14.313018280 RL-A-VASOACT PEPTDE 99435 17.813018290 RL-A-VASOPRESSIN 70027 37.533018300 RL-A-VGCC ANTIBODY 92628 14.943018340 RL-A-VIRAL CULT ISOLATION 16.243018350 RL-A-VISCOSITY WB 20054 12.913018360 RL-A-VITAMIN B2 81123 22.373018380 RL-A-VITAMIN B5 803018381 RL-A-IMMUNOHIST STN ADDL 503018382 RL-A-IMMUNOHIST SNGL STN 503018390 RL-A-VITAMIN D 25-HYDROXY 24.793018420 RL-A-VZ VIRUS IGM CSF 14.253018430 RL-A-VZ VIRUS IGG CSF 14.25

3018440 RL-A-VZ VIRUS IGG SERUM 14.253018450 RL-A-VZ VIRUS IGM SERUM 14.253018460 RL-A-VZ VIRUS PCR 60042 38.83018470 RL-A-W EQUINE ENCP AB BLD 14.583018560 RL-A-ZONISAMIDE 97908 14.473018579 RL-A-B CELL IMMUNODEF 29.933018620 RL-A-AFB CULTURE 9.123018650 RL-A-YEAST BROTH DILU 9.553018670 RL-A-PHOSPH INOSITOL IGM 14.313018736 RL-BS-PRESELECT DONOR PT 533018800 RL-A-FLOW CYTO MARKER 203018810 RL-A-FLOW CYTO MRKR ADDL 203019010 RL-A-FARMER PNL AB 50157 13.993019020 RL-A-FRMR PNL AB AD 50157 12.443019030 RL-A-HLA2 DQB1 AL 2011272 3003019040 RL-A-HLA-DRB1 ALLO AG 2583019050 RL-A-WESTNILE VIR SER IGG 16.093019060 RL-A-WESTNILE VIR SER IGM 18.833019090 RL-A-DRUG PNL 9 SER 92420 50.43019100 RL-A-VITAMIN K 99225 15.153019120 UA MICRO ONLY 183019130 BNP POC 2363019148 RL-A-TSH RCPT AB 2002734 14.313019155 RL-A-DRUG 9A UR 92187 23.243019171 SWEAT CONDUCTIVITY EXP 0 33019189 RL-BS-CLASS 1/2 HLA ID 1103019197 RL-BS-HI FREQ RBC AG NEG 3153019205 RL-BS-PRESEL DNR/PT PR UN 533019213 CULT BONE MARROW 763019221 CULT CSF 683019247 CULT BACT UROGENITAL 683019262 CULT RESPIRATORY 683019288 CULT SCRN GC 393019304 CULT SPUTUM 683019320 CULT BODY FLUID 683019346 CULT MEDICAL DEVICE 683019361 CULT CATHETER TIP 683019387 CULT TRANSFUSION REACT 763019388 RL-A-RAST IGE QN 2010161 6.133019389 RL-A-RAST IGE QT 2010161 6.133019390 RL-A-EIA SQ MULTI 6.93019437 RL-A-HIV PHENOS EXP 92399 0 33019445 RL-A-CRYPTO/CYC EXP 60046 0 33019452 RL-A-MICROSPORD EXP 60050 0 33019460 RL-A-PEMPHIG AB EXP 90650 0 33019478 INFLUENZA IA OPTIC EXP 0 33019486 RL-HD-AFB PANEL EXP 0 3

3019494 CULTURE STOOL EXP 0 23019502 CULT AEROBIC OTHER QN 683019528 CBC W/ MAN DIFF EXP 0 23019585 RL-A-ANGL/PW SYND 2005077 27.43019593 RL-A-CA 27-29 80392 23.013019601 RL-A-URINE CREATINE 5.123019635 H-ALPHA 1 ANTITRYPSN 8218 433019643 HEMATOCRIT QW 1033019650 RL-A-PANCRT POLYPEP 99436 14.943019700 RL-SR-HEPARN ASOC AB 25.023019710 RL-A-GM1 AB PANEL EXP 0 33019711 SWEAT CONDUCTIVITY EXP 0 33019715 RL-A-HIV PHENOSENSE EXP 0 33019716 RL-A-CRYPT/CYCL/ISO EXP 0 33019717 RL-A-MICROSPORIDIA EXP 0 33019718 RL-A-PEMPHIGUS AB EXP 0 33019719 INFLUENZA IA OPTIC EXP 0 33019720 RL-HD-AFB PANEL EXP 0 33019721 CULTURE STOOL EXP 0 23019723 CBC W/ MAN DIFF EXP 0 23019724 RL-A-BETA 2 TRNF EXP 0 33019725 RL-AA-GEM CANCER PANEL 68003019734 OCCULT BLOOD OTHER QL QW 213019767 REF LAB HANDLING FEE 303019775 RL-SR-URINALYSIS W/ MICRO 4.323019817 RL-MV-HISTOPLASMA QNT 953019825 RL-MV-BLASTOMYCES 973019833 RL-MV-PLATELIA A GALACTO 953019866 RL-A-CHROM COUNT 15-20 1503019874 RL-A-TISSUE CULT NON-NEO 1503019890 RL-A-PML/RARA ALP 2002871 282.833019916 RL-A-BCR/ABL1 MAJOR BKPT 74.543019924 RL-A-BCR/ABL1 MINOR BKPT 74.543019932 RL-A-TACROLIMUS 15.183019940 RL-A-MEFV FULL GENE SEQ 7663019943 RL-A-PINWORM EXAM 4.723019958 RL-A-FOLLICLE STIM HORM 20.553019959 RL-A-VISCOSITY SERM 20056 12.913019962 RL-A-BUPRENORPHINE BLD 21.513019963 RL-A-BUPRENORPHILE MEC 26.483019968 RL-A-UGT1A1 GENOTYPING 46.143019971 RL-A-D DIMER QN 30268 14.953019972 RL-A-HOMOCYSTINE 18.653019973 RL-SR-DILANTIN 18.063019974 RL-SR-BETA HCG QUANT 20.513019975 RL-SR-VANCOMYCIN 18.463019976 RL-SR-CARBAMAZEPINE 19.84

3019977 RL-SR-VALPROIC ACID 18.463019978 RL-A-IA QN NEURONAL AB 84.63019979 RL-A-IA QN RIA 84.63019981 RL-A-NEISSERIA AMP PRB 38.83019983 RL-A-FL AB SCR 10.93019984 RL-A-CALCIUM URINE 6.673019985 RL-A-HLA II LR ONE LOCUS 1453019986 RL-A-MONONUCLEAR AG 31.263019987 RL-A-MATERNAL SCRN 80269 74.773019988 RL-A-RAST MULTI QL 7.33019990 RL-SR-INFLUENZA A/B IGG 12.643019991 H-HIV1 DIFFERENTIATN 8305 363019992 H-HIV2 DIFFERENTIATN 8305 303019993 RL-SR-PROCALCITONIN 36.493019995 H-CPK MB ONLY 653019996 RL-QD-TOXOPLASMA AB 353019997 RL-QD-C PNEUMONIAE IGG 153019998 RL-QD-C PNEUMONIAE IGM 15.033019999 H-CRP HIGH SENSITIVITY 84.583020001 RL-A-HLA-DR GENOTYPING 2583020002 RL-A-JAK2 V617F QL 51245 125.063020003 CALCIUM UR RAN/UNTIMED 443020007 RL-A-HLA-A GENOTYPE 3253020008 RL-A-HLA-B GENOTYPE 3253020009 RL-A-PHOSPHORUS BLD 5.253020010 HEPARIN ANTI-XA UNFRC 493020012 RL-A-HEPATITIS A IGM 12.443020013 RL-A-JAK2 EXON12 MUT PCR 54.83020015 RL-A-FERRITIN 36.253020016 RL-US-NPM1 MUT ANALYSIS 3743020017 RL-M-IMMUNO QN RIA 73.973020018 RL-M-FLUOR AB TITER 73.973020019 RL-M-NON SPEC IMMUNOASSY 73.923020020 H-COMP METAB PANEL 763020021 RL-A-FRAGILE X 2009033 1053020023 RL-A-VIBRIO STOOL CULT 2.613020024 RL-A-EBV VIR CAP AB 50600 17.683020025 RL-A-EBV NUCL AG AB 50600 17.683020026 RL-A-EBV ERLY AG AB 50600 17.693020027 RL-A-MYELOPROLIF NEO RFLX 69.53020028 AMNIOT PROT AMNISURE POC 1053020029 RL-A-CYTOGEN DNA PROBE EA 76.223020030 RL-A-CYTOGEN INSITU HYBRD 76.223020032 RL-A-CHEMILUM PROT 92660 15.623020033 RL-SR-ALBUMIN FLUID 4.463020034 RL-SR-AMYLASE FLUID 8.833020035 RL-SR-GLUCOSE FLUID 5.35

3020036 RL-SR-PROTEIN TOTAL FLD 53020037 RL-SR-LDH FLUID 8.223020038 RL-SR-CALCIUM IONIZED 18.633020039 RL-A-H PYLORI AG STL EIA 15.93020040 RL-A-IGF BINDING PROT-2 1153020041 RL-A-VHL SEQUENCING 99.653020043 RL-A-BONE MARROW/PBL CULT 139.643020044 RL-A-THROMBIN/ANTITHROM 1413020045 RL-A-BRAC1/2 COMM DUP/DEL 11663020046 RL-A-BRAC1/2 UNCOM VARNT 11663020047 RL-A-CELIAC DL AG 2010161 6.073020048 RL-A-C-REACTIVE PROTEIN 5.723020049 RL-A-CELL FUNCTION ASSY 186.753020050 RL-SR-CREATININE FLUID 7.053020051 RL-SR-UREA NITROGEN FLD 6.473020052 RL-SR-PLATELET AGG EA 29.273020053 RL-A-T GONDII IGG CSF 87.93020055 MS-NATRIURETIC PEPTIDE 1503020056 RL-BS-HLA CLASS I AB IDNT 2803020057 RL-BS-HLA CLASS I AT 1:10 2503020058 RL-BS-CLASS I PHENO DNA 4003020059 RL-A-HEPATITIS A AB TOTAL 13.73020060 RL-A-FLUOXETINE/METAB 15.143020061 RL-A-CYTOGN SNPMA 2003414 10953020062 RL-A-PT INHIBITOR 1:1 4.363020063 RL-A-BCR-ABL1 MUT NGS 7853020064 RL-A-JAK2 GENE V617F QNT 50.373020067 RL-A-INDIA INK STN 4.723020068 RL-A-MARFAN SYN SEQ SPCM 999.53020069 RL-A-MARFAN SYN SEQ INT 999.53020070 IMMUNO SHIGA TOXI EXP 0 33020071 MM-IMMUNO SHIGA TOX EXP 0 33020072 IMMUNO SHIGA TOXI EXP 0 33020073 MM-IMMUNO SHIGA TOXI EXP 0 33020074 RL-A-HCV RNA NS3 GENOTYP 7423020075 RL-A-BRAF V600E HCL PCR 54.83020076 RL-A-PHOSPHATIDYLGLYCEROL 18.273020077 RL-A-5-FU TOX CHEMO RESP 125.023020078 RL-A-5-FU TOX CMO RSP ADD 125.013020079 RL-A-ENCEPH CALIF AB BLD 14.383020080 RL-A-ENCPH EAST EQUINE AB 14.373020081 RL-SR-KETONES 6.163020082 RL-M-FLOR AB SRC NEURO 591.73020083 RL-A-TITANIUM QNT BLD 1213020084 RL-A-BETH F8 BILL ONLY 14.243020086 RL-A-HEP C RNA TMA QUAL 2513020087 PH BODY FLUID NOS QW 19

3020088 H-HIV AG/AB 8289 1303020089 RL-A-COMPLETE METAB PNL 11.693020090 RL-A-LACTIC ACID FLUID 11.813020091 RL-A-FIBRINOGEN ACTIVITY 9.393020094 RL-A-LISTERIA AB 99529 70.33020095 RL-A-AFB CONCENTRATION 7.383020096 RL-A-LIPOPROT HI RES NMR 41.123020097 RL-A-ANA PATTERN BY IFA 211.323020098 RL-SR-IRON 8.823020099 RL-SR-SODIUM URINE 6.633020100 RL-A-CLONIDINE BLOOD 2233020101 RL-A-DULOXETINE QNT BLD 2003020102 RL-A-ARIPIPRAZOLE/METAB 15.143020103 NA PROBE AMP INF AGNT 1423020104 HLA-B51 DNA TYPING QUEST 1053020105 RL-US-COMPREHENSIVE BRCA1 12063020106 RL-US-COMPREHENSIVE BRCA2 12063020107 IVD GENE SEQ PREV GEN 8823020108 RL-A-LACOSA SP 2003182 15.143020109 RL-A-CULTURE CSF 9.523020110 RL-A-GRAM STAIN 4.723020111 RL-A-LACTOSE TOL 3 SPEC 7.523020112 RL-A-LACTOSE ADD SPEC 7.53020113 RL-A-IA TUMOR OTHR AG QN 23.013020114 RL-A-FDP/FSP AGGLUT SQ 6.083020115 CYSTATIN C QUEST 603020116 RL-SF-PATH LEVEL 4 COMB 681.23020117 RL-SF-HISTOCHM STN FZ COM 350.43020118 RL-SF-ENZYME STAIN COMB 561.63020119 RL-A-MAT SCRN SEQ SPC 1 30.893020120 RL-SF-IMMUNOHIST STN EA 188.83020121 RL-SF-IMMUNOHIST STN COMB 2723020122 RL-SR-H PYLORI AB 19.773020123 RL-US-JAK2 EXON 12 MUT 4503020124 RL-M-NEUROMYELITIS OPTICA 643.43020126 POC/TISSUE MICROARRAY ESO 14703020127 RL-QD-MUSK ANTIBODY 7353020131 FEBRILE ANTIBODY PANL EXP 0 33020133 PAP TLP AUTO/MNL LABCORP 1453020134 RL-A-LIPOPRO FRAC 2012200 553020135 RL-A-RESP VIRUS PNL PCR 388.393020136 HIV-1/HIV-2 AB SINGLE 1103020137 IMMUNOASSAY OPTICAL 323020139 RL-A-STACHYBOTRYS IGA 30.953020140 RL-A-STACHYBOTRYS IGE 30.953020141 RL-A-STACHYBOTRYS IGG 30.953020144 RL-DV-ETHYLENE GLYCOL 94

3020145 RL-SR-COMP METABOLIC PNL 14.393020146 RL-SR-AMMONIA 19.853020147 RL-SR-MAGNESIUM 9.123020148 RL-SR-PHOSPHORUS 6.463020149 RL-A-T. CRUZI IGG 51076 13.73020150 RL-A-TRYPANO CRUZI IGM AB 13.73020151 RL-US-B CELL PCR PARAFFIN 6953020152 RL-A-OCCULT BLD FEC IA 14.313020160 RL-SR-SALICYLATE 9.663020161 RL-SR-ACETAMINOPHEN 27.543020162 RL-SR-THYROID STIM HORM 22.893020163 RL-SR-EIA RSV QL AG 12.643020173 H-THYROXINE TOTAL 343020174 H-THYROID HORM UPTK 7848 293020175 RL-A-S.CHRT/ATR IGA 92582 30.953020176 RL-A-S.CHRT/ATR IGE 92582 30.953020177 RL-A-S.CHRT/ATR IGG 92582 30.953020178 RL-A-CRYPTOCOCCUS AB 141.763020179 RL-A-FAM MED FEVER SEQ 398.43020180 RL-A-PORPH (PBG) DEAM RBC 19.973020181 RL-A-HPV HYBRID CAPT 38.83020190 RL-BW-NAT FLUOR PROBES 533020191 RL-BW-NAT PLATLET AB ID 523020192 RL-A-ONCOPROTEIN DCP 72.983020193 RL-A-METHAQUALONE QT 1483020194 H-ALBUMIN FLUID 243020195 RL-QD-PARVO B19 DNA PCR 1013020200 RL-A-EVEROLIMUS 18.733020201 RL-PL-IMMUNOFL INDIRECT 41.513020202 RL-SR-PARATHYROID RAPID 56.233020203 RL-A-TARGET GENOM SEQ ANL 2003020204 RL-A-PH BODY FLUID 3.963020205 RL-A-HEPATITIS E IGG EIA 14.253020210 SP-IMMUNOPEROX STN SUB 2113020211 SP-IMMUNOPERX STN MLTX 2643020212 SP-INSIT HYBR MULT MNL 2643020213 RL-A-C BRUNETII AB 46.353020214 RL-A-C BRUNETII AB TITER 65.13020215 RL-QD-HEP B ULTRA QN 6617 85.363020217 RL-A-CYP2C9 COMMON VAR 1003020218 RL-A-VKORC1 COMMON VAR 1003020220 RL-SR-PROTEIN URINE 53020221 RL-SR-CREATININE URINE 7.053020222 STRATIFY JCV AB QUEST 14313020223 H-H PYLORI AB 643020224 RL-A-COPPER RBC 663020225 RL-A-CA 19-9 23.01

3020226 RL-A-ALPRAZOLAM 90010 20.453020227 RL-A-GLYCOHEMOGLOBIN 10.743020228 RL-A-COMPLEMENT C3 13.273020229 RL-A-HIV 1,2 AB CIA 12.653020231 RL-A-INFX AG PHENOTYP DRG 1003020232 RL-T-GROSS & MICRO LVL 4 253020233 RL-T-STAIN GROUP 2 253020234 RL-T-HISTOCHEMICAL STN 253020235 RL-T-STAIN 3 ENZYME THER 253020236 RL-T-IMMUNOHIST SNGL STN 253020237 H-HGB ACID CONFIRM 8239 643020238 RL-QD-T PALIDM CONF 99723 223020239 RL-A-MATERNAL SCRN SPEC 1 16.823020240 RL-A-COMPLEMENT C2 50148 13.273020241 RL-A-TRANSFERRIN 14.123020242 RL-A-PROT ELECT SERUM 4.33020243 RL-A-NEPHELOMETRY EA 4.33020244 RL-A-PROTEIN REFRACT 4.293020245 RL-SR-BF CRYSTALS 9.753020247 RL-A-AFP-L3 TOTAL/FRACT 71.993020248 RL-A-ARSENIC OTHR 2007342 2103020249 H-BODY FLD SPEC GRAV 93020250 RL-A-ABCD1 SEQUENCING 9903020251 RL-A-C PNEUMONIAE PCR 38.83020252 PLASMA CRYO REDU EA JUMBO 8433020253 H-PROTEIN BLOOD 173020254 H-PROTEIN URINE 383020255 RL-A-TUMOR NECR FACT ALPH 14.313020256 H-HEPATITIS A IGG 843020257 RL-SR-ALCOHOL 14.73020258 RL-SR-TROPONIN 13.43020259 RL-SR-CREATININE KINASE 8.873020261 RL-US-CALRETICULIN MUT 4953020262 RL-A-MECP2FULL SEQ ANALYS 304.753020263 RL-A-MECP2 DUP/DEL VAR 304.753020264 RL-A-MOLEC PATH PROC LVL5 503020265 RL-A-MOLEC PATH PROC LVL6 503020266 RL-A-MOLEC PATH PROC LVL7 503020267 RL-A-MOLEC PATH PROC LVL8 503020268 RL-A-MCG DNA PROBE 304.753020270 RL-A-SPECTROPHOTOMETRY 304.753020271 RL-A-MOLEC PATH PROC LVL3 203020273 RL-A-POTASSIUM STL 20380 11.483020274 RL-A-SODIUM STOOL 20379 5.433020275 RL-A-CHLORIDE STOOL 7.413020276 RL-MV-COCCIDIOIDES AB 973020277 RL-MV-COCCIDIOIDES AG 50

3020279 RL-A-SMEAR ACID FST/FLUOR 53020280 H-THYROXINE FREE 923020283 RL-SR-ALT/SGPT 7.223020284 RL-A-IA INFECTIOUS AB QN 16.583020285 RL-US-MPL MUTATION ANALY 5403020286 RL-A-TOTAL T3 15.683020287 RL-A-FLUOR AB TITER 103020288 RL-A-CULT TYP SEROLOGICAL 4.563020289 RL-M-PHOSPHORUS FLUID 54.053020292 RL-A-SPEC GRAV FLD 20508 2.773020293 RL-A-CAMP JEJ 98841 14.53020294 RL-A-COTININE UR 2007081 19.63020295 RL-A-ANDROSTERONE 328.253021844 H-CALCIUM URINE 283021845 H-BILIRUBIN DIRECT 303021846 RL-A-HCV NS5A DRG SEQ 236.133021847 RL-A-GGT/GGTP 47.293021848 RL-A-NEPHELOMETRY EA 47.293021849 RL-A-ALT/SGPT 47.293032264 RL-A-GLUTATHIONE TOT 683032265 RL-A-CORD DRUG 2006621 983032267 H-LIPID PANEL 793032268 H-THYROID STIM HORM 1083032269 H-URIC ACID 263032270 RL-A-CELL FUNC ASSY W/STM 191.193032271 RL-SR-DRUG OF ABUSE URINE 14.863032272 RL-A-F TULARENSIS AB 11.53032273 H-GLUCOSE URINE 703032274 RL-SR-DIGOXIN 18.093032275 RL-A-OVARIAN PROT (OVA1) 6363032276 RL-A-CHOLESTEROL 11.043032277 RL-A-GLUCOSE 36.253032278 RL-A-AST/SGOT 36.253032279 RL-A-ALT/SGPT 36.253032280 RL-A-TRIGLYCERIDES 11.043032281 RL-A-BORON 773032283 RL-SR-AST/SGOT 7.053032284 RL-A-FETAL ANEUPLOIDY 5753032285 RL-A-ALCOHOL URINE QT 11.943032286 RL-A-ANTIDEPRES PNL UR QT 2103032287 RL-SR-BILIRUBIN DIRECT 6.833032288 RL-SR-LIPASE 9.383032289 RL-A-FLUNITRAZEPAM/METAB 1553032290 RL-A-HEAVY METAL BLD QN 103032291 RL-A-THIOPURINE DRG METAB 19.973032293 RL-A-MITOCHOND GENE SEQ 36003032294 RL-A-MOLEC PATH PROC LVL1 10

3032295 RL-A-FATTY ACID VERY LONG 19.973032296 RL-A-PREALBUMIN 16.133032297 RL-A-DRONEDARONE 1273032298 MRSA AMP PROBE 763032300 RL-A-SUSCEPT ENZYME DET 2.493032301 RL-A-MOLEC PATH PROC LVL1 503032302 RL-A-MOLEC GENE SEQ MISC 503032303 RL-A-ANTIEPILEPTICS 1-3 15.143032304 RL-A-STRONGYLOIDES IGG 14.383032305 RL-A-GBA COMMON VAR 223.853032307 RL-US-C-KIT MUTATION LIQ 8403032308 RL-US-CEBPA MUT ANALYSIS 3903032309 RL-US-FLT3 TAND DUPL VAR 1503032310 RL-US-FTL3 GENE ANALY VAR 1503032311 RL-BW-REDCELL GENOTYP CMN 2453032312 RL-A-ENZYME CELL ACTIVITY 153032313 RL-A-CELL FUNC ASSY W/STM 1503032314 RL-A-IMMUNOFLUOR PER INIT 1003032315 RL-A-IMMUNOFLU EA SPE ADD 1003032316 INFLUENZA AB MOLECULR EXP 0 33032317 RL-A-18-HYDROXYCORTICOST 150.63032318 FFP THAWING EA UNIT 2463032319 H-PH BODY FLUID 163032321 CRYO THAWING 2213032322 RL-A-DRGSCRURQL EXP 90500 0 33032323 RL-A-DRG ANYL UR AD 90500 23.43032324 RL-A-AMPHETAMINE QNT EXP 0 33032325 RL-A-AMPHETAMINE QT ADDL 8.593032326 RL-A-OPIATE QNT EXP 0 33032327 RL-A-OPIATE QT ADDL 10.753032329 H-MAGNESIUM URINE 403032330 H-FLUID LDH 393032331 H-FLUID PROTEIN 363032332 RL-A-OSTEOCALCIN EIA 17.813032333 RL-QD-LYME IGG/IGM WB 19.063032334 RL-DV-RAST IGE QN EA 573032335 RL-A-DHEA 27.943032336 RL-A-17-HYDROXYPREGN 25.233032337 RL-A-SUSCEPT PER ENZYME 2.493032338 RL-A-DEOXYCORTISOL 32.373032339 BONE MARROW ASSIST NC 0 13032340 ASP FINE NDL ASSIST NC 0 13032341 PTH INTRAOP ASSIST NC 0 13032342 RL-BR-IMMUNOHIST SNGL STN 3933032343 RESP VIRUS 3-5 TARGETS 3683032344 H-ALBUMIN FLUID 483032345 RSV A/B MOLECULAR EXP 0 3

3032346 H-LITHIUM 563032347 RL-A-AFB ID BY MALDI 5.783032348 RL-A-N MENINGIT 2001603 13.473032349 RL-A-N MENING AD 2001603 13.453032350 H-MAGNESIUM 403032352 RL-A-FIBROMETER 2012521 1453032353 RL-A-ANTIPLASMIN ACTIVITY 8.533032354 RL-A-FIBRINOLYTIC PLASMIN 19.013032355 RL-A-ALLOPUR/METAB 91204 1363032356 RL-A-FIBRINOGEN 9.393032357 RL-QD-GLUCOSE FLUID 3.13032358 RL-A-DCP 81312 72.983032359 RL-QD-HEP INDUC PLT AB 100.543032360 RL-QD-LYME AB WEST BLOT 19.063032361 RL-QD-PARVO B19 QL PCR 101.13032362 RL-A-DRUG PNL ADDL 90499 34.33032363 RL-A-STRPTZYM TTR 2013574 11.763032364 RL-A-MUSK AB RIA 2012420 9543032365 RL-A-PROTHROMBIN 1/2 178.853032366 RL-A-A1 ANTITRYP 51256 39.263032367 RL-A-A1ANTITRP PTYP 51256 39.253032368 RL-BS-HBG S SCRN UNIT 863032369 RL-A-PURKINJE CELL AB 13.333032373 H-RETICULOCYTE AUTO 433032376 RL-SR-OCCULT BLD OTHER QL 4.433032377 H-STREP B AMP PROBE 603032378 RL-A-VIRUS ANTIBODY NOS 14.253032379 RL-A-14-3-3 CSF 2008095A 503032380 RL-A-14-3-3 CSF 2008095B 50.883032381 RL-A-VPA-F 99310A 16.713032382 RL-A-VPA-F 99310B 16.713032383 PLATELET AGG ASPIRIN 853032384 PLATELET AGG PLAVIX 853032385 RL-A-LEISH IGG 51726 13.543032387 RL-A-TROPHERYMA PCR 38.593032388 RL-US-TISS CULT OTHER 586.753032389 RL-A-HYPOGLYPAN 2010292 19.973032390 RL-QD-FREE KAPPA UR 72.963032391 RL-QD-FREE LAMBDA UR 72.973032394 RL-A-CDT 70412 9.323032395 RL-A-B CELL TLT CNT 95862 68.083032396 RL-A-IONCA S 20135 15.13032397 RL-A-ITRACONAZ 98519 15.143032398 H-CULT AER ID LIM BROTH 333032400 H-NA PROBE MTB AMP 6650 963032401 H-NA PRB AMP RIF RES 6650 963032402 RL-QD-VAGINALIS RNA PCR 90.8

3032403 RL-US-CHROMO MICROARY 21003032406 RL-A-GLUCA 99165 15.83032407 RL-A-ENT AB PAN 2014108 14.413032408 RL-NE-B CELL GENE REARNGE 1323032409 RL-NE-IGK GENE ANALYSIS 1283032410 RL-NE-BRAF GENE 753032411 RL-NE-KRAS GENE 2563032412 RL-A-LEAD WB 20098 13.383032413 RL-A-K RBC 2014041 813032414 RL-DV-HC MENINGITIS/ENCH 46143100006 RL-PL-PATH LEVEL 4 34.783100007 RL-PL-SPECIAL STAIN EA 58.083100008 RL-PL-WRIGHT-GIEMSA STN 59.633100009 RL-PL-IMMUNOFL STAIN EA 68.563100010 RL-PL-ELECTRON MCR DIAG 6003100030 SP-GROSS & MICRO LVL 6 6553100040 SP-GROSS & MICRO LVL 5 4593100060 SP-GROSS ONLY LEVEL 1 553100070 SP-GROSS & MICRO LVL 2 1503100090 SP-FROZEN SEC 1ST BLK 1293100100 SP-FROZN SEC EA ADD 793100110 SP-DECALCIFICATION 443100120 SP-SPECIAL STAIN 1 2543100130 SP-SPECIAL STAIN 2 2033100140 SP-GROSS & MICRO LVL 3 1903100150 SP-GROSS & MICRO LVL 4 2463100170 SP-FNA INTERPRET 2833100180 SP-CYTOPATH CON SMR/IN 1593100190 SP-FNA DIAG 1ST EVAL 1293100300 FFP 8-24 HR EA UNIT PEDI 1993100330 RED CELLS DEGLY EA 7853100390 SP-IMMUNOHISTCHM EA AB 2183100410 PLATELETS PHER L/R EA 13073100450 RED CELLS AUTO PREPAID 3153100460 SP-CYTOPATH FLD SMEAR 1293100540 FFP > 8 HR JUMBO 7653100560 BLOOD SPLT UNIT 80 ML 3163100650 SP-IMUNCYT HER2 NEU QN 2643100750 CRYOPRECIP POOLED EA UNIT 16393100760 SP-INTRAOP CYTPTH CNS1 1543100770 SP-INTRAOP CYTPTH CNS2 973100780 PLASMA CRYO REDUCE EA 5683100820 RED CELLS L/R EA 5963100840 FFP 8-24 HR EA UNIT 3123100850 PLASMA PLT- RICH EA 9083100860 RED CELLS WASHED EA 9323100940 FFP 8-24 HR EA UNIT 498

3100970 RED CELLS L/R IRR EA 6493100980 PLT PHERESIS L/R IRRAD 13593100990 RBC FRZ/DEG/WSH L/R IRR 11133101150 RED CELLS WASHED EA 9853101160 SP-SMEAR CYTO OTHER 1133101280 FFP 8-24 HR EA UNIT IRR 4983101390 RL-A-PROCALCITONIN 20763 37.693101590 WHOLE BLOOD EA IRR 7893101600 RL-US-UROVYSN (FISH) 7353101610 RL-US-MOLEC EGFR MICRD 496.123101620 RL-US-CHROM ANLYS KRTYPE 51.843101630 RL-US-CHROM TISS CULT SLD 206.123101640 RL-US-CHROM TISSUE CULT 1003101650 RL-US-CHROM ANLY15-20CELL 1803101660 RL-US-CHROMO ANALY ADD 1003101670 RL-US-CHRM TISCLT NONNEO 1503101680 RL-US-CHROM ANLY5CEL CNT 2753101690 RL-US-CHROM MOSAIC CT 1903101700 RL-US-CHROMO CNT ADD 403101710 RL-US-FISH CULTURE 176.473101720 RL-US-FISH DNA PRB 403101730 RL-US-FISH DNAPRB25-99CEL 53.493101740 RL-US-FISH DNA PROB ADD 61.723101750 RL-US-FLOW DNA PLOIDY 80.753101760 RL-US-FLOW CYTO 1ST MARK 403101770 RL-US-FLOW CYTO ADDL MARK 123101780 RL-US-HER-2 FISH CMP AST 753101790 RL-US-HER-2 FISH PATHVYSN 753102090 RL-A-PEMPHIGUS PNL AB 215.963102100 RL-A-PEMPHIGUS PNL ADD 215.953102110 RL-A-PHENYLALANINE 80315 18.653102231 SP-IMMUNOPEROX QT COMP 3573102232 SP-INSITU HYBRID MANL 2643102258 GRANULOCYTES PHER EA 48883102259 RL-SF-PATH EXAM LEVEL 4 247.23102260 RL-SF-SPECIAL STAIN GP 2 171.23102266 RED CELLS DEGLY EA 10413102274 PLATELETS L/R 10873102276 RL-US-JAK2EXON 12 MUT PCR 4503102277 RL-US-IGVH SOMAT MUT ANAL 4073102278 RL-US-CEBPA MUT ANALYSIS 3903102279 RL-SF-HISTOCHEM STN FRZ 274.43102280 RL-SF-ENZYME STAIN 465.63102281 RL-SF-ELECT MICROSC DIAG 1486.83102287 RL-US-IMMUNOHIST STN 1ST 383102288 RL-US-SPEC STAIN GR II 653102289 RL-US-IMMUNOHIST STN ADDL 38

3102290 RL-US-CONSULT/REPORT TECH 503102313 RL-NE-NOTCH1 MUT ANALY 7753102314 RL-NE-SF3B1 MUT ANALYSIS 2753102315 RL-NE-FISH PROBE EACH 1303102316 RL-NE-IHC MORPHO ANALYSIS 753102317 RL-NE-FISH MULTIPLEX PRB 2603102320 RL-NE-IHC QUAL INIT STN 423102322 RL-NE-IHC QUAL MLTPX STN 673102323 RL-NE-IHC QUAL ADDL STN 423102324 RL-NE-PROFESSIONAL CNSLT 503102326 RL-NE-SPECIAL STAIN 443102329 RL-NE-IHC QUANTITATIVE 453200000 ARTHROCEN ASP MAJOR JT WO 4593200001 GASTRO TUBE CHANGE W IMAG 10653200002 DUOD/JEJ TUBE REPLC PERC 14553200003 JEJUNOSTMY TUBE REPL PERC 22363200004 DUOD/JEJ TUBE PERC PLACE 40813200010 IOHEXOL 240MG/ML 50ML INJ 101.483200020 IOPAMID 300MG/ML 30ML INJ 100.793200030 IOHEXOL 300MG/ML 50ML INJ 119.293200040 IOHEXOL 300MG/ML 100ML IN 231.533200050 IOHEXOL 300MG/ML 150ML IN 296.753200060 IOHEXOL 350MG/ML 50ML INJ 128.873200070 IOHEXOL 350MG/ML 100ML IN 248.773200080 IOHEXOL 350MG/ML 150ML IN 363.043200090 XR SWALLOW FUNCT CINE/VID 17983200150 XR AC JTS W/WO WTS BIL 7963200250 XR PELVIS 1 OR 2 VIEWS 6743200260 XR PELVIS CMPL 3+ VIEWS 10043200400 XR BONE SURVEY COMPLETE 18393200410 XR CHEST 1 VIEW 8363200420 XR CHEST 2 VIEWS 10873200430 XR CHEST 4+ VIEWS 11983200440 XR CHEST 4+ VWS W FLUORO 14313200450 XR STERNUM 2+ VIEWS 12193200460 XR STERNOCLAVIC JT(S) 3+ 9163200480 XR RIBS 3 VIEWS BIL 12743200490 XR ABDOMEN 1 VIEW (AP) 7563200500 XR ABD AP + OBLIQ+ CONE 12023200510 XR ABD AP DECUB UPR+CHEST 15123200530 XR SKULL <4 VIEWS 9863200540 XR TMJ OPEN/CLOSED BIL 12213200550 XR SINUSES <3 VIEWS 8613200560 XR SINUSES 3+ VIEWS 13053200570 XR FACIAL BONES <3 VIEWS 8603200580 XR FACIAL BONES 3+ VIEWS 12213200590 XR NASAL BONES 3+ VIEWS 875

3200600 XR MANDIBLE <4 VIEWS 8653200610 XR MANDIBLE 4+ VIEWS 9953200630 XR NECK SOFT TISSUE 7223200650 XR CERVICAL SPINE 2-3 VW 11583200660 XR CERVICAL SPINE 4-5 VW 15633200670 XR CERVICAL SPINE >=6 VW 20033200680 XR THORACIC SPINE 2 VIEWS 11813200690 XR THORACOLUM JUNCT>=2 VW 10543200700 XR LUMBAR SPINE 2 OR 3 VW 10543200710 XR LUMBAR SPINE 4+ VIEWS 14433200720 XR L SPINE CMP W BND 6+VW 18863200730 XR L SPINE BEND ONLY 2-3V 11903200740 XR SACROILIAC JTS <3 VWS 9183200750 XR SACROILIAC JT 3+ VWS 10783200760 XR SACRUM & COCCYX 2+ VWS 8993200770 XR MYELOGRAM THORACIC 34183200780 IR DISKOGRAM C/T SPINE 48263200800 IR RENAL CYST STDY TRANSL 14313200810 XR CERVICAL SPINE 1 VIEW 6113200820 XR CHOLANGIO/PANC INTRAOP 8353200840 XR ESOPHAGUS 14283200850 XR UGI W KUB 20093200860 XR UGI W SMALL INTESTINE 30143200870 XR SMALL BOWEL 15703200880 XR COLON BE W OR WO KUB 17213200890 XR COLON BE W AIR CON 24103200900 XR FLUORO < 1 HR 26373200910 XR UROGRM (IVP) WWO TOMO 28203200920 XR UROGRM INFUS DRP/BOLUS 29333200930 XR UROGRAM RETROGRADE 14103200940 XR CYSTOGRAM 3+ VIEWS 13433200960 IR SINUS TRACT/FIST/ABSC 12783200970 XR PORTABLE PER TRIP NC 0 13200980 IR AORTOGRM ABD W ILIOFEM 97813200990 IR VENOUS SAMPLE WWO ANG 75993201010 IR VENOGRAM EXTREMITY BIL 33173201020 IR VENACAVAGRAM INFERIOR 81513201040 US GUIDED NEEDL PLACEMENT 18023201050 IR TRNSCTH ANG EXIST CATH 19813201060 IR FLUORO GUIDE NDL PLCMT 19123201070 IR DISKOGRM LUMBAR SPINE 55053201120 XR CYSTOURETHROGR RETRO 16883201130 XR MYELOGRAM CERVICAL 37883201140 XR MYELOGRAM LUMBAR 37943201190 GASTRO TUBE PERC PLACE 35493201200 IR REMOVE FB ESOPHAGUS 24343201210 XR ENTEROCLYSIS TUBE PERC 2258

3201220 IR INTRALUMINL STRICT DIL 23523201230 IR TUBE/CATH CHANGE W CON 19173201250 IR BILE DUCT DIL WWO STNT 58283201270 XR NEPHRO/URET/URTHRA DIL 47803201300 IR VENACAVAGRAM SUPERIOR 26083201320 IR VENOGRAM RENAL BIL 101883201340 IR VENOGRAM ADRENAL BIL 78723201350 IR TRANSCATH THRPY EMBOLZ 92043201400 MC IR PTA RENAL/VISCERAL 180443201410 MC IR PTA REN/VISC EA ADD 29413201420 IR BIOPSY TRANSCATH 44113201430 MC IR PTA VENOUS 117993201440 MC IR ANGIO AV DIAL SHUNT 26583201450 IR ANGIO EA ADD VESSEL 33393201470 IR AORTOGRAM THORAC W SER 66713201480 IR AORTOGRAM ABD W SERIAL 81513201500 IR ANGIO BRACHIAL RETRO 66713201580 IR ANGIO SPINAL 62983201600 IR ANGIO EXTREMITY BIL 97813201630 IR ANGIO ADRENAL BIL 66713201640 IR ANGIO PELVIC 81513201670 IR ANGIO PULM NON SELECT 48033201680 DIATRIZO MEG 60% 50MLINJ 5.443201690 DIATRIZOATE MEG 60% 150ML 22.433201700 IR VENOGRM HEPAT W HEMODY 66713201710 XR GI TUBE LONG INTRO 10043201720 IODIXANOL 320MG/ML 50ML 68.583201730 IODIXANOL 320MG/ML 150ML 189.113201750 IOTHALAM MEG17.2%250MLINJ 43.613201820 XR BONE SURVEY INFANT 18573201910 THROMBOLY CEREBR IV INFUS 12003201920 CATH PLACE PUL ART SEGMNT 9693201930 CATH/NDL PLC CARO/VER ART 9693201940 CATH/NDL PLACE EXTREM ART 9993201950 CTH PLC ABD/PEL/EX 1ST EA 14663201960 CTH PLC ABD/PEL/ 2ND INIT 10823201970 CTH PLC ABD/PEL/ 3RD INIT 12883201980 CTH PLC ABD/PEL/EX EA ADD 7573201990 ARTHROGRAM SHOULDER INJ 7623202000 ARTHROGRAM KNEE CON INJ 7623202010 DACRYOCYSTOGRAPHY INJ 7623202020 SIALOGRAM INJ 8763202030 ARTHROGRAM ELBOW INJ 6523202040 ARTHROGRAM WRIST INJ 7623202050 ARTHROGRM HIP WO ANES INJ 8323202060 ARTHROGRAM ANKLE INJ 7623202270 ABS/CYST DRN CATH EXCHNGE 7986

3202280 BONE MARROW ASP ONLY 9233202290 BX BONE SUPERFIC TROC/NDL 15243202300 BIOPSY PROSTATE NDL/PUNCH 25483202310 CTH PLC THOR/BRAC 1ST SEL 10703202320 CTH PLC THOR/BRAC 2ND SEL 13103202330 CTH PLC THOR/BRAC 3RD SEL 15723202340 CTH PLC THOR/BRAC ADD 2-3 2493202360 CATH PLACE RT HRT/PUL ART 9693202370 CATH PLC PULM L/R ART SEL 11133202380 CATH PLACE VEN 1ST SELECT 10573202390 CATH PLACE VEN 2ND ORD 11733202400 CATH PLACE AORTA 13753202410 CATH/NDL PLC RETROG BRACH 11993202420 CATH/NDL PLC AORTA TRANSL 11993202430 VENA CAVA INTRO CATH 9613202440 VENOGRAM EXTREMTY INJ 9613202450 PORTAL VEIN CATH PERC 14943202500 OCCLUSON/EMBOLIZ CNS PERM 17093202510 OCCLUS/EMBOL NON CNS PERM 193683202530 TRANSCATHETER BIOPSY 55883202540 MC PTA RENAL/VISCERAL 129383202550 MC PTA AORTIC 86643202560 MC PTA BRACHIOCEP EA VES 115523202570 MC PTA VENOUS 113453202600 MC THROMBECT AV FISTL GRF 77093202610 IR ANGIO INTERNAL MAMMARY 31463202620 IR VENOGRAM SINUS/JUGULAR 31463202630 IR VENOGRAM SUP SAGITTAL 23663202660 IR VENOGRM HEPAT WO HEMOD 66713202670 IR PORTOGRAM W HEMODYNAMC 66713202680 IR PORTOGRAM WO HEMODYNAM 42393202700 REPOSITION CV CATH W FLUR 20423202710 INS TUNNEL CVAD W PUMP 59793202720 REPL TUN CVAD W PORT CV 74573202730 REM TUN CVA DEV W PORT/P 21073202740 VASC ACCES THROMBL DECLOT 4203202760 GASTRO TUBE CHANG WO IMAG 8343202770 GASTROSTOMY TUBE REPOSIT 15563202780 PLACE NG/OG TUBE PHY SKIL 7833202810 DILATE BILE DUCT WO STENT 53713202820 DILATE BILE DUCT W STENT 107653202860 XR CYSTOURETHROGRAM VOID 11823202870 RENAL CYST ASP/INJ PERC 28223202910 NEPHRO TRACT DILAT W GUID 48393202920 LUMBAR PUNCTURE DIAGNOSTC 16773202930 MYELOGRAM/CT LUMBAR INJ 10453203040 XR FLUORO NDL LOCAL SPINE 2398

3203190 BX BONE TROCAR/NDL DEEP 33543203200 THORACOSTOMY TUBE 13233203210 US GUIDED VASCULAR ACCESS 17583203220 INSERT NONTUN CV CATH >5 26703203230 INS TUN CV CATH WO PORT>5 78673203240 INS TUNNEL CVAD W PORT>5 55883203260 INS PICC WO PORT/PUMP>5YR 28113203270 INS CVAD PERIPH WPOR=>5YR 98103203280 REPAIR CV CATH WO PUM/POR 11443203290 REPAIR CVAD W PORT OR PMP 20423203300 REPLACE CATH ONLY CVAD W 46543203310 REPL NOTUN CV CATH WO PRT 21623203320 REPL TUN CV CATH WO PORT 48113203340 REPL PICC WO PORT 21623203350 REM TUN CV CATH WO PORT/P 12223203380 REM PERICATH MATER CV DEV 46543203390 IR REMOV PERICATH MATERL 6663203400 REM INTRALUM MATERL CVDEV 20423203410 INSERT TIPS 461613203420 REVISE TIPS 407053203460 XR TIBIA & FIBULA 1VW BIL 8363203490 XR SURGICAL SPECIMEN EA 16603203550 EVAL CV DVCE W FLUORO INJ 4593203560 IR FLUORO CVAD PL/RPL/REM 14823203580 ART MECH THROMBECTMY PRIM 80493203590 ART MECH THROMB PRIM ADD 28983203600 VENOUS MECH THROMBECTOMY 97813203630 NEPHRO TB REMOVE W FLUORO 12473203640 CAROTID STNT TRANSCATH W 233133203670 BX SALIVARY GLAND NDL 17633203680 INTRACRN VASO BLN DIL INI 49163203690 DUOD/JEJ TUBE PERC PLACE 40813203700 DUOD/JEJ TUBE REPLC PERC 14553203710 GASTRO TUBE CHANGE W IMAG 10653203720 JEJUNOSTMY TUBE REPL PERC 22363203730 REM TUBE OBSTR W FLUORO 7453203740 EVAL GI TBE PRC W FLU INJ 4973203750 VENOUS BLOOD SAMPL SPECIF 13793203760 IR FLUORO NDL LOCAL SPINE 23983203770 CHEMO ADMIN INTRATHECAL 8193203780 PLEURODESIS INSTIL AGENT 12853203790 INS TUN CTH PLEURAL W CUF 71863203800 URETER STNT REM&REP TRANS 48393203810 URETEROSTOMY TUBE CHANGE 37523203820 URETERAL STENT REM&REPL 61563203830 IOHEXOL 300MG/ML 100ML IN 152.773203840 CYSTO/VOID URETHR INJ 991

3203850 OCCLUSIVE DEVICE ART/VEIN 52063203860 IR PERITONEOGRAM 8343203870 PERITONEL CAV AIR/CON INJ 11903203890 SACRL AUGMENT INJ IMAG BI 92273203900 REM TUNNEL PLEURAL CATH 3713203910 LYSE CHEST FIBRIN SUB DAY 12843203920 MC CATH PLC AV SH DI INI 20673203930 MC CATH PLC AV SH DI ADD 803203950 LYSE CHEST FIBRIN INI DAY 12843203960 URETERAL STNT REM TRANSUR 29293203970 REM&REP NEPHROURE CTH EXT 29933203980 LUMBAR PUNCTURE THERA 9313203990 XR FLUORO 1-2 HOURS NC 0 13204000 XR FLUORO 2-3 HOURS NC 0 13204010 XR FLUORO 4-5 HOURS NC 0 13204020 XR FLUORO 3-4 HOURS NC 0 13204030 XR FLUORO 5-6 HOURS NC 0 13204050 IR ANGIO VISC WO OR W FLS 102673204070 XR FLUORO <1 HOUR NC 0 13204080 IR FLUORO 1-2 HOURS NC 0 13204090 IR FLUORO 2-3 HOURS NC 0 13204100 IR FLUORO 3-4 HOURS NC 0 13204110 IR FLUORO 4-5 HOURS NC 0 13204120 IR FLUORO <1 HOUR NC 0 13204390 BX BONE MARROW 13013204400 BONE MARRW ASP BX SME INC 13013204410 IOPAMID 300MG/ML 500MLINJ 151.83204420 IOPAMID 300MG/ML 150MLINJ 47.643204430 IOPAMID 300MG/ML 100MLINJ 32.73204440 IOPAMID 300MG/ML 50ML INJ 16.743204450 IOPAMID 300MG/ML 15MLINTH 46.53204460 IOPAMID 200MG/ML 20MLINTH 47.953204470 IOPAMID 370MG/ML 100MLINJ 37.393204480 IOPAMID 370MG/ML 500MLINJ 18.733204490 IOPAMID 250MG/ML 100MLINJ 35.023204500 IOPAMID 250MG/ML 50ML INJ 19.763204510 IOPAMID 300MG/ML 50ML INJ 16.743204520 IOPAMID 250MG/ML 50ML INJ 16.483204550 TRANSLUM ATHEREC ILIAC EA 220793204560 REVAS ILIAC TRNS ANG INI 394023204570 REVAS ILIAC STENT INI VES 486453204580 REVAS IPSIL ILI ANGIO ADD 179993204590 REVAS IPSIL ILI STENT ADD 204313204600 REVAS FEM POP TRANS ANGIO 283803204610 REVAS FEM POP ATHERECTOMY 383513204620 REVAS FEMORAL POPLT STENT 333653204630 REVAS FEM POP STENT ATHER 46405

3204640 REVAS TIBIAL PERN ANG INI 281163204650 REVAS TIB PERON ATHER INI 362703204660 REVAS TIB PERON STENT INI 359883204670 REVAS TIB PR STNT ATH INI 390813204680 REVAS TIB PERON ANGIO ADD 101223204690 REVAS TIB PERON ATHER ADD 165883204700 REVAS TIB PERON STENT ADD 143393204710 REVAS TIB PR STNT ATH ADD 196813204720 BILIARY ENDO DX PERC 74493204730 PERITN-VEN SHUNT EVAL INJ 6393204740 IR SHUNTOGRAM NONVASCULAR 5923204790 MSI ABDOMEN/PELVIS NC 0 13204800 MSI CHEST AP/OBLIQUE NC 0 13204810 MSI CRANIUM AP/LATERAL NC 0 13204820 MSI EXT LOW AP/LAT LT NC 0 13204830 MSI EXT LOW AP/LAT RT NC 0 13204840 MSI EXT UPPR AP/LAT LT NC 0 13204850 MSI EXT UPPR AP/LAT RT NC 0 13204860 MSI SPINE AP/PA/LATERL NC 0 13204870 MSI VAGINA AND INLET NC 0 13204880 INTERVRT DISC DX ASP PERC 13483204970 NACL 0.9% 250ML INJ 1003204980 NACL 0.9% 1000ML INJ 1003205040 INS IVC FILTER ENDOVAS 110743205050 CTH PLC RENAL SUPRSEL BIL 102113205070 CTH PLC RENAL ART SEL BIL 88033205090 REPOS IVC FILTER ENDOVAS 173863205100 RETR IVC FILTER ENDOVAS 169433205110 LYMPHOCELE ABLAT INGUINAL 11283205120 XR MYELOGRAM 2 OR>REGIONS 19313205130 LYMPHATIC IMMUNOTHRPY INJ 11283205140 SINUS TRACT INJ DIAG 7193205150 PERITL CTH DRN/DIALY PERM 70803205160 REM PERM PERITONEAL CATH 41963205180 CTH PLC RENAL ART SEL LT 66023205190 CTH PLC RENAL ART SEL RT 66023205200 CTH PLC RENAL SUPRSEL LT 89793205210 CTH PLC RENAL SUPRSEL RT 89793205220 IR ANGIO ADRENAL LT 78973205230 IR ANGIO ADRENAL RT 78973205300 IR ANGIO EXTREMITY LT 81513205310 IR ANGIO EXTREMITY LT XU 81513205320 IR ANGIO EXTREMITY RT 81513205330 IR ANGIO EXTREMITY RT XU 81513205340 IR ANGIO PULMONARY LT 66713205350 IR ANGIO PULMONARY RT 66713205420 IR UROGRAM ANTEGRADE LT 1410

3205430 IR UROGRAM ANTEGRADE RT 14103205440 IR VENOGRAM ADRENAL LT 62983205450 IR VENOGRAM ADRENAL RT 62983205470 IR VENOGRAM EXTREMITY LT 26543205490 IR VENOGRAM EXTREMITY RT 26543205500 IR VENOGRAM RENAL LT 81513205510 IR VENOGRAM RENAL RT 81513205520 MA MAMMARY DUCTO MULT LT 14463205530 MA MAMMARY DUCTO MULT RT 14463205540 MA MAMMARY DUCTO SNGL LT 9233205550 MA MAMMARY DUCTO SNGL RT 9233205660 SACRL AUGMENT INJ IMAG LT 63573205670 SACRL AUGMENT INJ IMAG RT 63573205820 XR ANKLE 2 VIEWS LT 7433205850 XR ANKLE 2 VIEWS RT 7433205880 XR ANKLE 3+ VIEWS LT 8753205910 XR ANKLE 3+ VIEWS RT 8753205940 XR ARTHROGRAM ANKLE LT 9073205960 XR ARTHROGRAM ANKLE RT 9073205980 XR ARTHROGRAM ELBOW LT 11563205990 XR ARTHROGRAM ELBOW RT 11563206000 XR ARTHROGRAM HIP LT 21843206010 XR ARTHROGRAM HIP RT 21843206020 XR ARTHROGRAM KNEE LT 9073206030 XR ARTHROGRAM KNEE RT 9073206040 XR ARTHROGRAM SHOULDER LT 23183206050 XR ARTHROGRAM SHOULDER RT 23183206060 XR ARTHROGRAM WRIST LT 18603206070 XR ARTHROGRAM WRIST RT 18603206080 XR CALCANEUS 2+ VIEWS LT 7093206110 XR CALCANEUS 2+ VIEWS RT 7093206140 XR CLAVICLE COMPLETE LT 7963206170 XR CLAVICLE COMPLETE RT 7963206200 XR ELBOW 2 VIEWS LT 7043206230 XR ELBOW 2 VIEWS RT 7043206260 XR ELBOW 3+ VIEWS LT 8383206290 XR ELBOW 3+ VIEWS RT 8383206320 XR EYE FOREIGN BODY LT 5153206340 XR EYE FOREIGN BODY RT 5153206440 XR FINGER(S) 2+ VIEWS LT 6743206470 XR FINGER(S) 2+ VIEWS RT 6743206500 XR FOOT 2 VIEWS LT 7713206530 XR FOOT 2 VIEWS RT 7713206560 XR FOOT 3+ VIEWS LT 8863206590 XR FOOT 3+ VIEWS RT 8863206620 XR FOREARM 2 VIEWS LT 7923206650 XR FOREARM 2 VIEWS RT 792

