Docstoc

106190555_CDM_2011

Document Sample
106190555_CDM_2011 Powered By Docstoc
					Cedars-Sinai Medical Center
AB1045 Chargemaster Submission
Prices Effective July 1, 2011

  Charge
   Code                   Description              CPT Code OP/Default Price   IP/ED Price
03610030    HB FINE NEEDLE ASP W/O GUIDANCE         10021        680.23          885.32
03610031    HB ASPIRATION FNE NDLW GUID             10022        1531.35        1990.54
03610738    HB ASPIRATION FNE NDLW GUID IR          10022        1531.35
03610034    HB INCISION & DRAINAGE, ABSCESS         10060        681.36          885.32
04500007    HB I & D ABSCESS COMPL/MULTI            10061        594.24          772.51
04500008    HB I&D PILONIDAL CYST                   10080                        772.51
04500009    HB PILONIDAL CYST COMPLEX               10081                       5035.01
04500010    HB REMOVAL FB SQ SIMPLE                 10120        681.19          885.32
04500011    HB I&D HEMATOMA                         10140                       3150.45
03610035    HB PUNCTURE ASPIRATION CYST             10160        357.77          464.88
05100006    HB I&D OF POSTOP WOUND COMPLEX          10180        5176.30
03610037    HB DEBRIDE SURGICAL WOUND               11000        673.39          875.06
04500210    HB DEBR O FX; SKIN - TO BONE            11012                       1403.74
03610391    HB DEBRIDEMENT, SKIN PARTIAL THICK      11040        415.89          540.65
05100008    HB DEBRIDEMENT, SKIN FULL THICKNESS     11041        576.54
03610392    HB DEBRIDEMENT SQ TISSUE                11042        732.64          951.40
05100009    HB DEBRIDEMENT MUSCLE/FASCIA            11043        1594.03
03610678    HB INCISION & DRAINAGE,ABSCESS          11044        1674.00
03610667    HB DEBRIDE SUBQ TISSUE ADD-ON           11045                        797.20
03610668    HB DEBRIDE MUSC/FASCIA ADD-ON           11046                        797.20
03610669    HB DEBRIDE BONE ADD-ON                  11047                       2124.31
03610393    HB PARING OR CURETTEMENT 1 LESION       11055        153.82
03610394    HB PARING OR CURETTEMENT 2-4 LESI       11056        137.87
05100012    HB PARING OR CURETTEMENT 4> LESIO       11057        157.24
03610038    HB BX SKIN SQ TISSUE SIMPL CLS          11100        699.59          909.24
03610040    HB BX SKIN SQ ADDITIONAL LESIONS        11101        194.84          252.95
03610395    HB RMVL SKIN TAGS UP TO 15              11200        404.49          525.83
03610004    HB EXC, BENIGN DIA 0.5 CM- LESS         11400        1347.92
03610043    HB EXC,BENIGN DIA 0.6 TO 1.0            11401        602.75
03610507    HB EXC, BENIGN DIA 1.1-2.0 CM           11402        1319.43
03610033    HB EXCISION 2.1 TO 3.0 CM               11403        2312.98        3006.88
03610527    HB EXC,BEN LES,T/A/L;3.1-4.0CM          11404                       1495.27
03610036    HB EXC LES SCLP/NECK/EXT <.5            11420        860.25         1060.02
03610608    HB EXC,BLES,S/N/EX,G;1.1-2.0CM          11422                       1993.31
03610524    HB EXC,BLES,S/N/EX,G;2.1-3.0CM          11423                       1495.27
03610546    HB EXC FACE-MM B9+MARG 0.5< CM          11440        1005.16        1306.70
03610016    HB DBRDMT NAIL ANY METH 1-5             11720        241.55          313.34
05100015    HB DEBRIDEMENT/NAILS ANY METH > 6       11721        175.47



                                               1
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
04500012   HB AVULSION NAIL PLATE FIRST              11730        351.46          456.90
03610679   HB AVULSION NAIL PLATE; SGL               11730        404.49
03610680   HB AVULSION NP; SGL EA ADDL               11732        404.49
04500013   HB SUBUNGUAL HEMATOMA EVAC                11740                        276.88
03610516   HB REMOVAL OF NAIL BED                    11750                        377.94
04500213   HB REMOVE NAIL BED/FINGER TIP             11752                       6534.81
04500014   HB REPAIR NAIL BED                        11760                        717.82
04500016   HB WEDGE EXCISON SKIN NAIL FOLD           11765                        697.31
04500215   HB REM IMPL CONTRACEP CAPS                11976                       1403.74
03610396   HB SIMPLE LAC REPAIR UP TO 2.5 CM         12001        765.68          994.70
04500018   HB SIMPLE LAC REPAIR 2.6-7.5 CM           12002                        796.45
04500019   HB SIMPLE LAC REPAIR 7.6-12.5 CM          12004                        796.45
04500020   HB SIMPLE LAC REPAIR 12.6-20.0 CM SCALP 12005                          796.45
04500021   HB SIMPLE LAC REPAIR 20.1-30.0 CM         12006                        796.45
04500022   HB SIMPLE LAC REPAIR OVER 30.0 CM         12007                        796.45
04500023   HB SIMPLE LAC REPAIR UP TO 2.5 CM FACE 12011                           796.45
04500024   HB SIMPLE LAC REPAIR 2.6 - 5.0 CM         12013                        796.45
04500025   HB SIMPLE LAC REPAIR 5.1 - 7.5 CM         12014                        796.45
04500026   HB SIMPLE LAC REPAIR 7.6-12.5 CM FACE     12015                        796.45
04500027   HB SIMPLE LAC REPAIR 12.6-20.0 CM FACE    12016                        796.45
04500202   HB TX S WND DEHISC; SMPL                  12020                       2362.24
04500028   HB WOUND DEHISCENCE PACKING               12021                        854.55
04500029   HB INTERM LAC REPAIR UP TO 2.5 CM SCALP12031                           894.43
04500030   HB INTERM LAC REPAIR 2.6-7.5 CM SCALP     12032        688.01          894.43
04500031   HB INTERM LAC REPAIR 7.6-12.5 CM SCALP 12034                           894.43
04500032   HB INTERM LAC REPAIR 12.6-20.0 CM         12035                        894.43
03610598   HB TERM INTMD WND REPAIR S/TR/EXT         12037                        708.93
04500033   HB INTERM LAC REPAIR UP TO 2.5 CM         12041                        894.43
04500034   HB INTERM LAC REPAIR 2.6-7.5 CM           12042                        894.43
04500035   HB INTERM LAC REPAIR 7.6-12.5 CM          12044                        894.43
04500036   HB INTERM LAC REPAIR UP TO 2.5 CM FACE 12051                           894.43
04500037   HB INTERM LAC REPAIR 2.6-5.0 CM           12052                        894.43
04500038   HB INTERM LAC REPAIR 5.1-7.5 CM           12053                        894.43
04500039   HB INTERM LAC REPAIR 7.6-12.5 CM          12054                        894.43
04500040   HB INTERM LAC REPAIR 12.6-20.0 CM FACE 12055                           894.43
04500041   HB COMPLEX REPAIR 1.1 TO 2.5 CM TRUNK 13100                           1980.28
04500042   HB COMPLEX REPAIR 2.6 TO 7.5 CM TRUNK 13101                           1980.28
04500043   HB CMPLX REPAIR TRUNK @ADD 5CM            13102                        894.43
04500044   HB COMPLEX REPAIR 1.1 TO 2.5 CM           13120                        894.43
04500045   HB COMPLEX REPAIR 2.6 TO 7.5 CM           13121                        894.43
04500046   HB CMPLX RPR HEAD/EXTR @ADD 5CM           13122                        894.43
04500047                                         13131
           HB COMPLEX REPAIR 1.1 TO 2.5 CM FOREHEAD                               894.43



                                               2
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
04500048                                         13132
           HB COMPLEX REPAIR 2.6 TO 7.5 CM FOREHEAD                             894.43
04500049   HB CMPLX RPR FACE/HANDS @ADD 5CM        13133                        894.43
04500050   HB COMPLEX REPAIR UNDER 1.0 CM          13150                       1980.28
04500051   HB COMPLEX REPAIR 1.1 TO 2.5 CM EYE     13151                       1980.28
04500052   HB COMPLEX REPAIR 2.6 TO 7.5 CM EYELID 13152                        1980.28
04500053   HB CMPLX RPR EYELID @ADD 5CM            13153                        894.43
03610520   HB LCL SURG WND/DEH, EXTENS             13160                       2045.11
03610625   HB ATT F/C/M/N/A/G/H/F; 10 SQ CM        14040                       1404.00
04500207   HB SKIN FULLGRFT FACE/GENIT/HF          15240                       2021.30
04500054   HB BURN INIT RX 1ST DEGREE              16000                        301.95
04500055   HB BURN DRESSING SMALL                  16020                        448.92
04500056   HB BURN DRESSING MEDIUM                 16025                        461.46
04500057   HB BURN DRESSION LARGE                  16030                       1117.76
04500058   HB ESCHAROTOMY, INITIAL                 16035                       2521.50
04500059   HB ESCHAROTOMY, @ ADD INCISION          16036                       2521.50
05100017   HB DESTRUCT BENIGN NONFACE 1ST LE       17000        137.87
05100018   HB DSTRCT BENIGN FACE ADDL              17003        156.10
05100019   HB CHEMICAL CAUTERIZATION/TISSUE        17250        409.05
03610623   HB DESTR MLES T/A/L; > 4.0 CM           17266                        679.95
04900002   HB RE-SUTURING                          17999        959.37
03610039   HB ASPIRATION BREAST CYST               19000        713.26
03610044   HB ASPIRATION BREAST CYST ADDL          19001        303.08
04500204   HB MASTOTOMY W EXPL, DEEP               19020        3489.99        4536.97
03610045   HB BIOPSY NEEDLE CORE WO GDNCE          19100        1056.23
03610046   HB BIOPSY BREAST W GUIDANCE             19102        2215.43        2880.06
03610005   HB BIOPSY BREAST VACUUM DEVICE          19103        4394.37
03610580   HB CRYOABLATION FIBROADENOMA            19105        9847.84       12802.30
03610049   HB LOC NEEDLE WIRE BREAST               19290        1803.68        2343.75
03610416   HB LOC NEEDLE WIRE BREAST PRIM          19290        1803.68        2343.75
03610414   HB LOC WIRE BREAST INIT PRE-OP          19290        1803.68        2343.75
03610050   HB LOC NEEDLE WIRE BREAST ADDL          19291        769.10
03610417   HB LOC WIRE BREAST ADDL PRE-OP          19291        769.10
03610051   HB PLCMT BREAST CLIP, PERCUT            19295        472.86
03610433   HB PLACEMENT, CATH RADIOELEMENT         19296       14824.74
03610583   HB INJ TISSUE EXPNDR BRST RECO          19499        227.88
03610636   HB INCISION ST ABSC;SUBFASCIAL          20005        5340.07
04500060   HB EXPLORE PENE WOUND EXTREMITY         20103                       1367.28
03610541   HB BIOPSY MUSCLE; SUPERFICIAL           20200        2080.54        2704.94
03610542   HB BIOPSY MUSCLE; DEEP                  20205        2527.19        3284.90
03610052   HB BIOPSY MUSCLE, PERC NEEDLE           20206        2154.61        2800.65
03610413   HB BIOPSY BONE, TR/NDL; SUPERF          20220        2080.54        2704.94
03610739   HB BIOPSY DEEP BNE,TRCR/NDL IR          20225        2527.19



                                              3
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03610054   HB BIOPSY DEEP BONE, TRCR/NDL           20225        2527.19        3284.90
03610501   HB SINUS TRACT INJ THERAPEUTIC          20500        1272.23
03610587   HB SINUS INJECTION, DIAGNOSTIC          20501        842.40
04500061   HB REMOVE FB MUSCLE SIMPLE              20520                       1530.22
03610685   HB CARPAL TUNNEL TX INJ                 20526        2656.28        3453.41
03610055   HB INJ-SING TENDON-SHEATH/LIG           20550        918.36         1131.62
03610684   HB INJ TENDON ORIGIN/INSERT             20551        863.67
03610449   HB TRIGGER PT INJ 1-2 MUSCLE(S*         20552        918.36         1192.96
03610441   HB TRIGGER PT INJ >3 MUSCLE(S)          20553        918.36         1192.96
03220001   HB ASPIR/INJECT JOINT SMALL             20600        412.46          535.52
03220002   HB ASPIR/INJECT JOINT MED               20605        496.78          646.05
03610719   HB ASPIR/INJECT JOINT MED IR            20605        496.78
03220006   HB ASPIR/INJECT JOINT MAJOR             20610        863.67         1123.45
03610736   HB ASPIR/INJECT JOINT MAJOR IR          20610        863.67
03610442   HB ASPIR/INJECT JOINT MAJOR*            20610        863.67         1123.45
03610443   HB ASPIR/INJECT GANGLION CYST(S)        20612        607.31
03610059   HB ASPIR/INJECT BONE CYST               20615        584.52
03610464   HB ADJUST BONE FIXATION DEVICE          20693        5517.83
03610060   HB ABLATION BONE TUMOR(S)               20982       18246.35
03610560   HB EXC FACE LES SC < 2 CM               21011        1415.73
03610561   HB EXC FACE LES SC = 2 CM               21012        1415.73
03610562   HB EXC FACE TUM DEEP < 2 CM             21013        1415.73
03610563   HB EXC FACE TUM DEEP = 2 CM             21014        1415.73
03610564   HB RESECT FACE TUM = 2 CM               21016        1998.65
03610599   HB APPLY INTERDENTAL FIXTION            21110                       1851.56
04500064   HB NASAL FX W/O MANIPULATION            21310                        402.21
04500065   HB NASAL FX W/O STABILIZATION           21315                       1481.22
03610696   HB CL TX NSL BN FX; W STABILIZ          21320        1481.22
04500066   HB CLOSED TX MANDIBLAR FX WO MANI       21450                        782.77
04500067   HB CLOSED TX MANDIBLAR FX W MANIP       21451                       2636.57
03610619   HB OP TX OF MAND FX W EXT FIX           21454                       2160.00
04500068   HB TM JOINT DISLOCATION                 21480                        782.77
03610612   HB IDL WIRING,FOR OTHER THAN F          21497                       1404.00
03610008   HB BIOPSY NECK/THORAX SFT TISS          21550        2752.79        3577.72
03610565   HB EXC NECK LES SC = 3 CM               21552        1998.65
03610589   HB UNLIST PROC NECK/THORAX              21899        325.08
03610671   HB BIOPSY BACK/FLANK; SUPERF            21920        2211.15        2874.48
03610672   HB BIOPSY BACK/FLANK; DEEP              21925        5977.64        7770.92
03610566   HB EXC BACK LES SC = 3 CM               21931        1998.65
03610567   HB EXC BACK TUM DEEP < 5 CM             21932        3026.82
03610061   HB VERTEBROPLASTY THOR 1-BODY           22520        7490.42
03610062   HB VERTEBROPLASTY LUMB 1-BODY           22521        7490.42



                                              4
  Charge
   Code                 Description             CPT Code OP/Default Price   IP/ED Price
03610063   HB VERTEBROPLASTY EA ADDL LEVEL       22522        7490.42
03610064   HB KYPHOPLASTY T-SPINE 1-BODY         22523       11373.49
03610065   HB KYPHOPLASTY L-SPINE 1-BODY         22524       11373.49
03610066   HB KYPHOPLASTY EA ADDL LEVEL          22525       11373.49
03610067   HB UNLISTED SPINE PROCEDURE           22899        5517.83
04500069   HB UNLIST PROC ABD/MUSK SYS           22999                       1880.01
03610568   HB EXC SHOULDER LES SC > 3 CM         23071        3026.82
04500070   HB FB SQ SHOULDER                     23330                       1293.22
03610068   HB ARTHROGRAM INJ SHOULDER UNI        23350        1002.67
03610465   HB CL TX CLAVICULAR FX;W MANIP        23505        3356.22
03610466   HB CL TX PROX HUM FX; WO MANIP        23600        404.75
04500071   HB HUMERAL NECK FX W/MANIP            23605        1314.68        1709.10
04500072   HB HUMERAL FX WO MANIPULATE CLOSE     23620                        748.59
04500073   HB SHOULDER DISLOCATION               23650        664.28          863.67
03610518   HB CL TX SHLDR DISL,MANIP;ANES        23655                       1314.87
04500074   HB I&D UPPER ARM/ELBOW BURSA          23931                       4945.00
03610569   HB EXC ARM/ELBOW LES SC = 3 CM        24071        3026.82
03610609   HB REM FB, UP ARM OR ELBOW; SQ        24200                       1060.10
03610628   HB DEEP REM FB FROM UA/ELBOW          24201        1414.77
03610069   HB ARTHROGRAM INJ ELBOW UNILAT        24220        608.44
03610467   HB CL TX HUMERUS FX WO MANIP          24500        404.75
04500075   HB HUMERAL SHAFT FX W/ MANIP          24505        3231.34        4199.83
03610468   HB CL TX SC/TC HUM FX WO MANIP        24530        404.75
04500076   HB FX HUMERAL W MANIPULATION          24535        917.22         1192.96
03610469   HB CL TX EC HUM FX WO MANIP           24560        404.75
03610470   HB CL TX C HUMERUS FX WO MANIP        24576        404.75
03610471   HB CL TX C HUMERUS FX W MANIP         24577        1557.44
04500077   HB ELBOW DISLOCATION                  24600        575.40          748.59
03610522   HB TX CL ELBOW DISLOC W ANESTH        24605                       1314.58
03610472   HB CL TX MONTGG ELB FX W MANIP        24620        3356.22
04500078   HB RADIAL HEAD SUBLUXATION            24640        748.59          973.05
04500079   HB RADIAL HEAD/NECK FRACTURE          24650        1259.04        1636.18
03610473   HB TREAT ULNAR FRACTURE               24670        404.75
03610590   HB UNLIST PROC HUMERUS/ELBOW          24999        468.72
03610570   HB EXC FOREARM LES SC > 3 CM          25071        3026.82
03610571   HB EXC FOREARM TUM DEEP = 3 CM        25073        3026.82
03610572   HB RESECT FOREARM/WRIST TUM3CM        25078        3026.82
03610070   HB ARTHROGRAM INJ WRIST UNILAT        25246        1182.70
04500206   HB OPEN REPAIR WRIST JOINT            25320                       5744.28
03610474   HB CL TX RAD SHFT FX; WO MANIP        25500        404.75
03610500   HB CL TX RADIAL SHFT FX WMANIP        25505        1557.44
03610475   HB GALEAZZI FX/DISLOC                 25520        1557.44



                                            5
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03610476   HB CL TX ULNAR SHFT FX WOMANIP          25530        404.75
03610477   HB CL TX ULNAR SHFT FX W MANIP          25535        404.75
04500080   HB RAD/ULNAR SHAFT FX WO MANIP          25560        1505.15        1957.49
04500214   HB CL TX RADIAL&ULNA FX WMANIP          25565                       1465.02
03610478   HB TREAT FRACTURE RADIUS/ULNA           25600        404.75
03610071   HB DIST RAD/COLLES FX W MANIP           25605        1228.27        1597.44
04500081   HB CLOSED TX CARPAL DISLOC W/MANI       25660                        648.32
04500082   HB I&D ABSCESS FINGER SIMPLE            26010                        772.51
04500083   HB I&D ABSCESS FINGER COMPLICATED       26011                       4620.27
03610573   HB EXC HAND LES SC > 1.5 CM             26111        3026.82
03610574   HB EXC HAND TUM DEEP> 1.5 CM            26113        3026.82
03610525   HB 1' PROFUNDUS TENDON REPAIR           26370                       2364.26
04500084   HB REV/REP EXTEN TENDON FINGER          26418                       4359.34
03610602   HB IP JNT ARTHROPLASTY - EA             26535                       3240.00
04500216   HB REPAIR,INTRINSIC MSCLS HAND          26591                       3560.63
03610479   HB CL TX MC FX,SGLWO MNP EA BN          26600        404.75
03610480   HB CL TX MC FX, SGL; W MANIP            26605        404.75
04500085   HB CLOSED TX METACARPAL FX W/MA @       26605                       1419.69
04500086   HB METACARPOPHLANGEAL DISLOCATION 26700                              748.59
04500087   HB FINGER SHAFT PROX FX                 26720        822.65         1068.76
04500088   HB FINGER PROX/MID FX MAN REDUCT        26725        748.59          973.05
04500089   HB CLOSED TX ARTICULAR FX W MANIP       26742                        749.73
04500090   HB FINGER DISTAL PHALANGEAL             26750                       1249.93
04500091   HB DIST PHALANGEAL FX W/MANIP           26755                        748.59
04500211   HB TREAT FINGER FRACTURE, EACH          26765                       2700.38
04500092   HB INTERPHALANGEAL JT DISLOC            26770        575.40          748.59
03610481   HB CL TX IP JT D, W MNP;W ANES          26775        3943.72        5126.84
04500205   HB TREAT FINGER DISLOCATION             26785                       2700.38
04500093   HB AMPUTATION FINGER/THUMB              26951                       8155.83
03610591   HB UNLIST PROC HAND/FINGERS             26989        468.72
03610072   HB BX PELVIS/HIP SFT TIS SUPF           27040        2973.83        3865.99
03610073   HB BIOPSY PELVIS/HIP ST DEEP            27041        2973.83        3865.99
03610575   HB EXC HIP PELVIS LES SC> 3 CM          27043        3026.82
03610074   HB ARTHROGRAM INJ HIP WO ANES           27093        1002.67
03610075   HB ARTHROGRAM INJ HIP W ANES            27095        1263.60
03610457   HB SIJ ANESTH/STEROID INJ               27096        1816.91
04500094   HB COCCYGEAL FRACTURE                   27200                       1231.70
04500095   HB HIP DISLOCATION                      27250                       1403.74
04500208   HB CL TX TRAUMA HIPDISLC WANES          27252                       3415.69
04500186   HB TX HIP DISLOCATION SPLNT/TRAC        27256        560.58          560.58
04500201   HB ARTHRPLSTY, HIP DISL W/ANES          27265        311.34          404.75
04500200   HB ARTHRPLST HIP DISL W/O ANES          27266        2021.12        2627.46



                                              6
  Charge
   Code                  Description            CPT Code OP/Default Price   IP/ED Price
03610592   HB UNLSIT PROC PELVIS/HIP JNT         27299        468.72
03610594   HB DEEP I & D, THIGH/KNEE             27301        5505.34
03610576   HB EXC THIGH/KNEE LES SC> 3 CM        27337        3026.82
03610076   HB ARTHROGRAM INJ KNEE UNILAT         27370        608.44
04500096   HB FB KNEE/THIGH DEEP                 27372                       7122.39
03610482   HB CL TX FEM SHAFT FX, W MANIP        27502        3356.22
03610483   HB CL TX SC/TC FEM FX, W MANIP        27503        404.75
03610484   HB CL TX D FEM FX WO MANIP            27508        404.75
03610485   HB CL TX DST FEM EPIP SP;WOMAN        27516        404.75
03610486   HB CL TX DST FEM EPIP SP; WMAN        27517        404.75
03610487   HB CLOSED TX PTLLR FX,WO MANIP        27520        404.75
03610488   HB CL TX PROX TIB FX, WO MANIP        27530        404.75
03610489   HB CL TX PROX TIB FX W SK TRCT        27532        3356.22
03610490   HB CLOSED TX IC SP ORTUBEROSTY        27538        404.75
04500097   HB KNEE DISLOCATION                   27550                       3887.63
03610517   HB CL TX KNEE DISL; W ANES            27552                       1314.87
04500098   HB PATELLAR DISLOCATION               27560        575.40          748.59
03610077   HB UNLISTED PROCEDURE FEM/KNEE        27599       14550.14       18916.32
03610577   HB EXC LEG/ANKLE LES SC> 3 CM         27632        3026.82
04500099   HB TIB/FIB FX SHAFT                   27750        1882.29        2446.30
04500100   HB FX TIBIAL SHAFT W MANIPULATION     27752        1314.69        1709.10
04500101   HB ANK MED MALLEOUS FX CLOSED         27760        1612.26        2096.50
04500102   HB FX MEDIAL MALLEOLUS W MANIPUL      27762        1709.10        2221.83
03610491   HB CL TX PRX FIB/SHFT FX WOMNP        27780        404.75
03610492   HB CL TX DSTL FIB FX WO MANIP         27786        404.75
03610600   HB CL TX DISTL FIB FX W MANIP         27788                        402.80
04500103   HB BIMALLEOLAR ANKLE FX CLOSED        27808        1914.19        2487.32
04500104   HB BIMALLEOLAR ANKLE FX CLD W/MAN     27810        3553.79        4620.27
04500105   HB TRIMALLEOLAR ANK FX W/O MAN        27816        1997.37        2596.70
04500106   HB TRIMALLEOLAR ANK FX W/MAN          27818        3470.61        4512.02
03610493   HB CL TX WB DSTL TIB WO MANIP         27824        404.75          526.18
04500107   HB ANKLE DISLOCATION                  27840        522.99          680.23
03610593   HB UNLIST PROC LEG/ANKLE              27899        468.72
03610578   HB EXC FOOT/TOE TUM SC> 1.5 CM        28039        3026.82
03610579   HB EXC FOOT/TOE TUM DEEP>1.5CM        28041        3026.82
03610681   HB EXC FOOT/TOE TUM SC <1.5 CM        28043        2160.00
03610682   HB EXC INTRDG MRTN NERM EA SGL        28080        5517.83
04500108   HB FB REMOVE FOOT SQ                  28190                       2191.07
03610494   HB CL TX CALCANEAL FX;WO MANIP        28400        404.75
03610495   HB CL TX TALUS FX; WO MANIP           28430        404.75
04500109   HB FX TALUS W MANIPULATION            28435                        737.20
03610496   HB TX TARSAL BONE FX;WO MANIPU        28450        404.75



                                            7
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03610497   HB TX TARSAL BONE FX;W MANIP            28455        404.75
03610498   HB CL TX METATARSAL FX;WOMANIP          28470        404.75
03610499   HB CL TX METATARSAL FX;W MANIP          28475        404.75
04500110   HB GREAT TOE FX                         28490                        877.34
04500111   HB FX TOE W MANIPULATION                28495                        410.18
04500112   HB TOES 2-5 FX W/O MAINIP               28510        674.52          877.34
04500113   HB TOES 2-5 FX W/MAINIP                 28515                       1188.40
04500114   HB METATARSAL-PHALANGEAL DISLOC         28630                       1132.56
04500115   HB INTERPHALANGEAL DISLOCATION          28660                       1138.27
03610461   HB AUTO PLATELET INJECTION              28899        404.75
03610078   HB CAST APP - LONG ARM                  29065        404.49          526.40
03610397   HB CAST APP - SHORT ARM                 29075        358.92          467.15
04500117   HB CAST GAUNTLET                        29085                        594.77
03610079   HB CAST APP - THUMB/FINGER              29086        458.04          594.77
03610398   HB SPLINT APP - LONG ARM                29105        445.51          579.96
03610080   HB SPLINT APP - SHORT ARM               29125        444.37          578.82
04500119   HB APPLICATION, FINGER SPLINT           29130                        447.79
03610399   HB STRAPPING CHEST                      29200        183.45          238.14
03610400   HB STRAPPING, SHOULDER                  29240        183.45          238.14
03610401   HB STRAPPING, ELBOW/WRIST               29260        183.45          238.14
04500123   HB STRAPPING HAND/FINGER                29280                        582.24
03610081   HB CAST APP - LONG LEG                  29345        937.73
03610082   HB CAST APP - LONG LEG WALK CAST        29355        703.02
03610083   HB CAST APP-CYLINDER                    29365        703.02          914.94
04500197   HB CAST LONG LEG/THIGH TO ANKLE         29365        914.94          914.94
03610084   HB CAST APP - SHORT LEG                 29405        395.38          513.87
03610085   HB CAST APP - SHORT LEG WALK CAST       29425        372.59          484.25
03610086   HB CAST APP - PTB                       29435        703.02
03610087   HB CAST APP - CLUBFOOT W/ MANI          29450        685.92
03610402   HB SPLINT APP - LONG LEG                29505        447.79          582.24
03610403   HB SPLINT APP - SHORT LEG               29515        447.79          582.24
04200013   HB PT TAPE/STRAP HIP                    29520        183.45          226.04
03610404   HB STRAPPING, KNEE                      29530        183.45          238.14
03610405   HB STRAPPING ANKLE &/OR FOOT            29540        183.45          238.14
03610406   HB STRAPPING TOES                       29550        115.08          149.27
03610683   HB UNNA BOOT STRAPPING                  29580        231.30
05100023   HB UNNA PASTE BOOT                      29580        231.30
03610627   HB REM GAUNTLET,BOOT - BDY CST          29700        255.57
03610407   HB REM/BIVALVE - FULL ARM/LEG           29705        458.04          594.77
03610088   HB REM/BIVALVE - SHOULDER/HIP           29710        703.02
03610089   HB CAST - REPAIR                        29720        458.04
03610090   HB CAST - WINDOWING                     29730        395.38          513.87



                                              8
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
04500130   HB CAST WEDGING                         29740        594.77          594.77
04200010   HB PT TAPE/STRAP LOW BACK               29799        183.45
04500131   HB REMOVE INTRANASAL FB                 30300                        338.41
04500132   HB ANT. EPISTAXIS SIMPLE                30901                        518.43
03610408   HB ANT. EPISTAXIS COMPLEX               30903        557.17          724.66
03610409   HB POSTERIOR EPISTAXIS INITIAL          30905        557.17          724.66
04500135   HB ENDOTRACHEAL INTUBATION              31500        1031.61        1341.08
03610091   HB TRACH TUBE CHANGE                    31502        1031.16        1341.08
03610519   HB LARYNGOSCOPY, IND; DIAGNOSTIC        31505                        69.38
03610410   HB LARYNGOSCOPY, DIRECT ASPIRATIO       31515        2976.11        3869.40
03610620   HB DX LARYNGOSCOPY EXCL NB              31525                       1836.00
03610092   HB PEDS ENT-LARYNGO,W/WO TRACH,DX       31525        6575.48
03610093   HB PEDS ENT-LARYNGO, FLEXE FIB,DX       31575        589.08          725.87
03610439   HB SP VIDEOSTROBOSCOPY - (2) INT        31579        533.24
03610438   HB SP VIDEOSTROBOSCOPY - (3) MOD        31579        799.86
03610011   HB SP VIDEOSTROBOSCOPY - (4) EXT        31579        1066.48
03610097   HB TRACHEOSTOMY                         31600        3333.88        4334.28
04500136   HB TRACHEOSTOMY EMERGENT                31603        2050.05        2665.06
04500137   HB TRACHEOSTOMY (CRICO)                 31605                       2309.57
03610098   HB DX BRONCHOSCOPE/WASH                 31622        5973.88        7766.15
03610099   HB PC BRONCH:BRUSHING                   31623        4967.78
03610100   HB PC BRONCH:ALEVOLAR LAVAGE            31624        4967.78
03610101   HB PC BRONCH W/BIOPSY                   31625        5588.76
03610547   HB BRONCH W FLUORO COMPTR ASST          31627        4967.78
03610102   HB BRONCH W TB SGL LOBE LUNG BX         31628        5588.76
03610103   HB ASPIR NDL BIOPSY(S) TRNSBRONCH       31629        5588.76
03610622   BRONCHOSCOPY DILATE/FX REPR             31630                       2160.00
03610104   HB PC BRONCH: TRACH STENT               31631        9348.78
03610105   HB TB LUNG BIOPSY, EA ADDTL LOBE        31632        5588.76
03610106   HB BRONCHOSCOPY; W REMOVAL FB           31635        5588.76
03610107   HB PC BRONCH: BRONCH STENT              31636        9348.78
03610108   HB PC BRONCH: ADDL BRONCH STENT         31637        9348.78
03610109   HB PC BRONCH: STENT REVISION            31638        9348.78
03610110   HB BRONCHOSCOPY,TREAT BLOCKAGE          31641        9348.78
03610111   HB PC DX BRONCHOSCOPE/CATH REPL         31643        5588.76
07610002   HB PC SUCTIONING                        31720        273.46
04500138   HB THORACOSTOMY/CARDIAC MASSAGE         32160                       3757.74
03610112   HB DRAINAGE LUNG ABSCESS                32201        1298.92        1688.59
03610113   HB BIOPSY LUNG                          32400        2268.55        2948.77
03610412   HB PC PLUERAL BIOPSY PROCEDURE          32400        2268.55
03610114   HB BIOPSY LUNG/MEDIASTINUM              32405        2508.96        3262.11
03610418   HB PC THORACENTESIS PROCEDURE           32421        1171.30



                                              9
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
03610381   HB THORACENTESIS                         32421        1171.30        1522.24
03610710   HB THORACENTESIS CL                      32421        1171.30
03610724   HB THORACENTESIS IR                      32421        1171.30
03610419   HB THORACENTESIS W CHEST TUBE            32422        1586.04        2062.31
03610012   HB INDWL TUNN PLEU CATH W/CUFF           32550        2753.94        3579.99
03610013   HB CHEST TUBE PLACEMENT                  32551        1644.16        2137.51
03610550   HB REMOVE LUNG CATHETER                  32552        426.14          553.75
03610718   HB TREAT PLEURODESIS W AGNT CL           32560        1673.78
03610734   HB TREAT PLEURODESIS WAGENT IR           32560        1673.78
03610552   HB LYSE CHEST FIBRIN INIT DAY            32561        1673.78        2176.25
03610553   HB LYSE CHEST FIBRIN SUBQ DAY            32562        1673.78        2176.25
03610629   HB PERQ RF ABLATE TX PUL TUMOR           32998       12458.64       16196.23
03610115   HB REMOVAL OF PLEURAX CATHETER           32999        9903.66       12875.22
03610581   HB UL PROC, CRYOABLATION LUNG            32999        9903.66       12875.22
03610116   HB UNLISTED ABLATION LUNG                32999        9903.66       12875.22
03610420   HB PERIOCARDIOCENTESIS                   33010        1190.68        1548.45
03610711   HB PERIOCARDIOCENTESIS CL                33010        1190.68
04810002   HB INSERT PERM PCMKR+ATRIAL LEAD         33206       28147.74
04810003   HB INSERT PERM PCMKR+VNTRC LEAD          33207       28147.74
04810004   HB INSERT PERM PCMKR+VNTRC/ATRIAL        33208       34275.43
03610421   HB INSERT TEMP PACE LEAD SINGLE          33210       16230.76       21099.41
03610712   HB INSERT TEMP PACELEAD SGL CL           33210       16230.76
04810005   HB INSERT TEMP PACE LEAD DUAL            33211       14161.61
04810006   HB INSERT PCMKR GEN ONLY-SNGL            33212       23256.30
04810007   HB INSERT PCMKR GEN ONLY-DUAL            33213       27067.59
04810008   HB UPGRADE PCMKR SNGL TO DUAL            33214       34275.43
04810009   HB REPOSITION TRNSVN LEAD-RA/RV          33215        4608.88
04810010   HB INSERT LEAD SINGLE CHAMBER            33216       16230.76
04810011   HB INSERT LEAD DUAL CHAMBER              33217       14165.02
04810012   HB REPAIR LEAD SINGLE CHAMBER            33218       14165.02
04810013   HB REPAIR LEAD DUAL CHAMBER              33220       14165.02
04810014   HB REVISION/RELOCAT PCMKR POCKET         33222        4180.46
04810015   HB REVISION/RELOCAT ICD POCKET           33223        4180.46
04810016   HB INSRT BI-V LEAD PREV PCMKR/ICD        33224       28930.51
04810017   HB INSRT BI-V LEAD NEW PCMKR/ICD         33225       28930.51
04810018   HB REPOSITN LV LEAD+GEN REPLACE          33226        4608.88
04810019   HB REMOVE PACEMAKER GEN                  33233        4608.88
04810020   HB REMOVE PCMKR LEAD SINGLE              33234        4608.88
04810021   HB REMOVE PCMKR LEAD DUAL                33235        4608.88
04810022   HB INSERT ICD SC/DC GEN. ONLY            33240       94677.30
04810023   HB REMOVE ICD GEN SINGLE/DUAL            33241        5591.04
04810024   HB REMOVE ICD LEAD SINGLE/DUAL           33244        4608.88



                                              10
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
04810025   HB INS/REP ICD SNGL/DUAL W LEADS         33249       121684.51
04810026   HB IMPLANT CARDIAC LOOP RECRDER          33282       21069.78
04810027   HB REMOVE CARDIAC LOOP RECRDR            33284        2475.92
04810028   HB REP PDA;BY DIVISION,18 OR04810029     33822       17018.08
03610382   HB REP PDA;BY DIVISION,18 OR>YRS         33824       17018.08
03610117   HB REPAIR DECEND AORT W SUBCLAV          33880        7889.21
03610118   HB REPAIR DECEND AORT WO SUBCLAV         33881        6783.99
03610361   HB PLCMT PROX EXTENSION PROS             33883        4736.49
03610630   HB ENDOVASC PROSTH TAA ADD-ON            33884        2777.86
03610538   HB ECMO INITIAL 24HR >12 HOUR            33960        7465.35
03610537   HB ECMO INITIAL 24HR 0-12 HOUR           33960        3732.67
03610540   HB ECMO EA ADDL 24HR >12 HOUR            33961        7465.35
03610539   HB ECMO EA ADDL 24HR 0-12 HOUR           33961        3732.67
04810029   HB INSERT INTRA-AORT BALLOON             33967        4733.07
03610119   HB REMOV INTRA-AORT BALLOON              33968        610.72
04810030   HB INSERT L-VAD TANDEM HEART             33975       17146.84
04810119   HB PULMONARY VLV REPL(G060242)           33999       30763.80
03610120   HB REPR AORT ANEURYSM-TUBE GRFT          34800        6668.91
03610121   HB REPAIR AAA MOD BIFUR 1-LIMB           34802        7311.54
03610122   HB REPAIR AAA MOD BIFUR 2-LIMB           34803        6095.79
03610123   HB REPAIR AAA UNI BIFUR W PROS           34804        7312.67
03610124   HB REPR AORT ANEUR-AORTA PROSTH          34805        730.36
03610125   HB INSERT ILIAC OCCL DEVICE              34808        1313.73
03610631   HB EXPOSE FEM ART PROSTH UNI             34812        2777.86
03610126   HB INSERT PROST AA REPAIR INIT           34825        4762.69
03610127   HB INSERT PROST AA REPAIR ADDL           34826        1254.48
03610728   HB ENDOVAS ILIAC REPRW/GRFT IR           34900        3054.62
03610714   HB ENDOVASC ILIAC REPR W/GRAFT CL        34900        3054.62
03610601   HB REPAIR BLD VSL,DRCT;LWR EXT           35226        2243.16        2916.00
03610595   HB ILIAC ENDARTERECTOMY                  35351                       8655.79
03610596   HB THROMBOENDARTARECTOMY OF RF           35371                       8655.79
03610129   HB ANGIOPLASTY PERC RENAL/VISCERAL       35471       10899.50
03610300   HB ANGIOPLASTY AORTA                     35472       14241.37
03610130   HB PTA AORTA PERC                        35472       14241.37
03610292   HB ANGIOPLASTY ART AV SHUNT              35475       11771.15
03610133   HB ANGIOPLASTY BRACIOCEPHALIC            35475       11771.15
03610134   HB ANGIOPLASTY VENOUS                    35476       11771.15
03610298   HB VENOPLASTY AV SHUNT                   35476       11771.15
03610422   HB CATH PLCMT NON-SELECTIVE              36000        160.66
03610138   HB PSEUDOANEURYSM INJ EXT UNI            36002        895.57
03610139   HB VENOGRAM INJ EXT UNILATERAL           36005        842.02
03610140   HB CATH INTRO SVC/IVC                    36010        3141.33



                                              11
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03610141   HB CATH PLCMT VENOUS 1ST ORD            36011        3920.68
03610703   HB CATH PLCMT VENOUS 2NDORD CL          36012        4330.86
03610740   HB CATH PLCMT VENOUS2ND ORD IR          36012        4330.86
03610143   HB CATH INTRO RT HEART/PULM AR          36013        3019.41
03610144   HB CATH PLCMT RT/LT PULM ART            36014        3724.70
03610145   HB CATH PLCMT SEGMENTAL ARTERY          36015        2876.99
03610146   HB CATH INTRO BRACHIAL ART              36120        860.25
03610147   HB CATH INTRO ARTERY EXT UNI            36140        1979.14
03610716   HB ACCESS AV DIAL GRFT EVAL CL          36147        722.38
03610732   HB ACCESS AV DIAL GRFT EVAL IR          36147        722.38
03610717   HB ACCESS AV DIAL GRFT PROC CL          36148        170.05
03610733   HB ACCESS AV DIAL GRFT PROC IR          36148        170.05
03610149   HB CATH INTRO AORTIC TRANSLUMN          36160        3169.81
03610150   HB CATH AORTA                           36200        2777.86
03610151   HB CATH PLCMT THORACIC 1ST ORD          36215        5759.67
03610152   HB CATH PLCMT THORACIC 2ND ORD          36216        6487.74
03610153   HB CATH PLCMT THORACIC 3RD ORD          36217        7828.82
03610154   HB CATH PLCMT THORACIC EA ADDL          36218        1246.50
03610155   HB CATH PLCMT ABD-EXT 1ST ORD           36245        5857.66
03610156   HB CATH PLCMT ABD-EXT 2ND ORD           36246        3850.04
03610157   HB CATH PLCMT ABD-EXT 3RD ORD           36247        2777.86
03610158   HB CATH PLCMT ABD-EXT EA ADDL           36248        1163.33
03610715   HB UL VASCULAR INJECTION CL             36299        3054.62
03610729   HB UL VASCULAR INJECTION IR             36299        3054.62
04500140   HB VENIPUN/IV <3YRS CENTRAL             36400                        287.10
04500141   HB VENIPUN/IV SCALP UNDER 3 YRS         36405        116.84          116.84
04500142   HB VENIPUN/IV <3YRS OTHER               36406                        90.14
03610704   HB VENIPUNCTURE INF 3YR/OLD CL          36410         35.36
03610159   HB VENIPUNCTURE INFNT 3YR/OLDER         36410         37.84          50.08
03000005   HB LAB COLLECTION VENIPUNCTURE          36415         66.77          86.80
03000265   HB LAB BLOOD COLLECTION FEE             36416         7.48
03000264   HB LAB COLLECTION CAPILLARY             36416         26.49
03000274   HB LAB COLLECTION CAPILLARY*            36416         27.55
03000002   HB NEONATE HEEL STICK                   36416        244.82
03610160   HB VENIPNCTR,CD YGR THAN 1 YR           36420        690.62          752.95
03610161   HB VENIPUNCTURE CUTDOWN > 1 YR          36425        427.73          466.22
80000275   HB PROF CONS BLD TX OP                  36430
03910001   HB TRANSFUSION, BLOOD COMPLEX           36430        1877.29
03910003   HB TRANSFUSION, BLOOD COMPONENT         36430        995.96
03910002   HB TRANSFUSION, BLOOD INTERM            36430        1583.51
03910004   HB TRANSFUSION, BLOOD SIMPLE            36430        1428.84        1857.26
80000227   HB PROF CONS RED CELL EXCHANGE          36455



                                             12
  Charge
   Code                 Description                 CPT Code OP/Default Price   IP/ED Price
03910005   HB TRFSN, INTRAUTERINE, FETAL             36460        2114.32
03610164   HB CATH PLCMT PERC PORTAL VEIN            36481        2906.61
03610165   HB VENOUS SAMPLING                        36500        1367.28
03610015   HB THER APHERSIS, FOR WHITE BLD CELLS 36511            9191.30
09400001   HB THERAPEUTIC APHER WBC                  36511        3238.17
03610018   HB UNSTIM. LEUK. PHYSICAL EXAM            36511        3238.17
03610017   HB UNSTIM. LEUK. WORK-UP CANCELL.         36511        3238.17
09400002   HB THER APHER FOR RBC'S                   36512        3124.23
09400003   HB THER APHER FOR PLTS                    36513        3124.23
80000249   HB PROF PLASMA PHERESIS                   36514
03610019   HB THR APHER, PLASMA PHERESIS             36514        3124.23
03610440   HB THER APHER W/ PROTEIN A COL            36515        2847.44
03610021   HB THR APHER SEL ADS/FIL PL REINF         36516        8676.54
03610509   HB PHOTOPHERESIS, EXTRACORP               36522        9245.04
03610423   HB CATH INSRT NON-TUN 5YR/LESS            36555        2887.24        3753.18
03610022   HB CATH INSRT NON-TUN 5YR/M               36556        3294.01        4281.87
03610701   HB CATH INSRT NON-TUN 5YR/M CL            36556        3294.01
03610737   HB CATH INSRT NON-TUN 5YR/M IR            36556        3294.01
03610301   HB CATH INSRT TUNNLED 5YR/LESS            36557        6388.62        8303.95
03610748   HB CATH INSRT TUNNLED 5YR< IR             36557        6388.62
03610705   HB CATH INSRT TUNNLED 5YR/M CL            36558        5140.97
03610174   HB CATH INSRT TUNNLED 5YR/MORE            36558        5140.97        6683.72
03610721   HB CATH INSRT TUNNLED 5YR/MORE            36558        5140.97
03610444   HB INSRT TUNN CVC WO PORT >5 YRS          36558        5140.97
03610175   HB INSRT TUNN CVC W/PORT >5YRS            36561        6894.51        8963.67
03610706   HB INSRT TUNN CVC W/PR>5Y CL              36561        6894.51
03610176   HB CATH INSRT TUNNLED 2-SITES             36565        8162.66
03610177   HB CATH INSRT PICC 5YR/LESS               36568        3928.65        5107.94
03610178   HB CATH INSRT PICC 5YR/MORE               36569        4288.70        5575.09
03610707   HB CATH INSRT PICC 5YR/MORE CL            36569        4288.70
03610722   HB CATH INSRT PICC 5YR/MORE IR            36569        4288.70
03610179   HB PAS PORT FOR YGR THAN 5 YR             36570        4930.19        6409.13
03610180   HB PAS PORT INSERTION >5 YRS              36571        5793.85        7532.58
03610181   HB CATH REPAIR CV OR PICC                 36575        3299.70        4289.85
03610182   HB CVC REPAIR                             36576        3486.56
03610531   HB REPLACE CATH ONLY OF VAD               36578        6310.00        8203.00
03610183   HB CATH REPLCMT NON-TUN CV                36580        3338.44        4339.98
03610708   HB CATH REPLCMT NON-TUN CV CL             36580        3338.44
03610723   HB CATH REPLCMT NON-TUN CV IR             36580        3338.44
03610184   HB CATH REPLCMT TUNNLED CV                36581        4591.78        5969.32
03610743   HB CATH REPLCMT TUNNLED CV IR             36581        4591.78
03610185   HB REPL CHEST PORT VIA CATH EX            36582       11211.70       14575.20



                                               13
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03610224   HB CATH REPLCMT PICC                   36584        3299.70        4289.85
03610186   HB REPL PAS PORT VIA CATH EXCH         36585        4402.64        5723.21
03610424   HB CATH REMOVE TUNNLED CV              36589        3426.18        4453.92
03610713   HB CATH REMOVE TUNNLED CV CL           36589        3426.18
03610726   HB CATH REMOVE TUNNLED CV IR           36589        3426.18
03610188   HB CATH REMOVE TUNNLED VAD             36590        2728.87        3548.09
03610024   HB BLOOD DRAW VIA IMPL. DEVICE         36591        259.78          337.26
03610425   HB BLOOD DRAW PICC                     36592        259.78          337.26
03610026   HB DECLOT VASCULAR DEVICE              36593        989.00         1285.24
03610189   HB REMOVE PERICATH OBST CVC            36595        7452.82
03610190   HB REMOVE INTRACATH OBST MAT           36596        1290.95
03610763   HB REMOVE INTRACATH OBST MAT IR        36596        1290.95
03610027   HB CATH REPOSITIONING                  36597        3299.70        4289.85
03610702   HB CATH REPOSITIONING CL               36597        3299.70
03610720   HB CATH REPOSITIONING IR               36597        3299.70
03610193   HB CATH CONTRAST INJECTION             36598        621.29
03610426   HB ARTERIAL PUNCTURE                   36600        372.59          483.11
03610028   HB ARTERIAL CATH INSERT PERC           36620        728.08          945.70
04500148   HB INTRAOSSEOUS NEEDLE INSERTION       36680                        749.73
03610029   HB THROMBECTOMY AV FISTULA             36870        7791.22
03610197   HB SHUNT INSERT HEPATIC TIPS           37182        5184.27
03610198   HB SHUNT REMOVAL HEPATIC TIPS          37183       13296.80
03610199   HB THROMBECTOMY PRIM MECH              37184       13296.80
03610362   HB THROMBECTOMY PRIM MECH ADON         37185        3532.14
03610677   HB THROMECTOMY PRIM MECH ADDON         37185        3532.14
03610709   HB THROMBECTOMY SECNDRY MCH CL         37186        3770.28
03610744   HB THROMBECTOMY SECNDRY MCH IR         37186        3770.28
03610201   HB THROMBECTOMY VENOUS MECH            37187        8062.39
03610202   HB THROMBECTOMY VENOUS MECH ADD ON37188             8062.39
03610203   HB BIOPSY TRANSCATHETER                37200        3609.62
03610204   HB INFUSION THROMBOLYSIS               37201        1823.04
03610205   HB INFUSION NON-THROMBOLYSIS           37202        1823.04
03610206   HB CATH RETREIVAL                      37203        6030.85
03610208   HB EMBOLIZATION NON-NEURO              37204        7747.92
03610209   HB STENT PLCMT INCL LOWER EXT ART      37205        9249.65
03610210                                        37206
           HB STENT PLCMT INCL LOWER EXT EACH ADDL             9249.65
03610588                                        37207
           HB INJ CARDIOVASCULAR TRNSCATH INCL LOWER EXT 23655.24
03610211   HB CATH EXCHNG DURNG LYTIC TX          37209        6764.62
03610032   HB EMBOLIZE UTERINE FIBROID            37210       12641.65
03610212   HB STENT PLCMT W DIST PROTECT          37215       12164.23
03610213   HB STENT PLCMT WO DIST PROTECT         37216       12164.23
03610644   HB ANGIO ILIAC, INITIAL VESSEL         37220       28627.04



                                            14
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03610645   HB STENT ILIAC, INITIAL VESSEL          37221       28169.51
03610646   HB ANGIO ILIAC, ADDL VESSEL             37222       18833.23
03610647   HB STENT ILIAC, ADDL VESSEL             37223       20288.38
03610648   HB ANGIO FEM/POP SYSTEM                 37224       28426.51
03610649   HB ATHERECTOMY FEM/POP SYSTEM           37225       28368.45
03610650   HB STENT PLACEMENT FEM/POP              37226       27097.33
03610651   HB STENT PLCMNT W/ATHRCTMY FEM          37227       44806.79
03610652   HB ANGIO PTA TIB/PERON,INI VSL          37228       27554.86
03610653   HB ATHERECTOMY TIB/PERON,INI            37229       46027.72
03610654   HB STENT PLCMNT TIB/PERON, INI VSL      37230       27097.33
03610655                                           37231
           HB STENT PLCMNT W/ATH TIB, INITIAL VESSEL           45570.19
03610656   HB ANGIO TIB/PERONEAL,EA ADDL           37232       16146.53
03610657   HB ATHERECTOMY TIB/PERON,EA             37233       17661.41
03610658   HB STENT PLCMNT TIB/PERON,EA            37234       17601.68
03610659   HB STENT PLCMNT TIB/PER W/ATH, EA ADDL37235         34099.76
04810115   HB IVUS NON-CORONARY INIT VSSL          37250        8544.37
04810116   HB IVUS NON-CORONARY ADDL VSSL          37251        4886.89
03610214   HB FILTER PLCMT IVC                     37620        9436.51
03610446   HB DEPLOY HEMOSTASIS DEVICE             37799        282.57
04810106   HB DEPLOY HEMOSTASIS DEVICE             37799        282.57
03610697                                         37799
           HB PTA CAROTID ART W/ DISTAL EMB DEVICE             12164.23       15813.50
03610660   HB PTA PLACEMENT INTRACRANIAL           37799       12164.23
03610661   HB STENT PLACEMENT INTRACRANIAL         37799       15205.30
03610613   HB UNLISTED VASC PROCEDURE              37799                        149.01
03610445   HB SPLENOPORTOGRAPHY INJECTION          38200        160.66
08140001   HB W/U CANCELLTN FEE PER DONOR          38204        3509.35
08190002   HB ALLO PB STEM CELL APHERESIS BD       38205        3435.30
08190001   HB HARVEST, STEM CELL, ALLOGENEIC       38205       106703.68
80016275   HB PROF BB STM CL HRVST ALLO            38205
03610042   HB AUTO PB STEM CELL APHERESIS BD       38206        3976.51
03620001   HB MARROW/WORK-UP CANCELLATION          38206        3976.51
03000007   HB BM/PBSC PROCESSING, LIQUID           38207        325.87
03110194   HB BM THAWING                           38208        814.60
03100001   HB BM/PB STEM CELL RBC DEPLETE          38212        887.60
03100353   HB BM/PB STEM CELL PLAS DEPLETE         38214        1428.84
03610218   HB BONE MARROW ASPIRATION ONLY          38220        808.97         1051.67
80000356   HB PROF BM BIOPSY PERFORMANCE           38220
03610219   HB BONE MARROW BIOPSY                   38221        1145.10        1489.20
08190003   HB MARROW HARV/COLLECTION/ACQ           38230       95591.10
80000254   HB PROF HB STEM CELL COLLECT            38231
80000317   HB PROF STEM CELL COLLECTION            38231
03620002   HB PBSC DONOR INFORMATION               38240        7777.54



                                             15
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03620004   HB PBSC DONOR PHYSICAL EXAM            38240        7777.54
03620005   HB PBSC WORK-UP CANCELLATION           38240        7777.54
03620003   HB BONE MARROW TRANSP-AUTOLOGOUS 38241              2931.68
04900006   HB BONE MARROW TRANSP-ALLOG DLI        38242        7777.54
03610222   HB BIOPSY LYMPH NODE                   38505        2436.04        3166.40
03610095   HB ACTIVATION FOR DONOR SEARCH         38999        1199.79
03610058   HB FORMAL DONOR SEARCH NMDP            38999        1199.79
03610094   HB FORMAL DONOR SEARCH/CX FEE          38999        1030.26
04500149   HB RPR LIP THRU&THRU/VERM BORDER       40650                       2396.16
03610617   HB UNLISTED PROCEDURE, LIPS            40799                        279.97
04500150   HB DRAIN ABSCESS VEST MOUTH SIMP       40800                        782.77
03610227   HB PEDS ENT - FRENULECTOMY             40819        1627.06
04500151   HB REPAIR VEST MOUTH <2.5 CM           40830                       1256.76
03610523   HB CL LAC, MTH VESTIB; >2.5 CM         40831                        636.13
04500152   HB TONGUE LAC REPAIR UNDER 2.6 CM      41250                       1385.51
04500153   HB RPR TONGUE >2.5/COMPLEX             41252                       2843.94
04500154   HB I&D ABCESS/CYST DENTOALVEOLAR       41800                        772.51
03610638   HB DENTOALVEOLAR TOOTH EXTRACT         41899        279.51
03610632   HB BIOPSY SALIVARY GLAND NDL           42400        2436.04        3166.40
03610228   HB SIALOGRAM INJECTION                 42550        528.68          687.29
03610690   HB UNLISTED SALVRY GLND PROC           42699        330.63          429.82
04500155   HB I&D ABSCESS PERITONSILAR            42700                       1385.51
04500156   HB FB THROAT REMOVAL                   42809                       1196.37
03610616                                     4
           HB CNTRL OROPHRYNGEAL HEMORRH;SIMPL2960                             279.97
03610528   HB UNLISTED PROC, PHARYNX,ADEN         42999                        93.82
03610605   HB UGI W BX. SGL/MULTIPLE              43239                       2125.34
03610606   HB UGI W REMOVAL OF FB                 43247                       2125.34
04500157   HB ESOPHAGOGASTRIC TAMPONADE BALL 43460                            1954.08
03610302   HB PLCMT NG TUBE BY W FLUORO           43752        423.86          551.47
03610749   HB PLCMT NG TUBE BY WFLU0RO IR         43752        423.86
04500191   HB GASTRIC LAVAGE/INTUB OD             43753                        649.46
03610624   HB CHANGE GASTROSTOMY TUBE             43760                       1114.33
03610427   HB TUBE CHANGE G-TUBE WO GDNCE         43760        856.83         1114.33
03610230   HB REPOSIT NG/OG TUBE                  43761        1891.40        2457.69
03610231   HB TUBE PLCMT ENTEROCLYSIS             44015        1580.35        2054.46
04500190   HB INTEST TUBE PLACE/MONITOR           44500        1026.60        1334.24
03610725   HB INTRODUCTION LONG GI TUBE           44500        1026.60
03610611   HB PROCTOSIG, RIGID; W REM FB          45307                       1944.00
03610615   HB REMOVE FECAL IMPACTION OR FB        45915                       1188.00
04500160   HB RECTAL PROLAPSE MAN REDUC           45999                       1349.05
04500161   HB ABSCESS ISCHOIO/PERIRECTAL          46040        5236.34        7181.64
04500162   HB I&D PERIANAL ABSCESS                46050                       2867.88



                                            16
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
04500163   HB INC THROMBOSED HEMORRHOID EXT       46083                        282.57
04500164   HB HEMORRHOID ENUC/EXC                 46320                       2050.92
05100025   HB INJECTION HEMORRHOID W/ PHENOL      46500        2409.84
03610692   HB CHEMODENERVATION ANAL MUSC          46505        2268.00        2948.40
04500165   HB ANOSCOPY DIAGNOSTIC                 46600                        267.76
04500166   HB ANOSCOPY FB REMOVAL                 46608                       3534.42
03610614   HB UNLISTED PROCEDURE, ANUS            46999                       1303.71
03610233   HB BIOPSY LIVER                        47000        2486.17        3231.34
03610745   HB BIOPSY LIVER IR                     47000        2486.17
03610002   HB LIVER BIOPSY OR                     47000        2486.17        3231.34
03610234   HB DRAIN LIVER ABCESS/CYST             47011        2889.52        3756.61
03610235   HB ABLATION LIVER TUMOR                47382       15870.71       20631.92
03610582   HB UL PROC, CRYOABLATION LIVER         47399        9847.84       12802.30
03610236                                      47490
           HB CHOLECYTOSTOMY, COMPLETE WITH S & I              6647.26
03610238   HB CHOLANGIOGRAM INJ PERC              47500        876.20         1139.40
03610746   HB CHOLANGIOGRAM INJ PERC IR           47500        876.20
03610239   HB CHOLANGIOGRAM INJ EXT CATH          47505        654.02
03610240   HB CATH PLCMT BILIARY DRAINAGE         47510        5483.94
03610241   HB STENT PLCMT BILIARY DRAINGE         47511        5483.94
03610242   HB CATH CHANGE BILIARY DRAINGE         47525        3034.23
03610243   HB T-TUBE REVISION/REINSERTION         47530        3010.29
03610673   HB BIL ENDO PERC VIA T-TUBE DX         47552        5483.94
03610244   HB ENDOSCOPY BILIARY WO STENT          47555        4326.31
03610245   HB ENDOSCOPY BILIARY W STENT           47556        5483.94
03610246   HB BIOPSY PANCREAS                     48102        2080.54        2704.94
03610247   HB DRAINAGE PANCREASE CYST             48511        2889.52        3756.61
03610248   HB DRAIN PERITONEAL ABSCESS,PERC       49021        3853.45        5008.80
03610249   HB DRAIN RETROPERITNL ABSCSS,PERC      49061        2889.52        3756.61
03610162   HB PERITONEOCENTESIS                   49080        1490.34        1938.12
03610741   HB PERITONEOCENTESIS IR                49080        1490.34
04900007   HB PARACENTESIS SUBSEQUENT             49081        617.55
03610251   HB BIOPSY RETROPERITONEAL MASS         49180        2466.81        3207.42
03610505   HB INSERT TEMP PERITONEAL CATH         49418        5042.98
03610506   HB INSERT IP CATH DR/DIAL;PERM         49421        5042.98
03610761   HB EXCHANGE PREVIOUS DRAINAGE CATH 49423            3034.23
03610252   HB CATH INJ ABSCESS/CYST               49424        960.52
03610380   HB PLCMT PERC GASTROSTOMY TUBE         49440        2227.53
03610534   HB PLACE DUOD/JEJ TUBE PERC            49441        2556.81
03610163   HB TUBE PLCMT CECOSTOMY/COLON          49442        3736.10
03610166   HB TUBE CHANGE G-TUBE TO GJ            49446        3050.18
03610753   HB REPLACE G/C TUBE PERC               49450        1355.89
03610167   HB TUBE REPLACE DUOD/JEJ               49451        1124.59        1385.75



                                            17
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
03610742   HB TUBE REPLACE DUOD/JEJ IR            49451        1124.59
03610168   HB TUBE REPLACE GJ                     49452        1124.59
03610169   HB TUBE FIX G-GOLON                    49460        1124.59
03610170   HB G-COLON CONTRAST INJECTION          49465        472.86
04500212   HB UNLISTED PROC, ABD, PERITON         49999                       5973.88
03610502   HB DRAIN PERIRENAL/RENAL DRN           50021        3424.45
03610253   HB BIOPSY KIDNEY                       50200        2080.54        2704.94
03610503   HB CHANGE URETER STENT, PERCUT         50382        4321.38
03610727   HB REMOVE URETER STENT PERCUT          50384        5554.39
03610171   HB REPLACE STENT TRANSURETH SI         50385        6558.39
03610172   HB REMOVE STENT URETERAL S&I           50386        2045.23
03610254   HB REMOVE TUBE NEPHROSTOMY             50389        710.99
03610255   HB ASPIRATION/INJ RNL CYST             50390        1804.81        2346.03
03610747   HB ASPIRATION/INJ RNL CYST IR          50390        1804.81
03610256   HB CATH PLCMT RENAL PELVIS             50392        6206.32
03610257   HB CATH PLCMT URETER VIA KIDNY         50393        6883.12
03610258   HB PYELOGRAM INJ INDWEL CATH           50394        790.74
03610259   HB DILATE NEPHROSTOMY TRACT            50395        7449.40
03610260   HB CHANGE NEPHROSTOMY TUBE             50398        2523.78
03610261   HB ABLATION KIDNEY TUMOR UNI           50592        5506.92        7158.86
03610511   HB CRYOABLATION RENAL TUM UNI          50593       13743.72       15707.09
03610262   HB INJ URETEROPYELOGRAM/LOOP           50690        933.17
03610603   HB DRAIN BL W/CATH INSERTION           51102                       1728.00
03610373   HB INJ CYSTOGRAM/VCUG                  51600        202.81          263.21
03610376   HB INJ URETHROCYSTOGRAM RETRO          51610        263.21          342.17
03610264   HB BLADDER INSTILLATION/IRRGTN         51700        466.02          606.16
03610265   HB CATHERIZATION, STRAIGHT             51701        389.67          507.04
03610699   HB CATHETERIZATION,NON-INDWELLNG       51701        243.83
03610428   HB CATHETERIZATION, INDWELLING         51702        389.67          507.04
04500168   HB INSERT FOLEY CATH COMPLICATED       51703                       1041.41
03610266   HB CYSTOSTOMY TUBE CHANGE              51705        801.00         1041.29
03610674   HB CHNGE CYSTO TUBE COMPLICATD         51710        1847.10        2401.23
03610267   HB COLLAGEN URETHRAL INJECTION         51715        6205.17
03610504   HB INSTILATN OF ANTICARCINOGNC         51720        730.58
03610268   HB CYSTOMETRY, SIMPLE                  51725        1980.28
03610187   HB COMPLEX CMG (CYSTOMETROGRAM)        51726        1188.40
03610271   HB UROFLOWMETRY (SIMPLE)               51736        737.20
03610272   HB UROFLOWMETRY (COMPLEX)              51741        737.20
09220001   HB EMG URETHA / ANUS                   51784        763.40
09200020   HB NEEDLE EMG ANL/URTHRL SPHNCT        51785        1733.03        1333.10
09200019   HB STIMULUS EVOKED RESPONSE            51792        635.04          824.95
03610275   HB PRESSURE VOID-INTRA-ABDOMINAL       51797        818.09



                                            18
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03610276   HB POST-VOID RESIDUAL MEASUREMENT      51798        243.83
03610277   HB CYSTOSCOPY                          52000        2939.65
03610278   HB CYTOURETHROSCOPY                    52005        6877.42
03610279   HB CYSTOSCOPY W/ BIOPSY                52204        7905.16
03610280   HB CYSTO W/ DILATION URETHRA STRT      52281        5903.24
03610281   HB CYSTO W/ STENT REMOVE (SIMPLE)      52310        4408.34
03610283   HB CYSTOURETHROSCOPY                   52351        5469.12
03610284   HB DILITATION URETHRAL STRICTURE       53600        921.78
03610521   HB DIL URETHR STRICT, MALE,1ST         53620                       1692.01
03610285   HB DILATION URETHA, INITIAL            53660        345.24
03610286   HB CIRCUM., BY CLAMP OR DEVICE         54150        7449.40
03610287   HB CIRCUM.,SURG.EXCISION; NEWBORN      54160        1989.74
03610584   HB CIRCUMCISION 28 DAYS OR OLD         54161        7449.40
03610586   HB LYSIS OF PENILE ADHESION            54162        7449.40
03610700   HB REPAIR INCOMPLETE CIRCUMCIS         54163        7449.40
04500209   HB IRRIG CRPR CVERNSA PRIAPISM         54220                        556.44
03610730   HB INJ CORPORA CAVERNOSOGRAM           54230        3054.62
03610458   HB DYNMC CAVRNSMTRY W MED INJ          54231        5075.45
04500169   HB I&D TEST/SCROTUM EPIDIDYMIS         54700                       8419.03
03610288   HB BIOPSY PROSTATE                     55700        1335.38        1736.45
03610545   HB PLACE RT DEVICE/MARKER,PROS         55876        4147.42
03610191   HB I & D VULVA/PERINEUM                56405        1311.45        1704.54
04500003   HB I&D BARTHOLIN ABSCESS               56420        1359.74        1767.21
03610291   HB BIOPSY, VULVA 1ST LESION            56605        708.71
03610385   HB BX VULVA/PERINEUM EA ADDL LES       56606        708.71
03610634   HB COLPOSCOPY OF VULVA                 56820        756.56
03610607   HB COLPOTOMY; WITH EXPLORATION         57000                       1728.00
04900009   HB BIOPSY OF VAGINA                    57100        1321.70
03610293   HB IRRIGATION VAGINAL/APPLY OINT.      57150        166.35
03610294   HB PESSARY FITTING                     57160        534.38
03610295   HB HEMOSTATIC AGENT, INTRODUCTION      57180        276.88
03610635   HB EXAM/BIOPSY OF VAG W/SCOPE          57421        756.56
04900010   HB COLPOSCOPY                          57452        756.56
04900011   HB COLPOSCOPY W/CERVICAL BIO           57454        756.56
03610633   HB CERV COLP W EC CURETT               57456        756.56
04900012   HB BIOPSY OF CERVIX                    57500        1321.70
03610296   HB ECC                                 57505        763.40
04900013   HB LOOP ELECTRODE EXCISION PROC        57522        9459.30
05100027   HB CERVICAL DILATION                   57800        1712.98
03610297   HB BIOPSY, ENDOMETRIAL                 58100        535.52
03610386   HB IUD INSERTION                       58300        225.60
03610304   HB IUD-INSERTION                       58300        225.60



                                            19
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
03610387   HB IUD REMOVAL                           58301        682.51
05100029   HB ARTIFICAL INSEM/INTRA- UT             58322        504.76
03610192   HB HYSTEROSALPINGOGRAM INJECT            58340        450.07
03610388   HB HYSTEROSCOPY                          58555       10804.94
03610639   HB HYSTEROSCOPY BX ENDM-PLYPT            58558       10804.94
04020008   HB AMNIOCENTESIS WITH ULTRASOUND         59000        1232.83
03610195   HB AMNIOCENTESIS, THERAPEUTIC            59001        1813.92
03610305   HB CORDOCENTESIS                         59012        932.03
03610306   HB CHORIONIC VILLUS SAMPLING             59015        1232.83
03610307   HB FETAL STRESS TEST                     59020        1632.77
09200001   HB FETAL NON-STRESS TEST                 59025        807.84
03610429   HB TRANS ABD AMNIOINFUSION W/US          59070        786.19
03610309   HB INSERT CERVICAL DILATOR               59200        818.09
04500172   HB EPISIOTOMY REPAIR                     59300                       1709.10
07200015   HB VAGINAL DELIVERY                      59409        8749.46
04500004   HB VAGINAL DELIVERY ED                   59409                      11374.64
07200004   HB BREECH VERSION ATTEMPT                59412        2269.68
04500005   HB PLACENTAL DELIVERY                    59414                       3616.46
07200016   HB REMOVAL OF RETAINED PLACENTA          59414        2782.41
03610310   HB BIOPSY THYROID                        60100        1207.76        1568.96
03610196   HB ASPIRATION AND/OR INJ THYROID         60300        567.42
03610735   HB PUNCTURE C1-2 (WITHOUT INJ)           61050        2170.56
03610311   HB PUNCTURE C-SPINE W MEDS               61055        1666.95
03610312   HB PUNCTURE OF SHUNT TUBING              61070        844.30
03610313   HB ENDOVSC TEMP BALLN ART OCCLUSN        61623       13477.97
03610314   HB EMBOLIZATION CNS                      61624        8969.36
03610315   HB EMBOLIZATION EXTRACRANIAL             61626       12707.73
03610316   HB ANGIOPLASTY CRANIAL                   61630       12164.23
03610317   HB ANGIOPLASTY CRANIAL W STENT           61635       15205.30
03610318   HB DIL CRANIAL VASOSPASM INIT            61640       15205.30
03610319   HB DIL CRANIAL VASOSPASM ADDL            61641        6082.12
03610320   HB DIL CRANIAL VASOSPASM ADDON           61642       12164.23
03610321   HB STEREOTACTIC LOCALIZATION             61770        9496.90       12345.40
03610731   HB INTERDISCAL PERQ ASPIR, DX            62267        1321.91
03610430   HB PUNCTURE L-SPINE DIAG                 62270        1772.91        2305.01
03610751   HB PUNCTURE L-SPINE DIAG IR              62270        1772.91
03610431   HB DRAINAGE CSF FLUID                    62272        1159.91        1507.43
03610752   HB DRAINAGE CSF FLUID IR                 62272        1159.91
03610750   HB INJ EPIDURAL -BLD PATCH IR            62273        2164.86
03610323   HB INJ EPIDURAL OR BLOOD PATCH           62273        2164.86        2814.32
03610324   HB MYELOGRAM INJECTION                   62284        2248.04
03610325   HB ASPIR/DECOMPRESS VERT DISC            62287        8487.40



                                              20
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03610326   HB INJ DISCOGRAM L-SPINE                62290       2731.15
03610327   HB INJ DISCOGRAM C/T-SPINE              62291       905.83
03610328   HB INJ EPIDURAL C/T-SPINE               62310       2410.97
03610329   HB INJ EPIDURAL L/S-SPINE               62311       2633.16
03610215   HB INJ EPIDURAL C/T SPINE CONT          62318       2155.74
03610377   HB INJ EPIDURAL L/S-SPINE               62319       2156.89
03610330   HB CATH REPOSITIONING EPIDURAL          62350      12295.27
03610331   HB LAMINOTOMY L-SPINE                   63030      20537.69
04500176   HB NERVE BLOCK FACIAL NERVE             64402                       650.60
03610695   HB INJ ANESTH; PHRENIC NERVE            64410       1857.22        2414.39
03610332   HB NERVE BLOCK C-SPINE                  64413       982.16         1276.13
03610760   HB INJ ANES BRACH PLEX CON INF          64416       2214.44
03610459   HB INJ ANES INTRCSTL NRVE SGLE          64420       924.65
03610460   HB INJ ANES INTECSTL NRVE MULT          64421       1816.91
03610333   HB INJ ANESTH; PUDENDAL NERVE           64430       1211.27
05100030   HB PARACERVICAL BLOCK                   64435       672.25
03610535   HB INJ SCIATIC NERVE ANES SNGL          64445       1076.74
03610411   HB INJ PERIPHERAL NERVE BLOCK           64450       2462.25        3200.58
04500203   HB N BLOCK INJ, PLANTAR DIGIT           64455                      1423.35
03610339                                           64479
           HB INJ C/T-SPINE TRNSFORAM INI- IMG GUIDE INCL      1950.65
03610340                                         64480
           HB INJ C/T-SPINE TRNSFORAM ADL-IMG GUIDE INCL       1808.23
03610341                                           64483
           HB INJ L/S-SPINE TRNSFORAM INI-IMG GUIDE INCL       3033.08
03610342                                          64484
           HB INJ L/S-SPINE TRNSFORAM ADL-IMG GUIDE INCL       1748.98
03610754   HB INJ C/T-SPINE FACET FRST             64490       3616.46
03610755   HB INJ C/T-SPINE FACET SECOND           64491       1623.65
03610756   HB INJ C/T-SPINE FACET ADDL             64492       1623.65
03610757   HB INJ L/S-SPINE FACET FIRST            64493       3616.46
03610758   HB INJ L/S-SPINE FACET SECOND           64494       1623.65
03610759   HB INJ L/S-SPINE FACET ADDL             64495       1623.65
07610003   HB INJ C-SPINE STELLATE GANGLN          64510       3185.76
07610004   HB INJ T/L-SPINE SYMPATHETIC            64520       3185.76
03610308   HB INJ CELIAC PLEXUS                    64530       2322.10
03610526   HB REVISE/RMV PN/GASTR STIMUL           64595                      2495.29
03610691   HB CHEMODENERV SALIV GLANDS             64611       518.43          673.96
09900510   HB BOTOX; FACIAL NERVE                  64612       518.43
03610435   HB CHEMODENERVATION;FACIAL NERVE        64612       518.43
03610343   HB BOTOX: CERVICAL SPINAL MUSCLES       64613       904.68         1175.86
05100031   HB CHEMODENERVATION;EXTREM/TRUNK        64614       537.80          698.46
03610436   HB DESTRC, NEUROLYTIC AGENT, OTHR       64640       1857.22
03610687   HB CHEMODENRV ECRN GLNDS 2AXIL          64650       2656.28        3453.41
03610688   HB CHEMODENRV ECRN GLNDS OTHR           64653       2656.28        3453.41
03610762   HB NERVE INJ GANGLN IMPR BLCK           64999       863.67



                                            21
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
04500178   HB REMOVE FB CONJUNCT SUPERFIC         65205                        592.49
03610530   HB REM FB,EXTEYE;CRNL,SLT LAMP         65220                        78.86
04500179   HB REMOVAL CORNEAL FB W/SLIT LAMP      65222                        696.18
04500180   HB RUST RING REMOVAL CONEAL            65435                        683.64
03610344   HB ARG/KRYP TRABECULOPLASTY      *     65855        2128.40
03610345   HB YAG IRIDOTOMY 1 OR MORE             66761        4368.46
03610346   HB YAG DISCISSION A-CATARACT MEM*      66821        2128.40
03610347   HB ARG/KRYP ANTERIOR SMGNT EYE *       66999        3721.28
03610348   HB AR/KR/YG SEVER VITREOUS STRAN*      67031        3402.25
03610349   HB ARG/KRYP DESTRUCTION RETINA *       67210        1817.35
03610350   HB ARG/KRYP DESTRUCT RETINOPATHY*      67228        2726.59
03610686   HB CHEMODENRV EXTRCLR MUSCLE           67345        1772.91        2305.01
03610351   HB ARG/KRYP RETINAL DETACHMENT         68720        5439.50
04500181   HB I&D ABSCESS AURICLE SIMPLE          69000                        772.51
04500182   HB I&D ABSCESS EXT AUD CANAL           69020                        772.51
03610432   HB PEDS ENT-REMOVE-FB-EXTAUDITCAN      69200        265.49          345.24
03610009   HB RMVL IMPACTED CERUMEN               69210        194.84          252.95
03610352   HB MYRINGOTOMY                         69420        1627.06
03200029   HB CISTERNOGRAM S&I                    70015        1751.70
03200030   HB XR MANDIBLE 1-3VW                   70100        533.92          693.61
03200031   HB XR MANDIBLE 4VW/MORE                70110        847.21         1101.98
03200032   HB XR MASTOIDS 1-3VW                   70120        692.39          900.11
03200033   HB XR FACIAL BONES 1-2VW               70140        532.70          692.39
03200034   HB XR FACIAL BONES 3VW/MORE            70150        944.73          #N/A
03200035   HB XR NASAL BONES 3VW/MORE             70160        805.76         1047.12
03200036   HB XR OPTIC FORAMINA UNILAT            70190        460.78          599.02
03200037   HB XR ORBITS 4VW/MORE                  70200        766.75          995.92
03200038   HB XR SINUSES 1-2VW                    70210        354.73          460.78
03200039   HB XR SINUSES 3VW/MORE                 70220        786.26         1021.52
03200040   HB XR SKULL 1-3VW                      70250        532.70          692.39
03200041   HB XR SKULL 4VW/MORE                   70260        1206.81        1568.85
03200042   HB XR TMJ UNILATERAL                   70328        655.82          852.57
03200043   HB XR TMJ BILAT                        70330        533.92          693.61
06100015   HB MRI TMJ BILATERAL                   70336        3670.41        4771.54
03200044   HB XR NECK SOFT TISSUE                 70360        577.81          750.90
03200227   HB SIALOGRAM S&I                       70390        892.31
03510039   HB CT HEAD/BRAIN WO CONT               70450        3046.28        3959.31
03510002   HB CT HEAD/BRAIN W CONT                70460        4032.45        5241.70
03510003   HB CT HEAD/BRAIN WO/W CONT             70470        4705.34        6118.16
03510005   HB CT IAC WO CONT                      70480        2782.98        3617.99
03510010   HB CT IAC/NM PETROUS BNE WO CO         70480        2782.98        3617.99
03510008   HB CT ORBITS WO CONT                   70480        2782.98        3617.99



                                            22
  Charge
   Code                    Description           CPT Code OP/Default Price   IP/ED Price
03510011   HB CT ORBITS/SELLA/EAR WO CONT         70480        2782.98        3617.99
03510036   HB CT TEMPORAL BNE WO CONT             70480        2782.98        3617.99
03510014   HB CT ORBITS/SELLA/EAR W CONT          70481        3426.61        4454.23
03510012   HB CT TEMPORAL BNE W CONT              70481        3426.61        4454.23
03510022   HB CT ORBIT/SELLA/EAR WO/W CON         70482        4377.43        5690.29
03510041   HB CT ORBITS WO/W CON                  70482        4377.43        5690.29
03510040   HB CT SELLA/PITUITARY WO/W CON         70482        4377.43        5690.29
03500001   HB CT FACIAL & ORBITAL BONES           70486        2871.96        3733.80
03510026   HB CT MAXILLOFACIAL WO CONT            70486        2871.96        3733.80
03510038   HB CT MAXILLOFACIAL WO CONT            70486        2871.96        3733.80
03510042   HB CT MAXILLOFACIAL WO CONT CT         70486        2871.96        3733.80
03510037   HB CT SINISES                          70486        2871.96        3733.80
03510024   HB CT SINUSES WO CONT LIMITED          70486        2871.96        3733.80
03510025   HB CT TMJ WO CONT                      70486        2871.96        3733.80
03510031   HB CT MAXILLOFACIAL W CONT             70487        3728.92        4847.96
03510044   HB CT SINUSES W CONT                   70487        3728.92        4847.96
03510032   HB CT MAXILLOFACIAL WO/W CONT          70488        4090.96        5318.50
03500047   HB CT NECK SFT TISS WO CONT            70490        2445.31        3177.93
03500048   HB CT NECK SFT TISS W CONT             70491        3728.92        4847.96
03500049   HB CT NECK SFT TISS WO/W CONT          70492        4498.11        5847.54
03510019   HB CT ANGIO HEAD/BRAIN                 70496        4153.13        5398.95
03510020   HB CT ANGIO NECK                       70498        4153.13        5398.95
06100003   HB MRI NECK WO CONT                    70540        4662.68        6060.87
06100002   HB MRI ORBITS WO CONT                  70540        4662.68        6060.87
06100016   HB MRI ORBITS/FACE/NECK WO CONT        70540        4662.68        6060.87
06100001   HB MRI SINUSES WO CONT                 70540        4662.68        6060.87
06100017   HB MRI ORBITS/FACE/NECK W CONT         70542        5770.75        7501.97
06100104   HB MRI NECK WO/W CONT                  70543        6951.96        9036.45
06110001   HB MRI ORBITS WO/W CONT                70543        6951.96        9036.45
06100103   HB MRI ORBITS/FCE/NCK WO/W CON         70543        6951.96        9036.45
06110006   HB MRI SINUSES WO/W CONT               70543        6951.96        9036.45
06150003   HB MR ANGIO HEAD/BRAIN WO CONT         70544        4264.06        5544.01
06100105   HB MR ANGIO HEAD/BRAIN W CONT          70545        4477.39        5820.61
06150004   HB MR ANGIO HEAD/BRAIN WO/W CN         70546        5500.13        7149.44
06150001   HB MR ANGIO NECK WO CONT               70547        3960.53        5149.06
06150002   HB MR ANGIO NECK W CONT                70548        4490.80        5839.01
06100106   HB MR ANGIO NECK WO/W CONT             70549        5500.13        6715.47
06110003   HB MRI HEAD/BRAIN WO CONT              70551        5665.91        7366.42
06110007   HB MRI HEAD/BRAIN WO CONT CSF          70551        5665.91        7366.42
06110014   HB MRI HEAD/BRAIN WO CONT LTD          70551        5665.91        7366.42
06110004   HB MRI HEAD/BRAIN W CONT               70552        6394.87        8312.36
06100107   HB MRI HEAD/BRAIN WO/W CNT IAC         70553        8591.51       11169.70



                                            23
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
06110012   HB MRI HEAD/BRAIN WO/W CONT            70553        8591.51       11169.70
06110009   HB MRI HEAD/BRAIN WO/W CONT, PERF      70553        8591.51       11169.70
06110010   HB MRI HEAD/PITUITARY WO/W CNT         70553        8591.51       11169.70
06110013   HB MRI BRAIN FUNCT WO MD ASST          70554        5013.75        6517.88
06110015   HB MRI BRAIN FUNCT W MD ASST           70555        5665.91        7365.69
03240008   HB XR CHEST 1VW FRONTAL                71010        577.81          752.12
03240009   HB XR CHEST 2VW FRONT/LATERAL          71020        646.07          839.89
03240001   HB XR CHEST 3VW FRONT/LAT/LORD         71021        471.75          577.81
03240010   HB XR CHEST 4VW FRONT/LAT/OBLQ         71022        574.15          746.03
03240007   HB XR CHEST 2VW W/ FLUOROSCOPY         71023        792.35         1030.06
03240011   HB XR CHEST 4VW                        71030        847.21         1101.98
03240003   HB XR CHEST 4VW W/ FLUOROSCOPY         71034        597.31          776.50
03240004   HB XR CHEST SPECIAL VIEW(S)            71035        460.78          599.02
03200051   HB FLUORO FOR PACER INSERTION          71090        761.88
03200052   HB XR RIBS 2VW UNILATERAL              71100        704.58          915.47
03200053   HB XR RIBS+CHEST 3VW UNILAT            71101        705.80          917.91
03200054   HB XR RIBS 3VW BILATERAL               71110        845.99         1099.54
03240005   HB XR RIBS+CHEST 4VW BILATERAL         71111        604.62          786.01
03200055   HB XR STERNUM 2VW/MORE                 71120        748.47          972.76
03200056   HB XR STERNOCLAV JNT 3VW/MORE          71130        533.92          693.61
03520052   HB CT CHEST WO CONTRAST                71250        4982.05        6476.55
03520006   HB CT CHEST WO CONTRAST HI-RES         71250        4982.05        6476.55
03520040   HB CT CHEST W CONTRAST                 71260        5183.19        6738.63
03500045   HB CT CHEST W CONTRAST HI-RES          71260        5183.19        6738.63
03520007   HB CT CHEST WO/W CONTRAST              71270        5808.54        7551.71
03520011   HB CT ANGIO CHEST                      71275        4153.13        5398.95
06100117   HB MRI BREAST LYMPH NODES LTD          71550        3014.59        3919.09
06100116   HB MRI CHEST WO CONTRAST               71550        3014.59        3919.09
06100118   HB MRI CHEST WO CONTRAST LTD           71550        3014.59        3680.16
06100129   HB RSH MR CHEST W/CONTRAST             71551
06140002   HB MRI CHEST WO/W CONT ANR/DIS         71552        6922.70        8999.88
06100025   HB MRI CHEST WO/W CONTRAST             71552        6922.70        8999.88
03200057   HB XR SPINE SURVEY 2VW                 72010        533.92          694.10
03200002   HB XR C-SPINE 1VW                      72020        354.73          462.00
03200005   HB XR C-SPINE 1VW (IN SURGERY)         72020        354.73          462.00
03200003   HB XR L-SPINE 1VW                      72020        354.73          462.00
03200006   HB XR L-SPINE 1VW (IN SURGERY)         72020        354.73          462.00
03200210   HB XR SPINE 1VW ANY LEVEL              72020        354.73          462.00
03200004   HB XR T-SPINE 1VW                      72020        354.73          462.00
03200007   HB XR T-SPINE 1VW (IN SURGERY)         72020        354.73          462.00
03200060   HB XR C-SPINE 2-3VW                    72040        585.12          760.66
03200061   HB XR C-SPINE 4-5VW                    72050        814.29         1059.31



                                            24
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
03200062   HB XR C-SPINE 7VW FLEX/EXT             72052        1091.01        1418.92
03200063   HB XR T-SPINE 2VW                      72070        766.75          995.92
03200064   HB XR T-SPINE 3VW                      72072        914.25         1188.53
03200065   HB XR T-SPINE 4VW/MORE                 72074        533.92          694.10
03200066   HB XR T/L-SPINE 2VW                    72080        674.11          876.46
03200067   HB XR SCOLIOSIS STUDY                  72090        836.23         1087.35
03200068   HB XR L-SPINE 2-3VW                    72100        670.45          870.37
03200069   HB XR L-SPINE 4-5VW                    72110        1092.22        1420.14
03200070   HB XR L-SPINE 7VW BENDING              72114        1186.09        1542.04
03200071   HB XR L-SPINE 4VW BENDING ONLY         72120        711.90          954.12
03520041   HB CT C-SPINE WO CONTRAST              72125        2672.05        3474.15
03520042   HB CT C-SPINE W CONTRAST               72126        3693.57         #N/A
03520013   HB CT C-SPINE WO/W CONTRAST            72127        4356.71        5663.47
03520043   HB CT T-SPINE WO CONTRAST              72128        3728.92        4847.96
03500050   HB CT T-SPINE W CONT POST-MYEL         72129        3788.65        4924.76
03520044   HB CT T-SPINE W CONTRAST               72129        3788.65        4924.76
03520014   HB CT T-SPINE WO/W CONTRAST            72130        4279.91        5563.52
03500043   HB CT L-SPINE WO CONT POST-MYL         72131        3728.92        4847.96
03520015   HB CT L-SPINE WO CONTRAST              72131        3728.92        4847.96
03520019   HB CT SACRUM W/O CONTRAST              72131        3728.92        4847.96
03590002   HB CT T/L-SPINE WO CONTRAST            72131        3728.92        4847.96
03520016   HB CT L-SPINE W CONTRAST               72132        4014.17        5217.32
03520017   HB CT L-SPINE WO/W CONTRAST            72133        4409.12        5731.74
06120008   HB MRI C-SPINE W/O CONTRAST            72141        5604.96        7285.96
06120001   HB MRI C-SPINE WO CONTRAST             72141        5604.96        7285.96
06120004   HB MRI C-SPINE WO CONTRAST CSF         72141        5604.96        7285.96
06120011   HB MRI C-SPINE WO CONTRAST LTD         72141        5604.96        7285.96
06120012   HB MRI C-SPINE W CONTRAST              72142        7227.45        9396.05
06120003   HB MRI T-SPINE WO CONTRAST             72146        3265.70        3987.35
06120009   HB MRI T-SPINE WO CONTRAST CSF         72146        3265.70        3987.35
06120018   HB MRI T-SPINE WO CONTRAST LTD         72146        3265.70        3987.35
06120013   HB MRI T-SPINE W CONTRAST              72147        4710.22        6123.04
06120005   HB MRI L-SPINE WO CONTRAST             72148        5973.10        7765.03
06120010   HB MRI L-SPINE WO CONTRAST CSF         72148        5973.10        7765.03
06120019   HB MRI L-SPINE WO CONTRAST LTD         72148        5973.10        7765.03
06120014   HB MRI L-SPINE W CONTRAST              72149        6465.58        8405.01
06120015   HB MRI C-SPINE WO/W CONTRAST           72156        8280.14       10764.18
06120016   HB MRI T-SPINE WO/W CONTRAST           72157        8280.14       10764.18
06120006   HB MRI L-SPINE WO/W CONTRAST           72158        7050.70        9165.66
03200072   HB XR PELVIS 1-2VW                     72170        633.88          825.26
03200073   HB XR PELVIS 3VW/MORE                  72190        660.70          858.18
03520018   HB CT ANGIO PELVIS                     72191        3195.00        4153.13



                                            25
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
03520030   HB CT PELVIS WO CONTRAST               72192        3928.84        5106.39
03520020   HB CT PELVIS W CONTRAST                72193        5033.25        6543.59
03520045   HB CT PELVIS WO/W CONTRAST             72194        6397.31        8316.02
06100031   HB MRI PELVIS WO CONTRAST              72195        3654.56        4750.44
06120017   HB MRI S-SPINE WO CONTRAST             72195        3654.56        4750.44
06100007   HB MRI PELVIS W CONTRAST               72196        4067.80        5288.02
06100032   HB MRI PELVIS W CONTRAST               72196        4067.80        5288.02
06100119   HB MRI PELVIS W CONTRAST BONEY         72196        4067.80        5288.02
06100033   HB MRI PELVIS WO/W CONT                72197        5661.04        7359.35
06100011   HB MRI S-SPINE WO/W CONTRAST           72197        5661.04        7359.35
03200074   HB XR SACROILIAC JNT 2VW/LESS          72200        354.73          460.78
03200075   HB XR SACROILIAC JNT 3VW/MORE          72202        759.44          987.39
03200076   HB XR SACRUM/COCCYX 2VW/MORE           72220        900.84         1170.24
03200077   HB MYELOGRAM C-SPINE                   72240        2463.60
03200078   HB MYELOGRAM T-SPINE                   72255        2129.59
03200079   HB MYELOGRAM L-SPINE                   72265        2463.60
03200080   HB MYELOGRAM 2/MORE REGIONS            72270        1490.84
03200215   HB DISCOGRAM CERV/THOR S&I             72285        3461.96
03200008   HB VERT/SACROPLASTY FLUORO S&I         72291        1234.85
03200081   HB DISCOGRAM LUMBAR S&I                72295        4159.23
03200082   HB XR CLAVICLE UNILATERAL              73000        501.01          650.95
03200083   HB XR SCAPULA UNILATERAL               73010        658.26          854.52
03200084   HB XR SHOULDER 1VW UNILATERAL          73020        618.03          803.32
03200085   HB XR SHOULDER 2VW/MORE UNILT          73030        746.03          969.11
03220003   HB ARTHROGRAM S&I UNILATERAL           73040        1701.72        2211.27
03200086   HB XR AC JNTS WO/W WEIGHTS BIL         73050        670.45          871.59
03200087   HB XR HUMERUS 2VW/MORE UNILAT          73060        633.88          825.26
03200088   HB XR ELBOW 2VW UNILATERAL             73070        558.30          725.31
03200089   HB XR ELBOW 3VW/MORE UNILAT            73080        543.67          705.80
03200200   HB ARTHROGRAM ELBOW S&I UNILAT         73085        984.95         1280.44
03200090   HB XR FOREARM 2VW UNILATERAL           73090        585.12          760.66
03200091   HB XR EXT UPP INFANT 2VW UNI           73092        533.92          693.61
03200093   HB XR WRIST 2VW UNILATERAL             73100        446.15          580.24
03200094   HB XR WRIST 3VW/MORE UNILAT            73110        696.05          904.50
03200095   HB XR ARTHROGRAM WRIST S&I UNILAT      73115        1109.29        1442.08
03200096   HB XR HAND 2VW UNILATERAL              73120        520.51          676.55
03200097   HB XR HAND 3VW/MORE UNILATERAL         73130        670.45          871.59
03200098   HB XR FINGER(S) 2VW UNILATERAL         73140        501.01          650.95
03520022   HB CT EXT UPP WO CONTRAST UNI          73200        3095.04        4023.92
03520023   HB CT EXT UPP W CONTRAST UNI           73201        3476.59        4520.05
03520024   HB CT ANGIO EXT UPPER UNILAT           73206        2429.47        3158.43
06100112   HB MRI EXT UPP WO CONT UNI             73218        3165.74        4115.34



                                            26
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
06100035   HB MRI FOREARM WO CONT UNILAT           73218        3165.74        4115.34
06100012   HB MRI HUMERUS WO CONT UNILAT           73218        3165.74        4115.34
06100113   HB MRI EXT UPP WO/W CONT UNI            73220        5151.49        6695.97
06100013   HB MRI FOREARM WO/W CONT UNI            73220        5151.49        6695.97
06100036   HB MRI HUMERUS WO/W CONT UNILAT         73220        5151.49        6695.97
06100040   HB MRI ELBOW WO CONTRAST UNI            73221        3672.85        4774.82
06100037   HB MRI EXT UPP JT WO CONT UNI           73221        3672.85        4774.82
06100038   HB MRI HAND/FINGER WO CONT UNI          73221        3672.85        4774.82
06100014   HB MRI HAND/FINGER WO CONT UNILAT       73221        3672.85        4774.82
06100114   HB MRI SHOULDER WO CONT UNILAT          73221        3672.85        4774.82
06100039   HB MRI WRIST WO CONTRAST UNI            73221        3672.85        4774.82
06100041   HB MRI WRIST WO CONTRAST UNI            73221        3672.85        4774.82
06100115   HB MRI EXT UPP JT W CONT UNI            73222        4187.27        5442.84
06100046   HB MRI SHOULDER W CONT UNILAT           73222        4187.27        5442.84
06100056   HB MRI ELBOW WO/W CONT UNILAT           73223        4717.27        6132.45
06100058   HB MRI EXT UPP JT WO/W CNT UNI          73223        4717.27        6132.45
06100053   HB MRI EXT UPP JT WO/W CNT UNI*         73223        4717.27        6132.45
06100057   HB MRI SHOULDER WO/W CONT UNI           73223        4717.27        6132.45
06100051   HB MRI WRIST WO/W CONT UNILAT           73223        4717.27        6132.45
03200186   HB XR HIP 1VW UNILATERAL                73500        540.02          702.14
03200100   HB XR HIP+PELVIS 2VW/MORE UNI           73510        641.19          833.80
03200101   HB XR HIP+PELVIS 2VW/MORE BIL           73520        1069.06        1390.88
03220007   HB XR ARTHROGRAM HIP S&I UNILAT         73525        1268.98        1649.31
03200103   HB XR HIP 1VW UNI (IN SURGERY)          73530        702.14          912.79
03200104   HB XR HIP+PELVIS 2VW BIL INFNT          73540        533.92          693.61
03200105   HB XR FEMUR 2VW UNILATERAL              73550        604.62          786.26
03200010   HB KNEE 3 VIEWS                         73560        532.70          692.39
03200011   HB XR KNEE 1-2VW UNILATERAL             73560        532.70          692.39
03200009   HB XR PATELLA 1-2VW UNILATERAL          73560        532.70          692.39
03200212   HB XR KNEE 3VW UNILATERAL               73562        620.47          805.76
03200109   HB XR KNEE 4VW/MORE UNILATERAL          73564        761.88          989.83
03200110   HB XR KNEE 1VW STANDING BILAT           73565        354.73          461.15
03220004   HB ARTHROGRAM KNEE S&I UNILAT           73580        1219.00        1584.70
03200111   HB XR TIBIA/FIBULA 2VW UNILAT           73590        744.81          967.89
03200112   HB XR EXT LOW 2VW UNILAT INFNT          73592        425.43          553.43
03200113   HB XR ANKLE 2VW UNILATERAL              73600        547.33          710.68
03200114   HB XR ANKLE 3VW/MORE UNILAT             73610        750.90          976.42
03220005   HB ARTHROGRAM ANKLE S&I UNILAT          73615        636.32          827.21
03200115   HB XR FOOT 2VW UNILATERAL               73620        552.21          717.99
03200116   HB XR FOOT 3VW/MORE UNILAT              73630        750.90          976.42
03200194   HB XR CALCANEUS 2VW/MORE UNI            73650        702.14          911.81
03200118   HB XR TOE(S) 2VWS/MORE UNILAT           73660        354.73          462.00



                                             27
  Charge
   Code                     Description             CPT Code OP/Default Price   IP/ED Price
03520046   HB CT HIP WO CONT UNILAT                  73700        3007.27        3909.33
03520047   HB CT LOW EXT WO CONT, UNILAT             73700        3007.27        3909.33
03500010   HB CT LOWER EXTREMITY/SACRUM              73700        3007.27        3909.33
03500044   HB CT EXT LOW W CONT UNILAT               73701        3730.14        4849.18
03520048   HB CT EXT LOW W CONT UNILAT               73701        3730.14        4849.18
03520035   HB CT HIP W CONT UNILATERAL               73701        3730.14        4849.18
03520034   HB CT HIP W/IV                            73701        3730.14        4849.18
03520037   HB CT HIP LOW WO/W CONT UNILAT            73702        3827.66        4975.96
03520028   HB CT LOW EXT WO/W CONT UNILAT            73702        3827.66        4975.96
03520029   HB CT ANGIO EXT LOW WO/W CN UNILAT        73706        2580.62        2917.07
06100099   HB MRI EXT LOW WO CONT UNI                73718        3672.85        4774.82
06100043   HB MRI FEMUR WO CONT UNILAT               73718        3672.85        4774.82
06100098   HB MRI TIB/FIB WO CONT UNILAT             73718        3672.85        4774.82
06100100   HB MRI EXT LOW W CONT UNILAT              73719        4506.64        5858.51
06100044   HB MRI TIBIA/FIBULA W CONT UNILAT         73719        4506.64        5858.51
06100101   HB MRI EXT LOW WO/W CONT UNILAT           73720        6594.79        8573.23
06100059   HB MRI FEMUR WO/W CONT UNILAT             73720        6594.79        8573.23
06100061   HB MRI TIB/FIB WO/W CONT UNI              73720        6594.79        8573.23
06100064   HB MRI ANKLE WO CONT UNILAT               73721        4273.81        5556.20
06100102   HB MRI EXT LOW JT WO CONT UNI             73721        4273.81        5556.20
06100063   HB MRI FOOT/TOES WO CONT UNI              73721        4273.81        5556.20
06100065   HB MRI HIP WO CONT UNILATERAL             73721        4273.81        5556.20
06100066   HB MRI KNEE WO CONT UNILATERAL            73721        4273.81        5556.20
06100068   HB MRI EXT LOW JT W CONT UNI              73722        4687.06        6093.18
06100077   HB MRI ANKLE WO/W CONT UNILAT             73723        5217.06        6782.18
06100072   HB MRI EXT LOW JT WO/W CNT UNI            73723        5217.06        6782.18
06100070   HB MRI FOOT/TOES WO/W CONT UNI            73723        5217.06        6782.18
06100078   HB MRI HIP WO/W CONT UNILAT               73723        5217.06        6782.18
06100076   HB MRI KNEE WO/W CONT UNILAT              73723        5217.06        6782.18
03200119   HB XR ABDOMEN 1VW FRONTAL                 74000        487.60          632.66
03200120   HB XR ABDOMEN 2-3VW                       74020        722.87          939.85
03200121   HB XR ABDOMEN+CHEST 3VW ACUTE             74022        697.27          905.72
03520049   HB CT ABDOMEN WO CONTRAST                 74150        4190.92        5448.93
03520050   HB CT ABDOMEN W CONTRAST                  74160        4995.46        6493.61
03520051   HB CT ABDOMEN WO/W CONTRAST               74170        5661.04        7359.10
03500013   HB CT ANGIO ABDOMEN WO/W CONT             74175        4995.46        6493.61
03500046   HB CT ANGIO ABDOMEN WO/W CONT             74175        4995.46        6493.61
03520056   HB CT ABD & PELVIS WO CONTRAST            74176        8119.76       10555.69
03520057   HB CT ABD & PELVIS W CONTRAST             74177       10028.71       13037.33
03520058   HB CT ABD & PELVIS WO/W CONT              74178       12058.35       15675.85
06100079   HB MRI ABDOMEN WO CONT MRCP               74181        6183.99        8039.31
06100080   HB MRI ABDOMEN WO CONTRAST                74181        5959.69        7746.75



                                               28
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
06100054   HB MRI ABDOMEN WO/W CONT MRCP          74183        7652.88        9948.26
06100055   HB MRI ABDOMEN WO/W CONTRAST           74183        6922.70        8999.88
03200122   HB XR ESOPHAGRAM                       74220        1139.77        1481.09
03200123   HB XR VIDEO SWALLOW STUDY CINE         74230        1115.39        1449.39
03200124   HB XR UGI WO KUB                       74240        1072.72        1395.76
03200125   HB XR UGI WO AIR W KUB                 74241        1208.03        1570.44
03200126   HB XR UGI W SMALL BOWEL SERIES         74245        1924.80         #N/A
03200127   HB XR UGI W AIR WO KUB                 74246        945.94         1229.73
03200128   HB XR SMALL BOWEL SERIES               74250        1596.89        2075.96
03200129   HB XR SMALL BOWEL ENTEROCLYSIS         74251        1245.82        1620.05
03520004   HB CT COLONOGRAPHY DIAG WO CNT         74261        9741.03       12662.97
03520054   HB CT COLONOGRAPHY DIAG W CONT         74262        9995.80       12994.54
03520002   HB CT COLONOGRAPHY SCREENING           74263        3934.29        5114.57
03200014   HB XR COLON CONTRAST ENEMA             74270        1521.31        1978.44
03200013   HB XR COLON POUCH-O-GRAM               74270        1521.31        1978.44
03200132   HB XR COLON BARIUM ENEMA W AIR         74280        1817.53        2363.64
03200213   HB XR COLON BARIUM ENEMA W AIR         74280        1817.53        2363.64
03200206   HB XR UL PROC DEFECOGRAPHY             74280        1817.53        2363.64
03200133   HB CHOLECYSTOGRAM ORAL                 74290        707.02          919.13
03200134   HB CHOLANGIOGRAM T-TUBE S&I            74305        1239.72        1612.74
03200232   HB CHOLANGIOGRAM T-TUBE S&I IR         74305        1239.72
03200135   HB CHOLANGIOGRAM PERC S&I              74320        2292.94
03200136   HB ENDO CATH- BILE DUCT S & I          74328        769.19
03200137   HB ENDO CATH- PANCR DUCT S & I         74329        769.19
03200138   HB ENDO CATH-BIL- PANCR DUCT S& I      74330        984.95
03200207   HB PLCMT PERC ENTEROCLYSIS TBE         74355        643.63
03200140   HB DILATE BILIARY DUCT S&I             74363        5022.28
03200141   HB UROGRAM IVP                         74400        2095.46         #N/A
03200233   HB UROGRAM IVP IR                      74400        2095.46
03200142   HB UROGRAM INFUSION                    74410        933.75         1214.12
03200143   HB UROGRAM INFUSION W TOMO             74415        1766.33        2296.60
03200144   HB UROGRAM RETROGRADE                  74420        1279.95        1663.94
03200234   HB UROGRAM RETROGRADE IR               74420        1279.95
03200145   HB UROGRAM ANTEGRADE S&I               74425        318.16          388.86
03200235   HB UROGRAM ANTEGRADE S&I IR            74425        318.16
03200146   HB CYSTOGRAM 3VW/MORE S&I              74430        1076.38        1399.41
03200236   HB CYSTOGRAM 3VW/MORE S&I IR           74430        1076.38
03200147   HB VESICULOGRAM S&I                    74440        1220.22
03200148   HB CORPORA CAVERNOSOGRAM S&I           74445        841.11
03200149   HB URETHROCYSTOGRAM RETRO S&I          74450        1376.25
03200150   HB URETHROCYSTOGRM VOID S&I            74455        1867.51        2427.03
03200237   HB URETHROCYSTOGRM VOID S&I IR         74455        1867.51



                                            29
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03200151   HB CATH INSERT RENAL PELVIS SI         74475        2681.80
03200152   HB CATH INSERT URETERAL S&I            74480        3500.97
03200153   HB DILATE URETER/URETHRA S&I           74485        1656.62
03200154   HB HYSTEROSALPINGOGRAM S&I             74740        1897.98        2467.38
03200155   HB VAGINOGRAM/PERINEOGRAM              74775        992.27         1289.70
06100081   HB MRI HEART WO CONTRAST               75557        6531.40        8491.55
06100083   HB MRI HEART WO/W CONTRAST             75561        6962.93        9052.29
06100121   HB MRI HEART WO/W CONT W STRES         75563       11337.31       14738.51
06100122   HB MRI HEART FLOW/VELOCITY             75565        2917.07        3789.87
03520003   HB CT HEART WO CONTRAST                75571        4182.39        5437.11
03500053   HB CT HEART W CONT                     75572        4876.00        6338.80
03500054   HB CT HEART W CONT, CONGEN DZ          75573        4876.00        6338.80
03520008   HB CT ANGIO HEART                      75574        3424.46        4451.79
03230001   HB ANGIOGRAM AORTA THORACIC SI         75605        6832.50
03230002   HB ANGIOGRAM AORTA ABDOMEN S&I         75625        6641.11
03230003   HB ANGIOGRAM AORTA RUNOFF S&I          75630        5696.39
03500033   HB CT ANGIO ABDOMINAL RUNOFF           75635        2469.69        3210.85
03230004   HB ANGIOGRAM AORTIC ARCH               75650        8017.36
03230005   HB ANGIOGRAM BRACH RETRO S&I           75658        6353.43
03230006   HB ANGIOGRAM CAROTD EXT UNI SI         75660        5807.32
03230007   HB ANGIOGRAM CAROTD EXT BIL SI         75662        7457.84
03230010   HB ANGIOGRAM CEREBRAL UNI S&I          75665        7457.84
03230008   HB ANGIOGRAM CEREBRAL BIL S&I          75671        9409.46
03230013   HB ANGIOGRAM CERVICAL UNI S&I          75676        7457.84
03230009   HB ANGIOGRAM CERVICAL BIL S&I          75680        7457.84
03230011   HB ANGIOGRAM VERT/CERV/CRAN SI         75685        8208.75
03230019   HB ANGIOGRAM SPINE S&I                 75705        8168.52
03230020   HB ANGIOGRAM EXTREMITY UNI S&I         75710        7457.84
03230021   HB ANGIOGRAM EXTREMITY BIL S&I         75716        8208.75
03230023   HB ANGIOGRAM KIDNEY UNILAT S&I         75722        7866.21
03230024   HB ANGIOGRAM KIDNEY BILAT S&I          75724        9942.16
03230025   HB ANGIOGRAM VISCERAL S&I              75726        8156.33
03230026   HB ANGIO ADRENAL BILAT                 75733        5682.98
03230028   HB ANGIOGRAM PELVIC S&I                75736        8208.75
03230029   HB ANGIOGRAM PULMONARY UNI S&I         75741        4234.81
03230030   HB ANGIOGRAM PULMONARY BIL S&I         75743        8208.75
03230032   HB ANGIOGRAM PULM NON-SEL S&I          75746        5255.11
03230033   HB ANGIOGRAM INT MAMMARY S&I           75756        5202.69
03230034   HB ANGIOGRAM EA ADDL VESSEL SI         75774        7116.52
03200226   HB AV DIALYSIS SHUNT S&I CL            75791        1076.71
03200240   HB AV DIALYSIS SHUNT S&I IR            75791        1076.71
03200208   HB SHUNTOGRAM NON-VAS SHUNT SI         75809        1015.43



                                            30
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03200157   HB SPLENOPORTOGRAM S&I                  75810       10404.17
03200216   HB SPLENOPORTOGRAPHY                    75810       10404.17
03200158   HB VENOGRAM EXTREMITY UNI S&I           75820        2064.99
03200159   HB VENOGRAM EXTREMITY BIL S&I           75822        2672.05
03200160   HB VENOGRAM VENA CAVA INF S&I           75825        4761.41
03200161   HB VENOGRAM VENA CAVA SUP S&I           75827        4432.28
03200162   HB VENOGRAM RENAL UNILAT S&I            75831        5463.56
03200163   HB VENOGRAM RENAL BILAT S&I             75833        6353.43
03200164   HB VENOGRAM JUGULAR S&I                 75860        5596.43
03200165   HB PORTOGRAPHY HEP W HEMO S&I           75885        8208.75
03200166   HB VENOGRAM HEPATIC W HEMO S&I          75889        8208.75
03610354   HB VENOGRAM HEPATIC WO HEMO SI          75891        9205.89
03200167   HB VENOUS SAMPLING S&I                  75893        3989.79
03200168   HB TRANSCATH EMBOLIZATION S&I           75894        8291.64
03200015   HB TRANSCATH INF THERAPY S&I            75896        8568.35
03230012   HB ANGIOGRAM THRU EXIST CATH            75898        3500.97
03200016   HB CATH EXCHANGE INTRAVASCULAR          75900        5127.11
03200173   HB CATH REMOVAL OBS MAT S&I             75901        984.95
03200174   HB CATH REMOVAL OBS MAT CV S&I          75902        843.55
03200175   HB IVC FILTER PLCMT PERQ S&I            75940        5476.97
04020071   HB IVUS NON-CORONARY INIT S&I           75945        1355.53
04020072   HB IVUS S&I (NOT CORONARY) ADDL         75946        677.76
03200176   HB REPAIR INFRARENAL AAA S&I            75952        1492.06
03200177   HB REPAIR PROST AORT/ILIAC SI           75953        596.09
03200178   HB REPAIR ILIAC ART ANYSM S&I           75954        3109.67
03200179   HB REPAIR DEC AORTA W SUB S&I           75956        3405.89
03200180   HB REPAIR DEC AORTA WO SUB S&I          75957        2918.29
03200220   HB PLCMT PROX EXT THOR AORTA            75958        1815.61
03200181                                         75960
           HB PLCMT TRANSCATH IV STENT S&I EACH VESS            7055.57
03200017   HB RETR INTRAVAS FOR BOD S&I            75961        6313.20
03200184   HB ANGIOPLASTY PERIPH ART S&I           75962        5885.33
03200018   HB ANGIOPLASTY PERIPH EA AD SI          75964        4008.07
03200187   HB PTA RENAL/VISCERAL ARTERY INIT       75966        6566.75
03230014   HB ANGIOPLASTY VENOUS ADL S&I           75968        6808.12
03230038   HB PTA RENAL/VISCERAL ARTERY ADDL       75968        6808.12
03200188   HB BIOPSY TRANSCATHERTER S&I            75970        4295.76
03200189   HB ANGIOPLASTY VENOUS S&I               75978        6989.75
03200190   HB DRAINAGE HEP/BILIARY S&I             75980        2503.83
03200191   HB CATH PLCMT BIL DRAIN S&I             75982        3521.69
03200192   HB CATH CHANGE BIL DRAIN S&I            75984        1726.10
03500014   HB CT DRAINAGE S&I                      75989        2030.85        2639.14
04020001   HB US DRAINAGE S&I                      75989        2030.85        2639.14



                                             31
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03200193   HB XR DRAINAGE S&I                      75989        2030.85        2639.14
03200238   HB XR DRAINAGE S&I IR                   75989        2030.85
03200197   HB FLUOROSCOPY 1HR/LESS                 76000        1588.36        2064.99
03200224   HB FLUOROSCOPY 1HR/LESS CL              76000        1588.36
03200239   HB FLUOROSCOPY 1HR/LESS IR              76000        1588.36
03200198   HB FLUOROSCOPY 1HR/MORE                 76001        2341.70
03200225   HB FLUOROSCOPY 1HR/MORE CL              76001        2341.70
03200019   HB XR ABSCESS/FISTULAGRM S&I            76080        948.38
03200229   HB XR ABSCESS/FISTULGRM S&I IR          76080        948.38
03200021   HB PATHOLOGY TISSUE XRAY                76098        532.70
03200202   HB XR SURGICAL SPECIMEN                 76098        532.70          692.39
03200204   HB XR TOMOGRAPHY SINGLE PLANE           76100        525.39          682.64
03500035   HB RECON 3D TECH WORKSTATN              76376        1679.78        2183.23
03500055   HB RECON 3D TECH WORKSTATN IR           76376        1679.78
03500036   HB RECON 3D INDPNDNT WRKSTN             76377        1679.78        2183.23
03500056   HB RECON 3D INDPNDNT WRKSTN IR          76377        1679.78
03500015   HB CAT SCAN FOLLOW-UP STUDY             76380        2216.14        2880.50
03500017   HB CT BRAIN LIMITED                     76380        2216.14        2880.50
03500016   HB CT LIMITED/FOLLOW-UP SCAN            76380        2216.14        2880.50
03520038   HB CT LIMITED/FOLLOW-UP SCAN CT         76380        2216.14        2880.50
03500039   HB CT UL PROC                           76497        2149.10        2793.83
06100123   HB MRI UL PROC ANGIO HEART              76498        3313.24        4307.95
06110008   HB MRI UL PROC FETAL SCAN               76498        3313.24        4307.95
06100062   HB MRI UL PROC MYELOMA BNE SVY          76498        3313.24        4307.95
03200022   HB CATH CHECK                           76499        1384.78
03200023   HB CATH INSERTION                       76499        1384.78
03200242   HB UNLISTED DXA FAT COMP ASMNT          76499        874.89         1137.36
04020010   HB US BRAIN W DOPPLER                   76506        725.31          943.51
04020002   HB US HEAD/NECK SOFT TISSUE             76536        1350.65        1756.58
04020004   HB US HEAD/NECK THYROID                 76536        1350.65        1756.58
04020014   HB US CHEST                             76604        1160.49        1507.90
04020019   HB U/S BREAST BILATERAL, LTD            76645        592.43
04020017   HB U/S BREAST UNILATERAL, LTD           76645        526.61
04020016   HB US BREAST BILATERAL                  76645        1229.97        1599.33
04020015   HB US BREAST UNILATERAL                 76645        876.46         1139.40
04020020   HB US ABDOMEN COMPLETE                  76700        1740.73        2262.46
04020022   HB US ABDOMEN LIMITED                   76705        1101.98        1432.33
04020023   HB US RETROPERITONEUM COMPLETE          76770        1229.97        1599.33
04020005   HB US RETROPERITONEUM LIMITED           76775        1005.68        1306.77
04020006   HB US TRANSPLANTED KIDNEY               76776        1314.08        1707.82
04020026   HB US SPINAL CANAL                      76800        1160.49        1507.90
04020027   HB US OB < 14 WKS SINGLE FETUS          76801        739.93



                                             32
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
04020028   HB OB US < 14 WKS, ADD'L FETUS         76802        304.75
04020029   HB ULTRASOUND OB >14 WEEKS             76805        802.10
04020030   HB US OB > 14 WKS ADD'L GEST           76810        720.43
04020009   HB U/S OB W/ DETAIL FETAL EXAM         76811        1466.46
04020011   HB U/S OB, ADDL GESTATION              76812        1520.09
04020012   HB OB U/S NUCHAL MEAS, 1 GEST          76813        470.53
04020013   HB U/S OB NUCHAL, ADDL GESTATION       76814        319.38
04020035   HB ULTRND,PREG/UTERUS,LMTD             76815        752.12
04020021   HB U/S OB FOLLOW UP PER FETUS          76816        620.47          806.98
04020069   HB US PELVIS TRANSVAG PREGNANT         76817        1004.46        1305.55
04020074   HB FETAL BIOPHYS PROF W NONSTRESS      76818        2361.20
04020025   HB FETAL BIOPH PROFILE W/O NST         76819        1398.19
04020042   HB UMBILICAL ARTERY DOPPLER            76820        549.77
04020043   HB FETAL MID CEREBRAL ARTERY DPLR      76821        552.21
04020044   HB FETAL ECHO COMPLETE                 76825        1179.90
04020045   HB FETAL ECHO FOLLOW UP                76826        737.50
04020046   HB FETAL ECHO COMPLETE DOPPLER         76827        590.00
04020047   HB FETAL ECHO FOLLOW UP DOPPLER        76828        426.65
04020031   HB US PELVIS TRANSVAGINAL              76830        1004.76        1334.73
04020050   HB US PELVIS HYSTEROSONOGRAM           76831        1376.25
04020033   HB ULTRASOUND, PELVIC NON-OB COM.      76856        1367.72
04020037   HB US PELVIS TRANSABDOMEN COM          76856        1367.72        1778.52
04020038   HB ULTRASOUND, BLADDER                 76857        752.12
04020073   HB ULTRASOUND, BLADDER LIMITED         76857        752.12
04020055   HB ULTRASOUND, FOLLICLE                76857        752.12
04020034   HB US PELVIS LIMITED                   76857        752.12          978.86
04020056   HB US SCROTUM & TESTICLE(S)            76870        1438.42        1869.95
04020057   HB US TRANSRECTAL                      76872        1160.49        1507.90
04020058   HB US EXTRM NON-VASC COMP              76881        1197.06        1555.44
04020079   HB US EXTRM NON-VASC LTD UNI           76882        752.12          977.77
04020078   HB U/S GUID ENDO BIOPSY S&I            76932        979.44
04020059   HB U/S GUID PSEUDOANEURYSM REPR        76936        1126.36
04020039   HB U/S GUID VASCULAR ACCESS            76937        803.32         1044.68
04020080   HB U/S GUID VASCULAR ACCESS CL         76937        803.32
04020061   HB VASCULAR ACCESS GUIDANCE            76937        803.32         1044.68
04020082   HB VASCULAR ACCESS GUIDANCE IR         76937        803.32
04020067   HB US ABLATION                         76940        736.74          958.13
04020040   HB US GUIDE IUT/CORDOCENTESIS          76941        553.43
04020053   HB U/S GUIDANCE                        76942        1355.53
03200001   HB U/S GUIDANCE FOR NEEDLE PLACEM      76942        1355.53        1762.67
04020048   HB ULTRASOUND GUIDANCE                 76942        1355.53        1762.67
04020041   HB US PLCMT NEEDLE                     76942        1355.53        1762.67



                                            33
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
04020081   HB US PLCMT NEEDLE IR                   76942        1355.53
04020070   HB PRENATAL CVS GUIDANCE                76945        403.49
04020062   HB US GUIDE FOR AMNIOCENTESIS           76946        664.36
04020063   HB US INTRAOPERATIVE GUIDANCE           76998        773.59         1005.68
04020065   HB ULTRASOUND - SOFT TISSUE             76999        725.31
04020064   HB US UNLISTED PROCEDURE                76999        725.31
03200024   HB PLCMT VEIN DEVICE                    77001        691.17          898.40
03200223   HB PLCMT VEIN DEVICE CL                 77001        691.17
03200230   HB PLCMT VEIN DEVICE IR                 77001        691.17
03200243   HB PLCMENT NEEDLE IR                    77002        1012.99
03200027   HB PLCMT NEEDLE                         77002        1012.99
03200048   HB XR FLUORO PLCMT NDLE SPN             77003        849.64         1104.41
03200231   HB XR FLUORO PLCMT NDLE SPN IR          77003        849.64
03500042   HB CT STEREOTACTIC LOCALIZATN           77011        2247.84        2921.94
03590001   HB CT STEREOTACTIC LOCALIZATN           77011        2247.84        2921.94
03500020   HB CT STEREOTACTIC RAD                  77011        2247.84
03500027   HB CT PLCMT NEEDLE S&I                  77012        3340.06
03500037   HB CT ABLATION                          77013        2868.31        3728.92
03500052   HB CT CONE BEAM                         77014        3271.80
03330001   HB CT RAD THERAPY                       77014        3271.80
06100088   HB MRI PLCMT NEEDLE S&I                 77021        3725.26        4842.84
03200058   HB MAMMO STEREOTACTIC LOC S&I           77031        3821.57
03200059   HB MAMMO PLCMT NEEDLE S&I               77032        1305.55        1696.85
04010001   HB MAMMO DIAGNOSTIC CAD                 77051        197.48          256.72
04030001   HB MAMMO SCREENING CAD                  77052        168.22          218.69
03200092   HB MAMMO DUCTOGRAM SINGLE S&I           77053        839.89
04030002   HB MAMMO SCREENING BILATERAL            77057        351.07
06100089   HB MRI BREAST WO/W CONT UNILAT*         77058        1700.97        2211.27
06100096   HB MRI BREAST WO CONT BILAT             77059        3554.60        4620.99
06100094   HB MRI BREAST WO/W CONT BILAT           77059        3949.56        5134.43
03200106   HB XR BONE SURVEY AGE                   77072        354.73          460.78
03500038   HB CT BONE SURVEY SCANOGRAM             77073        905.72         1177.55
03200107   HB XR BONE SURVEY LENGTH                77073        905.72         1177.55
03200130   HB XR BONE SURVEY OSSEOUS LTD           77074        906.94         1178.77
03200131   HB BONE MULTI MYELOMA                   77075        1917.49        2492.86
03200211   HB XR BONE SURVEY COMPLETE              77075        1917.49        2492.86
03200156   HB XR BONE SURVEY METASTASIS            77075        1917.49        2492.86
03200171   HB XR BONE SURVEY CHILD                 77076        682.64          887.43
03500040   HB CT BONE DENSITY AXIAL SKEL           77078        1173.90        1526.07
03200182   HB DXA BONE DEN AXIAL SKELETON          77080        866.71         1126.36
03200172   HB DXA BONE DEN PERIPH SKEL             77081        698.49
03330003   HB RT SIMULATION SIMPLE                 77280        866.71



                                             34
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03330004   HB RT SIMULATION COMPLEX                 77290        2757.38
03330005   HB RT 3-D SIMULATION                     77295        8112.45
03330002   HB RT 3-D SIMULATION - GK                77295        9583.78
03330006   HB RT 3-D SIMULATION - IGRT              77295        6472.89
03330007   HB RT 3-D SIMULATION - LSRS              77295        6472.89
03330010   HB RT DOSIMETRY BASIC                    77300        1144.64
03330009   HB RT DOSIMETRY BASIC - GK               77300        2395.34
03330014   HB RT DOSIMETRY BASIC - LSRS             77300        1437.20
03330073   HB RT DOSIMETRY BASIC HD                 77300        1013.04
03330008   HB RT DOSIMETRY BASIC IGRT               77300        1437.20
03330011   HB RT IMRT TX PLANNING                   77301        7062.89
03330012   HB RT TELE-ISODOSE TX PLAN SIMPLE        77305        1293.36
03330013   HB RT TELE-ISODOSE TX PLAN INTERM        77310        1543.25
03330016   HB RT TELE-ISO TX PLN CPX IGRT           77315        2875.62
03330015   HB RT TELE-ISODOSE TX PLAN COMPLX        77315        993.49
03330017   HB RT TELE-ISODOSE TX PLN CPX GK         77315        4025.14
03330022   HB RT TELE-ISODOSE TX PLN CPX SRS        77315        1988.19
03330018   HB RT TOTL BDY IRRIDATION TX PLAN        77321        1289.70
03330019   HB RT BRACHY ISODOSE TX PLAN SM          77326        1312.86
03330076   HB BRACHYTHERAPY ISODOSE PLAN            77327        2133.25
03420001   HB RT BRACHY-ISODOSE TX PLAN CMPX        77328        2981.67
03330020   HB RT INVIVO DOSIMTRY DIODE/TLD          77331        1140.98
03330021   HB RT TX DEVICE SIMPLE                   77332        833.80
03330026   HB RT TX DEVICE COMPLEX - BLOCKS         77334        2213.70
03330024   HB RT TX DEVICE COMPLEX - MASKS          77334        2213.70
03330075   HB RT TX DEVICE COMPLX: HELMET           77334        1959.49
03330023   HB RT TX DEVICE CPX - GK FRAME           77334        2875.62
03330025   HB RT TX DEVICE CPX - LSRS FRAME         77334        958.13
03330030   HB RT CONT PHYSICS CNSLT - GK            77336        1724.89
03330027   HB RT CONTIN PHYSICS CNSLT - IGRT        77336        1149.52
03330029   HB RT CONTIN PHYSICS CNSLT - LSRS        77336        1149.52
03330072   HB RT CONTINU PHYSICS CNSLT HD           77336        842.06
03330028   HB RT CONTINUING PHYSICS CNSLT           77336        952.04
03330077   HB DESIGN MLC FOR IMRT                   77338        2207.99
03330059   HB RT SPCL RAD PHYS CSULT GK             77370        6708.16
03330060   HB RT SPCL RAD PHYS CSULT IGRT           77370        4791.89
03330058   HB RT SPCL RAD PHYS CSULT SRS/SRT        77370        2303.91
03330061   HB RT SPECIAL PHYSIC CONSULT TSET        77370        3074.32
03330062   HB RT SPECIAL PHYSICS CONSULT HDR        77370        2303.91
03330031   HB RT SPECIAL PHYSICS CONSULT TBI        77370        2303.91
03330063   HB RT GK TREATMENT DELIVERY              77371       44566.64
03330032   HB RT SUPERFICIAL                        77401        626.57



                                              35
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03330033   HB DAILY TRMT SMPL <5MEV                 77402        1089.79
03330034   HB RT DLY TX SIMPL 6 - 10 MEV            77403        741.15
03330035   HB RT DLY TX SIMPL 11 - 19 MEV           77404        1111.73
03330036   HB RT DAILY TX SIM > 20 MEV              77406        927.66
03330037   HB DAILY TRMT INTERM <5MEV               77407        1056.87
03330038   HB RT DLY TX INTERM 6-10 MEV             77408        1111.73
03330039   HB RT DLY TX INTERM 11-19 MEV            77409        1111.73
03330040   HB RT DLY TX INTERM > 20 MEV             77411        1056.87
03330041   HB RT DAILY TX CMPLX <5 MEV              77412        1534.72
03330043   HB RT DAILY TX COMPLEX /TSET             77413        2375.83
03330042   HB RT DLY TX CMPLX 6 - 10 MEV            77413        1306.77
03330044   HB RT DLY TX CMPLX 11 - 19 MEV           77414        1543.25
03330045   HB RT DLY TX CMPX > 20 MEV               77416        1528.63
03330046   HB RT PORT FILMS                         77417        248.68
03330047   HB RT IMRT TX DELIVERY                   77418        4076.34
03330078   HB CALYPSO VERIFICATION IMAGES           77421        815.51
03330068   HB STEREO X-RAY GUID RT DELIVERY         77421        815.51
03330064   HB RT SRS DELIVERY SINGLE FRACTIO        77432       13131.07
03330048   HB RT SPECIAL TX PROCEDURE               77470        4372.55
03330050   HB RT SPECIAL TX PROCEDURE - GK          77470        4791.89
03330051   HB RT SPECIAL TX PROCEDURE - IGRT        77470        3162.09
03330049   HB RT SPECIAL TX PROCEDURE - LSRS        77470        3354.69
03330074   HB RT SPECIAL TX PROCEDURE HD            77470        3869.24
03420002   HB RT INTRACAVITARY RAD ELEM SIM         77761        692.18
03330052   HB RT INTRACAVITARY RAD ELEM INT         77762        1360.40
03330053   HB RT INTRACAVITARY RAD ELEM CPX         77763        1626.15
03330054   HB RT INTERSTITIAL RAD ELEM SIM          77776        787.58
03330055   HB RT INTERSTITIAL RAD ELEM INT          77777        1583.48
03420003   HB RT INTERSTITIAL RAD ELEM CMPX         77778        4222.62
03330070   HB HDR BRACHYTX, 1 CHANNEL               77785        6580.16
03330069   HB HDR BRACHYTX, 2-12 CHANNEL            77786        8830.44
03330071   HB HDR BRACHYTX OVER 12 CHAN             77787        9870.24
03330057   HB RT SURFACE APPLICATOR RAD ELEM        77789        331.57
03420007   HB NM RAD DOSE HANDLING/LOADING          77790        1779.74
03420008   HB RT BRACHY ISOTOPE HANDLING            77790        1779.74
03410001   HB NM THYROID UPTAKE ONLY                78001        598.53            777.72
03410002   HB NM THYROID UPTAKE & SCAN              78007        1734.64           2255.15
03410003   HB NM THYROID SCAN                       78010        1133.67           1473.77
03410004   HB NM THYROID METS SCAN LTD              78015        1253.13           1629.07
03400002   HB NM THYROID METS SCAN ADL              78016        1245.82           1619.56
03410005   HB NM THYRD METS SCAN WHO BODY           78018        2447.75       $    3,182.81
03410006   HB NM PARATHYROID SCAN                   78070        2205.17           2867.09



