Memorial Hospital Association Los Banos by HC12071121244

VIEWS: 27 PAGES: 119

									                                           d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


 CHARGE              BILLING DESCRIPTION             CURRENT    CURRENT      DEPARTMENT      DEPARTMENT DESCRIPTION
  CODE                                              INPATIENT OUTPATIENT        CODE
                                                      PRICE      PRICE
317020600   ROOM MED/SURG/GYN                         $2,149.00   $2,149.00 083081        LOS MED/SURG
454051026   AB ID                                       $443.13     $443.13 084100        LOS BLOOD BANK REV
454051027   AB TTR                                      $163.92     $163.92 084100        LOS BLOOD BANK REV
454051005   FFP PS                                       $67.00      $67.00 084100        LOS BLOOD BANK REV
454051025   PHER PS                                     $636.00     $636.00 084100        LOS BLOOD BANK REV
454051013   RBC L/D PS                                  $214.25     $214.25 084100        LOS BLOOD BANK REV
454051008   RBC PS                                      $214.25     $214.25 084100        LOS BLOOD BANK REV
454051003   WASHED RBC PS                               $296.75     $296.75 084100        LOS BLOOD BANK REV
454051001   WB PS                                       $214.25     $214.25 084100        LOS BLOOD BANK REV
44706659    S CATH INFSN NO HD                           $75.62      $75.62 084050        LOS CENTRAL SUPPLY REV
44706649    S NSTRL AMBUALARM                           $357.35     $357.35 084050        LOS CENTRAL SUPPLY REV
44706655    S NSTRL BILI MASK PRM                       $167.20     $167.20 084050        LOS CENTRAL SUPPLY REV
44706654    S NSTRL BILI MASK RG                        $167.20     $167.20 084050        LOS CENTRAL SUPPLY REV
44706605    S NSTRL BLAKEMORE TUBE                    $4,284.20   $4,284.20 084050        LOS CENTRAL SUPPLY REV
44706645    S NSTRL DUO THERM PD                        $275.00     $275.00 084050        LOS CENTRAL SUPPLY REV
44706561    S NSTRL EASILAV KIT 24 FR                   $973.35     $973.35 084050        LOS CENTRAL SUPPLY REV
44706562    S NSTRL EASILAV KIT 28FR                    $973.00     $973.00 084050        LOS CENTRAL SUPPLY REV
44706563    S NSTRL EASILAV KIT 34FR                    $973.35     $973.35 084050        LOS CENTRAL SUPPLY REV
447045701   S NSTRL HOSE KNEE H/M R                      $51.00      $51.00 084050        LOS CENTRAL SUPPLY REV
447045415   S NSTRL HOSE KNEE HI LG/L                    $63.00      $63.00 084050        LOS CENTRAL SUPPLY REV
447045414   S NSTRL HOSE KNEE HI S/R                     $63.00      $63.00 084050        LOS CENTRAL SUPPLY REV
447045417   S NSTRL HOSE KNEE HI XL                      $63.00      $63.00 084050        LOS CENTRAL SUPPLY REV
447045890   S NSTRL HOSE KNEE HI/LG R                    $65.80      $65.80 084050        LOS CENTRAL SUPPLY REV
447045891   S NSTRL HOSE KNEE HI/M L                     $66.00      $66.00 084050        LOS CENTRAL SUPPLY REV
447045189   S NSTRL HOSE THI HI MD/LO                    $90.00      $90.00 084050        LOS CENTRAL SUPPLY REV
447045496   S NSTRL HOSE THI HI/L/SHT                    $96.10      $96.10 084050        LOS CENTRAL SUPPLY REV
447045188   S NSTRL HOSE THI HI/MD                       $90.00      $90.00 084050        LOS CENTRAL SUPPLY REV
447045191   S NSTRL HOSE THI HI/SM R                     $96.00      $96.00 084050        LOS CENTRAL SUPPLY REV
447045997   S NSTRL HOSE THI/HI LG/RG                    $96.00      $96.00 084050        LOS CENTRAL SUPPLY REV
447045604   S NSTRL HOSE THI/L LNG                       $96.00      $96.00 084050        LOS CENTRAL SUPPLY REV
44706558    S NSTRL HOSE THIGH M/S                      $273.00     $273.00 084050        LOS CENTRAL SUPPLY REV
44706616    S NSTRL IMPAD-LG RIGID                    $1,158.99   $1,158.99 084050        LOS CENTRAL SUPPLY REV
44706617    S NSTRL IMPAD-REG RIGID                   $1,158.99   $1,158.99 084050        LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                             1
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44706618    S NSTRL IMPAD-XLG RIGID                $1,390.78    $1,390.78   084050   LOS CENTRAL SUPPLY REV
44706608    S NSTRL LEG TRAC. ADULT                $2,799.00    $2,799.00   084050   LOS CENTRAL SUPPLY REV
44706609    S NSTRL LEG TRAC. PEDS                 $2,798.76    $2,798.76   084050   LOS CENTRAL SUPPLY REV
44706603    S NSTRL NASAL AIRWAY 28                   $99.00       $99.00   084050   LOS CENTRAL SUPPLY REV
44706604    S NSTRL NASAL AIRWAY 34                   $99.00       $99.00   084050   LOS CENTRAL SUPPLY REV
44706569    S NSTRL OSTOMY BELT                      $237.69      $237.69   084050   LOS CENTRAL SUPPLY REV
44706590    S NSTRL OSTOMY POUCH 1.5                  $76.00       $76.00   084050   LOS CENTRAL SUPPLY REV
44706591    S NSTRL OSTOMY POUCH 3"                  $112.67      $112.67   084050   LOS CENTRAL SUPPLY REV
44706570    S NSTRL OXISENSOR PED                    $600.00      $600.00   084050   LOS CENTRAL SUPPLY REV
44706564    S NSTRL PEDIPADZ ZOLL                    $787.00      $787.00   084050   LOS CENTRAL SUPPLY REV
44706586    S NSTRL POST OP SHOE M-SM                $355.00      $355.00   084050   LOS CENTRAL SUPPLY REV
447046152   S NSTRL RESUSC. ACT                      $510.00      $510.00   084050   LOS CENTRAL SUPPLY REV
44706556    S NSTRL RIB BELT FEM                     $261.00      $261.00   084050   LOS CENTRAL SUPPLY REV
44706667    S NSTRL RIB BELT MALE                    $235.11      $235.11   084050   LOS CENTRAL SUPPLY REV
44706557    S NSTRL RIB BELT MALE                    $385.00      $385.00   084050   LOS CENTRAL SUPPLY REV
44706560    S NSTRL SEQ COMP SLEEVE S                $977.00      $977.00   084050   LOS CENTRAL SUPPLY REV
44706585    S NSTRL SIGMOIDOSCOPE DIS                $104.95      $104.95   084050   LOS CENTRAL SUPPLY REV
44706641    S NSTRL SITZ BATH                         $69.45       $69.45   084050   LOS CENTRAL SUPPLY REV
447045509   S NSTRL SLING LARGE                       $76.00       $76.00   084050   LOS CENTRAL SUPPLY REV
447045510   S NSTRL SLING MED                         $69.00       $69.00   084050   LOS CENTRAL SUPPLY REV
447045516   S NSTRL SLING SMALL                       $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045513   S NSTRL SPLINT UNIV KNEE                 $370.00      $370.00   084050   LOS CENTRAL SUPPLY REV
447045925   S NSTRL SPLINT,SM                        $709.98      $709.98   084050   LOS CENTRAL SUPPLY REV
44706653    S NSTRL TRUZONE METER                    $403.35      $403.35   084050   LOS CENTRAL SUPPLY REV
44706632    S NSTRL VAG SPEC LG                       $99.00       $99.00   084050   LOS CENTRAL SUPPLY REV
44706631    S NSTRL VAG SPEC MD                       $99.00       $99.00   084050   LOS CENTRAL SUPPLY REV
44706630    S NSTRL VAG SPEC SM                       $99.00       $99.00   084050   LOS CENTRAL SUPPLY REV
44706614    S NSTRLSPLINT,COLLAR-SM                  $709.98      $709.98   084050   LOS CENTRAL SUPPLY REV
447045115   S ORTHO BRC ANK TRNG RT                  $325.00      $325.00   084050   LOS CENTRAL SUPPLY REV
447045061   S ORTHO BRC ANK TRNG RT                  $472.00      $472.00   084050   LOS CENTRAL SUPPLY REV
447076524   S ORTHO FING SPLNT 2 1/4                  $25.00       $25.00   084050   LOS CENTRAL SUPPLY REV
447076525   S ORTHO FING SPLNT 3 1/4                  $33.00       $33.00   084050   LOS CENTRAL SUPPLY REV
447076526   S ORTHO FING SPLNT 4 1/4                  $35.00       $35.00   084050   LOS CENTRAL SUPPLY REV
447076527   S ORTHO FING SPLNT 5 1/4                  $54.00       $54.00   084050   LOS CENTRAL SUPPLY REV
447076528   S ORTHO FING SPLNT 6 1/4                  $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447076529   S ORTHO FING SPLNT 7 1/4                  $70.00       $70.00   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                     2
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


447076451   S ORTHO IMBLR SHLD MED                  $168.00      $168.00   084050   LOS CENTRAL SUPPLY REV
447076453   S ORTHO IMBLR SHLD XL                   $168.00      $168.00   084050   LOS CENTRAL SUPPLY REV
447076465   S ORTHO IMBLR SHOULDER S                $184.10      $184.10   084050   LOS CENTRAL SUPPLY REV
447076452   S ORTHO IMMOB SHOULDR L                 $168.00      $168.00   084050   LOS CENTRAL SUPPLY REV
447045638   S ORTHO PHIL COLAR L OLA                $147.00      $147.00   084050   LOS CENTRAL SUPPLY REV
447076474   S ORTHO SHOE PST-OP F LG                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447076473   S ORTHO SHOE PST-OP F MD                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447076472   S ORTHO SHOE PST-OP F SM                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447076476   S ORTHO SHOE PST-OP M LG                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447076475   S ORTHO SHOE PST-OP M MD                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447076477   S ORTHO SHOE PST-OP M XL                $293.00      $293.00   084050   LOS CENTRAL SUPPLY REV
447045515   S ORTHO SPLNT BRD CGE L                  $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045503   S ORTHO SPLNT BRD CGE M                  $32.00       $32.00   084050   LOS CENTRAL SUPPLY REV
447045508   S ORTHO SPLNT BRD CGE S                  $32.00       $32.00   084050   LOS CENTRAL SUPPLY REV
447045529   S ORTHO SPLNT CCOLAR FM M               $147.00      $147.00   084050   LOS CENTRAL SUPPLY REV
447045531   S ORTHO SPLNT CCOLAR FM S               $147.40      $147.40   084050   LOS CENTRAL SUPPLY REV
447045637   S ORTHO SPLNT CKUP LG RT                 $66.00       $66.00   084050   LOS CENTRAL SUPPLY REV
447045121   S ORTHO SPLNT CKUP MD RT                 $93.00       $93.00   084050   LOS CENTRAL SUPPLY REV
447045636   S ORTHO SPLNT CKUP MED                   $63.00       $63.00   084050   LOS CENTRAL SUPPLY REV
447045635   S ORTHO SPLNT CKUP SM LFT                $63.00       $63.00   084050   LOS CENTRAL SUPPLY REV
447045632   S ORTHO SPLNT CKUP SM RT                 $58.00       $58.00   084050   LOS CENTRAL SUPPLY REV
447046112   S ORTHO SPLNT WRST LG LFT               $134.00      $134.00   084050   LOS CENTRAL SUPPLY REV
447046113   S ORTHO SPLNT WRST LG RT                $134.00      $134.00   084050   LOS CENTRAL SUPPLY REV
447045018   S ORTHO SPT LG                           $75.50       $75.50   084050   LOS CENTRAL SUPPLY REV
447045129   S ORTHO STRAP CLAV MED                  $103.00      $103.00   084050   LOS CENTRAL SUPPLY REV
447045130   S ORTHO STRAP CLAVICLE LG               $103.00      $103.00   084050   LOS CENTRAL SUPPLY REV
447045131   S ORTHO STRAP CLAVICLE SM               $103.00      $103.00   084050   LOS CENTRAL SUPPLY REV
44706644    S STRL AMNIOCENTSS TRAY                 $517.05      $517.05   084050   LOS CENTRAL SUPPLY REV
447076345   S STRL ANGIOCATH 24-3/4                  $48.00       $48.00   084050   LOS CENTRAL SUPPLY REV
447076335   S STRL ANGIOCATH20X1 1/4                 $39.00       $39.00   084050   LOS CENTRAL SUPPLY REV
447076500   S STRL ARTERIAL LINE KIT                $515.00      $515.00   084050   LOS CENTRAL SUPPLY REV
44706648    S STRL BARRIER WIPES                      $2.00        $2.00   084050   LOS CENTRAL SUPPLY REV
447045046   S STRL BILE BAG                          $96.00       $96.00   084050   LOS CENTRAL SUPPLY REV
447045177   S STRL BIOP NEEDLE 4 1/2                $210.00      $210.00   084050   LOS CENTRAL SUPPLY REV
447046149   S STRL BIPAP CIRCUIT                    $336.00      $336.00   084050   LOS CENTRAL SUPPLY REV
447046148   S STRL BIPAP MASK - L                   $749.00      $749.00   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                    3
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


447046147   S STRL BIPAP MASK - M                   $749.00      $749.00   084050   LOS CENTRAL SUPPLY REV
447046146   S STRL BIPAP SM MASK                    $736.19      $736.19   084050   LOS CENTRAL SUPPLY REV
44706588    S STRL BLOOD REIP. SET                  $203.21      $203.21   084050   LOS CENTRAL SUPPLY REV
447076386   S STRL BLOOD SET 2227                   $395.00      $395.00   084050   LOS CENTRAL SUPPLY REV
447076541   S STRL BLOOD WARMING SET                $615.00      $615.00   084050   LOS CENTRAL SUPPLY REV
44706656    S STRL BREAST KIT                       $846.93      $846.93   084050   LOS CENTRAL SUPPLY REV
447045054   S STRL BREAST PUMP                       $66.00       $66.00   084050   LOS CENTRAL SUPPLY REV
447045106   S STRL CATH 3 WAY IRR 20                 $86.65       $86.65   084050   LOS CENTRAL SUPPLY REV
447045491   S STRL CATH 3 WAY IRR 22                $178.00      $178.00   084050   LOS CENTRAL SUPPLY REV
447045676   S STRL CATH 3 WAY IRR 24                $178.00      $178.00   084050   LOS CENTRAL SUPPLY REV
447045987   S STRL CATH ANTON 18G                    $34.00       $34.00   084050   LOS CENTRAL SUPPLY REV
447045668   S STRL CATH ARROW ART 20                $147.00      $147.00   084050   LOS CENTRAL SUPPLY REV
44706566    S STRL CATH COUDE 16 FR                 $461.00      $461.00   084050   LOS CENTRAL SUPPLY REV
447045609   S STRL CATH FOLEY 10X3CC                 $51.00       $51.00   084050   LOS CENTRAL SUPPLY REV
447045735   S STRL CATH FOLEY 12 X 5                 $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045734   S STRL CATH FOLEY 14 X 5                $189.00      $189.00   084050   LOS CENTRAL SUPPLY REV
447045732   S STRL CATH FOLEY 16 X 5                 $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045733   S STRL CATH FOLEY 18 X 5                 $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045721   S STRL CATH FOLEY 20 X 30                $82.00       $82.00   084050   LOS CENTRAL SUPPLY REV
447045730   S STRL CATH FOLEY 20X5CC                 $76.00       $76.00   084050   LOS CENTRAL SUPPLY REV
447045731   S STRL CATH FOLEY 22X5CC                 $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045720   S STRL CATH FOLEY 24 X 30                $87.00       $87.00   084050   LOS CENTRAL SUPPLY REV
447045610   S STRL CATH FOLEY 8X3CC                 $226.00      $226.00   084050   LOS CENTRAL SUPPLY REV
447045612   S STRL CATH FOLEY COUD 14               $181.00      $181.00   084050   LOS CENTRAL SUPPLY REV
447045110   S STRL CATH KIT STERILE                  $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045419   S STRL CATH STRAIGHT 1                   $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045424   S STRL CATH STRAIGHT 16                  $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045740   S STRL CATH SUCTION 10 FR                $18.00       $18.00   084050   LOS CENTRAL SUPPLY REV
447045737   S STRL CATH SUCTION 14 FR                $21.00       $21.00   084050   LOS CENTRAL SUPPLY REV
447045743   S STRL CATH SUCTION 8 FR                 $15.00       $15.00   084050   LOS CENTRAL SUPPLY REV
447045738   S STRL CATH TROCAR 28                   $288.00      $288.00   084050   LOS CENTRAL SUPPLY REV
447045494   S STRL CATH TROCAR 32 FR                $189.00      $189.00   084050   LOS CENTRAL SUPPLY REV
447045073   S STRL CATHETER STRT 14                  $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
44706576    S STRL CAUTERY DISP                     $290.00      $290.00   084050   LOS CENTRAL SUPPLY REV
44706674    S STRL CAVILON WIPE                      $41.15       $41.15   084050   LOS CENTRAL SUPPLY REV
44706666    S STRL CENTRAL DRESS                    $728.09      $728.09   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                    4
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


447076511   S STRL CMPRSS SLEEVE M                 $1,029.00    $1,029.00   084050   LOS CENTRAL SUPPLY REV
447076512   S STRL CMPRSS SLV KNEE-HI                $964.00      $964.00   084050   LOS CENTRAL SUPPLY REV
447076520   S STRL CMPRSS SLV THIGH L              $1,250.00    $1,250.00   084050   LOS CENTRAL SUPPLY REV
44706660    S STRL CONCHA PACK                       $505.73      $505.73   084050   LOS CENTRAL SUPPLY REV
447076325   S STRL CS ANGIO CATH 16-2                 $18.00       $18.00   084050   LOS CENTRAL SUPPLY REV
447076340   S STRL CS ANGIO CATH 22-1                 $18.00       $18.00   084050   LOS CENTRAL SUPPLY REV
447046028   S STRL CS DRAIN NG 16                     $43.00       $43.00   084050   LOS CENTRAL SUPPLY REV
447045395   S STRL CS. DRAINAGE BAF U                 $82.00       $82.00   084050   LOS CENTRAL SUPPLY REV
447076355   S STRL CUTDOWN CATH 22-12                 $53.00       $53.00   084050   LOS CENTRAL SUPPLY REV
44706598    S STRL CVP MONITOR                       $366.82      $366.82   084050   LOS CENTRAL SUPPLY REV
447076553   S STRL DECANNULATION CAP                  $64.83       $64.83   084050   LOS CENTRAL SUPPLY REV
447047031   S STRL DERMABOND SUTURE                  $729.00      $729.00   084050   LOS CENTRAL SUPPLY REV
447045328   S STRL DRAIN NG 12                        $34.00       $34.00   084050   LOS CENTRAL SUPPLY REV
447045361   S STRL DRAIN NG 18                        $51.00       $51.00   084050   LOS CENTRAL SUPPLY REV
447045391   S STRL DRAINAGE URIMETER                 $170.00      $170.00   084050   LOS CENTRAL SUPPLY REV
44706670    S STRL DRESS FOAM 3.5                    $154.34      $154.34   084050   LOS CENTRAL SUPPLY REV
44706559    S STRL DRESSING ULCER                    $215.67      $215.67   084050   LOS CENTRAL SUPPLY REV
447076494   S STRL DRSG CMFEEL CON                   $153.00      $153.00   084050   LOS CENTRAL SUPPLY REV
447076489   S STRL DRSG COMFEEL 311                  $136.00      $136.00   084050   LOS CENTRAL SUPPLY REV
447076491   S STRL DRSG COMFEEL 353                   $70.00       $70.00   084050   LOS CENTRAL SUPPLY REV
447076490   S STRL DRSG COMFEEL 353                   $98.00       $98.00   084050   LOS CENTRAL SUPPLY REV
447076492   S STRL DRSG COMFEEL BUT                  $176.00      $176.00   084050   LOS CENTRAL SUPPLY REV
447076493   S STRL DRSG COMFEEL TRI                  $387.00      $387.00   084050   LOS CENTRAL SUPPLY REV
447045874   S STRL DRSG DUODERM                      $168.00      $168.00   084050   LOS CENTRAL SUPPLY REV
447045375   S STRL DRSG VASELINE 1                    $27.35       $27.35   084050   LOS CENTRAL SUPPLY REV
447045450   S STRL DRSG VSLNE 1X36                    $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045454   S STRL DRSG VSLNE 3X18                    $31.00       $31.00   084050   LOS CENTRAL SUPPLY REV
447045455   S STRL DRSG VSLNE 3X9                     $39.00       $39.00   084050   LOS CENTRAL SUPPLY REV
447045539   S STRL DRSG XEROFM 2X2                    $21.00       $21.00   084050   LOS CENTRAL SUPPLY REV
447045568   S STRL DUO DERM EXTRA T                  $113.00      $113.00   084050   LOS CENTRAL SUPPLY REV
44706597    S STRL DUODERM 6X6                       $194.98      $194.98   084050   LOS CENTRAL SUPPLY REV
44706596    S STRL DUODERM CGF 6X6                   $571.58      $571.58   084050   LOS CENTRAL SUPPLY REV
447045978   S STRL EXTRACTN CUP & TU                 $247.00      $247.00   084050   LOS CENTRAL SUPPLY REV
447076519   S STRL EYEBRW OXISENSOR                  $926.00      $926.00   084050   LOS CENTRAL SUPPLY REV
44706580    S STRL FEEDING TUBE 10 FR                 $49.90       $49.90   084050   LOS CENTRAL SUPPLY REV
44706579    S STRL FEEDING TUBE 5 FR.                 $19.00       $19.00   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                     5
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44706578    S STRL FEEDING TUBE 8 FR.                 $42.00       $42.00   084050   LOS CENTRAL SUPPLY REV
44706677    S STRL FOAM 2X2 3M                       $131.70      $131.70   084050   LOS CENTRAL SUPPLY REV
44706671    S STRL FOAM BARRIER                       $84.37       $84.37   084050   LOS CENTRAL SUPPLY REV
44706662    S STRL FOAM DRESS 8X8                    $573.13      $573.13   084050   LOS CENTRAL SUPPLY REV
44706678    S STRL FOAM SQU 4X4                      $199.61      $199.61   084050   LOS CENTRAL SUPPLY REV
44706652    S STRL FOLEY MTR 16FR                    $644.40      $644.40   084050   LOS CENTRAL SUPPLY REV
44706651    S STRL FOLEY MTR 18FR                    $644.40      $644.40   084050   LOS CENTRAL SUPPLY REV
44706611    S STRL HEEL/ELBOW PRO                    $234.00      $234.00   084050   LOS CENTRAL SUPPLY REV
44706685    S STRL HI/LO ET 6.0                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706686    S STRL HI/LO ET 6.5                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706687    S STRL HI/LO ET 7.0                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706688    S STRL HI/LO ET 7.5                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706689    S STRL HI/LO ET 8.0                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706690    S STRL HI/LO ET 8.5                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706691    S STRL HI/LO ET 9.0                      $655.96      $655.96   084050   LOS CENTRAL SUPPLY REV
44706612    S STRL HUBER 20GX1                       $418.00      $418.00   084050   LOS CENTRAL SUPPLY REV
44706577    S STRL HUBER 20GX1.5                     $437.00      $437.00   084050   LOS CENTRAL SUPPLY REV
44706669    S STRL HYDROCEL 15MG                     $144.05      $144.05   084050   LOS CENTRAL SUPPLY REV
44706620    S STRL IMPAD STERILE-LEFT                $965.82      $965.82   084050   LOS CENTRAL SUPPLY REV
44706619    S STRL IMPAD STERILE-RT                  $965.82      $965.82   084050   LOS CENTRAL SUPPLY REV
447046138   S STRL INF. HYPERFLAT BG                 $283.00      $283.00   084050   LOS CENTRAL SUPPLY REV
447076552   S STRL INNER CANNULA 10.0                 $78.72       $78.72   084050   LOS CENTRAL SUPPLY REV
447076549   S STRL INNER CANNULA 6.0                  $78.72       $78.72   084050   LOS CENTRAL SUPPLY REV
447076550   S STRL INNER CANNULA 8.0                  $78.72       $78.72   084050   LOS CENTRAL SUPPLY REV
447076551   S STRL INNER CANNULA 9.0                  $78.72       $78.72   084050   LOS CENTRAL SUPPLY REV
44706635    S STRL INST TRAY                         $156.00      $156.00   084050   LOS CENTRAL SUPPLY REV
447045117   S STRL INTRAUTER CATH.TI                 $250.00      $250.00   084050   LOS CENTRAL SUPPLY REV
44706595    S STRL INTRODUCER 6.3                  $1,260.00    $1,260.00   084050   LOS CENTRAL SUPPLY REV
44706594    S STRL INTRODUCER 8.0                  $1,260.00    $1,260.00   084050   LOS CENTRAL SUPPLY REV
447045523   S STRL INTROKIT PERCUTAN                 $285.00      $285.00   084050   LOS CENTRAL SUPPLY REV
447076456   S STRL JAMSHID NEEDLE1518                $326.25      $326.25   084050   LOS CENTRAL SUPPLY REV
44706582    S STRL JAMSHIDI 13 GA.                 $1,051.04    $1,051.04   084050   LOS CENTRAL SUPPLY REV
44706634    S STRL LENS MORGAN                       $776.86      $776.86   084050   LOS CENTRAL SUPPLY REV
44706593    S STRL MECONIUM ASP.                     $173.38      $173.38   084050   LOS CENTRAL SUPPLY REV
447046135   S STRL MISTY NEBULIZER                    $40.00       $40.00   084050   LOS CENTRAL SUPPLY REV
44706640    S STRL MITY VAC CUP                      $733.10      $733.10   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                     6
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


447046145   S STRL MONA AEROCHAM LG                  $583.00      $583.00   084050   LOS CENTRAL SUPPLY REV
447046144   S STRL MONA AEROCHAM MED                 $552.00      $552.00   084050   LOS CENTRAL SUPPLY REV
447046143   S STRL MONA AEROCHAM SM                  $552.00      $552.00   084050   LOS CENTRAL SUPPLY REV
447046142   S STRL MONA AEROCHAM W/M                 $230.00      $230.00   084050   LOS CENTRAL SUPPLY REV
44706613    S STRL NASAL OXISENSOR                   $601.94      $601.94   084050   LOS CENTRAL SUPPLY REV
44706592    S STRL NASAL PACKING SM                  $344.00      $344.00   084050   LOS CENTRAL SUPPLY REV
447046176   S STRL NEEDLE SAFTIMA 18G                $129.00      $129.00   084050   LOS CENTRAL SUPPLY REV
447046177   S STRL NEEDLE SAFTIMA 20G                $129.00      $129.00   084050   LOS CENTRAL SUPPLY REV
447046178   S STRL NEEDLE SAFTIMA 22G                $129.00      $129.00   084050   LOS CENTRAL SUPPLY REV
447046179   S STRL NEEDLE SAFTIMA 24G                $129.00      $129.00   084050   LOS CENTRAL SUPPLY REV
447045706   S STRL NEEDLE SP 20X3X1/2                 $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045749   S STRL NEEDLE SP 22X1 1/2                 $31.00       $31.00   084050   LOS CENTRAL SUPPLY REV
447045809   S STRL NEEDLE SP 22X3                     $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
447045707   S STRL NEEDLE SP 22X5LBB                  $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
447045428   S STRL NEEDLE SP 25X31/2                  $24.00       $24.00   084050   LOS CENTRAL SUPPLY REV
44706555    S STRL NEEDLE SPINAL                     $230.07      $230.07   084050   LOS CENTRAL SUPPLY REV
44706610    S STRL NEOPUF CIRCUIT 3                  $540.00      $540.00   084050   LOS CENTRAL SUPPLY REV
44706584    S STRL NO2 STOP KIT                      $807.74      $807.74   084050   LOS CENTRAL SUPPLY REV
447045254   S STRL NOZ STOP KIT SSE                  $199.00      $199.00   084050   LOS CENTRAL SUPPLY REV
44706661    S STRL ORAL CLEAN KIT                    $595.36      $595.36   084050   LOS CENTRAL SUPPLY REV
447045135   S STRL OSTMY SKIN GEL                     $63.00       $63.00   084050   LOS CENTRAL SUPPLY REV
447045759   S STRL OSTOMY POUCH 2                     $27.00       $27.00   084050   LOS CENTRAL SUPPLY REV
447076523   S STRL OSTY PCH 2 1/4                     $65.00       $65.00   084050   LOS CENTRAL SUPPLY REV
447045089   S STRL OXISENS ADULT                     $288.00      $288.00   084050   LOS CENTRAL SUPPLY REV
447076464   S STRL OXISENSOR I-20                    $510.00      $510.00   084050   LOS CENTRAL SUPPLY REV
44706607    S STRL PACING BIPOLAR 5FR              $1,212.11    $1,212.11   084050   LOS CENTRAL SUPPLY REV
44706663    S STRL PACKING 1/2X1YD                    $34.47       $34.47   084050   LOS CENTRAL SUPPLY REV
44706664    S STRL PACKING 1/4X1YD                    $32.92       $32.92   084050   LOS CENTRAL SUPPLY REV
44706665    S STRL PACKING 1X1YD                      $38.58       $38.58   084050   LOS CENTRAL SUPPLY REV
447076371   S STRL PALL BLOOD FILT CB                $258.00      $258.00   084050   LOS CENTRAL SUPPLY REV
447076502   S STRL PATRL EZ FEED BG                   $67.00       $67.00   084050   LOS CENTRAL SUPPLY REV
447076501   S STRL PATRL SPIKE 52040                  $52.00       $52.00   084050   LOS CENTRAL SUPPLY REV
447046166   S STRL PEAK FLOW METER                    $13.00       $13.00   084050   LOS CENTRAL SUPPLY REV
447046164   S STRL PEDIATRIC CANOPY                  $275.00      $275.00   084050   LOS CENTRAL SUPPLY REV
44706574    S STRL PENROSE DR 1/2"                    $17.49       $17.49   084050   LOS CENTRAL SUPPLY REV
44706575    S STRL PENROSE DR 1/4"                    $47.33       $47.33   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                     7
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44706573    S STRL PENROSE DRAIN 1"                   $17.49       $17.49   084050   LOS CENTRAL SUPPLY REV
447045229   S STRL PKNG IODO 1                        $90.00       $90.00   084050   LOS CENTRAL SUPPLY REV
447045228   S STRL PKNG IODO 1/2                      $69.00       $69.00   084050   LOS CENTRAL SUPPLY REV
447045227   S STRL PKNG IODO 1/4IN                    $66.00       $66.00   084050   LOS CENTRAL SUPPLY REV
447045230   S STRL PKNG IODO 2                       $120.00      $120.00   084050   LOS CENTRAL SUPPLY REV
44706587    S STRL PLATELET INF. SET                 $207.00      $207.00   084050   LOS CENTRAL SUPPLY REV
44706684    S STRL PLEUR S110-08LF                   $913.20      $913.20   084050   LOS CENTRAL SUPPLY REV
44706658    S STRL PRO-PADZ                          $821.11      $821.11   084050   LOS CENTRAL SUPPLY REV
447045436   S STRL QUIK CONNECT SPIRL                $150.00      $150.00   084050   LOS CENTRAL SUPPLY REV
44706646    S STRL RECTAL PROBE DP                   $288.00      $288.00   084050   LOS CENTRAL SUPPLY REV
447046156   S STRL RESUS BAG,ADULT                   $482.00      $482.00   084050   LOS CENTRAL SUPPLY REV
447046154   S STRL RESUS BAG,INF.                    $689.00      $689.00   084050   LOS CENTRAL SUPPLY REV
447046009   S STRL SET INF PORT 20G                   $93.00       $93.00   084050   LOS CENTRAL SUPPLY REV
447046008   S STRL SET INF PORT 22G                   $93.00       $93.00   084050   LOS CENTRAL SUPPLY REV
447076542   S STRL SOLOSITE WOUND GEL                $353.00      $353.00   084050   LOS CENTRAL SUPPLY REV
44706621    S STRL SPINAL 18X3.5                      $52.00       $52.00   084050   LOS CENTRAL SUPPLY REV
44706650    S STRL SPINAL 25X1-1/2                   $229.97      $229.97   084050   LOS CENTRAL SUPPLY REV
447046021   S STRL ST BLOOD/FLUID WMR                $283.35      $283.35   084050   LOS CENTRAL SUPPLY REV
44706657    S STRL STAT-PADZ                         $821.11      $821.11   084050   LOS CENTRAL SUPPLY REV
447076522   S STRL STMHSV WAFER                      $120.00      $120.00   084050   LOS CENTRAL SUPPLY REV
44706642    S STRL STOMCH TBE LEV12                    $2.16        $2.16   084050   LOS CENTRAL SUPPLY REV
44706643    S STRL STOMCH TBE LEV14                   $64.31       $64.31   084050   LOS CENTRAL SUPPLY REV
447045739   S STRL SUCTION TRACH CARE                $258.00      $258.00   084050   LOS CENTRAL SUPPLY REV
44706637    S STRL SURG BLADE 10                      $13.00       $13.00   084050   LOS CENTRAL SUPPLY REV
44706622    S STRL SURG BLADE 11                      $13.00       $13.00   084050   LOS CENTRAL SUPPLY REV
44706623    S STRL SURG BLADE 12                      $13.37       $13.37   084050   LOS CENTRAL SUPPLY REV
44706624    S STRL SURG BLADE 15                      $13.00       $13.00   084050   LOS CENTRAL SUPPLY REV
44706625    S STRL SURG BLADE 20                      $13.37       $13.37   084050   LOS CENTRAL SUPPLY REV
44706565    S STRL SURGICEL 4X8                      $290.00      $290.00   084050   LOS CENTRAL SUPPLY REV
447045327   S STRL SUTURE #1 TO 4.0                   $58.00       $58.00   084050   LOS CENTRAL SUPPLY REV
44706636    S STRL SUTURE REMOVAL                    $136.00      $136.00   084050   LOS CENTRAL SUPPLY REV
447076554   S STRL SUTURE TRAY                       $374.00      $374.00   084050   LOS CENTRAL SUPPLY REV
44706601    S STRL SWANGANZ CATH 7 FR              $1,183.30    $1,183.30   084050   LOS CENTRAL SUPPLY REV
44706673    S STRL TEGA 3.1X5.6                      $110.61      $110.61   084050   LOS CENTRAL SUPPLY REV
44706672    S STRL TEGA 4.5X6.8                      $174.92      $174.92   084050   LOS CENTRAL SUPPLY REV
44706668    S STRL TEGAGEN 4X4                       $132.73      $132.73   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                     8
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44706682    S STRL TEGAPAD 3584                      $25.20       $25.20   084050   LOS CENTRAL SUPPLY REV
44706683    S STRL TEGAPAD 3588                      $88.49       $88.49   084050   LOS CENTRAL SUPPLY REV
44706615    S STRL TEGASORB 51/2X63/4               $483.00      $483.00   084050   LOS CENTRAL SUPPLY REV
44706681    S STRL TEGPAD 3587                       $37.04       $37.04   084050   LOS CENTRAL SUPPLY REV
44706568    S STRL TOOMEY SYRINGE                    $55.00       $55.00   084050   LOS CENTRAL SUPPLY REV
44706639    S STRL TRACH SUCT 14FR                   $70.48       $70.48   084050   LOS CENTRAL SUPPLY REV
447076546   S STRL TRACH TUBE 10.0                  $973.11      $973.11   084050   LOS CENTRAL SUPPLY REV
447045322   S STRL TRACH TUBE 4                      $62.70       $62.70   084050   LOS CENTRAL SUPPLY REV
447076543   S STRL TRACH TUBE 6.0                   $973.11      $973.11   084050   LOS CENTRAL SUPPLY REV
447076544   S STRL TRACH TUBE 8.0                   $973.11      $973.11   084050   LOS CENTRAL SUPPLY REV
447076545   S STRL TRACH TUBE 9.0                   $973.11      $973.11   084050   LOS CENTRAL SUPPLY REV
447045829   S STRL TRAY BONE MARROW                 $723.25      $723.25   084050   LOS CENTRAL SUPPLY REV
447045593   S STRL TRAY CATH & BAG 16               $130.00      $130.00   084050   LOS CENTRAL SUPPLY REV
447045772   S STRL TRAY CATH & BAG 18               $130.00      $130.00   084050   LOS CENTRAL SUPPLY REV
447045837   S STRL TRAY CATH URETHRAL                $34.00       $34.00   084050   LOS CENTRAL SUPPLY REV
447045855   S STRL TRAY LP ADULT                    $411.00      $411.00   084050   LOS CENTRAL SUPPLY REV
447045851   S STRL TRAY LP NEONATAL                 $151.00      $151.00   084050   LOS CENTRAL SUPPLY REV
447045168   S STRL TRAY PARA CERVICAL               $285.05      $285.05   084050   LOS CENTRAL SUPPLY REV
447045863   S STRL TRAY THORACENTESIS               $288.00      $288.00   084050   LOS CENTRAL SUPPLY REV
44706572    S STRL TROCAR CATH 24FR                 $660.00      $660.00   084050   LOS CENTRAL SUPPLY REV
447045860   S STRL TUBE E.T.3.0 BOO                  $58.00       $58.00   084050   LOS CENTRAL SUPPLY REV
447045862   S STRL TUBE E.T.3.5 BOO                  $58.00       $58.00   084050   LOS CENTRAL SUPPLY REV
447045957   S STRL TUBE ET 2.0                       $45.00       $45.00   084050   LOS CENTRAL SUPPLY REV
447045801   S STRL TUBE ET 2.5 BHC                   $39.00       $39.00   084050   LOS CENTRAL SUPPLY REV
447045648   S STRL TUBE ET 4.0                      $103.00      $103.00   084050   LOS CENTRAL SUPPLY REV
447045868   S STRL TUBE ET 4.5                       $27.00       $27.00   084050   LOS CENTRAL SUPPLY REV
447045869   S STRL TUBE ET 5.0                      $114.00      $114.00   084050   LOS CENTRAL SUPPLY REV
447045870   S STRL TUBE ET 5.5                      $114.00      $114.00   084050   LOS CENTRAL SUPPLY REV
447045066   S STRL TUBE FEED 8                       $10.00       $10.00   084050   LOS CENTRAL SUPPLY REV
447045736   S STRL TUBE FEEDING 5 FR                 $16.00       $16.00   084050   LOS CENTRAL SUPPLY REV
447045349   S STRL TUBE LAVAGE/EVACS                $187.00      $187.00   084050   LOS CENTRAL SUPPLY REV
447045014   S STRL TUBE STOMACH #32F                $162.00      $162.00   084050   LOS CENTRAL SUPPLY REV
447045967   S STRL TUBING GOULD ALINE               $261.00      $261.00   084050   LOS CENTRAL SUPPLY REV
44706599    S STRL UMBILICAL CATH 3F                $580.84      $580.84   084050   LOS CENTRAL SUPPLY REV
44706600    S STRL UMBILICAL CATH 5FR               $580.84      $580.84   084050   LOS CENTRAL SUPPLY REV
447046151   S STRL UNIHEART NEBULIZER               $300.00      $300.00   084050   LOS CENTRAL SUPPLY REV


7/11/2012                                                                                                    9
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


447076507   S STRL VACGEL CANISTR SET                $822.00      $822.00   084050   LOS CENTRAL SUPPLY REV
447076462   S STRL VENOUS CATH TRILUM              $1,359.00    $1,359.00   084050   LOS CENTRAL SUPPLY REV
447046136   S STRL VENT CIR                          $356.00      $356.00   084050   LOS CENTRAL SUPPLY REV
44706638    S STRL XEROFOAM 5X9                       $35.00       $35.00   084050   LOS CENTRAL SUPPLY REV
44706571    S STRL XEROFORM DRSG                      $23.00       $23.00   084050   LOS CENTRAL SUPPLY REV
447076547   S STRL X-L TRACH TUBE 7.0              $3,372.47    $3,372.47   084050   LOS CENTRAL SUPPLY REV
44706633    S STRL YANKAUER                           $21.00       $21.00   084050   LOS CENTRAL SUPPLY REV
450055610   1 TOUCH TEST STRIP & PROC                 $48.00       $48.00   084060   LOS CLINICAL LABORATORY REV
525465      17 OH PROGESTRONE                         $20.35       $20.35   084060   LOS CLINICAL LABORATORY REV
5251007     5 HIAA UR                                 $15.60       $15.60   084060   LOS CLINICAL LABORATORY REV
5251768     5 NUCLEOTIDASE                            $66.21       $66.21   084060   LOS CLINICAL LABORATORY REV
5250195     AB ID                                     $64.00       $64.00   084060   LOS CLINICAL LABORATORY REV
450050162   AB SCRN                                  $293.00      $293.00   084060   LOS CLINICAL LABORATORY REV
450050166   ABO TYP                                   $77.00       $77.00   084060   LOS CLINICAL LABORATORY REV
5251780     ACE (ANGIOTN CONVR ENZ)                   $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
450050168   ACETAMINOPHEN                            $497.00      $497.00   084060   LOS CLINICAL LABORATORY REV
5251873     ACETYLCHOLINE RECEPT AB                   $45.00       $45.00   084060   LOS CLINICAL LABORATORY REV
5251760     ACTH                                      $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5252380     ADENOVIRUS AB                             $22.00       $22.00   084060   LOS CLINICAL LABORATORY REV
5250234     ADRENAL AB SCRN                           $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5250181     ADRENAL AB TTR                            $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5251798     AFB CULT                                  $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
5250226     AFB ISOLATE ID                           $113.00      $113.00   084060   LOS CLINICAL LABORATORY REV
5251012     AFP TUMOR MARKER                          $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
525478      AG DETECT EIA MULT STEP                  $375.22      $375.22   084060   LOS CLINICAL LABORATORY REV
525476      AG DETECT EIA MULT STEP                   $24.00       $24.00   084060   LOS CLINICAL LABORATORY REV
450056001   AG SCRN PER UNIT PT SPEC                  $88.24       $88.24   084060   LOS CLINICAL LABORATORY REV
5250194     AG SCRN PER UNIT PT SPEC                  $40.00       $40.00   084060   LOS CLINICAL LABORATORY REV
450050019   ALBUMIN                                  $121.00      $121.00   084060   LOS CLINICAL LABORATORY REV
450050359   ALCOHOL (ETHANOL)                        $268.00      $268.00   084060   LOS CLINICAL LABORATORY REV
450050800   ALCOHOL BREATH                            $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
5251751     ALDOLASE                                   $8.50        $8.50   084060   LOS CLINICAL LABORATORY REV
5250971     ALDOSTERONE                               $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
5250233     ALK PHOS ISOENZYMES                       $17.00       $17.00   084060   LOS CLINICAL LABORATORY REV
5250232     ALK PHOSPHATASE                            $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
450050021   ALK PHOSPHATASE                          $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                          10
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5251014     ALPHA 1 ANTITRYPSIN                     $13.25       $13.25   084060   LOS CLINICAL LABORATORY REV
450050116   ALT (SGPT)                             $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5252209     AMINO ACIDS PLAS >5 QN                  $96.50       $96.50   084060   LOS CLINICAL LABORATORY REV
5252203     AMINO ACIDS SGL QN                      $97.00       $97.00   084060   LOS CLINICAL LABORATORY REV
5252067     AMITRIPTYLINE                           $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV
450050022   AMMONIA                                $357.00      $357.00   084060   LOS CLINICAL LABORATORY REV
5250810     AMPHETAMINE CONF                        $37.00       $37.00   084060   LOS CLINICAL LABORATORY REV
450050024   AMYLASE                                $449.00      $449.00   084060   LOS CLINICAL LABORATORY REV
450050496   AMYLASE UR 2HR                         $182.00      $182.00   084060   LOS CLINICAL LABORATORY REV
450050494   AMYLASE UR RAN                         $248.00      $248.00   084060   LOS CLINICAL LABORATORY REV
450050495   AMYLASE UR TIM                         $182.00      $182.00   084060   LOS CLINICAL LABORATORY REV
5250242     ANA (ANTI NUCLEAR AB)                  $345.00      $345.00   084060   LOS CLINICAL LABORATORY REV
5250957     ANA (ANTI NUCLEAR AB)                    $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5250243     ANA TTR                                 $45.00       $45.00   084060   LOS CLINICAL LABORATORY REV
5259219     ANA TTR                                  $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5250186     ANTI DNA DBL STRAND                     $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
5250371     ANTI-NEUTRO CYTOPLAS AB                  $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5250026     APOLIPOPROTEIN A1                       $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
5250210     ARSENIC BLD                             $19.00       $19.00   084060   LOS CLINICAL LABORATORY REV
5251875     ASCORBIC ACID                           $14.00       $14.00   084060   LOS CLINICAL LABORATORY REV
450050164   ASO SCRN                               $144.00      $144.00   084060   LOS CLINICAL LABORATORY REV
450050115   AST (SGOT)                             $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5251761     AT3 ACTIVITY                            $19.00       $19.00   084060   LOS CLINICAL LABORATORY REV
525438      B HENSELAE IGG TIT                      $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
525420      B HENSELAE IGG TIT                       $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525424      B HENSELAE IGM TIT                       $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
5250904     B PERTUSSIS/PARAPERT DFA                $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
525439      B QUINTANA IGG AB                        $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525421      B QUINTANA IGG AB                        $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525422      B QUINTANA IGG TIT                       $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525443      B QUINTANA IGM AB                        $6.01        $6.01   084060   LOS CLINICAL LABORATORY REV
525425      B QUINTANA IGM AB                        $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525426      B QUINTANA IGM TIT                       $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
5250146     BACTERIAL AG EA AG                       $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5250102     BACTERIAL AG EA AG                      $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV
5250161     BACTERIAL AG EA AG                       $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        11
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250160     BACTERIAL AG EA AG                      $116.00      $116.00   084060   LOS CLINICAL LABORATORY REV
5250159     BACTERIAL AG EA AG                      $116.00      $116.00   084060   LOS CLINICAL LABORATORY REV
5250157     BACTERIAL AG EA AG                      $116.00      $116.00   084060   LOS CLINICAL LABORATORY REV
5250156     BACTERIAL AG EA AG                      $116.00      $116.00   084060   LOS CLINICAL LABORATORY REV
5250815     BARBITURATES CONF                        $44.10       $44.10   084060   LOS CLINICAL LABORATORY REV
525437      BARTONELLA AB IGG                         $6.01        $6.01   084060   LOS CLINICAL LABORATORY REV
525416      BARTONELLA AB IGG                         $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
525441      BARTONELLA AB IGM                         $6.01        $6.01   084060   LOS CLINICAL LABORATORY REV
525423      BARTONELLA AB IGM                         $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
5259096     BARTONELLA AMP PRB                       $24.07       $24.07   084060   LOS CLINICAL LABORATORY REV
450050274   BASIC METABOLIC PNL                     $210.00      $210.00   084060   LOS CLINICAL LABORATORY REV
5252175     BENZODIAZEPINES                          $64.70       $64.70   084060   LOS CLINICAL LABORATORY REV
5250840     BENZODIZEPINE CONF                       $40.30       $40.30   084060   LOS CLINICAL LABORATORY REV
450050987   BETA HCG QL                             $167.00      $167.00   084060   LOS CLINICAL LABORATORY REV
450055503   BETA HCG QN                             $370.00      $370.00   084060   LOS CLINICAL LABORATORY REV
5259194     BETA HCG QN                             $379.00      $379.00   084060   LOS CLINICAL LABORATORY REV
5252409     BETA2 MICROGLOBULIN                      $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
450050029   BILIRUBIN DIRECT                        $121.00      $121.00   084060   LOS CLINICAL LABORATORY REV
450050028   BILIRUBIN TOTAL                         $121.00      $121.00   084060   LOS CLINICAL LABORATORY REV
5250217     BLD CNT RBC AUTO                          $2.00        $2.00   084060   LOS CLINICAL LABORATORY REV
450050507   BLD SMR EXAM W MAN DIFF                  $83.00       $83.00   084060   LOS CLINICAL LABORATORY REV
450050130   BLEEDING TIME TEST                      $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
525487      BODY FLUID PH NOT BLOOD                 $125.00      $125.00   084060   LOS CLINICAL LABORATORY REV
525451      BORDETELLA AB                            $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5250165     BRUCELLA AB                              $21.00       $21.00   084060   LOS CLINICAL LABORATORY REV
450056007   B-TYP NATRIURETIC PEPTIDE               $835.00      $835.00   084060   LOS CLINICAL LABORATORY REV
450050118   BUN                                      $96.00       $96.00   084060   LOS CLINICAL LABORATORY REV
5251825     C DIFFICILE TOXIN EIA                    $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5251859     C DIFFICILE TOXIN EIA                    $63.00       $63.00   084060   LOS CLINICAL LABORATORY REV
5252033     C PEPTIDE                                $16.00       $16.00   084060   LOS CLINICAL LABORATORY REV
5250485     C REACTIVE PROTEIN                       $44.00       $44.00   084060   LOS CLINICAL LABORATORY REV
450056006   C REACTIVE PROTEIN                      $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5252322     CA 125                                   $15.25       $15.25   084060   LOS CLINICAL LABORATORY REV
5252326     CA 19 9                                  $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5259178     CALC ANALYSIS INFRARED                   $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5250178     CALCIUM                                   $5.11        $5.11   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         12
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


