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Ancillary - OSHPD

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					                                                Ancillary



Cedars-Sinai Medical Center
AB1045 Chargemaster Submission
Prices Effective July 1, 2007

Charge Code                  Description                    Price      CPT Code
       2000001 OP TRANSFUSION, BLOOD SIMPLE           $      1,014.59 36430
       2000006 OP TRANSFUSION, BLOOD INTERM           $      1,245.59 36430
       2000007 OP TRANSFUSION, BLOOD COMPLEX          $      1,476.59 36430
       2000011 OP IV PUSH INITIAL                     $       270.35 90774
       2000012 OP INFUS THRPY 1ST HOUR                $       615.80 90765
       2000013 OP INFUSION THRPY EA ADDL HR           $       134.30 90766
       2000014 OP THERAPEUTIC INJ SQ IM               $       100.00 90772
       2000019 OP IV PHLEBOTOMY                       $        49.21 36415
       2000022 OP REPAIR CNTRL TUNN OR PICC           $      2,506.35 36575
       2000040 OP THORACENTESIS                       $       889.35 32000
       2000041 OP LUMBAR PUNCTURE DIAGNOSTIC          $      1,346.93 62270
       2000042 OP PERITONEOCENTESIS                   $      1,132.42 49080
       2000045 OP DECLOT IMP/VAD CATH HEP/TPA         $       710.86 36550
       2000047 OP FLEX SIGMOIDOSCOPY                  $      1,314.50 45330
       2000050 OP OXYGEN 15MINS INTERVALS             $       178.86
       2000051 OP PICC REPOSITION W/FLUORO            $      2,506.35 36597
       2000055 OP BONE MARROW BIOPSY                  $       823.35 38221
       2000058 OP LYMPH NODE BIOPSY                   $       909.43 38505
       2000059 OP SKIN BIOPSY, SINGLE LESION          $       502.90 11100
       2000067 OP FINE NEEDLE ASPIR W/O IMAG          $       498.27 10021
       2000068 OP INCISION & DRAINAGE ABS             $       489.72 10060
       2000070 OP TRACHEOSTOMY                        $      2,397.08 31600
       2000072 OP SKIN TEST ID IMMED, PER TST         $        98.22 95015
       2000073 OP SKIN TEST ID DELAY EA SITE          $       117.88 95028
       2000084 PROC CTR NEW PT., LEVEL 1              $       129.05 99201
       2000085 PROC CTR NEW PT., LEVEL 2              $       140.68 99202
       2000086 PROC CTR NEW PT., LEVEL 3              $       185.80 99203
       2000087 PROC CTR NEW PT., LEVEL 4              $       232.80 99204
       2000088 PROC CTR NEW PT., LEVEL 5              $       296.74 99205
       2000089 PROC CTR EST. PT., LEVEL 1             $       129.05 99211
       2000090 PROC CTR EST. PT., LEVEL 2             $       140.68 99212
       2000091 PROC CTR EST. PT., LEVEL 3             $       160.78 99213
       2000092 PROC CTR EST. PT., LEVEL 4             $       204.38 99214
       2000093 PROC CTR EST. PT., LEVEL 5             $       291.00 99215
       2000118 OP SKIN BIOPSY, EA ADDL LESION         $       139.76 11101
       2000119 OP PICC INSERT. YGR THAN 5 YRS         $      2,984.65 36568
       2000120 OP PICC INSERT. PROCRM > 5 YRS         $      3,257.63 36569
       2000121 OP ARTERIAL CATH INSERT PERC           $       523.13 36620
       2000122 OP ARTERIAL CATH INSERT. CTDWN         $      2,664.86 36625
       2000123 OP REPL PICC VIA CATH EXCH             $      2,506.35 36584
       2000124 OP REPL CNTRL LN VIA CATH EX           $      2,400.08 36580
       2000125 OP REPL TUNN CNTRL LN CATH EX          $      3,488.08 36581
       2000127 OP REPL PAS PORT VIA CATH EXCH         $      3,164.77 36585
       2000128 OP CNTRL LN N/T YGR THAN 5 YR          $      2,193.25 36555



                                                Page 1
                                         Ancillary


2000129 OP CNTRL LN INSERT PERC > 5YRS         $     2,501.88 36556
2000130 OP TUNN CATH YGR THAN 5 YRS            $     4,852.43 36557
2000131 OP TUNN CATH INSERTION > 5 YRS         $     3,905.48 36558
2000133 OP CHEST PORT INSERT > 5 YRS           $     4,956.86 36561
2000134 OP PAS PORT FOR YGR THAN 5 YR          $     3,544.54 36570
2000135 OP PAS PORT INSERTION >5 YRS           $     4,165.44 36571
2000136 OP REMOVAL CHEST OR PAS PORT           $     2,073.13 36590
2000137 OP REMOVAL TUNN CNTRL VEN CATH         $     2,602.40 36589
2000139 OP BLOOD COLLECT FROM PORT DEV         $      186.81 36540
2000140 OP FLUORO GUID. VENOUS ACCESS          $      473.11 77001
2000141 OP ULTRASOUND GUID., VENOUS AC         $      550.40 76937
2000142 OP VENIPNCTR, CD YGR THAN 1 YR         $      420.19 36420
2000143 OP VENIPUNCTURE CUTDOWN > 1 YR         $      260.24 36425
2000144 OP BRONCHOSCOPY                        $     4,295.07 31622
2000145 OP IV PUSH ADDL SEQUENTIAL             $      270.35 90775
2000147 OP INFUS THRPY 1ST HR ALBUMIN          $      615.80 90765
2000148 OP IV INFUSION HYDRATION 1 HR          $      615.80 90760
2000149 OP IV INFUSION HYDRATION ADDL          $      134.30 90761
2000152 OP EXCISION 2.1 TO 3.0 CM              $     1,662.82 11403
2000153 OP TRACH TUBE CHANGE                   $      741.47 31502
2000156 OP ULTRASOUND GUIDANCE                 $      990.81 76942
2000157 OP LUMBAR PUNCTURE THERAPEUTIC         $      833.93 62272
2000158 OP BONE MARROW BX W/ASPIRATION         $      327.45 G0364
2000159 OP INDWL TUNN PLEU CATH W/CUFF         $     1,979.55 32019
2000161 OP REMOVAL OF PLEURAX CATHETER         $     1,158.53 32999
2000163 OP VACCINE ADMINISTRATION              $       70.69 90471
2000164 OP MOD SED YGR THAN 5 YR 30 MN         $      308.96 99143
2000165 OP MOD SEDATION >5YRS 30 MIN           $      308.96 99144
2000166 OP MOD SEDATION EA ADDL 15 MIN         $      121.00 99145
2000167 OP MECH REMOVAL LMN OBSTR CVAD         $     1,790.42 36596
2000168 OP BONE MARROW ASPIRATION ONLY         $      581.79 38220
2000169 OP CHEMO INFUS 1ST HR REMICADE         $      845.90 96413
2000170 OP CHEMO INFUS EA ADDL HR REM          $      270.35 96415
2000171 OP IV THERAPY SEQ FIRST HOUR           $      305.39 90767
2000172 OP IV INFUSION CONCURRENT              $      178.14 90768
2000200 IP IV PUSH INITIAL                     $      351.46 90774
2000201 IP IV PUSH ADDL SEQUENTIAL             $      351.46 90775
2000205 IP IV PHLEBOTOMY                       $       63.97 36415
2000206 IP FLUORO GUID, VENOUS ACCESS          $      615.04 77001
2000207 IP BRONCHOSCOPY                        $     5,583.59 31622
2000208 IP VENIPNCTR,CD YGR THAN 1 YR          $      546.24 36420
2000209 IP VENIPUNCTURE CUTDOWN > 1 YR         $      338.31 36425
2000210 IP BLOOD COLLECT FROM PORT DEV         $      242.85 36540
2000211 IP DECLOT IMP/VAD CATH HEP/TPA         $      924.12 36550
2000212 IP CNTRL LN N/T YGR THAN 5 YRS         $     2,851.22 36555
2000213 IP CNTRL LN INSERT PERC > 5YRS         $     3,252.45 36556
2000214 IP TUNN CATH YGR THAN 5 YRS            $     6,308.16 36557
2000215 IP TUNN CATH INSERTION > 5 YRS         $     5,077.13 36558
2000217 IP CHEST PORT INSERT > 5 YRS           $     6,443.92 36561




                                         Page 2
                                         Ancillary


2000218 IP PICC INSERT YGR THAN 5 YRS          $     3,880.05 36568
2000219 IP PICC INSERT PROCRM > 5 YRS          $     4,234.92 36569
2000220 IP PAS PORT FOR YGR THAN 5 YRS         $     4,607.90 36570
2000221 IP PAS PORT INSERTION > 5 YRS          $     5,415.07 36571
2000222 IP REPAIR CNTRL TUNN OR PICC           $     3,258.26 36575
2000224 IP REPL CNTRL LN VIA CATH EX           $     3,120.10 36580
2000225 IP REPL TUNN CNTRL LN CATH EX          $     4,534.50 36581
2000226 IP REPL CHEST PORT VIA CATH EX         $     8,060.18 36582
2000227 IP REPL PICC VIA CATH EXCH             $     3,257.63 36584
2000228 IP REPL PAS PORT VIA CATH EXCH         $     4,114.20 36585
2000229 IP REMOVAL TUNN CNTRL VEN CATH         $     3,383.12 36589
2000230 IP REMOVAL CHEST OR PAS PORT           $     2,695.06 36590
2000231 IP ARTERIAL CATH INSERT PERC           $      680.07 36620
2000232 IP ARTERIAL CATH INSERT CUTDOW         $     3,464.32 36625
2000235 IP ULTRASOUND GUID, VENOUS AC          $      715.52 76937
2000236 IP ULTRASOUND GUIDANCE                 $     1,288.05 76942
2000237 IP THORACENTESIS                       $     1,156.16 32000
2000238 IP LUMBAR PUNCTURE DIAGNOSTIC          $     1,751.01 62270
2000239 IP THERAPEUTIC INJ SQ IM               $      130.00 90772
2000243 IP FINE NEEDLE ASPIR W/O IMAG          $      647.76 10021
2000244 IP INCISION & DRAINAGE ABS             $      636.64 10060
2000245 IP SKIN BIOPSY, SINGLE LESION          $      653.77 11100
2000246 IP SKIN BIOPSY, EA ADD LESION          $      181.68 11101
2000247 IP EXCISION 2.1 TO 3.0 CM              $     2,161.66 11403
2000248 IP TRACHEOSTOMY                        $     3,116.20 31600
2000251 IP PICC REPOSITION W/FLUORO            $     3,258.26 36597
2000254 IP BONE MARROW BIOPSY                  $     1,070.36 38221
2000255 IP LYMPH NODE BIOPSY                   $     1,182.26 38505
2000256 IP PERITONEOCENTESIS                   $     1,472.14 49080
2000260 IP PICC CONSULT                        $       87.76
2000261 IP TRACH TUBE CHANGE                   $      963.91 31502
2000271 IP RN'S CIRCULATING                    $         -
2000272 IP LUMBAR PUNCTURE THERAPEUTIC         $     1,084.11 62272
2000273 IP BONE MARROW BX W/ASPIRATION         $      425.68 G0364
2000274 IP INDWL TUNN PLEU CATH W/CUFF         $     2,573.42 32019
2000277 IP REMOVAL OF PLEURAX CATHETER         $     1,506.09 32999
2000279 IP MOD SED YGR THAN 5 YR 30 MN         $      401.64 99143
2000280 IP MOD SEDATION >5YRS 30 MIN           $      401.64 99144
2000281 IP MOD SEDATION EA ADDL 15 MIN         $      157.30 99145
2000283 IP MECH REMOVAL LMN OBSTR CVAD         $     2,327.54 36596
2000284 IP BONE MARROW ASPIRATION ONLY         $      756.33 38220
1200120 PERIODIC ORAL EVALUATION               $       49.01 D0120
1200140 LMTD ORAL EVALPROB FOCUS               $      106.93
1200145 ORAL EVAL UNDER THREE YEARS            $      106.93
1200150 COMPREHENSIVE ORAL EVAL                $      106.93
1200210 INTRAORAL-COMPLETE SERIES              $      124.75 D0210
1200220 INTRAORAL-PERIAPICAL-FIRST FLM         $       42.77 D0220
1200230 INTRORAL-PERIAPICL-EACH + FILM         $       35.00 D0230
1200240 INTRAORAL-OCLUSAL FILM                 $       25.46 D0240




                                         Page 3
                                         Ancillary


1200272 BITEWINGS - TWO FILMS                  $      42.77 D0272
1200274 BITEWINGS - FOUR FILMS                 $      44.55 D0274
1200290 POST-ANT LAT SURVEY FILM               $      65.03 D0290
1200321 OTHER TEMPORO MAND JOINT FILM          $      92.35 D0321
1200330 PANORAMIC FILM                         $     106.93 D0330
1200340 CEPHALOMETRIC FILM                     $      96.27 D0340
1200350 ORAL/FAC PHOTO IMAC                    $      46.35
1200486 ACCESSION BRUSH BIOP MICRO EX          $     100.00
1201110 ADULT PROPHYLAXIS                      $     127.42 D1110
1201120 CHILD PROPHYLAXIS                      $      78.41 D1120
1201203 TOPICAL FLUORIDE CHILD                 $      60.00 D1203
1201204 TOPICAL FLUORIDE ADULT                 $      60.00 D1204
1201206 TOPICAL FLUORIDE VARNISH               $      60.00
1201351 SEALANT - PER TOOTH                    $      39.78 D1351
1201510 SPACE MAINTAIN-FIXED-UNI               $     262.55 D1510
1201515 SPAC MAINTAIN-FIXED-BILAT              $     262.55 D1515
1201550 RECEMTATION OF SPAC MAINTAIN           $      97.24 D1550
1201555 REMOVAL FIXED MAINTAINER               $      80.00
1202140 AMALGAM 1 SURF PRIM/PERM               $     106.08 D2140
1202150 AMAL 2 SURF PRIM/PERM                  $     132.60 D2150
1202160 AMALG 3 SURF PRIM/PERM                 $     154.70 D2160
1202161 AMALG 4>SURF PRIM/PERM                 $     179.01 D2161
1202330 RESIN COMP 1 SURF ANT                  $     147.03 D2330
1202331 RESIN COMP 2 SURF ANT                  $     212.38 D2331
1202332 RESIN - THREE SURFACES                 $     228.70 D2332
1202335 RESIN 4> SURFACE/INCISAL ANGLE         $     303.85 D2335
1202390 RESIN BASED COMP CROWN ANT             $     106.08
1202391 RESIN BASED 1 SURF                     $     132.60
1202392 RESIN BASED COMP 2 SURF POST           $     154.70
1202393 RESIN BASED COMP 3SURF POST            $     179.01
1202394 RESIN BASED COMP 4> SURF POST          $     133.66
1202610 INLAY PORCELAIN\CERAM 1SURFACE         $     607.75 D2610
1202620 INLAY PORCELAIN\CERAM 2SURFACE         $     729.30 D2620
1202630 INLAY PORCELAIN\CERAM 3SURFACE         $     729.30 D2630
1202642 ONLAY PORCELAIN/CERAMIC 2 SURF         $     500.00
1202643 ONLAY PORCELAIN/CERAMIC 3 SURF         $     500.00
1202644 ONLAY PORCELAIN/CERAMIC 4>SURF         $     500.00
1202740 CROWN PORCELAIN/CERAMIC SUBST          $     513.73 D2740
1202750 CROWN PORC FUSED HI NOBLEMETAL         $     715.32 D2750
1202751 CROWN PORC FUSE PREDOM BS METL         $     513.73 D2751
1202752 CROWN PORCE FUSE T NOBLE METAL         $     585.27 D2752
1202791 CROWN FULL CAST (METAL)                $     585.27
1202792 CROWN FULL CAST NOBLE                  $     858.39
1202799 PROVISIONAL CROWN                      $     150.00
1202910 RECEMNT INLAYS ONLAYS PARTIAL          $      60.78 D2910
1202920 RECEMENT CROWN                         $     132.00 D2920
1202930 PFAB STAIN STEEL CRN PRIMARY           $      93.64 D2930
1202931 PFAB STAIN STEEL CRN PREMANENT         $      65.03 D2931
1202932 PREFABRICATED RESIN CROWN              $      97.55 D2932




                                         Page 4
                                         Ancillary


1202940 SEDATIVE FILING                        $      110.00 D2940
1202950 CROWN BUILDUP, INCLUDING PINS          $      144.21 D2950
1202952 CAST POST CORE IN ADD TO CRWN          $      195.09 D2952
1202953 ADD CAST POST SAME TOOTH               $       97.55 D2953
1202954 PREFAB POST&CORE IN ADD TO CRN         $      130.06 D2954
1202960 LABIAL VENER RES LAMINTE CHAIR         $      520.23 D2960
1202961 LABIAL VNEER RESIN LAMINAT LAB         $      945.79
1203220 THERAPEUTIC PULPOTOMY                  $      120.83 D3220
1203221 PUPAL DEBRIDMNT PRIM PERM TEET         $      130.83
1203310 ANT (RCT)                              $      624.28 D3310
1203320 BICUS (RCT)                            $      658.13 D3320
1203330 MOLAR (RCT)                            $      787.64 D3330
1203331 TREAT ROOT OBST NON SURG               $      400.00
1203351 APEXRECAL REPAIR                       $      331.50
1203410 APIECTOMY PERIRADICU SRG ANT           $      218.73 D3410
1203421 APIECOTMY PERADUCU-SRG BICUSPD         $      218.73
1203425 APIECOTMY PERADUCU-SRG MOLAR           $      218.73
1203430 RETROGRADE FILLING - PER ROOT          $      200.00 D3430
1203450 ROOT AMPUTATION _PER ROOT              $       91.04 D3450
1203460 ENDONDONTIC ENDOSSEOUS IMPLANT         $      390.18 D3460
1203920 HEMISECTION INCLUD ROOT REMOVE         $       91.04 D3920
1204210 GINGIV/ GINGIVO 4> CONT TEETH          $      140.46 D4210
1204211 GINGIVE/GINGIVO 1-3 CONT TEETH         $      104.87 D4211
1204240 GINGIVAL FLAP PROCEDURE                $      450.00
1204241 GINGIVAL FLAP INCL RT 1-3 TEET         $      450.00
1204245 APICAL LLY POSITIONED FLAP             $      450.00
1204249 CROWN LENGTHENING HARD TISSUE          $      450.00
1204260 OSSEOUS SRG(W FLAP ETRY&CLOSE)         $      437.01 D4260
1204261 OSSEOUS GRAFT - SINGLE SITE            $      325.15 D4261
1204263 BONE REPLCMNT 1ST SITE QUAD            $      300.00
1204264 BONE REPLACE EA ADDTNL SITE            $      175.00
1204270 PEDICAL SOFT TISSUE GRAFTS             $      260.12 D4270
1204320 PROVISAL SPLNTING INTRACORONAL         $      291.34 D4320
1204321 PROVISAL SPLNTING EXTRACORONAL         $      104.05 D4321
1204341 PERIO SCALING 4>PER QUADRANT           $      350.06 D4341
1204342 PERIO SCALING ROOT PLAN 103 TE         $      318.24
1204910 PREVENT PERIODONTALL PROCEDURE         $      121.55 D4910
1205110 COMPLETE UPPER DENTURE                 $     1,225.22 D5110
1205120 COMPLETE LOWER DENTURE                 $     1,225.22 D5120
1205130 IMMEDIATE UPPER DENTURE                $     1,225.22 D5130
1205140 IMMEDIATE LOWER DENTURE                $     1,093.95 D5140
1205211 UPPER PARTIAL - ACRYLIC BASE           $      875.16 D5211
1205212 LOWER PARTIAL ACRYLIC BASE             $      875.16 D5212
1205213 UPPER PARTIAL PERDOM BASE CAST         $     1,588.94 D5213
1205214 LOWER PARTAL PERDOM BASE CAST          $     1,588.94 D5214
1205410 ADJUST COMPLETE DENTURE-MAX            $       79.01 D5410
1205411 ADJUST COMPLETE DENTURE-MAD            $       79.01 D5411
1205421 ADJUST PARTIAL - MAX                   $       37.47 D5421
1205422 ADJUST PARTIAL - MAND                  $       37.47 D5422




                                         Page 5
                                         Ancillary


1205510 REPAIR RESIN DENTURE BASE              $      136.14 D5510
1205520 REPLACE MISSING / BROKEN TEETH         $      121.55 D5520
1205610 REPAIR RESIN DENTURE BASE              $      136.14 D5610
1205620 REPAIR CAST FRAMEWORK                  $      145.86 D5620
1205630 REPAIR OR REPLACE BROKEN CLASP         $      136.14 D5630
1205640 REPLACE BROKEN TEETH                   $      145.86 D5640
1205650 ADD TOOTH EXISTING PART DENT           $       97.55 D5650
1205660 ADD CLASP TO EXISTING PARTIAL          $      109.25 D5660
1205670 REPLCE ACRY CAST METL MAX              $     1,444.49
1205671 REPLCE ACRY CAST METAL MAND            $     1,444.49
1205710 REBASE COMPLETE MAX DENTURE            $      260.12 D5710
1205711 REBASE COMPLETE MAND DENTURE           $      260.12 D5711
1205720 REBASE MAX PARTIAL DENTURE             $      130.06 D5720
1205721 REBASE MAND PARTIAL DENTURE            $      130.06 D5721
1205730 RELINEMAX DENTURE CHAIRSIDE            $      171.68 D5730
1205731 RELINE MAND DENTURE CHAIRSIDE          $      171.68 D5731
1205740 RELINE MAX PARTIAL DENT CHAIR          $      143.07 D5740
1205741 RELINE MAND PARTIAL DENT CHAIR         $      143.07 D5741
1205750 RELINE MAX COMPLETE DENT LAB           $      273.12 D5750
1205751 RELINE MAND COMPLETE DENT LAB          $      273.12 D5751
1205760 RELINE MAX PARTIAL DENT LAB            $      227.60 D5760
1205761 RELINE MAND PARTIAL DENT LAB           $      227.60 D5761
1205810 INTERIM COMPLETE DENT MAX              $      286.13 D5810
1205811 INTERIM COMPLETE DENT MAND             $      286.13 D5811
1205820 INTERIM PARTIAL DENT MAX               $      816.82 D5820
1205821 INTERIM PARTIAL DENT MAND              $      816.82 D5821
1205850 TISS CONDITINGMAXILLARY                $      145.86 D5850
1205851 TISSUE CONDITIONING MADIBULAR          $      132.60
1205860 OVERDENTURE COMPLETE (BY REPT)         $      780.35 D5860
1205861 OVERDENTURE PARTIAL (BY REPRT)         $      780.35 D5861
1205982 SURGICAL STENT                         $      437.25
1205988 SURGICAL SPLINT                        $      300.00
1206010 SURGCAL REPLACE IMPLNT ENDOST          $     1,500.00
1206012 SURGCAL PLACEMNT IMPLANT BODY          $      500.00
1206056 PREFABRICATED ABUTMENT                 $      356.42
1206066 IMPLNT SUPORT PRCLN METAL CRWN         $     1,059.29
1206091 REPLACMNT ATTACHMNT MALE/FEM           $      260.00
1206092 RECEMENT IMPLANT/ABUTMNT CROWN         $     1,100.00
1206093 RECEMENT IMPNT/ABUT PRTIAL DEN         $      900.00
1206210 PONTIC - CAST HIGH NOBLE METAL         $      866.98 D6210
1206211 PONTIC CASH PREDOM BASE METAL          $      668.53 D6211
1206212 PONTIC - CASH NOBLE METAL              $      585.27 D6212
1206240 PONTC PORC FUSED HI NOBL METAL         $     1,040.37 D6240
1206241 PONTC PORC FUS PREDOM BSE MET          $      513.73 D6241
1206242 PONTIC POR FUSE TO NOBLE METAL         $      585.27 D6242
1206250 PONTIC RESIN WTH HI NOBEL METL         $      715.32 D6250
1206251 PONTIC RESN W PREDOM BASE METL         $      513.73 D6251
1206252 PONTIC - RESIN WITH NOBLE METL         $      585.27 D6252
1206606 INLAY CAST METAL 2 SURF                $      500.00




                                         Page 6
                                         Ancillary


1206607 INLAY CAST METAL 3> +                  $      500.00
1206750 CRN PORCL FUSED HI NOBLE METAL         $     1,165.22 D6750
1206751 CRN PORCL FUS PREDOM BASE METL         $      622.66 D6751
1206752 CRN PORCELAIN FUSED NOBLE METL         $      585.27 D6752
1206780 CROWN 3/4 CST HIGH NOBLE METAL         $      715.32 D6780
1206790 CROWN FULL CAST HI NOBEL METAL         $      858.39 D6790
1206791 CRN FL CAST PREDOM BASE METAL          $      513.73 D6791
1206792 CROWN - FULL CAST NOBEL METAL          $      585.27 D6792
1206930 RECEMENT FIXED PARTIAL DENTURE         $       60.78 D6930
1206940 STRESS BREAKER                         $      156.08 D6940
1206950 PRECISION ATTACHMENT                   $      260.12 D6950
1206972 PREFB PST & CRE ADD TO BRDG RT         $      392.06 D6972
1207111 EXT CORONAL REMNANT TOOTH BAB          $      178.21
1207140 EXTRACTION, ERUPTED TOOTH              $      178.21 D7140
1207210 SURGICAL REMOVE ERUPTED TOOTH          $      192.53 D7210
1207220 REMOVE IMPACT TOOTH SOFT TISSU         $      100.14 D7220
1207230 REMOVE IMPACT TTH PARTIAL BONY         $      100.14 D7230
1207240 REM IMPACT TTH COMPLETELY BONY         $      128.76 D7240
1207250 SURG REMOVE RESIDUAL TOOTH RTS         $      100.14 D7250
1207260 ORANTRAL FISTUAL CLOSURE               $      260.12 D7260
1207270 TOOTH RE-IMPLANTATION                  $      104.05 D7270
1207272 TOOTH TRANSPLANTATOIN                  $      260.12 D7272
1207280 SURGICAL ACESS UNERUPTED TOOTH         $       65.03 D7280
1207285 BIOPSY OF ORAL TISSUE (HARD)           $      236.47 D7285
1207286 BIOPSY OF ORAL TISSUE (SOFT)           $      141.88 D7286
1207471 REMOVAL LAT EXOSTOSIS MAX/MAND         $      200.00
1207473 REMOVAL OF TORUS MADIBULARIS
1207510 INCISION& DRAINAGE ABCES INTRA         $       74.91 D7510
1208210 REMOVABLE APPLIANCE THERAPY            $      260.12 D8210
1208220 FIXED APPLIANCE THERAPY                $      260.12 D8220
1208693 REDOND RECEMENT FIXD RETAINERS         $      100.00
1209120 IXD PARTIAL DENTURE SECTIONING         $      100.00
1209940 OCCLUSAL GUARD                         $      272.27 D9940
1209941 FABRCATE ATHLETIC MOUTHGUARDS          $      130.06 D9941
1209951 OCCLUSAL ADJUSTMENT - LIMITED          $       65.03 D9951
1209972 GNGVL FLAP INCL ROOT PLAN >4           $      450.00 D4240
1209973 EXTERNAL BLEACHING                     $      450.00
1209974 INTERNAL BLEACHING                     $      300.00
111413 ADMIN INFLUENZA VACCINE                 $       70.69 G0008
111414 ADMIN PNEUMOCOCCAL VACCINE              $       70.69 G0009
111416 ADMIN HEPATITIS B VACCINE               $       70.69 90471
111417 INTRAMUSCULAR INJECTION                 $      100.00 90772
111418 12-LEAD ECG, TRACING ONLY               $      737.01 93005
111419 ARTHROCENTESIS MID JOINT/BURSA          $      266.81 20605
111420 ARTHROCENTESIS MAJOR JOINT/BUR          $      304.92 20610
111421 INJ TRIG PT TEND SHEATH OR LIG          $      550.00 20550
111422 ADMIN. HEPATITIS B. VACCINE             $       70.69 G0010
114131 FINE NEEDLE ASP W/O GUIDANCE            $      498.27 10021
114132 FLEXIBLE LARYNGOSCOPY                   $     2,139.98 31515




                                         Page 7
                                        Ancillary


114134 I & D 0F ABCESS SIMPLE                 $      489.72 10060
114140 OXYGEN-15 MIN/INTERVALS                $       68.67
114143 SUTURE REMOVAL                         $       33.28
114144 SUTURE REMOVAL KIT                     $      104.53
114145 VENIPUNCTURE                           $       49.21 36415
114147 WOUND CARE/DEBRIDEMENT                 $      299.15 11040
114149 SUTURING 2.5 CM OR LESS                $      550.10 12001
114152 URETERAL CATH INSERTION                $      243.78 51701
114215 ADULT INJECTION SQ OR IM               $      100.00 90772
114231 PULSE OXIMETRY SNGL                    $      107.20 94760
114232 PULSE OXIMETRY MONITORING/HOUR         $       44.14
114251 BRONCHODILATOR ADMINISTATION           $      388.41 94664
114541 DSTRCT BENIGN FACE ADDL                $      112.40 17003
114542 DESTRUCT BENIGN NONFACE 1ST LE         $       98.87 17000
114543 DESTRUCT BENIGN NONFACE ADDL L         $      112.40 17003
114553 PUNC ASPIR OF ABCESS/HEMATOM           $      257.30 10160
114554 I&D OF POSTOP WOUND COMPLEX            $     3,721.67 10180
114555 WART RMVL SINGLE                       $      110.25 11055
114556 WART RMVL 2 TO 4                       $       99.52 11056
114557 WART RMVL MORE THAN 4                  $      112.93 11057
114558 RMVL SKIN TAGS UP TO 15                $      290.88 11200
114562 ASPIR AND/OR INJECT, MJR JOINT         $      632.94 20610
114565 CANDIDA SKIN TEST                      $       55.08 86485
114566 COCCIDIODOMYCOSIS SKIN TEST            $       50.26 86490
114569 RMVL IMPACTED CERUMEN                  $      140.15 69210
114582 PULSE OXIMETRY MULT                    $      154.21 94761
114600 AUDIOMETRY                             $      129.05 99211
114601 TYMPANOMETRY                           $      129.05 99201
114604 PRENATAL AT RISK ASSESSMENT            $      164.10 H1000
114605 ANTEPARTUM MANAGEMENT                  $      127.63 H1001
114606 PRENATAL AT RISK CARE COORD.           $      127.63 H1002
114607 PRENATAL AT RISK EDUCATION             $      127.63 H1003
114608 PRENATAL CARE ENHANCED SRV PK          $      145.86 H1005
114613 ASPIR AND/OR INJECT, SM JOINT          $      313.01 20600
114614 ASPIR AND/OR INJECT, INT JOINT         $      377.69 20605
114616 VACCINE ADMIN, SINGLE OR COMBO         $       36.59 90471
114617 VACCINE ADMIN, EA ADD'L                $       36.59 90472
114892 AMB.CARE NEW PT., LEVEL 1              $      129.05 99201
114893 AMB.CARE NEW PT., LEVEL 2              $      140.68 99202
114894 AMB.CARE NEW PT., LEVEL 3              $      185.80 99203
114895 AMB.CARE NEW PT., LEVEL 4              $      232.80 99204
114896 AMB CARE NEW PT LEVEL 5                $      296.74 99205
114897 AMB.CARE EST. PT., LEVEL 1             $      129.05 99211
114898 AMB.CARE EST. PT., LEVEL 2             $      140.68 99212
114899 AMB.CARE EST. PT., LEVEL 3             $      160.78 99213
114900 AMB.CARE EST. PT., LEVEL 4             $      204.38 99214
114901 AMB.CARE EST. PT., LEVEL 5             $      291.00 99215
114912 INJECTION HEMORRHOID W/ PHENOL         $     1,732.50 46500
114913 INJECT HEMORRHOID W/ OLIVE OIL         $     1,732.50 46500




                                        Page 8
                                        Ancillary


114915 BREAST BX W/O IMAGE GUIDANCE           $      802.59 19100
114917 FINE NEEDLE ASPIR W/ IMAGE             $     1,163.00 10022
114918 INCISION & DRAINAGE, ABSCESS           $      489.72 10060
114919 BX SKIN SQ TISSUE SIMPLE CLS           $      502.90 11100
114920 BX SKIN SQ ADDITIONAL LESIONS          $      139.76 11101
114921 ASPIRATION CYST                        $      407.87 60001
100702 ORAL RAE ENDOTRACHEAL TUBE             $      177.89
100703 REINFORCED ENDOTRACHEAL TUBE           $      211.78
100704 MICROLARYNGEAL ENDOTRACH TUBE          $      415.88
100708 DISPOSABLE LARYNGEAL BLADE             $      109.75
100714 SHEATH, TRANSESOPHAGEAL                $      190.61 C1756
100726 LONG EPIDURAL NEEDLE                   $      134.77
100727 EPIDURAL CATHETER                      $      207.94 C1755
170000 ANES TUBE ET                           $      204.45
170001 IV BLOOD FILTER PALL                   $      137.73
170002 IV BLOOD PUMP Y-TYPE                   $      269.68
170407 ANES TUBE ET                           $      204.45
170410 ANES TRAY EPIDURAL                     $      843.82
170415 ANES TRAY SPINAL                       $      735.04
170429 ANES NORMOSOL                          $      543.70
170433 IV BLOOD FILTER PALL                   $      137.73
170437 IV BLOOD PUMP Y-TYPE                   $      269.68
170439 IV ADMINISTRATION SET                  $      166.74
170442 IV EXTENSION W/2 INJ SITES             $      123.23
170544 MISCELLANEOUS SUPPLY                   $          -
170620 ANESTHESIA BREATHING TRACT             $      373.34
170744 IV MICRODRIP SET                       $      639.40
170992 SOL IV 500CC                           $      547.00
170993 SOL, IV 1000CC                         $      598.07
170995 TUBING LEVEL 1 D-100                   $     1,396.21
171616 TUBING ARTERIAL LINE M/F               $      156.83
171634 ANES TRAY CVP MONITOR                  $      133.31
177006 ANES-CAT 1-BASIC OUTLYING AREA         $     1,921.92
177007 ANES-CAT 2+ALINE OUTLYING AREA         $     2,513.28
177100 ANES-CAT 1- BASIC - 1ST HOUR           $     3,057.67
177101 ANES-CAT 1 - EA ADDL MIN               $       39.71
177102 ANES-CAT 2-BASIC+A LINE-1ST HR         $     4,180.44
177103 ANES-CAT 2 - EA ADDL MIN               $       52.10
177104 ANES-CAT 3+CVP,SWAN-1ST HOUR           $     5,635.25
177105 ANES-CAT 3 - EA ADDL MIN               $       80.85
177202 ANES CONT NERVE BLOCK TRAY             $      925.32
177203 ANES CONT NERVE BLOCK CATHS            $     1,195.70
177204 ANES STIMUPLEX CATH                    $      153.12
177206 ANES ET TUBE EXCHANGE CATH             $      229.68
177210 TUBE ET DOUBLE LUMEN                   $      370.92
177216 TUBING HOTLINE                         $      235.17
177225 ANES NACL 0.9% HEPARIN 2U/ML           $       43.56
177226 ANES INTRODUCER KIT MAC 9.5FR          $      270.60
177228 ANES PA CATHETER LATEX FREE            $     1,967.90




                                        Page 9
                                        Ancillary


177229 ANES CATH PA PEDIATRIC                 $      529.32
177230 CATH PA HEPARIN FREE                   $      220.00
177232 ANES ET INTUBATING INTRODUCER          $      571.56
177233 ANES EMER/EXCH AIRWAY CATH             $      471.90
178487 ANES TUBE ET REINFORCED                $      146.30
290534 NON-STRESS TEST                        $      580.47 59025
290539 TRFSN, INTRAUTERINE, FETAL             $     1,663.20 36460
290541 ULTRASOUND LIMITED                     $      496.74 76815
290542 BREECH VERSION ATTEMPT                 $     1,631.48
290544 REMOVAL OF RETAINED PLACENTA           $     4,457.15 59414
290635 TRANS ABD AMNIOINFUSION W/US           $      565.19 59070
290637 OXYGEN USE PER HOUR                    $       76.98
290647 FETAL BIOPHYS PROF W/NST               $     1,558.24 76818
290700 RETURN TO OR/MINOR PROCEDURE           $     3,763.00
290701 VAGINAL BIRTH W/HYSTERECTOMY           $     7,300.00
290702 RECOVERY PER HOUR                      $     1,063.80
290703 L & D MINOR PROCEDURE                  $     2,118.70
290704 BLOOD PATCH                            $     1,614.82 62273
290705 IV INFUSION HYDRATION 1ST HOUR         $      615.80 90760
290706 IV INFUSION HYDRATION EA ADDL          $      134.30 90761
290707 IV INFUSION THERAPY 1ST HOUR           $      615.80 90765
290709 IV THERAPY SEQ FIRST HOUR              $      134.30 90767
290710 IV THERAPY-CONCURRENT                  $      134.30 90768
290711 THERAPEUTIC IM/SQ INJECTION            $      134.30 90772
290713 IV PUSH INITIAL                        $      270.35 90774
290714 IV PUSH EA ADDL SEQUENTIAL             $      270.35 90775
290716 AMNIOCENTESIS, THERAPEUTIC             $     1,352.22 59001
290717 INJ ANESTH; PUDENDAL NERVE             $      316.89 64430
290718 INSERT CERVICAL DILATOR                $      588.18 59200
290719 OBSERVATION PER HOUR                   $      123.12 G0378
290720 DOPPLER COLOR FLOW                     $      710.46 93325
290721 U/S OB W/ DETAIL FETAL EXAM            $      499.65 76811
290722 U/S OB, ADDL GESTATION                 $      872.53 76812
290723 U/S OB FOLLOW UP PER FETUS             $      356.40 76816
290725 FETAL BIOPHS PROFILE W/O NST           $      802.16 76819
290726 U/S GUIDE IUT/CORDOCENTESIS            $      241.29 76941
290727 U/S GUIDE FOR AMNIOCENTESIS            $      381.08 76946
290728 AMNIOCENTESIS, WITH U/S                $      805.54 59000
290729 CATHETER, MAKRI TAMPONADE              $      646.95
292501 VAGINAL DELIVERY                       $     6,290.13 59409
292502 VAGINAL DELIVERY W/TUBAL LIGA          $     6,628.37
292503 C-SECTION                              $     6,288.50
292504 C-SECTION W/TUBAL LIGATION             $     7,605.98
292510 VAGINAL MULTIPLE BIRTHS                $     7,500.00
292511 C-SECTION MULTIPLE BIRTHS              $     7,750.00
292512 RETURN TO OR/MAJOR PROCEDURE           $     5,000.00
292640 C-SECTION W/HYSTERECTOMY               $     2,223.33
292642 VAGINAL DELVRY-W/VBAC SUCCESS          $     7,456.27
292643 C-SECTION W/FAILED VBAC                $     7,686.04




                                        Page 10
                                         Ancillary


 298000 L & D NEW PATIENT, LEVEL 1             $      129.05 99201
 298001 L & D NEW PATIENT, LEVEL 2             $      140.69 99202
 298002 L & D NEW PATIENT, LEVEL 3             $      185.80 99203
 298003 L & D NEW PATIENT, LEVEL 4             $      232.80 99204
 298004 L & D NEW PATIENT, LEVEL 5             $      296.73 99205
 298005 L & D EST. PATIENT, LEVEL 1            $      129.05 99211
 298006 L & D EST. PATIENT, LEVEL 2            $      140.69 99212
 298007 L & D EST. PATIENT, LEVEL 3            $      160.77 99213
 298008 L & D EST. PATIENT, LEVEL 4            $      204.38 99214
 298009 L & D EST. PATIENT, LEVEL 5            $      291.00 99215
 298010 VENIPUNCTURE                           $       49.21 36415
 298011 ULTRASOUND, TRANSVAGINAL               $      433.07 76830
 400029 GI BEDSIDE PROC UP TO 1 HR             $     2,744.00
 400046 BILIARY MANOMETRY                      $      699.75
 400164 ENDOSCOPIC ULTRASOUND                  $     3,293.00
 400165 ENDO ULTRASOUND W/FNA                  $     3,293.00
 400210 COLON I-WO ANES UP TO 1 HR             $     2,131.00
 400212 COLON II - W/ ANES UP TO 1 HR          $     2,841.00
 400213 PEG TUBE PLACEMENT                     $     2,525.50
 400214 EGD-GI PX I WO ANES UP TO 1 HR         $     2,938.00
 400216 EGD-GI PX II W ANES UP TO 1 HR         $     3,138.00
 400220 ERCP-GI-WITH ANES UP TO 1 HR           $     7,297.00
 400222 SIGMOID I - WO ANES UP TO 1 HR         $     1,395.00
 400224 SIGMOID II- W/ANES UP TO 1 HR          $     2,389.00
 400226 GI PROC I-WO ANES UP TO 1 HR           $     3,390.00
 400228 GI PROC II- W/ANES UP TO 1 HR          $     7,943.00
 400229 GI PROCEDURE-EACH ADDL 30 MIN          $      420.00
 400230 ENDO CATH- BILE DUCT S & I             $      500.00 74328
 400231 ENDO CATH- PANCR DUCT S & I            $      500.00 74329
 400232 ENDO CATH-BIL- PANCR DUCT S& I         $      650.00 74330
6350700 LIVER BIOPSY                           $     2,282.00
6350701 COLON I- WO ANES UP TO 1 HR            $     2,131.00
6350702 COLON II- W/ANES UP TO 1 HR            $     2,841.00
6350703 EGD-GI PX I-WOANES UP TO 1 HR          $     2,938.00
6350704 EGD-GI PX II W ANES UP TO 1 HR         $     3,138.00
6350705 SIGMOID I-WO ANES UP TO 1 HR           $     1,395.00
6350706 SIGMOID II- W/ANES UP TO 1 HR          $     2,389.00
6350707 GI PROC I-WO ANES UP TO 1 HR           $     3,390.00
6350708 GI PROC II- W/ANES UP TO 1 HR          $     7,943.00
6350709 GI PROCEDURE-EACH ADDL 30 MIN          $      420.00
 410002 EGD TRAY                               $      697.75
 410003 PEG TRAY                               $      967.12
 410004 COLONOSCOPY/SIGMOID TRAY               $      612.62
 410005 ERCP TRAY                              $      930.31
 410010 INSYTE IV CATHETER 22G                 $       93.49
 410012 STENT- WALL COATED-W/DEL               $     3,183.84 C1876
 410014 IV EXTENSION SET                       $      104.70
 410015 BLOOD ADMIN SET Y TYPE                 $       87.98
 410017 IV SOLUTION, 1000CC                    $       61.08




                                         Page 11
                                        Ancillary


410030 CYTOLOGY BRUSH                         $      476.69
410031 SCLEROSING NEEDLE                      $      442.96
410032 BIOPSY FORCEPS                         $      800.00
410033 SNARE                                  $      498.39
410041 TUBE, ENTRIFLEX (NG)                   $      316.25
410042 TUBE, JEJUNAL FEED/SINGL LUMEN         $      535.79
410043 TUBE,JEJUNOSTOMY SUCTION/DOUBL         $      569.75
410044 TUBE,REPLACEMENT GASTROSTOMY           $      362.96
410045 TUBE, NASO-ENTERO FEED (NG/J)          $      285.97
410046 MAXFORCE DILATION BALLOON              $      587.64 C1726
410047 JAGWIRE                                $      432.58 C1769
410050 CRE DILATION BALLOON                   $      672.22 C1726
410061 STENT-WILSON COOK Z COLONIC            $     2,018.27 C1877
410062 ACHALASIA DILATOR                      $      919.09
410070 STENT-ENTERAL WALL                     $     5,582.42 C1876
410080 INTRODUCER, OASIS                      $      282.49 C1769
410081 CANNULA, ERCP                          $      581.57
410082 RETRIEVAL BALLOON                      $      966.14
410083 RETRIEVAL BASKET, SOFT WIRE            $     1,211.43
410084 STENT-ESOPH WALL COAT-W/DEL            $     4,962.16 C1874
410085 LITHOTRIPSY BASKET                     $     1,379.97
410086 SPHINCTERTOME/PAPILLOTOME              $     1,058.50
410087 STENT-BILI RAP EXCH COAT-W/SY          $     3,029.09 C1874
410093 STENT-BILIARY WALL-NON-CO W/DE         $     2,787.05 C1876
410094 BILIARY DILATION BALLOON               $     1,208.13 C1726
410095 GLIDEWIRE                              $     1,445.19 C1769
410098 HOT BIOPSY FORCEPS                     $     1,198.35
410101 BICAP PROBE CATHETER                   $     2,294.72
410106 OXYGEN MASK                            $      143.53
410114 ENDO MUCOSAL RESECTION KIT             $      559.45
410115 LIGATION-QUICK CLIP                    $      249.95
410116 LIGATION TRI-CLIP                      $      387.78
410117 LIGATION-RESOLUTION CLIP               $      424.71
410119 VARICEAL BANDING KIT                   $      640.39
410120 EUS BIOPSY NEEDLE                      $      686.31
410121 EHL PROBE                              $      714.51
410122 ARGON COAG PROBE CATHETER              $      644.03
410124 NASO BIL DRAINAGE SET                  $      309.10 C1729
410125 BILIARY MANOMETRY CATHETER             $      430.88
410127 ROTH RETRIEVAL NET                     $      522.37
410130 WIRELESS CAPSULE                       $     1,278.37
410132 CORE BIOPSY NEEDLE-EUS                 $      821.63
410133 ENDO LOOP                              $      363.97
410134 COLON DECOMPRESSION KIT                $      337.00
410135 BILIARY DILATION CATHETER              $      578.05
410136 STENT-BILI/PAN COAT/W/DEL SYS          $     3,636.59 C1874
410610 SURGISIS ES STRIP                      $      521.59
410611 SPOT TATOO MARKER-GI PROCEDURE         $      127.66
410615 QUICKSILVER PROBE CATHETER             $      376.19




                                        Page 12
                                         Ancillary


 410616 DOUBLE BALLOON TRAY                    $      697.75
 410617 STENT-ESOPHAGEAL ULTRAFLEX             $     2,914.02 C1874
 410618 EUS TRAY                               $      697.75
 410619 FNA TRAY                               $      697.75
 410620 ABLATION CATHETER                      $     1,960.62 C1726
 410621 SIZING BALLOON                         $      771.30
 410622 IV BLOOD PUMP Y-TYPE                   $       39.82
 410623 CATHETER, DELIVERY SPY SCOPE           $     1,857.63
 410624 FORCEPS, BIOPSY SPYBITE                $     1,121.73
 410625 DERMABOND                              $      168.43
 410626 STENT, NON-METAL                       $      304.24
 410627 CAPSULE ENDOSCOPE DELIVERY DEV         $     1,185.80
 410628 ANESTHESIA BREATHING TRACT             $       49.07
 410639 LOCM 300-349 MG/ML IODINE,50ML         $       97.33 Q9949
6350628 ANESTHESIA BREATHING TRACT             $       49.07
6350801 EGD TRAY                               $      697.75
6350802 COLONOSCOPY/SIGMOID TRAY               $      672.22
6350803 INSYTE IV CATHETER 22G                 $       93.49
6350805 IV EXTENSION SET                       $      104.70
6350806 IV SOLUTION, 1000CC                    $       61.08
6350807 SCLEROSING NEEDLE                      $      442.96
6350808 SNARE                                  $      498.39
6350809 HOT BIOPSY FORCEPS                     $     1,198.35
6350810 BICAP PROBE CATHETER                   $     2,294.72
6350812 OXYGEN MASK                            $      143.53
6350813 CYTOLOGY BRUSH                         $      476.69
6350814 BIOPSY FORCEPS                         $      800.00
6350815 CRE DILATION BALLOON                   $      672.22 C1726
6350816 QUICKSILVER PROBE CATHETER             $      376.19
6350817 RETRIEVAL BASKET, SOFT WIRE            $     1,211.43
6350818 ROTH RETRIEVAL NET                     $      522.37
6350819 SPOT TATOO MARKER-GI PROCEDURE         $      127.66
6350820 LIVER BIOPSY TRAY                      $      537.87
6350821 IV BLOOD PUMP Y-TYPE                   $       39.82
 430301 IBD NEW PT., LEVEL1                    $      129.05 99201
 430302 IBD NEW PT., LEVEL 2                   $      140.68 99202
 430303 IBD NEW PT., LEVEL 3                   $      185.80 99203
 430304 IBD NEW PT., LEVEL 4                   $      232.80 99204
 430305 IBD NEW PT., LEVEL 5                   $      296.74 99205
 430306 IBD EST. PT., LEVEL 1                  $      129.05 99211
 430307 IBD EST. PT., LEVEL 2                  $      140.68 99212
 430308 IBD EST. PT., LEVEL 3                  $      160.78 99213
 430309 IBD EST. PT., LEVEL 4                  $      204.38 99214
 430310 IBD EST. PT., LEVEL 5                  $      291.00 99215
 460208 PANC.NEW PT., LEVEL1                   $      129.05 99201
 460209 PANC.NEW PT., LEVEL 2                  $      140.68 99202
 460210 PANC.NEW PT., LEVEL 3                  $      185.80 99203
 460211 PANC.NEW PT., LEVEL 4                  $      232.80 99204
 460212 PANC.NEW PT., LEVEL 5                  $      296.74 99205




                                         Page 13
                                        Ancillary


460213 PANC.EST. PT., LEVEL 1                 $      129.05 99211
460214 PANC.EST. PT., LEVEL 2                 $      140.68 99212
460215 PANC.EST. PT., LEVEL 3                 $      160.78 99213
460216 PANC.EST. PT., LEVEL 4                 $      204.38 99214
460217 PANC.EST. PT., LEVEL 5                 $      291.00 99215
860301 MOTILITY NEW PT., LEVEL 1              $      129.05 99201
860302 MOTILITY NEW PT., LEVEL 2              $      140.68 99202
860303 MOTILITY NEW PT., LEVEL 3              $      185.80 99203
860304 MOTILITY NEW PT., LEVEL 4              $      232.80 99204
860305 MOTILITY NEW PT., LEVEL 5              $      296.74 99205
860306 MOTILITY EST. PT., LEVEL 1             $      129.05 99211
860307 MOTILITY EST. PT., LEVEL 2             $      140.68 99212
860308 MOTILITY EST. PT., LEVEL 3             $      160.78 99213
860309 MOTITLIY EST. PT., LEVEL 4             $      204.38 99214
860310 MOTILITY EST. PT., LEVEL 5             $      291.00 99215
860311 24 HR ESOPHAGEAL PH STUDY              $     1,940.13 91034
860312 INTRA ESOPH DRIP/BERNSTEIN TST         $      770.14 91030
860313 ESOPHAGEAL MANOMETRY                   $     3,437.50 91010
860314 ESOPHAGEAL MANOMETRY STIMULATE         $     2,628.12 91011
860315 ESOPH MANOMETRY-INTRA ESOP DRP         $     1,823.25 91012
860316 LACT/GLUC HYDROGEN BREATH TEST         $     1,808.73 91065
860317 HELIOBACTER PYLORI                     $      391.48 83013
860318 DRUG ADMIN & SAMPLE COLLECTION         $      673.65 83014
860319 INTRO LONG GASTRO TUBE - X-RAY         $      665.39 74340
860320 INTRO LONG GASTRO TUBE                 $      808.37 44500
860321 GASTRIC MOTILITY STUDIES               $     1,940.13 91020
860322 ELECTROGASTROGRAPHY                    $     1,221.39 91132
860323 ANORECTAL MANOMETRY                    $     1,460.54 91122
860324 ANORECTAL BIOFEEDBACK                  $      934.81 90911
860325 COLONIC MANOMETRY                      $      681.23 91299
860326 GASTRIC INTUBATION                     $      278.46 89135
860327 GASTRIC ANALYSIS TEST                  $     1,034.00 91052
860328 GASTRIC INTUBATION 2 HR                $      332.67 89136
860329 COLLECTION MULT FRACT SPECIME          $      853.29 89105
860330 CRYSTAL ID BY LIGHT MICROSCOPY         $      275.35 89060
860336 PARASYMPATHETIC FUNCTION TEST          $      198.56 95921
860339 CATHETER SOLID STATE                   $      481.34
860340 24 HR PH PROBE                         $     1,117.89
860341 BRAVO 48 HR PH STUDY                   $     4,065.60 91035
860342 BRAVO CAPSULE                          $     1,058.51
860343 ANTRODUODENAL MANOMETRY                $     1,940.13 91020
860344 PUDENDAL EMG NERVE STUDY               $      934.81 90911
860345 ANORECTAL ULTRASOUND                   $      794.58 76872
860346 IMPEDANCE PH REFLUX                    $     1,940.13 91034
860347 IMPEDANCE PROBE                        $      580.80
860348 IMPEDANCE SM BOWEL MANOMETRY           $     1,940.13 91020
860353 ANORECTAL CATHETER                     $      382.71
860355 INJ SING/MULT TRIGGER POINT            $      550.00 20552
860356 VASOACTIVE INTESTINAL PEPTIDE          $       61.88 84586




                                        Page 14
                                     Ancillary


480001 2D ECHO M-MODE                      $     1,902.05 93307
480010 DOPPLER COLOR FLOW                  $      723.61 93325
503007 BALLOON INTRAORTIC                  $     7,864.31
503009 INTRA AORTIC MONITOR                $     4,097.28
503022 CATH INTRA-AORTC BALLOON            $     5,561.80
503023 INTRODUCER                          $      102.10
503025 GUIDE WIRE                          $       94.00 C1769
503028 TRAY CUTDOWN                        $      406.75
503032 CATH MULTIMED                       $      359.74
520001 CATH PACK -CATH LAB *               $      717.08
520004 PRESSURE TUBING                     $      268.35
520005 COOK NEEDLE                         $      237.33
520008 LOCM<149MG,OMNIPAQUE, 1 ML          $        5.20 Q9945
520011 INTRODUCER CATH                     $      400.46
520012 DILATOR                             $      199.09
520013 GUIDE WIRE                          $      811.14 C1769
520014 SUTURE                              $       71.35
520018 INJECTOR                            $      547.54
520022 D5W 250ML                           $      109.87
520023 D5W 500ML                           $       91.56
520025 D5 .2% NACL                         $       59.90
520026 D5 .45% NACL                        $      120.88
520040 CATH FOLEY                          $      322.99
520047 FEMSTOP                             $      432.38
521001 CATH DIAGNOSTIC ANGIO               $      756.98 C1887
522001 CATH THERMODILUTION                 $     1,962.57 C1887
522003 BIOPTOME                            $     3,894.26
523001 CATH GUIDING                        $     1,652.85 C1887
523002 CATH DILITATION PTCA                $     9,061.44 C1725
523003 GUIDE WIRE PTCA                     $     1,047.81 C1769
523004 GUIDEWIRE EXCHANGE PTCA             $      989.00 C1769
523007 GUIDE WIRE ACCESSORY KIT            $      564.62 C1769
523009 CATH INFUSION PTCA                  $     1,070.37 C1725
523012 INDEFLATOR PTCA                     $     1,276.67
523013 CATH DUOSTAT PTCA                   $      375.01 C1725
523014 PUNCTURE KIT PTCA                   $      176.61
525001 CATH THERMODILUTION                 $      490.60 C1887
525002 CATH BERMAN                         $      706.44 C1887
525003 CATH BALLOON WEDGE                  $      309.52 C1887
525004 CATH DILATION SEPTOSTOMY            $      845.53 C1726
525007 TEMP PROBE PEDS CATH LAB *          $      562.24
525010 GUIDE WIRE TIP DEFLECTOR            $      480.83 C1769
526001 CATH DILATION VALVULOPLASTY         $     4,553.33 C1726
526005 INTRO/SHEATH TRNSPTAL NEEDL         $      775.72 C1893
527005 TEGADERM                            $      105.34
527018 CATH ARTHERECTOMY                   $     6,680.14 C1714
527024 SMART NEEDLE                        $      677.55
527027 CATH ULTRASOUND INTRAVASC           $     4,061.49 C1753
528002 CATH ANGIOPLASTY LASER              $     7,023.08 C1885




                                     Page 15
                                        Ancillary


528008 EMOBOLIZATION COIL IMPLNT              $       429.73
528009 SNARE RETRIEVER DEVICE                 $       741.83 C1773
528010 CATH BALLOON PERIPH                    $      8,171.47 C1725
528013 PERICARDIOCENTESIS KIT                 $       492.32
528022 LOCM 200-249MG/ML IODINE, 1ML          $          5.21 Q9947
528023 LOCM<149MG,VISIPAQUE                   $          5.21 Q9945
528024 LOCM<149MG,HYPAQUE, 1 ML               $          5.21 Q9945
528027 LOCM 250-299MG/ML IODINE, 1ML          $          5.21 Q9948
528028 D STAT FLOWABLE HEMOSTAT               $       953.79 C1760
528038 CLOSURE DEVICE VASCULAR                $      1,068.11 C1760
528040 INTRO/SHEATH EP FIXED NON-PEEL         $       629.56 C1766
528051 STENT, NON-COA/CON-COV W/DEL           $      8,597.03 C1876
528057 CATH ULTRASOUND ACUNAV                 $      9,836.05 C1759
528059 SEPTAL DEFECT CLOSE IMPLANT            $     20,666.38 C1817
528060 INTRO/SHEATH GUIDE EP TRNSPTL          $       570.49 C1893
528061 CATH SIZING BALLOON                    $       845.96
528063 STENT COATED W/ DELIVERY               $     11,944.02 C1874
528064 TANDEM HEART L-VAD IMPLANT             $     17,401.38
528067 EMBOLIC PROTECTION SYSTEM              $      4,610.91 C1884
528069 CATH BALLOON PTA                       $      1,597.60 C1725
528070 CATH DILITATION PTA                    $      2,262.99 C1725
528080 CATH U.K. INFUSION CATH                $       461.18
528090 CATHETER, INFUSION                     $      1,312.67
528093 CATH FOGARTY                           $      1,362.00 C1757
528095 GUIDE WIRE-J BENTSON COONS             $       215.55 C1769
528096 WIRE UROKINASE INFUSION                $       728.05 C1769
528097 GLIDE WIRE TERUMO                      $       188.08 C1769
528098 GLIDE/AMPLAX WIRE TERUMO               $       223.21 C1769
528099 GUIDE WIRE                             $       748.13 C1769
528100 GUIDE WIRE ACCESSORY KIT               $       728.05 C1769
528104 IVC SNARE REMOVAL DEVICE               $      1,425.24 C1773
528125 STENT COATED W/O DELIVERY              $      3,893.67 C1875
528164 VENA CAVA FILTER IMPLANT               $      4,163.87 C1880
528165 CATH GUIDING                           $       458.63 C1887
528310 CATH THROMBCT/EMBOLECT-50CM            $      2,109.35 C1757
528311 CATH THROMBCT/EMBOLECT-120CM           $      4,245.75 C1757
528380 IONIC CONTRAST 50 ML                   $        85.17
528383 COILS MWCE IMPLANT                     $       153.80
528384 MICRO PUNCTURE SET                     $       129.47
528392 COIL IMPLANT                           $      1,829.65
528427 CATH SUPPORT CTO                       $      1,472.63 C2628
528428 WATCHMAN IDE#G020312/S13               $          1.21
528429 HEARTPOD IDE# G050018                  $          1.21
528432 IV SET BLOOD TUBING                    $        36.81
528433 RADIAL ARTERY KIT                      $       210.10
528434 STATLOCK                               $       109.18
528435 TRAY CENTRAL VENOUS                    $       113.47
528436 BIOPSY KIT                             $       137.63
528438 RECOVERY CATHETER                      $      3,596.18




                                        Page 16
                                        Ancillary


528439 CAROTID STENT SYSTEM                   $      7,425.00 C1876
528440 EMBOLIC PROTECTION SYSTEM              $      5,115.00 C1884
528441 CATH PERIPHERAL DILITATION             $       955.13
528442 CATH ENDOPROSTHESIS DELVRY             $      5,763.84
528443 INTRODUCER SHEATH                      $       360.20
529002 G030064/S41 CVRS STEERBL GUIDE         $      5,445.00 C1769
529003 G030064/S41 CVRS DEL SYS W/CLP         $     21,780.00
529005 CATH DILITATION POLARCATH              $      1,633.50 C1725
529007 INFLATION UNIT                         $      2,586.38
529008 LOCM 300-349MG/ML IODINE, 1 ML         $          5.21 Q9949
529009 LOCM 350-399 MG/ML IODINE, 1ML         $          5.21 Q9950
529014 LOCM >400MG/ML IODINE, 1 ML            $          5.21 Q9951
529015 IVC SNARE REMOVAL DEVICE               $      1,728.76 C1773
529016 CATHETER FLOWIRE                       $       952.55 C1769
529019 CATH DIAGNOSTC ANGIO MULTIPACK                           C1887
510119 OP ROUTINE ECG                         $       411.90 93005
510219 OP ECG RHYTHM STRIP                    $       120.87 93041
510819 OP ECG CARDIOVERSION                   $      2,759.61 92960
510919 OP ECG SIGNAL AVR HIGH GAIN TE         $       824.86 93278
512319 OP CARDVERT DEFIB ANAL WO PR D         $       421.81 93743
512419 OPCARDVERT DEFIB ANAL W PR DUA         $       527.77 93744
512519 OP CARDVERT DEFIB ANAL WO PR S         $       372.04 93741
512619 OP CARDVERT DEFIB ANAL W PR SG         $       468.77 93742
512819 OP TILT TABLE TEST                     $      2,696.73 93660
513319 OP ECG 24 HR SCAN ANALY W RPT          $       691.98 93226
514419 OP ECG 24 HR HOLTER, RECORD            $       396.55 93225
516130 OP PACER ANLY DUAL NO REPROG           $       313.65 93731
516230 OP PACER ANLY DUAL WITH REPROG         $       181.98 93732
516330 OP PACER ANLY DUAL TELEPHONIC          $       179.46 93733
516430 OP PACER ANLY SNGL W/O REPROG          $       264.65 93734
516530 OP PACER ANLY SNGL WITH REPROG         $       136.01 93735
516630 OP PACER ANLY SNGL TELEPHONIC          $       125.78 93736
516719 OP PATIENT DEMAND EVENT RECOR          $       325.77 93270
516819 OP PATIENT DEMAND ANALY & RPT          $      1,174.82 93271
517202 OP EKG NEW PT., LEVEL 1                $       129.05 99201
517203 OP EKG NEW PT., LEVEL 2                $       140.68 99202
517204 OP EKG NEW PT., LEVEL 3                $       185.80 99203
517205 OP EKG NEW PT., LEVEL 4                $       232.80 99204
517206 OP EKG NEW PT., LEVEL 5                $       296.74 99205
517207 OP EKG EST. PT., LEVEL 1               $       129.05 99211
517208 OP EKG EST. PT., LEVEL 2               $       140.68 99212
517209 OP EKG EST. PT., LEVEL 3               $       160.78 99213
517210 OP EKG EST. PT., LEVEL 4               $       204.38 99214
517211 OP EKG EST. PT., LEVEL 5               $       291.00 99215
517225 OP BPM 24HR OR >, SCAN ANAL W          $       683.88 93788
517226 OP BPM 24HR OR >,RECORD                $       415.60 93786
517229 OP T-WAVE ALTERNANS                    $      4,293.91 93025
518001 IP TILT TABLE TEST                     $      3,505.75 93660
518020 IP ROUTINE ECG                         $       535.46 93005




                                        Page 17
                                        Ancillary


518022 IP ECG RHYTHM STRIP                    $       157.13 93041
518023 IP PATIENT DEMAND EVNT RECORD          $       423.49 93270
518024 IP PATIENT DEMAND ANALY & RPT          $      1,985.44 93271
518025 IP ECG SIGNAL AVR HGH GAIN TST         $      1,072.31 93278
518026 IP ECG 24 HR HOLTER, RECORDING         $       515.52 93225
518027 IP ECG 24 HR SCAN ANALY W RPT          $       899.57 93226
518028 IP PACER ANLY DUAL WITH REPROG         $       236.57 93732
518029 IP PACER ANLY DUAL TELEPHONIC          $       233.30 93733
518030 IP PACER ANLY SNGL WITH REPROG         $       176.81 93735
518031 IP PACER ANLY SNGL TELEPHONIC          $       163.51 93736
518032 IP CARDVERT DEFIB ANAL W PR SG         $       609.41 93742
518033 IP CARDVERT DEFIB ANAL W PR DU         $       686.10 93744
518034 IP ECG CARDIOVERSION                   $      3,587.50 92960
518035 IP PACER ANLY DUAL NO REPROG           $       407.75 93731
518036 IP PACER ANLY SNGL W/O REPROG          $       344.05 93734
518037 IP CARDVERT DEFIB ANL WO PR DL         $       548.37 93743
518038 IP CARDVERT DEFIB ANAL WO PR S         $       483.64 93741
519099 OP THERAPUTIC INJECTION IM/SQ          $       100.00 90772
532971 EXTRN CIRCULATORY&CARDIOASSIST         $      1,183.60 92971
532975 THRMOBOLYSIS INTRACOR INFUSN           $      4,767.84 92975
532977 THROMBOLYSIS,IV INFUSION               $      1,038.35 92977
532978 INTRAVSC U/S CORONRY/GRFT VSSL         $      6,523.84 92978
532979 INTRAVSC U/S COR/GRFT ADDL VSS         $      6,523.84 92979
532980 STENT PLACEMENT                        $     16,372.49 92980
532981 STENT PLACE ADDL VESSEL                $     17,963.73 92981
532982 PTCA SINGLE VESSEL                     $     13,225.17 92982
532984 PTCA EA ADDL VESSL                     $     13,225.17 92984
532987 VALVULOPLASTY MITRAL                   $     11,726.11 92987
532992 ATRIAL SEPTECTOMY SEPTOSTOMY           $     21,852.60 92992
532995 ARTHERECTOMY MECHANICAL                $     23,814.12 92995
532996 ARTHERECTOMY EA ADDL VESSL             $     23,187.01 92996
533010 PERIOCARDIOCENTESIS                    $       856.39 33010
533280 FLUOROSCOPY UP TO 1HR                  $      1,088.03 76000
533400 AORTIC VALVUOPLASTY                    $     13,225.17 92986
533471 VALVULOPLASTY PULM VALVE               $     13,225.17 92990
533501 RIGHT HEART CATH                       $      8,363.74 93501
533503 INSERT SWAN GANZ CATH                  $      2,301.42 93503
533505 ENDOMYOCARDIAL BIOPSY                  $      2,927.75 93505
533510 LEFT HEART CATH RETROGRADE             $      9,699.38 93510
533536 INSERT INTRA-AORT BALLOON              $      3,402.52 33967
533539 INJECT ARTERIAL CONDUIT-IMA            $       401.13 93539
533540 INJECT AORTOCORNRY BYPASS GRFT         $       429.22 93540
533541 INJECT FOR PULMONARY ANGIO             $       238.13 93541
533542 INJECT FOR RT VENT/ATR ANGIO           $       287.98 93542
533543 INJECT FOR LEFT VENT/ATR ANGIO         $       287.98 93543
533544 INJECT FOR AORTOGRAPY                  $       253.06 93544
533545 INJECT FOR CORONARY ANGIO              $       401.13 93545
533549 RHC & RETROGRADE LHC                   $     11,592.91 93526
533799 CATH UNLISTED PROCEDURES               $          -   93799




                                        Page 18
                                        Ancillary


535894 EMBOLIZATION TRANSCATH                 $      5,678.67 75894
537204 EMBOLIZATION NON-HEAD/NECK             $      6,183.18 37204
539355 S&I VENTRIC/ATRIAL ANGIO               $      1,928.87 93555
539356 S&I PULM/CORON/AORT ANGIO              $      3,227.47 93556
539357 CARDIAC CATH NEW PT., LEVEL 1          $       129.05 99201
539358 CARDIAC CATH NEW PT., LEVEL 2          $       140.68 99202
539359 CARDIAC CATH NEW PT., LEVEL 3          $       185.80 99203
539360 CARDIAC CATH NEW PT., LEVEL 4          $       232.80 99204
539361 CARDIAC CATH NEW PT., LEVEL 5          $       296.74 99205
539362 CARDIAC CATH EST. PT. LEVEL 1          $       129.05 99211
539363 CARDIAC CATH EST. PT. LEVEL 2          $       140.68 99212
539364 CARDIAC CATH EST. PT.,LEVEL 3          $       160.78 99213
539365 CARDIAC CATH EST. PT.,LEVEL 4          $       204.38 99214
539366 CARDIAC CATH EST. PT.,LEVEL 5          $       291.00 99215
539378 STENT PLACE LC-SNGL VESSL              $     24,351.25 G0290LC
539379 STENT PLACE LD-SNGL VESSL              $     24,351.25 G0290LD
539380 STENT PLACE RC-SNGL VESSL              $     24,351.25 G0290RC
539381 STENT PLACE LC-EA ADDL VESSL           $     24,351.25 G0291LC
539382 STENT PLACE LD-EA ADDL VESSL           $     24,351.25 G0291LD
539383 STENT PLACE RC-EA ADDL VESSL           $     24,351.25 G0291RC
539384 INSERT L-VAD TANDEM HEART              $     12,327.00 33975
539386 REPAIR PATENT DUCTUS ARTERIOS          $     12,234.60 33822
539387 CLOSURE ATRIAL DEFECT                  $     20,692.43 93580
539388 CLOSURE VENTRICULR DEFECT              $      8,167.50 93581
539390 STENT PLACE ADDL VESSL-LD              $     17,963.73 92981LD
539391 STENT PLACE LD ARTERY                  $     16,372.49 92980LD
539392 STENT PLACE LC ARTERY                  $     16,372.49 92980LC
539393 STENT PLACE ADDL VESSL-RC              $     17,963.73 92981RC
539394 STENT PLACE ADDL VESSL-LC              $     17,963.73 92981LC
539395 RHC&TRNSPT LHC OPEN SEPT CNGN          $      7,132.95 93533
539396 RHC CONGENITAL ANOMALY                 $      7,132.95 93530
539397 STENT PLACE RCA ARTERY                 $     16,372.49 92980RC
539398 RHC&TRNSPT LHC OPEN SEPTUM             $      7,132.95 93529
539399 RHC&TRNSPT LHC INTCT SEPT CNGN         $      7,132.95 93532
539400 THROMBECTOMY, CORONARY                 $       825.00 92973
539401 RHC&TRNSPT LHC INTACT SEPTUM           $      8,559.54 93527
539403 DEPLOY HEMOSTASIS DEVICE               $       207.00 G0269
539404 PTCA RC ARTERY                         $     13,225.17 92982RC
539405 CATH PLC CORON ART WO/HRT CATH         $      7,910.23 93508
539406 ATHERECTOMY ADD'L CIRCUMFLEX           $     23,187.01 92996LC
539407 ATHERECTOMY ADD'L LAD                  $     23,187.01 92996LD
539408 ATHERECTOMY ADD'L RC                   $     23,187.01 92996RC
539409 ATHERECTOMY CIRCUMFLEX                 $     19,845.10 92995LC
539410 ATHERECTOMY LAD                        $     19,845.10 92995LD
539411 ATHERECTOMY RCA                        $     19,845.10 92995RC
539414 BLADE ATRIAL SEPTOSTOMY                $     21,852.60 92993
539416 ENDOVSC TEMP BALLN ART OCCLUSN         $     10,238.25 61623
539418 PTCA EA ADDL VESSL-RC                  $     13,225.17 92984RC
539419 PTCA LD ARTERY                         $     13,225.17 92982LD




                                        Page 19
                                        Ancillary


539420 PTCA LC ARTERY                         $     13,225.17 92982LC
539421 PTCA EA ADDL VESSL-LC                  $     13,225.17 92984LC
539423 PTCA EA ADDL VESSL-LD                  $     13,225.17 92984LD
539424 PULM ART ANGIOPLASTY                   $      6,938.14 92997
539425 PULM ART ANGIOPLSTY ADDL VESSL         $      6,938.14 92998
539429 INTRACARDIAC ECHO                      $      6,523.84 93662
539439 REMOV INTRA-AORT BALLOON               $       438.90 33968
539443 CARDIOPULMONARY RESUSCITATION          $       883.69 92950
539445 RENAL ANGIO W/HEARTH CATH              $       207.00 G0275
539446 ILIAC ANGIO W/HEART CATH               $       207.00 G0278
539448 REPR AORT ANEURYSM-TUBE GRFT           $      4,794.71 34800
539449 REPR AORT ANEURYSM-MOD BIFURCT         $      5,553.98 34802
539450 REPR AORT ANEURYSM-UNI BIFURCT         $      5,554.53 34804
539451 REPR AORT ANEUR-AORTA PROSTH           $       525.00 34805
539452 INSERT ILIAC OCCLUSN DEVICE            $       998.16 34808
539453 PLAC PROSTH AAA EA ADDL VESSL          $       952.77 34826
539454 PTA TIBIOPERONEAL PERC                 $      8,279.17 35470
539455 PTA RENAL/VISCERAL ARTERY PERC         $      8,279.17 35471
539456 PTA AORTA PERC                         $     10,238.25 35472
539457 PTA ILIAC PERC                         $      8,279.17 35473
539458 PTA FEMORAL-POPLITAL PERC              $      8,279.17 35474
539459 PTA BRACHIOCEPHAL PERC                 $      8,279.17 35475
539460 PTA VENOUS                             $      8,279.17 35476
539461 INJECT FOR PSEUDOANEURYSM REPR         $       680.60 36002
539464 INTRO CATH SUPR/INFR VENA CAVA         $      2,385.91 36010
539465 INTRO CATH VENOUS 1ST ORDR             $      2,978.20 36011
539466 INTRO CATH VENOUS 2ND ORDR             $      3,289.88 36012
539467 INTRO CATH RT HEART/PULM ART           $      2,293.83 36013
539468 INTRO CATH L/R PULM ARTERY             $      2,829.75 36014
539469 INTRO CATH PULM ARTERY SEG             $      2,185.26 36015
539470 INTRO CATH BRACH ART RETRO             $       618.24 36120
539471 INTRO CATH EXTREMITY ARTERY            $      1,503.30 36140
539472 INTRO CATH ARTERIOVEN SHUNT            $      1,767.07 36145
539473 INTRO CATH AORTIC TRANSLMBR            $      2,408.18 36160
539474 INTRO CATH AORTA                       $      2,110.48 36200
539475 INTRO CATH THORAC 1ST ORDR             $      4,374.96 36215
539476 INTRO CATH THORAC 2ND ORDR             $      4,928.02 36216
539477 INTRO CATH THORAC 3RD ORDR             $      5,946.59 36217
539478 INTRO CATH THORAC ADDL 2ND/3RD         $       947.19 36218
539479 INTRO CATH ABD ART 1ST ORDR            $      4,449.60 36245
539480 INTRO CATH ABD ART 2ND ORDR            $      2,924.46 36246
539481 INTRO CATH ABD ART 3RD ORDR            $      2,110.48 36247
539482 INTRO CATH ABD ADDL 2ND/3RD            $       883.95 36248
539486 VENOUS CATH ORGAN BLOOD SMPL           $      1,038.33 36500
539487 DECLOT VAD BY THROMBOLYTC              $       710.86 36550
539488 INSERT NON-TUNN CVC < 5 YRS            $      2,193.25 36555
539489 INSERT NON-TUNN CVC > 5 YRS            $      1,847.74 36556
539492 INSRT TUNN CVC WO PORT >5 YRS          $      3,905.48 36558
539494 INSRT TUNN CVC W/PORT >5YRS            $      4,956.86 36561




                                        Page 20
                                        Ancillary


539498 INSRT PICC W/O PORT <5 YRS             $       577.50 36568
539499 INSRT PICC W/O PORT>5 YRS              $      3,257.63 36569
539505 REPLC TUNN CVC WO PORT                 $      3,488.08 36581
539509 REMOV TUNN CVC W/O PORT                $      2,602.40 36589
539512 REMOVE PERICATH OBSTRUCT CVC           $      5,661.17 36595
539515 ARTERIAL CATH SAMPLE+K167              $       523.13 36620
539519 THROMBCTMY ARTERIOVEN FISTULA          $      1,581.50 36870
539522 BIOPSY- TRANSCATH                      $      2,742.23 37200
539523 INFUS THROMBLYTC TRNSCATH              $      1,038.81 37201
539524 INFUS NON-THROMBLYTC TRNSCATH          $      1,038.35 37202
539525 RETRIEVAL FB TRANSCATH                 $      2,320.47 37203
539528 VASC STENT PLACE PERC INIT             $      7,026.36 37205
539529 VASC STENT PLACE PEREC EA ADDL         $      7,026.36 37206
539530 CATH EXCHNG DURNG LYTIC TX             $      5,138.77 37209
539531 INSERT IVC FILTER                      $      7,167.71 37620
539568 EMBOLIZATN INTRACRAN/SPINE             $      6,813.57 61624
539569 EMBOLIZATN EXTRACRANIAL                $      5,543.38 61626
539582 INJ EPIDURAL CERVIC/THORAC             $      1,831.38 62310
539634 AORTOGRAPHY THORACIC                   $      4,679.40 75605
539635 AORTOGRAPHY ABDOMINAL                  $      4,548.48 75625
539636 AORTOGRPHY ABD+ILIOFEM BILAT           $      3,901.59 75630
539637 AORTOGRAPHY ARCH                       $      5,490.81 75650
539640 ANGIO EXT CAROTID UNILAT               $      3,977.13 75660
539641 ANGIO EXT CAROTID BILAT                $      5,721.68 75662
539642 ANGIO CAROTID CEREBRAL UNILAT          $      3,977.13 75665
539643 ANGIO CAROTID CEREBRAL BILAT           $      8,069.27 75671
539644 ANGIO CARTOID CERVICAL UNILAT          $      3,977.13 75676
539645 ANGIO CAROTID CERVICAL BILAT           $      5,659.71 75680
539646 ANGIO VERTEBR/CERV/INTRACRAN           $      4,772.56 75685
539647 ANGIO SPINAL                           $     34,684.89 75705
539648 ANGIO EXTREMITY UNILAT                 $      5,107.55 75710
539649 ANGIO EXTREMITY BILAT                  $      4,098.62 75716
539650 ANGIO RENAL/FLUSH AORTOGRM UNI         $      5,387.76 75722
539651 ANGIO RENAL/FLUSH AORTOGRM BIL         $      6,809.50 75724
539652 ANGIO VISCERAL W/WO FLUSH AORT         $      5,586.06 75726
539653 ANGIO ADRENAL UNILAT                   $      4,276.00 75731
539654 ANGIO ADRENAL BILAT                    $      3,750.23 75733
539655 ANGIO PELVIC SELECTIVE                 $      5,441.64 75736
539656 ANGIO PULMONARY UNILAT                 $      2,900.65 75741
539657 ANGIO PULMONARY BILAT                  $      3,314.27 75743
539658 ANGIO PULM NON SELECT CATH             $      3,598.96 75746
539659 ANGIO INTERNAL MAMMARY                 $      3,563.34 75756
539660 ANGIO SELECT EA ADDL VESSEL            $      4,873.61 75774
539661 ANGIO ARTERIOVENOUS SHUNT              $      2,522.79 75790
539662 SPLENOPORTOGRAPHY                      $      4,534.69 75810
539663 VENOGRAPHY EXTREMITY UNILAT            $      1,414.02 75820
539664 VENOGRAPHY EXTREMITY BILAT             $      1,830.14 75822
539665 VENOGRAPHY INFERIOR CAVAL              $      3,261.26 75825
539666 VENOGRAPHY SUPERIOR CAVAL              $      3,035.85 75827




                                        Page 21
                                        Ancillary


539667 VENOGRAPHY RENAL UNILAT                $      3,741.50 75831
539668 VENOGRAPHY RENAL BILAT                 $      4,643.10 75833
539671 VENOGRAPHY, VENOUS SINUS,JUGUL         $      5,387.76 75860
539675 VENOUS SAMPLE W/WO ANGIO               $      7,176.94 75893
539677 THRMOBOLYTC INFUSN THERAPY             $      6,844.18 75896
539678 ANGIO THRU EXIST CATH FOR F/U          $      1,126.45 75898
539679 CATH XCHNG W/THRMBLYTC THERAPY         $      4,749.75 75900
539680 REMOV PERICATH OBSTRCT CVC             $       673.85 75901
539681 REMOV INTRALUM OBSTRCT CVC             $       577.50 75902
539682 PLACEMENT IVC FILTER                   $      3,750.86 75940
539683 REPAIR INFRARENAL AAA                  $      1,021.89 75952
539684 PROSTH REPR AORT/ILIAC ANEURYS         $       408.36 75953
539685 REPR ANEURYS/PSEUDOANEURYS/AVM         $      2,216.27 75954
539686 INTRO INTRAVASC STENT                  $      4,832.27 75960
539687 FB RETRIEVAL INTRAVASC                 $      4,425.01 75961
539688 PTA PERIPHERAL ARTERY INITIAL          $      4,030.39 75962
539689 PTA EA ADDL PERIPH ARTERY              $      4,322.97 75964
539692 BIOPSY TRANSCATH                       $      2,942.95 75970
539693 PTA VENOUS                             $      4,786.97 75978
539698 FLUORO GUID CVC PLACE/REMOV            $       473.11 77001
539700 FLUOROSCOPY > 1 HR                     $       865.32 76001
539701 FLUORO NEEDLE PLCMT                    $       693.90 77002
539706 U/S GUID PSEUDOANEURYSM REPR           $       743.22 76936
539707 U/S GUID VASCULAR ACCESS               $       464.89 76937
539708 U/S GUID BIOP/ASP/INJ/LOCALIZN         $      1,362.37 76942
539732 ATHERECTOMY FEM/POPLITEAL PERC         $     10,238.25 35493
539733 ATHERECTOMY TIBIOPERONAL PERC          $     10,238.25 35495
539734 ATHERECT PERIPHERAL ARTERY INI         $      2,740.75 75992
539735 ARTHERECT EA ADDL ARTERY               $      1,461.53 75993
539754 DOPPLER FLOW WIRE INITL VESSL          $      6,254.52 93571
539755 DOPPLER FLOW WIRE ADDL VESSL           $      3,577.30 93572
539756 STENT CAROTID W DIST PROTCT            $      9,240.00 37215
539757 STENT CAROTID WO DIST PROTCT           $      9,240.00 37216
539760 ATHERECT CATHETER ROTATIONAL           $      4,537.50 C1724
539761 RPR AAA W/ VISCERAL S&I                $      1,021.89 0080T
539762 PROSTH PLACMT AAA W/VISCER S&I         $      1,021.89 0081T
539763 RPL NON-TUN CVC SAME ACCESS            $      2,400.08 36580
539764 ATHERECTOMY ILIAC PERC                 $     10,238.25 35492
539765 ART MECH THROMBECT PRIMARY             $      6,124.64 37184
539766 ART MECH THROMBECT PRIM ADDL           $      2,864.24 37185
539767 ART MECH THROMBECT SECND ADDL          $      2,864.24 37186
539768 VENOUS MECH THROMBECTOMY               $      6,124.64 37187
539769 VENOUS MECH THROMB REPEAT              $      6,124.64 37188
539770 RPR DECEND AORTA W SUBCLAV S&I         $      2,427.26 75956
539771 RPR DECEND AORTA WO SUBCLV S&I         $      2,079.39 75957
539772 PROSTH PLACMT PROX S&I                 $      1,386.38 75958
539773 PROSTH PLACMT DISTAL DELAYED           $       572.37 75959
539774 PTA RENAL/VISCERAL ARTERY ADDL         $      2,000.00 75968
539775 ANGIOPLASTY ART AV SHUNT               $     11,624.68 G0392




                                        Page 22
                                        Ancillary


539776 VENOPLASTY AV SHUNT                    $     11,624.68 G0393
539777 PLAC PROSTH AAA INITIL VESSL           $      3,617.80 34825
539778 STENT PLACE - SNGL VESSL               $     24,351.25
539779 STENT PLACE - EA ADDL VESSL            $     24,351.25
511116 IP 2D ECHO                             $      2,472.67 93307
511216 OP COLOR DOPPLER                       $       723.61 93325
511816 OP 2D ECHO, LIMITED                    $      1,521.65 93308
514016 OP TEE/2D                              $      3,785.94 93312
515116 OP 2D ECHO                             $      1,902.05 93307
515316 OP PULSE WAVE DOPPLER                  $       556.90 93320
515416 OP ECG STRESS TST TRACING ONLY         $      1,285.02 93017
515516 OP STRESS ECHO                         $      1,670.70 93350
515640 ECHO NEW PT., LEVEL 1                  $       129.05 99201
515641 ECHO NEW PT., LEVEL 2                  $       140.68 99202
515642 ECHO NEW PT., LEVEL 3                  $       185.80 99203
515643 ECHO NEW PT., LEVEL 4                  $       232.80 99204
515644 ECHO NEW PT., LEVEL 5                  $       296.74 99205
515645 ECHO EST. PT., LEVEL 1                 $       129.05 99211
515646 ECHO EST. PT., LEVEL 2                 $       140.68 99212
515647 ECHO EST. PT., LEVEL 3                 $       160.78 99213
515648 ECHO EST. PT., LEVEL 4                 $       204.38 99214
515649 ECHO EST. PT., LEVEL 5                 $       291.00 99215
515660 OP ESOPHAGEAL ATRIAL PACING            $      7,732.92 93616
515662 OP IV PUSH INITIAL                     $       270.35 90774
515664 OP IMT CAROTID STUDY                   $       925.16 76536
515665 OP 3D ECHO - ADULT                     $       758.38 93799
515672 OP 2D ECHO M-MODE                      $       723.61 93321
515673 OP EPICARDIAL INTRAOP ECHO             $      1,902.05 93307
515674 OP DOPLER ECHOCARDIOGRAPHY             $       556.90 93320
515676 OP ECHOCARD M-MODE 2D FU LMTD          $      1,521.65 93308
515677 OP DOPPLER COLOR FLOW                  $       723.61 93325
515678 OP DOPPLER ECHO FU OR LMTD             $       723.61 93321
515690 OP CHD RISK IMT STUDY                  $       967.44 0126T
517231 OP CATHETER, EP,19 OR FEW ELEC         $      2,361.70 C1730
518002 IP TEE-INTRAOP TRANS 2D ECHO           $      4,921.72 93312
518003 IP ESOPHAGEAL ATRIAL PACING            $     10,052.80 93616
518004 IV PUSH INITIAL                        $       351.46 90774
518005 IP ECG STRESS TST TRACING ONLY         $      1,670.53 93017
518006 IP 2D ECHO                             $      2,472.67 93307
518007 IP EPICARDIAL INTRAOP ECHO             $      2,472.67 93307
518008 IP 2D ECHO, LIMITED                    $      1,978.15 93308
518009 IP ECHOCARD M-MODE 2D FU LMTD          $      1,978.15 93308
518010 IP TEE/2D                              $      4,921.72 93312
518012 IP PULSE WAVE DOPPLER                  $       723.97 93320
518013 IP DOPLER ECHOCARDIOGRAPHY             $       723.97 93320
518014 IP 2D ECHO M-MODE                      $       940.70 93321
518015 IP DOPPLER ECHO FU OR LMTD             $       940.70 93321
518016 IP COLOR DOPPLER                       $       940.70 93325
518018 IP STRESS ECHO                         $      2,171.91 93350




                                        Page 23
                                        Ancillary


504028 CARD REHAB INIT EVAL #                 $      735.38 93798
504030 CONT CARD EXERC           #            $      294.15 93798
504031 P2 CONT CARD EX W/O CONT MON#          $      149.51 93797
504041 CARDIO NEW PT., LEVEL 1                $      129.05 99201
504042 CARDIO NEW PT., LEVEL 2                $      140.68 99202
504043 CARDIO NEW PT., LEVEL 3                $      185.80 99203
504044 CARDIO NEW PT., LEVEL 4                $      232.80 99204
504045 CARDIO NEW PT., LEVEL 5                $      296.74 99205
504046 CARDIO EST. PT. LEVEL 1                $      129.05 99211
504047 CARDIO EST. PT. LEVEL 2                $      140.68 99212
504048 CARDIO EST. PT.,LEVEL 3                $      160.78 99213
504049 CARDIO EST. PT.,LEVEL 4                $      204.38 99214
504050 CARDIO EST. PT.,LEVEL 5                $      291.00 99215
512923 EKG AT PRCC                            $      411.90 93005
554061 MED NUTR THPY 15 MIN                   $       37.13 97802
554062 MED NUTR THPY 30 MIN                   $       74.25 97802
554063 MED NUTR THPY 45 MIN                   $      111.38 97802
554064 MED NUTR THPY 60 MIN                   $      148.50 97802
554065 MED NUTR THPY REASS/INT 15 MIN         $       37.13 97803
554066 MED NUTR THPY REASS/INT 30 MIN         $       74.25 97803
554067 MED NUTR THPY REASS/INT 45 MIN         $      111.38 97803
554068 MED NUTR THPY REASS/INT 60 MIN         $      148.50 97803
554069 GROUP MED NUTR THPY 30 MIN             $      148.50 97804
554070 GROUP MED NUTR THPY 60 MIN             $      148.50 97804
554071 EXTERNAL COUNTERPULSATION              $      406.03 G0166
600030 EMG - 1 EXTREMITY                      $      804.80 95860
600031 EMG - 2 EXTREMITIES                    $      789.88 95861
600032 EMG-3 EXTREMITIES                      $      884.38 95863
600033 EMG-4 EXTREMITIES                      $      510.61 95864
600034 MOTOR NERVE TEST                       $      198.59 95900
600035 SENSORY NERVE TEST                     $      301.19 95904
600036 NCS - MOTOR W/F WAVE                   $      516.64 95903
600042 NEEDLE EMG- URETHRAL SPHINCTER         $      481.95 51785
600043 NEEDLE EMG; CRANIAL NERVE (ONE         $      422.11 95867
600044 NEEDLE EMG; CRANIAL NERVE (BOT         $     3,345.75 95868
600046 NEEDLE EMG/THORACIC PARASPINAL         $     1,601.15 95869
600047 NEEDLE EMG; SINGLE FIBER               $     1,302.26 95872
600048 H-REFLEX, GASTROC/SOLEUS               $     1,601.15 95934
600049 BOTOX: CERVICAL SPINAL MUSCLES         $      627.49 64613
600050 BOTOX: FACIAL NERVE                    $      627.49 64612
600053 ISCHEMIC LIMB EXERCISE                 $      773.50 95875
600054 NCS - REPET STIM                       $      422.11 95937
600056 NCS - (BLINK) REFLEX                   $     2,573.27 95933
600057 PELVIC FLOOR EVOKED POTENTIAL          $     2,728.91 51792
600059 NEEDLE EMG - ANAL SPHINCTER            $      481.95 51785
600097 THERAPEUTIC CARPAL TUNNEL INJ          $     2,762.50 20526
600098 TROCHANTERIC BURSA INJ                 $      632.94 20610
600100 DESTRC, NEUROLYTIC AGENT, OTHR         $     1,495.19 64640
600101 TENSILON TEST                          $      414.38 95857




                                        Page 24
                                        Ancillary


600102 CHEMODENERVATION;EXTREM/TRUNK          $      372.69 64614
640202 NEW EXPANDED-LEVEL 2                   $      140.68 99202
640203 NEW DETAILED-LEVEL 3                   $      185.80 99203
640204 NEW COMPREHENSIVE-LEVEL 4              $      232.80 99204
640205 NEW COMPLEX-LEVEL 5                    $      296.74 99205
640206 ESTABLISHED FOCUSED- LEVEL 1           $      129.05 99211
640207 ESTABLISHED EXPANDED-LEVEL 2           $      140.68 99212
640208 ESTABLISHED DETAILED-LEVEL 3           $      160.78 99213
640209 ESTABLISHED COMPREHEN-LEVEL 4          $      204.38 99214
640210 ESTABLISHED COMPLEX-LEVEL 5            $      291.00 99215
640221 NEW FOCUSED-LEVEL 1                    $      129.05 99201
650204 HEART FAILURE NEW PT, LEVEL 2          $      140.68 99202
650205 HEART FAILURE NEW PT, LEVEL 3          $      185.80 99203
650206 HEART FAILURE NEW PT, LEVEL 4          $      232.80 99204
650207 HEART FAILURE NEW PT, LEVEL 5          $      296.74 99205
650208 HEART FAILURE EST PT, LEVEL 1          $      129.05 99211
650209 HEART FAILURE EST PT, LEVEL 2          $      140.68 99212
650210 HEART FAILURE EST PT, LEVEL 3          $      160.78 99213
650211 HEART FAILURE EST PT, LEVEL 4          $      204.38 99214
650212 HEART FAILURE EST PT, LEVEL 5          $      291.00 99215
650223 HEART FAILURE NEW PT, LEVEL 1          $      129.05 99201
700000 LC PULMONARY                           $          -
700120 NEONATE HEEL STICK                     $      203.12
700121 PC BLOOD GAS NEONATE                   $      634.96 82803
700124 PF BLD GAS EXERCISE                    $      634.96 82803
700142 RIGHT HEART CATH                       $     8,363.74 93501
700286 PC BRONCH:BRUSHING                     $     4,295.07 31623
700287 PC BRONCH:ALEVOLAR LAVAGE              $     2,863.38 31624
700288 PC BRONCH:BRACHYTHERAPY                $     3,721.62 31643
700290 PC FLUOROSCOPY-RT HEART CATH           $     1,088.03 76000
700291 PC MDI INITIAL                         $      388.41 94664
700294 ASPIR NDL BIOPSY(S) TRNSBRONCH         $     1,933.68 31629
700295 TB LUNG BIOPSY, EA ADDTL LOBE          $     1,933.68 31632
700296 BRONCHOSCOPY; W REMOVAL FB             $     1,933.68 31635
700301 PC INITIAL IPPB TRT                    $      388.41 94664
700302 PC INITIAL HAND NEBULIZER TRT          $      388.41 94664
700303 PC INITIAL CHEST PHYSIOTHERAP          $      351.41 94667
700304 PC CHEST PHYSIO THER SUBS              $      260.88 94668
700305 SURFACTANT TREATMENT-NICU              $      388.41 94664
700306 PC HAND NEB. TRT SUBS                  $      187.94 94640
700307 PC HEATED AERO. TRT.                   $      388.41 94664
700308 PC IPPB TRT SUBSEQUENT                 $      141.18 94640
700310 PC POST.DRAINAGE TRT                   $      351.41 94667
700312 PC USN TRT.                            $      388.41 94664
700313 SPIROMETRY                             $      748.87 94010
700314 PC MICRO-SPIROMETER                    $     4,020.60
700315 PC PLUERAL BIOPSY PROCEDURE            $     1,662.15 32400
700316 PC BRONCHIAL STENT                     $     2,529.91
700317 PC YAG LASER FIBER                     $     2,345.48




                                        Page 25
                                        Ancillary


700318 PC AEROSOL TREATMENT INIT HR           $      247.20 94644
700322 PC EMERGENCY FEE CPR *20 MIN.          $      883.69 92950
700323 PC HEATED AERO KIT                     $      297.46
700325 PC IPPB KIT                            $      121.80
700326 PC TRANSPORT                           $      444.68
700327 VITAL CAPACITY PER MEASUREMENT         $      371.70 94150
700328 PC SPECIAL DUTY 20 MINUTES             $      946.44
700331 PC SPECIAL DUTY-20 MINUTES             $      432.38 94799
700332 PC SPUTUM INDUCTION                    $      388.41 94664
700333 PC SUCTIONING                          $      196.91 31720
700334 PC U.S.N. KIT                          $      177.91
700336 BRONCH W TB SGL LOBE LUNG BX           $     1,933.68 31628
700337 PC BRONCH: TRACH STENT                 $     7,371.89 31631
700338 PC BRONCH: BRONCH STENT                $     7,371.89 31636
700339 PC BRONCH: ADDL BRONCH STENT           $     7,371.89 31637
700340 PC BRONCH: STENT REVISION              $     7,371.89 31638
700341 PC VENT INITL DAY 1-12 HRS             $     1,624.72 94002
700342 ARTERIAL PUNCTURE                      $      272.34 36600
700343 PC VENT INITL DAY >12 HRS              $     3,364.32 94002
700344 PC VENT SUBSQT DAY 1-12 HRS            $     1,243.99 94003
700345 PC ENDOTRACHEAL TUBE #                 $      368.89
700346 PC VENT SUBSQT DAY >12 HRS             $     3,990.81 94003
700347 PC E CYL. MEICAL GAS                   $          -
700348 MUCUS CLEARING DEVICE                  $      127.07
700351 PC NITRIC OXIDE GAS PER HOUR           $      401.12
700353 PC PEP VALVE                           $      143.87
700354 PC H.H.N. KIT                          $       93.82
700355 PC CONCHA WATER                        $       46.51
700356 PC CONCHA COLUMN                       $      114.54
700360 PC PENTAMIDINE TREATMENT               $      515.83 94642
700361 PENTAMIDINE TREATMENT ADDL 10*         $      515.83 94642
700362 PENTAMIDINE KIT                        $      180.27
700368 PC AEROSOL TRMNT EA ADDL HOUR          $      120.51 94645
700369 PC 02 PER HOUR                         $       69.89
700371 PASSY MUIR SPEAKING VALVE              $      281.23
700372 PC TRACHEOSTOMY TUBE                   $      653.02
700373 LASER BRONCHOSCOPY                     $     6,721.41 31641
700374 BRONCHOSCOPY WITH DILITATION           $     7,371.89 31631
700376 PC BRONCHOSCOPY FORCEPS                $     1,241.96
700377 PC WANG NEEDLE                         $      814.08
700378 PC PNEUMOTHORAX SET                    $     1,190.76
700379 PC SPECIAL ITEM                        $          -
700383 PC THORACENTESIS TRAY                  $     1,004.78
700384 PC THORACENTESIS PROCEDURE             $      889.35 32000
700385 PC PLUERAL BIOPSY TRAY                 $      778.82
700387 PC RESP GAS ANAL                       $      600.88 94799
700389 PC SPECIAL PROC BRON RM                $     4,423.31
700390 PC BRONCH:DIAGNOSTIC W/WO WASH         $     4,295.07 31622
700391 PC BRONCH W/BIOPSY                     $     2,863.38 31625




                                        Page 26
                                             Ancillary


700393 PC CYTOLOGY BRUSH                           $      505.53
700394 PC MICRO BRUSH                              $      707.05
700395 PC BROCH OCC CATH                           $     1,772.93
700396 PC ZAVALA BIOPSY NEEDLE                     $      187.79
700400 OP IPPB TRT, SUBSEQ                         $      141.18 94640
700402 PC O/P 1PPB EQUIP                           $      130.60
700403 OP AEROSOL INHAL, USN TREAT                 $      388.41 94664
700404 PC O/P USN EQUIPMENT                        $      368.89
700405 OP AEROSOL INHAL, HHN TRT,SUBS              $      187.94 94640
700406 PC O/P HHN EQUIPMENT                        $      233.64
700407 PC O/P H A TREATMENT                        $      388.41 94664
700408 PC O/P H A EQUIPMENT                        $      282.08
700410 OP CW MANIPULATION, SUBSEQ                  $      260.88 94668
700411 OP BICYCLE EXER                             $      471.25 G0239
700412 PC O/P BICYCLE EXER W O2                    $      471.25 G0239
700415 PR OP BREATHING EXERCISE                    $      471.25 G0239
700416 PC O/P SPUTUM INDUCT                        $      388.41 94664
700417 OP IPPB TRT INITIAL/EVAL                    $      333.65 94640
700418 OP AEROSOL INHAL, INITIAL HHN               $      388.41 94664
700419 OP CW MANIPULATION, INITIAL                 $      351.41 94667
700421 PC 02 PER HOUR                              $       88.95
700422 PC O/P E CYCLE MED GAS                      $      224.62
700429 PLUSE OX-MULTI DETER                        $      154.21 94761
700430 AEROSOL INHAL, PENTAMIDINE                  $      515.83 94642
700431 AEROSOL INHAL, PENTAM ADD'L 10              $      517.34
700432 PENTAMIDINE EQUIPMENT OP *                  $      413.99
700440 SCREENING SPIROMETRY - BEDSIDE              $      748.87 94010
700441 PULMONARY INSTRUCTIONS                      $      206.36 G0238
700444 PAG-HEART NEB EQUIP                         $      273.25
700445 PAG-HEART NEB INITIAL                       $      388.41 94664
700446 PAG HEAR NEB CONT-TX                        $      202.38 94640
700447 PEFR-EQUIPMENT                              $      319.70
700449 REHAB EVAL (30 MIN)                         $      185.80 99203
700450 EXER TRAIN INDIV 15 MIN                     $      206.36 G0238
700451 EXER TRAIN INDIV 30 MIN                     $      471.25 G0239
700459 REHAB - PSYCH - COUN-GRP                    $       74.62 90853
700460 POST REHAB EVAL (20 MIN)                    $      160.78 99213
700461 O/P OFFICE VISIT NEW PT 10MIN               $      129.05 99201
700462 O/P OFFICE VISIT NEW PT 20MIN               $      140.68 99202
700463 O/P OFFICE VISIT NEW PT 30MIN               $      185.80 99203
700464 PR THER PROCEDURE 15 MIN                    $       94.36 G0237
700465 PR THER GROUP 2 OR                          $      471.25 G0239
700466 PR SELF CARE/HOME MGT                       $      206.36 G0238
700467 O/P OFFICE VISIT ESTAB PT 5MIN              $      129.05 99211
700468 O/P OFFICE VISIT ESTAB PT 10MN              $      140.68 99212
700469 O/P OFFICE VISIT ESTAB PT 15MN              $      160.78 99213
700470 PR PHYS PERFORM TEST 15 MIN                 $      206.36 G0238
700602 INITIAL TRANSCUTANEOUS        *             $      200.48 94761
700603 TRANSCUTANEOUS PER HOUR           *         $      200.48 94761




                                             Page 27
                                         Ancillary


700613 CO, EXPIRED GAS BY IR                   $      372.31 94770
700617 CO, EXPIRED GAS BY IR                   $      372.31 94770
700623 PC TOTAL FACE MASK                      $      517.15
700624 PC NASAL MASKS BIPAP                    $      432.58
700625 PC HELIOX ADMIN. PER HOUR               $       79.86
700626 PC NITROGEN ADMIN. PER HOUR             $       79.86
700627 PC MDI TX-PEDS                          $      600.88 94799
700630 18 VISITS,3X/WK X 6 WKS                 $         -
700708 PC VENT JET INITL DAY 1-12 HRS          $     2,738.68 94002
700709 PC VENT JET INITL DAY >12 HRS           $     6,216.84 94002
700710 PC VENT JET SUBSQT DAY 1-12 HR          $     2,487.25 94003
700711 PC VENT JET SUBSQT DAY >12 HRS          $     7,979.26 94003
700728 PC CPAP INITL DAY 1-12 HRS              $     1,455.67 94660
700729 PC CPAP INITL DAY >12 HRS               $     3,240.95 94660
700730 PC CPAP SUBSQT DAY 1-12 HRS             $     1,122.74 94660
700731 PC CPAP SUBSQT DAY >12 HRS              $     3,514.15 94660
700738 PC BIPAP INITL DAY 1-12 HRS             $     1,396.71 94660
700739 PC BIPAP INITL DAY >12 HRS              $     3,385.91 94660
700740 PC BIPAP SUBSQT DAY 1-12 HRS            $     1,139.62 94660
700741 PC BIPAP SUBSQT DAY >12 HRS             $     3,542.92 94660
700074 LUNG VOLUME-HELIUM                      $      543.94 94240
700075 THORACIC GAS-VOLUME                     $      349.73 94260
700076 DIFFUSING CAPACITY                      $      362.63 94720
700077 AIRWAY RESISTANCE                       $      455.88 94360
700078 PULMONARY EXERCISE STUDY                $     1,692.47 94621
700079 SPIROMETRY                              $      748.87 94010
700080 SCREENING SPIROMETRY                    $      442.34 94375
700081 PRE/POST SPIROMETRY                     $      843.05 94060
700083 CO2 RESPONSE                            $      390.18 94400
700084 HYPOXIC RESPONSE                        $      356.36 94450
700085 METHACHOLINE CHALLENGE                  $     1,384.12 94070
700086 STATIC LUNG COMPL/ELAST RECOIL          $      362.63 94750
700087 EXERC INDUCED BROCHO SPASM              $      843.05 94060
700088 PF MIPS/MEPS-PIMAX PEMAX-MVV            $      247.80 94200
700091 PF PARTIAL/MAX FLOW-VOL LOOP            $      442.34 94375
700092 EXERCISE STUDY NI                       $     1,692.47 94621
700093 PF SCREENG SPIROMETRY-BEDSIDE           $      748.87 94010
700095 PF ALTITUDE 02 STUDY W/ O2              $     2,517.88 94453
700097 PF ALTITUDE 02 STUDY                    $     2,954.18 94452
700098 SPECIAL STUDY                           $         -     94799
700100 TRANSDIAPHRAGM PRES MEASUREMEN          $      600.88 94799
700101 O2 PERSCRIPTION INVASIVE                $      817.96 94620
700102 O2 PERSCRIPTION NONINVASIVE             $     2,978.53 94680
700118 PF PULSE OXIMETRY/6 MIN WALK            $      200.48 94761
700119 PULSE OX (SINGLE DETER/HR)              $      109.75 94760
700123 PF BLD GAS RESTING                      $      634.96 82803
700125 PF BLD GAS SHUNT                        $      634.96 82803
700127 PF ARTERIAL PUNCTURE          *         $      272.34 36600
700135 ARTERIAL CANNULATION                    $      523.13 36620




                                         Page 28
                                        Ancillary


700141 PF REFUSES PROCEDURE                   $          -
700223 SLOW VITAL CAPACITY                    $       371.70 94150
700224 RESIDUAL VOLUME                        $       543.94 94240
700225 BRONCHODILATOR ADMIN                   $       388.41 94664
700234 PF 02 TITRATION                        $       200.48 94761
700122 PC BLDG GAS ANALYSIS                   $       634.96 82803
700140 PF CO OXIMETRY                         $       443.14 82375
780001 LC NEW PT., LEVEL 1                    $       129.05 99201
780002 LC EST. PT. LEVEL 1                    $       129.05 99211
780003 GEN PURPOSE KIT (SUTURE)               $        49.43
780004 LC PLEURAL CATH KIT                    $       948.81
780005 LC PLEURAL DRAIN PROC KIT              $       180.27
780006 LC PLEURAL DRAIN VACUUM BOT            $       134.15
780007 LC NEW PT., LEVEL 2                    $       140.68 99202
780008 LC NEW PT., LEVEL 3                    $       185.80 99203
780009 LC NEW PT., LEVEL 4                    $       232.80 99204
780010 LC NEW PT., LEVEL 5                    $       296.74 99205
780011 LC EST. PT. LEVEL 2                    $       140.68 99212
780012 LC EST. PT.,LEVEL 3                    $       160.78 99213
780013 LC EST. PT.,LEVEL 4                    $       204.38 99214
780014 LC EST. PT.,LEVEL 5                    $       291.00 99215
780025 LC NEW PT., LEVEL 1 W/ANC              $       129.05 9920125
780026 LC NEW PT., LEVEL 2 W/ANC              $       140.68 9920225
780027 LC NEW PT., LEVEL 3 W/ANC              $       185.80 9920325
780028 LC NEW PT., LEVEL 4 W/ANC              $       232.80 9920425
780029 LC NEW PT., LEVEL 5 W/ANC              $       296.74 9920525
780030 LC EST PT., LEVEL 1 W/ANC              $       129.05 9921125
780031 LC EST PT., LEVEL 2 W/ANC              $       140.68 9921225
780032 LC EST PT., LEVEL 3 W/ANC              $       160.78 9921325
780033 LC EST PT., LEVEL 4 W/ANC              $       204.38 9921425
780034 LC EST PT., LEVEL 5 W/ANC              $       291.00 9921525
780035 CARDIOTHOR NEW PT., LEVEL 1            $       129.05 99201
780036 CARDIOTHOR NEW PT., LEVEL 2            $       140.68 99202
780037 CARDIOTHOR NEW PT., LEVEL 3            $       185.80 99203
780038 CARDIOTHOR NEW PT., LEVEL 4            $       232.80 99204
780039 CARDIOTHOR NEW PT., LEVEL 5            $       296.74 99205
780040 CARDIOTHOR EST. PT., LEVEL 1           $       129.05 99211
780041 CARDIOTHOR EST. PT., LEVEL 2           $       140.68 99212
780042 CARDIOTHOR EST. PT., LEVEL 3           $       160.78 99213
780043 CARDIOTHOR EST. PT., LEVEL 4           $       204.38 99214
780044 CARDIOTHOR EST. PT., LEVEL 5           $       291.00 99215
790088 EEG W/MED &/OR ACTIVTN W/MD            $      3,573.98 95954
790094 ECOG(ELECTROCORTICOGRAPHY              $     10,631.39 95829
790095 INTRA-OP NEURO TESTING, PER HR         $       665.21 95920
790097 FUNCT/MOTOR/LANGUAG MAP/1ST HR         $      1,906.13 95961
790098 FUNCT/MOTOR/LANG MAP ADD'L HR          $      1,429.60 95962
790102 STEREOTACTIC LOCALIZATION              $      6,585.58 61770
790104 SSEP - INTRA-OPERTIVE UPPERS           $      2,359.86 95925
790105 SSEP - INTRA-OPERTIVE LOWERS           $      2,375.84 95926




                                        Page 29
                                        Ancillary


790106 EEG IN COMA OR SLEEP ONLY              $      1,663.19 95822
790130 DBS - MICRO TARGET ELECTRODES          $       359.39
790132 C MOTOR EVOKED, UPPR LIMBS             $       721.08 95928
790133 C MOTOR EVOKED, LWR LIMBS              $       781.71 95929
790135 ANA NEUROST BRAIN ADD 30 MIN           $       694.94 95979
790136 NEURO STIM ANALY NO PROGRAM            $       941.18 95974
790137 SIMPLE NEURO STIM ANALYSIS             $       429.82 95975
790141 8-CONTACT STRIP ELECTRODE              $      1,077.51 Z7610
790142 EMG -1 EXTREMITY                       $      1,046.25 95860
790143 EMG -2 EXTREMITIES                     $      1,026.85 95861
790145 BAER COMPREH-W/LATENCY                 $      5,365.36 92585
800002 EEG EXT- MON ( 41-60 MIN)              $      3,812.25 95812
800003 EEG EXTENDED MON > 1 HOUR              $      4,269.72 95813
800014 EEG (AWAKE & SLEEP)                    $      1,460.97 95819
800020 EEG AWAKE/DROWSY                       $      1,224.47 95816
800021 EEG IN COMA OR SLEEP ONLY              $      1,279.38 95822
800024 ECI (BRAIN DEATH) STUDY                $      4,384.09 95824
800050 VEP - CHECKBOARD OR FLASH              $      1,765.11 95930
800051 BAER COMPREH-W/LATENCY                 $      1,726.44 92585
800053 SSEP - UPPER EXTREMITIES               $      1,815.28 95925
800057 SSEP - LOWER EXTREMITIES               $      1,827.57 95926
800080 AMBULATORY EEG MONITORING 24HR         $      3,668.65 95950
800090 STAT NEUROPHYSIOLOGY PROCEDURE         $       349.31
800098 BAER LTD - W/OUT LATENCY               $      3,522.52 92586
800100 EEG MONITORING/COMPUT EA 24 HR         $      4,279.44 95953
800101 EEG MONITOR/VIDEORECORD 24 HR          $      5,773.03 95951
800102 EEG MONITOR/CABLE/RADIO 24 HR          $      5,337.15 95956
800103 EEG DIGITAL ANALYSIS                   $      1,216.23 95957
810000 PERIOCARDIOCENTESIS                    $       856.39 33010
810001 INSERT PERM PCMKR+ATRIAL LEAD          $     20,235.76 33206
810002 INSERT PERM PCMKR+VNTRC LEAD           $     20,235.76 33207
810003 INSERT PERM PCMKR+VNTRC/ATRIAL         $     24,641.17 33208
810004 INSERT TEMP PACE LEAD SINGLE           $     11,668.43 33210
810005 INSERT TEMP PACE LEAD DUAL             $     10,181.18 33211
810006 INSERT PCMKR GEN ONLY-SNGL             $     16,719.66 33212
810007 INSERT PCMKR GEN ONLY-DUAL             $     19,459.33 33213
810008 UPGRADE PCMKR SNGL TO DUAL             $     24,641.17 33214
810009 REPOSITION TRNSVN LEAD-RA/RV           $      3,313.55 33215
810011 INSERT LEAD SINGLE CHAMBER             $     11,668.43 33216
810012 INSERT LEAD DUAL CHAMBER               $     10,183.29 33217
810013 REPAIR LEAD SINGLE CHAMBER             $     10,183.29 33218
810014 REPAIR LEAD DUAL CHAMBER               $     10,183.29 33220
810015 REVISION/RELOCAT PCMKR POCKET          $      3,005.31 33222
810016 REVISION/RELOCAT ICD POCKET            $      3,005.31 33223
810017 INSRT BI-V LEAD PREV PCMKR/ICD         $     20,798.78 33224
810018 INSRT BI-V LEAD NEW PCMKR/ICD          $     20,798.78 33225
810019 REPOSITN LV LEAD+GEN REPLACE           $      3,313.55 33226
810020 REMOVE PACEMAKER GEN                   $      3,313.55 33233
810021 REMOVE PCMKR LEAD SINGLE               $      3,313.55 33234




                                        Page 30
                                        Ancillary


810022 REMOVE PCMKR LEAD DUAL                 $      3,313.55 33235
810023 REMOVE ICD GEN SINGLE/DUAL             $      4,019.45 33241
810024 REMOVE ICD LEAD SINGLE/DUAL            $      3,313.55 33244
810025 IMPLANT CARDIAC LOOP RECRDER           $     15,147.59 33282
810026 REMOVE CARDIAC LOOP RECRDR             $      1,779.62 33284
810027 CARDIOVERSION                          $      2,759.61 92960
810028 INTRAVENTR OR ATR MAPPING              $      9,462.68 93609
810030 INTRACARDIAC EP 3D MAPPING             $      7,897.54 93613
810031 INDUCT ARRHYTH BY ELECTR PACE          $      9,462.68 93618
810032 COMP EP EVAL W/O ARRHYT INDUCT         $     11,830.30 93619
810033 COMP EP EVAL W/ARRHYT INDUCT           $      9,857.41 93620
810034 COMP EP EVAL LFT ATRIAL PACE           $      8,415.79 93621
810035 COMP EP EVAL LFT VNTRC PACE            $      8,415.79 93622
810036 EP STIM+PACE POST DRUG INFUSN          $      9,462.68 93623
810037 EP F/U STUDY THERAPY TEST              $      5,315.76 93624
810038 EP EVAL ICD LEAD W/INSERT              $      2,500.34 93640
810039 EP EVAL ICD GEN & LEADS                $      3,944.64 93641
810040 EP EVAL ICD W/PROGRAMMING              $      2,500.34 93642
810041 ABLATION ATRIOVENTRC NODE              $     12,760.51 93650
810042 ABLATION SUPRAVENTRC TACHY             $     10,680.91 93651
810043 ABLATION VENTRIC TACHY                 $     10,680.91 93652
810044 INTRACARDIAC ECHO                      $      6,523.84 93662
810045 INSERT ICD SNGL GEN ONLY               $     69,302.95 G0297
810046 INSERT ICD DUAL GEN ONLY               $     69,302.95 G0298
810047 INSERT ICD SNGL GEN+LEAD               $     89,071.68 G0299
810048 INSERT ICD DUAL GEN+LEAD               $     89,071.68 G0300
810049 FLUORO FOR PACER INSERTION             $       502.50 7109059
810050 CARDIOPULMONARY RESUSCITATION          $       883.69 92950
810051 RHC&TRNSPT LHC INTACT SEPTUM           $      8,559.54 93527
810052 RHC&TRNSPT LHC OPEN SEPTUM             $      7,132.95 93529
810053 BUNDLE OF HIS RECORDING                $      7,793.76 93600
810054 INTRA ATRIAL RECORDING                 $      7,793.76 93602
810055 RT VENTRICULAR RECORDING               $      7,793.76 93603
810056 INTRA ATRIAL PACING                    $      7,793.76 93610
810057 INTRAVENTRC PACING                     $      7,793.76 93612
820000 CATH INTRA-AORTC BALLOON               $      5,561.80
820001 INTRODUCER                             $       102.10
820002 GUIDE WIRE                             $        94.00 C1769
820003 CATH ULTRASOUND ACUNAV                 $      9,836.05 C1759
820004 INTRO/SHEATH GUIDE EP TRNSPTL          $       570.49 C1893
820005 CATH PACK -CATH LAB *                  $       717.08
820006 IV SET SPIKE                           $       128.71
820008 PRESSURE TUBING                        $       268.35
820013 DILATOR                                $       199.09
820014 GUIDE WIRE                             $       811.14 C1769
820015 SUTURE                                 $        71.35
820017 INJECTOR                               $       547.54
820018 D5W 250ML                              $       109.87
820019 D5W 500ML                              $        91.56




                                        Page 31
                                        Ancillary


820020 D5 .2% NACL                            $        59.90
820021 D5 .45% NACL                           $       120.88
820023 IV SET NON-VENTED                      $        69.37
820024 IV SET VENTED                          $        99.88
820027 CATH FOLEY                             $       322.99
820031 CATH DIAGNOSTIC ANGIO                  $       756.98 C1887
820032 CATH BERMAN                            $       706.44 C1887
820033 CATH BALLOON WEDGE                     $       309.52 C1887
820034 CATH ULTRASOUND INTRAVASC              $      4,061.49 C1753
820035 INTRO/SHEATH FIXED NON PEEL            $       629.56 C1893
820037 ICD DUAL CHAMBER                       $ 105,840.00 C1721
820038 ICD SINGLE CHAMBER                     $     56,700.00 C1722
820039 LEAD ICD ENDOCARD COIL                 $     28,715.05 C1895
820043 LEAD PCMKR TRANSVN SNGL PASS           $      3,464.53 C1779
820044 LEAD PCMKR/ICD COMBINATION             $      3,464.53 C1899
820045 ICD OTHER THAN SINGLE/DUAL             $     92,940.76 C1882
820046 LEAD BI-V LEFT VENTRCULAR              $     15,432.19 C1900
820047 CATH DELIVERY SYSTEM                   $      2,360.84
820048 CATH BALLOON BI-VNTRC PACE             $      1,573.89 C1726
820049 CATH EP ENSITE 3D MAP                  $      9,049.15 C1732
820050 NAV-X EP MAP ELECTRODE                 $      3,382.52
820051 EP MAP REFERENCE PATCH                 $      2,759.43
820052 EP DIAGNOSTIC CATHETER                 $      2,361.70
820053 CATH EP ABLATION NON 3D                $      6,293.17 C1733
820054 PADS R2 EP STUDY                       $       440.64
820055 PACEMAKER DUAL CHMBR                   $     26,082.00 C1785
820056 PACEMAKER SINGLE CHMBR                 $     23,058.00 C1786
820061 CATH EP <19 ELECTRODES                 $      2,361.70 C1730
820063 CATH EP COOL-TIP                       $      6,293.17 C2630
820064 CATH EP DIAG/ABLAT 3D MAP              $      4,811.93 C1732
820065 CATH EP ABLATION NON-COOL TIP          $      4,811.93 C1733
820066 CATH OCCLUSION                         $       589.63 C2628
820067 LOOP RECRDR CARDIAC IMPLANT            $     10,174.54 C1764
820068 INTRO/SHEATH FIXED PEEL-AWAY           $       223.83 C1892
820069 CATH EP ABLATION 3D                    $      3,947.63 C1732
820070 LOCM<149MG,OMNIPAQUE, 1 ML             $         5.21 Q9945
820071 LOCM<149MG,VISIPAQUE, 1ML              $         5.21 Q9945
820072 LOCM<149MG,HYPAQUE, 1 ML               $         5.21 Q9945
820073 LOCM 200-249MG/ML IODINE, 1ML          $         5.21 Q9947
820074 LOCM 250-299MG/ML IODINE, 1ML          $         5.21 Q9948
820075 LOCM 300-349MG/ML IODINE, 1 ML         $         5.21 Q9949
820076 LOCM 350-399 MG/ML IODINE, 1ML         $         5.21 Q9950
820077 LOCM >400MG/ML IODINE, 1 ML            $         5.21 Q9951
820078 CATH GUIDING                           $      2,665.96 C1887
820079 LEAD PCMKR OTHER THAN VDD              $      3,464.53 C1898
820080 PCMKR OTHER THAN SINGLE/DUAL           $     34,650.00 C2621
820081 CORONARY SINUS ACCESS KIT              $      2,310.00
820082 D STAT FLOWABLE HEMOSTAT               $        93.50 C1760
820083 THEMOCOOL TUBING SET                   $       115.50




                                        Page 32
                                        Ancillary


820084 CATH DILITATION POLARCATH              $     9,061.44 C1725
820085 INTRO/SHEATH EP FIXED NON-PEEL         $      629.56 C1766
820087 GUIDE WIRE EXCHANGE PTCA               $      899.09 C1769
820088 GUIDE WIRE PTCA                        $     1,047.81 C1769
820089 GLIDE WIRE TERUMO                      $      188.08 C1769
820090 GLIDE/AMPLAX WIRE TERUMO               $      223.21 C1769
820091 INTRO/SHEATH TRNSPTAL NEEDL            $      775.72 C1893
820092 MICRO PUNCTURE SET                     $      129.47
820093 ERGONOVINE PROV TEST                   $      600.22 93024
820094 AICD,DL,CHMB, 135 GUID REPLC           $        1.00 C1721
820095 AICD,DL,CHMB,GUID,PRIZM2 REPLC         $        1.00 C1721
820096 CLOSURE DEVICE VASCULAR                $     1,068.11 C1760
820097 PERICARDIOCENTESIS KIT                 $      492.32
820098 CATHETER FLOWIRE                       $      952.55 C1769
820099 COOK NEEDLE                            $      237.33
820100 CATH DIAGNOSTC ANGIO MULTIPACK                         C1887
820101 CATH EP >20 ELECTRODES                                 C1731
840202 NEURO CLINIC NEW PT., LEVEL 1          $      129.05 99201
840203 NEURO CLINIC NEW PT., LEVEL 2          $      140.68 99202
840204 NEURO CLINIC NEW PT., LEVEL 3          $      185.80 99203
840205 NEURO CLINIC NEW PT., LEVEL 4          $      232.80 99204
840211 NEURO CLINIC NEW PT., LEVEL 5          $      296.74 99205
840212 NEURO CLINIC EST. PT., LEVEL 1         $      129.05 99211
840213 NEURO CLINIC EST. PT., LEVEL 2         $      140.68 99212
840214 NEURO CLINIC EST. PT., LEVEL 3         $      160.78 99213
840215 NEURO CLINIC EST. PT., LEVEL 4         $      204.38 99214
840241 NEURO CLINIC EST. PT., LEVEL 5         $      291.00 99215
840252 SEIZURE DISORDER CTR NEW PT L1         $      129.05 99201
840253 SEIZURE DISORDER CTR NEW PT L2         $      185.80 99203
840254 SEIZURE DISORDER CTR NEW PT L3         $      185.80 99203
840255 SEIZURE DISORDER CTR NEW PT L4         $      232.80 99204
840256 SEIZURE DISORDER CTR NEW PT L5         $      296.74 99205
840257 SEIZURE DISORDER CTR EST PT L1         $      129.05 99211
840258 SEIZURE DISORDER CTR EST PT L2         $      140.68 99212
840259 SEIZURE DISORDER CTR EST PT L3         $      160.78 99213
840260 SEIZURE DISORDER CTR EST PT L4         $      204.38 99214
840261 SEIZURE DISORDER CTR EST PT L5         $      291.00 99215
840262 NEUROMUSCULAR CTR NEW PT. L1           $      129.05 99201
840263 NEUROMUSCULAR CTR NEW PT. L2           $      140.68 99202
840264 NEUROMUSCULAR CTR NEW PT. L3           $      140.68 99202
840265 NEUROMUSCULAR CTR NEW PT. L4           $      232.80 99204
840266 NEUROMUSCULAR CTR NEW PT. L5           $      296.74 99205
840267 NEUROMUSCULAR CTR ESTAB PT. L1         $      129.05 99211
840268 NEUROMUSCULAR CTR ESTAB PT. L2         $      140.68 99212
840269 NEUROMUSCULAR CTR ESTAB PT. L3         $      160.78 99213
840270 NEUROMUSCULAR CTR ESTAB PT. L4         $      204.38 99214
840271 NEUROMUSCULAR CTR ESTAB PT. L5         $      291.00 99215
840272 STROKE SPECIALTY CTR NEW PT L1         $      129.05 99201
840273 STROKE SPECIALTY CTR NEW PT L2         $      140.68 99202




                                        Page 33
                                        Ancillary


840274 STROKE SPECIALTY CTR NEW PT L3         $     185.80 99203
840275 STROKE SPECIALTY CTR NEW PT L4         $     232.80 99204
840276 STROKE SPECIALTY CTR NEW PT L5         $     296.74 99205
840277 STROKE SPECIALTY CTR EST PT L1         $     129.05 99211
840278 STROKE SPECIALTY CTR EST PT L2         $     140.68 99212
840279 STROKE SPECIALTY CTR EST PT L3         $     160.78 99213
840280 STROKE SPECIALTY CTR EST PT L4         $     204.38 99214
840281 STROKE SPECIALTY CTR EST PT L5         $     291.00 99215
840312 MULTI SCLEROSIS CTR NEW PT L1          $     129.05 99201
840313 MULTI SCLEROSIS CTR NEW PT L2          $     140.68 99202
840314 MULTI SCLEROSIS CTR NEW PT L3          $     185.80 99203
840315 MULTI SCLEROSIS CTR NEW PT L4          $     232.80 99204
840316 MULTI SCLEROSIS CTR NEW PT L5          $     296.74 99205
840317 MULTI SCLEROSIS CTR ESTA PT L1         $     129.05 99211
840318 MULTI SCLEROSIS CTR ESTA PT L2         $     140.68 99212
840319 MULTI SCLEROSIS CTR ESTA PT L3         $     160.78 99213
840320 MULTI SCLEROSIS CTR ESTA PT L4         $     204.38 99214
840321 MULTI SCLEROSIS CTR ESTA PT L5         $     291.00 99215
840332 PARKINSONS DIS CTR NEW PT L1           $     129.05 99201
840333 PARKINSONS DIS CTR NEW PT L2           $     140.68 99202
840334 PARKINSONS DIS CTR NEW PT L3           $     185.80 99203
840335 PARKINSONS DIS CTR NEW PT L4           $     232.80 99204
840336 PARKINSONS DIS CTR NEW PT L5           $     296.74 99205
840337 PARKINSONS DIS CTR EST PT L1           $     129.05 99211
840338 PARKINSONS DIS CTR EST PT L2           $     140.68 99212
840339 PARKINSONS DIS CTR EST PT L3           $     160.78 99213
840340 PARKINSONS DIS CTR EST PT L4           $     204.38 99214
840341 PARKINSONS DIS CTR EST PT L5           $     291.00 99215
840353 ANALYZE NEUROSTIM, SIMPLE              $     447.94 95971
840359 H & B INTERVEN 15MIN/FAM/WO/PT         $      89.79 96155
840366 ANALYZE NEUROSTIM, NO PROG             $     569.30 95970
840370 VNS - SIMPLE PROGRAMMING               $     749.46 95971
840401 ALS CENTER NEW PT, LEVEL 1             $     129.05 99201
840402 ALS CENTER NEW PT, LEVEL 2             $     140.68 99202
840403 ALS CENTER NEW PT, LEVEL 3             $     185.80 99203
840404 ALS CENTER NEW PT, LEVEL 4             $     232.80 99204
840405 ALS CENTER NEW PT, LEVEL 5             $     296.74 99205
840406 ALS CENTER EST PT, LEVEL 1             $     129.05 99211
840407 ALS CENTER EST PT, LEVEL 2             $     140.68 99212
840408 ALS CENTER EST PT, LEVEL 3             $     160.78 99213
840409 ALS CENTER EST PT, LEVEL 4             $     204.38 99214
840410 ALS CENTER EST PT, LEVEL 5             $     291.00 99215
850205 NEURO CLINIC NEW PT.,LEVEL 1           $     129.05 99201
850206 NEURO CLINIC NEW PT., LEVEL 2          $     140.68 99202
850207 NEURO CLINIC NEW PT., LEVEL 3          $     185.80 99203
850208 NEURO CLINIC NEW PT., LEVEL 4          $     232.80 99204
850209 NEURO CLINIC NEW PT., LEVEL 5          $     296.74 99205
850210 NEURO CLINIC EST. PT., LEVEL 1         $     129.05 99211
850211 NEURO CLINIC EST. PT., LEVEL 2         $     140.68 99212




                                        Page 34
                                        Ancillary


850212 NEURO CLINIC EST. PT., LEVEL 3         $      160.78 99213
850213 NEURO CLINIC EST. PT., LEVEL 4         $      204.38 99214
850214 NEURO CLINIC EST. PT., LEVEL 5         $      291.00 99215
850304 PUNCTURE OF SHUNT TUBING               $      607.29 61070
850306 SHUNTOGRAM OF PREV. INDWELLING         $      401.69 75809
880001 EEGMONIT W/VIDEO, 24 HR                $     5,773.03 95951
880002 EEG EXT- MON ( 41-60 MIN)              $     3,812.25 95812
880003 EEG EXTENDED MON > 1 HOUR              $     4,269.72 95813
880004 EEG MONITOR W/OUT VIDEO 24 HR          $     5,337.15 95956
880006 WADA ( MEMORY DOMINANCE TEST)          $     6,404.61 95958
880007 DIG/ANALYS/EPILEP/SPIKE/ANALYS         $     1,216.22 95957
880008 EEG MONITORING/COMPUT EA 24 HR         $     2,854.75 95953
880009 8-CONTACT STRIP ELECTRODE              $     2,098.57
880010 ECOG (ELECTROCORTICOGRAPHY)            $     8,177.99 95829
880011 FUNCT/MOTOR/LANGUAGMAP/1STHR           $     1,906.13 95961
880012 FUNCT/MOTOR/LANGUAGMAP/ADD'LHR         $     1,429.60 95962
880014 STEREOTACTIC LOCALIZATION              $     6,585.58 61770
880015 ANALYZE NEUROSTIM, NO PROG             $      941.18 95970
880016 ANALYZE NEUROSTIM, SIMPLE              $      429.82 95971
880018 20 CONTACT STRIP ELECTRODE             $     1,932.60
880019 64-CONTACT STRIP ELECTRODE             $     2,718.09
880020 2 CONTACT STRIP ELECTRODE              $      488.66
880021 SPENCER DEPTH ELECTRODES 8 CON         $      862.86
880022 DEPT ELECTRODE PASSING NEEDLE          $      368.25
880023 ANCHOR BOLTS                           $      124.44
880024 WYLER SUBDURAL STRIP ELECTRODE         $     1,421.60
910030 XR EYE FOREIGN BODY, UNILAT            $      373.43 70030
910100 XR MANDIBLE LTD, LESS 4VW              $      475.26 70100
910110 XR MANDIBLE COM, MIN 4VW               $      754.38 70110
910120 XR MASTOIDS LTD, LESS 3VW              $      474.51 70120
910140 XR FACIAL BONES LTD, LESS 3VW          $      474.51 70140
910150 XR FACIAL BONES COM, MIN 3VW           $      841.04 70150
910160 XR NASAL BONES COM, MIN 3VW            $      717.53 70160
910199 XR OPTIC FORAMINA                      $      315.74 70190
910200 XR ORBITS COM, MIN 4VW                 $      682.47 70200
910210 XR SINUSES LTD, LESS 3VW               $      315.74 70210
910220 XR SINUSES COM, MIN 3VW                $      699.92 70220
910250 XR SKULL LTD, LESS 4VW                 $      474.51 70250
910260 XR SKULL COM, MIN 4VW                  $     1,074.54 70260
910330 XR TMJ, UNILATERAL                     $      367.01 70328
910332 XR TMJ, BILATERAL                      $      475.26 70330
910360 XR NECK, SOFT TISSUE                   $      513.91 70360
911010 XR CHEST 1VW, FRONTAL                  $      514.83 71010
911020 XR CHEST 2VW, FRONT/LAT                $      575.49 71020
911021 XR CHEST 3VW, FRONT/LAT/LORDIC         $      419.90 71021
911022 XR CHEST SPECIAL, MIN 4VW              $      754.38 71030
911023 XR CHEST 4VW, FRONT/LAT/OBLIQS         $      511.11 71022
911024 XR CHEST 2VW, FRONT/LAT/FLUORO         $      575.58 71023
911100 XR RIBS LTD, 2VW UNILAT                $      626.97 71100




                                        Page 35
                                        Ancillary


911101 XR RIBS+CHEST 3VWS UNILAT              $     628.89 71101
911110 XR RIBS COM, 3VW BILAT                 $     753.11 71110
911111 XR RIBS COM, 3VW BILAT+CHEST           $     538.34 71111
911120 XR STERNUM COM, MIN 2VW                $     666.51 71120
911130 XR STERNOCLAV JOINT, MIN 3VW           $     475.26 71130
912040 XR C-SPINE LTD, 2-3VW                  $     521.23 72040
912050 XR C-SPINE COM, MIN 4VW                $     725.19 72050
912052 XR C-SPINE COM+FLEX/EXT, 7VW           $     971.43 72052
912070 XR T-SPINE LTD, 2VW                    $     682.23 72070
912072 XR T-SPINE COM, 3VW                    $     814.03 72072
912074 XR T-SPINE COM, MIN 4VW                $     475.26 72074
912080 XR T/L-SPINE LTD, 2VW                  $     600.47 72080
912100 XR L-SPINE LTD, 2-3VW                  $     596.39 72100
912110 XR L-SPINE COM, MIN 4VW                $     972.44 72110
912170 XR PELVIS, 1-2VW                       $     564.83 72170
912190 XR PELVIS, MIN 3VW                     $     587.81 72190
912200 XR SACROILIAC JOINTS, LESS 3VW         $     315.74 72200
912202 XR SACROILIAC JOINTS, MIN 3VW          $     675.97 72202
912220 XR SACRUM/COCCYX, MIN 2VW              $     801.60 72220
913000 XR CLAVICLE COM, UNILAT                $     446.22 73000
913010 XR SCAPULA COM, UNILAT                 $     585.55 73010
913020 XR SHOULDER LTD, 1VW UNILAT            $     550.21 73020
913030 XR SHOULDER COM, MIN 2VW UNILT         $     663.84 73030
913050 XR AC JOINT WO/W WEIGHT, BILAT         $     597.31 73050
913060 XR HUMERUS COM, MIN 2VW UNILAT         $     564.83 73060
913070 XR ELBOW LTD, 2VW UNILAT               $     497.05 73070
913080 XR ELBOW COM, MIN 3VW UNILAT           $     483.61 73080
913090 XR FOREARM COM, 2VW UNILAT             $     521.23 73090
913092 XR UPP EXT INFANT, 2VW UNILAT          $     475.26 73092
913100 XR WRIST LTD, 2VW UNILAT               $     397.20 73100
913110 XR WRIST COM, MIN 3VW UNILAT           $     619.34 73110
913120 XR HAND LTD, 2VW UNILAT                $     463.19 73120
913130 XR HAND COM, MIN 3VW UNILAT            $     596.95 73130
913140 XR FINGER(S) COM, MIN 2VW UNI          $     446.05 73140
913500 XR HIP LTD, 1VW UNILAT                 $     480.75 73500
913510 XR HIP COM, 2VW UNILAT+PELVIS          $     571.27 73510
913520 XR HIP COM, 2VW BILAT+PELVIS           $     952.18 73520
913529 XR HIP COM, 2VW UNILAT+PELVIS          $     571.27 73510
913540 XR HIPS+PELVIS, MIN 2VW PEDS           $     475.26 73540
913550 XR FEMUR 2VW, UNILAT                   $     538.86 73550
913559 XR PATELLA LTD, 1-2VW UNILAT           $     474.51 73560
913560 XR KNEE LTD, 1-2VW UNILAT              $     474.51 73560
913562 XR KNEE COM, 3VW UNILAT                $     236.53 73562
913564 XR KNEE COM, MIN 4VW UNILAT            $     677.80 73564
913565 XR KNEE LTD, AP STANDING BILAT         $     316.34 73565
913590 XR TIB/FIB, 2VW UNILAT                 $     662.69 73590
913592 XR LOW EXT INFANT, 2VW UNILAT          $     378.63 73592
913600 XR ANKLE COM, MIN 2VW UNILAT           $     486.82 73600
913610 XR ANKLE COM, MIN 2VW UNILAT           $     668.39 73610




                                        Page 36
                                        Ancillary


913620 XR FOOT LTD, 2VW UNILAT                $       491.56 73620
913630 XR FOOT COM, MIN 3VW UNILAT            $       668.39 73630
913650 XR CALCANEUS COM, MIN 2VW UNI          $       624.61 73650
913660 XR TOE(S) COM, MIN 2VW UNILAT          $       316.34 73660
914000 XR ABDOMEN 1VW, UPPER                  $       433.64 74000
914002 XR ABDOMEN 1VW, KUB                    $       433.64 74000
914010 XR ABDOMEN 2-3VW                       $       643.45 74020
914012 XR ABDOMEN 2-3VW+CHEST, ACUTE          $       620.59 74022
914430 XR CYSTOGRAM, MIN 3VW, S&I             $       958.74 74430
917076 XR BONE SURVEY, CHILD                  $       607.78 77076
920001 ABLATION PROBE 12 CM                   $      3,622.74
920002 ABLATION PROBE SEMI-FLEX 25 CM         $      3,187.14
920003 ABLATION PROBE SDE 12 CM               $      2,896.74
920004 ABLATION PROBE FLEX 25 CM              $      3,310.56
920022 FINE NDLE ASP. W/IMAG.GUID.            $      1,511.90 10022
920145 CT HEART+CCS WO/W CONT                 $      3,575.00 0145T
920146 CTA HEART WO/W CONT                    $      4,160.00 0146T
920147 CTA HEART+CCS WO/W CONT                $      4,290.00 0147T
920148 CT+CTA HEART WO/W CONT                 $      4,420.00 0148T
920149 CT+CTA HEART+CCS WO/W CONT             $      4,875.00 0149T
920151 CT HEART+EF+WM WO/W CONT               $      5,070.00 0151T
920152 CT HEART+MORPH WO/W CONT               $      4,160.00 0150T
920200 BX RENAL/KIDNEY,PERC                   $      2,054.80 50200
920206 BX MUSCLE, PERC                        $      2,127.63 20206
920220 BX BONE, SUPFL, PERC                   $      2,055.05 20220
920222 BRACHYTHERAPY CATH PLCMT CHEST         $      1,735.03 32020
920223 RADIOLO. GD PERC. DRAIN W/PLCM         $      1,807.85 75989
920225 BX BONE, DEEP                          $      2,495.25 20225
920390 INJ OR ASP RENAL PELVIS/CYST           $      1,782.45 50390
920496 CT BRAIN ANGIO WITH & WITHOUT          $      3,697.60 70496
920497 CT BRAIN W/PERFUSION WITH CON.         $      2,960.10 0042T
920498 CTA NECK W&WO                          $      3,697.60 70498
920499 CT GUIDED NECK W/CSF GLUE INJ.         $      1,233.38 76499
920501 INJ SINOGRAM                           $       296.21 20501
920592 CT RFA RENAL TUMOR                     $      2,000.00 50592
920982 BONE ABLATION, RIB                     $     13,860.00 20982
920999 BONE ABLATION, MUSCUL, GEN             $     13,860.00 20999
921000 BX OR ASP STEREOTACTIC BRAIN           $      7,017.56 61751
921004 CT BONE SURVEY, SCANOGRAM              $       806.38 77073
921250 CT CHEST HI-RESOLUTION W/O CON         $      4,615.31 71250
921251 CT CORONARY ANGIO W & W/ CONT.         $      1,471.83 76497
921275 CTA CHEST WO/W CONT                    $      3,697.60 71275
922021 CT GD CHEST TUBE PLACEMENT             $      1,735.03 32020
922191 CT ANGIO PELVIS W/WO CONTRAST          $      2,844.48 72191
922201 DRAIN LUNG ABCESS                      $      1,282.49 32201
922292 CT PERQ VERTEBROPLASTY                 $       518.67 72292
922400 BX PLEURA,PERC                         $      2,160.80 32400
922405 BX LUNG/MEDIASTINUM,PERC               $      2,477.85 32405
922689 BONE ABLATION, HANDS FINGERS           $     13,860.00 26989