                                              36
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
03410062   HB NM BONE MARROW SCAN LIMITED         78102        1495.71           1945.52
03410007   HB NM BONE MARROW SCAN MULT            78103        1779.74           2313.66
03400003   HB NM BONE MARROW SCAN WHO BDY         78104        1503.03           1953.94
03410008   HB NM SPLEEN SCAN                      78185        1156.83           1503.89
03410009   HB NM LYMPHATICS/NODES SCAN            78195        3499.75       $    4,549.31
03410010   HB NM UL BONE MARROW SPECT             78199        1779.74           2313.66
03400004   HB NM LIVER SCAN STATIC ONLY           78201        977.64            1271.42
03410011   HB NM LIVER SCAN W VAS FLOW            78202        1843.13           2396.07
03410012   HB NM LIVER SPECT                      78205        1433.54           1750.48
03410013   HB NM LIVER SPECT W VAS FLOW           78206        3148.68       $    4,093.40
03410014   HB NM LIVER/SPLEEN SCAN STATIC         78215        1902.86           2473.72
03410015   HB NM LIVER/SPLEEN SCAN VAS/FL         78216        1750.48           2274.65
03410016   HB NM HEPATOBILIARY SCAN               78223        2099.12           2729.34
03400013   HB NM SALIVARY GLAND IMAGING           78230        1442.08           1874.82
03410017   HB NM GASTRIC EMPTYING STUDY           78264        2753.72            #N/A
03410018   HB NM ACUTE GI BLEED STUDY             78278        2190.54           2847.71
03410061   HB NM INTESTINE SCAN                   78290        1245.82           1620.05
03410021   HB NM PERITONEAL SHUNT PATENCY         78291        1835.81           2386.80
03410022   HB NM BONE/JNT SCAN LIMITED            78300        936.19            1217.78
03410023   HB NM BONE/JNT SCAN MULT AREAS         78305        2670.83            #N/A
03410024   HB NM BONE/JNT SCAN WHOLE BODY         78306        2958.51            #N/A
03410025   HB NM BONE/JNT SCAN 3-PHASE            78315        2915.85            #N/A
03410026   HB NM BONE/JNT SPECT                   78320        2302.69           2992.65
03410069   HB NM HEART SPECT SNGL RST/STR         78451        4354.27           5661.04
03410070   HB NM HEART SPECT MULT RST/STR         78452        4037.33           5249.01
03410071   HB NM HEART PLANR SNGL RST/STR         78453        4354.27           5661.04
03410072   HB NM HEART PLANR MULT RST/STR         78454        3763.35           4893.07
04040001   HB NM PET CARDIAC METABOLIC            78459        4004.88           5206.35
03410031   HB NM CARDIAC INFARCT SPECT            78469        1464.02           1904.08
03410063   HB NM CARDIAC MUGA WM/EF SINGL         78472        2762.25           3589.96
03400005   HB NM CARDIAC MUGA WM/EF MULT          78473        2130.81           2769.57
03400006   HB NM CARDIAC 1ST PASS SINGLE          78481        2046.70           2661.08
04040002   HB NM PET CARDIAC PERF SINGLE          78491        5163.68           6711.81
04040003   HB NM PET CARDIAC PERF MULT            78492       16644.23           21637.49
03410034   HB NM CARDIAC MUGA WM/EF SPECT         78494        2063.77           2681.80
03410068   HB NM MISC CARDIOVASCULAR PROC         78499        1281.74           1666.27
03410035   HB NM LUNG PERFUSION SCAN              78580        2123.50           2759.82
03400007   HB NM LUNG VENT/PERF SCAN SING         78584        2631.82            #N/A
03410036   HB NM LUNG VENT/PERF W RB&WASH         78585        2455.07           3191.34
03400008   HB NM LUNG VENT GAS SINGLE             78586        1320.18           1716.24
03410037   HB NM LUNG VENT GAS MULT               78587        1271.42           1652.96
03410038   HB NM LUNG VENT/PERF GAS               78588        3703.32            #N/A



                                            37
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
03400009   HB NM LUNG VENT GAS 1-BRTH             78591        1271.42        1652.85
03410039   HB NM LUNG VENT GAS W RB/WO SG         78593        1271.42        1652.96
03400010   HB NM LUNG VENT GAS W RB/WO MU         78594        826.11         1073.94
03410040   HB NM LUNG VENT/PERF QUANT             78596        3949.56        5134.43
03410041   HB NM UL RESPIRATORY                   78599        977.64         1271.42
03410065   HB NM BRAIN SCAN 4VW/LESS              78600        813.07         1056.87
03410042   HB NM BRAIN SCAN W VAS FLOW            78601        1315.30        1709.90
03410067   HB NM BRAIN SCAN 4VWS/MORE             78605        1251.91        1627.37
03410043   HB NM BRAIN SPECT                      78607        3349.81         #N/A
04040004   HB NM PET BRAIN METABOLIC EVAL         78608        9797.10       12736.24
03410044   HB NM CSF FLOW/CISTERNOGRAM            78630        2260.03        2939.01
03410045   HB NM CSF FLOW/SHUNT EVAL              78645        1880.92        2445.20
03400011   HB NM CSF LEAK SCAN                    78650        1126.36        1464.26
03410046   HB NM KIDNEY SCAN MORPHOLOGY           78700        1780.96        2314.88
03410047   HB NM KIDNEY SCAN W FLOW               78701        1940.65        2523.33
03410048   HB NM KIDNEY SCAN FLOW/FUNCT           78707        2865.87         #N/A
03410049   HB NM KIDNEY SPECT                     78710        1780.96        2314.88
03410050   HB NM KIDNEY FUNCTION STUDY            78725        577.81          752.12
03410073   HB NM CYSTOGRAM RESIDUAL STUDY         78730        785.06         1020.58
03410051   HB NM CYSTOGRAM REFLUX STUDY           78740        2311.22        3004.59
03410052   HB NM TESTICULAR SCAN W VAS FL         78761        1139.77        1481.70
03410053   HB NM TUMOR SCAN LIMITED AREA          78800        1095.88        1425.01
03410054   HB NM TUMOR SCAN MULT AREAS            78801        2015.01        2619.63
03410055   HB NM TUMOR SCAN WHOLE BODY            78802        3024.34         #N/A
03410056   HB NM TUMOR SPECT                      78803        3024.34         #N/A
03410057   HB NM TUMOR SCAN 2DAYS/MORE            78804        2007.69        2608.66
03410058   HB NM INFLAMM SCAN LTD AREA            78805        2016.23        2620.85
03410059   HB NM INFLAMM SCAN WHOLE BODY          78806        2625.73        3414.42
03410060   HB NM INFLAMM SPECT                    78807        2100.34        2730.56
04040005   HB NM PET LIMITED AREA                 78811        9410.68       12233.88
04040006   HB NM PET SKULL-THIGH                  78812        7058.01        9175.41
04040007   HB NM PET/CT LIMITED AREA              78814       10228.63       13297.22
04040008   HB NM PET/CT SKULL-THIGH               78815       10852.76       14108.71
04040009   HB NM PET/CT WHOLE BODY                78816        9087.65       11813.94
03420010   HB RADIOPHARM TX ORAL                  79005        1888.23        2453.85
03420011   HB NM RADIOPHARM THERAPY, IV           79101        1460.36        1897.98
03420012   HB RADIOPHARM TX INTRACAVTY            79200        1500.59        1950.77
03420014   HB PHARM MONOCLONAL THERAPY            79403        1213.10        1577.03
03420013   HB RADIOPHARM TX INTRAARTERIAL         79445        1678.56
03010001   HB LAB BASIC METABOLIC PANEL POC       80047        475.17
03010004   HB LAB BASIC METABOLIC PANEL           80048        456.89
03011926   HB LAB BASIC METABOLIC PANEL           80048         68.46



                                            38
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
03011982   HB LAB BASIC METABOLIC PANEL*              80048        393.23
03010002   HB LAB ELECTROLYTES                        80051        224.70
03011981   HB LAB ELECTROLYTES*                       80051        224.70
03010006   HB LAB COMP METABOLIC PANEL                80053        786.45
03010003   HB CHOLESTECH - LIPID PANEL                80061        600.91
03000084   HB LAB LIPID PANEL                         80061        440.84
03090146   HB LAB LIPID PANEL*                        80061         17.36
03000087   HB LAB RENAL FUNCTION PANEL                80069        593.12
03000259   HB LAB RENAL FUNCTION PANEL*               80069        593.12
03010005   HB LAB ACUTE HEPATITIS PANEL               80074        860.19
03011900   HB HEPATIC FUNCTION PANEL A                80076        393.23
03011881   HB LAB HEPATIC FUNCTION PANEL              80076        393.23
03091996   HB DRGU DRG SCN QUAL/MULTI                 80100         4.66
03091847   HB SULFONYLUREA HYPOGLYCEMICS              80100         88.10
03091435   HB TRICYCLIC ANTIDEPRESS SCR               80100         38.72
03091992   HB DRGU DRG SCN SINGLE                     80101         4.41
03090839   HB METHAQUALONE                            80102         9.73
03010021   HB LAB AMIKACIN                            80150        298.23
03090489   HB LAB AMITRIPTYLINE         #             80152         14.00
03091670   HB ALPRAZOLAM (XANTAX)                     80154         50.08
03091666   HB BENZODIAZEPINE CONFIRMATION             80154         89.02
03090047   HB BENZODIAZEPINE, SERUM                   80154         34.65
03091848   HB CHLORDIAZEPOXIDE (LIBRIUM)              80154         55.64
03090184   HB LAB CLONAZEPAM                          80154         16.00
03090652   HB LORAZEPAM (ATIVAN)                      80154         30.00
03091675   HB VALIUM (DIAZEPAM)                       80154         50.08
03010022   HB LAB CARBAMAZEPINE                       80156        446.23
03010023   HB LAB CYCLOSPORINE, MONOCLONAL            80158        418.41
03091396   HB LAB DESIPRAMINE                         80160         17.60
03091414   HB LAB DESIPRAMINE IN PKG                  80160         12.00
03000136   HB DIGOXIN                                 80162        506.32
03010025   HB LAB VALPROIC ACID                       80164        298.23
03091397   HB LAB DOXEPIN                             80166         16.40
03091429   HB ETHOSUXIMIDE                            80168         12.80
03010026   HB LAB GENTAMICIN                          80170        426.20
03090424   HB HALOPERIDOL                             80173         23.10
03090491   HB LAB IMIPRAMINE                          80174         12.00
03090502   HB LIDOCAINE                               80176         27.52
03010027   HB LAB LITHIUM                             80178        149.12
03090467   HB LAB NORTRIPTYLINE                       80182         15.36
03091413   HB LAB NORTRIPTYLINE IN PKG      #         80182         14.00
03090872   HB LAB MYSOLINE (PHENOBARBITAL)            80184         14.30



                                                39
  Charge
   Code                   Description                        CPT Code OP/Default Price   IP/ED Price
03010028   HB LAB PHENOB QN SE SC                             80184        637.63
03091011   HB LAB PHENOBARBITAL                               80184         6.54
03090516   HB PHENOBARBITAL                                   80184         7.50
03000160   HB LAB DILANTN QN SE SC                            80185        589.78
03090500   HB LAB PHENYTOIN, TOTAL                  #         80185         14.35
03090499   HB LAB PHENYTOIN, FREE               #             80186         12.85
03090871   HB LAB PRIMIDONE                                   80188         9.46
03091701   HB LAB PRIMIDONE                 *                 80188         20.70
03091430   HB PRIMIDONE                                       80188         10.00
03010030   HB LAB PRONESTYL & NAPA                            80192        597.57
03091894   HB PROCAINAMIDE + NAPA                             80192         21.35
03091698   HB LAB QUINIDINE                                   80194         16.00
03010031   HB LAB QUINIDN QN SE SC                            80194        589.78
03000168   HB LAB SIROLIMUS                                   80195        108.59
03091994   HB DRGU SALICYLATE                                 80196         2.27
03000169   HB LAB SALICYL QN SE SC                            80196        219.22
03010034   HB LAB FK506                                       80197        120.03
03000171   HB LAB THEOPHYLIN SE SC                            80198        386.14
03010036   HB LAB TOBRAMYCIN                                  80200        426.20
03090852   HB TOPIRAMATE                                      80201         50.08
03010037   HB LAB VANCOMYCIN                                  80202        450.68
03091599   HB AMIODARONE AND METABOLITE                       80299         18.15
03091432   HB BROMIDE                                         80299         36.40
03090956   HB CAFFEINE                                        80299         21.00
03091434   HB DIGITOXIN                                       80299         26.60
03091431   HB FELBAMATE                                       80299         20.80
03091185   HB GABAPENTIN                                      80299         21.50
03090393   HB LAB ANTIMICROBIAL, ISONIAZID                    80299        129.75
03090866   HB LAB BUPROPION                                   80299         49.00
03090466   HB LAB CLOMIPRAMINE+METABOLITE                     80299         9.60
03092031   HB LAB DEXAMETHASONE                               80299         80.00
03091788   HB LAB DISOPYRAMIDE                                80299         20.80
03090687   HB LAB DRUG QUANTITATION NES DOXR                  80299         14.40
03090688   HB LAB DRUG QUANTITATION NES MSUX                  80299         11.00
03092010   HB LAB EVEROLIMUS LEVEL                            80299         99.20
03091408   HB LAB FLECAINIDE            #                     80299         20.80
03090505   HB LAB LAMOTRIGINE               #                 80299         24.00
03010038   HB LAB METHOTREXATE                                80299        291.04
03090864   HB LAB METHOTREXATE                      *         80299         55.45
03090496   HB LAB METHYPRYLON                                 80299         48.48
03090685   HB LAB MYCOPHENOLIC ACID                           80299         32.00
03090483   HB LAB PROTRIPTYLINE                 #             80299         30.10



                                                        40
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
03090675   HB LAB SULFONAMIDES                     80299         19.95
03090484   HB LAB TRAZODONE             #          80299         20.80
03091956   HB LACOSAMIDE LEVEL                     80299        157.00
03091099   HB METHYLPHENIDATE (RITALIN)            80299         39.00
03091998   HB OCTREOTIDE                           80299        175.00
03011894   HB OKT3 EIA TEST                        80299        302.68
03091683   HB OLANZAPINE                           80299         73.60
03090020   HB PROPAFENONE (RHYTHMOL)               80299         25.08
03090021   HB PROZAC (FLUOXETINE)                  80299         20.05
03091690   HB TOCAINIDE                            80299         44.51
03090853   HB TRILEPTAL                            80299         55.64
03091882   HB VORICONAZOLE LEVEL                   80299        183.00
03091957   HB ZONISAMIDE LEVEL                     80299         44.10
03091551   HB MICROSAT PCR CLIN CONS               80500         24.00
80016040   HB PROF CEL MORPH PLRAL FLD SM          80500
80016061   HB PROF CEL MORPH-CSF CYTOSPIN          80500
80016041   HB PROF CEL MRPH PERITN FLD SM          80500
80016064   HB PROF CELL MORPH -OTHER               80500
80000230   HB PROF CLINICAL CONSULT                80500
80000325   HB PROF CLINICAL CONSULT                80500
80016102   HB PROF CLINICAL TEST LIMITED           80500
80000286   HB PROF CONSULT, COAG LIMITED           80500
80016104   HB PROF LIMITED CA                      80500
80000287   HB PROF PATH CONSULT, HEMOGLOBIN        80500
03100011   HB LAB CFADD CONSULT CF DX              80502        303.03
03000232   HB LAB MOLECULAR WARFARIN CONS          80502        303.03
03100006   HB LAB PROF. COMPR CONSULT15;17         80502        303.03
03000223   HB MOLECULAR UGT1A1 CONS                80502        303.03
80016103   HB PROF CLINICAL TEST COMPREH           80502
80016358   HB PROF COMP HGB THAL CONSULT           80502
80000281   HB PROF COMPLEX CLINICAL CONS           80502
03000225   HB PROF COMPR CONS CT-B/SO              80502        303.03
03000228   HB PROF COMPR CONSULT IGHP              80502        303.03
03000222   HB PROF COMPR CONSULT JAK2              80502        303.03
03000227   HB PROF COMPR CONSULT JH/SO             80502        303.03
03000229   HB PROF COMPR CONSULT JK/SO             80502        303.03
03000230   HB PROF COMPR CONSULT TCR-G             80502        303.03
80000285   HB PROF CONSULT, COAG COMPR             80502
80016042   HB PROF LE PREP INTERPRETATION          80502
80000343   HB PROF MOLECULAR UGT1A1 CONSULT        80502
80000341   HB PROF MOLECULAR WARFARIN CONS         80502
03000221   HB PROF. COMPR CONSULT P9 22            80502        303.03



                                             41
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03070001   HB LAB URINE MICRO SED                  81000        225.90
03070026   HB LAB URINALYSIS W/ MICRO              81001        181.48
03070002   HB LAB URINALYSIS W/ MICROSCOPY         81001        181.47
03070003   HB LAB URINALYSIS                       81002        150.23
03070025   HB LAB POC URINE CHEMISTRY              81003        151.34
03070004   HB LAB SPECIFIC GRAV UR                 81003         67.88
03070005   HB LAB URINALYSIS; AUTO W/O MICRO       81003        151.34
03070014   HB URINALYSIS AUTO W/O MICRO            81003        151.34
03070029   HB URINE DIRECT BACT EXAM               81007         20.75
03070028   HB LAB DYSMORPHIC RED CELLS UR          81015        109.87
03070022   HB LAB MICRO, URINE LYMPHOCYTE          81015        120.18
03070008   HB LAB PREGNANCY TEST URINE             81025        298.23
03070027   HB LAB PREGNANCY TEST URINE*            81025        298.23
03011921   HB LAB URINE PREGNANCY TEST             81025        298.23
03010505   HB ACETAMINOPHEN                        82003        327.16
03091993   HB DRGU ACETAMINOPHEN                   82003         6.49
03011877   HB LAB ACETOACETI BL ER                 82009        163.58
03011980   HB LAB ACETOACETI BL ER*                82009        163.58
03090522   HB BETA-HYDROXYBUTERIC ACID             82010         18.24
03091753   HB ACETYLCHOLINESTERASE                 82013         59.50
03091557   HB ACYLCARNITINE PROF                   82017        140.00
03091789   HB LAB ACTH                             82024         30.87
03090873   HB LAB ACTH HIGHLY SENSITIVE            82024         89.00
03090167   HB LAB CYCLIC AMP (P)                   82030         23.75
03090168   HB LAB CYCLIC AMP (U)                   82030         21.50
03091132   HB LAB ALBUMIN                          82040         3.80
03010041   HB LAB ALBUMIN, SERUM - ER              82040        283.55
03011979   HB LAB ALBUMIN, SERUM - ER*             82040        283.55
03091123   HB T4PP - SERUM ALBUMIN                 82040         10.74
03010043   HB LAB ALBUMIN FLD                      82042        294.89
03010045   HB LAB URN MICROALBUMIN, RANDOM         82043        100.15
03010044   HB LAB URN MICROALBUMIN, TIMED          82043        100.15
03091696   HB ALCOHOL (ETHANOL)                    82055         6.46
03091695   HB LAB ALCOHOL (ETHANOL)                82055         4.55
03010048   HB LAB ETHANOL QUAN ER                  82055        418.41
03010527   HB LAB ETHANOL QUAN SC                  82055        418.41
03010047   HB LAB ETHANOL URN                      82055        418.41
03091724   HB ALDOLASE                             82085         18.00
03011902   HB LAB ALDOLASE                         82085        111.28
03090879   HB ALDOSTERONE                          82088         9.78
03091117   HB URN ALDOSTERONE                      82088         22.05
03090731   HB ALPHA 1 ANTITRYPSIN, STOOL           82103         19.30



                                             42
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
03010538   HB LAB ALPHA ANTI TRYPS                  82103        319.37
03090706   HB LAB ALPHA-1-ANTITRYPSIN TOTAL         82103         15.94
03090086   HB LAB A1 ANTITRYP PHENO                 82104         22.00
03090707   HB LAB ALPHA-1-ANTITRYPSIN PHNTYP        82104         17.14
03010050   HB LAB ALPHA FETOPROT                    82105        248.15
03010051   HB ALPHA FETO PROTEIN AMNIOTIC FL        82106        135.72
03091165   HB LAB AMNIO FLD AFP W/REF               82106         30.00
03091436   HB ALUMINUM, URINE                       82108         12.80
03091419   HB LAB ALUMINUM, SERUM       #           82108         12.80
03091189   HB AMINO ACID SCREEN                     82128         27.35
03091437   HB CYSTINE, URINE                        82131         70.00
03090185   HB TRYPTOPHAN                            82131        102.60
03091807   HB URINE CYSTINE                         82131         64.00
03091183   HB LAB AMINOLEVULINIC ACID               82135         37.44
03091188   HB LAB GLUTAMINE CSF                     82136         66.00
03091757   HB AMINO ACIDS QUANT URINE               82139         96.00
03091115   HB AMINO ACIDS, CSF                      82139        101.30
03090084   HB AMINO ACIDS, PLASMA                   82139         90.50
03091867   HB AMINO ACIDS, QN, PLASMA               82139         96.00
03010568   HB LAB AMMONIA BL                        82140        248.15
03010052   HB LAB AMMONIA BL ER                     82140        248.15
03010570   HB LAB AMINO FL SCAN SC                  82143        787.86
80000348   HB PROF AMNIO FL SCAN ST                 82143
03091663   HB AMPHETAMINE CONFIRMATION              82145         25.00
03091672   HB AMPHETAMINE SCREEN                    82145         25.00
03011888   HB LAB AMYLASE FL SC                     82150        291.04
03010057   HB LAB AMYLASE UR     SC                 82150        291.04
03010054   HB LAB ANYLASE SE                        82150        291.04
03011985   HB LAB ANYLASE SE*                       82150        291.04
03090525   HB PANCREATIC AMYLASE                    82150         8.96
03091438   HB SALIVARY AMYLASE                      82150         8.96
03091439   HB ANDROSTANEDIOL GLUCURONID             82154         25.90
03091440   HB ANDROSTENEDIONE                       82157         37.12
03091856   HB ANGIOTENSIN CONVERT ENZ CSF           82164         19.05
03091441   HB ANGIOTENSIN CONVERT ENZYM             82164         13.00
03010586   HB LAB APOLIPOPROT A1                    82172        274.86
03010059   HB LAB APOLIPOPROT B                     82172        274.86
03090530   HB ARSENIC                               82175         16.00
03091443   HB ARSENIC, BLOOD                        82175         14.20
03091866   HB ARSENIC, FRACTIONATED URINE           82175        126.00
03091442   HB ARSENIC,URINE                         82175         22.05
03090533   HB URN ARSENIC                           82175         17.24



                                              43
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03091406   HB LAB VITAMIN C             #          82180         27.52
03091671   HB AMOBARBITAL                          82205         44.51
03091664   HB BARBITURATE CONFIRMATION             82205         89.02
03090830   HB BARBITURATES, IDENTIFICATION         82205        122.41
03091673   HB BUTABARBITAL                         82205         25.00
03091674   HB BUTALBITAL                           82205         44.51
03090870   HB LAB MEPHOBARBITAL                    82205         25.00
03091094   HB MEPHOBARBITAL                        82205         13.00
03091444   HB PENTOBARBITAL                        82205         18.20
03090843   HB SECOBARBITAL                         82205         44.51
03010060   HB LAB BETA-2 MICROGLOBULIN             82232        334.95
03091445   HB URN B-2-MICROGLOBULIN                82232         12.80
03010061   HB LAB BILIRU TOTAL ER                  82247        238.61
03010063   HB LAB BILIRU TOTAL SC                  82247        238.61
03010064   HB LAB BILIRUBIN TOT CSF                82247        238.61
03010629   HB LAB FLUID BILIRUBIN, TOTAL           82247        238.61
03010065   HB LAB BILIRU FRAC ST                   82248        245.93
03010632   HB LAB BILIRUBIN, DIRECT                82248        238.61
03090934   HB LAB BIOTINIDASE                      82261         14.50
03010068   HB LAB OCCULT BLOOD FEE                 82270         93.09
03010067   HB LAB POC OCCULT BLOOD                 82270         96.81
03010069   HB LAB OCCULT BLOOD, GASTRIC            82271         90.14
03010635   HB LAB OCCULT BLOOD FE                  82272         96.81
03010071   HB LAB OCCULT BLOOD (AB)                82274        160.24
03091446   HB CADMIUM, BLOOD                       82300         16.00
03091447   HB URN CADMIUM                          82300         16.00
03092016   HB LAB VITAMIN D: D2+D3                 82306         41.60
03091448   HB VIT D: 25, HIDROXY                   82306         15.00
03012046   HB VIT D:25-HYDROXY                     82306        235.24
03091179   HB VITAMIN D: 25-HYDROXY                82306         56.00
03090875   HB CALCITONIN                           82308         22.00
03010648   HB LAB CALCIUM CSF                      82310        238.61
03010647   HB LAB CALCIUM FL     SC                82310        238.61
03010076   HB LAB CALCIUM SE       AU              82310        238.61
03010073   HB LAB CALCIUM, FREE                    82310        248.15
03091449   HB CALCIUM, IONIZED                     82330         9.60
03011974   HB LAB CALCIUM, FREE*                   82330        248.15
03011901   HB LAB CALCIUM, FREE**                  82330        238.61
03010079   HB LAB IONIZED CALCIUM                  82330        248.15
03010655   HB LAB CALCIUM UR       AU              82340        248.15
03090540   HB URINE CALCIUM                        82340         5.12
03090541   HB STONE ANALYSIS                       82365         14.00



                                             44
  Charge
   Code                  Description                    CPT Code OP/Default Price   IP/ED Price
03090732   HB CARBOHYDRATE DEF TRNSFRN                   82373         43.70
03010085   HB CARBON DIOXIDE (BICARBONATE)               82374        238.61
03010663   HB LAB BICARB-CO2 FL AU                       82374        238.61
03010082   HB LAB BICARB-CO2 SE AU                       82374        238.61
03010081   HB LAB CARBON DIOXIDE BICARBONATE             82374        238.61
03011930   HB LAB CARBON DIOXIDE, SERUM                  82374         38.39
03091450   HB LAB CARBOXYHEMOGLOBIN                      82375         41.77
03010086   HB PF CO OXIMETRY                             82375        533.03
03010087   HB LAB CARCINOEMB AN SE                       82378        506.32
03091731   HB LAB CSF CEA                                82378         42.00
03090914   HB LAB FLD CEA PERICARDIAL                    82378         42.00
03091732   HB LAB FLD CEA PERITONEAL                     82378         42.00
03090916   HB LAB FLD CEA PLEURAL                        82378         42.00
03090700   HB LAB FLD CEA, PANCREATIC                    82378         15.00
03090494   HB LAB CARNITINE, TOTAL         #             82379         27.56
03090498   HB LAB CAROTENE             #                 82380         14.40
03092025   HB LAB CAROTENES, FRACTIONATED                82380         48.00
03090163   HB LAB CATECHOLAMINES, FRAC         #         82384         29.50
03091577   HB LAB PLSMA CATECHOLAMINES, FRAC             82384         29.77
03090186   HB LAB URN CATECHOLAMINE, FR                  82384         19.20
03091574   HB LAB URN CATECHOLAMINES, FRAC               82384         26.46
03010089   HB LAB CERULOPLASMIN                          82390        435.10
03000011   HB CHEMILUMINESCENT ASSAY                     82397        318.26
03091647   HB LAB IBDDX - CHEMILUMIN AS                  82397         12.23
03091601   HB PTH RELATED PROTEIN                        82397         24.55
03091600   HB URN NITROGEN TOTAL                         82397         43.55
03091676   HB CHLORAMPHENICOL                            82415         30.00
03010093   HB CHLORIDE                                   82435        238.61
03011889   HB LAB CHLORIDE                               82435        238.61
03010695   HB LAB CHLORIDE SE AU                         82435        238.61
03010094   HB LAB CHLORIDE UR AU                         82436        248.15
03010096   HB LAB CHLORIDE FL AU                         82438        238.61
03010702   HB LAB CHLORIDE SF AU                         82438        238.61
03010700   HB LAB CHLORIDE, SWEAT                        82438        715.53
03091616   HB LAB STOOL CL                               82438         42.80
03090057   HB CHOLESTEROL                                82465         5.71
03010705   HB LAB CHOLESTEROL FLD                        82465        248.15
03010098   HB LAB CHOLESTROL SE AU                       82465        248.15
03091176   HB CHOLINESTERASE, PLASMA                     82480         30.14
03091083   HB CHOLINESTERASE, PSEUDO                     82480         11.55
03091084   HB CHOLINESTERASE, PSEUDO                     82480         7.84
03092045   HB LAB CHOLINESTERASE, SERUM                  82480         21.76



                                                   45
  Charge
   Code                   Description                        CPT Code OP/Default Price   IP/ED Price
03090041   HB CHOLINESTERASE, RBC                             82482         29.41
03092046   HB LAB CHOLINESTERASE, RBC                         82482         21.24
03090735   HB COUMADIN (WARFARIN)                             82491         37.30
03091689   HB DIPHENHYDRAMINE                                 82491         44.51
03091626   HB LAB 6MP METABOLITES                             82491         90.45
03090173   HB LAB CLOZAPINE                                   82491         23.00
03091560   HB LAB COENZYME Q                                  82491        125.00
03091691   HB LAB KEPPRA (CHROMATOGRAPHY)                     82491         72.33
03090856   HB LAB MEXILETENE                                  82491         50.08
03091693   HB LAB PHENELZINE (NARDIL)                         82491        399.00
03091646   HB LAB TPMT ENZ COLMN SGL ANALYTE                  82491         73.70
03091411   HB LAB TRIMIPRAMINE                                82491         17.60
03091678   HB MAPROTILENE                                     82491         30.00
03091688   HB CITALOPRAM (CELEXA)                             82492         83.46
03091883   HB ITRACONAZOLE AND METABOLITE                     82492        129.75
03091677   HB PROPOXYPHENE (DARVON)                           82492         61.20
03090849   HB SERTRALINE (ZOLOFT)                             82492         66.77
03090729   HB URN DIURETIC SCREEN                             82492        125.83
03091684   HB VERAPAMIL                                       82492         35.00
03090486   HB LAB CHROMIUM, SERUM               #             82495         16.00
03090487   HB LAB CHROMIUM, URINE               #             82495         16.00
03091181   HB LAB CITRATE               #                     82507         25.00
03090409   HB LAB URN CITRATE                                 82507         14.40
03090543   HB URINE CITRIC ACID                               82507         23.50
03090042   HB URN CITRATE                                     82507         20.02
03091661   HB COCAINE CONFIRMATION                            82520         15.00
03091871   HB C-TELOPEPTIDE, SERUM                            82523         89.60
03090955   HB LAB N-TELOPEPTIDE                               82523         20.30
03090683   HB LAB N-TELOPEPTIDE SE GC/MS                      82523        127.04
03011957   HB LAB PYRIDINIUM X LINKS 24H #                    82523         30.95
03091933   HB LAB PYRIDINIUM X LINKS 24H#                     82523         30.95
03090159   HB LAB PYRIDINIUM X LINKS 2H #                     82523         30.95
03091781   HB URN TELPEP 24H COL CX LNK                       82523         45.74
03091420   HB LAB COPPER                                      82525         14.40
03090501   HB LAB COPPER, URINE             #                 82525         15.75
03090694   HB LAB FREE COPPER                                 82525         40.00
03091598   HB LAB QUANTITATIVE COPPER               #         82525         57.90
03091951   HB URINE COPPER                                    82525         14.40
03091352   HB LAB CORTICOSTERONE                              82528         69.00
03090961   HB LAB SERUM FREE CORTISOL                         82530         62.50
03090164   HB LAB URINE FREE CORTISOL               #         82530         42.00
03010771   HB LAB CORTISOL SE RI                              82533        506.32



                                                        46
  Charge
   Code                  Description            CPT Code OP/Default Price   IP/ED Price
03091193   HB LAB CREATINE                       82540         18.00
03091796   HB LAB CREATINE*                      82540         18.00
03090136   HB LAB CREATINE, 24 HR URINE          82540         68.25
03091995   HB DRGU COLM CHROM QUAL               82541         5.79
03091668   HB CANNABINOID CONFIRMATION           82542         38.95
03090867   HB LAB RISPERIDONE                    82542         50.00
03091680   HB METHAQUALONE                       82542
03091086   HB CK TOTAL                           82550         6.55
03091166   HB LAB CKIE-CK                        82550         13.00
03010103   HB LAB CPK TOTAL SE AU                82550        319.37
03011975   HB LAB CPK TOTAL SE AU*               82550        319.37
03091087   HB CK ISOENZYMES                      82552         13.45
03010783   HB CKMB FRACTION                      82553        143.55
03010106   HB CREATININE                         82565        238.61
03010107   HB LAB CREATININE                     82565        238.61
03010457   HB LAB CREATININE ERL                 82565        224.70
03011872   HB LAB CREATININE SE AU               82565        238.61
03010787   HB LAB CREATININE FLD                 82570        238.61
03010789   HB LAB CREATININE UR AU               82570        238.61
03091172   HB LAB CREATININE, NOT BLOOD          82570         5.70
03091355   HB LAB PREGNANETRIOL URINE C          82570         18.46
03091782   HB LAB URN TELPEP 24H CRT OTH SRC     82570         12.76
03010111   HB LAB CREATININ-CLR AU               82575        248.15
03091887   HB CRYOFIBRINOGEN                     82585         28.42
03010112   HB LAB CRYOFIBRINOGEN PL              82585         69.39
03091888   HB CRYOGLOB - QUAL/SEMI QUAN          82595         16.58
03010113   HB LAB CRYOGLOBULIN SE                82595        211.43
03091451   HB CYANIDE                            82600         35.20
03010798   HB LAB VITAMIN B-12 RI                82607        668.79
03091452   HB VIT B12 BINDING CAPACITY           82608         17.60
03091034   HB LAB CYSTATIN C                     82610         54.00
03091400   HB LAB DEHYDROEPIANDROSTERONE #       82626         25.00
03091401   HB LAB DHEA SO4             #         82627         8.00
03090142   HB LAB DEOXYCORTICOSTERONE      #     82633         77.00
03091453   HB 11-DEOXYCORTISOL                   82634         32.32
03091085   HB DIBUCAINE NUMBER                   82638         12.16
03091454   HB DIHYDROTESTOSTERONE                82651         40.00
03091012   HB VIT D: 1,25-DIHYDROXY              82652         26.00
03091180   HB VITAMIN D: 1,25-DIHYDROX           82652         31.00
03090389   HB LAB CHRONIC GRANULO DIS            82657         62.50
03090796   HB LAB TPMT ENZ NON-RADIO SUBSTRA     82657         73.70
03090105   HB LAB LDL SUBPARTICLES               82664         34.00



                                           47
  Charge
   Code                     Description          CPT Code OP/Default Price   IP/ED Price
03091095   HB LIPOPROTEIN ELECTR SEP              82664         14.75
03010115   HB LAB ERYTHROPOIETIN LEVEL            82668        418.41
03091961   HB ESTROGENS, FRACT ESTRADIOL          82670         59.80
03010116   HB LAB ESTRADIOL                       82670        226.08
03090031   HB LAB ESTRADIOL SE                    82670         57.50
03090079   HB LAB ESTROGEN TOTAL                  82672         24.75
03090046   HB ESTRIOL, UNCONJUGATED               82677         19.00
03091962   HB ESTROGENS, FRACT ESTRIOL            82677         51.77
03091963   HB ESTROGENS, FRACT ESTRONE            82679         53.43
03091455   HB ESTRONE                             82679         32.00
03091456   HB ETHELYNE GLYCOL                     82693         29.44
03091534   HB LAB FECAL FAT, QUAL                 82705         14.33
03090182   HB LAB FECAL FAT, TIMED                82710         44.80
03091187   HB LAB FATTY ACIDS, FREE               82725         12.85
03010843   HB LAB FERRITIN                        82728        390.59
03010844   HB FETAL FIBRONECTIN                   82731        1089.26
03090551   HB FLURAZEPAM                          82742         36.05
03010120   HB LAB FOLATE SE       RI              82746        474.05
03091116   HB FOLATE, RBC                         82747         8.50
03091716   HB LAB NB GAL1PO4 URD TRANS SCN#       82776         14.50
03091640   HB CELIAPLUS GAMMA GLOB                82784         13.82
03091458   HB IGD                                 82784         17.60
03010854   HB LAB IG A SE                         82784        298.23
03010852   HB LAB IG A, CORD BL                   82784        298.23
03010861   HB LAB IG G SE                         82784        298.23
03010858   HB LAB IG G, CORD BL                   82784        298.23
03090199   HB LAB IG GAMAGLOB                     82784         9.88
03010124   HB LAB IG M SE                         82784        298.23
03010122   HB LAB IG M, CORD BL                   82784        298.23
03091633   HB LAB TOT SE IGA BY NEPHELOMETRY      82784         16.75
03091284   HB SERUM IGA                           82784         21.18
03091808   HB ALLERGY PROF ASSY GAMMA IGE         82785         31.20
03091764   HB LAB CAPQ GAMMA IGG                  82785         31.96
03010870   HB LAB IGE                             82785        208.09
03091902   HB RESP REGN XIII GAM GLOB IGE         82785         21.88
03091203   HB LAB IGG SUBCLASSES                  82787         8.53
03010129   HB LAB BLOOD GASES, ART POC            82803        975.93
03010877   HB LAB O2 SATURATION                   82803        156.53
03011884   HB PC BLDG GAS ANALYSIS                82803        764.49
03011883   HB PC BLOOD GAS NEONATE                82803        764.49
03011885   HB PF BLD GAS EXERCISE                 82803        764.49
03010130   HB PF BLD GAS RESTING                  82803        764.49



                                            48
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03011886   HB PF BLD GAS SHUNT                     82803        764.49
03091089   HB LAB GASTRIN SE                       82941         8.50
03091459   HB GLUCAGON                             82943         19.20
03000284   HB GLUCAGON STIMULATION GR TST          82943         98.14
03010883   HB LAB GLUCOSE FL     AU                82945        248.15
03010133   HB LAB GLUCOSE SF     AU                82945        248.15
03010881   HB LAB GLUCOSE URN                      82945        248.15
03012035   HB POC MD CSF GLUCOSE                   82945        184.62
03010134   HB LAB - GLUCOSE-POC                    82947        238.61
03010886   HB LAB GLUCOSE                          82947        238.61
03010137   HB LAB GLUCOSE FAST AU                  82947        238.61
03011977   HB LAB GLUCOSE**                        82947        238.61
03010135   HB LAB GLUCOSE, PRENATAL SCREEN         82947        238.61
03010887   HB LAB GLUCOSE 2H PP                    82950        238.61
03010142   HB GLUCOSE TOLERANCE TEST               82951        757.56
03010143   HB LAB GLUCOS TOL 3H AU                 82951        787.86
03011984   HB LAB GLUCOS TOL 4H AU*                82951        743.35
03011983   HB LAB GLUCOS TOL 6H AU*                82951        743.35
03010891   HB LAB GLUC TOL, EA ADNL SPEC           82952        248.15
03010890   HB LAB GLUCOSE TOL 5H AU                82952
03091869   HB GLUCOSE 6 PHOSPH DHYDRG, QN          82955         16.00
03010147   HB LAB GLUCOS-G6PD SCRN                 82960        302.68
03010148   HB LAB - POC GLUCOSE                    82962        238.61
03010894   HB LAB BLOOD GLUCOSE; WAIVED MTHD       82962        248.15
03010149   HB LAB POC GLUCOSE                      82962        248.15
03010896   HB LAB GAM GLUT TRAN SC                 82977        203.30
03090862   HB LAB GLUTETHIMIDE                     82980         32.10
03091523   HB GLYCATED ALBUMIN                     82985         46.20
03091418   HB LAB FRUCTOSAMINE         #           82985         12.16
03010151   HB LAB FOLLICLE STIM HORMONE            83001        150.31
03010152   HB LAB LUTENIZING HORMONE               83002        149.83
03090018   HB LAB HGH SE                           83003         15.00
03010153   HB LAB HAPTOGLOBIN                      83010        418.41
03010154   HB HELIOBACTER PYLORI                   83013        517.51
03091007   HB LAB COBALT SERUM                     83018         17.50
03091008   HB LAB URN COBALT                       83018         24.50
03010156   HB LAB HGB ELECTROPH ACID BL            83020        506.32
03010911   HB LAB HGB ELECTROPH BL                 83020        506.32
80000452   HB PROF HGB ELECTROPH BL                83020
03010158   HB LAB HGB EVAL W/ CONF - HPLC          83021        145.47
03091717   HB LAB NB HGB ELECTROPHORESIS #         83021         14.50
03010160   HB LAB HGB FETAL ALKALI CORD BL         83033        173.60



                                             49
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
03010159   HB LAB HGB FETAL APT                    83033        183.61
03010926   HB LAB GLYCATED HEMOGLOBIN              83036        127.97
03010925   HB LAB HEMOGLOBIN A1C                   83036        127.97
03091545   HB LAB METHEMOGLOBIN                    83050         38.57
03090624   HB HEMOGLOBIN, PLASMA                   83051         12.45
03010163   HB LAB MICRO HEMOSID UR                 83070        163.58
03091460   HB HISTAMINE                            83088         27.20
03091461   HB URN HISTAMINE                        83088         27.20
03010164   HB LAB HOMOCYSTEINE                     83090        136.37
03091462   HB URN HOMOCYSTINE                      83090         20.80
03091752   HB HOMOVANILLIC ACID                    83150         17.60
03090178   HB LAB 17-OH-CORTICOSTEROIDS            83491         26.00
03090877   HB 5-HYDROXYINDOLACETIC ACID            83497         13.50
03091872   HB HIAA, URINE                          83497         17.92
03091463   HB 17-HYDROXYPROGESTERONE               83498         9.00
03091719   HB LAB NB 17-OHP                        83498         14.50
03091747   HB HYDROXYPROLINE, FREE RAND            83500         29.00
03091091   HB URN HYDROXYPROLENE, FREE             83500         29.00
03090940   HB HYDROXYPROLINE, TOTAL, RAND.         83505         89.50
03091190   HB LAB HYDROXYPROLINE, TOTAL            83505         35.00
03092043   HB LAB URN HYDROXYPROL, TOT             83505         54.08
03091876   HB ANTI MULLERIAN ANTIBODY              83516         77.00
03091959   HB CONCT TIS DIS PRF IMM ASSY           83516         9.56
03010169   HB GAMMA INTERFERON EIA                 83516        409.51
03091283   HB IGA FIBRONECTIN AGGREGATE            83516         21.17
03010165   HB IL-1 INTERLEUKIN          *          83516        409.51
03010171   HB IL-2 INTERLEUKIN          *          83516        409.51
03010168   HB INTERLEUKIN-2 RECEPTOR EIA           83516        409.51
03010170   HB INTERLEUKIN-6 EIA                    83516        409.51
03091042   HB LAB ANNEXIN V AB PANEL               83516         37.50
03091009   HB LAB HISTONE AB, IGG                  83516         12.80
03090935   HB LAB IMMUNOREACTIVE TRYPSINOGEN       83516         14.50
03090983   HB LAB PHOSPHATIDYLCHOLINE ABS          83516         22.40
03090986   HB LAB PHSPHATIDYLETHANOLMINE ABS       83516         22.40
03090141   HB LAB TRANSGLUTAMIN IGG/IGA            83516         34.00
03090380   HB LAB TRANSGLUTAMINASE IGA             83516        100.00
03092026   HB LAB TTG, IGG                         83516         30.87
03091213   HB LAB TYSABRI ABS                      83516        243.75
03010166   HB OKT3 ANTIBODY TEST *                 83516        409.51
03010167   HB TUMOR NECROSIS FACTOR EIA            83516        409.51
03091486   HB ACETYLCHOLINE BLOCKING AB            83519         36.38
03091485   HB ACETYLCHOLINE RECEPTOR AB            83519         36.38



                                             50
  Charge
   Code                    Description               CPT Code OP/Default Price   IP/ED Price
03091915   HB IGF BIND PROTEIN-1                      83519         46.00
03091110   HB IGF-I BINDING PROTEIN 3                 83519         26.25
03091975   HB INTERLEUKIN 12                          83519        425.00
03090696   HB LAB ACETYLCHOL MODUL AB                 83519         36.38
03091554   HB LAB ACETYLCHOL RECEPT AB PNL            83519         24.25
03090137   HB LAB ALPHA SUBUNIT BLOOD       #         83519         68.00
03090649   HB LAB GLUTAMIC ACID DECARB AB             83519         44.10
03090415   HB LAB IGF-II                              83519         66.00
03092034   HB LAB INTERLEUKIN 8                       83519        275.00
03090464   HB LAB LEMS AB IMM ASSAY RIA               83519        215.95
03090455   HB LAB MUSK AB RIA                         83519        347.06
03091002   HB LAB MYS GRVS IMM ASSAY, NONAB           83519         32.56
03090447   HB LAB NEOCOMPLETE - IMM ASSAY             83519        121.28
03091517   HB LAB PANCREASTATIN                       83519        200.00
03092037   HB LAB PEPTIDE YY                          83519        225.00
03092011   HB LAB PROCOLLAGEN TYPE I                  83519        102.50
03091044   HB LAB SANDOSTATIN                         83519        200.00
03091770   HB LAB SEROTONIN RELEASE ASSAY             83519        260.00
03091422   HB LAB TRYPSINOGEN                         83519         22.40
03091810   HB LEMS AB IMMUON ASSY NON-AB              83519        242.96
03091838   HB MISK ANTIBODY TEST                      83519        585.00
03091809   HB NEOCMPLT PRF IMM ASSY NO-AB             83519        160.82
03091863   HB NEUROKININ A                            83519        225.00
03091602   HB PANCREATIC POLYPEPTIDE                  83519         65.74
03091175   HB THYROTROPIN RELEASE HORM                83519        200.00
03091973   HB AMD13Y IMM ASY INF AGNT                 83520        152.00
03090378   HB ASIALO GM1 ANTIBODIES                   83520         56.62
03091839   HB GALOP ANTIBODY                          83520        250.00
03090247   HB GLIADIN IGG AB                          83520         63.75
03091645   HB IBD SER ELISA                           83520         23.45
03091603   HB IGA ANTIBODIES                          83520         29.92
03091111   HB INHIBIN A                               83520         36.00
03091948   HB INTERFERON GAMMA                        83520         95.00
03091768   HB INTERLEUKIN 6                           83520        116.00
03091159   HB LAB ADINOPECTIN                         83520        178.50
03090050   HB LAB AHT TRANSGLUTAMINASE                83520         30.15
03090987   HB LAB ANLZR - IMMUNOASSAY, RIA            83520         3.36
03091630   HB LAB ANTI-GLIADIN ELISA, IGA             83520         23.45
03090770   HB LAB ANTI-GLIADIN ELISA, IGG             83520         23.45
03091631   HB LAB ANTI-HU-TTG ELISA IGA REC           83520         30.15
03090783   HB LAB CELIAPLUS IMM ASSAY                 83520         19.25
03010172   HB LAB COLLAGEN BINDING PROTEIN            83520        211.43



                                                51
  Charge
   Code                  Description                        CPT Code OP/Default Price   IP/ED Price
03090793   HB LAB FIBR IA NOT INFCT AGNT NOS                 83520         73.70
03090445   HB LAB GALOP - IMMUNO ASSAY                       83520         98.20
03090269   HB LAB GANGLIOSIDE AB TEST 1 #                    83520         28.80
03090270   HB LAB GANGLIOSIDE AB TEST 2 #                    83520         28.80
03090248   HB LAB GLIADIN IGA AB       #                     83520         63.75
03090762   HB LAB GMB AB                                     83520         35.90
03090790   HB LAB HACA INFLIX SPE ELISA                      83520         67.00
03091025   HB LAB IBDDX - IMMUNOASSAY, RIA                   83520         23.45
03090144   HB LAB INHIBIN B                                  83520        158.00
03091160   HB LAB INTERLEUKIN 2                              83520        100.00
03090267   HB LAB MAG ANTIBODY 1           #                 83520         18.37
03090268   HB LAB MAG ANTIBODY 2           #                 83520         18.38
03090265   HB LAB MOTOR NEUROPATHY AB TST1#                  83520         29.07
03090266   HB LAB MOTOR NEUROPATHY AB TST2#                  83520         29.10
03090449   HB LAB NEOCOMPLETE - IMM ASY OTH                  83520        116.21
03091381   HB LAB NEOENCEPHALITIS - IMM ASY                  83520        116.90
03090699   HB LAB PANCREATIC ELASTASE                        83520        160.00
03090969   HB LAB PROTHROMBIN ABS                            83520         75.00
03090052   HB LAB PROTHROMBIN ABS              *             83520         25.08
03090263   HB LAB SENSORIMOTOR TEST 1              #         83520         32.67
03091254   HB LAB SENSORY NEUROPATHY TEST1#                  83520         57.99
03090994   HB LAB SENSORY NEUROPATHY-XP                      83520        148.57
03090791   HB LAB SERUM INFLIXIMAB LEVEL                     83520         83.75
03091328   HB LAB SUBSTANCE P                                83520        169.65
03091528   HB LAB TRYPTASE                                   83520        110.00
03090774   HB LAB TTG IGA                                    83520         51.26
03090922   HB LAB TUMOR NECROSIS FACTOR                      83520         75.00
03090968   HB LAB VWF COLLAGEN BINDING                       83520        110.00
03091319   HB MITOCHONDRIAL M2 AB                            83520         41.25
03091912   HB MULLERIAN INHIB SUBSTANCE                      83520         56.00
03091811   HB NEOCMPLT PRF IMM ASSY RIA                      83520        154.03
03090558   HB NEURONAL CELL AB, SERUM                        83520         73.05
03090032   HB RIBOSOMAL P PROTEIN                            83520         25.00
03090324   HB SENSORY NEUROPATHY TEST 3                      83520         58.00
03090376   HB SOLUBLE LIVER ANTIGEN AB                       83520         80.00
03091790   HB SULFATIDE ANTIBODY                             83520         51.75
03091840   HB SULFATIDE ANTIBODY *                           83520        187.50
03091947   HB TRNSF GRWTH FAC BETA, PL                       83520        160.00
03091897   HB TSH RECEPTOR ANTIBODY                          83520         36.80
03092003   HB VW COLLAGEN BINDING                            83520        110.00
03091465   HB INSULIN, SERUM                                 83525         9.92
03090560   HB INSULIN, TOTAL                                 83525         10.00



                                                       52
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
03090672   HB LAB INSULIN, 120 MINUTES              83525         9.92
03091543   HB LAB INSULIN, 30 MINUTES               83525         9.92
03090670   HB LAB INSULIN, 60 MINUTES               83525         9.92
03090671   HB LAB INSULIN, 90 MINUTES               83525         9.92
03090668   HB LAB INSULIN, FASTING                  83525         9.92
03090562   HB INSULIN, FREE                         83527         12.72
03011084   HB LAB PANEL IRON, TOTAL                 83540        183.16
03091597   HB LAB QUANTITATIVE IRON       #         83540         48.52
03011085   HB LAB PANEL IRON BIND CAPACITY          83550        183.16
03090180   HB LAB 17-KETOSTEROIDS                   83586         32.50
03091527   HB LAB CSF LACTIC ACID                   83605         7.68
03010177   HB LAB LACTIC AC BL SC                   83605        319.37
03091349   HB LACTATE                               83605
03012036   HB POC MD CSF LACTATE                    83605        184.62
03011096   HB LAB LDH CSF                           83615        307.09
03011095   HB LAB LDH FL       SC                   83615        307.09
03010180   HB LAB LDH SE       AU                   83615        188.51
03091466   HB LD, TOTAL                             83615         5.75
03091467   HB LD ISOENZYMES                         83625         10.75
03011108   HB LAB LEAD BL                           83655        279.31
03091529   HB LAB URN LEAD                          83655         7.72
03091468   HB LEAD                                  83655         9.00
03091865   HB LEAD, CAPILLARY                       83655         8.00
03091864   HB LEAD, VENOUS                          83655         8.00
03091469   HB URN LEAD                              83655         10.99
03010183   HB LAB L/S RATIO                         83661        382.80
03011111   HB LAB LAMELLAR BODY DENSITY             83664         94.59
03091191   HB LAB LEUCINE AMINOPEPTIDASE            83670         25.50
03091530   HB LAB FLD LIPASE                        83690         8.00
03011114   HB LAB LIPASE SE ST                      83690        253.68
03011116   HB LAB LIPOPROTEIN A                     83695        102.44
03090147   HB LAB LIPOPROTIEN A                     83695         16.77
03091868   HB LPA-A2                                83698        125.00
03091158   HB LAB VAL CHOL LIPO PRO                 83701         13.80
03091163   HB LAB LIPOPRT QUANT PRTC SUBCL          83704         40.87
03011120   HB LAB HDL CHOLESTEROL                   83718         66.17
03010188   HB LAB LDL CHOLESTEROL                   83721         76.30
03091170   HB LAB LIPFQ-LDL DIRECT BILL             83721         20.50
03090959   HB LAB GONADOTROPIN RELEAS HRM           83727        225.00
03091125   HB LAB MAGNESIOUM, RBC                   83735         30.00
03010189   HB LAB MAGNESIUM SE ER                   83735        253.59
03011129   HB LAB MAGNESIUM SE SC                   83735        253.59



                                              53
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
03011127   HB LAB MAGNESIUM UR SC                   83735        253.59
03091617   HB LAB STOOL MG                          83735         58.65
03091859   HB MANGANESE, BLOOD                      83785         16.00
03091860   HB MANGANESE, SERUM                      83785         16.00
03090567   HB URN MANGANESE                         83785         16.00
03090188   HB LAB BILE ACIDS, FRAC                  83789        150.00
03090493   HB LAB CARNITINE, FREE     #             83789         12.80
03091718   HB LAB NB TANDEM MS.MS QUANT             83789         14.75
03091471   HB MEPROBAMATE                           83805         38.15
03091474   HB LAB MERCURY                           83825         11.20
03091473   HB LAB URN MERCURY                       83825         14.77
03091472   HB MERCURY                               83825         12.08
03091475   HB URN MERCURY                           83825         13.23
03091615   HB LAB METANEPHRINES, FRAC               83835         68.45
03091017   HB LAB URN METANEPHRINE                  83835         23.15
03091194   HB LAB URN METANEPHRINES, FR             83835         27.00
03091679   HB METHADONE                             83840         77.90
03091665   HB METHADONE CONFIRMATION                83840         13.91
03090674   HB LAB METHEMALBUMIN                     83857         87.06
03090573   HB METHSUXIMIDE (CELONTIN)               83858         11.76
03091604   HB LAB MUCOPOLYSACCH, ACID QUANT         83864         59.95
03091622   HB LAB MUCOPOLYSACCH, ACID SCRN          83866         29.65
03092004   HB FLD MUCIN CLOT TEST                   83872         25.70
03010193   HB LAB MUCIN CLOT                        83872        163.58
03090019   HB MYELIN BASIC PROTEIN                  83873         22.00
03091476   HB MYOGLOBIN                             83874         13.76
03091426   HB URINE MYOGLOBULIN                     83874         13.76
03011167   HB LAB NATRIURETIC PEPTIDE ASSY          83880        274.66
03011978   HB LAB NATRIURETIC PEPTIDE ASSY*         83880        274.66
03091949   HB PRO BRAIN NATRIURETIC PEPT            83880         80.00
03091315   HB A1 ACID GLYCOPROTEIN                  83883         17.90
03091813   HB ALPHA2 MACCROGLOBULIN                 83883         34.40
03090307   HB ALPHA-2-MACROGLOBULIN                 83883         16.80
03091812   HB C3 ACTIVATOR                          83883         19.50
03011175   HB LAB ANTI-STREPTOLYSIN O ANTIBD        83883        219.22
03091644   HB LAB FIBRO NEPH, EA ANALYTE NES        83883         87.10
03011168   HB LAB FREE KAPPA LIGHT CHAINS           83883        110.12
03011171   HB LAB FREE LAMBDA LIGHT CHAINS          83883        110.12
03091214   HB LAB FREE LIGHT CHAINS, 24H URN        83883         96.75
03011169   HB LAB IGG SYNTHETIC RATE, CSF           83883        169.15
03090388   HB LAB URN FREE LIGHT CHAINS NEPH        83883         62.50
03091477   HB RETINOL BINDING PROTEIN               83883         17.50



                                              54
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03091409   HB LAB NICKEL, SERUM         #           83885         16.00
03091410   HB LAB NICKEL, URINE                     83885         17.50
03090859   HB LAB NICOTINE URINE                    83887         35.00
03091682   HB NICOTINE                              83887         35.00
03091478   HB APO E - CARD, ISOLATION               83890         10.25
03091605   HB HHC ISOLATION OR EXTRACTION           83890         11.48
03091171   HB LAB HB5G-PROCESSING BILL              83890         44.00
03091212   HB LAB HIVG MOL ISOL & EXTRACT           83890         44.00
03090807   HB LAB HRPN MOLEC. DIAG.                 83890        116.00
03091636   HB LAB LACTOTYPE ISOL/EXT                83890         24.79
03091552   HB LAB MICROSAT PCR ISOLATION            83890         6.00
03010203   HB LAB MOLEC ISOL/EXTRACTION             83890        100.15
03010200   HB LAB PCR JAK2 NUC ACID EXTRACT         83890        137.99
03090813   HB LAB SPNK ISOL & EXTRCT                83890        116.00
03011189   HB NUCLISENS ISOLATION                   83890        171.37
03012017   HB 2C19 ISOL AND EXTRACTION              83891         42.50
03012023   HB 2D6 ISOL AND EXTRACTION               83891         42.50
03012044   HB ACGH DNA ISOLATION                    83891         50.15
03091985   HB AML PNL ISOL/EXT EA NUC               83891         17.79
03091803   HB APO E-ALZHS MOL ISOL NUC              83891         11.54
03091804   HB ATAXIA EVAL MOL ISOL NUC              83891         10.94
03012014   HB BRAF, N.A. ISOL AND EXTRACT           83891         46.52
03091805   HB CMT COMP MOL ISOL NUC                 83891         7.60
03091802   HB CYP2D6 GENOTYPE MOL ISO NUC           83891         3.30
03010458   HB DNA, HIGH PURITY EXTRACTION           83891        231.46
03010225   HB DNA/RNA EXTRACTION                    83891        135.76
03091976   HB FLT3 ISOL/EXT EA NUC                  83891        400.00
03091952   HB HFE MUT AN 3 ISO/EX EA NUC            83891         13.37
03091908   HB HRPN MOL ISOL EA                      83891         37.33
03092012   HB IL28B MOL ISOLATE NUCLEIC             83891         20.54
03012039   HB KRAS ISOL AND EXTRACTION              83891         50.15
03091372   HB LAB APOE ALZHEIMERS - ISOL/EXT        83891         34.10
03091738   HB LAB ASKENAZI PNL MOL ISO/EXT          83891         8.98
03091386   HB LAB ATAXIA EVAL - ISOL/EXT            83891         44.50
03011936   HB LAB BLN ISOL. PUR NA 2ND NODE         83891         32.29
03011938   HB LAB BLN ISOL. PURIFIED N.A.           83891         32.29
03091135   HB LAB CANAVAN DIS ISO/EXT               83891         31.37
03091634   HB LAB CELIAGENE ISO EXT NUCA            83891         3.75
03091641   HB LAB CELIAPLUS ISO EXT NUCA            83891         5.95
03091581   HB LAB CF MUT ANLY ISO EXT NUCA          83891         23.05
03020281   HB LAB CFADD NA ISOL/EXTR CF DX          83891         74.56
03020276   HB LAB CFADS NA ISOL/EXTR CF SCRN        83891         74.56



                                              55
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03091573   HB LAB CGH ISOL AND EXTRACT              83891         26.43
03091388   HB LAB CMT ISOL/EXTRACT                  83891         10.00
03020309   HB LAB CT-B/SO MOLEC EXTR                83891        101.26
03091760   HB LAB CYP2D6 GENO ISOL EXTR             83891         3.40
03091375   HB LAB DM1 DNA TEST - ISOL/EXT           83891         52.21
03020263   HB LAB EXTRACTION NUC ACID 15;17         83891        312.70
03020290   HB LAB EXTRACTION NUC ACID P9;22         83891        312.70
03020277   HB LAB EXTRACTION NUCLEIC ACID           83891        142.44
03091775   HB LAB FAC V HR2 MUT - ISO/EX            83891         8.90
03020307   HB LAB FAC V LEIDEN PCR- EXTRACT         83891        115.73
03091588   HB LAB FRGX MOLEC ISOLATE NUCLEIC        83891         11.66
03091144   HB LAB HEP G PHENOTYPE ISO/EXT           83891         10.50
03020262   HB LAB HPV ISOL/EXTRACT                  83891        212.54
03020308   HB LAB IGHP MOLEC ISOL/EXTRACT           83891        106.83
03020291   HB LAB JH/SO MOLEC EXTR                  83891        101.26
03020266   HB LAB JK/SO MOLEC EXTRACT.              83891        101.26
03011903   HB LAB KRASP ISOL N.A.                   83891         34.50
03011937   HB LAB LAB PCA3 ISOL. PURIFIED N.A.      83891         99.04
03020257   HB LAB MOLEC EXTRACT-WARFA               83891         43.40
03020903   HB LAB MOLECULAR EXTRACT-UGT1A1          83891         32.29
03020922   HB LAB MOLECULAR EXTRACT-UGT1A1          83891         40.31
03020278   HB LAB MOLECULAR EXTRACT-WARFA           83891         45.62
03020298   HB LAB MTHFR MUT PCR- EXTRACT            83891        115.73
03091741   HB LAB MUUCLIPID IV MOL ISO/EXT          83891         23.86
03020264   HB LAB PCR EGFRP NUC ACID EXT            83891        175.82
03020287   HB LAB PCR FLT3P NUC ACID EXT            83891        175.82
03020299   HB LAB PCR JAK2 NUC ACID EXTRACT *       83891        137.99
03020258   HB LAB PCR NPM1P NUC ACID EXT            83891        175.82
03091758   HB LAB PRAD/WILL ANGL ISO EXT NCA        83891         14.75
03020275   HB LAB PROTHROMB MUT PCR- EXTRACT        83891        115.73
03020265   HB LAB RBC AG DNA EXTRACTION             83891         56.05
03091148   HB LAB TAY-SACHS DISEASE ISO/EXT         83891         11.75
03020310   HB LAB TCR-G MOLEC EXTR                  83891        106.83
03091629   HB LAB TPMT ISOL/EXTRACT NUC ACID        83891         13.40
03091584   HB LAB WPM MOLEC ISOLATE NUCLEIC         83891         32.25
03011991   HB MPL, N.A., ISOP & EXTRACT             83891         32.45
03091981   HB NPM1 ISOL/EXT EA NUC                  83891         28.94
03020295   HB NUCLISENS EXTRACTION                  83891        171.37
03092017   HB PANC PNL MOL ISOLATE NUC              83891         13.20
03012030   HB PCR JAK2Q NUC ACID EXTRCT             83891         50.15
03012009   HB PJ ISOLATION/EXTRACTION               83891         32.29
03091905   HB SPINK1 POLYM ISOL EA                  83891         43.62



                                              56
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03012018   HB 2C19 ENZYME DIGEST                     83892         32.52
03012024   HB 2D6 ENZYME DIGEST                      83892         32.52
03091987   HB AML PNL ENZ DIGEST                     83892         17.80
03091815   HB APO E-ALZHS MD ENZ DIG                 83892         11.55
03012015   HB BRAF, ENZYME DIGEST                    83892         47.95
03091814   HB CYP2D6 GENOTYPE MOL DIAG               83892         3.30
03091978   HB FLT3 ENZ DIGEST                        83892         15.20
03091954   HB HFE MUT AN 3 ENZ DIG EA                83892         13.38
03010235   HB LAB P15;17 EZ DIG PRT K & DNS          83892         33.38
03091373   HB LAB APOE ALZHEIMERS - ENZ DIG          83892         34.10
03090925   HB LAB ASKENAZI PNL MOL ENZ DIG           83892         8.98
03091139   HB LAB CANAVAN DIS ENZ DIG                83892         31.36
03090711   HB LAB CF MUT ANLY ENZ DIGEST             83892         23.05
03010243   HB LAB CFADD NA ENZ DIGEST CF DX          83892         74.56
03011240   HB LAB CFADS NA ENZ DIGST CF SCRN         83892         74.56
03091389   HB LAB CMT ENZ DIGESTION                  83892         10.01
03010241   HB LAB CT-B/SO ENZ DIG (N)                83892         32.52
03091029   HB LAB CYP2D6 GENO ENZ DIG                83892         3.40
03010240   HB LAB ENZ DIG PROTEIN K-UGT1A1           83892         33.38
03010254   HB LAB ENZ DIG PRT K & DNSE P9;22         83892         33.38
03011272   HB LAB ENZYMATIC PRO K DIGEST -W          83892         43.40
03011238   HB LAB ENZYMATIC PRO K DIGEST-W           83892         45.62
03091589   HB LAB FRGX MOLECULAR DIAGNOSTICS*        83892         11.67
03091654   HB LAB HRPN ENZ DIGESTION                 83892         84.00
03010238   HB LAB IGHP ENZYME DIGEST.                83892         33.38
03010253   HB LAB JH/SO ENZYME DIGEST (NEW)          83892         32.52
03010244   HB LAB JK/SO ENZYME DIGEST(NEW)           83892         32.52
03011904   HB LAB KRASP ENZY DIGESTION               83892         34.50
03090679   HB LAB MICROSAT PCR ENZ DIGEST            83892         6.40
03010251   HB LAB MOL ENZYME DIGEST-UGT1A1           83892         35.61
03010249   HB LAB MOL ENZYME DIGEST-WARFAR           83892         38.95
03010233   HB LAB MOL ENZYME DIGEST-WARFAR *         83892         41.17
03011227   HB LAB MOL ENZYME-UGT1A1                  83892         53.41
03011263   HB LAB MOLEC ENZYME DIGESTION             83892         32.52
03011939   HB LAB PCA3 ENZY. DIGEST                  83892         32.52
03011255   HB LAB PCR EGFRP MOL ENZ DIG              83892         87.91
03010464   HB LAB PCR FLT3P MOL ENZ DIG              83892         87.91
03011275   HB LAB PCR JAK2 MOL ENZ DIG JAK2          83892         74.56
03010236   HB LAB PCR JAK2 MOL ENZ DIGEST            83892         74.56
03010462   HB LAB PCR NPM1P MOL ENZ DIG              83892         90.14
03090951   HB LAB PRAD/WILL ANGL ENZ DIGEST          83892         14.75
03011270   HB LAB RBC AG ENZ DIGESTION               83892         32.52



                                               57
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03090816   HB LAB SPNK ENZ DIGST                    83892         84.00
03091149   HB LAB TAY-SACHS DISEASE ENZ DIG         83892         11.75
03010245   HB LAB TCR-G ENZ DIG PRT K (N)           83892         33.38
03091585   HB LAB WPM MOLECULAR DIAGNOSTICS         83892         32.25
03011992   HB MPL, ENZYME DIGEST                    83892         33.88
03012031   HB PCR JAK2 MOL ENZ DIG JAK2Q            83892         50.49
03012010   HB PJ ENZYME DIGESTION                   83892         35.88
03091806   HB ATAXIA EVAL MOL GEL ELCRPHR           83894         10.92
03010262   HB ELECTROPHORESIS DNA/RNA SEPARA        83894        185.84
03090432   HB LAB APOE ALZHEIMERS - GEL EP          83894         34.10
03090923   HB LAB ASKENAZI PNL MOL SEP GELP         83894         8.99
03090452   HB LAB ATAXIA EVAL - SEP GEL EP          83894         44.50
03091642   HB LAB CELIAPLUS SEP G-EP                83894         5.95
03091390   HB LAB CMT SEP GEL ELP                   83894         10.01
03011337   HB LAB CT-B/SO SEP/ELECTROPH (N)         83894         53.41
03090436   HB LAB DM1 DNA TEST - GEL EP             83894         52.21
03090721   HB LAB FRGX MOLEC GEL ELECTROPHOR        83894         11.66
03091145   HB LAB HEP G PHENOTYPE SEP GEL EP        83894         10.50
03090809   HB LAB HRPN SEP BY GEL EPHER             83894         35.75
03011279   HB LAB IGHP MOL SEP/ELECTROPH            83894         81.23
03010259   HB LAB JH/SO SEP/ELECTROPH(NEW)          83894         50.08
03010264   HB LAB JK/SO SEP/ELECTROPH(NEW)          83894         53.41
03090681   HB LAB MICROSAT PCR SEP BY GEL EP        83894         6.40
03010260   HB LAB MOLEC SEP/ELECTROPHORES           83894         86.80
03010261   HB LAB PCR JAK2 SEP/ELECPH               83894         74.56
03090954   HB LAB PRAD/WILL ANGL SEP G-EP           83894         14.74
03091657   HB LAB SPNK GEL ELP                      83894         35.75
03010255   HB LAB TCR-G PCR SEP/ELECH               83894         86.80
03091586   HB LAB WPM MOLEC GEL ELECTROPHOR         83894         32.25
03010258   HB SEPARATION-ELECTROPHORESIS            83894        244.82
03090577   HB APO E - CARD, NUCLEIC ACI             83896         10.00
03091816   HB APO E-ALZHS NUC ACID PRB              83896         11.54
03012013   HB BRAF, N.A. PROBE, EA                  83896         32.52
03091817   HB CMT COMP MOL DIAG                     83896         7.60
03092014   HB IL28B NUCLEIC ACID PROBE EA           83896         20.54
03012041   HB KRAS DNA PROBE                        83896         50.49
03090926   HB LAB ASKENAZI PNL MOL NUC ACD P        83896         8.99
03011940   HB LAB BLN N.A. PROBE, EA                83896         32.52
03011942   HB LAB BLN N.A. PROBE EA 2ND NODE        83896         32.52
03090777   HB LAB CELIAGENE SEP G-EP                83896         3.75
03090712   HB LAB CF MUT ANLY NUC A PROBE           83896         23.05
03011373   HB LAB CFADD NA PROBE EA, CF DX          83896         64.54



                                              58
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
03010265   HB LAB CFADS NA PROBE EA, CF SCRN          83896         64.54
03010267   HB LAB CT-B/SO N A PROBE                   83896        417.30
03090973   HB LAB FAC V HR2 MUT - NUCA PROB           83896         8.90
03011467   HB LAB FAC V LEIDEN PCR- PRB ADNL          83896         41.17
03091590   HB LAB FRGX MOLECULAR DIAGNOSTICS          83896         11.66
03010266   HB LAB JH/SO NUC ACID PROBE                83896        393.93
03010276   HB LAB JK/SO NUC ACID PROBE                83896        417.30
03011905   HB LAB KRASP NA PROBE, EA                  83896         32.52
03090782   HB LAB LACTOTYPE NUC A PROBE               83896         24.79
03010273   HB LAB MOLEC NUC ACID PROBE                83896        417.30
03010328   HB LAB MTHFR MUT PCR- PROBES ADNL          83896         41.17
03091742   HB LAB MUUCLIPID IV MUT NC AC PRB          83896         19.45
03010275   HB LAB NUC ACID DNA PROBE JAK2             83896         74.56
03011387   HB LAB NUCLEIC ACID PRB, EA 15;17          83896         43.40
03011351   HB LAB NUCLEIC ACID PRB, EA 15;17*         83896         95.70
03011376   HB LAB NUCLEIC ACID PRB, EA 9;22           83896         34.50
03011371   HB LAB NUCLEIC ACID PRB, EA 9;22 *         83896         64.54
03010280   HB LAB NUCLEIC ACID PROBE EA-UG            83896         35.61
03010269   HB LAB NUCLEIC ACID PROBE EA-UG *          83896         53.41
03010274   HB LAB NUCLEIC ACID PROBE EA-WA            83896         41.17
03010272   HB LAB NUCLEIC ACID PROBE EA-WA *          83896         38.95
03011941   HB LAB PCA3 N.A. PROBE, EA                 83896         94.31
03011468   HB LAB PROTHROMB MUT PCR- PRB ADL          83896         48.96
03090768   HB LAB TPMT NUCLEIC ACID PROBE             83896         12.73
03011989   HB MPL, N.A., PROBE, EA                    83896        103.19
03012033   HB NUC ACID DNA PROBE JAK2Q                83896         50.49
03010278   HB NUCLEIC ACID PROBE                      83896         32.52
03011994   HB PJ AIRE NA PROBE EA                     83896         32.52
03011997   HB PJ BCHE NA PROBE EA                     83896         32.52
03012003   HB PJ CMO II R81W NA PROBE EA              83896         32.52
03012006   HB PJ CMO II V386A NA PROBE EA             83896         32.52
03012000   HB PJ HIBM NA PROBE EA                     83896         32.52
03091391   HB LAB CMT NUC ACID TRANSFER               83897         10.01
03020321   HB LAB CT-B/SO NUC ACID TRANSF             83897        149.12
03090723   HB LAB FRGX MOLEC NUCLEIC TRANSF           83897         11.66
03020319   HB LAB JH/SO NUC ACID TRANSF               83897        141.33
03020327   HB LAB JK/SO NUC ACID TRANSF               83897        149.12
03020326   HB LAB MOLEC NUC ACID TRANSFER             83897        149.12
03091986   HB AML PNL AMPL TRGT EA SEQ                83898         74.43
03011417   HB AMPLIFICATION/PCR 15,17                 83898        311.48
03010286   HB AMPLIFICATION-PCR                       83898        391.71
03090578   HB APO E - CARD, AMPLIFICATION             83898         42.00



                                                59
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03091818   HB ATAXIA EVAL MOL NUC AMPLI            83898         45.90
03012012   HB BRAF, AMPL TGT, EA SEQ               83898        311.48
03091819   HB CMT COMP MOL NUC AMPLI               83898         31.81
03091977   HB FLT3 AMPL TRGT EA SEQ                83898         63.60
03090742   HB HHC SINGLE PRIMER PAIR PCR           83898         47.96
03012042   HB KRAS AMPL PCR 1 SEQUENCE             83898        483.73
03010288   HB LAB AMPLIFICATION/PCR 15;17          83898        311.48
03010293   HB LAB AMPLIFICATION/PCR 9;22           83898        311.48
03010291   HB LAB AMPLIFICATION/PCR P9 22          83898        311.48
03090433   HB LAB APOE ALZHEIMERS - AMPLF          83898        142.60
03090927   HB LAB ASKENAZI PNL MOL AMPLIF          83898         37.57
03090453   HB LAB ATAXIA EVAL - AMPLIF             83898        186.10
03091643   HB LAB CELIAPLUS AMP EA PAIR            83898         24.92
03090461   HB LAB CMT NUC ACID SEQUENCE            83898         41.88
03091376   HB LAB DM1 DNA TEST - AMPLF             83898        218.37
03091776   HB LAB FAC V HR2 MUT - AMPL             83898         37.20
03091591   HB LAB FRGX MOLECULE NUCLEIC AMPL       83898         48.78
03091653   HB LAB HRPN AMPLIFICATION               83898         48.63
03011421   HB LAB IGHP PCR AMPLIFICATION           83898        311.48
03011906   HB LAB KRASP AMPL. TARGET               83898        311.48
03090780   HB LAB LACTOTYPE AMP EA PAIR            83898         99.16
03090680   HB LAB MICROSAT PCR AMP EA PAIR         83898         24.00
03010296   HB LAB MOLEC AMPLIFICATION/SING         83898        311.48
03011943   HB LAB PCA3 AMPL. TARGET EA SEQ         83898        311.48
03010465   HB LAB PCR EGFRP AMPLIFICATION          83898        311.48
03010467   HB LAB PCR FLT3P AMPLIFICATION          83898        311.48
03011966   HB LAB PCR JAK2 AMPLIFICATION           83898        311.48
03010290   HB LAB PCR JAK2 AMPLIFICATION *         83898        311.48
03010466   HB LAB PCR NPM1P AMPLIFICATION          83898        311.48
03091656   HB LAB SPNK AMPLIFICATION               83898         56.81
03011427   HB LAB TCR-G AMPLIFICATION/SING         83898        311.48
03091627   HB LAB TPMT PCR DNA MARKERS             83898         52.49
03011988   HB MPL, AMPL, TARGET EAS SEQ            83898        311.48
03091982   HB NPM1 AMPL TRGT EA SEQ                83898        121.06
03011986   HB NUCLEIC ACID 2ND AMPLI               83898        311.48
03092018   HB PANC PNL MOL NUC AMPLI EACH          83898         55.20
03012032   HB PCR JAK2Q AMPLIFICATION              83898        483.73
03011993   HB PJ AIRE AMPL TARGET EAS SEQ          83898        311.48
03011996   HB PJ BCHE AMPL TARGE EA SEQ            83898        311.48
03012002   HB PJ CMO II R81W AMPL TARGET           83898        311.48
03012005   HB PJ CMO II V386W AMPL TARGET          83898        311.48
03011999   HB PJ HIBM AMPL TARGET EA SEQ           83898        311.48



                                             60
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03012019   HB 2C19 MULTIAMP TGT1ST 2NASEQ            83900        265.29
03012025   HB 2D6 MULTIAMP TGT1ST 2NASEQ             83900        265.29
03091821   HB CMT CMP MOL NC AMPL MPX 1-2            83900         64.29
03091820   HB CYP2D6 GNTYP AMP MLTX ACD S            83900         27.90
03091953   HB HFE MUT AN 3 AMP TRGT M2               83900        111.88
03092013   HB IL28B MOL NUC AMPLI 2 SEQ              83900        171.79
03011944   HB LAB BLN MUTIPLEX TARGET AMP            83900        265.29
03011945   HB LAB BLN MUTPLX TRGT AMP 2ND ND         83900        265.29
03091137   HB LAB CANAVAN DIS AMPL FRST 2            83900         31.37
03090778   HB LAB CELIAGENE AMP EA PAIR              83900         31.38
03011446   HB LAB CFADD AMP PT NA MULT CF DX         83900        265.29
03011444   HB LAB CFADS AMP PT NA MULT CF SC         83900        265.29
03091030   HB LAB CYP2D6 GENO MLTX NUC AC SQ         83900         28.44
03090122   HB LAB HEP G PHENOTYPE AMPL               83900         87.86
03011907   HB LAB MOL IGHP AMP TGT 1 2 NA SQ         83900        265.29
03011909   HB LAB MOL IGK AMP TGT 1 2 NA SEQ         83900        265.29
03011908   HB LAB MOL TCRB AMP TGT 1 2 NA SQ         83900        265.29
03011910   HB LAB MOL TCRG AMP TGT 1 2 NA SQ         83900        265.29
03011453   HB LAB MOLEC AMP-FIRST 2-WAR              83900        265.29
03011442   HB LAB MOLECULAR AMP-FIRST 2              83900        265.29
03090932   HB LAB MUUCLIPID IV MUT AMP MLPLX         83900        199.56
03011439   HB LAB PCR EGFRP TARGET AMP               83900        265.29
03090952   HB LAB PRAD/WILL ANGL AMPLIF              83900         61.64
03011440   HB LAB RBC AG MLTPLX AMP FIRST 2          83900        659.02
03091152   HB LAB TAY-SACHS DISEASE AMPL             83900         11.75
03012020   HB 2C19 MULTIAMP TGT EA SEQ>2             83901        135.01
03012026   HB 2D6 MULTIAMP TGT EA SEQ > 2            83901        135.01
03010311   HB AMPLIFICATION-PCR DBL                  83901        519.68
03091822   HB CMT CMP MOL NC AMPL MPX >2             83901         31.81
03011868   HB CORD HR-DRB1 TYPING STD                83901        590.64
03011871   HB DQB1 TYPING, IR/HR, STD/URG            83901        135.01
03011870   HB DRB4 TYPING, IR/HR, STD/URG            83901        135.01
03010327   HB DRB5 TYPING, IR/HR, STD/URG            83901        135.01
03011869   HB HR DRB1,3,4,5, TYPING                  83901        684.60
03091739   HB LAB ASKENAZI PNL MOL AMP MULPL         83901         37.58
03091138   HB LAB CANAVAN DIS AMPL OTHR              83901         31.37
03091582   HB LAB CF MUT ANLY AMPLIF                 83901         96.45
03011455   HB LAB CFADD AMP PT NA ADDN CF DX         83901        135.01
03011454   HB LAB CFADS AMP PT NA ADD CF SC          83901        135.01
03011911   HB LAB MOL IGHP AMP TGT ADDNL SQ          83901        135.01
03011912   HB LAB MOL TCRB AMP TGT ADDNL SQ          83901        135.01
03011461   HB LAB MOLEC AMPLIFICATION/MULT           83901        135.01



                                               61
  Charge
   Code                 Description                   CPT Code OP/Default Price   IP/ED Price
03010316   HB LAB MOLECULAR AMP-EA ADD-WA              83901        135.01
03011969   HB LAB MOLECULAR AMP-EA ADD-WA              83901        135.01
03011460   HB LAB RBC AG MLTPLX ADDITIONAL             83901        135.01
03011947   HB LAB BLN REV TRANSCR. 2ND NODE            83902        205.81
03011946   HB LAB BLN REVERSE TRANSCR.                 83902        205.81
03011481   HB LAB MOLEC REV TRANSCRIPTION              83902        205.81
03011948   HB LAB PCA3 REVERSE TRANSCR.                83902        205.81
03010332   HB LAB REVERSE TRANSCRIP 15;17              83902        205.81
03010331   HB LAB REVERSE TRANSCRIP 15;17 *            83902        205.81
03011479   HB LAB REVERSE TRANSCRIP 9;22               83902        205.81
03011476   HB LAB REVERSE TRANSCRIP 9;22     *         83902        205.81
03010337   HB LAB CFADD MUTATION SCAN CF DX            83903        135.01
03010338   HB LAB CFADS MUTATION SCAN CF SCR           83903        135.01
03011913   HB LAB KRASP MUT SCAN EA                    83903        135.01
03010340   HB LAB MUTATION SCANNING EA-UGT             83903        135.01
03020333   HB LAB MUTATION SCANNING EA-UGT *           83903        135.01
03010339   HB LAB MUTATION SCANNING EA-WAR             83903        135.01
03020329   HB LAB MUTATION SCANNING EA-WAR *           83903        135.01
03012011   HB LAB PJ CMOII R81W MUT SCAN               83903        135.01
03012007   HB PJ CMO II V386W MUT SCAN                 83903        135.01
03091823   HB ATAXIA EVAL MOL MUTATION ID              83904         45.90
03091824   HB CMT COMP MOL MUT ID                      83904         31.81
03010344   HB ENGRAFTMENT B-CELL SUBSET                83904        733.34
03011862   HB ENGRAFTMENT CD34 SUBSET                  83904        733.34
03011863   HB ENGRAFTMENT MYELOID SUBSET               83904        733.34
03011864   HB ENGRAFTMENT T-CELL SUBSET                83904        733.34
03091909   HB HRPN MOL MUT ID SEQ                      83904         37.80
03091392   HB LAB CMT MUT ID EA SEGMENT                83904         41.88
03091146   HB LAB HEP G PHENOTYPE MUT ID               83904         43.91
03091906   HB SPINK1 POLYM MUT ID SEQ                  83904         44.16
03012040   HB KRAS CELL LYSIS                          83907        164.18
03020341   HB LAB HPV LYSIS OF CELLS                   83907        106.83
03092007   HB LAB LACTP NUC MOL LYSIS                  83907         24.79
03092006   HB LAB TPMT NUC MOL LYSIS                   83907         18.09
03091825   HB APO E-ALZHS AMP EA NUC S                 83908         48.83
03091740   HB LAB ASKENAZI PNL MOL SIGNL AMP           83908         37.58
03011484   HB LAB CFADD SIG AMP PT NA CF DX            83908        132.67
03011489   HB LAB CFADS SGL AMP PT NA CF SCR           83908        132.67
03091777   HB LAB FAC V HR2 MUT - SING AMP             83908         37.20
03011260   HB LAB FAC V LEIDEN PCR- DIGEST             83908        188.06
03010299   HB LAB FAC V LEIDEN PCR- PROBES             83908        132.67
03011244   HB LAB MTHFR MUT PCR- DIGEST                83908        188.06



                                                 62
  Charge
   Code                  Description                   CPT Code OP/Default Price   IP/ED Price
03011445   HB LAB MTHFR MUT PCR- PROBES                 83908        132.67
03011262   HB LAB PROTHROMB MUT PCR- DIGEST             83908        188.06
03010301   HB LAB PROTHROMB MUT PCR- PROBES             83908        132.67
03011487   HB LAB SIGNAL AMP, EA-UGT1A1                 83908        132.67
03011485   HB LAB SIGNAL AMP, EA-UGT1A1       *         83908        132.67
03011887   HB LAB SIGNAL AMP, EA-WARFARIN               83908        132.67
03011490   HB LAB SIGNAL AMP, EA-WARFARIN *             83908        132.67
03010300   HB MOLECULE NUCLEIC AMPLI 2 SEQ              83908        257.06
03091988   HB AML PNL SEP & ID EA NUC                   83909         74.44
03091827   HB ATAXIA EVL MOL AML HR SP EA               83909         46.39
03091828   HB CMT COMP HR SEP & ID EA                   83909         32.13
03091826   HB CYP2D6 GNTYP SP ID HR EA NU               83909         13.96
03010343   HB ENGRAFTMENT UNSEPARATED CELLS             83909        984.83
03091979   HB FLT3 SEP & ID EA NUC                      83909         63.60
03091910   HB HRPN MOL SEP ID                           83909         70.92
03091141   HB LAB CANAVAN DIS SE & ID                   83909         31.37
03091761   HB LAB CYP2D6 GENO SEP & ID                  83909         14.22
03091592   HB LAB FRGX MOL SEP & ID HI RES              83909         48.79
03091553   HB LAB MICROSAT PCR SEP AND ID               83909         24.00
03011917   HB LAB MOL IGHP SEP ID HI RES TCH            83909        132.67
03011914   HB LAB MOL IGK SEP ID HI RES TECH            83909        132.67
03011915   HB LAB MOL TCRB SEP ID HI RES TCH            83909        132.67
03011916   HB LAB MOL TCRG SEP ID HI RES TCH            83909        132.67
03011491   HB LAB PCR FLT3P SEP & ID HI RES             83909        132.67
03011497   HB LAB PCR NPM1P SEP & ID HI RES             83909        132.67
03091150   HB LAB TAY-SACHS DISEASE SEP & ID            83909         11.75
03091983   HB NPM1 SEP & ID EA NUC                      83909        121.06
03092019   HB PANC PNL NUC ACID HIGH RES                83909         55.20
03091907   HB SPINK1 POLYM SEP ID                       83909         82.86
03011987   HB ZMOL EGFRP SIRT NUC ACID HR               83909        132.67
03012022   HB 2C19 LAB INTERP & RPT                     83912         32.41
03012028   HB 2D6 LAB INTERP & RPT                      83912         32.41
03012045   HB ACGH INT REPORT                           83912         50.33
03091989   HB AML PNL INTERP & RPT                      83912         17.80
03090579   HB APO E - CARD, INTERP & RP                 83912         10.00
03091830   HB APO E-ALZHEIMER'S GEN EXAM                83912         11.54
03091831   HB ATAXIA EVAL GENETIC EXAM                  83912         10.97
03012029   HB BRAF THYROID INTERP/REPORT                83912         32.41
03012016   HB BRAF, INTRP & RPT TC                      83912         32.41
03091143   HB CANAVAN DIS INTRP & RPT*                  83912
03091832   HB CMT COMP GENETIC EXAM                     83912         7.60
03011556   HB CT-B/SO INTERP & REPORT                   83912         42.29



                                                  63
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03091829   HB CYP2D6 GENOTYPE GEN EXAM               83912         3.30
03091980   HB FLT3 INTERP & RPT                      83912         15.20
03091955   HB HFE MUT AN 3 INTERP & RPT              83912         13.37
03091606   HB HHC INTERP & REPORT                    83912         48.30
03092015   HB IL28B NUC MOL DX; INT & REP            83912         20.54
03012034   HB INTERPRETATION JAK2Q                   83912         50.33
03011895   HB INTREPRETATION AND REPORTING           83912        293.78
03012043   HB KRAS LAB INTERP & RPT                  83912         50.33
03010372   HB LAB ADEV INTERP & REPORT               83912         32.41
03011972   HB LAB ADEV INTERP & REPORT*              83912         32.41
03010367   HB LAB ADGBS INTERP & REPORT              83912         32.41
03011968   HB LAB ADGBS INTERP & REPORT              83912         32.41
03090434   HB LAB APOE ALZHEIMERS - INTERP           83912         34.10
03090145   HB LAB ASKENAZI PNL MOL INTERP RP         83912         8.99
03090454   HB LAB ATAXIA EVAL - INTERP & RPT         83912         44.50
03011949   HB LAB BLN INTERP                         83912         32.41
03011950   HB LAB BLN INTERP 2ND NODE                83912         32.41
03011958   HB LAB CANAVAN DIS INTRP & RPT            83912         31.36
03091923   HB LAB CANAVAN DIS INTRP & RPT            83912         31.36
03090776   HB LAB CELIAGENE INTERP & RPT             83912         4.37
03090785   HB LAB CELIAPLUS INTERP & RPT             83912         5.96
03091583   HB LAB CF MUT ANLY INTERP & RPT           83912         23.05
03010374   HB LAB CFADS INTRP & RPT CF NA SC         83912         32.41
03010371   HB LAB CHLAMYDIA INTERPRETATION           83912         32.41
03091393   HB LAB CMT INTERP & REPORT                83912         10.01
03091032   HB LAB CYP2D6 GENO INTERP & RPT           83912         3.40
03091377   HB LAB DM1 DNA TEST - INTERP              83912         52.21
03090976   HB LAB FAC V HR2 MUT - INTRP RPT          83912         8.90
03090726   HB LAB FRGX GENETIC EXAMINATION           83912         11.66
03090446   HB LAB GALOP - INTERP & RPT               83912         30.40
03010354   HB LAB GC AMPLIFICATION INTERP            83912         32.41
03010369   HB LAB HCV RNA QUANT INTERPRET            83912         32.41
03090125   HB LAB HEP G PHENO INTERP & RPT           83912         10.50
03010381   HB LAB HPV 16,18 INTERP & RPT             83912         32.41
03010373   HB LAB HPV INTERPRETATION                 83912         32.41
03011971   HB LAB HPV INTERPRETATION                 83912         32.41
03010379   HB LAB HPVC INTERP & REPORT               83912         32.41
03090811   HB LAB HRPN INTERP & REPORT               83912         59.60
03090812   HB LAB HRPN PATH INTERP & RPT             83912         60.00
03010382   HB LAB IGHP PCR INTERP/REPORT             83912         41.17
03010355   HB LAB INTERP C.T. CONFIRM                83912         32.41
03010380   HB LAB INTERP N.G. CONFIRM                83912         32.41



                                               64
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03010364   HB LAB INTERP, EA MUT-WARFARIN           83912         32.41
03010362   HB LAB INTERP, EA MUT-WARFARN            83912         32.41
03010375   HB LAB INTERP/REPORT-0UGT1A1             83912         32.41
03010378   HB LAB INTERP/REPORT-UGT1A1              83912         32.41
03011540   HB LAB INTERPRETATION TECH JAK2          83912         38.95
03010387   HB LAB JH/SO INTERP & REPORT             83912         42.29
03010356   HB LAB JK/SO INTERP & REPORT             83912         42.29
03011918   HB LAB KRASP INTERP/REPORT TECH.         83912         32.41
03090781   HB LAB LACTOTYPE INTERP & RPT            83912         24.79
03090465   HB LAB LEMS AB INTERP & REPORT           83912         64.05
03010363   HB LAB M. TB BY TMA INTERP.              83912         32.41
03011959   HB LAB MICROSAT PCR INTERP & RPRT        83912         6.00
03091931   HB LAB MICROSAT PCR INTERP&RPT           83912         6.00
03011920   HB LAB MOL IGK INTERP & RPT              83912         32.41
03011919   HB LAB MOL TCRB INTERP & RPT             83912         32.41
03011532   HB LAB MOLEC DIAG INTERP & RPT           83912         32.41
03010377   HB LAB MOLEC INTERP & REPORT             83912         52.30
03010365   HB LAB MRSA INTERP & REPORT              83912         32.41
03000263   HB LAB MRSA PCR INTERP*                  83912         32.41
03091387   HB LAB MUSK AB INTERP & REPORT           83912        102.94
03091743   HB LAB MUUCLIPID IV MUT INTRP RPT        83912         19.45
03091385   HB LAB NEOCOMPLETE - INTERP & RPT        83912         35.97
03090444   HB LAB NEOENCEPHALITIS - INTERP          83912         36.18
03011951   HB LAB PCA3 INTERP                       83912         49.23
03010473   HB LAB PCR EGFRP INTERP & RPT            83912         57.87
03010386   HB LAB PCR JAK2 INTERP & RPT             83912         32.41
03010472   HB LAB PCR NPM1P INTERP & RPT            83912         57.87
03010366   HB LAB PCR/INTERP AND RPT 15;17          83912         42.29
03010370   HB LAB PCR/INTERP AND RPT P9;22          83912         42.29
03090953   HB LAB PRAD/WILL ANGL INTRP & RPT        83912         14.74
03011569   HB LAB QUANT HBV BY BDNA - I             83912         32.41
03011896   HB LAB RBC AG INTERPRETATION             83912         32.41
03091658   HB LAB SPNK INTERP & RPT                 83912         69.64
03090131   HB LAB TAY-SACHS DIS INTRP & RPT         83912         11.75
03010358   HB LAB TCR-G INTERP & RPT                83912         43.40
03090766   HB LAB TPMT INTERP & REPORT              83912         12.73
03091587   HB LAB WPM GENETIC EXAMINATION           83912         32.25
03091833   HB LEMS AB GENETIC EXAM                  83912         72.04
03011990   HB MPL, INTERP/REPORT TECH               83912         32.41
03091984   HB NPM1 INTERP & RPT                     83912         28.94
03092020   HB PANC PNL NC MOL DX INT REP            83912         13.20
03011574   HB PCS EGFRP INTERP & RPT                83912         57.87



                                              65
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03011995   HB PJ AIRE INTERP/RPT TECH              83912         32.41
03011998   HB PJ BCHE INTERP/RPT TECH              83912         32.41
03012004   HB PJ CMO II R81W INT RPT TECH          83912         32.41
03012008   HB PJ CMO II V386W INT/RPT              83912         32.41
03012001   HB PJ HIBM INTERP/RPT TECH              83912         32.41
80016268   HB PROF ADEV INTERP & REPORT            83912
80016269   HB PROF ADGBS INTERP & REPORT           83912
80016276   HB PROF BB MOL DX INTERP & RPT          83912
80016193   HB PROF BLN INTERP & RPT                83912
80016192   HB PROF BLN INTRP RPT 2ND NODE          83912
80016272   HB PROF C DIF TOX B INTRP RPT           83912
80000773   HB PROF CHLAMYDIA INTERP                83912
80000764   HB PROF GC AMPLIFICATION INTRP          83912
80016262   HB PROF H1N1 INTERP AND REPORT          83912
80000745   HB PROF HCV GENOTYP INTRP RPT           83912
80000738   HB PROF HCV PCR QUAL INTRP RPT          83912
80009995   HB PROF HEP B RT PCRQ INTP RPT          83912
80000776   HB PROF HEP C VIR NUC INTR RPT          83912
80000438   HB PROF HIVR INTERP & REPORT            83912
80016353   HB PROF HMPV INTERP & RPT               83912
80000766   HB PROF HPV 16,18 INTERP & RPT          83912
80000769   HB PROF HPVI INTERP & REPORT            83912
80016354   HB PROF INF A SUBTYP INTERP/RPT         83912
80016351   HB PROF INFL A/B INTERP & RPT           83912
80009988   HB PROF INTERP CTBS                     83912
80009978   HB PROF INTERP EGFRP                    83912
80016177   HB PROF INTERP FLTP                     83912
80009986   HB PROF INTERP IGHP                     83912
80009975   HB PROF INTERP IGK                      83912
80009985   HB PROF INTERP JAK2                     83912
80009987   HB PROF INTERP JHS                      83912
80009997   HB PROF INTERP JKS                      83912
80009993   HB PROF INTERP KRASP                    83912
80009999   HB PROF INTERP NPM1P                    83912
80016172   HB PROF INTERP P1517                    83912
80009977   HB PROF INTERP P922                     83912
80016173   HB PROF INTERP TCRB                     83912
80016182   HB PROF INTERP TCRP                     83912
80009998   HB PROF INTERP UGT1A1                   83912
80009989   HB PROF INTERP WARFARIN                 83912
80016190   HB PROF INTERPRETATION AXCT             83912
80016184   HB PROF INTERPRETATION AXGC             83912



                                             66
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
80016185   HB PROF INTERPRETATION CFADS            83912
80016188   HB PROF INTERPRETATION IMTRM            83912
80016189   HB PROF INTERPRETATION IPFV             83912
80016187   HB PROF INTERPRETATION IPMP             83912
80014894   HB PROF M. TB BY TMA INTERP.            83912
80009965   HB PROF MRSA INTERP & REPORT            83912
80016186   HB PROF PCA3 INTERP.& RPT.              83912
80000226   HB PROF PCR/INTERP AND REPORT           83912
80016355   HB PROF PIV INTERP & RPT                83912
80016352   HB PROF RSV INTERP & REPORT             83912
80016279   HB PROF ZFISH MM INTERP & RPT           83912
80016289   HB PROF, BRAF, INTRP & RPT              83912
03090429   HB SULFATIDE INTERP & REPORT            83912         69.75
03011527   HB WEST NILE VIRUS, INTERP.             83912         32.41
03011953   HB LAB BLN RNA STABL 2ND NODE           83913        105.72
03011954   HB LAB BLN RNA STABILIZATION            83913        105.72
03011952   HB LAB PCA3 RNA STABILIZATION           83913        120.06
03010388   HB LAB RNA STABILIZATION 15;17          83913        105.72
03010389   HB LAB RNA STABILIZATION P9;22          83913        105.72
03012021   HB 2C19 MUTATION ID BY ASPE             83914        132.67
03012027   HB 2D6 MUTATION ID BY ASPE              83914        132.67
03091835   HB CMT COMP MUT ID EZ EA SEG            83914         32.14
03091834   HB CYP2D6 GNTYP MUT ID EZ E SG          83914         13.96
03091142   HB LAB CANAVAN DIS MUT ID               83914         31.36
03091033   HB LAB CYP2D6 GENO MUT ID               83914         14.22
03090978   HB LAB MUCLPD MUT ENZ LIG PRM EX        83914         81.36
03010474   HB LAB PCR EGFRP MUT ID ENZ LIG         83914        132.67
03011897   HB LAB RBC AG PRIMER EXT MULTI          83914        132.67
03090129   HB LAB TAY-SACHS DISEASE MUT ID         83914         11.75
03091421   HB LAB 5' NUCLEOTIDASE                  83915         16.00
03010390   HB LAB PROTEIN ELECT SP                 83916        553.06
03091773   HB LAB URN ORGANIC ACIDS,QUANT          83918        128.00
03092028   HB LAB URN OROTIC ACID                  83921         96.00
03091113   HB METHYLMALONIC ACID, SERUM            83921         35.00
03090024   HB URN METHYLMALONIC ACID               83921         35.00
03091697   HB LAB FENTANYL                         83925         45.90
03090051   HB LAB MEPERIDINE                       83925         35.00
03090855   HB LAB OXYCODONE                        83925         65.00
03091093   HB MEPERIDINE                           83925         30.00
03091681   HB MORPHINE                             83925         50.08
03090820   HB OPIATE CONFIRMATION                  83925         15.00
03090824   HB PROPOXYPHENE CONFIRMATION            83925         9.73



                                             67
  Charge
   Code                    Description                CPT Code OP/Default Price   IP/ED Price
03011632   HB LAB OSMOLALITY SE AU                     83930        183.61
03011633   HB OSMOLALITY, URINE                        83935        183.61
03091169   HB LAB OSTEOCALCIN            #             83937         29.95
03091016   HB LAB URN OXALATE                          83945         15.36
03091479   HB URINE OXALATE                            83945         10.90
03090058   HB URN OXALATE                              83945         20.02
03091556   HB LAB HER 2 / NEU                          83950         88.02
03010393   HB LAB PTH                                  83970        333.91
03011643   HB LAB PH QUAL FL                           83986         67.88
03011641   HB LAB PH STOOL                             83986         67.88
03090995   HB LAB PH, BODY FLUID                       83986         5.44
03011646   HB LAB PH, URINE                            83986         67.88
03011647   HB LAB POC - PH, BODY FLUIDS                83986        247.04
03091669   HB PHENCYCLIDINE CONFIRMATION               83992         38.95
03091043   HB LAB CALPROTECTIN, STOOL                  83993        174.00
03091184   HB LAB CHLORPROMAZINE                       84022         24.00
03091027   HB LAB CHLORPROMAZINE             *         84022         30.00
03091699   HB LAB STELAZINE                            84022         37.50
03091799   HB STELAZINE*                               84022
03091480   HB THIORIDAZINE/MEZORIDAZINE                84022         19.80
03090025   HB PHENYLALANINE                            84030         58.00
03090878   HB PROSTATIC ACID PHOSPHATASE               84066         13.00
03010398   HB LAB ALK PHOS SE AU                       84075        253.59
03010399   HB LAB ALK PHOS SE ER                       84075        253.59
03091481   HB TOTAL ALKALINE PHOSPHATASE               84075         4.78
03091482   HB ALK PHOS ISOENZYMES                      84080         13.55
03090132   HB LAB BONE SPECIFIC ALK PHOSPH#            84080         21.50
03091342   HB LAB PHOSPHATIDYLGLYCEROL ABS             84081         25.08
03010401   HB LAB PHOSPHOR SE AU                       84100        238.61
03010402   HB LAB PHOSPHORUS - ER                      84100        238.61
03011670   HB LAB PHOSPHORUS FLD                       84100        238.61
03011671   HB LAB PHOSPHOR UR AU                       84105        238.61
03091186   HB LAB PORPHOBILINOGEN, URINE               84110         32.96
03091416   HB LAB PORPHYRINS, URINE                    84120         24.00
03091531   HB LAB FECAL PORPHYRINS                     84126        134.40
03020349   HB LAB POTASSIUM                            84132        238.61
03010405   HB LAB POTASSIUM              *             84132        238.61
03020348   HB LAB POTASSIUM FL AU                      84132        238.61
03010407   HB LAB POTASSIUM SE AU                      84132        236.47
03010410   HB LAB POTASSIUM UR AU                      84133        248.15
03010411   HB LAB PREALBUMIN                           84134        280.43
03091122   HB T4PP - PREALBUMIN                        84134         31.61



                                                 68
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03091354   HB PREGNANETIOL                           84138         67.54
03091353   HB PREGNENOLONE                           84140         65.00
03090149   HB LAB 17-HYDROXYPREGNENOLONE             84143         67.50
03020350   HB LAB PROGESTERONE                       84144        168.78
03091898   HB PROCALCITONIN                          84145        180.00
03010413   HB LAB PROLACTIN                          84146        160.24
03091950   HB MACROPROLACTIN                         84146         44.80
03092032   HB LAB PROSTAGLANDIN D2                   84150        275.00
03092033   HB LAB PROSTAGLANDIN E2                   84150        275.00
03010415   HB LAB PROSTATE SPEC ANTIGN               84153        197.95
03010414   HB LAB PROSTATE SPECIFIC ANTGN            84153        205.87
03020352   HB LAB PSA, FREE                          84154        205.87
03011874   HB LAB PROTEIN TOTAL - ER                 84155        218.28
03010417   HB LAB PROTEN TOT SE AU                   84155        218.28
03020353   HB LAB PROTEN TOT UR SC                   84156        227.01
03010420   HB LAB PROTEN TOT FL SC                   84157        227.01
03010421   HB LAB PROTEN TOT SF SC                   84157        227.01
03010480   HB LAB PROTEIN ELECTROPHORESIS SE         84165        506.32
80000360   HB PROF CSF OLIGOCLONAL BANDS             84165
80016071   HB PROF ELECROPHER IMUNO SERUM            84165
80000302   HB PROF PROTEIN ELECTPHR URINE            84165
80000231   HB PROF PROTEIN ELECTROPHOR               84165
03091120   HB T4PP - PEP FRAC & QUANT                84165         23.27
03010423   HB LAB PROTEIN ELECTROPHORESIS UR         84166        553.06
80016072   HB PROF ELECROPHER IMUNO URINE            84166
03091321   HB MAG AB-WESTERN BLOT                    84181         73.50
80000278   HB PROF WESTERN BLOT INTERP               84181
03092035   HB LAB CSF PROT WB; IM ID BNDS            84182         38.67
03090448   HB LAB NEOCOMPLETE - WEST BLOT            84182        161.56
03091380   HB LAB NEOENCEPHALITIS - WST BLT          84182        162.51
03091836   HB NEOCMPLT PRF PROT WEST BLOT            84182        214.19
03091483   HB ZINC PROTOPORPHYRIN                    84202         15.75
03091484   HB PROINSULIN                             84206         25.60
03091405   HB LAB VITAMIN B6           #             84207         18.00
03091607   HB LAB PYRUVIC ACID                       84210         22.80
03012037   HB POC MD CSF PYRUVATE                    84210        184.62
03091348   HB PYRUVATE                               84210
03091533   HB LAB PYRUVATE KINASE                    84220         45.50
03091526   HB SOLUBLE TRANSFERRIN RECPT              84238         19.20
03090970   HB LAB PLASMA RENIN ACTIVITY              84244         12.20
03090653   HB VIT B2, RIBOFLAVIN                     84252         17.80
03091402   HB LAB SELENIUM, SERUM          #         84255         16.00



                                               69
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
03090174   HB LAB SEROTONIN                         84260         35.00
03091964   HB SEROTONIN, SERUM/PLASMA               84260         50.50
03090107   HB LAB SEX HORM BINDING GLOB             84270         15.20
03091129   HB LAB SEX HORMONE BIND GLOB             84270         17.50
03010489   HB LAB SODIUM                            84295        238.61
03010427   HB LAB SODIUM SE      AU                 84295        238.61
03011970   HB LAB SODIUM*                           84295        238.61
03011740   HB LAB SODIUM UR       AU                84300        238.61
03091619   HB LAB STOOL NA                          84302         42.55
03020355   HB SODIUM, OTHER SOURCE                  84302        248.15
03091124   HB LAB SOMATOMEDIN-C, RIA                84305         16.25
03090060   HB SOMATOSTATIN                          84307         45.50
03091544   HB LAB ADENOSINE DEAMINASE,FLD           84311         32.00
03091566   HB LAB PORPHYRINS                        84311         12.80
03090760   HB LAB URN ARYLSULFATASE A               84311         82.19
03011751   HB LAB SPEC GRAV FLD                     84315         84.57
03020356   HB STOOL REDUCING SUBSTANCE              84376        120.18
03091861   HB STOOL REDUCING SUBSTANCE              84376         39.37
03091608   HB URN OLIGOSACCHARIDES                  84377         34.38
03091127   HB LAB TESTOSTERONE FREE                 84402         12.60
03020249   HB LAB - TESTOSTERONE TOTAL              84403        208.81
03091130   HB LAB TESTOSTERONE BIOAV TOT            84403         19.00
03090108   HB LAB TESTOSTERONE TOT (AD MALE)        84403         10.00
03091126   HB LAB TESTOSTERONE TOT (FE/CH)          84403         20.00
03090103   HB LAB TESTOSTERONE TOTAL                84403         15.40
03090921   HB LAB VITAMIN B1 (SERUM/PLASMA)         84425         16.00
03091404   HB LAB VITAMIN B1 (THIAMINE) #           84425         18.00
03091572   HB LAB VITAMIN B1, PLASMA                84425         25.36
03090588   HB THIOCYNATE                            84430         29.75
03090066   HB HERPES VIRUS 6, IGM                   84432         14.33
03091350   HB LAB THYROGLOBULIN                     84432         29.00
03091990   HB THYROGLOB PNL THYROGLOBULIN           84432         48.00
03010432   HB LAB THYROXINE                         84436        188.51
03090094   HB T4PP - T4 TOTAL                       84436         14.90
03090110   HB LAB FREE T4 BY DIALYSIS               84439         20.00
03090111   HB LAB FREE T4, NON-DIALYSIS             84439         20.50
03090055   HB LAB TBG RIA SE                        84442         7.00
03090082   HB LAB THYRO BIND INHIB                  84442         40.00
03091121   HB T4PP - THYROX BINDING GLOB            84442         32.05
03090943   HB LAB NB TSH                            84443         14.50
03010433   HB LAB THYRO TSH SE RI                   84443        188.51
03090117   HB LAB THYRO GR STIM IMG                 84445        130.00



                                              70
  Charge
   Code                    Description                CPT Code OP/Default Price   IP/ED Price
03091911   HB THYROID STIMULAT IGG                     84445        143.00
03091298   HB THYROID STIMULATING IG                   84445         27.65
03091407   HB LAB VITAMIN E              #             84446         16.00
03091960   HB CORTISOL BINDING GLOBULIN                84449         38.50
03011792   HB ASPARTATE AMINOTRANSFERA                 84450        238.61
03010434   HB LAB S G O T SE ER                        84450        238.61
03011890   HB LAB S G P T SE AU                        84460        238.61
03010436   HB LAB SGPT SE ER                           84460        238.61
03010438   HB LAB TRANSFERRIN SE                       84466        302.68
03010439   HB LAB TRIGLYCER SE SC                      84478        302.68
03010441   HB LAB TRIGLYCERIDES FLD                    84478        302.68
03090139   HB LAB VAL CHOL TRIG                        84478         3.20
03090056   HB TRIGLYCERIDES                            84478         7.54
03010442   HB LAB T UPTAKE                             84479        188.51
03091487   HB T3, TOTAL                                84480         5.00
03091837   HB T3, TOTAL*                               84480         5.00
03091457   HB T3 FREE                                  84481         8.00
03091488   HB REVERSE T3                               84482         23.04
03010443   HB LAB TROPONIN I                           84484        154.35
03011967   HB LAB TROPONIN I                           84484        154.35
03090638   HB TROPONIN T                               84484         48.00
03091896   HB STOOL TRYPSIN                            84488         11.73
03091100   HB TYROSINE                                 84510         51.95
03010447   HB LAB UREA NITRO SE AU                     84520        238.61
03010444   HB LAB UREA NITROGEN                        84520        238.61
03010446   HB LAB UREA NITROGEN FLD                    84520        238.61
03010475   HB LAN UREA NITROGEN ERL                    84520        224.70
03010445   HB UREA NITROGEN                            84520        238.61
03011817   HB LAB UREA NITRO UR                        84540        248.15
03010450   HB LAB URIC ACID SE AU                      84550        236.47
03011821   HB LAB URIC ACID UR AU                      84560        248.15
03090677   HB LAB URIC ACID, FLUID                     84560         7.70
03090591   HB URINE URIC ACID                          84560         4.00
03091014   HB URN VMA                                  84585         17.92
03090942   HB VANILMANDELIC ACID                       84585         57.00
03090083   HB LAB VIP                                  84586         17.45
03090470   HB LAB ANTIDIURETIC HORMONE       #         84588         25.60
03091403   HB LAB VITAMIN A              #             84590         15.36
03091769   HB VITAMIN B3                               84591         80.00
03090738   HB VITAMIN K                                84597         66.25
03091088   HB D-XYLOSE                                 84620         26.60
03090063   HB XYLOSE, BLOOD                            84620         27.30



                                                 71
  Charge
   Code                    Description                    CPT Code OP/Default Price   IP/ED Price
03090592   HB ZINC, PLASMA                                 84630         7.00
03090593   HB ZINC,URINE                                   84630         11.20
03091399   HB LAB C-PEPTIDE              #                 84681         7.00
03090920   HB LAB CSF HCG                                  84702         40.00
03090918   HB LAB FLD HCG PERICARDIAL                      84702         40.00
03090919   HB LAB FLD HCG PERITONEAL                       84702         40.00
03011892   HB LAB FLD HCG PLEURAL                          84702         40.00
03011891   HB LAB HCG B SUB      RI          *             84702        454.02
03091623   HB LAB TUMOR HCG                                84702         27.04
03010455   HB LAB BETA HCG, QUAL                           84703        298.23
03011973   HB LAB BETA HCG, QUAL*                          84703        298.23
03011861   HB LAB BETA-HCG QUAL                            84703        298.23
03091369   HB DRUG PROOF TESTING TO LOP                    84999
03011893   HB LAB CSF 14-3-3 PROTEIN                       84999         10.00
03091793   HB LAB MACROAMYLASE                             84999         74.80
03011956   HB LAB SPECIAL TEST                             84999         0.00
03091943   HB LAB SPECIAL TEST                             84999
03011899   HB LAB STOOL K                                  84999         0.06
03011898   HB LAB STOOL OSMOLALITY                         84999         0.06
03012038   HB POC MD CSF GLUTAMATE                         84999        184.62
03091395   HB PRICE ARUP                                   84999
03091659   HB PTL MISCELLANEOUS                            84999
03090746   HB STOOL NITROGEN TOTAL                         84999         67.92
03050001   HB LAB BLEED TIME TEMPL                         85002        301.57
03050340   HB AUTOMATED DIFFERENTIAL                       85004        239.25
03050002   HB AUTOMATED DIFFERENTIAL*                      85004        239.25
03050003   HB MANUAL DIFFERENTIAL                          85007        307.13
03050341   HB MANUAL DIFFERENTIAL*                         85007        307.13
03050343   HB PLATELET SMEAR REVIEW                        85008        227.01
03050342   HB PLATELET SMEAR REVIEW*                       85008        227.01
03050005   HB LAB POC SPUN HEMATOCRIT, BLD                 85013        155.79
03050346   HB LAB HEMATOCRIT                               85014        155.79
03050093   HB LAB HEMATOCRIT*                              85014        155.79
03050347   HB HEMOGLOBIN BY HEMOCUE                        85018        105.72
03050094   HB HEMOGLOBIN BY HEMOCUE*                       85018        105.72
03050096   HB CBC WITH AUTO DIFF                           85025        372.24
03050113   HB LAB CBC WITH AUTO DIFF                       85025        372.25
03050009   HB LAB CBC WITH AUTO DIFF             *         85025        318.86
03050344   HB LAB CBC HEMOGRAM W/PLT                       85027        203.30
03050116   HB LAB CBC HEMOGRAM W/PLT*                      85027        203.30
03050012   HB LAB CELL C EOSINO BL                         85032        183.61
03050013   HB LAB PLATELT COUNT BL (MANUAL)                85032        176.55



                                                     72
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03050014   HB RETICULOCYTE; AUTOMATED              85045        227.01
03050117   HB PLATELET COUNT, AUTOMATED            85049         96.81
03050102   HB PLATELET CT AUTOMATED                85049         96.81
03050104   HB BLOOD SMEAR INTERP W/REPO            85060
80016356   HB PROF BLD SMEAR INTRP W/REPO          85060
80000253   HB PROF PERIPHERAL BLD INTERP           85060
80014759   HB PROF PERIPHERAL BLD SMEARS           85060
80000301   HB PROF PERIPHERAL BLOOD INTER          85060
80016060   HB PROF BM STAIN AND INTERP             85097
80016053   HB PROF BM WRIGT STN INTRP ASP          85097
80000324   HB PROF BONE MAR ASP STAIN              85097
03050108   HB FACTOR II ASSAY                      85210        390.59
03050018   HB LAB FACTOR 5 ASSAY                   85220        390.59
03050019   HB LAB FACTOR 7 ASSAY                   85230        390.59
03050020   HB LAB FACTOR 8 ASSAY                   85240        368.34
03050021   HB LAB RISTOCETIN CO-FACTOR             85245        390.59
03050115   HB VON WILLEBRAND FACTOR AG             85246        373.90
03091136   HB FACTOR 8 MULTIMERIC                  85247         25.00
03091774   HB VW PROTEASE ACT/INHIB                85247        110.00
03050121   HB FACTOR IX ASSAY                      85250        390.59
03050122   HB FACTOR X ASSAY                       85260        390.59
03050025   HB LAB FACTOR 11 ASSAY                  85270        390.59
03050124   HB FACTOR XII ASSAY                     85280        390.59
03050125   HB FACTOR XIII SCREEN                   85291        248.15
03090708   HB LAB FLETCHER FACTOR                  85292        125.00
03090412   HB LAB FITZGERALD FACTOR                85293        125.00
03050129   HB ANTI-THROMBIN 3                      85301        358.32
03090977   HB LAB ANTITHROMBIN III ANTIGEN         85301         75.50
03090072   HB PROTEIN C ANTIGEN                    85302         17.25
03050132   HB PROTEIN C FUNCTIONAL                 85303        585.33
03050118   HB LAB PROTEIN S TOTAL AG               85305        440.67
03091610   HB PROTEIN S AG, TOTAL                  85305         23.00
03050030   HB LAB PROTEIN S ASSAY                  85306        551.95
03050119   HB LAB PROTEIN S FREE AG                85306        418.41
03090748   HB PROTEIN S AG, FREE                   85306         30.90
03050031   HB LAB PROT C RESIST                    85307        215.88
03091873   HB ADAMTS 13 INHIBITOR                  85335         41.97
03091972   HB AMD13X FAC INHIBITOR TST             85335        121.00
03050138   HB FACTOR INHIBITOR TEST                85335        372.79
03050034   HB LAB ACTIVATED CLOTTING TIME          85347        218.11
03050348   HB LAB ACTIVATED CLOTTING TIME*         85347        218.11
03050035   HB LAB WHOLE BLOOD ACT                  85347        218.11



                                             73
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
03050036   HB LAB HEPARIN DOSE RESPONSE             85348        358.32
03050140   HB EUGLOBLN CLOT LYSIS                   85360        347.19
03091875   HB EUGLOBULIN CLOT LYSIS                 85360         90.00
03050038   HB LAB FIBRIN MONOMER                    85362        219.22
03050144   HB D-DIMER ULTRASENS                     85379        395.04
03050040   HB LAB D-DIMER QUANT                     85379        395.04
03050142   HB PLASMA D-DIMER                        85379        395.04
03050146   HB FIBRINOGEN                            85384        248.15
03090594   HB FIBRINOGEN (RID)                      85385         41.60
03091874   HB ADAMTS 13 ACTIVITY                    85397         79.03
03091971   HB ADAMTS-13 ACTIVITY                    85397        125.00
03091845   HB VW PROTEASE ACT/INHIB *               85397        110.00
03091965   HB ALPHA 2 ANTIPLASMIN                   85410         39.04
03091532   HB LAB PLASMINOGEN ACTIVTR INHIB         85415         57.60
03091580   HB PLASMINOGEN ACTIVITY                  85420        100.00
03090947   HB LAB PLASMINOGEN          #            85421        147.00
03091567   HB HEINZ BODIES, DIRECT                  85441         54.98
03050043   HB LAB HEINZ PREP BLOOD                  85441        163.58
03091568   HB HEINZ BODIES, INDUCED                 85445         89.02
03050157   HB FETAL KLEIHAUER BETKE                 85460        418.41
03050158   HB SCRN FETAL-MATERNAL                   85461        159.13
03050047   HB LAB HEPARIN ASSAY                     85520        358.32
03090965   HB LAB HEPARIN,LMW XA INHIBITION         85520         76.50
03090966   HB LAB HEPRN,UNFRAC XA INHIBIT           85520         67.50
03050048   HB LAB LOW MOL WT HEPARIN                85520         97.93
03050046   HB LAB UNFRACTIONATED HEPARIN            85520         89.98
03050049   HB LAB HEPZYMED PTT                      85525        255.94
03050168   HB LEUKOCYTE ALKALINE PHOSP              85540        347.19
03090643   HB SERUM LYSOZYME                        85549         14.72
03090644   HB URINE MURAMIDASE                      85549         14.72
03090639   HB OSMOTIC FRAGILITY                     85555         75.00
80000445   HB PROF OSMOTIC FRAG IMMEDIATE           85555
80000277   HB PROF AUTOHEMOLYSIS BL                 85557
03050057   HB LAB ADP FULL DOSE                     85576        147.65
03050052   HB LAB ADP LOW DOSE                      85576        147.65
03050181   HB LAB ARACHIDONIC ACID                  85576        147.65
03050054   HB LAB ASPIRIN ASSAY                     85576        208.09
03050060   HB LAB COLLAGEN                          85576        147.65
03050053   HB LAB EPINEPHRINE FULL DOSE             85576        147.65
03050056   HB LAB EPINEPHRINE LOW DOSE              85576        147.65
03050064   HB LAB IIA/IIIB (REOPRO) ASSAY           85576        255.94
03050058   HB LAB PFA - ADP                         85576        147.65



                                              74
  Charge
   Code                    Description              CPT Code OP/Default Price   IP/ED Price
03050062   HB LAB PFA - EPINEPHRINE                  85576        147.65
03050059   HB LAB PLAVIX RESISTANCE ASSAY            85576        309.36
03050178   HB LAB RISTOCETIN FULL DOSE               85576        147.65
03050185   HB LAB RISTOCETIN LOW DOSE                85576        147.65
03050182   HB LAB SPONTANEOUS PLT AGG                85576        147.65
80000355   HB PROF PFA-ADP                           85576
03050065   HB LAB LUPUS ANTICOAG/ HEXA PL            85597        314.92
03050067   HB LAB PRO TIME            ER             85610        235.91
03050069   HB LAB PRO TIME ROU PL                    85610        177.41
03050066   HB LAB WHOLE BLOOD PROTIME                85610        235.91
03050192   HB LAB PRO TIME DIFF PL                   85611        227.01
03050072   HB LAB DIL RUSL VIPER VNM TIME            85613        296.00
03050071   HB LAB RVVT CORRECTION                    85613        432.88
03050073   HB LAB REPTILASE TIME                     85635        454.02
03050196   HB LAB SED RATE WESTEGN                   85651        208.09
03050345   HB LAB SED RATE WESTEGN*                  85651        208.09
03050338   HB HGBS PER UNIT                          85660         85.17
03050076   HB LAB SICKLE CELL SCRN                   85660        163.58
03050077   HB LAB THROMBIN TIME PL                   85670        227.01
03050120   HB LAB PTT LA                             85730        177.41
03050079   HB LAB PTT            ER                  85730        177.41
03050336   HB LAB PTT PL                             85730        230.05
03050080   HB LAB PTT DIFF PL                        85732        227.01
03050208   HB LAB VISCOSITY SE SC                    85810        183.61
03050339   HB LAB WHOLE BLOOD VISCOSITY              85810         12.25
03091946   HB LAB WHOLE BLOOD VISCOSITY              85810         12.25
03050349   HB LAB THROMBELASTOGRAPH OR               85999        566.40
03050211   HB PERIPHERAL SMEAR PREP                  85999
03091578   HB PRICE COLORADO COAG CONS               85999
80016065   HB PROF HEMATOLOGY OTHER                  85999
03091276   HB BRUCELLA AGGLUTININ                    86000         4.43
03090207   HB LAB TULAREMIA AGGLUTININ               86000         72.75
03091274   HB SALMONELLA AGGLUTININ                  86000         4.43
03091279   HB WEIL FELIX AGGLUTININ                  86000         13.42
03091275   HB WEIL FELIX AGGLUTININ        *         86000         4.44
03091841   HB ALLERGY PRF ALLERG SPEC IGE            86003         9.92
03091035   HB FOOD ALLERGY PROFILE                   86003         10.00
03091765   HB LAB CAPQ IGE                           86003         10.14
03092021   HB LAB NUT ALLERGEN PANEL                 86003         6.11
03091174   HB LAB PEDIATRIC ALLERGY PNL              86003         6.00
03090964   HB LAB SOUTH CA ALLERGY PANE              86003         7.00
03091744   HB RAST ANTIBODY                          86003         6.00



                                               75
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03091903   HB RESP REGN XIII EA ALLERGEN           86003         5.63
03020001   HB LAB ANCA                             86021        224.79
03091766   HB LAB NEUTROPHIL ANTIBODY              86021         78.50
03091336   HB LAB PAN ANCA EVAL LEUK AB            86021         12.05
03090071   HB MYELOPEROXIDASE AB                   86021         27.00
03090369   HB NEUTROPHIL AB                        86021         85.80
03090073   HB PROTEINASE-3 AB                      86021         25.35
03091974   HB DRUG DEPENDENT PLATELET AB           86022        149.00
03091709   HB LAB MGMT TISSUE TESTING              86022        103.00
03020426   HB LAB PLATELET ANTBD                   86022        736.67
03020424   HB LAB PLATELET CROSSMATCH              86022        303.79
03020926   HB LAB PLT AB - HIT PF4-HEP EIA         86022        291.55
03020002   HB PLATELET ANTIBODY SCREEN             86022        303.79
03091327   HB PLATELET CIRCULATING AB PNL          86022         47.50
03091842   HB SEROTONIN RELEASE ASSAY              86022        148.00
03090988   HB LAB ANLZR - ANTINUCLEAR ABS          86038         3.14
03090401   HB LAB PAN ANCA EVAL ANA                86038         9.70
03020434   HB LAB ANTIBODY ANA, TITER              86039        418.41
03020433   HB LAB CENTROMERE ANTIBODY              86039        418.41
03090326   HB STREPTOZYME                          86063         16.10
80000248   HB PROF CONS XMATCH IRREG AB            86077
80000386   HB PROF TRANSF REACTN INVESTIG          86078
03900075   HB TRANSFUSION REACT WORKUP             86078        479.62
80000316   HB PROF CONSULT DIRECTED DONOR          86079
80000318   HB PROF DEVIATE NORM BB PROC            86079
03020008   HB LAB C-REACT PROT CORD BL             86140        334.95
03020009   HB LAB C-REACT PROT QT                  86141        334.95
03091282   HB B2GPI IGA AB                         86146         9.80
03090308   HB B2GPI IGG AB                         86146         9.80
03090310   HB B2GPI IGM AB                         86146         9.80
03020445   HB LAB BETA 2 GLYCOPROTEIN1-IGG         86146        205.71
03020011   HB LAB BETA 2 GLYCOPROTEIN1-IGM         86146        205.71
03091106   HB CARDIOLIPIN IGA AB                   86147         15.00
03020447   HB LAB ANTIBD ANTICARDIOLIPIN           86147        183.61
03091112   HB ANTIPHOSPHATIDYLSERINE ABS           86148         24.75
03091341   HB LAB PHOSPHATIDYLSERINE ABS           86148         21.25
03091425   HB COLD AGGLUTININS                     86157         8.96
03090595   HB C1 ESTERASE INHIBITOR                86160         15.04
03091101   HB COMPLEMENT COMPONENT C2              86160         8.75
03091102   HB COMPLEMENT COMPONENT C5              86160         38.15
03091105   HB COMPLEMENT COMPONENT C6              86160         25.55
03091754   HB COMPLIMENT C1Q                       86160         15.75