450050032   CALCIUM                                $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5251907     CALCIUM                                  $5.00        $5.00   084060   LOS CLINICAL LABORATORY REV
5251711     CALCIUM IONIZED                         $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
450050034   CALCIUM UR 24HR                        $150.00      $150.00   084060   LOS CLINICAL LABORATORY REV
450050033   CALCIUM UR RAN                         $119.82      $119.82   084060   LOS CLINICAL LABORATORY REV
450056008   CANDIDA DNA DIR PROBE                   $80.35       $80.35   084060   LOS CLINICAL LABORATORY REV
5250820     CANNABINOIDS CONF                       $37.00       $37.00   084060   LOS CLINICAL LABORATORY REV
450056000   CAPILLARY PUNCTURE                      $26.00       $26.00   084060   LOS CLINICAL LABORATORY REV
450050500   CARBAMAZEPINE TOTAL                    $357.00      $357.00   084060   LOS CLINICAL LABORATORY REV
525471      CARDIOLIPIN AB                          $26.13       $26.13   084060   LOS CLINICAL LABORATORY REV
5252154     CARDIOLIPIN IGG AB                      $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5252155     CARDIOLIPIN IGM AB                      $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5252375     CARNITINE FREE & TOTAL                  $31.00       $31.00   084060   LOS CLINICAL LABORATORY REV
5250090     CAROTENE                                $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
525427      CATECHOL FRAC UR                        $28.00       $28.00   084060   LOS CLINICAL LABORATORY REV
5251869     CATECHOLAMINES PLAS                     $28.00       $28.00   084060   LOS CLINICAL LABORATORY REV
450050509   CBC AUTO                               $167.27      $167.27   084060   LOS CLINICAL LABORATORY REV
450050506   CBC AUTO                               $159.00      $159.00   084060   LOS CLINICAL LABORATORY REV
5250926     CBC AUTO W AUTO DIFF WBC                $34.71       $34.71   084060   LOS CLINICAL LABORATORY REV
450050131   CBC AUTO W AUTO DIFF WBC               $191.00      $191.00   084060   LOS CLINICAL LABORATORY REV
5251021     CEA                                    $247.00      $247.00   084060   LOS CLINICAL LABORATORY REV
450050221   CELL CNT FLD W/ DIFF                   $134.00      $134.00   084060   LOS CLINICAL LABORATORY REV
5250966     CERULOPLASMIN                           $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
525010      CHLAMYDIA AB                            $14.00       $14.00   084060   LOS CLINICAL LABORATORY REV
525449      CHLAMYDIA AB IGG                        $25.50       $25.50   084060   LOS CLINICAL LABORATORY REV
525006      CHLAMYDIA AB IGM                        $14.00       $14.00   084060   LOS CLINICAL LABORATORY REV
525003      CHLAMYDIA AB IGM                        $24.99       $24.99   084060   LOS CLINICAL LABORATORY REV
525008      CHLAMYDIA PNEUMO AB                     $14.00       $14.00   084060   LOS CLINICAL LABORATORY REV
525007      CHLAMYDIA SPEC AB IGG EX                 $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
525002      CHLAMYDIA SPECIES AB EX                  $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
525004      CHLAMYDIA TRACH AB                      $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
525490      CHLAMYDIA TRACH AMP PRB                $195.29      $195.29   084060   LOS CLINICAL LABORATORY REV
5252399     CHLAMYDIA TRACH DIR PRB                $504.00      $504.00   084060   LOS CLINICAL LABORATORY REV
450050036   CHLORIDE                               $115.00      $115.00   084060   LOS CLINICAL LABORATORY REV
450050038   CHOLESTEROL                            $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
5259104     CHOLINESTERASE RBC                      $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        13
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5259110     CHOLINESTERASE SER                      $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
5250260     CHRMOSOM CNT/KARY                      $375.00      $375.00   084060   LOS CLINICAL LABORATORY REV
5259108     CITRATE UR 24HR                         $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
450050308   CK MB FRACTION                         $287.00      $287.00   084060   LOS CLINICAL LABORATORY REV
450050040   CK TOTAL                               $159.00      $159.00   084060   LOS CLINICAL LABORATORY REV
5250024     CLOZAPINE                               $36.00       $36.00   084060   LOS CLINICAL LABORATORY REV
525434      CMV AB IGG                              $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
525435      CMV AB IGM                              $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
525417      CMV AMP PRB                             $87.50       $87.50   084060   LOS CLINICAL LABORATORY REV
525418      CMV DNA QN                             $109.00      $109.00   084060   LOS CLINICAL LABORATORY REV
450050049   CO2 (BICARBONATE)                       $94.00       $94.00   084060   LOS CLINICAL LABORATORY REV
5250825     COCAINE CONF                            $42.30       $42.30   084060   LOS CLINICAL LABORATORY REV
5251763     COCCIDIOIDES AB                         $45.00       $45.00   084060   LOS CLINICAL LABORATORY REV
525484      COCCIDIOIDES AB                         $22.50       $22.50   084060   LOS CLINICAL LABORATORY REV
450050462   COLD AGGLUTININ TTR                    $198.00      $198.00   084060   LOS CLINICAL LABORATORY REV
450050992   COMPATIBILITY TEST AHG                 $370.00      $370.00   084060   LOS CLINICAL LABORATORY REV
450050991   COMPATIBILITY TEST INCUB               $370.00      $370.00   084060   LOS CLINICAL LABORATORY REV
450050990   COMPATIBILITY TEST IS                  $440.00      $440.00   084060   LOS CLINICAL LABORATORY REV
5251767     COMPLEMENT C3                            $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5251854     COMPLEMENT C4                            $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5252207     COMPLEMENT TOT (CH50)                   $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
450050151   COMPR MET PNL                          $261.00      $261.00   084060   LOS CLINICAL LABORATORY REV
450055999   COOMBS DIRECT C3                       $134.00      $134.00   084060   LOS CLINICAL LABORATORY REV
450050173   COOMBS DIRECT IG                       $134.00      $134.00   084060   LOS CLINICAL LABORATORY REV
450055998   COOMBS DIRECT POLY                     $134.00      $134.00   084060   LOS CLINICAL LABORATORY REV
5250092     COPPER                                  $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5250170     CORTISOL FREE UR                        $21.25       $21.25   084060   LOS CLINICAL LABORATORY REV
5251064     CORTISOL TOTAL                          $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
5250212     C-REACTIVE PROTEIN HS                   $12.11       $12.11   084060   LOS CLINICAL LABORATORY REV
450050041   CREATININE                             $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
450050043   CREATININE CLEARANCE                   $236.00      $236.00   084060   LOS CLINICAL LABORATORY REV
450050042   CREATININE FLD                         $131.00      $131.00   084060   LOS CLINICAL LABORATORY REV
450056004   CREATININE UR RAN                      $131.00      $131.00   084060   LOS CLINICAL LABORATORY REV
5250805     CRYPTO AG DFA                          $235.00      $235.00   084060   LOS CLINICAL LABORATORY REV
5250249     CRYPTOCOCCAL AG TTR AGGL                $63.90       $63.90   084060   LOS CLINICAL LABORATORY REV
5250800     CRYPTOSPORIDIUM                         $21.00       $21.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        14
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


450056003   CRYSTAL ID TISS/FLD NO UR               $281.00      $281.00   084060   LOS CLINICAL LABORATORY REV
5251784     CULT BACT AEROBIC ID                    $184.00      $184.00   084060   LOS CLINICAL LABORATORY REV
525460      CULT BACT AEROBIC ID                     $31.50       $31.50   084060   LOS CLINICAL LABORATORY REV
525455      CULT BACT AEROBIC ID                     $34.20       $34.20   084060   LOS CLINICAL LABORATORY REV
450050217   CULT BACT AEROBIC ID                    $203.00      $203.00   084060   LOS CLINICAL LABORATORY REV
525457      CULT BACT ANAEROBIC ID                   $40.00       $40.00   084060   LOS CLINICAL LABORATORY REV
450050216   CULT BACT ANAEROBIC ID                  $203.00      $203.00   084060   LOS CLINICAL LABORATORY REV
450050080   CULT BETA STREP A ONLY                  $170.00      $170.00   084060   LOS CLINICAL LABORATORY REV
450050203   CULT BLD BACTERIA                       $262.00      $262.00   084060   LOS CLINICAL LABORATORY REV
5250189     CULT C DIFFICILE                         $62.50       $62.50   084060   LOS CLINICAL LABORATORY REV
5250238     CULT C DIFFICILE SCRN                    $16.00       $16.00   084060   LOS CLINICAL LABORATORY REV
5250969     CULT FUNG SKIN HAIR NAIL                  $2.50        $2.50   084060   LOS CLINICAL LABORATORY REV
5250431     CULT FUNGUS BLD                          $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
5250167     CULT FUNGUS MOLD ID                      $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5250434     CULT FUNGUS OTHER SOURCE                 $50.00       $50.00   084060   LOS CLINICAL LABORATORY REV
5250432     CULT FUNGUS YEAST ID                     $79.00       $79.00   084060   LOS CLINICAL LABORATORY REV
450050398   CULT NOSE/THROAT                        $216.00      $216.00   084060   LOS CLINICAL LABORATORY REV
5251866     CULT QN ANAEROBIC                       $236.00      $236.00   084060   LOS CLINICAL LABORATORY REV
5250436     CULT SCRN B PERTUSSUS                   $130.00      $130.00   084060   LOS CLINICAL LABORATORY REV
5250262     CULT SCRN ONLY                           $16.00       $16.00   084060   LOS CLINICAL LABORATORY REV
450050205   CULT SPEC BACTERIA                      $216.00      $216.00   084060   LOS CLINICAL LABORATORY REV
5251952     CULT STL CAMPHYLOB EA PLT               $214.00      $214.00   084060   LOS CLINICAL LABORATORY REV
450050401   CULT STL CAMPHYLOB EA PLT                $32.00       $32.00   084060   LOS CLINICAL LABORATORY REV
5251953     CULT STL E COLI EA PLATE                $214.00      $214.00   084060   LOS CLINICAL LABORATORY REV
450050402   CULT STL E COLI EA PLATE                 $32.00       $32.00   084060   LOS CLINICAL LABORATORY REV
450050397   CULT STL SALM & SHIG                    $236.00      $236.00   084060   LOS CLINICAL LABORATORY REV
450050212   CULT TYP AGGL                           $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5250224     CULT TYP BY NA PRB                       $75.00       $75.00   084060   LOS CLINICAL LABORATORY REV
5250223     CULT TYP BY NA PRB                       $95.00       $95.00   084060   LOS CLINICAL LABORATORY REV
5250222     CULT TYP BY NA PRB                      $104.00      $104.00   084060   LOS CLINICAL LABORATORY REV
5250225     CULT TYP GLC METHOD                     $129.00      $129.00   084060   LOS CLINICAL LABORATORY REV
5250263     CULT TYP OTHER METHOD                    $24.00       $24.00   084060   LOS CLINICAL LABORATORY REV
5250227     CULT TYP OTHER METHOD                   $332.00      $332.00   084060   LOS CLINICAL LABORATORY REV
450050208   CULT UR ID EACH ISOLATE                 $203.00      $203.00   084060   LOS CLINICAL LABORATORY REV
5251917     CYCLOSPORINE                             $25.35       $25.35   084060   LOS CLINICAL LABORATORY REV
5252359     CYSTICERCUS AB                           $52.00       $52.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         15
                                      d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250261     CYTGNTC INTERP/RPRT                      $5.50        $5.50   084060   LOS CLINICAL LABORATORY REV
450050498   D DIMER QN                             $249.00      $249.00   084060   LOS CLINICAL LABORATORY REV
5252191     DESIPRAMINE                             $18.25       $18.25   084060   LOS CLINICAL LABORATORY REV
5251745     DHEA                                    $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5251785     DHEA SULFATE                            $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
450050119   DIGOXIN                                $325.00      $325.00   084060   LOS CLINICAL LABORATORY REV
450055502   DRG SCRN QL CHROM EA                   $357.00      $357.00   084060   LOS CLINICAL LABORATORY REV
5251888     DRG SCRN QL CHROM EA                    $57.85       $57.85   084060   LOS CLINICAL LABORATORY REV
450050031   DRG SCRN QL CHROM EA                   $357.00      $357.00   084060   LOS CLINICAL LABORATORY REV
5250100     E HISTOLYTICA GRP EIA                   $42.95       $42.95   084060   LOS CLINICAL LABORATORY REV
5251796     EBV AB EBNA                              $5.07        $5.07   084060   LOS CLINICAL LABORATORY REV
5251797     EBV VCA AB IGG                          $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
5251799     EBV VCA AB IGM                          $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
450050915   ELECTROLYTE PNL FLD                    $172.00      $172.00   084060   LOS CLINICAL LABORATORY REV
5250961     ENA AB                                  $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5251850     ERYTHROPOIETIN                          $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5251718     ESTRADIOL (E2)                         $304.00      $304.00   084060   LOS CLINICAL LABORATORY REV
5251891     ESTROGEN TOTAL                          $26.00       $26.00   084060   LOS CLINICAL LABORATORY REV
5259217     ETHYLENE GLYCOL                         $79.55       $79.55   084060   LOS CLINICAL LABORATORY REV
5250310     FAT STL QL                              $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV
525429      FAT STL QL                              $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV
5250230     FAT STL QN                              $44.80       $44.80   084060   LOS CLINICAL LABORATORY REV
525477      FCTR VIII                               $45.00       $45.00   084060   LOS CLINICAL LABORATORY REV
5259223     FCTR VIII VW AG                         $62.37       $62.37   084060   LOS CLINICAL LABORATORY REV
5259224     FCTR VIII VW MULTIMER                  $103.00      $103.00   084060   LOS CLINICAL LABORATORY REV
5250255     FCTR XII                                $49.00       $49.00   084060   LOS CLINICAL LABORATORY REV
5250256     FCTR XIII SCRN                         $102.60      $102.60   084060   LOS CLINICAL LABORATORY REV
5251918     FERRITIN                               $347.00      $347.00   084060   LOS CLINICAL LABORATORY REV
450056002   FETAL FIBRONECTIN                    $1,587.00    $1,587.00   084060   LOS CLINICAL LABORATORY REV
450050141   FIBRINOGEN                             $216.00      $216.00   084060   LOS CLINICAL LABORATORY REV
5250187     FLUOR AB SCRN EA AB TTR                 $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
5250704     FOLATE                                 $373.00      $373.00   084060   LOS CLINICAL LABORATORY REV
5250714     FOLATE RBC                              $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5252228     FREE T4                                $229.00      $229.00   084060   LOS CLINICAL LABORATORY REV
5250594     FRESNO COMMUNITY MED CENTER              $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5250596     FRESNO, CA. 93777-2309                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        16
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250258     FRUCTOSAMINE                             $10.25       $10.25   084060   LOS CLINICAL LABORATORY REV
5251071     FSH                                     $206.00      $206.00   084060   LOS CLINICAL LABORATORY REV
5251717     FTA ABS (TPPA)                            $9.00        $9.00   084060   LOS CLINICAL LABORATORY REV
5250184     G6PD QN                                  $14.00       $14.00   084060   LOS CLINICAL LABORATORY REV
525450      GABAPENTIN                               $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
450056009   GARDNER VAG DNA DIR PROBE                $80.35       $80.35   084060   LOS CLINICAL LABORATORY REV
525483      GBM AB                                   $42.00       $42.00   084060   LOS CLINICAL LABORATORY REV
525479      GC AMP PRB                              $196.16      $196.16   084060   LOS CLINICAL LABORATORY REV
5250531     GC DIR PRB                              $504.00      $504.00   084060   LOS CLINICAL LABORATORY REV
450050011   GENTAMICIN                              $402.00      $402.00   084060   LOS CLINICAL LABORATORY REV
450050156   GGT                                     $179.00      $179.00   084060   LOS CLINICAL LABORATORY REV
525482      GIARDIA AG EIA                           $21.25       $21.25   084060   LOS CLINICAL LABORATORY REV
450050109   GLUCOSE                                  $96.00       $96.00   084060   LOS CLINICAL LABORATORY REV
450050053   GLUCOSE 1HR PP                          $115.00      $115.00   084060   LOS CLINICAL LABORATORY REV
450055016   GLUCOSE 2HR PP                          $115.00      $115.00   084060   LOS CLINICAL LABORATORY REV
450050112   GLUCOSE CSF                              $96.00       $96.00   084060   LOS CLINICAL LABORATORY REV
5251755     GLUCOSE FLD                              $92.00       $92.00   084060   LOS CLINICAL LABORATORY REV
450050113   GLUCOSE FLD                              $96.00       $96.00   084060   LOS CLINICAL LABORATORY REV
5251005     GROWTH HORMONE                           $13.00       $13.00   084060   LOS CLINICAL LABORATORY REV
450050229   GRP TYPE & ANTIBODY EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450055992   GTT 1ST 3 SPEC INADDITION                $58.79       $58.79   084060   LOS CLINICAL LABORATORY REV
450050058   GTT 2HR 1ST 3 SPEC                      $319.00      $319.00   084060   LOS CLINICAL LABORATORY REV
450050065   GTT 3HR 1ST 3 SPEC                      $319.00      $319.00   084060   LOS CLINICAL LABORATORY REV
450050066   GTT 4HR 1ST 3 SPEC                      $250.00      $250.00   084060   LOS CLINICAL LABORATORY REV
450050126   GTT ADDED SAMPLE                         $44.75       $44.75   084060   LOS CLINICAL LABORATORY REV
450050125   GTT ADDED SAMPLE                         $44.75       $44.75   084060   LOS CLINICAL LABORATORY REV
450050124   GTT ADDED SAMPLE                         $44.75       $44.75   084060   LOS CLINICAL LABORATORY REV
450050123   GTT ADDED SAMPLE                         $44.75       $44.75   084060   LOS CLINICAL LABORATORY REV
450050068   GTT ADDED SAMPLE                         $78.00       $78.00   084060   LOS CLINICAL LABORATORY REV
450050067   GTT ADDED SAMPLE                         $78.00       $78.00   084060   LOS CLINICAL LABORATORY REV
5259144     H PYLORI AB IGA                          $17.00       $17.00   084060   LOS CLINICAL LABORATORY REV
5259133     H PYLORI AB IGG                          $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
5259134     H PYLORI AB IGM                          $21.00       $21.00   084060   LOS CLINICAL LABORATORY REV
450050396   H PYLORI AB TOTAL                       $357.00      $357.00   084060   LOS CLINICAL LABORATORY REV
5250098     H PYLORI STL EIA                         $53.00       $53.00   084060   LOS CLINICAL LABORATORY REV
5251067     HAPTOGLOBIN QN                           $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         17
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5252043     HAV AB IGM                               $281.00      $281.00   084060   LOS CLINICAL LABORATORY REV
5250910     HAV AB TOTAL                             $314.00      $314.00   084060   LOS CLINICAL LABORATORY REV
5252044     HB CORE AB IGM                           $294.00      $294.00   084060   LOS CLINICAL LABORATORY REV
5250265     HB CORE AB TOTAL                         $307.00      $307.00   084060   LOS CLINICAL LABORATORY REV
5250267     HBS AB                                   $268.00      $268.00   084060   LOS CLINICAL LABORATORY REV
450050600   HBS AG                                   $236.00      $236.00   084060   LOS CLINICAL LABORATORY REV
450050137   HCT & HGB EX                               $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251824     HCV AB                                   $146.53      $146.53   084060   LOS CLINICAL LABORATORY REV
5252321     HCV AB                                    $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
450055988   HDL CHOLESTEROL                          $204.00      $204.00   084060   LOS CLINICAL LABORATORY REV
5251753     HEAVY METAL SCRN UR                       $82.00       $82.00   084060   LOS CLINICAL LABORATORY REV
450050136   HEMATOCRIT                                $57.00       $57.00   084060   LOS CLINICAL LABORATORY REV
5250219     HEMATOCRIT                                 $2.00        $2.00   084060   LOS CLINICAL LABORATORY REV
450050135   HEMOGLOBIN                                $57.00       $57.00   084060   LOS CLINICAL LABORATORY REV
5250218     HEMOGLOBIN                                 $2.00        $2.00   084060   LOS CLINICAL LABORATORY REV
5250220     HEMOGLOBIN FRACTION QN                    $40.00       $40.00   084060   LOS CLINICAL LABORATORY REV
525463      HEMOGLOBIN FRACTION QN                    $20.35       $20.35   084060   LOS CLINICAL LABORATORY REV
5251966     HEMOGLOBIN GLYCOSYLTD A1C                $242.00      $242.00   084060   LOS CLINICAL LABORATORY REV
5252051     HEP C VIRAL RNA GENOT EX                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
525410      HEP C VIRAL RNA GENOTYPE                 $145.00      $145.00   084060   LOS CLINICAL LABORATORY REV
5250250     HEP C VIRUS PCR QN                        $92.86       $92.86   084060   LOS CLINICAL LABORATORY REV
450050056   HEPATIC FUNCTION PNL                     $209.00      $209.00   084060   LOS CLINICAL LABORATORY REV
450050007   HEPATITIS PNL ACUTE                    $1,276.00    $1,276.00   084060   LOS CLINICAL LABORATORY REV
5251967     HERP SIMP AB IGG 1&2 EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251894     HERP SIMP AB IGM 1&2 EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251845     HERPES SIMP TYPE 1&2 EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251807     HERPES SIMPLEX AB EX                       $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5252404     HISTO CAPSULATUM AG EIA                   $40.50       $40.50   084060   LOS CLINICAL LABORATORY REV
450056013   HIV 1 AB                                  $56.00       $56.00   084060   LOS CLINICAL LABORATORY REV
5250246     HIV 1 AB                                 $222.00      $222.00   084060   LOS CLINICAL LABORATORY REV
5250104     HIV 1 QN PCR ULTRA                        $99.00       $99.00   084060   LOS CLINICAL LABORATORY REV
5259114     HIV 1/HIV 2 AB                             $9.00        $9.00   084060   LOS CLINICAL LABORATORY REV
525481      HIV 1/HIV 2 AB                           $259.00      $259.00   084060   LOS CLINICAL LABORATORY REV
5259151     HIV 2 AMP PRB                             $53.05       $53.05   084060   LOS CLINICAL LABORATORY REV
525470      HIV AB CONF WESTERN BLOT                  $55.00       $55.00   084060   LOS CLINICAL LABORATORY REV
5259122     HIV AB CONF WESTERN BLOT                  $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                          18
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250982     HLA B27                                 $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5259204     HOMOCYSTINE                             $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5251811     HSV 1 AB IGG                            $14.25       $14.25   084060   LOS CLINICAL LABORATORY REV
5251813     HSV 2 AB IGG                            $14.25       $14.25   084060   LOS CLINICAL LABORATORY REV
5251814     HSV 2 AB IGM                            $17.10       $17.10   084060   LOS CLINICAL LABORATORY REV
5250215     HSV AB                                  $17.10       $17.10   084060   LOS CLINICAL LABORATORY REV
5251045     IGA                                      $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5250707     IGE                                      $6.25        $6.25   084060   LOS CLINICAL LABORATORY REV
5251922     IGE                                      $6.25        $6.25   084060   LOS CLINICAL LABORATORY REV
5250094     IGG                                      $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5251046     IGG                                      $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5251047     IGM                                      $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5252161     IMIPRAMINE                              $22.00       $22.00   084060   LOS CLINICAL LABORATORY REV
5250168     IMMUNOASSAY ANALYTE QN                  $45.31       $45.31   084060   LOS CLINICAL LABORATORY REV
525413      IMMUNOASSAY NONINFECT                   $29.14       $29.14   084060   LOS CLINICAL LABORATORY REV
525412      IMMUNOASSAY NONINFECT                   $38.15       $38.15   084060   LOS CLINICAL LABORATORY REV
525411      IMMUNOASSAY NONINFECT                   $38.15       $38.15   084060   LOS CLINICAL LABORATORY REV
5250713     IMMUNOASSAY NOT SPEC                    $32.00       $32.00   084060   LOS CLINICAL LABORATORY REV
5250712     IMMUNOASSAY NOT SPEC                    $31.98       $31.98   084060   LOS CLINICAL LABORATORY REV
5250711     IMMUNOASSAY NOT SPEC                    $31.98       $31.98   084060   LOS CLINICAL LABORATORY REV
5250710     IMMUNOASSAY NOT SPEC                    $31.98       $31.98   084060   LOS CLINICAL LABORATORY REV
5250709     IMMUNOASSAY NOT SPEC                    $31.98       $31.98   084060   LOS CLINICAL LABORATORY REV
5250708     IMMUNOASSAY NOT SPEC                    $31.98       $31.98   084060   LOS CLINICAL LABORATORY REV
5250962     IMMUNOELECTRO;SERUM EX                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
525452      IMMUNOFIX SER                           $39.00       $39.00   084060   LOS CLINICAL LABORATORY REV
5250347     IMMUNOFIX UR                            $30.25       $30.25   084060   LOS CLINICAL LABORATORY REV
525414      INDIA INK PREP CSF                     $102.00      $102.00   084060   LOS CLINICAL LABORATORY REV
450055995   INFLUENZA AG A OR B EACH               $181.40      $181.40   084060   LOS CLINICAL LABORATORY REV
450056011   INFLUENZA ASSAY W/OPTIC                $293.00      $293.00   084060   LOS CLINICAL LABORATORY REV
5252094     INSULIN                                 $10.50       $10.50   084060   LOS CLINICAL LABORATORY REV
5252202     INSULIN ANTIBODIES                      $70.00       $70.00   084060   LOS CLINICAL LABORATORY REV
5250385     IRON                                   $164.00      $164.00   084060   LOS CLINICAL LABORATORY REV
5250386     IRON BINDING CAPACITY                  $222.00      $222.00   084060   LOS CLINICAL LABORATORY REV
525468      KAPPA CHAIN                             $60.00       $60.00   084060   LOS CLINICAL LABORATORY REV
450050005   KETONES QL                             $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
450056012   KETONES QN                             $204.00      $204.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        19
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


450050989   LAB CROSSMATCH EACH ADDL                 $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251000     LACTIC ACID                            $188.00      $188.00   084060   LOS CLINICAL LABORATORY REV
525469      LAMBDA CHAIN                            $60.00       $60.00   084060   LOS CLINICAL LABORATORY REV
5252024     LAMICTAL                                $29.26       $29.26   084060   LOS CLINICAL LABORATORY REV
525419      LAMOTRIGINE                             $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
450050091   LDH                                      $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
450050090   LDH                                    $147.00      $147.00   084060   LOS CLINICAL LABORATORY REV
450050088   LDH ISOENZYMES                           $9.00        $9.00   084060   LOS CLINICAL LABORATORY REV
5251709     LEAD BLD                                 $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5252197     LEGIONELLA AB IGG                       $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
5252201     LEGIONELLA AB IGM                       $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5250415     LH                                     $188.00      $188.00   084060   LOS CLINICAL LABORATORY REV
5251899     LIDOCAINE                               $19.25       $19.25   084060   LOS CLINICAL LABORATORY REV
5259105     LIPASE                                 $154.00      $154.00   084060   LOS CLINICAL LABORATORY REV
5250096     LIPASE                                   $8.50        $8.50   084060   LOS CLINICAL LABORATORY REV
450056005   LIPASE                                 $172.00      $172.00   084060   LOS CLINICAL LABORATORY REV
450050076   LIPID PNL                              $523.00      $523.00   084060   LOS CLINICAL LABORATORY REV
450055604   LITHIUM                                $170.00      $170.00   084060   LOS CLINICAL LABORATORY REV
5252025     LUPUS TYPE ANTICOAG EX                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5252264     LYME DISEASE AB IGG                     $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5252275     LYME DISEASE AB IGM                     $23.00       $23.00   084060   LOS CLINICAL LABORATORY REV
5252265     LYME DISEASE IGG,IGM EX                  $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5252233     LYME DISEASE PANEL EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050269   MAGNESIUM                              $166.00      $166.00   084060   LOS CLINICAL LABORATORY REV
5250183     MARIJUANA CONF                          $37.00       $37.00   084060   LOS CLINICAL LABORATORY REV
525466      MASS SPECT/TANDEM QN NES                $20.35       $20.35   084060   LOS CLINICAL LABORATORY REV
5250211     MERCURY                                 $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5251069     METANEPHRINES UR                        $28.00       $28.00   084060   LOS CLINICAL LABORATORY REV
5250248     METHYLMALONIC ACID QN                   $31.49       $31.49   084060   LOS CLINICAL LABORATORY REV
5250593     MHLB NEWBORN SCREENING                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450055997   MICROALBUMIN UR 24HR                   $135.00      $135.00   084060   LOS CLINICAL LABORATORY REV
5252360     MICROALBUMIN UR 24HR                   $115.00      $115.00   084060   LOS CLINICAL LABORATORY REV
450055996   MICROALBUMIN UR RAN                    $144.00      $144.00   084060   LOS CLINICAL LABORATORY REV
450050999   MISC LAB PROC                           $16.00       $16.00   084060   LOS CLINICAL LABORATORY REV
5250931     MITOCHONDRIAL AB SCRN                   $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
525472      MITOCHONDRIAL AB TTR                    $11.50       $11.50   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        20
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250231     MOL DX AMP NA MLTIP EA SQ                $86.00       $86.00   084060   LOS CLINICAL LABORATORY REV
5250273     MOL DX AMP PT N ACD EA SQ                $50.00       $50.00   084060   LOS CLINICAL LABORATORY REV
5250228     MOL DX EXTRACTION HI PUR                 $36.00       $36.00   084060   LOS CLINICAL LABORATORY REV
450050176   MONO TEST SCRN                          $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5250247     MUMPS AB IGG                             $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
5250221     MUMPS AB IGM                             $17.00       $17.00   084060   LOS CLINICAL LABORATORY REV
5252262     MURAMIDASE                               $41.54       $41.54   084060   LOS CLINICAL LABORATORY REV
5251831     MYCOPLAS AB                              $57.10       $57.10   084060   LOS CLINICAL LABORATORY REV
5250175     MYCOPLAS AB IGG                          $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5250176     MYCOPLAS AB IGM                          $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5251835     MYCOPLAS CULT                            $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
5250373     MYELOPEROXIDASE AB                       $16.62       $16.62   084060   LOS CLINICAL LABORATORY REV
450050074   MYOGLOBIN                               $185.77      $185.77   084060   LOS CLINICAL LABORATORY REV
525428      MYOGLOBIN                                $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
450050497   NATRIURETIC PEPTIDE                     $340.00      $340.00   084060   LOS CLINICAL LABORATORY REV
525462      NB GENETIC SCR GALACT                    $20.35       $20.35   084060   LOS CLINICAL LABORATORY REV
5252408     NEWBORN SCRN PANEL                       $94.75       $94.75   084060   LOS CLINICAL LABORATORY REV
5252206     NORTRIPTYLINE                            $16.40       $16.40   084060   LOS CLINICAL LABORATORY REV
450050030   OCCLT BLD STL QL MULT SPC                $83.00       $83.00   084060   LOS CLINICAL LABORATORY REV
450055611   OCLT BLD STL SCN MULT SPC                $55.90       $55.90   084060   LOS CLINICAL LABORATORY REV
5250830     OPIATES CONF                             $43.30       $43.30   084060   LOS CLINICAL LABORATORY REV
5250325     OSMOLALITY SER                          $170.00      $170.00   084060   LOS CLINICAL LABORATORY REV
5250326     OSMOLALITY UR                           $170.00      $170.00   084060   LOS CLINICAL LABORATORY REV
5252406     OVA & PARASITES W CONC                   $15.20       $15.20   084060   LOS CLINICAL LABORATORY REV
5250870     OXALATE UR                              $369.00      $369.00   084060   LOS CLINICAL LABORATORY REV
5250595     P.O. BOX 12309                            $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5250164     PARVOVIRUS B19 AB IGG                    $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5250163     PARVOVIRUS B19 AB IGM                    $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5250835     PHENCYCLIDINE CONF                       $44.40       $44.40   084060   LOS CLINICAL LABORATORY REV
450050492   PHENOBARBITAL                           $281.00      $281.00   084060   LOS CLINICAL LABORATORY REV
450050501   PHENYLALANINE BLOOD                      $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
525453      PHENYTOIN FREE                           $22.50       $22.50   084060   LOS CLINICAL LABORATORY REV
450050491   PHENYTOIN TOTAL                         $325.00      $325.00   084060   LOS CLINICAL LABORATORY REV
5250191     PHOSHATASE ACID TOTAL                    $22.00       $22.00   084060   LOS CLINICAL LABORATORY REV
5259211     PHOSPHOROUS UR RAN                       $13.00       $13.00   084060   LOS CLINICAL LABORATORY REV
450050095   PHOSPHORUS (PO4)                        $118.00      $118.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         21
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


450050202   PINWORM CELLOPHANE TAPE                $102.00      $102.00   084060   LOS CLINICAL LABORATORY REV
525454      PLT AGGREGATION EA AGENT               $648.00      $648.00   084060   LOS CLINICAL LABORATORY REV
450050143   PLT CNT AUTO                           $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
5250173     PLT NEUTRALIZATION                      $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
5250172     PLT NEUTRALIZATION                      $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
450055994   POOLING BLD PROD                       $185.00      $185.00   084060   LOS CLINICAL LABORATORY REV
450050097   POTASSIUM                              $118.00      $118.00   084060   LOS CLINICAL LABORATORY REV
450050098   POTASSIUM UR 24 HR                     $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
5259198     PREALBUMIN                             $366.00      $366.00   084060   LOS CLINICAL LABORATORY REV
450050063   PREGNANCY SCRN UR                      $153.00      $153.00   084060   LOS CLINICAL LABORATORY REV
450050242   PRENATAL PNL                           $851.00      $851.00   084060   LOS CLINICAL LABORATORY REV
5250341     PRIMIDONE                               $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5251731     PROCAINAMIDE & NAPA                    $385.00      $385.00   084060   LOS CLINICAL LABORATORY REV
5251880     PROGESTERONE                            $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
5250417     PROLACTIN                              $215.00      $215.00   084060   LOS CLINICAL LABORATORY REV
5250188     PROTEIMASE 3                            $17.50       $17.50   084060   LOS CLINICAL LABORATORY REV
5252118     PROTEIN C AG                            $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5250205     PROTEIN ELECTRO SER                     $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5250204     PROTEIN ELECTRO SER EX                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050102   PROTEIN ELECTRO UR                      $66.00       $66.00   084060   LOS CLINICAL LABORATORY REV
5250349     PROTEIN ELECTRO UR                      $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5250207     PROTEIN ELECTRO UR                      $20.15       $20.15   084060   LOS CLINICAL LABORATORY REV
5250350     PROTEIN ELECTRO UR EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5250206     PROTEIN ELECTRO UR EX                    $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5250203     PROTEIN NEPHELOMET                       $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
5252119     PROTEIN S AG TOTAL                      $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5250202     PROTEIN TOTAL BLOOD                      $2.00        $2.00   084060   LOS CLINICAL LABORATORY REV
450050104   PROTEIN TOTAL CSF                       $89.00       $89.00   084060   LOS CLINICAL LABORATORY REV
5250964     PROTEIN TOTAL FLD                       $73.00       $73.00   084060   LOS CLINICAL LABORATORY REV
450050105   PROTEIN TOTAL FLD                       $89.00       $89.00   084060   LOS CLINICAL LABORATORY REV
450050100   PROTEIN TOTAL FLD                       $89.00       $89.00   084060   LOS CLINICAL LABORATORY REV
450050931   PROTEIN UR QN 24 HR                     $92.00       $92.00   084060   LOS CLINICAL LABORATORY REV
5250348     PROTEIN UR QN RAN                       $10.25       $10.25   084060   LOS CLINICAL LABORATORY REV
450050144   PROTHROMBIN TIME                        $96.00       $96.00   084060   LOS CLINICAL LABORATORY REV
5252187     PSA FREE                                $20.19       $20.19   084060   LOS CLINICAL LABORATORY REV
450050602   PSA TOTAL                              $465.00      $465.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        22
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5252186     PSA TOTAL                                $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
5251905     PTH, INTACT - EXPLD CHRG                  $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050149   PTT PLAS OR WB                          $147.00      $147.00   084060   LOS CLINICAL LABORATORY REV
5250171     PTT PLAS OR WB                            $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
5251839     Q-FEVER - EXPLDING CHARGE                 $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050087   RENAL FUNCTION PNL                      $217.00      $217.00   084060   LOS CLINICAL LABORATORY REV
5250972     RENIN                                    $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
450050146   RETICULOCYTE MAN                        $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
450050167   RH TYP                                  $147.00      $147.00   084060   LOS CLINICAL LABORATORY REV
450050180   RHEUMATOID FCTR QL                      $140.00      $140.00   084060   LOS CLINICAL LABORATORY REV
5259172     RHEUMATOID FCTR QN                      $144.00      $144.00   084060   LOS CLINICAL LABORATORY REV
5251874     RIBOFLAVIN                               $55.00       $55.00   084060   LOS CLINICAL LABORATORY REV
5250158     ROTAVIRUS AB                             $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
5250236     ROTAVIRUS AG EIA                        $275.00      $275.00   084060   LOS CLINICAL LABORATORY REV
5250123     ROTAVIRUS AG EIA                         $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
450050183   RPR QL                                  $105.00      $105.00   084060   LOS CLINICAL LABORATORY REV
5252153     RSV DFA                                  $24.00       $24.00   084060   LOS CLINICAL LABORATORY REV
450050170   RUBELLA AB                              $366.00      $366.00   084060   LOS CLINICAL LABORATORY REV
5252320     RUBEOLA AB                                $8.08        $8.08   084060   LOS CLINICAL LABORATORY REV
450050106   SALICYLATE                              $172.00      $172.00   084060   LOS CLINICAL LABORATORY REV
450050147   SEDIMENTATION RATE MAN                   $89.00       $89.00   084060   LOS CLINICAL LABORATORY REV
450050225   SEMEN ANALYSIS COMPLETE                 $300.00      $300.00   084060   LOS CLINICAL LABORATORY REV
450050081   SEMEN PRESENCE/MOT POST                 $217.00      $217.00   084060   LOS CLINICAL LABORATORY REV
5250155     SEROTONIN BLD                            $50.00       $50.00   084060   LOS CLINICAL LABORATORY REV
5259102     SICKLE CL SCRN                          $128.00      $128.00   084060   LOS CLINICAL LABORATORY REV
5251858     SIROLIMUS                                $55.00       $55.00   084060   LOS CLINICAL LABORATORY REV
5252212     SJOGRENS AB                              $11.50       $11.50   084060   LOS CLINICAL LABORATORY REV
5250240     SMOOTH MUSCLE AB SCRN                    $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5251800     SMR AFB STAIN                            $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
450050215   SMR GRAM STAIN                          $102.00      $102.00   084060   LOS CLINICAL LABORATORY REV
450050213   SMR WET MOUNT                           $102.00      $102.00   084060   LOS CLINICAL LABORATORY REV
450050107   SODIUM                                  $121.00      $121.00   084060   LOS CLINICAL LABORATORY REV
450050108   SODIUM UR RAN                           $121.00      $121.00   084060   LOS CLINICAL LABORATORY REV
5259225     SOMATOSTATIN                            $140.00      $140.00   084060   LOS CLINICAL LABORATORY REV
5250806     SPEC CONCENTRATION                      $130.00      $130.00   084060   LOS CLINICAL LABORATORY REV
5250201     SPEC CONCENTRATION                        $8.23        $8.23   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         23
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


525436      SPEC CONCENTRATION                       $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
450050197   SPEC HANDL PATRNTY                      $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
450050195   SPEC HANDL TO REF LAB                   $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
450050193   SPEC HANDL TO REF LAB                   $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
450050196   SPEC HANDL TO REF LAB                   $59.00       $59.00   084060   LOS CLINICAL LABORATORY REV
450050194   SPEC HANDL TO REF LAB                   $27.00       $27.00   084060   LOS CLINICAL LABORATORY REV
450050192   SPEC HANDL TO REF LAB                   $15.00       $15.00   084060   LOS CLINICAL LABORATORY REV
5250192     SPEC HANDL TO REF LAB                   $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5252407     SPEC STAIN GRP II                        $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV
450050400   STOOL CULTURE GROUP EX                   $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050085   STREPT A BY IA W/OPTIC                 $293.00      $293.00   084060   LOS CLINICAL LABORATORY REV
5250257     SUGARS QL EA SPEC                      $110.00      $110.00   084060   LOS CLINICAL LABORATORY REV
450050410   SUSCEPT BY E TEST                       $39.34       $39.34   084060   LOS CLINICAL LABORATORY REV
450050404   SUSCEPT BY ENZYME DETECT                $22.00       $22.00   084060   LOS CLINICAL LABORATORY REV
525475      SUSCEPT BY MIC                          $71.00       $71.00   084060   LOS CLINICAL LABORATORY REV
525473      SUSCEPT BY MIC                         $184.00      $184.00   084060   LOS CLINICAL LABORATORY REV
525461      SUSCEPT BY MIC                          $69.00       $69.00   084060   LOS CLINICAL LABORATORY REV
525459      SUSCEPT BY MIC                         $184.00      $184.00   084060   LOS CLINICAL LABORATORY REV
525458      SUSCEPT BY MIC                          $53.00       $53.00   084060   LOS CLINICAL LABORATORY REV
525456      SUSCEPT BY MIC                          $71.00       $71.00   084060   LOS CLINICAL LABORATORY REV
450050211   SUSCEPT BY MIC                         $216.00      $216.00   084060   LOS CLINICAL LABORATORY REV
450050409   SUSCEPT KB DISK <=12                   $177.00      $177.00   084060   LOS CLINICAL LABORATORY REV
5250193     SUSCEPT MYCOBACT PROPORT                $18.00       $18.00   084060   LOS CLINICAL LABORATORY REV
5250106     T LYMPH CD4 (HELPER) CNT                $29.45       $29.45   084060   LOS CLINICAL LABORATORY REV
5252216     T3 FREE                                 $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
5252240     T3 TOTAL                                $10.00       $10.00   084060   LOS CLINICAL LABORATORY REV
450050062   T3 UPTAKE                              $164.00      $164.00   084060   LOS CLINICAL LABORATORY REV
5250182     TACROLIMUS (FK506)                      $50.00       $50.00   084060   LOS CLINICAL LABORATORY REV
5252016     TESTOSTERONE FREE                       $21.80       $21.80   084060   LOS CLINICAL LABORATORY REV
5250940     TESTOSTERONE TOTAL                      $13.00       $13.00   084060   LOS CLINICAL LABORATORY REV
5250938     TESTOTERONE, TOT&FREE EX                 $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
454051016   THAWING PROD PER UNIT                  $159.00      $159.00   084060   LOS CLINICAL LABORATORY REV
450050921   THEOPHYLLINE                           $351.00      $351.00   084060   LOS CLINICAL LABORATORY REV
5250245     THYROGLOBULIN                           $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5250525     THYROGLOBULIN AB                         $8.08        $8.08   084060   LOS CLINICAL LABORATORY REV
5250244     THYROGLOBULIN AB                         $8.00        $8.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                        24
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5252274     THYROGLOBULIN AB                          $7.00        $7.00   084060   LOS CLINICAL LABORATORY REV
5252272     THYROID AB PANEL 1 EX                     $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
450050071   THYROID PANEL EX                          $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5252273     THYROID PEROXIDASE AB                     $9.00        $9.00   084060   LOS CLINICAL LABORATORY REV
450050953   THYROXINE (T4)                          $177.00      $177.00   084060   LOS CLINICAL LABORATORY REV
5250259     TISSUE CULT BM/BLD                      $129.00      $129.00   084060   LOS CLINICAL LABORATORY REV
450050013   TOBRAMYCIN                              $406.00      $406.00   084060   LOS CLINICAL LABORATORY REV
5251836     TOXOPLAS AB IGG                           $8.75        $8.75   084060   LOS CLINICAL LABORATORY REV
525415      TOXOPLAS AB IGM                           $8.75        $8.75   084060   LOS CLINICAL LABORATORY REV
5251885     TRANSFERRIN                              $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
450056010   TRICHOMONAS VAG DIR PROBE               $491.00      $491.00   084060   LOS CLINICAL LABORATORY REV
5250190     TRICYCLIC SCRN                           $67.00       $67.00   084060   LOS CLINICAL LABORATORY REV
450050117   TRIGLYCERIDE                            $140.00      $140.00   084060   LOS CLINICAL LABORATORY REV
450050072   TROPONIN I QN                           $242.00      $242.00   084060   LOS CLINICAL LABORATORY REV
5250169     TRYPSIN                                  $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
450050504   TSH                                      $11.88       $11.88   084060   LOS CLINICAL LABORATORY REV
450050393   TSH                                     $425.00      $425.00   084060   LOS CLINICAL LABORATORY REV
525464      TSH                                      $20.35       $20.35   084060   LOS CLINICAL LABORATORY REV
450050502   TYROSINE                                 $11.00       $11.00   084060   LOS CLINICAL LABORATORY REV
5252400     UR NITROGEN UR 24HR                     $138.00      $138.00   084060   LOS CLINICAL LABORATORY REV
450050121   URIC ACID                               $108.00      $108.00   084060   LOS CLINICAL LABORATORY REV
450050079   URIC ACID UR 24 HR                      $118.00      $118.00   084060   LOS CLINICAL LABORATORY REV
5250927     URNALYSIS AUTO W/ MICRO                  $63.00       $63.00   084060   LOS CLINICAL LABORATORY REV
450050026   URNALYSIS AUTO W/ MICRO                  $77.00       $77.00   084060   LOS CLINICAL LABORATORY REV
450050078   URNALYSIS AUTO W/O MICRO                 $57.00       $57.00   084060   LOS CLINICAL LABORATORY REV
5259220     URNALYSIS QL OR SEMI QL                  $51.00       $51.00   084060   LOS CLINICAL LABORATORY REV
450055993   URNALYSIS VOL MEASURE                    $77.00       $77.00   084060   LOS CLINICAL LABORATORY REV
5251714     VALPROIC ACID                           $340.00      $340.00   084060   LOS CLINICAL LABORATORY REV
5252092     VANCOMYCIN                              $376.00      $376.00   084060   LOS CLINICAL LABORATORY REV
5259208     VDRL CSF QL                               $6.00        $6.00   084060   LOS CLINICAL LABORATORY REV
450050799   VENIPUNCTURE                             $52.00       $52.00   084060   LOS CLINICAL LABORATORY REV
5251790     VIRUS CULT ID                            $44.00       $44.00   084060   LOS CLINICAL LABORATORY REV
5250235     VIRUS CULT SHELL VIAL                    $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
5250199     VIRUS CULT SHELL VIAL                    $30.00       $30.00   084060   LOS CLINICAL LABORATORY REV
450050408   VISCOSITY                               $230.00      $230.00   084060   LOS CLINICAL LABORATORY REV
5251789     VITAMIN A                                $16.00       $16.00   084060   LOS CLINICAL LABORATORY REV


7/11/2012                                                                                                         25
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


5250977     VITAMIN B1 (THIAMINE)                     $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
5250128     VITAMIN B12                              $304.00      $304.00   084060   LOS CLINICAL LABORATORY REV
5250129     VITAMIN B12 BINDING CAP                  $105.00      $105.00   084060   LOS CLINICAL LABORATORY REV
5251864     VITAMIN B6                                $28.00       $28.00   084060   LOS CLINICAL LABORATORY REV
5259201     VITAMIN D (125 DI HYDROX)                 $35.00       $35.00   084060   LOS CLINICAL LABORATORY REV
5259200     VITAMIN D 25HYDROXY                       $20.00       $20.00   084060   LOS CLINICAL LABORATORY REV
5250370     VMA UR 24HR                               $13.75       $13.75   084060   LOS CLINICAL LABORATORY REV
5252142     VZV AB                                    $12.00       $12.00   084060   LOS CLINICAL LABORATORY REV
450050140   WBC CNT AUTO                              $64.00       $64.00   084060   LOS CLINICAL LABORATORY REV
525431      WEST NILE VIRUS AB                         $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
525432      WEST NILE VIRUS AB IGG                    $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
525433      WEST NILE VIRUS AB IGM                    $25.00       $25.00   084060   LOS CLINICAL LABORATORY REV
450050165   XMATCH FIRST UNIT EX                       $0.00        $0.00   084060   LOS CLINICAL LABORATORY REV
5251878     ZINC                                      $13.00       $13.00   084060   LOS CLINICAL LABORATORY REV
468062077   CON LOCM >= 400S I 1ML                     $1.23        $1.23   084144   LOS CT SCAN REV
468062075   CON LOCM 300-349S I 1ML                    $1.23        $1.23   084144   LOS CT SCAN REV
468062076   CON LOCM 350-399S I 1ML                    $1.23        $1.23   084144   LOS CT SCAN REV
468062084   CT 3D RENDER W/O POSTPROS              $1,822.81    $1,822.81   084144   LOS CT SCAN REV
468062085   CT 3D RENDER W/POSTPROCES              $2,382.81    $2,382.81   084144   LOS CT SCAN REV
468062003   CT ABD W/CON                           $5,724.00    $5,724.00   084144   LOS CT SCAN REV
468062004   CT ABD W/O CON                         $4,773.00    $4,773.00   084144   LOS CT SCAN REV
468062005   CT ABD W-W/O CON                       $7,053.00    $7,053.00   084144   LOS CT SCAN REV
468062000   CT BRAIN W CON                         $4,757.00    $4,757.00   084144   LOS CT SCAN REV
468062001   CT BRAIN W/O CON                       $3,939.00    $3,939.00   084144   LOS CT SCAN REV
468062002   CT BRAIN W-W/O CON                     $5,905.00    $5,905.00   084144   LOS CT SCAN REV
468062083   CT CS DIFF MD ADD 15M                    $111.00      $111.00   084144   LOS CT SCAN REV
468062082   CT CS DIFF MD GT5YR 0-30M                $222.00      $222.00   084144   LOS CT SCAN REV
468062081   CT CS DIFF MD LT5YR 0-30M                $222.00      $222.00   084144   LOS CT SCAN REV
468062080   CT CS SAME MD ADD 15M                    $111.00      $111.00   084144   LOS CT SCAN REV
468062079   CT CS SAME MD GT5YR 0-30M                $222.00      $222.00   084144   LOS CT SCAN REV
468062078   CT CS SAME MD LT5YR 0-30M                $222.00      $222.00   084144   LOS CT SCAN REV
468062011   CT EXT LOW W CON                       $4,962.00    $4,962.00   084144   LOS CT SCAN REV
468062012   CT EXT LOW W/O CON                     $4,191.00    $4,191.00   084144   LOS CT SCAN REV
468062058   CT EXT UPP W CON                       $4,861.00    $4,861.00   084144   LOS CT SCAN REV
468050002   CT LTD OR FU STDY                      $2,958.00    $2,958.00   084144   LOS CT SCAN REV
468062066   CT MAXILLOFACIAL W/O CON               $4,010.00    $4,010.00   084144   LOS CT SCAN REV


7/11/2012                                                                                                          26
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


468062032   CT NEC W CON                           $4,820.00    $4,820.00   084144   LOS CT SCAN REV
468062033   CT NEC W/O CON                         $4,050.00    $4,050.00   084144   LOS CT SCAN REV
468062072   CT NEC W-W/O CON                       $5,945.00    $5,945.00   084144   LOS CT SCAN REV
468062070   CT ORBIT SELLA FOSA W-W/O              $4,655.00    $4,655.00   084144   LOS CT SCAN REV
468062071   CT ORBIT SELLA FOSSA W                 $3,921.45    $3,921.45   084144   LOS CT SCAN REV
468062036   CT ORBIT/SELLA/FOSSA W/O               $4,050.00    $4,050.00   084144   LOS CT SCAN REV
468062016   CT PELV W CON                          $5,693.00    $5,693.00   084144   LOS CT SCAN REV
468062017   CT PELV W/O CON                        $4,946.00    $4,946.00   084144   LOS CT SCAN REV
468062015   CT PELV W-W/O CON                      $7,006.00    $7,006.00   084144   LOS CT SCAN REV
468062068   CT SPINE CERV W CON                    $5,890.00    $5,890.00   084144   LOS CT SCAN REV
468062026   CT SPINE CERV W/O CON                  $4,962.00    $4,962.00   084144   LOS CT SCAN REV
468062069   CT SPINE LUMB W CON                    $5,890.00    $5,890.00   084144   LOS CT SCAN REV
468062021   CT SPINE LUMB W/O CON                  $4,962.00    $4,962.00   084144   LOS CT SCAN REV
468062074   CT SPINE THOR W CON                    $6,517.30    $6,517.30   084144   LOS CT SCAN REV
468062024   CT SPINE THOR W/O CON                  $4,962.00    $4,962.00   084144   LOS CT SCAN REV
468062073   CT SPINE THOR W-W/O                    $6,905.25    $6,905.25   084144   LOS CT SCAN REV
468062028   CT THORAX W CON                        $5,897.00    $5,897.00   084144   LOS CT SCAN REV
468062029   CT THORAX W/O CON                      $4,962.00    $4,962.00   084144   LOS CT SCAN REV
468062067   CT THORAX W-W/O                        $7,336.00    $7,336.00   084144   LOS CT SCAN REV
462053001   EEG AWAKE AND ASLEEP                   $1,286.00    $1,286.00   084130   LOS EEG REV
462053013   EEG AWAKE AND DROWSY                     $942.00      $942.00   084130   LOS EEG REV
462053012   EEG CEREBRAL DEATH EVAL                $1,091.00    $1,091.00   084130   LOS EEG REV
459152001   EKG 12 LEAD TRACING                      $445.00      $445.00   084110   LOS EKG REV
401090020   ADMIN IMMUN SGL VACC                      $55.00       $55.00   084230   LOS EMERGENCY ROOM REV
401090018   ADMIN INFLUENZA VACC                      $70.00       $70.00   084230   LOS EMERGENCY ROOM REV
401090019   ADMIN PNEUMOCOCCAL VACC                   $32.00       $32.00   084230   LOS EMERGENCY ROOM REV
401090032   BLOOD TRANSFUSN 2-4 HR                 $1,242.00    $1,242.00   084230   LOS EMERGENCY ROOM REV
401090017   BLOOD TRANSFUSN LT 2 HR                  $711.00      $711.00   084230   LOS EMERGENCY ROOM REV
401090015   CARDIOVERT ELECTIVE EXT                $1,308.00    $1,308.00   084230   LOS EMERGENCY ROOM REV
401090013   CPR                                      $720.00      $720.00   084230   LOS EMERGENCY ROOM REV
401088025   ED CC 1ST 30-74 MN                     $1,921.00    $1,921.00   084230   LOS EMERGENCY ROOM REV
401090022   ED CC EA ADD 30 MN                       $638.00      $638.00   084230   LOS EMERGENCY ROOM REV
401089005   ED LEVEL 1                               $220.00      $220.00   084230   LOS EMERGENCY ROOM REV
401090000   ED LEVEL 2                               $396.00      $396.00   084230   LOS EMERGENCY ROOM REV
401088002   ED LEVEL 3                               $869.00      $869.00   084230   LOS EMERGENCY ROOM REV
401088003   ED LEVEL 4                             $1,331.00    $1,331.00   084230   LOS EMERGENCY ROOM REV