3206680 XR HAND 2 VIEWS LT 8363206710 XR HAND 2 VIEWS RT 8363206740 XR HAND 3+ VIEWS LT 9943206770 XR HAND 3+ VIEWS RT 9943206920 XR HUMERUS 2+ VIEWS LT 8863206950 XR HUMERUS 2+ VIEWS RT 8863206980 XR KNEE 1 OR 2 VIEWS LT 6433207010 XR KNEE 1 OR 2 VIEWS RT 6433207040 XR KNEE 3 VIEWS LT 7843207070 XR KNEE 3 VIEWS RT 7843207100 XR KNEE 4+ VIEWS LT 9063207130 XR KNEE 4+ VIEWS RT 9063207160 XR KNEE AP STANDING LT 7463207170 XR KNEE AP STANDING RT 7463207180 XR LOW EXTRM INFANT 2+ LT 6433207200 XR LOW EXTRM INFANT 2+ RT 6433207240 XR RIBS 2 VIEWS LT 10193207270 XR RIBS 2 VIEWS RT 10193207300 XR RIBS W CHEST 3+ VWS LT 12333207330 XR RIBS W CHEST 3+ VWS RT 12333207360 XR SCAPULA COMPLETE LT 8473207390 XR SCAPULA COMPLETE RT 8473207420 XR SHOULDER 1 VIEW LT 7563207450 XR SHOULDER 1 VIEW RT 7563207480 XR SHOULDER 2+ VIEWS LT 9943207510 XR SHOULDER 2+ VIEWS RT 9943207540 XR SIALOGRAM LT 7773207550 XR SIALOGRAM RT 7773207560 XR TIBIA & FIBULA 1VW LT 8363207570 XR TIBIA & FIBULA 1VW RT 8363207580 XR TIBIA & FIBULA 2 VW LT 8363207610 XR TIBIA & FIBULA 2 VW RT 8363207640 XR TOE(S) 2+ VIEWS LT 6743207670 XR TOE(S) 2+ VIEWS RT 6743207700 XR UPP EXTRM INFANT 2+ LT 1513207720 XR UPP EXTRM INFANT 2+ RT 1513207760 XR WRIST 2 VIEWS LT 7043207790 XR WRIST 2 VIEWS RT 7043207820 XR WRIST 3+ VIEWS LT 8453207850 XR WRIST 3+ VIEWS RT 8453207890 XR ORBITS 4+ VIEWS 2153207900 XR CHEST W OBLIQUES 16633207910 XR IMAGE COPY NC 0 13207920 XR MASTOIDS 3+ VIEWS/SIDE 1513207930 XR SKULL 4+ VIEWS 12523207940 XR RIBS W/CHEST 4+ VW BIL 16603207980 XR ABDOMEN AP/DECUB/ERECT 1255

3207990 XR UGI WO KUB 19283208000 XR UGI W AIR CON WO KUB 3733208040 XR UROGRM (IVP) LTD 28203208060 XR UROGRAM ANTEGRADE 14103208070 XR SINUS TRACT/FIST/ABSC 12783208120 XR HYSTEROSALPINGOGRAM 7773208130 XR THORACIC SPINE 3 VIEWS 13223208140 HYSTERO NS/CON INTRO 6523208150 URETHROCYSTOGRM RETRO INJ 2473208570 XR TELERADIOGRPHY/EXAM NC 0 13208590 XR KNEE AP STANDING BIL 7463208610 XR HAND 2 VIEWS BIL 8363208630 ARTHROGRAM HIP W ANES INJ 9823208640 LUMBAR PUNCTURE THERA 9313208760 BIOPSY LUNG/MEDIASTIN NDL 31043208810 EGD G TUBE PLACE PERC 23303208820 GASTRO TUBE CHANG WO IMAG 8343208860 BX PANCREAS NEEDLE PERC 31043208890 BX ABD/RETROPERITONL MASS 32063208950 XR CHEST 2 VWS W APIC LOR 13383208960 XR CHEST SPECIAL VIEWS 1403208970 XR UGI W AIR CON+SM BOWEL 3733208990 XR CHOLAN INTRAOP ADD SET 5053209030 XR FLUOR GUIDE CATH DRAIN 43333209040 XR UROGRM DRP/BOLUS W/TOM 34413209130 XR FLUORO GUIDE NDL PLCMT 19123209160 XR READ OUTSIDE IMAGES NC 0 13209200 XR TUBE/CATH CHANGE W CON 19173209220 XR UGI W AIR CON W KUB 3733209230 INS PICC WO PORT/PUMP>5YR 28113209240 REPOSITION CV CATH W FLUR 20423209280 XR FLUORO CVAD PL/RPL/REM 14823209540 XR IMAGE COPY NC 0 13209550 XR READ OUTSIDE IMAGES NC 0 13210250 GASTRO TUBE PERC PLACE 35493210270 ARTHROCEN ASP INTER JT WO 3723210290 PARACENTSIS ABD W IMAGING 22203210560 CTH PL CAR/INM ART SEL BI 198963210570 CTH PL CAR/INM SEL ICA BI 218643210580 CTH PL SUB/INM ART SEL BI 218643210590 CTH PLC CAR/INOM ART SEL 132643210600 CTH PLC CAR/INOM SEL ICA 145763210610 CTH PLC ECA SEL ADDON 52473210620 CTH PLC ICA SEL 164713210630 CTH PLC ICA SEL BILAT 247063210640 CTH PLC ICA/VER SEL ADDON 59383210650 CTH PLC SUBC/INOM ART SEL 14576

3210660 CTH PLC THOR AOR NSEL 97663210670 CTH PLC VERT SEL 163253210680 CTH PLC VERT SEL BILAT 244873210690 INS CATH PLEURAL W IMAG 14753210700 IOPAMID 370MG/ML 100MLINJ 373210760 THORACENTESIS W IMAGING 20193210770 THROMBOLYS ART INIT DAY 173763210780 THROMBOLYS FINAL DAY 59713210790 THROMBOLYS SUBSEQUENT DAY 107483210800 THROMBOLYS VEN INIT DAY 151663210810 TRANSCTH RET IVAS FB PERC 97643210840 PORT INDWELL 254X-331 10243210850 PORT INDWELL 195X-254 7863210860 PORT INDWELL 331X-431 13343210870 FILTER VENA CAV 730X-949 29383210880 FILTER VENA CAV 949X-1234 38203210890 FILTER VENA CAV1234X-1605 49683210900 STENT NCOV W 730X-949 29383210910 STENT NCOV W 949X-1234 38203210920 INTRO SHTH OTH 39X-51 1583210930 INTRO SHTH OTH 67X-88 2713210940 INTRO SHTH OTH 88X-115 3553210960 CATH PTA NLASR 115X-150 4643210970 CATH PTA NLASR 195X-254 7863210980 CATH PTA NLASR 254X-331 10243210990 CATH PTA NLASR 331X-431 13343211000 CATH GUIDING 561X-730 22593211010 CATH GUIDING 254X-331 10243211020 XR FB LOCAL NOSE TO RECTM 2033211040 XR EYE FOREIGN BODY BIL 7733211050 XR BONE LENGTH STUDIES 2153211070 XR JNT SURVEY 1 VW 2+ JTS 1513211080 HOCM 350-399MG/ML IODINE 533211090 XR MYELOGRAM 2 OR>REGIONS 19313211100 BX LIVER NEEDLE PERC 31043211120 XR CHOLECYSTOGRM ORAL CON 2513211200 CATH GUIDING 88X-115 3553211700 PORT INDWELL 150X-195 6043211740 STENT NCOV W 1234X-1605 49683211760 STENT NCOV W 561X-730 22593211840 MA MAMMO DIAG W CAD BIL 3033211850 MA MAMMO DIAG W CAD LT 1643211860 MA MAMMO SCREEN W CAD BIL 2483211960 XR BONE SURVEY LIMITED 12333212010 XR HUMERUS 1 VIEW LT 8863212020 XR HUMERUS 1 VIEW RT 8863212030 CATH PTA NLASR 88X-115 355

3212040 CATH PTA NLASR 150X-195 6043212050 CATH GUIDING 331X-431 13343212060 GASTRO IMP 30X-39 1213212070 VASC CLOSE DVC 150X-195 6043212110 MODERATE SEDAT ADD 15MIN 4883212120 MA MAMMO DIAG W CAD RT 1643212130 IR FLUOR GUIDE CATH DRAIN 43333212156 IOPAMID 300MG/ML 100MLINJ 403212164 IOPAMID 300MG/ML 200MLINJ 743212172 XR PORTABLE PER TRIP NC 0 13212198 IOPAMID 300MG/ML 200MLINJ 743212263 GUIDEWIRE 88X-115 3553212289 XR FLUORO 1-2 HOURS NC 0 13212313 INS CATH PLEURAL W IMAG 14753212339 PARACENTSIS ABD W IMAGING 22203212362 THORACENTESIS W IMAGING 20193212370 US V DPLX AO/IVC/GRFT CMP 17873212388 MR CHOLANGIO MRCP WO CON 16743212396 XR PHARYX &/OR CERV ESOPH 2943212453 INST/SUPP STERL 23X-30 933212461 INST/SUPP STERL 30X-39 1213212479 INST/SUPP STERL 39X-51 1583212487 INST/SUPP STERL 67X-88 2713212511 KIT/PACK DISP 431X-561 17363212529 KIT/PACK DISP 50X-67 2073212537 CATH DRAINAGE 67X-88 2713212554 CATH DIALYS LT 331X-431 13343212555 CATH DIALYSIS ST 67X-88 2713212556 CATH DRAINAGE 949X-1234 38203212557 CATH INFUSION 331X-431 13343212558 CATH THROM EMB 2087X-2714 84023212559 CATH THROM EMB 331X-431 13343212560 XR FLUORO 2-3 HOURS NC 0 13212561 CATH THROM EMB 431X-561 17363212562 CATH THROM EMB 730X-949 29383212563 CATH THROM EMB 949X-1234 38203212564 INST/SUPP STERL 88X-115 3553212565 STENT NONCOR W 115X-150 4643212566 STENT NONCOR W 88X-115 3553212579 PLC BRST LOC DEV MAMM 1ST 29783212581 PLC BRST LOC DEV MAMM ADD 29783212585 PLC BRST LOC DEV US 1ST 32053212587 PLC BRST LOC DEV US ADD 32053212588 PLC BRST LOC DEV MRI 1ST 30953212590 PLC BRST LOC DEV MRI ADD 30953212591 IMAGE CATH FLUID PERITO 52833212613 STNT PLC TRANSCTH ART INI 26324

3212614 STNT PLC TRANSCTH ART ADD 212913212615 STNT PLC TRANSC VEIN INI 263243212616 STNT PLC TRANSC VEIN ADD 212913212617 OCC/EMB NON HEMORR VENOUS 273193212618 OCC/EMB NON HEMORR ART 273193212619 OCC/EMB TUMOR/ORGAN INFAR 292423212620 OCC/EMB HEMORRHAG/LYMPH 273193212621 IMAGE CATH FLUID VISCERAL 52833212622 MR CHOLANGIO MRCP W CON 59803212623 MR CHOLANGIO MRCP WO CON 41243212624 MR CHOLANGI MRCP WO&WCON 68883212633 IMAGE CATH FLUID SOFT TIS 4193212634 CATH DIALYS LT 254X-331 10243212635 ANCHOR/SCREW 331X-431 13343212636 CATH PTA NLASR 431X-561 17363212637 CATH INFUSION 195X-254 7863212638 CATH INFUSION 254X-331 10243212639 CATH THROM EMB 150X-195 6043212640 VASC CLOSE DVC 195X-254 7863212641 GUIDEWIRE 51X-67 2073212642 GUIDEWIRE 115X-150 4643212643 GUIDEWIRE 254X-331 10243212644 GUIDEWIRE 431X-561 17363212645 STENT COV W 3529X-4588 142053212646 INTRO SHTH OTH 51X-67 2073212647 STENT NCOV W 2087X-2714 84023212648 STENT NCOV W 1605X-2087 64613212649 EMB PROTCT SYS 1605X-2087 64613212650 EMB PROTCT SYS 254X-331 10243212651 CATH OCCLUSION 331X-431 13343212652 CATH OTHER 150X-195 6043212653 CATH OTHER 13X-17 533212654 CATH OTHER 115X-150 4643212655 GASTRO IMP 23X-30 933212656 GASTRO IMP 195X-254 7863212657 GASTRO IMP 88X-115 3553212658 INST/SUPP STERL 17X-23 703212659 INST/SUPP STERL 331X-431 13343212660 INST/SUPP STERL 150X-195 6043212662 VASCULAR IMP 730X-949 29383212663 VASCULAR IMP 67X-88 2713212664 VASCULAR IMP 254X-331 10243212665 XR UGI W SMALL INTESTINE 30143212666 XR PORTABLE PER TRIP NC 0 13212667 MR ABDOMEN WO CON 41243212668 MR ANGIO HEAD WO CON 35033212669 MR BRAIN FUNCT WO PHY/PSY 3688

3212670 MC IR PTA PERIPHER ARTERY 25763212671 US UPPER BACK SOFT TISSUE 17733212672 US LO BACK SFT TIS WO CON 18723212676 KIT/PACK DISP 88X-115 3553212677 ANCHOR/SCREW 115X-150 4643212678 GASTRO IMP 51X-67 2073212679 INST/SUPP STERL 51X-67 2073212680 CATH OTHER 30X-39 1213212681 ANCHOR/SCREW 150X-195 6043212682 ANCHOR/SCREW 254X-331 10243212683 ANCHOR/SCREW 431X-561 17363212684 ANCHOR/SCREW 730X-949 29383212685 ANCHOR/SCREW 88X-115 3553212686 CATH DIALYSIS ST 115X-150 4643212687 CATH DIALYSIS ST 88X-115 3553212688 CATH DRAINAGE 17X-23 703212689 CATH GUIDING 115X-150 4643212690 CATH GUIDING 195X-254 7863212691 CATH GUIDING 431X-561 17363212692 CATH INFUSION 115X-150 4643212693 CATH OCCLUSION 150X-195 6043212694 CATH OTHER 10-13 403212695 CATH OTHER 254X-331 10243212696 CATH OTHER 67X-88 2713212697 CATH PTA LASER 2087X-2714 84023212698 CATH THROM EMB 1234X-1605 49683212699 CATH THROM EMB 1605X-2087 64613212700 EMB PROTCT SYS 1234X-1605 49683212701 EMB PROTCT SYS 2087X-2714 84023212702 GUIDEWIRE <10 183212703 GUIDEWIRE 10-13 403212704 GUIDEWIRE 13X-17 533212705 GUIDEWIRE 150X-195 6043212706 GUIDEWIRE 17X-23 703212707 GUIDEWIRE 195X-254 7863212708 GUIDEWIRE 23X-30 933212709 GUIDEWIRE 30X-39 1213212710 GUIDEWIRE 39X-51 1583212711 GUIDEWIRE 67X-88 2713212712 INST/SUPP STERL 10-13 403212713 INST/SUPP STERL 115X-150 4643212714 INST/SUPP STERL 13X-17 533212715 INST/SUPP STERL 195X-254 7863212717 INST/SUPP STERL 949X-1234 38203212718 INTRO SHTH OTH <10 183212719 INTRO SHTH OTH 115X-150 4643212720 INTRO SHTH OTH 17X-23 70

3212721 INTRO SHTH OTH 23X-30 933212722 INTRO SHTH OTH 254X-331 10243212723 INTRO SHTH OTH 30X-39 1213212724 INTRO SHTH OTH 331X-431 13343212725 INTRO SHTH OTH 561X-730 22593212726 KIT/PACK DISP 115X-150 4643212727 KIT/PACK DISP 150X-195 6043212728 KIT/PACK DISP 2087X-2714 84023212729 KIT/PACK DISP 2714X-3529 109253212731 KIT/PACK DISP 331X-431 13343212732 KIT/PACK DISP 3529X-4588 142053212733 NACL 0.9% 1000ML INJ 783212734 NACL 0.9% 250ML INJ 783212735 PORT INDWELL 431X-561 17363212736 RETRV FRAC DVC 254X-331 10243212737 RETRV FRAC DVC 561X-730 22593212738 STENT COV W 2714X-3529 109253212739 VASCULAR IMP 331X-431 13343212740 VASCULAR IMP 431X-561 17363212741 VASCULAR IMP 51X-67 2073212742 VASCULAR IMP 88X-115 3553212743 INS CATH PLEURAL WO IMAG 11803212744 LIVER TUM ABLAT CRYO PERC 10283212745 BX ADRENAL GLAND NDL PERC 99323212747 VERTEBROPL INJ C/T W IMAG 80523212748 VERTEBROPL INJ L/S W IMAG 80523212749 VERTEBROPL INJ ADD W IMAG 80523212750 VERTEB AUGM THORAC W IMAG 179623212751 VERTEB AUGM LUMBAR W IMAG 179623212752 VERTEB AUGM EA ADD W IMAG 95033212753 BONE TUM ABLAT CRYO IMAGE 98133212758 CATH THROM EMB 2714X-3529 109253212760 PULM TUM ABLAT CRYO IMAGE 134683212761 MYELOGRA CERVIC W INJ LUM 20203212762 MYELOGRA THORAC W INJ LUM 20203212763 MYELOGRA LUMBOS W INJ LUM 20203212764 MYELOGR>= 2 REG W INJ LUM 20203212765 MA BREAST TOMO DIG DX LT 1643212766 MA BREAST TOMO DIG DX RT 1643212767 MA BREAST TOMO DIG DX BIL 3033212768 MA BRST TOMO DIG SCRN BIL 2483212769 XR DXA VERTEBRA FX ASSESS 2263212770 MA BRST TOMO DIG SCRN BIL 3033212771 MYELOGRA CERVIC W INJ LUM 20203212772 MYELOGRA THORAC W INJ LUM 20203212773 MYELOGRA LUMBOS W INJ LUM 20203212774 MYELOGR>= 2 REG W INJ LUM 2020

3212775 CAROTID STNT TRANSC ANTEG 233133212778 XR TOMOGRAM SINGLE PLANE 3443212779 XR TOMOGRAM SINGLE PLANE 3443212782 INST/SUPP STERL 88X-115 3553212783 ARTHROGRAM SACROIL JT INJ 7623212784 SACROIL JT TX W/WO ARTHRO 7623212785 CHOLANG EX ACCES INJ IMAG 18923212786 CHOLANG EX ACCES INJ IMAG 18923212789 CHOLANG NW ACCES INJ IMAG 23743212792 CONV BILI DRN CTH INT-EXT 54343212793 EXCH BILI DRN CATH W IMAG 47843212794 REM BILI DRN CTH W FLUORO 47843212795 PLC STENT BILE DUCT EXIST 47843212796 PLC STENT BILE DUCT NEW 47843212797 PLC STNT BILE DUCT CTH NW 47843212800 PLC BILI DRN CTH EXT IMAG 90463212803 PLC BILI DRN CTH INT-EXT 104243212806 REM CALCULI BILI DUCT/GB 101643212810 PLC NEPHROSTOM CTH W IMAG 79343212812 EXCHNG NEPHROS CTH W IMAG 52173212814 XR SPINE ENTIRE 2-3 VIEWS 21093212816 XR HIP W PELVIS 1 VIEW RT 5033212818 XR HIP W PELVIS 1 VIEW LT 5033212828 XR FEMUR 1 VIEW LT 6963212830 XR FEMUR 1 VIEW RT 6963212832 INJ ANTEGR NEPH&/URETE NW 33033212833 INJ ANTEG NEPH&/URETER EX 33033212835 INJ ANTEGR NEPH&/URETE NW 22913212836 INJ ANTEG NEPH&/URETER EX 22913212840 PLC NEPHROUR CTH IMAG NEW 89573212841 CONV NEPHRS TO NEPHRU CTH 89573212842 ENDOLUM BX UETER/RNL PELV 89573212843 PLC URETER STNT PRE EXIST 89573212844 PLC URETER STNT NW ACCESS 89573212845 PLC URETER STNT NEW W CTH 89573212847 ENDO INTR PRLNG AD RX INI 146913212848 ENDO INTR PRLNG AD RX ADD 146913212856 XR SPINE ENTIRE 1 VIEW 10543212857 XR SPINE ENTIRE 4-5 VIEWS 26373212858 XR SPINE ENTIRE 6+ VIEWS 32943212869 XR HIP W PEL 2-3 VIEWS LT 7283212870 XR HIP W PEL 2-3 VIEWS RT 7283212871 XR HIP W PELV 4+ VIEWS LT 9093212872 XR HIP W PELV 4+ VIEWS RT 9093212873 XR HIP W PELV 2 VIEWS BIL 7723212874 XR HIP W PEL 3-4 VIEWS BI 9653212875 XR HIP W PEL 5+ VIEWS BIL 1205

3212899 XR FEMUR 2+ VIEWS LT 6963212900 XR FEMUR 2+ VIEWS RT 6963212913 PLC ACCESS BILI TREE SB 89573212914 PLC NEPHROU CTH IMA NW BI 134353212915 CON NPHRS TO NPHRU CTH BI 134353212916 EXCHNG NEPHRO CTH IMAG BI 78253212917 IVUS NON CORON W IMAG INI 34033212918 IVUS NON CORO W IM EA ADD 42543212919 PLC URETER STNT PRE EX BI 134353212920 PLC URETER STNT NW ACC BI 134353212921 PLC URET STNT NW W CTH BI 134353212922 INJ ANTE NEPH&/URET NW BI 49543212923 INJ ANTE NEPH&/URET EX BI 49543212925 XR ENDO ERCP LTD 18433212926 INS INTRAPERIT CATH PERM 71863212928 INTRCRN VASO DIL SAME ADD 24583212929 INTRCRN VASO DIL DIF ADD 24583212930 THROMBECT ART MECHAN PERC 24583212931 IOPAMID 200MG/ML 20MLINTH 483212932 INST/SUPP STERL5965X-7755 240103212933 CATH GUIDING 1234X-1605 49683212934 CATH THROM EMB 5965X-7755 240103212935 CATH GUIDING 1605X-2087 64613212936 VASCULAR IMP 2714X-3529 109253212937 GUIDEWIRE 561X-730 22593212938 CATH GUIDING 949X-1234 38203212939 INST/SUPP STERL2714X-3529 109253212940 VASCULAR IMP 2087X-2714 84023212941 CATH OCCLUSION 2087X-2714 84023212942 CATH OCCLUSION 1605X-2087 64613212943 VASCULAR IMP 13419X-14761 493153212944 CATH GUIDING 730X-949 29383212945 CATH OCCLUSION 1234X-1605 49683212946 CATH GUIDING 2087X-2714 84023212947 STENT NCOV W 5965X-7755 240103212948 INST/SUPP STER7755X-10082 312153212949 CATH PTA NLASR 949X-1234 38203212950 VASCULAR IMP 5965X-7755 240103212952 CATH INFUSION 88X-115 3553212954 MOD SEDAT <5YRS 1ST 15M 4653212955 MOD SEDAT =>5YRS 1ST 15M 5543212956 MA MAMMO SCREEN W CAD RT 2363212957 MA MAMMO SCREEN W CAD LT 2363212962 INTRO CATH DIALY CIRCUIT 26113212963 INTRO CTH DIALY CIRCU BLN 199013212964 INT CTH DIALY CIR IVAS ST 228893212965 THROMBECT DIALY CIRCUIT 19901

3212966 THROMB DIALY CIRCUIT BLN 228893212967 THROMB DIALY CIRC IVAS ST 228893212968 ANGIO BLN CENT DIALY SEG 228893212969 ANGIO BLN TRANS ART INI 199013212970 ANGIO BLN TRANS ART EAADD 199013212971 ANGIO BLN TRANSL VEIN INI 199013212972 ANGIO BLN TRAN VEIN EAADD 199013212973 STNT PLC TRANSC DIALY SEG 212913212974 EMBOLIZ DIALY CIRCU PERM 17093212975 INJ EPI/SUBAR L/S W IMAG 16773212976 DIL URETER STRICT W IMAG 48393212977 FACET JT NRV C/T DEST SGL 45963212978 FACET JT NRV C/T DEST BIL 57453212979 FACET JT NRV C-T ADD JNT 34473212980 FACET JT NRV L/S DEST SGL 45963212981 FACET JT NRV L-S ADD JNT 34473212982 DESTR NEUR PER NRV/BRANCH 49603212983 PTA INTRACRANIAL PERC 186553212984 INTRACRAN STNT TRANSCATH 239023212985 FACET JT/NRV L/S SNG INJ 20253212986 FACET JT/NRV L/S 2ND LVL 20253300010 VISIT LEVEL 1 NEW PT 2653300020 THERAPEUT RAD PORT IMAGES 3603300030 SPECIAL TX PROCEDURE 45243300060 SPECIAL TELETX PORT PLAN 25313300080 SPEC MED RAD PHYS CONSULT 12503300090 BASIC RAD DOSIM CALC PLAN 7183300100 TX DEVICE DESIGN SIMPLE 17263300110 SIMUL AIDED FIELD SIMPLE 34413300120 SIMUL AIDED FIELD COMPLEX 64523300150 TELETX ISODOSE PLAN SIMP 25043300160 TELETX ISODOSE PLAN CPLX 41183300170 SPECIAL RAD DOSIMETRY TLD 8733300180 TX DEVICE DESIGN COMPLEX 32583300190 CONTINUING PHYSICS CONSLT 8163300200 CT GUIDED THERAPY PLACEMT 22353300210 RADIOTHERAPY PLAN 3D 61453300220 VISIT LEVEL 1 EST PT 973300240 IMRT TREATMENT PLAN 144213300260 INJ TX/DX/PROPH SUBQ/IM 3823300280 VASC ACCES THROMBL DECLOT 4473300290 BLOOD COLLECTION VAD 3393300350 INF IV HYDRA INIT 31-60MN 21703300360 INF TX/DX/PRO SEQ 1HR 11123300370 INF TX/DX/PRO INIT 1ST HR 25773300380 INF TX/DX CONCURRENT 15473300390 INF IV HYDRAT EA ADD HR 570

3300400 INF TX/DX/PRO EA ADD HR 7053300410 INJ TX/DX/PRO IVPUSH INIT 3823300420 INJ TX/DX/PRO IV PUSH SEQ 3823300430 CHEMO SQ/IM NONHORMONAL 9503300440 CHEMO SQ/IM HORMONAL 4103300450 CHEMO IV PUSH INITIAL 11713300460 CHEMO IV PUSH EA ADD 6543300470 CHEMO INF INIT 1ST HR 20913300480 CHEMO INF EA ADD HR 4393300490 CHEMO INF EA SEQ 1ST HR 20913300510 VENIPUNCTURE NON LAB 223300520 VISIT LEVEL 2 EST PT 2603300530 VISIT LEVEL 3 EST PT 5093300560 IRRIG IMPLANTED VEN ACCES 3233300570 ADMIN INFLUENZA VACCINE 3643300580 ADMIN PNEUMO VACCINE 3643300660 VISIT LEVEL 1 NEW W PROC 2653300670 VISIT LEVEL 2 NEW PT 5093300680 VISIT LEVEL 2 NEW W PROC 5093300690 VISIT LEVEL 3 NEW PT 7693300700 VISIT LEVEL 3 NEW W PROC 7693300710 VISIT LEVEL 4 NEW PT 9213300720 VISIT LEVEL 4 NEW W PROC 9213300730 VISIT LEVEL 5 NEW PT 12323300740 VISIT LEVEL 5 NEW W PROC 12323300750 VISIT LEVEL 1 EST W PROC 973300760 VISIT LEVEL 2 EST W PROC 2603300770 VISIT LEVEL 3 EST W PROC 5093300780 VISIT LEVEL 4 EST PT 7893300790 VISIT LEVEL 4 EST W PROC 7893300800 VISIT LEVEL 5 EST PT 11103300810 VISIT LEVEL 5 EST W PROC 11103300870 PICC INSERT/REPLACE RN 15823300970 INJ TX/PRO/DX IVP SME DRG 3823300980 ADMIN OTHER IMMUN VAC ADD 1823300990 ADMIN OTHER IMMUN VAC ONE 3643301000 BLOOD COLLECTION PICC 3763301020 DESIGN MLC DEVIC FOR IMRT 31073301040 SIMUL AIDED FIELD INTER 54083301061 PUMP PORTABL REFILL/MAINT 5443301062 PUMP IMPLANTD REFIL/MAINT 5443301063 TRANSFUS BLOOD/COMP 1HR 10033301064 TRANSFUS BLOOD/COMP 2HR 12543301065 TRANSFUS BLOOD/COMP 3HR 15053301066 TRANSFUS BLOOD/COMP 4HR 17553301067 TRANSFUS BLOOD/COMP 5HR 20063301068 TRANSFUS BLOOD/COMP 6HR 2257

3301069 TRANSFUS BLOOD/COMP 7HR 25083301070 TRANSFUS BLOOD/COMP 8HR 27583301071 TRANSFUS BLOOD/COMP >8HR 30093301072 D5% 250ML INJ 783301073 D5% 500ML INJ 783301074 LACTATED RINGERS 1L INJ 783301075 LACTATED RINGERS 500MLINJ 783301076 NACL 0.45% 1000ML INJ 783301077 NACL 0.9% 1000ML INJ 783301078 NACL 0.9% 250ML INJ 783301079 NACL 0.9% 500ML INJ 783301080 IMRT SIMPLE 29513301081 IMRT COMPLEX 35423301082 RAD TX SIMPLE >1 MEV 13893301083 RAD TX COMPLEX >1 MEV 15893301084 GUIDANCE RAD TX DELIVERY 37183301085 ADMIN HEP B VACCINE 3643400010 NM RADIOPHARM THRPY ORAL 9003400011 PET BRAIN METABOLIC EVAL 32103400012 PET MYOCARD METABOL EVAL 32103400013 PET MYOCARD PERFUS MULTI 32103400014 PET MYOCARD PERFUS SINGLE 32103400020 NM COMPUTER <30 MIN NC 0 13400030 NM PARATHYROID PLANAR 21203400040 NM COMPUTER >30 MIN NC 0 13400050 F-18 FDG DX UP TO 45MCI 8313400080 NM INFLAM PROCESS LOC WB 45473400090 NM INFLAM PROCESS LOC LTD 25003400100 CARDIOVAS STR TEST WO RX 12913400110 NM BONE LTD 20373400120 NM URETERAL REFLUX (VCUG) 36553400130 NM BRAIN FLOW ONLY 17543400150 NM CSF FLOW CISTERNOGRAM 37523400170 NM BONE MARROW WHOLE BODY 22233400180 NM BONE WHOLE BODY 28303400190 NM CARD BLOOD POOL SNGL 27573400200 NM LIVER & SPLEEN 29793400210 NM PUL PERF PARTICULATE 21143400220 NM GASTROINTEST BL LOSS 21173400230 NM GASTRIC EMPTYING 32613400250 NM THYROID CA METS WB 11643400260 NM TUMOR LOCAL WB SNG DAY 41543400360 NM KIDNEY W FLW&FUN SNG W 26023400370 NM KIDNEY W FLOW & FUNC 35183400380 PET W CT LTD AREA 97693400390 PET SKULL MIDTHIGH 97693400400 PET LIMITED AREA 9769

3400410 PET WHOLE BODY 97693400420 SESTAMBI DX PER DOSE 6403400430 MEDRONATE DX UP TO 30MCI 3033400440 THALLIUM TL201 DX PER MCI 6883400480 MACROAG ALBUM DX TO 10MCI 2683400490 MEBROFENIN DX TO 15MCI 3463400500 PENTETATE DX AERO TO 75MC 3993400520 SULF COLL TC99<=20MCI FLT 1953400530 NM I-131 NA IODID SOL/MCI 5003400540 GALLIUM GA-67 DX PER MCI 2963400550 MERTIATIDE DX TO 15MCI 4213400560 LABELED RBC DX TO 30MCI 1433400590 NM MYOCAR PLNR WALL SNGL 49543400600 NM MYOCAR PLNR WALL MULT 59683400670 CARDIOVAS STR TEST W RX 12913400680 NM MYOCAR PERF 1 DAY NC 0 13400690 NM GASTROESOPHAG REFLUX 23223400700 DELAYED SCAN 1 UNIT NC 0 23400710 NM MYOCAR SPECT WALL SNGL 49543400720 NM MYOCAR SPECT WALL MULT 59683400730 NM PERTECHNETATE PER MCI 593400750 NM HEPATOBILIARY SYSTEM 10883400760 NM HEPATOBILIARY SYS W/RX 14913400770 NM PUL PERF VNT QUAN DIFF 12363400780 NM PUL PERFUSN QUANT DIFF 7923400850 DIPYRIDAMOLE 50MG/10MLINJ 1013400860 NM BONE 3 PHASE 39343400880 NM KIDNEY SCAN 26393400890 NM KID W FLO/FN MULT WO&W 55573400910 NM TESTES W FLOW 10123400920 NM TUMOR LOCALIZE MULTI 15273400940 NM BONE MULTIPLE 26033400950 NM TUMOR LOCALIZE LTD 9113400960 NM LYMPH SYSTEM 8523400970 SENTINL NDE RAD TR ID INJ 8763401000 EXAMETAZIME DX TO 25MCI 52203401010 NM BRAIN <4 VIEWS 8023401020 NM BRAIN <4 VWS W FLOW 13923401040 IN-111 PENTETR DX TO 6MCI 116053401050 NM TELERADIOGRPY/EXAM NC 0 13401060 NM CSF LEAK DETECTION 15183401070 NM CSF SHUNT EVALUATION 8023401080 NM PERIT-VEN SHUNT PATEN 7803401090 NM UREA TEST C-14 ACQ 323401100 NM UREA TEST C-14 ANALYS 2823401110 NM BONE MARROW LTD 8523401120 NM BONE MARROW MULTI AREA 852

3401130 NM SALIVARY GLAND 7803401140 SUCCIMER DX TO 10MCI 16853401150 I-131 NA IODID CAP DX/MCI 503401160 I-123 IOBENGUANE TO 15MCI 141753401170 NM ADRENAL CORTEX/MEDULLA 29033401180 NM RADIOPHARM INPT ADMIT 13401190 I-123 NA IO DX 100UCI/CAP 1253401200 DISOFENIN DX UP TO 15MCI 3153401210 OXIDRONATE DX TO 30MCI 653401220 NM CARDIOVAS STRES TEST 12913401230 NM PUL VENT PERFUSN IMAG 29813401240 NM PUL VENTILATION IMAG 16493401250 PERSANTINE IV 1963401260 NM SPLEEN W OR WO VAS FLW 8523401280 XENON XE-133 DX PER 10MCI 1823401290 NM LIVER W FLOW 15183401300 NM INTESTINE MECK/VOLVUL 7803401310 NM INFLAM PROCES LOC SPEC 46383401320 NM TUMOR LOCALIZE SPECT 19263401330 NM KIDNEY SPECT 30253401340 NM CSF FLOW SPECT 23993401350 NM BRAIN TOMO SPECT 23993401360 NM CARD BLD POOL SPECT 11633401370 NM BONE SPECT 25763401380 NM LIVER SPECT W VAS FLOW 11483401390 NM LIVER SPECT 11483401400 NM MYOCARD INFARCT SPECT 11633401420 NM PARATHYRO PLANAR SPECT 12033401430 NM THYROID IMAG W MEASURE 12223401440 NM THYROID IMAGING 5613401450 NM THYROID UPTAKE MEASURE 4263401460 NM TUMOR LOC WB MULTI DAY 35703401480 NM PORTABLE PER TRIP NC 0 13401510 PENTETATE DX UP TO 25MCI 853401520 NM RED CELL VOLUME SINGLE 13243401530 NM CARD BLOOD POOL MULTI 30113401531 IN-111 WBC DX PER DOSE 80003401532 IMT STDY FOR CHD RSK FCTR 1733401533 NM GASTRIC EMPTY SB TRANS 31063401534 NM GASTRIC EMPTY SB&COLON 31063500010 CT GUIDED NEEDLE PLACEMNT 45393500030 CT GUIDE CATH DRAIN 43333500050 CT CHEST WO CON 24873500060 CT CERVICAL SPINE W CON 104543500070 CT CERVICAL SPINE WO CON 53073500080 CT THORACIC SPINE WO CON 53073500090 CT CHEST W CON 4877

3500100 CT LUMBAR SPINE WO CON 53073500110 CT CHEST WO&W CON 55113500160 CT THORACIC SPINE W CON 104543500170 CT LUMBAR SPINE W CON 104543500190 CT PELVIS W CON 78843500200 CT MAXILLOFACIAL WO&W CON 58403500210 CT MAXILLOFACIAL WO CON 40283500220 CT MAXILLOFACIAL W CON 48743500250 CT SOFT TISSUE NECK W CON 41623500260 CT SOFT TISSUE NECK WO 34553500270 CT SOFT TISSUE NECK WO&W 49533500300 CT ANGIO PELVIS W CON 44383500310 CT ANGIO NECK W CON 51783500330 CT ANGIO HEAD W CON 38383500340 CT ANGIO CHEST W CON 48433500350 CT ANGIO AORTA W RUNOFF 48433500360 CT ANGIO ABDOMEN W CON 48433500400 BX ABD/RETROPERITONL MASS 32063500410 BX BONE TROCAR/NDL DEEP 33543500420 BX BONE SUPERFIC TROC/NDL 15243500480 BIOPSY LUNG/MEDIASTIN NDL 31043500490 BX MUSCLE NEEDLE PERC 17553500500 BX PANCREAS NEEDLE PERC 31043500510 BIOPSY PLEURA PERC NEEDLE 21553500520 ASP FINE NDL W IMAGING 12173500540 CT GUIDE TISSUE ABLATION 12743500610 MODERATE SEDAT ADD 15MIN 4883500620 CT 3D W SEPARATE WKSTATN 7253500630 CT 3D WO SEPARATE WKSTATN 2503500640 CT PELVIS WO&W CON 88853500650 CT ORBIT/SEL/FOS/EAR WO 13323500660 CT HRT STRC/MORP/3D W CON 16113500670 CT ANGIO HRT/COR ART 3D W 16113500710 CT HRT STRC/MORP CONGENTL 16113500730 PULM TUMOR ABLAT RADIO 107653500740 CT HRT EVAL COR CA WO CON 3903500750 BX LIVER NEEDLE PERC 31043500760 BX/EXC LYMPH NODE SUPERFI 19533500770 BX RENAL NDL/TROCAR PERC 26323500780 ASP ABSC/HEMA/CYST/BULLA 4043500790 THORACOSTOMY TUBE 13233500800 I&D ABSCESS SIMPLE 5993500810 CT HEAD W CON 50013500820 CT HEAD WO CON 36513500830 CT HEAD WO&W CON 59873500850 CT ABDOMEN W CON 47243500860 CT ABDOMEN WO CON 4302

3500870 CT ABDOMEN WO&W CON 43023500880 CT PELVIS WO CON 40033500900 LIVER TUMOR ABLAT RF PERC 107653500910 BLADDER ASP W INS SUPRAP 37653500920 IOPAMID 300MG/ML 100MLINJ 32.73500930 IOPAMID 300MG/ML 50ML INJ 16.743500940 IOPAMID 370MG/ML 100MLINJ 37.393500950 IOPAMID 250MG/ML 50ML INJ 19.763500960 BONE TUMOR ABLAT RADIO W 98133500970 CT ABDOMEN PELVIS WO CON 83313500980 CT ABDOMEN PELVIS W CON 89863500990 CT ABDOMEN PELVIS WWO CON 99963501010 RENAL TISSUE ABLAT PERC 22563501020 CCTA POST PROCESSING NC 0 13501030 CT ANGIO LOW EXTREM W LT 50423501050 CT ANGIO LOW EXTREM W RT 50423501070 CT ANGIO UPP EXTREM W LT 38793501090 CT ANGIO UPP EXTREM W RT 38793501110 CT LOW EXTREMITY W LT 51613501130 CT LOW EXTREMITY W RT 51613501150 CT LOW EXTREMITY WO LT 41623501170 CT LOW EXTREMITY WO RT 41623501190 CT LOW EXTREMITY WO&W LT 64513501210 CT LOW EXTREMITY WO&W RT 64513501230 CT UPP EXTREM W CON LT 48263501250 CT UPP EXTREM W CON RT 48263501270 CT UPP EXTREM WO CON LT 39553501290 CT UPP EXTREM WO CON RT 39553501310 CT UPP EXTREM WO&W LT 61723501330 CT UPP EXTREM WO&W RT 61723501350 CT ORBIT/SEL/FOS/EAR WO&W 17193501390 CT IMAGE COPY NC 0 13501400 CT BONE MIN DENSITY AXIAL 2253501420 BX NECK/THORAX SOFT TISS 29733501440 BX SALIVARY GLAND NDL 17633501450 BX THYROID NDL CORE PERC 10283501460 CT GUIDED THERAPY PLACEMT 22353501480 CT TELERADIOGRPY/EXAM NC 0 13501490 CT ANGIO UPP EXTREM W BIL 58163501500 CT ANGIO LOW EXTREM W BIL 50423501510 IOPAMID 200MG/ML 20MLINTH 483501540 CT L SPINE WO NC 0 23501550 CT T SPINE WO NC 0 23502890 INS CATH PLEURAL W IMAG 14753502900 IOPAMID 370MG/ML 500MLINJ 2983502950 IR MYELOGRAM LUMBAR 37943502960 GADOLINIUM-BAS MR CON/ML 85

3502970 CT ORBIT/SEL/FOS/EAR W 15593502980 CT CERVICAL SPINE WO&W 117803502990 CT THORACIC SPINE WO&W 117803503000 XR BONE DENSITY(DXA)AXAL 2253503020 KIT/PACK DISP 115X-150 4643503030 CT ANGIO ABD/PELVIS W CON 68283503059 CT BONE LENGTH STUDIES 2153503067 IOPAMID 300MG/ML 200MLINJ 743503083 IOPAMID 350MG/ML 100MLINJ 333503091 IODIXANOL 370MG/ML 100ML 373503125 INST/SUPP STERL 23X-30 933503133 INST/SUPP STERL 30X-39 1213503141 INST/SUPP STERL 39X-51 1583503158 INST/SUPP STERL 67X-88 2713503174 KIT/PACK DISP 431X-561 17363503182 KIT/PACK DISP 50X-67 2073503183 IMAGE CATH FLUID VISCERAL 72633503184 IMAGE CATH FLUID PERITO 72633503185 IMAGE CATH FLUID SOFT TIS 4193503186 CT LUNG SCREEN LOW DOSE 2773503187 BONE TUM ABLAT CRYO IMAGE 98133503188 PULM TUM ABLAT CRYO IMAGE 134683503189 CT VIRTUAL COLON DIAG WO 3313503190 CT LOW EXTREMITY W BIL 77423503191 CT LOW EXTREMITY WO BIL 62433503192 CT LOW EXTREMITY WO&W BIL 96773503196 CT ABDOMEN PELV W CON CT 89863503197 CT ABDOMEN PELV WO CON CT 83313503198 CT ABDOMEN PEL WWO CON CT 99963503199 CT ABDOMEN W CON CT 47243503200 CT ABDOMEN WO CON CT 43023503201 CT ABDOMEN WO&W CON CT 43023503202 CT ANGIO ABD/PEL W CON CT 68283503203 CT ANGIO ABDOMEN W CON CT 48433503204 CT ANGIO CHEST W CON CT 48433503205 CT ANGIO HEAD W CON CT 38383503206 CT ANG HRT/COR AR 3D W CT 16113503207 CT ANG LOW EXTREM W BI CT 50423503208 CT ANG LOW EXTREM W LT CT 50423503209 CT ANG LOW EXTREM W RT CT 50423503210 CT ANGIO NECK W CON CT 51783503211 CT ANGIO PELVIS W CON CT 44383503212 CT ANGIO UP EXTR W BIL CT 58163503213 CT ANG UPP EXTREM W LT CT 38793503214 CT ANG UP EXTREM W RT CT 38793503215 CT CERVIC SPINE W CON CT 104543503216 CT CERVIC SPINE WO CON CT 5307

3503217 CT CERVICAL SPINE WO&W CT 117803503218 CT CHEST W CON CT 48773503219 CT CHEST WO CON CT 24873503220 CT CHEST WO&W CON CT 55113503221 CT HEAD W CON CT 50013503222 CT HEAD WO CON CT 36513503223 CT HEAD WO&W CON CT 59873503224 CT HRT EVAL COR CA WO CT 3903503225 CT HRT STR/MORP CONGEN CT 16113503226 CT HRT STRC/MORP/3D W CT 16113503227 CT LOW EXTREMITY W BIL CT 77423503228 CT LOW EXTREMITY W LT CT 51613503229 CT LOW EXTREMITY W RT CT 51613503230 CT LOW EXTREM WO BIL CT 62433503231 CT LOW EXTREMITY WO LT CT 41623503232 CT LOW EXTREMITY WO RT CT 41623503233 CT LOW EXTREM WO&W BIL CT 96773503234 CT LOW EXTREM WO&W LT CT 64513503235 CT LOW EXTREM WO&W RT CT 64513503236 CT LUMBAR SPINE W CON CT 104543503237 CT LUMBAR SPINE WO CON CT 53073503238 CT MAXILLOFACIAL W CON CT 48743503239 CT MAXILLOFACIA WO CON CT 40283503240 CT MAXILLOFAC WO&W CON CT 58403503241 CT ORBIT/SEL/FOS/EAR W CT 15593503242 CT ORBIT/SEL/FO/EAR WO CT 13323503243 CT ORBIT/SEL/FO/E WO&W CT 17193503244 CT PELVIS W CON CT 78843503245 CT PELVIS WO CON CT 40033503246 CT PELVIS WO&W CON CT 88853503247 CT SOFT TIS NECK W CON CT 41623503248 CT SOFT TISSUE NECK WO CT 34553503249 CT SOFT TISS NECK WO&W CT 49533503250 CT THORAC SPINE W CON CT 104543503251 CT THORAC SPINE WO CON CT 53073503252 CT THORACIC SPINE WO&W CT 117803503253 CT UPP EXTREM W CON LT CT 48263503254 CT UPP EXTREM W CON RT CT 48263503255 CT UP EXTREM WO CON LT CT 39553503256 CT UPP EXTR WO CON RT CT 39553503257 CT UPP EXTREM WO&W LT CT 61723503258 CT UPP EXTREM WO&W RT CT 61723503259 CT VIRTU COLON DIAG WO CT 3313503260 CT MYELOGRAM LUMBAR CT 37943503321 BIOPSY SKIN SINGLE LESION 5573503322 CT UPP EXTREM WO CON BIL 56513503324 CT UPP EXTR WO CON BIL CT 5651

3503326 CT CEREBRL PERFUSION WCON 36553503327 MOD SEDAT <5YRS 1ST 15M 4603503328 MOD SEDAT =>5YRS 1ST 15M 5543503329 RENAL TUMOR(S ABLAT RADIO 107653503330 SACROIL JT TX W/WO ARTHRO 7623503331 CT THERAPY TX PLANNING 2143503333 INJ EPI/SUBAR L/S W IMAG 16773600300 LACTATED RINGERS 1L INJ 43600319 PROG PT REPLC 1234X-1605 49683600327 NEURSTM RECH 16237X-17861 596723600335 NEURSTM RECH 17861X-19647 656393600343 INST/SUPP NONST2714X-3529 109253600350 NEURSTM RECH 21611X-23772 794203600368 LEAD NEUROSTIM 4588X-5965 184683600376 LEAD NEUROSTIM 3529X-4588 142053600384 NEUROSTIM PROG 1234X-1605 49683600392 LEAD NEUROSTIM 5965X-7755 240103600400 MICROMATR 500MG1234X-1605 49683600418 CATH INTRASPINE 949X-1234 38203600426 CATH INTRASPINE 561X-730 22593600434 INF PUMP PRG 11090X-12199 407563602167 CATH PTA NLASR 88X-115 2073602168 CATH DIALYS LT 254X-331 10243602169 KIT/PACK DISP 2714X-3529 109253602820 APLIGRF/SQCM 2464.283603030 ALLODERM 8X16 3529X-4588 142053604520 ALLODERM 6X16 811.133605440 SURGERY LEVEL 1 1ST 30MIN 39753605450 SURGERY LEVEL 1 ADD 15MIN 13853605460 SURGERY LEVEL 2 1ST 30MIN 48183605470 SURGERY LEVEL 2 ADD 15MIN 16793605480 SURGERY LEVEL 3 1ST 30MIN 58393605490 SURGERY LEVEL 3 ADD 15MIN 20343605500 SURGERY LEVEL 4 1ST 30MIN 71513605510 SURGERY LEVEL 4 ADD 15MIN 24833605520 SURGERY LEVEL 5 1ST 30MIN 85783605530 SURGERY LEVEL 5 ADD 15MIN 29893605540 SURGERY LEVEL 6 1ST 30MIN 103963605550 SURGERY LEVEL 6 ADD 15MIN 36223605560 ANESTH GENERAL 1ST 30MIN 11013605570 ANESTH GENERAL ADDL 15MIN 3863605580 ANESTH MAC/REG 1ST 30MIN 8473605590 ANESTH MAC/REG ADDL 15MIN 3863605600 LOCAL ANESTHESIA 4043605620 SURGERY PER MINUTE NC 0 13615920 NEEDLE EMG 3 EXTREMITIES 8223615930 NEEDLE EMG 4 EXTREMITIES 935

3615940 NEEDLE EMG 1 EXTREMITY 4713615950 NEEDLE EMG 2 EXTREMITIES 6633615960 SOMATOSEN TSTNG UPP EXT 10993615970 SOMATOSEN TSTNG LOW EXT 8183615980 AD EVOKED POTENTIALS COMP 4983615990 SOMATOSEN TSTNG HEAD/TRUN 6503616290 C MOTOR EVOKED UPP EXTREM 8583616300 C MOTOR EVOKED LOW EXTREM 8583618050 PACU STANDARD 1ST 30MIN 7913618060 PACU STANDARD ADDL 15MIN 2773618070 PACU COMPLEX 1ST 30MIN 10283618080 PACU COMPLEX ADDL 15MIN 3593618170 ANLY NEUROSTM SMPL REPROG 2953618180 TRANSFUS BLD/BLD COMP 8613618190 GLUCOSE BLD BY DEVICE POC 173618220 ANCHOR/SCREW <10 183618230 ANCHOR/SCREW 115X-150 4643618240 ANCHOR/SCREW 1234X-1605 49683618250 ANCHOR/SCREW 13X-17 533618260 ANCHOR/SCREW 150X-195 6043618270 ANCHOR/SCREW 1605X-2087 64613618280 ANCHOR/SCREW 17X-23 703618290 ANCHOR/SCREW 195X-254 7863618300 ANCHOR/SCREW 2087X-2714 84023618310 ANCHOR/SCREW 23X-30 933618320 ANCHOR/SCREW 254X-331 10243618330 ANCHOR/SCREW 2714X-3529 109253618340 ANCHOR/SCREW 30X-39 1213618350 ANCHOR/SCREW 331X-431 13343618360 ANCHOR/SCREW 3529X-4588 142053618370 ANCHOR/SCREW 39X-51 1583618380 ANCHOR/SCREW 431X-561 17363618390 ANCHOR/SCREW 4588X-5965 184683618400 ANCHOR/SCREW 51X-67 2073618410 ANCHOR/SCREW 561X-730 22593618420 ANCHOR/SCREW 67X-88 2713618430 ANCHOR/SCREW 730X-949 29383618440 ANCHOR/SCREW 88X-115 3553618450 ANCHOR/SCREW 949X-1234 38203618460 BONE SUBSTITUTE 115X-150 4643618470 BONE SUBSTITUTE 150X-195 6043618480 BONE SUBSTITUTE 195X-254 7863618490 BONE SUBSTITUTE 431X-561 17363618500 BONE SUBSTITUTE 51X-67 2073618510 BONE SUBSTITUTE 561X-730 22593618520 BONE SUBSTITUTE 730X-949 29383618530 BONE SUBSTITUTE 88X-115 355

3618540 BONE SUBSTITUTE1234X-1605 49683618550 BONE SUBSTITUTE2714X-3529 109253618560 BREAST PROS SIL 730X-949 29383618570 BREAST PROSTH 431X-561 17363618580 BREAST PROSTH 561X-730 22593618590 CATH ABL NCARD 949X-1234 38203618600 CATH ATHR DIR 2714X-3529 109253618610 CATH ATHR ROT 1234X-1605 49683618620 CATH ATHR ROT 949X-1234 38203618630 CATH DIALYS LT 331X-431 13343618640 CATH DIALYS LT 67X-88 2713618650 CATH DIALYS LT 88X-115 3553618660 CATH DIALYSIS ST 115X-150 4643618670 CATH DIALYSIS ST 150X-195 6043618680 CATH DIALYSIS ST 195X-254 7863618690 CATH DIALYSIS ST 51X-67 2073618700 CATH DIALYSIS ST 67X-88 2713618710 CATH DRAINAGE 115X-150 4643618720 CATH DRAINAGE 13X-17 533618730 CATH DRAINAGE 150X-195 6043618740 CATH DRAINAGE 195X-254 7863618750 CATH DRAINAGE 331X-431 13343618760 CATH DRAINAGE 431X-561 17363618770 CATH DRAINAGE 51X-67 2073618780 CATH DRAINAGE 67X-88 2713618790 CATH DRAINAGE 88X-115 3553618800 CATH GUIDING <10 183618810 CATH GUIDING 150X-195 6043618820 CATH GUIDING 195X-254 7863618830 CATH GUIDING 2087X-2714 84023618840 CATH GUIDING 254X-331 10243618850 CATH GUIDING 39X-51 1583618860 CATH GUIDING 431X-561 17363618870 CATH GUIDING 51X-67 2073618880 CATH GUIDING 561X-730 22593618890 CATH GUIDING 67X-88 2713618900 CATH GUIDING 88X-115 3553618930 CATH INFUSION 115X-150 4643618940 CATH INFUSION 150X-195 6043618950 CATH INFUSION 23X-30 933618960 CATH INFUSION 331X-431 13343618970 CATH INFUSION 39X-51 1583618980 CATH INFUSION 51X-67 2073618990 CATH INFUSION 67X-88 2713619000 CATH INTVAS US 561X-730 22593619010 CATH NONVAS DIL 115X-150 4643619020 CATH NONVAS DIL 195X-254 786