                                        Page 37
                                        Ancillary


922999 ABLATION, RF LUNG TUMOR                $      1,655.05 32999
923200 PUNCTURE THORACENTESIS                 $      1,156.16 32000
923214 IONIC CONTRAST 50 ML                   $       174.85
923899 KIDNEY ABLATION                        $      5,438.20 53899
924175 CTA ABDOMEN W&W/O                      $      3,876.96 74175
924176 CTA RENAL (ABDOMEN) W&W/O              $      3,876.96 74175
924413 CT GUIDED CERVICAL NERVE BLOCK         $       969.36 64413
924999 BONE ABLATION HUMERUS OR ELBOW         $     13,860.00 24999
925000 CT ABDOMEN W/O CONTRAST                $      3,731.68 74150
925001 CT ABDOMEN W/CONTRAST                  $      4,447.67 74160
925002 CT ABDOMEN W/WOUT CONTRAST             $      5,040.06 74170
925013 CT UROGRAM W/O CONTRAST                $      3,497.51 72192
925014 CT UROGRAM W & WO CONTRAST             $      5,695.78 72194
925030 CT HEAD/BRAIN WO CONT                  $      2,711.69 70450
925031 CT HEAD/BRAIN W CONT                   $      3,589.75 70460
925032 CT BRAIN W/WOUT CONTRAST               $      4,189.77 70470
925040 CT C-SPINE                             $      3,878.75 72125
925041 CT C-SPINE W/CONTRAST                  $      3,289.00 72126
925042 CT C-SPINE W/WOUT CONTRAST             $      2,379.09 72127
925043 CT CERVICAL SPINE POST MYELO           $      3,289.00 72126
925044 CT INSTRA-TRAK C/S W/O CONT            $      3,878.75 72125
925050 CT CHEST                               $      3,628.61 71250
925051 CT CHEST W/CONTRAST                    $      4,287.83 71260
925052 CT CHEST W/WOUT CONTRAST               $      5,172.02 71270
925070 CT GD NDL PLCMT DRAIN CYST S&I         $      2,973.79 77012
925080 CT FACIAL BONES                        $      2,556.81 70486
925081 CT FACIAL BONES W/CONTRAST             $      3,642.27 70487
925082 CT FACIAL BONES W/WOUT CONTRST         $      3,320.25 70488
925140 CT HIP WO CONT, UNILAT                 $      3,321.36 73700
925141 CT HIP W CONT, UNILAT                  $      3,407.84 73701
925142 CT HIP WO/W CONT, UNILAT               $      2,677.00 73702
925150 CT I.A.C.                              $      3,050.74 70480
925151 CT I.A.C. W/CONTRAST                   $      2,478.18 70481
925152 CT I.A.C. W/WOUT CONTRAST              $      3,897.26 70482
925160 CT IAC/PETROUB BONES                   $      3,050.74 70480
925161 CT IAC/PETROUB BONES W/CONTRAT         $      2,478.18 70481
925162 CT IAC/PETROUB BONES W/WOUT CO         $      3,897.26 70482
925170 CT ABD/KIDNEY W/O CONT                 $      3,731.68 74150
925171 CT ABD/KIDNEY W CONT                   $      4,447.67 74160
925172 CT KIDNEY W/WOUT CONTRAST              $      5,040.06 74170
925179 CT THOR TO LUMBAR-3 SPINE W/O          $      3,573.43 72131
925180 CT LUMBAR SPINE W/O CONT               $      3,573.43 72131
925181 CT LUMBAR SPINE W/CONTRAST             $      3,925.42 72132
925182 CT LUMBAR SPINE W/WOUT CONTRAT         $      3,320.25 72133
925183 CT LUMBAR SPINE POST MYELO             $      3,573.43 72131
925184 CT INSTRA-TRAK L/S W/O CONT.           $      3,573.43 72131
925190 CT LARYNX                              $      2,176.71 70490
925191 CT LARYNX W/CONTRAST                   $      4,004.93 70491
925192 CT LARYNX W/WOUT CONTRAST              $      3,320.25 70492




                                        Page 38
                                        Ancillary


925200 CT LOWER EXTREMITY WO CONT             $     3,321.36 73700
925201 CT LOWER EXTREM W CONT                 $     3,407.84 73701
925202 CT LOWER EXTREMITY W/WOUT CONS         $     2,677.00 73702
925220 CT NASOPHARYNX                         $     2,176.71 70490
925221 CT NASOPHARYNX W/CONTRAST              $     4,004.93 70491
925222 CT NASOPHARYNX W/WOUT CONTRAST         $     3,320.25 70492
925230 CT NECK                                $     2,176.71 70490
925231 CT NECK W/CONTRAST                     $     4,004.93 70491
925232 CT NECK W/WOUT CONTRAST                $     3,320.25 70492
925240 CT ORBITS                              $     3,050.74 70480
925241 CT ORBITS W/CONTRAST                   $     2,478.18 70481
925242 CT ORBITS W/WOUT CONTRAST              $     3,897.26 70482
925250 CT ORBITAL BONES                       $     3,050.74 70480
925251 CT ORBITAL BONES W/CONTRAST            $     2,478.18 70481
925252 CT ORBITAL BONES W/WOUT CNTST          $     3,897.26 70482
925260 CT PAROTIDS                            $     2,176.71 70490
925261 CT PAROTIDS W/CONTRAST                 $     4,004.93 70491
925262 CT PAROTIDS W/WOUT CONTRAST            $     3,320.25 70492
925270 CT PELVIS W/O CONT                     $     3,497.51 72192
925271 CT PELVIS W/CONTRAST                   $     4,481.16 72193
925272 CT PELVIS W/WOUT CONTRAST              $     5,695.78 72194
925280 CT PETROUS BONES                       $     3,050.74 70480
925281 CT PETROUS BONES W/CONTRAST            $     2,478.18 70481
925282 CT PETROUS BONES W/WOUT CONTST         $     3,897.26 70482
925290 CT SACRO JOINTS                        $     3,497.51 72192
925291 CT SACRO JOINTS W/CONTRAST             $     4,481.16 72193
925292 CT SACRO JOINTS W/WOUT CONTRST         $     5,695.78 72194
925300 CT SALIVARY GLANS                      $     2,176.71 70490
925301 CT SALIVARY GLANS W/CONTRAST           $     4,004.93 70491
925302 CT SALIVARY GLAN W/WOUT CONRST         $     3,320.25 70492
925310 CT SELLA                               $     3,050.74 70480
925311 CT SELLA W/CONTRAST                    $     2,478.18 70481
925312 CT SELLA W/WOUT CONTRAST               $     3,897.26 70482
925320 CT SINUSES                             $     2,556.81 70486
925321 CT SINUSES W/CONTRAST                  $     3,642.27 70487
925322 CT SINUSES W/WOUT CONTRAST             $     3,320.25 70488
925325 CT SINUS INSTA-TRAK                    $     2,556.81 70486
925326 CT SINUSES-LIMITED W/O CONT.           $     1,973.16 76380
925330 CT TEMPORAL BONES                      $     3,050.74 70480
925331 CT TEMPORAL BONES W/CONTRAST           $     2,478.18 70481
925332 CT TEMPORAL BONES W/WOUT CTRST         $     3,897.26 70482
925340 CT THORACIC SPINE W/O                  $     3,373.02 72128
925341 CT THORACIC SPINE W/CONTRAST           $     3,810.33 72129
925342 CT THORACIC SPINE W&W/O CONT           $     3,320.25 72130
925343 CT THORACIC SPINE POST MYELO           $     3,810.33 72129
925350 CT UPPER EXTREMITY W/O CONT            $     3,095.36 73200
925351 CT UPPER EXTREMITY W CONT              $     2,755.64 73201
925352 CT UPPER EXTREMTY W/WOUT CTRST         $     2,600.75 73202
925360 CT AXIAC                               $     3,050.74 70480




                                        Page 39
                                        Ancillary


925392 CT SACRUM W/O CONTRAST                 $      3,573.43 72131
925393 CT SACRUM W/O CONTRAST                 $      3,573.43 72131
925635 CT ANGIO ABDOMINAL AORTA-ILIOF         $      2,120.39 75635
925989 RAD GUIDANCE PERC. DRAIN W/ C          $      1,807.85 75989
925999 BONE ABLATION,FOREARM OR WRIST         $     13,860.00 25999
926003 CT FLUORO NEEDLE PLCMT                 $       902.07 77002
926071 CT BONE DENSITY AXIAL SKEL             $       804.16 77078
926360 CT GD NDL PLCMT BX/ASP/INJ S&I         $      2,973.79 77012
926362 CT GD RFA                              $      2,554.07 77013
926376 #CT 3D RECON, TECH CONSOLE             $      1,495.29 76376
926377 #CT 3D RECON, SEP WORKSTATION          $      1,495.29 76377
927000 BX LIVER,PERC                          $      2,367.65 47000
927011 DRAIN LIVER ABCESS/CYST                $      2,853.37 47011
927015 NEEDLE CHIBA BIOPSY DISP.              $        72.60
927019 NEEDLE OSTYCUT BONE BIOPSY             $       363.00
927020 GUIDE WIRE INTERVENTIONAL COON         $        79.86
927026 DRAINAGE BAG 600 ML, TRU-CLOSE         $        72.60
927027 CATHETER APDL DRAINAGE                 $       435.60
927028 CATHETER FASTNER, PERCU-STAY           $        50.82
927031 NEEDLE MANAN AUTO. CUTTING             $        72.60
927032 INTRODUCER MANAN NEEDLE                $        65.34
927033 VENT KIT (T-VENT) THORACIC             $       544.50
927034 INJECTION KIT GLUE                     $      1,815.00
927299 BONE ABLATION PEL OR HIP JOINT         $     13,860.00 27299
927382 ABLATION, RF LIVER TUMOR               $     12,055.34 47382
927599 BONE ABLATION, FEMUR OR KNEE           $     13,860.00 27599
927899 BONE ABLATION, LEG OR ANKLE            $     13,860.00 27899
928102 BX PANCREAS,PERC                       $      2,054.80 48102
928511 DRAIN,PANCREAS PSEUDOCYST,PERC         $      2,853.37 48511
928870 CT GUIDE NEEDLE PLACEMENT S&I          $      2,973.79 77012
928885 CT. LIMITED OR LOCAL F/U STUDY         $      1,973.16 76380
928899 BONE ABLATION, FOOT OR TOES            $     13,860.00 28899
929000 FIBRIN GLUE INJ KIT                    $      1,275.51
929021 DRAIN PERITONEAL ABSCESS,PERC          $      3,804.80 49021
929040 DRAIN SUBDIAPHRAGM/PHRENIC ABS         $      2,417.84 49040
929060 DRAIN RETROPERITNL ABSCSS,OPEN         $      2,123.74 49060
929061 DRAIN RETROPERITNL ABSCSS,PERC         $      2,853.37 49061
929080 PARACENTESIS                           $      1,472.14 49080
929180 BX ABD OR RETROPERI MASS,PERC          $      1,782.45 49180
929835 CT TEMP MANDIB JOINTS W/O CONT         $      2,556.81 70486
929836 CT VIRTUAL COLONOSCOPY, DIAG           $      8,672.28 0067T
929839 CTA EXT LOWER WO/W CONT UNILAT         $      1,997.48 73706
929841 CTA EXT UPPER WO/W CONT UNILAT         $      1,881.02 73206
929949 GASTROGAFFIN                           $         2.77 Q9949
929950 CT/XR IODINE 350-399                   $         1.85 Q9950
939708 PREVIEW TX PLANNING SOFTWARE           $      2,348.98 G0288
1020002 ABLATION PROBE 12 CM                  $      3,622.74
1020004 CT VIRTUAL COLONSCOPY(SCREEN)         $      2,870.53 74150
1020005 CT VIRTUAL COLONOSCOPY (DIAG)         $      2,870.53 74150




                                        Page 40
                                         Ancillary


1020006 ABLATION PROBE SEMI-FLEX 25 CM         $     3,187.14
1020007 ABLATION PROBE SDE 12 CM               $     2,896.74
1020008 ABLATION PROBE FLEX 25 CM              $     2,758.80
1020022 FINE NEEDLE ASPI W/ IMG GUID           $     1,163.00 10022
1020144 CT HEART+CCS WO CONT                   $     2,530.00 0144T
1020145 CT HEART+CCS WO/W CONT                 $     3,162.50 0145T
1020146 CTA HEART WO/W CONT                    $     3,200.00 0146T
1020147 CTA HEART+CCS WO/W CONT                $     3,795.00 0147T
1020148 CT+CTA HEART WO/W CONT                 $     3,400.00 0148T
1020149 CT+CTA HEART+CCS WO/W CONT             $     3,750.00 0149T
1020151 CT HEART+EF+WM WO/W CONT               $     3,900.00 0151T
1020152 CT HEART+MORPH WO/W CONT               $     3,200.00 0150T
1020202 BX RENAL/KIDNEY,PERC                   $     1,580.62 50200
1020206 BX MUSCLE, PERC                        $     1,636.64 20206
1020225 BX BONE, DEEP                          $     1,919.42 20225
1020226 BX THYROID, PERC                       $      917.06 60100
1020390 INJ OR ASP RENAL PELVIS/CYST           $     1,371.12 50390
1020496 CTA HEAD/BRAIN                         $     2,844.31 70496
1020497 CT BRAIN W/PERFUSION WITH CON.         $     2,277.00 0042T
1020499 CT GUIDED NECK W/CSF GLUE INJ.         $      948.75 76499
1020501 INJ SINOGRAM                           $      227.85 20501
1021004 CT BONE SURVEY, SCANOGRAM              $      620.30 77073
1022191 CTA PELVIS W&W/O                       $     2,188.06 72191
1022201 DRAIN LUNG ABCESS                      $      986.53 32201
1022203 DRAIN LIVER ABCESS/CYST                $     2,194.90 47011
1022400 BX PLEURA,PERC                         $     1,662.15 32400
1022405 BX LUNG/MEDIASTINUM,PERC               $     1,906.04 32405
1023200 PUNCTURE THORACENTESIS                 $      889.35 32000
1023525 XR ARTHROGRAM HIP S&I UNILAT           $      868.98 73525
1024413 CERVICAL SPINE NERVE BLOCK             $      745.67 64413
1024700 BX LIVER,PERC                          $     1,821.27 47000
1025000 CT ABDOMEN W/O CONTRAST                $     2,870.53 74150
1025001 CT ABDOMEN W/CONTRAST                  $     3,421.28 74160
1025002 CT ABDOMEN W/WOUT CONTRAST             $     3,876.96 74170
1025030 CT HEAD/BRAIN W/O CONT                 $     2,085.92 70450
1025031 CT HEAD/BRAIN W CONT                   $     2,761.35 70460
1025032 CT HEAD/BRAIN W & W/O CONT             $     3,222.90 70470
1025040 CT C-SPINE                             $     2,983.65 72125
1025041 CT C-SPINE W/CONTRAST                  $     2,530.00 72126
1025042 CT C-SPINE W/WOUT CONTRAST             $     1,830.06 72127
1025043 CT CERVICAL SPINE POST MYELO           $     2,983.65 72125
1025050 CT THORAX, WITHOUT CONTRAST            $     2,791.23 71250
1025051 CT THORAX, WITH CONTRAST               $     3,412.19 71260
1025052 CT THORAX W & WO CONTRAST              $     3,978.47 71270
1025053 CT CHEST HI-RESOLUTION W/O CON         $     3,550.23 71250
1025070 CT GD NDL PLCMT DRAIN CYST S&I         $     2,287.52 77012
1025080 CT FACIAL BONES W/O CONT               $     1,966.76 70486
1025081 CT FACIAL BONES W/CONTRAST             $     2,801.75 70487
1025082 CT FACIAL BONES W/WOUT CONTRST         $     2,554.04 70488




                                         Page 41
                                         Ancillary


1025140 CT HIP WO CONT, UNILAT                 $     2,554.90 73700
1025141 CT HIP W CONT, UNILAT                  $     2,621.43 73701
1025142 CT HIP WO/W CONT, UNILAT               $     2,059.24 73702
1025150 CT I.A.C.                              $     2,346.72 70480
1025151 CT I.A.C. W/CONTRAST                   $     1,906.30 70481
1025152 CT IAC WO/W CONTRAST                   $     2,997.89 70482
1025160 CT IAC/PETROUS BONES                   $     2,346.72 70480
1025161 CT IAC/PETROUS BONES W CONT            $     1,906.30 70481
1025162 CT IAC/PETROUS BONES W/WO CONT         $     2,997.89 70482
1025170 CT ABD/KIDNEY W/O CONT                 $     2,870.53 74150
1025171 CT ABD/KIDNEY W CONT                   $     3,421.28 74160
1025172 CT KIDNEY W/WOUT CONTRAST              $     3,876.96 74170
1025180 CT LUMBAR SPINE W/O CONT               $     2,748.80 72131
1025181 CT LUMBAR SPINE W/CONTRAST             $     3,019.56 72132
1025182 CT LUMBAR SPINE W/WOUT CONTRAT         $     2,554.04 72133
1025183 CT POST MYELOGRAM L/SPINE W/O          $     2,748.80 72131
1025190 CT LARYNX                              $     1,674.39 70490
1025191 CT LARYNX W/ CONTRAST                  $     3,080.72 70491
1025192 CT LARYNX W/WOUT CONTRAST              $     2,554.04 70492
1025200 CT LOWER EXTREMITY WO CONT             $     2,554.90 73700
1025201 CT LOWER EXTREMITY W CONT              $     2,621.43 73701
1025202 CT LOWER EXTREMITY W/WOUT CONS         $     2,059.24 73702
1025220 CT MAXILLOFACIAL AREA W/O CONT         $     1,966.76 70486
1025221 CT MAXILLOFACIAL AREA W/ CONT          $     2,801.75 70487
1025222 CT MAXILLOFACIAL W & W/O CONT          $     2,554.04 70488
1025223 DENTAL MAXILLAE SINGLE WO CONT         $     1,966.76 70486
1025224 DENTAL MANDIBLE SINGLE WO CONT         $     1,966.76 70486
1025225 DENTAL MAXILLAE COMBO WO CONT          $     1,966.76 70486
1025230 CT SOFT TISSUE NECK W/O CONT           $     1,674.39 70490
1025231 CT SOFT TISSUE NECK WITH CONT          $     3,080.72 70491
1025232 CT SOFT TISS NECK W & W/O CONT         $     2,554.04 70492
1025240 CT ORBITS                              $     2,346.72 70480
1025241 CT ORBITS W/CONTRAST                   $     1,906.30 70481
1025242 CT ORBITS WO/W CONTRAST                $     2,997.89 70482
1025250 CT ORBITS WO CONT                      $     2,346.72 70480
1025251 CT ORBITS W CONT                       $     1,906.30 70481
1025252 CT ORBITS WO/W CONT                    $     2,997.89 70482
1025260 CT PAROTIDS                            $     1,674.39 70490
1025261 CT PAROTIDS W/CONTRAST                 $     3,080.72 70491
1025262 CT PAROTIDS W/WOUT CONTRAST            $     2,554.04 70492
1025270 CT PELVIS WO CONTRAST                  $     2,690.39 72192
1025271 CT PELVIS W/CONTRAST                   $     3,447.04 72193
1025272 CT PELVIS WO/W CONTRAST                $     4,381.37 72194
1025280 CT PETROUS BONES                       $     2,346.72 70480
1025281 CT PETROUS BONES W/ CONTRAST           $     1,906.30 70481
1025282 CT PETROUS BONES W/WOUT CONTST         $     2,997.89 70482
1025290 CT SACRO JOINTS                        $     2,690.39 72192
1025291 CT SACRO JOINTS W/CONTRAST             $     3,447.04 72193
1025292 CT SACROILIAC JOINTS WO/W CONT         $     4,381.37 72194




                                         Page 42
                                         Ancillary


1025300 CT NECK WO CONT, SALIVARY GLND         $     1,674.39 70490
1025301 CT NECK W CONT, SALIVARY GLAND         $     3,080.72 70491
1025302 CT NECK WO/W CONT, SALIVARY GL         $     2,554.04 70492
1025310 CT SELLA                               $     2,346.72 70480
1025311 CT SELLA W/CONTRAST                    $     1,906.30 70481
1025312 CT SELLA W/WOUT CONTRAST               $     2,997.89 70482
1025319 CT SINUS W/INSTSTRAC W/O CONTR         $     1,966.76 70486
1025320 CT SINUSES                             $     1,966.76 70486
1025321 CT SINUSES W/CONTRAST                  $     2,801.75 70487
1025322 CT SINUSES W/WOUT CONTRAST             $     2,554.04 70488
1025325 CT SINUS INSTA-TRAK                    $     1,966.76 70486
1025330 CT TEMPORAL BONES                      $     2,346.72 70480
1025331 CT TEMPORAL BONES W/CONTRAST           $     1,906.30 70481
1025332 CT TEMPORAL BONES W/WOUT CTRST         $     2,997.89 70482
1025340 CT THORACIC SPINE W/O                  $     2,594.63 72128
1025341 CT THORACIC SPINE W/CONTRAST           $     2,931.03 72129
1025342 CT THORACIC SPINE W&W/O CONT           $     2,554.04 72130
1025343 CT THORACIC SPINE POST MYELO           $     2,931.03 72129
1025350 CT UPPER EXTREMITY W/O CONT            $     2,381.05 73200
1025351 CT UPPER EXTREMITY W CONT              $     2,119.73 73201
1025352 CT UPPER EXTREMTY W/WOUT CTRST         $     2,000.57 73202
1025353 ENT HEADSET                            $      175.33
1026071 CT BONE DENSITY AXIAL SKEL             $      618.59 77078
1026360 CT GD NDL PLCMT BX/ASP/INJ S&I         $     2,287.52 77012
1026365 CT GD NDL PLCMT ASPIR CYST S&I         $     2,287.52 77012
1026376 #CT 3D RECON, TECH CONSOLE             $     1,150.22 76376
1026377 #CT 3D RECON, SEP WORKSTATION          $     1,150.22 76377
1027011 DRAIN LIVER ABCESS/CYST                $     2,194.90 47011
1027015 NEEDLE CHIBA BIOPSY DISP.              $       72.60
1027027 NEEDLE OSTYCUT BONE BIOPSY             $      302.50
1027029 GUIDE WIRE INTERVENTIONAL COON         $       66.55
1027033 DRAINAGE BAG 600 ML, TRU-CLOSE         $       60.50
1027035 CATHETER APDL DRAINAGE                 $      363.00
1027037 CATHETER FASTNER, PERCU-STAY           $       42.35
1027043 NEEDLE MANAN AUTO. CUTTING             $       72.60
1027045 INTRODUCER MANAN NEEDLE                $       65.34
1027047 VENT KIT (T-VENT) THORACIC             $      544.50
1027049 INJECTION KIT GLUE                     $     1,815.00
1027370 XR GD ARTHROGRAM KNEE INJ UNI          $      462.00 27370
1027950 IMG GD NAVIGATION HEADSET              $      211.20
1028511 DRAIN,PANCREAS PSEUDOCYST,PERC         $     2,194.90 48511
1028885 XRY CT SCAN BDY LTD                    $     1,517.82 76380
1029021 DRAIN PERITONEAL ABSCESS,PERC          $     2,926.77 49021
1029061 DRAIN RETROPERITNL ABSCSS,PERC         $     2,194.90 49061
1029081 PARACENTESIS                           $     1,132.42 49080
1029180 BX ABD OR RETROPERI MASS,PERC          $     1,807.49 49010
1029229 CT GD NDL PLCMT ASPIR CYST S&I         $     2,287.52 77012
1029230 CT GD NDL PLCMT BX KIDNEY S&I          $     2,287.52 77012
1029231 CT-KIDNEY DRAINAGE                     $     1,390.65 75989




                                         Page 43
                                         Ancillary


1029232 CT-KIDNEY LOCALIZATION                 $     2,870.53 74150
1029233 CT GD NDL PLCMT DRAIN CYST S&I         $     2,287.52 77012
1029234 CT GD NDL PLCMT BX CHEST S&I           $     2,287.52 77012
1029235 CT-CHEST DRAIN                         $     1,390.65 75989
1029236 CT-CHEST LOCALIZATION                  $     2,791.23 71250
1029237 CT GD NDL PLCMT ASPIR ABD S&I          $     2,287.52 77012
1029238 CT GD NDL PLCMT BX ABD S&I             $     2,287.52 77012
1029239 CT-ABDOMEN DRAIN                       $     1,390.65 75989
1029240 CT-ABDOMEN LOCALIZATION                $     2,870.53 74150
1029802 XRY WIRE TEFLON COATED 35/145C         $      200.38
1029803 XRY NEEDLE HARDWIRE LOCAL 20G          $      150.28
1029804 XRY KIT-NEPHROSTOMY-PIGTAIL            $      308.91
1029805 XRY TUBE-CONNECT                       $       83.49
1029807 XRY DRAINAGE BAG                       $      392.40
1029808 XRY TRAY-BIOPSY                        $      333.96
1029809 XRY WIRE-MOVEABLE CORE 35/50C          $      133.58
1029810 XRY NEEDLE-INTRODUCER 21/15CM          $      133.58
1029811 XRY NEEDLE-INTRODUCER 4.5/21G          $      183.68
1029812 XRY NEEDLE-BIOPSY 20G/6                $      125.24
1029813 XRY NEEDLE-BIOPSY 22G/6                $      125.24
1029814 XRY DRAINAGE CATH SET ALL PUR          $      333.96
1029815 XRY DRAINAGE CATH SET 10.3 FR          $      333.96
1029816 XRY VAN SONNENBERG SUMP                $      250.47
1029817 XRY DRAIN SET MULTI-PURPOSE            $      400.75
1029822 XRY MINOR TRAY                         $      381.74
1029823 XRY-NEEDLE BIOPSY                      $      162.11
1029825 XRY-NEEDLE                             $       42.09
1029833 CT MANDIBLE                            $     1,966.76 70486
1029834 CT-MAXILLA                             $     1,966.76 70486
1029835 CT-TMJ                                 $     1,966.76 70486
1029836 CTA CHEST WO/W CONT                    $     2,844.31 71275
1029837 CT ABDOMEN ANGIOGRAM                   $     3,421.28 74160
1029838 CTA NECK WO/W CONTRAST                 $     2,844.41 70498
1029839 CTA LOWER EXTREM W&W/O                 $     1,767.00 73706
1029840 CTA PELVIS W&W/O                       $     2,188.06 72191
1029841 CTA UPPER EXTREM W&W/O                 $     1,663.98 73206
1029843 CT-SINUS/LTD                           $     1,517.82 76380
1029845 INJ HIP ARTHRO W/O ANESTH              $      762.03 27093
1029882 CTA HEAD/BRAIN                         $     2,844.31 70496
1029886 BX BONE, SUPFL, PERC                   $     1,580.81 20220
1029887 BX PANCREAS,PERC                       $     1,580.62 48102
1029946 CT VIRTUAL COLONOSCOPY, DIAG           $     6,670.98 0067T
1029947 CT VIRTUAL COLONOSCOPY, SCREEN         $      759.00 0066T
1029949 +CT/XR IODINE 300-349MG/ML,1ML         $        2.77 Q9949
1029950 CT/XR IODINE 350-399                   $        1.85 Q9950
1090918 COR ANGIO & CT WHLE BDY W/ CON         $     1,891.18
 938902 CT ABDOMEN W/O CONTRAST                $     3,731.68 74150
 940015 CIT CISTERNOGRAM                       $     1,200.08 70015
 940016 REPAIR AAA MOD BIFURCT 2 LIMB          $     4,630.09 34803




                                         Page 44
                                        Ancillary


940017 KYPHO-PLASTY INTRO SYSTEM              $     10,317.91
940018 KYPHOPLAST TRAY ADDITIONAL LEV         $      5,706.36
940019 +IR KYPHON BONE BX DEVICE              $       153.91
940020 INJ. PROC. PERITONEAL ABSCESS          $      2,926.77 49021
940021 +IR COIL EMBOLIZATION-01               $       237.60
940022 +IR COIL EMBOLIZATION-02               $       675.73
940023 +IR COIL EMBOLIZATION-03               $       712.80
940024 +IR COIL EMBOLIZATION-04               $       950.40
940025 +IR COIL EMBOLIZATION-05               $      1,672.23
940026 +IR COIL EMBOLIZATION-06               $      1,306.80
940027 +IR COIL EMBOLIZATION-07               $      2,136.97
940028 +IR COIL EMBOLIZATION-08               $      2,440.63
940029 +IR COIL EMBOLIZATION-09               $      1,841.40
940030 +IR COIL EMBOLIZATION-10               $      3,047.94
940031 +IR COIL EMBOLIZATION-11               $      2,630.23
940032 +IR COIL EMBOLIZATION-12               $      2,868.31
940033 +IR COIL EMBOLIZATION-13               $      3,106.38
940034 +IR COIL EMBOLIZATION-14               $      3,344.46
940035 +IR COIL EMBOLIZATION-15               $      2,806.65
940036 +IR COIL EMBOLIZATION-16               $      2,851.20
940037 +IR COIL EMBOLIZATION-17               $      3,029.40
940038 +IR COIL EMBOLIZATION-18               $      3,207.60
940039 +IR COIL EMBOLIZATION-19               $      3,385.80
940040 +IR COIL EMBOLIZATION-20               $      4,772.91
940041 +IR COIL EMBOLIZATION-21               $      3,742.20
940042 +IR COIL EMBOLIZATION-22               $      3,920.40
940043 +IR COIL EMBOLIZATION-23               $      4,098.60
940044 +IR COIL EMBOLIZATION-24               $      4,276.80
940045 +IR COIL EMBOLIZATION-25               $      4,455.00
940046 +IR COIL EMBOLIZATION-26               $      6,201.36
940047 +IR COIL EMBOLIZATION-27               $      4,811.40
940048 +IR COIL EMBOLIZATION-28               $      4,989.60
940049 +IR COIL EMBOLIZATION-29               $      5,167.80
940050 +IR COIL EMBOLIZATION-30               $      5,346.00
940051 +IR COIL EMBOLIZATION-31               $      5,524.20
940052 +IR COIL EMBOLIZATION-32               $      5,702.40
940053 +IR COIL EMBOLIZATION-33               $      5,880.60
940054 +IR COIL EMBOLIZATION-34               $      6,058.80
940055 +IR COIL EMBOLIZATION-35               $      6,237.00
940056 +IR COIL EMBOLIZATION-36               $      6,415.20
940057 +IR COIL EMBOLIZATION-37               $      6,593.40
940058 +IR COIL EMBOLIZATION-38               $      6,771.60
940059 +IR COIL EMBOLIZATION-39               $      6,949.80
940060 +IR COIL EMBOLIZATION-40               $      7,128.00
940061 +IR COIL EMBOLIZATION-41               $      7,306.20
940062 +IR COIL EMBOLIZATION-42               $      7,484.40
940063 +IR COIL EMBOLIZATION-43               $      7,662.60
940064 +IR COIL EMBOLIZATION-44               $      7,840.80
940065 +IR COIL EMBOLIZATION-45               $      8,019.00




                                        Page 45
                                      Ancillary


940066 +IR COIL EMBOLIZATION-46             $     8,197.20
940067 +IR COIL EMBOLIZATION-47             $     8,375.40
940068 +IR COIL EMBOLIZATION-48             $     8,553.60
940069 +IR COIL EMBOLIZATION-49             $     8,731.80
940070 +IR COIL EMBOLIZATION-50             $     8,910.00
940071 KYPHON BONE CEMENT W/ MIXER          $       60.50
940072 +IR KYPHON BONE CEMENT               $      870.78
940096 INJ SI JOINT                         $     1,003.99 27096
940097 +IR STNT Y-COAT/COV W DEL-20         $     3,564.00 C1874
940098 +IR STNT Y-COAT/COV W DEL-21         $     3,742.20 C1874
940099 +IR STNT Y-COAT/COV W DEL-22         $     3,920.40 C1874
940101 +IR STNT Y-COAT/COV W DEL-23         $     4,098.60 C1874
940102 +IR STNT Y-COAT/COV W DEL-24         $     4,276.80 C1874
940103 +IR STNT Y-COAT/COV W DEL-25         $     4,455.00 C1874
940104 +IR STNT Y-COAT/COV W DEL-26         $     4,633.20 C1874
940105 +IR STNT Y-COAT/COV W DEL-27         $     4,811.40 C1874
940106 +IR STNT Y-COAT/COV W DEL-28         $     4,989.60 C1874
940107 +IR STNT Y-COAT/COV W DEL-29         $     5,167.80 C1874
940108 +IR STNT Y-COAT/COV W DEL-30         $     5,346.00 C1874
940109 +IR STNT Y-COAT/COV W DEL-31         $     5,524.20 C1874
940111 +IR STNT Y-COAT/COV W DEL-32         $     5,702.40 C1874
940112 +IR STNT Y-COAT/COV W DEL-33         $     5,880.60 C1874
940113 +IR STNT Y-COAT/COV W DEL-34         $     6,058.80 C1874
940114 +IR STNT Y-COAT/COV W DEL-35         $     6,237.00 C1874
940115 +IR STNT Y-COAT/COV W DEL-36         $     6,415.20 C1874
940183 BIOPSY BONE SUPERFICIAL              $     1,580.81 20220
940202 +IR STNT Y-COAT/COV W DEL-37         $     6,593.40 C1874
940203 +IR STNT Y-COAT/COV W DEL-38         $     6,771.60 C1874
940204 +IR STNT Y-COAT/COV W DEL-39         $     6,949.80 C1874
940205 +IR STNT Y-COAT/COV W DEL-40         $     7,128.00 C1874
940206 +IR STNT Y-COAT/COV W DEL-41         $     7,306.20 C1874
940207 +IR STNT Y-COAT/COV W DEL-42         $     7,484.40 C1874
940208 +IR STNT Y-COAT/COV W DEL-43         $     7,662.60 C1874
940209 +IR STNT Y-COAT/COV W DEL-44         $     7,840.80 C1874
940211 +IR STNT Y-COAT/COV W DEL-45         $     8,019.00 C1874
940212 +IR STNT Y-COAT/COV W DEL-46         $     8,197.20 C1874
940213 +IR STNT Y-COAT/COV W DEL-47         $     8,375.40 C1874
940214 +IR STNT Y-COAT/COV W DEL-48         $     8,553.60 C1874
940215 +IR STNT Y-COAT/COV W DEL-49         $     8,910.00 C1874
940216 +IR STNT Y-COAT/COV W DEL-50         $     9,088.20 C1874
940217 STENT N-COAT/COV W DEL-20            $     3,564.00 C1876
940218 STENT N-COAT/COV W DEL-21            $     3,742.20 C1876
940219 STENT N-COAT/COV W DEL-22            $     3,920.40 C1876
940221 STENT N-COAT/COV W DEL-23            $     4,098.60 C1876
940222 STENT N-COAT/COV W DEL-24            $     4,276.80 C1876
940223 STENT N-COAT/COV W DEL-25            $     4,455.00 C1876
940224 STENT N-COAT/COV W DEL-26            $     4,633.20 C1876
940225 BIOPSY BONE DEEP                     $     1,919.42 20225
940226 STENT N-COAT/COV W DEL-27            $     4,811.40 C1876




                                      Page 46
                                        Ancillary


940227 STENT N-COAT/COV W DEL-28              $     4,989.60 C1876
940228 STENT N-COAT/COV W DEL-29              $     5,167.80 C1876
940229 STENT N-COAT/COV W DEL-30              $     5,346.00 C1876
940230 STENT N-COAT/COV W DEL-31              $     5,524.20 C1876
940231 STENT N-COAT/COV W DEL-32              $     5,702.40 C1876
940232 STENT N-COAT/COV W DEL-33              $     5,880.60 C1876
940233 STENT N-COAT/COV W DEL-34              $     6,058.80 C1876
940234 STENT N-COAT/COV W DEL-35              $     6,237.00 C1876
940235 STENT N-COAT/COV W DEL-36              $     6,415.20 C1876
940236 STENT N-COAT/COV W DEL-37              $     6,593.40 C1876
940237 STENT N-COAT/COV W DEL-38              $     6,771.60 C1876
940238 STENT N-COAT/COV W DEL-39              $     6,949.80 C1876
940239 STENT N-COAT/COV W DEL-40              $     7,128.00 C1876
940241 STENT N-COAT/COV W DEL-41              $     7,306.20 C1876
940242 STENT N-COAT/COV W DEL-42              $     7,484.40 C1876
940243 STENT N-COAT/COV W DEL-43              $     7,662.60 C1876
940244 STENT N-COAT/COV W DEL-44              $     7,840.80 C1876
940245 STENT N-COAT/COV W DEL-45              $     8,019.00 C1876
940246 STENT N-COAT/COV W DEL-46              $     8,197.20 C1876
940247 STENT N-COAT/COV W DEL-47              $     8,375.40 C1876
940248 STENT N-COAT/COV W DEL-48              $     8,553.60 C1876
940249 STENT N-COAT/COV W DEL-49              $     8,910.00 C1876
940251 STENT N-COAT/COV W DEL-50              $     9,088.20 C1876
940252 STENT-20COAT/COV. W/O DEL SYS          $     3,564.00 C1875
940253 STENT-21COAT/COVER W/O DEL SYS         $     3,742.20 C1875
940254 STENT-22COAT/COVER W/O DEL SYS         $     3,920.40 C1875
940255 STENT-23COAT/COVER W/O DEL SYS         $     4,098.60 C1875
940256 STENT-24COAT/COVER W/O DEL SYS         $     4,276.80 C1875
940257 STENT-25COAT/COVER W/O DEL SYS         $     4,455.00 C1875
940258 STENT-26COAT/COVER W/O DEL SYS         $     4,633.20 C1875
940259 STENT-27COAT/COVER W/O DEL SYS         $     4,811.40 C1875
940261 +IR STNT Y-COAT/COV WO DEL-28          $     4,989.60 C1875
940262 +IR STNT Y-COAT/COV WO DEL-29          $     5,167.80 C1875
940263 +IR STNT Y-COAT/COV WO DEL-30          $     5,346.00 C1875
940264 +IR STNT Y-COAT/COV WO DEL-31          $     5,524.20 C1875
940265 +IR STNT Y-COAT/COV WO DEL-32          $     5,702.40 C1875
940266 +IR STNT Y-COAT/COV WO DEL-33          $     5,880.60 C1875
940267 +IR STNT Y-COAT/COV WO DEL-34          $     6,058.80 C1875
940268 +IR STNT Y-COAT/COV WO DEL-35          $     6,237.00 C1875
940269 +IR STNT Y-COAT/COV WO DEL-36          $     6,415.20 C1875
940271 +IR STNT Y-COAT/COV WO DEL-37          $     6,593.40 C1875
940272 +IR STNT Y-COAT/COV WO DEL-38          $     6,771.60 C1875
940273 +IR STNT Y-COAT/COV WO DEL-39          $     6,949.80 C1875
940274 +IR STNT Y-COAT/COV WO DEL-40          $     7,128.00 C1875
940275 +IR STNT Y-COAT/COV WO DEL-41          $     7,306.20 C1875
940276 +IR STNT Y-COAT/COV WO DEL-42          $     7,484.40 C1875
940277 +IR STNT Y-COAT/COV WO DEL-43          $     7,662.60 C1875
940278 +IR STNT Y-COAT/COV WO DEL-44          $     7,840.80 C1875
940279 +IR STNT Y-COAT/COV WO DEL-45          $     8,019.00 C1875




                                        Page 47
                                        Ancillary


940321 L.P.MYELOGRAM TRAY                     $       220.32
940322 ENDO PERC DISCECTOMY SET               $      3,373.00
940326 +IR STNT J&J ARTICLTED 424/564         $      2,254.23 C1877
940327 +IR STNT WALLSTENT 1440/1640           $      2,151.77 C1876
940330 STENT WALLSTENT 1490/1690              $      3,278.88 C1876
940331 +IR STNT SYMPHONY 8/44-10/60           $      1,502.82 C1876
940335 +IR STNT Y-COAT/COV WO DEL-46          $     10,962.86 C1875
940336 +IR STNT Y-COAT/COV WO DEL-47          $      8,375.40 C1875
940337 +IR STNT Y-COAT/COV WO DEL-48          $      8,553.60 C1875
940338 +IR STNT Y-COAT/COV WO DEL-49          $      8,910.00 C1875
940339 +IR STNT Y-COAT/COV WO DEL-50          $      9,088.20 C1875
940340 STENT N-COAT/COV WO DEL-20             $      3,564.00 C1877
940341 STENT N-COAT/COV WO DEL-21             $      3,742.20 C1877
940342 STENT N-COAT/COV WO DEL-22             $      3,920.40 C1877
940343 STENT N-COAT/COV WO DEL-23             $      4,098.60 C1877
940344 STENT N-COAT/COV WO DEL-24             $      4,276.80 C1877
940345 +IR COIL 3-D                           $      2,366.95
940346 +IR MICROSYS DETACH BALLOON            $      1,391.50
940347 STENT N-COAT/COV WO DEL-26             $      4,864.86 C1877
940348 STENT N-COAT/COV WO DEL-27             $      4,811.40 C1877
940349 STENT N-COAT/COV WO DEL-28             $      4,989.60 C1877
940350 STENT N-COAT/COV WO DEL-29             $      5,167.80 C1877
940351 STENT N-COAT/COV WO DEL-30             $      5,346.00 C1877
940352 STENT N-COAT/COV WO DEL-31             $      5,524.20 C1877
940353 STENT N-COAT/COV WO DEL-32             $      5,702.40 C1877
940354 STENT N-COAT/COV WO DEL-33             $      5,880.60 C1877
940355 STENT N-COAT/COV WO DEL-34             $      6,058.80 C1877
940356 STENT N-COAT/COV WO DEL-35             $      6,237.00 C1877
940357 STENT N-COAT/COV WO DEL-36             $      6,415.20 C1877
940358 STENT N-COAT/COV WO DEL-37             $      6,593.40 C1877
940359 STENT N-COAT/COV WO DEL-38             $      6,771.60 C1877
940361 STENT-06-07                            $      1,516.48 C1874
940362 STENT-08                               $      2,123.08 C1874
940363 STENT-09                               $      2,274.72 C1874
940364 STENT-10                               $      2,322.54 C1874
940365 STENT-11                               $      2,390.85 C1874
940366 STENT-12                               $      2,459.16 C1874
940367 STENT-13                               $      3,196.91 C1874
940368 STENT-14                               $      2,869.02 C1874
940369 STENT-15                               $      3,873.19 C1874
940370 STENT-16                               $      3,934.66 C1874
940371 STENT-17                               $      3,483.81 C1874
940372 STENT-18                               $      3,873.18 C1874
940373 STENT-19                               $      4,672.40 C1874
940374 +IR STNT N-COAT/COV WO DEL-38          $      6,949.80 C1877
940375 +IR STNT N-COAT/COV WO DEL-39          $      7,128.00 C1877
940376 +IR STNT N-COAT/COV WO DEL-40          $      7,306.20 C1877
940377 +IR STNT N-COAT/COV WO DEL-41          $      7,484.40 C1877
940378 +IR STNT N-COAT/COV WO DEL-42          $      7,662.60 C1877




                                        Page 48
                                        Ancillary


940379 +IR STNT N-COAT/COV WO DEL-43          $      7,840.80 C1877
940381 +IR STNT N-COAT/COV WO DEL-44          $      8,019.00 C1877
940382 +IR STNT N-COAT/COV WO DEL-45          $      8,197.20 C1877
940383 +IR STNT N-COAT/COV WO DEL-46          $      8,375.40 C1877
940384 +IR STNT N-COAT/COV WO DEL-47          $      8,553.60 C1877
940385 +IR STNT N-COAT/COV WO DEL-48          $      8,910.00 C1877
940386 +IR STNT N-COAT/COV WO DEL-49          $      9,088.20 C1877
940387 +IR STNT N-COAT/COV WO DEL-25          $      4,455.00 C1877
940389 NEPHROSTOMY TUBE REMOVAL               $       540.47 50389
940390 SIALOGRAM                              $       611.00 70390
940392 PERC DRAIN OR INJ RENAL                $      4,714.55 50392
940393 PERC DRAIN STNT URETER                 $      5,228.61 50393
940394 PYELO VIA PCN TUBE                     $       600.39 50394
940395 NEPHROS TRACT DILAT                    $      5,658.35 50395
940396 WHITAKER TEST                          $       481.95 50396
940398 NEPHROS TUBE EXCHGE                    $      1,916.73 50398
940400 PTA RENAL/VISCERAL ARTERY ADDL         $      2,000.00 75968
940401 INJECTION OF SINUS TRACT               $       155.00 20501
940402 UNILAT FEM CUTDOWN FOR AAA             $      1,500.00 34812
940403 UNILAT ILIAC CUTDOWN FOR AAA           $      2,100.00 34820
940404 SINUS TRACT STUDY S&I                  $       460.00 76080
940405 DEPLOY HEMOSTASIS DEVICE                              G0269
940406 ANGIOPLASTY ART AV SHUNT               $     11,624.68 G0392
940407 VENOPLASTY AV SHUNT                    $     11,624.68 G0393
940592 RFA RENAL TUMOR                        $      2,400.00 50592
940600 INJ ASP SMALL JOINT                    $       407.68 20600
940601 ASPIR/ARTHRO FINGER, TOES              $       313.01 20600
940605 INJ ASP MEDIUM JOINT                   $       377.69 20605
940606 ASPIR/ARTHRO WRIST,ELBOW,ANKLE         $       377.69 20605
940610 INJ ASP LARGE JOINT                    $       513.68 20610
940611 ASPIR/ARTHRO HIP,SHOULDER,KNEE         $       632.94 20610
940615 ASPIRATION/INJECTION BONE CYST         $       420.06 20615
940690 LOOPGRAM / URETEROGRAM                 $       670.75 50690
940760 IV INFUSION HYDRATION 1ST HOUR         $       615.80 90760
940761 IV INFUSION HYDRATION ADDL HR          $       134.30 90761
940773 IR TX/DX/PROPH INJECTION               $       188.78 90773
940930 ALLOGRAFT, MORSELIZED                  $       504.00 20930
940982 RFA BONE TUMOR PERC                    $     13,860.00 20982
941010 CHEST SINGLE VIEW                      $       396.03 71010
941055 CERVICAL PUNCTURE FOR INJ              $      1,265.88 61055
941382 URETER STENT CHANGE                    $      3,545.86 50382
941384 URETER STENT RMVL                      $      3,545.86 50384
941387 NEPHROURETER STENT CHANGE              $      1,642.95 50387
941623 ENDOVSC TEMP BALLN ART OCCLUSN         $     10,238.25 61623
941624 EMBOLIZATN INTRACRAN/SPINE             $      6,813.57 61624
941626 EMBOLIZATN EXTRACRANIAL                $      9,653.20 61626
941630 CRANIAL ANGIOPLASTY                    $      9,240.00 61630
941635 CRANIAL ANGIOPLASTY W/STENT            $     11,550.00 61635
941640 CRANIAL VASOSPASM DIL, INIT            $     11,550.00 61640




                                        Page 49
                                        Ancillary


941641 CRANIAL VASOSPASM DIL, ADDL            $     4,620.00 61641
941642 CRANIAL VASOSPASM DIL ADD FAM          $     9,240.00 61642
941884 EMBOLIZATION PROTECTIVE SYSTEM         $     3,596.18 C1884
942000 PERC DRAIN THORCEN W NEEDL             $      889.35 32000
942002 PERC DRAIN THOR N INSERT               $      876.72 32002
942020 PERC DRAIN EMPYEMA                     $     1,334.64 32020
942040 CERVICAL SP 2 OR 3 VIEWS               $      400.95 72040
942052 CERVICAL SP COMP W/FLEX                $      747.25 72052
942070 THORACIC SP 2 VIEWS                    $      524.78 72070
942100 LUMBAR SPINE 2 OR 3 VIEWS              $      458.76 72100
942240 MYELOGRAPHY CERVICAL                   $     1,687.20 72240
942247 +IR SPINEOLOGY AIR TUBE                $       29.70
942248 +IR BONE GRANULES 15CC                 $     3,326.40
942249 +IR BONE GRANULES 08CC                 $     1,118.11
942250 +IR BONE GRANULES 04CC                 $      534.60
942251 VERTEBROPLASTY SINGLE LVL LUMB         $     5,690.03 22521
942255 MYELOGRAPHY THORACIC                   $     1,458.55 72255
942263 LYSIS OF EPIDURAL ADHESIONS            $     2,096.29 62263
942265 MYELOGRAPHY LUMBAR                     $     1,687.20 72265
942270 SPINAL PUNCTURE, LUMBAR DX             $     1,346.93 62270
942271 LP DIAGNOSTIC                          $     1,346.93 62270
942272 SPINAL PUNCTURE THERAPEUTIC            $      833.93 62272
942273 INJ BLOOD PATCH                        $     1,644.72 62273
942274 LP CATH-NEEDLE DRAINAGE CSF            $      833.35 62272
942275 EPIDUROGRAPHY                          $      845.90 72275
942276 MYELOGRAPHY 2 OR MORE REGIONS          $     1,062.51 72270
942278 INJ EPIDURAL LUMBAR/SAC                $     2,000.00 62311
942284 INJ. PROC MYLEOGRAM                    $     1,707.34 62284
942285 DISCOGRAPHY CERV/THORACIC              $     3,605.76 72285
942287 ASP/DECOMPRESS LUMBAR DISC             $     6,447.55 62287
942290 INJ FOR DISCOGRAPHY LUMBAR             $     2,074.62 62290
942291 INJ FOR DISCOGRAPHY CERV/THOR          $      688.16 62291
942296 DISCOGRAPHY LUMBAR                     $     2,848.78 72295
942310 INJ EPIDURAL CERV/THOR                 $     1,831.38 62310
942328 INSERT DEVICE EA ADD'L BODY            $     3,156.30 22328
942330 +IR STNT WALLSTENT 1440/1640           $     2,151.77 C1877
942335 CYSTOURETHROSCOPY                      $     1,664.58 52351
942350 IMPL.REV/REPOS.TUNN INT.CATH           $     8,839.61 62350
942400 PERC PLEURAL BIOPSY                    $     1,662.15 32400
942405 PERC LUNG BIOPSY                       $     1,906.04 32405
942520 VERTEBROPLASTY SINGLE LVL THOR         $     5,690.03 22520
942522 VERTEBROPLASTY EA ADDL LEVEL           $     5,690.06 22522
942523 KYPHOPLASTY SINGLE LVL THOR            $     8,639.16 22523
942524 KYPHOPLASTY SINGLE LVL LUMB            $     8,639.16 22524
942525 KYPHOPLASTY EA ADDL LVL                $     8,639.16 22525
942550 SIALOGRAM                              $      327.31 42550
942660 SIALOGRAM W DUCT DILATION              $      497.91 42660
942899 SPINE UNLISTED PROCEDURE               $      553.37 22899
943001 CATHETER PERM-A-CATH                   $      427.68 C1751




                                        Page 50
                                        Ancillary


943002 +IR IVC FILTER RETREIVAL SET           $      428.34 C1773
943003 +IR BALLOON ATHRECTOMY DEVICE          $     6,050.00 C1714
943004 COVERED STENT                          $     7,260.00 C1875
943005 BALLOON CUTTING                        $     2,689.95 C1725
943006 BALLOON CRYO                           $     1,024.95 C1725
943007 BALLOON CRYO INFLATION                 $     1,622.82 C1725
943009 +IR ALLOGRAFT BONE MESH IMPLNT         $     7,840.80 C1781
943202 CATHETER                               $     1,575.20 C1757
943203 +IR ENTRY NEEDLE                       $      110.76
943204 WIRE J BENTSON COONS                   $      221.52 C1769
943205 +IR VESSEL DIALATOR                    $       70.57
943206 SHEATH                                 $      141.67 C1894
943207 SHEATH BLKN LONG                       $      280.50 C1894
943208 PRESSURE MONITOR                       $       93.69
943209 +IR ANGIO TRAY SETUP                   $     1,332.45
943210 +IR ANGIO TRAY BASIC                   $      380.15
943214 IONIC CONTRAST 50 ML                   $      102.21
943217 BALLOON PTA                            $     1,641.64 C1725
943218 BALLOON SMALL VESSEL                   $     2,325.59 C1725
943219 TEGWIRE                                $     1,436.89 C1769
943220 FILTER IVC                             $     4,279.06 C1880
943221 UK INFUSION CATHETER                   $      473.94 C1751
943222 WIRE INFUSION UK                       $      748.12 C1887
943223 WIRE TERUMO                            $      225.70 C1769
943224 WIRE TERUMO AMPLAX                     $      267.85 C1769
943225 WIRE .18/GOLD                          $      897.77 C1769
943227 +IR COIL MWCE .035                     $      181.20
943228 +IR MICROPUNCTURE SET                  $      133.06
943229 +IR TRANSJUGULAR LIVER BX              $     1,630.37
943230 +IR TIPS KIT                           $     1,307.06
943231 +IR STNT J&J PALMAZ                    $     2,392.28 C1877
943232 +IR TOUY BORST VALVE-Y CONNECT         $      133.06
943235 PERC.DISCECTOMY SET SURGICAL           $     4,697.68
943236 +IR DISCOGRAM SET                      $      436.40
943237 +IR L.T.C. EMBOLI                      $     1,496.14
943238 +IR COIL HILAL .018                    $      341.37
943239 CATHETER GUIDING                       $      471.32 C1887
943240 LONG WIRE .018-.014                    $     3,596.18 C1769
943241 CTU CONNECTOR                          $       71.39
943242 MICROSYS CATHETER                      $     1,244.82 C1769
943243 WIRE MICROSYS MICROWIRE                $      748.12 C1769
943244 +IR COIL                               $     1,845.92
943245 COIL PUSHER                            $      598.50 C1769
943246 COIL RETREIVER                         $     1,436.89 C1773
943247 MICROSYS STEALTH BALLOON               $     2,953.13 C1725
943251 SNARE GNC                              $     1,464.54 C1773
943252 HIESHIMA CATH                          $      514.38
943253 NEURO WIRE                             $      888.86
943254 WIRE US1408/1809/2500                  $      374.06 C1769




                                        Page 51
                                        Ancillary


943258 CATHETER, BILIARY DRAINAGE             $      388.38 C1729
943259 CATHETER DRAINAGE                      $      440.15 C1729
943260 CATHETER DRAINAGE, LARGE               $      475.65 C1729
943262 AMPLATZ ANCHOR                         $      494.85 C1729
943265 +IR BANNANA PEEL SHEATH                $      524.44
943266 +IR PCC/PERCU-STAY                     $      141.67
943267 +IR SUTURE 2.0/4.0 SILK/NYLON          $       94.86
943268 AMPLATZ SS WIRE                        $      423.52 C1769
943269 STENT GZS Z                            $     1,008.41 C1877
943270 Z STENT INTRODUCER/SHEATH              $      514.38
943271 PMG NITREZ 18-60 WIRE                  $      104.56 C1769
943274 +IR GASTROSTOMY GIAS-100               $      493.81
943275 +IR GASTROSTOMY PLV-24-.38             $      236.94
943276 +IR COUNCIL CATH                       $      604.91
943277 +IR COUNCIL CATH STIFFNERS             $      132.90
943280 +IR STNT WALLSTENT                     $     2,669.14 C1876
943281 STENT WALLSTENT 1094                   $     4,631.36 C1876
943282 +IR STNT WALLSTENT 1240/1260           $     3,744.48 C1876
943283 STENT WALLSTENT 1240/1260              $     4,866.66 C1876
943284 +IR STENT URETERAL                     $      566.98 C2617
943285 +IR STENT URETERAL 90-3390-91          $      916.33 C2617
943286 CATHETER NEPHROSTOMY DRAINAGE          $      390.71 C1729
943287 RDS DIALATOR SET                       $     1,121.73
943290 +IR TRU-CLOSE THORACIC CENT            $      809.45
943291 +IR BALLOON PRESSURE DEVICE            $      622.20
943292 MICROSYS INFUSION CATH                 $     1,436.89 C1751
943293 +IR NEPHROSTOMY KIT 23-510-11          $     1,099.59
943300 +IR GDC-10 02X04-03X08                 $     1,970.24
943301 +IR GDC-10 04X06-05X15                 $     2,086.15
943302 +IR GDC-10 06X10-09X30                 $     2,180.24
943303 +IR GDC-10 10X30                       $     2,294.99
943304 +IR GDC-18 02X04-03X08                 $     1,639.28
943305 +IR GDC-18 04X06-05X20                 $     1,721.24
943306 +IR GDC-18 06X20-09X30                 $     2,180.24
943307 +IR GDC-18 10X30-18X30                 $     2,616.28
943308 +IR GDC-18 06X20-09X30                 $     1,730.34
943309 TRACKER10 UNI 150-3 CM.                $     1,160.31 C1751
943310 FASTRACKER10 UNI 150-3 CM.             $     1,573.91 C1751
943311 TRACKER 18 UNI 150-18 CM.              $     1,335.71 C1751
943312 TRACKER 18 MX 150-18 CM.               $     1,217.91 C1751
943323 +IR THROMBECTOMY DEVICE 50CM           $     2,074.74 C1757
943324 +IR THROMBECTOMY DEVICE 120CM          $     2,919.24 C1757
943325 IR CATHETER FOGARTY                    $     1,634.39 C1757
943326 +IR STNT J&J ARTICLTED 424/564         $     2,254.23 C1877
943327 +IR STNT SYMPHONY 8/44-10/60           $     1,502.82 C1876
943329 +IR HEMOSTASIS DEVICE                  $     1,215.13 C1760
943331 +IR STNT WALLSTENT 1490/1690           $     3,278.88 C1876
943332 VERTEBROPLASTY KIT                     $     1,753.29
943333 MICROSYS CATHETER 2-TIP                $     1,139.66 C1751




                                        Page 52
                                        Ancillary


943334 MICROSYS CATHETER 1-TIP                $     1,085.37 C1751
943347 +IR EMBOLIC LIQUID SYSTEM GLUE         $     9,829.80
943350 SHEATH CONTRALATERAL                   $      363.00 C1894
943351 +IR LP DRAINAGE KIT                    $      363.00
943352 +IR MICRO CATH / WIRE KIT              $     1,310.43
943353 MICROSYS STENT                         $     4,969.40 C1876
943354 +IR EMBOLIC SPHERES                    $      713.90
943355 +IR SPINE CEMENT                       $      670.03
943356 +IR VERTEBROPLASTY NEEDLE              $      294.03
943360 +IR STNT Y-COAT/COV W DEL-05           $     1,263.74 C1874
943361 +IR STNT Y-COAT/COV W DEL-067          $     1,516.48 C1874
943362 +IR STNT Y-COAT/COV W DEL-08           $     1,769.23 C1874
943363 +IR STNT Y-COAT/COV W DEL-09           $     2,274.72 C1874
943365 +IR STNT Y-COAT/COV W DEL-11           $     2,390.85 C1874
943366 +IR STNT Y-COAT/COV W DEL-12           $     2,459.16 C1874
943380 +IR STNT Y-COAT/COV WO DEL-05          $     1,263.74 C1875
943381 +IR STNT Y-COAT/COV WO DEL-067         $     1,516.48 C1875
943382 +IR STNT Y-COAT/COV WO DEL-08          $     1,769.23 C1875
943383 +IR STNT Y-COAT/COV WO DEL-09          $     2,274.72 C1875
943384 +IR STNT Y-COAT/COV WO DEL-10          $     2,322.54 C1875
943385 +IR STNT Y-COAT/COV WO DEL-11          $     2,527.47 C1875
943386 +IR STNT Y-COAT/COV WO DEL-12          $     2,459.16 C1875
943387 +IR STNT Y-COAT/COV WO DEL-13          $     2,664.09 C1875
943388 +IR STNT Y-COAT/COV WO DEL-14          $     3,012.47 C1875
943389 +IR STNT Y-COAT/COV WO DEL-15          $     3,073.95 C1875
943390 +IR STNT Y-COAT/COV WO DEL-16          $     3,278.88 C1875
943391 +IR STNT Y-COAT/COV WO DEL-17          $     3,483.81 C1875
943392 +IR STNT Y-COAT/COV WO DEL-19          $     3,688.74 C1875
943393 STENT-19 COATED/COVERED WO DEL         $     3,893.67 C1875
943400 +IR STNT N-COAT/COV W DEL-05           $     1,263.74 C1876
943401 +IR STNT N-COAT/COV W DEL-067          $     1,516.48 C1876
943402 +IR STNT N-COAT/COV W DEL-08           $     1,769.23 C1876
943403 +IR STNT N-COAT/COV W DEL-09           $     2,274.72 C1876
943404 +IR STNT N-COAT/COV W DEL-10           $     2,580.34 C1876
943405 +IR STNT N-COAT/COV W DEL-11           $     2,602.45 C1876
943406 +IR STNT N-COAT/COV W DEL-12           $     3,098.55 C1876
943407 +IR STNT N-COAT/COV W DEL-13           $     3,356.74 C1876
943408 +IR STNT N-COAT/COV W DEL-14           $     3,614.96 C1876
943409 +IR STNT N-COAT/COV W DEL-15           $     3,873.19 C1876
943410 +IR STNT N-COAT/COV W DEL-16           $     4,131.39 C1876
943411 +IR STNT N-COAT/COV W DEL-17           $     4,389.59 C1876
943412 +IR STNT N-COAT/COV W DEL-18           $     3,873.18 C1876
943413 +IR STNT N-COAT/COV W DEL-19           $     3,893.67 C1876
943420 +IR STNT N-COAT/COV WO DEL-05          $     1,263.74 C1877
943421 +IR STNT N-COAT/COV WO DEL-067         $     1,516.48 C1877
943422 +IR STNT N-COAT/COV WO DEL-08          $     1,769.23 C1877
943423 +IR STNT N-COAT/COV WO DEL-09          $     2,274.72 C1877
943424 +IR STNT N-COAT/COV WO DEL-10          $     2,600.32 C1877
943425 +IR STNT N-COAT/COV WO DEL-11          $     2,527.47 C1877




                                        Page 53
                                        Ancillary


943426 +IR STNT N-COAT/COV WO DEL-12          $     2,459.16 C1877
943427 +IR STNT N-COAT/COV WO DEL-13          $     2,797.29 C1877
943428 +IR STNT N-COAT/COV WO DEL-14          $     3,012.47 C1877
943429 +IR STNT N-COAT/COV WO DEL-15          $     3,227.65 C1877
943430 +IR STNT N-COAT/COV WO DEL-16          $     3,278.88 C1877
943431 +IR STNT N-COAT/COV WO DEL-17          $     4,180.57 C1877
943432 +IR STNT N-COAT/COV WO DEL-18          $     3,688.74 C1877
943433 +IR STNT N-COAT/COV WO DEL-19          $     3,893.67 C1877
943450 NERVE BLOCK PERIPHERAL                 $     1,870.00 64450
943453 DILATION ESOPHAGUS OVER GW             $     1,099.80 43453
943525 ARTHROGRAPHY HIP                       $      868.98 73525
943605 S&I DILAT URETNRA                      $     4,243.57 53605
943648 PORTAL VEIN CATH                       $     2,207.48 36481
943664 STENT N-COAT/COV WO DEL-10             $     2,322.54 C1877
943750 PERC PLACE GASTRO TUBE                 $     2,233.02 43750
943760 CHANGE GASTRO/JEJENO TUBE              $      651.13 43760
943761 REPOSIT G-TUBE/DUDODENUM               $     1,436.34 43761
943880 REPAIR DECEND AORT W SUBCLAV           $     5,992.40 33880
943881 REPAIR DECEND AORT WO SUBCLAV          $     5,153.37 33881
943883 PROSTH PLACMT DEC/PROX AORTA           $     3,814.18 33883
943884 PROSTH PLACMT DEC AO PROX ADL          $     1,406.13 33884
943886 PROSTH PLACMT DEC AO,DIST,DEL          $     3,298.11 33886
944000 ABDOMEN, SINGLE VIEW                   $      333.57 74000
944015 PERC ENTEROCLYSIS TUBE                 $      979.07 44015
944220 ESOPHAGRAM                             $      780.59 74220
944300 ENTEROSTOMY, CECOSTOMY                 $      979.07 44300
944305 CHOLANGIO EXIST CATH F/U               $      849.40 74305
944320 PERC TRANS HEPATIC CHOLANGIO           $     1,570.30 74320
944327 BILIARY STONE REMOVE T TUBE            $      657.80 74327
944350 PERC GASTROSTOMY TUBE PLACE            $     1,887.20 74350
944355 PERC ENTEROCLYSIS TUBE PLACE           $      738.10 74355
944360 INTRALUM DILAT STRICT/OBSTR            $      850.92 74360
944363 PERC DILATN BILIARY STRICTURE          $     3,439.37 74363
944425 UROGRAPHY ANTEGRADE                    $      226.89 74425
944440 S & L LUMBAR SGL                       $     2,304.29 64483
944441 INJ TRANSFOR EPI LUMB/SAC ADL          $     1,328.25 64484
944442 INJ LUMBAR FACET INIT                  $     2,747.07 64475
944443 S & L LUMBAR ADD'L                     $     1,233.53 64476
944470 INJ CERV/THOR FACET INIT               $     1,373.54 64470
944472 INJ CERV/THOR FACET ADDL               $     1,233.53 64472
944475 PERC DRAIN OR INJ RENAL PELVIS         $     1,836.45 74475
944476 INJ LUMBAR FACET ADDL                  $     1,233.53 64476
944479 INJ TRANSFOR EPI CERV/THOR INT         $     1,482.00 64479
944480 PERC URETERAL DRAIN/STENT PLC          $     2,397.42 74480
944481 NON SELECT PORT ANY ACCG               $     2,207.48 36481
944482 INJ TRANSFOR EPI CERV/THOR ADL         $     1,373.54 64480
944483 INJ TRANSFOR EPI LUMB/SAC INIT         $     2,304.29 64483
944485 NEPHROS TRACT DILATION                 $     1,134.71 74485
944510 STELLATE GANGLION NERVE BLOCK          $     2,420.00 64510




                                        Page 54
                                        Ancillary


944520 LUMB/THORACIC SYMP NERVE BLOCK         $      2,420.00 64520
944530 NERVE BLOCK CELIAC PLEXUS              $      1,870.00 64530
944610 CIT RHIZOTOMY                          $      2,096.29 64610
944800 REPAIR AAA TUBE GRFT                   $      4,794.71 34800
944802 REPAIR AAA MOD BIFURCT 1 LIMB          $      5,553.98 34802
944804 REPAIR AAA UNI BIFURCT                 $      5,554.53 34804
944805 REPAIR AAA AO AUI/AO AUF               $       525.00 34805
944808 INSRT ILIAC OCCLUSN DEVICE             $       998.16 34808
944825 PROSTH PLACMT ABD AO/ILIAC INT         $      3,617.80 34825
944826 PROSTH PLACMT ABD AO/ILIAC ADL         $       952.77 34826
945470 PTA TIBIOPERONEAL PERC                 $      8,279.17 35470
945471 PTA RENAL/VISCERAL ARTERY PERC         $      8,279.17 35471
945472 PTA AORTA PERC                         $     10,238.25 35472
945473 PTA ILIAC PERC                         $      8,279.17 35473
945474 PTA FEMORAL-POPLITAL PERC              $      8,279.17 35474
945475 PTA BRACHIOCEPHAL PERC                 $      8,279.17 35475
945476 PTA VENOUS                             $      8,279.17 35476
945490 ATHERECT RENAL/VISC PERC               $     10,238.25 35490
945491 ATHERECT AORTA PERC                    $     10,238.25 35491
945492 ATHERECT ILIAC PERC                    $     10,238.25 35492
945493 ATHERECT FEM/POPLITEAL PERC            $     10,238.25 35493
945495 ATHERECT TIBIOPERONAL PERC             $     10,238.25 35495
945605 AORTOGRAPHY THORACIC                   $      4,679.40 75605
945625 AORTOGRAPHY ABDOMINAL                  $      4,548.48 75625
945626 CIT TLA AORTA                          $      4,662.80 75966
945630 AORTOGRAPHY ABD+ILIOFEM BILAT          $      3,901.59 75630
945650 AORTOGRAPHY ARCH                       $      5,490.81 75650
945651 CIT-BRACHIAL                           $      4,351.60 75658
945658 ANGIO BRACHIAL RETROGRADE              $      4,351.60 75658
945660 ANGIO EXT CAROTID UNILAT               $      3,977.13 75660
945662 ANGIO EXT CAROTID BILAT                $      5,107.55 75662
945665 ANGIO CAROTID CEREBRAL UNILAT          $      5,107.55 75665
945671 ANGIO CAROTID CEREBRAL BILAT           $      6,443.91 75671
945676 ANGIO CAROTID CERVICAL UNILAT          $      5,107.55 75676
945680 ANGIO CAROTID CERVICAL BILAT           $      5,107.55 75680
945685 ANGIO VERTEBR/CERV/INTRACRAN           $      5,621.60 75685
945705 ANGIO SPINAL                           $      5,594.68 75705
945710 ANGIO EXTREMITY UNILAT                 $      5,107.55 75710
945716 ANGIO EXTREMITY BILAT                  $      5,621.67 75716
945722 ANGIO RENAL/FLUSH AORTOGRM UNI         $      5,387.76 75722
945724 ANGIO RENAL/FLUSH AORTOGRM BIL         $      6,809.50 75724
945726 ANGIO VISCERAL W/WO FLUSH AORT         $      5,586.06 75726
945731 ANGIO ADRENAL UNILAT                   $      5,107.55 75731
945733 ANGIO ADRENAL BILAT                    $      3,157.44 75733
945736 ANGIO PELVIC SELECTIVE                 $      5,621.76 75736
945741 ANGIO PULMONRY UNILAT                  $      2,900.65 75741
945743 ANGIO PULMONRY BILAT                   $      5,621.65 75743
945746 ANGIO PULM NON SELECT CATH             $      3,598.96 75746
945756 ANGIO INTERNAL MAMMARY                 $      3,563.34 75756




                                        Page 55
                                        Ancillary


945774 ANGIO SELECT EA ADDL VESSEL            $     4,873.61 75774
945790 ANGIO ARTERIOVENOUS SHUNT              $     2,522.79 75790
945809 SHUNTOGRAM NON-VASC SHUNT              $      695.75 75809
945810 SPLENOPORTOGRAPHY                      $     4,351.60 75810
945820 VENOGRAPHY EXTREMITY UNILAT            $     1,414.02 75820
945822 VENOGRAPHY EXTREMITY BILAT             $     1,830.14 75822
945825 VENOGRAPHY INFERIOR CAVAL              $     3,261.26 75825
945827 VENOGRAPHY SUPERIOR CAVAL              $     3,035.85 75827
945831 VENOGRAPHY RENAL UNILAT                $     3,741.50 75831
945833 VENOGRAPHY RENAL BILAT                 $     4,351.60 75833
945840 VENOGRAPHY ADRENAL UNILAT              $     5,107.55 75840
945842 VENOGRAPHY ADRENAL BILAT               $     5,107.55 75842
945860 VENOGRAPHY, VENOUS SINUS,JUGUL         $     3,832.61 75860
945885 PERC TRANSHEP PORT W HDM               $     5,621.91 75885
945887 PERC TRANSHEP PORT WO HDM              $     3,057.61 75887
945889 VENOGRAQM HEPATIC W HDM                $     5,621.76 75889
945891 VENOGRAM HEPATIC WO HDM                $     1,930.29 75891
945893 VENOUS SAMPLE W/WO ANGIO               $     2,732.26 75893
945894 EMBOLIZATION TRANSCATH                 $     5,678.67 75894
945896 THROMBOLYTC INFUSN THERAPY             $     5,868.16 75896
945898 ANGIO THRU EXIST CATH FOR F/U          $     2,397.90 75898
945900 CATH EXCHANGE DURING LYTIC TX.         $     3,653.66 75900
945901 REMOV PERICATH OBSTRCT CVC             $      674.26 75901
945902 REMOV INTRALUM OBSTRCT CVD             $      577.50 75902
945940 PLACEMENT IVC FILTER                   $     3,750.86 75940
945952 REPAIR INFARENAL AAA                   $     1,021.89 75952
945953 PROSTH REPR AORT/ILIAC ANEURYS         $      408.12 75953
945954 RPR ANEURYS/PSEUDOANEURYS/AVM          $     2,216.27 75954
945956 RPR DECEND AORTA W SUBCLAV S&I         $     2,427.20 75956
945957 RPR DECEND AORTA WO SUBCLV S&I         $     2,079.45 75957
945958 WADA HEMISHPERIC FUNCTION              $     2,285.53 95958
945959 PROSTH PLACMT DISTAL DELAYED           $     1,213.81 75959
945960 INTRO INTRAVASC STENT                  $     4,832.27 75960
945961 FB RETRIEVAL INTRAVASC                 $     4,323.97 75961
945962 PTA PERIPHERAL ARTERY INITIAL          $     4,030.39 75962
945964 PTA EA ADDOL PERIPH ARTERY             $     2,745.21 75964
945966 PTA RENAL/VISCERAL ARTERY INIT         $     4,662.80 75966
945970 BIOPSY TRANSCATH                       $     2,942.36 75970
945978 PTA VENOUS                             $     4,786.97 75978
945980 PERC EXT BILIARY DRAINAGE              $     1,714.86 75980
945982 PERC INT/EXT BILIARY DRAINAGE          $     2,411.73 75982
945984 CHANGE OF PERC DRAINAGE CATH           $     1,182.48 75984
945989 FLUORO GUIDE FOR ABSC DRAINAGE         $     1,390.65 75989
945992 ATHERECT PERIPHERAL ARTERY INI         $     4,351.60 75992
945993 ATHERECT PERIPHERAL ARTERY ADD         $     2,175.90 75993
945994 ATHERECT RENAL ARTERT                  $     1,892.09 75994
945995 ATHERECT VISCERAL ARTERY INIT          $     1,892.09 75995
945996 ATHERECT VISCERAL ARTERY ADDL          $     1,892.09 75996
945998 FLUORO GUID CVC PLACE/REMOV            $      473.11 77001




                                        Page 56
                                        Ancillary


946000 FLUOROSCOPY <1HR                       $      1,088.03 76000
946001 FLUOROSCOPY >1HR                       $      1,603.82 76001
946003 FLUORO GUID NEEDLE PLCMT               $       693.90 77002
946005 FLUORO GUID SPINE PROCEDURE            $       581.90 77003
946010 INTRO CATH SUPR/INFR VENA CAVA         $      2,385.91 36010
946011 INTRO CATH VENOUS 1ST ORDER            $      2,978.20 36011
946012 INTRO CATH VENOUS 2ND ORDER            $      3,289.88 36012
946013 INTRO CATH RT HEART/PULM ART           $      2,293.83 36013
946014 INTRO CATH L/R PULM ARTERY             $      2,829.75 36014
946015 INTRO CATH PULM ARTERY SEG             $      2,185.26 36015
946120 INTRO CATH BRACH ART RETRO             $       618.24 36120
946138 INJECTION FOR EXT. VENOGRAPHY          $       639.57 36005
946139 US GUID PSEUDOANEURYSM REPR            $       629.04 76936
946140 INTRO CATH EXTREMITY ARTERY            $      1,503.30 36140
946145 INTRO CATH ARTERIOVEN SHUNT            $      1,767.07 36145
946160 INTRO CATH AORTIC TRANSLMBR            $      2,408.18 36160
946200 INTRO CATH AORTA                       $      2,110.48 36200
946215 INTRO CATH THORAC 1ST ORDR             $      4,374.96 36215
946216 INTRO CATH THORAC 2ND ORDR             $      4,928.02 36216
946217 INTRO CATH THORAC 3RD ORDR             $      5,946.59 36217
946218 INTRO CATH THORAC ADDL 2ND/3RD         $       947.19 36218
946245 INTRO CATH ABD ART 1ST ORDER           $      4,449.60 36245
946246 INTRO CATH ABD ART 2ND ORDER           $      2,924.46 36246
946247 INTRO CATH ABD ART 3RD ORDER           $      2,110.48 36247
946248 INTRO CATH ABD ADDL 2ND/3RD            $       883.95 36248
946355 CT GUIDE FOR STEREOTACTIC LOC          $      2,447.78 77011
946410 VENIPUNCTURE INFANT 3YRS/LESS          $        31.91 36410
946422 IA CHEMO THERAPY<L HR.                 $       238.05 96422
946450 IR LUMBAR PUNCTURE, CHEMO TX           $       461.14 96450
946481 PERC. SPLENOPORTOGRAPHY                $      2,207.48 36481
946493 REPOS.OF PREV.C.V.CATH FLUORO          $      2,506.35 36597
946500 VENOUS CATH ORGAN BLOOD SMPL           $      1,038.33 36500
946533 CATHETER HEMODIALYSIS                  $      5,004.14 C1752
946534 REVISION OF IMPLANTABLE V.A.D.         $      1,879.93 36576
946535 REMOVAL OF IMPLANTABLE V.A.D.          $      2,073.13 36590
946536 REMOV PERICATH OBSTRUCT CVC            $      5,661.17 36595
946550 DECLOT VAD BY THROMBOLYTIC             $       710.86 36550
946555 INSRT NON-TUNN CVC <5 YEARS            $      2,193.25 36555
946556 INSRT NON-TUNN CVC >5 YEARS            $      2,501.88 36556
946557 INSRT TUNN CVC WO PORT <5 YRS          $      4,852.43 36557
946558 INSRT TUNN CVC WO PORT >5 YRS          $      3,905.48 36558
946560 INSRT TUNN CVC W/PORT <5 YEARS         $      6,200.14 36560
946561 INSRT TUNN CVC W/PORT >5 YEARS         $      4,956.86 36561
946563 INSRT TUNN CVC W/PUMP                  $      6,200.14 36563
946565 TUNN CV ACC.2CATH SEP.SITE W/O         $      6,200.14 36565
946566 TUNN.CV ACC.2 CATH.SEP.SITE W/         $     18,229.39 36566
946568 INSRT PICC W/O PORT <5 YEARS           $      2,984.65 36568
946569 INSRT PICC W/O PORT >5 YEARS           $      3,257.63 36569
946575 REP.TUNN.OR NON-TUNN.C.V.A.CAT         $      2,506.35 36575




                                        Page 57
                                        Ancillary


946576 REP.C.V.ACCESS W/PORT OR PUMP          $      1,879.93 36576
946578 REPLAC.CATH.ONLY,C.V.ACCESS W/         $      4,852.43 36578
946580 REPL. COMP., NON-TUNNEL C.V.W/         $      2,400.08 36580
946581 REPLC TUNN CVC WO PORT                 $      3,488.08 36581
946582 REPLC TUNN CVC W/ PORT                 $      6,200.14 36582
946583 REPLC TUNN CVC W/ PUMP                 $      6,200.14 36583
946584 REP.COM.PICC W/O SUB. PRT/PUMP         $      2,506.35 36584
946589 REMOV TUNN CVC W/O PORT                $      2,602.40 36589
946590 REMOVAL TUNN.C.V.A W/PUMP              $      2,073.13 36590
946596 REMOV INTRALUM OBSTRUCT CVC            $       980.20 36596
946598 CONTRAST INJ INTO CV CATH              $       138.01 36598
946620 ARTERIAL PRESS                         $       523.13 36620
946640 HEPATIC CHEMO                          $      6,200.14 36640
946832 REV AV FISTULA W-W/O THROMBECT         $      7,580.98 36832
946861 PERC. THMOBECTOMY OF AV FISTUL         $      8,957.84 36861
946870 THROMBCTMY ARTERIOVEN FISTULA          $      5,918.49 36870
946937 US GUID VASCULAR ACCESS                $       550.40 76937
946942 US GUID BIOP/ASP/INJ/LOCALIZN          $       928.48 76942
946958 PROSTH PLACMT PROX S&I                 $      1,386.42 75958
947000 BIOPSY LIVER PERCUTANEOUS              $      1,821.27 47000
947001 INJECT. PROC. FOR EXTRE. VENO          $       639.57 36005
947002 UROGRAPHY, PYELO W OR W/O KUB          $      1,435.55 74400
947003 INFUSION UROGRAPHY                     $       639.32 74410
947004 UROGRAPHY-RETRO W OR W/O KUB           $       876.68 74420
947005 UROGRAPHY-ANTE PYELO,NEPHROST.         $       226.89 74425
947006 CYSTOGRAM MIN, 3 VIEWS                 $       737.50 74430
947007 VASOGRAPHY, VESICULOGRAPHY             $       836.00 74440
947008 CORPORA CAVERNOSOGRAPHY                $       576.40 74445
947009 URETHROCYSTOGRAM RETROGRADE            $       942.44 74450
947012 URETHROCYSTOGRAM VOIDING               $      1,278.64 74455
947093 HIP ARTHRO W/O ANESTH                  $       762.03 27093
947095 HIP ARTHRO W/ANESTH                    $       959.81 27095
947182 INSERTION OF TIP SHUNTS                $      3,938.33 37182
947183 REVISION OF TIP SHUNTS                 $     10,100.59 37183
947184 ART MECH THROMBECT PRIMARY             $      6,124.64 37184
947185 ART MECH THROMBECT PRIM ADDL           $      2,864.24 37185
947186 ART MECH THROMBECT SECND ADDL          $      2,864.24 37186
947187 VENOUS MECH THROMBECTOMY               $      6,124.64 37187
947188 VENOUS MECH THROMB REPEAT              $      6,124.64 37188
947200 BIOPSY TRANSCATHETER                   $      2,742.23 37200
947201 INFUS THROMBLYTC TRNSCATH              $      1,038.81 37201
947202 INFUS NON-THROMBLYTIC TRNSCATH         $      1,038.35 37202
947203 RETRIEVAL FB TRANSCATH                 $      4,580.73 37203
947204 EMBOLIZATION NON-HEAD/NECK             $      6,183.18 37204
947205 VASC STENT PLACE PERC INIT             $      7,026.36 37205
947206 VASC STENT PLACE PEREC EA ADDL         $      7,026.36 37206
947207 VASC STENT PLACE OPEN INIT             $     13,903.35 37207
947208 VASC STENT PLACE OPEN EA ADDL          $     13,903.35 37208
947209 CATH EXCHNG DURNG LYTIC TX             $      5,138.77 37209




                                        Page 58
                                        Ancillary


947210 IR EMBOLIZE UTERINE FIBROID            $     9,602.31 37210
947215 STENT CAROTID W DIST PROTCT            $     9,240.00 37215
947216 STENT CAROTID WO DIST PROTCT           $     9,240.00 37216
947490 PERC CHOLECYTOSTOMY                    $     5,049.45 47490
947500 INJ PROC TRANS HEPAT CHOLANG           $      665.97 47500
947505 INJ EXISTING TUBE FOR CHOLANG          $      496.53 47505
947510 PLACE EXT BILIARY DRAIN TUBE           $     4,165.62 47510
947511 ESTAB INT/EXT BILIARY DRAINAGE         $     4,165.62 47511
947525 BIL DRAIN CATH EXCHANGE                $     2,304.87 47525
947530 REVISION/REINSERTION T-TUBE            $     2,286.38 47530
947553 BILE DUCT BRUSH BX                     $     4,165.62 47553
947555 PERC DIL BIL STRICT WO STN             $     3,286.01 47555
947556 PERC DIL BIL STRICT W STNT             $     4,165.62 47556
947620 INSRT IVC FILTER                       $     7,167.71 37620
947630 BIL STONE REMOVE                       $     4,165.62 47630
947799 UNLISTED VASCULAR PROCEDURE            $     2,974.56 37799
948220 BONE MARROW ASPIRATION                 $      814.28 38220
949000 ENDOVASC ILIAC REPAIR W GRAFT          $     1,578.96 34900
949011 INJ PSEUDOANEURYSM REPAIR              $      680.60 36002
949021 ABSCESS DRAINAGE,PERITONEAL            $     2,926.77 49021
949080 ABD PARA OR PERITONEAL LAV             $     1,132.42 49080
949180 BIOPSY ABD/RETROPERIT PERC             $     1,371.12 49180
949181 PERC ANTEGRADE PYELO                   $     1,371.12 50390
949182 VERTEBROPLASTY FLUORO GUIDE            $      845.67 72291
949201 IR E&M NEW PT, LEVEL 1                 $      129.05 99201
949202 IR E&M NEW PT, LEVEL 2                 $      140.68 99202
949203 IR E&M NEW PT, LEVEL 3                 $      185.80 99203
949204 IR E&M NEW PT, LEVEL 4                 $      232.80 99204
949205 IR E&M NEW PT, LEVEL 5                 $      296.74 99205
949211 IR E&M EST PT, LEVEL 1                 $      129.05 99211
949212 IR E&M EST PT, LEVEL 2                 $      140.68 99212
949213 IR E&M EST PT, LEVEL 3                 $      160.78 99213
949214 IR E&M EST PT, LEVEL 4                 $      204.38 99214
949215 IR E&M EST PT, LEVEL 5                 $      291.00 99215
949216 IR E&M NEW PT, LEVEL 1 W/PROC          $      129.05 9920125
949217 IR E&M NEW PT, LEVEL 2 W/PROC          $      140.68 9920225
949218 IR E&M NEW PT, LEVEL 3 W/PROC          $      185.80 9920325
949219 IR E&M NEW PT, LEVEL 4 W/PROC          $      232.80 9920425
949220 IR E&M NEW PT, LEVEL 5 W/PROC          $      296.74 9920525
949221 IR E&M EST PT, LEVEL 1 W/PROC          $      129.05 9921125
949222 IR E&M EST PT, LEVEL 2 W/PROC          $      140.68 9921225
949223 IR E&M EST PT, LEVEL 3 W/PROC          $      160.78 9921325
949224 IR E&M EST PT, LEVEL 4 W/PROC          $      204.38 9921425
949225 IR E&M EST PT, LEVEL 5 W/PROC          $      291.00 9921525
949423 EXCH PREV. ABSC/CYCT DR. CATH          $     2,286.38 49423
949424 CONT INJECT PREV DRAINAGE CATH         $      729.91 49424
949425 PERC ATHERECTOMY DEVICE                $     4,537.50 C1724
949445 RAD TX INTRA-ART PART ADMIN            $     1,150.00 79445
949720 +IR KYPHON NEEDLE                      $      432.58




                                        Page 59
                                        Ancillary


949721 +IR KYPHON BONE FILLER DEVICE          $      333.91
949722 +IR KYPHON BALLOON                     $     2,230.43
949723 +IR BONE BX OSTYCUT                    $      297.54
949724 +IR DISC NEEDLE                        $      253.25
949725 +IR HEMOSTASIS PATCH                   $      297.54
949726 +IR NESTOR COILS                       $     1,527.77
949727 +IR GASTROSTOMY G-J TUBE               $      950.64
949728 +IR OCCLUSION BALLOON                  $      587.64 C2628
949729 +IR CATH MAHURKAR                      $      379.09 C1752
949730 +IR KYPHON INFLATION DEVICE            $      348.00
949731 +IR MICRO EXCHANGE WIRES               $      925.96
949732 LOCM 300-349MG/ML IODINE, 1 ML         $        1.86 Q9949
949733 LOCM 350-399MG/ML IODINE, 1 ML         $        1.86 Q9950
949734 LOCM 250-299MG/ML IODINE               $        1.86 Q9948
949735 LOCM 300-349 MG,VISIPAQUE,1ML          $        1.86 Q9949
949736 LOCM 150-199MG/ML IODINE, 1 ML         $        1.86 Q9946
949737 LOCM 200-249MG/ML IODINE, 1 ML         $        1.86 Q9947
949738 US LYSIS INFUSION SYSTEM               $     3,949.17
949739 RADIO-FREQ ABLATION SPINE WAND         $     3,596.18
949740 *IR RFA BONE ACCESS KIT                $      935.00
949952 CONTRAST GADOLINIUM/ML                 $       23.30 Q9952
1029228 INJ SPINAL MYELOGRAM                  $     1,707.34 62284
950100 XRY-MANDIBLE-PARTIAL < 4 VIEWS         $      475.26 70100
950110 XRY-MANDIBLE SER 4V+                   $      754.38 70110
950130 XRY-MASTOIDS MIN 3V/SIDE               $      411.13 70130
950140 FACIAL BONES LESS 3 VIEWS              $      474.51 70140
950150 FACIAL BONES 3 OR MORE VS              $      841.04 70150
950160 XRY-NASAL BONES 3VIEWS                 $      717.53 70160
950200 ORBITS 4 OR MORE VIEWS                 $      682.47 70200
950201 XRY-OPTIC FORAMINA                     $      315.74 70190
950210 XRY-SINUSES < 3 VIEWS                  $      315.74 70210
950220 SINUSES MIN 3 VIEWS                    $      699.92 70220
950250 SKULL LESS 4VS W/ORW/O STEREO          $      474.51 70250
950260 SKULL 4 VS W/ W/O STEREO               $     1,074.54 70260
950332 XRY-TM JOINTS BILAT                    $      475.26 70330
950360 XRY-NECK,SOFT TISSUE                   $      513.91 70360
950394 PYELOGRAPHY INJ THRY TUBE/C            $      780.51 50394
950501 INJECTION FOR SINOGRAM                 $      296.21 20501
950601 ASPIR/ARTHRO FINGER, TOES              $      406.91 20600
950606 ASPIR/ARTHRO WRIST,ELBOW,ANKLE         $      491.00 20605
950610 XR HIP ASPIRATION, UNILAT              $      822.82 20610
950611 ASPIR/ARTHRO HIP,SHOULDER,KNEE         $      822.82 20610
951010 XRY CHEST 1 VIEW                       $      514.83 71010
951020 XRY-CHEST 2 VIEWS                      $      575.49 71020
951021 CHEST AP & LAT.W APICAL LORD.          $      419.90 71021
951022 CHEST AP & LAT. W/ OBLIQUE             $      511.11 71022
951023 CHEST AP & LAT. W/ FLUOROSCOPY         $      575.58 71023
951025 CHEST, PA., LAT AND BOTH DECUB         $      315.74 71035
951035 CHEST SPECIAL VIEWS LAT.DECUB.         $      315.74 71035




                                        Page 60
                                        Ancillary


951100 RIBS UNILATERAL 2 VIEWS                $      626.97 71100
951110 RIBS BILATERAL 3 VIEWS                 $      753.11 71110
951111 RIBS BIL W PA CHEST 4V                 $      538.34 71111
951116 INJ. ARTHROGRAM TMJ                    $      696.70 21116
951120 XRY-STERNUM     3 VIEWS                $      666.51 71120
951130 XRY-SC JTS MIN 2 V                     $      475.26 71130
951600 XRY-CYSTO/URETHROCYSTO INJ             $      497.07 51600
952020 XR C-SPINE 1VW, O.R.                   $      316.34 7202076
952021 CERVICAL SPINE 1 VIEW                  $      316.34 72020
952022 THORACIC SPINE 1 VIEW (OR)             $      316.34 7202076
952023 THORACIC SPINE 1 VIEW                  $      316.34 72020
952024 LUMBAR SPINE 1 VIEW (OR)               $      316.34 7202076
952025 LUMBAR SPINE 1 VIEW                    $      316.34 72020
952040 CERVICAL SPINE 2 OR 3 VIEWS            $      521.23 72040
952050 CERVICAL SPINE 4 VIEWS OR MORE         $      725.19 72050
952052 XRY-C-SPINE+FLEX./EXT.                 $      971.43 72052
952070 THORACIC SPINE 2 VIEWS                 $      682.23 72070
952072 THORACIC SPINE 3 VIEWS                 $      814.03 72072
952074 THORACIC SPINE 4 VS OR MORE            $      475.26 72074
952080 THORACOLUMBAR 2 VIEWS                  $      600.47 72080
952090 SCOLIOSIS STUDY,SP-ERECT STUD.         $      745.00 72090
952100 LUMBAR SPINE 2 OR 3 VIEWS              $      596.39 72100
952110 LUMBAR SPINE 4 VIEWS OR MORE           $      972.44 72110
952114 LUMBAR SPINE INCLUDING BENDING         $     1,056.01 72114
952120 LUMBAR SPINE BENDING ONLY 4VS          $      487.65 72120
952170 XRY-PELVIS AP                          $      564.83 72170
952175 X-RAY PELVIS, 2 VS                     $      564.83 72170
952190 XRY-PELVIS 3 VIEWS                     $      587.81 72190
952200 XRY-SACRO-ILIAC-PART 2 VIEWS           $      315.74 72200
952202 XRY-SACRO-ILIAC SER. 4 VIEWS           $      675.97 72202
952220 XRY-COCCYX/SACRUM 2 VIEWS              $      801.60 72220
952270 LUMBAR PUNCTURE, LUMBAR DX             $     1,751.01 62270
953000 XRY-CLAVICLE 2 VIEWS                   $      446.22 73000
953010 XRY-SCAPULA                            $      585.55 73010
953020 XRY-SHOULDER,1 VIEW                    $      550.21 73020
953030 SHOULDER COMPLETE 2 VS OR MORE         $      663.84 73030
953040 ARTHROGRAM, SHOULDER                   $     1,514.58 73040
953050 AC JOINTS BIL. W / W/O WEIGHTS         $      597.31 73050
953060 XRY-HUMERUS 2 VIEWS                    $      564.83 73060
953070 XRY-ELBOW,AP+LAT 2 VIEWS               $      497.05 73070
953080 XRY-ELBOW,SERIES 4 VIEWS               $      483.61 73080
953090 XRY-FOREARM+JOINT 2 VIEWS              $      521.23 73090
953092 XRY UP EXT INFANT 2 V                  $      475.26 73092
953100 XRY-WRIST 2 VIEWS                      $      397.20 73100
953110 XRY-WRIST MIN 3 V                      $      619.34 73110
953115 WRIST ARTHROGRAM                       $      987.60 73115
953120 XRY-HAND 2 VIEWS            *          $      463.19 73120
953130 XRY-HAND MIN 3 VWS                     $      596.95 73130
953140 XRY-FINGER-S            *              $      446.05 73140




                                        Page 61
                                          Ancillary


953214 XRY-IONIC CONTRAST 50 ML                 $      489.06 A4641
953390 INJ. ARTHROGRAM SHOULDER                 $      990.63 23350
953500 XR HIP 1VW UNILATERAL                    $      480.75 73500
953501 HIP , AP(NON-OR)                         $      480.75 73500
953510 HIP SERIES, UNILATERAL                   $      571.27 73510
953520 HIP SERIES, BILATERAL                    $      952.18 73520
953525 HIP ARTHROGRAM                           $     1,129.67 73525
953529 XRY HIP 3 VIEWS                          $      571.27 73510
953530 XR HIP 1VW UNILAT (OR/PACU)              $      480.75 73530
953540 HIPS/PELVIS,PEDIATRIC                    $      475.26 73540
953550 XRY-FEMUR,AP+LAT                         $      538.86 73550
953559 XRY PATELLA                              $      474.51 73560
953560 XRY-KNEE,AP+LAT                          $      474.51 73560
953561 KNEE 1 VIEW, WEIGHT BEARING              $      474.51 73560
953562 KNEE 3 VIEWS                             $      236.53 73562
953564 KNEE 4 VIEWS OR MORE                     $      677.80 73564
953570 XRY-KNEE,SERIES 4 VIEWS                  $      677.80 73564
953580 ARTHROGRAM, KNEE                         $     1,084.96 73580
953590 XRY-TIBIA-FIBULA 2 VIEWS                 $      662.69 73590
953592 XRY LOW EXTREM INFANT                    $      378.63 73592
953600 XRY-ANKLE 2 VIEWS                        $      486.82 73600
953610 ANKLE 3 VS OR MORE                       $      668.39 73610
953615 ANKLE ARTHROGRAM                         $      600.24 73615
953620 XRAY FOOT 2 VIEWS                        $      491.56 73620
953630 XRY-FOOT, SERIES 3 VIEWS                 $      668.39 73630
953650 XRY-OS CALCIS 2 VIEWS                    $      624.61 73650
953660 XRY-TOE-S            *                   $      316.34 73660
954000 XRY ABDOMEN 1 VIEW             *         $      433.64 74000
954002 XRY KUB                                  $      433.64 74000
954010 XRY-ABDOMEN,SERIES 2 VIEWS               $      643.45 74020
954011 XRY ABDOMEN 3 VIEWS            *         $      643.45 74020
954012 ABD.SERIES SUP-ERECT-DEC-CXR             $      620.59 74022
954020 ABDOMEN / DECUB.& OR ERECT VS            $      643.45 74020
954220 XRY-ESOPHAGUS                            $     1,014.77 74220
954221 INJ. ARTHROGRAM ELBOW                    $      600.60 24220
954222 XRY-ESOPHAGUS,SOLUBLE CONTRAST           $     1,014.77 74220
954230 XRY-SWALLOWING FUNCTION VIDEO            $      992.97 74230
954238 XRY-UGI W/O KUB                          $      955.59 74240
954240 XRY-UGI W/O KUB                          $      955.59 74240
954241 XRY-UPPER GI + KUB         *             $     1,075.58 74241
954242 XRY-UPPER GI,SOLUBLE CONTRAST            $      955.59 74240
954245 XRY-UP.GI.SM.BOWEL                       $     1,713.34 74245
954247 XRY-UP.GI.SM.BOWEL,SOL.CONTRST           $     1,713.34 74245
954248 ESOPHAGRAM, UGI, SB                      $     1,713.34 74245
954250 XRY-SMALL BOWEL                          $     1,421.50 74250
954251 SM BOWEL STUDY, ENTEROCLYSIS             $     1,109.46 74251
954252 XRY-SMALL BOWEL,SOLUBLE CONTR            $     1,421.50 74250
954268 XRY BARIUM ENEMA                         $     1,354.82 74270
954270 XRY-BARIUM ENEMA                         $     1,354.82 74270




                                          Page 62
                                        Ancillary


954276 XRY-ENEMA,SOLUBLE CONTRAST             $     1,354.82 74270
954280 XRY-AIR CONTR. BAR ENEMA               $     1,618.66 74280
954290 CHOLECYSTOGRAM                         $      629.92 74290
954300 CHOLANGIOGRAPHY/PERC W/ INJECT         $     2,041.40 74320
954305 XRY-CHOLANGIO.T-TUBE                   $     1,104.22 74305
954340 XRY-PASS G.I. TUBE                     $      865.01 74340
954345 XRY-SOLUBLE CONTRAST                   $      228.11 A4641
954399 XRY-IVP INF/DRIP/BOLUS                 $      831.12 74410
954400 XRY IVP INF/DRIP/BOLUS                 $      831.12 74410
954405 XRY-UROGRAM HPER.                      $      831.12 74410
954415 IVP W NEPHROTOMO                       $     1,572.97 74415
954420 XRY-UROGRAM RETRO.                     $     1,139.68 74420
954425 XR UROGRAM, LOOPOGRAM S&I              $      294.95 74425
954430 XRY-CYSTOGRAM SI                       $      958.74 74430
954455 XRY-URETHOA VOID SI                    $     1,662.22 74455
954500 PLACE LONG TUBE-MILLER-ABBOT           $     1,050.89 44500
954740 XRY-HYSTEROSALPNG SI                   $     1,689.41 74740
955246 INJ. ARTHROGRAM WRIST                  $     1,168.17 25246
955801 XRY-LYMPHANGIOGRAM UNI                 $     1,233.43 75801
955803 XRY-LYMPHANGIOGRAM BILAT               $     2,235.87 75803
956000 XRY-FLUOROSCOPY UP TO 1 HR             $     1,414.44 76000
956005 XR FLUORO NEEDLE PLCMT SPINE           $      756.47 77003
956020 XR BONE SURVEY, AGE                    $      315.74 77072
956040 XR BONE SURVEY, LENGTH                 $      806.38 77073
956041 XR BONE SURVEY, OSSEOUS LTD            $      807.51 77074
956042 BONE SURVEY COMP AX & APP SKEL         $     1,707.11 77075
956062 BONE SURVEY COMP AX & APP SKEL         $     1,707.11 77075
956064 XR BONE SURVEY, CHILD                  $      607.78 77076
956065 XR BONE SURVEY, CHILD                  $      607.78 77076
956066 XRY-KNEE ARTHRO SI                     $     1,084.96 73580
956070 XRY-SHOULDER ARTHRO SI                 $     1,514.58 73040
956080 XRY-SINUS TR.STDY SI                   $      844.68 76080
956098 XRY TOMO SINGLE PLANE                  $      467.61 76100
956099 XRY-TOMO COMPLEX UNI                   $      497.87 76101
957000 XRY ZYGOMA, 3 VIEW                     $      841.04 70150
957006 XRY-FLUORO ASSIST, 1HR/LESS            $     1,414.44 76000
957008 XRY-FLUORO ASSIST 1HR/MORE             $     2,084.97 76001
957022 ERCP                                   $     2,945.26 43260
957097 INJ. ARTHROGRAM KNEE                   $     1,247.75 27095
957098 INJ. ARTHROGRAM SACROILIAC JNT         $     1,305.19 27096
957370 KNEE ARTHROGRAPHY INJ                  $      762.03 27370
957648 INJ. ARTHROGRAM ANKLE                  $      825.51 27648
958012 PERC ENTEROCLYSIS TUBE                 $      959.53 74355
958016 ESOPHAGRAM & UPPER GI                  $      955.59 74240
958017 XR DEFECOGRAPHY UL FLUORO PROC         $     1,196.00 76496
958064 XRY-NEPHROSTOGRAM                      $      294.95 74425
958340 CATH/INTRO SALINE/CONST HYSTRO         $      444.55 58340
959001 INJ PROC RETRO URETHROCYST                           51610
959002 INJ PROC SIALOGRAM                     $      425.50 42550




                                        Page 63
                                         Ancillary


 959003 INJ PROC PERC CHOLE                    $      865.76 47500
 959004 TUBE/NDL CATH JEJUNOSTOMY              $     1,272.79 44015
 959005 INJ PROC SIALOGRAM                     $      425.50 42550
 959292 XR VAGINAGRAM S&I                      $      844.68 76080
 959295 IMG GUID PLMT, CLIP PERC.              $      467.21 19295
 959826 XRY-BLUE DYE                           $      116.59
 959828 SIALOGRAM WITH INJECT                  $      794.29 70390
 959949 +CT/XR IODINE 300-349MG/ML,1ML         $        2.77 Q9949
 959950 +CT/XR IODINE 350-399MG/ML,1ML         $        1.85 Q9950
 959996 FISTULAGRAM                            $      844.68 76080
 998012 XRY-SM BOWEL ENTEROCLYSIS              $      853.44 74251
1020100 XRY-MANDIBLE-PARTIAL < 4 VIEWS         $      365.59 70100
1020110 XRY-MANDIBLE SER 4V+                   $      580.29 70110
1020130 XRY-MASTOIDS MIN 3V/SIDE               $      316.25 70130
1020140 FACIAL BONES LESS 3 VIEW               $      365.01 70140
1020150 FACIAL BONES 3 VIEWS OR MORE           $      646.96 70150
1020160 XRY-NASAL BONES 3V                     $      551.94 70160
1020201 XRY-OPTIC FORAMINA                     $      242.88 70190
1020210 XRY-SINUSES < 3 VIEWS                  $      242.88 70210
1020220 SINUSES MIN 3 VIEWS                    $      538.41 70220
1020250 SKULL, LESS THAN 4 VIEWS               $      365.01 70250
1020260 SKULL, COMPLETE MIN OF 4 VIEWS         $      826.56 70260
1020332 XRY-T-M JOINTS BI. 4-5V                $      365.59 70330
1020360 NECK, SOFT TISSUE                      $      395.31 70360
1020394 XRY PYELOGRAPHY INJ TUBE CATH          $      600.39 50394
1021010 XRY CHEST 1 VIEW                       $      396.03 71010
1021020 XRY-CHEST 2 VIEWS                      $      442.69 71020
1021021 XRY CHEST 3 VIEWS                      $      323.00 71021
1021022 XRY CHEST MIN 4 V                      $      580.29 71030
1021023 CHEST AP&LAT. W/FLUOROSCOPY            $      442.75 71023
1021034 CHEST COMP.MORE 4VS W/FLUORO           $      408.79 71034
1021035 CHEST SPECIAL VS LAT DECUB.            $      242.88 71035
1021100 XR RIBS SERIES UNILAT                  $      482.29 71100
1021110 XR RIBS SERIES BILAT                   $      579.32 71110
1021114 XR L-SPINE COMPLETE + BENDING          $      812.31 72114
1021116 INJ. ARTHROGRAM TMJ                    $      535.92 21116
1021120 XRY-STERNUM                            $      512.69 71120
1021130 XRY-SC JTS MIN 3 V                     $      365.59 71130
1022010 XRY-SPINE, SURVEY                      $      365.59 72010
1022030 XR NECK, SOFT TISSUE                   $      395.31 70360
1022040 CERVICAL SPINE 2/3 VIEWS               $      400.95 72040
1022050 XRY-CERVICAL,SERIES 4-5V               $      557.83 72050
1022052 XRY-C SP+FLEX/EXT                      $      747.25 72052
1022070 THORACIC SPINE 2 VIEWS                 $      524.78 72070
1022072 THORACIC SPINE 3VS                     $      626.18 72072
1022074 THORACIC SPINE 4VS OR MORE             $      365.59 72074
1022080 THORACOLUMBAR 2 VIEWS                  $      461.90 72080
1022090 XRY-SCOLIOSIS STUDY                    $      573.08 72090
1022100 LUMBAR SPINE 2/3 VIEWS                 $      458.76 72100




                                         Page 64
                                         Ancillary


1022110 LUMBAR SPINE MINI 4 VIEW               $     748.03 72110
1022114 LUMBAR SPINE COMPLETE,FLEX/EXT         $     812.31 72114
1022170 PELVIS 1/2 VIEWS                       $     434.49 72170
1022190 XRY PELVIS & HIPS MIN 3V               $     732.45 73520
1022200 XRY-SACRO-ILIAC-PART 2V                $     242.88 72200
1022202 XRY-SACRO-ILIAC SER. 4V                $     519.98 72202
1022220 XRY-COCCYX/SACRUM 2V                   $     616.62 72220
1023000 XRY-CLAVICLE 2V                        $     343.25 73000
1023010 XRY-SCAPULA                            $     450.42 73010
1023020 XRY-SHOULDER,1 VIEW                    $     423.23 73020
1023030 XRY-SHOULDER,SERIES 4V                 $     510.65 73030
1023050 XR ACROMIOCLAVICULAR JOINT             $     459.47 73050
1023060 XRY-HUMERUS 2V                         $     434.49 73060
1023070 ELBOW 2 VIEWS                          $     382.35 73070
1023080 XRY-ELBOW,SERIES 4V                    $     372.01 73080
1023085 XR ARTHROGRAM ELBOW S&I UNI            $     715.00 73085
1023090 XRY-FOREARM+JOINT 2V                   $     400.95 73090
1023092 XRY UP EXT INFANT 2 V                  $     365.59 73092
1023100 XRY-WRIST 2 VIEWS                      $     305.53 73100
1023110 XRY-WRIST MIN 3 V                      $     476.42 73110
1023115 XR ARTHROGRAM WRIST S&I UNILAT         $     759.69 73115
1023120 XRY-HAND 2 VIEWS                       $     356.30 73120
1023130 XRY-HAND MIN 3 VWS                     $     459.20 73130
1023140 XR FINGER(S) 2-3 VIEWS                 $     343.11 73140
1023222 XR C-SPINE 1 VIEW                      $     243.34 72020
1023223 XR T-SPINE 1 VIEW                      $     243.34 72020
1023224 XR L-SPINE 1 VIEW                      $     243.34 72020
1023351 XRY INJ SHOULDER ARTHROGRAPHY          $     762.03 23350
1023352 INJ. ARTHROGRAM SHOULDER               $     762.03 23350
1023500 HIP SERIES, UNILATERAL                 $     369.81 73500
1023510 XRY-HIP MIN 2 VIEWS                    $     439.44 73510
1023520 HIP SERIES, BILATERAL                  $     732.45 73520
1023526 XR ARTHROGRAM HIP S&I UNILAT           $     868.98 73525
1023540 HIPS/PELVIS,PEDIATRIC                  $     365.59 73540
1023550 XRY-FEMUR,AP+LAT                       $     414.51 73550
1023559 XRY PATELLA                            $     365.01 73560
1023560 XRY-KNEE,AP+LAT                        $     365.01 73560
1023564 KNEE SERIES W/PATELLAR VIEWS           $     521.39 73564
1023565 XR KNEES BILAT STANDING (AP)           $     243.34 73565
1023570 XRY-KNEE,SERIES 4V                     $     521.39 73564
1023590 XRY-TIBIA-FIBULA 2V                    $     509.76 73590
1023592 XRY LOW EXTREM INFANT                  $     291.25 73592
1023600 XRY-ANKLE 2 VIEWS                      $     374.47 73600
1023610 XRY-ANKLE, SERIES 3V                   $     514.14 73610
1023615 XR ARTHROGRAM ANKLE S&I UNILAT         $     461.73 73615
1023616 XR ARTHROGRAM ANKLE S&I UNILAT         $     461.73 73615
1023620 XRY-FOOT 2V                            $     378.12 73620
1023630 XRY-FOOT, SERIES 3V                    $     514.14 73630
1023650 XRY-OS CALCIS 2V                       $     480.47 73650




                                         Page 65
                                          Ancillary


1023660 XRY-TOE-S 3V                            $      243.34 73660
1024000 XRY ABDOMEN 1 VIEW                      $      333.57 74000
1024011 XRY ABDOMEN 3 VIEWS                     $      494.96 74020
1024012 XRY-ABD 4VWS W PA CXR                   $      477.38 74022
1024020 ABDOMEN/DECUB.AND/OR ERECT VS           $      494.96 74020
1024220 XRY-ESOPHAGUS                           $      780.59 74220
1024221 INJ. ARTHROGRAM ELBOW                   $      462.00 24220
1024230 XRY-SWALLOWING FUNCTION VIDEO           $      763.82 74230
1024238 XRY-UGI W/O KUB                         $      735.07 74240
1024240 XRY-UGI W/O KUB                         $      735.07 74240
1024241 XRY-UPPER GI + KUB                      $      827.38 74241
1024242 ESPHOGRAM, UGI, SB                      $     1,317.95 74245
1024245 XRY-UP.GI.SM.BOWEL                      $     1,317.95 74245
1024250 XRY-SMALL BOWEL                         $     1,093.47 74250
1024268 XRY BARIUM ENEMA                        $     1,042.16 74270
1024270 XRY-BARIUM ENEMA                        $     1,042.16 74270
1024271 POUCH-O-GRAM                            $     1,042.16 74270
1024280 XRY-AIR CONTR.ENEMA                     $     1,245.13 74280
1024290 XRY-CHOLECYSTOGRAM                      $      484.55 74290
1024305 XRY-CHOLANGIO.T-TUBE                    $      849.40 74305
1024340 ABD FOR TUBE PLACE                      $      333.57 74000
1024399 XRY-IVP                                 $     1,435.55 74400
1024400 XRY-UROGRAM, IVP                        $     1,435.55 74400
1024405 XRY-UROGRAM HPER.         *             $      639.32 74410
1024415 IVP W NEPHROTOMO                        $     1,209.97 74415
1024420 XRY-UROGRAM RETRO.            *         $      876.68 74420
1024425 XR LOOPOGRAM                            $      226.89 74425
1024431 XRY-CYSTOGRAM SP                        $      737.50 74430
1024450 URETHRCYSTOGRPHY RETROW/INJECT          $      942.44 74450
1024456 XRY-URETHRO.VOID.CM                     $     1,278.64 74455
1024500 PLACE LONG GI TUBE MILLER-ABB           $      808.37 44500
1024740 XRY-HYSTEROSALPNG SI                    $     1,299.55 74740
1025246 INJ. ARTHORGRAM WRIST                   $      898.59 25246
1025790 SHUNT SERIES                            $      695.75 75809
1026020 XR BONE SURVEY, AGE                     $      242.88 77072
1026040 XR BONE SURVEY, LENGTH                  $      620.30 77073
1026041 BONE SURVEY COMP AX & APP SKEL          $     1,313.16 77075
1026042 XR BONE SURVEY, OSSEOUS LTD             $      621.16 77074
1026061 BONE MYELOMA STUDY                      $     1,313.16 77075
1026062 BONE SURVEY COMP AX & APP SKEL          $     1,313.16 77075
1026064 XR BONE SURVEY, CHILD                   $      467.52 77076
1026066 XRY-KNEE ARTHRO SI                      $      834.59 73580
1026070 XRY-SHOULDER ARTHRO SI                  $     1,165.07 73040
1026081 XR FISTULAGRAM S&I                      $      649.75 76080
1026098 XRY TOMO SINGLE PLANE                   $      359.70 76100
1026099 XRY-TOMO COMPLEX UNI                    $      382.98 76101
1027006 XRY-FLUORO ASSIST, 1HR/LESS             $     1,088.03 76000
1027008 XRY-FLUORO ASSIST 1HR/MORE              $     1,603.82 76001
1027096 INJ HIP ARTHRO W/ANESTH                 $      959.81 27095




                                          Page 66
                                         Ancillary


1027097 INJ. ARTHROGRAM KNEE                   $      462.00 27370
1027098 INJ. ARTHROGRAM SACROILIAC JNT         $     1,003.99 27096
1027371 INJ FOR KNEE ARTHROGRAPHY              $      462.00 27370
1027648 INJ. ARTHROGRAM ANKLE                  $      635.01 27648
1028001 XRY-BARIUM SWAL/VIDEOFLOR P#M          $      763.82 74230
1028007 XRY-SOLBL CNTRST ENEMA                 $     1,042.16 74270
1028008 XRY-SOLBL CNTRST & ESPOHGR P#M         $      780.59 74220
1028009 XRY-SOLBL CNTRST & UPPR GI P#M         $      735.07 74240
1028012 XRY-SM BOWEL ENTEROCLYSIS              $      853.44 74251
1028015 XRY-SOLBL CNTRST SMALL BOWEL           $     1,093.47 74250
1028064 XRY-NEPHROSTOGRAM                      $      226.89 74425
1029223 ORBITS 4 OR MORE V                     $      524.98 70200
1029224 XR RIBS SERIES UNILAT + CHEST          $      483.76 71101
1029225 XR RIBS SERIES BILAT + CHEST           $      414.10 71111
1029226 XRY LUMBAR SP 5VW COMPL                $      748.03 72110
1029227 XRY LUMBAR SP 3VW BENDING              $      812.31 72114
1029242 XRY CHEST-PA-OBL                       $      393.16 71022
1029800 XRY CATH KIT                           $      158.63
1029827 HYSTERO CATH                           $      363.56
1029828 XRY-SIALOGRAM W/ INJECT                $      611.00 70390
1029832 XR DEFECOGRAPHY UL FLUORO PROC         $      920.00 76496
1029889 XRY WIRE TEFLON COATED 35/145C         $      200.38
1029901 XRY NEEDLE HARDWIRE LOCAL 20G          $      125.24
1029903 XRY KIT-NEPHROSTOMY-PIGTAIL            $      308.91
1029909 XRY DRAINAGE BAG                       $      392.40
1029911 XRY TRAY-BIOPSY                        $      333.96
1029913 XRY WIRE-MOVEABLE CORE 35/145C         $      133.58
1029915 XRY NEEDLE-INTRODUCER 21/15CM          $      133.58
1029917 XRY NEEDLE-INTRODUCER 4.5/21G          $      183.68
1029919 XRY NEEDLE-BIOPSY 20G/6                $      125.24
1029921 XRY NEEDLE-BIOPSY 22G/6                $      125.24
1029923 XRY DRAINAGE CATH SET ALL PUR          $      333.96
1029925 XRY DRAINAGE CATH SET 10.3 FR          $      333.96
1029927 XRY VAN SONNENBERG SUMP                $      250.47
1029929 XRY DRAIN SET MULTI-PURPOSE            $      333.96
1029934 XRY MINOR TRAY                         $      252.48
1029936 XRY-NEEDLE BIOPSY                      $      107.21
1029938 XRY IONIC CONTRAST                     $      100.19
1029942 INJ WRIST/ARTHROGRAM                   $      898.59 25246
1029943 INJ HIP ARTHRO W/O ANESTH              $      762.03 27093
1029944 INJ ELBOW ARTHROGRAM                   $      462.00 24220
1029945 INJ ANKLE ARTHROGRAM                   $      635.01 27648
1029996 XRY-FISTULAGRAM                        $      649.75 76080
1000021 FINE NDLE ASPIR W/O IMA GUID           $      647.76 10021
1000022 FINE NDLE ASPIR W IMAG GUID.           $     1,511.90 10022
1000023 BX OF BREAST PERC W GUIDANCE           $     2,476.31 19102
1000100 BIOPSY THYROID PERC NDL                $     1,192.17 60100
1000200 INJ PROC RENAL BX PERC NDL             $     2,054.80 50200
1000390 INJ PROC RENAL ABCESS DRAINAGE         $     1,782.45 50390




                                         Page 67
                                         Ancillary


1002000 INJ PROC THORACENTESIS                 $     1,156.16 32000
1002005 CHEMICAL PLEURODESIS                   $      855.81 32005
1002020 U/S GUIDED CHEST TUBE PLMT             $     1,735.03 32020
1002201 INJ PROC LUNG ABC DRAIN PERC           $     1,282.49 32201
1004802 BIOPSY LIVER PERC NDL                  $     2,367.65 47000
1005700 NEEDLE BIOPSY PROSTATE                 $     1,319.22 55700
1006201 DUPLEX SCAN ABDOMEN                    $     1,456.73 93975
1006202 DUPLEX SCAN PELVIS                     $     1,456.73 93975
1006204 DUPLEX SCAN TESTICLES                  $     1,456.73 93975
1006206 U/S BRAIN W/ DOPPLER                   $      646.29 76506
1006490 U/S GD RFA                             $      695.75 76940
1006510 U/S NEONATAL BRAIN                     $      646.29 76506
1006535 U/S THYROID                            $     1,202.70 76536
1006630 U/S CHEST                              $     1,032.96 76604
1006700 U/S ABDOMEN                            $     1,549.53 76700
1006703 US ABDOMEN LIMITED                     $      980.93 76705
1006730 US RENAL LIMITED                       $      688.64 76775
1006731 U/S RETROPERITONEUM, RENAL             $     1,095.28 76770
1006765 US AORTA LIMITED                       $      688.64 76775
1006766 U/S PELVIS, TRANSABDOMINAL             $     1,217.86 76856
1006767 U/S PELVIS, TRANSABDOMINAL             $     1,217.86 76856
1006770 U/S RETROPERITONEUM, AORTA             $     1,095.28 76770
1006780 U/S BLADDER                            $     1,217.86 7685652
1006817 US PELVIS PREGNANCY TRANSVAGNL         $      687.92 76817
1006836 U/S BREAST BILAT                       $     1,095.28 76645
1006838 GD. BREAST NEEDLE LOCALIZATION         $     1,780.60 19290
1006846 U/S EXTREMITY NON-VAS                  $     1,065.43 76880
1006872 ECHOGRAPHY, TRANSRECTAL                $     1,032.96 76872
1006880 U/S TESTICULAR                         $     1,281.03 76870
1006881 U/S TRANSPLANTED KIDNEY                $     1,169.75 76776
1006883 PERC DRNG PERITONEAL ABCESS            $     1,807.85 75989
1006890 U/S HEAD/NECK, SOFT TISSUE             $     1,202.70 76536
1006942 US GD PLCMT NEEDLE                     $     1,207.01 76942
1006971 ULTRASOUND STUDY F/U                   $      500.50 76970
1006977 U/S PELVIS, TRANSABDOMINAL, RL         $     1,217.86 76856
1006978 U/S EXTREMITY NON-VAS HIP(S)           $     1,065.43 76880
1006984 U/S ABDOMEN LIMITED                    $      980.93 76705
1006988 U/S SACRUM/SPINAL CANAL                $     1,032.75 76800
1006989 US NON-OB TRANSVAG                     $     1,032.96 76830
1006991 US NON-OB TRANSVAG                     $     1,032.96 76830
1006993 INJ PROC BX PROSTATE NDL/PUNCH         $     1,319.22 55700
1006994 U/S GUIDE INTRAOPERATIVE               $      689.05 76998
1006996 U/S PROSTATE (TRANSRECTAL)             $     1,032.96 76872
1006999 U/S UNLISTED EXAM                      $      646.29 76999
1007001 TRAY, BIOPSY (SPECIALTY)               $      302.50
1007002 GUIDEWIRES                             $      181.50
1007003 CATHETER DRAIN, PIG TAIL               $      370.70
1007004 GUN BIOPSY SEMI-AUTO DISPOS.           $      242.00
1007005 GUN BIOPSY AUTOMATIC DISPOS.           $      290.40




                                         Page 68
                                         Ancillary


1007006 TRAY,CHEST TUBE                        $      605.00
1007007 INTRODUCERS                            $       54.45
1007011 PERC DRAIN LIVER ABSCESS               $     2,853.37 47011
1007015 NEEDLE CHIBA BIOPSY DISP.              $       60.50
1007019 NEEDLE OSTYCUT BONE BIOPSY             $      302.50
1007020 GUIDE WIRE INTERVENTIONAL COON         $       66.55
1007022 DRAINAGE BAG 600 ML, TRU-CLOSE         $       60.50
1007023 CATHETER APDL DRAINAGE                 $      363.00
1007024 CATHETER FASTNER, PERCU-STAY           $       42.35
1007027 NEEDLE MANAN AUTO. CUTTING             $       72.60
1007028 INTRODUCER MANAN NEEDLE                $       65.34
1007029 VENT KIT (T-VENT) THORACIC             $      544.50
1007031 NEEDLE COAX                            $      242.00
1007032 AUTOMATIC DISPOS. BX GUN               $      363.00
1008340 HYSTEROSALPINGOGRAPHY INJ              $      444.55 58340
1008511 PERC DRAIN PANC PSEUDOCYST, EX         $     2,853.37 48511
1009021 PERC DRAIN PERITONEAL ABSCESS          $     3,804.80 49021
1009061 PERC DRAIN PERITONEAL ABSCESS          $     2,853.37 49061
1009080 PARACENTESIS/PERITONEOCENTESIS         $     1,472.14 49080
1009180 BIOPSY PROC ABD/RETROP MASS            $     1,782.45 49180
1009247 U/S GUIDED THYROID NDLE ASPIR          $     1,511.90 10022
1009877 HYSTEROSONOGRAM, W W/O DOPPLER         $     1,224.99 76831
1020023 FINE NEEDLE ASPIR WO/IMG GUID          $      498.27 10021
1020024 FINE NEEDLE ASPI W/ IMG GUID           $     1,163.00 10022
1020203 INJ PROC RENAL BX PERC NDL             $     1,580.62 50200
1020208 BIOPSY MUSCLE, PERC                    $     1,636.64 20206
1020227 BIOPSY BONE DEEP PER NDL               $     1,919.42 20225
1020228 BIOPSY THYROID PERC NDL                $      917.06 60100
1020392 INJ PROC RENAL ABCESS DRAINAGE         $     2,194.90 50021
1020393 PERC DRAIN PANC PSEUDOCYST, EX         $     2,194.90 48511
1022402 BIOPSY PLEURA PERC NDL                 $     1,662.15 32400
1022407 BIOPSY LUNG/MEDIAST PERC               $     1,906.04 32405
1023202 INJ PROC THORACENTESIS(U/S)            $      889.35 32000
1024702 BIOPSY LIVER PERC NDL US               $     1,821.27 47000
1025700 U/S PROSTATE NEEDLE BIOPSY             $     1,014.78 55700
1025701 BX PROSTATE;NDL/PUNCH SNGL/MX          $     1,014.78 55700
1026201 U/S ABDOMEN W/ DOPPLER                 $     1,120.56 93975
1026202 U/S PELVIS W/ DOPPLER                  $     1,120.56 93975
1026204 U/S TESTICULAR W/ DOPPLER              $     1,120.56 93975
1026206 U/S BRAIN W/ DOPPLER                   $      497.15 76506
1026510 U/S NEONATAL BRAIN                     $      497.15 76506
1026535 U/S THYROID                            $      925.16 76536
1026536 U/S HEAD/NECK, SOFT TISSUE             $      925.16 76536
1026630 U/S CHEST                              $      794.58 76604
1026700 U/S ABDOMEN                            $     1,191.95 76700
1026705 ABDOMINAL AORTIC ULTRASOUND            $       71.50
1026730 U/S RENAL                              $      842.52 76770
1026765 U/S RETROPERITONEUM, AORTA             $      842.52 76770
1026766 U/S PELVIS, TRANSABDOMINAL             $      936.81 76856




                                         Page 69
                                         Ancillary


1026780 U/S BLADDER                            $      936.81 7685652
1026836 U/S BREAST BILAT                       $      842.52 76645
1026846 U/S EXTREMITY NON-VAS                  $      819.56 76880
1026856 LIMITED PELVIC ULTRASOUND              $      936.81 7685652
1026857 ULTRASOUND PELVIS NON-OB,LIMIT         $      496.74 76857
1026872 ECHOGRAPHY, TRANSRECTAL                $      794.58 76872
1026880 U/S TESTICULAR                         $      985.41 76870
1026881 U/S TRANSPLANTED KIDNEY                $      899.81 76776
1026970 ULTRASOUND STUDY F/U                   $      385.00 76970
1026977 U/S PELVIS, TRANSABDOMINAL, RL         $      936.81 76856
1026978 U/S EXTREMITY NON-VAS HIP(S)           $      819.56 76880
1026984 US ABDOMEN LIMITED                     $      754.56 76705
1026988 U/S SACRUM/SPINAL CANAL                $      794.42 76800
1026989 US NON-OB TRANSVAG                     $      794.58 76830
1026993 U/S PROSTATE W/BIOPSY                  $      928.48 76942
1026996 U/S PROSTATE (TRANSRECTAL)             $      794.58 76872
1026999 U/S UNLISTED EXAM                      $      497.15 76999
1027002 TRAY, BIOPSY (SPECIALTY)               $      302.50
1027003 GUIDEWIRES                             $      181.50
1027004 CATHETER DRAIN, PIG TAIL               $      308.91
1027005 GUN BIOPSY SEMI-AUTO DISPOS.           $      242.00
1027007 GUN BIOPSY AUTOMATIC DISPOS.           $      290.40
1027009 TRAY,CHEST TUBE                        $      605.00
1027010 INTRODUCERS                            $       54.45
1027013 PERC DRAIN LIVER ABSCESS               $     2,194.90 47011
1027014 PERC DRAIN PERITONEAL ABSCESS          $     2,926.77 49021
1027016 NEEDLE CHIBA BIOPSY DISP.              $       60.50
1027028 NEEDLE OSTYCUT BONE BIOPSY             $      302.50
1027030 GUIDE WIRE INTERVENTIONAL COON         $       66.55
1027034 DRAINAGE BAG 600 ML, TRU-CLOSE         $       60.50
1027036 CATHETER APDL DRAINAGE                 $      363.00
1027038 CATHETER FASTNER, PERCU-STAY           $       42.35
1027044 NEEDLE MANAN AUTO. CUTTING             $       72.60
1027046 INTRODUCER MANAN NEEDLE                $       65.34
1027048 VENT KIT (T-VENT) THORACIC             $      544.50
1027051 NEEDLE COAX                            $      242.00
1027052 AUTOMATIC DISPOS. BX GUN               $      363.00
1028103 BX PROSTATE;NEEDLE/PUNCH SNG/M         $     1,014.78 55700
1028340 INJ HYSTERSALPINGOGRAM                 $      341.96 58340
1029024 INJ PROC RENAL ABCESS DRAINAGE         $     2,194.90 50021
1029063 PERC DRAIN PERITONEAL ABSCESS          $     2,194.90 49061
1029082 PARACENTESIS/PERITONEOCENTESIS         $     1,132.42 49080
1029103 IMG GD BREAST BX VACUUM DEVICE         $     1,033.30 19103
1029181 US GD PLCMT NEEDLE                     $      928.48 76942
1029182 BIOPSY PROC ABD/RETROP MASS            $     1,371.12 49180
1029245 U/S BREAST UNILAT                      $      600.00 76645
1029247 U/S GUIDE NEEDLE ASPIR/THYROID         $      928.48 76942
1029248 US GUIDE LIVER BIOPSY                  $      928.48 76942
1029295 IMG GD PLCMT METAL LOC CLIP            $      359.39 19295




                                         Page 70
                                         Ancillary


1029869 U/S GUIDE NEEDLE PLACEMENT S&I         $      850.00 76942
1029877 U/S HYSTERO-SONOGRAM                   $      942.30 76831
1029888 XRY CATH KIT                           $      199.88
1029900 XRY WIRE TEFLON COATED 35/145C         $      200.38
1029902 XRY NEEDLE HARDWIRE LOCAL 20G          $      125.24
1029904 XRY KIT-NEPHROSTOMY-PIGTAIL            $      308.91
1029910 XRY DRAINAGE BAG                       $      392.40
1029912 XRY TRAY BIOPSY                        $      333.96
1029914 XRY WIRE-MOVEABLE CORE 35/50C          $      133.58
1029916 XRY NEEDLE-INTRODUCER 21/15CM          $      133.58
1029918 XRY NEEDLE-INTRODUCER 4.5/21G          $      183.68
1029920 XRY NEEDLE-BIOPSY 20G/6                $      125.24
1029922 XRY NEEDLE-BIOPSY 22G/6                $      157.81
1029924 XRY DRAINAGE CATH SET ALL PUR          $      333.96
1029926 XRY DRAINAGE CATH SET 10.3 FR          $      333.96
1029928 XRY VAN SONNENBERG SUMP                $      250.47
1029930 XRY DRAIN SET MULTI-PURPOSE            $      400.75
1029935 XRY MINOR TRAY                         $      318.12
1029937 XRY-NEEDLE BIOPSY                      $      128.65
1029941 HYSTERO CATH                           $      252.48
1029954 BIOPSY BONE SUPERF PERC NDL            $     1,580.81 20220
1546940 U/S GUID. FOR VASCULAR ACCESS          $      550.40 76937
6206836 U/S BREAST BILAT                       $      842.52 76645
6206942 U/S GUIDANCE NDL PLACEMENT             $      928.48 76942
6209103 IMG GD BREAST BX VACUUM DEVICE         $     1,033.30 19103
6209181 U/S GUIDANCE FOR NDLE PLCMT            $      928.48 76942
6209217 US BREAST CYST ASPIRATION              $      928.48 76942
6209218 EACH ADD'L CYST                        $      230.00 76645
6209245 U/S BREAST UNILAT                      $      600.00 76645
1010014 MRI BRAIN W/O CONTRAST LTD             $     5,045.08 7055152
1010015 MRI BRAIN W/O CONTRAST                 $     5,045.08 70551
1010016 MRI IAC                                $     7,649.77 70553
1010045 MRI ORBITS WO CONT                     $     4,151.28 70540
1010046 MRI ORBITS WO/W CONT                   $     6,124.68 70543
1010047 MRI NECK WO/W CONT                     $     6,124.68 70543
1010055 MRI SINUSES WO CONT                    $     4,151.28 70540
1010056 MRI SINUSES WO/W CONT                  $     6,124.68 70543
1010065 MRI TMJ                                $     3,267.96 70336
1010075 MRI NECK WO CONT                       $     4,151.28 70540
1010084 MRI C-SPINE W/O CONTRAST LTD           $     4,990.34 7214152
1010085 MRI C-SPINE W/O CONTRAST               $     4,990.34 72141
1010086 MRI CARDIAC MAPPPING                   $     2,596.16 75556
1010094 MRI T-SPINE W/O CONTRAST LTD           $     4,193.57 7214652
1010095 MRI T-SPINE W/O CONTRAST               $     4,193.57 72146
1010104 MRI L-SPINE W/O CONTRAST LTD           $     5,317.93 7214852
1010105 MRI L-SPINE W/O CONTRAST               $     5,317.93 72148
1010154 MRI CHEST W/O CONTRAST, LTD            $     2,520.85 7155052
1010155 MRI CHEST W/O CONTRAST                 $     2,520.85 71550
1010156 MRI CHEST(ANEURYSM/DISSE/ W/WO         $     6,163.71 71552




                                         Page 71
                                         Ancillary


1010165 MRI SHOULDER W/O CONTRAST              $     3,727.92 73221
1010175 MRI ELBOW W/O CONTRAST                 $     3,727.92 73221
1010195 MRI HUMERUS W/O & W CONTRAST           $     4,586.20 73220
1010205 MRI FOREARM W/O & W CONTRAST           $     4,586.20 73220
1010215 MRI WRIST W/O & W CONTRAST             $     3,727.92 73221
1010235 MRI HAND/FINGER W/O CONTRAST           $     3,727.92 73221
1010255 MRI HIP W/O CONTRAST                   $     3,805.30 73721
1010256 MRI HIP W CONT UNILAT                  $     4,172.98 73722
1010265 MRI FEMUR W/O & W CONTRAST             $     5,871.47 73720
1010266 MRI FEMUR W CONT UNILAT                $     3,071.34 73719
1010267 MRI FEMUR WO CONT UNILAT               $     4,012.68 73718
1010275 MRI KNEE, W/O CONTRAST                 $     3,805.30 73721
1010276 MRI KNEE WO/W CONT UNILAT              $     5,685.39 73723
1010285 MRI TIBIA/FIBIA W/O & W CONT           $     5,871.47 73720
1010287 MRI TIBIA/FIBULA W CONT UNILAT         $     3,071.34 73719
1010295 MRI ANKLE W/O CONTRAST                 $     3,805.30 73721
1010296 MRI ANKLE W CONT UNILAT                $     4,172.98 73722
1010315 MRI FOOT/TOES W/O CONTRAST             $     3,805.30 73721
1010334 MRI ABDOMEN W/O CONTRAST, LTD          $     5,305.70 7418152
1010335 MRI ABDOMEN W/O CONTRAST               $     5,305.70 74181
1010345 MRI PELVIS                             $     3,253.61 72196
1010355 MRI BONY PELVIS                        $     3,253.61 72196
1010356 MRI BONEY PELVIS W/O CONTRAST          $     3,621.26 72195
1010357 MRI BONEY PELVIS W & WO CONT.          $     5,695.78 72194
1010366 MRI PATELLA FEMOR MOTION STDY          $     3,805.30 73721
1010375 MRI BRAIN W-CONTRAST                   $     5,693.16 70552
1010385 MRI C-SPINE W-CONTRAST                 $     6,435.34 72142
1010395 MRI T-SPINE W-CONTRAST                 $     3,025.18 72147
1010405 MRI L-SPINE W-CONTRAST                 $     5,756.11 72149
1010406 MRA OF CHEST, W/O CONT.                $     2,800.01 C8910
1010407 MRA OF CHEST, W/CONT.                  $     4,054.47 C8909
1010408 MRA OF CHEST, W & WO CONT.             $     4,200.50 C8911
1010409 MRA OF ABDOMEN W/O CONT.               $     2,524.07 C8901
1010410 MRA OF ABDOMEN W/CONT.                 $     3,289.00 C8900
1010416 MRA OF ABDOMEN W & W/O CONT.           $     3,918.67 C8902
1010504 MRI BRAIN WO/W CONTRAST                $     7,649.77 70553
1010509 MRI C-SPINE WO/W CONTRAST              $     7,320.28 72156
1010514 MRI T-SPINE WO/W CONTRAST              $     7,373.00 72157
1010519 MRI L-SPINE WO/W CONTRAST              $     6,277.14 72158
1010521 MRA NECK W/O & W CONTRAST              $     5,095.00 70549
1010522 MRA CHEST W/O FOL W/CONTRAST           $     4,200.50 C8911
1010523 MRA SPINE W OR W/O CONT.               $     3,771.37 72159
1010524 MRA PELVIS W OR W/O CONT.              $     3,048.25 72198
1010525 MRA UPPER EXT. W OR W/O CONT.          $     3,609.46 73225
1010526 MRA LOWER EXT W/O & W/CONTRAST         $     5,229.51 C8914
1010527 MRA ABDOMEN W/O FOL W/CONTRAST         $     3,918.67 C8902
1010528 CARDIAC MRI FOR MORPHO W/CONT          $     3,219.28 75553
1010529 CARDIAC MRI FOR FUNCTION, COMP         $     6,199.77 75554
1010530 CARDIAC MRI FOR FUNCTION, LTD          $     3,063.70 75555




                                         Page 72
                                         Ancillary


1010533 MRA NECK W/O CONTRAST                  $     3,526.34 70547
1010534 MRA HEAD W/WO                          $     5,095.00 70546
1010535 MRA HEAD W/CONTRAST                    $     3,986.23 70545
1010536 MRA HEAD                               $     3,796.79 70544
1010537 MRI KNEE W CONT UNILAT                 $     4,172.98 73722
1010538 MRI TIBIA/FIBULA W/O                   $     4,012.68 73718
1010539 MRI FOOT/TOE(S) W CONT UNILAT          $     4,172.98 73722
1010540 MRI ABDOMEN W CONT                     $     4,053.69 74182
1010541 MRI PELVIS WO CONT                     $     3,621.26 72195
1010542 MRI PELVIS WO/W CONT                   $     5,695.78 72197
1010543 MRI C-SPINE WO CONT                    $     4,990.34 72141
1010544 MRI T-SPINE WO CONT                    $     4,193.57 72146
1010545 MRI L-SPINE WO CONT                    $     5,317.93 72148
1010547 MRI SHOULDER WO CONT UNILAT            $     3,727.92 73221
1010548 MRI SHOULDER W CONT UNILAT             $     3,071.34 73222
1010549 MRI HUMERUS W CONT UNILAT              $     3,087.41 73219
1010550 MRI HUMERUS WO CONT UNILAT             $     2,818.60 73218
1010551 MRI ELBOW WO CONT UNILAT               $     3,727.92 73221
1010552 MRI ELBOW W CONT UNILAT                $     3,071.34 73222
1010553 MRI FOREARM WO CONT UNILAT             $     2,818.60 73218
1010554 MRI FOREARM W CONT UNILAT              $     3,087.41 73219
1010555 MRI WRIST W CONT UNILAT                $     3,071.34 73222
1010556 MRI WRIST WO CONT UNILAT               $     3,727.92 73221
1010557 MRI HAND/FINGER W CONT UNILAT          $     3,071.34 73222
1010558 MRI HAND/FINGER WO CONT UNILAT         $     3,727.92 73221
1010559 MRI BRAIN, DURING OPEN PROC. W         $     4,961.91 70559
1010560 MRI BRAIN, DURING OPEN PROC.W          $     3,289.00 70558
1010561 MRA NECK W/CONTRAST                    $     3,998.67 70548
1010562 MRI BRAIN, DURING OPEN PROC. W         $     3,043.67 70557
1010600 MRI ABDOMEN WO & W CONT                $     6,987.07 74183
1010601 MRI CHEST WO & W CONT                  $     6,163.71 71552
1010602 MRI PELVIS WO & W CONT                 $     5,695.78 72197
1010603 MRI SHOULDER WO & W CONT               $     5,685.39 73223
1010604 MRI HUMERUS WO & W CONT                $     4,586.20 73220
1010605 MRI ELBOW WO & W CONT                  $     5,685.39 73223
1010606 MRI FOREARM WO & W CONT                $     4,586.20 73220
1010607 MRI WRIST WO & W CONT                  $     5,685.39 73223
1010608 MRI HAND/FINGER WO & W CONT            $     5,685.39 73223
1010609 MRI HIP WO & W CONT                    $     5,685.39 73723
1010610 MRI FEMUR WO & W CONT                  $     5,871.47 73720
1010611 MRI KNEE WO & W CONT                   $     5,685.39 73723
1010612 MRI TIBIA/FIBIA WO & W CONT            $     5,871.47 73720
1010613 MRI ANKLE WO & W CONT                  $     5,685.39 73723
1010614 MRI FOOT/TOES WO & W CONT              $     5,685.39 73723
1010615 MRI PELVIS W PROSTATE                  $     3,253.61 72196
1010616 MRI BRACHIAL PLEXUS W/O                $     2,520.85 71550
1010617 MRI CHEST (ANEURYSM/DISSEC)W/O         $     2,520.85 71550
1010618 MRI PITUITARY W & WO                   $     7,649.77 70553
1010619 MRA CHEST W/CONTRAST                   $     4,054.47 C8909