                                             76
  Charge
   Code                  Description                         CPT Code OP/Default Price   IP/ED Price
03091345   HB LAB ANLZR - COMPLEMENT, AG                      86160         3.12
03091561   HB LAB C1 ESTERASE COMPL AG, EA                    86160         18.39
03020454   HB LAB COMPLMNT C3 ASSY                            86160        319.37
03020449   HB LAB COMPLMNT C4 ASSY                            86160        426.20
03091492   HB C1 ESTERASE INHIBITOR, FUNC.                    86161         29.12
03091562   HB LAB C1 EST COMPL FCN ACT EA                     86161         18.41
03090512   HB LAB TOTAL COMPLEMENT                            86162         11.20
03091652   HB LAB COCCI CF IGG                                86171         11.25
03092005   HB LAB COCCI COMP FIX TEST                         86171         16.25
03091257   HB LAB HISTO MYCELIAL AB-CF          #             86171         20.78
03091256   HB LAB HISTO YEAST AB - CF       #                 86171         20.78
03091329   HB LAB NEISSERIA GONORRHOEAE AB                    86171         66.75
03090640   HB CYC CITRULLINAT AB, IGG                         86200         20.00
03020462   HB LAB CYCLIC CITRULINATD PEP IGG                  86200        102.44
03090597   HB STREP DNASE B AB                                86215         11.20
03091801   HB STREP DNASE B AB *                              86215
03090990   HB LAB ANLZR - DNA ANTIBODY                        86225         3.56
03020017   HB LAB ANTIBD DNA 1F                               86225        409.51
03091335   HB LAB ANTIBD DNA-FARR                             86225         68.00
03020016   HB LAB DSDNA ANTIBODIES                            86225        111.16
03090264   HB LAB SENSORIMOTOR TEST 2               #         86225         32.70
03091493   HB DNA AB, SINGLE STRANDED                         86226         20.48
03090091   HB ANTI CHROMATIN AB IGG                           86235         40.05
03091958   HB CONCT TIS DIS PRF ENA EA AB                     86235         18.49
03090991   HB LAB ANLZR - NUCLEAR ANTIGEN AB                  86235         4.65
03090087   HB LAB ANTIBD PM-1                                 86235         34.00
03020023   HB LAB CENTROMERE AB                               86235        123.20
03020026   HB LAB HISTONE ANTIBODIES                          86235        123.20
03091565   HB LAB JO-1 AB, IGG                                86235         25.60
03020027   HB LAB JO-1 ANTIBODIES                             86235        123.20
03020475   HB LAB RNP ANTIBODIES                              86235        123.20
03020480   HB LAB RNP ANTIBODIES         *                    86235        123.20
03020020   HB LAB SCL 70 ANTIBODIES                           86235        123.20
03020022   HB LAB SCL 70 ANTIBODIES         *                 86235        123.20
03020029   HB LAB SM ANTIBODIES                               86235        123.20
03020028   HB LAB SM ANTIBODIES         *                     86235        123.20
03020018   HB LAB SSA ANTIBODIES                              86235        123.20
03020019   HB LAB SS-A ANTIBODIES                             86235        123.20
03020030   HB LAB SSB ANTIBODIES                              86235        123.20
03020482   HB LAB SS-B ANTIBODIES                             86235        123.20
03092002   HB ADRENAL AB W RFLX                               86255         35.00
03091281   HB ADRENAL ANTIBODY                                86255         12.95



                                                        77
  Charge
   Code                     Description                    CPT Code OP/Default Price   IP/ED Price
03091844   HB ANNA SCREEN                                   86255         40.89
03090039   HB ANTI-STRIATIONAL AB*                          86255
03090070   HB ISLET CELL AB EVALUATION                      86255         18.00
03092027   HB LAB CSF NMO                                   86255        228.65
03090249   HB LAB ENDOMYSIAL IGA AB           #             86255         42.00
03090205   HB LAB EPIDERMAL AB, IFA                         86255         59.25
03091003   HB LAB MYS GRVS FLU AB, SCRN                     86255         29.06
03090271   HB LAB NEURONAL NUCLER (HU)            #         86255         40.89
03091024   HB LAB NMO ANTIBODY                              86255        228.65
03090272   HB LAB PURKINJE CELL (YO) AB                     86255         29.70
03090251   HB LAB RETICULIN AB IGA        #                 86255         21.39
03020918   HB LAB RETICULIN AB IGG                          86255         21.45
03091942   HB LAB RETICULIN AB IGG                          86255         21.45
03090262   HB LAB SENSORY NEUROPATHY TEST2#                 86255         57.99
03091285   HB MYOCARDIAL AB                                 86255         9.50
03091901   HB OVARIAN AB, RFLX TTR (IFA)                    86255         37.00
03091314   HB OVARY ANTIBODY                                86255         32.55
03091843   HB PCCA SCREEN                                   86255         29.70
03090325   HB SENSORY NEUROPATHY TEST 4                     86255         58.00
03090126   HB STRIATIONAL AB                                86255         17.60
03091344   HB DERMAL-EPIDERMAL AB                           86256         8.42
03091343   HB INTER-EPITHELIAL AB                           86256         8.43
03020524   HB LAB ANTIBD ANTIPARIETAL                       86256        418.41
03020924   HB LAB ANTIBD MITO TITER                         86256        410.53
03020509   HB LAB ANTIBD SM MS TITER                        86256        418.41
03091549   HB STRIATED MUSCLE AB TITER                      86256         46.90
03090960   HB LAB GROWTH HORMONE AB                         86277        108.00
03020034   HB CANCER ANTIGEN 27.29                          86300        268.57
03020527   HB LAB CA 15-3                                   86300        168.24
03020526   HB LAB CA 27.29                                  86300        279.31
03091726   HB LAB CSF CA 15-3                               86300
03091727   HB LAB FLD CA 15-3 PERICARDIAL                   86300
03091721   HB LAB FLD CA 15-3 PERITONEAL                    86300
03091722   HB LAB FLD CA 15-3 PLEURAL                       86300
03020250   HB LAB - CA 19.9                                 86301        168.24
03020037   HB LAB CA 19-9                                   86301        168.24
03090909   HB LAB CSF CA 19-9                               86301         49.00
03020919   HB LAB FLD CA 19-9 PERICARDIAL                   86301         49.00
03091926   HB LAB FLD CA 19-9 PERICARDIAL                   86301         49.00
03091729   HB LAB FLD CA 19-9 PERITONEAL                    86301         49.00
03091730   HB LAB FLD CA 19-9 PLEURAL                       86301         49.00
03091725   HB FLD CA 125, PLEURAL                           86304         49.00



                                                      78
  Charge
   Code                     Description            CPT Code OP/Default Price   IP/ED Price
03090095   HB LAB CA 125                            86304        134.91
03091723   HB LAB CA125                             86304         49.00
03020186   HB LAB CA125 IA                          86304        168.24
03091728   HB LAB FLD CA 125, PERITONEAL            86304         49.00
03091878   HB HE4 OVARIAN CANCER MONITOR            86305        256.00
03020545   HB LAB ANTIBD MONO S ER                  86308        227.01
03091118   HB ALPHA FETOPROTEIN, FLUID              86316
03090941   HB CHROMAGRANIN A                        86316         55.00
03091464   HB LAB NEURONAL CELL AB, CSF             86316         73.05
03091524   HB NEURON SPECIFIC ENOLASE               86316         33.08
03091862   HB NEURON SPECIFIC ENOLASE CSF           86316         33.08
03090601   HB H. INFLUENZA B AB                     86317         11.20
03090805   HB LAB COCCI EIA IGM/IGG                 86317         11.25
03092036   HB LAB CSF IA INF AGNT AB QUAN           86317         32.21
03090398   HB LAB W NILE ANTIBODY PNL, CSF          86317         52.12
03091309   HB WEST NILE VIRUS IGG AB                86317         14.87
03090348   HB WEST NILE VIRUS IGM AB                86317         14.88
80016070   HB PROF ELECROPHER IMUNO CSF             86325
03090233   HB LAB C3 ACTIVATOR                      86329         23.45
03091495   HB TEICHOIC ACID AB                      86329         16.80
03091107   HB AB BY GEL DIFFUSION                   86331         2.59
03090806   HB LAB COCCI ID IGG & IGM                86331         16.25
03091216   HB LAB TWAR PNL ID GEL QUAL EA           86331         9.81
03091525   HB CIC RAJI CELL                         86332        157.44
03091412   HB LAB CIQ BINDING ASSAY       #         86332         19.20
03020041   HB LAB PROTEIN IFE, SERUM                86334        787.86
80016073   HB PROF ELECROPHR IMUNOFIX CSF           86334
80000255   HB PROF ELECTRPHOR IMFX CSF 14           86334
80000282   HB PROF PROTEIN IFE URINE                86334
03091624   HB LAB BETA 2 TRANSFERRIN                86335        115.00
03020042   HB LAB PROTEIN IFE, URINE                86335        827.92
03091496   HB INSULIN ANTIBODIES                    86337         41.60
03091092   HB INTRINSIC FACTOR ANTIBODY             86340         18.00
03091535   HB LAB IA-2 AB                           86341        185.60
03091167   HB LAB ISLET CELL AB W/REFLEX            86341         18.00
03091904   HB HISTAMINE RELEASE                     86343        150.00
03091780   HB LAB CU INDEX                          86343        150.00
03090370   HB CON A MITOGEN                         86353         94.75
03000027   HB LYMPHOCYTE BLASTOGENESIS              86353        1362.07
03090371   HB PHA MITOGEN                           86353         94.75
03090372   HB POKEWEED MITOGEN                      86353         94.75
03020591   HB LAB B LYMPH QUANTITATION              86355        298.51



                                              79
  Charge
   Code                     Description            CPT Code OP/Default Price   IP/ED Price
03020592   HB LAB NK LYMPH QUANTITATION             86357        298.51
03050245   HB LAB T CELLS, TOTAL COUNT              86359        305.70
03050246   HB LAB CD4 AND CD8 T CELL COUNT          86360        464.04
03020047   HB T CELL ABSOLUTE COUNT, CD4            86361        579.77
03020593   HB LAB CD34 STEM CELL QUANT              86367        464.04
03091497   HB ANTI-THYROIDPEROXIDASE AB             86376         9.60
03091346   HB LAB ANLZR - MICROSOMAL AB             86376         3.77
03020596   HB LAB ANTIBD MICROSOM                   86376        390.59
03091756   HB LIVER-KIDNEY MICROSOMAL AB            86376         14.30
03020937   HB THYROID PEROXIDASE ANTIBODY           86376        110.71
03091611   HB MYCOPLASMA AB BY IFA                  86378         8.66
03091797   HB MYCOPLASMA AB BY IFA*                 86378         8.67
03091378   HB LAB NABFERON AB TEST - NEUT           86382        268.46
03090440   HB LAB NABFERON AB TEST - NTD            86384        180.83
80000349   HB PROF BLDBK TX PLAT PAK C              86392
03092024   HB LAB STREP PNEU AG                     86403         60.75
03090751   HB FLD RHEUMATOID FACTOR, IGM            86430         41.50
03091347   HB LAB ANLZR - RHEUM FAC, QUANT          86431         1.47
03020050   HB LAB ANTIB RA QUANT                    86431        183.61
03092044   HB LAB FLD RHEUMATOID FACTOR             86431         42.75
03091785   HB LAB RA, IGA                           86431         15.00
03091784   HB LAB RA, IGG                           86431         15.00
03091786   HB LAB RA, IGG, IGA, IGM                 86431         15.00
03020930   HB TB INTRADERMAL TEST                   86465         48.15
03020607   HB LAB TB TEST CELL IMMUN, MEASUR        86480        490.43
03020929   HB SKIN TEST, CANDIDA                    86485         72.81
03020052   HB COCCIDIODOMYCOSIS SKIN TEST           86490         66.45
03610621   HB SKIN TEST; TB, ID                     86580                        19.23
03020053   HB LAB ANTIBD SY RPR QL                  86592        175.82
03050259   HB LAB SYPHILIS SCRN (S)                 86592         34.53
03091707   HB LAB TBPP BLD SER, QUALITATIVE         86592         4.52
03020055   HB STS                                   86592        104.60
03020054   HB STS (SCREENING)                       86592         34.53
03091424   HB VDRL - CORD BLOOD                     86592         7.00
03091423   HB VDRL CSF                              86592         6.40
03020056   HB FTA-ABS CONFRM                        86602         82.29
03090678   HB LAB ADENOVIRUS ANTIBODY               86603         11.20
03090076   HB ASPERGILLUS AB                        86606         3.25
03091499   HB ASPERGILLUS AB BY CF                  86606         8.82
03090607   HB ASPERGILLUS AB BY ID                  86606         8.82
03091211   HB LAB ASPERGILLUS PPT, ID               86606         75.00
03091339   HB LAB ASPIRGILLUS AB PNL                86606         20.41



                                              80
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
03091305   HB S. PNEUMO IGG AB                        86609         11.65
03091501   HB B. HENSELAE IGG                         86611         12.13
03091502   HB B. HENSELAE IGM                         86611         12.13
03090252   HB LAB BLASTOMYCOSIS - CF        #         86612         30.20
03091247   HB BORDETELLA IGA (FHA)                    86615         7.51
03091248   HB BORDETELLA IGA (PT)                     86615         7.51
03090253   HB BORDETELLA IGG (FHA)                    86615         7.50
03090254   HB BORDETELLA IGG (PT)                     86615         7.50
03091563   HB LAB B PERTUSSIS AB                      86615         19.20
03092041   HB LAB B PERTUSSIS IGA BY IB               86615         33.60
03092039   HB LAB B PERTUSSIS IGG BY IB               86615         33.60
03092040   HB LAB B PERTUSSIS IGM BY IB               86615         33.60
03090237   HB LAB ANTIBD LYME DIS W BLTIGG            86617         22.45
03090238   HB LAB ANTIBD LYME DIS W BLTIGM            86617         22.45
03090257   HB LAB LYME WESTERN BLOT IGG #             86617         11.22
03090258   HB LAB LYME WESTERN BLOT IGM #             86617         11.23
03091251   HB LAB CSF LYME AB IGG       #             86618         22.45
03091252   HB LAB CSF LYME AB IGM       #             86618         22.45
03091227   HB LYME IGG AB                             86618         11.22
03091320   HB LYME IGM AB                             86618         11.23
03091886   HB BRUCELLA IGG/IGM                        86622         38.50
03090239   HB LAB ANTIBD BRUCELLA PANEL #             86622         23.94
03091000   HB LAB BRUCELLA AB PANEL                   86622         19.60
03091503   HB CAMDODA ANTIBODY - ID                   86628         13.44
03090394   HB LAB CANDIDA ANTIBODY PANEL              86628         28.00
03090287   HB C. PNEUMONIAE IGA                       86631         4.29
03090286   HB C. PNEUMONIAE IGG                       86631         4.29
03090293   HB C. PSITTACI IGA                         86631         4.28
03090292   HB C. PSITTACI IGG                         86631         4.28
03090290   HB C. TRACHOMATIS IGA                      86631         4.29
03090289   HB C. TRACHOMATIS IGG                      86631         4.29
03090221   HB LAB ANTIBD CHLAM IGG                    86631         20.72
03091201   HB LAB C. PNEUMONIAE AB ID                 86631         14.47
03090230   HB LAB CHLAMYDIA GROUP AB                  86631         41.44
03090318   HB ANTIBD CHLAM IGM                        86632         20.72
03090288   HB C. PNEUMONIAE IGM                       86632         4.29
03090294   HB C. PSITTACI IGM                         86632         4.28
03090291   HB C. TRACHOMATIS IGM                      86632         4.28
03090198   HB LAB C. PNEUMONIAE AB ID IGM             86632         15.53
03090217   HB LAB TWAR PNL AB CHLAMYDIA IGM           86632         10.38
03091334   HB LAB COCCI CF                            86635         11.90
03020057   HB LAB COCCI IGG                           86635         94.12



                                                81
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03020662   HB LAB COCCI IGM                        86635         94.12
03020921   HB LAB COCCI PPTN (LATEX)     #         86635         28.12
03091924   HB LAB COCCI PPTN (LATEX)#              86635         28.12
03020058   HB LAB CSF COCCI IGG                    86635         94.12
03020060   HB LAB CSF COCCI IGM                    86635         94.12
03090246   HB LAB Q FEVER ANTIBODY                 86638         7.35
03091219   HB LAB ANTIBD CRYPTO                    86641         14.40
03020062   HB CMV ANTIBODY                         86644        116.06
03020671   HB CMV ANTIBODY TEST                    86644        116.06
03020672   HB CMV SCREEN                           86644        208.09
03090328   HB CSF CMV IGG                          86644         35.00
03020061   HB IDM- ANTI-CMV                        86644        116.06
03020668   HB LAB CMV AB, IGG                      86644        344.97
03091708   HB LAB CMV ANTIBODY                     86644         12.98
03092023   HB LAB CMV IGG AVIDITY                  86644         53.50
03020065   HB CMV ANTIBODY, IGM                    86645        344.97
03020675   HB LAB CMV AB, IGM                      86645        344.97
03091231   HB LAB DIPHTHERIA ANTITOXOID #          86648         29.20
03090278   HB CALIFORNIA ENCEPH AB, IGG            86651         13.61
03091258   HB CALIFORNIA ENCEPH AB, IGM            86651         13.61
03090224   HB LAB ANTIBD CA EQ ENCP                86651         14.01
03090659   HB LAB CSF MENINGO PNL CA LA CRS        86651         15.95
03020920   HB EASTERN EQ ENCEPH AB                 86652         54.75
03091919   HB EASTERN EQ ENCEPH AB                 86652         54.75
03091259   HB EASTERN EQUINE AB, IGG               86652         13.62
03091260   HB EASTERN EQUINE AB, IGM               86652         13.62
03091537   HB LAB CSF MENINGO PNL EA EQUINE        86652         15.95
03091538   HB LAB CSF MENINGO PNL ST LOUIS         86653         15.95
03090282   HB ST. LOUIS ENCEPH AB, IGG             86653         13.62
03091262   HB ST. LOUIS ENCEPH AB, IGM             86653         13.62
03091218   HB ST. LOUIS EQ ENCEPH AB               86653         17.85
03090662   HB LAB CSF MENINGO PNL W EQUINE         86654         15.95
03091791   HB LAB WESTERN EQUINE AB, IGG           86654         13.62
03090316   HB WESTERN EQ ENCEPH IGG                86654         66.37
03091288   HB WESTERN EQ ENCEPH IGM                86654         66.38
03091264   HB WESTERN EQUINE AB, IGM               86654         13.62
03091504   HB COXSACKIE B1                         86658         16.54
03090612   HB COXSACKIE B2                         86658         16.54
03090613   HB COXSACKIE B3                         86658         16.54
03091507   HB COXSACKIE B4                         86658         16.54
03091508   HB COXSACKIE B5                         86658         16.54
03091509   HB COXSACKIE B6                         86658         16.53



                                             82
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
03091215   HB LAB ANTIBD COXSACK A                   86658         9.50
03090381   HB POLIOVIRUS (TYPE 1 1-2) AB, CF         86658         8.81
03090382   HB POLIOVIRUS (TYPE 1 3) AB, CF           86658         8.82
03090617   HB EPSTEIN-BARR EARLY AG                  86663         10.24
03091511   HB LAB EPSTEIN-BARR NUCLEAR AG            86664         9.92
03091296   HB CSF EBV IGG                            86665         35.00
03020068   HB LAB ANTIBD EBV IGM                     86665        344.97
03020067   HB LAB ANTIBODY EBV IGG                   86665        344.97
03091512   HB EHRLICHIA CHAFEENSIS IGG               86666         12.64
03090620   HB EHRLICHIA CHAFEENSIS IGM               86666         12.63
03091870   HB S CEREVISIAE IGG/IGA                   86671         28.80
03091613   HB SPOROTHRIX AB                          86671         38.92
03090320   HB GIARDIA IGA AB                         86674         14.28
03090319   HB GIARDIA IGG AB                         86674         14.28
03090321   HB GIARDIA IGM AB                         86674         14.29
03090621   HB H. PYLORI IGA AB                       86677         12.80
03091514   HB H. PYLORI IGM AB                       86677         12.80
03020720   HB LAB H. PYLORI ANTIBODY                 86677        126.86
03091966   HB CSF CYSTERCERCUS ANTIBODY              86682         88.50
03091515   HB ECHINOCOCCUS IGG AB                    86682         20.80
03090304   HB ECHOVIRUS TYPE 11                      86682         6.23
03090305   HB ECHOVIRUS TYPE 30                      86682         6.23
03090301   HB ECHOVIRUS TYPE 4                       86682         6.22
03090302   HB ECHOVIRUS TYPE 7                       86682         6.23
03091280   HB ECHOVIRUS TYPE 9                       86682         6.23
03090208   HB LAB ANTIBD CYSTICER                    86682         46.20
03090222   HB LAB ANTIBD SCHISTOSOM                  86682         75.20
03090315   HB STRONGYLOIDES IGG AB                   86682         23.80
03090223   HB TOXOCARA AB                            86682         37.85
03020071   HB ANTI-HTLV I/II (SCRN/CONFRM)           86687         67.86
03020070   HB ANTI-HTLV TYPE I (SCRN/CNFRM)          86687         67.86
03020072   HB ANTI-HTLV TYPE II (SCRN/CFRM)          86688        373.90
03020074   HB ANTI-HTLV-II                           86688        373.90
03020073   HB LAB HTLV-I/HTLV-II                     86688        373.90
03020077   HB ANTI-HIV 1 WESTERN BLOT CNFRM          86689        334.95
03020075   HB ANTI-HIV 1&2 WSTRN/IMMUNO CONFRM 86689              334.95
03091914   HB HTLV WESTERN BLOT                      86689         83.20
03020076   HB LAB HIV AB WESTERN BLOT                86689        334.95
03090203   HB LAB HTLV 1/II AB                       86689         22.50
03091196   HB HEPATITIS D IGM AB                     86692         32.95
03091745   HB LAB HEPATITIS DELTA ANTIBODY           86692         30.00
03090625   HB CSF HERPES 1 AND 2 - IGG               86694         15.44



                                               83
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03091541   HB CSF MENINGO PNL HERP                   86694         23.52
03091854   HB LAB CSF MENIN PNL AB HSV NS            86694         16.81
03091857   HB CSF HSV 1 IGG                          86695         23.99
03020741   HB LAB HERPES SIMPLEX TYP 1 IGG           86695        470.71
03020742   HB LAB HERPES SIMPLEX TYP 1 IGM           86695        470.71
03090657   HB LAB HSV 1 IGG,CSF                      86695         13.50
03091858   HB CSF HSV 2 IGG                          86696         23.99
03020081   HB LAB HERPES SIMPLEX TYP 2 IGG           86696        477.39
03020925   HB LAB HERPES SIMPLEX TYP 2 IGM           86696        468.26
03090658   HB LAB HSV 2 IGG, CSF                     86696         13.50
03091338   HB LAB HISTOPLASMA AB                     86698         15.75
03091340   HB LAB HISTOPLASMA AB PNL                 86698         15.75
03091330   HB LAB HISTOPLASMA CAPSULATUM IGG         86698         67.50
03050292   HB LAB EHS HIV SCREEN                     86701        498.53
03090202   HB LAB HIV 2 IGG AB                       86702         28.00
03020083   HB ANTI-HIV 1&/OR 2(ELISA)SCRN            86703        2716.34
03020754   HB HIV-1/HIV-2 ANTIBODY SCREEN            86703        279.31
03020085   HB IDM ANTI-HIV 1&2                       86703        279.31
03090882   HB LAB TBPP HIV-1/HIV-2 SGL ASSAY         86703         14.54
03020900   HB ANTI-HBC                               86704         94.38
03020901   HB ANTI-HBC-TOTAL                         86704         94.38
03020899   HB ANTI-HBC-TOTAL-AG                      86704        104.60
03020088   HB IDM-ANTI-HBC                           86704        104.60
03020757   HB LAB HEP ANTI-HBC                       86704        163.58
03020909   HB LAB HEPATITIS B CORE AB, EIA           86704         94.38
03090886   HB LAB TBPP HEP B CORE AB, TOTAL          86704         12.78
03020923   HB LAB HEPATITIS B CORE AB, IGM           86705         92.41
03020091   HB LAB ANTI-HEP B SURF ANTIBD             86706        188.06
03020763   HB LAB HEP ANTI-HBS                       86706        143.55
03090048   HB HEPATITIS BE ANTIBODY                  86707         11.75
03020092   HB LAB ANTI-HAV TOTAL                     86708         96.94
03020093   HB LAB ANTI-HAV IGM                       86709         94.59
03090028   HB INFLUENZA VIRUS TYPES A & B            86710         10.00
03090514   HB LAB LEGIONELLA ANTIBODY                86713         11.84
03090366   HB L. BRAZILIENSIS IGG                    86717         2.76
03090367   HB L. BRAZILIENSIS IGM                    86717         2.76
03090360   HB L. DONOVANI IGG                        86717         2.75
03090361   HB L. DONOVANI IGM                        86717         2.75
03090362   HB L. MEXICANA IGG                        86717         2.75
03090363   HB L. MEXICANA IGM                        86717         2.76
03090364   HB L. TROPICA IGG                         86717         2.76
03090365   HB L. TROPICA IGM                         86717         2.76



                                               84
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03090626   HB LEPTOSPIRA AB                        86720         30.40
03090226   HB LAB ANTIBD LCM                       86727         48.00
03091855   HB LAB CSF MENINGO PNL AB; LCM          86727         15.57
03090667   HB LAB CSF MENINGO PNL LYM CHORIO       86727         23.60
03091852   HB LAB CSF MENINGO PL AB MUMPS          86735         15.78
03091197   HB LAB MUMPS IGG                        86735         9.00
03090192   HB LAB MUMPS IGM                        86735         8.50
03091277   HB MUMPS IGG AB                         86735         8.75
03091278   HB MUMPS IGM AB                         86735         8.75
03091229   HB LAB ANTIBD MYCOPLASMA CF             86738         40.89
03090277   HB LAB MYCOPLASMA IGM ANTIBODY          86738         36.00
03091900   HB MYCOPLASMA IGG/IGM, IFA              86738         53.25
03091108   HB NOCARDIA AB                          86744         5.45
03091230   HB PARVOVIRUS (B19) AB                  86747         11.80
03090093   HB BABESIA MICROTI IGG & IGM AB         86753         12.50
03091516   HB E. HISTOLYTICA IGG AB                86753         12.80
03091013   HB LAB BABESIA IGG/IGM                  86753         19.20
03091307   HB TRYPANSOMA CRUZI IGG AB              86753         14.37
03091308   HB TRYPANSOMA CRUZI IGM AB              86753         14.38
03091225   HB LAB ANTIBD RESP SYN                  86756         15.80
03091884   HB RICKETTSIA IGG TITER                 86757         7.88
03091885   HB RICKETTSIA IGM TITER                 86757         7.88
03090373   HB SPOTTED FEVER IGG AB                 86757         13.32
03090374   HB SPOTTED FEVER IGM AB                 86757         13.33
03091293   HB TYPHUS FEVER AB IGG                  86757         7.87
03091294   HB TYPHUS FEVER AB IGM                  86757         7.88
03020803   HB LAB ANTIBD RUBELLA                   86762        227.01
03020805   HB LAB ANTIBD RUBELLA CORD BL           86762        227.01
03091428   HB RUBELLA IGM ANTIBODY                 86762         9.60
03020096   HB LAB ANTIBD MEASLES IGG               86765        180.27
03090663   HB LAB CSF MENINGO PNL RUBELLA          86765         15.59
03090629   HB MEASLES IGG                          86765         11.03
03091518   HB MEASLES IGM                          86765         11.03
03090236   HB LAB ANTIBD TETANUS ANTITOXID#        86774         26.20
03091892   HB AB; TOXOPLASMA                       86777         58.50
03091297   HB CSF TOXO IGG                         86777         36.20
03020818   HB LAB ANTIBD TOX IGG                   86777        344.97
03091893   HB AB; TOXOPLASMA, IGM                  86778         58.50
03020819   HB LAB ANTIBD TOXO IGM                  86778        344.97
03020893   HB LAB TOXO IGM - EIA                   86778        344.97
03091895   HB CSF T PALLIDUM IGG (IFA)             86780         11.20
03020825   HB LAB ANTIBD SY FTA                    86780        553.06



                                             85
  Charge
   Code                      Description            CPT Code OP/Default Price   IP/ED Price
03020102   HB LAB ANTIBD SY FTA CSF                  86780        553.06
03091204   HB LAB FTA-ABS (IGM)                      86780         15.00
03090605   HB T. PALLIDUM AB, IGM                    86780         18.20
03091226   HB TRICHINELLA AB                         86784         23.63
03090220   HB LAB ANTIBD VZACIF                      86787         40.80
03091853   HB LAB CSF MENINGO PL AB VZ               86787         15.59
03091540   HB LAB CSF MENINGO PNL VAR-ZOS            86787         23.52
03020927   HB LAB VARICELLA ZOSTER IGG               86787        217.99
03090261   HB LAB VARICELLA ZOSTER IGM AB #          86787         21.08
03090231   HB VARICELLA ZOSTER ACIF                  86787         18.02
03090327   HB VARICELLA ZOSTER IGM                   86787         18.02
03091851   HB LAB CSF MENN PL WNV AB, IGM            86788         20.64
03091850   HB LAB CSF MENIN PNL WNV AB               86789         17.61
03091519   HB DENGUE FEVER AB                        86790         20.32
03091310   HB HANTAVIRUS IGG AB                      86790         63.52
03091311   HB HANTAVIRUS IGM AB                      86790         63.53
03090874   HB HERPES VIRUS 6, IGG                    86790         14.32
03091312   HB HERPESVIRUS 7 IGG AB                   86790         21.87
03090352   HB HERPESVIRUS 7 IGM AB                   86790         21.88
03091318   HB HERPESVIRUS 8 IGG AB                   86790         48.06
03091913   HB HTLV I/II AB                           86790         12.80
03090666   HB LAB CSF MENINGO PNL VIR NES            86790         23.52
03091332   HB LAB HEPATITIS E IGG                    86790         50.25
03090396   HB LAB HEPATITIS E IGM                    86790         50.25
03091333   HB LAB HEPATITIS E IGG AND IGM            86790         15.05
03090883   HB LAB TBPP VIRUS ANTIBODY NOS            86790         13.66
03090067   HB PARAINFLUENZA AB                       86790         4.91
03090876   HB PARAINFLUENZA AB             *         86790         4.92
03020104   HB WNV-NAT TESTING                        86790        104.24
03091890   HB Y ENTEROCOLITICA IGG/IGA               86793         63.75
03090383   HB YERSINIA ENTEROCOLITICA AB             86793         5.68
03020105   HB LAB ANTIBD THYROGLOB                   86800        390.59
03090411   HB LAB THYROGLOBULIN ANTIB                86800         28.00
03091991   HB THYROGLOB PNL THYROGLOB AB             86800         27.00
03020936   HB THYROGLOBULIN ANTIBODY IGG             86800        120.22
03020108   HB ANTI-HCV (SCRN/CNFRM)                  86803        111.76
03020106   HB IDM- ANTI-HCV SCRN                     86803        111.76
03020109   HB IDM-HSV                                86803        111.76
03020860   HB LAB HEP C ANTIBD                       86803        163.58
03091705   HB LAB TBPP HEPATITIS C AB TEST           86803         15.13
03020110   HB IDM-ANTI-HCV CONFRM                    86804        121.23
03091182   HB LAB HEPATITIS C AB, RIBA               86804         57.75



                                               86
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03020139   HB AUTO B-CELL XM NO DTT                86805        886.90
03020133   HB AUTO B-CELL XM NO DTT-GLYCINE        86805        886.90
03020111   HB AUTO B-CELL XM NO DTT-IVIG           86805        886.90
03020147   HB AUTO B-CELL XM W/DTT                 86805        886.90
03020141   HB AUTO T-CELL XM NO DTT                86805        886.90
03020136   HB AUTO T-CELL XM NO DTT-GLYCINE        86805        886.90
03020137   HB AUTO T-CELL XM NO DTT-IVIG           86805        886.90
03020142   HB AUTO T-CELL XM WITH DTT              86805        886.90
03020146   HB B-CELL XM W/DTT                      86805        886.90
03020129   HB GLYCINE AUTO B-CELL XM W/DTT         86805        886.90
03020148   HB GLYCINE AUTO T-CELL XM WITH DT       86805        886.90
03020122   HB GLYCINE B-CELL XM NO DTT             86805        886.90
03020144   HB GLYCINE B-CELL XM W/DTT              86805        886.90
03020135   HB GLYCINE T-CELL XM NO DTT             86805        886.90
03020134   HB GLYCINE T-CELL XM W/DTT              86805        886.90
03020140   HB HLA B CELL X-MATCH/SERUM             86805        1191.81
03020114   HB HLA T CELL X-MATCH/SERUM             86805        1191.81
03020130   HB IVIG AUTO B-CELL XM W/DTT            86805        886.90
03020121   HB IVIG AUTO T-CELL XM WITH DTT         86805        886.90
03020132   HB IVIG B-CELL XM NO DTT                86805        886.90
03020138   HB IVIG B-CELL XM W/DTT                 86805        886.90
03020116   HB IVIG T-CELL XM NO DTT                86805        886.90
03020145   HB IVIG T-CELL XM W/ DTT                86805        886.90
03020127   HB REVERSE B-CELL XM NO DTT-CDC         86805        886.90
03020112   HB REVERSE B-CELL XM WITH DTT-CDC       86805        886.90
03020131   HB REVERSE T-CELL XM NO DTT-CDC         86805        886.90
03020128   HB REVERSE T-CELL XM WITH DTT-CDC       86805        886.90
03020123   HB T-CELL CROSSMATCH WITH DTT           86805        886.90
03020152   HB CLASS II IVIG QS NO DTT              86806        388.37
03020151   HB CLASS II IVIG QS W/DTT               86806        388.37
03020153   HB CLASS II QUICK SCREEN NO DTT         86806        388.37
03020150   HB CLASS II QUICK SCREEN W/DTT          86806        388.37
03020175   HB HLA LYMPHOCYTE AUTOANTIBODY          86806        540.82
03020149   HB LYMPHOCYTE AUTO AB W/DTT             86806        402.83
03020155   HB AS & ID W/DTT                        86807        496.31
03020161   HB CLASS II ATB SCREEN NO DTT           86807        635.41
03020169   HB CLASS II ATB SCREEN W/DTT            86807        635.41
03020163   HB CLASS II IVIG SCREEN NO DTT          86807        635.41
03020171   HB CLASS II IVIG SCREEN W/DTT           86807        635.41
03020156   HB GLYCINE AS & ID NO DTT               86807        496.31
03020164   HB GLYCINE AS & ID W/DTT                86807        496.31
03020158   HB HLA ANTIBODY SRN & ID/SERUM          86807        666.57



                                             87
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
03020165   HB IVIG AS & ID NO DTT                  86807        496.31
03020162   HB IVIG DTT-AS & ID W/DTT               86807        496.31
03020184   HB ANTIBODY QUICKSCREEN WITH DTT        86808        407.28
03020185   HB GLYCINE QS NO DTT                    86808        407.28
03020181   HB GLYCINE QS W/DTT                     86808        407.28
03020173   HB HLA ANTIBODY QUICK SRN/SERUM         86808        548.61
03020183   HB IVIG AB QS NO DTT                    86808        407.28
03020182   HB IVIG AB QS W/DTT                     86808        407.28
03020003   HB HLA B27 TYPING                       86812        340.52
03090038   HB LAB HLA B27 TYPING                   86812
03010342   HB A LOCUS SEQUENCING                   86813        469.09
03020197   HB A,B,C TYPING, LOW RESOLUTION         86813        469.09
03011961   HB B LOCUS SEQUENCING                   86813        469.09
03011962   HB C LOCUS SEWUENCING                   86813        469.09
03020203   HB CORD HR-A,B,C, TYPING STD            86813        1971.48
03010329   HB GENERIC ABC OLIGO                    86813        859.08
03020201   HB HIGH RESOLUTION A,B,C TYP URG        86813        469.09
03020189   HB HLA A,B,C TYPING                     86813        1072.74
03010313   HB LUMINEX TYPING CLASS I A LOCUS       86813        469.09
03011867   HB LUMINEX TYPING CLASS I ABC           86813        859.08
03010318   HB LUMINEX TYPING CLASS I B LOCUS       86813        469.09
03011866   HB LUMINEX TYPING CLASS I C LOCUS       86813        469.09
03020865   HB PROCESS HLA MATCHING                 86813        469.09
03020866   HB PROCESS PLT HLA MATCHING             86813        592.01
03020205   HB CORD IR CONFIM TYPING STD            86816        1251.90
03010312   HB DPA OLIGO                            86817        442.19
03010309   HB DPB OLIGO                            86817        905.82
03010322   HB DQA OLIGO                            86817        899.14
03010326   HB DQB OLIGO                            86817        674.36
03011963   HB DRB LOCUS SEQUENCING                 86817        442.19
03010308   HB DRB1 COMPLETE OLIGO                  86817        1362.07
03010289   HB DRB1*04 OLIGO                        86817        442.19
03011860   HB DRB3 OLIGO                           86817        442.19
03010314   HB DRB4 OLIGO                           86817        442.19
03010325   HB DRB5 OLIGO                           86817        442.19
03010323   HB GENERIC DR OLIGO                     86817        899.14
03020206   HB HIGH RESOLUTION-DPB1 TYP, STD        86817        442.19
03020219   HB HIGH RESOLUTION-DPB1 TYP, URG        86817        442.19
03020209   HB HIGH RESOLUTION-DQB1 TYP, STD        86817        442.19
03020210   HB HIGH RESOLUTION-DQB1 TYP, URG        86817        442.19
03020225   HB HIGH RESOLUTION-DRB1 TYP, STD        86817        442.19
03020226   HB HIGH RESOLUTION-DRB1 TYP, URG        86817        442.19



                                             88
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03020213   HB HIGH RESOLUTION-DRB2 TYP, STD          86817        442.19
03020229   HB HIGH RESOLUTION-DRB2 TYP, URG          86817        442.19
03020214   HB HIGH RESOLUTION-DRB3 TYP, STD          86817        442.19
03020231   HB HIGH RESOLUTION-DRB3 TYP, URG          86817        442.19
03020216   HB HIGH RESOLUTION-DRB4 TYP, STD          86817        442.19
03020233   HB HIGH RESOLUTION-DRB4 TYP, URG          86817        442.19
03020217   HB HIGH RESOLUTION-DRB5 TYP, STD          86817        442.19
03020235   HB HIGH RESOLUTION-DRB5 TYP, URG          86817        442.19
03020222   HB HLA DR,DQ TYPING *                     86817        886.90
03020207   HB INTERMDT RES-DPB1 TYP, STD             86817        442.19
03020208   HB INTERMDT RES-DPB1 TYP, URG             86817        442.19
03020211   HB INTERMDT RES-DQB1 TYP, STD             86817        442.19
03020221   HB INTERMDT RES-DQB1 TYP, URG             86817        442.19
03020227   HB INTERMDT RES-DRB1 TYP, STD             86817        442.19
03020228   HB INTERMDT RES-DRB1 TYP, URG             86817        442.19
03020224   HB INTERMDT RES-DRB2 TYP, STD             86817        442.19
03020230   HB INTERMDT RES-DRB2 TYP, URG             86817        442.19
03020232   HB INTERMDT RES-DRB3 TYP, URG             86817        442.19
03020234   HB INTERMDT RES-DRB4 TYP, STD             86817        442.19
03020220   HB INTERMDT RES-DRB4 TYP, URG             86817        442.19
03020236   HB INTERMDT RES-DRB5 TYP, STD             86817        442.19
03020218   HB INTERMDT RES-DRB5 TYP, URG             86817        442.19
03020212   HB IR A,B,DRB3,4,5,HR DRB1 URG            86817        442.19
03020223   HB IR-DB TYPING                           86817        442.19
03011865   HB LUMINEX MIC TYPING                     86817        859.08
03010330   HB LUMINEX TYPING CLASS II DQA1           86817        899.14
03010319   HB LUMINEX TYPING CLASS II DQB1           86817        674.36
03010321   HB LUMINEX TYPING CLASS II DRB1           86817        899.14
03010306   HB LUMINEX TYPING CLASS II DRB3,4         86817        442.19
03020240   HB HR A,B,DRB1,IR DR3,4,5 STD             86821        441.96
03020237   HB HR A,B,DRB1,IR DR3,4,5 URG             86821        441.96
03020239   HB IR A,B,DRB3,4,5,R DRB1 STD             86821        441.96
03000282   HB FACS AUTO B-CELL-1ST SERUM             86825        1181.79
03000283   HB FACS AUTO T-CELL-1ST SERUM             86825        1181.79
03000281   HB FACS B-CELL XM-1ST SERUM               86825        1181.79
03000280   HB FACS T-CELL XM-1ST SERUM               86825        1181.79
03000278   HB FACS AUTO B-CELL ADDLSERA/D            86826        1181.79
03000279   HB FACS AUTO T-CELL ADDLSERA/D            86826        1181.79
03000277   HB FACS B-CELL XM-ADDLSERA/DIL            86826        1181.79
03000276   HB FACS T-CELL XM-ADDLSERA/DIL            86826        1181.79
03020241   HB BLOOD SAMPLE                           86849        519.45
03091879   HB CIRCULAT TUMOR CELLS BREAST            86849        580.00



                                               89
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03091880   HB CIRCULAT TUMOR CELLS, COLON            86849        580.00
03091881   HB CIRCULAT TUMOR CELLS, PROST            86849        580.00
03020868   HB AB SCREEN FICIN (EZ)                   86850         87.35
03900001   HB AB SCREEN LISS                         86850         87.35
03900003   HB AB SCREEN, GEL                         86850        248.15
03900005   HB ANTIBODY ELUTION (RBC)                 86860        620.94
03900101   HB ANTIBODY ELUTION (RBC) - ARC*          86860        529.69
03900004   HB RBC ANTIBODY ELUTION                   86860        436.22
03900011   HB ANTIBODY I.D. GEL                      86870        182.02
03900009   HB ANTIBODY I.D. GEL EZ                   86870        182.02
03900008   HB ANTIBODY I.D. LISS                     86870        182.02
03900012   HB ANTIBODY I.D. PEG                      86870        182.02
03900007   HB ANTIBODY RBC IDENTIFICATION            86870        185.84
03900010   HB DIL OF PLASMA BY TITRATI               86870        182.02
03900013   HB CORD BLOOD SCREEN                      86880        446.23
03900017   HB DAT (COOMBS) IGG                       86880         66.77
03900016   HB DAT C3                                 86880         76.78
03900014   HB DAT C3D                                86880         86.80
03020875   HB DAT, POLYSPECIFIC                      86880        279.31
03900094   HB ANTIBODY RBC TITRE                     86886        279.31
03900113   HB ANTIBODY RBC TITRE*                    86886
03020880   HB TITRATION EACH                         86886        113.51
03000029   HB PROCESS AUTOLOGUS UNIT                 86890        800.66
03000255   HB PROCESS AUTOLOOUS UNIT                 86890        800.66
03900021   HB ALLO BM/PBSC DONOR ABO *               86900         87.91
03900020   HB PATIENT ABO TYPE                       86900         87.91
03900022   HB ALLO BM/PBSC DONOR RH (D)              86901         87.91
03900023   HB PATIENT RH TYPE                        86901         87.91
03900078   HB AG SCREEN UNIT HIGH INCI               86902        296.25
03900079   HB AG SCREEN UNIT HIGH INCI - ARC         86902        296.25
03000030   HB AG TYPE /UNIT/AG                       86902        296.25
03900026   HB AG TYPE /UNIT/AG - LARC                86902        296.25
03900081   HB PRE SC UNIT PT                         86904         76.90
03900028   HB RBC PHENO PT/BLD GRP AG                86905        133.54
03900084   HB RH PHENOTYPE                           86906        113.51
03900030   HB ALLO BM/PBSC CROSSMATCH                86920        322.71
03900031   HB I. S. CROSSMATCH                       86920        322.71
03900032   HB INC. CROSSMATCH PRE WARM               86921        291.16
03900086   HB AHG CROSSMATCH                         86922        436.22
03900097   HB LAB ELECTRONIC CROSSMATCH              86923        272.64
03900034   HB PLASMA THAW FFP                        86927         86.80
03900035   HB HLA LYMPHOCYTE PREP                    86930        393.93



                                               90
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
03900037   HB DONATH LANDSTEINER, BLOOD             86941        446.23
03900036   HB HEMOL/AGGLUTININ INCUBA               86941        385.03
03000031   HB IRRADIATION OF BLOOD PRODUCT          86945        145.58
03900089   HB POOLING PLATELETS                     86965        338.29
03000033   HB PROCESS OUTSIDE POOL CRYO             86965        531.92
03900090   HB PROCESS POOLING CRYO                  86965        564.19
03900103   HB PRETREAT RBC'S/DRUGS*                 86970        1126.15
03900039   HB PRETREAT RBC'S ENZM EA                86971        131.31
03900102   HB PRETREAT RBC'S ENZM EA - ARC*         86971        123.52
03900105   HB INCUBATE SERA W DRUGS/CH*             86975        1636.93
03900092   HB PRETREAT RBC'S/DRUGS - ARC            86975        1126.15
03900043   HB INHIBITION                            86977        150.23
03900045   HB PT. SERA DIFF ABSORPTION              86978        352.76
03900044   HB PT. SERA DIFF ABSORPTION - ARC        86978        332.73
03900100   HB SPLIT BLD/BLD COMP*                   86985        242.59
03900096   HB THAWING RARE RBC PREP                 86999        140.21
03060002   HB CONCENTRATION - ANY TYPE              87015         54.02
03060210   HB CONCENTRATION - STOOL                 87015         65.66
03060005   HB CONCENTRATION, CSF FOR GS             87015         54.02
03060212   HB LAB CONCENTRATION(BROTH ENRICH        87015         54.02
03060004   HB LAB SPECIMEN CONCENTRATIO             87015         54.02
03060207   HB LAB SPECIMEN CONCENTRATION            87015         57.87
03060571   HB CORD BLOOD/STEM CELL CX               87040         83.49
03060218   HB LAB BLOOD STEM CELL CULTURE           87040         90.14
03060215   HB LAB CULT BAC BLOOD                    87040        514.11
03060008   HB LAB CULT BLOOD BRUCELLA ONLY          87040        514.11
03060007   HB LAB CULT BLOOD LEGIONELLA             87040        485.18
03060012   HB CULTURE, BACT FECAL ROUTINE           87045        200.30
03060223   HB ADDITIONAL PATHOGENS                  87046         93.48
03060013   HB SRN VRE C. DIFF TOX POS STOOL         87046        101.26
03060241   HB CULTURE ANY SOURCE                    87070        342.74
03060016   HB LAB CULT RESPIR CYSTIC FIBRO          87070        194.74
03060239   HB LAB CULT RESPIRATORY QUANT            87070        446.23
03060015   HB LAB CULTURE ABSCESS                   87070        262.62
03060240   HB LAB CULTURE BONE                      87070        262.62
03060244   HB LAB CULTURE BONE MARROW               87070        262.62
03060033   HB LAB CULTURE CATHETER TIP              87070        446.23
03060028   HB LAB CULTURE CSF                       87070        262.62
03060023   HB LAB CULTURE EAR                       87070        262.62
03060243   HB LAB CULTURE ENVIRONMENTAL             87070        446.23
03060247   HB LAB CULTURE EYE                       87070        262.62
03060030   HB LAB CULTURE FLUID                     87070        262.62



                                              91
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03060024   HB LAB CULTURE GASTRIC                  87070        248.15
03060238   HB LAB CULTURE GENITAL                  87070         69.60
03060227   HB LAB CULTURE RESPIRATORY              87070        446.23
03060036   HB LAB CULTURE SKIN                     87070        262.62
03060299   HB LAB CULTURE STERILE GENITAL          87070        262.62
03060598   HB LAB CULTURE STERILE RESPIRTY         87070        420.64
03060237   HB LAB CULTURE TISSUE                   87070        262.62
03060246   HB LAB CULTURE UMBILICUS                87070        248.15
03060029   HB LAB CULTURE WOUND                    87070        262.62
03060567   HB LAB UPPER RESP CULTURE               87070        273.75
03000272   HB MODIFIED GENITAL CULTURE             87070
03060249   HB LAB CULT BAC-ANAROB                  87075        772.28
03060248   HB LAB CULTURE ACTINOMYCES              87075        772.28
03060579   HB LAB ANA DEFIN ID 2 ORGS              87076        101.90
03060583   HB LAB ANA DEFIN ID 3 ORGS              87076        146.29
03060578   HB LAB ANA DEFIN ID 4 ORGS              87076        243.74
03060042   HB LAB ANA DEFIN ID, EACH ORG           87076        101.90
03060039   HB LAB ANAEROBE IDENTIFICATION          87076        101.90
03060040   HB LAB CHLAMYDIA ADNL WORK              87076        126.86
03060041   HB LAB CULT ADNL WORKUP                 87076        251.49
03060043   HB LAB IDENTIF, BACTERIAL               87076        446.23
03060046   HB LAB BACTERIAL ANTGEN DETECT          87077        119.07
03060581   HB LAB BACTI ADD ID 2 ORGS              87077         99.32
03060582   HB LAB BACTI ADD ID 3 ORGS              87077        148.99
03060589   HB LAB BACTI ADD ID 4 ORGS              87077        198.63
03060576   HB LAB BACTI ADD ID 5 ORGS              87077        248.30
03060587   HB LAB BACTI ADD ID 6 ORGS              87077        297.95
03060592   HB LAB BACTI ADD ID 7 ORGS              87077        334.25
03060267   HB LAB BACTI ADDNL. ID, EACH            87077         95.70
03060271   HB LAB URINE DEFIN ORG ID, EACH         87077         70.11
03060590   HB LAB URINE ID 2 ORGS                  87077         85.18
03060586   HB LAB URINE ID 3 ORGS                  87077         69.06
03060588   HB LAB URINE ID 4 ORGS                  87077        170.35
03091968   HB ACANTHAMOEBA/NAEGLERIA CULT          87081        135.00
03060050   HB LAB BETA STREP SCREEN                87081        227.01
03060611   HB LAB CULT BAC-GC                      87081        222.59
03060053   HB LAB CULT BAC-PERTUS                  87081        227.01
03060615   HB LAB CULT BAC-STREP A                 87081        222.59
03060048   HB LAB CULT LEGIONELLA                  87081        413.96
03060618   HB LAB CULT STOOL-VIBRIO                87081        472.75
03060613   HB LAB SURVEILLANCE CULTURE             87081        222.59
03060607   HB LAB UPPER RESP CULT MRSA SCRN        87081        168.48



                                             92
  Charge
   Code                    Description           CPT Code OP/Default Price   IP/ED Price
03060608   HB LAB YERSINIA CULTURE                87081         55.99
03060617   HB MRSA SCREEN ONLY                    87081         53.21
03060058   HB CULTURE, URINE                      87088        506.32
03060306   HB LAB CULT URINE STERILE              87088        506.32
03060059   HB LAB CULT FUNG UNSPCF                87102        514.11
03060309   HB LAB CULT FUNG BLOOD                 87103        514.11
03060597   HB LAB FUNGAL BLD CULTURE PEDS         87103        514.11
03060612   HB LAB HISTOPLASMA BLD CULT            87103        503.92
03060293   HB LAB FUNG DEFIN. ID, 1ST ORG         87106         90.14
03060296   HB LAB FUNG DEFIN. ID, 2ND ORG         87106         90.14
03060295   HB LAB FUNG DEFIN. ID, 3RD ORG         87106         90.14
03060294   HB LAB FUNG DEFIN. ID, 4TH ORG         87106         84.57
03060292   HB LAB IDENTIF, FUNGAL                 87106        514.11
03060298   HB LAB CULT BLOOD MYCOPLASMA           87109        514.11
03060570   HB LAB GENITAL MYCOPLASMA CULT         87109        481.84
03091195   HB LAB RESP MYCOPLASMA CULT            87109         45.00
03060070   HB CHLAMYDIA PNEUMONIAE                87110        158.54
03060301   HB LAB CHLAMYDIA CULTURE               87110        224.79
03060303   HB CULTURE, AFB UNSPECIFIED            87116        514.11
03060073   HB LAB CULT AFB BLOOD                  87116        514.11
03060307   HB AFB DEFIN ID, 1ST ORG               87118         90.14
03060305   HB LAB AFB DEFIN. ID, 2ND ORG          87118         90.14
03060308   HB LAB AFB ID                          87118        545.27
03060079   HB LAB SEROLOGIC ID, BACTERIA          87147         37.86
03060077   HB LAB SEROTYPING, EACH ORG            87147         48.96
03060311   HB MEC A GENE MUTATION                 87147
03060082   HB BACT ID BY FLUOR - ENC              87149        162.08
03060314   HB BACT ID BY FLUOR - STAPH            87149        254.83
03060315   HB BACT ID BY FLUOR - YST              87149        254.83
03060620   HB BACT ID NA PRB FA - BIFN            87149        162.08
03060083   HB LAB DARKFIELD EXAMINATION           87164        395.04
80000358   HB PROF DARKFIELD SMEAR INTERP         87164
03060084   HB LAB MICRO PINWORMS                  87172        173.60
03060085   HB TISSUE GRINDING                     87176        171.37
03060086   HB LAB O & P DIRECT WET MOUNT          87177        103.49
03060087   HB LAB O&P CONC/IODN MNT NONSTO        87177        103.49
03060089   HB LAB O&P CONC/WET MOUNT STOOL        87177        206.98
03060088   HB LAB STRING TEST                     87177        213.66
03060090   HB WET MOUNT                           87177         97.93
03060324   HB LAB AFB ETEST SUSC, EACH DRUG       87181        145.78
03060326   HB LAB ETEST MIC, EACH DRUG            87181         53.41
03060093   HB LAB FUNGAL SENSI, EACH DRUG         87181        143.55



                                            93
  Charge
   Code                 Description                  CPT Code OP/Default Price   IP/ED Price
03060095   HB CLIND INDUCED RES.TEST                  87184         55.71
03060097   HB LAB SENSI CONFIRMATION, EACH            87184         60.09
03060096   HB LAB SUSCEPT KB                          87184        314.92
03060094   HB OX PLATE SCREEN 1                       87184         55.71
03060335   HB BETA LAC ENZ DETECT                     87185         53.41
03091916   HB GONOCOCCUS SENSI                        87186        162.00
03060101   HB LAB CONFIRM AGAR DIL MIC                87186         69.94
03060599   HB LAB FUNGAL MIC                          87186         57.75
03090243   HB LAB FUNGAL MIC                          87186         56.25
03091927   HB LAB FUNGAL MIC                          87186         57.75
03091795   HB LAB FUNGAL MIC*                         87186         57.00
03060616   HB LAB SENST BAC ANAERO                    87186        757.08
03060339   HB LAB SUSCEPT MIC                         87186        446.23
03060596   HB LAB MIC 1 DRUG          #               87187         83.72
03091928   HB LAB MIC 1 DRUG#                         87187         83.72
03060601   HB LAB MIC/MBC                             87187         83.72
03091929   HB LAB MIC/MBC                             87187         83.72
03060602   HB LAB MIC/MBC DRUG (UCLA)      #*         87187         83.72
03091930   HB LAB MIC/MBC DRUG (UCLA) #*              87187         83.72
03091359   HB MIC/MBC UCLA 2 DRUGS                    87187
03091360   HB MIC/MBC UCLA 3 DRUGS                    87187
03091361   HB MIC/MBC UCLA 4 DRUGS                    87187
03091362   HB MIC/MBC UCLA 5 DRUGS                    87187
03091363   HB MIC/MBC UCLA 6 DRUGS                    87187
03060600   HB LAB ANTIBIOTIC SYNER*                   87188        209.90
03091922   HB LAB ANTIBIOTIC SYNER*                   87188        209.90
03091356   HB LAB SYNERGY DRUG SET         #          87188        209.90
03091357   HB SYNERGY 3 DRUG SETS                     87188        629.90
03060610   HB AFB TB SUSCEPT, EACH DRU                87190         64.48
03090332   HB ANTIMCROB AFB PRIM, DRUG 1              87190         17.10
03091299   HB ANTIMCROB AFB PRIM, DRUG 2              87190         17.10
03090334   HB ANTIMCROB AFB PRIM, DRUG 3              87190         17.10
03091300   HB ANTIMCROB AFB PRIM, DRUG 4              87190         17.10
03090336   HB ANTIMCROB AFB PRIM, DRUG 5              87190         17.10
03091301   HB ANTIMCROB AFB SEC, DRUG 1               87190         7.83
03091302   HB ANTIMCROB AFB SEC, DRUG 2               87190         7.84
03091303   HB ANTIMCROB AFB SEC, DRUG 3               87190         7.84
03090340   HB ANTIMCROB AFB SEC, DRUG 4               87190         7.84
03090341   HB ANTIMCROB AFB SEC, DRUG 5               87190         7.84
03090342   HB ANTIMCROB AFB SEC, DRUG 6               87190         7.84
03091200   HB LAB AFB PRIM/SECON SUS PANEL            87190         14.25
03090196   HB LAB AFB PRIMARY PANEL SUS               87190         9.40



                                                94
  Charge
   Code                  Description                  CPT Code OP/Default Price   IP/ED Price
03060593   HB LAB BACTEC AFB SENSI, 1 DRUG             87190         72.82
03091364   HB LAB SERUM CIDAL                          87197         97.66
03060609   HB LAB GRAM ST UNSPCFD                      87205        179.94
03060106   HB LAB GRAM STAIN FOR BV SCREEN             87205        183.61
03060605   HB LAB MICRO GIEMSA                         87205        340.56
03060388   HB LAB MICRO WBC FE                         87205        151.34
03060107   HB LAB MICRO WRIGHT ST                      87205        127.97
03060603   HB LAB MICRO WRIGHT ST                      87205        127.97
03060619   HB LAB RHODAMINE AUROMN                     87206        496.33
03060114   HB SMEAR, AFB STOOL                         87206         65.66
03060614   HB SMEAR, AFB UNSPECIFIED                   87206         61.97
03060112   HB ZIEHL-NEELSEN STAIN-CONF                 87206        100.15
03060116   HB LAB MICRO MALARIA BL                     87207        183.61
03060118   HB LAB MICRO TZANCK                         87207        328.28
03060400   HB LAB MICROSPORIDIUM STAIN                 87207         89.02
03060401   HB LAB O&P TRICHROME STAIN                  87209        206.98
03060121   HB LAB (KOH) FUNGAL EXAM                    87210        189.18
03060123   HB LAB INDIA INK CRYPTO                     87210        175.82
03060337   HB LAB WETMT FUNG                           87210        151.34
03060120   HB LAB WETMT FUNG UNSPC                     87210        215.88
03060405   HB LAB C DIFF CYTOTOXIN                     87230        159.74
03060595   HB LAB C DIFF TOX CONFIRMATION              87230        209.38
03060577   HB LAB CMV CULTURE, URINE                   87252        210.88
03060591   HB LAB CULTURE, BLOOD, VIRAL                87252        210.88
03060584   HB LAB CULTURE, VIRAL                       87252        210.88
03060406   HB LAB RHINOVIRUS ID                        87252        210.88
03091366   HB LAB VIR SUSC INNOC/OBS 1 DRG#            87252         33.00
03060422   HB LAB VIRUS INOCULATION, TISSUE            87252        210.88
03091326   HB POLIOVIRUS ISOL - INNOC                  87252         32.10
03091235   HB LAB ENTEROVIRUS TYPING         #         87253        207.75
03091379   HB LAB NABFERON AB TEST - TIS CLT           87253        145.71
03090426   HB LAB VIR SUSC ADDN STUD 1                 87253         12.00
03090241   HB LAB VIRUS IDENTIFICATION      #          87253        169.50
03091325   HB POLIOVIRUS INNOC STUDY                   87253         11.23
03060438   HB LAB VIR RAP INFLU A & B CULT             87254        255.94
03060436   HB LAB VIR RAPID SHELL VIAL CX              87254         86.80
03060437   HB LAB VIR SHELL VIAL FA STAIN              87254         57.87
03060129   HB LAB VIRUS INOCULATION, SHELL V           87254         86.80
03060132   HB LAB GENET VIRUS ISOLATE, HSV             87255        273.90
03060623   HB LAB ADENOVIRUS AG, DFA                   87260         74.60
03060629   HB LAB ADENOVIRUS DFA STAIN                 87260         72.71
03060636   HB RESP LIQUID DFA ADENOVIR                 87260        232.49



                                                 95
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
03091236   HB LAB B PERTUSS FLUORES STAIN #       87265         11.00
03060441   HB LAB GIARDIA DFA                     87269        120.18
03060443   HB LAB CHLAMYDIA CONFIRMATION          87270         72.71
03060135   HB LAB CHLAMYDIA DFA                   87270         72.71
03060624   HB LAB CYTOMEGALOVIRUS AG,DFA          87271         73.53
03060136   HB LAB CRYPTO DFA                      87272        120.18
03060138   HB LAB HERPES TYPE TWO DFA             87273        158.02
03060594   HB LAB HSV TYPE 2 FA                   87273        154.51
03060139   HB LAB HERPES TYPE ONE DFA             87274        158.02
03060140   HB LAB HSV TYPE 1 FA                   87274        149.12
03060628   HB LAB INFLUENZA B DFA STAIN           87275         75.10
03060634   HB RESP LIQUID DFA INFL B              87275        240.13
03060141   HB LAB INFLUENZA A IFA STAIN           87276         72.71
03060633   HB RESP LIQUID DFA INFL A              87276        232.49
03060630   HB LAB PARAINF TYP 1 DFA STAIN         87279         75.10
03060631   HB LAB PARAINF TYP 2 DFA STAIN         87279         75.10
03060632   HB LAB PARAINF TYP 3 DFA STAIN         87279         75.10
03060625   HB LAB RSV AG,DFA                      87280         74.60
03060450   HB LAB RSV DIRECT EXAM                 87280        285.69
03060142   HB LAB RSV IFA STAIN                   87280         72.71
03060638   HB RESP LIQUID DFA RSV                 87280        232.49
03060144   HB LAB PNEUMOCYSTIS DFA                87281        289.33
03060627   HB LAB VARICELA ZOSTER AG, DF          87290         77.95
03060626   HB LAB VARICELLA ZOSTER AG,DFA         87290        227.34
03060145   HB LAB VARICELLA ZOSTER DFA            87290        314.92
03091239   HB LAB TOXOPLASMA DFA                  87299         54.60
03060454   HB LAB VIR RESP IFA STAIN, NOS         87299        166.92
03060147   HB LAB VIRAL FA STAIN, NOS             87299         72.71
03060146   HB LAB VIRUS DETECTION BY DFA          87299        314.92
03060637   HB RESP LIQUID DFA HMPV                87299        232.49
03060635   HB RESP LIQUID DFA PIV                 87300        120.18
03060604   HB LAB ADENOVIRUS EIA                  87301        109.05
03091555   HB LAB GALACTOMANNAN                   87305         89.60
03092009   HB LAB GALACTOMANNAN, BRONCH           87305         89.60
03060150   HB LAB C DIFF TOXIN EIA                87324        386.14
03060152   HB LAB ANTGN CRYPTO SE                 87327        279.31
03060606   HB LAB ANTGN CRYPTO SF                 87327        274.09
03060153   HB LAB DIRECT GIARDIA AG               87328        386.14
03091570   HB LAB E HISTOLYTICA, STOOL            87337         19.20
03060154   HB LAB H. PYLORI STOOL AG EIA          87338        184.72
03060155   HB LAB RAPID HELICOBACTER SCRN         87339         75.10
03060574   HB HBSAG                               87340        104.60



                                            96
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03060156   HB HBSAG SCRN                           87340         80.83
03020892   HB LAB HEP B S ANTIG                    87340        143.55
03090884   HB LAB TBPP HEP B SURF AG, EIA          87340         10.95
03060158   HB HBSAG NEUT CONFRM                    87341         83.49
03060157   HB LAB HBSAG CONFIRMATION               87341        492.97
03091090   HB HEPATITIS BE ANTIGEN                 87350         11.75
03091746   HB HEPATITIS DELTA ANTIGEN              87380         44.00
03090422   HB HISTOPLASMA ANTIGEN                  87385        140.00
03091846   HB HISTOPLASMA ANTIGEN *                87385         78.00
03090049   HB LAB URINE HISTOPLASMA ANTIGEN        87385        140.00
03091550   HB LAB URN HISTOPLASMA AG               87385        140.00
03091849   HB URINE HISTOPLASMA ANTIGEN            87385         78.00
03060159   HB HIV P-24 AG (SCREENING)              87390        138.12
03900049   HB LAB HIV P24 ANTIGEN                  87390        212.54
03090204   HB LAB HIV-1 DIRECT AG                  87390        107.25
03060161   HB LAB INFLUENZA A MEMBRANE EIA         87400        196.97
03060160   HB LAB INFLUENZA B MEMBRANE EIA         87400        196.97
03060162   HB LAB RSV EIA                          87420         85.69
03060481   HB LAB RSVMEMBRANE EIA                  87420        322.71
03060164   HB LAB ROTAVIRUS BY EIA                 87425        413.96
03060165   HB LAB CAMPYLOBACTER DR AG IN STL       87427        204.76
03060166   HB LAB HEMORRHAGIC E. COLI TOXIN        87427        194.74
03060167   HB LAB RAPID STREP GROUP A              87430        107.94
03091899   HB 1,3 BETA D GLUCAN                    87449        165.00
03060338   HB LAB C DIFFICILE AG BY EIA            87449         85.69
03060485   HB LAB MRSA RAPID LATEX                 87450        123.52
03060169   HB LAB URINE BACTERIAL EXAM             87450         80.12
03092030   HB LAB BARTONELLA PCR                   87471        123.69
03090092   HB BORRELIA BURGDORFERI DNA             87476         55.00
03060170   HB LAB DNA PROBE CANDIDA SP             87480        156.96
03060489   HB LAB CHLAMYDIA DNA PROBE              87490        255.94
03060172   HB LAB CHLAMYDIA PROBE CONFIRM          87490        156.96
03060173   HB CHLAMYDIA BY AMPLIFICATION           87491        431.77
03060490   HB LAB AMPL DETECT C.T. CONF            87491        274.71
03020251   HB CMV-PCR                              87496        1286.40
03091969   HB ENTEROVIRUS PCR                      87498        237.50
03060493   HB LAB ENTEROVIRUS AMP PROBE            87498        612.04
03060639   HB INFLUENZA A/B BY AMPL PCR            87501        336.20
03060642   HB INFL A SUBTYPING PCR, 1ST 2          87502        557.48
03060644   HB PARAFLU TYPES 1, 2 AMPL PCR          87502        557.48
03060643   HB INFL A 3RD SUBTYPE BY PCR            87503        136.00
03060645   HB PARAFLU TYPE 3 AMP PCR               87503        136.00



                                             97
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03060494   HB LAB DNA PROBE GARD VAGINALIS         87510        156.96
03091161   HB LAB HEP B PCR, QUAL                  87516        110.00
03090963   HB LAB HBV DNA, QUANT PCR               87517        196.00
03060575   HB LAB HEP B RT PCR QUANT               87517        605.36
03060178   HB LAB HEP B VIR QUANT PCR              87517        626.51
03060177   HB LAB QUANT HBV BY BDNA                87517        311.58
03091156   HB HCV RNA (TMA), QUAL                  87521        250.00
03060502   HB LAB HCV QUALITATIVE BY PCR           87521        593.12
03091703   HB LAB NUC ACID TST HEPC AMP            87521         14.55
03060180   HB HCV RNA QUANT BDNA                   87522        470.71
03091155   HB LAB HCV RNA (TMA), QUANT             87522        396.00
03090206   HB LAB HCV RNA PCR, QUANT               87522        261.75
03060343   HB LAB HEP C VIR QUANT NUC ACID         87522        592.01
03091209   HB LAB HEPATITIS G PCR                  87526        298.00
03020252   HB HSV-PCR                              87529        1286.40
03090353   HB HERPESVIRUS 6 DNA, PCR               87532        107.25
03091316   HB HIV-1 PROVIRAL DNA, PCR              87535         96.65
03090881   HB LAB NUC ACID TST HIV1 AMP            87535         14.55
03060518   HB LAB HIV QUANTITATION BY BDNA         87536        471.83
03060519   HB LAB HIV QUANTITATION BY PCR          87536        486.29
03060183   HB LAB LEGIONELLA DIRECT                87540        279.31
03060521   HB LAB AFB DNA PROBE, 1ST ID            87550        156.96
03060523   HB LAB AFB DNA PROBE, 2ND ID            87550        156.96
03060524   HB LAB AFB DNA PROBE, 3RD ID            87550        156.96
03060522   HB LAB AFB DNA PROBE, 4TH ID            87550        156.96
03060184   HB LAB M. TB DIRECT BY TMA              87556        593.12
03091877   HB TB COMPLEX PCR STERILE FLDS          87556        213.38
03091313   HB MYCOPLASMA DNA, PCR                  87581         49.50
03060186   HB LAB GC PROBE CONFIRMATION            87590        156.96
03060185   HB LAB RAPID N. GC                      87590        156.96
03060528   HB GC BY AMPLIFICATION                  87591        431.77
03060529   HB LAB N.G. AMP DETECT CONF             87591        274.71
03050325   HB LAB HPV AMPLIFIED PROBE 16           87621        274.71
03060192   HB LAB HPV AMPLIFIED PROBE 18           87621        300.46
03060189   HB LAB HPV DETECTION                    87621        281.54
03060193   HB LAB HPV DETECTION PROBE NO 1         87621        274.71
03060190   HB LAB HPV DETECTION PROBE NO 2         87621        274.71
03060194   HB LAB MRSA AMP PROBE                   87641        505.21
03060195   HB LAB STREP GROUP A DNA PROBE          87650        188.06
03060532   HB LAB GRP B STREP AMP PROBE            87653        538.60
03060533   HB LAB DNA PROBE TRICH VAGINALIS        87660        162.79
03060535   HB LAB FUNGAL PROBE ID                  87797        156.96



                                             98
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03060621   HB C.DIFFICILE TOXIN B PCR              87798        274.71
03020931   HB EBV-PCR                              87798        1286.40
03091520   HB ENTEROVIRUS RNA                      87798        115.00
03091317   HB HERPESVIRUS 8 DNA, PCR               87798        232.75
03060641   HB HMPV BY AMPL PCR                     87798        274.71
03020253   HB INFECT, AGENT DETECTION QUANT.       87798        369.45
03060622   HB INFLUENZA H1N1 RT PCR                87798        274.71
03091614   HB JC VIRUS DNA PCR                     87798        118.87
03091210   HB LAB HEPATITIS D PCR                  87798        160.80
03060540   HB LAB MRSA PCR DIR DETECTION           87798        446.23
03091198   HB LAB WEST NILE VIRUS, PCR             87798         75.00
03091967   HB NOROVIRUS PCR                        87798        223.50
03020932   HB PARVOVIRUS B19-PCR                   87798        1286.40
03020933   HB POLYOMA VIRUS BK-PCR                 87798        1286.40
03020934   HB POLYOMAVIRUS JC-PCR                  87798        1286.40
03060640   HB RSV BY AMPL PCR                      87798        274.71
03091324   HB TOPHERYMYA WHIPPELLI DNA, PCR        87798        223.50
03091306   HB TOXOPLASMA DNA, PCR QUAL             87798         93.50
03091522   HB VARICELLA ZOSTER VIRUS PCR           87798         93.36
03060200   HB WEST NILE VIRUS, DETECTION           87798        299.34
03091970   HB HERPESVIRUS 8 PCR, QUANT             87799        261.75
03090194   HB LAB B. PERTUSSIS PCR                 87801        223.50
03091706   HB LAB TBPP DET AG MULT DNA AMPLI       87801         74.42
03091997   HB NUCLEIC ACID TESTING                 87801         30.25
03060201   HB LAB STREP A RPD SCN                  87880        188.06
03060552   HB E COLI TOXIN AG DETECT               87899         72.71
03060551   HB LAB E COLI TOXIN AG DETCT OTHR       87899         99.04
03092008   HB LAB HIV PHENO INFECT AG DRG          87900        125.93
03060204   HB HIV AG NAT (SCREENING)               87901        2081.30
03090311   HB HIV-1 GENOTYPING (RT+PROT)           87901        315.87
03090800   HB LAB GENOTYPE DNA HIV REVERSE T       87901        248.74
03091045   HB LAB HIV GENOTYPING                   87901        385.00
03060205   HB HCV AG NAT (SCREENING)               87902        2081.30
03060573   HB HCV GENOTYPING                       87902        2081.30
03091648   HB LAB HIV PHENOTYPE, COMPREHEN         87903        621.61
03091650   HB LAB PHENOTYPE DNA HIV W/CULT         87903        472.12
03091649   HB LAB HIV PHENOTYPING, ADDL DRGS       87904         33.34
03090802   HB LAB PHENOTYPE DNA HIV W/CLT AD       87904         25.32
03091651   HB LAB TROFILE                          87999        1960.00
03092042   HB LAB TROFILE DNA                      87999        2800.00
03110002   HB PATHOLOGY FLUID, SMEAR               88104        264.85
03110003   HB PATHOLOGY FLUID, CONCENTRATE         88108        326.05



                                             99
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
80000320   HB PROF CYTO CONCENTRATE TECH            88108
03110004   HB PATHOLOGY FLUID, SUREPATH             88112        357.66
03100364   HB LAB UROVYSION *                       88121        2056.47
80016270   HB PROF UROVYSION PC                     88121
80015143   HB PROF GYN PATH INTERPRET               88141
03110164   HB PATHOLOGY GYN LIQUID/MAN SCR          88142        114.37
03110006   HB PATHOLOGY GYN/AUTO SCREEN             88147        133.54
03110007   HB PATHOLOGY GYN AUTO SC/MAN R           88148        250.38
03110008   HB PATHOLOGY, CYTO GYN MAT I             88155         48.47
03110010   HB PATHOLOGY SMEAR SCR & INTERP          88160         64.54
80000354   HB PROF CYTOPATH,SLIDE INT 3-4           88160
03110009   HB PATHOLOGY SMEAR PREP/SCR/INT          88161        151.34
03110011   HB PATHOLOGY SMEAR EXTEND STDY           88162        143.55
03110012   HB PATHOLOGY GYN (BETHESDA) MAN          88164        143.55
03110013   HB PATHOLOGY GYN (BETHESDA) RSC          88165        284.88
03110198   HB CYTO QUICK STAIN                      88172        117.85
03110015   HB PATHOLOGY FNA INTERP & RPT            88173        264.85
03110017   HB LAB DNA ANAL, BONE MARROW             88182        1027.11
03110016   HB LAB DNA ANAL, TISSUE                  88182        1082.75
80000362   HB PROF DNA ANAL BONE MARROW             88182
03110174   HB FLOW CYTOM- 1ST MARKER                88184        315.55
03110020   HB FLOW CYTOMETRY, FIRST MARKER          88184        315.55
03110184   HB FLOW ID SCREEN CLASS II               88184        460.70
03110186   HB FLOW SPEC. SCREEN CLASS I             88184        460.70
03110185   HB FLOW SPEC. SCREEN CLASS II            88184        460.70
03110019   HB LAB FLOW CYTOMETRY 1ST AB             88184        315.55
03091207   HB LUK ADH DF FLW CYT 1STMRK             88184        123.50
03110188   HB LUMINEX PRA AND ID CLASS I            88184        817.91
03110022   HB LUMINEX QUICK SCREEN POS/NEG          88184        548.61
03110182   HB LUMINEX SINGLE AG ID CLASS I          88184        505.21
03110181   HB REVERSE FLOW B-CELL CROSSMATCH        88184        817.91
03110183   HB REVERSE FLOW T-CELL CROSSMATCH        88184        1181.79
03110032   HB FACS, ADDL MARKER 1 (4X)              88185        155.05
03110027   HB FACS, ADDL MARKER 1 (6X)              88185        155.05
03110031   HB FACS, ADDL MARKER 2 (4X)              88185        155.05
03110026   HB FACS, ADDL MARKER 2 (6X)              88185        155.05
03110025   HB FACS, ADDL MARKER 3 (4X)              88185        155.05
03110030   HB FACS, ADDL MARKER 3 (6X)              88185        155.05
03110029   HB FACS, ADDL MARKER 4 (4X)              88185        155.05
03110028   HB FACS, ADDL MARKER 4 (6X)              88185        155.05
03100016   HB LAB FLOW CYTOM-ADDL MARKERS           88185        231.46
03091208   HB LAB LUK ADH DF FLW CYT ADL MKR        88185        123.50



                                             100
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03110023   HB LUMINEX PRA AND ID CLASS II            88185        460.70
03110033   HB FACS, INTERP 2-8 MARKERS (4X)          88187        401.88
03110034   HB FACS, INTERP 2-8 MARKERS (6X)          88187        401.88
80000466   HB PROF INTERP 2-8 MARKERS                88187
80000283   HB PROF INTERP 9-15 MARKERS               88188
03011965   HB FLOW ID CLASS I B                      88189        817.91
03110021   HB FLOW ID CLASS I A                      88189        817.91
03110187   HB FLOW SCREEN CLASS I                    88189        660.53
03011964   HB FLOW SCREEN CLASS II                   88189        660.53
03010310   HB LUMINEX MIC ANTIBODY SCREEN            88189        660.53
03110024   HB LUMINEX SINGLE AG ID CLASS II          88189        660.53
80000329   HB PROF INTERP >=16 MARKERS               88189
03110035   HB PATHOLOGY FNA CYTOTECH ASST            88199        227.01
03110200   HB LAB CBK-BLOOD TISSUE CULTURE           88230        808.72
03100316   HB LAB CFKS-TISSUE CULTURE LYMPH          88230        800.11
03120037   HB LAB CHRK-TIS CULT LYMPHOCYTE           88230        800.11
03110201   HB LAB CMS-INTERP & REPORT                88230        808.72
03100334   HB TISSUE CULTURE-LYMPHOCYTE              88230        989.28
03120040   HB LAB CTK-TIS CULT SOLID TISSUE          88233        977.04
03100023   HB LAB GCSOF-TIS CULT SOLID TIS           88233        966.45
03100335   HB TISSUE CULTURE-SOLID TISSUE            88233        966.45
03120042   HB LAB CAK-TISSUE CULTURE AMNIO           88235        893.19
03120043   HB LAB CCCK-TISSUE CULTURE CVS            88235        893.19
03100336   HB TISSUE CULTURE-AMMIO/CVS               88235        893.19
03120044   HB LAB CCBK-TIS CULT CANCER/HEM           88237        867.43
03100337   HB TC-HEME                                88237        1005.97
03120045   HB LAB CMS-BLOOD TISSUE CULTURE           88239        1154.83
03100338   HB TC-SOLID TUMOR                         88239        1154.83
03110195   HB ALLOGEN BM PROCESS FRZ                 88240       11664.37
03110196   HB AUTO BM PROCESS FRZ                    88240       12831.70
03110042   HB CELL CRYOPRESERVE/STORE                88240        122.41
03110047   HB DONOR CELL CRYOPRESERVE/STORE          88240        602.02
03110043   HB FREEZE CELLS                           88240        146.89
03120046   HB LAB GCSOF-FRZ & STRG OF CELLS          88240        199.19
03110046   HB PB STEM CELL FREEZING                  88240        2269.00
03110208   HB CFC LEVEL 1                            88241        180.27
03110050   HB FROZEN CELL/THAW                       88241        180.27
03110051   HB FROZEN CELL/THAW X 2                   88241        360.55
03120047   HB LAB GCSOF-THAW AND EXP FRZ CLS         88241        199.19
03110048   HB THAW AND GROW                          88241        146.89
03110049   HB THAW PERIPH BLOOD STEM CELLS           88241        1031.57
03110052   HB CYTO SISTER CHROMATID EXCHANG          88245        2611.74



                                              101
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03110055   HB CYTO CHROMOSOME BREAKAGE ANAL 88248                 2612.85
03100339   HB CHROM ANAL-5CELLS/1 KARYO              88261        1213.71
03120048   HB LAB ANALYSIS 5 CELLS/1 KARYT           88261        1213.71
03120050   HB LAB CDC-ANALYSIS 5 CELLS/1KARY         88261        1213.71
03120049   HB LAB CFKS-CHROM ANL 5 CELLS/1K          88261        1213.71
03100340   HB CHROM ANAL 15-20 CELLS/2 KARYO         88262        1256.35
03100329   HB LAB CBK-CYT BL 15-20 CLS 2K            88262        1008.27
03120084   HB LAB CHRK-CHRM ANL 15-20 CLS/1K         88262        1008.27
03120085   HB LAB CMS-CHRM AN 15-20 CELLS/1K         88262        1008.27
03120054   HB LAB CTK-TIS CHROM AN 20 CELLS          88262        1008.27
03110062   HB COUNT 45 CELLS FOR MOSAICISM           88263        1176.29
03100328   HB LAB ANALYZE 20-25 CELLS                88264        1022.66
03120055   HB LAB CCBK-ANALYZE 20-25 CELLS           88264        1022.66
03120057   HB LAB CKST-ANALYZE 20-25 CELLS           88264        1022.66
03100341   HB FLASK ANALYSIS                         88267        1454.27
03120058   HB LAB CCCK-ANALYSIS 15 CELLS/1K          88267        1454.27
03100342   HB IN SITU CHROM ANAL 12CELLS 1KA         88269        1778.25
03100036   HB LAB CAK-IN SITU ANL 15 CL/1K           88269        1345.40
03100094   HB FISH PROBE EACH                        88271        385.20
03110192   HB LAB ANEU-FISH PROBE, EACH              88271        385.20
03100038   HB LAB FMP-ADDITIONAL PROBE               88271        385.20
03100333   HB LAB FMP-FISH PROBE EACH                88271        385.20
03100090   HB LAB IISH1-ADDITIONAL PROBE             88271        385.20
03100095   HB LAB IISH1-FISH PROBE, EACH             88271        385.20
03100091   HB LAB IISH2-ADDITIONAL PROBE             88271        385.20
03100089   HB LAB IISH2-FISH PROBE, EACH             88271        385.20
03100343   HB LAB MOLEC DNA PROBE/EACH               88271        385.20
03091594   HB LAB SUBTE - CYTOGEN, DNA PRB           88271         81.40
03110205   HB ZFISH IGHP PROBE, EACH                 88271        385.20
03110202   HB ZFISH MM PROBE EACH                    88271        385.20
03110067   HB FISH 3-5 CELLS EVALUATED               88272        1443.06
03100344   HB FISH 10-30 CELLS MICRODELETION         88273        1537.16
03120060   HB LAB FMP-FISH 10-30 CELLS               88273        1537.16
03091595   HB LAB SUBTE CYTOGENETICS, 10-30          88273        122.08
03100042   HB LAB IISH1-ANALYZE 25-99 CELLS          88274        1694.01
03110197   HB LAB INSITU HYBR, 25-99 CELLS           88274        1694.01
03100347   HB FISH INTERPHASE 100-300 CELLS          88275        2117.52
03100043   HB LAB IISH2-ANALYZE100-300 CELLS         88275        2117.52
03100346   HB LAB INSITU HYB, 100-300 CELL           88275        2117.52
03110193                                        88275       2117.52
           HB LAB MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL
03110206   HB ZFISH IGHP ANALYZE 100-300             88275        2117.52
03110203   HB ZFISH MM ANALYZE 100-300               88275        2117.52



                                              102
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
03100348   HB 1 CHROMO ADD'L KARYO                  88280        203.04
03100044   HB LAB ADDITIONAL KARYOTYPE              88280        203.04
03120063   HB LAB CAK-1 CHROMO ADD KARYOTYPE        88280        203.04
03120062   HB LAB CCBK-1 CHROM ADD KARYOTYPE        88280        203.04
03120066   HB LAB CCCK-1 CHROM ADD KARYOTYPE        88280        203.04
03120065   HB LAB CKST-ADDITIONAL KARYTYPE          88280        203.04
03100349   HB CHROM ANAL ADD'L CELLS COUNTED        88285        130.55
03110199   HB LAB ADNL CELLS COUNT/KARYOTYPE        88285        130.55
03120082   HB LAB CAK-ADNL CELLS CNT/KARYO          88285        130.55
03120069   HB LAB CCCK-AD CELLS CNT/KARY            88285        130.55
03120070   HB LAB CMS-ANALYSIS ADDNL CELLS          88285        130.55
03100350   HB CYTO HIGH RESOLUTION BANDING          88289        3578.76
03120071   HB LAB CHRK-CYTO HI RES BANDING          88289        100.15
03100351   HB INTERPRETATION & REPORT               88291        151.14
03100047   HB LAB INTERPRETATION & REPORT           88291        199.19
03091022   HB LAB SUBTE - CYTO/MOLECULAR RPT        88291         78.57
80016191   HB PROF ANEU INTERP & REPORT             88291
80009958   HB PROF CAK-INTERP & REPORT              88291
80009959   HB PROF CBK-INTERP & REPORT              88291
80009966   HB PROF CCBK-INTERP & REPORT             88291
80009968   HB PROF CCCK-INTERP & REPORT             88291
80009969   HB PROF CDC-INTERP & REPORT              88291
80009955   HB PROF CFKS-INTERP & REPORT             88291
80009956   HB PROF CHRK-INTERP & REPORT             88291
80009967   HB PROF CKST-INTERP & REPORT             88291
80009962   HB PROF CMS-INTERP & REPORT              88291
80009972   HB PROF CTK-INTERP & REPORT              88291
80009960   HB PROF FMP-INTERP & REPORT              88291
80009973   HB PROF IISH1-INTERP & REPORT            88291
80009970   HB PROF IISH2-INTERP & REPORT            88291
80016271   HB PROF ZFISH IGHP INTRP & RPT           88291
03110207   HB ZFISH IGHP INTERP AND RPT             88291
03110204   HB ZFISH MM INTERP AND RPT               88291
03091559   HB FAM MEDITERRANEAN FVR                 88299        405.00
03091712   HB LAB SPECIAL TST                       88299         0.00
03120001   HB PATHOLOGY LEVEL I SURGICAL            88300        175.82
03120002   HB LAB TISSUE REF                        88302        307.13
03120003   HB PATHOLOGY LEVEL II SURGICAL           88302        307.13
03120004   HB PATHOLOGY LEVEL III SURGICAL          88304        402.83
80016044   HB PROF UNCOMPLICATED ASP                88304
80016048   HB PROF UNCOMPLICATED BLOPS              88304
03120007   HB CYTOLOGY CELL BLOCK                   88305        109.14



                                             103
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
03120086   HB LAB CDC-GROSS/MICRO - PLACENTA         88305        547.50
03120006   HB LAB TISSUE GR M 7                      88305        605.36
03120008   HB LAB TISSUE GR M 7 - BM                 88305        605.36
03120005   HB PATHOLOGY LEVEL IV SURGICAL            88305        605.36
80000448   HB PROF BM BIOPSY INTERP (PAS)            88305
80016057   HB PROF BM BIOPSY INTERP ONLY             88305
80000389   HB PROF BM BIOPSY SEC INTERP              88305
80000455   HB PROF BM CLOT SECTION INTERP            88305
80016059   HB PROF BM CLT SECT INTRP ONLY            88305
80000387   HB PROF BNE MARROW CLT INTRP 6            88305
80016045   HB PROF COMPLICATED          ASP          88305
80016049   HB PROF COMPLICATED BIOPSY                88305
03090068   HB SKIN BX SERVICE CHRG                   88305
03090133   HB SP LIGHT MICROSCOPY                    88305
03120009   HB PATHOLOGY LEVEL V SURGICAL             88307        971.47
80016050   HB PROF MULT-COMPLIC BIOPSY               88307
80016046   HB PROF MULTI & COMPLICA ASP              88307
03120010   HB PATHOLOGY LEVEL VI SURGICAL            88309        1572.39
80016051   HB PROF COMPLEX         BIOPSY            88309
80016047   HB PROF COMPLEX ASP                       88309
03120012   HB PATHOLOGY DECAL - BM                   88311         67.88
03120011   HB PATHOLOGY DECALICIFICATION             88311         67.88
03090183   HB H & E, 11 OR MORE SLIDES               88312
03090143   HB H & E, 7-10 SLIDES                     88312
03120013   HB PATHOLOGY TISSUE STAIN GR I            88312        151.34
80000388   HB PROF SPECIAL STAIN/GROUP 1             88312
03120017   HB LAB IRON STAIN                         88313        163.58
03120016   HB LAB IRON STAIN - BM                    88313        163.58
03120014   HB LAB SUDAN BLACK STAIN                  88313        263.73
03120015   HB PATHOLOGY TISS STN GR II - BM          88313        151.34
03120018   HB PATHOLOGY TISSUE STAIN GR II           88313        151.34
80016029   HB PROF BM SM SP STAIN IRON               88313
80016034   HB PROF BM SM SP STAIN LIPASE             88313
80016033   HB PROF BM SM SP STAIN TRAP               88313
80016031   HB PROF BM SM SP STN MYLOPRXDS            88313
80016035   HB PROF BM SM SP STN PRVIDASE             88313
80016285   HB PROF BM SM SP STN SUDAN BLK            88313
80000279   HB PROF IRON STAIN INTERP                 88313
80000321   HB PROF KLEIHAUER STAIN INTERP            88313
80016024   HB PROF PB SP STAIN LAP                   88313
80016286   HB PROF PB SP STAIN LIPASE                88313
80016028   HB PROF PB SP STAIN OTHER                 88313



                                              104
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
80016026   HB PROF PB SP STAIN SUDAN BLACK          88313
80016287   HB PROF PB SP STAIN TRAP                 88313
80016025   HB PROF PB SP STN MYLPRXDASE             88313
80000323   HB PROF SPECIAL STAINS/GROUP 2           88313
80000471   HB PROF SPECIAL STAINS/GROUP 2           88313
03120093   HB SPEC STAIN, GROUP II - DAPI           88313        333.32
03120019   HB PATHOLOGY TISSUE STAIN, FROZ          88314        506.32
03120020   HB PATHOLOGY TISSUE STAIN, CHEM          88318        151.34
03120021   HB LAB ACID PHOSPHATASE STAIN            88319        263.73
03120023   HB LAB LIPASE STAIN                      88319        263.73
03120022   HB PATHOLOGY TISSUE STAIN, ENZ           88319        151.34
80000322   HB PROF ATPASE 9.8                       88319
80016357   HB PROF ADDNL OUTSIDE CONSULT            88321
80000241   HB PROF HB OUTSIDE CONS SLIDES           88321
80000229   HB PROF OUTSIDE CONS PREP ELSW           88321
03090077   HB RENAL BIOPSY                          88321
03120091   HB OUTSIDE CONSULT, WITH PREP            88323         69.82
80016078   HB PROF REF MAT'L PREP                   88323
03090081   HB SKIN BX CONSULT                       88323
80016083   HB PROF COMPREHENSIVE AP                 88325
80016082   HB PROF EXTENSIVE AP                     88325
80000427   HB PROF OUTSIDE CONS, COMPR              88325
80000327   HB PROF OUTSIDE CONSULT W HX             88325
80016079   HB PROF REF MAT'L COMPREH                88325
03120025   HB PATHOLOGY INTRAOPERATIVE CON          88329        234.14
03100368   HB PATH CON INTRAOP FZS, 1 BLOC          88331        128.81
03120027   HB PATH CON INTRAOP FZS, ADDL            88332         81.23
03100049   HB PATH INTROP TCH PRP, INITIAL          88333        132.78
03100050   HB PATH INTROP TCH PRP, ADDL             88334         81.20
03091710   HB LAB EGFR TISSUE TESTING               88342        103.00
03100352   HB LAB IHC MISC-SLIDE ONLY               88342         85.69
03100052   HB LAB IMMUNOHISTOCHEMISTRY EA AB        88342        506.32
03091711   HB LAB PTEN TISSUE TESTING               88342        103.00
03100170   HB MYELOPEROXIDASE (IHC)                 88342
03100182   HB SKIN IMMUNOPEROXIDASE                 88342
03091891   HB ENTEROCYTE ANTIBODIES                 88346        148.00
03120092   HB IMMUNOFLRESCENT STDY, EA AB           88346        444.60
03120028   HB PATHOLOGY IMMUNOFLUOR STUDY           88346        545.27
03091638   HB CELIAPLUS IMMFL INDIR                 88347         96.92
03091632   HB LAB ANTI-EMA IGA BY IFA               88347        100.50
03092038   HB LAB ENTEROCYTE ANTIBODIES             88347        163.39
03090795   HB LAB IBD SER IIFA                      88347         90.45



                                             105
  Charge
   Code                    Description               CPT Code OP/Default Price   IP/ED Price
03120030   HB LAB TDT                                 88347        669.91
03120081   HB LAB TDT-BM                              88347        669.91
03120087   HB PATHOLOGY IMMUNOFL, INDIRECT            88347        121.30
03120032   HB PATHOLOGY EM, DIAGNOSTIC                88348        2865.46
03120031   HB PATHOLOGY EM, PARTIAL                   88348        545.27
03120033   HB LAB DNA PLOIDY/DNSM                     88358        1575.72
03100354   HB MORPHOMETRIC ANALYSIS; TUMOR            88358        265.40
03100076   HB LAB TUMOR IHC QUANT MAN                 88360        477.39
03100058   HB LAB ESTROGEN RECEPTOR                   88361        536.03
03120078   HB LAB HER2/NEU RECEPTOR                   88361        536.03
03120079   HB LAB KI67 (MIB-1)                        88361        536.03
03100059   HB LAB PROGESTERONE RRECEPTOR              88361        536.03
03100077   HB LAB TUMOR IHC QUANT COMPUTER            88361        536.03
03120094   HB MORPHOMET ANLYSIS COMP AST              88361        536.03
03100372   HB NERVE TEASING PREPARATION               88362        798.48
03120088   HB LAB HPV HIGH RISK IN SITU               88365        351.64
03120089   HB LAB HPV LOW RISK IN SITU                88365        351.64
03120090   HB LAB TISSUE INSITU INTRP, RPT            88365        302.16
03120034   HB TISSUE IN SITU HYBRID (FISH)            88365        306.02
03100310   HB TISSUE IN SITU INTERP                   88365        263.73
03100065   HB LAB UROVYSION                           88367        854.58
03100369   HB UROVYSION PC CPLM (PROF)                88367
03100079   HB LAB ANEUVYSION                          88368        696.37
03100074   HB LAB CLL FISH PROBES                     88368        696.37
03100366   HB LAB CLL FISH PROBES *                   88368        696.37
03100075   HB LAB EGFR FISH ASSAY                     88368        696.37
03100358   HB LAB EGFR FISH ASSAY *                   88368        696.37
03100071   HB LAB HER-2/NEU FISH PROBE                88368        696.37
03100362   HB LAB HER-2/NEU FISH PROBE *              88368        696.37
03100066   HB LAB MDS FISH PROBES                     88368        696.37
03100355   HB LAB MDS FISH PROBES *                   88368        696.37
03100072   HB LAB MORPHO ANALY, FISH 13Q DEL          88368        786.75
03100363   HB LAB MORPHO ANALY, FISH 13Q DEL *        88368        786.75
03100064   HB LAB MORPHO ANALY, FISH, 11;14           88368        696.37
03100361   HB LAB MORPHO ANALY, FISH, 11;14*          88368        696.37
03100069   HB LAB MORPHO ANALY, FISH, 14;18           88368        696.37
03100356   HB LAB MORPHO ANALY, FISH, 14;18 *         88368        696.37
03100073   HB LAB MORPHO ANALY, FISH, 15;17           88368        696.37
03100357   HB LAB MORPHO ANALY, FISH, 15;17 *         88368        696.37
03100063   HB LAB MORPHO ANALY, FISH, 19Q             88368        696.37
03100360   HB LAB MORPHO ANALY, FISH, 19Q *           88368        696.37
03100068   HB LAB MORPHO ANALY, FISH, 1P              88368        696.37



                                               106
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
03100359   HB LAB MORPHO ANALY, FISH, 1P *            88368        696.37
03100067   HB LAB MORPHO ANALY, FISH, 9;22            88368        696.37
03100365   HB LAB MORPHO ANALY, FISH, 9;22 *          88368        696.37
03100070   HB LAB MORPHO ANALY, FISH, MYC             88368        696.37
03100367   HB LAB MORPHO ANALY, FISH, MYC *           88368        696.37
03100370   HB BRAF, MICRODISECT, MANL                 88381        978.32
03100371   HB KRAS MICRODISECTION MAN                 88381        1519.38
03120095   HB MICRO ARRAY PROBES 11-50                88384        845.84
03120096   HB MICRO ARRAY PROBES 51-250               88385        1015.00
03091005   HB LAB CGH MOL PROBES 251-500              88386        271.19
03120097   HB MICRO ARRAY PROBES 251-500              88386        1353.34
80016273   HB PROF MICROARRAY                         88386
03100315   HB PS EM PARTIAL                           88399        273.75
03000266   HB LAB MICRO EOSINOPHILS URN               89050        125.70
03000273   HB LAB CELL CT TOT & DF                    89051        242.92
03000267   HB LAB CELL CT TOTAL & DIFF                89051        242.92
03000268   HB LAB CELL CT TOTAL & DIFF CSF            89051        242.92
03000036   HB CRYSTAL ID BY LIGHT MICROSCOPY          89060        331.61
03000269   HB LAB MICRO CRYSTL UNS                    89060        125.70
80000450   HB PROF CRYSTAL ID LIGH MICRO              89060
80000311   HB PROF PATHOLOGY, CRYSTAL ID              89060
03000270   HB LAB SUDAN III STAIN (FAT) URN           89125        336.19
03092029   HB LAB URN FAT STAIN                       89125         9.60
03000271   HB LAB MICRO EOSINO                        89190        125.70
03000275   HB LAB MICRO STARCH FE                     89225        140.23
03000038   HB LAB SWEAT COL, IONTOPHERESIS            89230        101.90
03090896   HB LAB PATHFINDERTG BP CYTOLOGY            89240        1650.00
03000258   HB LAB PATHFINDERTG BP FLD ASP             89240        1550.00
03091932   HB LAB PATHFINDERTG BP FLD ASP             89240        1550.00
03091714   HB LAB PATHFINDERTG BP TISSU               89240        1700.00
03091068   HB LAB SPECIAL TEST                        89240         0.00
03000040   HB LAB SPERM ISOL; PREP FOR IUI            89260        318.26
03000041   HB POST COITAL TEST                        89300        121.30
03000250   HB LAB SEMEN ANALYSIS; COMPLETE            89320        191.40
03091889   HB SPERM IGG / IGA                         89325         19.94
07710009   HB ADMIN IMMUN 1ST VAC/TOX (PEDS)          90460        105.95
07710010   HB ADMIN IMMUN ADDL VAC/TOX(PEDS)          90461        105.95
07710008   HB INFLUENZA 1 (H1N1) ADMIN                90470        105.95          136.75
07710002   HB ADMIN INFLUENZA VACCINE                 90471        105.95
07710003   HB ADMIN PNEUMOCOCCAL VACCINE              90471        105.95
07710001   HB IMMUNIZATION ADM;1 VACCINE              90471        105.95          140.45
07710006   HB VACCINE ADMIN, EA ADD'L                 90472         54.21          71.46



                                               107
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
07710007   HB VACCINE/IMMUNIZATION ADMIN ADD         90472         54.21          71.46
04900005   HB TETANUS VACCINE IM                     90703        330.12
09000003   HB DIAG INTERVIEW EXAM 60 MINUTES         90801        413.95
09000004   HB DIAGNOSTIC INTERVIEW EXAM 90           90801        551.94
09140001   HB INDIVIDUAL THERAPY 20-30 MIN           90804        219.30
09140002   HB IND THERAPY / MED MGMT 20-30           90805        316.62
09140003   HB INDIVIDUAL THERAPY 45-50 MIN           90806        397.94
09140004   HB IND THERAPY W/MED MGMT 45-50           90807        471.86
09140014   HB IND THERAPY 75-80 MIN                  90808         3.30
09140016   HB IND THERAPY W/MED MGMT 75-80           90809        551.94
09030001   HB IND PLAY/NONVERBAL THPRY 45-50         90812        336.34
09030002   HB IND PLAY/NONVERBAL THPRY 75-80         90814        502.66
09140015   HB PHP INDIV.THERAPY 20-30 MIN            90816        219.30
09140005   HB INDIVIDUAL THERAPY 45-50 MINUTES       90818        463.23
09160001   HB FAMILY THERAPY 60 MINUTES              90846        412.72
09160002   HB FAMILY THERAPY WITHOUT CLNT 90         90846        412.72
09160003   HB FAMILY THERAPY WITH CLIENT 90          90847        551.94
09150005   HB ADULT IOP DAY RATE                     90853        766.30
09150010   HB GROUP THERAPY 45-50 MINUTES            90853        411.49
09150009   HB GROUP THERAPY 60 MIN                   90853        289.52
09150002   HB GROUP THERAPY 90 MIN                   90853        289.52
09150008   HB GROUP THERAPY 90 MIN                   90853        551.94
09150003   HB GROUP THERAPY 90 MINUTES               90853        551.94
09120003   HB IOP PARTIAL HOSPITAL                   90853        710.86
09120001   HB PARTIAL HOSP - FULL DAY                90853        2378.99
09150001   HB PHP GROUP THERAPY 45-50 MIN            90853        411.49
09140008   HB PHARMACOLOGICAL MANAGEMENT             90862        242.70
09010001   HB ELECTROCONVULSIVE THERAPY              90870        2531.76
04400011   HB SP BIOFEEDBACK                         90901        186.39
03610226   HB ANORECTAL BIOFEEDBACK                  90911        1393.39
04200018   HB PT BIFDBK/INCNT TRN - (1) BRF          90911        251.33
04200019   HB PT BIFDBK/INCNT TRN - (2) INT          90911        502.66
04200020   HB PT BIFDBK/INCNT TRN - (3) MOD          90911        753.98
04200017   HB PT BIFDBK/INCNT TRN - (4) EXT          90911        1005.31
03610225   HB PUDENDAL EMG NERVE STUDY               90911        1393.39
08010001   HB ACUTE HEMODIALYSIS                     90935        3331.33
08210001   HB OUTPATIENT HEMODIALYSIS                90935        3331.33
08010002   HB CRRT VENOUS HEMODIALYSIS               90945       10130.74
08020001   HB PERITONEAL DIALYSIS                    90945        3331.33
03610357                                      91010
           HB ESOPHAGEAL MANOMTRY W/INTER RPT 2D                  4696.61
03610358   HB ESOPHAGEAL MANOMETRY STIMULATE 91013                3590.25
03610237   HB ANTRODUODENAL MANOMETRY                91020        2650.24



                                              108
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
03610270   HB 24 HR ESOPHAGEAL PH STUDY               91034        2748.23
03610269   HB ACID REFLUX TEST                        91034        2748.23
09200002   HB BRAVO 48 HR PH STUDY                    91035        5787.60
03610282   HB IMPEDANCE PH REFLUX                     91038        2748.23
09200003   HB LACT/GLUC HYDROGEN BREATH TEST          91065        2575.04
09200004   HB ANORECTAL MANOMETRY                     91122        2078.79
03610364   HB ELECTROGASTROGRAPHY                     91132        1668.08
03610365   HB COLONIC MANOMETRY                       91299        930.90
04500192   HB EYE EXAM INTERMEDIATE                   92002                        524.12
09200005   HB PERIMETRY VFS LTD W/O READING*          92081        426.20
09200006   HB PERIMETRY VFS INTMD W/O READ *          92082        364.47
09200007   HB PERIMETRY VFS COMPR W/O READ*           92083        438.08
05100145   HB DIABETIC RETINAL (FUNDUS)               92250        329.38
03610366   HB FIBERLAYER PHO OPTHAL NERVE             92499        420.44
04400014   HB SP EVAL - (2) INT                       92506                        531.87
04400016   HB SP EVAL - (3) MOD                       92506                        797.80
04440011   HB SP EVAL - (4) EXT                       92506                       1063.73
04440009   HB SP EVALUATION                           92506         0.00          1063.73
04440007   HB SP LANG VOICE EVAL - (1) BRF            92506        204.20
04440025   HB SP LANG VOICE EVAL - (2) INT            92506        409.58
04440010   HB SP LANG VOICE EVAL - (3) MOD            92506        613.78
04440006   HB SP LANG VOICE EVAL - (4) EXT            92506        817.98
04440005   HB SP REEVALUATION                         92506                        797.80
04440026   HB SP VOICE REEVALUATION                   92506                        531.87
04400013   HB SPEECH-LANG PATH BRIEF EVAL             92506                        265.93
04400024   HB SP LNG VC SPCH IND TRT (1) BRF          92507                        314.61
04400025   HB SP LNG VC SPCH IND TRT (2) INT          92507                        630.40
04400021   HB SP LNG VC SPCH IND TRT (3) MOD          92507                        945.01
04400020   HB SP LNG VC SPCH IND TRT (4) EXT          92507                       1259.62
04400017   HB SP VOICE LANG THER - (1) BRF            92507        242.19
04400023   HB SP VOICE LANG THER - (2) INT            92507        484.38          630.40
04400022   HB SP VOICE LANG THER - (3) MOD            92507        726.57
04400018   HB SP VOICE LANG THER - (4) EXT            92507        968.76
04400026   HB SP VC SWALLOW GROUP - (2) INT           92508        263.56          341.91
03610604   HB NASOPHARYNGOSCOPY W ENDOSCP             92511                        194.59
04400029   HB SP LARYN FUNC STUDY - (1) BRF           92520        194.70
04400030   HB SP LARYN FUNC STUDY - (2) INT           92520        388.21
04400028   HB SP LARYN FUNC STUDY - (3) MOD           92520        582.92
04400027   HB SP LARYN FUNC STUDY - (4) EXT           92520        777.62
04300008   HB SWALLOW THERAPY - (1) BRF               92526        242.19          314.61
04300005   HB SWALLOW THERAPY - (2) INT               92526        484.38          630.40
04300007   HB SWALLOW THERAPY - (3) MOD               92526        726.57          945.01



                                               109
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
04300006   HB SWALLOW THERAPY - (4) EXT               92526        968.76         1259.62
04400032   HB HEARING SCREENING                       92551        214.88          278.99
04710001   HB BAER COMPREH-W/LATENCY                  92585        5197.56        6757.54
04710002   HB BAER LTD - W/OUT LATENCY                92586        2547.73        3312.29
04440013   HB SP VC PRSTH DEV EVAL - (4) EXT          92597        817.98         1063.73
04400034   HB SP VOICE PROSTHETIC TRAINING            92597                       1063.73
04440027   HB EVAL SPEECH RX 1HR                      92607        817.98
04440028   HB EVAL SPEECH RX EA ADDL 30 MIN           92608        408.99
04400035   HB SP AUG DEV TRAINING EXTEND              92609                       1063.73
04400036   HB SP AUG DEV TRAINING INTERM              92609                        531.87
04400037   HB SP AUG DEV TRAINING MOD                 92609                        797.80
04440022   HB SWALLOW EVAL - (3) MOD                  92610        613.78          797.80
04440023   HB SWALLOW EVAL (1) BRF                    92610        204.20          265.93
04340023   HB SWALLOW EVAL (2) INT                    92610        409.58          531.87
04440024   HB SWALLOW EVALUATION- (4) EXT             92610        817.98         1063.73
04300009   HB VIDEO SWALLOW EVAL                      92611        1057.80        1374.78
04440018   HB SP ENDO SWALLOW EVAL - (3) MOD          92612        613.78
04440019   HB SP ENDO SWALLOW EVAL - (4) EXT          92612        817.98
04440016   HB SP ENDOSCOPIC SWALLOW EVAL              92612                       1063.73
04440020   HB SP END/SWALLW EVAL W/SENS               92616                        952.13
04810158   HB CARDIOPULMONARY RESUSCIT CL             92950        1258.43
04800008   HB CARDIOPULMONARY RESUSCITAT              92950        1258.43        1634.77
04500194   HB TRANSCUTANEOUS PACE TEMP                92953                        227.88
04800011   HB ECG CARDIOVERSION                       92960        3928.44        5106.15
04810159   HB ECG CARDIOVERSION CL                    92960        3928.44
04800001   HB CARDIOVERSION, INTERNAL                 92961        3999.68        5106.15
04810117   HB INSERT CARD ASSIST IMPELLA              92970       17866.17
04810031   HB EXTRN CIRCULATORY&CARDIOASSIST          92971        1684.64
04810032   HB THROMBECTOMY, CORONARY                  92973       10640.70
04810033   HB THRMOBOLYSIS INTRACOR INFUSN            92975        6910.69
04500196   HB THROMBOLYSIS CORONARY                   92977        1877.73        1877.73
04810034   HB INTRAVSC U/S CORONRY/GRFT VSSL          92978        9286.28
04810035   HB INTRAVSC U/S COR/GRFT ADDL VSS          92979        9286.28
04810109   HB STENT, PLACE LC RX-ELUT                 92980       34662.68
04810110   HB STENT, PLACE LD RX-ELUT                 92980       34662.68
04810111   HB STENT, PLACE RC RX-ELUT                 92980       34662.68
04810036   HB STENT, PLACE RX-ELUT                    92980       34662.68
04810120   HB STENT, PLACEMENT                        92980       34662.68
04810121   HB STENT, PLACEMENT LC                     92980       34662.68
04810122   HB STENT, PLACEMENT LD                     92980       34662.68
04810123   HB STENT, PLACEMENT RC                     92980       34662.68
04810112   HB STENT, PLACE LC RX ADDL VSL             92981       34662.68



                                               110
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
04810114   HB STENT, PLACE LD RX ADDL VSL          92981       34662.68
04810113   HB STENT, PLACE RC RX ADDL VSL          92981       34662.68
04810037   HB STENT, PLACE RX ADDL VSL             92981       34662.68
04810124   HB STENT, PLACEMENT ADDL VSL            92981       34662.68
04810125   HB STENT, PLACEMENT LC ADDL VSL         92981       34662.68
04810127   HB STENT, PLACEMENT LD ADDL VSL         92981       34662.68
04810126   HB STENT, PLACEMENT RC ADDL VSL         92981       34662.68
04810044   HB PTCA LC ARTERY                       92982       18825.43
04810039   HB PTCA LD ARTERY                       92982       18825.43
04810038   HB PTCA RC ARTERY                       92982       18825.43
04810045   HB PTCA SINGLE VESSEL                   92982       18825.43
04810128   HB PTCA EA ADDL VESSL                   92984       18825.43
04810096   HB PTCA EA ADDL VESSL-LC                92984       18825.43
04810046   HB PTCA EA ADDL VESSL-LD                92984       18825.43
04810095   HB PTCA EA ADDL VESSL-RC                92984       18825.43
04810040   HB AORTIC VALVUOPLASTY                  92986       18825.43
04810041   HB VALVULOPLASTY MITRAL                 92987       16692.03
04810042   HB VALVULOPLASTY PULM VALVE             92990       18825.43
04810043   HB ATRIAL SEPTECTOMY SEPTOSTOMY         92992       31105.83
04810098   HB ARTHERECTOMY MECHANICAL              92995       28248.24
04810099   HB ATHERECTOMY CIRCUMFLEX               92995       28248.24
04810097   HB ATHERECTOMY LAD                      92995       28248.24
04810100   HB ATHERECTOMY RCA                      92995       28248.24
04810101   HB ARTHERECTOMY EA ADDL VESSL           92996       33005.35
04810102   HB ATHERECTOMY ADD'L CIRCUMFLEX         92996       33005.35
04810103   HB ATHERECTOMY ADD'L LAD                92996       33005.35
04810104   HB ATHERECTOMY ADD'L RC                 92996       33005.35
04810047   HB PULM ART ANGIOPLASTY                 92997        9876.32
04810048   HB PULM ART ANGIOPLSTY ADDL VESSL       92998        9876.32
07300001   HB EKG                                  93005        586.48
07300002   HB ROUTINE ECG                          93005        586.48          762.18
04820001   HB CARDIAC STRESS TEST                  93017        1762.99        2291.30
04820002   HB CARDIAC STRESS TEST CL               93017        1663.20
04810049   HB ERGONOVINE PROVOCATION TEST          93024        1220.44
04800002   HB T-WAVE ALTERNANS                     93025        6111.71        7945.93
07300005   HB ECG RHYTHM STRIP                     93041        172.14          223.19
07310001   HB ECG UP TO 48HRS RECORDING            93225        563.92          733.69
07310002   HB ECG UP TO 48HRS SCAN ANLYS RPT       93226        985.38         1280.99
07300006   HB PATIENT DEMAND EVENT RECOR           93270        464.20          603.10
07300007   HB PATIENT DEMAND ANALY & RPT           93271        1733.31        2253.31
07300008   HB ECG SIGNAL AVR HIGH GAIN TE          93278        1174.14        1526.74
04800038   HB PROGRAMMING SNG LEAD PPM             93279        193.51          251.69



                                            111
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
04800041   HB PROGRAMMING DUAL LEAD PPM             93280        258.81          337.16
04800023   HB PROGRAMMING MULT LEAD PPM             93281        258.81          337.16
04800020   HB PROGRAMMING SNG LEAD ICD              93282        667.21          867.84
04800014   HB PROGRAMMING DUAL LEAD ICD             93283        600.72          779.99
04800031   HB PROGRAMMING MULT LEAD ICD             93284        600.72          779.99
04800032   HB PROGRAMMING IMP LOOP REC              93285        134.15          135.34
04800012   HB PERI-PROC PRG DEV EVAL PPM            93286        258.81          337.16
04810160   HB PERI-PROC PRG DV EVALPPM CL           93286        258.81
04810161   HB PERI-PROC PRG DE EVAL ICD CL          93287        600.72
04800042   HB PERI-PROC PRG DEV EVAL ICD            93287        600.72          779.99
04800029   HP INTERROGATION IN PERSON PPM           93288        258.81          337.16
04800027   HB INTERROGATION IN PERSON ICD           93289        600.72          779.99
04800026   HB INTERROGATION IN PERSON ICM           93290        600.72          779.99
04800043   HB INTERROGATION IN PERSON ILR*          93291        123.47          135.34
04800018   HB TRANSTELEPHONIC 90 DAYS PPM           93293        305.11          311.05
04800013   HB INTERRO REM 90DAYS PPM/ICD            93296        779.99          600.72
04800035   HB 2D ECHO W/SPEC,COLR FLW DOP           93306        2377.96        3091.47
04830001   HB 2D ECHO W/O SPEC/COLOR DOP            93307        2708.00        3520.05
04830002   HB 2D ECHO, LIMITED                      93308        1219.91        1585.88
04830009   HB TEE/2D                                93312        4484.16        5829.42
04830003   HB PULSE WAVE DOPPLER                    93320        720.63         1030.49
04830004   HB PULSE WAVE DOPPLER/SPEC,LTD           93321        1030.49        1339.16
04830006   HB PULSE WAVE DOPPLER/SPEC,LTD           93321        1030.13        1339.16
04830005   HB DOPPLER COLOR FLOW                    93325        1030.49        1339.16
04830008   HB STRESS ECHO                           93350        2377.96        3091.47
04800036   HB STRESS ECHO W ECG,MD SUPRV            93351        2377.96        3091.47
04810050   HB RIGHT HEART CATH                      93451       17070.75
04810131   HB LHC +/- LV GRAM                       93452       16962.71
04810132   HB R/LHC +/- LV GRAM                     93453       19657.66
04810133   HB COR ANGIO W/INJ S & I                 93454       16424.91
04810134   HB COR ANGIO W/GRFT INJ S & I            93455       16465.28
04810135   HB RHC W/COR INJ S & I                   93456       17070.75
04810136   HB RHC W/COR + GRFT INJ S & I            93457       17111.11
04810137   HB LHC W/COR +/- LV GRAM                 93458       17124.17
04810138   HB LHC W/COR +/- LV GRM W/GRFT           93459       22739.63
04810139   HB R/LHC+/-LV GRAM W/COR                 93460       24252.12
04810140   HB R/LHC +/- LV GRM W/COR+GRFT           93461       20269.07
04810141   HB TRNSPTL TRNSAP PUNCTURE               93462       10152.93
04810142   HB NITRIC OXIDE/HEMO MEAS                93463        1081.20
04810051   HB INSERT SWAN GANZ CATH                 93503        3336.03
04810162   HB INSERT SWAN GANZ CATH CL              93503        3336.03
04810052   HB ENDOMYOCARDIAL BIOPSY                 93505        4167.07



                                             112
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
04810058   HB RHC CONGENITAL ANOMALY                93530       10152.93
04810144   HB RHC & RETROGR LHC, CONGENITAL         93531       10152.93
04810059   HB RHC&TRNSPT LHC INTCT SEPT CNGN        93532       10152.93
04810060   HB RHC&TRNSPT LHC OPEN SEPT CNGN         93533       10152.93
04810145   HB INJ CNGNTL COR ANGIO W/S&I            93563        571.04
04810146   HB INJ CNGNTL ART/GRFT WS&I              93564        611.41
04810147   HB INJ CNGNTL LV/LA W/S&I                93565        409.58
04810148   HB INJ RV/RA W/S&I                       93566        409.58
04810149   HB INJ AORTO W/S&I                       93567        359.72
04810150   HB INJ PULM ART W/S&I                    93568        339.54
04810070   HB DOPPLER FLOW WIRE INITL VESSL         93571        8902.81
04810071   HB DOPPLER FLOW WIRE ADDL VESSL          93572        5091.90
04810072   HB CLOSURE ATRIAL DEFECT                 93580       29454.43
04810073   HB CLOSURE VENTRICULR DEFECT             93581       13652.80
04810074   HB BUNDLE OF HIS RECORDING               93600       11094.38
04810075   HB INTRA ATRIAL RECORDING                93602       11094.38
04810076   HB RT VENTRICULAR RECORDING              93603       11094.38
04810077   HB INTRAVENTR OR ATR MAPPING             93609       13469.97
04810078   HB INTRA ATRIAL PACING                   93610       11094.38
04810079   HB INTRAVENTRC PACING                    93612       11094.38
04810080   HB INTRACARDIAC EP 3D MAPPING            93613       11241.60
04800004   HB ESOPHAGEAL ATRIAL PACING              93616       11007.72       14309.32
04810081   HB INDUCT ARRHYTH BY ELECTR PACE         93618       13469.97
04810082   HB COMP EP EVAL W/O ARRHYT INDUCT        93619       16840.43
04810083   HB COMP EP EVAL W/ARRHYT INDUCT          93620       14031.52
04810084   HB COMP EP EVAL LFT ATRIAL PACE          93621       11980.04
04810085   HB COMP EP EVAL LFT VNTRC PACE           93622       11980.04
04810086   HB EP STIM+PACE POST DRUG INFUSN         93623       13469.97
04810087   HB EP F/U STUDY THERAPY TEST             93624        7567.21
04810088   HB EP EVAL ICD LEAD W/INSERT             93640        3559.23
04810089   HB EP EVAL ICD GEN & LEADS               93641        5615.46
04810090   HB EP EVAL ICD W/PROGRAMMING             93642        3559.23
04810091   HB ABLATION ATRIOVENTRC NODE             93650       18164.16
04810092   HB ABLATION SUPRAVENTRC TACHY            93651       15203.28
04810093   HB ABLATION VENTRIC TACHY                93652       15203.28
04800005   HB TILT TABLE TEST                       93660        3838.22        4989.80
04810094   HB INTRACARDIAC ECHO                     93662        9286.28
04800046   HB INTERROGATION VAD,IN PERSON           93750        430.95
09200008   HB BPM 24HR OR >,RECORD                  93786        591.23
09200009   HB BPM 24HR OR >, SCAN ANAL W            93788        973.50
09430003   HB CARDIAC REHAB; WO CONT ECG            93797        158.93
09430002   HB CARD REHAB INIT EVAL #                93798        1096.48



                                             113
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
09430001   HB CONT CARD EXERC         #            93798        438.59
04810156   HB ATHERECTOMY ILIAC,EA VESSEL          93799       18130.77
04810105   HB CATH UNLISTED PROCEDURES             93799         0.00
04810152   HB CATH-LAA OCCLUSION                   93799        8053.64
04810130   HB EMBO SHIELD DEP CORONARY             93799        294.43
04810151   HB EVALVE MITRAL CLIP                   93799       24127.37
04810108   HB ILIAC ANGIO W/HEART CATH             93799        294.43
04810157   HB INTRAVSC IMG COR VSL(S) OCT          93799        9286.28
04810129   HB PROCANIMIDE CHALLENGE STUDY          93799       13469.97
04810107   HB RENAL ANGIO W/HEARTH CATH            93799        294.43
03610543   HB STENT PLCMT INTERNAL CAROT           93799       12674.55
09210061   HB EXTRACRANIAL STUDY                   93875        508.80
09210011   HB VAS DUPLEX CAROTIDS BILAT            93880        2463.44        3201.88
09210012   HB VAS DUPLEX CAROTID LTD UNI           93882        1327.29        1725.00
09210013   HB VAS DUPLEX TRANSCRANIAL COM          93886        1328.48        1726.19
09210014   HB VAS DUPLEX TRANSCRANIAL LTD          93888        897.52         1167.02
09210062   HB TCD, VASOREACTIVITY STUDY            93890        1513.03
09210063   HB TCD, EMBOLI DETECT W/O INJ           93892        1572.49
09210064   HB TCD, EMBOLI DETECT W/INJ             93893        1529.60
09210015   HB VAS DUPLEX ABI WO EX BILAT           93922        920.08         1196.70
09210019   HB VAS DUPLEX ABI W EX BILAT            93923        1443.64        1876.96
09210020   HB VAS DUPLEX ARM SEGMENTAL             93923        1443.64        1876.96
09210017   HB VAS DUPLEX DIG FINGERS MULT          93923        1443.64        1876.96
09210021   HB VAS DUPLEX DIG TOES MULT             93923        1443.64        1876.96
09210018   HB VAS DUPLEX TCP02 MULT                93923        1443.64        1876.96
09210016   HB VAS DUPLEX THORACIC OUTLET           93923        1443.64        1876.96
09210060   HB VAS THORACIC OUTLET STUDY            93923        1443.64        1876.96
09210023   HB VAS DUPLEX LEG ART BILAT             93925        2021.80        2627.27
09210022   HB VAS DUPLEX LEG GRAFT BILAT           93925        2021.80        2627.27
09210027   HB VAS DUPLEX FEMORAL ANSM UNI          93926        1778.43        2311.48
09210026   HB VAS DUPLEX LEG ART UNILAT            93926        1778.43        2311.48
09210025   HB VAS DUPLEX LEG GRAFT UNILAT          93926        1778.43        2311.48
09210024   HB VAS DUPLEX POPLITEAL ASM UN          93926        1778.43        2311.48
09210028   HB VAS DUPLEX ARM ARTERY BILAT          93930        1992.12        2589.28
09210029   HB VAS DUPLEX ARM GRAFT BILAT           93930        1992.12        2589.28
09210031   HB VAS DUPLEX ARM ARTERY UNI            93931        1537.42        1998.06
09210032   HB VAS DUPLEX ARM GRAFT UNILAT          93931        1537.42        1998.06
09210034   HB VAS DUPLEX ARM VEIN BILAT            93970        2438.51        3169.82
09210035   HB VAS DUPLEX ARM VN SP/DP BIL          93970        2438.51        3169.82
09210057   HB VAS DUPLEX EXT UPP/LOW BIL           93970        3451.19        4486.43
09210036   HB VAS DUPLEX LEG VEIN DVT BIL          93970        2438.51        3169.82
09210033   HB VAS DUPLEX LEG VN SP/DP BIL          93970        2438.51        3169.82



                                            114
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
09210040   HB VAS DUPLEX ARM VEIN UNILAT              93971        1909.02        2481.25
09210037   HB VAS DUPLEX ARM VN SP/DP UNI             93971        1909.02        2481.25
09210038   HB VAS DUPLEX LEG VEIN DVT UNI             93971        1909.02        2481.25
09210039   HB VAS DUPLEX LEG VN SP/DP UNI             93971        1909.02        2481.25
09210059   HB VAS LEG VARICOS VEIN UNI                93971        1909.02        2481.25
09210043   HB US DUPLEX ABDOMEN                       93975        1537.42        1998.06
09210041   HB US DUPLEX PELVIS                        93975        1537.42        1998.06
09210045   HB US DUPLEX TESTICLE(S)                   93975        1537.42        1998.06
09210042   HB VAS DUPLEX RENAL/VISC ART               93975        1537.42        1998.06
09210044   HB VAS DUPLEX SMA/CELIAC ART               93975        1537.42        1998.06
09210046   HB DOPPLER, UTERINE ARTERY                 93976        1377.15        1789.11
09210047   HB VAS DUPLEX REN/VISC ART LTD             93976        1377.15        1789.11
09210048   HB VAS DUPLEX RENAL TRANSPLANT             93976        1377.15        1789.11
09210050   HB VAS DUPLEX AOR/ILI ANSM COM             93978        1596.78        2076.41
09210051   HB VAS DUPLEX AOR/ILI ART COM              93978        1596.78        2076.41
09210049   HB VAS DUPLEX IVC/ILI VEIN COM             93978        1596.78        2076.41
09210053   HB VAS DUPLEX ABD GRAFT LTD                93979        1436.51        1867.47
09210055   HB VAS DUPLEX AOR/ILI ANSM LTD             93979        1436.51        1867.47
09210054   HB VAS DUPLEX IVC/ILI VEIN LTD             93979        1436.51        1867.47
09210056   HB VAS DUPLEX DIALYSIS ACCESS              93990        1909.02        2482.44
09210030   HB VAS DUPLEX DIALYSIS ACCESS *            93990        1909.02        2482.44
04100004   HB PC VENT INITL DAY >12 HRS               94002        4789.16
04100002   HB PC VENT INITL DAY 1-12 HRS              94002        2312.67
04100003   HB PC VENT JET INITL DAY >12 HRS           94002        8849.39
04100001   HB PC VENT JET INITL DAY 1-12 HRS          94002        3898.76
04100008   HB PC VENT JET SUBSQT DAY >12 HRS          94003       11357.94
04100006   HB PC VENT JET SUBSQT DAY 1-12 HR          94003        3540.23
04100005   HB PC VENT SUBSQT DAY >12 HRS              94003        5680.75
04100007   HB PC VENT SUBSQT DAY 1-12 HRS             94003        1771.30
04600046   HB SPIROMETRY                              94010        1066.11
04600017   HB EXERC INDUCED BROCHO SPASM              94060        1200.26
04600011   HB PEDS - BRONCHOSPASM EVAL                94060        1200.26
04600021   HB PRE/POST SPIROMETRY                     94060        1200.26
04600005   HB METHACHOLINE CHALLENGE                  94070        1970.75
04600022   HB SLOW VITAL CAPACITY                     94150        529.49
04600023   HB VITAL CAPACITY PER MEASUREMENT          94150        529.49
04600007   HB PF MIPS/MEPS-PIMAX PEMAX                94200        352.60
04600044   HB LUNG VOLUME-HELIUM                      94240        774.05
04600009   HB THORACIC GAS-VOLUME                     94260        497.44
04600010   HB AIRWAY RESISTANCE                       94360        649.40
04600045   HB SCREENING SPIROMETRY                    94375        629.22
04600014   HB PF ALTITUDE 02 STUDY                    94452        4205.06