7/11/2012                                                                                                     27
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


401088004   ED LEVEL 5                             $1,595.00    $1,595.00   084230   LOS EMERGENCY ROOM REV
401090002   ED PROC MAJOR                            $751.00      $751.00   084230   LOS EMERGENCY ROOM REV
401090001   ED PROC MINOR                            $313.00      $313.00   084230   LOS EMERGENCY ROOM REV
401089085   EKG 12 LEAD TRACING ONLY                 $445.00      $445.00   084230   LOS EMERGENCY ROOM REV
401090011   GASTRIC LAVAGE                           $458.00      $458.00   084230   LOS EMERGENCY ROOM REV
401090010   GI INTUB CONT HEM                      $1,051.00    $1,051.00   084230   LOS EMERGENCY ROOM REV
401088018   GLUCOSE FINGERSTICK                       $22.00       $22.00   084230   LOS EMERGENCY ROOM REV
401090004   HEMATOCRIT                                $22.00       $22.00   084230   LOS EMERGENCY ROOM REV
401090006   HYDRATION INFSN 0-60MN                   $408.00      $408.00   084230   LOS EMERGENCY ROOM REV
401090007   HYDRATN INFSN EA ADD HR                  $285.00      $285.00   084230   LOS EMERGENCY ROOM REV
401090038   INFSN W/MED EA ADD HR                    $285.00      $285.00   084230   LOS EMERGENCY ROOM REV
401090037   INFUSION W/MED 0-60MN                    $408.00      $408.00   084230   LOS EMERGENCY ROOM REV
401090008   INJ IVP SNGL/INIT DRG                    $143.00      $143.00   084230   LOS EMERGENCY ROOM REV
401090009   INJECTION IM/SQ EA                       $180.00      $180.00   084230   LOS EMERGENCY ROOM REV
401090023   OCCLT BLD STL QL MULT SPC                 $32.00       $32.00   084230   LOS EMERGENCY ROOM REV
401090024   OCCULT BLD GASTRIC QL                     $32.00       $32.00   084230   LOS EMERGENCY ROOM REV
401090021   PT LEFT AFTER TRIAGE                       $0.00        $0.00   084230   LOS EMERGENCY ROOM REV
401090034   PULSE OXIMETRY - MULTIPLE                $164.00      $164.00   084230   LOS EMERGENCY ROOM REV
401090033   PULSE OXIMETRY - SINGLE                   $63.00       $63.00   084230   LOS EMERGENCY ROOM REV
401090031   RHYTHM EKG 3 LEAD TRACING                 $85.00       $85.00   084230   LOS EMERGENCY ROOM REV
401088012   S ORTHO ANKLE SPLINT FG                  $191.00      $191.00   084230   LOS EMERGENCY ROOM REV
401088011   S ORTHO ARM SPLINT FG                    $191.00      $191.00   084230   LOS EMERGENCY ROOM REV
401088013   S ORTHO KNEE SPLINT FG                   $262.00      $262.00   084230   LOS EMERGENCY ROOM REV
401088014   S ORTHO LEG SPLINT FG                    $271.00      $271.00   084230   LOS EMERGENCY ROOM REV
401088010   S STRL SUTURE #1 TO 4-0                   $67.00       $67.00   084230   LOS EMERGENCY ROOM REV
401090035   SEEN NO CHARGE                             $0.00        $0.00   084230   LOS EMERGENCY ROOM REV
401090025   SKIN TEST TB                              $62.00       $62.00   084230   LOS EMERGENCY ROOM REV
401090014   TEMP TRANSCUTANEOUS PACE                 $715.00      $715.00   084230   LOS EMERGENCY ROOM REV
401090016   THROMBOLYSIS CORO IV                   $1,667.00    $1,667.00   084230   LOS EMERGENCY ROOM REV
401088019   URNALYSIS MAN W/O MICRO                   $25.00       $25.00   084230   LOS EMERGENCY ROOM REV
401090026   VENIPUNCTURE                              $20.00       $20.00   084230   LOS EMERGENCY ROOM REV
401090028   VX RABIES INTRAMUSCULAR                  $208.20      $208.20   084230   LOS EMERGENCY ROOM REV
407102162   APP LONG LEG SPLNT                       $187.00      $187.00   084071   LOS HEALTH CLINIC
407102163   APP LOW LEG SPLNT                        $137.00      $137.00   084071   LOS HEALTH CLINIC
407102161   APP SPLNT FINGER STA                      $82.00       $82.00   084071   LOS HEALTH CLINIC
407102159   APP SPLNT LONG ARM                       $323.00      $323.00   084071   LOS HEALTH CLINIC


7/11/2012                                                                                                     28
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


407102160   APP SPLNT SHRT ARM STA                   $176.00      $176.00   084071   LOS HEALTH CLINIC
407102131   BX/LOCAL EXCSN CERV LSION                $187.00      $187.00   084071   LOS HEALTH CLINIC
407102138   DRAIN ABSCESS COMP/MULT                  $279.00      $279.00   084071   LOS HEALTH CLINIC
407102151   DRAIN ABSCESS SMPL/SNGL                  $108.00      $108.00   084071   LOS HEALTH CLINIC
407102152   GLUCOSE FINGERSTICK                       $57.00       $57.00   084071   LOS HEALTH CLINIC
407102155   HEMOGLOBIN                                $57.00       $57.00   084071   LOS HEALTH CLINIC
407102130   INSERT CATH TEMP INDWLLNG                $232.00      $232.00   084071   LOS HEALTH CLINIC
407102144   LAC SMPL 2.5CM/LESS                       $75.00       $75.00   084071   LOS HEALTH CLINIC
407102145   LAC SMPL 2.6-7.5CM                       $121.00      $121.00   084071   LOS HEALTH CLINIC
407102147   LAC SMPL/F,E,N 2.5CM/LESS                $102.00      $102.00   084071   LOS HEALTH CLINIC
407102148   LAC SMPL/F,E,N 2.6-5.0CM                 $181.00      $181.00   084071   LOS HEALTH CLINIC
407102122   LEVEL 1 EST PATIENT                      $202.00      $202.00   084071   LOS HEALTH CLINIC
407102118   LEVEL 1 NEW PATIENT                      $202.00      $202.00   084071   LOS HEALTH CLINIC
407102123   LEVEL 2 EST PATIENT                      $212.00      $212.00   084071   LOS HEALTH CLINIC
407101111   LEVEL 2 NEW PATIENT                      $212.00      $212.00   084071   LOS HEALTH CLINIC
407102124   LEVEL 3 EST PATIENT                      $252.00      $252.00   084071   LOS HEALTH CLINIC
407102119   LEVEL 3 NEW PATIENT                      $252.00      $252.00   084071   LOS HEALTH CLINIC
407102125   LEVEL 4 EST PATIENT                      $292.00      $292.00   084071   LOS HEALTH CLINIC
407102120   LEVEL 4 NEW PATIENT                      $292.00      $292.00   084071   LOS HEALTH CLINIC
407102126   LEVEL 5 EST PATIENT                      $342.00      $342.00   084071   LOS HEALTH CLINIC
407102121   LEVEL 5 NEW PATIENT                      $342.00      $342.00   084071   LOS HEALTH CLINIC
407102134   OBTAIN SCREEN PAP SMEAR                   $30.00       $30.00   084071   LOS HEALTH CLINIC
407102154   PULSE OXIMETRY SINGLE                     $34.00       $34.00   084071   LOS HEALTH CLINIC
407102142   REMOVE NAIL PLATE SNGL                   $191.00      $191.00   084071   LOS HEALTH CLINIC
407102137   RMV FB AUD CANAL WO ANES                 $129.00      $129.00   084071   LOS HEALTH CLINIC
407102150   RMVL IMPACTED CERUMEN                     $61.00       $61.00   084071   LOS HEALTH CLINIC
407102007   SCRN PURE TONE AIR                        $37.00       $37.00   084071   LOS HEALTH CLINIC
407102008   SCRN VISUAL ACTY QN BIL                   $18.00       $18.00   084071   LOS HEALTH CLINIC
407102153   SKIN TEST TB                              $53.00       $53.00   084071   LOS HEALTH CLINIC
407102128   STRAP UNNA BOOT                          $184.00      $184.00   084071   LOS HEALTH CLINIC
407102143   TOENAIL EXCISION                         $158.00      $158.00   084071   LOS HEALTH CLINIC
407102127   VENIPUNCTURE                              $12.00       $12.00   084071   LOS HEALTH CLINIC
301012000   ROOM ICU                               $5,019.00    $5,019.00   083010   LOS INTENSIVE CARE REV
44611515    AMINO ACIDS 3.5% 1000ML                  $127.96      $127.96   084171   LOS IV THERAPY REV
44611564    CARDIOPLGIC SOL                          $491.00      $491.00   084171   LOS IV THERAPY REV
44610491    D10W 1000ML                               $89.08       $89.08   084171   LOS IV THERAPY REV


7/11/2012                                                                                                     29
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44610509    D10W 500ML                               $89.64       $89.64   084171   LOS IV THERAPY REV
44610079    D10W 500ML                               $91.24       $91.24   084171   LOS IV THERAPY REV
44610087    D51/2NS 1000ML                           $88.76       $88.76   084171   LOS IV THERAPY REV
44610533    D51/2NS 250ML                             $3.62        $3.62   084171   LOS IV THERAPY REV
44610137    D51/2NS 500ML                            $88.60       $88.60   084171   LOS IV THERAPY REV
44610541    D51/4NS 1000ML                           $88.50       $88.50   084171   LOS IV THERAPY REV
44610145    D51/4NS 500ML                            $88.60       $88.60   084171   LOS IV THERAPY REV
44610111    D5LR 1000ML                              $88.88       $88.88   084171   LOS IV THERAPY REV
44610657    D5LR 500 ML                              $89.04       $89.04   084171   LOS IV THERAPY REV
44610129    D5NS 1000ML                              $88.40       $88.40   084171   LOS IV THERAPY REV
44610525    D5NS 500ML                               $88.60       $88.60   084171   LOS IV THERAPY REV
44610152    D5W 1000ML                               $88.90       $88.90   084171   LOS IV THERAPY REV
44610475    D5W 100ML                                 $4.06        $4.06   084171   LOS IV THERAPY REV
44610483    D5W 150ML                                $10.00       $10.00   084171   LOS IV THERAPY REV
44610160    D5W 250ML                                $10.00       $10.00   084171   LOS IV THERAPY REV
44611309    D5W 25ML                                  $5.36        $5.36   084171   LOS IV THERAPY REV
44610178    D5W 500ML                                $88.06       $88.06   084171   LOS IV THERAPY REV
44610467    D5W 50ML                                  $4.02        $4.02   084171   LOS IV THERAPY REV
44611358    D70W 500ML                              $106.86      $106.86   084171   LOS IV THERAPY REV
44610046    DEXTRAN 40 500ML                        $376.88      $376.88   084171   LOS IV THERAPY REV
44611341    DOPAMINE 400MG/D5W 250ML                $150.86      $150.86   084171   LOS IV THERAPY REV
44612018    FENTANYL MARC PCA/DRIP                   $88.34       $88.34   084171   LOS IV THERAPY REV
44611614    HEPARIN 1000U/500ML NS                   $98.74       $98.74   084171   LOS IV THERAPY REV
44611705    HEPARIN 12500U/250ML DRIP               $125.06      $125.06   084171   LOS IV THERAPY REV
44610624    IONOSOL-T/D5W 1000ML                    $116.92      $116.92   084171   LOS IV THERAPY REV
44611473    K CL 10MEQ/SW 50ML PREMX                $118.26      $118.26   084171   LOS IV THERAPY REV
44611481    K CL 20MEQ/SW 100ML PREMX               $118.26      $118.26   084171   LOS IV THERAPY REV
44610277    LACTATED RINGERS 1000                    $88.50       $88.50   084171   LOS IV THERAPY REV
44610285    LACTATED RINGERS 500                     $88.60       $88.60   084171   LOS IV THERAPY REV
44611093    LIDOCAINE DRP 2GM/500ML                 $134.94      $134.94   084171   LOS IV THERAPY REV
44611903    MAG SO4 40GM/1000ML                     $122.84      $122.84   084171   LOS IV THERAPY REV
44611457    MANNITOL 20% 250ML IJ                   $174.56      $174.56   084171   LOS IV THERAPY REV
44610301    MANNITOL 20% 500ML                      $149.56      $149.56   084171   LOS IV THERAPY REV
44611945    MORPHINE 150MG/NS 150ML                  $58.44       $58.44   084171   LOS IV THERAPY REV
44610715    NA CL 0.45% 1000ML                      $134.84      $134.84   084171   LOS IV THERAPY REV
44610707    NA CL 0.45% 500ML                        $87.76       $87.76   084171   LOS IV THERAPY REV


7/11/2012                                                                                                30
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44610418    NA CL 0.9% 1000ML                         $88.62       $88.62   084171   LOS IV THERAPY REV
44610681    NA CL 0.9% 100ML                           $4.06        $4.06   084171   LOS IV THERAPY REV
44611325    NA CL 0.9% 10ML                           $28.68       $28.68   084171   LOS IV THERAPY REV
44610699    NA CL 0.9% 150ML                           $8.60        $8.60   084171   LOS IV THERAPY REV
44610434    NA CL 0.9% 250ML                           $2.80        $2.80   084171   LOS IV THERAPY REV
44610426    NA CL 0.9% 500ML                          $87.56       $87.56   084171   LOS IV THERAPY REV
44610673    NA CL 0.9% 50ML                            $3.96        $3.96   084171   LOS IV THERAPY REV
44610723    NA CL 3% 500ML                           $106.54      $106.54   084171   LOS IV THERAPY REV
44610210    NA CL IRRIG 1000ML                        $36.52       $36.52   084171   LOS IV THERAPY REV
44610228    NA CL IRRIG 1500ML                        $33.36       $33.36   084171   LOS IV THERAPY REV
44610855    NA CL IRRIG 500ML                         $31.76       $31.76   084171   LOS IV THERAPY REV
44611630    NTG 50MG/D5W 250ML                       $126.92      $126.92   084171   LOS IV THERAPY REV
44610764    S STRL EVAC 1000CC                       $101.54      $101.54   084171   LOS IV THERAPY REV
44610798    S STRL EVAC 150CC                         $40.72       $40.72   084171   LOS IV THERAPY REV
44610780    S STRL EVAC 250CC                        $100.12      $100.12   084171   LOS IV THERAPY REV
44610772    S STRL EVAC 500CC                         $43.56       $43.56   084171   LOS IV THERAPY REV
44611994    TOTAL PARENTRL NUTRI DLY               $1,482.90    $1,482.90   084171   LOS IV THERAPY REV
44610459    WATER IJ 1000ML                           $90.22       $90.22   084171   LOS IV THERAPY REV
44610244    WATER IRRIG 1500ML                        $59.30       $59.30   084171   LOS IV THERAPY REV
44611374    WATER STERILE                              $1.90        $1.90   084171   LOS IV THERAPY REV
40109015    ABR SCREEN INIT IP                        $41.00       $41.00   084010   LOS LABOR & DELIVERY REV
40109030    ABR SCREEN INIT OP                        $64.00       $64.00   084010   LOS LABOR & DELIVERY REV
40109004    AMNIOCENTESIS DX                         $344.00      $344.00   084010   LOS LABOR & DELIVERY REV
40109003    CIRCUMCISION                              $40.00       $40.00   084010   LOS LABOR & DELIVERY REV
40109002    DELIVERY VAGINAL LEVEL 1               $2,026.00    $2,026.00   084010   LOS LABOR & DELIVERY REV
40109001    DELIVERY VAGINAL LEVEL 2               $2,315.00    $2,315.00   084010   LOS LABOR & DELIVERY REV
440041009   FETAL MON INTERN W/REPORT                $243.00      $243.00   084010   LOS LABOR & DELIVERY REV
40109006    INJ BLOOD PATCH                          $258.00      $258.00   084010   LOS LABOR & DELIVERY REV
40109013    INJ IVP SNGL/INIT DRG                     $65.00       $65.00   084010   LOS LABOR & DELIVERY REV
40109012    INJECTION IM/SQ EA                        $82.00       $82.00   084010   LOS LABOR & DELIVERY REV
440041001   LABOR LEVEL 1 / HR-IP                    $269.00      $269.00   084010   LOS LABOR & DELIVERY REV
40109000    LABOR LEVEL 2 / HR-IP                    $336.00      $336.00   084010   LOS LABOR & DELIVERY REV
40109023    LEVEL 1 EST PATIENT                      $222.00      $222.00   084010   LOS LABOR & DELIVERY REV
40109018    LEVEL 1 NEW PATIENT                      $222.00      $222.00   084010   LOS LABOR & DELIVERY REV
40109024    LEVEL 2 EST PATIENT                      $283.00      $283.00   084010   LOS LABOR & DELIVERY REV
40109019    LEVEL 2 NEW PATIENT                      $283.00      $283.00   084010   LOS LABOR & DELIVERY REV


7/11/2012                                                                                                       31
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


40109025    LEVEL 3 EST PATIENT                      $297.00      $297.00   084010   LOS LABOR & DELIVERY REV
40109020    LEVEL 3 NEW PATIENT                      $297.00      $297.00   084010   LOS LABOR & DELIVERY REV
40109026    LEVEL 4 EST PATIENT                      $394.00      $394.00   084010   LOS LABOR & DELIVERY REV
40109021    LEVEL 4 NEW PATIENT                      $394.00      $394.00   084010   LOS LABOR & DELIVERY REV
40109027    LEVEL 5 EST PATIENT                      $515.00      $515.00   084010   LOS LABOR & DELIVERY REV
40109022    LEVEL 5 NEW PATIENT                      $515.00      $515.00   084010   LOS LABOR & DELIVERY REV
440041011   NST (NON-STRESS TEST)                    $494.00      $494.00   084010   LOS LABOR & DELIVERY REV
40109017    PULSE OXIMETRY-SINGLE                     $29.00       $29.00   084010   LOS LABOR & DELIVERY REV
40109009    US BIO PROFILE WO NOSTRES              $1,405.00    $1,405.00   084010   LOS LABOR & DELIVERY REV
40109007    US OB AFTR 1ST TRI 1 GEST              $1,846.00    $1,846.00   084010   LOS LABOR & DELIVERY REV
40109008    US OB AFTR 1ST TRI EA GES              $1,952.00    $1,952.00   084010   LOS LABOR & DELIVERY REV
440041008   US OB LTD 1/MORE FETUSES               $1,778.00    $1,778.00   084010   LOS LABOR & DELIVERY REV
40109028    VENIPUNCTURE                               $9.00        $9.00   084010   LOS LABOR & DELIVERY REV
44210054    CON GAD-BASE MR 1ML IJ                     $6.57        $6.57   084420   LOS MAGNETIC RES IMAGING RV
44210055    MR 3D RENDER W/O POSTPROS              $1,882.81    $1,882.81   084420   LOS MAGNETIC RES IMAGING RV
44210056    MR 3D RENDER W/POSTPROCES              $2,282.81    $2,282.81   084420   LOS MAGNETIC RES IMAGING RV
44210044    MR ABD W CON                           $4,171.00    $4,171.00   084420   LOS MAGNETIC RES IMAGING RV
44210043    MR ABD W/O CON                         $3,476.00    $3,476.00   084420   LOS MAGNETIC RES IMAGING RV
44210045    MR ABD W-W/O CON                       $7,199.00    $7,199.00   084420   LOS MAGNETIC RES IMAGING RV
44210011    MR BRAIN W STEM W CON                  $4,177.00    $4,177.00   084420   LOS MAGNETIC RES IMAGING RV
44210010    MR BRAIN W STEM W/O CON                $3,479.00    $3,479.00   084420   LOS MAGNETIC RES IMAGING RV
44210012    MR BRAIN W STEM W-W/O CON              $7,638.00    $7,638.00   084420   LOS MAGNETIC RES IMAGING RV
44210048    MR CARDIAC FNCTN CMPL                  $3,172.50    $3,172.50   084420   LOS MAGNETIC RES IMAGING RV
44210049    MR CARDIAC FNCTN LTD                   $2,626.50    $2,626.50   084420   LOS MAGNETIC RES IMAGING RV
44210050    MR CARDIAC VELOCITY FLOW               $2,626.50    $2,626.50   084420   LOS MAGNETIC RES IMAGING RV
44210047    MR CARDIAC W CON                       $3,328.00    $3,328.00   084420   LOS MAGNETIC RES IMAGING RV
44210046    MR CARDIAC W/O CON                     $3,294.00    $3,294.00   084420   LOS MAGNETIC RES IMAGING RV
44210014    MR CHEST W CON                         $3,935.00    $3,935.00   084420   LOS MAGNETIC RES IMAGING RV
44210013    MR CHEST W/O CON                       $3,476.00    $3,476.00   084420   LOS MAGNETIC RES IMAGING RV
44210015    MR CHEST W-W/O CON                     $7,199.00    $7,199.00   084420   LOS MAGNETIC RES IMAGING RV
44210059    MR CS SAME MD ADD 15M                    $169.55      $169.55   084420   LOS MAGNETIC RES IMAGING RV
44210058    MR CS SAME MD GT5YR 0-30M                $339.10      $339.10   084420   LOS MAGNETIC RES IMAGING RV
44210057    MR CS SAME MD LT5YR 0-30M                $339.10      $339.10   084420   LOS MAGNETIC RES IMAGING RV
44210000    MR DENTAL PARTIAL EXAM                 $3,280.00    $3,280.00   084420   LOS MAGNETIC RES IMAGING RV
44210041    MR EXT LOW JNT W CON                   $3,924.00    $3,924.00   084420   LOS MAGNETIC RES IMAGING RV
44210042    MR EXT LOW JNT W-W/O CON               $7,618.00    $7,618.00   084420   LOS MAGNETIC RES IMAGING RV


7/11/2012                                                                                                          32
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44210040    MR EXT LOW JT W/O CON                  $3,464.00    $3,464.00   084420   LOS MAGNETIC RES IMAGING RV
44210038    MR EXT LOW NO JNT W CON                $4,159.00    $4,159.00   084420   LOS MAGNETIC RES IMAGING RV
44210037    MR EXT LOW W/O CON                     $3,464.00    $3,464.00   084420   LOS MAGNETIC RES IMAGING RV
44210039    MR EXT LOW W-W/O CON                   $7,190.00    $7,190.00   084420   LOS MAGNETIC RES IMAGING RV
44210034    MR EXT UPP JNT W CON                   $4,159.00    $4,159.00   084420   LOS MAGNETIC RES IMAGING RV
44210033    MR EXT UPP JNT W/O CON                 $3,464.00    $3,464.00   084420   LOS MAGNETIC RES IMAGING RV
44210035    MR EXT UPP JNT W-W/O CON               $7,190.00    $7,190.00   084420   LOS MAGNETIC RES IMAGING RV
44210031    MR EXT UPP NO JNT W/CON                $3,924.00    $3,924.00   084420   LOS MAGNETIC RES IMAGING RV
44210030    MR EXT UPP NO JNT W/O CON              $3,464.00    $3,464.00   084420   LOS MAGNETIC RES IMAGING RV
44210032    MR EXT UPP NO JNT W-W/O                $7,190.00    $7,190.00   084420   LOS MAGNETIC RES IMAGING RV
44210002    MR ORBIT FACE NEC W CON                $4,159.00    $4,159.00   084420   LOS MAGNETIC RES IMAGING RV
44210001    MR ORBIT FACE NEC W/O CON              $3,464.00    $3,464.00   084420   LOS MAGNETIC RES IMAGING RV
44210003    MR ORBIT FACE NEC W-W/O                $7,618.00    $7,618.00   084420   LOS MAGNETIC RES IMAGING RV
44210027    MR PELV W CON                          $3,935.00    $3,935.00   084420   LOS MAGNETIC RES IMAGING RV
44210026    MR PELV W/O CON                        $3,476.00    $3,476.00   084420   LOS MAGNETIC RES IMAGING RV
44210028    MR PELV W-W/O CON                      $7,199.00    $7,199.00   084420   LOS MAGNETIC RES IMAGING RV
44210052    MR SPECTROSCOPY                        $1,003.00    $1,003.00   084420   LOS MAGNETIC RES IMAGING RV
44210017    MR SPINE CERV W CON                    $4,192.00    $4,192.00   084420   LOS MAGNETIC RES IMAGING RV
44210016    MR SPINE CERV W/O CON                  $3,491.00    $3,491.00   084420   LOS MAGNETIC RES IMAGING RV
44210022    MR SPINE CERV W-W/O CON                $7,659.00    $7,659.00   084420   LOS MAGNETIC RES IMAGING RV
44210021    MR SPINE LUMB W CON                    $4,180.00    $4,180.00   084420   LOS MAGNETIC RES IMAGING RV
44210020    MR SPINE LUMB W/O CON                  $3,850.00    $3,850.00   084420   LOS MAGNETIC RES IMAGING RV
44210024    MR SPINE LUMB W-W/O                    $7,638.00    $7,638.00   084420   LOS MAGNETIC RES IMAGING RV
44210019    MR SPINE THOR W CON                    $3,955.00    $3,955.00   084420   LOS MAGNETIC RES IMAGING RV
44210018    MR SPINE THOR W/O CON                  $3,862.00    $3,862.00   084420   LOS MAGNETIC RES IMAGING RV
44210023    MR SPINE THOR W-W/O                    $7,656.00    $7,656.00   084420   LOS MAGNETIC RES IMAGING RV
44210060    MRA ABD W CON                          $2,719.00    $2,719.00   084420   LOS MAGNETIC RES IMAGING RV
44210062    MRA EXT LOW W CON                      $3,246.00    $3,246.00   084420   LOS MAGNETIC RES IMAGING RV
44210036    MRA EXT UPP W-W/O CON                  $3,269.00    $3,269.00   084420   LOS MAGNETIC RES IMAGING RV
44210005    MRA HEAD W CON                         $3,450.00    $3,450.00   084420   LOS MAGNETIC RES IMAGING RV
44210004    MRA HEAD W/O CON                       $3,453.00    $3,453.00   084420   LOS MAGNETIC RES IMAGING RV
44210006    MRA HEAD W-W/O CON                     $6,846.00    $6,846.00   084420   LOS MAGNETIC RES IMAGING RV
44210008    MRA NEC W CON                          $3,450.00    $3,450.00   084420   LOS MAGNETIC RES IMAGING RV
44210007    MRA NEC W/O CON                        $3,450.00    $3,450.00   084420   LOS MAGNETIC RES IMAGING RV
44210009    MRA NEC W-W/O CON                      $6,846.00    $6,846.00   084420   LOS MAGNETIC RES IMAGING RV
44210061    MRA PELV W CON                         $3,602.00    $3,602.00   084420   LOS MAGNETIC RES IMAGING RV


7/11/2012                                                                                                          33
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44210025    MRA SPNAL CANAL W-W/O CON              $3,616.00    $3,616.00   084420   LOS MAGNETIC RES IMAGING RV
358039998   NEWBORN BOARDER BABY                     $967.00      $967.00   083170   LOS NURSERY REV
358039999   NEWBORN LEVEL I                        $1,078.00    $1,078.00   083170   LOS NURSERY REV
358040000   NEWBORN LEVEL II                       $2,493.00    $2,493.00   083170   LOS NURSERY REV
358040001   NEWBORN LEVEL III                      $2,390.00    $2,390.00   083170   LOS NURSERY REV
358040002   NEWBORN LEVEL IV                       $4,238.00    $4,238.00   083170   LOS NURSERY REV
443030008   DIRECT ADMIT OBSERVATION                 $276.00      $276.00   083087   LOS OBSERVATION-DHS RV
443030007   OBSERVATION PER HOUR                     $110.00      $110.00   083087   LOS OBSERVATION-DHS RV
338030000   ROOM OB/MATERNAL                       $2,008.00    $2,008.00   083160   LOS OBSTETRIC REV
75047050    ABCIXIMAB 2MG/ML 5ML VIAL              $1,372.38    $1,372.38   084170   LOS PHARMACY REV
75004929    ACAMPROSATE CALCIUM 333MG                 $15.52       $15.52   084170   LOS PHARMACY REV
75001735    ACARBOSE 50MG TAB                         $15.66       $15.66   084170   LOS PHARMACY REV
75034165    ACEBUTOLOL 200MG CAP                      $16.02       $16.02   084170   LOS PHARMACY REV
75034181    ACEBUTOLOL 400MG CAP                      $16.68       $16.68   084170   LOS PHARMACY REV
75072041    ACEMANNAN GEL 3OZ                         $54.22       $54.22   084170   LOS PHARMACY REV
75008730    ACETAZOLAMIDE 250MG TAB                   $14.88       $14.88   084170   LOS PHARMACY REV
75002113    ACETAZOLAMIDE 500MG TAB                   $17.84       $17.84   084170   LOS PHARMACY REV
75052720    ACETAZOLAMIDE INJ                        $102.00      $102.00   084170   LOS PHARMACY REV
75070557    ACETIC ACID 250ML                         $38.92       $38.92   084170   LOS PHARMACY REV
75096925    ACETYLCHOLINE OPTH 2ML                   $110.32      $110.32   084170   LOS PHARMACY REV
75046482    ACETYLCHOLINE-E 2ML                      $123.86      $123.86   084170   LOS PHARMACY REV
75096974    ACETYLCYSTEINE 10% 4ML                    $24.62       $24.62   084170   LOS PHARMACY REV
75096990    ACETYLCYSTEINE 20% 10ML                   $30.30       $30.30   084170   LOS PHARMACY REV
75097006    ACETYLCYSTEINE 20% 30ML                   $43.62       $43.62   084170   LOS PHARMACY REV
75096982    ACETYLCYSTEINE 20% 4ML                    $27.12       $27.12   084170   LOS PHARMACY REV
75047746    ACETYLCYSTEINE 6G/30ML IJ                $393.00      $393.00   084170   LOS PHARMACY REV
75045229    ACYCLOVIR 200MG CAP                       $17.62       $17.62   084170   LOS PHARMACY REV
75001834    ACYCLOVIR 200MG/5ML SUSP                  $16.70       $16.70   084170   LOS PHARMACY REV
75090019    ACYCLOVIR 5% OINT 3GM                    $131.08      $131.08   084170   LOS PHARMACY REV
75069971    ACYCLOVIR 500MG/10ML IJ                  $260.90      $260.90   084170   LOS PHARMACY REV
75045237    ACYCLOVIR 800MG TAB                       $22.42       $22.42   084170   LOS PHARMACY REV
75089896    ACYCLOVIR OINT 15GM                      $199.42      $199.42   084170   LOS PHARMACY REV
75046409    ADENOSINE 6 MG RX IJ                     $194.88      $194.88   084170   LOS PHARMACY REV
75047753    ADENOSINE 90MG/30ML VIAL                 $560.00      $560.00   084170   LOS PHARMACY REV
75073445    AL SO4 PWD                                $58.22       $58.22   084170   LOS PHARMACY REV
75046375    ALBUMIN 25% 100ML                        $438.00      $438.00   084170   LOS PHARMACY REV


7/11/2012                                                                                                          34
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75046359    ALBUMIN 25%/20ML                         $363.00      $363.00   084170   LOS PHARMACY REV
75046367    ALBUMIN 25%/50ML                         $463.00      $463.00   084170   LOS PHARMACY REV
75046342    ALBUMIN 5% 500ML                         $643.00      $643.00   084170   LOS PHARMACY REV
75046334    ALBUMIN 5%/250ML                         $463.00      $463.00   084170   LOS PHARMACY REV
75046326    ALBUMIN 5%/50ML IV                       $198.28      $198.28   084170   LOS PHARMACY REV
75065789    ALBUMIN HUM MICROSPHERES                 $344.30      $344.30   084170   LOS PHARMACY REV
75094367    ALBUTEROL 0.5% IN 20ML                    $47.00       $47.00   084170   LOS PHARMACY REV
75094433    ALBUTEROL 0.83% IN 3ML UD                 $18.10       $18.10   084170   LOS PHARMACY REV
75094771    ALBUTEROL 2.5MG/0.5ML UD                  $16.46       $16.46   084170   LOS PHARMACY REV
75000208    ALBUTEROL 2MG TAB                         $15.44       $15.44   084170   LOS PHARMACY REV
75000232    ALBUTEROL 4MG TAB                         $16.06       $16.06   084170   LOS PHARMACY REV
75096834    ALBUTEROL HFA INH 6.7GM                  $115.92      $115.92   084170   LOS PHARMACY REV
75094409    ALBUTEROL INHALER 17GM                   $111.62      $111.62   084170   LOS PHARMACY REV
75029942    ALBUTEROL LIQ 5ML                         $39.18       $39.18   084170   LOS PHARMACY REV
75029991    ALBUTEROL REPETAB                         $16.20       $16.20   084170   LOS PHARMACY REV
75001883    ALBUTEROL SO4 4MG ER TAB                  $16.18       $16.18   084170   LOS PHARMACY REV
75001669    ALENDRONATE 10MG TAB                      $19.24       $19.24   084170   LOS PHARMACY REV
75001495    ALENDRONATE 35MG TAB                      $51.50       $51.50   084170   LOS PHARMACY REV
75001800    ALENDRONATE 70MG TAB                      $52.50       $52.50   084170   LOS PHARMACY REV
75046425    ALFENTANIL INJ 5ML                       $116.38      $116.38   084170   LOS PHARMACY REV
75002741    ALFUZOSIN 10MG TAB                        $18.94       $18.94   084170   LOS PHARMACY REV
75045161    ALLOPURINOL 100MG TAB                     $14.34       $14.34   084170   LOS PHARMACY REV
75045179    ALLOPURINOL 300MG TAB                     $15.56       $15.56   084170   LOS PHARMACY REV
75000950    ALOH 360ML                                $33.08       $33.08   084170   LOS PHARMACY REV
75044107    ALPRAZOLAM 0.25MG TB                      $30.14       $30.14   084170   LOS PHARMACY REV
75044099    ALPRAZOLAM 0.5MG TAB                      $30.66       $30.66   084170   LOS PHARMACY REV
75044115    ALPRAZOLAM 1MG TAB                        $31.56       $31.56   084170   LOS PHARMACY REV
75066266    ALPROSTADIL PED 500MCG VL                $345.00      $345.00   084170   LOS PHARMACY REV
75046292    ALTEPLASE 100MG VIAL TPA               $6,922.56    $6,922.56   084170   LOS PHARMACY REV
75047654    ALTEPLASE 2MG/2ML IJ SYRG                $275.22      $275.22   084170   LOS PHARMACY REV
75068908    ALTEPLASE 50MG VIAL TPA                $3,269.06    $3,269.06   084170   LOS PHARMACY REV
75035469    AMANTADINE 100MG CAP                      $15.20       $15.20   084170   LOS PHARMACY REV
75035477    AMANTADINE 100MG/10ML LIQ                 $62.68       $62.68   084170   LOS PHARMACY REV
75046961    AMIFOSTINE 500MG IJ                    $1,578.56    $1,578.56   084170   LOS PHARMACY REV
75046516    AMIKACIN 500MG VIAL                      $238.00      $238.00   084170   LOS PHARMACY REV
75022376    AMILORIDE HCL 5MG TAB                     $14.96       $14.96   084170   LOS PHARMACY REV


7/11/2012                                                                                               35
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75021246    AMILORIDE HCL TAB 5/50                   $14.84       $14.84   084170   LOS PHARMACY REV
44611549    AMINO ACIDS 10% 500ML                   $257.30      $257.30   084170   LOS PHARMACY REV
44611606    AMINO ACIDS 15% 2000ML                  $253.08      $253.08   084170   LOS PHARMACY REV
75046474    AMINOCAPROIC AC INJ 5GM                 $116.36      $116.36   084170   LOS PHARMACY REV
75000760    AMINOPHYLLINE 200MG TAB                  $14.14       $14.14   084170   LOS PHARMACY REV
75046557    AMINOPHYLLINE 250MG IJ VL               $114.58      $114.58   084170   LOS PHARMACY REV
75046581    AMINOPHYLLINE 500MG IJ VL               $114.96      $114.96   084170   LOS PHARMACY REV
75047308    AMIODARONE 150/3ML IJ AMP               $324.42      $324.42   084170   LOS PHARMACY REV
75002618    AMIODARONE 400MG TAB                     $28.12       $28.12   084170   LOS PHARMACY REV
75006676    AMIODARONE TAB 200MG TAB                 $22.10       $22.10   084170   LOS PHARMACY REV
75011213    AMITRIPTYLINE 100MG TAB                  $16.22       $16.22   084170   LOS PHARMACY REV
75011171    AMITRIPTYLINE 10MG TAB                   $14.36       $14.36   084170   LOS PHARMACY REV
75011221    AMITRIPTYLINE 150MG TAB                  $18.84       $18.84   084170   LOS PHARMACY REV
75011189    AMITRIPTYLINE 25MG TAB                   $14.74       $14.74   084170   LOS PHARMACY REV
75011197    AMITRIPTYLINE 50MG TAB                   $15.30       $15.30   084170   LOS PHARMACY REV
75011205    AMITRIPTYLINE 75MG TAB                   $15.80       $15.80   084170   LOS PHARMACY REV
75025395    AMLODIPINE 10MG TAB                      $18.34       $18.34   084170   LOS PHARMACY REV
75001545    AMLODIPINE 5MG TABLET                    $17.10       $17.10   084170   LOS PHARMACY REV
75002055    AMLODIPINE/BENAZ 10/20MG                 $20.72       $20.72   084170   LOS PHARMACY REV
75000869    AMOXICILLIN 125/5 LIQ UD                 $16.00       $16.00   084170   LOS PHARMACY REV
75000893    AMOXICILLIN 250/5 LIQ UD                 $14.58       $14.58   084170   LOS PHARMACY REV
75000919    AMOXICILLIN 250/5ML 150ML                $33.64       $33.64   084170   LOS PHARMACY REV
75000836    AMOXICILLIN 250MG CAP                    $14.52       $14.52   084170   LOS PHARMACY REV
75001404    AMOXICILLIN 250MG CHEW TB                $14.74       $14.74   084170   LOS PHARMACY REV
75000844    AMOXICILLIN 500MG CAP                    $14.98       $14.98   084170   LOS PHARMACY REV
75047670    AMPHO B LIPOSOME                        $505.50      $505.50   084170   LOS PHARMACY REV
75046714    AMPHOTERICIN B 50 MG IJ                 $153.90      $153.90   084170   LOS PHARMACY REV
75046730    AMPICILLIN 125MG IJ                     $116.16      $116.16   084170   LOS PHARMACY REV
75046771    AMPICILLIN 1GM IJ                       $122.76      $122.76   084170   LOS PHARMACY REV
75047712    AMPICILLIN 1GM KIT                      $122.76      $122.76   084170   LOS PHARMACY REV
75000984    AMPICILLIN 250MG CAP                     $14.42       $14.42   084170   LOS PHARMACY REV
75046748    AMPICILLIN 250MG IJ                     $116.24      $116.24   084170   LOS PHARMACY REV
75001057    AMPICILLIN 250MG/5ML LIQ                 $14.90       $14.90   084170   LOS PHARMACY REV
75046789    AMPICILLIN 2GM IJ                       $132.50      $132.50   084170   LOS PHARMACY REV
75047720    AMPICILLIN 2GM KIT                      $122.18      $122.18   084170   LOS PHARMACY REV
75001008    AMPICILLIN 500MG CAP                     $14.72       $14.72   084170   LOS PHARMACY REV


7/11/2012                                                                                              36
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75046755    AMPICILLIN 500MG IJ                      $116.48      $116.48   084170   LOS PHARMACY REV
75069278    AMPICILLIN/SULB INJ 1.5GM                $129.28      $129.28   084170   LOS PHARMACY REV
75002477    ANAGRELIDE HCL 0.5MG CAP                  $26.40       $26.40   084170   LOS PHARMACY REV
75001610    ANASTROZOLE 1MG TAB                       $29.62       $29.62   084170   LOS PHARMACY REV
75047738    ANTITHROMBIN 3 VL IJ                   $2,753.20    $2,753.20   084170   LOS PHARMACY REV
75051177    ANTIVENIN CROTAL INJ VIAL              $2,336.00    $2,336.00   084170   LOS PHARMACY REV
75047043    ANTIVENIN SPIDER                         $121.80      $121.80   084170   LOS PHARMACY REV
75070185    ANUSOL 30GM OINT                          $35.54       $35.54   084170   LOS PHARMACY REV
75091157    ANUSOL SUP                                $14.80       $14.80   084170   LOS PHARMACY REV
75091025    APAP 10GR SUPP                            $14.78       $14.78   084170   LOS PHARMACY REV
75038455    APAP 10ML LIQ                             $15.08       $15.08   084170   LOS PHARMACY REV
75038604    APAP 25ML LIQ                             $15.38       $15.38   084170   LOS PHARMACY REV
75091009    APAP 2GR SUPP                             $14.76       $14.76   084170   LOS PHARMACY REV
75038414    APAP 325MG TAB                             $0.00        $0.00   084170   LOS PHARMACY REV
75038497    APAP 500MG TAB                             $0.00        $0.00   084170   LOS PHARMACY REV
75091017    APAP 5GR SUPP                             $14.88       $14.88   084170   LOS PHARMACY REV
75038448    APAP 5ML LIQ                              $14.96       $14.96   084170   LOS PHARMACY REV
75038430    APAP DRP 15ML                             $17.74       $17.74   084170   LOS PHARMACY REV
75038695    APAP ELIX 160MG/5ML 120ML                 $28.26       $28.26   084170   LOS PHARMACY REV
75045716    APAP/COD #3 TAB W/C                        $0.00        $0.00   084170   LOS PHARMACY REV
75038588    APAP/COD 12.5ML                           $29.14       $29.14   084170   LOS PHARMACY REV
75038521    APAP/COD 30MG TAB                         $28.72       $28.72   084170   LOS PHARMACY REV
75038539    APAP/COD 60MG TAB                         $29.82       $29.82   084170   LOS PHARMACY REV
75027912    APAP/OXYCOD 5MG TAB                       $28.88       $28.88   084170   LOS PHARMACY REV
75030262    APAP/OXYCOD 7.5MG TAB                     $29.94       $29.94   084170   LOS PHARMACY REV
75008177    APAP/PROPOX NAP 100 TAB                   $30.18       $30.18   084170   LOS PHARMACY REV
75045724    APAP/PROPOX NAP 100 W/C                    $0.00        $0.00   084170   LOS PHARMACY REV
75096297    APRACLONIDINE OP 1% .25ML                 $50.98       $50.98   084170   LOS PHARMACY REV
75002592    APREPITANT 125MG CAP                     $283.24      $283.24   084170   LOS PHARMACY REV
75002667    APREPITANT 80MG CAP                      $226.74      $226.74   084170   LOS PHARMACY REV
75068148    APROTININ 1 MU/ML 100ML                  $695.18      $695.18   084170   LOS PHARMACY REV
75068189    APROTININ 1 MU/ML 200ML                $1,245.02    $1,245.02   084170   LOS PHARMACY REV
75047183    ARGATROBAN 250MG/2.5ML IJ              $2,391.68    $2,391.68   084170   LOS PHARMACY REV
75002725    ARIPIPRAZOLE 10MG TAB                     $39.62       $39.62   084170   LOS PHARMACY REV
75002709    ARIPIPRAZOLE 5MG TAB                      $39.62       $39.62   084170   LOS PHARMACY REV
75047704    ARSENIC TRIOX 10MG IJ                  $1,295.00    $1,295.00   084170   LOS PHARMACY REV


7/11/2012                                                                                               37
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75091199    ASA 300MG SUPP                           $14.72       $14.72   084170   LOS PHARMACY REV
75001990    ASA 325MG TAB                             $0.00        $0.00   084170   LOS PHARMACY REV
75091207    ASA 600 MG SUPP                          $14.70       $14.70   084170   LOS PHARMACY REV
75001982    ASA 81MG TAB                              $0.00        $0.00   084170   LOS PHARMACY REV
75016212    ASA 81MG TABLET                           $0.00        $0.00   084170   LOS PHARMACY REV
75003731    ASA BUFFERED TAB                          $0.00        $0.00   084170   LOS PHARMACY REV
75001891    ASA BUFFERED TAB                          $0.00        $0.00   084170   LOS PHARMACY REV
75002014    ASA EC 325MG TAB                          $0.00        $0.00   084170   LOS PHARMACY REV
75012385    ASA/APAP/CAFF EXT/S TAB                  $14.10       $14.10   084170   LOS PHARMACY REV
75045567    ASA/CARISOPROD 350MG W/C                  $0.00        $0.00   084170   LOS PHARMACY REV
75002550    ASA/DIPYR 200MG/25MG TAB                 $18.18       $18.18   084170   LOS PHARMACY REV
75027938    ASA/OXYCOD TAB                           $30.40       $30.40   084170   LOS PHARMACY REV
75001859    ASCORBIC ACID 250MG TAB                  $14.06       $14.06   084170   LOS PHARMACY REV
75049908    ASCORBIC ACID 500MG AMP                 $152.36      $152.36   084170   LOS PHARMACY REV
75001867    ASCORBIC ACID 500MG TAB                  $14.08       $14.08   084170   LOS PHARMACY REV
75055046    ASPARAGINASE 10000U IJ                  $626.84      $626.84   084170   LOS PHARMACY REV
75036509    ATENOLOL 100MG TAB                       $16.74       $16.74   084170   LOS PHARMACY REV
75038893    ATENOLOL 25MG TAB                        $15.60       $15.60   084170   LOS PHARMACY REV
75036517    ATENOLOL 50MG TAB                        $16.24       $16.24   084170   LOS PHARMACY REV
75020297    ATORVASTATIN 10MG TAB                    $18.94       $18.94   084170   LOS PHARMACY REV
75020305    ATORVASTATIN 20MG TAB                    $22.26       $22.26   084170   LOS PHARMACY REV
75020313    ATORVASTATIN 40MG TAB                    $21.28       $21.28   084170   LOS PHARMACY REV
75068999    ATRACURIUM 100MG INJ                    $225.78      $225.78   084170   LOS PHARMACY REV
75047381    ATROPINE 0.4MG/ML 1ML VL                 $57.88       $57.88   084170   LOS PHARMACY REV
75047605    ATROPINE 0.4MG/ML 20ML VL               $119.00      $119.00   084170   LOS PHARMACY REV
75047431    ATROPINE 0.5MG/5ML JECT                  $60.96       $60.96   084170   LOS PHARMACY REV
75094680    ATROPINE 1% OPTH 15ML                    $36.92       $36.92   084170   LOS PHARMACY REV
75094664    ATROPINE 1% OPTH 1ML                     $24.88       $24.88   084170   LOS PHARMACY REV
75094672    ATROPINE 1% OPTH 5ML                     $33.88       $33.88   084170   LOS PHARMACY REV
75047449    ATROPINE 1MG/10ML JECT                   $62.26       $62.26   084170   LOS PHARMACY REV
75047415    ATROPINE 1MG/ML 1ML VIAL                 $57.98       $57.98   084170   LOS PHARMACY REV
75045617    AUGMENTIN 125MG/5ML                      $63.28       $63.28   084170   LOS PHARMACY REV
75045625    AUGMENTIN 250/5 LIQ 5ML                  $98.02       $98.02   084170   LOS PHARMACY REV
75002394    AUGMENTIN 250MG TAB                      $20.10       $20.10   084170   LOS PHARMACY REV
75002428    AUGMENTIN 250MG/5ML 75ML                $119.92      $119.92   084170   LOS PHARMACY REV
75002535    AUGMENTIN 400/5 LIQ 5ML                  $95.22       $95.22   084170   LOS PHARMACY REV