                                         Page 73
                                         Ancillary


1010620 MRA CHEST W/O CONTRAST                 $     2,800.01 C8910
1010621 MRA LOWER EXTREMITY W/ CONT.           $     2,524.12 C8912
1010622 MRA LOWER EXT. W/O CONTRAST            $     2,902.90 C8913
1010623 MRI CHEST                              $     6,163.71 71552
1013052 CARDIOVASCULAR TRACING ONLY            $     1,670.53 93017
1014181 MRI ABDOMEN CHOLANGIOGRAM/MRCP         $     5,305.70 74183
1016350 SUBTRACTION IN CONJ. W./CONTR          $      986.70 7635059
1016376 #MR 3D RECON, TECH CONSOLE             $     1,495.29 76376
1016377 #MR 3D RECON, SEP WORKSTATION          $     1,495.29 76377
1016394 MRI GD RFA                             $     1,989.01 77022
1017001 SEMI-AUTO DISPOS. BX GUN               $      302.50
1017002 AUTOMATIC DISPOS. BX GUN               $      363.00
1017003 NEEDLE COAX                            $      242.00
1017876 MRI PELVIS, MALE W CONTRAST            $     3,253.61 72196
1017877 MRI PELVIS, MALE W & WO CONT.          $     5,695.78 72197
1017879 MRI SACRUM W/O                         $     3,621.26 72195
1017881 MRI SACRUM WITH CONTRAST               $     3,253.61 72196
1017884 MRI BREAST W/O & W/CONT. UNI           $     4,220.43 C8905
1017885 MRI BREAST W/O & W/CONT BILAT          $     6,500.00 C8908
1017886 MRI BREAST IMPLANT UNILAT              $     1,677.50 77058
1017887 MRI BREAST IMPLANT BILATERAL           $     6,000.00 C8907
1017888 MRI MYELOMA BONE SURVEY                $     2,950.23 76498
1017889 MRI SPECTROSCOPY                       $     3,900.00 76390
1017891 MRI FUNCTIONAL                         $     2,950.23 76498
1017893 MRI BREAST W/CONT. UNI.                $     2,180.75 C8903
1017894 MRI BREAST W/O CONTRAST UNI            $     2,180.75 C8904
1017895 MRI BREAST W/CONTRAST BILAT            $     2,544.26 C8906
1017896 MRI BREAST W/O CONTRAST BILAT          $     6,000.00 C8907
1017897 MRI SACRUM W & W/O CONT.               $     5,695.78 72197
1018900 MRA ABDOMEN W/CONTRAST                 $     3,289.00 C8900
1018901 MRA ABDOMEN W/O CONTRAST               $     2,524.07 C8901
1018902 MRA PELVIS W/CONTRAST                  $     3,010.72 C8918
1018903 MRA PELVIS W/O CONTRAST                $     3,047.26 C8919
1018904 MRA PELVIS W/WO CONTRAST               $     4,990.34 7214159
1018905 MRI T-SPINE CSF FLOW STUDY             $     4,193.57 7214659
1018906 MRI L-SPINE CSF FLOW STUDY             $     5,317.93 7214859
1018907 MRI BRAIN CSF FLOW STUDY               $     5,045.08 7055159
1018910 MRI C-SPINE CSF FLOW STUDY             $     4,990.34 7214159
1019143 MRI HEAD/BRAIN WO/W CONT, PERF         $     7,649.77 70553
1019952 CONTRAST GADOLINIUM/ML                 $       23.30 Q9952
1060615 MRI PELVIS W CONT, PROSTATE            $     2,502.78 72196
1062222 MRI HEAD/BRAIN WO/W CONT               $     5,884.44 70553
1090254 MRI HIP LIMITED W/O CONTRAST           $     2,927.15 7372152
1090255 MRI HIP WO CONT UNILAT                 $     2,927.15 73721
1090256 MRI HIP W CONT UNILAT                  $     3,209.98 73722
1090264 MRI FEMUR LIMITED W & W/O CONT         $     4,516.52 7372052
1090265 MRI FEMUR WO/W CONT UNILAT             $     4,516.52 73720
1090266 MRI FEMUR W CONT UNILAT                $     2,362.57 73719
1090267 MRI FEMUR WO CONT UNILAT               $     3,086.68 73718




                                         Page 74
                                         Ancillary


1090274 MRI KNEE LIMITED W/O CONRAST           $     2,927.15 7372152
1090275 MRI KNEE WO CONT UNILAT                $     2,927.15 73721
1090276 MRI KNEE WO/W CONT UNILAT              $     4,373.38 73723
1090284 MRI TIBIA/FIBULA LIMITED W&W           $     4,516.52 7372052
1090285 MRI TIBIA/FIBULA WO/W CONT UNI         $     4,516.52 73720
1090287 MRI TIBIA/FIBULA W CONT UNILAT         $     2,362.57 73719
1090294 MRI ANKLE LIMITED W/O CONTRAST         $     2,927.15 7372152
1090295 MRI ANKLE WO CONT UNILAT               $     2,927.15 73721
1090296 MRI ANKLE W CONT UNILAT                $     3,209.98 73722
1090315 MRI FOOT/TOE(S) WO CONT UNILAT         $     2,927.15 73721
1090334 MRI ABDOMEN LIMITED W/O CONTRA         $     4,081.30 74181
1090335 MRI ABDOMEM WO CONT                    $     4,081.30 74181
1090336 MRI TMJ                                $     2,513.81 70336
1090345 MRI PELVIS W CONT                      $     2,502.78 72196
1090346 MRA PELVIS W/CONTRAST                  $     2,315.94 C8918
1090347 MRA PELVIS W/O CONTRAST                $     2,344.05 C8919
1090349 MRA PELVIS W/WO CONTRAST               $     3,710.82 C8920
1090355 MRI PELVIS W CONT                      $     2,502.78 72196
1090356 MRI BONEY PELVIS W/O CONTRAST          $     2,785.58 72195
1090357 MRI BONEY PELVIW WO/W CONTRAST         $     4,381.37 72197
1090366 MRI PATELLA FEMOR MOTION STDY          $     2,927.15 73721
1090375 MRI HEAD/BRAIN W CONT                  $     4,379.35 70552
1090385 MRI C-SPINE W CONT                     $     4,950.27 72142
1090395 MRI T-SPINE W CONT                     $     2,327.06 72147
1090405 MRI L-SPINE W CONT                     $     4,427.78 72149
1090406 MRA OF CHEST, W/O CONT.                $     2,153.86 C8910
1090407 MRA OF CHEST, W/CONT.                  $     3,118.82 C8909
1090408 MRA OF CHEST, W & WO CONT.             $     3,231.16 C8911
1090409 MRA OF ABDOMEN W/O CONT.               $     2,153.86 C8910
1090410 MRA OF ABDOMEN W/CONT.                 $     3,118.82 C8909
1090411 MRA OF ABDOMEN W & W/O CONT.           $     3,014.36 C8902
1090503 MRI HEAD/BRAIN WO CONT                 $     3,880.84 70551
1090504 MRI HEAD/BRAIN WO/W CONT               $     5,884.44 70553
1090505 MRI UNLISTED, FETUS                    $     2,269.41 76498
1090509 MRI C-SPINE WO/W CONT                  $     5,630.99 72156
1090513 MRI T-SPINE WO/W CONTRAST LIMI         $     5,671.54 7215752
1090514 MRI T-SPINE WO/W CONT                  $     5,671.54 72157
1090518 MRI L-SPINE WO/W CONTRAST LIMI         $     4,828.57 7215852
1090519 MRI L-SPINE WO/W CONT                  $     4,828.57 72158
1090520 +ENDORECTAL COIL                       $      464.87 C1770
1090522 MRA CHEST W/O FOL W/CONTRAST           $     3,231.16 C8911
1090523 MRA SPINE W OR W/O CONTRAST            $     2,901.05 72159
1090524 MRA PELVIS W OR W/O CONTRAST           $     3,710.82 C8920
1090525 MRA UPPER EXT. W OR W/OCONTRA          $     2,776.51 73225
1090526 MRA LOWER EXT. W/O & W/C               $     4,022.70 C8914
1090527 MRA ABDOMEN W/O FOL W/CONTRAST         $     3,014.36 C8902
1090528 MRI CARDIAC FUN/MORPH W/ CONT          $     2,476.36 75553
1090529 MRI CARDIAC FUN/MORPH WO/W CON         $     4,769.05 75554
1090530 MRI HEART FUNCT WO/W MORPH LTD         $     2,356.70 75555




                                         Page 75
                                         Ancillary


1090533 MRA NECK W & W/O CONTRAST              $     3,919.23 70549
1090534 MRA NECK W/O CONTRAST                  $     2,712.56 70547
1090535 MRA HEAD W/CONTRAST                    $     3,066.34 70545
1090536 MRA HEAD W/O CONTRAST                  $     2,920.61 70544
1090537 MRI KNEE W CONT UNILAT                 $     3,209.98 73722
1090538 MRI TIBIA/FIBULA WO CONT UNI           $     3,086.68 73718
1090539 MRI FOOT/TOE(S) W CONT UNILAT          $     3,209.98 73722
1090540 MRI ABDOMEN W CONT                     $     3,118.23 74182
1090541 MRI PELVIS WO CONT                     $     2,785.58 72195
1090542 MRI PELVIS WO/W CONT                   $     4,381.37 72197
1090543 MRI C-SPINE WO CONT                    $     3,838.73 72141
1090544 MRI T-SPINE WO CONT                    $     3,225.82 72146
1090545 MRI L-SPINE WO CONT                    $     4,090.72 72148
1090547 MRI SHOULDER WO CONT UNILAT            $     2,867.63 73221
1090548 MRI SHOULDER W CONT UNILAT             $     2,362.57 73222
1090549 MRI HUMERUS W CONT UNILAT              $     2,374.93 73219
1090550 MRI HUMERUS WO CONT UNILAT             $     2,168.16 73218
1090551 MRI ELBOW WO CONT UNILAT               $     2,867.63 73221
1090552 MRI ELBOW W CONT UNILAT                $     2,362.57 73222
1090553 MRI FOREARM WO CONT UNILAT             $     2,168.16 73218
1090554 MRI FOREARM W CONT UNILAT              $     2,374.93 73219
1090555 MRI WRIST W CONT UNILAT                $     2,362.57 73222
1090556 MRI WRIST WO CONT UNILAT               $     2,867.63 73221
1090557 MRI HAND/FINGER W CONT UNILAT          $     2,362.57 73222
1090558 MRI HAND/FINGER WO CONT UNILAT         $     2,867.63 73221
1090561 MRA NECK W/CONTRAST                    $     3,075.89 70548
1090600 MRI ABDOMEN WO/W CONT                  $     4,741.32 74183
1090601 MRI CHEST W & W/O CONTRAST             $     4,741.32 71552
1090602 MRI CHEST W/O CONTRAST, LTD            $     1,939.12 71550
1090603 MRI SHOULDER WO/W CONT UNILAT          $     4,373.38 73223
1090604 MRI HUMERUS WO/W CONT UNILAT           $     3,527.84 73220
1090605 MRI ELBOW WO/W CONT UNILAT             $     4,373.38 73223
1090606 MRI FOREARM WO/W CONT UNILAT           $     3,527.84 73220
1090607 MRI WRIST WO/W CONT UNILAT             $     4,373.38 73223
1090608 MRI HAND/FINGER WO/W CONT UNI          $     4,373.38 73223
1090609 MRI HIP WO/W CONT UNILAT               $     4,373.38 73723
1090613 MRI ANKLE WO/W CONT UNILAT             $     4,373.38 73723
1090614 MRI FOOT/TOE(S) WO/W CONT UNI          $     4,373.38 73723
1090616 MRI BRACHIAL PLEXUS WO CONT            $     1,939.12 71550
1090617 MRI CHEST (ANRSM/DIS) W & WO           $     4,741.32 71552
1090618 MRI HEAD/PITUITARY WO/W CONT           $     5,884.44 70553
1090621 MRI HEART VELOCITY MAPPING             $     1,997.05 75556
1090634 MRA HEAD W/WO                          $     3,919.23 70546
1090635 MRA ABDOMEN W/CONTRAST                 $     2,530.00 C8900
1090636 MRA ABDOMEN W/O CONTRAST               $     1,941.59 C8901
1090637 MRA CHEST W/CONTRAST                   $     3,118.82 C8909
1090638 MRA CHEST W/O CONTRAST                 $     2,153.86 C8910
1090639 MRA LOWER EXTREMITY W/ CONT            $     1,941.71 C8912
1090640 MRA LOWER EXTREMITY W/O CONT           $     2,233.00 C8913




                                         Page 76
                                         Ancillary


1090641 MRI ORBITS/FACE/NECK W CONT            $     3,952.29 70542
1090642 MRI ORBITS/FACE/NECK WO CONT           $     3,193.29 70540
1090643 MRI ORBITS/FACE/NECK WO/W CONT         $     4,760.83 70543
1091001 MRI BREAST LYMPH NODES LIMITED         $     1,939.12 71550
1091550 MRI CHEST W/O CONTRAST                 $     1,939.12 71550
1092222 MRI BRAIN WO/W CONT, IAC               $     8,207.55 70553
1093052 CARDIOVASCULAR TRACING ONLY            $     1,285.02 93017
1094181 MRI ABDOMEN CHOLANGIOGRAM/MRCP         $     5,241.32 74183
1096350 SUBTRACTION IN CONJ. W./CONTR          $      759.00 7635059
1096376 #MR 3D RECON, TECH CONSOLE             $     1,150.22 76376
1096377 #MR 3D RECON, SEP WORKSTATION          $     1,150.22 76377
1096393 MRI GD NEEDLE PLACEMENT                $     2,551.30 77021
1097001 SEMI-AUTO DISPOS. BX GUN               $      363.00
1097002 AUTOMATIC DISPOS. BX GUN               $      363.00
1097003 NEEDLE COAX                            $      242.00
1097370 INJECTION-KNEE ARTHROGRAPHY            $      462.00 27370
1097876 MRI PELVIS W CONT, MALE                $     2,502.78 72196
1097880 MRI SACRUM LIMITED                     $     2,502.78 7219652
1097881 MRI PELVIS WO CONT, SACRUM             $     2,785.58 72195
1097882 MRI SACRUM/COCCYX W/ CONTRAST          $     2,502.78 72196
1097883 MRI SACRUM/COCCYX WOW CONTRAST         $     4,381.37 72197
1097884 MRI BREAST CA, W & W/O UNI             $     3,246.48 C8905
1097885 MRI BREAST CA, W & W/O BILAT           $     3,960.00 C8908
1097886 MRI BREAST IMPLANT UNILATERAL          $     3,246.48 C8905
1097887 MRI BREAST IMPLANT BILATERAL           $     3,960.00 C8908
1097888 MRI MYELOMA BONE SURVEY                $     3,838.73 7214159
1097889 MRI SPECTROSCOPY                       $     3,000.00 76390
1097891 MRI HEAD/BRAIN FUNCTION WO MD          $     3,880.84 70554
1097901 MRI BRAIN CSF FLOW STUDY               $     3,880.84 7055159
1097902 MRI L-SPINE CSF FLOW STUDY             $     4,090.72 7214859
1097903 MRI T-SPINE CSF FLOW STUDY             $     3,225.82 7214659
1097904 MRI C-SPINE CSF FLOW STUDY             $     3,838.73 7214159
1099103 IMG GD BREAST BX VACUUM DEVICE         $     1,826.20 19103
1099143 MRI HEAD/BRAIN WO/W CONT, PERF         $     5,884.44 70553
1099144 MRI HEAD/BRAIN WO/W CONT, PERF         $     5,884.44 70553
1099202 MRI NEEDLE LOCALIZATION                $     1,369.70 19290
1099210 MRI NEEDLE LOC. ADD LESION             $      584.59 19291
1099822 MRI BIOPSY, NEEDLE                     $      295.99
1099823 MRI BIOPY TRAY                         $      140.94
1099884 MRI BREAST BX, PERCUTANEOUS            $     1,904.86 19102
1099952 CONTRAST GADOLINIUM/ML                 $       23.30 Q9952
956086 MAMMO DUCTOGRAM SNGLE DUCT S&I          $      747.51 77053
956088 XRY-MAMMO DUCTOGRAM - MULT              $      833.73 77054
956090 MAMMO DIAGNOSTIC UNILAT                 $      399.15 77055
956091 MAMMO DIAGNOSTIC BILAT                  $      502.70 77056
956092 MAMMO SCREENING BILAT 2VWS              $      312.55 77057
956096 MAMMO GD LOC NEEDLE EA LSN S&I          $     1,162.05 77032
957001 XRY-BREAST SURG SPECIMEN                $      474.51 76098
959030 INJ MAMMARY DUCTOGRAM                   $      111.93 19030




                                         Page 77
                                         Ancillary


959202 BRST NDL WIRE PLCMNT INIT               $     1,780.60 19290
959205 XRY BIOPSY GUN NEEDLE                   $      285.26
959210 MAMMO GD LOC NEEDLE EA LSN S&I          $     1,162.05 77032
959250 MAMMO SCREENING BILAT 2VWS              $      312.55 77057
959291 PREOP PLCMNT NDL LOC BRST ADDT          $      759.97 19291
1021401 XR DXA BONE DENSITY AXIAL SKEL         $      593.43 77080
1026086 MAMMO DUCTOGRAM SNGLE DUCT S&I         $      575.00 77053
1026088 MAMMO DUCTOGRAM MULT DUCT S&I          $      641.32 77054
1026093 DIGIT UNI SCREENING MAMMO SPEC         $      322.54 G0202
1026094 DIGIT BIL SCREENING MAMMO SPEC         $      322.54 G0202
1027001 XRY-BREAST SURG SPECIMEN               $      365.01 76098
1029030 INJ MAMMO DUCTOGRAM                    $       86.10 19030
1029100 U/S BREAST BIOPSY NEEDLE CORE          $     1,904.86 19102
1029201 MAMMO GD LOC/BX EA LESION S&I          $     2,617.37 77031
1029202 BRST NDL WIRE PLCMNT INIT              $     1,369.70 19290
1029205 XRY BIOPSY GUN NEEDLE                  $       83.49
1029210 XRY MAMMO LOCAL-ADDIL AREA             $      584.59 19291
1029213 MAMMO GD LOC/BX EA LESION S&I          $     2,617.37 77031
1029217 ULT BREAST CYST ASPIRATION             $      541.70 19000
1029218 ULT BREAST CYST ASPIRAT EA ADD         $      230.00 19001
1029246 US BREAST BIOPSY LOCAL EA ADDL         $      584.59 19291
1029831 US GD LOC NEEDLE EA LSN S&I            $      893.88 77032
1029874 MAMMOTOME BREAST MULTI-PROB            $      677.18
1029884 BX BREAST; PERC NEEDLE CORE W/         $     1,904.86 19102
1057001 XRY-BREAST SURG SPECIMEN               $      365.01 76098
1059202 BRST NDL WIRE PLCMNT INIT              $     1,369.70 19290
1059205 XRY-BIOPSY GUN NEEDLE                  $       83.49
1080202 DIGITAL SCREENING MAMMO, BILAT         $      322.54 G0202
1080204 DIGITAL DIAGNOSTIC MAMMO BILAT         $      458.26 G0204
1080206 DIGITAL DIAGNOSTIC MAMMO UNI           $      366.60 G0206
1086082 MAMMO CAD SCREEN FILM ADD-ON           $      115.00 77052
1086083 MAMMO CAD DIAG DIGITAL ADD-ON          $      172.50 77051
1119214 U/S BREAST BIOPSY                      $     1,904.86 19102
6200250 SC-SKULL<VIEWS                         $      365.01 70250
6200260 SC-SKULL MIN 4 VWS                     $      826.56 70260
6201010 SC-PORT CHEST 1 VIEW                   $      396.03 71010
6201020 X-RAY CHEST 2 VIEW                     $      442.69 71020
6201021 X-RAY CHEST 3 VIEWS                    $      323.00 71021
6201022 X-RAY CHEST 4 VIEWS                    $      580.29 71030
6202040 SC-SPINE CERV 2-3 VIEWS                $      400.95 72040
6202050 SC-SPINE CERVICAL 4+ VIEWS             $      557.83 72050
6202070 SC-THORACIC 3 VIEWS                    $      626.18 72072
6202080 SC-THORACO-LUMBAR 2 VIEWS              $      461.90 72080
6202100 SC-SPINE LUMBAR 2 VIEWS                $      458.76 72100
6202110 SC-SPINE LUMBAR 5 VIEWS                $      748.03 72110
6202170 XR PELVIS                              $      434.49 72170
6203020 SC-SHOULDER 1 VIEW                     $      423.23 73020
6203030 SC-SHOULDER 4 VIEWS                    $      510.65 73030
6203060 SC-HUMERUS 2 VIEWS                     $      434.49 73060




                                         Page 78
                                         Ancillary


6203070 ELBOW 2 VIEWS                          $      382.35 73070
6203080 ELBOW MIN 3 VIEWS                      $      372.01 73080
6203090 FOREARM                                $      400.95 73090
6203100 WRIST 2 VIEWS                          $      305.53 73100
6203110 WRIST MIN 3 VIEWS                      $      476.42 73110
6203120 XRAY HAND 2 VIEWS                      $      356.30 73120
6203130 HAND MIN 3 VIEWS                       $      459.20 73130
6203140 X-RAY FINGERS                          $      343.11 73140
6203550 SC-FEMUR 2 VIEWS                       $      414.51 73550
6203559 SC-PATELLA                             $      365.01 73560
6203560 SC-KNEE AP & LAT                       $      365.01 73560
6203570 SC-LNEE 4 VIEWS                        $      521.39 73564
6203590 TIB/FIB                                $      509.76 73590
6203600 SC-ANKLE 2 VIEWS                       $      374.47 73600
6203610 SC-ANKLE 4 VIEWS                       $      514.14 73610
6203620 FOOT 2 VIEWS                           $      378.12 73620
6203630 X-RAY FOOT 3 VIEWS                     $      514.14 73630
6203660 SC-TOES                                $      243.34 73660
6204000 X-RAY ABDOMEN 1 VW                     $      333.57 74000
6204011 X-RAY ABDOMEN SERIES                   $      494.96 74020
6204644 NON-IONIC 100-199 MG                   $      153.07
6204645 NON-IONIC 200-299 MG                   $      166.98
6204646 NON-IONIC 30-399 MG                    $      183.68
6206082 MAMMO CAD SCREEN FILM ADD-ON           $      115.00 77052
6206083 MAMMO CAD DIAG DIGITAL ADD-ON          $      172.50 77051
6206086 MAMMO DUCTOGRAM SNGLE DUCT S&I         $      575.00 77053
6206088 MAMMO DUCTOGRAM MULT DUCT S&I          $      641.32 77054
6206090 MAMMO DIAGNOSTIC UNILAT                $      307.04 77055
6206091 MAMMO DIAGNOSTIC BILAT                 $      386.70 77056
6206092 MAMMO SCREENING BILAT 2VWS             $      240.42 77057
6206130 SC-PORTABLE FEE
6206131 SC-SURG FEE
6207001 SC-BREAST SURG SPECIMEN                $      365.01 76098
6207006 XR FLUOROSCOPY 1HR/LESS                $     1,088.03 76000
6207008 XR FLUOROSCOPY 1HR/MORE                $     1,603.82 76001
6209201 STEREOSTACTIC BIOPSY 1 LESION          $     2,617.37 77031
6209202 BREAST LOCAL NEEDLE-LOC 1 LESI         $     1,369.70 19290
6209210 BREAST LOCAL EACH ADD'L LESION         $      584.59 19291
6209214 BREAST BIOPSY                          $     1,904.86 19102
6209242 CHEST PA AND BOTH OBLIQUE              $      393.16 71022
6209246 EACH ADD'L BIOPSY                      $     1,904.86 1910259
6209822 BIOPSY TRAY                            $      363.08
6209823 BIOPSY NEEDLE                          $      172.91
6209825 NEEDLE                                 $       42.88
6209826 BLUE DYE                               $       96.05
6209831 MAMMO GD LOC NEEDLE EA LSN S&I         $      893.88 77032
6209833 SITE SELECT BIOPSY NEEDLE              $     1,374.87
6209874 XRY MAMMOTOME BREAST MULTIPROB         $      812.61
6209875 MAMMO SCREENING (CASH PKG)STAT




                                         Page 79
                                         Ancillary


6209884 BX BREAST;PERC NEEDLE CORE W/          $     1,904.86 19102
6209885 IMG GD PLCMT METAL LOC CLIP            $      359.39 19295
6209886 BX BREAST;PERC NEEDLE CORE WO/         $      802.59 19100
6209949 +CT/XR IODINE 300-349MG/ML,1ML         $        2.77 Q9949
1060255 MRI HIP W/O CONTRAST                   $     2,927.15 73721
1060256 MRI HIP W CONT UNILAT                  $     3,209.98 73722
1060265 MRI FEMUR W & W/O CONTRAST             $     4,516.52 73720
1060266 MRI FEMUR W CONT UNILAT                $     2,362.57 73719
1060267 MRI FEMUR WO CONT UNILAT               $     3,086.68 73718
1060275 MRI KNEE W/O CONTRAST                  $     2,927.15 73721
1060276 MRI KNEE WO/W CONT UNILAT              $     4,373.38 73723
1060285 MRI TIBIA/FIBULA W & W/O CONTR         $     4,516.52 73720
1060287 MRI TIBIA/FIBULA W CONT UNILAT         $     2,362.57 73719
1060295 MRI ANKLE W/O CONTRAST                 $     2,927.15 73721
1060296 MRI ANKLE W CONT UNILAT                $     3,209.98 73722
1060315 MRI FOOT/TOES W/O CONTRAST             $     2,927.15 73721
1060335 MRI ABDOMEN W/O CONTRAST               $     4,081.30 74181
1060336 MRI TMJ                                $     2,513.81 70336
1060345 MRI PELVIS W/CONTRAST                  $     2,502.78 72196
1060346 FETAL BRAIN MRI, W/O CONTRAST          $     2,269.41 76498
1060347 MRA PELVIS W/CONTRAST                  $     2,315.94 C8918
1060348 MRA PELVIS W/O CONTRAST                $     2,344.05 C8919
1060349 MRA PELVIS W/WO CONTRAST               $     3,710.82 C8920
1060355 MRI BONEY PELVIS W/CONTRAST            $     2,502.78 72196
1060366 MRI PATELLA FEMUR MOTION STUDY         $     2,927.15 73721
1060375 MRI BRAIN W-CONTRAST                   $     4,379.35 70552
1060385 MRI C-SPINE W-CONTRAST                 $     4,950.27 72142
1060395 MRI T-SPINE W-CONTRAST                 $     2,327.06 72147
1060405 MRI L-SPINE W-CONTRAST                 $     4,427.78 72149
1060406 MRA OF CHEST, W/O CONT.                $     2,153.86 C8910
1060407 MRA OF CHEST, W/CONT.                  $     3,118.82 C8909
1060408 MRA OF CHEST, W & WO CONT.             $     3,231.16 C8911
1060409 MRA OF ABDOMEN W/O CONT.               $     1,941.59 C8901
1060410 MRA OF ABDOMEN W/CONT.                 $     2,530.00 C8900
1060411 MRA OF ABDOMEN W & W/O CONT.           $     3,014.36 C8902
1060503 MRI BRAIN WO/CONTRAST                  $     3,880.84 70551
1060504 MRI BRAIN WO/W CONTRAST                $     5,884.44 70553
1060509 MRI C-SPINE WO/W CONTRAST              $     5,630.99 72156
1060514 MRI T-SPINE WO/W CONTRAST              $     5,671.54 72157
1060519 MRI L-SPINE WO/O CONTRAST              $     4,828.57 72158
1060520 MRI SUPPLIES ENDORECTAL COIL           $      268.57
1060522 MRA CHEST W/O FOL W/CONTRAST           $     3,231.16 C8911
1060523 MRA SPINE W OR W/O CONTRAST            $     2,901.05 72159
1060524 MRA PELVIS W OR W/O CONTRAST           $     2,344.80 72198
1060525 MRA UPPER EXT. W OR W/O CONTRA         $     2,776.51 73225
1060526 MRA LOWER EXT. W/O & W/CONT.           $     4,022.70 C8914
1060527 MRA ABDOMEN W/O FOL W/CONTRAST         $     3,014.36 C8902
1060528 CARDIAC MRI MORPHOLOGY W CONTR         $     2,476.36 75553
1060529 CARDIAC MRI FUNCTION COMPLETE          $     4,769.05 75554




                                         Page 80
                                         Ancillary


1060533 MRA NECK W & W/O CONTRAST              $     3,919.23 70549
1060534 MRA NECK W/O CONTRAST                  $     2,712.56 70547
1060535 MRA HEAD W/CONTRAST                    $     3,066.34 70545
1060536 MRA HEAD W/O CONTRAST                  $     2,920.61 70544
1060537 MRI KNEE W CONT UNILAT                 $     3,209.98 73722
1060538 MRI TIBIA/FIBULA WO CONT UNI           $     3,086.68 73718
1060539 MRI FOOT/TOE(S) W CONT UNILAT          $     3,209.98 73722
1060540 MRI ABDOMEN W CONT                     $     3,118.23 74182
1060541 MRI PELVIS WO CONT                     $     2,785.58 72195
1060542 MRI PELVIS WO/W CONT                   $     4,381.37 72197
1060543 MRI C-SPINE WO CONT                    $     3,838.73 72141
1060544 MRI T-SPINE WO CONT                    $     3,225.82 72146
1060545 MRI L-SPINE WO CONT                    $     4,090.72 72148
1060547 MRI SHOULDER WO CONT UNILAT            $     2,867.63 73221
1060548 MRI SHOULDER W CONT UNILAT             $     2,362.57 73222
1060549 MRI HUMERUS W CONT UNILAT              $     2,374.93 73219
1060550 MRI HUMERUS WO CONT UNILAT             $     2,168.16 73218
1060551 MRI ELBOW WO CONT UNILAT               $     2,867.63 73221
1060552 MRI ELBOW W CONT UNILAT                $     2,362.57 73222
1060553 MRI FOREARM WO CONT UNILAT             $     2,168.16 73218
1060554 MRI FOREARM W CONT UNILAT              $     2,374.93 73219
1060555 MRI WRIST W CONT UNILAT                $     2,362.57 73222
1060556 MRI WRIST WO CONT UNILAT               $     2,867.63 73221
1060557 MRI HAND/FINGER W CONT UNILAT          $     2,362.57 73222
1060558 MRI HAND/FINGER WO CONT UNILAT         $     2,867.63 73221
1060561 MRA NECK W/CONTRAST                    $     3,075.89 70548
1060600 MRI ABDOMEN WO/W CONT                  $     4,741.32 74183
1060601 MRI CHEST W & W/O CONTRAST             $     4,741.32 71552
1060603 MRI SHOULDER WO/W CONT UNILAT          $     4,373.38 73223
1060604 MRI HUMERUS WO/W CONT UNILAT           $     3,527.84 73220
1060605 MRI ELBOW WO/W CONT UNILAT             $     4,373.38 73223
1060606 MRI FOREARM WO/W CONT UNILAT           $     3,527.84 73220
1060607 MRI WRIST WO/W CONT UNILAT             $     4,373.38 73223
1060608 MRI HAND/FINGER WO/W CONT UNI          $     4,373.38 73223
1060609 MRI HIP WO/W CONT UNILAT               $     4,373.38 73723
1060613 MRI ANKLE WO/W CONT UNILAT             $     4,373.38 73723
1060614 MRI FOOT/TOE(S) WO/W CONT UNI          $     4,373.38 73723
1060616 MRI CHEST (BRACH PLEX) W & WO          $     4,741.32 71552
1060617 MRI CHEST (ANRSM/DIS) W & WO           $     4,741.32 71552
1060618 MRI PITUITARY WO & W CONTRAST          $     5,884.44 70553
1060634 MRA HEAD W/WO                          $     3,919.23 70546
1060635 MRA ABDOMEN W/CONTRAST                 $     2,530.00 C8900
1060636 MRA ABDOMEN W/O CONTRAST               $     1,941.59 C8901
1060637 MRA CHEST W/CONTRAST                   $     3,118.82 C8909
1060638 MRA CHEST W/O CONTRAST                 $     2,153.86 C8910
1060639 MRA LOWER EXTREMITY W/ CONT.           $     1,941.63 C8912
1060640 MRA LOWER EXTREMITY W/O CONT.          $     2,233.00 C8913
1060641 MRI ORBITS/FACE/NECK W CONT            $     3,952.29 70542
1060642 MRI ORBITS/FACE/NECK WO CONT           $     3,193.29 70540




                                         Page 81
                                         Ancillary


1060643 MRI ORBITS/FACE/NECK WO/W CONT         $     4,760.83 70543
1061550 MRI CHEST W/O CONTRAST                 $     1,939.12 71550
1064181 MRI ABDOMEN CHOLANGIOGRAM/MRCP         $     4,081.30 74183
1066350 SUBTRACTION IN CONJ. W./CONTR          $      759.00 7635059
1066376 #MR 3D RECON, TECH CONSOLE             $     1,150.22 76376
1066377 #MR 3D RECON, SEP WORKSTATION          $     1,150.22 76377
1067876 MRI PELVIS, MALE                       $     2,502.78 72196
1067881 MRI SACRUM                             $     2,502.78 72196
1067883 MRI T-SPINE CSF FLOW STUDY             $     3,225.82 7214659
1067888 MRI UNLISTED, MULT MYELOMA             $     2,269.41 76498
1067889 MRI SPECTROSCOPY                       $     3,000.00 76390
1067891 MRI UNLISTED, BRAIN FUNCTION           $     2,269.41 76498
1067901 MRI BRAIN CSF FLOW STUDY               $     3,880.84 7055159
1067902 MRI L-SPINE CSF FLOW STUDY             $     4,090.72 7214859
1067903 MRI C-SPINE CSF FLOW STUDY             $     3,838.73 7214159
1069000 MRI SACRUM/COCCYX W/ CONTRAST          $     2,502.78 72196
1069001 MRI SACRUM/COCCYX WOW CONTRAST         $     4,381.37 72197
1069952 CONTRAST GADOLINIUM/ML                 $       23.30 Q9952
1090150 XR FACIAL BONES COM, MIN 3VW           $      646.96 70150
1090250 XR SKULL LTD, LESS 4VW                 $      365.01 70250
1090260 XR SKULL COM, MIN 4VW                  $      826.56 70260
1091010 XR CHEST 1VW, FRONT                    $      396.03 71010
1091020 XR CHEST 2VW, FRONT/LAT                $      442.69 71020
1091021 XR CHEST 3VW, FRONT/LAT/LORDIC         $      323.00 71021
1091022 XR CHEST SPECIAL, MIN 4VW              $      580.29 71030
1091100 XR RIBS LTD, 2VW UNILAT                $      482.29 71100
1091110 XR RIBS COM, 3VW BILAT                 $      579.32 71110
1091120 XR STERNUM COM, MIN 2VW                $      512.69 71120
1091130 XR STERNOCLAV JOINT, MIN 3VW           $      365.59 71130
1092010 XR SPINE SURVEY, FRONT/LAT             $      365.59 72010
1092020 XR C-SPINE LTD, 1VW                    $      243.34 72020
1092021 XR T-SPINE LTD, 1VW                    $      243.34 72020
1092022 XR L-SPINE LTD, 1VW                    $      243.34 72020
1092040 XR C-SPINE LTD, 2-3VW                  $      400.95 72040
1092050 XR C-SPINE COM, MIN 4VW                $      557.83 72050
1092052 XR C-SPINE COM+FLEX/EXT, 7VW           $      747.25 72052
1092070 XR T-SPINE LTD, 2VW                    $      524.78 72070
1092080 XR T/L-SPINE LTD, 2VW                  $      461.90 72080
1092090 XR SCOLIOSIS STUDY                     $      573.08 72090
1092100 XR L-SPINE LTD, 2-3VW                  $      458.76 72100
1092110 XR L-SPINE COM, MIN 4VW                $      748.03 72110
1092114 XR L-SPINE COM+BENDING, 5-7VW          $      812.31 72114
1092170 XR PELVIS, 1-2VW                       $      434.49 72170
1092190 XR PELVIS, MIN 3VW                     $      452.16 72190
1092200 XR SACROILIAC JOINTS, LESS 3VW         $      242.88 72200
1092202 XR SACROILIAC JOINTS, MIN 3VW          $      519.98 72202
1092220 XR SACRUM/COCCYX, MIN 2VW              $      616.62 72220
1093000 XR CLAVICLE COM, UNILAT                $      343.25 73000
1093010 XR SCAPULA COM, UNILAT                 $      450.42 73010




                                         Page 82
                                         Ancillary


1093020 XR SHOULDER LTD, 1VW UNILAT            $      423.23 73020
1093030 XR SHOULDER COM, MIN 2VW UNILT         $      510.65 73030
1093050 XR AC JOINT WO/W WEIGHT, BILAT         $      459.47 73050
1093060 XR HUMERUS COM, MIN 2VW UNILAT         $      434.49 73060
1093070 XR ELBOW LTD, 2VW UNILAT               $      382.35 73070
1093080 XR ELBOW COM, MIN 3VW UNILAT           $      372.01 73080
1093090 XR FOREARM COM, 2VW UNILAT             $      400.95 73090
1093092 XR UPP EXT INFANT, 2VW UNILAT          $      365.59 73092
1093100 XR WRIST LTD, 2VW UNILAT               $      305.53 73100
1093110 XR WRIST COM, MIN 3VW UNILAT           $      476.42 73110
1093120 XR HAND LTD, 2VW UNILAT                $      356.30 73120
1093130 XR HAND COM, MIN 3VW UNILAT            $      459.20 73130
1093140 XR FINGER(S) COM, MIN 2VW UNI          $      343.11 73140
1093500 XR HIP LTD, 1VW UNILAT                 $      369.81 73500
1093510 XR HIP COM, 2VW UNILAT+PELVIS          $      439.44 73510
1093520 XR HIP COM, 2VW BILAT+PELVIS           $      732.45 73520
1093540 XR HIPS+PELVIS, MIN 2VW PEDS           $      365.59 73540
1093550 XR FEMUR 2VW, UNILAT                   $      414.51 73550
1093560 XR KNEE LTD, 1-2VW UNILAT              $      365.01 73560
1093565 XR KNEE LTD, AP STANDING BILAT         $      243.34 73565
1093570 XR KNEE COM, MIN 4VW UNILAT            $      521.39 73564
1093590 XR TIB/FIB, 2VW UNILAT                 $      509.76 73590
1093592 XR LOW EXT INFANT, 2VW UNILAT          $      291.25 73592
1093600 XR ANKLE LTD, 2VW UNILAT               $      374.47 73600
1093610 XR ANKLE COM, MIN 2VW UNILAT           $      514.14 73610
1093620 XR FOOT 2VWS UNILAT                    $      378.12 73620
1093630 XR FOOT 3VWS/MORE UNILAT               $      514.14 73630
1093650 XR CALCANEUS 2VWS/MORE UNILAT          $      480.47 73650
1093660 XR TOE(S) 2VWS/MORE UNILAT             $      243.34 73660
1094000 XR ABDOMEN 1VW, FRONT                  $      333.57 74000
1094012 XR ABDOMEN+CHEST 4VWS, ACUTE           $      477.38 74022
1096003 XR FLUORO NEEDLE PLCMT                 $      693.90 77002
1096005 XR FLUORO NEEDLE PLCMT SPINE           $      581.90 77003
1096020 XR BONE SURVEY, AGE                    $      242.88 77072
1096040 XR BONE SURVEY, LENGTH                 $      620.30 77073
1096042 XR BONE SURVEY, ARTHRITIS              $     1,313.16 77075
1096062 XR BONE SURVEY, METASTASIS             $     1,313.16 77075
1096064 XR BONE SURVEY, CHILD                  $      467.52 77076
1099223 XR ORBITS COM, MIN 4VW                 $      524.98 70200
1099224 XR RIBS LTD, 3VW UNILAT+CHEST          $      483.76 71101
1099225 XR RIBS COM, 3VW BILAT+CHEST           $      414.10 71111
1099240 XR DXA BONE DENSITY AXIAL SKEL         $      593.43 77080
1099242 XR CHEST 4VW, FRONT/LAT/OBLIQS         $      393.16 71022
1110100 XR MANDIBLE LTD, LESS 4VW              $      365.59 70100
1110110 XR MANDIBLE COM, MIN 4VW               $      580.29 70110
1110130 XR MASTOIDS COM, MIN 3VW               $      316.25 70130
1110140 XR FACIAL BONES LTD, LESS 3VW          $      365.01 70140
1110150 XR FACIAL BONES COM, MIN 3VW           $      646.96 70150
1110160 XR NASAL BONES COM, MIN 3VW            $      551.94 70160




                                         Page 83
                                         Ancillary


1110210 XR SINUSES LTD, LESS 3VW               $     242.88 70210
1110220 XR SINUSES COM, MIN 3VW                $     538.41 70220
1110250 XR SKULL LTD, LESS 4VW                 $     365.01 70250
1110260 XR SKULL COM, MIN 4VW                  $     826.56 70260
1110332 XR TMJ, BILATERAL                      $     365.59 70330
1111004 CT BONE SURVEY, SCANOGRAM              $     620.30 77073
1111010 XR CHEST 1VW, FRONT                    $     396.03 71010
1111020 XR CHEST 2VW, FRONT/LAT                $     442.69 71020
1111021 XR CHEST 3VW, FRONT/LAT/LORDIC         $     323.00 71021
1111022 XR CHEST SPECIAL, MIN 4VW              $     580.29 71030
1111100 XR RIBS LTD, 2VW UNILAT                $     482.29 71100
1111110 XR RIBS COM, 3VW BILAT                 $     579.32 71110
1111120 XR STERNUM COM, MIN 2VW                $     512.69 71120
1111130 XR STERNOCLAV JOINT, MIN 3VW           $     365.59 71130
1111225 XR RIBS COM, 3VW BILAT+CHEST           $     414.10 71111
1112010 XR SPINE SURVEY, FRONT/LAT             $     365.59 72010
1112020 XR C-SPINE LTD, 1VW                    $     243.34 72020
1112021 XR T-SPINE LTD, 1VW                    $     243.34 72020
1112022 XR L-SPINE LTD, 1VW                    $     243.34 72020
1112030 XR NECK, SOFT TISSUE                   $     395.31 70360
1112040 XR C-SPINE LTD, 2-3VW                  $     400.95 72040
1112050 XR C-SPINE COM, MIN 4VW                $     557.83 72050
1112052 XR C-SPINE COM+FLEX/EXT, 7VW           $     747.25 72052
1112070 XR T-SPINE LTD, 2VW                    $     524.78 72070
1112072 XR T-SPINE COM, 3VW                    $     626.18 72072
1112074 XR T-SPINE COM, MIN 4VW                $     365.59 72074
1112080 XR T/L-SPINE LTD, 2VW                  $     461.90 72080
1112100 XR L-SPINE LTD, 2-3VW                  $     458.76 72100
1112110 XR L-SPINE COM, MIN 4VW                $     748.03 72110
1112114 XR L-SPINE COM+BENDING, 5-7VW          $     812.31 72114
1112170 XR PELVIS, 1-2VW                       $     434.49 72170
1112190 XR HIP COM, 2VW BILAT+PELVIS           $     732.45 73520
1112200 XR SACROILIAC JOINTS, LESS 3VW         $     242.88 72200
1112202 XR SACROILIAC JOINTS, MIN 3VW          $     519.98 72202
1112220 XR SACRUM/COCCYX, MIN 2VW              $     616.62 72220
1113000 XR CLAVICLE COM, UNILAT                $     343.25 73000
1113010 XR SCAPULA COM, UNILAT                 $     450.42 73010
1113020 XR SHOULDER LTD, 1VW UNILAT            $     423.23 73020
1113030 XR SHOULDER COM, MIN 2VW UNILT         $     510.65 73030
1113050 XR AC JOINT WO/W WEIGHT, BILAT         $     459.47 73050
1113060 XR HUMERUS COM, MIN 2VW UNILAT         $     434.49 73060
1113070 XR ELBOW LTD, 2VW UNILAT               $     382.35 73070
1113080 XR ELBOW COM, MIN 3VW UNILAT           $     372.01 73080
1113090 XR FOREARM COM, 2VW UNILAT             $     400.95 73090
1113092 XR UPP EXT INFANT, 2VW UNILAT          $     365.59 73092
1113100 XR WRIST LTD, 2VW UNILAT               $     305.53 73100
1113110 XR WRIST COM, MIN 3VW UNILAT           $     476.42 73110
1113120 XR HAND LTD, 2VW UNILAT                $     356.30 73120
1113130 XR HAND COM, MIN 3VW UNILAT            $     459.20 73130




                                         Page 84
                                         Ancillary


1113140 XR FINGER(S) COM, MIN 2VW UNI          $      343.11 73140
1113500 XR HIP LTD, 1VW UNILAT                 $      369.81 73500
1113510 XR HIP COM, 2VW UNILAT+PELVIS          $      439.44 73510
1113540 XR HIPS+PELVIS, MIN 2VW PEDS           $      365.59 73540
1113550 XR FEMUR 2VW, UNILAT                   $      414.51 73550
1113560 XR KNEE LTD, 1-2VW UNILAT              $      365.01 73560
1113565 XR KNEE LTD, AP STANDING BILAT         $      243.34 73565
1113570 XR KNEE COM, MIN 4VW UNILAT            $      521.39 73564
1113590 XR TIB/FIB, 2VW UNILAT                 $      509.76 73590
1113592 XR LOW EXT INFANT, 2VW UNILAT          $      291.25 73592
1113600 XR ANKLE LTD, 2VW UNILAT               $      374.47 73600
1113610 XR ANKLE COM, MIN 2VW UNILAT           $      514.14 73610
1113620 XR FOOT LTD, 2VW UNILAT                $      378.12 73620
1113630 XR FOOT COM, MIN 3VW UNILAT            $      514.14 73630
1113650 XR CALCANEUS COM, MIN 2VW UNI          $      480.47 73650
1113660 XR TOE(S) COM, MIN 2VW UNILAT          $      243.34 73660
1114000 XR ABDOMEN 1VW, KUB                    $      333.57 74000
1114011 XR ABDOMEN 2-3VW                       $      494.96 74020
1114012 XR ABDOMEN 2-3VW+CHEST, ACUTE          $      477.38 74022
1114220 XR ESOPHAGRAM, BARIUM                  $      780.59 74220
1114230 XR VIDEO SWALLOW STUDY                 $      763.82 74230
1114238 XR UGI WO KUB, LTD                     $      735.07 7424052
1114240 XR UGI WO KUB, COM                     $      735.07 74240
1114241 XR UGI W KUB, BARIUM                   $      827.38 74241
1114245 XR UGI+SMALL BOWEL SERIES              $     1,317.95 74245
1114250 XR SMALL BOWEL, BARIUM                 $     1,093.47 74250
1114270 XR ENEMA, BARIUM WO AIR                $     1,042.16 74270
1114280 XR ENEMA, BARIUM W AIR                 $     1,245.13 74280
1115000 CT ABDOMEN WO CONT                     $     2,870.53 74150
1115001 CT ABDOMEN W CONT                      $     3,421.28 74160
1115002 CT ABDOMEN WO/W CONT                   $     3,876.96 74170
1115030 CT HEAD/BRAIN WO CONT                  $     2,085.92 70450
1115031 CT HEAD/BRAIN W CONT                   $     2,761.35 70460
1115032 CT HEAD/BRAIN WO/W CONT                $     3,222.90 70470
1115040 CT C-SPINE WO CONT                     $     2,983.65 72125
1115041 CT C-SPINE W CONT                      $     2,530.00 72126
1115050 CT CHEST WO CONT                       $     2,791.23 71250
1115051 CT CHEST W CONT                        $     3,412.19 71260
1115052 CT CHEST WO/W CONT                     $     3,978.47 71270
1115053 CT CHEST W CONT, HI-RES                $     3,412.19 71260
1115054 CT CHEST WO CONT, HI-RES               $     3,550.23 71250
1115080 CT FACIAL BONES WO CONT                $     1,966.76 70486
1115081 CT FACIAL BONES W CONT                 $     2,801.75 70487
1115082 CT FACIAL BONES WO/W CONT              $     2,554.04 70488
1115140 CT HIP WO CONT, UNILAT                 $     2,554.90 73700
1115141 CT HIP W CONT, UNILAT                  $     2,621.43 73701
1115142 CT HIP WO/W CONT, UNILAT               $     2,059.24 73702
1115150 CT IAC WO CONT                         $     2,346.72 70480
1115151 CT IAC W CONT                          $     1,906.30 70481




                                         Page 85
                                         Ancillary


1115180 CT L-SPINE WO CONT                     $     2,748.80 72131
1115181 CT L-SPINE W CONT                      $     3,019.56 72132
1115190 CT LARYNX WO CONT                      $     1,674.39 70490
1115191 CT LARYNX W CONT                       $     3,080.72 70491
1115192 CT LARYNX WO/W CONT                    $     2,554.04 70492
1115200 CT LOW EXT WO CONT, UNILAT             $     2,554.90 73700
1115201 CT LOW EXT W CONT, UNILAT              $     2,621.43 7370127
1115202 CT LOW EXT WO/W CONT, UNILAT           $     2,059.24 73702
1115222 CT MAXILLOFACIAL BNS WO/W CONT         $     2,554.04 70488
1115230 CT NECK WO CONT, SOFT TISSUE           $     1,674.39 70490
1115231 CT NECK W CONT, SOFT TISSUE            $     3,080.72 70491
1115232 CT NECK WO/W CONT, SOFT TISSUE         $     2,554.04 70492
1115240 CT ORBITS WO CONT                      $     2,346.72 70480
1115241 CT ORBITS W CONT                       $     1,906.30 70481
1115242 CT ORBITS WO/W CONT                    $     2,997.89 70482
1115270 CT PELVIS WO CONT                      $     2,690.39 72192
1115271 CT PELVIS W CONT                       $     3,447.04 72193
1115272 CT PELVIS WO/W CONT                    $     4,381.37 72194
1115280 CT PETROUS BONES WO CONT               $     2,346.72 70480
1115281 CT PETROUS BONES W CONT                $     1,906.30 70481
1115282 CT PETROUS BONES WO/W CONT             $     2,997.89 70482
1115290 CT SACROILIAC JOINTS WO CONT           $     2,690.39 72192
1115291 CT SACROILIAC JOINTS W CONT            $     3,447.04 72193
1115310 CT SELLA TURCICA WO CONT               $     2,346.72 70480
1115311 CT SELLA TURCICA W CONT                $     1,906.30 70481
1115312 CT SELLA TURCICA WO/W CONT             $     2,997.89 70482
1115320 CT SINUSES WO CONT                     $     1,966.76 70486
1115321 CT SINUSES W CONT                      $     2,801.75 70487
1115322 CT SINUSES WO/W CONT                   $     2,554.04 70488
1115323 CT SINUSES WO CONT, INSTATRAK          $     1,966.76 70486
1115330 CT TEMPORAL BONES WO CONT              $     2,346.72 70480
1115331 CT TEMPORAL BONES W CONT               $     1,906.30 70481
1115332 CT TEMPORAL BONES WO/W CONT            $     2,997.89 70482
1115340 CT T-SPINE WO CONT                     $     2,594.63 72128
1115341 CT T-SPINE W CONT                      $     2,931.03 72129
1115350 CT UPP EXT WO CONT, UNILAT             $     2,381.05 73200
1115351 CT UPP EXT W CONT, UNILAT              $     2,119.73 73201
1115352 CT UPP EXT WO/W CONT, UNILAT           $     2,000.57 73202
1116020 XR BONE SURVEY, AGE                    $      242.88 77072
1116040 XR BONE SURVEY, LENGTH                 $      620.30 77073
1116042 XR BONE SURVEY, ARTHRITIS              $     1,313.16 77075
1116061 XR BONE SURVEY, OSSEOUS LTD            $      621.16 77074
1116062 XR BONE SURVEY, GENETIC                $     1,313.16 77075
1116064 XR BONE SURVEY, CHILD                  $      467.52 77076
1116376 #CT 3D RECON, TECH CONSOLE             $     1,150.22 76376
1116377 #CT 3D RECON, SEP WORKSTATION          $     1,150.22 76377
1117006 XR FLUOROSCOPY, LESS 1HR               $     1,088.03 76000
1117224 XR RIBS LTD, 3VW UNILAT+CHEST          $      483.76 71101
1117950 IMG GD NAVIGATION HEADSET              $      211.20




                                         Page 86
                                         Ancillary


1118007 XR ENEMA, GASTROGRAFIN                 $      1,042.16 74270
1118008 XR ESOPHAGRAM, SOLUBLE                 $       780.59 74220
1118009 XR UGI WO KUB, COM SOLUBLE             $       735.07 74240
1118015 XR SMALL BOWEL, SOLUBLE                $      1,093.47 74250
1119223 XR ORBITS COM, MIN 4VW                 $       524.98 70200
1119242 XR CHEST 4VW, FRONT/LAT/OBLIQS         $       393.16 71022
1119822 +BX TRAY                               $       363.57
1119835 CT TMJ WO CONT                         $      1,966.76 70486
1119843 CT SINUSES, LTD                        $      1,966.76 7048652
1119949 CT/XR IODINE 300-349                   $         2.77 Q9949
1119950 +CT/XR IODINE 350-399MG/ML,1ML         $         1.85 Q9950
1511376 NM PET SCAN SKULL-THIGH                $      6,283.89 78812
1511815 NM PET/CT SKULL-THIGH                  $      9,662.30 78815
1515004 CT CORONARY ANGIO W & W/ CONT.         $      1,471.83 76497
1515231 CT NECK W/CONTRAST                     $      4,004.93 70491
1520229 PET SCAN; BRAIN SEIZURE PRE-OP         $      6,445.18 78811
1520949 +CT/XR IODINE 300-349MG/ML,1ML         $         2.77 Q9949
1520950 +CT/XR IODINE 350-399MG/ML,1ML         $         1.85 Q9950
1521814 NM PET/CT TUMOR LIMITED AREA           $      7,005.57 78814
1521815 NM PET/CT TUMOR SKULL-THIGH            $      7,432.48 78815
1521816 NM PET/CT TUMOR WHOLE BODY             $      6,223.80 78816
1525000 NM CT ABDOMEN WO CONT                  $      2,870.53 7415059
1525003 NM CT ABDOMEN W/ CONT                  $      3,421.28 7416059
1525030 NM CT HEAD/BRAIN W/O CONT              $      2,085.92 7045059
1525050 NM CT CHEST WO CONT                    $      2,791.23 7125059
1525051 NM CT CHEST W/ CONT                    $      3,412.19 7126059
1525230 NM CT NECK W/O CONT                    $      1,674.39 7049059
1525231 NM CT NECK W CONTRAST                  $      3,080.72 7049159
1525270 NM CT PELVIS WO CONT                   $      2,690.39 7219259
1525271 NM CT PELVIS W CONT                    $      3,447.04 7219359
1525272 NM CT PELVIS WO/W CONT                 $      4,427.78 7214959
1529981 NM PET CARD REST/STRESS MULT           $     10,444.61 78492
1300206 PAIN CLINIC NEW PT., LEVEL 1           $       129.05 99201
1300207 PAIN CLINIC NEW PT., LEVEL 2           $       140.68 99202
1300208 PAIN CLINIC NEW PT., LEVEL 3           $       185.80 99203
1300209 PAIN CLINIC NEW PT., LEVEL 4           $       232.80 99204
1300210 PAIN CLINIC NEW PT., LEVEL 5           $       296.74 99205
1300211 PAIN CLINIC EST. PT., LEVEL 1          $       129.05 99211
1300212 PAIN CLINIC EST. PT., LEVEL 2          $       140.68 99212
1300213 PAIN CLINIC EST. PT., LEVEL 3          $       160.78 99213
1300214 PAIN CLINIC EST. PT., LEVEL 4          $       204.38 99214
1300215 PAIN CLINIC EST. PT., LEVEL 5          $       291.00 99215
1300226 EKG                                    $       670.01 93005
1300227 DIAGNOSTIC INTERVIEW EXAM 90           $       296.09 90801
1300229 VENIPUNCTURE                           $        49.21 36415
1300230 PAIN CTR NEW PT., LVL 1 W/PROC         $       125.40 9920125
1300231 PAIN CTR NEW PT., LVL 2 W/PROC         $       125.40 9920225
1300232 PAIN CTR NEW PT., LVL 3 W/PROC         $       136.40 9920325
1300233 PAIN CTR NEW PT., LVL 4 W/PROC         $       193.60 9920425




                                         Page 87
                                         Ancillary


1300234 PAIN CTR NEW PT., LVL 5 W/PROC         $       193.60 9920525
1300235 PAIN CTR EST PT., LVL 1 W/PROC         $       125.40 9921125
1300236 PAIN CTR EST PT., LVL 2 W/PROC         $       125.40 9921225
1300237 PAIN CTR EST PT., LVL 3 W/PROC         $       136.40 9921325
1300238 PAIN CTR EST PT., LVL 4 W/PROC         $       193.60 9921425
1300239 PAIN CTR EST PT., LVL 5 W/PROC         $       193.60 9921525
1300300 LOCM 200MG/ML IODINE,1ML               $        26.75 Q9947
1301000 ACUPUNCTURE W/O STIMUL 15 MIN          $       110.00 97810
1301001 ACUPUNCT W/O STIMUL ADDL 15MIN         $       110.00 97811
1305000 CHRONIC PAIN CNTR PROCEDURES 1         $       660.00
1305001 CHRONIC PAIN CNTR PROCEDURES 2         $      2,244.00
1305002 CHRONIC PAIN CNTR PROCEDURES 3         $      2,640.00
1305003 CHRONIC PAIN CNTR PROCEDURES 4         $      6,336.00
1305004 CHRONIC PAIN CNTR PROCEDURES 5         $      9,900.00
1305005 CHRONIC PAIN CNTR PROCEDURES 6         $     39,600.00
1310419 SOLUTION D5W 500ML                     $       232.89
1310444 SUTURE,KS-30 SILK                      $       267.40
1310449 SOLUTION IV .9 NACL, 500 ML            $       120.32
1310480 500CC LACTATED RINGERS                 $       210.53
1310488 TOUEY-WEISS NEEDLE                     $       342.83
1310499 PAIN PROCEDURE TRAY                    $       171.71
1310502 MEDTRONIC REFILL KIT                   $       541.97
1310504 02 CONNECTION TUBING MASK              $       169.91
1310545 ANES TRAY EPIDURAL PERIFIX             $       231.96
1310548 CATH EPID TUN-L XL 16GA X 3.5          $       398.94
1310553 IV TUBING                              $       171.42
1310554 IV TUBING EXTENSION                    $       126.69
1310569 LOCM 240MG/ML IODINE, 1 ML             $        15.13 Q9947
1305008 ORAL APPLIANCE                         $       714.51
1310600 EPIDURAL CATHETER ARROW 19 GA          $      2,641.57 C1754
1310603 MERIT MEDICAL RESPONSE KIT             $       494.19
1310604 STIMUPLEX INSUL. NEEDLE 100 GA         $       109.63
1310606 LEAD, NEUROSTIMULATOR IMPLANT          $      4,070.20 C1778
1310609 PORT-A CATH                            $        55.79 C1751
1310610 ORTHOVISC 30 MG                        $       657.56 Q4086
1310611 HYLAN G-F 20 16 MG                     $       657.56 Q4084
1310612 STRYKER RF NEEDLE                      $       163.33
1310613 OXYGEN 15 MINUTE INTERVAL              $        68.67
1310614 GADOLINIUM 287 MG/ML, 1 ML             $        19.11 Q9952
1310615 CATHETER, EPIDURAL DU PEN              $      1,784.16 C1751
1330000 ANES TUBE ET                           $       204.45
1330001 IV BLOOD FILTER PALL                   $       137.73
1330002 IV BLOOD PUMP Y-TYPE                   $       269.68
1330410 ANES TRAY EPIDURAL                     $       843.82
1330415 ANES TRAY SPINAL                       $       735.04
1330429 ANES NORMOSOL                          $       543.70
1330436 ICP PRESSURE                           $       425.55
1330439 IV ADMINISTRATION SET                  $       166.74
1330442 IV EXTENSION W/2 INJ SITES             $       123.23




                                         Page 88
                                         Ancillary


1330544 MISCELLANOUS SUPPLY                    $          -
1330620 ANESTHESIA BREATHING TRACT             $      373.34
1330744 IV MICRODRIP SET                       $      639.40
1330992 SOL IV 500CC                           $      547.00
1330993 SOL, IV 1000CC                         $      598.07
1330995 TUBING LEVEL 1 D-100                   $     1,396.21
1331616 TUBING ARTERIAL LINE M/F               $      156.83
1331634 ANES TRAY CVP MONITOR                  $      133.31
1337100 ANES-CAT 1-BASIC - 1ST HOUR            $     3,057.67
1337101 ANES-CAT 1 - EA ADDL MIN               $       39.71
1337102 ANES-CAT 2-BASIC+A LINE-1ST HR         $     4,180.00
1337103 ANES-CAT 2 - EA ADDL MIN               $       51.70
1337104 ANES-CAT 3-+CVP,SWAN-1ST HOUR          $     5,635.25
1337105 ANES-CAT 3 - EA ADDL MIN               $       80.85
1337202 ANES CONT NERVE BLOCK TRAY             $      925.32
1337203 ANES CONT NERVE BLOCK CATHS            $     1,195.70
1337204 ANES STIMUPLEX CATH                    $      153.12
1337206 ANES ET TUBE EXCHANGE CATH             $      229.68
1337210 TUBE ET DOUBLE LUMEN                   $      370.92
1337216 TUBING HOTLINE                         $      235.17
1337225 ANES NACL 0.9% HEPARIN 2U/ML           $       43.56
1337226 ANES INTRODUCER KIT MAC 9.5FR          $      270.60
1337228 ANES PA CATHETER LATEX FREE            $     1,967.90
1337229 ANES CATH PA PEDIATRIC                 $      529.32
1337230 CATH PA HEPARIN FREE                   $      220.00
1337232 ANES ET INTUBATING INTRODUCER          $      571.56
1337233 ANES EMER/EXCH AIRWAY CATH             $      471.90
1338487 ANES TUBE ET REINFORCED                $      146.30
1370221 PCC NEW PT., LEVEL 1                   $      129.05 99201
1370222 PCC NEW PT., LEVEL 2                   $      140.68 99202
1370223 PCC NEW PT., LEVEL 3                   $      185.80 99203
1370224 PCC NEW PT., LEVEL 4                   $      232.80 99204
1370225 PCC NEW PT., LEVEL 5                   $      296.74 99205
1370226 PCC EST. PT., LEVEL 1                  $      129.05 99211
1370227 PCC EST. PT., LEVEL 2                  $      140.68 99212
1370228 PCC EST. PT., LEVEL 3                  $      160.78 99213
1370229 PCC EST. PT., LEVEL 4                  $      204.38 99214
1370230 PCC EST. PT., LEVEL 5                  $      291.00 99215
1370262 THERAPEUTIC IM/SQ INJECTION            $       68.31 90772
1370263 VENIPUNCTURE                           $       49.21 36415
1370264 CHEMO ADMIN, NON HORMONAL              $      261.27 96402
1370265 CHEMO ADMIN, HORMONAL /ANTINEO         $      261.27 96401
1380001 COMPLEX UROFLOW                        $      529.84 51741
1380003 PESSARY FITTING                        $      384.13 57160
1380009 URO/GYN NEW PT., LEVEL 1               $      129.05 99201
1380010 URO/GYN NEW PT., LEVEL 2               $      140.68 99202
1380011 URO/GYN NEW PT., LEVEL 3               $      185.80 99203
1380012 URO/GYN NEW PT., LEVEL 4               $      232.80 99204
1380013 URO / GYN NEW PT., LEVEL 5             $      296.74 99205




                                         Page 89
                                         Ancillary


1380014 URO/GYN EST. PT., LEVEL 1              $      129.05 99211
1380015 URO/GYN EST. PT., LEVEL 2              $      140.68 99212
1380016 URO/GYN EST. PT., LEVEL 3              $      160.78 99213
1380017 URO/GYN EST. PT., LEVEL 4              $      204.38 99214
1380018 URO/GYN EST. PT., LEVEL 5              $      291.00 99215
1380031 COMPLEX CMG (CYSTOMETROGRAM)           $      854.25 51726
1380032 EMG URETHA / ANUS                      $      548.66 51784
1380033 PRESSURE VOID-INTRA-ABDOMINAL          $      588.45 51797
1380034 PRESSURE PROFILE-URETHRA               $     1,193.24 51772
1380035 PRESSURE STUDY-VOIDING                 $      353.23 51795
1380036 IRRIGATION VAGINAL/APPLY OINT.         $      119.23 57150
1380039 CYSTO W OR W/O IRRIG OR PYELO          $     5,104.62 52005
1380040 EMG SURFACE,ANAL/URETL SPHNCTR         $      548.66 51784
1380041 PELVIC ELECT STIM, EA 15 MIN           $      143.75 97032
1380042 BIOPSY, CERVIX                         $      950.04 57500
1380043 BIOPSY, ENDOMETRIAL                    $      384.62 58100
1380044 HEMOSTATIC AGENT, INTRODUCTION         $      198.71 57180
1380045 EXCISE VAGINAL SEPTUM                  $      138.44 57130
1380046 EXC.GENIT LESION < 0.5 CM              $      618.83 11420
1380049 EXCISION VAGINAL CYST                  $      136.19 57135
1380050 I & D BARTHOLINS GLAND ABSCESS         $      725.34 56420
1380051 MARSUPIALIZATION BART GL.CYST          $      236.25 56440
1380052 SKIN TAG REMOVAL-1 TO 15 TAGS          $      290.88 11200
1380054 BIOPSY, VULVA 1ST LESION               $      509.11 56605
1380056 CYSTOSCOPY                             $     2,112.97 52000
1380057 BLADDER, INSTILLATION / LAVAGE         $      335.41 51700
1380058 DILATION URETHA, INITIAL               $      248.04 53660
1380059 DILATION URETHA, SUBSEQUENT            $      255.43 53661
1380060 DILATION, FAILED                       $     4,243.57 5228152
1380061 COLLGEN SKIN TEST                      $      117.88 95028
1380062 COLLAGEN URETHRAL INJECTION            $     4,460.65 51715
1380063 CATHERIZATION, FOLEY                   $      280.31 51702
1380064 CATHERIZATION, STRAIGHT                $      280.31 51701
1380065 CONTIGEN TEST & SYRINGE                $      117.88 95028
1380066 DEBRIDE SURGICAL WOUND                 $      483.95 11000
1380068 IMPLANT PERCUTANEOUS                   $     5,082.69 64561
1380069 IMPLANT REPROGRAMING                   $      558.68 9597258
1380070 INJECTION, TRIGGER POINT               $      550.00 20550
1380071 MARCAINE                               $       90.75
1380072 ULTRASOUND, BLADDER                    $      496.74 76857
1380073 CYSTOMETRY, SIMPLE                     $     1,423.61 51725
1380076 CYSTO W/ DILATION URETHRA STRT         $     4,243.57 52281
1380077 EXCISE URETHRAL LESION                 $      330.44 53260
1380078 PESSARY KIT                            $      242.19
1380079 VAGINAL DILATOR SET                    $      390.29
1380082 LABORIE PUMP TUBING INFUS.LINE         $      107.76
1380086 COLLAGEN IMPLANT                       $      978.18
1380089 DURASPHERE 1ML 890-201                 $      853.04 L8603
1380092 ECC                                    $      549.18 57505




                                         Page 90
                                                 Ancillary


1380093 IUD-INSERTION                                  $      182.08 58300
1380094 IUD-REMOVAL                                    $      549.18 58301
1380095 LEEP                                           $     6,800.20 57522
1380096 TRNSVAGINAL SCAN                               $      433.07 76830
1380097 VAGINAL BIOPSY                                 $     1,055.59 57100
1380098 SALINE INTRO FOR HYSTEROSONOGR                 $      115.26 58340
1380099 AIR CHAR. DUAL SENSOR CATHETER                 $      141.66
1380100 AIR CHAR. ABD. SENSOR CATH                     $       79.40
1380101 PROCEDURE TRAY                                 $      330.07
1380102 THERAPEUTIC INJ SC IM                          $      250.75 90772
1380103 WET MOUNT                                      $       81.59 87177
1380104 PRE PROCEDURE COMBO DRUG                       $      211.60
1380105 ULTRASOUND, PELVIC NON-OB COM.                 $      896.91 76856
1380106 COMPLEX CMG WITH SUPPLIES                      $      854.25 51726
1380107 ULTRASOUND, TRANSVAGINAL                       $      794.58 76830
1380108 SONOHYSTEROGRAM                                $      942.30 76831
1380109 VENIPUNCTURE                                   $       49.21 36415
1380110 GLUCOSE TOLERANCE                              $      650.48 82951
1380111 LAB GLUCOSE (POC)                              $      204.54 82962
1380112 SCREENING PAP CERV/VAG                         $       86.91 Q0091
1380113 IV TUBING                                      $       59.68
1380114 CATHETER, FOLEY 16 FR                          $       73.89
1380115 SUTURE REMOVAL TRAY                            $       28.59
1390100 INDIVIDUAL VISIT-LOW DEC 30MIN                 $      204.38 99214
1390101 GROUP VISIT LOW DECISION 30MIN                 $      150.41 99214
1390102 PHYSICIANS OFFICE-LOW DEC 30MN                 $      204.38 99214
1390103 INDIVIDUAL VISIT-MOD DEC 60MIN                 $      668.49 99205
1390104 GROUP VISIT-MOD DECISION 60MIN                 $      296.74 99205
1390105 PHYSICIANS OFFICE-MOD DEC 60MN                                  99205
1390106 INDIVIDUAL VISIT-HIGH DEC 90MN                 $      808.64 99205
1390107 GROUP VISIT-HIGH DECISION 90MN                 $      296.74 99205
1390108 PHYSICIANS OFFICE-HIGH DE 90MN                 $      296.74 99205
1390109 INITIAL ASSMT NEW PT.-15 MIN                   $      103.62 G0270
1390110 MEDICAL NUT THERAPY RE-ASSESS                  $      113.96 97803
1390111 GROUP MNT -30 MIN                              $      150.41 G0271
1420001 LONG ARM CAST                                  $     1,755.08
1420002 SHORT ARM CAST                                 $      697.55
1420005 SUGARTONG SPLINT                               $     1,091.77
1420006 LONG LEG CAST                                  $     1,442.66
1420007 SHORT LEG CAST                                 $     1,634.88
1420025 UNIVALVE CAST OR SPL                           $      103.52
1420102 KNEE KODEL FULL LENGHT               *         $      423.39
1420135 SPLINT WRIST LEFT MED        *                 $      203.86
1420136 SPLINT WRIST LEFT LRG        *                 $      169.90
1420138 SPLINT WRIST RIGHT MED           *             $      169.88
1420141 SUPPORT LUMBO-SACRAL                           $      465.21
1420158 KNEE IMMOBILIZER         *                     $      480.41
1420200 ORTHO SERVICES NEW PT, LEVEL 1                 $      129.05 99201
1420201 ORTHO SERVICES NEW PT, LEVEL 2                 $      140.68 99202




                                                 Page 91
                                         Ancillary


1450242 PED/NEUR NEW PAT VISIT, LEV 1          $      129.05 99201
1450246 PED/NEUR NEW PAT VISIT, LEV 5          $      296.74 99205
1450250 PED/NEUR EST PAT VISIT, LEV 4          $      204.38 99214
1450251 PED/NEUR EST PAT VISIT, LEV 5          $      291.00 99215
1460201 ENDOURO NEW PT., LEVEL 1               $      129.05 99201
1460202 ENDOURO NEW PT., LEVEL 2               $      140.68 99202
1460203 ENDOURO NEW PT., LEVEL 3               $      185.80 99203
1460204 ENDOURO NEW PT., LEVEL 4               $      232.80 99204
1460205 ENDOURO NEW PT., LEVEL 5               $      296.74 99205
1460211 ENDOURO EST. PT., LEVEL 1              $      129.05 99211
1460212 ENDOURO EST. PT., LEVEL 2              $      140.68 99212
1460213 ENDOURO EST. PT., LEVEL 3              $      160.78 99213
1460214 ENDOURO EST. PT., LEVEL 4              $      204.38 99214
1460215 ENDOURO EST. PT., LEVEL 5              $      291.00 99215
1460251 CYSTOSCOPY (MINOR)                     $     2,112.97 52000
1460252 CYSTO W/ STENT REMOVE (SIMPLE)         $     3,169.45 52310
1460253 CYSTOSCOPY W/ BIOPSY                   $     5,683.23 52204
1460254 BIOPSY - PROSTATE                      $     1,014.78 55700
1460255 U/S, RENAL (LIMITED)                   $      529.72 76775
1460256 UROFLOWMETRY (COMPLEX)                 $      529.84 51741
1460257 U/S, PELVIC, B-SCAN (LIMITED)          $      496.74 76857
1460258 CYSTOSCOPY W/ URETEROSCOPY             $     6,665.80 52351
1460259 BCG / BLADDER INSTILLATION             $      335.41 51700
1460260 CATHETERIZATION, URETHRA               $      280.31 51702
1460261 UROFLOWMETRY (SIMPLE)                  $      529.84 51736
1460262 U/S, RENAL (COMPLETE)                  $      842.52 76770
1460263 U/S PELVIC, B-SCAN COMPLETE            $      496.74 76856
1460270 CYSTOMETROGRAM (COMPLEX)               $     2,157.86 51726
1460271 CYSTOSTOMY TUBE CHANGE                 $      575.67 51705
1460272 POST-VOID RESIDUAL MEASUREMENT         $      174.89 51798
1460273 ULTRASOUND - ABDOMINAL, B-SCAN         $     1,263.84 76700
1460274 CYTOURETHROSCOPY                       $     4,943.90 52005
1460275 U/S SCROTUM                            $      985.41 76870
1460276 BIOPSY - SKIN                          $      502.90 11100
1460277 DILITATION URETHRAL STRICTURE          $      662.89 53600
1500100 CT RAD THERAPY                         $     2,159.03 77014
1500208 RT NEW PT/OP LVL 1                     $      129.05 99201
1500209 RT - NEW PT/OP LVL 2                   $      140.68 99202
1500210 RT NEW PT/OP LVL 3                     $      185.80 99203
1500218 RT ESTAB PT/OP LVL 3                   $      160.78 99213
1500240 RT NEW PT/OP LVL 4                     $      232.80 99204
1500262 RT ESTAB PT/OP LVL 4                   $      204.38 99214
1500271 INJECTION - SC/IM                      $      100.00 90772
1501004 RT ESTAB PT/OP LVL 1                   $      129.05 99211
1502303 RT DAILY TX SIM > 20 MEV               $      612.25 77406
1502304 RT DLY TX INTERM 6-10 MEV              $      733.39 77408
1502305 RT DLY TX INTERM 11-19 MEV             $      733.39 77409
1502306 RT DLY TX INTERM > 20 MEV              $      697.80 77411
1502309 RT DLY TX CMPX > 20 MEV                $     1,008.75 77416




                                         Page 92
                                         Ancillary


1502310 RT SUPERFICIAL                         $      413.80 77401
1502330 RT SURFACE APPLICATOR RAD ELEM         $      218.79 77789
1502331 RT INTRACAVITARY RAD ELEM SIM          $      525.35 77761
1502332 RT INTRACAVITARY RAD ELEM INT          $      897.75 77762
1502333 RT INTRACAVITARY RAD ELEM CPX          $     1,072.86 77763
1502334 RT BRACHY ISOTOPE HANDLING             $     1,651.72 77790
1502335 DAILY TRMT SMPL <5MEV                  $      719.03 77402
1502338 DAILY TRMT INTERM <5MEV                $      697.80 77407
1502340 RT TELE-ISODOSE TX PLAN SIMPLE         $      853.86 77305
1502341 RT TELE-ISODOSE TX PLAN INTERM         $     1,018.15 77310
1502342 RT BRACHY ISODOSE TX PLAN SM           $      866.63 77326
1502346 RT INVIVO DOSIMTRY DIODE/TLD           $      753.11 77331
1502348 RT SIMULATION SIMPLE                   $      866.63 77280
1502351 RT BRACYTX SOURCE, HDR IR-192          $      673.73 C1717
1502352 RT BRACHYTX SOURCE, IODINE 125         $      198.56 C1718
1502356 RT CONTINUING PHYSICS CNSLT            $      627.98 77336
1502359 RT SIMULATION COMPLEX                  $     1,819.93 77290
1502360 RT PORT FILMS                          $      164.14 77417
1502361 RT INTERSTITIAL RAD ELEM SIM           $      597.83 77776
1502362 RT INTERSTITIAL RAD ELEM INT           $     1,044.67 77777
1502363 RT INTERSTITIAL RAD ELEM CMPX          $     2,786.59 77778
1502374 RT BRACHY-ISODOSE TX PLAN CMPX         $     1,967.88 77328
1502375 RT TOTL BDY IRRIDATION TX PLAN         $      851.29 77321
1502376 RT DOSIMETRY BASIC                     $      755.49 77300
1502377 RT TELE-ISODOSE TX PLAN COMPLX         $      655.71 77315
1502378 RT TX DEVICE SIMPLE                    $      550.36 77332
1502379 RT SPECIAL TX PROCEDURE                $     2,885.55 77470
1502385 RT DLY TX SIMPL 6 - 10 MEV             $      488.92 77403
1502386 RT DLY TX SIMPL 11 - 19 MEV            $      733.39 77404
1502387 RT DLY TX CMPLX 6 - 10 MEV             $      862.18 77413
1502388 RT DLY TX CMPLX 11 - 19 MEV            $     1,018.15 77414
1502389 RT BRACHY HDR 5-8 SR                   $     5,548.46 77782
1502390 RT BRACHY HDR 9-12 SR                  $     6,107.04 77783
1502391 RT BRACHY HDR > 12 SR                  $     6,513.81 77784
1502399 RT DAILY TX CMPLX <5 MEV               $     1,012.90 77412
1502400 RT BRACHY HDR 1-4 SR                   $     4,342.54 77781
1502402 RT TELE-ISODOSE TX PLN CPX SRS         $     1,311.81 77315
1502404 RT SPCL RAD PHYS CSULT SRS/SRT         $     1,520.71 77370
1502407 RT SPECIAL PHYSICS CONSULT HDR         $     1,520.71 77370
1502408 RT SPECIAL PHYSICS CONSULT TBI         $     1,520.71 77370
1502410 RT TX DEVICE COMPLEX - MASKS           $     1,461.33 77334
1502411 RT TX DEVICE COMPLEX - BLOCKS          $     1,461.33 77334
1502414 RT SPECIAL PHYSIC CONSULT TSET         $     2,029.34 77370
1502415 RT DAILY TX COMPLEX /TSET              $     1,568.01 77413
1502428 RT IMRT TX PLANNING                    $     4,661.33 77301
1502429 RT IMRT TX DELIVERY                    $     2,690.57 77418
1502459 RT 3-D SIMULATION                      $     5,354.35 77295
1502604 RT SRS DELIVERY SINGLE FRACTIO         $     8,666.52 G0173
1502605 RT SRS DELIVERY MULTI-FRACTION         $     1,733.30 G0251




                                         Page 93
                                         Ancillary


1502606 RT BRACHTYX NEEDLE MUPPIT              $      128.70 C1715
1502607 RT BRACHYTX NEEDLE I-125               $       58.83 C1715
1502608 RT CATH, BRACHYTX SEED ADMIN B         $      173.21 C1728
1502609 RT CATH, BRACHYTX SEED ADMIN I         $       55.15 C1728
1506996 RT U/S PROSTATE (TRANSRECTAL)          $      794.58 76872
1510254 PET IMA. BREAST CA EVAL-TREAT          $     6,283.89 78812
1510774 IV PUSH INITIAL                        $      270.35 90774
1511102 NM-THYROID UPTAKE-SG                   $      260.00 78000
1511103 NM-THYROID SCAN                        $     1,009.37 78010
1511104 NM-THYRD UPTK-S W/SC                   $      650.00 78006
1511109 NM-PARATHYROID IMAG                    $     1,963.83 78070
1511110 NM THYRD CA METS-LIMITED               $     1,115.74 78015
1511111 NM THYRD CA METS-WHOLE BODY            $     2,179.48 78018
1511119 NM-I131 ABLTN THYR CA                  $     1,680.68 79005
1511120 NM RAI THYROID RXH-INT                 $     1,680.68 79005
1511126 NM-RADINUCLDE THRPY, POLYCYTH          $     1,300.00 79101
1511127 NM-INTRCAVTRY RAD COLLOID THR          $     1,027.79 79200
1511128 NM-BONE MRW SC-LMTD                    $     1,332.15 78102
1511129 NM-BONE MRW SC-MULT                    $     1,584.31 78103
1511131 NM-PLASMA/BLD VOL-ML                   $      513.43 78111
1511133 NM-RBC SURVIVAL                        $      875.32 78130
1511135 NM-RBC SURV&SEQUESTN                   $     1,575.65 78135
1511143 NM RED CELL MASS,MULT                  $      518.13 78121
1511146 NM/SCHLNG W/WO INTRSC                  $      845.57 78272
1511147 NM-MECKLES DIV STUDY                   $     1,109.60 78290
1511148 NM-COLON SCINTIGRAPH                   $     1,109.60 78290
1511149 NM-BONE-THREE PHASE STUDY              $     2,596.29 78315
1511150 NM-BONE SCAN-LIMITED                   $      834.02 78300
1511151 NM-BONE-SCAN MULTIPLE AREA             $     2,378.43 78305
1511152 NM-BONE SCAN-WHL BDY                   $     2,633.70 78306
1511153 NM BRAIN SCAN LIMITED                  $      792.02 78600
1511154 NM BRAIN SCAN COMPLETE W/FLOW          $     1,141.85 78606
1511155 NM BRAIN SCAN, COMPLETE                $     2,241.45 78605
1511156 NM-BRAIN SCAN, LIMITED/FLOW            $      900.73 78601
1511158 NM PERITONEAL SHUNT PATENCY            $     1,634.63 78291
1511160 NM-BRAIN FLOW                          $      396.72 78610
1511161 NM-CISTERNOGRAPHY                      $     2,012.52 78630
1511163 NM-CSF SHUNT EVAL                      $     1,288.60 78645
1511166 NM-VASCULAR FLOW                       $      514.02 78445
1511167 NM VENOGRAM UNI                        $      981.20 78457
1511168 NM-SPLEEN SCAN                         $      792.02 78185
1511170 NM-LIVER SC W/FLOW                     $     1,262.16 78202
1511171 NM-LIVER & SPLEEN STATIC               $     1,303.03 78215
1511172 NM-LIVER & SPLEEN & FLOW               $     1,558.15 78216
1511173 NM-HEPATOBIL IMAGING                   $     1,868.99 78223
1511175 NM-SALIVARY GLAND SC                   $      944.50 78231
1511177 NM-LUNG SCAN PERFN                     $     1,890.20 78580
1511178 NM LUNG VENT RB;WORWO 1BR;1PR          $     1,132.22 78593
1511180 NM-GASTRIC EMPTYNG                     $     2,451.59 78264




                                         Page 94
                                         Ancillary


1511181 NM-GI BLEED                            $     1,500.00 78278
1511182 NM KIDNEY SCAN MORPHOLOGY              $     1,585.30 78700
1511183 NM-KIDNEY SCAN W/FLOW                  $     1,728.18 78701
1511185 NM KIDNEY SCAN FLW/FCT WO PHAR         $     2,551.93 78707
1511187 NM-CYSTOGRAM                           $     2,057.38 78740
1511190 NM-TUMOR LOCAL-LMTD                    $     1,137.19 78800
1511191 NM-TUMOR LOCAL MULTIPLE                $     1,794.15 78801
1511192 NM-TUMOR LOCAL WHOLE BODY              $     2,692.35 78802
1511194 NM LUNG VENT;AEROSAL,MULT              $     1,132.22 78587
1511195 NM LOCALZ INFLAMTRY PROCES W/B         $     2,338.26 78806
1511196 NM-LYMPHOSCNTIGRPHY                    $     3,115.52 78195
1511197 NM LOCALZ INFLAMTRY PROCES LMT         $     1,794.90 78805
1511264 NM-BRAIN IMAGING SPECT                 $     2,982.24 78607
1511265 NM-BONE-IMAGING SPECT                  $     2,049.81 78320
1511266 NM-LIVER IMAGING SPECT                 $     1,327.97 78205
1511267 NM KIDNEY SPECT                        $     1,585.30 78710
1511268 NM TESTICULAR SCAN W VAS FLOW          $     1,183.13 78761
1511269 NM-HEART SCAN MI                       $      961.07 78466
1511271 NM MYOCARDIAL PERF,SINGL PLAN          $     1,095.11 78460
1511272 NM MYOCARDIAL PERF,MULT PLAN           $     1,736.12 78461
1511273 NM MYOCARDIAL PERF,SNGL SPECT          $     2,395.28 78464
1511274 NM MYOCARDIAL PERF,MULT SPEC           $     4,264.04 78465
1511275 NM MUGA PLANAR SGL STDY WM & E         $     2,459.05 78472
1511276 NM MUGA MULT STDY,WM&EF,RST&ST         $     1,827.67 78473
1511277 NM 1ST PASS MYOCARD FUNC SNGL          $     1,822.11 78481
1511278 NM 1ST PASS MYOCARD FUNC MULT          $     1,709.31 78483
1511279 NM-TUMOR LOCALIZATION SPECT            $     2,692.35 78803
1511287 NM-RADNUCLIDE TX METASTES BONE         $     1,300.00 79101
1511303 CARDIAC STRESS TEST                    $     1,670.53 93017
1511304 NM MYOCARDIAL PERF W EF                $      751.54 78480
1511305 NM MYOCARDIAL PERF W WALL MOTN         $      652.06 78478
1511316 NM-RENAL FUNCTION-GFR                  $      600.00 78725
1511317 PHARM STRESS DIPYRADAMOLE-INJ          $      411.79
1511318 LOCALZ INFLAMTRY PROCES/S              $     1,869.68 78807
1511330 NM-BONE MARROW IMAGING SPECT           $     1,584.31 78199
1511333 NM-THYROID SCAN W UPTAKE MULTP         $     1,544.19 78007
1511334 NM-THYROID UPTAKE ONLY MULTP           $      390.00 78001
1511346 NM-CARDIAC MI SCAN SPECT               $     1,303.85 78469
1511348 NM ISOTOPE TC MEDRONATE                $      122.18
1511350 NM CISTERNOGRAM SPECT                  $     1,181.67 78647
1511380 NM LUNG SCAN-QUANTITATIVE              $     3,516.14 78596
1511382 NM CARDIAC SHUNT DETECTION             $      514.02 78428
1511401 NM DXA BONE DENSITY AXIAL SKEL         $      771.47 77080
1511426 NM VENOUS ACUTE THROMB, PEPTID         $      971.50 78456
1511430 NM MYOCARDIAL IMG PET METABOLC         $     3,323.08 78491
1511432 NM LIVER IMG SPECT W VASCL FLW         $     2,803.87 78206
1511434 NM MUGA SPECT SGL WM & EF              $     1,836.95 78494
1511436 NM LUNG VENT/PERF W RB&WASH            $     2,185.57 78585
1511438 NM LUNG SCAN AEROSOL/PERF              $     3,297.07 78588




                                         Page 95
                                         Ancillary


1511804 LOCAL.OF TUMOR,W/B 2 OR MORE D         $     1,787.00 78804
1511805 IV INFUSION THERAPY 1ST HOUR           $      615.80 90765
1511806 IV THERAPY SEQ FIRST HOUR              $      134.30 90767
1511807 IV THERAPY-CONCURRENT                  $      338.12 90768
1516376 #CT 3D RECON, TECH CONSOLE             $     1,495.29 76376
1516377 #CT 3D RECON, SEP WORKSTATION          $     1,495.29 76377
1518003 NM THYROID SUPPRESS/STIMUL             $     1,428.27 78003
1518011 NM THYROID IMAGING WITH FLOW           $      938.76 78011
1518016 NM THYROID MET IMAGING/STUDIES         $     1,109.45 78016
1518020 NM THYROID MET UPTAKE                  $      390.00 78020
1518075 NM ADRENAL IMAGING                     $     1,235.68 78075
1518099 NM ENDOCRINE UNLISTED                  $     1,029.29 78099
1518104 NM BONE MARROW IMAG, WHOLEBODY         $     1,029.29 78104
1518120 NM RED CELL MASS, SINGLE               $     1,428.27 78120
1518122 NM BLOOD VOLUME                        $     1,428.27 78122
1518140 NM RED CELL SEQUESTRATION              $     1,428.27 78140
1518190 NM PLATE SRV KNTCS W OR WO DIF         $     1,428.27 78190
1518191 NM PLATELET SURVIVAL STUDY             $     1,669.79 78191
1518201 NM LIVER IMAGING, STATIC               $      870.94 78201
1518220 NM LIVER FUNCTION STUDY                $      870.94 78220
1518230 NM SALIVARY GLAND IMAGING              $      938.76 78230
1518232 NM SALIVARY GLAND FUNCTION             $      938.76 78232
1518258 NM ESOPHAGEAL MOTILITY                 $      870.94 78258
1518261 NM GASTRIC MUCOSA                      $      870.94 78261
1518262 NM GASTROESOPHAGEAL REFLUX             $      938.76 78262
1518270 NM VIT B-12 ABSORPTION/SCHILLI         $     1,428.27 78270
1518271 NM VIT B-12 ABSORPTN W INT FAC         $     1,428.27 78271
1518299 NM GI NUCLEAR UNLISTED PROC            $      870.94 78299
1518399 NM MUSCULOSCKELETAL UNLIST             $      870.94 78399
1518414 NM NON-IMAGING HEART FUNCT             $     1,428.27 78414
1518458 NM VENOGRAM BILAT                      $      938.76 78458
1518468 NM MYO INFARCT W EF 1ST PASS           $     1,029.29 78468
1518496 NM MUGA SGL W RT VENT EF 1ST P         $      648.44 78496
1518584 NM LUNG VENT/PERF, SINGL BR            $     2,343.41 78584
1518586 NM LUNG VENT;AEROSAL,SINGLE            $      870.94 78586
1518587 NM LUNG VENT;AEROSAL,MULT              $      870.94 78587
1518591 NM LUNG VENT GAS SNGL BRTH/PRO         $      870.94 78591
1518594 NM LUNG VENT RB;WORWO 1BR;MUL          $     1,234.65 78594
1518599 NM RESPIRATORY UNLISTED                $      870.94 78599
1518615 NM CEREBRAL VASC FLOW                  $      938.76 78615
1518635 NM CSF VENTRICULOGRAPHY                $     1,671.07 78635
1518650 NM CSF LEAKAGE                         $      854.27 78650
1518699 NM NERVOUS SYSTEM UNLISTED             $      938.76 78699
1518708 NM KIDNEY SCAN FLW/FCT W PHARM         $      938.76 78708
1519999 NUCLEAR MEDICINE THERAPY               $      892.11 79999
1520144 CT HEART+CCS WO CONT                   $     3,036.00 0144T
1520145 CT HEART+CCS WO/W CONT                 $     3,542.00 0145T
1520146 CTA HEART WO/W CONT                    $     4,174.50 0146T
1520147 CTA HEART+CCS WO/W CONT                $     4,427.50 0147T




                                         Page 96
                                         Ancillary


1520148 CT+CTA HEART WO/W CONT                 $     3,036.00 0148T
1520149 CT+CTA HEART+CCS WO/W CON              $     3,542.00 0149T
1520151 CT HEART+EF+WM WO/W CONT               $     4,174.50 0151T
1520152 CT HEART+MORPH WO/W CONT               $     4,427.50 0150T
1520252 PET SCAN; BREAST CA                    $     4,833.76 78812
1520253 PET SCAN; BREAST CA STAG/RESTG         $     4,833.76 78812
1521050 ADENOSINE DIAG INJ 30MG/3ML            $      962.77 J0152
1521102 NM-THYROID UPTAKE-SG                   $      200.00 78000
1521103 NM-THYROID SCAN                        $      776.43 78010
1521104 NM-THYROID UPTAKE-S W/SC               $      500.00 78006
1521109 NM-PARATHYROID IMAG                    $     1,510.64 78070
1521110 NM THYRD CA METS-LIMITED               $      858.27 78015
1521111 NM THYRD CA METS-WHOLE BODY            $     1,676.52 78018
1521120 NM RAI THYROID RXH-INT                 $     1,292.83 79005
1521128 NM-BONE NRW SC-LMTD                    $     1,024.73 78102
1521129 NM-BONE MRW SC-MULT                    $     1,218.70 78103
1521147 NM-MECKLES DIV STUDY                   $      853.57 78290
1521148 NM-COLON SCINTIGRAPH                   $      853.57 78290
1521149 NM-BONE-THREE PHASE STUDY              $     1,997.14 78315
1521150 NM-BONE SCAN-LIMITIED                  $      641.55 78300
1521151 NM-BONE SCAN MULTIPLE AREA             $     1,829.56 78305
1521152 NM-BONE SCAN WHOLE BODY                $     2,025.92 78306
1521154 NM-BRAIN SCAN COMPLETE W/FLOW          $      878.35 78606
1521155 NM-BRAIN SCAN, COMPLETE                $     1,724.20 78605
1521158 NM PERITONEAL SHUNT PATENCY            $     1,257.41 78291
1521161 NM-CISTERNOGRAPHY                      $     1,548.10 78630
1521163 CSF SHUNT EVAL                         $      991.23 78645
1521172 NM-LIVER&SPLEEN&FLOW                   $     1,198.58 78216
1521173 NM-HEPATOBIL IMAGING                   $     1,437.68 78223
1521177 NM-LUNG SCAN PERFN                     $     1,454.00 78580
1521178 NM LUNG VENT RB;WORWO 1BR;1PR          $      747.27 78593
1521180 NM-GASTRIC EMPTYNG                     $     1,885.84 78264
1521181 NM-GI BLEED                            $      990.00 78278
1521182 NM KIDNEY SCAN MORPHOLOGY              $     1,219.46 78700
1521183 NM-KIDNEY SCAN W/FLOW                  $     1,329.37 78701
1521185 NM KIDNEY SCAN FLW/FCT WO PHAR         $     1,963.03 78707
1521187 NM-CYSTOGRAM                           $     1,582.61 78740
1521190 NM-TUMOR LOCAL-LMTD                    $      750.55 78800
1521191 TUMOR LOC                              $     1,380.12 78801
1521192 NMTUMOR LOCAL WHOLE BODY               $     2,071.04 78802
1521195 NM LOCALZ INFLAMTRY PROCES W/B         $     1,798.67 78806
1521196 NM-LYMPHOSCNTIGRAPHY                   $     2,396.55 78195
1521197 NM LOCALZ INFLAMTRY PROCES LMT         $     1,380.69 78805
1521255 ISOTOPE-TC KIT                         $      262.00
1521259 ISOTOPE XENON PER DOSE                 $      722.11 A4641
1521261 NM TC99 EXAMETAZ                       $      804.39 A9521
1521264 NM-BRAIN IMAGING SPECT                 $     2,294.03 78607
1521265 NM-BONE-IMAGING SPECT                  $     1,576.78 78320
1521266 NM-LIVER IMAGING SPECT                 $     1,021.51 78205




                                         Page 97
                                         Ancillary


1521267 NM KIDNEY SPECT                        $     1,219.46 78710
1521268 NM TESTICULAR SCAN W VAS FLOW          $      780.87 78761
1521270 NM TC99 SESTAMIBI                      $      681.73 A9500
1521271 NM MYOCARDIAL PERF,SINGL PLAN          $      414.88 78460
1521272 NM MYOCARDIAL PERF,MULT PLAN           $     1,027.65 78461
1521273 NM MYOCARDIAL PERF,SNGL SPECT          $     1,842.53 78464
1521274 NM MYOCARDIAL PERF,MULT SPEC           $     3,280.03 78465
1521275 NM MUGA PLANAR SGL STDY WM & E         $     1,891.58 78472
1521276 NM MUGA MULT STDY,WM&EF,RST&ST         $     1,405.91 78473
1521277 NM 1ST PASS MYOCARD FUNC SNGL          $     1,401.62 78481
1521278 NM 1ST PASS MYOCARD FUNC MULT          $     1,314.86 78483
1521279 NM-TUMOR LOCALIZATION SPECT            $     2,071.04 78803
1521290 +NM I123 DX CAPSULE/100UCI             $      570.16 A9516
1521295 +NM I131 IOBENGUANBE/0.5MCI            $     5,366.68 A9508
1521296 +NM IN111 SATUMOMAB/DOSE <6MCI         $     2,490.92 A4642
1521303 CARDIAC STRESS TEST                    $     1,285.02 93017
1521304 NM MYOCARDIAL PERF W EF                $      578.11 78480
1521305 NM MYOCARDIAL PERF W WALL MOTN         $      501.60 78478
1521308 PET SCAN; THYROID CA RESTAGING         $     6,445.18 78811
1521310 NM DIPYRIDAMOLE                        $      553.36 J1245
1521316 RENAL FUNCTION                         $      396.00 78725
1521318 LOCALZ INFLAMTRY PROCES/S              $     1,438.21 78807
1521330 NM-BONE MARROW IMAGING SPECT           $     1,218.70 78199
1521333 NM-THYROID SCAN W UPTAKE MULTP         $     1,187.84 78007
1521334 NM-THYROID UPTAKE ONLY MULTP           $      409.89 78001
1521336 NM TL201 THALLOUS                      $      433.69 A9505
1521344 NM IN111 CAPROMAB                      $     9,394.83 A9507
1521346 NM-CARDIAC MI SCAN SPECT               $     1,002.96 78469
1521376 NM PET SCAN SKULL-THIGH                $     4,833.76 78812
1521380 NM LUNG SCAN-QUANTITATIVE              $     2,704.72 78596
1521401 NM DXA BONE DENSITY AXIAL SKEL         $      593.43 77080
1521418 PET SCAN; PULMOMARY NODULE             $     4,833.76 78812
1521422 +NM THYROTROPIN INJ 0.9MG              $     5,910.41 J3240
1521424 ISOTOPE TC-APCITIDE                    $      978.48
1521428 NM BRAIN SCAN PET METABOLIC            $     6,709.56 78608
1521430 NM MYOCARDIAL IMG PET METABOLC         $     2,556.21 78491
1521432 NM LIVER IMG SPECT W VASCL FLW         $     2,156.83 78206
1521434 NM MUGA SPECT SGL WM & EF              $     1,413.04 78494
1521436 NM LUNG VENT/PERF W RB&WASH            $     1,681.21 78585
1521438 NM LUNG SCAN AEROSOL/PERF              $     2,536.21 78588
1521467 +NM TC99 DISOFENIN/DOSE <15MCI         $      543.78 A9510
1521508 +NM I131 TX CAPSULE/MCI                $       10.12 A9517
1521522 +NM TC99 MEDRONATE/DOSE <30MCI         $      217.40 A9503
1521523 NM TC99 APCITIDIDE                     $      889.53 A9504
1521536 *I131 NAI DX/UCI                       $        1.15 A9531
1521540 NM TC99 TETROFOS                       $      292.27 A9502
1521550 PET SCAN; LUNG CA                      $     4,833.76 78812
1521551 PET SCAN; LUNG CA INIT STAG            $     4,833.76 78812
1521552 PET SCAN; LUNG CA RESTAGING            $     4,833.76 78812




                                         Page 98
                                         Ancillary


1521554 PET SCAN; COLORECTAL INIT STAG         $      4,833.76 78812
1521555 PET SCAN; COLORECTAL RESTAGING         $      4,833.76 78812
1521558 PET SCAN; MELANOMA RESTAGING           $      4,833.76 78812
1521560 PET SCAN; LYMPHOMA                     $      4,833.76 78812
1521561 PET SCAN; LYMPHOMA INIT STAG           $      4,833.76 78812
1521562 PET SCAN; LYMPHOMA RESTAGING           $      4,833.76 78812
1521563 PET SCAN; HEAD/NECK CA                 $      6,445.18 78811
1521565 PET SCAN; HEAD/NECK CA RESTAGE         $      6,445.18 78811
1521567 PET SCAN; ESOPHAGEAL CA IN STG         $      4,833.76 78812
1521568 PET SCAN; ESOPHAGEAL CA RESTAG         $      4,833.76 78812
1521569 PET IMG METABOLOC BRAIN PRES           $      4,833.76 78812
1521570 PET SCAN; MYOCARD VIAB ASSESMT         $      6,445.18 78811
1521804 LOCAL.OF TUMOR,W/B 2 OR MORE D         $      1,374.61 78804
1522616 *NM YITRIUM-90                         $     49,500.00 C2616
1526076 NM DXA BONE DENSITY APPEN SKEL         $       265.66 76081
1526376 #CT 3D RECON, TECH CONSOLE             $      1,150.22 76376
1526377 #CT 3D RECON, SEP WORKSTATION          $      1,150.22 76377
1527300 NM RAD DOSE CALCULATION                $       754.40 77300
1527790 NM RAD DOSE HANDLING/LOADING           $      1,219.00 77790
1528016 NM THYROID MET IMAGING/STUDIES         $       853.42 78016
1528020 NM THYROID MET UPTAKE                  $       589.49 78020
1528075 NM ADRENAL IMAGING                     $       950.53 78075
1528099 NM ENDOCRINE UNLISTED                  $       791.76 78099
1528104 NM BONE MARROW IMAG, WHOLEBODY         $       791.76 78104
1528468 NM MYO INFARCT W EF 1ST PASS           $       791.76 78468
1528584 NM LUNG VENT/PERF, SINGL BR            $      1,802.63 78584
1528594 NM LUNG VENT RB;WORWO 1BR;MUL          $       814.87 78594
1528650 CSF LEAKAGE                            $       657.13 78650
1529512 *TC99M PERTECHNETATE/MCI               $       273.91 A9512
1529528 *I131 DX CAPSULE/MCI                   $        70.78 A9528
1529536 +NM TC99 DEPREOTID/DOSE <35MCI         $      2,516.09 A9536
1529537 NM TC99 MEBROFENIN/DOSE <15MCI         $       189.75 A9537
1529538 *TC99 PYROPHOS/DOSE <25MCI             $       586.50 A9538
1529539 NM TC99M MAA                           $       506.00 A9539
1529540 +NM TC99M MAA/DOSE <10MCI              $       166.98 A9540
1529541 +NM TC99M SUL COL/DOSE <20MCI          $       260.87 A9541
1529542 +NM IN111 ZEVALIN DX/DOSE<5MCI         $      8,386.95 A9542
1529543 +NM Y90 ZEVALIN TX/DOSE <40MCI         $     50,321.70 A9543
1529544 +NM I131 BEXXAR DX/DOSE                $      8,386.95 A9544
1529545 +NM I131 BEXXAR TX/DOSE                $     50,321.70 A9545
1529546 RADIOPHARM THERAPY-IV INFUSION         $      2,101.64 79403
1529547 +NM IN111 OXYQUINOLINE/0.5MCI          $      2,540.12 A9547
1529548 +NM IN111 PENTETATE/0.5MCI             $      2,373.14 A9548
1529549 ISOTOPE TC99M/DOSE <45MCI              $      2,851.31 A9568
1529551 +NM TC99M SUCCIMER/DOSE <10MCI         $       561.30 A9551
1529552 +NM F18 FDG/DOSE <45MCI                $      2,318.83 A9552
1529553 +NM CR51 CHROMATE/DOSE <250UCI         $       635.03 A9553
1529555 +NM RB82 RUBIDIUM/DOSE <60MCI          $       885.50 A9555
1529556 +NM GA67 GALLIUM CITRATE/MCI           $        63.25 A9556




                                         Page 99
                                         Ancillary


1529557 +NM TC99M BICISATE/DOSE <25MCI         $      2,191.30 A9557
1529558 +NM XE133 XENON GAS/10MCI              $       600.88 A9558
1529560 +NM TC99M RBC/DOSE <30MCI              $       586.96 A9560
1529561 +NM TC99M OXIDRON/DOSE <30MCI          $       105.00 A9561
1529562 +NM TC99M MERTIAT/DOSE <15MCI          $       603.41 A9562
1529563 +NM P32 NAP TX/MCI                     $      6,451.50 A9563
1529564 +NM P32 CR PHOSPHATE TX/MCI            $      1,370.82 A9564
1529565 +NM IN111 PENTETREOTIDE/MCI            $      1,550.89 A9565
1529566 +NM TC99M FANOLESO/DOSE <25MCI         $      3,036.00 A9566
1529567 +NM TC99M PENTETAT GAS <75MCI          $       172.04 A9567
1529600 +NM SR89 STRONTIUM TX/MCI              $      1,138.50 A9600
1529605 +NM SM153 LEXIDRONAM TX/50MCI          $     11,764.50 A9605
543001 VAS ABI WO EXERCIES, BILAT              $       872.48 93922
543002 VAS ARM, SEGMENTAL                      $      1,320.10 93923
543004 VAS DIGITAL FINGERS, MULT SITE          $      1,320.10 93923
543005 VAS DIGITAL TOES, MULT SITES            $      1,320.10 93923
543007 VAS ABI W EXERCISE, BILAT               $      1,320.10 93923
543008 VAS ARM VEIN, BILAT                     $      2,311.18 93970
543009 VAS LEG VEIN, BILAT DVT                 $      2,311.18 93970
543010 VAS LEG VEIN, UNILAT DVT                $      1,745.04 93971
543011 VAS ARM VEIN, UNILAT                    $      1,745.04 93971
543012 VAS ARM VEIN SUPER/DEEP, BILAT          $      2,311.18 93970
543013 VAS LEG VEIN SUPER/DEEP, BILAT          $      2,311.18 93970
543014 VAS LEG VEIN SUPER/DEEP, UNI            $      1,745.04 93971
543015 VAS ARM VEIN SUPER/DEEP, UNI            $      1,745.04 93971
543018 VAS ARM ARTERY, BILAT                   $      1,887.77 93930
543019 VAS LEG ARTERY, BILAT                   $      1,915.60 93925
543020 VAS FEMORAL ANEURYSM, UNILAT            $      1,684.99 93926
543021 VAS POPLITEAL ANEURYSM, UNILAT          $      1,684.99 93926
543022 VAS ARM ARTERY, UNILAT                  $      1,456.88 93931
543023 VAS LEG ARTERY, UNILAT                  $      1,684.99 93926
543024 VAS ARM GRAFT BILAT                     $      1,887.77 93930
543025 VAS DIALYSYS ACCESS                     $      1,456.88 93931
543026 VAS LEG GRAFT, BILAT                    $      1,915.60 93925
543027 VAS LEG GRAFT, UNILAT                   $      1,684.99 93926
543028 VAS ARM GRAFT, UNILAT                   $      1,456.88 93931
543030 VAS CAROTID VESSLES COM, BILAT          $      2,334.34 93880
543031 VAS CAROTID VESSLES LTD, UNI            $      1,257.67 93882
543032 VAS TRANSCRANIAL, COM                   $      1,258.51 93886
543033 VAS TRANSCRANIAL, LTD                   $       850.77 93888
543034 VAS RENAL TRANSPLANT LTD                $      1,258.51 93976
543036 VAS RENAL/VISCREAL ARTERY COM           $      1,456.73 93975
543037 VAS RENAL/VISCERAL ARTERY LTD           $      1,258.51 93976
543038 VAS AORTA/ILIAC ARTERIES COM            $      1,513.76 93978
543039 VAS AORTA/ILIAC ANEURYSM COM            $      1,513.76 93978
543040 VAS IVC/ILIAC VEINS COM                 $      1,513.76 93978
543042 VAS ABDOMINAL GRAFT LTD                 $      1,312.86 93979
543043 VAS AORTA/ILIAC ANEURYSM                $      1,312.86 93979
543044 VAS IVC/ILIAC VEINS LTD                 $      1,312.86 93979




                                         Page 100
                                         Ancillary


 543048 VAS SMA/CELIAC ARTERY COM              $     1,456.73 93975
 543049 VAS LASER TCPO2, MULT SITES            $     1,320.10 93923
1543001 VAS ABI WO EXERCIES, BILAT             $      671.14 93922
1543002 VAS ARM, SEGMENTAL                     $     1,015.45 93923
1543004 VAS DIGITAL FINGERS, MULT SITE         $     1,015.45 93923
1543005 VAS DIGITAL TOES, MULT SITES           $     1,015.45 93923
1543006 VAS THORACIC OUTLET STUDY              $     1,015.45 93923
1543007 VAS ABI W EXERCISE, BILAT              $     1,015.45 93923
1543008 VAS ARM VEIN, BILAT                    $     1,777.83 93970
1543009 VAS LEG VEIN, BILAT DVT                $     1,777.83 93970
1543010 VAS LEG VEIN, UNILAT DVT               $     1,342.34 93971
1543011 VAS ARM VEIN, UNILAT                   $     1,342.34 93971
1543012 VAS ARM VEIN SUPER/DEEP, BILAT         $     1,777.83 93970
1543013 VAS LEG VEIN SUPER/DEEP, BILAT         $     1,777.83 93970
1543014 VAS LEG VEIN SUPER/DEEP, UNI           $     1,342.34 93971
1543015 VAS ARM VEIN SUPER/DEEP, UNI           $     1,342.34 93971
1543018 VAS ARM ARTERY, BILAT                  $     1,452.13 93930
1543019 VAS LEG ARTERY, BILAT                  $     1,473.54 93925
1543020 VAS FEMORAL ANEURYSM, UNILAT           $     1,296.15 93926
1543021 VAS POPLITEAL ANEURYSM, UNILAT         $     1,296.15 93926
1543022 VAS ARM ARTERY, UNILAT                 $     1,120.68 93931
1543023 VAS LEG ARTERY, UNILAT                 $     1,296.15 93926
1543024 VAS ARM GRART, BILAT                   $     1,452.13 93930
1543025 VAS DIALYSYS ACCESS                    $     1,342.57 93990
1543026 VAS LEG GRAFT, BILAT                   $     1,473.54 93925
1543027 VAS LEG GRAFT, UNILAT                  $     1,296.15 93926
1543028 VAS ARM GRAFT, UNILAT                  $     1,120.68 93931
1543030 VAS CAROTID VESSLES COM, BILAT         $     1,795.64 93880
1543031 VAS CAROTID VESSLES LTD, UNI           $      967.44 93882
1543032 VAS TRANSCRANIAL, COM                  $      968.09 93886
1543033 VAS TRANSCRANIAL, LTD                  $      654.44 93888
1543034 VAS RENAL TRANSPLANT LTD               $      968.09 93976
1543036 VAS RENAL/VISCREAL ARTERY COM          $     1,120.56 93975
1543037 VAS RENAL/VISCERAL ARTERY LTD          $      968.09 93976
1543038 VAS AORTA/ILIAC ARTERIES COM           $     1,164.42 93978
1543039 VAS AORTA/ILIAC ANEURYSM COM           $     1,164.42 93978
1543040 VAS IVC/ILIAC VEINS COM                $     1,164.42 93978
1543042 VAS ABDOMINAL GRAFT LTD                $     1,009.90 93979
1543043 VAS AORTA/ILIAC ANEURYSM LTD           $     1,009.90 93979
1543044 VAS IVC/ILIAC VEINS LTD                $     1,009.90 93979
1543048 VAS SMA/CELIAC ARTERY COM              $     1,120.56 93975
1543049 VAS TCPO2, MULT SIT                    $     1,015.45 93923
1511255 ISOTOPE-TC KIT #                       $      149.58
1511256 ISOTOPE-CR-51 #                        $      598.75
1511257 ISOTOPE-I125 RISA #                    $      445.64
1511258 ISOTOPE - CO 57/58                     $      293.25
1511259 ISOTOPE XENON PER 10 MCI               $       40.98
1511260 ISOTOPE I-131 TX/MCI                   $     3,380.86 A9530
1511270 ISOTOPE MIBI PER DOSE                  $      349.57 A9500




                                         Page 101
                                         Ancillary


1511290 ISOTOPE-L123 CAPSULE PER UCI           $        1.10
1511297 ISOTOPE TC LUNG ARESOL KIT             $      139.13
1511299 ISOTOPE-L131 CAPSULE,ABLATION          $     3,233.87
1511312 ISOTOPE-L131 CAPSULE,THERAPY           $      636.44
1511336 ISOTOPE - THALLIUM PER MCI             $      111.21 A9505
1511342 ISOTOPE MYSOSCINT                      $     2,295.72
1511354 ISOTOPE VERLUMA                        $     2,228.19
1511356 ISOTOPE MYOVIEW                        $      310.60
1511424 NM ISOTOPE TC-APCITIDE                 $      935.94
1511440 ISOTOPE C-14 CAPSULE                   $      100.29
1511460 ISOTOPE-ALBUMIN AGGR.                  $      160.45
1511462 ISOTOPE-TC99M MEBROFENIN               $      240.67
1511464 ISOTOPE-TC99M PYROPHOSPHATE            $      160.45
1560001 BX BREAST;PERC NEEDLE CORE WO          $      802.59 19100
1560002 FINE NEEDLE ASPIRATION W/O IMG         $      498.27 10021
1560003 MAMMOTOME BREAST BIOPSY                $     1,826.20 19103
1560004 U/S GUIDANCE                           $      928.48 76942
1560005 IMG GD PLCMT METAL LOC CLIP            $      359.39 19295
1560006 U/S BREAST UNILATERAL, LTD             $      400.00 76645
1560007 BREAST BX, PERC. NEEDLE WITH I         $     1,904.86 19102
1560008 INCISION & DRAINAGE                    $      257.30 10160
1560009 BREAST CYST ASPIRATION                 $      541.70 19000
1560010 ULT. BREAST CYST ASPIR. EA.            $      375.38 19001
1560011 FINE NEEDLE ASPIRATION WITH IM         $     1,163.00 10022
1560012 EXC,BENIGN DIA 0.6 TO 1.0              $      433.13 11401
1560013 BX SKIN SQ TISSUE SIMPLE CLS           $      502.90 11100
1560014 BS SKIN SQ ADDITIONAL LESIONS          $      139.76 11101
1560201 BCH NEW PT., LEVEL 1                   $      129.05 99201
1560202 BCH NEW PT., LEVEL 2                   $      140.68 99202
1560203 BCH NEW PT., LEVEL 3                   $      185.80 99203
1560204 BCH NEW PT., LEVEL 4                   $      232.80 99204
1560205 BCH NEW PT., LEVEL 5                   $      296.74 99205
1560211 BCH EST. PT., LEVEL 1                  $      129.05 99211
1560212 BCH EST. PT., LEVEL 2                  $      140.68 99212
1560213 BCH EST. PT., LEVEL 3                  $      160.78 99213
1560214 BCH EST. PT., LEVEL 4                  $      204.38 99214
1560215 BCH EST. PT., LEVEL 5                  $      291.00 99215
1560300 EXC, BENIGN DIA 0.5 CM- LESS           $      969.36 11400
1560301 EXC, BENIGN DIA 1.1 TO 2.0 CM          $      969.36 11402
1560302 EXC, BENIGN DIA 2.1 TO 3.0 CM          $     1,612.87 11403
1560303 EXC, BENIGN DIA 3.1 TO 4.0 CM          $     3,577.77 11404
1560304 EXC, BENIGN DIA OVER 4.0 CM            $     3,577.77 11406
1560306 DRAIN LYMPH NODE ABC-SIMPLE            $     2,642.36 38300
1560307 DRAIN LYMPH NODE ABC-EXTENSIVE         $     4,147.81 38305
1560308 LYMPHANGIOTOMY- LYMPHATIC CHAN         $     5,037.02 38308
1560309 EXC.MAL DIA 0.5 CM OR LESS             $      969.36 11600
1560310 EXC.MAL DIA 0.6 TO 1.0 CM              $      969.36 11601
1560311 EXC.MAL DIA 1.1 TO 2.0 CM              $      969.36 11602
1560312 EXC.MAL DIA 2.1 TO 3.0 CM              $     1,612.87 11603




                                         Page 102
                                         Ancillary


1560313 EXC.MAL DIA 3.1 TO 4.0 CM              $      1,612.87 11604
1560314 EXC.MAL DIA OVER 4.0 CM                $      3,577.77 11606
1560316 DUCTAL LAVAGE,EACH ADDITIONAL          $      2,000.00 0047T
1560500 DUCTAL LAVAGE, 1 DUCT                  $      2,735.72 0046T
1560505 U/S BREAST BILATERAL, LTD              $       450.00 76645
1560507 BIOPSY NEEDLE                          $       144.09
1560509 BIOPSY GUN NEEDLE                      $       100.19
1560510 MAMMOTOME KIT                          $       682.44
1560513 CASSI BIOPSY KIT                       $       726.00
1560514 ACUPUNCTURE W/O STIMUL 15 MIN          $       110.00 97810
1560515 MAMMOTOME NEEDLE                       $       532.40
1560523 LARYNGOSCOPY, IND;DIAGNOSTIC           $       221.37 31505
1560524 LARYNGOSCOPY, IND; W BX                $      3,499.61 31510
1560528 ACUPUNCT W/O STIMUL ADDL 15MIN         $       110.00 97811
1560529 ULTRASOUND - THYROID                   $       460.00 76536
1560530 ULTRASOUND - SOFT TISSUE               $       497.15 76999
1570001 IV BLOOD FILTER PALL                   $       137.73
1570002 IV BLOOD PUMP Y-TYPE                   $       269.68
1570003 SOL D5W 100ML                          $       469.73
1570008 SOL NORMOSOL 1000CC                    $       543.70
1570417 SOL D5W 250ML GLASS                    $       543.70
1570419 SOL D5W 50ML                           $       543.70
1570420 SOL D5W 100ML                          $       469.73
1570423 SOL NACL 0.9%                          $       453.08
1570437 IV BLOOD PUMP Y-TYPE                   $       269.68
1570439 IV TUBING ADMIN SET                    $       166.74
1570442 IV TUBING EXTENSION                    $       123.23
1570445 BUTTERFLY, IV INFUSION                 $        75.50
1570448 IV METRISET                            $       234.44
1570463 CATH FOLEY TRAY                        $       289.98
1570464 CATH FOLEY                             $       540.08
1570469 CATHETER, ROBINSON                     $       277.57
1570544 MISCELLANEOUS SUPPLY                   $           -
1570614 ABDOMINAL BINDER                       $       593.26
1570744 IV MICRODRIP SET                       $       639.40
1570825 SECONDARY PIGGY BACK                   $       330.55
1570883 TUBE, TRACHEOSTOMY 1                   $       216.60
1570991 SOL IV 250CC                           $       543.70
1570992 SOL IV 500CC                           $       547.00
1570993 SOL IV 1000CC                          $       543.70
1571140 DRAIN AUTOTRANSFUSION ZIMMER           $       499.40
1574550 PACU - 1ST HOUR                        $      2,249.94
1574551 PACU - EA ADDL MINUTE                  $        35.81
1574552 OXYGEN ADMIN - 1ST HOUR                $       254.10
1574553 OXYGEN ADMIN - EA ADDL MIN             $          3.87
1578056 STOCKING SEQUENTIAL COMPRESS           $       234.30
1578060 DRAIN PLEUR-EVAC ADULT/PEDS            $       190.30
1578382 IV PCA TUBING                          $        59.40
1584102 MAJOR 2 - 1ST HOUR                     $     12,864.85




                                         Page 103
                                       Ancillary


1584103 MAJOR 2 - EA ADDL MINUTE             $       120.50
1584104 MAJOR 3 - 1ST HOUR                   $     10,897.29
1584105 MAJOR 3 - EA ADDL MINUTE             $        91.22
1584106 MINOR 1 - 1ST HOUR                   $      7,783.13
1584107 MINOR 1 - EA ADDL MINUTE             $        67.57
1584108 MINOR 2 - 1ST HOUR                   $      4,139.30
1584109 MINOR 2 - EA ADDL MINUTE             $        53.90
590001 ADAPTER 1                             $      1,014.48
590002 ADAPTER 2                             $      5,213.87
590003 ADHESION BARRIER                      $       666.05 C1765
590004 ANCHOR / SCREW 1                      $       358.05 C1713
590005 ANCHOR / SCREW 10                     $      8,085.00 C1713
590006 ANCHOR / SCREW 11                     $     10,411.69 C1713
590007 ANCHOR / SCREW 12                     $     11,400.74 C1713
590008 ANCHOR / SCREW 13                     $     18,456.90 C1713
590009 ANCHOR / SCREW 2                      $      1,108.80 C1713
590010 ANCHOR / SCREW 3                      $      2,036.65 C1713
590011 ANCHOR / SCREW 4                      $      2,814.35 C1713
590012 ANCHOR / SCREW 5                      $      3,472.70 C1713
590013 ANCHOR / SCREW 6                      $      4,281.20 C1713
590014 ANCHOR / SCREW 7                      $      4,793.25 C1713
590015 ANCHOR / SCREW 8                      $      6,006.00 C1713
590016 ANCHOR / SCREW 9                      $      6,160.00 C1713
590017 BALLOON PRESS                         $      5,120.50
590020 BLOCK CARVING TESTICULAR IMP          $      3,060.75
590027 BUTTON CHIN                           $       770.00
590054 COLPOPEXY SACRAL SYSTEM               $      5,351.50
590055 CORNEAL GRAFT                         $       327.25
590056 COVER BUR HOLE                        $       408.10
590058 CUFF OCCLUSIVE                        $      8,046.50
590059 EXTERNAL FIXATION                     $       519.75
590060 EXTERNAL FIXATION 1                   $       351.64
590061 EXTERNAL FIXATION 2                   $      1,516.90
590064 GENERATOR NEUROSTIMULATOR 2           $     53,110.75 C1767
590067 GRAFT 2                               $      7,099.40
590073 GRAFT INTEXEN DERMAL MATRIX 1         $      1,838.38
590074 GRAFT INTEXEN DERMAL MATRIX 2         $      3,118.50
590075 GRAFT SYNTHETIC TISSUE 1              $      1,232.00 C1763
590076 GRAFT SYNTHETIC TISSUE 2              $      2,340.80 C1763
590077 GRAFT SYNTHETIC TISSUE 3              $      3,003.00 C1763
590078 GRAFT SYNTHETIC TISSUE 4              $      4,762.45 C1763
590079 GRAFT SYNTHETIC TISSUE 5              $      9,513.35 C1763
590091 GRAFT VASCULAR 2                      $      1,228.15 C1768
590102 GRAFTJACKET REG MATRIX 4              $      3,203.20 J7344
590104 GUIDEWIRE 1                           $       234.85 C1769
590106 GUIDEWIRE 3                           $      2,005.85 C1769
590108 HUMAN TISSUE 1                        $       519.75 C1762
590109 HUMAN TISSUE 10                       $      7,513.91 C1762
590110 HUMAN TISSUE 11                       $      7,862.99 C1762




                                       Page 104
                                        Ancillary


590111 HUMAN TISSUE 12                        $      9,713.55 C1762
590112 HUMAN TISSUE 13                        $     10,718.40 C1762
590113 HUMAN TISSUE 14                        $     12,004.30 C1762
590114 HUMAN TISSUE 15                        $     14,175.70 C1762
590115 HUMAN TISSUE 16                        $     14,772.45 C1762
590116 HUMAN TISSUE 17                        $     15,400.00 C1762
590117 HUMAN TISSUE 18                        $     17,428.95 C1762
590118 HUMAN TISSUE 19                        $     18,865.00 C1762
590119 HUMAN TISSUE 2                         $      1,081.21 C1762
590120 HUMAN TISSUE 20                        $     19,423.25 C1762
590121 HUMAN TISSUE 21                        $     21,656.25 C1762
590122 HUMAN TISSUE 22                        $     23,369.50 C1762
590123 HUMAN TISSUE 23                        $     26,950.00 C1762
590124 HUMAN TISSUE 24                        $     29,240.75 C1762
590125 HUMAN TISSUE 25                        $     30,522.80 C1762
590126 HUMAN TISSUE 3                         $      1,959.65 C1762
590127 HUMAN TISSUE 4                         $      2,674.46 C1762
590128 HUMAN TISSUE 5                         $      3,516.98 C1762
590129 HUMAN TISSUE 6                         $      4,040.58 C1762
590130 HUMAN TISSUE 7                         $      4,835.17 C1762
590131 HUMAN TISSUE 8                         $      5,632.55 C1762
590132 HUMAN TISSUE 9                         $      6,737.50 C1762
590133 INJECTION TRANSURETHRAL CONTIG         $        88.55
590134 ISERTER COLPOPEXY SAC SYS              $      1,232.00
590135 JOINT DEVICE 1                         $       382.05 C1776
590136 JOINT DEVICE 10                        $      4,752.70 C1776
590137 JOINT DEVICE 11                        $      5,162.85 C1776
590138 JOINT DEVICE 12                        $      5,388.46 C1776
590139 JOINT DEVICE 13                        $      6,008.45 C1776
590140 JOINT DEVICE 14                        $      6,283.20 C1776
590141 JOINT DEVICE 15                        $      7,018.55 C1776
590142 JOINT DEVICE 16                        $      7,619.15 C1776
590143 JOINT DEVICE 17                        $      7,873.25 C1776
590144 JOINT DEVICE 18                        $      8,671.38 C1776
590145 JOINT DEVICE 19                        $      8,951.25 C1776
590146 JOINT DEVICE 2                         $      1,428.31 C1776
590147 JOINT DEVICE 20                        $      9,401.70 C1776
590148 JOINT DEVICE 21                        $     10,164.00 C1776
590149 JOINT DEVICE 22                        $     11,449.09 C1776
590150 JOINT DEVICE 23                        $     14,572.25 C1776
590151 JOINT DEVICE 3                         $      1,711.53 C1776
590152 JOINT DEVICE 4                         $      2,020.10 C1776
590153 JOINT DEVICE 5                         $      2,477.23 C1776
590154 JOINT DEVICE 6                         $      2,877.78 C1776
590155 JOINT DEVICE 7                         $      3,380.30 C1776
590156 JOINT DEVICE 8                         $      3,629.10 C1776
590157 JOINT DEVICE 9                         $      4,126.85 C1776
590159 KIT STIM INTERSTIM                     $       596.75
590160 KIT TWIST LOK CBL LEAD                 $       211.75




                                        Page 105
                                    Ancillary


590161 KIT URINARY CONTROL SYS            $      1,809.50
590174 LEAD INTERSTIM UROLOGICAL          $     10,472.00
590187 LENS INTRAOCULAR 1                 $       288.75 C1780
590188 LENS INTRAOCULAR 2                 $       482.97 C1780
590189 LENS INTRAOCULAR 3                 $       577.50 C1780
590190 LENS INTRAOCULAR 4                 $       770.00 C1780
590191 MACROPORE                          $      3,784.55
590192 MEDPOR SHEET                       $      1,001.00
590193 MESH 1                             $       335.81 C1781
590194 MESH 10                            $      7,080.15 C1781
590195 MESH 11                            $      7,775.08 C1781
590198 MESH 14                            $     12,454.75 C1781
590203 MESH 2                             $      1,050.81 C1781
590204 MESH 3                             $      1,793.00 C1781
590205 MESH 4                             $      2,626.34 C1781
590206 MESH 5                             $      3,221.16 C1781
590207 MESH 6                             $      4,320.47 C1781
590208 MESH 7                             $      4,897.84 C1781
590209 MESH 8                             $      5,927.71 C1781
590210 MESH 9                             $      6,532.49 C1781
590213 ORBITAL FLOOR SHEET                $      1,001.00
590214 ORBITAL LINER                      $      1,963.50
590215 ORTHO ASSEMBLY 1                   $      7,353.50
590216 ORTHO ASSEMBLY 2                   $     10,437.35
590217 ORTHO ASSEMBLY 3                   $     16,266.25
590218 ORTHO BACK TRIDENT                 $      4,412.10
590219 ORTHO BAR 1                        $       437.94
590220 ORTHO BAR 2                        $      3,218.17
590221 ORTHO BONE                         $       134.75
590222 ORTHO BONE GRAFT SUBST 1           $      1,347.50
590223 ORTHO BONE GRAFT SUBST 2           $      1,876.88
590224 ORTHO BONE GRAFT SUBST 3           $      2,964.50
590225 ORTHO BONE GRAFT SUBST 4           $      4,427.50
590226 ORTHO CABLE 1                      $       377.30
590227 ORTHO CABLE 2                      $      1,161.41
590228 ORTHO CABLE 3                      $     13,467.30
590229 ORTHO CARRIAGE WIRE                $      2,202.20
590230 ORTHO CENTRALIZER                  $      6,695.15
590231 ORTHO CENTRALIZER REVISION         $       219.45
590232 ORTHO CLAMP 1                      $       779.63
590233 ORTHO CLAMP 2                      $      1,805.65
590234 ORTHO CLAMP 3                      $      2,591.05
590235 ORTHO CLAMP 4                      $      5,865.48
590236 ORTHO CLAMP 5                      $      6,333.25
590237 ORTHO CLUSTER                      $      4,412.10
590238 ORTHO COMPONENT 1                  $      1,729.29
590239 ORTHO COMPONENT 2                  $      2,175.25
590240 ORTHO COMPONENT 3                  $      2,945.25
590241 ORTHO COMPONENT 4                  $      6,086.85




                                    Page 106
                                 Ancillary


590242 ORTHO COMPONENT 5               $      6,695.15
590243 ORTHO COMPONENT 6               $      8,000.30
590244 ORTHO COMPONENT 7               $      9,582.65
590245 ORTHO COMPONENT 8               $     15,738.80
590246 ORTHO COMPONENT 9               $     17,463.60
590247 ORTHO CONNECTOR                 $      1,104.95
590248 ORTHO CUP RINGLOC               $      2,956.80
590249 ORTHO DISC                      $       800.80
590250 ORTHO DURA DURATION 1           $      1,540.00
590251 ORTHO DURA DURATION 2           $      2,310.00
590252 ORTHO DURACON 1                 $      1,540.00
590253 ORTHO DURACON 2                 $      6,160.00
590254 ORTHO END CAP                   $       518.98
590255 ORTHO EXTERNAL FIXATION         $      1,158.85
590256 ORTHO FEMORAL 1                 $      5,386.15 C1776
590257 ORTHO FEMORAL 2                 $      5,801.95 C1776
590258 ORTHO FEMORAL 3                 $      6,525.75 C1776
590259 ORTHO FEMORAL 4                 $      7,078.23 C1776
590260 ORTHO FEMORAL 5                 $     10,914.75 C1776
590261 ORTHO FIXATION                  $       269.50
590262 ORTHO FIXATOR 1                 $      4,129.76
590263 ORTHO FIXATOR 2                 $      5,116.65
590264 ORTHO FIXATOR 3                 $      5,554.59
590265 ORTHO FIXATOR 4                 $      8,208.20
590266 ORTHO FIXATOR 5                 $      8,964.73
590267 ORTHO FIXATOR 6                 $     10,358.43
590268 ORTHO FIXATOR 7                 $     11,935.00
590269 ORTHO FIXATOR 8                 $     15,711.85
590270 ORTHO FIXATOR 9                 $     20,659.10
590271 ORTHO GRIP                      $      2,167.55
590272 ORTHO GUIDE TEMPLATE 1          $       291.31
590273 ORTHO GUIDE TEMPLATE 2          $      3,341.80
590274 ORTHO GUIDE TEMPLATE 3          $      4,034.80
590275 ORTHO H PLATE                   $       604.45
590276 ORTHO HOOK                      $      1,597.75
590277 ORTHO HUMAN TISSUE 1            $     11,068.75 C1762
590278 ORTHO HUMAN TISSUE 2            $     14,437.50 C1762
590279 ORTHO HUMAN TISSUE 3            $     18,865.00 C1762
590280 ORTHO HUMAN TISSUE 4            $     32,725.00 C1762
590281 ORTHO INSERT 1                  $      2,560.25 C1776
590282 ORTHO INSERT 2                  $      4,052.32 C1776
590283 ORTHO INSERT 3                  $      4,849.89 C1776
590284 ORTHO JOINT FINGER              $      3,060.75
590285 ORTHO L PLATE 1                 $       154.00
590286 ORTHO L PLATE 2                 $      1,240.34
590287 ORTHO LINER 1                   $      1,925.00
590288 ORTHO LINER 2                   $      3,037.45
590289 ORTHO LINER 3                   $      3,701.74
590290 ORTHO LINER 4                   $      4,235.00




                                 Page 107
                                       Ancillary


590291 ORTHO LINER 5                         $      8,470.00
590292 ORTHO LOCKING PIN                     $       284.90
590293 ORTHO MECHANISM                       $      1,878.37
590294 ORTHO NAIL FIXATION                   $       224.07
590295 ORTHO OMNI FIT                        $      7,469.00
590296 ORTHO PEG 1                           $       269.50
590297 ORTHO PEG 2                           $      1,786.40
590298 ORTHO PIN 1                           $        18.06 C1713
590299 ORTHO PIN 2                           $       263.09 C1713
590300 ORTHO PIN 3                           $       739.20 C1713
590301 ORTHO SEGMENT                         $     11,457.60
590302 ORTHO SHELL                           $      1,212.75
590303 ORTHO TRAUMA ARC                      $      1,486.10
590304 ORTHO TRAUMA ARM 1                    $      3,271.86
590305 ORTHO TRAUMA ARM 2                    $      4,403.76
590306 ORTHO TRAUMA ARM 3                    $     15,915.90
590307 ORTHO TRAUMA BRIDGE                   $       725.73
590308 ORTHO TRAUMA CONNECTOR 1              $      2,202.20
590309 ORTHO TRAUMA CONNECTOR 2              $      3,880.80
590310 ORTHO TRAUMA CONNECTOR 3              $      5,122.43
590311 ORTHO TRAUMA CONNECTOR 4              $      6,333.25
590312 ORTHO TRAUMA COUPLER                  $      1,470.70
590313 ORTHO TRAUMA COVER BONE               $       277.20
590314 ORTHO TRAUMA EXTENSION                $      1,792.18
590315 ORTHO TRAUMA FIXTURE                  $       962.50
590316 ORTHO TRAUMA HAMMER                   $      1,817.20
590317 ORTHO TRAUMA HANDLE 1                 $       554.40
590318 ORTHO TRAUMA HANDLE 2                 $      3,445.75
590319 ORTHO TRAUMA HIP DEVICE               $     11,141.90
590320 ORTHO K WIRE 1                        $       262.57
590321 ORTHO TRAUMA KIT 1                    $       358.05
590322 ORTHO TRAUMA KIT 2                    $      1,905.75
590323 ORTHO TRAUMA KIT 3                    $      3,189.34
590324 ORTHO TRAUMA KIT 4                    $      5,644.10
590325 ORTHO TRAUMA KIT 5                    $      8,662.50
590326 ORTHO TRAUMA KIT 6                    $     12,670.35
590327 ORTHO TRAUMA KNUCKLE CONSTRUX         $      2,695.00
590328 ORTHO TRAUMA RING 1                   $      1,282.05
590329 ORTHO TRAUMA RING 2                   $      1,878.03
590330 ORTHO TRAUMA SPACER                   $       605.42
590331 ORTHO TRAUMA TEMPLATE 1               $       558.25
590332 ORTHO TRAUMA TEMPLATE 2               $      1,499.96
590339 PLATE 1                               $       388.50
590340 PLATE 2                               $      1,225.40
590341 PLATE 3                               $      2,007.78
590342 PLATE 4                               $      2,679.35
590343 PLATE 5                               $      3,293.68
590344 PLATE 6                               $      4,219.53
590345 PLATE 7                               $      4,777.85




                                       Page 108
                                        Ancillary


590346 PLATEAU 1                              $      2,883.65
590347 PLATEAU 2                              $      9,147.60
590348 PLUG                                   $       488.95
590349 PLUG UROLOGY                           $       385.00
590350 PROSTHESIS BREAST IMP 1                $        38.50 C1789
590351 PROSTHESIS BREAST IMP 2                $       250.25 C1789
590352 PROSTHESIS BREAST IMP 3                $      2,016.50 C1789
590353 PROSTHESIS BREAST IMP 4                $      2,624.02 C1789
590354 PROSTHESIS BREAST IMP 5                $      3,288.02 C1789
590355 PROSTHESIS BREAST IMP 6                $      4,204.61 C1789
590356 PROSTHESIS BREAST IMP 7                $      4,985.75 C1789
590357 PROSTHESIS BREAST IMP 8                $      7,700.00 C1789
590358 PROSTHESIS ENT                         $      1,135.75
590359 PROSTHESIS PENILE INFLATAB 1           $       924.00 C1813
590360 PROSTHESIS PENILE INFLATAB 2           $      1,097.25 C1813
590361 PROSTHESIS PENILE INFLATAB 3           $      1,501.50 C1813
590362 PROSTHESIS PENILE INFLATAB 4           $      9,220.75 C1813
590363 PROSTHESIS PENILE INFLATAB 5           $     11,357.50 C1813
590364 PROSTHESIS PENILE INFLATAB 6           $     12,613.37 C1813
590365 PROSTHESIS PENILE INFLATAB 7           $     19,769.75 C1813
590366 PROSTHESIS PENILE INFLATAB 8           $     21,053.29 C1813
590369 PUMP PROSTHESIS                        $      9,328.55
590370 RAIL 1                                 $       712.25
590371 RAIL 2                                 $      2,624.41
590372 RAIL 3                                 $      3,567.23
590373 RAIL 4                                 $      4,890.27
590374 RAIL 5                                 $      7,155.02
590375 RAIL 6                                 $      8,458.45
590376 REP DEV URINARY W/O SLING              $      2,887.50 C2631
590377 REP DEV URINARY W/SLING 1              $       712.25 C1771
590378 REP DEV URINARY W/SLING 2              $      2,643.03 C1771
590379 REP DEV URINARY W/SLING 3              $      3,465.00 C1771
590380 REP DEV URINARY W/SLING 4              $     11,684.75 C1771
590381 RESERVOIR UROLOGY                      $      4,774.00
590382 ROCKWOOD SHOULDER 1                    $       242.55
590383 ROCKWOOD SHOULDER 2                    $      1,093.40
590384 ROD 1                                  $       410.94
590385 CARBON FIBER ROD 2                     $      3,060.75 C1713
590386 ROD 3                                  $      4,600.75
590387 SCREW UROLOGY                          $       943.25
590389 SET CYLINDER AND PUMP INFRAPUB         $     21,309.75
590390 SHAFT COLPOPEXY SAC SYS                $       385.00
590391 SHANZ THREAD                           $       408.10
590394 SHUNT 3                                $      3,153.15
590395 SLEEVE 2                               $      3,353.35
590396 SLEEVE 3                               $      5,505.50
590397 SPHERE EYE PLASTIC 1                   $        61.60
590398 SPHERE EYE PLASTIC 2                   $      2,310.00
590459 KWIRE DUAL TROCAR                      $        34.65