3619030 CATH NONVAS DIL 254X-331 10243619040 CATH NONVAS DIL 561X-730 22593619050 CATH NONVAS DIL 730X-949 29383619060 CATH OTHER 10-13 403619070 CATH OTHER 115X-150 4643619080 CATH OTHER 13X-17 533619090 CATH OTHER 150X-195 6043619100 CATH OTHER 17X-23 703619110 CATH OTHER 30X-39 1213619120 CATH OTHER 561X-730 22593619130 CATH PTA NLASR 431X-561 17363619140 CATH SUPRAPUBIC 150X-195 6043619150 CATH SUPRAPUBIC 30X-39 1213619160 CATH SUPRAPUBIC 51X-67 2073619170 CATH THROM EMB 150X-195 6043619180 CATH THROM EMB 254X-331 10243619190 CATH THROM EMB 39X-51 1583619200 CATH THROM EMB 67X-88 2713619210 CLOSURE EXTERN 10-13 403619220 CLOSURE EXTERN 13X-17 533619230 CLOSURE EXTERN 150X-195 6043619240 CLOSURE EXTERN 17X-23 703619250 CLOSURE EXTERN 23X-30 933619260 CLOSURE EXTERN 30X-39 1213619270 CLOSURE EXTERN 39X-51 1583619280 CLOSURE IMPLNT 115X-150 4643619290 CLOSURE IMPLNT 150X-195 6043619300 CLOSURE IMPLNT 17X-23 703619320 CLOSURE IMPLNT 254X-331 10243619330 CLOSURE IMPLNT 331X-431 13343619340 CLOSURE IMPLNT 39X-51 1583619350 CLOSURE IMPLNT 431X-561 17363619360 CLOSURE IMPLNT 51X-67 2073619370 CLOSURE IMPLNT 561X-730 22593619380 CLOSURE IMPLNT 67X-88 2713619390 CLOSURE IMPLNT 730X-949 29383619400 CLOSURE IMPLNT 88X-115 3553619410 CONN TISS HUM 150X-195 6043619420 CONN TISS HUM 254X-331 10243619430 CONN TISS HUM 331X-431 13343619440 CONN TISS HUM 431X-561 17363619450 CONN TISS HUM 561X-730 22593619460 CONN TISS HUM 730X-949 29383619470 CONN TISS HUM 88X-115 3553619480 CONN TISS HUM 949X-1234 38203619490 CONN TISS NHUM 1234X-1605 49683619500 CONN TISS NHUM 150X-195 604

3619510 CONN TISS NHUM 1605X-2087 64613619520 CONN TISS NHUM 2087X-2714 84023619530 CONN TISS NHUM 254X-331 10243619540 CONN TISS NHUM 331X-431 13343619550 CONN TISS NHUM 3529X-4588 142053619551 ADPT/EXT LEAD 730X-949 29383619560 CONN TISS NHUM 431X-561 17363619570 CONN TISS NHUM 4588X-5965 184683619580 CONN TISS NHUM 561X-730 22593619590 CONN TISS NHUM 730X-949 29383619600 CONN TISS NHUM 949X-1234 38203619610 EXPANDER TISS 1234X-1605 49683619620 EXTERN FIXATION 561X-730 22593619630 EYE IMPLANT 67X-88 2713619650 GASTRO IMP 150X-195 6043619660 GASTRO IMP 195X-254 7863619670 GASTRO IMP 23X-30 933619680 GASTRO IMP 30X-39 1213619690 GRAFT VASC 115X-150 4643619700 GRAFT VASC 1605X-2087 64613619710 GRAFT VASC 2087X-2714 84023619720 GRAFT VASC 2714X-3529 109253619730 GRAFT VASC 331X-431 13343619740 GRAFT VASC 431X-561 17363619750 GRAFT VASC 561X-730 22593619760 GRAFT VASC 730X-949 29383619770 GRAFT VASC 949X-1234 38203619780 GUIDEWIRE <10 183619790 GUIDEWIRE 10-13 403619800 GUIDEWIRE 115X-150 4643619810 GUIDEWIRE 150X-195 6043619820 GUIDEWIRE 17X-23 703619830 GUIDEWIRE 195X-254 7863619840 GUIDEWIRE 23X-30 933619850 GUIDEWIRE 30X-39 1213619860 GUIDEWIRE 39X-51 1583619870 GUIDEWIRE 51X-67 2073619880 GUIDEWIRE 67X-88 2713619890 GUIDEWIRE 88X-115 3553619900 ICD DUAL 14761X-16237 542473619910 ICD NOT S/D 19647X-21611 722023619920 ICD NOT S/D 21611X-23772 794203619930 INST/SUPP NONST 23X-30 933619940 INST/SUPP NONST 30X-39 1213619950 INST/SUPP NONST 39X-51 1583619960 INST/SUPP STERL 10-13 403619970 INST/SUPP STERL 115X-150 464

3619980 INST/SUPP STERL 13X-17 533619990 INST/SUPP STERL 150X-195 6043620000 INST/SUPP STERL 17X-23 703620010 INST/SUPP STERL 195X-254 7863620020 INST/SUPP STERL 23X-30 933620030 INST/SUPP STERL 254X-331 10243620040 INST/SUPP STERL 30X-39 1213620050 INST/SUPP STERL 331X-431 13343620060 INST/SUPP STERL 39X-51 1583620070 INST/SUPP STERL 431X-561 17363620080 INST/SUPP STERL 51X-67 2073620090 INST/SUPP STERL 561X-730 22593620100 INST/SUPP STERL 67X-88 2713620110 INST/SUPP STERL 730X-949 29383620120 INST/SUPP STERL 88X-115 3553620130 INST/SUPP STERL 949X-1234 38203620140 INST/SUPP STERL1234X-1605 49683620150 INST/SUPP STERL1605X-2087 64613620160 INST/SUPP STERL2087X-2714 84023620170 INTRO EP LASR 2087X-2714 84023620180 INTRO SHTH OTH 39X-51 1583620190 INTRO SHTH OTH 67X-88 2713620200 JOINT DEVICE 115X-150 4643620210 JOINT DEVICE 1234X-1605 49683620220 JOINT DEVICE 150X-195 6043620230 JOINT DEVICE 1605X-2087 64613620240 JOINT DEVICE 2087X-2714 84023620250 JOINT DEVICE 23X-30 933620260 JOINT DEVICE 254X-331 10243620270 JOINT DEVICE 2714X-3529 109253620290 JOINT DEVICE 331X-431 13343620300 JOINT DEVICE 3529X-4588 142053620310 JOINT DEVICE 431X-561 17363620320 JOINT DEVICE 4588X-5965 184683620330 JOINT DEVICE 561X-730 22593620340 JOINT DEVICE 5965X-7755 240103620350 JOINT DEVICE 67X-88 2713620360 JOINT DEVICE 730X-949 29383620370 JOINT DEVICE 88X-115 3553620380 JOINT DEVICE 949X-1234 38203620390 KIT/PACK DISP 115X-150 4643620400 KIT/PACK DISP 1234X-1605 49683620420 KIT/PACK DISP 150X-195 6043620430 KIT/PACK DISP 195X-254 7863620460 KIT/PACK DISP 431X-561 17363620470 KIT/PACK DISP 50X-67 2073620480 KIT/PACK DISP 67X-88 271

3620490 KIT/PACK DISP 730X-949 29383620500 KIT/PACK DISP 88X-115 3553620510 LEAD ICD DUAL 3529X-4588 142053620520 LEAD LT VENTRC 1605X-2087 64613620530 LEAD LT VENTRC 3529X-4588 84023620540 MESH IMP 115X-150 4643620550 MESH IMP 1234X-1605 49683620560 MESH IMP 150X-195 6043620570 MESH IMP 254X-331 10243620580 MESH IMP 331X-431 13343620590 MESH IMP 431X-561 17363620600 MESH IMP 561X-730 22593620610 MESH IMP 67X-88 2713620620 MESH IMP 730X-949 29383620630 MESH IMP 88X-115 3553620640 MESH IMP 949X-1234 38203620650 MORCELLATOR 730X-949 29383620660 NON JOINT IMP <10 183620670 NON JOINT IMP 10-13 403620680 NON JOINT IMP 115X-150 4643620690 NON JOINT IMP 1234X-1605 49683620700 NON JOINT IMP 13X-17 533620710 NON JOINT IMP 150X-195 6043620720 NON JOINT IMP 1605X-2087 64613620730 NON JOINT IMP 195X-254 7863620740 NON JOINT IMP 23X-30 933620750 NON JOINT IMP 254X-331 10243620760 NON JOINT IMP 2714X-3529 109253620770 NON JOINT IMP 331X-431 13343620780 NON JOINT IMP 3529X-4588 142053620790 NON JOINT IMP 39X-51 1583620800 NON JOINT IMP 431X-561 17363620810 NON JOINT IMP 561X-730 22593620820 NON JOINT IMP 5965X-7755 240103620830 NON JOINT IMP 67X-88 2713620840 NON JOINT IMP 730X-949 29383620850 NON JOINT IMP 7755X-10082 312153620860 NON JOINT IMP 88X-115 3553620870 NON JOINT IMP 949X-1234 38203620880 ORTHO L0190 431X-561 17363620890 ORTHO L0200 431X-561 17363620900 ORTHO L0472 331X-431 13343620910 ORTHO L0625 <10 183620920 ORTHO L0627 254X-331 10243620930 ORTHO L0628 67X-88 2713620940 ORTHO L0637 949X-1234 38203620960 ORTHO L0810 2087X-2714 8402

3620970 ORTHO L1686 730X-949 29383620980 ORTHO L1820 88X-115 3553620990 ORTHO L1832 431X-561 17363621000 ORTHO L1930 195X-254 7863621010 ORTHO L2624 331X-431 13343621020 ORTHO L2830 195X-254 7863621030 ORTHO L2830 88X-115 3553621040 ORTHO L2999 39X-51 1583621050 ORTHO L3980 254X-331 10243621060 PACEMKR DUAL RR3529X-4588 142053621070 PACEMKR DUAL RR4588X-5965 184683621080 PACEMKR OTHR 5965X-7755 240103621090 PACEMKR SNG RR 2714X-3529 109253621100 PACEMKR SNG RR 3529X-4588 142053621110 PORT INDWELL 254X-331 10243621120 PORT INDWELL 331X-431 13343621130 PORT INDWELL 431X-561 17363621140 RETRV FRAC DVC 431X-561 17363621160 SHUNT IMPLANT 1234X-1605 49683621170 SHUNT IMPLANT 3529X-4588 142053621180 SHUNT IMPLANT 561X-730 22593621190 STENT NONCOR W 88X-115 3553621200 UR SPHINCT 1605X-2087 64613621210 URO DVC W SLING 730X-949 29383621220 URO DVC W SLING 949X-1234 38203621230 URO DVC W SLING1234X-1605 49683621240 URO DVC W SLING4588X-5965 184683621250 URO REP DVC WO 949X-1234 38203621260 INTRAOP MON IN OR EA15MIN 6173621290 ADHESION BARR 254X-331 10243621300 ANCHOR/SCREW 10-13 403621310 BONE SUBSTITUTE 67X-88 2713621320 BREAST PROS SIL 949X-1234 38203621330 CATH INFUSION 195X-254 7863621340 CATH INFUSION 254X-331 10243621350 CATH INFUSION 30X-39 1213621360 CATH INFUSION 88X-115 3553621370 CATH NONVAS DIL 39X-51 1583621380 CATH OCCLUSION 115X-150 4643621390 CATH OCCLUSION 67X-88 2713621400 CATH OTHER 23X-30 933621410 CATH OTHER 39X-51 1583621420 CATH PTA NLASR 115X-150 4643621430 CATH PTA NLASR 254X-331 10243621440 CATH THROM EMB 51X-67 2073621450 CATH URETERAL <10 183621460 CATH URETERAL 10-13 40

3621470 CATH URETERAL 67X-88 2713621480 CLOSURE EXTERN 115X-150 4643621490 CLOSURE EXTERN 51X-67 2073621500 CLOSURE IMPLNT 195X-254 7863621520 CONN TISS HUM 1234X-1605 49683621530 CONN TISS HUM 1605X-2087 64613621540 CONN TISS HUM 3529X-4588 142053621550 CONN TISS NHUM 195X-254 7863621560 CONN TISS NHUM 67X-88 2713621580 EMB PROTCT SYS 331X-431 13343621590 ENT IMPLANT <10 183621600 ENT IMPLANT 10-13 403621610 EYE IMPLANT 10-13 403621620 EYE IMPLANT 13X-17 533621630 EYE IMPLANT 17X-23 703621640 EYE IMPLANT 39X-51 1583621650 GASTRO IMP 13X-17 533621660 GASTRO IMP 17X-23 703621670 GASTRO IMP 51X-67 2073621690 INST/SUPP NONST 115X-150 4643621700 INST/SUPP NONST 13X-17 533621710 INST/SUPP NONST 17X-23 703621720 INST/SUPP NONST 51X-67 2073621730 INST/SUPP NONST 67X-88 2713621740 INST/SUPP NONST 88X-115 3553621770 INTRO SHTH OTH 23X-30 933621780 INTRO SHTH OTH 30X-39 1213621790 INTRO SHTH OTH 51X-67 2073621800 IOL ANTERIOR 115X-150 4643621810 IOL ASTIGMATISM 431X-561 17363621820 IOL POSTERIOR 115X-150 4643621830 IOL POSTERIOR 150X-195 6043621840 IOL PRESBYOPIA 730X-949 29383621850 JOINT DEVICE 195X-254 7863621860 JOINT DEVICE 30X-39 1213621870 JOINT DEVICE 51X-67 2073621900 KIT/PACK DISP 331X-431 13343621910 MESH IMP 11090X-12199 407563621920 MESH IMP 14761X-16237 542473621930 MESH IMP 1605X-2087 64613621940 MESH IMP 195X-254 7863621950 MESH IMP 23X-30 933621960 MESH IMP 30X-39 1213621970 MESH IMP 3529X-4588 142053621980 MESH IMP 39X-51 1583621990 MESH IMP 5965X-7755 240103622000 NON JOINT IMP 2087X-2714 8402

3622010 NON JOINT IMP 30X-39 1213622020 NON JOINT IMP 51X-67 2073622030 ORTHO L0120 <10 183622050 ORTHO L1830 13X-17 533622060 ORTHO L1830 17X-23 703622070 ORTHO L3650 <10 183622080 ORTHO L3908 <10 183622090 PORT INDWELL 150X-195 6043622100 PORT INDWELL 195X-254 7863622110 RET TAMPON SIL 331X-431 13343622120 SHUNT IMPLANT 115X-150 4643622130 SHUNT IMPLANT 331X-431 13343622140 SHUNT IMPLANT 51X-67 2073622150 SHUNT IMPLANT 67X-88 2713622160 SHUNT IMPLANT 88X-115 3553622170 STENT NCOV WO 13X-17 533622180 STENT NONCOR WO 115X-150 4643622190 STENT NONCOR WO 195X-254 7863622200 STENT NONCOR WO 67X-88 2713622220 URO DVC W SLING1605X-2087 64613622230 BONE SUBSTITUTE 254X-331 10243622240 BREAST PROSTH 730X-949 29383622250 CATH ABL NCARD 1234X-1605 49683622260 CATH DRAINAGE 254X-331 10243622270 CATH DRAINAGE 561X-730 22593622280 CATH GUIDING 331X-431 13343622290 CATH INFUSION 13X-17 533622300 CATH OTHER 195X-254 7863622310 CATH OTHER 331X-431 13343622320 CATH OTHER 431X-561 17363622330 CATH OTHER 51X-67 2073622340 CATH OTHER 67X-88 2713622350 CATH OTHER 949X-1234 38203622360 CATH PTA NLASR 195X-254 7863622370 CATH SUPRAPUBIC 13X-17 533622380 CATH THROM EMB 195X-254 7863622400 CLOSURE IMPLNT 1234X-1605 49683622410 CLOSURE IMPLNT 13X-17 533622420 CLOSURE IMPLNT 23X-30 933622430 CLOSURE IMPLNT 30X-39 1213622440 CONN TISS HUM 2087X-2714 84023622450 CONN TISS HUM 2714X-3529 109253622460 CONN TISS HUM 4588X-5965 184683622480 ENT IMPLANT 150X-195 6043622490 ENT IMPLANT 17X-23 703622500 EXPANDER TISS 431X-561 17363622510 EXPANDER TISS 561X-730 2259

3622520 FILTER VENA CAV 730X-949 29383622530 FILTER VENA CAV 949X-1234 38203622540 GASTRO IMP 67X-88 2713622550 GRAFT VASC 150X-195 6043622560 GRAFT VASC 254X-331 10243622570 GUIDEWIRE 13X-17 533622580 GUIDEWIRE 254X-331 10243622590 GUIDEWIRE 331X-431 13343622600 GUIDEWIRE 431X-561 17363622610 GUIDEWIRE 561X-730 22593622620 ICD DUAL 26149X-28764 960983622630 INST/SUPP NONST 10-13 403622640 INTRO SHTH OTH 17X-23 703622650 INTRO SHTH OTH 254X-331 10243622660 INTRO SHTH OTH 949X-1234 38203622670 IOL ANTERIOR 88X-115 3553622680 KIT/PACK DISP 1605X-2087 64613622690 KIT/PACK DISP 2087X-2714 84023622700 KIT/PACK DISP 254X-331 10243622720 KIT/PACK DISP 561X-730 22593622730 NON JOINT IMP 4588X-5965 184683622740 ORTHO L0172 67X-88 2713622750 ORTHO L1830 10-13 403622760 RETRV FRAC DVC 561X-730 22593622770 RETRV FRAC DVC 730X-949 29383622780 RING/BND HEART 1605X-2087 64613622790 RING/BND HEART 2087X-2714 84023622800 SHUNT IMPLANT 1605X-2087 64613622810 STENT NCOV W 1605X-2087 64613622820 STENT NONCOR WO 150X-195 6043622830 STENT NONCOR WO 51X-67 2073622840 STENT NONCOR WO 88X-115 3553622850 STRATT 20X25 12199X-13419 448323622860 STRATT 6X8 949X-1234 38203622870 STRATT 6X10 1234X-1605 49683622880 URO DVC W SLING 431X-561 17363622890 URO DVC W SLING 561X-730 22593622900 URO REP DVC WO 730X-949 29383622910 VALVE HEART 3529X-4588 142053622920 VALVE HEART 4588X-5965 184683622930 VALVE HEART 5965X-7755 240103622940 CATH INFUSION 10-13 403622950 SEALANT PUL LIQ 730X-949 29383622960 D5% 250ML INJ 33622970 D5% 500ML INJ 23622980 D5% 0.45 NACL 1000ML INJ 783622990 LACTATED RINGERS 500MLINJ 3

3623000 D5% LR 500ML INJ 783623010 NACL 0.9% 250ML INJ 33623020 NACL 0.9% 500ML INJ 23623030 NACL 0.9% 1000ML INJ 33623040 D5% W ELECTROL 148 1000ML 783623050 CATH THROM EMB 331X-431 13343623060 NACL 0.9% 100ML INJ 33623070 D5% 100ML INJ 33623080 NACL 0.9% 50ML PB 33623090 D5% 50ML INJ 33623110 ORTHO L2116 67X-88 2713623120 NACL 0.45% 1000ML INJ 783623130 D5% 1000ML INJ 783623140 D5% LR 1000ML INJ 783623150 GLYCINE 1.5% 3000ML IRR 783623230 MODERATE SEDAT ADD 15MIN 4883623240 CLOSURE EXTERN 88X-115 3553623250 JOINT DEVICE 7755X-10082 312153623260 PERMACOL 10X10 1605X-2087 64613623270 PERMACOL 5X10 730X-949 29383623280 IOPAMIDOL 300MG/ML 100ML 3703623290 IOPAMIDOL 370MG/ML100ML 3703623300 INTRO SHTH OTH <10 183623310 CATH DIALYSIS ST 88X-115 3553623330 GRAFT VASC 1234X-1605 49683623345 LEAD NEUROSTIM 1605X-2087 64613623352 STENT NCOV W 1234X-1605 49683623360 EXTERN FIXATION1234X-1605 49683623370 EXTERN FIXATION 115X-150 4643623380 EXTERN FIXATION 195X-254 7863623390 CATH DIALYS LT 431X-561 17363623402 MRK RADIATION THRPY30X-39 1213623410 ORTHO L0170 51X-67 2073623428 ORTHO L0486 561X-730 22593623436 ORTHO L0637 254X-331 10243623444 BN MATRX PTY 0.5CC 49683623451 INTRO EP STEER 88X-115 3553623469 VASCULAR IMP 150X-195 6043623470 EXTERN FIXATION 150X-195 6043623480 SURG ENDO LVL 2 1ST 30MIN 20243623490 SURG ENDO LVL 2 ADD 15MIN 6093623500 KIT/PACK DISP 3529X-4588 142053623510 NEURSTM RECH 26149X-28764 960983623520 NEUROSTIM PROG 1605X-2087 64613623535 ORTHO L3670 51X-67 2073623543 NEURSTM RECH 19647X-21611 722023623550 NEUROSTIM PROG 949X-1234 3820

3623568 BONE SUBSTITUTE2087X-2714 84023623576 BONE SUBSTITUTE 331X-431 13343623584 BONE SUBSTITUTE1605X-2087 64613623592 BONE SUBSTITUTE 949X-1234 38203623600 IOL POSTERIOR 1605X-2087 64613623618 EYE IMPLANT 1605X-2087 64613623634 PENILE INFLAT 1605X-2087 64613623642 PENILE INFLAT 2087X-2714 84023623659 PENILE INFLAT 2714X-3529 109253623667 PENILE INFLAT 3529X-4588 142053623675 PENILE INFLAT 7755X-10082 312153623683 JOINT DEVICE 39X-51 1583623691 CONN TISS HUM 115X-150 4643623709 JOINT DEVICE 11090X-12199 407563623717 STENT COV W 2714X-3529 109253623725 STENT COV W 431X-561 17363623733 STENT COV W 561X-730 22593623741 STENT COV W 730X-949 29383623758 STENT COV W 949X-1234 38203623766 STENT COV W 1234X-1605 49683623774 STENT COV W 1605X-2087 64613623782 STENT COV W 2087X-2714 84023623808 CATH URETERAL 23X-30 933623816 CATH URETERAL 30X-39 1213623824 CATH URETERAL 39X-51 1583623832 CATH URETERAL 51X-67 2073623840 CATH URETERAL 13X-17 533623857 CATH URETERAL 17X-23 703623865 INST/SUPP STERL 2714X-352 109253623873 INST/SUPP STERL3529X-4588 109253623881 SOMATOSEN TST UP/LW EXTRM 21233623899 CONN TISS NHUM 2714X-3529 109253623907 URO DVC W SLING3529X-4588 142053623915 URO DVC W SLING2087X-2714 84023623923 URO DVC W SLING2714X-3529 109253623931 URO DVC W SLING5965X-7755 240103623980 ANALY NEUROSTIM CMPLX PRO 3693623998 NEURSTM NREC 7755X-10082 312153624004 NEURSTM NREC 1234X-1605 49683624012 NEURSTM NREC 1605X-2087 64613624020 NEURSTM NREC 949X-1234 38203624038 STENT COV W 3529X-4588 142053624046 VASC IMP 67X-88 2713624053 STENT COV W 4588X-5965 184683624061 JOINT DEVICE 10082X-11090 370513624062 STENT COV W 5965X-7755 240103624066 STENT COV W 7755X-10082 31215

3624067 PENILE INFLAT 5965X7755 240103624068 CLOSURE IMPLNT 1605X-2087 64613624069 CLOSURE IMPLNT 2087X-2714 84023624070 CLOSURE IMPLNT 2714X-3529 109253624071 CLOSURE IMPLNT 3529X-4588 142053624072 NEURSTM NREC 10082X-11090 370513624073 NEURSTM NREC 11090X-12199 407563624074 NEURSTM NREC 12199X-14761 448323624075 NEURSTM NREC 14761X-16237 542473624076 GASTRO IMP 88X-115 3553624077 GASTRO IMP 115X-150 4643624078 GASTRO IMP 39X-51 1583624080 VASC CLOSE DVC 150X-195 6043624081 VASC CLOSE DVC 195X-254 7863624082 VASC CLOSE DVC 88X-115 3553624083 VASC CLOSE DVC 115X-150 4643624084 INTRO SHTH OTH 88X-115 3553624085 INTRO SHTH OTH 115X-150 4643624086 INTRO SHTH OTH 150X-195 6043624087 INTRO SHTH OTH 195X-254 7863624088 CATH DRAINAGE 730X-949 29383624089 CATH DRAINAGE 949X-1234 38203624090 CATH DRAINAGE 1234X-1605 49683624091 STENT NCOV W 949X-1234 38203624092 STENT NCOV W 730X-949 29383624093 STENT NCOV W 561X-730 22593624094 STENT NCOV W 431X-561 17363624095 STENT NCOV W 331X-431 13343624100 ALLODERM 6X16 2714X-3529 109253624101 UR SPHINCT 2087X-2714 84023624102 UR SPHINCT 2714X-3529 109253624103 UR SPHINCT 3529X-4588 142053624104 UR SPHINCT 4588X-5965 184683624105 UR SPHINCT 5965X-7755 240103624106 ADPT/EXT LEAD 949X-1234 38203624107 ORTHO L3650 67X-88 2713624108 ORTHO L1832 115X-150 4643624109 CATH DIALYS LT 1605X-2087 64613624110 INTRO SHTH OTH 431X-561 17363624111 EXTERN FIXATION 254X-331 10243624112 EXTERN FIXATION 331X-431 13343624113 EXTERN FIXATION 431X-561 17363624114 EXTERN FIXATION 730X-949 29383624115 EXTERN FIXATION 949X-1234 38203624116 MESH IMP 4588X-5965 184683624117 MESH IMP 7755X-10082 312153624118 MESH IMP 10082X-11090 37051

3624119 MESH IMP 12199X-14761 448323624120 KIT/PACK DISP 949X-1234 38203624121 CATH OTHER 88X-115 3553624122 CATH OTHER 254X-331 10243624123 NEURST CHG RPL 949X-1234 38203624124 NEURSTM RECH 13419X-14761 493153624125 ADPT/EXT LEAD 431X-561 17363624126 APLIGRF 44SQCM 1234X-1605 49683624127 EEG DURING SURGERY 13013624128 GASTRO IMP 254X-331 10243624129 GRFTJKT 25SQCM 2087X-2714 84023624130 EYE IMPLANT 730X-949 29383624131 NEUROSTIM PROG 730X-949 29383624132 ENT IMPLANT 254X-331 10243624133 ICD NOT S/D 16237X-17861 596723624134 BONE SUBSTITUTE4588X-5965 184683624135 LEAD NEUROSTIM 2714X-3529 109253624136 C MOTOR EVOKED UP/LW EXTR 11533624137 INTROP MON REMOTE/>1PT/HR 8823624138 NEUROMSC JNCT TST EA NRVE 4183624140 IMPLANT NO COST NC 0 23624141 EYE IMPLANT 2087X-2714 84023624143 NON JOINT IMP13419X-14761 493153624144 NON JOINT IMP16237X-17861 596723624147 ADPT/EXT LEAD 1605X-2087 64613624148 EXTERN FIXATION1605X-2087 64613624149 GRAFT VASC 39X-51 1583624150 BONE SUBSTITUTE3529X-4588 142053624151 CHOLINESTRASE CHALLNG TST 3973624152 CATH OTHER 730X-949 29383624153 PROB/NDL CRYO 1234X-1605 49683624154 PROB/NDL CRYO 2087X-2714 84023624155 LEAD PMKR NO VDD 431X-561 17363624156 ADPT/EXT LEAD 561X-730 22593624157 ADPT/EXT LEAD 115X-150 4643624158 ADPT/EXT LEAD 195X-254 7863624159 CATH GUIDING 730X-949 29383624160 ICD DUAL 5965X-7755 240103624161 ICD DUAL 7755X-10082 312153624162 ICD DUAL 11090X-12199 407563624163 ICD DUAL 12199X-13419 448323624164 ICD DUAL 13419X-14761 493153624165 ICD DUAL 16237X-17861 596723624166 ICD DUAL 17861X-19647 656393624167 ICD NOT S/D 7755X-10082 312153624168 ICD NOT S/D 10082X-11090 370513624169 ICD NOT S/D 11090X-12199 40756

3624170 ICD NOT S/D 12199X-13419 448323624171 ICD NOT S/D 13419X-14761 493153624172 ICD NOT S/D 14761X-16237 542473624173 ICD NOT S/D 17861X-19647 656393624174 ICD NOT S/D 23772X-26149 873623624175 ICD SINGLE 5965X-7755 240103624176 ICD SINGLE 7755X-10082 312153624177 ICD SINGLE 10082X-11090 370513624178 ICD SINGLE 11090X-12199 407563624179 ICD SINGLE 13419X-14761 448323624180 ICD SINGLE 14761X-16237 493153624181 ICD SINGLE 16237X-17861 542473624182 ICD SINGLE 17861X-19647 656393624183 ICD SINGLE 21611X-23772 794203624184 LEAD ICD DUAL 2087X-2714 84023624185 LEAD ICD DUAL 2714X-3529 109253624186 LEAD ICD OTHER 3529X-4588 142053624187 LEAD ICD SNGL 2087X-2714 84023624188 LEAD ICD SNGL 2714X-3529 109253624189 LEAD ICD SNGL 3529X-4588 142053624190 LEAD LT VENTRC 730X-949 29383624191 LEAD LT VENTRC 1234X-1605 49683624192 LEAD PMKR NO VDD254X-331 10243624193 LEAD PMKR NO VDD 331X-431 13343624194 LEAD PMKR NO VDD 561X-730 22593624195 LEAD PMKR TRN VDD431X-561 17363624196 PACEMKR DUAL RR1605X-2087 64613624197 PACEMKR DUAL RR2087X-2714 84023624198 PACEMKR DUAL RR2714X-3529 109253624199 PACEMKR OTHR 3529X-4588 142053624200 PACEMKR OTHR 4588X-5965 184683624201 PACEMKR OTHR 7755X-10082 312153624202 PACEMKR SNG RR 1234X-1605 49683624203 PACEMKR SNG RR 1605X-2087 64613624204 PACEMKR SNG RR 2087X-2714 84023624205 GRAFIX P 1.5X2CM 730X-949 29383624206 GRAFIX P 2X3CM 949X-1234 38203624207 GRAFIX P 3X4CM1234X-1605 49683624208 GRAFIX P 14MM 431X-561 17363624209 GRAFIX C 14MM 431X-561 17363624210 GRAFIX C 1.5X2CM 730X-949 29383624211 GRAFIX C 2X3CM 949X-1234 38203624212 GRAFIX C 3X4CM 1234X-1605 49683624213 SHUNT IMPLANT 23X-30 933624214 CATH INFUSION 17X-23 703624216 MESH IMP 2087X-2714 84023624217 MESH IMP 16237X-17861 59672

3624218 CATH NONVAS DIL1234X-1605 49683624219 IOL PRESBYOPIA 150X-195 6043624220 CATH DRAINAGE <10 183624221 ORTHO L3260 <10 183624222 ORTHO L2820 88X-115 3553624223 CONN TISS HUM 51X-67 2073624224 ORTHO L4360 23X-30 933624225 INTRO SHTH OTH 13X-17 533624226 ORTHO L2036 1605X-2087 64613624227 ORTHO L0464 949X-1234 38203624228 ORTHO L1932 730X-949 29383624229 STENT NONCOR W 561X-730 22593624230 HMATRIX 5X4CM 561X-730 22593624231 ORTHO L3982 331X-431 13343624232 CATH PTA NLASR 331X-431 13343624233 IOL ANTERIOR 254X-331 10243624234 ORTHO L0200 254X-331 10243624235 GRAFT VASC 88X-115 3553624236 NON JOINT IMP 17X-23 703624237 VASCULAR IMP 254X-331 10243624238 EXPANDER TISS 88X-115 3553624239 CLOSURE EXTERN 67X-88 2713624240 VASCULAR IMP 12199X-13419 448323624241 NEURSTM RECH 14761X-16237 542473624242 INST/SUPP STERL4588X-5965 184683624244 VNT ASST DVC 42112X-46323 1547623624245 SURGERY LEVEL 5 1ST 30MIN 85783624246 SURGERY LEVEL 5 ADD 15MIN 29893624247 ANESTH GENERAL 1ST 30MIN 29363624248 ANESTH GENERAL ADDL 15MIN 10283624249 SURGERY LEVEL 5 1ST 30MIN 119233624250 SURGERY LEVEL 5 ADD 15MIN 41723624251 INTRO SHTH OTH 10-13 403624252 EXTERN FIXATION 51X-67 2513624253 EXTERN FIXATION 39X-51 1583624254 CATH INTVAS US 949X-1234 38203624255 CLOSURE EXTERN 195X-254 7863624256 NERVE CONDUCT 1-2 STUDIES 1503624257 ADPT/EXT LEAD 331X-431 13343624258 MOD SEDAT <5YRS 1ST 15M 4653624259 MOD SEDAT =>5YRS 1ST 15M 5543624260 EXTERN FIXATION 67X-88 2713624261 MOD SED ENDO=>5YR 1ST 15M 4653624262 ENT IMPLANT 115X-150 4643624264 VASCULAR IMP 195X-254 7863624265 VASCULAR IMP 30X-39 1213624266 CATH NONVAS DIL2714X-3529 10925

3624267 CATH NONVAS DIL3529X-4588 142053624268 ORTHO L1832 67X-88 2713624269 NEURSTM RECH 1234X-1605 49683624270 ALLODERM 2X4 331X-431 13343624271 CATH NONVAS DIL 150X-195 6043624272 CATH PTA NLASR 730X-949 29383624273 CARDIOVERSION ELCTIVE EXT 12033624274 ECHO TEE WO CON 11253624275 LEAD ICD OTHER 2087X-2714 84023624276 STENT COV W 10082X-11090 370513624278 GRAFT VASC 4588X-5965 184683624279 CLOSURE EXTERN 730X-949 29383701280 ANESTH GENERAL 1ST 30MIN 29363701290 ANESTH GENERAL ADDL 15MIN 10283701300 ANESTH MAC/REG 1ST 30MIN 10283701310 ANESTH MAC/REG ADDL 15MIN 8473701320 LOCAL ANESTHESIA 10283701330 SURGERY LEVEL 1 1ST 30MIN 40123701340 SURGERY LEVEL 1 ADD 15MIN 14063701350 SURGERY LEVEL 2 1ST 30MIN 54263701360 SURGERY LEVEL 2 ADD 15MIN 18983701370 SURGERY LEVEL 3 1ST 30MIN 70543701380 SURGERY LEVEL 3 ADD 15MIN 24693701390 SURGERY LEVEL 4 1ST 30MIN 91703701400 SURGERY LEVEL 4 ADD 15MIN 32113701410 SURGERY LEVEL 5 1ST 30MIN 119233701420 SURGERY LEVEL 5 ADD 15MIN 41723701430 SURGERY PER MINUTE NC 0 13701640 CATH INFUSION 39X-51 1583701650 CATH INFUSION 88X-115 3553701660 CATH OTHER 30X-39 1213701670 CATH OTHER 561X-730 22593701680 CATH OTHER 67X-88 2713701690 CATH THROM EMB 39X-51 1583701700 CLOSURE EXTERN 10-13 403701710 CLOSURE EXTERN 13X-17 533701720 CLOSURE EXTERN 17X-23 703701740 CLOSURE EXTERN 30X-39 1213701750 CLOSURE EXTERN 39X-51 1583701770 CLOSURE EXTERN 88X-115 3553701780 CLOSURE IMPLNT 150X-195 6043701790 CLOSURE IMPLNT 195X-254 7863701800 CLOSURE IMPLNT 331X-431 13343701810 CLOSURE IMPLNT 431X-561 17363701830 CLOSURE IMPLNT 51X-67 2073701840 CLOSURE IMPLNT 730X-949 29383701850 CLOSURE IMPLNT 88X-115 355

3701860 GRAFT VASC 150X-195 6043701870 GRAFT VASC 431X-561 17363701880 GUIDEWIRE 10-13 403701890 GUIDEWIRE 1605X-2087 64613701900 ICD DUAL 14761X-16237 542473701910 ICD NOT S/D 19647X-21611 722023701920 ICD NOT S/D 21611X-23772 794203701930 INST/SUPP NONST 30X-39 1213701940 INST/SUPP STERL 10-13 403701980 INST/SUPP STERL 115X-150 4643702000 INST/SUPP STERL 13X-17 533702020 INST/SUPP STERL 17X-23 703702040 INST/SUPP STERL 195X-254 7863702060 INST/SUPP STERL 23X-30 933702110 INST/SUPP STERL 30X-39 1213702150 INST/SUPP STERL 39X-51 1583702160 INST/SUPP STERL 561X-730 22593702170 INST/SUPP STERL 67X-88 2713702180 INST/SUPP STERL2087X-2714 84023702190 INTRO SHTH OTH 67X-88 2713702210 KIT/PACK DISP 115X-150 4643702220 KIT/PACK DISP 561X-730 22593702230 KIT/PACK DISP 67X-88 2713702250 LEAD ICD DUAL 3529X-4588 142053702260 LEAD LT VENTRC 1605X-2087 64613702270 LEAD LT VENTRC 2087X-2714 84023702280 LEAD PMKR NO VDD 431X-561 17363702290 MESH IMP 39X-51 1583702300 PACEMKR DUAL RR3529X-4588 142053702320 PACEMKR DUAL RR4588X-5965 184683702340 PACEMKR OTHR 5965X-7755 240103702370 PACEMKR SNG RR 2714X-3529 109253702390 PACEMKR SNG RR 3529X-4588 142053702400 RING/BND HEART 1605X-2087 64613702410 RING/BND HEART 2087X-2714 84023702420 RING/BND HEART 2714X-3529 109253702430 SHUNT IMPLANT 115X-150 4643702440 SHUNT IMPLANT 88X-115 3553702450 VALVE HEART 3529X-4588 142053702460 VALVE HEART 4588X-5965 184683702500 VALVE HEART 5965X-7755 240103702530 CLOSURE EXTERN 23X-30 933702540 CLOSURE EXTERN 51X-67 2073702550 GUIDEWIRE 23X-30 933702570 INST/SUPP NONST 67X-88 2713702580 INST/SUPP STERL 150X-195 6043702590 INST/SUPP STERL 254X-331 1024

3702620 CATH OTHER 13X-17 533702630 CATH OTHER 17X-23 703702660 INST/SUPP NONST 39X-51 1583702670 INST/SUPP NONST 51X-67 2073702680 NACL 0.9% 250ML INJ 33702690 NACL 0.9% 500ML INJ 23702700 NACL 0.9% 1000ML INJ 33702710 D5% W ELECTROL 148 1000ML 783702720 NACL 0.9% 50ML PB 783702730 NACL 0.9% 100ML INJ 783702740 D5% 250ML INJ 783702750 D5% 500ML INJ 783702760 D5% 50ML INJ 783702770 D5% 100ML INJ 783702780 INST/SUPP STERL 431X-561 17363702790 EMB PROTCT SYS 331X-431 13343702800 INST/SUPP STERL 730X-949 29383702900 CARD PLEG COR 16MEQ/1LSOL 1573702910 GRAFT VASC 561X-730 22593702925 CLOSURE IMPLNT 115X-150 4643702926 VALVE HEART 2714X-3529 109253702927 ICD DUAL 10082X-11090 370513702928 ICD DUAL 12199X-13419 448323702929 ICD DUAL 16237X-17861 596723702930 ICD DUAL 17861X-19647 656393702931 GUIDEWIRE 150X-195 6043702932 GUIDEWIRE 195X-254 7863702933 INST/SUPP STERL1605X-2087 64613702941 GUIDEWIRE <10 183702942 GUIDEWIRE 254X-331 10243702943 GUIDEWIRE 331X-431 13343702944 GUIDEWIRE 39X-51 1583702945 GUIDEWIRE 431X-561 17363702946 GUIDEWIRE 51X-67 2073702947 GUIDEWIRE 561X-730 22593702948 GUIDEWIRE 115X-150 4643702958 GUIDEWIRE 88X-115 3553702966 INST/SUPP NONST 23X-30 933702974 INST/SUPP STERL 51X-67 2073702975 GRAFT VASC 115X-150 4643702976 GRAFT VASC 195X-254 7863702977 GRAFT VASC 254X-331 10243702978 GRAFT VASC 331X-431 13343702979 INTRO SHTH OTH 254X-331 10243702980 STENT GRAFT 2087X-2714 84023702981 STENT GRAFT 2714X-3529 109253702982 LACTATED RINGERS 1L INJ 78

3702983 STENT COV W 3529X-4588 142053702984 STENT COV W 4588X-5965 184683702985 STENT COV W 5965X-7755 240103702986 STENT COV W 7755X-10082 312153702987 STENT COV W 10082X-11090 370513702990 NON JOINT IMP 23X-30 933703006 PACU COMPLEX 1ST 30MIN 10283703014 PACU COMPLEX ADDL 15MIN 3593703015 ICD SINGLE 10082X-11090 370513703016 ICD SINGLE 11090X-12199 407563703017 ICD SINGLE 12199X-13419 448323703018 ICD SINGLE 13419X-14761 493153703019 ICD SINGLE 14761X-16237 542473703020 ICD SINGLE 16237X-17861 596723703021 ICD SINGLE 17861X-19647 656393703022 ICD DUAL 11090X-12199 407563703023 ICD DUAL 13419X-14761 493153703024 INST/SUPP STERL 88X-115 3553703025 INST/SUPP STERL 331X-431 13343703026 INST/SUPP STERL 949X-1234 38203703027 INST/SUPP STERL1234X-1605 49683703028 MESH IMP 51X-67 2073703029 MESH IMP 67X-88 2713703030 MESH IMP 88X-115 3553703031 MESH IMP 115X-150 4643703032 MESH IMP 150X-195 6043703033 MESH IMP 195X-254 7863703034 MESH IMP 254X-331 10243703035 MESH IMP 331X-431 13343703036 MESH IMP 431X-561 17363703037 MESH IMP 561X-730 22593703038 MESH IMP 730X-949 29383703039 MESH IMP 949X-1234 38203703040 MESH IMP 1234X-1605 49683703041 PACU STANDARD 1ST 30MIN 7913703042 PACU STANDARD ADDL 15MIN 2773703043 ICD NOT S/D 23772X-26149 873623703044 PORT INDWELL 254X-331 10243703045 VNT ASST DVC 17861X-19647 656393703046 VNT ASST DVC 42112X-46323 1547623703047 CATH PTA NLASR 431X-561 17363703048 PORT INDWELL 331X-431 13343703049 CATH OTHER 730X-949 29383703050 PACEMKR DUAL RR1605X-2087 64613703051 ICD NOT S/D 12199X-13419 448323703052 ICD DUAL 5965X-7755 240103703053 LEAD ICD DUAL 2087X-2714 8402

3703054 LEAD PMKR NO VDD254X-331 10243703055 ICD NOT S/D 7755X-10082 312153703056 LEAD LT VENTRC 730X-949 29383703057 LEAD LT VENTRC 1234X-1605 49683703058 LEAD ICD DUAL 2714X-3529 109253703059 LEAD PMKR NO VDD 331X-431 13343703060 CATH OTHER 23X-30 933703062 GRAFT VASC 1605X-2087 64613703063 SEALANT PUL LIQ 730X-949 29383703064 GRAFT VASC 39X-51 1583703065 ADPT/EXT LEAD 115X-150 4643703066 ADPT/EXT LEAD 195X-254 7863703067 ADPT/EXT LEAD 561X-730 22593703068 CATH GUIDING 150X-195 6043703069 CATH GUIDING 195X-254 7863703070 CATH GUIDING 254X-331 10243703071 CATH GUIDING 431X-561 17363703072 CATH GUIDING 561X-730 22593703073 CATH GUIDING 730X-949 29383703074 CATH OTHER 88X-115 3553703075 ICD DUAL 7755X-10082 312153703076 ICD NOT S/D 10082X-11090 370513703077 ICD NOT S/D 11090X-12199 407563703078 ICD NOT S/D 13419X-14761 493153703079 ICD NOT S/D 14761X-16237 542473703080 ICD NOT S/D 16237X-17861 596723703081 ICD NOT S/D 17861X-19647 656393703082 ICD SINGLE 21611X-23772 794203703083 ICD SINGLE 5965X-7755 240103703084 ICD SINGLE 7755X-10082 312153703085 LEAD ICD OTHER 3529X-4588 142053703086 LEAD ICD SNGL 2087X-2714 84023703087 LEAD ICD SNGL 2714X-3529 109253703088 LEAD ICD SNGL 3529X-4588 142053703089 LEAD LT VENTRC 3529X-4588 142053703090 LEAD PMKR NO VDD 561X-730 22593703091 LEAD PMKR TRN VDD431X-561 17363703092 PACEMKR DUAL RR2087X-2714 84023703093 PACEMKR DUAL RR2714X-3529 109253703094 PACEMKR OTHR 3529X-4588 142053703095 PACEMKR OTHR 4588X-5965 184683703096 PACEMKR OTHR 7755X-10082 312153703097 PACEMKR SNG RR 1234X-1605 49683703098 PACEMKR SNG RR 1605X-2087 64613703099 PACEMKR SNG RR 2087X-2714 84023706228 STENT COV W 14761X-16237 811853706229 CATH INFUSION 51X-67 207

3706230 GUIDEWIRE 17X-23 703706231 CATH DRAINAGE <10 183706232 CLOSURE IMPLNT 10-13 403706233 CLOSURE IMPLNT 17X-23 703706234 INTRO SHTH OTH <10 183800010 CLOSURE IMPLNT 88X-115 3553800060 GASTRIC MOTILITY 17003800070 GASTROESOPH REFLUX TEST 15453800290 CARDIOVERSION ELCTIVE EXT 24913800300 ESOPH IMPED FUNC TST >1HR 8113800310 PATIENT COUNT PRIMARY NC 0 13800320 INJ TX/DX/PROPH SUBQ/IM 3823800330 TRANSFUS BLD/BLD COMP 5953800400 INSERT CATH BLADDER SMPL 3353800420 CHEMO SQ/IM NONHORMONAL 9503800430 CHEMO IV PUSH INITIAL 11713800440 CHEMO INF INIT 1ST HR 20913800450 INJ TX/DX/PRO IVPUSH INIT 3823800530 APHERESIS PLASM THERAPEUT 30333800540 INF IV HYDRA INIT 31-60MN 22523800550 INF IV HYDRAT EA ADD HR 5703800560 INF TX/DX/PRO INIT 1ST HR 25773800570 INF TX/DX/PRO EA ADD HR 7053800580 INF TX/DX/PRO SEQ 1HR 11123800600 INJ TX/DX/PRO IV PUSH SEQ 3823800620 CHEMO SQ/IM HORMONAL 4103800640 CHEMO IV PUSH EA ADD 6543800660 CHEMO INF EA ADD HR 4393800670 CHEMO INF EA SEQ 1ST HR 20913800720 ENDO PROC UP TO 10 MIN 13013800730 ENDO PROC 11-20 MIN 15313800740 ENDO PROC 21-30 MIN 17623800750 ENDO PROC 31-40 MIN 19913800760 ENDO PROC 41-50 MIN 22243800770 ENDO PROC 51-60 MIN 24543800780 ENDO PROC 61-70 MIN 26843800790 ENDO PROC 71-80 MIN 29153800800 ENDO PROC 81-90 MIN 31473800810 ENDO PROC 91-100 MIN 33763800820 ENDO PROC 101-110 MIN 36073800830 ENDO PROC 111-120 MIN 38373800840 ENDO PROC 121-130 MIN 40683800850 ENDO PROC 131-140 MIN 43003800860 ENDO PROC 141-150 MIN 45293800870 ENDO PROC 151-160 MIN 47603800880 ENDO PROC 161-170 MIN 49923800890 ENDO PROC 171-180 MIN 5223

3800900 ENDO PROC OVER 180 MIN 54533800910 BRONCH/OTHER PROC 0-10 9173800920 BRONCH/OTHER PROC 11-20 10563800930 BRONCH/OTHER PROC 21-30 11973800940 BRONCH/OTHER PROC 31-40 13363800950 BRONCH/OTHER PROC 41-50 14773800960 BRONCH/OTHER PROC 51-60 16153800970 BRONCH/OTHER PROC 61-70 17573800980 BRONCH/OTHER PROC 71-80 18963800990 BRONCH/OTHER PROC 81-90 20363801000 BRONCH/OTHER PROC 91-100 21753801010 BRONCH/OTHER PROC 101-110 23163801020 BRONCH/OTHER PROC 111-120 24553801030 BRONCH/OTHER PROC 121-130 25963801040 BRONCH/OTHER PROC 131-140 27353801050 BRONCH/OTHER PROC 141-150 28763801060 BRONCH/OTHER PROC 151-160 30153801070 BRONCH/OTHER PROC 161-170 31543801080 BRONCH/OTHER PROC 171-180 32933801090 BRONCH/OTHER PROC > 180 34333801100 IRRIG IMPLANTED VEN ACCES 3233801110 INF TX/DX CONCURRENT 15473801120 GTB REM/REPLC/TRACH CHNG 973801130 GI NON TIMED PROC/MIN NC 0 13801200 ESOPH IMPED FUNC TST <1HR 7483801220 VENIPUNCTURE NON LAB 223801230 BLOOD COLLECTION VAD 3393801300 INJ TX/PRO/DX IVP SME DRG 3823801310 VASC ACCES THROMBL DECLOT 4203801320 BLOOD COLLECTION PICC 3763801330 APLIGRF/SQCM 2464.283801340 SURGERY LEVEL 1 1ST 30MIN 15013801350 SURGERY LEVEL 1 ADD 15MIN 7503801360 SURGERY LEVEL 2 1ST 30MIN 21733801370 SURGERY LEVEL 2 ADD 15MIN 10883801490 INS/REPL/DECL NONTUN/PIC 15823801510 PHLEBOTOMY THERAPEUT 3413801520 VISIT LEVEL 1 EST PT 973801530 VISIT LEVEL 1 EST W PROC 973801540 VISIT LEVEL 1 NEW PT 2653801550 VISIT LEVEL 1 NEW W PROC 2653801560 VISIT LEVEL 2 EST PT 2603801570 VISIT LEVEL 2 EST W PROC 2603801580 VISIT LEVEL 2 NEW PT 5093801590 VISIT LEVEL 2 NEW W PROC 5093801600 VISIT LEVEL 3 EST PT 5093801610 VISIT LEVEL 3 EST W PROC 509

3801620 VISIT LEVEL 3 NEW PT 7693801630 VISIT LEVEL 3 NEW W PROC 7693801690 CATH DRAINAGE 115X-150 4643801700 CATH NONVAS DIL 195X-254 7863801710 GASTRO IMP 13X-17 533801720 GASTRO IMP 17X-23 703801730 GASTRO IMP 23X-30 933801740 GASTRO IMP 39X-51 1583801750 GUIDEWIRE 115X-150 4643801760 GUIDEWIRE 150X-195 6043801770 GUIDEWIRE 195X-254 7863801780 INST/SUPP STERL 10-13 403801790 INST/SUPP STERL 115X-150 4643801800 INST/SUPP STERL 13X-17 533801810 INST/SUPP STERL 150X-195 6043801820 INST/SUPP STERL 17X-23 703801840 INST/SUPP STERL 195X-254 7863801850 INST/SUPP STERL 23X-30 933801860 INST/SUPP STERL 254X-331 10243801870 INST/SUPP STERL 30X-39 1213801880 INST/SUPP STERL 39X-51 1583801890 INST/SUPP STERL 67X-88 2713801900 INST/SUPP STERL 88X-115 3553801910 INTRO SHTH OTH 51X-67 2073801930 STENT NCOV W 51X-67 2073801940 STENT NONCOR W 115X-150 4643801950 STENT NONCOR W 88X-115 3553801960 STENT NONCOR WO 39X-51 1583802220 STENT NCOV W 1234X-1605 49683802230 CATH OTHER 13X-17 533802240 GASTRO IMP 10-13 403802250 GASTRO IMP 30X-39 1213802260 NACL 0.9% 500ML INJ 23802270 NACL 0.9% 1000ML INJ 33802280 D5% 250ML INJ 783802290 D5% 500ML INJ 783802300 D5% 0.45 NACL 1000ML INJ 783802310 LACTATED RINGERS 500MLINJ 783802320 LACTATED RINGERS 1L INJ 783802330 NACL 0.9% 250ML INJ 783802340 NACL 0.45% 1000ML INJ 783802360 INST/SUPP STERL 51X-67 2073802379 CLOSURE IMPLNT 67X-88 2713802386 SURGERY LEVEL 3 1ST 30MIN 58393802394 SURGERY LEVEL 3 ADD 15MIN 20343802402 SURG ENDO LVL 2 1ST 30MIN 20243802410 SURG ENDO LVL 2 ADD 15MIN 609

3802411 STENT NONCOR WO 67X-88 2713802412 GASTRO IMP 88X-115 3553802414 GSTRESPH RFLX TST W ELEC 8113802415 INST/SUPP STERL 561X-730 22593802416 INST/SUPP STERL 730X-949 29383802417 CATH DRAINAGE 17X-23 703802418 CATH OTHER 67X-88 2713802419 INST/SUPP STERL 431X-561 17363802420 INST/SUPP STERL 331X-431 13343802421 STENT COV W 2087X-2714 84023802422 CATH OTHER 39X-51 1583802423 STENT COV W 4588X-5965 184653802424 MOD SEDAT <5YRS 1ST 15M 4653802425 MOD SEDAT =>5YRS 1ST 15M 5543802426 MODERATE SEDAT ADD 15MIN 4653802427 BLAD INSTL ANTICARCINOGEN 22563802428 PACU COMPLEX 1ST 30MIN 10283802429 PACU COMPLEX ADDL 15MIN 3593802430 PACU STANDARD 1ST 30MIN 7913802431 PACU STANDARD ADDL 15MIN 2773802432 ANESTH GENERAL 1ST 30MIN 29363802433 ANESTH GENERAL ADDL 15MIN 10283802434 ANESTH MAC/REG 1ST 30MIN 10283802435 ANESTH MAC/REG ADDL 15MIN 3863802436 CLOSURE IMPLNT 195X-254 7864100004 VENIPUNCTURE NON LAB 224100010 AD EVOKED POTENTIALS COMP 4984100020 EEG AWAKE & DROWSY 15814100030 VEP TEST CNS CHECKER/FLAS 21234100040 EEG AWAKE & ASLEEP 17974100050 EEG COMA OR SLEEP ONLY 17074100060 RT ASSESSMENT COMPLETE NC 0 14100070 AIRWAY MANAGEMENT NC 0 14100090 PULSE OX SINGLE DETERMIN 494100100 VITAL CAPACITY TOTAL 2034100110 EEG DURING NONCRANIA SURG 13014100120 PH BODY FLUID NOS POC 604100130 RT ASSESSMENT LIMITED NC 0 14100140 SPIROMETRY 4344100150 BRNCHSPASM EVAL PRE/POST 7394100160 PULMONARY COMPLIANC STUDY 2804100180 PULSE OX CONTIN OVERNIGHT 3784100190 AEROSOL INH PENTAMIDIN TX 3374100200 CIRCADIAN RESP 12-24HR 6414100210 PULSE OX MULTI W EXERCISE 774100220 RESP FLOW VOLUME LOOP 6954100230 ARTERIAL PUNCTURE 118