                                               115
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
04600015   HB PF ALTITUDE 02 STUDY W/ O2             94453        3584.16
04600032   HB 6 MIN WALK/ PULSE OXIMETRY             94620        705.20
04600027   HB PULMONARY STRESS; SIMPLE               94620        705.20
04600026   HB PULMONARY STRESS; COMPLEX              94621        2386.27
04100009   HB AEROSOL INHAL, HHN TRT,SUBS            94640        277.80
04100029   HB AEROSOL INHAL, INITIAL HHN             94640        553.24
04120003   HB AEROSOL INHAL, TREATMENT               94640        277.80
04100028   HB AEROSOL INHAL, USN TREAT               94640        553.24
04100053   HB AIRWAY INHALATION TREATMENT            94640        277.80
04100031   HB BRONCHODILATOR ADMIN                   94640        553.24
04100034   HB BRONCHODILATOR ADMINISTATION           94640        553.24
04100010   HB IPPB TRT, SUBSEQ                       94640        277.80
04100011   HB PAG HEAR NEB CONT-TX                   94640        277.80
04120001   HB PC HAND NEB. TRT SUBS                  94640        277.80
04100033   HB PC HEATED AERO. TRT.                   94640        553.24
04100038   HB PC INITIAL HAND NEBULIZER TRT          94640        553.24
04100037   HB PC INITIAL IPPB TRT                    94640        553.24
04100012   HB PC IPPB TRT SUBSEQUENT                 94640        277.80
04100036   HB PC MDI INITIAL                         94640        553.24
04100035   HB PC O/P H A TREATMENT                   94640        553.24
04100039   HB PC O/P SPUTUM INDUCT                   94640        553.24
04100027   HB PC SPUTUM INDUCTION                    94640        553.24
04100032   HB PC USN TRT.                            94640        553.24
04120002   HB PEDS PULM -INHAL. TREAT, MLTP          94640        277.80
04100014   HB AEROSOL INHAL, PENTAMIDINE             94642        733.69
04100013   HB PC PENTAMIDINE TREATMENT               94642        733.69
04100015   HB PENTAMIDINE TREATMENT ADDL 10*         94642        733.69
04100030   HB PAG-HEART NEB INITIAL                  94644        553.24
04100016   HB PC AEROSOL TREATMENT INIT HR           94644        351.41
04100054   HB PAG-HEART NEB EACH ADDL HR             94645        170.96
04100017   HB PC AEROSOL TRMNT EA ADDL HOUR          94645        170.96
04100021   HB PC BIPAP INITL DAY >12 HRS             94660        4996.92
04100020   HB PC BIPAP INITL DAY 1-12 HRS            94660        2060.98
04100022   HB PC BIPAP SUBSQT DAY >12 HRS            94660        5228.43
04100025   HB PC BIPAP SUBSQT DAY 1-12 HRS           94660        1621.72
04100019   HB PC CPAP INITL DAY >12 HRS              94660        4783.23
04100024   HB PC CPAP INITL DAY 1-12 HRS             94660        2071.66
04100023   HB PC CPAP SUBSQT DAY >12 HRS             94660        5185.69
04100018   HB PC CPAP SUBSQT DAY 1-12 HRS            94660        1657.33
04100051   HB IPPB TRT, INITIAL                      94664        553.24
04100026   HB SURFACTANT TREATMENT-NICU              94664        553.24
04100040   HB CW MANIPULATION, INITIAL               94667        499.81



                                              116
  Charge
   Code                  Description                  CPT Code OP/Default Price   IP/ED Price
04100041   HB PC INITIAL CHEST PHYSIOTHERAP            94667        499.81
04100042   HB PC POST.DRAINAGE TRT                     94667        499.81
04100043   HB CW MANIPULATION, SUBSEQ                  94668        371.59
04100044   HB PC CHEST PHYSIO THER SUBS                94668        371.59
04600018   HB O2 PERSCRIPTION                          94680        4395.01
04600047   HB O2 UPTAKE,EXP GAS, CO2/VO2 EXT           94680        349.04
04600048   HB O2 UPTAKE, EXP GAS DIR/VO2 EXT           94681        378.72
04600049   HB OXYGEN UPTAKE REST INDIRECT              94690        144.63
04600019   HB DIFFUSING CAPACITY                       94720        516.43
04600028   HB PULSE OXIMETRY SNGL                      94760        157.90
04600030   HB INITIAL TRANSCUTANEOUS        *          94761        295.61
04600033   HB PULSE OXIMETRY MULT                      94761        227.94
04600034   HB TRANSCUTANEOUS PER HOUR           *      94761        295.61
04600036   HB CO, EXPIRED GAS BY IR                    94770        529.49
04600038   HB PNEUMOCARD 12HR 4 CHAN                   94772        4169.45
04600039   HB PNEUMOCARD 12HR 5 CHAN                   94772        4169.45
04600040   HB PC MDI TX-PEDS                           94799        886.84
04600041   HB PC RESP GAS ANAL                         94799        886.84
04100045   HB PR THER PROCEDURE 15 MIN                 94799        138.90
09240001   HB PEDS - PERCUTAN.SKIN TESTS               95004        308.00
09240011   HB PERCUT ALLERGY SKIN TESTS                95004         80.08
09240012   HB PERCUT ALLERGY TITRATE TEST              95010         80.08
09240005   HB SKIN TEST ID IMED,NON-CHEMO              95015        146.61
09240006   HB SKIN TEST ID IMMED, CHEMO                95015        146.61
09240002   HB SKIN TEST ID IMMED, PER TST              95015        146.61
09240008   HB ID ALLERGY TEST, DRUG/BUG                95024         80.08
09240003   HB SKIN TEST ID DELAY EA SITE               95028        176.18
09240010   HB PATCH -APPLICATION TEST(S)               95044         80.08
09240009   HB DIR NASAL MUCOUS MEMBR TEST              95065         80.08
09240007   HB INGESTION CHALLENGE TEST                 95075        907.98
05100143   HB IMMUNOTHERAPY INJECTIONS                 95117         86.24
05100141   HB ANTGNS-ALLRGN IMM;SGL STNGI              95145         86.24
05100142   HB ANTGNS-ALLRGN IMM; SGL/MUL               95165         86.24
05100144   HB RAPID DESENSITIZATION                    95180        332.64
09200014   HB GLUCOSE MONITORING CONT                  95250        415.21          539.77
07400002   HB EEG EXT- MON ( 41-60 MIN)                95812        5626.14        7313.15
07400003   HB EEG EXTENDED MON > 1 HOUR                95813        6300.47        8190.49
07400004   HB EEG AWAKE/DROWSY                         95816        1806.92        2349.47
07400005   HB EEG (AWAKE & SLEEP)                      95819        2155.96        2802.98
07400006   HB EEG IN COMA OR SLEEP ONLY                95822        1821.16        2367.28
07400007   HB ECI (BRAIN DEATH) STUDY                  95824        6469.05        8410.12
07400021   HB ECOG (ELECTROCORTICOGRAPHY)              95829       11640.50       15133.24



                                                117
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
09200010   HB CHOLINESTERASE INHIBITOR TEST        95857        611.41          795.42
09220016   HB EMG - 1 EXTREMITY                    95860        1220.44        1587.29
09220017   HB EMG - 2 EXTREMITY                    95861        1254.87        1631.21
09220002   HB EMG -3 EXTREMITIES                   95863        1288.11        1673.95
09220003   HB EMG -4 EXTREMITIES                   95864        1321.35        1717.88
09220022   HB MUSCLE TEST LARYNX                   95865        967.33         1257.53
09220027   HB MUSCLE TEST HEMIDIAPHRAGM            95866        383.85          499.01
09220004   HB NEEDLE EMG; CRANIAL NERVE (ONE       95867        623.28          809.67
09220005   HB NEEDLE EMG; CRANIAL NERVE (BOT       95868        4937.56        6418.00
09220006   HB NEEDLE EMG/THORACIC PARASPINAL       95869        2362.53        3071.29
09220024   HB MUSCLE TST NONPRSPNL 1 EXTR          95870        293.24          381.09
09220018   HB NEEDLE EMG; SINGLE FIBER             95872        338.80
09220021   HB GUIDE NERV DESTR, ELEC STIM          95873        214.96
09220020   HB GUIDE NERV DESTR,NEEDLE EMG          95874        214.96
09220023   HB LIMB EXERCISE TEST                   95875        967.33         1257.53
09220007   HB MOTOR NERVE TEST                     95900        293.24          381.09
09220008   HB NCS - MOTOR W/F WAVE                 95903        762.18          991.31
09220009   HB SENSORY NERVE TEST                   95904        444.01          578.17
09220019   HB MOTOR/SENSRY NRV COND W/FWA          95905        762.18          991.31
07400008   HB INTRA-OP NEURO TESTING, PER HR       95920                        947.39
09220010   HB SSEP - UPPER EXTREMITIES             95925        2705.47        3517.36
09220011   HB SSEP - LOWER EXTREMITIES             95926        2723.95        3542.00
03610371   HB C MOTOR EVOKED, UPPR LIMBS           95928                        985.59
03610372   HB C MOTOR EVOKED, LWR LIMBS            95929                       1067.62
09220012   HB VEP - CHECKBOARD OR FLASH            95930        2604.72        3385.89
09220013   HB NCS - (BLINK) REFLEX                 95933        3797.85        4936.38
09220014   HB H-REFLEX, GASTROC/SOLEUS             95934        2362.53        3071.29
09220015   HB NCS - REPET STIM                     95937        623.28          809.67
07400009   HB AMBULATORY EEG MONITORING 24HR       95950        5413.63        7037.72
07400010   HB EEG MONITOR/VIDEORECORD 24 HR        95951        8519.35       11075.39
07400011                                      95953
           HB EEG MNTRNG/COMPT EA 24HR UNATTENDED               4212.19        5476.55
07400012   HB EEG W/MED &/OR ACTIVTN W/MD          95954        5273.54        6856.08
07400014   HB EEG DURING CEA SURGERY               95955        2045.55        2659.33
07400015                                       95956
           HB EEG MNTR/CABLE/RADIO 24HR ATTENDED                7875.88       10238.41
07400016   HB DIG/ANALYS/EPILEP/SPIKE/ANALYS       95957        1795.05        2332.85
07400013   HB WADA ( MEMORY DOMINANCE TEST)        95958        3096.22        4025.80
07400017   HB WADA ACT HEMISPHERIC FUNCT           95958        3096.22
07400019   HB FUNCT/MOTOR/LANGUAG MAP/1ST HR       95961        2812.48        3656.58
07400020   HB FUNCT/MOTOR/LANG MAP ADD'L HR        95962        2109.65        2742.43
05100046   HB ANALYZE NEUROSTIM, NO PROG           95970        806.70         1048.25
09200013   HB ANALYZE NEUROSTIM, SIMPLE            95971        633.96          825.10
09200011   HB VNS - SIMPLE PROGRAMMING             95971        633.96          825.10



                                            118
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
09200017   HB ELECT ANALYSIS INS PG 1 HR              95972        597.17          777.22
09200018   HB EA SNS PG; EA ADDTL 30 MIN              95973        597.17          777.22
03610374   HB NEURO STIM ANALY NO PROGRAM             95974        1333.10        1733.03
03610375   HB SIMPLE NEURO STIM ANALYSIS              95975        608.44          791.89
03600015   HB ANALYZE NEUROSTIM BRAIN1ST/HR           95978        1548.56
03610437   HB ANA NEUROST BRAIN ADD 30 MIN            95979        713.26
09180002   HB PSYCH TEST W INT/RPT, PHD PSYD          96101        498.96
09180001   HB PSYCHOLOGICAL TESTING HOURLY            96101        498.96
09180003   HB PSYCH TEST, COMP W INT/RPT              96103        498.96
04390001   HB INFANT PROG - DEV TEST/HR OT            96111        515.24
04290001   HB INFANT PROG - DEV TEST/HR PT            96111        515.24
09180004   HB NEUROBHV STATUS EXAM W INT/RPT          96116        619.70
09180005   HB NEUROPSYCH BATTERY W INT/RPT            96118        619.70
09180006   HB NEUROPSY TEST COMP W INT/RPT            96120        498.96
09140010   HB ASSESS BEH/HLTH, INIT EA 15M            96150        104.72
09140011   HB ASSESS BEH/HLTH, SUBSEQ EA 15M          96151        104.72
09140012   HB INTRVNTN BEH/HLTH, IND EA 15M           96152        104.72
09150007   HB INTRVNTN BEH/HLTH, GRP EA 15M           96153        104.72
09160005   HB INTRVNTN BEH/HLTH FAM/PT EA15M          96154        104.72
05100022   HB H & B INTERVEN 15MIN/FAM/WO/PT          96155        107.18
09160006   HB INTRVNTN BEH/HLTH FAM EA 15M            96155        107.18
02600001   HB IV INFUS HYDRATION 31-60 MIN            96360        819.50         1065.90
02600002   HB IV INFUSION HYDRATION ADDL HR           96361        200.82          259.95
02600003   HB IV INFUSION THERAPY 1ST HR              96365        917.84         1193.81
02600012   HB IV INFUSION THERAPY EA ADDL HR          96366        200.82          259.95
02600004   HB IV THERAPY ADDL SEQ UP TO 1 HR          96367        200.82          259.95
02600005   HB IV THERAPY-CONCURRENT                   96368        266.11          344.96
02600007   HB INFUSION SC INITIAL FIRST HR            96369        376.99
02600008   HB SC INFUSION ADD'L HOURS                 96370        187.26
03610220   HB THER/PROPH/DIAG INJ, SC/IM              96372        133.10          172.70
05100095   HB INJ TX/DX/PROPHYLACTIC                  96373        256.26
02600013   HB IV PUSH INITIAL                         96374        298.14          388.08
02600014   HB IV PUSH ADDL SEQ NEW DRUG               96375        402.86          523.60
02600015   HB IVP ADDL SEQ SAME DRUG                  96376        402.86          523.60
03310002   HB CHEMO ANTI-NEOPL, SC/IM                 96401        389.31
03310004   HB CHEMO ADMIN, NON HORMONAL               96402        400.40
03310003   HB CHEMO HORMNL ANTI-NEOPL, SC/IM          96402        357.50
03310011   HB CHEMO HORMONAL INTINEOPL, SC/I          96402        246.40
03310012   HB CHEMO IVP/INF 0-15 MIN INITIAL          96409        804.50
03310013   HB CHEMO PUSH                              96409        804.50
03310005   HB CHEMO IVP/INF 0-15 MIN ADD/SEQ          96411        501.42
03350001   HB CHEMO INFUSION FIRST HOUR               96413        1261.57



                                               119
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
03350002   HB CHEMO INFUSION ADDL HOUR             96415        402.86
03310006   HB CHEMO INF>8HRS VIA AMB PUMP          96416        786.02
03350004   HB CHEMO INF ADD/SEQ 1ST HOUR           96417        523.60
03310007   HB CHEMOTHERAPY INTRA-ART PUSH          96420        618.46
03310008   HB CHEMO INF,INTRACAV PERITONEAL        96446        786.02
03310016   HB CHEMOTHERAPY SPINE PUNCT IR          96450        662.82
03310010   HB CHEMOTHERAPY SPINE PUNCTURE          96450        662.82
03310009   HB CHEMOTHERAPY, INTO CNS               96450        662.82
09400006   HB AMBUL PUMP REFIL/MAINT-NONCHEM       96521        638.98
09400005   HB AMBUL PUMP REFILL /MAINT-CHEMO       96521        638.98
05100049   HB FLUSH IMPLANTABLE PORTS              96523        625.86
03310014   HB CHEMOTHERAPY INJECTION               96542        786.02
03300001   HB PROVIDE CHEMOTHERAPY AGENT           96549        591.36
04240004   HB PT EVALUATION - (2) INT              97001        409.58          531.87
04240002   HB PT EVALUATION - (3) MOD              97001        613.78          797.80
04340007   HB PT EVALUATION (1) BRF                97001                        265.93
04240009   HB PT EVALUATION (4) EXT                97001        817.98         1063.73
04240006   HB PT RE-EVALUATION - (2) INT           97002        409.58          531.87
04240005   HB PT RE-EVALUATION - (3) MOD           97002        613.78
04240013   HB PT REEVALUATION (1) BRF              97002                        265.93
04240011   HB PT REEVALUATION (3) MOD              97002                        797.80
04240012   HB PT REEVALUATION (4) EXT              97002                       1063.73
04340013   HB OT EVAL-(3) MOD                      97003        548.02          712.32
04340011   HB OT EVALUATION - (2) INT              97003        365.70          474.88
04340012   HB OT EVALUATION - (3) MOD              97003        548.02          712.32
04340010   HB OT EVALUATION - (4) EXT              97003        730.34          949.76
04340025   HB OT EVALUATION (1) BRF                97003                        237.44
04340018   HB M CAL OT EVAL EA ADDL 15M            97004        186.39
04340019   HB OCCUPATIONAL THERAPY REEVAL          97004                        531.87
04340015   HB OT RE-EVAL(2) INT                    97004        409.58
04340027   HB OT REEVALUATION (1) BRF              97004                        265.93
04340029   HB OT REEVALUATION (3) MOD              97004        613.78          797.80
04340028   HB OT REEVALUATION (4) EXT              97004                       1063.73
04300010   HB OT MODALITY HOT COLD PACK            97010         0.00           195.89
04200022   HB PT HOT OR COLD PACK                  97010        150.77          195.89
04200023   HB PT TRACTION, MECHANICAL              97012        166.21          216.07
04200054   HB ELEC STIM, UNATTENDED                97014        166.21
04300011   HB OT ELEC STIM, UNATTEND EA 15M        97014                        216.07
04200024   HB PT ELEC STIM, UNATTEND EA 15M        97014                        216.07
04300012   HB OT VASOPNEUMATIC DEVICES             97016        146.03
04200025   HB PT COMPRESSION TREATMENT             97016        146.03
04300025   HB OT PARAFFIN BATH EA 15M              97018        174.52          227.94



                                            120
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
04200026   HB WHIRLPOOL/FLUIDTHERAPY                97022        409.58          531.87
04200027   HB ELEC STIM, ATTENDED EA 15M            97032        204.20          265.93
04300014   HB OT ELEC STIM, ATTENDED EA 15M         97032        204.20          265.93
04200028   HB IONTOPHORESIS 15 MIN                  97033        204.20          265.46
04210001   HB OT IONTOPHORESIS                      97033        204.20
04300015   HB OT CONTRAST BATH EA 15M               97034         89.04          116.35
04300016   HB OTM ULTRASOUND EA 15M                 97035        197.08
04200029   HB PT ULTRASOUND EA 15M                  97035        197.08          256.44
04300017   HB OT UPPER EXT EXERCISE EA 15M          97110        188.68
04200030   HB THER EXERCISE EA 15M                  97110        188.68          244.86
04200031   HB NEUROMUSC REED EA 15M                 97112        199.28          258.64
04300002   HB OT NEUROMUSC RE-ED 15M                97112                        258.64
04200032   HB PT GAIT TRAINING EA 15M               97116        204.20          265.93
04300027   HB OT MASSAGE EA 15M                     97124                        224.38
04200033   HB PT MASSAGE THERAPY EA 15M             97124                        224.38
09410001   HB RC THER RECREATION EVAL               97139                        740.43
04200034   HB MANUAL THERAPY EA 15M                 97140        182.32          237.44
04200035   HB EXERCISE GRP OF 2 OR MORE             97150        263.56          341.91
04200038   HB THER ACTVTIES, DIR EA 15M             97530        199.28          259.70
04400041   HB COGNITIVE THERAPY EA 15M              97532        204.20          265.93
04300020   HB OT COGNITIVE RETRAIN EA 15M           97532        204.20          265.93
04300019   HB OT COGNITIVE SKILL DEVELOP 15M        97532         0.00           265.93
04300021   HB OT ADL THERAPY EA 15M                 97535        202.46          262.88
04200039   HB COMM TRN/REINT 15M                    97537        205.39          267.12
04200040   HB PT W/C MAN/PROPLSN TRN EA 15M         97542        178.08          231.50
04200041   HB PT WND CARE SELECT DEBRDMNT           97597                        440.45
04200042   HB PT WND CARE NONSELECT DEBRDMNT 97602                               173.33
04200043   HB PT NEG PRES WND THER <50CM            97605                        273.06
04200044   HB PT NEG PRES WND THER >50CM            97606                        547.30
04340020   HB OT DRIVING EVAL EA 15M                97750        204.20
04300022   HB OT JOB SITE EVAL EA 15M               97750        204.20
04200045   HB PDC FUNCTIONAL CAPACITY EA 15M        97750        204.20
04200046   HB PT PHYS PERFRM TEST EA 15M            97750        204.20
04300023   HB PT ASSIST TECH ASSESS EA 15M          97755                        311.05
04300024   HB ORTHOTIC SPLINT/TRN 15M               97760                        257.58
04200047   HB ORTHTC ASSESS/TRN EA 15M              97760        198.22          257.58
04200049   HB PT PROSTHETIC TRAIN EA 15M            97761        211.32          274.24
04200051   HB ORTH/PROS CHECK EA 15M                97762        263.56          343.10
04340021   HB OT JOB SITE EVALUATION                97799        1272.68
04200053   HB PATIENT/FAM CONF BRIEF                97799                        319.36
04200052   HB PATIENT/FAM CONF INTERM               97799                        403.65
04400043   HB SP PATIENT/FAM CONF INTERM            97799                        403.65



                                             121
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
04400042   HB SP PATIENT/FAM CONF INTERM      *       97799                        400.09
09420008   HB INITIAL ASSMT NEW PT.-15 MIN            97802         73.92
09420001   HB MED NUTR THPY 60 MIN                    97802        221.76
09420002   HB NUTRITION THERAPY (IND) EA 15           97802         73.92
05100026   HB MEDICAL NUT THERAPY RE-ASSESS           97803        203.28
09420003   HB NUTRITION REASSES (IND) EA 15           97803         61.60
09420009   HB GROUP MNT -30 MIN                       97804        203.28
09420004   HB NUTRITION THER (GRP V1) EA 30M          97804        203.28
09420011   HB NUTRITION THER (GRP VS) EA 30M          97804        203.28
03740001   HB ACUPUNCTURE W/O STIMUL 15 MIN           97810        150.40
03740002   HB ACUPUNCT W/O STIMUL ADDL 15MIN          97811        150.40
80000315   HB PROF CONS AFTER HOURS                   99050
80000420   HB PROF CONS 10 PM - 8 AM                  99052
80000344   HB PROF CONS SUNDAY / HOLIDAY              99054
80014879   HB PROF PLT CULTURE DONOR PLT              99070
03700010   HB MOD SED YGR THAN 5 YR 30 MN             99143        437.53          568.57
03700009   HB MODERATE SEDATION <5YO 30 MIN           99143        437.53          568.57
03700011   HB MOD SEDATION >5YRS 30 MIN               99144        437.53          568.57
03700012   HB MODERATE SEDATION >4YO 30 MIN           99144        437.53          568.57
03700014   HB MOD SEDATION EA ADDL 15 MIN             99145        170.91          223.32
03700013   HB MODERATE SEDATION @ ADD 15 MIN          99145        170.91          223.32
80000300   HB PROF CONS THERAP PHLEB                  99195
09400007   HB THERAPEUTIC PHLEBOTOMY                  99195        316.62
05100028   HB THERAPEUTIC PHLEBOTOMY CC               99195        316.62
05100068   HB ECT NEW PATIENT, LEVEL 1                99201         81.31
05100069   HB NEW PATIENT, LEVEL 1                    99201        168.52
05100070   HB NEW PATIENT, LEVEL 1 W/PROC             99201        168.52
80015988   HB PROF AUTOLOG DONOR                      99201
05100071   HB NEW PATIENT, LEVEL 2                    99202        190.65
05100076   HB NEW PATIENT, LEVEL 2 W/PROC             99202        190.65
05100072   HB NEW PATIENT, LEVEL 3                    99203        242.64
05100079   HB NEW PATIENT, LEVEL 3 W/PROC             99203        242.64
05100055   HB NEW PATIENT, LEVEL 4                    99204        304.02
05100084   HB NEW PATIENT, LEVEL 4 W/PROC             99204        304.02
05100035   HB GROUP VISIT-HIGH DECISION 90MN          99205        401.63
05100040   HB GROUP VISIT-MOD DECISION 60MIN          99205        401.63
05100034   HB INDIVIDUAL VISIT-HIGH DEC 90MN          99205        1096.48
05100033   HB INDIVIDUAL VISIT-MOD DEC 60MIN          99205        905.52
05100057   HB NEW PATIENT, LEVEL 5                    99205        387.51
05100038   HB NEW PATIENT, LEVEL 5 W/PROC             99205        387.51
05100039   HB PHYSICIANS OFFICE-HIGH DE 90MN          99205        426.27
05100042   HB EST PATIENT, LEVEL 1                    99211        168.52



                                               122
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
05100091   HB EST PATIENT, LEVEL 1 W/PROC          99211        168.52
80000276   HB PROF AUTO DNR FOLLOWUP               99211
80000443   HB PROF EVAL MGMT CONS F/UP OP          99211
05100088   HB EST PATIENT, LEVEL 2 W/PROC          99212        183.71
05100061   HB EST. PATIENT, LEVEL 2                99212        183.71
80000441   HB PROF CONS OP F/U 10 MIN              99212
05100073   HB EST PATIENT, LEVEL 3 W/PROC          99213        217.90
05100045   HB EST. PATIENT, LEVEL 3                99213        217.90
80000346   HB PROF CONS OP F/U 15 MIN              99213
05100075   HB EST PATIENT, LEVEL 4 W/PROC          99214        276.98
05100064   HB EST. PATIENT, LEVEL 4                99214        276.98
80000383   HB PROF CONS OP F/U 25 MIN              99214
05100093   HB EST PATIENT, LEVEL 5 W/PROC          99215        380.03
05100065   HB EST. PATIENT, LEVEL 5                99215        380.03
80000347   HB PROF CONS OP F/U 40 MIN              99215
05100048   HB CASE CONSULTATION 15 MIN             99241        105.95
05100047   HB GEN/RISK CONSULT, LEVEL 1            99241        306.77
80000299   HB PROF EVAL MGMT CONS INIT OP          99241
05100052   HB CASE CONSULTATION 30 MIN             99242        283.36
05100050   HB DONOR INFORMATION SESSION            99242        285.82
05100051   HB GEN/RISK CONSULT, LEVEL 2            99242        351.12
80016278   HB PROF BB THER PHLEB OP                99242
80000251   HB PROF EVAL MGMT CONS INIT OP          99242
05100053   HB GEN/RISK CONSULT, LEVEL 3            99243        394.24
80000252   HB PROF CON OP EVL STM CELL CL          99243
80000468   HB PROF CONS OP MD/HG SEV               99243
80000353   HB PROF EVAL MGMT CONS INIT OP          99243
05100054   HB CASE CONSULTATION 60 MIN             99244        425.04
05100056   HB DONOR PHYSICAL EXAM                  99244        442.29
05100058   HB GEN/RISK CONSULT, LEVEL 4            99244        438.59
80000415   HB PROF CONS OP INITIAL 60 MIN          99244
80000385   HB PROF EVAL MGMT CONS INIT OP          99244
05100059   HB GEN/RISK CONSULT, LEVEL 5            99245        481.71
80016106   HB PROF CONS EXITENSIVE CP              99245
80016277   HB PROF BB THER PHLEB IP                99251
80016113   HB PROF EVAL MGMT INITIAL IP            99251
80016105   HB PROF INTERMEDIATE CP                 99251
80016080   HB PROF LIMITED AP                      99251
80000228   HB PROF CONSULT INTERMED AP             99252
80016081   HB PROF INTERMEDIATE AP                 99252
80000250   HB PROF CONSULT IP/BLOOD BANK           99253
80000351   HB PROF EVAL MGMT INITIAL IP            99253



                                            123
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
80000384   HB PROF CONS IP INITIAL 80 MIN            99254
80016084   HB PROF COMPLEX AP                        99255
80016107   HB PROF COMPREHESIVE CP                   99255
80016108   HB PROF CONS COMPLEX CP                   99255
80016085   HB PROF BRIEF FOLLOW-UP AP                99261
80016109   HB PROF CONS BRICF F/U CP                 99261
80016086   HB PROF LIMITED FOLLOW-UP AP              99261
80015989   HB PROF CONS AUTO DONOR F/U               99262
80016087   HB PROF INTERMEDIATE F/U AP               99262
80016111   HB PROF INTERMEDIATE F/U CP               99262
80016110   HB PROF LIMITED FOLLOW-UP CP              99262
80016088   HB PROF COMPLEX FOLLOW-UP AP              99263
80016112   HB PROF COMPLEX FOLLOW-UP CP              99263
04500121   HB ED FACILITY LEVEL 1                    99281        537.47          537.47
04500122   HB ED FACILITY LEVEL 1 W/PROC             99281        537.47          537.47
04500126   HB ED FACILITY LEVEL 2                    99282        734.46          734.46
04500127   HB ED FACILITY LEVEL 2 W/PROC             99282        734.46          734.46
04500128   HB ED FACILITY LEVEL 3                    99283        1576.18        1576.18
04500143   HB ED FACILITY LEVEL 3 W/PROC             99283        1576.18        1576.18
04500145   HB ED FACILITY LEVEL 4                    99284        4413.24        4413.24
04500147   HB ED FACILITY LEVEL 4 W/PROC             99284        4413.24        4413.24
04500171   HB ED FACILITY LEVEL 5                    99285        4886.04        4886.04
04500170   HB ED FACILITY LEVEL 5 W/PROC             99285        4886.04        4886.04
04500173   HB CRITICAL CARE 30-74 MIN                99291        5516.54        5516.54
04500174   HB CRITICAL CARE 30-74 MIN W/PROC         99291        5516.54        5516.54
04500177   HB CRITICAL CARE EACH ADD 30 MIN          99292        2206.61        2206.61
07700002   HB INIT PREVENT VISIT 12-17               99384        168.52
07700003   HB INIT PREVENT VISIT 18-39               99385        183.71
07700004   HB INIT PREVENT VISIT 40-64               99386        242.64
07700005   HB INIT PREVENT VISIT >65                 99387        304.02
07700006   HB EST PREVENT VISIT 12-17                99394        168.52
07700007   HB EST PREVENT VISIT 18-39                99395        190.65
07700008   HB EST PREVENT VISIT 40-64                99396        217.90
07700009   HB EST PREVENT VISIT >65                  99397        276.98
05100060   HB PREV MED COUNSELING 1 HR               99404        261.18
09000006   HB PHONE CONSULTATION 0.25 HOUR *         99441        129.36
09000007   HB PHONE CONSULT .50HR                    99442        243.94
09000008   HB PHONE CONSULTATION 1.0 HOUR            99443        401.63
04500184   HB NEWBORN RESUSITATION                   99465                       1816.20
02700001   HB CATHETER SOLID STATE                  02700001      606.30
02700002   HB DBS - MICRO TARGET ELECTRODES         02700002      452.68
02700003   HB PC U.S.N. KIT                         02700003      224.09



                                              124
  Charge
   Code                     Description              CPT Code OP/Default Price   IP/ED Price
02700004   HB D5W 5% 50CC                            02700004       92.16
02700005   HB CYTOTOXIC SPILL KIT                    02700005      111.16
02700006   HB LUER ADAPTOR/BOX                       02700006      153.61
02700007   HB 24 HR PH PROBE                         02700007      1408.10
02700008   HB FEMSTOP                                02700008      544.63
02700009   HB PC IPPB KIT                            02700009      153.42
02700010   HB TRAY, BIOPSY/ASP/LOC/INJ MOT           02700010      457.96
02700011   HB BARICARE BED                           02700011      1176.90
02700012   HB GLOVES, SHLDER/BOX                     02700012       68.80
02700014   HB PC SPECIAL ITEM                        02700014       0.00
02700016   HB PEFR-EQUIPMENT                         02700016      402.71
02700018   HB PC AERO KIT                            02700018      374.68
02700019   HB PC O/P H A EQUIPMENT                   02700019      355.31
02700020   HB PC O/P USN EQUIPMENT                   02700020      464.66
02700021   HB PC MICRO-SPIROMETER                    02700021      5064.36
02700022   HB PC O/P HHN EQUIPMENT                   02700022      294.29
02700033   HB STOCKINETTE,2"X25YD/BOX                02700033      132.71
02700034   HB DIALATOR, RDS                          02700034      1308.28
02700035   HB NEEDLE, BIOPSY/ASP/LOC/INJ MOT         02700035      189.07
02700037   HB CVC DRESSING TRAYS                     02700037       55.23
02700042   HB HMGG, TRAVEL CASE MM                   02700042      784.48
02710001   HB SUPPORTER, SCROTAL                     02710001      387.21
02710002   HB SPLINT FOREARM - SMALL                 02710002      223.12
02710003   HB SPLINT, SUGARTONG                      02710003      1227.86
02710004   HB RISSER TAB BODY CAST                   02710004      1778.14
02710005   HB SPICA - HIP (SINGLE OR DOUBLE)         02710005      2425.18
02710006   HB COLLAR, CERVICAL                       02710006      301.17
02710007   HB RISSER BODY JACKET                     02710007      1748.57
02710008   HB LONG LEG CAST                          02710008      1817.18
02710009   HB CAST, SHORT ARM CAST                   02710009      784.51
02710010   HB SPICA CAST - INFANT W/ TABLE           02710010      1818.88
02710011   HB SHORT LEG CAST                         02710011      2059.30
02710012   HB PADS R2 EP STUDY                       02710012      555.03
02710013   HB SPLINT FINGER 2 INCHES                 02710013      159.23
02710014   HB MUCUS CLEARING DEVICE                  02710014      160.06
02710015   HB STOMA WAFER W/ SURFIT FLANGE *         02710015      171.11
02710016   HB CAST, VALPEAU BODY                     02710016      1597.03
02710017   HB ALTERNATING SURFACE BED                02710017      939.42
02710018   HB BILE BAG REG                           02710018      280.65
02710019   HB FETAL INCONTINENCE COLLECTOR           02710019      228.87
02710020   HB AMNIO PROCEDURE TRAY-WILLIAMS          02710020       71.78
02710021   HB TRANSABDOMINAL PROCEDURE TRAY 02710021               172.23



                                               125
  Charge
   Code                   Description                     CPT Code OP/Default Price   IP/ED Price
02710022   HB PC PEP VALVE                                02710022      181.22
02710023   HB SPLINT WRIST - LARGE                        02710023      191.07
02710024   HB SPLINT WRIST - MEDIUM                       02710024      191.07
02710025   HB SPLINT WRIST RIGHT MED            *         02710025      213.98
02710026   HB SPLINT WRIST LEFT LRG         *             02710026      214.00
02710027   HB PENTAMIDINE KIT                             02710027      227.06
02710028   HB SPLINT WRIST LEFT MED         *             02710028      256.79
02710029   HB SPLINT, WRIST                               02710029      535.87
02710030   HB AMNIO PROCEDURE TRAY                        02710030      139.36
02710032   HB SUPPORT LUMBO-SACRAL                        02710032      585.99
02710033   HB KNEE IMMOBILIZER          *                 02710033      605.13
02710034   HB ENDO ANTI FOG 50.00                         02710034       76.98
02710035   HB AEROSOL INHAL, PENTAM ADD'L 10              02710035      651.65
02710036   HB SPICA - THUMB OR FINGER                     02710036      732.23
02710037   HB BI-VALVE OR DC CAST                         02710037      176.35
02710038   HB OSTOMY POUCH                                02710038      745.95
02710039   HB SPLINT, MOLDED                              02710039      754.83
02710040   HB PC TRACHEOSTOMY TUBE                        02710040      822.54
02710041   HB EAR LAVAGE                                  02710041      212.77
02710042   HB SHORT ARM CAST                              02710042      878.63
02710043   HB ROTATIONAL SURFACE BED                      02710043      1292.73
02710044   HB 02 CONNECTION TUBING MASK                   02710044      214.02
02710045   HB HEADSET NAVIGATION DEVICE                   02710045      220.85
02710047   HB SPLINT FOREARM - MEDIUM                     02710047      270.41
02710048   HB SUGARTONG SPLINT                            02710048      1375.20
02710049   HB CABLE, INTERSTIM STIMULATION                02710049      296.00
02710050   HB SPICA CAST - INFANT                         02710050       80.04
02710051   HB PC 02 PER HOUR                              02710051       99.50
02710052   HB TRASVAGINAL PROCEDURE TRAY                  02710052       93.70
02710053   HB PC HELIOX ADMIN. PER HOUR                   02710053      100.59
02710054   HB PC NITROGEN ADMIN. PER HOUR                 02710054      100.59
02710055   HB ILEOSTOMY POUCH                             02710055      374.21
02710056   HB UNIVALVE CAST OR SPLINT                     02710056      116.41
02710057   HB PC H.H.N. KIT                               02710057      118.18
02710058   HB SPLINT FOREARM - LARGE                      02710058      321.29
02710059   HB SPLINT,THUMB                                02710059      336.38
02710060   HB PAG-HEART NEB EQUIP                         02710060      344.19
02710061   HB PASSY MUIR SPEAKING VALVE                   02710061      354.24
02710062   HB CAST, SHORT ARM                             02710062      548.57
02710063   HB STOMAHESIVE WAFER 8X8                       02710063      362.12
02710064   HB SPLINT, ARM                                 02710064      431.83
02710066   HB PC NITRIC OXIDE GAS PER HOUR                02710066      505.25



                                                    126
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02710067   HB PENTAMIDINE EQUIPMENT OP *           02710067      521.46
02710068   HB KNEE KODEL FULL LENGHT     *         02710068      533.30
02710069   HB CAST, LONG ARM MM                    02710069      760.53
02710070   HB SPLINT, KNEE VELCRO                  02710070      2159.08
02710071   HB LONG ARM CAST                        02710071      2210.71
02710072   HB CAST, LONG LEG MM                    02710072      958.27
02710073   HB CAST, SHORT LEG WALKING              02710073      984.69
02710074   HB CAST, CYLINDER THIGH TO ANKLE        02710074      1118.11
02710075   HB SPICA - SHOULDER                     02710075      2638.60
02710076   HB SPICA CAST - ADULT                   02710076      3606.56
02710077   HB CAST, PATELLAR TENDON BEARING        02710077      1393.40
02710078   HB CAST, LONG LEG                       02710078      1622.48
02710079   HB UNIVALVE CAST OR SPL                 02710079      130.39
02710080   HB KIT, WOUND CLEASING                  02710080      136.08
02710081   HB SPLINT, SHORT/LONG LEG               02710081      1318.14
02710082                                    02710082
           HB STOCKING SEQUENTIAL COMPRESS OR                    295.12
02710083   HB PUMP DISCONNECT KIT                  02710083       60.51
02710085   HB SPLINT WRIST - SMALL                 02710085      159.23
02710087   HB CAST, SHOE                           02710087      326.45
02710088   HB CAST, STUMP                          02710088      698.08
02710089   HB CAST SHORT LEG                       02710089      1838.66
02710090   HB CAST, LONG ARM                       02710090      1973.84
02710091   HB CAST, LONG LEG WALKING               02710091      984.69
02710096   HB MISCELLANEOUS SUPPLY                 02710096
02710098   HB CONFORMER, EYE 1                     02710098      146.87
02710100   HB HEARTMATE CABLE, PBU TO PUMP         02710100      1307.42
02710101   HB SPLINT, IMMOBILIZER KNEE             02710101      605.13
02720001   HB BASKET GEMINI 3FR                    02720001      847.98
02720003   HB CRYOCATH, FROSTBYTE CLAMP            02720003      6265.27
02720005   HB KIT, KYPHON 3                        02720005     16780.57
02720007   HB OXYGEN USE PER HOUR                  02720007       99.50
02720008   HB MEDIA FOR IUI                        02720008       99.65
02720009   HB WIRE, MICRO EXCHANGE                 02720009      1166.34
02720011   HB TUBING PACK, CUSTOM 2                02720011      1338.96
02720012   HB FORCEPS, HOT BIOPSY                  02720012      209.41
02720014   HB MICRO-RESECTOR, HYDRODISECTOMY02720014             2485.20
02720015   HB VALVULOTME                           02720015      1767.22
02720016   HB LASER FIBER, 2                       02720016      1856.65
02720017   HB NEUROPEN WITH NEUROENDOSCOPES02720017              1942.31
02720018   HB VALVE, DRAINAGE/FARRELL              02720018      134.78
02720019   HB FIBEROPTIC SIGMOIDSCOPE DISP         02720019      774.66
02720020   HB PACK, CUSTOM 2                       02720020      491.88



                                             127
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02720021   HB CATH DELIVERY SYSTEM                 02720021      2973.72
02720022   HB OT SPLINT MTRL FOREARM BASE          02720022      497.48
02720023   HB DRAIN 8                              02720023      3831.71
02720024   HB ARTHRO WAND 3                        02720024      5582.56
02720025   HB CATH INTRA-AORTC BALLOON             02720025      7005.66
02720026   HB INTUBATION TRAY - DIFFICULT          02720026      499.91
02720028   HB TUBING HI PSI 30 DCT-130             02720028       49.88
02720029   HB SUTURE, SILK MM                      02720029      503.96
02720030   HB INTRODUCER CATH                      02720030      504.43
02720031   HB TUBE, ESU COAGULATION                02720031       86.92
02720032   HB DILATOR 10FR 072110                  02720032       90.06
02720033   HB CATHETER, FOLEY 16 FR                02720033       93.07
02720034   HB CLIP SURGICAL SPRING CLIP            02720034       95.60
02720035   HB TWO-PIECE OSTOMY SYS 3-1/2"          02720035      506.98
02720036   HB LEVEL I TUBING D-50                  02720036      515.65
02720037   HB DRAIN 1                              02720037      163.28
02720038   HB TRAY, CHEST TUBE                     02720038      519.29
02720039   HB ENDOSCOPIC VERSATEP                  02720039      442.03
02720040   HB ENDO LLETZ BALL/LOOP ELECTRODE       02720040      140.38
02720041   HB BLADE, DERMATOME/MICROTOME           02720041      446.41
02720042   HB TUBE, ENDOTRACHEAL 1                 02720042      257.53
02720043   HB ENDO SUCTION WAVE 007200-901         02720043      257.72
02720045   HB COLOSTOMY BAG                        02720045      258.17
02720046   HB KYPHON BONE FILLER DEVICE OR         02720046      534.83
02720047   HB CATHETER, EPISTAXIS BALLOON          02720047      263.47
02720048   HB ENDO ELECTRODE CUTTING LOOP          02720048      430.36
02720049   HB SHEATH, PERITONEAL/AMPLATZ           02720049      267.41
02720050   HB PC NASAL MASKS BIPAP                 02720050      544.89
02720051   HB ENDO IRRIG ENDO-FLO 0037970          02720051      271.58
02720052   HB STAPLER SKIN 1                       02720052      467.69
02720053   HB BIOPSY BRUSH COOK 040310             02720053      272.96
02720054   HB NEEDLE, SCLEROSING                   02720054      557.96
02720055   HB CATH FOLEY W/THERMISTER              02720055      233.26
02720056   HB CANNULA, CORONARY PERFUSION DL 02720056            274.07
02720057   HB TRAY, TRACH CARE                     02720057      563.76
02720058   HB ELECTRODE, ACRIM/MENIS/PEN           02720058      274.59
02720059   HB CATHETER, UMBILICAL VES              02720059      274.62
02720060   HB KIT ARTERIAL INSERT EDWS PIKA        02720060      277.11
02720061   HB KIT VENOUS INSERT EDWARDS PIKV       02720061      277.11
02720062   HB TRAY TRACHEOTOMY #8028               02720062      573.03
02720063   HB BLADE, FULL RADIUS 1                 02720063      278.99
02720064   HB CANNULA AVR CABG KIT                 02720064      282.65



                                             128
  Charge
   Code                    Description                 CPT Code OP/Default Price   IP/ED Price
02720067   HB IRRIGATION PUMP W/SMOKE EVAC             02720067      289.58
02720068   HB TRACH TUBE #14                           02720068      573.66
02720069   HB ASPIRATOR EXTRA LENGTH                   02720069      292.36
02720071   HB IV TUBING METRISET                       02720071      295.31
02720072   HB CLAMP, DISPOSABLE                        02720072      183.90
02720073   HB FILTER, BLOOD TRANSFUSION      *         02720073      299.25
02720074   HB PACING WIRE, TEMPORARY                   02720074      365.30
02720075   HB LEADWIRE, EKG                            02720075       69.28
02720076   HB NEEDLE, SPINE NIM PEDICLE                02720076      2427.25
02720077   HB FRAZIER SUCTION TIPS                     02720077      146.95
02720079   HB CATHETER, URETHRAL MEASURING             02720079      589.50
02720080   HB HANDLE, ENDOSCOPIC GIA                   02720080      447.74
02720081   HB TROCAR, ENDOSCOPIC 1                     02720081      311.70
02720082   HB CLIP GUN MAGAZINE                        02720082      146.87
02720084   HB NEEDLE, SPINAL/DISC                      02720084      319.00
02720085   HB OXYGEN ADMIN - 1ST HOUR                  02720085       99.50
02720086   HB KIT, PACEMAKER 1                         02720086      321.20
02720087   HB BLADE, STRAIGHT                          02720087      321.46
02720088   HB INTRODUCER, OSTEO ONE STEP               02720088      3617.58
02720089   HB CATHETER, THORACIC MM                    02720089      328.55
02720090   HB CATHETER PASSER                          02720090      424.49
02720091   HB SPINEJET / MICRORESECTOR                 02720091      1317.54
02720092   HB SPINEJET 2                               02720092      1704.24
02720093   HB PIN, DISTRACTION 1                       02720093      248.42
02720094   HB ANESTHESIA TRAY CVP MONITOR              02720094      167.92
02720096   HB ENDO TIP CAUTERY PEDS RT ANGLE           02720096      332.53
02720097   HB MISCELLANOUS SUPPLY                      02720097       0.00
02720098   HB LACRIMAL INTUBATION SET                  02720098      335.32
02720099   HB ROD, OSTOMY                              02720099      100.77
02720100   HB KNIFE, V LANCE                           02720100      268.29
02720101   HB PEN, HEATING LACTOSORB PLATE             02720101      370.33
02720102   HB ANES INTRODUCER KIT MAC 9.5FR            02720102      340.85
02720103   HB PC PLUERAL BIOPSY TRAY                   02720103      981.01
02720104   HB ENDO BIPOLAR EBF01                       02720104      346.01
02720105   HB TRAY, TRACHEOSTOMY BIVONA CUST 02720105                987.63
02720107   HB ENDO BABCOCK                             02720107      513.17
02720108   HB PIN SKULL PINS MAYFIELD- OMI             02720108       99.77
02720109   HB DRESSING WEBRIL                          02720109      351.59
02720110   HB PREP DURA                                02720110       93.30
02720111   HB BLADE, TREPHINE                          02720111      357.48
02720112   HB LTA KIT                                  02720112       44.47
02720114   HB ENDO TUBING INSUFFLATOR HI FLO           02720114      193.61



                                                 129
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02720115   HB KYPHON BONE ACCESS NEEDLE 11 G 02720115            153.80
02720116   HB ANTENNA,EXTRNL NEUROSTIMALUTOR02720116             495.02
02720117   HB SHEATH, AEM DISPOSABLE               02720117      162.49
02720118   HB QUILTED HEEL PROTECTOR               02720118      174.58
02720119   HB CANNULA, NASAL GAS SAMPLING          02720119      189.54
02720122   HB SCOPE, CHANNELSCOPE                  02720122      3844.31
02720123   HB ADHESIVE, DERMABOND/SILICONE         02720123      201.77
02720124   HB 23G BIPOLAR TAPERED FINE POINT       02720124      217.54
02720125   HB SYRINGE MEDRAD POWER INJECTOR 02720125              79.54
02720126   HB ARTHRO, MENISCAL SYSTEM              02720126      609.64
02720127   HB SUTURE 1                             02720127      162.12
02720128   HB ENDO ACCESS NEEDLE 3MM AN3MM         02720128      248.02
02720129   HB SLEEVE, ENDOSCOPIC                   02720129      254.94
02720130   HB PROBE, ARTHRO VULCAN                 02720130      2245.13
02720132   HB FILTER MILEX                         02720132       38.49
02720133   HB SONOHYSTOGRAM CATHETER               02720133      113.35
02720134   HB TRAY, PERICARDIOCENTESIS             02720134      656.86
02720135   HB NET, RETRIEVAL ROTH                  02720135      582.41
02720136   HB TRAY URINARY 18FR                    02720136      663.29
02720137   HB OSTENE BONE HEMOSTASIS 2.5GRMS 02720137            385.44
02720138   HB MAMMOTOME NEEDLE                     02720138      670.61
02720139   HB TUBE, JEJUN FEED/SGL LUMEN           02720139      618.43
02720140   HB FORCEPS, BIOPSY 1                    02720140      419.83
02720142   HB TUBE TRACH DFEN W/DISP CNN 8         02720142      682.01
02720144   HB TUBE,TRACH DCT/DFEN W/DISP CAN       02720144      682.01
02720145   HB KIT, NEUROSTIMULATOR 1               02720145      461.96
02720147   HB TIP SIMPULSE SUCTION LONG            02720147      499.38
02720148   HB MEDTRONIC REFILL KIT                 02720148      682.67
02720149   HB DRESS NU-KNIT KELP 6 X 9             02720149      544.52
02720150   HB TRAY, UMBILICAL ARTERY               02720150      688.04
02720151   HB ENT DIEGO TURBINATOR 2MM ST          02720151      568.08
02720152   HB CATHETER TRAY, CARDIOVASCULAR        02720152      571.86
02720153   HB TUNNELING ROD, CATH PASSER           02720153      584.46
02720154   HB TUBE, MIC (FEEDING)                  02720154      1021.85
02720155   HB DRAIN AUTOTRANSFUSION ZIMMER         02720155      629.04
02720156   HB TROCAR, ENDOSCOPIC 3                 02720156      642.40
02720157   HB SLEEVE, KNEE/THIGH LENGTH            02720157      697.09
02720158   HB NEEDLE, BIOPSY 4                     02720158      668.19
02720159   HB TOOL, DISSECTING 2                   02720159      678.93
02720160   HB TRAY, THORACENTESIS W/CATHETER 02720160            703.87
02720161   HB KIT, TRANFIX/BIO-TENODESIS           02720161      705.25
02720162   HB NEEDLE, ELECT/BEVEL/TROCAR           02720162      724.65



                                             130
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
02720163   HB TEMP PROBE PEDS CATH LAB *             02720163      708.20
02720165   HB HEMOSTAT, SOF-GRIP                     02720165      360.25
02720166   HB BAG DRAINAGE URINARY                   02720166      365.27
02720167   HB CATH FOLEY TRAY                        02720167      338.21
02720168   HB CUTTER, LOCKING LEAD                   02720168      469.84
02720169   HB PERF QUICK PRIME LINE                  02720169      122.38
02720170   HB ENDO PROBE HANDPIECE                   02720170      366.10
02720171   HB PC MICRO BRUSH                         02720171      890.59
02720172   HB STRIPPER VEIN DISPOSABLE               02720172      370.96
02720173   HB CATHETER, SIZING BALLOON               02720173      1419.23
02720174   HB PLEUR-EVAC                             02720174      1046.25
02720175   HB SPENCER DEPTH ELECTRODES 8 CON 02720175              1086.86
02720176   HB NEEDLE, OSTYCUT                        02720176      374.78
02720177   HB T-TUBE, 2                              02720177      375.50
02720178   HB ENDO TROCAR 10MM BLNT OMST10BT 02720178              379.65
02720179   HB LEVEL I TUBING D-100                   02720179      1727.26
02720181   HB LOADING UNIT, STAPLER                  02720181      382.92
02720182   HB TUBING PACK, CUSTOM 1                  02720182      382.92
02720183   HB ILIUMINATOR, LIGHTMAT SURGICAL         02720183      384.18
02720184   HB PC BROCH OCC CATH                      02720184      2233.19
02720185   HB PERF HEMOCONCENTRATOR PEDS             02720185      396.27
02720186   HB SEALANT HEMOSTATIC 2                   02720186      2519.21
02720187   HB TWIST DRILL SURGICAL 1                 02720187      399.04
02720189   HB KIT, KYPHOPLASTY INTRO SYSTEM          02720189     12996.48
02720190   HB TRACH PERCUTANEOUS SET                 02720190      324.40
02720191   HB ENDO SUCTION/IRRIG/PROBE               02720191      404.59
02720192   HB TOOL MIDAS REX M31                     02720192      404.59
02720193   HB CATHETER, MULTI LUMEN                  02720193      405.37
02720194   HB BLOOD ADMIN SET Y TYPE 6'    *         02720194      408.10
02720195   HB CANNULA, RETROGRADE CARDIOPLEG 02720195              410.31
02720196   HB PROBE, PRASS/OCULAR                    02720196      414.28
02720197   HB BLADE, CONCAVE                         02720197      414.52
02720198   HB CANNULA, RETROGRADE 1                  02720198      415.67
02720199   HB IV PUMP SET, NITROGLYCERIN             02720199      329.85
02720200   HB APNEA MONITOR PER DAY                  02720200      330.06
02720201   HB ARTHRO WAND 1                          02720201      835.49
02720202   HB BLADE, ACROM/BLASTER/MIONIZER          02720202      393.04
02720204   HB SUTURE,KS-30 SILK                      02720204      336.81
02720205   HB TRAY, ANES PUDENDAL                    02720205      337.98
02720206   HB KIT, COLON DECOMPRESSION               02720206      766.56
02720208   HB IRRIGATION SET, CYSTO                  02720208      341.82
02720210   HB BONE MARROW TRAY                       02720210      405.71



                                               131
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
02720211   HB KIT, VERTEBROPLASTY                02720211      2208.45
02720213   HB PERF RESERVOIR CARDIOTOMY          02720213      435.06
02720214   HB TRAY, NASAL HEMORRHAGE             02720214      2209.91
02720215   HB DRAIN JACKSON PRATT RESERVOIR      02720215      438.29
02720216   HB DRAIN LUMBAR DRAINAGE SET          02720216      438.70
02720217   HB CATH DOUBLE LUMEN CV 4.0FR         02720217      439.22
02720218   HB PACK, AFFINITY VAVD ACCESSORY      02720218      231.76
02720219   HB WIRE, NEURO                        02720219      1119.62
02720222   HB NEURO MONITORING KIT 3             02720222      1918.38
02720224   HB ENDO SUTURE ASSISTANT 5M SW100     02720224      446.56
02720225   HB SHOULDER SUSPENSION KIT 2          02720225      450.94
02720226   HB INFUSION SET BUTTERFLY 23          02720226      113.55
02720228   HB KIT, LUMBAR PUNCTURE DRAINAGE      02720228      457.23
02720229   HB TUBE, RECTAL                       02720229      259.52
02720230   HB RADIAL ARTERY KIT                  02720230      264.64
02720231   HB ENDO POLY LOOP                     02720231      609.05
02720232   HB TUBING, PCA                        02720232      267.97
02720233   HB TUBE, GASTROSTOMY 1                02720233      273.33
02720234   HB OT CICA CARE MEDIUM                02720234      274.34
02720235   HB CABLE, LEAD EKG WIRE               02720235      464.80
02720236   HB RESUSCITATION BAG                  02720236      125.22
02720237   HB IV SET VENTED                      02720237      125.81
02720238   HB CANNULA, AORTIC PERFUSOR           02720238      361.45
02720239   HB INTRODUCER                         02720239      128.60
02720241   HB TUBE ET DOUBLE LUMEN               02720241      467.20
02720243   HB ANESTHESIA BREATHING TRACT OR      02720243      470.27
02720244   HB TRAY, MYELOGRAM/LUMBAR PUNCTRE 02720244          277.53
02720245   HB PROBE FOR INTERPHASE FISH          02720245      291.10
02720246   HB NEEDLE SET, BX/ASPIR, ECHO TIP     02720246      296.50
02720247   HB TROCAR, ENDOSCOPIC 2               02720247      475.24
02720248   HB RELIEVA INFLATION DEVICE           02720248      476.63
02720249   HB PESSARY KIT                        02720249      305.07
02720251   HB BLADE, INCISOR/ABRADER             02720251      479.40
02720252   HB BONE MARROW SURGICAL TRAY          02720252      479.79
02720253   HB INTRODUCER ACCUSTICK               02720253      306.21
02720254   HB CANNULA ANTERIOR CHAMBER           02720254      191.88
02720255   HB JACKSON-PRATT RESERVOIR            02720255      482.12
02720256   HB IV TUBING EXTENSION                02720256      159.58
02720257   HB MARKER, SPOT TATOO                 02720257      160.80
02720258   HB IV SET SPIKE                       02720258      162.13
02720259   HB MICRO PUNCTURE SET                 02720259      163.08
02720260   HB NEURO MONITORING KIT 2             02720260      1767.22



                                           132
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
02720261   HB BLADE, TRICUT 1                       02720261      489.20
02720262   HB CAPSULE, WIRELESS AGILE               02720262      635.70
02720263   HB STAPLER, ENDOSCOPIC 5                 02720263      1336.43
02720264   HB TAP, DISPOSABLE 1                     02720264      491.25
02720265   HB TUBING PENUMBRA STERILE               02720265      1386.83
02720266   HB PC PNEUMOTHORAX SET                   02720266      1499.88
02720267   HB BASKET, RETRIEVAL II                  02720267      1229.28
02720269   HB BASKET, RETRIEVAL 1                   02720269      500.19
02720271   HB ELECTRODE, ESU 1                      02720271      501.58
02720272   HB CATH EPID TUN-L XL 16GA X 3.5         02720272      502.51
02720275   HB PROCEDURE TRAY                        02720275      415.76
02720276   HB IRRIG SLEEVE COLOPLAST                02720276      416.17
02720277   HB BLADE, RETRACTING 1                   02720277      508.93
02720279   HB SECONDARY PIGGY BACK                  02720279      384.88
02720280   HB UNIVER MICROINTRODUCER KIT 7FR        02720280      423.27
02720281   HB ACMI DOL-TUB TRANSDUCER               02720281      529.29
02720282   HB ENDO FORCEPS DISSECTING 3700PK        02720282      529.29
02720283   HB ENDO SWITCH BLADE TIPS                02720283      316.07
02720284   HB TRAY, WITH FOLEY CATHETER             02720284      236.64
02720285   HB COLLAGEN, HEMOSTAT INSTAT 1           02720285      531.55
02720286   HB PICC SELDING CONVERSION SET           02720286      238.18
02720287   HB PROBE ESPOHAGEAL RECTAL DISP          02720287      243.61
02720288   HB DRAIN, VENTRICULAR                    02720288      538.57
02720289   HB CATHETER, VENTRICULAR 2               02720289      542.89
02720290   HB NEEDLE, KYPHON                        02720290      544.89
02720292   HB CATHETER,PICC SNGL LUMEN-TRAY         02720292      545.74
02720293   HB VEIN STRIPPER                         02720293      548.42
02720294   HB 8-CONTACT STRIP ELECTRODE             02720294      1357.23
02720295   HB KIT, DISCOGRAM                        02720295      549.69
02720296   HB KYPHX SYRINGE A08A                    02720296      554.23
02720297   HB PC YAG LASER FIBER                    02720297      2954.38
02720298   HB INFUSION SET, BUTTERFLY               02720298       95.56
02720299   HB NEEDLE, SCALP VEIN                    02720299       95.56
02720300   HB NEURO LUMBAR CATHETER ACCESSOR02720300              568.08
02720301   HB PERF PUMP ADAPTER PACK CSMC           02720301      568.08
02720303   HB TUBING CYSTO IRRIGATION               02720303      569.79
02720306   HB SMART NEEDLE                          02720306      853.44
02720307   HB MAMMOTOME KIT                         02720307      859.61
02720308   HB NEEDLE, FNA                           02720308      864.47
02720309   HB TRAY, EUS                             02720309      197.53
02720311   HB ORAL APPLIANCE                        02720311      900.00
02720312   HB GUIDE, DRILL 1                        02720312      590.76



                                              133
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02720313   HB BAG DRAINAGE VINTRICULAR            02720313      592.11
02720314   HB SHEATH, EXCLUDER / INSULATION       02720314      594.53
02720315   HB CEMENT CART.SYS 540198000           02720315      595.80
02720316   HB ENDO GRASP, LONG/SHORT              02720316      454.86
02720317   HB TROCAR, 2                           02720317      602.09
02720318   HB CATHETER, THORACIC                  02720318      602.68
02720319   HB SUTURE 5                            02720319      603.35
02720320   HB BASKET, LITHO EXTRACTION            02720320      719.54
02720321   HB ENDO DISSECT, LONG/SHORT            02720321      1399.56
02720322   HB RETRACTOR, ABDOMINAL MOBIUS         02720322      606.87
02720323   HB RETRACTOR, TISS/SCROTL/VAGINL       02720323      606.87
02720324   HB TUBING CUSA MANIFOLD                02720324      606.87
02720325   HB TUBE HARVESTER WITH PINS            02720325      1700.47
02720326   HB LACRICATH 1                         02720326      2022.05
02720327   HB TEGADERM                            02720327      132.69
02720328   HB BLADE, HELICUT                      02720328      621.64
02720329   HB CANNULA, HYDRODISSECTOR             02720329       67.74
02720330   HB BLADE, MICRO SAW 3                  02720330      344.06
02720331   HB ADHESIVE, INDERMIL                  02720331      170.04
02720332   HB IV ADMINISTRATION SET               02720332      210.03
02720333   HB HEADSET NAVIGATION DEVICE MOT       02720333       0.00
02720334   HB APPLICATOR TIP 1                    02720334      335.06
02720335   HB BLADE, GENERAL 2                    02720335      614.68
02720337   HB CATH CHIOU SP 075920                02720337      615.19
02720338   HB NEEDLE, BIOPSY/ASP/LOC/INJ MRI      02720338      372.83
02720339   HB PERF RESEVOIR CARDIO 90300018       02720339      619.35
02720340   HB ELECTRODES                          02720340      620.00
02720341   HB OT SPLINT MTRL FINGER/HAND          02720341      373.11
02720342   HB GASTROSTOMY GIAS-100                02720342      622.00
02720343   HB NEURO BECKER EDMS                   02720343      624.89
02720344   HB CYSTO SET                           02720344      569.79
02720345   HB INTRODUCER, NEEDLE                  02720345      374.21
02720346   HB ABC DISPOSABLE TIP (NOZZLE)         02720346      627.77
02720347   HB ENDO SLEEVE VERSASTEP               02720347      374.38
02720348   HB TUR SETS                            02720348      475.85
02720349   HB TRAY, BIOPSY/ASP/LOC/INJ            02720349       0.00
02720350   HB ARTHRO 45 SUT LASSO AR4065-45R      02720350      585.01
02720353   HB SEAL AKIN OSTOMY SMALL              02720353      117.45
02720355   HB BLOOD CONSERVATION SYSTEM           02720355      644.92
02720356   HB INFLATION APPARATUS                 02720356      651.21
02720357   HB TWIST DRILL, SURGICAL 2             02720357      651.21
02720358   HB PRESSURE MONITOR                    02720358      118.02



                                            134
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
02720359   HB BLADE, OSCILLATING/HARVEST           02720359      652.66
02720360   HB PC THORACENTESIS TRAY                02720360      1265.62
02720361   HB TRAY UROLOGIST'S URETHRA OBS*        02720361      1279.98
02720362   HB SEALANT HEMOSTATIC 1                 02720362      943.54
02720363   HB PERF CDI 500 SHUNT SENSOR            02720363      665.07
02720364   HB ANES CATH PA PEDIATRIC               02720364      666.74
02720365   HB ENDO SHEARS, LONG/SHORT              02720365      1059.00
02720366   HB CATHETER,PENUMBRA NEURON GUIDE02720366             673.89
02720367   HB MONITORING KIT, VENTRICULAR          02720367      3096.48
02720368   HB REAMER, MODULAR SHAFT 1              02720368      677.06
02720369   HB CANNULA, CORONARY PERF               02720369      678.82
02720370   HB INFLATION UNIT                       02720370      3257.82
02720372   HB TUBING HTA PROCEDURE SET 55015       02720372      2877.26
02720373   HB TRAY, THORACOTOMY                    02720373      3492.54
02720374   HB MONITORING KIT, INTRACRANIAL P       02720374      3954.39
02720375   HB BASKET SEGURA 2.4FR                  02720375      688.86
02720376   HB STAPLER, ENDO GIA                    02720376      3972.50
02720377   HB TUBE, ENDOTRACHEAL 2                 02720377      694.17
02720378   HB PROBE, SOMN/ULTRSND/ARTHRO           02720378      696.56
02720379   HB NAV-X EP MAP ELECTRODE               02720379      4260.63
02720380   HB PROBE, ABLATION                      02720380      5583.13
02720381   HB KIT, ENDO MUCOSAL RESECTION          02720381      1097.40
02720382   HB TUBE, GASTROSTOMY 3                  02720382      708.03
02720384   HB BONE MILL BM200                      02720384      710.79
02720385   HB KIT, DISCECTOMY SURGICAL             02720385      5917.21
02720386   HB NEURO DOPPLER PROBE DISPOSABLE 02720386            721.89
02720387   HB CATHETER, BILIARY DILAT              02720387      728.11
02720388   HB SEPARATOR PENUMBRA                   02720388      6307.91
02720389   HB IMPEDANCE PROBE                      02720389      731.57
02720390   HB CANNULA, ERCP BALL/CONTOUR           02720390      370.07
02720391   HB RETRACTOR, FAN ENDOSCOPIC            02720391      732.96
02720392   HB NEEDLE, ENTRY                        02720392      139.52
02720393   HB TRAY, KYPHON ADDITIONAL LEV          02720393      7187.76
02720394   HB KIT,PENUMBRA                         02720394     10172.21
02720395   HB SPHINCTERTOME DBL LUMEN              02720395      676.20
02720396   HB TRAY, BIOPSY/ASP/LOC/INJ MRI         02720396       0.00
02720397   HB SUTURE, SILK*                        02720397      143.41
02720398   HB BRUSH, FEMORAL/CYTO                  02720398      145.49
02720399   HB PROBE, ENDOSCOPIC 1                  02720399      207.84
02720400   HB IV BAG-O-JET                         02720400      135.88
02720401   HB CATHETER, UMBILICAL                  02720401      148.63
02720402   HB POSITION COLLAR CERVICAL SOFT        02720402      150.22



                                             135
  Charge
   Code                    Description              CPT Code OP/Default Price   IP/ED Price
02720403   HB CANNULA, ARTHRO/ENDO                  02720403      152.41
02720404   HB TUBING TO EVACUATOR MACHINE           02720404      152.41
02720405   HB ARTHRO 7MM CLR CANNULA 7207227        02720405      153.80
02720406   HB NEEDLE, ENDO VERESS 1                 02720406      153.80
02720407   HB URODYNAMIC PUMP TUBING                02720407      153.80
02720409   HB INTRODUCER FIBER OPTIC 661506         02720409      155.19
02720410   HB IV TUBING EXTENSION OR                02720410      155.22
02720411   HB ENDO CLOSURE PROC/KIT CTI-512N        02720411      627.47
02720412   HB ENDO VERSASTEP NEEDLE 14G             02720412      157.95
02720413   HB TRAY, SIGMOIDSCOPY DISPOSABLE         02720413       55.98
02720414   HB PC ZAVALA BIOPSY NEEDLE               02720414      236.53
02720415   HB CLIP, HEMOLOK                         02720415      162.12
02720416   HB TUBING, TAB                           02720416       85.14
02720417   HB CATHETER, CANSONNENBERG-SUMP 02720417               315.50
02720418   HB ARTHRO SMARTSTITCH CONNECTOR          02720418      163.50
02720419   HB BLADE, MICRO OSCILLATOR               02720419      163.50
02720420   HB DRAIN ABRAMSON TRIPLE LUMEN           02720420      164.88
02720422   HB KIT, MICROPUNCTURE                    02720422      167.59
02720423   HB WIRE, TOUHY-BORST Y-VALVE CONN        02720423      167.59
02720425   HB TUBING INTERPULSE IRRIGATION          02720425      279.91
02720426   HB COLOSTOMY CLAMP                       02720426      168.15
02720427   HB TRAY,IRRIGATION W/PISTON SYRNG        02720427      327.59
02720428   HB PRESSURE TUBING                       02720428      338.01
02720429   HB TUBING, STACKHOUSE/EVACUATOR          02720429      171.81
02720430   HB DRAINAGE SET, CHEST SNGL LINE         02720430      172.44
02720431   HB ALUMI-HAND IMMOBLZR 760               02720431      173.20
02720432   HB BALLOON, KYPHON                       02720432      2809.46
02720433   HB CANNULA 8.25MM X 7 CM AR 6530         02720433      173.20
02720434   HB CATH ROBINSON 2-EYE 30FR              02720434      173.30
02720435   HB BIOPSY KIT                            02720435      173.36
02720436   HB IV BLOOD FILTER PALL                  02720436      173.49
02720437   HB OT CICA CARE EXTENDED                 02720437      548.69
02720438   HB RETAINER, VISCERA SURGIFISH           02720438      176.35
02720439   HB CABLE, BIPOLAR ESU                    02720439      177.35
02720441   HB AIR CHAR. DUAL SENSOR CATHETER        02720441      178.43
02720442   HB CANNULA, ARTHRO 1                     02720442      178.73
02720444   HB ENDO ILLUMINATOR BULLET SHIELD        02720444      180.28
02720445   HB BAG A JET                             02720445      135.88
02720446   HB DRAIN, PENROSE                        02720446      151.62
02720447   HB BIOPSY NEEDLE                         02720447      181.50
02720448   HB TRAY, ANES SPINAL                     02720448      605.94
02720449   HB TRAY, TRANSFUSION EXCHANGE            02720449      657.87



                                              136
  Charge
   Code                    Description              CPT Code OP/Default Price   IP/ED Price
02720450   HB PC CONCHA WATER                       02720450       58.58
02720451   HB TUBING ARTHRO PUMP DYONICS            02720451      188.44
02720452   HB APPLICATOR, FIBRIJET/CHLOROPREP 02720452            189.83
02720453   HB ENDO TIP COVER INTUI 400180-0         02720453      189.83
02720454   HB CANNULA, VENOUS 2 STAGE OVAL          02720454      190.19
02720455   HB PERF ARTERIAL FILTER (351)            02720455      192.59
02720457   HB ANES STIMUPLEX CATH                   02720457      192.87
02720458   HB CATH ROBINSON 2-EYE 20FR              02720458      193.14
02720459   HB CATHETER, ROBINSON                    02720459      193.14
02720460   HB CONVERTOR SURGIPORT                   02720460      193.65
02720461   HB BIOPSY DEVICE KYPHON                  02720461      193.86
02720462   HB SCALPEL, SURGICAL 2                   02720462      196.03
02720463   HB DERMABOND PROPEN TOPICAL SKIN         02720463      196.75
02720464   HB TUBING ARTERIAL LINE M/F              02720464      197.54
02720465   HB SET MINI TRIFUSE                      02720465       61.12
02720466   HB KNIFE, HANDLE BEV/LARYN               02720466      199.02
02720467   HB LABORIE PUMP TUBING INFUS.LINE        02720467      135.73
02720468   HB STATLOCK                              02720468      137.52
02720469   HB BLADE, SAW 1                          02720469      205.31
02720472   HB PROBE, FLOW PUMP                      02720472      207.84
02720473   HB SURGIFOAM, ABSORBABLE SPONGE 2 02720473             207.84
02720474   HB DRESSING VAC                          02720474      208.13
02720475   HB ENDO PROBE ELECTRODE                  02720475      209.79
02720476   HB PERF PUMP TABLE PACK                  02720476      213.56
02720477   HB CATHETER, FOLEY 5CC/30CC              02720477      214.00
02720478   HB CANNULA, OPS VALVE                    02720478      215.13
02720479   HB LC PLEURAL CATH KIT                   02720479      1195.12
02720480   HB BALLOON, EXTRACT/BASKET               02720480      565.68
02720481   HB PEG TRAY                              02720481      672.70
02720482   HB CRYO FIBRIN GLUE ADMIN KIT            02720482      218.26
02720483   HB CANNULA, INNER DISP                   02720483      218.72
02720484   HB BLADE, AORTIC PUNCH                   02720484      219.17
02720485   HB KIT, REFILL NEUROSTIMULATION          02720485      221.69
02720486   HB NEEDLE, JAM/INF/CAR/MNS/DURA          02720486      221.69
02720488   HB HYDROJET FLUID MATERIAL               02720488      222.95
02720489   HB SUTURE BOOTS                          02720489      306.36
02720490   HB INTRODUCER, TRACHEAL                  02720490       73.06
02720491   HB APPLICATOR HNDL, FIBRIN SEAL          02720491      1228.11
02720492   HB OPHTH ACCURUS FLUID CONTROL           02720492      375.55
02720493   HB INSEMI-CATHETER                       02720493       72.43
02720494   HB IV TUBING*                            02720494       75.17
02720495   HB IV TUBING ADMIN SET                   02720495      117.80



                                              137
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02720496   HB ENDO IRRIGATOR HYDRO-SURG PLUS 02720496            355.72
02720497   HB TUBING, PENROSE DRAIN                02720497       75.45
02720499   HB OT CICA CARE LIMITED                 02720499       76.21
02720500   HB CANNULA, MICRO J-SHAPED              02720500       32.66
02720501   HB TUBE, GASTROSTOMY 2                  02720501      590.25
02720503   HB ABDOMINAL BINDER                     02720503      561.62
02720504   HB ENDO STRYKEFLOW II 250-070-500       02720504      243.86
02720505   HB DRESSING, BURN                       02720505      244.07
02720506   HB CHISEL, LIGAMENT ANGLED              02720506      606.87
02720507   HB TRAY, ANES EPIDURAL                  02720507      618.48
02720508   HB CANNULA , VENOUS RETURN              02720508      246.62
02720509   HB DILATOR                              02720509      250.78
02720510   HB PERICARDIOCENTESIS KIT               02720510      620.13
02720511   HB JACKSON-PRATT TUBING                 02720511      468.85
02720512   HB SNARE, POLYPECTOMY                   02720512      365.32
02720513   HB CONTAINER, PLEURX EVAC               02720513      255.92
02720514   HB BLADE, LARYNGOSCOPE                  02720514      256.33
02720515   HB CATH CHOLANGRM 7.5FR 20018-010       02720515      256.33
02720516   HB ANES TUBE ET                         02720516      257.53
02720517   HB ANESTHESIA TUBE ET 1                 02720517      257.53
02720519   HB TRAY, DOUBLE LUMEN CATHETER          02720519      742.38
02720520   HB CLIP, ANEURYSM / U                   02720520      742.43
02720521   HB OT SPLINT MTRL FULL ARM BASE         02720521      746.21
02720522   HB MONITORING TRANSDUCER VENOUS         02720522      755.09
02720523   HB MONITORING TRANSDUCER ARTERY         02720523      758.64
02720524   HB TRAY, SUTURE                         02720524      770.88
02720526   HB CANNULA, IRRIGATING 2                02720526      762.06
02720528   HB TOOL, DISSECTING SHAVER              02720528      765.84
02720529   HB TRAY, SIGMOID                        02720529      586.72
02720530   HB TRAY, COLONOSCOPY/SIGMOID            02720530      771.66
02720531   HB BALLOON, PRESSURE DEVICE             02720531      783.73
02720532   HB ENDO CLIP APPLIER 5MM                02720532      784.24
02720533   HB BLADE, HARMONIC                      02720533      787.00
02720534   HB TAP, NEURO/SPINE/ORTHO 1             02720534      787.00
02720535   HB ADULT LP TRAY                        02720535      797.90
02720536   HB PROBE, COAGULATING BEAM              02720536      590.25
02720537   HB INJECTOR                             02720537      689.68
02720538   HB TUBE, BRONCHCATH, RT/LT              02720538      371.58
02720539   HB PROBE, VICTRECTOMY                   02720539      718.44
02720540   HB SUTURE 2                             02720540      453.08
02720541   HB ANORECTAL CATHETER                   02720541      482.07
02720543   HB TRAY, AMNIOCENTESIS                  02720543      770.14



                                             138
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02720544   HB LC PLEURAL DRAIN VACUUM BOT         02720544      168.97
02720545   HB TUBE, ET                            02720545      169.88
02720546   HB URINARY DRAIN BAG                   02720546      176.04
02720548   HB ANES TRAY SPINAL                    02720548      925.86
02720549   HB INFUSION US LYSIS SYSTEM            02720549      4974.39
02720550   HB TRAY GENERAL PURPOSE                02720550      246.47
02720552   HB EXTRACTOR, TISSUE STERILE           02720552      2137.55
02720553   HB TRAY, GENERAL INSTRUMENT            02720553      246.47
02720554   HB TRAY, INTERVENTIONAL BASIC          02720554      478.84
02720555   HB TRAY, INTERVENTIONAL SET-UP         02720555      1678.36
02720556   HB SHEATH, BANNANA PEEL                02720556      660.60
02720557   HB CATHETER, COUNCIL STIFFNERS         02720557      167.40
02720558   HB GASTROSTOMY PLV-24-.38              02720558      298.46
02720559   HB HEMOSTASIS PATCH                    02720559      374.78
02720560   HB INFLATION DEVICE KYPHON             02720560      438.35
02720561   HB SUTURE, PCC/PERCU-STAY              02720561      178.44
02720562   HB KIT, TIPS                           02720562      1646.38
02720563   HB 2 CONTACT STRIP ELECTRODE           02720563      615.52
02720564   HB AIR CHAR. ABD. SENSOR CATH          02720564      100.01
02720565   HB ANES TRAY EPIDURAL PERIFIX          02720565      292.18
02720566   HB ANESTHESIA TUBE ET 2                02720566      558.01
02720567   HB CATHETER, ARGON COAG PROBE          02720567      811.22
02720568   HB NASOGASTRIC TUBE IRRIGATION         02720568      251.28
02720569   HB ADDITIONAL PROBE                    02720569      164.60
02720570   HB CATHETER, BILIARY MANOMETRY         02720570      858.34
02720572   HB BLADE, DISSECTING DIEGO             02720572      561.15
02720574   HB BLADE, MICRO SAW 1                  02720574       96.41
02720575   HB BLADE, PIVOTAL/FIXED HEAD           02720575       40.31
02720576   HB BLADE, RAD CURVED                   02720576      489.20
02720577   HB BLADE CASPAR BONE GRAFT 9MM         02720577      663.35
02720579   HB BLADE SAW OSCILLATING KM-7566       02720579      171.81
02720582   HB CANNULA SEAL                        02720582      178.73
02720583   HB CANNULA, AORTIC ROOT 2              02720583      594.53
02720584   HB CANNULA, ARTERIAL 1                 02720584      271.58
02720586   HB CANNULA, ARTERIAL 2                 02720586      924.54
02720587   HB CANNULA, ARTERIAL KIT               02720587      668.19
02720588   HB CANNULA, IMA                        02720588      141.55
02720589   HB CANNULA, OPHTHALMIC                 02720589      225.84
02720590   HB CANNULA, PORTAL                     02720590      237.79
02720591   HB CANNULA, QUICK DRAW VENOUS          02720591      2021.54
02720593   HB CANNULA, ATRIAL 2                   02720593      3594.91
02720594   HB CANNULA, VENTRICULAR                02720594      425.37



                                            139
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
02720595   HB CATH FOLEY SP BARD 143112              02720595      1062.73
02720597   HB CATHETER, KUMPE 1                      02720597      461.38
02720599   HB CATHETER, VENTRICULAR 1                02720599      189.83
02720600   HB CLIP CORONARY ARTERY RETRACTON 02720600              103.92
02720601   HB CLIP OMNI CLIP GUN                     02720601      340.85
02720602   HB CLIP SURGICLIP PREMIUM                 02720602      1112.85
02720603   HB CUSA EXCELL MICROTIP                   02720603      1337.07
02720604   HB CUTTER, ENDOSCOPIC 4                   02720604      1367.56
02720606   HB DISSECTOR, BLUNT CHERRY                02720606      170.42
02720607   HB ENDO ARTICULATING LC ATW45             02720607      901.68
02720608   HB ENDO CLIP II M/L 10MM (176657)         02720608      559.77
02720609   HB ENDO ENDOPOUCH PRO RETRIEVAL           02720609      341.73
02720610   HB ENDO HANDPIECE SUCTION/IRRIGAT         02720610      429.53
02720611   HB ENDO LAP DISC HAND DVICE LD111         02720611      2218.29
02720612   HB SCISSORS, ENDOSCOPIC 1                 02720612      577.79
02720613   HB ENDO SURESEAL II                       02720613      101.99
02720615   HB HANDPIECE, ENDOSCOPIC 1                02720615      451.45
02720618   HB ESU RITA GROUNDING PAD                 02720618      338.08
02720619   HB EXTRACTOR, STONE TIPLESS 2             02720619      1151.41
02720620   HB FLOW CONTRL DEVICE 15-300              02720620      117.77
02720621   HB GELPORT, SEAL CAP                      02720621      1748.58
02720622   HB HEMOCLIP                               02720622      186.61
02720623   HB CATHETER, HYDRAGLIDE 1                 02720623      156.19
02720624   HB ISOLATOR, ENDO XCL / XCR               02720624      6037.28
02720625   HB IV EXTENSION W/2 INJ SITES             02720625      155.22
02720626   HB IV METRISET                            02720626       51.32
02720627   HB IV MICRODRIP SET                       02720627      805.39
02720628   HB KIT CAP 6701                           02720628      258.76
02720629   HB KIT GFI TUBING SET ACCURUS             02720629      199.52
02720631   HB KIT, WIRE STYLET                       02720631      287.19
02720632   HB KIT, NEEDLE EYE SNARE WRKSTN           02720632      2500.31
02720633   HB KIT, PROCEDURAL CARDIOVASCULAR 02720633              123.45
02720634   HB KIT, REPAIR CATHETER                   02720634      569.34
02720636   HB KYPHON OSTEO INTRODUCER SYSTEM02720636               5029.60
02720637   HB LEAD EXTENDER, BULLDOG                 02720637      717.97
02720638   HB MIDAS REX LUBRICANT/DIFFU              02720638      173.20
02720639   HB NEEDLE KEITH                           02720639       45.72
02720640   HB NEURO MONITORING KIT 1                 02720640      1564.43
02720641   HB NV MODULE W/ELECTRODE                  02720641      1564.43
02720644   HB PERFUSION OXYGENATOR 4                 02720644      2550.70
02720645   HB TUBE, GASTROSTOMY                      02720645      251.28
02720646   HB PACK, PHACO                            02720646      633.20



                                               140
  Charge
   Code                   Description            CPT Code OP/Default Price   IP/ED Price
02720649   HB PERF HEMOCONCENTRATOR ADULT        02720649      548.59
02720650   HB PERF PUMP HEAD BIOMEDICUS PED      02720650      825.79
02720652   HB PERF SUCTION CELL SAVER            02720652      133.19
02720654   HB PERFUSION ASSIST PACK              02720654      1417.43
02720655   HB RASP MICRO RECIPROCATING           02720655      351.06
02720656   HB REAMER, CORING/HEAD                02720656      947.72
02720658   HB RELOAD, GIA ENDO 1                 02720658      614.31
02720659   HB SET SPINAL TRIGEMINAL GANGLION     02720659      1125.08
02720660   HB SHUNT CAROTID ARTERY               02720660      540.68
02720661   HB KIT, CATHETER                      02720661      251.77
02720662   HB ENDO TACKER SYSTEM 5MM             02720662      1197.13
02720665   HB TAP, NEURO/SPINE 2                 02720665      1589.62
02720667   HB IV SET BLOOD TUBING                02720667       46.36
02720669   HB T-TUBE, 1                          02720669      145.49
02720671   HB TUBING LEVEL 1 IR 600              02720671       83.14
02720672   HB TUBING TUR 2 LEAD                  02720672      475.85
02720673   HB TUBING, TEFLON                     02720673      802.37
02720675   HB ARTHRO SUTURE LASSO 1              02720675      695.00
02720676   HB ARTHRO FLOOR SUCTION MAT           02720676      170.42
02720677   HB BASIN OPEN HEART CUSTOM PACK       02720677      452.74
02720678   HB BASKET, RETRIEVAL 3                02720678      896.47
02720679   HB BASKET, URETERAL SEGURA 1          02720679      775.31
02720681   HB BIOGLUE, SKNCLSR SYRINGE 3         02720681      2399.08
02720682   HB BLADE, GENERAL 1                   02720682      265.78
02720683   HB CABLE, MICROTARGETING              02720683      546.66
02720684   HB CANNULA, ARTHRO 2                  02720684      1005.17
02720685   HB CANNULA, ENDO/ERCP/IRRIG           02720685      239.33
02720686   HB CANNULA, INNER 1                   02720686       54.16
02720687   HB CATH THORACIC 36FR                 02720687      250.97
02720688   HB CATH U.K. INFUSION CATH            02720688      580.90
02720689   HB CATH, CNTRL VENOUS, SNGL LMN       02720689       57.90
02720690   HB CATHETER, DELIVERY SPY SCOPE       02720690      2339.88
02720691   HB CATHETER, FEMORAL/ARTERY TRAY      02720691      359.11
02720692   HB CATHETER, FOLEY 3WAY 5CC/30CC      02720692      295.76
02720693   HB CATHETER, MAKRI TAMPONADE          02720693      814.90
02720695   HB CATHETER, TEXAS EXTERNAL           02720695       75.45
02720696   HB CATHETER, TROCAR MM                02720696      669.95
02720697   HB CATHETER,PENUMBRA DELIVERY 6F      02720697      1846.58
02720698   HB COLOSTOMY BAG 45MM                 02720698      234.44
02720699   HB CORE BIOPSY NEEDLE-EUS             02720699      1034.93
02720700   HB CANNULA, J HOOK                    02720700       67.05
02720702   HB CANNULA, VENOUS 1                  02720702      361.64



                                           141
  Charge
   Code                   Description                 CPT Code OP/Default Price   IP/ED Price
02720703   HB CANNULA, VENOUS 2                       02720703      668.19
02720705   HB CHARGER, NEUROSTIMULATOR 2              02720705      5923.92
02720706   HB COOK NEEDLE                             02720706      298.95
02720707   HB CUTTER, MESH/WIRE                       02720707      1968.76
02720708   HB DRAIN PLEUR-EVAC ADULT/PEDS             02720708      239.70
02720709   HB ENDO CAP MULTISEAL 5MM                  02720709       68.92
02720711   HB EXPANDER COIL 2                         02720711      367.80
02720712   HB EYE RETRACTOR FLEXIBLE                  02720712      520.97
02720713   HB GUIDE, DRILL 2                          02720713      1262.12
02720714   HB GUN, BIOGLUE APPLICATOR 1               02720714      991.31
02720715   HB INSERTER, DILAMEZ INTRODUCER            02720715      2141.33
02720716   HB INTRO BLUE-ON-BLUE 8FR 260-120          02720716      250.79
02720717   HB IV BLOOD PUMP Y-TYPE OR                 02720717      339.68
02720718   HB KIT, DEEP BRAIN STIMULATION             02720718      162.49
02720719   HB KIT, FRACTURE 3                         02720719      8925.55
02720720   HB LASER FIBER, 6                          02720720      4374.23
02720721   HB LIGACLIP                                02720721      118.96
02720722   HB MALLEABLE OCCLUSION ASSEMBLY            02720722      1846.58
02720723   HB MICRINS BACKGROUND MATERIAL             02720723       90.06
02720726   HB NO COST SUPPLY                          02720726       1.39
02720727   HB PERI PATCH REPAIR KIT                   02720727      217.92
02720729   HB SHOULDER SUSPENSION KIT 1               02720729      311.76
02720730   HB SILASTIC PA BAND                        02720730      247.93
02720731   HB SLEEVE, KNEE SCD                        02720731      389.21
02720733   HB STAPLER, MULTIFEED ENDO 1               02720733      477.39
02720734   HB SUTURE 1                                02720734       77.60
02720735   HB SUTURE, 6                               02720735      820.01
02720736   HB CATHETER, CONNECTOR CTU                 02720736       89.92
02720737   HB CVC INSERTION KIT                       02720737      306.78
02720738   HB BRUSH, CYTOLOGY RX                      02720738      645.87
02720739   HB DEPT ELECTRODE PASSING NEEDLE           02720739      463.85
02720740   HB DERMABOND, SKIN ADHESIVE                02720740      212.15
02720741   HB DILATOR HYDROPLUS 240-110               02720741      192.59
02720742   HB DRAIN, URINARY                          02720742      176.04
02720743   HB DRAINAGE BAG AIR SHIELD     *           02720743      286.67
02720744   HB PROBE, EHL                              02720744      1483.67
02720745   HB ELECTRODE, FETAL SCALP                  02720745      202.67
02720746   HB ENDO ARTICULATIN LIN CUT ATB35          02720746      756.68
02720747   HB ENDO ARTICULATIN LIN CUT ATW35          02720747      756.68
02720748   HB EP MAP REFERENCE PATCH                  02720748      3475.79
02720749   HB EYE CARE DRESSING TRAY        *         02720749      823.84
02720750   HB NEEDLE, GUN SEMI-AUTO DISP              02720750      304.82



                                                142
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
02720753   HB HEIMLICH CHEST                       02720753      102.07
02720754   HB INDEFLATOR PTCA                      02720754      1608.09
02720755   HB DISPOSABLE ET TUBE GUIDE             02720755       57.94
02720757   HB TRAY, LUMBAR PUNCTURE                02720757      797.90
02720758   HB CAP REDUCER, ENDOSCOPIC              02720758       59.58
02720759   HB PACK, CUSTOM 3                       02720759      800.75
02720760   HB CAST PLASTER SPLINT                  02720760       87.47
02720761   HB ENDO GAUGE                           02720761      234.43
02720762   HB TRACT, ANESTHESIA BREATHING          02720762       61.81
02720763   HB ELC URINARY DRAIN BAG 154002         02720763       62.07
02720764   HB GEN PURPOSE KIT (SUTURE)             02720764       62.25
02720765   HB TUBE, TRACHEOSOFT                    02720765      413.14
02720766   HB CATHETER, FASTNER PERCU-STAY         02720766       64.02
02720767   HB FLOW CONTRL DEVICE 44-201            02720767       69.28
02720768   HB DISSECTOR, SPONGE PEANUTS            02720768       46.65
02720769   HB BLADE, BEAVER                        02720769       71.80
02720770   HB PIN GUIDE                            02720770      437.84
02720771   HB IV PCA TUBING                        02720771       74.81
02720772   HB STAPLER, ENDOSCOPIC 1                02720772      575.01
02720773   HB MERIT MEDICAL RESPONSE KIT           02720773      622.49
02720775   HB PACK, CUSTOM EYE                     02720775      1060.17
02720777   HB CANNULA, BISHOP HARMON               02720777       54.82
02720778   HB TUBE, REPLACMNT Y-PORT               02720778       95.78
02720779   HB LENS GLIDE                           02720779       80.36
02720780   HB SURGIFOAM, ABSORBABLE SPONGE 1 02720780             62.98
02720781   HB DIALATOR, VESSEL                     02720781       88.90
02720782   HB TUBING LIPOSUCTION                   02720782       83.97
02720783   HB DECUBICARE PAD                       02720783      128.47
02720784   HB ADAPTER TUOHY-BORST TBA-6            02720784      153.80
02720785   HB ENT DIEGO TUBING SUCT IRRG 12        02720785      170.42
02720786   HB CATH FOL 30CC 18F                    02720786      211.24
02720787   HB TUNNELER, SURGICAL 1                 02720787      240.59
02720789   HB TUBING HOTLINE                       02720789      296.22
02720790   HB COLOSTOMY POUCH                      02720790      337.98
02720791   HB NEEDLE, VERTEBROPLASTY               02720791      370.36
02720793   HB TRAY FOR BIOPSY                      02720793      480.85
02720794   HB MONITORING KIT, INTRAUTERINE P       02720794      485.32
02720795   HB ELECTRODE TEMP PACING 6F             02720795      533.31
02720796   HB TRAY, CIRCUMCISION                   02720796      490.25
02720797   HB CANNULA, ARTERIAL FEMORAL 3          02720797      622.12
02720798   HB CATH FOLEY OR                        02720798      583.15
02720799   HB ELECTRODE, ESU 3                     02720799      757.91



                                             143
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
02720800   HB BLADE, OPTHALMOLOGIC 1               02720800      191.53
02720803   HB TRAY, PARACENTESIS                   02720803      490.49
02720805   HB VAGINAL DILATOR SET                  02720805      491.61
02720806   HB INTRODUCER SHEATH                    02720806      453.71
02720807   HB CLIP, DISPOSABLE 1                   02720807      461.85
02720808   HB ENDO ANTI FOG                        02720808       76.98
02720809   HB NEEDLE, OSTYCUT BIOPSY               02720809      457.23
02720810   HB PROBE FOR X & Y                      02720810      458.46
02720811   HB PC ENDOTRACHEAL TUBE #               02720811      464.66
02720813   HB ESU INSULATED COATED BLADE           02720813       87.29
02720814   HB SMOKE HOUSE FILTER                   02720814       87.29
02720815   HB TRAY, PNEUMOTHORAX                   02720815      466.04
02720817   HB CATHETER, AIRWAY                     02720817       90.53
02720818   HB BAG, DRAINAGE 600ML TRU-CLOSE        02720818       91.45
02720819   HB NEEDLE, CHIBA                        02720819       91.45
02720820   HB SUTURE, SILK                         02720820      120.72
02720821   HB NEEDLE, THORACENTESIS TURKEL         02720821      134.11
02720822   HB PC CONCHA COLUMN                     02720822      144.27
02720823   HB ADHESIVE REPAIR SUPPLY               02720823       94.49
02720825   HB BUTTERFLY, IV INFUSION               02720825       95.10
02720826   HB CANNULA SHOULDER 7CM                 02720826      163.28
02720827   HB SYNERA TOPICAL PATCH                 02720827       38.49
02720828   HB TRACH BUTTON #33                     02720828       38.66
02720829   HB CHROMOVISION LIGHT HANDLE            02720829       95.60
02720831   HB TRAY, SWAN-GANZ W/CATH CUSTOM        02720831      731.27
02720832   HB TRAY, URINARY WITH FOLEY             02720832      361.52
02720833   HB BLADE GIGLI SAW                      02720833      102.06
02720835   HB TUBE STOMACH EVACUATOR 32FR          02720835      102.53
02720837   HB ANES PRESS TRANS VENOUS              02720837      109.71
02720842   HB NEEDLE CYSTOME                       02720842       99.14
02720843   HB CANNULA, INTRACARDIAC SUMP           02720843      116.51
02720844   HB NEEDLE, BIOPSY 22G/6                 02720844      198.77
02720845   HB NEEDLE, LONG, AMNIO, ECHOTIP         02720845      202.68
02720846   HB OT STRAPPING MATERIAL                02720846       7.62
02720847   HB RELOAD, ENDOSTITCH 1                 02720847      142.99
02720848   HB SUTURE REMOVAL TRAY                  02720848       36.02
02720849   HB THEMOCOOL TUBING SET                 02720849      145.49
02720850   HB TUBING, PRESSURE 1                   02720850      117.77
02720851   HB TRAY, MONITORING CVP                 02720851      427.26
02720852   HB SUTURE, 2.0/4.0 SILK/NYLON           02720852      119.49
02720853   HB 4-0 SUTURE                           02720853      120.72
02720854   HB TUBING SMOKE EVACUATOR               02720854       97.97



                                             144
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
02720856   HB MISCELLANEOUS SUPPLY OR               02720856       0.00
02720857   HB OXYGEN ADMIN - EA ADDL MIN            02720857       1.66
02720858   HB CLIP APPLIER LIGACLIP                 02720858      443.19
02720859   HB SCALPEL, SURGICAL 1                   02720859       31.49
02720860   HB MASTISOL LIQUID ADHESIVE              02720860       34.64
02720861   HB TOUEY-WEISS NEEDLE                    02720861      431.83
02720862   HB TRAY, PICC W/O CATHETER               02720862      434.55
02720863   HB SUCTION, RESEVOIR J-P                 02720863      440.59
02720864   HB CATH URINARY EXTERNAL (6200)          02720864       37.42
02720865   HB OPTHALMIC SURG KIT                    02720865       37.42
02720867   HB ENDO STEP DILATING SLEEVE             02720867      444.36
02720868   HB PRASS PAIRED ELECTRODES               02720868      446.16
02720871   HB NEEDLE, INTRODUCER MANAN              02720871       82.30
02720872   HB OXYGEN ADMIN.- PER HOUR               02720872       99.50
02720874   HB PLASTIBELL, CIRCUMCISION              02720874       47.11
02720875   HB SPLINT, IMMOBILIZER SHOULDER          02720875       97.97
02720876   HB BAG, DRAINAGE URINARY                 02720876       48.96
02720877   HB IV SET NON-VENTED                     02720877       87.38
02720878   HB SUTURE                                02720878       89.88
02720879   HB NEEDLE, MANAN AUTO CUTTING            02720879       91.45
02720880   HB UROSTOMY POUCH                        02720880       91.96
02720881   HB BIOPSY GUN NEEDLE                     02720881      126.21
02720883   HB SNARE 1                               02720883      119.66
02720884   HB TIP,PULSEVAC FLEX / IRRIGATION        02720884      127.22
02720885   HB ANES PRESSURE BAG DISP                02720885      127.48
02720887   HB NEEDLE, BIOPSY/ASP/LOC/INJ CT         02720887       0.00
02720889   HB NEEDLE, RADIOFREQUENCY                02720889      205.74
02720890   HB MED HYPAQUE DYE 50% 50CC              02720890      131.63
02720891   HB IV TUBING                             02720891      215.92
02720892   HB PORT-A-CATH FLUSH                     02720892      215.95
02720893   HB ENDO LAPRA TY SUTURE CLIPS            02720893      133.01
02720894   HB NEEDLE FOR BIOPSY                     02720894      340.12
02720895   HB TRAY, PROCEDURE                       02720895      216.29
02720896   HB CORD, DISPOSABLE 1                    02720896      136.04
02720899   HB PERF PMP PCK MEMBRANE 62003-01        02720899      806.41
02720900   HB ABLATOR, ARTHRO                       02720900      810.56
02720901   HB STAPLER, SKIN AUTO                    02720901      226.35
02720902   HB CATHETER, RENAL DILATOR               02720902      822.86
02720904   HB SPLINT 1                              02720904      295.07
02720905   HB ENDOVASCULAR/RENAL DILATOR SET 02720905             835.49
02720908   HB ENDO STAPLER ET45G                    02720908      850.74
02720910   HB LC PLEURAL DRAIN PROC KIT             02720910      227.06



                                              145
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02720911   HB TRANSDUCER, NEONATE                 02720911      309.29
02720912   HB BLADE, MYRINGOTOMY                  02720912      128.29
02720913   HB CANNULA, ARTERIAL FEMORAL 4         02720913      857.38
02720914   HB CATH ROBINSON                       02720914      294.26
02720915   HB BLADE, SAW 2                        02720915      466.52
02720916   HB NEEDLE, BIOPSY 3                    02720916      876.93
02720917   HB DOUBLE BALLOON TRAY                 02720917      878.89
02720918   HB TRAY, EGD                           02720918      878.89
02720919   HB KYPHON BONE BIOSPY DEVICE           02720919      631.82
02720920   HB TRAY, FNA                           02720920      878.89
02720921   HB PC CYTOLOGY BRUSH                   02720921      636.77
02720922   HB PC TOTAL FACE MASK                  02720922      651.41
02720923   HB CURRETTE, KYPHEX                    02720923      895.58
02720924   HB INTRODUCER, OSTEO TOOL              02720924      895.58
02720925   HB PACK, PERFUSION PUMP PED 1          02720925      897.84
02720926   HB PC BRONCHOSCOPY FORCEPS             02720926      1564.38
02720927   HB MODULE EMG INTRAOP DISPOSABLE       02720927      1564.43
02720928   HB CATH PACK -CATH LAB *               02720928      903.24
02720929   HB NERVE STIMULATOR                    02720929      903.99
02720930   HB TRAY TRACHEOTOMY                    02720930      1587.24
02720931   HB EXTRACTOR, STONE                    02720931      906.87
02720932   HB PC WANG NEEDLE                      02720932      1025.42
02720933   HB CATHETER, SWAN-GANZ W/THROMBO 02720933            920.42
02720934   HB BASKET, LITHOCATCH/PARACHUTE        02720934      926.94
02720935   HB FORCEPS, ENDOSCOPIC 1               02720935      940.80
02720936   HB ENDO CLIP                           02720936      956.73
02720937   HB TAP, DISPOSABLE 3                   02720937      966.11
02720938   HB PACK, CUSTOM 4                      02720938      1054.29
02720939   HB FORCEPS, TRIPOLAR                   02720939      1057.18
02720940   HB VENOUS PRESSURE DISP                02720940      1081.18
02720941   HB SLEEVE, TRUKOR DRILL                02720941      991.02
02720942   HB ANCHOR/SCREW 19                     02720942      991.31
02720943   HB FORCEPS, BIOPSY I                   02720943      200.44
02720944   HB KIT, CRANIAL ACCESS                 02720944      1008.95
02720945   HB KIT VITRECTOMY ACCURUS PAK          02720945      1011.28
02720946   HB TUBE CANTOR TRAY PED                02720946      1085.40
02720947   HB TUBE, GASTROSTOMY 4                 02720947      1041.94
02720948   HB TUBE GASTROSTOMY MIC-KEY            02720948      469.13
02720949   HB TUBING, IVAC PUMP NICU              02720949      471.08
02720950   HB CATH SIZING BALLOON                 02720950      1065.58
02720951   HB TUBE, TRACH DCT W/DISP CANN 4       02720951      789.46
02720952   HB PACK, CUSTOM 1                      02720952      361.55



                                            146
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02720953   HB ENDO IRRIGATION HYSTEROSCOPIC       02720953      651.96
02720954   HB TWIST DRILL, SURGICAL 3             02720954      1095.85
02720955   HB HYDRODISSECTION, FLUIDJET           02720955      1097.11
02720956   HB BLADE, RETRACTING 2                 02720956      1104.97
02720957   HB SNARE, GOOSE NECK                   02720957      1113.99
02720958   HB CATHETER, DRAINAGE APDL             02720958      548.69
02720960   HB TRAY, BIOPSY/ASP/LOC/INJ CT         02720960       0.00
02720961   HB ADAPTER HARMONIC CS/LCS BLADE       02720961      1151.62
02720962   HB CATHETER, ACHALASIA DILATOR         02720962      1252.85
02720963   HB ANES CONT NERVE BLOCK TRAY          02720963      1165.54
02720964   HB TRAY, ERCP                          02720964      1171.82
02720965   HB BLADE, HARMONIC SCALPEL             02720965      771.93
02720966   HB KIT, LEAD ACCSRY INTR/REV           02720966      1187.43
02720967   HB DISPOSABLE BLADES                   02720967      1192.47
02720968   HB NEEDLE, SPINAL                      02720968      141.35
02720969   HB PERF RESERVOIR OXGYENATOR           02720969      1212.99
02720971   HB TRAY CENTRAL VENOUS                 02720971      142.93
02720972   HB SET LEVEL I DISP                    02720972      358.49
02720973   HB ANES ARTERIAL LINE FEMORAL          02720973      122.64
02720974   HB ANCHOR, FIXATION APPARATUS          02720974      1084.52
02720975   HB ANES CONT NERVE BLOCK CATHS         02720975      1506.11
02720976   HB ANES EMER/EXCH AIRWAY CATH          02720976      594.41
02720977   HB ANES ET INTUBATING INTRODUCER       02720977      719.94
02720978   HB TUBE,NASO-ENTERO FEED(NG/J)         02720978      209.41
02720980   HB INTRODUCER/SHEATH, CV 1             02720980      1228.11
02720981   HB TIP, CATHETER INTRODUCER            02720981      1228.11
02720982   HB IV INFUSION BUTTERFLY               02720982       88.06
02720983   HB FORCEPS, ENDOSCOPIC 2               02720983      1238.70
02720984   HB TUBE, REAMER/IRRIG/ASPIRATOR        02720984      1240.71
02720985   HB LIGASURE, ESU 1                     02720985      1251.16
02720986   HB ELECTRODE, VERSA/LOW IMPEDENCE 02720986           1255.83
02720987   HB PIN, GUARD                          02720987      167.95
02720989   HB TRAY,CATHETER INSERT W/O FOLEY      02720989      184.69
02720992   HB ARTHRO WAND 2                       02720992      1312.13
02720995   HB CLIP, DYNAMIC STIMULATION 1         02720995      1335.18
02720998   HB QUICK CONNECT SPINEJET              02720998      1386.83
02721000   HB FORCEPS, SPYBITE BIOPSY             02721000      1412.94
02721001   HB SHEARS, HARMONIC 1                  02721001      1431.29
02721002   HB INJECTION, SILICONE OIL             02721002      1434.69
02721003   HB COOK FORCEP CUP 220130              02721003      1492.25
02721004   HB CAPSULE, ENDOSCOPE DEL SYS          02721004      1493.63
02721005   HB LIGASURE, ESU 2                     02721005      1497.67



                                            147
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721007   HB STYLET,LOCK LIBERATOR/RDFRCNCY 02721007           1514.04
02721009   HB BLADE, RETRACTING 3                 02721009      1540.65
02721010   HB PIN, DISTRACTION 2                  02721010      1545.53
02721011   HB FORCEP BX PIRANHA 505-160           02721011      1553.22
02721015   HB TAP, DISPOSABLE 4                   02721015      1608.51
02721016   HB TIB TUNNEL CANN AR-1802D            02721016      177.35
02721017   HB TIP, KELMAN / INFRATIP              02721017      614.68
02721019   HB TUBE, TRACHEOSTOMY 1                02721019      279.91
02721020   HB TUBE, TRACHEOSTOMY 2                02721020      730.57
02721022   HB HEMORRHOID STAPLER                  02721022      1639.12
02721023   HB KIT, MICRO WIRE CATHETER            02721023      1650.61
02721024   HB CATHETER, INFUSION                  02721024      1653.44
02721025   HB KIT, UROLOGY OR                     02721025      1662.67
02721027   HB CANNULA, VENOUS FEMORAL 2           02721027      1704.24
02721029   HB LASER FIBER, 1                      02721029      1704.24
02721033   HB GELPORT SEAL                        02721033      1748.58
02721034   HB BALLOON, MICROSYS                   02721034      1752.73
02721035   HB CANNULA, DIAGNOSTIC/ENDORETURN 02721035           1762.18
02721037   HB ENDO OMNIPORT                       02721037      1822.02
02721040   HB PROBE, HOE (OSCAR SYSTEM)           02721040      1856.65
02721041   HB BASKET, URETERAL 2                  02721041      1862.55
02721042   HB BLADE, SHAVER 2                     02721042      1896.83
02721043   HB CLIP, DYNAMIC STIMULATION 2         02721043      1896.96
02721047   HB BONE CEMENT REMOVAL SYSTEM          02721047      1958.69
02721048   HB LASER FIBER, 3                      02721048      1991.06
02721049   HB CATHETER,DISCYPHOR SYS W/GUIDE 02721049           2050.86
02721050   HB NEEDLE, TRANSJUGULAR LIVER          02721050      2053.62
02721054   HB TUBING PACK, CUSTOM 3               02721054      2224.47
02721056   HB NEURO MICROTARGETING DEVICE         02721056      2308.35
02721058   HB BIO BIOGLUE 10ML                    02721058      2405.34
02721059   HB PROBE, NIM 2                        02721059      2427.25
02721063   HB CHARGER, NEUROSTIMULATOR 1          02721063      2616.19
02721066   HB KIT, ELECTRODE COOL TIP 1           02721066      2777.43
02721067   HB CATHETER, BICAP PROBE               02721067      2890.44
02721068   HB LASER FIBER, 4                      02721068      3056.95
02721071   HB EP DIAGNOSTIC CATHETER              02721071      2974.81
02721073   HB KIT, ENDOVESSEL HARVEST             02721073      3077.34
02721077   HB TOOL, DISSECTING ROTOLINK           02721077      3296.38
02721080   HB 64-CONTACT STRIP ELECTRODE          02721080      3423.72
02721081   HB CATHETER, PENUMBRA REPERFUSION 02721081           3424.87
02721086   HB CATHETER, PULMONARY 1               02721086      4108.83
02721087   HB KIT, ENDO-DISCECTOMY                02721087      4248.65



                                            148
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02721089   HB CANNULA, ARTERIAL 3                  02721089      4335.55
02721091   HB CATHETER, SINUS 1                    02721091      5533.44
02721097   HB HYDROJET WITH APPLICATOR             02721097      7168.41
02721100   HB ESU RITA STARBURST DEVICE            02721100      9694.80
02721102   HB KIT, KYPHON 2                        02721102     11458.62
02721103   HB KIT KYPHOPAK KP2001                  02721103     13983.12
02721105   HB BIOPTOME                             02721105      4584.32
02721107   HB BLADE, SHAVER 1                      02721107      767.09
02721108   HB BLADE, OPHTHALMOLOGIC 2              02721108      420.70
02721109   HB BLOOD ADMIN SET Y TYPE               02721109      110.82
02721110   HB BLOOD PUMP SET W/FILT 7'   *         02721110      203.76
02721111   HB BRAVO CAPSULE                        02721111      1333.31
02721112   HB CANISTER, V.A.C.                     02721112      274.38
02721113   HB CATH FOLEY                           02721113      406.84
02721114   HB CATH ROBINSON 2-EYE 26FR             02721114      154.73
02721119   HB CATHETER, DIAGNOSTIC                 02721119      1984.13
02721163   HB COIL, PUSHER                         02721163      753.87
02721215   HB NEEDLE, TRANSEPTAL                   02721215      977.10
02721234   HB TUBING, SUCTION 2                    02721234      620.47
02721236   HB NEEDLE, SCLERO / SUTURE ZONE         02721236      265.92
02721237   HB K-WIRE, SUPPLY 2                     02721237      470.02
02721238   HB ENDOSCOPIC STRYKEFLOW II             02721238      296.24
02721239   HB TOOL, DISSECTING 1                   02721239      554.23
02721241   HB K-WIRE, SUPPLY 3                     02721241      720.77
02721243   HB BASKET SEGURA                        02721243      877.37
02721244   HB PERFUSION BIO PUMP 1                 02721244      764.62
02721246   HB FILTER, BUFFALO KTP                  02721246      283.41
02721249   HB GUIDE, ROD BALL TIP                  02721249      835.07
02721252   HB CUTTER, ENDOSCOPIC 2                 02721252      896.88
02721253   HB PACK, CUSTOM EYE                     02721253      1568.03
02721254   HB K-WIRE, SUPPLY 1                     02721254      185.44
02721255   HB RELOAD, ENDOSCOPIC 2                 02721255      649.63
02721256   HB EXTENSION, SINUS GUIDE               02721256      370.88
02721258   HB ARTHRO FLOOR SUCTION MAT OR          02721258      213.90
02721259   HB PRESSURIZER, FEMORAL CEMENT          02721259      330.06
02721261   HB K-WIRE, SUPPLY 6                     02721261      1632.82
02721262   HB SUCTION MINI POINT WAND              02721262      186.61
02721264   HB BLADE, FULL RADIUS 2                 02721264      452.55
02721265   HB WAXING SLEEVE                        02721265      136.51
02721267   HB TRANSFER CAP                         02721267      189.53
02721269   HB IMPRESSION MATERIAL PROS             02721269      1076.93
02721271   HB SPRAY SET, BIO TISSEEL               02721271      332.40



                                             149
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02721296   HB COUPLER, ANASTOMOTIC 1               02721296      889.89
02721297   HB SLEEVE, INFUSION 1                   02721297      281.08
02721298   HB CATHETER,ANORECTAL MANOSHLD AR02721298             268.52
02721300   HB PINS, HEADLESS DISPOSABLE            02721300      594.81
02721301   HB KIT, CATHETER STEER NAVIGATION       02721301      3297.13
02721302   HB ISOLATOR, SYNERGY W/GLIDEPATH        02721302      6698.06
02721303   HB CATHETER, CENTESIS                   02721303      305.86
02721304   HB KIT, BONOPTY SYSTEM                  02721304      354.13
02721305   HB NEEDLE, TROCAR                       02721305      162.32
02721306   HB CATHETER, ENTEROCLYSIS               02721306      246.09
02721307   HB CATHETER, TROCAR                     02721307      162.32
02721308   HB IRRIGATOR, SUCTION SIMPULSE          02721308      270.58
02721309   HB QUADRANT ILLUMINATION                02721309      1036.84
02721310   HB PROBE, SIMPLICITY III                02721310      2586.90
02721311   HB SUPPORT, HEART DISPOSABLE            02721311      463.02
02721312   HB ANESTHESIA, PA CATH LATEX FREE       02721312      2295.16
02721313   HB PROBE, ABLATION RITAS                02721313      2731.77
02721314   HB PROBE, ABLATION VALLEY LAB           02721314      1978.41
02721315   HB CATHETER, ESOPHAGEAL MANOSHLD 02721315             218.73
02721316   HB KYPHON BONE FILLER DEVICE            02721316      389.44
02721317   HB NEEDLE, BONOPTY BIOPSY               02721317      435.31
02721318   HB INTRODUCER, FIBER OPTIC              02721318      155.19
02721319   HB NEEDLE, ACCESS BEVEL TIP             02721319      1355.24
02721320   HB RETRACTOR, WOUND                     02721320      365.61
02721321   HB NEEDLE, MAXI-CELL                    02721321      189.53
02721322   HB DIALATOR                             02721322       98.51
02721323   HB KIT, BARD BIOPSY SYSTEM              02721323      317.80
02721324   HB KIT, EASY CORE BIOPSY SYSTEM         02721324      308.80
02721325   HB PROBE, NIM 1                         02721325      425.70
02721326   HB ADAPTER, CATHETER 1                  02721326      261.25
02721327   HB VACTHERAPY, CANISTER 300/500ML       02721327      276.41
02721328   HB TUBE, VINYL CONNECTOR                02721328      162.32
02721329   HB WIRE, LOCALIZATION 20G               02721329      119.33
02721330   HB DILATOR, SPINE 1                     02721330      454.86
02721331   HB CABLE, TRIAL LEAD/EMG                02721331      728.94
02721335   HB ANES ET TUBE EXCHANGE CATH           02721335      267.87
02721349   HB VACTHERAPY, DRAPE DRESSING           02721349      251.92
02721351   HB TUBE, FEEDING JEJUNAL 1              02721351      686.95
02721352   HB VACTHERAPY, ABDOMINAL DRESSING 02721352            1273.60
02721353   HB PROBE, MONOPOLAR 3                   02721353      3297.13
02721354   HB BLADE, REAMER 1                      02721354      747.60
02721355   HB BLADE, TRICUT 2                      02721355      1349.41



                                             150
  Charge
   Code                   Description            CPT Code OP/Default Price   IP/ED Price
02721356   HB SUTURE, PROLENE MH 3-0             02721356      307.40
02721357   HB NEURO MONITORING KIT 4             02721357      2350.09
02721359   HB TAP, DISPOSABLE 5                  02721359      1715.63
02721360   HB SPRAY SET, CSL/TSSL/BIOCUE         02721360      332.40
02721361   HB CHUCK, APEX FITTING                02721361      943.54
02721362   HB SIZER, BREAST ALL SIZES            02721362      297.41
02721363   HB PIN, PERCUTANEOUS                  02721363      908.55
02721364   HB PROBE, MONOPOLAR / ENDO OTO        02721364      2803.79
02721365   HB ANESTHESIA TUBE 2                  02721365      694.12
02721367   HB RETRIEVER, SUTURE 1                02721367      418.70
02721368   HB TAP, DISPOSABLE 2                  02721368      812.91
02721369   HB CUTTER, ENDOSCOPIC 5               02721369      1602.50
02721370   HB OCCLUDERS, COLPO-NEUMO             02721370      309.07
02721371   HB TRAY, CIRCUMCISION                 02721371       96.43
02721372   HB CAPIO SUTURE CAPTURING DEVICE2     02721372      2747.80
02721373   HB CAPIO SUTURE CAPTURING DEVICE1     02721373      1130.14
02721374   HB DISSECTOR, BALLOON ENDO 2          02721374      1293.43
02721375   HB SHEATH, EVOLUTION SHORTIE          02721375      2659.16
02721377   HB TRAY, UROLOGIST OBSTCT URETHRA 02721377          972.69
02721378   HB PERFUSION, PCK ADAPTR INFANT 2     02721378      2560.03
02721380   HB WRENCH, EXT/FIXATOR DISPOSABLE     02721380      1294.59
02721381   HB TIP, RUMI                          02721381      265.92
02721383   HB TUBING, CUSA / MWA                 02721383      916.71
02721384   HB WAFER, SKIN BARRIER                02721384       68.81
02721385   HB PERFUSION, PACK ADAPTER 1          02721385      496.84
02721387   HB TAP, DISPOSABLE 6                  02721387      2211.30
02721388   HB KIT, INTERNAL TRAJECTORY GUIDE     02721388      3166.50
02721389   HB CONFORMER, EYE 2                   02721389      256.59
02721395   HB LASER FIBER, 4                     02721395      2316.97
02721396   HB LASER, FIBER 1                     02721396      741.77
02721398   HB PACK, PERFUSION PUMP PED 2         02721398      2289.45
02721399   HB CANNULA, ARTERIAL 1*               02721399      307.90
02721401   HB REAMER, MODULAR SHAFT 3            02721401      2015.37
02721402   HB NEEDLE, MICRODISSECTION            02721402      372.05
02721403   HB CATHETER, SEEKING/EMBOL 1*         02721403      221.60
02721404   HB CANNULA, DIAGNOSTIC 1              02721404      2358.26
02721405   HB BLADE, SAW 5                       02721405      2190.31
02721406   HB BALLOON, OCCLUSION NON-NEURO       02721406      1006.69
02721407   HB KIT, SPINAL CORD STIM 2            02721407      6677.07
02721408   HB BALLOON, OCCLUSION NEURO           02721408      3494.23
02721409   HB IMMOBILIZER, ALUMI - HAND          02721409      193.61
02721410   HB PUNCH, BIOPSY DISPOSABLE           02721410       29.16



                                           151
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02721416   HB SPATULA, BRAIN SILICONE DISP         02721416      296.24
02721417   HB LASER FIBER, 2*                      02721417      1466.04
02721418   HB STRAP, FOOT/ANKLE DISTRACTOR         02721418      254.25
02721420   HB LASER FIBER, 5*                      02721420      2500.55
02721421   HB SET, ENDOBRONCHIAL BLOCKER           02721421      737.10
02721422   HB RETRACTOR, WOUND 1                   02721422      365.05
02721424   HB MARKER, VISICOIL GOLD                02721424      737.10
02721425   HB PIN, GUIDE 2                         02721425      720.77
02721426   HB PUMP SUCTION LINE                    02721426      195.94
02721429   HB ERX 272 (OP 250)                     02721429
02721451   HB ADAPTER, TISS/EXPNDR INFLTR          02721451      148.73
02721452   HB ANESTHESIA TRAY EPIDURAL             02721452      975.12
02721453   HB ANESTHESIA TRAY SPINAL               02721453      849.41
02721454   HB BLADE, SAW 3                         02721454      787.52
02721455   HB CANNULA, ARTERIAL FEMORAL 2          02721455      348.69
02721456   HB CATH DUAL LUMEN ANTIMICROB           02721456      433.35
02721457   HB CATHETER, MAMMOSITE CED              02721457      688.01
02721458   HB DRAIN, EXTERNAL 1                    02721458      572.45
02721459   HB KIT, INTRODUCER                      02721459      804.64
02721460   HB KIT, NEUROLOGY                       02721460      340.26
02721462   HB REAMER, TREPHINE 1                   02721462      1661.71
02721463   HB REAMER, TREPHINE 2                   02721463      1955.96
02721464   HB REAMER, TREPHINE 3                   02721464      2777.72
02721465   HB TUBE NASO-ENTRO FED NG/J OR          02721465      1022.92
02721466   HB MICROTIP, CUSA 1                     02721466      1315.03
02721467   HB RETRACTOR LP/CHK, ADLT/CHLD          02721467      179.76
02721468   HB SHEATH, MURPHY MALLEABLE             02721468      2465.28
02721469   HB PADS, ARCTIC SUN ADDL PAD            02721469      952.65
02721470   HB PADS, ARCTIC SUN MULTI-PK            02721470      2503.56
02721471   HB CATHETER-PERIPHERAL CTO 14           02721471      4444.75
02721472   HB CATHETER-PERIPHERAL CTO 14P          02721472      4444.75
02721473   HB CATHETER-PERIPHERAL CTO 14S          02721473      4444.75
02721475   HB STYLET, PACEMAKR ACCSS LEAD          02721475      296.24
02721476   HB KIT, THORACENTESIS                   02721476      233.26
02721477   HB SCREWDRIVER, STIM/LOC DISP           02721477      753.43
02721478   HB CAGE MAX TITANIUM                    02721478      5128.22
02721479   HB KIT, NAVIGATED PEDCLS ACCSS          02721479      2007.20
02721481   HB CATHETER, JETSTREAM G2 PV            02721481      8248.49
02721482   HB CATHETER, RELIANT BALLOON            02721482      1548.78
02721485   HB CATHETER-PERIPHERAL CTO 18           02721485      4444.75
02721486   HB SEALANT HEMOSTATIC MM                02721486      777.89
02721487   HB COLLAGEN,HEMOSTAT INSTAT MM          02721487      343.18



                                             152
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02721488   HB PRF CLLSVR BRAT KT 250ML MM         02721488      605.30
02721489   HB PLATELET SEPARATION SYSTEM          02721489      1841.63
02721490   HB T-TUBE 4                            02721490      737.23
02721491   HB SMALL JOINT CANNULA SET             02721491      449.40
02721492   HB SUTURE 3*                           02721492      644.14
02721493   HB SUTURE 4                            02721493      976.91
02721494   HB KIT, FRACTURE 1                     02721494      6040.15
02721495   HB KIT, FRACTURE 2                     02721495      7727.54
02721496   HB KIT, FRACTURE 4                     02721496      8317.11
02721497   HB KIT, FRACTURE 5                     02721497      8445.51
02721498   HB GUIDEWIRE 4 *                       02721498      918.06
02721499   HB KIT, BONECEMENTDELIVERYSYS          02721499      499.69
02721500   HB CUTTER, DISC SET                    02721500      2758.46
02721502   HB TUBE, TRACHEOSTOMY 3                02721502      842.09
02721503   HB RELOAD, ENDOSCOPIC 1                02721503      360.79
02721504   HB TOOL, ULTRA DISK DRIVE              02721504      2174.24
02721505   HB TOOL, TIP EXTENDER                  02721505      2174.24
02721506   HB KIT,ENDOBUTTON PAC CRUCIATE         02721506      1564.34
02721507   HB NEEDLE, ELECTRODE MICRO TIP         02721507      298.53
02721508   HB TOOL, TUNNELING LONG                02721508      935.18
02721509   HB SPACE PASSING ELEVATOR              02721509      344.54
02721510   HB SHEATH, EVOLUTION 11F               02721510      2738.16
02721511   HB SHEATH, EVOLUTION 11F-SHORT         02721511      2439.76
02721512   HB LIBERATOR LOCKING STYLET            02721512      1500.80
02721513   HB ENDOLOGIX CUFF                      02721513      5736.98
02721514   HB PROBE, ENDOSCOPIC 2                 02721514      858.14
02721515   HB ENDOSCOPIC STRYKEFLOW W/TIP         02721515      604.55
02721516   HB GUIDEWIRE, .35 X 135CM              02721516      828.82
02721517   HB CATHETER, SUPPORT .9 MM OTW         02721517      773.90
02721518   HB PERIPHERAL INFUSION SYSTEM          02721518      6713.78
02721519   HB IMPELLA MONITOR SET TUBING          02721519      323.29
02721520   HB IMPELLA TUBING                      02721520      165.79
02721521   HB PROBE, UHD GASTROFLEX               02721521      1734.64
02721522   HD PROBE, CHOLANGIOFLEX UHD            02721522      2992.21
02721523   HB BINDER, ABDOMINAL/BACK              02721523      145.69
02721524   HB KIT, NEUROMODULATION TRIAL          02721524      505.74
02721525   HB BIOPSY TRUPATH                      02721525      196.41
02721526   HB BIOPSY CORE WITH DELTA              02721526      305.87
02721527   HB SYSTEM, TITANIUM KNOT               02721527      662.33
02721528   HB RETRACTOR ORACLE LIGHT CLIP         02721528      909.50
02721529   HB CARDIAC ABLATION SYSTEM             02721529      4079.91
02721530   HB PAS SYSTEM                          02721530      545.70



                                            153
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721531   HB REAMER, NAIL                        02721531      1573.97
02721532   HB HANDHELD ABLATION TOOL              02721532      2772.37
02721533   HB MANIPULATOR, UTERINE                02721533      438.70
02721534   HB PACK, CUSTOM 5                      02721534      1193.05
02721535   HB TUBING, DOLPHIN 1                   02721535      491.13
02721536   HB ESU SEALER DISSECTING               02721536      3021.68
02721537   HB HALO COLLECTION CUPS                02721537      203.21
02721539   HB CATHETER, PACING BALLOON            02721539      395.43
02721540   HB BIOPSY FORCEP 7F                    02721540      659.16
02721541   HB CANNULA TANDEM                      02721541      5466.16
02721542   HB ELECTRODE, TEMPORARY PACING         02721542      2510.61
02721543   HB CATHETER, EXPORT ASPIRATION         02721543      1774.23
02721544   HB PADS, UNIVERSAL ARCTIC GEL          02721544      1037.86
02721545   HB PADS, ARCTIC GEL (S,M,L)            02721545      3424.60
02721547   HB STAPLER, ENDOSCOPIC 2               02721547      708.34
02721548   HB STAPLER, ENDOSCOPIC 3               02721548      953.37
02721549   HB STAPLER, ENDOSCOPIC 4               02721549      1162.02
02721550   HB LASER FIBER, 8                      02721550      4445.85
02721551   HB BLADE, TRUNCATED 2                  02721551      2695.33
02721553   HB KNIFE, BAYONET DISECTOMY            02721553      1447.71
02721554   HB TIP, PHACO ABS                      02721554      370.22
02721555   HB PUNCH, AORTIC HEART                 02721555      253.59
02721557   HB CATHETER, MULTI-TRACK               02721557      302.79
02721558   HB PERF CELL SAVER BRAT KIT            02721558      659.12
02721559   HB PERF UNIV 3 SPIKE                   02721559      619.53
02721560   HB BASKET, RETRIEVAL 2                 02721560      712.62
02721561   HB CANNULA, VENOUS FEMORAL 1           02721561      908.64
02721562   HB KIT LEAD LOCKING DEVICE             02721562      1761.22
02721563   HB RETRACTOR, SCROTAL/TISSUE           02721563      1125.64
02721564   HB RETRACTOR, VAGINAL                  02721564      695.50
02721566   HB MISC SUPPLY CATH LAB                02721566
02721567   HB ESTECH PYRAMID POSITIONER           02721567      1365.32
02721568   HB ESTECH OPVAC SYNERGY PLUS           02721568      1999.83
02721569   HB KIT, ASPIRATION VIZISHOT            02721569      689.08
02721570   HB COLLAGEN, HEMOSTAT INSTAT 2         02721570      735.09
02721571   HB KIT, CDS DISPOSABLE                 02721571      609.90
02721572   HB MICROPORT, EXPNDR COMPONENT         02721572      847.44
02721573   HB NEEDLE, BIOPSY 1                    02721573      291.04
02721574   HB NEEDLE, BIOPSY 2                    02721574       96.30
02721575   HB BIOGLUE, SKNCLSR SYRINGE 2          02721575      1893.00
02721576   HB NEEDLE, ASPIRATION 1                02721576      498.62
02721577   HB CATHETER, ANORECTAL DISP.           02721577      330.75