                                        Page 109
                                        Ancillary


590525 WIRE, ORTHO/SPINE                      $       174.00
590526 STEM 1                                 $       219.45
590527 STEM 10                                $     11,079.52
590528 STEM 2                                 $      3,352.12
590529 STEM 3                                 $      4,223.45
590530 STEM 4                                 $      5,386.15
590531 STEM 5                                 $      6,676.62
590532 STEM 6                                 $      7,346.70
590533 STEM 7                                 $      7,830.50
590534 STEM 8                                 $      9,068.68
590535 STEM 9                                 $     10,419.39
590536 STENT COATED/COV W/DEL SYS 1           $      6,982.50 C1874
590540 STENT COATED/COV W/O DEL SYS           $      7,122.50 C1875
590541 SUPPORT RAIL                           $      1,026.03
590542 SYRINGE COLLAGEN INJ                   $      1,258.95
590543 SYSTEM CORRECTION                      $     10,473.29
590544 T PLATE                                $       687.40
590545 TESTICULAR PROSTHESIS 1                $      3,060.75
590546 TESTICULAR PROSTHESIS 2                $      4,427.50
590547 TIBIA BEARING                          $      2,467.85
590548 TIBIA TRAY 1                           $      5,024.25
590549 TIBIA TRAY 2                           $      4,550.70
590550 TIBIA TRAY 3                           $      4,764.51
590551 TIBIA TRAY 4                           $      7,157.15
590552 TIBIA TRAY 5                           $      7,942.55
590553 UNICOM TIBIAL TRAY 1                   $      3,033.80
590554 UNICOM TIBIAL TRAY 2                   $      6,814.50
590555 UNICOM VANGUARD                        $      4,427.50
590556 UROLOGY PORCINE DERMAL MATRIX          $      1,838.38
590558 VALVE 1                                $      1,863.40
590562 VISION PULLER                          $       460.08
590563 Y PLATE                                $       645.51
590564 BUTTON CERCLAG SYNTHES 298.804         $      1,265.00
590565 BUTTON FIXATION CRUCIATE 13186         $       485.10
590566 BONE CEMENT                            $       392.70
590567 GASTRIC BANDING SYSTEM B-22XX          $     12,994.30
590568 SHAFT WRNCH RTCHT BN EBI 03235         $       539.00
590569 SYSTEM COLPOPEXY AMS 72403600          $      5,756.30
590570 TACK RESORBABLE MACRAPORE              $       248.60
590571 TAPE SURGCL CRCTE LGMNT 14868          $       225.50
590572 VALVE NEUROSURGICAL SM 42856           $      8,311.60
590573 SHOULDER MAGNUM PLUS                   $      1,463.00
590574 PLUG ANAL                              $      3,272.50
590575 IMPLANT JONES TUBES                    $        96.80
590576 TUBE, PRESSURE EQUALIZING              $        42.90
590577 TEFLON INJECTION                       $      1,598.30
590578 LEAD, NEUROSTIMULATOR                  $      8,662.50 C1778
590579 OCCLUSION COIL                         $       304.70
590580 BAND BUCKLING                          $        42.35




                                        Page 110
                                        Ancillary


590581 CATHETER, BALLOON                      $       519.75
590582 LAP BAND SYSTEM 2                      $     12,994.30
590583 ORTHO CONNECTOR 2                      $      1,940.40
590584 STENT, URETERAL 1                      $       254.10 C2617
590585 STENT, URETERAL 2                      $       500.50 C2617
590586 STENT, URETERAL 3                      $      1,232.00 C2617
590587 ORTHO HUMAN TISSUE 5                   $      4,050.20 C1762
590588 ORTHO PLATE 8                          $      5,634.20 C1713
590589 IMPLANT TITANIUM BLADE                 $      1,925.00 C1713
590590 HEX TITANIUM BUTTON CERCLAGE 2         $       366.30
590591 CAP FIXATION PROTECTION PIN            $       107.80
590592 ORTHO CLIP                             $       300.30
590593 ORTHO INSERT 4                         $       277.20 C1713
590594 NAIL TITANIUM ORTHO 1                  $       866.80 C1713
590595 NAIL TITANIUM ORTHO 2                  $      3,272.50 C1713
590596 NAIL TITANIUM ORTHO 3                  $      5,060.00 C1713
590597 NAIL TITANIUM ORTHO 4                  $      5,582.50 C1713
590598 WIRE, SPADE POINT REDUCTION            $       877.80 C1713
590599 SCREW / ORTHO NUT                      $       104.50 C1713
590600 ORTHO RING                             $      1,386.00
590602 CARBON FIBER ROD 4                     $       889.90 C1713
590603 CARBON FIBER ROD 5                     $      2,040.50 C1713
590604 SLEEVE TITANIUM 1                      $      1,031.80 C1713
590605 SPACER TITANIUM ORTHO                  $       275.00 C1713
590606 ORTHO T PLATE 1                        $      1,756.70 C1713
590607 IMPLANT WASHER ORTHO                   $       401.50 C1713
590608 IMPLANT TROCHANTER DEVICE 1            $      5,354.80
590609 IMPLANT TROCHANTER DEVICE 2            $      7,715.40
590610 IMPLANT JONES TUBES W/ HOLES           $       927.85
590635 BAR PECTUS                             $       200.20
590636 SUPPORT BAR PECTUS                     $      3,276.35
590637 CLAMP PECTUS                           $      2,190.65
590638 STABALIZER PECTUS                      $      1,282.05
590639 HEAD FRAME                             $       592.90
590676 ORTHO ASSEMBLY 4                       $     11,877.25 C1776
590678 ORTHO BALL 3                           $      2,733.50 C1713
590683 ORTHO BALL 1                           $      1,027.95 C1713
590684 ORTHO BALL 2                           $      1,543.85 C1713
590685 ORTHO CEMENTRALIZER                    $       134.75
590686 ORTHO CUP 1                            $      4,523.75 C1776
590687 ORTHO FACESHIELD                       $       404.25 C1776
590688 ORTHO HEAD 1                           $      2,421.65 C1776
590689 ORTHO HEAD 2                           $      4,916.45 C1776
590690 ORTHO INSERT 5                         $      2,891.35 C1776
590691 PATELLA KNEE                           $      1,736.35 C1776
590692 WEDGE TIBIAL KNEE                      $      4,315.85 C1776
590695 ORTHO CUP 2                            $      3,657.50 C1776
590696 ORTHO GLENOID                          $      3,688.30
590697 ORTHO SURFACE NEXGEN                   $      2,695.00




                                        Page 111
                                        Ancillary


590698 SPINE BOLT 1                           $       716.10 C1713
590699 SPINE BOLT 2                           $      1,559.25 C1713
590700 SPINE BOLT 3                           $      5,682.60 C1713
590701 SPINE BOLT 4                           $      6,887.65 C1713
590739 ROD 5                                  $      2,036.65
590740 COIL EMBOLECTOMY                       $       231.00
590741 ADAPTER 3                              $      1,636.25
590743 LENGTHENING APPARATUS 1                $     13,475.00
590752 ORTHO CLAMP 6                          $      4,235.00
590757 CUFF VASCULAR 1                        $      8,951.25
590758 CUFF VASCULAR 2                        $     12,512.50
590759 ORTHO CUP 3                            $      7,449.75 C1776
590761 EYELID PROSTHESIS                      $       227.15
590762 FELT                                   $       288.75
590763 VENA CAVA FILTER 1                     $      5,547.85 C1880
590765 ANCHOR/SCREW K-WIRE 1                  $       259.60 C1713
590766 K WIRE 4                               $       250.80
590767 COSEAL SEALANT                         $      1,707.20
590768 FLOSEAL                                $      3,465.00
590769 K WIRE 3                               $       317.90
590770 CEMENT RESTRICTOR                      $       481.25
590771 STENT, NON/COATED W/DEL SYS 1          $      3,977.60 C1876
590772 STENT, NON/COATED W/O DEL SYS          $      6,526.30 C1877
590773 ADAPTER/LEAD IMPLANTABLE 1             $       741.40 C1883
590775 GRAFT 8                                $      3,461.15
590776 GRAFT 9                                $      4,693.15
590777 SURGICAL ADHESIVE                      $      2,306.15
590778 CHIN IMPLANT                           $       866.25
590779 GLAUCOMA DRAINAGE DEVICE               $      1,135.75
590780 ORTHO INSERT 6                         $      8,316.00
590781 ORTHO NAIL 5                           $      4,789.40
590782 ORTHO NAIL 6                           $      3,003.00
590784 LENGTHENING APPARATUS 2                $     28,875.00
590785 MAMMOSITE RADIATION THERAPY SY         $     10,587.50
590786 ORTHO MECHANISM 1                      $      3,245.55
590787 MESH 19                                $     27,947.15 C1781
590788 EXTERNAL FIXATION 2                    $      9,548.00
590789 ORTHO NAIL 7                           $      6,444.90
590796 ORTHO BOLT                             $       693.00
590804 SPACER 1                               $      2,683.45
590808 STEM 12                                $      2,683.45
590809 STEM 13                                $     14,245.00
590811 TIBIA TRAY 6                           $     11,642.40
590812 JOINT DEVICE 24                        $     17,325.00 C1776
590813 JOINT DEVICE 25                        $     20,790.00 C1776
590814 JOINT DEVICE 26                        $     23,781.45 C1776
590815 JOINT DEVICE 27                        $     29,837.50 C1776
590816 JOINT DEVICE 28                        $     31,050.25 C1776
590817 STENT COATED/COV W/DEL SYS 5           $     28,811.16 C1874




                                        Page 112
                                        Ancillary


 590818 HUMAN TISSUE 26                       $     33,245.10 C1762
 590819 LEAD, PACEMAKER 3                     $      2,268.00 C1898
 590820 X STOP                                $     16,632.00
 590821 ORTHO NAIL 8                          $      7,560.00 C1713
 590822 CATHETER, BROVIAC 1                   $       530.45 C1751
 590825 JOINT DEVICE 29                       $     27,008.00 C1776
 590826 STENT, NON/COATED W/DEL SYS 2         $      6,263.00 C1876
 590827 GENERATOR NEUROSTIMULATOR RECH        $     67,095.00 C1820
 590828 PORT, INDWELLING 2                    $      3,548.00 C1788
 590829 IMPLANT, AUDITORY                     $      1,104.00
 590830 IMPLANT, OCULAR                       $      2,457.00 L8610
 590831 ORTHO BONE GRAFT SUBSTITUTE 5         $      7,258.00
 590832 ORTHO BONE GRAFT SUBSTITUTE 6         $     10,433.00
 590833 CATHETER, DIAGNOSTIC/ABLATION         $     12,134.00 C1732
 590836 TUBE, PRESSURE EQUALIZING 1           $       108.00
 590837 GENERATOR NEUROSTIMULATOR 6           $     34,530.00 C1767
 591502 IMPLANT                               $           -
 596209 NO COST IMPLANT                       $          1.10
1590000 ANES TUBE ET                          $       204.45
1590001 IV BLOOD FILTER PALL                  $       137.73
1590002 IV BLOOD PUMP Y-TYPE                  $       269.68
1590003 SOL D5W 100ML                         $       469.73
1590312 PACK, CUSTOM PROCEDURE                $      1,618.74
1590325 PREP DURA                             $        93.05
1590407 TUBE, ENDOTRACHEAL ADULT              $       224.90
1590408 TUBE, ENDOTRACHEAL                    $       191.38
1590423 SOL NACL 0.9%                         $       498.39
1590427 SOL D5 LR 1000 ML                     $       370.82
1590429 SOL NORMISOL 1000CC                   $       498.39
1590439 IV TUBING ADMIN SET                   $       183.41
1590442 IV TUBING EXTENSION                   $       135.55
1590445 IV INFUSION BUTTERFLY                 $       111.64
1590448 IV TUBING METRISET                    $       234.44
1590463 CATH FOLEY TRAY                       $       318.98
1590464 CATH FOLEY                            $       594.09
1590469 CATH ROBINSON                         $       277.53
1590480 DRAIN HEMOVAC                         $      2,655.39
1590485 JACKSON-PRATT TUBING                  $       497.59
1590486 JACKSON-PRATT RESERVOIR               $       382.76
1590509 CYSTO SET                             $       497.59
1590510 BLADE, DERMATOME/MICROTOME            $       382.76
1590521 HEMOCLIP                              $        86.13
1590522 LIGACLIP                              $       133.95
1590538 TUR SET                               $       497.59
1590539 VEIN STRIPPER                         $       435.39
1590544 MISCELLANEOUS SUPPLY                  $           -
1590585 CANNULA ANTERIOR CHAMBER              $       243.22
1590590 SOL BSS PLAIN 500ML                   $       571.49
1590610 SOL BSS PLAIN 500CC                   $       822.99




                                        Page 113
                                      Ancillary


1590614 ABDOMINAL BINDER                    $      593.26
1590629 BAG A JET                           $      143.53
1590630 BEAVER BLADE                        $       57.00
1590640 DISPOSABLE BLADES                   $      946.70
1590646 BONE WAX                            $      238.80
1590650 BUTTERFLY CLIPS                     $      162.79
1590656 CATH FOLEY W/THERMISTER             $      217.16
1590678 NEEDLE CYSTOME                      $      153.11
1590698 PACK CUSTOM EYE STERILE             $     1,344.45
1590707 FRAZIER SUCTION TIPS                $      244.02
1590715 GREISHABER MICRO KNIFE              $     1,746.34
1590717 GUIDE WIRE                          $      259.16
1590728 UTERINE MANIPULATOR                 $      703.34
1590741 IRRIG TRAY/60 CC SYRINGE            $      602.82
1590744 IV ADMIN SET MACRO DRIP             $      703.34
1590761 MARLEX MESH                         $     2,470.90
1590793 PENROSE DRAIN                       $      143.53
1590799 PLASTER ARM SPLINT                  $       48.40
1590823 SAW BLADES                          $      660.25
1590825 SECONDARY PIGGY BACK                $      363.61
1590840 IRRIG SORBITAL 3% 3000ML            $      435.39
1590871 TUBING SUCTION                      $      153.11
1590872 SUPERKNIFE                          $      421.03
1590873 SUTURE BOOTS                        $      243.22
1590875 TUBING SUCTION TAB                  $       79.11
1590876 TAB TUBING                          $      191.38
1590883 TUBE, TRACHEOSTOMY 1                $      187.41
1590889 TUR SETS                            $      499.13
1590911 DRESSING WEBRIL                     $      279.13
1590991 SOL, IV 250CC                       $      598.07
1590992 SOL, IV 500CC                       $      598.07
1590993 SOL, IV 1000CC                      $      598.07
1591001 STAPLES SKIN APPOSE                 $      440.19
1591008 SUT CUSTOM PROC PACK                $     3,233.58
1591035 STAPLER TA LONG                     $      976.05
1591047 TROCAR SURGIPORT 5MM                $     1,277.47
1591048 TROCAR SURGIPORT 8MM                $     1,459.27
1591049 TROCAR SURGIPORT 10MM               $     1,279.85
1591050 TROCAR SURGIPORT 11MM               $     1,550.97
1591053 TROCAR SURGIVIEW BLUNT              $     1,473.65
1591057 STAPLER ENDO HERNIA                 $     2,492.72
1591060 DTAPLER ENDO GIA 30                 $     3,153.77
1591065 ENDO SHEARS, LONG/SHORT             $     1,521.47
1591066 ENDO GRASP, LONG/SHORT              $     1,358.45
1591067 ENDO DISSECT, LONG/SHORT            $     1,523.07
1591068 ENDO BABCOCK                        $      786.15
1591081 ENDO GAUGE 60                       $      331.27
1591090 BASKET SEGURA 4.5 FR 2CM            $      390.42
1591091 BLADE ALCON CURVED CRESCENT         $      594.81




                                      Page 114
                                         Ancillary


1591092 BLADE BEAVER 7120 MYRINGOTOMY          $      369.34
1591105 CANNULA HYDRO DISSECT 27GA*8M          $       58.22
1591106 CANNULA MICRO J-SHAPED GA21            $       93.45
1591108 CANNULA SHOULDER 7CM                   $      182.66
1591119 CATH GROSHONG SINGLE LUMEN 8FR         $      348.98 C1751
1591132 CATHETER, MRI PORT IMPLANT             $     2,067.99 C1788
1591134 CATHETER, PORT-A-CATH 6FR IMPL         $     1,126.33 C1788
1591135 CATHETER, PORT-A-CATH 9FR IMPL         $     1,261.50 C1788
1591172 ENDO ANTI FOG 50.00                    $      129.38
1591175 ENDO BAG DEVICE                        $       80.86
1591250 MED FIBRIN SEALANT 2ML                 $      938.32
1591251 MED FIBRIN SEALANT 5ML                 $     2,163.13
1591259 KNIFE OCUTOME 1006 DISPOSABLE          $      866.87
1591261 LOOP VESSEL MAXI 2/PKG                 $       37.75
1591262 FILTER MILEX                           $      126.81
1591288 PACK CUSTOM ARTHROSCOPY                $      340.71
1591289 PACK CUSTOM ENDO GYN                   $      265.23
1591290 PACK CUSTOM EXTREMITY                  $      394.63
1591291 PACK CUSTOM HAND                       $      278.18
1591293 PACK CUSTOM LAP CHOLE                  $      357.62
1591297 PACK CUSTOM MINOR VASCULAR             $      368.39
1591299 PACK CYSTOSCOPY                        $      127.22
1591502 IMPLANTS                               $          -
1591513 ENDO TROCAR WITH SLEEVE                $      344.50
1591514 ENDO TROCAR BLUNT TIP 10/12            $      497.77
1591532 IMPLANT MARLEX PLUG                    $      571.64
1591533 IMPLANT MARLEX PLUG LARGE              $      635.16
1591535 IMPLANT MITEK QUICKANCHOR #2           $      631.63
1591538 TRAY, SIGMOIDSCOPY DISPOSABLE          $      347.18
1591542 INTRODUCER COOK 10FR                   $      288.95
1591543 INTRODUCER COOK 11FR                   $      257.99
1591545 INTRODUCER / SHEATH, GUIDING           $      195.45 C1892
1591549 INTRODUCER COOK 9FR                    $      288.95
1591553 KIT ACUFEX UNIVERSAL CANNULA           $      362.92
1591554 PACK HEAD & NECK                       $      265.23
1591558 PATCH GORETEX SOFT TISSUE 1MM          $     1,272.16
1591565 PIN GUARD .028                         $      210.19
1591566 PIN GUARD 0.035                        $      252.23
1591567 PIN GUARD 0.045                        $      282.50
1591568 PIN GUARD 0.062                        $      282.50
1591577 SPLINT DENVER SERIES 4000 LRG          $      237.19
1591580 CLIP APPLIER LIGACLIP                  $      503.16
1591581 STAPLER EMS ETHICON                    $      821.60
1591602 SUT BAND PARHAM ZIMALITE               $      149.75
1591643 BLADE, ABRADER 5.5MM                   $      361.82
1591644 BLADE, ACROMIONIZER 4.0MM              $      361.82
1591645 BLADE, FULL RADIUS 2.9MM               $      359.28
1591651 BLADE, MICRO SAW BLADE KM-005          $      117.35
1591654 BLADE, MICRO SAW BLADE KM-101          $      143.47




                                         Page 115
                                         Ancillary


1591655 BLADE, MICRO SAW BLADE KM-102          $     140.04
1591678 BLADE, RESECTOSCOPE 24FR               $     532.18
1591679 BLADE, SAGIT KOMET KM602               $     122.40
1591683 BLADE, SAGIT SAW MICRO 5608-55         $     128.10
1591685 BLADE, SAGIT SAW MICRO ZS-039          $     104.20
1591686 BLADE, SAW SAGITTAL                    $     146.87
1591702 CANNULA ARTHREX TIBIAL TUNNEL          $     142.42
1591764 ENDO CANNULA ACUFEX 5MM X 76MM         $     621.36
1591765 ENDO CAP REDUCER MULTISEAL             $      66.51
1591774 ENDO ENDOSHEARS AUTOSUTURE             $     400.88
1591788 ENDO SUT PDS 0 ENDOLOOP                $     157.34
1591791 ENDO SUT SILK 0                        $     113.53
1591793 ENDO TROCAR 5MM 355SD                  $     338.91
1591794 ENDO TROCAR 5MM SLEEVE                 $     205.78
1591795 ENDO TROCAR SLEEVE 11MM                $      95.30
1591799 ENT SPLINT BROWN DENVER S/L            $     179.73
1591801 ENT TAMPON PEDIATRIC MEROCEL           $     131.42
1591821 KNIFE ALCON SATIN 3.2 SLIT             $     145.22
1591829 GUIDEWIRE, J FIXED 150CM               $     122.07
1591830 GUIDEWIRE, STR/FLEX 0.035              $     140.55
1591831 GUIDEWIRE, STR/STIFF 0.035/.03         $     283.42
1591856 PACK CUSTOM MINOR BASIN                $     183.74
1591878 SPLINT IMMOBILIZER SHOULDER LG         $     100.90
1591879 SPONGE DISSECTOR PEANUTS               $      55.99
1591905 MESH, HERN BARD COMPOS MESH 8          $     165.85 C1781
1591910 MESH, HERN BARD COMPOSIX MESH3         $     108.50 C1781
1591917 MESH, HERN BARD COMPOS MESH 1          $      87.31 C1781
1591925 SUT BAND PARHAM ZIMALITE               $     110.00
1591932 SUT CHROMIC 0 CT C/R 8-18              $     100.02
1591943 SUT CHROMIC 1 CT C/R 8-18              $     114.74
1591945 SUT CHROMIC 1 CT-1 8-18                $      94.11
1591948 SUT CHROMIC 1 TIES 18                  $      78.25
1591949 SUT CHROMIC 1 UR-5 27                  $      30.86
1591955 SUT CHROMIC 2-0 OS-4 27                $      34.99
1591958 SUT CHROMIC 2-0 UR-5 27                $      36.94
1591962 SUT CHROMIC 3-0 PS-2 27                $      43.46
1591978 SUT CHROMIC 6-0 G-6 18                 $      91.12
1591981 SUT CHROMIC 7-0 CS175-8 18             $     110.13
1591990 SUT ETHIBOND 0 V-34 30                 $      34.13
1591996 SUT ETHIBOND 2 LR 30 DA                $      37.27
1591997 SUT ETHIBOND 2 V-37 4-30               $     100.60
1592017 SUT ETHIBOND 5 D-6296                  $      58.82
1592020 SUT ETHIBOND 6-0 BV-1 24               $      78.74
1592021 SUT ETHILON 10-0 9000G                 $     101.83
1592027 SUT ETHILON 11-0 CS160-6 8 DA          $     126.27
1592036 SUT ETHILON 3-0 30                     $      50.17
1592040 SUT ETHILON 3-0 PS-2 18                $      50.56
1592041 SUT ETHILON 3-0 PSLX 30                $      40.76
1592045 SUT ETHILON 4-0 PC-1 18                $      48.88




                                         Page 116
                                        Ancillary


1592046 SUT ETHILON 4-0 PC-5 18               $      52.36
1592047 SUT ETHILON 4-0 PS-2 18               $      50.60
1592048 SUT ETHILON 5-0 PC-1 18               $      58.64
1592049 SUT ETHILON 5-0 PC-3 18               $      58.66
1592050 SUT ETHILON 5-0 PC-5 18               $      52.35
1592051 SUT ETHILON 5-0 S-24 18 DA            $      75.12
1592052 SUT ETHILON 6-0 P-3 18                $      50.68
1592053 SUT ETHILON 6-0 PC-1 18               $      59.66
1592054 SUT ETHILON 6-0 PC-3 18               $      59.70
1592055 SUT ETHILON 6-0 PS-3 18               $      50.96
1592056 SUT ETHILON 7-0 P-1 18                $      38.85
1592058 SUT ETHILON 8-0 BV130-4 5             $      98.30
1592060 SUT ETHILON 8-0 CS175-8 12            $     103.98
1592062 SUT ETHILON 9-0 BV-100-4 5            $     146.87
1592063 SUT ETHILON 9-0 BV130-4 5             $     129.79
1592065 SUT ETHIPACK 1 18                     $      57.60
1592066 SUT ETHI-PACK 5 18                    $      55.42
1592067 SUT GUT 4-0 P-3 18                    $      47.10
1592068 SUT GUT 4-0 PS-2 18                   $      46.59
1592070 SUT MERSILENE 10-0 CS160-6 12         $      98.47
1592071 SUT MERSILENE 10-0 TG160-4 12         $     147.60
1592076 SUT MERSILENE 4-0 P-3 18              $      50.56
1592078 SUT MERSILENE 5-0 P-3 36              $      43.38
1592080 SUT MERSILENE 5-0 S-24 18             $     105.01
1592081 SUT MERSILENE 5-0 S-24 18 DA          $     106.02
1592082 SUT MERSILENE 5MM CTX 12 DA           $     147.39
1592085 SUT MERSILENE 5-0 P-3 18              $      52.05
1592086 SUT MONOCRYL 0 CT-1 27                $      30.36
1592091 SUT MONOCRYL 2-0 CT-1 36 UNDY         $      37.35
1592094 SUT MONOCRYL 2-0 UR-6 27 UNDY         $      93.06
1592096 SUT MONOCRYL 3-0 PS-1 27              $      59.40
1592097 SUT MONOCRYL 3-0 PS-2 27 UNDY         $      59.38
1592100 SUT MONOCRYL 4-0 P-3 18 CLEAR         $      59.27
1592101 SUT MONOCRYL 4-0 PS-1 27              $      59.37
1592103 SUT MONOCRYL 4-0 PS-2 27              $      59.38
1592104 SUT MONOCRYL 5-0 P-1 18               $      59.40
1592106 SUT MONOCRYL 6-0 P-1 18               $      59.40
1592110 SUT NUROLON 2-0 M0-6 8-18             $      81.02
1592111 SUT NUROLON 3-0 CT-2 8-18             $     308.66
1592112 SUT NUROLON 3-0 FSL 8-18              $     137.40
1592113 SUT NUROLON 3-0 RB-1 8-18             $      90.33
1592114 SUT NUROLON 3-0 SH 8-18 C/R           $      87.99
1592117 SUT PACING WIRE 2-0 SH 24             $      89.53
1592118 SUT PACING WIRE TEMPORARY             $     116.56
1592119 SUT PACING WIRE TEMPORARY P           $      89.76
1592121 SUT PDS 0 CT-1 27                     $      38.80
1592122 SUT PDS 0 TP-1 60 LOOP                $      57.57
1592124 SUT PDS 1 TP-1 48 LOOP                $      56.22
1592125 SUT PDS 2-0 CT-1 27                   $      35.06




                                        Page 117
                                       Ancillary


1592128 SUT PDS 3-0 PS-2 18 CLEAR            $      59.70
1592130 SUT PDS 4-0 P-3 18 CLEAR             $      60.02
1592131 SUT PDS 4-0 PS-4 18 CLEAR            $      44.50
1592133 SUT PDS 4-0 SH 27                    $      39.18
1592135 SUT PDS 4-0 SH-1 27                  $      34.11
1592136 SUT PDS 5-0 P-3 18                   $      44.68
1592137 SUT PDS 6-0 BV-1 30 DA               $     112.35
1592138 SUT PDS 7-0 BV-1 30 DA               $     127.03
1592140 SUT PDS II 2-0 CT-2 27               $      38.91
1592141 SUT PDS II 3-0 RB-1                  $      39.63
1592142 SUT PDS II 4-0 PS-1 18               $      61.71
1592143 SUT PDS II 4-0 PS-2 18 CLEAR         $      59.63
1592147 SUT PDSII 7-0 BV-1                   $     133.82
1592149 SUT PDSII 1 CT 36                    $      40.03
1592152 SUT PDSII 3-0 SH 27                  $      39.30
1592153 SUT PDSII 4-0 ST-4 14                $      45.64
1592155 SUT PDSII 5-0 P-3 18                 $      59.63
1592156 SUT PDSII 6-0 BV-1 30                $     109.84
1592164 SUT PLAIN 3-0 CP-1                   $      36.67
1592168 SUT PLAIN 3-0 PS-2 27                $      51.85
1592169 SUT PLAIN 4-0 54 REEL                $      36.53
1592171 SUT PLAIN 5-0 G-3 18                 $     105.27
1592172 SUT PLAIN 5-0 P-3 18                 $      53.09
1592173 SUT PLAIN 5-0 PC-1 18                $      55.58
1592174 SUT PLAIN 5-0 S-14 12 DA             $      95.35
1592175 SUT PLAIN 6-0 G-1 18                 $      66.70
1592176 SUT PLAIN 6-0 G-1 18 DA              $     106.49
1592177 SUT PLAIN 6-0 G-6 18                 $     116.33
1592178 SUT PLAIN 6-0 PC-1 18                $      55.58
1592179 SUT PROLENE 0 CT 30                  $      37.29
1592180 SUT PROLENE 0 CT-1 30                $      37.05
1592181 SUT PROLENE 0 CT-2 30                $      37.29
1592183 SUT PROLENE 1 CT 30                  $      37.51
1592184 SUT PROLENE 1 CT-1 30                $      37.52
1592187 SUT PROLENE 10-0 CIF-4 8             $     143.79
1592189 SUT PROLENE 10-0 CS160-6 12          $     116.04
1592190 SUT PROLENE 10-0 SIF-2 8             $      99.50
1592191 SUT PROLENE 10-0 STC-6 8             $      94.37
1592192 SUT PROLENE 2 TP-1 60                $      45.51
1592193 SUT PROLENE 2-0 CT-1 30              $      37.52
1592194 SUT PROLENE 2-0 CT-2 30              $      37.29
1592198 SUT PROLENE 2-0 MO-6 30 DA           $     104.42
1592199 SUT PROLENE 2-0 SH 30                $      37.29
1592200 SUT PROLENE 2-0 SH 36 DA             $      60.62
1592201 SUT PROLENE 2-0 V-7 36 DA            $      58.43
1592203 SUT PROLENE 3-0 FS-2 18              $      43.59
1592204 SUT PROLENE 3-0 FSL 30               $      37.38
1592205 SUT PROLENE 3-0 PS-1 18              $      58.54
1592206 SUT PROLENE 3-0 PS-2 18              $      58.59




                                       Page 118
                                        Ancillary


1592208 SUT PROLENE 3-0 SH 30                 $      38.20
1592209 SUT PROLENE 3-0 SH 36 DA              $      61.15
1592210 SUT PROLENE 3-0 SH-1 30 DA            $      44.94
1592211 SUT PROLENE 4-0                       $      62.71
1592213 SUT PROLENE 4-0 BB 36 DA              $      47.91
1592218 SUT PROLENE 4-0 PC-3 18               $      62.74
1592219 SUT PROLENE 4-0 PS-2 18               $      58.65
1592220 SUT PROLENE 4-0 RB-1 30               $      38.47
1592221 SUT PROLENE 4-0 RB-1 36 DA            $      61.22
1592223 SUT PROLENE 4-0 SH 36 DA              $      50.93
1592224 SUT PROLENE 4-0 SH 48 DA              $     119.94
1592225 SUT PROLENE 4-0 SH-1 30 DA            $      54.21
1592229 SUT PROLENE 5-0 BV-1 24 DA            $      91.69
1592230 SUT PROLENE 5-0 C-1 24 DA             $      78.19
1592232 SUT PROLENE 5-0 C-1 36 DA VB          $      70.88
1592233 SUT PROLENE 5-0 P-3 18                $      59.75
1592234 SUT PROLENE 5-0 PC-1 18               $      63.17
1592235 SUT PROLENE 5-0 PC-3 18               $      63.17
1592236 SUT PROLENE 5-0 PC-5 18               $      56.46
1592237 SUT PROLENE 5-0 PS-2 18               $      59.09
1592238 SUT PROLENE 5-0 PS-3 18               $      59.04
1592241 SUT PROLENE 6-0 BV-1 24 DA VB         $     120.31
1592242 SUT PROLENE 6-0 C-1 24 DA             $      78.20
1592246 SUT PROLENE 6-0 P-1 18                $      59.21
1592247 SUT PROLENE 6-0 P-3 18                $      59.66
1592249 SUT PROLENE 6-0 PC-3 18               $      63.77
1592250 SUT PROLENE 6-0 PS-3 18               $      59.51
1592251 SUT PROLENE 7-0 BV 175-6 24           $     127.37
1592254 SUT PROLENE 7-0 BV-1 30 DA            $      77.22
1592256 SUT PROLENE 7-0 C-1 18                $     113.65
1592257 SUT PROLENE 7-0 P-1 18                $      44.72
1592260 SUT PRONOVA 5-0 C-1 36 DA             $      55.61
1592261 SUT PRONOVA 6-0 C-1 30 DA             $      62.27
1592262 SUT PRONOVA 7-0 BV-1 24 DA            $      79.05
1592268 SUT ILK 0 PSL 30                      $      54.09
1592282 SUT SILK 2-0 PS 18                    $      54.11
1592283 SUT SILK 2-0 PSL 18                   $      58.65
1592286 SUT SILK 2-0 SH 3-30                  $      58.40
1592287 SUT SILK 2-0 SH 8-18 C/R              $      82.98
1592290 SUT SILK 2-0 TIES 12-30               $      37.47
1592296 SUT SILK 3-0 PS-1 18                  $      49.82
1592297 SUT SILK 3-0 PS-2 18                  $      51.55
1592302 SUT SILK 3-0 SH 8-18 C/R              $      99.75
1592303 SUT SILK 3-0 SH 8-30 C/R              $      78.35
1592304 SUT SILK 3-0 SH C/R 5-18              $     125.74
1592305 SUT SILK 3-0 SH C/R 8-18              $      74.18
1592307 SUT SILK 3-0 TIES 12-30               $      38.06
1592309 SUT SILK 4-0 C-3 12 DA                $      50.86
1592312 SUT SILK 4-0 G-3 18                   $      60.24




                                        Page 119
                                         Ancillary


1592313 SUT SILK 4-0 G-3 18 DA                 $      93.64
1592318 SUT SILK 4-0 SH C/R 8-30               $      76.79
1592321 SUT SILK 4-0 TIES 12-30                $      38.38
1592328 SUT SILK 5-0 TF-4 18                   $      38.12
1592330 SUT SILK 6-0 18                        $      42.90
1592331 SUT SILK 6-0 C-1 18                    $      35.42
1592332 SUT SILK 6-0 G-1 18 DA                 $      93.56
1592333 SUT SILK 6-0 G-6 18 DA                 $     100.11
1592334 SUT SILK 6-0 G-7 18 DA                 $     100.43
1592335 SUT SILK 6-0 TG140-8 18                $      89.80
1592336 SUT SILK 8-0 TG100-8 18                $     103.68
1592337 SUT SILK 8-0 TG140-8 12                $      89.75
1592339 SUT STEEL 2-0 17-18                    $      75.86
1592340 SUT STEEL XXGA                         $      78.43
1592343 SUT STEEL 6 CCS 4-18                   $     108.70
1592345 SUT STERNA-BAND                        $     185.26
1592346 SUT SURGICAL STEEL 24                  $      58.61
1592347 SUT SURGICAL STEEL 4-0                 $      77.14
1592348 SUT SURGIDAC 3-0 CV-24 10-30           $     290.20
1592352 SUT TICRON 2-0 CV-316 MP W/O           $     111.51
1592353 SUT TICRON 3-0 CV-331 DA               $      47.04
1592354 SUT TICRON 4-0 CV-331 36 DA            $      68.04
1592355 SUT TICRON 5-0 CV-330                  $      57.40
1592356 SUT TICRON 5-0 T-37                    $      75.48
1592358 SUT UMBILICAL TAPE                     $     109.02
1592367 SUT VICRYL 0 CT 8-18 C/R               $      85.34
1592371 SUT VICRYL 0 CT-1 8-18 C/R             $     110.31
1592375 SUT VICRYL 0 CT-2 8-18 C/R             $     126.97
1592379 SUT VICRYL 0 CTX C/R 8-18 UND          $     112.98
1592380 SUT VICRYL 0 OS-6 27 UNDYED            $      44.53
1592381 SUT VICRYL 0 OS-6 3-18                 $      66.18
1592385 SUT VICRYL 0 TIES 12-18 UNDYE          $      54.91
1592386 SUT VICRYL 0 TIES 6-18 UNDYED          $      66.19
1592388 SUT VICRYL 0 UR-6 27                   $      38.03
1592389 SUT VICRYL 0 XLH 27                    $      44.88
1592400 SUT VICRYL 1 OS-4 27 UNDYED            $      45.63
1592401 SUT VICRYL 1 OS-6 27 UNDYED            $      44.85
1592404 SUT VICRYL 1 TIES 6-18 UNDYED          $      55.53
1592405 SUT VICRYL 10-0 CS140-6 4              $     123.16
1592406 SUT VICRYL 10-0 CS160-8 12             $     138.45
1592407 SUT VICRYL 2 TP-1 2-27 UNDYED          $      63.13
1592408 SUT VICRYL 2 TP-1 4-27                 $      59.17
1592409 SUT VICRYL 2-0 12-18 UNDYED            $      70.88
1592414 SUT VICRYL 2-0 CP-2 8-18               $     120.36
1592420 SUT VICRYL 2-0 CT-1 8-18 C/R           $      93.58
1592421 SUT VICRYL 2-0 CT-1 C/R 8-18           $      93.56
1592422 SUT VICRYL 2-0 CT-1 C/R UNDYED         $     120.43
1592425 SUT VICRYL 2-0 CT-2 8-18 C/R           $     122.94
1592427 SUT VICRYL 2-0 OS-6 27 UNDYED          $      44.86




                                         Page 120
                                        Ancillary


1592429 SUT VICRYL 2-0 PS-2 27                $      52.72
1592430 SUT VICRYL 2-0 PSL 27                 $      49.13
1592432 SUT VICRYL 2-0 REEL 54                $      37.52
1592436 SUT VICRYL 2-0 SH C/R 8-18            $     122.77
1592439 SUT VICRYL 2-0 TIES 3-18 UNDY         $      36.56
1592441 SUTURE VICRYL 2-0 UR-6 27             $      29.06
1592444 SUT VICRYL 3-0 CP-2 8-18 UNDY         $      60.82
1592445 SUT VICRYL 3-0 CP-2 C/R 8-18          $      89.54
1592450 SUT VICRYL 3-0 CT-1 C/R 8-18          $      94.08
1592451 SUT VICRYL 3-0 FS C/R 8-18            $     113.30
1592454 SUT VICRYL 3-0 PS-1 27 UNDYED         $      54.07
1592455 SUT VICRYL 3-0 PS-2                   $      54.08
1592456 SUT VICRYL 3-0 PS-2 27 UNDYED         $      53.97
1592459 SUT VICRYL 3-0 RB-1 8-18              $      95.50
1592460 SUT VICRYL 3-0RB-1 C/R 8-18           $      95.21
1592461 SUT VICRYL 3-0 REEL 54                $      37.30
1592469 SUT VICRYL 3-0 SH-1 8-18 C/R          $     126.91
1592475 SUT VICRYL 4-0 P-3 18                 $      54.13
1592476 SUT VICRYL 4-0 P-3 18 UNDYED          $      54.21
1592477 SUT VICRYL 4-0 PC-1 18                $      58.85
1592478 SUT VICRYL 4-0 PC-3 18 UNDYED         $      58.43
1592479 SUT VICRYL 4-0 PC-5 18                $      43.76
1592480 SUT VICRYL 4-0 PS-1 18                $      54.35
1592481 SUT VICRYL 4-0 PS-1 18 UNDYED         $      45.10
1592482 SUT VICRYL 4-0 PS-1 27 UNDYED         $      54.37
1592483 SUT VICRYL 4-0 PS-2 18 UNDYED         $      54.77
1592484 SUT VICRYL 4-0 PS-2 27                $      45.18
1592487 SUT VICRYL 4-0 RB-1 8-18              $     114.72
1592489 SUT VICRYL 4-0 REEL 54 UNDYED         $      37.11
1592493 SUT VICRYL 4-0 SH C/R 8-18            $      94.08
1592497 SUT VICRYL 4-0 TF 27 UNDYED           $      38.34
1592498 SUT VICRYL 4-0 TF 8-18 C/R            $     108.91
1592501 SUT VICRYL 5-0 P-3 18                 $      54.77
1592502 SUT VICRYL 5-0 P-3 18 UNDYED          $      54.60
1592503 SUT VICRYL 5-0 PC-3 18 UNDYED         $      58.83
1592504 SUT VICRYL 5-0 PC-5 18                $      43.79
1592505 SUT VICRYL 5-0 PS-2 18                $      54.40
1592506 SUT VICRYL 5-0 PS-2 18 UNDYED         $      54.35
1592507 SUT VICRYL 5-0 S-14 18                $     118.33
1592508 SUT VICRYL 5-0 S-14 8                 $     116.42
1592509 SUT VICRYL 5-0 S-24 8                 $     116.08
1592511 SUT VICRYL 5-0 TF 27 UNDYED           $      39.29
1592512 SUT VICRYL 6-0 G-6 18                 $      96.17
1592513 SUT VICRYL 6-0 P-3 18                 $      55.04
1592515 SUT VICRYL 6-0 PC-3 18                $      50.90
1592516 SUT VICRYL 6-0 S-14 18                $     120.37
1592517 SUT VICRYL 6-0 S-14 18 UNDYED         $     117.46
1592518 SUT VICRYL 6-0 S-28 18 DA             $      86.52
1592519 SUT VICRYL 6-0 S-29 18                $     119.28




                                        Page 121
                                         Ancillary


1592520 SUT VICRYL 7-0 TG140-8 18              $      121.14
1592521 SUT VICRYL 7-0 TG160-8 12              $      120.16
1592522 SUT VICRYL 8-0 BV130-4 5               $      119.83
1592523 SUT VICRYL 8-0 TG140-8 8               $      129.02
1592524 SUT VICRYL 8-0 TG160-6 12              $      155.39
1592526 SUT VICRYL 9-0 TG140-8 12              $      122.94
1592527 SUT VICRYL KNITTED MESH 12X12          $     1,700.45
1592528 SUT PROLENE 6-0 CV-1 MULTIPACK         $      109.49
1592529 SUT PROLENE 5 O CV 1 MULTIPACK         $      133.53
1592530 SUT SURGICAL STEEL 24                  $       58.61
1592531 SUT MONOCRYL 2-0 UR-6 27 UNDY          $       69.23
1592535 SUT VICRYL 6-0 S-28 18 DA              $      116.28
1592537 SUT MERSILENE 5-0 S-24 18 DA           $       78.89
1592538 SUT CHROMIC 0 CT C/R 8-18              $       89.30
1592545 SUT SILK 3-0 SH C/R 5-18               $       93.56
1592547 SUT SURGICAL STEEL 4-0                 $       77.14
1592549 SUT PRONOVA 7-0 BV-1 24 DA             $       79.05
1592550 SUT PRONOVA 6-0 C-1 30 DA              $       55.61
1592551 SUT PRONOVA 5-0 C-1 36 DA              $       55.61
1592552 SUT CHROMIC 2-0 OS-4 27                $       42.01
1592553 SUT BONE WAX                           $       39.79
1592560 SUT NUROLON 3-0 CT-2 8-18              $      308.66
1592561 SUT ETHILON 5-0 S-24 18 DA             $       75.14
1592562 SUT ETHIBOND 2-0 MH 36 DA              $       41.87
1592563 SUT PROLENE 4-0 SH-1 30 DA             $       45.17
1592564 SUT PDS II 4-0 PS-1 18                 $       55.10
1592565 SUT PLAIN 5-0 S-14 12 DA               $       85.10
1592569 SUT SILK 3-0 SH C/R 8-18               $       74.18
1592570 SUT NUROLON 2-0 M0-6 8-18              $       90.85
1592572 SUT SILK 4-0 SH C/R 8-30               $       76.79
1592576 SUT VICRYL 5-0 P-3 18 UNDYED           $       40.65
1592577 SUT VICRYL 0 CTX C/R 8-18 UND          $       94.15
1592578 SUT ETHIBOND 0 V-34 30                 $       34.14
1592579 SUT PROLENE 6-0 BV-1 24 DA             $       93.19
1592580 SUT PROLENE 7-0 BV-1 24 DA VB          $       88.68
1592581 SUT VICRYL 1 CT-1 36                   $       56.07
1592584 SUT PROLENE 1 TP-1 60                  $       39.05
1592585 SUT ETHIBOND 0 MH 36 DA                $       43.46
1592586 SUT ETHIBOND 2-0 TIES 18               $       34.63
1592587 SUT VICRYL 6-0 PC-1 18 UNDYED          $       43.76
1592589 SUT PROLENE 3-0 SH-1 30 DA             $       44.98
1592590 SUT ETHIBOND 2-0 V-5 30 DA             $       54.96
1592591 SUT PROLENE 2-0 V-7 36 DA              $       58.43
1592592 SUT PDS 4-0 PS-4 18 CLEAR              $       44.50
1592594 SUT PROLENE 8-0 BV130-5 24 DA          $      125.10
1592595 SUT PROLENE 2 TP-1 60                  $       37.92
1592596 SUT NUROLON 2-0 SH 8-18                $       87.99
1592597 SUT NUROLON 3-0 SH 8-18 C/R            $       87.99
1592598 SUT NUROLON 3-0 FSL 8-18               $      122.67




                                         Page 122
                                         Ancillary


1592599 SUT ETHILON 7-0 P-1 18                 $       38.85
1592600 SUT BAND PARHAM ZIMALITE               $      110.00
1592603 SUT TICRON 2-0 CV-305 MP W/            $      108.14
1592604 SUT TICRON 2-0 CV-316 MP W/O           $      111.51
1592605 SUT TICRON 2-0 CV-316 MP W/            $      179.83
1592606 SUT TICRON 5-0 T-37                    $       75.49
1592607 SUT TICRON 5-0 CV-330                  $       57.40
1592608 SUT TICRON 3-0 CV-331 DA               $       39.15
1592609 SUT TICRON 4-0 CV-331 36 DA            $       50.62
1592614 SUT PROLENE 4-0 BB 54 DA               $      120.64
1592615 SUT ETHILON 2-0 PS-2 18                $       36.15
1592616 SUT TICRON 7-0 CV-310 DA               $       95.81
1592618 SUT PROLENE 7-0 BV-1 30 DA             $       77.22
1592619 SUT VICRYL 2-0 CT C/R 8-18             $       97.93
1592621 SUT VICRYL 3-0 RB-1 C/R 8-18           $       95.21
1592622 SUT SILK 6-0 18                        $       38.30
1592623 SUT VICRYL 5-0 S-14 18                 $       87.38
1592624 SUT VICRYL 6-0 S-14 18                 $       89.55
1592625 SUT ETHILON 10-0 9000G                 $      101.83
1592626 SUT ETHILON 10-0 BV75-4 5              $      113.93
1592627 SUT MERSILENE 10-0 CS160-6 12          $       98.47
1592628 SUT VICRYL 2-0 CT-1 C/R 8-18           $       93.56
1592629 SUT VICRYL 3-0 CT-1 C/R 8-18           $       94.08
1592630 SUT VICRYL 4-0 SH C/R 8-18             $      105.37
1592631 SUT VICRYL 4-0 SH-1 C/R 8-18           $      102.40
1592632 SUT NUROLON 4-0 TF-5 D-5620 SO         $      122.78
1592634 SUT PDS 3-0 PS-2 18 CLEAR              $       44.42
1592639 SUT VICRYL 3-0 FS C/R 8-18             $       84.30
1592643 SUT PROLENE 3-0 FS-2 18                $       52.15
1592644 SUT ETHIBOND 1 TIES 6-30               $       90.60
1592646 SUT ETHIBOND 0 OS-2 C/R 3-18           $       48.92
1592647 SUT PDS II 0 TP-1 LOOPED ON            $       66.20
1592648 SUT VICRYL 4-0 PS-1 18 UNDYED          $       40.27
1592650 SUT UMBILICAL TAPE                     $       89.22
1592651 SUT VICRYL 3-0 CP-2 8-18 UNDY          $       54.30
1592652 SUT CHROMIC 1 CT C/R 8-18              $      114.74
1592654 SUT LIVER PROCEDURE E-PACK             $     1,018.48
1592657 SUT ETHILON 11-0 CS160-6 8 DA          $      112.74
1592658 SUT VICRYL 6-0 S-14 18 UNDYED          $       87.38
1592659 SUT ETHIBOND 5 TIES                    $       56.99
1592660 SUT ETHILON 10-0 TGW160-6 12           $      107.76
1592661 SUT ETHIBOND 5 D-6296                  $       58.82
1592663 SUT MONOCRYL 5-0 P-3 18                $       59.44
1592665 SUT STERNA-BAND                        $      185.26
1592667 SUT ETHIBOND 2-0 SH 10-30 W/O          $      130.38
1592668 SUT ETHIBOND 2-0 SH 10-30 W/           $      210.40
1592669 SUT ETHIBOND 2-0 SH-2 DA MP W/         $      204.40
1592670 SUT ETHIBOND 2-0 SH-2 DA MPW/O         $      226.63
1592672 SUT PROLENE 4-0 SH 36 DA               $       54.54




                                         Page 123
                                         Ancillary


1592673 SUT PROLENE 4-0 SH 48 DA               $      119.94
1592674 SUT ETHILON 2 CT-2 30 DA               $       92.94
1592678 SUT SURGIDAC 3-0 CV-24 10-30           $      290.20
1592686 SUT BUTTON POLYPROPYLENE 14MM          $      104.93
1592687 SUTURE, VICRYL KNITTED MESH            $      880.42 C1781
1592750 CANNULA 8.25MM X 9CM AR 6540           $      141.90
1592751 TOOL MIDAS DISSECTING 21TA30           $      480.70
1592752 TOOL MIDAS REX LEGEND 7BA15            $      391.60
1592753 TOOL MIDAS DISSECTING 7BA60            $      376.20
1592754 TOOL MIDAS DISSECTING 7BA60D           $      403.70
1592755 TOOL MIDAS DISSECTING 26BA75           $      503.80
1592756 ADAPTER TUOHY-BORST TBA-6              $      122.10 C2629
1592757 TOOL MIDAS DISSECTING MC254            $      519.20
1592758 CATH SIMI G08584                       $      117.70
1592759 CATH KMP 5-38-65 228361                $      139.70
1592760 ARTHRO 9MM CLEAR CANN 7207229          $      122.10
1592761 PACK CUSA OLD                          $     1,069.20
1592762 ENDO STEP DIL/SLEEVE S101005           $      352.00
1592763 ENDO VERSASTEP 12MM VS101012P          $      420.20
1592764 ENDO TROCAR 10/12MM 512XD              $      370.70
1592767 CATH KMP 4.1FR G08542                  $      160.60
1592768 CATH PIGTAIL 8.2X22 AQ039822R          $      490.60 C1887
1592769 BONE MILL BM200                        $      564.30
1592770 BLADE DERMACARRIER 1 1/2               $      118.80
1592771 STAPLER LINEAR CUTTER                  $      979.00
1592772 ARTHRO MICR RECIP RASP 5053082         $      434.03
1592773 ENDO CLOSURE PROC/KIT CTI-512N         $      424.60
1592774 CANNULA RETROGRADE 10FR 94010          $      330.00
1592775 PERF UNIV 3 SPIKE 903-00006            $      416.90
1592776 PERF RESEVOIR CARDIO 90300018          $      491.70
1592777 CANNULA VENOUS EDWARDS VFEM020         $      849.20
1592778 CANNULA VENOUS EDWARDS VFEM022         $      794.20
1592779 CATH PIG CSC 5-35-100 250684           $      419.10
1592780 FLOW QC KEY 314-5                      $      540.10
1592781 TUBING HTA PROCEDURE SET 55015         $     2,681.80
1592782 TOOL MIDAS REX DISSECT 9MC254          $      519.20
1592783 ARTHRO SUTURE LASSO AR4065-45L         $      135.30
1592784 ARTHRO 45 SUT LASSO AR4065-45R         $      194.70
1592785 ARTHRO 90 SUT LASSO AR4065-90W         $      806.30
1592786 TRAY BRAIN BIOPSY DISPOSABLE           $      951.50
1592787 SUT VICRY 0 CT 36                      $       30.80
1592788 ENDO OVAL PDS S2 OMS-PDBS2             $      513.70
1592789 SUTURE FIBERWIRE #2 AR                 $      119.90
1592790 CANNULA ARTERIAL THORTEC 14812         $     9,323.58
1592791 BLADE CURVED ULTRACISION 5MM           $      442.20
1592792 RETRACTOR OCTOPUS                      $     2,912.80
1592793 ANES EPIDURAL CATH KIT                 $       95.26
1592794 ANES TRAY TUN-L XL 16GA X 3.5          $      311.30
1592795 ASPIRATOR EXTRA LENGTH                 $      389.40




                                         Page 124
                                         Ancillary


1592796 IRRIGATION SPIKE                       $       83.60
1592797 STRAIGHT SHAFT SHAVER                  $      324.50
1592798 CURVED SHAFT 15 DEGREE                 $      324.50
1592799 CURVED SHAFT 15 DEGREE W/              $      324.50
1592800 BASE OF TONGUE RF APPLINCE             $      279.40
1592801 CATH COUDE 14FR/5CC 0168L14            $      101.20 C1729
1592803 ACCESS SHEATH B7021                    $      578.60 C1874
1592804 ACCESS SHEATH B7011                    $      578.60 C1874
1592805 INTRODUCER FIBER OPTIC 661506          $      123.20
1592806 BIOPSY BRUSH COOK 040310               $      216.70
1592807 VINYL CONNECT TUBE 081398              $       99.00
1592808 CATH URETERAL OLIVE TIP 4FR RT         $       65.01 C1758
1592809 ENDOSCRUB 2 SHEATH 4MM 0               $      204.60
1592810 ESU VAPORTRODE ELECTRODE               $      601.70
1592811 ARCH BARS ROLL                         $      137.50
1592812 ARCH BARS 12 STRIPS                    $      112.20
1592813 CLIP HEM O LOK MLX 544240              $      128.70
1592814 ANES 6 TUBE & STOPCK 42408 01          $       35.20
1592815 ANES MONITOR LINE 48                   $       37.40
1592816 CANNULA QUICK DRAW VENOUS 25FR         $     1,604.90
1592817 VULCAN TAC-11 7209628                  $     1,181.40
1592818 PROBE MICRO TAC-S 7209631              $     1,252.90
1592819 LIG CHISEL ST 7209649                  $      478.50
1592820 LIG CJISEL HOOK 7209646                $      481.80
1592821 LIG CHISEL ANGLED 7209648              $      481.80
1592822 VULCAN CHISEL CVD 7209647              $      481.80
1592823 MICRO CHISEL ANG 7209645               $      587.40
1592824 VUL ABLATOR 60DEG 7209650              $      561.00
1592825 ABLATOR 90 DEG 7209655                 $      537.90
1592826 ABLATOR-S 60DEG 7209653                $      643.50
1592827 ABLATOR-S 90DEG 7209654                $      643.50
1592828 ENDO VESSEL HARVEST KIT RAD06A         $     2,443.10
1592829 DRAIN BLAKE SILICONE 24FR 2234         $      132.00
1592830 ENDO SUCTION WAVE 007200-901           $      204.60
1592831 CANNULA ARTERIAL EDW FEM11018A         $      493.90
1592832 CANNULA ARTERIAL EDW FEM11020A         $      493.90
1592833 ENDO VERSAPORT PLUS 10-15MM            $      331.10
1592834 CANNULA ART DISPERSION DCT21A          $      192.50
1592835 KIT ARTERIAL INSERT EDWS PIKA          $      220.00
1592836 KIT VENOUS INSERT EDWARDS PIKV         $      220.00
1592837 CHROMOVISION LIGHT HANDLE              $       75.90
1592838 CANNULA RETROGRADE 6FR 94006           $      337.70
1592839 NEURO BECKER EDMS                      $      496.10
1592840 NEURO LUMBAR CATHETER ACCESSOR         $      451.00
1592841 CANNULA, VENOUS 1                      $      239.80
1592842 CATH VENT EDWARDS E061                 $      150.70
1592843 TUBE LARYNGEAL 6                       $      778.80
1592844 TUBE LARYNGEAL SIZE 7                  $      689.70
1592845 CANNULA VENOUS 20FR VFEM020            $      239.80




                                         Page 125
                                         Ancillary


1592846 PERFUSION BIOPUMP BPX 80               $     655.60
1592847 CANNULA VENOUS 22FR VFEM022            $     239.80
1592848 PERFUSION BIOPUMP PEDS BP 50           $     655.60
1592849 INTRODUCER VENOUS EDWARDS PIKV         $     220.00
1592850 DILATOR HYDROPLUS 240-110              $     152.90
1592851 ENDO VERSASTEP NEEDLE 14G              $     125.40
1592852 SUT PDS II 7-0 BV-1 24                 $     121.65
1592853 FORCEPS STONE GRASPIT                  $     746.90
1592854 MASTISOL LIQUID ADHESIVE               $      27.50
1592855 SUT VICRYL 2-0 27 CT-3 J328H           $      30.80
1592856 ENDOVASCULAR/RENAL DILATOR SET         $     663.30
1592857 AMPLATZ INTRODUCER 30FR                $     157.30
1592858 AMPLATZ INTRODUCER 28FR                $     157.30
1592859 AMPLATZ INTRODUCER 26FR                $     157.30
1592860 AMPLATZ INTRODUCER 24FR                $     157.30
1592861 SUPER SHEATH 7 FR                      $     173.80 C1766
1592862 SUT TEVDEK 0 TIES                      $      28.88
1592863 SUT MERSILENE 2 LR 30 DA               $      30.73
1592864 SUT ETHILON 6-0 P-1 18                 $      31.04
1592865 SUT CHROMIC 3-0 PS-2 27                $      31.92
1592866 SUT PROLENE 1 CT-1 60                  $      32.13
1592867 SUT PROLENE 5-0 P-3 18                 $      36.30
1592868 TUBING LATEX AMBER 1/4                 $      36.30
1592869 SUT PROLENE 3-0 SH 48 DA               $      37.40
1592870 ENDO CAP REDUCER FLIP TOP 5.5          $      40.70
1592871 ENDO CAP REDUCER MS712                 $      47.45
1592872 CATH COUDE 22FR 5CC                    $      51.70 C1729
1592873 SUT PROLENE 5-0 C-1 24 DA VB           $      52.80
1592874 SUT ETHIBOND 5 LR 3-20                 $      53.90
1592876 ENDO CAP MULTISEAL 5MM                 $      54.71
1592877 KIT MEDTRONIC SERVICE 5873C            $      55.00
1592878 SUT SILK 4-0 RB-1 8-18                 $      60.32
1592879 CATH URETERAL WHISTLE 4FR RT           $      64.33 C1758
1592880 CATH URETERAL WHISTLE 6FR RT           $      64.33 C1758
1592881 CATH URETERAL WHISTLE 5FR L            $      64.33 C1758
1592882 CATH URETERAL WHISTLE 4FR L            $      64.33 C1758
1592883 CATH URETERAL WHISTLE 6FR L            $      64.33 C1758
1592884 CATH URETERAL OLIVE TIP 5FR RT         $      65.01 C1758
1592885 CATH URETERAL OLIVE TIP 6FR RT         $      65.01 C1758
1592886 CATH URETERAL OLIVE TIP 4FR L          $      65.01 C1758
1592887 CATH URETERAL OLIVE TIP 5FR L          $      65.01 C1758
1592888 CATH URETERAL OLIVE TIP 6FR L          $      65.01 C1758
1592889 BLADE SAW KM-450                       $      65.44
1592890 BLADE SAW KM-456                       $      65.44
1592891 BLADE SAW OSCILL KM-272                $      65.44
1592892 BLADE OSCILLATING MICROAIRE            $      66.30
1592893 BLADE RECIP SAW ZR-020                 $      66.30
1592894 BLADE RECIP SAW ZR-021                 $      66.30
1592895 BLADE RECIP SAW ZR-120                 $      66.30




                                         Page 126
                                         Ancillary


1592896 BLADE OSCILLATING MICRO ZO-060         $      66.30
1592897 BLADE OSCILLATING MICRO ZO-064         $      66.30
1592898 BLADE SAW SAGIT MICRO ZS-038           $      66.30
1592899 CATH URETERAL SPIRAL 4FR RT            $      67.50 C1758
1592900 CATH URETERAL SPIRAL 6FR RT            $      67.50 C1758
1592901 CATH URETERAL SPIRAL 4FR L             $      67.50 C1758
1592902 CATH URETERAL SPIRAL 5FR L             $      67.50 C1758
1592903 CATH URETERAL SPIRAL 6FR L             $      67.50 C1758
1592905 BLADE SAW OSCILL KM-256                $      73.16
1592906 BLADE RECIP SAW ZR-058                 $      74.88
1592907 BLADE RECIP SAW ZR-059                 $      74.88
1592908 BLADE RECIP SAW ZR-060                 $      74.88
1592909 BLADE RECIP SAW ZR-061                 $      74.88
1592910 CATH URETERAL CONE TIP 10FR RT         $      77.19 C1758
1592911 CATH URETERAL CONE TIP 12FR RT         $      77.19 C1758
1592912 CATH URETERAL CONE TIP 10FR L          $      77.19 C1758
1592913 SUT VICRYL 8-0 TG160-8 8               $      78.10
1592914 ENDO SUT CHROMIC 0 LOOP 18             $      79.96
1592915 BLADE SAW CARBIDE SIDE ZB-101          $      80.87
1592916 BLADE SAW CARBIDE SIDE ZB-102          $      80.87
1592917 SUT PROLENE 3-0 SH 54 DA               $      84.70
1592918 BLADE OSCILLATING ZO-069               $      84.73
1592919 PROTECTOR WOUND 9 RING                 $      85.80
1592920 ESU CONCEPT CAUTERY                    $      85.80
1592921 TUBING DISSECTOR BLUNT TIP             $      88.00
1592923 BLADE OSCILLATING KM-31L LGE           $      91.45
1592924 BLADE OSCILLATING MICROAIRE            $      92.88
1592925 BLADE OSCILLATING ZO-050               $      92.88
1592926 BLADE OSCILLATING ZO-055               $      92.88
1592927 BLADE OSCILLATING ZO-056               $      92.88
1592928 BLADE SAW CARBIDE SIDE ZB-106          $      92.88
1592929 BLADE SAW CARBIDE SIDE ZB-114          $      92.88
1592930 BLADE CARBIDE OVAL 5607-22             $      95.70
1592931 BLADE SAW CARBIDE SIDE ZB-203          $      96.10
1592932 ENDO KNOT PUSHER LAPAROSCOPIC          $      96.80
1592933 BLADE SAW MICRO AIRE BARREL CU         $      98.88
1592934 BLADE OSCILLATING MICRO 560797         $      99.67
1592935 BLADE SAW SAGIT MICRO 5602-63          $      99.67
1592936 BLADE SAW SAGIT MICRO 5602-70          $      99.67
1592937 BLADE RECIP LG 5608-29                 $      99.67
1592938 BLADE SAW SAGIT MICRO MS-132           $     100.74
1592939 BLADE SAW SAGIT MS-125                 $     100.74
1592940 CATH COUDE 20FR 5CC                    $     101.20 C1729
1592941 BLADE SAW KM-23L                       $     101.45
1592942 BLADE SAW KM-27L                       $     101.45
1592943 SUCTION KAMVAC CVD MINI                $     103.40
1592944 SUT TICRON 5-0 CV-301 DA 30            $     104.50
1592945 BLADE SAW MICRO AIRE RECIP SAW         $     104.89
1592946 PERF SUCTION CELL SAVER                $     105.74




                                         Page 127
                                         Ancillary


1592947 BLADE OSCILLATING S0-100 LGE           $     105.74
1592948 SUT ETHILON 10-0 CU-5                  $     108.90
1592949 SUT NYLON 11-0 CU-15                   $     108.94
1592950 SUT NYLON 11-0 CU-5                    $     108.94
1592951 BLADE RECIP SAW 5608-37                $     108.96
1592952 PIN CAP                                $      36.30
1592953 TUBE T 10FR                            $     110.12
1592954 BLADE SAW CUTTING CARBIDE              $     111.74
1592955 SHIELD SIMPULSE SPLASH                 $     113.30
1592956 TUBE TRACH 4 CUFFLESS                  $     116.60
1592957 TUBE, TRACH 6                          $     116.60
1592958 BLADE OSCILLATING MO-121               $     118.60
1592959 BLADE OSCILLATING MO-138 LGE           $     118.60
1592960 BLADE OSCILLATING K-2000-46            $     124.26
1592961 BLADE OSCILLATING K-2000-02            $     124.26
1592962 ENDO NEEDLE VERESS 150MM               $     127.51
1592963 BLADE OSCILLATING ZO-071               $     128.46
1592964 BLADE OSCILLATING ZO-072               $     128.46
1592965 PROBE PARSONNET 1.0MM                  $     128.70
1592966 TUBE, TRACH 8                          $     130.90
1592967 TUBE TRACH 10 CUFFLESS                 $     130.90
1592968 CANNULA VENOUS RETURN 22FR             $     130.90
1592969 TUBING SILASTIC                        $     134.20
1592970 BLADE OSCILLATING K-2000-26            $     140.80
1592971 CAP 4.0MM                              $     144.10
1592972 CAP 2.5MM                              $     144.10
1592973 CATH CHOLANGIOCATH 16GA                $     147.40
1592974 SPLINT II DOYLE                        $     154.00
1592975 BLADE OSCILLATIING 5610-14 LGE         $     156.32
1592976 CATH URETERAL WHISTLE 3FR RT           $     162.97 C1758
1592977 CATH URETERAL WHISTLE 3FR L            $     162.97 C1758
1592978 ENDO PROBE PLUS HOOK 5MM EPS01         $     166.56
1592979 ENDO PROBE PLUS SUCTION 10MM           $     168.41
1592980 BLADE ACROMIONIZER 5.5MM               $     184.80
1592981 BLADE OSCILLATING .032                 $     185.90
1592982 CANNULA, VENOUS 2                      $     188.10
1592983 KIT DISPENSER DUO FLO                  $     188.14
1592984 SILASTIC PA BAND                       $     196.83
1592985 ENDO IRRIG ENDO-FLO 0037970            $     215.60
1592986 CANNULA ARTERIAL ABIOMED               $     215.60
1592987 BLADE FULL RADIUS 3.5MM                $     221.49
1592988 BLADE NOTCHBLASTER 5.5MM               $     221.49
1592989 BLADE TURBO TRIMMER 4.5MM              $     263.92
1592990 BLADE NOTCHBLASTER 4.0MM               $     263.92
1592991 BLADE STONE CUTTER ACROMION 5.         $     263.92
1592992 ENDO TIP CAUTERY PEDS RT ANGLE         $     264.00
1592994 ENDO CATCH GOLD 10MM ECATCH10G         $     271.30
1592995 TOURNIQUET CUFF #12                    $     278.64
1592996 TOURNIQUET CUFF 18NON-STERILE          $     278.64




                                         Page 128
                                         Ancillary


1592997 TOURNIQUET DOUBLE CUFF 18/24           $      278.64
1592998 ENDO PROBE PLUS HANDPIEC EPH01         $      290.65
1592999 ENDO SUCTION/IRRIG/PROBE               $      321.20
1593000 PERF RESERVOIR CARDIOTOMY              $      345.40
1593001 CATH HICKMAN 10.8FR                    $      389.40 C1751
1593002 DRAIN VENTRICULAR EXTERNAL             $      397.10
1593003 KIT OCUTOME PACK DISPOSABLE            $      499.59
1593004 TOURNIQUET 12 NONSTERILE               $      500.50
1593005 PERF PUMP TABLE PACK 62211             $      169.55
1593006 ENDO PROBE OCULAR                      $      535.70
1593007 PERF PUMP PACK PED 62210-01            $      712.80
1593008 DRILL SUPERANCHOR MITEK                $     1,141.80
1593009 SUT SILK 4-0 PS-2 18                   $       30.50
1593010 SUT VICRYL 4-0 PS-2 18                 $       34.10
1593011 SUT TEVDEK 1 C-2 7-775                 $       36.30
1593012 SUT PROLENE 2-0 SH 48 DA               $       37.79
1593014 SUT MERSILENE LF 6-0 18                $       44.00
1593015 ENDO REDUCER 5MM LONG                  $       45.10
1593016 ENDO CAP REDUCER 10/12 R1810           $       47.30
1593017 ENDO REDUCER CAP 5-18MM R1805          $       47.38
1593018 TOURNIQUET 5/PK DLP                    $       52.80
1593019 CANNULA J HOOK 585003                  $       53.23
1593020 TUBING LEVEL 1 IR 600                  $       66.00
1593021 ENDO CANNULA SEAL 5MM                  $       74.80
1593022 ENDO CANNULA SEAL 11M                  $       74.80
1593023 ENDO CANNULA SEAL 12M                  $       74.80
1593024 SUT VICRYL 1 CT-1 8-27 C/R             $       80.30
1593026 CATH MAHURKAR 11.5 X16CM CURVE         $       84.93 C1750
1593027 INTRODUCER DILAMEZINSERT               $       90.20
1593028 ANES SENSOR PULSE OX DISPOSABL         $       90.74
1593029 ENDO SUT ENDOSTITCH AUTOSUTURE         $       93.19
1593030 FALLOPE RINGS                          $       94.60
1593031 TUBING IRRIGATION MALIS W/BIPO         $       94.60
1593032 TIP HARMONIC TEST                      $       99.00
1593033 SUT NYLON 10-0 CU-5                    $       99.47
1593034 BLADE SAW SAGITTAL KM 658              $      103.40
1593035 PACK SETUP STERILE (88128)             $       49.50
1593036 ENDO LLETZ BALL ELCTRODE               $      111.45
1593037 ESU BIPOLAR BRUSH W/CORD               $      112.20
1593038 CLIP GUN MAGAZINE                      $      116.60
1593039 ACMI DOLPHIN COLLECTION KIT            $      116.60
1593040 ENDO POUCH TISSUE 2X5 LAPSAC           $      126.50
1593041 PACK CUSTOM MINOR BASIN                $      139.19
1593042 CANNULA BLOWER MISTER CLEARVUE         $      182.90
1593043 ADAPTER HARMONIC SYSTEM 5MM            $      143.00
1593044 ENDO KITTNER                           $      150.70
1593045 CSI FLEXIBLE WEAR CONTACT LENS         $      150.70
1593046 JONES GOLD DILATORS #1&2               $      155.10
1593047 ENDO PROBE PLUS SPATULA EPS02          $      165.00




                                         Page 129
                                         Ancillary


1593048 ENDO PROBE PLUS STONE EPS12            $      165.00
1593049 SYRINGE LEVEEN INFLATOR 10CC           $      165.99
1593050 GUIDEWIRE ANG/FLEX 0.035               $      170.50 C1769
1593051 ANES PROBE TEMPERATURE PEDS            $      170.85
1593052 ANES NEEDLE EPIDURAL LONG              $      170.85
1593053 23G BIPOLAR TAPERED FINE POINT         $      172.70
1593054 ENDO SLEEVE XCEL 10/11 CB11LT          $      202.40
1593055 SUT PROLENE 4-0 SH 54 DA               $       99.00
1593056 TUBING DOLPHIN II DOL-TUB              $      304.70
1593057 TUBE VACTNR 4ML LVNDR (367861)         $       75.90
1593058 TUBE TRACH UNCUFFED (3.0 PED)          $      115.50
1593059 TUBE TRACH UNCUFFED (3.5 PED)          $      119.90
1593060 CANNULA HYDR/DST 25GX22 585037         $       48.40
1593061 TOOL MIDAS REX LEGEND (14BA75)         $      431.20
1593062 TOOL MIDAS REX LEGEND (14BA90)         $      431.20
1593063 TOOL MDS REX DST LGND F1/8TA15         $      344.30
1593064 TOOL MIDAS REX LEGEND                  $      431.20
1593065 TOOL MDS RX 6X6M DISCT 26BA30          $      449.90
1593066 ENDOSTITCH 2-0 48IN (173023)           $      160.60
1593067 ENDO CLIP II M/L 10MM (176657)         $      444.40
1593068 PERF STRLTUBING 4FTX3/8 (3504)         $       72.60
1593069 BASKET STN SEGURA 2.4F 380-107         $      709.50
1593070 CATH URETERAL SPIRAL 5FR RT            $       81.40 C1758
1593071 INFUSOR PRESS BG 1000ML 4010           $      343.20
1593072 INFUSOR PRSS BG 500ML PIB500           $       84.70
1593073 BLADE HARMONIC SCALPEL LCSK5           $      606.10
1593074 BLADE SAW OSCILLATING KM-7566          $      136.40
1593075 BLADE FULL RADIUS 4.5M 7205306         $      268.63
1593076 BLADE FULL RADIUS 5.5M 7205307         $      308.00
1593077 CANNULA CRYSTAL 5.75MM AR6562          $      141.90
1593078 ARTHRO 8MM CLR CANNULA 7207228         $      121.00
1593079 CATH CHOLNGRM 7.5FR 20018-010          $      203.50
1593080 CANNULA SEAL 400077                    $      141.90
1593081 CANNULA ARTERIAL BIOMEDICUS 17         $      636.57
1593082 CANNULA VENOUS RETURN 20FR             $      223.30
1593083 CANNULA VENOUS RETURN 24FR             $      195.80
1593084 CANNULA VENOUS RETURN 26FR             $      195.80
1593085 CANNULA, VENOUS RETURN                 $      195.80
1593086 CANNULA VENOUS RETURN 30FR             $      195.80
1593087 CANNULA VENOUS RETURN 32FR             $      195.80
1593088 CANNULA VENOUS RETURN 34FR             $      195.80
1593089 CANNULA VENOUS RETURN 36FR             $      195.80
1593090 CANNULA VENOUS RETURN 40FR             $      191.40
1593091 CANNULA VENOUS RETURN 16FR             $      223.30
1593092 CANNULA VENOUS RETURN 18FR             $      223.30
1593093 ENDO FORCEPS SEITZINGER TRIPOL         $     1,157.20
1593094 ENDO LAPAROSCOPIC HANDPIECE            $      240.90
1593095 ENDO HARMONIC SHEARS LCS6S             $     1,097.13
1593096 LACRICATH 2MM 3MM 5MM                  $      640.20




                                         Page 130
                                         Ancillary


1593097 CATH SUPRAPUBIC 420-100                $      441.10 C2627
1593098 CATH FOLEY SP BARD 143112              $      843.70
1593099 CATH URETER CONE 8FR 138008            $       92.40 C1758
1593100 CLIP OMNI CLIP GUN                     $      270.60
1593101 ARTHRO 7MM CLR CANNULA 7207227         $      122.10
1593102 ARTHRO SHOULDER STABI KIT 7627         $      279.40
1593103 ENDO HARMONIC SCALPEL SHEARS           $     1,136.30
1593104 BLADE HARMONIC 5MM HC325               $      624.80
1593105 ENDO HARMONIC SHEAR LCS15              $     1,045.00
1593106 ENDO HARMONIC SHEARS CS14C             $     1,184.70
1593107 ARTHRO SHOULDER SUSP KIT #3583         $      247.50
1593108 ENDO CUTTER LONG 45MM LONG45A          $     1,085.70
1593109 BLADE MICRO OSCILLATOR                 $      129.80
1593110 ENDO TROCAR 10/12MM                    $      247.46
1593111 ENDO TROCAR 10/11MM 511SD DILA         $      247.46
1593113 ENDO INSUFFLATION NEEDLE               $      122.10
1593114 ESU ACCUTEMP LOW TEMP                  $       66.00
1593115 ESU CABLE ACTIVE 10FT BPLR DAC         $      140.80
1593116 ESU COLORADO TIP                       $      182.60 C1758
1593117 INTRODUCER COOK 20FR                   $      322.30
1593118 EYE CONFORMER W/HOLES MED              $      116.60
1593119 EYE CONFORMER W/HOLES LG               $      116.60
1593120 EYE CONFORMER W/HOLES SM               $      116.60
1593121 MICRINS BACKGROUND MATERIAL            $       71.50
1593122 SOFT TISSUE/SCROTAL RETRACTOR          $      481.80
1593123 PACK CUSTOM HEAD & NECK 779315         $      178.20
1593124 PACK PHACO 3OR MICRO ABS               $      502.70
1593125 PAD SOMONOPLASTY PADS                  $     2,681.25
1593126 PIN GUIDE 2.4MM ATHRX AR-1297L         $      347.60
1593127 DRESS NU-KNIT KELP 6 X 9               $      432.30
1593128 HEMORRHOID STAPLER                     $     1,301.30
1593131 SUT ETHILON 5-0 P-3 18 698H            $       31.04
1593132 SUT PLAIN 3-0 SH 27                    $       31.90
1593133 SUT SILK 6-0 CV-301 18                 $       66.00
1593134 SUT SUPRAMID 4-0 1/2 CIRCLE            $       67.10
1593135 TOURNIQUET CUFF 42 NONSTERILE          $      785.40
1593136 TUBING HIGH PRESSURE 91051482          $       93.50
1593137 ENDO APPLIER CLIP ESAL326 5MM          $      354.75
1593138 URODYNAMIC PUMP TUBING                 $      122.10
1593139 ELLICK EVACUATOR DISP                  $      118.80
1593140 SUT TICRON 3-0 CE-5 30                 $       31.90
1593141 CANNULA HYDR/DISS NCLS 585099          $       53.78
1593142 ARTHRWAND SCTN COVAC AS3730-01         $      719.40
1593143 BLADE, OPHTHALMOLOGIC                  $      102.30
1593144 SUT PDSII 7-0 BV1 30                   $      108.90
1593145 CATH DOUBLE LUMEN CV 4.0FR             $      348.70
1593146 SUT GORE TEX CV-7 24 TTC-09            $      158.40
1593147 SUTURE OPUS SMARTSTITCH                $      634.70
1593148 SUTURE 1                               $       61.60




                                         Page 131
                                         Ancillary


1593149 SUTURE 2                               $      245.30
1593150 SUTURE 3                               $      359.70
1593151 ARTHRO FLOOR SUCTION MAT               $      135.30
1593152 TRIPOLAR FORCEP                        $      839.30
1593154 ARTHRO SMARTSTITCH CONNECTOR           $      129.80
1593155 IRRIGATION PUMP W/SMOKE EVAC           $      229.90
1593156 TUBING STACKHOUSE                      $      136.40
1593157 EYE RETRACTOR FLEXIBLE                 $      413.60
1593158 TUBING STACKHOUSE REDUCER              $       71.54
1593159 TUBING IRRIGATION SURE SHOT            $      104.50
1593160 KIT NEUROSTIMILATOR PT PRGMR           $     2,339.70 C1787
1593161 QUILTED HEEL PROTECTOR                 $      138.60
1593163 CLIP CORONARY ARTERY RETRACTON         $       82.50
1593164 BIOPSY NEEDLE BNE/BRST                 $      264.00
1593165 CANNULA OPHTHALMIC                     $      179.30
1593166 SET SPINAL TRIGEMINAL GANGLION         $      893.20
1593167 LACRIMAL INTUBATION SET                $      266.20
1593168 STAPLER INTERNAL REIN/BBSRBLE          $      570.90
1593169 STAPLER RELOAD LINEAR CUTTER           $      655.60
1593171 TOOL DISSECTING CUTTER                 $      532.40
1593172 TOOL DISSECTING TAPER                  $      854.70
1593173 TOOL DISSECT MATCHHEAD                 $      539.00
1593174 TUBE GASTROSTOMY 1                     $      562.10
1593175 TUBE ENDOTRACHEAL 1                    $      551.10
1593176 TROCAR ENDO 10MM                       $      377.30
1593178 TUBE GASTROSTOMY 2                     $      827.20
1593179 ENDO TISSUE POUCH RETRIEVEL            $      258.50
1593180 EXTRACTOR, TISSUE STERILE              $      606.10
1593181 ENDO HARMONIC SCALPEL SHEARS           $     1,136.30
1593182 ENDO HARMONIC CURVE SHEAR              $     1,193.50
1593183 BLADE, TREPHINE                        $      283.80
1593184 BLADE, PIVOTAL/FIXED HEAD              $       32.00
1593186 SCALPEL, SURGICAL 2                    $      155.63
1593187 NEEDLE, BIOPSY 1                       $      352.00
1593188 NEEDLE, MONOPTY BIOPSY                 $      184.80
1593193 BLADE, LARYNGOSCOPE                    $      203.50
1593194 BLADE, SHAVER                          $     1,505.90
1593195 CATHETER, RELIEVA SINUS GUIDE          $     1,025.20 C1769
1593196 ESU LIGASURE                           $      993.30
1593197 GELPORT SEAL                           $     1,388.20
1593198 SCALPEL, SURGICAL 1                    $       25.00
1593199 NEUROPEN WITH NEUROENDOSCOPES          $     1,542.00
1593200 HYDROJET WITH APPLICATOR               $     5,691.00
1593201 HYDROJET FLUID MATERIAL                $      177.00
1593202 BLADE, OSCILLATING/HARVEST             $      518.15
1593203 BLADE, RETRACTING 1                    $      404.05
1593204 BLADE, RETRACTING 2                    $     1,223.12
1593205 SLEEVE, TRUKOR DRILL                   $      786.78
1593206 NEEDLE, BIOPSY 2                       $      696.19




                                         Page 132
                                         Ancillary


1593207 NEEDLE, BIOPSY 3                       $     1,340.39
1593208 LACRICATH 1                            $     1,605.31
1593209 PROBE, CRYO ABLATION                   $     7,137.99 C2618
1596000 FLUOROSCOPY < 1 HOUR                   $     1,088.03 76000
1596208 NO COST SUPPLY                         $        1.10
1597204 STIMUPLEX CATH                         $      168.43
1597216 HOT LINE TUBING                        $      258.69
1597225 SOL NACL 0.9% HEPARIN 2U/ML            $       47.92
1598026 ENT TAMPON ADULT NASAL MEROCEL         $       83.49
1598040 PIN CAP FITS .028 .035 .045            $      209.09
1598056 STOCKING SEQUENTIAL COMPRESS           $      309.28
1598064 ENDO STEP INSUFFLATOR                  $      116.16
1598065 ENDO TROCAR 10MM STEP W/SLEEVE         $      514.01
1598091 SUT ETHILON 4-0 PS-2 18 CLEAR          $       40.27
1598093 DERMABOND                              $      168.43
1598094 SUT PDSII 7-0 BV-175-6 27 DA           $       55.99
1598101 SUT ETHILON 3-0 PS-1 18                $      133.58
1598103 ENDO SWITCH BLADE TIPS                 $      187.31
1598104 CLIP FILSHIE                           $      398.09
1598106 ENDO ELECTRODE CUTTING LOOP            $      427.13
1598110 SUT SILK 4-0 PS-2 18                   $       50.82
1598111 ENDO IRRIGATOR HYDRO-SURG PLUS         $      202.07
1598121 SUT PRONOVA 5-0 C-1 24 DA              $       89.86
1598123 TUBING INTERPULSE IRRIGATION           $      146.72
1598167 SUT UMBILICAL TAPE 2X30 ROUND          $       50.82
1598168 ENDO TROCAR SLEEVE 10/12 512ST         $      192.39
1598171 ENDO REDUCER 5.5MM R1805               $       75.02
1598172 ENDO SLEEVE VERSASTEP                  $      302.50
1598174 SUT ETHILON 4-0 PC-3 18                $       39.52
1598175 SUT ETHILON 3-0 PS-1 18                $       34.08
1598192 ENT DRILL BIT 21.5D6ST                 $      238.37
1598193 TUBE PE COLLAR BUTTON .050             $      101.64
1598194 TUBE PE SHEPARD WITH TAB .040          $       80.18
1598201 SUT NUROLON 2-0 CT-2 8-18              $      108.90
1598204 TUBE PE RICHARD T TUBE .045            $       91.14
1598211 ENDO IRRIGATION HYSTEROSCOPIC          $      367.84
1598215 SET INTUBATION CRAWFORD                $      257.73
1598234 STAPLER SKIN PROXIMATE PMW35           $      101.04
1598249 ENDO RELOAD TR35W/TR45W                $      578.38
1598273 CANNULA BISHOP HARMON                  $       67.55
1598302 BLADE CLIPPER SURGICAL                 $       79.86
1598308 SUT VICRYL 2-0 54 UNDYED               $       33.88
1598326 SUT NYLON 8-0 DRM6 SHARP POINT         $      146.41
1598327 CANNULA, ARTHRO PART/THREADED          $      156.09
1598339 ENDO STEP DILATING SLEEVE              $      387.20
1598340 ENDO VERSASTEP 12MM                    $      462.22
1598345 DURASPHERE 1ML 890-201                 $      921.28 L8603
1598346 DEFLUX INJECTION 10-92203              $     4,785.23 L8603
1598350 BLADE DERMACARRIER 1 1/2               $      130.68




                                         Page 133
                                         Ancillary


1598352 RASP MICRO RECIPROCATING               $      143.99
1598353 ENDO CLOSURE PROC/KIT CTI-512N         $      467.06
1598360 TROCAR NEEDLE 18G X 15CM               $      133.10
1598362 TUBING HTA PROCEDURE SET 55015         $     2,949.98
1598364 ARTHRO 3MM SUT TAK#2 AR1934BF2         $     1,000.30 C1713
1598368 ANCHOR,ARTHRO 6.5 SUT AR1925BF         $     1,000.30 C1713
1598369 ARTHRO 90 SUT LASSO AR4065-90W         $      551.76
1598370 SUTURE FIBREWIRE LOOP #2 AR            $      244.73
1598376 SMALL JOINT TUBING CANNULA             $      354.53
1598377 IMPLANT ORBITAL MEDPOR                 $     1,083.46 C1713
1598394 TUBING LIPOSUCTION                     $       88.33
1598400 SUT PDS 5-0 BV1 24                     $      204.49
1598401 SUT 6-0 PDS BV1 24                     $      306.13
1598410 BLADE SAW TEAR KM-82                   $      291.61
1598413 SUT POLYDEK II SILK 2-0 C4 30          $       96.80
1598414 TWIST DRILL SURGICAL 1                 $      348.48
1598419 ENDO TUBING INSUFFLATOR HI FLO         $      119.79
1598421 SUT ETHILON 6-0 P-1 18                 $       52.03
1598422 SUT ETHILON 5-0 P-3 18                 $       50.82
1598423 SUT ETHILON 5-0 P3 18 STERILE          $       50.82
1598424 SUT ETHILON 4-0 P-3 18                 $       50.82
1598427 SUT PROLENE 4-0 P-3 18                 $       60.50
1598428 SUT VICRYL 5-0 P-3 18                  $       55.66
1598429 SUT VICRYL 3-0 KS 27                   $       35.09
1598430 SUT VICRYL 5-0 PC-1 18                 $       59.29
1598432 SUT MONOCRYL 5-0 P-3 18                $       60.50
1598439 INTRODUCER SHEATH 9FR X 23CM           $       85.91 C1894
1598450 PACK LITHOTOMY                         $      104.06
1598454 ENDO CAP REDUCER 5-12MM 1SEAL          $      119.79
1598471 BIO TISSEEL SPRAY SET BAXTER           $      246.84
1598474 BLADE SAW SAGIT KM-605                 $      118.67
1598487 ANES TUBE ET REINFORCED                $      160.93
1598496 CATHETER, PORT-A-CATH SINGLE           $      891.00 C1788
1598508 CANNULA IRRIGATING 18GA ASICO          $       36.30
1598509 PACK PHACO 20,000 30K ABS MICR         $      569.91
1598510 PACK PHACO 20,000 45K ABS MICR         $      329.12
1598513 PACK PHACO 20,000 30R                  $      370.26
1598515 PACK PHACO 20,000 STANDARD             $      251.68
1598518 KNIFE ALCON 3.5MM ANGLED               $       88.33
1598520 LACRICATH 2MM 3MM 5MM                  $      704.22
1598522 DRAIN BLAKE 19FR ROUND                 $      102.74
1598525 SUT SILK 6-0 BV-1 18 DA                $       41.14
1598526 ESU ENDO DISP GRN CORD 30-1203         $       83.49
1598528 NEEDLE ASAP BIOPSY                     $      123.42
1598529 PACK PHACO 20000 FLARED TIP 3O         $      399.30
1598535 TOURNIQUET 18 SINGLE BLADDER           $      104.06
1598536 SUT ETHIBOND 2-0 RB-1 10-30 W/         $      726.00
1598538 SUT PACING WIRE BIPOLAR TEMP           $      104.06
1598539 DRAIN BLAKE 15FR ROUND                 $      133.10




                                         Page 134
                                             Ancillary


1598554 BLADE HELICUT 4.5MM                        $      290.31
1598555 BLADE ACROMIOBLASTER 4.0MM                 $      290.31
1598577 DRILL BIT 3.2MM DISPOSABLE                 $     1,030.92
1598580 SUT PANACRYL 20 CT2 UNDYED 27              $       70.18
1598583 CATH HEMOGLIDE 14.5X24 5664192             $      810.46 C1750
1598589 TUBING SMOKE EVACUATOR                     $       98.38
1598590 TUBING TO EVACUATOR MACHINE                $      133.10
1598591 KNIFE 2.8 KERATOME                         $       91.96
1598614 INTRODUCER SHEATH 6FR X 11CM               $       85.91 C1894
1598616 INTRODUCER SHEATH 8FR X 11CM               $       85.91 C1894
1598661 GLIDEWIRE SM VESSEL 46231                  $      292.60 C1769
1598662 GLIDEWIRE BENTSON 49-145                   $      141.90 C1769
1598663 GLIDEWIRE ROSEN 49-156                     $       71.50 C1769
1598665 GLIDEWIRE V-18 46-852                      $      289.30 C1769
1598678 ENDO RADIAL JAW BIOPSY 2.2MM               $      333.30
1598680 CEMENT CART.SYS 540198000                  $      473.00
1598681 FEM.PRESS.DEPUY 546126000                  $      132.00
1598682 NIGHTHAWK DIS. HOOD                        $      133.10
1598683 CANAL BRUSH 206-711                        $      115.50
1598684 ALUMI-HAND IMMOBLZR 760                    $      137.50
1598685 BLADE INCISOR 2.9MM 7209065                $      380.60
1598686 ENDO TROCAR XCEL 12MM                      $      352.00
1598687 ENDO SLEEVE XCEL 12MM CB12LT               $      207.90
1598688 ENDO TROCAR XCEL 11MM B11LT                $      342.10
1598689 ENDO TROCAR XCEL 5MM B5LT                  $      269.50
1598690 ENDO SLEEVE XCEL 5MM CB5                   $      162.80
1598691 ENDO STRYKEFLOW II 250-070-500             $      193.60
1598692 SUT CHROMIC 3-0 CT1 810H                   $       34.10
1598693 ENDO STARION SHEAR        102-137D         $     1,446.50
1598694 TUBING ARTHRO PUMP DYONICS                 $      149.60
1598695 ENDO LAP DISC HAND DVICE LD111             $     1,761.10
1598696 ENDO TIP COVER INTUI 400180-0              $      150.70
1598698 FEMORAL BRUSH 5461-22-000                  $      121.00
1598700 SUT VICRYL 1 OS-8 J718T                    $       79.20
1598701 SUT VICRYL 2-0 CTX J363H                   $       30.80
1598702 BLADE SAW KOMET 11-2222                    $      122.10
1598703 BAG COLOSTOMY GENTLE 1.75                  $      196.90
1598704 ENDO PCH TISS RTRVL (054100)               $      155.10
1598705 SUT VICRYL 7-0 TG160-8 18                  $       73.70
1598706 STAPLER SURGICLIP 9.5                      $      752.31
1598707 CATH HICKMAN 1.6MM PREATTACHAB             $      867.90 C1751
1598708 ESU DISSECT SEALER TISSUELINK              $     3,839.00
1598709 SUT PDSII 2-0 CT-2 27                      $       35.37
1598710 ANES PRESSURE BAG DISP                     $      101.20
1598711 PERF MUF PACK                              $      405.90
1598712 PERF CANISTER BLUE                         $       38.50
1598713 PERF ADAPTER PACK INFANT                   $      345.40
1598714 PERF PUMP PACK MEMBRANE                    $      409.20
1598715 PERF TABLE PACK PED                        $      259.60




                                             Page 135
                                         Ancillary


1598716 PERF OXYGENATOR MINIMAX PED            $     983.40
1598717 PERF ISOLYZER                          $      29.70
1598718 PERF CELL SAVER BRAT KIT 135ML         $     354.20
1598719 PERF SPIKE LINE                        $      46.20
1598720 PERF ARTERIAL FILTER                   $     152.90
1598721 INSTRUMENT SET CJD                     $     980.10
1598722 TOOL BLACK MAX CUTTER BLU-8            $     270.60
1598723 TOOL BLACK MAX CUTTER BLU-5            $     341.00
1598724 TOOL BLACK MAX CUTTER BLU-4            $     341.00
1598725 TOOL BLACK MAX CUTTER GRE-1            $     270.60
1598726 TOOL BLACK MAX CUTTER GRE-1S           $     270.60
1598727 TOOL BLACK MAX CUTTER SIL-0            $     248.60
1598728 TOOL BLACK MAX CUTTER SIL-8            $     270.60
1598729 TOOL BLACK MAX CUTTER SIL-15           $     440.00
1598730 TOOL BLACK MAX CUTTER RED-4            $     341.00
1598731 TOOL BLACK MAX CUTTER RED-8            $     341.00
1598732 TOOL BLACK MAX GREY-MIA20-8            $     376.20
1598733 TOOL BLACK MAX GREY-MIA20-17-7         $     383.90
1598734 TOOL MICRO MAX CUTTER L-8NS-M          $     289.30
1598735 TOOL MICRO MAX CUTTER L-5B             $     298.10
1598736 TOOL MICRO MAX CUTTER L-4B             $     298.10
1598737 TOOL MICRO MAX CUTTER QD11-8NS         $     315.70
1598738 TOOL MICRO MAX CUTTER QD14-8NS         $     294.80
1598739 TOOL MIDAS REX G8-350                  $     330.00
1598740 TOOL MIDAS REX G12-130                 $     412.50
1598741 TOOL MIDAS REX G12-350                 $     339.90
1598742 TOOL MIDAS REX G16-130                 $     342.10
1598743 TOOL MIDAS REX G16-360                 $     352.00
1598744 TOOL MIDAS REX G16-570                 $     359.70
1598745 TOOL MIDAS REX A9                      $     298.10
1598746 TOOL MIDAS REX AF7                     $     258.50
1598747 TOOL MIDAS REX AF8                     $     258.50
1598748 TOOL MIDAS REX AM9                     $     330.00
1598749 TOOL MIDAS REX AM2                     $     313.50
1598750 TOOL MIDAS REX AM24                    $     352.00
1598751 TOOL MIDAS REX AM31                    $     328.90
1598752 TOOL MIDAS REX AM32                    $     328.90
1598753 TOOL MIDAS REX AM33                    $     328.90
1598754 TOOL MIDAS REX AM3                     $     465.30
1598755 TOOL MIDAS REX AM51                    $     389.40
1598756 TOOL MIDAS REX AM52                    $     420.20
1598757 TOOL MIDAS REX O 1                     $     280.50
1598758 TOOL MIDAS REX O 3                     $     280.50
1598759 TOOL MIDAS REX M31                     $     321.20
1598760 TOOL MIDAS REX M32                     $     321.20
1598761 TOOL MIDAS REX M33                     $     321.20
1598762 TOOL MIDAS REX R1                      $     325.60
1598763 TOOL MIDAS REX R3                      $     325.60
1598764 TOOL MIDAS REX R370DXC                 $     375.10




                                         Page 136
                                        Ancillary


1598765 TOOL MIDAS REX R350DXC                $      375.10
1598766 TOOL MIDAS REX TU8                    $      325.60
1598767 TOOL MIDAS REX WH31                   $      331.10
1598768 SYMMETRY SYSTEM GRAY                  $     1,446.50
1598769 SYMMETRY SYSTEM GREEN                 $     1,446.50
1598770 SYMMETRY SYSTEM BLUE                  $     1,446.50
1598771 SYMMETRY SYSTEM PURPLE                $     1,446.50
1598772 SYMMETRY SIZERS DISPOSABL             $       52.80
1598773 PERF CDI 500 SHUNT SENSOR             $      528.00
1598774 PERF HEMOCONCENTRATOR ADULT           $      435.53
1598775 PERF OXYGENATOR LILLIPUT PED          $     1,279.30
1598776 PERF LIVER ASSIST PACK                $     1,125.30
1598777 TUBING CUSA MANIFOLD                  $      481.80
1598778 CANNULA VENOUS WILLIAM HARVEY         $      106.70
1598779 PERF RAPID INFUSION SET               $     1,607.10
1598780 WAND 4.5 90DEG A1345-01               $      583.00
1598781 GUIDEWIRE BENTSON .035                $      130.90 C1769
1598782 SMOKE HOUSE FILTER                    $       69.30
1598783 BLADE SYNOVATOR 4.5MM                 $      263.92
1598784 BLADE STONECUTTER 5.5MM               $      263.92
1598785 BLADE ABRADER 2.9MM                   $      263.92
1598786 BLADE ORBIT INCISOR 4.5MM             $      329.08
1598787 BLADE ORBIT INCISOR PLUS              $      329.08
1598788 BLADE CONCAVE INCISOR                 $      329.08
1598789 BLADE CONCAVE FULL RADIUS             $      329.08
1598790 STENT URETER 4.7FR X 18CM             $      435.60
1598791 PERF KIT ARTERIAL BIOMEDICUS          $      626.93
1598792 PERF KIT VENOUS BIOMEDICUS            $      636.57
1598793 ARTHRO WAND 3.0 /3.5 /3.75 MM         $      663.30
1598794 PERF INTRAAORTIC BALLOON              $     2,218.37
1598795 WAND 3.0 50DEG AS2530-01              $      663.30
1598796 WAND 3.6 90DEG A1336-01               $      583.00
1598797 PERF QUICK PRIME LINE                 $       97.16
1598798 PERF CPDA-1 BLOOD BAG                 $       57.68
1598799 ENDO FORCEPS CUTTING 3005PK           $      983.40
1598800 PERF MEMBRANE OXYGENTOR H/E           $     2,580.60
1598801 CATH VNUS 8FR                         $     2,797.30 C1760
1598802 CATH VNUS 6FR                         $     2,797.30 C1760
1598803 PACK VNUS CLOSURE PROCEDURE           $      502.70
1598804 ENDO CLIP APPLIER 5MM                 $      622.60
1598805 TOOL DIAMOND BALL                     $      337.70
1598806 TOOL DIAMOND BALL 3MM QD8-3SD         $      337.70
1598807 TOOL DIAMOND BALL                     $      347.60
1598808 TOOL FLUTED BALL                      $      337.70
1598809 TOOL DIAMOND BALL 4MM QD8-4SD         $      337.70
1598810 TOOL DIAMOND BALL 5MM QD8-5D          $      321.20
1598811 ESU INSULATED COATED BLADE            $       69.30
1598812 WAND 3.0 CAPSURE A1830-01             $     1,041.70
1598813 WAND 2.5MM A2723-01                   $      583.00




                                        Page 137
                                         Ancillary


1598814 WAND 3.0 45DEG A1630-01                $     1,041.70
1598815 TRANSFIX KIT AR-1978S                  $      559.90
1598816 TIB TUNNEL CANN AR-1802D               $      140.80
1598817 ESTECH OPVAC SYNERGY PLUS              $     1,350.80
1598818 ESU TAC-S EFLEX 7209637                $     1,925.00
1598819 ESU LIG CHISEL EFLEX 7209663           $     1,805.10
1598820 ESTECH PYRAMID POSITIONER              $      675.40
1598821 ENDO CLIP LARGE USSC 176625            $      421.30
1598822 TOOL MIDAS REX DISSECT 7BA20           $      376.20
1598823 TOOL MIDAS REX DISSECT 7BA20D          $      403.70
1598824 TOOL MIDAS REX DISSECT 7BA30           $      376.20
1598825 TOOL MIDAS REX DISSECT 7BA30D          $      403.70
1598826 TOOL MIDAS REX DISSECT 7BA40           $      376.20
1598827 TOOL MIDAS REX DISSECT 7BA40D          $      403.70
1598828 TOOL MIDAS REX DISSECT 7BA50           $      403.70
1598829 TOOL MIDAS REX DISSECT 7BA50D          $      403.70
1598830 TOOL MIDAS REX DISSECT 8TD156          $      303.60
1598831 TOOL MIDAS REX DISSECT 8TD114          $      319.00
1598832 TOOL MIDAS REX DISSECT 8TD114          $      319.00
1598833 TOOL MIDAS REX DISSEC F2/8TA23         $      349.80
1598834 TOOL MIDAS REX DISSECT 9AC90           $      399.30
1598835 TOOL MIDAS REX DISSECT 21BA60          $      480.70
1598836 TOOL MIDAS REX DISSECT 21MH30          $      426.80
1598837 CANNULA 5.75MM X 7 CM -CRYSTAL         $      137.50
1598838 CANNULA 8.25MM X 7 CM AR 6530          $      137.50
1598839 CANNULA 7MM X 7CM AR 6550              $      141.90
1598840 LASER FIB SHARPLAN 200MICRON           $     3,819.20
1598841 LASER FIB SHARPLAN 300MICRON           $     3,472.70
1598842 LASER FIB SHARPLAN 365MICRON           $     1,562.00
1598843 LASER FIB SHARPLAN 550MICRON           $     1,562.00
1598844 LASER FIB SHARPLAN 1000MICRON          $     3,472.70
1598845 LASER FIB SLIMLINE 200MICRON           $     4,629.90
1598846 LASER FIBER 1                          $     1,678.60
1598847 LASER FIB SLIMLINE 550MICRON           $     1,986.60
1598848 LASER FIB SLIMLINE 1000MICRON          $     2,681.80
1598850 BASKET GEMINI 3FR                      $      673.20
1598851 BASKET ZERO TIP 2.4FR                  $      711.70
1598852 BASKET 11M GU6354                      $      397.10
1598853 BASKET 8MM GU6350                      $       66.00
1598854 ESU TIP CLEANER                        $       56.10
1598855 BASKET 15MM GU6358                     $     1,100.00
1598856 CATH CHIOU SP 075920                   $      488.40
1598857 BASKET LITHOCATCH 2.2F 840-412         $      673.20
1598858 BASKET PARACHUTE 3.1FR 320302          $      735.90
1598859 BASKET SEGURA 3FR                      $      718.30
1598860 WIRE ST .035 630-100                   $      189.20 C1769
1598861 WIRE ANGLED .035 630-102               $      189.20 C1769
1598862 WIRE STIFF ST.035 630-109              $      337.07 C1769
1598863 WIRE STIF ANG.035 630-110              $      250.80 C1769




                                         Page 138
                                         Ancillary


1598864 WIRE ANG GOLD .018 46-242              $      598.40 C1769
1598865 WIRE V-18 .018 46-850                  $      330.00 C1769
1598866 NEEDLE MAYO TAPER #3                   $       36.30
1598867 WIRE ZEBRA .035 670-112                $      254.10 C1769
1598868 WIRE BENTSON .035 635497               $      172.98 C1769
1598869 WIRE .035 THSF-035145-AUS              $      130.90 C1769
1598870 WIRE .038 THSF-038145-AUS              $      130.90 C1769
1598871 NEEDLE MAYO TAPER 209501               $       36.30
1598872 WIRE NITNOL .018 US-1806               $      347.60 C1769
1598873 WIRE .035 MD-082                       $      397.10 C1769
1598874 WIRE NITNOL .018 N180802               $      322.30 C1769
1598875 NEEDLE MAYO TAPER #6                   $       36.30
1598876 CATH FOLEY 22FR 30CC SILICONE          $      106.70
1598877 GLIDEX MAGIC TORQ 46-591               $      260.70
1598878 GUIDEWIRE AMPLATZ 526                  $      858.00 C1769
1598879 GUIDEWRIE AMPLATZ 525                  $      819.50 C1769
1598880 NEEDLE ANGIO ENTRY 18GA 44-163         $       61.60
1598885 CATH VS3 5-38-80     245835            $      100.74
1598886 FLOW CONTRL DEVICE 15-300              $       93.50
1598887 CATH GLIDECATH .038X100 32-160         $      266.20 C1750
1598888 CATH GLIDECATH .038X100 32-154         $      272.80 C1750
1598889 CATH GLIDECATH .038X100 32-151         $      272.80 C1750
1598890 CATH GLIDECATH .038X100 32-146         $      272.80 C1750
1598891 CATH GLIDECATH .038 X65 32-145         $      272.80 C1750
1598892 CATH GLIDECATH .038 X65 32-142         $      266.20 C1750
1598893 CATH BALLOON DILATION 14-552           $      922.90 C1726
1598894 CATH BALLOON DILATION 14-514           $      812.90 C1726
1598895 CATH BALLOON DILATION 14-510           $      812.90 C1726
1598896 STAPLER SIZERS EEA                     $     1,043.12
1598897 CATH MAHURKAR 10FR X 12CM              $      335.29 C1750
1598898 CATH MAHURKAR 8FR X 12CM               $      269.23 C1750
1598899 CATH MAHURKAR 11.5FR X 16CM            $      187.86 C1750
1598900 ENDO SUCTION VALVE                     $       66.73
1598901 CATH MAHURKAR 13.5FR X 45CM            $      485.66 C1750
1598902 CATH MAHURKAR 13.5FR X 50CM            $      498.33 C1750
1598903 CATH GROSHONG 9.5FR DUAL LUMEN         $     1,481.70 C1750
1598904 ENDO BIOPSY VALVE                      $       36.51
1598905 CATH CURLCATH 57CM                     $      381.70 C1750
1598906 CATH CURLCATH 39CM                     $      381.70 C1750
1598907 CANNULA AORTIC ROOT VENT PEDS          $       98.24
1598908 SUT GORETEX CV-6 TT-13 18              $      143.00
1598909 CATH URETERAL PIGTAIL 6 X 70           $      183.70 C1758
1598910 LENS GLIDE                             $       63.80
1598911 SUT GORETEX CV-0 THX-26                $      136.40
1598912 CATH URETERAL WHISTLE 5FR RT           $       77.00 C1758
1598913 BASKET GEMINI 3FR 330-109              $      673.20
1598914 BASKET ZERO TIP 2.4FR 390-101          $      711.70
1598915 BASKET 11M GU6354                      $      247.50
1598916 BASKET 8MM GU6350                      $      397.10




                                         Page 139
                                         Ancillary


1598917 ESU TIP CLEANER                        $       56.10
1598918 BASKET, RETRIEVAL                      $      488.40
1598919 CATH CHIOU SP 075920                   $      488.40
1598920 BASKET LITHOCATCH 2.2F 840-412         $      673.20
1598921 BASKET PARACHUTE 3.1FR 320302          $      735.90
1598922 BASKET SEGURA 3FR 380-112              $      718.30
1598923 WIRE ST .035 630-100                   $      189.20 C1769
1598924 WIRE ANGLED .035 630-102               $      189.20 C1769
1598925 WIRE STIFF ST.035 630-109              $      337.07 C1769
1598926 WIRE STIF ANG.035 630-110              $      250.80 C1769
1598927 WIRE ANG GOLD .018 46-242              $      598.40 C1769
1598928 WIRE V-18 .018 46-850                  $      330.00 C1769
1598929 NEEDLE MAYO TAPER #3                   $       36.30
1598930 WIRE ZEBRA .035 670-112                $      254.10 C1769
1598931 WIRE BENTSON .035 635497               $      172.98 C1769
1598932 WIRE .035 THSF-035145-AUS              $      130.90 C1769
1598933 WIRE .038 THSF-038145-AUS              $      130.90 C1769
1598934 NEEDLE MAYO TAPER 209501               $       36.30
1598935 WIRE NITNOL .018 US-1806               $      347.60 C1769
1598936 WIRE .035 MD-082                       $      397.10 C1769
1598937 WIRE NITNOL .018 N180802               $      322.30 C1769
1598938 NEEDLE MAYO TAPER #6                   $       36.30
1598939 AMPLTZ SHEATH 16F 260-146              $      212.30
1598940 CATHETER, NEPHROMAX 210-118            $      944.90 C1729
1598941 NEEDLE MAYO TROCAR #6                  $       36.30
1598942 CATHETER, UROMAX ULTRA 225-122         $      781.00 C1726
1598943 FORCEP BX PIRANHA 505-160              $     1,233.10
1598944 CATH FOLEY 28FR (0166V28S)             $       58.30
1598945 COOK FORCEP CUP 220130                 $     1,184.70
1598946 CATH FOLEY 16FR 30CC 3-WAY             $      100.73
1598947 CATH NEPH 8FR X 25CM 27-179            $      410.30 C1729
1598948 TUBING CYSTO IRRIGATION                $      376.96
1598949 CATH NEPH 12FR X 25CM 27-181           $      410.30 C1729
1598950 INTRO BLUE-ON-BLUE 8FR 260-120         $      199.10
1598951 INTRODUCER ACCUSTICK 20-705            $      243.10
1598952 INTRODUCER ACCUSTICK 20-604            $      102.30
1598953 DILATOR 10FR 072110                    $       71.50
1598954 CATH URETERAL 5FR 021415-S1            $      103.49 C1758
1598956 CATH FOLEY 18FR 5CC 3-WAY              $      450.07
1598957 CATH FOLEY 30FR 30CC 2-WAY             $       57.20
1598958 CATHETER MAZER 6FR MASC-060060         $       79.20 C2617
1598959 CATHETER OPEN-END 4FR 020014           $       77.00 C1758
1598960 CATH COBRA 6FR 023806                  $      134.20
1598961 CATH JB1(PINK) CEREBRAL 004057         $      124.30
1598962 CATH COUNCILL 16FR/5CC 0196L16         $      132.00
1598963 CATH COUNCILL 18FR/5CC 0196L18         $      132.00
1598964 CATH COUNCILL 20FR/5CC 0196L20         $      132.00
1598965 CATH COUNCILL 22FR/5CC 0196L22         $      132.00
1598966 CATH COUDE 12FR/5CC 0168L12            $      101.20 C1729




                                         Page 140
                                         Ancillary


1598967 CATH COUDE 16FR/5CC 0168L16            $     101.20 C1729
1598968 CATH COUDE 18FR/5CC 0168L18            $     101.20 C1729
1598969 CATH COUDE 20FR/5CC 0168L20            $     101.20 C1729
1598970 CATH COUDE 22FR/5CC 0168L22            $     101.20 C1729
1598971 CATH SILICONE 8FR/3CC 165808           $      52.80 C1729
1598972 CATH SILICONE 10R/3CC 165810           $      52.80 C1729
1598973 CATH SILICONE 12FR/5CC 165812          $      51.70 C1729
1598974 CATH SILICONE 12FR/5CC 165813          $      51.70 C1729
1598975 CATH SILICONE 18FR/5CC 165818          $      51.70 C1729
1598976 NEEDLE MAYO TROCAR #4                  $      36.30
1598977 CATH SILICONE 22FR/5CC 165822          $      51.70 C1729
1598978 CATH FOLEY 16FR 30CC 2-WAY             $     540.08
1598979 NEEDLE MAYO TROCAR #5                  $      36.30
1598980 CATH SILICONE 24FR/5CC 165824          $      51.70 C1729
1598981 CATH SILICONE 20FR/30CC 166820         $      67.10 C1729
1598982 CATH SILICONE 22FR/30CC 166822         $      67.10 C1729
1598983 NEEDLE KEITH                           $      36.30
1598984 CATH SILICONE 24FR/30CC 166824         $      67.10 C1729
1598985 CATH JB1 004022                        $     117.70
1598986 CATH TEGT 5-35-100     189775          $     127.60
1598987 CATH H1 5-38-100     214183            $     139.70
1598988 NEEDLE BUNNELL                         $      36.30
1598989 CATHETER, HICKMAN 16.2FR DUAL          $     452.10 C1751
1598990 TUBING DOLPHIN II DOL-TUB              $     304.70
1598991 TUBE VACTNR 4ML LVNDR (367861)         $      75.90
1598992 CANNULA HYDR/DST 25GX22 585037         $      48.40
1598993 TOOL MIDAS REX LEGEND (14BA75)         $     431.20
1598994 ESU CUTTING LOOP 24FR 27050GS          $     398.20
1598995 ELC URINARY DRAIN BAG 154002           $      49.28
1598996 TOOL MIDAS REX LEGEND (14BA90)         $     431.20
1598997 CATH KUMPE 4.1FR 217465                $     366.30
1598998 DERMABOND PROPEN TOPICAL SKIN          $     156.20
1599000 OPTHALMIC SURG KIT                     $      29.70
1599054 ENT COBLATOR REFLEX ULTRA 45 W         $     540.10
1599068 ENT COBLATOR EVAC 70 EXTRA WC          $     586.30
1599074 PACK, CUSTOM MAJOR ORTHO               $     390.50
1599075 KYPHON BONE BIOSPY CUTTER              $     557.70
1599077 TRAY UROLOGIST OBSTRUCT URETHR         $     419.45
1599109 CANNULA AORTIC ROOT                    $      64.90
1968000 CEMENT CART.SYS 540198000              $     473.00
1570004 SOL D5W 250ML GLASS                    $     543.70
1570005 SOL D5W 50ML                           $     543.70
1570006 SOL NACL 0.9%                          $     453.08
1590004 SOL D5W 250ML GLASS                    $     543.70
1590005 SOL D5W 50ML                           $     543.70
1590006 SOL NACL 0.9%                          $     453.08
1700001 IV BLOOD FILTER PALL                   $     137.73
1700002 IV BLOOD PUMP Y-TYPE                   $     269.68
1700003 SOL D5W 100ML                          $     469.73




                                         Page 141
                                         Ancillary


1700004 SOL D5W 250ML GLASS                    $      543.70
1700005 SOL D5W 50ML                           $      543.70
1700006 SOL NACL 0.9%                          $      453.08
1700008 SOL NORMISOL 1000CC                    $      543.70
1700437 IV BLOOD PUMP Y-TYPE                   $      269.68
1700439 IV TUBING ADMIN SET                    $      166.74
1700442 IV TUBING EXTENSION                    $      123.23
1700445 BUTTERFLY, IV INFUSION                 $       75.50
1700448 IV METRISET                            $      234.44
1700463 CATH FOLEY TRAY                        $      289.98
1700464 CATH FOLEY                             $      540.08
1700469 CATH ROBINSON                          $      277.57
1700544 MISCELLANEOUS SUPPLY                   $          -
1700614 ABDOMINAL BINDER                       $      593.26
1700744 IV MICRODRIP SET                       $      639.40
1700825 SECONDARY PIGGY BACK                   $      330.55
1700883 TUBE, TRACHEOSTOMY 1                   $      216.60
1700991 SOL IV 250CC                           $      543.70
1700992 SOL IV 500CC                           $      547.00
1700993 SOL IV 1000CC                          $      543.70
1701140 DRAIN AUTOTRANSFUSION ZIMMER           $      499.40
1701551 IV FILTER BLOOD                        $      111.10
1704550 PACU - 1ST HOUR                        $     2,249.94
1704551 PACU - EA ADDL MINUTE                  $       35.81
1704552 OXYGEN ADMIN - 1ST HOUR                $      254.10
1704553 OXYGEN ADMIN - EA ADDL MIN             $        3.87
1708056 STOCKING SEQUENTIAL COMPRESS           $      234.30
1708060 DRAIN PLEUR-EVAC ADULT/PEDS            $      190.30
1708098 OXISENSOR                              $      109.56
1708382 IV PCA TUBING                          $       59.40
1960004 SOL D5W 250ML GLASS                    $      543.70
1960005 SOL D5W 50ML                           $      543.70
1960006 SOL NACL 0.9%                          $      453.08
1800001 DIABETES EDUCATION INIT 1 HR           $      259.70
1800002 DIABETES EDUCATION ADDL 30 MIN         $      134.43
1810003 ENDO/DIABETES NEW PT., LEVEL1          $      129.05 99201
1810004 ENDO/DIABETES NEW PT., LEVEL 2         $      140.68 99202
1810005 ENDO/DIABETES NEW PT., LEVEL 3         $      185.80 99203
1810006 ENDO/DIABETES NEW PT., LEVEL 4         $      232.80 99204
1810007 ENDO/DIABETES NEW PT., LEVEL 5         $      296.74 99205
1810008 ENDO/DIABETES EST.PT., LEVEL1          $      129.05 99211
1810009 ENDO/DIABETES EST.PT., LEVEL 2         $      140.68 99212
1810010 ENDO/DIABETES EST.PT., LEVEL 3         $      160.78 99213
1810011 ENDO/DIABETES EST. PT.LEVEL 4          $      204.38 99214
1810012 ENDO/DIABETES EST.PT.LEVEL 5           $      291.00 99215
1810203 BONE CENTER NEW, LEVEL1                $      129.05 99201
1810204 BONE CENTER NEW PT., LEVEL 2           $      140.68 99202
1810205 BONE CENTER NEW PT., LEVEL 3           $      185.80 99203
1810206 BONE CENTER NEW PT., LEVEL 4           $      232.80 99204




                                         Page 142
                                         Ancillary


1810207 BONE CENTER NEW PT., LEVEL 5           $     296.74 99205
1810208 BONE CENTER EST.PT., LEVEL1            $     129.05 99211
1810209 BONE CENTER EST.PT., LEVEL 2           $     140.68 99212
1810210 BONE CENTER EST.PT., LEVEL 3           $     160.78 99213
1810211 BONE CENTER EST. PT.LEVEL 4            $     204.38 99214
1810212 BONE CENTER EST.PT.LEVEL 5             $     291.00 99215
1810303 RHEUMATOLOGY NEW, LEVEL1               $     129.05 99201
1810304 RHEUMATOLOGY NEW PT., LEVEL 2          $     140.68 99202
1810305 RHEUMATOLOGY NEW PT., LEVEL 3          $     185.80 99203
1810306 RHEUMATOLOGY NEW PT., LEVEL 4          $     232.80 99204
1810307 RHEUMATOLOGY NEW PT., LEVEL 5          $     296.74 99205
1810308 RHEUMATOLOGY EST.PT., LEVEL1           $     129.05 99211
1810309 RHEUMATOLOGY EST.PT., LEVEL 2          $     140.68 99212
1810310 RHEUMATOLOGY EST.PT., LEVEL 3          $     160.78 99213
1810311 RHEUMATOLOGY EST. PT.LEVEL 4           $     204.38 99214
1810312 RHEUMATOLOGY EST.PT.LEVEL 5            $     291.00 99215
1810600 DIABETES TEACH, IND PER 30 MIN         $     176.74 G0108
1810601 DIABETES TEACH, GRP PER 30 MIN         $     194.07 G0109
1810604 ROUTINE ECG                            $     411.90 93005
1810605 DIABETES FU-CDE-INDIV                  $     176.74 G0108
1810606 DIABETES BRIEF FU-CDE-INDIV            $     176.74 G0108
1810608 ADMIN INFLUENZA VACCINE                $      70.69 G0008
1810609 ADMIN PNEUMOCOCCAL VACCINE             $      70.69 G0009
1810610 ADMIN HEPATITIS B VACCINE              $      70.69 G0010
1810612 THERAPEUTIC INJ SC IM                  $     100.00 90772
1830202 MED NEW PT., LEVEL 1                   $     129.05 99201
1830203 MED NEW PT., LEVEL 2                   $     140.68 99202
1830204 MED NEW PT., LEVEL 3                   $     185.80 99203
1830205 MED NEW PT., LEVEL 4                   $     232.80 99204
1830206 MED NEW PT., LEVEL 5                   $     296.74 99205
1830207 MED EST. PT., LEVEL 1                  $     129.05 99211
1830208 MED EST. PT., LEVEL 2                  $     140.68 99212
1830209 MED EST. PT., LEVEL 3                  $     160.78 99213
1830210 MED EST. PT., LEVEL 4                  $     204.38 99214
1830211 MED EST. PT., LEVEL 5                  $     291.00 99215
1850201 SPINE CTR NEW PT., LEVEL 1             $     129.05 99201
1850202 SPINE CTR NEW PT., LEVEL 2             $     140.68 99202
1850203 SPINE CTR NEW PT., LEVEL 3             $     160.78 99203
1850204 SPINE CTR NEW PT., LEVEL 4             $     204.38 99204
1850205 SPINE CTR NEW PT., LEVEL 5             $     291.00 99205
1850211 SPINE CTR EST. PT., LEVEL 1            $     129.05 99211
1850212 SPINE CTR EST. PT., LEVEL 2            $     140.68 99212
1850213 SPINE CTR EST. PT., LEVEL 3            $     185.80 99213
1850214 SPINE CTR EST. PT., LEVEL 4            $     232.80 99214
1850215 SPINE CTR EST. PT., LEVEL 5            $     296.74 99215
1860002 IV INFUSION THERAPY 1ST HR ARG         $     615.80 90765
1860003 IV INFUSION THERAPY EA ADDL HR         $     134.30 90766
1860012 GLUCOSE TOLERANCE TEST                 $     650.48 82951
1860022 IV PUSH INITIAL (RAPID ACTH)           $     270.35 90774




                                         Page 143
                                         Ancillary


1860062 IV INFUSION THERAPY SEQ (ARG)          $       134.30 90767
1860077 IM/SC INJECTION                        $       100.00 90772
1860078 IV PUSH INITIAL                        $       270.35 90774
1860080 EKG                                    $       411.90 93005
1860081 VENIPUNCTURE                           $        49.21 36415
1860202 PITUITARY NEW PT., LEVEL 1             $       129.05 99201
1860203 PITUITARY NEW PT., LEVEL 2             $       140.68 99202
1860204 PITUITARY NEW PT., LEVEL 3             $       185.80 99203
1860205 PITUITARY NEW PT., LEVEL 4             $       129.05 99211
1860206 PITUITARY NEW PT., LEVEL 5             $       296.74 99205
1860207 PITUITARY EST. PT., LEVEL 1            $       129.05 99211
1860208 PITUITARY EST. PT., LEVEL 2            $       140.68 99212
1860209 PITUITARY EST. PT., LEVEL 3            $       160.78 99213
1860210 PITUITARY EST. PT., LEVEL 4            $       204.38 99214
1860211 PITUITARY EST. PT., LEVEL 5            $       291.00 99215
1860223 IV PUSH EA ADDL SEQUENTIAL             $       270.35 90775
1954100 MAJOR I - 1ST HOUR                     $     15,135.12
1954101 MAJOR I - EA ADDL MINUTE               $       150.90
1954102 MAJOR 2 - 1ST HOUR                     $     12,864.85
1954103 MAJOR 2 - EA ADDL MINUTE               $       120.50
1954104 MAJOR 3 - 1ST HOUR                     $     10,897.29
1954105 MAJOR 3 - EA ADDL MINUTE               $        91.22
1954106 MINOR 1 - 1ST HOUR                     $      7,783.13
1954107 MINOR 1 - EA ADDL MINUTE               $        67.57
1954108 MINOR 2 - 1ST HOUR                     $      4,139.30
1954109 MINOR 2 - EA ADDL MINUTE               $        53.90
1955000 BEDSIDE PROCEDURE - MAJOR              $      5,675.67
1955001 BEDSIDE PROCEDURE - MINOR              $      2,342.34
 173082 SHEATH KIT P03360                      $        70.40
 590803 ROD, ORTHO/SPINE 8                     $      5,005.00 C1713
1700007 ALARIS TUBING                          $        51.70
1700476 BAG DRAINAGE URINARY                   $       289.98
1960000 ANES TUBE ET                           $       204.45
1960001 IV BLOOD FILTER PALL                   $       137.73
1960002 IV BLOOD PUMP Y-TYPE                   $       269.68
1960003 SOL D5W 100ML                          $       469.73
1960007 CATH FOLEY 28FR (0166V28S)             $        58.30
1960069 CANNULA, AORTIC PERFUSOR               $       286.95
1960070 CANNULA FEMORAL ARTERY                 $       325.88
1960071 CANNULA, CORONARY PERF                 $       538.92
1960072 SUT PACING WIRE TEMPORARY 2/PK         $       313.21
1960074 CANNULA VENOUS DUAL DRAIN 3240         $       386.56
1960086 LASER CO2 INFRAGUIDES                  $      1,323.10
1960312 PACK, CUSTOM PROCEDURE                 $      1,471.58
1960325 PREP DURA                              $        84.59
1960328 CANNULA IMA                            $       112.38
1960330 SUCTION MINI POINT WAND                $       143.83
1960331 CANNULA OPS VALVE                      $       170.80
1960344 CANNULA VENOUS                         $       231.48




                                         Page 144
                                        Ancillary


1960407 TUBE, ENDOTRACHEAL ADULT              $      204.45
1960408 TUBE, ENDOTRACHEAL                    $      173.98
1960409 CATH EPIDURAL NON-VENTED              $      112.38
1960410 ANES TRAY EPIDURAL                    $      753.41
1960417 SOL D5W 250 ML GLASS                  $      543.70
1960419 SOL D5W 50CC                          $      543.70
1960420 SOL D5W 100CC                         $      469.73
1960423 SOL 0.9% NACL 100CC                   $      453.08
1960429 SOL NORMISOL 1000CC                   $      543.70
1960432 IV TRANSFER PACK 1000ML               $      137.72
1960433 IV BLOOD FILTER PALL                  $      137.73
1960437 IV BLOOD PUMP Y-TYPE                  $      269.68
1960439 IV TUBING ADMIN SET                   $      166.74
1960442 IV TUBING EXTENSION                   $      123.23
1960445 IV INFUSION BUTTERFLY                 $       75.50
1960448 IV METRISET                           $      213.13
1960457 CATH FOGARTY IRRIGATION 6FR           $      516.90 C1757
1960458 CATH FOGARTY EMBOL SHORT              $     1,087.39 C1757
1960459 CATH FOGARTY EMBOL LONG               $      950.65 C1757
1960460 CATH FOGARTY EMBOLECTOMY 10FR         $      280.93 C1757
1960463 CATH FOLEY TRAY                       $      289.98
1960464 CATH FOLEY                            $      540.08
1960469 CATH ROBINSON                         $      252.30
1960470 CATH THORACIC                         $      478.46
1960476 BAG DRAINAGE URINARY                  $      289.98
1960480 DRAIN HEMOVAC                         $     2,413.99
1960485 JACKSON-PRATT TUBING                  $      452.35
1960486 DRAIN JACKSON PRATT RESERVOIR         $      347.96
1960489 CATH MALECOT 34FR                     $      179.80 C2627
1960490 CATH PEZZER                           $      179.80 C2627
1960495 T - TUBE                              $      110.12
1960496 CATH COUDE 18FR 5CC                   $      143.83 C1726
1960509 TUBING CYSTO IRRIGATION               $      452.35
1960510 BLADE, DERMATOME/MICROTOME            $      310.68
1960521 HEMOCLIP                              $       65.25
1960522 LIGACLIP                              $      121.77
1960538 TUBING TUR Y-SET IRRIGATION           $      452.35
1960539 STRIPPER VEIN DISPOSABLE              $      294.50
1960544 MISCELLANEOUS SUPPLY                  $          -
1960563 TRAY FOLEY UROTRACK PLUS 16FR         $      764.81
1960585 CANNULA ANTERIOR CHAMBER              $      164.52
1960610 SOL BSS PLAIN 500CC                   $      748.17
1960614 ABDOMINAL BINDER                      $      481.54
1960617 ESU ACCUTEMP CAUTERY                  $      362.47
1960629 IV BAG-O-JET                          $      116.50
1960630 BLADE BEAVER                          $       57.00
1960640 DISPOSABLE BLADES                     $      946.70
1960647 CATH BONANO                           $      370.82
1960655 CATHETER INTRODUCER                   $      385.11 C1892




                                        Page 145
                                       Ancillary


1960656 CATH FOLEY W/THERMISTER              $      221.11
1960666 COLOSTOMY BAG                        $      204.96
1960667 COLOSTOMY CLAMP                      $      133.49
1960669 UNIPACK 10000                        $      475.74
1960676 TUBE CULTURE                         $      187.02
1960678 NEEDLE CYSTOME                       $      124.28
1960689 DRILL BIT                            $     1,096.11
1960698 PACK CUSTOM EYE STERILE              $      909.39
1960707 FRAZIER SUCTION TIPS                 $      221.84
1960715 GREISHABER MICRO KNIFE               $     1,181.24
1960728 UTERINE MANIPULATOR                  $      475.74
1960744 IV MICRODRIP SET                     $      639.40
1960763 FEMORAL BRUSH                        $      310.13
1960771 CEMENT RESTRICTOR                    $      200.20
1960778 NERVE STIMULATOR                     $      717.68
1960793 PENROSE DRAIN                        $      130.48
1960799 CAST PLASTER SPLINT                  $      101.20
1960823 SAW BLADES                           $      500.19
1960825 SECONDARY PIGGY BACK                 $      363.61
1960831 SHUNT CAROTID ARTERY                 $      429.25
1960834 TIP SIMPULSE SUCTION LONG            $      396.45
1960835 TUBING DAVOL SIMPULSE                $      488.14
1960840 SORBITAL 3% 3000ML                   $      435.39
1960843 CLIP SURGICAL SPRING CLIP            $       75.90
1960872 BLADE WECK                           $       79.20
1960873 SUTURE BOOTS                         $      221.11
1960874 STAPLER TA 30/55/90                  $      959.65
1960876 TUBING TAB                           $       35.20
1960883 TUBE, TRACHEOSTOMY 1                 $      152.12
1960889 TUBING TUR 2 LEAD                    $      453.75
1960907 SUCTION VITAL VUE TUBING             $       82.50
1960911 DRESSING WEBRIL                      $      279.13
1960991 SOL, IV 250CC                        $      543.70
1960992 SOL, IV 500CC                        $      543.70
1960993 SOL, IV 1000CC                       $      543.70
1960994 LEVEL I TUBING D-50                  $      409.38
1960995 LEVEL I TUBING D-100                 $     1,371.27
1960996 ABC DISPOSABLE TIP (NOZZLE)          $      498.39
1961001 STAPLER SKIN PROXIMATE PRW35         $      400.17
1961003 SOL FLUSH LIVER PORTAL               $      267.43
1961010 CANNULA LIVER VENOUS RETURN          $      265.19
1961018 STAPLER 60 TRANS/MULTIFIRE           $     1,400.14
1961031 STAPLER TA 30                        $      676.48
1961032 STAPLER ENDO 4.8                     $      689.96
1961034 STAPLER RELOAD TA/CONTOUR            $      613.54
1961035 STAPLER TA LONG                      $      792.25
1961036 STAPLER ROTICULATOR 55               $     1,548.01
1961037 STAPLER GIA 60                       $      784.33
1961038 STAPLER GIA 60 (RELOAD)              $      487.70




                                       Page 146
                                         Ancillary


1961039 STAPLER GIA 80                         $     1,215.85
1961040 CLIP SURGICLIP PREMIUM                 $      883.49
1961041 STAPLER PREMIUM CEEA                   $     1,960.88
1961042 STAPLER LDS PREMIUM                    $      856.27
1961045 STAPLER ROTICULATOR 55 POLY            $     1,352.95
1961047 TROCAR SURGIPORT 5MM                   $     1,161.34
1961048 TROCAR SURGIPORT 8MM                   $     1,105.51
1961049 TROCAR SURGIPORT 10MM                  $      865.70
1961050 TROCAR SURGIPORT 11MM                  $     1,258.90
1961051 TROCAR SURGIPORT 12MM                  $     1,093.85
1961052 TROCAR SURGIPORT 15MM                  $      851.20
1961053 TROCAR SURGIVIEW BLUNT                 $      996.79
1961054 ENDO NEEDLE VERESS 120MM               $      492.94
1961055 CONVERTOR SURGIPORT                    $      153.74
1961056 SURGICLIP SLEEVE                       $      210.35
1961057 ENDO STAPLER HERNIA EMS                $     1,686.09
1961059 ENDO ENDOCLIP LARGE                    $     1,686.09
1961060 STAPLER ENDO GIA 30                    $     2,133.23
1961061 STAPLER ENDO GIA 30 (RELOAD)           $     1,043.70
1961065 ENDO SHEARS, LONG/SHORT                $     1,029.13
1961066 ENDO GRASP, LONG/SHORT                 $     1,029.13
1961067 ENDO DISSECT, LONG/SHORT               $     1,384.61
1961068 ENDO BABCOCK                           $      714.68
1961076 ENDO POUCH                             $      776.12
1961080 STAPLER ENDO GIA 60 (RELOAD)           $     1,339.81
1961081 ENDO GAUGE                             $      272.54
1961090 BASKET SEGURA 4.5FR 2CM                $      354.93
1961091 BLADE ALCON CURVED CRESCENT            $      402.34
1961092 BLADE BEAVER 7120 MYRINGOTOMY          $      249.82
1961093 BLADE HARMONIC SCALPEL LAP             $     1,128.95
1961094 BLADE HARMONIC SCALPEL OPEN            $      940.69
1961095 BLADE OSCILLATING SAW ZS-03            $       80.22
1961097 BLADE SAW SAGIT MICRO 5610-40          $      233.38
1961101 CANNULA CORONARY PERF DLP              $      217.58
1961102 CANNULA FEMORAL ARTERY 18FR            $      680.68
1961103 CANNULA FEMORAL ARTERY 22FR            $      680.68
1961104 CANNULA FEMORAL ARTERY 24FR            $      680.68
1961105 CANNULA HYDRO DISSECT 27 GA*8M         $       39.38
1961106 CANNULA MICRO J-SHAPED GA21            $       63.21
1961107 CANNULA RETROGRADE CARDIOPLEG          $      325.75
1961108 CANNULA SHOULDER 7CM                   $       93.17
1961109 CANNULA SINGLE-ARM SCOPE DYON          $      198.00
1961110 CANNULA SUMP MALLEABLE PEDS            $      136.40
1961111 CATH BROVIAC 2.7FR SINGLE              $      335.63 C1751
1961112 CATH CAPD DISCONNECT Y-SET             $       68.20
1961113 CATH CAPD TRANSFER SET                 $      287.10
1961114 CATH COUDE 16FR 5CC                    $       74.80 C1729
1961115 CATH CURLCATH 62CM                     $      455.08 C1750
1961117 CATH EPIDURAL TUN-LXL 16GA 3.5         $      211.20 C1755




                                         Page 147
                                         Ancillary


1961119 CATH GROSHONG SINGLE LUMEN 8FR         $      287.10 C1750
1961120 CATH HEMED 11FR DUAL LUMEN             $      373.42 C1751
1961121 CATH HEMED 7FR DUAL LUMEN              $      337.93 C1751
1961122 CATH HEMED 9.5FR SINGLE LUMEN          $      271.14 C1751
1961123 CATH HEMED 9FR DUAL LUMEN              $      341.00 C1751
1961124 CATH HICKMAN 13.5FR DUAL LUMEN         $      463.38 C1751
1961125 CATH HICKMAN 7FR DUAL LUMEN            $      337.93 C1751
1961126 CATH HICKMAN 9FR DUAL LUMEN            $      452.10 C1751
1961127 CATH HICKMAN SUBCUT PORT               $      452.10 C1751
1961128 CATH LEONARD 10FR DUAL LUMEN           $      452.10 C1751
1961130 CATH MAHURKAR 11.5 X 13.5 CVD          $      272.80 C1750
1961131 CATH MAHURKAR 11.5FR X 19.5CM          $      300.30 C1750
1961133 CATH MAHURKAR 13.5FR X 36CM            $      330.00 C1750
1961136 CATHETER, STAMEY SUPRAPUBIC            $      237.60 C2677
1961140 DRAIN AUTOTRANSFUSION ZIMMER           $      499.40
1961170 DRILL 2.4MM ACUFEX TIP G/WIRE          $      514.80
1961172 ENDO ANTI FOG                          $       66.00
1961173 ENDO ARTICULATIN LIN CUT ATB35         $      600.73
1961174 ENDO ARTICULATIN LIN CUT ATW35         $      600.73
1961175 ENDO BAG DEVICE                        $       59.40
1961250 BIO FIBRIN SEALANT TISSEEL 2ML         $     1,023.62
1961251 BIO FIBRIN SEALANT TISSEEL 5ML         $     2,359.78
1961252 CANNULA AVR CABG KIT                   $      224.40
1961253 KIT CAP 6701                           $      205.43
1961257 KIT SERVICE 5873-C                     $      205.43
1961259 KNIFE OCUTOME 1006 DISPOSABLE          $      586.36
1961261 LOOP VESSEL MINI/MAXI                  $       34.32
1961262 FILTER MILEX                           $       85.77
1961263 GUIDEWIRE SCHNEID STR.035              $      121.31 C1769
1961272 RESERVOIR CATH HH 6CM                  $      223.30
1961274 SMOOTHER GORE 6.5MM                    $      297.00
1961275 SMOOTHER GORE 7.9MM                    $      297.00
1961276 SMOOTHER GORE 9.5MM                    $      266.20
1961277 TUNNELER SCANLAN BLUE                  $       83.60
1961278 TUNNELER SCANLAN GREEN                 $       83.60
1961281 NEURO 1X8 GRID ELECTRODE W/BLK         $     1,036.20 C1883
1961282 NEURO 1X8 GRID STRIP ELECTRODE         $     1,069.20 C1883
1961284 NEURO 4X5 PLAT GRID ELECTRO            $     1,365.10 C1883
1961286 NEURO 8 PIN RIBBON CABLE CONN          $       69.30
1961288 PACK CUSTOM ARTHROSCOPY                $      230.46
1961289 PACK CUSTOM ENDO GYN                   $      215.29
1961290 PACK CUSTOM EXTREMITY                  $      201.30
1961291 PACK CUSTOM HAND                       $      210.74
1961292 PACK CUSTOM HIP                        $      295.90
1961293 PACK CUSTOM LAP CHOLE                  $      218.90
1961294 PACK CUSTOM LIVER #1                   $      351.29
1961295 PACK CUSTOM LIVER 2                    $      635.71
1961296 PACK CUSTOM MAJOR VASCULAR             $      303.60
1961297 PACK CUSTOM MINOR VASCULAR             $      225.50




                                         Page 148
                                        Ancillary


1961298 PACK CUSTOM NEURO                     $       317.90
1961299 PACK CYSTOSCOPY                       $       127.22
1961510 ENDO THORACOPORT 12.0 MM              $       118.80
1961511 ENDO TRIANGLE RETRACTOR               $       178.20
1961512 ENDO TROCAR 18MM TEC18                $       468.60
1961513 ENDO TROCAR WITH SLEEVE               $       175.74
1961514 ENDO TROCAR BLUNT 10/12 512B          $       304.70
1961538 TRAY, SIGMOIDSCOPY DISPOSABLE         $       177.10
1961542 INTRODUCER COOK 10FR                  $       218.90
1961543 INTRODUCER COOK 11FR                  $       147.40
1961544 INTRODUCER COOK 12FR                  $       147.40
1961545 INTRODUCER / SHEATH, GUIDING          $       147.40 C1892
1961546 INTRODUCER COOK 16FR                  $       147.40
1961547 INTRODUCER COOK 18FR                  $       147.40
1961548 INTRODUCER COOK 24FR                  $       147.40
1961549 INTRODUCER COOK 9FR                   $       195.45
1961551 IV FILTER BLOOD                       $       111.10
1961553 KIT ACUFEX UNIVERSAL CANNULA          $       185.13
1961554 PACK HEAD & NECK                      $       135.30
1961555 PACK LAPAROSCOPY                      $        91.30
1961556 PACK LAPAROTOMY                       $       160.60
1961558 PATCH GORETEX SOFT TISSUE 1MM         $      1,051.72
1961559 PATCH PERI-STRIPS/2                   $       297.00
1961560 PATCH PERI-STRIPS/5                   $       297.00
1961561 PATCH SAUVAGE 1 X 4                   $       227.70
1961562 PERF ABIOMED BVS SYSTEM               $     10,945.00
1961563 PERF HEMOCONCENTRATOR PEDS            $       314.60
1961565 PIN GUARD .028                        $       144.10
1961566 PIN GUARD 0.035                       $       144.10
1961567 PIN GUARD 0.045                       $       144.10
1961568 PIN GUARD 0.062                       $       144.10
1961569 PIN SKULL PINS MAYFIELD- OMI          $        79.20
1961572 POSITION COLLAR CERVICAL SOFT         $       119.26
1961573 POSITION COLLAR PHILADELPHIA          $       106.48
1961576 SPLINT DENVER SERIES 1500 LRG         $       160.45
1961577 SPLINT DENVER SERIES 4000 LRG         $       160.45
1961579 STAPLER ARTICULATING AX55G            $       566.50
1961580 CLIP APPLIER LIGACLIP                 $       340.34
1961581 STAPLER EMS ETHICON                   $       419.10
1961582 STAPLER LINEAR CUTTER 1               $       641.78
1961583 STAPLER LINEAR CUTTER TLC55           $       385.32
1961584 STAPLER LINEAR CUTTER TLC75           $       369.51
1961585 STAPLER LINEAR TX60B                  $       247.96
1961586 STAPLER RELOAD GIA 80                 $       216.36
1961587 STAPLER RELOAD TA-30 3.5              $       291.72
1961588 STAPLER RELOAD TCR55                  $       193.27
1961589 STAPLER RELOAD TRT10                  $       337.91
1961590 STAPLER RELOAD TTR55                  $       269.84
1961591 STAPLER ROTICULATOR 30 3.5            $       322.30