4100240 EEG SEIZURE 8-CH/ 24 HR 56754100250 BRONCH BRONCHOSCOPY DX 25634100260 BRONCH BRUSHING/PROTECTED 8354100270 BRONCH ALVEOLAR LAVAGE 14124100280 BRNCH W ENDOBR BX SNG/MUL 16244100290 BRONCH W BX NEEDLE ASP 19134100320 BRONCH W REMOVAL FB 10114100330 NEO-LOW RISK DEL NC 0 14100340 VENT INITIAL HFV 12HR NC 0 14100350 CPAP/BIPAP OSA INIT/DAY 38164100360 EEG 41-60 MINUTES 17274100370 EEG EXTENDED >1 HOUR 20724100380 EEG SEIZURE PORT>=16/24HR 47164100390 EEG ALL NIGHT RECORDING 40784100400 NEEDLE EMG 3 EXTREMITIES 8224100410 NEEDLE EMG 4 EXTREMITIES 9354100430 EEG CEREBRAL SILENCE 15434100440 BLAND AERO TX INIT EA DAY 2164100450 BLAND AERO TX SUBSEQUENT 2164100460 DEMO/EVAL INHALATION TX 2164100470 INH TX INIT W VENT/DAY 2484100480 INH TX SUBSEQUENT W VENT 2164100490 INH TX INITIAL EA DAY 2484100500 INH TX EA SUBSEQ TX/DAY 2164100510 MANIPULAT CHEST WALL INIT 2174100520 MANIPULAT CHEST WALL SUB 1584100530 VENT INITIAL DAY NITRIC 54454100540 VENT SUBSEQ DAY NITRIC 48774100550 CLINICAL ROUNDS EA 20M NC 0 14100560 CO2 EXPIRED GAS INFRARED 10484100570 CPAP/BIPAP OSA SUB 12H NC 0 14100580 CPR 22984100590 CPR NC 0 14100600 NEO-HIGH RISK DEL NC 0 14100610 VENT INITIAL 12HR NC 0 14100620 VENT SUBSEQUENT 12HR NC 0 14100630 VENT SUBSEQ HFV 12HR NC 0 14100640 VENT INIT NITRIC 12HR NC 0 14100650 VENT SUBSEQ NITRC 12HR NC 0 14100660 ARTERIAL LINE DRAW NC 0 14100670 PEAK FLOW MEASUREMENT NC 0 14100680 BRNCH W TRNSBR BX SNG LBE 17714100690 BRNCH TRNS BX EA ADD LOBE 17714100700 BRONCH BX NDL ASP EA ADD 17714100710 BRONCH THER ASPIRATE INIT 26384100720 BRONCH THER ASPIRAT SUBQ 22694100780 VENT INIT DAY INVASIVE 4735

4100790 VENT INITIAL DAY HFV 47354100800 VENT SUBSEQ DAY INVASIVE 47354100810 VENT SUBSEQUENT DAY HFV 47354100830 INH TX CONTINOUS 1ST HR 1984100840 INH TX CONT EA ADD HR 1984100850 DIFFUSING CAPACITY 7484100870 ACAPELLA NC 0 14100880 FLUTTER NC 0 14100901 MECHANIC CHEST WALL OSCIL 2164100910 CPAP/BIPAP VNT SUB 12H NC 0 14100920 CPAP/BIPAP VENT INIT/DAY 38554100930 INTRAPUL SRFCT VIA ETT NC 0 14100950 AIRWY RES PLSE OSCILLMTRY 6104100960 PLETHYSMOGRAPHY LUNG VOL 8244100970 TRANSCUT MONITOR INITIAL 1934100980 TRANSCUT MONITOR SUBSEQ 1934100990 TOBACCO COUNSELING 3-10MN 1054101000 TOBACCO COUNSELING >10MIN 2184101030 NEEDLE EMG 1 EXTREMITY 4714101040 NEEDLE EMG 2 EXTREMITIES 6634101050 MUSCLE TEST LARYNX 2894101090 EEG SEIZURE COMB>=16/24HR 30164101100 GAS DILUTION LUNG VOLUME 6594101130 ARTERIAL CATH/CANN PERC 2894101140 AMBULATORY BP ANALYSIS 1764101150 PULM STRESS TEST SIMPLE 1674101160 BRONCH BRONCHOSCOPY DX NC 0 14101170 BRONCH ALVEOLAR LAVAGE NC 0 14101190 CATH OTHER 39X-51 1584101200 INST/SUPP STERL 23X-30 934101210 INST/SUPP STERL 39X-51 1584101240 INTUBATION ET EMERGENCY 3714101250 NERVE CONDUCT 1-2 STUDIES 1704101260 NERVE CONDUCT 3-4 STUDIES 3014101270 NERVE CONDUCT 5-6 STUDIES 5274101280 COLLECT CAPILLAR BLOOD 224101290 TRACH TUBE CHG NO FISTULA 8344101300 BRONCH W EXCISION TUMOR 41664101310 CALCIUM IONIZED POC 1554101320 BLOOD GAS PH POC 364101330 HELIOX PER 24 HOURS 1004101340 THRP RSP-OTH INDV EA15MIN 1314101350 THERAP STRG ENDR EA 15MIN 1314101366 ECG 12 LEAD TRACING ONLY 3604101374 BRONCH BRONCHOSCOPY DX NC 0 14101375 BLOOD GAS W O2 SAT POC 8874101376 VIBRATORY PEP DEVICE NC 0 1

4101382 BRONCH W BX NEEDLE ASP NC 0 14101383 PULM REHAB COPD W EX 1HR 1314101384 PULM REHAB PHASE III NC 0 14101385 THRP RSP STRG END GR<=30M 2464101386 THRP RSP STRG END GR<=45M 3694101387 THRP RSP STRG END GR<=60M 4894101388 THRP RSP STRG END GR<=90M 7314101389 THRP RSP STG END GR<=105M 8534101390 THRP RSP STG END GR<=120M 9734101391 CCHD SCREENING 1684101392 INST/SUPP STERL 254X-331 10244101393 ECMO/ECLS VENOUS INIT 45474101394 ECMO/ECLS ARTERIAL INIT 45474101395 ECMO VENOUS MANAGE EA DAY 45474101396 ECMO ART MANAGE EA DAY 45474101397 HIGH ALTITUDE SIMULATION 7074101398 HAST W O2 TITRATION 7074101399 SLEEP UNATTEN W RESP EFFT 6424500010 NACL 0.9% 1000ML INJ 193.644500020 CARDIOVERSION ELCTIVE EXT 23914500030 INCIS/DRAIN/ASP LEVEL 1 4894500040 LUMBAR/SHUNT PUNCTURE 10544500050 THORACENTESIS/THORACOSTOM 19014500060 INSERT CATH BLADDER 3864500080 INTUBATION ENDOTRACHEAL 9884500090 ARTERIAL CATH/CANN PERC 12114500100 ER LEVEL 1 8284500110 ER LEVEL 2 12974500120 ER LEVEL 3 20934500130 ER LEVEL 4 32484500140 ER LEVEL 5 49744500150 TRANSFUS BLD/BLD COMP 7414500160 APPLICATION OF SPLINT 3604500170 ER CRITICAL CARE 30-74MIN 95394500180 EMERG ROOM CPR 21534500190 ER LEVEL 2 W/PROCEDURE 12974500200 ER LEVEL 4 W/PROCEDURE 32484500210 ER LEVEL 3 W/PROCEDURE 20934500220 ER LEVEL 5 W/PROCEDURE 49744500240 PACING TRANSCUTANEOUS 13764500250 PERICARDIOCENTES INITIAL 7704500260 REMOVE CERUMEN IMPACTED 2644500270 ANOSCPY/LARYNGOSCOPY DIAG 1974500280 REMOVE FB/IMPLANT LEVEL 2 13254500290 IRRIG/LAV/INSTL BLAD/OTHR 5434500300 REMOV/BIVALV/RPR CAST 2664500310 APPLICATION OF CAST 1015

4500320 REM FB/SKN LES IMP LVL 1 6184500330 REMOVE FB/IMPLANT LEVEL 3 27104500340 CHANGE TUBE SIMPLE 5744500350 PLACE NDL INTRAOSSO INFUS 10654500360 EXCISE/REPAIR NAIL 8824500370 PARACENTESIS/PERIT LAVAGE 13254500380 LAC RPR LEVEL 3 49674500390 ADMIN OTHER IMMUN VAC ONE 1824500400 ADMIN INFLUENZA VACCINE 3644500410 INJ TX/PRO/DX IVP SME DRG 3824500420 ADMIN PNEUMO VACCINE 3644500430 INJ TX/DX/PROPH SUBQ/IM 3824500440 LAC RPR LEVEL 1 9694500450 DRESS/DEBRIDE BURN 6624500460 ER EVIDENTIARY EXAM 49744500520 TRAUMA COMPREHENSIVE 574614500530 TRAUMA ESSENTIAL 403694500540 TRAUMA LIMITED 152234500550 TRAUMA LVL 2 ACTIVATE 4/5 58864500560 ADMIN OTHER IMMUN VAC ADD 1824500570 INJ TX/DX/PRO INTRA-ARTER 3824500580 LAC RPR LEVEL 2 21014500590 LAC RPR LVL3 ADD<5CM 44774500600 INCIS/DRAIN/ASP LEVEL 3 25404500610 DEBRID OPEN FX W/FB REMOV 32354500620 DEBRIDE SKIN/SUBQ/MUS 15934500630 INJ NERVE/OTHR ASP/INJ JT 7444500640 TX FX/DISLOC LEVEL 1 24534500650 WINDOWING/WEDGING OF CAST 11284500660 CAUT/CNTRL BLEED LEVEL 1 26174500670 INS/REPL TEMP PACER ELECT 154054500680 VENIPUNCTURE 224500690 HEMORRHOID EXC/INC SIMPLE 17904500700 DEBRID/AVUL NAIL EVAC HEM 9854500710 ER LEVEL 1 W/PROCEDURE 8284500860 CV CATH/PICC LEVEL 2 30044500870 CYSTOSTOMY PROC COMPLEX 28034500880 ER CRIT CARE 30-74 W/PROC 95394500890 ER CRITIC CARE ADD 30MIN 47704500900 CLOSE/PK WND DEHISCEN SMP 4864500910 TRACHEOSTOMY EMERGENCY 18214500920 TX FX/DISLOC LEVEL 2 44554500930 TX FX/DISLOC LEVEL 3 64574500940 TX DISLOC LEVEL 3 W ANES 77494500950 OB/GYN PROCEDURE LEVEL 3 64084500960 CURETTAGE NON OB 8014500970 TRAUMA COMPREHENS W/PROC 57461

4500980 TRAUMA ESSENTIAL W/PROC 403694500990 TRAUMA LIMITED W/PROC 152234501000 EPIDURAL BLOOD PATCH 15934501010 TRAUMA COMPREH ADD 30MIN 161134501020 INF IV HYDRA INIT 31-60MN 22474501030 INF IV HYDRAT EA ADD HR 5834501040 INF TX/DX/PRO INIT 1ST HR 27134501050 INF TX/DX/PRO EA ADD HR 7404501060 INF TX/DX/PRO SEQ 1HR 11904501070 INJ TX/DX/PRO IVPUSH INIT 3824501080 INJ TX/DX/PRO IV PUSH SEQ 3824501110 MODERATE SEDAT ADD 15MIN 4884501120 TRAUMA LVL 2 ACTIVATE CC 61814501130 EXPLORE WOUND 23064501140 CATH FOR SPECIMEN COLLECT 1254501150 STRAPPING 1684501160 CV CATH/PICC LEVEL 1 25794501170 THORACOTOMY 207614501180 BLADDER PROCEDURE LEVEL 2 49004501190 RECTAL PROCEDURE INTERMED 33454501200 INCIS/DRAIN/ASP LEVEL 2 10654501210 LEFT WO BEING SEEN NC 0 24501220 ENDOSCOPY PROC COMPLEX 46084501340 INF TX/DX CONCURRENT 14024501370 DENTAL PROC/REIMPLANT 2484501380 TRAUMA LVL 3 ACTIVATE 4/5 58864501390 ER OBSERVATION PER HOUR 1664501400 GLUCOSE BLD BY DEVICE POC 174501410 TRAUMA LVL 3 ACTIVATE CC 61814501430 CB BLOOD ALCOHOL 3004501460 EXCISION LEVEL 2 61344501480 FORESKIN MANIPULATION 9344501490 CATH DRAINAGE 88X-115 3554501500 CATH OTHER 23X-30 934501510 CATH OTHER 30X-39 1214501520 INST/SUPP STERL 39X-51 1584501530 INST/SUPP STERL 88X-115 3554501550 ORTHO L0120 <10 184501560 ORTHO L1830 13X-17 534501570 ORTHO L3650 <10 184501580 ORTHO L3908 <10 184501590 ORTHO L4350 17X-23 704501620 ADMIN HEP B VACCINE 3644501630 THROMBOLYSIS CORONARY IV 4584501640 CATH INFUSION 67X-88 2714501650 CATH INFUSION 115X-150 4644501664 BLADDER PROCEDURE LEVEL 1 3345

4501672 CV CATH LEVEL 3 33454501680 DECLOT THROMBOLYSIS 64574501698 ENDOSCOPY PROC INTERMED 33454501706 EXCISION LEVEL 1 21014501714 GASTR INTB/ASP/LAV PHY SK 28034501722 INS PERITL CATH/CANN 28034501730 PREG URINE VISUAL POC 224501748 SKIN PROCEDURE COMPLEX 49674501755 CATH OTHER 17X-23 704501771 CATH INFUSION 17X-23 704501789 CATH INFUSION 88X-115 3554501797 CATH INFUSION 13X-17 534501805 GASTRO IMP 13X-17 534501813 GUIDEWIRE 10-13 404501821 INST/SUPP NONST 10-13 404501847 INST/SUPP STERL 23X-30 934501854 INST/SUPP STERL 30X-39 1214501862 INST/SUPP STERL 51X-67 2074501904 INTRO SHTH OTH 39X-51 1584501912 ORTHO L0172 67X-88 2714501946 ORTHO L0172 13X-17 534501953 ORTHO L1830 17X-23 704501961 ORTHO L3650 10-13 404501979 ORTHO L3670 13X-17 534501987 ORTHO L4386 13X-17 534501995 INST/SUPP NONST 23X-30 934502001 INST/SUPP NONST 30X-39 1214502027 CATH OCCLUSION 115X-150 4644502035 CATH OTHER 13X-17 534502043 INST/SUPP NONST 51X-67 2074502050 INST/SUPP STERL 13X-17 534502069 KIT/PACK DISP 195X-254 7864502070 KIT/PACK DISP 67X-88 2714502084 LACTATED RINGERS 1L INJ 784502092 NACL 0.9% 500ML INJ 784502093 ORTHO L0172 10-13 404502094 ORTHO L0172 17X-23 704502095 ORTHO L0172 23X-30 934502096 ORTHO L0172 30X-39 1214502097 ORTHO L0200 431X-561 17364502098 ORTHO L1686 730X-949 29384502099 ORTHO L1830 10-13 404502100 ORTHO L1832 115X-150 4644502101 ORTHO L1832 431X-561 17364502102 ORTHO L1930 195X-254 7864502104 ORTHO L3807 13X-17 534502105 ORTHO L3923 10-13 40

4502106 ORTHO L3961 88X-115 3554502107 DEBR SL SESSION 1ST 20CM 6324502108 CLOSURE EXTERN 17X-23 704502109 PLACE NG/OG TUBE PHY SKIL 17974502111 OP/ED PSYCH SITTER/HR NC 0 14502112 OB/GYN PROCEDURE LEVEL 1 13814502116 NACL 0.9% 250ML INJ 784502117 MOD SEDAT <5YRS 1ST 15M 4654502118 MOD SEDAT =>5YRS 1ST 15M 4654502119 BRONCHOSCPY PROC INTERMED 25004800000 CAROTID STNT TRANSCATH W 230364800010 CAROTID STNT TRANSCATH WO 230364800020 PACEMKER INS TEMP SNGL 103234800030 PERICARDIOCENTES INITIAL 38224800040 CARDIOVERSION ELCTIVE EXT 24914800060 THROMBOLYSIS CORONARY IC 26584800170 INSERT IAB DEVICE PERC 65604800310 CARDIAC CATH CPR 22984800400 ECHO TEE WO CON 31374800420 OCCLUSIVE DEVICE ART/VEIN 52064800430 ENDOLUM COR VESS IVUS INI 42544800440 ENDOLUM COR VESS IVUS ADD 34034800450 COR DOPL VEL/PRESS INITAL 18464800460 COR DOPL VEL/PRESS ADDL 14774800530 CL AORTOGRAM ABD W SERIAL 81514800550 NON IONIC CONTRAST 50ML 344.024800610 ANGIO IN L VNT/AT CRD CTH 67124800620 INTERATRIAL CLOSURE PERC 410024800640 CL AORTOGRM ABD W ILIOFEM 97814800650 ANGIO IN SUPR AORT CD CTH 75424800680 INTRACARDIAC ECHO 37734800690 ANGIO IN PULM AORT CD CTH 67884800700 PACEMAKER UPGR SNGL-DUAL 272254800710 PACEMK GENERATOR REM ONLY 92664800720 PACEMK INS EXIS DUAL LEAD 213724800730 PACEMAKER LEAD REM SINGLE 111194800750 PACEMKR SKIN POCK RELOCAT 64374800760 L VENT LEAD INS W DEF/GEN 275384800870 MC PTA BRACHIOCEP EA VES 115524800880 MC PTA RENAL/VISCERAL 129384800920 MC CL PTA VENOUS 117994800930 CTH PLC THOR/BRAC 1ST SEL 10704800940 CTH PLC THOR/BRAC 2ND SEL 13104800960 CTH PLC THOR/BRAC ADD 2-3 2494801020 CTH PLC ABD/PEL/EX 1ST EA 14664801030 CTH PLC ABD/PEL/ 3RD INIT 12884801040 CTH PLC ABD/PEL/ 2ND INIT 1082

4801050 CATH PLACE AORTA 13754801100 LOOP RECORDER REMOVAL 55984801110 LOOP RECORDER IMPLANT 163584801150 DEFIB IMP INS EX SNG LEAD 851184801180 PACEMAKER LEAD REM DUAL 138994801280 DEFIB IMP SYS INS/REPL TV 977094801300 LEAD INS PACE/DEF IMP 1TV 139314801310 LEAD INS PACE/DEF IMP 2TV 174764801360 DEFIB IMP SKIN POCK RELOC 79804801370 PACEMAKER INS/REPL ATRIAL 230304801380 PACEMAKER INS/REPL VENT 243534801390 PACEMAKER INS/REPL A/V 264714801410 LEAD PACE/DEFIB IMP REPOS 62064801420 LEAD REPOS W GEN REM/RPL 58964801430 DEFIB IMP LEAD REM TRANSV 141874801450 EP EVAL LEADS & GEN INIT 24234801460 DEFIB IMP REM GEN ONLY 64374801470 L VENT LEAD IMP INS&CONNE 305144801500 LEAD REP PACE/DEF IMP 2TV 146494801540 ART MECH THROMBECTMY PRIM 80494801690 MC PTA VENOUS 113454801710 CATH/NDL PLACE EXTREM ART 9994801720 CATH/NDL PLC RETROG BRACH 11994801730 ART MECH THROM 2NDARY ADD 109764801820 TRANSFUS BLD/BLD COMP 9834801880 CL PER MINUTE NC 0 14801950 IOPAMIDOL 300MG/ML 150ML 47.644801970 RIGHT HEART CATH 166914801980 RT LT HRT CTH LT VNTRICUL 242024801990 COR ANGIO CATH PLACE 233504802000 COR ANG CTH PLC BYPS GRFT 270864802010 RT HRT CATH COR ANGIO 512734802020 RT HRT CTH COR ANG BYP GR 581754802030 LT HRT CTH COR ANG VNTRCU 493014802040 LT HRT CTH ANG VNT BYP GR 542314802050 RT LT HRT CTH COR ANG VNT 581754802060 RT LT HRT CTH ANG VNT BYP 665564802080 DRUG ADMIN HEMODYN MEAS 8874802090 ANGIO INJ CONG CR CRD CTH 84474802130 RT HRT CTH COGEN ANOMAL 175704802150 RT&LT HC SEPTAL OPEN ANOM 738874802230 REVAS ILIAC TRNS ANG INI 394024802240 REVAS ILIAC STENT INI VES 486454802250 REVAS IPSIL ILI ANGIO ADD 179994802260 REVAS IPSIL ILI STENT ADD 204314802270 REVAS FEM POP TRANS ANGIO 283804802280 REVAS FEM POP ATHERECTOMY 38351

4802290 REVAS FEMORAL POPLT STENT 333654802300 REVAS FEM POP STENT ATHER 464054802310 REVAS TIBIAL PERN ANG INI 281164802340 REVAS TIB PERON ANGIO ADD 101224802390 CL ANGIO EXTREMITY BIL 97814802510 CL AORTOGRAM THOR WO SER 81514802640 IOPAMIDOL 250MG/ML 150ML 44.14802660 CTH PLC RENAL ART SEL BIL 88034802710 PACEMK GEN REPL SNGL LEAD 264124802720 PACEMK GEN REPL DUAL LEAD 275124802730 PACEMK GEN REPL MULT LEAD 291634802750 DEFIB IMP GEN REPLACE SNG 859014802760 DEFIB IMP GEN REPLC MULT 923674802770 DEFIB IMP GEN REPLC DUAL 886724802800 CL FLUORO < 1 HR 26374802880 VENOUS MECH THROMBECTOMY 97814803030 CL ANGIO EXTREMITY LT 81514803040 CL ANGIO EXTREMITY RT 81514803070 CL VENOGRAM EXTREMITY LT 26544803080 CL VENOGRAM EXTREMITY RT 26544803090 CTH PLC RENAL ART SEL LT 66024803100 CTH PLC RENAL ART SEL RT 66024803140 CATH ATHR DIR 2714X-3529 109254803150 CATH EP NCOOL 561X-730 22594803160 CATH GUIDING 115X-150 4644803170 CATH GUIDING 150X-195 6044803180 CATH GUIDING 195X-254 7864803190 CATH GUIDING 39X-51 1584803200 CATH GUIDING 51X-67 2074803210 CATH GUIDING 67X-88 2714803220 CATH GUIDING 88X-115 3554803230 CATH INTVAS US 730X-949 29384803240 CATH OTHER 1605X-2087 64614803250 CATH OTHER 17X-23 704803260 CATH OTHER 331X-431 13344803270 CATH OTHER 561X-730 22594803280 CATH OTHER 730X-949 29384803290 CATH OTHER 88X-115 3554803300 CATH PTA NLASR 115X-150 4644803310 CATH PTA NLASR 150X-195 6044803320 CATH PTA NLASR 254X-331 10244803330 CATH PTA NLASR 561X-730 22594803340 CATH PTA NLASR 730X-949 29384803350 CATH PTA NLASR 949X-1234 38204803360 CATH THROM EMB 1234X-1605 49684803370 CATH THROM EMB 431X-561 17364803380 CLOSURE EXTERN 17X-23 70

4803390 CLOSURE IMPLNT 88X-115 3554803400 EMB PROTCT SYS 1234X-1605 49684803410 EMB PROTCT SYS 730X-949 29384803420 GUIDEWIRE <10 184803430 GUIDEWIRE 10-13 404803440 GUIDEWIRE 115X-150 4644803460 GUIDEWIRE 17X-23 704803480 GUIDEWIRE 39X-51 1584803490 GUIDEWIRE 51X-67 2074803500 GUIDEWIRE 67X-88 2714803510 GUIDEWIRE 730X-949 29384803520 GUIDEWIRE 88X-115 3554803530 ICD DUAL 14761X-16237 542474803540 ICD DUAL 17861X-19647 656394803550 ICD NOT S/D 19647X-21611 722024803560 ICD NOT S/D 21611X-23772 794204803570 ICD NOT S/D 26149X-28764 960984803580 ICD SINGLE 16237X-17861 596724803590 INST/SUPP STERL 13X-17 534803610 INST/SUPP STERL 30X-39 1214803620 INST/SUPP STERL 730X-949 29384803640 INTRO SHTH OTH <10 184803650 INTRO SHTH OTH 23X-30 934803670 INTRO SHTH OTH 67X-88 2714803690 KIT/PACK DISP 88X-115 3554803700 LEAD ICD DUAL 3529X-4588 142054803710 LEAD LT VENTRC 1605X-2087 64614803720 LEAD LT VENTRC 2087X-2714 84024803730 LEAD PMKR NO VDD 730X-949 29384803740 PACEMKR DUAL RR3529X-4588 142054803750 PACEMKR DUAL RR4588X-5965 184684803760 PACEMKR OTHR 5965X-7755 240104803770 PACEMKR OTHR 7755X-10082 312154803780 PACEMKR SNG RR 2714X-3529 109254803790 PACEMKR SNG RR 3529X-4588 142054803800 RETRV FRAC DVC 431X-561 17364803810 STENT COV W 1234X-1605 49684803820 STENT NCOV W 1234X-1605 49684803830 STENT NCOV W 561X-730 22594803840 STENT NCOV W 730X-949 29384803850 STENT NCOV W 949X-1234 38204803860 VASC CLOSE DVC 150X-195 6044803890 COR ATHERECT DES ADD 309444803900 COR ATHERECT DES SNGL LC 309444803910 COR ATHERECT DES SNGL LD 309444803920 COR ATHERECT DES SNGL LM 309444803930 COR ATHERECT DES SNGL RC 30944

4803940 COR ATHERECT DES SNGL RI 309444803950 COR ATHERECT EA ADD 352764803960 COR ATHERECT NDES ADD 253744803970 COR ATHERECT NDES SNGL LC 253744803980 COR ATHERECT NDES SNGL LD 253744803990 COR ATHERECT NDES SNGL LM 253744804000 COR ATHERECT NDES SNGL RC 253744804010 COR ATHERECT NDES SNGL RI 253744804020 COR ATHERECT SNGL LC 352764804030 COR ATHERECT SNGL LD 352764804040 COR ATHERECT SNGL LM 352764804050 COR ATHERECT SNGL RC 352764804060 COR ATHERECT SNGL RI 352764804070 CTH PL CAR/INM ART SEL BI 198964804080 CTH PL CAR/INM SEL ICA BI 218644804090 CTH PL SUB/INM ART SEL BI 218644804100 CTH PLC CAR/INOM ART SEL 132644804110 CTH PLC CAR/INOM SEL ICA 145764804120 CTH PLC ECA SEL ADDON 52474804130 CTH PLC ICA SEL 164714804140 CTH PLC ICA SEL BILAT 247064804150 CTH PLC ICA/VER SEL ADDON 59384804160 CTH PLC SUBC/INOM ART SEL 145764804170 CTH PLC THOR AOR NSEL 97664804180 CTH PLC VERT SEL 163254804190 CTH PLC VERT SEL BILAT 244874804200 IC DES PLC EA ADD 309444804210 IC DES PLC SNGL LC 309444804220 IC DES PLC SNGL LD 309444804230 IC DES PLC SNGL LM 309444804240 IC DES PLC SNGL RC 309444804250 IC DES PLC SNGL RI 309444804260 IC NDES PLC EA ADD 253744804270 IC NDES PLC SNGL LC 253744804280 IC NDES PLC SNGL LD 253744804290 IC NDES PLC SNGL LM 253744804300 IC NDES PLC SNGL RC 253744804310 IC NDES PLC SNGL RI 253744804320 PTCA EA ADDITIONAL 176384804330 PTCA SINGLE LC 176384804340 PTCA SINGLE LD 176384804350 PTCA SINGLE LM 176384804360 PTCA SINGLE RC 176384804370 PTCA SINGLE RI 176384804380 REVASC ACUT MI DES SNG LC 309444804390 REVASC ACUT MI DES SNG LD 309444804400 REVASC ACUT MI DES SNG LM 30944

4804410 REVASC ACUT MI DES SNG RC 309444804420 REVASC ACUT MI DES SNG RI 309444804430 REVASC ACUT MI NDES SG LC 253744804440 REVASC ACUT MI NDES SG LD 253744804450 REVASC ACUT MI NDES SG LM 253744804460 REVASC ACUT MI NDES SG RC 253744804470 REVASC ACUT MI NDES SG RI 253744804480 REVASC CABG DES ADD 309444804490 REVASC CABG DES SNGL LC 309444804500 REVASC CABG DES SNGL LD 309444804510 REVASC CABG DES SNGL LM 309444804520 REVASC CABG DES SNGL RC 309444804530 REVASC CABG DES SNGL RI 309444804540 REVASC CABG NDES SNGL LC 253744804550 REVASC CABG NDES SNGL LD 253744804560 REVASC CABG NDES SNGL LM 253744804570 REVASC CABG NDES SNGL RC 253744804580 REVASC CABG NDES SNGL RI 253744804590 REVASC CABG NDES ADD 253744804600 REVASC CHRONC NDES SNG LC 253744804610 REVASC CHRONC NDES SNG LD 253744804620 REVASC CHRONC NDES SNG LM 253744804630 REVASC CHRONC NDES SNG RC 253744804640 REVASC CHRONC NDES SNG RI 253744804650 REVASC CHRONIC DES ADD 309444804660 REVASC CHRONIC DES SNG LC 309444804670 REVASC CHRONIC DES SNG LD 309444804680 REVASC CHRONIC DES SNG LM 309444804690 REVASC CHRONIC DES SNG RC 309444804700 REVASC CHRONIC DES SNG RI 309444804710 REVASC CHRONC NDES ADD 253744804720 THORACENTESIS W IMAGING 20194804730 TRANSCTH RET IVAS FB PERC 72594804770 CATH PTA NLASR 195X-254 7864804790 CATH PTA NLASR 331X-431 13344804820 CATH THROM EMB 115X-150 4644804840 CATH THROM EMB 150X-195 6044804850 CATH THROM EMB 1605X-2087 64614804860 CATH THROM EMB 331X-431 13344804900 EVENT REC CARD 3529X-4588 142054804940 GUIDEWIRE 150X-195 6044804950 GUIDEWIRE 2087X-2714 84024804960 GUIDEWIRE 23X-30 934804990 GUIDEWIRE 561X-730 22594805040 INST/SUPP STERL 561X-730 22594805070 INTRO SHTH OTH 115X-150 4644805100 INTRO SHTH OTH 39X-51 158

4805110 LEAD PMKR TRN VDD254X-331 10244805140 STENT COV W 2087X-2714 84024805150 STENT COV W 2714X-3529 109254805190 CATH ATHR ROT 1234X-1605 49684805200 CATH ATHR ROT 949X-1234 38204805210 CATH INFUSION 39X-51 1584805220 CATH INFUSION 51X-67 2074805230 CATH INFUSION 88X-115 3554805240 CATH INTVAS US 561X-730 22594805250 CATH OTHER 115X-150 4644805260 CATH OTHER 13X-17 534805270 CATH OTHER 67X-88 2714805280 CATH PTA LASER 2087X-2714 84024805290 CATH PTA NLASR 88X-115 3554805300 CLOSURE IMPLNT 17X-23 704805310 EMB PROTCT SYS 1605X-2087 64614805320 INST/SUPP STERL 254X-331 10244805330 INST/SUPP STERL 39X-51 1584805340 INST/SUPP STERL 67X-88 2714805370 INTRO EP LASR 2087X-2714 84024805380 INTRO SHTH OTH 10-13 404805400 KIT/PACK DISP 195X-254 7864805410 NON JOINT IMP 150X-195 6044805420 D5% 250ML INJ 784805430 D5% 500ML INJ 784805440 D5% 0.45 NACL 500ML INJ 784805450 D5% 0.45 NACL 1000ML INJ 784805460 LACTATED RINGERS 500MLINJ 784805470 LACTATED RINGERS 1L INJ 784805480 D5% LR 500ML INJ 784805490 NACL 0.9% 250ML INJ 784805500 NACL 0.9% 500ML INJ 784805510 NACL 0.9% 1000ML INJ 784805520 D5% W ELECTROL 148 1000ML 784805530 ICD DUAL 12199X-13419 448324805540 ICD DUAL 16237X-17861 596724805550 ICD DUAL 21611X-23772 794204805560 ICD DUAL 23772X-26149 873624805570 ICD NOT S/D 17861X-19647 656394805580 ICD NOT S/D 23772X-26149 873624805590 LEAD PMKR NO VDD 431X-561 17364805600 LEAD PMKR NO VDD 561X-730 22594805602 CATH OCCLUSION 39X-51 1584805610 ICD DUAL 13419X-14761 493154805620 ICD SINGLE 13419X-14761 493154805628 PACEMKR DUAL RR2714X-3529 109254805630 ICD SINGLE 14761X-16237 54247

4805636 SEPTAL DEFECT 4588X-5965 184684805640 INST/SUPP STERL 51X-67 2074805650 INST/SUPP STERL 88X-115 3554805660 INTRO EP FC NPL 561X-730 22594805690 LEAD PMKR NO VDD949X-1234 38204805701 GUIDEWIRE 13X-17 534805719 GUIDEWIRE 30X-39 1214805727 GUIDEWIRE 195X-254 7864805735 CATH GUIDING 254X-331 10244805743 CATH GUIDING 331X-431 13344805750 CATH GUIDING 431X-561 17364805768 CATH GUIDING 561X-730 22594805776 CATH GUIDING 730X-949 29384805784 CATH OTHER 10-13 404805792 CATH OTHER 150X-195 6044805800 CATH OTHER 2087X-2714 84024805818 INTRO EP FC PEEL 51X-67 2074805826 INTRO SHTH OTH 254X-331 10244805834 LEAD ICD DUAL 4588X-5965 184684805842 LEAD ICD SNGL 3529X-4588 142054805859 INST/SUPP STERL 23X-30 934805867 KIT/PACK DISP 331X-431 13344805875 KIT/PACK DISP 730X-949 29384805883 ADPT/EXT LEAD 561X-730 22594805891 INST/SUPP STERL 17X-23 704805900 CATH OTHER 23X-30 934805910 CATH ATHR ROT 2714X-3529 109254805920 ICD SINGLE 11090X-12199 407564805933 THROMBECTOMY CORON MECHAN 109764805941 LT HRT CTH VENTRICULGRPHY 188614805942 STNT PLC TRANSCTH ART INI 273194805943 STNT PLC TRANSCTH ART ADD 224394805944 STNT PLC TRANSC VEIN INI 273194805945 STNT PLC TRANSC VEIN ADD 224394805946 PACEMKR LEAD TEMP150X-195 6044805947 REVAS TIB PERON ATHER INI 362704805948 REVAS TIB PERON ATHER ADD 165884805949 REVAS TIB PERON STENT ADD 143394805950 REVAS TIB PERON STENT INI 359884805951 REVAS TIB PR STNT ATH INI 390814805952 REVAS TIB PR STNT ATH ADD 196814818198 I&D HEMATOMA/SEROMA/FLUID 43424818199 CATH OTHER 1234X-1605 49684818200 CATH GUIDING 2087X-2714 84024818202 NON JOINT IMP 3529X-4588 142054818203 PACU STANDARD 1ST 30MIN 7914818204 PACU STANDARD ADDL 15MIN 277

4818205 PACU COMPLEX 1ST 30MIN 10284818206 PACU COMPLEX ADDL 15MIN 3594818207 REVISION PACEMAKER POCKET 79804818208 EP EVAL DEFIB TRANSV PROG 32954818209 HEPARIN FL PF 1KU/500MLIV 784818210 LEAD LT VENTRC 3529X-4588 142054818211 EVENT REC CARD 4588X-5965 184684818212 DEFIB SUBQ INS/REP W LEAD 1028524818213 LEAD SUBQ DEFIB INSERT 215154818214 DEFIB SUBQ LEAD REMOVAL 77154818215 DEFIB&/OR LEAD SUBQ REPOS 77154818216 TRANSCTH RPR MITRAL INIT 65604818217 TRANSCTH RPR MITRAL ADDL 65604818218 THORACOSTOMY TUBE 13234818219 ICD NOT S/D 7755X-10082 312154818220 PACEMKER INS TEMP DUAL 215224818221 STENT NCOV W 1605X-2087 64614818223 LEAD PMKR NO VDD254X-331 10244818224 PACEMKR SNG RR 1234X-1605 49684818225 PACEMKR SNG RR 1605X-2087 64614818226 CATH ATHR ROT 3529X-4588 142054818227 ADPT/EXT LEAD 115X-150 4644818228 ADPT/EXT LEAD 195X-254 7864818229 ADPT/EXT LEAD 67X-88 2714818230 CLOSURE IMPLNT 23X-30 934818231 INST/SUPP NONST 431X-561 17364818232 INST/SUPP STERL 115X-150 4644818233 INST/SUPP STERL 331X-431 13344818234 INST/SUPP STERL 949X-1234 38204818235 INTRO EP FC PEEL 195X-254 7864818236 INTRO SHTH OTH 331X-431 13344818237 INTRO SHTH OTH 51X-67 2074818238 NON JOINT IMP 10-13 404818239 NON JOINT IMP 17X-23 704818240 NON JOINT IMP 30X-39 1214818241 NON JOINT IMP 39X-51 1584818242 NON JOINT IMP 67X-88 2714818243 NON JOINT IMP 730X-949 29384818244 ADPT/EXT LEAD 431X-561 17364818245 CATH OCCLUSION 88X-115 3554818246 CLOSURE IMPLNT 30X-39 1214818247 EVENT REC CARD 1605X-2087 64614818248 EVENT REC CARD 2714X-3529 109254818249 ICD DUAL 11090X-12199 407564818250 ICD DUAL 5965X-7755 240104818251 ICD DUAL 7755X-10082 312154818252 ICD NOT S/D 10082X-11090 37051

4818253 ICD NOT S/D 11090X-12199 407564818254 ICD NOT S/D 12199X-13419 448324818255 ICD NOT S/D 14761X-16237 542474818256 ICD NOT S/D 16237X-17861 596724818257 ICD SINGLE 10082X-11090 370514818258 ICD SINGLE 17861X-19647 656394818259 ICD SINGLE 21611X-23772 794204818260 ICD SINGLE 5965X-7755 240104818261 ICD SINGLE 7755X-10082 312154818262 INST/SUPP NONST 150X-195 6044818263 INST/SUPP STERL 195X-254 7864818264 INTRO EP FC NPL 431X-561 17364818265 INTRO EP FC PEEL 254X-331 10244818266 INTRO EP FC PEEL 39X-51 1584818267 INTRO EP FC PEEL 431X-561 17364818268 KIT/PACK DISP 67X-88 2714818269 LEAD ICD DUAL 2087X-2714 84024818270 LEAD ICD DUAL 2714X-3529 109254818271 LEAD ICD OTHER 3529X-4588 142054818272 LEAD ICD SNGL 2087X-2714 84024818273 LEAD ICD SNGL 2714X-3529 109254818274 LEAD LT VENTRC 1234X-1605 49684818275 LEAD LT VENTRC 730X-949 29384818276 LEAD PMKR NO VDD 331X-431 13344818277 LEAD PMKR TRN VDD431X-561 17364818278 NON JOINT IMP 561X-730 22594818279 PACEMKR DUAL RR1605X-2087 64614818280 PACEMKR DUAL RR2087X-2714 84024818281 PACEMKR OTHR 3529X-4588 142054818282 PACEMKR OTHR 4588X-5965 184684818283 PACEMKR SNG RR 2087X-2714 84024818284 INST/SUPP STERL 150X-195 6044818285 NON JOINT IMP 88X-115 3554818286 ICD NOT S/D 13419X-14761 493154818287 CATH PTA DC 1234X-1605 49684818289 THROMBOLYS ART INIT DAY 20424818290 THROMBOLYS VEN INIT DAY 20424818291 THROMBOLYS SUBSEQUENT DAY 72594818292 THROMBOLYS FINAL DAY 72594818293 ENDO INTR PRLNG AD RX INI 146914818294 ENDO INTR PRLNG AD RX ADD 146914818295 KIT/PACK DISP 254X-331 10244818296 DEBR SUBQ TISS 1ST 20SQCM 9594818297 DEBR SUBQ TISS ADD 20SQCM 4134818298 DEBR SUBQ/MSCL 1ST 20SQCM 24354818299 DEBR SUBQ/MSCL ADD 20SQCM 8544818300 INTRO SHTH OTH 17X-23 70

4818301 STENT COV W 730X-949 29384818302 INTRO SHTH OTH 13X-17 534818303 INTRO SHTH OTH 431X-561 17364818304 STENT NCOV W 331X-431 13344818305 ICD DUAL 19647X-21611 722024818306 INST/SUPP NONST1234X-1605 49684818307 INST/SUPP NONST 730X-949 29384818308 PACEMKR SNG RR 4588X-5965 184684818309 INTRO CTH DIALY CIRCU BLN 227894818310 THROMB DIALY CIRCUIT BLN 241754818311 ANGIO BLN CENT DIALY SEG 227894818312 ANGIO BLN TRANS ART INI 227894818313 ANGIO BLN TRANS ART EAADD 227894818314 ANGIO BLN TRANSL VEIN INI 227894818315 ANGIO BLN TRAN VEIN EAADD 227894818316 VNT ASST DVC 23772X-26149 873624818317 MOD SEDAT <5YRS 1ST 15M 4654818318 MOD SEDAT =>5YRS 1ST 15M 5544818319 MODERATE SEDAT ADD 15MIN 4654818320 RETRV FRAC DVC 1605X-2087 64614818321 CATH INTVAS US 949X-1234 38204818322 INS VAD ART ACCESS S&I 65604818323 REM VAD SEPARATE SESSION 55984818324 REPOS VAD W IMAG SEP SESS 55985100080 I&D ABSCESS SIMPLE 5995100090 I&D ABSCESS COMPLEX 11135100100 DEBR SUBQ TISS 1ST 20SQCM 9595100110 DEBR SUBQ/MSCL 1ST 20SQCM 24355100120 DEBR SUBQ/MUS/BONE 1ST 20 36425100130 TRIM SKIN LESION 1ST 2565100140 BIOPSY SKIN SINGLE LESION 3665100150 BIOPSY SKIN LESION EA ADD 2455100160 EXC BEN LES S/N/HF .6-1CM 26915100170 TRIM NONDYSTROPHIC NAILS 2705100180 DEBRIDE NAIL UP TO 5 2705100190 DEBRIDE NAIL 6 OR > 3455100200 AVULSION NAIL PLAT SINGLE 3525100210 EXC NAIL & MATRIX 14605100220 DRESS/DEBR BURN SMALL 4955100230 CHEMICAL CAUTERIZ TISSUE 4955100240 TRANS O2 MEAS >=3 LVL BI 8135100250 DEBR NON-SELECTIV SESSION 2545100260 NEG PRESS WD DME<=50CM 45 3415100270 NEG PRESS WD DME<=50CM 60 3415100280 NEG PRESS WD DME>50CM 45 6005100290 NEG PRESS WD DME>50CM 60 6005100300 VISIT LEVEL 1 NEW PT 265

5100310 VISIT LEVEL 2 NEW PT 5095100320 VISIT LEVEL 2 NEW W PROC 5095100330 VISIT LEVEL 3 NEW PT 7695100340 VISIT LEVEL 3 NEW W PROC 7695100350 VISIT LEVEL 4 NEW PT 9215100360 VISIT LEVEL 4 NEW W PROC 9215100370 VISIT LEVEL 5 NEW PT 12325100380 VISIT LEVEL 5 NEW W PROC 12325100390 VISIT LEVEL 1 EST PT 975100400 VISIT LEVEL 1 EST W PROC 975100410 VISIT LEVEL 2 EST PT 2605100420 VISIT LEVEL 2 EST W PROC 2605100430 VISIT LEVEL 3 EST PT 5095100440 VISIT LEVEL 3 EST W PROC 5095100450 VISIT LEVEL 4 EST PT 7895100460 VISIT LEVEL 4 EST W PROC 7895100470 VISIT LEVEL 5 EST PT 11105100480 VISIT LEVEL 5 EST W PROC 11105100490 STRAPPING UNNA BOOT 3625100500 BX BONE SUPERFIC TROC/NDL 26915100510 BX BONE TROCAR/NDL DEEP 32895100520 BX BONE OPEN SUPERFICIAL 71195100530 APLIGRF/SQCM 98.115100540 DERMAGRFT SQCM 116.685100550 HYPERBARIC O2 EACH 30 MN 6535100560 MC HBO THERAPY 1ST 15 MN 2705100570 MC HBO THPY EA ADD 15 MN 2705100630 STRAPPING UNNA BOOT BIL 3625100650 I&D HEMATOMA/SEROMA/FLUID 41045100660 I&R FB SUBQ SIMPLE 8895100670 PREP SITE FN/HF/G 1ST 100 12605100680 ASP ABSC/HEMA/CYST/BULLA 4375100690 TRIM SKIN LESION 2-4 3615100700 APPL LAYRD COMPRES BK BIL 3145100710 APPL LAYRED COMPRES BK LT 3145100720 APPL LAYRED COMPRES BK RT 3145100730 OASIS WND MATRIX/SQCM 15.685100740 PART EXC BONE PHALANX TOE 66605100750 DEBR SELCT SESSION ADD 20 2715100760 DEBR SL SESSION 1ST 20CM 5655100780 DEBR SUBQ TISS ADD 20SQCM 4135100790 DEBR SUBQ/MSCL ADD 20SQCM 8545100800 DEBR SUBQ/MUS/BONE ADD 20 15055100820 DRESS/DEBR BURN MEDIUM 10195100830 DRESS/DEBR BURN LARGE 12325100840 AP SK HI GR T/A/L<100 1ST 7565100850 AP SK HI GR T/A/L<100 ADD 151

5100860 AP SK HI GR T/A>=100 1ST 17695100870 AP SK HI GR T/A>=100 ADD 3855100880 AP SK HI GR F/N/G<100 1ST 8775100890 AP SK HI GR F/N/G<100 ADD 2195100900 AP SK HI GR F/N>=100 1ST 19355100910 AP SK HI GR F/N>=100 ADD 4845100920 APP LAYR CMPRS ARM/HND BI 3935100930 APP LAYR CMPRS ARM/HND LT 3935100940 APP LAYR CMPRS ARM/HND RT 3935100950 APPL LAYRD COMPRES ARM LT 2795100960 APPL LAYRD COMPRES ARM RT 2795100970 APPL LAYRD COMPRES LEG LT 3935100980 APPL LAYRD COMPRES LEG RT 3935100990 APPL LAYRD COMPRS ARM BIL 2795101000 APPL LAYRD COMPRS LEG BIL 3935101010 EXC S/P ULCER W/PRIM SUT 54355101020 TX DSLC HIP TRAUMA CLSD 4525101030 APPL CST LEG RIGD CONTACT 5695101040 INST/SUPP STERL 10-13 405101050 INST/SUPP STERL 13X-17 535101060 VISIT LEVEL 1 NEW W PROC 2655101070 NEG PRESS WD DME<=50CM 15 3415101080 NEG PRESS WD DME>50CM 15 6005101090 GLUCOSE BLD BY DEVICE POC 175101100 NEG PRESS WD DME<=50CM 30 3415101110 NEG PRESS WD DME>50CM 30 6005101120 STRAPPING UNNA BOOT RT 3625101130 STRAPPING UNNA BOOT LT 3625101140 TX BURN 1ST DEG INITIAL 24205101160 INSERT CATH BLADDER SMPL 3355101170 SOMATOSEN TSTNG UPP EXT 8875101180 TRANS O2 MEAS 1-2 LVL BI 5185101190 OASIS ULT TRILY MTRX/SQCM 475101191 AP SK LO GR T/A/L<100 1ST 7945101192 AP SK LO GR T/A/L<100 ADD 3765101193 AP SK LO GR T/A>=100 1ST 15555101194 AP SK LO GR T/A>=100 ADD 10215101195 AP SK LO GR F/N/G<100 1ST 10215101196 AP SK LO GR F/N/G<100 ADD 3765101197 AP SK LO GR F/N>=100 1ST 15555101198 AP SK LO GR F/N>=100 ADD 10215101199 REARRANGE TIS TRUNK <=10 7565101200 ARTHROCEN ASP MAJOR JT WO 5305101201 LR SMPL TRNK/NECK 2.6-7.5 2195101202 EXPLORE WOUND EXTREMITY 22175101203 LR CPLX TRUNK 2.6-7.5 10745101204 LR CPLX TRUNK ADD <=5 399

5101205 REMOVE SKIN TAGS <=15 2845101206 NEG PRES WD NONDME<=50 15 4555101207 NEG PRES WD NONDME<=50 30 4555101208 NEG PRES WD NONDME<=50 45 4555101209 NEG PRES WD NONDME<=50 60 4555101210 NEG PRES WD NONDME<=50 75 4555101211 NEG PRES WD NONDME<=50 90 4555101212 NEG PRES WD NON DME>50 15 4555101213 NEG PRES WD NON DME>50 30 4555101214 NEG PRES WD NON DME>50 45 4555101215 NEG PRES WD NON DME>50 60 4555101216 NEG PRES WD NON DME>50 75 4555101217 NEG PRES WD NON DME>50 90 4555101218 EPIFIX 18MM 561X-730 22595101219 EPIFIX 2X2CM 949X-1234 38205101220 EPIFIX MSH 2X3 949X-1234 38205101221 EPIFIX 4X4CM 2714X-3529 109255101222 EPIFIX 5X6CM 4588X-5965 184685101223 EPIFIX 7X7CM 7755X-10082 312155101224 EPIFIX 14MM 254X-331 10245101225 PURAPLY AM 5X5 2714X-3529 109255101226 PURAPLY AM 2X2 561X-730 22595101227 PURAPLY AM 2X4 730X-949 29385101228 PURAPLY AM 6X9 5965X-7755 240105101229 IRRIG/LAVG CERUMEN IMPACT 2335101230 EPIFIX MSH 4.5 1234X-1605 49685101231 REARRAN TIS S/A/L 10.1-30 13535101232 REMOVAL IMPLNT SUPRFICIAL 44625101233 EXC MAL LES T/A/L 2.1-3CM 12615101234 INST/SUPP STERL 195X-254 7865101235 EXC BEN LES T/A/L 2.1-3CM 12615101236 GRAFIX P 1.5X2CM 730X-949 29385101237 GRAFIX P 2X3CM 949X-1234 38205101238 GRAFIX P 3X4CM1234X-1605 49685101239 GRAFIX P 14MM 431X-561 17365101240 GRAFIX C 14MM 431X-561 17365101241 GRAFIX C 1.5X2CM 730X-949 29385101242 GRAFIX C 2X3CM 949X-1234 38205101243 GRAFIX C 3X4 1605X-2087 49685101244 GRAFIX C 16MM 431X-561 17365101245 LR SMPL FACE/EAR <=2.5 2195101246 CNTRL NOSEBLEED ANTR SMPL 3175101247 I&D ABSC PERIANAL SUPERFC 2125101248 AMPUTATE METATARSO JOINT 77355101249 I&R FB SUBQ COMPLEX 41045101250 EPIFIX 2X4CM 1234X-1605 49685101251 GRAFIX P 16MM 431X-561 1736

5101252 EPIFIX MSH 3.5 949X-1234 38205200610 ADMIN INFLUENZA VACCINE 3645200620 ADMIN OTHER IMMUN VAC ADD 1825200630 ADMIN OTHER IMMUN VAC ONE 3645200640 ADMIN PNEUMO VACCINE 3645200650 BLOOD COLLECTION PICC 3765200660 BLOOD COLLECTION VAD 3395200670 CHEMO INF EA ADD HR 4395200680 CHEMO INF EA SEQ 1ST HR 20915200690 CHEMO INF INIT 1ST HR 20915200700 CHEMO IV PUSH EA ADD 6545200710 CHEMO IV PUSH INITIAL 11715200720 CHEMO SQ/IM HORMONAL 4105200730 CHEMO SQ/IM NONHORMONAL 9505200740 INF IV HYDRA INIT 31-60MN 21705200750 INF IV HYDRAT EA ADD HR 5705200770 INF TX/DX CONCURRENT 15475200780 INF TX/DX/PRO EA ADD HR 7055200790 INF TX/DX/PRO INIT 1ST HR 25775200800 INF TX/DX/PRO SEQ 1HR 11125200810 INJ TX/DX/PRO IV PUSH SEQ 3825200820 INJ TX/DX/PRO IVPUSH INIT 3825200830 INJ TX/DX/PROPH SUBQ/IM 3825200840 INJ TX/PRO/DX IVP SME DRG 3825200850 IRRIG IMPLANTED VEN ACCES 3235200870 PICC INSERT/REPLACE RN 16775200900 VENIPUNCTURE NON LAB 225200910 VISIT LEVEL 1 EST PT 975200920 VISIT LEVEL 1 EST W PROC 975200930 VISIT LEVEL 1 NEW PT 2655200940 VISIT LEVEL 1 NEW W PROC 2655200950 VISIT LEVEL 2 EST PT 2605200960 VISIT LEVEL 2 EST W PROC 2605200970 VISIT LEVEL 2 NEW PT 5095200980 VISIT LEVEL 2 NEW W PROC 5095200990 VISIT LEVEL 3 EST PT 5095201000 VISIT LEVEL 3 EST W PROC 5095201010 VISIT LEVEL 3 NEW PT 7695201020 VISIT LEVEL 3 NEW W PROC 7695201030 VISIT LEVEL 4 EST PT 7895201040 VISIT LEVEL 4 EST W PROC 7895201050 VISIT LEVEL 4 NEW PT 9215201060 VISIT LEVEL 4 NEW W PROC 9215201070 VISIT LEVEL 5 EST PT 11105201080 VISIT LEVEL 5 EST W PROC 11105201090 VISIT LEVEL 5 NEW PT 12325201100 VISIT LEVEL 5 NEW W PROC 1232

5201110 CATH INFUSION 195X-254 7865201537 PUMP PORTABL REFILL/MAINT 5445201538 PUMP IMPLANTD REFIL/MAINT 5445201539 INF IV TX/DX PUMP PROLONG 4015201540 INJ TX/DX/PRO INTRA-ARTER 3825201541 CATH FOR SPECIMEN COLLECT 1255201542 GLUCOSE BLD BY DEVICE POC 175201543 CHEMO INJ SUBARAC/VENTRIC 18995201544 CHEMO INTRA-ART PUSH 6605201545 CHEM ART INF PUMP PROLONG 18995201546 CHEMO ADMIN THORACENTESIS 12505201547 CHEMO ADMIN INTRATHECAL 8195201548 CHEMO IV INF PUMP PROLONG 46405201549 CHEMO ART INF INIT 1ST HR 8195201550 CHEMO ART INF EA ADD HR 6605201551 VASC ACCES THROMBL DECLOT 4475201552 APHERESIS PLASM THERAPEUT 30335201553 INSERT CATH BLADDER 3195201554 PHLEBOTOMY THERAPEUT 3415201555 CATH FOR SPECIMEN COLLECT 1255201565 TRANSFUS BLOOD/COMP 1HR 10035201566 TRANSFUS BLOOD/COMP 2HR 12545201567 TRANSFUS BLOOD/COMP 3HR 15055201568 TRANSFUS BLOOD/COMP 4HR 17555201569 TRANSFUS BLOOD/COMP 5HR 20065201570 TRANSFUS BLOOD/COMP 6HR 22575201571 TRANSFUS BLOOD/COMP 7HR 25085201572 TRANSFUS BLOOD/COMP 8HR 27585201573 TRANSFUS BLOOD/COMP >8HR 30095201574 D5% 250ML INJ 785201575 D5% 500ML INJ 785201576 LACTATED RINGERS 1L INJ 785201577 LACTATED RINGERS 500MLINJ 785201578 NACL 0.45% 1000ML INJ 785201579 NACL 0.9% 1000ML INJ 785201580 NACL 0.9% 250ML INJ 785201581 NACL 0.9% 500ML INJ 785201582 ADMIN HEP B VACCINE 3646100010 MR PELVIS WO&W CON 84996100060 MR ABDOMEN W CON 59806100070 MR ABDOMEN WO&W CON 68886100080 MR ORB/FAC/NECK WO CON 35186100090 MR ORB/FAC/NECK WO&W CON 58616100100 MR ANGIO HEAD WO CON 35036100110 MR ANGIO HEAD W CON 50796100120 MR ANGIO NECK WO CON 36206100130 MR ANGIO NECK W CON 5250