7/11/2012                                                                                              38
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75002543    AUGMENTIN 400/5 LIQ 10ML                 $95.22       $95.22   084170   LOS PHARMACY REV
75002402    AUGMENTIN 500MG TAB                      $22.96       $22.96   084170   LOS PHARMACY REV
75002469    AUGMENTIN 875MG TAB                      $25.96       $25.96   084170   LOS PHARMACY REV
75004937    AUGMENTIN XR 1000MG TAB                  $20.78       $20.78   084170   LOS PHARMACY REV
75094730    AURALGAN 15ML                            $67.72       $67.72   084170   LOS PHARMACY REV
75070607    AVEENO BATH PACKET                       $58.36       $58.36   084170   LOS PHARMACY REV
75017210    AZATHIOPRINE 50MG TAB                    $17.26       $17.26   084170   LOS PHARMACY REV
75096131    AZELASTINE NAS SPY 34ML                 $157.68      $157.68   084170   LOS PHARMACY REV
75045351    AZITHROMYCIN 200/5 10ML                  $83.78       $83.78   084170   LOS PHARMACY REV
75002527    AZITHROMYCIN 200/5 15ML                  $94.46       $94.46   084170   LOS PHARMACY REV
75047662    AZITHROMYCIN 200/5 30ML                  $97.78       $97.78   084170   LOS PHARMACY REV
75045336    AZITHROMYCIN 200/5 5ML                   $83.78       $83.78   084170   LOS PHARMACY REV
75045252    AZITHROMYCIN 250MG TAB                   $31.30       $31.30   084170   LOS PHARMACY REV
75047639    AZITHROMYCIN 500MG IJ VL                $174.38      $174.38   084170   LOS PHARMACY REV
75002451    AZITHROMYCIN SUS 1GM PKT                 $62.74       $62.74   084170   LOS PHARMACY REV
75047563    AZTREONAM 2GM IJ                        $209.92      $209.92   084170   LOS PHARMACY REV
75047555    AZTREONAM INJ 1GM                       $164.82      $164.82   084170   LOS PHARMACY REV
75091454    B&O 30MG SUPP                            $33.92       $33.92   084170   LOS PHARMACY REV
75091462    B&O 60MG SUPP                            $34.68       $34.68   084170   LOS PHARMACY REV
75084111    BACI/POLYMIX 15GM OINT                   $39.60       $39.60   084170   LOS PHARMACY REV
75097642    BACI/POLYMIX 3.75GM OINT                 $94.28       $94.28   084170   LOS PHARMACY REV
75084137    BACI/POLYMIX 30GM OINT                   $45.20       $45.20   084170   LOS PHARMACY REV
75048017    BACITRACIN 50MU VIAL                    $136.76      $136.76   084170   LOS PHARMACY REV
75071084    BACITRACIN OINT                          $33.80       $33.80   084170   LOS PHARMACY REV
75094847    BACITRACIN OPT OINT                      $37.50       $37.50   084170   LOS PHARMACY REV
75019505    BACLOFEN 10MG TAB                        $14.86       $14.86   084170   LOS PHARMACY REV
75048025    BACTRIM 80MG/ML IJ 10ML                 $130.42      $130.42   084170   LOS PHARMACY REV
75048041    BACTRIM 80MG/ML IJ 30ML                 $153.60      $153.60   084170   LOS PHARMACY REV
75003038    BACTRIM DS SUSP 20ML                     $17.40       $17.40   084170   LOS PHARMACY REV
75003046    BACTRIM TAB                              $16.06       $16.06   084170   LOS PHARMACY REV
75086082    BECAPLERMIN GEL 15GM                  $1,094.30    $1,094.30   084170   LOS PHARMACY REV
75099234    BECLOMETHASONE 40MCG INH                $141.80      $141.80   084170   LOS PHARMACY REV
75099242    BECLOMETHASONE 80MCG INH                $160.78      $160.78   084170   LOS PHARMACY REV
75098798    BECLOMETHASONE NAS 19GM                 $147.20      $147.20   084170   LOS PHARMACY REV
75094813    BECLOMETHASONE SPY 25GM                 $171.28      $171.28   084170   LOS PHARMACY REV
75003574    BENAZEPRIL 10MG TAB                      $16.34       $16.34   084170   LOS PHARMACY REV


7/11/2012                                                                                              39
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75020214    BENAZEPRIL 20/12.5 TAB                    $16.34       $16.34   084170   LOS PHARMACY REV
75020255    BENAZEPRIL 20MG TABLET                    $16.34       $16.34   084170   LOS PHARMACY REV
75020263    BENAZEPRIL 40MG TABLET                    $16.34       $16.34   084170   LOS PHARMACY REV
75020206    BENAZEPRIL 5MG TABLET                     $16.34       $16.34   084170   LOS PHARMACY REV
75004218    BENAZEPRIL/HCT 10/12.5MG                  $16.72       $16.72   084170   LOS PHARMACY REV
75083022    BENZOCAINE 10% 5.6GM JEL                  $34.60       $34.60   084170   LOS PHARMACY REV
75005587    BENZOCAINE LOZ                            $14.50       $14.50   084170   LOS PHARMACY REV
75070110    BENZOCAINE OINT                           $36.72       $36.72   084170   LOS PHARMACY REV
75077354    BENZOCAINE SPR 20% 60GM                   $85.98       $85.98   084170   LOS PHARMACY REV
75073122    BENZOCAINE SPR 20% 90GM                   $82.38       $82.38   084170   LOS PHARMACY REV
75071415    BENZOIN TR 120ML TOP                     $157.68      $157.68   084170   LOS PHARMACY REV
75036657    BENZONATATE 100MG CAP                     $16.26       $16.26   084170   LOS PHARMACY REV
75006312    BENZTROPINE 0.5MG TAB                     $14.44       $14.44   084170   LOS PHARMACY REV
75006320    BENZTROPINE 1MG TAB                       $14.76       $14.76   084170   LOS PHARMACY REV
75006338    BENZTROPINE 2MG TAB                       $14.82       $14.82   084170   LOS PHARMACY REV
75050302    BENZTROPINE 2MG/2ML IJ                    $73.44       $73.44   084170   LOS PHARMACY REV
75067900    BERACTANT 25MG/ML 4ML SDV              $1,070.50    $1,070.50   084170   LOS PHARMACY REV
75067884    BERACTANT 25MG/ML 8ML SDV              $1,751.88    $1,751.88   084170   LOS PHARMACY REV
75089243    BETAMETHASONE 15GM CRM                    $40.12       $40.12   084170   LOS PHARMACY REV
75049551    BETAMETHASONE 3MG/3ML MDV                 $97.94       $97.94   084170   LOS PHARMACY REV
75009720    BETAMETHASONE CRM 15GM                   $112.80      $112.80   084170   LOS PHARMACY REV
75071738    BETAMETHASONE OINT 45GM                   $76.56       $76.56   084170   LOS PHARMACY REV
75073395    BETAMETHASONE ONT                         $82.84       $82.84   084170   LOS PHARMACY REV
75049569    BETAMETHASONE SL 6MG/ML                  $117.78      $117.78   084170   LOS PHARMACY REV
75094581    BETAXOLOL OPH SLN                         $76.00       $76.00   084170   LOS PHARMACY REV
75094532    BETAXOLOL OPTH SOL 5ML                   $108.00      $108.00   084170   LOS PHARMACY REV
75040147    BETHANECHOL 10MG TAB                      $17.00       $17.00   084170   LOS PHARMACY REV
75040154    BETHANECHOL 25MG TAB                      $17.98       $17.98   084170   LOS PHARMACY REV
75048504    BEVACIZUMAB 100MG IJ                   $1,488.00    $1,488.00   084170   LOS PHARMACY REV
75048512    BEVACIZUMAB 400MG IJ                   $5,995.00    $5,995.00   084170   LOS PHARMACY REV
75003988    BICALUTAMIDE 50MG TAB                     $42.96       $42.96   084170   LOS PHARMACY REV
75098970    BIMATOPROST .03% OPT 5ML                 $276.38      $276.38   084170   LOS PHARMACY REV
75009837    BISACODYL 5MG TAB                         $14.10       $14.10   084170   LOS PHARMACY REV
75091488    BISACODYL SUP                             $15.42       $15.42   084170   LOS PHARMACY REV
75006775    BISACODYL TAB                             $14.20       $14.20   084170   LOS PHARMACY REV
75045294    BISOPROLOL/HCTZ 2.5MG TAB                 $17.46       $17.46   084170   LOS PHARMACY REV


7/11/2012                                                                                               40
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75045302    BISOPROLOL/HCTZ 5MG TAB                   $16.84       $16.84   084170   LOS PHARMACY REV
75048488    BIVALIRUDIN 250MG IJ                   $1,087.00    $1,087.00   084170   LOS PHARMACY REV
75048322    BLEOMYCIN 15U IJ                       $1,104.30    $1,104.30   084170   LOS PHARMACY REV
75097717    BLEPHAMIDE FORTE OP 10ML                 $127.10      $127.10   084170   LOS PHARMACY REV
75094938    BLEPHAMIDE OPTH 10% 10ML                 $159.20      $159.20   084170   LOS PHARMACY REV
75094920    BLEPHAMIDE OPTH 10% 5ML                  $116.42      $116.42   084170   LOS PHARMACY REV
75048496    BORTEZOMIB 3.5MG IJ                    $2,941.26    $2,941.26   084170   LOS PHARMACY REV
75048082    BOTULINUM 100U IJ                      $1,233.00    $1,233.00   084170   LOS PHARMACY REV
75094227    BRIMONIDINE 0.2% OPTH 5ML                $204.02      $204.02   084170   LOS PHARMACY REV
75096230    BRINZOLAMIDE 1% OPTH 5ML                  $94.00       $94.00   084170   LOS PHARMACY REV
75027342    BROMOCRIPTINE 2.5MG TAB                   $20.26       $20.26   084170   LOS PHARMACY REV
75094789    BSS SLN 15ML                              $41.38       $41.38   084170   LOS PHARMACY REV
75098913    BUDESONIDE 0.25MG/2ML RSP                 $23.50       $23.50   084170   LOS PHARMACY REV
75098905    BUDESONIDE 0.5MG/2ML RESP                 $25.20       $25.20   084170   LOS PHARMACY REV
75004192    BUDESONIDE EC 3MG CAP                     $23.08       $23.08   084170   LOS PHARMACY REV
75098780    BUDESONIDE INH 200MET DS                 $330.00      $330.00   084170   LOS PHARMACY REV
75098996    BUDESONIDE NASAL SPRY                    $202.86      $202.86   084170   LOS PHARMACY REV
75048447    BUMETANIDE 0.25MG/ML IJ                   $60.26       $60.26   084170   LOS PHARMACY REV
75048454    BUMETANIDE 0.5MG INJ                      $60.94       $60.94   084170   LOS PHARMACY REV
75048470    BUMETANIDE INJ 1MG/4ML                    $60.50       $60.50   084170   LOS PHARMACY REV
75004077    BUMETANIDE TAB 0.5MG                      $14.90       $14.90   084170   LOS PHARMACY REV
75004085    BUMETANIDE TAB 1MG                        $15.26       $15.26   084170   LOS PHARMACY REV
75062372    BUPIV/EPI 0.25% 10ML VL                   $64.38       $64.38   084170   LOS PHARMACY REV
75062182    BUPIV/EPI 0.25% 30ML                      $69.62       $69.62   084170   LOS PHARMACY REV
75062448    BUPIV/EPI 0.5% 10ML VIAL                  $65.04       $65.04   084170   LOS PHARMACY REV
75062208    BUPIV/EPI 0.5% IJ                         $76.68       $76.68   084170   LOS PHARMACY REV
75062133    BUPIVACAINE 0.25% 10ML                    $63.40       $63.40   084170   LOS PHARMACY REV
75062166    BUPIVACAINE 0.25% 30ML VL                 $62.28       $62.28   084170   LOS PHARMACY REV
75062174    BUPIVACAINE 0.25% 50ML IJ                 $75.90       $75.90   084170   LOS PHARMACY REV
75062158    BUPIVACAINE 0.5% 10ML VL                  $62.26       $62.26   084170   LOS PHARMACY REV
75062190    BUPIVACAINE 0.5% 30ML VL                  $61.70       $61.70   084170   LOS PHARMACY REV
75062216    BUPIVACAINE 0.5% 50ML VL                  $66.00       $66.00   084170   LOS PHARMACY REV
75067314    BUPIVACAINE 0.75% PF 10ML                 $66.60       $66.60   084170   LOS PHARMACY REV
75062117    BUPIVACAINE SPINL 2ML AMP                 $62.42       $62.42   084170   LOS PHARMACY REV
75048462    BUPRENORPHINE 0.3MG/ML IJ                 $64.52       $64.52   084170   LOS PHARMACY REV
75043125    BUPROPION 100MG TAB                       $16.88       $16.88   084170   LOS PHARMACY REV


7/11/2012                                                                                               41
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75043133    BUPROPION 75 MG TAB                      $16.16       $16.16   084170   LOS PHARMACY REV
75004200    BUPROPION SR 100MG TAB                   $19.32       $19.32   084170   LOS PHARMACY REV
75043141    BUPROPION SR 150MG TAB                   $18.02       $18.02   084170   LOS PHARMACY REV
75004184    BUPROPION XL 150MG TAB                   $22.02       $22.02   084170   LOS PHARMACY REV
75003673    BUPROPION XL 300MG PO                    $24.60       $24.60   084170   LOS PHARMACY REV
75003962    BUSPIRONE TAB 10MG                       $17.04       $17.04   084170   LOS PHARMACY REV
75003921    BUSPIRONE TAB 5MG                        $15.76       $15.76   084170   LOS PHARMACY REV
75067538    BUTORPHANOL 2MG VL                      $102.56      $102.56   084170   LOS PHARMACY REV
75067546    BUTORPHANOL 4MG VL                       $82.50       $82.50   084170   LOS PHARMACY REV
75098095    BUTORPHANOL NAS SP 2.5ML                $178.50      $178.50   084170   LOS PHARMACY REV
75005041    CA ACET 667MG TAB                        $14.46       $14.46   084170   LOS PHARMACY REV
75038265    CA CARB 12 TAB ROLL                      $28.06       $28.06   084170   LOS PHARMACY REV
75005744    CA CARB 1250MG/5ML U.D                   $15.18       $15.18   084170   LOS PHARMACY REV
75005082    CA CARB 1500MG TAB                       $14.20       $14.20   084170   LOS PHARMACY REV
75005033    CA CARB 650MG TAB                        $14.04       $14.04   084170   LOS PHARMACY REV
75038232    CA CARB ROLL                             $28.08       $28.08   084170   LOS PHARMACY REV
75005801    CA CARB SUSP 1250MG/5ML                  $38.74       $38.74   084170   LOS PHARMACY REV
75022897    CA CARB TAB                              $14.18       $14.18   084170   LOS PHARMACY REV
75026393    CA CARB TAB                              $14.18       $14.18   084170   LOS PHARMACY REV
75026476    CA CARB/VIT D 500MG TB                   $14.24       $14.24   084170   LOS PHARMACY REV
75026385    CA CARB/VIT D TAB                        $14.12       $14.12   084170   LOS PHARMACY REV
75007450    CA CIT TABLET                            $14.14       $14.14   084170   LOS PHARMACY REV
75007906    CA CIT/VITD TAB                          $14.22       $14.22   084170   LOS PHARMACY REV
75049007    CA CL INJ 10ML                          $114.58      $114.58   084170   LOS PHARMACY REV
75049015    CA CL JECT                               $62.60       $62.60   084170   LOS PHARMACY REV
75005058    CA GLUCONATE 500MG                       $14.32       $14.32   084170   LOS PHARMACY REV
75049023    CA GLUCONATE INJ                        $114.78      $114.78   084170   LOS PHARMACY REV
75051194    CAFF CIT 60MG/3ML IJ                    $147.38      $147.38   084170   LOS PHARMACY REV
75051219    CAFF NA BENZ 500MG IJ                   $135.50      $135.50   084170   LOS PHARMACY REV
75006023    CAFFEINE 10MG/ML ORAL SYR                $57.56       $57.56   084170   LOS PHARMACY REV
75072017    CALADRYL LTN                             $29.80       $29.80   084170   LOS PHARMACY REV
75072033    CALAMINE LTN                             $29.80       $29.80   084170   LOS PHARMACY REV
75072819    CALCIPOTRIENE .005% 60GM                $403.64      $403.64   084170   LOS PHARMACY REV
75049064    CALCITONIN INJ                          $147.90      $147.90   084170   LOS PHARMACY REV
75097634    CALCITONIN NAS SP 2ML                   $226.18      $226.18   084170   LOS PHARMACY REV
75032722    CALCITRIOL 0.25MCG CAP                   $16.84       $16.84   084170   LOS PHARMACY REV


7/11/2012                                                                                              42
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75032730    CALCITRIOL 0.5MCG CAP                     $18.48       $18.48   084170   LOS PHARMACY REV
75049056    CALCITRIOL INJ 1MCG                       $87.62       $87.62   084170   LOS PHARMACY REV
75072066    CALMOSEPTINE OINT 120GM                   $38.00       $38.00   084170   LOS PHARMACY REV
75002493    CANDESARTAN 4MG TAB                       $17.08       $17.08   084170   LOS PHARMACY REV
75002501    CANDESARTAN 8MG TAB                       $17.08       $17.08   084170   LOS PHARMACY REV
75007195    CANDIDA SKN TST INJ                       $91.20       $91.20   084170   LOS PHARMACY REV
75005943    CAPECITABINE 500MG TAB                    $39.26       $39.26   084170   LOS PHARMACY REV
75072207    CAPSAICIN 0.75% CRM 60GM                 $110.90      $110.90   084170   LOS PHARMACY REV
75072025    CAPSAICIN OINT 45GM                       $47.90       $47.90   084170   LOS PHARMACY REV
75005363    CAPTOPRIL 12.5MG TAB                      $16.44       $16.44   084170   LOS PHARMACY REV
75005215    CAPTOPRIL 25MG TAB                        $16.64       $16.64   084170   LOS PHARMACY REV
75005223    CAPTOPRIL 50MG TAB                        $18.54       $18.54   084170   LOS PHARMACY REV
75005512    CAPTOPRIL/HCTZ 25/15 TAB                  $16.68       $16.68   084170   LOS PHARMACY REV
75036400    CARBAMAZEPINE 100MG TAB                   $14.70       $14.70   084170   LOS PHARMACY REV
75036434    CARBAMAZEPINE 200/10ML LQ                 $28.86       $28.86   084170   LOS PHARMACY REV
75036392    CARBAMAZEPINE 200MG TAB                   $15.28       $15.28   084170   LOS PHARMACY REV
75007716    CARBAMAZEPINE XR 100MG TB                 $16.40       $16.40   084170   LOS PHARMACY REV
75007724    CARBAMAZEPINE XR 200MG TB                 $16.40       $16.40   084170   LOS PHARMACY REV
75072777    CARBAMIDE PEROX OTIC 15ML                 $32.96       $32.96   084170   LOS PHARMACY REV
75007898    CARBIDOPA/LEVODOPA 25/100                 $15.88       $15.88   084170   LOS PHARMACY REV
75013532    CARBONYL IRON 50MG CAP                    $14.38       $14.38   084170   LOS PHARMACY REV
75013037    CARBONYL IRON LIQ 5ML                     $30.48       $30.48   084170   LOS PHARMACY REV
75004663    CARBOPLATIN 150MG INJ                  $1,518.92    $1,518.92   084170   LOS PHARMACY REV
75049213    CARBOPLATIN 450MG INJ                  $3,566.80    $3,566.80   084170   LOS PHARMACY REV
75066217    CARBOPROST 1ML AMP                       $175.86      $175.86   084170   LOS PHARMACY REV
44611622    CARDIOPLGIC SOL TOB 1L                   $496.40      $496.40   084170   LOS PHARMACY REV
44611556    CARDIOPLGIC SOL VH 765ML                 $887.00      $887.00   084170   LOS PHARMACY REV
75034850    CARISOPRODOL TAB 350MG                    $21.50       $21.50   084170   LOS PHARMACY REV
75098897    CARTEOLOL HCL 1% 5ML DROP                 $67.28       $67.28   084170   LOS PHARMACY REV
75007666    CARVEDILOL 12.5MG TAB                     $17.60       $17.60   084170   LOS PHARMACY REV
75007732    CARVEDILOL 25MG TAB                       $17.60       $17.60   084170   LOS PHARMACY REV
75007500    CARVEDILOL 3.125MG TAB                    $17.60       $17.60   084170   LOS PHARMACY REV
75007518    CARVEDILOL 6.25MG TAB                     $17.60       $17.60   084170   LOS PHARMACY REV
75051185    CASPOFUNGIN 50MG/10ML VAC                $912.70      $912.70   084170   LOS PHARMACY REV
75024422    CASTOR OIL 120ML LIQ                      $33.38       $33.38   084170   LOS PHARMACY REV
75005355    CASTOR OIL 30ML LIQ                       $34.18       $34.18   084170   LOS PHARMACY REV


7/11/2012                                                                                               43
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75005405    CEFACLOR 250MG CAP                       $18.66       $18.66   084170   LOS PHARMACY REV
75045658    CEFACLOR 250MG/5ML LQ DSE                $31.80       $31.80   084170   LOS PHARMACY REV
75005413    CEFACLOR 500MG CAP                       $21.80       $21.80   084170   LOS PHARMACY REV
75010090    CEFADROXIL 500MG CAP                     $21.74       $21.74   084170   LOS PHARMACY REV
75049395    CEFAZOLIN 1GM VIAL                      $119.00      $119.00   084170   LOS PHARMACY REV
75049387    CEFAZOLIN 500MG VIAL                    $117.40      $117.40   084170   LOS PHARMACY REV
75007930    CEFDINIR 125MG/5ML LIQ                   $36.60       $36.60   084170   LOS PHARMACY REV
75007922    CEFDINIR 300 MG                          $24.85       $24.85   084170   LOS PHARMACY REV
75063255    CEFEPIME 1GM INJ VIAL                   $149.16      $149.16   084170   LOS PHARMACY REV
75050815    CEFOPERAZONE 1GM INJ                    $149.00      $149.00   084170   LOS PHARMACY REV
75050120    CEFOTAXIME 1GM VL                       $134.20      $134.20   084170   LOS PHARMACY REV
75050138    CEFOTAXIME 2GM VL                       $157.48      $157.48   084170   LOS PHARMACY REV
75051011    CEFOTETAN 1GM INJ                       $310.46      $310.46   084170   LOS PHARMACY REV
75051029    CEFOTETAN 2GM INJ                       $486.66      $486.66   084170   LOS PHARMACY REV
75062257    CEFOXITIN 1GM VL                        $136.96      $136.96   084170   LOS PHARMACY REV
75062273    CEFOXITIN 2GM VL                        $160.74      $160.74   084170   LOS PHARMACY REV
75050997    CEFTAZIDIME 1GM VL                      $146.86      $146.86   084170   LOS PHARMACY REV
75051003    CEFTAZIDIME 2GM VL                      $175.30      $175.30   084170   LOS PHARMACY REV
75050880    CEFTIZOXIME 1GM VL                      $135.78      $135.78   084170   LOS PHARMACY REV
75050898    CEFTIZOXIME 2GM VL                      $155.28      $155.28   084170   LOS PHARMACY REV
75051102    CEFTRIAXONE 1000MG IM IJ                $215.22      $215.22   084170   LOS PHARMACY REV
75050971    CEFTRIAXONE 1GM IV INJ                  $219.58      $219.58   084170   LOS PHARMACY REV
75051086    CEFTRIAXONE 250MG IM INJ                $148.46      $148.46   084170   LOS PHARMACY REV
75051037    CEFTRIAXONE 250MG INJ                   $145.96      $145.96   084170   LOS PHARMACY REV
75050989    CEFTRIAXONE 2GM INJ                     $316.14      $316.14   084170   LOS PHARMACY REV
75051094    CEFTRIAXONE 500MG IM INJ                $172.74      $172.74   084170   LOS PHARMACY REV
75050963    CEFTRIAXONE 500MG INJ                   $172.74      $172.74   084170   LOS PHARMACY REV
75050955    CEFUROXIME 1.5GM IJ                     $145.32      $145.32   084170   LOS PHARMACY REV
75007401    CEFUROXIME TAB 250MG                     $24.76       $24.76   084170   LOS PHARMACY REV
75007419    CEFUROXIME TAB 500 MG                    $33.62       $33.62   084170   LOS PHARMACY REV
75007625    CELECOXIB 100MG CAP                      $17.62       $17.62   084170   LOS PHARMACY REV
75007633    CELECOXIB 200MG CAP                      $19.94       $19.94   084170   LOS PHARMACY REV
75072157    CEPACOL 180ML LIQ                        $28.50       $28.50   084170   LOS PHARMACY REV
75005603    CEPASTAT LOZ                             $14.28       $14.28   084170   LOS PHARMACY REV
75018200    CEPHALEXIN 125/5ML LIQ UD                $14.90       $14.90   084170   LOS PHARMACY REV
75018242    CEPHALEXIN 250/5ML 100ML                 $65.80       $65.80   084170   LOS PHARMACY REV


7/11/2012                                                                                              44
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75018234    CEPHALEXIN 250/5ML LIQ UD                 $14.38       $14.38   084170   LOS PHARMACY REV
75018184    CEPHALEXIN 250MG CAP                      $15.68       $15.68   084170   LOS PHARMACY REV
75018192    CEPHALEXIN 500MG CAP                      $17.52       $17.52   084170   LOS PHARMACY REV
75072181    CETACAINE APPL                           $154.08      $154.08   084170   LOS PHARMACY REV
75072199    CETACAINE SPY                            $154.08      $154.08   084170   LOS PHARMACY REV
75007658    CETIRIZINE 10MG TAB                       $18.22       $18.22   084170   LOS PHARMACY REV
75007641    CETIRIZINE 5MG TAB                        $18.22       $18.22   084170   LOS PHARMACY REV
75051193    CETUXIMAB 100MG IJ                     $1,695.00    $1,695.00   084170   LOS PHARMACY REV
75007484    CHARCOAL 25GM/120ML LIQ                   $38.56       $38.56   084170   LOS PHARMACY REV
75007492    CHARCOAL 50GM/240ML LIQ                   $35.80       $35.80   084170   LOS PHARMACY REV
75007468    CHARCOAL/SORB 25GM/120 LQ                 $39.86       $39.86   084170   LOS PHARMACY REV
75007476    CHARCOAL/SORB 50GM/240 LQ                 $36.60       $36.60   084170   LOS PHARMACY REV
75005884    CHLORASEPTIC LOZ                          $92.08       $92.08   084170   LOS PHARMACY REV
75072702    CHLORASEPTIC SPRAY                        $37.12       $37.12   084170   LOS PHARMACY REV
75019372    CHLORDIAZEPOXD 25MG CAP                   $28.46       $28.46   084170   LOS PHARMACY REV
75019356    CHLORDIAZEPOXD 5MG CAP                    $29.50       $29.50   084170   LOS PHARMACY REV
75077339    CHLORHEX GLUC 120ML TOP                   $33.54       $33.54   084170   LOS PHARMACY REV
75028068    CHLORHEX GLUC 480ML LIQ                   $39.60       $39.60   084170   LOS PHARMACY REV
75072801    CHLORHEX GLUC JELLY 4OZ                   $61.76       $61.76   084170   LOS PHARMACY REV
75063875    CHLOROPROCAINE 2% 30ML VL                $101.88      $101.88   084170   LOS PHARMACY REV
75063883    CHLOROPROCAINE 2% PF 30ML                 $99.12       $99.12   084170   LOS PHARMACY REV
75063891    CHLOROPROCAINE 3% PF 30ML                $108.72      $108.72   084170   LOS PHARMACY REV
75009456    CHLOROTHIAZIDE 250MG TAB                  $14.34       $14.34   084170   LOS PHARMACY REV
75053074    CHLOROTHIAZIDE 500MG INJ                 $133.26      $133.26   084170   LOS PHARMACY REV
75009464    CHLOROTHIAZIDE 500MG TAB                  $14.54       $14.54   084170   LOS PHARMACY REV
75005900    CHLORPHENIRAMIN 4MG TAB                   $14.06       $14.06   084170   LOS PHARMACY REV
75007807    CHLORPROMAZINE 100MG TAB                  $14.82       $14.82   084170   LOS PHARMACY REV
75007872    CHLORPROMAZINE 10MG TAB                   $14.70       $14.70   084170   LOS PHARMACY REV
75068551    CHLORPROMAZINE 25MG IJ                    $76.28       $76.28   084170   LOS PHARMACY REV
75037093    CHLORPROMAZINE 25MG TAB                   $15.38       $15.38   084170   LOS PHARMACY REV
75068569    CHLORPROMAZINE 50MG IJ                    $85.04       $85.04   084170   LOS PHARMACY REV
75037101    CHLORPROMAZINE 50MG TAB                   $15.72       $15.72   084170   LOS PHARMACY REV
75016667    CHLORTHALIDONE 25MG TAB                   $14.46       $14.46   084170   LOS PHARMACY REV
75016675    CHLORTHALIDONE 50MG TAB                   $14.38       $14.38   084170   LOS PHARMACY REV
75007823    CHOLECALCIFEROL 400U TAB                  $14.06       $14.06   084170   LOS PHARMACY REV
75007856    CHOLESTYRAMINE LHT 4GM PK                 $18.22       $18.22   084170   LOS PHARMACY REV


7/11/2012                                                                                               45
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75031062    CHOLESTYRAMINE PWD 4GM PK                 $19.58       $19.58   084170   LOS PHARMACY REV
75037994    CHOLINE SALICYL 500MG TAB                 $16.16       $16.16   084170   LOS PHARMACY REV
75038000    CHOLINE SALICYL 750MG TAB                 $16.66       $16.66   084170   LOS PHARMACY REV
75007849    CILOSTAZOL 100MG TAB                      $17.68       $17.68   084170   LOS PHARMACY REV
75068122    CIMETIDINE 300MG IJ                       $59.98       $59.98   084170   LOS PHARMACY REV
75036087    CIMETIDINE 300MG TAB                      $16.38       $16.38   084170   LOS PHARMACY REV
75036095    CIMETIDINE 300MG/5ML LIQ                 $206.20      $206.20   084170   LOS PHARMACY REV
75036103    CIMETIDINE 400 MG TAB                     $17.96       $17.96   084170   LOS PHARMACY REV
75036152    CIMETIDINE TAB 800MG                      $20.56       $20.56   084170   LOS PHARMACY REV
75007757    CINACALCET 30MG TAB                       $16.34       $16.34   084170   LOS PHARMACY REV
75099309    CIPRO 0.3% OPTH DRP 5ML                  $142.26      $142.26   084170   LOS PHARMACY REV
75006445    CIPRO 100MG/ML LIQ 5ML                   $290.98      $290.98   084170   LOS PHARMACY REV
75051060    CIPRO INJ 200MG/20ML                     $141.82      $141.82   084170   LOS PHARMACY REV
75051078    CIPRO INJ 400MG/40ML                     $173.02      $173.02   084170   LOS PHARMACY REV
75072082    CIPRO OTIC SUSP 10ML                     $193.38      $193.38   084170   LOS PHARMACY REV
75007336    CIPRO TAB 250MG                           $24.26       $24.26   084170   LOS PHARMACY REV
75007344    CIPRO TAB 500MG                           $25.98       $25.98   084170   LOS PHARMACY REV
75007351    CIPRO TAB 750MG                           $26.58       $26.58   084170   LOS PHARMACY REV
75064386    CISATRACURIUM 200MG/20ML                 $534.30      $534.30   084170   LOS PHARMACY REV
75064311    CISATRACURIUM 2MG/ML 10ML                $147.88      $147.88   084170   LOS PHARMACY REV
75065359    CISPLATIN 100MG IJ                     $1,494.96    $1,494.96   084170   LOS PHARMACY REV
75065334    CISPLATIN 10MG IJ                        $995.06      $995.06   084170   LOS PHARMACY REV
75065342    CISPLATIN 50MG IJ                        $995.06      $995.06   084170   LOS PHARMACY REV
75007526    CITALOPRAM 20MG TAB                       $19.32       $19.32   084170   LOS PHARMACY REV
75007534    CITALOPRAM 40MG TAB                       $19.56       $19.56   084170   LOS PHARMACY REV
75003459    CITRIC ACID 30ML LIQ                      $33.76       $33.76   084170   LOS PHARMACY REV
75061630    CLADRIBINE 1MG/ML IJ 10ML              $1,914.78    $1,914.78   084170   LOS PHARMACY REV
75004168    CLARITHROMYCIN 250/5 10ML                $119.12      $119.12   084170   LOS PHARMACY REV
75004135    CLARITHROMYCIN 250/5 5ML                 $170.26      $170.26   084170   LOS PHARMACY REV
75003640    CLARITHROMYCIN 250MG TAB                  $23.56       $23.56   084170   LOS PHARMACY REV
75003616    CLARITHROMYCIN 500MG TAB                  $23.04       $23.04   084170   LOS PHARMACY REV
75007914    CLARITHROMYCIN XL 500MG                   $25.12       $25.12   084170   LOS PHARMACY REV
75006064    CLINDAMYCIN 150MG CAP                     $19.18       $19.18   084170   LOS PHARMACY REV
75050161    CLINDAMYCIN 300MG IJ                     $120.48      $120.48   084170   LOS PHARMACY REV
75050187    CLINDAMYCIN 600MG IJ                      $65.58       $65.58   084170   LOS PHARMACY REV
75007864    CLINDAMYCIN 75MG/5ML LIQ                  $17.10       $17.10   084170   LOS PHARMACY REV


7/11/2012                                                                                               46
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75050245    CLINDAMYCIN 900MG IJ                    $133.42      $133.42   084170   LOS PHARMACY REV
75088179    CLOBETASOL 0.05% CRM 30GM                $99.72       $99.72   084170   LOS PHARMACY REV
75007369    CLOMIPRAIME HCL 25MG CAP                 $20.58       $20.58   084170   LOS PHARMACY REV
75007880    CLOMIPRAMINE 50MG CAP                    $16.28       $16.28   084170   LOS PHARMACY REV
75006163    CLONAZEPAM 0.5MG TAB                     $30.10       $30.10   084170   LOS PHARMACY REV
75006171    CLONAZEPAM 1MG TAB                       $30.40       $30.40   084170   LOS PHARMACY REV
75006189    CLONAZEPAM 2MG TAB                       $31.32       $31.32   084170   LOS PHARMACY REV
75005371    CLONIDINE 0.1MG TAB                      $15.82       $15.82   084170   LOS PHARMACY REV
75005389    CLONIDINE 0.2MG TAB                      $14.64       $14.64   084170   LOS PHARMACY REV
75005397    CLONIDINE 0.3MG TAB                      $17.48       $17.48   084170   LOS PHARMACY REV
75072744    CLONIDINE TTS-1 PATCH                    $43.12       $43.12   084170   LOS PHARMACY REV
75072751    CLONIDINE TTS-2 PATCH                    $63.04       $63.04   084170   LOS PHARMACY REV
75072769    CLONIDINE TTS-3 PATCH                    $84.86       $84.86   084170   LOS PHARMACY REV
75006635    CLOPIDOGREL 75MG TAB                     $23.36       $23.36   084170   LOS PHARMACY REV
75037648    CLORAZEPATE 7.5MG TAB                    $34.02       $34.02   084170   LOS PHARMACY REV
75080234    CLOTRI/BETAMETH 15GM CRM                 $80.66       $80.66   084170   LOS PHARMACY REV
75080259    CLOTRI/BETAMETH CRM 45GM                $141.40      $141.40   084170   LOS PHARMACY REV
75072793    CLOTRI/BETAMETH LTN 30ML                $191.74      $191.74   084170   LOS PHARMACY REV
75081554    CLOTRIMAZOLE 15GM CRM                    $37.36       $37.36   084170   LOS PHARMACY REV
75080176    CLOTRIMAZOLE 15GM CRM                    $47.54       $47.54   084170   LOS PHARMACY REV
75080184    CLOTRIMAZOLE 30GM CRM                    $83.06       $83.06   084170   LOS PHARMACY REV
75080192    CLOTRIMAZOLE 45GM CRM                   $152.16      $152.16   084170   LOS PHARMACY REV
75092346    CLOTRIMAZOLE CRM                         $42.40       $42.40   084170   LOS PHARMACY REV
75080218    CLOTRIMAZOLE SLN                         $45.96       $45.96   084170   LOS PHARMACY REV
75023200    CLOTRIMAZOLE TROCHE                      $17.60       $17.60   084170   LOS PHARMACY REV
75072355    COCAINE 10% TOP SL 1-4ML                $114.02      $114.02   084170   LOS PHARMACY REV
75072637    COCAINE 4% SOLN 4ML                      $78.36       $78.36   084170   LOS PHARMACY REV
75050286    CODEINE 30MG IJ                          $86.96       $86.96   084170   LOS PHARMACY REV
75050278    CODEINE 30MG IJ                          $86.96       $86.96   084170   LOS PHARMACY REV
75006288    CODEINE 30MG TAB                         $28.94       $28.94   084170   LOS PHARMACY REV
75006403    COLBENEMID TAB                           $15.68       $15.68   084170   LOS PHARMACY REV
75006429    COLCHICINE 0.5MG TAB                     $14.80       $14.80   084170   LOS PHARMACY REV
75006437    COLCHICINE 0.6MG TAB                     $14.64       $14.64   084170   LOS PHARMACY REV
75007831    COLESEVELAM 625MG TAB                    $16.10       $16.10   084170   LOS PHARMACY REV
75006411    COLESTIPOL PKT                           $17.78       $17.78   084170   LOS PHARMACY REV
75070524    COLLAGEN HEMOST 1 GM                    $283.72      $283.72   084170   LOS PHARMACY REV


7/11/2012                                                                                              47
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75070532    COLLAGEN HEMOST WEB                     $283.74      $283.74   084170   LOS PHARMACY REV
75072405    COLLAGENASE 30GM OINT                   $173.06      $173.06   084170   LOS PHARMACY REV
75015495    COLYTE PREP                             $133.00      $133.00   084170   LOS PHARMACY REV
75007765    COLYTE/BISACODYL PREP                   $125.50      $125.50   084170   LOS PHARMACY REV
75098681    COMBIVENT INH 14.7GM                    $187.80      $187.80   084170   LOS PHARMACY REV
75065631    CON PERFLUTREN LIP MIC ML               $329.06      $329.06   084170   LOS PHARMACY REV
75095448    CORTISPORIN 3.5GM OPTH                  $111.72      $111.72   084170   LOS PHARMACY REV
75095471    CORTISPORIN OTIC 1% 10ML                $146.72      $146.72   084170   LOS PHARMACY REV
75095455    CORTISPORIN SUS                         $148.08      $148.08   084170   LOS PHARMACY REV
75072652    CORTISPORIN UNG                         $134.10      $134.10   084170   LOS PHARMACY REV
75099226    COSOPT OPTH DROPS 5ML                   $128.76      $128.76   084170   LOS PHARMACY REV
75050500    COSYNTROPIN 0.25MG/ML VL                $151.40      $151.40   084170   LOS PHARMACY REV
75007609    CREON 10 CAP                             $15.96       $15.96   084170   LOS PHARMACY REV
75007617    CREON 20 CAP                             $17.80       $17.80   084170   LOS PHARMACY REV
75096354    CROMOLYN 20MG/2ML INH SLN                $16.44       $16.44   084170   LOS PHARMACY REV
75072785    CROMOLYN 4%NAS SPY 13ML                  $46.20       $46.20   084170   LOS PHARMACY REV
75096321    CROMOLYN INHALER 14.2GM                 $144.82      $144.82   084170   LOS PHARMACY REV
75051227    CYANIDE KIT                             $606.12      $606.12   084170   LOS PHARMACY REV
75050625    CYANOCOBALAMIN 1000MCG IJ               $114.28      $114.28   084170   LOS PHARMACY REV
75007682    CYANOCOBALAMIN 1000MCG TB                $14.12       $14.12   084170   LOS PHARMACY REV
75067674    CYANOCOBALAMIN 100MCG TAB                $58.28       $58.28   084170   LOS PHARMACY REV
75007997    CYANOCOBALAMIN 2500MCG TB                $13.25       $13.25   084170   LOS PHARMACY REV
75013433    CYCLOBENZAPRINE 10MG TAB                 $15.94       $15.94   084170   LOS PHARMACY REV
75045559    CYCLOBENZAPRINE 10MG W/C                  $0.00        $0.00   084170   LOS PHARMACY REV
75095588    CYCLOMYDRIL OPH 5ML                      $79.50       $79.50   084170   LOS PHARMACY REV
75095513    CYCLOPENTOLATE 1% 2ML OP                 $54.88       $54.88   084170   LOS PHARMACY REV
75007070    CYCLOPHOSPHAMID 25MG TAB                 $18.06       $18.06   084170   LOS PHARMACY REV
75050740    CYCLOPHOSPHAMID 500MG VL                $544.36      $544.36   084170   LOS PHARMACY REV
75007088    CYCLOPHOSPHAMID 50MG TAB                 $22.28       $22.28   084170   LOS PHARMACY REV
75007260    CYCLOSPORINE (S) 25MG CAP                $17.48       $17.48   084170   LOS PHARMACY REV
75025460    CYCLOSPORINE 100MG PO                    $26.22       $26.22   084170   LOS PHARMACY REV
75007815    CYCLOSPORINE 100MG PO                    $27.86       $27.86   084170   LOS PHARMACY REV
75051714    CYCLOSPORINE 250MG IJ                   $171.32      $171.32   084170   LOS PHARMACY REV
75025452    CYCLOSPORINE 25MG CAP                    $17.06       $17.06   084170   LOS PHARMACY REV
75028027    CYPROHEPTADINE 4MG TAB                   $14.96       $14.96   084170   LOS PHARMACY REV
75050641    CYTARABINE 100MG IJ                     $512.96      $512.96   084170   LOS PHARMACY REV


7/11/2012                                                                                              48
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75051136    CYTARABINE 2GM VIAL                     $595.02      $595.02   084170   LOS PHARMACY REV
75050682    CYTARABINE 500MG VL                     $566.28      $566.28   084170   LOS PHARMACY REV
75052563    D25W 10ML                                $69.72       $69.72   084170   LOS PHARMACY REV
44611572    D5 ISOLYTE P 500ML                      $135.02      $135.02   084170   LOS PHARMACY REV
75052670    D50W 50 ML                                $2.28        $2.28   084170   LOS PHARMACY REV
44611267    D51/2NS 1000ML/KCL 20                   $117.10      $117.10   084170   LOS PHARMACY REV
75053371    DACARBAZINE 200MG INJ                   $542.26      $542.26   084170   LOS PHARMACY REV
75052035    DACTINOMYCIN 0.5MG IJ                   $524.24      $524.24   084170   LOS PHARMACY REV
75073031    DAKINS SLN 0.0625% 1500ML                $29.26       $29.26   084170   LOS PHARMACY REV
75073015    DAKINS SLN 0.25% 1500ML                  $41.14       $41.14   084170   LOS PHARMACY REV
75073114    DAKINS SOLN 0.125% 1500ML                $41.14       $41.14   084170   LOS PHARMACY REV
75052050    DANTROLENE 200MG IJ                     $320.10      $320.10   084170   LOS PHARMACY REV
75008078    DANTROLENE 50MG CAP                      $17.56       $17.56   084170   LOS PHARMACY REV
75008110    DAPSONE TAB 100MG                        $14.40       $14.40   084170   LOS PHARMACY REV
75053553    DAPTOMYCIN 500MG IJ VL                  $558.36      $558.36   084170   LOS PHARMACY REV
75049817    DAUNORUBICIN 20MG VL                    $848.76      $848.76   084170   LOS PHARMACY REV
75052571    DEFEROXAMINE 500MG IJ                   $153.28      $153.28   084170   LOS PHARMACY REV
75008466    DEMECLOCYCLINE 150MG TAB                 $34.98       $34.98   084170   LOS PHARMACY REV
75024992    DESIPRAMINE 100MG TAB                    $17.00       $17.00   084170   LOS PHARMACY REV
75028233    DESIPRAMINE 25MG                         $14.96       $14.96   084170   LOS PHARMACY REV
75024968    DESIPRAMINE 25MG TAB                     $17.22       $17.22   084170   LOS PHARMACY REV
75024976    DESIPRAMINE 50MG TAB                     $15.18       $15.18   084170   LOS PHARMACY REV
75024984    DESIPRAMINE 75MG TAB                     $14.98       $14.98   084170   LOS PHARMACY REV
75025015    DESIPRAMINE TAB 10MG                     $14.80       $14.80   084170   LOS PHARMACY REV
75073213    DESITIN ONT                              $49.22       $49.22   084170   LOS PHARMACY REV
75010439    DESLORATADINE 5MG TAB                    $20.34       $20.34   084170   LOS PHARMACY REV
75010447    DESMOPRESSIN 0.1MG TAB                   $20.04       $20.04   084170   LOS PHARMACY REV
75052167    DESMOPRESSIN INJ 4MCG                   $167.94      $167.94   084170   LOS PHARMACY REV
75095679    DESMOPRESSIN NAS SP 5ML                 $314.68      $314.68   084170   LOS PHARMACY REV
75095620    DEXAMETHASONE 0.1% OP 5ML                $62.62       $62.62   084170   LOS PHARMACY REV
75008359    DEXAMETHASONE 0.5MG TAB                  $15.30       $15.30   084170   LOS PHARMACY REV
75008334    DEXAMETHASONE 0.5MG/ML LQ                $14.50       $14.50   084170   LOS PHARMACY REV
75052134    DEXAMETHASONE 100MG/10ML                $123.22      $123.22   084170   LOS PHARMACY REV
75052092    DEXAMETHASONE 10MG VIAL                  $61.66       $61.66   084170   LOS PHARMACY REV
75008433    DEXAMETHASONE 1MG TAB                    $14.68       $14.68   084170   LOS PHARMACY REV
75008383    DEXAMETHASONE 2MG TAB                    $15.30       $15.30   084170   LOS PHARMACY REV


7/11/2012                                                                                              49
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75052084    DEXAMETHASONE 4MG IJ VL                   $59.18       $59.18   084170   LOS PHARMACY REV
75008391    DEXAMETHASONE 4MG TAB                     $18.70       $18.70   084170   LOS PHARMACY REV
75066233    DEXMEDETOMIDINE 200MCG VL                $194.50      $194.50   084170   LOS PHARMACY REV
75052027    DEXTRAN 1 150MG/ML 20ML                   $75.76       $75.76   084170   LOS PHARMACY REV
75052688    DEXTROSE 50% 50ML JECT                    $63.52       $63.52   084170   LOS PHARMACY REV
75092098    DIAZEPAM 10MG RECTAL GEL                 $272.66      $272.66   084170   LOS PHARMACY REV
75052712    DIAZEPAM 10MG/ML VIAL                     $90.08       $90.08   084170   LOS PHARMACY REV
75069351    DIAZEPAM INJ 10MG                         $90.08       $90.08   084170   LOS PHARMACY REV
75069344    DIAZEPAM INJ 5MG                         $100.26      $100.26   084170   LOS PHARMACY REV
75041103    DIAZEPAM TAB 2MG                          $29.54       $29.54   084170   LOS PHARMACY REV
75041111    DIAZEPAM TAB 5MG                          $30.40       $30.40   084170   LOS PHARMACY REV
75041129    DIAZEPAM TB 10MG                          $28.74       $28.74   084170   LOS PHARMACY REV
75001685    DICLOFEN/MISOPR 75/200 TB                 $17.82       $17.82   084170   LOS PHARMACY REV
75042135    DICLOFENAC 25MG TAB                       $15.20       $15.20   084170   LOS PHARMACY REV
75042143    DICLOFENAC 50MG TAB                       $16.32       $16.32   084170   LOS PHARMACY REV
75042150    DICLOFENAC 75MG TAB                       $18.70       $18.70   084170   LOS PHARMACY REV
75009910    DICLOXACILLIN 250MG CAP                   $15.32       $15.32   084170   LOS PHARMACY REV
75009928    DICLOXACILLIN 500MG CAP                   $16.40       $16.40   084170   LOS PHARMACY REV
75045526    DICLOXACILLIN 500MG W/C                    $0.00        $0.00   084170   LOS PHARMACY REV
75003301    DICYCLOMINE 10MG CAP                      $14.70       $14.70   084170   LOS PHARMACY REV
75003319    DICYCLOMINE 20MG TAB                      $15.00       $15.00   084170   LOS PHARMACY REV
75048181    DICYCLOMINE INJ 20MG                      $92.92       $92.92   084170   LOS PHARMACY REV
75003343    DICYCLOMINE LIQ 10MG/5ML                  $14.90       $14.90   084170   LOS PHARMACY REV
75010389    DIDANOSINE 400MG CAP                      $35.46       $35.46   084170   LOS PHARMACY REV
75010132    DIFLUNISAL 500MG TAB                      $16.64       $16.64   084170   LOS PHARMACY REV
75008995    DIGOXIN 0.125MG TAB                       $14.50       $14.50   084170   LOS PHARMACY REV
75010363    DIGOXIN 0.125MG/2.5ML LIQ                 $16.68       $16.68   084170   LOS PHARMACY REV
75009001    DIGOXIN 0.25MG TAB                        $14.50       $14.50   084170   LOS PHARMACY REV
75009068    DIGOXIN 0.25MG/5ML LIQ                    $18.54       $18.54   084170   LOS PHARMACY REV
75052886    DIGOXIN 0.5MG IJ                          $62.56       $62.56   084170   LOS PHARMACY REV
75019117    DIGOXIN 60ML ELIX                         $55.08       $55.08   084170   LOS PHARMACY REV
75052852    DIGOXIN IMM FAB VIAL IJ                $1,629.48    $1,629.48   084170   LOS PHARMACY REV
75052704    DIHYDROERGOT INJ                         $147.73      $147.73   084170   LOS PHARMACY REV
75004994    DILTIAZEM 120MG TAB                       $17.44       $17.44   084170   LOS PHARMACY REV
75005173    DILTIAZEM 30MG TAB                        $15.16       $15.16   084170   LOS PHARMACY REV
75038968    DILTIAZEM 360MG CAP                       $19.70       $19.70   084170   LOS PHARMACY REV


7/11/2012                                                                                               50
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75049361    DILTIAZEM 5MG/ML 10ML VL                 $170.32      $170.32   084170   LOS PHARMACY REV
75049296    DILTIAZEM 5MG/ML 5ML VIAL                $143.92      $143.92   084170   LOS PHARMACY REV
75005207    DILTIAZEM 60MG TAB                        $15.86       $15.86   084170   LOS PHARMACY REV
75004986    DILTIAZEM 90MG TAB                        $16.62       $16.62   084170   LOS PHARMACY REV
75005975    DILTIAZEM CD 120MG CAP                    $16.88       $16.88   084170   LOS PHARMACY REV
75007435    DILTIAZEM CD 180MG CAP                    $17.46       $17.46   084170   LOS PHARMACY REV
75007443    DILTIAZEM CD 240MG CAP                    $18.92       $18.92   084170   LOS PHARMACY REV
75006049    DILTIAZEM CD 300MG CAP                    $20.34       $20.34   084170   LOS PHARMACY REV
75038927    DILTIAZEM ER 120MG CAP                    $16.54       $16.54   084170   LOS PHARMACY REV
75038935    DILTIAZEM ER 180MG CAP                    $17.06       $17.06   084170   LOS PHARMACY REV
75038943    DILTIAZEM ER 240MG CAP                    $17.58       $17.58   084170   LOS PHARMACY REV
75004960    DILTIAZEM SR 120MG TAB                    $17.26       $17.26   084170   LOS PHARMACY REV
75004945    DILTIAZEM SR 60MG TAB                     $16.20       $16.20   084170   LOS PHARMACY REV
75004952    DILTIAZEM SR 90MG TAB                     $16.50       $16.50   084170   LOS PHARMACY REV
75010256    DILTIAZEM XR 120MG CAP                    $17.70       $17.70   084170   LOS PHARMACY REV
75010264    DILTIAZEM XR 180MG CAP                    $18.36       $18.36   084170   LOS PHARMACY REV
75010272    DILTIAZEM XR 240MG CAP                    $18.66       $18.66   084170   LOS PHARMACY REV
75009324    DIMETAPP LIQ 5ML                          $14.30       $14.30   084170   LOS PHARMACY REV
75091710    DINOPROSTONE 10MG VAG SUP                $470.12      $470.12   084170   LOS PHARMACY REV
75003210    DIPHENHYDRAMINE 25MG CAP                  $14.26       $14.26   084170   LOS PHARMACY REV
75003236    DIPHENHYDRAMINE 25MG/10ML                 $14.86       $14.86   084170   LOS PHARMACY REV
75003228    DIPHENHYDRAMINE 50MG CAP                  $14.54       $14.54   084170   LOS PHARMACY REV
75048157    DIPHENHYDRAMINE 50MG IJ                   $77.36       $77.36   084170   LOS PHARMACY REV
75071209    DIPHENHYDRAMINE CRM                       $34.84       $34.84   084170   LOS PHARMACY REV
75098467    DIPIVEFRIN 0.1% OP DP 5ML                 $56.14       $56.14   084170   LOS PHARMACY REV
75028191    DIPYRIDAMOLE 25MG TAB                     $15.10       $15.10   084170   LOS PHARMACY REV
75028209    DIPYRIDAMOLE 50MG TAB                     $15.76       $15.76   084170   LOS PHARMACY REV
75028217    DIPYRIDAMOLE 75MG TAB                     $16.36       $16.36   084170   LOS PHARMACY REV
75010413    DIVALPROEX 125MG SPKL CAP                 $15.44       $15.44   084170   LOS PHARMACY REV
75008656    DIVALPROEX 125MG TAB                      $15.14       $15.14   084170   LOS PHARMACY REV
75008599    DIVALPROEX 500MG TAB                      $18.42       $18.42   084170   LOS PHARMACY REV
75008052    DIVALPROEX ER 250MG TAB                   $17.18       $17.18   084170   LOS PHARMACY REV
75010371    DIVALPROEX ER 500MG TAB                   $17.70       $17.70   084170   LOS PHARMACY REV
75053116    DOBUTAMINE 250MG INJ VIAL                $121.76      $121.76   084170   LOS PHARMACY REV
44611432    DOBUTAMINE 500/D5W250                    $174.22      $174.22   084170   LOS PHARMACY REV
75053520    DOCETAXEL 20MG/0.5ML INJ               $1,248.50    $1,248.50   084170   LOS PHARMACY REV