                                            154
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721579   HB CATHETER, CRYOSPRAY TIP             02721579      3296.67
02721580   HB SUCTION VALVE 1                     02721580      134.82
02721581   HB BONE TAMP, INFLATABLE 1             02721581      3525.65
02721582   HB CANNULA BLOWER MISTER               02721582      345.61
02721583   HB KIT, TRI/QUAD LPRSCPC SYS           02721583      1433.80
02721584   HB PACK, PERFUSION MUF                 02721584      595.99
02721585   HB PERFUSION LINE SPIKE                02721585      105.93
02721586   HB ESU FILTER SMOKE EVACUATOR          02721586      567.10
02721587   HB PROBE, PRASS MONOPOLAR STIM         02721587      1227.89
02721588   HB PROBE, BALL TIP PEDICL STIM         02721588      1227.89
02721589   HB KIT, CATHETER STR NAVGTN BR         02721589      3297.13
02721590   HB PACK, PERFUSION PUMP TABLE1         02721590      557.47
02721591   HB KIT, OPTIVAC TRIPLE MIX             02721591      663.40
02721592   HB REAMER, MODULAR SHAFT 2             02721592      1364.25
02721593   HB KIT, VITRECTOMY INNOVAT PAK         02721593      1401.70
02721594   HB KIT, OPTIVAC TRIPLE MIX             02721594      663.40
02721595   HB IV TRANSFER PACK 1000ML             02721595      147.36
02721596   HB RELOAD, ENDOSCOPIC 4                02721596      1664.92
02721597   HB KIT, PATIENT SPINAL CORD            02721597      506.11
02721598   HB ELECTRODE, ESU 2                    02721598      582.08
02721599   HB KIT, PEDICLE ACESS                  02721599      911.64
02721600   HB KIT, MARS DISPOSABLE                02721600      1228.36
02721601   HB HANDPIECE, ENDOSCOPIC 2             02721601      731.88
02721602   HB HANDPIECE, ENDOSCOPIC 3             02721602      1135.27
02721603   HB BASKET, RETIEVAL 3                  02721603      882.75
02721605   HB CANNULA, VENOUS 4                   02721605      1291.49
02721606   HB PERFUSION, MANOMETER LINE           02721606      199.02
02721607   HB TUBE, ENDOTRACHEAL 3                02721607      1016.50
02721610   HB CANNULA, ARTERIAL FEMORAL 6         02721610      1291.49
02721611   HB TUBING, PERFUSION 1                 02721611      177.62
02721612   HB SUTURE 5                            02721612      1555.78
02721613   HB PROBE, MONOPOLAR 1                  02721613      505.04
02721614   HB SPATULA, PLASMA DISPOSABLE          02721614      1133.13
02721615   HB K-WIRE, SUPPLY 4                    02721615      984.40
02721617   HB STAPLER, ENDOSCOPIC 6               02721617      1601.79
02721620   HB TROCAR, FLEXIPATH 1                 02721620      378.78
02721621   HB CANNULA, ARTERIAL FEMORAL 5         02721621      1037.90
02721622   HB EXTENSION, STAPLER 1                02721622      543.56
02721623   HB KIT, SPINAL CORD STIM 1             02721623      1152.39
02721624   HB PROBE, MONOPOLAR 2                  02721624      736.16
02721625   HB KIT, ELECTRODE COOL TIP 2           02721625      3311.65
02721626   HB KIT, ELECTRODE COOL TIP 3           02721626      3765.33



                                            155
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721627   HB KIT, ELECTRODE COOL TIP 4           02721627      6475.64
02721629   HB MONITORING CATH W LICOX BLT         02721629      2075.36
02721630   HB ENDOSTITCH SUTURING SYSTEM          02721630      725.46
02721631   HB PACK, CUSTOM 7                      02721631      1836.12
02721632   HB VAC THERAPY, FOAM DRESSING          02721632      309.23
02721633   HB LIGASURE, ESU 3                     02721633      2325.11
02721634   HB HEAT EXCHANGER 1                    02721634      1005.80
02721635   HB DIALYSIS PACK 1                     02721635      227.91
02721636   HB FLANGE, ACETABULAR 1                02721636      658.05
02721637   HB CLAMP, BULLDOG 1                    02721637       92.02
02721638   HB CANNULA, INTRODUCTION               02721638      342.40
02721639   HB DISPOSABLE PULLBACK SLED            02721639      271.04
02721640   HB DILATOR,VSSL,PERI,HYDRO CTD         02721640      106.36
02721641   HB DILATOR,VSSL, PERIPHERAL IR         02721641       73.56
02721645   HB SLEEVE, TRACTION ARM                02721645      405.53
02721646   HB FILTER, BLOOD 1                     02721646      162.64
02721647   HB PACK, ECMO 1                        02721647      1878.92
02721648   HB SUTURE CLOSURE SYSTEM               02721648      1021.85
02721649   HB REAMER SWANSON 1                    02721649      147.66
02721650   HB REAMER CRTCLSCRW RMVR DISP2         02721650      1529.03
02721651   HB CANNULA, ATRIAL 3                   02721651      5580.05
02721652   HB ADAPTOR, CELL SAVER                 02721652      135.89
02721654   HB CATHETER, DIAGNOSTIC 1              02721654      116.63
02721655   HB NEEDLE, SPINAL 1                    02721655       68.48
02721656   HB PACK, CUSTOM 6                      02721656      1535.00
02721657   HB EXTRACTOR, STONE TIPLESS 1          02721657      453.00
02721658   HB FILTER, PEDIATRIC ARTERIAL          02721658      702.00
02721661   HB KIT, MINI STICK DILATOR             02721661      303.00
02721662   HB CATHETER, BAKRI TOMPONADE           02721662      902.00
02721663   HB ELECTRODE, ESU 4                    02721663      1029.00
02721664   HB TUBE, HOLLOW REAMER                 02721664      990.00
02721666   HB BOLT EXTRACTION SCREW RMVL          02721666      556.00
02721668   HB CANNULA, ARTERIAL FEMORAL 8         02721668      1745.00
02721670   HB HEMOSTAT ABSORBABLE SURGICE         02721670      329.57
02721672   HB SLEEVE, PACEMAKER 1                 02721672      164.00
02721673   HB CABLE, SAFETY PACEMAKER             02721673      400.00
02721674   HB BIOGLUE, SKNCLSR SYRINGE 1          02721674      1341.00
02721678   HB SHEARS, HARMONIC 2                  02721678      1593.00
02721679   HB PLEDGET, CARDIOVASCULAR 1           02721679       92.00
02721680   HB SNARE, W/HOOKS                      02721680      1529.00
02721681   HB SHEATH, CARDIOVASCULAR 1            02721681      569.00
02721682   HB ESU RESECTING SEALER                02721682      2214.00



                                            156
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02721683   HB ASPIRATOR, ENT 2                    02721683      451.00
02721684   HB CATHETER, GLIDECATH HYDRA 1         02721684      316.00
02721686   HB SCISSORS, ENDOSCOPIC 2              02721686      1070.00
02721695   HB BP CUFF HF LATITUDE KIT             02721695      3022.11
02721697   HB PACEMAKER LEAD DELIVERY SYS         02721697      594.11
02721698   HB PACING WIRE, TEMPORARY CL           02721698      1247.13
02721699   HB CANNULA LONG TERM SET 1             02721699      610.00
02721700   HB CANNULA SHORT TERM SET 1            02721700      975.00
02721701   HB KIT, VERTEBRALAUGMENTATION          02721701      4220.00
02721702   HB K-WIRE, SUPPLY 5                    02721702      1387.00
02721703   HB CANNULA, CATH VENT SUMP 1           02721703      192.00
02721704   HB CANNULA, AORTIC ROOT 1              02721704      187.00
02721705   HB KIT, DILATOR XLIF                   02721705      1466.00
02721706   HB ATRIAL CATH MONITORING SET          02721706      238.00
02721707   HB REAMER SWANSON 2                    02721707      582.00
02721708   HB SUCTION COAGULATOR 1                02721708      105.00
02721709   HB PRESSURE MONITORING SET 1           02721709      475.00
02721710   HB SEALANT, HEMOSTATIC 3               02721710      2616.00
02721712   HB ANESTHESIA LARYNGEAL AIRWAY         02721712      144.00
02721713   HB CANNULA, GRAFT 1                    02721713      2007.00
02721714   HB TUBE, TRACHEOSTOMY 1                02721714      279.91
02721716   HB PERFUSION OXYGENATOR 5              02721716      2694.00
02721717   HB PERFUSION OXYGENATOR 6              02721717      3240.00
02721718   HB PERFUSION OXYGENATOR 1              02721718      1143.00
02721719   HB PERFUSION OXYGENATOR 2              02721719      1367.00
02721720   HB PERFUSION OXYGENATOR 3              02721720      1837.00
02721722   HB TOOL, WASHER EXTRACTOR              02721722      751.00
02721723   HB PERF CRDPLG DELIVERY SYSTEM         02721723      655.00
02721724   HB PERF FILTER SET 1                   02721724      487.00
02721726   HB KIT, SECCA THERAPY 1                02721726      4334.00
02721727   HB CATHETER, CARDIOPLEGIA 1            02721727      526.00
02721728   HB PACK, ACCESSORY VNS                 02721728      1964.00
02721729   HB KIT, SUCTION BIOPSY                 02721729      569.00
02721730   HB SCALPEL, SURGICAL W/LOCK            02721730       28.35
02721731   HB BAG,DRAINAGE URN MTR 2000ML         02721731       82.43
02721732   HB CATHETER, FOLEY 2 WAY SEC           02721732       48.84
02721733   HB SUTURE, ETHL                        02721733       40.23
02721734   HB SUTURE, VICRYL                      02721734       49.52
02721735   HB SUTURE, CHROMIC                     02721735       33.56
02721736   HB SUTURE, PL                          02721736       33.90
02721737   HB TRAY, PORT ACCESS                   02721737      212.44
02721738   HB NEEDLE, BIOPSY ASP W ADPTR          02721738      179.03



                                            157
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721739   HB KIT, PICC 5FR                       02721739      790.91
02721740   HB KIT, PICC SELDING                   02721740      400.39
02721741   HB RELOAD, ENDOSCOPIC 3                02721741      948.00
02721742   HB RELOAD, ENDOSCOPIC 4                02721742      1174.00
02721743   HB TUBING, SUCTION 1                   02721743      153.00
02721744   HB ANTENNA PERCUTANEOUS 1              02721744      4788.00
02721745   HB CANNULA, VENOUS 3                   02721745      1034.00
02721747   HB DRAIN, HEMOVAC 1                    02721747      104.00
02721748   HB BOTTLE, REPLCMNT AUTOTRANS          02721748      669.00
02721749   HB BLADE, DERMACARRIER 1               02721749      223.00
02721751   HB CARDIOPLEGIA EXTEN LINE             02721751      245.00
02721755   HB BLADE, SAW 4                        02721755      1187.00
02721756   HB CATHETER, BRACHYTHERAPY 1           02721756      294.00
02721757   HB CATHETER, BRACHYTHERAPY             02721757      294.00
02721758   HB SENSOR, CEREBRAL OXIMETRIX          02721758      673.00
02721759   HB SENSOR, CARDIAC OUTPUT              02721759      1351.00
02721771   HB CANNULA ARTERIAL FEMORAL            02721771      974.51
02721772   HB FILTER, BLOOD 2                     02721772      550.00
02721773   HB SCREW POWER DRIVER                  02721773      480.00
02721774   HB PLATE, TEMPLATE 1                   02721774      285.00
02721775   HB PUNCH, BIOPSY DISPOSABLE MM         02721775       29.16
02721776   HB VEIN HOLDER                         02721776      242.00
02721777   HB SUCTION KAMVAC CVD MINI 1           02721777      216.00
02721778   HB ADAPTER, LUER 1                     02721778       35.00
02721779   HB CANNULA, VENOUS 5                   02721779      6377.00
02721780   HB STERNAL CABLE SYSTEM                02721780      375.00
02721781   HB RETRIEVER, ROTH NET 1               02721781      519.00
02721782   HB REAMER CRTCLSCRW RMVR DISP1         02721782      1099.00
02721783   HB DISSECTOR, BALLOON ENDO 1           02721783      738.00
02721784   HB DISSECTOR, BALLOON ENDO 2           02721784      1101.00
02721786   HB CATHETER, INTRVSC OCT LIGHT         02721786      3297.61
02721787   HB AMBULATORY CARDIAC ZIO PATCH        02721787      638.49
02721788   HB MISCELLANEOUS SUPPLY GI             02721788
02721789   HB PROBE, ESU 1                        02721789      1738.00
02721790   HB PROBE, ESU 2                        02721790      1877.00
02721791   HB SUCTION IRRIGATION SYSTEM 1         02721791      762.00
02721793   HB DILATOR, DISPOSABLE 1               02721793      889.00
02721794   HB DILATOR, DISPOSABLE 2               02721794      1618.00
02721796   HB SET, CJD DISPOSABLE                 02721796      1173.00
02721798   HB BLADE, BANANA 1                     02721798      115.00
02721799   HB BLADE, BANANA 2                     02721799      790.00
02721800   HB KIT, ESOPHYX SYSTEM                 02721800      8760.00



                                            158
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721801   HB FASTENER CARTRIDGE ESOPHYX          02721801      1545.00
02721802   HB ADJUSTABLE BAND                     02721802      1133.00
02721803   HB CHISEL, ESU LIGAMENT                02721803      1656.00
02721804   HB GENERATOR, RADIO FREQUENCY          02721804      594.00
02721805   HB CANNULA, RADIO FREQUENCY 1          02721805      231.00
02721806   HB TUNNELER, SURGICAL 2                02721806      1507.00
02721807   HB KIT, PLASMA EXCHANGE                02721807      1037.91
02721808   HB ANTICOAGULANT                       02721808       57.33
02721809   HB TUBING, BLOOD WARMER                02721809       99.30
02721810   HB TUBING, EXTENSION PHERESIS          02721810       34.46
02721811   HB TUBING, ALARIS PUMP SET             02721811       48.84
02721812   HB KIT,RED BLOOD CELL EXCHANGE         02721812      901.06
02721813   HB TUBING,LOW DENSTY LIPID RED         02721813      345.11
02721814   HB PROSORBA COLUMNS                    02721814      3766.11
02721815   HB BLOOD CELL SEPARATOR                02721815      594.11
02721816   HB KIT, PHOTOPHERESIS                  02721816      4220.11
02721817   HB UVADEX                              02721817      569.21
02721818   HB KIT, STEM CELL COLLECTION           02721818      817.06
02721819   HB KIT, WHITE CELL DEPLETION           02721819      817.06
02721820   HB TRICITRSOL 50CC                     02721820      394.71
02721821   HB KIT, PLATELET DEPLETION             02721821      3108.94
02721822   HB BASKET, RETRIEVAL I                 02721822      867.89
02721823   HB BASKET, RETRIEVAL III               02721823      2082.44
02721824   HB BASKET, RX LITHO COMPAT             02721824      1175.01
02721825   HB BASKET, LITHO MECHANICAL            02721825      2549.97
02721826   HB CATHETER, ERCP                      02721826      673.55
02721827   HB CANNULA, ERCP SWING TIP             02721827      910.44
02721828   HB SPHINCTERTOME/PAPILLOTOME I         02721828      848.98
02721829   HB SPHINCTERTOME/PAPILLOTOMEII         02721829      1109.38
02721830   HB BALLOON,RX EXTRACT/MULTI 3V         02721830      783.52
02721831   HB STENT, RETRIEVER                    02721831      685.90
02721832   HB BALLOON, CHOLANGIOSCOPY ACCESS 02721832           1961.93
02721833   HB BALLOON EXTRACTION DBL LMN          02721833      1076.64
02721834   HB OVERTUBE, DOUBLE BALLOON I          02721834      1054.60
02721835   HB OVERTUBE, DOUBLE BALLOON II         02721835      1483.67
02721836   HB OVERTUBE, GASTRIC GARDIS            02721836      833.55
02721837   HB TUBE, JEJUN GW(FEEDING)             02721837      1229.28
02721838   HB CAPSULE, WIRELESS PILLCAM           02721838      1822.86
02721846   HB FORCEPS, RESCUE                     02721846      2301.21
02721847   HB FORCEPS, BIOPSY II                  02721847      1385.31
02721849   HB BALLOON, ENDOSCOPY EXTRACTN         02721849      1008.81
02721850   HB RAPID REFILL CONT. INJ SYS          02721850      217.94



                                            159
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
02721851   HB NEEDLE, EUS ECHO-HD                 02721851      1347.89
02721852   HB NEEDLE, HD U/S ACCESS               02721852      1541.34
02721853   HB BRUSH, CYTOLOGY GASTROSCOPE         02721853      174.80
02721854   HB SUCTION, ENDO BROVAC                02721854      1314.08
02721855   HB OTSC SYSTEM SET 100.10              02721855      1615.96
02721856   HB OTSC TRIPOD ANCHOR ST200.10         02721856      1548.12
02721858   HB OTSC TWIN GRASPER 200.45            02721858      2051.41
02721860   HB THIRD EYE POLARIZING CAP            02721860      236.05
02721861   HB SUTURE ANCHOR SET                   02721861      593.07
02721862   HB PIN, DISTRACTION 1                  02721862      248.42
02721863   HB PERF PUMP SUCTION LINE              02721863      169.00
02721864   HB LASER, 7                            02721864      3403.00
02721865   HB TOOL, BONE SOMNOPLASTY              02721865      664.00
02721866   HB ELECTRODE, ESU 5                    02721866      1740.00
02721867   HB CAPSULE, ENDOSCOPE DEL SYS          02721867      738.00
02721868   HB KIT, ENDO MUCUS RESECTION           02721868      936.00
02721869   HB TRAY, ENDO ULTRASOUND               02721869      188.00
02721870   HB TIP, SILICONE IRR/ASP               02721870      497.00
02721871   HB BLADE, CHISEL                       02721871      879.00
02721872   HB BLADE, TRUNCATED 1                  02721872      2239.00
02721873   HB ENDO CATCH 1                        02721873      530.00
02721875   HB COBLATOR, ENT 1                     02721875      975.00
02721876   HB NO COST/NO CHARGE                   02721876       1.00
02721877   HB TRAY, GI PROCEDURE                  02721877      741.00
02740002   HB MISC. PROSTHETIC/ORTHOTIC           02740002       0.00
02760005   HB LENS INTRAOCULAR 4                  02760005      2161.40
02780001   HB STENT, GRAFT BIFURCATED 4           02780001     34519.45
02780002   HB GRAFT 11                            02780002     34528.27
02780003   HB CARDIAC VALVE HUMAN TISSUE 4        02780003     36831.76
02780004   HB CARDIAC VALVE HUMAN TISSUE6         02780004     39828.74
02780005   HB CARDIAC VALVE HUMAN TISSUE9         02780005     42846.69
02780006   HB GRAFT 14                            02780006     53344.23
02780007   HB CARDIO VASCULAR ASSIST PUMP         02780007     116400.00
02780008   HB CRANIAL DEFECT CUSTOM IMPLANT2 02780008          19045.21
02780009   HB IMPLANT, CARDIAC PLEDGET            02780009       36.53
02780010   HB IMPLANT PIN DISTRACT/STEIN          02780010      101.84
02780012   HB TEMPLATE NEURO 1                    02780012      121.24
02780013   HB ANCHOR BOLTS                        02780013      156.76
02780014   HB ORTHO CEMENTRALIZER                 02780014      169.73
02780015   HB TUBE, JONES                         02780015      180.12
02780016   HB KIT FRACTURE                        02780016      184.28
02780017   HB KIT, VARICEAL BANDING               02780017      823.90



                                            160
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02780018   HB VESSEL GUARD 1                      02780018      2070.79
02780019   HB CARDIAC SHUNT                       02780019      213.38
02780020   HB WIRE, ORTHO/SPINE                   02780020      219.26
02780021   HB BAR PECTUS                          02780021      252.18
02780022   HB LEAD, CARDIAC                       02780022      272.08
02780024   HB COIL EMBOLECTOMY                    02780024      290.97
02780025   HB CONNECTOR, CEREBRAL 1               02780025      299.96
02780026   HB EXTERNAL FIXATION 4                 02780026      2500.31
02780028   HB CRANIAL DEFECT CUSTOM IMPLANT1 02780028           9522.60
02780030   HB ORTHO FIXATION                      02780030      339.47
02780032   HB PEG, ORTHO 1                        02780032      339.47
02780033   HB FELT, SURGICAL 1                    02780033      363.71
02780034   HB CUFF VASCULAR 1                     02780034     11275.03
02780035   HB STENT, GRAFT BIFURCATED 1           02780035     11641.26
02780036   HB EXTERNAL FIXATION 13                02780036     12026.70
02780037   HB EMBOLIC LIQUID SYSTEM GLUE          02780037     12381.65
02780038   HB IMPLANT, ARCUATE KIT 3              02780038     12593.53
02780039   HB MANDIBLE 4                          02780039     12608.63
02780042   HB SKULL 2                             02780042     13093.58
02780043   HB SPINE ADD ON                        02780043     13093.58
02780044   HB SPINE LEOPARD                       02780044     13093.58
02780045   HB ORTHO ASSEMBLY 2                    02780045     13146.93
02780047   HB GRAFT 8                             02780047     13942.24
02780048   HB LAP BAND SYSTEM 1                   02780048     14121.42
02780049   HB INTERBODY INTERFIX                  02780049     14256.58
02780050   HB SPACER, ORTHO/SPINE 3               02780050     14500.44
02780052   HB TIBIA TRAY 6                        02780052     14664.81
02780053   HB CUFF VASCULAR 3                     02780053     15760.80
02780054   HB GRAFT 9                             02780054     15940.23
02780055   HB LAP BAND SYSTEM 2                   02780055     16367.67
02780056   HB CAGE, SPINE 16                      02780056     16541.56
02780058   HB CABLE, SPINE 4                      02780058     16861.63
02780059   HB LENGTHENING APPARATUS 1             02780059     16973.16
02780060   HB ADAPTER, ORTHO 1                    02780060      1277.85
02780061   HB ADAPTER, ORTHO 2                    02780061      2061.02
02780062   HB CARDIAC VALVE HUMAN TISSUE 3        02780062     34877.43
02780063   HB CARDIAC VALVE HUMAN TISSUE8         02780063     41423.34
02780064   HB CARDIAC RING ANNULOPLASTY 1         02780064      6061.85
02780065   HB CARDIAC VALVE 5                     02780065     21330.13
02780066   HB CARDIAC VALVE 10                    02780066     27615.56
02780069   HB CARDIAC GRAFT AORTIC VALVED CO      02780069     25983.48
02780070   HB CARDIAC RING ANASTOMOTIC            02780070      509.19



                                            161
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02780071   HB CABLE, SPINE 2                      02780071      5717.53
02780072   HB BONE CEMENT OPACIFIER 5GRAMS        02780072      910.70
02780073   HB CLAMP NEURO 1                       02780073      189.12
02780074   HB CLIP ANEURYSM WECK                  02780074      217.54
02780075   HB CARDIAC BAND                        02780075      5819.37
02780076   HB BAR SONGER                          02780076      586.79
02780077   HB BMP XLARGE                          02780077     23762.43
02780078   HB SPACER, SPINE 10                    02780078     17264.13
02780080   HB BMP SMALL                           02780080     17409.62
02780081   HB CAGE, SPINE LT PEEK                 02780081     17686.04
02780082   HB SPINE PEEK 7                        02780082     18664.81
02780083                                   02780083
           HB HEARTMATEOUTFLOWVALVE CONDUIT2                   19997.48
02780084   HB CAGE, SPINE 22                      02780084     26877.43
02780085   HB VERTE-SPAN 2                        02780085     20610.28
02780086   HB CARDIAC VALVE 4                     02780086     20818.42
02780087   HB DISC, CERVICAL SPINE 2              02780087     21187.80
02780088   HB BMP MEDIUM                          02780088     21774.15
02780089   HB KIT URINARY CONTROL SYS             02780089      2279.25
02780090   HB CARDIAC VALVE 7                     02780090     24247.38
02780092   HB SPACER, SPINE 16                    02780092     25435.49
02780093   HB CARDIAC VALVE 8                     02780093     25600.38
02780094   HB VERTE-SPAN 3                        02780094     27481.99
02780096   HB HEARTMATE, INFLOW VALVE CONDU       02780096     29520.08
02780097   HB OSTEOSYTHESIS SYSTEM                02780097     30183.14
02780099   HB SUPPORT BAR PECTUS                  02780099      4126.90
02780100   HB PLATE 5                             02780100      4148.73
02780101   HB SPINE CROSSLINK ASSEMBLY            02780101      4194.80
02780103   HB TRANSCONNECTOR, SPINE 3             02780103      4230.13
02780104   HB EXTERNAL FIXATION 9                 02780104      6927.82
02780105   HB CEMENTRALIZER, ORTHO 2              02780105      391.88
02780106   HB CORNERSTONE LATERAL PORT            02780106      4359.67
02780107   HB GRAFT 2                             02780107      4359.67
02780108   HB SPINE PEEK 2                        02780108      4359.67
02780110   HB RAIL 3                              02780110      4493.29
02780111   HB IMPLANT, NEUROMATRIX CONDUIT        02780111      4523.24
02780112   HB LEAD, PADDLE 2                      02780112     26735.09
02780115   HB IMPLANT, HEARTMATE KIT LVAD         02780115     122265.00
02780116   HB ORTHO GLENOID                       02780116      4645.79
02780117   HB BONE GRAFT 2                        02780117      4713.69
02780118   HB GRIP CABLE 2                        02780118      4762.18
02780119   HB CONNECTOR, SPINE 6                  02780119      4809.38
02780120   HB SPINE POLYAX 2                      02780120      5169.54



                                            162
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02780121   HB COIL, EMBOLIZATION 1                02780121      4849.48
02780122   HB HEAD FRAME KIT                      02780122      5247.14
02780123   HB VERTE-SPAN 1                        02780123      5271.39
02780124   HB SPINE ANTARES                       02780124      5300.47
02780125   HB PLATE 6                             02780125      5314.94
02780126   HB ORTHO CLAMP 4                       02780126      5334.42
02780127   HB KIT ZEPHIR                          02780127      5358.67
02780128   HB EXTERNAL FIXATION 7                 02780128      5480.54
02780129   HB ORTHO TRAUMA ARM 2                  02780129      5547.00
02780130   HB ORTHO BACK TRIDENT                  02780130      5557.51
02780131   HB SKULL 1                             02780131      6003.64
02780132   HB RESERVOIR UROLOGY                   02780132      6013.35
02780133   HB PLATE 7                             02780133      6018.20
02780134   HB CONNECTOR, SPINE 7                  02780134      6019.07
02780135   HB NAIL, ORTHO 2                       02780135      6032.75
02780136   HB CABLE, SPINE SONGER 2               02780136      6134.59
02780138   HB CARDIAC RING ANNULOPLASTY 2         02780138      6483.75
02780139   HB ADAPTER, ORTHO 3                    02780139      6567.41
02780140   HB COIL, EMBOLIZATION 2                02780140      6172.06
02780141   HB COLPOPEXY SACRAL SYSTEM             02780141      6740.78
02780142   HB HEARTMATE, LOCKING SCREW RING       02780142      7141.95
02780143   HB SPINE DOMINO 4                      02780143      7196.62
02780144   HB CROSSCONNECTOR, 4                   02780144      7369.95
02780145   HB ORTHO CLAMP 6                       02780145      7388.18
02780146   HB CANNULA, ARTERIAL GRAFT             02780146      7393.87
02780147   HB CONNECTOR, SPINE 9                  02780147      7759.16
02780148   HB SPINE VERTI STACK 1                 02780148      7856.15
02780150   HB EXTERNAL FIXATION 10                02780150      8431.79
02780151   HB CARDIAC RING ANNULOPLASTY 4         02780151      8690.01
02780152   HB STAPLE, SPINE 5                     02780152      8911.70
02780153   HB ORTHO OMNI FIT                      02780153      9407.99
02780154   HB SPACER, SPINE 5                     02780154      9504.97
02780155   HB STRUT, SPINE PSR 2                  02780155      9508.75
02780156   HB ORTHO FIXATOR 4                     02780156     10339.09
02780157   HB VALVE, NEURO 1                      02780157     10469.33
02780158   HB SPINAL MOSAIC VERTEBRA IMPLAN       02780158     10469.83
02780159   HB RAIL 6                              02780159     10654.30
02780160   HB LEAD 4                              02780160     10668.84
02780161   HB VALVE 3                             02780161     10784.42
02780162   HB ORTHO TRAUMA KIT 5                  02780162     10911.33
02780163   HB WASHER, SPINE 1                     02780163      591.65
02780164   HB EMBOLIC SPHERES                     02780164      899.23



                                            163
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02780166   HB SPINE BOLT PEDICLE                  02780166      1687.61
02780167   HB VALVE 1                             02780167      2347.14
02780168   HB SHEET, MEDPOR 4                     02780168      2904.64
02780169   HB SPINE END CAP 2                     02780169      2012.53
02780170   HB SHUNT 3                             02780170      2027.07
02780171   HB BAND                                02780171      2124.07
02780172   HB CROSSLINK, SPINE 1                  02780172      1545.53
02780173   HB SHUNT 4                             02780173      3971.72
02780174   HB SPINE POLYAX 1                      02780174      4117.20
02780175   HB VALVE 2                             02780175      4210.09
02780176   HB SPINE BENGAL                        02780176      4359.67
02780177   HB SPINE DOMINO 2                      02780177      4713.69
02780178   HB TIBIA TRAY 3                        02780178      6001.39
02780179   HB SPINE SEXTANT                       02780179      6187.93
02780180   HB COIL, EMBOLIZATION 3                02780180      6612.92
02780181   HB GRAFT 4                             02780181      8942.43
02780182   HB TIBIA TRAY 5                        02780182     10004.47
02780183   HB LINER, ORTHO 5                      02780183     10668.84
02780184   HB SYSTEM CORRECTION                   02780184     13192.19
02780185   HB VALVE, ENDOBRACHIAL 2               02780185     14283.91
02780186   HB CUFF, OCCLUSIVE PENILE 2            02780186     15926.44
02780188   HB COVER PLATE, SPINE                  02780188      2128.91
02780189   HB SEALANT 3                           02780189      2150.40
02780190   HB SPINE CLAMP                         02780190      2196.81
02780191   HB HOOK, SPINE 2                       02780191      2214.96
02780192   HB PEG, ORTHO 2                        02780192      2250.16
02780193   HB GRAFT, DURAGEN 3                    02780193      2306.65
02780194   HB COIL IMPLANT                        02780194       0.00
02780195   HB ENDPLATE                            02780195      2337.45
02780196   HB SLIDING CORE, SPINE CHARITE         02780196      2376.25
02780197   HB ORTHO TRAUMA KIT 2                  02780197      2400.49
02780198   HB CONNECTOR, ORTHO 2                  02780198      2444.14
02780199   HB CONDYL RECON NEURO                  02780199      2560.52
02780200   HB SPINE STAPLE 2                      02780200      2575.07
02780201   HB CLAMP PECTUS                        02780201      2759.35
02780202   HB ORTHO CARRIAGE WIRE                 02780202      2773.90
02780203   HB SPHERE EYE PLASTIC 2                02780203      2909.68
02780204   HB LAP BAND , PORT ONLY 1              02780204      2952.52
02780205   HB BONE FILLER 3                       02780205      3032.95
02780206   HB SPINE SUMMIT                        02780206      3113.37
02780207   HB ORTHO CLAMP 3                       02780207      3263.69
02780208   HB PLATE 4                             02780208      3374.92



                                            164
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
02780209   HB SPACER, 3                            02780209      3380.09
02780210   HB ORTHO SURFACE NEXGEN                 02780210      3394.63
02780211   HB SPINE POLY SILHOUETTE 1              02780211      3481.92
02780212   HB PATCH 2                              02780212      3569.22
02780213   HB SPINE SPIN                           02780213      3598.31
02780214   HB NAIL, ORTHO 1                        02780214      3782.59
02780215   HB LINER, ORTHO 2                       02780215      3825.99
02780216   HB BLOCK CARVING TESTICULAR IMP         02780216      3855.33
02780217   HB TESTICULAR PROSTHESIS 1              02780217      3855.33
02780218   HB CROSSCONNECTOR, 2                    02780218      3928.08
02780219   HB GRAFT INTEXEN DERMAL MATRIX 2        02780219      3928.08
02780220   HB CORD, SPINE LIS DYNESYS 1            02780220      3932.92
02780221   HB BOTTOM STACK                         02780221      3966.86
02780222   HB CROSSLINK, SPINE 3                   02780222      4005.67
02780223   HB ORTHO TRAUMA KIT 3                   02780223      4017.30
02780224   HB CONNECTOR, SPINE 5                   02780224      4029.61
02780225   HB ORTHO BAR 2                          02780225      4053.62
02780226   HB ORTHO MECHANISM 2                    02780226      4088.11
02780227   HB COIL, HILAL .018                     02780227      429.99
02780228   HB EXTERNAL FIXATION 1                  02780228      442.93
02780229   HB ORTHO TRAUMA KIT 1                   02780229      450.99
02780230   HB SPINE SLIDER                         02780230      450.99
02780231   HB IMPLANT, PENILE DEACTIVATION         02780231      452.19
02780233   HB CLIP, LIGATION-RESOLUTION            02780233      753.28
02780234   HB PLATE 1                              02780234      489.35
02780235   HB SHUNT 1                              02780235      504.34
02780237   HB EMOBOLIZATION COIL IMPLNT            02780237      541.29
02780238   HB BLOCKER                              02780238      547.99
02780239   HB ORTHO BAR 1                          02780239      551.64
02780240   HB EYEBOLT CROSSLINK                    02780240      586.79
02780241   HB CEMENT RESTRICTOR                    02780241      606.19
02780242   HB PLUG                                 02780242      615.89
02780243   HB HANDLE NEURO                         02780243      620.73
02780244   HB PLUG, SPINE 1                        02780244      625.58
02780245   HB ORTHO END CAP                        02780245      653.72
02780246   HB SPINE CLIP                           02780246      654.68
02780248   HB SPINE BAR                            02780248      674.08
02780249   HB RESERVOIR, NEURO 1                   02780249      678.93
02780250   HB SPONGE OPHTHALMO                     02780250      727.42
02780251   HB SLEEVE CABLE                         02780251      746.82
02780253   HB EXTERNAL FIXATION 6                  02780253      4275.10
02780254   HB SEAMGUARD BIOAB                      02780254      790.46



                                             165
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02780255   HB ISOTOPE, MICROSPHERES LC BEADS      02780255      8800.00
02780256   HB CEMENT, SPINE                       02780256      843.97
02780257   HB TEMPLATE NEURO 2                    02780257      863.20
02780258   HB SPINE PEEK 1                        02780258      868.06
02780259   HB SPINE PIN PLATE                     02780259      882.61
02780260   HB CLAMP NEURO 2                       02780260      906.86
02780261   HB SPINE SLEEVE WITH SET SCREW         02780261      940.80
02780262   HB CAP, SPINE                          02780262      1016.77
02780263   HB CONNECTOR, SPINE 2                  02780263      1081.43
02780264   HB WIRE OLIVE 2                        02780264      1152.54
02780265   HB GASTROSTOMY G-J TUBE                02780265      1197.43
02780266   HB IMP, NEEDLE FAST FIX SYSTEM         02780266      1261.75
02780267   HB KIT, NEPHROSTOMY 23-510-11          02780267      1385.05
02780268   HB GLAUCOMA DRAINAGE DEVICE            02780268      1430.59
02780269   HB CLIP, LIGATION-QUICK                02780269      381.35
02780270   HB ORTHO CABLE 2                       02780270      1462.91
02780271   HB TRANSCONNECTOR, SPINE 1             02780271      1514.04
02780272   HB SHELL, ORTHO 1                      02780272      1527.59
02780273   HB BONE FILLER 2                       02780273      1552.18
02780274   HB CABLE, SPINE 1                      02780274      1576.08
02780275   HB GRIP CABLE 1                        02780275      1605.18
02780276   HB KIT, GLUE FIBRIN INJECTION          02780276      1606.64
02780277   HB STABALIZER PECTUS                   02780277      1614.87
02780278   HB SHEET, MEDPOR 2                     02780278      1784.44
02780279   HB ORTHO BONE GRAFT SUBST 1            02780279      1697.32
02780280   HB SPINE HEAD                          02780280      1716.71
02780281   HB CABLE, SPINE SONGER 1               02780281      1729.63
02780282   HB PATCH 1                             02780282      1791.90
02780283   HB COUPLER, ORTHO 1                    02780283      1852.50
02780284   HB LINK, SPINE 1                       02780284      1870.51
02780285   HB ORTHO DURACON 1                     02780285      1939.79
02780286   HB BOLT CANCELLOUS                     02780286      1944.64
02780287   HB CONNECTOR, SPINE 3                  02780287      1961.87
02780288   HB COIL, EMBOLIZATION 4                02780288     11021.54
02780289   HB COLLAGEN IMPLANT                    02780289      1232.12
02780291   HB LOCKING PIN, ORTHO/SPINE            02780291      358.86
02780292   HB NAIL, ORTHO 3                       02780292      8118.02
02780293   HB NEURO CATH KIT                      02780293      1914.57
02780294   HB NO COST IMPLANT                     02780294       1.39
02780295   HB ORTHO BOLT                          02780295      872.91
02780296   HB ORTHO BONE GRAFT SUBSTITUTE 2       02780296      2364.12
02780297   HB ORTHO BONE GRAFT SUBSTITUTE 5       02780297      9142.21



                                            166
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02780298   HB ORTHO CLAMP 1                       02780298      982.02
02780299   HB ORTHO CLUSTER                       02780299      5557.51
02780300   HB ORTHO COMPONENT 1                   02780300      2178.22
02780301   HB ORTHO DURACON 2                     02780301      7759.16
02780302   HB ORTHO FIXATOR 7                     02780302     15033.37
02780305   HB ORTHO JOINT FINGER                  02780305      3855.33
02780306   HB ORTHO MECHANISM 1                   02780306      2366.01
02780307   HB ORTHO TRAUMA ARM 1                  02780307      4121.24
02780308   HB ORTHO TRAUMA KNUCKLE CONSTRUX 02780308            3394.63
02780309   HB ORTHO TRAUMA RING 1                 02780309      1614.87
02780310   HB SPACER, ORTHO/SPINE 1               02780310      762.59
02780313   HB IMPLANT, SMARTSTITCH SUTURE         02780313      714.19
02780314   HB INSERT, ORTHO 6                     02780314     10474.87
02780315   HB ISERTER COLPOPEXY SAC SYS           02780315      1551.83
02780316   HB HEAD FRAME                          02780316      746.82
02780317   HB HOOK, SPINE 3                       02780317      3471.11
02780318   HB MISCELLANEOUS IMPLANT               02780318       0.00
02780319   HB IMPLANT INJECTION, DEFLUX           02780319      4975.44
02780321   HB HORIZON AXIAL                       02780321      2958.18
02780322   HB AUDITORY IMPLANT 2                  02780322      1390.60
02780323   HB IMPLANT, ELASTOMERIC TUBING         02780323      337.57
02780324   HB IMPLANT, EXTENDER TIP 1             02780324      524.00
02780325   HB PATCH 4                             02780325     10808.66
02780326   HB PLATE 2                             02780326      1543.52
02780327   HB PLATE 3                             02780327      2529.01
02780328   HB CRANIAL CUSTOM IMPLANT 5            02780328     30472.34
02780329   HB PORT 2                              02780329      3879.58
02780330   HB PROSTHESIS ENT                      02780330      1430.59
02780331   HB PUMP PROSTHESIS                     02780331     11750.27
02780332   HB ORTHO BONE GRAFT SUBSTITUTE 6       02780332     13141.45
02780333   HB IMPLANT, ROD AND CONNECTOR          02780333      4094.98
02780335   HB NEURO BAR                           02780335      116.38
02780336   HB SHANZ THREAD                        02780336      514.05
02780337   HB SHOULDER MAGNUM PLUS                02780337      1842.80
02780338   HB SPACER, 4                           02780338      4737.37
02780339   HB SPACER, SPINE 8                     02780339     12855.52
02780341   HB SPINE C RING                        02780341      1406.34
02780342   HB SPINE COUPLER                       02780342      3251.57
02780343   HB SPINE DOMINO 3                      02780343      5872.72
02780344   HB SPINE LOCK 1                        02780344      1634.28
02780345   HB SPINE DOMINO 1                      02780345      3389.78
02780346   HB SPINE PEEK 3                        02780346      9684.41



                                            167
  Charge
   Code                    Description            CPT Code OP/Default Price   IP/ED Price
02780347   HB SPINE SET SCREW                     02780347      594.55
02780348   HB ORTHO FIXATOR 6                     02780348     13047.52
02780350   HB PC BRONCHIAL STENT                  02780350      3186.68
02780351   HB DISC, CERVICAL SPINE 3              02780351     22616.19
02780352   HB BEARING, KNEE 1                     02780352      3108.52
02780353   HB BLOCK FILLER                        02780353      290.97
02780354   HB EXTERNAL FIXATION 2                 02780354      1459.69
02780355   HB IMP, EMBOLIZATION CARDIAC DRUG      02780355      404.33
02780356   HB IMPLANT, POUCH PAIN PUMP            02780356      404.33
02780357   HB CONNECTOR, SPINE 1                  02780357      106.69
02780358   HB COUPLING NEURO                      02780358      630.43
02780359   HB CLIP, ANEURYSM 1                    02780359      1172.55
02780361   HB ORTHO CLAMP 2                       02780361      2274.40
02780362   HB MANDIBLE 1                          02780362      3554.66
02780363   HB SPACER, SPINE 3                     02780363      4359.67
02780364   HB TUBE, LACRIMAL SILICONE             02780364      262.00
02780365   HB MANDIBLE 2                          02780365      5601.14
02780366   HB SPINE PEEK 4                        02780366     13093.58
02780367   HB ENDPLATE, SPINE CHARITE             02780367     18331.02
02780368   HB STENT, GRAFT BIFURCATED 10          02780368     47374.97
02780369   HB SPINE CRIMP                         02780369      630.43
02780370   HB CAP FIXATION PROTECTION PIN         02780370      135.78
02780371   HB WIRE OLIVE 1                        02780371      641.68
02780372   HB SHEET, MEDPOR 1                     02780372      1404.23
02780374   HB UNICOM TIBIAL TRAY 1                02780374      3821.39
02780375   HB LINER, ORTHO 3                      02780375      4662.73
02780376   HB SPINE BOOM                          02780376      5712.68
02780378   HB CABLE, SPINE 3                      02780378     13719.17
02780379   HB CABLE SPINE 5                       02780379     20731.51
02780380   HB COIL, MWCE 0.35                     02780380      228.24
02780381   HB CEMENT, BONE KYPHON                 02780381      1096.84
02780382   HB SPINE SPACER DYNESYS                02780382      2274.40
02780383   HB STAPLE, SPINE 2                     02780383      4202.07
02780384   HB STAPLE, SPINE 3                     02780384      5576.89
02780385   HB SUBDURAL ELECTRODE 1                02780385      513.92
02780386   HB SUBDURAL ELECTRODE 4                02780386      4865.85
02780387   HB SYSTEM COLPOPEXY AMS 72403600       02780387      7250.65
02780388   HB STAPLE, ORTHO/SPINE 1               02780388      969.89
02780389   HB TIBIA TRAY 4                        02780389      9015.17
02780390   HB TOP STACK                           02780390      4170.55
02780391   HB TUBE,EAR PRESSURE EQUALIZING 1      02780391       54.04
02780392   HB UNICOM VANGUARD                     02780392      5576.89



                                            168
  Charge
   Code                   Description              CPT Code OP/Default Price   IP/ED Price
02780393   HB VENTRICLE SET, 32/42 FR              02780393     19800.00
02780395   HB Y PLATE                              02780395      813.08
02780396   HB SATELLITE SPHERE 2                   02780396     17954.40
02780397   HB PLUG ANAL                            02780397      4122.06
02780399   HB BLOCK TEFLON GRAFT                   02780399      1139.62
02780400   HB ROD 1                                02780400      517.62
02780401   HB CONNECTOR, ORTHO 4                   02780401      6452.23
02780402   HB CONNECTOR, SPINE 4                   02780402      2892.46
02780403   HB CORD, SPINE LIS DYNESYS 2            02780403      4970.72
02780404   HB COVER, BUR HOLE 1                    02780404      514.05
02780405   HB CROSSCONNECTOR, 1                    02780405      2409.62
02780406   HB CROSSLINK, SPINE 4                   02780406      4796.13
02780407   HB CROSSLINK, SPINE 5                   02780407      5557.51
02780408   HB CUFF, OCCLUSIVE PENILE 1             02780408     10135.40
02780409   HB PROSTHESIS, EYELID 1                 02780409      286.12
02780410   HB FLOSEAL                              02780410      714.19
02780411   HG GRAFT 16                             02780411     94250.00
02780412   HB GRAFT 5                              02780412     11173.19
02780413   HB GRAFT 3                              02780413      5911.50
02780414   HB GRAFT INTEXEN DERMAL MATRIX 1        02780414      2315.63
02780415   HB GRAFT, DURAGEN 1                     02780415      637.17
02780416   HB GRAFT, DURAGEN 2                     02780416      1269.41
02780417   HB GRAFT, DURAGEN 4                     02780417      4109.48
02780418   HB SKULL 3                              02780418     15033.37
02780419   HB SLEEVE 2                             02780419      4223.90
02780420   HB IMPLANT, EXTENDER TIP 2              02780420      1412.01
02780422   HB LENGTHENING APPARATUS 2              02780422     36371.07
02780423   HB LINER, ORTHO 4                       02780423      5334.42
02780427   HB ROD, SPINE 1                         02780427      722.57
02780454   HB ROD 2                                02780454      1168.73
02780464   HB ROD, SPINE 2                         02780464      1404.95
02780491   HB LEAD BIPOLAR STEROID ELUT LH         02780491     20235.54
02780496   HB ROD, SPINE 3                         02780496      1993.13
02780497   HB TANDEM HEART L-VAD IMPLANT           02780497     21918.84
02780498   HB COIL, NESTOR                         02780498      753.13
02780523   HB BONE CEMENT 3                        02780523      2531.43
02780525   HB ROD 3                                02780525      2565.37
02780536   HB ROD, SPINE 4                         02780536      3055.17
02780559   HB ROD, SPINE 5                         02780559      3884.43
02780603   HB BONE CEMENT 5                        02780603      4931.92
02780610   HB ROD, SPINE 6                         02780610      5300.47
02780626   HB ROD 5                                02780626      5795.12



                                             169
  Charge
   Code                   Description           CPT Code OP/Default Price   IP/ED Price
02780670   HB BONE CEMENT 7                     02780670      9856.40
02780687   HB BONE CEMENT 8                     02780687     11759.66
02780709   HB BONE CEMENT 9                     02780709     13962.71
02780760   HB KIT, AXIALIF 1                    02780760     33946.33
02780790   HB CARDIAC VALVE HUMANTISSUE13       02780790     56550.00
02780791                                   02780791
           HB HEARTMATEOUTFLOWGRFTBENDRELIEF                 11420.41
02780792   HB CHIN IMPLANT 1                    02780792      1261.01
02780805   HB VALVE 4                           02780805     11443.74
02780806   HB ORTHO TRAUMA HIP DEVICE           02780806     12994.80
02780807   HB HEARTMATE II, IMPLANT KIT         02780807     315000.00
02780808   HB RAIL 2                            02780808      3240.54
02780809   HB HEARTMATE, RING APICAL SEWING     02780809      2974.07
02780810   HB BUTTON FIXATION 1                 02780810      842.25
02780811   HB SPINE PEEK 8                      02780811     29502.72
02780812   HB PLUG, TRUFIT BGS                  02780812      2379.25
02780813   HB CARDIAC VALVE 6                   02780813     21889.12
02780814   HB VALVE, NEURO 3                    02780814     16145.09
02780815   HB ROD, SPINE 8                      02780815     17368.54
02780816   HB RAIL 5                            02780816      8841.30
02780822   HB ABUTMENT, AUROBASE                02780822      617.41
02780823   HB ABUTMENT, AESTHETIC               02780823      499.65
02780824   HB IMPLANT, FIXTURE                  02780824      1206.29
02780825   HB CATHETER, IMPELLA                 02780825     95170.08
02780826   HB TRANSFER COPING                   02780826      271.23
02780827   HB ANALOG                            02780827      951.70
02780828   HB CUFF, VASCULAR 4                  02780828     17284.57
02780829   HB STENT, GRAFT BIFURCATED 3         02780829     17801.24
02780830   HB ABUTMENT, BALL AND SOCKET         02780830      590.05
02780831   HB ABUTMENT, BAR AND COPING          02780831       71.38
02780832   HB COVER SCREW                       02780832       99.93
02780833   HB BONE GRAFT, FIXTURE               02780833      240.30
02780834   HB ABUTMENT, CUSTOM BASE             02780834      951.70
02780835   HB STENT, GRAFT BIFURCATED 5         02780835     37473.22
02780836   HB CUFF, VASCULAR 2                  02780836     11463.56
02780837   HB PIVOTING CAP, MALE                02780837      261.72
02780838   HB GINGIVA FORMER                    02780838      124.91
02780839   HB STENT, GRAFT BIFURCATED 2         02780839     14728.04
02780845   HB CONTRALATERAL LIMB 1              02780845     17487.50
02780846   HB CONTRALATERAL LIMB 2              02780846     19129.65
02780847   HB PROSTHESIS, EYELID 2              02780847      1118.48
02780848   HB STENT, GRAFT BIFURCATED 7         02780848     41975.14
02780849   HB STENT, GRAFT BIFURCATED 6         02780849     40566.25



                                          170
  Charge
   Code                   Description           CPT Code OP/Default Price   IP/ED Price
02780850   HB CEMENT,HYDROSET INJECTABLE 5CC 02780850         3568.88
02780851   HB CONTRALATERAL LIMB 3              02780851     20818.46
02780852   HB EXTNSN, AORTIC/ILIAC/THORACIC3    02780852     19343.09
02780853   HB STENT, GRAFT BIFURCATED 8         02780853     43302.39
02780854   HB CEMENT,HYDROSET INJECTABLE 3CC 02780854         2098.17
02780855   HB CEMENT,HYDROSETINJECTABLE 10CC 02780855         6657.24
02780856   HB VALVE, NEURO 4                    02780856     18034.50
02780857   HB CROSSCONNECTOR, 3                 02780857      5092.07
02780858   HB EXTNSN, AORTIC/ILIAC/THORACIC1    02780858     14156.55
02780859   HB WASHER, SPINE 2                   02780859      1818.26
02780860   HB ROD, SPINE 7 *                    02780860      7947.17
02780861   HB EXTNSN, AORTIC/ILIAC/THORACIC4    02780861     20661.00
02780862   HB HOOK, SPINE 5                     02780862      4896.13
02780863   HB STENT, GRAFT BIFURCATED 9         02780863     44677.45
02780864   HB EXTNSN, AORTIC/ILIAC/THORACIC2    02780864     17487.50
02780865   HB CEMENT,HYDROSETINJECTABLE 15CC 02780865         8560.64
02780881   HB SPINE VARIABLE TRINCA             02780881      866.56
02780882   HB ORTHO FIXATOR 3                   02780882      6866.52
02780883   HB SPACER, ORTHO/SPINE 2             02780883      1617.66
02780884   HB BUTTON FIXATION 2                 02780884      1256.11
02780885   HB SPINE COUGAR                      02780885     12123.69
02780886   HB DISC, CERVICAL SPINE 1            02780886     20223.64
02780887   HB SCREW, UROLOGY 3                  02780887      5177.21
02780888   HB ORTHO BONE GRAFT SUBST 7          02780888     21394.61
02780889   HB CRANIAL CUSTOM IMPLANT 4          02780889     25473.16
02780890   HB CRANIAL CUSTOM IMPLANT 6          02780890     30428.77
02780891   HB EXTNSN, AORTIC/ILIAC/THORACIC5    02780891     26171.77
02780892   HB CAGE, SPINE 29                    02780892     41323.18
02780893   HB SCREW, UROLOGY 2                  02780893      2379.25
02780894   HB CRANIAL CUSTOM IMPLANT 3          02780894     20284.29
02780898   HB INTRAUTERINE DEVICE (IUD)         02780898      2232.30
02780899   HB SPINE PEEK 6                      02780899     15631.92
02780900   HB COIL, MICRO DETACHABLE            02780900      1577.23
02780901   HB KIT, AXIALIF - LEVEL 2            02780901     48730.50
02780902   HB BONE CEMENT 1                     02780902      780.25
02780906   HB TUBE, JONES 1                     02780906      223.93
02780907   HB KIT, AXIALIF 3                    02780907     46780.50
02780908   HB SHUNT 2*                          02780908      985.52
02780910   HB KIT, AXIALIF 6                    02780910     64330.50
02780911   HB CARDIAC VALVE HUMANTISSUE10       02780911     43568.30
02780912   HB KIT, AXIALIF 5                    02780912     56530.50
02780924   HB ANCHOR LEAD 1                     02780924      209.72



                                          171
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02780925   HB CARDIAC VALVE 9                     02780925     23792.52
02780926   HB CARDIAC VALVE HUMANTISSUE12         02780926     48750.00
02780928   HB EXTERNAL FIXATION 12                02780928     10167.14
02780929   HB EXTERNAL FIXATION 3                 02780929      1720.56
02780933   HB KIT, PUMP INFUSION                  02780933      654.84
02780934   HB ORTHO BONE GRAFT SUBST 3            02780934      3361.94
02780935   HB SHEET, MEDPOR 3                     02780935      2270.54
02780936   HB SUBDURAL ELECTRODE 2                02780936      1820.07
02780940   HB EYE SPHERE W/CONFORMER              02780940      301.74
02780941   HB VALVE, ENDOBRACHIAL 1               02780941     12005.40
02780943   HB COVER, BUR HOLE 2                   02780943      1527.96
02780945   HB COUPLER 1                           02780945      873.12
02780946   HB BMP XX-SMALL 1                      02780946      3824.18
02780947   HB BMP X-SMALL 2                       02780947      7534.94
02780948   HB BMP SMALL 3                         02780948     15065.60
02780949   HB BMP MEDIUM 4                        02780949     21360.41
02780950   HB BMP LARGE 5                         02780950     23609.55
02780951   HB BMP X-LARGE 6                       02780951     23609.55
02780953   HB SKIN(SUB)TISSUEMENDPERSQCM1         02780953      8731.20
02780954   HB KIT, AXIALIF 6                      02780954     64330.50
02780956   HB VESSEL GUARD 3                      02780956      4086.33
02780961   HB CARDIAC VALVE HUMAN TISSUE5         02780961     37193.20
02780962   HB CARDIAC VALVE HUMAN TISSUE7         02780962     40229.86
02780963   HB CARDIAC VALVE HUMANTISSUE11         02780963     44278.74
02780965   HB KIT, STALIF-C 1                     02780965     11765.72
02780966   HB KIT, STALIF-C 2                     02780966     17880.98
02780967   HB KIT, STALIF-C 3                     02780967     22426.80
02780968   HB KIT, STALIF-C 4                     02780968     30111.94
02780969   HB KIT, STALIF- TT 1                   02780969     31543.60
02780970   HB KIT, STALIF- TT 2                   02780970     52258.80
02780971   HB KIT, STALIF- TT 3                   02780971     60450.00
02780972   HB IMP TROCHANTER DEVICE 1             02780972      7613.05
02780973   HB IMP TROCHANTER DEVICE 2             02780973     10969.64
02780975   HB SPACER, SPINE 9                     02780974     13096.80
02780984   HB VALVE, NEURO 2                      02780984     10870.13
02780986   HB INTRAUTERINE DEVICE (IUD) 1         02780986      1845.75
02780989   HB STENT, AAA GRAFT BIFURCATED         02780989     42018.90
02780990   HB STENT, AAA GRAFT CONTRALATERAL 02780990          20362.10
02780991   HB VALVE, PULMONIC EDWARDS             02780991     94160.00
02780993   HB EXTERNAL FIXATION 14                02780993     20315.02
02780995   HB MISC IMPLANT CATH LAB               02780995
02780996   HB CARDIAC RING ANNULOPLASTY 3         02780996      7273.86



                                            172
  Charge
   Code                     Description           CPT Code OP/Default Price   IP/ED Price
02780998   HB PLUG, ILIAC                         02780998      8625.27
02781000   HB EXTERNAL FIXATION 8                 02781000      6002.70
02781005   HB BONE CEMENT 2                       02781005      1562.20
02781006   HB BONE CEMENT 4                       02781006      3968.63
02781007   HB BONE CEMENT 6                       02781007      7626.96
02781008   HB SHUNT 5                             02781008      6261.64
02781011   HB MARKER VISICOIL IMPLANTABLE         02781011      682.66
02781013   HB AUDITORY IMPLANT 1                  02781013      551.05
02781016   HB SPHERE EYE PLASTIC 1                02781016       80.25
02781019   HB SHEET, MEDPOR 5                     02781019      3295.60
02781020   HB SUBDURAL ELECTRODE 3                02781020      3211.07
02781021   HB CAGE, SPINE 23                      02781021     27075.28
02781025   HB ORBITAL IMPLANT                     02781025       37.45
02781027   HB PIN, HEMORRHAGE OCCLUDER            02781027      1765.50
02781028   HB CARDIAC VALVE 1                     02781028     16478.00
02781031   HB SPACER, SPINE 1                     02781031      2589.40
02781033   HB SHEET, SILASTIC 1                   02781033      121.98
02781034   HB SHEET, SILASTIC 2                   02781034      555.33
02781035   HB CROSSLINK, SPINE 6                  02781035      6967.84
02781036   HB STENT, SELF RETAINING               02781036      310.30
02781037   HB KIT, ALIF LEVEL 1                   02781037     31543.60
02781038   HB KIT, ALIF LEVEL 2                   02781038     52258.80
02781039   HB KIT, ALIF LEVEL 3                   02781039     60450.00
02781040   HB KIT, ACDF LEVEL 1                   02781040     11765.72
02781041   HB KIT, ACDF LEVEL 2                   02781041     17880.77
02781042   HB KIT, ACDF LEVEL 3                   02781042     23996.89
02781043   HB EXTERNAL FIXATION 11                02781043      8784.70
02781045   HB LAP BAND, PORT ONLY 2               02781045      4025.34
02781048   HB INTRACRANAL IP2 INTRDCR             02781048      4658.65
02781050   HB SCREW UROLOGY 1                     02781050      1873.57
02781051   HB PROSTHESIS, EYELID 3                02781051      2306.92
02781052   HB PROSTHESIS, EYELID 4                02781052      3531.00
02781054   HB KIT, ACDF LEVEL 4                   02781054     30111.94
02781055   HB CANNULA, VENTRICULAR PVAD 2         02781055      7311.31
02781057   HB CANNULA, ARTERIAL PVAD 1            02781057     17419.60
02781058   HB CANNULA, ARTERIAL PVAD 2            02781058     18573.06
02781059   HB CANNULA, ATRIAL PVAD                02781059      9416.00
02781060   HB CANNULA, VENTRICULAR PVAD 1         02781060      6591.20
02781062   HB SPINE VERTI STACK 2                 02781062     12711.60
02781063   HB CONNECTOR, ORTHO 1                  02781063      1351.41
02781066   HB CROSSLINK, SPINE 2                  02781066      2200.00
02781068   HB EXTERNAL FIXATION 5                 02781068      3005.00



                                            173
  Charge
   Code                   Description            CPT Code OP/Default Price   IP/ED Price
02781069   HB ANCHOR LEAD 2                      02781069      660.00
02781070   HB CANNULA, ATRIAL                    02781070      4950.00
02781084   HB SHEET, SILASTIC 3                  02781084      1320.00
02781085   HB STENT, GRAFT THORACIC 4            02781085     48360.00
02781086   HB STENT, GRAFT THORACIC 5            02781086     50778.00
02781087   HB STENT, GRAFT BIFURCATED 11         02781087     42101.00
02781095   HB SEALANT 5                          02781095      3819.00
02781097   HB MEMBRANE, COLLAGEN 1               02781097      440.00
02781104   HB STENT, GRAFT THORACIC 1            02781104     42120.00
02781105   HB STENT, GRAFT THORACIC 2            02781105     43524.00
02781106   HB FELT, SURGICAL 2                   02781106      497.00
02781109   HB SPACER, SPINE 14                   02781109     22242.00
02781110   HB SPACER, SPINE 15                   02781110     22800.00
02781126   HB CANNULA, ARTERIAL PVAD 1           02781126     10560.00
02781128   HB STENT, GRAFT THORACIC 3            02781128     46800.00
02781134   HB GRAFT 1                            02781134      902.00
02781135   HB SPACER, 1                          02781135      295.00
02781136   HB SPACER, SPINE 2                    02781136      3080.00
02781141   HB CAGE, SPINE 13                     02781141     14463.00
02781143   HB SPACER, SPINE 7                    02781143     11282.00
02781144   HB SPINE PEEK 5                       02781144     13200.00
02781146   HB TRANSCONNETOR, SPINE 2             02781146      2200.00
02781147   HB PLUG, VASCULAR 1                   02781147      3080.00
02781148   HB PLUG, VASCULAR 2                   02781148      3520.00
02781150   HB CAGE, SPINE 1                      02781150      1408.00
02781151   HB CAGE, SPINE 2                      02781151      3648.00
02781152   HB CAGE, SPINE 3                      02781152      3951.00
02781153   HB CAGE, SPINE 4                      02781153      4761.00
02781154   HB CAGE, SPINE 5                      02781154      6701.00
02781155   HB CAGE, SPINE 6                      02781155      7665.00
02781156   HB CAGE, SPINE 7                      02781156      8624.00
02781157   HB CAGE, SPINE 8                      02781157      9236.00
02781158   HB CAGE, SPINE 9                      02781158     10208.00
02781159   HB CAGE, SPINE 10                     02781159     11013.00
02781160   HB CAGE, SPINE 11                     02781160     11871.00
02781161   HB CAGE, SPINE 12                     02781161     13200.00
02781162   HB CAGE, SPINE 13                     02781162     14463.00
02781163   HB CAGE, SPINE 14                     02781163     15013.00
02781164   HB CAGE, SPINE 15                     02781164     15787.00
02781165   HB CAGE, SPINE 17                     02781165     18097.00
02781166   HB CAGE, SPINE 18                     02781166     20240.00
02781167   HB CAGE, SPINE 19                     02781167     22400.00



                                           174
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02781168   HB CAGE, SPINE 20                      02781168     22858.00
02781169   HB CAGE, SPINE 21                      02781169     23320.00
02781170   HB CAGE, SPINE 24                      02781170     26057.00
02781171   HB CAGE, SPINE 25                      02781171     27100.00
02781172   HB CAGE, SPINE 26                      02781172     30100.00
02781173   HB CAGE, SPINE 27                      02781173     33110.00
02781174   HB CAGE, SPINE 28                      02781174     34329.00
02781176   HB KIT, PENILE PROSTHESIS 1            02781176      1971.00
02781177   HB SLEEVE, BRACHYTHERAPHY 1            02781177      286.00
02781178   HB SLEEVE, BRACHYTHERAPY               02781178      286.00
02781187   HB STENT, GRAFT THORACIC 6             02781187     62888.00
02781188   HB STENT, GRAFT THORACIC 7             02781188     67373.00
02781195   HB SEALANT 1                           02781195      990.00
02781196   HB SEALANT 2                           02781196      1514.00
02781197   HB SEALANT 4                           02781197      2420.00
02781221   HB VALVE, NEURO 3                      02781221     11462.00
02781222   HB VALVE, NEURO 4                      02781222     12474.00
02781223   HB VALVE, NEURO 7                      02781223     17046.00
02781224   HB CLIP, ANEURYSM 2                    02781224      1624.00
02781225   HB SPACER, SPINE 4                     02781225      7902.00
02781226   HB VESSEL GUARD 2                      02781226      2988.00
02781227   HB MISCELLANEOUS IMPLANT GI            02781227
02781228   HB RESERVOIR, NEURO 2                  02781228      1210.00
02781229   HB RESERVOIR, NEURO 3                  02781229      1469.00
02781230   HB STABLIZATION SYSTEM TRANS 1         02781230      660.00
02781231   HB STABLIZATION SYSTEM TRANS 2         02781231      1100.00
02781235   HB KIT, ANCHOR/BOOT 1                  02781235      220.00
02781236   HB SPACER, SPINE 6*                    02781236      9803.00
02781237   HB STENT, GRAFT THORACIC 6             02781237     56258.00
02781238   HB GRAFT 9                             02781238     43978.00
02781239   HB GRAFT 11                            02781239     47093.00
02781245   HB GRAFT 13                            02781245     43978.00
02781246   HB GRAFT 15                            02781246     47093.00
02781248   HB GRAFT 6                             02781248     11770.00
02781249   HB GRAFT 7                             02781249     12320.00
02781250   HB COLLAGEN IMPLANT 1                  02781250      2684.00
02781251   HB TESTICULAR PROSTHESIS 2             02781251      6380.00
02781252   HB NO COST/NO CHARGE                   02781252       1.00
02781263   HB OTSC FISTULA CLOSURE 200.40         02781263      2160.97
02781264   HB KIT, CAGE INTERLOCK 1               02781264     10996.00
02781265   HB KIT, CAGE INTERLOCK 2               02781265     16711.00
02781266   HB KIT, CAGE INTERLOCK 3               02781266     22427.00



                                            175
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
02781267   HB KIT, CAGE INTERLOCK 4              02781267     28142.00
02781268   HB KIT, CAGE INTERLOCK 5              02781268     33858.00
02781272   HB GRAFT 13                           02781272     36133.00
02781273   HB SPACER, SPINE 11                   02781273     20975.00
02781274   HB SPACER, SPINE 12                   02781274     21371.00
02781275   HB SPACER, SPINE 13                   02781275     21846.00
02781276   HB SPACER, SPINE 18                   02781276     34786.00
02781277   HB PROSTHESIS, PENILE INFLT 4         02781277      6472.00
02781278   HB STENT, GRAFT CONVERTER 1           02781278     38170.00
02781279   HB STENT, GRAFT THORACIC 8            02781279     65618.00
03000001   HB LAB PROCESSING FEE X6              03000001      418.41
03000051   HB LAB DRAW (PIC/HEMA/CHEMO)          03000051       56.75
03000260   HB LAB RSCH SPECIMEN RETRIEVAL #*     03000260       0.00
03000261   HB LAB RSCH SPECIMEN PROCESS #*       03000261       0.00
03000262   HB LAB RSCH SPECIMEN STORAGE #*       03000262       0.00
03010481   HB THYROID PANEL                      03010481
03090016   HB PRICE NICHOLS                      03090016
03090017   HB PRICE UCLA TISSUE TYPING           03090017
03090022   HB PRICE REF LAB                      03090022
03090023   HB PRICE FOCUS TECHNOLOGIES           03090023
03090026   HB PRICE RHEUM DIAGNOSTIC L           03090026
03090027   HB PRICE SPECIALTY LAB                03090027
03090029   HB PRICE BAYLOR UROTHIASIS            03090029
03090030   HB PRICE CHILDRENS HOSPITAL           03090030
03090033   HB PRICE LIVER RESEARCH               03090033
03090034   HB PRICE ENDOCRINE SCIENCE            03090034
03090035   HB PRICE PARK CLINIC LAB              03090035
03090036   HB PRICE UCLA MEDICAL CENTE           03090036       0.00
03090037   HB PRICE:                             03090037
03090040   HB PRICE, BB OF SAN BERNADIN          03090040       0.00
03090043   HB CONSOLIDATED LAB SVCS              03090043
03090044   HB UNIV OF PITTSBURG                  03090044
03090045   HB PRICE SMITH KLINE-BEECHA           03090045
03200221   HB RSH XR FOREARM 1VW 218785          03200221
03200222   HB RSH XR HAND 1VW 218785             03200222
03520055   HB RSH CT CHEST - 217631              03520055
03600002   HB MINOR 2 - EA ADDL MINUTE           03600002       75.91
03600003   HB MINOR 1 - EA ADDL MINUTE           03600003       94.32
03600004   HB MAJOR 3 - EA ADDL MINUTE           03600004      126.48
03600005   HB MAJOR 2 - EA ADDL MINUTE           03600005      166.70
03600006   HB MAJOR 1 - EA ADDL MINUTE           03600006      208.66
03600007   HB BEDSIDE PROCEDURE - MINOR          03600007      3258.68



                                           176
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
03600008   HB MAJOR 1 - 1ST HOUR                    03600008     20952.92
03600010   HB BEDSIDE PROCEDURE - MAJOR             03600010      7894.91
03600011   HB MINOR 1 - 1ST HOUR                    03600011     10929.20
03600012   HB MAJOR 3 - 1ST HOUR                    03600012     15157.44
03600013   HB MAJOR 2 - 1ST HOUR                    03600013     17809.47
03600014   HB MINOR 2 - 1ST HOUR                    03600014      5811.97
03600016   HB MAJOR 1 - 1ST HOUR CANCELED           03600016      5986.55
03600017   HB MAJOR 2 - 1ST HOUR CANCELED           03600017      5088.42
03600018   HB MAJOR 3 - 1ST HOUR CANCELED           03600018      4310.17
03600019   HB MINOR 1 - 1ST HOUR CANCELED           03600019      3078.65
03600020   HB MINOR 2 - 1ST HOUR CANCELED           03600020      1637.17
03610390   HB CASSI BIOPSY KIT                      03610390      914.48
03610536   HB MISCELLANOUS ED PROCEDURE             03610536       0.00
03700001   HB ANES-CAT 2-BASIC+A LINE-1ST HR        03700001      5814.36
03700002   HB ANES-CAT 2 - EA ADDL MIN              03700002       72.92
03700003   HB ANES-CAT 1-BASIC - 1ST HOUR           03700003      4253.39
03700004   HB ANES-CAT 2+ALINE OUTLYING AREA        03700004      3495.68
03700005   HB ANES-CAT 3 - EA ADDL MIN              03700005      112.81
03700006   HB ANES-CAT 1-BASIC OUTLYING AREA        03700006      2673.03
03700007   HB ANES-CAT 1 - EA ADDL MIN              03700007       54.69
03700008   HB ANES-CAT 3+CVP,SWAN-1ST HOUR          03700008      7839.07
04200002   HB M CAL PT EXRCSE EA ADDL 15M           04200002      192.33          249.31
04200003   HB M CAL PT EVALUATION                   04200003      817.98         1063.73
04200004   HB M CAL PT EXRCSE 1ST 30M               04200004      383.47          498.62
04200005   HB M CAL PT MOD/EXER 1ST 30M             04200005      383.47          498.62
04200008   HB M CAL PT MOD/EXER EA ADDL 15M         04200008      192.33          249.31
04200055   HB M CAL PT SNGL MODAL, INIT 30M         04200055                      130.59
04300003   HB M CAL OT TRTMNT EA ADDL 15M           04300003      211.32          274.24
04300004   HB M CAL OT TRTMNT INIT 30 MIN           04300004      422.64          548.49
04300028   HB M CAL SINGLE MODAL, INIT 30M          04300028      371.59          143.65
04340001   HB M CAL OT EVAL ADD'L 15M               04340001      186.39          242.19
04340002   HB M CAL OT EVAL INIT 30 MIN             04340002      371.59          483.19
04400001   HB M CAL LANG SWALL IND TX 30M           04400001                      572.23
04400002   HB M CAL LANG SWALL IND TX ADD 30        04400002      440.45
04400003   HB M CAL SWALLOW EVAL 60 MIN             04400003      817.98         1063.73
04400004   HB M CAL VIDEO SWALLOW                   04400004      1055.42
04400005   HB SP SWALLOW THERAPY INIT 60 MIN        04400005                     1145.65
04400007   HB M CAL SPEECH EVAL                     04400007                     1063.73
04400008   HB M CAL LANG SWALL IND TX 60M           04400008                     1145.65
04400009   HB SP SWALLOW THER ADD 30 MIN            04400009                      572.23
04400010   HB M CAL LANG SWALL IND TX 60 MIN        04400010      880.90
04440001   HB M CAL LANGUAGE EVAL                   04440001                      624.47



                                              177
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
04440002   HB SP LANG/COGNITIVE EVALUATION        04440002                      630.40
04440003   HB M CAL LANG COG EVAL 60 MIN          04440003      817.98
04440004   HB M CAL SPEECH VOICE EVALUATION       04440004      817.98
04700001   HB INT NEWBORN HEARING SCREEN TST 04700001           387.03
04700002   HB RPT NEWBORN HEARING SCREEN TST 04700002           387.03
05100002   HB SUTURE REMOVAL                      05100002       45.58
05100106   HB SUTURE REMOVAL KIT                  05100106      142.43
05120202   HB PART PULP FOR APEXOGENESIS          05120202      304.92
05120203   HB ALVEOPLASTY W/EXTRA>4TEETH          05120203      338.80
05120204   HB ALVEOPLASTY W/EXTRA<3TEETH          05120204      338.80
05120205   HB TREATMENT OF COMPLICATIONS          05120205      129.36
05120206   HB OFFICE VISIT DURING HOURS           05120206      172.48
05120207   HB ABUTMENT, CUSTOM                    05120207      2195.42
06100124   HB RSH MRI HRT COC LNG 218818          06100124
06100125   HB RSH MRI HRT COC SHT 218818          06100125
06100126   HB RSH MRS FAT, PANCREAS,LIVER         06100126
06100127   HB RSH MRI- PRE & POST 218729          06100127
06100128   HB RSH MR SPECT LIVER 219281           06100128
06210001   HB NEEDLE, BIOPSY/ASP/LOC/INJ          06210001       0.00
06210002   HB NEEDLE, MAMMOTOME MULTI-PROBE 06210002            1023.57
06210003   HB TRAY, HYSTEROSALPINGOGRAM           06210003      457.94
06210004   HB BIOPSY TRAY                         06210004       0.00
06240001   HB STUDYDURAGENADHBARMATG060035 06240001              1.26
06240002   HB G030069 PRTNR AORT VLVE W/STNT      06240002     18894.06
06240003   HB G030064/S41 CVRS DEL SYS W/CLP      06240003     61204.00
06240004   HB STUDYIMPULSETANTALUSIDEG040103 06240004            1.17
06240006   HB STUDYAPSPISTABILIMAXIDEG060214      06240006       1.26
06240009   HB G030069 PARTNER STUDY DEVICE        06240009     88796.30
06240010   HB CATHETER-THROM CATH                 06240010      5583.12
06240011   HB STUDY SATIETY TOGA IDE G070163      06240011       1.17
06240013   HB HEARTPOD IDE# G050018               06240013       1.53
06240014   HB CATHETER, CRYOCATH # G03010159      06240014     11262.68
06240015   HB WATCHMAN LAA SYS(G020312/S64)       06240015     28551.02
06240016   HB STUDY-MDTR DIAM IDE G050234S14      06240016       1.17
06240017   HB WATCHMAN OBTURATOR(G020312/S64)06240017           1596.95
06240018                                    06240018
           HB WATCHMAN TRANSEPTL ACC SYS(G020312/S64)           1596.95
06240019   HBSTUDYAXIOMEDFRDMLDISCG070215         06240019       1.22
06240020   HBSTUDYFACETACADIA G060073/S12         06240020       1.22
06240021   HB STDYSTRTTCEFCLMSHIDEK080353         06240021       1.22
06240022   HB STDYETHMDSPCRIDG080081/S001         06240022       1.22
06240024   HB KAST KIVA KYPHO SYS G090147         06240024       1.00
06240025   HB STUDYMDTNCDSSCTIDE#G090199/118 206240025         54600.00



                                            178
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
06240026   HB STUDYMDTNCDSSCTIDE#G090199/118 106240026            39600.00
06240027   HB G090216 PARTNERII STUDY DVC            06240027     85000.00
06240028   HBSTUDYSCFALLRGNMESHIDEK080442            06240028       4.40
06360018   HB ERX 636 (NO ALT)                       06360018
06810001   HB TRAUMA, LOW LEVEL RESPONSE             06810001      5852.53        5852.53
06820001   HB TRAUMA, MID LEVEL RESPONSE             06820001     13654.53       13654.53
06830001   HB TRAUMA, HIGH LEVEL RESPONSE            06830001     17555.82       17555.82
07100003   HB 3SP - EA ADDL MINUTE                   07100003       12.54
07100004   HB RECOVERY PER HOUR                      07100004      1480.09
07100005   HB HOURLY EXT RECOVERY                    07100005      212.00
07100006   HB 3SP - 1ST HOUR                         07100006      771.38
07100044   HB PACU - 1ST HOUR                        07100044      3129.94
07100047   HB PACU - EA ADDL MINUTE                  07100047       50.13
07200001   HB VAGINAL DELVRY-W/VBAC SUCCESS          07200001     10371.96
07200002   HB C-SECTION W/FAILED VBAC                07200002     10691.00
07200003   HB C-SECTION W/TUBAL LIGATION             07200003     10579.33
07200005   HB L & D MINOR PROCEDURE                  07200005      2947.63
07200006   HB VAGINAL BIRTH W/HYSTERECTOMY           07200006     10154.33
07200007   HB VAGINAL DELIVERY W/TUBAL LIGA          07200007      9220.02
07200008   HB C-SECTION MULTIPLE BIRTHS              07200008     10779.87
07200009   HB C-SECTION                              07200009      9598.31
07200010   HB VAGINAL MULTIPLE BIRTHS                07200010     10432.35
07200011   HB RETURN TO OR/MINOR PROCEDURE           07200011      5234.40
07200012   HB C-SECTION W/HYSTERECTOMY               07200012     10432.35
07200013   HB RETURN TO OR/MAJOR PROCEDURE           07200013      6954.90
07500001   HB GI PROC I-WO ANES UP TO 1 HR           07500001      4715.98
07500002   HB ENDO ULTRASOUND W/FNA                  07500002      4580.39
07500003   HB SIGMOID I - WO ANES UP TO 1 HR         07500003      1940.40
07500004   HB GI PROCEDURE-EACH ADDL MINUTE          07500004       19.38
07500005   HB COLON I- WO ANES UP TO 1 HR            07500005      2964.72
07500006   HB ENDOSCOPIC ULTRASOUND                  07500006      4580.39
07500007   HB GI PROC II- W/ANES UP TO 1 HR          07500007     11048.77
07500008   HB SIGMOID II- W/ANES UP TO 1 HR          07500008      3322.49
07500009   HB EGD-GI PX II W ANES UP TO 1 HR         07500009      4365.05
07500010   HB BILIARY MANOMETRY                      07500010      973.05
07500011   HB COLON II - W/ ANES UP TO 1 HR          07500011      3951.44
07500012   HB LIVER BIOPSY                           07500012      3174.37
07500013   HB EGD-GI PX I WO ANES UP TO 1 HR         07500013      4087.03
07500014   HB PEG/G-TUBE/NJ TUBE INSERTION           07500014      3512.78
07500015   HB GI BEDSIDE PROC UP TO 1 HR             07500015      3816.99
07500019   HB ERCP-GI-WITH ANES UP TO 1 HR           07500019     10149.78
07500020   HB GI PROC LEVEL I                        07500020      5301.00



                                               179
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
07500021   HB GI PROC BILLIARY LEVEL II            07500021     12250.00
07500022   HB GI PROC MOD LVL III-1ST HR           07500022     10967.50
07500023   HB GI PROC COMPL LVL IV-1ST HR          07500023     13910.00
07610005   HB CHRONIC PAIN CNTR PROCEDURES 1 07610005            918.36
07610006   HB CHRONIC PAIN CNTR PROCEDURES 2 07610006            3120.82
07610008   HB CHRONIC PAIN CNTR PROCEDURES 4 07610008            8813.26
07610009   HB CHRONIC PAIN CNTR PROCEDURES 5 07610009           13770.79
07610010   HB CHRONIC PAIN CNTR PROCEDURES 3 07610010            3672.29
07620004   HB OBSERVATION, PER HOUR DIR-ADMIT 07620004           212.00
08110001   HB ORGAN ACQ LIVER LIVE DONOR           08110001     169337.63
08110002   HB ORGAN ACQ KIDNEY LIVE DONOR          08110002     175155.40
08120002   HB ORGAN ACQ LIVER DEC DONOR            08120002     169337.63
08120003   HB ORGAN ACQ HEART DEC DONOR            08120003     201591.76
08120004   HB ORGAN ACQ LUNG BILA DEC DNR          08120004     257992.06
08120005   HB ORGAN ACQ SNGL LUNG DEC DNR          08120005     174745.22
08120006   HB ORGAN ACQ KIDNEY DEC DONOR           08120006     174820.42
08120007   HB ORGAN ACQ PANCREAS                   08120007     179776.81
09000001   HB NO ACTIVITY                          09000001       0.00
09460001   HB PEDICARE BED                         09460001      1135.90
09460002   HB CLINITRON THERAPY BED DA             09460002      1010.24
09900052   HB ROOM PRIVATE DELUX                   09900052      1499.00
09900053   HB ROOM OB DELUX 1 RM                   09900053      2673.00
09900054   HB ROOM OB DELUX 2 RM                   09900054      3117.00
09900055   HB ROOM OB DELUX 3 RM                   09900055      3784.00
09900500   HB A LA CARTE TRAY                      09900500       0.00
09900501   HB STD GUEST TRAY                       09900501       32.00
09900502   HB DELUXE SERVICE                       09900502      185.00
09900503   HB ADD-ON FOR DELUXE ROOM 8-NE          09900503      1499.00
09900504   HB PER DAY OB DELUX 3 ROOMS             09900504      3784.00
09900505   HB ADD-ON FOR DELUXE ROOM 8-SE          09900505      1499.00
09900506   HB ADD-ON FOR DELUXE ROOM 8-SW          09900506      1499.00
09900507   HB PER DAY OB DELUX 1 ROOM              09900507      2673.00
09900508   HB PER DAY OB DELUX 2 ROOMS             09900508      3117.00
09900509   HB ADD-ON FOR DELUXE ROOM 8-NW          09900509      1499.00
80000001   HB ACC UOS STATS                        80000001
80000002   HB ADJ PT MNGT DAYS & HH VISITS         80000002
80000003   HB HOME HLTH NON-BILLABLE STATS         80000003
80000004   HB NO OF CSHS EMPLOYEES, UOS STS        80000004
80000005   HB HOME HLTH BILLABLE VISIT STATS       80000005
80000006   HB EMPLOYEE HEALTH UOS STATS            80000006
80000007   HB INTERPRETER SVC UOS STATS            80000007
80000008   HB HOME CARE -PERSONAL CARE             80000008



                                             180
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
80000009   HB AUTHORIZATION/PRE-AUTH-INS             80000009
80000010   HB AUTHORIZATION/PRE-AUTH-HOSP            80000010
80000011   HB LACK OF MEDICAL NECESSITY-INS          80000011
80000012   HB LACK OF MEDICAL NECESSITY-HOSP         80000012
80000013   HB NON-COVERED - INS                      80000013
80000014   HB NON-COVERED - HOSP                     80000014
80000015   HB UNTIMELY FILLING - INS                 80000015
80000016   HB UNTIMELY FILLING - HOSP                80000016
80000017   HB ABN                                    80000017
80000018   HB STOP LOSS LOC PSYCH                    80000018
80000019   HB STOP LOSS LOC REHAB                    80000019
80000020   HB STOP LOSS LOC OB                       80000020
80000021   HB STOP LOSS LOC NON-NICU                 80000021
80000022   HB STOP LOSS LOC NICU                     80000022
80000023   HB STOP LOSS LOC DOU                      80000023
80000024   HB STOP LOSS LOC ICU/CCU                  80000024
80000025   HB STOP LOSS LOC ICU PEDS                 80000025
80000026   HB STOP LOSS LOC MED/SURG/PEDS            80000026
80000027   HB LOC DAY DOU                            80000027
80000028   HB LOC DAY ICU/CCU                        80000028
80000029   HB LOC DAY MED/SURG/PEDS                  80000029
80000030   HB TMHC OP LEVEL 2 PHS                    80000030
80000031   HB TMHC OP LEVEL 1                        80000031
80000032   HB EVAL ADD'L TO XPLT GLOBAL RATE         80000032
80000033   HB TRANSPLANT EVALUATION ONLY             80000033
80000034   HB COVERED RE TRANSPLANT                  80000034
80000035   HB DAYS EXCL XPLNT GLOBAL RATE            80000035
80000036   HB SVC INCL XPLNT GLOBAL RATE             80000036
80000037   HB STOP LOSS NEWBORN LEVEL II LBW         80000037
80000038   HB STOP LOSS NICU LEVEL III INTER         80000038
80000039   HB CM BOARDER BABY STAT                   80000039
80000040   HB CM PRENATAL STAT                       80000040
80000041   HB NO ROOM CHARGE APPLICABLE              80000041
80000042   HB BILLED IML ZERO ACCOUNT                80000042
80000043   HB VENDOR PYMT-SPLT PRJT                  80000043
80000044   HB STAT IML W NONIMAG HSC                 80000044
80000045   HB FOLLOW-UP-NO CHARGE VISIT              80000045
80000046   HB STATISTICAL RECOVERY                   80000046
80000049   HB CARDIAC REHAB UOS STATS ONLY           80000049
80000051   HB PF UNCHG TECH TIME 02 PER              80000051
80000052   HB PF UNCHG TECH TIME                     80000052
80000053   HB PF UNCRGD T.TIME EX REF/UN             80000053



                                               181
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
80000054   HB PF UNCHGD T.TIME QC PFT               80000054
80000055   HB PF UNCHGD T.TIME QC EXERCISE          80000055
80000056   HB PC ER BLD GAS ANALYS        *         80000056
80000057   HB UNCHARGED COGNITIVE/TECH              80000057
80000058   HB PULMONARY UOS STATS                   80000058
80000059   HB PC PATIENT NOT AVAIL                  80000059
80000060   HB PC INSTRUCTION                        80000060
80000061   HB PC ISOLATION PRECAUTIONS              80000061
80000063   HB MUCUS CLEARING COUNTER                80000063
80000064   HB INHALED NITRIC OXIDE-RT/PER HR        80000064
80000065   HB I/P BRONC RECOV-INITIAL               80000065
80000066   HB PC I/P BRONC RECOV-ADD HOUR           80000066
80000067   HB PC O/P BRONC RECOV-INITIAL            80000067
80000068   HB PC O/P BRONC RECOV-ADD 1/2 HR         80000068
80000069   HB PC VENT. CIRCUIT CHANGE               80000069
80000070   HB PC REFUSES PROCEDURE                  80000070
80000072   HB PC PAG - PERF                         80000072
80000074   HB PC VENT INITL HR STAT                 80000074
80000075   HB PC VENT SUBSQT HR - STAT              80000075
80000076   HB PC VENT JET INITL HR STAT             80000076
80000077   HB PC VENT JET SUBSQT HR - STAT          80000077
80000078   HB PC CPAP INITL HR STAT                 80000078
80000079   HB PC CPAP SUBSQT HR - STAT              80000079
80000080   HB PC BIPAP INITL HR STAT                80000080
80000081   HB PC BIPAP SUBSQT HR - STAT             80000081
80000083   HB NEUROSURGICAL PROCEDURES              80000083
80000084   HB STATISTICAL UOS                       80000084
80000085   HB HOT PACKS DISPOSABLE                  80000085
80000086   HB NS IRRIG 1000ML                       80000086
80000088   HB STATISTIC STONE CTR LASER             80000088
80000089   HB STATISTIC STONE CTR ESWL              80000089
80000090   HB STATISTIC DRESSING CHANGE             80000090
80000091   HB STATISTIC MISC PROCEDURE              80000091
80000092   HB STATISTIC CATHETER PULL               80000092
80000093   HB STATISTIC GI LAB                      80000093
80000094   HB STATISTIC PORTABLE XR                 80000094
80000095   HB STATISTIC PORTABLE XR SUR             80000095
80000096   HB STATISTIC PORTABLE US                 80000096
80000097   HB STATISTIC RECONSTRUCTION 2D*          80000097
80000098   HB STATISTIC EMPLOYEE HLTH XR            80000098
80000101   HB STATISTIC RECONSTRUCTION 2D           80000101
80000102   HB STATISTIC RECONSTRUCTION 2D CT        80000102



                                              182
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
80000103   HB STAT RECOVERY TIME 15 MINUTES        80000103
80000105   HB STATISTIC PORTABLE NM                80000105
80000106   HB STATISTIC AFTER HRS                  80000106
80000107   HB STATISTIC COMPUTER PROC              80000107
80000108   HB STATISTIC HOLIDAY                    80000108
80000109   HB STATISTIC ADDL VWS CISTERN*          80000109
80000110   HB STATISTIC ADDL VWS 24HR TL           80000110
80000111   HB STATISTIC ADDL VWS SPECT*            80000111
80000112   HB NC MYOC PERF W GATED SPECT           80000112
80000113   HB NC MYOC PERF WM GATED SPECT          80000113
80000114   HB STATISTIC EXTRA VIEWS                80000114
80000115   HB STATISTIC UOS                        80000115
80000116   HB STATISTIC COMPUTER PROC              80000116
80000117   HB STATISTIC PORTABLE NM                80000117
80000118   HB STATISTIC AFTER HOURS                80000118
80000119   HB STATISTIC COMPUTER PROC*             80000119
80000120   HB STATISTIC HOLIDAY NM                 80000120
80000121   HB STATISTIC ADDL VWS CISTERN           80000121
80000122   HB STATISTIC ADDL VWS CARDIAC           80000122
80000123   HB STATISTIC ADDL VWS SPECT             80000123
80000124   HB NM CARDIAC W GATED SPECT             80000124
80000125   HB NM CARDIAC WM W GATED SPECT          80000125
80000126   HB STATISTIC EXTRA VIEWS*               80000126
80000127   HB STATISTIC CT W CCS                   80000127
80000128   HB P/O WOUND CHECK LEVEL 3              80000128
80000130   HB STAT - PACU - EA ADDL 15 MIN         80000130
80000135   HB STAT - PRE OP - 1ST HOUR             80000135
80000138   HB STAT - PRE OP - EA ADDL MIN          80000138
80000140   HB STAT - PACU - EA ADDL MIN            80000140
80000142   HB STAT - PREADM/PPTP-EA ADDL MIN       80000142
80000145   HB RX-CODE BLUE 30MINS                  80000145
80000152   HB RX - WEBVS MONITORING                80000152
80000161   HB CA CARB CHEW 500MG                   80000161
80000168   HB SACCHAROMYCES CP 250MG               80000168
80000183   HB LAB HIV GENOTYPING*                  80000183
80000203   HB AMIODARONE ORAL SUSP 10MG/ML 1       80000203
80000205   HB ONDANSETRON ODT 4MG                  80000205
80000215   HB LAL ASSAY, QUANT                     80000215
80000216   HB LAB RUNC NOTIFICATION*               80000216
80000223   HB LAB STAT ONLY-OS AUTO#               80000223
80000256   HB CONSULT IP LOW SEVERITY              80000256
80000264   HB LAB SPECIAL TEST#*                   80000264



                                             183
  Charge
   Code                 Description                 CPT Code OP/Default Price   IP/ED Price
80000267   HB LAB CONSULTATION                      80000267
80000273   HB CHLORAMPHN SUS 150MG                  80000273
80000274   HB LAB HEP B VIR PCR INTER & RPT         80000274
80000280   HB CHLORPROMAZINE 25MG SUPP              80000280
80000288   HB LAB SPECIMEN CONCENTRATION*           80000288
80000289   HB CLOFAZIMINE CP 100MG                  80000289
80000290   HB LAB SPECIAL TEST*                     80000290
80000296   HB CORTISONE ACETATE 5MG TABLET          80000296
80000298                                        80000298
           HB PATH CONSULT - SEPARATE BILL 8027911
80000303   HB DELAVIRDINE TB 50MG                   80000303
80000304   HB LAB VRE SCREEN (NO CHARGE) #          80000304
80000307   HB DES PHOSPHATE 100MGO                  80000307
80000309   HB LAB SPECIAL TEST    #                 80000309
80000319   HB DIAZOXIDE 50MG SUS                    80000319
80000328                                        80000328
           HB PATH CONSULT - SEPARATE BILL# 7627056
80000330   HB LAB SURV. WORKUP (NO CHRG) #          80000330
80000333   HB DIMENHYDRINAT 100MGO                  80000333
80000340   HB LAB STAT ONLY-CS AUTO#*               80000340
80000342   HB DONEPEZIL TAB 2.5MG                   80000342
80000345   HB DOXEPIN 300MG CAP                     80000345
80000350   HB ENTEX-PSE 1TAB                        80000350
80000352   HB ER-CHLOR.HYD500MG PR                  80000352
80000357   HB ER-IBUPROFEN SUS 100MG                80000357
80000359   HB ER-PHENAZOPYR 200MG                   80000359
80000361   HB ER-THEOPH SR 200MG                    80000361
80000363                                        80000363
           HB PATH CONSULT - SEPARATE BILL# 7627042
80000364   HB ESTRAMUSTINE PHOS SODIUM 140MG 80000364
80000365                                        80000365
           HB PATH CONSULT - SEPARATE BILL# 7627073
80000366   HB ETHACRYNIC 200MG O                    80000366
80000367                                        80000367
           HB PATH CONSULT - SEPARATE BILL# 7627214
80000368   HB ETHOSUXIMID 250MGSUS                  80000368
80000370   HB ETIDRONATE DISODIUM 200MG TABL        80000370
80000372   HB ETODOLAC ER TB 400MG                  80000372
80000373   HB FAMOTIDINE TAB 10MG                   80000373
80000375   HB FELODIPINE SR 10 MG                   80000375
80000379   HB PROCESS PLATELET PACK*                80000379
80000390                                        80000390
           HB PATH CONSULT - SEPARATE BILL# 7627045
80000391   HB CONSULT OP EVAL THERAP APHER          80000391
80000393                                        80000393
           HB PATH CONSULT - SEPARATE BILL# 7627911
80000394   HB LAB FLOW CYTMTRY INTRP 2-8 MRK        80000394
80000395   HB LAB AGAR MIC (NO CHARGE)   #          80000395
80000405   HB HYDRALAZINE ORAL SUSP 10MG/ML         80000405



                                              184
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
80000406   HB PROCESS CRYOPRECIPITATE             80000406
80000407   HB IBUPROFEN SUS 20MG                  80000407
80000409   HB ILOPAN-CHOLINE 2TAB                 80000409
80000410   HB INDINAVIR CAP 200MG                 80000410
80000412   HB INDOMETH SUPP 50MG                  80000412
80000414   HB IPODATE SODIUM 500MG CAPSULE        80000414
80000416   HB ISONIAZID 100MG TABLET              80000416
80000417   HB ISONIAZID SYR 50MG                  80000417
80000419   HB ISOPTO TEARS                        80000419
80000421   HB ISOSOBIDE CHEW 10MG                 80000421
80000423   HB ISOSORBIDE DN 5MG TABLET SL         80000423
80000425   HB LAB AA-AUTOPSY SERV*                80000425
80000426   HB J-DACRIOSE                          80000426
80000428   HB J-FLURESS                           80000428
80000430   HB J-GONIASOL                          80000430
80000432   HB J-KETOROLAC 0.5%                    80000432
80000433   HB J-OPHTHOCORT UNG                    80000433
80000435   HB J-PILOCARPINE 4%                    80000435
80000437   HB J-TETRACAINE DROPS                  80000437
80000439   HB K GLUCONAT 600MG TAB                80000439
80000440   HB K IODIDE 10 DROP O                  80000440
80000444   HB KOVIA OINT 3.5GM                    80000444
80000446   HB LACTINEX TAB 3 TAB                  80000446
80000447   HB LACTULOSE 30CC ENEMA                80000447
80000451   HB LEVAMISOLE TB 25MG                  80000451
80000453   HB LEVODOPA 1GM TAB                    80000453
80000454   HB LEVODOPA 250MG TABLET               80000454
80000457   HB CONSULT OP LOW SEVERITY             80000457
80000458   HB LOVASTATIN 20MG TABLET              80000458
80000459                                        80000459
           HB PATH CONSULT - SEPARATE BILL# 7627054
80000460   HB LOXAPIN 25MG SOLN                   80000460
80000461   HB PLATELET AGREGATE                   80000461
80000462   HB MAPROTILINE 50MG TABLET             80000462
80000463   HB MEFLOQUINE 250MG TABLET             80000463
80000465   HB MENTHOL                             80000465
80000469   HB MEPROBAMATE 200MG TB                80000469
80000470   HB MESORIDAZINE BESYLATE 10MG TAB      80000470
80000472   HB METAPROTERENOL SULFATE 10MG TA 80000472
80000474   HB METHEN MAND .25GM                   80000474
80000477   HB METHYLTEST 10MG CAP                 80000477
80000478   HB NEEDLE SPINAL PEDI                  80000478
80000479   HB METHYSERGIDE MALEATE 2MG TABLE 80000479



                                            185
  Charge
   Code                  Description            CPT Code OP/Default Price   IP/ED Price
80000480   HB STOPCOCK 3-WAY 2169               80000480
80000481   HB METYRAPONE ORAL SUSP 50MG/ML 1 80000481
80000482   HB SRS HEAD SCREW SET                80000482
80000483   HB MIDRIN 2 CAP                      80000483
80000484   HB CATH URINE TRAY 18F               80000484
80000485   HB MINOCYCLINE 200MG                 80000485
80000486   HB MODURETIC 2TAB                    80000486
80000487   HB LP TRAY, PEDI                     80000487
80000488   HB MOLINDONE HCL 25MG TABLET         80000488
80000489   HB TRAY THORACENTISIS                80000489
80000490   HB MOM/CASCARA 30CC                  80000490
80000491   HB ACETAMINOPHEN LQ 5CC              80000491
80000492   HB MONTELUKAST TB 2.5MG              80000492
80000493   HB MORICIZINE TB 100MG               80000493
80000494   HB CANNULA, NASAL SHT N              80000494
80000496   HB LOMUSTINE 10MG CAP                80000496
80000498   HB LEVOFLOXACIN 250MG TAB            80000498
80000501   HB SUCRALFATE 1GM TAB                80000501
80000502   HB MVI W/ FLUORIDE 0.25MG/ML DROP    80000502
80000503   HB TRIAZOLAM .25MG TAB               80000503
80000504   HB NABUMETONE TB 250MG               80000504
80000505   HB LACTULOSE 30ML SYRUP              80000505
80000506   HB NAPROXEN SOD 275MG TABLET         80000506
80000507   HB NELFINAVIR TB 125MG               80000507
80000508   HB FLUOXETINE CAP 20MG               80000508
80000509   HB NEPHROX SUSP 60CC                 80000509
80000510   HB KCL 20 MEQ ELIX                   80000510
80000511   HB NEUTRA-PHOS 500MG                 80000511
80000512   HB KCL SR 1 TAB                      80000512
80000513   HB NIACIN 25MG TAB                   80000513
80000514   HB PUMP, EXTENSION TUBING            80000514
80000515   HB NICARDIPINE 20MG                  80000515
80000516   HB NICARDIPINE 60MG                  80000516
80000517   HB GABAPENTIN 300MG CAP              80000517
80000518   HB NORTRIPTYLN 25MG SOL              80000518
80000519   HB ANAPHALAXIS KIT                   80000519
80000520   HB ZOLPIDEM 5 MG TAB                 80000520
80000521   HB D5/0.45% NACL IV-ADD              80000521
80000522   HB RED CAP                           80000522
80000523   HB CHEMO START                       80000523
80000524   HB NEEDLE SPINAL                     80000524
80000525   HB SYRINGE                           80000525



                                          186
  Charge
   Code                 Description             CPT Code OP/Default Price   IP/ED Price
80000526   HB DRESSING TEGADERM                 80000526
80000527   HB BIOPSY NEEDLE                     80000527
80000529   HB GLYBURIDE 5MG TAB                 80000529
80000530   HB MORPHINE 30MG SR TAB              80000530
80000531   HB METHADONE 10MG TAB                80000531
80000532   HB POTASSIUM ACETATE IV-ADD          80000532
80000533   HB LARGE VOLUME INFUSOR*             80000533
80000535   HB ACET & COD 30MG TAB               80000535
80000536   HB COVERLET OR DRESSING              80000536
80000537   HB ELECTROSURG DISP ELECTROD         80000537
80000538   HB LARGE VOLUME INFUSOR              80000538
80000539   HB BLOOD SET Y TYPE                  80000539
80000540   HB CARBAMAZEPINE 200MG TAB           80000540
80000541   HB CHLORAL HYD 1.0GM SYR             80000541
80000542   HB RE-FLUX VALVE                     80000542
80000543   HB LUER ADAPTER                      80000543
80000544   HB SORBAVIEW                         80000544
80000545   HB PERGOLIDE MESYLATE 1MG TABLET     80000545
80000546   HB FUROSEMIDE 20MG PO                80000546
80000547   HB PERICOLACE SY 15CC                80000547
80000548   HB ACETAMINOPHEN SUPP                80000548
80000549   HB PERPHENAZINE 2MG TABLET           80000549
80000550   HB VICODIN TAB                       80000550
80000551   HB PHENELZINE 30MG TAB               80000551
80000552   HB PROCHLORPERAZINE 25MG SUP         80000552
80000553   HB PIOGLITAZON TB 60MG               80000553
80000554   HB PIROXICAM 10MG                    80000554
80000555   HB TEMAZEPAM 15 MG CAP               80000555
80000556   HB PRAZOSIN 3MG PO                   80000556
80000557   HB AZITHROMYCIN 250MG CAP            80000557
80000558   HB PROCAINAMD-SR -250MG              80000558
80000559   HB METOCLOPRAM TAB 10MG              80000559
80000560   HB PROCHLORPER SUP 2.5               80000560
80000561   HB PROGEST SUPP 200MG                80000561
80000562   HB LIDOCAINE VISCOUS 20CC            80000562
80000565   HB PROPANTHELINE 30MG S              80000565
80000566   HB IBUPROFEN 400MG TAB               80000566
80000567   HB PROTRIPTYLINE HCL 5MG TAB         80000567
80000569   HB METRONIDAZOLE 500MG TAB           80000569
80000570   HB QUINACRINE 100MG PO               80000570
80000571   HB CIPROFLOXACIN 500MG TAB           80000571
80000572   HB QUINIDIN SO4 100MGTB              80000572



                                          187
  Charge
   Code                 Description                 CPT Code OP/Default Price   IP/ED Price
80000573   HB PENCILLIN VK 250MG TAB                80000573
80000574   HB QUINIDINE POLYGALACTURONATE 27 80000574
80000575   HB QUININE 2TAB                          80000575
80000576   HB OXYCODONE SOLUTION                    80000576
80000577   HB RESERPINE 0.25MG TABLET               80000577
80000578   HB D10/0.9% NACL                         80000578
80000580   HB SODIUM CHLOR 0.45%                    80000580
80000582   HB MYCOLOG OINT 15GM                     80000582
80000583   HB RIVASTIGMIN CP 4.5MG                  80000583
80000584   HB RIVASTIGMIN SOL 3MG                   80000584
80000585   HB SET SUB Q AUTO SYRINGE                80000585
80000586   HB ROFECOXIB TB 12.5MG                   80000586
80000587   HB PRIM SET-OMNI-FLO PUMP                80000587
80000588   HB SECOBARBITL CP 100MG                  80000588
80000589   HB DRESSING CHANGE                       80000589
80000590   HB SELEGILINE TB 10 MG                   80000590
80000591   HB SENNA SYR 5CC                         80000591
80000592   HB PORT ACCESS TRAY                      80000592
80000593   HB SEVELAMER 1CAP                        80000593
80000594   HB STAPLE REMOVER SET                    80000594
80000595   HB SOD FLUOR 25MG TAB                    80000595
80000596   HB SPONGE, GZE 8X4 12PL STRL 2'S         80000596
80000597   HB BISACODYL 5MG TAB                     80000597
80000598   HB MEDI-PORE PATCH                       80000598
80000599   HB INDOMETHACIN 25 MG CAP                80000599
80000600   HB MAGNESIUM CITRATE                     80000600
80000601   HB DIAZEPAM 5MG TAB                      80000601
80000602   HB DSS 100MG CAP                         80000602
80000603   HB NAPROXEN 500MG TAB                    80000603
80000604   HB ALPRAZOLAM 0.25MG TAB                 80000604
80000605   HB ACYCLOVIR 200MG CAP                   80000605
80000607   HB LOPERAMIDE 2MG CAP                    80000607
80000608   HB METHYLPHENIDATE 5MG TAB               80000608
80000609   HB MMX MOUTHWASH 10ML                    80000609
80000610   HB FLUCONAZOLE 200MG TAB                 80000610
80000611   HB INTRAVENOUS INFUSION                  80000611
80000612   HB RESEARCH PATIENT                      80000612
80000613   HB SEPTRA DS 1 TAB                       80000613
80000614   HB COLD PACKS DISPOSABLE                 80000614
80000615   HB ABDOMINAL PAD 5X9                     80000615
80000616   HB THIOGUANINE 40MG TABLET               80000616
80000617   HB SPONGE 2X2, GAUZE                     80000617



                                              188
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
80000618   HB CT MEDRAD INJECTOR SYRINGE         80000618
80000619   HB KERLIX ROLL                        80000619
80000620   HB BLOOD DONOR SET                    80000620
80000621   HB HUMIDIFERS 7302-13                 80000621
80000622   HB STERILE GOWN                       80000622
80000623   HB THIORIDAZN 200MG TAB               80000623
80000624   HB LACTATED RINGERS SOLN              80000624
80000625   HB SODIUM CHLOR 0.9% IV-ADD           80000625
80000626   HB MINERAL OIL                        80000626
80000627   HB CASSETTE, P-D 50ML                 80000627
80000628   HB TUBING, REMOTE RSV                 80000628
80000629   HB RANITIDINE 150MG TAB               80000629
80000631   HB NYSTATIN SUSP 500,000              80000631
80000632   HB CALCIUM GLUCONATE IV               80000632
80000633   HB IV SET TAXOL                       80000633
80000634   HB BIOPATCH DRESSING                  80000634
80000635   HB LUER ADAPTOR EACH                  80000635
80000636   HB HUBER LOCK REMOVER                 80000636
80000637   HB LONG LINE, PERIPHERAL              80000637
80000638   HB PHYDRION PAPER                     80000638
80000639   HB TRAY TPN DRESSING                  80000639
80000640   HB MILK OF BISMUTH 30CC               80000640
80000641   HB ANGIO CATHETERS                    80000641
80000642   HB RESEARCH LAB                       80000642
80000643   HB ALLOPURINOL 100 MG TAB.            80000643
80000644   HB DEXAMETHASONE 4MG(0.25MGDU)TAB 80000644
80000645   HB DEXTROSE 5%/WATER IV-ADD           80000645
80000646   HB TRIMIPRAMINE 25MG                  80000646
80000647   HB MYLANTA II 15 ML                   80000647
80000648   HB WATER, STERILE 5ML                 80000648
80000649   HB CASSETTE, P-D 100ML                80000649
80000650   HB METRONIDAZOLE 250MG TAB            80000650
80000651   HB FLUCONAZOLE 100MG TAB              80000651
80000652   HB PHENOBARBITAL 30MG TAB             80000652
80000653   HB IV SET SECONDARY                   80000653
80000654   HB OXYCODONE SR 10MG TAB              80000654
80000655   HB ERYTHROMYCIN BASE 500MG TAB        80000655
80000656   HB LEVOFLOXACIN 500 MG TAB            80000656
80000657   HB NEOMYCIN SULFATE 500MG TAB         80000657
80000658   HB HYDROMORPHONE 4 MG TAB             80000658
80000659   HB ALBUTEROL SULFATE 1 MG             80000659
80000660   HB SODIUM CHLORIDE INHALATION SOL     80000660



                                           189
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
80000661   HB WARFARIN 5MG TAB                      80000661
80000662   HB SEPTRA SUSP 10ML                      80000662
80000663   HB FLEET ENEMA                           80000663
80000664   HB PRIMAPORE DRESSING                    80000664
80000665   HB TEGADERM-HP DRESSING                  80000665
80000666   HB COVERLET                              80000666
80000667   HB STERI STRIP                           80000667
80000668   HB SUTURE, SILK 3-0 30INCH               80000668
80000669   HB CATH, ROBINSON RBR 2EYE               80000669
80000670   HB BISACODYL 1 SUPP                      80000670
80000671   HB CIMETIDINE 300MG TAB                  80000671
80000672   HB EXT. TUBING                           80000672
80000673   HB BAG URINE LEG DISP                    80000673
80000674   HB ALLOPURINOL 300MG TAB                 80000674
80000675   HB FOLIC ACID 1 MG TAB                   80000675
80000676   HB INVESTIGATIONAL DRUG                  80000676
80000677   HB PHENAZOPYRIDINE 200MG TAB             80000677
80000678   HB ACETAMINOPHEN 600MG TAB               80000678
80000679   HB D5LR IV-ADD                           80000679
80000680   HB D5/0.2% NACL IV-ADD                   80000680
80000681   HB DIPHENHYDRAM 12.5MG ELIX              80000681
80000682   HB CLOTRIMAZOLE 1 TROCHE                 80000682
80000683   HB FUROSEMIDE 40MG PO                    80000683
80000684   HB ACETAMINOPHEN 120MG SUPP              80000684
80000685   HB PROCHLORPERAZINE 10MG TAB             80000685
80000686   HB MORPHINE 15MG IR TAB                  80000686
80000687   HB VANCOMYCIN 125MG CAP                  80000687
80000688   HB CIPROFLOXACIN 750MG TAB               80000688
80000690   HB D5/0.9% NACL IV-ADD                   80000690
80000691   HB TINCTURE OF OPIUM 10% SOL             80000691
80000692   HB POTASSIUM CHLORIDE IV-ADD             80000692
80000693   HB MAGNESIUM SULFATE IV ADD              80000693
80000694   HB LANSOPRAZOLE 15 MG CAPSULE            80000694
80000695   HB SALINE FLUSH 10ML (2ML DU)            80000695
80000696   HB ENEMA OIL                             80000696
80000697   HB COVER-ROLL DRESSING/BOX               80000697
80000698   HB ELECTROSURGICAL HAND CONT             80000698
80000699   HB Y-TUBE CONNECTOR                      80000699
80000700   HB EXTENSION TUBE "T"                    80000700
80000701   HB STERILE FIELD BARRIER                 80000701
80000702   HB CATH IV ANGIO 16GX1-1/4 #3288         80000702
80000703   HB INFUSION SET BUTTERFLY 23             80000703



                                              190
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
80000704   HB IV START KIT                        80000704
80000705   HB HUBER NEEDLE 22X 3/4                80000705
80000706   HB BIO PATCH                           80000706
80000707   HB TAXOL FILTER TUBING LINE            80000707
80000708   HB CVC DBL LUMEN                       80000708
80000709   HB AMPICILLIN 500MG CAP                80000709
80000710   HB MYCOLOG CREAM 15GM                  80000710
80000711   HB BACLOFEN 10MG TAB                   80000711
80000713   HB PHENAZOPYRIDINE 100MG TAB           80000713
80000714   HB DIPHENHYDRAM 50MG CAP               80000714
80000715   HB LOMOTIL 2.5MG TAB                   80000715
80000716   HB FLUDROCORTISONE 0.2MG TAB           80000716
80000717   HB NIFEDIPINE 10MG CAP                 80000717
80000718   HB HYDROXYUREA 500MG CAP               80000718
80000719   HB METHYL SAL/MENTHOL OINT (BENGA      80000719
80000720   HB MEPERIDINE 50MG TAB                 80000720
80000721   HB NTG 0.4MG SL                        80000721
80000722   HB IPRATORPIUM BROMIDE 1 MG            80000722
80000723   HB TRIMETHOBENZ 200MG SUPP             80000723
80000724   HB SORBAVIEW DRESSING                  80000724
80000725   HB REFLUX VALVE                        80000725
80000726   HB PHARMACY ITEM                       80000726
80000727   HB IV SET STND                         80000727
80000728   HB OMEPRAZOLE SRC 20MG CAP             80000728
80000729   HB HUBER NEEDLE 20X 3/4                80000729
80000730   HB DIPHENHYDRAM 25MG CAP               80000730
80000737   HB LAB PCR NPM1P INTERP & RPT*         80000737
80000741   HB LAB PCR FLT3P INTERP & RPT          80000741
80000742   HB DEXTRO-AMPHETAMINE 5MG TABLET       80000742
80000752   HB LAB CREATININE ERL*                 80000752
80000757   HB LAB HIV RNA QNT INTRP & RPT         80000757
80000758   HB LAN UREA NITROGEN ERL*              80000758
80000759   HB LAB AHT TRANSGLUTAMINASE*           80000759
80000760   HB LAB QUANT HBV BY BDNA - I*          80000760
80000761   HB HCV RNA QUANT INTERP                80000761
80000765   HB FUROSEMIDE TB 20MG                  80000765
80000768   HB SPINE PRE-OPERATIVE CLASS           80000768
80000771   HB ORTHO PRE-OPERATIVE CLASS           80000771
80000774   HB STATISTIC PORTABLE 310              80000774
80000775   HB LAB MEPERIDINE*                     80000775
80000779   HB LAB PROTEIN S FREE AG*              80000779
80000780   HB LAB PROTEIN S TOTAL AG*             80000780



                                            191
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
80000781   HB LAB ANEUVYSION*                        80000781
80000782   HB LAB PTT LA*                            80000782
80000836   HB NEOMYCIN 1GM O                         80000836
80000852   HB SULINDAC 150MG TABLET                  80000852
80000882   HB ACETAMINOPHEN 160MG/5ML ELX 2          80000882
80000889   HB ALLOPURINOL 200MG                      80000889
80000891   HB VITAMIN E 400IU CAPSULE                80000891
80000898   HB AMINOCAPROIC ACID 500MG TABLET         80000898
80000905   HB AMITRIPTYLINE HCL 100MG TAB            80000905
80000921   HB ASPIRIN 600MG SUPPOSITORY              80000921
80000928   HB AZATHIOPRIN 200MG PO                   80000928
80000935   HB BENZTROPINE MES 1MG TABLET             80000935
80000942   HB BETHANECHOL 20MG O                     80000942
80000944   HB BETHANECHOL 50MG TABLET                80000944
80000975   HB CHLORAMBUCIL 2MG TABLET                80000975
80000977   HB CHLORPHENIRAM 8MG TB                   80000977
80000979   HB CHLORPROMAZINE 50MGO                   80000979
80000981   HB CHLORPROMAZINE 200MG TABLET            80000981
80000982   HB CHLORPROM SYR 10MG                     80000982
80000984   HB CHOLESTYRAMINE 8GM O                   80000984
80000986   HB AMOXAPINE 100MG TABLET                 80000986
80000993   HB CLONIDINE HCL 0.2MG TABLET             80000993
80000996   HB CLONIDINE 0.6MG     O                  80000996
80001005   HB COLCHICINE 0.6MG TABLET                80001005
80001007   HB CORTISONE ACETATE 25MG TABLET          80001007
80001009   HB CYANOCOBALAMIN 100MCG TABLET           80001009
80001012   HB CYANOCOBALAMIN 1000MCG/ML              80001012
80001014   HB CYCLOBENZAPRIN 20MGO                   80001014
80001016   HB CYPROHEPTADINE 4MG TABLET              80001016
80001019   HB DANTROLENE 50MG CAP                    80001019
80001023   HB DESIPRAMINE 150MG TABLET               80001023
80001025   HB DEXAMETHASONE 1 MGO                    80001025
80001028   HB DEXAMETHASONE 3 MGO                    80001028
80001030   HB DEXAMETHASONE 10MG O                   80001030
80001032   HB DEXAMETHASON 1MG SOL                   80001032
80001039   HB DICYCLOMINE HCL 10MG CAPSULE           80001039
80001042   HB VIVONEX FLAVOR PACKET                  80001042
80001044   HB DIGOXIN 0.25MG TABLET                  80001044
80001046   HB DIGOXIN .5MG    TAB                    80001046
80001049   HB DIGOXIN 0.05MG/ML ELIXIR 2.5ML         80001049
80001051   HB DIGOXIN ELIX .25MG                     80001051
80001053   HB HEPATIC AID 2PACK                      80001053



                                               192
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80001055   HB DSS CAP 200MG                      80001055
80001058   HB DOCUSATE SOD 100MG/30ML SYRUP      80001058
80001060   HB DIPHENHYDRAMINE 50MG CAPS          80001060
80001062   HB DIPHENHYDRAM 12.5 SY               80001062
80001065   HB DIPHENOXYLATE/ATROPINE TAB         80001065
80001067   HB LOMOTIL LIQ 2.5MG                  80001067
80001069   HB PHENYTOIN SRC 300MG                80001069
80001072   HB PHENYTOIN TAB 100MG                80001072
80001074   HB PHENYTOIN SUS 200MG                80001074
80001076   HB PHENYTOIN SUS 400MG                80001076
80001078   HB DIPYRIDAMOLE 50MG TABLET           80001078
80001081   HB DISOPYRAMIDE 100MG CAPSULE         80001081
80001083   HB DISOPYRAMIDE 200MG O               80001083
80001085   HB DISULFIRAM 500MG O                 80001085
80001088   HB DOXEPIN 50MG CAPSULE               80001088
80001090   HB DOXEPIN 100MG CAPSULE              80001090
80001122   HB FERROUS SULF 300MG/5ML LIQ         80001122
80001131   HB FLUPHENAZN ELX 1MG                 80001131
80001138   HB FUROSEMIDE TB 160MG                80001138
80001145   HB GUAIFENESIN 30CC                   80001145
80001152   HB CAPTOPRIL 100MG TABLET             80001152
80001161   HB THEOPHYLIN SRT 400MG               80001161
80001168   HB KCL 50MEQ PO                       80001168
80001170   HB ACETAZOLAMD 500MGTB                80001170
80001172   HB PHENYTOIN SRC 600MG                80001172
80001174   HB COLCHICINE 1MG O                   80001174
80001175   HB NORETHINDRON AC 10MG               80001175
80001177   HB PROPRANOLOL 100MG O                80001177
80001179   HB PROCARBAZINE 100MG                 80001179
80001181   HB VERAPAMIL 10MG P                   80001181
80001184   HB DIPIVEFRIN 0.1% OPTH DROPS 5ML     80001184
80001188   HB ATENOLOL 100MG TABLET              80001188
80001190   HB AMILORIDE HCL 5MG TABLET           80001190
80001191   HB AMILORIDE 10MG                     80001191
80001202   HB NITROGLYCERIN 0.2MG/HR ADH. PA     80001202
80001204   HB NITROGLYCERIN 0.6MG/HR ADH. PA     80001204
80001209   HB SUCRALFATE 1GM TABLET              80001209
80001211   HB NIFEDIPINE 20MG                    80001211
80001213   HB METOCLOPRAM TAB 20MG               80001213
80001218   HB TRAZODONE 100MG TABLET             80001218
80001225   HB DILTIAZEM HCL 30MG TABLET          80001225
80001227   HB DILTIAZEM HCL 90MG TABLET          80001227



                                           193
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80001232   HB DAPSONE 25MG TABLET                 80001232
80001234   HB RANITIDINE 75MG PO                  80001234
80001236   HB DILTIAZEM 15MG PO                   80001236
80001241   HB HEMORRHOIDAL HC 25MG SUPPOS         80001241
80001243   HB BICITRA 15ML                        80001243
80001250   HB NETILMICIN 20MG 1M                  80001250
80001255   HB OXYBUTYNIN 5MG TABLET               80001255
80001257   HB PROCHLORPER TAB 5MG                 80001257
80001259   HB SALSALATE 750MG TABLET              80001259
80001266   HB TRACE METALS VIAL 10 ML             80001266
80001268   HB LABETALOL 150MG TB                  80001268
80001275   HB TRAZODONE 200MG PO                  80001275
80001280   HB GLYBURIDE 10MG TAB                  80001280
80001286   HB GLUCOSE TAB X1                      80001286
80001289   HB METOCLOPRAM SYR 10ML                80001289
80001291   HB NICOTINE POLACRILEX 2MG GUM         80001291
80001293   HB DOXEPIN 200MG CAP                   80001293
80001295   HB SENOKOT 4 TABS                      80001295
80001323   HB HALOPERIDOL 1MG TABLET              80001323
80001324   HB HALOPERIDOL 2MG TABLET              80001324
80001326   HB HALOPERIDOL 10MG TABLET             80001326
80001328   HB VITAMIN,MULTI 2TAB                  80001328
80001330   HB HYDRALAZINE 50MG TABLET             80001330
80001332   HB HYDROCHLOROTHIAZIDE 50MG TABLE 80001332
80001333   HB HCTZ 100MG O                        80001333
80001339   HB HYDROCRT ACET 50MG P                80001339
80001340   HB HYDROCRT ACET 100MGP                80001340
80001346   HB HYDROXCOLBLAMN 2MG P                80001346
80001351   HB HYDROXYZNE 25MG TAB                 80001351
80001353   HB HYDROXYZINE PAM 50MG CAP            80001353
80001355   HB HYDROXYZNE 25MG SUSP                80001355
80001356   HB HYDROXYZNE 50MG SUSP                80001356
80001358   HB HYDROXYZNE 25MG SYRP                80001358
80001362   HB HYOSCYAMINE TB.15MG                 80001362
80001363   HB HYOSCYAMINE .25MG O                 80001363
80001365   HB IBUPROFEN 400MG TABLET              80001365
80001367   HB IMIPRAMINE HCL 10MG TABLET          80001367
80001369   HB IMIPRAMINE HCL 50MG TABLET          80001369
80001370   HB IMIPRAMINE 100MG TAB                80001370
80001372   HB GUAIFENESIN TB 400MG                80001372
80001374   HB ISONIAZID 300MG TABLET              80001374
80001376   HB ISOSORBIDE DN 5MG TABLET            80001376



                                            194
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80001377   HB ISOSORBIDE DN 10MG TABLET           80001377
80001379   HB ISOSORBIDE 30MG TAB                 80001379
80001381   HB ATTAPULGITE 60CC                    80001381
80001383   HB LACTULOSE 10GM/15ML SYRUP 15ML      80001383
80001385   HB LACTULOSE 45CC O                    80001385
80001386   HB LACTULOSE 60CC O                    80001386
80001388   HB LACTULOSE 60CC ENEMA                80001388
80001390   HB LEVODOPA 500MG TAB                  80001390
80001392   HB LEVORPHANOL 4MG O                   80001392
80001393   HB LEVOTHYROXINE SODIUM 0.05MG TA      80001393
80001395   HB LEVOTHYROXINE SODIUM 0.15MG TA      80001395
80001397   HB LEVOTHYROXINE SODIUM 0.2MG TAB      80001397
80001399   HB L-THYROXINE .4MG                    80001399
80001400   HB L-THYROXINE .5MG                    80001400
80001402   HB LIOTHYRONINE SODIUM 25MCG TABL      80001402
80001404   HB LITHIUM CARBONATE 300MG CAP         80001404
80001406   HB LOPERAMIDE 2MG CAPSULE              80001406
80001408   HB LOXAPINE SUCCINATE 50MG CAPSUL      80001408
80001409   HB LOXAPIN 100MG CAP                   80001409
80001413   HB MECLIZINE HCL 12.5MG TABLET         80001413
80001415   HB MECLIZINE 50MG                      80001415
80001416   HB MEDROXYPROGESTERONE ACET 2.5MG80001416
80001422   HB MEPROBAMATE 400MG TABLET            80001422
80001430   HB METHENAMINE MANDELATE 500MG TA 80001430
80001432   HB METHIMAZOLE 5MG TABLET              80001432
80001434   HB METHIMAZOLE 20MG                    80001434
80001436   HB METHOCARBAMOL 750MG TABLET          80001436
80001438   HB METHOCARBAMOL 1.5GM                 80001438
80001439   HB METHYLDOPA 250MG TABLET             80001439
80001468   HB MULTIVITAMINS,THER W-MINERALS       80001468
80001470   HB MEXILETINE HCL 150MG CAPS           80001470
80001472   HB MEXILETINE 400MG PO                 80001472
80001474   HB AMIODARONE 400MG PO                 80001474
80001477   HB DEXAMETHASONE 6MG TABLET            80001477
80001479   HB CIMETIDINE 800MG PO                 80001479
80001481   HB CLOBETASOL PROPIONATE 0.05% CR      80001481
80001482   HB BUSPIRONE TAB 2.5MG                 80001482
80001484   HB BUSPIRONE TAB 7.5MG                 80001484
80001486   HB BUSPIRONE TAB 15MG                  80001486
80001488   HB NORFLOXACIN 400MG TABLET            80001488
80001491   HB VERAPAMIL HCL 240MG CAP SR PEL      80001491
80001495   HB CAPTOPRIL 12.5MG TABLET             80001495



                                            195
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80001497   HB BICITRA 30ML                       80001497
80001498   HB TRAZODONE 300MG                    80001498
80001502   HB LOVOSTATIN TB 10MG                 80001502
80001504   HB H FLU B/DIPHTH VAC                 80001504
80001505   HB ALBUTEROL SULFATE 4MG SR           80001505
80001507   HB THIOSULFATE 2GM                    80001507
80001509   HB FLUOXETINE CAP 40MG                80001509
80001512   HB CHLORHEXIDINE GLUC 0.12% LIQ 4     80001512
80001514   HB MISOPROSTOL 200MCG                 80001514
80001516   HB MISOPROSTOL 600MCG                 80001516
80001518   HB DILTIAZEM SR 60MG                  80001518
80001520   HB DILTIAZEM-XR 120MG                 80001520
80001521   HB COLESTIPOL HCL 5GM PACKET          80001521
80001523   HB OMEPRAZOLE 20MG CAPSULE            80001523
80001525   HB NAPROXEN 250MG TABLET              80001525
80001527   HB NEOMYCIN 500MG SUSP                80001527
80001528   HB NEOMYCIN 1GM SUSP                  80001528
80001530   HB NIACIN 250MG SR CAP                80001530
80001532   HB NIACIN 50MG TABLET                 80001532
80001534   HB NIACIN 250MG TAB                   80001534
80001535   HB NIACIN 500MG TABLET                80001535
80001541   HB NTG 2 INCH OINT                    80001541
80001542   HB NTG 3 INCH OINT                    80001542
80001544   HB NITROGLYCERIN 0.4MG TAB            80001544
80001546   HB NORETHINDRONE 5MG O                80001546
80001548   HB NORTRIPTYLINE HCL 25MG CAP         80001548
80001558   HB OXANDRELONE TB 2.5MG               80001558
80001564   HB PANCREATIN 2 TAB                   80001564
80001565   HB PANCREATIN 3 TAB                   80001565
80001574   HB PENTAZOCINE/NALOXONE 50-0.5MG      80001574
80001578   HB PERPHENAZINE 4MG TABLET            80001578
80001581   HB PHENELZINE SULFATE 15MG TABLET     80001581
80001616   HB NIFEDIPINE-CC 90MG TABLET          80001616
80001618   HB PRAZOSIN 2MG CAPSULE               80001618
80001620   HB PRAZOSIN 5MG CAPSULE               80001620
80001621   HB PREDNISOLONE 5MG TABLET            80001621
80001623   HB PREDNISOLONE 15MG O                80001623
80001625   HB PREDNISOLONE 30MG O                80001625
80001627   HB PREDNISONE 2.5MG TABLET            80001627
80001628   HB PREDNISONE 5MG TABLET              80001628
80001630   HB PREDNISONE 20MG TABLET             80001630
80001632   HB PREDNISONE 40MG TAB                80001632