6100140 MR ANGIO NECK WO&W CON 60356100150 MR BRAIN WO CON 43296100160 MR BRAIN W CON 62786100170 MR BRAIN WO&W CON 72306100171 MR BRAIN FUNCT WO PHY/PSY 36886100180 MR CHEST WO CON 64876100190 MR CHEST WO&W CON 64876100200 MR C SPINE WO CON 50706100210 MR C SPINE W CON 73526100220 MR T SPINE WO CON 50566100230 MR T SPINE W CON 73336100240 MR L SPINE WO CON 52746100250 MR L SPINE W CON 76476100260 MR C SPINE WO&W CON 84686100270 MR T SPINE WO&W CON 84456100280 MR L SPINE WO&W CON 88076100290 MR PELVIS WO CON 50996100300 MR ANGIO PELVIS W CON 30726100400 MR ABDOMEN WO CON 41246100410 MR ANGIO ABDOMEN W CON 36886100420 MR ANGIO ABDOMEN WO CON 36886100430 MR ANGIO ABDOMEN WO&W CON 36886100440 GADOLINIUM-BAS MR CON/ML 84.866100460 GADOBEN DIMEG /1ML-20MLVL 104.036100470 GADOBEN DIMEG /1ML 15MLVL 78.076100480 GADOBEN DIMEG /1ML-10MLVL 52.046100490 MR ANGIO LOW EXTR WO&W LT 16706100500 MR ANGIO LOW EXTR WO&W RT 16706100510 MR ANGIO LOW EXTREM W LT 13826100520 MR ANGIO LOW EXTREM W RT 13826100530 MR ANGIO LOW EXTREM WO LT 10296100540 MR ANGIO LOW EXTREM WO RT 10296100550 MR ANGIO UPP EXTR WO&W LT 16706100560 MR ANGIO UPP EXTR WO&W RT 16706100570 MR BREAST W CON LT 13826100580 MR BREAST W CON RT 13826100590 MR BREAST WO CON LT 10296100600 MR BREAST WO CON RT 10296100610 MR BREAST WO&W CON LT 16706100620 MR BREAST WO&W CON RT 16706100630 MR LOW EXTREM JNT W LT 52596100640 MR LOW EXTREM JNT W RT 52596100650 MR LOW EXTREM JNT WO LT 36286100660 MR LOW EXTREM JNT WO RT 36286100670 MR LOW EXTREM JNT WO&W LT 60576100680 MR LOW EXTREM JNT WO&W RT 60576100690 MR LOW EXTREM W CON LT 4565

6100700 MR LOW EXTREM W CON RT 45656100710 MR LOW EXTREM WO CON LT 31496100720 MR LOW EXTREM WO CON RT 31496100730 MR LOW EXTREM WO&W CON LT 52576100740 MR LOW EXTREM WO&W CON RT 52576100750 MR UPP EXTREM JNT W LT 52596100760 MR UPP EXTREM JNT W RT 52596100770 MR UPP EXTREM JNT WO LT 36286100780 MR UPP EXTREM JNT WO RT 36286100790 MR UPP EXTREM JNT WO&W LT 60576100800 MR UPP EXTREM JNT WO&W RT 60576100810 MR UPP EXTREM W CON LT 19586100820 MR UPP EXTREM W CON RT 19586100830 MR UPP EXTREM WO CON LT 25846100840 MR UPP EXTREM WO CON RT 25846100850 MR UPP EXTREM WO&W CON LT 45406100860 MR UPP EXTREM WO&W CON RT 45406100870 MR ANGIO LOW EXTREM WO BI 15446100880 MR ANGIO PELVIS WO&W CON 16706100910 MR BREAST W CON BIL 13826100930 MR TELERADIOGRPY/EXAM NC 0 16100940 MR LOW EXTREM JNT WO LTD 36286100950 MR TMJ(S) UNI OR BIL 10296100970 MR ANGIO HEAD WO&W CON 58506100980 MR ANGIO CHEST W CON 13826100990 MR ANGIO SPINE WO&W CON 16706101000 MR ORB/FAC/NECK W CON 50996101010 MR CHEST W CON 13826101030 MR ANGIO CHEST WO CON 10296101050 MR BREAST WO&W CON BIL 16706101110 MR 3D WO SEPARATE WKSTATN 2506101130 MR BREAST WO CON BIL 10296101160 MR ANGIO CHEST WO&W CON 16706101170 MR PELVIS W CON 73946101180 MR GUIDED NDL BX/ASP/INJ 16746101190 MR CHOLANGIO MRCP WO CON 16746101191 MR CHOLANGIO MRCP W CON 59806101192 MR CHOLANGIO MRCP WO CON 41246101193 MR CHOLANGI MRCP WO&WCON 68886101194 BX BREAST MRI PERC 1ST 44106101196 BX BREAST MRI PERC EA ADD 44106101197 PLC BRST LOC DEV MRI 1ST 30956101199 PLC BRST LOC DEV MRI ADD 30956101200 MR CAD BREAST DATA ANALY 466101201 MR ANGIO LOW EXTREM W BIL 20736300018 aprepitant 80 mg Cap 5896300020 Fluzone Quadrival. influenza virus vac 195

6300021 IJPEDS influenza quadriv. (age 6-35 1266300100 ADMIN HEP B VACCINE 3646300101 ADMIN INFLUENZA VACCINE 3646300102 ADMIN OTHER IMMUN VAC ADD 3646300103 ADMIN OTHER IMMUN VAC ONE 3646300104 ADMIN PNEUMO VACCINE 3646300230 acebutolol 200 mg Cap 56300255 acetaminophen 325 mg Supp 26300263 acetaminophen 120 mg Supp 26300271 acetaminophen 650 mg Supp 26300289 acetaminophen 325 mg Tab 26300297 acetaminophen 500 mg Tab 26300313 acetaminophen 80 mg Chew Tab 26300347 acetaZOLAMIDE 250 mg Tab 46300354 acetaZOLAMIDE 500 mg ER Cap 336300362 acyclovir 200 mg Cap 66300370 alginic acid/Al hyd/Mg tris (80-20m 26300396 albuterol 2 mg Tab 276300412 allopurinol 100 mg Tab 46300420 allopurinol 300 mg Tab 46300446 amantadine 100 mg Cap 106300453 aMILoride 5 mg Tab 66300479 aminocaproic acid 500 mg Tab 366300511 amiodarone 200 mg Tab 166300537 amitriptyline 25 mg Tab 46300545 amitriptyline 50 mg Tab 56300552 amitriptyline 75 mg Tab 96300560 amitriptyline 10 mg Tab 46300610 amoxicillin 250 mg Cap 46300628 amoxicillin 500 mg Cap 46300644 amoxicillin/clav (500/125) mg Tab 86300669 ampicillin 500 mg Cap 46300677 atropine/hyoscym/phenob/scopolam 226300685 phenyleph/shrk lv/coco but/corn oil 26300719 ascorbic acid 500 mg Tab 26300750 aspirin 300 mg Supp 36300768 aspirin 600 mg Supp 36300792 aspirin/citric acid/Na bicarb (alka-sel 26300800 aspirin buffered 325 mg Tab 26300818 aspirin 81 mg Chew Tab 26300826 aspirin 325 mg EC Tab 26300834 atenolol 100 mg Tab 76300842 atenolol 50 mg Tab 46300875 baclofen 10 mg Tab 126300917 benztropine 2 mg Tab 46300925 bethanechol 10 mg Tab 106300933 bethanechol 25 mg Tab 13

6300966 bisacodyl 10 mg Supp 26300974 bisacodyl 5 mg EC Tab 26300982 bromocriptine 2.5 mg Tab 296300990 bumetanide 1 mg Tab 46301014 busPIRone 5 mg Tab 46301022 busPIRone 10 mg Tab 76301030 calcitriol (vit D) 0.25 mcg Cap 66301055 calcium carbonate 1250 (500 mg ele 26301089 calcium gluconate 500 mg Tab 26301139 captopril 12.5 mg Tab 86301147 captopril 25 mg Tab 46301154 captopril 50 mg Tab 66301170 carBAMazepine 200 mg Tab 86301188 carBAMazepine 100 mg Chew Tab 46301196 carbidopa/levodopa (10/100) mg Ta 66301204 carbidopa/levodopa (25/100) mg EXT 56301212 carbidopa/levodopa (25/250) mg Ta 56301220 carisoprodol 350 mg Tab 96301253 cefaclor 250mg Cap 166301287 cephalexin monohydrate 500 mg Ca 46301345 chlorpheniramine 4 mg Tab 26301352 chlorproMAZINE 25 mg Tab 106301360 chlorproMAZINE 50 mg Tab 146301394 chlorproMAZINE 10 mg Tab 76301410 chlorthalidone 25 mg Tab 56301501 ciprofloxacin 500 mg Tab 226301527 clindamycin 150 mg Cap 66301543 cloNIDine 0.1 mg Tab 46301550 cloNIDine 0.2 mg Tab 166301568 cloNIDine 0.3 mg Tab 46301576 clotrimazole 10 mg Loz 86301642 estrogens, conjugated 0.3 mg Tab 156301675 cortisone 25 mg Tab 156301685 neomycin/polymyxin B/HC otic 10mL 1396301709 cyclobenzaprine 10 mg Tab 56301717 cyproheptadine 4 mg Tab 46301766 dantrolene 25 mg Cap 56301774 demeclocycline 300 mg Tab 966301790 desipramine 10 mg Tab 66301816 desipramine 50 mg Tab 136301857 dexamethasone 2 mg Tab 46301881 dexamethasone 4 mg Tab 46301899 diclofenac sodium 50 mg EC Tab 56301915 dicloxacillin 250 mg Cap 46301931 dicyclomine 10 mg Cap 46301949 dicyclomine 20 mg Tab 46301972 diflunisal 500mg Tab 8

6301998 digoxin 0.125 mg Tab 76302004 digoxin 0.25 mg Tab 76302020 diltiaZEM 30 mg Tab 46302038 diltiaZEM 60 mg Tab 46302053 diphenhydrAMINE 25 mg Cap 26302079 dipyridamole 25 mg Tab 56302103 disopyramide 100 mg Cap 46302111 disopyramide 150 mg Cap 46302152 divalproex sodium 250 mg DR Tab 146302178 docusate sodium 100 mg Cap 26302186 docusate sodium 250 mg Cap 26302194 doxepin 10 mg Cap 46302202 doxepin 25 mg Cap 46302210 doxepin 50 mg Cap 56302285 enalapril 5 mg Tab 96302293 enalapril 10 mg Tab 96302301 enalapril 20 mg Tab 136302319 ergocalciferol 50,000 Unit (1.25mg) 86302376 erythromycin stearate 250 mg Tab 236302418 estropipate 0.75 mg Tab 46302426 estropipate 1.5 mg Tab 66302459 ethambutol 400 mg Tab 96302509 famotidine 20 mg Tab 86302525 ferrous fumarate 50 mg ER Tab 26302590 flavoxATE 100 mg Tab 76302608 flecainide 100 mg Tab 136302624 fludrocortisone 0.1 mg Tab 46302665 fluPHENAZine 5 mg Tab 66302699 folic acid 1 mg Tab 46302707 furosemide 20 mg Tab 46302715 furosemide 40 mg Tab 46302731 glipiZIDE 5 mg ER Tab 46302749 glipiZIDE 10 mg Tab 46302764 glyBURIDE 5 mg Tab 46302772 glyBURIDE 2.5 mg Tab 46302780 glycerin adult Supp 26302798 glycerin pediatric Supp 86302806 glycopyrrolate 1 mg Tab 326302863 haloperidol 1 mg Tab 46302871 haloperidol 2 mg Tab 56302889 haloperidol 5 mg Tab 56302897 hydrocortisone 25 mg Supp 46302905 HCTZ/triamterene (25/37.5) mg Cap 46302913 HCTZ/triamterene (50/75) mg Tab 56302939 hydrALAZINE 25 mg Tab 46302954 hydrALAZINE 10 mg Tab 46302962 hydrochlorothiazide 25 mg Tab 4

6302996 hydrocortisone 5 mg Tab 46303002 hydrocortisone 10 mg Tab 56303010 hydroxychloroquine 200 mg Tab 56303028 hydroxyurea 500 mg Cap (Hydrea) 106303036 hydrOXYzine HCl 10 mg Tab 46303044 hydrOXYzine pamoate 25 mg Cap 46303093 ibuprofen 800 mg Tab 46303119 ibuprofen 600 mg Tab 46303127 ibuprofen 400 mg Tab 46303135 ibuprofen 200 mg Tab 26303150 imipramine HCl 25 mg Tab 46303176 indapamide 2.5 mg Tab 76303184 indomethacin 50 mg Supp 766303192 indomethacin 25 mg Cap 46303218 indomethacin 75 mg ER Cap 146303242 isoniazid 300 mg Tab 46303267 isosorbide dinitrate 5 mg Tab 56303275 isosorbide dinitrate 20 mg Tab 76303283 isosorbide dinitrate 10 mg Tab 46303309 ketoconazole 200 mg Tab 156303333 labetalol 200 mg Tab 46303341 labetalol 100 mg Tab 46303374 levothyroxine 25 mcg (0.025 mg) Tab 46303382 levothyroxine 50 mcg (0.05 mg) Tab 46303390 levothyroxine 100 mcg (0.1 mg) Tab 46303408 levothyroxine 150 mcg (0.15 mg) Tab 56303416 levothyroxine 175 mcg (0.175 mg) T 46303424 levothyroxine 200 mcg (0.2 mg) Tab 46303440 levothyroxine 125 mcg (0.125 mg) T 56303457 levothyroxine 75 mcg (0.075 mg) Tab 56303481 lisinopril 5 mg Tab 56303507 lisinopril 20 mg Tab 56303515 lithium carbonate 300 mg Cap 46303523 loperamide 2 mg Cap 46303614 magnesium gluconate 500mg tab 26303671 meclizine 25 mg Tab 26303705 medroxyPROGESTERone 2.5 mg Tab 46303788 methenamine mandelate 1 gm Tab 86303812 methimazole 5 mg Tab 46303820 methocarbamol 500 mg Tab 46303838 methocarbamol 750 mg Tab 46303846 methyldopa 250 mg Tab 46303879 methylergonovine 0.2 mg Tab 1266303903 metoclopramide 10 mg Tab 46303911 metolazone 5 mg Tab 46303929 metolazone 2.5 mg Tab 96303952 metoprolol 100 mg IMMediate Relea 4

6303960 metroNIDAZOLE 250 mg Tab 46303978 metroNIDAZOLE 500 mg Tab 66303994 mexiletine 150 mg Cap 126304026 minocycline 100 mg Cap 166304034 minoxidil 10 mg Tab 66304042 minoxidil 2.5 mg Tab 86304067 multivitamins tab (Theragran equiv) 26304075 Theragran M (multivitamin with mine 26304117 naproxen 375 mg Tab 56304125 naproxen 500 mg Tab 76304133 naproxen 250 mg Tab 56304208 niacin (vitamin B3) 100mg Tab 26304224 niacin (vitamin B3) 500mg Tab 26304240 NIFEdipine 10 mg Cap 66304257 nitrofurantoin macrocry-monohydra 186304273 nitrofurantoin macrocrystals 100 mg 176304331 nortriptyline 25 mg Cap 46304364 oxybutynin 5 mg Tab 46304422 penicillin VK 500 mg Tab 46304455 pentoxifylline 400 mg ER Tab 76304505 phenazopyridine 100 mg Tab 46304513 phenazopyridine 200 mg Tab 56304547 phenoxybenzamine 10 mg Cap 6086304554 phenytoin 30 mg ER Kapseals 46304562 phenytoin 100 mg ER Kapseals 46304570 phenytoin 50 mg Chew Tab 56304588 phytonadione (vit K) 5 mg Tab 1996304620 potassium chloride 8 mEq ER Tab 46304653 prazosin 1 mg Cap 46304687 predniSONE 5 mg Tab 46304695 predniSONE 1 mg Tab 46304703 predniSONE 10 mg Tab 46304711 predniSONE 20 mg Tab 46304729 predniSONE 50 mg Tab 46304760 primaquine 26.3 mg (15 mg base) Ta 106304778 primidone 250 mg Tab 56304786 primidone 50 mg Tab 46304794 probenecid 500 mg Tab 56304851 prochlorperazine 25 mg Supp 616304869 prochlorperazine 5 mg Tab 46304877 prochlorperazine 10 mg Tab 56304893 promethazine 12.5 mg Supp 186304919 promethazine 50 mg Supp 1616304927 promethazine 25 mg Supp 806304943 promethazine 25 mg Tab 46304950 propantheline 15 mg Tab 46304968 propranolol 40 mg Tab 4

6304984 propranolol 80 mg ER Cap 116305023 propranolol 10 mg Tab 46305031 propranolol 20 mg Tab 46305049 propylthiouracil 50 mg Tab 46305098 pseudoePHEDrine 30 mg Tab 26305122 pyrazinamide 500 mg Tab 146305130 pyridostigmine 60 mg Tab 226305148 pyridostigmine 180mg ER tab 416305155 pyridoxine 100 mg Tab 26305163 pyridoxine 50 mg Tab 26305205 quiNIDine sulfate 200 mg Tab 46305296 zidovudine 100 mg Cap 106305304 rifampin 300 mg Cap 236305320 salsalate 500 mg Tab 96305338 senna 8.6 mg Tab 26305346 docusate/senna (50/8.6) mg Tab 26305361 simethicone 80 mg Chew Tab 26305379 sodium bicarbonate 650 mg Tab 26305395 sodium chloride 1 gm Tab 26305452 spironolactone 100 mg Tab 76305460 spironolactone 50 mg Tab 46305478 spironolactone 25 mg tab 46305486 sucralfate 1 gm Tab 46305510 sulfASALAZINE 500 mg Tab 46305544 sulindac 200 mg Tab 66305569 terbutaline 2.5 mg Tab 46305668 theophylline 200 mg ER Tab 46305676 theophylline 300 mg ER Tab 46305692 thiamine (vitamin B1) 100 mg Tab 26305726 thioridazine 50 mg Tab 56305775 thyroid desiccated 60 mg (1gr) Tab 46305866 sulfamethoxazole/TMP (800/160) mg 96305924 traZODone 50 mg Tab 46305932 traZODone 100 mg Tab 46305940 traZODone 150 mg tab 76305965 triamterene 50 mg Cap 196305973 trifluoperazine 5 mg Tab 86306005 trihexyphenidyl 2 mg Tab 46306070 valproic acid 250 mg Cap 206306104 verapamil 80 mg Tab 46306112 verapamil 120 mg Tab 46306138 vitamin A 10,000 Unit Cap 26306153 vitamin B complex with C Tab 26306161 vitamin E 100 Unit Cap 26306187 vitamin E 400 Unit Cap 26306195 warfarin 2 mg Tab 96306203 warfarin 2.5 mg Tab 4

6306211 warfarin 5 mg Tab 106306229 warfarin 7.5 mg Tab 136306237 warfarin 10 mg Tab 146306245 zinc sulfate 220 mg(50mg Zn) Cap 26306278 EPINEPHrine, racemic 2.25% 0.5mL I 46306294 cromolyn 10 mg/mL 2mL Inh Soln 96306328 albuterol (0.083%) 2.5 mg/3 mL Inh 46306336 HYDROcod/acetamin (5/325) mg Tab 96306344 HYDROcod/acetamin (7.5/325) mg T 96306369 vitamin E 1000 Unit Cap 26306377 lidocaine topical 5% Trans Patch 366306443 sitaGLIPtin 50mg tab 526306492 ipratropium 0.02% 2.5mL Inh Soln 66306500 albuterol (0.5%) 2.5 mg/ 0.5mL Inh S 56306633 aluminum sulf/Ca acetate top pwd P 26306641 cefuroxime 250 mg Tab 206306690 cloNIDine 0.1 mg/24 hr Transd Patch 1506306708 cloNIDine 0.2 mg/24 hr Transd Patch 2516306716 cloNIDine 0.3 mg/24 hr Transd Patch 5576306724 colestipol 5 gm oral Pkt 206306799 erythromycin 0.5% ophth 1gm Oint 466306815 estradiol 0.05mg/24hr weekly Patch 1286306823 estradiol 0.1mg/24hr weekly Patch 1056306831 flutamide 125 mg Cap 106306849 hydrocortisone 100 mg/60 mL Enem 576306864 L. acidophilus/bulgaricus 1gm Gran P 26306922 methylPREDNISolone 4 mg Tab 106306948 neomycin/polymyxin B sulfate 1mL Inj 556306963 niCARdipine 20 mg Cap 46306989 nicotine 2 mg gum (each) 26306997 niMODipine 30 mg Cap 496307003 nitroglycerin 0.6 mg/hr Transd Patch 116307011 nitroglycerin 0.1 mg/hr Transd Patch 96307029 nitrofurantoin macrocrystals 50 mg 166307037 nitroglycerin 0.2 mg/hr Transd Patch 96307045 nitroglycerin 0.3 mg/hr Transd Patch 246307110 pindolol 5 mg Tab 66307144 FLUoxetine 20 mg Cap 126307151 psyllium 3.4gm/dose UD Pkt 26307169 mesalamine 4 gm/60 mL Enema 1686307177 scopolamine 1.5 mg/3 Day Transd Pa 916307185 tetracaine 0.5% ophth 2mL Soln 446307193 theophylline 100 mg ER Tab 46307235 thrombin topical 5000 unit Pwd 3536307292 misoprostol 200 mcg Tab 66307300 potassium chloride 20 mEq ER Tab 46307318 diltiaZEM 60mg/12hours ER Cap 6

6307383 NIFEdipine 30 mg ER Tab 76307391 NIFEdipine 60 mg ER Tab 116307409 NIFEdipine 90 mg ER Tab 146307458 divalproex sodium 125 mg DR Tab 56307466 enalapril 2.5 mg Tab 76307482 selegiline 5 mg Tab 146307490 propafenone 150 mg Tab 86307540 buPROPion 100 mg Tab 56307557 lisinopril 40 mg Tab 86307599 fluconazole 100 mg Tab 986307607 fluconazole 200 mg Tab 1606307615 benzonatate 100 mg Cap 76307623 ferrous sulfate 142mg (45mg Fe) ER 26307631 dexamethasone 1 mg Tab 46307649 nitroglycerin 0.4 mg/hr Transd Patch 106307656 nadolol 20 mg Tab 166307680 dapsone 100 mg Tab 66307698 dapsone 25 mg Tab 56307706 flucytosine 250 mg Cap 1056307714 gemfibrozil 600 mg Tab 116307730 lithium carbonate 300 mg ER Tab 46307789 verapamil 180 mg ER Tab 46307797 cycloSPORINE (modified) 100 mg Ca 326307805 cycloSPORINE (non-modified) 25 mg 146307813 warfarin 1 mg Tab 96307847 nortriptyline 10 mg Cap 46307862 bacitracin 1 gm oint packet 26307870 doxazosin 1 mg Tab 56307888 doxazosin 2 mg Tab 76307896 doxazosin 4 mg Tab 76307946 misoprostol 100 mcg Tab 46307979 ondansetron 8 mg Disinteg Tab 1886308019 tolterodine 4 mg ER Cap 416308027 tolterodine 2 mg ER Cap 416308126 galantamine 4 mg Tab 146308134 leflunomide 20 mg Tab 186308167 lamoTRIgine 100 mg Tab 226308191 meloxicam 7.5 mg Tab 316308217 levothyroxine 137 mcg (0.137 mg) T 46308225 sevelamer HCL 800 mg Tab 256308258 montelukast 4 mg chew tab 266308282 emtricitabine-tenofovir 200 mg-300 2006308290 lopinavir/ritonavir (200-50) mg Tab 336308316 calcium acetate 667 mg (169 mg ele 26308340 atenolol 25 mg Tab 46308357 ramipril 5 mg Cap 106308365 ramipril 2.5 mg Cap 9

6308381 verapamil 120 mg ER Tab 46308399 acyclovir 800 mg Tab 196308407 potassium chloride 10 mEq ER Tab 46308431 benazepril 40 mg Tab 56308449 benazepril 20 mg Tab 56308464 benazepril 10 mg Tab 46308506 felodipine 5 mg ER Tab 76308548 clarithromycin 500 mg Tab 216308563 nicotine 7 mg/24 hr Transd Patch 46308571 nicotine 14 mg/24 hr Transd Patch 126308589 nicotine 21 mg/24 hr Transd Patch 126308621 carbidopa/levodopa (50/200) mg EXT 86308647 etodolac 300 mg Cap 86308662 levothyroxine 88 mcg (0.088 mg) Tab 46308670 levothyroxine 112 mcg (0.112 mg) T 46308704 terazosin 1 mg Cap 86308738 quinapril 10 mg Tab 146308746 terazosin 2 mg Cap 86308753 terazosin 5 mg Cap 86308779 metoclopramide 5 mg tab 46308845 simvastatin 20 mg Tab 176308886 nabumetone 500 mg Tab 46308910 lamiVUDine/zidovudine (150/300) m 716308928 nicotine 4 mg Gum (each) 26309017 sertraline 50 mg Tab 306309025 sertraline 100 mg Tab 306309090 metoprolol 50 mg EXTended Release 76309108 itraconazole 100 mg Cap 1006309157 flecainide 50 mg Tab 86309165 finasteride 5 mg Tab 46309181 amLODIPine 2.5 mg Tab 186309199 amLODIPine 5 mg Tab 186309207 amLODIPine 10 mg Tab 246309256 sirolimus 1 mg Tab 866309264 metoprolol 25 mg IMMediate Releas 46309298 loratadine 10 mg Tab 26309306 zolpidem 5 mg Tab 216309322 isosorbide mononitrate 20 mg Tab 46309330 clemastine 1.34 mg tab 26309389 liothyronine 5 mcg Tab 66309439 baclofen 20 mg Tab 56309447 diltiaZEM 90 mg Tab 46309504 diltiaZEM 180 mg/24 hours ER Cap 46309512 sotalol 80 mg Tab 126309546 lidocaine-prilocaine 2.5% - 2.5% top 376309553 ketorolac 10 mg Tab 66309561 gabapentin 300 mg Cap 16

6309579 gabapentin 400 mg Cap 196309587 torsemide 20 mg Tab 96309611 venlafaxine 75 mg Tab 56309637 ondansetron 8 mg Tab 1826309645 ondansetron 4 mg Tab 1076309694 ursodiol 300 mg Cap 126309702 venlafaxine 25 mg Tab 56309728 etodolac 400 mg Tab 76309744 lithium carbonate 150 mg Cap 46309769 hydrOXYzine HCl 25 mg Tab 56309793 mesalamine 250 mg ER Cap 106309819 cyanocobalamin 100 mcg Tab 26309827 warfarin 4 mg Tab 106309868 clindamycin 300 mg Cap 196309884 diltiaZEM 240 mg/24 hours ER Cap 106309892 diltiaZEM 120 mg/24 hours ER Cap 56309900 ramipril 10 mg cap 226309918 FLUoxetine 10 mg Cap 126309942 buPROPion 75 mg Tab 46309975 PARoxetine 20 mg Tab 136310007 divalproex sodium 500 mg DR Tab 156310031 venlafaxine 37.5 mg Tab 56310056 buPROPion 150 mg ER (12hr) Tab 96310106 buPROPion 150 mg XL (24hr) Tab 246310114 buPROPion 300 mg XL (24hr) Tab 296310130 memantine 5 mg Tab 56310189 amoxicillin/clav (1000/62.5) mg ER T 1816310205 fenofibrate 145 mg Tab 266310213 fenofibrate 48 mg Tab 116310288 tetracaine 0.5% ophth 15 mL Soln 486310296 SUMAtriptan 25 mg Tab 1376310346 lamiVUDine 150 mg Tab 336310361 metFORMIN 850 mg Tab 96310379 sodium biphos/sodium phos 133mL 26310429 glimepiride 2 mg Tab 46310437 glimepiride 4 mg Tab 46310478 terbinafine 250 mg Tab 1016310528 valACYclovir 500 mg Tab 376310536 traMADol 50 mg Tab 46310551 lidocaine 2% 5 mL Jelly 366310593 losartan 50 mg Tab 166310627 zafirlukast 20 mg Tab 116310635 mycophenolate mofetil 250 mg Cap 336310643 acarbose 50 mg Tab 56310650 nefazodone 100 mg Tab 86310692 calcium carbonate 500 (200 mg ele 26310718 famciclovir 250 mg Tab 42

6310726 famciclovir 500 mg Tab 826310734 Multivitamin with Minerals (Ocuvite) 26310759 nefazodone 150 mg Tab 106310783 doxylamine 25mg tab 26310791 estrogens/medroxyPROGEST (0.625-2 226310809 bicalutamide 50 mg Tab 846310817 folic acid 0.4 mg Tab 26310858 gabapentin 100 mg Cap 46310874 fexofenadine 60 mg Tab 106310890 levofloxacin 500 mg Tab 876310908 levofloxacin 250 mg Tab 676311005 risperiDONE 1 mg Tab 416311013 cetirizine 10 mg Tab 46311039 warfarin 3 mg Tab 106311047 atorvastatin 10 mg Tab 296311070 azithromycin 250 mg Tab 366311088 carvedilol 3.125 mg Tab 146311112 potass phosp/sodium phosp pwd Pkt 26311245 PARoxetine 10 mg Tab 126311252 tiZANidine 4 mg Tab 126311294 pramipexole 0.25 mg Tab 276311302 topiramate 25 mg Tab 126311310 tacrolimus 1 mg Cap 246311344 carvedilol 25 mg Tab 146311385 carvedilol 6.25 mg Tab 146311393 carvedilol 12.5 mg Tab 126311401 clopidogrel 75 mg Tab 356311427 losartan/HCTZ 50/12.5 mg tab 126311435 midodrine 5 mg Tab 116311443 montelukast 10 mg Tab 266311450 OLANZapine 5 mg Tab 46311484 tamsulosin 0.4 mg Cap 316311500 bismuth subsalicyl 262 mg Chew Tab 26311534 acyclovir 400 mg Tab 466311567 atorvastatin 20 mg Tab 436311575 citalopram 20 mg Tab 286311583 celecoxib 100 mg Cap 226311591 celecoxib 200 mg Cap 356311609 cefdinir 300mg Cap 236311617 vitamin A & D 5gm UD Oint 26311641 buPROPion 100 mg ER (12hr) Tab 216311666 QUEtiapine 25 mg Tab 216311674 risperiDONE 2 mg Tab 686311716 tolterodine 2 mg Tab 116311724 irbesartan 150 mg Tab 146311757 repaglinide 1 mg Tab 246311799 risperiDONE 0.5 mg Tab 38

6311807 risperiDONE 0.25 mg Tab 356311831 mirtazapine 30 mg Tab 136311849 mirtazapine 15 mg Tab 136311864 calcium carbonate 1500 mg (600 mg 26311880 diclofenac/misoprostol 50mg-200mc 246311906 OLANZapine 2.5 mg Tab 46311914 rOPINIRole 0.25 mg Tab 196311922 rOPINIRole 0.5 mg Tab 196311930 rOPINIRole 1 mg Tab 186311955 metFORMIN 1000mg tab 76311963 oseltamivir 75 mg Cap 606311971 SUMAtriptan 50 mg Tab 1916312003 aspirin/dipyridamole (25-200) mg ER 286312011 oxybutynin 5 mg ER Tab 146312029 pioglitazone 15 mg Tab 476312037 pioglitazone 30 mg Tab 726312045 pioglitazone 45 mg Tab 786312094 acetaminophen 80 mg Supp 26312102 fluconazole 150 mg Tab 1566312110 ca carb/vit D 500mg/200 Int Unit (2 26312128 raloxifene 60 mg Tab 286312136 cyanocobalamin 500 mcg Tab 26312193 pramipexole 1 mg Tab 276312201 fluvoxaMINE 50 mg Tab 126312219 QUEtiapine 100 mg Tab 376312276 venlafaxine 37.5 mg XR Cap 376312284 venlafaxine 150 mg XR Cap 456312292 venlafaxine 75 mg XR Cap 416312367 pentoSAN polysulfate sodium 100 m 316312508 atorvastatin 40 mg Tab 416312524 dofetilide 125 mcg Cap 266312565 OLANZapine 10 mg Tab 846312573 pantoprazole 40 mg EC Tab 406312599 topiramate 100 mg Tab 326312615 cilostazol 50mg tab 96312649 candesartan 16 mg Tab 166312706 pramipexole 0.5 mg Tab 276312722 linezolid 600 mg Tab 346312789 nitroglycerin 2% 1 gm Oint 126312813 niacin (Niaspan) 500 mg ER Tab 46312821 busPIRone 15 mg tab 106312839 niacin (Niaspan) 750 mg ER Tab 276312870 PARoxetine 12.5 mg ER Tab 266312888 fentaNYL 400 mcg Loz 1086312896 tenofovir 300 mg Tab 1586312938 efavirenz 600 mg Tab 1286312946 voriconazole 200 mg Tab 330

6312953 levETIRAcetam 500 mg Tab 166313001 desloratadine 5mg tab 236313019 fentaNYL 200 mcg Loz 856313035 metFORMIN 500 mg ER Tab 66313043 OXcarbazepine 300 mg Tab 46313068 zonisamide 100 mg Cap 106313100 metoprolol 25 mg EXTended Release 76313134 entacapone 200 mg Tab 226313142 colesevelam 625 mg Tab 126313217 anagrelide 0.5 mg Cap 386313266 exemestane 25 mg Tab 1066313357 acetamin/ASA/caff (250/250/65) mg 26313365 rivastigmine 1.5 mg Cap 206313381 ziprasidone 20 mg Cap 646313399 ziprasidone 40 mg Cap 646313480 tretinoin 10 mg Cap 1356313530 OLANZapine 5 mg Disinteg Tab 726313662 telmisartan 40 mg Tab 276313704 polyethylene glycol 3350 17gm Pwd 146313720 famotidine 10 mg Tab 26313761 ezetimibe 10 mg Tab 346313787 modafinil 100 mg Tab 1006313795 sertraline 25 mg Tab 136313803 olmesartan 5mg tab 176313811 olmesartan 20 mg Tab 216313902 imatinib 100mg Tab 3836313928 midodrine 2.5 mg Tab 66313944 progesterone 100 mg Cap 136313977 glipiZIDE 2.5 mg ER Tab 66313985 oxybutynin 10mg ER tab 156314066 dutasteride 0.5 mg Cap UD 246314082 DULoxetine 20 mg EC Cap 306314090 DULoxetine 30 mg EC Cap 366314116 divalproex sodium 250 mg EXTended 126314124 divalproex sodium 500 mg EXTended 206314140 hydrochlorothiazide 12.5 mg Cap 46314223 liothyronine 25 mcg Tab 86314272 atorvastatin 80 mg Tab 416314298 sildenafil 20 mg tab 916314371 gabapentin 600 mg Tab 286314389 metaxalone 800 mg Tab 306314397 sildenafil 25 mg Tab 1576314405 sildenafil 50mg tab 1576314421 rifaximin 200 mg Tab 806314439 cinacalcet 30 mg Tab 916314603 alfuzosin 10 mg ER Tab 196314611 valGANciclovir 450 mg Tab 293

6314629 solifenacin 5 mg Tab 406314785 budesonide 3 mg EC Cap 956314918 ALPRAZolam 1 mg Tab 96314926 ALPRAZolam 0.5 mg Tab 96314934 aspirin/butalbital/caffeine (325-50- 126314959 acetamin/butal/caff (325-50-40) mg 86314967 HYDROmorphone PCA 0.2mg/mL 50 546314975 HYDROmorphone (Dilaudid) PCA 1m 1576315048 chlordiazePOXIDE 10 mg Cap 96315055 chlordiazePOXIDE 25 mg Cap 96315071 clonazePAM 1 mg Tab 96315089 clonazePAM 0.5 mg Tab 96315113 acetamin/codeine (300/30) mg Tab 96315212 acetamin/codeine (120-12mg/5 mL) 96315220 diazePAM 2 mg Tab 96315238 diazePAM 5 mg Tab 96315261 diphenoxylate/atropine 2.5-0.025 m 96315352 homatrop/HYDROcod 1.5-5mg/5mL 5 96315386 LORazepam 0.5 mg Tab 96315394 LORazepam 2 mg Tab 96315402 LORazepam 1 mg Tab 96315436 oxazepam 15 mg Cap 96315451 oxazepam 10 mg Cap 96315485 PHENobarbital 20 mg/5 mL 5mL Elix 96315543 promethazine/cod 6.25-10mg/5mL 5 96315576 temazepam 7.5 mg Cap 456315618 temazepam 15 mg Cap 96315675 chlorphenir/hydrocod 8mg-10mg/5m 156315832 HYDROcod/acetamin (10/325) mg Ta 96315840 diphenox/atrop 2.5-0.025mg/5mL So 96315915 midazolam 2 mg/mL 5 mL Syrup 256315931 diazePAM 5 mg/mL 2mL Inj 606315949 LORazepam 2 mg/mL 1mL Inj 266315980 LORazepam 2 mg/mL 10 mL INJ 376315998 methohexital 500 mg Inj 2936316004 midazolam 5 mg/mL 2mL Inj 266316012 midazolam 5 mg/mL 1mL Inj 266316046 PHENobarbital 65 mg/mL Inj 596316053 PHENobarbital 130 mg/mL 1mL 1566316129 midazolam 1 mg/mL 2mL Inj 266316178 midazolam 1 mg/mL 10mL inj 266316210 cocaine topical 4% 4 mL Soln 7996316343 methadone 5 mg/5 mL 5mL Oral Sol 96316350 methadone 10 mg Tab 96316368 methadone 5 mg Tab 96316418 morphine 30 mg EXTended Release 96316467 morphine 15 mg IMMediate Release 9

6316475 morphine 10 mg/5 mL 5 mL Oral Sol 96316509 belladonna/opium (16.2/60) mg Sup 1406316566 morphine 60 mg EXTended Release 156316590 oxyCODONE/acetaminophen (5/325) 96316616 morphine 15 mg EXTended Release 96316624 fentaNYL 50 mcg/hr Transd Patch 1196316632 fentaNYL 25 mcg/hr Transd Patch 656316640 fentaNYL 100 mcg/hr Transd Patch 6626316657 fentaNYL 75 mcg/hr Transd Patch 1816316665 morphine 100 mg EXTended Release 236316731 oxyCODONE 20mg/mL dose 1mL Con 96316749 oxyCODONE 40 mg ER Tab 436316756 oxyCODONE 20 mg ER Tab 246316772 oxyCODONE 5 mg Tab Immediate Rel 96316806 alfentanil 500 mcg/mL 5mL Inj 856316830 fentaNYL 50 mcg/mL 2 mL Inj 266316848 fentaNYL 50 mcg/mL 10 mL Inj (titrat 266316863 HYDROmorphone 2 mg/mL 1mL Inj 266316913 meperidine 25 mg/mL 1mL Inj 266316921 meperidine 50 mg/mL 1mL Inj 266316947 meperidine 100 mg/mL 1mL Inj 266316970 morphine 8 mg/mL 1mL Inj 266316988 morphine 2 mg/mL 1mL Inj 266316996 morphine 4 mg/mL 1mL Inj 266317002 morphine 10 mg/mL 1mL Inj 266317051 morphine PF 0.5 mg/mL 10mL Inj 326317119 SUFentanil 50 mcg/mL 5mL Inj 876317127 SUFentanil 50 mcg/mL 1mL Inj 266317135 HYDROmorphone 10 mg/mL 5mL Inj (t 436317218 meperidine 10 mg/mL 50mL PCA 1466317226 HYDROmorphone 1 mg/mL 1 mL Syri 266317267 midazolam 5 mg/mL 10mL Inj (additi 456317275 oxyCODONE 10 mg ER Tab 136317291 oxyCODONE 80 mg ER Tab 816317309 fentaNYL 50 mcg/mL 20 mL Inj (non-t 266317366 pregabalin 50 mg Cap 226317374 pregabalin 75 mg Cap 226317390 azaTHIOprine 50 mg Tab 356317416 chlorambucil 2 mg Tab 516317549 fluorouracil 50 mg/mL 10 mL Inj 636317572 mechlorethamine 10 mg Inj 7676317598 megestrol acetate 40 mg Tab 56317606 melphalan 2 mg Tab 506317614 mesna 100 mg/mL 2 mL Inj 1346317622 mercaptopurine 50 mg Tab 196317655 methotrexate 2.5 mg Tab 176317671 octreotide 50 mcg/mL 1mL Inj 26

6317689 octreotide 500 mcg/mL 1mL (addtive 1796317697 procarbazine 50 mg Cap 2646317705 tamoxifen 10 mg Tab 46317721 ganciclovir 500 mg Inj 4386317747 leucovorin 5 mg Tab 116317754 leucovorin 25 mg Tab 636317762 etoposide 50 mg Cap 3196317770 leucovorin 50 mg Inj 636317796 leucovorin 100 mg Inj 636317838 vinorelbine 10 mg/mL Inj 1086317853 anastrozole 1 mg Tab 796317861 leuprolide 22.5 mg Kit 45966317879 methotrexate 25 mg/mL PF 2mL Inj 636317895 capecitabine 500 mg Tab 1596317929 temozolomide 100 mg Cap 11376317960 albumin human 25% 100mL Inj 9346317978 albumin human 5% 500mL Inj 10006317986 amino acid 10% 500 mL 786317994 ae- cefTRIAXone 2000 mg (100 N) Mi 636318018 dantrolene 20 mg Inj 4566318026 desmopressin 4 mcg/mL 10mL Inj 10446318059 hepatitis B immune globulin 5mL Inj 36206318067 hepatitis B immune globulin 1mL Inj 8276318083 interferon alfa-2b 10 milUnit Inj 10896318117 medroxyPROGESTERone 400mg/mL 1 5666318133 plasma protein fraction 5% 250 mL In 1916318141 pneumococcal 23-valent vaccine 0.5 3696318158 rabies immune globulin, human 150 23276318166 rabies immune globulin, human 150 45006318174 sodium hyaluronate 10 mg/mL ophth 8426318208 tobramycin 1.2 gm Inj 9456318240 asparaginase 10,000 Unit Inj 2976318257 bleomycin 15 Unit Inj 2426318265 carmustine 100 mg Inj 51846318273 CISplatin 10 mg Inj (50mL) 636318406 mesna 100 mg/mL 10 mL Inj 2766318414 ifosfamide 1 gm Inj 3146318430 CARBOplatin 10 mg/mL Inj 45 mL 396318471 alprostadil 500 mcg/mL 1mL Inj 4866318489 alteplase 50 mg Inj 64146318554 methylPREDNISolone Na succ 500mg I 686318562 pentamidine 300 mg Inj 5346318570 albumin human 5% 250mL Inj 5006318604 fat emulsion 20% 250 mL Inj 2426318612 pm- hetastarch 6% 30 gm Premix (50 1206318638 epoetin alfa 10,000 units/mL Inj (No 9966318646 epoetin alfa 4,000 units/mL Inj (Non 399

6318711 fat emulsion 20% 500 mL Inj 2056318729 mannitol 20% 500mL Premix 826318745 arginine 10% 300 mL Inj Premix 266318810 vancomycin 1000 mg Inj 746318851 rifampin 600 mg Inj 6146318885 methylPREDNISolone Na succ 1gm Inj 1276318901 sargramostim 500 mcg Inj 19306318919 filgrastim 300 mcg/mL Inj 16536318927 epoetin alfa 3,000 units/mL Inj (Non 2036318943 filgrastim 480 mcg/1.6 mL Inj 26316318968 flumazenil 0.1 mg/mL 10mL Inj 746318976 pamidronate 30 mg/10 mL Inj 656318992 foscarnet 24mg/mL 250mL Infus Bott 4146319024 milrinone 1 mg/mL 10mL Inj (additiv 346319032 cladribine 1 mg/mL 10 mL Inj 23496319040 alteplase 100 mg Inj 109976319073 goserelin acetate 3.6 mg Inj 22346319081 abciximab 2mg/mL 5mL Inj 45006319099 hepatitis A adult vaccine 1440 units/m 3416319131 fenoldopam 10 mg/mL 1mL Inj 9676319164 levofloxacin 750 mg/150 mL Premix 546319214 zoledronic acid 4 mg/5 mL Inj 43976319255 caffeine citrate 20 mg/mL 3mL Inj 1026319271 antivenin (crotalidae) polyvalent - ov 45006319289 thyrotropin alpha 1.1 mg Kit 45006319297 pentostatin 10 mg Inj 45006319388 ae- piperacillin/tazobactam 4500 mg 2426319396 enalapril 1.25 mg/mL 1mL Inj 266319404 enalapril 1.25 mg/mL 2mL Inj 266319412 trastuzumab 440 mg Inj (10mg) 4766319479 vinBLAStine 1 mg Inj (10mL MDV) 186319495 leuprolide 7.5 mg Kit 45006319503 dacarbazine 100mg Inj 636319552 ketorolac 15 mg/mL 1mL Inj 266319560 ketorolac 30 mg/mL 1mL Inj 266319578 ketorolac 30 mg/mL 2mL Inj 266319602 meropenem 500 mg inj 306319628 alteplase (cathflo) 2 mg Inj 5706319636 enoxaparin 120mg/0.8mL Inj 5376319644 enoxaparin 150mg/1mL 1mL Inj 6716319677 diphtheria-tetanus toxoid (Td) adult 1206319685 fondaparinux 2.5 mg/0.5 mL syringe 2466319693 ceFAZolin 1 g/50 mL in Dextrose Pre 546319701 cefTRIAXone 1,000 mg/50 mL in Dext 2136319727 clindamycin 600 mg/50mL D5W Prem 956319735 clindamycin 900 mg/50mL D5W Prem 1166319842 balanced salt intraoc irrig 500mL 131

6319875 TPN NICU 13506319891 tromethamine 3.6 gm/100 mL 500mL 13186319909 gemcitabine 200 mg Inj 636319941 fosphenytoin 50 mg/mL 10mL Inj (add 686319958 ibutilide 0.1mg/mL 10mL Inj 24436320071 poractant 80mg/mL 3mL Susp 37806320097 palivizumab 50 mg/0.5 mL Inj 45006320170 immune globulin IV 10% 5 gm/50 mL 29226320188 carmustine 7.7 mg wafer (box of 8) 1567876320196 morphine PF 10 mg/mL 20mL Inj 7026320212 DAPTOmycin (500 mg vial) 1 mg Inj 56320238 TPN Central 9006320295 pm-nitroglycerin 50 mg Premix (250D 396320303 phentolamine 5 mg Inj 8106320329 succinylcholine 20 mg/mL 10mL Inj 896320402 IDArubicin 1mg/mL 5 mL Inj 2706320428 leuprolide 3.75 mg Kit 38576320436 acyclovir 50 mg/mL 10mL Inj 816320444 amikacin 250 mg/mL 2mL Inj 376320493 triamcinolone acetonide 40mg/mL 5m 2146320519 dinoprostone topical 20 mg vaginal 82436320550 dinoprostone 10 mg vaginal insert 18206320584 pm- eptifibatide 75 mg (100S) 21956320600 Boostrix (Tdap) vaccine booster 0.5 m 2016320667 immune globulin IV 5% 5 gm/100 mL 2756320675 immune globulin IV 10 gm Inj (Polyg 45006320717 amiodarone 50 mg/mL 3mL Inj 266320725 sodium thiosulfate 250 mg/mL 50 mL 4166320758 amphotericin B liposomal 50 mg Inj 8486320774 riTUXimab 10 mg/mL 10 mL Inj 34846320808 epoetin alfa 20,000 units/mL Inj (No 19926320816 botulinum toxin type A 100 unit Inj 28416320857 dipyridamole 5 mg/mL 2mL Inj 266320865 tenecteplase 50 mg Inj 62926320956 isosulfan blue 10 mg/mL 5mL Inj 34266321004 nesiritide 1.5 mg Inj (additive) 45006321038 epoetin alfa 40,000 units/mL Inj (No 39836321061 acetaZOLAMIDE 500 mg/5 mL Inj 2256321087 aminocaproic acid 250mg/mL 20mL I 266321095 aminophylline 25mg/mL 20mL Inj 266321111 ammonia inhalant amp 0.33mL 26321145 ampicillin 500 mg Inj 266321152 ampicillin 250 mg Inj 266321160 ampicillin 1 gm Inj 276321178 ampicillin 2 gm Inj 436321186 ampicillin/sulbactam 1.5 gm Inj 266321194 ampicillin/sulbactam 3 gm Inj 42

6321210 black widow spdr antivenin 6000 unit 1466321244 atracurium 10 mg/mL 10mL Inj 876321251 atropine 0.4 mg/mL 20mL Inj 1906321269 atropine 1 mg/mL 1mL Inj 316321293 atropine 0.4 mg/mL 1mL Inj 266321368 aztreonam 2 gm Inj 3626321376 iron dextran 50 mg/mL 2mL Inj 2036321384 bacitracin 50,000 Unit Inj 606321400 benztropine 1 mg/mL 2mL Inj 2976321467 bumetanide 0.25 mg/mL 10mL Inj 266321483 bupivacaine PF 0.75% 10mL Inj 266321491 bupivacaine 0.25% 50mL Inj 266321509 bupivacaine PF 0.25% 30mL 336321533 bupivacaine PF 0.75% spinal 2mL Inj 266321574 butorphanol 1 mg/mL 1mL Inj 266321582 butorphanol 2 mg/mL 1mL Inj 266321590 caffeine/Na benzoate (125/125) mg/m 576321608 calcitonin 200 Unit/mL 2mL Inj 45006321624 calcium chloride 100 mg/mL (1.36 mE 266321632 calcium chloride 1gm/10mL syringe 266321640 calcium gluconate 100 mg/mL 10mL In 266321657 carboprost 250 mcg/mL 1mL Inj 8106321673 ceFAZolin 1 gm/50 mL NS Add-Ease 546321715 cefotaxime 1,000 mg Inj 266321756 cefOXitin 1000 mg Inj 516321764 cefOXitin 2000 mg Inj 1026321772 cefTAZidime 1,000 mg Inj 266321780 cefTAZidime 2,000 mg Inj 546321814 cefTRIAXone 1000 mg Inj 266321848 chloramphenicol na succ 1 gm Inj 1626321855 chlorothiazide 500 mg/18 mL Inj 23396321871 chlorproMAZINE 25 mg/mL 2mL Inj 1196321905 clindamycin 150 mg/mL 4mL Inj 266321921 estrogens, conjugated 25 mg Inj 9106321939 cosyntropin 0.25 mg Inj 5766321947 cyanocobalamin 1000 mcg/mL 1mL I 266321962 deferoxamine 500 mg Inj 436321970 desmopressin 4 mcg/mL 1mL Inj 3266321996 dexamethasone 4 mg/mL 5mL Inj 266322002 dexamethasone 4 mg/mL 1mL Inj 266322028 Dextrose 50% (25gm) PF 50 mL Syrin 636322051 dicyclomine 10 mg/mL 2mL Inj 1926322077 digoxin 0.25 mg/mL 2mL Inj 306322085 digoxin 100mcg/mL 1mL Inj 2956322093 dihydroergotamine 1 mg/mL 1mL Inj 3556322119 diphenhydrAMINE 50 mg/mL 1mL Inj 266322143 DOBUTamine 12.5 mg/mL 20mL Inj 26

6322150 DOPamine 40 mg/mL 5mL Inj 266322168 DOPamine 80 mg/mL 5mL Inj 266322176 DOPamine 160 mg/mL 5mL Inj 376322184 doxapram 20 mg/mL 20 mL Inj 2276322192 doxycycline 100 mg Inj 1316322242 ePHEDrine 50 mg/mL 1mL Inj 536322259 EPINEPHrine 0.1mg/mL 10mL PFS 266322283 erythromycin lactobionate 500 mg In 2346322333 ethacrynic acid 50 mg Inj 45006322358 famotidine 10 mg/mL 2 mL Inj 266322390 folic acid 5 mg/mL 10 mL Inj 1456322408 furosemide 100 mg/10mL Inj 266322416 furosemide 40mg/4mL Inj 266322424 furosemide 20mg/2mL Inj 266322440 gentamicin 40 mg/mL 2 mL Inj 266322457 gentamicin 10 mg/mL 2 mL Inj 266322481 glycopyrrolate 0.2 mg/mL 2mL Inj 266322499 glycopyrrolate 0.2 mg/mL 5mL Inj 3106322515 haloperidol 5 mg/mL 1mL Inj 446322531 heparin 5,000 Unit/mL 1mL Inj 266322572 heparin 1,000 Unit/mL 10mL Inj 416322598 heparin 1,000 unit/mL 1mL Inj (addit 266322622 hydrALAZINE 20 mg/mL 1mL Inj 4356322630 hydrocortisone 1 gm Inj 2486322648 hydrocortisone 500 mg Inj 1326322655 hydrocortisone 250 mg Inj 606322663 hydrocortisone 100 mg/2 mL Inj 346322697 imipenem-cilastatin 250 mg inj 946322705 imipenem/cilastatin 500 mg Inj 1776322713 immune globulin IM 2mL Inj 1596322721 indigo carmine 8 mg/mL 5 mL Inj 396322739 indomethacin 1 mg Inj 24846322770 insulin REGular hm (additive) 3426322804 isoproterenol 0.2 mg/mL 5mL Inj 45006322838 kanamycin 1 gm/3 mL 3mL Inj 826322861 labetalol 5 mg/mL 20 mL Inj 1416322945 lidocaine 1% MPF 2mL Inj 266322994 lidocaine 4% MPF 5mL Inj 346323000 lidocaine 2% 20 mL Inj 266323026 lidocaine 2% MPF 2mL Inj 266323067 lido 2%/epi (10 mcg/mL) 30mL Inj 266323075 lido 1%/epi (10 mcg/mL) 30mL Inj 266323091 lido 2%/epi (10 mcg/mL) 20mL Inj 266323125 IJNICU trace elements 266323133 magnesium sulfate 50% (4 mEq/mL) 2m 266323141 magnesium sulfate 50% 10mL Inj (add 906323166 mannitol 25% 50 mL Inj 54