7/11/2012                                                                                               51
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75053538    DOCETAXEL 80MG/2ML INJ                 $3,599.36    $3,599.36   084170   LOS PHARMACY REV
75006361    DOCUSATE 100MG CAP                        $14.66       $14.66   084170   LOS PHARMACY REV
75006379    DOCUSATE 100MG/10ML LQ                    $14.74       $14.74   084170   LOS PHARMACY REV
75006387    DOCUSATE 100MG/30ML LQ                    $31.48       $31.48   084170   LOS PHARMACY REV
75035444    DOCUSATE 240MG CAP                        $14.40       $14.40   084170   LOS PHARMACY REV
75009811    DOCUSATE CAP 250MG                        $14.14       $14.14   084170   LOS PHARMACY REV
75010405    DOLASETRON 100MG PO TAB                  $165.50      $165.50   084170   LOS PHARMACY REV
75053595    DOLASETRON 12.5MG IJ                      $93.10       $93.10   084170   LOS PHARMACY REV
75010397    DOLASETRON 50MG TAB                      $128.10      $128.10   084170   LOS PHARMACY REV
75010306    DONEPEZIL 10MG TAB                        $23.92       $23.92   084170   LOS PHARMACY REV
75010298    DONEPEZIL 5MG TAB                         $23.92       $23.92   084170   LOS PHARMACY REV
75009563    DONNATAL 5ML LQ                           $15.20       $15.20   084170   LOS PHARMACY REV
75009589    DONNATAL TAB                              $14.74       $14.74   084170   LOS PHARMACY REV
75053173    DOPAMINE 400MG VIAL                      $116.06      $116.06   084170   LOS PHARMACY REV
75066225    DORNASE ALFA 1MG/ML 2.5ML                $163.80      $163.80   084170   LOS PHARMACY REV
75098574    DORZOLAMIDE 2% OPT SL 5ML                 $86.16       $86.16   084170   LOS PHARMACY REV
75053199    DOXAPRAM 400MG/20ML VL                   $307.76      $307.76   084170   LOS PHARMACY REV
75010223    DOXAZOSIN 1MG TAB                         $16.38       $16.38   084170   LOS PHARMACY REV
75010314    DOXAZOSIN 2MG TAB                         $16.38       $16.38   084170   LOS PHARMACY REV
75010322    DOXAZOSIN 4MG TAB                         $16.50       $16.50   084170   LOS PHARMACY REV
75010330    DOXAZOSIN 8MG TAB                         $16.62       $16.62   084170   LOS PHARMACY REV
75034595    DOXEPIN 100MG CAP                         $16.92       $16.92   084170   LOS PHARMACY REV
75034553    DOXEPIN 10MG CAP                          $14.88       $14.88   084170   LOS PHARMACY REV
75034603    DOXEPIN 150MG CAP                         $18.16       $18.16   084170   LOS PHARMACY REV
75034561    DOXEPIN 25MG CAP                          $15.14       $15.14   084170   LOS PHARMACY REV
75073486    DOXEPIN 5% CRM 45GM                      $156.92      $156.92   084170   LOS PHARMACY REV
75034579    DOXEPIN 50MG CAP                          $15.62       $15.62   084170   LOS PHARMACY REV
75034587    DOXEPIN 75MG CAP                          $16.68       $16.68   084170   LOS PHARMACY REV
75046201    DOXORUBICIN 10MG IJ                      $602.28      $602.28   084170   LOS PHARMACY REV
75046219    DOXORUBICIN 20MG IJ                      $550.00      $550.00   084170   LOS PHARMACY REV
75046243    DOXORUBICIN 50MG IJ                    $1,031.36    $1,031.36   084170   LOS PHARMACY REV
75041509    DOXYCYCLINE 100MG CAP                     $16.68       $16.68   084170   LOS PHARMACY REV
75053223    DOXYCYCLINE 100MG IJ                     $162.78      $162.78   084170   LOS PHARMACY REV
75041566    DOXYCYCLINE 100MG TAB                     $15.20       $15.20   084170   LOS PHARMACY REV
75023309    DRONABINOL 2.5MG CAP                      $37.28       $37.28   084170   LOS PHARMACY REV
75023291    DRONABINOL 5MG CAP                        $47.30       $47.30   084170   LOS PHARMACY REV


7/11/2012                                                                                               52
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75059139    DROPERIDOL 5MG/2ML IJ                     $65.50       $65.50   084170   LOS PHARMACY REV
75070151    DROTRECOGIN 20MG INJ                   $2,362.52    $2,362.52   084170   LOS PHARMACY REV
75070086    DROTRECOGIN 5MG INJ                      $619.38      $619.38   084170   LOS PHARMACY REV
75010454    DULOXETINE 20MG CAP                       $20.84       $20.84   084170   LOS PHARMACY REV
75010462    DULOXETINE 30MG CAP                       $21.68       $21.68   084170   LOS PHARMACY REV
75010470    DULOXETINE 60MG CAP                       $21.68       $21.68   084170   LOS PHARMACY REV
75010421    DUTASTERIDE 0.5MG CAP                     $20.36       $20.36   084170   LOS PHARMACY REV
75010173    DYAZIDE 37.5MG/25MG CAP                   $15.20       $15.20   084170   LOS PHARMACY REV
75087478    ECONAZOLE CRM 30GM                       $101.92      $101.92   084170   LOS PHARMACY REV
75068213    EDROPHONIUM 10MG IJ                       $66.36       $66.36   084170   LOS PHARMACY REV
75055517    EDTA CA DISODUM 1000MG IJ                $205.84      $205.84   084170   LOS PHARMACY REV
75027565    EES/SULFISOX 100ML LIQ                   $142.50      $142.50   084170   LOS PHARMACY REV
75011056    EES/SULFISOX ES 200MG LQ                  $14.44       $14.44   084170   LOS PHARMACY REV
75045682    EES/SULFISOX SUSP 5ML                     $49.30       $49.30   084170   LOS PHARMACY REV
75012484    EFAVIRENZ 200MG TAB                       $23.80       $23.80   084170   LOS PHARMACY REV
75012559    EFAVIRENZ 600MG TAB                       $45.40       $45.40   084170   LOS PHARMACY REV
75074302    EMLA CRM 5GM                              $45.88       $45.88   084170   LOS PHARMACY REV
75074161    EMOLLIENTS 120GM                          $38.20       $38.20   084170   LOS PHARMACY REV
75074260    EMOLLIENTS EUCERIN                       $234.00      $234.00   084170   LOS PHARMACY REV
75042101    ENALAPRIL 10MG TAB                        $16.48       $16.48   084170   LOS PHARMACY REV
75042051    ENALAPRIL 2.5MG TAB                       $15.88       $15.88   084170   LOS PHARMACY REV
75042119    ENALAPRIL 20 MG TAB                       $17.48       $17.48   084170   LOS PHARMACY REV
75042093    ENALAPRIL 5MG TAB                         $16.36       $16.36   084170   LOS PHARMACY REV
75042127    ENALAPRIL/HCTZ 10/25 TAB                  $16.78       $16.78   084170   LOS PHARMACY REV
75069310    ENALAPRILAT INJ 1.25MG                   $185.00      $185.00   084170   LOS PHARMACY REV
75055392    ENOXAPARIN 100MG IJ SY                   $205.84      $205.84   084170   LOS PHARMACY REV
75055509    ENOXAPARIN 150MG IJ SY                   $289.26      $289.26   084170   LOS PHARMACY REV
75055368    ENOXAPARIN 30MG IJ SY                    $101.60      $101.60   084170   LOS PHARMACY REV
75061564    ENOXAPARIN 40MG IJ SY                    $116.46      $116.46   084170   LOS PHARMACY REV
75055376    ENOXAPARIN 60MG IJ SY                    $146.30      $146.30   084170   LOS PHARMACY REV
75055384    ENOXAPARIN 80MG IJ SY                    $176.08      $176.08   084170   LOS PHARMACY REV
75055095    EPHEDRINE 50MG IJ                        $115.02      $115.02   084170   LOS PHARMACY REV
75070029    EPINEPHRINE 0.1% TOP 30ML                 $99.52       $99.52   084170   LOS PHARMACY REV
75055129    EPINEPHRINE 1:10,000 10ML                 $67.64       $67.64   084170   LOS PHARMACY REV
75055079    EPINEPHRINE 1:1000 30ML                  $121.76      $121.76   084170   LOS PHARMACY REV
75046151    EPINEPHRINE 1MG/ML IJ                     $58.28       $58.28   084170   LOS PHARMACY REV


7/11/2012                                                                                               53
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75055533    EPOETIN 20000U IJ                        $683.00      $683.00   084170   LOS PHARMACY REV
75012013    EPOETIN NON-ESRD 10,000U                 $361.28      $361.28   084170   LOS PHARMACY REV
75011791    EPOETIN NON-ESRD 2000U VL                $665.50      $665.50   084170   LOS PHARMACY REV
75055400    EPOETIN NON-ESRD 40000U                $1,274.00    $1,274.00   084170   LOS PHARMACY REV
75011999    EPOETIN NON-ESRD 4000U                   $178.70      $178.70   084170   LOS PHARMACY REV
75055459    EPTIFIBATIDE 20MG/10ML                   $271.54      $271.54   084170   LOS PHARMACY REV
75055467    EPTIFIBATIDE 75MG/100ML                  $609.14      $609.14   084170   LOS PHARMACY REV
75041814    ERGOCALCIFEROL 50,000U CP                 $17.04       $17.04   084170   LOS PHARMACY REV
75055426    ERTAPENEM 1GM IJ                         $215.95      $215.95   084170   LOS PHARMACY REV
75011007    ERYTHROMYCIN 250MG TAB                    $14.42       $14.42   084170   LOS PHARMACY REV
75011874    ERYTHROMYCIN 250MG TAB                    $14.58       $14.58   084170   LOS PHARMACY REV
75017111    ERYTHROMYCIN 250MG/5ML LQ                 $14.64       $14.64   084170   LOS PHARMACY REV
75011817    ERYTHROMYCIN 333MG TAB                    $14.74       $14.74   084170   LOS PHARMACY REV
75055194    ERYTHROMYCIN 500MG IJ VL                 $120.40      $120.40   084170   LOS PHARMACY REV
75011882    ERYTHROMYCIN 500MG TAB                    $14.54       $14.54   084170   LOS PHARMACY REV
75011072    ERYTHROMYCIN ES-200 100ML                 $33.20       $33.20   084170   LOS PHARMACY REV
75096289    ERYTHROMYCIN OP ONT 3.5GM                 $39.16       $39.16   084170   LOS PHARMACY REV
75098111    ERYTHROMYCIN OPTH 1GM                     $31.88       $31.88   084170   LOS PHARMACY REV
75012468    ESCITALOPRAM 10MG TAB                     $17.96       $17.96   084170   LOS PHARMACY REV
75012476    ESCITALOPRAM 20MG TAB                     $18.20       $18.20   084170   LOS PHARMACY REV
44611929    ESMOLOL 2500MG/NS250ML                   $267.18      $267.18   084170   LOS PHARMACY REV
75055293    ESMOLOL DYDROCL 100/10 VL                $155.52      $155.52   084170   LOS PHARMACY REV
75055210    ESMOLOL INJ 10ML                         $357.50      $357.50   084170   LOS PHARMACY REV
75055483    ESOMEPRAZOLE SOD 40MG IJ                 $167.00      $167.00   084170   LOS PHARMACY REV
75074369    ESTRADIOL 0.05MG PATCH                    $65.72       $65.72   084170   LOS PHARMACY REV
75074286    ESTRADIOL 0.05MG PATCH                    $76.10       $76.10   084170   LOS PHARMACY REV
75074377    ESTRADIOL 0.1MG PATCH                     $66.04       $66.04   084170   LOS PHARMACY REV
75074294    ESTRADIOL 0.1MG PATCH                     $76.06       $76.06   084170   LOS PHARMACY REV
75074351    ESTRADIOL 0.25MG PATCH                    $66.12       $66.12   084170   LOS PHARMACY REV
75052332    ESTRADIOL 10MG IJ                        $189.92      $189.92   084170   LOS PHARMACY REV
75074385    ESTRADIOL 2.5/1.74 CREAM                  $82.58       $82.58   084170   LOS PHARMACY REV
75052316    ESTRADIOL 20MG IJ                        $244.30      $244.30   084170   LOS PHARMACY REV
75012070    ESTRADIOL 2MG TAB                         $16.02       $16.02   084170   LOS PHARMACY REV
75052324    ESTRADIOL 40MG IJ                        $367.76      $367.76   084170   LOS PHARMACY REV
75052415    ESTRADIOL 5MG/ML IJ                      $117.82      $117.82   084170   LOS PHARMACY REV
75012567    ESTRADIOL ACET 0.9MG TAB                  $16.56       $16.56   084170   LOS PHARMACY REV


7/11/2012                                                                                               54
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75055525    ESTRADIOL CYP 25MG/5ML IJ               $124.62      $124.62   084170   LOS PHARMACY REV
75012062    ESTRADIOL TB 1MG                         $15.38       $15.38   084170   LOS PHARMACY REV
75074393    ESTRADIOL-DOT .075MG PTCH                $68.36       $68.36   084170   LOS PHARMACY REV
75012492    ESTRATEST TAB                            $17.98       $17.98   084170   LOS PHARMACY REV
75011734    ESTRATEST TAB                            $17.24       $17.24   084170   LOS PHARMACY REV
75065532    ESTROGEN CONJ 25 MG IJ                  $249.50      $249.50   084170   LOS PHARMACY REV
75029058    ESTROGENS 0.3MG TAB                      $15.68       $15.68   084170   LOS PHARMACY REV
75021717    ESTROGENS 0.625MG TAB                    $15.08       $15.08   084170   LOS PHARMACY REV
75029041    ESTROGENS 0.625MG TAB                    $15.92       $15.92   084170   LOS PHARMACY REV
75029033    ESTROGENS 0.9MG TAB                      $16.32       $16.32   084170   LOS PHARMACY REV
75029066    ESTROGENS 1.25MG TAB                     $16.68       $16.68   084170   LOS PHARMACY REV
75021725    ESTROGENS 1.25MG TAB                     $15.52       $15.52   084170   LOS PHARMACY REV
75029074    ESTROGENS 2.5MG TAB                      $17.60       $17.60   084170   LOS PHARMACY REV
75084202    ESTROGENS CRM                           $158.12      $158.12   084170   LOS PHARMACY REV
75012591    ESTROGENS ESTER 0.3 TAB                  $15.06       $15.06   084170   LOS PHARMACY REV
75026104    ESTROPIPATE 0.625MG TAB                  $15.82       $15.82   084170   LOS PHARMACY REV
75026112    ESTROPIPATE 1.25MG TAB                   $16.54       $16.54   084170   LOS PHARMACY REV
75026120    ESTROPIPATE 2.5MG TAB                    $18.40       $18.40   084170   LOS PHARMACY REV
75011122    ETHACRYNIC ACID 25MG TAB                 $14.74       $14.74   084170   LOS PHARMACY REV
75012096    ETHAMBUTOL 100MG TAB                     $17.56       $17.56   084170   LOS PHARMACY REV
75012104    ETHAMBUTOL 400MG TAB                     $18.52       $18.52   084170   LOS PHARMACY REV
75012575    ETHOSUXIMIDE 250MG TAB                   $15.82       $15.82   084170   LOS PHARMACY REV
75074153    ETHYL CL SPY                             $45.90       $45.90   084170   LOS PHARMACY REV
75012112    ETODOLAC 200MG CAP                       $17.10       $17.10   084170   LOS PHARMACY REV
75052423    ETOH 5ML AMP                            $186.76      $186.76   084170   LOS PHARMACY REV
75047589    ETOMIDATE 2MG/ML IJ 10ML                $159.26      $159.26   084170   LOS PHARMACY REV
75047597    ETOMIDATE 2MG/ML IJ 20ML                $169.46      $169.46   084170   LOS PHARMACY REV
75055350    ETOPOSIDE 100MG/5ML VL                  $767.98      $767.98   084170   LOS PHARMACY REV
75012286    EVAC-Q-KWIK KIT                          $39.26       $39.26   084170   LOS PHARMACY REV
75055475    EXENATIDE 1.2ML PEN                     $446.56      $446.56   084170   LOS PHARMACY REV
75074344    EYE IRRIG SOLN 30ML                      $52.38       $52.38   084170   LOS PHARMACY REV
75098087    EYE LUBE                                 $33.86       $33.86   084170   LOS PHARMACY REV
75096701    EYE LUBE OPTH OINT 0.7GM                 $31.78       $31.78   084170   LOS PHARMACY REV
75096727    EYE LUBE SOP                             $45.30       $45.30   084170   LOS PHARMACY REV
75012534    EZETIMIBE 10MG TAB                       $20.34       $20.34   084170   LOS PHARMACY REV
75060624    FACTOR 8 HUMAN/IU IJ                    $289.72      $289.72   084170   LOS PHARMACY REV


7/11/2012                                                                                              55
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75060616    FACTOR 8 HUMAN/IU IJ                     $287.06      $287.06   084170   LOS PHARMACY REV
75058750    FACTOR 8 RECM/IU IJ                        $2.31        $2.31   084170   LOS PHARMACY REV
75056002    FACTOR 9 CMPLX 500U VL                   $287.72      $287.72   084170   LOS PHARMACY REV
75058685    FACTOR COMP HUMAN PER IU               $4,283.00    $4,283.00   084170   LOS PHARMACY REV
75013102    FAMCICLOVIR 500MG TAB                     $31.98       $31.98   084170   LOS PHARMACY REV
75065029    FAMOTIDINE 20MG IJ                       $122.46      $122.46   084170   LOS PHARMACY REV
75027441    FAMOTIDINE LIQ 20MG/2.5ML                $243.42      $243.42   084170   LOS PHARMACY REV
75027904    FAMOTIDINE TAB 20MG                       $18.06       $18.06   084170   LOS PHARMACY REV
75027920    FAMOTIDINE TAB 40MG                       $21.84       $21.84   084170   LOS PHARMACY REV
75013110    FE GLUCONATE 240MG TAB                    $14.14       $14.14   084170   LOS PHARMACY REV
75013276    FE SO4 160MG TAB                          $14.46       $14.46   084170   LOS PHARMACY REV
75013250    FE SO4 300MG/5ML LIQ                      $14.82       $14.82   084170   LOS PHARMACY REV
75013268    FE SO4 325MG TAB                          $14.34       $14.34   084170   LOS PHARMACY REV
75013060    FE SO4 75MG/0.6ML DRP                     $33.38       $33.38   084170   LOS PHARMACY REV
75013227    FE SO4/DSS CAP                            $14.34       $14.34   084170   LOS PHARMACY REV
75028662    FELODIPINE 5MG TAB                        $16.72       $16.72   084170   LOS PHARMACY REV
75013813    FENOFIBRATE 145MG TAB                     $21.52       $21.52   084170   LOS PHARMACY REV
75013961    FENOFIBRATE 160MG TAB                     $20.06       $20.06   084170   LOS PHARMACY REV
75013805    FENOFIBRATE 48MG TAB                      $16.50       $16.50   084170   LOS PHARMACY REV
75013953    FENOFIBRATE 54MG TAB                      $15.36       $15.36   084170   LOS PHARMACY REV
75013946    FENOFIBRATE 67MG CAP                      $15.72       $15.72   084170   LOS PHARMACY REV
75051151    FENOLDOPAM 10MG/ML 1ML IJ                $664.20      $664.20   084170   LOS PHARMACY REV
75051169    FENOLDOPAM 10MG/ML 2ML IJ                $664.20      $664.20   084170   LOS PHARMACY REV
75056127    FENTANYL 100MCG/2ML IJ                    $86.30       $86.30   084170   LOS PHARMACY REV
75075366    FENTANYL 1200MCG LOZENGE                  $72.08       $72.08   084170   LOS PHARMACY REV
75075374    FENTANYL 1600MCG LOZENGE                  $82.34       $82.34   084170   LOS PHARMACY REV
75075333    FENTANYL 200MCG LOZENGE                   $44.16       $44.16   084170   LOS PHARMACY REV
75056135    FENTANYL 250MCG/5ML IJ                    $86.72       $86.72   084170   LOS PHARMACY REV
75075341    FENTANYL 400MCG LOZENGE                   $48.76       $48.76   084170   LOS PHARMACY REV
75056432    FENTANYL 500MCG/10ML INJ                  $91.88       $91.88   084170   LOS PHARMACY REV
75075358    FENTANYL 800MCG LOZENGE                   $58.00       $58.00   084170   LOS PHARMACY REV
75056598    FENTANYL EPIDURAL CASS                    $91.28       $91.28   084170   LOS PHARMACY REV
44612000    FENTANYL EPIDURL PCA/DRIP                 $86.94       $86.94   084170   LOS PHARMACY REV
75056606    FENTANYL MARC EPID CASS                   $96.88       $96.88   084170   LOS PHARMACY REV
75056531    FENTANYL TRANSDERM 100MCG                $146.70      $146.70   084170   LOS PHARMACY REV
75056507    FENTANYL TRANSDERM 25MCG                  $58.30       $58.30   084170   LOS PHARMACY REV


7/11/2012                                                                                               56
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75056515    FENTANYL TRANSDERM 50MCG                  $86.64       $86.64   084170   LOS PHARMACY REV
75056523    FENTANYL TRANSDERM 75MCG                 $117.44      $117.44   084170   LOS PHARMACY REV
75014043    FEXOFENADINE 180MG TAB                    $19.24       $19.24   084170   LOS PHARMACY REV
75013680    FEXOFENADINE 60MG CAP                     $16.36       $16.36   084170   LOS PHARMACY REV
75014050    FEXOFENADINE/PSEUDO 12HR                  $17.48       $17.48   084170   LOS PHARMACY REV
75014068    FEXOFENADINE/PSEUDO 24HR                  $21.00       $21.00   084170   LOS PHARMACY REV
75013763    FILGRASTIM 300MCG IJ                     $570.76      $570.76   084170   LOS PHARMACY REV
75013771    FILGRASTIM 480MCG IJ                     $828.00      $828.00   084170   LOS PHARMACY REV
75013797    FINASTERIDE 5MG TAB                       $19.58       $19.58   084170   LOS PHARMACY REV
75011965    FIORICET TAB                              $29.64       $29.64   084170   LOS PHARMACY REV
75013789    FIORICET/COD TAB                          $32.96       $32.96   084170   LOS PHARMACY REV
75013375    FIORINAL TAB                              $30.10       $30.10   084170   LOS PHARMACY REV
75013391    FIORINAL/COD #3 CAP                       $32.42       $32.42   084170   LOS PHARMACY REV
75014035    FISH OIL 1000MG CAP                       $14.20       $14.20   084170   LOS PHARMACY REV
75040246    FLAVOXATE 100MG TAB                       $17.18       $17.18   084170   LOS PHARMACY REV
75036236    FLECAINIDE 100MG TAB                      $20.82       $20.82   084170   LOS PHARMACY REV
75013698    FLEET PHOS SODA 45ML                      $31.92       $31.92   084170   LOS PHARMACY REV
75013490    FLEET PHOSPHO SODA 90ML                   $35.02       $35.02   084170   LOS PHARMACY REV
75056309    FLOXURIDINE 500MG IJ                     $767.60      $767.60   084170   LOS PHARMACY REV
75013896    FLUCONAZOLE 100MG TAB                     $34.54       $34.54   084170   LOS PHARMACY REV
75013144    FLUCONAZOLE 150MG TAB                     $42.84       $42.84   084170   LOS PHARMACY REV
75056473    FLUCONAZOLE 200MG IVPB                   $355.74      $355.74   084170   LOS PHARMACY REV
75013904    FLUCONAZOLE 200MG TAB                     $47.62       $47.62   084170   LOS PHARMACY REV
75056481    FLUCONAZOLE 400MG IVPB                   $467.78      $467.78   084170   LOS PHARMACY REV
75013078    FLUCONAZOLE 40MG/ML 5ML                  $304.58      $304.58   084170   LOS PHARMACY REV
75056614    FLUDARABINE 50MG IJ                    $1,259.62    $1,259.62   084170   LOS PHARMACY REV
75013466    FLUDROCORTISONE TAB                       $15.76       $15.76   084170   LOS PHARMACY REV
75056630    FLUMAZENIL 0.5MG/5ML VIAL                $320.16      $320.16   084170   LOS PHARMACY REV
75056648    FLUMAZENIL 1MG/10ML VIAL                 $442.56      $442.56   084170   LOS PHARMACY REV
75097691    FLUNISOLIDE INHALER 7GM                  $181.90      $181.90   084170   LOS PHARMACY REV
75097121    FLUNISOLIDE SPY                          $121.98      $121.98   084170   LOS PHARMACY REV
75094318    FLUNISOLIDE SPY 7GM                      $181.90      $181.90   084170   LOS PHARMACY REV
75087338    FLUOCINOLONE 0.01% 15GM                   $32.56       $32.56   084170   LOS PHARMACY REV
75087353    FLUOCINOLONE 0.03% 15GM                   $84.50       $84.50   084170   LOS PHARMACY REV
75080101    FLUOCINONIDE 0.05% 15GM                  $104.80      $104.80   084170   LOS PHARMACY REV
75080127    FLUOCINONIDE 0.05% 60GM                  $185.58      $185.58   084170   LOS PHARMACY REV


7/11/2012                                                                                               57
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75056259    FLUOROURACIL 500MG IJ                    $502.50      $502.50   084170   LOS PHARMACY REV
75074005    FLUOROURACIL CRM                         $390.88      $390.88   084170   LOS PHARMACY REV
75074013    FLUOROURACIL SLN 2%                      $626.70      $626.70   084170   LOS PHARMACY REV
75074021    FLUOROURACIL SLN 5%                      $514.40      $514.40   084170   LOS PHARMACY REV
75056465    FLUOROURACIL-5 1000MG INJ                $499.66      $499.66   084170   LOS PHARMACY REV
75013920    FLUOXETINE 10MG CAP                       $21.24       $21.24   084170   LOS PHARMACY REV
75030049    FLUOXETINE 20MG/5ML LIQ                  $366.80      $366.80   084170   LOS PHARMACY REV
75029975    FLUOXETINE CAP 20MG                       $21.42       $21.42   084170   LOS PHARMACY REV
75065755    FLUPHENAZINE 25MG IJ                     $307.90      $307.90   084170   LOS PHARMACY REV
75008003    FLURAZEPAM 15MG CAP                       $14.58       $14.58   084170   LOS PHARMACY REV
75096016    FLURBIPROFEN OPT SL 2.5ML                 $68.96       $68.96   084170   LOS PHARMACY REV
75096008    FLUROMETHOLONE 0.1% 5ML                   $80.76       $80.76   084170   LOS PHARMACY REV
75012625    FLUTAMIDE 125 MG CAP                      $19.44       $19.44   084170   LOS PHARMACY REV
75095893    FLUTICASONE 0.05% NS SPY                 $164.52      $164.52   084170   LOS PHARMACY REV
75099325    FLUTICASONE 100/50 INH                    $33.92       $33.92   084170   LOS PHARMACY REV
75098749    FLUTICASONE 110MCG 13GM                  $198.22      $198.22   084170   LOS PHARMACY REV
75095836    FLUTICASONE 220MCG 13GM                  $292.40      $292.40   084170   LOS PHARMACY REV
75099333    FLUTICASONE 250/50 INH                   $250.14      $250.14   084170   LOS PHARMACY REV
75098731    FLUTICASONE 44MCG 13GM                   $155.12      $155.12   084170   LOS PHARMACY REV
75099341    FLUTICASONE 500/50 INH                    $38.28       $38.28   084170   LOS PHARMACY REV
75013938    FLUVASTATIN 20MG CAP                      $17.70       $17.70   084170   LOS PHARMACY REV
75014092    FLUVASTATIN XL 80MG TAB                   $20.70       $20.70   084170   LOS PHARMACY REV
75014001    FLUVOXAMINE 100MG TAB                     $19.28       $19.28   084170   LOS PHARMACY REV
75013482    FOLIC ACID 1MG TAB                        $14.32       $14.32   084170   LOS PHARMACY REV
75014019    FOLIC ACID 400MG TAB                      $14.02       $14.02   084170   LOS PHARMACY REV
75056291    FOLIC ACID INJ 5MG                       $137.66      $137.66   084170   LOS PHARMACY REV
75056663    FOMEPIZOLE 1.5GM IJ                    $3,146.00    $3,146.00   084170   LOS PHARMACY REV
75056556    FONDAPARINUX 2.5 IJ                      $148.75      $148.75   084170   LOS PHARMACY REV
75014084    FORMOTEROL 6 CAP STRIP                    $36.44       $36.44   084170   LOS PHARMACY REV
75014076    FORMOTEROL INH/6CAPS                      $52.50       $52.50   084170   LOS PHARMACY REV
75056200    FOSCARNET 24MG/ML 250ML                  $230.42      $230.42   084170   LOS PHARMACY REV
75014308    FOSINOPRIL 10MG TAB                       $16.38       $16.38   084170   LOS PHARMACY REV
75014027    FOSINOPRIL 20MG TAB                       $16.38       $16.38   084170   LOS PHARMACY REV
75056689    FOSPHENYTOIN 100MG/2ML VL                $160.04      $160.04   084170   LOS PHARMACY REV
75056697    FOSPHENYTOIN 500MG/2ML VL                $252.73      $252.73   084170   LOS PHARMACY REV
75061101    FUROSEMIDE INJ 100MG                      $63.88       $63.88   084170   LOS PHARMACY REV


7/11/2012                                                                                               58
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75061069    FUROSEMIDE INJ 20MG                       $58.50       $58.50   084170   LOS PHARMACY REV
75061077    FUROSEMIDE INJ 40MG                       $61.10       $61.10   084170   LOS PHARMACY REV
75020057    FUROSEMIDE LIQ 40MG                       $17.24       $17.24   084170   LOS PHARMACY REV
75019257    FUROSEMIDE TAB 20MG                       $14.30       $14.30   084170   LOS PHARMACY REV
75019265    FUROSEMIDE TAB 40MG                       $14.66       $14.66   084170   LOS PHARMACY REV
75019273    FUROSEMIDE TAB 80MG                       $15.02       $15.02   084170   LOS PHARMACY REV
75015677    GABAPENTIN 100MG CAP                      $15.30       $15.30   084170   LOS PHARMACY REV
75015743    GABAPENTIN 250MG/5ML LIQ                  $23.50       $23.50   084170   LOS PHARMACY REV
75015230    GABAPENTIN 300MG CAP                      $17.40       $17.40   084170   LOS PHARMACY REV
75015255    GABAPENTIN 400MG CAP                      $17.54       $17.54   084170   LOS PHARMACY REV
75015750    GALANTAMINE 4MG TAB                       $16.45       $16.45   084170   LOS PHARMACY REV
75057414    GANCICLOVIR 500MG IJ                     $190.28      $190.28   084170   LOS PHARMACY REV
75015693    GANCICLOVIR 500MG TAB                     $31.94       $31.94   084170   LOS PHARMACY REV
75057554    GATIFLOXACIN 400MG IJ                    $133.30      $133.30   084170   LOS PHARMACY REV
75015123    GAVISCON 360ML                            $30.06       $30.06   084170   LOS PHARMACY REV
75015099    GAVISCON TAB                              $14.20       $14.20   084170   LOS PHARMACY REV
75076059    GEL OPTH FILM                            $110.58      $110.58   084170   LOS PHARMACY REV
75076083    GELATIN SPONGE 100                       $113.92      $113.92   084170   LOS PHARMACY REV
75076075    GELATIN SPONGE 12                         $45.72       $45.72   084170   LOS PHARMACY REV
75076109    GELFOAM POWDER                           $213.18      $213.18   084170   LOS PHARMACY REV
75057539    GEMCITABINE 200MG IJ                     $767.60      $767.60   084170   LOS PHARMACY REV
75057547    GEMCITABINE 20MG/ML 50ML               $1,858.06    $1,858.06   084170   LOS PHARMACY REV
75019687    GEMFIBROZIL 600 MG TAB                    $17.42       $17.42   084170   LOS PHARMACY REV
75057232    GENTAMICIN 20MG/2ML VL                   $114.68      $114.68   084170   LOS PHARMACY REV
75096099    GENTAMICIN 3MG/ML OPT 1ML                 $35.90       $35.90   084170   LOS PHARMACY REV
75057281    GENTAMICIN 80MG/2ML IJ                    $58.68       $58.68   084170   LOS PHARMACY REV
75096040    GENTAMICIN DRP                            $71.68       $71.68   084170   LOS PHARMACY REV
75096057    GENTAMICIN OPTH DROP 5ML                  $71.68       $71.68   084170   LOS PHARMACY REV
75015636    GLIMEPIRIDE 1MG TAB                       $14.72       $14.72   084170   LOS PHARMACY REV
75015644    GLIMEPIRIDE 2MG TAB                       $15.18       $15.18   084170   LOS PHARMACY REV
75015651    GLIMEPIRIDE 4MG TAB                       $16.24       $16.24   084170   LOS PHARMACY REV
75015529    GLIPIZIDE 10MG TAB                        $15.24       $15.24   084170   LOS PHARMACY REV
75015511    GLIPIZIDE 5MG TAB                         $14.72       $14.72   084170   LOS PHARMACY REV
75015628    GLIPIZIDE XL 10MG TAB                     $15.80       $15.80   084170   LOS PHARMACY REV
75015610    GLIPIZIDE XL 5MG TAB                      $14.90       $14.90   084170   LOS PHARMACY REV
75057422    GLUCAGON 1U VL                           $219.50      $219.50   084170   LOS PHARMACY REV


7/11/2012                                                                                               59
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75017624    GLUCOSE 31GM TUBE                        $34.26       $34.26   084170   LOS PHARMACY REV
75015701    GLUCOSE TAB                              $14.52       $14.52   084170   LOS PHARMACY REV
75015537    GLUCOSE TABLETS PACK                     $16.10       $16.10   084170   LOS PHARMACY REV
75015545    GLYBURIDE 1.25 MG TAB                    $14.46       $14.46   084170   LOS PHARMACY REV
75015719    GLYBURIDE 1.25/250MG TAB                 $15.80       $15.80   084170   LOS PHARMACY REV
75015727    GLYBURIDE 2.5/500MG TAB                  $16.14       $16.14   084170   LOS PHARMACY REV
75015552    GLYBURIDE 2.5MG TAB                      $14.92       $14.92   084170   LOS PHARMACY REV
75015578    GLYBURIDE 3MG TAB                        $15.28       $15.28   084170   LOS PHARMACY REV
75015735    GLYBURIDE 5/500MG TAB                    $16.14       $16.14   084170   LOS PHARMACY REV
75015560    GLYBURIDE 5MG TAB                        $15.68       $15.68   084170   LOS PHARMACY REV
75092312    GLYCERIN ADULT SUP                       $14.38       $14.38   084170   LOS PHARMACY REV
75015438    GLYCERIN LIQ 1ML                         $14.95       $14.95   084170   LOS PHARMACY REV
75092304    GLYCERIN PED SUP                         $14.46       $14.46   084170   LOS PHARMACY REV
75066670    GLYCOPYRROLATE 0.2MG IJ                  $59.88       $59.88   084170   LOS PHARMACY REV
75032565    GLYCOPYRROLATE 1MG TB                    $15.52       $15.52   084170   LOS PHARMACY REV
75057448    GLYCOPYRROLATE 1MG/5ML VL                $63.28       $63.28   084170   LOS PHARMACY REV
75095653    GONAK 2.5% OPTH 15ML                     $50.38       $50.38   084170   LOS PHARMACY REV
75018853    GRANISETRON 1MG PO                      $108.08      $108.08   084170   LOS PHARMACY REV
75057505    GRANISETRON HCL 1MG IJ VL               $447.40      $447.40   084170   LOS PHARMACY REV
75033068    GUAIF/COD LIQ 10ML                       $29.10       $29.10   084170   LOS PHARMACY REV
75032656    GUAIF/DM 10ML LIQ                        $32.60       $32.60   084170   LOS PHARMACY REV
75016410    GUAIF/HYDROCOD LIQ 5ML                   $87.06       $87.06   084170   LOS PHARMACY REV
75015768    GUAIF/PSEU 400/120MG CAP                 $16.54       $16.54   084170   LOS PHARMACY REV
75032615    GUAIFENESIN 10ML LIQ                     $28.58       $28.58   084170   LOS PHARMACY REV
75016907    GUAIFENESIN 600MG TAB                    $15.16       $15.16   084170   LOS PHARMACY REV
75043109    GUANABENZ 4MG TAB                        $15.96       $15.96   084170   LOS PHARMACY REV
75036582    GUANFACINE TAB 1MG                       $18.34       $18.34   084170   LOS PHARMACY REV
75016782    HALOPERIDOL 2MG/1ML LIQ                  $28.72       $28.72   084170   LOS PHARMACY REV
75057992    HALOPERIDOL INJ 50MG                    $146.88      $146.88   084170   LOS PHARMACY REV
75058008    HALOPERIDOL INJ 5MG                      $80.06       $80.06   084170   LOS PHARMACY REV
75016063    HALOPERIDOL LQ 40Z                      $122.64      $122.64   084170   LOS PHARMACY REV
75016006    HALOPERIDOL TAB .5MG                     $14.58       $14.58   084170   LOS PHARMACY REV
75016048    HALOPERIDOL TAB 10MG                     $17.28       $17.28   084170   LOS PHARMACY REV
75016014    HALOPERIDOL TAB 1MG                      $14.90       $14.90   084170   LOS PHARMACY REV
75016022    HALOPERIDOL TAB 2MG                      $14.96       $14.96   084170   LOS PHARMACY REV
75016030    HALOPERIDOL TAB 5MG                      $15.94       $15.94   084170   LOS PHARMACY REV


7/11/2012                                                                                              60
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75030114    HCTZ 12.5MG/20MG TAB                     $16.70       $16.70   084170   LOS PHARMACY REV
75021378    HCTZ 50/TRIAMTER 75 TAB                  $15.50       $15.50   084170   LOS PHARMACY REV
75016527    HCTZ TAB 25MG                            $14.34       $14.34   084170   LOS PHARMACY REV
75016535    HCTZ TAB 50MG                            $14.36       $14.36   084170   LOS PHARMACY REV
75000307    HCTZ/SPIRON TAB                          $15.46       $15.46   084170   LOS PHARMACY REV
75058107    HEPARIN 10000U/ML 1ML VL                $116.22      $116.22   084170   LOS PHARMACY REV
75058545    HEPARIN 10000U/ML 4ML MDV               $123.98      $123.98   084170   LOS PHARMACY REV
75058065    HEPARIN 1000U/ML 1ML VIAL                $59.16       $59.16   084170   LOS PHARMACY REV
75058560    HEPARIN 1000U/ML MDV 10ML               $115.82      $115.82   084170   LOS PHARMACY REV
75058279    HEPARIN 100U/ML 10 ML VL                 $58.62       $58.62   084170   LOS PHARMACY REV
75058339    HEPARIN 100U/ML 30ML VIAL                $31.90       $31.90   084170   LOS PHARMACY REV
75058693    HEPARIN 10U/ML 10ML IJ                   $58.18       $58.18   084170   LOS PHARMACY REV
75058388    HEPARIN 30U/30ML VIAL                    $59.16       $59.16   084170   LOS PHARMACY REV
75057984    HEPARIN 5000U/1ML IJ                     $58.98       $58.98   084170   LOS PHARMACY REV
75058081    HEPARIN 5000U/ML VIAL                   $115.42      $115.42   084170   LOS PHARMACY REV
75058024    HEPARIN FLUSH 10U/ML 1ML                 $29.56       $29.56   084170   LOS PHARMACY REV
75058503    HEPARIN FLUSH DAILY CHG                  $33.22       $33.22   084170   LOS PHARMACY REV
75058636    HEPARIN NEO FLSH DLY CH                 $114.56      $114.56   084170   LOS PHARMACY REV
75058255    HETASTARCH 500ML                        $219.40      $219.40   084170   LOS PHARMACY REV
75084046    HEXACHLOROPHENE 150ML TOP                $43.44       $43.44   084170   LOS PHARMACY REV
75096628    HOMATROPINE 5% OPTH 15ML                 $94.38       $94.38   084170   LOS PHARMACY REV
75099317    HOMATROPINE 5% OPTH 5ML                  $83.00       $83.00   084170   LOS PHARMACY REV
75069831    HYALURONIDASE 150U IJ                   $117.00      $117.00   084170   LOS PHARMACY REV
75016378    HYCODAN LQ 5ML                           $87.10       $87.10   084170   LOS PHARMACY REV
75001537    HYDRALAZINE 100MG TAB                    $14.20       $14.20   084170   LOS PHARMACY REV
75001503    HYDRALAZINE 10MG TAB                     $14.12       $14.12   084170   LOS PHARMACY REV
75047084    HYDRALAZINE 20MG/1ML IJ                  $94.50       $94.50   084170   LOS PHARMACY REV
75058347    HYDRALAZINE 20MG/ML AMP                  $87.00       $87.00   084170   LOS PHARMACY REV
75001511    HYDRALAZINE 25MG TAB                     $14.34       $14.34   084170   LOS PHARMACY REV
75001529    HYDRALAZINE 50MG TAB                     $14.42       $14.42   084170   LOS PHARMACY REV
75025403    HYDROCOD/APAP 10/325MG TB                $29.40       $29.40   084170   LOS PHARMACY REV
75020164    HYDROCOD/APAP 10/500 TAB                 $30.10       $30.10   084170   LOS PHARMACY REV
75016808    HYDROCOD/APAP 5/325 TAB                  $15.08       $15.08   084170   LOS PHARMACY REV
75042234    HYDROCOD/APAP 5MG TAB                    $29.80       $29.80   084170   LOS PHARMACY REV
75045476    HYDROCOD/APAP 5MG TAB W/C                 $0.00        $0.00   084170   LOS PHARMACY REV
75042168    HYDROCOD/APAP 7.5MG TAB                  $30.00       $30.00   084170   LOS PHARMACY REV


7/11/2012                                                                                              61
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75045583    HYDROCOD/APAP 7.5MG W/C                   $2.18        $2.18   084170   LOS PHARMACY REV
75002584    HYDROCOD/APAP LIQ 15ML                   $34.68       $34.68   084170   LOS PHARMACY REV
75042085    HYDROCOD/APAP TAB                        $28.90       $28.90   084170   LOS PHARMACY REV
75038380    HYDROCOD/CHLORP 5ML LIQ                  $32.60       $32.60   084170   LOS PHARMACY REV
75042259    HYDROCOD/IBUPR 7.5/200 TB                $30.94       $30.94   084170   LOS PHARMACY REV
75077230    HYDROCORT 0.005% CRM 30GM               $105.90      $105.90   084170   LOS PHARMACY REV
75077248    HYDROCORT 1% CR 30GM                     $33.50       $33.50   084170   LOS PHARMACY REV
75077271    HYDROCORT 1% OIN 30GM                    $36.20       $36.20   084170   LOS PHARMACY REV
75067348    HYDROCORT 100MG INJ VIAL                $119.06      $119.06   084170   LOS PHARMACY REV
75016584    HYDROCORT 10MG TAB                       $14.80       $14.80   084170   LOS PHARMACY REV
75016592    HYDROCORT 20MG TAB                       $15.50       $15.50   084170   LOS PHARMACY REV
75067355    HYDROCORT 250MG INJ VIAL                $121.00      $121.00   084170   LOS PHARMACY REV
75016576    HYDROCORT 5MG TAB                        $14.44       $14.44   084170   LOS PHARMACY REV
75070193    HYDROCORT CRM                           $106.70      $106.70   084170   LOS PHARMACY REV
75077289    HYDROCORT CRM 2/5% 30GM                  $50.00       $50.00   084170   LOS PHARMACY REV
75072611    HYDROCORT ENEMA                          $52.24       $52.24   084170   LOS PHARMACY REV
75084293    HYDROCORT RECT FOAM 10GM                $124.32      $124.32   084170   LOS PHARMACY REV
75074146    HYDROCORT RECT FOAM 10GM                 $75.38       $75.38   084170   LOS PHARMACY REV
75091165    HYDROCORT SUP                            $21.30       $21.30   084170   LOS PHARMACY REV
75077297    HYDROGEN PEROX 120ML TOP                 $29.36       $29.36   084170   LOS PHARMACY REV
75052936    HYDROMORPHONE 10MG/ML IJ                $121.24      $121.24   084170   LOS PHARMACY REV
75053488    HYDROMORPHONE 1MG/ML IJ                  $87.06       $87.06   084170   LOS PHARMACY REV
75052902    HYDROMORPHONE 2MG IJ                     $87.66       $87.66   084170   LOS PHARMACY REV
75009167    HYDROMORPHONE 2MG TAB                    $28.98       $28.98   084170   LOS PHARMACY REV
75092122    HYDROMORPHONE 3MG SUPP                   $36.00       $36.00   084170   LOS PHARMACY REV
75052928    HYDROMORPHONE 4MG IJ                     $88.40       $88.40   084170   LOS PHARMACY REV
75009183    HYDROMORPHONE 4MG TAB                    $29.90       $29.90   084170   LOS PHARMACY REV
75053504    HYDROMORPHONE PCA                        $87.54       $87.54   084170   LOS PHARMACY REV
75016501    HYDROXYUREA CAP                          $16.84       $16.84   084170   LOS PHARMACY REV
75002071    HYDROXYZINE HCL 10MG TAB                 $15.40       $15.40   084170   LOS PHARMACY REV
75069625    HYDROXYZINE HCL 25MG IJ                  $58.48       $58.48   084170   LOS PHARMACY REV
75002089    HYDROXYZINE HCL 25MG TAB                 $16.04       $16.04   084170   LOS PHARMACY REV
75069633    HYDROXYZINE HCL 50MG IJ                  $57.98       $57.98   084170   LOS PHARMACY REV
75002097    HYDROXYZINE HCL 50MG TAB                 $16.50       $16.50   084170   LOS PHARMACY REV
75002063    HYDROXYZINE HCL LIQ 5ML                  $45.08       $45.08   084170   LOS PHARMACY REV
75041707    HYDROXYZINE PAM 25/5 LIQ                $380.76      $380.76   084170   LOS PHARMACY REV


7/11/2012                                                                                              62
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75041665    HYDROXYZINE PAM 25MG CAP                  $16.18       $16.18   084170   LOS PHARMACY REV
75041673    HYDROXYZINE PAM 50MG CAP                  $16.66       $16.66   084170   LOS PHARMACY REV
75019349    HYOSCYAMNE 0.125MG TAB                    $15.46       $15.46   084170   LOS PHARMACY REV
75006999    HYOSCYAMNE 0.15MG TAB                     $14.78       $14.78   084170   LOS PHARMACY REV
75019380    HYOSCYAMNE TIMECP 0.37MG                  $16.68       $16.68   084170   LOS PHARMACY REV
75058552    HYSKON INJ 100ML                         $171.26      $171.26   084170   LOS PHARMACY REV
75017137    IBUPROFEN 100MG/5ML 120ML                 $28.06       $28.06   084170   LOS PHARMACY REV
75017053    IBUPROFEN 100MG/5ML LIQ                   $28.52       $28.52   084170   LOS PHARMACY REV
75017038    IBUPROFEN 200MG TAB                       $14.14       $14.14   084170   LOS PHARMACY REV
75022665    IBUPROFEN 400MG TAB                       $14.44       $14.44   084170   LOS PHARMACY REV
75022673    IBUPROFEN 600MG TAB                       $14.82       $14.82   084170   LOS PHARMACY REV
75022681    IBUPROFEN 800MG TAB                       $14.86       $14.86   084170   LOS PHARMACY REV
75059758    IBUTILIDE 0.1MG/ML 10ML                  $720.70      $720.70   084170   LOS PHARMACY REV
75059766    IDARUBICIN/5MG IJ                      $1,379.08    $1,379.08   084170   LOS PHARMACY REV
75059055    IFOSFAMIDE/1GM IJ                        $834.68      $834.68   084170   LOS PHARMACY REV
75058354    IG HEPATITIS B HUMAN IM                  $320.34      $320.34   084170   LOS PHARMACY REV
75059931    IG IVIG LYOPHILIZD 500MG                 $329.00      $329.00   084170   LOS PHARMACY REV
75066720    IG RABIES IM/SUBCU                     $1,880.50    $1,880.50   084170   LOS PHARMACY REV
75068338    IG TETANUS 250 IU IJ                     $545.00      $545.00   084170   LOS PHARMACY REV
75065953    IMIPENEM/CILAST INJ 500MG                $181.00      $181.00   084170   LOS PHARMACY REV
75017145    IMIPRAMINE 10MG TAB                       $16.40       $16.40   084170   LOS PHARMACY REV
75017152    IMIPRAMINE 25MG TAB                       $18.00       $18.00   084170   LOS PHARMACY REV
75017160    IMIPRAMINE 50MG TAB                       $20.80       $20.80   084170   LOS PHARMACY REV
75019885    INDAPAMIDE 2.5MG TAB                      $15.70       $15.70   084170   LOS PHARMACY REV
75059204    INDIGO CARMINE 5ML IJ                     $75.00       $75.00   084170   LOS PHARMACY REV
75017640    INDINAVIR 400MG CAP                       $20.08       $20.08   084170   LOS PHARMACY REV
75059741    INDOMETHACIN 1MG INJ SDV                 $121.80      $121.80   084170   LOS PHARMACY REV
75017343    INDOMETHACIN 25MG CAP                     $15.34       $15.34   084170   LOS PHARMACY REV
75017350    INDOMETHACIN 50MG CAP                     $16.20       $16.20   084170   LOS PHARMACY REV
75017368    INDOMETHACIN SR 75MG CAP                  $18.74       $18.74   084170   LOS PHARMACY REV
75066795    INFLIXIMAB 100MG IJ                    $1,496.22    $1,496.22   084170   LOS PHARMACY REV
75059998    INFLIXIMAB 10MG IJ                       $145.00      $145.00   084170   LOS PHARMACY REV
75059873    INSULIN ASPART INJ                       $196.92      $196.92   084170   LOS PHARMACY REV
75059816    INSULIN GLARGIN INJ                       $70.26       $70.26   084170   LOS PHARMACY REV
75059279    INSULIN LENTE INJ                         $63.14       $63.14   084170   LOS PHARMACY REV
75059782    INSULIN LISPRO INJ                        $71.00       $71.00   084170   LOS PHARMACY REV