                                           196
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
80001634   HB PRIMAQUINE 26.3MG TABLET             80001634
80001635   HB PRIMIDONE 250MG SUSP                 80001635
80001637   HB PRIMIDONE 250MG TABLET               80001637
80001639   HB PRIMIDONE 750MG TAB                  80001639
80001643   HB PROCHLORPER 5MG SYR                  80001643
80001644   HB PROCHLORPERAZINE MALEATE 5MG S 80001644
80001646   HB PROCHLORPER TAB 25MG                 80001646
80001648   HB PROMETHAZINE HCL 12.5MG SUPPOS 80001648
80001650   HB PROMETHAZINE 12.5MG                  80001650
80001651   HB PROMETHAZINE HCL 25MG TAB            80001651
80001653   HB PROPRANOLOL 10MG TABLET              80001653
80001655   HB PROPRANOLOL 30MG O                   80001655
80001657   HB PROPRANOLOL 50MG O                   80001657
80001658   HB PROPRANOLOL 60MG O                   80001658
80001662   HB PROPYLTHIOURACIL 50MG TABS           80001662
80001664   HB PROPYLTHIOUR 200MGTB                 80001664
80001666   HB PSEUDOEPHEDRINE 60MG TABLET          80001666
80001667   HB PSEUDEPHDRN 30MG SYR                 80001667
80001669   HB CLOMIPRAMINE 100MG O                 80001669
80001671   HB MARCAINE SPINAL 0.75% AMP 2ML        80001671
80001673   HB SUCRALFATE 2GM O                     80001673
80001674   HB RANITIDIN SYR 150MG                  80001674
80001676   HB LOPERAMIDE CAP 4MG                   80001676
80001678   HB LOPERAMIDE LIQ 4MG                   80001678
80001685   HB CLOZARIL TAB 100MG                   80001685
80001687   HB DIDEOXYINISINE 100MG CHEW TABL       80001687
80001688   HB DIDEOXYINISINE 150MG CHEW TABL       80001688
80001694   HB VERAPAMIL HCL 180MG CAP SR           80001694
80001696   HB LEVOTHYROXINE SODIUM 0.075MG T       80001696
80001697   HB ATENOLOL 25MG TABLET                 80001697
80001701   HB DESIPRAMINE 10MG TABLET              80001701
80001706   HB LEVOTHYROXINE SODIUM 0.125MG T       80001706
80001710   HB TICLOPIDINE HYDROCHLORIDE 250M       80001710
80001711   HB NICOTINE 7MG/24HR ADH. PATCH         80001711
80001713   HB NICOTINE 21MG/24HR ADH. PATCH        80001713
80001719   HB DEXTROAMPHET TB 20MG                 80001719
80001722   HB NITROGLYCERIN 0.3MG/HR ADH. PA       80001722
80001726   HB POLYCITRA-K 15CC                     80001726
80001727   HB POLYCITRA-K 30CC                     80001727
80001729   HB SALSALATE 1500MG                     80001729
80001731   HB SELENIUM TB 100MCG                   80001731
80001733   HB FUROSEMIDE SOL 20MG                  80001733



                                             197
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80001734   HB FUROSEMIDE SOL 40MG                 80001734
80001767   HB ARGININE 2.5MEQ                     80001767
80001774   HB GLIPIZIDE 20MG O                    80001774
80001781   HB AZATHIOPRINE 75MG O                 80001781
80001783   HB LITHIUM CO3 1200MG                  80001783
80001790   HB CARBAMAZE SUSP 400MG                80001790
80001797   HB CHLORPROM TAB 300MG                 80001797
80001799   HB FLUPHENAZN ELX 15MG                 80001799
80001806   HB PYRIMETHAMINE 100MGO                80001806
80001813   HB TRAZODONE 400MG                     80001813
80001820   HB SOTALOL TAB 200MG                   80001820
80001824   HB AMITRIPTYLINE 300MG                 80001824
80001826   HB HALOPERIDOL 20MG PO                 80001826
80001827   HB VALPROIC ACID 750MG                 80001827
80001831   HB NORTRIPTYLN 150MG CP                80001831
80001833   HB PAROXETINE TB 10MG                  80001833
80001834   HB PAROXETINE TB 15MG                  80001834
80001836   HB PAROXETINE HCL 30MG TABLET          80001836
80001838   HB PAROXETINE TB 60MG                  80001838
80001840   HB FLUPHENAZN TAB 20MG                 80001840
80001842   HB WARFARIN 1MG TABLET                 80001842
80001843   HB CHLORPROM TAB 600MG                 80001843
80001845   HB LORATIDIN TB 10MG                   80001845
80001847   HB AMLODIPINE 2.5MG TABLET             80001847
80001849   HB AMLODIPIN TB 7.5MG                  80001849
80001850   HB AMLODIPINE 10MG TABLET              80001850
80001852   HB AMLODIPIN TB 20MG                   80001852
80001854   HB NABUMETONE 750MG TABLET             80001854
80001856   HB SUCRALFATE SUS 100MG                80001856
80001857   HB SUCRALFATE SUS 200MG                80001857
80001861                                   80001861
           HB MEDROXYPROGESTERONE ACET 5MG T
80001870   HB IBUPROFEN SUS 100MG                 80001870
80001872   HB IBUPROFEN SUS 300MG                 80001872
80001873   HB IBUPROFEN SUS 400MG                 80001873
80001875   HB ISONIAZID SYR 300MG                 80001875
80001880   HB PREDNISON SOL 10 MG                 80001880
80001908   HB VENLAFAXINE HCL 50MG TABLET         80001908
80001910   HB VENLAFAXIN TB 100MG                 80001910
80001912   HB VENLAFAXIN TB 150MG                 80001912
80001913   HB VENLAFAXIN TB 200MG                 80001913
80001920   HB CAL ACETATE 667MG                   80001920
80001927   HB GABAPENTIN 400MG CAPSULE            80001927



                                            198
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
80001936   HB FLUVOXAMINE TB 50MG                  80001936
80001943   HB NEFAZODONE TAB 300MG                 80001943
80001950   HB ASPIRIN 125MG SUPPOSITORY            80001950
80001959   HB LEVOCARNITINE 250MG CAPSULE          80001959
80001966   HB NEUTRA-PHOS 1.25GM PACKET            80001966
80001973   HB ACETAMIN DRP 1ML                     80001973
80001980   HB THEOPHYLIN 400MG/250                 80001980
80002059   HB ISOSORBIDE MN 30MG                   80002059
80002061   HB ISOSORBIDE MN 90MG                   80002061
80002066   HB NELFINAVIR TB 750MG                  80002066
80002068   HB ALBENDAZOLE TB 400MG                 80002068
80002075   HB ATORVASTATIN TB 20MG                 80002075
80002082   HB RX - PT ENCOUNT / PT OWN MED         80002082
80002084   HB RX-RN INSERVICE 60MN                 80002084
80002089   HB CEPACOL 2LOZ                         80002089
80002091   HB PHENYTOIN SUS 50MG                   80002091
80002105   HB GABAPENTN CAP 1200MG                 80002105
80002107   HB FLUVOXAMINE TB 300MG                 80002107
80002112   HB METFORMIN 2000MG                     80002112
80002114   HB NEVIRAPINE TB 400MG                  80002114
80002119   HB LANSOPRAZOLE CP 60MG                 80002119
80002121   HB VFC-COMVAX 0.5CC                     80002121
80002128   HB DOXAZOSIN TB 8MG                     80002128
80002130   HB DOXAZOSIN TB 12MG                    80002130
80002135   HB MIDODRINE TB 10MG                    80002135
80002137   HB GUAIFENESN-ER 600MG                  80002137
80002142   HB DILTIAZEM-XR 540MG                   80002142
80002158   HB DOXEPIN LIQ 25MG                     80002158
80002160   HB CARVEDILOL 6.25MG                    80002160
80002165   HB CARVEDILOL 50MG                      80002165
80002172   HB ANAGRELIDE CP 0.5MG                  80002172
80002174   HB ANAGRELIDE CP 1.5MG                  80002174
80002176   HB ANAGRELIDE CP 2.5MG                  80002176
80002178   HB VITAMIN E 1000U                      80002178
80002180   HB DSS CAP 300MG                        80002180
80002181   HB DSS CAP 400MG                        80002181
80002183   HB DSS SYR 300MG                        80002183
80002185   HB OPIUM, TINC. 20GTTS                  80002185
80002186   HB OPIUM, TINC. 30GTTS                  80002186
80002194   HB RALOXIFENE PO 60MG                   80002194
80002196   HB MAALOX+ ES 1CC                       80002196
80002198   HB RISPERIDON SOL 0.5MG                 80002198



                                             199
  Charge
   Code                  Description         CPT Code OP/Default Price   IP/ED Price
80002214   HB RX-ROUT. INTERV 10MN           80002214
80002217   HB DELAVIRDINE TB 600MG           80002217
80002219   HB WARFARIN 6MG                   80002219
80002228   HB BUPROPION-SR 100MG             80002228
80002233   HB BUPROPION-SR 450MG             80002233
80002235   HB CARBAMAZE-XR 400MG             80002235
80002237   HB CARBAMAZE-XR 800MG             80002237
80002267   HB CITALOPRAM 60MG                80002267
80002272   HB REPAGLINIDE 2 MG               80002272
80002274   HB REPAGLINIDE 4MG                80002274
80002279   HB LEFLUNOMIDE TB 20MG            80002279
80002281   HB LEFLUNOMIDE TB 60MG            80002281
80002288   HB SEVELAMER 4CAP                 80002288
80002290   HB GLIPIZIDE-XL 10MG              80002290
80002297   HB LAMIVUDIN TB 100MG             80002297
80002302   HB IRBASARTAN TB 225MG            80002302
80002304   HB TRIENTINE CAP 250MG            80002304
80002311   HB VALPROIC SYR 2500MG            80002311
80002318   HB ROSEGLITAZON TB 1MG            80002318
80002320   HB ROSEGLITAZON TB 4MG            80002320
80002325   HB DONEPEZIL TAB 10MG             80002325
80002332   HB MESALAMINE-CR 1250MG           80002332
80002334   HB VERAPAMIL-SR 360MG             80002334
80002341   HB PIOGLITAZON TB 7.5MG           80002341
80002343   HB PIOGLITAZON TB 30MG            80002343
80002348   HB MONTELUKAST TB 10MG            80002348
80002350   HB TIZANIDINE TB 2MG              80002350
80002355   HB VITAMIN E LIQ 30CC             80002355
80002357   HB SORBITOL 70% 30CC              80002357
80002371   HB LEVETIRACETM TB 750MG          80002371
80002373   HB LEVETIRACETM TB 1500MG         80002373
80002378   HB OXCARBAZEPIN TB 900MG          80002378
80002387   HB OXYBUTYNIN SYR 2MG             80002387
80002389   HB OXYBUTYNIN SYR 5MG             80002389
80002391   HB ZONISAMIDE CP 200MG            80002391
80002393   HB ZONISAMIDE CP 400MG            80002393
80002399   HB SEVELAMER TAB 800MG            80002399
80002400   HB SEVELAMER TAB 1600MG           80002400
80002402   HB SEVELAMER TAB 3200MG           80002402
80002404   HB SEVELAMER TAB 4800MG           80002404
80002406   HB MIRTAZAPN SOLTB 30MG           80002406
80002407   HB MIRTAZAPN SOLTB 45MG           80002407



                                       200
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80002423   HB METOPROLOL-XL 50MG                 80002423
80002425   HB METOPROLOL-XL 100MG                80002425
80002427   HB METOPROLOL-XL 150MG                80002427
80002430   HB URSODIOL TAB 500MG                 80002430
80002441   HB VALSARTAN TAB 160MG                80002441
80002446   HB TOLTERODINE-LA 2MG                 80002446
80002448   HB TOLTERODINE-LA 6MG                 80002448
80002450   HB AQUAPHOR 14GM                      80002450
80002483   HB DOFETILIDE CP 250MCG               80002483
80002490   HB MAGNES OX TAB 800MG                80002490
80002497   HB RIVASTIGMIN CP 1.5MG               80002497
80002499   HB RIVASTIGMIN CP 6MG                 80002499
80002506   HB PCS-DIPHENHYD 50MGP                80002506
80002513   HB LACTOBACILLUS 3CAP                 80002513
80002520   HB LISINOPRIL TB 40MG                 80002520
80002522   HB ARIPIPRAZOLE TB 15MG               80002522
80002529   HB GALANTAMINE TAB 4MG                80002529
80002543   HB BIRTH CONTROL 1TAB                 80002543
80002548   HB OC-LIDOCAIN 1% 2CCAMP              80002548
80002550   HB RISPERID SOLUTB .5MG               80002550
80002552   HB RISPERID SOLUTB 2MG                80002552
80002553   HB RISPERID SOLUTB 3MG                80002553
80002555   HB LANSOPRAZOL SUS 15MG               80002555
80002557   HB TOPIRAMATE SRC 25MG                80002557
80002559   HB TOPIRAMATE SRC 75MG                80002559
80002560   HB TOPIRAMATE SRC 100MG               80002560
80002562   HB FENOFIBRATE CP 200MG               80002562
80002564   HB SENNA SYR 15CC                     80002564
80002566   HB SENNA SYR 30CC                     80002566
80002567   HB MEMANTINE TB 5MG                   80002567
80002569   HB MEMANTINE TB 20MG                  80002569
80002571   HB EPLERENONE TB 50MG                 80002571
80002573   HB VITAMN,MULT ADEK 1CC               80002573
80002575   HB VITAMN,MULT ADEK 5CC               80002575
80002576   HB ENTACAPONE TB 200MG                80002576
80002580   HB DESMOPRESIN TB 0.1MG               80002580
80002582   HB PSYLLIUM 15CC                      80002582
80002583   HB PSYLLIUM 30CC                      80002583
80002585   HB PYRIDOSTIGMN 120MGTB               80002585
80002587   HB PYRIDOXINE TB 50MG                 80002587
80002589   HB PYRIMETHAMINE 25MG TABLET          80002589
80002590   HB QUININE SULFATE 325MG CAPS         80002590



                                           201
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80002594   HB SULFASALAZINE 1GM                  80002594
80002596   HB SULFSALAZINE EC .5GM               80002596
80002597   HB SULFSALAZINE EC 1GM                80002597
80002599   HB SENOKOT 1 TAB                      80002599
80002601   HB SIMETHICONE 40MG TAB               80002601
80002603   HB SIMETHICONE 160MG TB               80002603
80002605   HB SIMETHICONE 1.2CC                  80002605
80002606   HB SOD BICARB TAB 325MG               80002606
80002608   HB SOD BICARB TAB 1 GM                80002608
80002610   HB SOD CHLORIDE 2GM TAB               80002610
80002612   HB SORBITOL 70% 100CC                 80002612
80002613   HB SPIRONOLACTONE 25MG TABLET         80002613
80002615   HB SPIRONOLACTONE 75MG                80002615
80002617   HB SULFADIAZINE 1GM O                 80002617
80002619   HB TERBUTALINE SULFATE 2.5MG TABL     80002619
80002620   HB TERBUTALINE SULFATE 5MG TABLET     80002620
80002622   HB TETRACAINE .3% 5CC P               80002622
80002626   HB THEOPHYLIN TAB 200MG               80002626
80002628   HB THEOPHYLIN ELIX 100MG              80002628
80002629   HB THEOPHYLIN ELIX 200MG              80002629
80002631   HB THEOPHYLIN SRC 125MG               80002631
80002633   HB THIAMINE 50MG TABLET               80002633
80002635   HB THIAMINE 250MG TAB                 80002635
80002636   HB THIOTHIXENE 2MG CAPSULE            80002636
80002638   HB THIOTHIXENE 10MG CAPSULE           80002638
80002640   HB THYROID 15MG TABLET                80002640
80002642   HB THYROID 60MG TABLET                80002642
80002643   HB THYROID 100MG                      80002643
80002645   HB THYROID 150MG                      80002645
80002647   HB THYROID 240MG TABLET               80002647
80002649   HB TOLAZAMIDE 100MG TABLET            80002649
80002650   HB TOLAZAMIDE 250MG TABLET            80002650
80002652   HB TOLNAFTATE 1% CREAM 15GM           80002652
80002654   HB TRIAMCINOLONE 0.025% OINT 15GM     80002654
80002656   HB TRIAMCINOLONE 0.025% CREAM 15G     80002656
80002658   HB TRIAMCN CR .1% 80GM                80002658
80002659   HB TRIAMCN SPRAY 23GM                 80002659
80002661   HB TRIAMTERENE 50MG CAPSULE           80002661
80002663   HB TRIFLUOPERAZINE HCL 1MG TABLET     80002663
80002692   HB ZINC OXIDE 25% PASTE               80002692
80002694   HB ZINC SULF 220MG TAB                80002694
80002696   HB CETIRIZINE SYR 5MG                 80002696



                                           202
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80002697   HB CETIRIZINE SYR 10MG                80002697
80002699   HB CETIRIZINE TAB 10MG                80002699
80002701   HB GLIMEPIRIDE TAB 1MG                80002701
80002703   HB GLIMEPIRIDE TAB 3MG                80002703
80002704   HB GLIMEPIRIDE TAB 4MG                80002704
80002706   HB GLIMEPIRIDE TAB 8MG                80002706
80002708   HB ESCITALOPRAM TB 10MG               80002708
80002710   HB ESCITALOPRAM TB 20MG               80002710
80002712   HB MAGNES CL SATB 64MG                80002712
80002713   HB MAGNES CL SATB 128MG               80002713
80002715   HB FENOFIBRATE TB 145MG               80002715
80002717   HB NATEGLINIDE TB 120MG               80002717
80002719   HB OS-CAL D 500MG 2TAB                80002719
80002720   HB MELOXICAM TB 7.5MG                 80002720
80002724   HB RIFAXIMIN TB 200MG                 80002724
80002726   HB TRIMETHOBENZ 300MG O               80002726
80002727   HB GUAIFENESIN-SF 5CC                 80002727
80002729   HB GUAIFENESIN-SF 15CC                80002729
80002731   HB DIMETAPP 10CC ELIX                 80002731
80002740   HB DONNATAL TABLET                    80002740
80002742   HB DONNATAL 5CC ELIX                  80002742
80002743   HB DONNATAL 15CC ELIX                 80002743
80002745   HB CAFERGOT 2 TAB                     80002745
80002747   HB CHLORZOXAZONE 500MG TABLET         80002747
80002749   HB HYDRALAZINE/RESERPINE/HCTZ TAB     80002749
80002750   HB OS-CAL D 250MG 1TAB                80002750
80002752   HB SPIRONOLACT/HCTZ 25/25 TAB         80002752
80002754   HB DYAZIDE 2 CAP                      80002754
80002759   HB GUAIFENESIN-DM 15CC                80002759
80002761   HB PROMETHAZIN EXP 5CC                80002761
80002763   HB PROMETHAZIN EXP 15CC               80002763
80002768   HB CHLORASEPTIC (EQ) SPRAY 180ML      80002768
80002770   HB DONNAGEL 30CC                      80002770
80002772   HB LACTINEX PACKET                    80002772
80002773   HB LACTINEX PDR 2 PK                  80002773
80002775   HB ACIDOPHILUS/BULGARICUS TAB CHE     80002775
80002777   HB MYLANTA DOUBLE-STRENGTH TAB        80002777
80002779   HB MAALOX+ ES 30CC                    80002779
80002780   HB PERICOLACE 2 CAP                   80002780
80002782   HB PHOSPHO-SODA 15CC                  80002782
80002786   HB QUININE SULFATE 260MG TAB          80002786
80002788   HB CARBIDOPA/LEVO 10/100 TAB          80002788



                                           203
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
80002789   HB SINEMET 10/100 2TAB                   80002789
80002791   HB FLEET MINERAL OIL ENEMA               80002791
80002798   HB GAVISCON 2 TABS                       80002798
80002805   HB ACETAMINOPHEN W/ CODEINE 60MG         80002805
80002814   HB B & O SUPPRETTES NO.16-A              80002814
80002816   HB URISED 2 TAB                          80002816
80002818   HB ASPIRIN,EC 2TABS                      80002818
80002819   HB NPH/REGULAR INSULIN                   80002819
80002821   HB KONDREMUL 15 CC                       80002821
80002823   HB CARBIDOPA/LEVO 25/100 TAB             80002823
80002825   HB MIRALAX 17GM                          80002825
80002826   HB LEVETIRACETAM SOL 250MG               80002826
80002828   HB STAT - PACU - 1ST HOUR                80002828
80002830   HB STAT - 3SP - 1ST HOUR                 80002830
80002832   HB DIABETES EDUCATION INIT 1 HR          80002832
80002833   HB DIABETES EDUCATION ADDL 30 MIN        80002833
80002835   HB RX-ADR:AV/DET 20MINS                  80002835
80002837   HB RX - ORDER CLARIFICATIONS             80002837
80002839   HB RX-IDS 30MINS                         80002839
80002841   HB RX - MEETINGS / CLIN OP FORUM         80002841
80002842   HB RX - NONPROTOCOL INIT                 80002842
80002844   HB RX-PT ROUNDS 60MINS                   80002844
80002846   HB DULOXETINE DRCAP 20MG                 80002846
80002848   HB DULOXETINE DRCAP 60MG                 80002848
80002849   HB CILOSTAZOL TAB 50MG                   80002849
80002851   HB LANTHANUM CO3 500MG                   80002851
80002853   HB LORATIDIN SYR 5MG                     80002853
80002856   HB VALSARTAN TAB 40MG                    80002856
80002858   HB EXCEDRIN MIGRAINE 1TAB                80002858
80002860   HB TIPRANAVIR CAP 250MG                  80002860
80002862   HB ROPINIROLE TB 1MG                     80002862
80002863   HB ROPINIROLE TB 4MG                     80002863
80002867   HB PREGABALIN CP 50MG                    80002867
80002869   HB RX- DAILY MAR REVIEW                  80002869
80002871   HB TESTOST 1% GEL 5GM                    80002871
80002872   HB PINDOLOL TB 5MG                       80002872
80002878   HB ACCUZYME OINT 1GM                     80002878
80002906   HB AMYL NITRITE AMPUL 0.3ML              80002906
80002908   HB ASA & COD 30MG 1TAB                   80002908
80002910   HB ATOVAQUONE 250MG TABLET               80002910
80002911   HB ATROPINE 0.3MG O                      80002911
80002913   HB ATROPINE 0.6MG O                      80002913



                                              204
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
80002915   HB AVEENO                              80002915
80002917   HB AZATADINE 2MG                       80002917
80002920   HB BASALGEL 1TAB                       80002920
80002922   HB BELLADONNA TINC 5GTT                80002922
80002924   HB BELLERGAL-S (EQ) TABLET             80002924
80002926   HB BORIC ACID 10% OINTMENT             80002926
80002927   HB BROMPHENIRAM 4MG TB                 80002927
80002929   HB BUMETANIDE 2.5MG PO                 80002929
80002931   HB BUSPIRONE TAB 50MG                  80002931
80002933   HB CAFERGOT PB 2 TAB                   80002933
80002934   HB CAL GLUCONATE 1GM O                 80002934
80002936   HB CALAMINE OINT                       80002936
80002938   HB CALCIUM CARBONATE 1250MG TABLE 80002938
80002940   HB CAMPHOR/PHENOL LIQUID 45 ML         80002940
80002941   HB CARBAMAZE SUSP 800MG                80002941
80002943   HB CARRASYN V GEL 1GM                  80002943
80002945   HB CASTOR OIL                          80002945
80002957   HB CEFTIBUTEN 400MG                    80002957
80002966   HB CHLORAMPHN SUS 200MG                80002966
80002968   HB CHLORPHENIRAM 2MG SY                80002968
80002970   HB CHLORPROM SPAN 75MG                 80002970
80002971   HB CHLORPROM SPAN 150MG                80002971
80002973   HB CHLORPROPAMIDE 250MG TABLET         80002973
80002975   HB CHOLESTY RESIN 4GM                  80002975
80002977   HB CIMETIDINE 200MG TABLET             80002977
80002980   HB CLOFAZIMINE 50MG CAPSULE            80002980
80002982   HB CLOFAZIMINE CP 150MG                80002982
80002984   HB CLOMIPHENE CITRATE 50MG TABLET      80002984
80002987   HB CORTISONE AC 10MG TB                80002987
80002989   HB CROMOLYN 1CAP                       80002989
80002991   HB DANAZOL 100MG CAPSULE               80002991
80002993   HB DEHYDROCHOL AC 125MG                80002993
80002994   HB DEHYDROCHOLIC ACID 250MG TABLE 80002994
80002996   HB DELAVIRDINE TB 100MG                80002996
80002998   HB DES 1MG         O                   80002998
80003000   HB DES PHOSPHATE 50MG O                80003000
80003002   HB DEXTRANOMER BEADS PACKET            80003002
80003003   HB DEXTROAMPHET SP 10MG                80003003
80003005   HB DEXTROAMPHET TB 15MG                80003005
80003007   HB DEXTRO-AMPHETAMINE 5MG SPANSUL 80003007
80003009   HB DHT .25MG      CAP                  80003009
80003010   HB DIAZOXIDE 100MG      O              80003010



                                            205
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80003012   HB DIAZOXIDE 50MG CAPSULE              80003012
80003014   HB DICLOFENAC 25MG PO                  80003014
80003016   HB DICUMAROL 25MG TABLET               80003016
80003017   HB DICYCLOMINE 10MG SY                 80003017
80003019   HB DIDEOXYINISINE 50MG CHEW TABLE      80003019
80003021   HB DIETHYLSTILBESTROL 5MG TAB          80003021
80003023   HB DIHYDROTACHYSTEROL 0.125MG TAB 80003023
80003024   HB DIHYDROTACHYSTEROL 0.2MG TABLE 80003024
80003026   HB DIMENHYDRINAT 50MGLQ                80003026
80003028   HB DIMETAPP 1 TAB                      80003028
80003030   HB DOFETILIDE CP 125MCG                80003030
80003032   HB DOMEBORO 2 TAB                      80003032
80003033   HB DOMEBORO PWDR 2 PKT                 80003033
80003035   HB DONEPEZIL TAB 20MG                  80003035
80003041   HB ENCAINIDE CAP 25MG                  80003041
80003043   HB ER-ACETAMIN+COD. 30MG               80003043
80003045   HB ER-DIPHENHYDRAM 25MG                80003045
80003046   HB ERGOLOID MESYLATES 1MG TAB          80003046
80003048   HB ER-IBUPROFEN 400MG                  80003048
80003050   HB ER-NAPROXEN 250MG                   80003050
80003052   HB ER-TERFENADINE 60MG                 80003052
80003054   HB ER-THEOPH SR 300MG                  80003054
80003055   HB ER-VICODIN 4PK                      80003055
80003057   HB ETHACRYNIC 100MG O                  80003057
80003212   HB NTG-TRANSDERMAL 40CM                80003212
80003219   HB OXYBUTYNIN SYR 1MG                  80003219
80003221   HB PAROMOMYCIN SULFATE 250MG CAPS 80003221
80003235   HB PERGOLIDE MESYLATE 0.25MG TABL      80003235
80003242   HB PHENAZOPYRIDINE 10MG/ML SOLN 6      80003242
80003244   HB PHENYLEPHRINE HCL 0.5% NASAL D      80003244
80003397   HB QUINIDINE SULFATE 200MG TAB         80003397
80003436   HB DICLOXACILN 125MGCAP                80003436
80003438   HB DIMENHYDRINATE 50MG/ML VIAL         80003438
80003443   HB ASPIRIN 325MG TABLET EC             80003443
80003445   HB ERGOTAMINE 0.2MG/1ML                80003445
80003452   HB GALLAMINE 200MG P                   80003452
80003459   HB HYDRALAZINE 10MG TABLET             80003459
80003585   HB ALTERNAGEL 30CC                     80003585
80003587   HB AMANTADINE 200MG                    80003587
80003592   HB AMINOPHYLLINE 500MG/20ML VL         80003592
80003594   HB AMITRIPTYLINE HCL 25MG TAB          80003594
80003599   HB AMM CHLORIDE 50MEQIV                80003599



                                            206
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
80003614   HB PC-ATROPINE 0.4MG 1ML*               80003614
80003615   HB ATROPINE .5MG P                      80003615
80003617   HB ATROPINE 2MG IVP                     80003617
80003622   HB BENZOCAINE 20% ORAL SPRAY 60 M       80003622
80003624   HB BENZONATATE 200MG                    80003624
80003629   HB BENZTROPINE 4MG O                    80003629
80003631   HB BETAMETHASONE DIP 0.05% OINT 1       80003631
80003638   HB BISACODYL 10MG O                     80003638
80003640   HB BISACODYL 20MG O                     80003640
80003643   HB BRETYLIUM 1500MG P                   80003643
80003645   HB CALCITRIOL 0.5MCG CAPSULE            80003645
80003647   HB CALCIUM CARB 2TAB                    80003647
80003648   HB CALCIUM CARB 3TAB                    80003648
80003650   HB CAL CHLORIDE 2GM P                   80003650
80003652   HB NEOCALGLUCON 5CC                     80003652
80003654   HB NEOCALGLUCON 30CC                    80003654
80003655   HB CARBAMAZEPINE 200MG TABLET           80003655
80003657   HB CARISOPRODOL 700MG                   80003657
80003668   HB CHLORAMBUCIL 4MG O                   80003668
80003670   HB CHLORPROMAZINE 25MGO                 80003670
80003861   HB KCL 60MEQ PO                         80003861
80003891   HB MG-PLUS 2TAB                         80003891
80003907   HB VERAPAMIL 80MG TABLET                80003907
80003914   HB NIFEDIPINE-XL 60MG TABLET            80003914
80003930   HB MULTIVITAMINS,THERAPEUTIC TABL       80003930
80003937   HB BUMETANIDE 1MG TABLET                80003937
80003982   HB METOCLOPRAM SYR 20ML                 80003982
80003991   HB NORTRIPTYLN 50MG CAP                 80003991
80003992   HB NORTRIPTYLN 100MG CAP                80003992
80003994   HB GLIPIZIDE 2.5MG O                    80003994
80003996   HB GLIPIZIDE 10MG TABLET                80003996
80003998   HB MAG SULFATE AMP 1-7                  80003998
80003999   HB NALTREXONE HCL 50MG TABLET           80003999
80004001   HB GLYCERIN 50% SOLUTION 220 ML         80004001
80004003   HB GEMFIBROZIL 300MG O                  80004003
80004006   HB SALIVA SUBSTITUTE SOLUTION 120       80004006
80004008   HB FLECAINIDE 100MG TABLET              80004008
80004012   HB RANITIDINE 300MG TABLET              80004012
80004014   HB HALOPERIDOL 0.5MG TABLET             80004014
80004017   HB HALOPERIDOL 5MG TABLET               80004017
80004019   HB HALOPERIDOL 5MG SOLN                 80004019
80004021   HB HYDRALAZINE 25MG TABLET              80004021



                                             207
  Charge
   Code                 Description             CPT Code OP/Default Price   IP/ED Price
80004026   HB HC 1% 6OCC LOT                    80004026
80004044   HB HYDROXYZINE PAM 25MG CAP          80004044
80004049   HB HYDROXYZNE 10MG SYRP              80004049
80004051   HB HYDROXYZNE 100MG SYR              80004051
80004056   HB HYOSCYAMINE SR.375MG              80004056
80004058   HB IBUPROFEN 600MG TABLET            80004058
80004063   HB INDOMETHACIN 50MG CAPSULE         80004063
80004065   HB LUGOLS 5GTT SOLN                  80004065
80004067   HB ISOSORBIDE 10MG SL                80004067
80004070   HB ISOSORBIDE DN 20MG TABLET         80004070
80004072   HB ATTAPULGITE 30CC                  80004072
80004074   HB LACTOBACILLUS ACIDOPHILUS TABL    80004074
80004079   HB LACTULOSE ENEMA 300CC             80004079
80004081   HB LEVODOPA 250MG TAB                80004081
80004086   HB LEVOTHYROXINE SODIUM 0.1MG TAB    80004086
80004088   HB LEVOTHYROXINE SODIUM 0.175MG T    80004088
80004095   HB LIOTHYRONINE SODIUM 50MCG TABL    80004095
80004097   HB LITHIUM CO3 600MG                 80004097
80004104   HB MANNITOL 50CC                     80004104
80004109   HB MEDROXYPROGES 10 MG               80004109
80004127   HB METHOCARBAMOL 500MG TABLET        80004127
80004141   HB METOLAZONE 5MG TABLET             80004141
80004236   HB PC-NTG 1/150GR TAB                80004236
80004284   HB PHENYLEPHRINE 0.25% NASAL SPRY    80004284
80004286   HB PROPAFENONE HCL 150MG TAB         80004286
80004287   HB PHYTONADIONE 5MG TABLET           80004287
80004289   HB PILOCARPINE HCL 4% DROPS 15 ML    80004289
80004291   HB KCL 40MEQ LIQUID 30ML             80004291
80004294   HB KCL 15MEQ LIQUID 11.25ML          80004294
80004296   HB KCL 30MEQ LIQUID 22.5ML           80004296
80004298   HB K ACETATE 20MEQ IV                80004298
80004300   HB K ACETATE 40MEQ IV                80004300
80004301   HB KCL 10MEQ PO                      80004301
80004303   HB KCL 30MEQ PO                      80004303
80004305   HB K PHOSPHATE 30MEQ P               80004305
80004307   HB BUPROPION HCL 75MG TABLET         80004307
80004309   HB PRAZOSIN 1MG CAPSULE              80004309
80004314   HB PREDNISOLONE 10MG O               80004314
80004316   HB PREDNISOLONE 20MG O               80004316
80004321   HB PREDNISONE 10MG TABLET            80004321
80004323   HB PREDNISONE 30MG TAB               80004323
80004328   HB PRIMIDONE 50MG TABLET             80004328



                                          208
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80004330   HB PRIMIDONE 500MG TAB                 80004330
80004332   HB PROBENECID 1GM TAB                  80004332
80004337   HB PROCHLORPERAZINE 25MG SUPP          80004337
80004339   HB PROMAZINE 25MG TAB                  80004339
80004344   HB PROMETHAZINE 50MGTB                 80004344
80004346   HB PROPRANOLOL 20MG TABLET             80004346
80004351   HB PROPANTHELINE 15MG TABLET           80004351
80004360   HB CLOMIPRAMINE HYDROCHLORIDE 50M 80004360
80004362   HB CLOMIPRAMINE 150MG O                80004362
80004367   HB ASPIRIN BUFFERED 325MG TAB          80004367
80004378   HB LEVOTHYROXINE SODIUM 0.025MG T      80004378
80004387   HB VERAPAMIL HCL 120MG CAP SR          80004387
80004417   HB POLYCITRA 15CC                      80004417
80004428   HB DILTIAZEM-XR 180MG                  80004428
80004430   HB DILTIAZEM-SR 300MG                  80004430
80004431   HB MESALAMINE 400MG TABLET             80004431
80004433   HB MESALAMINE SR 1200MG                80004433
80004435   HB TERAZOSIN HCL 2MG TABLET            80004435
80004437   HB TERAZOSIN TAB 10MG                  80004437
80004439   HB SERTRALINE HCL 50MG TABLET          80004439
80004440   HB SERTRALINE HCL 100MG TABLET         80004440
80004442   HB SERTRALINE TAB 200MG                80004442
80004444   HB FLUOXETINE ORAL SUSP 1MG/6ML 6      80004444
80004446   HB FLUOXETINE LIQ 30MG                 80004446
80004447   HB FLUOXETINE LIQ 40MG                 80004447
80004451   HB CAL CARB SUSP 2.5CC                 80004451
80004453   HB CAL CARB SUSP 10CC                  80004453
80004454   HB CAL CARB SUSP 15CC                  80004454
80004456   HB MG-PLUS 4TABS                       80004456
80004458   HB ARGININE 2 MEQ                      80004458
80004460   HB ARGININE 5 MEQ                      80004460
80004461   HB ARGININE 6 MEQ                      80004461
80004463   HB FINASTERID TB 2.5MG                 80004463
80004465   HB FINASTERID TB 10 MG                 80004465
80004467   HB MESALAMINE SR 1600MG                80004467
80004469   HB FLUOXETINE CAP 60MG                 80004469
80004470   HB FLUOXETINE LIQ 60MG                 80004470
80004472   HB BUPROPION 200MG TAB                 80004472
80004474   HB LITHIUM CO3 900MG                   80004474
80004476   HB LITHIUM CO3 1500MG                  80004476
80004477   HB LITHIUM CIT 900MG                   80004477
80004479   HB LITHIUM CIT 1500MG                  80004479



                                            209
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80004481   HB CARBAMAZE SUSP 200MG                80004481
80004483   HB CARBAMAZE SUSP 600MG                80004483
80004484   HB CARBAMAZEPINE 600MG                 80004484
80004486   HB CHLORPROM SYR 25MG                  80004486
80004488   HB CHLORPROMAZINE 50MG TABLET          80004488
80004490   HB CHLORPROM TAB 400MG                 80004490
80004492   HB FLUPHENAZN TAB 7.5MG                80004492
80004493   HB NIFEDIPINE 50MG                     80004493
80004495   HB NIFEDIPINE XL 120MG                 80004495
80004497   HB PYRIMETHAMINE 50MGO                 80004497
80004499   HB SULFADIAZINE 2GM O                  80004499
80004500   HB FLUPHENAZN TAB 2MG                  80004500
80004502   HB BUMETANIDE 2 MG PO                  80004502
80004504   HB BUMETANIDE 4 MG PO                  80004504
80004506   HB FLUOXETINE HCL 10MG CAPSULE         80004506
80004509   HB SOTALOL HCL 80MG TABLET             80004509
80004511   HB SOTALOL HCL 160MG TABLET            80004511
80004513   HB SOTALOL TAB 240MG                   80004513
80004514   HB AMITRIPTYLINE 200MG                 80004514
80004517   HB HALOPERIDOL 15MG PO                 80004517
80004543   HB AMLODIPIN TB 15MG                   80004543
80004545   HB NABUMETONE 500MG TABLET             80004545
80004547   HB NABUMETONE TB 1000MG                80004547
80004550   HB SUCRALFATE SUS 500MG                80004550
80004559   HB CHLOROTHIAZ SUS 50MG                80004559
80004561   HB IBUPROFEN SUS 50MG                  80004561
80004563   HB IBUPROFEN SUS 200MG                 80004563
80004566   HB IBUPROFEN SUS 600MG                 80004566
80004568   HB METHYLDOPA SUS 125MG                80004568
80004569   HB PREDNISON SOL 1MG                   80004569
80004571   HB PREDNISON SOL 5 MG                  80004571
80004578   HB DEXAMETHASONE 16MG O                80004578
80004580   HB SUCRALFATE SUS 1GM                  80004580
80004613   HB CAL ACETATE 1334MG                  80004613
80004614   HB CAL ACETATE 2001MG                  80004614
80004616   HB GABAPENTIN 100MG CAPSULE            80004616
80004618   HB GABAPENTIN 300MG CAPSULE            80004618
80004620   HB GABAPENTN CAP 500MG                 80004620
80004621   HB GABAPENTN CAP 600MG                 80004621
80004623   HB LAMOTRIGINE 25MG TABLET             80004623
80004625   HB LAMOTRIGINE TB 100MG                80004625
80004627   HB LAMOTRIGINE TB 250MG                80004627



                                            210
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
80004629   HB FLUVOXAMINE TB 100MG                80004629
80004630   HB FLUVOXAMINE TB 150MG                80004630
80004632   HB NEFAZODONE TAB 50MG                 80004632
80004634   HB NEFAZODONE TAB 200MG                80004634
80004636   HB NEFAZODONE TAB 400MG                80004636
80004637   HB NEFAZODONE TAB 500MG                80004637
80004639   HB METFORMIN HCL 850MG TABLET          80004639
80004641   HB AMMONIA AROMATIC AMPUL 0.33ML       80004641
80004643   HB ASPIRIN 81MG TABLET CHEW            80004643
80004644   HB ATROPINE 8MG/20ML VIAL              80004644
80004650   HB GLYCERIN PEDIATRIC SUPPOS           80004650
80004652   HB LEVOTHYROXINE SODIUM 0.088MG T      80004652
80004655   HB MEDROXYPROGESTERONE ACET 10MG80004655
80004659   HB NEUTRA-PHOS-K 1.45GM PACKET         80004659
80004660   HB B & O SUPPRETTES NO. 15-A (30M      80004660
80004662   HB PSYLLIUM POWDER 30ML                80004662
80004664   HB ACETAMINOPHEN 120MG SUPPOS.         80004664
80004666   HB ACETAMINOPHEN 325MG TABLET          80004666
80004669   HB FERROUS SULFATE 325MG TAB           80004669
80004671   HB THEOPHYLIN 800MG/500                80004671
80004673   HB LOSARTEN TAB 12.5MG                 80004673
80004677   HB LOSARTEN TAB 100MG                  80004677
80004682   HB MOM 30CC                            80004682
80004687   HB TRIAMTERENE/HCTZ 50/25 (DYAZID      80004687
80004689   HB LEVOTHYROXINE SODIUM 0.112MG T      80004689
80004696   HB BENAZEPRIL HCL 40MG TABLET          80004696
80004703   HB ALLOPURINOL ORAL SUSP 20MG/ML       80004703
80004705   HB FLECAINIDE ORAL SUSP 5MG/ML 1M      80004705
80004712   HB CAFFEINE CITRATED POWDER            80004712
80004719   HB PROCANBID 500MG                     80004719
80004733   HB LEVOCARNITINE 330MG TABLET          80004733
80004740   HB GUAIFENESIN-DM 10CC                 80004740
80004742   HB ER-VICODIN 6PK                      80004742
80004756   HB PEPTO-BISMOL 30CC                   80004756
80004763   HB SIMVASTATIN TB 20MG                 80004763
80004765   HB SIMVASTATIN TB 60MG                 80004765
80004772   HB MIRTAZAPIN TB 30MG                  80004772
80004779   HB MIRTAZAPIN TB 60MG                  80004779
80004786   HB BUSPIRONE TAB 30MG                  80004786
80004788   HB METOCLOPRAM TAB 30MG                80004788
80004793   HB NEUTRA-PHOS 2.5GM PK                80004793
80004865   HB ANAGRELIDE CP 1 MG                  80004865



                                            211
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
80004893   HB CARBAMAZEPINE 800MG                80004893
80004923   HB BUPROPION-SR 300MG                 80004923
80004939   HB VITAMIN E LIQ .5CC                 80004939
80004946   HB METOPROLOL 150MG                   80004946
80004948   HB MOM 60CC                           80004948
80004962   HB REPAGLINIDE 1 MG                   80004962
80004976   HB CELECOXIB CP 300MG                 80004976
80004978   HB SEVELAMER 2CAP                     80004978
80004985   HB TESTOST-TTS 5MG/DAY                80004985
80004992   HB IRBASARTAN TB 75MG                 80004992
80004999   HB VALPROIC SYR 1000MG                80004999
80005001   HB VALPROIC SYR 1500MG                80005001
80005006   HB TAMSULOSIN CP 0.4MG                80005006
80005090   HB SEVELAMER TAB 400MG                80005090
80005093   HB SEVELAMER TAB 2400MG               80005093
80005095   HB SEVELAMER TAB 4000MG               80005095
80005097   HB MIRTAZAPN SOLTB 15MG               80005097
80005136   HB OXYBUTYNIN-XL 15MG                 80005136
80005145   HB AGGRENOX 200/25 1CAP               80005145
80005152   HB FEXOFENADINE 180MG                 80005152
80005159   HB LANSOPRAZOL SR SUS 15MG            80005159
80005161   HB ETODOLAC TAB 400MG                 80005161
80005184   HB MAGNES OX TAB 1200MG               80005184
80005248   HB LANSOPRAZOL SUS 30MG               80005248
80005250   HB TOPIRAMATE SRC 50MG                80005250
80005253   HB FENOFIBRATE TB 108MG               80005253
80005255   HB SENNA SYR 10CC                     80005255
80005257   HB SENNA SYR 20CC                     80005257
80005260   HB MEMANTINE TB 10MG                  80005260
80005262   HB EPLERENONE TB 25MG                 80005262
80005264   HB EPLERENONE TB 100MG                80005264
80005266   HB VITAMN,MULT ADEK 2CC               80005266
80005269   HB LETROZOLE TAB 2.5MG                80005269
80005276   HB PYRIDOSTIGMN 180MGSR               80005276
80005278   HB PYRIDOXINE TB 25MG                 80005278
80005280   HB PYRIDOXINE TB 100MG                80005280
80005283   HB QUININE 600MG O                    80005283
80005285   HB SULFASALAZINE 500MG TABLET         80005285
80005287   HB SULFASALAZINE 1.5GM                80005287
80005292   HB SENOKOT 2 TAB                      80005292
80005294   HB SIMETHICONE 80MG TAB               80005294
80005296   HB SIMETHICONE 0.6CC                  80005296



                                           212
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
80005299   HB SODIUM BICARB 650MG TABLET            80005299
80005301   HB SODIUM CHLORIDE 1GM TABLET            80005301
80005303   HB SOD FLUOR .5MG CHEW                   80005303
80005306   HB SPIRONOLACTONE 50MG                   80005306
80005308   HB SPIRONOLACTONE 100MG                  80005308
80005310   HB SULINDAC 200MG TABLET                 80005310
80005319   HB THEOPHYLIN SRC 250MG                  80005319
80005326   HB THIAMINE HYDROCHLORIDE 100MG T        80005326
80005349   HB TRIAMCINOLONE 0.1% CREAM 15GM         80005349
80005358   HB TRIFLUOPERAZ 1MGSOL                   80005358
80005365   HB TRIMETHOPRIM 100MG TABLET             80005365
80005372   HB VITAMIN A 50000U PO                   80005372
80005374   HB WARFARIN 2.5MG TABLET                 80005374
80005379   HB WARFARIN 25 MG TAB                    80005379
80005381   HB TRIFLUOPERAZINE 2MG TABLET            80005381
80005397   HB GLIMEPIRIDE TAB 6MG                   80005397
80005461   HB DONNAGEL 15CC                         80005461
80005466   HB LACTINEX PDR 3 PK                     80005466
80005468   HB LACTINEX TAB 2 TAB                    80005468
80005473   HB FLEET ENEMA PEDIATRIC                 80005473
80005475   HB PHOSPHO-SODA 75CC                     80005475
80005482   HB FLEET ENEMA                           80005482
80005489   HB GAVISCON (EQ) CHEW TABLET             80005489
80005507   HB ATROSEPT TABLET                       80005507
80005509   HB AMIODARONE 600MG                      80005509
80005514   HB KONDREMUL 30CC                        80005514
80005516   HB MIRALAX 8.5GM                         80005516
80005519   HB LEVETIRACETAM SOL 500MG               80005519
80005521   HB PICC FOLLOW UP/DC*                    80005521
80005522   HB RN'S CIRCULATING                      80005522
80005523   HB PICC FOLLOW UP/DC                     80005523
80005524   HB PICC DRESSING CHANGE                  80005524
80005525   HB IV START/RE-START                     80005525
80005526   HB RN'S CIRCULATING*                     80005526
80005527   HB IV START (STATISTICAL)                80005527
80005528   HB IV RESTART (STATISTICAL)              80005528
80005529   HB IV START COMP (STATISTICAL)           80005529
80005530   HB IV RESTART COMP (STATISTICAL)         80005530
80005531   HB IV DRESSING CHANGE (STAT)             80005531
80005532   HB IV VENIPUNCTURE (STAT)                80005532
80005533   HB IV CHEMOTHERAPY IVP (STAT)            80005533
80005534   HB IV CHEMO INF 1ST HOUR (STAT)          80005534



                                              213
  Charge
   Code                  Description             CPT Code OP/Default Price   IP/ED Price
80005535   HB IV CHEMO INF EA ADDL HR.(STAT)     80005535
80005536   HB IV CHEMO INF & IVP                 80005536
80005537   HB AMINOPHYLIN    5MGP                80005537
80005538   HB AMINOPHYLIN 10MGP                  80005538
80005542   HB RX-DRUG INT'XN 20MIN               80005542
80005544   HB RX-MD DRUG INFO 10MN               80005544
80005549   HB RX - CHEMO ORDER REVIEW            80005549
80005551   HB DULOXETINE DRCAP 30MG              80005551
80005558   HB LORATIDIN SYR 10MG                 80005558
80005565   HB ROPINIROLE TB 0.5MG                80005565
80005572   HB PREGABALIN CP 75MG                 80005572
80005574   HB RX- OUTPT UOS 771019               80005574
80005588   HB ALBUTEROL SULF 2MG/5ML SYRUP       80005588
80005590   HB ALTERNAGEL 1CC                     80005590
80005595   HB AMINOPHYLINE 500MGPR               80005595
80005597   HB AMINOPHYLN LQ 2.5ML                80005597
80005611   HB ANALGESIC BALM OINT.               80005611
80005613   HB ATORVASTATIN TB 60MG               80005613
80005618   HB AURANOFIN 3MG                      80005618
80005620   HB AVEENO BATH PACKETS OILATED        80005620
80005625   HB BELLADENAL-S 1 TAB                 80005625
80005627   HB BELLERGAL 2 TAB                    80005627
80005629   HB BETHANECHOL 30MG O                 80005629
80005632   HB BUMETANIDE 1.5MG PO                80005632
80005634   HB BUSPIRONE TAB 40MG                 80005634
80005636   HB CAFERGOT PB 1 SUPP                 80005636
80005641   HB CALCIUM CARB 1250MG/5ML SUSP 5     80005641
80005643   HB CALDESENE POWD 2OZ                 80005643
80005648   HB CASCARA AROMATIC EXT 5ML           80005648
80005678   HB CHLORPROPAMIDE 500MG               80005678
80005680   HB CHOLINE BITARTRATE/D-PANTHENOL 80005680
80005694   HB CYCLOSERINE 250MG PO               80005694
80005701   HB DELAVIRDINE TB 200MG               80005701
80005708   HB DEXTROAMPHET TB 2.5                80005708
80005717   HB DICHLORPHENAM 25MG                 80005717
80005724   HB DIETHYLSTILBESTROL 1MG TAB         80005724
80005731   HB DIMETANE EXP-DC 5CC                80005731
80005773   HB FENOFIBRATE CP 134MG               80005773
80005778   HB FLUOXYMESTERONE 2MG TABLET         80005778
80005780   HB FLUPHENAZN ELX 5MG                 80005780
80005782   HB FLUTAMIDE 250MG                    80005782
80005785   HB GALANTAMINE SUS 8MG                80005785



                                           214
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80005787   HB GEMFIBROZIL 150MG O                 80005787
80005789   HB GRISEFULVN 125MG TAB                80005789
80005794   HB GUANETHIDINE SULFATE 10MG TABL      80005794
80005796   HB HALOPERIDOL 25MG PO                 80005796
80005921   HB OSCAL-500 2TAB                      80005921
80005926   HB PEDIAZOLE 5ML                       80005926
80005928   HB PEDIAZOLE 10CC                      80005928
80005930   HB PEMOLINE TB 18.75MG                 80005930
80005931   HB PEMOLINE TB 37.5MG                  80005931
80005933   HB PENICILLAMINE 125MG CAPSULE         80005933
80005938   HB PERGOLIDE MESYLATE 0.05MG TABL      80005938
80005940   HB PERGOLIDE MESYLATE 0.5MG TABLE      80005940
80005942   HB PERICOLACE SY 10CC                  80005942
80005944   HB PERPHENAZIN SOL 2MG                 80005944
80005951   HB POLYCITRA 30CC                      80005951
80005972   HB REPAGLINIDE 2.5MG                   80005972
80005993   HB SOD FLUORIDE 30ML                   80005993
80005995   HB SULFAMETHOX 500MGSU                 80005995
80005998   HB SULFINPYRAZONE 100MG TABLET         80005998
80006000   HB SULFISOXAZ SUS .5GM                 80006000
80006002   HB TAC 1CC                             80006002
80006007   HB THIABENDAZL SUS .5GM                80006007
80006009   HB THIAMINE 500MG TAB                  80006009
80006014   HB THIORIDAZIN 25MG SOL                80006014
80006016   HB THIORIDAZINE 10MG TABLET            80006016
80006021   HB THIOTHIXENE 5MG SOL                 80006021
80006023   HB TIOPRONIN TAB 100MG                 80006023
80006025   HB TIZANIDINE TB 10MG                  80006025
80006028   HB TOLBUTAMIDE 250MG                   80006028
80006030   HB TOLTERODIN TB 0.5MG                 80006030
80006032   HB TOPIRAMATE SRC 15MG                 80006032
80006037   HB TRIFLUOPERAZ 15MG                   80006037
80006039   HB TRIHEXYPHEN 5MG SR                  80006039
80006044   HB TUSSIORGAN-DM 5CC                   80006044
80006046   HB ULTRASE MT 12 2CAP                  80006046
80006048   HB URACIL MUSTARD 1MG                  80006048
80006051   HB VALDECOXIB TAB 10MG                 80006051
80006053   HB VALPROIC SYR 1750MG                 80006053
80006055   HB VERAPAMIL ORAL SUSP 25MG/ML 1M      80006055
80006058   HB VITAMIN E LIQ 1CC                   80006058
80006060   HB VITAMIN E LIQ 3CC                   80006060
80006062   HB VITAMINS A,C,AND D DROPS 50 ML      80006062



                                            215
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
80006067   HB VITAMN,THER 2TAB                       80006067
80006069   HB VITAMN,THER+MIN 2TB                    80006069
80006104   HB VITAMIN A AND D OINTMENT               80006104
80006106   HB ACETIC ACID 0.25% IRRIG. 1000M         80006106
80006111   HB ASCORBIC ACID 100MG TABLET             80006111
80006118   HB ERGOTAMINE TARTRATE/CAFFEINE T 80006118
80006120   HB CALCIUM CHLORIDE 10% SYRINGE 1         80006120
80006125   HB CHLORPHENIRAMINE 4MG TABLET            80006125
80006127   HB CHLORPROMAZINE 10MG TABLET             80006127
80006134   HB CYPROHEPTADINE 2MG O                   80006134
80006141   HB DIMENHYDRINATE 50MG TABLET             80006141
80006143   HB DIOTHANE OINT                          80006143
80006144   HB DIPHENHYDRAMINE 25MG CAPS              80006144
80006146   HB SALSALATE 500MG TABLET                 80006146
80006148   HB THEOPHYLIN ELIX 15CC                   80006148
80006155   HB FIORICET TABLET                        80006155
80006158   HB FLUDROCORTISONE ACETATE 0.1MG          80006158
80006160   HB FLUORESCEIN 5% P                       80006160
80006162   HB FUROSEMIDE TB 80MG                     80006162
80006164   HB HYDROCHLOROTHIAZIDE 25MG TABLE 80006164
80006165   HB HYDROXYZINE HCL 10MG TABLET            80006165
80006167   HB ISOSORBIDE DN 40MG TAB SA              80006167
80006169   HB LACRI-LUBE S.O.P. OPTH OINT 7G         80006169
80006174   HB MAGNESIUM CITRATE SOLUTION 300         80006174
80006176   HB METARAMINOL 1CC                        80006176
80006181   HB MINERAL OIL STERILE LUB FOR ER         80006181
80006188   HB TRANYLCYPROMINE SULFATE 10MG T 80006188
80006190   HB HYDROXYCHLOROQUINE SO4 200MG T 80006190
80006192   HB SSKI 1GM/ML SOLUTION 30ML              80006192
80006197   HB PROBENECID 500MG TABLET                80006197
80006199   HB PROCAINAMIDE 500MG CAPSULE             80006199
80006204   HB PROPRANOLOL 80MG TABLET                80006204
80006206   HB PYRIDOXINE 50MG P                      80006206
80006208   HB ROBAXISAL                              80006208
80006211   HB DIETHYLSTILBESTROL 50MG/ML AMP         80006211
80006213   HB THEOPHYLIN TAB 100MG                   80006213
80006215   HB TRIAMCINOLONE P                        80006215
80006218   HB PANCRELIPASE TABLET                    80006218
80006220   HB CYANOCOBAL 100MCG P                    80006220
80006222   HB WARFARIN 2MG TABLET                    80006222
80006227   HB ACTIVATED CHARCOAL 250MG TABLE 80006227
80006229   HB IV-TPN-NEPHRAMINE RX                   80006229



                                               216
  Charge
   Code                   Description               CPT Code OP/Default Price   IP/ED Price
80006234   HB SOD CHLORIDE .5GMTB                   80006234
80006236   HB ACETAMINOPHEN 650MG SUPPOS.           80006236
80006238   HB FERROUS SULF 75MG/0.6ML DROPS         80006238
80006241   HB VITAMIN C DROPS/DOSE                  80006241
80006243   HB BROMOCRIPTINE 2.5MG TABLET            80006243
80006245   HB CYCLOBENZAPRINE 10MG TABLET           80006245
80006250   HB PHENAZOPYRIDINE HCL 200MG TABL        80006250
80006252   HB DANAZOL 200MG CAPSULE                 80006252
80006257   HB FLUORESCEIN SODIUM 9MG OPTH ST 80006257
80006259   HB AMIODARONE HCL 200MG                  80006259
80006261   HB ATROPINE OPH UNG 1%                   80006261
80006264   HB CIMETIDINE 150MG/ML VIAL 2 ML         80006264
80006266   HB METHAZOLAMIDE 50MG TABLET             80006266
80006268   HB MINOXIDIL 2.5MG TABLET                80006268
80006271   HB FLUORESCEIN SODIUM 10% AMPUL 5        80006271
80006273   HB NADOLOL 80MG TABLET                   80006273
80006275   HB ACETAMINOPHEN 600MG                   80006275
80006280   HB ACETAZOLAMD 1000MGSQ                  80006280
80006282   HB AL HYDROXIDE 15CC                     80006282
80006357   HB NEOCALGLUCON 10CC                     80006357
80006364   HB CHARCOAL 2 TABS                       80006364
80006488   HB DOXEPIN LIQ 10MG                      80006488
80006493   HB ERGOCALCIFEROL 50000U CAPSULE         80006493
80006495   HB VITAMIN D   2CC SOL                   80006495
80006530   HB FOLIC ACID 4MG O                      80006530
80006532   HB FUROSEMIDE TB 40MG                    80006532
80006537   HB GLYCERIN ADULT SUPP                   80006537
80006544   HB METOCLOPRAM TAB 10MG                  80006544
80006546   HB CAPTOPRIL 25MG TABLET                 80006546
80006551   HB LITHIUM CIT 300MG                     80006551
80006553   HB ACETAMIN SUP 1200MG                   80006553
80006560   HB IBUPROFEN 800MG TABLET                80006560
80006567   HB NAPROXEN SOD 550MGTB                  80006567
80006569   HB CALCITRIOL 1MCG                       80006569
80006574   HB HYDRALAZINE 150MG O                   80006574
80006576   HB VERAPAMIL 2.5MG/ML VIAL 2ML           80006576
80006581   HB PANCRELIPASE 2CAP                     80006581
80006583   HB ATENOLOL 50MG TABLET                  80006583
80006648   HB ACETAZOLAMIDE 125MG TABLET            80006648
80006660   HB GLYBURIDE 2.5MG TABLET                80006660
80006667   HB LABETALOL 400MG TB                    80006667
80006690   HB PERPHENAZINE 24MG TB                  80006690



                                              217
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80006697   HB METOPROLOL 200MG O                 80006697
80006699   HB GLIPIZIDE 5MG TABLET               80006699
80006701   HB CIMETIDINE 400MG TABLET            80006701
80006706   HB LORAZEPAM/HYDROXYZN                80006706
80006708   HB GEMFIBROZIL 600MG TABLET           80006708
80006713   HB METOCLOPRAM TAB 5MG                80006713
80006750   HB HYDROXYZINE PAM 100MG CAP          80006750
80006757   HB HYOSCYAMINE TB.125MG               80006757
80006764   HB IMIPRAMINE HCL 25MG TABLET         80006764
80006780   HB LACTULOSE 10GM/15ML SYRUP 30ML     80006780
80006787   HB LEVORPHANOL 2MG TABLET             80006787
80006794   HB LEVOTHYROXINE SODIUM 0.3MG TAB     80006794
80006803   HB LOXAPINE SUCCINATE 25MG CAPSUL     80006803
80006820   HB METARAMINOL 200MG P                80006820
80006827   HB METHENAMINE MANDELATE 1G TABLE 80006827
80006829   HB METHIMAZOLE 10MG                   80006829
80006836   HB METHYLERGON TB 0.2MG               80006836
80006843   HB METHYLPREDNISOLONE 16MG TABLET 80006843
80006850   HB MINERAL OIL 60CC                   80006850
80006859   HB MULTIVITAMINS TABLET               80006859
80006861   HB VITAMIN,MULTI 10CC                 80006861
80006996   HB PROPAFENONE TB 600MG               80006996
80007003   HB K ACETATE 30MEQ IV                 80007003
80007010   HB NAPROXEN 375MG TABLET              80007010
80007078   HB MESALAMINE 500MG SUPPOS.           80007078
80007101   HB FLUORESCEIN 2% OPTH DROPS 1ML      80007101
80007108   HB NICOTINE 14MG/24HR ADH. PATCH      80007108
80007136   HB MESALAMINE SR 800MG                80007136
80007233   HB PAROXETINE TB 40MG                 80007233
80007283   HB DEXAMETHASONE 20MG O               80007283
80007285   HB SUCRALFATE SUS 2GM                 80007285
80007291   HB FLUVASTATIN SODIUM 20MG CAPSUL     80007291
80007292   HB FLUVASTATIN SODIUM 40MG CAPSUL     80007292
80007294   HB TORSEMIDE 5MG TABLET               80007294
80007296   HB TORSEMIDE 20MG TABLET              80007296
80007297   HB TORSEMIDE TB 25MG                  80007297
80007298   HB TORSEMIDE TB 30MG                  80007298
80007299   HB TORSEMIDE TB 50MG                  80007299
80007303   HB VENLAFAXINE HCL 37.5MG TABLET      80007303
80007305   HB VENLAFAXIN TB 75MG                 80007305
80007319   HB CAL ACETATE 2668MG                 80007319
80007321   HB GABAPENTN CAP 200MG                80007321



                                           218
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80007326   HB GABAPENTN CAP 800MG                80007326
80007328   HB LAMOTRIGINE TB 50MG                80007328
80007335   HB FLUVOXAMINE TB 200MG               80007335
80007342   HB METFORMIN HCL 500MG TABLET         80007342
80007344   HB VITAMIN A 10000IU CAPSULE          80007344
80007349   HB ASPIRIN 325MG TABLET               80007349
80007378   HB LOSARTAN 25MG TABLET               80007378
80007380   HB LOSARTEN TAB 75MG                  80007380
80007385   HB ACTIVATED CHARCOAL 25GM LIQ 12     80007385
80007387   HB MINERAL OIL 30ML                   80007387
80007389   HB THEOPHYLIN SRT 200MG               80007389
80007390   HB THEOPHYLIN SRT 300MG               80007390
80007394   HB ALENDRONATE SODIUM 10MG TABLET 80007394
80007398   HB BENAZEPRIL HCL 10MG TABLET         80007398
80007399   HB BENAZEPRIL HCL 20MG TABLET         80007399
80007406   HB URSODIOL 20MG/ML ORAL SUSP 1ML     80007406
80007408   HB CAPTOPRIL ORAL SUSP 1MG/ML 1ML     80007408
80007410   HB KCL ORAL SOLUTION 1MEQ/ML 1ML      80007410
80007412   HB SPIRONOLACTONE ORAL SUSP 5MG/M 80007412
80007415   HB PRENATAL-S (PRENATAL VITAMIN)      80007415
80007417   HB CAFFEINE CITRATED 20MG/ML SOLU     80007417
80007419   HB LOXAPINE 10MG CAPSULE              80007419
80007421   HB ACARBOSE 100MG TABLET              80007421
80007422   HB NEVIRAPINE TB 200MG                80007422
80007428   HB LAMIVUDINE TB 300MG                80007428
80007431   HB LEVOCARNITINE 100MG/ML LIQ 1 M     80007431
80007433   HB LEVOCARNITINE 300MG/ML LIQ 3 M     80007433
80007435   HB LORATADINE 10MG TABLET             80007435
80007436   HB FEXOFENADINE HCL 60MG CAPSULE      80007436
80007445   HB FIORICET 2TAB                      80007445
80007447   HB GUAIFENESIN TB 600MG               80007447
80007454   HB ZAFIRLUKAST TB 20MG                80007454
80007456   HB ISOSORBIDE MN 60MG                 80007456
80007458   HB ISOSORBIDE MN 120MG                80007458
80007459   HB TRAUMEEL CREAM                     80007459
80007461   HB NELFINAVIR TB 250MG                80007461
80007463   HB ALBENDAZOLE TB 200MG               80007463
80007465   HB SIMVASTATIN TB 5MG                 80007465
80007466   HB SIMVASTATIN TB 10MG                80007466
80007468   HB SIMVASTATIN TB 40MG                80007468
80007470   HB ATORVASTATIN TB 10MG               80007470
80007472   HB ATORVASTATIN TB 40MG               80007472



                                           219
  Charge
   Code                 Description         CPT Code OP/Default Price   IP/ED Price
80007474   HB MIRTAZAPIN TB 7.5MG           80007474
80007475   HB MIRTAZAPIN TB 15MG            80007475
80007477   HB MIRTAZAPIN TB 45MG            80007477
80007479   HB RX - NONPROTOCOL F/U          80007479
80007481   HB RX-RX BASED PROT45MN          80007481
80007482   HB RX-PROTOCOL FOLOW-UP          80007482
80007484   HB DONNATAL 10CC                 80007484
80007486   HB PHENYTOIN SRC 500MG           80007486
80007488   HB INDINAVIR CAP 800MG           80007488
80007489   HB BUSPIRONE TAB 25MG            80007489
80007491   HB BACLOFEN 30MG                 80007491
80007493   HB VALPROIC ACID 1500MG          80007493
80007496   HB ASPIRIN 650MG TAB             80007496
80007498   HB NEUTRA-PHOS-K 2.9GMP          80007498
80007500   HB GABAPENTN CAP 1000MG          80007500
80007504   HB PROCANBID 1500MG              80007504
80007505   HB PROCANBID 2000MG              80007505
80007507   HB METFORMIN 1500MG              80007507
80007509   HB NEVIRAPINE TB 100MG           80007509
80007511   HB CAL ACETATE 3335MG            80007511
80007514   HB LANSOPRAZOLE CP 30MG          80007514
80007516   HB GLYBURIDE 20MG TAB            80007516
80007518   HB DOXAZOSIN TB 1MG              80007518
80007519   HB DOXAZOSIN TB 2MG              80007519
80007521   HB DOXAZOSIN TB 4MG              80007521
80007523   HB DOXAZOSIN TB 6MG              80007523
80007525   HB DOXAZOSIN TB 10MG             80007525
80007527   HB MIDODRINE TB 1.25MG           80007527
80007528   HB MIDODRINE TB 2.5MG            80007528
80007530   HB MIDODRINE TB 7.5MG            80007530
80007532   HB DELAVIRDINE TB 300MG          80007532
80007534   HB GUAIFENESN-ER 1200MG          80007534
80007539   HB ASPIRIN 160MG                 80007539
80007548   HB PHENYTOIN SUS 1GM             80007548
80007549   HB NELFINAVIR TB 1250MG          80007549
80007551   HB ASPIRIN,EC 160MG              80007551
80007553   HB PANCRELIPASE 4CAPS            80007553
80007555   HB CARVEDILOL 3.125MG            80007555
80007557   HB CARVEDILOL 12.5MG             80007557
80007558   HB CARVEDILOL 18.75MG            80007558
80007560   HB CARVEDILOL 37.5MG             80007560
80007591   HB OXANDRELONE TB 5MG            80007591



                                      220
  Charge
   Code                 Description         CPT Code OP/Default Price   IP/ED Price
80007593   HB PSEUDEPHDRN 6MG SYR           80007593
80007596   HB NIFEDIPINE 30MG               80007596
80007598   HB TRIHEXYPHEN SYR 1MG           80007598
80007609   HB PYRETHRUM 4OZ.                80007609
80007611   HB BUSPIRONE TAB 60MG            80007611
80007612   HB MESALAMINE SR 2000MG          80007612
80007614   HB WARFARIN 3MG                  80007614
80007625   HB BUPROPION-SR 150MG            80007625
80007626   HB BUPROPION-SR 200MG            80007626
80007628   HB BUPROPION-SR 400MG            80007628
80007630   HB CARBAMAZE-XR 200MG            80007630
80007632   HB CARBAMAZE-XR 600MG            80007632
80007644   HB VITAMIN E LIQ 5CC             80007644
80007649   HB LANSINOH PKT 2GM              80007649
80007651   HB VERAPAMIL-SR 480MG            80007651
80007653   HB GLUCOSE 2TABS                 80007653
80007655   HB ULTRASE MT 20 1CAP            80007655
80007656   HB ULTRASE MT 20 2CAP            80007656
80007662   HB CITALOPRAM 40MG               80007662
80007664   HB CITALOPRAM 80MG               80007664
80007665   HB REPAGLINIDE 0.5MG             80007665
80007667   HB REPAGLINIDE 1.5MG             80007667
80007669   HB REPAGLINIDE 3MG               80007669
80007671   HB MISOPROSTOL     25MCG         80007671
80007674   HB LEFLUNOMIDE TB 10MG           80007674
80007676   HB LEFLUNOMIDE TB 40MG           80007676
80007678   HB CELECOXIB CP 100MG            80007678
80007679   HB CELECOXIB CP 200MG            80007679
80007681   HB CELECOXIB CP 400MG            80007681
80007683   HB SEVELAMER 3CAP                80007683
80007685   HB GLIPIZIDE-XL 5MG              80007685
80007687   HB GLIPIZIDE-XL 15MG             80007687
80007688   HB GLIPIZIDE-XL 20MG             80007688
80007692   HB LAMIVUDIN TB 50MG             80007692
80007694   HB LAMIVUDIN TB 200MG            80007694
80007695   HB CARBAMAZE-XR 100MG            80007695
80007697   HB IRBASARTAN TB 150MG           80007697
80007699   HB IRBASARTAN TB 300MG           80007699
80007701   HB MINOCYCLINE 100MG             80007701
80007702   HB VALPROIC SYR 750MG            80007702
80007704   HB VALPROIC SYR 1250MG           80007704
80007706   HB VALPROIC SYR 2000MG           80007706



                                      221
  Charge
   Code                  Description         CPT Code OP/Default Price   IP/ED Price
80007708   HB VALPROIC SYR 3000MG            80007708
80007711   HB TAMSULOSIN CP 0.8MG            80007711
80007713   HB FERRIC GLUC 125MG P            80007713
80007715   HB ROSEGLITAZON TB 2MG            80007715
80007717   HB ROSEGLITAZON TB 6MG            80007717
80007718   HB ROSEGLITAZON TB 8MG            80007718
80007720   HB DONEPEZIL TAB 5MG              80007720
80007722   HB ROFECOXIB TB 25MG              80007722
80007724   HB MESALAMINE-CR 250MG            80007724
80007725   HB MESALAMINE-CR 500MG            80007725
80007727   HB MESALAMINE-CR 1000MG           80007727
80007729   HB MESALAMINE-CR 1500MG           80007729
80007731   HB LITHIUM CO3-SR 900MG           80007731
80007732   HB LITHIUM CO3-SR1350MG           80007732
80007734   HB ACETIC ACID 250CC              80007734
80007738   HB PIOGLITAZON TB 15MG            80007738
80007740   HB PIOGLITAZON TB 45MG            80007740
80007741   HB TOLTERODIN TB 1MG              80007741
80007743   HB MONTELUKAST TB 5MG             80007743
80007745   HB TIZANIDINE TB 1MG              80007745
80007747   HB TIZANIDINE TB 4MG              80007747
80007748   HB TIZANIDINE TB 6MG              80007748
80007750   HB VITAMIN E LIQ 15CC             80007750
80007752   HB ER-LO-OVRAL 4TABS              80007752
80007755   HB PYRIDOXINE TB 200MG            80007755
80007759   HB SIMVASTATIN TB 80MG            80007759
80007761   HB SOD CHLORIDE 3GM TAB           80007761
80007762   HB SOD CHLORIDE 4GM TAB           80007762
80007764   HB PROPAFENONE TB 450MG           80007764
80007766   HB LEVETIRACETM TB 500MG          80007766
80007768   HB LEVETIRACETM TB 1000MG         80007768
80007770   HB OXCARBAZEPIN TB 150MG          80007770
80007771   HB OXCARBAZEPIN TB 300MG          80007771
80007773   HB OXCARBAZEPIN TB 600MG          80007773
80007775   HB VITAMIN B COMP SRT             80007775
80007818   HB METOPROLOL-XL 25MG             80007818
80007820   HB METOPROLOL-XL 75MG             80007820
80007822   HB METOPROLOL-XL 125MG            80007822
80007824   HB METOPROLOL-XL 200MG            80007824
80007825   HB URSODIOL TAB 250MG             80007825
80007836   HB VALSARTAN TAB 80MG             80007836
80007838   HB OXYBUTYNIN-XL 5MG              80007838



                                       222
  Charge
   Code                 Description         CPT Code OP/Default Price   IP/ED Price
80007839   HB OXYBUTYNIN-XL 10MG            80007839
80007841   HB OXYBUTYNIN-XL 20MG            80007841
80007843   HB TOLTERODINE-LA 4MG            80007843
80007845   HB TOLTERODINE-LA 8MG            80007845
80007847   HB NEFAZODONE TAB 150MG          80007847
80007850   HB PACERONE TB 200MG             80007850
80007855   HB HYDROXYZNE 150MG CAP          80007855
80007857   HB SPIRONOLACTONE 200MG          80007857
80007862   HB LET 5CC                       80007862
80007864   HB ETODOLAC CAP 400MG            80007864
80007868   HB IVERMECTIN TB 3MG             80007868
80007869   HB ALLOPURINOL 400MG             80007869
80007875   HB LIDOCAINE PATCH 5%            80007875
80007880   HB DOFETILIDE CP 500MCG          80007880
80007882   HB TRAMADOL TAB 100MG            80007882
80007884   HB MAGNES OX TAB 400MG           80007884
80007885   HB MAGNES OX TAB 500MG           80007885
80007887   HB MAGNES OX TAB 1000MG          80007887
80007889   HB MAGNES OX TAB 1600MG          80007889
80007891   HB TEGASEROD TAB 4MG             80007891
80007892   HB TEGASEROD TAB 6MG             80007892
80007894   HB RIVASTIGMIN CP 3MG            80007894
80007896   HB RIVASTIGMIN SOL 1.5MG         80007896
80007898   HB EZETIMIDE TB 20MG             80007898
80007901   HB PCS-ATROPINE .4MG V           80007901
80007905   HB ACETYLCYST TAB 600MG          80007905
80007907   HB LACTOBACILLUS 1CAP            80007907
80007908   HB LACTOBACILLUS 2CAP            80007908
80007912   HB LISINOPRIL TB 5MG             80007912
80007914   HB LISINOPRIL TB 20MG            80007914
80007915   HB LISINOPRIL TB 30MG            80007915
80007917   HB ARIPIPRAZOLE TB 10MG          80007917
80007919   HB ARIPIPRAZOLE TB 20MG          80007919
80007926   HB GALANTAMINE TAB 8MG           80007926
80007928   HB GALANTAMINE SUS 4MG           80007928
80007930   HB ZOLPIDEM TAB 5MG              80007930
80007931   HB ZOLPIDEM TAB 10MG             80007931
80007940   HB CHLORHEX GLUC. 4OZ            80007940
80007947   HB RISPERID SOLUTB 1MG           80007947
80008017   HB TETANUS ANT 50,000U           80008017
80008019   HB TETRACAINE OPTH 15CC          80008019
80008026   HB THEOPHYLIN 125MG SR           80008026



                                      223
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
80008028   HB THEOPHYLIN SRC 300MG                80008028
80008033   HB THIOTHIXENE 5MG CAPSULE             80008033
80008035   HB THIOTHIXENE 20MG CAP                80008035
80008037   HB THYROID 30MG TABLET                 80008037
80008040   HB THYROID 120MG TABLET                80008040
80008042   HB THYROID 180MG TABLET                80008042
80008044   HB THYROID 300MG TABLET                80008044
80008047   HB TOLAZAMIDE 500MG O                  80008047
80008049   HB TOLNAFTATE 1% POWDER 45GM           80008049
80008058   HB TRIAMTERENE 100MG O                 80008058
80008060   HB TRIFLUOPERAZINE 5MG TABLET          80008060
80008061   HB TRIFLUOPERAZINE 10MG TABLET         80008061
80008063   HB MCT OIL 15CC                        80008063
80008065   HB TRIHEXYPHENIDYL 2MG TABLET          80008065
80008067   HB TRIMETHOBENZAMIDE 100MG SUPP.       80008067
80008068   HB TRIMETHOBENZAMIDE 200MG SUPP        80008068
80008072   HB VALPROIC ACID 500MG                 80008072
80008074   HB VALPROIC SYR 500MG                  80008074
80008075   HB VITAMIN A 25000IU CAPSULE           80008075
80008077   HB VITAMIN A 5000U 0                   80008077
80008079   HB WARFARIN 5MG TABLET                 80008079
80008081   HB WARFARIN 10MG TABLET                80008081
80008082   HB WARFARIN 20 MG TAB                  80008082
80008084   HB WARFARIN 30 MG TAB                  80008084
80008086   HB ZINC OXIDE OINTMENT 30GM            80008086
80008091   HB CETIRIZINE SYR 2.5MG                80008091
80008098   HB GLIMEPIRIDE TAB 2MG                 80008098
80008105   HB ESCITALOPRAM TB 15MG                80008105
80008107   HB ESCITALOPRM SOL 5MG                 80008107
80008114   HB OS-CAL D 500MG 1TAB                 80008114
80008128   HB PSEUDOEPHEDRINE HCL/TRIPROL TA 80008128
80008137   HB DONNATAL 2 TAB                      80008137
80008144   HB FERROUS FUMARATE/DSS SA TABLET 80008144
80008158   HB PROMETHAZIN EXP 10CC                80008158
80008167   HB PEPTO-BISMOL 15CC                   80008167
80008174   HB MYLANTA II 2 TAB                    80008174
80008181   HB DOMEBORO 16OZ SOLN                  80008181
80008183   HB SINEMET 25/250 2TAB                 80008183
80008230   HB TRIAMCINOLONE 1MGTAB                80008230
80008232   HB SALINE SYRINGE 5ML                  80008232
80008246   HB SANTYL OINT 1GM                     80008246
80008247   HB SILVADENE CRM 1GM                   80008247



                                            224
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80008248   HB POLYSPORIN PWDR 1GM                 80008248
80008250   HB TRIAMCIN. LOT. 5CC                  80008250
80008257   HB LANTHANUM CO3 250MG                 80008257
80008264   HB ACAMPROSATE TB 333MG                80008264
80008273   HB PREGABALIN CP 25MG                  80008273
80008280   HB PINDOLOL TB 10MG                    80008280
80008287   HB ACETAMINOPHEN 80MG CHEW TAB         80008287
80008288   HB ACETOHEXAMD 1000MGTB                80008288
80008290   HB AL PHOSPHATE 15CC                   80008290
80008292   HB ALBUTEROL SYR 4MG                   80008292
80008294   HB ALTERNAGEL 60CC                     80008294
80008295   HB ALUMINUM HYDROXIDE 500MG CAPSU 80008295
80008297   HB AMILORIDE HCL/HCTZ 5/50 TAB         80008297
80008299   HB AMINOPHYLLINE 250MG SUPPOS          80008299
80008301   HB AMINOPHYLN LQ 5 ML                  80008301
80008303   HB AMM CHLORIDE 1GM O                  80008303
80008304   HB AMM CHLORIDE 500MG O                80008304
80008326   HB BALNEOL LOTION                      80008326
80008443   HB DOXAZOSIN TB 0.5MG                  80008443
80008447   HB EMETROL 15CC PO SOLN                80008447
80008454   HB ERGOTAMINE TARTRATE/CAFFEINE S 80008454
80008466   HB ETHINL ESTRAD .5MG O                80008466
80008468   HB ETHOSUXIMIDE 250MG CAPSULE          80008468
80008470   HB ETODOLAC CAP 200MG                  80008470
80008473   HB FELODIPINE SR 2.5MG                 80008473
80008475   HB FENOFIBRATE CP 67MG                 80008475
80008478   HB FIORINAL CAP 1 CAP                  80008478
80008482   HB FLUPHENAZN ELX 2.5MG                80008482
80008484   HB FLUPHENAZN ELX 10MG                 80008484
80008486   HB FLUTAMIDE 125MG CAPSULE             80008486
80008487   HB FOLIC ACID ORAL SUSP 1MG/ML 1M      80008487
80008491   HB GENTIAN VIOLET 1% SOLUTION 30       80008491
80008493   HB GRISEOFULVIN MICROSIZE 250MG T      80008493
80008494   HB GUAIFENESIN 1CC                     80008494
80008496   HB GUAIFENESIN-SF 30CC                 80008496
80008498   HB GUANETHIDINE SULFATE 25MG TABL      80008498
80008500   HB HALOPERIDOL 30MG PO                 80008500
80008501   HB HCL .1NORMAL 10CC                   80008501
80008503   HB HYDERGINE 0.5MG SL                  80008503
80008505   HB HYPOTEARS 15CC                      80008505
80008507   HB IBUPROFEN SUS 800MG                 80008507
80008510   HB INDINAVIR CAP 400MG                 80008510



                                            225
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
80008512   HB IPECAC SYRUP                         80008512
80008514   HB ISOCARBOXAZID 10MG                   80008514
80008517   HB ISONIAZID SYR 100MG                  80008517
80008519   HB ISOSOBIDE CHEW 5MG                   80008519
80008521   HB ISOSORBIDE 7.5MG SL                  80008521
80008524   HB J-BSS                                80008524
80008526   HB J-DICLOFENAC 0.1%                    80008526
80008528   HB J-GLYCERIN                           80008528
80008530   HB J-ISOSORBIDE/DOSE                    80008530
80008533   HB J-PILOCARPINE 2%                     80008533
80008535   HB J-PROPARACAINE 0.5%                  80008535
80008537   HB J-VASOCON-A                          80008537
80008542   HB KONDREMUL 60CC                       80008542
80008544   HB K-PHOS NEUTRAL 1 TAB                 80008544
80008547   HB LACTULOSE 45CC ENEMA                 80008547
80008549   HB LEVAMISOLE HCL 50MG TABLET           80008549
80008551   HB LEVODOPA 100MG TABLET                80008551
80008556   HB LORATIDIN TB 20MG                    80008556
80008558   HB LOVOSTATIN TB 40MG                   80008558
80008560   HB MAPROTILINE 25MG TABLET              80008560
80008563   HB MEFLOQUINE TB 125MG                  80008563
80008567   HB MEPHENYTOIN 100MG TABLET             80008567
80008570   HB MESORIDAZINE BESYLATE 25MG TAB       80008570
80008572   HB METAPROTERNOL 10MGSY                 80008572
80008574   HB METHYLENE BLUE 65MGO                 80008574
80008577   HB METHYLTEST 20MG CAP                  80008577
80008579   HB METOCLOPRAM SYR 30ML                 80008579
80008581   HB MEXILETINE HCL 250MG CAPS            80008581
80008583   HB MINERAL OIL (HEAVY) OIL 1 ML         80008583
80008586   HB MOLINDONE 5MG CAP                    80008586
80008588   HB MOLINDONE HCL 5MG TABLET             80008588
80008590   HB MOM/CASCARA 60CC                     80008590
80008600   HB MURO-128 OPH                         80008600
80008602   HB NA FLUORIDE DRP (0.125MG F/DP)       80008602
80008604   HB NALIDIXIC ACID 500MG TABLET          80008604
80008607   HB NEOMYCIN SULFATE 0.5% OINTMENT       80008607
80008609   HB NEUTRA-PHOS 250MG                    80008609
80008611   HB NIACIN 125MG CAPSULE SA              80008611
80008613   HB NIACINAMIDE 25MG TAB                 80008613
80008616   HB NIZATIDINE TAB 150MG                 80008616
80008618   HB NTG-FP 1GM                           80008618
80008622   HB OBECALP PO                           80008622



                                             226
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80008623   HB OLSALAZINE SODIUM 250MG CAPSUL     80008623
80008625   HB OXCARBAZEPIN TB 75MG               80008625
80008627   HB PANCRELIPASE 5CAPS                 80008627
80008630   HB PEDIAZOLE 7.5CC                    80008630
80008656   HB PROBUCOL 250MG TABLET              80008656
80008658   HB PROCAINAMIDE 375MG CAPSULE         80008658
80008661   HB PROMAZINE HYDROCHLORIDE 50MG T 80008661
80008663   HB PROMETHAZINE 50MG SUPPOS           80008663
80008665   HB PROPANTHELINE BROMIDE 7.5MG TA     80008665
80008668   HB PYRAZINAMIDE ORAL SUSP 10MG/ML     80008668
80008670   HB QUINIDIN GLUC 660MG                80008670
80008672   HB QUINIDINE GLUCONATE 324MG TABL     80008672
80008677   HB RIFAMPIN ORAL SUSP 10MG/ML 1ML     80008677
80008679   HB RITODRINE HYDROCHLORIDE 10MG T 80008679
80008684   HB ROFECOXIB TB 6.25MG                80008684
80008688   HB SELEGILINE TB 2.5MG                80008688
80008691   HB SERAPES 2 TAB                      80008691
80008693   HB SILVER NITRATE 1% OPTH SOLN AM     80008693
80008695   HB SOD FLUORIDE 2.2MG (1MG F) TAB     80008695
80008699   HB SULFAMETHOX 500MGTB                80008699
80008700   HB SULFANILAMIDE 15% SUPPOS.          80008700
80008702   HB SULFINPYRAZONE 200MG CAP           80008702
80008704   HB SULFISOXAZOLE 500MG TABLET         80008704
80008706   HB TEAR TEST STRIP                    80008706
80008707   HB TESTOST-TTS 4MG/DAY                80008707
80008709   HB THEOPHYLIN SRC 50MG                80008709
80008711   HB THIABENDAZOLE 500MG                80008711
80008713   HB THIETHYLPER 10MG PR                80008713
80008714   HB THIOGUANINE 80MG O                 80008714
80008716   HB THIOGUANINE ORAL SUSP 5MG/ML 1     80008716
80008718   HB THIORIDAZINE 100MG TABLET          80008718
80008720   HB THIORIDAZINE 50MG TABLET           80008720
80008721   HB THIORIDAZINE HCL 100MG/ML CONC     80008721
80008723   HB THIOTHIXENE 1MG CAPSULE            80008723
80008725   HB TICLOPIDIN TB 125MG                80008725
80008727   HB TIZANIDINE TB 3MG                  80008727
80008729   HB TOCAINIDE 200MG PO                 80008729
80008730   HB TOLAZOLINE 50MG O                  80008730
80008732   HB TOLBUTAMIDE 500MG TABLET           80008732
80008734   HB TOLTERODINE-LA 10MG                80008734
80008736   HB TOPIRAMATE SRC 60MG                80008736
80008737   HB TORSEMIDE TB 15MG                  80008737



                                           227
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
80008739   HB TRICHLORMETHIAZ 2MGO                80008739
80008741   HB TRIFLUOPERAZ 30MG                   80008741
80008743   HB TRIHEXYPHEN SYR 2MG                 80008743
80008744   HB TRIMETHOPRIM ORAL SUSP 10MG/ML 80008744
80008746   HB TROGLITAZON TB 100MG                80008746
80008748   HB TUSSI-ORGANIDIN 15CC                80008748
80008750   HB UNDECYLENIC ACID 10% POWDER 60      80008750
80008752   HB URSODIOL 600MG PO                   80008752
80008753   HB URSODIOL 300MG CAPSULE              80008753
80008755   HB VALPROIC ACID 1250MG                80008755
80008759   HB VITAMIN A&D UNG 30GM                80008759
80008760   HB VITAMIN E 1200U                     80008760
80008762   HB VITAMIN E LIQ 2CC                   80008762
80008764   HB VITAMIN,MULTI 1CHEW                 80008764
80008766   HB VITAMINS A,D,C W/FLUORIDE DRPS      80008766
80008767   HB VITAMN,MULT ADEK 3CC                80008767
80008769   HB VITAMN,MULT ADEK 2TB                80008769
80008771   HB VITAMN,THER+FE 2TAB                 80008771
80008773   HB VITAMN,THER+MIN1CHEW                80008773
80008774   HB XYLOMETAZ 0.1% 20CC                 80008774
80008776   HB ZALCITABIN TB 1.125                 80008776
80008778   HB ZALCITABINE 0.375MG TABLET.         80008778
80008780   HB METOPROLOL TB 25MG                  80008780
80008782   HB ESOMEPRAZOLE DR CAP 40MG            80008782
80008783   HB ALLOPURINOL 100MG TABLET            80008783
80008785   HB AMINOPHYLLINE 250MG/10ML VL         80008785
80008787   HB ASPIRIN 300MG SUPPOSITORY           80008787
80008789   HB DEXAMETHASONE 0.5MG TABLET          80008789
80008790   HB DEXAMETHASONE 1.5MG TABLET          80008790
80008792   HB DICLOXACILLIN 250MG CAPSULE         80008792
80008794   HB DSS CAP 50MG                        80008794
80008796   HB FERROUS SULF 300MGTB                80008796
80008797   HB FOLIC ACID 1MG TABLET               80008797
80008799   HB PSYLLIUM 5CC                        80008799
80008801   HB PREDNISONE 1MG TABLET               80008801
80008803   HB QUINIDIN GLUC 330MG                 80008803
80008805   HB QUINIDINE SULFATE 300MG TAB         80008805
80008808   HB ACETAMINOPHEN 325MG SUPPOS.         80008808
80008813   HB HYDROXYPROPYLMETHYLCELL. 0.5%       80008813
80008815   HB ANTIPYRINE/BENZOCAINE DROPS 15      80008815
80008817   HB BACITRACIN/POLYMYXIN B SULFATE      80008817
80008819   HB DIPHENHYDRAMINE HCL 2% CREAM 3 80008819



                                            228
  Charge
   Code                     Description             CPT Code OP/Default Price   IP/ED Price
80008820   HB IIV BURROWS SOLN                      80008820
80008822   HB CAFF/SOD BENZOATE 250MG/ML VL         80008822
80008824   HB DIPHENHYDRAMINE/CALAMINE LOT 1        80008824
80008826   HB OPIUM, TINC. 15GTTS                   80008826
80008827   HB CARISOPRODOL 350MG TABLET             80008827
80008829   HB CHLORPROMAZINE 25MG/ML AMP 2ML 80008829
80008831   HB CHLORPROPAMIDE 100MG TABLET           80008831
80008835   HB PROBENECID/COLCHICINE TABS            80008835
80008836   HB CYCLOPHOSPHAMIDE 25MG TABLET          80008836
80008838   HB DACRIOSE OPHTH                        80008838
80008840   HB DIAPER RASH OINT (DESITIN-EQ)         80008840
80008869   HB INDOMETHACIN 25MG CAPSULE             80008869
80008871   HB ISOSORBIDE 40MG TAB                   80008871
80008873   HB LANOLIN OINTMENT 30GM                 80008873
80008874   HB LIBRAX (EQ)                           80008874
80008875   HB FLUOCINONIDE 0.05% CREAM 15GM         80008875
80008876   HB LIOTHYRONINE SODIUM 5MCG TABLE 80008876
80008878   HB MCT OIL 5CC                           80008878
80008880   HB METHYLDOPA 125MG TABLET               80008880
80008881   HB METHYLDOPA 500MG TABLET               80008881
80008883   HB MINERAL OIL                           80008883
80008887   HB MAALOX+ ES 15CC                       80008887
80008890   HB ORABASE PLAIN PASTE 5 GM              80008890
80008892   HB PILOCARPINE HCL 2% DROPS 1 ML         80008892
80008894   HB POLYSPORIN TOP                        80008894
80008896   HB POVIDONE-IODINE 10% OINTMENT 3        80008896
80008897   HB TUBERCULIN, PPD 1TU/0.1ML VIAL        80008897
80008899   HB PREPARATION H SUPP                    80008899
80008901   HB PROCAINAMIDE 250MG CAPSULE            80008901
80008903   HB PROCARBAZINE HCL 50MG CAPSULE         80008903
80008904   HB PROPARACAINE HCL 0.5% EYE DROP        80008904
80008908   HB PYRIDOSTIGMINE BROMIDE 60MG TA        80008908
80008910   HB RESERPINE 5MG P                       80008910
80008912   HB CARBIDOPA/LEVO 25/250 TAB             80008912
80008913   HB SPECTINOMYCIN 4GM                     80008913
80008917   HB TOLNAFTATE 1% SOLUTION 10ML           80008917
80008919   HB BETAMETHASONE VAL 0.1% CREAM 1        80008919
80008922   HB TETRAHYDROZOLINE 0.05% EYEDROP 80008922
80008924   HB VITAMIN D P                           80008924
80008926   HB AVEENO BATH PACKETS REGULAR           80008926
80008929   HB CALCITRIOL 0.25MCG CAPSULE            80008929
80008931   HB PHOSPHO-SODA 5CC                      80008931



                                              229
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80008933   HB METOPROLOL 50MG TABLET             80008933
80008934   HB METOPROLOL 100MG TABLET            80008934
80008936   HB SILVER NITRATE APPLICATOR          80008936
80008940   HB VALPROIC ACID 250MG                80008940
80008942   HB MULTIVITAMINS DROPS (PEDS) 50M     80008942
80008943   HB POLY VI SOL/DOSE                   80008943
80008945   HB BROMOCRIPTINE 1.25MG               80008945
80008947   HB OXYBUTYNIN ORAL SUSP 1MG/ML 1M     80008947
80008949   HB ESTRADIOL 1MG TABLET               80008949
80008950   HB MITOTANE 500MG TABLET              80008950
80008952   HB PHENAZOPYRIDINE HCL 100MG TABL     80008952
80008954   HB PHENOXYBENZAMINE HCL 10MG CAPS 80008954
80008956   HB BENZTROPINE MES 0.5MG TAB          80008956
80008959   HB ABSORBASE OINT 120GM               80008959
80008961   HB ETHIONAMIDE 250MG TABLET           80008961
80008963   HB ACETOHEXAMIDE 250MG TABLET         80008963
80008965   HB MENADIOL 75MG P                    80008965
80008966   HB GUAIFENESIN TB 200MG               80008966
80008968   HB NORTRIPTYLINE HCL 10MG CAP         80008968
80008970   HB SULFADIAZINE 500MG TABLET          80008970
80008972   HB MINOXIDIL 10MG TABLET              80008972
80008973   HB ALUMINUM ACETATE PACKET            80008973
80008975   HB NADOLOL 40MG TABLET                80008975
80008977   HB ACETAMIN EX ST 2TAB                80008977
80008979   HB ACETAMINOPHEN LQ 5CC               80008979
80008980   HB ACETAMINOPHEN LQ10CC               80008980
80008982   HB ACETAZOLAMIDE 500MG SEQUELS (S     80008982
80008984   HB ACETAZOLAMIDE 250MG TABLET         80008984
80008986   HB AL HYDROXIDE 30CC                  80008986
80008987   HB AL HYDROXIDE 60CC                  80008987
80008989   HB VITAMIN E 200IU CAPSULE            80008989
80008991   HB ALTERNAGEL 15CC                    80008991
80008993   HB AMANTADINE 100MG CAPSULE           80008993
80008995   HB AMANTADINE LIQ 100MG               80008995
80008996   HB AMINOCAP ACID 1.5GMD               80008996
80008998   HB AMINOCAP ACID 1 GM O               80008998
80009000   HB AMITRIPTYLINE HCL 10MG TAB         80009000
80009002   HB AMITRIPTYLINE HCL 50MG TAB         80009002
80009003   HB AMITRIPTYLINE HCL 75MG TAB         80009003
80009005   HB AMITRIPTYLINE 150MG                80009005
80009007   HB AMMONIUM CHLORIDE 5MEQ/ML 20ML 80009007
80009016   HB ASCORBIC ACID 250MG TABLET         80009016



                                           230
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80009018   HB ASCORBIC ACD 1GM PO                80009018
80009019   HB ASCORBATE SODIUM 500MG/ML AMP      80009019
80009025   HB AZATHIOPRIN 100MG PO               80009025
80009026   HB AZATHIOPRIN 150MG O                80009026
80009028   HB BACLOFEN 20MG                      80009028
80009030   HB BENZONATATE 100MG CAPSULE          80009030
80009032   HB BENZYL PEROX 5% CR                 80009032
80009033   HB BENZOYL PEROXIDE 5% GEL 90 GM      80009033
80009035   HB BENZTROPINE MES 2MG TABLET         80009035
80009037   HB BETAMETHASONE DIP. 0.05% CREAM     80009037
80009039   HB BETHANECHOL 5MG TABLET             80009039
80009040   HB BETHANECHOL 10MG TABLET            80009040
80009042   HB BETHANECHOL 25MG TABLET            80009042
80009044   HB BISACODYL 5MG TABLET EC            80009044
80009046   HB BISACODYL 15MG O                   80009046
80009048   HB BISACODYL 10MG SUPPOSITORY         80009048
80009049   HB BISACODYL 2 SUPP                   80009049
80009051   HB BROMOCRIPTINE 5MG CAPSULE          80009051
80009053   HB CALCIUM CARB 1TAB                  80009053
80009056   HB CALCIUM CARB 4TAB                  80009056
80009082   HB CHOLESTYRAMINE 4GM PACKET          80009082
80009084   HB AMOXAPINE 50MG TABLET              80009084
80009086   HB CIMETIDINE 300MG TABLET            80009086
80009087   HB CIMETIDINE 600MG O                 80009087
80009091   HB CLONIDINE HCL 0.1MG TABLET         80009091
80009093   HB CLONIDINE HCL 0.3MG TABLET         80009093
80009094   HB CLONIDINE 0.4MG    O               80009094
80009103   HB COLCHICINE 0.5MG TABLET            80009103
80009105   HB CORTISONE AC 12.5MGO               80009105
80009107   HB CYANOCOBALAMIN 50MCG TABLET        80009107
80009109   HB VITAMIN B12 500MCG TABLET          80009109
80009110   HB CYANOCOBAL 1000MCG O               80009110
80009112   HB CYANOCOBAL 2000MCG P               80009112
80009114   HB CYCLOPHOSPHAMIDE 50MG TABLET       80009114
80009116   HB CYPROHEPTADIN 2MG SY               80009116
80009117   HB DANTROLENE 25MG CAPSULE            80009117
80009121   HB DESIPRAMINE 50MG TABLET            80009121
80009123   HB DEXAMETHASONE 0.75MG TABLET        80009123
80009125   HB DEXAMETHASONE 2MG TABLET           80009125
80009126   HB DEXAMETHASONE 2.5MG                80009126
80009128   HB DEXAMETHASONE 3.5MG                80009128
80009130   HB DEXAMETHASON .5MGSOL               80009130



                                           231
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
80009132   HB DEXTROAMPHET TB 10MG                80009132
80009137   HB DICLOXACILN 500MGCAP                80009137
80009139   HB DICYCLOMINE HCL 20MG TABLET         80009139
80009140   HB DICYCLOMINE 20MG CAP                80009140
80009142   HB DES 5MG         O                   80009142
80009144   HB DIGOXIN .375MG TAB                  80009144
80009146   HB DIGOXIN .75MG       TAB             80009146
80009147   HB DIGOXIN ELIX .05MG                  80009147
80009149   HB DIGOXIN ELIX .125MG                 80009149
80009151   HB GLYCERIN 120CC                      80009151
80009153   HB DSS CAP 100MG                       80009153
80009155   HB DSS CAP 250MG                       80009155
80009156   HB DSS SYR 100MG                       80009156
80009158   HB DSS SYR 200MG                       80009158
80009160   HB DIPHENHYDRAM 100MG O                80009160
80009162   HB DIPHENHYDRAM 25MG SY                80009162
80009163   HB DIPHENHYDRAM 50MG SY                80009163
80009165   HB LOMOTIL 5.0MG       TAB             80009165
80009167   HB PHENYTOIN SRC 200MG                 80009167
80009169   HB PHENYTOIN SRC 400MG                 80009169
80009170   HB PHENYTOIN TAB 50MG                  80009170
80009172   HB PHENYTOIN SUS 100MG                 80009172
80009174   HB PHENYTOIN SUS 300MG                 80009174
80009176   HB DIPYRIDAMOLE 25MG TABLET            80009176
80009178   HB DIPYRIDAMOLE 75MG TABLET            80009178
80009179   HB DIPYRIDAMOLE 100MG O                80009179
80009181   HB DISOPYRAMIDE 150MG CAPSULE          80009181
80009183   HB DISULFIRAM 250MG TABLET             80009183
80009185   HB DOXEPIN 10MG CAPSULE                80009185
80009186   HB DOXEPIN 25MG CAPSULE                80009186
80009188   HB DOXEPIN 75MG CAPSULE                80009188
80009190   HB DOXEPIN 150MG CAP                   80009190
80009195   HB VITAMIN D 25000U CAP                80009195
80009197   HB VITAMIN D   1CC SOL                 80009197
80009199   HB VITAMIN D   3CC SOL                 80009199
80009206   HB ESTROGENS,CONJUGATED 0.3MG TAB 80009206
80009208   HB ESTROGENS,CONJUGATED 1.25MG TA 80009208
80009209   HB ESTROGEN EST 2.5MG O                80009209
80009211   HB ESTROGEN,CONJ 5 MG O                80009211
80009213   HB ETHACRYNIC ACID 50MG TABLET         80009213
80009214   HB ETHACRYNIC 75MG           O         80009214
80009216   HB FERROUS GLUC 10CC                   80009216



                                            232
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80009218   HB FERROUS GLUC 2TAB O                 80009218
80009220   HB FERROUS SULF 225MGLQ                80009220
80009222   HB FERROUS SULF 600MGLQ                80009222
80009223   HB FLAVOXATE HCL 100MG TABLET          80009223
80009225   HB FLUDROCORTISONE .3MG                80009225
80009227   HB FLUPHENAZINE 2.5MG TABLET           80009227
80009229   HB FLUPHENAZINE 10MG TABLET            80009229
80009231   HB FOLIC ACID 2MG O                    80009231
80009232   HB FOLIC ACID 3MG O                    80009232
80009234   HB FOLIC ACID 5MG O                    80009234
80009236   HB FUROSEMIDE TB 120MG                 80009236
80009238   HB FUROSEMIDE 200MG O                  80009238
80009239   HB FUROSEMIDE SOL 80MG                 80009239
80009241   HB GUAIFENESIN 5CC                     80009241
80009243   HB GUAIFENESIN 15CC                    80009243
80009245   HB GLYCOPYRROLATE 1MG TABLET           80009245
80009246   HB GLYCOPYRROLATE 2MG O                80009246
80009248   HB NIFEDIPINE-XL 30MG TABLET           80009248
80009250   HB CAPTOPRIL 50MG TABLET               80009250
80009252   HB AMINOGLUTETHIMIDE 250MG TABLET      80009252
80009253   HB DEXTROSE 100G/180ML LIQUID 180      80009253
80009255   HB LITHIUM CIT 600MG                   80009255
80009257   HB NAPROXEN 500MG                      80009257
80009259   HB THEOPHYLIN SRC 375MG                80009259
80009261   HB ISOSORBIDE 80MG TAB                 80009261
80009262   HB ISOSORBIDE 80MG SR                  80009262
80009264   HB KCL 80MEQ ELIX                      80009264
80009266   HB AMINOPHYLIN 1000MGP                 80009266
80009297   HB AMINO ACIDS/MAGNESIUM SULFATE       80009297
80009299   HB PROPRANOLOL 160MG O                 80009299
80009300   HB GAVISCON 30CC                       80009300
80009302   HB NITROGLYCERIN 0.4MG/HR ADH. PA      80009302
80009309   HB NIFEDIPINE 10MG SOFTGEL CAP         80009309
80009311   HB NIFEDIPINE-CC 30MG TABLET           80009311
80009313   HB ENTEX-LA (EQ) TABLET SA             80009313
80009315   HB VERAPAMIL HCL 120MG TABLET          80009315
80009316   HB TRAZODONE 50MG TABLET               80009316
80009318   HB TRAZODONE 150MG                     80009318
80009322   HB ALBUTEROL SULFATE 2MG TAB           80009322
80009323   HB ALBUTEROL SULFATE 4MG TAB           80009323
80009325   HB DILTIAZEM HCL 60MG TABLET           80009325
80009329   HB PROCAINAMID 1GM O                   80009329



                                            233
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
80009330   HB PROCANBID 1000MG TABLET             80009330
80009332   HB MEBENDAZOLE 100MG TAB               80009332
80009334   HB RANITIDINE HCL 150MG TABLET         80009334
80009338   HB DAPSONE 100MG TABLET                80009338
80009339   HB ANUSERT SUPP                        80009339
80009341   HB AMERICAIN/DERMOPLAST                80009341
80009343   HB BUMETANIDE 0.5MG PO                 80009343
80009346   HB PHENOL 1%                           80009346
80009348   HB VITAMIN B COMP + C TABLET           80009348
80009350   HB NETILMICIN 20MG PB                  80009350
80009352   HB ACETAMIN EX ST 1TAB                 80009352
80009353   HB METYRAPONE 250MG TABLET             80009353
80009355   HB OXYBUTYNIN 10MG TAB                 80009355
80009357   HB PROCHLORPER TAB 10MG                80009357
80009359   HB NITROGLYCERIN 0.1MG/HR ADH. PA      80009359
80009360   HB PAIN COCKTAIL/DOSE                  80009360
80009362   HB GLYBURIDE 1.25MG TB                 80009362
80009364   HB GLYBURIDE 5MG TABLET                80009364
80009366   HB LABETALOL HCL 100MG TABLET          80009366
80009368   HB LABETALOL HCL 200MG TABLET          80009368
80009369   HB LABETALOL HCL 300MG TABLET          80009369
80009371   HB LABETALOL 600MG TB                  80009371
80009373   HB VERAPAMIL 160MG                     80009373
80009375   HB PENTOXIFYLLINE 400MG TABLET SA      80009375
80009376   HB PENTOXIFYLN 800MG TB                80009376
80009378   HB GLYBURIDE 7.5MG TAB                 80009378
80009380   HB GLYBURIDE 15MG TAB                  80009380
80009391   HB DESIPRAMINE 300MG                   80009391
80009513   HB MECLIZINE 25MG TABLET               80009513
80009536   HB METHOCARBAMOL 1GM                   80009536
80009543   HB METHYLPREDNISOLONE 2MG TABLET 80009543
80009545   HB METHYLPREDNISOLONE 8MG TABLET 80009545
80009547   HB METOLAZONE 2.5MG TABLET             80009547
80009549   HB METOLAZONE 10MG TABLET              80009549
80009561   HB B-COMPLEX & C 1CAP                  80009561
80009563   HB MULTIVITAMINS,THERAPEUTIC LIQ       80009563
80009565   HB VITAMN,PRENATAL 1TAB                80009565
80009566   HB VITAMN,THER 5CC                     80009566
80009568   HB MULTIVITS,THERAP W-FE,HEMATIN       80009568
80009570   HB MEXILETINE HCL 200MG CAPS           80009570
80009572   HB AMIODARONE 300MG PO                 80009572
80009577   HB DILTIAZEM 120MG                     80009577



                                            234
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80009582   HB BUSPIRONE TAB 5MG                   80009582
80009584   HB BUSPIRONE TAB 10MG                  80009584
80009586   HB BUSPIRONE TAB 20MG                  80009586
80009589   HB FAMOTIDINE 20MG TABLET              80009589
80009593   HB CAPTOPRIL 6.25MG                    80009593
80009595   HB CARBAMAZEPINE 100MG CHEW TAB        80009595
80009605   HB ALBUTEROL SR 8MG                    80009605
80009607   HB FLUOXETINE HCL 20MG CAPSULE         80009607
80009612   HB TRNSPLNT,SPEC.NSS 1L                80009612
80009614   HB MISOPROSTOL 400MCG                  80009614
80009618   HB DILTIAZEM-XR 90MG                   80009618
80009623   HB NAPHAZOLINE .1% SPR                 80009623
80009625   HB SELEGILINE HCL 5MG TABLET           80009625
80009628   HB NEOMYCIN 500MG TABLET               80009628
80009630   HB NIACIN 500MG CAPSULE SA             80009630
80009632   HB NIACIN 100MG TABLET                 80009632
80009635   HB NIACIN 1GM TAB                      80009635
80009639   HB NTG 1 INCH OINT                     80009639
80009642   HB NITROGLYCERIN 0.3MG TAB             80009642
80009644   HB NITROGLYCERIN 0.6MG TAB             80009644
80009646   HB NORETHINDRONE ACETATE 5MG TABL 80009646
80009648   HB NORTRIPTYLN 10MG SOL                80009648
80009660   HB NADOLOL 20MG TABLET                 80009660
80009662   HB PANCREATIN 1 TAB                    80009662
80009665   HB PANCREATIN 4 TAB                    80009665
80009667   HB PAREGORIC 15CC                      80009667
80009674   HB PENTAZOCINE 100MG O                 80009674
80009676   HB PERPHENAZIN SOL 8MG                 80009676
80009688   HB PHENYLEPHRINE .25%ND                80009688
80009690   HB PHENYLEPHRINE 0.125% NASAL DRP      80009690
80009695   HB PHYTONADIONE 10MG O                 80009695
80009725   HB BUPROPION HCL 100MG TABLET          80009725
80009732   HB PREDNISONE 100MG TAB                80009732
80009741   HB PROCAINAMIDE 500MG TAB SR           80009741
80009748   HB PROMETHAZINE HCL 25MG SUPPOS        80009748
80009755   HB PROPRANOLOL 40MG TABLET             80009755
80009762   HB PROPYLTHIOUR 100MGTB                80009762
80009764   HB PSEUDOEPHEDRINE 30MG TABLET         80009764
80009776   HB LOPERAMIDE LIQ 2MG                  80009776
80009783   HB CLOZARIL TAB 25MG                   80009783
80009792   HB VERAPAMIL HCL 40MG TABLET           80009792
80009806   HB SINEMET CR 50/200 TABLET SA         80009806



                                            235
  Charge
   Code                 Description              CPT Code OP/Default Price   IP/ED Price
80009820   HB MISOPROSTOL 100MCG                 80009820
80009822   HB NTG 0.15MG SL                      80009822
80009827   HB PANCREASE CAPSULE EC               80009827
80009829   HB SELENIUM W/YEAST 50MCG TAB         80009829
80009836   HB DILTIAZEM-XR 240MG                 80009836
80009841   HB TERAZOSIN HCL 1MG TABLET           80009841
80009843   HB TERAZOSIN HCL 5MG TABLET           80009843
80009845   HB SERTRALINE TAB 25MG                80009845
80009848   HB SERTRALINE TAB 150MG               80009848
80009850   HB MG-PLUS 3TABS                      80009850
80009852   HB FLUOXETINE LIQ 20MG                80009852
80009859   HB CAL CARB SUSP 5CC                  80009859
80009862   HB CAL CARB SUSP 30CC                 80009862
80009864   HB ARGININE 1 MEQ                     80009864
80009871   HB FINASTERIDE 5MG TABLET             80009871
80009878   HB BUPROPION 150MG TAB                80009878
80009885   HB LITHIUM CIT 1200MG                 80009885
80009887   HB CARBAMAZE SUSP 100MG               80009887
80009892   HB IBUPROFEN 200MG TABLET             80009892
80009901   HB NIFEDIPINE-CC 60MG TABLET          80009901
80009934   HB PAROXETINE HCL 20MG TABLET         80009934
80009938   HB NEPHRO-VITE TABLET                 80009938
80009943   HB LORATIDIN TB 5MG                   80009943
80009945   HB AMLODIPIN TB 1.25MG                80009945
80009946   HB ONDANSETRON TB 4MG                 80009946
80009947   HB ONDANSETRON TB 12MG                80009947
80009948   HB ONDANSETRON TB 24MG                80009948
80009949   HB NACL 0.9% VIAL 2ML                 80009949
80009950   HB ONDANSETRON ODT 8MG                80009950
80009951   HB ONDANSETRON TB 2MG                 80009951
80009952   HB ONDANSETRON TB 6MG                 80009952
80009953   HB ONDANSETRON TB 8MG                 80009953
80009954   HB ONDANSETRON TB 16MG                80009954
80009957   HB LAB IMMUNOHISTOCHEMISTRY EA AB* 80009957
80009961   HB AUTOMATED DIFFERENTIAL*            80009961
80009963   HB LAB QUANT HBV BY BDNA - INTERP     80009963
80009964   HB PLATELET SMEAR REVIEW*             80009964
80009971   HB MANUAL DIFFERENTIAL*               80009971
80009974   HB LAB MOL IGK INTERP & RPT           80009974
80009976   HB LAB MOL TCRB AMP TGT ADDNL SQ      80009976
80009979   HB LAB KRASP AMPL. TARGET             80009979
80009980   HB LAB KRASP NA PROBE, EA             80009980



                                           236
  Charge
   Code                 Description                  CPT Code OP/Default Price   IP/ED Price
80009981   HB LAB PRENATAL FISH ANEU EVAL            80009981
80009982   HB LAB ALDOLASE                           80009982
80009983   HB LAB ELECTRONIC CROSSMATCH              80009983
80009984   HB LAB MOL TCRG SEP ID HI RES TCH         80009984
80009990   HB LORATADINE TAB                         80009990
80009991   HB LAB MOL TCRB AMP TGT 1 2 NA SQ         80009991
80009992   HB LAB MOL IGHP SEP ID HI RES TCH         80009992
80009994   HB LAB KRASP MUT SCAN EA                  80009994
80009996   HB LAB MOL IGHP AMP TGT ADDNL SQ          80009996
80010061   HB LITHIUM CARBONATE 450MG TABLET         80010061
80010068   HB PAREGORIC LIQUID 5 ML                  80010068
80010070   HB SORBITOL 70% SOLUTION 15ML             80010070
80010075   HB EYE-STREAM OPTHALMIC SOLUTION          80010075
80010077   HB THEOPHYLIN 400MG/500                   80010077
80010091   HB THEOPHYLIN SRT 100MG                   80010091
80010098   HB LAMIVUDINE TB 150MG                    80010098
80010100   HB BENAZEPRIL HCL 5MG TABLET              80010100
80010121   HB ALUMINUM POTASSIUM SULF PWD            80010121
80010274   HB ANAGRELIDE CP 2 MG                     80010274
80010281   HB DSS CAP 500MG                          80010281
80010283   HB OPIUM, TINC. 10GTTS                    80010283
80010364   HB CITALOPRAM 20MG                        80010364
80010487   HB OXYBUTYNIN SYR 3MG                     80010487
80010584   HB TRAMADOL TAB 50MG                      80010584
80010593   HB TEGASEROD TAB 2MG                      80010593
80010600   HB EZETIMIDE TB 10MG                      80010600
80010607   HB PCS-TYLENL ES 500MG                    80010607
80010614   HB LISINOPRIL TB 2.5MG                    80010614
80010616   HB LISINOPRIL TB 10MG                     80010616
80010623   HB ARIPIPRAZOLE TB 30MG                   80010623
80010630   HB GALANTAMINE TAB 12MG                   80010630
80010644   HB OC-BUPIV.25% 10CCSDV                   80010644
80010697   HB SALSALATE 1000MG O                     80010697
80010790   HB ZINC OXIDE OINTMENT 454GM              80010790
80010792   HB ZINC SULFATE 220MG CAPSULE             80010792
80010797   HB CETIRIZINE TAB 5MG                     80010797
80010806   HB ESCITALOPRAM TB 5MG                    80010806
80010813   HB FENOFIBRATE TB 48MG                    80010813
80010827   HB GUAIFENESIN-SF 10CC                    80010827
80010829   HB DIMETAPP 5CC ELIX                      80010829
80010843   HB APAP/ISOMETHEPTENE/DICHLPHEN C 80010843
80010850   HB OS-CAL D 250MG 2TAB                    80010850



                                               237
  Charge
   Code                    Description               CPT Code OP/Default Price   IP/ED Price
80010857   HB GUAIFENESIN-DM 5CC                     80010857
80010859   HB GUAIFENESIN-DM 30CC                    80010859
80010866   HB CEPACOL LOZENGE                        80010866
80010937   HB WK REL/MED DIS EVAL-OTHER              80010937
80010938   HB STAT REQUEST                           80010938
80010939   HB POTENTIAL BMR                          80010939
80010940   HB SERUM SEND OUT TO THE OPO LAB          80010940
80010941   HB CLASS II GLYCINE QS NO DTT             80010941
80010942   HB CLASS II GLYCINE QS W/DTT              80010942
80010943   HB CLASS II GLYCINE SCREEN NO DTT         80010943
80010944   HB CLASS II GLYCINE SCREEN W/DTT          80010944
80010945   HB HLA MEDICARE UOS STATS                 80010945
80010946   HB MEDICARE HLA TEST                      80010946
80010947   HB INTERPRETATION & REPORT (STAT)         80010947
80010949   HB DIAG IMM STATISTCAL CODE               80010949
80010956   HB STAT - 3SP - EA ADDL MIN               80010956
80010959   HB STAT - PREADMT/PPTP - 1ST HOUR         80010959
80010963   HB STAT - PRE OP - EA ADDL 15 MIN         80010963
80011017   HB AGGRENOX 200/25 2CAP                   80011017
80011024   HB AMANTADINE LIQ 200MG                   80011024
80011047   HB ATROPINE 0.4MG O                       80011047
80011070   HB CALADRYL CREAM                         80011070
80011077   HB CARDIOQUIN 550MG                       80011077
80011097   HB CETAPHIL LOTION                        80011097
80011102   HB CHLORDIAZEPOX 5MG O                    80011102
80011104   HB CHLORPROM SPAN 30MG                    80011104
80011113   HB CISAPRIDE TB 20MG                      80011113
80011118   HB CLOFIBRATE 1GM        O                80011118
80011120   HB CLOMIPRAMINE HYDROCHLORIDE 25M 80011120
80011127   HB DANOCRINE 50MG                         80011127
80011136   HB DESIPRAMINE 200MG                      80011136
80011141   HB DEXTRO-AMPHETAMINE 15MG SPANSU 80011141
80011143   HB DHT .125MG       LQ                    80011143
80011150   HB DICLOFENAC 75MG PO                     80011150
80011157   HB DIGOXIN ELIX .375MG                    80011157
80011164   HB DIMETAPP EXTENTAB                      80011164
80011166   HB DOMEBORO 1 TAB                         80011166
80011207   HB FLUCYTOSINE ORAL SUSP 10MG/ML          80011207
80011360   HB PEMOLIN CHW 18.75MG                    80011360
80011496   HB VITAMN,MULT ADEK 1TB                   80011496
80011503   HB ZAFIRLUKAST TB 10MG                    80011503
80011505   HB ZALCITABIN TB 1.5MG                    80011505



                                               238
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80011507   HB ZINC ACETATE 25MG                   80011507
80011509   HB ESOMEPRAZOLE DR CAP 20MG            80011509
80011512   HB ALLOPURINOL 300MG TABLET            80011512
80011519   HB DEXAMETHASONE 4MG TABLET            80011519
80011521   HB DIGOXIN 0.125MG TABLET              80011521
80011523   HB PERICOLACE CAPSULE                  80011523
80011526   HB ISOSORBIDE DN 2.5MG TAB SL          80011526
80011530   HB PREDNISONE 50MG TABLET              80011530
80011544   HB AZATHIOPRINE 50MG TABLET            80011544
80011553   HB CALAMINE LOTION 120 ML              80011553
80011560   HB CIMETIDINE 300MG PB                 80011560
80011567   HB DESIPRAMINE 25MG TABLET             80011567
80011576   HB PHENYTOIN SRC 100MG                 80011576
80011590   HB FLUOCINOLONE 0.01% SOLUTION 60      80011590
80011626   HB PREPARATION H OINT                  80011626
80011633   HB PROPRANOLOL 5MG O                   80011633
80011656   HB BACLOFEN 10MG TABLET                80011656
80011745   HB ASCORBIC ACID 500MG TABLET          80011745
80011786   HB CAL CHLORIDE 3GM P                  80011786
80011791   HB CARBAMAZEPINE 400MG                 80011791
80011807   HB CHLORPROMAZINE 100MG TABLET         80011807
80011929   HB ERGOTAMINE 1MG      P               80011929
80011933   HB ESTRADIOL 2MG TABLET                80011933
80011935   HB ESTROGENS,CONJUGATED 0.625MG T 80011935
80011938   HB ESTROGENS,CONJUGATED 2.5MG TAB 80011938
80011940   HB ETHACRYNIC ACID 25MG TABLET         80011940
80011945   HB FERROUS GLUCONATE 325MG TAB         80011945
80011947   HB FERROUS SULF 600MG O                80011947
80011952   HB FLUDROCORTISONE .2MG                80011952
80011954   HB FLUPHENAZINE 1MG TABLET             80011954
80011956   HB FLUPHENAZINE 5MG TABLET             80011956
80011970   HB GUAIFENESIN 10CC                    80011970
80011986   HB PROCAINAMIDE HCL 750MG TABLET       80011986
80011993   HB HEPARIN-CALCIUM 5000                80011993
80012016   HB ATENOLOL 200MG                      80012016
80012105   HB PYRAZINAMIDE 500MG TABLET           80012105
80012135   HB NALTREXONE 100MG TAB                80012135
80012142   HB FLECAINIDE 50MG O                   80012142
80012148   HB GLIPIZIDE 15MG PO                   80012148
80012158   HB HYDRALAZINE 100MG TABLET            80012158
80012165   HB HYDROCRT ACET 25MG P                80012165
80012272   HB METHYLPREDNISOLONE 4MG TABLET 80012272



                                            239
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
80012425   HB PROPAFENONE HCL 300MG TAB           80012425
80012430   HB KCL 20MEQ LIQUID 15 ML              80012430
80012432   HB K ACETATE 10MEQ IV                  80012432
80012437   HB KCL 20MEQ PO                        80012437
80012439   HB KCL 40MEQ PO                        80012439
80012446   HB PRAZOSIN 4MG PO                     80012446
80012597   HB ARGININE 12 MEQ                     80012597
80012622   HB CHLORPROMAZINE 25MG TABLET          80012622
80012638   HB BUMETANIDE 3 MG PO                  80012638
80012643   HB SOTALOL TAB 40MG                    80012643
80012645   HB SOTALOL TAB 120MG                   80012645
80012650   HB AMITRIPTYLINE 250MG                 80012650
80012655   HB VALPROIC ACID 1000MG                80012655
80012657   HB NORTRIPTYLN 125MG CP                80012657
80012659   HB NORTRIPTYLN 200MG CP                80012659
80012675   HB AMLODIPINE 5MG TABLET               80012675
80012705   HB PREDNISON SOL 2.5MG                 80012705
80012712   HB DEXAMETHASONE 12MG O                80012712
80012721   HB FLUOXETINE CAP 80MG                 80012721
80012724   HB FLUVASTATIN CP 80MG                 80012724
80012726   HB TORSEMIDE 10MG TABLET               80012726
80012731   HB TORSEMIDE 100MG TABLET              80012731
80012733   HB VENLAFAXINE HCL 25MG TABLET         80012733
80012738   HB VENLAFAXIN TB 125MG                 80012738
80012761   HB LAMOTRIGINE TB 150MG                80012761
80012768   HB NEFAZODONE HCL 100MG TABLET         80012768
80012784   HB ESTROGENS,CONJUGATED 0.9MG TAB 80012784
80012810   HB LOSARTAN 50MG TABLET                80012810
80012851   HB ACARBOSE 50MG TABLET                80012851
80012863   HB LEVOCARNITINE 200MG/ML LIQ 2 M      80012863
80012865   HB LEVOCARNITINE 500MG/ML LIQ 5 M      80012865
80012930   HB GABAPENTN CAP 900MG                 80012930
80012937   HB METFORMIN 1000MG                    80012937
80012944   HB LANSOPRAZOLE CP 15MG                80012944
80012951   HB DOXAZOSIN TB 3MG                    80012951
80012953   HB DOXAZOSIN TB 5MG                    80012953
80012960   HB MIDODRINE TB 5MG                    80012960
80012981   HB ASPIRIN,EC 81MG                     80012981
80012983   HB PANCRELIPASE 3CAPS                  80012983
80012990   HB CARVEDILOL 25MG                     80012990
80013004   HB VITAMIN E 800U                      80013004
80013006   HB SENOKOT 3TABS                       80013006



                                            240
  Charge
   Code                    Description               CPT Code OP/Default Price   IP/ED Price
80013020   HB RALOXIFENE PO 30MG                     80013020
80013076   HB VITAMIN E LIQ 10CC                     80013076
80013085   HB ULTRASE MT 12 1CAP                     80013085
80013157   HB MESALAMINE-CR 750MG                    80013157
80013164   HB PYRIDOSTIG SYR 30MG                    80013164
80013173   HB TOLTERODIN TB 2MG                      80013173
80013180   HB TIZANIDINE TB 8MG                      80013180
80013187   HB DILTIAZEM-XR 360MG                     80013187
80013194   HB PROPAFENONE TB 225MG                   80013194
80013196   HB LEVETIRACETM TB 250MG                  80013196
80013203   HB OXCARBAZEPIN TB 450MG                  80013203
80013217   HB ZONISAMIDE CP 100MG                    80013217
80013219   HB ZONISAMIDE CP 300MG                    80013219
80013282   HB PACERONE TB 400MG                      80013282
80013289   HB RIMANTADINE TB 100MG                   80013289
80013314   HB MAGNES OX TAB 250MG                    80013314
80013337   HB TOLTERODIN TB 4MG                      80013337
80013360   HB GALANTAMINE SUS 12MG                   80013360
80013375   HB OC-LIDOCAIN 1% 2CCAMP                  80013375
80013495   HB MCT OIL 30CC                           80013495
80013497   HB TRIHEXYPHENIDYL 5MG TABLET             80013497
80013502   HB CARBAMIDE PEROXIDE 6.5% DRP 15         80013502
80013504   HB VALPROIC SYR 250MG                     80013504
80013511   HB WARFARIN 7.5MG TABLET                  80013511
80013527   HB CETIRIZINE TAB 20MG                    80013527
80013543   HB NATEGLINIDE TB 60MG                    80013543
80013580   HB DYAZIDE 1 CAP                          80013580
80013656   HB PICU OBS, NO CHARGE, HOURLY            80013656
80013658   HB CMIS - POST OP (90 DAY GLOBAL)         80013658
80013659   HB CETACAINE SPRAY *                      80013659
80013660   HB ETHYL CHLORIDE SPRAY                   80013660
80013661   HB PAIN EASE MIST SPRAY                   80013661
80013662   HB NITROGLYCERIN OINT 2% 1GM PKTS         80013662
80013663   HB TRAUMATIC                              80013663
80013664   HB RADIATION                              80013664
80013665   HB CHEMICAL                               80013665
80013666   HB ET LEVEL 2                             80013666
80013667   HB ET LEVEL 3                             80013667
80013668   HB MISCELLANEOUS                          80013668
80013669   HB ILEOSTOMY                              80013669
80013670   HB COLOSTOMY                              80013670
80013671   HB UROSTOMY                               80013671



                                               241
  Charge
   Code                    Description                         CPT Code OP/Default Price   IP/ED Price
80013672   HB TUBE                                             80013672
80013673   HB PRESSURE                                         80013673
80013674   HB DIABETIC                                         80013674
80013675   HB VASCULAR                                         80013675
80013676   HB DRAINAGE                                         80013676
80013677   HB INFECTIOUS                                       80013677
80013678   HB INCONTINENCE                                     80013678
80013680   HB PT.CONVENIENCE-15 MIN                            80013680
80013681   HB RECOVERY PT-15 MIN                               80013681
80013689   HB PROPAFENONE (RHYTHMOL)*                          80013689
80013731   HB STELAZINE                                        80013731
80013984   HB HIV-1 GENOTYPING (RT+PROT)*                      80013984
80014119   HB LAB RUNC NOTIFICATION                            80014119
80014152   HB LAB ATAXIA EVAL - INTERP & RPT*                  80014152
80014709   HB LAB SUDAN BLACK STAIN              #             80014709
80014710   HB LAB LIPASE STAIN           #                     80014710
80014724   HB LAB CA125*                                       80014724
80014725   HB TEST SENT TO OUTSIDE REF LAB#                    80014725
80014727   HB LAB IRON STAIN - BM*                             80014727
80014734   HB LAB ACID PHOSPHATASE STAIN #                     80014734
80014863   HB LAB ADENOVIRUS EIA             #                 80014863
80014864   HB LAB RSV EIA            #                         80014864
80014885   HB LAB VIRUS INOCULATION, SHELL V*                  80014885
80014900   HB CONCENTRATION, CSF FOR GS*                       80014900
80014903   HB LAB INTERP N.G. CONFIRM*                         80014903
80014905   HB LAB INTERP C.T. CONFIRM*                         80014905
80015002   HB LAB IDENTIF, VIRAL         #                     80015002
80015054   HB LAB HIV AB WESTERN BLOT                #         80015054
80015071   HB MORPHOMETRIC ANALYSIS; TUMOR                     80015071
80015081   HB PATH CONSULT, COAG COMPR                         80015081
80015093   HB LAB PROGESTERONE RRECEPTOR*                      80015093
80015094   HB LAB ESTROGEN RECEPTOR*                           80015094
80015105   HB LAB ACUTE LEUKEMIA PANEL               #         80015105
80015119   HB LAB DNA PLOIDY/DNAM            #                 80015119
80015120   HB LAB DNA PLOIDY/DNSM            #                 80015120
80015121   HB LAB BLOOD DONOR CMV TESTING #                    80015121
80015127   HB PATHOLOGY SMEAR EXTEND STDY*                     80015127
80015130   HB PATHOLOGY FLUID, SUREPATH*                       80015130
80015131   HB CYTOLOGY CELL BLOCK*                             80015131
80015133   HB PATHOLOGY FLUID, SMEAR*                          80015133
80015134   HB PATHOLOGY FNA CYTOTECH ASST*                     80015134
80015135   HB PATHOLOGY FLUID, CONCENTRATE*                    80015135