6323174 measles/mumps/rubella vacc 0.5mL I 3046323216 methylene blue 5 mg/mL 10mL Inj 10226323224 methylene blue 10 mg/mL 1mL Inj 766323232 methylergonovine 0.2 mg/mL 1mL In 316323257 methylPREDNISolone Na succ 125mg 496323265 methylPREDNISolone Na succ 40mg/ 266323273 methylPREDNISolone(Depo) acet40m 456323281 methylPREDNISolone(Depo) acet80m 786323307 metoclopramide 5 mg/mL 2mL Inj 266323315 metoprolol 1 mg/mL 5mL Inj 266323331 midazolam 1 mg/mL 5mL Inj 266323349 multivitamin 10mL Inj 426323356 nafcillin 1 gm Inj 656323364 nafcillin 2 gm Inj 1576323414 nalOXone 0.4 mg/mL 1mL Inj 1196323422 nalOXone 1 mg/mL 2mL Syr Inj 1796323448 neostigmine 1 mg/mL 1mL inj 16323455 neostigmine 0.5 mg/mL 10mL Inj 536323505 nitroglycerin 5 mg/mL 10 mL Inj 406323513 nitroprusside 25 mg/ml 2ml Inj 45006323521 norEPINEPHrine 1 mg/mL 4ml Inj (add 826323547 orphenadrine 30 mg/mL 2 mL Inj 1026323554 oxytocin 10 Unit/mL 1mL Inj 266323562 pancuronium 1 mg/mL 10mL Inj 266323570 papaverine 30 mg/mL 2mL Inj 646323646 penicillin G potassium 20 mil Unit Inj 1446323653 penicillin G potassium 5 mil Unit Inj 1906323687 phenylephrine 10 mg/mL 1mL Inj 266323695 phenytoin 50 mg/mL 5 mL Inj (additi 266323703 phenytoin 50 mg/mL 2 mL Inj 266323711 physostigmine 1 mg/mL 2 mL Inj 276323729 phytonadione (vit K) 10 mg/mL 1mL I 1516323737 phytonadione (vit K) 1 mg/0.5mL 0.5 266323745 polymyxin B 500,000 Units Inj 616323752 sodium acetate 2 mEq/mL 20 mL Inj ( 266323760 potassium chloride 2 mEq/mL 20 mL 266323778 potassium chloride 2 mEq/mL 10 mL 266323810 procainamide 500 mg/mL 2mL Inj 2466323836 prochlorperazine 5 mg/mL 2 mL Inj 1006323869 promethazine 25 mg/mL 1mL Inj 266323885 propranolol 1 mg/mL Inj (additive) 456323893 protamine 10 mg/mL 25 mL Inj 1466323901 protamine 10 mg/mL 5 mL Inj 496323927 pyridostigmine 5mg/mL 2 mL Inj 1586323935 pyridoxine (vitamin B6) 100 mg/mL I 516323968 scopolamine 0.4 mg/mL 1mL Inj 436323976 sincalide 5 mcg Inj 451

6323992 sodium bicarb 4.2% 0.5mEq/mL 5mL In 266324008 sodium bicarb 4.2% 0.5mEq/mL 10mL I 286324016 sodium bicarb 8.4% 1mEq/mL 10mL In 266324024 sodium bicarb 8.4% 1mEq/mL 50mL I 296324040 sodium chloride concentrated 23.4% 266324057 sodium chloride 0.9% 50mL 546324107 terbutaline 1 mg/mL 1mL Inj 986324131 tetanus immune globulin 250 Unit Sy 13826324149 thiamine (vitamin B1) 100 mg/mL 2mL 566324180 tobramycin 40 mg/mL 2mL Inj 266324198 sulfamethoxazole/TMP 80-16mg/mL 266324206 sulfamethoxazole/TMP 80-16mg/mL 456324222 triamcinolone acetonide 10mg/mL 5m 586324321 vancomycin 500 mg Inj 266324347 vasopressin 20 Unit/mL 1mL 2686324362 vecuronium 1 mg/mL 10 mL SW Inj 336324370 verapamil 2.5 mg/mL 2mL Inj 1436324396 trace elements 1mL Inj 406324412 cefTRIAXone 500 mg Inj 436324446 epoetin alfa 2,000 units/mL Inj (Non 2096324453 clindamycin 150 mg/mL 6mL Inj 266324495 Diprivan (sulfite free) 10 mg/mL 20 m 886324529 selenium 40 mcg/mL 10 mL Inj (addit 266324545 esmolol 10 mg/mL 10 mL Inj 1056324552 dexamethasone 10 mg/mL 1mL Inj 266324586 lidocaine 2% 10mL Inj 266324610 zinc sulfate 1 mg/mL 10mL Inj 266324677 dextrose 25% (2.5 gm) Syr 10 mL 386324719 pm-propofol 500mg Premix (50S) 766324768 diltiaZEM 5 mg/mL 5mL Inj 266324776 diltiaZEM 5 mg/mL 10 mL Inj 266324792 calcitriol 1 mcg/mL 1mL Inj 346324826 diphtheria-tetanus toxoids (DT) 0.5m 1986324834 EPINEPHrine 1 mg/mL 30 mL Inj 386324842 etomidate 2 mg/mL 10 mL Inj 366324859 etomidate 2 mg/mL 20 mL Inj 306324875 SUMAtriptan 6 mg/0.5 mL 0.5mL Inj 5056324883 sod ferric gluconate cmplx 62.5mg/5 1726324925 flumazenil 0.1 mg/mL 5mL Inj 376324941 cisatracurium 2 mg/mL 10mL Inj 1316324974 paricalcitol 5 mcg/mL 1 mL Inj 2736324990 bortezomib 3.5 mg Inj 45006325054 octreotide 100 mcg/mL 1mL Inj 546325104 enoxaparin 30mg/0.3mL Inj 1346325138 zidovudine 10 mg/mL 20mL Inj 1286325153 cefotaxime 500 mg Inj 266325161 levofloxacin 25 mg/mL 20mL Inj 202

6325286 dornase alfa 1 mg/mL 2.5mL neb sol 4346325310 RHo (D) immune globulin 300 mcg/2 9036325328 valproic acid 100 mg/mL 5mL Inj 376325336 varicella virus vaccine Inj 5246325344 poliovirus vaccine inactivated 0.5mL 1486325351 levofloxacin 250 mg/50 mL Premix 546325369 enoxaparin 60mg/0.6mL Inj 2696325377 levofloxacin 500 mg/100 mL Premix 546325385 rocuronium 10 mg/mL 5 mL Inj 1156325401 cefepime 1000 mg Inj 316325419 vecuronium 1mg/mL 20 mL Inj 546325450 diltiaZEM 5 mg/mL 25 mL Inj (additiv 376325468 pm-propofol 1000mg Premix (100S) 1446325476 enoxaparin 100mg/mL 1mL Inj 4486325518 niCARdipine 2.5 mg/mL 10mL Inj (add 926325567 potassium phosphate 3mmol P/mL 15m 266325575 ketamine 50 mg/mL 10 mL Inj 266325583 cycloSPORINE 50 mg/mL 5 mL Inj 2136325609 pancuronium 2 mg/mL 2mL Inj 266325633 bupivacaine 0.5% 50mL Inj 266325641 lidocaine 2% (20mg/mL) PF 5mL Inj 266325674 piperacillin/tazobactam 4.5 gm Inj 1196325682 piperacillin/tazobactam 3.375 gm Inj 946325716 medroxyPROGESTERone 150mg/ml 1m 3106325773 tuberculin purif prot deriv 5 unit/0.1 266325781 EPINEPHrine 0.3 mg Kit (autoinjector 8396325849 epoprostenol 0.5 mg Inj (Flolan) 866325864 hepatitis A Pediatric vaccine 25 units 1716325880 fosphenytoin 50 mg/mL 2mL Inj 266325906 ropivacaine (0.2%) 2 mg/mL 100 mL I 2206325914 magnesium sulfate 4 gm/ 100mL pre 546325948 azithromycin 500 mg Inj 566325971 enoxaparin 40mg/0.4 mL Inj 1796325989 haemoph b/tetanus tox 10-24 mcg/0. 1416326003 eptifibatide 2 mg/mL 10 mL Inj 7026326029 piperacillin/tazobactam 2.25 gm Inj 636326037 enoxaparin 80mg/0.8mL Inj 3586326045 sodium chloride 0.9% bact 30 mL Inj 266326060 linezolid 600 mg/300 mL Premix 4326326094 cefepime 2000 mg Inj 1826326102 pantoprazole 40 mg Inj (additive) 266326136 pm-milrinone 20 mg (100D) 836326144 voriconazole 200 mg Inj 8066326185 oprelvekin 5 mg Inj 13776326201 bivalirudin 250 mg Inj 45006326219 bupivacaine PF 0.5% 10mL Inj 266326227 ziprasidone 20 mg/1 mL SW Inj 129

6326235 ertapenem 1 gm Inj 4226326268 tigecycline 50 mg Inj 4856326276 mycophenolate mofetil 500 mg Inj 4146326292 meningococcal polysac vaccine (A,C 6336326359 ciprofloxacin 400 mg/200 mL D5W P 266326392 DOXOrubicin 2 mg/mL 25 mL Inj 1746326409 decitabine 5 mg/mL 10mL Inj 45006326417 ropivacaine 1 % (10mg/ml) 20ml Inj 1236326458 adenosine 3 mg/mL 30mL (additive) I 17646326466 PACLitaxel protein-bound 100 mg Inj 45006326474 cefOXitin 1000 mg/50 mL D5W Prem 586326482 cefOXitin 2000 mg/50 mL D5W Prem 1066326490 dexmedetomidine 100 mcg/mL 2mL I 4666326508 octreotide 30 mg Kit 64736326516 fomepizole 1 gm/mL 1.5mL Inj 45006326524 iohexol 300 mg/mL 50mL Inj 2616326557 famotidine 20 mg/ NS 50 mL premix 546326581 fluconazole/NS 200 mg/100 mL Prem 496326599 fluconazole/NS 400 mg/200 mL Prem 996326607 acetylcysteine 20% 30mL (additive) S 8816326631 glycopyrrolate 0.2 mg/mL 20mL Inj 11426326649 pegfilgrastim 6 mg/0.6 mL INJ 92816326698 ondansetron 2 mg/mL Inj 2 mL (addit 266326714 rabies vacc 2.5 Unit/1mL Inj (RabAver 15146326755 albuterol (0.5%) 20mL Inh Soln 876326789 atropine 1% opth 3.5 gm Oint 906326797 hydrocortisone 2.5% 30 gm rectal C 4226326813 azelastine nasal 0.1% 30mL spray 6056326847 bacitracin/polymyxin B 3.5gm ophth 1296326854 bacitracin ophth 3.5 gm Oint 906326862 bacitracin 30 gm Oint 96326870 bacitracin/polymyxin B 0.94gm UD O 26326961 SUMAtriptan 20 mg nasal spray 2176326987 tiotropium 18 mcg Cap Inhal #5's 3296327019 clobetasol 0.05% 30 gm Crm 1626327068 clotrimazole 1% 30 gm Crm 386327076 clotrimazole/betamethasone 45gm 2876327118 cycloSPORINE non-modified (Sand 26526327175 dibucaine 1% 30 gm Oint 96327183 econazole nitrate 1% cream 30 gm 1406327209 erythromycin 0.5% ophth 3.5 gm Oin 846327308 fluocinonide 0.05% 30 gm Crm 4106327316 fluocinonide 0.05% 15 gm Oint 1296327373 gentamicin 0.1% 15 gm Oint 1416327381 gentamicin 0.3% ophth 3.5 gm Oint 896327415 hydrocortisone 0.5% 30 gm Crm 66327423 hydrocortisone 1% 30 gm Oint 33

6327472 azelastine 0.05% ophth 6ml Soln 6266327514 sterile talc powder 5gm 3836327548 nystatin 15 gm Crm 796327555 nystatin-triamcinolone 15 gm Crm 5046327563 nystatin-triamcinolone 30 gm Crm 7186327589 nystatin-triamcinolone 15 gm Oint 5046327597 nystatin-triamcinolone 30 gm Oint 156327654 silver sulfadiazine 1% 400gm Crm 2936327662 silver sulfadiazine 1% 50gm Crm 676327712 tobramycin 0.3% ophth 3.5 gm Oint 4686327738 triamcinolone 0.5% 15 gm Crm 506327761 triamcinolone 0.1% 15 gm Crm 266327779 triamcinolone 0.1% 15 gm Oint 266327787 triamcinolone 0.1% 80 gm Oint 636327829 vitamin A & D 60 gm Oint 66327845 acetic acid 2% otic 15mL Soln 1806327852 acetic acid 0.25% 1000mL top Soln 236327878 acetylcysteine 20% 10mL Soln 376327886 acetylcysteine 20% 30mL Soln 416327951 benzocaine/menthol 20% 56 gm spra 76328009 calamine/pramoxine 180 mL lotion 66328025 calamine 8% 120 mL lotion 46328108 clotrimazole 1% 45 gm Crm 2216328157 sodium hypochlorite 1/2 473 mL Sol 186328165 desmopressin 0.01% (10mcg/inh) 2. 11056328181 dexamethasone 0.1% ophth 5 mL Sol 966328371 triamcinolone 0.1% 5 gm oral Paste 3636328397 ocular lubricant ophth 3.5 gm Oint 176328439 lidocaine 4% topical Soln 50 mL 426328488 Mg hydrox/Al h/smc (200-200-20/5m 26328538 miconazole 2% topical 30 gm Crm 116328546 miconazole 2% vaginal 45 gm Crm 136328579 miconazole 100 mg vaginal (7) Supp 186328595 bacitr/HC/neomy/polymyx 3.5gm Op 2936328603 neomycin/polymyx/bacitr 3.5gm oph 2576328611 neomycin/polymyxin/bacitracin 30g 126328686 nitroglycerin 0.4 mg (25) tab 596328728 nystatin (100,000 Unit/gm) 15 gm t 1246328769 phenylephrine 0.5% nasal spray 15m 66328785 pilocarpine 4% Ophth 4 gm Gel 4116328819 phenyleph/mo/petrolat 30gm Oint 106328850 sodium chloride 0.65% nasal 45mL S 46328892 tolnaftate 1% 45 gm top Pwd 66328900 triamcinolone 0.1% 60 mL lotion 4056328926 trifluridine 1% ophth 7.5 mL Soln 6956328983 acetylcholine ophth 1% 2mL Vial 3856328991 antipyrine/benzocaine otic 15 mL So 59

6329023 atropine 1% ophth 5mL Soln 766329031 atropine 1% ophth 2 mL Soln 1396329056 carbachol 1.5% ophth 15mL Soln 2856329072 cromolyn 4% OPHT 10 mL Soln 1686329098 cyclopentolate 1% ophth 2 mL Soln 766329106 cyclopentolate 2% ophth 2 mL Soln 1516329122 cadexomer iodine 0.9% gel 40gm 6126329148 fluorometholone 0.1% ophth 5 mL S 4816329155 flurbiprofen 0.03% 2.5 mL Ophth Sol 406329163 gentamicin 0.3% ophth 5 mL Soln 986329171 homatropine 5% Ophth Soln; 5 mL 1896329221 levobunolol 0.5% ophth 5 mL Soln 1226329296 naphazoline/pheniramine ophth 15m 146329304 neo/polymyx B/dexameth ophth 3.5 1996329312 neomy/polymyxB/gramicid ophth 10 2796329403 phenylephrine 10% ophth 5 mL Soln 176329411 pilocarpine 2% ophth 15 mL Soln 1896329429 pilocarpine 1% ophth 15 mL Soln 1846329437 pilocarpine 4% ophth 15 mL Soln 1986329486 prednisoLONE acetate 1% ophth 5 m 4816329502 prednisoLONE acet 0.12% ophth 5 m 4816329510 proparacaine 0.5% ophth 15 mL Soln 1256329544 balanced salt intraocular irrig 15mL 386329569 prednisoLONE/sod sulfacetamide 0. 4816329577 sodium sulfacetamide 10% ophth 15 2756329619 timolol 0.25% ophth 5 mL Soln 796329635 timolol 0.5% ophth 5 mL Soln 776329650 tobramycin 0.3% ophth 5 mL Soln 4166329676 tropicamide 0.5% ophth 15 mL Soln 1216329684 tropicamide 1% ophth 15 mL Soln 2156329742 ethinyl estradiol/norgestrel (0.03/0. 56329783 ketoconazole 2% 30 gm Crm 2056329791 levobunolol 0.25% ophth 5 mL Soln 646329841 terconazole 80 mg vaginal (3) Supp 4416329957 tobramycin/dexamethasone ophth 3 9046329981 permethrin 5% 60 gm Crm 5576329999 metipranolol 0.3% ophth 5 mL Soln 1036330039 polymyxin B/trimethoprim ophth 10 616330047 ciprofloxacin 0.3% ophth 5 mL Soln 4776330088 butorphanol nasal 2.5 mL spray 4346330096 clindamycin 2% vaginal 40 gm Crm 5716330153 apraclonidine 0.5% ophth 5mL soln 6196330179 brimonidine 0.2% ophth 5 mL Soln 826330187 brimonidine 0.15% ophth 5 mL Soln 5406330211 moxifloxacin 0.5% ophth 3mL soln 5436330260 pimecrolimus 1% top 30 gm Crm 9746330294 nystatin 30 gm Crm 119

6330302 oxybutynin 3.9 mg/24 hr twice weekl 2176330328 desmopressin 0.01% (10mcg/inh) 5 11096330344 nystatin 15 gm Oint 766330385 atropine 1% ophth 15mL Soln 1716330435 benzocaine 20% 30 gm Oint 76330476 fluorescein ophth 1 mg Strip 46330526 lidocaine 5% 35 gm Oint 12966330575 clobetasol 0.05% oint 45gm 2266330583 terconazole 0.4% vaginal 45 gm Crm 2166330609 tobramycin/dexamethasone ophth 5 6856330658 ofloxacin 0.3% ophth 5 mL Soln 3146330674 collagenase 30 gm Oint 10046330682 diphenhydrAMINE 1% 30 gm Crm 56330690 pramoxine/HC 1%-1% 10gm Foam 3636330708 mometasone 0.1% 15 gm Crm 1326330716 capsaicin 0.025% 60 gm Crm 256330757 fluticasone nasal 16 gm Spray 3806330765 lodoxamide 0.1% ophth 10ml Soln 6736330799 terconazole 0.8% vaginal 20 gm Crm 1856330815 metroNIDAZOLE 0.75% vaginal 70 gm 2836330864 timolol 0.5% ophth 5 mL gel 2646330880 latanoprost 0.005% ophth 2.5 mL Sol 6136330898 betamethasone dip 0.05% 45gm Crm 3976330914 mafenide 8.5% 60 gm Crm 1926330931 belatacept 250 mg Inj 45006330989 fluticasone HFA 110 mcg 12 gm Inhal 3166331037 ipratropium nasal 0.06% (42mcg) 15 5176331045 penciclovir 1% 5 gm Crm 26586331094 ketorolac 0.5% 5mL ophth Soln 9486331136 hydrocortisone 1% 30 gm Crm 356331151 fluticasone HFA 220 mcg 12gm Inhal 4886331193 phenylephrine 2.5% ophth 2 mL Soln 336331227 fleet mineral oil enema (4.5 oz) 133 26331250 fluticasone HFA 44 mcg 10.6 gm Inha 2356331300 dorzolamide-timolol ophth Soln 10 3046331318 ofloxacin 0.3% 5mL otic Soln 3186331326 ciprofloxacin-HC 0.2%/1% otic 10 mL 9856331334 permethrin topical 1% 60 mL top Sol 136331540 olopatadine 0.1% ophth 5 mL Soln 7496331557 mupirocin 2% Topical Oint 22 gm 1926331565 mupirocin 2% Topical Crm 15 gm 2116331581 salmeterol 50mcg/inh diskus (28) 5136331664 budesonide 0.5 mg/2mL Inh Susp 566331680 atovaquone (750 mg/5 mL) Susp 5m 1486331714 albuterol (ProAir) CFC free 90 mcg/i 816331722 fentaNYL 12 mcg/hr Transd Patch 926331748 ciprofloxacin/dexamethasone 0.3%/0 819

6331771 tobramycin 300mg/7.5mL SW (For Inh 9656331789 cyclopentolate-phenylephrine ophth 1216331797 cyclopentolate-phenylephrine 0.2%- 2126331847 phenylephrine 1% nasal spray 15mL 76332191 acetaminophen (160mg/5mL) 10mL L 26332217 charcoal activated 25 gm 120 mL Sus 266332258 bismuth subsalicyl 262mg/15mL 240 46332340 Sodium Citrate/Citric Acid 3gm/2gm 56332357 diphenhydrAMINE 12.5mg/5mL 5mL 26332373 docusate sodium 100mg/10mL Liq 26332415 ergocalciferol 8000 Unit/mL 60mL ora 2826332423 polyethylene glycol electrolyte 400 1046332431 erythro ethylsucc 200 mg/5 mL 5mL 206332472 ferrous sulfate 220mg/5ml UD elixir 26332522 indomethacin oral susp 25mg/5ml 376332555 magnesium citrate 300 mL Liquid 36332563 magnesium hydroxide 8% 30 mL Sus 26332597 multivitamin pediatric 10mL Inj 4146332647 bromphen/pseudoeph (1-15mg/5mL) 26332662 penicillin VK 250 mg/5 mL 100mL Su 206332688 sod polysty sulf 15gm/60mL 60mL (w 516332696 potassium chloride 10% 20 mEq/15 716332779 sorbitol 70% 30 mL Soln 36332811 sulfamethoxazole/TMP 200-40mg/5 236332886 ibuprofen 100 mg/5 mL 5 mL Susp 36332894 zidovudine 10 mg/mL 5mL Syrup 66332910 acyclovir (200 mg/5 mL) 5mL Susp 106332928 FLUoxetine 20 mg/5 mL 5mL Soln 316333017 sucralfate 1 gm/10 mL 10mL Susp 296333082 lamiVUDine 10 mg/mL 5 mL Soln 116333116 loperamide 1 mg/5 mL 10 mL Liquid 46333124 phenytoin 100 mg/4 mL Susp 46333132 furosemide 40 mg/4 mL Soln UD 96333314 budesonide 0.25 mg/2 mL Inh Susp 486333363 amox/clav (200-28.5/5mL) 5 mL Susp 96333397 cycloSPORINE modified (Gengraf) 10 286333462 mineral oil 100% sterile lubricant 10 66333488 nystatin 100,000 Unit/mL 5 mL Susp 116333496 valproic acid 250 mg/5 mL 5mL Syru 46333553 promethazine 6.25 mg/5 mL 5mL 46333579 predniSONE 5 mg/5 mL 5mL Syrup 46333611 metoclopramide 10 mg/10mL Syrup 46333645 lactulose 10 gm/15 mL 30 mL Syrup 46333660 hydrOXYzine HCl 10mg/5mL UD Syru 46333686 guaiFENesin 100mg/5mL Liq 5mL 26333694 guaiFEN/DM (100-10mg/5mL) 5mL Li 26333751 glycerin topical Liq 120 mL 5

6333785 famotidine 40 mg/5 mL 5 mL Susp 566334056 cephalexin 250 mg/5 mL 100 mL Sus 1136334080 dexamethasone intensol 1mg/mL 30 1186334098 dexamethasone 0.5 mg/5 mL UD Elixi 46334106 digoxin 0.05 mg/mL 5mL Elix 186334114 furosemide 10 mg/mL 60 mL Liqu 476334122 haloperidol 2 mg/mL 5 mL Conc 206334189 multivitamins drop, pediatric 50mL L 136334262 potassium iodide 1 gm/mL 30 mL Sol 1026334312 simethicone 40 mg/0.6 mL 30 mL liq 136334486 oralnicu dexamethasone 1 mg/mL Su 86334510 amoxicillin (250mg/5mL) 5 mL Susp 46334585 lidocaine 2% viscous 100 mL Soln 166334726 charcoal (activ)-sorbitol 25gm 120m 266334791 prednisoLONE 15 mg/5 mL 5mL Syru 76334809 methadone 25 mg/2.5 mL Oral Conc 96334833 chlorhexidine gluconate 0.12% oral r 66334841 amox/clav ES (600-42.9/5mL) 5mL S 166334882 levETIRAcetam 100 mg/mL 5 mL Soln 436334890 oralnicu zidovudine 10 mg/ mL Syrup 86334924 D5 - 1/2NS / KCl 20mEq/L 1000mL 546334940 D5 - LR 1000mL 546334957 D5 - LR 500mL 546334965 D5 - 1/4 NS 500mL 546334973 sodium chloride 0.9% 100mL 546334999 sterile water 100mL 546335012 sterile water 50mL Inj 266335038 D5 - NS 1000mL 596335046 D5 - NS 500mL 546335061 D5 - 1/2 NS 1000mL 546335079 D5 - 1/2 NS 500mL 546335087 D5 - 1/4 NS 1000mL 546335103 D10W 1000mL 546335129 D20%W 500mL 626335137 D5W 250mL 546335152 D5W 1000mL 546335160 D5W 500mL 546335178 D70W 500mL 1006335186 D5W 100mL 546335194 D5W 50mL 546335244 metroNIDAZOLE 500 mg/100 mL Pre 546335251 lactated ringers 1000mL 546335269 lactated ringers 500mL 546335277 sodium chloride (hypertonic) 3% 50 546335285 sodium chloride 0.9% 250mL 546335293 sodium chloride 0.45% 1000mL 546335301 sodium chloride 0.9% 1000mL 54

6335319 sodium chloride 0.9% 500mL 546335327 0.45% sodium chloride 500mL 546335384 sterile water 10mL Inj 266335392 D10W 500mL 546335400 dextran 40 (10%) D5W 500mL 1246335418 dextran 40 (10%) NS 500mL 1556335509 potassium chloride 10 mEq/100 mL 266335665 magnesium sulfate 1gm/100mL D5W 546335699 alpha 1-proteinase inhibitor human in 216335715 levETIRAcetam 100 mg/mL 5 mL inj 1986335749 nitroglycerin 2.5 mg ER Cap 46335756 magnesium oxide 400 mg Tab 26335764 estradiol 0.1mg/24hr twice weekly P 526335855 zoledronic acid 5 mg/100 mL Premix 58556335897 aliskiren 150 mg Tab 196335988 palonosetron 0.25 mg/5 mL 5mL Inj 19006336036 sterile talc powder 4gm Aerosol 5566336168 oxyCODONE/acetaminophen (10/325 166336275 pantoprazole 40 mg Granules 406336572 acyclovir 50 mg/mL 20ml inj 1526336614 albendazole 200 mg Tab 9066336648 alcohol dehydrate 98% 5mL Inj 2006336754 aluminum hydroxide (320mg/5mL) 3 26336762 amino acid 10% 1000 mL 1106336770 amino acid 15% 2000 mL 5126336929 ceFAZolin 2 g/100 mL in Dextrose Pr 546337026 ampicillin (250mg/5mL) 5 mL Susp 166337109 ARIPiprazole 5 mg Tab 1406337182 azaCITIDine 10 mg/mL Inj 10 mL 25206337232 bacitracin/polymyxin B 15gm Oint 126337349 atropine/hyoscym/phenob/scopolami 466337356 atropine/hyoscym/phenob/scopolami 56337596 bupivac/EPINEPH PF 0.25% 10mL Inj 266337695 calcium carb 750 mg (300 mg elem) r 26337711 calcium carbonate 1250 mg/5 mL (5 26337752 calcium citrate + Vit D 315mg-250 ta 26337760 calcium citrate 950 mg (200 mg elem 26337810 candesartan 4 mg Tab 166337836 candida albicans extract (1:100) 0.1 656337893 carboxymethylcellulose 1% Ophth 0. 26337919 carteolol 1% ophth 5 mL Soln 896337950 IJPEDS ceFAZolin 20mg/mL 266337984 cefTRIAXone 2,000 mg/50 mL in Dext 3736338115 cholecalciferol 1000 Unit Tab 26338123 cholecalciferol 400 Unit Tab 26338156 citalopram 10 mg tab 126338180 cisatracurium 10 mg/mL 20mL Inj 1407

6338214 ciprofloxacin 0.3% ophth 3.5gm Oint 6536338370 cycloSPORINE (modified) 25 mg Cap 76338396 D10 - 1/2NS 1000mL 546338453 D5 - LR / KCl 20mEq/L 1000mL 546338511 desmopressin 0.2 mg Tab 486338529 desonide 0.05% 118mL Lotion 19136338552 D10W 250mL 546338602 D5W 25mL 546338610 dextrose 50% (25gm) 50mL Vial 306338636 D70W 1000mL 3686338669 diatrizoate 50% 50mL Inj 496338701 diazePAM 5mg/ml 2mL rectal Gel 15196338867 cloNIDine 100 mcg/mL 10 mL Inj 2276338883 colistimethate 150 mg Inj 1526338933 oralnicu amLODIPine 1mg/mL Susp 86338982 oralnicu nystatin 100000 Unit/mL Su 86338990 oralnicu enalapril 1mg/mL Susp 86339022 oralnicu propranolol 4 mg/mL Soln 86339089 IJNICU acyclovir 5 mg/mL 16339113 IJPEDS ampicillin 100 mg/mL 266339139 IJNICU calcium gluconate 50 mg/mL 266339147 IJNICU digoxin 25 mcg/mL 266339162 IJNICU hydrALAZINE 1 mg/mL 686339170 IJNICU methylPREDNISolone 2mg/ml 266339188 IJNICU midazolam 1 mg/mL 266339204 IJNICU penicillin G potassium 100,00 266339212 IJNICU vancomycin 5 mg/mL 266339246 IJNICU albumin 25% (250 mg/mL) 266339253 IJNICU albumin 5% (50mg/ml) 266339295 IJNICU flumazenil 0.05 mg/mL 266339303 IJNICU fosphenytoin 10 mg PE/mL 266339345 IJNICU caffeine citrate 20mg/mL 266339352 IJNICU ceFAZolin 20 mg/ml 266339360 IJNICU cefepime 20mg/ml 266339378 IJNICU cefotaxime 40 mg/ml 266339394 IJNICU cefTRIAXone 40 mg/mL 266339428 oralnicu erythromycin ethylsuccinat 86339469 IJNICU hydrocortisone 1 mg/mL 276339485 IJNICU amphotericin B liposomal 1 266339535 IJNICU phenytoin 50 mg/mL 266339592 IJNICU zidovudine 4 mg/mL D5W inj 266339626 oralnicu calcium gluconate 100 mg/ 86339634 IJNICU fluconazole 2mg/mL 266339683 IJNICU tromethamine 0.3mMol/ml 266339766 diltiaZEM 300 mg/24 hours ER Cap 136339782 dimercaprol 10% 100 mg/mL 3mL Inj 4456339816 Infanrix (DTaP) vaccine 0.5 mL inj (a 112

6339873 pm- DOPamine 200 mg (250D) 546339881 DOPamine 40 mg/mL 10mL Inj 266339899 dorzolamide 2% ophth 10 mL Soln 3776339915 doxepin 5% cream 45 gm 17596339980 econazole 1% 15 gm Crm 806340004 edrophonium 10 mg/mL 15mL Inj 4326340202 erythromycin base 500 mg Tab 376340228 pm- esmolol 2500 mg (250N) 9716340244 estradiol 0.1 mg/gm vaginal 42.5 gm 8206340251 estradiol 1 mg Tab 46340350 ethiodized oil 37% (475mg/mL) 10mL 546340376 ethyl chloride 103 mL Spray 1326340426 mitotane 500 mg Tab 256340459 benzocaine topical gel 10% 7gm 66340483 sargramostim 250 mcg Inj 11806340525 DACTINomycin 0.5 mg Inj 41976340814 ferrous sulfate 325mg (65mg Fe) Tab 26340848 lovaza (omega-3-acid ethyl esters) 1 106340855 fluconazole/NS 100 mg/50 mL Premi 546340922 cefTAZidime 1 g/50 mL D5W Premix 596341028 fluPHENAZine decanoate 25 mg/mL 5 7286341051 folic acid 0.05mg/mL oral solution 56341085 fondaparinux 7.5 mg/ 0.6mL syringe 6706341101 furosemide 10 mg/mL 120 mL Liqu 916341440 haloperidol decanoate 100mg/mL 1m 2146341523 heparin 100 Unit/mL 1mL Inj 266341556 hep B ped/nicu vac 10mcg/0.5mL Inj 1156341572 hyaluronidase 200 units/mL Soln (Ov 4326341671 HYDROmorphone 10 mg/mL 1mL Inj (n 266341689 HYDROmorphone 10 mg/mL 50mL In 4806341739 hydrOXYzine HCl 50 mg/mL 1mL Inj 266341754 hyoscyamine 0.125 mg SL Tab 46341762 hyoscyamine 0.125 mg/mL 15 mL Sol 1896341788 hypromellose 2.5% ophth 15mL Soln 176341838 imatinib 400 mg Tab 13796341846 indocyanine green 25 mg Inj 4776341895 interferon beta-1a 22 mcg/0.5 mL Inj 21776341937 iohexol 180 mg/mL 20mL Inj 2826341994 iopamidol 61% 300 mg/mL 50 mL 2446342018 iothalamate 60% 50mL Inj 796342042 ipratropium HFA 12.9 gm Inhaler 4266342133 ivermectin 3 mg Tab 256342141 lido 0.5%/epi (5 mg/mL) 50mL Inj 266342158 lido 1%/epi (10 mcg/mL) 20mL Inj 266342166 lido 1%/epi (5 mcg/mL) MPF 30mL In 566342190 lido 2%/epi (5 mcg/mL) MPF 20mL In 706342224 pm- lidocaine 0.4% 2 gm Premix (50 54

6342232 lidocaine 0.5% 50mL Inj 306342257 lidocaine 1% 20mL Inj 266342265 lidocaine 1% MPF 30mL Inj 266342273 lidocaine 1% MPF 5mL Inj 266342323 lidocaine 2% MPF 5mL Inj 266342364 lidocaine/dextrose (5 /7.5)% 2mL Inj 386342414 lithium citrate 300mg/5mL 5mL Syru 46342422 lopinavir/ritonavir 400mg-100mg/5m 626342455 loratadine 5 mg/5 mL 5 mL Syrup 26342505 lidocaine 4% topical 4mL soln (LTA ki 396342539 K ph/Na ph (250mg P, 1.1mEq K, 13 46342547 ketamine 10 mg/mL 20mL Inj 816342612 ketorolac LS 0.4% ophth 5 mL Soln 9756342638 L. acidophilus/bulgaricus Tab 26342646 labetalol 5 mg/mL 4mL Inj 266342661 lactated ringers 250mL 546342711 lamoTRIgine 25 mg Tab 196342786 letrozole 2.5 mg Tab 1106342794 leuprolide 11.25 mg Kit 45006342851 levETIRAcetam 250mg tab 136342885 levOCARNitine 100 mg/mL 1mL Oral 336342943 magnesium sulfate 100% 480 gm Gr 26342950 magnesium sulfate 2 gm/50 mL SW 546342968 pm- magnesium sulfate 20 gm (500W 546342984 magnesium sulfate 50% 20mL Inj (add 306343057 mesalamine 1000 mg Supp 976343149 methadone 40 mg Dispersable Tab 96343156 methyl salicylate topical 30 gm Balm 36343206 methylcellulose 500mg caplet 26343263 methylPREDNISolone(Depo) acet40 m 1596343297 metroNIDAZOLE 0.75% crm 45gm 7396343412 mirtazapine 15 mg Disinteg Tab 116343446 mitoMYcin 20mg inj lyophilized 28446343453 mitoXANTRONE 2 mg/mL 10 mL Inj 17036343545 morphine 30 mg IMMediate Release 96343586 multivitamin Chew Tab 26343651 mycophenolate acid 360 mg DR Tab 406343677 naltrexone 50 mg Tab 206343727 naproxen sod 220 mg Tab 26343792 neomycin/polymyxin/bacitracin 15g 76343800 neomycin/polymyxinB/HC ophth 7.5 4116343818 neostigmine 1 mg/mL 10mL Inj 226343859 nevirapine suspension 50 mg/5ml 176344048 nystatin 30 gm Oint 1146344055 octreotide 1000 mcg/mL 5mL Inj (add 45006344063 octreotide 20 mg Kit 55586344071 octreotide 200 mcg/mL 5mL Inj (addi 1296

6344089 ocular lubricant ophth preserved 15 156344113 OLANZapine 10 mg/2 mL SW Inj 1936344188 ondansetron 4 mg Disinteg Tab 1136344196 ondansetron oral solution 4 mg/5 mL 1086344204 ophthalmic extraocular irrig 118mL S 96344337 oxytocin 10 Unit/mL 10 mL Inj 436344386 panitumumab 20 mg/mL 5 mL inj 45006344394 papaverine 30 mg/mL 10 mL Inj 276344402 PARoxetine 40 mg Tab 46344477 PENTobarbital 50 mg/mL 20 mL Inj 45006344576 phenol 1.4% 180 mL spray 56344584 phenylephrine 0.1 mg/ mL 10 mL NS 266344592 nicu phenylephrine 0.125% nasal dr 66344626 phenylephrine 2.5% ophth 15 mL Sol 5076344675 pilocarpine 5 mg Tab 76344782 potassium chloride 20 mEq/50 mL P 266344790 potassium iodide/iodine 15mL Soln 2826344808 potassium citrate 10 mEq ER Tab 76344980 pramoxine-zno-mineral oil Top 1%- 66345243 quiNINE 324 mg Cap 326345276 rasagiline mesylate 0.5mg tab 796345292 RHo (D) imm glob 5000 Unit (1000 mc 45006345383 risperiDONE 0.5mg disint Tab 406345524 rocuronium 10 mg/mL 10 mL Inj (addi 876345565 ropivacaine (0.5%) 5 mg/mL 30 mL In 1186345706 silver topical - Gel 45 mL 466345789 sodium biphos/sodium phosphate 45 66345797 sodium biphos/sodium phosphate 90 56345805 sodium chloride 0.45% + KCL 20mEq 546345847 0.45% sodium chloride 250mL 546345896 Saline flush 10 mL syringe 66345912 sodium chloride 0.9% + KCl 20mEq/ 546345979 sodium chloride 10% 15mL Inh Soln 56346001 sodium hyaluronate chondroitin 0.5 6806346027 sodium hyaluronate (duovisc) ophth 9466346100 sodium hypochlorite 1/2 (0.25%) 10 226346142 sodium hypochlorite Full (0.5%) 100 366346159 sodium phosphate 3 mmol P/mL 15 m 486346217 sterile water 1000mL 546346332 tacrolimus 0.03% 30 gm Oint 11476346340 tacrolimus 0.1% top 60 gm Oint 22946346357 tacrolimus 0.5mg Cap 126346381 terbinafine 1% 15 gm Crm 166346431 tetrahydrozoline 0.05% ophth 15 mL 46346498 tiaGABine 4 mg Tab 336346613 triamcinolone 0.025% 15 gm Crm 216346647 triamcinolone acetonide 40mg/mL 1m 42

6346670 HCTZ/triamterene (25/37.5) mg Tab 46346720 tropicamide 1% ophth 3 mL Soln 646346845 verapamil 2.5 mg/mL 4mL Inj 446346852 verapamil 240 mg ER Tab 46346902 zinc oxide 40% 60 gm Oint 56346969 zinc oxide(Boudreaux's) topical 16% 76347017 glycerin-witch hazel (40) Pad 36347066 hyaluronidase 150 units/mL 1mL Inj 3026347124 aldesleukin 22 milUnit Inj 45006347215 busulfan 2 mg Tab 586347223 carbachol 0.01% ophth 1.5mL Soln 1606347330 citric acid/gluconodelta-lactone/Mg 1896347389 cyclopentolate 2% ophth 5 ml Soln 2496347397 cysteine 50 mg/mL 10 mL Inj 396347462 D5 - NS / KCl 20mEq/L 1000mL 546347546 diazePAM 5mg/5mL 5 mL oral Soln 116347785 fluocinonide 0.05% 60 mL top Soln 4386347827 gallium nitrate 45006347843 gentian violet 1% 30mL top Soln 66347959 insulin ASPART prot/ASPART (70/30) 10366348098 lomustine 10 mg Cap 936348262 mometasone 0.1% 15 gm Oint 2426348312 nalmefene 1 mg/mL 2mL Inj 2936348353 oxaprozin 600 mg Tab 176357669 micafungin 100 mg Inj 10106357834 propranolol 60 mg ER Cap 56357859 rifampin 150 mg Cap 176357958 streptozocin 1 gm Inj 18866357966 prednisoLONE/sod sulfacetamide 0. 856358022 tetracaine 1% 2mL Inj 746358337 zinc chloride 1 mg/mL 10mL inj 866358352 IJNICU aminophylline 5 mg/mL 266358394 IJPEDS cefotaxime 40 mg/mL 506358436 IJPEDS cefTRIAXone 40mg/mL 1356358451 IJNICU clindamycin 6 mg/mL 266358519 IJPEDS erythromycin lactobionate 5 456358550 IJNICU furosemide 2 mg/mL 266358584 IJPEDS immune globulin 50mg/mL 2186358626 IJPEDS metroNIDAZOLE 5mg/mL 266358634 IJPEDS midazolam 1 mg/mL 266358659 IJNICU nafcillin 40 mg/mL 266358675 IJPEDS nalOXone 1 mg/mL 266358709 IJNICU PHENobarbital 10 mg/mL 596358717 IJPEDS phenytoin 50 mg/mL 266358758 IJNICU tobramycin 2 mg/mL 266358766 IJPEDS vancomycin 5 mg/mL 406358899 aluminum ammonium sulfate 5gm (for 5

6358998 amyl nit/Na nit/Na thio 0.3mL-30mg 20696359004 Anticoagulant Citrate Dextrose - A 5 1136359012 arformoterol 15 mcg/2 mL Inh Soln 506359087 azaTHIOprine 100 mg Inj 11076359228 CliniMix PPN Soln 4.25/10 2000mL P 6946359236 CliniMix PPN Soln 4.25/10 with elec 3116359293 collodion, flexible 100mL 56359368 D12.5W 250 mL 546359376 Dextrose 15% in Water NICU 546359384 D7.5W 250mL 546359392 diatrizoate 66%-10% 30 mL Soln 906359517 etravirine 100 mg Tab 396359533 fentaNYL 50 mcg/mL 50 mL Inj 266359582 glucose 40% Oral Gel 37.5gm (15 gm 36359608 guaiFEN/codeine (100-10mg/5mL) 5m 96359640 heparin flush 100 units/mL Soln 5 mL 46359665 hydrocortisone 2.5% 30 gm Crm 506359707 IJNICU gamunex 100mg/ml 5226359715 IJNICU meropenem 5 mg/mL 3526359772 IJNICU sodium bicarbonate 4.2% (0. 266359905 raltegravir 400 mg Tab 1016360051 vancomycin 1 gm/200 mL D5W Prem 1626360077 triamcinolone 0.1% 80 gm Crm 636360200 mepivacaine 2% 20mL Inj 416360275 Morphine PCA 1mg/mL 30 mL 546360408 oralnicu amoxicillin 25 mg/mL Susp 86360416 oralnicu caffeine citrate 20mg/mL So 776360432 oralnicu digoxin 50mcg/mL Elix 86360440 oralnicu famotidine 8mg/mL Susp 126360465 oralnicu fluconazole 10mg/mL Susp 86360481 oralnicu furosemide 10mg/mL Liq 86360499 oralnicu spironolact/HCTZ 5-5mg/mL 86360580 oralnicu ranitidine 15mg/mL Syr 86360606 nateglinide 60 mg Tab 126360622 oralnicu vitamin D 8000 Unit/mL Liq 176360861 IJNICU metroNIDAZOLE 5 mg/ mL 266360879 IJNICU nalOXone 1 mg/mL 486360887 iodixanol 320 mg/mL 50mL Inj 2906360929 nebivolol 10 mg Tab 156360945 nebivolol 5 mg Tab 156360960 IJPEDS mannitol 200mg/mL 266360978 IJPEDS methylPREDNISolone 2mg/m 266360994 posaconazole 40 mg/mL Susp 5mL 2326361075 regadenoson 0.08 mg/mL 5 mL Soln 11396361224 micafungin 50 mg Inj 5266361398 Ferric Subsulfate, Aqueous 8gm soln 556361562 PENTobarbital 50 mg/mL 50 mL Soln 9547

6361588 diazePAM 2.5 mg rectal gel 12806361604 ropivacaine 0.5% 20 mL Inj 796361620 ae- cefepime 2000 mg (100 N) AddEa 2036361737 vancomycin 1 gm/250 mL NS Premix 1076361745 ampicillin 2 gm/100 mL NS 766361810 coagulation factor IX recombinant 66361828 antihemophilic factor VIII recombin 96361851 oralnicu amoxicillin 50 mg/mL Susp 86361869 oralpeds amoxicillin-clavulanate 40 86361877 oralpeds azithromycin 40 mg/mL sus 146361885 oralpeds calcium carbonate 100 mg 86361901 oralpeds cefuroxime 50 mg/mL susp 86361935 coagulation factor VIIa 1,000 mcg via 45006362032 acetylcysteine 20% 4mL soln 296362198 methylnaltrexone 12 mg/0.6 mL Inj 4266362230 multivitamin with minerals 15 mL Li 26362362 pm- norEPINEPHrine 4 mg (250D) 546362461 immune globulin IV 10% 5 gm/50 m 26106362511 ARIPiprazole 2 mg Tab 1456362578 travoprost PF ophth 0.004% Soln 2.5 5526362651 linezolid 100 mg/5 mL 5mL Susp 1126362669 oralnicu rifampin 10mg/ml 106362677 oralnicu sulfameth-tmp200-40mg/5 86362719 oralnicu calcium carbonate 100 mg 86362727 oralnicu captopril 1mg/ml susp 86362743 oralnicu carvedilol 1.67mg/ml susp 116362750 oralnicu cephalexin 50mg/mL susp 86362768 oralnicu chlorothiazide 50 mg/mL 86362792 oralnicu clindamycin 15 mg/mL Susp 86362859 oralnicu flucytosine 10mg/ml susp 566362917 oralnicu levETIRAcetam 100 mg/mL s 86362958 oralnicu metroNIDAZOLE 15mg/ml s 86362974 oralnicu omeprazole 2mg/ml 256362982 oralnicu phenytoin 25 mg/ mL Susp 86362990 oralnicu potassium phosphate 3 mm 86363006 oralnicu predniSONE 1mg/ mL Soln 86363014 oralnicu prednisoLONE 3mg/ml syru 86363030 oralnicu sildenafil 2mg/ml susp 656363048 oralnicu simethicone 40 mg/0.6 mL 86363055 oralnicu sodium acetate 2 mEq/mL 86363063 oralnicu Na polystyrene sulfonate 86363071 oralnicu acyclovir 40 mg/mL Susp 86363139 brinzolamide 1% ophth 10 mL Susp 14046363147 oralnicu spironolactone 4mg/ml 86363162 temsirolimus 25 mg/mL Soln 45006363212 Penicillin G Potassium 5 mil Unit/10 1906363485 prasugrel 10 mg tab 35

6363519 dronedarone 400 mg Tab 306363527 penicillin G-K 3 mil Units/50 mL in D 576363550 conivaptan 20 mg/100 mL-D5W Prem 32216363576 triptorelin 11.25 mg inj 131756363592 IJNICU fentaNYL 5 mcg/mL 2 mL NS 266363600 oralnicu metroNIDAZOLE 50mg/mL 86363634 melatonin 3 mg Tab 26363667 mycophenolic acid 180 mg Tab delay 206363741 febuxostat 40 mg Tab 396363790 insulin REGular human 100 units/mL 1476363808 mycophenolate mofetil 200 mg/mL 1 266363816 amox/clav (400-57/5mL) 5 mL Susp 166363840 pm-niCARdipine 20 mg (200N) 5136363857 iron sucrose 20 mg/mL 5mL Inj 2706363998 glycerin pediatric liquid suppository 26364053 doripenem 50 mg/mL 10 mL inj 2076364129 insulin NPH (isophane) human 100 un 1476364145 insulin LISPRO 100 units/mL 3 mL via 2756364178 Ropivacaine 0.5% 400 ml On Q Pum 9106364251 inFLIXimab 100 mg Inj 55166364269 oralnicu cholecalciferol 400 Unit/mL 356364285 atracurium 10 mg/mL 5 mL inj 436364368 pneumococcal 13-valent vacc Inj 7306364467 oralpeds prednisoLONE 3mg/mL 86364616 heparin flush 1 units/mL 2 mL Soln 156364624 immune globulin IV 10% (Privigen) 1 3006364640 sevelamer carbonate 2.4 g PWDR 596364657 secretin synthetic human 16 mcg/8 m 28356364772 cefepime 1,000 mg/50 mL in Dextros 1206364830 fentaNYL 50 mcg/mL 5 mL Vial 266364855 IJPEDS meropenem 5 mg/mL 3526365886 pen G benzathine 600000 Unit/mL 1m 2376365894 pen G benzathine 600000 Unit/mL 2m 3986365928 pen G benz/procaine 600000 Unit/mL 3186365944 topotecan 4 mg Inj 12696365951 EPINEPHrine 1mg/mL 1mL Inj 266365969 immune globulin IM 10mL Inj 10056365977 estradiol valerate 20 mg/mL 1mL Inj 1226366033 dabigatran 150 mg Cap 266366041 dabigatran 75 mg Cap 266366066 estrogens, conjugated 0.45 mg Tab 176366074 telavancin 250 mg (additive) Inj 10766366090 tolvaptan 15 mg Tab 16886366157 vancomycin 750 mg/150 mL D5W Pr 666366173 fosfomycin 3 gm 2986366199 vancomycin 500 mg/100 mL NS ene 546366249 acetaminophen 10 mg/mL 100 mL in 192

6366272 sevelamer carbonate 0.8 g PWDR 596366322 cabazitaxel 60 mg/1.5 mL Soln 155896366389 rifaximin 550 mg Tab 1286366504 fidaxomicin 200 mg Tab 7996366512 pm- amiodarone 360 mg (200D) 2366366520 amiodarone 150 mg/100 mL D5W Pre 1776366553 romiPLOStim 250 mcg INJ 45006366561 lurasidone 40 mg Tab 1276366579 denosumab 60 mg/mL inj 44556366603 benzocaine topical 20% 0.5 mL spra 296366736 meropenem 1000 mg Inj 2546366751 ticagrelor 90 mg Tab 226366827 ferrous gluconate 324 mg (39 mg Fe) 26366835 levothyroxine 100 mcg (0.1 mg)/ 5 mL 5716366843 rivaroxaban 10 mg Tab 526367064 aspirin 325 mg Tab 26367072 amoxicillin/clav (875/125) mg Tab 236367080 ALPRAZolam 0.25 mg Tab 96367114 carbidopa/levodopa (25/100) mg Ta 46367171 IJNICU DOBUTamine 2 mg/mL 266367197 benztropine 1 mg Tab 46367205 bisoprolol 5 mg Tab 66367221 cephalexin monohydrate 250 mg Ca 46367239 ciprofloxacin 250 mg Tab 276367247 losartan 25 mg Tab 86367254 DULoxetine 60 mg EC Cap 366367262 ofatumumab 20 mg/mL 50 mL inj 79206367270 ofatumumab 20 mg/mL 5 mL inj 23766367304 diclofenac sodium 75 mg EC Tab 86367338 valsartan 160 mg tab 236367346 valsartan 80 mg Tab 216367361 donepezil 5 mg Tab 696367403 fexofenadine 180mg tab 46367411 polycarbophil 625 mg Tab 26367452 guanFACINE 1 mg Tab 46367478 sodium chloride 7% INH 4 mL Soln 46367486 hydrALAZINE 50 mg Tab 46367502 hydrocortisone 20 mg Tab 46367510 HYDROmorphone 2 mg Tab 96367528 isosorbide mononitrate ER 30 mg Ta 66367536 isosorbide mononitrate 60 mg ER Ta 76367551 levofloxacin 750 mg Tab 1636367569 escitalopram 10 mg Tab 246367585 lisinopril 10 mg Tab 56367593 pregabalin 25 mg Cap 226367601 dronabinol 2.5 mg Cap 456367627 metFORMIN 500 mg Tab 4

6367635 methylphenidate 5 mg Tab 96367643 estrogens, conjugated 0.625 mg Tab 176367650 multivitamin, prenatal Tab 46367684 ramipril 1.25 mg Cap 156367692 ranolazine 500 mg ER Tab 236367700 sevelamer carbonate 800 mg Tab 206367932 rivaroxaban 15 mg Tab 526367999 metoprolol 50 mg IMMediate Releas 46368005 guaiFENesin 600 mg ER Tab 26368013 nabumetone 750 mg Tab 76368021 neomycin 500 mg Tab 76368039 vitamin B+C Comp. w/folic acid Tab 26368088 prazosin 5 mg Cap 96368096 ipilimumab 5 mg/mL 40 mL inj 404646368104 ipilimumab 5 mg/mL 10 mL inj 98196368187 fosaprepitant 150 mg Inj 13836368229 levoleucovorin 50 mg Inj 546368260 PRALAtrexate 20 mg/mL 2 mL Inj 133856368286 bupivacaine liposome 1.3% (13.3 mg 16206368310 tranexamic acid 100 mg/mL 10 mL in 546368419 PHENobarbital 32.4 mg Tab 96368427 PHENobarbital 97.2 mg Tab 96368468 eribulin 1 mg/2 mL Inj 45006368567 acyclovir 5% 5 gm Oint 6326368583 albuterol CFC free 90 mcg 8gm Inhal 276368609 amiodarone 50 mg/mL 9 mL inj 266368682 pancrelipase 4.2-17.5-10K (L/A/P) un 56368690 pancrelipase 10.5-43.75-25K (L/A/P) 126368716 aspirin 81 mg Chew Tab (4pk) 26368773 cefdinir 125 mg/5 mL 5 mL Susp 206368815 cisatracurium 2 mg/mL 5 mL Inj 756368831 colistin/neomycin/HC otic 5mL Soln 2056368849 conjugated estrogens synthetic A, 0 196368930 dehydroepiandrosterone 50 mg Tab 26368948 dexamethasone 6 mg Tab 56368971 digoxin immune FAB 40 mg 45006368989 dimethicone 1% Cream 120 gm 146369003 pm- DOBUTamine 250 mg (250D) 906369029 ePHEDrine 50 mg/10 mL NS syringe 556369052 estradiol valerate 40 mg/mL 5 mL Inj 9986369078 Factor IX Cmplx (Profilnine) 1500 Unit 76369086 felbamate 600 mg/5 mL Susp 10 mL 1316369094 fluorometholone 0.1% ophth oint 3. 4816369102 gatifloxacin ophth 0.5% 2.5mL Soln 6336369110 Gelatin, absorbable Film 42626369128 Gelfoam Size 100 1886369136 Gelfoam Size 12-7mm Sponge 34