                                        Page 149
                                         Ancillary


1961592 STAPLER SURGICLIP 13.0                 $     424.60
1961602 SUT BAND PARHAM ZIMALITE               $     123.20
1961606 TOOL MIDAS REX 9MH30                   $     403.55
1961607 TOOL MIDAS REX DISSECTING AM12         $     365.20
1961608 TOOL MIDAS REX 14MH30                  $     403.55
1961609 TOOL MIDAS REX F2                      $     309.10
1961610 TOOL MIDAS REX DISSECT 8TA11           $     414.94
1961611 TOOL MIDAS REX DISSECTING M1           $     244.20
1961612 TOOL MIDAS REX DISSECTING M8D          $     346.50
1961615 TUBE, TRACHEOSTOMY CUFFLESS            $     145.86
1961616 TUBING ARTERIAL LINE M/F               $     156.83
1961617 TUBING ARTHRO PUMP TUBING 3M           $      78.65
1961618 SHORT POINTER - VTI ACCESSORY          $     338.80
1961619 LONG POINTER - VTI ACCESSORY           $     338.80
1961620 THREADED BONE PIN/TRANSMITTER          $     410.23
1961621 AWL - VTI ACCESSORY                    $     804.38
1961622 SHORT AWL - VTI ACCESSORY              $     804.38
1961623 DRILL BIT - VTI ACCESSORY              $     866.25
1961625 SHORT SPINE PROBE/VTI ACCESS.          $     742.50
1961628 ADAPTER HARMONIC CS/LCS BLADE          $     914.27
1961629 ANES ARTERIAL LINE FEMORAL             $      97.37
1961634 ANES TRAY CVP MONITOR                  $     133.31
1961635 ANES TRAY EPIDURAL PERIFIX             $     353.33
1961637 BAG URINE METER                        $      78.11
1961638 BAG UROSTOMY 1.5                       $     144.20
1961642 BLADE ABRADER 4.0MM                    $     184.57
1961643 BLADE ABRADER 5.5MM                    $     184.57
1961644 BLADE ACROMIONIZER 4.0MM               $     184.57
1961645 BLADE FULL RADIUS 2.9MM                $     219.93
1961646 BLADE GIGLI SAW                        $      81.02
1961647 BLADE OSCILLATING SAW 5610-20          $     100.90
1961648 BLADE MICRO OSCILLATING KM-001         $      70.49
1961649 BLADE MICRO OSCILLATING KM-002         $      73.18
1961650 BLADE MICRO SAW BLADE KM-004           $      80.87
1961651 BLADE MICRO OSCILLATING KM-005         $      71.83
1961652 BLADE MICRO SAW BLADE KM-006           $      77.89
1961653 BLADE MICRO OSCILLATING KM-008         $      76.54
1961654 BLADE SAW SAGIT KM-101                 $      73.18
1961655 BLADE MICRO SAGITTAL KM-102            $      94.73
1961656 BLADE OSCILLATING 5610-18 LGE          $      99.55
1961657 BLADE OSCILLATING 5610-07              $      99.55
1961658 BLADE OSCILLATING 5610-11 LGE          $      95.26
1961660 BLADE OSCILLATING KM-21L               $      84.55
1961661 BLADE OSCILLATING KM-274               $      57.75
1961662 BLADE SAW OSCILL KM-453                $      71.27
1961663 BLADE OSCILLATING MO-127 LGE           $     116.70
1961664 BLADE OSCILLATING ZO-052               $      77.40
1961665 BLADE OSCILLATING MICRO 560796         $      70.49
1961666 BLADE OSCILLATING MICRO 560799         $      71.83




                                         Page 150
                                         Ancillary


1961667 BLADE OSCILLATING MICRO 560801         $       70.49
1961668 BLADE OSCILLATING MICRO 560802         $       73.18
1961669 BLADE OSCILLATING MICRO 560803         $       93.26
1961670 BLADE OSCILLATING MICRO 560809         $      165.56
1961671 BLADE OSCILLATING MICRO 560810         $      165.56
1961672 BLADE OSCILLATING MICRO 560811         $       73.18
1961673 BLADE RECIP SAW 5608-39                $       70.85
1961674 BLADE RECIP SAW 5608-40                $       70.85
1961675 BLADE SAW RECIPRO KM-062PT             $       93.12
1961676 BLADE SAW RECIPRO KM-14003             $       86.92
1961677 BLADE RECIP KM-325R                    $       89.90
1961678 BLADE RESECTOSCOPE 24FR                $      412.78
1961679 BLADE SAW SAGIT KM-602                 $       89.90
1961680 BLADE SAW SAGIT KM-651                 $       84.55
1961683 BLADE SAW SAGIT MICRO 5608-55          $       73.18
1961684 BLADE SAW SAGIT MICRO 5608-56          $       85.73
1961685 BLADE SAW SAGIT MICRO ZS-039           $       85.73
1961686 BLADE SAW SAGITTAL                     $       89.90
1961687 BLADE SAW KM-101L                      $       84.55
1961688 BLADE SAW KM-30L                       $       84.55
1961689 BLADE SAW KM-36L                       $      100.90
1961690 BLADE OSCILLATING KM-38L               $       93.42
1961691 BLADE SAW KM-452                       $       54.54
1961692 BLADE SAW KM-454                       $       54.54
1961693 BLADE SAW KM-455                       $       80.01
1961694 BLADE SAW KM-460                       $       54.54
1961695 BLADE SAW KM-461                       $       70.85
1961696 BLADE SAW KM-473                       $       70.85
1961697 BLADE SIDE CUTTING 5607-11             $       86.69
1961698 CANNULA, ARTERIAL 1                    $      401.87
1961699 CANNULA ARTERIAL BIOMEDICUS 12         $      361.69
1961700 CANNULA ART KIT 21 96530-021           $      530.48
1961701 CANNULA, ARTERIAL DLP                  $      644.78
1961702 CANNULA ARTHREX TIBIAL TUNNEL          $       97.65
1961703 CANNULA FEMORAL ARTERY 20FR            $       81.32
1961704 CANNULA INTRACARDIAC SUMP              $       92.50
1961706 CANNULA VENOUS 2-STAGE OVAL            $      150.99
1961707 CANNULA VENOUS BIOMEDICUS 12FR         $      361.69
1961708 CANNULA VENOUS BIOMEDICUS 14FR         $      361.69
1961709 CANNULA VENOUS BIOMEDICUS 19FR         $      530.48
1961710 CANNULA VENOUS BIOMEDICUS 21FR         $      530.48
1961711 CATH FOLEY 16FR 30CC 3-WAY             $      120.87
1961713 CATH INTRAAORTIC BALLOON               $     1,728.08 C1726
1961714 CATH MALECOT 10FR                      $       77.33 C2627
1961715 CATH MALECOT 12FR                      $       98.71 C2627
1961716 CATH MALECOT 14FR                      $       91.16 C2627
1961717 CATH MALECOT 16FR                      $       91.93 C2627
1961718 CATH MALECOT 18FR                      $       98.71 C2627
1961719 CATH MALECOT 20FR                      $       94.49 C2627




                                         Page 151
                                         Ancillary


1961720 CATH MALECOT 22FR                      $      70.66 C2627
1961721 CATH MALECOT 24FR                      $      75.39 C2627
1961722 CATH MALECOT 26FR                      $      91.93 C2627
1961723 CATH MALECOT 28FR                      $      91.93 C2627
1961724 CATH PEZZER 10FR                       $      71.97 C2627
1961725 CATH PEZZER 12FR                       $      72.40 C2627
1961726 CATH PEZZER 14FR                       $      78.47 C2627
1961727 CATH PEZZER 16FR                       $      79.68 C2627
1961728 CATH PEZZER 18FR                       $      79.68 C2627
1961729 CATH PEZZER 20FR                       $      79.68 C2627
1961730 CATH PEZZER 22FR                       $      79.68 C2627
1961731 CATH PEZZER 24FR                       $      78.47 C2627
1961732 CATH PEZZER 26FR                       $      79.68 C2627
1961733 CATH ROBINSON 22FR 056122              $      39.52
1961734 CATH ROBINSON 26FR   056126            $      40.17
1961738 CLIP SUGITA ANEURYSM CLIP              $     589.42
1961743 DRAIN LUMBAR DRAINAGE SET              $     348.29
1961763 ENDO BIPOLAR EBF01                     $     274.69
1961764 ENDO CANNULA ACUFEX 5MM X 76MM         $     316.95
1961765 ENDO CAP REDUCER MLTSEAL MS512         $      45.60
1961766 ENDO CATCH DEVICE 15MM                 $     271.30
1961767 ENDO CLOSE                             $     117.62
1961768 ENDO ELC 45MM 3.5                      $     637.81
1961769 ENDO STAPLER THORACIC EZ45G            $     637.81
1961771 ENDO ENDOHERNIA RELOAD 4.8MM           $     181.20
1961772 ENDO ENDOHERNIA RELOAD 4MM             $     181.20
1961773 ENDO ENDOPOUCH PRO RETRIEVAL           $     271.30
1961774 ENDO ENDOSHEARS AUTOSUTURE             $     294.47
1961775 ENDO IRRIGATOR/ASPIRATOR GYNEF         $     267.30
1961776 ENDO KELLY BOWEL BK10                  $     336.46
1961778 ENDO SUTURE ASSISTANT 5M SW100         $     354.53
1961779 ENDO RELOAD EVU35                      $     330.77
1961780 ENDO RELOAD LINEAR CUT ZR45B           $     270.83
1961781 STAPLER RELOAD TRT75                   $     305.64
1961782 ENDO RELOAD TRV30                      $     191.74
1961785 ENDO STAPLER CIRCULAR ECS21            $     884.14
1961786 ENDO STAPLER CIRCULAR ECS25            $     884.14
1961787 ENDO RELOAD ZR45B                      $     637.81
1961788 ENDO SUT PDS 0 ENDOLOOP                $      96.33
1961790 ENDO SUT POLYSORB 2-0                  $      93.40
1961791 ENDO SILK 0 ENDOSTITCH 48              $      93.40
1961792 ENDO SUT SURGIDAC 0 ES-9               $      99.22
1961793 ENDO TROCAR 5MM 355SD                  $     172.89
1961794 ENDO TROCAR 5MM SLEEVE 35LST           $     104.97
1961795 ENDO TROCAR SLEEVE 10/11 511ST         $      48.61
1961796 ENDO STAPLER VASCULAR TSW35            $     681.67
1961797 ENT ASPIRATOR 45 DEGREE                $     188.14
1961798 ENT ASPIRATOR STRAIGHT                 $     188.14
1961799 ENT SPLINT BROWN DENVER S/L            $      91.69




                                         Page 152
                                         Ancillary


1961800 ENT SPLINT WHITE DENVER L/S            $       95.26
1961813 KIT DBS IN-LINE EXTENSION              $     1,326.19
1961814 KIT FEMORAL CANNULA INSERTION          $      170.27
1961815 KIT LEAD LOCKING ACCESSORY             $      366.75
1961816 KIT LEAD LOCKING DEVICE                $     1,083.27
1961818 KIT VITRECTOMY ACCURUS PAK             $      802.85
1961822 LASER SHEATH 12FR                      $     5,486.98 C2629
1961823 LASER SHEATH 14FR                      $     5,486.98 C2629
1961824 LASER SHEATH 16FR                      $     5,486.98 C2629
1961828 GUIDEWIRE ANG/STIFF 0.035              $      184.60 C1769
1961829 GUIDEWIRE J FIXED 150CM                $       82.57 C1769
1961830 GUIDEWIRE STR/FLEX 0.035               $      127.77 C1769
1961831 GUIDEWIRE, STR/STIFF 0.035/.03         $      191.71 C1769
1961837 SCREW BONE                             $      399.67
1961844 NEEDLE BIOPSY 14GA X 6 DISP            $       81.36
1961845 NEEDLE CHIBA 22GA X 8                  $       87.51
1961851 NEURO 4X8 PLAT GRID ELECTRODE          $     2,390.31 C1883
1961856 PACK CUSTOM MINOR BASIN                $      167.04
1961860 PERF CELL SAVER BRAT KIT 250ML         $      364.74
1961862 PERF FILTERED GAS LINE                 $       81.18
1961864 PERF PUMP SUCTION LINE                 $       79.93
1961878 SPLINT IMMOBILIZER SHOULDER LG         $       69.18
1961879 SPONGE DISSECTOR PEANUTS               $       50.90
1961883 STAPLER ARTICULATING AX55B             $      573.64
1961884 STAPLER ILS CURVED 21MM                $      749.74
1961885 STAPLER ILS CURVED 29MM                $      749.74
1961886 STAPLER RELOAD ERU35                   $      333.60
1961887 STAPLER RELOAD RU60                    $      331.21
1961888 STAPLER RELOAD TCR75                   $      305.64
1961889 STAPLER RELOAD TR30                    $      174.42
1961890 STAPLER RELOAD TR60                    $      183.82
1961891 STAPLER RELOAD XR60B                   $      187.14
1961892 STAPLER RELOAD 60MM 4.8 XR60G          $      187.14
1961893 STAPLER RELOAD Z45G                    $      270.83
1961894 STAPLER TRANSVERSE TX30B               $      366.32
1961895 STAPLER TRANSVERSE TX30G               $      359.54
1961896 STAPLER TRANSVERSE TX30V               $      290.27
1961897 STAPLER TRANSVERSE TX60G               $      359.54
1961924 ADAPTER STUB NEURO                     $      132.00
1961932 SUT CHROMIC 0 CT 8-18 C/R              $       73.47
1961948 SUT CHROMIC 1 TIES 18                  $       53.65
1961955 SUT CHROMIC 2-0 OS-4 27                $       28.79
1961978 SUT CHROMIC 6-0 G-6 18                 $       66.94
1961981 SUT CHROMIC 7-0 CS175-8 18             $       75.50
1961990 SUT ETHIBOND 0 V-34 30                 $       28.08
1962020 SUT ETHIBOND 6-0 BV-1 24               $       71.58
1962027 SUT ETHILON 11-0 CS160-6 8 DA          $      102.49
1962036 SUT ETHILON 3-0 30                     $       45.61
1962041 SUT ETHILON 3-0 PSLX 30                $       33.53




                                         Page 153
                                        Ancillary


1962045 SUT ETHILON 4-0 PC-1 18               $      35.90
1962046 SUT ETHILON 4-0 PC-5 18               $      35.89
1962047 SUT ETHILON 4-0 PS-2 18 BLACK         $      34.23
1962048 SUT ETHILON 5-0 PC-1 18               $      35.88
1962049 SUT ETHILON 5-0 PC-3 18               $      39.68
1962050 SUT ETHILON 5-0 PC-5 18               $      35.88
1962051 SUT ETHILON 5-0 S-24 18 DA            $      61.80
1962053 SUT ETHILON 6-0 PC-1 18               $      36.52
1962054 SUT ETHILON 6-0 PC-3 18               $      48.46
1962055 SUT ETHILON 6-0 PS-3 18               $      34.47
1962056 SUT ETHILON 7-0 P-1 18                $      31.97
1962057 SUT ETHILON 7-0 P-6 18                $      31.60
1962058 SUT ETHILON 8-0 BV130-4 5             $      80.87
1962059 SUT ETHILON 8-0 BV130                 $      79.16
1962060 SUT ETHILON 8-0 CS175-8 12            $      76.38
1962061 SUT ETHILON 8-0 TG175-8 12            $      76.73
1962062 SUT ETHILON 9-0 BV-100-4 5            $     119.21
1962063 SUT ETHILON 9-0 BV130-4 5             $      79.44
1962064 SUT ETHILON 9-0 TG140-8 12 DA         $      76.74
1962065 SUT ETHIPACK 1 18                     $      47.39
1962066 SUT ETHI-PACK 5 18                    $      45.60
1962067 SUT GUT 4-0 P-3 18                    $      32.30
1962068 SUT GUT 4-0 PS-2 18                   $      31.93
1962069 SUT LIVER PROCEDURE E-PACK            $     837.91
1962070 SUT MERSILENE 10-0 CS160-6 12         $      81.02
1962071 SUT MERSILENE 10-0 TG160-4 12         $      90.35
1962076 SUT MERSILENE 4-0 P-3 18              $      30.95
1962077 SUT MERSILENE 4-0 S-4 18 DA           $      64.32
1962079 SUT MERSILENE 5-0 S-14 18             $      65.35
1962080 SUT MERSILENE 5-0 S-24 18             $      64.27
1962081 SUT MERSILENE 5-0 S-24 18 DA          $      64.90
1962082 SUT MERSILENE 5MM CTX 12 DA           $      90.22
1962083 SUT MERSILENE 6-0 S-14 18             $      65.43
1962084 SUT MERSILENE BP-1 5MM 12 DA          $      92.06
1962085 SUT MERSILENE 5-0 P-3 18              $      31.87
1962091 SUT MONOCRYL 2-0 CT-1 36 UNDY         $      28.29
1962094 SUT MONOCRYL 2-0 UR-6 27 UNDY         $      56.96
1962096 SUT MONOCRYL 3-0 PS-1 27              $      36.37
1962097 SUT MONOCRYL 3-0 PS-2 27 UNDY         $      36.34
1962100 SUT MONOCRYL 4-0 P-3 18 UNDYE         $      36.29
1962101 SUT MONOCRYL 4-0 PS-1 27              $      36.33
1962103 SUT MONOCRYL 4-0 PS-2 27              $      36.34
1962104 SUT MONOCRYL 5-0 P-1 18               $      40.18
1962106 SUT MONOCRYL 6-0 P-1 18               $      36.37
1962107 SUT MONOCRYL 6-0 PC-1 18              $      39.20
1962110 SUT NUROLON 2-0 M0-6 8-18             $      66.65
1962111 SUT NUROLON 3-0 CT-2 8-18             $     253.94
1962112 SUT NUROLON 3-0 FSL 8-18              $     100.93
1962113 SUT NUROLON 3-0 RB-1 8-18             $      74.32




                                        Page 154
                                         Ancillary


1962114 SUT NUROLON 3-0 SH 8-18 C/R            $      72.39
1962115 SUT NUROLON 4-0 TF 8-18                $      86.58
1962116 SUT NUROLON 4-0 TF-5 D-5620 SO         $     101.01
1962117 SUT PACING WIRE 2-0 SH 24              $      73.66
1962121 SUT PDSII 0 CT-1 27                    $      29.40
1962125 SUT PDS 2-0 CT-1 27                    $      35.06
1962128 SUT PDSII 3-0 PS-2 18 CLEAR            $      36.54
1962130 SUT PDSII 4-0 P-3 18 CLEAR             $      36.73
1962131 SUT PDSII 4-0 PS-4 18 CLEAR            $      36.61
1962133 SUT PDSII 4-0 SH 27                    $      35.62
1962134 SUT PDSII 4-0 SH 27 CLEAR              $      28.50
1962135 SUT PDSII 4-0 SH-1 27                  $      27.69
1962139 SUT PDSII CTXB 36                      $      28.80
1962142 SUT PDSII 4-0 PS-1 18                  $      37.77
1962143 SUT PDSII 4-0 PS-2 18 CLEAR            $      54.12
1962145 SUT PDSII 5-0 PS-2 18                  $      36.76
1962148 SUT PDSII 0 TP-1 LOOPED ON             $      60.18
1962150 SUT PDSII 1 TP-1 54                    $      38.87
1962153 SUT PDSII 4-0 ST-4 14                  $      37.55
1962154 SUT PDSII 5-0 C-1 30 DA                $      65.65
1962155 SUT PDSII 5-0 P-3 18                   $      36.51
1962156 SUT PDSII 6-0 BV-1 30                  $      67.23
1962157 SUT PDSII 6-0 C-1 30                   $      45.78
1962168 SUT PLAIN 3-0 PS-2 27                  $      31.74
1962169 SUT PLAIN 4-0 54 REEL                  $      33.21
1962171 SUT PLAIN 5-0 G-3 18                   $      64.44
1962172 SUT PLAIN 5-0 P-3 18                   $      32.49
1962173 SUT PLAIN 5-0 PC-1 18                  $      34.02
1962174 SUT PLAIN 5-0 S-14 12 DA               $      70.04
1962175 SUT PLAIN 6-0 G-1 18                   $      40.83
1962176 SUT PLAIN 6-0 G-1 18 DA                $      65.19
1962177 SUT PLAIN 6-0 G-6 18                   $      71.21
1962178 SUT PLAIN 6-0 PC-1 18                  $      34.02
1962184 SUTURE, PROLENE 1 CT-1 30              $      37.52
1962186 SUT PROLENE 1 MO-6 36 DA               $      68.60
1962187 SUT PROLENE 10-0 CIF-4 8               $      88.02
1962188 SUT PROLENE 10-0 CS140-6 12            $      96.54
1962189 SUT PROLENE 10-0 CS160-6 12            $      95.47
1962190 SUT PROLENE 10-0 SIF-2 8               $      73.08
1962191 SUT PROLENE 10-0 STC-6 8               $      69.31
1962192 SUT PROLENE 2 TP-1 60                  $      31.20
1962197 SUT PROLENE 2-0 MH 36 DA               $      37.27
1962198 SUT PROLENE 2-0 MO-6 30 DA             $      85.91
1962200 SUT PROLENE 2-0 SH 36 DA               $      37.11
1962201 SUT PROLENE 2-0 V-7 36 DA              $      48.07
1962205 SUT PROLENE 3-0 PS-1 18                $      35.84
1962206 SUT PROLENE 3-0 PS-2 18                $      35.87
1962207 SUT PROLENE 3-0 RB-1 36                $      37.43
1962210 SUT PROLENE 3-0 SH-1 30 DA             $      36.97




                                         Page 155
                                         Ancillary


1962211 SUT PROLENE 4-0 PC-5 18                $      38.39
1962212 SUT PROLENE 4-0 BB 24 DA               $      39.25
1962213 SUT PROLENE 4-0 BB 36 DA               $      39.41
1962214 SUT PROLENE 4-0 BB 54 DA               $      99.25
1962215 SUT PROLENE 4-0 C-1 30 DA              $      61.75
1962217 SUT PROLENE 4-0 PC-1 18                $      38.41
1962218 SUT PROLENE 4-0 PC-3 18                $      38.40
1962219 SUT PROLENE 4-0 PS-2 18                $      35.89
1962221 SUT PROLENE 4-0 RB-1 36 DA             $      41.40
1962223 SUT PROLENE 4-0 SH 36 DA               $      37.41
1962224 SUT PROLENE 4-0 SH 48 DA               $      98.68
1962225 SUT PROLENE 4-0 SH-1 30 DA             $      37.16
1962226 SUT PROLENE 4-0 TF 24                  $      42.55
1962227 SUT PROLENE 5-0 C-1 MULTIPACK          $      91.54
1962228 SUT PROLENE 5-0 BB 36 DA               $      39.68
1962229 SUT ETHILON 3-0 PS-2 18                $      39.66
1962230 SUT VICRYL 2-0 UR-6 27                 $      97.66
1962231 SUT PROLENE 5-0 C-1 36 DA              $      50.15
1962232 SUT PROLENE 5-0 C-1 36 DA VB           $      52.06
1962233 SUT PROLENE 5-0 P-3 18                 $      36.58
1962234 SUT PROLENE 5-0 PC-1 18                $      38.68
1962235 SUT PROLENE 5-0 PC-3 18                $      38.68
1962236 SUT PROLENE 5-0 PC-5 18                $      38.71
1962237 SUT PROLENE 5-0 PS-2 18                $      36.18
1962238 SUT PROLENE 5-0 PS-3 18                $      36.14
1962239 SUT PROLENE 5-0 RB-4 24 DA             $      79.53
1962240 SUT PROLENE 6-0 BV-1 24 DA             $      63.90
1962241 SUT PROLENE 6-0 BV-1 24 DA VB          $      73.65
1962242 SUT PROLENE 6-0 C-1 24 DA              $      47.87
1962243 SUT PROLENE 6-0 C-1 30 DA              $      47.86
1962244 SUT PROLENE 6-0 C-1 30 DA VB           $      50.77
1962245 SUT PROLENE 6-0 CV-1 MULTIPACK         $      90.08
1962246 SUT PROLENE 6-0 P-1 18                 $      36.25
1962247 SUT PROLENE 6-0 P-3 18                 $      40.36
1962248 SUT PROLENE 6-0 PC-1 18                $      39.00
1962249 SUT PROLENE 6-0 PC-3 18                $      39.03
1962250 SUT PROLENE 6-0 PS-3 18                $      36.42
1962252 SUT PROLENE 7-0 BV-1 24 DA             $      63.91
1962253 SUT PROLENE 7-0 BV-1 24 DA VB          $      72.94
1962254 SUT PROLENE 7-0 BV-1 30 DA             $      63.54
1962255 SUT PROLENE 7-0 BV175-6 24 DA          $     104.79
1962256 SUT PROLENE 7-0 C-1 18                 $      93.50
1962257 SUT PROLENE 7-0 P-1 18                 $      36.78
1962258 SUT PROLENE 8-0 BV130-5 24 DA          $      87.44
1962259 SUT PROLENE 8-0 BV175-6 24 DA          $     104.28
1962260 SUT PRONOVA 5-0 C-1 36 DA              $      45.74
1962261 SUT PRONOVA 6-0 C-1 30 DA              $      45.74
1962262 SUT PRONOVA 7-0 BV-1 24 DA             $      65.03
1962268 SUT SILK 0 PSL 30                      $      33.11




                                         Page 156
                                        Ancillary


1962276 SUT PDSII 7-0 BV-1                    $     121.65
1962282 SUT SILK 2-0 PS 18                    $      33.13
1962283 SUT SILK 2-0 PSL 18                   $      58.65
1962286 SUT SILK 2-0 SH 3-30                  $      35.75
1962287 SUT SILK 2-0 SH 8-18 C/R              $      60.95
1962288 SUT SILK 2-0 SH 8-30 C/R              $      63.47
1962289 SUT SILK 2-0 TIES 12-30               $      34.06
1962296 SUT SILK 3-0 PS-1 18                  $      30.49
1962297 SUT SILK 3-0 PS-2 18                  $      31.56
1962299 SUT SILK 3-0 RB-1 CR/8 C053D          $      63.21
1962302 SUT SILK 3-0 SH 8-18 C/R              $      61.06
1962303 SUT SILK 3-0 SH 8-30 C/R              $      47.96
1962304 SUT SILK 3-0 SH 18 CR/8 C013D         $      76.97
1962307 SUT SILK 3-0 TIES 12-30               $      28.83
1962309 SUT SILK 4-0 C-3 12 DA                $      31.14
1962312 SUT SILK 4-0 G-3 18                   $      36.87
1962313 SUT SILK 4-0 G-3 18 DA                $      57.32
1962315 SUT SILK 4-0 RB-1 8-18 C/R            $      63.36
1962317 SUT SILK 4-0 SH 8-18 C/R              $      61.16
1962318 SUT SILK 4-0 SH 8-30 C/R              $      63.17
1962323 SUT SILK 5 LR 30                      $      32.20
1962325 SUT SILK 5-0 P-3 18                   $      30.82
1962326 SUT SILK 5-0 PS-2 18                  $      31.61
1962330 SUT SILK 6-0 P-1 18                   $      31.50
1962331 SUT SILK 6-0 C-1 18                   $      26.02
1962332 SUT SILK 6-0 G-1 18 DA                $      57.27
1962333 SUT SILK 6-0 G-6 18 DA                $      61.28
1962334 SUT SILK 6-0 G-7 18 DA                $      61.48
1962335 SUT SILK 6-0 TG140-8 18               $      73.89
1962336 SUT SILK 8-0 TG100-8 18               $      76.15
1962337 SUT SILK 8-0 TG140-8 12               $      73.83
1962338 SUT STEEL 2 LS-1 4-20                 $      78.52
1962339 SUT STEEL 2-0 17-18                   $      46.43
1962340 SUT STEEL XXGA                        $      78.43
1962341 SUT STEEL 5 18 MS/12                  $      47.95
1962342 SUT STEEL 5 CCS 4-18                  $      88.87
1962343 SUT STEEL 6 CCS 4-18                  $      89.43
1962344 SUT STEEL 7 CCS 4-18                  $      91.14
1962345 SUT STERNA-BAND                       $     152.42
1962348 SUT SURGIDAC 3-0 CV-24 10-30          $     238.76
1962349 SUT TICRON 2-0 CV-305 MP W/           $      88.97
1962350 SUT TICRON 2-0 CV-305 MP W/O          $     147.94
1962351 SUT TICRON 2-0 CV-316 MP W/           $     147.95
1962352 SUT TICRON 2-0 CV-316 MP W/O          $      91.73
1962353 SUT TICRON 3-0 CV-331 DA              $      32.24
1962354 SUT TICRON 4-0 CV-331 36 DA           $      46.02
1962355 SUT TICRON 5-0 CV-330                 $      47.22
1962356 SUT TICRON 5-0 T-37                   $      62.10
1962357 SUT TICRON 7-0 CV-310 DA              $      78.82




                                        Page 157
                                         Ancillary


1962358 SUT UMBILICAL TAPE                     $     109.02
1962366 SUT VICRYL 0 CT 8-18                   $      77.77
1962367 SUT VICRYL 0 CT 8-18 C/R               $      70.21
1962371 SUT VICRYL 0 CT-1 8-18 C/R             $      83.57
1962372 SUT VICRYL 0 CT-1 8-27 C/R             $      76.91
1962375 SUT VICRYL 0 CT-2 8-18 C/R             $      77.73
1962378 SUT VICRYL 0 CTX 8-18 C/R              $      77.77
1962379 SUT VICRYL 0 CTX 8-18 C/R UND          $      77.46
1962380 SUT VICRYL 0 OS-6 27 UNDYED            $      40.48
1962381 SUT VICRYL 0 OS-6 3-18                 $      54.44
1962385 SUT VICRYL 0 TIES 12-18 UNDYE          $      33.62
1962386 SUT VICRYL 0 TIES 6-18 UNDYED          $      44.77
1962389 SUT VICRYL 0 XLH 27                    $      36.93
1962393 SUT VICRYL 1 CT 8-18                   $      77.77
1962395 SUT VICRYL 1 CT-1 36                   $      46.13
1962396 SUT VICRYL 1 CT-1 8-18 C/R             $      77.69
1962399 SUT VICRYL 1 CTX 8-18                  $      77.73
1962400 SUT VICRYL 1 OS-4 27 UNDYED            $      37.54
1962401 SUT VICRYL 1 OS-6 27 UNDYED            $      33.97
1962404 SUT VICRYL 1 TIES 6-18 UNDYED          $      40.79
1962405 SUT VICRYL 10-0 CS140-6 4              $      75.38
1962406 SUT VICRYL 10-0 CS160-8 12             $      84.74
1962407 SUT VICRYL 2 TP-1 2-27 UNDYED          $      51.93
1962408 SUT VICRYL 2 TP-1 4-27                 $      40.57
1962414 SUT VICRYL 2-0 CP-2 8-18               $      73.68
1962417 SUT VICRYL 2-0 CT 8-18 C/R             $      80.58
1962422 SUT VICRYL 2-0 CT-1 8-18 C/R           $      73.71
1962425 SUT VICRYL 2-0 CT-1 C/R UNDYED         $      83.16
1962427 SUT VICRYL 2-0 OS-6 27 UNDYED          $      40.78
1962428 SUT VICRYL 2-0 OS-6 3-18 C/R           $      54.44
1962429 SUT VICRYL 2-0 PS-2 27                 $      32.27
1962430 SUT VICRYL 2-0 PSL 27                  $      40.41
1962436 SUT VICRYL 2-0 SH C/R 8-18             $      75.15
1962437 SUT VICRYL 2-0 TIES 12-18 UND          $      57.76
1962441 SUT VICRYL 2-0 UR-6 27                 $      29.06
1962444 SUT VICRYL 3-0 CP-2 8-18 UNDY          $      37.22
1962445 SUT VICRYL 3-0 CP-2 C/R 8-18           $      91.17
1962450 SUT VICRYL 3-0 CT-1 C/R 8-18           $      77.40
1962451 SUT VICRYL 3-0 FS C/R 8-18             $      69.36
1962454 SUT VICRYL 3-0 PS-1 27 UNDYED          $      33.09
1962455 SUT VICRYL 3-0 PS-2                    $      33.10
1962456 SUT VICRYL 3-0 PS-2 27 UNDYED          $      33.04
1962459 SUT VICRYL 3-0 RB-1 8-18               $      78.57
1962465 SUT VICRYL 3-0 SH 8-18 C/R             $      78.40
1962466 SUT VICRYL 3-0 SH C/R 8-18             $      84.83
1962469 SUT VICRYL 3-0 SH-1 8-18 C/R           $      85.84
1962475 SUT VICRYL 4-0 P-3 18                  $      36.62
1962476 SUT VICRYL 4-0 P-3 18 UNDYED           $      49.28
1962477 SUT VICRYL 4-0 PC-1 18                 $      36.03




                                         Page 158
                                        Ancillary


1962478 SUT VICRYL 4-0 PC-3 18 UNDYED         $       35.77
1962479 SUT VICRYL 4-0 PC-5 18                $       35.99
1962480 SUT VICRYL 4-0 PS-1 18                $       33.26
1962482 SUT VICRYL 4-0 PS-1 27 UNDYED         $       36.78
1962483 SUT VICRYL 4-0 PS-2 18 UNDYED         $       33.53
1962484 SUT VICRYL 4-0 PS-2 27                $       33.19
1962487 SUT VICRYL 4-0 RB-1 8-18              $       78.65
1962489 SUT VICRYL 4-0 REEL 54 UNDYED         $       22.72
1962492 SUT VICRYL 4-0 SH 8-18 C/R            $       70.21
1962496 SUT VICRYL 4-0 SH-1 8-18 C/R          $       84.25
1962498 SUT VICRYL 4-0 TF 8-18 C/R            $       80.00
1962500 SUT VICRYL 5-0 P-1 18 UNDYED          $       33.32
1962502 SUT VICRYL 5-0 P-3 18 UNDYED          $       33.43
1962503 SUT VICRYL 5-0 PC-3 18 UNDYED         $       36.01
1962504 SUT VICRYL 5-0 PC-5 18                $       36.03
1962505 SUT VICRYL 5-0 PS-2 18                $       33.30
1962506 SUT VICRYL 5-0 PS-2 18 UNDYED         $       33.26
1962507 SUT VICRYL 5-0 S-14 18                $       72.44
1962508 SUT VICRYL 5-0 S-14 8                 $       71.27
1962509 SUT VICRYL 5-0 S-24 8                 $       71.06
1962512 SUT VICRYL 6-0 G-6 18                 $       70.64
1962513 SUT VICRYL 6-0 P-3 18                 $       33.69
1962514 SUT VICRYL 6-0 PC-1 18 UNDYED         $       36.03
1962515 SUT VICRYL 6-0 PC-3 18                $       37.38
1962516 SUT VICRYL 6-0 S-14 18                $       73.69
1962517 SUT VICRYL 6-0 S-14 18 UNDYED         $       71.90
1962519 SUT VICRYL 6-0 S-29 18                $       73.02
1962520 SUT VICRYL 7-0 TG140-8 18             $       74.15
1962521 SUT VICRYL 7-0 TG160-8 12             $       73.56
1962522 SUT VICRYL 8-0 BV130-4 5              $       73.36
1962523 SUT VICRYL 8-0 TG140-8 8              $       78.98
1962524 SUT VICRYL 8-0 TG160-6 12             $       95.12
1962525 SUT VICRYL 9-0 BV100-3 5              $       91.83
1962526 SUT VICRYL 9-0 TG140-8 12             $       90.30
1962527 SUT VICRYL KNITTED MESH 12X12         $     1,424.87
1962535 SUT VICRYL 6-0 S-28 18 DA             $       71.18
1962584 SUT PROLENE 1 TP-1 60                 $       32.12
1962596 SUT NUROLON 2-0 SH 8-18               $       72.39
1962663 SUT MONOCRYL 5-0 PC-3 18              $       36.39
1962671 SUT PDSII 0 CT-2 27                   $       48.46
1962750 CANNULA, ARTHRO PART/THREADED         $      141.90
1962751 TOOL MIDAS DISSECTING 21TA30          $      480.70
1962752 TOOL MIDAS REX LEGEND 7BA15           $      391.60
1962753 TOOL MIDAS DISSECTING 7BA60           $      376.20
1962754 TOOL MIDAS DISSECTING 7BA60D          $      403.70
1962755 TOOL MIDAS DISSECTING                 $      503.80
1962756 ADAPTER TUOHY-BORST TBA-6             $      122.10 C2629
1962757 TOOL MIDAS DISSECTING MC254           $      519.20
1962758 CATH SIMI G08584                      $      117.70




                                        Page 159
                                         Ancillary


1962759 CATH KMP 5-38-65 228361                $      139.70
1962760 ARTHRO 9MM CLEAR CANN 7207229          $      121.00
1962761 PACK CUSA OLD                          $     1,069.20
1962762 ENDO STEP DILATING SLEEVE              $      352.00
1962763 ENDO VERSASTEP 12MM                    $      420.20
1962764 ENDO TROCAR 10/12MM 512XD              $      370.70
1962767 CATH KMP 4.1FR G08542                  $      160.60
1962768 CATH PIGTAIL 8.2X22 AQ039822R          $      490.60 C1887
1962769 BONE MILL BM200                        $      564.30
1962770 BLADE DERMACARRIER 1 1/2               $      118.80
1962771 STAPLER LINEAR CUTTER                  $      979.00
1962772 RASP MICRO RECIPROCATING               $      130.90
1962773 ENDO CLOSURE PROC/KIT CTI-512N         $      424.60
1962774 CANNULA RETROGRADE 10FR 94010          $      330.00
1962775 PERF UNIV 3 SPIKE 903-00006            $      416.90
1962776 PERF RESEVOIR CARDIO 90300018          $      491.70
1962777 CANNULA VENOUS EDWARDS VFEM020         $      849.20
1962778 CANNULA VENOUS EDWARDS VFEM022         $      794.20
1962779 CATH PIG CSC 5-35-100 250684           $      419.10
1962780 FLOW QC KEY 314-5                      $      540.10
1962781 TUBING HTA PROCEDURE SET 55015         $     2,681.80
1962782 TOOL MIDAS REX DISSECT 9MC254          $      519.20
1962783 ARTHRO SUTURE LASSO AR4065-45L         $      501.60
1962784 ARTHRO 45 SUT LASSO AR4065-45R         $      501.60
1962785 ARTHRO 90 SUT LASSO AR4065-90W         $      501.60
1962786 TRAY BRAIN BIOPSY DISPOSABLE           $      951.50
1962787 SUT VICRY 0 CT 36                      $       30.80
1962788 ENDO OVAL PDS S2 OMS-PDBS2             $      513.70
1962789 SUTURE FIBERWIRE #2 AR                 $      119.90
1962790 CANNULA ARTERIAL THORTEC 14812         $     9,323.58
1962791 BLADE CURVED ULTRACISION 5MM           $      442.20
1962792 RETRACTOR OCTOPUS                      $     2,912.80
1962793 ANES EPIDURAL CATH KIT                 $       95.26
1962794 ANES TRAY TUN-L XL 16GA X 3.5          $      311.30
1962795 ASPIRATOR EXTRA LENGTH                 $      232.10
1962796 IRRIGATION SPIKE                       $       83.60
1962797 STRAIGHT SHAFT SHAVER                  $      324.50
1962798 CURVED SHAFT 15 DEGREE                 $      324.50
1962799 CURVED SHAFT 15 DEGREE W/              $      324.50
1962800 BASE OF TONGUE RF APPLINCE             $      790.90
1962801 CATH COUDE 14FR/5CC 0168L14            $      101.20 C1729
1962803 ACCESS SHEATH B7021                    $      578.60 C1874
1962804 ACCESS SHEATH B7011                    $      578.60 C1874
1962805 INTRODUCER FIBER OPTIC 661506          $      123.20
1962806 BIOPSY BRUSH COOK 040310               $      216.70
1962807 VINYL CONNECT TUBE 081398              $       99.00
1962808 CATH URETERAL OLIVE TIP 4FR RT         $       65.01 C1758
1962809 ENDOSCRUB 2 SHEATH 4MM 0               $      204.60
1962810 ESU VAPORTRODE ELECTRODE               $      601.70




                                         Page 160
                                         Ancillary


1962811 ARCH BARS ROLL                         $      137.50
1962812 ARCH BARS 12 STRIPS                    $      112.20
1962813 CLIP HEM O LOK MLX 544240              $      128.70
1962814 ANES 6 TUBE & STOPCK 42408 01          $       35.20
1962815 ANES MONITOR LINE 48                   $       37.40
1962816 CANNULA QUICK DRAW VENOUS 25FR         $     1,604.90
1962817 VULCAN TAC-11 7209628                  $     1,181.40
1962818 PROBE MICRO TAC-S 7209631              $     1,252.90
1962819 LIG CHISEL ST 7209649                  $      478.50
1962820 LIG CJISEL HOOK 7209646                $      481.80
1962821 LIG CHISEL ANGLED 7209648              $      481.80
1962822 VULCAN CHISEL CVD 7209647              $      481.80
1962823 MICRO CHISEL ANG 7209645               $      587.40
1962824 VUL ABLATOR 60DEG 7209650              $      561.00
1962825 ABLATOR 90 DEG 7209655                 $      537.90
1962826 ABLATOR-S 60DEG 7209653                $      643.50
1962827 ABLATOR-S 90DEG 7209654                $      643.50
1962828 ENDO VESSEL HARVEST KIT RAD06A         $     2,443.10
1962829 DRAIN BLAKE SILICONE 24FR 2234         $      132.00
1962830 ENDO SUCTION WAVE 007200-901           $      204.60
1962831 CANNULA ARTERIAL EDW FEM11018A         $      493.90
1962832 CANNULA ARTERIAL EDW FEM11020A         $      493.90
1962833 ENDO VERSAPORT PLUS 10-15MM            $      331.10
1962834 CANNULA ART DISPERSION DCT21A          $      192.50
1962835 KIT ARTERIAL INSERT EDWS PIKA          $      220.00
1962836 KIT VENOUS INSERT EDWARDS PIKV         $      220.00
1962837 CHROMOVISION LIGHT HANDLE              $       75.90
1962838 CANNULA RETROGRADE 6FR 94006           $      337.70
1962839 NEURO BECKER EDMS                      $      496.10
1962840 NEURO LUMBAR CATHETER ACCESSOR         $      451.00
1962841 CANNULA, VENOUS 1                      $      239.80
1962842 CATH VENT EDWARDS E061                 $      150.70
1962843 TUBE LARYNGEAL 6                       $      778.80
1962844 TUBE LARYNGEAL SIZE 7                  $      689.70
1962845 CANNULA VENOUS 20FR VFEM020            $      239.80
1962846 PERFUSION BIOPUMP BPX 80               $      655.60
1962847 CANNULA VENOUS 22FR VFEM022            $      239.80
1962848 PERFUSION BIOPUMP PEDS BP 50           $      655.60
1962849 INTRODUCER VENOUS EDWARDS PIKV         $      220.00
1962850 DILATOR HYDROPLUS 240-110              $      152.90
1962851 ENDO VERSASTEP NEEDLE 14G              $      125.40
1962852 SUT PDS II 7-0 BV-1 24                 $      121.65
1962853 FORCEPS STONE GRASPIT                  $      746.90
1962854 MASTISOL LIQUID ADHESIVE               $       27.50
1962855 SUT VICRYL 2-0 27 CT-3 J328H           $       30.80
1962856 ENDOVASCULAR/RENAL DILATOR SET         $      663.30
1962857 AMPLATZ INTRODUCER 30FR                $      157.30
1962858 AMPLATZ INTRODUCER 28FR                $      157.30
1962859 AMPLATZ INTRODUCER 26FR                $      157.30




                                         Page 161
                                         Ancillary


1962860 AMPLATZ INTRODUCER 24FR                $     157.30
1962861 SUPER SHEATH 7FR                       $     173.80 C1766
1962862 SUT TEVDEK 0 TIES                      $      28.88
1962863 SUT MERSILENE 2 LR 30 DA               $      30.73
1962864 SUT ETHILON 6-0 P-1 18                 $      31.04
1962866 SUT PROLENE 1 CT-1 60                  $      32.13
1962867 SUT PROLENE 5-0 P-3 18                 $      36.30
1962868 TUBING LATEX AMBER 1/4                 $      36.30
1962869 SUT PROLENE 3-0 SH 48 DA               $      37.40
1962870 ENDO CAP REDUCER FLIP TOP 5.5          $      40.70
1962871 ENDO CAP REDUCER MS712                 $      47.45
1962872 CATH COUDE 22FR 5CC                    $      51.70 C1729
1962873 SUT PROLENE 5-0 C-1 24 DA VB           $      52.80
1962874 SUT ETHIBOND 5 LR 3-20                 $      53.90
1962876 ENDO CAP MULTISEAL 5MM                 $      54.71
1962877 KIT MEDTRONIC SERVICE 5873C            $      55.00
1962878 SUT SILK 4-0 RB-1 8-18                 $      60.32
1962879 CATH URETERAL WHISTLE 4FR RT           $      64.33 C1758
1962880 CATH URETERAL WHISTLE 6FR RT           $      64.33 C1758
1962881 CATH URETERAL WHISTLE 5FR L            $      64.33 C1758
1962882 CATH URETERAL WHISTLE 4FR L            $      64.33 C1758
1962883 CATH URETERAL WHISTLE 6FR L            $      64.33 C1758
1962884 CATH URETERAL OLIVE TIP 5FR RT         $      65.01 C1758
1962885 CATH URETERAL OLIVE TIP 6FR RT         $      65.01 C1758
1962886 CATH URETERAL OLIVE TIP 4FR L          $      65.01 C1758
1962887 CATH URETERAL OLIVE TIP 5FR L          $      65.01 C1758
1962888 CATH URETERAL OLIVE TIP 6FR L          $      65.01 C1758
1962889 BLADE SAW KM-450                       $      65.44
1962890 BLADE SAW KM-456                       $      65.44
1962891 BLADE SAW OSCILL KM-272                $      65.44
1962892 BLADE OSCILLATING MICROAIRE            $      66.30
1962893 BLADE RECIP SAW ZR-020                 $      66.30
1962894 BLADE RECIP SAW ZR-021                 $      66.30
1962895 BLADE RECIP SAW ZR-120                 $      66.30
1962896 BLADE OSCILLATING MICRO ZO-060         $      66.30
1962897 BLADE OSCILLATING MICRO ZO-064         $      66.30
1962898 BLADE SAW SAGIT MICRO ZS-038           $      66.30
1962899 CATH URETERAL SPIRAL 4FR RT            $      67.50 C1758
1962900 CATH URETERAL SPIRAL 6FR RT            $      67.50 C1758
1962901 CATH URETERAL SPIRAL 4FR L             $      67.50 C1758
1962902 CATH URETERAL SPIRAL 5FR L             $      67.50 C1758
1962903 CATH URETERAL SPIRAL 6FR L             $      67.50 C1758
1962905 BLADE SAW OSCILL KM-256                $      73.16
1962906 BLADE RECIP SAW ZR-058                 $      74.88
1962907 BLADE RECIP SAW ZR-059                 $      74.88
1962908 BLADE RECIP SAW ZR-060                 $      74.88
1962909 BLADE RECIP SAW ZR-061                 $      74.88
1962910 CATH URETERAL CONE TIP 10FR RT         $      77.19 C1758
1962911 CATH URETERAL CONE TIP 12FR RT         $      77.19 C1758




                                         Page 162
                                         Ancillary


1962912 CATH URETERAL CONE TIP 10FR L          $      77.19 C1758
1962913 SUT VICRYL 8-0 TG160-8 8               $      78.10
1962914 ENDO SUT CHROMIC 0 LOOP 18             $      79.96
1962915 BLADE SAW CARBIDE SIDE ZB-101          $      80.87
1962916 BLADE SAW CARBIDE SIDE ZB-102          $      80.87
1962917 SUT PROLENE 3-0 SH 54 DA               $      84.70
1962918 BLADE OSCILLATING ZO-069               $      84.73
1962919 PROTECTOR WOUND 9 RING                 $      85.80
1962920 ESU CONCEPT CAUTERY                    $      85.80
1962921 TUBING DISSECTOR BLUNT TIP             $      88.00
1962923 BLADE OSCILLATING KM-31L LGE           $      91.45
1962924 BLADE OSCILLATING MICROAIRE            $      92.88
1962925 BLADE OSCILLATING ZO-050               $      92.88
1962926 BLADE OSCILLATING ZO-055               $      92.88
1962927 BLADE OSCILLATING ZO-056               $      92.88
1962928 BLADE SAW CARBIDE SIDE ZB-106          $      92.88
1962929 BLADE SAW CARBIDE SIDE ZB-114          $      92.88
1962930 BLADE CARBIDE OVAL 5607-22             $      95.70
1962931 BLADE SAW CARBIDE SIDE ZB-203          $      96.10
1962932 ENDO KNOT PUSHER LAPAROSCOPIC          $      96.80
1962933 BLADE SAW MICRO AIRE BARREL CU         $      98.88
1962934 BLADE OSCILLATING MICRO 560797         $      99.67
1962935 BLADE SAW SAGIT MICRO 5602-63          $      99.67
1962936 BLADE SAW SAGIT MICRO 5602-70          $      99.67
1962937 BLADE RECIP LG 5608-29                 $      99.67
1962938 BLADE SAW SAGIT MICRO MS-132           $     100.74
1962939 BLADE SAW SAGIT MS-125                 $     100.74
1962940 CATH COUDE 20FR 5CC                    $     101.20 C1729
1962941 BLADE SAW KM-23L                       $     101.45
1962942 BLADE SAW KM-27L                       $     101.45
1962943 SUCTION KAMVAC CVD MINI                $     103.40
1962944 SUT TICRON 5-0 CV-301 DA 30            $     104.50
1962945 BLADE SAW MICRO AIRE RECIP SAW         $     104.89
1962946 PERF SUCTION CELL SAVER                $     105.74
1962947 BLADE OSCILLATING S0-100 LGE           $     105.74
1962948 SUT ETHILON 10-0 CU-5                  $     108.90
1962949 SUT NYLON 11-0 CU-15                   $     108.94
1962950 SUT NYLON 11-0 CU-5                    $     108.94
1962951 BLADE RECIP SAW 5608-37                $     108.96
1962952 PIN CAP                                $      36.30
1962953 TUBE T 10FR                            $     110.12
1962954 BLADE SAW CUTTING CARBIDE              $     111.74
1962955 SHIELD SIMPULSE SPLASH                 $     113.30
1962956 TUBE TRACH 4 CUFFLESS                  $     116.60
1962957 TUBE TRACH 6                           $     116.60
1962958 BLADE OSCILLATING MO-121               $     118.60
1962959 BLADE OSCILLATING MO-138 LGE           $     118.60
1962960 BLADE OSCILLATING K-2000-46            $     124.26
1962961 BLADE OSCILLATING K-2000-02            $     124.26




                                         Page 163
                                         Ancillary


1962962 ENDO NEEDLE VERESS 150MM               $      127.51
1962963 BLADE OSCILLATING ZO-071               $      128.46
1962964 BLADE OSCILLATING ZO-072               $      128.46
1962965 PROBE PARSONNET 1.0MM                  $      128.70
1962966 TUBE, TRACH 8                          $      130.90
1962967 TUBE TRACH 10 CUFFLESS                 $      130.90
1962968 CANNULA VENOUS RETURN 22FR             $      130.90
1962969 TUBING SILASTIC                        $      134.20
1962970 BLADE OSCILLATING K-2000-26            $      140.80
1962971 CAP 4.0MM                              $      144.10
1962972 CAP 2.5MM                              $      144.10
1962973 CATH CHOLANGIOCATH 16GA                $      147.40
1962974 SPLINT II DOYLE                        $      154.00
1962975 BLADE OSCILLATIING 5610-14 LGE         $      156.32
1962976 CATH URETERAL WHISTLE 3FR RT           $      162.97 C1758
1962977 CATH URETERAL WHISTLE 3FR L            $      162.97 C1758
1962978 ENDO PROBE PLUS HOOK 5MM EPS01         $      166.56
1962979 ENDO PROBE PLUS SUCTION 10MM           $      168.41
1962980 BLADE ACROMIONIZER 5.5MM               $      184.80
1962981 BLADE OSCILLATING .032                 $      185.90
1962982 CANNULA, VENOUS 2                      $      188.10
1962983 KIT DISPENSER DUO FLO                  $      188.14
1962984 SILASTIC PA BAND                       $      196.83
1962985 ENDO IRRIG ENDO-FLO 0037970            $      215.60
1962986 CANNULA ARTERIAL ABIOMED               $      215.60
1962987 BLADE FULL RADIUS 3.5MM                $      221.49
1962988 BLADE NOTCHBLASTER 5.5MM               $      221.49
1962989 BLADE TURBO TRIMMER 4.5MM              $      263.92
1962990 BLADE NOTCHBLASTER 4.0MM               $      263.92
1962991 BLADE STONE CUTTER ACROMION 5.         $      263.92
1962992 ENDO TIP CAUTERY PEDS RT ANGLE         $      264.00
1962994 ENDO CATCH GOLD 10MM ECATCH10G         $      271.30
1962995 TOURNIQUET CUFF #12                    $      278.64
1962996 TOURNIQUET CUFF 18NON-STERILE          $      278.64
1962997 TOURNIQUET DOUBLE CUFF 18/24           $      278.64
1962998 ENDO PROBE PLUS HANDPIEC EPH01         $      290.65
1962999 ENDO SUCTION/IRRIG/PROBE               $      321.20
1963000 PERF RESERVOIR CARDIOTOMY              $      345.40
1963001 CATH HICKMAN 10.8FR                    $      389.40 C1751
1963002 DRAIN VENTRICULAR EXTERNAL             $      397.10
1963003 KIT OCUTOME PACK DISPOSABLE            $      499.59
1963004 TOURNIQUET 12 NONSTERILE               $      500.50
1963005 PERF PUMP TABLE PACK                   $      169.55
1963006 ENDO PROBE OCULAR                      $      535.70
1963007 PERF PUMP PACK PED                     $      712.80
1963008 DRILL SUPERANCHOR MITEK                $     1,141.80
1963009 SUT SILK 4-0 PS-2 18                   $       30.50
1963010 SUT VICRYL 4-0 PS-2 18                 $       34.10
1963011 SUT TEVDEK 1 C-2 7-775                 $       36.30




                                         Page 164
                                         Ancillary


1963012 SUT PROLENE 2-0 SH 48 DA               $      37.79
1963014 SUT MERSILENE LF 6-0 18                $      44.00
1963015 ENDO REDUCER 5MM LONG                  $      45.10
1963016 ENDO CAP REDUCER 10/12 R1810           $      47.30
1963017 ENDO REDUCER CAP 5-18MM R1805          $      47.38
1963018 TOURNIQUET 5/PK DLP                    $      52.80
1963019 CANNULA J HOOK 585003                  $      53.23
1963020 TUBING LEVEL 1 IR 600                  $      66.00
1963021 ENDO CANNULA SEAL 5MM                  $      74.80
1963022 ENDO CANNULA SEAL 11M                  $      74.80
1963023 ENDO CANNULA SEAL 12M                  $      74.80
1963024 SUT VICRYL 1 CT-1 8-27 C/R             $      80.30
1963026 CATH MAHURKAR 11.5 X16CM CURVE         $      84.93 C1750
1963027 INTRODUCER DILAMEZINSERT               $      90.20
1963028 ANES SENSOR PULSE OX DISPOSABL         $      90.74
1963029 ENDO SUT ENDOSTITCH AUTOSUTURE         $      93.19
1963030 FALLOPE RINGS                          $      94.60
1963031 TUBING IRRIGATION MALIS W/BIPO         $      94.60
1963032 TIP HARMONIC TEST                      $      99.00
1963033 SUT NYLON 10-0 CU-5                    $      99.47
1963034 BLADE SAW SAGITTAL KM 658              $     103.40
1963035 PACK SETUP STERILE (88128)             $      49.50
1963036 ENDO LLETZ BALL ELCTRODE               $     111.45
1963037 ESU BIPOLAR BRUSH W/CORD               $     112.20
1963038 CLIP GUN MAGAZINE                      $     116.60
1963039 ACMI DOLPHIN COLLECTION KIT            $     116.60
1963040 ENDO POUCH TISSUE 2X5 LAPSAC           $     126.50
1963041 PACK CUSTOM MINOR BASIN                $     139.19
1963042 CANNULA BLOWER MISTER CLEARVUE         $     182.90
1963043 ADAPTER HARMONIC SYSTEM 5MM            $     143.00
1963044 ENDO KITTNER                           $     150.70
1963045 CSI FLEXIBLE WEAR CONTACT LENS         $     150.70
1963046 JONES GOLD DILATORS #1&2               $     155.10
1963047 ENDO PROBE PLUS SPATULA EPS02          $     165.00
1963048 ENDO PROBE PLUS STONE EPS12            $     165.00
1963049 SYRINGE LEVEEN INFLATOR 10CC           $     165.99
1963050 GUIDEWIRE ANG/FLEX 0.035               $     170.50 C1769
1963051 ANES PROBE TEMPERATURE PEDS            $     170.85
1963052 ANES NEEDLE EPIDURAL LONG              $     170.85
1963053 23G BIPOLAR TAPERED FINE POINT         $     172.70
1963054 ENDO SLEEVE XCEL 10/11 CB11LT          $     202.40
1963055 SUT PROLENE 4-0 SH 54 DA               $      99.00
1963056 CATH FOLEY COUDE 20FR 0102L20          $     115.50
1963057 ENDO HANDPIECE SUCTION/IRRIGAT         $     341.00
1963058 RELIEVA SINUS GDWRE GW35100S           $     114.40 C1769
1963059 ENDO ELECT/SUCTION E2610-6             $      68.20
1963060 ESU CABLE BIPOLAR CIRCON (DAC)         $     140.80
1963061 ESU INSULATED COATED BLADE             $      69.30
1963062 CATH CHOLANGRM 7.5FR 20018-010         $     203.50




                                         Page 165
                                         Ancillary


1963063 OPHTH SURG PROC KIT (581066)           $        33.00
1963064 CANNULA HYDR/DST 25GX22 585037         $        48.40
1963065 TOOL MIDAS REX LEGEND                  $       431.20
1963066 TOOL MIDAS REX LEGEND (14BA90)         $       431.20
1963067 TOOL MDS REX DST LGND F1/8TA15         $       344.30
1963068 TOOL MDS RX 26CMX3M MCH 26MH30         $       431.20
1963069 TOOL MDS RX 6X6M DISCT 26BA30          $       449.90
1963070 ENDOSTITCH 2-0 48IN (173023)           $       160.60
1963071 NEEDLE, MONOPTY BIOPSY                 $       184.80
1963072 RELIEVA SIN BALLN CATH BC0516          $     10,828.40 C1726
1963073 RELIEVA SIN BALLN CATH BC0716          $     10,828.40 C1726
1963074 700 ACCESSORY KIT                      $      1,320.00
1963075 RELIEVA SINUS GUIDE CATH               $      1,025.20
1963076 RELIEVA INFLATION DEVICE BID30         $       378.40
1963078 SYNTHES REAMING ROD 351.706S           $       195.80
1963079 SUT CV-5 TH-18                         $       624.80
1963080 ENDO POUCH TISSUE 4X6 054601           $        36.30
1963082 SONOSITE SHEATH KIT P03360             $        71.50
1963083 PULMONARY BALLOON DILATOR 5032         $      2,681.25
1963084 COOK GANGLION TRIGEMINAL SET           $       239.80
1963087 SUT PROLENE 4-0 P-3 18                 $        60.50
1963088 QUILTED HEEL PROTECTOR                 $       138.60
1963089 KIT NEUROSTIMILATOR PT PRGMR           $      2,339.70 C1787
1963090 BIOPSY NEEDLE BNE/BRST                 $       264.00
1963091 STAPLER RELOAD LINEAR CUTTER           $       179.30
1963093 TOOL DISSECTING CUTTER                 $       532.40
1963094 TOOL DISSECTING TAPER                  $       854.70
1963095 TOOL DISSECT MATCHHEAD                 $       539.00
1963096 TUBE GASTROSTOMY 1                     $       562.10
1963097 TUBE ENDOTRACHEAL 1                    $       551.10
1963098 TROCAR ENDO 10MM                       $       377.30
1963099 CANNULA OPHTHALMIC                     $       179.30
1963100 TUBE GASTROSTOMY 2                     $       827.20
1963101 ENDO TISSUE POUCH RETRIEVEL            $       258.50
1963102 EXTRACTOR, TISSUE STERILE              $       606.10
1963103 ENDO HARMONIC SCALPEL SHEARS           $      1,136.30
1963104 ENDO HARMONIC CURVE SHEAR              $      1,193.50
1963105 BLADE, TREPHINE                        $       283.80
1963106 TWIST DRILL SURGICAL 1                 $       517.00
1963107 BLADE, PIVOTAL/FIXED HEAD              $        32.00
1963108 KIT, PROCEDURAL CARDIOVASCULAR         $        98.00
1963109 NEEDLE, BIOPSY 1                       $       352.00
1963114 BLADE, LARYNGOSCOPE                    $       203.50
1963115 BLADE, SHAVER                          $      1,505.90
1963116 ESU LIGASURE                           $       993.30
1963117 GELPORT SEAL                           $      1,388.20
1963118 SCALPEL, SURGICAL 1                    $        25.00
1963119 NEUROPEN WITH NEUROENDOSCOPES          $      1,542.00
1963120 HYDROJET WITH APPLICATOR               $      5,691.00




                                         Page 166
                                         Ancillary


1963121 HYDROJET FLUID MATERIAL                $      177.00
1963123 SCALPEL, SURGICAL 2                    $      155.63
1963124 BLADE, OSCILLATING/HARVEST             $      518.15
1963125 BLADE, RETRACTING 1                    $      404.05
1963126 BLADE, RETRACTING 2                    $     1,223.12
1963127 SLEEVE, TRUKOR DRILL                   $      786.78
1963128 NEEDLE, BIOPSY 2                       $      696.19
1963129 NEEDLE, BIOPSY 3                       $     1,340.39
1963130 LACRICATH 1                            $     1,605.31
1963131 TAP, NEURO/SPINE 2                     $     1,262.00
1963132 PROBE, CRYO ABLATION                   $     7,137.99 C2618
1966208 NO COST SUPPLY                         $        1.10
1967202 ANES CONT NERVE BLOCK TRAY             $      925.32
1967203 ANES CONT NERVE BLOCK CATHS            $     1,195.70
1967204 ANES STIMUPLEX CATH                    $      153.12
1967206 ANES ET TUBE EXCHANGE CATH             $      229.68
1967210 TUBE ET DOUBLE LUMEN                   $      370.92
1967216 TUBING HOTLINE                         $      235.17
1967225 ANES NACL 0.9% HEPARIN 2U/ML           $       43.56
1967226 ANES INTRODUCER KIT MAC 9.5FR          $      270.60
1967228 ANES PA CATHETER LATEX FREE            $     1,967.90
1967229 ANES CATH PA PEDIATRIC                 $      529.32
1967230 CATH PA HEPARIN FREE                   $      220.00
1967232 ANES ET INTUBATING INTRODUCER          $      571.56
1967233 ANES EMERG AIRWAY CATH KIT             $      471.90
1968002 FEM.PRESS.DEPUY 546126000              $      132.00
1968003 NIGHTHAWK DIS. HOOD                    $      133.10
1968004 CANAL BRUSH 206-711                    $      115.50
1968005 ENDO SWITCH BLADE TIPS                 $      141.90
1968006 ALUMI-HAND IMMOBLZR 760                $      137.50
1968007 ENDO LAPAROSCOPIC MORCELLATOR          $     1,909.60 C1782
1968008 ENDO ELECTRODE CUTTING LOOP            $      388.30
1968009 BLADE INCISOR 2.9MM 7209065            $      380.60
1968010 ENDO TROCAR 5MM OPTIVIEW               $      181.91
1968011 ENDO TROCAR XCEL 12MM                  $      352.00
1968012 SUT SILK 4-0 PS-2 18                   $       46.20
1968013 ENDO IRRIGATOR HYDRO-SURG PLUS         $      183.70
1968014 NEEDLE BONE MARROW HARVEST             $       96.80
1968015 ENDO SLEEVE XCEL 12MM CB12LT           $      207.90
1968016 ENDO TROCAR XCEL 11MM B11LT            $      342.10
1968017 ENDO TROCAR XCEL 5MM B5LT              $      269.50
1968018 ENDO RETRACT MINI 174209               $      401.73
1968019 ENDO SLEEVE XCEL 5MM CB5               $      162.80
1968020 EMG ELECTRODE PAIRED 4 CH              $      424.60
1968021 ENDO STRYKEFLOW II 250-070-500         $      193.60
1968022 SUT CHROMIC 2-0 CT-1 27                $       66.00
1968023 SUT PRONOVA 5-0 C-1 24 DA              $       81.69
1968024 CANNULA AORTIC 20FR DLP                $      124.60
1968025 TUBING INTERPULSE IRRIGATION           $      133.38




                                         Page 167
                                             Ancillary


1968026 SUT CHROMIC 3-0 CT1 810H                   $       34.10
1968027 ENDO STARION SHEAR        102-137D         $     1,446.50
1968028 ENDO STAPLER GIA-II 12MM                   $      327.91
1968029 VALVE DELTA REGULAR 1.5MM                  $     2,197.80
1968030 TUBING ARTHRO PUMP DYONICS                 $      149.60
1968031 ENDO LAP DISC HAND DVICE LD111             $     1,761.10
1968032 ENDO TIP COVER INTUI 400180-0              $      150.70
1968034 FEMORAL BRUSH 5461-22-000                  $      121.00
1968036 SUT VICRYL 1 OS-8 J718T                    $       79.20
1968037 SUT VICRYL 2-0 CTX J363H                   $       30.80
1968038 BLADE SAW KOMET 11-2222                    $      122.10
1968039 BAG COLOSTOMY GENTLE 1.75                  $      196.90
1968040 BLADE SAW COTTLE KM-80                     $      221.27
1968041 VALVE DELTA 1.5MM SMALL                    $     1,608.75
1968042 CAP BACKFLOW TTG AR-1812                   $       95.70
1968043 ENDO STAPLER ET45G                         $      675.40
1968044 ENDO STAPLER ET45B                         $      675.40
1968045 ENDO SURESEAL II                           $       80.97
1968046 ENDO URETERAL BALLOON CATH                 $      651.04 C1726
1968047 ENDO RELOAD GIA-II 30-2.0                  $      337.19
1968048 ENDO RELOAD GIA-II 30-2.5                  $      280.50
1968049 ENDO RELOAD GIA-II 30-3.5                  $      280.50
1968050 ENDO RELOAD GIA-II 45-4.8                  $      295.03
1968051 ENDO GIA-II 60-4.8 SULU                    $      272.80
1968052 MED HYPAQUE DYE 50% 50CC                   $      104.50
1968053 ANES PRESS TRANS VENOUS                    $       87.09
1968054 ENDO PCH TISS RTRVL (054100)               $      155.10
1968055 LEMAITRE STENT GUIDE 1102-20               $      126.50
1968056 SUT VICRYL 7-0 TG160-8 18                  $       73.70
1968058 SUT ETHILON 5-0 P-3 18                     $       31.04
1968059 STAPLER SURGICLIP 9.5                      $      752.31
1968060 CANNULA FEMORAL ARTERY 18FR                $      131.46
1968061 CANNULA FEMORAL ARTERY 16FR                $      131.46
1968062 STAPLER LINEAR CUTTER TCT75                $      442.20
1968063 KIT PLEURAL CATHETER                       $      669.90
1968064 KIT PLEURAL DRAINAGE KIT                   $      281.60 C1729
1968065 CATH HICKMAN 1.6MM PREATTACHAB             $      867.90 C1751
1968066 ENDO TROCAR SLEEVE 10/12 512ST             $      174.90
1968067 ENDO TROC 5MM 35NLT BLADELESS              $      297.00
1968068 ENDO REDUCER 10/12MM R1810                 $       68.20
1968069 ENDO REDUCER 5.5MM R1805                   $       68.20
1968070 ENDO SLEEVE VERSASTEP                      $      275.00
1968071 ENDO SUT VICRYL 2-0 26MM SW222             $      127.60
1968072 SUT ETHILON 4-0 PC-3 18                    $       35.93
1968073 SUT ETHILON 3-0 PS-1 18                    $       30.98
1968074 ENDO SUT VICRYL 0 20MM SW210               $      128.70
1968075 ENDO SUT VICRYL 0 26MM SW220               $      127.60
1968076 ENDO SUT VICRYL 2-0 20MM SW212             $      127.60
1968077 STAPLER RELOAD 30MM XR30G                  $      139.70




                                             Page 168
                                         Ancillary


1968078 BLADE SERRATED 3MM 70-0077-103         $      255.20
1968079 ESU DISSECT SEALER TISSUELINK          $     3,839.00
1968080 ENDO ACCESS NEEDLE 3MM AN3MM           $      196.90
1968081 EYE MICROSTAR INJECTOR                 $      135.30
1968082 SUT PDSII 2-0 CT-2 27                  $       35.37
1968083 ENDO FORCEPS DISSECTING 3700PK         $      420.20
1968084 ENDO SCISSORS 3804PK                   $      458.70
1968085 ENDO NEEDLE ELECTRODE 3400PK           $      575.30
1968086 SUT ETHILON 4-0 PC-3 18                $       35.84
1968088 BLADE SAW SAGIT KM-618                 $      101.45
1968089 DRILL BIT 21.5D6ST                     $      216.70
1968090 TUBE PE COLLAR BUTTON .050             $       92.40
1968091 TUBE PE SHEPARD WITH TAB .040          $       72.89
1968092 TUBE PE SHEPARD WITH TAB .045          $      103.40
1968093 DRILL BIT 22DL6ST                      $      216.70
1968094 TUBE PE SHEPARD WITH WIRE .040         $       72.89
1968095 DRILL BIT 22B6ST                       $      195.80
1968096 DRILL BIT 22.5B6ST                     $      195.80
1968097 TUBE PE VENT .045                      $       72.17
1968098 SUT NUROLON 2-0 CT-2 8-18              $       40.08
1968099 DRILL BIT 23B6ST                       $      195.80
1968100 DRILL BIT 24B6ST                       $      195.80
1968101 TUBE PE RICHARD T TUBE .045            $       82.85
1968102 DRILL BIT 22.5D6ST                     $      216.70
1968103 TUBE PE VENT .035                      $       72.89
1968104 STAPLER RELOAD XR30V                   $      183.70
1968105 DRILL BIT 23D6ST                       $      216.70
1968106 ENDO STAPLER MULTIFEED EMS             $      401.50
1968107 ENDO TROCAR 10MM OPTIVIEW              $      297.00
1968108 ENDO IRRIGATION HYSTEROSCOPIC          $      334.40
1968109 KIT VITRECTOMY INNOVIT PAK             $      407.51
1968110 DRILL BIT 711003                       $      116.60
1968111 DRILL BIT 22S6ST                       $      231.00
1968112 SET INTUBATION CRAWFORD                $      234.30
1968113 DRILL BIT 26B9ST                       $      213.40
1968114 DRILL BIT 22D9ST                       $      216.70
1968115 ENDO ILLUMINATOR BULLET SHIELD         $      143.13
1968116 CATH MAHURKAR 13.5FR X 40CM            $      460.24 C1750
1968117 DRAIN PLEUR-EVAC INFANT                $      214.50
1968118 ENDO RELOAD THICK TR45G                $      316.80
1968119 ENDO RELOAD REGULAR TR45B              $      380.60
1968121 STAPLER RELOAD TRH90                   $      320.10
1968122 STAPLER RELOAD TCR10                   $      401.65
1968123 STAPLER BOWEL CEEA28                   $     1,041.95
1968124 STAPLER BOWEL CEEA31                   $     1,146.15
1968125 STAPLER BOWEL CEEA29                   $     1,041.95
1968126 ENDO STAPLER CIRCULAR ECS29            $     1,060.99
1968127 ENDO STAPLER RELOAD 35MM TR35B         $      456.50
1968128 STAPLER RELOAD 90NN TR90               $      233.99




                                         Page 169
                                         Ancillary


1968129 STAPLER SKIN PROXIMATE PMW35           $       91.85
1968130 ENDO GIA RELOAD 30-2.5                 $      410.48
1968131 STAPLER CEEA PREMIUM 21                $     1,244.10
1968132 STAPLER RELOAD TA-30 4.8               $      275.00
1968133 STAPLER RELOAD TA-90B 4.8              $     1,311.20
1968134 ENDO STAPLER EAS                       $      489.50
1968135 STAPLER TRANSVERSE TLH90               $      393.80
1968136 CANNULA RETINAL PICK                   $       79.20
1968137 ENDO STAPLER ECS29                     $      801.90
1968138 ENDO STAPLER CIRCULAR ECS33            $      731.52
1968139 ENDO RELOAD ERU35                      $      422.40
1968140 ENDO STAPLER ELC60                     $      561.00
1968141 ENDO RELOAD ERU60                      $      561.00
1968142 ENDO STAPLER HERNIA EAS                $      787.60
1968143 ENDO RELOAD VASCULAR TR35W             $      380.09
1968144 ENDO ARTICULATING LC ATW45             $      715.84
1968145 ENDO RELOAD TR35W/TR45W                $      456.50
1968146 ENDO STAPLER ECS21                     $      865.70
1968147 STAPLER RELOAD TR90                    $      255.18
1968148 ENDO STAPLER THORACIC EZ45B            $      765.37
1968149 ENDO RELOAD ZR45G                      $      325.01
1968150 STAPLER RELOAD TLV30                   $      425.70
1968151 STAPLER RELOAD XR30B                   $      170.50
1968152 STAPLER ILS CURVED 33MM                $     1,130.80
1968153 ENDO RELOAD 45 3.5MM 6R45B             $      421.30
1968154 OPHTH IRIS RETRACTOR FLEXIBLE          $      328.90
1968155 ENDO HAND PORT SYSTEM                  $     1,004.30
1968156 LASER IRIS ENDOPROBE                   $      468.60
1968157 CANNULA BISHOP HARMON                  $       61.41
1968158 OPHTH SCLERAL SPONGE 505               $      145.20
1968159 OPHTH SCLERAL SPONGE 506               $      138.60
1968160 OPHTH SCLERAL SPONGE 507               $      145.20
1968161 OPHTH SCLERAL SPONGE 509               $      159.50
1968162 OPHTH SCLERAL SPONGE 511               $      145.20
1968164 CANNULA FLEXIBLE TIP ASPIRATOR         $       89.71
1968165 CANNULA VENOUS BIOMEDICUS 23FR         $      906.64
1968166 CANNULA VENOUS BIOMEDICUS 25FR         $      694.44
1968167 CANNULA BICAVAL BIOMED 24/29           $      520.84
1968168 CANNULA BICAVAL BIOMED 30/33           $      520.84
1968169 CANNULA VENOUS BIOMEDICUS 8FR          $      520.84
1968170 CANNULA ARTERIAL BIOMEDICUS 15         $      636.57
1968171 CANNULA ARTERIAL DLP                   $      192.76
1968172 CANNULA ARTERIAL DLP 10FR              $      192.76
1968173 CANNULA ARTERIAL DLP 12FR              $      192.76
1968174 CANNULA ARTERIAL DLP 14FR              $      192.76
1968175 ESU RITA GROUNDING PAD                 $      268.40
1968176 DRILL BIT 21D9ST                       $      216.70
1968177 BLADE HARMONIC SCALPEL 5MM             $      499.40
1968178 BLADE CLIPPER SURGICAL                 $       42.90




                                         Page 170
                                         Ancillary


1968179 DRILL BIT 25B9ST                       $     213.40
1968180 HEART STABILIZER USSC                  $     709.50
1968181 HEART STABILIZER USSC LUNG             $     761.20
1968182 BASE UNIVERSAL RETRACTOR               $     796.40
1968183 DRILL BIT 24B9ST                       $     216.70
1968184 SUT VICRYL 2-0 54 UNDYED               $      30.80
1968185 DRILL BIT 26D6ST                       $     216.70
1968186 SHUNT INTRALUMINAL 1.5MM               $     167.20
1968187 SHUNT INTRALUMINAL 2.0MM               $     167.20
1968188 DRILL BIT 20.D6ST                      $     210.10
1968189 DRILL BIT 21D6ST                       $     216.70
1968190 DRILL BIT 21DL6ST                      $     216.70
1968191 DRILL BIT 21B6ST                       $     195.80
1968192 DRILL BIT 21.5B6ST                     $     195.80
1968193 SHUNT INTRALUMINAL 2.5MM               $     167.20
1968194 SHUNT INTRALUMINAL 3.0MM               $     167.20
1968195 DRILL BIT 23F6ST                       $     216.70
1968196 DRILL BIT 26X6ST                       $     216.70
1968197 DRILL BIT 23DL6ST                      $     216.70
1968198 DRILL BIT 25B6ST                       $     195.80
1968199 LEAD EXTRACTION PIN VISE               $     209.00
1968200 ENDO ELECTRODE NEEDLE                  $     210.10
1968201 GUIDEWIRE STR/STIFF 0.035              $     214.71 C1769
1968202 ENDO PUNCTURE CLOSURE EXIT             $     231.00
1968203 ENDO LAPAROSCOPIC HANDPIECE            $     240.90
1968204 ENDO TROCAR 10MM BLUNT ORIGIN          $     245.30
1968205 TIP GUIDE DEFLECTING WIRE              $     248.60
1968206 TOOL MIDAS REX DISSECTING M3           $     251.90
1968207 SUTURE FIBREWIRE LOOP #2 AR            $     226.60
1968208 DRAIN PLEUR-EVAC DUAL CHAMBER          $     254.10
1968209 TOOL MIDAS REX DISSECT G8-130          $     262.90
1968210 LACRIMAL INTUBATION SET                $     266.20
1968211 BLADE FULL RADIUS 4.5MM                $     268.63
1968212 CLIP OMNI CLIP GUN                     $     270.60
1968213 PIN GAUGE                              $     288.20
1968214 CANNULA VENOUS FEMORAL 19FR            $     287.10
1968215 CANNULA VENOUS FEMORAL 21FR            $     287.10
1968216 BLADE FULL RADIUS 5.5MM                $     308.00
1968217 LEAD SHEATH DILATOR 8.5FR BYRD         $     308.00
1968218 LEAD SHEATH DILATOR 10.0 BYRD          $     308.00
1968219 LEAD SHEATH DILATOR 11.5 BYRD          $     308.00
1968220 LEAD SHEATH DILATOR 002 TEFLON         $     308.00
1968221 INTRODUCER COOK 20FR                   $     322.30
1968222 CLIP APPLIER MSM20                     $     342.10
1968223 PIN GUIDE 2.4MM ARTHREX                $     347.60
1968224 ENDO APPLIER CLIP AL326 5MM            $     354.75
1968225 ENDO VALLEYLAB HANDPIECE               $     358.41
1968226 BASKET HELICAL 2.4FR                   $     379.37
1968227 SET RETRIEVER INTRAVASCULAR            $     407.00




                                         Page 171
                                         Ancillary


1968228 CANNULA VENOUS FEMORAL 17FR            $      413.19
1968229 ACMI DOL-TUB TRANSDUCER                $      420.20
1968230 STAPLER TLV30                          $      425.70
1968231 DRESS NU-KNIT KELP 6 X 9               $      432.30
1968232 HARMONIC DISSCTNG HOOK5MM              $      442.20
1968233 SET DILATOR TELESCOPING SHEATH         $      445.50
1968234 ENDO RELOAD TR35W                      $      456.50
1968235 TRAY FLEX LAP CHOLE                    $      486.20
1968236 ENDO NEEDLE BIOPSY ASAP MICROV         $      486.20
1968237 ENDO ROUND PDB     OMS-PDB1000         $      502.70
1968238 ESU VAPORTRODE FLUTED BAR VE-F         $      511.50
1968239 BASKET SEGURA 2.4FR                    $      546.88
1968240 BASKET SEGURA 3.0FR                    $      546.88
1968241 BASKET GEMINI 2.4FR                    $      546.88
1968242 ENDO ENDOHERNIA 4.8MM                  $      563.68
1968243 BLADE HARMONIC SCALPEL LCSK5           $      606.10
1968244 TIP DEFLECTING WIRE HANDLE             $      623.70
1968245 CANNULA ARTERIAL BIOMEDICUS 17         $      636.57
1968246 TOOL MIDAS REX F117TA15                $      693.00
1968247 LASER SHEATH OUTER 12FR                $      751.41 C2629
1968248 ENDO CLIP M/L USSC 176657              $      759.55
1968249 CANNULA VENOUS BIOMEDICUS 17FR         $      755.54
1968250 BASKET HELICAL 3.0FR                   $      768.90
1968251 TOURNIQUET CUFF 42 NONSTERILE          $      785.40
1968252 LENS DIOPTER 20 NIKON                  $      804.10
1968253 SHORT AWL - VTI ACCESSORY              $      804.38
1968254 ENDO TROCAR BLUE ACUFEX                $      849.20
1968255 DRILL BIT - VTI ACCESSORY              $      866.25
1968256 SHORT DRILL BIT - VTI ACCESS.          $      866.25
1968257 ENDO HARMONIC PISTOL GRIP 10MM         $      915.20
1968258 CLIP YASARGIL ANEURYSM                 $      926.20
1968259 ENDO HARMONIC SHEAR LCS15              $     1,045.00
1968260 ENDO CUTTER LONG 45MM LONG45A          $     1,085.70
1968261 ENDO FORCEPS SEITZINGER TRIPOL         $     1,157.20
1968262 HARMONIC COAGULATNG SHEAR              $     1,184.70
1968263 BASKET HELICAL LOOP PRE LOADED         $     1,205.60
1968264 CATH GROSHONG 9.5FR DUAL LUMEN         $     1,238.60 C1750
1968265 HEMORRHOID STAPLER                     $     1,301.30
1968266 RETRIEVAL SET FEMORAL                  $     2,005.30
1968267 PAD SOMONOPLASTY PADS                  $     2,681.25
1968268 TIP CURVED EXTENDED MICRO              $      975.70
1968269 PACK PERF PUMP TABLE (62007)           $      379.50
1968270 CATH URINARY EXTERNAL (6200)           $       29.70
1968271 CATH FOLEY 24FR (0174L24)              $      110.00
1968272 CATH FOLEY 26FR (0167V26S)             $      110.00
1968273 CANNULA BISHOP HARMAN                  $       61.41
1968274 CATH FOLEY 30FR (0166V30S)             $       57.20
1968275 SUT CAPROSYN 2-0 GU-46 UC-878          $       66.00
1968276 SUT CAPROSYN 2-0 GU-46 UC-978          $       66.00




                                         Page 172
                                         Ancillary


1968277 EYE CONFORMER W/HOLES MED              $      116.60
1968278 EYE CONFORMER W/HOLES LG               $      116.60
1968279 EYE CONFORMER W/HOLES SM               $      116.60
1968280 EYE RETRACTOR FLEXIBLE                 $      413.60
1968281 TUBING STACKHOUSE                      $      136.40
1968282 TUBING HIGH PRESSURE 91051482          $       93.50
1968283 TUBING HI PSI 48 DCT-148               $       68.20
1968284 CORD ACTIVE CIRCON                     $      132.00
1968285 TOOL FLUTED BALL 4MM S-4B              $      347.60
1968286 TOOL DIAMOND BALL                      $      347.60
1968287 TOOL FLUTED BALL                       $      347.60
1968288 TOOL FLUTED BALL 5MM QD8-5SB           $      347.60
1968289 WIRE STIFF ST.035 630-109              $      337.07 C1769
1968290 STONE EXTRACTOR TIPLESS                $      914.10
1968291 SHEATH, FLEXOR 1                       $      435.60 C2629
1968292 SHEATH, FLEXOR FUS-120035              $      435.60 C2629
1968293 FLEXOR SHEATH FUS-120020               $      435.60 C2629
1968294 SHEATH, FLEXOR FUS-120055              $      435.60 C2629
1968295 TROCAR NEEDLE 18G X 15CM               $      121.00
1968296 URODYNAMIC PUMP TUBING                 $      122.10
1968297 ELLICK EVACUATOR DISP                  $      118.80
1968298 MAGNUM BX NEEDLE MN1820                $      144.10
1968299 BLADE, OPHTHALMOLOGIC                  $      102.30
1968300 SUT PDSII 7-0 BV1 30                   $      108.90
1968301 ARTHRWAND SCTN COVAC AS3730-01         $      719.40
1968302 SUT GORE TEX CV-7 24 TTC-09            $      158.40
1968303 CLIP FILSHIE                           $      361.90
1968304 SUTURE OPUS SMARTSTITCH                $      634.70
1968305 SUTURE 1                               $       61.60
1968306 SUTURE 2                               $      245.30
1968307 SUTURE 3                               $      359.70
1968308 CATH JB1 004022                        $      117.70
1968309 CANNULA , VENOUS RETURN                $      195.80
1968310 BLADE HARMONIC 5MM CVD HC325           $      624.80
1968311 ESU INSULATED COATED BLADE             $       69.30
1968312 MICRINS BACKGROUND MATERIAL            $       71.50
1968313 PAD SOMONOPLASTY PADS                  $     2,681.25
1968315 SUT ETHIBOND 2-0 SH                    $       50.49
1968316 ENDO VALVE SUCTION DISP 52898          $       36.30
1968317 SET SPINAL TRIGEMINAL GANGLION         $      893.20
1968318 STAPLER INTERNAL REIN/BBSRBLE          $      570.90
1968319 TRIPOLAR FORCEP                        $      839.30
1968321 ARTHRO SMARTSTITCH CONNECTOR           $      400.40
1968322 IRRIGATION PUMP W/SMOKE EVAC           $      229.90
1968323 PALATE RF APPLIANCE                    $      796.40
1968324 TURBINATES RF APPLIANCE                $      334.40
1968325 TAMPON ADULT NASAL MEROCEL             $       75.90
1968326 CATH EPIDURAL 20GA                     $       78.10
1968327 ESU GROUND PAD RADIONICS               $       85.80




                                         Page 173
                                         Ancillary


1968328 NEEDLE RADIONICS SMK-C-10              $       95.70
1968329 CATH URETERAL 4FR                      $       63.04 C1758
1968330 CLIP GUN RANEY                         $      270.60
1968331 ARTHRO SHOULDER SUSP KIT #3583         $      247.50
1968332 CATH URETERAL 5FR                      $       63.04 C1758
1968333 TOOL MIDAS REX DISSECTING WH3          $      357.50
1968334 PIN CAP FITS .028 .035 .045            $      158.40
1968335 REAMER SWANSON #5091-142               $      129.80
1968336 KIT DBS LEAD KIT NEURO                 $     4,809.20
1968337 KIT FRAME LEKSELL                      $     2,665.30
1968338 STOCKING SEQUENTIAL COMPRESS           $      234.30
1968339 PACK CUSTOM NEURO MINOR                $      354.86
1968340 REAMER SWANSON #5091-143               $      199.10
1968341 DRAIN PLEUR-EVAC ADULT/PEDS            $      190.30
1968342 TOOL MIDAS REX DISSECTING WH2          $      357.50
1968343 KIT GFI TUBING SET ACCURUS             $      158.40
1968344 KIT FRAGMATOME PAK ACCURUS             $      326.70
1968345 ENDO STEP INSUFFLATOR                  $       88.00
1968346 ENDO TROCAR 10MM STEP W/SLEEVE         $      389.40
1968347 KIT PERFLURON                          $     1,446.50
1968348 ENDO TROCAR 12MM STEP W/SLEEVE         $      422.40
1968349 LASER PROBE CURVED                     $      526.90
1968350 ENDO PROTAK PTA CK30                   $      905.30
1968351 HAND PIECE TURBINATE 1120              $      466.18
1968352 HANDPIECE PALATE 1010                  $     1,044.88
1968353 HAND PIECE TONGUE 1200                 $     1,044.88
1968354 ARTHRO 5MM TWIN FIX TI 720936          $      806.30
1968355 TOOL MIDAS REX 14BA50                  $      273.90
1968356 ATHRO 5MM TWINFIX AB 7209369           $     1,100.00
1968357 ARTHRO 7MM CLR CANNULA 7207227         $      122.10
1968358 ARTHRO 8MM CLR CANNULA 7207228         $      121.00
1968359 CANNULA ARTERIAL BIOMEDICUS 08         $      434.03
1968360 CANNULA ARTERIAL BIOMEDICUS 14         $      434.03
1968361 CANNULA VENOUS BIOMEDICUS 10           $      520.84
1968362 KIT ANDREWS TABLE                      $      125.40
1968363 KIT GRAFT HARVESTING                   $      326.70
1968364 ARTHRO MENISCL REP SYS 7209084         $      389.40
1968365 REAMER CORING 9MM                      $      522.50
1968366 REAMER CORING 10MM                     $      521.40
1968367 ARTHO PIN AND WIRE PAC 7207738         $      194.70
1968368 REAMER CORING                          $      752.40
1968369 CATH CARDIOVASCULAR PRO-FLO XT         $       93.50 C1725
1968370 SUT ETHILON 4-0 PS-2 18 CLEAR          $       30.50
1968371 PACK CUSTOM SPINE                      $      328.90
1968372 DERMABOND                              $      153.12
1968373 SUT PDSII 7-0 BV-175-6 27 DA           $       50.90
1968374 ENDO TACKER SYSTEM 5MM                 $      950.40
1968375 KIT CTS RELIEF KIT                     $      509.30
1968376 SMALL JOINT TUBING CANNULA             $      322.30




                                         Page 174
                                         Ancillary


1968377 ANASTOMOTIC DEV MICRO 1.0              $      640.20
1968381 IV PCA TUBING                          $       59.40
1968382 BLADE OSCILL SAW 15MM MC961            $      134.20
1968383 ENDO BLUNT CHERRY DISSEC BCD10         $      135.30
1968384 INTRODUCER CATHETER PASSER 55          $      436.70
1968385 INTRODUCER CATHETER PASSER 36          $      401.50
1968386 INTRODUCER SHEATH PERITONEAL           $      170.50 C1894
1968387 BLADE SAW KM519-10                     $       79.20
1968388 BLADE SAW KM11-2222                    $      122.10
1968389 ANASTOMOTIC DEV MICRO 1.5              $      640.20
1968390 ANASTOMOTIC DEV MICRO 2.0              $      640.20
1968391 ANASTOMOTIC DEV MICRO 2.5              $      640.20
1968392 TUBING LIPOSUCTION                     $       80.30
1968393 BLADE SAW K-2000-02                    $      149.60
1968394 BLADE SAW K-2000-67                    $      149.60
1968395 SUT NYLON 9-0 DRM5 SHARP POINT         $      184.80
1968396 SUT NYLON 10-0 DRM5 SHARPPOINT         $      198.00
1968397 SUT NYLON 9-0 HSV6 SHARP POINT         $      157.30
1968398 SUT PDS 5-0 BV1 24                     $      185.90
1968399 SUT 6-0 PDS BV1 24                     $      278.30
1968400 PACK CUSA EXCELL NEW                   $     1,732.50
1968401 CUSA EXCELL MICROTIP                   $     1,061.50
1968402 BLADE SAW OSCILL KM-000                $       69.30
1968403 BLADE SAW RECIP KM-060                 $       75.90
1968404 BLADE SAW RECIPRO KM-111R              $      137.50
1968405 BLADE SAW OSCILL KM-261                $       69.30
1968406 BLADE SAW OSCILL KM-269                $       85.80
1968407 BLADE SAW LARGE KM-81                  $      265.10
1968408 BLADE SAW TEAR KM-82                   $      265.10
1968409 BLADE SAW RECIPRO KM-14002             $       73.70
1968410 BLADE OSCILL SAW 10MM MD960            $      134.20
1968411 SUT POLYDEK II SILK 2-0 C4 30          $       88.00
1968412 TWIST DRILL SURGICAL                   $      316.80
1968413 GUIDEWIRE AMPLATZ SUPER 46-523         $      158.40 C1769
1968414 ENDO FLEXIPATH 20MM                    $      212.30
1968415 ENDO FLEXIPATH 15MM                    $      212.30
1968416 ENDO FLEXIPATH 7MM                     $      212.30
1968417 ENDO TUBING INSUFFLATOR HI FLO         $      108.90
1968418 SUT CHROMIC 3-0 PS-2 27                $       51.70
1968419 SUT ETHILON 6-0 P-1 18                 $       47.30
1968420 SUT ETHILON 5-0 P-3 18                 $       46.20
1968421 SUT ETHILON 5-0 P3 18 STERILE          $       46.20
1968422 SUT ETHILON 4-0 P-3 18                 $       46.20
1968423 PACK CUSTOM HEAD & NECK 779315         $      178.20
1968424 PACK CUSTOM LITHOTOMY 779235           $      140.80
1968425 CATH BALLOON DILATION 16-443           $      565.40 C1726
1968426 TUBE STOMACH EVACUATOR 32FR            $       81.40
1968427 ESU GROUND PAD ABC PEDIATRIC           $       77.00
1968428 SUT VICRYL 5-0 P-3 18                  $       50.60




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                                         Ancillary


1968429 SUT VICRYL 3-0 KS 27                   $       31.90
1968430 SUT VICRYL 5-0 PC-1 18                 $       53.90
1968432 SUT MONOCRYL 5-0 P-3 18                $       55.00
1968433 BIO BIOGLUE 10ML                       $     1,909.60
1968434 BIO BIOGLUE APPLICATOR TIP             $      150.70
1968435 BIO BIOGLUE APPLICATOR GUN             $      141.90
1968436 ENDO RETRACT II FAN 176647             $      581.90
1968438 ESU RITA STRBRST DEVICE W/PAD          $     3,469.40
1968439 INTRODUCER SHEATH 9FR X 23CM           $       78.10 C1894
1968440 CATH BALLOON DILATION 16-437           $      565.40 C1726
1968441 PIN CASPAR DISTRACTION 12MM            $      388.30
1968442 PIN CASPAR DISTRACTION 14MM            $      388.30
1968443 BLADE CASPAR BONE GRAFT 6MM            $      526.63
1968444 BLADE CASPAR BONE GRAFT 7MM            $      526.63
1968445 BLADE CASPAR BONE GRAFT 8MM            $      526.63
1968446 BLADE CASPAR BONE GRAFT 9MM            $      526.63
1968447 ENDO OMNIPORT                          $     1,446.50
1968448 TEMPERATURE PROBE ENDOCAR              $      238.70
1968449 TRIFUSE MINI 3 TO 1                    $       39.11
1968450 PACK LITHOTOMY                         $       94.60
1968451 CATH URETERAL SPIRAL 5FR RT            $       81.40 C1758
1968452 CRYOPROBE 5MM                          $     1,474.00
1968454 ENDO CAP REDUCER 5-12MM 1SEAL          $      108.90
1968455 BLADE HARMONIC SCALPEL 5M HOOK         $      463.10
1968456 BLADE HARMONIC 5MM CVD LCSC5           $      464.17
1968457 CATH ASH SPLIT 10FR X 18CM             $     1,176.16 C1750
1968458 ENDO AVITENE 5MM                       $      176.00
1968459 ENDO LAPRA TY SUTURE CLIPS             $      105.60
1968460 ENDO TROCAR 10MM BLNT OMST10BT         $      301.40
1968461 TUBE T PERCUTANEOUS                    $      298.10
1968462 CATH ASH SPLIT 14FR X 32CM             $     1,068.99 C1750
1968464 CATH URETERAL CONE TIP 8FR RT          $       92.40 C1758
1968465 CATH URETERAL CONE TIP 8FR LT          $       92.40 C1758
1968466 CATH BROVIAC 4.2FR SINGLE              $      624.80 C1751
1968467 ENDO VIDEO TAPE CASSETTE               $       28.60
1968468 PERF TUBING 3/8 X 4'                   $       60.96
1968469 BIO FOCAL SEAL AIR LEAK SEALNT         $     1,138.50
1968470 BIO KIT APPLICATOR FOCAL SEAL          $      188.10
1968471 BIO TISSEEL SPRAY SET BAXTER           $      224.40
1968472 LASER FIBER PDT 1.0CM DCYL215          $     1,138.50
1968473 LASER FIBER PDT 2.5CM DCYL225          $     1,474.00
1968474 BLADE SAW SAGIT KM-605                 $      107.88
1968475 ENDO ENDOSTITCH SUTURING DEVIC         $      228.89
1968476 LASER FIBER PDT 5.0CM DCYL25O          $     1,580.70
1968477 TOOL MIDAS REX 8MH22                   $       81.40
1968478 TOOL MIDAS REX DISSECTING M5           $      251.90
1968479 TOOL MIDAS REX 9BA50                   $      268.40
1968480 TOOL MIDAS REX DISSECTING M52          $      280.50
1968481 TOOL MIDAS REX DISSECTING R33          $      286.00




                                         Page 176
                                         Ancillary


1968482 TOOL MIDAS REX R8                      $      270.60
1968483 TOOL MIDAS REX DISSECTING S1           $      233.20
1968484 TOOL MIDAS REX DISSECTING TU10         $      289.30
1968485 TOOL MIDAS REX DISSECTING TU11         $      270.60
1968486 TOOL MIDAS REX DISSECTING TU33         $      286.00
1968487 ANES TUBE ET REINFORCED                $      146.30
1968488 TOOL MIDAS REX DISSECT AM34ODX         $      295.90
1968489 TOOL MIDAS REX DISSECT R35ODXC         $      312.40
1968490 TOOL MIDAS REX DISSECT TDQ125          $      247.50
1968491 TUBE GASTROSTOMY MOSS 14FR             $      617.10
1968492 ENDO ENDOSTICH 2-0 48                  $      113.30
1968494 DRAIN ABRAMSON TRIPLE LUMEN            $      130.90
1968495 TUBE GASTROSTOMY                       $      468.60
1968496 SUT SILK 2-0 PSL 18                    $       53.32
1968497 CATH URETERAL 5FR 021415-S1            $       88.00 C1758
1968498 KEYED THREADED BONE PIN TRANSM         $      401.50
1968499 KIT GASTROSTOMY LOW PROF 14FR          $      404.80
1968500 AWL DISPOSABLE                         $     1,045.00
1968501 TUBE TRACH UNCUFFED (4.0 PED)          $      119.90
1968502 TUBE TRACH UNCUFFED (3.0 PED)          $      115.50
1968503 TUBE TRACH UNCUFFED (4.5 PED)          $      119.90
1968504 TUBE TRACH UNCUFFED (5.0 PED)          $      119.90
1968505 TUBE TRACH UNCUFFED (3.5 PED)          $      119.90
1968507 LASER FIBER PDT 2.0CM DCYL220          $     1,406.90
1968508 CANNULA IRRIGATING 18GA ASICO          $       33.00
1968509 PACK PHACO 20,000 30K ABS MICR         $      518.10
1968510 PACK PHACO 20,000 45K ABS MICR         $      299.20
1968511 PACK PHACO 20,000 30K MICROTIP         $      392.70
1968512 PACK PHACO 20,000 30R MICROTIP         $      392.70
1968513 PACK PHACO 20,000 30R                  $      336.60
1968514 PACK PHACO 20,000 30K                  $      392.70
1968515 PACK PHACO 20,000 STANDARD             $      228.80
1968519 CUTTING BLOCK CORNEA                   $       99.00
1968520 LACRICATH 2MM 3MM 5MM                  $      640.20
1968521 RETRACTOR AXIUS EXPOSE                 $     2,665.30
1968522 DRAIN BLAKE 19FR ROUND                 $       93.40
1968523 CATH SHEATH ROTATOR 6FX5CM 2.8         $     1,768.80
1968524 CATH FOGARTY 5F X 40CM BALLOON         $      347.60 C1757
1968525 SUT SILK 6-0 BV-1 18 DA                $       37.40
1968526 ESU ENDO DISP GRN CORD 30-1203         $       75.90
1968527 NEEDLE ASAP BIOPSY                     $      112.20
1968528 PACK PHACO 20000 FLARED TIP 3O         $      363.00
1968530 PACK PHACO 3OR MICRO ABS               $      502.70
1968531 MIDAS REX LUBRICANT/DIFFU              $      137.50
1968532 CATH OPTICATH 4FR X 40CM               $      655.60
1968533 BRONCHO PULMON BX FORCEPS              $      404.80
1968534 TOURNIQUET 18 SINGLE BLADDER           $       94.60
1968535 SUT ETHIBOND 2-0 RB-1 10-30 W/         $      660.00
1968536 CANNULA SEAL 400077                    $      141.90




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                                         Ancillary


1968537 SUT PACING WIRE BIPOLAR TEMP           $       94.60
1968538 DRAIN BLAKE 15FR ROUND                 $      121.00
1968539 NEEDLE, BIOPSY                         $      530.48
1968540 T-TUBE BARD SILICONE 8FR               $       96.80
1968541 T-TUBE BARD SILICONE 10FR              $      115.50
1968542 LONG POINTER (13.9CM) W/D              $      359.70
1968543 SHORT POINTER (4.7CM) W/D              $      294.80
1968544 TUBE EMG REINFORCED 6MM                $      658.90
1968545 TUBE EMG REINFORCED 7MM                $      658.90
1968546 TUBE EMG REINFORCED 8MM                $      658.90
1968547 PRASS PAIRED ELECTRODES                $      354.20
1968548 BLADE TRICUT 4MM                       $      388.38
1968549 PRASS STANDARD PROBE                   $      328.90
1968550 BLADE RAD 40 CURVED                    $      388.38
1968551 BLADE RAD 60 X-TREME CURVED            $      401.87
1968552 BLADE RADENOID PEDIATRIC               $      440.10
1968553 BLADE HELICUT 4.5MM                    $      263.92
1968554 BLADE ACROMIOBLASTER 4.0MM             $      263.92
1968555 NEEDLE TRAP SYSTEM BONE MARROW         $      105.60
1968556 MED BARIUM SULFATE 6 GMS               $      300.30
1968557 ENDO SUT SILK 0 ENDOSTITCH 7           $      105.60
1968558 ENDO SUT POLYSORB 0 STITCH 7           $      105.57
1968559 ENDO SUT POLYSORB 0 STITCH 48          $      105.60
1968560 BLADE HARMONIC 5MM LCS-05 CVD          $     1,097.13
1968561 ENDO GIA ROTICULATOR 30 2.0            $      486.20
1968562 ENDO GIA ROTICULATOR 30 2.5            $      486.20
1968563 ENDO GIA ROTICULATOR 45 2.5            $      564.30
1968564 ENDO GIA ROTICULATOR 60 2.5            $      599.41
1968565 ENDO GIA ROTICULATOR 60 3.5            $      599.50
1968566 ENDO GIA ROTICULATOR 60 4.8            $      599.50
1968567 ENDO GIA II 60 2.5 SULU                $      368.50
1968568 ENDO GIA II 60 3.5 030414              $      368.50
1968569 ENDO GIA UNIVERSAL 12MM INST           $      557.70
1968570 TUBE GASTRIC SUCTION BALLOON           $      520.30
1968571 ENDO GIA ROTICULATOR 45MM              $      669.90
1968572 ENDO GIA UNIVERSAL 12MM HANDLE         $      383.90
1968573 SHORT AWL (95MM) DISP                  $      871.20
1968574 SHORT DRILL BIT 3.2MM DIS              $      937.20
1968575 CATH MEDIASTINAL 34FR STRAIGHT         $       48.10
1968576 DRILL BIT 3.2MM DISPOSABLE             $      937.20
1968577 SUT ETHILON 3-0 PS-2 18                $       39.66
1968578 TUBE VACTNR 4ML LVNDR (367861)         $       75.90
1968579 SUT PANACRYL 20 CT2 UNDYED 27          $       63.80
1968580 CATH TESIO 10FR X 52CM RIGHT           $      785.40 C1750
1968581 CATH ASH SPLIT 14FR X 28CM             $     1,412.40 C1750
1968582 CATH HEMOGLIDE 14.5X24 5664192         $      736.78 C1750
1968583 CATHETER UROSHEATH MEDIUM              $       29.70
1968585 TUBE PE SHEEHY COLLAR BUTTON           $       95.45
1968586 CATH TESIO 10FR X 52CM BIOFLEX         $     1,369.50 C1750




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                                         Ancillary


1968587 CATH TESIO 10FR X 52CM LEFT            $     1,369.50 C1750
1968588 TUBING SMOKE EVACUATOR                 $       89.44
1968589 TUBING TO EVACUATOR MACHINE            $      121.00
1968590 KNIFE 2.8 KERATOME                     $       83.60
1968591 TUBING HI PSI 30 DCT-130               $       39.60
1968592 SYRINGE MEDRAD POWER INJECTOR          $       68.20
1968593 CATH KMP 5-38-100      247647          $      121.00
1968594 CATH RIM 5.0-38-65     235345          $      101.20
1968595 CATH STRAIGHT 5-38-70 246354           $      101.20
1968596 CATH STRAIGHT 5-38-100 246351          $      101.20
1968597 CATH PIG 5-38-70      246356           $      101.20
1968598 CATH PIG 5-38-100      226070          $      101.20
1968599 CATH PIG CSC 5-35-70    250686         $      379.50
1968600 ADAPTER TUOHY-BORST TBAYR-6            $      146.30 C2629
1968601 CATH H3 5-38-100     214183            $      121.00
1968602 CATH MPA 8-55        236005            $      466.40
1968603 CATH MPB 8-55        236011            $      466.40
1968604 CATH RDC 8-55        236009            $      466.40
1968605 CATH GUIDING 260212                    $      363.00 C1887
1968606 CATH GUIDING 260214                    $      363.00 C1887
1968607 CATH GUIDING 248765                    $      240.90 C1887
1968608 CATH GUIDING 248758                    $      240.90 C1887
1968609 CATH FOGRTY 3X40 12TLW403F             $      414.70 C1757
1968610 CATH FOGARTY 3X80 12TLW803F            $      414.70 C1757
1968611 CATH FOGRTY 5.5X80 12TLW805F35         $      414.70 C1757
1968612 INTRODUCER SHEATH 5FR X 11CM           $       78.10 C1894
1968613 INTRODUCER SHEATH 6FR X 11CM           $       78.10 C1894
1968614 INTRODUCER SHEATH 7FR X 11CM           $       78.10 C1894
1968615 INTRODUCER SHEATH 8FR X 11CM           $       78.10 C1894
1968616 INTRODUCER SHEATH 9FR X 11CM           $       78.10 C1894
1968617 INTRODUCER SHEATH 5FR X 23CM           $      125.40 C1894
1968618 INTRODUCER SHEATH 6FR X 23CM           $      125.40 C1894
1968619 INTRODUCER SHEATH 7FR X 23CM           $      125.40 C1894
1968620 INTRODUCER SHEATH 8FR X 23CM           $      125.40 C1894
1968621 BAG FLUID COLLECTION ANGIO             $       62.70
1968622 TUBING FLUID COLLECTION ANGIO          $       62.70
1968623 SHEATH FLEXIBLE 7FR X45CM              $      311.30 C1894
1968624 SHEATH FLEXIBLE 8FR X45CM              $      289.30 C1894
1968625 SHEATH FLEXIBLE 10F X45CM              $      289.30 C1894
1968626 SHEATH FLEXIBLE 9FR X65CM              $      333.30 C1894
1968627 CATH BALLOON DILATION 16-438           $      677.08 C1726
1968628 CATH BALLOON DILATION 16-444           $      564.30 C1726
1968629 CATH BALLOON DILATION 16-457           $      565.40 C1726
1968630 CATH BALLOON DILATION 16-458           $      564.30 C1726
1968631 CATH BALLOON DILATION 16-463           $      565.40 C1726
1968632 CATH BALLOON DILATION 16-464           $      564.30 C1726
1968633 CATH BALLOON DILATION 16-477           $      565.40 C1726
1968634 CATH BALLOON DILATION 16-483           $      565.40 C1726
1968635 CATH BALLOON DILATION 16-505           $      565.40 C1726




                                         Page 179
                                         Ancillary


1968636 CATH BALLOON DILATION 16-506           $      565.40 C1726
1968637 CATH BALLOON DILATION 16-517           $      565.40 C1726
1968638 CATH BALLOON DILATION 16-525           $      678.70 C1726
1968639 CATH BALLOON DILATION 16-526           $      677.60 C1726
1968640 CATH BALLOON DILATION 12-552           $      665.50 C1726
1968641 CATH BALLOON DILATION 12-561           $      665.50 C1726
1968642 CATH BALLOON DILATION 12-570           $      665.50 C1726
1968643 CATH, INFUSION 1                       $      310.20 C1751
1968644 CATH MEWISSEN INFUSION 46-187          $      310.20 C1751
1968645 CATH MEWISSEN INFUSION 46-413          $      310.20 C1751
1968646 CATH MEWISSEN INFUSION 46-179          $      310.20 C1751
1968647 INFLATION DEVICE 15-105                $      517.00
1968648 FLOW CONTRL DEVICE 44-200              $       56.10
1968649 FLOW CONTRL DEVICE 44-201              $       55.00
1968650 INTRODUCER SHEATH PINAC 15-716         $      564.30 C1894
1968651 INTRODUCER SHEATH PINACCLE             $      564.30 C1894
1968652 GLIDEWIRE STIFF 46-305                 $      224.40 C1769
1968653 GLIDEWIRE STIFF 46-309                 $      233.20 C1769
1968654 GLIDEWIRE STIFF 46-316                 $      245.30 C1769
1968655 GLIDEWIRE SM VESSEL 46231              $      292.60 C1769
1968656 GLIDEWIRE BENTSON 49-145               $      141.90 C1769
1968657 GLIDEWIRE ROSEN 49-156                 $       71.50 C1769
1968658 GLIDEWIRE PLATINUM 46-604              $      403.70 C1769
1968659 GLIDEWIRE V-18 46-852                  $      289.30 C1769
1968660 KIT MINI STICK DILATOR 45-988          $     1,366.20
1968661 CATH BALLOON SYMMETRY 10-536           $     1,238.60 C1726
1968662 CATH BALLOON SYMMETRY 10-537           $     1,350.80 C1726
1968663 CATH BALLOON SYMMETRY 10-542           $     1,238.60 C1726
1968664 CATH BALLOON SYMMETRY 10-543           $     1,350.80 C1726
1968665 GOOSE NECK SNARE 10MM                  $      884.40
1968666 GOOSE NECK SNARE 25MM                  $      884.40
1968667 PLASTIBELL 1.3CM                       $       37.40
1968668 PLASTIBELL 1.2CM                       $       37.40
1968669 PLASTIBELL 1.1CM                       $       37.40
1968670 PLASTIBELL 1.4CM                       $       38.50
1968671 PLASTIBELL 1.5 / 1.7CM                 $       37.40
1968672 ENDO JAW BIOPSY (1537-20)              $      333.30
1968673 SUT PROLENE 6-0 BV-1 30 DA             $       75.90
1968674 GLIDEX MAGIC TORQ 46-591               $      260.70
1968675 GUIDEWIRE AMPLATZ 526                  $      858.00 C1769
1968676 GUIDEWRIE AMPLATZ 525                  $      819.50 C1769
1968677 CATH HICKMAN 12.5FR TRIPLE             $      594.00 C1751
1968682 CATH VS3 5-38-80     245835            $      100.74
1968683 FLOW CONTRL DEVICE 15-300              $       93.50
1968684 CATH GLIDECATH .038X100 32-160         $      266.20 C1750
1968685 CATH GLIDECATH .038X100 32-154         $      272.80 C1750
1968686 CATH GLIDECATH .038X100 32-151         $      272.80 C1750
1968687 CATH GLIDECATH .038X100 32-146         $      272.80 C1750
1968688 CATH GLIDECATH .038 X65 32-145         $      272.80 C1750




                                         Page 180
                                         Ancillary


1968689 CATH GLIDECATH .038 X65 32-142         $      266.20 C1750
1968690 CATH BALLOON DILATION 14-552           $      922.90 C1726
1968691 CATH BALLOON DILATION 14-514           $      812.90 C1726
1968692 CATH BALLOON DILATION 14-510           $      812.90 C1726
1968693 STAPLER SIZERS EEA                     $     1,043.12
1968694 CATH MAHURKAR 10FR X 12CM              $      335.29 C1750
1968695 CATH MAHURKAR 8FR X 12CM               $      269.23 C1750
1968696 CATH MAHURKAR 11.5FR X 16CM            $      187.86 C1750
1968697 ENDO SUCTION VALVE                     $       66.73
1968698 CATH MAHURKAR 13.5FR X 45CM            $      485.66 C1750
1968699 CATH MAHURKAR 13.5FR X 50CM            $      498.33 C1750
1968700 CATH GROSHONG 9.5FR DUAL LUMEN         $     1,481.70 C1750
1968701 ENDO BIOPSY VALVE                      $       36.51
1968702 CATH CURLCATH 57CM                     $      381.70 C1750
1968703 CATH CURLCATH 39CM                     $      381.70 C1750
1968704 CANNULA AORTIC ROOT VENT PEDS          $       98.24
1968705 SUT GORETEX CV-6 TT-13 18              $      143.00
1968706 CATH URETERAL PIGTAIL 6 X 70           $      183.70 C1758
1968707 LENS GLIDE                             $       63.80
1968708 SUT GORETEX CV-0 THX-26                $      136.40
1968709 CATH URETERAL WHISTLE 5FR RT           $       77.00 C1758
1968710 BLADE MICRO OSCILLATOR                 $      129.80
1968711 SUT GORETEX CV-4 CS-50                 $      125.40
1968713 CANNULA ARTERIAL BIOMED KIT 23         $      755.54
1968714 PERF PUMP ADAPTER PACK CSMC            $      451.00
1968715 SUT SUPRAMID 4-0 1/2 CIRCLE            $       67.10
1968716 SUT TICRON 6-0 PRE-1 18                $       55.00
1968717 SUT TICRON 3-0 CE-5 30                 $       31.90
1968718 SUT SILK 6-0 CV-301 18                 $       66.00
1968719 TUBING DOLPHIN II                      $      304.70
1968720 CATH DOUBLE LUMEN CV 4.0FR             $      348.70
1968724 SOFT TISSUE RETRACTOR SM               $      481.80
1968725 SOFT TISSUE/SCROTAL RETRACTOR          $      481.80
1968726 SOFT TISSUE RETRACTOR LGE              $      481.80
1968727 ENDO POUCH TISSUE 8 X 5 COOK           $      127.60
1968728 DRAIN JP 10MM FLAT FULLY PERF          $      104.50
1968729 CANNULA CRYSTAL 5.75MM AR6562          $      141.90
1968730 TUBING STACKHOUSE REDUCER              $       71.54
1968731 ENDO TROCAR 10/11 511NT                $      247.46
1968732 ENDO TROCAR 10/12 512NT                $      247.46
1968733 ENDO TROCAR 10/11MM 511SD DILA         $      247.46
1968734 ENDO TROCAR 10/12MM                    $      247.46
1968735 BLADE SAW OSCILLATING KM-7566          $      136.40
1968736 ARTHRO SHOULDER STABI KIT 7627         $      279.40
1968737 ENDO HARMONIC SHEAR LCS6S              $     1,097.13
1968738 ENDO HARMONIC SHEARS LCSC5             $     1,151.98
1968739 ENDO HARMONIC SHEARS CS14C             $     1,184.70
1968740 ESU ACCUTEMP LOW TEMP                  $       66.00
1968741 ENDO RADIAL JAW BIOPSY 3.3MM           $      342.10




                                         Page 181
                                         Ancillary


1968742 TUBING IRRIGATION SURE SHOT            $     104.50
1968743 ENDO TROCAR 12MM VS101012              $     341.00
1968744 ENDO INSUFFLATION NEEDLE               $     122.10
1968745 IRIS RETRACTOR                         $     367.40
1968746 PROBE SET LACRIMAL JACKS               $     152.90
1968747 ESU COLORADO TIP                       $     182.60 C1758
1968748 SUT PLAIN 3-0 SH 27                    $      31.90
1968749 KIT INFLATION DEVICE PRISTO            $     188.10
1968750 CANNULA HYDR/DISS NCLS 585099          $      53.78
1968751 CANNULA HYDR/DISS NCLS 585037          $      53.78
1968755 CATH FOLEY SP BARD 143112              $     843.70
1968756 SCLERAL STRIP 4050                     $      92.40
1968757 ENDO NEEDLE VERESS STEP 14G            $      88.00
1968758 ENDO SLEEVE STEP 12MM S101000          $     179.30
1968759 CANNULA CRYSTAL 5.75MM AR6562          $     141.90
1968760 ANES PRESSURE BAG DISP                 $     101.20
1968761 PERF MUF PACK                          $     405.90
1968762 PERF CANISTER BLUE                     $      38.50
1968763 PERF ADAPTER PACK INFANT               $     345.40
1968764 PERF PMP PCK MEMBRANE 62003-01         $     640.20
1968765 PERF TABLE PACK PED                    $     259.60
1968766 OXYGENATOR, MINIMAX/CAPIOX             $     983.40
1968767 PERF ISOLYZER                          $      29.70
1968768 PERF CELL SAVER BRAT KIT 135ML         $     354.20
1968769 PERF SPIKE LINE                        $      46.20
1968770 PERF ARTERIAL FILTER (351)             $     152.90
1968771 INSTRUMENT SET CJD                     $     980.10
1968772 TOOL BLACK MAX CUTTER BLU-8            $     270.60
1968773 TOOL BLACK MAX CUTTER BLU-5            $     341.00
1968774 TOOL BLACK MAX CUTTER BLU-4            $     341.00
1968775 TOOL BLACK MAX CUTTER GRE-1            $     270.60
1968776 TOOL BLACK MAX CUTTER GRE-1S           $     270.60
1968777 TOOL BLACK MAX CUTTER SIL-0            $     248.60
1968778 TOOL BLACK MAX CUTTER SIL-8            $     270.60
1968779 TOOL BLACK MAX CUTTER SIL-15           $     440.00
1968780 TOOL BLACK MAX CUTTER RED-4            $     341.00
1968781 TOOL BLACK MAX CUTTER RED-8            $     341.00
1968782 TOOL BLACK MAX GREY-MIA20-8            $     376.20
1968783 TOOL BLACK MAX GREY-MIA20-17-7         $     383.90
1968784 TOOL MICRO MAX CUTTER L-8NS-M          $     289.30
1968785 TOOL MICRO MAX CUTTER L-5B             $     298.10
1968786 TOOL MICRO MAX CUTTER L-4B             $     298.10
1968787 TOOL MICRO MAX CUTTER QD11-8NS         $     315.70
1968788 TOOL MICRO MAX CUTTER QD14-8NS         $     294.80
1968789 TOOL MIDAS REX G8-350                  $     330.00
1968790 TOOL MIDAS REX G12-130                 $     412.50
1968791 TOOL MIDAS REX G12-350                 $     339.90
1968792 TOOL MIDAS REX G16-130                 $     342.10
1968793 TOOL MIDAS REX G16-360                 $     352.00




                                         Page 182
                                        Ancillary


1968794 TOOL MIDAS REX G16-570                $      359.70
1968795 TOOL MIDAS REX A9                     $      298.10
1968796 TOOL MIDAS REX AF7                    $      258.50
1968797 TOOL MIDAS REX AF8                    $      258.50
1968798 TOOL MIDAS REX AM9                    $      330.00
1968799 TOOL MIDAS REX AM2                    $      313.50
1968800 TOOL MIDAS REX AM24                   $      352.00
1968801 TOOL MIDAS REX AM31                   $      328.90
1968802 TOOL MIDAS REX AM32                   $      328.90
1968803 TOOL MIDAS REX AM33                   $      328.90
1968804 TOOL MIDAS REX AM3                    $      465.30
1968805 TOOL MIDAS REX AM51                   $      389.40
1968806 TOOL MIDAS REX AM52                   $      420.20
1968807 TOOL MIDAS REX O 1                    $      280.50
1968808 TOOL MIDAS REX O 3                    $      280.50
1968809 TOOL MIDAS REX M31                    $      321.20
1968810 TOOL MIDAS REX M32                    $      321.20
1968811 TOOL MIDAS REX M33                    $      321.20
1968812 TOOL MIDAS REX R1                     $      325.60
1968813 TOOL MIDAS REX R3                     $      325.60
1968814 TOOL MIDAS REX R370DXC                $      375.10
1968815 TOOL MIDAS REX R350DXC                $      375.10
1968816 TOOL MIDAS REX TU8                    $      325.60
1968817 TOOL MIDAS REX WH31                   $      331.10
1968818 SYMMETRY SYSTEM GRAY                  $     1,446.50
1968819 SYMMETRY SYSTEM GREEN                 $     1,446.50
1968820 SYMMETRY SYSTEM BLUE                  $     1,446.50
1968821 SYMMETRY SYSTEM PURPLE                $     1,446.50
1968822 SYMMETRY SIZERS DISPOSABL             $       52.80
1968823 PERF CDI 500 SHUNT SENSOR             $      528.00
1968824 PERF HEMOCONCENTRATOR ADULT           $      435.53
1968825 OXYGENATOR LILLI/MINI/BABYRX          $     1,279.30
1968826 PERF LIVER ASSIST PACK                $     1,125.30
1968827 TUBING CUSA MANIFOLD                  $      481.80
1968828 CANNULA VENOUS WILLIAM HARVEY         $      106.70
1968829 PERF RAPID INFUSION SET               $     1,607.10
1968830 WAND 4.5 90DEG A1345-01               $      583.00
1968831 GUIDEWIRE BENTSON .035                $      130.90 C1769
1968832 SMOKE HOUSE FILTER                    $       69.30
1968833 BLADE SYNOVATOR 4.5MM                 $      263.92
1968834 BLADE STONECUTTER 5.5MM               $      263.92
1968835 BLADE ABRADER 2.9MM                   $      263.92
1968836 BLADE ORBIT INCISOR 4.5MM             $      329.08
1968837 BLADE ORBIT INCISOR PLUS              $      329.08
1968838 BLADE CONCAVE INCISOR                 $      329.08
1968839 BLADE CONCAVE FULL RADIUS             $      329.08
1968840 CANNULA TWIST IN 8.5MM AR6570         $      141.90
1968841 PERF KIT ARTERIAL BIOMEDICUS          $      626.93
1968842 PERF KIT VENOUS BIOMEDICUS            $      636.57




                                        Page 183
                                         Ancillary


1968843 ARTHRO WAND 3.0 /3.5 /3.75 MM          $      663.30
1968844 PERF INTRAAORTIC BALLOON               $     2,218.37
1968845 WAND 3.0 50DEG AS2530-01               $      663.30
1968846 WAND 3.6 90DEG A1336-01                $      583.00
1968847 PERF QUICK PRIME LINE                  $       97.16
1968848 PERF CPDA-1 BLOOD BAG                  $       57.68
1968849 ENDO FORCEPS CUTTING 3005PK            $      983.40
1968850 PERF MEMBRANE OXYGENTOR H/E            $     2,580.60
1968851 CATH VNUS 8FR                          $     2,797.30 C1760
1968852 CATH VNUS 6FR                          $     2,797.30 C1760
1968853 PACK VNUS CLOSURE PROCEDURE            $      502.70
1968854 ENDO CLIP APPLIER 5MM                  $      622.60
1968855 TOOL DIAMOND BALL                      $      337.70
1968856 TOOL DIAMOND BALL 3MM QD8-3SD          $      337.70
1968857 TOOL FLUTED BALL 3MM QD8-3SB           $      347.60
1968858 TOOL FLUTED BALL 2MM QD8-2SD           $      337.70
1968859 TOOL DIAMOND BALL 4MM QD8-4SD          $      337.70
1968860 TOOL DIAMOND BALL 5MM QD8-5D           $      321.20
1968861 ARTHRO FLOOR SUCTION MAT               $      135.30
1968862 WAND 3.0 CAPSURE A1830-01              $     1,041.70
1968863 WAND 2.5MM A2723-01                    $      583.00
1968864 WAND 3.0 45DEG A1630-01                $     1,041.70
1968865 TRANSFIX KIT AR-1978S                  $      559.90
1968866 TIB TUNNEL CANN AR-1802D               $      140.80
1968867 ESTECH OPVAC SYNERGY PLUS              $     1,350.80
1968868 ESU TAC-S EFLEX 7209637                $     1,925.00
1968869 ESU LIG CHISEL EFLEX 7209663           $     1,805.10
1968870 ESTECH PYRAMID POSITIONER              $      675.40
1968871 ENDO CLIP LARGE USSC 176625            $      421.30
1968872 TOOL MIDAS REX DISSECT 7BA20           $      376.20
1968873 TOOL MIDAS REX DISSECT 7BA20D          $      403.70
1968874 TOOL MIDAS REX DISSECT 7BA30           $      376.20
1968875 TOOL MIDAS REX DISSECT 7BA30D          $      403.70
1968876 TOOL MIDAS REX DISSECT 7BA40           $      376.20
1968877 TOOL MIDAS REX DISSECT 7BA40D          $      403.70
1968878 TOOL MIDAS REX DISSECT 7BA50           $      403.70
1968879 TOOL MIDAS REX DISSECT 7BA50D          $      403.70
1968880 TOOL MIDAS REX DISSECT 8TD156          $      303.60
1968881 TOOL MIDAS REX DISSECT 8TD114          $      319.00
1968882 TOOL MIDAS REX DISSECT 8TD114          $      319.00
1968883 TOOL MIDAS REX DISSEC F2/8TA23         $      349.80
1968884 TOOL MIDAS REX DISSECT 9AC90           $      399.30
1968885 TOOL MIDAS REX DISSECT 21BA60          $      480.70
1968886 TOOL MIDAS REX DISSECT 21MH30          $      426.80
1968887 CANNULA 5.75MM X 7 CM -CRYSTAL         $      137.50
1968888 CANNULA 8.25MM X 7 CM AR 6530          $      137.50
1968889 CANNULA 7MM X 7CM AR 6550              $      141.90
1968890 LASER FIB SHARPLAN 200MICRON           $     3,819.20
1968891 LASER FIB SHARPLAN 300MICRON           $     3,472.70




                                         Page 184
                                         Ancillary


1968892 LASER FIB SHARPLAN 365MICRON           $     1,562.00
1968893 LASER FIB SHARPLAN 550MICRON           $     1,562.00
1968894 LASER FIB SHARPLAN 1000MICRON          $     3,472.70
1968895 LASER FIB SLIMLINE 200MICRON           $     4,629.90
1968896 LASER FIBER 1                          $     1,678.60
1968897 LASER FIB SLIMLINE 550MICRON           $     1,986.60
1968898 LASER FIB SLIMLINE 1000MICRON          $     2,681.80
1968900 BASKET GEMINI 3FR                      $      673.20
1968901 BASKET ZERO TIP 2.4FR                  $      711.70
1968902 BASKET 11M GU6354                      $      397.10
1968903 BASKET 8MM GU6350                      $      397.10
1968904 DRAPE D V INSTR ARM 400015-02          $      374.00
1968905 BASKET, RETRIEVAL                      $      488.40
1968906 CATH CHIOU SP 075920                   $      488.40
1968907 BASKET LITHOCATCH 2.2F 840-412         $      673.20
1968908 BASKET PARACHUTE 3.1FR 320302          $      735.90
1968909 BASKET SEGURA 3FR                      $      718.30
1968910 WIRE ST .035 630-100                   $      189.20 C1769
1968911 WIRE ANGLED .035 630-102               $      189.20 C1769
1968912 WIRE STIF ANG.035 630-110              $      250.80 C1769
1968913 WIRE ANG GOLD .018 46-242              $      598.40 C1769
1968914 WIRE V-18 .018 46-850                  $      330.00 C1769
1968915 ESU RITA STARBURST DEVICE              $     7,696.70
1968916 WIRE ZEBRA .035 670-112                $      254.10 C1769
1968917 WIRE BENTSON .035 635497               $      172.98 C1769
1968918 WIRE .035 THSF-035145-AUS              $      130.90 C1769
1968919 WIRE .038 THSF-038145-AUS              $      130.90 C1769
1968920 DERMABOND PROPEN TOPICAL SKIN          $      156.20
1968921 WIRE NITNOL .018 US-1806               $      347.60 C1769
1968922 WIRE .035 MD-082                       $      397.10 C1769
1968923 WIRE NITNOL .018 N180802               $      322.30 C1769
1968924 CLIP CORONARY ARTERY RETRACTON         $       82.50
1968925 AMPLTZ SHEATH 16F 260-146              $      212.30
1968926 CATH NEPHROMAX 210-118                 $      944.90 C1729
1968927 CATH KMP 5-38-100       247647         $      121.00
1968928 CATH UROMAX ULTRA 225-122              $      781.00 C1726
1968929 FORCEP BX PIRANHA 505-160              $     1,233.10
1968930 CATH FOLEY 28FR 30CC 2-WAY             $       58.30
1968931 COOK FORCEP CUP 220130                 $     1,184.70
1968932 CATH FOLEY 16FR 30CC 3-WAY             $      100.73
1968933 CATH NEPH 8FR X 25CM 27-179            $      410.30 C1726
1968934 ENDO PEDIPORT 5.5MM 240-55             $      270.60
1968935 CATH NEPH 12FR X 25CM 27-181           $      410.30 C1729
1968936 INTRO BLUE-ON-BLUE 8FR 260-120         $      199.10
1968937 INTRODUCER ACCUSTICK 20-705            $      243.10
1968938 INTRODUCER ACCUSTICK 20-604            $      102.30
1968939 DILATOR 10FR 072110                    $       71.50
1968940 CATH URETERAL 5FR 021415-S1            $      103.49 C1758
1968942 CATH FOLEY 18FR 5CC 3-WAY              $      450.07




                                         Page 185
                                         Ancillary


1968943 CATH FOLEY 30FR 30CC 2-WAY             $       57.20
1968944 CATHETER, MAZER 6FR                    $       79.20 C2617
1968945 CATHETER OPEN-END 4FR 020014           $       77.00 C1758
1968946 CATH COBRA 6FR 023806                  $      134.20 C1758
1968947 CATH JB1(PINK) CEREBRAL 004057         $      124.30
1968948 CATH COUNCILL 16FR/5CC 0196L16         $      132.00
1968949 CATH COUNCILL 18FR/5CC 0196L18         $      132.00
1968950 CATH COUNCILL 20FR/5CC 0196L20         $      132.00
1968951 CATH COUNCILL 22FR/5CC 0196L22         $      132.00
1968952 CATH COUDE 12FR/5CC 0168L12            $      101.20 C1729
1968953 CATH COUDE 16FR/5CC 0168L16            $      101.20 C1729
1968954 CATH COUDE 18FR/5CC 0168L18            $      101.20 C1729
1968955 CATH COUDE 20FR/5CC 0168L20            $      101.20 C1729
1968956 CATH COUDE 22FR/5CC 0168L22            $      101.20 C1729
1968957 CATH SILICONE 8FR/3CC 165808           $       52.80 C1729
1968958 CATH SILICONE 10R/3CC 165810           $       52.80 C1729
1968959 CATH SILICONE 12FR/5CC 165812          $       51.70 C1729
1968960 CATH SILICONE 12FR/5CC 165813          $       51.70 C1729
1968961 CATH SILICONE 18FR/5CC 165818          $       51.70 C1729
1968962 PERF OXYGENATOR AFFINITY               $      671.58
1968963 CATH SILICONE 22FR/5CC 165822          $       51.70 C1729
1968964 CATH FOLEY 16FR 30CC 2-WAY             $      540.08
1968965 CATH SILICONE 24FR/5CC 165824          $       51.70 C1729
1968966 CATH SILICONE 20FR/30CC 166820         $       67.10 C1729
1968967 CATH SILICONE 22FR/30CC 166822         $       67.10 C1729
1968968 CATH SILICONE 24FR/30CC 166824         $       67.10 C1729
1968970 CATH TEGT 5-35-100     189775          $      127.60
1968971 CATH H1 5-38-100     214183            $      139.70
1968973 CATH HICKMAN 16.2FR DUAL LUMEN         $      452.10 C1751
1968974 CATH FOLEY 24FR 5CC 3-WAY              $      110.00
1968975 ESU COAG ELEC POINT 24F 27050L         $      398.20
1968976 PREP DURA                              $       56.95
1968977 ESU COAG ELEC POINT 27F 27050K         $      398.20
1968978 ESU CUTTING LOOP 24FR 27050GS          $      398.20
1968979 ELC URINARY DRAIN BAG 154002           $       49.28
1968980 CATH FOLEY 26FR 5CC 3-WAY              $      450.07
1968981 CATH KUMPE 4.1FR 217465                $      366.30
1968982 ENDO ARTICUL LIN CUTTER ATB45          $     1,152.80
1968983 ENDO ARTICUL LIN CUTTER ATG45          $     1,152.80
1968984 STAPLER CIRCULAR SIZER SET CSS         $      717.20
1968985 STAPLER LIN CUT 100MM TLC10            $      944.90
1968986 SUT PROLENE 5-0 BV-1 24 DA             $       91.69
1968987 SUT PROLENE 5-0 C-1 24 DA              $       78.19
1968988 TOOL MIDAS REX DISSECTING WH1          $      313.39
1968989 LASER IRIS ENDOPROBE                   $      515.46
1969000 OPTHALMIC SURG KIT                     $       29.70
1969001 ENT DRILL BIT 26F6ST                   $      260.70
1969002 KYPHX SYRINGE A08A                     $      440.00
1969003 ENT DRILL BIT 25D6ST                   $      287.10




                                         Page 186
                                         Ancillary


1969004 KYPHX TOOL KIT                         $      3,993.00
1969005 ENT DRILL BIT 23X6ST                   $       287.10
1969006 BONE TAMP 15/3 K09A                    $      4,185.50
1969007 ENT DRILL BIT 24X6ST                   $       287.10
1969008 BONE TAMP 20/3                         $      2,451.90
1969009 ENT DRILL BIT 25X6ST                   $       287.10
1969010 BONE INFLAT STERILE 25/3               $      2,652.10
1969011 ENT DRILL BIT 26D9ST                   $       287.10
1969012 ENT DRILL BIT 24D6ST                   $       287.10
1969013 SPINE PROBE 154 MM                     $       804.10
1969014 ENT DRILL BIT 26B6ST                   $       260.70
1969015 SHORT SPINE PROBE (99MM) DISP          $       804.10
1969016 ENT DRILL BIT 27B6ST                   $       256.30
1969017 KIT KYPHOPAK KP1503                    $     11,005.50
1969018 ENT DRILL BIT 25D9ST                   $       287.10
1969019 KIT KYPHOPAK KP2001                    $     11,101.20
1969020 ENT DRILL BIT 21B9ST                   $       279.40
1969021 KIT KYPHOPAK KP2002                    $      7,581.20
1969022 ENT DRILL BIT 21.5B9ST                 $       279.40
1969023 KYPHON FIRST FRACTURE 10/3             $     13,322.10
1969024 ENT DRILL BIT 24D9ST                   $       287.10
1969025 KYPHON ADD FRACTURE 10/3               $      9,097.00
1969026 ENT DRILL BIT 22B9ST                   $       279.40
1969027 KYPHON FIRST FRACTURE 15/3             $     13,205.50
1969028 ENT DRILL BIT 23B9ST                   $       279.40
1969029 KYPHON ADD FRACTURE 15/3               $      9,097.00
1969030 ENT DRILL BIT 23S6ST                   $       311.30
1969031 KYPHON FIRST FRACTURE 20/3             $     13,322.10
1969032 ENT DRILL BIT 22.5M9ST                 $       334.40
1969033 KYPHON ADD FRACTURE 20/3               $      9,097.00
1969034 ENT DRILL BIT 22.5D9ST                 $       287.10
1969035 KYPHON BONE ACCESS NEEDLE 11 G         $       122.10
1969036 ENT DRILL BIT 23X9ST                   $       299.20
1969037 KYPHON HV-R BONE CEMENT MIXER          $       675.40
1969038 ENT DRILL BIT 23D9ST                   $       287.10
1969039 KYPHON BONE FILLER DEVICE              $       424.60
1969040 ENT DRILL BIT 22.5M6ST                 $       319.00
1969041 KYPHON INFLATABLE BONE TAMP 20         $      4,240.50
1969042 KYPHON INFLATABLE BONE TAMP 15         $      4,185.50
1969043 ENT DIEGO BLADE DISSECT 4MM ST         $       437.80
1969044 KYPHON INFLATABLE BONE TAMP 10         $      4,240.50
1969045 ENT DIEGO BLADE DISC 4MM CONCV         $       445.50
1969046 KYPHON OSTEO INTRODUCER SYSTEM         $      3,993.00
1969048 NEURO DOPPLER PROBE DISPOSABLE         $       573.10
1969050 NEURO ICP MONITORING KIT               $      2,479.40
1969051 ENT COBLATOR REFLEX ULTRA 55           $       632.50
1969052 UROL OBTRYX TRANSOBTURATOR CUR         $      2,852.30
1969053 NEURO PERFORATOR DISP 14MM             $       663.30
1969054 ENT COBLATOR REFLEX ULTRA 45 W         $       540.10




                                         Page 187
                                         Ancillary


1969055 NEURO MICROTARGETING DEVICE            $     1,832.60
1969056 NEURO CRANIAL ACCESS KIT               $      952.60
1969057 ENT TISSUE COAG TONSIL PROBES          $      737.00
1969058 ENT MONTGOMERY SAFE-T-TUBE 10          $      481.80
1969059 ENT MONTGOMERY SAFE-T-TUBE 11          $      481.80
1969060 ENT MONTGOMERY SAFE-T-TUBE 12          $      481.80
1969061 ENT MONTGOMERY SAFE-T-TUBE 13          $      481.80
1969062 ENT MONTGOMERY SAFE-T-TUBE 14          $      481.80
1969063 ENT MONTGOMERY SAFE-T-TUBE 15          $      481.80
1969064 ENT MONTGOMERY SAFE-T-TUBE 16          $      481.80
1969065 ENT DIEGO TUBING SUCT IRRG 12          $      135.30
1969066 ENT DIEGO BLADE DISSC 2.9MM ST         $      437.80
1969067 ENT DIEGO TURBINATOR 2MM ST            $      451.00
1969068 ENT COBLATOR EVAC 70 EXTRA WC          $      586.30
1969069 EYE SPHERE                             $       91.30
1969070 IRIS RETRACTOR FLEXIBLE                $      365.20
1969071 TAP, NEURO/SPINE 1                     $      624.80
1969072 NEURO DRILL 1.8X50/8 KLS               $      430.10
1969073 NEURO DRILL 1.8X5O/10 MM KLS           $      430.10
1969074 PACK CUSTOM MAJOR ORTHO                $      390.50
1969075 KYPHON BONE BIOSPY DEVICE              $      501.60
1969076 CANNULA VENTRICULAR SUMP-RM            $      104.79
1969077 TRAY UROLOGIST OBSTRUCT URETHR         $      419.45
1969078 CANNULA ATRIAL ABIOMED                 $      135.30
1969079 BASIN LIVER BASIN                      $      177.10
1969080 PACEMAKER EXPANDER COIL                $      189.20
1969081 LIVER BIOPSY KIT                       $      220.00
1969082 PACK CUSTOM OPEN HEART PEDS            $      628.10
1969083 SHORT SPINE PROBE/VTI ACCESS.          $      742.50
1969089 KIT NUCLEOTOME DISCECTOMY              $     1,768.80
1969096 PERF PUMP HEAD BIOMEDICUS PED          $      655.60
1969097 CANNULA CORONARY ERFUSION RM           $      489.92
1969098 NEURO 2X8 GRID W/TWO TAILS             $     1,398.54
1969099 NEURO 32 PIN RIBBON CABLE CONN         $      675.16
1969100 NEURO 4X8 PLAT GRID ELECTRODE          $     1,966.53 C1883
1969101 NEURO 8 CONTACT DEPTH ELECT 1M         $      562.63
1969102 NEURO 8X8 PLAT GRID ELECTRODE          $     2,432.71 C1883
1969103 NEURO SPHENOIDAL ELECTRODE KIT         $      177.42
1969104 PACEMAKER TORQUE WRENCH                $       98.84
1969105 PACK CUSTOM OPEN HEART                 $     5,083.53
1969106 BASIN OPEN HEART CUSTOM PACK           $      359.43
1969107 AORTIC PUNCH 4.O MM                    $       99.00
1969108 AORTIC PUNCH 5.2 MM                    $      110.00
1969109 CANNULA AORTIC ROOT                    $       64.90
1969110 TUBING LEFT ATRIAL LINE 3.0 FR         $      158.40
1969111 PERF CARDIOPLEGIA DELIVERY SET         $      930.33
1969112 CANNULA VENTRICULAR SUMP ADULT         $      123.20
1969113 LEAD INTRODUCER KIT 3550-18            $      942.70
1970001 ADAPTER 1                              $     1,014.48