7/11/2012                                                                                               63
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75059576    INSULIN NPH HUM INJ                      $118.00      $118.00   084170   LOS PHARMACY REV
75059725    INSULIN NPH HUM RNBW INJ                  $63.40       $63.40   084170   LOS PHARMACY REV
75059744    INSULIN REG HUM DAILY                    $118.00      $118.00   084170   LOS PHARMACY REV
75059568    INSULIN REG HUM INJ                      $118.00      $118.00   084170   LOS PHARMACY REV
75059436    INSULIN REG HUM RNBW INJ                 $118.00      $118.00   084170   LOS PHARMACY REV
75059915    INSULIN REG HUM U-500 VL                 $489.95      $489.95   084170   LOS PHARMACY REV
75059634    INSULIN REG/NPH 70/30 IJ                 $118.00      $118.00   084170   LOS PHARMACY REV
75059261    INTERFERON A-2B 3MIL U IJ              $1,105.70    $1,105.70   084170   LOS PHARMACY REV
75059618    INTERFERON A-2B 5MU                      $637.08      $637.08   084170   LOS PHARMACY REV
75058990    INTERFERON B IA 30MCG IJ                 $928.16      $928.16   084170   LOS PHARMACY REV
75094391    IPRATROPIUM 0.02% 2.5ML                   $31.52       $31.52   084170   LOS PHARMACY REV
75070623    IPRATROPIUM 0.06% NAS SPY                $115.84      $115.84   084170   LOS PHARMACY REV
75094623    IPRATROPIUM INHALER                      $153.16      $153.16   084170   LOS PHARMACY REV
75017749    IRBESARTAN 150MG TAB                      $17.32       $17.32   084170   LOS PHARMACY REV
75017731    IRBESARTAN 75MG TAB                       $17.16       $17.16   084170   LOS PHARMACY REV
75059857    IRINOTECAN 100MG IJ                    $1,591.12    $1,591.12   084170   LOS PHARMACY REV
75025312    IRON COMPLEX 150 CAP                      $14.78       $14.78   084170   LOS PHARMACY REV
75059105    IRON DEXTRAN 50MG/ML 2ML                 $188.40      $188.40   084170   LOS PHARMACY REV
75069112    IRON SUCROSE 100MG/5ML IJ                $250.60      $250.60   084170   LOS PHARMACY REV
75017400    ISONIAZID TAB 100MG                       $14.20       $14.20   084170   LOS PHARMACY REV
75017418    ISONIAZID TAB 300MG                       $14.24       $14.24   084170   LOS PHARMACY REV
75078030    ISOPROPYL ETOH 480ML                      $28.34       $28.34   084170   LOS PHARMACY REV
75059154    ISOPROTERENOL 0.2MG/ML IJ                 $68.40       $68.40   084170   LOS PHARMACY REV
75059428    ISOPROTERENOL 1MG/5ML AMP                $120.66      $120.66   084170   LOS PHARMACY REV
75017533    ISOSORBIDE 10MG TAB                       $14.36       $14.36   084170   LOS PHARMACY REV
75017541    ISOSORBIDE 20MG TAB                       $14.60       $14.60   084170   LOS PHARMACY REV
75017558    ISOSORBIDE 30MG TAB                       $15.40       $15.40   084170   LOS PHARMACY REV
75017566    ISOSORBIDE 40MG TAB                       $15.52       $15.52   084170   LOS PHARMACY REV
75017525    ISOSORBIDE 5MG TAB                        $14.28       $14.28   084170   LOS PHARMACY REV
75017392    ISOSORBIDE MONO 20MG TAB                  $16.86       $16.86   084170   LOS PHARMACY REV
75017707    ISOSORBIDE MONO 30MG TAB                  $17.86       $17.86   084170   LOS PHARMACY REV
75017699    ISOSORBIDE MONO 60MG TAB                  $18.46       $18.46   084170   LOS PHARMACY REV
75017459    ISOTRETINOIN 40MG 10PK                    $34.16       $34.16   084170   LOS PHARMACY REV
75017673    ISRADIPINE 2.5MG CAP                      $16.90       $16.90   084170   LOS PHARMACY REV
75017681    ISRADIPINE 5MG CAPSULE                    $18.24       $18.24   084170   LOS PHARMACY REV
75017756    ITRACONAZOLE 100MG CAP                    $34.78       $34.78   084170   LOS PHARMACY REV


7/11/2012                                                                                               64
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75059840    ITRACONAZOLE 250MG IJ                   $536.82      $536.82   084170   LOS PHARMACY REV
75017723    IVERMECTIN 3MG TAB                       $24.88       $24.88   084170   LOS PHARMACY REV
75065441    K ACET 40MEQ/20ML VL                    $116.20      $116.20   084170   LOS PHARMACY REV
75018606    K ACID PHOS TAB                          $14.20       $14.20   084170   LOS PHARMACY REV
75018556    K BICARB/K CIT 25MEQ TAB                 $16.98       $16.98   084170   LOS PHARMACY REV
75022335    K CL 10MEQ CAP                           $14.72       $14.72   084170   LOS PHARMACY REV
75022228    K CL 10MEQ TAB                           $14.68       $14.68   084170   LOS PHARMACY REV
75060103    K CL 20MEQ VIAL                          $64.40       $64.40   084170   LOS PHARMACY REV
75018390    K CL 20MEQ/15ML LIQ U.D.                 $23.78       $23.78   084170   LOS PHARMACY REV
75018531    K CL 25MEQ TAB                           $16.98       $16.98   084170   LOS PHARMACY REV
75018408    K CL 30MEQ/22.5ML LQ UD                  $19.26       $19.26   084170   LOS PHARMACY REV
75060137    K CL 40MEQ VIAL                         $113.68      $113.68   084170   LOS PHARMACY REV
75018416    K CL 40MEQ/30ML LIQ U.D.                 $14.78       $14.78   084170   LOS PHARMACY REV
75018333    K CL PKT 20MEQ                           $17.22       $17.22   084170   LOS PHARMACY REV
75018366    K CL TAB 20MEQ                           $14.70       $14.70   084170   LOS PHARMACY REV
75035063    K IODIDE DRP 30ML                        $52.20       $52.20   084170   LOS PHARMACY REV
75065466    K PHOS 45MM IJ                          $115.58      $115.58   084170   LOS PHARMACY REV
75018804    KALETRA 200MG/50MG TAB                   $25.65       $25.65   084170   LOS PHARMACY REV
75060020    KANAMYCIN 1GM/3ML VL                    $132.22      $132.22   084170   LOS PHARMACY REV
75018028    KAOLIN-PECTIN 30ML                       $14.98       $14.98   084170   LOS PHARMACY REV
75030379    KCIT 1080MG TAB                          $15.16       $15.16   084170   LOS PHARMACY REV
75060376    KETAMINE 100MG/ML 5ML VL                $142.90      $142.90   084170   LOS PHARMACY REV
75060475    KETAMINE 50MG IJ                         $76.66       $76.66   084170   LOS PHARMACY REV
75018861    KETAMINE 50MG/1ML ORAL SY               $117.50      $117.50   084170   LOS PHARMACY REV
75060368    KETAMINE 50MG/ML 10ML VL                $144.04      $144.04   084170   LOS PHARMACY REV
75024703    KETOCONAZOLE 200MG TAB                   $23.48       $23.48   084170   LOS PHARMACY REV
75082495    KETOCONAZOLE CRM 15GM                    $69.92       $69.92   084170   LOS PHARMACY REV
75095604    KETOROLAC 0.5% OP DRP 5ML               $161.70      $161.70   084170   LOS PHARMACY REV
75060467    KETOROLAC 15MG SYRINGE                   $71.06       $71.06   084170   LOS PHARMACY REV
75018952    KETOROLAC 30MG IJ                       $127.72      $127.72   084170   LOS PHARMACY REV
75018960    KETOROLAC 60MG SYRINGE                   $71.72       $71.72   084170   LOS PHARMACY REV
75019083    LABETALOL 100MG TAB                      $15.50       $15.50   084170   LOS PHARMACY REV
75061036    LABETALOL 100MG/20ML IJ                 $124.00      $124.00   084170   LOS PHARMACY REV
75019034    LABETALOL 200MG TAB                      $15.36       $15.36   084170   LOS PHARMACY REV
75061663    LABETALOL 20MG/4ML IJ                    $66.52       $66.52   084170   LOS PHARMACY REV
75019059    LABETALOL 300MG TAB                      $16.76       $16.76   084170   LOS PHARMACY REV


7/11/2012                                                                                              65
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75080010    LACHYDRIN 12% LOTION                     $112.72      $112.72   084170   LOS PHARMACY REV
75020545    LACTASE CHEW TAB                          $14.40       $14.40   084170   LOS PHARMACY REV
75019067    LACTOBACILLUS PKT                         $15.54       $15.54   084170   LOS PHARMACY REV
75019075    LACTOBACILLUS TAB                         $14.32       $14.32   084170   LOS PHARMACY REV
75005629    LACTULOSE 30ML LIQ                        $19.78       $19.78   084170   LOS PHARMACY REV
75020420    LACTULOSE 480ML                           $94.40       $94.40   084170   LOS PHARMACY REV
75072165    LACTULOSE ENEMA 1000ML                   $122.00      $122.00   084170   LOS PHARMACY REV
75020107    LAMIVUDINE 150MG TAB                      $24.54       $24.54   084170   LOS PHARMACY REV
75020487    LAMIVUDINE/ZIDOVUDINE TAB                 $37.00       $37.00   084170   LOS PHARMACY REV
75020529    LAMIVUDIVE HBV 100MG TAB                  $32.04       $32.04   084170   LOS PHARMACY REV
75020404    LAMOTRIGINE 100MG TAB                     $20.64       $20.64   084170   LOS PHARMACY REV
75020396    LAMOTRIGINE 25MG TAB                      $20.26       $20.26   084170   LOS PHARMACY REV
75080341    LANOLIN (PURE) 7GM TUBE                   $59.14       $59.14   084170   LOS PHARMACY REV
75020271    LANSOPRAZOLE 15MG TAB                     $23.36       $23.36   084170   LOS PHARMACY REV
75020289    LANSOPRAZOLE 30MG TAB                     $23.54       $23.54   084170   LOS PHARMACY REV
75030254    LANSOPRAZOLE 30MG/10ML LQ                 $23.54       $23.54   084170   LOS PHARMACY REV
75020479    LANSOPRAZOLE SOLU 15MG TB                 $23.72       $23.72   084170   LOS PHARMACY REV
75020461    LANSOPRAZOLE SOLU 30MG TB                 $23.92       $23.92   084170   LOS PHARMACY REV
75020537    LANTHANUM CHW 250MG TAB                   $15.40       $15.40   084170   LOS PHARMACY REV
75020552    LANTHANUM CHW 500MG TAB                   $19.00       $19.00   084170   LOS PHARMACY REV
75098830    LATANOPROST 0.005% 2.5ML                 $139.20      $139.20   084170   LOS PHARMACY REV
75020503    LEFLUNOMIDE 10MG TAB                      $53.60       $53.60   084170   LOS PHARMACY REV
75020511    LEFLUNOMIDE 20MG TAB                      $53.60       $53.60   084170   LOS PHARMACY REV
75061648    LEPIRUDIN 50MG IJ                        $442.68      $442.68   084170   LOS PHARMACY REV
75061457    LEUCOVORIN 100MG INJ                     $506.26      $506.26   084170   LOS PHARMACY REV
75061150    LEUCOVORIN 50MG IJ                       $502.50      $502.50   084170   LOS PHARMACY REV
75019224    LEUCOVORIN 5MG TAB                        $20.50       $20.50   084170   LOS PHARMACY REV
75061432    LEUPROLIDE 7.5MG IJ                    $1,865.42    $1,865.42   084170   LOS PHARMACY REV
75061655    LEUPROLIDE/3.75MG IJ                   $1,634.18    $1,634.18   084170   LOS PHARMACY REV
75098848    LEVALBUTEROL 0.63MG/3ML                   $19.80       $19.80   084170   LOS PHARMACY REV
75099358    LEVALBUTEROL 1.25MG/0.5ML                 $19.80       $19.80   084170   LOS PHARMACY REV
75098855    LEVALBUTEROL 1.25MG/3ML                   $19.80       $19.80   084170   LOS PHARMACY REV
75020412    LEVETIRACETAM 500MG TAB                   $17.70       $17.70   084170   LOS PHARMACY REV
75094755    LEVOBUNOLOL 0.25% OP 10ML                $125.30      $125.30   084170   LOS PHARMACY REV
75094565    LEVOBUNOLOL 0.5% OP 5ML                   $92.58       $92.58   084170   LOS PHARMACY REV
75061580    LEVOFLOX 250MG/50ML D5W                  $158.66      $158.66   084170   LOS PHARMACY REV


7/11/2012                                                                                               66
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75061598    LEVOFLOX 500MG/100ML D5W                $204.30      $204.30   084170   LOS PHARMACY REV
44611663    LEVOFLOX 750MG/150ML D5W                $206.18      $206.18   084170   LOS PHARMACY REV
75020354    LEVOFLOXACIN 250MG TAB                   $34.58       $34.58   084170   LOS PHARMACY REV
75061572    LEVOFLOXACIN 500MG IJ VL                $204.30      $204.30   084170   LOS PHARMACY REV
75020347    LEVOFLOXACIN 500MG TAB                   $37.56       $37.56   084170   LOS PHARMACY REV
75020495    LEVOFLOXACIN 750MG TAB                   $60.00       $60.00   084170   LOS PHARMACY REV
75020578    LEVONORGESTREL 0.75MG TAB                $48.95       $48.95   084170   LOS PHARMACY REV
75019315    LEVORPHANAL 2MG TAB                      $29.14       $29.14   084170   LOS PHARMACY REV
75061184    LEVORPHANAL 2MG/1ML AMP                  $92.92       $92.92   084170   LOS PHARMACY REV
75035535    LEVOTHYROXINE 0.025MG TAB                $14.66       $14.66   084170   LOS PHARMACY REV
75035626    LEVOTHYROXINE 0.05MG TAB                 $14.78       $14.78   084170   LOS PHARMACY REV
75035519    LEVOTHYROXINE 0.075MG TAB                $14.82       $14.82   084170   LOS PHARMACY REV
75035733    LEVOTHYROXINE 0.088MG TAB                $14.54       $14.54   084170   LOS PHARMACY REV
75035741    LEVOTHYROXINE 0.112MG TAB                $14.98       $14.98   084170   LOS PHARMACY REV
75035634    LEVOTHYROXINE 0.125MG TAB                $15.06       $15.06   084170   LOS PHARMACY REV
75035568    LEVOTHYROXINE 0.15MG TAB                 $15.08       $15.08   084170   LOS PHARMACY REV
75035659    LEVOTHYROXINE 0.175MG TAB                $14.74       $14.74   084170   LOS PHARMACY REV
75035550    LEVOTHYROXINE 0.1MG TAB                  $14.90       $14.90   084170   LOS PHARMACY REV
75035576    LEVOTHYROXINE 0.2MG TAB                  $15.56       $15.56   084170   LOS PHARMACY REV
75035584    LEVOTHYROXINE 0.3MG TAB                  $15.64       $15.64   084170   LOS PHARMACY REV
75067959    LEVOTHYROXINE 200MCG VL                 $240.16      $240.16   084170   LOS PHARMACY REV
75067942    LEVOTHYROXINE 500MCG VL                 $253.06      $253.06   084170   LOS PHARMACY REV
75019422    LEVY'S MW NO 5 120ML                     $61.92       $61.92   084170   LOS PHARMACY REV
75019455    LEVY'S MW NO 5 240ML                     $70.84       $70.84   084170   LOS PHARMACY REV
75019307    LEVY'S WASH 120ML LIQ                    $61.54       $61.54   084170   LOS PHARMACY REV
75019323    LEVY'S WASH PT                           $70.08       $70.08   084170   LOS PHARMACY REV
75019331    LIBRAX CAP                               $19.00       $19.00   084170   LOS PHARMACY REV
75061325    LIDO/DEXTROSE 5%/GLUC7.5%                $66.28       $66.28   084170   LOS PHARMACY REV
75061531    LIDO/EPI 0.5% 50ML VL                    $69.36       $69.36   084170   LOS PHARMACY REV
75069872    LIDO/EPI 1% 20ML VIAL                    $59.76       $59.76   084170   LOS PHARMACY REV
75061481    LIDO/EPI 1% 30ML VL                      $81.98       $81.98   084170   LOS PHARMACY REV
75061168    LIDO/EPI 1% MPF 2ML VL                   $60.98       $60.98   084170   LOS PHARMACY REV
75061697    LIDO/EPI 1% MPF 30ML VL                  $82.74       $82.74   084170   LOS PHARMACY REV
75061390    LIDO/EPI 1.5% 30ML AMP                   $59.76       $59.76   084170   LOS PHARMACY REV
75061739    LIDO/EPI 1.5% MPF 5ML AMP                $63.04       $63.04   084170   LOS PHARMACY REV
75069138    LIDO/EPI 2% 20ML AMP                     $60.22       $60.22   084170   LOS PHARMACY REV


7/11/2012                                                                                              67
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75069906    LIDO/EPI 2% 20ML VIAL                     $73.66       $73.66   084170   LOS PHARMACY REV
75061713    LIDO/EPI 2% MPF 20ML VL                   $89.76       $89.76   084170   LOS PHARMACY REV
75061507    LIDO/EPI MPF 2% 20ML VL                   $88.80       $88.80   084170   LOS PHARMACY REV
75061275    LIDOCAINE 1% 10ML VIAL                    $60.26       $60.26   084170   LOS PHARMACY REV
75061192    LIDOCAINE 1% 20ML VIAL                    $66.10       $66.10   084170   LOS PHARMACY REV
75061366    LIDOCAINE 1% 2ML AMP                      $61.14       $61.14   084170   LOS PHARMACY REV
75061556    LIDOCAINE 1% MPF 30ML VL                  $77.72       $77.72   084170   LOS PHARMACY REV
75069880    LIDOCAINE 1.5% 20ML AMP                   $68.90       $68.90   084170   LOS PHARMACY REV
75061549    LIDOCAINE 1.5% 20ML VL                    $68.48       $68.48   084170   LOS PHARMACY REV
75069922    LIDOCAINE 100MG JECT                     $124.56      $124.56   084170   LOS PHARMACY REV
75061721    LIDOCAINE 2% 10ML VL                      $63.35       $63.35   084170   LOS PHARMACY REV
75069898    LIDOCAINE 2% 20ML VIAL                    $61.00       $61.00   084170   LOS PHARMACY REV
75061473    LIDOCAINE 2% 2ML IJ                       $62.68       $62.68   084170   LOS PHARMACY REV
75089821    LIDOCAINE 2% JELLY 30GM                   $61.34       $61.34   084170   LOS PHARMACY REV
75061671    LIDOCAINE 2% MPF 10ML                     $72.06       $72.06   084170   LOS PHARMACY REV
75061705    LIDOCAINE 2% MPF 10ML VL                  $63.22       $63.22   084170   LOS PHARMACY REV
75089839    LIDOCAINE 2.5% OINT 35GM                  $58.38       $58.38   084170   LOS PHARMACY REV
75068049    LIDOCAINE 4% PF 5ML AMP                   $72.26       $72.26   084170   LOS PHARMACY REV
75089854    LIDOCAINE 4% TOP SL 50ML                  $71.76       $71.76   084170   LOS PHARMACY REV
75089847    LIDOCAINE 5% OINT 35GM                    $34.26       $34.26   084170   LOS PHARMACY REV
75080325    LIDOCAINE 5% PATCH #5PK                   $38.20       $38.20   084170   LOS PHARMACY REV
75069856    LIDOCAINE 5%50ML VIAL                     $82.46       $82.46   084170   LOS PHARMACY REV
75074310    LIDOCAINE CREAM 30GM                     $166.02      $166.02   084170   LOS PHARMACY REV
75080291    LIDOCAINE JELLY 5ML                       $72.60       $72.60   084170   LOS PHARMACY REV
75061515    LIDOCAINE MPF 0.5% 50ML                   $82.46       $82.46   084170   LOS PHARMACY REV
75061440    LIDOCAINE MPF 1% 10ML VL                  $69.54       $69.54   084170   LOS PHARMACY REV
75044065    LIDOCAINE VISCOUS 100ML                   $33.70       $33.70   084170   LOS PHARMACY REV
75044057    LIDOCAINE VISCOUS 15ML                    $59.04       $59.04   084170   LOS PHARMACY REV
75019836    LINEZOLID 600MG TAB                      $149.28      $149.28   084170   LOS PHARMACY REV
75061614    LINEZOLID 600MG/300ML BAG                $283.90      $283.90   084170   LOS PHARMACY REV
75061622    LINEZOLID/200MG IJ                       $142.48      $142.48   084170   LOS PHARMACY REV
75068528    LIOTHYRONINE 10MCG/ML 1ML              $1,018.98    $1,018.98   084170   LOS PHARMACY REV
75007047    LIOTHYRONINE 25MCG TAB                    $15.60       $15.60   084170   LOS PHARMACY REV
75007054    LIOTHYRONINE 50MCG TAB                    $16.60       $16.60   084170   LOS PHARMACY REV
75007039    LIOTHYRONINE 5MCG TAB                     $15.22       $15.22   084170   LOS PHARMACY REV
75037275    LIOTRIX 1 TAB                             $15.46       $15.46   084170   LOS PHARMACY REV


7/11/2012                                                                                               68
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


44611887    LIPID EMULSION 20% 100ML                $145.20      $145.20   084170   LOS PHARMACY REV
44611135    LIPID EMULSION 20% 500ML                $173.58      $173.58   084170   LOS PHARMACY REV
75029215    LISINOPRIL 10MG TAB                      $16.24       $16.24   084170   LOS PHARMACY REV
75029231    LISINOPRIL 20MG TAB                      $16.38       $16.38   084170   LOS PHARMACY REV
75028993    LISINOPRIL 5MG TAB                       $16.16       $16.16   084170   LOS PHARMACY REV
75019604    LITHIUM 300MG CAP                        $14.52       $14.52   084170   LOS PHARMACY REV
75019588    LITHIUM 300MG CAP                        $14.42       $14.42   084170   LOS PHARMACY REV
75019596    LITHIUM 300MG/5ML LIQ                    $44.78       $44.78   084170   LOS PHARMACY REV
75019711    LOMOTIL 2.5MG TAB                        $29.50       $29.50   084170   LOS PHARMACY REV
75019703    LOMOTIL 60ML LIQ                        $131.82      $131.82   084170   LOS PHARMACY REV
75005470    LOMUSTINE 10MG CAP                       $32.10       $32.10   084170   LOS PHARMACY REV
75005496    LOMUSTINE 40MG CAP                       $68.52       $68.52   084170   LOS PHARMACY REV
75017194    LOPERAMIDE 120ML LIQ                     $35.02       $35.02   084170   LOS PHARMACY REV
75017186    LOPERAMIDE CAP                           $14.96       $14.96   084170   LOS PHARMACY REV
75017483    LOPERAMIDE LIQ 60ML                      $42.06       $42.06   084170   LOS PHARMACY REV
75020222    LORATADINE 10MG TAB                      $20.46       $20.46   084170   LOS PHARMACY REV
75002147    LORAZEPAM 0.5MG TB                       $29.28       $29.28   084170   LOS PHARMACY REV
75002154    LORAZEPAM 1MG TAB                        $30.44       $30.44   084170   LOS PHARMACY REV
75061689    LORAZEPAM 20MG/10ML ML                   $63.00       $63.00   084170   LOS PHARMACY REV
75047464    LORAZEPAM INJ 2MG                        $98.40       $98.40   084170   LOS PHARMACY REV
75020198    LOSARTAN K 50MG TAB                      $17.18       $17.18   084170   LOS PHARMACY REV
75016980    LOSARTAN/HCTZ 50/12.5 TAB                $17.18       $17.18   084170   LOS PHARMACY REV
75080358    LOTEPREDNOL 0.5% OPTH 5ML               $112.94      $112.94   084170   LOS PHARMACY REV
75020446    LOTREL 2.5MG/10MG TAB                    $18.40       $18.40   084170   LOS PHARMACY REV
75020362    LOTREL 5MG/10MG CAP                      $18.92       $18.92   084170   LOS PHARMACY REV
75020438    LOTREL 5MG/10MG TAB                      $18.48       $18.48   084170   LOS PHARMACY REV
75020453    LOTREL 5MG/20MG TAB                      $18.74       $18.74   084170   LOS PHARMACY REV
75022319    LOVASTATIN 20MG TAB                      $19.36       $19.36   084170   LOS PHARMACY REV
75087254    LUBRICANTS 60GM TUBE                     $30.60       $30.60   084170   LOS PHARMACY REV
75087213    MAFENIDE CRM                            $106.02      $106.02   084170   LOS PHARMACY REV
75021048    MAG ALOH HYD 150ML                       $28.50       $28.50   084170   LOS PHARMACY REV
75021030    MAG ALOH HYD 30ML                        $14.90       $14.90   084170   LOS PHARMACY REV
75021097    MAG ALOH SIMETH 150ML                    $30.52       $30.52   084170   LOS PHARMACY REV
75022913    MAG ALOH SIMETH 30ML                     $15.28       $15.28   084170   LOS PHARMACY REV
75022855    MAG ALOH SIMETH 30ML                     $15.28       $15.28   084170   LOS PHARMACY REV
75023010    MAG ALOH SIMETH LIQ 30ML                 $15.02       $15.02   084170   LOS PHARMACY REV


7/11/2012                                                                                              69
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75007104    MAG CIT 300ML                            $28.66       $28.66   084170   LOS PHARMACY REV
75021261    MAG CL 64MG TAB                          $14.32       $14.32   084170   LOS PHARMACY REV
75021170    MAG GLUC 500MG TAB                       $14.32       $14.32   084170   LOS PHARMACY REV
75022616    MAG HYDROXIDE 30ML                       $14.74       $14.74   084170   LOS PHARMACY REV
75021337    MAG OXIDE 400MG TAB                      $14.40       $14.40   084170   LOS PHARMACY REV
75081661    MAG SO4 (EPSOM SALT)                     $62.94       $62.94   084170   LOS PHARMACY REV
44611895    MAG SO4 4GM/100ML PR                    $128.50      $128.50   084170   LOS PHARMACY REV
75062042    MAG SO4 50% 20ML VL                     $116.76      $116.76   084170   LOS PHARMACY REV
75062018    MAG SO4 50% 2ML VL                      $116.36      $116.36   084170   LOS PHARMACY REV
75032391    MAGALDRATE LI 360ML                      $39.54       $39.54   084170   LOS PHARMACY REV
75062125    MANNITOL 12.5GM VL                      $117.06      $117.06   084170   LOS PHARMACY REV
75020024    MAPROTILINE 50MG TAB                     $15.48       $15.48   084170   LOS PHARMACY REV
75096800    MAXITROL 0.1% OPTH 5ML                  $133.88      $133.88   084170   LOS PHARMACY REV
75098947    MAXITROL OPTH OINT 3.5GM                 $73.00       $73.00   084170   LOS PHARMACY REV
75021352    MAXZIDE 25MG TAB                         $15.20       $15.20   084170   LOS PHARMACY REV
75023630    MEBENDAZOLE 100MG CHW TAB                $24.64       $24.64   084170   LOS PHARMACY REV
75062943    MECHLORETHAMINE 10MG IJ                  $82.28       $82.28   084170   LOS PHARMACY REV
75001354    MECLIZINE 12.5MG TAB                     $14.74       $14.74   084170   LOS PHARMACY REV
75001362    MECLIZINE 25MG TAB                       $14.76       $14.76   084170   LOS PHARMACY REV
75063396    MEDROXYPROGEST 104MG IJ                 $238.10      $238.10   084170   LOS PHARMACY REV
75029611    MEDROXYPROGEST 10MG TAB                  $16.70       $16.70   084170   LOS PHARMACY REV
75053470    MEDROXYPROGEST 150MG/ML                 $174.90      $174.90   084170   LOS PHARMACY REV
75029603    MEDROXYPROGEST 2.5MG TAB                 $15.38       $15.38   084170   LOS PHARMACY REV
75052480    MEDROXYPROGEST 400MG IJ                 $297.66      $297.66   084170   LOS PHARMACY REV
75030031    MEDROXYPROGEST 5MG TAB                   $16.06       $16.06   084170   LOS PHARMACY REV
75021576    MEGESTROL 20MG TAB                       $15.46       $15.46   084170   LOS PHARMACY REV
75021584    MEGESTROL 40MG TAB                       $16.60       $16.60   084170   LOS PHARMACY REV
75021683    MEGESTROL 40MG/ML LQ 20ML                $54.66       $54.66   084170   LOS PHARMACY REV
75023655    MELOXICAM 7.5MG TAB                      $21.40       $21.40   084170   LOS PHARMACY REV
75023598    MELPHALAN 2MG PO                         $24.84       $24.84   084170   LOS PHARMACY REV
75023531    MEMANTINE 10MG TAB                       $19.40       $19.40   084170   LOS PHARMACY REV
75023523    MEMANTINE 5MG TAB                        $19.42       $19.42   084170   LOS PHARMACY REV
75062349    MEPERIDINE 100MG IJ                      $87.40       $87.40   084170   LOS PHARMACY REV
75062307    MEPERIDINE 25MG IJ                       $86.86       $86.86   084170   LOS PHARMACY REV
75062323    MEPERIDINE 50MG IJ                       $85.72       $85.72   084170   LOS PHARMACY REV
75062331    MEPERIDINE 75MG IJ                       $86.90       $86.90   084170   LOS PHARMACY REV


7/11/2012                                                                                              70
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75053579    MEPERIDINE PCA                           $86.06       $86.06   084170   LOS PHARMACY REV
75049155    MEPIVACAINE 1% 30ML VL                   $80.68       $80.68   084170   LOS PHARMACY REV
75065714    MEPIVACAINE 2% 20ML VL                   $75.32       $75.32   084170   LOS PHARMACY REV
75065664    MEPIVACAINE MPF 1% 30ML                  $73.50       $73.50   084170   LOS PHARMACY REV
75063263    MEPIVACAINE MPF 1.5% 30ML                $66.92       $66.92   084170   LOS PHARMACY REV
75021840    MEPROBAMATE 200MG TAB                    $16.12       $16.12   084170   LOS PHARMACY REV
75021857    MEPROBAMATE 400MG TAB                    $30.76       $30.76   084170   LOS PHARMACY REV
75029637    MERCAPTOPURINE 50MG TAB                  $23.10       $23.10   084170   LOS PHARMACY REV
75063305    MEROPENEM 1GM/30ML VIAL                 $238.00      $238.00   084170   LOS PHARMACY REV
75062950    MEROPENEM 500MG VIAL                    $175.50      $175.50   084170   LOS PHARMACY REV
75063313    MEROPENEM 500MG/20ML VIAL               $170.22      $170.22   084170   LOS PHARMACY REV
75022715    MESALAMINE 250MG TAB                     $15.28       $15.28   084170   LOS PHARMACY REV
75021899    MESALAMINE 400MG TAB                     $16.08       $16.08   084170   LOS PHARMACY REV
75093369    MESALAMINE 500MG SUPP                    $23.56       $23.56   084170   LOS PHARMACY REV
75081588    MESALAMINE EMEMA 4GM/60ML                $60.02       $60.02   084170   LOS PHARMACY REV
75063081    MESNA 200MG IJ                          $933.64      $933.64   084170   LOS PHARMACY REV
75034389    MESORIDAZINE 25MG TAB                    $16.42       $16.42   084170   LOS PHARMACY REV
75097378    METAPROTERENOL 0.4% IN UD                $30.46       $30.46   084170   LOS PHARMACY REV
75097444    METAPROTERENOL 0.6% IN UD                $16.46       $16.46   084170   LOS PHARMACY REV
75000661    METAPROTERENOL 10MG/5 LIQ                $14.50       $14.50   084170   LOS PHARMACY REV
75000653    METAPROTERENOL 20MG TAB                  $14.94       $14.94   084170   LOS PHARMACY REV
75094482    METAPROTERENOL INH 15ML                  $95.30       $95.30   084170   LOS PHARMACY REV
75023663    METAXALONE 800MG TAB                     $20.40       $20.40   084170   LOS PHARMACY REV
75023358    METFORMIN 500 MG TAB                     $15.62       $15.62   084170   LOS PHARMACY REV
75023366    METFORMIN 850MG TAB                      $16.76       $16.76   084170   LOS PHARMACY REV
75023606    METFORMIN XR 500MG TAB                   $15.90       $15.90   084170   LOS PHARMACY REV
75023614    METFORMIN XR 750MG TAB                   $16.84       $16.84   084170   LOS PHARMACY REV
75022186    METHADONE 10MG TAB                       $28.88       $28.88   084170   LOS PHARMACY REV
75023143    METHADONE 10MG/5ML LIQ                   $15.90       $15.90   084170   LOS PHARMACY REV
75022178    METHADONE 5MG TAB                        $28.76       $28.76   084170   LOS PHARMACY REV
75021220    METHENAMINE 1GM TAB                      $16.46       $16.46   084170   LOS PHARMACY REV
75036178    METHIMAZOLE 10MG TAB                     $15.96       $15.96   084170   LOS PHARMACY REV
75036160    METHIMAZOLE 5MG TAB                      $14.88       $14.88   084170   LOS PHARMACY REV
75032516    METHOCARBAMOL 500MG TAB                  $14.74       $14.74   084170   LOS PHARMACY REV
75032524    METHOCARBAMOL 750MG TAB                  $16.32       $16.32   084170   LOS PHARMACY REV
75066654    METHOCARBAMOL INJ 1GM                    $88.54       $88.54   084170   LOS PHARMACY REV


7/11/2012                                                                                              71
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75048397    METHOHEXITAL 500MG IJ                   $138.02      $138.02   084170   LOS PHARMACY REV
75062547    METHOTREXATE 100MG IJ                   $507.50      $507.50   084170   LOS PHARMACY REV
75022152    METHOTREXATE 2.5MG TAB                   $24.50       $24.50   084170   LOS PHARMACY REV
75062570    METHOTREXATE 50MG IJ                    $505.00      $505.00   084170   LOS PHARMACY REV
75062661    METHOTREXATE INJ 1GM                    $617.88      $617.88   084170   LOS PHARMACY REV
75062620    METHOTREXATE INJ 250MG                   $80.76       $80.76   084170   LOS PHARMACY REV
75062446    METHOTREXATE INJ 500MG                  $520.70      $520.70   084170   LOS PHARMACY REV
75023364    METHYLCELLULOSE CAP                      $14.52       $14.52   084170   LOS PHARMACY REV
75007096    METHYLCELLULOSE PKT 19GM                 $14.52       $14.52   084170   LOS PHARMACY REV
75000406    METHYLDOPA 250MG TAB                     $14.90       $14.90   084170   LOS PHARMACY REV
75000414    METHYLDOPA 500MG TAB                     $15.76       $15.76   084170   LOS PHARMACY REV
75046417    METHYLDOPATE 250MG/5MG VL               $116.98      $116.98   084170   LOS PHARMACY REV
75062596    METHYLENE BLUE 10MG/ML IJ                $71.00       $71.00   084170   LOS PHARMACY REV
75022137    METHYLERGONOVIN 0.2MG TAB               $201.56      $201.56   084170   LOS PHARMACY REV
75062455    METHYLERGONOVIN INJ                      $66.54       $66.54   084170   LOS PHARMACY REV
75032466    METHYLPHENIDATE 10MG TAB                 $29.48       $29.48   084170   LOS PHARMACY REV
75032474    METHYLPHENIDATE 20MG TAB                 $15.38       $15.38   084170   LOS PHARMACY REV
75032458    METHYLPHENIDATE 5MG TAB                  $29.04       $29.04   084170   LOS PHARMACY REV
75067413    METHYLPRED 125MG IJ VL                  $120.88      $120.88   084170   LOS PHARMACY REV
75067447    METHYLPRED 1GM INJ VIAL                 $155.36      $155.36   084170   LOS PHARMACY REV
75067397    METHYLPRED 40MG INJ VIAL                $119.20      $119.20   084170   LOS PHARMACY REV
75052431    METHYLPRED 40MG/ML VL                   $129.12      $129.12   084170   LOS PHARMACY REV
75067439    METHYLPRED 500MG IJ VL                  $133.96      $133.96   084170   LOS PHARMACY REV
75052449    METHYLPRED 80MG/ML VL                   $140.98      $140.98   084170   LOS PHARMACY REV
75021519    METHYLPRED TB 4MG                        $16.22       $16.22   084170   LOS PHARMACY REV
75022038    METHYLTESTOS 10MG TAB                    $18.02       $18.02   084170   LOS PHARMACY REV
75066571    METOCLOPRAMIDE 10MG IJ                   $61.70       $61.70   084170   LOS PHARMACY REV
75032110    METOCLOPRAMIDE 10MG LIQ                  $16.16       $16.16   084170   LOS PHARMACY REV
75032102    METOCLOPRAMIDE 10MG TAB                  $16.08       $16.08   084170   LOS PHARMACY REV
75032136    METOCLOPRAMIDE 5MG TAB                   $15.32       $15.32   084170   LOS PHARMACY REV
75045104    METOLAZONE 10MG TAB                      $17.94       $17.94   084170   LOS PHARMACY REV
75045088    METOLAZONE 2.5MG TAB                     $16.90       $16.90   084170   LOS PHARMACY REV
75045096    METOLAZONE 5MG TAB                       $17.30       $17.30   084170   LOS PHARMACY REV
75019786    METOPROLOL 100MG TAB                     $16.80       $16.80   084170   LOS PHARMACY REV
75022756    METOPROLOL 25MG TAB                      $14.48       $14.48   084170   LOS PHARMACY REV
75019778    METOPROLOL 50MG TAB                      $16.00       $16.00   084170   LOS PHARMACY REV


7/11/2012                                                                                              72
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75061234    METOPROLOL INJ 5MG                      $134.60      $134.60   084170   LOS PHARMACY REV
75023382    METOPROLOL SUCC 100MG TAB                $16.36       $16.36   084170   LOS PHARMACY REV
75023374    METOPROLOL SUCC 50MG TAB                 $15.56       $15.56   084170   LOS PHARMACY REV
75023580    METOPROLOL XL 25MG TAB                   $15.94       $15.94   084170   LOS PHARMACY REV
75081620    METRONIDAZOLE 0.75% 30GM                $106.50      $106.50   084170   LOS PHARMACY REV
75081646    METRONIDAZOLE 0.75% 70GM                $147.76      $147.76   084170   LOS PHARMACY REV
75013417    METRONIDAZOLE 250MG TAB                  $18.88       $18.88   084170   LOS PHARMACY REV
75056168    METRONIDAZOLE 500MG VL                   $22.56       $22.56   084170   LOS PHARMACY REV
75056150    METRONIDAZOLE RTU 500MG                 $117.90      $117.90   084170   LOS PHARMACY REV
75013425    METRONIDAZOLE TB 500MG                   $22.74       $22.74   084170   LOS PHARMACY REV
75023259    MEXILETINE 150MG CAP                     $15.38       $15.38   084170   LOS PHARMACY REV
75023267    MEXILETINE 200MG CAP                     $15.64       $15.64   084170   LOS PHARMACY REV
75081299    MICONAZOLE 2% 15GM CRM                   $97.86       $97.86   084170   LOS PHARMACY REV
75081307    MICONAZOLE 2% 30GM CRM                   $63.40       $63.40   084170   LOS PHARMACY REV
75081604    MICONAZOLE 2% POWDER 30GM                $96.56       $96.56   084170   LOS PHARMACY REV
75092767    MICONAZOLE 200MG 3EA VAG                 $41.50       $41.50   084170   LOS PHARMACY REV
75092775    MICONAZOLE 7S SUP                        $17.46       $17.46   084170   LOS PHARMACY REV
75092734    MICONAZOLE CRM                           $52.16       $52.16   084170   LOS PHARMACY REV
75069179    MIDAZOLAM 10MG/2ML VIAL                 $119.80      $119.80   084170   LOS PHARMACY REV
75063362    MIDAZOLAM 125MG/125ML DRP               $323.10      $323.10   084170   LOS PHARMACY REV
75042309    MIDAZOLAM 2MG/2ML LIQ 5ML                $97.48       $97.48   084170   LOS PHARMACY REV
75069187    MIDAZOLAM 2MG/2ML VIAL                   $88.76       $88.76   084170   LOS PHARMACY REV
75068056    MIDAZOLAM 50MG/50ML DRIP                $154.30      $154.30   084170   LOS PHARMACY REV
75069104    MIDAZOLAM 5MG/ML 10ML VL                 $99.74       $99.74   084170   LOS PHARMACY REV
75069161    MIDAZOLAM 5MG/ML 1ML VL                  $88.76       $88.76   084170   LOS PHARMACY REV
75023549    MIDODRINE 2.5MG TAB                      $16.40       $16.40   084170   LOS PHARMACY REV
75023556    MIDODRINE 5MG TAB                        $19.24       $19.24   084170   LOS PHARMACY REV
75022244    MIDRIN CAP                               $29.12       $29.12   084170   LOS PHARMACY REV
75062984    MILRINONE 20MG/20ML IJ VL               $453.84      $453.84   084170   LOS PHARMACY REV
75081380    MINERAL OIL 10ML                         $26.32       $26.32   084170   LOS PHARMACY REV
75022327    MINERAL OIL 30ML                         $19.06       $19.06   084170   LOS PHARMACY REV
75081653    MINERAL OIL OINT 3.5GM                   $70.42       $70.42   084170   LOS PHARMACY REV
75022434    MINOCYCLINE 100MG CAP                    $22.02       $22.02   084170   LOS PHARMACY REV
75022426    MINOCYCLINE 50MG CAP                     $17.38       $17.38   084170   LOS PHARMACY REV
75019752    MINOXIDIL 10MG TAB                       $18.00       $18.00   084170   LOS PHARMACY REV
75019745    MINOXIDIL 2.5MG TAB                      $15.82       $15.82   084170   LOS PHARMACY REV


7/11/2012                                                                                              73
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75023440    MIRALAX 17GM PWD PKT                      $18.22       $18.22   084170   LOS PHARMACY REV
75023390    MIRTAZAPINE 15MG TAB                      $20.30       $20.30   084170   LOS PHARMACY REV
75023408    MIRTAZAPINE 30MG TAB                      $20.50       $20.50   084170   LOS PHARMACY REV
75023416    MIRTAZAPINE 45MG TAB                      $20.62       $20.62   084170   LOS PHARMACY REV
75062687    MISC INJECTION                             $0.00        $0.00   084170   LOS PHARMACY REV
75023101    MISC ORAL LIQUID                           $0.00        $0.00   084170   LOS PHARMACY REV
75023093    MISC ORAL SOLID                            $0.00        $0.00   084170   LOS PHARMACY REV
75088385    MISC TOPICAL/RECTAL                        $0.00        $0.00   084170   LOS PHARMACY REV
75007781    MISOPROSTOL 100MG TAB                     $15.94       $15.94   084170   LOS PHARMACY REV
75007799    MISOPROSTOL 200MG TAB                     $16.82       $16.82   084170   LOS PHARMACY REV
75062976    MITOMYCIN 20MG IJ                      $1,400.98    $1,400.98   084170   LOS PHARMACY REV
75062968    MITOMYCIN 5MG IJ                         $763.30      $763.30   084170   LOS PHARMACY REV
75064287    MITOXANTRONE 20MG IJ                   $3,527.12    $3,527.12   084170   LOS PHARMACY REV
75063214    MIVACURIUM 2MG/ML IJ 10ML                $150.26      $150.26   084170   LOS PHARMACY REV
75063271    MIVACURIUM 2MG/ML IJ 50ML                $238.20      $238.20   084170   LOS PHARMACY REV
75063206    MIVACURIUM 2MG/ML IJ 5ML                 $136.86      $136.86   084170   LOS PHARMACY REV
75023515    MODAFINIL 200MG TAB                       $27.18       $27.18   084170   LOS PHARMACY REV
75023622    MOEXIPRIL 7.5MG TAB                       $15.76       $15.76   084170   LOS PHARMACY REV
75022632    MOM/CASCARA 15ML LIQ                      $15.00       $15.00   084170   LOS PHARMACY REV
75074237    MOMETASONE CRM 1% 15GM                    $85.12       $85.12   084170   LOS PHARMACY REV
75099291    MOMETASONE SPRAY 17GM                    $186.40      $186.40   084170   LOS PHARMACY REV
75023432    MONTELUKAST 10MG TAB                      $20.26       $20.26   084170   LOS PHARMACY REV
75023648    MONTELUKAST 4MG CHEW TAB                  $21.25       $21.25   084170   LOS PHARMACY REV
75023424    MONTELUKAST 5MG TAB                       $20.26       $20.26   084170   LOS PHARMACY REV
75063008    MORPHINE 10MG IJ                          $86.48       $86.48   084170   LOS PHARMACY REV
75062802    MORPHINE 10MG INJ                         $87.38       $87.38   084170   LOS PHARMACY REV
75063248    MORPHINE 10MG RT INHAL                    $30.38       $30.38   084170   LOS PHARMACY REV
75063412    MORPHINE 10MG/.5ML LQ AMP                 $31.80       $31.80   084170   LOS PHARMACY REV
75062794    MORPHINE 15MG INJ                        $116.86      $116.86   084170   LOS PHARMACY REV
75023457    MORPHINE 200MG/10ML SYR                   $39.00       $39.00   084170   LOS PHARMACY REV
75063404    MORPHINE 20MG/1ML LQ AMP                  $31.90       $31.90   084170   LOS PHARMACY REV
75033050    MORPHINE 20MG/ML LQ 1ML                   $86.30       $86.30   084170   LOS PHARMACY REV
75033043    MORPHINE 20MG/ML LQ 3ML                   $88.90       $88.90   084170   LOS PHARMACY REV
75062760    MORPHINE 2MG INJ                          $87.02       $87.02   084170   LOS PHARMACY REV
75062778    MORPHINE 4MG INJ                          $30.26       $30.26   084170   LOS PHARMACY REV
75033167    MORPHINE 600MG/30ML LIQ                   $61.00       $61.00   084170   LOS PHARMACY REV


7/11/2012                                                                                               74
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75062786    MORPHINE 8MG INJ                         $87.22       $87.22   084170   LOS PHARMACY REV
75022640    MORPHINE CONT 100MG TAB                  $38.94       $38.94   084170   LOS PHARMACY REV
75022418    MORPHINE CONT 60MG TAB                   $36.66       $36.66   084170   LOS PHARMACY REV
75022442    MORPHINE CONT TAB 15MG                   $30.00       $30.00   084170   LOS PHARMACY REV
75063339    MORPHINE LIPOSOM 10MG IJ                $506.00      $506.00   084170   LOS PHARMACY REV
75063347    MORPHINE LIPOSOM 15MG IJ                $499.00      $499.00   084170   LOS PHARMACY REV
75063354    MORPHINE LIPOSOM 20MG IJ                $536.80      $536.80   084170   LOS PHARMACY REV
75063289    MORPHINE PCA                            $137.20      $137.20   084170   LOS PHARMACY REV
75062851    MORPHINE PF 10MG IJ                     $103.44      $103.44   084170   LOS PHARMACY REV
75023341    MORPHINE SO4 30MG TAB                    $31.78       $31.78   084170   LOS PHARMACY REV
75022285    MORPHINE TAB 30MG                        $31.78       $31.78   084170   LOS PHARMACY REV
75062893    MORRHUATE IJ 30ML                       $238.00      $238.00   084170   LOS PHARMACY REV
75099382    MOXIFLOXACIN .5% OPTH 3ML               $148.80      $148.80   084170   LOS PHARMACY REV
75062901    MUMPS SKIN TEST                         $341.88      $341.88   084170   LOS PHARMACY REV
75071035    MUPIROCIN OINT 15GM                     $164.80      $164.80   084170   LOS PHARMACY REV
75059824    MVI                                     $130.08      $130.08   084170   LOS PHARMACY REV
75036939    MVI 5ML LIQ                              $14.70       $14.70   084170   LOS PHARMACY REV
75023572    MVI BARIATRIC TAB                        $14.30       $14.30   084170   LOS PHARMACY REV
75059832    MVI PEDI                                $139.88      $139.88   084170   LOS PHARMACY REV
75035253    MVI PRENATAL TAB                         $14.52       $14.52   084170   LOS PHARMACY REV
75022707    MVI TAB                                  $14.10       $14.10   084170   LOS PHARMACY REV
75030205    MVI/FE DROPS 50ML                        $43.52       $43.52   084170   LOS PHARMACY REV
75036913    MVI/MIN TAB                              $14.20       $14.20   084170   LOS PHARMACY REV
75063016    MVI-12 IJ 10ML                           $76.34       $76.34   084170   LOS PHARMACY REV
75007575    MYCOPHENOLATE 250MG PO                   $20.16       $20.16   084170   LOS PHARMACY REV
75023689    MYCOPHENOLATE 500MG PO                   $27.60       $27.60   084170   LOS PHARMACY REV
75067157    NA ACET 40MEQ/20ML VL                   $116.40      $116.40   084170   LOS PHARMACY REV
75034769    NA BICARB 325MG TAB                      $14.02       $14.02   084170   LOS PHARMACY REV
75063800    NA BICARB 4.2% IJ 10ML                  $117.58      $117.58   084170   LOS PHARMACY REV
75067652    NA BICARB 4.2% VIAL                      $63.28       $63.28   084170   LOS PHARMACY REV
75034777    NA BICARB 650MG TAB                      $14.18       $14.18   084170   LOS PHARMACY REV
75067223    NA BICARB 8.4% 50ML VIAL                $114.38      $114.38   084170   LOS PHARMACY REV
75067207    NA BICARB 8.4% IJ 10ML                   $63.82       $63.82   084170   LOS PHARMACY REV
75067215    NA BICARB 8.4% IJ 50ML                  $118.30      $118.30   084170   LOS PHARMACY REV
75067173    NA BIPHOSPHATE 45MM VL                  $115.86      $115.86   084170   LOS PHARMACY REV
75064261    NA CL .9% IJ 30ML                        $29.10       $29.10   084170   LOS PHARMACY REV