                                                         242
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
80015136   HB PATHOLOGY FNA INTERP & RPT*            80015136
80015138   HB PATHOLOGY FNA PERFORMANCE              80015138
80015141   HB PATHOLOGY SMEAR SCR & INTERP*          80015141
80015142   HB PATHOLOGY, CYTO GYN MAT INDX           80015142
80015145   HB OUTSIDE CONSULT, WITH PREP             80015145
80015146   HB PATHOLOGY IMMUNOFL, INDIRECT*          80015146
80015147   HB PATH INTROP TCH PRP, INITIAL*          80015147
80015148   HB PATH INTROP TCH PRP, ADDL*             80015148
80015151   HB PATH CON INTRAOP FZS, ADDL      *      80015151
80015152   HB PATHOLOGY DECAL - BM*                  80015152
80015153   HB LAB TISSUE GR M 7 - BM*                80015153
80015154   HB PATHOLOGY TISS STN GR II - BM*         80015154
80015159   HB PATHOLOGY, CRYSTAL ID*                 80015159
80015161   HB PATHOLOGY TISSUE STAIN GR I*           80015161
80015162   HB PATHOLOGY LEVEL I SURGICAL*            80015162
80015164   HB PATHOLOGY SMEAR PREP/SCR/INT*          80015164
80015165   HB PATHOLOGY TISSUE STAIN GR II*          80015165
80015167   HB PATHOLOGY TISSUE STAIN, ENZ*           80015167
80015169   HB PATHOLOGY LEVEL II SURGICAL*           80015169
80015170   HB PATHOLOGY LEVEL III SURGICAL*          80015170
80015171   HB LAB TISSUE GR M 7*                     80015171
80015172   HB PATHOLOGY LEVEL V SURGICAL*            80015172
80015173   HB PATHOLOGY LEVEL VI SURGICAL*           80015173
80015174   HB LAB TISSUE X-RAY                       80015174
80015175   HB PATHOLOGY DECALICIFICATION*            80015175
80015177   HB LAB H & E STAIN                        80015177
80015189   HB LAB GLUCOS TOL 4H AU                   80015189
80015191   HB LAB GLUCOS TOL 6H AU                   80015191
80015202   HB LAB UREA NITRO SE AU*                  80015202
80015222   HB LAB ACUTE HEPATITIS PANEL #            80015222
80015226   HB LAB GLUCOSE FAST AU*                   80015226
80015257   HB LAB CHEM 3 PANEL + LD & GGT #          80015257
80015309   HB PROCESS OUTSIDE POOL CRYO*             80015309
80015323   HB LAB STATISTICAL ONLY-OS AUTO#*         80015323
80015327   HB PT. SERA DIFF ABSORPTION - ARC*        80015327
80015328   HB PRETREAT RBC'S/DRUGS - ARC*            80015328
80015329   HB PRETREAT RBC'S ENZM EA - ARC           80015329
80015330   HB ANTIBODY ELUTION (RBC) - ARC           80015330
80015351   HB PRETREAT RBC'S/DRUGS                   80015351
80015352   HB PRETREAT RBC'S ENZM EA*                80015352
80015354   HB SPLIT BLD/BLD COMP                     80015354
80015381   HB THR APHER SEL ADS/FIL PL REINF*        80015381



                                               243
  Charge
   Code                   Description                CPT Code OP/Default Price   IP/ED Price
80015382   HB THER APHER W/ PROTEIN A COL            80015382
80015383   HB ALLO PB STEM CELL APHERESIS            80015383
80015387   HB LAB STATISTICAL ONLY-CS AUTO#          80015387
80015419   HB LAB MRSA PCR INTERP                    80015419
80015532   HB LAB CFADD MUTATION SCAN CF DX*         80015532
80015552   HB CONS, AFTER HOURS                      80015552
80015553   HB CONS, BLOOD TRANSFUSION OP             80015553
80015555   HB CONS, IP INITIAL 80 MIN*               80015555
80015557   HB CONS, OP FOLLOW-UP 15 MIN              80015557
80015559   HB CONS, OP FOLLOW-UP 40 MIN*             80015559
80015560   HB CONS, OP INITIAL 60 MIN                80015560
80015562   HB CONS, RED CELL EXCHANGE                80015562
80015564   HB CONSULT IP LIMITED SEVERITY            80015564
80015569   HB BLOOD COLLECTION, CAPILLARY            80015569
80015571   HB LAB RSCH SPECIMEN STORAGE #            80015571
80015572   HB LAB RSCH SPECIMEN PROCESS #            80015572
80015573   HB LAB RSCH SPECIMEN RETRIEVAL #          80015573
80015574   HB LAB BLOOD COLLECTION FEE*              80015574
80015578   HB LAB HER-2/NEU FISH PROBE*              80015578
80015581   HB LAB CLL FISH PROBES*                   80015581
80015584   HB LAB UROVYSION*                         80015584
80015590   HB LAB EGFR FISH ASSAY*                   80015590
80015591   HB PATHOLOGY IMMUNOFLUOR STUDY*           80015591
80015599   HB LAB MORPHO ANALY, FISH, 1P*            80015599
80015600   HB LAB MORPHO ANALY, FISH, 9;22*          80015600
80015601   HB LAB MORPHO ANALY, FISH 13Q DEL*        80015601
80015602   HB LAB MORPHO ANALY, FISH, MYC*           80015602
80015603   HB LAB MORPHO ANALY, FISH, 15;17*         80015603
80015604   HB LAB MORPHO ANALY, FISH, 11;14 *        80015604
80015605   HB LAB MORPHO ANALY, FISH, 14;18*         80015605
80015606   HB LAB MORPHO ANALY, FISH, 19Q*           80015606
80015619   HB LAB HPV HIGH RISK IN SITU*             80015619
80015620   HB LAB HPV LOW RISK IN SITU*              80015620
80015798   HB LAB MDS FISH PROBES*                   80015798
80015812   HB PROCESS GRANULOCYTE PHER*              80015812
80015815   HB PROCESS GRANULOCYTES PED               80015815
80015816   HB TRANSFUSION, BLOOD COMPONENT* 80015816
80015821   HB THER APHER FOR PLTS *                  80015821
80015822   HB THER APHER FOR RBC'S*                  80015822
80015823   HB RESEARCH THER APHER WBC                80015823
80015826   HB LAB SODIUM WHOLE BLOOD                 80015826
80015827   HB LAB POTASSIUM WHOLE BLOOD              80015827



                                               244
  Charge
   Code                   Description                                     CPT Code OP/Default Price   IP/ED Price
80015828   HB LAB GLUCOSE WHOLE BLOOD                                     80015828
80015830   HB LAB WHOLE BLOOD ACT                       #                 80015830
80015831   HB LAB POTASSIUM                 #                             80015831
80015832   HB LAB GLUCOSE                   #                             80015832
80015833   HB LAB HEMATOCRIT                    #                         80015833
80015834   HB LAB SODIUM                #                                 80015834
80015835   HB LAB IONIZED CALCIUM                   #                     80015835
80015837   HB LAB HEPARIN DOSE RESPONSE #                                 80015837
80015839   HB LAB ACTIVATED CLOTTING TIME #                               80015839
80015840   HB LAB POC GLUCOSE                   #                         80015840
80015841   HB LAB POC URINE CHEMISTRY                       #             80015841
80015842   HB LAB POC SPUN HEMATOCRIT, BLD#                               80015842
80015843   HB LAB POC OCCULT BLOOD                      #                 80015843
80015844   HB LAB BLOOD GASES, ART POC                      #             80015844
80015845   HB LAB WHOLE BLOOD PROTIME                           #         80015845
80015846   HB LAB (KOH) FUNGAL EXAM                     #                 80015846
80015848   HB CARBON DIOXIDE (BICARBONATE) *                              80015848
80015849   HB CHLORIDE*                                                   80015849
80015850   HB CREATININE*                                                 80015850
80015851   HB UREA NITROGEN*                                              80015851
80015856   HB LAB ASPIRIN ASSAY*                                          80015856
80015857   HB LAB PLAVIX RESISTANCE ASSAY*                                80015857
80015858   HB LAB IIB/IIIA (REOPRO) ASSAY                                 80015858
80015860   HB LAB BASIC METABOLIC PANEL POC*                              80015860
80015861   HB LAB HEMOGLOBIN                                              80015861
80015864   HB LAB URINALYSIS W/MICRO                                      80015864
80015865   HB LAB HEMATOCRIT*                                             80015865
80015873   HB LAB BETA-HCG QUAL*                                          80015873
80015876   HB LAB SED RATE WESTEGREN                                      80015876
80015881   HB LAB MANUAL DIFF                                             80015881
80015884   HB LAB ACTIVATED CLOTTING TIME*                                80015884
80015886   HB THAW PERIPH BLOOD STEM CELLS*                               80015886
80015887   HB BM/PB STEM CELL PLAS DEPLETE                                80015887
80015888   HB ALLO BM/PBSC CROSSMATCH *                                   80015888
80015889   HB ALLO BM/PBSC DONOR ABO*                                     80015889
80015890   HB ALLO BM/PBSC DONOR RH (D) *                                 80015890
80015968   HB PERIPHERAL BLD STEM XPLT ADULT                              80015968
80015976   HB PATH CONSULT, COAG LIMITED*                                 80015976
80015981   HB LAB LEVEL IV DERM/GI                                        80015981
80015985   HB LAB AA-AUTOPSY SERV                                         80015985
80016021   HB PB SM W/G REFERRED INTERP                                   80016021
80016089   HB CONS, 10 PM - 8 AM                                          80016089



                                                                    245
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
80016092   HB CONS, INCOMPLETE/ABORTED PROC          80016092
80016094   HB CONS, OP FOLLOW-UP 10 MIN              80016094
80016096   HB CONS, OP FOLLOW-UP 25 MIN*             80016096
80016099   HB CONS, PROC ABORT - PT INST*            80016099
80016101   HB CONS, SUNDAY / HOLIDAY*                80016101
80016120   HB LAB DOT/FAB UNIT TALLY     #           80016120
80016155   HB OBSERVATION, NO CHARGE, HOURLY 80016155
80016167   HB CSICU -OBS, NO CHARGE, HOURLY          80016167
80016168   HB HB URINE PREGNANCY TEST                80016168
80016169   HB LAB MOL IGHP AMP TGT 1 2 NA SQ         80016169
80016170   HB LAB KRASP ENZY DIGESTION               80016170
80016171   HB LAB HEP B RT PCR QUANT                 80016171
80016174   HB LAB MOL TCRB SEP ID HI RES TCH         80016174
80016175   HB LAB MOL IGK AMP TGT 1 2 NA SEQ         80016175
80016176   HB LAB MOL IGK SEP ID HI RES TECH         80016176
80016178   HB LAB KRASP ISOL N.A.                    80016178
80016179   HB LAB MOL TCRG AMP TGT 1 2 NA SQ         80016179
80016180   HB MICONAZOLE OINT 2% 2OZ                 80016180
80016181   HB LAB MOL TCRB INTERP & RPT              80016181
80016183   HB LAB KRASP INTERP/REPORT TECH.          80016183
80016194   HB LAB PCA3 INTERP*                       80016194
80016195   HB LAB BLN N.A. PROBE, EA*                80016195
80016196   HB LAB BLN N.A. PROBE EA 2ND NODE*        80016196
80016197   HB LAB BLN MUTIPLEX TARGET AMP*           80016197
80016198   HB LAB PCA3 RNA STABILIZATION*            80016198
80016199   HB LAB PCA3 ISOL. PURIFIED N.A.           80016199
80016200   HB LAB PCA3 N.A. PROBE, EA*               80016200
80016201   HB LAB BLN ISOL. PURIFIED N.A.*           80016201
80016202   HB LAB BLN REV TRANSCR. 2ND NODE*         80016202
80016203   HB LAB BLN INTERP 2ND NODE*               80016203
80016204   HB LAB BLN MUTPLX TRGT AMP 2ND ND*        80016204
80016205   HB LAB PCA3 REVERSE TRANSCR.*             80016205
80016206   HB LAB BLN REVERSE TRANSCR.*              80016206
80016207   HB LAB PCA3 AMPL. TARGET EA SEQ*          80016207
80016208   HB LAB ANEU-ANALY 100-300 CELLS           80016208
80016209   HB CYANOCOBAL 1000MCG*                    80016209
80016210   HB LAB BLN RNA STABILIZATION*             80016210
80016211   HB LAB BLN RNA STABL 2ND NODE*            80016211
80016212   HB LAB BLN ISOL. PUR NA 2ND NODE*         80016212
80016213   HB LAB BLN INTERP*                        80016213
80016214   HB LAB PCA3 ENZY. DIGEST*                 80016214
80016215   HB LAB ANEU-FISH PROBE, EACH*             80016215



                                               246
  Charge
   Code                  Description              CPT Code OP/Default Price   IP/ED Price
80016217   HB ERX 800 STAT PROCEDURES             80016217
80016218   HB ERX DUMMY CODE                      80016218
80016231   HB DEXTROSE 10% WATER 1000ML           80016231
80016232   HB RT FOLLOW UP VISIT                  80016232
80016234   HB CLIP ADD'L STAT G030064/S41         80016234
80016235   HB PROTOCOL DRUG IV ADDITIVE           80016235
80016236   HB RUNNER'S WELLNESS SCREEN            80016236
80016237   HB MD PICC CONSULTATION                80016237
80016238   HB GROUP THERAPY 90 MIN. STAT          80016238
80016239   HB GROUP THERAPY 60 MIN. STAT          80016239
80016240   HB PSYCHOSOCIAL ASSESSMNT              80016240
80016241   HB OUTCOME ASSESSMENT                  80016241
80016242   HB PRE SCREEN REHAB EVAL               80016242
80016243   HB COPD 6 MIN WALK TEST                80016243
80016244   HB PR PAT REPORT GENERATION            80016244
80016245   HB PR PLACEMENT OF LUNG TX PAT         80016245
80016246   HB PR PLCMNT LUNG TX PAT- MA           80016246
80016274   HB YOGA RESEARCH STUDY                 80016274
80016282   HB OT EVAL PRE-EMPLOYMENT              80016282
80016283   HB THAW PLAS STATISTICAL CHG           80016283
80016284   HB IRRADIATION STATISTICAL CHG         80016284
80016288   HB PT EVAL PRE-EMPLOYMENT              80016288
80016290   HB POSITIVE AFP CVS                    80016290
80016291   HB POSITIVE AFP AMNIO                  80016291
80016292   HB POSITIVE AFP GC                     80016292
80016293   HB ATROPINE SULF 0.01MG/.01ML          80016293
80016294   HB OMEPRAZOLE SRC 40MG                 80016294
80016295   HB TAC 5CC                             80016295
80016296   HB APROTININ 100CC                     80016296
80016297   HB BIRTH CONTROL 1CYCLE                80016297
80016298   HB CALCITONN NAS 2ML                   80016298
80016299   HB ROSEGLITAZON TB 10MG                80016299
80016300   HB PHENYTOIN SUS 600MG                 80016300
80016301   HB ESCITALOPRM SOL 10MG                80016301
80016302   HB DANOCRINE 400MG O                   80016302
80016303   HB ER-AUGMENTIN 75ML                   80016303
80016304   HB LANSOPRAZL PB 30MG                  80016304
80016305   HB LOMOTIL LIQ 5 MG                    80016305
80016306   HB ER-CEHPALEXIN 100CC                 80016306
80016307   HB LANSOPRAZL PB 15MG                  80016307
80016308   HB OXCARBAZEPIN TB 1500MG              80016308
80016309   HB ANASTRAZOLE TB 1MG                  80016309



                                            247
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
80016310   HB APSAC 30UNITS IVP                    80016310
80016311   HB NEOSPORIN GU IRIG L                  80016311
80016312   HB METARAMINOL BITARTRATE 10MG/ML 80016312
80016313   HB AUROTHIOGLUCOSE 50MG/ML VIAL 1       80016313
80016314   HB SPECTINOMYCIN HCL 2GM VIAL           80016314
80016315   HB VERTEPORFIN 0.1MG P                  80016315
80016316   HB MEDROL DOSE-PAK                      80016316
80016317   HB CORTISPORIN OTIC SUSP                80016317
80016318   HB CORTISPORIN OINT 15GM                80016318
80016319   HB AMINOCAP ACID 2 GM O                 80016319
80016320   HB AMINOCAP ACID 5 GM O                 80016320
80016321   HB METHYLPRED 24MG O                    80016321
80016322   HB METOPROLOL TB 200MG                  80016322
80016323   HB SOL, IV DEXTROSE 50% 100CC P         80016323
80016324   HB OXCARBAZEPIN TB 1200MG               80016324
80016325   HB BALANCED SALT SOLUTION 500 ML        80016325
80016326   HB DIAZOXIDE 300MG/20ML AMPUL           80016326
80016327   HB KCL-RX P                             80016327
80016328   HB PREDNISON SOL 50 MG                  80016328
80016329   HB PREDNISON SOL 20 MG                  80016329
80016330   HB METHYLPREDNISOLONE 32MG TABLET 80016330
80016331   HB GO-LYTELY 16.4GM                     80016331
80016332   HB SOD CHLORIDE BOLUS                   80016332
80016333   HB PREDNISOLONE SOD PHOS 20MG/ML        80016333
80016334   HB SODIUM CHLOR 0.9%                    80016334
80016335   HB ETIDRONATE 400MG O                   80016335
80016336   HB PAROXETINE TB 80MG                   80016336
80016337   HB ER-AMOXICILLIN 100CC                 80016337
80016338   HB GRISEFULVN 500MG TAB                 80016338
80016339   HB ORABASE-B PASTE 5 GM                 80016339
80016340   HB PILOCARPINE HCL 6% DROPS 15 ML       80016340
80016341   HB AZATHIOPRIN 300MG PO                 80016341
80016342   HB ESCITALOPRM SOL 20MG                 80016342
80016343   HB ER-PEDIAZOLE 100CC                   80016343
80016344   HB PHENYTOIN SUS 500MG                  80016344
80016345   HB MIDODRINE TB 15MG                    80016345
80016346   HB METYRAPONE 500MG O                   80016346
80016350   HB CATH LAB CANCELLED PROC              80016350
80016359   HB STATISTIC SPECTROSCOPY               80016359
80016361   HB POSITIVE AFP ULTRASOUND              80016361
90000001   HB CHOLANGIOGRAM PERC S&I               90000001
90000002   HB COMPLEX CMG WITH SUPPLIES            90000002



                                             248
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
90000003   HB NM CARDIAC SPECT COMPLETE           90000003
90000004   HB NM CARDIAC ADENOSINE COM            90000004
90000005   HB NM CARDIAC SPECT COMPLETE           90000005
90000006   HB NM CARDIAC ADENOSINE COM            90000006
90000007   COMP AS & ID (PRA) W & W/O DTT         90000007
90000008   AS PACKAGE-IVIG                        90000008
90000009   HB COMP AUTOAB W & W/O DTT             90000009
90000010   HB AUTO B-CELL XM PACKAGE              90000010
90000011   HB AUTO XM COMPLETE                    90000011
90000012   HB AUTO XM PACKAGE-IVIG                90000012
90000013   HB AUTO T-CELL XM PAGKAGE              90000013
90000014   HB COELIAC DISEASE                     90000014
90000015   HB HEMOCHROMATOSIS                     90000015
90000016   HB INFLAM BOWEL DIS-CHRN DIS           90000016
90000017   HB INFLAM BWEL DIS-ULCER COLTS         90000017
90000018   HB INSULIN DEPENDENT DIABETES          90000018
90000019   HB IVIG B-CELL XM PACKAGE              90000019
90000020   HB IVIG T-CELL XM PACKAGE              90000020
90000021   HB NARCOLEPSY                          90000021
90000022   HB POTENTIAL BMR-ENGRAFTMENT           90000022
90000023   HB POTENTIAL BMR-VER                   90000023
90000024   HB POTENTIAL HRT REC-NEW EVAL          90000024
90000025   HB POTN HEART TXP REC-POST TXP         90000025
90000026   HB POTENTIAL HEART REC-PRE TXP         90000026
90000027   HB POTENTIAL HEART REC W/VAD           90000027
90000028   HB POTENTIAL KIDNEY/HEART REC          90000028
90000029   HB POTENTIAL KIDNEY/LIVER REC          90000029
90000030   HB POTENTIAL KIDNEY/LUNG REC           90000030
90000031   HB POTENTIAL KIDNY/PANCRAS REC         90000031
90000032   HB POTN KIDNY REC-NW NOT LISTD         90000032
90000033   HB POTN KIDNY REC-ON WAIT LIST         90000033
90000034   HB POTN KIDNEY REC-POST TX             90000034
90000035   HB POTN LIVER REC-EVALUATION           90000035
90000036   HB LIVER TX REC-POST TX (GVHD)         90000036
90000037   HB POTN LIVR REC-PRE PRIMRY TX         90000037
90000038   HB POTN LIVER REC-REGRAFT              90000038
90000039   HB PLATELET RECIPIENT                  90000039
90000040   HB POTN LUNG REC-PRE TX                90000040
90000041   HB POTN LUNG REC-TRRANSPLANT           90000041
90000042   HB POTN PANCREAS RECIPIENT             90000042
90000043   HB QUICKSCRN COMPLT W+WO DTT           90000043
90000044   HB IVIG QUICKSCREEN PACKAGE            90000044



                                            249
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
90000045   HB REVERSE CROSSMATCH PACKAGE          90000045
90000046   HB B-CELL CROSSMATCH PACKAGE           90000046
90000047   HB IVIG CROSSMATCH PACKAGE             90000047
90000048   HB T-CELL CROSSMATCH PACKAGE           90000048
90000049   HB CYTO BLOOD KARYOTYPE                90000049
90000050   HB CYTO CANCER BL/BM KARYOTYPE         90000050
90000051   HB CYTO AMNIOCYTE KARYOTYPE            90000051
90000052   HB CYTO TISSUE KARYOTYPE               90000052
90000053   HB CYTO CVS-CULT KARYOTYPE             90000053
90000054   HB CYTO DIRECT CVS ANALYSIS            90000054
90000055   HB CYTO MOSAICISM STUDY                90000055
90000056   HB FISH-METPHSE/PROB 10-30CELL         90000056
90000057   HB CYTO FOCUS KARYOTYPE                90000057
90000058   HB CYTO KARYOTYPE SOLID TUMOR          90000058
90000059   HB CYTO HI-RES KARYOTYPE               90000059
90000060   HB CYTO CHROMO BREAKAGE                90000060
90000061   HB CYTO SIST CHRMAT EXCH PANEL         90000061
90000062   HB FISH-INTERPHASE                     90000062
90000063   HB FISH-INTERPHASE GENDER              90000063
90000064   HB FISH-UNCULTURED PRENATAL            90000064
90000068   HB PARVOVIRUS-PCR                      90000068
90000071   HB ANTI-CMV T CELL LEVEL               90000071
90000072   HB ANTI-EBV T CELL LEVEL               90000072
90000073   HB T CELL IMMUNE FUNC ASSAY            90000073
90000075   HB ANTI-3RD PARTY-CFC                  90000075
90000077   HB LINK ANTI-DONOR-CFC                 90000077
99999998   CONVERSION DUMMY EAP-DONT USE          99999998
99999999   RESEARCH STUDY-DO NOT USE              99999999
03510001   HB CT BRAIN PERFUSION                   0042T        2891.36        4322.57
03610378   HB STENT PLCMT VRT/CAR INI S&I          0075T       12164.23
03610379   HB STENT PLCMT VRT/CAR 2ND S&I          0076T       12164.23
03200025   HB RPR AAA W/ VISCERAL S&I              0080T       12020.56
03200026   HB PROSTH PLACMT AAA W/VISCER S&I       0081T        4006.85
04020007   HB CHD RISK IMT STUDY                   0126T        1466.46
03610532   HB SACROPLASTY UNILATERAL               0200T        6437.44
03610533   HB SACROPLASTY BILATERAL                0201T        8831.96
04800047   HB ACOUSTIC/ELECTR CARDGRPHY            0223T        530.00
04800048   HB ACSTIC/ELEC CARDGRPHY AV/VV          0224T        530.00
04800049   HB ACSTIC/ELEC CARDGRPHY AV+VV          0225T        530.00
04810153   HB TRLUML PERIP ATHRC RENAL ART         0234T       25970.00
04810154   HB TRLUML PERIP ATHRC VISCERAL          0235T                      12020.56
04810155   HB TRLUML PERIP ATHRC ABD AORTA         0236T       25970.00



                                            250
  Charge
   Code                  Description                  CPT Code OP/Default Price   IP/ED Price
03610662   HB EVASC RPR ILIAC ART BIFUR                0254T        5316.33        6911.23
03610670   HB EVASC RPR ILIAC ART BIF S&I              0255T                       8484.67
03610663   HB PARTNER TRANSFEMORAL                     0256T                      12247.36
03610664   HB PARTNER TRANSAPICAL                      0257T                      12247.36
02720044   HB ENDOSCOPE SHEATH DISPOSABLE              A4270        257.72
02781003   HB CATHETER,IMPLNTBLTOTALACCSS              A4301        1228.36
02721332   HB PUMP, PAIN ON-Q                          A4306        753.43
02721643   HB CATHETER, INDWLL SILICONE 1              A4344         79.18
02740027   HB KNEE ORTHOSES ELAS W STAYS               A4466        354.52
03430042   HB ISOTOPE, F18 FLT RESEARCH                A4641
03430001   HB ISOTOPE, NOC XENON                       A4641        1094.66
03430002   HB ISOTOPE, IN111 SATUMOMAB <6MCI           A4642        3637.50
03430003   HB ISOTOPE,TC99 SESTAMIBI/DOSE              A9500        995.92
03430005   HB ISOTOPE, TC99M TETROFOSMN <4MCI          A9502        426.65
03430006   HB ISOTOPE, TC99M MEDRONATE <30MCI          A9503        316.94
03430007   HB ISOTOPE, THALLIUM PER MCI                A9505        162.13
03430008   HB ISOTOPE, TL201 THALLOUS /MCI             A9505        632.66
03430009   HB ISOTOPE, IN111 CAPROMAB <10MCI           A9507       13717.41
03430010   HB ISOTOPE, I131 IODOBNGAT /0.5MCI          A9508        7835.73
03430041   HB ISOTOPE, I-123 NAI DIAG /MC              A9509        286.47
03430011   HB ISOTOPE, TC99M DISOFENIN <15MCI          A9510        793.57
03430012   HB ISOTOPE,TC99M PERTCHNTE/MCI              A9512        399.83
03430013   HB ISOTOPE, I123 NAI/100MCI                 A9516        832.58
03440001   HB ISOTOPE, I131 NAI CAPSL TX /MCI          A9517         20.13
03430014   HB ISOTOPE, TC99M EXAMETZME <25MCI          A9521        1173.90
03430015   HB ISOTOPE, I131 NAI CAPSL DX /MCI          A9528        103.62
03430016   HB ISOTOPE, I131 NAI DX /UCI                A9531         1.48
03430017   HB ISOTOPE, TC99M MEBROFEN <15MCI           A9537        276.71
03430018   HB ISOTOPE, TC99M PYROPHOS <25MCI           A9538        856.96
03430019   HB ISOTOPE, TC99M PENTETATE <25MCI          A9539        738.71
03430020   HB ISOTOPE, TC99M MAA <10MCI                A9540        243.80
03430021   HB ISOTOPE, TC99M SULFR COL <20MCI          A9541        380.33
03430022   HB ISOTOPE, IN111 IBRITUMOMB <5MCI          A9542       12246.07
03440002   HB ISOTOPE, Y90 ZEVALIN <40MCI              A9543       73475.23
03430023   HB ISOTOPE, IN111 OXYQUIN /0.5MCI           A9547        3709.42
03430024   HB ISOTOPE, IN111 PENTETAT /0.5MCI          A9548        3465.62
03430025   HB ISOTOPE, TC99M SUCCIMER <10MCI           A9551        819.17
03430026   HB ISOTOPE, F18 FDG <45MCI                  A9552        3385.16
03430027   HB ISOTOPE, RB82 RUBIDIUM <60MCI            A9555        1293.36
03430028   HB ISOTOPE, GA67 GALLIUM /MCI               A9556         92.64
03430029   HB ISOTOPE, TC99M BICISATE <25MCI           A9557        3199.88
03430030   HB ISOTOPE, XE133 XE GAS <10MCI             A9558        877.68



                                                251
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
02550004   HB ISOTOPE, XENON /10MCI                A9558         45.08
03430031   HB ISOTOPE, TC99M LABLD RBC <30MCI      A9560        856.96
03430032   HB ISOTOPE, TC99M MERTIATDE <15MCI      A9562        881.34
03430033   HB ISOTOPE, TC99M PENT GAS <75MCI       A9567        251.11
03430043   HB ISOTOPE, TC99M ARCIT/DOSE            A9568        4289.12
03430034   HB ISOTOPE,TC99M AUTO WBC/DOSE          A9569        3599.71
03430035   HB ISOTOPE,IN111 AUTO WBC/DOSE          A9570        3599.71
03430036   HB ISOTOPE, IN111 PENTETREO <6MCI       A9572       11749.94
02550010   HB CONTRAST, GADOMULTIHANCE ML          A9577         29.00
02550009   HB CONTRAST, GADOLINIUM /ML             A9579         25.63
02550008   HB GAD-BASE MR CONTRAST NOS,1ML         A9579         25.63
03430044   HB ISOTOPE, NAF F-18 /DOSE =30 MCI      A9580        1133.79
02502484   HB CONTRAST, GADO EOVIST /ML            A9581         42.92
03430039   HB ISOTOPE, I123 IOBENG <15MCI          A9582        9091.30
03440003   HB ISOTOPE, SR89 CHLORIDE /MCI          A9600        1662.72
03440004   HB ISOTOPE, SM153 LEXI <150MCI          A9604       17178.15
80000422   HB PROF CONS INCOMP/ABRT PROC          ADDM52
80000418   HB PROF CONS PROC ABRT PT INST         ADDM53
02780457   HB ANCHOR / SCREW 1                     C1713        450.99
02780482   HB ANCHOR / SCREW 10                    C1713        7759.16
02780057   HB ANCHOR / SCREW 11                    C1713        9522.60
02780476   HB ANCHOR / SCREW 12                    C1713       10183.90
02780501   HB ANCHOR / SCREW 13                    C1713       10399.29
02780500   HB ANCHOR / SCREW 14                    C1713       11589.62
02780477   HB ANCHOR / SCREW 17                    C1713       16628.85
02780434   HB ANCHOR / SCREW 2                     C1713        1396.65
02780466   HB ANCHOR / SCREW 3                     C1713        2565.37
02780440   HB ANCHOR / SCREW 4                     C1713        3544.97
02780475   HB ANCHOR / SCREW 5                     C1713        4374.23
02780443   HB ANCHOR / SCREW 6                     C1713        5392.62
02780437   HB ANCHOR / SCREW 7                     C1713        6037.59
02780449   HB ANCHOR / SCREW 9                     C1713        7565.18
02721052   HB ANCHOR, AMPLATZ                      C1713        623.32
02780473   HB ANCHOR/ SCREW 15                     C1713       13114.62
02780480   HB ANCHOR/ SCREW 16                     C1713       14360.42
02780942   HB ANCHOR/ SCREW 19                     C1713       18772.08
02780430   HB ANCHOR/ SCREW 8                      C1713        7031.74
02781088   HB ANCHOR/SCREW 18                      C1713       17600.00
02780428   HB CHANNEL REPLACEMENT                  C1713        193.98
02780468   HB HEMIMANDABLE                         C1713        4088.11
02780461   HB INSERT, ORTHO 1                      C1713        349.16
02780435   HB KIT, AXIALIF 2                       C1713       47589.10



                                            252
  Charge
   Code                    Description          CPT Code OP/Default Price   IP/ED Price
02780472   HB MANDIBLE 3                         C1713        7492.44
02780463   HB NAIL TITANIUM ORTHO 1              C1713        1091.82
02780469   HB NAIL TITANIUM ORTHO 2              C1713        4122.06
02780439   HB NAIL TITANIUM ORTHO 3              C1713        6373.59
02780456   HB NEURO NUT                          C1713         96.98
02780426   HB NEURO PAC                          C1713        1483.94
02780452   HB NUT, SPINE 1                       C1713        244.90
02780442   HB NUT, SPINE 2                       C1713        659.53
02780429   HB ORTHO BALL 1                       C1713        1294.82
02780027   HB ORTHO BALL 2                       C1713        1944.64
02780438   HB ORTHO BALL 3                       C1713        3443.13
02780467   HB ORTHO HEAD 1 OR                    C1713        3050.31
02780031   HB ORTHO PIN 4                        C1713        2894.57
02780011   HB PIN, ORTHO 1                       C1713         22.75
02780460   HB PIN, ORTHO 2                       C1713        331.39
02780447   HB PIN, ORTHO 3                       C1713        931.10
02780470   HB PLATE, ORTHO 1                     C1713        7096.86
02780431   HB PLATE, SPINE 10                    C1713       11173.19
02780451   HB PLATE, SPINE 11                    C1713       13256.84
02780446   HB PLATE, SPINE 3                     C1713        2873.58
02780450   HB PLATE, SPINE 4                     C1713        3993.14
02780432   HB PLATE, SPINE 5                     C1713        4720.05
02780455   HB PLATE, SPINE 6                     C1713        5426.56
02780478   HB PLATE, SPINE 7                     C1713        6682.57
02780458   HB PLATE, SPINE 8                     C1713        7060.83
02780479   HB PLATE, SPINE 9                     C1713        8292.61
02780441   HB ROD 4                              C1713        3855.33
02780433   HB ROD, ORTH/SPINE                    C1713        6304.32
02780474   HB SPACER, 2                          C1713        346.39
02780462   HB SPINE BOLT 1                       C1713        902.01
02780453   HB SPINE BOLT 2                       C1713        1964.04
02780471   HB SPINE BOLT 3                       C1713        7157.83
02780425   HB SPINE BOLT 4                       C1713        8675.71
02780436   HB SPINE HOOK 4                       C1713        4364.53
02780424   HB SPINE SCREW, DTO 1                 C1713        4552.21
02780481   HB SPINE SCREW, DTO 2                 C1713        6071.29
02780445   HB SPINE SCREW, DTO 3                 C1713       14283.91
02780459   HB WASHER NEURO IMPLANT               C1713        227.93
02720990   HB CATH ARTHERECTOMY                  C1714        8414.33
02720991   HB CATHETER, ATHERECTOMY BALLOON      C1714        7620.60
02721337   HB RT BRACHTYX NEEDLE MUPPIT          C1715        162.12
02721338   HB RT BRACHYTX NEEDLE I-125           C1715         74.11



                                          253
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780875   HB RT BRACYTX SOURCE, HDR IR-192        C1717        848.64
02781065   HB CARDIO DEFIB DUAL CHAMBER 1          C1721       78000.00
02780485   HB CARDIO DEFIB DUAL CHAMBER 2          C1721       72930.00
02780793   HB CARDIO DEFIB DUAL CHAMBER 3          C1721       73695.00
02780486   HB CARDIO DEFIB DUAL CHAMBER 4          C1721       74800.00
02780483   HB CARDIO DEFIB DUAL CHAMBER 6          C1721       84303.00
02780484   HB CARDIO DEFIB DUAL CHAMBER 7          C1721       85000.00
02780913   HB CARDIO DEFIB DUAL CHAMBER 9          C1721       90253.00
02780876   HB ICD DUAL CHAMBER                     C1721       133316.49
02781061   HB CARD DEFIB SINGLE CHAMBER 1          C1722       50700.00
02780489   HB CARD DEFIB SINGLE CHAMBER 2          C1722       54795.00
02780487   HB CARD DEFIB SINGLE CHAMBER 3          C1722       73359.00
02780488   HB CARD DEFIB SINGLE CHAMBER 6          C1722       73100.00
02780877   HB ICD SINGLE CHAMBER                   C1722       71419.55
02721762   HB CATHETER, ATHERECT ROTATION 1        C1724        3007.61
02721763   HB CATHETER, ATHERECT ROTATION 2        C1724        3877.61
02720993   HB CATHETER, ATHERECT ROTATION 3        C1724        5715.46
02721030   HB BALLOON, MICROSYS STEALTH            C1725        3719.77
02721006   HB CATH BALLOON PTA                     C1725        2012.35
02721012   HB CATH DILITATION POLARCATH            C1725        2057.57
02720999   HB CATH DILITATION PTA                  C1725        2663.99
02721021   HB CATH DILITATION PTCA                 C1725       10667.13
02720996   HB CATH DUOSTAT PTCA                    C1725        472.36
02721008   HB CATH INFUSION PTCA                   C1725        1348.24
02720010   HB CATH PERIPHERAL DILITATION           C1725        1203.09
02721013   HB CATHETER, BALLOON CUTTING DEV.       C1725        3388.27
02720994   HB CATHETER, BALLOON PTA                C1725        2067.82
02721014   HB CATHETER, BALLOON SMALL VSL DEV.     C1725        2929.33
02721125   HB CATHETER, TRANS/LU,NONLRS 3          C1725        1687.87
02721609   HB CATHETER,TRANS/LUM,NONLSR 1          C1725        863.49
02721412   HB CATHETER,TRANS/LUM,NONLSR 2          C1725        1359.91
02721036   HB CATH BALLOON BI-VNTRC PACE           C1726        1982.47
02721044   HB CATH DILATION SEPTOSTOMY             C1726        1065.04
02721032   HB CATH DILATION VALVULOPLASTY          C1726        5735.39
02721045   HB CATHETER, ABLA ESOPHAGUS             C1726        2469.60
02721839   HB CATHETER, BALLOON BIL RX             C1726        1082.58
02721792   HB CATHETER, BALLOON DILATION1          C1726        310.00
02721129   HB CATHETER, BALLOON DILATION2          C1726        705.38
02721141   HB CATHETER, BALLOON DILATION3          C1726        838.27
02721752   HB CATHETER, BALLOON DILATION3          C1726        838.27
02721131   HB CATHETER, BALLOON DILATION4          C1726        1023.93
02721619   HB CATHETER, BALLOON DILATION5          C1726        1373.88



                                            254
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02721616   HB CATHETER, BALLOON DILATION6          C1726        1949.54
02721137   HB CATHETER, BALLOON DILATION7          C1726        2176.70
02721721   HB CATHETER, BALLOON DILATION8          C1726        2503.00
02721031                                       C1726
           HB CATHETER, BALLOON MICROSYS STEALTH                3296.83
02721696   HB CATHETER, BALLOON PACEMAKER          C1726        345.11
02721556   HB CATHETER, BALLOON-IN-BALLOON         C1726        2296.22
02721051   HB CATHETER, CRE BAL DILAT              C1726        1014.14
02721039   HB CATHETER,BALLOON BIL DILAT           C1726        1521.76
02781018   HB CATHETER,BALLOON DILATION10          C1726        3742.86
02721653   HB CATHETER,BALLOON DILATION9           C1726        2803.40
02721840   HB CATHETER,CRE BAL DILAT ROTH          C1726        502.48
02721350   HB CATHETER, BALLOON RADIOELEMENT       C1728        7286.99
02781083   HB CATHETER,BRACHYTHSEEDADMIN1          C1728       11000.00
02780046   HB CATHETER,BRACHYTHSEEDADMIN2          C1728       13336.06
02700027   HB RT CATH, BRACHYTX SEED ADMIN B       C1728        218.18
02700026   HB RT CATH, BRACHYTX SEED ADMIN I       C1728         69.46
02720525   HB CATHETER, COUNCIL                    C1729        761.95
02721061   HB CATHETER, DRAINAGE                   C1729        554.41
02721147   HB CATHETER, DRAINAGE 1                 C1729        127.48
02721144   HB CATHETER, DRAINAGE 3                 C1729        1190.19
02721342   HB CATHETER, DRAINAGE 4                 C1729        2043.08
02721062   HB CATHETER, DRAINAGE BILIARY           C1729        489.20
02721053   HB CATHETER, DRAINAGE NEPHROSTOMY C1729              492.15
02721064   HB CATHETER, NASO BIL DRAINAGE          C1729        389.34
02721060   HB CATHETER, NEPH 12FR X 25CM 27-181    C1729        516.81
02721339   HB CATHETER, PLEURX WITH KIT            C1729        1571.11
02721069   HB CATH EP <19 ELECTRODES               C1730        2974.81
02721065   HB CATHETER, EP,19 OR FEW ELEC          C1730        2974.81
02721746   HB CATHETER, EP<19 ELECTRODES 1         C1730        519.00
02721604   HB CATHETER, EP<19 ELECTRODES 2         C1730        1386.72
02721474   HB CATHETER-EP 14 POLE                  C1730        2506.22
02721070   HB CATH EP 20+ ELECTRODES               C1731        4185.97
02721764   HB CATH EP 20+ ELECTRODES 1             C1731        3239.61
02721765   HB CATH EP 20+ ELECTRODES 2             C1731        4220.11
02721766   HB CATH EP 20+ ELECTRODES 3             C1731        4901.11
02721767   HB CATH EP 20+ ELECTRODES 4             C1731        5355.11
02721074   HB CATH EP ABLATION 3D                  C1732        4972.45
02721075   HB CATH EP DIAG/ABLAT 3D MAP            C1732        6061.12
02721072   HB CATH EP ENSITE 3D MAP                C1732       11398.35
02721768   HB CATHETER, DIAG/ABLATION 1            C1732        5809.11
02721769   HB CATHETER, DIAG/ABLATION 2            C1732        6490.11
02721770   HB CATHETER, DIAG/ABLATION 3            C1732        6887.36



                                            255
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02721343   HB CATHETER, DIAG/ABLATION 4            C1732       15284.03
02721076   HB CATH EP ABLATION NON 3D              C1733        7926.90
02721078   HB CATH EP ABLATION NON-COOL TIP        C1733        6061.12
02721859   HB THIRD EYE RETROSCOPE DISPOS          C1749        1483.67
02721079   HB CATH MAHURKAR 13.5FR X 40CM          C1750        579.73
02780866   HB CATHETER, DIALYSIS, LONG-TERM        C1750        2117.53
02721344   HB CATHETER, HEMO, LONG TERM 1          C1750        777.17
02721082   HB CATHETER, HEMO, LONG TERM 1 OR       C1750        318.16
02721392   HB CATHETER, HEMO, LONG TERM 4          C1750        1260.77
02721725   HB CATHETER, HEMO, LONG TERM 5          C1750        1680.00
02721095   HB CATHETER, CENTRAL VEN DBL LMN        C1751        544.97
02721085   HB CATHETER, CENTRAL VEN SNGL LMN       C1751        144.85
02721084   HB CATHETER, CENTRAL VEN TPL LMN        C1751        702.67
02721093   HB CATHETER, FASTNER 10 UNI             C1751        1982.50
02721164   HB CATHETER, INFUSION 1                 C1751        390.73
02721334   HB CATHETER, INFUSION 2                 C1751        692.78
02721333   HB CATHETER, INFUSION 3                 C1751        1012.23
02721167   HB CATHETER, INFUSION 6                 C1751        1286.05
02780494   HB CATHETER, INFUSION/NON-HEMO 1        C1751        668.16
02721345   HB CATHETER, INFUSION/NON-HEMO 2        C1751        1537.98
02721094   HB CATHETER, MICROSYS 1-TIP             C1751        1367.14
02721092   HB CATHETER, MICROSYS 2-TIP             C1751        1435.51
02721083   HB CATHETER, MICROSYS INFUSION          C1751        1809.92
02721088   HB CATHETER, MICROSYS UK                C1751        596.99
02721098   HB CATHETER, PERM-A-CATH                C1751        1307.82
02720694   HB CATHETER, PICC DBL LUMEN             C1751        441.79
02721101   HB CATHETER, PORT-A-CATH                C1751         70.27
02780632   HB CATHETER, DIALYSIS, SHORT TERM       C1752        468.91
02780507   HB CATHETER, DUAL LUMEN                 C1752        715.61
02780634   HB CATHETER, MAHURKAR                   C1752        477.51
02781032   HB CATHETER, MAHURKAR (CL)              C1752        606.13
02780544   HB CATHETER, MAHURKER TRPLE LUMEN       C1752        470.78
02780641   HB CATHETER, MAHURKER W/TRAY            C1752        983.24
02781044   HB CATHETER,HMDYLS,SHRT TERM            C1752        362.73
02721115   HB CATH ULTRASOUND INTRAVASC            C1753        5115.87
02721711   HB CATHETER, INTRAVAS ULTRSND1          C1753        2950.00
02721116   HB CATHETER, EPIDURAL ARROW 19 GA       C1754        3327.34
02780505   HB CATHETER, INTRASPINAL 1              C1755        466.05
02780504   HB CATHETER, INTRASPINAL 3              C1755        2832.85
02780976   HB CATHETER, INTRASPINAL 4              C1755        5541.53
02721118   HB CATH THROMBCT/EMBOLECT-50CM          C1757        2656.95
02721184   HB CATHETER, FOGARTY IRRIGATION 6FR C1757            651.08



                                            256
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02721120   HB CATHETER, 5.5F XSIZER 1.5MM          C1757        5347.97
02721121   HB CATHETER, FOGARTY                    C1757        2058.68
02721117                                      C
           HB CATHETER, THROMBCT/EMBOLECT-120CM1757             3677.09
02721122   HB CATHETER, THROMBCT/EMBOLECT-50CMC1757             2613.35
02721660   HB CATHETER,THRMBCTMYEMBLCTMY1          C1757        110.00
02721685   HB CATHETER,THRMBCTMYEMBLCTMY2          C1757        457.00
02721189   HB CATHETER, URETERAL 1                 C1758        130.36
02721190   HB CATHETER, URETERAL 2                 C1758        231.40
02721123   HB CATHETER, URETERAL 3                 C1758        248.42
02721413   HB CATHETER, URETERAL 4                 C1758        312.57
02721124   HB CATH ULTRASOUND ACUNAV               C1759       12389.52
02780509   HB CLOSURE CATHETER FAST VNUS           C1760        3523.49
02780868   HB CLOSURE DEVICE PROSTAR XL            C1760        4734.71
02780644   HB CLOSURE DEVICE VASCULAR              C1760        1345.40
02780510   HB CLOSURE DEVICE, VASC PLUG            C1760        1349.02
02780643   HB CLOSURE HEMOSTASIS DEVICE            C1760        1530.58
02721228   HB CLOSURE HEMOSTASIS DEVICE IR         C1760        2156.45
02780642   HB D STAT FLOWABLE HEMOSTAT             C1760        1201.40
02780511   HB HUMAN TISSUE 1                       C1762        654.68
02780517   HB HUMAN TISSUE 10                      C1762        8486.59
02780519   HB HUMAN TISSUE 11                      C1762        9464.55
02780535   HB HUMAN TISSUE 12                      C1762        9904.25
02780516   HB HUMAN TISSUE 13                      C1762       12235.23
02780533   HB HUMAN TISSUE 14                      C1762       13500.94
02780530   HB HUMAN TISSUE 15                      C1762       15120.66
02780895   HB HUMAN TISSUE 16                      C1762       16654.76
02780527   HB HUMAN TISSUE 17                      C1762       17855.77
02780528   HB HUMAN TISSUE 18                      C1762       18607.44
02781247   HB HUMAN TISSUE 19                      C1762       18040.00
02780520   HB HUMAN TISSUE 2                       C1762        1361.90
02780522   HB HUMAN TISSUE 20                      C1762       21953.58
02780534   HB HUMAN TISSUE 21                      C1762       23762.43
02780537   HB HUMAN TISSUE 23                      C1762       27278.30
02780524   HB HUMAN TISSUE 25                      C1762       33946.33
02780672   HB HUMAN TISSUE 29                      C1762       42947.46
02780521   HB HUMAN TISSUE 3                       C1762        2468.38
02781208   HB HUMAN TISSUE 30                      C1762       41039.00
02780671   HB HUMAN TISSUE 31                      C1762       45208.45
02780513   HB HUMAN TISSUE 32                      C1762       46800.00
02780914   HB HUMAN TISSUE 32                      C1762       45919.56
02780664   HB HUMAN TISSUE 33                      C1762       55282.50
02781209   HB HUMAN TISSUE 33                      C1762       39897.00



                                            257
  Charge
   Code                 Description             CPT Code OP/Default Price   IP/ED Price
02780529   HB HUMAN TISSUE 4                     C1762        3368.77
02780514   HB HUMAN TISSUE 5                     C1762        4430.00
02780515   HB HUMAN TISSUE 6                     C1762        5089.53
02780532   HB HUMAN TISSUE 7                     C1762        6090.40
02780869   HB HUMAN TISSUE 8                     C1762        6569.24
02780916   HB HUMAN TISSUE 9                     C1762        7409.50
02780518   HB ORTHO HUMAN TISSUE 5               C1762        5101.65
02780541   HB GRAFT SYNTHETIC TISSUE 1           C1763        1551.83
02781107   HB GRAFT SYNTHETIC TISSUE 10          C1763        6380.00
02780542   HB GRAFT SYNTHETIC TISSUE 11          C1763        7284.29
02780870   HB GRAFT SYNTHETIC TISSUE 12          C1763        8132.61
02781108   HB GRAFT SYNTHETIC TISSUE 13          C1763        8004.00
02781175   HB GRAFT SYNTHETIC TISSUE 13          C1763        8778.00
02781140   HB GRAFT SYNTHETIC TISSUE 14          C1763        8778.00
02780673   HB GRAFT SYNTHETIC TISSUE 15          C1763       10507.61
02780539   HB GRAFT SYNTHETIC TISSUE 16          C1763       11983.06
02780930   HB GRAFT SYNTHETIC TISSUE 17          C1763       13118.20
02781001   HB GRAFT SYNTHETIC TISSUE 2           C1763        2240.58
02780538   HB GRAFT SYNTHETIC TISSUE 3           C1763        2948.48
02781002   HB GRAFT SYNTHETIC TISSUE 4           C1763        3352.31
02780540   HB GRAFT SYNTHETIC TISSUE 5           C1763        3782.59
02781180   HB GRAFT SYNTHETIC TISSUE 6           C1763        3903.00
02780974   HB GRAFT SYNTHETIC TISSUE 7           C1763        4590.30
02780931   HB GRAFT SYNTHETIC TISSUE 8           C1763        4867.43
02780543   HB GRAFT SYNTHETIC TISSUE 9           C1763        5998.81
02780689   HB LOOP RECRDR CARDIAC IMPLANT        C1764       12815.89
02780545   HB ADHESION BARRIER 1                 C1765        838.95
02780903   HB ADHESION BARRIER 2                 C1765        1047.34
02781130   HB ADHESION BARRIER 3                 C1765        2587.00
02780938   HB ADHESION BARRIER MM                C1765        836.33
02721127   HB INTRO EP STEERABLE GUIDE CATH      C1766        3282.34
02721128   HB INTRO/SHEATH EP FIXED NON-PEEL     C1766        792.99
02780548   HB GENERATOR, NEUROSTIMULATOR 3       C1767       43494.13
02780550   HB GENERATOR, NEUROSTIMULATOR 5       C1767       50487.89
02780553   HB GENERATOR, NEUROSTIMULATOR 6       C1767       52350.08
02780546   HB GENERATOR, NEUROSTIMULATOR 7       C1767       46031.70
02780551   HB GENERATOR, NEUROSTIMULATOR 7       C1767       53800.50
02780547   HB GENERATOR, NEUROSTIMULATOR 8       C1767       55536.00
02781232   HB GENERATOR, NEUROSTIMULATOR1        C1767       37092.00
02781269   HB GENERATOR, NEUROSTIMULATOR2        C1767       38390.00
02781271   HB GENERATOR, NEUROSTIMULATOR4        C1767       39995.00
02781244   HB GENERATOR, NEUROSTIMULATOR9        C1767       63675.00



                                          258
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780983   HB GENERATOR,NEUROSTIMULATOR 6          C1767       53238.90
02780552   HB GENERATOR,NEUROSTIMULATOR10          C1767       70161.00
02780570   HB GRAFT VASCULAR 1                     C1768        659.53
02781145   HB GRAFT VASCULAR 11                    C1768        8580.00
02781240   HB GRAFT VASCULAR 12                    C1768        9020.00
02780569   HB GRAFT VASCULAR 13                    C1768       10571.86
02780818   HB GRAFT VASCULAR 14                    C1768       11976.73
02780555   HB GRAFT VASCULAR 15                    C1768       12642.59
02781205   HB GRAFT VASCULAR 15                    C1768       12870.00
02781198   HB GRAFT VASCULAR 16                    C1768       12870.00
02781206   HB GRAFT VASCULAR 16                    C1768       14071.00
02781199   HB GRAFT VASCULAR 17                    C1768       14071.00
02780556   HB GRAFT VASCULAR 18                    C1768       16774.34
02780564   HB GRAFT VASCULAR 18                    C1768       18015.80
02780558   HB GRAFT VASCULAR 2                     C1768        1546.98
02780566   HB GRAFT VASCULAR 20                    C1768       19936.20
02781200   HB GRAFT VASCULAR 21                    C1768       18920.00
02780561   HB GRAFT VASCULAR 22                    C1768       21905.08
02780694   HB GRAFT VASCULAR 23                    C1768       24734.85
02780957   HB GRAFT VASCULAR 24                    C1768       25738.85
02781077   HB GRAFT VASCULAR 26                    C1768       26290.00
02780557   HB GRAFT VASCULAR 27                    C1768       30710.40
02780959   HB GRAFT VASCULAR 27                    C1768       55282.50
02780922   HB GRAFT VASCULAR 28                    C1768       29249.52
02781078   HB GRAFT VASCULAR 29                    C1768       29920.00
02780568   HB GRAFT VASCULAR 3                     C1768        2282.30
02780958   HB GRAFT VASCULAR 30                    C1768       27306.40
02780562   HB GRAFT VASCULAR 4                     C1768        3176.05
02780565   HB GRAFT VASCULAR 5                     C1768        4564.75
02780567   HB GRAFT VASCULAR 6                     C1768        5170.76
02780560   HB GRAFT VASCULAR 7                     C1768        6297.29
02780554   HB GRAFT VASCULAR 8                     C1768        7201.47
02781142   HB GRAFT VASCULAR 9                     C1768        7458.00
02780985   HB VASCULAR GRAFT                       C1768        2282.30
02721483   HB CATH, MORPH 8G DFLCTBL GUID          C1769        1636.02
02721484   HB CATH,MORPH UNVRSL DFLCTB GD          C1769        1519.70
02721149   HB CATHETER FLOWIRE                     C1769        1199.83
02721341   HB G030064/S41 CVRS STEERBL GUIDE       C1769       12384.78
02721155   HB GLIDE WIRE TERUMO                    C1769        236.91
02721151   HB GLIDEWIRE/GUIDEWIRE                  C1769        707.74
02721760   HB GUIDE WIRE 2                         C1769        608.79
02721761   HB GUIDE WIRE 3                         C1769        853.73



                                            259
  Charge
   Code                    Description             CPT Code OP/Default Price   IP/ED Price
02721140   HB GUIDE WIRE ACCESSORY KIT              C1769        711.20
02721694   HB GUIDE WIRE ACCESSORY KIT 1            C1769        208.16
02721170   HB GUIDE WIRE CATH EP LAB                C1769        1021.71
02721150   HB GUIDE WIRE CATH LAB                   C1769        917.05
02721154   HB GUIDE WIRE EP                         C1769        118.41
02721172   HB GUIDE WIRE EXCHANGE PTCA              C1769        1132.50
02721135   HB GUIDE WIRE PTCA                       C1769        1319.82
02721173   HB GUIDE WIRE TIP DEFLECTOR              C1769        605.66
02721176   HB GUIDE WIRE-J BENTSON COONS            C1769        271.50
02721138   HB GUIDEWIRE                             C1769        181.71
02721427   HB GUIDEWIRE 1                           C1769        292.51
02721428   HB GUIDEWIRE 2                           C1769        597.15
02721230   HB GUIDEWIRE 3                           C1769        816.23
02721203   HB GUIDEWIRE 5                           C1769        1478.77
02721146   HB GUIDEWIRE EXCHANGE PTCA               C1769        1245.75
02721156   HB GUIDEWIRE J BENTSON COONS             C1769        279.02
02721843   HB GUIDEWIRE PATHFINDER/ACCESS           C1769        669.62
02721132   HB GUIDEWIRE, 0.18/GOLD                  C1769        1130.83
02721160   HB GUIDEWIRE, AMPLATZ SS                 C1769        533.47
02721152   HB GUIDEWIRE, INTERVENTIONAL COON        C1769        100.59
02721145   HB GUIDEWIRE, LONG .018-.015             C1769        544.84
02721166   HB GUIDEWIRE, MICROSYS MICROWIRE         C1769        942.34
02721143   HB GUIDEWIRE, MM                         C1769        102.43
02721171   HB GUIDEWIRE, PLATINUM .018 TIPPED       C1769        1049.74
02721175   HB GUIDEWIRE, PMG NITREZ 18-60           C1769        131.70
02721157   HB GUIDEWIRE, TERUMO                     C1769        284.30
02721139   HB GUIDEWIRE, TERUMO AMPLATZ             C1769        337.39
02721159   HB GUIDEWIRE, US 1408/1809/2500          C1769        471.16
02721844   HB GUIDEWIRE/GLIDEWIR/VISIGLID           C1769        920.45
02721161   HB JAGWIRE I                             C1769        635.70
02721845   HB JAGWIRE II                            C1769        888.40
02721136   HB WIRE UROKINASE INFUSION               C1769        917.05
02721177   HB ENDORECTAL MRI INSERTABLE COIL        C1770        585.56
02780575   HB REP DEV URINARY W/SLING 1             C1771        897.15
02780573   HB REP DEV URINARY W/SLING 2             C1771        3329.17
02780572   HB REP DEV URINARY W/SLING 3             C1771        4364.53
02780574   HB REP DEV URINARY W/SLING 4             C1771       14718.16
02781046   HB REP DEV URINARY W/SLING 5             C1771       18916.53
02781099   HB REP DEV URINARY W/SLING 6             C1771       19166.00
02780576   HB PUMP INFUSION 1                       C1772       43645.28
02780577   HB PUMP INFUSION 2                       C1772       43680.00
02721178   HB IVC SNARE REMOVAL DEVICE              C1773        2177.56



                                             260
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02721753   HB RET DEV, INSERTABLE 1                C1773        955.00
02721754   HB RET DEV, INSERTABLE 3                C1773        3837.00
02721179   HB RTRVL DVC, COIL                      C1773        1809.92
02721181   HB RTRVL DVC, FILTER IVC                C1773        539.54
02721245   HB RTRVL DVC, MECHANICAL DILATOR        C1773        2861.82
02721182   HB RTRVL DVC, SNARE GNC                 C1773        1844.73
02721346   HB RTRVL DVC, XENFORM REPAIR 1          C1773        2946.21
02721180   HB SNARE RETRIEVER DEVICE               C1773        934.42
02780583   HB GRAFT SYNTHETIC TISSUE 3             C1776        387.96
02780628   HB INSERT, ORTHO 2                      C1776        3224.91
02780601   HB INSERT, ORTHO 3                      C1776        3641.96
02780598   HB INSERT, ORTHO 4                      C1776        5104.33
02780596   HB INSERT, ORTHO 5                      C1776        6108.94
02780624   HB JOINT DEVICE 1                       C1776        481.22
02780604   HB JOINT DEVICE 10                      C1776        5986.52
02780600   HB JOINT DEVICE 11                      C1776        6503.15
02780611   HB JOINT DEVICE 12                      C1776        6787.33
02780618   HB JOINT DEVICE 13                      C1776        7568.27
02780585   HB JOINT DEVICE 14                      C1776        7914.35
02780581   HB JOINT DEVICE 15                      C1776        8840.59
02780589   HB JOINT DEVICE 16                      C1776        9597.11
02780595   HB JOINT DEVICE 17                      C1776        9917.18
02780620   HB JOINT DEVICE 18                      C1776       10922.51
02780590   HB JOINT DEVICE 19                      C1776       11275.03
02780587   HB JOINT DEVICE 2                       C1776        1799.10
02780621   HB JOINT DEVICE 20                      C1776       11842.43
02780607   HB JOINT DEVICE 21                      C1776       12802.61
02781182   HB JOINT DEVICE 22                      C1776       12100.00
02781183   HB JOINT DEVICE 23                      C1776       12439.00
02781184   HB JOINT DEVICE 24                      C1776       12967.00
02781185   HB JOINT DEVICE 25                      C1776       13134.00
02781186   HB JOINT DEVICE 26                      C1776       13640.00
02780584   HB JOINT DEVICE 27                      C1776       14421.32
02781089   HB JOINT DEVICE 28                      C1776       14652.00
02781090   HB JOINT DEVICE 29                      C1776       15044.00
02780602   HB JOINT DEVICE 3                       C1776        2155.85
02781091   HB JOINT DEVICE 30                      C1776       15440.00
02781092   HB JOINT DEVICE 31                      C1776       15884.00
02781093   HB JOINT DEVICE 32                      C1776       16236.00
02781131   HB JOINT DEVICE 33                      C1776       16557.00
02781132   HB JOINT DEVICE 34                      C1776       16966.00
02780597   HB JOINT DEVICE 35                      C1776       21822.64



                                            261
  Charge
   Code                  Description         CPT Code OP/Default Price   IP/ED Price
02780606   HB JOINT DEVICE 35                 C1776       18355.26
02781133   HB JOINT DEVICE 36                 C1776       18084.00
02780592   HB JOINT DEVICE 37                 C1776       26187.17
02781137   HB JOINT DEVICE 37                 C1776       18484.00
02780999   HB JOINT DEVICE 38                 C1776       27612.42
02781138   HB JOINT DEVICE 38                 C1776       18748.00
02780796   HB JOINT DEVICE 39                 C1776       29897.68
02781211   HB JOINT DEVICE 39                 C1776       19549.00
02780622   HB JOINT DEVICE 4                  C1776        2544.52
02780896   HB JOINT DEVICE 40                 C1776       31415.46
02781212   HB JOINT DEVICE 40                 C1776       19870.00
02780609   HB JOINT DEVICE 41                 C1776       32005.27
02781213   HB JOINT DEVICE 41                 C1776       20491.00
02780608   HB JOINT DEVICE 42                 C1776       32990.29
02781215   HB JOINT DEVICE 42                 C1776       20970.00
02780795   HB JOINT DEVICE 43                 C1776       23197.71
02780944   HB JOINT DEVICE 43                 C1776       30943.33
02780629   HB JOINT DEVICE 44                 C1776       34019.39
02781216   HB JOINT DEVICE 44                 C1776       22176.00
02780612   HB JOINT DEVICE 45                 C1776       37583.44
02781217   HB JOINT DEVICE 45                 C1776       22546.00
02780627   HB JOINT DEVICE 46                 C1776       39111.01
02781218   HB JOINT DEVICE 46                 C1776       23263.00
02780698   HB JOINT DEVICE 47                 C1776       38077.36
02781219   HB JOINT DEVICE 47                 C1776       23760.00
02781139   HB JOINT DEVICE 48                 C1776       39310.00
02781220   HB JOINT DEVICE 48                 C1776       24130.00
02780696   HB JOINT DEVICE 49                 C1776       43685.59
02781233   HB JOINT DEVICE 49*                C1776       24460.00
02780588   HB JOINT DEVICE 5                  C1776        3120.33
02781149   HB JOINT DEVICE 50                 C1776       42086.00
02781234   HB JOINT DEVICE 50*                C1776       25278.00
02780819   HB JOINT DEVICE 51                 C1776       44850.00
02780594   HB JOINT DEVICE 6                  C1776        3624.86
02780615   HB JOINT DEVICE 7                  C1776        4257.83
02780616   HB JOINT DEVICE 8                  C1776        4571.23
02780582   HB JOINT DEVICE 9                  C1776        5198.20
02780617   HB ORTHO CUP 1                     C1776        5698.14
02780605   HB ORTHO CUP 2                     C1776        4607.00
02780593   HB ORTHO CUP 3                     C1776        9383.74
02780630   HB ORTHO FACESHIELD                C1776        509.19
02780580   HB ORTHO FEMORAL 2                 C1776        7308.16



                                       262
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780623   HB ORTHO FEMORAL 3                      C1776        8219.86
02780619   HB ORTHO FEMORAL 4                      C1776        8915.76
02780586   HB ORTHO FEMORAL 5                      C1776       13748.26
02780631   HB ORTHO HEAD 1                         C1776        3050.31
02780599   HB SPINE ASSEMBLY 1                     C1776        1163.87
02780614   HB SPINE ASSEMBLY 2                     C1776        3903.83
02780625   HB WEDGE TIBIAL KNEE                    C1776        5436.26
02781203   HB LEAD ICD ENDOCARD DUAL COIL          C1777       22000.00
02780960   HB LEAD, AICD ENDO SINGLE COIL          C1777       23540.00
02780919   HB LEAD, NEUROSTIMULATOR 1              C1778        3516.39
02781207   HB LEAD, NEUROSTIMULATOR 1              C1778        506.00
02780635   HB LEAD, NEUROSTIMULATOR 10             C1778       17285.17
02780982   HB LEAD, NEUROSTIMULATOR 11             C1778       19243.95
02781053   HB LEAD, NEUROSTIMULATOR 12             C1778       21581.90
02780918   HB LEAD, NEUROSTIMULATOR 13             C1778       24467.81
02780633   HB LEAD, NEUROSTIMULATOR 14             C1778       26687.23
02780636   HB LEAD, NEUROSTIMULATOR 15             C1778       27749.08
02781064   HB LEAD, NEUROSTIMULATOR 2              C1778        4708.00
02780639   HB LEAD, NEUROSTIMULATOR 3              C1778        6338.27
02780702   HB LEAD, NEUROSTIMULATOR 4              C1778        6189.69
02780994   HB LEAD, NEUROSTIMULATOR 4              C1778        6685.36
02780637   HB LEAD, NEUROSTIMULATOR 5              C1778        8608.13
02780917   HB LEAD, NEUROSTIMULATOR 6              C1778        9441.20
02780640   HB LEAD, NEUROSTIMULATOR 7              C1778       10911.33
02780638   HB LEAD, NEUROSTIMULATOR 8              C1778       12215.83
02780701   HB LEAD, NEUROSTIMULATOR 8              C1778        9998.73
02781009   HB LEAD, NEUROSTIMULATOR 9              C1778       13196.31
02780710   HB LEAD PCMKR TRANSVN SNGL PASS         C1779        4363.93
02760004   HB LENS INTRAOCULAR 1                   C1780        363.71
02760003   HB LENS INTRAOCULAR 2                   C1780        608.35
02760001   HB LENS INTRAOCULAR 3                   C1780        713.78
02760002   HB LENS INTRAOCULAR 3                   C1780        969.89
02760006   HB LENS INTRAOCULAR 5                   C1780        3938.00
02780711   HB IMPLANT MESH BONE ALLOGRAFT          C1781        9876.30
02780661   HB MESH 1                               C1781        422.98
02780654   HB MESH 10                              C1781        8918.18
02780660   HB MESH 11                              C1781        9793.53
02780645   HB MESH 14                              C1781       15688.05
02781241   HB MESH 18                              C1781       24860.00
02780659   HB MESH 19                              C1781       35202.34
02780657   HB MESH 2                               C1781        1323.60
02780658   HB MESH 3                               C1781        2258.47



                                            263
  Charge
   Code                 Description             CPT Code OP/Default Price   IP/ED Price
02780662   HB MESH 4                             C1781        3308.15
02780647   HB MESH 5                             C1781        4057.39
02780649   HB MESH 6                             C1781        5442.08
02780653   HB MESH 7                             C1781        6169.34
02781201   HB MESH 8                             C1781        6239.00
02780648   HB MESH 9                             C1781        8228.35
02780871   HB MESH, SURGISIS                     C1781        2397.55
02780668   HB SHEET LACTOSORB 1                  C1781        1619.72
02780663   HB SHEET LACTOSORB 2                  C1781        3467.38
02780656   HB SHEET LACTOSORB 3                  C1781        7026.88
02780652   HB SPINE PYRAMESH 1                   C1781        6905.65
02780665   HB SPINE PYRAMESH 2                   C1781       12448.60
02780655   HB SPINE PYRAMESH 3                   C1781       16987.71
02780650   HB SPINE PYRAMESH 4                   C1781       22191.20
02780651   HB SPINE PYRAMESH 5                   C1781       26880.64
02780666   HB SPINE PYRAMESH 6                   C1781       31458.56
02780667   HB SPINE PYRAMESH 7                   C1781       36933.61
02780646   HB SPINE PYRAMESH 8                   C1781       44144.77
02721247   HB MORCELLATOR,ENDOLAPAROSCOPIC       C1782        2405.34
02780923   HB OCULAR IMP,AQUEOUS/DRNG/DVC        C1783        2597.53
02780669   HB OCULAR IMP, BAND BUCKLING          C1784         53.35
02750003   HB PACEMAKER DUAL CHMBR               C1785       32852.99
02750016   HB PACEMAKER DUAL CHMBR               C1785       19800.00
02750014   HB PACEMAKER, DUAL CHAMBER 1          C1785       21186.00
02750005   HB PACEMAKER, DUAL CHAMBER 2          C1785       23330.39
02750006   HB PACEMAKER, DUAL CHAMBER 3          C1785       26425.23
02750012   HB PACEMAKER, DUAL CHAMBER 4          C1785       27777.20
02750007   HB PACEMAKER, DUAL CHAMBER 5          C1785       29972.27
02750004   HB PACEMAKER, DUAL CHAMBER 6          C1785       32852.99
02750009   HB PACEMAKER SINGLE CHMBR             C1786       29043.95
02750013   HB PACEMAKER, SINGLE CHAMBER 1        C1786       17419.60
02721186   HB PT/PRGMR, NEUROSTIMULATOR 1        C1787        2427.25
02721414   HB PT/PRGMR, NEUROSTIMULATOR 2        C1787        2893.59
02721185   HB PT/PRGMR, NEUROSTIMULATOR 3        C1787        3383.30
02721248   HB PT/PRGMR, NEUROSTIMULATOR 4        C1787        3647.77
02721665   HB PT/PRGMR, NEUROSTIMULATOR 5        C1787        3784.00
02780712   HB PORT, INDWELLING (IMPLANTABLE)     C1788        1049.74
02780714   HB PORT, INDWELLING 1                 C1788        1379.73
02780987   HB PORT, INDWELLING 2                 C1788        3055.92
02781079   HB PROSTHESIS BREAST IMP 1            C1789        123.00
02781080   HB PROSTHESIS BREAST IMP 2            C1789        1100.00
02780678   HB PROSTHESIS BREAST IMP 3            C1789        2539.99



                                          264
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
02780679   HB PROSTHESIS BREAST IMP 4               C1789        3305.22
02780676   HB PROSTHESIS BREAST IMP 5               C1789        4141.61
02780675   HB PROSTHESIS BREAST IMP 6               C1789        5296.15
02780680   HB PROSTHESIS BREAST IMP 7               C1789        6280.07
02781103   HB PROSTHESIS, PENILE INFLT 1            C1813        1175.00
02780988   HB PROSTHESIS, PENILE INFLT 10           C1813       27753.66
02780683   HB PROSTHESIS, PENILE INFLT 11           C1813       29673.75
02781082   HB PROSTHESIS, PENILE INFLT 12           C1813       28534.00
02781100   HB PROSTHESIS, PENILE INFLT 13           C1813       29084.00
02781047   HB PROSTHESIS, PENILE INFLT 14           C1813       33167.86
02781181   HB PROSTHESIS, PENILE INFLT 15           C1813       35662.00
02780686   HB PROSTHESIS, PENILE INFLT 3            C1813        6170.65
02780872   HB PROSTHESIS, PENILE INFLT 5            C1813       12919.11
02780681   HB PROSTHESIS, PENILE INFLT 6            C1813       14305.95
02780685   HB PROSTHESIS, PENILE INFLT 7            C1813       15887.85
02780682   HB PROSTHESIS, PENILE INFLT 9            C1813       26518.81
02781094   HB PROSTHESISPENILEINFLATABLE14          C1813       35662.00
02781098   HB PROSTHESIS,URINARYSPHINCTER1          C1815        7625.00
02780688   HB PROSTHESIS,URINARYSPHINCTER2          C1815       14236.04
02781101   HB PROSTHESIS,URINARYSPHINCTR3           C1815       15981.00
02780715   HB SEPTAL DEFECT CLOSE IMPLANT           C1817       24328.46
02781129   HB SEPTAL DEFECT INTRACARDIAC1           C1817       22000.00
02721366   HB TISSUE LOCALIZATION-EXCISION          C1819        256.59
02780692   HB NEUROSTIMULATOR, RECHARGEABLE1 C1820              55555.50
02780691   HB NEUROSTIMULATOR, RECHARGEABLE2 C1820              57037.50
02780904   HB NEUROSTIMULATOR, RECHARGEABLE3 C1820              59724.60
02780693   HB NEUROSTIMULATOR, RECHARGEABLE4 C1820              64252.50
02781024   HB NEUROSTIMULATOR, RECHARGEABLE5 C1820              66670.50
02780690   HB NEUROSTIMULATOR, RECHARGEABLE6 C1820              69225.00
02781270   HB NEUROSTIMULATOR,RCHRGBLE 4            C1820       60645.00
02780716   HB IMPLANT, INTRASPINOUS X-STOP          C1821       20949.73
02721099   HB CATH ENDOPROSTHESIS DELVRY            C1874        7260.16
02780723   HB STENT COATED W/ DELIVERY              C1874       15044.74
02780722   HB STENT, BIL/PAN COAT/W DEL             C1874        7509.26
02780730   HB STENT, COATED/COV W DEL SYS 1         C1874        2645.17
02780724   HB STENT, COATED/COV W DEL SYS 2         C1874        5290.34
02780717   HB STENT, COATED/COV W DEL SYS 3         C1874        8817.23
02780729   HB STENT, COATED/COV W DEL SYS 4         C1874       10580.67
02780977   HB STENT, COATED/COV W/DEL SYS 1         C1874        8884.21
02780721   HB STENT, COATED/COV W/DEL SYS 2         C1874        9493.68
02780978   HB STENT, COATED/COV W/DEL SYS 4         C1874       10451.76
02780713   HB STENT, COATED/COV W/DEL SYS 5         C1874       11665.19



                                             265
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
02780703   HB STENT, COATED/COV W/DEL SYS 6         C1874       12366.16
02780707   HB STENT, COATED/COV W/DEL SYS 7         C1874       13240.96
02780706   HB STENT, COATED/COV W/DEL SYS 8         C1874       15009.13
02780697   HB STENT, COATED/COV W/DEL SYS 9         C1874       16664.57
02780979   HB STENT, COATED/COV W/DEL SYS10         C1874       24552.22
02780704   HB STENT, COATED/COV W/DEL SYS11         C1874       25382.28
02780905   HB STENT, COATED/COV W/DEL SYS12         C1874       28774.95
02780964   HB STENT, COATED/COV W/DEL SYS13         C1874       29189.60
02780980   HB STENT, COATED/COV W/DEL SYS14         C1874       29778.10
02780705   HB STENT, COATED/COV W/DEL SYS15         C1874       36290.64
02780981   HB STENT, COATED/COV W/DEL SYS16         C1874       38662.31
02780939   HB STENT, COATED/COV W/DEL SYS17         C1874       49767.84
02781255   HB STENT, ESOPH COV/ W/DEL               C1874        9345.38
02780720   HB STENT, ESOPH ULTRAFLEX W/DEL          C1874        7391.56
02780741   HB STENT, ESOPH WALLFLEX W/DEL           C1874        8050.68
02780719   HB STENT, WINGSPAN                       C1874       14057.18
02781257   HB STENT,BIL WALLFLEX COVERED            C1874       11534.60
02781262   HB STENT,BILIARY MTL HLS W/DEL           C1874        9722.02
02781189   HB STENT,COAT/COV W/DEL SYS18            C1874       45794.00
02781254   HB STENT,ESOPH COV/CODED W/DEL           C1874       12240.80
02781253   HB STENT,ESOPH WALLFLEX W/DEL            C1874       10593.00
02781259   HB STENT,WALLFLEX PT/COV W/DEL           C1874       11199.69
02780752   HB STENT COATED W/O DELIVERY             C1875         0.00
02780755   HB CAROTID STENT SYSTEM                  C1876        9352.56
02780764   HB STENT, BILIARY NON-COAT W/DEL         C1876        6544.12
02781260   HB STENT, ENTERAL NG                     C1876        8050.68
02780727   HB STENT, NEUROFORM                      C1876       11717.05
02780726   HB STENT, NON/COATED W/DEL SYS 1         C1876        5010.20
02780718   HB STENT, NON/COATED W/DEL SYS 2         C1876        7888.90
02780758   HB STENT, NON-COA/CON-COV W/DEL          C1876       10828.85
02780774   HB STENT, NON-COATED W DEL SYS 1         C1876        5731.20
02780773   HB STENT, NON-COATED W DEL SYS 2         C1876        6612.92
02780767   HB STENT, NON-COATED W DEL SYS 3         C1876        8376.37
02780772   HB STENT, NON-COATED W DEL SYS 4         C1876        8747.25
02721158   HB STENT, OASIS NON-COAT/COV W/DEL       C1876        255.86
02781258   HB STENT, WALLFLEX N-COV W/DEL           C1876        7768.20
02780771   HB STENT,ENT DUOD CLN WALLFLX I          C1876       11746.46
02781256   HB STENT,ENT DUOD CLNWALLFLXII           C1876       11275.66
02781127   HB STENT,NON/COATED W/DELSYS 3           C1876        9460.00
02780728   HB STENT, NON/COATED W/O DEL SYS         C1877        8220.55
02781202   HB STENT, NON-COA/COV W/O DEL            C1877        5940.00
02781261   HB STENT, SOLUS                          C1877        699.80



                                             266
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780775   HB/ STENT, BIL/PAN NON-METAL            C1877        383.22
02780777   HB MATRL, VOCAL CORD, SYNTHETIC         C1878        1585.84
02781096   HB IMPLANTABLE TISSUE MARKER            C1879        5280.00
02780303   HB VENA CAVA FILTER 1                   C1880        4617.51
02780920   HB VENA CAVA FILTER 2                   C1880        5948.13
02780731   HB VENA CAVA FILTER 3                   C1880        6988.10
02780304   HB VENA CAVA FILTER IMPLANT             C1880        5244.83
02780778   HB VENA CAVA FILTER, IVC                C1880        3311.30
02780997   HB CARD/DEFIB,OTHR THNSIN/DUAL3         C1882       78200.00
02780732   HB CARD/DEFIB,OTHR THNSIN/DUAL5         C1882       85000.00
02780734   HB CARD/DEFIB,OTHR THNSIN/DUAL6         C1882       87125.00
02780733   HB CARD/DEFIB,OTHR THNSIN/DUAL7         C1882       95200.00
02780878   HB ICD OTHER THAN SINGLE/DUAL           C1882       117068.55
06240023   HB PARADYM BI-V ICD8770G090064          C1882       78200.00
02780737   HB ADAPTER/LEAD IMPLANTABLE 1           C1883        933.86
02780736   HB ADAPTER/LEAD IMPLANTABLE 2           C1883        2466.31
02781242   HB ADAPTER/LEAD IMPLANTABLE 3           C1883        2904.00
02781243   HB ADAPTER/LEAD IMPLANTABLE 4           C1883        3309.00
02780735   HB ADAPTER/LEAD IMPLANTABLE 5           C1883        4048.37
02780952   HB ADAPTER/LEAD IMPLANTABLE 6           C1883        4067.07
02721187   HB EMBOLIC PROTECTION SYSTEM      *     C1884        5807.92
02721191   HB EMBOLIC PROTECTION SYSTEM*           C1884        6442.88
02721192   HB EMBOLIZATION PROTECTIVE SYSTEM       C1884        4529.76
06240005   HB WATCHMAN IDE#G020312/S13             C1884         1.53
02721193   HB CATH ANGIOPLASTY LASER               C1885        8846.30
02781072   HB CATHETER, LASER ABLATION             C1885        7334.56
02721397   HB CATH BALLOON WEDGE                   C1887        389.88
02721206   HB CATH BERMAN                          C1887        889.84
02721207   HB CATH DIAGNOSTC ANGIO MULTIPACK       C1887        1577.97
02721196   HB CATH DIAGNOSTIC ANGIO                C1887        953.50
02721201   HB CATH GUIDING PEDS                    C1887        617.97
02721202   HB CATH GUIDING RAPIDO DEL SYS          C1887        3358.06
02721194   HB CATH THERMODILUTION                  C1887        2472.06
02721538   HB CATH, IVUS GUIDED CTO/PERI           C1887        8290.32
02721785   HB CATHETER, GUIDE PER/INFUS 1          C1887        355.00
02721197   HB CATHETER, GUIDING                    C1887        593.68
02721200   HB CATHETER, GUIDING 1                  C1887        577.69
02721687   HB CATHETER, GUIDING 2                  C1887        1047.42
02721688   HB CATHETER, GUIDING 3                  C1887        1808.22
02721205   HB CATHETER, GUIDING 4                  C1887        2081.94
02721689   HB CATHETER, GUIDING 5                  C1887        2218.81
02721690   HB CATHETER, GUIDING 6                  C1887        3007.61



                                            267
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
02721174   HB CATHETER, GUIDING MICROSYS            C1887        1567.99
02721618   HB CATHETER, GUIDING PERF/INFUS          C1887        1684.18
02721415   HB CATHETER, GUIDING PERF/INFUS 1        C1887        781.42
02721347   HB CATHETER, GUIDING PERF/INFUS 2        C1887        1190.32
02721260   HB CATHETER, GUIDING PERF/INFUS 3        C1887        1268.42
02721841   HB CATHETER, HALO GUIDE WIRE             C1887        635.70
02721204   HB THROMBOLITIC INFUSION WIRE            C1887        942.34
02721842   HB CATHETER,ENDOSCOPY,ABLATION           C1888        4442.64
02721211   HB EP INTRO/SHEATH, GUIDING 1            C1892        281.95
02721691   HB EP INTRO/SHEATH, GUIDING 2            C1892        594.11
02721692   HB EP INTRO/SHEATH, GUIDING 3            C1892        911.11
02721693   HB EP INTRO/SHEATH, GUIDING 4            C1892        2227.51
02721208   HB INTRO/SHEATH, GUIDING                 C1892        312.99
02721209   HB INTRO/SHEATH, GUIDING 1               C1892        328.90
02721270   HB INTRO/SHEATH, GUIDING 2               C1892        485.08
02721213   HB INTRO/SHEATH FIXED NON PEEL           C1893        792.99
02721212   HB INTRO/SHEATH GUIDE EP TRNSPTL         C1893        718.59
02721224   HB INTRO/SHEATH                          C1894        178.44
02721874   HB INTRO/SHEATH ONSET BALLOON            C1894        1704.15
02721222   HB INTRO/SHEATH, BLKN LONG               C1894        353.31
02721220   HB INTRO/SHEATH, CONTRALATERA            C1894        457.23
02721216   HB INTRODUCER SHEATH, NON GUIDING        C1894        143.37
02721578   HB INTRODUCER/SHEATH,NONGDNG 1           C1894        240.75
02721284   HB INTRODUCER/SHEATH,NONGDNG 2           C1894        710.79
02721276   HB INTRODUCER/SHEATH,NONGDNG 3           C1894        1205.44
02721848   HB SHEATH, EUS BALLOON PROBE             C1894        1453.15
02721642   HB SHEATH, PINNACLE II RDPAQUE           C1894        240.75
02780779   HB LEAD ICD ENDOCARD COIL                C1895       36169.58
02780739   HB LEAD, AICD, ENDO DUAL COIL 3          C1895       30066.74
02780740   HB LEAD, CARDIO DEFIB ENDO COIL 1        C1895       23806.52
02780820   HB LEAD, CARDIO DEFIB ENDO COIL 2        C1895       25196.27
02780742   HB LEAD, AICD, NON SNGL/DUAL 1           C1896        4523.24
02781204   HB LEAD, NEUROSTIM TEST KIT 1            C1897        1342.00
02780780   HB LEAD, NEUROSTIM TEST KIT 10           C1897       26091.44
02780746   HB LEAD, NEUROSTIM TEST KIT 11           C1897       40978.07
02780744   HB LEAD, NEUROSTIM TEST KIT 2            C1897        2400.49
02780747   HB LEAD, NEUROSTIM TEST KIT 3            C1897        3268.54
02780955   HB LEAD, NEUROSTIM TEST KIT 4            C1897        4684.46
02781010   HB LEAD, NEUROSTIM TEST KIT 5            C1897        6685.36
02780745   HB LEAD, NEUROSTIM TEST KIT 7            C1897       12705.63
02780748   HB LEAD, NEUROSTIM TEST KIT 8            C1897       15069.90
02780781   HB LEAD PCMKR OTHER THAN VDD             C1898        4363.93



                                             268
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780750   HB LEAD, PACEMAKER 1                    C1898        2856.78
02780753   HB LEAD, PACEMAKER 2                    C1898        5188.94
02780751   HB LEAD, PACEMAKER 3                    C1898        6338.27
02780754   HB LEAD, PACEMAKER 4                    C1898       24247.38
02780782   HB LEAD PCMKR/ICD COMBINATION           C1899        4363.93
02780783   HB LEAD BI-V LEFT VENTRCULAR            C1900       19438.45
02781026   HB LEAD, CORONARY VENOUS                C1900       11770.00
02780880   HB ISOTOPE, Y90 SIRSPHERES              C2616       58500.00
02781194   HB ISOTOPE, Y90 THERASPHERES            C2616       58500.00
02780759   HB STENT, NON-COR, TEM, W/O DEL 1       C2617         32.75
02780763   HB STENT, NON-COR, TEM, W/O DEL 2       C2617        320.07
02780757   HB STENT, NON-COR, TEM, W/O DEL 4       C2617        1551.83
02780784   HB STENT, URETERAL                      C2617        714.17
02780785   HB STENT, URETERAL 90-3390-91           C2617        1154.22
02781179   HB STENT,NON-COR,TEM,W/O DEL3           C2617        510.00
02721546   HB KIT, CRYOABLATION                    C2618        9785.87
02721286   HB PROBE, ABLATION 6                    C2618        9785.87
02721394   HB PROBE, CRYOABLATION 1                C2618        2876.10
02721644   HB PROBE, CRYOABLATION 2                C2618        3538.49
02721287   HB PROBE, CRYOABLATION 3                C2618        6265.27
02721461   HB PROBE, CRYOABLATION 4                C2618        6034.80
02721285   HB PROBE, CRYOABLATION 5                C2618        8991.04
02750010   HB PACEMAKER, NOT SIN/DUAL 1            C2621       37400.00
02750011   HB PCMKR OTHER THAN SINGLE/DUAL         C2621       43645.28
02781049   HB PROSTHESIS, PENILE NONINF2           C2622       21219.17
02780797   HB PROSTHESIS, PENILE NONINF 1          C2622       16688.07
02781102   HB PROSTHESIS, PENILE NONINF 3          C2622       22748.00
02780765   HB STENT, NON-COR,TEM, W/DEL 1          C2625        4189.45
02721291   HB CATHETER, STAMEY SUPRAPUBIC          C2627        299.28
02721290   HB CATHETER, SUPRAPUBIC 1               C2627         98.85
02721288   HB CATHETER, SUPRAPUBIC 2               C2627        298.53
02721289   HB CATHETER, SUPRAPUBIC 3               C2627        555.62
02721293   HB CATHETER, OCCLUSION 1                C2628        1424.61
02721225   HB CATHETER, OCCLUSION BALLOON          C2628        740.19
02721295   HB INTRODUCER/SHEATH, LASER 1           C2629        548.69
02721294   HB INTRODUCER/SHEATH, LASER 2           C2629        6911.42
02721226   HB CATH EP COOL-TIP                     C2630        7926.90
02721272   HB CATHETER, EP COOL-TIP                C2630        2731.77
02721232   HB EP CATHETER-EZ STEER NAV BI-D        C2630        7221.44
02780786   HB REP DEV URINARY W/O SLING            C2631        1074.49
02780766   HB REP DEV URINARY W/O SLING 1          C2631        942.19
02780768   HB REP DEV URINARY W/O SLING 2          C2631        2827.81



                                            269
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
02780769   HB REP DEV URINARY W/O SLING 3          C2631        3637.11
02780873   HB REP DEV URINARY W/O SLING 4          C2631        4220.84
02780787   HB RT BRACHYTX STRANDED I-125           C2638        250.10
06180002   HB MR ANGIO ABDOMEN W CONTRAST          C8900        3693.57        4802.86
06180003   HB MR ANGIO ABDOMEN WO CONT             C8901        2835.39        3685.04
06180004   HB MR ANGIO ABDOMEN WO/W CONT           C8902        4401.81        5721.99
06100090   HB MRI BREAST WO/W CONT UNILAT          C8905        2925.60        3803.28
06180005   HB MR ANGIO CHEST W CONTRAST            C8909        4554.18        5919.46
06180006   HB MR ANGIO CHEST WO CONTRAST           C8910        3145.02        4088.53
06180008   HB MR ANGIO CHEST WO/W CONT             C8911        4717.53        6132.79
06100108   HB MR ANGIO EXT LOW W CONT              C8912        2835.39
06100109   HB MR ANGIO EXT LOW WO CONT             C8913        3260.83
06180011   HB MR ANGIO EXT LOW WO/W CONT           C8914        5873.14        7635.82
06100110   HB MR ANGIO PELVIS W CONTRAST           C8918        3381.51
06100095   HB MR ANGIO PELVIS WO CONTRAST          C8919        3229.13
06180001   HB MR ANGIO PELVIS WO/W CONT            C8920        5418.46        7043.38
04830011   HB 2D ECHO LIMITED W/ WO CONT           C8924        4931.63        6412.07
04830010   HB TEE/2D W OR WO CONT                  C8925        4931.63        6412.07
04830013   HB TTE/2D ECHO-W/OR W/O CONT            C8929        4931.63        6412.07
04830012   HB STRESS ECHO W/WO CONT,ECG            C8930        4931.63        6412.07
06180026   HB MR ANGIO SPINE W/ CONTRAST           C8931        4447.82        5781.53
06180025   HB MR ANGIO SPINE WO CONTRAST           C8932        4236.03        5506.22
06180024   HB MR ANGIO SPINE WO/W CONT             C8933        4670.21        6070.61
06180029   HB MR ANGIO EXT UPP W/ CONT UN          C8934        4257.11        5533.20
06180028   HB MR ANGIO EXT UPP WO CONT UN          C8935        4054.39        5269.74
06180027   HB MR ANGIO EXT UPP WO/W CN UN          C8936        4469.97        5809.86
03310015   HB NON-CHEMO INF >8HRS VIA AMB PU       C8957        786.02
02780788   HB NERVE GUIDE 1                        C9352        4607.00
02780874   HB NERVE GUIDE 2                        C9352        4929.95
02781081   HB NERVE GUIDE 3                        C9352        6116.00
03430045   HB ISOTOPE I123 IOFLUPANE DATSCAN       C9399        5916.92
02781067   HB PALATE, SOFT TISSUE 1                C9727        1100.00
03430040   HB ISOTOPE, IP AND OP SERVICES          C9898         1.23
05120002   HB PERIODIC ORAL EVALUATION             D0120        131.82
05120003   HB LMTD ORAL EVALPROB FOCUS             D0140        308.00
05120004   HB ORAL EVAL<3YRSCOUNSLNG PRIM          D0145        220.53
05120005   HB COMPREHENSIVE ORAL EVAL              D0150        220.53
05120006   HB INTRAORAL-COMP SERIES-BTWNG          D0210        352.35
05120007   HB INTRAORAL-PERIAPICAL-FIRST FLM       D0220         88.70
05120008   HB INTRORAL-PERIAPICL-EACH + FILM       D0230         25.87
05120009   HB INTRAORAL-OCLUSAL FILM               D0240         88.70
05120010   HB BITEWINGS - TWO FILMS                D0272         88.70



                                            270
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
05120011   HB BITEWINGS - FOUR FILMS                D0274        158.93
05120014   HB PANORAMIC FILM                        D0330        220.53
02721227   HB CEPHALOMETRIC FILM                    D0340        441.06
05120015   HB ORAL/FAC PHOTO IMAC                   D0350         52.98
05120220   HB COLLECT CULTURE & SENSITITY           D0415        155.23
05120016   HB ACCESS BRSH BX MICRO W/RPT            D0486        880.88
05120017   HB ADULT PROPHYLAXIS                     D1110        271.04
05120018   HB CHILD PROPHYLAXIS                     D1120        162.62
05120019   HB TOPICAL APPL FLUORIDE-CHILD           D1203         43.12
05120020   HB TOPICAL APPL FLUORIDE-ADULT           D1204         32.03
05120022   HB SEALANT - PER TOOTH                   D1351        119.50
05120023   HB SPACE MAINTAIN-FIXED-UNI              D1510        650.50
05120024   HB SPAC MAINTAIN-FIXED-BILAT             D1515        1084.16
05120025   HB RECEMTATION OF SPAC MAINTAIN          D1550        162.62
05120026   HB REMOVAL FIXED MAINTAINER              D1555        119.50
05120027   HB AMALGAM 1 SURF PRIM/PERM              D2140        264.88
05120028   HB AMAL 2 SURF PRIM/PERM                 D2150        325.25
05120029   HB AMALG 3 SURF PRIM/PERM                D2160        386.85
05120030   HB AMALG 4>SURF PRIM/PERM                D2161        406.56
05120031   HB RESIN COMP 1 SURF ANT                 D2330        373.30
05120032   HB RESIN COMP 2 SURF ANT                 D2331        406.56
05120033   HB RESIN - THREE SURFACES                D2332        441.06
05120034   HB RESIN 4> SURFACE/INCISAL ANGLE        D2335        576.58
05120035   HB RESIN BASED COMP CROWN ANT            D2390        508.82
05120036   HB RESIN BASED 1 SURF                    D2391        264.88
05120037   HB RESIN BASED COMP 2 SURF POST          D2392        325.25
05120038   HB RESIN BASED COMP 3 SURF POST          D2393        386.85
05120039   HB RESIN BASED COMP 4> SURF POST         D2394        406.56
05120046   HB TERM CROWN PORCEL SUBST               D2740        2094.40
05120047   HB CROWN PORC FUSED HI NOBLEMETAL        D2750        2303.84
05120048   HB CROWN PORC FUSE PREDOM BS METL D2751               2303.84
05120049   HB CROWN PORCE FUSE T NOBLE METAL        D2752        2303.84
05120051   HB CROWN FULL CAST NOBLE                 D2792        2303.84
05120052   HB PROVISIONAL CROWN                     D2799        508.82
05120054   HB RECEMENT CROWN                        D2920        203.28
05120055   HB PFAB STAIN STEEL CRN PRIMARY          D2930        508.82
05120056   HB PFAB STAIN STEEL CRN PREMANENT        D2931        609.84
05120057   HB PREFABRICATED RESIN CROWN             D2932        145.38
05120058   HB SEDATIVE FILING                       D2940        305.54
05120059   HB CROWN BUILDUP, INCLUDING PINS         D2950        508.82
05120062   HB PREFAB POST&CORE IN ADD TO CRN        D2954        508.82
05120064   HB LABIAL VNEER RESIN LAMINAT LAB        D2961        1016.40



                                             271
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
05120065   HB LABIAL VNEER PORCLN LAMIN LAB         D2962        1409.41
05120066   HB THERA PULPOTOMY EXCL. REST            D3220        529.76
05120067   HB PUPAL DEBRIDMNT PRIM PERM TEET        D3221        335.10
05120068   HB END THXPY, ANTERIOR TOOTH             D3310        1610.22
05120069   HB END THXPY, BICUSPID TOOTH             D3320        1945.33
05120070   HB END THXPY, MOLAR                      D3330        2467.70
05120072   HB APIECTOMY PERIRADICU SRG ANT          D3410        1355.20
05120075   HB RETROGRADE FILLING - PER ROOT         D3430        293.22
05120079   HB GINGIVECTOMY/PLASTY PR QUAD           D4210        1629.94
05120080   HB GINGIVECTOMY/PLASTY PRTOOTH           D4211        969.58
05120081   HB GINGIVAL FLAP PROC W/ PLAN            D4240        2158.46
05120083   HB GNGVL FLAP W ROOTPLAN 1-3TH           D4241        2158.46
05120084   HB APICAL LLY POSITIONED FLAP            D4245        2158.46
05120085   HB CROWN LENGTHENING HARD TISSUE         D4249        969.58
05120087   HB OSSEOUS SURG-1-3TEETHPRQUAD           D4261        2158.46
05120088   HB BONE REPLCMNT 1ST SITE QUAD           D4263        2158.46
05120089   HB BONE REPLACE EA ADDTNL SITE           D4264        2158.46
05120090   HB PEDICAL SOFT TISSUE GRAFTS            D4270        2158.46
05120091   HB PROVISAL SPLNTING INTRACORONAL        D4320        2158.46
05120092   HB PROVISAL SPLNTING EXTRACORONAL        D4321        155.23
05120093   HB PERIO SCALING 4>PER QUADRANT          D4341        441.06
05120094   HB PERIO SCALING ROOT PLAN 103 TE        D4342        1039.81
05120095   HB PERIODONTAL MAINTENANCE               D4910        441.06
05120096   HB COMPLETE UPPER DENTURE                D5110        3659.04
05120097   HB COMPLETE LOWER DENTURE                D5120        3659.04
05120098   HB IMMEDIATE UPPER DENTURE               D5130        3659.04
05120099   HB IMMEDIATE LOWER DENTURE               D5140        3659.04
05120100   HB UPPER PARTIAL - ACRYLIC BASE          D5211        2032.80
05120101   HB LOWER PARTIAL ACRYLIC BASE            D5212        2032.80
05120102   HB UPPER PARTIAL PERDOM BASE CAST        D5213        3821.66
05120103   HB LOWER PARTAL PERDOM BASE CAST         D5214        3821.66
05120109   HB ADJUST COMPLETE DENTURE-MAX           D5410        203.28
05120110   HB ADJUST COMPLETE DENTURE-MAD           D5411        203.28
05120111   HB ADJUST PARTIAL - MAX                  D5421        203.28
05120112   HB ADJUST PARTIAL - MAND                 D5422        203.28
05120104   HB REPAIR RESIN DENTURE BASE             D5510        406.56
05120105   HB REPLACE MISSING / BROKEN TEETH        D5520        406.56
05120106   HB REPAIR RESIN BASE PARTIAL             D5610        487.87
05120107   HB REPAIR CAST FRAMEWORK                 D5620        1870.18
05120108   HB REPAIR OR REPLACE BROKEN CLASP        D5630        813.12
05120113   HB REPLACE BROKEN TEETH                  D5640        406.56
05120119   HB ADD TOOTH EXISTING PART DENT          D5650        487.87



                                             272
  Charge
   Code                 Description                CPT Code OP/Default Price   IP/ED Price
05120120   HB ADD CLASP TO EXISTING PARTIAL         D5660        813.12
05120121   HB REBASE MAND PARTIAL DENTURE           D5721        193.42
05120122   HB RELINEMAX DENTURE CHAIRSIDE           D5730        569.18
05120123   HB RELINE MAND DENTURE CHAIRSIDE         D5731        569.18
05120124   HB RELINE MAX PARTIAL DENT CHAIR         D5740        569.18
05120125   HB RELINE MAND PARTIAL DENT CHAIR        D5741        569.18
05120126   HB RELINE MAX COMPLETE DENT LAB          D5750        1138.37
05120127   HB RELINE MAND COMPLETE DENT LAB         D5751        1138.37
05120128   HB RELINE MAX PARTIAL DENT LAB           D5760        1138.37
05120129   HB RELINE MAND PARTIAL DENT LAB          D5761        1138.37
05120130   HB INTERIM COMPLETE DENT MAX             D5810        3659.04
05120131   HB INTERIM COMPLETE DENT MAND            D5811        3659.04
05120132   HB INTERIM PARTIAL DENT MAX              D5820        2032.80
05120133   HB INTERIM PARTIAL DENT MAND             D5821        2032.80
05120134   HB TISS CONDITINGMAXILLARY               D5850        406.56
05120135   HB TISSUE CONDITIONING MADIBULAR         D5851        406.56
05120136   HB OVERDENTURE COMPLETE (BY REPT)        D5860        3659.04
05120137   HB OVERDENTURE PARTIAL (BY REPRT)        D5861        3659.04
05120211   HB PRECISION ATTACHMENT                  D5862        3326.40
05120210   HB REPLACEMENT OF PRECISION AT           D5867        3326.40
02781004   HB NASAL SEPTAL PROSTHESIS               D5922        743.65
05120138   HB SURGICAL STENT                        D5982        677.60
05120139   HB SURGICAL SPLINT                       D5988        1111.26
05120140   HB SURGICAL PLACEMNT IMPLNT              D6010        2195.42
05120141   HB SURGICAL REPLACEMNT IMPLANT           D6012        731.81
05120208   HB IMPLNT/ABTMNT SPRT REMV DNT           D6053        521.14
05120213   HB IMP/ABTMNT SPRT REMV PRTL             D6054        521.14
05120209   HB IMPLANT CONNECTING BAR                D6055        521.14
05120142   HB PREFABRICATED ABUTMENT                D6056        521.14
05120143   HB IMPLNT SUPORT PRCLN METAL CRWN        D6066        1843.07
05120144   HB REPLACMNT ATTACHMNT MALE/FEM          D6091        380.69
05120150   HB PONTC PORC FUSED HI NOBL METAL        D6240        2422.11
05120152   HB PONTIC POR FUSE TO NOBLE METAL        D6242        2422.11
05120158   HB CRN PORCL FUSED HI NOBLE METAL        D6750        2534.22
05120159   HB CRN PORCL FUS PREDOM BASE METL        D6751        2534.22
05120160   HB CRN PORCELAIN FUSED NOBLE METL        D6752        2534.22
05120162   HB CROWN FULL CAST HI NOBEL METAL        D6790        2534.22
05120165   HB RECEMENT FIXED PARTIAL DENTURE        D6930        373.30
05120167   HB PRECISION ATTACHMENT                  D6950        1016.40
05120169   HB EXT CORONAL REMNANT TOOTH BAB         D7111        305.54
05120170   HB EXTRACTION, ERUPTED TOOTH             D7140        305.54
05120171   HB SURGICAL REMOVE ERUPTED TOOTH         D7210        691.15



                                             273
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
05120172   HB REMOVE IMPACT TOOTH SOFT TISSU        D7220        813.12
05120173   HB REMOVE IMPACT TTH PARTIAL BONY        D7230        1097.71
05120174   HB REM IMPACT TTH COMPLETELY BONY        D7240        1341.65
05120175   HB SURG REMOVE RESIDUAL TOOTH RTS        D7250        813.12
05120177   HB TOOTH RE-IMPLANTATION                 D7270        155.23
05120178   HB TOOTH TRANSPLANTATOIN                 D7272        388.08
05120179   HB SURGICAL ACESS UNERUPTED TOOTH        D7280        745.36
05120181   HB BIOPSY OF ORAL TISSUE (SOFT)          D7286        224.22
05120194   HB RAD EXC LESION UP TO 1.25 CM          D7410        609.84
05120212   HB MALIG TUMOR EXC TO 1.25 CM            D7440        2202.20
05120199   HB REMOVAL OF TORUS MADIBULARIS          D7473        745.36
05120183   HB INCISION& DRAINAGE ABCES INTRA        D7510        373.30
05120196   HB BONE REPLCMT GRAFT PER SITE           D7953        1294.83
05120201   HB FRENULECTOMY SEPARTE PROCEDURE D7960               1490.72
05120214   HB LIMIT TX 1 DENTITION                  D8010        1519.98
05120215   HB LIMIT TX TRANSIT DENTITION            D8020        2105.57
05120216   HB LIMIT TX ADOLESC DENTITION            D8030        1955.42
05120217   HB LIMIT TX ADULT DENTITION              D8040        1955.42
05120218   HB INTERC TX 1 DENTITION                 D8050        1519.98
05120219   HB INTERC TX TRANSIT DENTITION           D8060        2105.57
05120221   HB COMPR TX -TRANSIT DENTITION           D8070        3706.40
05120222   HB COMPR TX, ADOLES DENTITION            D8080        4255.02
05120223   HB COMPR TX ADULT DENTITION              D8090        4255.02
05120184   HB REMOVABLE APPLIANCE                   D8210        1660.74
05120185   HB FIXED APPLIANCE THERAP                D8220        1498.11
05120200   HB PALLIATIVE(EMERG) TREATMENT           D9110        308.00
05120188   HB OCCLUSAL GUARD                        D9940        1945.33
05120190   HB OCCLUSAL ADJUSTMENT - LIMITED         D9951        237.78
05120224   HB EXTERNAL BLEACHING PER ARCH           D9972        671.44
05120192   HB INTERNAL BLEACHING                    D9974        438.59
03010456   HB LAB PSA, SCREEN                       G0103        205.87
09420005   HB DIABETES TEACH, IND PER 30 MIN        G0108        263.65
09420006   HB DIABETES TEACH, GRP PER 30 MIN        G0109        289.52
09040001   HB ACTIVITY THERAPY                      G0176        247.63
09420007   HB EDUCATION TRAINING                    G0177        236.54
04030004   HB MAMMO SCREEN DIG PARTL BIL            G0202        368.24          478.72
04030003   HB MAMMO SCREEN DIGITAL BILAT            G0202        368.24
04010004   HB MAMMO DIAG DIGITAL BILAT              G0204        523.75
04010005   HB MAMMO DIAG DIGITAL UNILAT             G0206        418.81
04100048   HB PR PHYS PERFORM TEST 15 MIN           G0238        293.24
04100046   HB PR SELF CARE/HOME MGT                 G0238        293.24
04100047   HB PULMONARY INSTRUCTIONS                G0238        293.24



                                             274
  Charge
   Code                   Description             CPT Code OP/Default Price   IP/ED Price
04100049   HB PR THER GROUP 2 OR                   G0239        670.77
03330065   HB RT SRS DELIVERY MULTI-FRACTION       G0251        2583.50
04500185   HB UNSCHEDULED/EMERGENCY DIALYSIS G0257              3206.90        3206.90
03610356   HB ARTHROGRAM INJ SI JOINT UNI          G0259        1383.57
03500051   HB RECON CTA SURGICAL PLANNING          G0288        2737.87        3559.48
03330066   HB RT IGRT TX - 1ST SESSION             G0339       13118.34
03330067   HB RT IGRT TX - SUBSEQUENT SESSIO       G0340        7379.68
03610290   HB BONE MARROW ASPIRATION W/BX          G0364        455.76          592.49
07620003   HB OBSERVATION, PER HOUR                G0378        212.00
04020066   HB VAS DUPLEX AAA SCREENING             G0389        440.06
09480001   HB PULM REHAB WEXER 1 HR P/SES          G0424        636.83
03091687   HB DRUG SCREEN, BREAST MILK             G0431         7.70
03091686   HB DRUG SCREEN, MECONIUM                G0431         8.50
03091660   HB DRUG SCREEN, URINE                   G0431         9.42
03010018   HB LAB AMPHETAMIN UR SC                 G0431        159.13
03010013   HB LAB BARBITURATES URN                 G0431        159.13
03010014   HB LAB BENODIAZEPINES URN               G0431        154.68
03010008   HB LAB CANNABINOIDS                     G0431        235.91
03000109   HB LAB COCAINE UR                       G0431        200.30
03000118   HB LAB DARVON                           G0431        194.74
03090835   HB LAB DRUG SCREEN, EA CLASS, BLD       G0431         93.75
03092022   HB LAB DRUG SCREEN,URINE                G0431        100.00
03091700   HB LAB ETHCHLORVYNOL                    G0431        242.00
03010010   HB LAB METHADONE UR                     G0431        194.74
03000107   HB LAB OPIATES UR                       G0431        181.39
03010009   HB LAB PHENCYCLIDINE UR                 G0431        154.68
03011960   HB LAB SALICYLATES URN                  G0431        131.96
03091694   HB ROHYPNOL URINE                       G0431         72.33
03091685   HB VOLATILES                            G0431         33.38
09110001   HB PSYCHOTHERAPY BY PHONE               H0046         5.50
05100067   HB PRENATAL AT RISK ASSESSMENT          H1000        245.17
09140013   HB COMPREHENSVE MED SVC-15 MIN          H2010        200.74
03430037   HB RX, DIPRIDAMOLE/PERSANT /10MG         J1245       838.67
06360014   HB VORICONAZOLE 10MG/1ML IV SOLN         J3465        65.48
06360015   HB FACTOR VIIA, RECOMBINANT 1MCG         J7189        14.14
06360002   HB FACTOR VIIA, RECOMBINANT 1MG          J7189       7492.90
06360001   HB FACTOR-7 1 MCG                        J7189        15.96
06360005   HB FACTOR-8 'H' / UNIT                   J7190        12.46
06360003   HB FACTOR-8 HC / UNIT                    J7190        12.46
06360004   HB FACTOR-8 'P' / UNIT                   J7191        12.46
06360008   HB FACTOR 8 - 1 UNIT                     J7192        12.47
06360007   HB FACTOR-8 'R' / UNIT                   J7192        12.46



                                            275
  Charge
   Code                  Description                CPT Code OP/Default Price   IP/ED Price
06360006   HB FACTOR-9 'NR'/ UNIT                     J7193        8.26
06360009   HB FACTOR-9 'C' / UNIT                     J7194        8.26
06360010   HB FACTOR-9 H / UNIT                       J7194        8.26
06360016   HB FACTOR IX RECOMBINANT                   J7195        7.14
06360012   HB FACTOR-9 1 UNIT                         J7195        10.03
06360011   HB FACTOR-9 'R' / UNIT                     J7195        8.26
02740003   HB FLEX THERMOPLASTIC COLLAR MOLD         L0130        648.03
02740004   HB CERV COLLAR THERMOPL FOAM 2PC          L0172        611.27
02740005   HB CERV COLLAR SEMIRIG THERMO2PC          L0174        1045.28
02740006   HB TLSO RIGID FRAME HYPEREX PRE           L0472        1407.55
02740007   HB TLSO RIGID PLASTIC CUSTOM FAB          L0484        4158.11
02740008   HB TLSO RIGIDLINED CUST FAB TWO           L0486        4417.02
02740009   HB SIO FLEX PELVISACRAL PREFAB            L0621        501.50
02740010   HB LO SAGITT RIGID PANEL PREFAB           L0627        1176.91
02740011   HB SLO POST RIGID PANEL PREFAB            L0630        631.96
02740012   HB LSO SAG-COR RIGID FRAME PREFAB         L0631        2466.72
02740013   HB LSO FLEXION CONTROL PREFAB             L0633        905.00
02740015   HB SLO SAGIT RIGID PANEL PREFAB           L0635        2858.85
02740016   HB LSO SAGITTAL RIGID PANEL CUST.         L0636        3877.44
02740018                                      L0700      5088.53
           CTLSO ANT-POSTERIOR-LAT CONTROL MOLDED PT MODEL
02740019   HB HALO CERVICAL INTO JACKET VEST         L0810        6205.51
02740020   HB HALO CERVICAL INTO BODY JACK           L0820        5111.94
02740021   HB MRI COMPATIBLE SYSTEM                  L0859        2747.67
02740022   HB PROTECTIVE BODY SOCK EACH              L0984        321.80
02740023   HB TENSION BASED SCOLIOSIS ORTHO          L1005        6057.91
02740024   HB KYPHOSIS PAD FLOATING                  L1025        603.07
02740025   HB RING FLANGE PLAS/LEATHER MOLD          L1110        991.36
02740026   HB POST-OP HIP ABDUCT CUSTOM FAB          L1685        3421.76
02740028   HB KO ELAS W CONDYLE PADS & JNTS          L1820        609.19
02740029   HB KO W ADJ FLEX/EXT ROTAT CUST           L1845        1979.63
02740030   HB KO W ADJ FLEX/EXT ROTAT MOLD           L1846        3267.39
02740031   HB AFT ANKLE GAUNTLET                     L1902        397.88
02740032   HB AFO SNGL UPRIGHT W/ADJUST STOP         L1920        1041.73
02740033   HB ANKLE FOOT ORTHOSIS, PREFAB            L1930        938.72
02740034   HB AFO POS SOLID ANK PLASTIC CUST         L1960        1826.54
02740035   HB AFT DOUBLE SOLID STIRRUP CALF          L1990        1523.22
02740036   HB KAFO FEMORAL FX CAST CUSTOM            L2128        4271.80
02740037   HB VARUS/VALGUS STRAP PADDED              L2270        332.51
02740038   HB PRE-TIBIAL SHELL MOLDED                L2340        1526.57
02740039   HB KNEE JOINT DROP LOCK EA JOINT          L2405        396.33
02740040   HB ADJ FLEX EXT HIP JNT CNTRL EA          L2624        1202.99
02740041   HB SOFT INTERFACE ABOVE KNEE MOLD         L2830        509.16



                                              276
  Charge
   Code                 Description                 CPT Code OP/Default Price   IP/ED Price
02740042   HB TIB LENGTH SOCK, FX/EQUAL, EA          L2840        240.60
02740043   HB SHLDR FIG 8 ABDUCT RESTRAIN            L3650        351.47
02740044   HB ABDUCT RESTRAINER CANVAS & WEB         L3660        488.66
02740045   HB EO MOTIONDOUBLE UPRIGHT CUSTOM L3720                2048.69
02740046   HB EO W ADJ POS LOCK JNTS PREFAB          L3760        1273.33
02740047   HB WHFO, NO JOINT, PREFAB                 L3807        775.50
02740048   HB WHFO, RIDID W/O JOINTS                 L3808        1183.12
02740049   HB HINGE EXT/FLEX WRIST/FINGER            L3900        3368.07
02740050   HB HINGE EXT/FLEX WRIST-FIN CABLE         L3901        3905.78
02740051   HB WHFO NONTORSION JOINT PREFAB           L3931        755.08
02740052   HB UPPER EXT FX ORTHOSIS HUMERAL          L3980        1123.03
02740053   HB ANKLE CONTROL ORTHOSIS PREFAB          L4350        489.09
02740054   HB PNEUMATI WALKING BOOT PREFAB           L4360        954.69
02781029   HB COLLAGEN SYRINGE 2.5ML                 L8603        1647.80
02781012   HB DEFLUX INJECTION 1ML                   L8604        8517.20
02781014   HB SYNTHETIC IMPLANT URINARY 1            L8606        931.97
02781015   HB SYNTHETIC IMPLANT URINARY 2            L8606        2796.98
02780770   HB IMPLANT, OCULAR                        L8610        3094.85
02780800   HB AUDITORY, OSSEO DEVICE 1               L8690       14108.97
02780804   HB AUDITORY, OSSEO DEVICE 2               L8690       14561.26
02780801   HB AUDITORY, OSSEO DEVICE 3               L8690       21127.52
02780799   HB AUDITORY, OSSEO DEVICE 4               L8690       24863.18
02780802   HB AUDITORY, OSSEO DEVICE 5               L8690       35640.96
02780803   HB AUDITORY, OSSEO DEVICE 6               L8690       48774.67
02780798   HB AUDITORY, OSSEO DEVICE 7               L8690       46098.00
02780821   HB REPLACEMENT,AUDITORYOSSEO DVC1 L8691               14108.97
03900051   HB PROCESS WHOLE BLOOD *                  P9010        719.50
03900116   HB PROCESS WHOLE BLOOD*                   P9010        719.50
03900053   HB PROCESS CRYOPRECIPITATE                P9012        117.00
03900110   HB PROCESS CRYOPRECIPITATE*               P9012        117.00
03900106   HB PROCESS PLATELET PACK*                 P9019        289.00
03900062   HB PROCESS PCK RBC WASHED                 P9022        1081.40
03900108   HB PROCESS PCK RBC WASHED*                P9022        1081.40
03900064   HB PROCESS PLATELETPHERESIS               P9036        1615.88
03840001   HB PROCESS PLATELETPHERESIS CS            P9036        1680.52
03900111   HB PROCESS PLT PHERESIS LEUKO RED*        P9037        1808.47
03900066   HB PROCESS PLT PHERS LEUKO RED-OS         P9037        1808.47
03900112   HB PROCESS PACKED RBC*                    P9038        846.50
03900058   HB PROCESS PACKED RBC-OS                  P9038        846.50
03900115   HB PROCESS PCK RBC LEUKOREDUCED*          P9040        992.22
03900114   HB PROCESS PCK RBC LEUKOREDUCED-OS P9040               992.22
03900071   HB PROCESS PLASMA FFP                     P9044        366.17



                                              277
  Charge
   Code                 Description               CPT Code OP/Default Price   IP/ED Price
03900109   HB PROCESS PLASMA FFP-OS                P9044        366.17
03900073   HB PROCESS GRANULOCYTE PHER             P9050        1933.00
03900104   HB PROCESS GRANULOCYTES PED             P9050        735.00
03900099   HB PROCESS PCK RBC DEGLYCEROLIZE*       P9057        1151.76
03900068   HB PROCESS PCK RBC DEGLYCEROLIZE-OSP9057             1077.00
03830001   HB PROCESS PLAS, FRZ 8-24HR CS          P9059        151.84
03900074   HB PROCESS PLASMA, FRZ BET 8-24HR       P9059        146.00
07700001   HB SCREENING PAP CERV/VAG               Q0091        244.68
03000050   HB LAB POC - FERN TEST                  Q0114        120.18
02740082   HB HMGG,POWER MOD DC INPUT CBL          Q0478        990.35
02740075   HB HMGG, POWER MODULE                   Q0479       14851.60
02740088   HB HMGG, POWER MODULE MM                Q0479       14851.60
02740100   HB TLC-II PORTABLE VAD DRIVER           Q0480       142500.00
02740108   HB TLC-II SYSTEM                        Q0480       180500.00
02740070   HB HEARTMATE, SYS CONTROLLER HM11       Q0481       11262.96
02740087   HB HMGG, SYSTEM DRIVER MM               Q0481       11262.82
02740056   HB HEARTMATE, SYS CONTROLLER XVE M Q0482             8991.05
02740055   HB HEARTMATE, SYS CONTROLLER XVE        Q0482        8991.05
02740086   HB HEARTMATE,SYS CNTRLR HMII M          Q0482       11262.96
02740057   HB MONITOR/DISPLAY ELEC/PNEUM VAD       Q0484       13331.64
02740084   HB HMGG,DISPLAY MODULE CABLE M          Q0486        1228.36
02740094   HB LVAD/RVAD PNEUMATIC LEAD             Q0487        802.50
02740093   HB LVAD/RVAD ELECT EXTEN LEAD           Q0487        946.95
02740095   HB LVAD/RVAD PNEUMT EXT LEAD            Q0487        914.85
02740092   HB LVAD/RVAD STERILE ELEC LEAD          Q0487        882.75
02740058   HB HEARTMATE, PWR PK BASE VAD,REP       Q0489       48750.00
02740059   HB HEARTMATE, PWR PK BASE VAD,REP MMQ0489           48750.00
02740060   HB HEARTMATE, EMERGENCY POWER PK        Q0490        3002.62
02740099   HB HAND PUMPING BULB                    Q0494        256.80
02740061   HB HEARTMATE, HAND PUMP                 Q0494        1070.10
02740077   HB HMGG,UNVRSL BTTRY CHARGR             Q0495       14209.60
02740090   HB HMGG,UNVRSL BTTRY CHARGR MM          Q0495       14209.60
02740102   HB TLC II BATTERY CHARGER               Q0495        9630.00
02740110   HB BATTERY, NIMH 12 VL OR               Q0496        2224.61
02700029   HB HEARTMATE, RCHRGBL BAT SET(MM)       Q0496        3021.79
02700028   HB HEARTMATE, RCHRGBL BAT SET(OR)       Q0496        3021.79
02700036   HB HEARTMATE, RCHRGBL BATTERY           Q0496        753.43
02740103   HB TLC II PORT VAD DRIVER BATT          Q0496        3210.00
02740064   HB HEARTMATE, BATTERY CLIP SET          Q0497        1418.32
02740063   HB HEARTMATE, BATTERY CLIP SET MM       Q0497        1418.32
02740076   HB HMGG, BATTERY CLIP SET               Q0497        3538.49
02740089   HB HMGG, BATTERY CLIP SET MM            Q0497        3538.49



                                            278
  Charge
   Code                  Description               CPT Code OP/Default Price   IP/ED Price
02740065   HB HEARTMATE, HOLSTER BATTERY            Q0498        903.70
02740079   HB HMGG, HOLSTER VEST LARGE MM           Q0498        1528.77
02740067   HB BELT, STABILIZATION THORATEC          Q0499        345.13
02740066   HB BELT, STABILIZATION THORATEC MM       Q0499        345.13
02740081   HB HMGG, CONSOLIDATED BAG MM             Q0499        1307.07
02740080   HB HMGG, MODULAR BELT LARGE MM           Q0499        1370.41
02740014   HB HEARTMATE, FILTER VENT                Q0500        1148.76
02740071   HB HEARTMATE, VENT FILTERS               Q0500        1149.34
02740068   HB HEARTMATE, SHOWER KIT                 Q0501        1624.78
02740078   HB HMGG, SHOWER BAG MM                   Q0501        1702.97
02740104   HB TLC II MOBILITY CART                  Q0502        1605.00
02740105   HB TLC II CAR POWER ADAPTER              Q0504        963.00
02740017   HB HEARTMATE, APICAL CORING KNIFE        Q0505        2007.81
02740073   HB HEARTMATE, PBU CABLE                  Q0505        320.82
02740072   HB HEARTMATE, POCKETPAK POUCH            Q0505        532.40
02740062   HB HEARTMATE, SYS CONTRO BTRY MOD        Q0505        536.54
02740069   HB HEARTMATE, VENT ADAPTER               Q0505        579.73
02740091   HB HMGG STABLIZATION BELT S/M            Q0505        345.61
02710103   HB HMGG,POWER MODULE CABLE               Q0505        3166.13
02740085   HB HMGG,POWER MODULE CABLE MM            Q0505        3166.13
02740106   HB TLC II CARRYING CASE                  Q0505        802.50
02740101   HB TLC II DOCKING STATION                Q0505       85000.00
02740107   HB TLC II SHIPPING CASE                  Q0505        2889.00
02740096   HB VAD CANNULA TUNNELER                  Q0505        1123.50
02740111   HB BATTERY,LITHIUM-ION 14VL MM           Q0506        2224.61
02740109   HB BATTERY,LITHIUM-ION 14VL OR           Q0506        2224.61
02780932   HB HUMAN TISSUE NEOFORM DERM 1           Q4100       12943.79
02781190   HB HUMAN TISSUE GRFT JCKT 4X7            Q4107        391.29
02781192   HB HUMAN TISSUE GRFT JCKT 5X10           Q4107        174.94
02781191   HB HUMAN TISSUE GRFT JCKT 5X5            Q4107        333.34
02781193   HB HUMAN TISSUE GRFT JCKT R5X5           Q4107        283.89
02781030   HB SKIN(SUB)GRFTJCKT PERSQCM 1           Q4107        1157.74
02780842   HB SKIN(SUB)GRFTJCKT PERSQCM 2           Q4107        3477.91
02780840   HB SKIN(SUB)GRFTJCKT PERSQCM 3           Q4107        7542.46
02780843   HB SKIN(SUB)GRFTJCKT PERSQCM 4           Q4107        9354.89
02780927   HB SKIN(SUB)GRFTJCKT PERSQCM 5           Q4107       12668.80
02780841   HB SKIN(SUB)GRFTJCKT PERSQCM 6           Q4107       15293.69
02780844   HB SKIN(SUB)GRFTJCKT PERSQCM 7           Q4107       18408.88
02780897   HB SKIN(SUB)GRFTJCKT PERSQCM 8           Q4107       45672.31
02781111   HB INJECT ALLODERM 2CC SYRINGE           Q4112        1430.00
02781116   HB HUMAN TISSUE ALLODERM 4X16            Q4116         24.41
02781112   HB HUMAN TISSUE ALLODERM 16X20           Q4116        128.01



                                             279
  Charge
   Code                  Description                 CPT Code OP/Default Price   IP/ED Price
02781113   HB HUMAN TISSUE ALLODERM 4X12              Q4116         73.88
02781114   HB HUMAN TISSUE ALLODERM 4X12              Q4116         68.02
02781115   HB HUMAN TISSUE ALLODERM 4X12              Q4116        122.10
02781117   HB HUMAN TISSUE ALLODERM 4X7               Q4116         80.14
02781118   HB HUMAN TISSUE ALLODERM 4X7               Q4116        123.83
02781119   HB HUMAN TISSUE ALLODERM 4X7               Q4116         38.66
02781210   HB HUMAN TISSUE ALLODERM 4X7               Q4116         71.98
02781120   HB HUMAN TISSUE ALLODERM 5X12              Q4116        125.84
02781122   HB HUMAN TISSUE ALLODERM 6 X16             Q4116        129.02
02781121   HB HUMAN TISSUE ALLODERM 6X12              Q4116        122.04
02781123   HB HUMAN TISSUE ALLODERM 8X12              Q4116        129.02
02781124   HB HUMAN TISSUE ALLODERM 8X16              Q4116        129.02
02502417   HB OCTAFLUOROPROPRANE MIC,VL OPTI          Q9956        556.05
02502418   HB PERFLUTREN LIP MICROS,VL DEFIN          Q9957        577.79
02550031   HB HOCM 300-349 MG/ML, IOD 1ML             Q9962        209.00
02502338   HB CONTRAST, IODINE 100-199MG /ML          Q9965         2.05
02502370   HB LOCM 100-199, OMNIPAQUE, 20,1M          Q9965        161.00
02502340   HB LOCM 100-199MG, 1 ML                    Q9965         0.00
02502341   HB LOCM 100-199MG,OMNIPAQUE, 1 ML          Q9965         5.72
02502339   HB LOCM 100-199MG,VISIPAQUE, 1 ML          Q9965         0.00
02502343   HB CONTRAST, IODINE 200-299MG /ML          Q9966         2.05
02502371   HB LOCM 200-299,OMNIPAQUE,10,1ML           Q9966        136.00
02502344   HB LOCM 200-299MG,OMNIPAQUE,1ML            Q9966         16.64
02502342   HB LOCM 200-299MG/ML IODINE, 1ML           Q9966         5.73
02502462   HB OMNIPAQUE 300 MG - 100 ML               Q9966         0.00
02502347   HB CONTRAST, IODINE OMNIPAQUE /ML          Q9967         2.04
02502348   HB CONTRAST, IODINE VISIPAQUE /ML          Q9967         2.05
02502351   HB CONTRAST, IODINE VISIPAQUE /ML          Q9967         3.05
02502349   HB LOCM 300-399 MG/ML IODINE,50ML          Q9967        107.06
02502375   HB LOCM 300-399, OMNIPAQUE,50,1ML          Q9967         80.00
02502377   HB LOCM 300-399,OMNIPAQUE,100,1ML          Q9967        145.00
02502376   HB LOCM 300-399,OMNIPAQUE,500,1ML          Q9967        383.00
02502373   HB LOCM 300-399,VISIPAQUE 500,1ML          Q9967        887.00
02502461   HB LOCM 300-399,VISIPQU 50,1ML             Q9967        200.00
02502350   HB LOCM 300-399MG/ML IODINE, 1 ML          Q9967         5.73
02502374   HB LOCM, VISIPAQUE 300-399,100, 1          Q9967        354.72
02502372   HB LOCM,OMNIPAQUE 300-399,100,1ML          Q9967        128.11
03610383   HB GASTRIC LAP BAND ADJUSTMENT             S2083        2598.98