6369185 hepatitis A ped vaccine PF 720 units 1556369250 iothalamate 17.2% 250 mL Soln 1256369268 labetalol 5 mg/mL 40mL Inj 266369276 levOCARNitine 200 mg/mL 5mL Inj (ad 3106369284 levofloxacin 0.5% ophth 5 mL Soln 3526369300 sodium chloride 3% INH 4 mL 46369383 palivizumab 100 mg/1 mL Inj 45006369391 pamidronate 90 mg/10 mL Inj 2346369433 pm- oxytocin 30 Unit (NS 500) 546369482 oralnicu oseltamivir 6 mg/mL 106369532 atazanavir 300 mg Cap 2086369540 tadalafil 5 mg Tab 216369565 CliniMix TPN 5/15 w/electrolytes 1 1926369573 CliniMix TPN 5/15 1000 mL Premix 1876369607 vancomycin 500 mg/100 mL D5W Pr 936369615 simethicone 125 mg Chew Tab 26369656 potassium chloride 40 mEq/100 mL 546369698 prasugrel 10 mg tab (6pk) 1906369706 predniSONE 5 mg/mL 30 mL 2106369722 aflibercept 25 mg/mL 4 mL inj 45006369730 aflibercept 25 mg/mL 8 mL inj 48006369748 carfilzomib 60 mg Inj 45006369813 multivitamin Vitamin A, D and C 50 136369821 multivitamin w/Iron, Vit C & FA (Foli 46369839 IJNICU acetaZOLAMIDE 5 mg/mL 1196369870 oralnicu glycopyrrolate 0.1 mg/mL 86369888 oralnicu hydrocortisone 1 mg/mL 86369896 oralnicu methadone 1mg/mL 86369912 oralnicu morphine 0.5 mg/mL 86369920 oralnicu PHENobarbital 10 mg/mL 86369946 oralnicu sodium bicarb 0.5 mEq/mL 86369953 oralnicu sodium phosphate 4 mEq/m 86369961 oralnicu sodium phosphate 3 mmol/ 86369979 D5 - 1/4 NS 250mL 546369987 D5 - 1/2 NS 250mL 546369995 itraconazole 10 mg/mL 20mLSoln 1096370001 ceFAZolin 2 g/50 mL D5W premix 546370002 chlorpheniramine 12 mg ER tab 26370019 tolvaptan 30 mg Tab 16886370027 SUMAtriptan 100 mg Tab 1146370043 clindamycin topical 1% Lotion 60 mL 5416370084 oralped sorbitol 70% 86370092 oralped theophylline 5.33 mg/mL 86370134 oralpeds penicillin VK 50 mg/mL 86370167 IJPEDS sodium bicarbonate 8.4% (1 266370175 IJNICU voriconazole 2mg/mL 6466370183 IJPEDS azithromycin 2mg/mL 56

6370191 IJNICU trimethoprim/sulfamethoxaz 266370209 denosumab 120 mg/1.7 mL Inj 45006370217 telavancin 750 mg inj 15966370225 rasburicase 1.5 mg/1 mL vial 35186370233 hydroxocobalamin 1000 mcg/mL inj 266370241 estradiol-norethindrone 0.05 mg-0.1 506370258 coagulation factor VIIa (recombinant 126046370266 insulin LISPRO prot-LISPRO 75/25 10m 9396370274 iopamidol 76% 370 mg/mL 100 mL 5286370282 IJPEDS ampicillin 20mg/mL 396370290 IJPEDS cefoxitin 40 mg/mL 356370316 IJNICU enoxaparin 20 mg/mL 3666370324 IJNICU famotidine 1mg/mL 266370332 IJNICU gentamicin 5mg/mL 266370340 oralnicu metoclopramide 1mg/mL 86370357 oralnicu cephalexin 25 mg/mL 86370365 IJNICU cefTAZidime 50mg/mL 656370399 IJNICU metoclopramide 0.1 mg/mL 266370415 cabergoline 0.5 mg Tab 1656370423 IJNICU propranolol 0.1 mg/mL Soln 426370449 IJNICU ganciclovir 5 mg/mL 406370456 IJNICU levetiracetam 10 mg/mL 266370464 IJNICU levothyroxine 20 mcg/mL 1086370472 IJNICU linezolid 2 mg/mL 266370480 IJPEDS micafungin 1.5 mg/mL 5056370498 IJNICU micafungin 1.5 mg/mL 5056370506 IJNICU morphine 0.2 mg/ml 266370522 IJPEDS aztreonam 20 mg/mL 726370530 IJNICU indomethacin 1mg/mL 28136370548 IJNICU magnesium sulfate 20mg/ml 266370555 IJNICU piperacillin/tazobactam 40 626370563 IJNICU potassium chloride 0.2 meq/ml 266370571 pm-DOBUTamine 60mg NICU (30D) 546370597 pm-milrinone 6mg NICU (30D) 266370613 octreotide 100 mcg/mL 1mL Inj (NIC 886370621 milrinone 1 mg/mL 10mL Inj (NICU/P 296370639 midazolam 5 mg/mL 1 mL Inj (NICU/P 266370647 furosemide 100 mg/10mL Inj (NICU/P 266370654 fentaNYL 50 mcg/mL 5 mL Inj (NICU/ 266370662 EPINEPHrine 1mg/mL 1 mL Inj (NICU/ 726370670 DOPamine 40 mg/mL 10 mL Inj (NICU 266370696 heparin 1,000 Unit/mL 1 mL Inj (NIC 266370704 amiodarone 50 mg/mL 3 mL Inj (NICU 516370712 dexmedetomidine 100 mcg/mL 2 mL I 3786370720 ketamine 50 mg/mL 10mL Inj (NICU/P 356370738 niCARdipine 2.5 mg/mL 10mL Inj (NI 3666370746 nitroprusside 25 mg/mL 2mL Inj (NIC 26

6370753 insulin hm REGular (NICU/PEDS addit 266370761 vecuronium 1mg/mL 10ml Inj (NICU/P 286370779 terbutaline 1mg/mL 1ml Inj (NICU/PE 1416370787 rocuronium 10 mg/mL 5 mL Inj (NICU 756370803 oralped guaiFENesin 20 mg/mL 86370829 oralped Mg hydrox/Al h/smc (200-2 86370837 oralped Mg hydrox/Al h/smc (400-4 86370878 oralnicu ursodiol 60mg/mL Susp 126370902 IJNICU aztreonam 20 mg/mL 726370910 IJNICU cefoxitin 40 mg/mL 356370951 IJNICU erythromycin lactobionate 5 456370977 IJNICU fat emulsion 20 % emulsion 266371033 IJNICU potassium chloride 0.1 meq/m 266371066 IJNICU midazolam 0.5 mg/mL 266371090 oralnicu azithromycin 20 mg/mL sus 156371181 IJPEDS sodium bicarbonate 4.2% (0. 266371264 pm-DOPamine 24mg NICU (30D) 546371272 pm-DOBUTamine 30mg NICU (30D) 546371280 pm-Heparin 1,500 units NICU (30D) 266371322 pm-DOPamine 48mg NICU (30D) 266371389 IJPEDS gamunex 100mg/ml 466371397 oralnicu hydrochlorothiazide 4mg/ml 86371405 IJNICU iron dextran 1mg/ml 266371413 oralnicu potassium Cl 1.33mEq/mL S 86371421 oralnicu amoxicillin 80 mg/mL Susp 86371439 IJNICU dexamethasone 1 mg/mL 266371447 oralnicu captopril 0.03mg/mL Susp 86371454 IJNICU filgrastim 30 mcg/mL 1196371470 acyclovir 5% 30 gm Oint 34566371488 aluminum chloride hexahydrate topi 336371504 amantadine 100 mg Tab 96371512 ammonium lactate topical 12% Lotio 2556371579 azithromycin 200 mg/5 mL 22.5 mL S 1576371603 betaxolol 0.25% ophth 10 mL Susp 9306371637 calcium chloride 100 mg/mL 10mL Inj 266371645 camphor/phenol 22.5 mL Liq 56371652 certolizumab 200 mg/mL Pre-filled Sy 49856371660 cetirizine 1 mg/mL Syrup 5 mL 86371694 degarelix 120 mg Inj 36466371702 degarelix 80 mg Inj 24306371793 eculizumab 10 mg/mL Inj 30 mL 115466371819 estrogens, conj 0.625mg/gm vag 30 11546371827 fentaNYL PCA 50 mcg/mL 40mL 686371843 glucagon recombinant 1 mg 7136371868 hydroxyethyl starch 6%-NaCl 0.9% So 2776371876 hydroxyprogesterone 250 mg/mL Inj 37266371892 iodoflex 5gm pad 86

6371900 iopamidol 51% 50 mL Soln 2356371918 ixabepilone 15 mg Inj 45006371926 ixabepilone 45 mg inj 51496371934 lidocaine 0.5% PF 50 mL Inj 266371942 lidocaine 1.5% MPF 10 mL Soln 366371959 lidocaine 4% 5mL Inj (NICU/PEDS addi 366371975 mannitol 20% 250mL Premix 1106371983 methotrexate 25mg/mL PF 40 mL inj 1976372007 miconazole 2% topical 43 gm powde 66372015 morphine PF 1 mg/mL 10mL Inj (NICU 616372031 nitroglycerin 0.4 mg Spray 4.9 gm 12926372049 nitroglycerin 5 mg/mL 5mL Inj (NICU 266372080 pancrelipase 21-84-55K (L/A/P) unit 236372114 perflutren protein A microsphere su 7596372148 prednisoLONE-sulfacetamide ophth 4816372163 remifentanil 1 mg Inj 2696372171 romiDEPsin 10 mg Inj 45006372197 saliva substitutes 44.3 mL Spray 86372213 tacrolimus 5 mg/mL 1 mL inj 8116372221 theophylline 100 mg/24 hours Cap 86372239 theophylline 80 mg/15 mL Soln 576372254 TLE Soln 5 mL 296372262 tolnaftate 1% 30 gm Crm 146372288 triptorelin 22.5 mg inj 263496372296 triptorelin 3.75 mg 34046372304 trolamine salicylate topical 10% Crm 66372312 oralnicu ferrous sulfate 50 mL (as e 406372338 oxymetazoline nasal 0.05% Spray 30 56372346 ibuprofen 50 mg/1.25 mL 15 mL Sus 76372353 valACYclovir 1 g Tab 576372361 doxycycline monohydrate 100 mg Ca 116372460 tocilizumab 20 mg/mL 4 mL inj 17786372494 vancomycin 250 mg/10 mL Oral Soln 746372502 mesalamine 400 mg DR Cap 136372528 pm- fentaNYL 1000mcg (250N) 1476372536 sodium chloride 0.9% 25 mL 726372544 mitoMYcin ophthalmic 0.2 mg/mL Ki 16166372569 succinylcholine 20 mg/mL 10 mL Syr 266372593 ropivacaine 1 % (10mg/ml) 10ml Inj 626372601 calcium carb-magnesium 119 mg (47 26372635 citric acid-potassium citrate 334 m 46372650 diphen/lido/nystat/maalox 180mL So 3246372676 amox/clav (200-28.5/5mL) 75 mL Su 1116372718 atovaquone-proguanil 250 mg-100 m 386372767 bimatoprost 0.01% ophth 5 mL Soln 12106372833 cefTRIAXone 1gm IM/Lido 1% 656372858 cefTRIAXone 500mg IM/Lido 1% 43

6372882 cyclophosphamide 1000 mg Inj 39566372890 dacarbazine 200 mg Inj 636372940 erythromycin 250 mg Base Tab 276372965 fentaNYL Epidural 1.39mcg/mL, bupi 886373070 iopamidol 61% 300 mg/ mL 100mL 4766373096 iron polysaccharide 150 mg Cap 26373146 oralpeds amoxicillin-clavulanate 80 86373229 pm- heparin 25,000 Unit (500D) 546373310 triamcinolone acetonide 40 mg/mL o 7746376339 IJNICU ampicillin-sulbactam 20mg/m 266376388 DOXOrubicin 2 mg/mL 10 mL Inj 1006376404 etoposide 10 mg/0.5 mL Inj (50mL 636376513 sodium hypochlorite 1/4th (0.125%) 186376514 sodium hypochlorite Full Soln (0.5%) 186376636 lamiVUDine 10 mg/mL 15 mL Soln 316376644 theophylline 200 mg/24 hours Cap 106376693 apixaban 5 mg Tab 246376792 iohexol 300 mg/mL 100 mL Inj 4706376800 lactase 9000 units tab 26376818 lidocaine 2% viscous 15 mL Soln 46376826 insulin mix NPH/REG (70/30) 10 mL v 4886376842 Prismasol B22GK 4/0 5000mL 1326376859 Prismasol BGK 4/0/1.2 5000mL 1326376867 Prismasol BGK 4/2.5 5000mL 1326376933 warfarin 0.5 mg Tab 56377089 phenylephrine rectal 0.25% Supp 26377097 n-acetyl-cysteine 600 mg Cap 46377212 DOBUTamine 12.5 mg/mL 40mL Inj 496377220 menthol cough drop SF loz 26377535 antihemophilic factor-VWF complex I 66377550 sulfamethoxazole/TMP (400/80) mg 46377576 fludarabine 25 mg/mL 2mL Inj 15756377592 hylan G-F 20 16 mg/2mL Inj 14946377600 hyaluronidase 48 mg/6mL Inj 44816377618 caffeine 200 mg Tab 26377667 rasburicase 7.5 mg Inj 61156377675 PEMEtrexed 500 mg Inj 45946377683 panitumumab 20 mg/mL 20 mL Inj 64156377691 DOXOrubicin liposomal 2 mg/mL 10 m 45006377709 epiRUBicin 2 mg/mL 25 mL Inj 3036377717 cetuximab 2 mg/mL 50 mL Inj 26036377725 brentuximab vedotin 50 mg Inj 86756377758 belimumab 400 mg Inj 85946377766 belimumab 120 mg Inj 25796377790 ascorbic acid 500 mg/mL 50 mL Inj 266377808 CISplatin 10 mg Inj (100mL) 636377865 rotavirus vaccine 2 mL susp 369

6377873 vitamin E 15 Unit/0.3 mL 30 mL liq D 616377923 oseltamivir 6 mg/mL susp 1256377980 IJNICU imipenem/cilastin 5 mg/ml 266377998 IJPEDS insulin regular 1 unit/ml 266378046 darunavir 800 mg Tab 1976378053 verapamil 120 mg ER Cap 66378061 PEMEtrexed 100 mg Inj 28126378079 pertuzumab 420 mg/14 mL Inj 73356378210 anti-inhibitor coagulant complex 1 un 106378236 coagulation factor VIIa 2,000 mcg Inj 50426378251 morphine 10 mg/ 0.5 mL Oral Conc 126378285 carBAMazepine 100 mg/5 mL Susp U 176378301 pm- sodium bicarb 150 mEq (1000 D 996378327 pm- dexmedetomidine 400 mcg Prem 8926378336 vancomycin 750 mg Inj 266378337 hydroxocobalamin 5 g Inj 33796378340 betamet ac/betamet na ph 3-3mg (6 396378341 HYDROcod/acetamin (7.5-325mg/15mL 156378342 alteplase 5 mg/ 5mL Inj 43046378346 neo/polymyx B/dexameth ophth 5mL 1986378349 ketamine 25mg/0.5mL oral Soln 96378368 bevacizumab 25 mg/mL 4 mL Inj 38326378407 Prismasol BGK 2/3.5 5000mL 1326378420 IJPEDS calcium gluconate 50 mg/mL 266378436 acetaminophen (80mg/2.5mL) 2.5mL 36378446 papaverine 30 mg/mL 5mL Inj 1136378449 ceFAZolin 2gm/1000mL NS IRR 686378455 ondansetron 1 mg/0.5 mL Inj (20mL 26378476 insulin GLARGINE pen 3286378487 buprenorphine-naloxone (2/0.5) mg 226378488 buprenorphine-naloxone (8/2) mg Fi 396378493 abatacept 250 mg Inj 44156378508 aspirin 81 mg EC Tab 26378509 atropine 0.1 mg/mL 10mL Syringe 266378512 betaxolol 0.5% ophth 5 mL Soln 2106378514 bleomycin 30 Unit Inj 4126378517 buprenorphine 8 mg Disinteg Tab 356378525 chloroprocaine 3% MPF 20 mL 1216378546 DAUNOrubicin 5 mg/mL 4 mL Inj 4276378550 dexrazoxane 500 mg Inj 45006378551 leuprolide 30 mg Kit 61286378554 sodium nitrite-sodium thiosulfate 17826378555 neomycin/polymyx/bacitracin 0.94g 26378558 levETIRAcetam 500 mg/100 mL 0.82% 1486378563 levETIRAcetam 1000 mg/100 mL 0.75 2476378564 diazoxide 50 mg/mL Susp 396378573 etravirine 200 mg Tab 77

6378576 Flucelvax influenza virus vacc, egg-fr 1066378589 HYDROmorphone 0.5 mg/0.5 mL Inj 266378591 IDArubicin 1 mg/mL 10 mL Inj 8906378600 leuprolide 45 mg/6 month Kit 98276378604 IJNICU LORazepam 0.4 mg/mL 266378612 mitoMYcin 40 mg Inj 45006378639 tacrolimus 1 mg/mL 1mL susp 176378653 DOCEtaxel 1 mg/0.1 mL Inj (8mL MD 456378656 fluorescein 10% 5 mL Inj 416378664 lidocaine 2% MPF 10mL Inj 266378668 bacteriostatic water 30mL Inj 266378672 glycopyrrolate 0.2mg/mL 1mL Inj 816378673 Hemin 313 mg Inj 112456378678 immune globulin IV 10% 20 gm/200 45006378685 leucovorin 350 mg Inj 3786378699 glipiZIDE 5 mg Tab 46378701 oralnicu HydrALAZINE 1mg/ml 86378721 Prothrombin Complex PCC (Kcentra) I 116378728 neomycin/polymyxin B/HC otic 10mL 1396378729 pegaspargase 750 Unit/mL 5 mL inj 107746378734 ritonavir 100 mg Tab 416378746 sodium chloride 5% ophth 15mL Soln 196378749 oralnicu sodium cl 4mEq/mL Liq 86378759 neostigmine 1 mg/mL 5mL Inj 2366378761 cromolyn nasal 4% 13 gm Spray 146378765 ae- ampicillin/sulbactam 1500 mg (1 546378766 ae- ampicillin/sulbactam 3000 mg (1 1686378767 ae- ampicillin 1000 mg (100 N) AddE 1606378770 bupivac/EPINEPH MDV 0.5% 50mL In 726378780 ae- ertapenem 1000 mg (100 NS) Ad 5546378794 immune globulin IV 10% 10 gm/100 38456378795 immune globulin IV 10% 10 gm/100 45006378803 leucovorin 200 mg Inj 2166378821 natalizumab 300 mg/15 mL Inj 79466378824 ae- pantoprazole 40 mg (100 N) Add 1616378827 ae- piperacillin/tazobactam 2250 mg 1926378829 ae- piperacillin/tazobactam 3375 mg 2196378837 vinCRIStine 1 mg/mL 2mL Inj 636378873 barium sulfate suspension 0.1% 450 386378894 hetastarch 6% 30 gm/ 500mL Lactate 2566378901 amoxicillin (400mg/5mL) 5 mL Susp 46378903 meningococcal conjugate vaccine (M 2226378927 certolizumab 200 mg lyoph Vial 49856378927 certolizumab 200 mg/mL Pre-filled Sy 49856378930 barium sulfate 98% 135mL 336378932 immune globulin IV 10% (Gamunex) 5226378936 IJNICU ampicillin 100 mg/mL 2.5 mL 26

6378937 ado-trastuzumab emtansine 100 mg I 49936378938 ado-trastuzumab emtansine 160 mg I 81086378949 dexamethasone 1 mg/0.25 mL Inj ( 16378951 tacrolimus topical 0.1% Oint 30gm 11476378954 immune globulin IV 5% 5gm/100mL I 21786378955 tbo-filgrastim 300 mcg/0.5 mL Inj 11256378956 tbo-filgrastim 480 mcg/0.8 mL Inj 17996378958 cholestyramine 4 gm resin/5 gm pwd 56378961 irinotecan 20 mg/mL 5 mL Inj 1916378963 sodium bicarb-Na citrate 1940 mg-1 26378966 carBAMazepine 100 mg ER cap (Carba 96378967 sodium chloride 3% (0.513mEq/mL) 1m 16378968 romiPLOStim 500 mcg INJ 45006378970 sipuleucel-T 250 mL Inj 558006378974 benzocaine-menthol 15 mg - 3.6 mg 26378975 sildenafil 100 mg Tab 1576378978 obinutuzumab 1000mg/ 40mL Inj (1 2796378980 nelarabine 250mg/ 50mL Inj 36356378982 immune globulin IV 5% 20gm/400mL 87106378986 immune globulin IV 5% 10gm/200mL 43556378990 antipyrine/benzocaine otic 10mL Sol 546378991 posaconazole 100 mg Tab 2696378992 darbepoetin alfa 25 mcg/mL (non ES 9126378995 nitroglycerin 100 mcg/mL 10mL 266378996 ramucirumab 100mg/ 10mL Inj 45006378997 ramucirumab 500mg/ 50mL Inj 91806378998 morphine PF 1 mg/mL 10mL Inj 356379000 megestrol acetate 40mg/mL 20mL S 386379003 metoprolol 100 mg EXTended Releas 106379005 amoxicillin (250mg/5mL) 100 mL Sus 286379007 selegiline 5 mg Cap 116379008 dipyridamole 5 mg/mL 10mL inj 256379013 potassium chloride 40mEq/30mL Liq 186379014 Saline flush 3 mL syringe 56379028 iopamidol 61% 300mg/mL 30 mL 2446379029 fulvestrant 250 mg/5 mL Inj 45006379055 ceftaroline 600 mg Inj 6836379059 ae- nafcillin 2000 mg (100 N) AddEas 2376379066 potassium bicarbonate-citrate 25 mE 66379072 vedolizumab 300 mg Inj 216866379073 vancomycin 1.25 gm/250 mL D5W Pr 526379089 oxaliplatin 100 mg/20 mL Inj 10806379096 amoxicillin/clav (250/125) mg Tab 276379126 oralpeds cefdinir 25mg/mL susp 86379129 fluticasone-vilanterol 100/25 14 Inha 1956379130 botulinum toxin type A 200 unit Inj 45006379134 adenosine 3 mg/mL 2mL Inj 195

6379135 IJNICU adenosine 300 mcg/mL 266379139 testosterone cypionate 200mg/mL 10 6286379140 testosterone cypionate 200mg/mL 1m 1296379146 morphine 50 mg/mL 50mL inj 1276379148 morphine 50 mg/mL 20 mL Inj 606379150 pm-morphine 100mg Premix (100N) 546379152 testosterone enanthate 200 mg/mL 1 786379166 pembrolizumab 50 mg Inj 45006379190 arsenic trioxide 1 mg/mL 10 mL inj 26776379192 betaxolol 0.5% ophth 10 mL Soln 4056379193 bupivac/EPINEPH MDV 0.25% 50mL I 466379194 bupivac/EPINEPH PF 0.5% 30mL Inj 456379195 calcitonin 200 Unit/inh nasal 3.7mL 7286379196 ceftolozane-tazobactam 1.5 gm Inj 4496379201 clofarabine 1 mg/mL IV Soln 20 mL 45006379203 cyclophosphamide 50 mg Cap 636379204 cytarabine 20 mg/mL 5 mL Inj 636379205 cytarabine 20 mg/mL 50 mL Inj 1086379206 cytarabine 2000 mg/ 20mL Inj 1006379211 dexamethasone 1 mg / 10mL Elixir 136379212 diclofenac 0.1% ophth 5 mL Soln 3296379213 IJNICU azithromycin 2mg/ml 266379218 darbepoetin alfa 300 mcg/0.6 mL Inj 45006379224 immune globulin IV 10% 20 gm/200 45006379233 phenyleph/mo/petrolat 60 gm Oint 176379235 heparin 50 unit/mL 1 mL Inj (NICU/PE 16379239 ustekinumab 45 mg/0.5 mL Inj 254916379242 immune globulin IV 5% 10 gm/200 m 45006379244 nivolumab 40 mg/4 mL Inj 13286379245 nivolumab 100 mg/10 mL Inj 45006379253 erythromycin base 250 mg DR Cap 166379257 pembrolizumab 100 mg/4 mL Inj 77696379258 lanreotide 120 mg/0.5 mL Inj 97336379259 Mg hydrox/Al hyd/smc (400-400-40/ 26379260 magnesium sulfate 100% 454 gm Gra 26379265 balsam Peru-castor oil topical 87 mg 1696379267 oralnicu cloNIDine 10 mcg/mL susp 86379289 potassium acetate 2 mEq/mL 20 mL In 266379294 hep B vac adult 10 mcg/mL 1 mL Inj 3276379295 gadobenate dimeglumine 529 mg/mL 3156379296 gadobenate dimeglumine 529 mg/mL 4606379297 gadobenate dimeglumine 529 mg/mL 5686379299 colchicine 0.6 mg Cap 286379300 PACLitaxel 1 mg Inj (16.7mL) 26379306 immune globulin IV 10% 20 gm/200 m 45006379309 granisetron 1 mg/mL 1mL Inj 3506379313 sodium tetradecyl sulfate 1% 2mL Inj 211

6379314 dalbavancin 500 mg Inj 45006379320 pm- fentaNYL 5000mcg (250N) 996379325 fluticasone-vilanterol 200/25 14 Inha 1956379336 lidocaine 2% 11mL jelly (Urojet) 356379340 deferoxamine 2gm Inj 1696379341 teduglutide 5mg Kit (3.8mg) 45006379346 meropenem 1000 mg/50 mL Premix 1196379347 meropenem 500 mg/50 mL Premix 886379352 idaruCIZUmab 2.5 gm/50 mL inj 45006379359 pm- tirofiban 12.5 mg (250S) 27976379361 zoledronic acid 4 mg/100 mL Premix 43976379365 levETIRAcetam 1500 mg/100 mL 0.54 3696379368 daratumumab 20 mg/mL 20mL Inj 45006379369 morphine PF 10 mg/mL 1mL Vial 266379373 immune globulin IV 10% 40 gm/400 m 79926379374 immune globulin IV 10% 20 gm/200 76906379377 bendamustine 1 mg/0.04 mL Inj (4m 1266379378 daratumumab 20 mg/mL 5mL Inj 24306379379 phenylephrine 1% nasal spray 30mL 86379382 vancomycin 1500 mg/300 mL NS 746379388 sugammadex 100 mg/mL 2 mL Inj 6486379391 immune globulin IV 10% 2.5 gm/25 13056379399 treprostinil 5 mg/mL 1mL inj 6646379453 pentazocine 30 mg/mL 1mL Inj 486379482 belinostat 500 mg Inj 45006379488 cephalexin (250mg/5mL) 5 mL Susp 66379489 clindamycin 75 mg/5 mL 5 mL Susp 146379505 trace elements (pediatric) vial 266379514 D70W 2000mL 876379521 immune globulin IV 5% 2.5 gm/50 m 13736379526 immune globulin IV 10% 10 gm/100 m 45006379529 fluconazole 200mg/5mL 5 mL Susp 686379605 pegfilgrastim 6 mg/0.6 mL Delivery Ki 92816379606 benzocaine topical 20% Liqu 12.3 mL 96379609 medium chain triglycerides 30 mL 46379611 vancomycin 1.5 gm/300 mL D5W Pre 956379612 vancomycin 1250 mg/250 mL NS Pre 596379617 epoetin alfa MDV 20,000 units/mL In 1006379618 sodium bicarb 8.4% 1 mEq/mL 50 mL 346379620 azithromycin 250 mg/6.25 mL Susp 446379621 cefuroxime 250 mg/5 mL 5 mL Susp 556379622 clarithromycin 250mg/5 mL 5 mL Sus 396379674 irinotecan liposomal 4.3 mg/mL 10 m 45006379717 atezolizumab 60 mg/mL 20 mL Inj 155166379720 sodium acetate 4 mEq/mL 100mL Inj ( 486379745 ae- ceftazidime 2000 mg (100 N) Ad 1586379751 estradiol 0.0375 mg/24 hours weekly 105

6379773 isavuconazonium 372 mg inj 12886379774 valrubicin 200 mg/5 mL Irrig Soln 45006379785 Prothrombin Complex PCC (Kcentra) I 116379790 uridine triacetate 10 g Gran 176246379796 carfilzomib 30 mg Inj 44366379801 vancomycin 500 mg/100 mL NS 816379807 argatroban 100 mg/mL 2.5mL Inj 45006380131 ae- cefazolin 1,000 mg (100 N) MiniB 546380138 ae- cefepime 1000 mg (100 N) AddEa 546380142 octreotide 10 mg Kit 45006380144 ae- cefOXitin 1000 mg (100 N) AddEa 1236380145 ae- cefOXitin 2000 mg (100 N) AddEa 1746380252 ae- aztreonam 2000 mg (100 N) Mini 5826380254 ae- cefTRIAXone 1000 mg (100 N) Mi 546380273 lanreotide 60 mg/0.2 mL Inj 216337100010 LACTATED RINGERS 1L INJ 203.327100020 NACL 0.9% 250ML INJ 50.837100030 NACL 0.9% 500ML INJ 101.667100040 NACL 0.9% 1000ML INJ 203.327100100 PACU STANDARD 1ST 30MIN 7917100110 PACU STANDARD ADDL 15MIN 2777100120 PACU COMPLEX 1ST 30MIN 10287100130 PACU COMPLEX ADDL 15MIN 3597100140 MINOR PROCEDURE 9377100160 LACTATED RINGERS 500MLINJ 787100170 D5% 0.45 NACL 1000ML INJ 787100180 D5% 0.45 NACL+KCL20 1LINJ 787100190 NACL 0.45% 1000ML INJ 787100200 ORTHO L0120 <10 187100210 PACU NOBILL OTH DEPT EA15 0 17200000 ADMIN OTHER IMMUN VAC ADD 1827200010 ADMIN OTHER IMMUN VAC ONE 3647200030 CARDIOVERSION ELCTIVE EXT 24917200040 CHEMO INF EA ADD HR 4397200050 CHEMO INF INIT 1ST HR 20917200060 D5% 0.45 NACL 500ML INJ 37200070 INF IV HYDRA INIT 31-60MN 21707200080 INF IV HYDRAT EA ADD HR 5707200090 INF TX/DX/PRO EA ADD HR 7057200100 INF TX/DX/PRO INIT 1ST HR 25777200110 INJ TX/DX/PRO IV PUSH SEQ 3827200120 INJ TX/DX/PRO IVPUSH INIT 3827200130 INJ TX/DX/PROPH SUBQ/IM 3827200140 IRRIG IMPLANTED VEN ACCES 3237200150 MINOR PROCEDURE 9377200160 PHLEBOTOMY THERAPEUT 3417200170 INS/REPL/DECL NONTUN/PIC 1582

7200180 PRE/POST VISIT PT CNT NC 0 17200190 TRANSFUS BLD/BLD COMP 8617200200 VISIT LEVEL 1 EST PT 977200210 VISIT LEVEL 1 NEW PT 2657200220 VISIT LEVEL 2 EST PT 2607200230 VISIT LEVEL 2 NEW PT 5097200240 VISIT LEVEL 3 EST PT 5097200250 VISIT LEVEL 3 NEW PT 7697200260 VISIT LEVEL 4 EST PT 7897200270 VISIT LEVEL 4 NEW PT 9217200280 VISIT LEVEL 5 EST PT 11107200290 VISIT LEVEL 5 NEW PT 12327200306 ADMIN INFLUENZA VACCINE 3647200314 ADMIN PNEUMO VACCINE 3647200322 ADMIN HEP B VACCINE 3647200330 INTRO SHTH OTH 30X-39 1217200348 CATH INFUSION 150X-195 6047200363 INF TX/DX CONCURRENT 15477200371 PREG URINE VISUAL POC 227200389 VISIT LEVEL 1 NEW W PROC 2657200397 VISIT LEVEL 2 NEW W PROC 5097200405 VISIT LEVEL 3 NEW W PROC 7697200413 VISIT LEVEL 4 NEW W PROC 9217200421 VISIT LEVEL 5 NEW W PROC 12327200439 VISIT LEVEL 1 EST W PROC 977200447 VISIT LEVEL 2 EST W PROC 2607200454 VISIT LEVEL 3 EST W PROC 5097200462 VISIT LEVEL 4 EST W PROC 7897200470 VISIT LEVEL 5 EST W PROC 11107200471 INSERT CATH BLADDER 3197200472 CATH FOR SPECIMEN COLLECT 1257200473 VASC ACCES THROMBL DECLOT 4207200474 BLOOD COLLECTION VAD 3397200475 BLOOD COLLECTION PICC 3537200476 GLUCOSE BLD BY DEVICE POC 177200477 INF IV TX/DX PUMP PROLONG 4017200478 INJ TX/PRO/DX IVP SME DRG 3827200479 APHERESIS PLASM THERAPEUT 30337200480 INF TX/DX/PRO SEQ 1HR 11127200481 CHEMO SQ/IM NONHORMONAL 9507200482 CHEMO SQ/IM HORMONAL 4107200483 CHEMO INF INIT 1ST HR 20917200484 CHEMO INF EA ADD HR 4398000010 APHERESIS THERAPEUTIC 31248000020 DIALY CONT RENAL REP CRRT 45478000030 DIALYSIS OP ESRD EMER 23328000040 DIALY CONT CYL PERIT CCPD 4547

8000070 HEMODIALY IP/NON ESRD OP 20738100010 ALS1-E SI/SCENE-SITE 55108100020 ALS1-E SH/SCENE-HOSP 55108100030 ALS1-E RI/RES-SITE 55108100040 ALS1-E RH/RES-HOSP 55108100050 ALS1-E HP/HOSP-MD OFFICE 55108100060 ALS1-E PH/OFFICE-HOSP 55108100070 ALS1-E NH/SNF-HOSP 55108100080 ALS1-E JH/DIALYSIS-HOSP 55108100090 ALS1-E HI/HOSP-SITE 55108100100 ALS1-E HH/HOSP-HOSP 55108100110 ALS1-E EH/ECF-HOSP 55108100120 TREATMENT NO TRANSPORT 9468100130 ALS2 SI/SCENE-SITE 59718100140 ALS2 SH/SCENE-HOSP 59718100150 ALS2-RH/RES-HOSP 59718100160 ALS2-PH/MD OFICE-HOSP 59718100170 ALS2-NH/SNF-HOSP 59718100180 ALS2-HH/HOSP-HOSP 59718100190 ALS2-EH/ECF-HOSP 59718100200 RESIDENTIAL TRANSPORT NC 0 18100210 MC RESPONSE - LITTER 668100220 MC LITTER CASE ATTENDANT 158100240 ALS1-NE SI/SCENE-SITE 48568100250 ALS1-NE SH/SCENE-HOSP 48568100260 ALS1-NE RH/RES-HOSP 48568100270 ALS1-NE PH/OFFICE-HOSP 48568100280 ALS1-NE NJ/SNF-DIALYSIS 48568100290 ALS1-NE NH/SNF-HOSP 48568100300 ALS1-NE NH/TCU-HOSP 48568100310 ALS1-NE JN/DIALYSIS-SNF 48568100320 ALS1-NE HH/HOSP-HOSP 48568100330 ALS1-NE HD/HOSP-DIAG TX 48568100340 ALS1-NE EH/ECF-HOSP 48568100350 ALS1-NE DH/DIAG TX-HOSP 48568100360 BLS-NE ND/SNF-DIAG TX 21078100370 BLS-NE JN/DIALYSIS-SNF 21078100380 BLS-NE JN/DIALYSIS-SNF 21078100390 BLS-NE JH/DIALYSIS-HOSP 21078100400 BLS-NE IN/SITE-SNF 21078100410 BLS-NE HI/HOSP-SITE 21078100420 BLS-NE HR/HOSP-RES 21078100430 BLS-NE HP/HOSP-MD OFFICE 21078100440 BLS-NE HN/HOSP-SNF 21078100450 BLS-NE HJ/HOSP-DIALYSIS 21078100460 BLS-NE HH/HOSP-HOSP 21078100470 BLS-NE HE/HOSP-ECF 2107

8100480 BLS-NE HD/HOSP-DIAG TX 21078100490 BLS-NE ES/ECF-SCENE 21078100500 BLS-NE ER/ECF-RESIDENCE 21078100510 BLS-NE EP/ECF-MD OFFICE 21078100520 BLS-NE EH/ECF-HOSP 21078100530 BLS-NE DN/DIAG-SNF 21078100540 BLS-NE DH/DIAG TX-HOSP 21078100550 CB EMERGNT ORGAN TRANSPRT 9338100570 BLS-E SI/SCENE-SITE 25038100580 BLS-E SH/SCENE-HOSP 25038100590 BLS-E RH/RESIDENCE-HOSP 25038100600 BLS-E PH/MD OFFICE-HOSP 25038100610 BLS-E NH/SNF-HOSP 25038100620 BLS-E HP/HOSP-MD OFFICE 25038100630 BLS-E HH/HOSP-HOSP 25038100640 BLS-E EH/ECF-HOSP 25038100910 CB QUOTED PER MILE RATE 128100920 CB QUOTED BASE RATE 9838100930 CB IFT CONTRACT TRANSPORT 19148100940 CB IFT MILEAGE 178100950 SNF TRANSPORT NE/SNF-ECF 18968100960 SNF TRANSPORT ND/SNF-DIAG 18968100970 SNF TRANSPORT NH/SNF-HOSP 18968100980 SNF TRANSPORT NI/SNF-SITE 18968100990 SNF TRANSPORT NJ/SNF-DIAL 18968101000 SNF TRANSPORT NN/SNF-SNF 18968101010 SNF TRANSPORT NP/SNF-OFFC 18968101020 SNF TRANSPORT NR/SNF-RES 18968101030 SNF TRANSPORT NS/SNF-SCEN 18968101040 SNF TRANSPORT EN/ECF-SNF 18968101050 SNF TRANSPORT DN/DIAG-SNF 18968101060 SNF TRANSPORT HN/HOSP-SNF 18968101070 SNF TRANSPORT IN/SITE-SNF 18968101080 SNF TRANSPORT JN/DIAL-SNF 18968101090 SNF TRANSPORT PN/OFFC-SNF 18968101100 SNF TRANSPORT RN/RES-SNF 18968101110 SNF TRANSPORT SN/SCEN-SNF 18968101300 IP TRANSPRT DX OUTSIDE NC 0 18101310 BLS-E HR/HOSP-RES QL MOD 25038101320 BLS-EHS/HOSP-SCEN QL MOD 25038101330 IP TRNSPRT DX MILE OUT NC 0 28101340 ALS2-JH/DIALYSIS-HOSP 59718101350 ALS2-HJ/HOSP-DIALYSIS 59718101360 BLS-E JH/DIALYSIS-HOSP 25038101370 BLS-E HJ/HOSP-DIALYSIS 25038101380 BLS-E HI/HOSP-SITE 25038101400 BLS-NE IH/SITE-HOSP 2107

8101411 BLS-E IH/SITE-HOSP 25038101412 BLS-NE SH/SCENE-HOSP 21078101413 BLS-NE HR/HOSP-RES QL MOD 21078101414 BLS-NE HS/HOS-SCEN QL MOD 21078101415 CB IFT MILEAGE H-H 178101416 CB IFT MILEAGE N-H 178101417 CB IFT MILEAGE H-N 178101418 CB IFT CONTRACT TRANS H-H 19148101419 CB IFT CONTRACT TRANS H-N 19148101420 CB IFT CONTRACT TRANS N-H 19148101421 BLS-NE PT DECEASED QL/QN 21078101422 ALS1-NE HN/HOSP-SNF 48568101423 BLS-E DS/DIAG TX-SCENE 25038101424 BLS-NE DS/DIAG TX-SCENE 21078101426 MILEAGE ALS EH/ECF-HOSP 178101427 MILE ALS ER/ECF-RESIDENCE 178101428 MILEAGE ALS ES/ECF-SCENE 178101429 MILEAGE ALS HE/HOSP-ECF 178101430 MILEAGE ALS HH/HOSP-HOSP 178101431 MILEAGE ALS HI/HOSP-SITE 178101432 MILE ALS HJ/HOSP-DIALYSIS 178101433 MILEAGE ALS HN/HOSP-SNF 178101434 MILEAGE ALS HR/HOSP-RES 178101435 MILEAGE ALS IH/SITE-HOSP 178101436 MILE ALS JH/DIALYSIS-HOSP 178101437 MILE ALS JN/DIALYSIS-SNF 178101438 MILEAGE ALS NE/SNF-ECF 178101439 MILEAGE ALS NH/SNF-HOSP 178101440 MILE ALS NJ/SNF-DIALYSIS 178101441 MILEAGE ALS NN/SNF-SNF 178101442 MILEAGE ALS NR/SNF-RES 178101443 MILE ALSPH/MD OFFICE-HOSP 178101444 MILE ALS PR/MD OFFICE-RES 178101445 MILEAGE ALS RE/RES-ECF 178101446 MILEAGE ALS RH/RES-HOSP 178101447 MILEAGE ALS RI/RES-SITE 178101448 MILEAGE ALS RN/RES-SNF 178101449 MILE ALS RP/RES-MD OFFICE 178101450 MILEAGE ALS RR/RES-RES 178101451 MILEAGE ALS SH/SCENE-HOSP 178101452 MILEAGE ALS SI/SCENE-SITE 178101453 MILEAGE BLS EH/ECF-HOSP 178101454 MILE BLS ER/ECF-RESIDENCE 178101455 MILEAGE BLS ES/ECF-SCENE 178101456 MILEAGE BLS HE/HOSP-ECF 178101457 MILEAGE BLS HH/HOSP-HOSP 178101458 MILEAGE BLS HI/HOSP-SITE 17

8101459 MILE BLS HJ/HOSP-DIALYSIS 178101460 MILEAGE BLS HN/HOSP-SNF 178101461 MILEAGE BLS HR/HOSP-RES 178101462 MILEAGE BLS IH/SITE-HOSP 178101463 MILE BLS JH/DIALYSIS-HOSP 178101464 MILE BLS JN/DIALYSIS-SNF 178101465 MILEAGE BLS NE/SNF-ECF 178101466 MILEAGE BLS NH/SNF-HOSP 178101467 MILE BLS NJ/SNF-DIALYSIS 178101468 MILEAGE BLS NN/SNF-SNF 178101469 MILEAGE BLS NR/SNF-RES 178101470 MILE BLS PH/MD OFFIC-HOSP 178101471 MILE BLS PR/MD OFFICE-RES 178101472 MILEAGE BLS RE/RES-ECF 178101473 MILEAGE BLS RH/RES-HOSP 178101474 MILEAGE BLS RI/RES-SITE 178101475 MILEAGE BLS RN/RES-SNF 178101476 MILE BLS RP/RES-MD OFFICE 178101477 MILEAGE BLS RR/RES-RES 178101478 MILEAGE BLS SH/SCENE-HOSP 178101479 MILEAGE BLS SI/SCENE-SITE 178101480 MILEAGE LITT EH/ECF-HOSP 178101481 MILE LITT ER/ECF-RES 178101482 MILEAGE LITT ES/ECF-SCENE 178101483 MILEAGE LITT HE/HOSP-ECF 178101484 MILEAGE LITT HH/HOSP-HOSP 178101485 MILEAGE LITT HI/HOSP-SITE 178101486 MILE LITT HJ/HOSP-DIALY 178101487 MILEAGE LITT HN/HOSP-SNF 178101488 MILEAGE LITT HR/HOSP-RES 178101489 MILEAGE LITT IH/SITE-HOSP 178101490 MILE LITT JH/DIALY-HOSP 178101491 MILE LITT JN/DIALYSIS-SNF 178101492 MILEAGE LITT NE/SNF-ECF 178101493 MILEAGE LITT NH/SNF-HOSP 178101494 MILE LITT NJ/SNF-DIALYSIS 178101495 MILEAGE LITT NN/SNF-SNF 178101496 MILEAGE LITT NR/SNF-RES 178101497 MILE LITT PH/MD OFFI-HOSP 178101498 MILE LITT PR/MD OFFIC-RES 178101499 MILEAGE LITT RE/RES-ECF 178101500 MILEAGE LITT RH/RES-HOSP 178101501 MILEAGE LITT RI/RES-SITE 178101502 MILEAGE LITT RN/RES-SNF 178101503 MILE LITT RP/RES-MD OFFIC 178101504 MILEAGE LITT RR/RES-RES 178101505 MILE LITT SH/SCENE-HOSP 17

8101506 MILE LITT SI/SCENE-SITE 178101507 SNFMILE1W ALS DN/DIAG-SNF 178101508 SNF MILE1W ALS EN/ECF-SNF 178101509 SNFMILE1W ALS HN/HOSP-SNF 178101510 SNFMILE1W ALS IN/SITE-SNF 178101511 SNFMILE1W ALS JN/DIAL-SNF 178101512 SNFMILE1W ALS ND/SNF-DIAG 178101513 SNF MILE1W ALS NE/SNF-ECF 178101514 SNFMILE1W ALS NH/SNF-HOSP 178101515 SNFMILE1W ALS NI/SNF-SITE 178101516 SNFMILE1W ALS NJ/SNF-DIAL 178101517 SNF MILE1W ALS NN/SNF-SNF 178101518 SNFMILE1W ALS NP/SNF-OFFC 178101519 SNF MILE1W ALS NR/SNF-RES 178101520 SNFMILE1W ALS NS/SNF-SCEN 178101521 SNFMILE1W ALS PN/OFFC-SNF 178101522 SNF MILE1W ALS RN/RES-SNF 178101523 SNFMILE1W ALS SN/SCEN-SNF 178101524 SNFMILE1W BLS DN/DIAG-SNF 178101525 SNF MILE1W BLS EN/ECF-SNF 178101526 SNFMILE1W BLS HN/HOSP-SNF 178101527 SNFMILE1W BLS IN/SITE-SNF 178101528 SNFMILE1W BLS JN/DIAL-SNF 178101529 SNF MILE1W BLS NE/SNF-ECF 178101530 SNFMILE1W BLS NH/SNF-HOSP 178101531 SNFMILE1W BLS NI/SNF-SITE 178101532 SNFMILE1W BLS NJ/SNF-DIAL 178101533 SNF MILE1W BLS NN/SNF-SNF 178101534 SNFMILE1W BLS NP/SNF-OFFC 178101535 SNF MILE1W BLS NR/SNF-RES 178101536 SNFMILE1W BLS NS/SNF-SCEN 178101537 SNFMILE1W BLS PN/OFFC-SNF 178101538 SNF MILE1W BLS RN/RES-SNF 178101539 SNFMILE1W BLS SN/SCEN-SNF 178101540 SNFMILE1WLITT DN/DIAG-SNF 178101541 SNFMILE1W LITT EN/ECF-SNF 178101542 SNFMILE1WLITT HN/HOSP-SNF 178101543 SNFMILE1WLITT IN/SITE-SNF 178101544 SNFMILE1WLITT JN/DIAL-SNF 178101545 SNFMILE1WLITT ND/SNF-DIAG 178101546 SNFMILE1W LITT NE/SNF-ECF 178101547 SNFMILE1WLITT NH/SNF-HOSP 178101548 SNFMILE1WLITT NI/SNF-SITE 178101549 SNFMILE1WLITT NJ/SNF-DIAL 178101550 SNFMILE1W LITT NN/SNF-SNF 178101551 SNFMILE1WLITT NP/SNF-OFFC 178101552 SNFMILE1W LITT NR/SNF-RES 17

8101553 SNFMILE1WLITT NS/SNF-SCEN 178101554 SNFMILE1WLITT PN/OFFC-SNF 178101555 SNFMILE1W LITT RN/RES-SNF 178101556 SNFMILE1WLITT SN/SCEN-SNF 178200010 ECHO TEE WO CON 31378200020 ECG 12 LEAD TRACING ONLY 3608200030 ECHO 2D COM WO CON WO DOP 16428200040 CARDIAC REHAB II W ECG OP 3518200060 DOP ECHO COLOR FLOW ADDON 9778200070 DOP ECHO COMP STUDY ADDON 20368200080 ECHO STR TEST COMP WO CON 21108200090 CARD REHAB I INIT IP NC 0 18200100 CARD REHAB III OP NC 0 18200110 CARDIOVAS STR TEST WO RX 12918200130 INJ FOR MICROBUBBLE STUDY 3828200140 CARDIOVAS STR TEST W RX 12918200150 ECHO 2D LTD WO CON 14408200170 ECHO 2D COMP W CON 16428200180 ECHO 2D LMTD W CON 14408200190 ECHO TEE W CON 31378200210 ECHO STR TEST COMP W CON 19208200220 CARD REHAB III SP 398200230 CARD REHAB INI ASMT OP NC 0 18200240 TTE W/DOPPLER COMPLETE 29268200250 TTE COMP W SPEC/CF W CON 29268200260 ECHO PORTABLE PER TRIP NC 0 18200270 ECG PORTABLE PER TRIP NC 0 18200280 DOP ECHO LMTD STUDY ADDON 10188200290 ECH CNG TRNSTHR LTD WOCON 22628200300 ECH CNG TRNSTHR COM WOCON 31868200310 ECG 1-3 LEAD TRACING ONLY 718200320 HOLTER RECRD ONLY <= 48HR 1768200330 HOLTER SCN & RPRT <= 48HR 1768200341 PULM REHAB COPD W EX 1HR 1318200342 PULM REHAB PHASE III NC 0 18200343 PULM STRESS TEST SIMPLE 1678200344 THERAP STRG ENDR EA 15MIN 1318200345 THRP RSP STG END GR<=105M 8538200346 THRP RSP STG END GR<=120M 9738200347 THRP RSP STRG END GR<=30M 2468200348 THRP RSP STRG END GR<=45M 3698200349 THRP RSP STRG END GR<=60M 4898200351 THRP RSP STRG END GR<=90M 7318200352 THRP RSP-OTH INDV EA15MIN 1318200354 TOBACCO COUNSELING 3-10MN 1058200356 TOBACCO COUNSELING >10MIN 2188200370 ECHO CNG TRNSTHR COM WCON 3696

8200371 PULM REHAB III SP 398200372 CARD REHAB II WO ECG OP 3518200373 ECHO STR TEST COMP W ECG 21109200010 US FETAL BIOP PROF WO NST 8749200030 US SOFT TISS HEAD & NECK 18729200060 US PREG TRANSVAGINAL 22099200070 US SCROTUM 25379200080 US ABD COMPLETE WO CON 24339200090 US ABDOMEN WO CON LTD 18729200100 US RETROPERITONEAL COMPL 24379200110 US PREG=>14WK SNG 1ST GES 7559200120 US PELVIS NON OB COMP 22099200130 CT GUIDE CATH DRAIN 43339200150 US PREG+DETL SNGL1ST GEST 16579200170 US FETAL BIOPH PROF W NST 11969200200 US CHEST 17739200210 US HIPS INFANT DYNAMIC 19099200240 BX LIVER NEEDLE PERC 31049200250 BX THYROID NDL CORE PERC 10289200260 CHOLECYSTOSTOMY PERC 53719200270 LIVER TUMOR ABLAT RF PERC 107659200310 AMNIOCENTESIS 15249200320 US GUIDED NEEDL PLACEMENT 18029200330 US SPINAL CANAL & CONTENT 5519200340 US PORTABLE PER TRIP NC 0 19200350 US TRANSVAGINAL 18439200360 US PREG<14WK SNGL1ST GEST 6499200370 US PREG<14WKS EA ADD GEST 3489200380 US PREG=>14WKS EA ADD GES 4999200390 US PREG 1 OR >FETUSES LTD 19679200400 US V DPLX AB/PEL/RET LTD 15279200430 US ENCEPHALOGRAM 17029200440 US FETAL ECHO UMBIL ART 4349200450 US FETAL ECHO MID CEREBRL 3939200480 PSEUDOANEURY TX EXTRM INJ 5229200490 ASP ABSC/HEMA/CYST/BULLA 4049200500 PARACENTSIS ABD W IMAGING 22209200510 PERITONEAL LAVAGE 13139200520 PARACENTESIS ABD WO IMAG 15109200530 US BREAST COMPLETE LT 3069200540 US BREAST COMPLETE RT 3069200550 US BREAST COMPLETE LT 3069200560 US BREAST COMPLETE RT 3069200570 US EXTREM NONVAS COMP LT 20019200580 US EXTREM NONVAS COMP RT 20019200590 US EXTREM NONVAS LTD LT 6019200600 US EXTREM NONVAS LTD RT 601

9200610 US V DPLX ART LOW EXT LT 15789200620 US V DPLX ART LOW EXT RT 15789200630 US V DPLX ART UP EXT LT 10569200640 US V DPLX ART UP EXT RT 10569200650 US V DPLX VENOUS EXT LT 13979200660 US V DPLX VENOUS EXT RT 13979200670 US TRANSRECTAL 3029200680 US RETROPERITONEAL LTD 11959200700 US PREG FOLLOWUP/EA GEST 25419200710 DOP ECHO COMP STUDY ADDON 20369200730 ECHO 2D COM WO CON WO DOP 16429200740 US V DPLX ART LOW EXT BIL 26749200750 US V DPLX ART UP EXT BIL 17049200760 US SONOHYSTEROGRAM 4699200770 US DOP ART EXT >=3 LVL BI 9929200780 US V DOP ART LOWEXT W/S B 12429200790 US PELVIS NON OB LTD F/U 14819200800 US GUIDED COMPRESS REPAR 3309200810 US GUIDE INTRAOP 1-2 HOUR 5109200820 US V DPLX AB/PEL/RET CMP 26269200830 US GUIDE INTRAOP 0-1 HOUR 3349200840 HYSTERO NS/CON INTRO 6529200850 US PREG+DETL EA ADDL GEST 8309200860 US DOP ART EXT 1-2 LVL BI 6409200870 US TELERADIOGRAPY/EXAM NC 0 19200880 ECHO 2D LTD WO CON 14409200890 BIOPSY PROSTATE NDL/PUNCH 14259200900 PLACE RT DEVICE PROSTATE 26099200930 US AAA SCREENING 3179200940 US BREAST COMPLETE BIL 4599200960 BREAST CYST PUNC ASPIRATE 9169200970 ECHO TEE WO CON 31379200980 DOP ECHO LMTD STUDY ADDON 10189201000 ASP FINE NDL W IMAGING 12179201030 US GUIDED VASCULAR ACCESS 17589201040 BREAST CYST ASP EA ADDL 3259201060 US V DPLX AO/IVC/GRFT LTD 11309201070 US V DPLX AO/IVC/GRFT CMP 17879201090 US PREG NUCAL TRANSLU 1ST 4869201100 US PREG NUCAL TRANSL ADD 2449201120 INS CATH PLEURAL W IMAG 14759201130 THORACENTESIS W IMAGING 20199201140 US GUIDED AMNIOCENTESIS 16839201150 DOP ECHO COLOR FLOW ADDON 9779201160 US DPLX EXTRACRAN CMP BIL 22529201170 US V DOP TRANSCRAN CMP 20029201180 US V DOP TRANSCRAN LTD 1335