7/11/2012                                                                                              75
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75064253    NA CL 0.9% 10ML VL                        $57.68       $57.68   084170   LOS PHARMACY REV
75097741    NA CL 10% INH SLN 15ML                    $15.60       $15.60   084170   LOS PHARMACY REV
44611580    NA CL 1000ML/KCL 20                      $109.00      $109.00   084170   LOS PHARMACY REV
75034793    NA CL 1GM TAB                             $14.14       $14.14   084170   LOS PHARMACY REV
75063552    NA CL 4MEQ/ML 30ML VL                    $116.60      $116.60   084170   LOS PHARMACY REV
75094276    NA CL 5% OPTH 15ML                        $58.56       $58.56   084170   LOS PHARMACY REV
75082768    NA CL NASAL GEL 0.5OZ                     $34.00       $34.00   084170   LOS PHARMACY REV
75097261    NA CL SPY 45ML                            $33.40       $33.40   084170   LOS PHARMACY REV
75058669    NA HYALURONATE HEALON10MG                $219.50      $219.50   084170   LOS PHARMACY REV
75058719    NA HYALURONATE HEALON5                   $244.50      $244.50   084170   LOS PHARMACY REV
75024125    NABUMETONE 500MG TAB                      $17.22       $17.22   084170   LOS PHARMACY REV
75006684    NADOLOL 40MG TAB                          $18.14       $18.14   084170   LOS PHARMACY REV
75006692    NADOLOL 80MG TAB                          $16.94       $16.94   084170   LOS PHARMACY REV
75063578    NAFCILLIN 1GM VL                         $119.70      $119.70   084170   LOS PHARMACY REV
75063594    NAFCILLIN 2GM VL                         $124.26      $124.26   084170   LOS PHARMACY REV
75064105    NALBUPHINE 10MG IJ                        $60.36       $60.36   084170   LOS PHARMACY REV
75064113    NALBUPHINE 20MG IJ                       $107.20      $107.20   084170   LOS PHARMACY REV
75063644    NALOXONE 0.02MG IJ                        $61.10       $61.10   084170   LOS PHARMACY REV
75063651    NALOXONE 0.4MG IJ                         $64.16       $64.16   084170   LOS PHARMACY REV
75063842    NALOXONE 0.4MG/ML 1ML IJ                  $59.96       $59.96   084170   LOS PHARMACY REV
75063537    NALOXONE 1MG/ML IJ 2ML SY                $113.96      $113.96   084170   LOS PHARMACY REV
75063669    NALOXONE INJ 4MG/10ML MDV                $201.00      $201.00   084170   LOS PHARMACY REV
75098350    NAPHAZOLONE OPTH 15ML                     $39.24       $39.24   084170   LOS PHARMACY REV
75024067    NAPROXEN 220MG TAB                        $14.22       $14.22   084170   LOS PHARMACY REV
75024075    NAPROXEN 250MG TAB                        $16.22       $16.22   084170   LOS PHARMACY REV
75024083    NAPROXEN 375MG TAB                        $16.84       $16.84   084170   LOS PHARMACY REV
75024091    NAPROXEN 500MG TAB                        $16.66       $16.66   084170   LOS PHARMACY REV
75045518    NAPROXEN 500MG TAB W/C                     $0.00        $0.00   084170   LOS PHARMACY REV
75064329    NATALIZUMAB 300MG IJ                   $4,632.22    $4,632.22   084170   LOS PHARMACY REV
75025429    NATEGLINIDE 120MG TAB                     $16.26       $16.26   084170   LOS PHARMACY REV
75025411    NATEGLINIDE 60MG TAB                      $16.18       $16.18   084170   LOS PHARMACY REV
75022780    NEFAZODONE 100MG TAB                      $17.58       $17.58   084170   LOS PHARMACY REV
75042267    NELFINAVIR 250MG TAB                      $19.04       $19.04   084170   LOS PHARMACY REV
75024448    NEOMYCIN 500MG TAB                        $17.96       $17.96   084170   LOS PHARMACY REV
75082305    NEOSPORIN 15GM OINT                       $35.48       $35.48   084170   LOS PHARMACY REV
75082297    NEOSPORIN 30GM OINT                       $41.76       $41.76   084170   LOS PHARMACY REV


7/11/2012                                                                                               76
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75082560    NEOSPORIN GU 15GM CRM                     $35.34       $35.34   084170   LOS PHARMACY REV
75063818    NEOSPORIN GU 1ML IJ                      $142.14      $142.14   084170   LOS PHARMACY REV
75097154    NEOSPORIN OINT                           $100.18      $100.18   084170   LOS PHARMACY REV
75097139    NEOSPORIN OTIC 10ML                      $103.06      $103.06   084170   LOS PHARMACY REV
75063776    NEOSTIGMINE 1MG/ML 10ML                   $65.50       $65.50   084170   LOS PHARMACY REV
75063685    NEOSTIGMINE 1MG/ML IJ                    $123.00      $123.00   084170   LOS PHARMACY REV
75063925    NESIRITIDE 1.5MG INJ VIAL              $1,172.86    $1,172.86   084170   LOS PHARMACY REV
75024331    NEUTRA-PHOS PACKET                        $14.98       $14.98   084170   LOS PHARMACY REV
75024364    NEUTRA-PHOS-K PKT                         $50.24       $50.24   084170   LOS PHARMACY REV
75024554    NIACIN 500MG CAP                          $14.16       $14.16   084170   LOS PHARMACY REV
75024588    NIACIN 500MG TAB                          $14.18       $14.18   084170   LOS PHARMACY REV
75025536    NIACIN ER 1000MG TAB                      $17.66       $17.66   084170   LOS PHARMACY REV
75025510    NIACIN ER 500MG TAB                       $15.80       $15.80   084170   LOS PHARMACY REV
75025528    NIACIN ER 750MG TAB                       $16.96       $16.96   084170   LOS PHARMACY REV
75004614    NICARDIPINE 20MG CAP                      $14.58       $14.58   084170   LOS PHARMACY REV
75050534    NICARDIPINE 25MG INJ AMP                 $309.25      $309.25   084170   LOS PHARMACY REV
75004689    NICARDIPINE 30MG CAP                      $15.26       $15.26   084170   LOS PHARMACY REV
75004697    NICARDIPINE SR 30MG CAP                   $15.98       $15.98   084170   LOS PHARMACY REV
75082073    NICOTINE 14MG/24 HR PATCH                 $19.24       $19.24   084170   LOS PHARMACY REV
75082289    NICOTINE 21MG/24 HR PATCH                 $19.24       $19.24   084170   LOS PHARMACY REV
75082131    NICOTINE 7MG/24 HR PATCH                  $19.24       $19.24   084170   LOS PHARMACY REV
75024885    NICOTINE GUM                              $14.88       $14.88   084170   LOS PHARMACY REV
75098814    NICOTINE INHALER KIT                      $30.02       $30.02   084170   LOS PHARMACY REV
75029223    NIFEDIPINE 10MG CAP                       $15.34       $15.34   084170   LOS PHARMACY REV
75030007    NIFEDIPINE 20MG CAP                       $16.24       $16.24   084170   LOS PHARMACY REV
75002386    NIFEDIPINE 30MG TAB                       $17.14       $17.14   084170   LOS PHARMACY REV
75002170    NIFEDIPINE 60MG TAB                       $19.58       $19.58   084170   LOS PHARMACY REV
75002196    NIFEDIPINE 90MG TAB                       $20.22       $20.22   084170   LOS PHARMACY REV
75030015    NIFEDIPINE XL 30MG TAB                    $17.24       $17.24   084170   LOS PHARMACY REV
75030023    NIFEDIPINE XL 60MG TAB                    $20.24       $20.24   084170   LOS PHARMACY REV
75030098    NIFEDIPINE XL 90MG CAP                    $20.46       $20.46   084170   LOS PHARMACY REV
75024794    NIMODIPINE 30MG CAP                       $30.00       $30.00   084170   LOS PHARMACY REV
75025346    NISOLDIPINE 10MG TAB                      $16.66       $16.66   084170   LOS PHARMACY REV
75025353    NISOLDIPINE 20MG TAB                      $16.66       $16.66   084170   LOS PHARMACY REV
75024711    NITROFURANTOIN 100MG CAP                  $18.52       $18.52   084170   LOS PHARMACY REV
75021147    NITROFURANTOIN 100MG CAP                  $18.30       $18.30   084170   LOS PHARMACY REV


7/11/2012                                                                                               77
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75013615    NITROFURANTOIN 50/10 LIQ                 $22.38       $22.38   084170   LOS PHARMACY REV
75021139    NITROFURANTOIN 50MG CAP                  $16.42       $16.42   084170   LOS PHARMACY REV
75063958    NITROPRUSSIDE 50MG/2ML VL               $116.68      $116.68   084170   LOS PHARMACY REV
75061200    NOREPINEPHRINE 4MG/4ML IJ               $136.52      $136.52   084170   LOS PHARMACY REV
44611960    NORMOSOL R 1000ML                        $63.14       $63.14   084170   LOS PHARMACY REV
75002220    NORTRIPTYLINE 10MG CAP                   $15.06       $15.06   084170   LOS PHARMACY REV
75027037    NORTRIPTYLINE 25MG CAP                   $22.52       $22.52   084170   LOS PHARMACY REV
75027250    NORTRIPTYLINE 50MG CAP                   $30.04       $30.04   084170   LOS PHARMACY REV
75027045    NORTRIPTYLINE 75MG CAP                   $38.46       $38.46   084170   LOS PHARMACY REV
75025148    NTG 0.4MG TAB                            $14.44       $14.44   084170   LOS PHARMACY REV
75025155    NTG 0.4MG TAB #25                        $28.20       $28.20   084170   LOS PHARMACY REV
75082669    NTG 10MG PATCH                           $19.16       $19.16   084170   LOS PHARMACY REV
75082677    NTG 15MG PATCH                           $19.84       $19.84   084170   LOS PHARMACY REV
75024620    NTG 2.5MG CAP                            $14.36       $14.36   084170   LOS PHARMACY REV
75082644    NTG 2.5MG PATCH                          $17.34       $17.34   084170   LOS PHARMACY REV
75063982    NTG 50MG/10ML VIAL                      $116.60      $116.60   084170   LOS PHARMACY REV
75082651    NTG 5MG PATCH                            $17.30       $17.30   084170   LOS PHARMACY REV
75024638    NTG 6.5MG CAP                            $14.38       $14.38   084170   LOS PHARMACY REV
75082636    NTG 7.5MG PATCH                          $19.08       $19.08   084170   LOS PHARMACY REV
75082701    NTG OINT 1GM TUBE                        $47.68       $47.68   084170   LOS PHARMACY REV
75082156    NTG OINT 2% 30GM                         $29.36       $29.36   084170   LOS PHARMACY REV
75082552    NTG OINT APPL.                           $47.80       $47.80   084170   LOS PHARMACY REV
75082693    NTG SPRAY APPL.                          $28.52       $28.52   084170   LOS PHARMACY REV
75097253    NTG SPY                                 $133.38      $133.38   084170   LOS PHARMACY REV
75081406    NYSTATIN 1% 15 GM CRM                    $67.98       $67.98   084170   LOS PHARMACY REV
75081414    NYSTATIN 1% 30 GM CRM                    $95.58       $95.58   084170   LOS PHARMACY REV
75081489    NYSTATIN 15GM CRM                        $87.42       $87.42   084170   LOS PHARMACY REV
75081497    NYSTATIN 30GM CRM                        $87.42       $87.42   084170   LOS PHARMACY REV
75022798    NYSTATIN 5ML LIQ                         $33.38       $33.38   084170   LOS PHARMACY REV
75022814    NYSTATIN 60ML LIQ                        $61.88       $61.88   084170   LOS PHARMACY REV
75081505    NYSTATIN OINT                            $87.42       $87.42   084170   LOS PHARMACY REV
75081448    NYSTATIN PWD                             $89.02       $89.02   084170   LOS PHARMACY REV
75082750    NYSTATIN VAG TAB                         $20.20       $20.20   084170   LOS PHARMACY REV
75081422    NYSTATIN/TRIAMC 60GM                     $81.76       $81.76   084170   LOS PHARMACY REV
75067231    OCTREOTIDE 50 MCG/ML                    $289.24      $289.24   084170   LOS PHARMACY REV
75067165    OCTREOTIDE 50 MCG/ML                    $105.16      $105.16   084170   LOS PHARMACY REV


7/11/2012                                                                                              78
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75067025    OCTREOTIDE 500 MCG/ML                    $243.60      $243.60   084170   LOS PHARMACY REV
75097824    OFLOXACIN 0.3% OPT SL 5ML                $120.12      $120.12   084170   LOS PHARMACY REV
75083097    OFLOXACIN 0.3% OTIC 5ML                  $152.80      $152.80   084170   LOS PHARMACY REV
75026682    OFLOXACIN 200MG TAB                       $24.64       $24.64   084170   LOS PHARMACY REV
75026708    OFLOXACIN 300MG TAB                       $25.38       $25.38   084170   LOS PHARMACY REV
75026690    OFLOXACIN 400MG TAB                       $28.12       $28.12   084170   LOS PHARMACY REV
75064451    OLANZAPINE 10MG IJ                       $111.50      $111.50   084170   LOS PHARMACY REV
75026724    OLANZAPINE 10MG TAB                       $34.78       $34.78   084170   LOS PHARMACY REV
75026799    OLANZAPINE 2.5MG TAB                      $25.58       $25.58   084170   LOS PHARMACY REV
75026716    OLANZAPINE 5MG TAB                        $27.68       $27.68   084170   LOS PHARMACY REV
75026823    OLMESARTAN MED 20MG TAB                   $17.50       $17.50   084170   LOS PHARMACY REV
75098962    OLOPATADINE 0.1% OPT 5ML                 $176.76      $176.76   084170   LOS PHARMACY REV
75026856    OMEGA-3 ACID ESTERS 1GM                   $16.48       $16.48   084170   LOS PHARMACY REV
75028803    OMEPRAZOLE 10MG CAP                       $21.40       $21.40   084170   LOS PHARMACY REV
75019737    OMEPRAZOLE 20MG CAP                       $23.22       $23.22   084170   LOS PHARMACY REV
75026641    ONDANSETRON 4MG TAB                       $56.04       $56.04   084170   LOS PHARMACY REV
75064618    ONDANSETRON 4MG/2ML IJ                   $166.44      $166.44   084170   LOS PHARMACY REV
75026658    ONDANSETRON 8MG PO                        $84.04       $84.04   084170   LOS PHARMACY REV
75026807    ONDANSETRON ODT 4MG TAB                   $63.54       $63.54   084170   LOS PHARMACY REV
75026815    ONDANSETRON ODT 8MG TAB                   $96.52       $96.52   084170   LOS PHARMACY REV
75026609    OPIUM TINCTURE 1ML LIQ                   $161.38      $161.38   084170   LOS PHARMACY REV
75064436    OPRELVEKIN 5MG IJ                        $669.00      $669.00   084170   LOS PHARMACY REV
75064055    ORPHENADRINE 60MG IJ                     $102.00      $102.00   084170   LOS PHARMACY REV
75024828    ORPHENADRINE TAB                          $18.62       $18.62   084170   LOS PHARMACY REV
75026880    OSELTAMIVIR 75MG CAP                      $30.85       $30.85   084170   LOS PHARMACY REV
75064634    OXALIPLATIN 100MG IJ                   $4,755.20    $4,755.20   084170   LOS PHARMACY REV
75064576    OXALIPLATIN 50MG IJ                    $2,563.08    $2,563.08   084170   LOS PHARMACY REV
75026872    OXAPROZIN 600MG TAB                       $17.02       $17.02   084170   LOS PHARMACY REV
75034330    OXAZEPAM 10MG CAP                         $29.72       $29.72   084170   LOS PHARMACY REV
75026864    OXCARBAZEPINE 300 MG TAB                  $19.48       $19.48   084170   LOS PHARMACY REV
75009381    OXYBUTYNIN 5MG TAB                        $16.00       $16.00   084170   LOS PHARMACY REV
75009399    OXYBUTYNIN LIQ 5ML                        $14.80       $14.80   084170   LOS PHARMACY REV
75026849    OXYBUTYNIN XL 10MG TAB                    $21.30       $21.30   084170   LOS PHARMACY REV
75026831    OXYBUTYNIN XL 5MG TAB                     $21.32       $21.32   084170   LOS PHARMACY REV
75026740    OXYCODONE 10MG TAB                        $31.12       $31.12   084170   LOS PHARMACY REV
75026757    OXYCODONE 20MG TAB                        $33.98       $33.98   084170   LOS PHARMACY REV


7/11/2012                                                                                               79
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75026765    OXYCODONE 20MG/ML LIQ 1ML                 $31.10       $31.10   084170   LOS PHARMACY REV
75026773    OXYCODONE 40MG TAB                        $38.62       $38.62   084170   LOS PHARMACY REV
75026732    OXYCODONE 5MG TAB                         $28.84       $28.84   084170   LOS PHARMACY REV
75026781    OXYCODONE 60MG/3ML ORL SY                 $34.90       $34.90   084170   LOS PHARMACY REV
75094334    OXYMETAZOLINE SPY 15ML                    $33.70       $33.70   084170   LOS PHARMACY REV
75094342    OXYMETAZOLINE SPY 30ML                    $36.10       $36.10   084170   LOS PHARMACY REV
75064584    OXYTOCIN 10U IJ                          $119.00      $119.00   084170   LOS PHARMACY REV
75066241    PACLITAXEL 100MG IJ                    $1,712.52    $1,712.52   084170   LOS PHARMACY REV
75066258    PACLITAXEL 300MG IJ                    $1,643.86    $1,643.86   084170   LOS PHARMACY REV
75064808    PACLITAXEL 30MG IJ                       $860.30      $860.30   084170   LOS PHARMACY REV
75067140    PALIVIZUMAB 100MG IJ                   $1,587.08    $1,587.08   084170   LOS PHARMACY REV
75067124    PALIVIZUMAB 50MG IJ                    $1,813.08    $1,813.08   084170   LOS PHARMACY REV
75066381    PALONOSETRON .25MG/5ML IJ                $809.00      $809.00   084170   LOS PHARMACY REV
75047571    PAMIDRONATE/30MG IJ                      $672.72      $672.72   084170   LOS PHARMACY REV
75027276    PANCREASE MT 16 CAP                       $17.56       $17.56   084170   LOS PHARMACY REV
75027235    PANCREASE TAB                             $15.14       $15.14   084170   LOS PHARMACY REV
75064790    PANCURONIUM IJ 10ML                       $65.66       $65.66   084170   LOS PHARMACY REV
75030270    PANTOPRAZOLE 20MG TAB                     $21.66       $21.66   084170   LOS PHARMACY REV
75029645    PANTOPRAZOLE 40MG TAB                     $21.66       $21.66   084170   LOS PHARMACY REV
75066274    PANTOPRAZOLE/VIAL IJ                     $173.00      $173.00   084170   LOS PHARMACY REV
75070631    PAPAIN/UREA DEBR ONT 30GM                $137.10      $137.10   084170   LOS PHARMACY REV
75064733    PAPAVERINE 30MG/ML 2ML VL                 $64.00       $64.00   084170   LOS PHARMACY REV
75068593    PARICALCITOL 5MCG/ML 1ML                 $171.40      $171.40   084170   LOS PHARMACY REV
75030155    PAROXETINE 10MG TAB                       $19.62       $19.62   084170   LOS PHARMACY REV
75030163    PAROXETINE 20MG TAB                       $20.00       $20.00   084170   LOS PHARMACY REV
75030171    PAROXETINE 30MG TAB                       $20.06       $20.06   084170   LOS PHARMACY REV
75030296    PAROXETINE CR 12.5MG TAB                  $18.86       $18.86   084170   LOS PHARMACY REV
75030304    PAROXETINE CR 25MG TAB                    $19.10       $19.10   084170   LOS PHARMACY REV
75048298    PCN G BENZ 1.2MILU/2ML IJ                $129.08      $129.08   084170   LOS PHARMACY REV
75048306    PCN G BENZ 2.4MILU/4ML IJ                $249.76      $249.76   084170   LOS PHARMACY REV
75048280    PCN G BENZ 600MU/ML IJ                    $80.78       $80.78   084170   LOS PHARMACY REV
75048264    PCN G BENZ CR 1.2ML IJ                   $135.56      $135.56   084170   LOS PHARMACY REV
75048256    PCN G BENZ CR 600MU IJ                   $102.36      $102.36   084170   LOS PHARMACY REV
75064881    PCN G K 10MIL VL                         $133.18      $133.18   084170   LOS PHARMACY REV
75064832    PCN G K 1MIL VL                          $114.86      $114.86   084170   LOS PHARMACY REV
75064873    PCN G K 5MIL VL                           $98.36       $98.36   084170   LOS PHARMACY REV


7/11/2012                                                                                               80
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75069815    PCN G PROC 1.2MU IJ                       $93.30       $93.30   084170   LOS PHARMACY REV
75069823    PCN G PROC 2.4MU IJ                      $191.12      $191.12   084170   LOS PHARMACY REV
75045690    PCN V K 125MG/5ML LQ DSE                  $32.52       $32.52   084170   LOS PHARMACY REV
75027821    PCN V K 250MG TAB                         $14.48       $14.48   084170   LOS PHARMACY REV
75045708    PCN V K 250MG/5ML LQ DSE                  $15.00       $15.00   084170   LOS PHARMACY REV
75027839    PCN V K 500MG TAB                         $14.18       $14.18   084170   LOS PHARMACY REV
75065607    PEGFILGRASTIM 6MG IJ                   $6,564.50    $6,564.50   084170   LOS PHARMACY REV
75066407    PEMETREXED 500MG IJ                    $5,789.78    $5,789.78   084170   LOS PHARMACY REV
75073411    PENCICLOVIR CREAM 1.5GM                   $80.90       $80.90   084170   LOS PHARMACY REV
75064931    PENTAMIDINE 300MG VL                     $219.14      $219.14   084170   LOS PHARMACY REV
75098640    PENTAMIDINE PWD 300MG VL                 $310.50      $310.50   084170   LOS PHARMACY REV
75036111    PENTAZOC/NALOX 50MG TAB                   $30.90       $30.90   084170   LOS PHARMACY REV
75030387    PENTOSAN POLY NA 100MG PO                 $20.18       $20.18   084170   LOS PHARMACY REV
75038620    PENTOXIFYLLINE 400MG TAB                  $15.70       $15.70   084170   LOS PHARMACY REV
75030189    PERGOLIDE 0.25MG TAB                      $18.14       $18.14   084170   LOS PHARMACY REV
75030403    PERINDOPRIL 4MG TAB                       $17.44       $17.44   084170   LOS PHARMACY REV
75074336    PERMETHRIN 5% CREAM 60GM                  $93.50       $93.50   084170   LOS PHARMACY REV
75082800    PERMETHRIN CR RNSE 60ML                   $46.40       $46.40   084170   LOS PHARMACY REV
75037960    PERPHENAZINE 4MG TAB                      $15.54       $15.54   084170   LOS PHARMACY REV
75089367    PETROLATUM 30GM TUBE                      $30.46       $30.46   084170   LOS PHARMACY REV
75029686    PHENAZOPYRIDINE 100MG TAB                 $15.46       $15.46   084170   LOS PHARMACY REV
75029694    PHENAZOPYRIDINE 200MG TAB                 $16.82       $16.82   084170   LOS PHARMACY REV
75028472    PHENOBARBITAL 100MG TAB                   $28.16       $28.16   084170   LOS PHARMACY REV
75065144    PHENOBARBITAL 130MG/ML VL                 $66.52       $66.52   084170   LOS PHARMACY REV
75028449    PHENOBARBITAL 15MG TAB                    $28.08       $28.08   084170   LOS PHARMACY REV
75028456    PHENOBARBITAL 30MG TAB                    $28.08       $28.08   084170   LOS PHARMACY REV
75028548    PHENOBARBITAL 30MG/7.5ML                  $28.84       $28.84   084170   LOS PHARMACY REV
75065136    PHENOBARBITAL 65MG/ML VL                  $88.40       $88.40   084170   LOS PHARMACY REV
75066555    PHENTOLAMINE 5MG/ML VL                   $183.00      $183.00   084170   LOS PHARMACY REV
75097170    PHENYLEPHRINE 0.25% SPY                   $34.98       $34.98   084170   LOS PHARMACY REV
75097212    PHENYLEPHRINE 0.5% DRP                    $34.98       $34.98   084170   LOS PHARMACY REV
75097188    PHENYLEPHRINE 0.5% SPY                    $35.34       $35.34   084170   LOS PHARMACY REV
75098590    PHENYLEPHRINE 1% DRP                      $35.90       $35.90   084170   LOS PHARMACY REV
75082743    PHENYLEPHRINE 1% SPY 15ML                 $36.22       $36.22   084170   LOS PHARMACY REV
75097162    PHENYLEPHRINE 10% NAS DP                  $88.08       $88.08   084170   LOS PHARMACY REV
75066290    PHENYLEPHRINE 100MG IJ                   $196.04      $196.04   084170   LOS PHARMACY REV


7/11/2012                                                                                               81
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75063834    PHENYLEPHRINE 10MG/ML IJ                $121.78      $121.78   084170   LOS PHARMACY REV
75097238    PHENYLEPHRINE 2.5% 15ML                  $90.88       $90.88   084170   LOS PHARMACY REV
75097014    PHENYLEPHRINE 2.5% OP 3ML                $51.26       $51.26   084170   LOS PHARMACY REV
75028357    PHENYLEPHRINE EXP 5ML LIQ                $14.80       $14.80   084170   LOS PHARMACY REV
75009076    PHENYTOIN 100MG CAP                      $14.70       $14.70   084170   LOS PHARMACY REV
75052944    PHENYTOIN 100MG/2ML IJ                  $116.50      $116.50   084170   LOS PHARMACY REV
75009142    PHENYTOIN 100MG/4ML LQ UD                $17.86       $17.86   084170   LOS PHARMACY REV
75052951    PHENYTOIN 250MG/5ML IJ VL               $116.02      $116.02   084170   LOS PHARMACY REV
75009100    PHENYTOIN 50MG CAP                       $14.80       $14.80   084170   LOS PHARMACY REV
75018572    PHOSPHORUS TAB                           $14.30       $14.30   084170   LOS PHARMACY REV
75047019    PHYSOSTIGMINE 2MG/2ML IJ                 $66.72       $66.72   084170   LOS PHARMACY REV
75047118    PHYTONADIONE 10MG INJ AMP                $68.84       $68.84   084170   LOS PHARMACY REV
75047100    PHYTONADIONE 1MG INJ AMP                 $62.16       $62.16   084170   LOS PHARMACY REV
75021824    PHYTONADIONE 5MG TAB                     $15.30       $15.30   084170   LOS PHARMACY REV
75097584    PILOCARPINE 1% OPTH 15ML                 $46.40       $46.40   084170   LOS PHARMACY REV
75098327    PILOCARPINE 1% OPTH 1ML                  $33.90       $33.90   084170   LOS PHARMACY REV
75097592    PILOCARPINE 2% OPTH 15ML                 $57.06       $57.06   084170   LOS PHARMACY REV
75098335    PILOCARPINE 2% OPTH 1ML                  $19.90       $19.90   084170   LOS PHARMACY REV
75097600    PILOCARPINE 3% OPTH 15ML                 $49.36       $49.36   084170   LOS PHARMACY REV
75097618    PILOCARPINE 4% OPTH 15ML                 $60.60       $60.60   084170   LOS PHARMACY REV
75030288    PILOCARPINE 5MG TAB                      $17.04       $17.04   084170   LOS PHARMACY REV
75097626    PILOCARPINE 6% OPTH 15ML                 $54.40       $54.40   084170   LOS PHARMACY REV
75084053    PIMECROLIMUS 1% CRM 30GM                $197.46      $197.46   084170   LOS PHARMACY REV
75029967    PINDOLOL 10MG TAB                        $15.98       $15.98   084170   LOS PHARMACY REV
75029959    PINDOLOL 5MG TAB                         $15.46       $15.46   084170   LOS PHARMACY REV
75027896    PINK BISMUTH 120ML                       $29.32       $29.32   084170   LOS PHARMACY REV
75027953    PINK BISMUTH TAB                         $14.22       $14.22   084170   LOS PHARMACY REV
75030221    PIOGLITAZONE 15MG TAB                    $20.92       $20.92   084170   LOS PHARMACY REV
75030239    PIOGLITAZONE 30MG TAB                    $25.08       $25.08   084170   LOS PHARMACY REV
75030197    PIOGLITAZONE 45MG TAB                    $26.02       $26.02   084170   LOS PHARMACY REV
75066126    PIPERACILLIN 2GM VL                      $74.40       $74.40   084170   LOS PHARMACY REV
75066084    PIPERACILLIN 3GM VL                      $83.10       $83.10   084170   LOS PHARMACY REV
75013656    PIROXICAM 20MG CAP                       $18.42       $18.42   084170   LOS PHARMACY REV
75028522    PLAQUENIL 200MG TAB                      $17.78       $17.78   084170   LOS PHARMACY REV
75013318    POLYCARBOPHIL TAB                        $14.26       $14.26   084170   LOS PHARMACY REV
75098954    POLYMYX/TRIMETH OPT 10ML                 $63.00       $63.00   084170   LOS PHARMACY REV


7/11/2012                                                                                              82
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75065391    POLYMYXIN B 500MU VL                     $85.76       $85.76   084170   LOS PHARMACY REV
75018150    POLYSTYRENE 15GM/60ML LIQ                $40.54       $40.54   084170   LOS PHARMACY REV
75092601    POLYSTYRENE-25 ENM                      $544.78      $544.78   084170   LOS PHARMACY REV
75092619    POLYSTYRENE-50 ENM                       $67.34       $67.34   084170   LOS PHARMACY REV
75078022    POVIDONE IODINE 10% 120ML                $39.42       $39.42   084170   LOS PHARMACY REV
75071480    POVIDONE IODINE 240ML                    $29.94       $29.94   084170   LOS PHARMACY REV
75071423    POVIDONE IODINE 30GM OINT                $47.02       $47.02   084170   LOS PHARMACY REV
75098889    POVIDONE IODINE 5% 30ML                  $51.12       $51.12   084170   LOS PHARMACY REV
75065946    PRALIDOXIME 1GM VL                      $273.76      $273.76   084170   LOS PHARMACY REV
75023465    PRAMIPEXOLE 0.125MG TAB                  $16.06       $16.06   084170   LOS PHARMACY REV
75023473    PRAMIPEXOLE 0.25MG TAB                   $16.62       $16.62   084170   LOS PHARMACY REV
75023481    PRAMIPEXOLE 0.5MG TAB                    $18.64       $18.64   084170   LOS PHARMACY REV
75023507    PRAMIPEXOLE 1.5MG TAB                    $18.64       $18.64   084170   LOS PHARMACY REV
75023499    PRAMIPEXOLE 1MG TAB                      $19.16       $19.16   084170   LOS PHARMACY REV
75066282    PRAMLINTIDE 5ML VL                      $284.52      $284.52   084170   LOS PHARMACY REV
75084285    PRAMOXINE 15GM RECTAL                    $89.70       $89.70   084170   LOS PHARMACY REV
75030346    PRAVASTATIN 10MG TAB                     $21.15       $21.15   084170   LOS PHARMACY REV
75028712    PRAVASTATIN 20 MG TAB                    $20.16       $20.16   084170   LOS PHARMACY REV
75029579    PRAVASTATIN 40MG TAB                     $23.04       $23.04   084170   LOS PHARMACY REV
75022343    PRAZOSIN 1MG CAP                         $15.64       $15.64   084170   LOS PHARMACY REV
75022350    PRAZOSIN 2MG CAP                         $17.38       $17.38   084170   LOS PHARMACY REV
75022368    PRAZOSIN 5MG CAP                         $18.68       $18.68   084170   LOS PHARMACY REV
75096065    PRED/GENT OPT OINT 3.5GM                 $67.38       $67.38   084170   LOS PHARMACY REV
75099374    PREDNISOLONE 0.12% OPTH                  $77.58       $77.58   084170   LOS PHARMACY REV
75097709    PREDNISOLONE 1% OPTH 5ML                 $77.58       $77.58   084170   LOS PHARMACY REV
75029520    PREDNISOLONE 15MG/5ML SYU                $32.40       $32.40   084170   LOS PHARMACY REV
75028845    PREDNISOLONE LIQ 5ML                     $80.84       $80.84   084170   LOS PHARMACY REV
75028910    PREDNISONE 10MG TAB                      $14.26       $14.26   084170   LOS PHARMACY REV
75028878    PREDNISONE 1MG TAB                       $14.46       $14.46   084170   LOS PHARMACY REV
75028886    PREDNISONE 2.5MG TAB                     $14.22       $14.22   084170   LOS PHARMACY REV
75028944    PREDNISONE 20MG TAB                      $14.34       $14.34   084170   LOS PHARMACY REV
75028985    PREDNISONE 50MG TAB                      $14.68       $14.68   084170   LOS PHARMACY REV
75028894    PREDNISONE 5MG TAB                       $14.14       $14.14   084170   LOS PHARMACY REV
75028860    PREDNISONE 5MG/5ML LIQ                   $16.02       $16.02   084170   LOS PHARMACY REV
75030312    PREGABALIN 25MG CAP                      $18.12       $18.12   084170   LOS PHARMACY REV
75030320    PREGABALIN 50MG CAP                      $18.12       $18.12   084170   LOS PHARMACY REV


7/11/2012                                                                                              83
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75030338    PREGABALIN 75MG CAP                      $18.12       $18.12   084170   LOS PHARMACY REV
75027300    PREMPRO .625MG/2.5MG TB                  $16.98       $16.98   084170   LOS PHARMACY REV
75030247    PREMPRO 0.625MG/5MG TAB                  $16.82       $16.82   084170   LOS PHARMACY REV
75084228    PREPARATION H 30GM TUBE                  $46.60       $46.60   084170   LOS PHARMACY REV
75093245    PREPARATION H SUP                        $15.06       $15.06   084170   LOS PHARMACY REV
75023044    PRIMIDONE 250MG TAB                      $17.48       $17.48   084170   LOS PHARMACY REV
75023036    PRIMIDONE 50MG TAB                       $14.96       $14.96   084170   LOS PHARMACY REV
75003285    PROBENECID 500MG TAB                     $18.38       $18.38   084170   LOS PHARMACY REV
75029132    PROCAINAMIDE 250MG CAP                   $15.36       $15.36   084170   LOS PHARMACY REV
75029157    PROCAINAMIDE 500MG CAP                   $15.90       $15.90   084170   LOS PHARMACY REV
75065615    PROCAINAMIDE 500MG/ML IJ                 $60.66       $60.66   084170   LOS PHARMACY REV
75029207    PROCAINAMIDE SR 500MG TAB                $15.98       $15.98   084170   LOS PHARMACY REV
75027383    PROCAINAMIDE SR 750MG TAB                $15.80       $15.80   084170   LOS PHARMACY REV
75065656    PROCAINE 2% 30ML VL                      $61.12       $61.12   084170   LOS PHARMACY REV
75050351    PROCHLORPERAZIN 10MG INJ                $150.12      $150.12   084170   LOS PHARMACY REV
75006569    PROCHLORPERAZIN 10MG TAB                 $16.20       $16.20   084170   LOS PHARMACY REV
75091843    PROCHLORPERAZIN 25MG SUPP                $21.68       $21.68   084170   LOS PHARMACY REV
75091835    PROCHLORPERAZIN 5MG SUPP                 $20.20       $20.20   084170   LOS PHARMACY REV
75006551    PROCHLORPERAZIN 5MG TAB                  $15.48       $15.48   084170   LOS PHARMACY REV
75066050    PROGESTERONE OIL 500MG IJ               $134.50      $134.50   084170   LOS PHARMACY REV
75028332    PROMETH DM 5ML LIQ                       $14.22       $14.22   084170   LOS PHARMACY REV
75028365    PROMETH VC/COD 5ML LIQ                   $29.20       $29.20   084170   LOS PHARMACY REV
75028324    PROMETH/COD 5ML LIQ                      $86.18       $86.18   084170   LOS PHARMACY REV
75093203    PROMETHAZINE 12.5MG SUPP                 $22.74       $22.74   084170   LOS PHARMACY REV
75028373    PROMETHAZINE 12.5MG TAB                  $14.66       $14.66   084170   LOS PHARMACY REV
75065094    PROMETHAZINE 25MG INJ                    $63.20       $63.20   084170   LOS PHARMACY REV
75093211    PROMETHAZINE 25MG SUPP                   $24.04       $24.04   084170   LOS PHARMACY REV
75028381    PROMETHAZINE 25MG TAB                    $15.18       $15.18   084170   LOS PHARMACY REV
75065102    PROMETHAZINE 50MG INJ                    $64.66       $64.66   084170   LOS PHARMACY REV
75093229    PROMETHAZINE 50MG SUPP                   $26.84       $26.84   084170   LOS PHARMACY REV
75028340    PROMETHAZINE 6.25/5 LIQ                  $14.60       $14.60   084170   LOS PHARMACY REV
75032953    PROPAFENONE 150MG TAB                    $18.26       $18.26   084170   LOS PHARMACY REV
75029108    PROPANTHELINE 15MG TAB                   $15.18       $15.18   084170   LOS PHARMACY REV
75097311    PROPARACINE 0.5% OP 15ML                 $77.38       $77.38   084170   LOS PHARMACY REV
75066399    PROPOFOL 1000MG IJ                      $208.92      $208.92   084170   LOS PHARMACY REV
75065292    PROPOFOL 200MG IJ                        $94.74       $94.74   084170   LOS PHARMACY REV


7/11/2012                                                                                              84
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75053033    PROPOFOL 500MG IJ                       $132.98      $132.98   084170   LOS PHARMACY REV
75008201    PROPOXYPHENE 65MG CAP                    $28.74       $28.74   084170   LOS PHARMACY REV
75008235    PROPOXYPHENE CPD-65 CAP                  $15.54       $15.54   084170   LOS PHARMACY REV
75017236    PROPRANOLOL 10MG TAB                     $14.90       $14.90   084170   LOS PHARMACY REV
75059162    PROPRANOLOL 1MG IJ                      $150.12      $150.12   084170   LOS PHARMACY REV
75017244    PROPRANOLOL 20MG TAB                     $15.26       $15.26   084170   LOS PHARMACY REV
75017251    PROPRANOLOL 40MG TAB                     $15.64       $15.64   084170   LOS PHARMACY REV
75017269    PROPRANOLOL 80MG TAB                     $16.60       $16.60   084170   LOS PHARMACY REV
75030361    PROPRANOLOL LA 120MG CAP                 $18.28       $18.28   084170   LOS PHARMACY REV
75017574    PROPRANOLOL LA 160MG CAP                 $17.96       $17.96   084170   LOS PHARMACY REV
75017178    PROPRANOLOL LA 60MG CAP                  $16.54       $16.54   084170   LOS PHARMACY REV
75017277    PROPRANOLOL LA 80MG CAP                  $17.20       $17.20   084170   LOS PHARMACY REV
75029512    PROPYLTHIOURACL 50MG TAB                 $14.32       $14.32   084170   LOS PHARMACY REV
75065573    PROTAMINE 250MG IJ VL                   $152.98      $152.98   084170   LOS PHARMACY REV
75065920    PROTAMINE 50MG IJ VL                    $126.32      $126.32   084170   LOS PHARMACY REV
75030395    PROTRIPTYLINE 10MG TAB                   $17.46       $17.46   084170   LOS PHARMACY REV
75000075    PSEUD/TRIP TAB                           $14.06       $14.06   084170   LOS PHARMACY REV
75035311    PSEUDOEPHEDRINE 30MG TAB                 $14.14       $14.14   084170   LOS PHARMACY REV
75030353    PSEUDOEPHEDRINE 60MG TAB                 $14.12       $14.12   084170   LOS PHARMACY REV
75022012    PSYLLIUM PKT                             $14.70       $14.70   084170   LOS PHARMACY REV
75029777    PYRAZINAMIDE 500MG TAB                   $16.20       $16.20   084170   LOS PHARMACY REV
75062380    PYRIDOSTIGMINE 10MG IJ                   $68.56       $68.56   084170   LOS PHARMACY REV
75021931    PYRIDOSTIGMINE 60MG TAB                  $15.34       $15.34   084170   LOS PHARMACY REV
75029710    PYRIDOXINE 25MG TAB                      $14.04       $14.04   084170   LOS PHARMACY REV
75029728    PYRIDOXINE 50MG TAB                      $14.06       $14.06   084170   LOS PHARMACY REV
75069674    PYRIDOXINE HCL 100 MG IJ                $119.60      $119.60   084170   LOS PHARMACY REV
75035832    QUETIAPINE 100MG TAB                     $20.20       $20.20   084170   LOS PHARMACY REV
75035824    QUETIAPINE 25MG TAB                      $17.40       $17.40   084170   LOS PHARMACY REV
75000273    QUINAPRIL 10MG TAB                       $16.52       $16.52   084170   LOS PHARMACY REV
75031377    QUINAPRIL 20MG TAB                       $16.70       $16.70   084170   LOS PHARMACY REV
75031328    QUINAPRIL 5MG TAB                        $16.52       $16.52   084170   LOS PHARMACY REV
75031237    QUINIDINE 200MG TAB                      $14.44       $14.44   084170   LOS PHARMACY REV
75031211    QUINIDINE 300MG TAB                      $16.30       $16.30   084170   LOS PHARMACY REV
75031245    QUINIDINE 324MG TAB                      $16.74       $16.74   084170   LOS PHARMACY REV
75031179    QUINIDINE 324MG TAB                      $15.22       $15.22   084170   LOS PHARMACY REV
75066340    QUINIDINE 80MG/ML IJ 10ML                $61.50       $61.50   084170   LOS PHARMACY REV


7/11/2012                                                                                              85
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75031278    QUININE 200MG CAP                         $15.12       $15.12   084170   LOS PHARMACY REV
75031286    QUININE 325MG CAP                         $15.56       $15.56   084170   LOS PHARMACY REV
75031195    QUININE TAB                               $15.74       $15.74   084170   LOS PHARMACY REV
75001784    RABEPRAZOLE 20MG TAB                      $22.90       $22.90   084170   LOS PHARMACY REV
75098921    RACEPINEPHRINE 2.25% UD                   $16.50       $16.50   084170   LOS PHARMACY REV
75098657    RACEPINEPHRINE SOLN 15ML                  $51.50       $51.50   084170   LOS PHARMACY REV
75095265    RACEPINEPHRINE TX                         $16.50       $16.50   084170   LOS PHARMACY REV
75011239    RALOXIFENE 60MG TAB                       $19.40       $19.40   084170   LOS PHARMACY REV
75033027    RAMIPRIL 2.5MG CAP                        $16.68       $16.68   084170   LOS PHARMACY REV
75033035    RAMIPRIL 5MG CAP                          $16.92       $16.92   084170   LOS PHARMACY REV
75045047    RANITIDINE 150MG TAB                      $18.38       $18.38   084170   LOS PHARMACY REV
75045112    RANITIDINE 150MG/10ML LIQ                 $87.20       $87.20   084170   LOS PHARMACY REV
75069195    RANITIDINE IJ 50MG                       $120.98      $120.98   084170   LOS PHARMACY REV
75045070    RANITIDINE TAB 300MG                      $21.84       $21.84   084170   LOS PHARMACY REV
75066647    RAPID SEQ INDUCT KIT(EXP)                  $0.00        $0.00   084170   LOS PHARMACY REV
75066837    REMIFENTANIL 1MG IJ                      $111.38      $111.38   084170   LOS PHARMACY REV
44612026    RENAL REPLACEMENT SOLN                   $213.00      $213.00   084170   LOS PHARMACY REV
75033118    REPAGLINIDE 0.5MG TAB                     $16.18       $16.18   084170   LOS PHARMACY REV
75033126    REPAGLINIDE 1MG TAB                       $16.18       $16.18   084170   LOS PHARMACY REV
75033134    REPAGLINIDE 2MG TAB                       $16.18       $16.18   084170   LOS PHARMACY REV
75066621    RETEPLASE 18.1MG 2VL IJ                $5,858.00    $5,858.00   084170   LOS PHARMACY REV
75066779    RETEPLASE 18.1MG IJ                    $2,985.50    $2,985.50   084170   LOS PHARMACY REV
75097899    RIBAVIRIN 6GM VIAL                     $2,974.10    $2,974.10   084170   LOS PHARMACY REV
75033241    RIFAMPIN 10MG/ML LIQ 15ML                 $60.30       $60.30   084170   LOS PHARMACY REV
75032292    RIFAMPIN 300MG CAP                        $18.48       $18.48   084170   LOS PHARMACY REV
75066704    RIFAMPIN 600MG/25ML VL                   $242.98      $242.98   084170   LOS PHARMACY REV
75033274    RIFAXIMIN 200MG TAB                       $23.12       $23.12   084170   LOS PHARMACY REV
75002576    RISEDRONATE 30MG TAB                      $49.24       $49.24   084170   LOS PHARMACY REV
75033282    RISEDRONATE 35MG TAB                      $44.64       $44.64   084170   LOS PHARMACY REV
75002568    RISEDRONATE 5MG TAB                       $17.84       $17.84   084170   LOS PHARMACY REV
75033175    RISPERIDONE 0.25MG TAB                    $20.34       $20.34   084170   LOS PHARMACY REV
75033183    RISPERIDONE 0.5MG TAB                     $20.70       $20.70   084170   LOS PHARMACY REV
75032987    RISPERIDONE 1MG TAB                       $21.12       $21.12   084170   LOS PHARMACY REV
75032995    RISPERIDONE 2MG TAB                       $25.16       $25.16   084170   LOS PHARMACY REV
75033001    RISPERIDONE 3MG TAB                       $27.76       $27.76   084170   LOS PHARMACY REV
75033191    RITONAVIR/LOPINAVIR CAP                   $27.10       $27.10   084170   LOS PHARMACY REV


7/11/2012                                                                                               86
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75066845    RITUXIMAB 100MG IJ                     $1,592.22    $1,592.22   084170   LOS PHARMACY REV
75066852    RITUXIMAB 500MG INJ VIAL               $5,981.06    $5,981.06   084170   LOS PHARMACY REV
75033373    RIVASTIGMINE 1.5MG CAP                    $20.85       $20.85   084170   LOS PHARMACY REV
75033381    RIVASTIGMINE 6MG CAP                      $20.85       $20.85   084170   LOS PHARMACY REV
75069096    ROCURONIUM 10MG/ML 10ML                  $176.90      $176.90   084170   LOS PHARMACY REV
75068965    ROCURONIUM 10MG/ML 5ML VL                $146.28      $146.28   084170   LOS PHARMACY REV
75033258    ROFECOXIB 12.5MG TAB                      $20.02       $20.02   084170   LOS PHARMACY REV
75033266    ROFECOXIB 25MG TAB                        $20.02       $20.02   084170   LOS PHARMACY REV
75032011    ROFECOXIB 25MG/5ML LIQ                   $296.56      $296.56   084170   LOS PHARMACY REV
75033308    ROPINIROLE 0.25MG TAB                     $18.22       $18.22   084170   LOS PHARMACY REV
75033316    ROPINIROLE 0.5MG TAB                      $18.22       $18.22   084170   LOS PHARMACY REV
75033324    ROPINIROLE 1MG TAB                        $18.22       $18.22   084170   LOS PHARMACY REV
75033332    ROPINIROLE 2MG TAB                        $18.22       $18.22   084170   LOS PHARMACY REV
75066811    ROPIVACAINE 2MG/ML 100ML                  $99.72       $99.72   084170   LOS PHARMACY REV
75066803    ROPIVACAINE 2MG/ML 20ML                   $70.68       $70.68   084170   LOS PHARMACY REV
75066878    ROPIVACAINE 5MG/ML 30ML                   $87.50       $87.50   084170   LOS PHARMACY REV
75066886    ROPIVACAINE 7.5MG/ML 20ML                 $84.06       $84.06   084170   LOS PHARMACY REV
75033357    ROSIGLITAZONE 2MG TAB                     $18.86       $18.86   084170   LOS PHARMACY REV
75002485    ROSIGLITAZONE 4MG TAB                     $19.78       $19.78   084170   LOS PHARMACY REV
75033365    ROSIGLITAZONE 8MG TAB                     $27.12       $27.12   084170   LOS PHARMACY REV
75033340    ROSUVASTATIN 10MG TAB                     $20.56       $20.56   084170   LOS PHARMACY REV
75087455    SALICYLIC ACID SHMP 8OZ                   $58.22       $58.22   084170   LOS PHARMACY REV
75034017    SALIVA SUBSTITE SUBST 40Z                 $38.10       $38.10   084170   LOS PHARMACY REV
75098764    SALMETEROL INH #28'S                      $32.06       $32.06   084170   LOS PHARMACY REV
75098525    SALMETEROL INH 13GM                      $211.80      $211.80   084170   LOS PHARMACY REV
75067199    SARGRAMOSTIM 500MCG IJ                   $702.46      $702.46   084170   LOS PHARMACY REV
75067009    SCOPOLAMINE 0.4MG/ML VL                   $60.96       $60.96   084170   LOS PHARMACY REV
75088369    SCOPOLAMINE 1.5MG PATCH                   $26.48       $26.48   084170   LOS PHARMACY REV
75067637    SECRETIN 16MCG INJ                       $869.50      $869.50   084170   LOS PHARMACY REV
75011569    SELEGILINE 5MG TAB                        $20.72       $20.72   084170   LOS PHARMACY REV
75034223    SENNA LIQ 5ML                             $32.58       $32.58   084170   LOS PHARMACY REV
75034231    SENNA TAB                                 $14.42       $14.42   084170   LOS PHARMACY REV
75034249    SENNA/DOCUSATE TAB                        $14.86       $14.86   084170   LOS PHARMACY REV
75034488    SERTRALINE 100MG TAB                      $19.46       $19.46   084170   LOS PHARMACY REV
75034462    SERTRALINE 50MG TAB                       $19.46       $19.46   084170   LOS PHARMACY REV
75033142    SEVELAMER 400MG CAP                       $15.48       $15.48   084170   LOS PHARMACY REV


7/11/2012                                                                                               87
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75033159    SEVELAMER 800MG CAP                      $17.10       $17.10   084170   LOS PHARMACY REV
75087155    SILV SULFADIAZN 400GM CRM                $98.14       $98.14   084170   LOS PHARMACY REV
75087148    SILV SULFADIAZN 50GM CRM                 $44.44       $44.44   084170   LOS PHARMACY REV
75087171    SILVER NIT APP TOP                       $28.16       $28.16   084170   LOS PHARMACY REV
75023002    SIMETHICONE 80MG TAB                     $14.22       $14.22   084170   LOS PHARMACY REV
75022988    SIMETHICONE DROPS 30ML                   $49.58       $49.58   084170   LOS PHARMACY REV
75045245    SIMVASTATIN 10MG TAB                     $19.26       $19.26   084170   LOS PHARMACY REV
75035774    SIMVASTATIN 20MG TAB                     $23.92       $23.92   084170   LOS PHARMACY REV
75035782    SIMVASTATIN 40MG TAB                     $23.92       $23.92   084170   LOS PHARMACY REV
75060426    SINCALIDE 5MCG VL                       $158.50      $158.50   084170   LOS PHARMACY REV
75034512    SINEMET 10/100 TAB                       $15.80       $15.80   084170   LOS PHARMACY REV
75034520    SINEMET 25/100 TAB                       $15.86       $15.86   084170   LOS PHARMACY REV
75034538    SINEMET 25/250 TAB                       $16.38       $16.38   084170   LOS PHARMACY REV
75034751    SINEMET CR 50/200 TAB                    $18.26       $18.26   084170   LOS PHARMACY REV
75035840    SIROLIMUS/1MG PO                         $31.52       $31.52   084170   LOS PHARMACY REV
75034934    SORBITOL 480ML                           $36.50       $36.50   084170   LOS PHARMACY REV
75034942    SORBITOL 70% 30ML LIQ                    $29.14       $29.14   084170   LOS PHARMACY REV
75034819    SOTALOL 80MG TABLET                      $20.40       $20.40   084170   LOS PHARMACY REV
75000182    SPIRONOLACTONE 100MG TAB                 $18.22       $18.22   084170   LOS PHARMACY REV
75000323    SPIRONOLACTONE 25MG TAB                  $15.36       $15.36   084170   LOS PHARMACY REV
75000331    SPIRONOLACTONE 50MG TAB                  $16.50       $16.50   084170   LOS PHARMACY REV
75099887    STATISTICAL TRACKING RX                   $0.00        $0.00   084170   LOS PHARMACY REV
75035204    STAVUDINE 40MG CAP                       $25.92       $25.92   084170   LOS PHARMACY REV
75046995    SUCCINYLCHOLINE 1GM VL                   $65.00       $65.00   084170   LOS PHARMACY REV
75046979    SUCCINYLCHOLINE 200MG VL                 $59.28       $59.28   084170   LOS PHARMACY REV
75005827    SUCRALFATE 1GM/10ML SUSP                 $30.04       $30.04   084170   LOS PHARMACY REV
75005249    SUCRALFATE TAB 1GM                       $16.18       $16.18   084170   LOS PHARMACY REV
75067991    SUFENTANIL 100MCG/2ML IJ                 $97.76       $97.76   084170   LOS PHARMACY REV
75097956    SULFACETAMIDE 10% OP 15ML                $44.20       $44.20   084170   LOS PHARMACY REV
75097972    SULFACETAMIDE OINT                       $41.90       $41.90   084170   LOS PHARMACY REV
75094474    SULFACETAMIDE OPT SL 5ML                 $65.42       $65.42   084170   LOS PHARMACY REV
75003053    SULFAMETHOXAZOL TAB                      $16.18       $16.18   084170   LOS PHARMACY REV
75091223    SULFANILAMIDE CRM 120GM                 $125.24      $125.24   084170   LOS PHARMACY REV
75002311    SULFASALAZINE 500MG TAB                  $14.70       $14.70   084170   LOS PHARMACY REV
75006122    SULINDAC 200MG TAB                       $17.02       $17.02   084170   LOS PHARMACY REV
75099275    SUMATRIPTAN 20MG NAS SPRY                $91.68       $91.68   084170   LOS PHARMACY REV