                                         Page 188
                                         Ancillary


1970002 ADAPTER 2                              $      5,213.87
1970003 ADHESION BARRIER                       $       666.05 C1765
1970004 ANCHOR / SCREW 1                       $       358.05 C1713
1970005 ANCHOR / SCREW 10                      $      8,085.00 C1713
1970006 ANCHOR / SCREW 11                      $     10,411.69 C1713
1970007 ANCHOR / SCREW 12                      $     11,400.74 C1713
1970008 ANCHOR / SCREW 13                      $     18,456.90 C1713
1970009 ANCHOR / SCREW 2                       $      1,108.80 C1713
1970010 ANCHOR / SCREW 3                       $      2,036.65 C1713
1970011 ANCHOR / SCREW 4                       $      2,814.35 C1713
1970012 ANCHOR / SCREW 5                       $      3,472.70 C1713
1970013 ANCHOR / SCREW 6                       $      4,281.20 C1713
1970014 ANCHOR / SCREW 7                       $      4,793.25 C1713
1970015 ANCHOR / SCREW 8                       $      6,006.00 C1713
1970016 ANCHOR / SCREW 9                       $      6,160.00 C1713
1970017 BALLOON PRESS                          $      5,120.50
1970018 BAR CONNECTOR                          $       288.75
1970019 BASE MOLD                              $        19.25
1970020 BLOCK CARVING TESTICULAR IMP           $      3,060.75
1970021 BMP MEDIUM                             $     17,286.50
1970022 BMP SMALL                              $     13,821.50
1970023 BMP XLARGE                             $     18,865.00
1970024 BONE FILLER                            $       354.20
1970025 BONE GRAFT 1                           $      1,921.15
1970026 BONE GRAFT 2                           $      3,742.20
1970027 BUTTON CHIN                            $       770.00
1970028 CARDIAC BAND                           $      4,620.00
1970029 CARDIAC GRAFT AORTIC VALVED CO         $     20,628.30
1970030 CARDIAC RING ANNULOPLASTY 1            $      4,812.50
1970031 CARDIAC RING ANNULOPLASTY 2            $      5,147.45
1970032 CARDIAC RING ANNULOPLASTY 3            $      9,394.00
1970033 CARDIAC SHUNT                          $       169.40
1970034 CARDIAC VALVE 1                        $     10,972.50
1970035 CARDIAC VALVE 2                        $     14,437.50
1970036 CARDIAC VALVE 3                        $     15,111.25
1970037 CARDIAC VALVE 4                        $     16,527.75
1970038 CARDIAC VALVE 5                        $     17,710.00
1970039 CARDIAC VALVE 6                        $     19,250.00
1970040 CARDIAC VALVE 7                        $     20,324.15
1970041 CARDIAC VALVE HUMAN TISSUE 3           $     22,330.00
1970042 CARDIAC VALVE HUMAN TISSUE 4           $     24,640.00
1970043 CARDIAC VALVE HUMAN TISSUE 5           $     27,689.20
1970044 CARDIAC VALVE HUMAN TISSUE 6           $     29,240.75
1970045 CARDIAC VALVE HUMAN TISSUE 7           $     31,620.05
1970046 CARDIO DEFIB DUAL CHAMBER 1            $     76,615.00 C1721
1970047 CARDIO DEFIB DUAL CHAMBER 2            $     88,530.75 C1721
1970048 CARDIO DEFIB OTHER THAN SING/D         $     84,700.00 C1882
1970049 CARDIO DEFIB OTHER THAN SING/D         $     86,856.00 C1882
1970050 CARDIO DEFIB OTHER THAN SING/D         $     92,631.00 C1882




                                         Page 189
                                        Ancillary


1970051 CARDIO DEFIB SINGLE CHAMBER 1         $     72,418.50 C1722
1970052 CARDIO DEFIB SINGLE CHAMBER 2         $     85,855.00 C1722
1970053 CLIP ANEURYSM                         $       930.89
1970054 COLPOPEXY SACRAL SYSTEM               $      5,351.50
1970055 CORNEAL GRAFT                         $       327.25
1970056 COVER BUR HOLE                        $       408.10
1970057 CRANIAL X DRIVE                       $        96.25
1970058 CUFF OCCLUSIVE                        $      8,046.50
1970059 EXTERNAL FIXATION                     $       519.75
1970060 EXTERNAL FIXATION 1                   $       351.64
1970061 EXTERNAL FIXATION 2                   $      1,516.90
1970062 GENERATOR CARDIAC W/O LEAD            $ 117,425.00
1970063 GENERATOR NEUROSTIM 1                 $     41,560.75 C1767
1970064 GENERATOR NEUROSTIMULATOR 2           $     53,110.75 C1767
1970065 GENERATOR VNS THERAPY                 $     46,196.15
1970066 GRAFT 1                               $      1,016.40
1970067 GRAFT 2                               $      7,099.40
1970068 GRAFT 3                               $      8,870.40
1970069 GRAFT 4                               $     11,068.75
1970070 GRAFT 5                               $     12,654.95
1970071 GRAFT 6                               $     27,412.00
1970072 GRAFT 7                               $     42,350.00
1970073 GRAFT INTEXEN DERMAL MATRIX 1         $      1,838.38
1970074 GRAFT INTEXEN DERMAL MATRIX 2         $      3,118.50
1970075 GRAFT SYNTHETIC TISSUE 1              $      1,232.00 C1763
1970076 GRAFT SYNTHETIC TISSUE 2              $      2,340.80 C1763
1970077 GRAFT SYNTHETIC TISSUE 3              $      3,003.00 C1763
1970078 GRAFT SYNTHETIC TISSUE 4              $      4,762.45 C1763
1970079 GRAFT SYNTHETIC TISSUE 5              $      9,513.35 C1763
1970080 GRAFT VASCULAR 1                      $       523.60 C1768
1970081 GRAFT VASCULAR 10                     $      7,099.40 C1768
1970082 GRAFT VASCULAR 11                     $      8,393.00 C1768
1970083 GRAFT VASCULAR 12                     $      9,690.45 C1768
1970084 GRAFT VASCULAR 13                     $     10,036.95 C1768
1970085 GRAFT VASCULAR 14                     $     13,317.15 C1768
1970086 GRAFT VASCULAR 15                     $     14,302.75 C1768
1970087 GRAFT VASCULAR 16                     $     14,945.70 C1768
1970088 GRAFT VASCULAR 17                     $     15,827.35 C1768
1970089 GRAFT VASCULAR 18                     $     16,555.00 C1768
1970090 GRAFT VASCULAR 19                     $     17,390.45 C1768
1970091 GRAFT VASCULAR 2                      $      1,228.15 C1768
1970092 GRAFT VASCULAR 3                      $      1,811.92 C1768
1970093 GRAFT VASCULAR 4                      $      2,521.46 C1768
1970094 GRAFT VASCULAR 5                      $      3,623.95 C1768
1970095 GRAFT VASCULAR 6                      $      4,105.07 C1768
1970096 GRAFT VASCULAR 7                      $      4,999.43 C1768
1970097 GRAFT VASCULAR 8                      $      5,717.25 C1768
1970098 GRAFT VASCULAR 9                      $      6,388.12 C1768
1970099 GRAFTJACKET REG MATRIX 1              $       496.65 J7344




                                        Page 190
                                         Ancillary


1970100 GRAFTJACKET REG MATRIX 2               $       989.45 J7344
1970101 GRAFTJACKET REG MATRIX 3               $      1,797.95 J7344
1970102 GRAFTJACKET REG MATRIX 4               $      3,203.20 J7344
1970103 GUIDE NERVE                            $      3,657.50
1970104 GUIDEWIRE 1                            $       234.85 C1769
1970106 GUIDEWIRE 3                            $      2,005.85 C1769
1970107 HOOK MICRO                             $       962.50
1970108 HUMAN TISSUE 1                         $       519.75 C1762
1970109 HUMAN TISSUE 10                        $      7,513.91 C1762
1970110 HUMAN TISSUE 11                        $      7,862.99 C1762
1970111 HUMAN TISSUE 12                        $      9,713.55 C1762
1970112 HUMAN TISSUE 13                        $     10,718.40 C1762
1970113 HUMAN TISSUE 14                        $     12,004.30 C1762
1970114 HUMAN TISSUE 15                        $     14,175.70 C1762
1970115 HUMAN TISSUE 16                        $     14,772.45 C1762
1970116 HUMAN TISSUE 17                        $     15,400.00 C1762
1970117 HUMAN TISSUE 18                        $     17,428.95 C1762
1970118 HUMAN TISSUE 19                        $     18,865.00 C1762
1970119 HUMAN TISSUE 2                         $      1,081.21 C1762
1970120 HUMAN TISSUE 20                        $     19,423.25 C1762
1970121 HUMAN TISSUE 21                        $     21,656.25 C1762
1970122 HUMAN TISSUE 22                        $     23,369.50 C1762
1970123 HUMAN TISSUE 23                        $     26,950.00 C1762
1970124 HUMAN TISSUE 24                        $     29,240.75 C1762
1970125 HUMAN TISSUE 25                        $     30,522.80 C1762
1970126 HUMAN TISSUE 3                         $      1,959.65 C1762
1970127 HUMAN TISSUE 4                         $      2,674.46 C1762
1970128 HUMAN TISSUE 5                         $      3,516.98 C1762
1970129 HUMAN TISSUE 6                         $      4,040.58 C1762
1970130 HUMAN TISSUE 7                         $      4,835.17 C1762
1970131 HUMAN TISSUE 8                         $      5,632.55 C1762
1970132 HUMAN TISSUE 9                         $      6,737.50 C1762
1970133 INJECTION TRANSURETHRAL CONTIG         $        88.55
1970134 ISERTER COLPOPEXY SAC SYS              $      1,232.00
1970135 JOINT DEVICE 1                         $       382.05 C1776
1970136 JOINT DEVICE 10                        $      4,752.70 C1776
1970137 JOINT DEVICE 11                        $      5,162.85 C1776
1970138 JOINT DEVICE 12                        $      5,388.46 C1776
1970139 JOINT DEVICE 13                        $      6,008.45 C1776
1970140 JOINT DEVICE 14                        $      6,283.20 C1776
1970141 JOINT DEVICE 15                        $      7,018.55 C1776
1970142 JOINT DEVICE 16                        $      7,619.15 C1776
1970143 JOINT DEVICE 17                        $      7,873.25 C1776
1970144 JOINT DEVICE 18                        $      8,671.38 C1776
1970145 JOINT DEVICE 19                        $      8,951.25 C1776
1970146 JOINT DEVICE 2                         $      1,428.31 C1776
1970147 JOINT DEVICE 20                        $      9,401.70 C1776
1970148 JOINT DEVICE 21                        $     10,164.00 C1776
1970149 JOINT DEVICE 22                        $     11,449.09 C1776




                                         Page 191
                                         Ancillary


1970150 JOINT DEVICE 23                        $     14,572.25 C1776
1970151 JOINT DEVICE 3                         $      1,711.53 C1776
1970152 JOINT DEVICE 4                         $      2,020.10 C1776
1970153 JOINT DEVICE 5                         $      2,477.23 C1776
1970154 JOINT DEVICE 6                         $      2,877.78 C1776
1970155 JOINT DEVICE 7                         $      3,380.30 C1776
1970156 JOINT DEVICE 8                         $      3,629.10 C1776
1970157 JOINT DEVICE 9                         $      4,126.85 C1776
1970159 KIT STIM INTERSTIM                     $       596.75
1970160 KIT TWIST LOK CBL LEAD                 $       211.75
1970161 KIT URINARY CONTROL SYS                $      1,809.50
1970162 LEAD 1                                 $      3,445.75
1970163 LEAD, NEUROSTIMULATOR 2                $      5,031.95 C1778
1970164 LEAD PACEMAKER 4                       $      5,031.95 C1898
1970165 LEAD 4                                 $      6,814.50
1970166 LEAD 5                                 $      7,507.50
1970167 LEAD 6                                 $      8,470.00
1970168 LEAD, NEUROSTIMULATOR 7                $      9,698.15 C1778
1970169 LEAD, NEUROSTIMULATOR 8                $     13,722.69 C1778
1970170 LEAD 9                                 $     14,245.00
1970171 LEAD CARDIO DEFIB ENDO DUAL CO         $     20,385.75 C1895
1970172 LEAD CARDIO DEFIB ENDO DUAL CO         $     23,870.00 C1895
1970173 LEAD CARDIO DEFIB NON SING/DUA         $     32,725.00 C1896
1970174 LEAD INTERSTIM UROLOGICAL              $     10,472.00
1970175 LEAD NEURO                             $      2,514.05
1970176 LEAD NEUROSTIM TEST KIT 1              $       750.75 C1897
1970177 GENERATOR NEUROSTIMULATOR 4            $     40,082.35 C1767
1970178 GENERATOR NEUROSTIMULATOR 5            $     45,441.55 C1767
1970179 LEAD NEUROSTIM TEST KIT 2              $      1,905.75 C1897
1970180 LEAD NEUROSTIM TEST KIT 3              $      2,594.90 C1897
1970181 LEAD NEUROSTIM TEST KIT 4              $      9,779.00
1970182 LEAD NEUROSTIM TEST KIT 5              $     10,087.00 C1897
1970183 LEAD NEUROSTIM TEST KIT 6              $     17,325.00 C1897
1970184 LEAD NEUROSTIM TEST KIT 7              $     32,532.50 C1897
1970185 GENERATOR NEUROSTIMULATOR 3            $     33,110.00 C1767
1970186 LEAD NEUROSTIM TEST KIT 9              $     34,630.75 C1897
1970187 LENS INTRAOCULAR 1                     $       288.75 C1780
1970188 LENS INTRAOCULAR 2                     $       482.97 C1780
1970189 LENS INTRAOCULAR 3                     $       577.50 C1780
1970190 LENS INTRAOCULAR 4                     $       770.00 C1780
1970191 MACROPORE                              $      3,784.55
1970192 MEDPOR SHEET                           $      1,001.00
1970193 MESH 1                                 $       335.81 C1781
1970194 MESH 10                                $      7,080.15 C1781
1970195 MESH 11                                $      7,775.08 C1781
1970196 MESH 12                                $      8,912.75 C1781
1970197 MESH 13                                $      9,702.00 C1781
1970198 MESH 14                                $     12,454.75 C1781
1970199 MESH 15                                $     13,860.00 C1781




                                         Page 192
                                     Ancillary


1970200 MESH 16                            $     14,899.50 C1781
1970201 MESH 17                            $     17,482.85 C1781
1970202 MESH 18                            $     20,963.25 C1781
1970203 MESH 2                             $      1,050.81 C1781
1970204 MESH 3                             $      1,793.00 C1781
1970205 MESH 4                             $      2,626.34 C1781
1970206 MESH 5                             $      3,221.16 C1781
1970207 MESH 6                             $      4,320.47 C1781
1970208 MESH 7                             $      4,897.84 C1781
1970209 MESH 8                             $      5,927.71 C1781
1970210 MESH 9                             $      6,532.49 C1781
1970211 NEUROSTIM PT PROGRAMMER            $     31,897.25 C1787
1970212 NEUROSTIMULATOR                    $       462.00
1970213 ORBITAL FLOOR SHEET                $      1,001.00
1970214 ORBITAL LINER                      $      1,963.50
1970215 ORTHO ASSEMBLY 1                   $      7,353.50
1970216 ORTHO ASSEMBLY 2                   $     10,437.35
1970217 ORTHO ASSEMBLY 3                   $     16,266.25
1970218 ORTHO BACK TRIDENT                 $      4,412.10
1970219 ORTHO BAR 1                        $       437.94
1970220 ORTHO BAR 2                        $      3,218.17
1970221 ORTHO BONE                         $       134.75
1970222 ORTHO BONE GRAFT SUBST 1           $      1,347.50
1970223 ORTHO BONE GRAFT SUBST 2           $      1,876.88
1970224 ORTHO BONE GRAFT SUBST 3           $      2,964.50
1970225 ORTHO BONE GRAFT SUBST 4           $      4,427.50
1970226 ORTHO CABLE 1                      $       377.30
1970227 ORTHO CABLE 2                      $      1,161.41
1970228 ORTHO CABLE 3                      $     13,467.30
1970229 ORTHO CARRIAGE WIRE                $      2,202.20
1970230 ORTHO CENTRALIZER                  $      6,695.15
1970231 ORTHO CENTRALIZER REVISION         $       219.45
1970232 ORTHO CLAMP 1                      $       779.63
1970233 ORTHO CLAMP 2                      $      1,805.65
1970234 ORTHO CLAMP 3                      $      2,591.05
1970235 ORTHO CLAMP 4                      $      5,865.48
1970236 ORTHO CLAMP 5                      $      6,333.25
1970237 ORTHO CLUSTER                      $      4,412.10
1970238 ORTHO COMPONENT 1                  $      1,729.29
1970239 ORTHO COMPONENT 2                  $      2,175.25
1970240 ORTHO COMPONENT 3                  $      2,945.25
1970241 ORTHO COMPONENT 4                  $      6,086.85
1970242 ORTHO COMPONENT 5                  $      6,695.15
1970243 ORTHO COMPONENT 6                  $      8,000.30
1970244 ORTHO COMPONENT 7                  $      9,582.65
1970245 ORTHO COMPONENT 8                  $     15,738.80
1970246 ORTHO COMPONENT 9                  $     17,463.60
1970247 ORTHO CONNECTOR                    $      1,104.95
1970248 ORTHO CUP RINGLOC                  $      2,956.80




                                     Page 193
                                  Ancillary


1970249 ORTHO DISC                      $       800.80
1970250 ORTHO DURA DURATION 1           $      1,540.00
1970251 ORTHO DURA DURATION 2           $      2,310.00
1970252 ORTHO DURACON 1                 $      1,540.00
1970253 ORTHO DURACON 2                 $      6,160.00
1970254 ORTHO END CAP                   $       518.98
1970255 ORTHO EXTERNAL FIXATION         $      1,158.85
1970256 ORTHO FEMORAL 1                 $      5,386.15 C1776
1970257 ORTHO FEMORAL 2                 $      5,801.95 C1776
1970258 ORTHO FEMORAL 3                 $      6,525.75 C1776
1970259 ORTHO FEMORAL 4                 $      7,078.23 C1776
1970260 ORTHO FEMORAL 5                 $     10,914.75 C1776
1970261 ORTHO FIXATION                  $       269.50
1970262 ORTHO FIXATOR 1                 $      4,129.76
1970263 ORTHO FIXATOR 2                 $      5,116.65
1970264 ORTHO FIXATOR 3                 $      5,554.59
1970265 ORTHO FIXATOR 4                 $      8,208.20
1970266 ORTHO FIXATOR 5                 $      8,964.73
1970267 ORTHO FIXATOR 6                 $     10,358.43
1970268 ORTHO FIXATOR 7                 $     11,935.00
1970269 ORTHO FIXATOR 8                 $     15,711.85
1970270 ORTHO FIXATOR 9                 $     20,659.10
1970271 ORTHO GRIP                      $      2,167.55
1970272 ORTHO GUIDE TEMPLATE 1          $       291.31
1970273 ORTHO GUIDE TEMPLATE 2          $      3,341.80
1970274 ORTHO GUIDE TEMPLATE 3          $      4,034.80
1970275 ORTHO H PLATE                   $       604.45
1970276 ORTHO HOOK                      $      1,597.75
1970277 ORTHO HUMAN TISSUE 1            $     11,068.75 C1762
1970278 ORTHO HUMAN TISSUE 2            $     14,437.50 C1762
1970279 ORTHO HUMAN TISSUE 3            $     18,865.00 C1762
1970280 ORTHO HUMAN TISSUE 4            $     32,725.00 C1762
1970281 ORTHO INSERT 1                  $      2,560.25 C1776
1970282 ORTHO INSERT 2                  $      4,052.32 C1776
1970283 ORTHO INSERT 3                  $      4,849.89 C1776
1970284 ORTHO JOINT FINGER              $      3,060.75
1970285 ORTHO L PLATE 1                 $       154.00
1970286 ORTHO L PLATE 2                 $      1,240.34
1970287 ORTHO LINER 1                   $      1,925.00
1970288 ORTHO LINER 2                   $      3,037.45
1970289 ORTHO LINER 3                   $      3,701.74
1970290 ORTHO LINER 4                   $      4,235.00
1970291 ORTHO LINER 5                   $      8,470.00
1970292 ORTHO LOCKING PIN               $       284.90
1970293 ORTHO MECHANISM                 $      1,878.37
1970294 ORTHO NAIL FIXATION             $       224.07
1970295 ORTHO OMNI FIT                  $      7,469.00
1970296 ORTHO PEG 1                     $       269.50
1970297 ORTHO PEG 2                     $      1,786.40




                                  Page 194
                                         Ancillary


1970298 ORTHO PIN 1                            $        18.06 C1713
1970299 ORTHO PIN 2                            $       263.09 C1713
1970300 ORTHO PIN 3                            $       739.20 C1713
1970301 ORTHO SEGMENT                          $     11,457.60
1970302 ORTHO SHELL                            $      1,212.75
1970303 ORTHO TRAUMA ARC                       $      1,486.10
1970304 ORTHO TRAUMA ARM 1                     $      3,271.86
1970305 ORTHO TRAUMA ARM 2                     $      4,403.76
1970306 ORTHO TRAUMA ARM 3                     $     15,915.90
1970307 ORTHO TRAUMA BRIDGE                    $       725.73
1970308 ORTHO TRAUMA CONNECTOR 1               $      2,202.20
1970309 ORTHO TRAUMA CONNECTOR 2               $      3,880.80
1970310 ORTHO TRAUMA CONNECTOR 3               $      5,122.43
1970311 ORTHO TRAUMA CONNECTOR 4               $      6,333.25
1970312 ORTHO TRAUMA COUPLER                   $      1,470.70
1970313 ORTHO TRAUMA COVER BONE                $       277.20
1970314 ORTHO TRAUMA EXTENSION                 $      1,792.18
1970315 ORTHO TRAUMA FIXTURE                   $       962.50
1970316 ORTHO TRAUMA HAMMER                    $      1,817.20
1970317 ORTHO TRAUMA HANDLE 1                  $       554.40
1970318 ORTHO TRAUMA HANDLE 2                  $      3,445.75
1970319 ORTHO TRAUMA HIP DEVICE                $     11,141.90
1970320 ORTHO K WIRE 1                         $       262.57
1970321 ORTHO TRAUMA KIT 1                     $       358.05
1970322 ORTHO TRAUMA KIT 2                     $      1,905.75
1970323 ORTHO TRAUMA KIT 3                     $      3,189.34
1970324 ORTHO TRAUMA KIT 4                     $      5,644.10
1970325 ORTHO TRAUMA KIT 5                     $      8,662.50
1970326 ORTHO TRAUMA KIT 6                     $     12,670.35
1970327 ORTHO TRAUMA KNUCKLE CONSTRUX          $      2,695.00
1970328 ORTHO TRAUMA RING 1                    $      1,282.05
1970329 ORTHO TRAUMA RING 2                    $      1,878.03
1970330 ORTHO TRAUMA SPACER                    $       605.42
1970331 ORTHO TRAUMA TEMPLATE 1                $       558.25
1970332 ORTHO TRAUMA TEMPLATE 2                $      1,499.96
1970333 CARDIO DEFIB SINGLE CHAMBER 3          $     75,883.50 C1722
1970334 PACEMAKER,OTHER THAN SNGL/DUAL         $     34,265.00 C2621
1970335 PATCH 1                                $      1,422.58
1970336 PATCH 2                                $      2,833.60
1970337 PATCH 3                                $      5,401.55
1970338 PIN                                    $       154.00
1970339 PLATE 1                                $       388.50
1970340 PLATE 2                                $      1,225.40
1970341 PLATE 3                                $      2,007.78
1970342 PLATE 4                                $      2,679.35
1970343 PLATE 5                                $      3,293.68
1970344 PLATE 6                                $      4,219.53
1970345 PLATE 7                                $      4,777.85
1970346 PLATEAU 1                              $      2,883.65




                                         Page 195
                                         Ancillary


1970347 PLATEAU 2                              $      9,147.60
1970348 PLUG                                   $       488.95
1970349 PLUG UROLOGY                           $       385.00
1970350 PROSTHESIS BREAST IMP 1                $        38.50 C1789
1970351 PROSTHESIS BREAST IMP 2                $       250.25 C1789
1970352 PROSTHESIS BREAST IMP 3                $      2,016.50 C1789
1970353 PROSTHESIS BREAST IMP 4                $      2,624.02 C1789
1970354 PROSTHESIS BREAST IMP 5                $      3,288.02 C1789
1970355 PROSTHESIS BREAST IMP 6                $      4,204.61 C1789
1970356 PROSTHESIS BREAST IMP 7                $      4,985.75 C1789
1970357 PROSTHESIS BREAST IMP 8                $      7,700.00 C1789
1970358 PROSTHESIS ENT                         $      1,135.75
1970359 PROSTHESIS PENILE INFLATAB 1           $       924.00 C1813
1970360 PROSTHESIS PENILE INFLATAB 2           $      1,097.25 C1813
1970361 PROSTHESIS PENILE INFLATAB 3           $      1,501.50 C1813
1970362 PROSTHESIS PENILE INFLATAB 4           $      9,220.75 C1813
1970363 PROSTHESIS PENILE INFLATAB 5           $     11,357.50 C1813
1970364 PROSTHESIS PENILE INFLATAB 6           $     12,613.37 C1813
1970365 PROSTHESIS PENILE INFLATAB 7           $     19,769.75 C1813
1970366 PROSTHESIS PENILE INFLATAB 8           $     21,053.29 C1813
1970367 PUMP INFUSION 1                        $     34,650.00
1970368 PUMP INFUSION 2                        $     43,120.00
1970369 PUMP PROSTHESIS                        $      9,328.55
1970370 RAIL 1                                 $       712.25
1970371 RAIL 2                                 $      2,624.41
1970372 RAIL 3                                 $      3,567.23
1970373 RAIL 4                                 $      4,890.27
1970374 RAIL 5                                 $      7,155.02
1970375 RAIL 6                                 $      8,458.45
1970376 REP DEV URINARY W/O SLING              $      2,887.50 C2631
1970377 REP DEV URINARY W/SLING 1              $       712.25 C1771
1970378 REP DEV URINARY W/SLING 2              $      2,643.03 C1771
1970379 REP DEV URINARY W/SLING 3              $      3,465.00 C1771
1970380 REP DEV URINARY W/SLING 4              $     11,684.75 C1771
1970381 RESERVOIR UROLOGY                      $      4,774.00
1970382 ROCKWOOD SHOULDER 1                    $       242.55
1970383 ROCKWOOD SHOULDER 2                    $      1,093.40
1970384 ROD 1                                  $       410.94
1970385 CARBON FIBER ROD 2                     $      3,060.75 C1713
1970386 ROD 3                                  $      4,600.75
1970387 SCREW UROLOGY                          $       943.25
1970388 SEAMGUARD BIOAB                        $       627.55
1970389 SET CYLINDER AND PUMP INFRAPUB         $     21,309.75
1970390 SHAFT COLPOPEXY SAC SYS                $       385.00
1970391 SHANZ THREAD                           $       408.10
1970392 SHUNT 1                                $       400.40
1970393 SHUNT 2                                $      1,609.30
1970394 SHUNT 3                                $      3,153.15
1970395 SLEEVE 2                               $      3,353.35




                                         Page 196
                                      Ancillary


1970396 SLEEVE 3                            $      5,505.50
1970397 SPHERE EYE PLASTIC 1                $        61.60
1970398 SPHERE EYE PLASTIC 2                $      2,310.00
1970399 SPINE BENGAL                        $      3,461.15
1970400 SPINE BOLT DYNALOCK                 $      1,274.35
1970401 SPINE BP LORDOTIC 1                 $     11,573.10
1970402 SPINE BP LORDOTIC 2                 $     13,821.50
1970403 SPINE CABLE SONGER 1                $      1,373.16
1970404 SPINE CABLE SONGER 2                $      4,870.25
1970405 SPINE CAGE 1                        $      7,546.00
1970406 SPINE CAGE 2                        $     13,132.35
1970407 SPINE CAGE 3                        $     20,113.84
1970408 SPINE CAP                           $       807.21
1970409 SPINE CLAMP BONE GRAFT              $       577.50
1970410 SPINE CLAMP NEUTRAL                 $      1,682.45
1970411 SPINE CLIP CONNECTOR                $      1,274.35
1970412 SPINE COLLAR                        $       361.90
1970414 SPINE CONNECTOR 1                   $        84.70
1970415 SPINE CONNECTOR 2                   $       858.55
1970416 SPINE CONNECTOR 3                   $      1,557.53
1970417 SPINE CONNECTOR 4                   $      2,296.32
1970418 SPINE CONNECTOR 5                   $      3,199.11
1970419 SPINE CONNECTOR 6                   $      3,818.17
1970420 SPINE CONNECTOR 7                   $      4,778.55
1970421 SPINE CONNECTOR 8                   $      5,390.00
1970422 SPINE CONNECTOR 9                   $      6,160.00
1970423 SPINE CORD FUSION DYNESIS 1         $      3,649.80
1970424 SPINE CORD FUSION DYNESIS 2         $      4,612.30
1970425 SPINE CORD LIS DYNESYS 1            $      3,122.35
1970426 SPINE CORD LIS DYNESYS 2            $      3,946.25
1970427 SPINE CORE SLIDING CHARITE          $      1,886.50
1970428 SPINE COUGAR                        $     10,395.00
1970429 SPINE COVER PLATE                   $      1,690.15
1970430 SPINE CROSSCONNECTOR                $      3,118.50
1970431 SPINE END CAP                       $       700.70
1970432 SPINE ENDPLATE CHARITE              $     14,553.00
1970433 SPINE FIXED SILHOUETTE              $      1,905.75
1970434 SPINE FIXED TRINCA                  $       700.70
1970435 SPINE FRACTURE KIT                  $     13,178.55
1970436 SPINE HEAD                          $      1,362.90
1970437 SPINE HEALOS 1                      $      1,062.60
1970438 SPINE HEALOS 2                      $      2,252.25
1970439 SPINE HEALOS 3                      $      4,523.75
1970440 SPINE HEALOS 4                      $      6,071.45
1970441 SPINE HOLDER 1                      $      3,984.75
1970442 SPINE HOLDER 2                      $      6,079.15
1970443 SPINE HOLDER 3                      $     11,804.10
1970444 SPINE HOOK 1                        $       796.95
1970445 SPINE HOOK 2                        $      1,758.46




                                      Page 197
                                     Ancillary


1970446 SPINE HOOK 3                       $      2,755.71
1970447 SPINE INSERT                       $       281.05
1970448 SPINE INTERBODY BAK C              $      6,275.50
1970449 SPINE INTERBODY BAK PROX 1         $      9,917.60
1970450 SPINE INTERBODY BAK PROX 2         $     13,224.75
1970451 SPINE INTERBODY BAK VISTA          $     13,228.60
1970452 SPINE INTERBODY BOOMERANG          $     10,395.00
1970453 SPINE INTERBODY CAGE BP II         $      9,917.60
1970454 SPINE J HOOK                       $       311.85
1970455 SPINE KANEDA                       $      2,895.20
1970456 SPINE KIT LAP SEAL                 $       369.60
1970457 KWIRE 1                            $      1,347.50
1970458 KWIRE 2                            $      3,657.50
1970459 KWIRE DUAL TROCAR                  $        34.65
1970460 SPINE LEOPARD                      $     10,395.00
1970461 SPINE LOCK                         $       388.85
1970462 SPINE LOCKING AXON                 $       192.50
1970463 SPINE LOCKING NUT 1                $       558.25
1970464 SPINE LOCKING NUT 2                $       180.95
1970465 SPINE LOCKING SCREW                $      1,559.25
1970466 SPINE LORDOTIC VISTA               $     13,228.60
1970467 SPINE LT CAGE PEEK                 $     14,040.95
1970468 SPINE MONARCH ROD                  $       796.95
1970469 SPINE NUT                          $       194.43 C1713
1970470 SPINE PAK                          $       635.25
1970471 SPINE PEDICLE                      $      1,584.28
1970472 SPINE PEEK                         $       689.15
1970473 SPINE PIN PLATE                    $       700.70
1970474 SPINE PIN STEINMANN                $        23.10
1970475 SPINE PLATE 15                     $        38.50
1970476 SPINE PLATE 16                     $       608.30 C1713
1970477 SPINE PLATE 17                     $      2,281.33 C1713
1970478 SPINE PLATE 18                     $      3,170.16 C1713
1970479 SPINE PLATE 19                     $      3,747.25 C1713
1970480 SPINE PLATE 20                     $      4,308.15 C1713
1970481 SPINE PLATE 21                     $      5,305.30 C1713
1970482 SPINE PLATE 22                     $      5,605.60 C1713
1970483 SPINE PLATE 23                     $      8,870.40 C1713
1970484 SPINE PLATE 24                     $     10,524.61 C1713
1970485 SPINE PLATE 25                     $     13,201.65 C1713
1970486 SPINE PLUG 1                       $       496.65
1970487 SPINE PLUG 2                       $      4,146.45
1970488 SPINE POLY SILHOUETTE 1            $      2,764.30
1970489 SPINE POLYAX                       $      3,268.65
1970490 SPINE REDUCTION MAS                $      4,874.10
1970491 SPINE REDUCTION PLUG               $       602.53
1970492 SPINE RING MESH                    $       727.65
1970493 SPINE ROD                          $      2,714.25
1970494 SPINE ROD 1                        $       573.65




                                     Page 198
                                       Ancillary


1970495 SPINE ROD 2                          $      1,115.39
1970496 SPINE ROD 3                          $      1,582.35
1970497 SPINE ROD 4                          $      2,425.50
1970498 SPINE ROD 5                          $      3,083.85
1970499 SPINE ROD 6                          $      4,208.05
1970500 SPINE SEAL                           $       336.88
1970501 SPINE SET FUSION DYNESYS             $      5,293.75
1970502 SPINE SET SCREW                      $       472.01
1970503 SPINE SEXTANT                        $      4,912.60
1970504 SPINE SIDE OPENING                   $      1,736.35
1970505 SPINE SLEEVE WITH SET SCREW          $       746.90
1970506 SPINE SLOT CONNECTOR ISOLA           $      1,813.35
1970507 SPINE SPACER 1                       $      3,461.15
1970508 SPINE SPACER 2                       $      7,546.00
1970509 SPINE SPACER 3                       $     11,511.50
1970510 SPINE SPACER 4                       $     13,706.00
1970511 SPINE SPACER DYNESYS                 $      1,805.65
1970512 STAPLE, ORTHO/SPINE 1                $       770.00
1970513 SPINE STAPLE 2                       $      2,044.35
1970514 SPINE STAPLE 3                       $      3,336.03
1970515 SPINE STAPLE 4                       $      4,427.50
1970516 SPINE STRUT PSR                      $      3,461.15
1970517 SPINE SUMMIT                         $      2,471.70
1970518 SPINE SYNEX                          $     18,441.50
1970519 SPINE TIMX VSP                       $      4,608.45
1970520 SPINE TRANSCONNECTOR                 $      3,358.30
1970521 SPINE TRANSVERSE BAR                 $      1,120.35
1970522 SPINE VARIABLE TRINCA                $       700.70
1970523 SPINE VERTI STACK                    $     10,395.00
1970524 SPINE WASHER                         $       469.70
1970525 WIRE, ORTHO/SPINE                    $       175.18
1970526 STEM 1                               $       219.45
1970527 STEM 10                              $     11,079.52
1970528 STEM 2                               $      3,352.12
1970529 STEM 3                               $      4,223.45
1970530 STEM 4                               $      5,386.15
1970531 STEM 5                               $      6,676.62
1970532 STEM 6                               $      7,346.70
1970533 STEM 7                               $      7,830.50
1970534 STEM 8                               $      9,068.68
1970535 STEM 9                               $     10,419.39
1970536 STENT COATED/COV W/DEL SYS 1         $      7,680.75 C1874
1970537 STENT COATED/COV W/DEL SYS 2         $      8,114.70 C1874
1970538 STENT COATED/COV W/DEL SYS 3         $      9,817.50 C1874
1970539 STENT COATED/COV W/DEL SYS 4         $     11,915.75 C1874
1970540 STENT COATED/COV W/O DEL SYS         $      7,122.50 C1875
1970541 SUPPORT RAIL                         $      1,026.03
1970542 SYRINGE COLLAGEN INJ                 $      1,258.95
1970543 SYSTEM CORRECTION                    $     10,473.29




                                       Page 199
                                         Ancillary


1970544 T PLATE                                $       687.40
1970545 TESTICULAR PROSTHESIS 1                $      3,060.75
1970546 TESTICULAR PROSTHESIS 2                $      4,427.50
1970547 TIBIA BEARING                          $      2,467.85
1970548 TIBIA TRAY 1                           $      5,024.25
1970549 TIBIA TRAY 2                           $      4,550.70
1970550 TIBIA TRAY 3                           $      4,764.51
1970551 TIBIA TRAY 4                           $      7,157.15
1970552 TIBIA TRAY 5                           $      7,942.55
1970553 UNICOM TIBIAL TRAY 1                   $      3,033.80
1970554 UNICOM TIBIAL TRAY 2                   $      6,814.50
1970555 UNICOM VANGUARD                        $      4,427.50
1970556 UROLOGY PORCINE DERMAL MATRIX          $      1,838.38
1970558 VALVE 1                                $      1,864.37
1970559 VALVE 2                                $      3,342.39
1970560 VALVE 3                                $      8,561.76
1970561 VENA CAVA FILTER                       $      3,665.84 C1880
1970562 VISION PULLER                          $       460.08
1970563 Y PLATE                                $       645.51
1970564 PACEMAKER, LEAD                        $      2,310.00 C1898
1970565 TUBE, PRESSURE EQUALIZING              $        42.90
1970566 BUTTON CERCLAG SYNTHES 298.804         $      1,265.00
1970567 BUTTON FIXATION CRUCIATE 13186         $       485.10
1970568 BONE CEMENT                            $       392.70
1970569 GASTRIC BANDING SYSTEM B-22XX          $     12,994.30
1970570 SHAFT WRNCH RTCHT BN EBI 03235         $       539.00
1970571 SYSTEM COLPOPEXY AMS 72403600          $      5,756.30
1970572 TACK RESORBABLE MACRAPORE              $       248.60
1970573 TAPE SURGCL CRCTE LGMNT 14868          $       225.50
1970574 VALVE NEUROSURGICAL SM 42856           $      8,311.60
1970575 SHOULDER MAGNUM PLUS                   $      1,463.00
1970576 PLUG ANAL                              $      3,272.50
1970577 IMPLANT JONES TUBES                    $        96.80
1970578 TEFLON INJECTION                       $      1,598.30
1970579 LEAD, NEUROSTIMULATOR                  $      8,662.50 C1778
1970580 OCCLUSION COIL                         $       304.70
1970581 LEAD, PNEUMATIC                        $      1,010.90
1970582 BAND BUCKLING                          $        42.35
1970583 BONE GRAFT 3                           $      6,314.00
1970584 CARDIAC RING ANASTOMOTIC               $       404.25
1970585 CATHETER, BALLOON                      $       519.75
1970586 CLIP ANEURYSM WECK                     $       172.70
1970587 CARDIO VASCULAR ASSIST PUMP            $ 216,477.80
1970588 GRIP CABLE 2                           $      3,780.70
1970589 GRIP CABLE 1                           $      1,274.35
1970590 INTERBODY INTERFIX                     $     11,318.31
1970591 KIT FRACTURE                           $       146.30
1970592 NEURO CATH KIT                         $      1,519.98
1970593 ORTHO CONNECTOR 2                      $      1,940.40




                                         Page 200
                                         Ancillary


1970594 IMPLANT PIN DISTRACT/STEIN             $        80.85
1970595 RESERVOIR NEURO                        $       539.00
1970596 ROD 4                                  $       927.85
1970597 SLEEVE CABLE                           $       592.90
1970598 SPINE BOLT PEDICLE                     $      1,339.80
1970599 SPINE COUPLER                          $      2,581.43
1970600 SPINE CROSSLINK ASSEMBLY               $      3,330.25
1970601 SPINE HOOK 4                           $      3,465.00 C1713
1970602 SPINE POLYAX 1                         $      4,104.10
1970603 ORTHO STEM 11                          $      1,824.90
1970604 STENT, URETERAL 1                      $       254.10 C2617
1970605 STENT, URETERAL 2                      $       500.50 C2617
1970606 STENT, URETERAL 3                      $      1,232.00 C2617
1970607 WIRE OLIVE                             $       509.43
1970608 ORTHO HUMAN TISSUE 5                   $      4,050.20 C1762
1970609 ORTHO PLATE 8                          $      5,634.20 C1713
1970610 IMPLANT TITANIUM BLADE                 $      1,925.00 C1713
1970611 HEX TITANIUM BUTTON CERCLAGE 2         $       366.30
1970612 CAP FIXATION PROTECTION PIN            $       107.80
1970613 ORTHO CLIP                             $       300.30
1970614 ORTHO INSERT 4                         $       277.20 C1713
1970615 NAIL TITANIUM ORTHO 1                  $       866.80 C1713
1970616 NAIL TITANIUM ORTHO 2                  $      3,272.50 C1713
1970617 NAIL TITANIUM ORTHO 3                  $      5,060.00 C1713
1970618 NAIL TITANIUM ORTHO 4                  $      5,582.50 C1713
1970619 WIRE, SPADE POINT REDUCTION            $       877.80 C1713
1970620 SCREW / ORTHO NUT                      $       104.50 C1713
1970621 ORTHO RING                             $      1,386.00
1970623 CARBON FIBER ROD 4                     $       889.90 C1713
1970624 CARBON FIBER ROD 5                     $      2,040.50 C1713
1970625 SLEEVE TITANIUM 1                      $      1,031.80 C1713
1970626 SPACER TITANIUM ORTHO                  $       275.00 C1713
1970627 ORTHO T PLATE 1                        $      1,756.70 C1713
1970628 IMPLANT WASHER ORTHO                   $       401.50 C1713
1970629 IMPLANT TROCHANTER DEVICE 1            $      5,354.80
1970630 IMPLANT TROCHANTER DEVICE 2            $      7,715.40
1970633 CARDIO DEFIB DUAL CHAMBER 3            $     97,405.00 C1721
1970634 IMPLANT JONES TUBES W/ HOLES           $       143.00
1970635 BAR PECTUS                             $       200.20
1970636 SUPPORT BAR PECTUS                     $      3,276.35
1970637 CLAMP PECTUS                           $      2,190.65
1970638 STABALIZER PECTUS                      $      1,282.05
1970639 HEAD FRAME                             $       592.90
1970640 CLAMP NEURO 1                          $       150.15
1970641 CLAMP NEURO 2                          $       719.95
1970642 COUPLING NEURO                         $       500.50
1970643 CONDYL RECON NEURO                     $      2,032.80
1970644 BLOCK FILLER                           $       231.00
1970645 BLOCK TEFLON GRAFT                     $       904.75




                                         Page 201
                               Ancillary


1970646 CHANNEL REPLACEMENT          $       154.00 C1713
1970647 HANDLE NEURO                 $       492.80
1970648 HEMIMANDABLE                 $      3,245.55 C1713
1970649 HEAD FRAME KIT               $      4,165.70
1970650 MANDIBLE 1                   $      2,822.05
1970651 MANDIBLE 2                   $      4,446.75
1970652 MANDIBLE 3                   $      5,948.25 C1713
1970653 MANDIBLE 4                   $     10,010.00
1970654 NEURO PAC                    $      1,178.10 C1713
1970655 OSTEOSYTHESIS SYSTEM         $     23,962.40
1970656 SHEET LACTOSORB 1            $      1,285.90 C1781
1970657 SHEET LACTOSORB 2            $      2,752.75 C1781
1970658 SHEET LACTOSORB 3            $      5,578.65 C1781
1970659 SKULL 1                      $      4,766.30
1970660 SKULL 2                      $     10,395.00
1970661 SKULL 3                      $     11,935.00
1970662 TEMPLATE NEURO 1             $        96.25
1970663 TEMPLATE NEURO 2             $       685.30
1970664 WASHER NEURO IMPLANT         $       180.95 C1713
1970665 BAND                         $      1,686.30
1970666 BAR SONGER                   $       465.85
1970667 BOLT CANCELLOUS              $      1,543.85
1970668 BOTTOM STACK                 $      3,149.30
1970669 SPINE CRIMP                  $       500.50
1970670 SPINE CABLE 1                $      1,251.25
1970671 SPINE CABLE 2                $      4,539.15
1970672 SPINE CABLE 3                $     10,891.65
1970673 SPINE CABLE 4                $     13,386.45
1970674 SPINE CABLE 5                $     16,458.75
1970675 SPINE CAGE 5                 $      2,098.25
1970676 ORTHO ASSEMBLY 4             $     11,877.25
1970677 SPINE CAGE 4                 $     10,395.00
1970678 ORTHO BALL 3                 $      2,733.50 C1713
1970679 SPINE LOCK 1                 $      1,297.45
1970680 PORT, INDWELLING 1           $      1,116.50 C1788
1970681 PORT 2                       $      3,080.00
1970682 TOP STACK                    $      3,311.00
1970683 ORTHO BALL 1                 $      1,027.95 C1713
1970684 ORTHO BALL 2                 $      1,543.85 C1713
1970685 ORTHO CEMENTRALIZER          $       134.75
1970686 ORTHO CUP 1                  $      4,523.75 C1776
1970687 ORTHO FACESHIELD             $       404.25 C1776
1970688 ORTHO HEAD 1                 $      2,421.65 C1713
1970689 ORTHO HEAD 2                 $      4,916.45 C1713
1970690 ORTHO INSERT 5               $      2,891.35 C1776
1970691 PATELLA KNEE                 $      1,736.35 C1776
1970692 WEDGE TIBIAL KNEE            $      4,315.85 C1776
1970693 FACIAL INSERT                $       308.00 C1776
1970694 NEURO NUT                    $        77.00 C1713




                               Page 202
                                   Ancillary


1970695 ORTHO CUP 2                      $      3,657.50 C1776
1970696 ORTHO GLENOID                    $      3,688.30
1970697 ORTHO SURFACE NEXGEN             $      2,695.00
1970698 SPINE BOLT 1                     $       716.10 C1713
1970699 SPINE BOLT 2                     $      1,559.25 C1713
1970700 SPINE BOLT 3                     $      5,682.60 C1713
1970701 SPINE BOLT 4                     $      6,887.65 C1713
1970702 SPINE ASSEMBLY 1                 $       924.00 C1776
1970703 SPINE ASSEMBLY 2                 $      3,099.25 C1776
1970704 SPINE ANTARES                    $      4,208.05
1970705 SPINE ADD ON                     $     10,395.00
1970706 SPINE BOOM                       $      4,535.30
1970707 CORNERSTONE LATERAL PORT         $      3,461.15
1970708 SPINE C RING                     $      1,116.50
1970709 SPINE CROSSLINK 1                $      3,180.10
1970710 SPINE CROSSLINK 2                $      3,807.65
1970711 SPINE CROSSLINK 3                $      4,412.10
1970712 SPINE DOMINO 1                   $      2,691.15
1970713 SPINE DOMINO 2                   $      3,742.20
1970714 SPINE DOMINO 3                   $      4,662.35
1970715 SPINE DOMINO 4                   $      5,713.40
1970716 SPINE END CAP 2                  $      1,597.75
1970717 EYEBOLT CROSSLINK                $       465.85
1970718 HORIZON AXIAL                    $      2,348.50
1970719 KIT ZEPHIR                       $      4,254.25
1970720 SPINE NUT 1                      $       523.60 C1713
1970721 SPINE PEEK 1                     $     10,395.00
1970722 SPINE PLATE 26                   $      6,583.50 C1713
1970723 SPINE PYRAMESH 1                 $      5,482.40 C1781
1970724 SPINE PYRAMESH 2                 $      9,882.95 C1781
1970725 SPINE PYRAMESH 3                 $     13,486.55 C1781
1970726 SPINE PYRAMESH 4                 $     17,617.60 C1781
1970727 SPINE PYRAMESH 5                 $     21,340.55 C1781
1970728 SPINE PYRAMESH 6                 $     24,974.95 C1781
1970729 SPINE PYRAMESH 7                 $     29,321.60 C1781
1970730 SPINE PYRAMESH 8                 $     35,046.55 C1781
1970731 SATELLITE SPHERE                 $     10,395.00
1970732 SPINE SLIDER                     $       358.05
1970733 SPINE SPIN                       $      2,856.70
1970734 SPINE STAPLE 5                   $      6,433.35
1970735 SPINE PEEK 2                     $      7,688.45
1970736 VERTE-SPAN 1                     $      4,184.95
1970737 VERTE-SPAN 2                     $     16,362.50
1970738 VERTE-SPAN 3                     $     21,817.95
1970739 ROD 5                            $      2,036.65
1970740 COIL EMBOLECTOMY                 $       231.00
1970741 ADAPTER 3                        $      1,636.25
1970743 LENGTHENING APPARATUS 1          $     13,475.00
1970744 NEURO BAR                        $        92.40




                                   Page 203
                                        Ancillary


1970745 SPINE BAR                             $       535.15
1970746 BLOCKER                               $       435.05
1970747 SPINE CAGE 6                          $     29,548.75
1970748 SPINE CAGE 7                          $     25,025.00
1970749 CATH BALLOON 1                        $      1,713.25 C1726
1970750 BONE CEMENT 1                         $      2,009.70
1970751 BONE CEMENT 2                         $      3,915.45
1970752 ORTHO CLAMP 6                         $      4,235.00
1970753 SPINE CLIP                            $       519.75
1970757 CUFF VASCULAR 1                       $      8,951.25
1970758 CUFF VASCULAR 2                       $     12,512.50
1970759 ORTHO CUP 3                           $      7,449.75 C1776
1970760 ENDPLATE                              $      1,855.70
1970761 EYELID PROSTHESIS                     $       227.15
1970762 FELT                                  $       288.75
1970763 VENA CAVA FILTER 1                    $      5,547.85 C1880
1970764 ICD, OTHER THAN SING/DUAL             $     96,250.00 C1882
1970765 ANCHOR/SCREW K-WIRE 1                 $       259.60 C1713
1970766 K WIRE 4                              $       250.80
1970767 COSEAL SEALANT                        $      1,707.20
1970768 FLOSEAL                               $      3,465.00
1970769 K WIRE 3                              $       317.90
1970770 CEMENT RESTRICTOR                     $       481.25
1970771 STENT, NON/COATED W/DEL SYS 1         $      3,977.60 C1876
1970772 STENT, NON/COATED W/O DEL SYS         $      6,526.30 C1877
1970773 ADAPTER/LEAD IMPLANTABLE 1            $       741.40 C1883
1970774 SPINE CLAMP                           $      1,744.05
1970775 GRAFT 8                               $      3,461.15
1970776 GRAFT 9                               $      4,693.15
1970777 SURGICAL ADHESIVE                     $      2,306.15
1970778 CHIN IMPLANT                          $       866.25
1970779 GLAUCOMA DRAINAGE DEVICE              $      1,135.75
1970780 ORTHO INSERT 6                        $      8,316.00
1970781 ORTHO NAIL 5                          $      4,789.40
1970782 ORTHO NAIL 6                          $      3,003.00
1970784 LENGTHENING APPARATUS 2               $     28,875.00
1970785 MAMMOSITE RAD. THERAPY SYSTEM         $     10,587.50
1970786 ORTHO MECHANISM 1                     $      3,245.55
1970787 MESH 19                               $     27,947.15 C1781
1970788 EXTERNAL FIXATION 2                   $      9,548.00
1970789 ORTHO NAIL 7                          $      6,444.90
1970796 ORTHO BOLT                            $       693.00
1970797 LEAD, PACEMAKER 1                     $      4,119.50 C1898
1970798 PACEMAKER, GENERATOR                  $     54,092.50 C1722
1970799 LEAD, PACEMAKER 2                     $     19,250.00 C1898
1970800 SPINE ROD 7                           $     26,950.00
1970801 SPINE PEEK 4                          $     13,706.00
1970802 SPINE PEEK 3                          $      3,461.15
1970803 ROD, ORTHO/SPINE 8                    $      5,005.00 C1713




                                        Page 204
                                         Ancillary


1970804 SPACER 1                               $      2,683.45
1970805 SPINE SPACER 5                         $     18,711.00
1970806 SPINE SPACER 6                         $     20,193.25
1970807 SPONGE OPHTHALMO                       $       577.50
1970808 STEM 12                                $      2,683.45
1970809 STEM 13                                $     14,245.00
1970811 TIBIA TRAY 6                           $     11,642.40
1970812 JOINT DEVICE 24                        $     17,325.00 C1776
1970813 JOINT DEVICE 25                        $     20,790.00 C1776
1970814 JOINT DEVICE 26                        $     23,781.45 C1776
1970815 JOINT DEVICE 27                        $     29,837.50 C1776
1970816 JOINT DEVICE 28                        $     31,050.25 C1776
1970817 STENT COATED/COV W/DEL SYS 5           $     28,811.16 C1874
1970818 HUMAN TISSUE 26                        $     33,245.10 C1762
1970819 LEAD, PACEMAKER 3                      $      2,268.00 C1898
1970820 X STOP                                 $     16,632.00
1970821 ORTHO NAIL 8                           $      7,560.00 C1713
1970822 CATHETER, BROVIAC 1                    $       530.45 C1751
1970823 LEAD, CARDIO DEFIB ENDO COIL 3         $     18,900.00 C1895
1970824 PACEMAKER, DUAL CHAMBER 1              $     26,082.00 C1785
1970825 JOINT DEVICE 29                        $     27,008.00 C1776
1970826 STENT, NON/COATED W/DEL SYS 2          $      6,263.00 C1876
1970827 GENERATOR NEUROSTIMULATOR RECH         $     67,095.00 C1820
1970828 PORT, INDWELLING 2                     $      3,548.00 C1788
1970829 IMPLANT, AUDITORY                      $      1,104.00
1970830 IMPLANT, OCULAR                        $      2,457.00 L8610
1970831 ORTHO BONE GRAFT SUBSTITUTE 5          $      7,258.00
1970832 ORTHO BONE GRAFT SUBSTITUTE 6          $     10,433.00
1970833 CATHETER, DIAGNOSTIC/ABLATION          $     12,134.00 C1732
1970834 SPINE ROD 8                            $     20,979.00
1970835 CARDIO DEFIB OTHER SING/DUAL 4         $ 105,874.00 C1882
1970836 TUBE, PRESSURE EQUALIZING 1            $       108.00
1970837 GENERATOR NEUROSTIMULATOR 6            $     34,530.00 C1767
1971502 IMPLANT                                $           -
1976209 NO COST IMPLANT                        $          1.10
2010023 PORTACATH                              $        82.49
2313599 GELFOAM 100                            $        54.31
2314900 GELFOAM 18 PROSTCONE                   $       222.93
2413599 GELFOAM 100                            $        54.31
2414900 GELFOAM 18 PROSTCONE                   $       222.93
2613599 GELFOAM 100                            $        54.31
2614900 GELFOAM 18 PROSTCONE                   $       222.93
2713599 GELFOAM 100                            $        54.31
2714900 GELFOAM 18 PROSTCONE                   $       222.93
2813599 GELFOAM 100                            $        54.31
2814900 GELFOAM 18 PROSTCONE                   $       222.93
3000103 PT NEUROMUSC RE-ED INT 30 MIN*         $       308.21 92611GN
3000201 PHYS THER EVAL INIT 30 MIN *           $       335.41
3000202 PHYS THER EVAL ADDL 15 MIN *           $       111.81




                                         Page 205
                                               Ancillary


3000221 PT THER EX INIT 30 MIN *                     $     328.49
3000222 PT THER EX ADD 15 MIN*                       $     164.24
3000250 PT E-STIM UNATTEND INIT 30 M*                $     171.48
3000261 PT ULTRASOUND *                              $     162.59
3000262 PT MASSAGE INIT 30 MIN*                      $     147.86
3000401 PHYSICAL THERAPY EVALUATION                  $     501.33 97001GP
3000402 PHYSICAL THERAPY REEVALUATION                $     375.53 97002GP
3000403 PEDS PHYSICAL THERAPY EVAL                   $     501.33 97001GP
3000404 PEDS PHYSICAL THERAPY REEVAL                 $     375.53 97002GP
3000415 PT THER EXERCISE 15 MIN                      $     265.22 97110GP
3000417 PED PT THEREXERCISE 15 MIN                   $     265.22 97110GP
3000419 PT NEUROMUSC REED 15 MIN                     $     203.91 97112GP
3000420 PT GAIT TRAINING 15 MIN                      $     186.88 97116GP
3000421 PEDS PT GAIT TRAINING - 15 MIN               $     186.88 97116GP
3000422 PT TRANS TRAIN/ BED MOB 15 MIN               $     208.44 97530GP
3000424 PED PT TRANSTRAIN/BED MOB15MIN               $     221.01 97530GP
3000426 PT PROSTHETIC TRAIN 15 MIN                   $     192.84 97761GP
3000430 PEDS PT ORTHOT TRAIN INIT15MIN               $     202.51 97760GP
3000440 PT EXERCISE GROUP                            $     388.13 97150GP
3000441 PT LARGE EXERCISE GROUP                      $     224.24 97150GP
3000444 PT MANUAL THER TECH 15 MIN                   $     186.88 97140GP
3000446 HOT OR COLD PACKS                            $     137.64 97010GP
3000448 ELEC STIM, UNATTENDED                        $     138.13 97014GP
3000451 WHIRLPOOL                                    $     373.75 97022GP
3000452 E-STIM ATTENDED 15 MIN                       $     186.88 97032GP
3000453 E-STIM ATTENDED ADD 15 MIN                   $     186.88 97032GP
3000458 ULTRASOUND 15 MIN                            $     180.09 97035GP
3000462 WOUND CARE                                   $     121.55 97602GP
3000463 WOUND CARE C DEBRIDEMENT LMTD                $     309.36 97597
3000464 MASSAGE 15 MIN                               $     173.25 97124GP
3000475 PT EVALUATION                                $     447.61
3000476 PT EXERCISE INITIAL 30 MIN                   $     250.27
3000477 PT EXERCISE ADD'L 15 MIN                     $     148.06
3000478 PT MODALITY &EXERC INIT30MIN                 $     322.47
3000479 PT MODALITY & EXERC ADD15MIN                 $     148.06
3000484 PT W/C MAN/PROPLSN TRN 15 MIN                $     162.69 97542GP
3000489 NEG PRESSURE WOUND THER <50CM                $     192.18 97605
3000490 NEG PRESSURE WOUND THER >50CM                $     384.36 97606
3000491 PT GROUP INT 30 MIN - WC*                    $     240.44
3000492 PT GROUP ADD 15 MIN - WC*                    $     120.22
3010201 PHYS THER EVAL LIMITED *                     $     287.50
3010221 PT THER EX OR GT INIT 30 MIN *               $     296.68
3010222 PT THER EX OR GT ADDL 15 MIN *               $     148.34
3010229 PT SMALL GROUP EX 30 MIN           *         $     184.95
3010249 TRACTION, MECHANICAL           *             $     116.88
3010250 ELEC STIM UNATTENDED           *             $     116.88
3010261 ULTRASOUND 15 MIN                            $     116.88
3010264 ELEC STIM MANUAL           *                 $     116.88
3010315 PT THER EXERCISE 15 MIN                      $     148.34 97110GP




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3010319 PT NEUROMUSC REED 15 MIN               $     156.85 97112GP
3010320 PT GAIT TRAINING 15 MIN                $     143.75 97116GP
3010322 PT TRANS TRAIN /BED MOB 15 MIN         $     156.99 97530GP
3010326 PT PROSTHETIC TRAIN 15 MIN             $     148.34 97761GP
3010328 PT ORTHOTIC ASSESS/TRAIN - 15'         $     155.77 97760GP
3010338 COMMUNITY TRAIN 15 MIN                 $     144.43 97537GP
3010340 PT EXERCISE GROUP                      $     184.95 97150GP
3010344 PT MANUAL THERAPY EACH 15 MIN          $     143.75 97140GP
3010347 TRACTION, MECHANICAL                   $     116.88 97012GP
3010348 ELEC STIM, UNATTENDED                  $     116.88 G0283GP
3010352 ELEC STIM, ATTENDED 15 MIN             $     143.75 97032GP
3010354 IONTOPHORESIS 15 MIN                   $     143.75 97033GP
3010358 ULTRASOUND 15 MIN                      $     138.53 97035GP
3010375 PT EVALUATION                          $     575.00
3010376 PT EXERCISE INITIAL 30 MIN             $     287.50
3010377 PT EXERCISE ADD'L 15 MIN               $     148.34
3010378 PT MODALITY & EXERC INIT 30MIN         $     287.50
3010379 PT MODALITY & EXERC ADD 15 MIN         $     148.34
3010401 PT EVALUATION - (4) EXT                $     575.00 97001GP
3010501 PT W/C MAN/PROPLSN TRN 15 MIN          $     125.15 97542GP
3010508 PHYS THER TAPE/STRAP THORAX            $     132.00 29200GP
3010509 PHYS THER TAPE/STRAP LOW BACK          $     132.00 29220GP
3010510 PHYS THER TAPE/STRAP SHOULDER          $     132.00 29240GP
3010511 PHYS THER TAPE/STRAP ELB/WRST          $     132.00 29260GP
3010512 PHYS THER TAPE/STRAP HIP               $     132.00 29520GP
3010513 PHYS THER TAPE/STRAP KNEE              $     132.00 29530GP
3010514 PHYS THER TAPE/STRAP ANKLE             $     132.00 29540GP
3010515 PHYS THER TAPE/STRAP TOES              $      82.50 29550GP
3010523 PT ORTHOTIC RE-CHECK/MOD - 15'         $     124.62 97762GP
3010524 PT REHAB BIOFEEDBACK EVAL              $     144.21 90901
3010525 PT REHAB BIOFEEDBACK TREATMENT         $     144.21 90901
3010526 PT EVALUATION - (3) MOD                $     431.25 97001GP
3010527 PT EVALUATION - (2) INT                $     287.50 97001
3010528 PT RE-EVALUATION - (3) MOD             $     431.25 97002
3010529 PT RE-EVALUATION - (2) INT             $     287.50 97002GP
3010530 PHYSICAL PERF TST/MEAS 15 MN           $     143.75 97750
3010531 PT BIOFEDBCK /INCONT TRAIN-EXT         $     680.80 90911
3010532 PT BIOFEDBCK /INCONT TRAIN-MOD         $     510.60 90911
3010533 PT BIOFEDBCK /INCONT TRAIN-INT         $     340.40 90911
3010534 PT BIOFEDBCK /INCONT TRAIN-BRF         $     170.20 90911
3010535 PHYS THER EVAL MOD *                   $     431.25
3010536 PHYS THER EVAL EXTENDED *              $     575.00
3010537 PT GAIT TRAINING INT 30 MIN *          $     287.50
3010538 PT GAIT TRAINING ADD 15 MIN *          $     143.75
3010539 NEUROMUSCULAR RE-ED INT 30 *           $     313.70
3010540 NEUROMUSCULAR RE-ED ADD 15 *           $     156.85
3020100 PT GAIT TRAINING INITIAL 30 MI         $     296.01
3020103 PT NEUROMUSC RE-ED INT 30 MIN          $     308.21
3020104 PT NERUMUSC RE-ED ADD 15 MIN           $     102.93




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3020105 PT TRANS TRAIN INT 30 MIN                   $     296.01
3020106 PT TRANS TRAIN ADD 15 MIN                   $      99.48
3020110 PT TAPING                                   $     193.93
3020201 PHYS THER EVAL INIT 30 MIN *                $     335.41
3020202 PHYS THER EVAL ADDL 15 MIN *                $     111.81
3020214 PT PATIENT FAMILY CONF 30 MIN*              $     267.71
3020221 PT THER EX INIT 30 MIN                      $     328.49
3020222 PT THER EX ADD 15 MIN                       $     110.70
3020223 PT PROCEDURE ASST 15 MIN          *         $     109.90
3020229 PT SMALL GROUP EX 30 MIN      *             $     206.09
3020230 PT LARGE GROUP EX 30 MIN      *             $     147.78
3020236 PT SMALL GROUP EX ADD 15 MIN *              $      70.48
3020237 PT LARGE GROUP EX ADD 15 MIN *              $      51.53
3020241 HOT OR COLD PACK INIT 30 MIN                $     122.89
3020264 ELEC STIM ATTENDED INIT 30 MIN              $     169.11
3020301 PHYSICAL THERAPY EVALUATION                 $     501.33 97001GP
3020309 ORTH/PROS CHECK 15 MIN                      $     240.63 97762GP
3020313 PT PATIENT/FAM CONF BRIEF                   $     224.25 97799GP
3020314 PT PATIENT/FAM CONF INTERM                  $     283.91 97799GP
3020315 PT THER EXERCISE 15 MIN                     $     265.22 97110GP
3020319 PT NEUROMUSC REED - 15 MIN                  $     203.90 97112GP
3020320 PT GAIT TRAINING 15 MIN                     $     186.88 97116GP
3020322 PT TRANS TRAIN / BED MOB 15                 $     221.01 97530GP
3020326 PT PROSTHETIC TRAIN 15 MIN                  $     192.83 97761GP
3020328 PT ORTHOTIC TRAIN 15 MIN                    $     202.51 97760GP
3020338 PT COMMUNITY TRAIN 15 MIN                   $     187.75 97537GP
3020340 PT EXERCISE GROUP                           $     388.13 97150GP
3020344 PT MANUAL THER TECH 15                      $     186.88 97140GP
3020346 HOT OR COLD PACKS                           $     137.64 97010GP
3020348 ELEC STIM UNATTENDED                        $     138.13 97014GP
3020352 ELEC STIM, ATTENDED 15 MIN                  $     186.88 97032GP
3020354 IONTOPHORESIS 15 MIN                        $     201.25 97033GP
3020358 PT ULTRASOUND 15 MIN                        $     180.09 97035GP
3020364 MASSAGE - 15 MIN                            $     173.25 97124GP
3020375 PT EVALUATION                               $     447.61
3020376 PT EXERCISE INITIAL 30 MIN                  $     250.27
3020377 PT EXERCISE ADD'L 15 MIN                    $      83.42
3020382 PT W/C MAN/PROPLSN TRN 15 MIN               $     162.69 97542GP
3090001 ADMIN INFLU VIRUS VACCINE                   $      70.69 G0008
3090002 ADMIN PNEUMOCOCCAL VACCINE                  $      70.69 G0009
3090003 ADMIN HEPATITIS B VACCINE                   $      70.69 90471
3090004 ANTIBIOTIC INJECTION                        $     100.00 90772
3090005 IM/SC INJECTION                             $     100.00 90772
3090006 TESTOSTERONE ADMINISTRATION                 $      70.69 G0008
3090007 INFECT/DIS NEW PT. VISIT LEV 1              $     129.05 99201
3090008 INFECT/DIS NEW PT. VISIT LEV 2              $     140.68 99202
3090009 INFECT/DIS NEW PT. VISIT LEV 3              $     185.80 99203
3090010 INFECT/DIS EST PT. VISIT LEV 1              $     129.05 99211
3090011 INFECT/DIS EST PT. VISIT LEV 2              $     140.68 99212




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                                              Ancillary


3090012 INFECT/DIS EST PT. VISIT LEV 3              $     160.78 99213
3090016 INFECT/DIS NEW PT. VISIT LEV 4              $     232.80 99204
3090017 INFECT/DIS NEW PT. VISIT LEV 5              $     296.74 99205
3090018 INFECT/DIS EST PT. VISIT LEV 4              $     204.38 99214
3090019 INFECT/DIS EST PT. VISIT LEV 5              $     291.00 99215
3100330 OT EVALUATION INITIAL 30 MIN *              $     375.66
3100331 OT EVALUATION ADDL 15 MIN         *         $     125.22
3100334 OT FAM CONF INITIAL 30 MIN *                $     221.08
3100351 OT THER EX ADDTL 15 MIN       *             $      99.65
3100352 ADL RX INITIAL 30MIN                        $     328.49
3100353 ADL RX ADDL 15 MIN        *                 $     110.70
3100355 OT LARGE GROUP INITIAL 30MIN *              $     240.44 97150GO
3100356 OT LARGE GROUP ADDL 15 MIN *                $     240.44 97150GO
3100357 OT SMALL GROUP INITIAL 30MIN *              $     240.44 97150GO
3100358 OT SMALL GROUP ADDL 15 MIN *                $     240.44 97150GO
3100400 OCCUPATIONAL THERAPY EVAL                   $     499.51 97003GO
3100401 OCCUPATIONAL THERAPY REEVAL                 $     373.75 97004GO
3100404 PEDS OCCUPATIONAL THERAPY EVAL              $     499.51 97003GO
3100405 PEDS OCCUPATIONAL THER REEVAL               $     373.75 97004GO
3100410 OT SWALLOWING EVALUATION                    $     712.00 92610GN
3100411 OT SWALLOWING REEVALUATION                  $     712.00 92610GN
3100412 OT VIDEO SWALLOW EVALUATION                 $     965.71 92611GN
3100413 OT VIDEO SWALLOW REEVALUATION               $     965.71 92611GN
3100418 OT THER EXERCISE 15 MIN                     $     265.22 97110GO
3100420 OT PED EXERCISE 15 MIN                      $     265.22 97110GO
3100422 OT ADL THERAPY 15 MIN                       $     221.01 97535GO
3100424 OT PED ADL THERAPY 15 MIN                   $     221.01 97535GO
3100426 OT SWALLOW THERAPY BRIEF                    $     265.94 92526GO
3100427 OT SWALLOW THERAPY INTM                     $     398.89 92526GO
3100428 OT SWALLOW THERAPY MOD                      $     531.86 92526GO
3100429 OT SWALLOW THERAPY EXTEND                   $     664.83 92526GO
3100430 OT SPLINTING 15 MIN                         $     202.51 97760GO
3100436 OT THER ACTIVITIES 15 MIN                   $     221.01 97530GO
3100440 OT COGNITIVE RETRAIN 15 MIN                 $     221.01 97532GO
3100442 OT EXERCISE GROUP                           $     388.13 97150GO
3100451 IONTOPHORESIS 15 MIN                        $     179.69 97033GO
3100461 OT EVAL INIT 30 MIN                         $     300.08
3100462 OT EVAL ADD 15 MIN                          $     100.63
3100464 OT TREATMENT INIT 30 MIN                    $     247.07
3100465 OT TREATMENT ADD 15 MIN                     $      83.42
3100469 OT NEUROMUSC RE ED EX 15 MIN                $     212.18 97112GO
3100470 OT VIDEO SWALLOW EVAL INT 30*               $     419.88
3100471 OT VIDEO SWALLOW EVAL ADD 15*               $     209.94
3110204 OT OINTOPHORESIS                            $      76.26
3110330 OT EVALUATION INITIAL 30 MIN *              $     287.50 97003GO
3110331 OT EVALUATION ADDL 15 MIN *                 $     143.75 97003GO
3110332 OT ADL EVALUATION INITIAL 30 *              $     287.50 97003GO
3110333 OT ADL EVALUATION ADDL 15 *                 $     143.75 97003GO
3110335 OT JOB PLACEMENT ASSESMENT                  $     488.75 97799GO




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3110349 OT JOB SITE EVALUATION                 $     893.96 97799GO
3110350 OT THER EX INITIAL 30 MIN *            $     287.50 97110GO
3110351 OT THER EX ADDTL 15 MIN *              $     143.75 97110GO
3110352 OT ADL THERAPY INIT 30 MIN             $     287.50 97535GO
3110353 ADL RX ADDL 15 MIN *                   $     143.75 97535GO
3110357 OT SMALL GROUP INITIAL 30MIN *         $     184.95 97150GO
3110358 OT SMALL GROUP ADDL 15 MIN *           $     184.95 97150GO
3110401 OCCUPATIONAL THERAPY REEVAL            $     287.50 97004GO
3110402 OT UPPER EXTREMITY EVALUATION          $     575.00 97003GO
3110410 OT SWALLOWING EVALUATION               $     547.69 92610GO
3110412 OT VIDEO SWALLOW EVALUATION            $     742.85 92611GO
3110416 OT UPPER EXTREM EX 15 MIN              $     148.34 97110GO
3110422 OT ADL THERAPY 15 MIN                  $     159.33 97535GO
3110426 OT SWALLOW THERAPY BRIEF               $     340.41 92526GO
3110436 THER ACTIVITIES 15 MIN                 $     156.99 97530GO
3110438 OT COMMUNITY TRAIN 15 MIN              $     144.43 97537GO
3110440 OT COGNITIVE RETRAIN 15 MIN            $     143.75 97532GO
3110442 OT SMALL EXERCISE GROUP                $     184.95 97150GO
3110447 COMPRESSION TREATMENT                  $     102.85 97016GO
3110448 PARAFFIN                               $     122.89 97018GO
3110449 ELEC STIM, ATTENDED 15 MIN             $     143.75 97032GO
3110451 IONTOPHORESIS 15 MIN                   $     109.63 97033GO
3110453 HOT/COLD CONTRAST 15 MIN               $      62.66 97034GO
3110461 OT EVALUATION INITIAL 30 MIN           $     215.40
3110462 OT EVALUATION - EA ADDL 15MIN          $     107.67 97004GO
3110464 OT TREATMENT INIT 30 MIN               $     296.68
3110465 OT TREATMENT ADD 15 MIN                $     148.34
3110471 OT JOB SITE EVAL 15 MIN                $     143.75 97750GO
3110475 OT DRIVING EVAL 15 MIN                 $     143.75 97750GO
3110501 OT EVALUATION - (4) EXT                $     575.00 97003GO
3110509 OCC THER FLUIDOTHERAPY                 $     287.50 97022GO
3110512 ULTRASOUND 15 MIN                      $     138.53 97035GO
3110515 OT NEUROMUSC REED 15 MIN               $     156.85 97112GO
3110517 OT MANUAL TECHNIQUES 15 MIN            $     143.75 97140GO
3110521 OT ELEC STIM UNATTND                   $     116.88 G0283
3110532 OT CICA-CARE-LIMITED                   $      60.50
3110533 OT CICA-CARE MEDIUM                    $     217.80
3110534 OT CICA-CARE EXTENDED                  $     435.60
3110536 OT STRAPPING MATERIAL                  $       6.05
3110537 OT SPLINT MATERIAL-FINGER/HAND         $     296.21
3110538 OT SPLINT MTRL FOREARM BASE            $     394.94
3110539 OT SPLINT MTRL FULL ARM BASE           $     592.42
3110540 OT ORTHOTIC FIT/TRAIN                  $     155.77 97760GO
3110541 OT ORTHO REISU/SPLNT MOD 15 MN         $     155.77 97762GO
3110542 OT WC - UE SPLINT INT 30 MIN           $     249.24
3110543 OT WC - UE SPLINT EACH 15 MIN          $     124.62
3110544 OT EVALUATION - (3) MOD                $     373.75 97003
3110545 OT EVALUATION - (2) INT                $     287.50 97003
3110546 OT RE-EVALUATION - (3) MOD             $     373.75 97004




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                                                   Ancillary


3110547 OT RE-EVALUATION - (2) INT                       $     287.50 97004
3120102 OT NERUOMUSC RE-ED INT 30 MIN                    $     308.21
3120103 OT NERUOMUSC RE-ED ADD 15                        $     102.93
3120107 OT ORTHO FAB INIT 30 MIN                         $     306.54
3120330 OT EVALUATION INITIAL 30 MIN *                   $     375.66
3120331 OT EVALUATION ADDL 15 MIN              *         $     125.22
3120334 OT FAM CONF INITIAL 30 MIN *                     $     221.23
3120336 OT SWALLOWING EVAL                               $     704.44
3120350 OT THER EX INITIAL 30 MIN      *                 $     328.49
3120351 OT THER EX ADDTL 15 MIN            *             $     111.61
3120352 ADL RX INITIAL 30MIN                             $     328.49
3120353 ADL RX ADDL 15 MIN         *                     $     110.70
3120355 OT LARGE GROUP INITIAL 30MIN *                   $     143.61
3120356 OT LARGE GRUP ADDL 15MIN               *         $      50.50
3120357 OT SMALL GROUP INITIAL 30MIN *                   $     200.41
3120358 OT SMALL GROUP ADDL 15 MIN *                     $      81.43
3120361 OT SWALLOW THERAPY INIT 30 -WC                   $     369.28
3120362 OT SWALLOW THERAPY ADD 15 - WC                   $     104.55
3120363 OT SPLINTING INIT 30 MIN                         $     329.02
3120364 OT SPLINTING ADD 15 MIN                          $      99.65
3120400 OCCUPATIONAL THERAPY EVAL                        $     499.51 97003GO
3120410 OT SWALLOWING EVALUATION                         $     446.00 92610GO
3120412 OT VIDEO SWALLOW EVAL                            $     839.75 G0196GN
3120414 OT PATIENT/FAM CONF BRIEF                        $     186.88 97799GO
3120415 OT PATIENT/FAM CONF INTERM                       $     283.91 97799GO
3120418 OT THER EX 15 MIN                                $     265.22 97110GO
3120422 OT ADL THERAPY 15 MIN                            $     221.01 97535GO
3120426 OT SWALLOW THERAPY BRIEF                         $     265.94 92526GO
3120427 OT SWALLOW THERAPY INTERM                        $     478.68 92526GO
3120428 OT SWALLOW THERAPY MOD                           $     531.86 92526GO
3120429 OT SWALLOW THERAPY EXTEND                        $     664.83 92526GO
3120430 OT SPLINTING INITIAL 15 MIN                      $     202.51 97760GO
3120436 OT THER ACTIVITIES 15 MIN                        $     221.01 97530GO
3120438 OT COMMUNITY TRAIN 15 MIN                        $     187.75 97537GO
3120440 OT COGNITIVE RETRAIN 15 MIN                      $     221.01 97532
3120442 OT EXERCISE GROUP                                $     388.13 97150GO
3120461 0T REEVALUATION INIT 30 MIN                      $     300.08
3120462 OT EVALUATION ADD'L 15 MIN                       $     100.63
3120464 OT TREATMENT INITIAL 30 MIN                      $     247.07
3120465 OT TREATMENT ADD'L 15 MIN                        $      83.42
3170100 PEDS PULM -NEW PATIENT LEVEL 1                   $     129.05 99201
3170101 PEDS PULM -NEW PATIENT LEVEL 2                   $     140.68 99202
3170102 PEDS PULM -NEW PATIENT LEVEL 3                   $     185.80 99203
3170103 PEDS PULM -NEW PATIENT LEVEL 4                   $     232.80 99204
3170104 PEDS PULM -NEW PATIENT LEVEL 5                   $     296.74 99205
3170105 PEDS PULM -EST.PATIENT LEVEL 1                   $     129.05 99211
3170106 PEDS PULM -EST.PATIENT LEVEL 2                   $     140.68 99212
3170107 PEDS PULM -EST.PATIENT LEVEL 3                   $     160.78 99213
3170108 PEDS PULM -EST.PATIENT LEVEL 4                   $     204.38 99214




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                                         Ancillary


3170109 PEDS PULM -EST.PATIENT LEVEL 5         $      291.00 99215
3170117 PEDS PULM -SPIROMETRY                  $      748.87 94010
3170118 PEDS PULM - BRONCHOSPASM EVAL          $      843.05 94060
3170119 PEDS PULM -INHALATION TREAT.           $      187.94 94640
3170120 PEDS PULM -INHAL. TREAT, MLTP          $      187.94 9464076
3170121 CO, EXPIRED GAS BY IR                  $      372.31 94770
3170122 PEDS PULM -PERCUTAN.SKIN TESTS         $      206.44 95004
3170200 PEDS NEUROL -NEW PAT. LEVEL 1          $      129.05 99201
3170201 PEDS NEUROL -NEW PAT. LEVEL 2          $      140.68 99202
3170202 PEDS NEUROL -NEW PAT. LEVEL 3          $      185.80 99203
3170203 PEDS NEUROL -NEW PAT. LEVEL 4          $      232.80 99204
3170204 PEDS NEUROL -NEW PAT. LEVEL 5          $      296.74 99205
3170205 PEDS NEUROL -EST.PAT. LEVEL 1          $      129.05 99211
3170206 PEDS NEUROL -EST.PAT. LEVEL 2          $      140.68 99212
3170207 PEDS NEUROL -EST. PAT. LEVEL 3         $      160.78 99213
3170208 PEDS NEUROL -EST.PAT. LEVEL 4          $      204.38 99214
3170209 PEDS NEUROL -EST.PAT. LEVEL 5          $      291.00 99215
3170300 PEDS INF DIS -NEW PAT. LEVEL 1         $      129.05 99201
3170301 PEDS INF DIS -NEW PAT. LEVEL 2         $      140.68 99202
3170302 PEDS INF DIS -NEW PAT. LEVEL 3         $      185.80 99203
3170303 PEDS INF DIS -NEW PAT. LEVEL 4         $      232.80 99204
3170304 PEDS INF DIS -NEW PAT. LEVEL 5         $      296.74 99205
3170305 PEDS INF DIS -EST.PAT. LEVEL 1         $      129.05 99211
3170306 PEDS INF DIS -EST.PAT. LEVEL 2         $      140.68 99212
3170307 PEDS INF DIS -EST.PAT. LEVEL 3         $      160.78 99213
3170308 PEDS INF DIS -EST.PAT. LEVEL 4         $      204.38 99214
3170309 PEDS INF DIS -EST.PAT. LEVEL 5         $      291.00 99215
3170322 PEDS INF DIS - RUBELLA                 $       48.40 90706
3170400 PEDS DEV/BEH -NEW PAT. LEVEL 1         $      129.05 99201
3170401 PEDS DEV/BEH -NEW PAT. LEVEL 2         $      140.68 99202
3170402 PEDS DEV/BEH -NEW PAT. LEVEL 3         $      185.80 99203
3170403 PEDS DEV/BEH -NEW PAT. LEVEL 4         $      232.80 99204
3170404 PEDS DEV/BEH -NEW PAT. LEVEL 5         $      296.74 99205
3170405 PEDS DEV/BEH -EST.PAT. LEVEL 1         $      129.05 99211
3170406 PEDS DEV/BEH -EST.PAT. LEVEL 2         $      140.68 99212
3170407 PEDS DEV/BEH -EST.PAT. LEVEL 3         $      160.78 99213
3170408 PEDS DEV/BEH -EST.PAT. LEVEL 4         $      204.38 99214
3170409 PEDS DEV/BEH -EST.PAT. LEVEL 5         $      291.00 99215
3170500 PEDS GI - NEW PATIENT LEVEL 1          $      129.05 99201
3170501 PEDS GI - NEW PATIENT LEVEL 2          $      140.68 99202
3170502 PEDS GI - NEW PATIENT LEVEL 3          $      185.80 99203
3170503 PEDS GI - NEW PATIENT LEVEL 4          $      232.80 99204
3170504 PEDS GI - NEW PATIENT LEVEL 5          $      296.74 99205
3170505 PEDS GI - EST. PATIENT LEVEL 1         $      129.05 99211
3170506 PEDS GI - EST. PATIENT LEVEL 2         $      140.68 99212
3170507 PEDS GI - EST. PATIENT LEVEL 3         $      160.78 99213
3170508 PEDS GI - EST. PATIENT LEVEL 4         $      204.38 99214
3170509 PEDS GI - EST. PATIENT LEVEL 5         $      291.00 99215
3170514 PEDS GI-ESOPHA REFX TEST/24HR          $     1,940.13 91034




                                         Page 212
                                         Ancillary


3170600 PEDS ENT - NEW PATIENT LEVEL 1         $      129.05 99201
3170601 PEDS ENT - NEW PATIENT LEVEL 2         $      140.68 99202
3170602 PEDS ENT - NEW PATIENT LEVEL 3         $      185.80 99203
3170603 PEDS ENT - NEW PATIENT LEVEL 4         $      232.80 99204
3170604 PEDS ENT - NEW PATIENT LEVEL 5         $      296.74 99205
3170605 PEDS ENT - EST.PATIENT LEVEL 1         $      129.05 99211
3170606 PEDS ENT - EST.PATIENT LEVEL 2         $      140.68 99212
3170607 PEDS ENT - EST.PATIENT LEVEL 3         $      160.78 99213
3170608 PEDS ENT - EST.PATIENT LEVEL 4         $      204.38 99214
3170609 PEDS ENT - EST.PATIENT LEVEL 5         $      291.00 99215
3170615 PEDS ENT-LARYNGO,W/WO TRACH,DX         $     4,727.59 31525
3170616 PEDS ENT-LARYNGO, FLEXE FIB,DX         $      423.66 31575
3170617 PEDS ENT - FRENULECTOMY                $     1,170.00 40819
3170618 PEDS ENT-CTR NAS BLD,ANAT,CPLX         $      400.79 30903
3170619 PEDS ENT-CTR NAS BLD,POST,INIT         $      400.82 30905
3170620 PEDS ENT-REMOVAL-EAR WAX-1OR2          $      140.15 69210
3170621 PEDS ENT-REMOVE-FB-EXTAUDITCAN         $      190.73 69200
3170622 PEDS ENT- MYRINGOTOMY W/ ASP           $     1,170.00 69420
3170700 PEDS NEPH -NEW PATIENT LEVEL 1         $      129.05 99201
3170701 PEDS NEPH -NEW PATIENT LEVEL 2         $      140.68 99202
3170702 PEDS NEPH -NEW PATIENT LEVEL 3         $      185.80 99203
3170703 PEDS NEPH -NEW PATIENT LEVEL 4         $      232.80 99204
3170704 PEDS NEPH -NEW PATIENT LEVEL 5         $      296.74 99205
3170705 PEDS NEPH -EST.PATIENT LEVEL 1         $      129.05 99211
3170706 PEDS NEPH -EST.PATIENT LEVEL 2         $      140.68 99212
3170707 PEDS NEPH -EST.PATIENT LEVEL 3         $      160.78 99213
3170708 PEDS NEPH -EST.PATIENT LEVEL 4         $      204.38 99214
3170709 PEDS NEPH -EST.PATIENT LEVEL 5         $      291.00 99215
3170715 PEDS NEPH - INJECT, IM OR SUBQ         $      100.00 90772
3170800 PEDS IBD - NEW PATIENT LEVEL 1         $      129.05 99201
3170801 PEDS IBD - NEW PATIENT LEVEL 2         $      140.68 99202
3170802 PEDS IBD - NEW PATIENT LEVEL 3         $      185.80 99203
3170803 PEDS IBD - NEW PATIENT LEVEL 4         $      232.80 99204
3170804 PEDS IBD - NEW PATIENT LEVEL 5         $      296.74 99205
3170805 PEDS IBD - EST.PATIENT LEVEL 1         $      129.05 99211
3170806 PEDS IBD - EST.PATIENT LEVEL 2         $      140.68 99212
3170807 PEDS IBD - EST.PATIENT LEVEL 3         $      160.78 99213
3170808 PEDS IBD - EST.PATIENT LEVEL 4         $      204.38 99214
3170809 PEDS IBD - EST.PATIENT LEVEL 5         $      291.00 99215
3170900 INFANT PROG - NEW PAT LEVEL 1          $      129.05 99201
3170901 INFANT PROG - NEW PAT LEVEL 2          $      140.68 99202
3170902 INFANT PROG - NEW PAT LEVEL 3          $      185.80 99203
3170903 INFANT PROG - NEW PAT LEVEL 4          $      232.80 99204
3170904 INFANT PROG - NEW PAT LEVEL 5          $      296.74 99205
3170905 INFANT PROG - EST. PAT LEVEL 1         $      129.05 99211
3170906 INFANT PROG - EST. PAT LEVEL 2         $      140.68 99212
3170907 INFANT PROG - EST.PAT LEVEL 3          $      160.78 99213
3170908 INFANT PROG - EST.PAT LEVEL 4          $      204.38 99214
3170909 INFANT PROG - EST.PAT LEVEL 5          $      291.00 99215




                                         Page 213
                                         Ancillary


3170911 INFANT PROG - DEV TEST/HR OT           $      362.15 96111GO
3170912 INFANT PROG - DEV TEST/HR PT           $      362.15 96111GP
3170913 INFANT PROG - INJECT. SQ OR IM         $       61.00 90772
3171000 ARTERIAL CATH PERC.                    $      523.13 36620
3171001 ARTERIAL CATH CUTDOWN                  $     2,664.86 36625
3171002 BLOOD COLLECT FROM PORT DEVICE         $      186.81 36540
3171003 CENTRAL LN INSERT PERC <5 YRS          $     2,193.25 36555
3171004 CENTRAL LN INSERT PERC >5 YRS          $     2,501.88 36556
3171005 IV INFUSION THERAPY 1ST HR             $      615.80 90765
3171006 IV INFUSION THERAPY EA ADDL HR         $      134.30 90766
3171007 IV INFUSION HYDRATION 1ST HOUR         $      615.80 90760
3171008 IV INFUSION HYDRATION ADDL HR          $      134.30 90761
3171011 IV PUSH INITIAL                        $      270.35 90774
3171012 IV PUSH EA ADDL SEQUENTIAL             $      270.35 90775
3171013 OP TRANSFUSION, BLOOD SIMPLE           $     1,014.59 36430
3171014 OP TRANSFUSION, BLOOD INTERM           $     1,245.59 36430
3171015 OP TRANSFUSION, BLOOD COMPLEX          $     1,476.59 36430
3171018 P A S PORT INSERTION <5 YEARS          $     3,544.54 36570
3171019 P A S PORT INSERTION >5 YEARS          $     4,165.44 36571
3171021 PICC DECLOT/WIRE                       $     5,918.49 36870
3171024 PICC INSERT PROMRM <5YEARS             $     2,984.65 36568
3171025 PICC INSERT PROMRM > 5 YEARS           $     3,257.63 36569
3171026 VENIPUNCTURE, CUTDOWN<AGE 1            $      420.19 36420
3171027 VENIPUNCTURE, CUTDOWN>AGE 1            $      260.24 36425
3171030 REMOVAL CHEST OR P A S PORT            $     2,073.13 36590
3171031 REMOVAL TUNL CNTL VENOUS CATH          $     2,602.40 36589
3171032 REPAIR CHEST PORT OR PAS PORT          $     1,879.93 36576
3171033 REPAIR TUNNELED OR PICC                $     2,506.35 36575
3171034 REPL CHEST PORT VIA CATH EXCHA         $     6,200.14 36582
3171035 REPL CNTRL LINE VIA CATH EXCHA         $     2,400.08 36580
3171036 REPL PAS PORT VIA CATH EXCHANG         $     3,164.77 36585
3171037 REPLACE PICC VIA CATH EXCHANGE         $     2,506.35 36584
3171038 REPL TUNL CNTRL LINE CATH EXCH         $     3,488.08 36581
3171039 THERAPEUTIC INJ SC/IM                  $      100.00 90772
3171040 TUNNELED CATH INSERT<5 YEARS           $     4,852.43 36557
3171041 TUNNELED CATH INSERT >5 YEARS          $     3,905.48 36558
3171043 INTRODUCER                             $       78.07 C1894
3171044 CATHETER                               $      179.17 C1751
3171045 INFUSION CTR- NEW PT. LEVEL 1          $      129.05 99201
3171046 INFUSION CTR- NEW PT. LEVEL 2          $      140.68 99202
3171047 INFUSION CTR- NEW PT. LEVEL 3          $      185.80 99203
3171048 INFUSION CTR- NEW PT. LEVEL 4          $      232.80 99204
3171049 INFUSION CTR- NEW PT. LEVEL 5          $      296.74 99205
3171050 INFUSION CTR- EST. PT. LEVEL 1         $      129.05 99211
3171051 INFUSION CTR- EST. PT. LEVEL 2         $      140.68 99212
3171052 INFUSION CTR- EST. PT. LEVEL 3         $      160.78 99213
3171053 INFUSION CTR- EST. PT. LEVEL 4         $      204.38 99214
3171054 INFUSION CTR- EST. PT. LEVEL 5         $      291.00 99215
3171129 REP. OF CVT ACCESS CATH                $     2,506.35 36575




                                         Page 214
                                         Ancillary


3171131 GASTROSTOMY TUBE CHANGE                $      651.13 43760
3171133 CIRCUM., CLAMP /DEVICE; OTHER          $     5,355.50 54150
3171134 CIRCUM.,SURG.EXCISION; NEWBORN         $      456.54 54160
3171136 POST OP VISIT                          $      215.12 99024
3171137 PEDIATRIC NEW PAT VISIT, LEV 1         $      129.05 99201
3171138 PEDIATRIC NEW PAT VISIT, LEV 2         $      140.68 99202
3171139 PEDIATRIC NEW PAT VISIT, LEV 3         $      185.80 99203
3171140 PEDIATRIC NEW PAT VISIT, LEV 4         $      232.80 99204
3171141 PEDIATRIC NEW PAT VISIT, LEV 5         $      296.74 99205
3171142 PEDS. EST. PAT VISIT, LEVEL 1          $      129.05 99211
3171143 PEDS. EST. PAT VISIT, LEVEL 2          $      140.68 99212
3171144 PEDS. EST. PAT VISIT, LEVEL 3          $      160.78 99213
3171145 PEDS. EST. PAT VISIT, LEVEL 4          $      204.38 99214
3171146 PEDS. EST. PAT VISIT, LEVEL 5          $      291.00 99215
3171202 PREV MED COUNSELING 1 HR               $      175.03 99404
3171213 SKIN BIOPSY UPPER INNER ARM            $      502.90 11100
3171300 PEDS HEM/ONC NEW PT LEVEL 1            $      125.40 99201
3171301 PEDS HEM/ONC NEW PT LEVEL 2            $      125.40 99202
3171302 PEDS HEM/ONC NEW PT LEVEL 3            $      136.40 99203
3171303 PEDS HEM/ONC NEW PT LEVEL 4            $      193.60 99204
3171304 PEDS HEM/ONC NEW PT LEVEL 5            $      193.60 99205
3171305 PEDS HEM/ONC EST. PT LEVEL 1           $      125.40 99211
3171306 PEDS HEM/ONC EST. PT LEVEL 2           $      125.40 99212
3171307 PEDS HEM/ONC EST. PT LEVEL 3           $      136.40 99213
3171308 PEDS HEM/ONC EST. PT LEVEL 4           $      193.60 99214
3171309 PEDS HEM/ONC EST. PT LEVEL 5           $      193.60 99215
3200069 SPEECH THERAPY INTERMED                $         -
3200070 SPEECH THERAPY EXTENDED                $         -
3200106 SP DYSPHAGIA EVAL EXTENDED             $         -   92526
3200300 SP EVALUATION                          $      499.51 92506GN
3200301 SP REEVALUATION                        $      371.94 92506GN
3200302 SP PEDS EVALUATION                     $      499.51 92506GN
3200303 SP PEDS REEVALUATION                   $      332.10 92506GN
3200304 SP SWALLOWING EVALUATION               $      712.00 92610GN
3200305 SP SWALLOWING REEVALUATION             $      712.00 92610
3200306 PEDS SP SWALLOW EVAL                   $      712.00 92610
3200307 PEDS SP SWALLOW REEVAL                 $      712.00 92610
3200308 SP VIDEO SWALLOW EVAL                  $      965.71 92611GN
3200309 SP VIDEO SWALLOW REEVAL                $      965.71 92611GN
3200310 PEDS SP VIDEO SWALLOW EVAL             $      965.71 92611GN
3200311 PEDS SP VIDEO SWALLOW REEVAL           $      965.71 92611
3200318 HEARING SCREENING                      $      309.74 92551GN
3200319 SP-LANGUAGE THER-BRIEF                 $      318.26 92507GN
3200320 SP-LANGUAGE THER INTERM                $      476.10 92507GN
3200321 SP-LANGUAGE THER MOD                   $      633.93 92507GN
3200322 SP-LANGUAGE THER EXTEND                $      794.35 92507GN
3200323 PEDS SP-LANG THER-BRIEF                $      265.22 92507GN
3200324 PEDS SP-LANG THER INTERM               $      396.75 92507GN
3200325 PEDS SP-LANG THER MOD                  $      528.26 92507GN




                                         Page 215
                                         Ancillary


3200326 PEDS SP-LANG THER EXTEND               $     661.95 92507GN
3200327 SP SWALLOW THER BRIEF                  $     382.95 92526GN
3200328 SP SWALLOW THER INTERM                 $     478.68 92526GN
3200329 SP SWALLOW THER MOD                    $     638.24 92526GN
3200330 SP SWALLOW THER EXTEND                 $     797.80 92526GN
3200331 PEDS SP SWALLOW THER BRIEF             $     319.13 92526GN
3200332 PEDS SP SWALLOW THER INTERM            $     478.68 92526GN
3200333 PEDS SP SWALLOW THER MOD               $     638.24 92526GN
3200334 PEDS SP SWALLOW THER EXTEND            $     797.80 92526GN
3200360 SP LANG/COGNITIVE EVALUATION           $     442.80
3200361 SP SPEECH/VOICE EVALUATION             $     442.80
3200362 SP LANG INDIV TX INIT 60 MIN           $     425.50
3200363 SP LANG INDIV TX ADD 30 MIN            $     170.20
3200368 SP PATIENT/FAM CONF BRIEF              $     186.88 97799GN
3200369 SP PATIENT/FAM CONF INTERM             $     283.91 97799GN
3200370 SP ORAL MOTOR EX 15 MIN                $     315.11 97110GN
3200372 SP NEUROMUSC TRAIN INIT 15 MIN         $     203.90 97112GN
3200373 SP THERAPEUTIC ACT 15 MIN              $     218.83 97530GN
3200374 SP THERAPEUTIC ACT ADD 15 MIN          $     110.30 97530GN
3200375 SP COGNITIVE THERAPY 15 MIN            $     218.83 97532GN
3200377 SP VOICE PROSTHETIC EVAL               $     441.59 92597
3200378 SP VOICE PROSTHETIC TRAINING           $     195.39 92597GN
3200380 SP COGN COMM EVAL 60 MIN               $     539.91 96116GN
3200387 SP ENDOSCOPIC SWALLOW EVAL             $     712.00 92610
3200388 SP ENDOSCOPIC SWALLOW REEVAL           $     331.99 92512
3200390 SP CONSULT                             $      79.42 92506GN
3200393 SP SWALLOW EVAL                        $     472.72
3200394 SP VIDEO SWALLOW NO TAR/CONSL          $     814.23
3200395 SP ENDOSCOPIC SWAL NOTAR/CNSL          $     813.28
3200396 SP SWALLOW THERAPY INIT 60 MIN         $     747.96
3200397 SP SWALLOW THER ADD 30 MIN             $     373.61
3200401 SP AUGMENTATIVE DEVICE EVAL            $        -     92607
3200404 SP ENDOSCOPIC SWAL W/SENS TEST         $     668.74 92616
3200418 SP AUG DEV TRAINING INTERM             $        -     92609
3200419 SP AUG DEV TRAINING MOD                $        -     92609
3200420 SP AUG DEV TRAINING EXTEND             $        -     92609
3200421 SP AURAL REHAB THER BRIEF              $        -     92507GN
3200422 SP AURAL REHAB THER INTERM             $        -     92507GN
3200423 SP AURAL REHAB THER MOD                $        -     92507GN
3200424 SP AURAL REHAB THER EXTEND             $        -     92507GN
3200425 SP VOICE REEVALUATION                  $     333.57 92506GN
3200427 SPEECH-LANG PATH BRIEF EVAL            $     335.17 92506GN
3210304 SP SWALLOW EVALUATION- (4) EXT         $     547.69 92610GN
3210308 SP VIDEO SWALLOW EVAL                  $     742.85 92611GN
3210319 SP LANGUAGE THERAPY - (1) BRF          $     170.20 92507GN
3210320 SP LANGUAGE THERAPY - (2) INT          $     340.41 92507GN
3210321 SP LANGUAGE THERAPY - (3) MOD          $     510.63 92507GN
3210322 SP LANGUAGE THERAPY - (4) EXT          $     680.83 92507GN
3210327 SP SWALLOW THERAPY - (1) BRF           $     170.20 92526GN




                                         Page 216
                                         Ancillary


3210328 SP SWALLOW THERAPY - (2) INT           $     458.84 92526GN
3210329 SP SWALLOW THERAPY - (3) MOD           $     510.63 92526GN
3210330 SP SWALLOW THERAPY - (4) EXT           $     680.83 92526GN
3210351 SP THERAPY GROUP                       $     184.95 92508GN
3210360 SP LANG-COGN EVAL - 60 MIN             $     575.00
3210361 SP SPEECH/VOICE EVALUATION             $     575.00
3210362 SP SWALL/SPCH THER - INT 60'           $     651.65
3210363 SP SWALL/SPCH THER - ADDL 30'          $     296.68
3210401 SP LANG-COGN EVAL - (4) EXT            $     575.00 92506GN
3210402 SP LANG-COGN EVAL - (3) MOD            $     431.25 92506GN
3210506 SP COGNITIVE THERAPY 15 MIN            $     143.75 97532GN
3210508 SP VOICE PROSTHETIC EVAL               $     575.00 92597
3210513 SP VOICE/SPEECH EVALUATION EXT         $     575.00 92506GN
3210514 SP VOICE THERAPY INDIV BRF             $     170.20 92507GN
3210515 SP VOICE THERAPY INDIV INT             $     340.41 92507GN
3210516 SP VOICE THERAPY MOD                   $     510.63 92507GN
3210517 SP VOICE THERAPY INDIV EXT             $     680.83 92507GN
3210518 SP ENDOSCOPIC SWALLOW EVAL EXT         $     547.69 92612GN
3210519 SP ENDOSCOPIC SWALLOW EVAL MOD         $     410.77 92612GN
3210520 LARYNGEAL FUNCTION STUDY INT           $     273.13 92520GN
3210525 SP VOICE/SPEECH EVAL - (2) INT         $     287.50 92506GN
3210528 SP SWALLOW EVAL - 60 MIN               $     575.00
3210529 SP VIDEO SWALLOW NO TAR/CONSL          $     741.75
3210576 LARYNGEAL FUNCTION STUDY EXT           $     546.25 92520GN
3210579 SWALLOW THERAPY GROUP                  $     184.95 92508GN
3210581 VIDEOSTROBOSCOPY EXT                   $     766.94 31579
3210582 SP VOICE/SPEECH EVALUATION MOD         $     431.25 92506GN
3210584 VOICE/PROSTETIC/TEP FOLLOW UP          $     474.38 92597GN
3210585 LARYNGEAL FUNCTION STUDY BRF           $     136.56 92520GN
3210586 SP SWALLOW EVALUATION- (2) INT         $     273.84 92610GN
3210588 LARYNGEAL FUNCTION STUDY MOD           $     409.69 92520GN
3210593 SPEECH PRE/POST-OP EDUC. - 30'         $     200.00 98960
3210596 VOICE/SPEECH GROUP                     $     184.95 92508
3210598 VIDEOSTROBOSCOPY MOD                   $     605.00 31579
3210599 VIDEOSTROBOSCOPY INT                   $     495.00 31579
3210600 SP SWALLOW EVALUATION- (3) MOD         $     410.77 92610GN
3220069 SPEECH THERAPY INTERMED                $        -     92507
3220070 SPEECH THERAPY EXTENDED                $        -     92507
3220071 VOICE/SPEECH GROUP                     $     240.44 92508
3220073 SP PATIENT FAMILY CONFERENCE *         $        -     97799
3220074 SP EVALUATION INTERM                   $        -     92506
3220075 SP COGNITIVE THERAPY 15 MIN            $        -     92506
3220079 SWALLOWING EVAL INTERM SLP             $        -     92610
3220101 SP COMMUNITY REINT VISIT 60MIN         $     187.75 97537
3220102 SP EVALUATION ADD 15 MIN               $     125.22 92506
3220103 SP THERAPY GROUP SMALL 30MIN           $     240.43 92508
3220300 SP LANGUAGE EVALUATION                 $     494.57 92506GN
3220304 SP SWALLOWING EVAL                     $     712.00 92610
3220305 SP SWALLOWING REEVALUATION             $     712.00 92610




                                         Page 217
                                         Ancillary


3220308 SP VIDEO SWALLOW EVALUATION            $      712.00 92610
3220319 SP-LANGUAGE THER BRIEF                 $      262.59 92507GN
3220320 SP-LANGUAGE THER INTERM                $      392.82 92507GN
3220321 SP-LANGUAGE THER MOD                   $      523.03 92507GN
3220322 SP-LANGUAGE THER EXTEND                $      655.40 92507GN
3220327 SP SWALLOW THER BRIEF                  $      315.96 92526GN
3220328 SP SWALLOW THER INTERM                 $      473.93 92526GN
3220329 SP SWALLOW THER MOD                    $      631.93 92526GN
3220330 SP SWALLOW THER EXTEND                 $      789.89 92526GN
3220351 SP THERAPY GROUP                       $      240.43 92508GN
3220360 SP LANGUAGE/COGNITIVE EVAL             $      438.41
3220361 SP SPEECH/VOICE EVAL                   $      438.41
3220362 SP LANG INDIV TX INIT 60 MIN           $      421.29
3220363 SP LANG INDIV TX ADD 30 MIN            $      168.51
3220368 SP PATIENT/FAM CONF BRIEF              $      222.02 97799GN
3220369 SP PATIENT/FAM CONF INTERM             $      281.09 97799GN
3220373 SP FUNC ACTIVITY TRAIN I 15MIN         $      197.33 97530GN
3220374 SP FUNC ACTIVITY TRAIN A 15MIN         $       99.48 97530GN
3220375 SP COGNITIVE THERAPY 15 MIN            $      221.01 97532GN
3220377 SP VOICE PROSTHETIC EVAL               $      446.00 92597
3220387 SP ENDOSCOPIC SWALLOW EVAL             $      712.00 92610
3220393 SP SWALLOW EVALUATION                  $      472.72
3220394 SP VIDEO SWALLOW NO TAR/CONSL          $      814.23
3220396 SP SWALLOW THERAPY INIT 60 MIN         $      747.96
3220397 SP SWALLOW THERAPY ADD 30 MIN          $      373.61
3220404 SP ENDOSCOPIC SWAL W/SENS TES          $      668.74 92616
3220418 SP AUG DEVICE TRAINING INTERM          $          -     92609
3320001 THERAP RECREATION EVAL 30 MIN*         $      334.94 G0176
3320002 THERAP RECRT EVAL ADDL 15 MIN*         $      111.65 G0176
3320003 THERAP RECREAT TREATMT 30 MIN*         $      293.30 G0176
3320004 THERAP RECRT TREAT ADD 15 MIN*         $       99.65 97537
3320005 ACTIVITY THERAPY 30 MINUTES *          $      290.87 G0176
3320006 ACTIVITY THERAPY ADD 15 MIN *          $       98.66 G0176
3320007 COMMUNITY REINTEGRATION 30MIN*         $      187.75 97537
3320008 COMMUNITY REINTEGRT ADD 15MIN*         $      187.75 97537
3320009 THER REC SMALL GROUP 30 MIN *          $      206.09 G0176
3320010 THER REC SMALL GRP ADD 15 MIN*         $       70.48 G0176
3320011 THER REC LARGE GROUP 30 MIN *          $      147.78 G0176
3320012 THER REC LARGE GRP ADD 15 MIN*         $       51.53 G0176
3320206 THERAPEUTIC RECREATION EVAL            $      501.33 97799
3320208 THER REC TREATMENT 15 MIN              $      219.22 97530
3320212 TR COMMUNITY REINTEGR 15 MIN           $      187.75 97537
3320214 THER REC GROUP                         $      388.13 97150
3320218 THER REC PT/FAMILY CONF BRIEF          $      186.88 97799
2425001 CAST, VALPEAU BODY                     $     1,267.88
2425002 CAST, LONG ARM                         $     1,567.03
2425003 CAST, SHORT ARM CAST                   $      622.82
2425004 CAST, LONG LEG WALKING                 $      781.74
2425005 CAST, SHORT LEG WALKING                $      781.74




                                         Page 218
                                         Ancillary


2425006 CAST, CYLINDER THIGH TO ANKLE          $      887.67
2425007 CAST, PATELLAR TENDON BEARING          $     1,106.22
2425008 CAST, STUMP                            $      554.20
2425009 HANGING CAST FOR ARM                   $      906.85
2425011 RISSER TAB BODY CAST                   $     1,411.67
2425012 RISSER BODY JACKET                     $     1,388.19
2425013 SPICA CAST - ADULT                     $     2,863.25
2425014 SPICA CAST - INFANT                    $       63.54
2425015 SPICA CAST - INFANT W/ TABLE           $     1,444.01
2425016 SPICA - THUMB OR FINGER                $      581.32
2425017 SPICA - SHOULDER                       $     2,094.79
2425018 SPICA - HIP (SINGLE OR DOUBLE)         $     1,925.35
2425019 UNIVALVE CAST OR SPLINT                $       92.42
2425020 BI-VALVE OR DC CAST                    $      140.00
2425022 SPLINT FINGER 2 INCHES                 $      126.41
2425023 SPLINT FOREARM - LARGE                 $      255.07
2425024 SPLINT FOREARM - MEDIUM                $      214.68
2425025 SPLINT FOREARM - SMALL                 $      177.13
2425026 SPLINT WRIST - LARGE                   $      151.69
2425027 SPLINT WRIST - MEDIUM                  $      151.69
2425028 SPLINT WRIST - SMALL                   $      126.41
2425029 SPLINT, SUGARTONG                      $      974.80
2425030 SPLINT, MOLDED                         $      599.26
2425031 CAST, LONG LEG                         $     1,288.09
2425032 CAST SHORT LEG                         $     1,459.71
3420200 ORTHO CLINIC NEW PT., LEVEL 1          $      129.05 99201
3420201 ORTHO CLINIC NEW PT., LEVEL 2          $      140.68 99202
3420202 ORTHO CLINIC NEW PT., LEVEL 3          $      185.80 99203
3420203 ORTHO CLINIC NEW PT., LEVEL 4          $      232.80 99204
3420204 ORTHO CLINIC NEW PT., LEVEL 5          $      296.74 99205
3420205 ORTHO CLINIC EST PT., LEVEL 1          $      129.05 99211
3420206 ORTHO CLINIC EST PT., LEVEL 2          $      140.68 99212
3420207 ORTHO CLINIC EST PT., LEVEL 3          $      160.78 99213
3420208 ORTHO CLINIC EST PT., LEVEL 4          $      204.38 99214
3420209 ORTHO CLINIC EST PT., LEVEL 5          $      291.00 99215
3420210 CAST APP - VALPEAU BODY                $      329.18 29058
3420211 CAST APP - LONG ARM                    $      291.06 29065
3420212 CAST APP - SHORT ARM                   $      258.18 29075
3420213 CAST APP - THUMB/FINGER                $      329.18 29086
3420214 CAST APP - LONG LEG                    $      674.52 29345
3420215 CAST APP - SHORT LEG                   $      284.13 29405
3420216 CAST APP - LONG LEG WALK CAST          $      505.78 29355
3420217 CAST APP - SHORT LEG WALK CAST         $      267.96 29425
3420218 CAST APP - CYLINDER                    $      505.78 29365
3420219 CAST APP - CLUBFOOT W/ MANI            $      493.19 29450
3420220 CAST APP - HIP SPICA (1 LEG)           $      565.95 29305
3420221 CAST APP - HIP SPICA (> 1 LEG)         $      762.30 29325
3420222 CAST APP - PTB                         $      505.78 29435
3420223 REM/BIVALVE - GAUNT/BOOT/BODY          $      246.73 29700




                                         Page 219
                                         Ancillary


3420224 REM/BIVALVE - FULL ARM/LEG             $      329.18 29705
3420225 REM/BIVALVE - SHOULDER/HIP             $      505.78 29710
3420226 CAST - REPAIR                          $      329.18 29720
3420227 CAST - WINDOWING                       $      284.10 29730
3420228 CAST - WEDGING                         $      329.18 29740
3420229 ADDING WALKER TO CAST                  $      246.73 29440
3420230 SPLINT APP - LONG ARM                  $      320.67 29105
3420231 SPLINT APP - SHORT ARM                 $      319.84 29125
3420232 SPLINT APP - LONG LEG                  $      322.26 29505
3420233 SPLINT APP - SHORT LEG                 $      322.26 29515
3420234 STRAPPING - KNEE                       $      329.18 29530
3420235 STRAPPING - ANKLE OR FOOT              $      329.18 29540
3420236 STRAPPING - TOE                        $      329.18 29550
3420237 STRAPPING - UNNA BOOT                  $      165.96 29580
3420238 ASP/INJ HIP, KNEE SHLDR- LG JT         $      632.94 20610
3420239 ASP/INJ - WRIST, ANKLE MED JT          $      377.69 20605
3420240 ASP/INJ - SMALL JOINT                  $      313.01 20600
3420241 ASP - ABSCESS HEMATOMA CYST            $      257.30 10160
3420243 REM IMP - SUPERFICIAL (WR, PN)         $     3,114.07 20670
3420244 REM IMP - DEEP (WIRE, PIN)             $     3,566.85 20680
3420245 DISTAL RAD FRACT, CLOSE W/ MAN         $      883.08 25605
3420246 EXTERNAL FIXATION ADJUSTMENT           $     3,150.00 20693
3420247 METACARPAL FRACTURE W/ MANIP           $      785.40 26605
3420248 PHALANGEAL FRACTURE W/ MANIP           $      538.21 26725
3420249 RADIAL/ULNAR SHAFT FRAC W/ MAN         $      785.40 25565
3420250 INJ - SING TENDON - SHEATH/LIG         $      550.00 20550
3420251 INJ - SINGLE TENDON - ORIG/INS         $      550.00 20551
3420252 INJ - TRIGGER POINT 1-2                $      525.00 20552
3420253 NURSEMAID ELBOW - CLOSED TX            $      538.22 24640
3420316 GORTEX LINER FOR PEDS CASTS            $          -
3420317 IMMUNIZATION ADMINISTRATION            $       35.02 90471
3420569 INJECT MAJOR JT/BURSA -LEFT            $      634.07 20610LT
3420570 INJECT MAJOR JT/BURSA - RIGHT          $      634.07 20610RT
3420571 INJECT MAJOR JT/BURSA-BILATERA         $      634.07 2061050
3425001 CAST, VALPEAU BODY                     $     1,267.88
3425002 CAST, LONG ARM                         $     1,567.03
3425003 CAST, SHORT ARM CAST                   $      622.82
3425004 CAST, LONG LEG WALKING                 $      781.74
3425005 CAST, SHORT LEG WALKING                $      781.74
3425006 CAST, CYLINDER THIGH TO ANKLE          $      887.67
3425007 CAST, PATELLAR TENDON BEARING          $     1,106.22
3425008 CAST, STUMP                            $      554.20
3425009 HANGING CAST FOR ARM                   $      906.85
3425011 RISSER TAB BODY CAST                   $     1,411.67
3425012 RISSER BODY JACKET                     $     1,388.19
3425013 SPICA CAST - ADULT                     $     2,863.25
3425014 SPICA CAST - INFANT                    $       63.54
3425015 SPICA CAST - INFANT W/ TABLE           $     1,444.01
3425016 SPICA - THUMB OR FINGER                $      581.32




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                                         Ancillary


3425017 SPICA - SHOULDER                       $     2,094.79
3425018 SPICA - HIP (SINGLE OR DOUBLE)         $     1,925.35
3425019 UNIVALVE CAST OR SPLINT                $       92.42
3425020 BI-VALVE OR DC CAST                    $      140.00
3425022 SPLINT FINGER 2 INCHES                 $      126.41
3425023 SPLINT FOREARM - LARGE                 $      255.07
3425024 SPLINT FOREARM - MEDIUM                $      214.68
3425025 SPLINT FOREARM - SMALL                 $      177.13
3425026 SPLINT WRIST - LARGE                   $      151.69
3425027 SPLINT WRIST - MEDIUM                  $      151.69
3425028 SPLINT WRIST - SMALL                   $      126.41
3425029 SPLINT, SUGARTONG                      $      974.80
3425030 SPLINT, MOLDED                         $      599.26
3425031 CAST, LONG LEG                         $     1,288.09
3425032 CAST SHORT LEG                         $     1,459.71
3440001 PLASTIC SURGERY NEW PT LEVEL 1         $      129.05 99201
3440002 PLASTIC SURGERY NEW PT LEVEL 2         $      140.68 99202
3440003 PLASTIC SURGERY NEW PT LEVEL 3         $      185.80 99203
3440004 PLASTIC SURGERY NEW PT LEVEL 4         $      232.80 99204
3440005 PLASTIC SURGERY NEW PT LEVEL 5         $      296.74 99205
3440011 PLASTIC SURGERY EST PT LEVEL 1         $      129.05 99211
3440012 PLASTIC SURGERY EST PT LEVEL 2         $      140.68 99212
3440013 PLASTIC SURGERY EST PT LEVEL 3         $      160.78 99213
3440014 PLASTIC SURGERY EST PT LEVEL 4         $      204.38 99214
3440015 PLASTIC SURGERY EST PT LEVEL 5         $      291.00 99215
3410113 PM&R PHYSIOL EVAL 30MINS *             $      167.90 90875
3410114 PM&RPHYSIOL EVAL 15MINS *              $       58.06 97001GP
3410119 PM&R BIOFEEDBACK TRG 30MINS *          $      190.79 90901
3410120 PM&R BIOFEEDBACK TRG 15MINS *          $      190.79 90901
3410121 PM&R PT/FAMILY CONF 30 MINS *          $      141.27 97799
3410122 PM&R PT/FAMILY CONF 15 MINS *          $       88.93 97799
3410123 PM&R THER. GROUP 2-3 30MINS *          $      184.95 97150
3410124 PM&R THER GROUP 4+ 30MIN *             $      184.95 97150
3410125 PM&R BIOF CONSULT 30 MINS *            $      212.96 90875
3410136 BIOFEEDBACK EVALUATION                 $      337.16 97799
3410137 BIOFEEDBACK TRAINING BRIEF             $      190.79 90901
3410138 BIOFEEDBACK TRAINING INTERM            $      190.79 90901
3410139 BIOFEEDBACK TRAINING MOD               $      190.79 90901
3410140 BIOFEEDBACK TRAINING EXTEND            $      190.79 90901
3410145 BIOFEEDBACK SMALL GROUP                $      434.60 97150
3410146 BIOFEEDBACK LARGE GROUP                $      313.36 97150
3410149 BIOFEEDBACK PT/FAM CONF BRIEF          $      194.42 97799
3410150 BIOFEEDBACK PT/FAMILY CONF INT         $      295.45 97799
3600100 ELECTROCONVULSIVE THERAPY              $     1,698.61 90870
3600103 PERIPHERAL NERVE STIMULATOR            $          -
3600105 ECT NEW PATIENT, LEVEL 1               $       60.00 99201
3910001 ACTIVITY THERAPY                       $      166.22 G0176
3910002 GROUP THERAPY                          $      276.29 90853
3910003 INDIVIDUAL THERAPY 30 MIN              $      155.46 90804




                                         Page 221
                                         Ancillary


3910004 INDIVIDUAL THERAPY 60 MIN              $      310.85 90818
3910005 FAMILY THERAPY                         $      204.84 90847
3910007 EDUCATION TRAINING                     $      158.58 G0177
3910011 PARTIAL HOSP - FULL DAY                $     1,595.68 90853
3910100 HALF DAY PARTIAL HOSPITAL              $      745.64 90853
3910101 IOP PARTIAL HOSPITAL                   $      477.22 90853
1121111 DIAGNOSTIC INTERVIEW                   $      370.12 90801
1121141 PSYCHOLOGICAL TESTING HOURLY           $      334.94 96101
1121151 PHONE CONSULTATION 1.0 HOUR            $      269.43 99373
1121152 PHONE CONSULT .50HR                    $      163.24 99372
1121153 PHONE CONSULTATION 0.25 HOUR *         $       86.53 99371
1121161 DIAGNOSTIC INTERVIEW EXM FIELD         $      616.85 90801
1121201 INDIVIDUAL THERAPY 45-50 MIN           $      266.72 90806
1121205 IND PLAY/NONVERBAL THPRY 45-50         $      225.78 90812
1121206 IND PLAY/NONVERBAL THPRY 75-80         $      337.50 90814
1121211 INDIVIDUALTHERAPY 30 MIN               $      146.80 90804
1121301 GROUP THERAPY 60 MIN                   $      194.29 90853
1121304 GROUP THERAPY 90 MIN                   $      194.29 90853
1121305 GROUP THRPY PLAY NONVERBAL 60          $      190.82 90857
1121401 FAMILY THERAPY WITH CLIENT 90          $      276.73 90847
1121403 MULTI FAMILY GROUP THERAPY 90          $      276.73 90849
1121501 IND THERAPY W/MED MGMT 45-50           $      316.86 90807
1121508 IND PLAY NNVRBL THPY/MED 45-50         $      248.35 90813
1121603 PHARMACOLOGIC MGT/ADMIN                $      162.94 90862
1121611 FAMILY THERAPY WITHOUT CLNT 90         $      276.73 90846
1121800 CASE CONSULTATION 15 MIN               $       75.71 99241
1121801 CASE CONSULTATION 30 MIN               $      203.51 99242
1121802 CASE CONSULTATION 60 MIN               $      305.27 99244
3621102 GERO IOP DAY RATE                      $      382.48 90853
3621111 DIAGNOSTIC INTERVIEW EXAM 90           $      388.59 90801
3621201 INDIVIDUAL THERAPY 1HR GERI            $      266.72 90806
3621211 INDIVIDUAL THERAPY 20-30 MIN           $      146.80 90804
3621301 GROUP THERAPY 60 MIN                   $      277.13 90853
3621603 PHARMACOLOGICAL MANAGEMENT 30          $      162.94 90862
3622102 ADULT IOP DAY RATE                     $      514.05 90853
3622111 DIAG INTERVIEW EXAM 90 MINUTES         $      380.60 90801
3622201 INDIVIDUAL THERAPY 45-50 MIN           $      266.72 90806
3622211 INDIVIDUAL THERAPY 20-30 MIN           $      146.80 90804
3622301 GROUP THERAPY 60 MINUTES               $      276.29 90853
3622304 GROUP THERAPY 90 MINUTES               $      414.44 90853
3622401 FAMILY THERAPY WITH CLIENT 90          $      245.80 90847
3622501 IND THERAPY W/MED MGMT 45-50           $      316.86 90807
3622603 PHARMACOLOGICAL MANAGEMENT 30          $      162.94 90862
3622605 DIAG INTERVIEW EXAM 60 MINUTES         $      234.96 90801
3623102 DUAL DX IOP DAY RATE                   $      514.05 90853
3623111 DIAGNOSTIC INTERVIEW EXAM 90           $      370.08 90801
3623201 INDIVIDUAL THERAPY 45-50 MIN           $      266.72 90806
3623301 GROUP THERAPY 60 MIN                   $      276.29 90853
3623304 GROUP THERAPY 90 MIN                   $      259.04 90853




                                         Page 222
                                         Ancillary


3623401 FAMILY THERAPY WITH CLIENT 90          $     247.06 90847
3623501 IND THERAPY / MED MGMT 45-50           $     235.75 90807
3623603 PHARMACOLOGICAL MANAGEMENT 30          $     162.94 90862
3624111 DIAGNOSTIC INTERVIEW EXAM 90           $     370.12 90801
3624141 PSYCHOLOGCAL TESTING HOURLY            $     334.94 96101
3624151 DIAGNOSTIC INTRVIW EXAM MED 60         $     277.59 90801
3624161 DIAGNOSTIC INTERVIEW EXM FIELD         $     550.77 90801
3624201 INDIVIDUAL THERAPY 45-50 MIN           $     266.72 90806
3624211 INDIVIDUAL THERAPY 20-30 MIN           $     146.80 90804
3624221 IND THERAPY / MED MGMT 20-30           $     212.72 90805
3624222 IND THERAPY / MED MGMT 45-50           $     316.86 90807
3624301 GROUP THERAPY 60 MINUTES               $     194.29 90853
3624304 GROUP THERAPY 90 MINUTES               $     194.29 90853
3624401 FAMILY THERAPY WITH CLIENT 90          $     276.73 90847
3624402 FAMILY THRPY WITHOUT CLIENT 90         $     276.73 90846
3624603 PHARMACOLOGICAL MANAGEMENT 30          $     162.94 90862
1133096 BEIG CLINICAL SUMMARY                  $     514.05 90801
1133098 BEIG FAMILY GROUP                      $     276.73 90847
1133099 BEIG GROUP                             $     194.29 90853
1133100 BEIG DIAGNOSTIC INTERVIEW              $     370.12 90801
1133101 DIAGNOSTIC INTERVIEW                   $     293.74 90801
1133201 INDIVIDUAL THERAPY 60 MIN              $     266.72 90806
1133211 INDIVIDUAL THERAPY 30 MIN              $     132.19 90804
1133304 GROUP THERAPY 1.5 HRS                  $     194.29 90853
1133403 FAMILY THERAPY                         $     276.73 90847
1133503 OCCUPATIONAL THERAPY-SCHL DIST         $     149.00
1133504 SPEECH THERAPY .5 HR                   $      86.53
1133505 DIS COUNSELING /SCHL DIST ONLY         $     146.80 90804
1133506 SPEECH THERAPY 1 HOUR                  $     173.06
1133525 CASE MANAGEMENT .5 HOUR                $      86.53 99371
1133526 CASE MANAGEMENT 1 HOUR                 $      86.53 99371
1133601 EDUCATION                              $     295.02 G0177
3800202 GEN/RISK NEW PT., LEVEL 1              $     129.05 99201
3800203 GEN/RISK NEW PT., LEVEL 2              $     140.68 99202
3800204 GEN/RISK NEW PT., LEVEL 3              $     185.80 99203
3800205 GEN/RISK NEW PT., LEVEL 4              $     232.80 99204
3800206 GEN/RISK NEW PT., LEVEL 5              $     296.74 99205
3800207 GEN/RISK EST. PT., LEVEL 1             $     129.05 99211
3800208 GEN/RISK EST. PT., LEVEL 2             $     140.68 99212
3800209 GEN/RISK EST. PT., LEVEL 3             $     160.78 99213
3800210 GEN/RISK EST. PT., LEVEL 4             $     204.38 99214
3800211 GEN/RISK EST. PT., LEVEL 5             $     291.00 99215
3800212 GEN/RISK CONSULT, LEVEL 1              $     226.42 99241
3800213 GEN/RISK CONSULT, LEVEL 2              $     258.76 99242
3800214 GEN/RISK CONSULT, LEVEL 3              $     291.12 99243
3800215 GEN/RISK CONSULT, LEVEL 4              $     323.46 99244
3800216 GEN/RISK CONSULT, LEVEL 5              $     355.81 99245
3800222 VENIPUNCTURE                           $      49.21 36415
3810001 HLA A,B,C TYPING                       $     891.24 86813




                                         Page 223
                                         Ancillary


3810002 HLA B27 TYPING                         $      282.74 86812
3810003 HLA DR,DQ TYPING *                     $      736.81 86817
3810004 HLA ANTIBODY QUICK SRN/SERUM           $      455.52 86808
3810005 HLA ANTIBODY SRN & ID/SERUM            $      554.07 86807
3810008 HLA T CELL X-MATCH/SERUM               $      990.27 86805
3810009 HLA B CELL X-MATCH/SERUM               $      990.27 86805
3810011 HLA LYMPHOCYTE AUTOANTIBODY            $      449.86 86808
3810020 DNA/RNA EXTRACTION                     $      112.93 83891
3810021 ELECTROPHORESIS DNA/RNA SEPARA         $      154.35 83894
3810022 DRB1 COMPLETE OLIGO                    $     1,131.62 83901
3810025 DRB1*04 OLIGO                          $      289.46 83898
3810027 GENERIC DR OLIGO                       $      746.95 83901
3810029 DRB3 OLIGO                             $      242.10 83901
3810030 DRB4 OLIGO                             $      290.52 83901
3810031 DRB5 OLIGO                             $      242.10 83901
3810032 DQB OLIGO                              $      560.21 83901
3810033 DQA OLIGO                              $      746.95 83901
3810034 DPB OLIGO                              $      752.59 83901
3810035 DPA OLIGO                              $      366.65 83901
3810036 A,B,C TYPING, LOW RESOLUTION           $      354.86 86813
3810038 GENERIC ABC OLIGO                      $      714.41 83901
3810039 FLOW T-CELL XM                         $      982.40 88184
3810040 AUTO B-CELL XM NO DTT-GLYCINE          $      736.81 86805
3810041 AUTO B-CELL XM NO DTT-IVIG             $      736.81 86805
3810043 AS & ID W/DTT                          $      412.26 86807
3810046 LYMPHOCYTE AUTO AB W/DTT               $      334.72 86806
3810047 AUTO T-CELL XM NO DTT-GLYCINE          $      736.81 86805
3810048 DNA SEQUENCING/PER LOCUS               $      327.46 83904
3810049 AUTO T-CELL XM NO DTT-IVIG             $      736.81 86805
3810054 AUTO B-CELL XM W/DTT                   $      736.81 86805
3810055 AUTO B-CELL XM NO DTT                  $      736.81 86805
3810056 GLYCINE AUTO B-CELL XM W/DTT           $      736.81 86805
3810057 IVIG AUTO B-CELL XM W/DTT              $      736.81 86805
3810058 B-CELL XM W/DTT                        $      736.81 86805
3810071 ENGRAFTMENT CD34 SUBSET                $      609.14 83904
3810072 ENGRAFTMENT B-CELL SUBSET              $      609.14 83904
3810073 ENGRAFTMENT MYELOID SUBSET             $      609.14 83904
3810074 ENGRAFTMENT T-CELL SUBSET              $      609.14 83904
3810075 ENGRAFTMENT UNSEPARATED CELLS          $      818.67 83904
3810076 FLOW B-CELL XM                         $      982.40 88184
3810077 FLOW AUTO B-CELL XM                    $      982.40 88184
3810078 QS FLOW ID                             $      679.48 88184
3810079 FLOW AUTO T-CELL XM                    $      982.40 88184
3810080 GLYCINE B-CELL XM W/DTT                $      736.81 86805
3810081 GLYCINE B-CELL XM NO DTT               $      736.81 86805
3810082 GLYCINE QS W/DTT                       $      338.93 86808
3810083 GLYCINE QS NO DTT                      $      338.93 86808
3810084 GLYCINE AS & ID W/DTT                  $      412.26 86807
3810085 GLYCINE AS & ID NO DTT                 $      412.26 86807




                                         Page 224
                                         Ancillary


3810086 GLYCINE T-CELL XM W/DTT                $     736.81 86805
3810087 GLYCINE T-CELL XM NO DTT               $     736.81 86805
3810090 IVIG B-CELL XM W/DTT                   $     736.81 86805
3810092 IVIG B-CELL XM NO DTT                  $     736.81 86805
3810096 IVIG AB QS W/DTT                       $     338.93 86808
3810097 IVIG AB QS NO DTT                      $     338.93 86808
3810098 IVIG DTT-AS & ID W/DTT                 $     412.26 86807
3810099 IVIG AS & ID NO DTT                    $     412.26 86807
3810100 IVIG T-CELL XM W/ DTT                  $     736.81 86805
3810101 IVIG T-CELL XM NO DTT                  $     736.81 86805
3810138 ANTIBODY QUICKSCREEN WITH DTT          $     338.93 86808
3810139 QUICKSCREEN BY FLOW-POS/NEG            $     455.52 88184
3810142 REVERSE B-CELL XM WITH DTT-CDC         $     736.81 86805
3810143 REVERSE B-CELL XM NO DTT-CDC           $     736.81 86805
3810144 REVERSE FLOW B-CELL CROSSMATCH         $     679.48 88184
3810145 REVERSE FLOW T-CELL CROSSMATCH         $     982.40 88184
3810146 REVERSE T-CELL XM WITH DTT-CDC         $     736.81 86805
3810147 REVERSE T-CELL XM NO DTT-CDC           $     736.81 86805
3810150 AUTO T-CELL XM WITH DTT                $     736.81 86805
3810151 AUTO T-CELL XM NO DTT                  $     736.81 86805
3810152 GLYCINE AUTO T-CELL XM WITH DT         $     736.81 86805
3810153 IVIG AUTO T-CELL XM WITH DTT           $     736.81 86805
3810154 T-CELL CROSSMATCH WITH DTT             $     736.81 86805
3810170 FLOW ID SCREEN CLASS II                $     382.88 88184
3810171 FLOW SPEC. SCREEN CLASS I              $     382.88 88184
3810172 FLOW SPEC. SCREEN CLASS II             $     382.88 88184
3810173 CLASS II QUICK SCREEN NO DTT           $     322.79 86806
3810174 CLASS II QUICK SCREEN W/DTT            $     322.79 86806
3810175 CLASS II IVIG QS NO DTT                $     322.79 86806
3810176 CLASS II IVIG QS W/DTT                 $     322.79 86806
3810179 CLASS II ATB SCREEN NO DTT             $     527.69 86807
3810180 CLASS II ATB SCREEN W/DTT              $     527.69 86807
3810181 CLASS II IVIG SCREEN NO DTT            $     527.69 86807
3810182 CLASS II IVIG SCREEN W/DTT             $     527.69 86807
3810185 CHIMERISM/ENGRAFTMENT TEST             $     240.45 83904
3810186 LUMINEX QUICK SCREEN POS/NEG           $     455.52 88184
3810187 LUMINEX PRA AND ID CLASS I             $     679.48 88184
3810188 LUMINEX PRA AND ID CLASS II            $     382.88 88184
3810189 LUMINEX SINGLE AG ID CLASS I           $     420.00 88184
3810190 LUMINEX SINGLE AG ID CLASS II          $     420.00 88184
3810191 LUMINEX TYPING CLASS I ABC             $     714.41 83901
3810192 LUMINEX TYPING CLASS I A LOCUS         $     315.00 83901
3810193 LUMINEX TYPING CLASS I B LOCUS         $     315.00 83901
3810194 LUMINEX TYPING CLASS I C LOCUS         $     315.00 83901
3810195 LUMINEX TYPING CLASS II DRB1           $     746.95 83901
3810196 LUMINEX TYPING CLASS II DRB3,4         $     289.46 83901
3810197 LUMINEX TYPING CLASS II DQA1           $     746.95 83901
3810198 LUMINEX TYPING CLASS II DQB1           $     560.21 83901
3810199 LUMINEX MIC ANTIBODY SCREEN            $     455.52 83901




                                         Page 225
                                         Ancillary


3810200 LUMINEX MIC TYPING                     $      714.41 83901
3810201 PT. SERA DIFF ABSORPTION - ARC         $      277.30 86978
3820202 PEDS/GENETIC NEW PT, LEVEL 1           $      129.05 99201
3820203 PEDS/GENETIC NEW PT, LEVEL 2           $      140.69 99202
3820204 PEDS/GENETIC NEW PT, LEVEL 3           $      185.80 99203
3820205 PEDS/GENETIC NEW PT, LEVEL 4           $      232.80 99204
3820206 PEDS/GENETIC NEW PT, LEVEL 5           $      296.73 99205
3820207 PEDS/GENETIC EST PT, LEVEL 1           $      129.05 99211
3820208 PEDS/GENETIC EST PT, LEVEL 2           $      140.69 99212
3820209 PEDS/GENETIC EST PT, LEVEL 3           $      160.77 99213
3820210 PEDS/GENETIC EST PT, LEVEL 4           $      204.38 99214
3820211 PEDS/GENETIC EST PT, LEVEL 5           $      291.00 99215
3820224 SKIN BIOPSY UPPER INNER ARM            $      502.90 11100
3820225 VENIPUNCTURE                           $       49.21 36415
3830008 CYTO HIGH RESOLUTION BANDING           $     2,974.46 88289
3830010 CYTO CHROMOSOME BREAKAGE ANAL          $     2,171.83 88248
3830011 CYTO SISTER CHROMATID EXCHANG          $     2,170.78 88245
3830012 SPECIAL STAIN                          $      547.60 88283
3830024 IN SITU CHROM ANAL 12CELLS 1KA         $     1,477.73 88269
3830025 1 CHROMO ADD'L KARYO                   $      153.59 88280
3830026 TISSUE CULTURE-AMMIO/CVS               $      675.68 88235
3830027 FLASK ANALYSIS                         $     1,100.12 88267
3830028 CHROM ANAL ADD'L CELLS COUNTED         $       98.76 88285
3830029 CHROM ANAL-5CELLS/1 KARYO              $      918.14 88261
3830030 TC-HEME                                $      836.03 88237
3830031 CHROM ANAL 15-20 CELLS/2 KARYO         $     1,043.90 88262
3830032 TISSUE CULTURE-LYMPHOCYTE              $      822.47 88230
3830033 TISSUE CULTURE-SOLID TISSUE            $      775.48 88233
3830034 TISSUE IN SITU HYBRID (FISH)           $      254.46 88365
3830035 NUCLEIC ACID PROBE                     $       24.60 83896
3830042 TC-SOLID TUMOR                         $      894.77 88239
3830044 ALPHA FETO PROTEIN AMNIOTIC FL         $      102.67 82106
3830106 PROBE FOR INTERPHASE FISH              $      231.11
3830108 PROBE -3 SLIDE TEST (+/- CTRL)         $      319.80
3830110 PROBE FOR X & Y                        $      363.97
3830111 ADDITIONAL PROBE                       $      130.68
3835002 FREEZE CELLS                           $      121.83 88240
3835003 THAW AND GROW                          $      121.83 88241
3835005 FISH- UNCULTURED PRENATAL              $      151.06
3835009 COUNT 45 CELLS FOR MOSAICISM           $      889.84 88263
3835010 ANALYZ 20-25 CELLS                     $      759.36 88264
3835012 INTERPRETATION & REPORT                $      121.83 88291
3835014 FISH 3-5 CELLS EVALUATED               $     1,091.64 88272
3835015 FISH 10-30 CELLS MICRODELETION         $     1,162.83 88273
3835016 FISH INTERPHASE 25-99 CELLS            $     1,281.48 88274
3835017 FISH INTERPHASE 100-300 CELLS          $     1,601.86 88275
3835026 FISH PROBE EACH                        $     1,038.24 88271
3920202 PED/NEP NEW PAT VISIT, LEV 1           $      129.05 99201
3920203 PED/NEP NEW PAT VISIT, LEV 2           $      140.68 99202