9201200 US V DPLX VENOUS EXT BIL 22909201210 INST/SUPP STERL 30X-39 1219201220 INST/SUPP STERL 51X-67 2079201290 MODERATE SEDAT ADD 15MIN 4889201328 TTE W/DOPPLER COMPLETE 29269201336 BX/EXC LYMPH NODE SUPERFI 19539201344 INST/SUPP STERL 23X-30 939201351 INST/SUPP STERL 39X-51 1589201369 INST/SUPP STERL 67X-88 2719201385 KIT/PACK DISP 431X-561 17369201393 KIT/PACK DISP 50X-67 2079201394 IMAGE CATH FLUID VISCERAL 71879201395 IMAGE CATH FLUID PERITO 71879201399 BX BREAST US PERC 1ST 45209201401 BX BRST US PERC EA ADD 45209201402 BX BREAST MRI PERC 1ST 44109201404 BX BREAST MRI PERC EA ADD 44109201405 PLC BRST LOC DEV MAMM 1ST 29789201407 PLC BRST LOC DEV MAMM ADD 29789201411 PLC BRST LOC DEV US 1ST 32059201413 PLC BRST LOC DEV US ADD 32059201414 PLC BRST LOC DEV MRI 1ST 30959201416 PLC BRST LOC DEV MRI ADD 30959201417 IMAGE CATH FLUID SOFT TIS 4199201419 US UPPER BACK SOFT TISSUE 17739201420 US LO BACK SFT TIS WO CON 18729201421 IMT STDY FOR CHD RSK FCTR 1739201422 US BREAST LIMITED LT 2299201423 US BREAST LIMITED RT 2299201424 US BREAST LIMITED BIL 3449201425 BX NECK/THORAX SOFT TISS 44109201426 ARTHROGRAM SACROIL JT INJ 7629201427 SACROIL JT TX W/WO ARTHRO 7629201428 PLC SOFT TISS LOC DEV 1ST 29789201429 BIOPSY SKIN SINGLE LESION 5579201430 US DPLX EXTRACRAN LTD LT 17799201431 US DPLX EXTRACRAN LTD RT 17799201433 MOD SEDAT <5YRS 1ST 15M 4609201434 MOD SEDAT =>5YRS 1ST 15M 5549400009 VIT B12 1000MCG/ML 1ML PC 59400011 INTRALESIONAL INJ >7 PO 939400012 INTRALESIONAL INJ >7 PO 939400013 INTRALESIONAL INJ >7 PO 939400014 INTRALESIONAL INJ >7 PO 2059400560 ARTHROC ASP MAJR JT WO PO 929400610 CIRCUMCISION PO 849400690 COMP PREV EVL12-17 INI NW 416

9400700 COMP PREV EVL 5-11 INI NW 4169400710 COMP PREV EVAL 1-4 INI NW 4169400720 COMP PREV EVAL <1 INI NEW 4169400730 COMP PREV REEVL 12-17 EST 4739400740 COMP PREV REEVAL 5-11 EST 4739400750 COMP PREV REEVAL 1-4 EST 4739400760 COMP PREV REEVAL <1YR EST 4739400770 UA NONAUTO W MICRO POC PO 399400780 UA NONAUT WO MICRO POC PO 219400790 OCC BLD FEC QL3 SP POC PO 229400800 GLUCOSE BLD BY DEV POC PO 259400810 PREG URINE VISUAL POC PO 199400820 STREP A IMMUNO OPT POC PO 319400830 SKIN TST TB INTRDRM POCPO 369400840 SMEAR WET MT W STN POC PO 929400850 TISSUE EXAM FUNGUS POC PO 169400860 ECG 12 LEAD TRAC ONLY PO 1449400870 SPIROMETRY PO 1649400880 BRNCHSPASM EVL PRE/PST PO 2599400890 INH TX INITIAL EA DAY PO 939400900 PULSE OX SNGL DETERM PO 309401260 FETAL NON STRESS TEST PO 49401270 SMEAR WET MT W STN POC PO 929401280 MC POSTPARTUM FU VISIT 4439401290 RHO(D) IMM GLOB 300MCG PC 389401300 VENIPUNCTURE OP PO 339401320 GLUCOSE BLD BY DEV POC PO 259401330 PREG URINE VISUAL POC PO 199401340 MNT NUTRIT SUBSEQ EA15 PO 229401360 MC PERINATAL ED IND EA15 489401370 MC PERINATAL ED GRP EA15 179401400 MC INIT ANTEPARTUM>16 WKS 8259401410 MC ANTEPARTUM FU VISIT 4439401560 MC INIT ANTEPARTUM<=16WKS 8259401561 MC INIT ANTEPARTUM<=16WKS 8259401580 MC NUTR ASSMT INIT ADD 15 229401590 MC POSTPART NUTRIT INDIV 439401600 MC PSYCH INIT EA ADD 15MN 299401610 MC PSYCH F/U ASSESS EA15 489401620 MC PSYCH POSTPT EA 15 MIN 489401630 MC HLTH ED INIT EA ADD15M 299401640 MC HLTH ED F/U INDIV EA15 489401650 MC POSTPART HEALTHED EA15 489401660 MC COMPHREHENS CARE PLAN 8069401690 COLPOSCPY CERVX BX CUR PO 12159401700 MC HLTH ED ORIENT EA 15 1169401710 MC INIT NUTR ASSESS 1ST30 91

9401720 MC ANTEPA F/U NUTR GRP 15 179401730 MC INI PSY ASSESS 1ST 30 889401740 COLPOSCOPY CERVIX PO 6799401810 MC INIT ANTEPARTUM>16 WKS 8259401820 MC ANTEPARTUM FU VISIT 4439401830 MC POSTPARTUM FU VISIT 4439401850 HEMATOCRIT SPUN POC PO 219401860 PRENATAL VITAMINS 30 DAY 519401870 MC COMPHREHENS CARE PLAN 8069401880 MC HLTH ED ORIENT EA 15 1169401890 MC INIT NUTR ASSESS 1ST30 919401910 MNT NUTRIT SUBSEQ EA15 PO 229401920 MC ANTEPA F/U NUTR GRP 15 179401930 MC NUTR ASSMT INIT ADD 15 229401940 MC INI PSY ASSESS 1ST 30 489401950 MC PSYCH INIT EA ADD 15MN 299401960 MC PSYCH F/U ASSESS EA15 489401970 MC PSYCH F/U GRP EA 15MN 59401980 MC PSYCH POSTPT EA 15 MIN 489401990 MC HLTH ED INIT 1ST 30MIN 489402000 MC HLTH ED INIT EA ADD15M 299402010 MC HLTH ED F/U INDIV EA15 489402020 MC HLTH ED F/U GRP EA 15 59402030 MC PERINATAL ED IND EA15 489402040 MC PERINATAL ED GRP EA15 179402050 MC POSTPART HEALTHED EA15 489402260 CATH SPECIMEN COLLECT PO 229402270 VIT B12100MCG/0.1ML IN PC 59402280 IG RHO-D RHOPH/100IUIV PC 1939402290 BETAMETH NA PH/AC 3MG PC 389402310 US PREG F/U EA GST 59 PO 23059402320 US PREG 1OR>FETUSES LTDPO 16039402330 VISIT LEVEL 2 EST PT PO 3789402340 VISIT LEVEL 3 EST PT PO 4739402350 VISIT LEVEL 4 EST PT PO 5679402360 CAST REINFORCE PO 2919402780 VISIT LEVEL 1 EST PT PO 959402790 VISIT LEVEL 5 EST PT PO 6809402800 INJ TX/DX/PROP SUBQ/IM PO 1019402810 VISIT LEVEL 1 NEW PT PO 3339402820 VISIT LEVEL 3 NEW PT PO 5209402830 INJ TX/DX/IV PUSH INIT PO 2139402840 ADMN OTHR IMMUN VAC ADDPO 889402850 ADMIN OTHR IMMUN VAC 1 PO 1279402860 INJ TX/DX/PROP SUBQ/IM PO 1019402870 INF IV HYDR INT 31-60MNPO 4899402880 INF IV HYDRAT EA AD HR PO 407

9402930 ADMIN INFLUENZ VACCINE PO 889402940 ADMIN PNEUMO VACCINE PO 889402970 CIRCUMCISION >28 DAYS PO 339402980 DIABETE SELF-MGNT 30MN PO 509402990 DIABET SELFMGT GRP 30M PO 329403010 FERN TEST POC PO 169403130 PH BODY FLUID NOS POC PO 179403320 VISIT LEVEL 1 EST PT PO 959403330 VISIT LEV 1 EST W PROC PO 3029403340 VISIT LEVEL 2 EST PT PO 3789403350 VISIT LEV 2 EST W PROC PO 3789403360 VISIT LEVEL 2 NEW PT PO 4169403370 VISIT LEV 2 NEW W PROC PO 4169403380 VISIT LEVEL 3 EST PT PO 4739403390 VISIT LEV 3 EST W PROC PO 4739403400 VISIT LEVEL 3 NEW PT PO 5209403410 VISIT LEV 3 NEW W PROC PO 5209403420 VISIT LEVEL 4 EST PT PO 5679403430 VISIT LEV 4 EST W PROC PO 5679403440 VISIT LEVEL 4 NEW PT PO 6249403450 VISIT LEV 4 NEW W PROC PO 6249403460 VISIT LEVEL 5 EST PT PO 6809403470 VISIT LEV 5 EST W PROC PO 6809403480 VISIT LEVEL 5 NEW PT PO 7499403490 VISIT LEV 5 NEW W PROC PO 7499403500 ACNE SURGERY PO 339403510 I&D ABSCESS SIMPLE PO 759403520 I&D ABSCESS COMP/MULTI PO 379403530 I&D CYST PILONIDAL SMP PO 99403540 I&D HEMATO/SEROM/FLUID PO 549403550 BX SKIN SINGLE LESION PO 689403560 BX SKIN LESION EA ADD PO 509403570 REMOVE SKIN TAGS <=15 PO 289403580 SHAVE LES T/A/L<=0.5CM PO 739403590 SHAVE LES T/A/L 0.6-1C PO 819403600 SHAVE LES T/A/L 1.1-2C PO 1519403610 SHAVE LES T/A/L >2.0CM PO 1209403620 SHAVE LES S/N/HF<=0.5C PO 699403630 SHAVE LES S/N/HF 0.6-1 PO 1229403640 SHAVE LES S/N/HF1.1-2C PO 1069403650 SHAVE LES F/E/NL<=0.5C PO 1639403660 SHAVE LES F/E/NL 0.6-1 PO 1569403670 SHAVE LES F/E/NL 1.1-2 PO 1609403680 SHAVE LES F/E/NL >2.0C PO 1869403690 EXC BEN LES T/A/L<0.5CMPO 929403700 EXC BEN LES T/A/L0.6-1 PO 1519403710 EXC BEN LES T/A/L1.1-2 PO 178

9403720 EXC BEN LES T/A/L2.1-3 PO 1609403730 EXC BEN LES T/A/L3.1-4 PO 3059403740 EXC BEN LES S/N/HF<=0.5PO 1079403750 EXC BEN LES S/N/HF.6-1 PO 1589403760 EXC BEN LES S/N/HF1.1-2PO 1669403770 EXC BEN LES F/E/NL<=0.5PO 999403780 EXC BEN LES F/E/NL.6-1 PO 1619403790 EXC BEN LES F/E/NL1.1-2PO 1959403800 EXC BEN LES F/E/NL2.1-3PO 1839403810 EXC MAL LES T/A/L<=0.5 PO 1679403820 EXC MAL LES T/A/L 0.6-1PO 1929403830 EXC MAL LES T/A/L1.1-2 PO 1779403840 EXC MAL LES T/A/L2.1-3 PO 2629403850 EXC MAL LES T/A/L 3.1-4PO 2619403860 EXC MAL LES S/N/HF<=0.5PO 1439403870 EXC MAL LES S/N/HF.6-1 PO 6759403880 EXC MAL LES S/N/HF1.1-2PO 2409403890 EXC MAL LES F/E/NL<=0.5PO 2559403900 EXC MAL LES F/E/NL0.6-1PO 3649403910 EXC MAL LES F/E/NL1.1-2PO 4549403920 EXC MAL LES F/E/NL2.1-3PO 4719403930 AVULSION NAIL PLAT SNG PO 869403940 EVAC HEMATOMA SUBUNGAL PO 279403950 EXC NAIL & MATRIX PO 1369403960 INTRALESIONAL INJ 1-7 PO 279403970 LR INT NK/HND/FT <=2.5 PO 519403980 LESION PREMAL DEST 1ST PO 369403990 LES PREMAL DES 2-14 EA PO 559404000 LES BENIGN DESTR 1-14 PO 129404020 LESION BENIGN DESTR=>15PO 1719404050 FERN TEST POC PO 169404060 FETAL FIBRONECTIN POC PO 4529404090 TOBACCO COUNSEL 3-10MN PO 599404100 TOBACCO COUNSELING >10 PO 69404230 US PREG+DETL SNGL GST PO 12289404240 US GUIDE AMNIOCENTESIS PO 9099404260 AMNIOCENTESIS PO 15399404280 US PREG+DETL EA AD GST PO 4849404290 US FETAL BIO PRO W NST PO 8969404300 US FET BIOP PRO WO NST PO 6549404310 US FET BIOP PRO WO NST PO 7929404420 INITIAL PREV PHYS EXAM PO 3329404460 STRAPPING UNNA BOOT PO 169404470 ROTAVIR VAC PENTA SUS PC 1429404480 MEASLES/MUMPS/RUBE VAC PC 1059404490 DTAP HIB IP VACCINE IM PC 1709404500 VARICELLA VACPF1350U/0.5 177

9404510 HEPATITI A VACC 0.5 ML PC 1019404520 HEP B VACC 10MCG PEDIM PC 529404570 DTAP IPV 0.5ML 4-6PDIM PC 899404580 ANNUAL DEPRESS SCRN 15 PO 1359404590 INTEN BEH THRY CARD 15 PO 669404600 HI INTEN BH CNSL STI 30PO 909404610 PNEUMOCOC VACC 13 VAL PC 3209404630 FLU VAC TRIVAL PF6-35M PC 629404640 HIB VA PRP-OMP CONJ IM PC 879404650 FLU TRI LIVE INTRANA PC 419404660 HPV VACC 4-VAL 0.5ML INJ 2619404670 DIP-TET-ACPRT0.5ML<7IM PC 509404680 BEH COUNSEL OBESITY 15 PO 909404690 US PREG F/U EA GST 59 PO 23059404700 TDAP 0.5ML >=7YR IM PC 689410130 ADMIN INFLUENZ VACCINE PO 1279410210 US FETL ECHO MID CEREB PO 2349410220 US FETAL ECHO UMBI ART PO 3219410230 US PREG NUCH TRANS ADD PO 1199410240 US PREG NUCH TRANS 1ST PO 2849410270 PSYCH DX EVAL 15 MIN PO 4329410290 PSYCH DX EVAL 30 MIN PO 3829410310 PSYCH DX EVAL 45 MIN PO 4799410330 PSYCH DX EVAL 60 MIN PO 5979410350 PSYCH DX EVAL 90 MIN PO 7479410370 PSYCHO PT W EVAL >53M PO 1319410390 PSYCH PT W EVAL 16-37 PO 729410410 PSYCH PT W EVAL 38-52 PO 859410430 PSYCHOTH PAT >53 MIN PO 2279410450 PSYCHOTH PAT 16-37 MIN PO 1519410470 PSYCHOTH PAT 38-52 MIN PO 2019410480 VISIT LEV 1 EST W PROC PO 1859410540 HEP B VAC/DTAP/IPV0.5MLIM 1299411050 ARTHROC ASP SMAL JT WO PO 939411060 ARTHROC ASP INTM JT WO PO 979411070 ASP FINE NDL WO IMAG PO 1659411080 DES MAL LS F/E/N/L<=0.5PO 1029411090 EXC BEN LES F/E/NL3.1-4PO 2279411100 I&R FB SUBQ SIMPLE PO 439411110 INJ TRIGER PT 1-2MUSCL PO 779411120 INSERT CATH BLADDER PO 1199411130 DES MAL LES T/A/L 1.1-2PO 1039411140 DES MAL LES T/A/L 2.1-3PO 1489411190 REMOVE CERUMEN IMPACT PO 519411200 TX DSLC SHLDR MAN CLS PO 279411210 TX ELBW CHLD W/MAN CLS PO 599411220 BLOOD COLLECTION PICC PO 273

9411230 BLOOD COLLECTION VAD PO 2449411240 CHEMO INF EA ADD HR PO 4909411250 CHEMO INF EA SEQ1ST HR PO 15709411260 CHEMO INF INIT 1ST HR PO 14889411270 CHEMO IV PUSH EA ADD PO 4439411530 INS/REPL/DECL NONTUN/PIC 15829411540 VASC ACC THROMB DECLOT PO 3229411550 ADMIN INFLUENZ VACCINE PO 3719411560 ADMN OTHR IMMUN VAC ADDPO 259411570 ADMIN OTHR IMMUN VAC 1 PO 3649411580 ADMIN PNEUMO VACCINE PO 889411590 BLOOD COLLECTION PICC PO 2739411600 BLOOD COLLECTION VAD PO 2449411610 CHEMO INF EA ADD HR PO 4909411620 CHEMO INF EA SEQ1ST HR PO 15709411630 CHEMO INF INIT 1ST HR PO 14889411640 CHEMO IV PUSH EA ADD PO 4439411650 CHEMO IV PUSH INITIAL PO 3889411660 CHEMO IV PUSH INITIAL PO 3889411670 CHEMO SQ/IM HORMONAL PO 7099411680 CHEMO SQ/IM HORMONAL PO 7099411690 CHEMO SQ/IM NONHORMONA PO 6619411700 CHEMO SQ/IM NONHORMONA PO 6619411710 INF IV HYDR INT 31-60MNPO 4899411720 INF IV HYDR INT 31-60MNPO 4899411730 INF IV HYDRAT EA AD HR PO 4079411740 INF IV HYDRAT EA AD HR PO 4079411750 INF TX/DX CONCURRENT PO 10019411760 INF TX/DX CONCURRENT PO 10019411770 INF TX/DX/PRO EA AD HR PO 5189411780 INF TX/DX/PRO EA AD HR PO 5189411790 INF TX/DX/PRO INI1ST HRPO 10009411800 INF TX/DX/PRO INI1ST HRPO 10009411810 INF TX/DX/PRO SEQ 1HR PO 5069411820 INF TX/DX/PRO SEQ 1HR PO 5069411830 INJ TX/DX/IV PUSH SEQ PO 2369411840 INJ TX/DX/IV PUSH SEQ PO 2369411850 INJ TX/DX/IV PUSH INIT PO 2139411860 INJ TX/DX/IV PUSH INIT PO 2139411870 INJ TX/DX/PROP SUBQ/IM PO 1019411880 INJ TX/DX/PROP SUBQ/IM PO 1019411890 INJ TX/DX IVP SME DRG PO 3829411900 INJ TX/DX IVP SME DRG PO 3829411910 IRRI IMPLANT VEN ACCES PO 2849411920 IRRI IMPLANT VEN ACCES PO 2849412150 PICC INSERT/REPLACE RN 16299412160 VENIPUNCTURE OP PO 33

9412170 VISIT LEVEL 1 EST PT PO 979412180 VISIT LEV 1 EST W PROC PO 3009412190 VISIT LEVEL 1 NEW PT PO 3319412200 VISIT LEV 1 NEW W PROC PO 3319412210 VISIT LEVEL 2 EST PT PO 3779412220 VISIT LEV 2 EST W PROC PO 3779412230 VISIT LEVEL 2 NEW PT PO 4179412240 VISIT LEVEL 2 NEW PT PO 4169412250 VISIT LEV 2 NEW W PROC PO 4179412260 VISIT LEVEL 3 EST PT PO 4739412270 VISIT LEV 3 EST W PROC PO 4739412280 VISIT LEVEL 3 NEW PT PO 5199412290 VISIT LEV 3 NEW W PROC PO 5199412300 VISIT LEVEL 4 EST PT PO 5659412310 VISIT LEV 4 EST W PROC PO 5659412320 VISIT LEVEL 4 NEW PT PO 6269412330 VISIT LEVEL 4 NEW PT PO 6249412340 VISIT LEV 4 NEW W PROC PO 6269412350 VISIT LEVEL 5 EST PT PO 6829412360 VISIT LEV 5 EST W PROC PO 6829412370 VISIT LEVEL 5 NEW PT PO 7489412380 VISIT LEVEL 5 NEW PT PO 7499412390 VISIT LEV 5 NEW W PROC PO 7489412420 CLINIC PATIENT COUNT NC 0 19412460 PRENATAL VITAMINS 30 DAY 2679412545 VISIT LEVEL 1 NEW PT PO 3339412552 CLINIC PATIENT COUNT NC 0 19412560 VISIT LEV 1 NEW W PROC PO 3339412610 DESTR VULVA LES SIMPLE PO 45759412628 DEST VULV LES EXTENSIV PO 45759412636 DESTR VAG LES SIMPLE PO 46949412644 DESTR VAG LES COMPLEX PO 46949412651 DESTR LSN PENS SMP CRY PO 899413181 SUTURE REMOVAL NC 0 29413182 GLOBAL OB PT COUNT 0 29413582 I&D ABSCESS SIMPLE PO 759413770 LR SMPL TRK/NECK <=2.5 PO 1269413771 LR SMPL TRK/NCK 2.6-7.5PO 2869413772 LR INT SCLP/TRNK <=2.5 PO 559413773 LR INT SCLP/TRNK2.6-7.5PO 2349413774 LR CPLX TRUNK 1.1-2.5 PO 579413775 LR CPLX TRUNK 2.6-7.5 PO 2909413782 LES PREMALG DESTR >=15 PO 599413788 HEP A 720U/0.5MLPDIM PC 679413798 EXC SNGL EXT TAG ANUS PO 329413799 EXC MULT EXT TAGS ANUS PO 569413800 ANOSCOPY DIAG PO 21

9413801 I&D ABSC VULV/PERINEAL PO 3249413802 I&D ABSC GLAND BARTHOL PO 3249413803 COLPOSCOPY CERVIX PO 6799413804 COLPOSCPY CERVX BX CUR PO 12159413805 CAUTERY CERVIX CRYO PO 3239413806 BX ENDOMETRIAL WO DIL PO 1559413807 LUMBAR PUNCT DIAGNOSTC PO 879413854 ZOSTER VAC LIVE SC 2459413855 TYPHYOI LIVE ATTEN VAC PC 829413856 TYPHOID POLY25MCG/0.5 PC 829413857 HEP A VAC 1440U 1ML IN PC 789413858 POLIO VACC(INACT) 0.5M PC 569413859 YELLOW FEV VAC 0.5MLSQ PC 829413860 HEP B VAC 10MCG 1ML IN PO 829413861 ADMIN HEP B VACCINE PO 3829413874 DES MAL LES T/A/L 0.6-1PO 2899413876 VISIT LEV 1 NEW W PROC PO 3339413877 VISIT LEV 2 NEW W PROC PO 4169413878 VISIT LEV 3 NEW W PROC PO 5209413879 VISIT LEV 4 NEW W PROC PO 6249413880 VISIT LEV 5 NEW W PROC PO 7499413881 VISIT LEV 1 EST W PROC PO 3029413882 VISIT LEV 2 EST W PROC PO 3789413883 VISIT LEV 3 EST W PROC PO 4739413884 VISIT LEV 4 EST W PROC PO 5679413885 VISIT LEV 5 EST W PROC PO 6809413896 APPLY CAST LONG ARM PO 2869413897 APPLY CAST SHORT ARM PO 2119413898 APP CAST HAND/FOREARM PO 1639413899 APPLY SPLINT LONG ARM PO 1639413900 APP SPLNT SHRT ARM STC PO 1639413901 APP SPLINT FINGER STC PO 989413902 APPLY CAST LONG LEG PO 3249413903 APPLY CAST SHORT LEG PO 3249413904 APP CAST SHORT LEG BIL PO 2329413905 APPL CAST PATELLR TEND PO 3249413906 APP SPLINT LONG LEG BI PO 2329413907 APPLY SPLINT SHORT LEG PO 1729413908 STRAPPING KNEE PO 829413909 STRAPP ANKLE &/OR FOOT PO 829413910 REM BIVL GNT BT BDY CSTPO 3249413911 REM/BIVAL CAST ARM/LEG PO 3249413975 CARE MISCARRIAGE TRI 2 PO 25969413976 MC HLTH ED INIT 1ST 30MIN 489413980 YELLOW FEVER VACC 0.5MLSQ 1259413981 TYPHYOID LIVE ATTEN VAC 549413982 TYPHOID VAC POLY25MCG/0.5 72

9413984 HEPAT A VACC 1440U 1ML IN 509413985 JAPAN ENCEPH VACC 0.5MLIM 2839413987 POLIO VACC(INACTIVE) 0.5M 289413988 TRAV CNSLT INDIV SELF PAY 609413989 TRAV CNSLT GRP 4 SELF PAY 37.59413990 TRAV CNSLT GRP 5 SELF PAY 359413991 TRAV CNSLT GRP 2 SELF PAY 459413992 TRAV CNSLT GRP 3 SELF PAY 409413993 TRAV CNSLT GR10-24SELFPAY 259413994 TRAV CNSLT GRP>25SELF PAY 209413995 TRVL CLINIC VAC ADMIN SP 119413996 VISIT LEVEL 1 EST PT PO 929413997 VISIT LEV 1 EST W PROC PO 2909413998 VISIT LEVEL 1 NEW PT PO 3169413999 VISIT LEV 1 NEW W PROC PO 3169414000 VISIT LEVEL 2 EST PT PO 3619414001 VISIT LEV 2 EST W PROC PO 3619414002 VISIT LEVEL 2 NEW PT PO 3979414003 VISIT LEV 2 NEW W PROC PO 3979414004 VISIT LEVEL 3 EST PT PO 4489414005 VISIT LEV 3 EST W PROC PO 4489414006 VISIT LEVEL 3 NEW PT PO 4949414007 VISIT LEV 3 NEW W PROC PO 4949414008 VISIT LEVEL 4 EST PT PO 5409414009 VISIT LEV 4 EST W PROC PO 5409414010 VISIT LEVEL 4 NEW PT PO 5969414011 VISIT LEV 4 NEW W PROC PO 5969414012 VISIT LEVEL 5 EST PT PO 6469414013 VISIT LEV 5 EST W PROC PO 6469414014 VISIT LEVEL 5 NEW PT PO 7139414015 VISIT LEV 5 NEW W PROC PO 7139414016 TRIM DYSTROPHIC NAILS PO 1709414017 TET/DIP PFVAC 0.5ML>=7 PC 75.19414018 GE VISIT LEVEL1 NEW PT PO 879414019 GE VISIT LEVEL1 NEW PT PO 879414020 GE VISIT LEVEL1 NEW PT PO 879414021 GE VISIT LEVEL1 NEW PT PO 879414022 ADMIN HEP B VACCINE PO 1279414023 ADMN OTHR IMMUN VAC ADDPO 259414024 ADMIN OTHR IMMUN VAC 1 PO 1279414025 ADMIN PNEUMO VACCINE PO 1279414026 ADMIN HEP B VACCINE PO 3719414027 OBTAIN SCRN PAP SM POC PO 39414028 BETAMETH NA PH/AC 3MG INJ 389414029 TOBACCO COUNSEL 3-10MN PO 349414030 UA NONAUT WO MICRO POC PO 219414031 EXC BEN LES SNHF>4.0CM PO 1642

9414032 LAPAR SURG WSALPINGOST PO 34029414033 HEMOGLOBIN A1C POC PO 169414035 ECH2D COM WO CON WO DP PO 3819414036 REM FB EXT AUD CANAL PO 1199414037 EXC BEN LES T/A/L >4.0 PO 12089414038 FLU VACC 4V PF 3YR+ IM PC 419414039 FLU VACC 4V PF 6-35MOS PC 529414040 PNEUMOCOC VACC 23 VAL PC 1579414041 FLU VAC FLUMIST 4V NAS PC 479414042 HEMOGLOBIN A1C POC PO 49414043 IRR/LAV CERUMEN IMPACT PO 429414044 COLLECT CAPILLAR BLOOD PO 169414045 MEDROXYPROG150MG/ML1ML PC 849414046 KETOROLAC 15MG/ML 1ML PC 179414047 TESTOST ENA200MG/ML5ML PC 359414048 TRIAMCIN ACE10MG/ML1ML PC 259414049 CEFTRIAXON500MG PWD IN PC 2179414050 CEFTRIAXONE 1GM PWD IN PC 309414051 HYALUR ART SYNVISC 1MG PC 11459414052 METHYLPRED NA 125MG IN PC 269414053 DENOSUMAB 60MG/ML 1ML PC 11399414054 ONDANSETRO/1MG20ML MDV PC 169414055 PROCHLORPER 5MG/ML 2ML PC 169414056 HIB VACC PRP-T CONJ IM PC 559414057 OCCULT BLD FECES QL POCPO 49414073 HPV VACC 9-VAL 0.5ML IM 3789414077 MENINGOC B OMV 0.5MLVACC 1439414081 SHAVE LES S/N/HF >2.0 PO 1129414082 EXC BEN LES S/N/HF2.1-3PO 8919414083 EXC BEN LES SNHF 3.1-4 PO 13379414084 EXC MAL LES T/A/L >4.0 PO 13379414085 EXC MAL LES S/N/HF>4.0 PO 13379414086 SMEAR WET MT INFEC POC PO 119414087 OSTEOPATHIC MAN1-2 REG PO 229414088 OSTEOPATHIC MAN3-4 REG PO 229414089 OSTEOPATHIC MAN5-6 REG PO 229414090 OSTEOPATHIC MAN7-8 REG PO 229414091 OSTEOPATHIC MAN9-10REG PO 229414092 TYMPANOMETRY PO 299414093 VISION ACUITY PO 69414094 HEAR TST PURE TONE AIR PO 239414095 INJ TENDON SHTH/LIG PO 2129414096 EPINEPH PF 1MG/1ML INJPC 269414097 TISS EX FUNG/ECTOP POC PO 119414098 HGB QN TRANSCUT POC PO 379414100 APPL ONBODY TIME INJ SUBQ 3599414101 APPL ONBODY TIME INJ SUBQ 359

9414102 DEBOSUMAB 1MG INJ 0 29414103 DEBOSUMAB 1MG INJ JW 0 29414104 VISIT LEVEL 4 EST PT 7889414105 VISIT LEVEL 3 EST PT 5099414106 VISIT LEVEL 1 EST PT 959414107 PROTHROMBIN TIME POC 119414108 LDCT SCREEN COUNSEL VISIT 1019414109 OCCULT BLD CA SCREEN IA 419414110 PROSTATE CA SCREENING 409414111 PELVIC/BREAST SCR EXAM PO 779414112 DENOSUMAB60MG/ML 1ML PCJW 199500200 MNT NUTRITION INITL EA15 509500250 DIABETES SELF-MGNT 30MIN 1799500260 MNT NUTRITION GRP EA 30MN 449500270 MNT NUTRITION SUBSEQ EA15 689500280 P-CARE CONSULT NC 0 29500281 IP/OBSV PSYCH SITTR/HR NC 0 19700006 ADJ BERGER REHAB 0 29700014 ADJ COMBINE ACCTS 0 29700030 ADJ MEDICARE UNBILLABLE 0 29700048 ADJ NO NDC 0 29700055 ADJ RETURNED CHK 0 29700063 ADJ SLF PAY PKG DISCOUNT 0 29700071 ADJ TRFR PT CREDIT 0 29700089 ADJ UNBILLABLE 0 29700097 ADJ UNCLAIMED PROPERTY 0 29700113 ADJ WCMG BLUD SHIELD 0 29700121 ADJ WCMG BLUE SHIELD NET 0 29700139 ADJ WCMG CAL CARE 0 29700147 ADJ WCMG CIGNA 0 29700154 ADJ WCMG HEALTHNET 0 29700162 ADJ WCMG HEALTHNET SR 0 29700170 ADJ WCMG PACIFICARE 0 29700188 ADJ WCMG PARTNERSHIP 0 29700196 ADJ WCMG SECURE HORIZONS 0 29700204 ADJ WCMG WHA 0 29700212 ADJ WCMG WHA SR 0 29700220 ADJ CONTRACT SUB CAP 0 29700238 ADJ CONTRACTUAL ADJUSTMEN 0 29700246 DEN ABN 0 29700253 DEN ALL OTH ADMIN 0 29700261 DEN CONTRACT INTERP 0 29700279 DEN DAYS MCL 0 29700287 DEN LEVEL OF CARE 0 29700295 DEN MCR RAC 0 29700303 DEN MED NEC 0 29700311 DEN NO AUTH FULL PMT 0 2

9700329 DEN NO AUTH PART PMT 0 29700337 DEN NON COVERED 0 29700345 DEN NOT AUTHORIZED 0 29700352 DEN OTHER 0 29700360 DEN UNTIMELY PFS 0 29700378 LATE CHG ADJUSTMENT 0 29700386 DEN ADMINISTRATIVE DAYS 0 29700394 DEN MAC 0 29700402 ADJ MENTAL HLTH TFR 0 29700410 ADJ OUTREACH LAB 0 29700428 ADJ ESCHEAT TO THE STATE 0 29700436 ADJ NON 340B 0 29700592 INS ZERO PAY 0 29700600 DEN MCD RAC 0 29700618 ADJ RE-ADMISSION DAYS 0 29700626 DEN UNTIMELY FACILITY 0 29700634 DEN UNTIMELY VENDOR 0 29700642 INTEREST PMT PATIENT 0 29700667 DEN MEDNEC MCAL IP NOTMET 0 29704008 CHARITY ADJUSTMENT 0 29704016 CHARITY PARO 0 29704024 CHARITY W/O PMT ASST AR 0 29708009 ADJ EMP FIST AID 0 29708017 ADJ EMP PHYSICAL 0 29708025 HOSPTIAL EVENT 0 29708033 SMALL BAL ADJUSTMENT 0 29708041 ADJ UNINSURED DISC 0 29708074 ADJ PROF COURTESY DISC 0 29708090 ADJ PROMPT PAY DISCOUNT 0 29709007 ADMIN ADJUSTMENT 0 29709106 HARDSHIP ADJUSTMENT 0 29709114 ADMIN ALLOWANCE FAP 0 29709502 REFUND INSURANCE 0 29709510 REFUND OTHER 0 29709528 REFUND PATIENT 0 29799917 TRANSFER FROM BD TO AR 0 29799990 TRANSFER FROM AR TO BD 0 29800004 BD ADJ BANKRUPTCY 0 29800012 BD ADJ CHARITY 0 29800020 BD ADJ INSURANCE 0 29800038 BD ADJ PARO CHARITY 0 29800046 BD ADJ TRAUMA FUNDING 0 29800053 BD ADJ ADMIN ADJ 0 29800061 BD SETTLEMENT IN FULL 0 29800079 BD SMALL BALANCE ADJ 0 29800087 BD CHARITY W/O PMT ASST 0 29800095 BD ADJ UNINSURED DISCOUNT 0 2

9800103 BAD DEBT INS ZERO PAY 0 29800129 BD HARDSHIP ADJUSTMENT 0 29800137 BD ADMIN ALLOWANCE FAP 0 29800152 BD ADJ RE-ADMISSION DAYS 0 29801002 BD DEN ABN 0 29801010 BD DEN ALL OTH ADMIN 0 29801028 BD DEN CONTRACT INTERP 0 29801036 BD DEN DAYS MCL 0 29801044 BD DEN LEVEL OF CARE 0 29801051 BD DEN MCR RAC 0 29801069 BD DEN MCD RAC 0 29801077 BD DEN MED NEC 0 29801085 BD DEN NO AUTH FULL PMT 0 29801093 BD DEN NO AUTH PART PMT 0 29801101 BD DEN NON COVERED 0 29801119 BD DEN NOT AUTHORIZED 0 29801127 BD DEN OTHER 0 29801135 BD DEN TAR 0 29801143 BD DEN UNTIMELY PFS 0 29801150 BD DEN UNTIMELY FACILITY 0 29801168 BD DEN UNTIMELY VENDOR 0 29801176 BD DEN ADMINISTRATIVE DAY 0 29801184 BD DEN MAC 0 29809500 BD REFUND 0 29810011 BD PMT RECOVERY 0 29810029 BD PMT RECOVERY MCR* 0 29810037 BD PMT RECOVERY MCL* 0 29810045 BD PMT RECOVERY COMM* 0 29810052 BD PMT RECOVERY AGENCY 0 29820010 AMBULANCE OTHER REVENUE 0 29820028 AR CASH TRANSFER-MMCMS 0 29820036 AR CASH TRANSFER-MMCR 0 29820044 AR CASH TRANSFER-REGION 0 29820051 AR CASH TRANSFER-SECH 0 29820069 AR CLEARING OTHER 0 29820077 AR-LEGACY SYSTEM 0 29820085 CAFETERIA REBATE/REFUND 0 29820093 CAFETERIA REVENUE 0 29820101 CARDIAC REHAB 0 29820119 CELL TOWER REVENUE 0 29820127 DUE TO CMSP 2004 0 29820135 DUE TO OTHER GOVERNMENT 0 29820143 EDUCATION DEPT REVENUE 0 29820150 ELECTRONEURO REVENUE 0 29820168 ENG-SALE OF SCRAP & WASTE 0 29820176 ER SEMINARS 0 29820184 FAMILY PRAC CLINIC REV 0 2

9820192 GUILD/AUX GIFT SHOP SALES 0 29820200 HEALTHNET RECOVERY-OLD AR 0 29820218 HOME HEALTH A/R 0 29820226 HOSPICE A/R 0 29820234 HOUSE OF MERCY(GUEST HOUS 0 29820242 INTEREST 0 29820259 INTEREST EXPENSE 0 39820267 MCAL PROVIDER FEE PAYMENT 0 29820275 MED STAFF STIPENDS 0 29820283 MEDICAID EHR INCENTIVE 0 29820291 MEDI-CAL OP CO-PAY 0 29820309 MEDICAL RECORDS AUDIT FEE 0 29820317 MEDICAL RECORDS/ABSTRACT 0 29820325 MEDICARE B/D ADJUSTMENT 0 29820333 MEDICARE D/M 0 29820341 MEDICARE GME 0 29820358 MEDICARE PART B PASS THRU 0 29820366 NSF CHECKS 0 29820374 NUTRITION SERV CONSULTING 0 29820390 OB/GYN CLINIC REVENUE 0 29820408 PHARM SALES TO EMP/VOLUN 0 29820416 PHARMACY REBATES 0 29820424 PHARMACY RETURN OLD LOTS 0 29820432 PUBLIC RELATION(COMM EDUC 0 29820440 RADIOLOGY FILM COPIES 0 29820457 SURGERY-HEART SEMINARS 0 29820465 TRAUMA SEMINARS 0 29820473 TRICARE REVENUE-CASH 0 29820481 VENDING MACHINE COMM 0 29820523 COLLECTION AGY FEE 0 29820531 LATE CHARGE PENALTIES 0 29820622 AFFILIATE PROVIDER WITHLD 0 29820804 CLINIC PYMT FOR PT AR 0 29821018 DUE TO MEDICARE 2000 0 29821026 DUE TO MEDICARE 2001 0 29821034 DUE TO MEDICARE 2002 0 29821042 DUE TO MEDICARE 2004 0 29821059 DUE TO MEDICARE 2004 0 29821067 DUE TO MEDICARE 2005 0 29821075 DUE TO MEDICARE 2006 0 29821083 DUE TO MEDICARE 2007 0 29821091 DUE TO MEDICARE 2008 0 29821109 DUE TO MEDICARE 2009 0 29821117 DUE TO MEDICARE 2010 0 29821125 DUE TO MEDICARE 2011 0 29821133 DUE TO MEDICARE 2012 0 29821141 DUE TO MEDICARE 2013 0 2

9821158 DUE TO MEDICARE 2014 0 29821166 DUE TO MEDICARE HOLDING A 0 29821174 DUE TO MEDICARE 2015 0 29821182 DUE TO MEDI-CAL 2016 0 29821984 MEDICARE EHR INCENTIVE 15 0 29821992 MEDICARE OP CONTRACTUAL 0 29822016 DUE TO MEDI-CAL 2000 0 29822024 DUE TO MEDI-CAL 2003 0 29822032 DUE TO MEDI-CAL 2004 0 29822040 DUE TO MEDI-CAL 2005 0 29822057 DUE TO MEDI-CAL 2006 0 29822065 DUE TO MEDI-CAL 2007 0 29822073 DUE TO MEDI-CAL 2008 0 29822081 DUE TO MEDI-CAL 2009 0 29822099 DUE TO MEDI-CAL 2010 0 29822107 DUE TO MEDI-CAL 2011 0 29822115 DUE TO MEDI-CAL 2012 0 29822123 DUE TO MEDI-CAL 2013 0 29822131 DUE TO MEDI-CAL 2014 0 29822149 DUE TO MEDI-CAL HOLDING A 0 29822164 DUE TO MEDICARE 2016 0 29822172 DUE TO MEDICARE 2017 0 29822198 DUE TO MEDI-CAL 2017 0 29822206 SB855 MEDI-CAL IP DISP SH 0 29900002 PMT BALANCE AFTER INSU 0 29900010 PMT SELF PAY UNINSURED 0 29900028 PMT HOMELESS 0 29900036 PMT SELF PAY NO DISCOUNT 0 29900044 PMT CARE PGM RYAN WHITE 0 29900051 PMT PEND TRAUMA FUND ELIG 0 29900069 PMT PENDING CHARITY 0 29900077 PMT DH MENTAL HLTH TRNSF 0 29900085 PMT PEND WORKERS COMP 0 29900093 PMT SELF PAY CARDIAC REH 0 29900101 PMT SELF PAY PACKAGE 0 29900119 PMT HOSPITAL EVENT 0 29900127 PMT CLIENT BILLING 0 29900135 PMT NORTH HIGHLANDS CLINI 0 29900143 PMT WHITE ROCK CLINIC 0 29900150 PMT FOLSOM FAMILY CLINIC 0 29900168 PMT INTERFACLIITY TANSFER 0 29900176 PMT PAYMENT ARRANGEMENT 0 29900184 PMT INTERNATIONAL ACCOUNT 0 29900192 PMT RESTRICT FOR PHI 0 29900994 PMT CONVERSION BAL AFTER 0 29909011 PMT PEND GOVT ELIGILBILIT 0 29910001 PMT MEDICARE INPT PARTB O 0 2

9910019 PMT MEDICARE 0 29910027 PMT MEDICARE ENCOUNTER 0 29910068 PMT RAC MAC 0 29910993 PMT UNID MCARE 0 29911009 PMT MD CARE HEALTHPLAN SR 0 29911017 PMT AETNA SR SEL CHOICE P 0 29911025 PMT AIDS HLTH FNDTN SR 0 29911033 PMT BLUE SHIELD CA SR 0 29911041 PMT MOLINA ADVANTAGE SR 0 29911058 PMT AARP SECURE HORIZONS 0 29911066 PMT HEALTH NET CA SR 0 29911074 PMT SECURE HORIZON SR 0 29911082 PMT BLUE CROSS CA SR 0 29911090 PMT SCAN SR 0 29911108 PMT AETNA SR 0 29911116 PMT HUMANA GOLD CHOICE SR 0 29911124 PMT CAREMORE HP SR 0 29911132 PMT BLUE CROSS FREEDOM BL 0 29911140 PMT CITIZEN CHOICE HLTH P 0 29911157 PMT PARTNERSHIP ADV SR 0 29911165 PMT CARE 1ST CA SR 0 29911173 PMT EASY CHOICE HLTH PLAN 0 29911181 PMT KAISER ST 0 29911199 PMT KAISER SR CARDIAC 0 29911207 PMT MEDICARE SR OTH 0 29911249 PMT BCBS ADV SR 0 29911371 PMT UHC SR 0 29915000 PMT HEALTH NET SR PLUS CA 0 29915018 PMT SECURE HORIZONS CAP 0 29915026 PMT AARP SECURE HORIZONS 0 29920000 PMT MEDICAID 0 29920018 PMT MEDI-CAL OP PRESUMPT 0 29920026 PMT MEDICARE IP B E MCAID 0 29920034 PMT MEDICAID OUT OF STATE 0 29920042 PMT MEDI-CAL FAM PAC 0 29920059 PMT MEDI-CAL SOC 0 29920075 PMT MEDI-CAL RESTICRED EL 0 29920083 PMT NEWBORN HEARING STUDY 0 29920091 PMT CANCER DETECTION PROG 0 29920109 PMT CCS CA CHILD SVCS 0 29920125 PMT MEDI-CAL CHDP 0 29920166 PMT MEDI-CAL HOSP PRESUM 0 29920992 PMT UNID MCAID 0 29921008 PMT PARTNERSHIP HLTHPLAN 0 29921016 PMT AIDS HLTH FNDTN MCAL 0 29921024 PMT KAISER MCAL 0 29921032 PMT CALOPTIMA 0 2

9921040 PMT CARE 1ST MCAL 0 29921057 PMT COMMUNITY HP MCAL 0 29921065 PMT LA CARE MCAL 0 29921073 PMT BLUE CROSS MCAL 0 29921081 PMT MOLINA MCAL 0 29921099 PMT HEALTH NET MCAL 0 29921107 PMT CCS PARTNERHSIP HP 0 29921115 PMT PARTNERSHIP HLTHPLAN 0 29921123 PMT MEDI CAL MGD OTH 0 29921305 PMT CA HEALTH WELLNESS 0 29921339 PMT PARTNERSHIP HLTH CHDP 0 29925017 PMT PARTNERSHIP HLTHPLAN 0 29925025 PMT COMMUNITY HP MCAL CAP 0 29925033 PMT HEALTH NET MCAL CAP 0 29930009 PMT CMSP 0 29930017 PMT Y CHIP YOLO COUNTY 0 29930025 PMT QUEENS CARE 0 29931007 PMT CMSP BLUE CROSS 0 29931015 PMT YOLO COUNTY CONTRACT 0 29931023 PMT CMSP BLUE CROSS SOC 0 29931031 PMT YOLO COUNTY MENTAL HL 0 29932005 PMT ZURICH WC 0 29932013 PMT BROADSPIRE WC 0 29932021 PMT CHARTIS WC 0 29932039 PMT CITY OF SACRAMENTO WC 0 29932047 PMT COUNTY OF SACRAMENTO 0 29932054 PMT ESIS WC 0 29932062 PMT FIRST AID ONLY DH EM 0 29932070 PMT GALLAGHER AND BASSETT 0 29932088 PMT LIBERTY MUTUAL WC 0 29932096 PMT PG E WC 0 29932104 PMT SCHOOL INS AUTH WC 0 29932112 PMT SEDGWICK CMS WC 0 29932120 PMT SPECIALITY RISK SVCS 0 29932138 PMT STATE COMP INS FUNDWC 0 29932146 PMT TRAVELERS WC 0 29932153 PMT TRISTAR WC 0 29932161 PMT US DEPT OF LABOR WC 0 29932179 PMT YORK INSURANCE WC 0 29932187 PMT WORK COMP OTH 0 29932310 PMT HARTFORD WORK COMP 0 29932328 PMT SIERRA PACIFIC WC 0 29937004 PMT BLUE CROSS MCS WORK 0 29937012 PMT NETWORKS BY DESIGN WC 0 29937020 PMT RISK MANAGEMENT 0 29940008 PMT AARP 0 29940016 PMT AMERICAN POSTAL WRKRS 0 2

9940024 PMT BANKERS LIFE AND CASU 0 29940032 PMT FED CORR INST TERM IS 0 29940040 PMT UNITED AMERICAN INS 0 29940057 PMT MUTUAL OF OMAHA 0 29940065 PMT GEHA 0 29940073 PMT STATE FARM 0 29940081 PMT MISC COMM INS 0 29940099 PMT SECONDARY COMM INS OT 0 29940107 PMT PHYSICIANS MUTUAL 0 29940115 PMT STANDARD LIFE & ACCI 0 29940123 PMT MERCY HOSPICE 0 29940131 PMT INTERNATIONAL 0 29940222 PMT KAISER NON CONTR INDV 0 29940313 PMT IAC SUPPLEMENTAL 0 29940990 PMT UNID COMM 0 29950015 PMT AFFLIATED HLTH FUNDS 0 29950023 PMT AETNA PPO 0 29950031 PMT BCE EMERGIS 0 29950049 PMT BLUE CROSS BLUE SHLD 0 29950056 PMT BLUE CROSS CA HMO 0 29950064 PMT BLUE CROSS CAL PERS P 0 29950072 PMT BEECH STREET 0 29950080 PMT BLUE CROSS DELTA HLTH 0 29950098 PMT BLUE CROSS FEC EMP PR 0 29950106 PMT BLUE CROSS MCS 0 29950114 PMT BLUE CROSS OUT OF STA 0 29950122 PMT BLUE CROSS PRUD BUYER 0 29950130 PMT BLUE SHIELD CAL PERS 0 29950148 PMT BLUE SHIELD HMO POS 0 29950155 PMT CHOICECARE NETWORK 0 29950163 PMT CIGNA PPO 0 29950171 PMT BLUE SHIELD NET VALUE 0 29950189 PMT BLUE SHIELD PPO 0 29950197 PMT BUTTE CO MENTAL HLTH 0 29950205 PMT CA FORENCIS MED GRP 0 29950213 PMT CIGNA HMO 0 29950221 PMT HEALTH NET HMO POS 0 29950239 PMT SECONDARY HOM PPO INS 0 29950247 PMT COUNTY OF SAC PRISON 0 29950254 PMT DEPT OF SOCIAL SVCS 0 29950262 PMT FIRST HEALTH AFFORDAB 0 29950270 PMT FOLSOM PRISON 0 29950288 PMT HEALTH NET PPO 0 29950296 PMT ORGAN DONOR 0 29950304 PMT GREAT WEST 0 29950312 PMT HEALTHCARE PARTNERS 0 29950320 PMT HILL REHAB 0 2

9950338 PMT HILL REHAB SENIOR 0 29950346 PMT HUMANA PPO 0 29950353 PMT KAISER CARDIAC 0 29950361 PMT KAISER 0 29950379 PMT INTERPLAN MISC 0 29950387 PMT MISC HMO PPO INS 0 29950395 PMT PACIFICARE PPO 0 29950403 PMT PCIP PRE EXISTING INS 0 29950411 PMT MULTIPLAN 0 29950429 PMT UNITED HEALTHCARE HMO 0 29950437 PMT VALUEOPTIONS 0 29950445 PMT AETNA HMO 0 29950452 PMT WESTERN HLTH ADV NTH 0 29950460 PMT PHCS PRIVATE HC PPO 0 29950478 PMT UNITED HEALTHCARE OPT 0 29950486 PMT UNITED HEALTHCARE CHO 0 29950494 PMT UMR 0 29950502 PMT WESTERN HLTH ADV 0 29950510 PMT COMMUNITH HLTH PLAN S 0 29950528 PMT BLUE CROSS AIM 0 29950536 PMT SUPERIOR CA PPO 0 29950544 PMT CA TRANSPLANT DONOR 0 29950551 PMT UC DAVIS AFP PROGRAM 0 29950593 PMT KEENAN HEALTH DIGNITY 0 29950619 PMT WESTERN GROWERS 0 29950627 PMT PINNACLE CLAIMS MGMT 0 29950643 PMT NETWORKS BY DESIGN PP 0 29950932 PMT UHC NAVIGATE 0 29950981 PMT BLUE CROSS PPO IND EX 0 29950999 PMT BC CAL PERS HMO 0 29951005 PMT BLUE SHIELD EPO IND E 0 29951013 PMT OTHER NON CONTRACTED 0 29951039 PMT HEALTH NET PURECARE 0 29951047 PMT HEALTH NET WHOLECARE 0 29951054 PMT HEALTH NET SMARTCARE 0 29951088 PMT HNET BLUE AND GOLD 0 29951278 PMT HEALTH NET INDV EX 0 29980004 PMT WEST HLTH ADV CAP 0 29980012 PMT HEALTH NET HMO CAP 0 29980020 PMT UNITED HEALTHCARE HMO 0 29980038 PMT BLUE SHIELD CAL PERS 0 29980046 PMT BLUE SHIELD NET VALUE 0 29984014 PMT ACTIVE DUTY MILITARY 0 29984022 PMT AIDS HLTH FNDTN POSS 0 29984030 PMT CORRECTCARE INTEG HLT 0 29984048 PMT EISNER PED AND FAMILY 0 29984055 PMT IN CUSTODY 0 2

9984063 PMT MLK IMPACTED HOSP PRG 0 29984071 PMT TRAUMA FUNDING 0 29984089 PMT TRICARE UMVS 0 29984097 PMT VETERANS ADMINISTATIO 0 29984105 PMT VICTIM OF CRIME 0 29984113 PMT CHAMPVA 0 29984121 PMT SECTION 1011 0 29984139 PMT INDIAN HLTH SERVICES 0 29984147 PMT TRICARE FOR LIFE 0 29984212 PMT MADDY FUND 0 29987009 PMT PARTNERSHIP HELTHY KI 0 29987017 PMT BLUE CROSS HLTHY FAM 0 29987025 PMT BLUE SHIELD HEALTHY F 0 29987033 PMT CARE 1ST HEALTHY FAM 0 29987041 PMT COMMUNITY HP HLTHY FA 0 29987058 PMT HEALTH NET HLTHY FAM 0 29987066 PMT LA CARE HEALTHY FAM 0 29987074 PMT MOLINA HEALTHY FAM 0 29987082 PMT PARTNERSHIP HEALTHY F 0 29987090 PMT LA CARE HELATHY KIDS 0 29989005 PMT GRANTS & RESEARCHES 0 29989013 PMT DIGNITY HLTH FOUNDATI 0 29989088 PMT INTERFACILITY TRNSF 0 2

Hospital Name: Mercy Medical Center ReddingOSHPD Facility No: 106450949Effective Date of Charges: June 1, 2017

Gross RevenueFacility Initial Increase

151 MERCY MEDICAL CENTER REDDING $ 1,663,351,388 $ 41,992,165

Gross Revenue Net Revenue Final Total Increase

$ 1,705,343,553 2.5% $ 830,952