                                               280
Cedars-Sinai Medical Center
AB1045 Chargemaster Submission
Prices Effective July 1, 2011



    Charge Code                    Description                Price
     01200001        HB ROOM CHARGE 1:5 SEMI PRIV         $      5,029.00
     01200002        HB ROOM CHG 1:5 OB PRIV DELX         $      5,029.00
     01200003        HB ROOM CHG 1:5 OB DELX 1 ROOM       $      5,029.00
     01200004        HB ROOM CHG 1:5 OB DELX 2 ROOMS      $      5,029.00
     01200005        HB ROOM CHG 1:5 OB DELX 3 ROOMS      $      5,029.00
     01240001        HB ROOM CHARGE 1:5 PSY               $      5,807.00
     01280001        HB ROOM CHARGE 1:5 REHAB             $      4,746.00
     01290001        HB ROOM CHARGE TRAUMA 1:5 MED/SURG   $      7,149.00
     01530001        HB ROOM CHARGE TRAUMA 1:5 PEDS       $      7,473.00
     01710001        HB ROOM CHARGE 1:8 NSY               $      2,568.00
     01720001        HB ROOM CHARGE 1:4 NSY               $      3,335.00
     01720003        HB ROOM CHARGE 1:4 NICU/PICU         $    13,202.00
     01730002        HB ROOM CHARGE 1:3 NICU/PICU         $    15,815.00
     01740001        HB ROOM CHARGE 2:1 NICU/PICU         $    35,906.00
     01740002        HB ROOM CHARGE 1:1 NICU/PICU         $    27,860.00
     01740003        HB ROOM CHARGE 1:2 NICU/PICU         $    23,033.00
     02000001        HB ROOM CHARGE 2:1 ICU               $    32,278.00
     02000002        HB ROOM CHARGE 1:1 ICU               $    25,535.00
     02000003        HB ROOM CHARGE 1:2 ICU               $    18,817.00
     02060001        HB ROOM CHARGE 1:3 STP DWN           $      7,899.00
     02060003        HB ROOM CHARGE TRAUMA 1:3 & 1:4      $    18,860.00
     02060006        HB ROOM CHARGE 1:4 STP DWN           $      7,135.00
     02080001        HB ROOM CHARGE TRAUMA 2:1 TO 1:2     $    37,613.00
      09900052       HB ROOM OB PRIVATE DELUX             $      1,499.00
      09900053       HB ROOM OB DELUX 1 RM                $      2,673.00
      09900054       HB ROOM OB DELUX 2 RM                $      3,117.00
      09900055       HB ROOM OB DELUX 3 RM                $      3,784.00




                                           281
Cedars-Sinai Medical Center
AB1045 Chargemaster Submission
Prices Effective July 1, 2011

                                                                                                                    ERx
 Charge                                                            CPT                       OP/Default   IP/ED    Charge
  Code                           Description                       Code        NDC             Price      Price   Quantity
      5732 QUINIDINE GLUCONATE 80 MG/ML IJ SOLN                            00002140701   $        30.00           10 mL
    12174 CAPREOMYCIN 1 GRAM IJ SOLR                                       00002148501   $     2,282.25           1 Each
    23850 ATOMOXETINE 10 MG PO CAPS                                        00002322730   $     1,694.11           30 Each
    23853 ATOMOXETINE 40 MG PO CAPS                                        00002322930   $     1,837.88           30 Each
      6797 OLANZAPINE 2.5 MG PO TABS                                       00002411233   $     9,986.90           100 Each
      4834 OLANZAPINE 5 MG PO TABS                                         00002411533   $ 11,786.50              100 Each
      6831 OLANZAPINE 7.5 MG PO TABS                                       00002411633   $ 14,345.32              100 Each
      5761 OLANZAPINE 10 MG PO TABS                                        00002411733   $ 17,762.91              100 Each
    18309 OLANZAPINE 5 MG PO TBDL                                          00002445385   $     3,846.26           30 Each
    12686 OLANZAPINE 10 MG PO TBDL                                         00002445485   $     5,638.91           30 Each
    81236 PRASUGREL 10 MG PO TABS                                          00002475977   $     5,431.64           90 Each
    81234 PRASUGREL 5 MG PO TABS                                           00002476030   $     1,847.54           30 Each
    12755 ABCIXIMAB 10 MG/5 ML IV SOLN                            J0130    00002714001   $     1,352.05           5 mL
    10180 GEMCITABINE 200 MG IV SOLR                              J9201    00002750101   $     2,440.18           1 Each
    11233 GEMCITABINE 1 GRAM IV SOLR                              J9201    00002750201   $ 12,200.56              1 Each
    15346 INSULIN LISPRO 100 UNIT/ML SC SOLN                      J1815    00002751001   $        49.31           10 mL
                                                                   J1815
    17037 INSULIN LISPRO PROTAM & LISPRO 100 UNIT/ML (75-25) SC SUSP       00002751101   $       448.20           10 mL
      7832 DROTRECOGIN ALFA (ACTIVATED) 5 MG IV SOLR                       00002755901   $     5,711.32           1 Each
    14136 DROTRECOGIN ALFA (ACTIVATED) 20 MG IV SOLR                       00002756101   $ 22,845.28              1 Each
    30817 OLANZAPINE 10 MG IM SOLR                                J2358    00002759701   $       376.20           1 Each
    28290 PEMETREXED 500 MG IV SOLR                               J9305    00002762301   $ 43,016.29              1 Each
       771 GLUCAGON (HUMAN RECOMBINANT) 1 MG IJ KIT               J1610    00002803101   $       841.72           1 Each
    77150 TERIPARATIDE 20 MCG/DOSE - 600 MCG/2.4 ML SC PNIJ                00002840001   $     4,205.03           2.4 mL
    10685 TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP                J3301    00003029305   $        83.38           1 mL
    10685 TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP                J3301    00003029320   $        84.66           5 mL
    10685 TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP                J3301    00003029328   $        63.23           10 mL
    15551 TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP                J3301    00003049420   $        30.00           5 mL
    36723 DASATINIB 70 MG PO TABS                                          00003052411   $ 129,781.74             60 Each
    36721 DASATINIB 20 MG PO TABS                                          00003052711   $ 64,891.38              60 Each
    36722 DASATINIB 50 MG PO TABS                                          00003052811   $ 129,781.74             60 Each
    33771 ENTECAVIR 0.5 MG PO TABS                                         00003161112   $ 12,589.15              30 Each
    33772 ENTECAVIR 1 MG PO TABS                                           00003161212   $ 12,589.15              30 Each
    33770 ENTECAVIR 0.05 MG/ML PO SOLN                                     00003161412   $        41.96           210 mL
    12220 STAVUDINE 15 MG PO CAPS                                          00003196401   $     5,786.46           60 Each
    17340 STAVUDINE 20 MG PO CAPS                                          00003196501   $     6,017.49           60 Each
    16257 STAVUDINE 30 MG PO CAPS                                          00003196601   $     6,391.32           60 Each
    13885 STAVUDINE 40 MG PO CAPS                                          00003196701   $     6,509.81           60 Each
    35539 ABATACEPT 250 MG IV SOLR                                J0129    00003218710   $     2,627.55           1 Each
       341 AZTREONAM IN DEXTROSE(ISO-OSM) 1 GRAM/50 ML IV PGBK             00003223011   $       559.95           50 mL
    16978 AZTREONAM IN DEXTROSE(ISO-OSM) 2 GRAM/50 ML IV PGBK              00003224011   $     1,121.41           50 mL
    37462 ATAZANAVIR 300 MG PO CAPS                                        00003362212   $ 15,300.00              30 Each
    25562 ATAZANAVIR 100 MG PO CAPS                                        00003362312   $ 15,519.30              60 Each
    25564 ATAZANAVIR 150 MG PO CAPS                                        00003362412   $ 15,519.30              60 Each
    25565 ATAZANAVIR 200 MG PO CAPS                                        00003363112   $ 15,519.30              60 Each
       964 VALGANCICLOVIR 450 MG PO TABS                                   00004003822   $ 42,447.81              60 Each
    33739 IBANDRONATE 150 MG PO TABS                                       00004018682   $     3,625.93           3 Each
    35688 IBANDRONATE 3 MG/3 ML IV SYKT                           J1740    00004018809   $     4,679.07           1 Each
    33073 SAQUINAVIR MESYLATE 500 MG PO TABS                               00004024451   $ 14,504.40              120 Each
    15855 SAQUINAVIR MESYLATE 200 MG PO CAPS                               00004024515   $ 14,194.58              270 Each
      3571 MYCOPHENOLATE MOFETIL 250 MG PO CAPS                   J7517    00004025943   $     3,822.28           500 Each
      7935 MYCOPHENOLATE MOFETIL 500 MG PO TABS                   J7517    00004026001   $     1,528.81           100 Each
    11364 MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR                 J7517    00004026129   $        71.98           160 mL
    16066 MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR                         00004029809   $       972.62           1 Each
    23576 PEGINTERFERON ALFA-2A 180 MCG/ML SC SOLN                         00004035009   $     6,136.90           1 mL
    24836 ENFUVIRTIDE 90 MG SC KIT                                J1324    00004038039   $       466.75           1 Each
    17132 DACLIZUMAB 5 MG/ML IV CONC                              J7513    00004050109   $     1,058.11           5 mL
    11009 OSELTAMIVIR 75 MG PO CAPS                               G9019    00004080085   $     1,406.75           10 Each



                                                                 282
                                                                                                                    ERx
Charge                                                             CPT                       OP/Default   IP/ED    Charge
Code                          Description                          Code        NDC             Price      Price   Quantity
  40481 OSELTAMIVIR 45 MG PO CAPS                                          00004080185   $     1,406.75           10 Each
  40480 OSELTAMIVIR 30 MG PO CAPS                                          00004080285   $     1,406.75           10 Each
  13149 OSELTAMIVIR 12 MG/ML PO SUSR                              G9019    00004081095   $        30.00           25 mL
   6554 CAPECITABINE 500 MG PO TABS                                J8521   00004110150   $ 49,113.51              120 Each
  18356 FLUMAZENIL 0.1 MG/ML IV SOLN                                       00004691106   $     1,215.50           5 mL
  18356 FLUMAZENIL 0.1 MG/ML IV SOLN                                       00004691206   $     1,933.80           10 mL
    461 GANCICLOVIR SODIUM 500 MG IV SOLR                          J1570   00004694003   $     1,212.44           1 Each
  11226 PNEUMOCOCCAL 7-VAL CONJ VACC 16 MCG/0.5 ML IM SUSP         90669   00005197067   $       922.68           .5 mL
  74136 PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG              90670   00005197101   $     1,255.65           .5 mL
  37424 SITAGLIPTIN 50 MG PO TABS                                          00006011228   $     6,992.81           100 Each
  37422 SITAGLIPTIN 25 MG PO TABS                                          00006022128   $     6,992.81           100 Each
  40498 RALTEGRAVIR 400 MG PO TABS                                         00006022761   $ 15,394.86              60 Each
   4423 RIZATRIPTAN 10 MG PO TABS                                          00006026718   $     4,574.59           18 Each
  37425 SITAGLIPTIN 100 MG PO TABS                                         00006027728   $     6,992.81           100 Each
  24892 APREPITANT 80 MG PO CAPS                                   J8501   00006046106   $     5,996.54           6 Each
  24893 APREPITANT 125 MG PO CAPS                                  J8501   00006046206   $     9,243.08           6 Each
  36749 APREPITANT 40 MG PO CAPS                                   J8501   00006046405   $     2,547.38           5 Each
   3598 IMIPENEM-CILASTATIN 500 MG IV SOLR                         J0743   00006351659   $       537.10           1 Each
  18063 DORZOLAMIDE 2 % OP DROP                                            00006351936   $       676.61           10 mL
  13992 IMIPENEM-CILASTATIN 250 MG IV SOLR                         J0743   00006355158   $       301.95           1 Each
  17629 IMIPENEM-CILASTATIN 500 MG IM SUSR                         J0743   00006358275   $     5,370.64           10 Each
  16139 RIZATRIPTAN 5 MG PO TBDL                                           00006380012   $       762.43           3 Each
  10546 RIZATRIPTAN 10 MG PO TBDL                                          00006380112   $       762.43           3 Each
  16899 CASPOFUNGIN 50 MG IV SOLR                                  J0637   00006382210   $     1,779.56           1 Each
  12542 CASPOFUNGIN 70 MG IV SOLR                                  J0637   00006382310   $     1,848.75           1 Each
  18500 ERTAPENEM 1 GRAM IJ SOLR                                   J1335   00006384371   $     1,037.68           1 Each
                                                                9
  41667 MEASLES VACCINE,LIVE,ATTEN(PF) 1000 TCID50/0.5 ML SC SUSR0705      00006458900   $       533.79           10 Each
  41669 RUBELLA VACCINE (PF) 1000 TCID50/0.5 ML SC SUSR            90706   00006467300   $       204.08           10 Each
                                                               90707 00006468100
  41670 MEASLES,MUMPS&RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SC SUSR                $       533.90           10 Each
  36472 VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SC SOLR    90716   00006482700   $       920.60           1 Each
  17527 PNEUMOCOCCAL 23-VALPS VACCINE 25 MCG/0.5 ML IJ INJ         90732   00006494300   $     1,198.80           .5 mL
  36429 ZOSTER VACCINE LIVE (PF) 19400 UNIT SC SOLR                        00006496341   $     1,691.54           1 Each
  41766 HEPATITIS B VIRUS VACCINE (PF) 5 MCG/0.5 ML IM SUSP        90744   00006498100   $       114.53           .5 mL
   6620 FONDAPARINUX 2.5 MG/0.5 ML SC SYRG                         J1652   00007323011   $       406.16           .5 mL
  32832 FONDAPARINUX 5 MG/0.4 ML SC SYRG                           J1652   00007323211   $     1,483.13           .4 mL
  32838 FONDAPARINUX 7.5 MG/0.6 ML SC SYRG                         J1652   00007323411   $       988.76           .6 mL
  32833 FONDAPARINUX 10 MG/0.8 ML SC SYRG                          J1652   00007323611   $       741.57           .8 mL
   9347 TOPOTECAN 4 MG IV SOLR                                     J9351   00007420101   $ 18,504.50              1 Each
  35164 NELARABINE 250 MG/50 ML IV SOLN                            J9261   00007440106   $       191.62           50 mL
   1665 ARGATROBAN 100 MG/ML IV SOLN                              C9121    00007440701   $     5,430.00           2.5 mL
  10876 PANTOPRAZOLE 40 MG PO TBEC                                         00008084199   $     5,202.67           100 Each
   5312 PANTOPRAZOLE 40 MG IV SOLR                                C9113    00008092355   $       384.67           1 Each
   9202 SIROLIMUS 1 MG/ML PO SOLN                                  J7520   00008103006   $       112.87           60 mL
  74454 SIROLIMUS 0.5 MG PO TABS                                           00008104010   $     5,641.35           100 Each
   9541 SIROLIMUS 1 MG PO TABS                                     J7520   00008104110   $ 11,282.92              100 Each
  39284 TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FINAL) IV SOLR         J9330   00008117901   $     6,848.28           1 mL
  41938 METHYLNALTREXONE 12 MG/0.6 ML SC SOLN                              00008121801   $       816.94           .6 mL
   8082 GEMTUZUMAB OZOGAMICIN 5 MG IV SOLR                         J9300   00008451001   $ 42,603.87              1 Each
  34244 TIGECYCLINE 50 MG IV SOLR                                  J3243   00008499002   $     1,008.47           1 Each
  74483 HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML IJ SOLR           J1720   00009001103   $        42.46           1 Each
  74481 HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML IJ SOLR           j1720   00009001612   $       168.52           1 Each
  73852 METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML IJ SOLR            J2920   00009003928   $        30.00           1 Each
  73853 METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML IJ SOLR         j2930   00009004722   $        30.00           1 Each
   8191 METHYLPREDNISOLONE 2 MG PO TABS                            J7509   00009004902   $       745.36           100 Each
  24433 METHYLPREDNISOLONE SODIUM SUCC 40 MG/ML IJ SOLR            J2920   00009011312   $        30.00           1 Each
  24434 METHYLPREDNISOLONE SODIUM SUCC 125 MG/2 ML IJ SOLR         J2930   00009019009   $        35.41           1 Each
   3029 ESTRADIOL CYPIONATE 5 MG/ML IM OIL                         J1000   00009027101   $        70.05           5 mL
  10806 GELATIN ABSORBABLE TP FILM                                         00009028301   $     6,188.60           1 Each
  15037 GELATIN ABSORBABLE 12-7 MM TP SPGE                                 00009031508   $       506.66           12 Each
   6285 GELATIN ABSORBABLE 100 TP SPGE                                     00009034201   $     1,361.12           6 Each
  15452 TESTOSTERONE CYPIONATE 200 MG/ML IM OIL                    J1080   00009041701   $       168.13           1 mL



                                                                  283
                                                                                                                     ERx
Charge                                                             CPT                       OP/Default   IP/ED    Charge
Code                          Description                          Code        NDC             Price      Price    Quantity
  18132 ARGININE HCL (L-ARGININE) 10 % IV SOLP                             00009043624   $       209.27           300 mL
  34848 MEDROXYPROGESTERONE 400 MG/ML IM SOLN                      J1051   00009062601   $       686.84           2.5 mL
  10877 METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV SOLR             J2930   00009069801   $       138.16           1 Each
  14838 METHYLPREDNISOLONE SODIUM SUCC 500 MG IV SOLR              J2930   00009075801   $        77.99           1 Each
   8944 CLINDAMYCIN PALMITATE HCL 75 MG/5 ML PO SOLR                       00009076004   $        30.00           100 mL
  18193 CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN                         00009085608   $     1,020.87           1 mL
    486 CLINDAMYCIN PHOSPHATE 150 MG/ML IJ SOLN                            00009087026   $        39.78           2 mL
    486 CLINDAMYCIN PHOSPHATE 150 MG/ML IJ SOLN                            00009090218   $        30.00           6 mL
  10938 METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP                J1030   00009307303   $        30.18           1 mL
   8121 METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP                J1040   00009347503   $        59.77           1 mL
  16098 IBUTILIDE FUMARATE 0.1 MG/ML IV SOLN                       J1742   00009379401   $       112.33           10 mL
   9811 LINEZOLID 600 MG PO TABS                                           00009513503   $ 37,861.38              30 Each
  22717 LINEZOLID 600 MG/300 ML IV SOLP                            J2020   00009514001   $        30.00           300 mL
  14593 NICOTINE 10 MG/ML NA SPRY                                          00009540101   $       346.96           10 mL
   9526 LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ             J7504   00009722402   $     1,765.16           5 mL
   9484 EXEMESTANE 25 MG PO TABS                                           00009766304   $     6,056.05           30 Each
   3122 ESTRAMUSTINE 140 MG PO CAPS                                        00013013202   $     9,250.55           100 Each
   1163 TRANEXAMIC ACID 100 MG/ML IV SOLN                                  00013111410   $        78.11           10 mL
   6013 SOMATROPIN 0.4 MG/0.25 ML SC SYRG                                  00013265002   $       267.19           1 Each
   5336 RIFABUTIN 150 MG PO CAPS                                           00013530117   $ 18,808.29              100 Each
    450 LATANOPROST 0.005 % OP DROP                                        00013830301   $       734.14           2.5 mL
   1651 DEXRAZOXANE 250 MG IV SOLR                                 J1190   00013871762   $     1,358.50           1 Each
  40530 IXABEPILONE 45 MG IV SOLR                                  J9207   00015191113   $ 46,226.91              1 Each
   8203 CARMUSTINE 100 MG IV SOLR                                  J9050   00015301260   $     2,822.51           1 Each
   8940 LOMUSTINE 10 MG PO CAPS                                            00015303020   $     2,905.47           20 Each
   7628 LOMUSTINE 40 MG PO CAPS                                            00015303120   $     8,749.56           20 Each
   2839 LOMUSTINE 100 MG PO CAPS                                           00015303220   $ 16,632.63              20 Each
  13448 TENIPOSIDE 10 MG/ML IV SOLN                               Q2017    00015307519   $     5,166.98           5 mL
  41026 WHITE PETROLATUM-MINERAL OIL 56.8-42.5 % OP OINT                   00023031204   $        85.36           3.5 g
   4638 SULFACETAMIDE-PREDNISOLONE 10-0.2 % OP OINT                        00023031304   $       592.68           3.5 g
   3372 ONABOTULINUMTOXINA 100 UNIT IJ SOLR                       Q2040    00023114501   $     5,775.00           1 Each
   7861 KETOROLAC 0.5 % OP DROP                                            00023218105   $     1,163.36           5 mL
  17399 BRIMONIDINE 0.15 % OP DROP                                         00023917705   $       730.51           5 mL
   6070 BIMATOPROST 0.03 % OP DROP                                         00023918703   $       859.65           2.5 mL
   6070 BIMATOPROST 0.03 % OP DROP                                         00023918705   $     1,718.53           5 mL
  40975 TROSPIUM 60 MG PO CP24                                             00023935030   $     2,274.09           30 Each
  34104 OXALIPLATIN 100 MG/20 ML IV SOLN                           J9263   00024059120   $     1,631.49           20 mL
  25463 PHENYLEPHRINE HCL 0.25 % NA SPRY                                   00024134803   $        30.00           15 mL
  10714 PHENYLEPHRINE HCL 1 % NA SPRY                                      00024135202   $        30.00           15 mL
  25468 PHENYLEPHRINE HCL 0.5 % NA SPRY                                    00024135301   $        30.00           15 mL
  81205 DRONEDARONE 400 MG PO TABS                                         00024414210   $     4,144.25           100 Each
  81205 DRONEDARONE 400 MG PO TABS                                         00024414218   $     7,104.24           180 Each
  27006 ALFUZOSIN 10 MG PO TB24                                            00024420010   $     4,099.04           100 Each
  23263 RASBURICASE 1.5 MG IV SOLR                                 J2783   00024515010   $     5,909.86           1 Each
  36754 RASBURICASE 7.5 MG IV SOLR                                 J2783   00024515175   $ 29,549.96              1 Each
  15870 ANTIHEMOPHILIC FACTOR (RECOMB) 1,000 (+/-) UNIT IV SOLR    J7192   00026378550   $        30.00           1000 Units
  13181 MUPIROCIN CALCIUM 2 % TP CREA                                      00029152722   $       499.62           15 g
  13181 MUPIROCIN CALCIUM 2 % TP CREA                                      00029152725   $       846.67           30 g
  18405 ROSIGLITAZONE 2 MG PO TABS                                         00029315818   $     1,663.53           60 Each
  15022 ROSIGLITAZONE 4 MG PO TABS                                         00029315900   $     3,703.29           90 Each
   1207 ROSIGLITAZONE 8 MG PO TABS                                         00029316059   $     6,728.04           90 Each
   3435 AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML PO SUSR               00029609023   $        30.00           100 mL
   3435 AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML PO SUSR               00029609039   $        30.00           75 mL
    162 TICARCILLIN-CLAVULANATE 3.1 G IV SOLR                              00029657126   $       173.38           1 Each
   7941 CEFOTAXIME 1 GRAM IJ SOLR                                  J0698   00039001810   $        30.00           1 Each
   7941 CEFOTAXIME 1 GRAM IJ SOLR                                  J0698   00039001825   $        30.00           1 Each
   7941 CEFOTAXIME 1 GRAM IJ SOLR                                  J0698   00039001850   $        30.00           1 Each
   4686 CEFOTAXIME 2 GRAM IJ SOLR                                  J0698   00039001910   $        52.04           1 Each
   4686 CEFOTAXIME 2 GRAM IJ SOLR                                  J0698   00039001925   $        52.04           1 Each
   4686 CEFOTAXIME 2 GRAM IJ SOLR                                  J0698   00039001950   $        52.04           1 Each
  15613 CEFOTAXIME 1 GRAM IV SOLR                                  J0698   00039002325   $        42.81           1 Each



                                                                  284
                                                                                                                 ERx
Charge                                                          CPT                      OP/Default   IP/ED    Charge
Code                             Description                   Code        NDC             Price      Price    Quantity
   3703 CEFOTAXIME 2 GRAM IV SOLR                              J0698   00039002425   $        77.72           1 Each
  13830 HALOPERIDOL DECANOATE 50 MG/ML IM SOLN                 J1631   00045025303   $       551.65           1 mL
  18049 CONJUGATED ESTROGENS 25 MG IJ SOLR                     J1410   00046074905   $     1,082.40           1 Each
  11154 CONJUGATED ESTROGENS 0.625 MG/G VA CREA                        00046087293   $     1,297.45           42.5 g
  25937 AMPICILLIN-SULBACTAM 3 GRAM IV PGBK                            00049002383   $     1,338.07           10 Each
   3629 PENICILLIN G POTASSIUM 5 MILLION UNIT IJ SOLR          J2540   00049052083   $        77.32           1 Each
  24441 ELETRIPTAN HBR 20 MG PO TABS                                   00049233045   $     1,398.87           6 Each
  24442 ELETRIPTAN HBR 40 MG PO TABS                                   00049234045   $     1,398.87           6 Each
  30732 VORICONAZOLE 200 MG/5 ML (40 MG/ML) PO SUSR                    00049316044   $       154.07           75 mL
  21560 VORICONAZOLE 50 MG PO TABS                                     00049317030   $     5,047.27           30 Each
  21561 VORICONAZOLE 200 MG PO TABS                                    00049318030   $ 20,189.52              30 Each
  21562 VORICONAZOLE 200 MG IV SOLN                            J3465   00049319028   $     1,969.11           1 Each
   3145 FLUCONAZOLE 150 MG PO TABS                                     00049350079   $       310.08           1 Each
   8998 ZIPRASIDONE HCL 20 MG PO CAPS                                  00049396041   $     5,670.72           80 Each
  14857 ZIPRASIDONE HCL 40 MG PO CAPS                                  00049397041   $     5,670.72           80 Each
  16506 ZIPRASIDONE HCL 60 MG PO CAPS                                  00049398041   $     6,881.49           80 Each
   8114 DRONABINOL 2.5 MG PO CAPS                              Q0167   00051002121   $     7,049.56           60 Each
   3330 DRONABINOL 5 MG PO CAPS                                Q0168   00051002221   $ 14,671.48              60 Each
  81533 ASENAPINE 5 MG SL SUBL                                         00052011890   $     8,269.03           100 Each
  81534 ASENAPINE 10 MG SL SUBL                                        00052011990   $     8,269.03           100 Each
  35188 BCG LIVE 50 MG IS SUSR                                 J9031   00052060202   $     1,549.57           1 Each
  16323 ALPHA-1 PROTEINASE INHIB.(HUM) 1000 MG IV SUSR         J0256   00053720102   $     1,550.00           1 Each
  35715 ANTIHEMOPHILIC FACTOR-VWF 250-600 UNIT IV KIT            -1    00053761505   $     7,446.00           600 Units
  35717 ANTIHEMOPHILIC FACTOR-VWF 500-1,200 UNIT IV KIT          -1    00053761510   $        30.00           1200 Units
  12801 ZIDOVUDINE 300 MG PO TABS                                      00054005221   $       574.43           60 Each
   6680 GALANTAMINE 4 MG/ML PO SOLN                                    00054013749   $        30.00           100 mL
   5143 ACARBOSE 50 MG PO TABS                                         00054014120   $       683.21           100 Each
  10484 ACARBOSE 100 MG PO TABS                                        00054014225   $     1,124.86           100 Each
  16308 MORPHINE 15 MG PO TABS                                         00054023524   $       427.55           100 Each
  13248 MORPHINE 10 MG/5 ML PO SOLN                                    00054023749   $        30.00           100 mL
  13248 MORPHINE 10 MG/5 ML PO SOLN                                    00054023755   $        30.00           5 mL
  13248 MORPHINE 10 MG/5 ML PO SOLN                                    00054023763   $        30.00           500 mL
   9418 MORPHINE 20 MG/5 ML PO SOLN                                    00054023849   $       194.14           100 mL
   9418 MORPHINE 20 MG/5 ML PO SOLN                                    00054023863   $       529.21           500 mL
   5817 CODEINE SULFATE 15 MG PO TABS                                  00054024324   $       495.38           100 Each
  15190 CODEINE SULFATE 30 MG PO TABS                                  00054024424   $       613.36           100 Each
  13033 ACETYLCYSTEINE 10 % (100 MG/ML) MISC SOLN              J7608   00054302502   $        30.00           30 mL
   7011 DEXAMETHASONE 1 MG/ML PO DROP                                  00054317644   $       167.86           30 mL
   9620 LIDOCAINE HCL 4 % MM SOLN                                      00054350547   $        30.00           50 mL
   6162 AZATHIOPRINE 50 MG PO TABS                             J7500   00054408425   $       183.26           100 Each
  14113 LEUCOVORIN CALCIUM 5 MG PO TABS                                00054449625   $     1,804.55           100 Each
   7316 DIAZEPAM 5 MG/5 ML PO SOLN                                     00054820716   $        30.00           5 mL
  13466 LIDOCAINE HCL 2 % MM SOLN                                      00054850016   $        30.00           20 mL
   9583 METHOTREXATE SODIUM 2.5 MG PO TABS                     J8610   00054855025   $     1,126.76           100 Each
  16455 METHADONE 5 MG PO TABS                                         00054855324   $       569.84           100 Each
   3901 METHADONE 10 MG PO TABS                                        00054855424   $       648.38           100 Each
   3732 MEPERIDINE 50 MG PO TABS                                       00054859511   $       164.22           25 Each
   4699 TRIAZOLAM 0.125 MG PO TABS                                     00054885825   $       336.60           100 Each
   2398 TRIAZOLAM 0.25 MG PO TABS                                      00054885925   $       191.08           100 Each
  14345 EFAVIRENZ 50 MG PO CAPS                                        00056047030   $       758.54           30 Each
  16347 EFAVIRENZ 200 MG PO CAPS                                       00056047492   $     9,097.38           90 Each
  35507 EMOLLIENT COMBINATION NO.10 TP EMUL                            00062020502   $       328.13           45 g
  35507 EMOLLIENT COMBINATION NO.10 TP EMUL                            00062020503   $       525.14           90 g
  18869 NORELGESTROM-ETHINYL ESTRADIOL 150-20 MCG/24 HR TD PTWK        00062192001   $       268.40           1 Each
    872 TERCONAZOLE 0.4 % VA CREA                                      00062535001   $       468.71           45 g
  31739 PAPAIN-UREA-CHLOROPHYLLIN 521,700-10-0.5 UNIT/G-%-% TP OINT    00064341030   $       744.81           30 g
  15156 COLLAGENASE CLOSTRIDIUM HIST. 250 UNIT/G TP OINT               00064501015   $       554.62           15 g
  15156 COLLAGENASE CLOSTRIDIUM HIST. 250 UNIT/G TP OINT               00064501030   $       805.42           30 g
  11983 CARBACHOL 0.01 % IO SOLN                                       00065002315   $        90.63           1.5 mL
  16980 NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP DROP                    00065008515   $        78.32           15 mL
   1343 BETAXOLOL 0.25 % OP DRPS                                       00065024610   $     1,315.05           10 mL



                                                              285
                                                                                                             ERx
Charge                                                     CPT                       OP/Default   IP/ED    Charge
Code                          Description                  Code        NDC             Price      Price    Quantity
   5468 TRAVOPROST 0.004 % OP DROP                                 00065026025   $       875.71           2.5 mL
  11568 OLOPATADINE 0.1 % OP DROP                                  00065027105   $     1,126.95           5 mL
  37860 OLOPATADINE 0.2 % OP DROP                                  00065027225   $     1,086.69           2.5 mL
   3922 BRINZOLAMIDE 1 % OP DRPS                                   00065027510   $     1,078.11           10 mL
   3922 BRINZOLAMIDE 1 % OP DRPS                                   00065027515   $     1,616.78           15 mL
  13631 CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP DROP               00065035902   $       175.23           2 mL
  18251 CYCLOPENTOLATE 0.5 % OP DROP                               00065039515   $       453.75           15 mL
  11655 CYCLOPENTOLATE 2 % OP DROP                                 00065039702   $       103.90           2 mL
  13446 TOBRAMYCIN SULFATE 0.3 % OP OINT                           00065064435   $       731.50           3.5 g
  18297 TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP DRPS                 00065064725   $       495.66           2.5 mL
   5755 TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT                 00065064835   $     1,277.98           3.5 g
  14144 CIPROFLOXACIN 0.3 % OP OINT                                00065065435   $       891.55           3.5 g
  16601 APRACLONIDINE 1 % OP DPET                                  00065066010   $       153.99           24 Each
   2406 APRACLONIDINE 0.5 % OP DROP                                00065066505   $       925.43           5 mL
   4221 TETRACAINE HCL 0.5 % OP DROP                               00065074112   $        38.36           2 mL
  25100 MOXIFLOXACIN 0.5 % OP DROP                                 00065401303   $       810.48           3 mL
  26184 CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT DRPS              00065853302   $     1,285.35           7.5 mL
  35729 SUNITINIB 12.5 MG PO CAPS                                  00069055038   $ 38,094.28              28 Each
  35730 SUNITINIB 25 MG PO CAPS                                    00069077038   $ 76,188.37              28 Each
  39902 MARAVIROC 150 MG PO TABS                                   00069080760   $     9,984.59           60 Each
  39907 MARAVIROC 300 MG PO TABS                                   00069080860   $     9,984.59           60 Each
    755 DOXYCYCLINE MONOHYDRATE 25 MG/5 ML PO SUSR                 00069097065   $        30.00           60 mL
  35731 SUNITINIB 50 MG PO CAPS                                    00069098038   $ 135,626.68             28 Each
  15600 AZITHROMYCIN 200 MG/5 ML PO SUSR                           00069313019   $        30.87           22.5 mL
   6833 SILDENAFIL 25 MG PO TABS                                   00069420030   $     5,705.57           30 Each
   2532 SILDENAFIL 50 MG PO TABS                                   00069421030   $     5,705.57           30 Each
   7115 SILDENAFIL 100 MG PO TABS                                  00069422030   $     5,705.37           30 Each
   5464 DOFETILIDE 125 MCG PO CAPS                                 00069580060   $     2,158.86           60 Each
  17032 DOFETILIDE 500 MCG PO CAPS                                 00069582043   $     1,439.24           40 Each
   1084 ATORVASTATIN 80 MG PO TABS                                 00071015823   $     4,112.36           90 Each
   4507 BERACTANT (IN NACL 0.9 %) 25 MG/ML ITL SUSP                00074104004   $       666.60           4 mL
  11549 DEPACON 500 MG/5 ML (100 MG/ML) IV SOLN                    00074156410   $        30.00           5 mL
   5668 PARICALCITOL 5 MCG/ML IV SOLN                      J2501   00074165801   $       159.82           1 mL
   3347 RITONAVIR 80 MG/ML PO SOLN                                 00074194063   $        98.80           240 mL
   8143 LEUPROLIDE 11.25 MG IM KIT                                 00074228203   $ 24,542.39              1 Each
  23018 DILTIAZEM HCL 5 MG/ML IV SYRG                              00074229111   $        30.00           5 mL
 104222 RITONAVIR 100 MG PO TABS                                   00074333330   $     4,234.53           30 Each
  11212 LEUPROLIDE (3 MONTH) 22.5 MG IM SYRG               J9217   00074334603   $ 40,172.19              1 Each
   1764 LEUPROLIDE 3.75 MG IM KIT                          J1950   00074364103   $ 11,237.00              1 Each
   6350 LEUPROLIDE 7.5 MG IM SYRG                          J9217   00074364203   $ 13,390.90              1 Each
   1736 LEUPROLIDE (3 MONTH) 11.25 MG IM KIT               J1950   00074366303   $ 33,711.68              1 Each
  24410 ADALIMUMAB 40 MG/0.8 ML SC KIT                     J0135   00074379902   $ 27,613.44              2 Each
   2057 LOPINAVIR-RITONAVIR 400-100 MG/5 ML PO SOLN                00074395646   $        36.11           160 mL
  34150 PARICALCITOL 2 MCG PO CAPS                                 00074431430   $     5,434.97           30 Each
  34151 PARICALCITOL 4 MCG PO CAPS                                 00074431530   $ 10,870.07              30 Each
  34149 PARICALCITOL 1 MCG PO CAPS                                 00074431730   $     2,717.55           30 Each
  36869 ADALIMUMAB 40 MG/0.8 ML SC PNKT                    J0135   00074433902   $ 17,867.52              2 Each
  11354 CISATRACURIUM 2 MG/ML IV SOLN                              00074438010   $        30.00           10 mL
   4754 CISATRACURIUM 10 MG/ML IV SOLN                             00074438220   $       134.67           20 mL
   7682 PARICALCITOL 2 MCG/ML IV SOLN                      J2501   00074463701   $        63.93           1 mL
  16884 DIVALPROEX 125 MG PO CPSP                                  00074611411   $     1,080.20           100 Each
   2348 DIVALPROEX 250 MG PO TBEC                                  00074621411   $     2,200.00           100 Each
   6661 DIVALPROEX 500 MG PO TBEC                                  00074621511   $     4,048.00           100 Each
   2039 ERYTHROMYCIN 500 MG PO TABS                                00074622713   $     1,620.95           100 Each
  11761 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR            00074630213   $        30.00           100 mL
   6066 ERYTHROMYCIN 250 MG PO TBEC                                00074630413   $     1,503.65           100 Each
  17775 ERYTHROMYCIN 333 MG PO TBEC                                00074632013   $     1,549.21           100 Each
   5157 ERYTHROMYCIN 500 MG PO TBEC                                00074632113   $     1,617.72           100 Each
  11761 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR            00074636902   $        30.00           100 mL
  11761 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR            00074636910   $        30.00           200 mL
   3103 CYCLOSPORINE MODIFIED 25 MG PO CAPS                J7515   00074646332   $       440.44           30 Each



                                                          286
                                                                                                                  ERx
Charge                                                          CPT                       OP/Default   IP/ED    Charge
Code                          Description                       Code        NDC             Price      Price    Quantity
  15140 CYCLOSPORINE MODIFIED 100 MG PO CAPS                    J7502   00074647932   $     1,759.81           30 Each
  35153 LOPINAVIR-RITONAVIR 200-50 MG PO TABS                           00074679922   $ 11,552.11              120 Each
  21312 ENOXAPARIN 40 MG/0.4 ML SC SYRG                         J1650   00075062040   $       432.50           .4 mL
  21309 ENOXAPARIN 60 MG/0.6 ML SC SYRG                         J1650   00075062160   $       433.02           .6 mL
  21310 ENOXAPARIN 80 MG/0.8 ML SC SYRG                         J1650   00075062280   $       433.02           .8 mL
  21311 ENOXAPARIN 100 MG/ML SC SYRG                            J1650   00075062300   $       433.02           1 mL
  21308 ENOXAPARIN 30 MG/0.3 ML SC SYRG                         J1650   00075062430   $       432.55           .3 mL
  13209 RILUZOLE 50 MG PO TABS                                          00075770060   $ 10,195.55              60 Each
   9300 DOCETAXEL 20 MG/2 ML (FINAL) IV SOLN                    J9171   00075800120   $     3,390.91           2 mL
  23533 DOCETAXEL 80 MG/8 ML (FINAL) IV SOLN                    J9171   00075800180   $     3,390.82           8 mL
   8387 METHYLERGONOVINE 0.2 MG/ML (1 ML) IJ SOLN               J2210   00078005303   $        76.29           1 mL
  18425 CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN                 J0630   00078014923   $       299.86           2 mL
   8639 TERBINAFINE 250 MG PO TABS                                      00078017915   $     4,931.19           30 Each
 503103 CYCLOSPORINE MODIFIED 25 MG PO CAPS                     J7515   00078024615   $       372.10           30 Each
 515140 CYCLOSPORINE MODIFIED 100 MG PO CAPS                    J7502   00078024815   $     1,487.16           30 Each
  14309 CYCLOSPORINE MODIFIED 100 MG/ML PO SOLN                 J7502   00078027422   $        54.04           50 mL
    445 RIVASTIGMINE 1.5 MG PO CAPS                                     00078032306   $     4,186.05           100 Each
  17511 RIVASTIGMINE 3 MG PO CAPS                                       00078032406   $     4,186.05           100 Each
  14935 BASILIXIMAB 20 MG IV SOLR                               J0480   00078033184   $ 17,775.34              1 Each
   4942 OCTREOTIDE ACETATE 20 MG IM KIT                         J2353   00078034161   $ 11,096.80              1 Each
   1394 OCTREOTIDE ACETATE 30 MG IM KIT                         J2353   00078034261   $ 16,616.60              1 Each
    726 DEFEROXAMINE 2 GRAM IJ SOLR                             J0895   00078034751   $     1,053.58           4 Each
   5171 PIMECROLIMUS 1 % TP CREA                                        00078037546   $       938.41           30 g
  28431 MYCOPHENOLATE SODIUM 180 MG PO TBEC                     J7518   00078038566   $     2,684.96           120 Each
  28432 MYCOPHENOLATE SODIUM 360 MG PO TBEC                     J7518   00078038666   $     5,369.89           120 Each
  25020 ZOLEDRONIC ACID 4 MG/5 ML IV SOLN                       J3487   00078038725   $     1,889.58           5 mL
  25441 IMATINIB 100 MG PO TABS                                         00078040134   $ 66,047.96              90 Each
  74562 EVEROLIMUS 0.5 MG PO TABS                                       00078041420   $     7,122.06           60 Each
  74561 EVEROLIMUS 0.75 MG PO TABS                                      00078041520   $ 10,683.42              60 Each
  74563 EVEROLIMUS 0.25 MG PO TABS                                      00078041720   $     3,561.10           60 Each
  33184 DARIFENACIN 7.5 MG PO TB24                                      00078041915   $     1,348.81           30 Each
  38551 ZOLEDRONIC ACID-MANNITOL&WATER 5 MG/100 ML IV SOLN      J3488   00078043561   $ 11,433.40              100 mL
  25440 IMATINIB 400 MG PO TABS                                         00078043815   $ 79,331.52              30 Each
  13271 ACETYLCHOLINE CHLORIDE 1:100 (20 MG/2 ML) IO KIT                00078047461   $       474.10           1 Each
   3327 KETOTIFEN FUMARATE 0.025 % OP DROP                              00078047661   $       103.84           5 mL
  38089 ALISKIREN 150 MG PO TABS                                        00078048535   $     2,825.68           100 Each
  38088 ALISKIREN 300 MG PO TABS                                        00078048635   $     3,564.77           100 Each
   2036 TOBRAMYCIN 300 MG/5 ML IN NEBU                          J7682   00078049471   $       120.36           5 mL
   3930 ALDESLEUKIN 22 MILLION UNIT IV SOLR                     J9015   00078049561   $ 16,038.14              1 Each
  39410 RIVASTIGMINE 9.5 MG/24 HOUR TD PT24                             00078050261   $        79.08           1 Each
  37496 TELBIVUDINE 600 MG PO TABS                                      00078053815   $     7,822.76           30 Each
  79622 EVEROLIMUS 5 MG PO TABS                                         00078056651   $ 109,480.00             28 Each
   8449 BETAMETHASONE ACET & SOD PHOS 6 MG/ML IJ SUSP           J0702   00085056605   $        71.48           5 mL
 400551 ALBUTEROL 90 MCG/ACTUATION IN AERO - PEDIATRIC                  00085113201   $       334.41           6.7 g
    870 EPTIFIBATIDE 2 MG/ML IV SOLN                            J1327   00085117702   $ 10,199.20              100 mL
                                                                J9214
  37747 INTERFERON ALFA-2B 3 MILLION UNIT /0.2 ML-6 DOSES SC PNKT       00085124201   $     3,500.09           1 Each
  13404 MOMETASONE 50 MCG/ACTUATION NA SPRY                             00085128801   $       807.57           17 g
  15804 PEGINTERFERON ALFA-2B 120 MCG/0.5 ML SC KIT                     00085130401   $     6,143.39           1 Each
  33791 PEGINTERFERON ALFA-2B 80 MCG/0.5 ML SC PNKT                     00085131601   $     5,850.68           1 Each
  37273 POSACONAZOLE 200 MG/5 ML (40 MG/ML) PO SUSP                     00085132801   $       117.40           105 mL
  34332 MOMETASONE 220 MCG (14 DOSES) IN AEPB                           00085134104   $       572.72           .24 g
   5443 TEMOZOLOMIDE 100 MG PO CAPS                             J8700   00085136602   $ 15,310.54              5 Each
    888 PEGINTERFERON ALFA-2B 50 MCG/0.5 ML SC KIT                      00085136801   $     5,572.60           1 Each
   7229 FORMOTEROL FUMARATE 12 MCG IN CPDV                              00085140101   $     1,613.70           60 Each
   7229 FORMOTEROL FUMARATE 12 MCG IN CPDV                              00085140201   $       398.42           12 Each
   5602 TEMOZOLOMIDE 250 MG PO CAPS                             J8700   00085141701   $ 38,287.57              5 Each
  38399 TEMOZOLOMIDE 140 MG PO CAPS                                     00085142502   $ 60,018.48              14 Each
  38400 TEMOZOLOMIDE 180 MG PO CAPS                                     00085143001   $ 27,559.38              5 Each
  16662 TEMOZOLOMIDE 20 MG PO CAPS                              J8700   00085151901   $     8,852.05           14 Each
   5208 MOXIFLOXACIN 400 MG PO TABS                                     00085173302   $ 13,435.61              50 Each
  15966 MOXIFLOXACIN IN NACL (ISO-OSM) 400 MG/250 ML IV PGBK    J2280   00085173701   $        30.00           250 mL



                                                               287
                                                                                                                 ERx
Charge                                                          CPT                       OP/Default   IP/ED    Charge
Code                          Description                       Code        NDC             Price      Price   Quantity
   4544 CIPROFLOXACIN IN D5W 400 MG/200 ML IV PGBK              J0744   00085174102   $        30.00           200 mL
   7050 PRAZIQUANTEL 600 MG PO TABS                                     00085174701   $     1,236.92           6 Each
   6747 CIPROFLOXACIN 500 MG PO TABS                                    00085175402   $       571.37           100 Each
  18492 CIPROFLOXACIN IN D5W 200 MG/100 ML IV PGBK              J0744   00085175502   $        30.00           100 mL
  31994 CIPROFLOXACIN 200 MG/20 ML IV SOLN                      J0744   00085176303   $        30.00           20 mL
   4317 CIPROFLOXACIN 250 MG/5 ML PO SUMC                               00085177701   $        30.00           100 mL
  26362 VARDENAFIL 2.5 MG PO TABS                                       00085192301   $     4,971.32           30 Each
  26366 VARDENAFIL 20 MG PO TABS                                        00085193401   $     4,971.32           30 Each
  12861 TEMOZOLOMIDE 5 MG PO CAPS                               J8700   00085300402   $       760.24           5 Each
  18977 DIDANOSINE 10 MG/ML (FINAL) PO SOLR                             00087663341   $        30.00           200 mL
  14969 DIDANOSINE 125 MG PO CPDR                                       00087667117   $     1,906.55           30 Each
  78529 DOLASETRON 100 MG/5 ML IV SOLN                          J1260   00088120632   $       415.58           5 mL
   1834 INSULIN GLARGINE 100 UNIT/ML SC SOLN                    J1815   00088222033   $        96.33           10 mL
  12268 EDETATE CALCIUM DISODIUM 200 MG/ML IJ SOLN              J0600   00089051006   $       404.88           5 mL
   7826 PANTOPRAZOLE 20 MG PO TBEC                                      00093001198   $       102.74           90 Each
   6628 LAMOTRIGINE 25 MG PO TBDP                                       00093013201   $       284.35           100 Each
   4086 VENLAFAXINE 25 MG PO TABS                                       00093019901   $       275.22           100 Each
   6253 FLUOCINONIDE 0.05 % TP OINT                                     00093026415   $        74.91           15 g
  14359 ACETAMINOPHEN-CODEINE 300-60 MG PO TABS                         00093035001   $       374.85           100 Each
  17294 LAMOTRIGINE 100 MG PO TABS                                      00093046301   $       275.22           100 Each
  11324 NITROFURANTOIN MACROCRYSTAL 100 MG PO CAPS                      00093213101   $       809.37           100 Each
   4268 CEPHALEXIN 250 MG PO TABS                                       00093223801   $       508.13           100 Each
  14183 AMOXICILLIN 250 MG PO CAPS                                      00093310793   $       149.26           100 Each
    348 AMOXICILLIN 500 MG PO CAPS                                      00093310993   $       262.65           100 Each
  16371 DICLOXACILLIN 250 MG PO CAPS                                    00093312301   $       555.90           100 Each
   3470 CEPHALEXIN 250 MG PO CAPS                                       00093314501   $       106.59           100 Each
  11112 CEPHALEXIN 250 MG/5 ML PO SUSR                                  00093417773   $        30.00           100 mL
  11112 CEPHALEXIN 250 MG/5 ML PO SUSR                                  00093417774   $        30.00           200 mL
   4285 ALENDRONATE 70 MG PO TABS                                       00093517120   $       100.65           20 Each
   8404 ALENDRONATE 35 MG PO TABS                                       00093517220   $       148.28           20 Each
   2086 RIBAVIRIN 200 MG PO CAPS                                        00093722758   $       487.22           84 Each
  24453 RIBAVIRIN 200 MG PO TABS                                        00093723281   $       761.41           168 Each
  15810 TOPIRAMATE 15 MG PO CPSP                                        00093733506   $       779.35           60 Each
  10891 VENLAFAXINE 37.5 MG PO TABS                                     00093738001   $       280.06           100 Each
  12990 VENLAFAXINE 50 MG PO TABS                                       00093738101   $       288.75           100 Each
   6869 GRANISETRON 1 MG PO TABS                                Q0166   00093748520   $       950.73           20 Each
   9499 FAMCICLOVIR 500 MG PO TABS                                      00093811956   $     3,293.73           30 Each
   7359 ACYCLOVIR 800 MG PO TABS                                        00093894793   $       819.74           100 Each
   9792 MEBENDAZOLE 100 MG PO CHEW                                      00093910729   $       591.47           12 Each
   4225 DEMECLOCYCLINE 150 MG PO TABS                                   00115211101   $     2,924.17           100 Each
  12852 DEMECLOCYCLINE 300 MG PO TABS                                   00115212214   $     2,662.37           48 Each
   7629 ACETAMINOPHEN-CODEINE 120-12 MG/5 ML PO ELIX                    00121050405   $        30.00           5 mL
   7629 ACETAMINOPHEN-CODEINE 120-12 MG/5 ML PO ELIX                    00121050416   $        30.00           473 mL
   2716 PHENOBARBITAL 20 MG/5 ML PO ELIX                                00121053105   $        30.00           5 mL
  12999 CHLORAL HYDRATE 500 MG/5 ML PO SYRP                             00121053205   $        30.00           5 mL
   5573 PROMETHAZINE-CODEINE 6.25-10 MG/5 ML PO SYRP                    00121054705   $        30.00           5 mL
   6389 DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML PO SYRP             00121063810   $        32.49           10 mL
       45 AMANTADINE 50 MG/5 ML PO SYRP                                 00121064610   $        30.00           10 mL
  41425 HYDROCODONE-ACETAMINOPHEN 7.5-500 MG/15 ML PO SOLN              00121065516   $        30.00           473 mL
  14315 CODEINE-GUAIFENESIN 10-100 MG/5 ML PO LIQD                      00121177505   $        30.00           5 mL
  14315 CODEINE-GUAIFENESIN 10-100 MG/5 ML PO LIQD                      00121177510   $        30.00           10 mL
  41449 HYDROCODONE-ACETAMINOPHEN 5-334 MG/10 ML PO SOLN                00121465510   $        30.00           10 mL
  17739 RANITIDINE HCL 15 MG/ML PO SYRP                                 00121472710   $        51.73           10 mL
  15008 THEOPHYLLINE 80 MG/15 ML PO SOLN                                00121479415   $        30.00           15 mL
  13057 HYDROCODONE-HOMATROPINE 5-1.5 MG/5 ML PO SYRP                   00121481105   $        30.00           5 mL
  79804 LACOSAMIDE 200 MG/20 ML IV SOLN                         C9254   00131181067   $       372.90           20 mL
  79426 LACOSAMIDE 50 MG PO TABS                                        00131247735   $     2,726.00           60 Each
   2324 CARBAMIDE PEROXIDE 10 % MM SOLN                                 00135009963   $        30.00           15 mL
   3649 PHENOBARBITAL 100 MG PO TABS                                    00143145801   $        39.44           100 Each
  11617 COD-BUTALBITAL-ACETAMINOP-CAF 30-50-325-40 MG PO CAPS           00143300001   $       438.94           100 Each
  41323 FOSPHENYTOIN 100 MG PE/2 ML IJ SOLN                     Q2009   00143978825   $        30.00           2 mL



                                                             288
                                                                                                                    ERx
Charge                                                          CPT                       OP/Default   IP/ED    Charge
Code                            Description                     Code        NDC             Price      Price    Quantity
   4315 CEFTRIAXONE 250 MG IJ SOLR                              J0696   00143985925   $        30.00           1 Each
  37523 ONDANSETRON HCL (PF) 4 MG/2 ML IJ SOLN                  J2405   00143989105   $        30.00           2 mL
  10814 CEPHALEXIN 500 MG PO CAPS                                       00143989701   $       417.86           100 Each
  12838 CEFOTAXIME 10 GRAM IJ SOLR                              J0698   00143993591   $       225.93           1 Each
    188 CEFUROXIME SODIUM 750 MG IJ SOLR                        J0697   00143997922   $        30.00           1 Each
  26359 EPINEPHRINE 1 MG/ML (1:1,000) IJ SOLN                           00143998490   $        30.00           30 mL
   4097 RISEDRONATE 5 MG PO TABS                                        00149047101   $     1,158.63           30 Each
  21264 RISEDRONATE 35 MG PO TABS                                       00149047201   $     1,081.19           4 Each
   7122 TRIAMCINOLONE ACETONIDE 0.1 % TP CREA                           00168000415   $        41.25           15 g
  11352 TRIAMCINOLONE ACETONIDE 0.1 % TP OINT                           00168000615   $        36.30           15 g
  11352 TRIAMCINOLONE ACETONIDE 0.1 % TP OINT                           00168000616   $       207.06           453.6 g
  11352 TRIAMCINOLONE ACETONIDE 0.1 % TP OINT                           00168000680   $        96.80           80 g
   3097 NYSTATIN 100000 UNIT/G TP OINT                                  00168000715   $        30.00           15 g
   3097 NYSTATIN 100000 UNIT/G TP OINT                                  00168000730   $        32.67           30 g
   6512 BACITRACIN ZINC 500 UNIT/G TP OINT                              00168001131   $        30.00           28.35 g
    710 HYDROCORTISONE 0.5 % TP CREA                                    00168001431   $        30.00           28.35 g
  10585 HYDROCORTISONE 1 % TP CREA                                      00168001516   $       382.47           453.6 g
   3605 HYDROCORTISONE 1 % TP OINT                                      00168002031   $        46.09           28.35 g
  25847 BACITRACIN-POLYMYXIN B 500-10,000 UNIT/G TP PACK                00168002109   $       293.47           144 Each
  15234 BACITRACIN-POLYMYXIN B 500-10,000 UNIT/G TP OINT                00168002131   $        30.00           28.35 g
  15234 BACITRACIN-POLYMYXIN B 500-10,000 UNIT/G TP OINT                00168002135   $        30.00           14.17 g
   3603 BACITRACIN 500 UNIT/G OP OINT                                   00168002638   $        65.99           3.5 g
   8531 DIBUCAINE 1 % TP OINT                                           00168004631   $        30.00           28.35 g
  11390 NYSTATIN 100000 UNIT/G TP CREA                                  00168005415   $        30.00           15 g
  13621 GENTAMICIN 0.1 % TP CREA                                        00168007115   $        30.00           15 g
  17621 GENTAMICIN 0.1 % TP OINT                                        00168007815   $        30.00           15 g
  14172 HYDROCORTISONE 2.5 % TP CREA                                    00168008016   $       392.70           453.6 g
  14172 HYDROCORTISONE 2.5 % TP CREA                                    00168008031   $        31.90           30 g
  12729 NYSTATIN-TRIAMCINOLONE 100,000-0.1 UNIT/G-% TP CREA             00168008115   $        30.00           15 g
  12729 NYSTATIN-TRIAMCINOLONE 100,000-0.1 UNIT/G-% TP CREA             00168008130   $        32.34           30 g
  16239 KETOCONAZOLE 2 % TP CREA                                        00168009930   $        58.63           30 g
  18442 CLINDAMYCIN PHOSPHATE 1 % TP LOTN                               00168020360   $        30.00           60 mL
  16543 LIDOCAINE HCL 5 % TP OINT                                       00168020437   $       185.57           35.44 g
  17168 METRONIDAZOLE 0.75 % TP GEL                                     00168027545   $        92.62           45 g
   3850 HYDROCORTISONE 1 % TP LOTN                                      00168028704   $        30.00           118 mL
  15404 TRIAMCINOLONE ACETONIDE 0.1 % TP LOTN                           00168033760   $       162.69           60 mL
  14713 MUPIROCIN 2 % TP OINT                                           00168035222   $       345.84           22 g
   7427 LIDOCAINE-PRILOCAINE 2.5-2.5 % TP CREA                          00168035730   $       170.06           30 g
   7427 LIDOCAINE-PRILOCAINE 2.5-2.5 % TP CREA                          00168035755   $        67.63           5g
  11704 INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN               J1815   00169183311   $       120.45           10 mL
  12484 NPH INSULIN HUMAN RECOMB 100 UNIT/ML SC SUSP            J1815   00169183411   $        30.00           10 mL
   5398 INSULIN NPH & REGULAR HUMAN 100 UNIT/ML (70-30) SC SUSP J1815   00169183711   $       109.40           10 mL
  34653 INSULIN DETEMIR 100 UNIT/ML SC SOLN                     J1815   00169368712   $        58.49           10 mL
                                                              J7189
  76256 COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) IV SOLR         00169701001   $ 22,610.00              1 Each
                                                              J7189
  76257 COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) IV SOLR         00169702001   $ 45,220.00              1 Each
                                                              J7189
  76258 COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) IV SOLR         00169705001   $ 113,050.00             1 Each
  18235 COAGULATION FACTOR VIIA RECOMB 1200 MCG IV SOLR         J7189   00169706001   $ 22,032.00              1 Each
  21420 COAGULATION FACTOR VIIA RECOMB 2400 MCG IV SOLR         J7189   00169706101   $ 46,512.00              1 Each
   2669 COAGULATION FACTOR VIIA RECOMB 4800 MCG IV SOLR         J7189   00169706201   $ 68,609.45              1 Each
       73 TETRACYCLINE 500 MG PO CAPS                                   00172240760   $        66.81           100 Each
   7906 TETRACYCLINE 250 MG PO CAPS                                     00172241610   $        71.06           100 Each
   6329 CIPROFLOXACIN 250 MG PO TABS                                    00172531110   $       493.51           100 Each
    631 FLUCONAZOLE 100 MG PO TABS                                      00172541110   $       183.09           100 Each
   3956 FLUCONAZOLE 200 MG PO TABS                                      00172541310   $       286.11           100 Each
   5311 CROMOLYN 20 MG/2 ML IN NEBU                             J7631   00172640649   $        30.00           2 mL
   3566 MELPHALAN 2 MG PO TABS                                  J8600   00173004535   $     5,844.60           50 Each
  17819 ZIDOVUDINE 10 MG/ML IV SOLN                             J3485   00173010793   $        30.00           20 mL
    111 ZIDOVUDINE 10 MG/ML PO SYRP                                     00173011318   $        30.00           240 mL
   8366 MELPHALAN 50 MG IV SOLR                                 J9245   00173013093   $ 27,055.67              1 Each
  11987 DIGOXIN 100 MCG/ML IJ SOLN                              J1160   00173026210   $        58.30           1 mL
  83735 RANITIDINE HCL 25 (25 MG/ML) IJ SOLN                    J2780   00173036238   $        30.00           2 mL



                                                              289
                                                                                                                  ERx
Charge                                                        CPT                       OP/Default   IP/ED    Charge
Code                           Description                    Code        NDC             Price      Price    Quantity
   7677 RANITIDINE HCL 25 MG/ML IJ SOLN                       J2780   00173036300   $       134.31           40 mL
   9894 BECLOMETHASONE DIPROP MONOHYD 42 MCG (0.042 %) NA SPRY        00173038879   $     1,047.00           25 g
  28384 CEFUROXIME-DEXTROSE (ISO-OSM) 750 MG/50 ML IV PGBK    J0697   00173042400   $        30.00           50 mL
  11087 RANITIDINE IN 1/2 NS 50 MG/50 ML IV PGBK              J2780   00173044100   $        39.37           50 mL
  16947 LAMIVUDINE 150 MG PO TABS                                     00173047001   $     6,415.97           60 Each
  14355 LAMIVUDINE 10 MG/ML PO SOLN                                   00173047100   $        30.00           240 mL
   2286 EPOPROSTENOL 0.5 MG IV SOLR                            -1     00173051700   $       397.12           1 Each
   6569 EPOPROSTENOL 1.5 MG IV SOLR                           J1325   00173051900   $       959.31           1 Each
  12639 SALMETEROL 50 MCG/DOSE IN DSDV                                00173052000   $       703.14           28 Each
  12639 SALMETEROL 50 MCG/DOSE IN DSDV                                00173052100   $     1,191.36           60 Each
  17731 ATOVAQUONE 750 MG/5 ML PO SUSP                                00173054700   $        74.04           5 mL
   3345 VALACYCLOVIR 1 G PO TABS                                      00173056504   $     5,730.87           30 Each
   8288 LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS                      00173059502   $ 27,823.15              120 Each
   7594 LAMOTRIGINE 25 MG PO TABS                                     00173063302   $     4,987.95           100 Each
   1697 LAMOTRIGINE 200 MG PO TABS                                    00173064460   $     4,078.80           60 Each
  18367 ABACAVIR 300 MG PO TABS                                       00173066101   $     8,621.55           60 Each
   2446 LAMIVUDINE 100 MG PO TABS                                     00173066200   $ 11,249.68              60 Each
    220 ZANAMIVIR 5 MG/ACTUATION IN DSDV                              00173068101   $       452.80           20 Each
  15893 ALBUTEROL SULFATE 90 MCG/ACTUATION IN HFAA                    00173068220   $       259.49           18 g
  15427 FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN DSDV                00173069500   $     1,308.48           60 Each
  15427 FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN DSDV                00173069504   $       626.08           14 Each
   1052 FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN DSDV                00173069600   $     1,534.08           60 Each
   1052 FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN DSDV                00173069604   $       626.08           14 Each
  12145 FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN DSDV                00173069702   $     1,239.39           28 Each
  12145 FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN DSDV                00173069704   $       655.87           14 Each
  18253 BUSULFAN 2 MG PO TABS                                 J8510   00173071325   $     1,606.50           25 Each
  12138 FLUTICASONE 44 MCG/ACTUATION IN AERO                          00173071820   $       786.69           10.6 g
  17637 FLUTICASONE 110 MCG/ACTUATION IN AERO                         00173071920   $     1,053.41           12 g
  14524 FLUTICASONE 220 MCG/ACTUATION IN AERO                         00173072020   $     1,636.22           12 g
  27528 FOSAMPRENAVIR 700 MG PO TABS                                  00173072100   $ 12,180.84              60 Each
  39897 FOSAMPRENAVIR 50 MG/ML PO SUSP                                00173072700   $        30.00           225 mL
   4106 SUMATRIPTAN SUCCINATE 25 MG PO TABS                           00173073500   $     2,516.88           9 Each
   5391 SUMATRIPTAN SUCCINATE 50 MG PO TABS                           00173073601   $     2,479.51           9 Each
   3451 SUMATRIPTAN SUCCINATE 100 MG PO TABS                          00173073701   $     2,479.51           9 Each
   2042 CEFUROXIME AXETIL 250 MG/5 ML PO SUSR                         00173074100   $        30.00           100 mL
   2042 CEFUROXIME AXETIL 250 MG/5 ML PO SUSR                         00173074110   $        30.00           50 mL
  38206 LAPATINIB 250 MG PO TABS                                      00173075200   $ 41,389.59              150 Each
   6714 VALACYCLOVIR 500 MG PO TABS                                   00173093356   $ 11,158.63              100 Each
   6740 SULFADIAZINE 500 MG PO TABS                                   00185075701   $     4,195.77           100 Each
   9771 RIFAMPIN 150 MG PO CAPS                                       00185080101   $     1,803.70           100 Each
  36299 LIDOCAINE (PF) 10 MG/ML (1 %) IJ SOLN                         00186011201   $        50.59           30 mL
  36299 LIDOCAINE (PF) 10 MG/ML (1 %) IJ SOLN                         00186011291   $        50.59           30 mL
   2035 LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 IJ SOLN              00186012291   $        30.00           20 mL
  14814 LIDOCAINE HCL 20 MG/ML (2 %) IJ SOLN                          00186015501   $        30.00           50 mL
  38804 BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION IN HFAA           00186037028   $       563.28           6g
  13426 BUDESONIDE 0.25 MG/2 ML IN NBSP                       J7626   00186198804   $        56.92           2 mL
  13582 BUDESONIDE 0.5 MG/2 ML IN NBSP                        J7626   00186198904   $        67.00           2 mL
  33808 ESOMEPRAZOLE SODIUM 20 MG IV SOLR                             00186602001   $        47.87           1 Each
  33809 ESOMEPRAZOLE SODIUM 40 MG INJECTION                           00186604001   $        47.87           1 Each
   8672 RIBAVIRIN 6 GRAM IN SOLR                                      00187000714   $ 286,050.84             4 Each
   3936 FLUCYTOSINE 250 MG PO CAPS                                    00187355410   $ 36,908.53              100 Each
   1945 FLUCYTOSINE 500 MG PO CAPS                                    00187355510   $ 71,418.36              100 Each
  13701 CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG PO CAPS                   00187410010   $     5,987.08           100 Each
  16424 PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR             J2543   00206885216   $       113.27           1 Each
  10292 PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR            J2543   00206885416   $       175.37           1 Each
 500188 PIPERACILLIN-TAZOBACTAM IVPB VIAL 4.5 G               J2543   00206885516   $       226.83           1 Each
   1610 PIPERACILLIN-TAZOBACTAM 40.5 GRAM IV SOLR             J2543   00206885910   $     2,343.79           1 Each
  12179 PIPERACILLIN-TAZOBACTAM-DEXTRS 2.25 GRAM/50 ML IV PGBKJ2543   00206886002   $        30.00           50 mL
                                                              J2543
  18963 PIPERACILLIN-TAZOBACTAM-DEXTRS 3.375 GRAM/50 ML IV PGBK       00206886102   $        30.00           50 mL
  18964 PIPERACILLIN-TAZOBACTAM-DEXTRS 4.5 GRAM/100 ML IV PGBKJ2543   00206886202   $        30.00           100 mL
  10156 CALCITONIN (SALMON) 200 UNIT/ACTUATION NA SPRA                00245000835   $       397.29           3.7 mL



                                                             290
                                                                                                                     ERx
Charge                                                           CPT                       OP/Default   IP/ED    Charge
Code                           Description                       Code        NDC             Price      Price   Quantity
   2266 AMMONIUM LACTATE 12 % TP LOTN                                    00245002322   $        60.94           225 g
  12273 DIVALPROEX 125 MG PO TBEC                                        00245018001   $       168.74           100 Each
  78478 DOPAMINE IN D5W 400 MG/250 ML (1,600 MCG/ML) IV SOLN    J1265    00264148255   $       112.73           250 mL
   6198 HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN                         00264196510   $       119.85           500 mL
   9359 CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV PGBK     J0690    00264310311   $        63.39           1 Each
  28384 CEFUROXIME-DEXTROSE (ISO-OSM) 750 MG/50 ML IV PGBK      J0697    00264311211   $        99.42           1 Each
  28383 CEFUROXIME-DEXTROSE (ISO-OSM) 1.5 GRAM/50 ML IV PGBK J0697       00264311411   $       184.62           1 Each
  40747 CEFOTETAN IN DEXTROSE, ISO-OSM 1 GRAM/50 ML IV PGBK              00264317311   $       229.70           1 Each
   5614 METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK             00264553532   $        30.00           100 mL
   1616 AMINO ACID (AMINOSYN) INFUSION 10 % 10 % IV SOLP                 00264934155   $        30.00           500 mL
   2709 AMINO ACID (HEPATAMINE) INFUSION 8 % 8 % IV SOLP                 00264937155   $       821.10           500 mL
   3250 DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN          Q9963    00270044535   $        30.00           30 mL
   3250 DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN          Q9963    00270044540   $        30.00           120 mL
   7208 SINCALIDE 5 MCG IJ SOLR                                 J2805    00270055615   $       767.79           1 Each
  14079 NITROGLYCERIN 2 % TD OINT                                        00281032608   $        30.00           1g
  14079 NITROGLYCERIN 2 % TD OINT                                        00281032630   $        92.73           30 g
  14079 NITROGLYCERIN 2 % TD OINT                                        00281032660   $       185.24           60 g
  32164 ETHIODIZED OIL 37 % IJ OIL                                       00281706237   $        89.97           10 mL
  23757 BENZOCAINE 20 % MM SPRA                                          00283067902   $       245.41           59.2 mL
  34331 METRONIDAZOLE 1 % TP GEL                                         00299382060   $     1,891.23           60 g
   9337 CLINDAMYCIN PHOSPHATE 1 % TP GEL                                 00299450040   $     2,195.60           40 mL
  31619 LANSOPRAZOLE 30 MG IV SOLR                                       00300395425   $       242.55           1 Each
    967 ANASTROZOLE 1 MG PO TABS                                         00310020130   $     6,481.39           30 Each
   6992 QUETIAPINE 100 MG PO TABS                                        00310027139   $     5,434.44           100 Each
   4765 QUETIAPINE 200 MG PO TABS                                        00310027239   $     9,935.42           100 Each
   2029 QUETIAPINE 300 MG PO TABS                                        00310027439   $ 12,749.66              100 Each
    123 QUETIAPINE 25 MG PO TABS                                         00310027539   $     3,248.63           100 Each
  35696 QUETIAPINE 50 MG PO TABS                                         00310027839   $     5,338.08           100 Each
  15572 PROPOFOL 10 MG/ML IV EMUL                                        00310030050   $        37.29           50 mL
  15572 PROPOFOL 10 MG/ML IV EMUL                                        00310030064   $        30.00           20 mL
  11691 MEROPENEM 1 GRAM IV SOLR                                J2185    00310032130   $       453.08           1 Each
  21201 FULVESTRANT 125 MG/2.5 IM SYRG                          J9395    00310072025   $     2,722.52           2.5 mL
  21200 FULVESTRANT 250 MG/5 ML IM SYRG                         J9395    00310072050   $     2,722.52           5 mL
  26269 ROSUVASTATIN 10 MG PO TABS                                       00310075190   $     4,175.33           90 Each
  26270 ROSUVASTATIN 20 MG PO TABS                                       00310075290   $     4,175.33           90 Each
  26268 ROSUVASTATIN 5 MG PO TABS                                        00310075590   $     4,175.33           90 Each
  17891 SODIUM CHLORIDE 3 % 3 % IV SOLP                                  00338005403   $        30.00           500 mL
  36311 LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV SOLP           J2001    00338040903   $        30.00           500 mL
  41080 AMINO ACID (CLINISOL) 15% NO.1 15 % IV SOLP                      00338050206   $       594.00           2000 mL
  37767 GENTAMICIN IN NACL (ISO-OSM) 60 MG/50 ML IV PGBK        J1580    00338050741   $        30.00           50 mL
  27683 GENTAMICIN IN NACL (ISO-OSM) 120 MG/100 ML IV PGBK               00338050748   $        30.00           100 mL
  25390 1/2 NS WITH POTASSIUM CHLORIDE 20 MEQ/L IV SOLP         J3480    00338070434   $        38.03           1000 mL
   9707 POTASSIUM CHLORIDE 20 MEQ/100 ML IV PGBK                J3480    00338070548   $        30.00           100 mL
  12352 D5-LR WITH POTASSIUM CHLORIDE 20 MEQ/L IV SOLP          J3480    00338081104   $        47.72           1000 mL
   9344 PENICILLIN G POT IN DEXTROSE 3 MILLION UNIT/50 ML IV PGBKJ2540   00338102541   $       162.18           50 mL
  41635 AMINO ACID (PREMASOL) 10% NO.7 IV SOLP                           00338113003   $        30.00           500 mL
  41635 AMINO ACID (PREMASOL) 10% NO.7 IV SOLP                           00338113004   $        30.00           1000 mL
  17566 ETOPOSIDE 50 MG PO CAPS                                 J8560    00378326694   $ 17,192.44              20 Each
   9085 ESTRADIOL 0.025 MG/24 HR TD PTWK                                 00378334999   $       395.45           4 Each
   4327 ESTRADIOL 0.05 MG/24 HR TD PTWK                                  00378335099   $       354.86           4 Each
  17327 ESTRADIOL 0.1 MG/24 HR TD PTWK                                   00378335299   $       354.86           4 Each
  14381 OXYCODONE-ACETAMINOPHEN 2.5-325 MG PO TABS                       00378710301   $     2,635.00           100 Each
  12962 LANSOPRAZOLE 15 MG PO CPDR                                       00378801593   $       586.74           30 Each
  34041 FENTANYL 12 MCG/HR TD PT72                                       00378911998   $       789.48           5 Each
  38591 ETHYL CHLORIDE 100 % TP SPRA                                     00386000103   $       276.98           103.5 mL
  32711 NORFLURANE-HFC 245FA TP SPRA                                     00386000404   $       293.04           103.5 mL
   1539 IODINE STRONG (LUGOLS) 5 % PO SOLN                               00395277516   $       377.22           473 mL
  10760 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS                     00406036662   $       403.24           100 Each
   6799 HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS                      00406036762   $       474.81           100 Each
   6036 ACETAMINOPHEN-CODEINE 300-15 MG PO TABS                          00406048301   $       227.63           100 Each
   6262 ACETAMINOPHEN-CODEINE 300-30 MG PO TABS                          00406048462   $       223.04           100 Each



                                                               291
                                                                                                                   ERx
Charge                                                            CPT                       OP/Default   IP/ED    Charge
Code                            Description                       Code        NDC             Price      Price   Quantity
   8500 OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS                          00406051262   $       153.51           100 Each
  15699 OXYCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS                        00406052262   $       886.55           100 Each
  18305 OXYCODONE 5 MG PO TABS                                            00406055262   $       172.89           100 Each
   4232 METHYLPHENIDATE 5 MG PO TABS                                      00406112101   $       105.57           100 Each
   8925 HYDROMORPHONE 2 MG PO TABS                                        00406324301   $       112.20           100 Each
   4210 HYDROMORPHONE 8 MG PO TABS                                        00406324901   $       642.26           100 Each
   7669 OXYCODONE 15 MG PO TABS                                           00406851501   $       241.91           100 Each
  15123 OXYCODONE 30 MG PO TABS                                           00406853001   $       412.59           100 Each
   7329 TEMAZEPAM 7.5 MG PO CAPS                                          00406991501   $ 16,146.77              100 Each
   1956 PENTOSTATIN 10 MG IV SOLR                                 J9268   00409080101   $ 14,984.48              1 Each
  76261 MEPIVACAINE (PF) 10 MG/ML (1 %) IJ SOLN                   J0670   00409103630   $        40.81           30 mL
  76259 MEPIVACAINE (PF) 20 MG/ML (2 %) IJ SOLN                   J0670   00409106720   $        36.85           20 mL
   8781 CODEINE PHOSPHATE 30 MG/ML IJ SYRG                        J0745   00409110232   $        35.90           2 mL
  25384 MORPHINE (PF) 25 MG/ML IJ SOLN                            J2275   00409113502   $        30.00           10 mL
  18087 SODIUM CHLORIDE 4 MEQ/ML IV SOLP                                  00409114102   $        30.00           100 mL
  13932 VERAPAMIL 2.5 MG/ML IV SOLN                                       00409114401   $        30.00           2 mL
   9489 HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML IV SOLN           J1642   00409115170   $        30.00           10 mL
  25324 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) IJ SOLN                       00409115901   $        30.00           10 mL
  34944 MEPERIDINE (PF) 50 MG/ML IJ SYRG                          J2175   00409117830   $        30.00           1 mL
  34948 MEPERIDINE (PF) 100 MG/ML IJ SYRG                         J2175   00409118069   $        30.00           1 mL
  15777 GENTAMICIN 40 MG/ML IJ SOLN                               J1580   00409120703   $        30.00           2 mL
   3697 NALOXONE 0.4 MG/ML IJ SOLN                                        00409121201   $        30.00           1 mL
  34936 MEPERIDINE (PF) 50 MG/ML IJ SOLN                          J2175   00409125301   $        30.00           1 mL
  34938 MEPERIDINE (PF) 75 MG/1.5 ML IJ SOLN                      J2175   00409125401   $        30.00           1.5 mL
  34947 MEPERIDINE (PF) 100 MG/ML IJ SOLN                         J2175   00409125601   $        30.00           1 mL
  22975 MORPHINE 4 MG/ML IJ SYRG                                  J2270   00409125830   $        30.00           1 mL
  22953 MORPHINE 10 MG/ML IJ SYRG                                 J2270   00409126130   $        30.00           1 mL
  22821 DIAZEPAM 5 MG/ML IJ SYRG                                  J3360   00409127332   $        30.00           2 mL
  39278 HYDROMORPHONE (PF) 4 MG/ML IJ SYRG                        J1170   00409130431   $        30.00           1 mL
  39281 HYDROMORPHONE (PF) 2 MG/ML IJ SYRG                        J1170   00409131230   $        30.00           1 mL
  35739 HEPARIN, PORCINE (PF) 5000 UNIT/0.5 ML IJ SYRG            J1644   00409131632   $        82.99           .5 mL
    794 ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN                               00409141005   $        31.65           5 mL
  14835 BUMETANIDE 0.25 MG/ML IJ SOLN                                     00409141210   $        30.00           10 mL
  10578 NALBUPHINE 10 MG/ML IJ SOLN                               J2300   00409146301   $        30.00           1 mL
  10578 NALBUPHINE 10 MG/ML IJ SOLN                               J2300   00409146401   $        30.00           10 mL
   8250 NITROGLYCERIN IN D5W 50 MG/250 ML (0.2 MG/ML) IV SOLN             00409148202   $        37.40           250 mL
  78484 NITROGLYCERIN IN D5W 100 MG/250 ML (0.4 MG/ML) IV SOLN            00409148402   $        30.00           250 mL
  26051 POTASSIUM CHLORIDE 2 MEQ/ML IV SOLP                       J3480   00409151302   $        52.85           250 mL
   3483 HETASTARCH IN LACT ELECTROLYTE 6 % IV SOLN                        00409155554   $       305.80           500 mL
  25326 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IJ SOLN                       00409158210   $        30.00           10 mL
  25326 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IJ SOLN                       00409158229   $        37.72           30 mL
  22775 TROMETHAMINE 36 MG/ML IV SOLP                                     00409159304   $     1,948.73           500 mL
   7752 SODIUM BICARBONATE 5 % IV SOLP                                    00409159403   $        30.00           500 mL
  12070 DEXMEDETOMIDINE 200 MCG/2 ML IV SOLN                              00409163802   $       354.64           2 mL
    371 BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 IJ SOLN                  00409175250   $        45.32           50 mL
  25331 BUPIVACAINE-DEXTROSE-WATER(PF) 7.5 MG/ML (0.75 %) IJ SOLN         00409176102   $        30.00           2 mL
  22955 MORPHINE IJ SYRG                                          J2270   00409176230   $        30.00           1 mL
   1556 PROCAINE 10 % IJ SOLN                                             00409181002   $        30.00           2 mL
  11121 TETRACAINE HCL 1 % IJ SOLN                                        00409184602   $        30.00           2 mL
  17141 TETRACAINE HCL 2 % TP SOLN                                        00409186601   $       149.60           30 mL
   6824 PROCAINAMIDE 100 MG/ML IJ SOLN                            J2690   00409190201   $        30.00           10 mL
   4351 PROCAINAMIDE 500 MG/ML IJ SOLN                            J2690   00409190301   $        40.06           2 mL
       53 PENTAZOCINE LACTATE 30 MG/ML IJ SOLN                    J3070   00409194101   $       175.37           1 mL
  74877 AMIKACIN 500 MG/2 ML IJ SOLN                                      00409195601   $        30.00           2 mL
   3926 LORAZEPAM 2 MG/ML IJ SOLN                                 J2060   00409198510   $        30.00           10 mL
  76266 MORPHINE (PF) 30 MG/30 ML IV PCAS                         J2275   00409202902   $        30.00           30 mL
  36300 LIDOCAINE (PF) 20 MG/ML (2 %) IJ SOLN                             00409206605   $        30.00           5 mL
   3821 MAGNESIUM SULFATE 50 % (4 MEQ/ML) IJ SOLN                 J3475   00409216803   $        30.00           50 mL
  39283 HYDROMORPHONE (PF) 10 MG/ML IJ SOLN                       J1170   00409217201   $        30.00           1 mL
  39283 HYDROMORPHONE (PF) 10 MG/ML IJ SOLN                       J1170   00409217205   $       126.63           5 mL
   1296 DESMOPRESSIN 4 MCG/ML IJ SOLN                             J2597   00409226501   $        52.00           1 mL



                                                                 292
                                                                                                                   ERx
Charge                                                            CPT                       OP/Default   IP/ED    Charge
Code                           Description                        Code        NDC             Price      Price   Quantity
   8098 ALFENTANIL 500 MCG/ML IJ SOLN                                     00409226605   $        30.00           5 mL
  16303 LABETALOL 5 MG/ML IV SOLN                                         00409226720   $        30.00           20 mL
  16303 LABETALOL 5 MG/ML IV SOLN                                         00409226754   $        30.00           40 mL
   8767 FENOLDOPAM 10 MG/ML IV SOLN                                       00409230402   $       520.19           2 mL
  18343 MIDAZOLAM 1 MG/ML IJ SOLN (PF)                            J2250   00409230502   $        30.00           2 mL
  18343 MIDAZOLAM 1 MG/ML IJ SOLN (PF)                            J2250   00409230505   $        30.00           5 mL
  18343 MIDAZOLAM 1 MG/ML IJ SOLN (PF)                            J2250   00409230549   $        30.00           2 mL
  18343 MIDAZOLAM 1 MG/ML IJ SOLN (PF)                            J2250   00409230550   $        30.00           5 mL
   3596 DEFEROXAMINE 500 MG IJ SOLR                               J0895   00409233610   $        64.99           1 Each
    726 DEFEROXAMINE 2 GRAM IJ SOLR                               J0895   00409233725   $       263.40           1 Each
  22958 PHENOBARBITAL SODIUM 60 MG/ML IJ SYRG                     J2560   00409234331   $        43.96           1 mL
  78467 DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) IV SOLN              J1250   00409234401   $        30.00           20 mL
  78470 DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP         J1250   00409234632   $        41.34           250 mL
   9050 DOBUTAMINE IN D5W 500 MG/250 ML (2,000 MCG/ML) IV SOLP    J1250   00409234732   $       100.47           250 mL
  22956 PHENOBARBITAL SODIUM 130 MG/ML IJ SYRG                    J2560   00409234931   $        59.45           1 mL
  12630 HYDROMORPHONE (PF) 4 MG/ML IJ SOLN                        J1170   00409254001   $        30.00           1 mL
   5738 MIDAZOLAM 5 MG/ML IJ SOLN                                 J2250   00409259605   $        30.00           10 mL
   5738 MIDAZOLAM 5 MG/ML IJ SOLN                                 J2250   00409259653   $        30.00           10 mL
  76425 MILRINONE IN D5W 20 MG/100 ML IV PGBK                     J2260   00409277623   $       114.00           100 mL
  14718 NITROPRUSSIDE 25 MG/ML IV SOLN                                    00409302401   $       139.06           2 mL
  17048 EPHEDRINE SULFATE 50 MG/ML IJ SOLN                                00409307331   $        30.00           1 mL
   4191 LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 IJ SOLN                     00409317701   $        30.00           50 mL
   8575 LIDOCAINE-EPINEPHRINE 1 %-1:100,000 IJ SOLN                       00409317801   $        30.00           20 mL
   8575 LIDOCAINE-EPINEPHRINE 1 %-1:100,000 IJ SOLN                       00409317802   $        30.00           30 mL
  16510 LIDOCAINE-EPINEPHRINE 2 %-1:100,000 IJ SOLN                       00409318203   $        30.00           50 mL
   3304 POTASSIUM ACETATE 2 MEQ/ML IV SOLN                                00409329406   $        30.00           100 mL
  13033 ACETYLCYSTEINE 10 % (100 MG/ML) MISC SOLN                 J7608   00409330703   $        30.00           30 mL
    939 ACETYLCYSTEINE 20 % (200 MG/ML) MISC SOLN                 J7608   00409330803   $        30.00           30 mL
   3220 THIOPENTAL SODIUM 500 MG IV SOLR                                  00409332901   $       523.63           1 Each
  38838 HYDROMORPHONE IJ SOLN                                     J1170   00409336501   $        30.00           1 mL
   9179 SUFENTANIL CITRATE 50 MCG/ML IV SOLN                              00409338049   $        33.42           1 mL
   1677 METOCLOPRAMIDE 5 MG/ML IJ SOLN                            J2765   00409341401   $        30.00           2 mL
  13831 TOBRAMYCIN IN NS 60 MG/50 ML IV PGBK                      J3260   00409346913   $        30.00           50 mL
   2199 TOBRAMYCIN IN NS 80 MG/100 ML IV PGBK                     J3260   00409347023   $        97.07           100 mL
   7236 KETOROLAC 30 MG/ML (1 ML) IJ SOLN                         J1885   00409379501   $        30.00           1 mL
  15996 KETOROLAC 60 MG/2 ML IM SOLN                              J1885   00409379601   $        30.00           2 mL
  17640 MORPHINE (PF) 0.5 MG/ML IJ SOLN                           J2275   00409381412   $        30.00           10 mL
  11042 FOSCARNET 24 MG/ML IV SOLN                                J1455   00409386302   $        30.00           250 mL
  11042 FOSCARNET 24 MG/ML IV SOLN                                J1455   00409386305   $     2,198.58           500 mL
    561 MANNITOL 25 % 25 % IV SOLN                                J2150   00409403101   $        30.00           50 mL
    486 CLINDAMYCIN PHOSPHATE 150 MG/ML IJ SOLN                           00409405101   $        30.00           4 mL
  35133 CLINDAMYCIN PHOSPHATE 600 MG/4 ML IV SOLN                         00409405403   $        30.00           4 mL
  35145 CLINDAMYCIN PHOSPHATE 900 MG/6 ML IV SOLN                         00409405503   $        30.00           6 mL
   7048 MORPHINE (PF) 1 MG/ML IJ SOLN                             J2275   00409405812   $        30.00           10 mL
  11888 CHLOROPROCAINE (PF) 30 MG/ML (3 %) IJ SOLN                J2400   00409417001   $        30.00           30 mL
  41357 PARENTERAL AMINO ACID 5% NO.1 5 % IV SOLP                         00409418103   $        30.00           500 mL
  41359 PARENTERAL AMINO ACID 8.5% NO2 8.5 % IV SOLP                      00409418703   $        84.13           500 mL
  41148 PARENTERAL AMINO ACID 10% NO.2 10 % IV SOLP                       00409419103   $       131.39           500 mL
  16864 AMINO ACIDS 8.5 %-ELECTROLYTES 8.5 % IV SOLP                      00409420303   $        95.68           500 mL
   8182 DOPAMINE 80 MG/ML IV SOLN                                 J1265   00409426501   $        30.00           10 mL
  25324 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) IJ SOLN                       00409427201   $        30.00           20 mL
  11186 LIDOCAINE HCL 5 MG/ML (0.5 %) IJ SOLN                             00409427501   $        30.00           50 mL
    949 LIDOCAINE HCL 10 MG/ML (1 %) IJ SOLN                              00409427602   $        30.00           50 mL
  36302 LIDOCAINE (PF) 5 MG/ML (0.5 %) IJ SOLN                            00409427801   $        30.00           50 mL
  36300 LIDOCAINE (PF) 20 MG/ML (2 %) IJ SOLN                             00409428201   $        30.00           2 mL
  36300 LIDOCAINE (PF) 20 MG/ML (2 %) IJ SOLN                             00409428202   $        30.00           10 mL
  36297 LIDOCAINE (PF) 40 MG/ML (4 %) IJ SOLN                             00409428301   $        30.00           5 mL
  13700 VANCOMYCIN 500 MG IV SOLR                                 J3370   00409433201   $        36.40           1 Each
   8117 AMINOCAPROIC ACID 250 MG/ML IV SOLN                               00409434673   $        30.00           20 mL
   5559 DILTIAZEM HCL 100 MG IV SOLR                                      00409435003   $        74.37           1 Each
  34971 PANCURONIUM 1 MG/ML IV SOLN                                       00409464601   $        30.00           10 mL



                                                                 293
                                                                                                                   ERx
Charge                                                            CPT                       OP/Default   IP/ED    Charge
Code                           Description                        Code        NDC             Price      Price   Quantity
   8181 FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK       J1450   00409468823   $        30.00           100 mL
  36856 LIDOCAINE HCL 4 % TP SOLN                                         00409469801   $        30.00           4 mL
  36299 LIDOCAINE (PF) 10 MG/ML (1 %) IJ SOLN                             00409471302   $        30.00           5 mL
  36299 LIDOCAINE (PF) 10 MG/ML (1 %) IJ SOLN                             00409471332   $        30.00           2 mL
  22680 DEXTROSE 50% IN WATER (D50W) IV SYRG                              00409490234   $        58.18           50 mL
  36304 LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG                          00409490334   $        30.00           5 mL
  11677 ATROPINE 0.1 MG/ML IJ SYRG                                J0461   00409491134   $        30.00           10 mL
  12301 EPINEPHRINE HCL 0.1 MG/ML IJ SYRG                         J0171   00409492134   $        30.00           10 mL
  22090 CALCIUM CHLORIDE 10 % (100 MG/ML) IV SYRG                         00409492834   $        30.00           10 mL
  15481 CEFTAZIDIME 1 GRAM IJ SOLR                                J0713   00409508216   $        51.05           1 Each
   4386 CEFTAZIDIME 2 GRAM IJ SOLR                                J0713   00409508411   $       121.86           1 Each
  22905 SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG                     00409553434   $        30.00           10 mL
  24434 METHYLPREDNISOLONE SODIUM SUCC 125 MG/2 ML IJ SOLR        J2930   00409568502   $        35.41           1 Each
  24434 METHYLPREDNISOLONE SODIUM SUCC 125 MG/2 ML IJ SOLR        J2930   00409568523   $        35.41           1 Each
  78473 DOPAMINE 200 MG/5 ML (40 MG/ML) IV SOLN                   J1265   00409582001   $        30.00           5 mL
  26317 AMINOPHYLLINE 250 MG/10 ML IV SOLN                        J0280   00409592101   $        30.00           10 mL
  26318 AMINOPHYLLINE 500 MG/20 ML IV SOLN                        J0280   00409592201   $        30.00           20 mL
    615 FUROSEMIDE 10 MG/ML IJ SOLN                               J1940   00409610210   $        43.67           10 mL
  13235 ACETIC ACID 0.25 % IR SOLN                                        00409614309   $        30.00           1000 mL
  11333 ERYTHROMYCIN LACTOBIONATE 1000 MG IV SOLR                 J1364   00409647844   $       153.14           1 Each
   7713 ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR                  J1364   00409648201   $       153.14           1 Each
   6010 VANCOMYCIN 5 GRAM IV SOLR                                 J3370   00409650949   $       342.38           1 Each
   6969 VANCOMYCIN 1000 MG IV SOLR                                J3370   00409653549   $        76.25           1 Each
  14478 SODIUM BICARBONATE 4 % IV SOLN                                    00409660902   $        30.00           5 mL
   7854 SODIUM BICARBONATE 8.4 % IV SOLN                                  00409662502   $        30.00           50 mL
  22906 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG                       00409663734   $        30.00           50 mL
  26051 POTASSIUM CHLORIDE 2 MEQ/ML IV SOLP                       J3480   00409665106   $        30.00           10 mL
  26051 POTASSIUM CHLORIDE 2 MEQ/ML IV SOLP                       J3480   00409665305   $        30.00           20 mL
   9360 ETOMIDATE 2 MG/ML IV SOLN                                         00409669501   $        30.00           10 mL
   9360 ETOMIDATE 2 MG/ML IV SOLN                                         00409669502   $        30.00           20 mL
  41043 MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IV PGBK            J3475   00409672723   $        30.00           100 mL
  40724 MAGNESIUM SULFATE 4 GRAM/100 ML IV PGBK                   J3475   00409672923   $        30.00           100 mL
   3926 LORAZEPAM 2 MG/ML IJ SOLN                                 J2060   00409678002   $        30.00           10 mL
   8993 POTASSIUM CHLORIDE 10 MEQ/100 ML IV PGBK                  J3480   00409707426   $        35.07           100 mL
   8235 POTASSIUM CHLORIDE 10 MEQ/50 ML IV PGBK                   J3480   00409707514   $        35.56           50 mL
  14795 POTASSIUM CHLORIDE 20 MEQ/50 ML IV PGBK                   J3480   00409707714   $        35.56           50 mL
   9514 POTASSIUM CHLORIDE 40 MEQ/100 ML IV PGBK                  J3480   00409707726   $        35.24           100 mL
   4482 D5-NS WITH POTASSIUM CHLORIDE 20 MEQ/L IV SOLP            J3480   00409710709   $        30.00           1000 mL
  12678 NS WITH POTASSIUM CHLORIDE 20 MEQ/L IV SOLP               J3480   00409711509   $        30.00           1000 mL
  40856 AMINO ACID (AMINOSYN) 15% NO.2 15 % IV SOLP                       00409712207   $       474.90           2000 mL
   1733 POTASSIUM PHOSPHATE DIBASIC 3 MMOLE/ML IV SOLP                    00409729501   $        30.00           15 mL
   1733 POTASSIUM PHOSPHATE DIBASIC 3 MMOLE/ML IV SOLP                    00409729601   $        30.00           5 mL
   3321 SODIUM ACETATE 2 MEQ/ML IV SOLN                                   00409729973   $        30.00           20 mL
   6776 CEFTRIAXONE 1 GRAM IV SOLR                                J0696   00409733304   $        58.62           1 Each
  15833 SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN                               00409739172   $        30.00           15 mL
  16382 DEXTRAN 40 10% IN D5W 10 % IV SOLP                        J7100   00409741803   $        30.00           500 mL
   8668 DEXTRAN 40 IN 0.9 % NACL 10 % IV SOLP                     J7100   00409741903   $       214.50           500 mL
  76561 HEPARIN (PORCINE) IN NS (PF) 1000 UNIT/500 ML IV SOLP     J1644   00409762003   $        43.64           500 mL
  35873 HEPARIN (PORCINE)-0.45% NACL 25000 UNIT/250 ML IV SOLP    J1644   00409765062   $        75.74           250 mL
  15455 MANNITOL 20 % 20 % IV SOLP                                        00409771503   $       106.70           500 mL
  35720 HEPARIN (PORCINE) IN D5W 25000 UNIT/250 ML IV SOLP        J1644   00409779362   $        92.21           250 mL
  78477 DOPAMINE IN D5W 800 MG/250 ML (3,200 MCG/ML) IV SOLN      J1265   00409781022   $        99.09           250 mL
  37769 GENTAMICIN IN NACL (ISO-OSM) 80 MG/50 ML IV PGBK          J1580   00409788313   $        30.00           50 mL
  37770 GENTAMICIN IN NACL (ISO-OSM) 80 MG/100 ML IV PGBK         J1580   00409788423   $        71.57           100 mL
  37772 GENTAMICIN IN NACL (ISO-OSM) 100 MG/100 ML IV PGBK        J1580   00409788923   $        71.57           100 mL
  13178 D5-1/4 NS & POTASSIUM CHLORIDE 20 MEQ/L IV SOLP           J3480   00409790109   $        30.00           1000 mL
   8027 D5-1/2 NS & POTASSIUM CHLORIDE 20 MEQ/L IV SOLP           J3480   00409790209   $        30.00           1000 mL
   1843 D5-1/2 NS & POTASSIUM CHLORIDE 30 MEQ/L IV SOLP           J3480   00409790309   $        30.00           1000 mL
   2338 D5-1/2 NS & POTASSIUM CHLORIDE 40 MEQ/L IV SOLP           J3480   00409790409   $        30.00           1000 mL
    681 D5W WITH POTASSIUM CHLORIDE 20 MEQ/L IV SOLP              J3480   00409790509   $        30.00           1000 mL
  36311 LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV SOLP             J2001   00409793132   $        30.00           250 mL



                                                                 294
                                                                                                                   ERx
Charge                                                           CPT                       OP/Default   IP/ED    Charge
Code                            Description                      Code        NDC             Price      Price    Quantity
   5493 CARDIOPLEGIC SOLN 16 MEQ/L (= K+) PF SOLN                        00409796905   $       327.80           1000 mL
  15119 D5-1/4 NS & POTASSIUM CHLORIDE 40 MEQ/L IV SOLP          J3480   00409799209   $        30.00           1000 mL
   4466 D5-1/2 NS & POTASSIUM CHLORIDE 10 MEQ/L IV SOLP          J3480   00409799309   $        30.00           1000 mL
   9360 ETOMIDATE 2 MG/ML IV SOLN                                        00409806101   $        30.00           20 mL
   3304 POTASSIUM ACETATE 2 MEQ/ML IV SOLN                               00409818301   $        30.00           20 mL
  25323 BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 IJ SOLN            00409904202   $        30.00           30 mL
  12876 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN                  J3010   00409909332   $        30.00           2 mL
  12876 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN                  J3010   00409909335   $        30.00           5 mL
  12876 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN                  J3010   00409909336   $        30.00           10 mL
  12876 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN                  J3010   00409909338   $        30.00           20 mL
   2525 PHYTONADIONE 1 MG/0.5 ML IJ SOLN                         J3430   00409915701   $        73.10           .5 mL
   2444 PHYTONADIONE 10 MG/ML IJ SOLN                            J3430   00409915801   $        75.22           1 mL
   5952 ROCURONIUM 10 MG/ML IV SOLN                                      00409955849   $        30.00           5 mL
  17996 ATROPINE 0.05 MG/ML IJ SYRG                              J0461   00409963005   $        30.00           5 mL
   2072 FAT EMULSION 20 % IV EMUL                                        00409979102   $       121.02           250 mL
   2072 FAT EMULSION 20 % IV EMUL                                        00409979103   $       148.04           500 mL
 400734 DAKINS SOLUTION 1/4 STRENGTH                                     00436067216   $       166.21           473 mL
  19008 SODIUM HYPOCHLORITE 0.25 % MISC SOLN                             00436093616   $       154.36           473 mL
  19009 SODIUM HYPOCHLORITE 0.5 % MISC SOLN                              00436094616   $       154.36           473 mL
  41061 NEBIVOLOL 2.5 MG PO TABS                                         00456140230   $       551.10           30 Each
  25851 INHALATIONAL SPACING DEVICE MISC SPCR                            00456315467   $       319.80           1 Each
  12694 DINOPROSTONE 10 MG VA INSR                                       00456412363   $     2,217.27           1 Each
  18173 TACROLIMUS 0.5 MG PO CAPS                                J7507   00469060773   $     2,111.78           100 Each
  17023 TACROLIMUS 1 MG PO CAPS                                  J7507   00469061711   $     4,223.45           100 Each
   4412 TACROLIMUS 5 MG PO CAPS                                  J7507   00469065711   $ 21,117.47              100 Each
   5489 ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN                   J0152   00469087120   $       100.25           20 mL
   5489 ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN                   J0152   00469087130   $       100.34           30 mL
  35607 CONIVAPTAN 20 MG/4 ML IV SOLN                                    00469160104   $     1,152.27           4 mL
  79537 CONIVAPTAN IN D5W 20 MG/100 ML IV SOLN                           00469160210   $     6,094.66           100 mL
   8321 TACROLIMUS 5 MG/ML IV SOLN                               J7525   00469301601   $     1,455.63           1 mL
  16430 AMPHOTERICIN B LIPOSOME 50 MG IV SUSR                    J0289   00469305130   $     2,577.03           1 Each
  37499 MICAFUNGIN 100 MG IV SOLR                                J2248   00469321110   $     3,070.88           1 Each
  12073 TACROLIMUS 0.03 % TP OINT                                        00469520130   $     1,294.92           30 g
  12073 TACROLIMUS 0.03 % TP OINT                                        00469520160   $     2,590.06           60 g
  10995 TACROLIMUS 0.1 % TP OINT                                         00469520230   $     1,294.92           30 g
  41976 REGADENOSON 0.4 MG/5 ML IV SYRG                          J2785   00469650189   $       426.18           5 mL
  21824 ADENOSINE 3 MG/ML IV SYRG                                J0150   00469823412   $       383.90           2 mL
   5318 PERMETHRIN 5 % TP CREA                                           00472024260   $       107.25           60 g
   9879 HYDROCORTISONE-ACETIC ACID 1-2 % OT DROP                         00472088282   $     2,140.60           10 mL
   1667 MICONAZOLE NITRATE 100 MG VA SUPP                                00472173607   $       134.30           7 Each
  31606 RACEPINEPHRINE 2.25 % IN NEBU                                    00487590199   $        30.00           1 Each
  17582 IPRATROPIUM BROMIDE 0.02 % IN SOLN                       J7644   00487980125   $        30.00           2.5 mL
  31607 ALBUTEROL SULFATE 2.5 MG/0.5 ML IN NEBU                  J7611   00487990130   $        30.00           1 Each
  17960 HYDROCORTISONE-PRAMOXINE 1-1 % PR CREA                           00496077804   $       672.65           30 g
   4828 LIDOCAINE 4 % TP CREA                                            00496088230   $       378.51           30 g
  16012 BACITRACIN-POLYMYXIN B 500-10,000 UNIT/G TP POWD                 00501379310   $        99.44           10 g
  33011 PRAMOXINE-MINERAL OIL-ZINC 1-12.5 % PR OINT                      00501410401   $        30.00           28.3 g
  17096 DEXPANTHENOL 250 MG/ML IJ SOLN                                   00517013125   $        30.00           2 mL
  13213 CALCITRIOL 1 MCG/ML IV SOLN                              J0636   00517013225   $        36.22           1 mL
  14862 PHENYLEPHRINE HCL 10 MG/ML IJ SOLN                       J2370   00517029925   $        30.32           1 mL
  12118 METHYLENE BLUE (ANTIDOTE) 1 % IJ SOLN                            00517030110   $        30.15           1 mL
  14625 ATROPINE 0.4 MG/ML IJ SOLN                               J0461   00517040125   $        30.00           1 mL
  74533 TORSEMIDE 20 MG/2 ML (10 MG/ML) IV SOLN                          00517077010   $        71.92           2 mL
   7266 HYDRALAZINE 20 MG/ML IJ SOLN                             J0360   00517090125   $        48.69           1 mL
   1745 ATROPINE 1 MG/ML IJ SOLN                                 J0461   00517101025   $        30.00           1 mL
  11274 VASOPRESSIN 20 UNIT/ML IJ SOLN                                   00517102025   $        30.00           1 mL
  37766 EPINEPHRINE (PF) 1 MG/ML (1:1,000) IJ SOLN               J0171   00517107125   $        30.00           1 mL
  26359 EPINEPHRINE 1 MG/ML (1:1,000) IJ SOLN                            00517113005   $        30.00           30 mL
   7854 SODIUM BICARBONATE 8.4 % IV SOLN                                 00517155025   $        30.00           50 mL
   8182 DOPAMINE 80 MG/ML IV SOLN                                J1265   00517190525   $        30.00           5 mL
   1733 POTASSIUM PHOSPHATE DIBASIC 3 MMOLE/ML IV SOLP                   00517230525   $        30.00           5 mL



                                                                295
                                                                                                                 ERx
Charge                                                           CPT                      OP/Default   IP/ED    Charge
 Code                          Description                      Code        NDC             Price      Price   Quantity
   1733 POTASSIUM PHOSPHATE DIBASIC 3 MMOLE/ML IV SOLP                  00517231525   $        30.00           15 mL
  12100 IRON SUCROSE 100 MG/5 ML IV SOLN                        J1756   00517234010   $       197.60           5 mL
   1733 POTASSIUM PHOSPHATE DIBASIC 3 MMOLE/ML IV SOLP                  00517235025   $        30.00           50 mL
   3304 POTASSIUM ACETATE 2 MEQ/ML IV SOLN                              00517240025   $        30.00           100 mL
                                                                      00517250210
   8352 CAFFEINE-SODIUM BENZOATE 250 MG/ML (125 MG/ML CAFFEINE) IJ SOLN               $        31.44           2 mL
4.08E+09 MAGNESIUM SULFATE 50 % (4 MEQ/ML) IJ SOLN              J3475   00517260225   $        30.00           2 mL
4.08E+09 MAGNESIUM SULFATE 50 % (4 MEQ/ML) IJ SOLN              J3475   00517261025   $        30.00           10 mL
4.08E+09 MAGNESIUM SULFATE 50 % (4 MEQ/ML) IJ SOLN              J3475   00517265025   $        30.00           50 mL
   9301 CALCIUM CHLORIDE 10 % IV SOLN                                   00517271025   $        30.00           10 mL
  18087 SODIUM CHLORIDE 4 MEQ/ML IV SOLP                                00517290025   $        30.00           100 mL
  18087 SODIUM CHLORIDE 4 MEQ/ML IV SOLP                                00517293025   $        30.00           30 mL
  15833 SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN                             00517340525   $        30.00           5 mL
  15833 SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN                             00517345025   $        30.00           50 mL
   9516 CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN               J0610   00517390025   $        30.00           100 mL
   9516 CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN               J0610   00517391025   $        30.00           10 mL
   9516 CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN               J0610   00517395025   $        30.00           50 mL
  17181 PAPAVERINE 30 MG/ML IJ SOLN                             J2440   00517401001   $        30.00           10 mL
   2523 GLYCOPYRROLATE 0.2 MG/ML IJ SOLN                                00517460125   $        30.00           1 mL
   2523 GLYCOPYRROLATE 0.2 MG/ML IJ SOLN                                00517460525   $        30.00           5 mL
  79353 NITROGLYCERIN 50 MG/10 ML (5 MG/ML) IV SOLN                     00517481025   $        30.00           10 mL
  15202 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN          J1100   00517490125   $        30.00           1 mL
  15202 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN          J1100   00517490525   $        30.00           5 mL
  15202 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN          J1100   00517493025   $        30.00           30 mL
   3671 MAGNESIUM CHLORIDE 20 % IJ SOLN                                 00517503401   $        59.95           50 mL
   5177 ASCORBIC ACID 500 MG/ML IJ SOLN                                 00517505001   $        30.00           50 mL
  17144 HYDROXYZINE HCL 50 MG/ML IM SOLN                        J3410   00517560125   $        30.00           1 mL
  17144 HYDROXYZINE HCL 50 MG/ML IM SOLN                        J3410   00517560225   $        30.00           2 mL
  17144 HYDROXYZINE HCL 50 MG/ML IM SOLN                        J3410   00517561025   $        30.00           10 mL
    615 FUROSEMIDE 10 MG/ML IJ SOLN                             J1940   00517570225   $        30.00           2 mL
   1289 ZINC SULFATE 1 MG/ML IV SOLN                                    00517611025   $        30.00           10 mL
   3130 MANGANESE SULFATE 0.1 MG/ML IV SOLN                             00517641025   $        30.00           10 mL
  13033 ACETYLCYSTEINE 10 % (100 MG/ML) MISC SOLN               J7608   00517750425   $        30.00           4 mL
    939 ACETYLCYSTEINE 20 % (200 MG/ML) MISC SOLN               J7608   00517760425   $        30.00           4 mL
    939 ACETYLCYSTEINE 20 % (200 MG/ML) MISC SOLN               J7608   00517763003   $        30.00           30 mL
  20265 ETHANOL (ETHYL ALCOHOL) 98 % IJ SOLN                            00517857110   $        94.83           1 mL
  15770 METHYLDOPATE 250 MG/5 ML IV SOLN                        J0210   00517890510   $        83.11           5 mL
  10851 COCAINE 4 % TP SOLN                                             00527172874   $       184.16           4 mL
   3823 SODIUM BICARBONATE 325 MG PO TABS                               00536454010   $        77.55           1000 Each
  10304 SODIUM BICARBONATE 650 MG PO TABS                               00536454410   $        88.88           1000 Each
  81020 MORPHINE (PF) 30 MG/30 ML (1 MG/ML) IV SPCA                     00548191125   $        98.63           30 mL
  76877 LIDOCAINE HCL 2 % MM JELP                                       00548301300   $        30.00           10 mL
  23026 NALOXONE 1 MG/ML IJ SYRG                                J2310   00548336900   $        63.88           2 mL
   5934 COSYNTROPIN 0.25 MG IJ SOLR                             J0834   00548590000   $       649.94           1 Each
  26359 EPINEPHRINE 1 MG/ML (1:1,000) IJ SOLN                           00548906100   $        30.00           30 mL
   7836 DIDANOSINE 200 MG PO CPDR                                       00555058801   $     1,927.80           30 Each
  11952 DIDANOSINE 250 MG PO CPDR                                       00555058901   $     2,446.13           30 Each
  16150 NORETHINDRONE (CONTRACEPTIVE) 0.35 MG PO TABS                   00555071558   $       195.86           28 Each
  17510 AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS                      00555076202   $     5,657.43           100 Each
    535 AMPHETAMINE-DEXTROAMPHETAMINE 7.5 MG PO TABS                    00555077502   $       405.79           100 Each
   5192 TRETINOIN (CHEMOTHERAPY) 10 MG PO CAPS                          00555080802   $ 29,808.48              100 Each
   1007 HYDROXYUREA 500 MG PO CAPS                                      00555088202   $       558.62           100 Each
  39283 HYDROMORPHONE (PF) 10 MG/ML IJ SOLN                     J1170   00555111707   $     1,580.83           50 mL
                                                                        00555901858
  14196 NORGESTIMATE-ETHINYL ESTRADIOL 0.18/0.215/0.25 MG-35 MCG (28) PO TABS         $       108.66           28 Each
   3261 LEVONORGESTREL-ETHINYL ESTRAD 0.1-20 MG-MCG PO TABS             00555904558   $       158.62           28 Each
   1822 NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG PO TABS              00555904958   $       187.95           28 Each
  22928 RHO(D) IMMUNE GLOBULIN 300 MCG IM SYRG                          00562780501   $        30.00           1 Each
   9097 BENZOCAINE 7.5 % MM GEL                                         00573021625   $        36.85           10 g
  10585 HYDROCORTISONE 1 % TP CREA                                      00573283010   $        56.43           26 g
    697 CLOTRIMAZOLE 10 MG MM TROC                                      00574010777   $       910.18           70 Each
  11646 PODOPHYLLUM RESIN 25 % TP LIQD                                  00574060115   $     1,188.55           15 mL
  13443 CAFFEINE CITRATED 60 MG/3 ML (20 MG/ML) IV SOLN         J0706   00574082301   $        39.93           3 mL



                                                               296
                                                                                                                 ERx
Charge                                                         CPT                       OP/Default   IP/ED    Charge
Code                          Description                      Code        NDC             Price      Price    Quantity
   6891 DIHYDROERGOTAMINE 1 MG/ML IJ SOLN                      J1110   00574085010   $       205.63           1 mL
   1387 COLISTIMETHATE SODIUM 150 MG IJ SOLR                   J0770   00574085801   $       518.84           1 Each
  15143 NYSTATIN 100000 UNIT/G TP POWD                                 00574200815   $        31.24           15 g
  12200 HYDROCORTISONE 100 MG/60 ML PR ENEM                            00574202007   $        60.97           60 mL
   1010 NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG-UNIT/ML-% OT SOLN        00574410010   $       124.85           10 mL
  17250 BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG PR SUPP                  00574704012   $     4,468.94           12 Each
  18328 HYDROMORPHONE 3 MG PR SUPP                                     00574722406   $     1,050.91           6 Each
  10436 PENTAZOCINE-NALOXONE 50-0.5 MG PO TABS                         00591039501   $     1,702.38           100 Each
   1966 SULFASALAZINE 500 MG PO TABS                                   00591079601   $       194.14           100 Each
  12711 OXYCODONE HCL-OXYCODONE-ASA 4.5-0.38-325 MG PO TABS            00591082001   $     1,144.44           100 Each
   5454 HYDROXOCOBALAMIN 1000 MCG/ML IM SOLN                           00591288830   $        30.00           30 mL
   8862 PROGESTERONE 50 MG/ML IM OIL                           J2675   00591312879   $        30.00           10 mL
  15645 FENTANYL 25 MCG/HR TD PT72                                     00591319872   $       228.65           5 Each
   9466 FENTANYL 100 MCG/HR TD PT72                                    00591321472   $       838.78           5 Each
  14904 TESTOSTERONE ENANTHATE 200 MG/ML IM OIL                J3120   00591322126   $       169.76           5 mL
   7276 BUTALBITAL-ACETAMINOPHEN-CAFF 50-325-40 MG PO TABS             00591336901   $        30.00           100 Each
    764 FENTANYL 50 MCG/HR TD PT72                                     00591360172   $       415.31           5 Each
  16468 FENTANYL 75 MCG/HR TD PT72                                     00591360272   $       630.53           5 Each
   6574 TRIMETHOPRIM 100 MG PO TABS                                    00591557101   $       514.59           100 Each
  15328 IPRATROPIUM-ALBUTEROL 18-103 MCG/ACTUATION IN AERO             00597001314   $     1,237.27           14.7 g
   1977 CLONIDINE 0.1 MG/24 HR TD PTWK                                 00597003134   $       831.60           4 Each
   2795 CLONIDINE 0.2 MG/24 HR TD PTWK                                 00597003234   $     1,375.99           4 Each
  14595 CLONIDINE 0.3 MG/24 HR TD PTWK                                 00597003334   $     1,923.90           4 Each
    428 NEVIRAPINE 50 MG/5 ML PO SUSP                                  00597004724   $        30.00           240 mL
   9794 TAMSULOSIN 0.4 MG PO CP24                                      00597005801   $     4,576.00           100 Each
   9184 METAPROTERENOL 650 MCG/ACTUATION IN AERO                       00597007017   $       290.75           14 g
  30837 TIOTROPIUM BROMIDE 18 MCG IN CPDV                              00597007541   $     2,190.21           30 Each
  30837 TIOTROPIUM BROMIDE 18 MCG IN CPDV                              00597007547   $     6,570.63           90 Each
  30837 TIOTROPIUM BROMIDE 18 MCG IN CPDV                              00597007575   $       614.02           5 Each
  34005 IPRATROPIUM BROMIDE 17 MCG/ACTUATION IN HFAA                   00597008717   $     1,125.09           12.9 g
  82931 DABIGATRAN ETEXILATE 75 MG PO CAPS                             00597010760   $     1,683.20           60 Each
  75596 DABIGATRAN ETEXILATE 150 MG PO CAPS                            00597013554   $     1,683.00           60 Each
  75596 DABIGATRAN ETEXILATE 150 MG PO CAPS                            00597013560   $     1,683.00           60 Each
  12975 PRAMIPEXOLE 0.125 MG PO TABS                                   00597018390   $     3,168.99           90 Each
  13330 PRAMIPEXOLE 0.25 MG PO TABS                                    00597018461   $     3,696.55           100 Each
    355 PRAMIPEXOLE 1 MG PO TABS                                       00597019061   $     3,696.55           100 Each
  17279 PRAMIPEXOLE 1.5 MG PO TABS                                     00597019190   $     3,168.99           90 Each
   5832 CAPSAICIN 0.075 % TP CREA                                      00603064988   $        43.23           60 g
  16419 PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2-0.1037 -0.0194 MG PO TABS00603241821     $       705.50           100 Each
   1545 DOXYCYCLINE HYCLATE 100 MG PO CAPS                             00603348128   $       496.06           500 Each
    175 HYDROCORTISONE 5 MG PO TABS                                    00603389919   $       136.07           50 Each
  15014 HYDROCORTISONE 10 MG PO TABS                                   00603390021   $       451.66           100 Each
   3210 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS                00603578021   $       169.32           100 Each
   9554 HYDROMORPHONE 2 MG/ML IJ SOLN                          J1170   00641012125   $        30.00           1 mL
   9146 DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN                   J1200   00641037625   $        30.00           1 mL
    482 PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN                  J2560   00641047625   $        30.00           1 mL
  15064 PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN                 J2560   00641047725   $        57.31           1 mL
  10355 PHENYTOIN SODIUM 50 MG/ML IV SOLN                      J1165   00641049325   $        30.00           2 mL
  12578 CHLORPROMAZINE 25 MG/ML IJ SOLN                        J3230   00641139735   $        66.70           1 mL
  12578 CHLORPROMAZINE 25 MG/ML IJ SOLN                        J3230   00641139835   $        37.08           2 mL
  10355 PHENYTOIN SODIUM 50 MG/ML IV SOLN                      J1165   00641255545   $        30.00           5 mL
  18210 LEVOCARNITINE 200 MG/ML IV SOLN                        J1955   00703040402   $        30.00           5 mL
   1567 ALPROSTADIL 500 MCG/ML IJ SOLN                         J0270   00703150102   $       351.60           1 mL
  18356 FLUMAZENIL 0.1 MG/ML IV SOLN                                   00703208403   $        30.00           5 mL
  18356 FLUMAZENIL 0.1 MG/ML IV SOLN                                   00703208493   $        30.00           5 mL
  18356 FLUMAZENIL 0.1 MG/ML IV SOLN                                   00703208593   $        30.00           10 mL
  10254 BLEOMYCIN 15 UNIT IJ SOLR                              J9040   00703315401   $       441.15           1 Each
  17345 LEUPROLIDE 1 MG/0.2 ML SC KIT                          J9218   00703401418   $     1,545.98           1 Each
  12060 IDARUBICIN 1 MG/ML IV SOLN                             J9211   00703415411   $       137.22           5 mL
  12060 IDARUBICIN 1 MG/ML IV SOLN                             J9211   00703415511   $       137.21           10 mL
  12060 IDARUBICIN 1 MG/ML IV SOLN                             J9211   00703415591   $       135.85           10 mL



                                                              297
                                                                                                                      ERx
Charge                                                            CPT                       OP/Default   IP/ED    Charge
Code                          Description                         Code        NDC             Price      Price    Quantity
  76830 VINORELBINE 50 MG/5 ML IV SOLN                            J9390   00703418301   $     1,104.15           5 mL
  76889 VINCRISTINE 2 MG/2 ML IV SOLN                             J9370   00703441211   $       105.23           2 mL
  41290 IRINOTECAN 100 MG/5 ML IV SOLN                            J9206   00703443411   $       146.17           5 mL
   8908 STREPTOZOCIN 1 GRAM IV SOLR                               J9320   00703463601   $        30.00           1000 mg
  15665 PACLITAXEL 6 MG/ML IV CONC                                J9265   00703476601   $        30.91           16.7 mL
  32482 FLUDARABINE 50 MG/2 ML IV SOLN                            J9185   00703485211   $       724.54           2 mL
  10670 DOXORUBICIN 2 MG/ML IV SOLN                               J9000   00703504001   $        30.00           100 mL
   1296 DESMOPRESSIN 4 MCG/ML IJ SOLN                             J2597   00703505401   $        38.08           10 mL
   9573 DACARBAZINE 200 MG IV SOLR                                J9130   00703507501   $       354.23           1 Each
   9118 LEUCOVORIN CALCIUM 100 MG IJ SOLR                         J0640   00703514001   $        48.28           1 Each
  10071 ETOPOSIDE 20 MG/ML IV SOLN                                J9181   00703565301   $        30.00           5 mL
  10071 ETOPOSIDE 20 MG/ML IV SOLN                                J9181   00703565601   $        30.00           25 mL
  10115 CISPLATIN 1 MG/ML IV SOLN                                 J9060   00703574711   $        30.00           50 mL
  10115 CISPLATIN 1 MG/ML IV SOLN                                 J9060   00703574811   $        30.00           100 mL
   1974 FLUDARABINE 50 MG IV SOLR                                 J9185   00703585401   $     1,446.70           1 Each
  17117 MEDROXYPROGESTERONE 150 MG/ML IM SUSP                     J1055   00703680101   $       347.71           1 mL
  14338 HALOPERIDOL LACTATE 5 MG/ML IJ SOLN                       J1630   00703704103   $        30.00           1 mL
  41124 GRANISETRON 1 MG/ML (1 ML) IV SOLN                        J1626   00703797103   $       227.81           1 mL
  11536 ADENOSINE 3 MG/ML IV SOLN                                 J0150   00703877103   $        49.02           2 mL
  13709 TOBRAMYCIN SULFATE 40 MG/ML IJ SOLN                       J3260   00703940204   $        30.00           2 mL
  13709 TOBRAMYCIN SULFATE 40 MG/ML IJ SOLN                       J3260   00703941601   $        30.00           30 mL
   4758 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN              00703950303   $        30.00           5 mL
   4758 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN              00703951403   $        30.00           10 mL
   4758 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN              00703952601   $       147.39           30 mL
   1667 MICONAZOLE NITRATE 100 MG VA SUPP                                 00713019757   $        51.85           7 Each
   4891 MICONAZOLE NITRATE 2 % VA CREA                                    00713025237   $        48.07           45 g
                                                                      00713026831
   1558 NEOMYCIN-BACITRACNZN-POLYMYXIN 3.5-400-5,000 MG-UNIT-UNIT/G TP OINT             $        30.00           28.4 g
  17308 AZITHROMYCIN 600 MG PO TABS                                       00781149731   $     3,950.12           30 Each
   5770 AMOXICILLIN-POT CLAVULANATE 250-125 MG PO TABS                    00781187431   $     1,973.70           30 Each
  11749 LANSOPRAZOLE 30 MG PO CPDR                                        00781235501   $     1,649.89           100 Each
   6230 SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN                 J0330   00781300995   $        30.00           10 mL
  14633 PYRIDOSTIGMINE BROMIDE 5 MG/ML IJ SOLN                            00781304095   $       121.94           2 mL
  11546 ISONIAZID 100 MG/ML IJ SOLN                                       00781305670   $       425.27           10 mL
   8857 SUMATRIPTAN SUCCINATE 6 MG/0.5 ML SC SOLN                 J3030   00781317414   $     1,633.81           .5 mL
  10308 FOMEPIZOLE 1 GRAM/ML IV SOLN                              J1451   00781318284   $     4,973.17           1.5 mL
   8740 CEFTRIAXONE 1 GRAM IJ SOLR                                J0696   00781320895   $        30.00           1 Each
   8559 AMPICILLIN SODIUM 250 MG IJ SOLR                          J0290   00781340295   $        30.00           1 Each
  14447 AMPICILLIN SODIUM 1 GRAM IJ SOLR                          J0290   00781340495   $        47.60           1 Each
   8076 AMPICILLIN SODIUM 10 GRAM IJ SOLR                         J0290   00781340995   $     1,341.62           1 Each
  11807 CEFAZOLIN 500 MG IJ SOLR                                  J0690   00781345095   $        30.00           1 Each
   7191 CEFAZOLIN 10 GRAM IJ SOLR                                 J0690   00781345295   $        97.38           1 Each
  16573 ONDANSETRON 4 MG PO TBDL                                 Q0179    00781523864   $        81.84           30 Each
   7414 ONDANSETRON 8 MG PO TBDL                                 Q0179    00781523980   $        45.76           10 Each
  10046 AMOXICILLIN 250 MG/5 ML PO SUSR                                   00781604155   $        30.00           150 mL
   3378 AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML PO SUSR              00781613957   $        30.00           75 mL
  14600 PENICILLIN G SODIUM 5 MILLION UNIT IJ SOLR                        00781615395   $     5,995.22           1 Each
   7427 LIDOCAINE-PRILOCAINE 2.5-2.5 % TP CREA                            00781705805   $        72.29           5g
  16221 OXACILLIN 1 GRAM IJ SOLR                                  J2700   00781910995   $       145.62           1 Each
  10481 OXACILLIN 2 GRAM IJ SOLR                                  J2700   00781911195   $       282.52           1 Each
  12477 HYDROCORTISONE 20 MG PO TABS                                      00904267460   $       125.51           100 Each
   6785 SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS                  00904272561   $       326.06           100 Each
  10372 SULFACETAMIDE SODIUM 10 % OP DROP                                 00904272835   $       131.67           15 mL
  12627 MEGESTROL 40 MG PO TABS                                           00904357161   $       285.34           100 Each
  25540 SODIUM CHLORIDE 0.65 % NA SPRA                                    00904386575   $        30.00           44 mL
   2324 CARBAMIDE PEROXIDE 10 % MM SOLN                                   00904406203   $        30.00           60 mL
   2052 CROMOLYN 5.2 MG/ACTUATION NA SPRY                                 00904553267   $        57.62           26 mL
  16869 CLOTRIMAZOLE 1 % TP CREA                                          00904782236   $        30.00           15 g
                                                                          SOLN
  37377 PERIT. DIALYSIS 8 & DEX 4.25 % LOWCA+= 2.5 MEQ &MAG= 0.5 MEQ/L IP 00941045925   $        30.00           5000 mL
                                                                          SOLN
  37377 PERIT. DIALYSIS 8 & DEX 4.25 % LOWCA+= 2.5 MEQ &MAG= 0.5 MEQ/L IP 00941045947   $        30.00           2000 mL
   6571 ALBUMIN, HUMAN 5 % 5 % IV SOLP                           P9041    00944049101   $       601.29           250 mL
   6571 ALBUMIN, HUMAN 5 % 5 % IV SOLP                           P9041    00944049102   $     1,203.94           500 mL



                                                                298
                                                                                                                     ERx
Charge                                                           CPT                       OP/Default   IP/ED    Charge
Code                          Description                        Code        NDC             Price      Price    Quantity
   6805 IMMUNE GLOBULIN (HUMAN) (IGG) 5 GRAM IV SOLR             J1569   00944262003   $     1,829.05           5g
  13193 IMMUNE GLOBULIN (HUMAN) (IGG) 10 GRAM IV SOLR            J1569   00944265504   $     3,630.35           10 g
   1237 ALPHA-1 PROTEINASE INHIB.(HUM) 500 MG IV SUSR            J0256   00944280101   $       938.10           1 Each
   1237 ALPHA-1 PROTEINASE INHIB.(HUM) 500 MG IV SUSR            J0256   00944280201   $       938.10           1 Each
  13237 CARBACHOL 1.5 % OP DROP                                          00998022315   $       407.11           15 mL
   9404 CARBACHOL 3 % OP DROP                                            00998022515   $       465.41           15 mL
   7615 HOMATROPINE HBR 2 % OP DROP                                      00998031105   $       245.96           5 mL
   9682 HOMATROPINE HBR 5 % OP DROP                                      00998031505   $       283.14           5 mL
    460 IRRIGATION SOLNS PHYSIOLOGICAL IR SOLN                           01000004606   $        30.00           1000 mL
  18161 SODIUM HYALURONATE 14 MG/ML IO SYRG                              05047450854   $       681.89           .55 mL
  10471 SODIUM HYALURONATE 10 MG/ML IO SYRG                      J7321   05047450858   $       415.58           .55 mL
   9452 SODIUM HYALURONATE (VISCOSUP) 10 MG/ML IX SOLN           J7321   08024072412   $       692.56           2 mL
                                                                         0
   2961 CHONDROITIN SULF-SOD HYALURON 3 %-4 %(0.5 ML) 1 % (0.55 ML) IO KIT8065183150   $     1,010.24           1 Each
 520039 KANAMYCIN ORAL SOLUTION 333 MG/ML