                                         Page 226
                                        Ancillary


3920204 PED/NEP NEW PAT VISIT, LEV 3          $     185.80 99203
3920205 PED/NEP NEW PAT VISIT, LEV 4          $     232.80 99204
3920206 PED/NEP NEW PAT VISIT, LEV 5          $     296.74 99205
3920207 PED/NEP EST. PAT VISIT, LEV 1         $     129.05 99211
3920208 PED/NEP EST. PAT VISIT, LEV 2         $     140.68 99212
3920209 PED/NEP EST. PAT VISIT, LEV 3         $     160.78 99213
3920210 PED/NEP EST. PAT VISIT, LEV 4         $     204.38 99214
3920211 PED/NEP EST. PAT VISIT, LEV 5         $     291.00 99215
3930222 PED/PUL NEW PT., LEVEL 1              $     129.05 99201
3930223 PED/PUL NEW PT., LEVEL 2              $     140.68 99202
3930224 PED/PUL NEW PT., LEVEL 3              $     185.80 99203
3930225 PED/PUL NEW PT., LEVEL 4              $     232.80 99204
3930226 PED/PUL NEW PT., LEVEL 5              $     296.74 99205
3930227 PED/PUL EST. PT., LEVEL 1             $     129.05 99211
3930228 PED/PUL EST. PT., LEVEL 2             $     140.68 99212
3930229 PED/PUL EST. PT., LEVEL 3             $     160.78 99213
3930230 PED/PUL EST. PT., LEVEL 4             $     204.38 99214
3930231 PED/PUL EST. PT., LEVEL 5             $     291.00 99215
3950242 PED/ID NEW PAT VISIT, LEV 1           $     129.05 99201
3950243 PED/ID NEW PAT VISIT, LEV 2           $     140.68 99202
3950244 PED/ID NEW PAT VISIT, LEV 3           $     185.80 99203
3950245 PED/ID NEW PAT VISIT, LEV 4           $     232.80 99204
3950247 PED/ID EST. PAT VISIT, LEV 1          $     129.05 99211
3950248 PED/ID EST. PAT VISIT, LEV 2          $     140.68 99212
3950249 PED/ID EST. PAT VISIT, LEV 3          $     160.78 99213
3950250 PED/ID EST. PAT VISIT, LEV 4          $     204.38 99214
3950251 PED/ID EST. PAT VISIT, LEV 5          $     291.00 99215
3990244 PED/IBD NEW PAT VISIT, LEV 3          $     185.80 99203
3990245 PED/IBD NEW PAT VISIT, LEV 4          $     232.80 99204
3990246 PED/IBD NEW PAT VISIT, LEV 5          $     296.74 99205
3990247 PED/IBD EST. PAT VISIT, LEV 1         $     129.05 99211
3990249 PED/IBD EST. PAT VISIT, LEV 3         $     160.78 99213
3990250 PED/IBD EST. PAT VISIT, LEV 4         $     204.38 99214
3990251 PED/IBD EST. PAT VISIT, LEV 5         $     291.00 99215
4000102 IL-2 INTERLEUKIN        *             $     340.72 83516
4000103 IL-1 INTERLEUKIN        *             $     340.72 83516
4000104 OKT3 ANTIBODY TEST *                  $     340.72 83516
4000105 GAMMA INTERFERON EIA                  $     340.72 83516
4000106 INTERLEUKIN-2 RECEPTOR EIA            $     340.72 83516
4000107 TUMOR NECROSIS FACTOR EIA             $     340.72 83516
4000108 OKT3 EIA TEST                         $     251.87 80299
4000109 INTERLEUKIN-6 EIA                     $     340.72 83516
4000117 DNA EXTRACTION                        $     203.72 83890
4000118 AMPLIFICATION-PCR                     $     325.94 83898
4000119 SEPARATION-ELECTROPHORESIS            $     203.72 83894
4000120 INTERPRETATION AND REPORT             $     244.47 83912
4000121 IMMUNOASSAY NOT SPECIFIED             $     162.97 83520
4000122 CELL CULTURE, NON-NEOPLASTIC          $     814.83 88230
4000123 MISCELLANEOUS PATHOLOGY TEST          $     591.80 89240




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                                         Ancillary


4000124 WBC COUNT                              $       37.86 85048
4000125 AMPLIFICATION-PCR DBL                  $      431.85 83901
4000126 STAT-PCR CHARGE                        $      160.14 99058
4000133 CELL CULTURE                           $      605.27 88230
4000134 IMMUNOFLUORESCENT, INDIRECT            $      553.01 88347
4000135 FLOW CYTOMETRY                         $      177.18 88180
4000136 INTREPRETATION AND REPORTING           $      244.47 83912
4000137 LYMPHOCYTE BLASTOGENESIS               $     1,132.27 86353
4000138 ABSOLUTE CD4 AND CD8 COUNT             $      455.77 86360
4000139 CHEMILUMINESCENT ASSAY                 $      264.60 82397
4000141 AMPLIFICATION-PCR                      $      235.62 83898
4000142 SEPARATION-ELECTROPHORESIS             $       26.54 83894
4000143 INTERPRETATION & REPORT                $       31.86 83912
4010005 3SP OBSERVATION - 1 HOUR               $      515.20 G0378
4010007 3SP - PULSE OX OBSERV ONLY             $      107.20 94760
4010010 3SP OBS - 1 HOUR DIR-ADMIT             $      258.11 G0379
4014600 LIVER BIOPSY                           $     1,821.27 47000
4014601 U/S GUIDANCE FOR NEEDLE PLACEM         $      928.48 76942
4014602 TRAY FOR BIOPSY                        $      381.74
4014603 NEEDLE FOR BIOPSY                      $      106.48
4014700 3SP - 1ST HOUR                         $      554.40
4014701 3SP - EA ADDL MINUTE                   $        9.24
4021501 INTRAOCULAR LENS                       $         -
4021502 IMPLANTS                               $         -
4030000 TREATMENT ROOM HOURLY RATE             $      146.32
4030010 OBSERVATION ROOM                       $      146.32
4050000 OBSERVATION CARE, PER HOUR             $      128.80 G0378
4050001 OBS CARE SURG PER HR DIR-ADMIT         $      258.11 G0379
4060010 OBSERVATION ROOM                       $      146.32
4100300 KIDNEY/PANC NEW PT LEVEL 1             $      129.05 99201
4100301 KIDNEY/PANC NEW PT LEVEL 2             $      140.68 99202
4100302 KIDNEY/PANC NEW PT LEVEL 3             $      185.80 99203
4100303 KIDNEY/PANC NEW PT LEVEL 4             $      232.80 99204
4100304 KIDNEY/PANC NEW PT LEVEL 5             $      296.74 99205
4100305 KIDNEY/PANC EST PT LEVEL 1             $      129.05 99211
4100306 KIDNEY/PANC EST PT LEVEL 2             $      140.68 99212
4100307 KIDNEY/PANC EST PT LEVEL 3             $      160.78 99213
4100308 KIDNEY/PANC EST PT LEVEL 4             $      204.38 99214
4100309 KIDNEY/PANC EST PT LEVEL 5             $      291.00 99215
4110300 LIVER TX NEW PT LEVEL 1                $      129.05 99201
4110301 LIVER TX NEW PT LEVEL 2                $      140.68 99202
4110302 LIVER TX NEW PT LEVEL 3                $      185.80 99203
4110303 LIVER TX NEW PT LEVEL 4                $      232.80 99204
4110304 LIVER TX NEW PT LEVEL 5                $      296.74 99205
4110305 LIVER TX EST PT LEVEL 1                $      129.05 99211
4110306 LIVER TX EST PT LEVEL 2                $      140.68 99212
4110307 LIVER TX EST PT LEVEL 3                $      160.78 99213
4110308 LIVER TX EST PT LEVEL 4                $      204.38 99214
4110309 LIVER TX EST PT LEVEL 5                $      291.00 99215




                                         Page 228
                                       Ancillary


4110310 HEPATOLOGY NEW PT LEVEL 1            $      129.05 99201
4110311 HEPATOLOGY NEW PT LEVEL 2            $      140.68 99202
4110312 HEPATOLOGY NEW PT LEVEL 3            $      185.80 99203
4110313 HEPATOLOGY NEW PT LEVEL 4            $      232.80 99204
4110314 HEPATOLOGY NEW PT LEVEL 5            $      296.74 99205
4110315 HEPATOLOGY EST PT LEVEL 1            $      129.05 99211
4110316 HEPATOLOGY EST PT LEVEL 2            $      140.68 99212
4110317 HEPATOLOGY EST PT LEVEL 3            $      160.78 99213
4110318 HEPATOLOGY EST PT LEVEL 4            $      204.38 99214
4110319 HEPATOLOGY EST PT LEVEL 5            $      291.00 99215
4110400 HEPATOBILIARY NEW PT LEVEL 1         $      129.05 99201
4110401 HEPATOBILIARY NEW PT LEVEL 2         $      140.68 99202
4110402 HEPATOBILIARY NEW PT LEVEL 3         $      185.80 99203
4110403 HEPATOBILIARY NEW PT LEVEL 4         $      232.80 99204
4110404 HEPATOBILIARY NEW PT LEVEL 5         $      296.74 99205
4110405 HEPATOBILIARY EST PT LEVEL 1         $      129.05 99211
4110406 HEPATOBILIARY EST PT LEVEL 2         $      140.68 99212
4110407 HEPATOBILIARY EST PT LEVEL 3         $      160.78 99213
4110408 HEPATOBILIARY EST PT LEVEL 4         $      204.38 99214
4110409 HEPATOBILIARY EST PT LEVEL 5         $      291.00 99215
4090001 ULTRASOUND OB >14 WEEKS              $      529.72 76805
4090002 AMNIOCENTESIS                        $      886.09 59000
4090004 US GUIDE IUT/CORDOCENTESIS           $      365.21 76941
4090006 CORDOCENTESIS                        $      670.05 59012
4090007 FETAL BIOPH PROFILE W/ NST           $     1,558.24 76818
4090008 FETAL STRESS TEST                    $     1,173.78 59020
4090009 FETAL NON-STRESS TEST                $      580.47 59025
4090010 US OB LIMITED                        $      496.74 76815
4090012 FETAL ECHO COMPLETE                  $      389.57 76825
4090013 FETAL ECHO COMPLETE DOPPLER          $      389.57 76827
4090015 FETAL ECHO FOLLOW UP                 $      486.97 76826
4090016 FETAL ECHO FOLLOW UP DOPPLER         $      281.81 76828
4090017 DOPPLER COLOR MAPPING                $      723.61 93325
4090024 US GUIDE FOR AMNIOCENTESIS           $      438.24 76946
4090026 US OB > 14 WKS ADD'L GEST            $      475.28 76810
4090027 US OB F/U PER FETUS                  $      409.86 76816
4090028 US OB TRANSVAGINAL                   $      529.72 76817
4090029 ECHO PELVIC CMPLT GYN                $      936.81 76856
4090202 NEW PT, LEVEL 1                      $      129.05 99201
4090203 NEW PT, LEVEL 2                      $      140.68 99202
4090204 NEW PT, LEVEL 3                      $      185.80 99203
4090205 NEW PT, LEVEL 4                      $      232.80 99204
4090206 NEW PT, LEVEL 5                      $      296.74 99205
4090207 EST. PT, LEVEL 1                     $      129.05 99211
4090208 EST. PT, LEVEL 2                     $      140.68 99212
4090209 EST. PT, LEVEL 3                     $      160.78 99213
4090210 EST. PT, LEVEL 4                     $      204.38 99214
4090211 EST. PT, LEVEL 5                     $      291.00 99215
4090222 INJECTION IM/SQ                      $      100.00 90772




                                       Page 229
                                         Ancillary


4090223 VENIPUNCTURE                           $        49.21 36415
4090224 CHORIONIC VILLUS SAMPLING              $       886.09 59015
4090230 PRENATAL CVS GUIDANCE                  $       266.56 76945
4090231 US OB W/ DETAIL FETAL EXAM             $       967.46 76811
4090236 U/S OB, ADDL GESTATION                 $      1,003.41 76812
4090238 AMNIO THER FLUID REDUCTION             $       972.33 59001
4090239 FETAL BIOPH PROFILE W/O NST            $       922.48 76819
4090240 AMNIO PROCEDURE TRAY                   $       110.64
4090241 RHOGAM                                 $       410.63
4090243 AMNIO PROCEDURE TRAY-WILLIAMS          $        56.98
4090244 TRASVAGINAL PROCEDURE TRAY             $        74.39
4090245 TRANSABDOMINAL PROCEDURE TRAY          $       136.73
4090246 US OB < 14 WKS SINGLE FETUS            $       488.74 76801
4090247 DIABETES TEACH, IND PER 30 MIN         $       176.74 G0108
4090249 DIABETES FU-CDE-INDIV                  $       176.74 G0108
4090251 UMBILICAL ARTERY DOPPLER               $       363.17 76820
4090252 FETAL MID CEREBRAL ARTERY DPLR         $       364.32 76821
4090253 DOPPLER, UTERINE ARTERY                $      1,258.51 93976
4090254 3D ULTRASOUND                          $      1,150.22 76376
4090255 TRANSABD AMNIOINFUS W US               $       273.25 59070
4090256 NEEDLE, LONG, AMNIO, ECHOTIP           $       160.91
4090257 NEEDLE SET, BX/ASPIR, ECHO TIP         $       235.39
4090258 CATH, CNTRL VENOUS, SNGL LMN           $        45.96
4090259 OB U/S NUCHAL MEAS, 1 GEST             $       310.15 76813
4090260 U/S OB NUCHAL, ADDL GESTATION          $       210.42 76814
4090261 GENETIC COUNSELING, EACH 30 MN         $       160.78 96040
4100001 ORGAN ACQ DECEASED DONOR KIDNY         $     64,269.57
4100002 KIDNEY PROCUREMENT UCLA                $     27,476.15
4100003 PANCREAS PROCUREMENT                   $     57,432.38
4100005 ORGAN ACQ LIVE DONOR KIDNEY            $     78,650.00
4100201 KP TX EVAL NEW PT LEVEL 1              $       129.05 99201
4100202 KP TX EVAL NEW PT LEVEL 2              $       140.68 99202
4100203 KP TX EVAL NEW PT LEVEL 4              $       185.80 99203
4100204 KP TX EVAL NEW PT LEVEL 5              $       232.80 99204
4100205 KP TX EVAL EST PT LEVEL 1              $       296.74 99205
4100211 KP TX EVAL EST PT LEVEL 2              $       129.05 99211
4100212 K P TX EVAL EST PT LEVEL 3             $       140.68 99212
4100213 KP TX EVAL NEW PT LEVEL 3              $       160.78 99213
4100214 K P TX EVAL EST PT LEVEL 4             $       204.38 99214
4100215 KP TX EVAL EST PT LEVEL 5              $       291.00 99215
4110001 ORGAN ACQ DECEASED DONOR LIVER         $     57,432.38
4110003 ORGAN ACQ LIVE DONOR LIVER             $     84,700.00
4110201 LIVER TX EVAL NEW PT LEVEL 1           $       129.05 99201
4110202 LIVER TX EVAL NEW PT LEVEL 2           $       140.68 99202
4110203 LIVER TX EVAL NEW PT LEVEL 4           $       185.80 99203
4110204 LIVER TX EVAL NEW PT LEVEL 5           $       232.80 99204
4110205 LIVER TX EVAL EST PT LEVEL 1           $       296.74 99205
4110211 LIVER TX EVAL EST PT LEVEL 2           $       129.05 99211
4110212 LIVER TX EVAL EST PT LEVEL 3           $       140.68 99212




                                         Page 230
                                         Ancillary


4110213 LIVER TX EVAL NEW PT LEVEL 3           $       160.78 99213
4110214 LIVER TX EVAL EST PT LEVEL 4           $       204.38 99214
4110215 LIVER TX EVAL EST PT LEVEL 5           $       291.00 99215
4110216 HEPATOBILIARY NEW PT LEVEL 1           $       129.05 99201
4110217 HEPATOBILIARY NEW PT LEVEL 2           $       140.68 99202
4110218 HEPATOBILIARY NEW PT LEVEL 3           $       185.80 99203
4110219 HEPATOBILIARY NEW PT LEVEL 4           $       232.80 99204
4110220 HEPATOBILIARY NEW PT LEVEL 5           $       296.74 99205
4110221 HEPATOBILIARY EST PT LEVEL 1           $       129.05 99211
4110222 HEPATOBILIARY EST PT LEVEL 2           $       140.68 99212
4110223 HEPATOBILIARY EST PT LEVEL 3           $       160.78 99213
4110224 HEPATOBILIARY EST PT LEVEL 4           $       204.38 99214
4110225 HEPATOBILIARY EST PT LEVEL 5           $       291.00 99215
4110252 LIVER BIOPSY, PERCUTANEOUS             $      1,821.27 47000
4120001 LUNG PROCUREMENT                       $     58,532.38
4120002 BILATERAL LUNG PROCUREMENT             $     69,532.38
4130001 HEART PROCUREMENT                      $     57,432.38
4150000 INT NEWBORN HEARING SCREEN TST         $       272.21
4150001 RPT NEWBORN HEARING SCREEN TST         $       272.21
    400 STD GUEST TRAY                         $        28.00
    401 A LA CARTE TRAY                        $           -
    402 DELUXE SERVICE                         $       173.60
4320100 WHP NEW PT., LEVEL 1                   $       129.05 99201
4320101 WHP NEW PT., LEVEL 2                   $       140.68 99202
4320102 WHP NEW PT., LEVEL 3                   $       185.80 99203
4320103 WHP NEW PT., LEVEL 4                   $       232.80 99204
4320104 WHP EST. PT., LEVEL 1                  $       129.05 99211
4320105 WHP EST. PT., LEVEL 2                  $       140.68 99212
4320106 WHP EST. PT., LEVEL 3                  $       160.78 99213
4320107 WHP EST. PT., LEVEL 4                  $       204.38 99214
4320108 ROUTINE ECG                            $       737.01 93005
4320109 CHOLESTECH - LIPID PANEL               $       288.94 80061QW
4330000 URO/GYN NEW PT., LEVEL 1               $       129.05 99201
4330001 URO/GYN NEW PT., LEVEL 2               $       140.68 99202
4330002 URO/GYN NEW PT., LEVEL 3               $       185.80 99203
4330003 URO/GYN NEW PT., LEVEL 4               $       232.80 99204
4330004 URO / GYN NEW PT., LEVEL 5             $       296.74 99205
4330005 URO/GYN EST. PT., LEVEL 1              $       129.05 99211
4330006 URO/GYN EST. PT., LEVEL 2              $       140.68 99212
4330007 URO/GYN EST. PT., LEVEL 3              $       160.78 99213
4330008 URO/GYN EST. PT., LEVEL 4              $       204.38 99214
4330009 URO/GYN EST. PT., LEVEL 5              $       291.00 99215
4330010 EMG URETHA / ANUS                      $       548.66 51784
4330011 IRRIGATION VAGINAL/APPLY OINT.         $       119.23 57150
4330012 CYSTO W OR W/O IRRIG OR PYELO          $      5,104.62 52005
4330013 EMG SURFACE,ANAL/URETL SPHNCTR         $       548.66 51784
4330014 PELVIC ELECT STIM, EA 15 MIN           $       143.75 97032
4330015 BIOPSY, CERVIX                         $       950.04 57500
4330016 BIOPSY, ENDOMETRIAL                    $       384.62 58100




                                         Page 231
                                            Ancillary


4330017 HEMOSTATIC AGENT, INTRODUCTION            $      198.71 57180
4330018 EXCISE VAGINAL SEPTUM                     $      138.44 57130
4330019 EXC.GENIT LESION < 0.5 CM                 $      618.83 11420
4330020 EXCISION VAGINAL CYST                     $      136.19 57135
4330021 I & D BARTHOLINS GLAND ABSCESS            $      725.34 56420
4330022 MARSUPIALIZATION BART GL.CYST             $      236.25 56440
4330023 SKIN TAG REMOVAL-1 TO 15 TAGS             $      290.88 11200
4330024 BIOPSY, VULVA 1ST LESION                  $      509.11 56605
4330025 CYSTOSCOPY                                $     2,112.97 52000
4330026 BLADDER, INSTILLATION / LAVAGE            $      335.41 51700
4330027 DILATION URETHA, INITIAL                  $      248.04 53660
4330028 DILATION URETHA, SUBSEQUENT               $      255.43 53661
4330029 DILATION, FAILED                          $     4,243.57 5228152
4330030 CONTIGEN TEST & SYRINGE                   $      117.88 95028
4330031 DEBRIDE SURGICAL WOUND                    $      483.94 11000
4330032 IMPLANT PERCUTANEOUS                      $     5,082.69 64561
4330033 IMPLANT REPROGRAMING                      $      558.68 9597258
4330034 CYSTOMETRY, SIMPLE                        $     1,423.61 51725
4330035 CYSTO W/ DILATION URETHRA STRT            $     4,243.57 52281
4330036 EXCISE URETHRAL LESION                    $      330.44 53260
4330037 ECC                                       $      549.18 57505
4330038 IUD-INSERTION                             $      182.08 58300
4330039 IUD-REMOVAL                               $      549.18 58301
4330040 LEEP                                      $     6,800.20 57522
4330041 TRNSVAGINAL SCAN                          $      433.07 76830
4330042 VAGINAL BIOPSY                            $     1,055.59 57100
4330043 SALINE INTRO FOR HYSTEROSONOGR            $      115.26 58340
4330044 PROCEDURE TRAY                            $      330.07
4330045 THERAPEUTIC INJ SC IM                     $      250.75 90772
4330046 WET MOUNT                                 $       81.58 87177
4330047 ULTRASOUND, PELVIC NON-OB COM.            $      896.91 76856
4330048 ULTRASOUND, TRANSVAGINAL                  $      794.58 76830
4330049 SONOHYSTEROGRAM                           $      942.30 76831
4330050 VENIPUNCTURE                              $       49.21 36415
4330051 XRY-HYSTEROSALPNG SI                      $     1,299.55 74740
4500001 DLYS ACUTE HEMODIALYSIS                   $     2,234.70 90935
4500004 TCU HEMODIALYSIS                          $     2,234.70
4500005 TCU PERITONEAL DIALYSIS                   $     2,234.70
4500006 ACUTE PERITONEAL DIALYSIS                 $     2,234.70
4505002 OUTPATIENT HEMODIALYSIS                   $     2,234.70 90935
4505005 IV INFUSION THERAPY 1ST HR                $      615.80 90765
4505006 IV INFUSION THERAPY EA ADDL HR            $      134.30 90766
4505007 UNSCHEDULED/EMERGENCY DIALYSIS            $     1,716.99 G0257
4540100 CONTINUOUS VENOUS HEMODIALYSIS            $     6,795.75 90947
4600101 YAG DISCISSION A-CATARACT MEM*            $     1,530.34 66821
4600103 AR/KR/YG SEVER VITREOUS STRAN*            $     2,445.59 67031
4600104 YAG    IRIDOTOMY        *                 $     3,140.60 66761
4600105 ARG/KRYP IRIDOTOMIES        *             $     3,140.60 66761
4600106 ARG/KRYP TRABECULOPLASTY        *         $     1,530.34 65855




                                            Page 232
                                         Ancillary


4600110 ARG/KRYP DESTRUCTION RETINA *          $     1,306.65 67210
4600111 ARG/KRYP DESTRUCT RETINOPATHY*         $     1,959.98 67228
4600114 ARG/KRYP ANTERIOR SMGNT EYE *          $     2,675.22 66999
4600301 PERIMETRY VFS LTD W/O READING*         $      299.00 92081
4600303 PERIMETRY VFS INTMD W/O READ *         $      256.17 92082
4600305 PERIMETRY VFS COMPR W/O READ*          $      307.41 92083
4600510 FIBERLAYER PHO* OPTHAL NERVE           $      307.41 92286
4600511 SELECTIVE LASER TRABECULOPLSTY         $     1,530.34 65855
4600907 ARG/KRYP RETINAL DETACHMENT            $     3,910.58 68720
4610004 PNEUMOCARD 12HR 4 CHAN NICU            $     2,929.49 94772
4610005 PNEUMOCARD 12HR 5 CHAN NICU            $     2,929.49 94772
4610006 PNEUMOCARD 12HR 4 CHAN PICU            $     2,929.49 94772
4610007 PNEUMOCARD 12HR 5 CHAN PICU            $     2,929.49 94772
4610008 PNEUMOCARD 12HR 4 CHAN FLOOR           $     2,929.49 94772
4610009 PNEUMOCARD 12HR 5 CHAN FLOOR           $     2,929.49 94772
4610010 ACID REFLUX TEST                       $     1,259.39 91033
4610020 4N OBS CARE,PER HR DIR-ADMIT           $      258.11 G0379
4610021 PICU OBS CARE, PER HR DIR-ADMI         $      258.11 G0379
4610022 NICU OBS CARE, PER HR DIR-ADMI         $      258.11 G0379
4610100 4N OBSERVATION CARE,PER HOUR           $      614.70 G0378
4610101 PICU OBSERVATION CARE, PER HR          $      670.67 G0378
4610102 NICU OBSERVATION CARE, PER HR          $      128.80 G0378
4610103 PNEUMOCARD 12HR 4 CHAN NURSERY         $     2,929.49 94772
4610104 PNEUMOCARD 12HR 5 CHAN NURSERY         $     2,929.49 94772
4610105 CVCC < 5YRS NON-TUNNELED               $     2,193.25 36555
4610106 CVCC > 5YRS NON-TUNNELED               $     2,501.88 36556
4610107 PICC < 5YRS NO PORT OR PUMP            $     2,984.65 36568
4610108 PICC > 5YRS NO PORT OR PUMP            $     3,257.63 36569
4610109 CVCC COMPLETE NO PORT OR PUMP          $     2,400.08 36580
4610110 PICC COMPLETE NO PORT OR PUMP          $     2,506.35 36584
4640000 NEW PT. FOCUSED                        $      129.05 99201
4640001 NEW PT. EXPANDED                       $      140.68 99202
4640002 NEW PT. DETAILED                       $      185.80 99203
4640003 NEW PT. COMP                           $      232.80 99204
4640004 NEW PT. COMPLEX                        $      296.74 99205
4640005 EST. PT. FOCUSED                       $      129.05 99211
4640006 EST. PT. EXPANDED                      $      140.68 99212
4640007 EST. PT. DETAILED                      $      160.78 99213
4640008 EST. PT. COMP                          $      204.38 99214
4640009 EST. PT. COMPLEX                       $      291.00 99215
4640025 SUPPORT THERAPY - 20 TO 30 MIN         $       93.44 90804
4640026 SUPPORT THERAPY - 45 TO 50 MIN         $      266.72 90806
4640027 SUPPORT THERAPY - 75 TO 80 MIN         $      466.13 90808
4640028 NUTRITION THERAPY (IND) EA 15          $       49.50 97802
4640029 NUTRITION THERAPY (GRP) EA 30          $      148.50 97804
4640030 NUTRITION REASSES (IND) EA 15          $       41.25 97803
4640031 POSTOP FOLLOW-UP VISIT                 $      283.06 99024
4640131 INJ SCLER SOLN-SGL VEIN                $      219.24 36470
4640132 INJ SCLER SOLN;MULTI, SAME LEG         $      219.34 36471




                                         Page 233
                                        Ancillary


4700210 PICC LINE INSERTION < 5 YRS           $     2,984.65 36568
4700211 PICC INSERTION > 5 YRS                $     3,257.63 36569
4700212 NEW PT/OP LVL 3                       $      185.80 99203
4700213 NEW PT/OP LVL 3                       $      185.80 99203
4700214 NEW PT OP LVL 3-PAIN MGMT             $      185.80 99203
4700215 NEW PT/OP LVL 3-DIETARY               $      185.80 99203
4700216 ESTAB PT/OP LVL 3                     $      160.78 99213
4700217 ESTAB PT/OP LVL 3                     $      160.78 99213
4700218 NEW PT/OP LEVEL 1                     $      129.05 99201
4700219 NEW PT/OP LEVEL 2                     $      140.68 99202
4700221 ESTAB PT/OP LVL 3-PAIN MGMT           $      160.78 99213
4700222 ESTAB PT/OP LVL 3-DIETARY             $      160.78 99213
4700223 NEW PT/OP LEVEL 2                     $      140.68 99202
4700224 NEW PT/OP LEVEL 1                     $      129.05 99201
4700241 NEW PT/OP LVL 4                       $      232.80 99204
4700242 NEW PT/OP LVL 4                       $      232.80 99204
4700243 NEW PT/OP LEVEL 5                     $      296.74 99205
4700244 NEW PT/OP LVL 4-PAIN MGMT             $      232.80 99204
4700245 NEW PT/OP LVL 4-DIETARY               $      232.80 99204
4700246 NEW PT/OP LEVEL 5                     $      296.74 99205
4700250 FLUSH IMPLANTABLE PORTS               $      419.68 96523
4700251 BLOOD DRAW CENTRAL LINE               $       90.91 36415
4700252 CVC EXCHANGE                          $     4,852.43 36584
4700253 CVC REMOVAL                           $     2,073.13 36589
4700255 INSERTING PERIPHERAL IV'S             $      115.51 36000
4700256 RE-SUTURING                           $      689.72 17999
4700258 TRANSF BLOOD & BLOOD PRODUCTS         $     1,245.59 36430
4700259 DECLOTTING CENTRAL LINE               $      710.86 36550
4700260 ESTAB PT/OP LVL 4                     $      204.38 99214
4700261 ESTAB PT/OP LVL 4                     $      204.38 99214
4700262 ESTAB PT/OP LVL 2                     $      140.68 99212
4700263 ESTAB PT/OP LVL 5                     $      291.00 99215
4700264 ESTAB PT/OP LVL 4-PAIN MGMT           $      204.38 99214
4700265 ESTAB PT/OP LVL 4-DIETARY             $      204.38 99214
4700266 ESTAB PT/OP LVL 2                     $      140.68 99212
4700267 ESTAB PT/OP LVL 5                     $      291.00 99215
4700271 INJECTION - SC/IM                     $      100.00 90772
4700273 IV PUSH INITIAL                       $      270.35 90774
4700276 THERAPEUTIC PHLEBOTOMY                $      267.05 99195
4700278 NEW PT/OP LVL 1 PSYCH SOC             $      129.05 99201
4700279 NEW PT/OP LVL 2 PSYCH SOC             $      140.68 99202
4700280 ESTAB PT/OP LVL 1-PSYCH SOC           $      129.05 99211
4700281 NEW PT/OP LVL 3-PSYCH SOC             $      185.80 99203
4700282 ESTAB PT/OP LVL 3-PSYCH SOC           $      160.78 99213
4700284 NEW PT/OP LVL 4-PSYCH SOC             $      232.80 99204
4700285 ESTAB PT/OP LVL 4-PSYCH SOC           $      204.38 99214
4700286 ESTAB PT/OP LVL 2-DIETARY             $      140.68 99212
4700287 ESTAB PT/OP LVL 2-PAIN MGMT           $      140.68 99212
4700288 ESTAB PT/OP LVL 2-PSYCH SOC           $      140.68 99212




                                        Page 234
                                         Ancillary


4700289 ESTAB PT/OP LVL 5-DIETARY              $      291.00 99215
4700290 ESTAB PT/OP LVL 5-PAIN MGMT            $      291.00 99215
4700291 ESTAB PT/OP LVL 5-PSYCH SOC            $      291.00 99215
4700292 NEW PT/OP LVL 5-DIETARY                $      296.74 99205
4700293 NEW PT/OP LVL 5-PAIN MGMT              $      296.74 99205
4700294 NEW PT/OP LVL 5-PSYCH SOC              $      296.74 99205
4700301 NEW PT/OP LVL 1 PAIN MGMT              $      129.05 99201
4700302 NEW PT/OP LVL 1 DIETARY                $      129.05 99201
4700303 NEW PT/OP LVL 2 PAIN MGMT              $      140.68 99202
4700304 NEW PT/OP LVL 2 DIETARY                $      140.68 99202
4700316 COLPOSCOPY                             $      543.70 57452
4700317 COLPOSCOPY W/CERVICAL BIO              $      543.70 57454
4700319 LOOP ELECTRODE EXCISION PROC           $     6,800.20 57522
4700320 BIOPSY OF CERVIX                       $      950.04 57500
4700324 BIOPSY OF UTERUS LINING                $      384.62 58100
4700326 BIOPSY OF VAGINA                       $      950.04 57100
4700328 BIOPSY OF VULVA/PERINEUM               $      509.11 56605
4700331 I & D VULVA/PERINEUM                   $      942.94 56405
4700349 PERITONEAL LAVAGE                      $     1,132.42 49080
4700350 PARACENTESIS SUBSEQUENT                $      443.62 49081
4700371 SCREENING PAP CERV/VAG                 $       86.91 Q0091
4700381 BONE MARROW TRANSP-AUTOLOGOUS          $     2,107.88 38241
4701001 ESTAB PT/OP LVL 1                      $      129.05 99211
4701002 ESTAB PT/OP LVL 1                      $      129.05 99211
4701003 ESTAB PT/OP LVL 1-PAIN MGMT            $      129.05 99211
4701004 ESTAB PT/OP LVL 1-DIETARY              $      129.05 99211
4703000 IV INFUSION THERAPY 1ST HR             $      615.80 90765
4703009 CHEMO ANTI-NEOPL, SC/IM                $      261.27 96401
4703010 CHEMO IVP/INF 0-15 MIN INITIAL         $      539.45 96409
4703011 CHEMO INFUSION FIRST HOUR              $      845.90 96413
4703020 NON-CHEMO INF >8HRS VIA AMB PU         $      526.99 C8957
4703022 CHEMO INF,INTRACAV PERITONEAL          $      526.99 96445
4703023 CHEMOTHERAPY, INTO CNS                 $      526.99 96450
4703026 IV INFUSION THERAPY EA ADDL HR         $      134.30 90766
4703027 CHEMO INFUSION ADD-ON                  $      270.35 96415
4703029 CHEMO INF>8HRS VIA AMB PUMP            $      526.99 96416
4703030 IV INFUSION HYDRATION 1ST HOUR         $      615.80 90760
4704000 IV INFUSION HYDRATION 1ST HOUR         $      615.80 90760
4704001 IV INFUSION HYDRATION ADDL HR          $      134.30 90761
4704002 IV THERAPY SEQ FIRST HOUR              $      134.30 90767
4704005 CHEMO INF ADD/SEQ 1ST HOUR             $      351.20 96417
4706846 U/S GUIDANCE, VENOUS AC                $      507.15 76937
4708000 FLUSH IMPLANTABLE PORTS                $      419.68 96523
4708001 BLOOD DRAW FROM CENTRAL LINE           $       90.91 36415
4708003 INSERTING PERIPHERAL IV'S              $      115.51 36000
4708004 DECLOTTING CENTRAL LINE                $      710.86 36550
4708005 FLU INJECTION                          $       70.69 G0008
4708031 ESTAB PT/OP LVL 3                      $      160.78 99213
4708032 ESTAB PT/OP LVL 4                      $      204.38 99214




                                         Page 235
                                         Ancillary


4708033 INJECTION SC/IM                        $      100.00 90772
4708034 IV PUSH INITIAL                        $      270.35 90774
4708035 ESTAB PT/OP LVL 1                      $      129.05 99211
4708037 ESTAB PT/OP LVL 2                      $      140.68 99212
4708038 ESTAB PT/OP LEVEL 5                    $      291.00 99215
4708039 NEW PT/OP LEVEL 1                      $      129.05 99201
4708040 NEW PT/OP LEVEL 2                      $      140.68 99202
4708041 NEW PT/OP LVL3                         $      185.80 99203
4708042 NEW PT/OP LVL 4                        $      232.80 99204
4708043 NEW PT/OP LVL 5                        $      296.74 99205
4709000 IV INFUSION THERAPY 1ST HR             $      615.80 90765
4709009 CHEMO ANTI-NEOPL, SC/IM                $      261.27 96401
4709010 CHEMO PUSH                             $      539.45 96409
4709011 CHEMO INFUSION FIRST HOUR              $      845.90 96413
4709020 NON-CHEMO INF >8HRS VIA AMB PU         $      526.99 C8957
4709026 IV INFUSION THERAPY EA ADDL HR         $      134.30 90766
4709027 CHEMO INFUSION ADDL HOUR               $      270.35 96415
4709028 CHEMO HORMNL ANTI-NEOPL, SC/IM         $      100.00 90772
4709029 CHEMO INF>8HRS VIA AMB PUMP            $      526.99 96416
4709031 IV INFUSION HYDRATION ADDL HR          $      134.30 90761
4709032 IV THERAPY SEQ FIRST HOUR              $      134.30 90767
4709033 IV PUSH EA ADDL SEQUENTIAL             $      270.35 90775
4709035 CHEMO INF SEQ 1ST HOUR                 $      504.10 96417
4740424 BONE MARROW TRANSP-ALLOG DLI           $     5,591.43 38242
4740437 SPINAL FLUID TAP, DIAGNOSTIC           $     1,346.93 62270
4740446 BONE MARROW BIOPSY                     $      823.35 38221
4740453 FLU INJECTION                          $       70.69 G0008
4740455 TETANUS VACCINE IM                     $       89.07 90703
4740458 PNEUMOVAX ADMIN                        $       70.69 G0009
4819111 NEW PT/OP LVL 4                        $      232.80 99204
4819112 ESTAB PT/OP LVL 4                      $      204.38 99214
4819178 NEW PT/OP LEVEL 4                      $      232.80 99204
4819179 ESTAB PT/OP LEVEL 4                    $      204.38 99214
6526071 CVC REPAIR                             $     2,506.35 36576
4710110 MANDIBLE-SER 4VT                       $      580.29 70110
4710150 FACIAL BONES SERIES                    $      646.96 70150
4710160 NASAL BONES                            $      551.94 70160
4710220 PARANSL SINUS-CM                       $      538.41 70220
4710250 SKULL PARTIAL                          $      365.01 70250
4710260 SKULL SERIES                           $      826.56 70260
4710331 T-M JOINTS UNI                         $      432.61 70328
4711010 XRY CHEST 1 VIEW                       $      396.03 71010
4711020 XRY CHEST 2 VIEWS                      $      442.69 71020
4711021 XRY CHEST 3 VIEWS                      $      323.00 71022
4711022 XRY CHEST 4 VIEWS                      $      580.29 71030
4711025 CHEST AP LAT W OBLIS                   $      393.16 71022
4711036 NEEDLE LOCALIZATION BY X-RAY           $      693.90 77002
4711100 RIBS UNILATERAL                        $      482.29 71100
4711110 RIBS, BILATERAL                        $      579.32 71110




                                         Page 236
                                         Ancillary


4711120 STERNUM                                $      512.69 71120
4712040 SPINE CERVICAL LTD                     $      400.95 72040
4712050 CERVICAL, SERIES                       $      557.83 72050
4712070 SPINE THORACIC                         $      524.78 72070
4712100 SPINE LUMBAR LTD                       $      458.76 72100
4712110 SPINE LUMBOSACRAL                      $      748.03 72110
4712170 PELVIS                                 $      434.49 72170
4712200 SACRO-ILIAC PART                       $      242.88 72200
4712202 SACRO-ILIAC SER                        $      519.98 72202
4712220 COCCYX SACRUM                          $      616.62 72220
4713000 CLAVICLE                               $      343.25 73000
4713010 SCAPULA                                $      450.42 73010
4713030 SHOULDER SERIES                        $      510.65 73030
4713060 HUMERUS                                $      434.49 73060
4713070 ELBOW AP&LAT                           $      382.35 73070
4713080 ELBOW SERIES                           $      372.01 73080
4713090 FOREARM&JOINT                          $      400.95 73090
4713093 XRY-UP EXTRM INFANT MIN 2 VIEW         $      554.96 73092
4713100 WRIST AP & LAT                         $      305.53 73100
4713103 XR FINGER(S) 2-3 VIEWS                 $      343.11 73140
4713110 WRIST SERIES, 3 VIEWS                  $      476.42 73110
4713120 HAND 2 VIEWS                           $      356.30 73120
4713130 HAND SERIES                            $      459.20 73130
4713510 HIP UNI SERIES                         $      439.44 73510
4713520 HIPS BILATERAL                         $      732.45 73520
4713550 FEMUR AP&LAT                           $      414.51 73550
4713560 KNEE AP&LAT                            $      365.01 73560
4713570 KNEE SERIES                            $      521.39 73564
4713590 TIBIA FIBULA                           $      509.76 73590
4713600 XRAY - ANKLE                           $      374.47 73600
4713610 ANKLE SERIES                           $      514.14 73610
4713630 FOOT SERIES                            $      514.14 73630
4714000 X-RAY EXAM (1), ABDOMEN                $      333.57 74000
4714010 X-RAY EXAM SERIES (2), ABDOMEN         $      494.96 74020
4714011 X-RAY EXAM SERIES (3), ABDOMEN         $      477.38 74022
4714012 X-RAY EXAM SERIES(4), ABDOMEN          $      477.38 74022
4714240 UPPER GI AIR                           $      624.22 74246
4714245 UPPER GI SM BOWEL                      $     1,317.95 74245
4714250 SMALL BOWEL                            $     1,093.47 74250
4714270 BARIUM ENEMA                           $     1,042.16 74270
4714275 BARIUM ENEMA AIR CONTR.                $     1,245.13 74280
4714345 SOLUABLE CONTRAST                      $     1,245.13 74280
4716000 FLUROSCOPY UP TO 1 HR                  $     1,088.03 76000
4716060 METASTASTIC SURVEY                     $      621.16 77074
4716061 BONE MULTI MYELOMA                     $     1,313.16 77075
4716065 METASTASTIC SRVY CLD                   $      568.15 77076
4718057 CATH CHECK                             $     1,014.02 76499
4718058 CATH INSERTION                         $     1,102.07 76499
1500241 RT NEW PT/OP LVL 5                     $      296.74 99205




                                         Page 237
                                         Ancillary


1500263 RT ESTAB PT/OP LVL 5                   $       291.00 99215
1501005 RT ESTAB PT/OP LVL 2                   $       140.68 99212
1502100 RT CONT PHYSICS CNSLT - GK             $      1,138.50 77336
1502101 RT SPECIAL TX PROCEDURE - LSRS         $      2,213.75 77470
1502102 RT SPECIAL TX PROCEDURE - GK           $      3,162.50 77470
1502103 RT SPCL RAD PHYS CSULT IGRT            $      3,162.50 77370
1502104 RT SPCL RAD PHYS CSULT GK              $      4,427.50 77370
1502105 RT GK TREATMENT DELIVERY               $     33,825.00 77371
1502106 RT IGRT TX - 1ST SESSION               $      8,800.00 G0339
1502107 RT IGRT TX - SUBSEQUENT SESSIO         $      4,950.00 G0340
1502108 RT SPECIAL TX PROCEDURE - IGRT         $      2,087.25 77470
1502357 RT CONTIN PHYSICS CNSLT - IGRT         $       759.00 77336
1502365 RT CONTIN PHYSICS CNSLT - LSRS         $       759.00 77336
1502392 RT DOSIMETRY BASIC IGRT                $       948.75 77300
1502393 RT DOSIMETRY BASIC - LSRS              $       948.75 77300
1502394 RT DOSIMETRY BASIC - GK                $      1,581.25 77300
1502395 RT TELE-ISO TX PLN CPX IGRT            $      1,897.50 77315
1502396 RT TELE-ISODOSE TX PLN CPX GK          $      2,656.50 77315
1502397 RT TX DEVICE CPX - LSRS FRAME          $       632.50 77334
1502398 RT TX DEVICE CPX - GK FRAME            $      1,897.50 77334
1502460 RT 3-D SIMULATION - IGRT               $      4,271.70 77295
1502461 RT 3-D SIMULATION - LSRS               $      4,271.70 77295
1502462 RT 3-D SIMULATION - GK                 $      6,325.00 77295
1509000 CT RAD THERAPY                         $      2,159.03 77014
1509001 RT - INJECTION SC/IM                   $       162.67 90772
1509003 RT NEW PT/OP LVL 3                     $       185.80 99203
1509004 RT NEW PT/OP LVL 4                     $       232.80 99204
1509005 RT NEW PT/OP LVL 5                     $       296.74 99205
1509011 RT ESTAB PT/OP LVL 1                   $       129.05 99211
1509012 RT ESTAB PT/OP LVL 2                   $       140.68 99212
1509013 RT ESTAB PT/OP LVL 3                   $       160.78 99213
1509014 RT ESTAB PT/OP LVL 4                   $       204.38 99214
1509015 RT ESTAB PT/OP LVL 5                   $       291.00 99215
1509300 RT NEW PT/OP LVL 1                     $       129.05 99201
1509301 RT NEW PT/OP LVL 2                     $       140.68 99202
4728014 LOCM <149MG/ML IODINE, 1ML             $       333.26 Q9945
4728879 CT BRAIN WITH AND W/O                  $      3,222.90 70470
4728880 CT BRAIN LIMITED                       $      1,517.82 76380
4728881 CT BRAIN W/O CONTRAST                  $      2,085.92 70450
4728882 CT BRAIN WITH CONTRST                  $      2,761.35 70460
4731001 CT FACIAL & ORBITAL BONES              $      1,966.76 70486
4735000 CT ABDOMEN                             $      2,870.53 74150
4735001 CT ABDOMEN W/CONTRAST                  $      3,421.28 74160
4735002 CT ABDOMEN W/WOUT CONTRAS              $      3,876.96 74170
4735020 CT BIOPSY                              $      2,287.52 77012
4735040 CT C-SPINE                             $      2,983.65 72125
4735050 CT CHEST                               $      2,791.23 71250
4735051 CT CHEST W/CONTRAST                    $      3,412.19 71260
4735052 CT CHEST W/WOUT CONTRAST               $      3,978.47 71270




                                         Page 238
                                        Ancillary


4735080 CT - FACIAL BONES                     $     1,966.76 70486
4735081 CT FACIAL BONES W/CONTRAS             $     2,801.75 70487
4735140 CT HIPS                               $     2,554.90 73700
4735141 CT HIP W/IV                           $     2,912.95 73701
4735180 CT LUMBAR SPINE                       $     2,748.80 72131
4735181 CT - LUMBAR SPINE W/ CONTRAST         $     3,019.56 72132
4735200 CT LOWER EXTREMITY/SACRUM             $     2,554.90 73700
4735201 CT LOWER EXTREMITY W/CONT             $     2,621.43 73701
4735230 CT NECK                               $     1,674.39 70490
4735231 CT NECK W/CONTRAST                    $     3,080.72 70491
4735240 CT ORBITS                             $     2,346.72 70480
4735241 CT ORBITS W/CONTRAST                  $     1,906.30 70481
4735242 CT ORBITS W/WOUT CONTRAST             $     2,997.89 70482
4735270 CT PELVIS                             $     2,690.39 72192
4735271 CT PELVIS W/CONTRAST                  $     3,447.04 72193
4735272 CT PELVIS W/W/OUT CONTRAST            $     5,695.78 72194
4735320 CT SINISES                            $     1,966.76 70486
4735321 CT SINUSES W/CONTRAST                 $     2,801.75 70487
4735322 CT SINUSES W/WOUT CONTRAS             $     2,554.04 70488
4735340 CT THORACIC SPINE                     $     2,594.63 72128
4735341 CT - THORACIC SPINE W/CONTR           $     2,931.03 72129
4735350 CT UPPER EXTREMIT                     $     2,381.05 73200
4735351 CT UPPER EXTREMITY W/CONT             $     2,119.73 73201
4735400 CT RAD THERAPY                        $     1,675.78 77014
4735410 CT STEREOTACTIC RAD                   $     2,447.78 77011
4738883 CT SCAN RECONTRUCTION                 $     1,150.22 76376
4738887 CAT SCAN FOLLOW-UP STUDY              $     1,517.82 76380
4738900 CT C-SPINE W/CONTRAST                 $     2,530.00 72126
6513008 BONE MARROW TRAY                      $      344.64
6513048 ADULT LP TRAY                         $      633.45
6514013 TRAY GENERAL PURPOSE                  $      195.68
6516017 5-0 SUTURE                            $      113.85
6516019 3-0 SUTURE                            $      113.85
6516021 4-0 SUTURE                            $       95.83
6519370 CVC INSERTION KIT                     $      243.56
6527005 SOL D-5-W 500ML                       $      344.48
6527006 SOL D-5-W 250ML                       $      273.50
6527010 SOL IV D-10-W 1000M                   $      327.42
6527022 SOL IV D-5-.9% NACL 1000              $      327.42
6527045 RINGERS LACTATE 1000ML                $      327.42 J7120
6527050 RINGER'S 1000 ML SOL IV               $      328.22 J7120
6527054 SOL IV .9% NAC                        $      265.76
6527056 SOL IV .9% NACL 250 ML                $      222.01
6530102 D5W 5% 50CC                           $       73.17
6530103 D5W 5% 100 CC                         $       73.17 J3490
6530104 CATH FOL 30CC 18F                     $      167.70
6530105 URINARY DRAIN BAG                     $      139.76
4750003 LAB GLUCOS TOL 3H AU                  $      650.48 82951
4750018 CANCER ANTIGEN 27.29                  $      230.79 86300




                                        Page 239
                                        Ancillary


4750070 HEPATIC FUNCTION TEST                 $      342.93 80076
4750071 LAB - METABOLIC PANEL, COMP           $      685.97 80053
4750101 LAB CHOLESTEROL, SERUM, TOTAL         $      204.54 82465
4750120 LAB UREA NITRO SE AU                  $      204.54 84520
4750121 LAB SG OT SE AU                       $      204.54 84450
4750122 LAB SODIUM SE                         $      204.54 84295
4750130 LAB CALCIUM SE AU                     $      204.54 82310
4750131 LAB S G P T SE AU                     $      204.54 84460
4750132 LAB POTASSIUM SE AU                   $      204.54 84132
4750140 LAB BICARB-CO2 SE AU                  $      204.54 82374
4750141 LAB LDH SE AU                         $      263.55 83615
4750160 LAB CHLORIDE SE AU                    $      204.54 82435
4750172 LAB PROTEN TOT SE AU                  $      187.43 84155
4750180 LAB ALK PHOS SE AU                    $      217.35 84075
4750181 LAB URIC ACID SE AU                   $      204.54 84550
4750190 LAB CREATININE SE AU                  $      204.54 82565
4750191 LAB PHOSPHOR SE AU                    $      204.54 84100
4750210 RENAL FUNCTION PANEL                  $      466.50 80069
4750310 LAB - 2 HRS POST PRANDIAL GLU         $      204.54 82947
4750311 LAB - GLUCOSE-POC                     $      204.52 82947
4750340 LAB BASIC METABOLIC PANEL             $      391.97 80048
4750343 LAB ELECTROLYTES                      $      196.14 80004
4751131 LAB LIPID PANEL                       $      496.13 80061
4751143 LAB TRIGLYCERIDES                     $      249.90 84478
4751151 LAB MAGNESIUM SE SC                   $      217.35 83735
4751171 LAB BILIRU TOTAL ST                   $      204.54 82247
4751182 LAB ALBUMIN SE ST                     $      243.50 82040
4751195 LAB BILIRU FRAC ST                    $      204.54 82248
4751201 LAB METHOTREXATE                      $      263.55 80299
4751300 LAB - POC GLUCOSE                     $      204.54 82962
4752240 LAB PLATELT COUNT BL (MANUAL)         $      187.43 85032
4752298 LAB - CBC WITH MANUAL DIFF            $      253.89 85007
4754620 LAB URINALYSIS                        $      125.16 81002
4754650 LAB URINE MICRO SED                   $      187.74 81000
4755288 LAB - COMPLETE BLOOD COUNT            $      174.51 85027
4755291 LAB CBC WITH AUTO DIFF                $      253.91 85025
4755298 LAB - CBC WITH DIFF                   $      253.89 85007
4755510 LAB OCCULT BLOOD FEE                  $       79.70 82270
4758193 LAB CARCINOEMB AM SE                  $      417.90 82378
4758222 LAB CA 125                            $      127.27 86304
4758226 LAB PROSTATE SPEC ANTIGN              $      169.89 84153
4759002 LAB PROCESSING FEE X6                 $      348.10
4759100 LAB VENIPUNCTURE                      $       47.39 36415
4759120 LAB PRO TIME ROU PL                   $      194.46 85610
4759121 LAB PTT PL                            $      194.46 85730
4810011 PANITUMUMAB 10 MG                     $      349.25 C9235
4810017 ATROPINE 0.3MG/0.3ML                  $       39.36 J0460
4810028 AMINOCAPROIC ACID 5000 MG             $      343.64
4810030 FACTOR VIIA, RECOMBINANT 1MG          $     6,811.73 J7189




                                        Page 240
                                         Ancillary


4810046 DIGOXIN .5MG IV                        $        51.11 J1160
4810047 DEXAMETHASONE 4MG(O.25MGDU)TAB         $         5.98 J8540
4810058 GENTAMICIN 80MG IV                     $        92.02 J1580
4810059 HEPARIN FLUSH 500 UNITS                $        86.48 J1642
4810064 INSULIN U-100 REG                      $        31.08
4810070 IRON SUCROSE 1MG IV                    $         1.55 J1756
4810089 D 10 W                                 $          -
4810095 PENICILN-G K 5 MU IV                   $       150.98 J2540
4810140 EPINEPHRINE 1:1000                     $        57.50 J0170
4810142 DOXORUBICIN HCL 10MG IV                $        94.96 J9000
4810161 AMIKACIN 500MG IV                      $       378.92
4810170 AMPHOTERICIN 50MG IV                   $       113.96
4810209 NEW PT/OP LVL 1                        $       129.05 99201
4810210 NEW PT/OP LVL 2                        $       140.68 99202
4810211 NEW PT OP LVL 3                        $       185.80 99203
4810212 NEW PT/OP LVL 5                        $       296.74 99205
4810219 ESTAB PT/OP LVL 3                      $       160.78 99213
4810265 BLENOXANE 15 U IV                      $       529.06 J9040
4810290 CALCIUM GLUC 1GM/10ML IV               $        57.50 J0610
4810317 BLENOXANE TEST DOSE                    $       124.15 J9040
4810319 CETACAINE SPRAY                        $       401.24
4810333 CHLORPROMAX 50MG IV                    $        69.93
4810341 CIMETIDINE 300 MG IV                   $       175.05 S0023
4810346 CLINDAMYCIN 600MG IV                   $        25.00
4810350 COCAINE SOLN TOP                       $        74.64
4810389 COSYNTROPIN 0.25MG/1ML                 $       293.14 J0835
4810404 CYTARABINE 100MG IV                    $        25.00 J9100
4810410 DARBEPOETIN ALFA 1 MCG                 $        23.28 J0881
4810415 DACTINOMYCIN 500MCG IV                 $      3,918.00 J9120
4810445 DEFEROXAMINE 500MG IV                  $        81.39 J0895
4810479 DIPHENHYDRAM 25MG CAP                  $          -
4810480 DIPHENHYDRAM 50MG IV                   $         4.48 J1200
4810482 DIPHTHERIA/TETANUS                     $       129.83 90718
4810504 DACARBAZINE 100 MG IV                  $        76.30 J9130
4810508 DROPERIDOL 5 MG IV                     $       103.90 J1790
4810550 ESTRADIOL VALERATE 20 MG               $       129.47 J1390
4810562 FENTANYL 100 MCG IV                    $        83.87 J3010
4810581 FLUOROURACIL 500MG IV                  $        25.00 J9190
4810598 FUROSEMIDE 20MG IV                     $        78.83 J1940
4810602 GAMMA GLOBULIN 2 ML                    $       157.99
4810611 GEMTUZUMAB 5 MG IV                     $     19,338.00 J9300
4810625 HALOPERIDOL 5 MG IV                    $        78.83 J1630
4810632 HEPARIN 1,000U 1CC                     $        60.90 J1644
4810633 HEPARIN 5,000U .5CC                    $        76.91 J1644
4810652 HYDRALAZINE 20MG IV                    $       124.77 J0360
4810659 HYDROCORTISONE 100MG IV                $        81.79 J1720
4810675 FULVESTRANT 25MG IM                    $       655.71 J9395
4810694 IRON DEXTRAN (INFED) 50 MG INJ         $       130.24 J1751
4810719 IV FLUID 1000 CC NORMAL SALINE         $       242.92 J7030




                                         Page 241
                                         Ancillary


4810720 IV FLUID+20MCG KCL/SALIN1000ML         $      199.72 J3490
4810730 ESTRADIOL VAG RING 2 MG                $      221.22
4810741 KETAMINE 500MG IV                      $       57.74
4810746 INVESTIGATIONAL DRUG                   $         -
4810750 LACTATED RINGERS SOLN                  $         -
4810756 LEUCOVORIN 50MG IV                     $      180.24 J0640
4810757 POTASS PHOS 40 MEQ IV-ADD              $       57.50
4810761 LEVOFLOXACIN 250MG IV                  $      134.12 J1956
4810763 SODIUM CHLOR 0.9% IV-ADD               $         -     J7050
4810764 DEXTROSE 5%/WATER IV-ADD               $         -
4810768 LIDOCAINE JELLY 2% SYR                 $       41.02
4810788 MAGNESIUM CITRATE                      $         -
4810820 METHOTREXATE 5MG INJ                   $       25.00 J9250
4810827 METHYLPRED AC 80MG                     $       57.86 J1040
4810829 METHYLPREDNS 125MG IV                  $      201.75 J2930
4810875 HAEMOPHILUS B VACCINE                  $      147.74 90646
4810880 OPRELVEKIN 5 MG                        $     1,139.55 J2355
4810889 MITHRAMYCIN 2.5MG IV                   $      395.33 J9270
4810890 MITOMYCIN 5MG IV                       $      244.16 J9280
4810891 TYPHOID VACCINE 25 MCG IM              $      279.43 90690
4810894 TRASTUZUMAB INJ 10 MG                  $      250.27 J9355
4810901 MECHLORETHAMINE 10MG IV                $     1,886.33 J9230
4810903 MVI-RX                                 $      138.02
4810906 OXALIPLATIN 0.5 MG                     $       46.08 J9263
4810907 MYCOLOG CREAM 15GM                     $       55.77
4810912 MYLANTA II 15 ML                       $         -
4810919 NALOXONE 1MG                           $       54.26
4811005 ESTAB PT/OP LVL 1                      $      129.05 99211
4811006 ESTAB PT/OP LVL 2                      $      140.68 99212
4811007 ESTAB PT/OP LVL 5                      $      291.00 99215
4811010 ALBUMIN, HUMAN, 5% 12.5 GM             $      539.85 P9045
4811014 AMPICILLIN 500MG IV                    $       50.00 J0290
4811033 POTASSIUM CHLORIDE 2M EQ/ML            $        4.58 J3480
4811034 POTASS PHOS 40 MEQ IV                  $       57.50
4811059 PROCHLORPERAZINE 10 MG IV              $      115.62 J0780
4811066 PROMETHAZINE 50MG INJ                  $       84.34 J2550
4811070 PROPARACAINE 0.5% O.S.                 $       12.88
4811128 SODIUM BICARB 50ML IV                  $       78.83 J3490
4811134 METHYLPREDNS 40MG IV                   $       94.88 J2920
4811206 TETANUS IMMUNE GLOBULIN                $      396.00 J1670
4811220 THIOTEPA 15MG IV                       $      513.28 J9340
4811225 THROMBIN TOP 10,000U                   $      414.89
4811237 TOBRAMYCIN 80MG IV                     $      175.90 J3260
4811290 VINCRISTINE 1MG IV                     $      353.75 J9370
4811373 H-BIG 1ML                              $      992.32 C9105
4811380 TENIPOSIDE 50 MG IV                    $     1,198.00 Q2017
4811388 INSULIN U-100                          $       25.00
4811412 PNEUMOVAX VACCINE                      $      149.70 90732
4811464 ASPARAGINASE 10,000U                   $      308.09 J9020




                                         Page 242
                                         Ancillary


4811504 ALBUTEROL INHALER                      $      166.65
4811506 CALCITONIN 400U                        $      298.27 J0630
4811510 IPRATROPIUM INHALER                    $      365.50
4811538 BENZTROPINE 1MG IV                     $      128.24
4811539 CEFOXITIN 1 GM IV                      $      151.72
4811541 CISPLATIN 10MG IV                      $      329.71 J9060
4811678 ETHYL CHLORIDE SPRAY                   $      112.28
4811724 INFLUENZA VACCINE (>/=3 YRS OL         $       84.34 90656
4811730 ALTEPLASE 1 MG INJ                     $      355.57 J2997
4811757 CEFAZOLIN 500MG                        $      115.00 J0690
4811769 ERUTHROMYCIN 500MG IV                  $       42.39
4811789 IONTOPHORESIS 1 EACH                   $      397.27 97033
4811795 METOCLOPRMD 10 MG IV                   $      113.24 J2765
4811834 CARMUSTINE 100 MG IV                   $     2,032.94 J9050
4812192 BUPIVACAINE 0.5%                       $      134.96
4812196 BUSULFAN TABLET 2MG                    $       25.00 J8510
4812500 METRONIDAZOLE 500MG IV                 $      173.50
4812522 CYANOCOBAL 1000MCG                     $        3.39 J3420
4812658 DEXTROSE 50% IV                        $       25.00
4812669 DEXAMETHASONE SOD PHOS 1MG IV          $        7.57 J1100
4813002 FLOXURIDINE 500MG IV                   $      965.86 J9200
4813139 CEFOTAXIME 1 GM IV                     $      176.00 J0698
4813346 ANTITHYMOCYTE GLOBULIN 25 MG           $     2,483.18 J7511
4813474 SILVADENE CREAM 20GM                   $       22.25
4813480 HEPATITIS B VAC 1 ML                   $      256.06 90746
4813488 ACYCLOVIR 500MG IV                     $      421.12
4813518 TRANSDERMAL SCOP PATCH                 $       58.20
4813537 LEUCOVORIN 5MG TAB                     $      108.57 J8999
4813538 LEUCOVORIN 25MG TAB                    $      159.24 J0640
4813568 BACTRIM IV 20 ML                       $      198.65
4813571 CYCLOSPRON A 250 MG                    $      169.19
4813582 CEFUROXIME 750 MG                      $       91.86 J0697
4813589 ZOSTER IM GLOB 125U                    $     1,014.59 90396
4813599 GELFOAM 100                            $      145.44
4813625 STREPTOZOCIN 1GM IV                    $      817.31 J9320
4813666 POLIO VIRUS VACCINE                    $       75.77 90713
4813696 PHENYTOIN 50MG INJ                     $       38.28
4813699 LIDOCAINE W EPI                        $       50.00
4813711 SODIUM CHLORIDE 120MEQ                 $       37.31
4813721 METHOTREXATE 2.5 MG TAB                $       25.00 J8610
4813752 PENTAMIDINE 300 MG IV                  $      569.77 S0080
4813867 MANNITOL 20% 500ML                     $      165.77 J2150
4813967 IMIPENEM 250 MG INJ                    $      176.75 J0743
4813976 SODIUM BICARB 5% 500 ML                $      165.77 J3490
4813991 UROKINASE 5,000 U                      $      287.34 J3364
4814020 HYDROCORTISONE 50MG IV                 $       92.02
4814042 HYALURONIDASE 150U/ML                  $      115.50 J3470
4814101 HYDROMORPHONE 4MG IV                   $       74.93 J1170
4814307 LOMUSTINE 40MG CAP                     $       32.09




                                         Page 243
                                        Ancillary


4814308 LOMUSTINE 100MG CAP                   $       599.00
4814319 LORAZEPAM 2 MG IV                     $        94.60 J2060
4814341 MANNITOL 50ML                         $        78.83 J2150
4814361 MELPHALAN 2 MG TABLET                 $        12.27 J8600
4814376 MEPERIDINE 100MG IV                   $        25.00 J2175
4814562 MORPHINE 10MG IV                      $        50.00 J2270
4814563 MORPHINE 100 MG INJ                   $       163.80
4814570 MAGNESIUM SULFATE 500 MG              $        42.17 J3475
4814603 IMMUNE GLOBULIN 500MG IV              $       115.03 J1567
4814643 CEFOTETAN 1GM IV                      $       228.61
4814648 INTERFERON 1 MU ALFA-2B               $        25.00 J9214
4814649 INTERFERON 3 MU ALFA-2A               $       502.95 J9213
4814658 INERFERON GAMMA 1B 100MCG3MMU         $       865.95 J9216
4814660 DRONABINOL 5 MG CAP                   $       147.90 J1790
4814686 LIDOCAINE 1%                          $        50.00
4814694 LIDOCAINE 1% 5ML+EPI                  $       125.27 J3490
4814706 THIOSULFATE 1 GM IV                   $       111.91
4814714 FAMOTIDINE 20MG IV                    $       147.05 S0028
4814733 AZTREONAM 1 GM IV                     $       335.41
4814735 AZTREONAM 2 GM IV                     $       710.41
4814746 CEFTRIAXONE 250MG                     $        34.06 J0696
4814839 FACTOR 8 - 1 UNIT                     $        11.34 J7192
4814840 FACTOR-9 1 UNIT                       $         7.14 J7195
4814881 ETOPOSIDE 50 MG CAP                   $       121.80 J8560
4814895 CHLORHEX GLUC .12% PT                 $        14.77
4814896 ALEMTUZUMAB 10 MG                     $      3,630.45 J9010
4814898 LIDOCAINE 4% CREAM 5 GM               $        40.94
4814900 GELFOAM 18 PROSTCONE                  $       193.60
4814920 IFOSFAMIDE 1GM IV                     $       480.00 J9208
4814921 MESNA 200 MG IV                       $        80.00 J9209
4814935 MUPIROCIN 2% 15 GM                    $        68.07
4814951 CARBOPLATIN 50MG IV                   $       165.00 J9045
4814975 GANCICLOVIR 500 MG IV                 $       398.58 J1570
4815081 NYSTATIN POWDER                       $        94.00
4815297 PHYONADIONE 1 MG INJ                  $        78.83 J3430
4815394 PORFIMER SODIUM 75 MG                 $     14,581.61 J9600
4815416 PREDNISONE 5MG                        $         4.73 J7506
4815455 FLUCONAZOLE 200 MG INJ                $       423.99 J1450
4815525 BUPIVACAINE 0.25%                     $        35.30
4815528 BUPIVACAINE 0.5% + EPI                $       129.19 J3490
4815586 MITOXANTRONE 5MG INJ                  $      2,202.65 J9293
4815670 KETOROLAC 30 MG INJ                   $        98.50
4815672 KETOROLAC 15 MG INJ                   $        49.25 J1885
4815679 BCG LIVE                              $       693.49 J9031
4815681 HEPARIN FLUSH 100U                    $        60.90
4815721 IDARUBICIN 5 MG INJ                   $      3,825.64 J9211
4815735 ONDANSETRON 1MG INJ                   $        45.83 J2405
4815736 ONDANSETRON 8MG TAB                   $        75.02 Q0179
4815758 GM-CSF 50 MCG INJ                     $       195.00 J2820




                                        Page 244
                                         Ancillary


4815770 FILGRASTIM 300 MCG/ML VIAL 1 M         $      1,634.00 J1440
4815771 FILGRASTIM 480 MCG P                   $      2,603.70 J1441
4815786 CIPROFLOX 200 MG IV                    $       176.33
4815803 FENTANYL TTS 25MCG/H                   $        63.62
4815804 FENTANYL TTS 50MCG/H                   $       116.26
4815805 FENTANYL TTS 75MCG/H                   $       177.30
4815806 FENTANYL TTS 100MCG/H                  $       235.37
4815895 AMPICILLIN/SULBACTAM 1.5GM             $        60.63 J0295
4815920 FLUDARABINE 50MG IV                    $      3,499.30 J9185
4815937 HYDROMORPHONE 500 MG IV                $      2,270.24 J1170
4815949 FLUMAZENIL 1 MG IV                     $        76.24
4816001 MEDROXYPROGESTERONE 100MG              $       432.41
4816042 PAMIDRONATE 30MG IV                    $      1,217.58 J2430
4816048 LEUPROLIDE DEPOT 3.75MG                $      1,547.00 J1950
4816118 MUPIROCIN 2% I GM                      $        16.29
4816163 INTERLEUKIN-2 22M IU                   $     10,191.86 J9015
4816245 PACLITAXEL 30MG IV                     $       288.75 J9265
4816286 OCTROETIDE ACETATE 25 MCG              $        19.80 J2354
4816333 MIDAZOLAM 1 MG INJ                     $        45.32
4816364 ONDANSETRON 4MG TABLET                 $        49.75
4816371 MELPHALAN 50MG IV                      $     20,419.84 J9245
4816401 ENOXAPARIN 10 MG                       $       130.83 J1650
4816421 CEREZYME 1 UNIT`                       $        14.34 J1785
4816435 AZITHROMYHCIN 500 MG IV ADD            $       168.90 J0456
4816436 ZOLEDRONIC ACID 1 MG                   $      1,038.20 J3487
4816438 ARSENIC TRIOXIDE 1 MG IV               $       456.26 J9017
4816440 ERYTHROPOIETIN 1000 U                  $       103.29 J0885
4816488 CEFTAZIDIME 500 MG                     $        37.31 J0713
4816512 OXACILLIN SODIUM INJECTION             $        78.53 J2700
4816605 TRIMETREXATE 25MG                      $       582.62 J3305
4816607 ZOSYN 1.125 GM                         $        77.68 J2543
4816609 SUBCUTANEOUS INJECTION                 $       129.70
4816753 VINORELBINE 10MG IV                    $       620.70 J9390
4816796 MENINGOCOCCAL VACCINE 0.5ML            $       601.54 90733
4816834 CLADRIBINE 1 MG                        $       321.64 J9065
4817044 TRIAMCINOLONE 10 MG INJ                $       135.29 J3301
4817156 PEGASPARGASE 3750 IU INJ               $      6,570.71 J9266
4817158 VINBLASTINE 1MG INJ                    $        64.38 J9360
4817220 DEXRAZOXANE 250 MG IV                  $      1,392.09 J1190
4817230 ASCORBIC ACID 500MG IV                 $        57.50
4817359 DEXTROSE 5% WATER                      $        62.58 J7060
4817366 ERVINA L-ASPARAG 10,000 V              $       715.40 J9020
4817370 GEMCITABINE 200 MG IV                  $      1,025.70 J9201
4817372 GRANISETRON 1 MG TAB                   $       323.74 Q0166
4817374 HEPATITIS A VACCINE                    $       319.61 90632
4817384 SODIUM CHLORIDE 3%                     $       243.13
4817388 TOPOTECAN 4 MG IV                      $      3,685.94 J9350
4817389 DOCETAXEL 20 MG IV                     $      2,731.61 J9170
4817395 AMIFOSTINE 500 MG IV                   $      3,212.51 J0207




                                         Page 245
                                         Ancillary


4817401 IRINOTECAN 20MG                        $      1,012.51 J9206
4817532 GRANISETRON 100MCG INJ                 $       105.92 J1626
4817820 SODIUM CHLOR 0.9%                      $        62.58 J7050
4817901 SOD FERRIC GLU 12.5MG IV               $        70.35 J2916
4818000 BORTEZOMIB 0.1 MG                      $       266.38 J9041
4818001 PALONOSETRON 0.025MG                   $       122.82 J2469
4818002 PAIN EASE MIST SPRAY                   $        36.61 J3490
4818004 HUMAN PAPILLOMAVIRUS VACC(HPV)         $       528.00 90649
4818005 PALIFERMIN 0.05MG IV                   $       342.29 J2425
4818007 HERPES ZOSTER VIRUS VACCINE            $       632.58 90736
4818009 DECITABINE 1 MG                        $       106.98 J0894
4818010 CIDOFOVIR 375 MG IV                    $     10,038.84 J0740
4818137 RITUXIMAB 100MG INJ                    $      2,384.88 J9310
4818402 ETANERCEPT 25MG/ML                     $      1,119.41 J1438
4818591 EPIRUBICIN 2 MG IV                     $       325.23 J9178
4818873 LINEZOLID 200 MG IV                    $       328.87 J2020
4819000 PHARMACY SET-UP FEE                    $       660.00
4819001 INVESTIGATL DISP FEE PART A            $        87.92
4819010 INVESTIGATIONAL DISP FEE PARTB         $       262.31
4819100 CEFEPIME 500 MG IV ADD                 $       104.21 J0692
4819101 CEFOTETAN 500 MG IV ADD                $       200.29
4819103 GOLYTELY 4000 ML SOLN                  $        28.84 J8499
4819110 INFLIXIMAB 10 MG IV                    $       216.72 J1745
4819114 PEGFILGRASTIM 6 MG INJ                 $     10,744.80 J2505
4819115 VORICONAZOLE 200 MG IV                 $       558.65
4819117 ETOPOSIDE 10 MG                        $        96.17 J9181
4819126 EMLA CREAM 5 GM                        $        37.22
4819127 PEMETREXED 10 MG IV ADD                $       199.32 J9305
4819128 BEVACIZUMAB 10 MG IV ADD               $       453.75 J9035
4819129 CETUXIMAB 10 MG IV ADD                 $       238.98 J9055
4819133 LACTATED RINGERS 1040 ML               $        52.15
4819137 AZACITIDINE 1 MG                       $        19.39 J9025
4819138 CYCLOPHOSPHA NONLYO 100MG IV           $        25.00 J9070
4819139 TEMOZOLOMIDE 5 MG CAPSULE              $        15.69 J8700
4819140 AMBUL PUMP REFILL /MAINT-CHEMO         $       471.50 96521
4819141 PROVIDE CHEMOTHERAPY AGENT             $       396.73 96549
4819150 DENILEUKIN DEFTITOX 300 MCG IV         $     18,449.76 J9160
4819151 INVESTIGATIONAL DISP FEE PARTC         $       287.49
4819152 LEVOTHYROXINE 200 MCG                  $       198.65
4819155 DALTEPARIN 2500 INT'L UNITS            $       527.43 J1645
4819156 ADALIMUMAB 20 MG                       $      1,389.93 J0135
4819160 ERTAPENEM 500 MG                       $       338.18 J1335
4819161 DIPHTHERIA TP VACCINE 0.5ML            $       111.81 90701
4819162 APREPITANT 80 MG (5MG DU)              $       199.23 J8501
4819163 APREPITANT 125 MG (5MG DU)             $       283.00 J8501
4819164 PROPOFOL 200 MG (200ML DU)             $       139.07 J3490
4819165 FENTANYL TTS PATCH 12MCG/HR            $        21.91 J3490
4819166 ACETYLCYSTEINE 10% INHALATION          $        24.34 J7608
4819167 GOSERELIN ACETATE IMPLANT              $      4,539.64 J9202




                                         Page 246
                                         Ancillary


4819168 SODIUM CHLORIDE INHALATION SOL                         J3490
4819169 ABRAXANE 1 MG DU                       $       57.73 J9264
4819170 CASPOFUNGIN 5MG DU                     $      123.45 J0637
4819171 INFLUENZA VACCINE (<3 YRS OLD)         $       84.34 90655
4819172 LEVONORGESTREL-RELEASING IUD           $     1,141.94 J7302
4819174 IRON DEXTRAN (DEXFER) 50MG INJ         $      292.64 J1752
4819176 DAPTOMYCIN 1 MG INJ                    $       39.95 J0878
4819177 PENTOSTATIN 10 MG DU/5 ML IV           $     7,987.27 J9268
4820140 SODIUM PHOS 40MEQ IV                   $      115.62
4820214 TESTOST ENAN 200 MG                    $      175.90 J3130
4820220 TETANUS TOXOID 0.5ML                   $       84.34
4820257 THIAMINE 100 MG IV                     $       76.27
4820451 PURIFIED PROTIEN DERIVATIV 5TU         $       69.97
4820464 DIAZEPAM 5MG INJ                       $       25.00 J3360
4820466 VANCOMYCIN 500MG IV                    $      175.90 J3370
4823716 DESMOPRESSIN 1 MCG                     $       42.68 J2597
4823728 DAUNORUBICIN HCL 10 MG                 $      548.01 J9150
4823934 AMBUL PUMP REFIL/MAINT-NONCHEM         $      471.50 96521
4823935 PREADMIN IV IMMUNOGLOBULIN             $      226.88 G0332
4824815 RANITIDINE 25MG INJ                    $       98.04 J2780
4824893 OCTREOTIDE LAR 1MG                     $      493.35 J2353
4825213 D10/0.9% NACL                          $         -
4827355 AMPHO B LIPID 10 MG                    $       87.22 J0287
4827363 DOXORUBICIN HCI 10 MG LIPIDS           $     3,283.10 J9001
4827381 RHO D 1MM GLOB 100U                    $       99.94 J2792
4840440 MYCOLOG OINT 15GM                      $       55.77
4910059 HEPARIN FLUSH 500 UNITS #25            $      316.22 J1642
4915681 HEPARIN FLUSH 100U #50                 $       52.67 J1642
4915682 CVC DRESSING TRAYS                     $       43.85
4915685 LUER ADAPTOR/BOX                       $      121.95
4915686 GLOVES, SHLDER/BOX                     $       54.62
4916422 HEPARIN FLUSH 1000U #10                $       60.90
4918000 CYTOTOXIC SPILL KIT                    $       88.25
4918003 PUMP DISCONNECT KIT                    $       48.04
4703028 CHEMO HORMONAL INTINEOPL, SC/I         $      100.00 90772
4704003 IV PUSH EA ADDL SEQUENTIAL             $      270.35 90775
4704004 CHEMO IVP/INF 0-15 MIN ADD/SEQ         $      336.06 96411
4709034 CHEMO IVP/INF 0-15 MIN ADD/SEQ         $      336.06 96411
4850043 IV ACTH / GNRH STIM TEST               $      100.00 90772
4850044 IV INFUSION THERAPY EA ADDL HR         $      134.30 90766
4850045 EXC, BEN LES < 15 LESIONS              $      290.88 11200
4850046 EXC LESION TRUNK/EXT <.5               $     1,263.57 11400
4850047 EXC LES TRUNK/EXT.6-1.0CM              $      433.13 11401
4850048 EXC LES SCLP/NECK/EXT <.5              $      618.83 11420
4850049 EX LESN SCP/NCK/EX .6-1.0              $     1,585.27 11421
4850050 PARACERVICAL BLOCK                     $       88.20 64435
4850051 POST COITAL TEST                       $      100.80 89300
4850052 ULTRASOUND,PELVIC, NON-OB              $      936.81 76856
4850053 ULTRND,PREG/UTERUS,LMTD                $      496.74 76815




                                         Page 247
                                         Ancillary


4850054 ULTRASOUND, TRANSVAGINAL               $      794.58 76830
4850055 ULTRASOUND, FOLLICLE                   $      496.74 76857
4850056 ARTIFICAL INSM/INTRA-CERV              $      279.42 58321
4850057 ARTIFICAL INSEM/INTRA- UT              $      362.84 58322
4850058 CATH/SALINE INTRO FOR HSG              $      341.96 58340
4850059 CERVICAL DILATION                      $      110.88 57800
4850060 ENDOMETRIAL BIOPSY                     $      384.62 58100
4850061 HYSTEROSON W/WO COLOR DOP              $      942.30 76831
4850062 NEW PATIENT - LEVEL 1                  $      129.05 99201
4850063 NEW PATIENT - LEVEL 2                  $      140.68 99202
4850064 NEW PATIENT - LEVEL 3                  $      185.80 99203
4850065 NEW PATIENT - LEVEL 4                  $      232.80 99204
4850066 NEW PATIENT - LEVEL 5                  $      296.74 99205
4850067 EST. PATIENT - LEVEL 1                 $      129.05 99211
4850068 EST. PATIENT - LEVEL 2                 $      140.68 99212
4850069 EST. PATIENT - LEVEL 3                 $      160.78 99213
4850070 EST. PATIENT - LEVEL 4                 $      204.38 99214
4850071 EST. PATIENT - LEVEL 5                 $      291.00 99215
4850077 VENIPUNCTURE                           $       49.21 36415
4850078 GLUCOSE TOLERANCE                      $      650.48 82951
4850079 IM INJECTION                           $      100.00 90772
4850080 SEMEN ANALYSIS                         $      158.76 89310
4850081 SPERM ISOL/PREP ART. INSM              $      264.60 89260
4850082 BETA HCG, QUANT. (BHCG)                $      246.52 84703
4850083 ESTRADIOL (EST2)                       $      140.77
4850084 PROGESTERONE (PRG)                     $      123.06
4850085 SONOHYSTOGRAM CATHETER                 $       89.98
4850086 INSEMI-CATHETER                        $       57.50
4850087 SHEPARD INTRAUTERINE INSEM.            $       75.41
4850088 MEDIA FOR IUI                          $       79.11
4851000 PROCEDURE TRAY                         $      330.07
4851001 SCREENING PAP CERV/VAG                 $       86.91 Q0091
4900001 ENTEROSTOMAL OP VISI                   $      129.05 99211
4900005 ET ESTABLISHED PATIENT LEVEL 2         $      129.05 99211
4900006 ET ESTABLISHED PATIENT LEVEL 3         $      160.78 99213
4900030 CHEMICAL CAUTERIZATION/TISSUE          $      294.00 17250
4900031 UNNA PASTE BOOT                        $      165.96 29580
4900032 DEBRIDEMENT,SKIN PARTIAL THICK         $      299.15 11040
4900033 DEBRIDEMENT,SKIN FULL THICKNES         $      414.65 11041
4900034 DEBRIDEMENT,FULL SKIN & SQ             $      526.30 11042
4900035 DEBRIDEMENT,FULL SKIN SQ/MUSCL         $     1,145.76 11043
4900036 PARING OR CURETTEMENT 1 LESION         $      110.25 11055
4900037 PARING OR CURETTEMENT 2-4 LESI         $       99.52 11056
4900038 PARING OR CURETTEMENT 4> LESIO         $      112.93 11057
4900039 DEBRIDEMENT/NAILS ANY METH 1-5         $      173.25 11720
4900040 DEBRIDEMENT/NAILS ANY METH > 6         $      125.90 11721
4900042 CULTURE ANY SOURCE                     $      284.83 87070
4900043 POST-OP FOLLOW UP VISIT                $      135.02 99024
4900200 FACILITY FEE/NEW PATIENT               $      129.05 99201




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                                         Ancillary


4900201 FACILITY FEE/ESTAB PATIENT             $      129.05 99211
5010060 I&D ABSCESS                            $      555.24 10060
5010061 I & D ABSCESS COMPL/MULTI              $      555.24 10061
5010080 I&D PILONIDAL CYST                     $      555.24 10080
5010081 PILONIDAL CYST COMPLEX                 $     3,619.77 10081
5010120 REMOVAL FB SQ SIMPLE                   $      636.64 10120
5010140 I&D HEMATOMA                           $     2,264.79 10140
5010160 PUNCTURE ASPIRATION CYST               $      334.49 10160
5011000 DEBRIDE INFECTED SKIN <10%             $      629.13 11000
5011042 DEBRIDE SKIN SQ TISSUE                 $      684.19 11042
5011720 DEBRIDE NAILS 1-5                      $      225.23 11720
5011730 AVULSION NAIL PLATE FIRST              $      328.53 11730
5011740 SUBUNGUAL HEMATOMA EVAC                $      198.66 11740
5011760 REPAIR NAIL BED                        $      516.31 11760
5011765 WEDGE EXCISON SKIN NAIL FOLD           $      501.27 11765
5012001 SIMPLE LAC REPAIR UP TO 2.5 CM         $      572.68 12001
5012002 SIMPLE LAC REPAIR 2.6-7.5 CM           $      572.68 12002
5012004 SIMPLE LAC REPAIR 7.6-12.5 CM          $      572.68 12004
5012005 SIMPLE LAC REPAIR 12.6-20.0 CM         $      572.68 12005
5012006 SIMPLE LAC REPAIR 20.1-30.0 CM         $      572.68 12006
5012007 SIMPLE LAC REPAIR OVER 30.0 CM         $      572.68 12007
5012011 SIMPLE LAC REPAIR UP TO 2.5 CM         $      572.68 12011
5012013 SIMPLE LAC REPAIR 2.6 - 5.0 CM         $      572.68 12013
5012014 SIMPLE LAC REPAIR 5.1 - 7.5 CM         $      572.68 12014
5012015 SIMPLE LAC REPAIR 7.6-12.5 CM          $      572.68 12015
5012016 SIMPLE LAC REPAIR 12.6-20.0 CM         $      572.68 12016
5012021 WOUND DEHISCENCE PACKING               $      614.12 12021
5012031 INTERM LAC REPAIR UP TO 2.5 CM         $      643.01 12031
5012032 INTERM LAC REPAIR 2.6-7.5 CM           $      643.01 12032
5012034 INTERM LAC REPAIR 7.6-12.5 CM          $      643.01 12034
5012035 INTERM LAC REPAIR 12.6-20.0 CM         $      643.01 12035
5012041 INTERM LAC REPAIR UP TO 2.5 CM         $      643.01 12041
5012042 INTERM LAC REPAIR 2.6-7.5 CM           $      643.01 12042
5012044 INTERM LAC REPAIR 7.6-12.5 CM          $      643.01 12044
5012051 INTERM LAC REPAIR UP TO 2.5 CM         $      643.01 12051
5012052 INTERM LAC REPAIR 2.6-5.0 CM           $      643.01 12052
5012053 INTERM LAC REPAIR 5.1-7.5 CM           $      643.01 12053
5012054 INTERM LAC REPAIR 7.6-12.5 CM          $      643.01 12054
5012055 INTERM LAC REPAIR 12.6-20.0 CM         $      643.01 12055
5013100 COMPLEX REPAIR 1.1 TO 2.5 CM           $     1,423.92 13100
5013101 COMPLEX REPAIR 2.6 TO 7.5 CM           $     1,423.92 13101
5013102 CMPLX REPAIR TRUNK @ADD 5CM            $      643.01 13102
5013120 COMPLEX REPAIR 1.1 TO 2.5 CM           $      643.01 13120
5013121 COMPLEX REPAIR 2.6 TO 7.5 CM           $      643.01 13121
5013122 CMPLX RPR HEAD/EXTR @ADD 5CM           $      643.01 13122
5013131 COMPLEX REPAIR 1.1 TO 2.5 CM           $      643.01 13131
5013132 COMPLEX REPAIR 2.6 TO 7.5 CM           $      643.01 13132
5013133 CMPLX RPR FACE/HANDS @ADD 5CM          $      643.01 13133
5013150 COMPLEX REPAIR UNDER 1.0 CM            $     1,423.92 13150




                                         Page 249
                                         Ancillary


5013151 COMPLEX REPAIR 1.1 TO 2.5 CM           $     1,423.92 13151
5013152 COMPLEX REPAIR 2.6 TO 7.5 CM           $     1,423.92 13152
5013153 CMPLX RPR EYELID @ADD 5CM              $      643.01 13153
5016000 BURN INIT RX 1ST DEGREE                $      217.14 16000
5016020 BURN DRESSING SMALL                    $      322.88 16020
5016025 BURN DRESSING MEDIUM                   $      331.49 16025
5016030 BURN DRESSION LARGE                    $      803.59 16030
5016035 ESCHAROTOMY, INITIAL                   $     1,812.83 16035
5016036 ESCHAROTOMY, @ ADD INCISION            $     1,812.83 16036
5020103 EXPLORE PENE WOUND EXTREMITY           $      937.81 20103
5020520 REMOVE FB MUSCLE SIMPLE                $     1,100.02 20520
5020600 INJECT SMALL JT/BURSA/GANGLION         $      406.91 20600
5020605 INJECT INTERM JT/BURSA/GANGLIO         $      491.00 20605
5020610 INJECT MAJOR JT/BURSA/GANSLION         $      822.82 20610
5021310 NASAL FX W/O MANIPULATION              $      289.51 21310
5021315 NASAL FX W/O STABILIZATION             $      838.77 21315
5021450 CLOSED TX MANDIBLAR FX WO MANI         $      562.72 21450
5021451 CLOSED TX MANDIBLAR FX W MANIP         $     1,895.36 21451
5021480 TM JOINT DISLOCATION                   $      562.49 21480
5022999 MANUAL REDUC ABD HERNIA                $      275.49 22999
5023330 FB SQ SHOULDER                         $      929.78 23330
5023605 HUMERAL NECK FX W/MANIP                $      538.22 23605
5023620 HUMERAL FX WO MANIPULATE CLOSE         $      538.24 23620
5023650 SHOULDER DISLOCATION                   $      620.70 23650
5023931 I&D UPPER ARM/ELBOW BURSA              $     3,555.27 23931
5024505 HUMERAL SHAFT FX W/ MANIP              $     3,019.57 24505
5024535 FX HUMERAL W MANIPULATION              $      857.66 24535
5024600 ELBOW DISLOCATION                      $      538.12 24600
5024640 RADIAL HEAD SUBLUXATION                $      699.69 24640
5024650 RADIAL HEAD/NECK FRACTURE              $     1,176.34 24650
5025560 RAD/ULNAR SHAFT FX WO MANIP            $     1,406.97 25560
5025605 DIST RAD/COLLES FX W MANIP             $     1,148.02 25605
5025660 CLOSED TX CARPAL DISLOC W/MANI         $      466.40 25660
5026010 I&D ABSCESS FINGER SIMPLE              $      555.24 26010
5026011 I&D ABSCESS FINGER COMPLICATED         $     3,321.69 26011
5026418 REV/REP EXTEN TENDON FINGER            $     3,133.69 26418
5026605 CLOSED TX METACARPAL FX W/MA @         $     1,021.02 26605
5026700 METACARPOPHLANGEAL DISLOCATION         $      538.19 26700
5026720 FINGER SHAFT PROX FX                   $      768.43 26720
5026725 FINGER PROX/MID FX MAN REDUCT          $      699.67 26725
5026742 CLOSED TX ARTICULAR FX W MANIP         $      538.69 26742
5026750 FINGER DISTAL PHALANGEAL               $      898.29 26750
5026755 DIST PHALANGEAL FX W/MANIP             $      538.18 26755
5026770 INTERPHALANGEAL JT DISLOC              $      538.26 26770
5026951 AMPUTATION FINGER/THUMB                $     5,863.50 26951
5027200 COCCYGEAL FRACTURE                     $      885.51 27200
5027250 HIP DISLOCATION                        $     1,008.87 27250
5027372 FB KNEE/THIGH DEEP                     $     5,120.81 27372
5027550 KNEE DISLOCATION                       $     2,795.00 27550




                                         Page 250
                                         Ancillary


5027560 PATELLAR DISLOCATION                   $       538.23 27560
5027750 TIB/FIB FX SHAFT                       $      1,758.71 27750
5027752 FX TIBIAL SHAFT W MANIPULATION         $       715.88 27752
5027760 ANK MED MALLEOUS FX CLOSED             $      1,507.08 27760
5027762 FX MEDIAL MALLEOLUS W MANIPUL          $       698.92 27762
5027808 BIMALLEOLAR ANKLE FX CLOSED            $      1,788.47 27808
5027810 BIMALLEOLAR ANKLE FX CLD W/MAN         $      3,321.31 27810
5027816 TRIMALLEOLAR ANK FX W/O MAN            $      1,866.93 27816
5027818 TRIMALLEOLAR ANK FX W/MAN              $      3,244.14 27818
5027840 ANKLE DISLOCATION                      $       489.18 27840
5028190 FB REMOVE FOOT SQ                      $      1,575.09 28190
5028435 FX TALUS W MANIPULATION                $       530.24 28435
5028490 GREAT TOE FX                           $       630.43 28490
5028510 TOES 2-5 FX W/O MAINIP                 $       630.43 28510
5028515 TOES 2-5 FX W/MAINIP                   $       854.56 28515
5028630 METATARSAL-PHALANGEAL DISLOC           $       814.42 28630
5028660 INTERPHALANGEAL DISLOCATION            $       818.20 28660
5029086 CAST FINGER                            $       427.93 29086
5029105 APPLICATION, LONG ARM SPLINT           $       416.88 29105
5029125 APPLICATION, SHORT ARM SPLINT          $       415.79 29125
5029130 APPLICATION, FINGER SPLINT             $       322.26 29130
5029200 STRAPPING CHEST                        $       427.93 29200
5029240 STRAPPING, SHOULDER                    $       417.04 29240
5029260 STRAPPING, ELBOW/WRIST                 $       427.93 29260
5029280 STRAPPING HAND/FINGER                  $       418.92 29280
5029505 APPLICATION, LONG LEG SPLINT           $       418.94 29505
5029515 APPLICATION, SHORT LEG SPLINT          $       418.94 29515
5029530 STRAPPING, KNEE                        $       427.93 29530
5029540 STRAPPING ANKLE &/OR FOOT              $       427.93 29540
5029550 STRAPPING TOES                         $       427.93 29550
5029705 REMOVE/BIVALE CAST                     $       427.93 29705
5029730 CAST WINDOWING                         $       369.33 29730
5029740 CAST WEDGING                           $       427.93 29740
5030300 REMOVE INTRANASAL FB                   $       243.24 30300
5030901 ANT. EPISTAXIS SIMPLE                  $       372.78 30901
5030903 ANT. EPISTAXIS COMPLEX                 $       521.03 30903
5030905 POSTERIOR EPISTAXIS INITIAL            $       521.07 30905
5031500 ENDOTRACHEAL INTUBATION                $      1,020.78 31500
5031515 LARYNGOSCOPY, DIRECT ASPIRATIO         $      2,781.98 31515
5031603 TRACHEOSTOMY EMERGENT                  $      1,916.13 31603
5031605 TRACHEOSTOMY (CRICO)                   $      1,660.32 31605
5032000 THORACENTESIS                          $      1,156.16 32000
5032002 THORACENTESIS WITH TUBE INSERT         $      1,139.73 32002
5032020 TUBE THORACOSTOMY                      $      1,735.03 32020
5032160 THORACOSTOMY/CARDIAC MASSAGE           $      2,701.87 32160
5033010 PERICARDIOCENTESIS                     $      1,113.31 33010
5033210 TEMP TRANSVENOUS PACER                 $     15,168.96 33210
5036400 VENIPUN/IV <3YRS CENTRAL               $       225.65 36400
5036405 VENIPUN/IV SCALP UNDER 3 YRS           $        92.17 36405




                                         Page 251
                                         Ancillary


5036406 VENIPUN/IV <3YRS OTHER                 $        70.49 36406
5036410 VENIPUN/IV OVER 3 YRS                  $       108.31 36410
5036430 TRANSFUSION BLOOD/BLOOD COMPON         $      1,318.94 36430
5036540 COLLECT BLOOD IMPLANTED VAD            $        90.91 36540
5036555 CENTRAL VENOUS ACCESS <5 YEARS         $      2,851.22 36555
5036556 CENTRAL VENOUS ACCESS >5 YEARS         $      3,252.45 36556
5036600 APC-ARTERIAL PUNCTURE                  $       354.04 36600
5036620 ARTERIAL LINE INSERTION                $       440.64 36620
5036680 INTRAOSSEOUS NEEDLE INSERTION          $       538.68 36680
5040650 RPR LIP THRU&THRU/VERM BORDER          $      1,723.02 40650
5040800 DRAIN ABSCESS VEST MOUTH SIMP          $       562.72 40800
5040830 REPAIR VEST MOUTH <2.5 CM              $       903.71 40830
5041250 TONGUE LAC REPAIR UNDER 2.6 CM         $       995.82 41250
5041252 RPR TONGUE >2.5/COMPLEX                $      2,044.40 41252
5041800 I&D ABCESS/CYST DENTOALVEOLAR          $       555.24 41800
5042700 I&D ABSCESS PERITONSILAR               $       995.82 42700
5042809 FB THROAT REMOVAL                      $       860.42 42809
5043460 ESOPHAGOGASTRIC TAMPONADE BALL         $      1,404.50 43460
5043752 NG TUBE PLCD BY MD INCLD FLURO         $       427.99 43752
5043760 GASTROSTOMY TUBE CHANGE                $       846.47 43760
5043761 REPOSITION GASTRIC FEEDING TUB         $      1,867.24 43761
5045999 RECTAL PROLAPSE MAN REDUC              $       970.23 45999
5046040 ABSCESS ISCHOIO/PERIRECTAL             $      5,162.88 46040
5046050 I&D PERIANAL ABSCESS                   $      2,061.84 46050
5046083 INC THROMBOSED HEMORRHOID EXT          $       202.94 46083
5046320 HEMORRHOID ENUC/EXC                    $       809.12 46320
5046600 ANOSCOPY DIAGNOSTIC                    $       192.40 46600
5046608 ANOSCOPY FB REMOVAL                    $      2,541.00 46608
5049080 PERITONEAL LAVAGE/PARCENTESIS          $      1,472.14 49080
5050000 FACILITY LEVEL 1                       $       447.06 99281
5050005 FACILITY LEVEL 2                       $       610.91 99282
5050007 FACILITY LEVEL 3                       $      1,311.02 99283
5050010 FACILITY LEVEL 4                       $      3,670.81 99284
5050015 FACILITY LEVEL 5                       $      4,064.08 99285
5050018 FACILITY LEVEL 6                       $      4,588.50 99291
5050019 CRITICAL CARE, EA ADDL 30 MIN          $      1,835.40 99292
5050022 OBSERVATION, PER HOUR                  $       128.80 G0378
5050026 OBS, PER HR DIR-ADMIT                  $       258.11 G0379
5050050 TRAUMA, LOW LEVEL RESPONSE             $      4,867.97 G0390
5050051 TRAUMA, MID LEVEL RESPONSE             $     11,357.46 G0390
5050052 TRAUMA, HIGH LEVEL RESPONSE            $     14,602.44 G0390
5050092 INTUBATION TRAY - DIFFICULT            $       396.88
5050094 ADHESIVE REPAIR SUPPLY                 $        75.02
5051700 BLADDER IRRIGATION                     $       436.04 51700
5051701 STRAIGHT CATHERIZATION                 $       364.41 51701
5051702 INSERT FOLEY CATH SIMPLE               $       364.41 51702
5051703 INSERT FOLEY CATH COMPLICATED          $       624.26 51703
5054700 I&D TEST/SCROTUM EPIDIDYMIS            $      6,052.34 54700
5056405 I&D PERINEAL ABSCESS                   $      1,176.36 56405




                                         Page 252
                                         Ancillary


5056420 I&D BARTHOLIN ABSCESS                  $      497.67 56420
5059300 EPISIOTOMY REPAIR                      $      860.91 59300
5059409 VAGINAL DELIVERY                       $     8,177.17 59409
5059414 PLACENTAL DELIVERY                     $     5,794.29 59414
5062270 SPINAL PUNTURE (LUMBAR), DIAG          $     1,751.01 62270
5064402 NERVE BLOCK FACIAL NERVE               $      467.34 64402
5064450 NERVE BLOCK PERIPHERAL                 $      585.81 64450
5065205 REMOVE FB CONJUNCT SUPERFIC            $      426.21 65205
5065222 REMOVAL CORNEAL FB W/SLIT LAMP         $      500.31 65222
5065435 RUST RING REMOVAL CONEAL               $      376.09 65435
5069000 I&D ABSCESS AURICLE SIMPLE             $      555.24 69000
5069020 I&D ABSCESS EXT AUD CANAL              $      555.24 69020
5069200 REMOVE FB EXTERNAL AUD CANAL           $      247.95 69200
5069210 REMOVAL OF IMPACTED CERUMEN            $      182.20 69210
5078495 FX TOE W MANIPULATION                  $      294.82 28495
5079065 CAST LONG ARM                          $      378.38 29065
5079075 CAST SHORT ARM                         $      335.63 29075
5079085 CAST GAUNTLET                          $      427.93 29085
5079365 CAST LONG LEG/THIGH TO ANKLE           $      657.51 29365
5079405 CAST SHORT LEG                         $      369.37 29405
5079425 CAST SHORT LEG WALKING                 $      348.35 29425
5080048 UNSCHEDULED/EMERGENCY DIALYSIS         $     2,232.09 G0257
5090465 IMMUNIZATION ONE<8 ID SQ IM            $       34.16 90471
5090471 IMMUNIZATION ONE GIVEN                 $       94.30 90471
5090472 IMMUNIZATION @ ADDITIONAL              $       34.16 90472
5090760 IV INFUSION HYDRATION 1ST HOUR         $      615.80 90760
5090761 IV INFUSION HYDRATION ADDL HR          $      134.30 90761
5090765 IV INFUSION THERAPY 1ST HR             $      615.80 90765
5090766 IV INFUSION THERAPY EA ADDL HR         $      134.30 90766
5090767 IV THERAPY SEQ FIRST HOUR              $      134.30 90767
5090768 IV INFUSION RX @ ADD HR ADD IV         $      292.66 90768
5090772 IM/SQ INJECTION                        $      100.00 90772
5090774 IV PUSH INITIAL                        $      270.35 90774
5090775 IV PUSH EA ADDL SEQUENTIAL             $      270.35 90775
5090787 IV PUSH INJECTION 1ST W/PROC           $      172.50 9077459
5090789 IV PUSH INJ EA ADD W/PROC              $      270.35 9076159
5090790 ED FACILITY LEVEL 1 W/PROC             $      447.06 9928125
5090791 ED FACILITY LEVEL 2 W/PROC             $      610.91 9928225
5090792 ED FACILITY LEVEL 3 W/PROC             $     1,311.02 9928325
5090793 ED FACILITY LEVEL 4 W/PROC             $     3,670.81 9928425
5090794 ED FACILITY LEVEL 5 W/PROC             $     4,064.08 9928525
5090795 ED FACILITY LEVEL 6 W/PROC             $     4,588.50 9929125
5091100 INTEST TUBE PLACE/MONITOR              $      412.30 91100
5091105 GASTRIC LAVAGE/INTUB OD                $      475.17 91105
5092002 EYE EXAM INTERMEDIATE                  $      383.71 92002
5092950 CPR                                    $     1,148.80 92950
5092953 TRANSCUTANEOUS PACE TEMP               $      105.66 92953
5092960 CONVERT ARRHYTHMIA                     $     3,587.51 92960
5092977 THROMBOLYSIS CORONARY                  $     1,349.85 92977




                                         Page 253
                                               Ancillary


5099143 MODERATE SEDATION <5YO 30 MIN                $      308.96 99143
5099144 MODERATE SEDATION >4YO 30 MIN                $      308.96 99144
5099145 MODERATE SEDATION @ ADD 15 MIN               $      121.00 99145
5099440 NEWBORN RESUSITATION                         $     1,329.66 99440
5090526 ER MINOR CRISIS EVAL                         $      249.78 90801
8009014 LAB FROZEN SECTION (310 B)                   $      377.63 88331
6810005 SOL IV NORMASOL                              $      244.52
6810007 SOL, IV DIANEAL-4.25-D 2000ML*               $      208.58
6811006 BINDER, SURG, UNIV 3-PANEL SM*               $      349.79
6811007 BINDER, SURG, UNIV 3-PANEL LG*               $      427.24
6811074 SUSPENSORY 0-16 NO STRAP LRG                 $      122.83
6811075 SUSPENSORY, 0-16 NO STRAP *                  $      122.83
6811076 SUPPORTER, SWIM CTN MED *                    $      307.41
6811077 SUPPORTER,SWIM NYL LRG                       $      128.06
6811102 PAD, BREAST CONTOUR *                        $       91.06
6811501 CATH TIEMAN 12FR                             $      296.49
6811504 CATH TIEMAN 24FR                             $      326.14
6811509 CATH FOLEY 3WAY 26FR 5CC                     $      329.44
6811531 PEZZER CATH 10FR                             $      154.03
6811535 PEZZER CATH 14FR                             $      128.36
6811644 STOMA WAFER W/ SURFIT FLANGE *               $      135.85
6811656 SUR OPQ DRAIN POUCH W/1-1/4 F*               $      125.15
6811904 DISP VACUUM EXTRACTOR                        $      234.84
6811905 CANNULA 02 PEDS                              $       71.74
6811919 NEEDLE BD SPINAL 22GX1-1/2                   $      112.21
6811924 ARTERIAL/VENOUS SET 18G            *         $      119.37
6811931 CVP CATH KIT 18G           *                 $      222.11
6811936 CATH PEDI FOLEY 10FR                         $      299.48
6811937 CATH PEDI FOLEY 8FR                          $      434.73
6811939 DOUBLE LUMEN HEMODIAL              *         $      388.92
6811956 CAST SHOE SMALL                *             $      285.10
6811960 CAST SHOE LARGE                *             $      259.17
6811961 TUBING,ARTERIAL DIAL-20 #7 15                $      679.26
6811989 SOL IV D 5% WATER 100CC                      $       60.97
6811991 CATH CENTRAL VENOUS NS                       $      320.45
6811999 CSR MISC SUPPLIES                            $         -
6813001 TRAY AMNIOCENTESIS                           $      611.42
6813009 PELVIC EXAM TRAY               *             $      452.61
6813011 TUBE CANTOR TRAY PED                         $      861.69
6813012 TUBE CANTOR TRAY ADULT                       $      650.20
6813014 CATH, TRAY "A"         *                     $      187.87
6813017 TRAY CIRCUMSION MOGEN                        $      509.52
6813018 ANES TRAY EPIDURAL 17GX3"          *         $      491.01
6813019 TRAY CIRCUMSION GOMCO                        $      389.21
6813023 TRAY CHEST TUBE INSERT                       $      412.27
6813029 TRAY DRESSING REG                            $      198.40
6813030 IRRIGATION SET CYSTO INTRMT                  $      271.37
6813031 EYE CARE DRESSING TRAY             *         $      654.05
6813033 CATH FOLEY                                   $      273.86




                                               Page 254
                                                Ancillary


6813034 CATHETER FOLEY 18FR                           $      301.25
6813035 TROCAR CATH 16FR NS                           $       98.35
6813036 TRAY URINARY 18FR                             $      526.59
6813040 TRAY URINARY 16FR                             $      287.01
6813042 IRR TRAY W/60CC PISTON SYRING*                $      260.07
6813043 CONTAINER URINE DRAINAGE                      $      400.09
6813048 LUMBAR PUNC TRAY, ADLT 20X3.5*                $      633.45
6813049 LUMBAR PUNC TRAY, INF 22GX1.5*                $      547.77
6813053 TRAY SUTURE #8030                             $      612.00
6813055 TRAY NASAL HEMORRHAGE #8018                   $     1,754.45
6813059 TRAY PARACENTESIS                             $     1,237.13
6813060 PELVIC TRAY                                   $      673.83
6813071 SIGMOID TRAY                                  $      465.80
6813074 SPINAL PUNCTURE REUS                          $      858.72
6813078 NEEDLE THORACENTESIS TURKEL                   $      106.47
6813079 TRAY THORACENTESIS W/NDL 16X3*                $      509.52
6813080 TRAY THORACENTESIS W/CATH           *         $      558.80
6813081 TRAY THORACOTOMY                              $     2,772.73
6813084 TRAY TRACHEOTOMY                              $     1,260.11
6813085 TRAY TRACHEOTOMY #8028                        $      454.93
6813088 TRAY UROLOGICAL                               $     2,036.98
6813090 VENOUS PRESSURE DISP                          $      858.35
6813092 TRAY UROLOGIST'S URETHRA OBS*                 $     1,016.18
6813099 PEDIATRIC CHEST TUBE                          $     1,203.35
6813101 TRAY PERINEAL VAGINAL                         $      851.00
6813106 TRAY SWAN-GANZ CATH CUSTOM                    $      580.56
6813107 TRAY CVP MONITORING                           $      339.20
6813108 TRAY CVP TPN DRESSING                         $      151.81
6813112 TRAY BIOPSY 100MM X 1.2 18G *                 $      722.89
6813114 CHEST TUBE INSERTION SUPPLE. *                $     1,300.46
6813115 ANES TRAY PUDENDAL         *                  $      268.32
6813121 ANES TRAY SPINAL 22G X 3.5"                   $      481.06
6813132 ADAPTER 18G                                   $       79.06
6813135 ADAPTER PIN, IV SET *                         $      102.20
6813143 CATH FOG ART EMBOL 5FR 80CM                   $      345.82
6813144 CATH FOG ART EMBOL 3FR 80CM                   $      410.87
6813148 CATH FOG ART EMBOL 7FR 80CM                   $      552.22
6813152 FILTER, BLOOD TRANSFUSION       *             $      237.57
6813156 CATH FOLEY 3WAY 22FR 30CC                     $      234.81
6813157 CATH FOLEY 3WAY 24FR 5CC                      $      234.81
6813158 CATH FOLEY 28FR 30CC                          $      167.70
6813162 CATH LUMBAR CAUDAL 20G X 36                   $      181.30
6813165 CATH ROBINSON 2-EYE 26FR                      $      122.84
6813166 CATH ROBINSON 2-EYE 30FR                      $      137.58
6813169 CATH SUPRAPUBLIC CYSTO 8F                     $      254.14
6813170 CATH THORACIC 36FR                            $      199.24
6813171 TRAY FOLEY CATH 18FR                          $      323.99
6813173 TRAY FOLEY CATH 16FR                          $      323.99
6813174 CATH TRAY PREP                                $      146.63




                                                Page 255
                                            Ancillary


6813178 CATH UMBIL VES 5FR                        $     218.02
6813179 CATH UMBIL VES 3.5FR                      $     218.02
6813181 CATH FOLEY 3WAY 18FR 30CC                 $     234.81
6813182 CATH FOLEY 3WAY 24FR 30CC                 $     352.96
6813183 CATH FOLEY 3WAY 26FR 30CC                 $     232.45
6813184 CATH MAHURKER TRAY                        $     780.60 C1752
6813185 CATH FOLEY 3WAY 16FR 30CC                 $     234.81
6813186 CATH FOLEY 3WAY 22FR 5CC                  $     321.98
6813187 CATH FOLEY 3WAY 18FR 5CC                  $     297.08
6813188 CATH FOLEY 30FR 30CC                      $     167.70
6813189 CATH FOLEY 24F 30CC                       $     167.70
6813190 CATH FOLEY 20FR 30CC                      $     167.70
6813191 CATH FOLEY 18FR 30CC                      $     167.70
6813192 CATH FOLEY 26FR 30CC                      $     167.70
6813193 CATH FOLEY 22FR 30CC                      $     167.66
6813195 CATH ROB-NEL 8FR                          $      67.08
6813196 CATH ROB-NEL 16FR                         $      67.08
6813197 CATH ROB-NEL 12FR                         $      67.08
6813198 CATH ROB-NEL 14FR                         $      67.08
6813200 CATH ROBINSON 2-EYE 20FR                  $     153.33
6813201 CATH ROBINSON 2-EYE 18FR                  $     153.33
6813205 CATH THORACIC 32FR                        $     260.84
6813206 CATH THORACIC 29FR                        $     260.84
6814012 URINOMETER                                $     433.64
6814013 TRAY INSTRUMENT GENERAL                   $     195.68
6814017 VAGINAL PREP SET                          $     218.23
6815019 PLASMA TRANSFER SET W/O NDL               $      63.54
6815200 PLEUR-EVAC, INFANT          *             $     797.80
6815201 PLEUR-EVAC, ADULT/PED           *         $     830.61
6815998 ORTHOPEDIC DEVICES/BH NS                  $        -
6815999 PROSTHETIC/ORTHOTIC                       $        -
6816013 SUTURE, SILK 3-0, KS, 30"                 $     108.16
6816015 SUTURE, SILK 3-0, SH, 18"                 $     170.35
6816017 SUTURE, SILK, OO, 30"                     $     113.85
6816019 SUTURE SILK 3-0 18                        $     113.85
6816020 SUTURE SILK 00 18                         $     113.85
6816021 SUTURE SILK 4-0 18                        $      95.83
6818013 FEEDING PLASTIC 8FR                       $      55.91
6818014 FEEDING PLASTIC 5FR                       $      55.91
6818015 FEEDING PLAST 8FR 42                      $      67.08
6818034 TUBE RECTAL 26FR                          $     179.69
6818038 TUBE RECTAL RUBBER 24FR                   $     184.47
6818039 TUBE RECTAL 30FR                          $     206.03
6819364 CERVICAL COLLAR                           $     201.25
6819365 CERVICAL COLLAR                           $     199.24
6819366 CERVICAL COLLAR                           $     239.10
6819367 CERVICAL COLLAR                           $     167.70
6821012 CATH,COUDE 14FR NS                        $     213.46
6821024 CATH FOLEY 16FR 5CC                       $     169.90




                                            Page 256
                                              Ancillary


6821025 CATH FOLEY 5FF 18FR                         $      169.90
6821026 CATH FOLEY 28FR 5CC                         $      301.25
6821028 CATH FOLEY 22FR 5CC                         $      169.90
6821029 CATH FOLEY 24FR 5CC                         $      169.90
6821031 CATH FOLEY 14FR 5CC                         $      169.90
6821033 CATH FOLEY 20FR 5CC                         $      155.73
6821035 CATH FOLEY 12FR 5CC                         $      169.90
6821040 CATH,COUDE 5CC,16FR                         $      213.46
6821042 CATH,COUDE 5CC,18FR                         $      232.86
6821044 CATH,COUDE 5CC,20FR                         $      159.67
6821098 CATH, SWAN-GANZ W/THROMBO 7F *              $      730.72
6821100 CATH TEXAS                                  $       59.90
6821103 CATH, TROCAR 28F          *                 $      531.87
6821106 TRAY UMBILICAL ARTERY                       $      546.24
6821138 UMBIL.ART.CATH 3.5NS                        $      103.96
6821139 UMBIL ART CATH 8FRNS                        $       63.54
6821140 TRAY TRACH CARE                             $      447.57
6821142 EPISTAXIX BALLOON                           $      209.17
6821150 CATH, COUDE 5CC 24FR                        $      109.60
6821151 MONITORING TRANSDUCER ARTERY                $      602.29
6821153 MONITORING TRANSDUCER VENOUS                $      599.46
6821154 MONITORING, KIT PRESS TRANSOU               $      385.30
6821158 CATHETER REPAIR KIT                         $      621.94
6821168 GUIDEWIRE                                   $      263.54 C1769
6822328 TRAY,TRANSFUSION NS                         $      522.28
6823003 HEIMLICH CHEST                              $       81.03
6823004 SUCTION, RESEVOIR J-P         *             $      349.79
6823005 PENROSE DRAIN 5/16 X 12                     $       67.08
6823006 TUBING,PENROSE DRAIN 1X36"                  $       71.16
6823007 TUBING,PENROSE DRAIN 3/4X12"                $       85.39
6823008 PENDROSE DRAIN 1 X 18                       $       59.90
6823009 TUBING,PENROSE DRAIN 5/16X12"               $       85.39
6823011 BILE BAG REG                                $      222.81
6823012 BILE BAG REG 19 OZ *                        $      222.81
6823016 DRAIN SET, UNDERWTR 2BTL/2MCC*              $      348.16
6823017 PLUER-EVAC CHEST SET                        $     1,079.41
6823018 URINARY DRAIN                               $      139.76
6823020 DRAINAGE BAG AIR SHIELD           *         $      227.59
6823039 URINE METER                                 $      253.57
6824048 SURGICEL                                    $      136.13
6824051 DRESSING, WET 4"X8" W/WATER *               $       91.06
6824052 DRESSING, WET 4"X8" W/SALINE *              $       95.83
6824082 DRESSING,SURGI.ADHESIVE 4X14"               $       97.85
6825011 PAD, DUOTHERM ADLT DISP 14X20*              $      296.52
6825042 MICRO EPIDURAL INFUSION PUMP                $          -
6825044 SLEEVE,KNEE LENGTH                          $      553.43
6825045 SLEEVE,THIGH LENGTH                         $      695.94
6825047 SLEEVE,THIGH LENGTH XSMALL                  $      583.12
6825048 SLEEVE,THIGH LENGTH XLRG                    $      584.95




                                              Page 257
                                            Ancillary


6825053 IVAC TUBING 565 PUMP NICU                 $     373.99
6825054 PCA TUBING 7154                           $     212.74
6826001 BLOOD ADMIN SET Y TYPE 6'       *         $     323.99
6826003 BLOOD PUMP SET W/FILT 7'     *            $     161.77
6826027 SCALP VEIN INFU 21GA                      $      75.87
6826028 INFUSION SET BUTTERFLY 19                 $      91.06
6826029 INFUSION SET BUTTERFLY 23                 $      90.15
6826044 INTRODUCER,NEEDLE 206                     $     297.08
6827004 SOL IV D-5-W 1000ML                       $     327.42
6827005 SOL D-5-W 500ML GLASS                     $     344.48
6827006 SOL D-5-W 250ML GLASS                     $     273.50
6827007 SOL D-5-W 1000ML                          $      61.61
6827008 SOL D-5-W 500ML                           $     273.50
6827009 SOL D-5-W 250ML                           $     273.50
6827010 SOL IV D-10-W 1000ML                      $     327.42
6827011 SOL IV D-10-W 500ML                       $     295.48
6827012 SOL IV D-10-W 250ML                       $     273.50
6827013 SOL IV D-20-W 500ML                       $     299.48
6827021 SOL,IV 1/6M SOD LAC 1000ML                $      61.61
6827022 SOL, IV D-5-.9% NACL 1000ML *             $     327.42
6827023 SOL, IV D-5-.9% NACL 500ML *              $     295.48
6827024 SOL, IV D-5-.9% NACL 250ML *              $     328.22
6827025 SOL, IV D-5-.45% NACL 1000ML *            $     327.42
6827026 SOL, IV D-5-.45% NACL 500ML *             $     295.48
6827027 SOL IV 5%D 45% NS                         $     211.97
6827028 SOL, IV D-5-.2% NACL 1000ML *             $     273.50
6827029 SOL, IV D-5-.2% NACL 500ML *              $     328.22
6827030 SOL, IV D-5-.2% NACL 250ML *              $     273.50
6827033 SOL, IV D-10-.9% NACL 1000ML *            $     328.22
6827042 SOL, IV D-10-.45% NACL 1000ML*            $     440.83
6827045 SOL IV LR 1000ML                          $     327.42
6827046 SOL IV LR 500ML GLASS                     $     295.48
6827047 SOL IV D-5-LR 1000ML                      $     327.42
6827048 SOL IV D-5-LR 500ML                       $     389.98
6827050 SOL IV RINGERS 1000ML                     $     328.22
6827051 SOL IV RINGERS 500ML                      $     326.18
6827052 SOL IV 5% D RING 1000                     $     233.35
6827058 SOL .9% NACL 250ML GL #1649               $      76.24
6827060 SOL IV 45% N.SAL 1000                     $     327.42
6827061 SOL IV 45% N.SAL 500                      $     224.11
6827062 SOL IV S4051 3% NACHL 500CC               $     186.75
6827076 SOL IV 45% NACL 1000ML                    $     126.49
6827077 SOL IV D-5-R 1000ML                       $     344.48
6827081 SOL IV 45% NACL 500ML                     $     273.50
6827090 SOL, IV D-5-.45% NACL 250ML *             $     273.50
6830174 PERICARDIOCENTESIS TRAY                   $     521.48
6830272 TRACH PERCUTANEOUS SET                    $     257.55
6830640 PORT-A-CATH FLUSH                         $     171.44
6830641 FOLEY CATH IRRIGATION                     $     199.49




                                            Page 258
                                         Ancillary


6830642 FOLEY CATH THRU AND THRU IRRIG         $      731.01
6830643 GASTROSTOMY TUBE INSERTION             $      199.49
6830644 NASOGASTRIC TUBE IRRIGATION            $      199.49
6830645 EAR LAVAGE                             $      168.92
6830646 EYE IRRIGATION                         $      295.43
6830648 CATHETER CARDIAC PACING                $      831.75
6830649 CATH MAHURKER TRAY CVD                 $      569.13 C1752
6830652 SPLINT THUMB                           $       75.67
6830653 SPLINT TRACTION BUCKS                  $      106.30
6830657 VIBCOPASTE                             $       56.27
6830660 INCENTIVE SPIROMETER                   $      220.12
6830661 SET FEEDING CLOSED                     $      189.68
6830701 DRESSING VAC                           $      165.23
6830704 PLEURX DRAINAGE CATHETER               $      132.00 C1729
6830705 CATH FEMORAL ARTERY TRAY               $      105.89
6830706 PARACENTESIS DRAINAGE DEVICE           $       33.97 C1729
6830707 LONG TERM CANNULA                      $      460.85
6830709 CATH, CEN PERI PICC BLUE W KIT         $      191.10 C1752
6830710 CENTRAL VEN.CATH 6F TRPL LUMEN         $      557.85 C1751
6830711 TRPL LUMN CV HYPRLI CATH W KIT         $      437.90 C1752
6830712 10FR DUAL-LUMN CV CATH W KIT           $      665.51 C1752
6830713 GUIDEWIRE PLATINUM .018 TIPPED         $      833.39 C1769
6830714 PICC LUMN PERI CATH W KIT              $      311.08 C1752
6830715 MALLEABLE TUNNELER                     $      119.58
6830716 BIOPATCH                               $       65.08
6830717 CATHETER FIXATION DEVICE               $       75.17
6830718 PLEURX EVAC CONTAINER                  $      203.18
6830719 GUIDEWIRE DUOFLEX                      $       81.32 C1769
6830720 GUIDEWIRE FIXED DBL ENDED              $       58.77 C1769
6830721 DUAL LUMN SOFT CELL PRE CURVED         $      568.12 C1752
6830722 PICC 5FR SNGLE LUMN POLY CATH          $      162.92 C1752
6830723 PLEURX VALVE CAP                       $       54.56
6830724 SNGLE DRAINAGE LINE SET                $      136.90
6830725 INTRODUCER SET WO GUIDEWRE             $      248.48 C1892
6830727 DBLE LUMN 5 FR CV CATH TRAY            $      529.88 C1752
6830728 TRPL LUMN 7FR ANTIMICR CV CATH         $      428.00 C1752
6830729 THAL QUICK CHST TUBE TRAY              $      465.64
6830730 AIRWAY EXCH CATH W ADAP                $      229.35
6830731 TRACHEOSOFT TUBE EXT 6-8 FR            $      327.99
6830732 POSIDYNE FILTER                        $       33.23
6830733 PLEURX CATHETER W KIT                  $     1,247.31 A7042
6830734 TWO LUMEN HEMODIAL CATH W KIT          $      474.53 C1752
6830735 UNIVER MICROINTRODUCER KIT 3.5         $      368.25
6830736 UNIVER MICROINTRODUCER KIT 7FR         $      336.04
6830737 CATH PICC SNGLE LMN TRAY               $      433.27
6830738 PICC SELDING CONVERSION SET            $      189.09
6830739 CATH PICC DBL LUMN PLATN 5 FR          $      350.74
6830740 CATH PERIF 8 FR TRPL LUMN              $      689.48 C1751
6830741 INTRODUCER 8 FR KIT                    $      248.48 C1892




                                         Page 259
                                         Ancillary


6830742 P.A.S.PORT/PORT-A-CATH                 $     134.16
6830743 PLEURX DRAIN KIT W 500 ML VAC          $     287.73
6830744 PLEURX DRAIN LN W 500 ML VAC           $     203.18
6830745 CATHETER 7FR W FASTNER                 $      29.67
6833021 STOMAHESIVE WAFER 4X4                  $     128.23
6833023 STOMAHESIVE WAFER 8X8                  $     287.49
6833031 ACTIVE LIFE                            $     592.21
6833041 DANSAC COMBI INFANT POUCH              $     268.32
6833049 SKIN BOND CEMENT                       $     219.60
6833050 FECAL INCONTINENCE COLLECTOR *         $     181.70
6833053 IRRIG SLEEVE COLOPLAST                 $     330.40
6833075 TWO-PIECE OSTOMY SYS 4" 3712           $     478.20
6833077 TWO-PIECE OSTOMY SYS 3-1/2"            $     402.49
6833085 NU-FLEX FOAM DRAIN POUCH               $     297.08
6833087 NU-FLEX TAPE DISC POUCN                $     297.08
6833096 VIGILON 6X8 STRL                       $     754.68
6833097 VIGILON 3X6 STRL                       $     329.44
6860007 BLOOD GAS TRAY           *             $     139.16
6860008 TUBE ET 3.0                            $     116.24
6860009 TUBE ET 3.5                            $     116.69
6860010 TUBE ET 4.0                            $     116.26
6860011 TUBE ET 4.5                            $     116.26
6860012 TUBE ET 5.0                            $     116.62
6860014 TUBE ET W/C 5                          $      64.17
6860015 TUBE ET W/C 6                          $     103.02
6860016 TUBE ET W/C 7                          $     103.02
6860017 TUBE ET W/7.5                          $     134.87
6860018 TUBE ET W/C 8                          $     112.61
6860019 TUBE ET W/8.5                          $     123.62
6860020 TUBE ET W/C 9                          $     155.24
6860022 AIRWAY CATH-G 0 INF                    $      76.67
6860023 AIRWAY CATH-G 6 X-LG                   $      91.09
6860024 AIRWAY GUEDEL PEDS O                   $      87.51
6860039 TRACH BUTTON #30                       $     401.12
6860040 TRACH BUTTON #33                       $      30.69
6860045 TUBE ET W/6.5                          $     103.02
6860046 TUBE ET #2.5                           $      91.06
6860047 TRACH TUBE #14                         $     455.43
6860052 TUBE, TRACH DCT W/DISP CANN 4          $     626.75
6860053 TUBE, TRACH DCT W/DISP CANN 6          $     620.52
6860054 TUBE, TRACH DCT W/DISP CANN 8          $     626.75
6860056 TUBE, TRACH DFEN W/DISP CNN 4          $     649.72
6860057 TUBE, TRACH DFEN W/DISP CNN 6          $     541.44
6860058 TUBE TRACH DFEN W/DISP CNN 8           $     541.44
6860060 AIRWAY CATH-G 5 LG                     $      94.09
6860061 AIRWAY CATH-G 3 SM                     $      71.87
6860062 AIRWAY CATH-G 2 SM                     $      71.87
6860063 AIRWAY CATH-G 4 MED                    $      71.87
6860064 AIRWAY CATH-G 1 MS CHILD               $      94.09




                                         Page 260
                                         Ancillary


6860076 INNER CANNULA, DISP SIZE 4             $      175.37
6860078 INNER CANNULA, DISP SIZE 6             $      173.64
6860080 INNER CANNULA, DISP SIZE 8             $      144.69
6860082 INNER CANNULA, DISP SIZE 10            $      146.14
6860120 RESUSCITATION BAG INFANT               $       99.42
6860121 RESUSCITATION BAG PEDS                 $      117.14
6860123 RESUSCITATION BAG ADULT                $       84.77
6860126 V.A.C. CANISTER                        $      217.83
6870000 CLINITRON THERAPY BED DA               $      690.33
6870003 KINAIR BED                             $      547.48
6870004 KINAIRE III BED                        $      745.81
6870005 FLUID AIR BED                          $     1,026.30
6871114 TEMP.PAC WIRE PER                      $      394.70
6871246 VALVE ANTI-REFLUX SALEM SUMP           $      107.80
6871285 INFUSION SET BUTTERFLY 25G             $       75.87
6871286 TRAY PARACENTESIS                      $      389.40
6871289 KIT PRESSURE MONITORING                $     3,139.39
6871290 SET LEVEL I DISP                       $      284.61
6871321 CATH 5FR DBL LUMN TRAY                 $      589.37
6871323 CATHETER TRAY 5FR 8CM DBL LUM          $      707.22
6871324 CATHETER ARTERIAL RADIAL 3FR           $      285.10
6871426 WRIST BRACE ELASTIC LARGE              $      119.37
6871428 PROBE ESPOHAGEAL RECTAL DISP           $      193.40
6871440 IV PUMP SET, NITROGLYCERIN             $      261.87
6871441 ELECTRODE SPIRAL                       $      160.90
6871446 COLOSTOMY BAG 45MM                     $      186.12
6871451 BAZA CREAM 2 OZ                        $      110.51
6871453 ENDOTRACH TUBE 3.5                     $      211.78
6871459 ACTIVE LIFE DRAIN POUCH                $      465.80
6871463 STAPLER SKIN AUTO PREM 35W             $      465.80
6871464 STAPLER SKIN AUTO ROYAL 35W            $      179.69
6871490 BAG DRAINAGE VINTRICULAR               $      470.07
6871491 MONITORING KIT VENTRICULAR             $     2,458.30
6871493 RESUSCITATION BAG NEONATE              $      267.45
6871496 PACK DELIVERY                          $      345.72
6871497 KIT NEONATAL                           $      196.38
6871500 TRANSDUCER NEONATE                     $      245.55
6871501 CATH MULTI-LUMEN                       $      321.82
6871509 GASTROSTOMY TUBE INSERTION             $      148.42
6871510 NASOGASTRIC TUBE IRRIGATION            $      199.49
6872001 ELECTRODE TEMP PACING 6F               $      423.40
6872002 ELECTRODE TEMP PACING 5F               $      423.40
6872003 PERCUTANEOUS SHEATH INTRO KIT          $      113.82 C1894
6872004 CATH CENTRAL VENOUS 7F 2L 35CM         $      279.47
6872005 CATH CENTRAL VENOUS 7F 3L 60CM         $      300.33
6872007 CATH MAHURKAR 12F TRPL LUMN            $      373.75 C1752
6872009 DRAIN VENTRICULAR                      $      427.57
6872021 CATH CENTRAL VENOUS                    $      209.89
6872022 CATHETER 8FR 12CM                      $       87.40




                                         Page 261
                                         Ancillary


6872024 CUSTOM BIVONA TRACHEOSTOMY             $      784.08
6872039 OSTOMY BAG 1                           $       45.24
6872042 SEAL AKIN OSTOMY SMALL                 $       93.25
6872044 SLIMPORT                               $      143.88
6872046 STOMAHESIVE WAFER WHITE 2 3/4          $       54.30
6872048 UROSTMY POUCH 1 3/4 HI OUTPUT          $       37.29
6872049 UROSTMY POUCH 2 3/4 HI OUTPUT          $       37.29
6872051 UROSTOMY POUCH                         $       73.00
6872062 SET MINI TRIFUSE                       $       48.52
6872064 CENTRAL VEN.CATH. 5F SGL LUMEN         $      114.99 C1751
6872067 CENTRAL VEN.CATH. 6F DBL LUMEN         $      432.66 C1751
6872070 COLLAR CERVICAL RIGID                  $      122.64
6872071 TUBE GASTROSTOMY MIC-KEY               $      372.44
6872075 CATHETER, DIALYSIS, LONG-TERM          $      286.19 C1750
6872076 CATHETER, DIALYSIS, SHORT-TERM         $      372.27 C1752
6872077 PICC TRAY/KIT W/O CATHETER             $      344.99
6872078 PORT, INDWELLING (IMPLANTABLE)         $      833.39 C1788
6880004 WOUND CLEASING KIT                     $      108.04
6880005 BURN SMALL                             $      193.77
6880006 BURN LARGE                             $      301.82
6880008 BARICARE BED                           $      934.34
6880010 PEDICARE BED                           $      776.24
6880011 SET ADMINISTRATION W/SPIKE             $      113.25
6880012 CATH 7FR X 20CM TPL LUMEN TRAY         $      472.32
6919275 LEG SPLINT LONG AL                     $     1,240.94
6919279 LEG SPLINT SHORT AL                    $     1,046.47
6919284 KNEE SPLINT VELCRO                     $     1,714.09
6919292 WRIST SPLINT                           $      425.43
6919293 WRIST SPLINT ALUM                      $      402.41
6919295 SPLINT,THUMB                           $      267.05
6919705 CAST LNG ARM ADULT                     $      603.79
6919710 CAST LNG ARM PED                       $      513.23
6919715 CAST SHORT ARM ADULT                   $      435.51
6919720 CAST SORT ARM PED                      $      341.57
6919725 CAST LNG LEG ADULT                     $      760.77
6919760 PLASTER ARM SPLINT                     $      342.83
8005002 LAB FUNGAL SENSI, EACH DRUG            $      119.22 87181
8005003 LAB H. PYLORI ANTIBODY                 $      105.19 86677
8005005 LAB GRAM ST UNSPCFD                    $      152.55 87205
8005006 LAB WETMT FUNG UNSPC                   $      179.20 87210
8005007 LAB CULT FUNG UNSPCF                   $      427.21 87102
8005008 LAB CULTURE ABSCESS                    $      218.73 87070
8005010 LAB O&P CONC/IODN MNT NONSTO           $       86.27 87177
8005017 LAB CULT FUNG BLOOD                    $      427.21 87103
8005018 LAB CULT BAC BLOOD                     $      427.21 87040
8005019 LAB CULT AFB BLOOD                     $      427.21 87116
8005026 LAB BACTEC AFB SENSI, 1 DRUG           $       61.74 87190
8005027 LAB FUNG DEFIN. ID, 1ST ORG            $       74.85 87106
8005028 LAB FUNG DEFIN. ID, 2ND ORG            $       74.85 87106




                                         Page 262
                                       Ancillary


8005029 LAB FUNG DEFIN. ID, 3RD ORG          $      74.85 87106
8005034 LAB CULT BLOOD BRUCELLA ONLY         $     427.21 87040
8005035 LAB CULT BLOOD PEDIATRICS            $     427.21 87040
8005036 LAB CULT BLOOD LEGIONELLA            $     427.21 87040
8005037 LAB CULT BLOOD MYCOPLASMA            $     427.21 87109
8005048 LAB CULTURE CSF                      $     218.73 87070
8005054 LAB FUNG DEFIN. ID, 4TH ORG          $      74.85 87106
8005059 LAB AFB DNA PROBE, 1ST ID            $     119.89 87550
8005068 LAB CULT BAC UR                      $     420.77 87088
8005077 LAB AFB DNA PROBE, 2ND ID            $     119.89 87550
8005078 LAB AFB DNA PROBE, 3RD ID            $     119.89 87550
8005079 LAB AFB DNA PROBE, 4TH ID            $     119.89 87550
8005083 LAB SENST BAC ANAERO                 $     641.83 87186
8005084 LAB FUNGAL PROBE ID                  $     119.89 87797
8005085 LAB AFB DEFIN. ID, 1ST ORG           $      78.97 87118
8005086 LAB SUSCEPT KB                       $     261.76 87184
8005087 LAB SUSCEPT MIC                      $     370.76 87186
8005093 LAB INDIA INK CRYPTO                 $     146.42 87210
8005098 LAB CULTURE GASTRIC                  $     218.73 87070
8005100 LAB AFB DEFIN. ID, 2ND ORG           $      78.97 87118
8005101 LAB ANAEROBE IDENTIFICATION          $      80.24 87076
8005102 LAB SEROTYPING, EACH ORG             $      40.81 87147
8005103 LAB YERSINIA CULTURE                 $      47.47 87081
8005110 LAB URINE DEFIN ORG ID, EACH         $      58.57 87077
8005111 LAB BACTI ADDNL. ID, EACH            $      79.82 87077
8005112 LAB SENSI CONFIRMATION, EACH         $      49.79 87184
8005113 LAB ANA DEFIN ID, EACH ORG           $      80.24 87076
8005115 LAB MICROSPORIDIUM STAIN             $      73.79 87207
8005116 LAB SPECIMEN CONCENTRATION           $      48.42 87015
8005120 LAB CULT URINE STERILE               $     420.77 87088
8005122 LAB HSV TYPE 1 FA                    $     130.99 87274
8005123 LAB HSV TYPE 2 FA                    $     130.99 87273
8005130 LAB CHLAMYDIA ADNL WORK              $     105.19 87076
8005131 LAB HERPES TYPE TWO DFA              $     130.99 87273
8005132 LAB C DIFF TOX CONFIRMATION          $     177.50 87230
8005133 LAB CHLAMYDIA DFA                    $      48.84 87270
8005141 LAB CHLAMYDIA PNEUMONIAE             $      73.79 87110
8005150 LAB CHLAMYDIA CONFIRMATION           $      48.84 87270
8005151 LAB ADENOVIRUS EIA                   $      96.40 87301
8005152 LAB RSV EIA                          $      71.10 87420
8005164 LAB VIR RESP IFA STAIN, NOS          $      27.38 87299
8005165 LAB VIRAL FA STAIN, NOS              $      49.48 87299
8005166 LAB VIR RAPID SHELL VIAL CX          $      76.12 87254
8005167 LAB VIR SHELL VIAL FA STAIN          $      50.96 87254
8005178 CHLAMYDIA BY AMPLIFICATION           $     358.71 87491
8005183 LAB M. TB DIRECT BY TMA              $     492.87 87556
8005191 LAB CHLAMYDIA DNA PROBE              $     212.60 87490
8005192 LAB ETEST MIC, EACH DRUG             $      44.83 87181
8005208 LAB CULT BAC-GC                      $     188.71 87081




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                                         Ancillary


8005228 LAB CULT BAC-PERTUS                    $     188.71 87081
8005238 LAB CULT BAC-ANAROB                    $     641.83 87075
8005252 LAB O&P TRICHROME STAIN                $     172.43 87209
8005253 LAB O & P DIRECT WET MOUNT             $      86.27 87177
8005256 LAB UPPER RESP CULTURE                 $     227.93 87070
8005257 LAB UPPER RESP CULT MRSA SCRN          $     142.83 87081
8005259 LAB RHINOVIRUS ID                      $     103.92 87252
8005260 SRN VRE C. DIFF TOX POS STOOL          $      84.36 87046
8005261 LAB AFB ETEST SUSC, EACH DRUG          $     120.73 87181
8005262 LAB VIRUS INOCULATION, SHELL V         $      71.89 87254
8005263 LAB VIRUS INOCULATION, TISSUE          $      83.94 87252
8005264 LAB GENET VIRUS ISOLATE, HSV           $     107.94 87255
8005266 LAB SPECIMEN CONCENTRATIO              $      29.28 87015
8005268 LAB CULT BAC-STREP A                   $     188.71 87081
8005269 LAB GRAM STAIN FOR BV SCREEN           $     152.55 87205
8005271 LAB INFLUENZA A IFA STAIN              $      27.38 87276
8005272 LAB RSV IFA STAIN                      $      27.38 87280
8005274 LAB M. TB BY TMA INTERP.               $      13.11 83912
8005275 LAB CHLAMYDIA INTERPRETATION           $      13.11 83912
8005276 LAB GC AMPLIFICATION INTERP            $      13.11 83912
8005277 LAB HPV INTERPRETATION                 $      13.11 83912
8005278 LAB BLOOD STEM CELL CULTURE            $      74.53 87040
8005280 MEC A GENE DETECTION TEST              $     225.40 87147
8005281 CONCENTRATION, CSF FOR GS              $      42.29 87015
8005282 LAB GIARDIA DFA                        $      99.48 87269
8005283 LAB N.G. AMP DETECT CONF               $     213.13 87591
8005284 LAB INTERP N.G. CONFIRM                $      12.90 83912
8005285 LAB AMPL DETECT C.T. CONF              $     213.13 87491
8005286 LAB INTERP C.T. CONFIRM                $      12.90 83912
8005287 LAB OCCULT BLOOD, GASTRIC              $      74.53 82271
8005288 LAB VIR RAP INFLU A & B CULT           $     212.71 87254
8005289 LAB MRSA RAPID LATEX                   $     102.71 87450
8005290 LAB OCCULT BLOOD (AB)                  $     132.95 82274
8005291 LAB RAPID STREP GROUP A                $      90.15 87430TC
8005292 LAB TB TEST CELL IMMUN, MEASUR         $     254.34 86480TC
8005297 LAB URINE BACTERIAL EXAM               $      66.92 87450
8005298 LAB HEMORRHAGIC E. COLI TOXIN          $     162.28 87427
8005299 LAB CAMPYLOBACTER DR AG IN STL         $     170.21 87427
8005320 LAB CULTURE RESPIRATORY                $     370.76 87070
8005321 LAB CULTURE STERILE RESPIRTY           $     370.76 87070
8005323 LAB CULT RESPIR CYSTIC FIBRO           $     162.07 87070
8005324 LAB CULT RESPIRATORY QUANT             $     370.76 87070
8005325 LAB T, VAGINALIS DFA                   $     150.55 87206
8005326 LAB DNA PROBE CANDIDA SP               $      92.59 87480TC
8005327 LAB DNA PROBE GARD VAGINALIS           $      92.59 87510TC
8005328 LAB DNA PROBE TRICH VAGINALIS          $      87.58 87660TC
8005352 LAB C DIFF CYTOTOXIN                   $     103.92 87230
8005380 ZIEHL-NEELSEN STAIN-CONF               $      82.99 87206
8005400 LAB STREP GROUP A DNA PROBE            $     156.04 87650




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                                       Ancillary


8005401 LAB CHLAMYDIA PROBE CONFIRM          $      78.34 87490
8005402 LAB GC PROBE CONFIRMATION            $      78.34 87590
8005403 GC BY AMPLIFICATION                  $     358.71 87591
8005411 LAB SURVEILLANCE CULTURE             $     188.71 87081
8005412 ENTEROVIRUS RNA DETECTION            $     264.09 87798
8005413 ENTEROVIRUS, INTERPRETATI            $      12.58 83912
8005414 WEST NILE VIRUS, DETECTION           $     264.09 87798
8005415 WEST NILE VIRUS, INTERP.             $      12.58 83912
8005416 NUCLISENS EXTRACTION                 $     150.76 83891
8005417 NUCLISENS ISOLATION                  $     151.18 83890
8005418 LAB CONFIRM AGAR DIL MIC             $      34.04 87186
8005510 LAB OCCULT BLOOD FE                  $      80.24 82272
8005512 LAB C DIFF TOXIN EIA                 $     321.28 87324
8005514 LAB CULT STOOL-VIBRIO                $     400.78 87081
8005520 LAB MICRO WBC FE                     $     126.02 87205
8005521 CULTURE, BACT FECAL ROUTINE          $     166.83 87045
8005522 ADDITIONAL PATHOGENS                 $      78.02 87046
8005523 CULTURE, AFB UNSPECIFIED             $     427.64 87116
8005524 SMEAR, AFB UNSPECIFIED               $      52.54 87206
8005525 CONCENTRATION - ANY TYPE             $      38.27 87015
8005526 SMEAR, AFB STOOL                     $      54.66 87206
8005527 CONCENTRATION - STOOL                $      54.66 87015
8005550 LAB MICRO STARCH FE                  $     126.02 89225
8005590 LAB O&P CONC/WET MOUNT STOOL         $     172.43 87177
8005595 LAB MICRO PINWORMS                   $     152.55 87172
8005596 LAB DIRECT GIARDIA AG                $     320.65 87328
8005597 LAB CRYPTO DFA                       $      99.48 87272
8005620 LAB CULTURE EAR                      $     218.73 87070
8005630 LAB CULTURE EYE                      $     218.73 87070
8005632 BACT ID BY FLUOR - ENC               $     105.93 87149
8005633 BACT ID BY FLUOR - STAPH             $     211.55 87149
8005634 BACT ID BY FLUOR - YST               $     211.55 87149
8005635 MRSA SCREEN ONLY                     $       9.09 87081
8005890 LAB CULTURE GENITAL                  $     162.07 87070
8005891 LAB CULTURE STERILE GENITAL          $     218.73 87070
8005898 LAB CULT ADNL WORKUP                 $     208.90 87076
8005901 LAB GENITAL MYCOPLASMA CULT          $     400.78 87109
8005902 LAB ROTAVIRUS BY EIA                 $     344.44 87425
8005903 LAB CULT LEGIONELLA                  $     344.44 87081
8005906 LAB CHLAMYDIA CULTURE                $     186.91 87110
8005907 LAB MICRO TZANCK                     $     273.10 87207
8005909 LAB STRING TEST                      $     188.71 87177
8005913 LAB PNEUMOCYSTIS DFA                 $     240.30 87281
8005918 LAB LEGIONELLA DIRECT                $     232.37 87540
8005920 LAB HPV DETECTION PROBE NO 1         $     213.87 87621
8005921 LAB CULTURE BONE MARROW              $     218.73 87070
8005922 LAB CULTURE BONE                     $     218.73 87070
8005923 LAB CULTURE CATHETER TIP             $     370.76 87070
8005924 LAB CULTURE ENVIRONMENTAL            $     370.76 87070




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8005925 LAB CULTURE FLUID                    $     218.73 87070
8005926 LAB CULTURE SKIN                     $     218.73 87070
8005927 LAB CULTURE TISSUE                   $     218.73 87070
8005928 LAB CULTURE UMBILICUS                $     218.73 87070
8005929 LAB CULTURE WOUND                    $     218.73 87070
8005930 LAB CULTURE ACTINOMYCES              $     641.83 87075
8005931 LAB MICRO GIEMSA                     $     288.72 87205
8005932 LAB HERPES TYPE ONE DFA              $     130.99 87274
8005933 LAB VARICELLA ZOSTER DFA             $     261.76 87290
8005934 LAB VIRUS DETECTION BY DFA           $     261.76 87299
8005935 LAB RSV DIRECT EXAM                  $     261.76 87280
8005940 LAB DARKFIELD EXAMINATION            $     348.03 87164
8005941 LAB AFB SUSCEPT, EACH DRUG           $      54.66 87190
8005942 LAB IDENTIF, FUNGAL                  $     427.21 87106
8005943 LAB IDENTIF, BACTERIAL               $     370.76 87076
8005947 LAB BETA STREP SCREEN                $     188.71 87081
8005948 LAB BACTERIAL ANTGEN DETECT          $      99.06 87077
8005953 LAB RAPID HELICOBACTER SCRN          $      43.35 87339
8005954 LAB RAPID N. GC                      $      96.84 87590
8005955 LAB FUNGAL BLD CULTURE PEDS          $     427.21 87103
8005956 LAB HISTOPLASMA BLD CULT             $     427.21 87103
8005957 LAB SEROLOGIC ID, BACTERIA           $      31.08 87147
8005958 LAB H. PYLORI STOOL AG EIA           $     153.72 87338
8005960 LAB INFLUENZA A MEMBRANE EIA         $     163.87 87400
8005961 LAB INFLUENZA B MEMBRANE EIA         $     163.87 87400
8005962 LAB RSVMEMBRANE EIA                  $     268.00 87420
8005963 OX PLATE SCREEN 1                    $      26.01 87184
8005964 TISSUE GRINDING                      $     141.98 87176
8005965 BETA LAC ENZ DETECT                  $      44.30 87185
8005966 CLIND INDUCED RES.TEST               $      24.10 87184
8005999 LAB AFB ID                           $     453.54 87118
8019012 LAB HPV DETECTION PROBE NO 2         $     213.87 87621
8007001 PATHOLOGY GYN AUTO SC/MAN R          $     207.85 88148
8007009 PATHOLOGY SMEAR EXTEND STDY          $     119.57 88162
8007010 LAB CYTO ADD SLIDE/STAIN             $      59.94 88313
8007012 PATHOLOGY GYN LIQUID/MAN SCR         $      45.88 88142
8007013 PATHOLOGY FLUID, SUREPATH            $      82.88 88112
8007050 CYTOLOGY CELL BLOCK                  $      89.97 88305
8007068 LAB CYTO FL ORGAN                    $     270.96 88104
8007069 PATHOLOGY FLUID, SMEAR               $     220.32 88104
8007070 PATHOLOGY FNA CYTOTECH ASST          $     188.71 88199
8007088 PATHOLOGY FLUID, CONCENTRATE         $     270.96 88108
8007099 PATHOLOGY FNA INTERP & RPT           $     220.32 88173
8007100 PATHOLOGY FNA IMMED ADEQUACY         $      99.91 88172
8007110 PATHOLOGY FNA PERFORMANCE            $     188.71 10021
8007112 PATHOLOGY GYN (BETHESDA) RSC         $     237.13 88165
8007113 PATHOLOGY GYN/AUTO SCREEN            $     111.43 88147
8007114 PATHOLOGY SMEAR SCR & INTERP         $      53.49 88160
8007115 PATHOLOGY, CYTO GYN MAT I            $       8.77 88155




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                                         Ancillary


8007949 PATHOLOGY GYN (BETHESDA) MAN           $      119.57 88164
8008001 OUTSIDE CONSULT, WITH PREP             $       50.11 88323
8008006 PATHOLOGY IMMUNOFL, INDIRECT           $      101.07 88347
8008007 PATH INTROP TCH PRP, INITIAL           $       29.81 88333
8008008 PATH INTROP TCH PRP, ADDL              $       29.81 88334
8008018 PATHOLOGY LEVEL IV SURGICAL            $      503.33 88305
8008019 PATH CON INTRAOP FZS, ADDL             $       67.77 88332
8008026 PATHOLOGY DECAL - BM                   $       56.45 88311
8008027 LAB TISSUE GR M 7 - BM                 $      503.33 88305
8008028 PATHOLOGY TISS STN GR II - BM          $      126.02 88313
8008033 LAB TISSUE PHOTO NO 1                  $       37.00 88399
8008800 LAB TISS H&E 1-3                       $      119.57 88313
8008802 PATHOLOGY TISSUE STAIN GR I            $      126.02 88312
8008803 PATHOLOGY LEVEL I SURGICAL             $      146.42 88300
8008804 PATHOLOGY INTRAOPERATIVE CON           $      188.71 88329
8008805 PATHOLOGY SMEAR PREP/SCR/INT           $      126.02 88160
8008806 PATHOLOGY TISSUE STAIN GR II           $      126.02 88313
8008808 PATHOLOGY TISSUE STAIN, CHEM           $      126.02 88318
8008809 PATHOLOGY TISSUE STAIN, ENZ            $      126.02 88319
8008810 PATH CON INTRAOP FZS, 1 BLOC           $       67.77 88331
8008813 PATHOLOGY LEVEL II SURGICAL            $      255.21 88302
8008814 PATHOLOGY LEVEL III SURGICAL           $      334.60 88304
8008820 LAB TISSUE GR M 7                      $      503.33 88305
8008823 PATHOLOGY LEVEL V SURGICAL             $      807.49 88307
8008832 PATHOLOGY LEVEL VI SURGICAL            $     1,306.80 88309
8008834 PATHOLOGY TISSUE XRAY                  $      278.36 76098
8008835 PATHOLOGY DECALICIFICATION             $       56.45 88311
8008990 LAB BIOPSY GYN REF                     $      503.23 88305
8008991 LAB BIOPSY SKIN OR CONFIRM REF         $      503.23 88305
8008999 LAB TISSUE REF                         $      255.21 88302
8060004 PATHOLOGY EM, PARTIAL                  $      453.54 8834852
8060005 PATHOLOGY EM, DIAGNOSTIC               $     2,381.34 88348
8060011 PATHOLOGY TISSUE STAIN, FROZ           $      420.77 88314
8060023 PATHOLOGY IMMUNOFLUOR STUDY            $      453.54 88346
8064001 LAB WHOLE BLOOD ACT                    $      181.20 85347
8064003 LAB POTASSIUM                          $      205.94 84132
8064004 LAB GLUCOSE                            $      205.94 82947
8064005 LAB HEMATOCRIT                         $      129.51 85014
8064006 LAB SODIUM                             $      205.94 84295
8064007 LAB IONIZED CALCIUM                    $      205.94 82330
8064008 LAB HEMOGLOBIN                         $       87.96 85018
8064009 LAB HEPARIN DOSE RESPONSE              $      298.02 85348
8064011 LAB HEPARIN ASSAY                      $      298.02 85520
8064012 LAB ACTIVATED CLOTTING TIME            $      181.20 85347
8064013 LAB POC GLUCOSE                        $      205.94 82962
8064014 LAB POC URINE CHEMISTRY                $      126.02 81003
8064015 LAB POC SPUN HEMATOCRIT, BLD           $      129.51 85013
8064016 LAB POC OCCULT BLOOD                   $       80.24 82270
8064018 LAB BLOOD GASES, ART POC               $      811.08 82803




                                         Page 267
                                         Ancillary


8064019 LAB WHOLE BLOOD PROTIME                $      195.79 85610
8064020 LAB (KOH) FUNGAL EXAM                  $      157.10 87210
8064021 URINE PREGNANCY TEST                   $      194.10 84703
8064022 CARBON DIOXIDE (BICARBONATE)           $      205.94 82374
8064023 CHLORIDE                               $      205.94 82435
8064024 CREATININE                             $      205.94 82565
8064025 UREA NITROGEN                          $      205.94 84520
8064026 LAB POC - PH, BODY FLUIDS              $      205.68 83986QW
8064027 LAB POC - FERN TEST                    $       99.96 Q0114
8064028 LAB HEMOGLOBIN A1C                     $      106.75 83036TC
8064130 LAB CALCIUM, FREE                      $      205.94 82330
8013001 PROCESS PLASMA, FRZ BET 8-24HR         $      142.72 P9059
8013010 PROCESS WHOLE BLOOD                    $      654.09 P9010
8013020 PROCESS PACKED RBC                     $      654.09 P9021
8013040 PROCESS PLATELET PACK                  $      283.12 P9019
8013050 PROCESS PLATELETPHERESIS               $     1,353.53 P9034
8013060 PROCESS PLASMA FFP                     $      261.97 P9017
8013070 PROCESS CRYOPRECIPITATE                $      114.60 P9012
8013080 PROCESS RH IMMUNE GLOBULIN             $      373.30 J2790
8013090 PROCESS PLT HLA MATCHING               $      521.94 86813
8013201 PROCESS AUTOLOOUS UNIT                 $      690.46 86890
8013304 PROCESS PCK RBC LEUKOREDUCED           $      786.56 P9016
8013305 PROCESS PCK RBC WASHED                 $      983.09 P9022
8013306 PROCESS PCK RBC DEGLYCEROLIZE          $      931.60 P9039
8013307 PROCESS PLT PHERESIS LEUKO RED         $     1,528.61 P9035
8013905 PLATELET ANTIBODY SCREEN               $      268.00 86022
8013906 PROCESS HLA MATCHING                   $      390.21 86813
8013907 LAB PLATELET CROSSMATCH                $      268.00 86022
8013908 PT. SERA DIFF ABSORPTION - ARC         $      293.16 86978
8013909 PRETREAT RBC'S/DRUGS - ARC             $      991.97 86975
8013910 PRETREAT RBC'S ENZM EA - ARC           $      109.10 86971
8013911 ANTIBODY ELUTION (RBC) - ARC           $      467.07 86860
8013912 AG TYPE /UNIT/AG - LARC                $       65.02 86903
8013913 AG SCREEN UNIT HIGH INCI - ARC         $      260.18 86903
8014002 I. S. CROSSMATCH                       $      268.42 86920
8014015 RBC ANTIBODY ELUTION                   $      384.08 86860
8014100 AB SCREEN, GEL                         $      205.94 86850
8014201 DAT, POLYSPECIFIC                      $      232.37 86880
8014202 CORD BLOOD SCREEN                      $      370.76 86880
8014203 TRANSFUSION REACT WORKUP               $      398.35 86078
8014204 IRRADIATION OF BLOOD PRODUCT           $      100.86 86945
8014206 CMV SCREEN                             $      172.54 86644
8014207 DIR DONOR ADM SERV PLT                 $      330.30 86999
8014208 FETAL-MATERN HMRG SCREEN               $      132.57 85461
8014209 PATIENT ABO TYPE                       $       73.16 86900
8014210 PATIENT RH TYPE                        $       73.16 86901
8014907 PLASMA THAW FFP                        $       71.89 86927
8014908 PT. SERA DIFF ABSORPTION               $      293.16 86978
8014909 PRETREAT RBC'S/DRUGS                   $      991.97 86970




                                         Page 268
                                       Ancillary


8014910 PRETREAT RBC'S ENZM EA               $       109.10 86971
8014911 ANTIBODY ELUTION (RBC)               $       516.02 86860
8014912 SPLIT BLD/BLD COMP                   $       213.98 86985
8014913 HGBS PER UNIT                        $        72.21 85660
8014914 HEMOL/AGGLUTININ INCUBA              $       339.57 86941
8014915 PRE SC UNIT PT                       $        47.26 86904
8014916 AG SCREEN UNIT HIGH INCI             $       260.18 86903
8014917 INCUBATE SERA W DRUGS/CH             $      1,442.34 86975
8014918 AHG CROSSMATCH                       $       362.83 86922
8014919 RH PHENOTYPE                         $        94.51 86906
8014920 RBC PHENO PT/BLD GRP AG              $       111.01 86905
8014921 DAT (COOMBS) IGG                     $        55.50 86880
8014922 DAT C3                               $        63.85 86880
8014923 DAT C3D                              $        72.21 86880
8014924 AB SCREEN LISS                       $        63.85 86850
8014925 AB SCREEN FICIN (EZ)                 $        63.85 86850
8014926 ANTIBODY I.D. LISS                   $       116.82 86870
8014927 ANTIBOFY I.D. GEL                    $       150.02 86870
8014928 ANTIBODY I.D. GEL EZ                 $       150.02 86870
8014929 ANTIBOFY I.D. PEG                    $       150.02 86870
8014930 DIL OF PLASMA BY TITRATI             $       150.02 86870
8014931 TITRATION EACH                       $        94.51 86886
8014932 INHIBITION                           $       124.96 86977
8014933 INC. CROSSMATCH PRE WARM             $       116.82 86921
8014934 THAWING RARE RBC PREP                $       116.82 86999
8015100 ANTIBODY RBC TITRE                   $       232.37 86886
8015101 ANTIBODY RBC IDENTIFICATION          $       163.44 86870
8015201 DONATH LANDSTEINER, BLOOD            $       370.76 86941
8015202 AG TYPE /UNIT/AG                     $       255.21 86903
8075002 T CELL DEPLETION                     $      2,587.18 38210
8075003 ALLOGEN BM PROCESS FRZ               $     10,276.72 88240
8075006 PB STEM CELL FREEZING                $      1,885.52 88240
8075007 PB STEM CELL PURGING                 $      2,587.18 38211
8075008 AUTO BM PROCESS FRZ                  $     11,304.43 88240
8075011 BM THAWING                           $       638.34 38208
8075012 THAW PERIPH BLOOD STEM CELLS         $       857.81 88241
8075013 BM/PBSC PROCESSING, LIQUID           $       233.96 38207
8075014 BM/PB STEM CELL RBC DEPLETE          $       637.91 38212
8075015 BM/PB STEM CELL PLAS DEPLETE         $       233.96 38214
8075016 ALLO BM/PBSC CROSSMATCH              $       268.42 86920
8075017 ALLO BM/PBSC DONOR ABO               $        73.16 86900
8075018 ALLO BM/PBSC DONOR RH (D)            $        73.16 86901
8005169 LAB HIV QUANTITATION BY BDNA         $       392.43 87536
8005945 LAB HCV QUALITATIVE BY PCR           $       492.97 87521
8019019 LAB MRSA PCR INTERP                  $        11.65 83912
8019020 LAB HPV DETECTION                    $       233.56 87621TC
8019021 LAB HPV ISOL/EXTRACT                 $       176.20 83891TC
8019022 LAB HPV LYSIS OF CELLS               $        89.24 83907TC
8019023 LAB HPVC INTERP & REPORT             $         8.37 83912TC




                                       Page 269
                                         Ancillary


8019061 LAB HIV QUANTITATION BY PCR            $       403.74 87536
8019111 LAB FAC V LEIDEN PCR- EXTRACT          $        95.99 83891
8019112 LAB FAC V LEIDEN PCR- DIGEST           $       156.25 83892
8019113 LAB FAC V LEIDEN PCR- PROBES           $        68.40 83900
8019115 LAB PROTHROMB MUT PCR- EXTRACT         $        95.99 83891
8019116 LAB PROTHROMB MUT PCR- DIGEST          $       156.25 83892
8019117 LAB PROTHROMB MUT PCR- PROBES          $        82.14 83900
8019119 LAB MTHFR MUT PCR- EXTRACT             $        95.99 83891
8019120 LAB MTHFR MUT PCR- DIGEST              $       156.25 83892
8019121 LAB MTHFR MUT PCR- PROBES              $        68.40 83900
8019126 HCV GENOTYPING                         $       576.39 87902
8019128 HCV RNA QUANT BDNA                     $       390.95 87522
8019129 HCV RNA QUANT INTERP                   $         6.34 83912
8019130 LAB QUANT HBV BY BDNA                  $       259.33 87517
8019131 LAB QUANT HBV BY BDNA - I              $        11.84 83912
8019132 LAB MRSA PCR DIR DETECTION             $       392.86 87798
8019133 LAB PROTHROMB MUT PCR- PRB ADL         $        41.13 83901
8019134 LAB MOLEC DIAG INTERP & RPT            $         6.24 83912
8019135 LAB MTHFR MUT PCR- PROBES ADNL         $        34.15 83901
8019136 LAB FAC V LEIDEN PCR- PRB ADNL         $        34.15 83901
8030011 LAB HANDLING NEWBORN SCREEN            $         6.00 99001
8030013 BLOOD COLLECTION, CAPILLARY            $        23.36 36416
8030020 LAB BLOOD COLLECTION FEE               $         6.00 36416
8050015 LAB VENIPUNCTURE         #             $        47.20 36415
7310002 STEM CELL ACQUISITION                  $     76,711.25 38205
7310007 CMV ANTIBODY                           $        87.80 86644
7310008 INFECT DIS MRKRS: ANTI-HBC             $        71.40 86704
7310009 ANTI-HBC-TOTAL                         $        71.40 86704
7310012 DONOR INFORMATION SESSION              $       186.84 99242
7310013 HCV CONFIRM                            $        91.71 86804
7310014 ANTI-HTLV-1                            $        66.29 86687
7310015 ANTI-HTLV-II                           $        81.37 86688
7310016 DONOR INFORMATION SESSION              $       291.00 99215
7310017 DONOR PHYSICAL EXAM                    $       289.14 99244
7310023 FORMAL SEARCH                          $       831.75 38999
7310025 ACTIVATION FOR DONOR SEARCH            $       831.75 38999
7310031 PERIPH STEM CELL HARV AUTO TXP         $      2,869.48 38206
7310032 BONE MARROW HARVEST                    $      2,512.68 38230
7310035 MARROW PROCUREMENT                     $     68,722.50 38230
7310037 STS                                    $        87.28 86592
7310038 INFECT DIS MARKRS:ANTI-HVC             $        87.28 86803
7310039 INFECT DIS MRKRS: ANTI-HBC             $        87.28 86704
7310043 HBSAG                                  $        87.28 87340
7310044 CMV ANTIBODY, IGM                      $        98.72 86645
7310045 BLOOD SAMPLE                           $       152.36 86849
7310046 ANTI-HBC-TOTAL-AG                      $        87.28 86704
7310047 ANTI-HCV                               $        87.28 86803
7310050 INFECT DIS MRKRS: ANTI-HIV 1,2         $        86.48 86703
7310052 INFECT DIS MRKRS: CMV                  $        87.80 86644




                                         Page 270
                                         Ancillary


7310068 HIGH RESOLUTION-DQB1 TYP, STD          $      334.50 86817
7310069 HIGH RESOLUTION-DQB1 TYP, URG          $      334.50 86817
7310070 INTERMDT RES-DQB1 TYP, STD             $      334.50 86817
7310071 INTERMDT RES-DQB1 TYP, URG             $      334.50 86817
7310072 HIGH RESOLUTION-DRB1 TYP, STD          $      334.50 86817
7310073 HIGH RESOLUTION-DRB1 TYP, URG          $      334.50 86817
7310074 INTERMDT RES-DRB1 TYP, STD             $      334.50 86817
7310075 INTERMDT RES-DRB1 TYP, URG             $      334.50 86817
7310076 HIGH RESOLUTION-DRB2 TYP, STD          $      334.50 86817
7310077 HIGH RESOLUTION-DRB2 TYP, URG          $      334.50 86817
7310078 INTERMDT RES-DRB2 TYP, STD             $      334.50 86817
7310079 INTERMDT RES-DRB2 TYP, URG             $      334.50 86817
7310080 HIGH RESOLUTION-DRB3 TYP, STD          $      334.50 86817
7310081 HIGH RESOLUTION-DRB3 TYP, URG          $      334.50 86817
7310082 INTERMDT RES-DRB3 TYP, URG             $      334.50 86817
7310083 HIGH RESOLUTION-DRB4 TYP, STD          $      334.50 86817
7310084 HIGH RESOLUTION-DRB4 TYP, URG          $      334.50 86817
7310085 INTERMDT RES-DRB4 TYP, STD             $      334.50 86817
7310086 INTERMDT RES-DRB4 TYP, URG             $      334.50 86817
7310087 HIGH RESOLUTION-DRB5 TYP, STD          $      334.50 86817
7310088 HIGH RESOLUTION-DRB5 TYP, URG          $      334.50 86817
7310089 INTERMDT RES-DRB5 TYP, STD             $      334.50 86817
7310090 INTERMDT RES-DRB5 TYP, URG             $      334.50 86817
7310091 HIGH RESOLUTION A,B,C, TYP STD         $      354.86 86813
7310092 HIGH RESOLUTION A,B,C TYP URG          $      354.86 86813
7310093 HIGH RESOLUTION-DPB1 TYP, STD          $      334.50 86817
7310094 HIGH RESOLUTION-DPB1 TYP, URG          $      334.50 86817
7310095 INTERMDT RES-DPB1 TYP, STD             $      334.50 86817
7310096 INTERMDT RES-DPB1 TYP, URG             $      334.50 86817
7310097 IR-DB TYPING                           $      334.50 86817
7310098 IR A,B,DRB3,4,5,R DRB1 STD             $      334.34 86821
7310099 HR A,B,DRB1,IR DR3,4,5 STD             $      334.34 86821
7310100 IR A,B,DRB3,4,5,HR DRB1 URG            $      334.50 86817
7310101 HR A,B,DRB1,IR DR3,4,5 URG             $      334.34 86821
7310103 FORMAL DONOR SEARCH NMDP               $     3,677.52 38999
7310106 W/U CANCELLTN FEE PER DONOR            $     2,522.99 38204
7310108 DR,DQ TYPING IR/HR, STD/URG            $      165.21 86816
7310110 DRB1 TYPING, IR/HR, STD/URG            $      102.13 83901
7310111 DRB3 TYPING, IR/HR, STD/URG            $      102.13 83901
7310112 DRB4 TYPING, IR/HR, STD/URG            $      102.13 83901
7310113 DRB5 TYPING, IR/HR, STD/URG            $      102.13 83901
7310114 DQB1 TYPING, IR/HR, STD/URG            $      102.13 83901
7310116 HBSAG (SCREENING)                      $       61.14 87340
7310117 HBSAG NEUT. (CONFIRMATORY)             $       63.16 87341
7310118 ANTI-HBC                               $       71.40 86704
7310119 ANTI-HCV (SCRN/CNFRM)                  $       84.54 86803
7310120 ANTI-HTLV TYPE I (SCRN/CNFRM)          $       51.34 86687
7310121 ANTI-HTLV TYPE II (SCRN/CFRM)          $       81.37 86688
7310122 HIV P-24 AG (SCREENING)                $      104.48 87390




                                         Page 271
                                         Ancillary


7310123 HIV AG NAT (SCREENING)                 $     1,574.46 87901
7310124 HCV AG NAT (SCREENING)                 $     1,574.46 87902
7310125 ANTI-HIV 1&/OR 2(ELISA)SCRN            $     2,258.10 86703
7310126 ANTI-HIV 1 WESTERN BLOT CNFRM          $      118.45 86689
7310127 ANTI-HIV 2 IMMUNOBLOT CNFRM            $      118.45 86689
7310128 STS (SCREENING)                        $       26.12 86592
7310129 FTB-ABS (CONFIRMATORY)                 $       62.25 86602
7310130 ANTI-CMV (TOTAL)                       $       81.04 86781
7310131 WNV-NAT (TESTING)                      $       78.86 86790
7310133 UNSTI. LEUKAPHERESIS PER DONOR         $     3,677.52 36511
7310135 MARROW/WORK-UP CANCELLATION            $     2,869.48 38206
7310136 PBSC DONOR INFORMATION                 $     5,591.43 38240
7310137 PBSC DONOR PHYSICAL EXAM               $     5,591.43 38240
7310138 PBSC WORK-UP CANCELLATION              $     5,591.43 38240
7310139 PBSC PRIMARY FILGRASTIM INJEC.         $     9,982.50 J2505
7310140 SECONDARY FILGRASTIM INJ.              $     9,982.50 J2505
7310141 UNSTIM. LEUK. PHYSICAL EXAM            $     3,677.52 36511
7310142 UNSTIM. LEUK. WORK-UP CANCELL.         $     3,677.52 36511
8001142 LAB LIPASE SE ST                       $      265.36 83690
8001152 LAB ACETOACETI AC ST                   $      136.38 82009
8001154 LAB AMMONIA BL                         $      205.94 82140
8001182 LAB ALBUMIN SE ST                      $      245.16 82040
8001740 LAB CYCLOSPORINE, MONOCLONAL           $      348.03 80158
8001819 LAB PANEL IRON BIND CAPACITY           $      180.78 83550
8001820 LAB PANEL IRON, TOTAL                  $      180.78 83540
8001835 LAB TROPONIN I                         $      110.48 84484
8001836 LAB LDL CHOLESTEROL                    $       34.15 83721
8001837 LAB HDL CHOLESTEROL                    $       30.45 83718
8001839 LAB LAMELLAR BODY DENSITY              $       21.88 83664
8002003 LAB HGB FETAL APT                      $      152.55 83033
8002010 LAB MUCIN CLOT                         $      136.38 83872
8002030 LAB PFA - ADP                          $       91.45 85576
8002031 LAB PFA - EPINEPHRINE                  $       91.45 85576
8002032 LAB MICRO EOSINO                       $      106.57 89190
8002035 LAB MICRO, URINE LYMPHOCYTE            $       99.91 81015
8002037 LAB CRYOFIBRINOGEN PL                  $       56.45 82585
8002038 LAB PH CSF                             $       56.45 83986
8002040 LAB CYSTINE QL UR                      $       56.45 82615
8002042 LAB ANTGN CRYPTO SE                    $      232.37 87327
8002043 LAB IG G, CORD BL                      $      248.23 82784
8002044 LAB IG M, CORD BL                      $      248.23 82784
8002045 LAB ANTIBD RUBELLA CORD BL             $      188.71 86762
8002046 LAB ANTGN CRYPTO SF                    $      232.37 87327
8002049 LAB CA125                              $      116.29 86304
8002073 LAB CA 19-9                            $      116.29 86301
8002076 LAB CBC WITH AUTO DIFF                 $      374.57 85025
8002200 LAB HEINZ PREP BLOOD                   $      136.38 85441
8002202 LAB MICRO LEUC AL PH                   $      288.72 85540
8002203 LAB SICKLE CELL SCRN                   $      136.38 85660




                                         Page 272
                                       Ancillary


8002204 LAB MICRO MALARIA BL                 $     152.55 87207
8002211 LAB CELL C EOSINO BL                 $     152.55 85032
8002234 LAB HGB FETAL KLEIHA                 $     348.03 85460
8002240 PLATELET SMEAR REVIEW                $     188.71 85008
8002283 LAB UNSTABLE HEMOGLOBIN              $     245.16 83068
8002291 LAB SED RATE WESTEGN                 $     172.54 85651
8002292 LAB FACTOR II                        $     324.56 85210
8002294 LAB PLATELET ANTBD                   $     612.65 86022
8002296 AUTOMATED DIFFERENTIAL               $     198.86 85004
8002298 MANUAL DIFFERENTIAL                  $     255.63 85007
8002299 LAB CBC HEMOGRAM W/PLT               $     175.71 85027
8002301 PLATELET COUNT, AUTOMATED            $      80.35 85049
8002417 LAB CELL CT TOTAL & DIFF CSF         $     205.94 89051
8002439 LAB MICRO WRIGHT ST                  $     106.57 87205
8002449 LAB MICRO CRYSTL UNS                 $     106.57 89060
8002510 LAB REDUCING SUBST FE                $      99.91 84376
8002511 LAB PH STOOL                         $      56.45 83986
8002521 LAB LE CELL PREP FLD                 $     288.72 87205
8002620 LAB MICRO EOSINOPHILS URN            $     106.57 89050
8002669 LAB GLUCOS-G6PD SCRN                 $     251.61 82960
8002840 LAB CELL CT TOTAL & DIFF             $     205.94 89051
8003016 LAB ADP FULL DOSE                    $      98.85 85576
8003017 LAB EPINEPHRINE FULL DOSE            $      98.85 85576
8003018 LAB COLLAGEN                         $      98.85 85576
8003019 LAB RISTOCETIN FULL DOSE             $      98.85 85576
8003020 LAB RISTOCETIN LOW DOSE              $      98.85 85576
8003021 LAB ARACHIDONIC ACID                 $      98.85 85576
8003022 LAB ADP LOW DOSE                     $      98.85 85576
8003023 LAB EPINEPHRINE LOW DOSE             $      98.85 85576
8003024 LAB SPONTANEOUS PLT AGG              $      98.85 85576
8003030 LAB PROT C RESIST                    $     179.41 85307
8003032 LAB LUPUS ANTICOAG/ HEXA PL          $     261.87 85597
8003100 LAB FIBRINOGEN QN PL                 $     205.94 85384
8003202 LAB PTT DIFF PL                      $     188.71 85732
8003211 LAB EUGLOBULIN LYSIS                 $     288.72 85360
8003223 LAB REPTILASE TIME                   $     377.63 85635
8003224 LAB BLEED TIME TEMPL                 $     265.36 85002
8003290 LAB PTT PL                           $     195.79 85730
8003302 LAB THROMBIN TIME PL                 $     188.71 85670
8003304 LAB DIL RUSL VIPER VNM TIME          $     246.22 85613
8003310 LAB PRO TIME ROU PL                  $     195.79 85610
8003311 LAB FACTOR 5 ASSAY                   $     324.56 85220
8003312 LAB FACTOR 7 ASSAY                   $     324.56 85230
8003313 LAB FACTOR 9 ASSAY                   $     324.56 85250
8003314 LAB FACTOR 10 ASSAY                  $     324.56 85260
8003315 LAB FACTOR 13 SCRN                   $     205.94 85291
8003321 LAB FIBRIN MONOMER                   $     182.26 85362
8003322 LAB PRO TIME DIFF PL                 $     188.71 85611
8003323 LAB FACTOR 8 ASSAY                   $     324.56 85240




                                       Page 273
                                         Ancillary


8003331 LAB FACTOR 11 ASSAY                    $     324.56 85270
8003332 LAB FACTOR 12 ASSAY                    $     324.56 85280
8003334 LAB RISTOCETIN CO-FACTOR               $     324.56 85245
8003337 LAB D-DIMER; ULTRASENS                 $     328.37 85379
8003338 LAB PROTEIN C ASSAY                    $     486.73 85303
8003343 LAB FACTOR INHIBITOR TEST              $     328.37 85335
8003351 LAB ANTITHROMBIN III ASSAY             $     298.02 85301
8003353 LAB PROTEIN S ASSAY                    $     486.73 85306
8003555 LAB D-DIMER QUANT                      $     328.37 85379
8004007 LAB URINALYSIS W/ MICROSCOPY           $     189.03 81001
8004008 LAB URINALYSIS AUT W/O MICRO           $     126.02 81003
8004601 LAB SUDAN III STAIN (FAT) URN          $     285.02 89125
8004604 LAB SPECIFIC GRAV UR                   $      56.45 81003
8004605 LAB PH QUAL FL                         $      56.45 83986
8004613 LAB MICRO HEMOSID UR                   $     136.38 83070
8004660 LAB SPEC GRAV FLD                      $      70.09 84315
8004690 LAB LIGNIN TEST URN                    $      99.91 81099
8004691 LAB DYSMORPHIC RED CELLS UR            $      93.14 81015
8004692 LAB PH, URINE                          $      56.45 83986
8004695 VON WILLEBRAND FACTOR ANTIGEN          $     329.42 85246
8006100 LAB ANTIB RA QUANT                     $     152.55 86431
8006114 LAB TRANSFERRIN SE                     $     251.61 84466
8006123 LAB CERULOPLASMIN                      $     361.25 82390
8006125 LAB ALPHA FETOPROT                     $     205.94 82105
8006130 LAB ALPHA ANTI TRYPS                   $     265.36 82103
8006133 LAB IG A SE                            $     248.23 82784
8006134 LAB IG G SE                            $     248.23 82784
8006135 LAB IG M SE                            $     248.23 82784
8006142 LAB ANTI-STREPTOLYSIN O ANTIBD         $     182.26 83883
8006143 LAB COMPLMNT C3 ASSY                   $     265.36 86160
8006144 LAB COMPLMNT C4 ASSY                   $     354.37 86160
8006151 LAB ANTIBD RUBELLA                     $     188.71 86762
8006161 LAB C-REACT PROT QT                    $     278.36 86141
8006177 LAB HAPTOGLOBIN                        $     348.03 83010
8006214 LAB IGG SYNTHETIC RATE, CSF            $     140.71 83883
8006242 LAB C-REACT PROT CORD BL               $     278.36 86140
8006258 LAB IGE                                $     172.54 82785
8006269 LAB URN MICROALBUMIN, TIMED            $      82.88 82043
8006270 LAB URN MICROALBUMIN, RANDOM           $      82.88 82043
8006302 LAB BETA-2 MICROGLOBULIN               $     278.36 82232
8006304 RETICULOCYTE; AUTOMATED                $     188.71 85045
8006309 LAB FREE LAMBDA LIGHT CHAINS           $      88.80 83883
8006310 LAB FREE KAPPA LIGHT CHAINS            $      88.80 83883
8006380 FETAL FIBRONECTIN                      $     567.82 82731
8006811 LAB APOLIPOPROT A1                     $     228.88 82172
8006812 LAB APOLIPOPROT B                      $     228.88 82172
8006928 LAB PREALBUMIN                         $     233.11 84134
8010002 LAB CREATININ-CLR AU                   $     205.94 82575
8010003 LAB GLUCOS TOL 3H AU                   $     654.94 82951




                                         Page 274
                                       Ancillary


8010004 LAB GLUCOS TOL 5H AU                 $     654.94 82951
8010005 LAB GLUCOS TOL 4H AU                 $     654.94 82951
8010006 LAB GLUC TOL, EA ADNL SPEC           $     205.94 82952
8010010 LAB GLUCOS TOL 6H AU                 $     654.94 82951
8010019 LAB SIROLIMUS                        $      72.21 80195
8010025 LAB LITHIUM                          $     124.22 80178
8010026 LAB UNFRACTIONATED HEPARIN           $      71.89 85520
8010027 LAB LOW MOL WT HEPARIN               $      81.40 85520
8010070 LAB HEPATIC FUNCTION PANEL           $     345.28 80076
8010071 LAB COMP METABOLIC PANEL             $     690.67 80053
8010073 LAB BILIRUBIN, DIRECT                $     205.94 82248
8010101 LAB CHOLESTROL SE AU                 $     205.94 82465
8010105 LAB HOMOCYSTEINE                     $      52.01 83090
8010111 LAB GLUCOSE FL       AU              $     205.94 82945
8010120 LAB UREA NITRO SE AU                 $     205.94 84520
8010121 LAB S G O T SE AU                    $     205.94 84450
8010122 LAB SODIUM SE     AU                 $     205.94 84295
8010130 LAB CALCIUM SE    AU                 $     205.94 82310
8010131 LAB S G P T SE AU                    $     205.94 84460
8010132 LAB POTASSIUM SE AU                  $     205.94 84132
8010140 LAB BICARB-CO2 SE AU                 $     205.94 82374
8010141 LAB LDH SE      AU                   $     265.36 83615
8010160 LAB CHLORIDE SE AU                   $     205.94 82435
8010162 LAB OSMOLALITY SE AU                 $     152.55 83930
8010170 LAB CPK TOTAL SE AU                  $     265.36 82550
8010172 LAB PROTEN TOT SE AU                 $     188.71 84155
8010180 LAB ALK PHOS SE AU                   $     218.84 84075
8010181 LAB URIC ACID SE AU                  $     205.94 84550
8010190 LAB CREATININE SE AU                 $     205.94 82565
8010191 LAB PHOSPHOR SE AU                   $     205.94 84100
8010210 LAB RENAL FUNCTION PANEL             $     493.18 80069
8010211 LAB GLUCOSE, PRENATAL SCREEN         $     205.94 82947
8010212 LAB PSA, SCREEN                      $     171.05 G0103
8010213 LAB ACUTE HEPATITIS PANEL            $     714.77 80074
8010214 LAB THYROXINE                        $     174.02 84436
8010215 LAB T UPTAKE                         $     174.02 84479
8010216 LAB LIPOPROTEIN A                    $      36.47 83695
8010310 LAB GLUCOSE FAST AU                  $     205.94 82947
8010330 LAB GLUCOSE 2H PP                    $     205.94 82950
8010340 LAB BASIC METABOLIC PANEL            $     394.65 80048
8010343 LAB ELECTROLYTES                     $     197.48 80051
8010400 LAB CHLORIDE SF AU                   $     205.94 82438
8010401 LAB GLUCOSE SF       AU              $     205.94 82945
8010429 LAB POTASSIUM FL AU                  $     205.94 84132
8010449 LAB BICARB-CO2 FL AU                 $     205.94 82374
8010450 LAB BILIRUBIN TOT CSF                $     205.94 82247
8010507 SODIUM, OTHER SOURCE                 $     205.94 84302
8010508 LAB CHLORIDE FL AU                   $     205.94 82438
8010509 LAB UREA NITRO UR                    $     205.94 84540




                                       Page 275
                                     Ancillary


8010511 LAB PHOSPHORUS FLD                 $     205.94 84100
8010512 LAB ALBUMIN FLD                    $     245.16 82042
8010513 LAB CHOLESTEROL FLD                $     205.94 82465
8010514 LAB TRIGLYCERIDES FLD              $     251.61 84478
8010515 LAB CREATININE FLD                 $     205.94 82570
8010516 LAB UREA NITROGEN FLD              $     205.94 84520
8010600 LAB CREATININE UR AU               $     205.94 82570
8010602 LAB SODIUM UR       AU             $     205.94 84300
8010610 LAB CHLORIDE UR AU                 $     205.94 82436
8010630 LAB POTASSIUM UR AU                $     205.94 84133
8010631 LAB CALCIUM UR      AU             $     205.94 82340
8010640 LAB GLUCOSE URN                    $     205.94 82945
8010650 LAB OSMOLALITY UR AU               $     152.55 83935
8010700 LAB PHOSPHOR UR AU                 $     205.94 84105
8010710 LAB URIC ACID UR AU                $     205.94 84560
8010712 LAB ETHANOL URN                    $     348.03 82055
8010719 LAB HBSAG CONFIRMATION             $     409.77 87341
8010813 CKMB FRACTION                      $     119.57 82553
8011005 LAB RVVT CORRECTION                $     359.54 85613TC
8011103 LAB DILANTN QN SE SC               $     490.01 80185
8011111 LAB QUINIDN QN SE SC               $     490.01 80194
8011112 LAB AMYLASE SE      SC             $     251.61 82150
8011122 LAB VISCOSITY SE SC                $     152.55 85810
8011131 LAB LIPID PANEL                    $     499.53 80061
8011132 LAB PRONESTYL & NAPA               $     496.67 80192
8011133 LAB PHENOB QN SE SC                $     529.66 80184
8011143 LAB TRIGLYCER SE SC                $     251.61 84478
8011144 LAB THEOPHYLIN SE SC               $     321.28 80198
8011145 LAB GAM GLUT TRAN SC               $     175.71 82977
8011150 LAB ETHANOL QUAN SC                $     348.03 82055
8011151 LAB MAGNESIUM SE SC                $     218.84 83735
8011153 LAB DARVON                         $     161.75 80101
8011155 LAB ACETAMINOPHEN                  $     271.81 82003
8011161 LAB SALICYL QN SE SC               $     182.26 80196
8011163 LAB GENTAMICIN                     $     354.37 80170
8011164 LAB TOBRAMYCIN                     $     354.37 80200
8011171 LAB BILIRU TOTAL SC                $     205.94 82247
8011201 LAB METHOTREXATE                   $     265.36 80299
8011202 LAB VANCOMYCIN                     $     374.14 80202
8011203 LAB AMIKACIN                       $     248.23 80150
8011214 LAB CARBAMAZEPINE                  $     370.76 80156
8011227 LAB VALPROIC ACID                  $     248.23 80164
8011300 LAB LACTIC AC BL SC                $     265.36 83605
8011402 LAB PROTEN TOT SF SC               $     188.71 84157
8011447 LAB FLUID BILIRUBIN, TOTAL         $     205.94 82247
8011448 LAB AMYLASE FL SC                  $     251.61 82150
8011507 LAB PROTEN TOT FL SC               $     188.71 84157
8011508 LAB LDH FL     SC                  $     265.15 83615
8011509 LAB CALCIUM FL    SC               $     205.94 82310




                                     Page 276
                                       Ancillary


8011600 LAB AMYLASE UR      SC               $     251.61 82150
8011621 LAB MAGNESIUM UR SC                  $     218.84 83735
8011624 LAB PROTEN TOT UR SC                 $     188.71 84156
8011630 LAB AMPHETAMIN UR SC                 $     132.26 80101
8011634 LAB PHENCYCLIDINE UR                 $     128.66 80101
8011635 LAB OPIATES UR                       $     150.55 80101
8011636 LAB COCAINE UR                       $     166.83 80101
8011640 LAB CANNABINOIDS                     $     195.79 80101
8011645 LAB BARBITURATES URN                 $     132.26 80101
8011646 LAB BENODIAZEPINES URN               $     128.66 80101
8011649 LAB SALICYLATES URN                  $      93.14 80101
8011711 LAB METHADONE UR                     $     161.75 80101
8011739 LAB AMINO FL SCAN SC                 $     654.94 82143
8011744 LAB L/S RATIO                        $     318.01 83661
8011788 LAB SWEAT COL, IONTOPHERESIS         $      77.81 89230
8011795 LAB LDH CSF                          $     265.15 83615
8011796 LAB CALCIUM CSF                      $     205.94 82310
8018105 LAB DIGOXIN SE     RI                $     420.77 80162
8018110 LAB CORTISOL SE RI                   $     420.77 82533
8018113 LAB FOLATE SE      RI                $     393.91 82746
8018114 LAB VITAMIN B-12 RI                  $     555.98 82607
8018115 LAB FERRITIN                         $     324.56 82728
8018120 LAB HCG B SUB      RI                $     377.63 84702
8018192 LAB THYRO TSH SE RI                  $     393.91 84443
8018193 LAB CARCINOEMB AN SE                 $     420.77 82378
8018202 LAB HEP ANTI-HBS                     $     119.57 86706
8018204 LAB ANTI-HAV TOTAL                   $      56.03 86708
8018205 LAB ANTI-HAV IGM                     $      78.34 86709
8018212 LAB HEP B S ANTIG                    $     119.57 87340
8018220 LAB BETA HCG, QUAL                   $     248.23 84703
8018223 LAB CA 15-3                          $     116.29 86300
8018224 LAB PREGNANCY TEST URINE             $     248.23 81025
8018225 LAB PTH                              $     139.55 83970
8018226 LAB PROSTATE SPECIFIC ANTGN          $     171.05 84153
8018230 LAB HEP C ANTIBD                     $     136.38 86803
8018231 LAB PROLACTIN                        $     132.89 84146
8018232 LAB LUTENIZING HORMONE               $      89.97 83002
8018233 LAB FOLLICLE STIM HORMONE            $      89.97 83001
8018235 LAB ANTI-HEP B SURF ANTIBD           $     156.04 86706
8018236 LAB HEPATITIS B CORE AB, IGM         $      78.34 86705
8018237 LAB PROGESTERONE                     $     102.55 84144
8018238 LAB ESTRADIOL                        $     167.14 82670
8018239 LAB CA 27.29                         $     232.37 86300
8018241 LAB PSA, FREE                        $     171.05 84154
8063107 LAB THROMBELASTOGRAPH OR             $     480.18 85999
8063108 LAB FK506                            $      71.89 80197
8063200 LAB CALCIUM, FREE                    $     205.94 82330
8063809 LAB NATRIURETIC PEPTIDE ASSY         $     146.74 83880
8002015 LAB SUDAN BLACK STAIN                $     218.84 88313




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                                         Ancillary


8002016 LAB LIPASE STAIN                       $     218.84 88319
8002024 BONE MARROW SURGICAL TRAY              $     380.91
8002074 LAB IRON STAIN - BM                    $     136.38 88313
8002075 LAB COLLAGEN BINDING PROTEIN           $     175.92 83520
8002206 LAB ACID PHOSPHATASE STAIN             $     218.84 88319
8002224 LAB HGB ELECTROPH BL                   $     420.77 83020
8002226 LAB HGB FETAL ALKALI CORD BL           $     152.55 83033
8002229 LAB HGB ELECTROPH ACID BL              $     420.77 83020
8002231 LAB HGB H STAIN                        $     245.16 83068
8002453 LAB IRON STAIN                         $     136.38 88313
8003220 LAB CLOT RETRACTION                    $     136.38 85170
8003352 LAB HEPARIN ASSAY                      $     298.02 85520
8006006 LAB COCCI IGG                          $      76.65 86635
8006007 LAB COCCI IGM                          $      76.65 86635
8006008 LAB CSF COCCI IGG                      $      76.65 86635
8006009 LAB CSF COCCI IGM                      $      76.65 86635
8006080 LAB TOXO IGM - EIA                     $     286.40 86778
8006091 LAB ANTIBODY EBV IGG                   $     286.40 86665
8006112 LAB ANTIBD THYROGLOB                   $     324.56 86800
8006115 LAB ANTIBODY ANA, TITER                $     348.03 86039
8006116 LAB ANTIBD EBV IGM                     $     286.40 86665
8006117 LAB ANTIBD TOXO IGM                    $     286.40 86778
8006120 LAB ANTIBD SY RPR QL                   $     146.42 86592
8006124 LAB PROTEIN IFE, SERUM                 $     654.94 86334
8006131 LAB CRYOGLOBULIN SE                    $     175.71 82595
8006154 LAB ANTIBD SY FTA                      $     460.09 86781
8006170 LAB PROTEIN ELECTROPHORESIS SE         $     420.77 84165
8006171 LAB ANTIBD MITO TITER                  $     348.03 86256
8006172 LAB ANTIBD SM MS TITER                 $     348.03 86256
8006178 LAB ANTIBD MICROSOM                    $     324.56 86376
8006179 LAB TDT                                $     556.83 88347
8006207 LAB HIV AB WESTERN BLOT                $     278.36 86689
8006212 LAB ANTIBD ANTIPARIETAL                $     348.03 86256
8006228 LAB HERPES SIMPLEX TYP 2 IGG           $     396.98 86696
8006229 LAB HERPES SIMPLEX TYP 2 IGM           $     396.98 86696
8006233 LAB HERPES SIMPLEX TYP 1 IGG           $     391.16 86695
8006234 LAB HERPES SIMPLEX TYP 1 IGM           $     391.16 86695
8006239 LAB IG A, CORD BL                      $     248.23 82784
8006248 LAB CMV AB, IGG                        $     286.61 86644
8006249 LAB CMV AB, IGM                        $     286.61 86645
8006250 LAB ANTIBD MEASLES IGG                 $     149.70 86765
8006267 LAB ANCA                               $     186.49 86021
8006284 MORPHOMETRIC ANALYSIS; TUMOR           $      11.10 88358
8006285 LAB CD4 AND CD8 T CELL COUNT           $     385.35 86360
8006286 LAB B LYMPH QUANTITATION               $     192.73 86355
8006287 LAB NK LYMPH QUANTITATION              $     192.73 86357
8006288 LAB CD34 STEM CELL QUANT               $     385.35 86367
8006289 LAB FLOW CYTOM-1 ST MARKER             $     192.73 88184
8006290 LAB FLOW CYTOM-ADDL MARKERS            $     192.73 88185




                                         Page 278
                                         Ancillary


8006291 LAB T CELLS, TOTAL COUNT               $      192.73 86359
8006293 LAB HEP ANTI-HBC                       $      136.38 86704
8006305 LAB ERYTHROPOIETIN LEVEL               $      348.03 82668
8006311 LAB HIV1/HIV3 PLUS O EIA               $      232.37 86703
8006312 LAB KI67 (MIB-1)                       $      138.07 88361
8006313 LAB HER2/NEU RECEPTOR                  $      138.07 88361
8006314 LAB PROGESTERONE RRECEPTOR             $      138.07 88361
8006315 LAB ESTROGEN RECEPTOR                  $      138.07 88361
8006318 LAB DSDNA ANTIBODIES                   $       26.01 86225
8006319 LAB SM ANTIBODIES                      $       26.01 86235
8006320 LAB RNP ANTIBODIES                     $       26.01 86235
8006321 LAB SSA ANTIBODIES                     $       26.01 86235
8006322 LAB SSB ANTIBODIES                     $       26.01 86235
8006323 LAB JO-1 ANTIBODIES                    $       26.01 86235
8006324 LAB SCL 70 ANTIBODIES                  $       26.01 86235
8006325 LAB CENTROMERE AB                      $       26.01 86235
8006326 LAB HISTONE ANTIBODIES                 $       26.01 86235
8006327 LAB FLOW CYTOMETRY 1ST AB              $      201.19 88184
8006402 LAB PROTEIN ELECT SP                   $      460.09 83916
8006412 LAB ANTIBD SY FTA CSF                  $      460.09 86781
8006452 LAB PLT AB - HIT PF4-HEP EIA           $      247.17 86022
8006600 LAB PROTEIN IFE, URINE                 $      688.34 86335
8006601 LAB PROTEIN ELECTROPHORESIS UR         $      460.09 84166
8006608 LAB HIV P24 ANTIGEN                    $      177.00 87390
8006820 LAB ANTIBD ANTICARDIOLIPIN             $      152.55 86147
8006900 LAB TDT-BM                             $      556.83 88347
8006910 LAB DNA ANAL, BONE MARROW              $      853.79 88182
8006911 LAB DNA ANAL, TISSUE                   $      900.31 88182
8006913 LAB DNA PLOIDY/DNSM                    $     1,310.08 88358
8006925 LAB HTLV-I/HTLV-II                     $      310.82 86688
8006927 LAB VARICELLA ZOSTER IGG               $      184.80 86787
8006988 LAB ANTIBD TOX IGG                     $      286.40 86777
8010194 LAB GLYCATED HEMOGLOBIN                $      106.57 83036
8011226 LAB LEAD BL                            $      232.37 83655
8011789 LAB CHLORIDE, SWEAT                    $      594.68 82438
8018242 LAB HGB EVAL W/ CONF - HPLC            $       68.61 83021
8060007 LAB BETA 2 GLYCOPROTEIN1-IGG           $      132.78 86146
8060008 LAB BETA 2 GLYCOPROTEIN1-IGM           $      132.78 86146
8060016 LAB ANTI-TPO AB                        $       39.00 86376
8060017 LAB ANTI-THRYOGLOBULIN AB              $       39.00 86800
8408801 4NE - OBSERVATION, PER HOUR            $      128.80 G0378
8408802 4NE - SHORT STAY, PER HOUR             $      123.20
8408803 4NE - OBS, PER HR DIR-ADMIT            $      258.11 G0379
8278801 4NW - OBSERVATION, PER HOUR            $      128.80 G0378
8278802 4NW - SHORT STAY PER HOUR              $      123.20
8278803 4NW - OBS, PER HR DIR-ADMIT            $      258.11 G0379
8488801 4SE - OBSERVATION,PER HOUR             $      128.80 G0378
8488802 4SE - SHORT STAY, PER HOUR             $      123.20
8488803 4SE - OBS,PER HR DIR-ADMIT             $      258.11 G0379




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                                         Ancillary


8498801 4SW - OBSERVATION, PER HOUR            $     128.80 G0378
8498802 4SW - SHORT STAY, PER HOUR             $     123.20
8498803 4SW - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8508801 5COU - OBSERVATION, PER HOUR           $     128.80 G0378
8508802 5COU - SHORT STAY, PER HOUR            $     123.20
8508803 5COU - OBS, PER HR DIR-ADMIT           $     258.11 G0379
8518801 5NW - OBSERVATION, PER HOUR            $     128.80 G0378
8518802 5NW - SHORT STAY, PER HOUR             $     123.20
8518803 5NW - OBS, PER HOUR                    $     258.11 G0379
8588801 5SE - OBSERVATION, PER HOUR            $     128.80 G0378
8588802 5SE - SHORT STAY, PER HOUR             $     123.20
8588803 5SE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8598801 5SW - OBSERVATION, PER HOUR            $     128.80 G0378
8598802 5SW - SHORT STAY, PER HOUR             $     123.20
8598803 5SW - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8658801 6ICU - OBSERVATION, PER HOUR           $     128.80 G0378
8658802 6ICU - SHORT STAY, PER HOUR            $     123.20
8658803 6ICU - OBS, PER HR DIR- ADMIT          $     258.11 G0379
8608801 6NE - OBSERVATION, PER HOUR            $     128.80 G0378
8608802 6NE - SHORT STAY, PER HOUR             $     123.20
8608803 6NE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8628801 6NW - OBSERVATION, PER HOUR            $     128.80 G0378
8628802 6NW - SHORT STAY, PER HOUR             $     123.20
8628803 6NW - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8478801 6SE - OBSERVATION, PER HOUR            $     128.80 G0378
8478802 6SE - SHORT STAY, PER HOUR             $     123.20
8478803 6SE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8708801 7NE - OBSERVATION, PER HOUR            $     128.80 G0378
8708802 7NE - SHORT STAY, PER HOUR             $     123.20
8708803 7NE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8060001 LAB HER-2/NEU FISH PROBE               $     512.42 88368
8060006 LAB CLL FISH PROBES                    $     205.41 88368
8060009 LAB UROVYSION                          $     152.66 88368
8060010 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060018 LAB PCR JAK2 INTERP & RPT              $      20.29 83912TC
8060032 LAB RHODAMINE AUROMN                   $     420.77 87206
8060045 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060046 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060047 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060048 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060049 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060050 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060062 LAB MORPHO ANALY, FISH, 1P             $     307.43 88368
8060063 LAB MORPHO ANALY, FISH, 9;22           $     326.78 88368
8060064 LAB MORPHO ANALY, FISH 13Q DEL         $     653.56 88368
8060065 LAB MORPHO ANALY, FISH, MYC            $     335.98 88368
8060066 LAB MORPHO ANALY, FISH, 15;17          $     326.78 88368
8060067 LAB MORPHO ANALY, FISH, 11;14          $     326.78 88368
8060068 LAB MORPHO ANALY, FISH, 14;18          $     326.78 88368




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                                         Ancillary


8060069 LAB MORPHO ANALY, FISH, 19Q            $     307.43 88368
8060070 LAB EXTRACTION NUCLEIC ACID            $     118.09 83891
8060071 LAB REVERSE TRANSCRIP 9;22             $      28.54 83902
8060072 LAB NUCLEIC ACID PRB, EA 9;22          $      28.54 83896
8060073 LAB AMPLIFICATION/PCR 9;22             $       7.40 83898
8060075 LAB REVERSE TRANSCRIP 15;17            $      36.05 83902
8060076 LAB NUCLEIC ACID PRB, EA 15;17         $      36.05 83896
8060077 LAB AMPLIFICATION/PCR 15;17            $       9.30 83898
8060078 LAB PCR JAK2 NUC ACID EXTRACT          $     114.60 83890
8060079 LAB PCR JAK2 AMPLIFICATION             $      61.95 83898
8060080 LAB PCR JAK2 SEP/ELECPH                $      61.95 83894
8060081 LAB PCR JAK2 MOL ENZ DIGEST            $      61.95 83892
8060083 LAB HPV HIGH RISK IN SITU              $     291.83 88365
8060084 LAB HPV LOW RISK IN SITU               $     291.83 88365
8060085 LAB MOLECULAR EXTRACT-WARFA            $      38.09 83891
8060086 LAB ENZYMATIC PRO K DIGEST-W           $      38.09 83892
8060087 LAB MOLECULAR AMP-FIRST 2              $      34.51 83900
8060088 LAB MOLECULAR AMP-EA ADD-WA            $      34.51 83901
8060089 LAB MOL ENZYME DIGEST-WARFAR           $      34.51 83892
8060090 LAB NUCLEIC ACID PROBE EA-WA           $      34.51 83896
8060091 LAB MUTATION SCANNING EA-WAR           $      34.51 83903
8060092 LAB SIGNAL AMP, EA-WARFARIN            $      34.51 83908
8060093 LAB INTERP, EA MUT-WARFARIN            $      13.39 83912
8060102 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060103 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060104 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060105 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060106 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060107 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060108 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060109 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060110 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060111 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060112 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060113 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060114 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060115 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060116 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060117 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060121 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060122 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060123 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060124 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060125 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060126 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060127 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060128 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060129 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060130 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342




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                                         Ancillary


8060131 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060132 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060133 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060134 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060135 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060137 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060138 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060139 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060140 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060141 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060142 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060143 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060144 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060145 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060146 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060147 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060148 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060150 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060153 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060154 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060155 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060156 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060157 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060158 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060159 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060160 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060161 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060162 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060164 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060165 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060166 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060167 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060168 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060169 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060172 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060173 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060174 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060175 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060176 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060177 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060178 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060179 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060180 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060181 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060185 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060186 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060188 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060189 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060190 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342




                                         Page 282
                                         Ancillary


8060191 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060192 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060193 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88361
8060194 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060195 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060196 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060197 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060198 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060199 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060206 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060207 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060208 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060209 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060210 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060211 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060212 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060213 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060214 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060215 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060216 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060217 LAB IMMUNOHISTOCHEMISTRY EA AB         $     420.77 88342
8060218 LAB PERIODIC ACID-SCHIFFS              $     127.92 88313
8060219 LAB GOMORI TRICHROME                   $     127.92 88313
8060220 LAB OIL RED O                          $     127.92 88313
8060221 LAB AZURE B CHLORIDE                   $     127.92 88313
8060222 LAB ATPASE 9.8                         $     197.48 88319
8060223 LAB ATPASE 4.6                         $     197.48 88319
8060224 LAB ATPASE 4.2                         $     197.48 88319
8060225 LAB DPNHTETRAZOLIUN REDUCTSE           $     197.48 88319
8060226 LAB CYTOCHROME C                       $     197.48 88319
8060227 LAB SUCCINYL DEHYDROGENASE             $     197.48 88319
8060228 LAB ALKALINE PHOSPHATASE               $     197.48 88319
8060229 LAB ACID PHOSPHATASE                   $     197.48 88319
8060230 LAB MYOPHOSPHORYLASE PHOS B            $     197.48 88319
8060231 LAB INSITU HYBR, 25-99 CELLS           $     256.16 88274
8060233 LAB TISSUE INSITU INTRP, RPT           $     256.16 88365
8060234 LAB JH/SO MOLECULAR EXTR               $      84.47 83890
8060235 LAB JH/SO ENZYME DIGEST                $      22.10 83892
8060236 LAB JH/SO SEP/ELECTROPH                $      44.40 83894
8060237 LAB JH/SO NUC ACID PROBE               $     347.18 83896
8060238 LAB JH/SO NUC ACID TRANSF              $     124.22 83897
8060239 LAB JH/SO INTERP & REPORT              $      34.78 83912
8060240 LAB JK/SO INTERP & REPORT              $      84.47 83912
8060241 LAB JK/SO ENZYME DIGEST                $      22.10 83892
8060242 LAB JK/SO SEP/ELECTROPH                $      44.40 83894
8060243 LAB JK/SO NUC ACID PROBE               $     347.18 83896
8060244 LAB JK/SO NUC ACID TRANSF              $     124.22 83897
8060245 LAB JK/SO INTERP & REPORT              $      34.78 83912
8060246 LAB CT-B/SO MOLECULAR EXTR             $      84.47 83912




                                         Page 283
                                        Ancillary


8060247 LAB MOLEC ENZYME DIGESTION            $      22.10 83892
8060248 LAB CT-B/SO SEP/SLECTROPH             $      44.40 83894
8060249 LAB MOLEC NUC ACID PROBE              $     347.18 83896
8060250 LAB MOLEC NUC ACID TRANSFER           $     124.22 83897
8060251 LAB CT-B/SO INTERP & REPORT           $      34.78 83912
8060252 LAB MOLEC ISOL/EXTRACTION             $      88.59 83890
8060253 LAB IGH PCR AMPLIFICATION             $      37.00 83898
8060254 LAB MOLEC SEP/ELECTROPHORES           $      72.00 83894
8060255 LAB IGH PCR INTERP & REPORT           $      36.47 83912
8060256 LAB TCR-G PCR MOLEC EXTR              $      88.59 83890
8060257 LAB MOLEC AMPLIFICATION/SING          $      37.00 83898
8060258 LAB MOLEC AMPLIFICATION/MULT          $      27.38 83901
8060259 LAB TCR-G PCR SEP/ELECPH              $      72.00 83894
8060260 LAB TCR-G PCR INTERP & RPT            $      36.47 83912
8060261 LAB T14;18 PCR MOLC EXTR              $      88.59 83890
8060262 LAB T14;18 PCR AMPLIFICATION          $      30.55 83898
8060263 LAB T14;18 PCR SEP/ELECPH             $      35.10 83894
8060264 LAB T14;18 PCR NUC ACID TRNF          $      47.57 83897
8060265 LAB T14;18 PCR NUC ACID PRBE          $     130.88 83896
8060266 LAB MOLEC INTERP & REPORT             $      46.31 83912
8060267 LAB T11;14 PCR MOLC EXTR              $      88.59 83890
8060268 LAB T11;14 PCR AMPLIFICATION          $      37.00 83898
8060269 LAB T11;14 PCR SEP/ELECPH             $      38.27 83894
8060270 LAB T11;14 PCR NUC ACID TRNF          $      61.32 83897
8060271 LAB T14;18 PCR NUC ACID PRBE          $     169.47 83896
8060272 LAB T14;18 PCR INTERP & RPT           $      36.47 83912
8060273 LAB T15;17 RT-PCR MOL EXT             $      84.58 83890
8060274 LAB T15;17 RT-PCR REV TRSC            $      96.63 83902
8060275 LAB T15;17 RT-PCR AMPLIF              $      37.00 83898
8060276 LAB T15;17 RT-PCR SEP/EP              $      38.27 83894
8060277 LAB T15;17 RT-PCR NUC AC TFR          $      61.32 83897
8060278 LAB T15;17 RT-PCR NUC AC PRB          $     169.47 83896
8060279 LAB T15;17 RT-PCR INTRP & RPT         $      36.47 83912
8060280 LAB T9;22 RT-PCR MOL EXT              $      84.58 83890
8060281 LAB MOLEC REV TRANSCRIPTION           $      96.63 83902
8060282 LAB T9;22 RT-PCR AMPLIF               $      33.62 83898
8060283 LAB T9;22 RT-PCR SEP/EP               $      35.10 83894
8060284 LAB T9;22 RT-PCR NUC AC TFR           $      47.57 83897
8060285 LAB T9;22 RT-PCR NUC AC PRB           $     130.88 83896
8060286 LAB T9;22 RT-PCR INTRP & RPT          $      46.31 83912
8060292 LAB MOLEC DNA PROBE/EACH              $     215.35 88271
8060296 LAB INSITU HYB, 100-300 CELL          $      95.89 88275
8060309 LAB MDS FISH PROBES                   $     248.44 88368
8060310 LAB MOLECULAR EXTRACT-UGT1A1          $      23.64 83891TC
8060311 LAB MOL ENZYME DIGEST-UGT1A1          $      30.95 83892TC
8060312 LAB NUCLEIC ACID PROBE EA-UG          $      30.95 83896TC
8060313 LAB MUTATION SCANNING EA-UGT          $      30.95 83903TC
8060314 LAB SIGNAL AMP, EA-UGT1A1             $      30.95 83908TC
8060315 LAB INTERP/REPORT-UGT1A1              $      18.16 83912TC




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                                         Ancillary


8060317 LAB IHC MISC-SLIDE ONLY                $       75.97 88342TC
8016016 THR APHER SEL ADS/FIL PL REINF         $     6,238.11 36516
8016018 THER APHER W/ PROTEIN A COL            $     2,075.28 36515
8016019 ALLO PB STEM CELL APHERESIS            $     2,766.38 38205
8016100 PROCESS POOLING CRYO                   $      469.08 86965
8016101 POOLING PLATELETS                      $      297.92 86965
8016102 PROCESS WASHING PLT                    $      338.30 P9022
8017003 THERAPEUTIC PHLEBOTOMY                 $      212.29 99195
8017010 THR APHER, PLASMA PHERESIS             $     2,245.92 36514
8061010 PROCESS WHOLE BLOOD                    $      654.09 P9010
8061020 PROCESS PACKED RBC                     $      654.09 P9021
8061040 PROCESS PLATELET PACK                  $      283.12 P9019
8061060 PROCESS PLASMA (FFP)                   $      261.97 P9017
8061070 PROCESS GRANULOCYTE PHER               $     1,723.13 P9050
8061071 PROCESS CRYOPRECIPITATE                $      114.60 P9012
8061080 PROCESS PLATELETPHERESIS               $     1,353.53 P9034
8061201 PROCESS GRANULOCYTES PED               $      720.90 P9050
8061203 PROCESS AUTOLOGUS UNIT                 $      654.09 86890
8061301 EMERG CHG THERAP APHER                 $      859.93 86999
8061303 TRANSFUSION, BLOOD COMPONENT           $      783.17 36430
8061304 PROCESS PCK RBC LEUKOREDUCED           $      786.56 P9016
8061305 PROCESS PCK RBC WASHED                 $      983.09 P9022
8061306 PROCESS PCK RBC DEGLYCEROLIZE          $      931.60 P9039
8061307 PROCESS PLT PHERSIS LEUKO RED          $     1,528.61 P9035
8061308 THER APHER FOR PLTS                    $     2,245.92 36513
8061309 THER APHER FOR RBC'S                   $     2,245.92 36512
8061310 THERAPEUTIC APHER WBC                  $     2,245.92 36511
8062005 AUTO/DD PROCESSING RBC FAB3 #          $      710.97 P9021
8062006 AUTO/DD PROCESSING FFP FAB #           $      443.18 P9021
8062009 AUTO/DD PROCESS PHER FFP FAB#          $      817.11 P9021
8062014 AUTO/DD PROC CRYO FIB GLUE W#          $      174.44 P9044
8062015 AU/DD PROC CRYO FIB GLUE PHR#          $      442.33 P9021
8062016 CRYO FIBRIN GLUE ADMIN KIT             $      173.28
8062018 PROCESS AUTO 1/2 RBC FAB3              $      354.16 P9021
8062019 PROCESS AUTO RBC FZ SHT TM             $      506.72 P9021
8075005 PB STEM CELL APHERESIS                 $     2,757.81 38206
8006110 LAB ANTIBD MONO SCRN                   $      188.71 86308
8006268 LAB EHS HIV SCREEN                     $      414.63 86701
8065002 LAB HEMOGLOBIN                         $       87.96 85018
8065003 LAB CBC WITH AUTO DIFF                 $      374.57 85025
8065006 LAB WETMT FUNG                         $      126.02 87210
8065007 LAB URINALYSIS W/ MICRO                $      189.03 81001
8065008 LAB URINALYSIS AUT W/O MICRO           $      126.02 81003
8065009 LAB HEMATOCRIT                         $      129.51 85014
8065015 LAB AMMONIA BL ER                      $      205.94 82140
8065110 LAB ANTIBD MONO S ER                   $      188.71 86308
8065112 LAB ANYLASE SE                         $      251.61 82150
8065120 LAB UREA NITROGEN                      $      205.94 84520
8065121 LAB S G O T SE ER                      $      205.94 84450




                                         Page 285
                                         Ancillary


8065122 LAB SODIUM                             $     205.94 84295
8065130 LAB CALCIUM, FREE                      $     205.94 82310
8065131 LAB SGPT SE ER                         $     205.94 84460
8065132 LAB POTASSIUM                          $     205.94 84132
8065140 LAB CARBON DIOXIDE BICARBONATE         $     205.94 82374
8065150 LAB ETHANOL QUAN ER                    $     348.03 82055
8065151 LAB MAGNESIUM SE ER                    $     218.84 83735
8065152 LAB ACETOACETI BL ER                   $     136.38 82009
8065160 LAB CHLORIDE                           $     205.94 82435
8065170 LAB CPK TOTAL SE ER                    $     265.36 82550
8065171 LAB BILIRU TOTAL ER                    $     205.94 82247
8065172 LAB BETA-HCG QUAL                      $     248.23 84703
8065180 LAB ALK PHOS SE ER                     $     218.84 84075
8065182 LAB ALBUMIN, SERUM - ER                $     245.16 82040
8065190 LAB CREATININE                         $     205.94 82565
8065191 LAB PHOSPHORUS - ER                    $     205.94 84100
8065224 LAB BLEED TIME TEMPL                   $     265.36 85002
8065240 PLATELET SMEAR REVIEW                  $     188.71 85008
8065271 LAB SED RATE WESTEGN                   $     172.54 85651
8065288 LAB CBC HEMOGRAM W/PLT                 $     175.71 85027
8065290 LAB PTT          ER                    $     195.79 85730
8065291 AUTOMATED DIFFERENTIAL                 $     198.86 85004
8065296 LAB STREP A RPD SCN                    $     156.04 87880
8065298 MANUAL DIFFERENTIAL                    $     255.63 85007
8065301 PLATELET COUNT, AUTOMATED              $      80.35 85049
8065310 LAB PRO TIME          ER               $     195.79 85610
8065320 LAB GLUCOSE                            $     205.94 82947
8065340 LAB BASIC METABOLIC PANEL              $     394.65 80048
8065343 LAB ELECTROLYTES                       $     197.48 80051
8065402 LAB PROTEIN TOTAL - ER                 $     188.71 84155
8065439 LAB MICRO WRIGHT ST                    $     106.57 87205
8065610 LAB PREG ROUT UR                       $     248.23 81025
8065820 LAB CELL CT TOT & DF                   $     205.94 89051
8065821 LAB TROPONIN I                         $     110.48 84484
8065822 LAB RENAL FUNCTION PANEL               $     493.18 80069
8065824 LAB HEPATIC FUNCTION PANEL             $     345.28 80076
8065825 LAB NATRIURETIC PEPTIDE ASSY           $     146.74 83880
8065826 LAB ACTIVATED CLOTTING TIME            $     181.20 85347
8788801 7SE - OBSERVATION, PER HOUR            $     128.80 G0378
8788802 7SE - SHORT STAY, PER HOUR             $     123.20
8788803 7SE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8798801 7SW (REHAB)OBSERVATION, PER HR         $     128.80 G0378
8798802 7SW (REHAB) SHORT STAY, PER HR         $     123.20
8798803 7SW(REHAB)OBS,PER HR DIR-ADMIT         $     258.11 G0379
8808801 8NE - OBSERVATION, PER HOUR            $     128.80 G0378
8808802 8NE - SHORT STAY, PER HOUR             $     123.20
8808803 8NE - OBS, PER HR DIR-ADMIT            $     258.11 G0379
8898801 8SE - OBSERVATION, PER HOUR            $     128.80 G0378
8898802 8SE - SHORT STAY,PER HOUR              $     123.20




                                         Page 286
                                        Ancillary


8898803 8SE - OBS, PER HR DIR-ADMIT           $     258.11 G0379
8638801 6CSI - OBSERVATION, PER HOUR          $     128.80 G0378
8638802 6CSI - SHORT STAY, PER HOUR           $     123.20
8638803 6CSI - OBS, PER HR DIR-ADMIT          $     258.11 G0379
  77779 SYSTEM BALANCE FORWARD                $        -
8828801 8 IC - OBSERVATION, PER HOUR          $     128.80 G0378
8828802 8 IC - SHORT STAY, PER HOUR           $     123.20
8828803 8 IC - OBS, PER HR DIR-ADMIT          $     258.11 G0379
8568801 7 IC - OBSERVATION, PER HOUR          $     128.80 G0378
8568802 7 IC - SHORT STAY, PER HOUR           $     123.20
8568803 7 IC - OBS, PER HR DIR-ADMIT          $     258.11 G0379
8528801 6 IC - OBSERVATION, PER HOUR          $     128.80 G0378
8528802 6 IC - SHORT STAY, PER HOUR           $     123.20
8528803 6 IC - OBS, PER HR DIR-ADMIT          $     258.11 G0379
8968801 5 IC - OBSERVATION, PER HOUR          $     128.80 G0378
8968802 5 IC - SHORT STAY, PER HOUR           $     123.20
8968803 5 IC - OBS, PER HR DIR-ADMIT          $     258.11 G0379
8208801 4 IC - OBSERVATION, PER HOUR          $     128.80 G0378
8208802 4 IC - SHORT STAY, PER HOUR           $     123.20
8208803 4 IC - OBS, PER HR DIR-ADMIT          $     258.11 G0379
8088801 3UN - OBSERVATION, PER HOUR           $     128.80 G0378
8088802 3UN - SHORT STAY, PER HOUR            $     123.20
8088803 3UN - OBS, PER HR DIR-ADMIT           $     258.11 G0379
8378801 3MFCU - OBSERVATION, PER HOUR         $     128.80 G0378
8378802 3MFCU - SHORT STAY, PER HOUR          $     123.20
8378803 3MFCU - OBS, PER HR DIR-ADMIT         $     258.11 G0379
8308801 3NE - OBSERVATION, PER HOUR           $     128.80 G0378
8308802 3NE - SHORT STAY, PER HOUR            $     123.20
8308803 3NE - OBS, PER HR DIR-ADMIT           $     258.11 G0379
8318801 3NW - OBSERVATION, PER HOUR           $     128.80 G0378
8318802 3NW - SHORT STAY, PER HOUR            $     123.20
8318803 3NW - OBS, PER HR DIR-ADMIT           $     258.11 G0379
8288801 3SEO - OBSERVATION, PER HOUR          $     128.80 G0378
8288802 3SEO - SHORT STAY, PER HOUR           $     123.20
8288803 3SEO - OBS, PER HR DIR-ADMIT          $     258.11 G0379
7888801 3SWO- OBSERVATION, PER HOUR           $     128.80 G0378
7888802 3SWO- SHORT STAY, PER HOUR            $     123.20
7888803 3SWO- OBS, PER HR DIR-ADMIT           $     258.11 G0379
7900000 LAB SPECIAL TEST                      $        -     89240
7900008 LAB CREATINE                          $      18.00 82540
7900009 HALOPERIDOL                           $      23.10 80173
7900019 HEMOGLOBIN, PLASMA                    $      12.45 83051
7900028 LORAZEPAM (ATIVAN)                    $      25.00 80154
7900030 LAB HGH SE                            $      15.00 83003
7900038 MYELIN BASIC PROTEIN                  $      22.00 83873
7900049 PROPAFENONE (RHYTHMOL)                $      25.08 80299
7900058 PROZAC (FLUOXETINE)                   $      20.05 80299
7900068 VITAMIN B2                            $      17.80 84252
7900069 VITAMIN K                             $      66.25 84597




                                        Page 287
                                      Ancillary


7900078 URN METHYLMALONIC ACID              $     35.00 83921
7900079 PHENYLALANINE                       $     58.00 84030
7900080 LAB ACTH HIGHLY SENSITIVE           $     89.00 82024
7900088 HERPES VIRUS 6, IGG                 $     14.32 86790
7900089 INFLUENZA VIRUS TYPES A & B         $     10.00 86710
7900090 LAB CALCITONIN SE                   $     22.00 82308
7900098 PARAINFLUENZA AB                    $      4.92 86790
7900100 LAB ESTRADIOL SE                    $     57.50 82670
7900108 RIBOSOMAL P PROTEIN                 $     25.00 83520
7900109 5-HYDROXYINDOLACETIC ACID           $     13.50 83497
7900118 PROSTATIC ACID PHOSPHATASE          $     13.00 84066
7900119 ALDOSTERONE                         $      9.78 82088
7900128 LAB N-TELOPEPTIDE       #           $     26.00 82523
7900129 CAFFEINE                            $     21.00 80299
7900139 CHOLINESTERASE, PSEUDO              $     11.55 82480
7900148 CHOLINESTERASE, PSEUDO              $      7.84 82480
7900149 DIBUCAINE NUMBER                    $     12.16 82638
7900158 CHOLINESTERASE, RBC                 $     29.41 82482
7900159 URN CITRATE                         $     20.02 82507
7900168 CK TOTAL                            $      6.55 82550
7900169 CK ISOENZYMES                       $     13.45 82552
7900178 D-XYLOSE                            $     26.60 84620
7900179 ESTRIOL, UNCONJUGATED               $     19.00 82677
7900180 LAB GASTRIN SE                      $      8.50 82941
7900189 HEPATITIS BE ANTIBODY               $     11.75 86707
7900198 HEPATITIS BE ANTIGEN                $     11.75 87350
7900199 HYDROXYPROLINE, FREE                $     29.00 83500
7900208 INTRINSIC FACTOR ANTIBODY           $     18.00 86340
7900209 MEPERIDINE                          $     30.00 83925
7900218 MEPHOBARBITAL                       $     13.00 82205
7900219 LIPOPROTEIN ELECTR. SEP.            $     14.75 82664
7900220 LAB TBG RIA SE                      $      7.00 84442
7900228 TRIGLYCERIDES                       $      7.54 84478
7900229 CHOLESTEROL                         $      5.71 82465
7900238 URN OXALATE                         $     20.02 83945
7900248 METHYLPHENIDATE (RITALIN)           $     39.00 80299
7900249 SOMATOSTATIN                        $     45.50 84307
7900259 TYROSINE                            $     51.95 84510
7900268 STELAZINE                           $     35.00 84022
7900269 XYLOSE                              $     27.30 84620
7900278 COMPLEMENT COMPONENT C2             $      8.75 86160
7900279 COMPLEMENT COMPONENT C5             $     38.15 86160
7900288 HERPES VIRUS 6, IGM                 $     14.33 84432
7900289 PARAINFLUENZA AB                    $      4.91 86800
7900298 COMPLEMENT COMPONENT C6             $     25.55 86160
7900299 CARDIOLIPIN IGA AB                  $     15.00 86147
7900318 ISLET CELL AB EVALUATION            $     18.00 86255
7900328 MYELOPEROXIDASE AB                  $     27.00 86021
7900329 PROTEIN C ANTIGEN                   $     17.25 85302




                                      Page 288
                                         Ancillary


7900338 PROTEINASE-3 AB                        $      25.35 86021
7900339 AB BY GEL DIFFUSION                    $       2.59 86331
7900348 NOCARDIA AB                            $       5.45 86744
7900349 ASPERGILLUS AB                         $       3.25 86606
7900358 IGF-I BINDING PROTEIN 3                $      26.25 83519
7900359 INHIBIN A                              $      36.00 83520
7900360 LAB ESTROGEN TOTAL                     $      24.75 82672
7900368 ANTIPHOSPHATIDYLSERINE ABS             $      24.75 86148
7900379 METHYLMALONIC ACID, SERUM              $      35.00 83921
7900390 LAB THYRO BIND INHIB                   $      40.00 84442
7900400 LAB VIP                                $      17.45 84586
7900418 AMINO ACIDS, PLASMA                    $      90.50 82139
7900419 AMINO ACIDS, CSF                       $     101.30 82139
7900420 LAB A1 ANTITRYP PHENO                  $      22.00 82104
7900430 LAB ANTIBD PM-1                        $      34.00 86235
7900438 FOLATE, RBC                            $       8.50 82747
7900439 URN ALDOSTERONE                        $      12.55 82088
7900448 ALPHA FETOPROTEIN, FLUID               $      11.00 86316
7900449 ANTI CHROMATIN AB IGG                  $      40.05 86235
7900458 BORRELIA BURGDORFERI DNA               $      55.00 87476
7900459 BABESIA MICROTI IGG & IGM AB           $      12.50 86753
7900478 T4PP - T4 TOTAL                        $      14.90 84436
7900479 T4PP - PEP FRAC & QUANT                $      23.27 84165
7900488 T4PP - THYROX BINDING GLOB             $      32.05 84442
7900489 T4PP - PREALBUMIN                      $      31.61 84134
7900498 T4PP - SERUM ALBUMIN                   $      10.74 82040
7900500 LAB SOMATOMEDIN-C, RIA                 $      16.25 84305
7900508 LAB MAGNESIOUM, RBC                    $      30.00 83735
7900509 LAB TESTOSTERONE TOT (FE/CH)           $      20.00 84403
7900518 LAB TESTOSTERONE FREE                  $      12.60 84402
7900519 LAB TESTOSTERONE TOTAL                 $      15.40 84403
7900528 LAB SEX HORMONE BIND GLOB              $      17.50 84270
7900529 LAB LDL SUBPARTICLES                   $      34.00 82664
7900538 LAB TESTOSTERONE BIOAV TOT             $      19.00 84403
7900539 LAB SEX HORM BINDING GLOB              $      15.20 84270
7900579 LAB TESTOSTERONE TOT (AD MALE)         $      10.00 84403
7900588 LAB ALBUMIN                            $       3.80 82040
7900589 LAB FREE T4 BY DIALYSIS                $      20.00 84439
7900598 LAB FREE T4, NON-DIALYSIS              $      20.50 84439
7900599 LAB CANAVAN DIS ISO/EXT                $      31.37 83891
7900608 LAB FACTOR 8 MULTIMERIC                $      25.00 85247
7900609 LAB CANAVAN DIS AMPL FRST 2            $      31.37 83900
7900618 LAB CANAVAN DIS AMPL OTHR              $      31.37 83901
7900619 LAB CANAVAN DIS ENZ DIG                $      31.36 83892
7900620 LAB THYRO GR STIM IMG                  $     143.00 84445
7900628 LAB CANAVAN DIS SE & ID                $      31.37 83909
7900629 LAB CANAVAN DIS MUT ID                 $      31.36 83914
7900638 LAB CANAVAN DIS INTRP & RPT            $      31.36 83912
7900639 LAB HEP G PHENOTYPE ISO/EXT            $      19.10 83891




                                         Page 289
                                                       Ancillary


7900648 LAB HEP G PHENOTYPE AMPL                             $      19.10 83900
7900649 LAB HEP G PHENOTYPE SEP GEL EP                       $      19.10 83894
7900658 LAB HEP G PHENOTYPE MUT ID                           $      79.90 83904
7900659 LAB HEP G PHENO INTERP & RPT                         $      19.10 83912
7900668 LAB TAY-SACHS DISEASE ISO/EXT                        $      11.75 83891
7900669 LAB TAY-SACHS DISEASE ENZ DIG                        $      11.75 83892
7900678 LAB TAY-SACHS DISEASE SEP & ID                       $      11.75 83909
7900679 LAB TAY-SACHS DISEASE MUT ID                         $      11.75 83914
7900688 LAB TAY-SACHS DISEASE AMPL                           $      11.75 83900
7900689 LAB TAY-SACHS DIS INTRP & RPT                        $      11.75 83912
7900690 LAB BONE SPECIFIC ALK PHOSPH#                        $      21.50 84080
7900698 LAB HCV RNA (TMA), QUANT                             $     396.00 87522
7900699 LAB HCV RNA (TMA), QUAL                              $     250.00 87521
7900708 LAB HANDLING CHRG PASS THRU                          $      35.00 99001
7900709 LAB CREATINE, 24 HR URINE                            $      37.50 8254090
7900710 LAB ALPHA SUBUNIT BLOOD            #                 $      68.00 83519
7900718 LAB VAL CHOL LIPO PRO                                $      13.80 83701
7900719 LAB VAL CHOL TRIG                                    $       3.20 84478
7900728 LAB ADINOPECTIN                                      $     178.50 8352090
7900729 LAB TRANSGLUTAMIN IGG/IGA                            $      34.00 8351690
7900730 LAB DEOXYCORTICOSTERONE                    #         $      77.00 82633
7900738 LAB INTERLEUKIN 2                                    $     100.00 8352090
7900739 LAB INHIBIN B                                        $     158.00 8352090
7900748 LAB HEP B PCR, QUAL                                  $     110.00 8751690
7900760 LAB 17-HYDROXYPREGNENOLONE                           $      67.50 84143
7900778 LAB ISLET CELL AB W/REFLEX                           $      18.00 8634190
7900779 LAB CREATINE                                         $      18.00 8254090
7900780 LAB OSTEOCALCIN            #                         $      29.95 83937
7900860 THYROTROPIN RELEASE HOMONE                           $     206.00 83519
7900869 CHOLINESTERASE, PLASMA                               $      30.14 82480
7900870 LAB PYRIDINIUM X LINKS 2H #                          $      30.95 82523
7900880 LAB PYRIDINIUM X LINKS 24H #                         $      30.95 82523
7900900 LAB VIT D: 25-HYDROXY          #                     $      56.00 8230690
7900910 LAB VIT D: 1,25-DIHYDROXY #                          $      31.00 8265290
7900954 LAB CATECHOLAMINES, FRAC               #             $      29.50 82384
7900955 LAB URINE FREE CORTISOL            #                 $      55.00 82530
7900960 LAB CITRATE           #                              $      25.00 82507
7900964 LAB HEPATITIS C AB, RIBA                             $      57.75 86804
7900965 LAB CYCLIC AMP (P)                                   $      23.75 82030
7900966 LAB CYCLIC AMP (U)                                   $      21.50 82030
7900969 LAB AMINOLEVULINIC ACID                              $      27.50 82135
7900970 LAB CHLORPROMAZINE                                   $      24.00 84022
7900971 LAB GABAPENTIN                                       $      21.50 80299
7900972 LAB PORPHOBILINOGEN, URINE                           $      25.75 84110
7900973 LAB CLOZAPINE                                        $      23.00 82491
7900975 LAB SEROTONIN                                        $      35.00 84260
7900978 LAB FATTY ACIDS, FREE                                $      12.85 82725
7900979 LAB GLUTAMINE CSF                                    $      66.00 82136
7900980 LAB AMINO ACID SCREEN                                $      27.35 82128




                                                       Page 290
                                         Ancillary


7900981 LAB 17-OH-CORTICOSTEROIDS              $      26.00 83491
7900982 LAB HYDROXYPROLINE, TOTAL              $      35.00 83505
7900983 LAB 17-KETOSTEROIDS                    $      32.50 83586
7900984 LAB LEUCINE AMINOPEPTIDASE             $      25.50 83670
7900985 LAB FECAL FAT, TIMED                   $      44.80 82710
7900991 LAB MACROAMYLASE                       $      74.80 84999
7900994 LAB CLONAZEPAM                         $      16.00 80154
7900995 TRYPTOPHAN                             $     102.60 82131
7900996 LAB URN CATECHOLAMINE, FR              $      19.20 82384
7900997 LAB URN METANEPHRINES, FR              $      27.00 83835
7900999 LAB BILE ACIDS, FRAC                   $     150.00 83789
7901000 LAB SPECIAL TEST                       $       -   89240
7902000 LAB SPECIAL TEST                       $       -   89240
7903000 LAB SPECIAL TEST                       $       -   89240
7903006 LAB RESP MYCOPLASMA CULT               $      73.50 87109
7903007 LAB HEPATITIS D IGM AB                 $      32.95 86692
7903008 LAB MUMPS IGG                          $      53.28 86735
7903009 LAB MUMPS IGM                          $      54.00 86735
7903016 LAB WEST NILE VIRUS, PCR               $      75.00 87798
7903017 LAB B. PERTUSSIS PCR                   $     223.50 87801
7903018 LAB AFB PRIM/SECON SUS PANEL           $      14.25 87190
7903019 LAB AFB PRIMARY PANEL SUS              $       9.40 87190
7903026 LAB C. PNEUMONIAE AB ID                $      14.47 86631
7903027 LAB C. PNEUMONIAE AB ID IGM            $      15.53 86632
7903028 LAB IG GAMAGLOB                        $       9.88 82784
7903029 LAB IGG SUBCLASSES                     $       8.53 82787
7903036 LAB FTA-ABS (IGM)                      $      15.00 86781
7903037 LAB HIV 2 IGG AB                       $      28.00 86702
7903039 LAB HTLV 1/II AB                       $      22.50 86689
7903046 LAB HIB-1 DIRECT AG                    $     107.25 87390
7903047 LAB EPIDERMAL AB, IFA                  $      59.25 86255
7903048 LAB HCV RNA PCR, QUANT                 $     261.75 87522
7903049 LAB TULAREMIA AGGLUTININ               $      72.75 8600090
7903050 LAB ANTIBD CYSTICER                    $      46.20 86682
7903056 LAB LUK ADH DF FLW CYT 1ST MKR         $     123.50 8818490
7903057 LAB LUK ADH DF FLW CYT ADL MKR         $     123.50 8818590
7903058 LAB HEPATITIS G PCR                    $     298.00 8752690
7903059 LAB HEPATITIS D PCR                    $     160.80 8779890
7903066 LAB ASPERGILLUS PPT, ID                $      75.00 8660690
7903070 LAB ANTIBD COXSACK A                   $       9.50 86658
7903080 ST. LOUIS EQ ENCEPH AB                 $      17.85 86653
7903100 LAB ANTIBD CRYPTO                      $      14.40 86641
7903120 LAB ANTIBD VZACIF                      $      40.80 86787
7903130 LAB ANTIBD CHLAM IGG                   $      20.72 86631
7903140 LAB ANTIBD SCHISTOSOM                  $      75.20 86682
7903150 TOXOCARA AB                            $      37.85 86682
7903210 LAB ANTIBD CA EQ ENCP                  $      14.01 86651
7903230 EASTERN EQ ENCEPH AB                   $      54.75 86652
7903280 LAB ANTIBD LCM                         $      48.00 86727




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                                                      Ancillary


7903360 LAB ANTIBD RESP SYN                                 $      15.80 86756
7903370 TRICHINELLA AB                                      $      23.63 86784
7903420 LYME IGG AB                                         $      11.22 86618
7903430 LAB CHLAMYDIA GROUP AB                              $      41.44 86631
7903440 VARICELLA ZOSTER ACIF                               $      18.02 86787
7903450 LAB ANTIBD MYCOPLASMA CF                            $      40.89 86738
7903470 LAB C3 ACTIVATOR                                    $      23.45 86329
7903510 PARVOVIRUS (B19) AB                                 $      11.80 86747
7903530 LAB DIPHTHERIA ANTITOXOID #                         $      29.20 86648
7903540 LAB ANTIBD TETANUS ANTITOXID#                       $      26.20 86774
7903550 LAB ANTIBD LYME DIS W BLTIGG                        $      22.45 86617
7903560 LAB ANTIBD LYME DIS W BLTIGM                        $      22.45 86617
7903580 LAB ANTIBD BRUCELLA PANEL #                         $      23.94 86622
7903600 LAB ENTEROVIRUS TYPING                #             $     207.75 87253
7903610 LAB VIRUS IDENTIFICATION          #                 $     169.50 87253
7903620 LAB B PERTUSS FLUORES STAIN #                       $      11.00 87265
7903650 LAB FUNGAL MIC                                      $      57.00 87186
7903660 LAB FUNGAL MIC                                      $      57.75 87186
7903690 LAB TOXOPLASMA DFA                #                 $      54.60 87299
7903728 LAB Q FEVER ANTIBODY                                $       7.35 86638
7903741 LAB GLIADIN IGG AB        #                         $      63.75 83520
7903742 LAB GLIADIN IGA AB       #                          $      63.75 83520
7903746 LAB ENDOMYSIAL IGA AB             #                 $      42.00 86255
7903748 LAB RETICULIN AB IGG                                $      21.45 86255
7903749 LAB RETICULIN AB IGA          #                     $      21.39 86255
7903755 LAB BLASTOMYCOSIS - CF                #             $      30.20 86612
7903757 BORDETELLA IGG (FHA)                                $       7.50 86615
7903758 BORDETELLA IGG (PT)                                 $       7.50 86615
7903759 BORDETELLA IGA (FHA)                                $       7.51 86615
7903760 BORDETELLA IGA (PT)                                 $       7.51 86615
7903766 LAB LYME WESTERN BLOT IGG #                         $      11.22 86617
7903767 LAB LYME WESTERN BLOT IGM #                         $      11.23 86617
7903769 LAB CSF LYME AB IGG           #                     $      22.45 86618
7903770 LAB CSF LYME AB IGM           #                     $      22.45 86618
7903771 LAB VARICELLA ZOSTER IGM AB #                       $      21.08 86787
7903772 LAB SENSORY NEUROPATHY TEST2#                       $      57.99 86255
7903774 LAB SENSORIMOTOR TEST 1                   #         $      32.67 83520
7903775 LAB SENSORIMOTOR TEST 2                   #         $      32.70 86225
7903777 LAB MOTOR NEUROPATHY AB TST1#                       $      29.07 83520
7903778 LAB MOTOR NEUROPATHY AB TST2#                       $      29.10 83520
7903780 LAB MAG ANTIBODY 1            #                     $      18.37 83520
7903781 LAB MAG ANTIBODY 2            #                     $      18.38 83520
7903783 LAB GANGLIOSIDE AB TEST 1 #                         $      28.80 83520
7903784 LAB GANGLIOSIDE AB TEST 2 #                         $      28.80 83520
7903786 LAB NEURONAL NUCLER (HU)                  #         $      40.89 86255
7903787 LAB PURKINJE CELL (YO) AB                           $      29.70 86255
7903788 LAB SENSORY NEUROPATHY TEST1#                       $      57.99 83520
7903790 LAB COCCI PPTN (LATEX)            #                 $      28.12 86635
7903792 LAB HISTO YEAST AB - CF           #                 $      20.78 86171




                                                      Page 292
                                        Ancillary


7903793 LAB HISTO MYCELIAL AB-CF    #         $     20.78 86171
7903796 LAB MYCOPLASMA IGM ANTIBODY           $     36.00 86738
7903797 CALIFORNIA ENCEPH AB, IGG             $     13.61 86651
7903798 CALIFORNIA ENCEPH AB, IGM             $     13.61 86651
7903799 EASTERN EQUINE AB, IGG                $     13.62 86652
7903800 EASTERN EQUINE AB, IGM                $     13.62 86652
7903801 ST. LOUIS ENCEPH AB, IGG              $     13.62 86653
7903802 ST. LOUIS ENCEPH AB, IGM              $     13.62 86653
7903803 WESTERN EQUINE AB, IGG                $     13.62 86654
7903804 WESTERN EQUINE AB, IGM                $     13.62 86654
7903805 C. PNEUMONIAE IGG                     $      4.29 86631
7903806 C. PNEUMONIAE IGA                     $      4.29 86631
7903807 C. PNEUMONIAE IGM                     $      4.29 86632
7903808 C. TRACHOMATIS IGG                    $      4.29 86631
7903809 C. TRACHOMATIS IGA                    $      4.29 86631
7903810 C. TRACHOMATIS IGM                    $      4.28 86632
7903811 C. PSITTACI IGG                       $      4.28 86631
7903812 C. PSITTACI IGA                       $      4.28 86631
7903813 C. PSITTACI IGM                       $      4.28 86632
7903814 SALMONELLA AGGLUTININ                 $      4.43 86000
7903815 WEIL FELIX AGGLUTININ                 $      4.44 86000
7903816 BRUCELLA AGGLUTININ                   $      4.43 86000
7903822 MUMPS IGG AB                          $      8.75 86735
7903823 MUMPS IGM AB                          $      8.75 86735
7903824 WEIL FELIX AGGLUTININ                 $     13.42 86000
7903826 ECHOVIRUS TYPE 4                      $      6.22 86682
7903827 ECHOVIRUS TYPE 7                      $      6.23 86682
7903828 ECHOVIRUS TYPE 9                      $      6.23 86682
7903829 ECHOVIRUS TYPE 11                     $      6.23 86682
7903830 ECHOVIRUS TYPE 30                     $      6.23 86682
7903831 ADRENAL ANTIBODY                      $     12.95 86255
7903832 ALPHA-2-MACROGLOBULIN                 $     16.80 83883
7903833 B2GPI IGG AB                          $      9.80 86146
7903834 B2GPI IGA AB                          $      9.80 86146
7903835 B2GPI IGM AB                          $      9.80 86146
7903837 HIV-1 GENOTYPING (RT+PROT)            $     78.96 87901
7903838 IGA FIBRONECTIN AGGREGATE             $     21.17 83516
7903839 SERUM IGA                             $     21.18 82784
7903840 MYOCARDIAL AB                         $      9.50 86255
7903841 STRONGYLOIDES IGG AB                  $     23.80 86682
7903842 WESTERN EQ ENCEPH IGG                 $     66.37 86654
7903843 WESTERN EQ ENCEPH IGM                 $     66.38 86654
7903844 ANTIBD CHLAM IGM                      $     20.72 86632
7903845 GIARDIA IGG AB                        $     14.28 86674
7903846 GIARDIA IGA AB                        $     14.28 86674
7903847 GIARDIA IGM AB                        $     14.29 86674
7903848 TYPHUS FEVER AB IGG                   $      7.87 86757
7903849 TYPHUS FEVER AB IGM                   $      7.88 86757
7903850 SENSORY NEUROPATHY TEST 3             $     58.00 83520




                                        Page 293
                                     Ancillary


7903851 SENSORY NEUROPATHY TEST 4          $      58.00 86255
7903852 STREPTOZYME                        $      16.10 86063
7903853 VARICELLA ZOSTER IGM               $      18.02 86787
7903854 CSF CMV IGG                        $      35.00 86644
7903855 CSF EBV IGG                        $      35.00 86665
7903856 CSF TOXO IGG                       $      36.20 86777
7903865 THYROID STIM IMMUNOGLOB            $      27.65 84445
7903868 ANTIMCROB AFB PRIM, DRUG 1         $      17.10 87190
7903869 ANTIMCROB AFB PRIM, DRUG 2         $      17.10 87190
7903870 ANTIMCROB AFB PRIM, DRUG 3         $      17.10 87190
7903871 ANTIMCROB AFB PRIM, DRUG 4         $      17.10 87190
7903872 ANTIMCROB AFB PRIM, DRUG 5         $      17.10 87190
7903873 ANTIMCROB AFB SEC, DRUG 1          $       7.83 87190
7903874 ANTIMCROB AFB SEC, DRUG 2          $       7.84 87190
7903875 ANTIMCROB AFB SEC, DRUG 3          $       7.84 87190
7903876 ANTIMCROB AFB SEC, DRUG 4          $       7.84 87190
7903877 ANTIMCROB AFB SEC, DRUG 5          $       7.84 87190
7903878 ANTIMCROB AFB SEC, DRUG 6          $       7.84 87190
7903881 S. PNEUMO IGG AB                   $      11.65 86609
7903882 TOXOPLASMA DNA, PCR QL             $      93.50 87798
7903883 TRYPANSOMA CRUZI IGG AB            $      14.37 86753
7903884 TRYPANSOMA CRUZI IGM AB            $      14.38 86753
7903885 WEST NILE VIRUS IGG AB             $      14.87 86317
7903886 WEST NILE VIRUS IGM AB             $      14.88 86317
7903888 HANTAVIRUS IGG AB                  $      63.52 86790
7903889 HANTAVIRUS IGM AB                  $      63.53 86790
7903890 HERPESVIRUS 7 IGG AB               $      21.87 86790
7903891 HERPESVIRUS 7 IGM AB               $      21.88 86790
7903892 HERPESVIRUS 6 DNA, PCR             $     107.25 87532
7903893 MYCOPLASMA DNA, PCR                $      49.50 87581
7903894 OVARY ANTIBODY                     $      32.55 86255
7903895 A1 ACID GLYCOPROTEIN               $      17.90 83883
7903896 HIV-1 PROVIRAL DNA, PCR            $      96.65 87535
7903897 HERPESVIRUS 8 DNA, PCR             $     232.75 87798
7903898 HERPESVIRUS 8 IGG AB               $      48.06 86790
7903899 L. DONOVANI IGG                    $       2.75 86717
7903900 L. DONOVANI IGM                    $       2.75 86717
7903901 L. MEXICANA IGG                    $       2.75 86717
7903902 L. MEXICANA IGM                    $       2.76 86717
7903903 L. TROPICA IGG                     $       2.76 86717
7903904 L. TROPICA IGM                     $       2.76 86717
7903905 L. BRAZILIENSIS IGG                $       2.76 86717
7903906 L. BRAZILIENSIS IGM                $       2.76 86717
7903907 MITOCHONDRIAL M2 AB                $      41.25 83520
7903909 NEUTROPHIL AB                      $      85.80 86021
7903927 CON A MITOGEN                      $      94.75 86353
7903928 PHA MITOGEN                        $      94.75 86353
7903929 POKEWEED MITOGEN                   $      94.75 86353
7903936 SPOTTED FEVER IGG AB               $      13.32 86757




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                                         Ancillary


7903937 SPOTTED FEVER IGM AB                   $      13.33 86757
7903938 LYME IGM AB                            $      11.23 86618
7903939 SOLUBLE LIVER ANTIGEN AB               $      80.00 83520
7903940 LAB FUNGAL MIC                         $      56.25 87186
7903941 ASIALO GM1 ANTIBODIES                  $      56.62 83520
7903942 MAG AB-WESTERN BLOT                    $      73.50 84181
7903943 LAB TRANSGLUTAMINASE IGA               $     100.00 83516
7903944 POLIOVIRUS (TYPE 1 1-2) AB, CF         $       8.81 86658
7903945 POLIOVIRUS (TYPE 1 3) AB, CF           $       8.82 86658
7903946 YERSINIA ENTEROCOLITICA AB             $       5.68 86793
7903947 TOPHERYMYA WHIPPELLI DNA, PCR          $     223.50 87798
7903948 POLIOVIRUS ISOL - INC ADD              $      11.23 87253
7903949 POLIOVIRUS ISOL - INNOC                $      32.10 87252
7903950 PLATELET CIRCULATING AB PNL            $      47.50 86022
7903951 LAB URN FREE LIGHT CHAINS NEPH         $      62.50 83883
7903952 LAB CHRONIC GRANULO DIS                $      62.50 82657
7903953 LAB SUBSTANCE P                        $     169.65 83520
7903954 LAB NEISSERIA GONORRHOEAE AB           $      66.75 86171
7903955 LAB HISTOPLASMA CAPSULATUM IGG         $      67.50 86698
7903956 LAB ANTIMICROBIAL, ISONIAZID           $     129.75 80299
7903957 LAB CANDIDA ANTIBODY PANEL             $      28.00 86628
7903958 LAB HEPATITIS E IGG                    $      50.25 86790
7903959 LAB HEPATITIS E IGM                    $      50.25 86790
7903960 LAB HEPATITIS E IGG AND IGM            $      15.05 86790
7903962 LAB W NILE ANTIBODY PNL, CSF           $      52.12 86317
7903963 LAB COCCI CF                           $      11.90 86635
7904000 LAB SPECIAL TEST                       $       -   89240
7904020 LAB ANTIBD DNA-FARR                    $      68.00 86225
7905000 LAB SPECIAL TEST                       $       -   89240
7905006 LAB PAN ANCA EVAL ANA                  $       9.70 86038
7905007 LAB PAN ANCA EVAL LEUK AB              $      12.05 86021
7905008 LAB CSF 14-3-3 PROTEIN                 $      30.00 8499990
7905009 LAB HISTOPLASMA AB                     $      15.75 8669890
7905016 LAB ASPIRGILLUS AB PNL                 $      20.41 8660690
7905017 LAB HISTOPLASMA AB PNL                 $      15.75 8669890
7905464 INTER-EPITHELIAL AB                    $       8.43 86256
7905465 DERMAL-EPIDERMAL AB                    $       8.42 86256
7906000 LAB SPECIAL TEST                       $       -   89240
7906020 LAB STONE ANALYSIS                     $      17.50 82355
7909000 LAB SPECIAL TEST                       $       -   89240
7910000 LAB SPECIAL TEST                       $       -   89240
7911000 LAB SPECIAL TEST                       $       -   89240
7911006 LAB THYROGLOBULIN                      $      29.00 84432
7911007 LAB THYROGLOBULIN ANTIB                $      28.00 86800
7911008 LAB FITZGERALD FACTOR                  $     125.00 85293
7911050 LAB CORTICOSTERONE                     $      69.00 82528
7911056 LAB PREGNENOLONE                       $      65.00 84140
7911057 LAB IGF-II                             $      66.00 83519
7911058 LAB PREGNANETRIOL                      $      67.54 84138




                                         Page 295
                                         Ancillary


7911059 LAB PREGNANETRIOL URINE C              $      18.46 82570
7912000 LAB SPECIAL TEST                       $       -   89240
7913000 LAB SPECIAL TEST                       $       -   89240
7913020 LAB ANTIBIOTIC SYNER                   $     209.90 87188
7913030 LAB SYNERGY DRUG SET         #         $     209.90 87188
7913040 LAB SYNERGY DRUG SET         #         $     209.90 87188
7913050 LAB SYNERGY DRUG SET         #         $     209.90 87188
7913060 LAB MIC/MBC                            $      83.72 87187
7913070 LAB MIC/MBC DRUG (UCLA)      #         $      83.72 87187
7913080 LAB MIC/MBC DRUG (UCLA)      #         $      83.72 87187
7913090 LAB MIC/MBC DRUG (UCLA)      #         $      83.72 87187
7913100 LAB MIC/MBC DRUG (UCLA)      #         $      83.72 87187
7913110 LAB MIC/MBC DRUG (UCLA)      #         $      83.72 87187
7913120 LAB SERUM CIDAL                        $      97.66 87197
7913140 LAB MIC 1 DRUG         #               $      83.72 87187
7913147 LAB MUSCLE BIOPSY                      $     537.00 88305
7913157 LAB NERVE EM PROFESSIONAL              $     340.00 8834826
7913158 LAB NERVE EM TECHNICAL                 $     452.00 88348
7917000 LAB SPECIAL TEST                       $       -   89240
7918000 LAB SPECIAL TEST                       $       -   89240
7921056 LAB VIR SUSC INNOC/OBS 1 DRG#          $      33.00 87252
7921057 LAB VIR SUSC ADDN STUD 1               $      12.00 87253
7923073 LAB DRUG PROOF TESTING 8               $      30.00 8499990
7925000 LAB SPECIAL TEST                       $       -   89240
7925041 SULFATIDE ANTIBODY                     $      51.75 83520
7925042 SULFATIDE INTERP & REPORT              $      69.75 83912
7925043 LAB APOE ALZHEIMERS - ISOL/EXT         $      34.10 83891
7925044 LAB APOE ALZHEIMERS - ENZ DIG          $      34.10 83892
7925045 LAB APOE ALZHEIMERS - GEL EP           $      34.10 83894
7925046 LAB APOE ALZHEIMERS - AMPLF            $     142.60 83898
7925047 LAB APOE ALZHEIMERS - INTERP           $      34.10 83912
7925048 LAB DM1 DNA TEST - ISOL/EXT            $      52.21 83891
7925049 LAB DM1 DNA TEST - GEL EP              $      52.21 83894
7925050 LAB DM1 DNA TEST - AMPLF               $     218.37 83898
7925051 LAB DM1 DNA TEST - INTERP              $      52.21 83912
7925052 LAB NABFERON AB TEST - NEUT            $     268.46 86382
7925053 LAB NABFERON AB TEST - NTD             $     180.83 86384
7925054 LAB NABFERON AB TEST - TIS CLT         $     145.71 87253
7925055 LAB NEOENCEPHALITIS - WST BLT          $     162.51 84182
7925056 LAB NEOENCEPHALITIS - IMM ASY          $     116.90 83520
7925057 LAB NEOENCEPHALITIS - INTERP           $      36.18 83912
7925058 LAB GALOP - IMMUNO ASSAY               $      98.20 83520
7925059 LAB GALOP - INTERP & RPT               $      30.40 83912
7925060 LAB NEOCOMPLETE - IMM ASSAY            $     121.28 83519
7925061 LAB NEOCOMPLETE - WEST BLOT            $     161.56 84182
7925062 LAB NEOCOMPLETE - IMM ASY OTH          $     116.21 83520
7925063 LAB NEOCOMPLETE - INTERP & RPT         $      35.97 83912
7925064 LAB ATAXIA EVAL - ISOL/EXT             $      44.50 83891
7925065 LAB ATAXIA EVAL - SEP GEL EP           $      44.50 83894




                                         Page 296
                                                           Ancillary


7925066 LAB ATAXIA EVAL - AMPLIF                                 $     186.10 83898
7925067 LAB ATAXIA EVAL - INTERP & RPT                           $      44.50 83912
7925068 LAB MUSK AB RIA                                          $     347.06 83519
7925069 LAB MUSK AB INTERP & REPORT                              $     102.94 83912
7925070 LAB CMT ISOL/EXTRACT                                     $      10.00 8389190
7925071 LAB CMT ENZ DIGESTION                                    $      10.01 8389290
7925072 LAB CMT SEP GEL ELP                                      $      10.01 8389490
7925073 LAB CMT NUC ACID TRANSFER                                $      10.01 8389790
7925074 LAB CMT NUC ACID SEQUENCE                                $      41.88 8389890
7925075 LAB CMT MUT ID EA SEGMENT                                $      41.88 8390490
7925076 LAB CMT INTERP & REPORT                                  $      10.01 8391290
7925077 LAB LEMS AB IMM ASSAY RIA                                $     215.95 8351990
7925078 LAB LEMS AB INTERP & REPORT                              $      64.05 8391290
7926000 LAB SPECIAL TEST                                         $       -   89240
7927000 LAB SPECIAL TEST                                         $       -   89240
7927008 LAB CLOMIPRAMINE+METABOLITE                              $      10.50 80299
7927009 LAB NORTRIPTYLINE                                        $      16.80 80182
7927010 LAB DESIPRAMINE                                          $      19.25 80160
7927011 LAB DOXEPIN                                              $      16.40 80166
7927014 LAB ANTIDIURETIC HORMONE                       #         $      28.00 84588
7927015 LAB C-PEPTIDE          #                                 $       7.00 84681
7927016 LAB DEHYDROEPIANDROSTERONE #                             $      10.00 82626
7927017 LAB DHEA SO4           #                                 $       8.00 82627
7927018 LAB SELENIUM, SERUM                    #                 $      17.50 84255
7927019 LAB VITAMIN A          #                                 $      16.80 84590
7927020 LAB VITAMIN B1 (THIAMINE) #                              $      18.00 84425
7927021 LAB VITAMIN B6         #                                 $      23.52 84207
7927022 LAB VITAMIN C          #                                 $      30.10 82180
7927023 LAB VITAMIN E          #                                 $      17.50 84446
7927025 LAB FLECAINIDE             #                             $      22.75 80299
7927027 LAB NICKEL, SERUM              #                         $      17.50 83885
7927028 LAB NICKEL, URINE                                        $      17.50 83885
7927032 LAB PROTRIPTYLINE              #                         $      30.10 80299
7927033 LAB TRAZODONE                  #                         $      22.75 80299
7927034 LAB TRIMIPRAMINE                                         $      17.60 82491
7927035 LAB CHROMIUM, SERUM                    #                 $      17.50 82495
7927036 LAB CHROMIUM, URINE                    #                 $      17.50 82495
7927039 LAB CIQ BINDING ASSAY                  #                 $      21.00 86332
7927041 LAB AMITRIPTYLINE              #                         $      14.00 80152
7927042 LAB NORTRIPTYLINE IN PKG                   #             $      14.00 80182
7927044 LAB IMIPRAMINE                                           $      13.13 80174
7927045 LAB DESIPRAMINE IN PKG                                   $      13.12 80160
7927047 LAB CARNITINE, FREE                #                     $      14.00 83789
7927048 LAB CARNITINE, TOTAL               #                     $      29.40 82379
7927049 LAB PORPHYRINS, URINE                                    $      26.25 84120
7927050 LAB METHYPRYLON                                          $      48.48 80299
7927052 LAB FRUCTOSAMINE                   #                     $      13.30 82985
7927053 LAB CAROTENE               #                             $      15.75 82380
7927055 LAB PHENYTOIN, FREE                #                     $      14.05 80186




                                                           Page 297
                                        Ancillary


7927056 LAB PHENYTOIN, TOTAL        #         $     15.70 80185
7927057 LAB COPPER, URINE       #             $     15.75 82525
7927058 LIDOCAINE                             $     30.10 80176
7927060 LAB ALUMINUM, SERUM         #         $      8.00 82108
7927061 LAB COPPER                            $     15.75 82525
7927062 LAB LAMOTRIGINE         #             $     26.00 80299
7927065 LAB 5' NUCLEOTIDASE                   $     17.50 83915
7927066 LAB TRYPSINOGEN                       $     24.50 83519
7927067 VDRL CSF                              $      7.00 86592
7927068 VDRL - CORD BLOOD                     $      7.00 86592
7927069 COLD AGGLUTININS                      $      9.80 86157
7927070 URINE MYOGLOBULIN                     $     15.05 83874
7927071 LAB TOTAL COMPLEMENT                  $     12.25 86162
7927072 RUBELLA IGM ANTIBODY                  $     10.50 86762
7927073 LAB LEGIONELLA ANTIBODY               $     12.95 86713
7927075 BENZODIAZEPINE, SERUM                 $     34.65 80154
7927076 ETHOSUXIMIDE                          $     14.00 80168
7927077 PHENOBARBITAL                         $      7.50 80184
7927078 PRIMIDONE                             $     10.00 80188
7927079 FELBAMATE                             $     22.75 80299
7927080 BROMIDE                               $     36.40 80299
7927081 DISOPYRAMIDE                          $     22.75 80299
7927083 DIGITOXIN                             $     26.60 80299
7927084 TRICYCLIC ANTIDEP. SCREEN             $     42.35 80100
7927085 BETA-HYDROXYBUTERIC ACID              $     19.95 82010
7927086 ALUMINUM, URINE                       $     14.00 82108
7927087 URN CYSTINE                           $     70.00 82131
7927091 PANCREATIC AMYLASE                    $      9.80 82150
7927092 SALIVARY AMYLASE                      $      9.80 82150
7927094 ANDROSTANEDIOL GLUCURONIDE            $     25.90 82154
7927095 ANDROSTENEDIONE                       $     23.80 82157
7927096 ANGIOTENSIN CONVERTING ENZ.           $     13.00 82164
7927097 ARSENIC                               $     17.50 82175
7927098 URN ARSENIC                           $     23.52 82175
7927099 ARSENIC                               $     15.44 82175
7927100 URN ARSENIC                           $     18.39 82175
7927101 PENTOBARBITAL                         $     18.20 82205
7927102 URN B-2-MICROGLOBULIN                 $     14.00 82232
7927103 CADMIUM, BLOOD                        $     17.50 82300
7927104 URN CADMIUM                           $     17.50 82300
7927105 VIT D: 25, HIDROXY                    $     15.00 82306
7927106 CALCIUM, IONIZED                      $      6.00 82330
7927107 URINE CALCIUM                         $      5.58 82340
7927108 STONE ANALYSIS                        $     14.00 82365
7927109 LAB CARBOXYHEMOGLOBIN                 $     38.57 82375
7927110 URINE CITRIC ACID                     $     25.71 82507
7927113 CYANIDE                               $     38.50 82600
7927114 VIT B12 BINDING CAPACITY              $     19.25 82608
7927115 11-DEOXYCORTISOL                      $     35.35 82634




                                        Page 298
                                      Ancillary


7927116 DIHYDROTESTOSTERONE                 $     26.25 82651
7927118 ESTRONE                             $     23.10 82679
7927119 ETHELYNE GLYCOL                     $     32.20 82693
7927120 T3 FREE                             $      8.00 84481
7927121 FLURAZEPAM                          $     36.05 82742
7927122 IGD                                 $     11.55 82784
7927123 GLUCAGON                            $     21.00 82943
7927124 HISTAMINE                           $     29.75 83088
7927125 URN HISTAMINE                       $     29.75 83088
7927126 URN HOMOCYSTINE                     $     22.75 83090
7927128 17-HYDROXYPROGESTERONE              $      9.00 83498
7927130 NEURONAL CELL AB, SERUM             $     73.05 83520
7927131 LAB NEURONAL CELL AB, CSF           $     35.28 86316
7927132 INSULIN, TOTAL                      $     11.58 83525
7927133 INSULIN, SERUM                      $     10.58 83525
7927134 INSULIN, FREE                       $     13.00 83527
7927135 LD, TOTAL                           $      6.00 83615
7927136 LD ISOENZYMES                       $     11.00 83625
7927137 LEAD                                $      9.84 83655
7927138 URN LEAD                            $     11.72 83655
7927140 URN MANGANESE                       $     17.50 83785
7927142 MEPROBAMATE                         $     38.15 83805
7927143 MERCURY                             $     13.22 83825
7927144 URN MERCURY                         $     15.75 83825
7927145 MERCURY                             $     12.25 83825
7927146 URN MERCURY                         $     14.11 83825
7927147 METHSUXIMIDE (CELONTIN)             $     11.76 83858
7927148 MYOGLOBIN                           $     15.05 83874
7927149 RETINOL BINDING PROTEIN             $     17.50 83883
7927150 APO E - CARD, ISOLATION             $     10.25 83890
7927154 APO E - CARD, NUCLEIC ACI           $     10.00 83896
7927156 APO E - CARD, AMPLIFICATION         $     42.00 83898
7927158 APO E - CARD, INTERP & RP           $     10.00 83912
7927159 URINE OXALATE                       $     11.92 83945
7927160 THIORIDAZINE/MEZORIDAZINE           $     19.80 84022
7927161 TOTAL ALKALINE PHOSPHATASE          $      5.20 84075
7927162 ALK PHOS ISOENZYMES                 $     14.75 84080
7927163 ZINC PROTOPORPHYRIN                 $     15.75 84202
7927164 PROINSULIN                          $     28.00 84206
7927165 ACETYLCHOLINE RECEPTOR AB           $     38.81 83519
7927166 ACETYLCHOLINE BLOCKING AB           $     38.81 83519
7927175 THIOCYANATE                         $     29.75 84430
7927177 T3, TOTAL                           $      5.00 84480
7927178 REVERSE T3                          $     25.20 84482
7927179 URINE URIC ACID                     $      4.39 84560
7927181 ZINC, PLASMA                        $     12.25 84630
7927182 URN ZINC                            $     12.25 84630
7927184 FIBRINOGEN (RID)                    $     45.50 85385
7927185 C1 ESTERASE INHIBITOR               $     16.45 86160




                                      Page 299
                                       Ancillary


7927186 C1 ESTERASE INHIBITOR, FUNC.         $      31.85 86161
7927187 STREP DNASE B AB                     $      12.25 86215
7927188 DNA AB, SINGLE STRANDED              $      22.40 86226
7927189 STRIATIONAL AB                       $      19.25 86255
7927190 STRIATIONAL AB                       $      19.25 86255
7927192 H. INFLUENZA B AB                    $      12.25 86317
7927193 TEICHOIC ACID AB                     $      16.80 86329
7927194 INSULIN ANTIBODIES                   $      45.50 86337
7927195 ANTI-THYROIDPEROXIDASE AB            $       8.00 86376
7927196 T. PALLIDUM AB, IGM                  $      18.20 86781
7927198 ASPERGILLUS AB BY CF                 $       9.54 86606
7927199 ASPERGILLUS AB BY ID                 $       9.54 86606
7927200 B. HENSELAE IGG                      $      12.94 86611
7927201 B. HENSELAE IGM                      $      12.94 86611
7927202 CAMDODA ANTIBODY - ID                $      14.70 86628
7927203 COXSACKIE B1                         $      15.00 86658
7927204 COXSACKIE B2                         $      15.00 86658
7927205 COXSACKIE B3                         $      15.00 86658
7927206 COXSACKIE B4                         $      15.00 86658
7927207 COXSACKIE B5                         $      15.00 86658
7927208 COXSACKIE B6                         $      15.00 86658
7927209 EPSTEIN-BARR EARLY AG                $      11.20 86663
7927210 LAB EPSTEIN-BARR NUCLEAR AG          $      10.58 86664
7927211 EHRLICHIA CHAFEENSIS IGG             $      13.81 86666
7927212 EHRLICHIA CHAFEENSIS IGM             $      13.82 86666
7927214 H. PYLORI IGA AB                     $      14.00 86677
7927215 H. PYLORI IGM AB                     $      14.00 86677
7927216 ECHINOCOCCUS IGG AB                  $      22.75 86682
7927217 HTLV I/II AB, WESTERN BLOT           $      91.00 86689
7927218 CSF HERPES 1 AND 2 - IGG             $      15.44 86694
7927219 LEPTOSPIRA AB                        $      33.25 86720
7927220 E. HISTOLYTICA IGG AB                $      14.00 86753
7927221 LAB PANCREASTATIN                    $     225.00 8351990
7927222 MEASLES IGG                          $      11.76 86765
7927223 MEASLES IGM                          $      11.76 86765
7927224 DENGUE FEVER AB                      $      22.22 86790
7927225 ENTEROVIRUS RNA                      $     115.00 87798
7927226 LAB HANDLING CHRG PASS THRU          $      30.00 9900190
7927227 VARICELLA ZOSTER VIRUS PCR           $      87.50 87798
7927248 GLYCATED ALBUMIN                     $      46.20 82985
7927249 NEURON SPECIFIC ENOLASE              $      35.28 86316
7927250 CIC RAJI CELL                        $     172.20 86332
7927251 TROPONIN T                           $      52.50 84484
7927252 OSMOTIC FRAGILITY                    $      75.00 85555
7927253 CYC CITRULLINAT AB, IGG              $      20.00 86200
7927254 HISTOPLASMA ANTIGEN                  $     110.00 87385
7927255 SOLUBLE TRANSFERRIN RECPT            $      21.00 84238
7927257 SERUM LYSOZYME                       $      16.10 85549
7927258 URINE MURAMIDASE                     $      16.10 85549




                                       Page 300
                                         Ancillary


7927260 LAB CSF LACTIC ACID                    $       8.40 83605
7927261 LAB TRYPTASE                           $     110.00 83520
7927262 LAB URN LEAD                           $       8.23 83655
7927263 LAB FLD LIPASE                         $      45.00 83690
7927266 LAB GLUTAMIC ACID DECARB AB            $      47.04 83519
7927267 LAB FECAL PORPHYRINS                   $     147.00 84126
7927268 LAB PLASMINOGEN ACTIVTR INHIB          $      63.00 85415
7927269 LAB HSV1 GLYCOPROTEIN IGG              $      26.24 86695
7927270 LAB HSV2 GLYCOPROTIEN IGG              $      26.24 86696
7927271 LAB PYRUVATE KINASE                    $      45.50 84220
7927272 LAB FECAL FAT, QUAL                    $      15.29 82705
7927273 LAB IA-2 AB                            $     203.00 86341
7927274 LAB HSV 1 IGG,CSF                      $      13.50 86695
7927275 LAB HSV 2 IGG, CSF                     $      13.50 86696
7927276 LAB CSF MENINGO PNL CA LA CRS          $      23.52 86651
7927277 LAB CSF MENINGO PNL EA EQUINE          $      23.52 86652
7927278 LAB CSF MENINGO PNL ST LOUIS           $      23.52 86653
7927279 LAB CSF MENINGO PNL W EQUINE           $      23.52 86654
7927280 LAB CSF MENINGO PNL RUBELLA            $      23.52 86765
7927281 LAB CSF MENINGO PNL VAR-ZOS            $      23.52 86787
7927282 LAB CSF MENINGO PNL HERP               $      23.52 86694
7927283 LAB CSF MENINGO PNL VIR NES            $      23.52 86790
7927284 LAB CSF MENINGO PNL LYM CHORIO         $      23.60 86727
7927287 LAB INSULIN, FASTING                   $      10.58 83525
7927288 LAB INSULIN, 30 MINUTES                $      10.58 83525
7927289 LAB INSULIN, 60 MINUTES                $      10.58 83525
7927290 LAB INSULIN, 90 MINUTES                $      10.58 83525
7927291 LAB INSULIN, 120 MINUTES               $      10.58 83525
7927292 LAB ADENOSINE DEAMINASE,FLD            $      35.00 84311
7927293 LAB METHEMALBUMIN                      $      87.06 83857
7927294 LAB SULFONAMIDES                       $      19.95 80299
7927295 LAB METHEMOGLOBIN                      $      38.57 83050
7927296 LAB URIC ACID, FLUID                   $       7.70 84560
7927297 LAB ADENOVIRUS ANTIBODY                $      12.25 86603
7927300 LAB MICROSAT PCR ENZ DIGEST            $       6.40 83892
7927301 LAB MICROSAT PCR AMP EA PAIR           $      24.00 83898
7927302 LAB MICROSAT PCR SEP BY GEL EP         $       6.40 83894
7927303 LAB MICROSAT PCR INTERP & RPRT         $       6.00 83912
7927304 LAB N-TELOPEPTIDE SE GC/MS             $     138.95 82523
7927305 LAB ASA TITER                          $      33.00 86256
7927306 LAB MYCOPHENOLIC ACID                  $      35.00 80299
7927308 LAB URN HISTOPLASMA AG                 $     110.00 87385
7927309 LAB DRUG QUANTITATION NES DOXR         $      14.40 80299
7927310 LAB DRUG QUANTITATION NES MSUX         $      11.00 80299
7927311 LAB MICROSAT PCR CLIN CONS             $      24.00 8050090
7927312 LAB MICROSAT PCR ISOLATION             $       6.00 8389090
7927313 LAB MICROSAT PCR SEP AND ID            $      24.00 8390990
7927314 LAB ACETYLCHOL RECEPT AB PNL           $      38.81 8351990
7927315 LAB GALACTOMANNAN                      $      98.00 8730590




                                         Page 301
                                          Ancillary


7927316 LAB FREE COPPER                         $      43.75 8252590
7927317 LAB HER 2 / NEU                         $     165.00 8395090
7927318 LAB ACETYLCHOL MODUL AB                 $      38.81 8351990
7927319 LAB ACYLCARNITINE PROF                  $     140.00 8201790
7927320 LAB WHOLE BLOOD VISCOSITY               $      12.25 8581090
7927321 LAB PANCREATIC ELASTASE                 $     175.00 8352090
7927322 LAB FLD CEA, PANCREATIC                 $      16.00 8237890
7927326 LAB FAM MEDITERRANEAN FVR               $     380.00 8829990
7927327 LAB COENZYME Q                          $     125.00 8249190
7927328 LAB C1 ESTERASE COMPL AG, EA            $      20.02 8616090
7927329 LAB C1 EST COMPL FCN ACT EA             $      20.03 8616190
7927330 LAB B PERTUSSIS AB                      $      21.00 8661590
7927333 LAB ALPHA-1-ANTITRYPSIN TOTAL           $      17.00 8210390
7927334 LAB ALPHA-1-ANTITRYPSIN PHNTYP          $      18.28 8210490
7928000 LAB SPECIAL TEST                        $       -   89240
7928007 LAB FLETCHER FACTOR                     $     125.00 85292
7928009 LAB PLASMINOGEN ACTIVITY      #         $     100.00 85420
7929000 LAB SPECIAL TEST                        $       -   89240
7929013 LAB CF MUT ANLY ISO EXT NUCA            $      23.05 83891
7929014 LAB CF MUT ANLY ENZ DIGEST              $      23.05 83892
7929015 LAB CF MUT ANLY NUC A PROBE             $      23.05 83896
7929016 LAB CF MUT ANLY AMPLIF                  $      96.45 83901
7929017 LAB CF MUT ANLY INTERP & RPT            $      23.05 83912
7930000 LAB SPECIAL TEST                        $       -   89240
7930006 LAB QUANTITATIVE IRON     #             $      48.52 83540
7930007 LAB QUANTITATIVE COPPER       #         $      57.90 82525
7930008 SULFONYLUREA HYPOGLYCEMICS              $      88.10 80100
7930009 URN DIURETIC SCREEN                     $      61.61 80100
7930010 AMIODARONE AND METABOLITE               $      18.15 80299
7930011 ALPHA 1 ANTITRYPSIN, STOOL              $      19.30 82103
7930012 CARBOHYDRATE DEF TRNSFRN                $      43.70 82373
7930013 URN NITROGEN TOTAL                      $      43.55 82397
7930014 PTH RELATED PROTEIN                     $      24.55 82397
7930016 COUMADIN (WARFARIN)                     $      37.30 82491
7930020 PANCREATIC POLYPEPTIDE                  $      65.74 83519
7930021 IGA ANTIBODIES                          $      29.92 83520
7930022 KETOGENIC STEROIDS                      $      22.42 83582
7930023 KETOSTEROIDS                            $      20.28 83586
7930024 LAB MUCOPOLYSACCH, ACID QUANT           $      59.95 83864
7930025 HHC ISOLATION OR EXTRACTION             $      11.48 83890
7930026 HHC SINGLE PRIMER PAIR PCR              $      47.96 83898
7930027 HHC INTERP & REPORT                     $      48.30 83912
7930028 LAB PYRUVIC ACID                        $      22.80 84210
7930029 URN OLIGOSACCHARIDES                    $      34.38 84377
7930030 STOOL NITROGEN TOTAL                    $      67.92 84999
7930031 PROTEIN S AG, TOTAL                     $      26.95 85305
7930032 PROTEIN S AG, FREE                      $      26.95 85306
7930033 MYCOPLASMA AB BY IFA                    $       8.67 86378
7930034 MYCOPLASMA AB BY IFA                    $       8.66 86378




                                          Page 302
                                         Ancillary


7930035 FLD RHEUMATOID FACTOR, IGM             $      41.50 86430
7930036 SPOROTHRIX AB                          $      38.92 86671
7930038 JC VIRUS DNA PCR                       $     118.87 87798
7930041 LAB METANEPHRINES, FRAC                $      68.45 83835
7930042 LAB STOOL CL                           $      42.80 82438
7930043 LAB STOOL MG                           $      58.65 83735
7930044 LAB STOOL K                            $       0.06 84999
7930045 LAB STOOL NA                           $      42.55 84302
7930046 LAB STOOL OSMOLALITY                   $       0.06 84999
7930048 LAB URN ARYLSULFATASE A                $      82.19 84311
7930049 LAB MUCOPOLYSACCH, ACID SCRN           $      29.65 83866
7930050 LAB GMB AB                             $      35.90 83520
7930051 LAB TUMOR HCG                          $      27.04 84702
7931000 LAB SPECIAL TEST                       $       -   89240
7931015 LAB 6MP METABOLITES                    $      90.45 82491
7931018 LAB TPMT PCR DNA MARKERS               $      53.87 83898
7931022 LAB TPMT INTERP & REPORT               $      12.88 83912
7931029 LAB TPMT ISOL/EXTRACT NUC ACID         $      12.88 83891
7931030 LAB TPMT NUCLEIC ACID PROBE            $      12.88 83896
7931033 LAB ANTI-GLIADIN ELISA, IGA            $      18.76 83520
7931034 LAB ANTI-GLIADIN ELISA, IGG            $      18.76 83520
7931035 LAB ANTI-HU-TTG ELISA IGA REC          $      51.25 83520
7931036 LAB ANTI-EMA IGA BY IFA                $      88.78 88347
7931037 LAB TOT SE IGA BY NEPHELOMETRY         $      16.75 82784
7931038 LAB TTG IGA                            $      51.26 83520
7931039 LAB CELIAGENE ISO EXT NUCA             $       5.45 83891
7931040 LAB CELIAGENE INTERP & RPT             $       5.45 83912
7931041 LAB CELIAGENE SEP G-EP                 $       5.48 83894
7931042 LAB CELIAGENE AMP EA PAIR              $      22.91 83898
7931043 LAB LACTOTYPE ISOL/EXT                 $      24.23 83890
7931044 LAB LACTOTYPE AMP EA PAIR              $     101.37 83898
7931045 LAB LACTOTYPE INTERP & RPT             $      24.24 83912
7931046 LAB LACTOTYPE NUC A PROBE              $      24.24 83896
7931047 LAB CELIAPLUS IMM ASSAY                $      19.25 83520
7931048 LAB CELIAPLUS IMMFL INDIR              $      96.92 88347
7931049 LAB CELIAPLUS INTERP & RPT             $       5.96 83912
7931050 LAB CELIAPLUS GAMMA GLOB               $      13.82 82784
7931051 LAB CELIAPLUS ISO EXT NUCA             $       5.95 83891
7931052 LAB CELIAPLUS SEP G-EP                 $       5.95 83894
7931053 LAB CELIAPLUS AMP EA PAIR              $      24.92 83898
7931054 LAB HACA INFLIX SPE ELISA              $      67.00 83520
7931055 LAB SERUM INFLIXIMAB LEVEL             $      83.75 83520
7931056 LAB FIBRO NEPH, EA ANALYTE NES         $      35.94 83883
7931057 LAB FIBR IA NOT INFCT AGNT NOS         $      99.28 83520
7931058 LAB IBD SER ELISA                      $      26.80 83520
7931059 LAB IBD SER IIFA                       $      82.08 88347
7931060 LAB TPMT ENZ NON-RADIO SUBSTRA         $      73.70 8265790
7931061 LAB TPMT ENZ COLMN SGL ANALYTE         $      73.70 8249190
7932000 LAB SPECIAL TEST                       $       -   89240




                                         Page 303
                                         Ancillary


7934000 LAB SPECIAL TEST                       $       -   89240
7935000 LAB SPECIAL TEST                       $       -   89240
7935022 LAB HIV PHENOTYPE, COMPREHEN           $     753.90 87903
7935023 LAB HIV PHENOTYPING, ADDL DRGS         $      40.22 87904
7935026 LAB GENOTYPE DNA HIV REVERSE T         $     323.11 87901
7935027 LAB PHENOTYPE DNA HIV W/CULT           $     613.29 87903
7935028 LAB PHENOTYPE DNA HIV W/CLT AD         $      32.72 87904
7936008 LAB COCCI CF IGG                       $      23.00 86171
7936009 LAB COCCI EIA IGM/IGG                  $      15.00 86317
7936010 LAB COCCI ID IGG & IGM                 $       7.00 86331
7938000 LAB SPECIAL TEST                       $       -   89240
7939000 LAB SPECIAL TEST                       $       -   89240
7939008 LAB HRPN MOLEC. DIAG.                  $      65.50 83890
7939009 LAB HRPN AMPLIFICATION                 $      68.25 83898
7939010 LAB HRPN SEP BY GEL EPHER              $      20.25 83894
7939011 LAB HRPN ENZ DIGESTION                 $      47.00 83892
7939012 LAB HRPN INTERP & REPORT               $      26.00 83912
7939013 LAB HRPN PATH INTERP & RPT             $      60.00 83912
7939014 LAB SPNK ISOL & EXTRCT                 $      54.14 8389090
7939015 LAB SPNK AMPLIFICATION                 $     226.44 8389890
7939016 LAB SPNK GEL ELP                       $      54.14 8389490
7939017 LAB SPNK ENZ DIGST                     $      54.14 8389290
7939018 LAB SPNK INTERP & RPT                  $      54.14 8391290
7940000 LAB SPECIAL TEST                       $       -   89240
7940006 DRUG SCREEN, URINE                     $       9.42 80101
7940007 COCAINE CONFIRMATION                   $      15.00 8252090
7940008 OPIATE CONFIRMATION                    $      15.00 83925
7940009 AMPHETAMINE CONFIRMATION               $      25.00 82145
7940010 BARBITURATE CONFIRMATION               $      89.02 82205
7940011 METHADONE CONFIRMATION                 $      13.91 83840
7940012 BENZODIAZEPINE CONFIRMATION            $      89.02 80154
7940013 PROPOXYPHENE CONFIRMATION              $       9.73 83925
7940014 CANNABOID CONFIRMATION                 $      38.95 82542
7940015 PHENCYCLIDINE CONFIRMATION             $      38.95 83992
7940016 ALPRAZOLAM (XANTAX)                    $      50.08 80154
7940017 AMOBARBITAL                            $      44.51 82205
7940018 AMPHETAMINE SCREEN                     $      38.95 82145
7940019 BARBITURATES, IDENTIFICATION           $     122.41 82205
7940020 BUTABARBITAL                           $      44.51 82205
7940021 BUTALBITAL                             $      44.51 82205
7940022 VALIUM (DIAZEPAM)                      $      50.08 80154
7940023 CHLORAMPHENICOL                        $      44.51 82415
7940024 LAB DRUG SCREEN, EA CLASS, BLD         $       8.92 80101
7940025 PROPOXYPHENE (DARVON)                  $      61.20 82492
7940027 MAPROTILENE                            $      44.51 82491
7940028 METHADONE                              $      77.90 83840
7940029 METHAQUALONE                           $       9.73 80102
7940030 MORPHINE                               $      50.08 83925
7940031 NICOTINE                               $      66.77 83887




                                         Page 304
                                        Ancillary


7940032 OLANZAPINE                            $       89.02 82491
7940033 SECOBARBITAL                          $       44.51 82205
7940034 VERAPAMIL                             $       55.64 82492
7940035 VOLATILES                             $       33.38 80101
7940036 CHLORDIAZEPOXIDE (LIBRIUM)            $       55.64 80154
7940037 DRUG SCREEN, MECONIUM                 $        8.50 80101
7940038 DRUG SCREEN, BREAST MILK              $        7.70 80101
7940039 CITALOPRAM (CELEXA)                   $       83.46 82492
7940040 SERTRALINE (ZOLOFT)                   $       66.77 82492
7940041 DIPHENHYDRAMINE                       $       44.51 82491
7940042 TOCAINIDE                             $       44.51 80299
7940043 TOPIRAMATE                            $       50.08 80201
7940044 TRILEPTAL                             $       55.64 80299
7940046 LAB KEPPRA (CHROMATOGRAPHY)           $       72.33 82491
7940047 LAB OXYCODONE                         $       65.00 83925
7940048 LAB MEXILETENE                        $       50.08 82491
7940049 LAB PHENELZINE (NARDIL)               $      399.00 82491
7940050 LAB ROHYPNOL URINE                    $       72.33 80101
7940051 LAB NICOTINE URINE                    $       35.00 83887
7940052 LAB ALCOHOL (ETHANOL)                 $        4.55 82055
7940053 LAB ALCOHOL (ETHANOL)                 $        6.46 82055
7940054 LAB GLUTETHIMIDE                      $       32.10 82980
7940055 LAB FENTANYL                          $       45.90 83925
7940056 LAB METHOTREXATE                      $       33.38 83520
7940057 LAB QUINIDINE                         $       29.21 80194
7940058 LAB BUPROPION                         $       49.00 80299
7950001 LAB 1P36 BY FISH                      $      500.00 88365
7950002 LAB FISH FOR CHROMOSOME 19Q