7/11/2012                                                                                              88
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75035790    SUMATRIPTAN 25MG TAB                      $54.14       $54.14   084170   LOS PHARMACY REV
75035808    SUMATRIPTAN 50MG TAB                      $49.72       $49.72   084170   LOS PHARMACY REV
75099267    SUMATRIPTAN 5MG NAS SPRAY                 $89.68       $89.68   084170   LOS PHARMACY REV
75067850    SUMATRIPTAN 6MG/0.5ML IJ                 $177.76      $177.76   084170   LOS PHARMACY REV
75066431    SYNERCID 500MG IJ                        $368.68      $368.68   084170   LOS PHARMACY REV
75036061    TACROLIMUS/1MG PO                         $20.64       $20.64   084170   LOS PHARMACY REV
75088088    TALC STERILE 5GM                          $74.32       $74.32   084170   LOS PHARMACY REV
75024802    TAMOXIFEN 10MG TAB                        $18.46       $18.46   084170   LOS PHARMACY REV
75038877    TAMSULOSIN 0.4MG TAB                      $18.14       $18.14   084170   LOS PHARMACY REV
75039057    TEGASEROD 2MG TAB                         $20.74       $20.74   084170   LOS PHARMACY REV
75039065    TEGASEROD 6MG TAB                         $20.94       $20.94   084170   LOS PHARMACY REV
75039073    TELMISARTAN 40MG TAB                      $17.84       $17.84   084170   LOS PHARMACY REV
75039081    TELMISARTAN 80MG TAB                      $18.12       $18.12   084170   LOS PHARMACY REV
75032235    TEMAZEPAM 15MG CAP                        $29.42       $29.42   084170   LOS PHARMACY REV
75032243    TEMAZEPAM 30MG CAP                        $29.66       $29.66   084170   LOS PHARMACY REV
75036459    TEMAZEPAM 7.5 MG CAP                      $31.22       $31.22   084170   LOS PHARMACY REV
75068650    TENECTEPLASE/50MG IJ                   $5,947.96    $5,947.96   084170   LOS PHARMACY REV
75039040    TENOFOVIR 300MG TAB                       $50.88       $50.88   084170   LOS PHARMACY REV
75036525    TENORETIC TAB 50MG                        $17.12       $17.12   084170   LOS PHARMACY REV
75037077    TERAZOSIN 1MG TAB                         $18.36       $18.36   084170   LOS PHARMACY REV
75016444    TERAZOSIN 2MG TAB                         $18.36       $18.36   084170   LOS PHARMACY REV
75037028    TERAZOSIN 5MG TAB                         $18.64       $18.64   084170   LOS PHARMACY REV
75039008    TERBINAFINE 250MG TAB                     $33.66       $33.66   084170   LOS PHARMACY REV
75088120    TERBINAFINE CRM 24GM                      $81.44       $81.44   084170   LOS PHARMACY REV
75068239    TERBUTALINE 1MG IJ                       $121.98      $121.98   084170   LOS PHARMACY REV
75003541    TERBUTALINE 2.5MG TAB                     $14.86       $14.86   084170   LOS PHARMACY REV
75003558    TERBUTALINE 5MG TAB                       $15.24       $15.24   084170   LOS PHARMACY REV
75088195    TERCONAZOLE VAG CR 45GM                  $119.06      $119.06   084170   LOS PHARMACY REV
75052555    TESTOSTERONE 200MG/ML IJ                 $259.78      $259.78   084170   LOS PHARMACY REV
75098137    TETRACAINE 0.5% 1ML                       $75.98       $75.98   084170   LOS PHARMACY REV
75068205    TETRACAINE 1% 20MG IJ                     $69.52       $69.52   084170   LOS PHARMACY REV
75098145    TETRACAINE OPT 2ML                        $27.12       $27.12   084170   LOS PHARMACY REV
75036673    TETRACYCLINE 250MG CAP                    $14.16       $14.16   084170   LOS PHARMACY REV
75036681    TETRACYCLINE 500MG CAP                    $14.38       $14.38   084170   LOS PHARMACY REV
75068064    TETRADECYL NA 1% IJ                      $131.50      $131.50   084170   LOS PHARMACY REV
75067694    TETRADECYL NA 3% IJ                      $175.50      $175.50   084170   LOS PHARMACY REV


7/11/2012                                                                                               89
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75098434    TETRAHYDROZOLIN OP 15ML                  $32.20       $32.20   084170   LOS PHARMACY REV
75098392    TH ALBUTEROL INHALER 17GM                $64.00       $64.00   084170   LOS PHARMACY REV
75096826    TH MAXITROL OINT 3.5GM                  $143.12      $143.12   084170   LOS PHARMACY REV
75098939    TH TOBRA/DEXAMETH 3.5GM                 $166.28      $166.28   084170   LOS PHARMACY REV
75038786    THEOPHYLLINE 100 MG CAP                  $14.94       $14.94   084170   LOS PHARMACY REV
75036723    THEOPHYLLINE 100MG TAB                   $15.10       $15.10   084170   LOS PHARMACY REV
75011288    THEOPHYLLINE 160/30 LIQ                  $28.68       $28.68   084170   LOS PHARMACY REV
75038794    THEOPHYLLINE 200 MG CAP                  $15.40       $15.40   084170   LOS PHARMACY REV
75036731    THEOPHYLLINE 200MG TAB                   $14.72       $14.72   084170   LOS PHARMACY REV
75034645    THEOPHYLLINE 300MG CAP                   $15.72       $15.72   084170   LOS PHARMACY REV
75038802    THEOPHYLLINE 300MG TAB                   $15.66       $15.66   084170   LOS PHARMACY REV
75036749    THEOPHYLLINE 300MG TAB                   $14.78       $14.78   084170   LOS PHARMACY REV
75040121    THEOPHYLLINE TAB 200MG                   $15.24       $15.24   084170   LOS PHARMACY REV
75040105    THEOPHYLLINE TAB 400MG                   $16.22       $16.22   084170   LOS PHARMACY REV
75037002    THIAMINE 100MG TAB                       $14.04       $14.04   084170   LOS PHARMACY REV
75036996    THIAMINE 50MG TAB                        $14.02       $14.02   084170   LOS PHARMACY REV
75068460    THIAMINE HCL 100 MG IJ                   $59.00       $59.00   084170   LOS PHARMACY REV
75065003    THIOPENTAL 500MG JECT                    $96.10       $96.10   084170   LOS PHARMACY REV
75021667    THIORIDAZINE 100MG TAB                   $15.72       $15.72   084170   LOS PHARMACY REV
75037549    THIORIDAZINE 10MG TAB                    $14.66       $14.66   084170   LOS PHARMACY REV
75021642    THIORIDAZINE 25MG TAB                    $15.22       $15.22   084170   LOS PHARMACY REV
75021659    THIORIDAZINE 50MG TAB                    $15.48       $15.48   084170   LOS PHARMACY REV
75024265    THIOTHIXENE 10MG CAP                     $17.08       $17.08   084170   LOS PHARMACY REV
75024273    THIOTHIXENE 20MG CAP                     $17.74       $17.74   084170   LOS PHARMACY REV
75024240    THIOTHIXENE CAP 2MG                      $18.32       $18.32   084170   LOS PHARMACY REV
75024257    THIOTHIXENE CAP 5MG                      $16.10       $16.10   084170   LOS PHARMACY REV
75068627    THROMBIN 10MU VL                        $259.24      $259.24   084170   LOS PHARMACY REV
75068221    THROMBIN 5000U IJ                       $167.52      $167.52   084170   LOS PHARMACY REV
75068635    THROMBIN KIT 20MU                       $672.90      $672.90   084170   LOS PHARMACY REV
75037218    THYROID 120MG TAB                        $14.68       $14.68   084170   LOS PHARMACY REV
75037192    THYROID 30MG TAB                         $14.50       $14.50   084170   LOS PHARMACY REV
75037200    THYROID 60MG TAB                         $14.54       $14.54   084170   LOS PHARMACY REV
75068718    TICAR/CLAV 3.1GM IJ                     $144.40      $144.40   084170   LOS PHARMACY REV
75037952    TICLOPIDINE HCL 250MG TAB                $18.94       $18.94   084170   LOS PHARMACY REV
75093658    TIGAN 100MG SUPP                         $19.56       $19.56   084170   LOS PHARMACY REV
75093666    TIGAN 200MG SUPP                         $20.60       $20.60   084170   LOS PHARMACY REV


7/11/2012                                                                                              90
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75037325    TIGAN 250MG CAP                           $15.44       $15.44   084170   LOS PHARMACY REV
75068734    TIGAN 250MG IJ                            $69.32       $69.32   084170   LOS PHARMACY REV
75070227    TIGECYCLINE 50MG IJ                      $226.08      $226.08   084170   LOS PHARMACY REV
75098665    TIMOLOL 0.25 OPTH DP 5ML                  $65.36       $65.36   084170   LOS PHARMACY REV
75098178    TIMOLOL 0.25% OP DP 2.5ML                 $47.02       $47.02   084170   LOS PHARMACY REV
75098194    TIMOLOL 0.25% OPTH 5ML                    $58.00       $58.00   084170   LOS PHARMACY REV
75098251    TIMOLOL 0.5% OPT DP 2.5ML                 $50.66       $50.66   084170   LOS PHARMACY REV
75098202    TIMOLOL 0.5% OPTH DP 5ML                  $72.20       $72.20   084170   LOS PHARMACY REV
75088443    TIMOLOL 0.5% OPTH GEL 5ML                $121.40      $121.40   084170   LOS PHARMACY REV
75098715    TIMOLOL XE 0.5% GL 2.5ML                  $67.46       $67.46   084170   LOS PHARMACY REV
75098723    TIMOLOL XE 0.5% GL 5ML                    $92.00       $92.00   084170   LOS PHARMACY REV
75098053    TIOTROPIUM #3 CAP STRIP                   $38.00       $38.00   084170   LOS PHARMACY REV
75098038    TIOTROPIUM INH/#6 CAPS                    $93.00       $93.00   084170   LOS PHARMACY REV
75068080    TIROFIBAN 12.5MG IJ                    $1,049.40    $1,049.40   084170   LOS PHARMACY REV
75038976    TIZANIDINE 4MG TAB                        $17.26       $17.26   084170   LOS PHARMACY REV
75096933    TOBRA/DEXAMETH OPT 3.5GM                 $177.14      $177.14   084170   LOS PHARMACY REV
75098582    TOBRA/DEXAMETH OPT SL 5CC                $143.00      $143.00   084170   LOS PHARMACY REV
75098566    TOBRAMYCIN 0.3% OP 3.5GM                 $130.26      $130.26   084170   LOS PHARMACY REV
75098558    TOBRAMYCIN 0.3% OPTH 5ML                 $121.26      $121.26   084170   LOS PHARMACY REV
75068452    TOBRAMYCIN 1.2GM IJ PWD                  $789.50      $789.50   084170   LOS PHARMACY REV
75068775    TOBRAMYCIN 40MG/ML IJ                    $127.56      $127.56   084170   LOS PHARMACY REV
75068817    TOBRAMYCIN 80MG IJ                       $125.48      $125.48   084170   LOS PHARMACY REV
75037556    TOLAZAMIDE 100MG TAB                      $15.02       $15.02   084170   LOS PHARMACY REV
75037564    TOLAZAMIDE 250MG TAB                      $16.26       $16.26   084170   LOS PHARMACY REV
75037572    TOLAZAMIDE 500MG TAB                      $15.02       $15.02   084170   LOS PHARMACY REV
75088047    TOLNAFTATE CRM                            $39.08       $39.08   084170   LOS PHARMACY REV
75010348    TOLTERODINE 1MG TAB                       $17.60       $17.60   084170   LOS PHARMACY REV
75010355    TOLTERODINE 2MG TAB                       $17.70       $17.70   084170   LOS PHARMACY REV
75033209    TOLTERODINE LA 2MG TAB                    $19.56       $19.56   084170   LOS PHARMACY REV
75033217    TOLTERODINE LA 4MG TAB                    $19.70       $19.70   084170   LOS PHARMACY REV
75039032    TOPIRAMATE 100MG TAB                      $25.52       $25.52   084170   LOS PHARMACY REV
75039024    TOPIRAMATE 25MG TAB                       $18.22       $18.22   084170   LOS PHARMACY REV
75070573    TOPOTECAN 4MG IJ                       $2,389.16    $2,389.16   084170   LOS PHARMACY REV
75038851    TORSEMIDE 10MG TAB                        $15.74       $15.74   084170   LOS PHARMACY REV
75053355    TORSEMIDE 20MG IJ AMP                    $125.20      $125.20   084170   LOS PHARMACY REV
75038869    TORSEMIDE 20MG TAB                        $16.02       $16.02   084170   LOS PHARMACY REV


7/11/2012                                                                                               91
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75052043    TORSEMIDE 50 MG IJ AMP                   $130.06      $130.06   084170   LOS PHARMACY REV
75038836    TRAMADOL 50MG TAB                         $16.48       $16.48   084170   LOS PHARMACY REV
75039016    TRAMADOL/APAP TAB                         $15.40       $15.40   084170   LOS PHARMACY REV
75051110    TRANEXAMIC ACID 1GM IJ VL                $185.33      $185.33   084170   LOS PHARMACY REV
75058677    TRASTUZUMAB 440MG IJ                   $6,352.78    $6,352.78   084170   LOS PHARMACY REV
75099283    TRAVOPROST 0.004% OPTH                   $167.52      $167.52   084170   LOS PHARMACY REV
75038687    TRAZODONE 100MG TAB                       $21.88       $21.88   084170   LOS PHARMACY REV
75038679    TRAZODONE 50MG TAB                        $18.50       $18.50   084170   LOS PHARMACY REV
75079004    TRIAMCINOLONE 0.025% 15GM                 $34.00       $34.00   084170   LOS PHARMACY REV
75079202    TRIAMCINOLONE 0.1% 15GM                   $58.26       $58.26   084170   LOS PHARMACY REV
75079020    TRIAMCINOLONE 0.1% 15GM                   $58.28       $58.28   084170   LOS PHARMACY REV
75079145    TRIAMCINOLONE 0.1% 5GM                    $61.98       $61.98   084170   LOS PHARMACY REV
75079228    TRIAMCINOLONE 0.1% 80GM                   $68.50       $68.50   084170   LOS PHARMACY REV
75079046    TRIAMCINOLONE 0.1% 80GM                  $117.32      $117.32   084170   LOS PHARMACY REV
75079061    TRIAMCINOLONE 0.5% 15GM                  $128.90      $128.90   084170   LOS PHARMACY REV
75060319    TRIAMCINOLONE 10MG IJ                     $74.52       $74.52   084170   LOS PHARMACY REV
75070466    TRIAMCINOLONE 20GM INH                   $188.28      $188.28   084170   LOS PHARMACY REV
75060327    TRIAMCINOLONE 40MG IJ                    $130.52      $130.52   084170   LOS PHARMACY REV
75060392    TRIAMCINOLONE 40MG/ML 5ML                 $70.58       $70.58   084170   LOS PHARMACY REV
75079111    TRIAMCINOLONE LTN 60ML                   $127.34      $127.34   084170   LOS PHARMACY REV
75098988    TRIAMCINOLONE NASAL SPRY                 $200.60      $200.60   084170   LOS PHARMACY REV
75009985    TRIAMTERENE 100MG CAP                     $17.86       $17.86   084170   LOS PHARMACY REV
75039099    TRIAMTERENE/HTZ 50/25 CAP                 $15.16       $15.16   084170   LOS PHARMACY REV
75016105    TRIAZOLAM 0.25MG TAB                      $30.92       $30.92   084170   LOS PHARMACY REV
75095224    TRIETHANOLAMINE OTIC 8ML                  $85.78       $85.78   084170   LOS PHARMACY REV
75035113    TRIFLUOPERAZINE 10MG TAB                  $17.36       $17.36   084170   LOS PHARMACY REV
75035105    TRIFLUOPERAZINE 5MG TAB                   $16.22       $16.22   084170   LOS PHARMACY REV
75001768    TRIHEXYPHENIDYL TAB 2MG                   $14.52       $14.52   084170   LOS PHARMACY REV
75001776    TRIHEXYPHENIDYL TAB 5MG                   $14.72       $14.72   084170   LOS PHARMACY REV
75038042    TRILISATE 500MG/5ML LIQ                   $15.10       $15.10   084170   LOS PHARMACY REV
75038018    TRIMETHOPRIM 100MG TAB                    $15.36       $15.36   084170   LOS PHARMACY REV
75097030    TROPICAMIDE 1% OPT SL 3ML                 $53.00       $53.00   084170   LOS PHARMACY REV
75068544    TRYPAN BLUE 0.06% OPTH SY                $153.00      $153.00   084170   LOS PHARMACY REV
75065474    TUBERCULN SKIN TEST INTRA                $110.76      $110.76   084170   LOS PHARMACY REV
75069047    TUBOCURARINE 30MG IJ                      $75.50       $75.50   084170   LOS PHARMACY REV
75088310    TUCKS PADS 40                             $28.18       $28.18   084170   LOS PHARMACY REV


7/11/2012                                                                                               92
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75079384    UREA OINT 30GM                           $137.10      $137.10   084170   LOS PHARMACY REV
75040204    URISED TAB                                $15.14       $15.14   084170   LOS PHARMACY REV
75046003    UROKINASE 250K IU IJ                   $1,192.56    $1,192.56   084170   LOS PHARMACY REV
75000257    URSODIOL 300MG CAP                        $21.78       $21.78   084170   LOS PHARMACY REV
75042325    VALACYCLOVIR 500MG TAB                    $26.00       $26.00   084170   LOS PHARMACY REV
75053546    VALPROATE 500MG IJ VIAL                  $140.92      $140.92   084170   LOS PHARMACY REV
75008573    VALPROIC ACID 250MG                       $18.32       $18.32   084170   LOS PHARMACY REV
75008581    VALPROIC ACID 250MG/5ML                   $32.60       $32.60   084170   LOS PHARMACY REV
75042226    VALSARTAN 160MG CAP                       $17.04       $17.04   084170   LOS PHARMACY REV
75042218    VALSARTAN 80MG CAP                        $16.80       $16.80   084170   LOS PHARMACY REV
75041368    VANCOMYCIN 125MG CAP                      $28.12       $28.12   084170   LOS PHARMACY REV
75041830    VANCOMYCIN 125MG/2.5ML LQ                 $21.88       $21.88   084170   LOS PHARMACY REV
75069146    VANCOMYCIN 1GM VIAL                      $125.12      $125.12   084170   LOS PHARMACY REV
75041384    VANCOMYCIN 250 MG CAP                     $42.26       $42.26   084170   LOS PHARMACY REV
75069443    VANCOMYCIN 500MG INJ VIAL                $130.36      $130.36   084170   LOS PHARMACY REV
75065276    VASOPRESSIN 20U IJ                        $76.24       $76.24   084170   LOS PHARMACY REV
75064048    VECURONIUM 10MG IJ                       $135.32      $135.32   084170   LOS PHARMACY REV
75011619    VENLAFAXINE 37.5MG TAB                    $17.60       $17.60   084170   LOS PHARMACY REV
75042184    VENLAFAXINE 50MG TAB                      $17.88       $17.88   084170   LOS PHARMACY REV
75042192    VENLAFAXINE 75MG TAB                      $17.94       $17.94   084170   LOS PHARMACY REV
75042291    VENLAFAXINE XR 150MG CAP                  $21.10       $21.10   084170   LOS PHARMACY REV
75042275    VENLAFAXINE XR 37.5MG CAP                 $19.82       $19.82   084170   LOS PHARMACY REV
75042283    VENLAFAXINE XR 75MG CAP                   $20.52       $20.52   084170   LOS PHARMACY REV
75041319    VERAPAMIL 120MG TAB                       $17.02       $17.02   084170   LOS PHARMACY REV
75041228    VERAPAMIL 240MG TAB                       $18.16       $18.16   084170   LOS PHARMACY REV
75041657    VERAPAMIL 40MG TAB                        $15.06       $15.06   084170   LOS PHARMACY REV
75069526    VERAPAMIL 5MG INJ VIAL                   $115.06      $115.06   084170   LOS PHARMACY REV
75041293    VERAPAMIL 80MG TAB                        $15.52       $15.52   084170   LOS PHARMACY REV
75041749    VERAPAMIL HCL 180MG TAB                   $17.44       $17.44   084170   LOS PHARMACY REV
75069476    VINBLASTINE 10MG IJ                      $123.26      $123.26   084170   LOS PHARMACY REV
75069591    VINCRISTINE 1MG IJ                       $558.50      $558.50   084170   LOS PHARMACY REV
75069609    VINCRISTINE 2MG IJ                       $571.50      $571.50   084170   LOS PHARMACY REV
75042200    VINORELBINE/10MG IJ                    $1,690.28    $1,690.28   084170   LOS PHARMACY REV
75041640    VIOKASE 325MG TAB                         $14.82       $14.82   084170   LOS PHARMACY REV
75042333    VIT A 8000U CAP                           $14.05       $14.05   084170   LOS PHARMACY REV
75042010    VIT A CAP 10MU                            $14.10       $14.10   084170   LOS PHARMACY REV


7/11/2012                                                                                               93
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75042028    VIT A CAP 25MU                           $14.24       $14.24   084170   LOS PHARMACY REV
75070045    VIT A&D OINT 15GM                        $32.68       $32.68   084170   LOS PHARMACY REV
75035212    VIT B CMPLX 600 TAB                      $14.34       $14.34   084170   LOS PHARMACY REV
75041756    VIT B CMPLX COM EX TAB                   $14.06       $14.06   084170   LOS PHARMACY REV
75024653    VIT B CMPLX TAB                          $14.34       $14.34   084170   LOS PHARMACY REV
75038034    VIT B&C FE CAP                           $14.68       $14.68   084170   LOS PHARMACY REV
75041848    VIT E CAP 100U                           $14.06       $14.06   084170   LOS PHARMACY REV
75041863    VIT E CAP 400U                           $14.10       $14.10   084170   LOS PHARMACY REV
75069120    VORICONAZOLE 200MG IJ                   $275.88      $275.88   084170   LOS PHARMACY REV
75071241    VX BCG IVSCL PER INSTILL                $409.30      $409.30   084170   LOS PHARMACY REV
75053058    VX DT DIP/TETTOX LT 7YRS                 $90.00       $90.00   084170   LOS PHARMACY REV
75053256    VX DTP DIP/TETTOX /PERTUS               $132.00      $132.00   084170   LOS PHARMACY REV
75056218    VX FLU SPLIT GT=3YRS IM                  $66.34       $66.34   084170   LOS PHARMACY REV
75058727    VX HEMOPH FLU B PRP-T                   $111.00      $111.00   084170   LOS PHARMACY REV
75058651    VX HEP B ADULT IM                       $204.72      $204.72   084170   LOS PHARMACY REV
75058297    VX HEP B PED/ADOL 3 DOSE                $114.58      $114.58   084170   LOS PHARMACY REV
75051201    VX HIB CONJUGATE HEP B                  $165.90      $165.90   084170   LOS PHARMACY REV
75063388    VX MENINGOCOCCAL CONJUGAT               $262.00      $262.00   084170   LOS PHARMACY REV
75063370    VX MENINGOCOCCAL POLYSACC               $272.52      $272.52   084170   LOS PHARMACY REV
75063321    VX MMR                                  $151.00      $151.00   084170   LOS PHARMACY REV
75065375    VX PNMOCOCCL PLYSAC GT 2Y               $301.94      $301.94   084170   LOS PHARMACY REV
75065730    VX POLIOVIRUS INACTIV INJ               $603.16      $603.16   084170   LOS PHARMACY REV
75064717    VX POLIOVIRUS INACTIV INJ               $113.60      $113.60   084170   LOS PHARMACY REV
75066563    VX RABIES INTRAMUSCULAR                 $389.08      $389.08   084170   LOS PHARMACY REV
75066712    VX RUBELLA                               $98.28       $98.28   084170   LOS PHARMACY REV
75053041    VX TET DIPTOX GT 7Y IM                  $321.00      $321.00   084170   LOS PHARMACY REV
75068320    VX TETANUS TOXOID                       $407.62      $407.62   084170   LOS PHARMACY REV
75068346    VX VARICELLA VIRUS LIVE                 $221.60      $221.60   084170   LOS PHARMACY REV
75006858    WARFARIN 10MG TAB                        $16.34       $16.34   084170   LOS PHARMACY REV
75006809    WARFARIN 1MG TAB                         $15.50       $15.50   084170   LOS PHARMACY REV
75006825    WARFARIN 2.5MG TAB                       $15.62       $15.62   084170   LOS PHARMACY REV
75006817    WARFARIN 2MG TAB                         $15.56       $15.56   084170   LOS PHARMACY REV
75006882    WARFARIN 3MG TAB                         $15.62       $15.62   084170   LOS PHARMACY REV
75006767    WARFARIN 4MG TAB                         $15.62       $15.62   084170   LOS PHARMACY REV
75006833    WARFARIN 5MG TAB                         $15.68       $15.68   084170   LOS PHARMACY REV
75006981    WARFARIN 6MG TAB                         $16.18       $16.18   084170   LOS PHARMACY REV


7/11/2012                                                                                              94
                                       d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


75006841    WARFARIN 7.5MG TAB                       $16.24       $16.24   084170   LOS PHARMACY REV
75058578    WATER 10ML VIAL                           $2.32        $2.32   084170   LOS PHARMACY REV
44610863    WATER IRRIG 500ML                        $31.38       $31.38   084170   LOS PHARMACY REV
75089912    XAP (ZAP) SOLUTION APPL.                 $88.20       $88.20   084170   LOS PHARMACY REV
75089920    XENADERM OINT 30GM                      $180.80      $180.80   084170   LOS PHARMACY REV
75089938    XENADERM OINT 60GM                      $202.60      $202.60   084170   LOS PHARMACY REV
75001719    ZAFIRLUKAST 20MG TAB                     $16.68       $16.68   084170   LOS PHARMACY REV
75032250    ZIDOVUDINE CAP 100MG                     $18.10       $18.10   084170   LOS PHARMACY REV
75090068    ZINC OX OINT                             $32.00       $32.00   084170   LOS PHARMACY REV
75045146    ZINC SO4 220MG CAP                       $14.12       $14.12   084170   LOS PHARMACY REV
75045369    ZIPRASIDONE 20MG CAP                     $23.30       $23.30   084170   LOS PHARMACY REV
75070060    ZIPRASIDONE 20MG IJ                      $81.50       $81.50   084170   LOS PHARMACY REV
75045377    ZIPRASIDONE 40MG CAP                     $23.30       $23.30   084170   LOS PHARMACY REV
75068247    ZOLEDRONIC ACID 4MG INJ               $2,111.78    $2,111.78   084170   LOS PHARMACY REV
75045732    ZOLPIDEM CR 6.25MG TAB                   $21.64       $21.64   084170   LOS PHARMACY REV
75045260    ZOLPIDEM TART 5MG TAB                    $34.04       $34.04   084170   LOS PHARMACY REV
75069054    ZOSYN 2.25GM IJ VL                      $135.66      $135.66   084170   LOS PHARMACY REV
75069062    ZOSYN 3.375GM IJ VL                     $148.88      $148.88   084170   LOS PHARMACY REV
477082036   PT DEBRIDE NON-SELECT 15                $183.00      $183.00   084200   LOS PHYSICAL THERAPY REV
477082044   PT E-STIM ADD 15                        $111.00      $111.00   084200   LOS PHYSICAL THERAPY REV
477082023   PT E-STIM EA 15                         $110.00      $110.00   084200   LOS PHYSICAL THERAPY REV
477082051   PT E-STIM MANUAL ADD 15                 $115.00      $115.00   084200   LOS PHYSICAL THERAPY REV
477082052   PT E-STIM MANUAL INIT 30                $274.00      $274.00   084200   LOS PHYSICAL THERAPY REV
477082053   PT E-STIM SUP INIT 30                   $243.00      $243.00   084200   LOS PHYSICAL THERAPY REV
477082022   PT E-STIM SUPERVISED 15                 $107.00      $107.00   084200   LOS PHYSICAL THERAPY REV
477082011   PT EVAL 30                              $310.00      $310.00   084200   LOS PHYSICAL THERAPY REV
477082033   PT EVAL 45                              $496.00      $496.00   084200   LOS PHYSICAL THERAPY REV
477082054   PT EVAL ADD 15                          $166.00      $166.00   084200   LOS PHYSICAL THERAPY REV
477082045   PT EVAL INIT 30                         $246.00      $246.00   084200   LOS PHYSICAL THERAPY REV
477082046   PT GAIT TRAIN ADD 15                    $146.00      $146.00   084200   LOS PHYSICAL THERAPY REV
477082028   PT GAIT TRAIN EA 15                     $158.00      $158.00   084200   LOS PHYSICAL THERAPY REV
477082040   PT GAIT TRAIN INIT 30                   $334.00      $334.00   084200   LOS PHYSICAL THERAPY REV
477082029   PT MANUAL THER EA 15                    $155.00      $155.00   084200   LOS PHYSICAL THERAPY REV
477082055   PT MANUAL TRACT INIT 30                 $249.00      $249.00   084200   LOS PHYSICAL THERAPY REV
477082047   PT NEUROMUSC REED ADD 15                $164.00      $164.00   084200   LOS PHYSICAL THERAPY REV
477082027   PT NEUROMUSC REED EA 15                 $168.00      $168.00   084200   LOS PHYSICAL THERAPY REV


7/11/2012                                                                                                      95
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


477082041   PT NEUROMUSC REED INIT 30                $240.00      $240.00   084200   LOS PHYSICAL THERAPY REV
477082037   PT ORTHOTIC TRAIN EA 15                  $154.00      $154.00   084200   LOS PHYSICAL THERAPY REV
477082038   PT PROSTH TRAIN EA 15                    $187.00      $187.00   084200   LOS PHYSICAL THERAPY REV
477082034   PT THER ACT EA 15                        $155.00      $155.00   084200   LOS PHYSICAL THERAPY REV
477082048   PT THER EX ADD 15                        $154.00      $154.00   084200   LOS PHYSICAL THERAPY REV
477082026   PT THER EX EA 15                         $170.00      $170.00   084200   LOS PHYSICAL THERAPY REV
477082042   PT THER EX INIT 30                       $219.00      $219.00   084200   LOS PHYSICAL THERAPY REV
477082049   PT THER MASSAGE ADD 15                   $166.00      $166.00   084200   LOS PHYSICAL THERAPY REV
477082030   PT THER MASSAGE EA 15                    $137.00      $137.00   084200   LOS PHYSICAL THERAPY REV
477082043   PT THER MASSAGE INIT 30                  $237.00      $237.00   084200   LOS PHYSICAL THERAPY REV
477082050   PT ULTRASOUND ADD 15                     $124.00      $124.00   084200   LOS PHYSICAL THERAPY REV
477082024   PT ULTRASOUND EA 15                      $130.00      $130.00   084200   LOS PHYSICAL THERAPY REV
477082057   PT ULTRASOUND INIT 30                    $285.00      $285.00   084200   LOS PHYSICAL THERAPY REV
477082025   PT UNLISTED MODAL                        $101.00      $101.00   084200   LOS PHYSICAL THERAPY REV
464360425   CON LOCM >= 400S I 1ML                     $1.23        $1.23   084140   LOS RADIOLOGY REV
464360423   CON LOCM 300-349S I 1ML                    $1.23        $1.23   084140   LOS RADIOLOGY REV
464360424   CON LOCM 350-399S I 1ML                    $1.23        $1.23   084140   LOS RADIOLOGY REV
46302024    CT EXT UPP W/O CON                     $4,191.00    $4,191.00   084140   LOS RADIOLOGY REV
463060140   XR ABD 1V AP                             $622.00      $622.00   084140   LOS RADIOLOGY REV
463060142   XR ABD CMPL DECUB ERECT                  $762.00      $762.00   084140   LOS RADIOLOGY REV
463050040   XR ABD CMPL W 1V CHEST                   $891.00      $891.00   084140   LOS RADIOLOGY REV
463060105   XR AC JNT                                $759.00      $759.00   084140   LOS RADIOLOGY REV
463060429   XR ANKLE 2V                              $579.00      $579.00   084140   LOS RADIOLOGY REV
463060428   XR ANKLE 2V                              $579.00      $579.00   084140   LOS RADIOLOGY REV
463060396   XR ANKLE 3V OR MORE                      $633.00      $633.00   084140   LOS RADIOLOGY REV
463060395   XR ANKLE 3V OR MORE                      $633.00      $633.00   084140   LOS RADIOLOGY REV
464360383   XR ARTHRO KNEE                         $2,871.00    $2,871.00   084140   LOS RADIOLOGY REV
463060150   XR BE                                  $2,071.00    $2,071.00   084140   LOS RADIOLOGY REV
463060151   XR BE W AIR CON                        $2,635.00    $2,635.00   084140   LOS RADIOLOGY REV
463060215   XR BONE SURVEY CMPL                    $1,738.00    $1,738.00   084140   LOS RADIOLOGY REV
464360403   XR BONE SURVEY INF                     $1,030.00    $1,030.00   084140   LOS RADIOLOGY REV
463060422   XR CALCANEOUS 2V OR MORE                 $558.00      $558.00   084140   LOS RADIOLOGY REV
463060421   XR CALCANEOUS 2V OR MORE                 $558.00      $558.00   084140   LOS RADIOLOGY REV
463060051   XR CHEST 1V                              $569.00      $569.00   084140   LOS RADIOLOGY REV
463060052   XR CHEST 2V                              $740.00      $740.00   084140   LOS RADIOLOGY REV
463060091   XR CHEST 2V CTY EM                        $71.00       $71.00   084140   LOS RADIOLOGY REV


7/11/2012                                                                                                       96
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


463060053   XR CHEST 2V W OBLIQUES                   $861.00      $861.00   084140   LOS RADIOLOGY REV
464360404   XR CHEST 4V CMPL                       $1,724.40    $1,724.40   084140   LOS RADIOLOGY REV
463060343   XR CHEST SPECIAL V EA                    $622.00      $622.00   084140   LOS RADIOLOGY REV
463060153   XR CHOLECYSTOGRAM ORAL                   $871.00      $871.00   084140   LOS RADIOLOGY REV
463060410   XR CLAVICLE CMPL                         $612.00      $612.00   084140   LOS RADIOLOGY REV
463060409   XR CLAVICLE CMPL                         $612.00      $612.00   084140   LOS RADIOLOGY REV
463060164   XR CYSTOGRAM 3V OR MORE                $1,200.00    $1,200.00   084140   LOS RADIOLOGY REV
463060704   XR DEXA APPEN                            $891.00      $891.00   084140   LOS RADIOLOGY REV
463060703   XR DEXA AXIAL SKELETON                 $3,434.00    $3,434.00   084140   LOS RADIOLOGY REV
463060390   XR ELBOW 2V                              $612.00      $612.00   084140   LOS RADIOLOGY REV
463060389   XR ELBOW 2V                              $612.00      $612.00   084140   LOS RADIOLOGY REV
463060144   XR ESOPH                               $1,438.00    $1,438.00   084140   LOS RADIOLOGY REV
463060016   XR FACIAL BONE 3V OR MORE                $923.00      $923.00   084140   LOS RADIOLOGY REV
463060015   XR FACIAL BONE LES 3V                    $730.00      $730.00   084140   LOS RADIOLOGY REV
464360406   XR FEMUR 2V                              $676.00      $676.00   084140   LOS RADIOLOGY REV
463060405   XR FEMUR 2V                              $676.00      $676.00   084140   LOS RADIOLOGY REV
463060404   XR FEMUR 2V                              $676.00      $676.00   084140   LOS RADIOLOGY REV
464360364   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060372   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060371   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060370   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060368   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060366   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060365   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060362   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060369   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060363   XR FINGER(S) 2V OR MORE                  $494.00      $494.00   084140   LOS RADIOLOGY REV
463060706   XR FLUORO 1HR OR LES                   $1,459.00    $1,459.00   084140   LOS RADIOLOGY REV
464360401   XR FOOT 2V                               $706.50      $706.50   084140   LOS RADIOLOGY REV
464360400   XR FOOT 2V                               $706.50      $706.50   084140   LOS RADIOLOGY REV
463060440   XR FOOT 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
463060441   XR FOOT 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
464360410   XR FOOT 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
463060374   XR FOOT 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
463060373   XR FOOT 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
463060419   XR FOREARM 2V                            $612.00      $612.00   084140   LOS RADIOLOGY REV


7/11/2012                                                                                                97
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


463060418   XR FOREARM 2V                            $612.00      $612.00   084140   LOS RADIOLOGY REV
463060763   XR HAND 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
46302022    XR HAND 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
464360422   XR HAND 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
464360417   XR HAND 2V                               $579.00      $579.00   084140   LOS RADIOLOGY REV
464360414   XR HAND 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
464360413   XR HAND 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
463060367   XR HAND 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
463060360   XR HAND 3V OR MORE                       $633.00      $633.00   084140   LOS RADIOLOGY REV
464360418   XR HIP UNI 2V OR MORE                    $687.00      $687.00   084140   LOS RADIOLOGY REV
463060408   XR HIP UNI 2V OR MORE                    $687.00      $687.00   084140   LOS RADIOLOGY REV
463060407   XR HIP UNI 2V OR MORE                    $687.00      $687.00   084140   LOS RADIOLOGY REV
464360415   XR HIPS BIL 2V W PELV                  $1,947.25    $1,947.25   084140   LOS RADIOLOGY REV
464360419   XR HIPS BIL 2V W PELV                    $816.00      $816.00   084140   LOS RADIOLOGY REV
463060416   XR HUMERUS 2V OR MORE                    $676.00      $676.00   084140   LOS RADIOLOGY REV
463060415   XR HUMERUS 2V OR MORE                    $676.00      $676.00   084140   LOS RADIOLOGY REV
463060173   XR HYSTEROSALPINGOGRAM                 $1,545.00    $1,545.00   084140   LOS RADIOLOGY REV
463060162   XR IVP W NEPHROTOMOGRAM                $2,457.00    $2,457.00   084140   LOS RADIOLOGY REV
464360420   XR IVP W-W/O TOMOGRAM                  $1,829.10    $1,829.10   084140   LOS RADIOLOGY REV
463060399   XR KNEE 1 OR 2V                          $622.00      $622.00   084140   LOS RADIOLOGY REV
463060398   XR KNEE 1 OR 2V                          $622.00      $622.00   084140   LOS RADIOLOGY REV
464360371   XR KNEE 3V                               $676.00      $676.00   084140   LOS RADIOLOGY REV
46302029    XR KNEE 3V                               $676.00      $676.00   084140   LOS RADIOLOGY REV
464360398   XR KNEE 4V OR MORE                       $718.00      $718.00   084140   LOS RADIOLOGY REV
464360408   XR KNEE 4V OR MORE                       $740.00      $740.00   084140   LOS RADIOLOGY REV
464360407   XR KNEE 4V OR MORE                       $740.00      $740.00   084140   LOS RADIOLOGY REV
463060352   XR MAMMO BIL                             $200.00      $200.00   084140   LOS RADIOLOGY REV
463060356   XR MAMMO GDE NDL EA LES                  $188.00      $188.00   084140   LOS RADIOLOGY REV
464360397   XR MAMMO UNI                             $152.00      $152.00   084140   LOS RADIOLOGY REV
464360365   XR MAMMO UNI                             $161.00      $161.00   084140   LOS RADIOLOGY REV
463060359   XR MAMMO UNI                             $161.00      $161.00   084140   LOS RADIOLOGY REV
463060011   XR MANDIBLE 4V OR MORE                   $751.00      $751.00   084140   LOS RADIOLOGY REV
463060018   XR NASAL BONES 3V OR MORE                $622.00      $622.00   084140   LOS RADIOLOGY REV
463060040   XR NEC SOFT TISSUE                       $515.00      $515.00   084140   LOS RADIOLOGY REV
464360389   XR OPTIC FORAMINA                        $707.00      $707.00   084140   LOS RADIOLOGY REV
463060020   XR OPTIC FORAMINA                        $740.00      $740.00   084140   LOS RADIOLOGY REV


7/11/2012                                                                                                98
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


464360416   XR PELV 1 OR 2V                          $622.00      $622.00   084140   LOS RADIOLOGY REV
464360391   XR PELV 1 OR 2V                          $622.00      $622.00   084140   LOS RADIOLOGY REV
463060081   XR PELV 1 OR 2V                          $622.00      $622.00   084140   LOS RADIOLOGY REV
464360409   XR PELV HIP 2V INF CHLD                  $687.00      $687.00   084140   LOS RADIOLOGY REV
464360395   XR PELV HIP 2V INF CHLD                  $656.00      $656.00   084140   LOS RADIOLOGY REV
463060120   XR PELV HIP 2V INF CHLD                  $656.00      $656.00   084140   LOS RADIOLOGY REV
463060058   XR RIBS BIL W PA CXR                   $1,062.00    $1,062.00   084140   LOS RADIOLOGY REV
463060425   XR RIBS UNI 2V                           $687.00      $687.00   084140   LOS RADIOLOGY REV
463060424   XR RIBS UNI 2V                           $687.00      $687.00   084140   LOS RADIOLOGY REV
463060086   XR SACRUM COCCYX 2 V MORE                $676.00      $676.00   084140   LOS RADIOLOGY REV
463060413   XR SCAPULA CMPL                          $622.00      $622.00   084140   LOS RADIOLOGY REV
463060412   XR SCAPULA CMPL                          $622.00      $622.00   084140   LOS RADIOLOGY REV
463060218   XR SCRN MAMMO                            $182.00      $182.00   084140   LOS RADIOLOGY REV
464360375   XR SHOULDER 1V                           $533.00      $533.00   084140   LOS RADIOLOGY REV
46302015    XR SHOULDER 1V                           $558.00      $558.00   084140   LOS RADIOLOGY REV
463060393   XR SHOULDER 2V OR MORE                   $676.00      $676.00   084140   LOS RADIOLOGY REV
463060392   XR SHOULDER 2V OR MORE                   $676.00      $676.00   084140   LOS RADIOLOGY REV
464360411   XR SI JNT 3V OR MORE                     $730.00      $730.00   084140   LOS RADIOLOGY REV
463060031   XR SIN PARA 3V OR MORE                   $923.00      $923.00   084140   LOS RADIOLOGY REV
463060034   XR SKULL 4V OR MORE                    $1,073.00    $1,073.00   084140   LOS RADIOLOGY REV
463060033   XR SKULL LES 4V                          $751.00      $751.00   084140   LOS RADIOLOGY REV
463050038   XR SM BOWEL SERIES                     $1,567.00    $1,567.00   084140   LOS RADIOLOGY REV
463060294   XR SPECIMEN SURGICAL                     $504.00      $504.00   084140   LOS RADIOLOGY REV
463060073   XR SPINE C 4V & FLEX/EXT               $1,341.00    $1,341.00   084140   LOS RADIOLOGY REV
463060071   XR SPINE CERV 2-3V                       $719.00      $719.00   084140   LOS RADIOLOGY REV
464360412   XR SPINE CERV 4V OR MORE               $1,062.00    $1,062.00   084140   LOS RADIOLOGY REV
463060072   XR SPINE CERV 4V OR MORE               $1,062.00    $1,062.00   084140   LOS RADIOLOGY REV
463060077   XR SPINE LUMB 2-3V                       $794.00      $794.00   084140   LOS RADIOLOGY REV
463060090   XR SPINE LUMB 2-3V CTY EM                 $71.00       $71.00   084140   LOS RADIOLOGY REV
463060078   XR SPINE LUMB 4V OR MORE               $1,084.00    $1,084.00   084140   LOS RADIOLOGY REV
463060079   XR SPINE LUMB 4V W BEND                $1,406.00    $1,406.00   084140   LOS RADIOLOGY REV
463060705   XR SPINE SNGL V CERV                     $504.00      $504.00   084140   LOS RADIOLOGY REV
463060074   XR SPINE THOR 3V                         $858.00      $858.00   084140   LOS RADIOLOGY REV
41406936    XR SPINE THOR LUMB 2V                    $794.00      $794.00   084140   LOS RADIOLOGY REV
463060059   XR STERNUM 2V OR MORE                    $773.00      $773.00   084140   LOS RADIOLOGY REV
463060402   XR TIBIA FIBULA 2V                       $622.00      $622.00   084140   LOS RADIOLOGY REV


7/11/2012                                                                                                99
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


463060401   XR TIBIA FIBULA 2V                       $622.00      $622.00   084140   LOS RADIOLOGY REV
463060038   XR TMJ BIL                               $987.00      $987.00   084140   LOS RADIOLOGY REV
464360402   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060385   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060384   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060383   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060382   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060381   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060380   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060379   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060378   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060377   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060376   XR TOE(S) 2V OR MORE                     $494.00      $494.00   084140   LOS RADIOLOGY REV
463060219   XR TOMOGRAM                            $1,476.00    $1,476.00   084140   LOS RADIOLOGY REV
463060147   XR UGI W AIR CON KUB                   $2,050.00    $2,050.00   084140   LOS RADIOLOGY REV
463060148   XR UGI W AIR CON SM BOWEL              $3,090.00    $3,090.00   084140   LOS RADIOLOGY REV
464360405   XR URETHROCYSTOGRAM VOID                 $706.60      $706.60   084140   LOS RADIOLOGY REV
463060427   XR VENOGRAM EXT UNI                    $1,210.00    $1,210.00   084140   LOS RADIOLOGY REV
463060426   XR VENOGRAM EXT UNI                    $1,210.00    $1,210.00   084140   LOS RADIOLOGY REV
464360367   XR WRIST 2V                              $564.00      $564.00   084140   LOS RADIOLOGY REV
46302020    XR WRIST 2V                              $579.00      $579.00   084140   LOS RADIOLOGY REV
463060387   XR WRIST 3V OR MORE                      $633.00      $633.00   084140   LOS RADIOLOGY REV
463060386   XR WRIST 3V OR MORE                      $633.00      $633.00   084140   LOS RADIOLOGY REV
472080136   AEROSOL TX DEMO/EVAL                     $443.00      $443.00   084180   LOS RESPIRATORY THERAPY REV
472082002   AEROSOL TX SUBSQ                         $206.00      $206.00   084180   LOS RESPIRATORY THERAPY REV
472082000   ARTERIAL PUNCTURE                        $194.00      $194.00   084180   LOS RESPIRATORY THERAPY REV
472080915   BLD GAS ART                              $356.00      $356.00   084180   LOS RESPIRATORY THERAPY REV
472082009   CPAP/BIPAP INTIAL DAY                  $1,831.00    $1,831.00   084180   LOS RESPIRATORY THERAPY REV
472082010   CPAP/BIPAP SUBSEQUENT DAY              $1,831.00    $1,831.00   084180   LOS RESPIRATORY THERAPY REV
472080174   CPR                                      $720.00      $720.00   084180   LOS RESPIRATORY THERAPY REV
472080140   CPT INITIAL                              $351.00      $351.00   084180   LOS RESPIRATORY THERAPY REV
472081062   ETCO2 INIT DAY                           $617.00      $617.00   084180   LOS RESPIRATORY THERAPY REV
472082008   ETCO2 SUBSQ DAY                          $617.00      $617.00   084180   LOS RESPIRATORY THERAPY REV
472080110   IPPB DEMO/EVAL                           $443.00      $443.00   084180   LOS RESPIRATORY THERAPY REV
472082006   IPPB TX SUBSEQUENT                       $206.00      $206.00   084180   LOS RESPIRATORY THERAPY REV
472080282   S O2 HOURLY                               $52.85       $52.85   084180   LOS RESPIRATORY THERAPY REV


7/11/2012                                                                                                          100
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


472082007   SPIROMETRY                               $701.00      $701.00   084180   LOS RESPIRATORY THERAPY REV
472080348   SPIROMETRY PRE/POST BD                   $997.00      $997.00   084180   LOS RESPIRATORY THERAPY REV
472080252   VENT MGMNT INITIAL                     $2,824.00    $2,824.00   084180   LOS RESPIRATORY THERAPY REV
472082003   VENT MGMNT SUBSEQUENT                  $2,303.00    $2,303.00   084180   LOS RESPIRATORY THERAPY REV
442043032   BRONCHOSCOPY                           $2,446.00    $2,446.00   084020   LOS SURGERY REV
442047179   BRONCHOSCOPY INTERVENTN                $2,679.00    $2,679.00   084020   LOS SURGERY REV
442043040   BX LIVER                               $1,789.00    $1,789.00   084020   LOS SURGERY REV
442043020   COLONOSCOPY                            $3,064.00    $3,064.00   084020   LOS SURGERY REV
442047180   COLONOSCOPY INTERVENTN                 $3,634.00    $3,634.00   084020   LOS SURGERY REV
445044042   CPLX GENRL ANES ADD 15M                  $536.00      $536.00   084020   LOS SURGERY REV
445044041   CPLX GENRL ANES FIRST 30M              $1,001.00    $1,001.00   084020   LOS SURGERY REV
442047178   CPLX PACU ADD 15M                      $1,299.00    $1,299.00   084020   LOS SURGERY REV
442047177   CPLX PACU FIRST 30M                    $2,617.00    $2,617.00   084020   LOS SURGERY REV
442047278   CS SAME MD ADD 15M                       $121.00      $121.00   084020   LOS SURGERY REV
442047277   CS SAME MD GT5YR 0-30M                   $242.00      $242.00   084020   LOS SURGERY REV
442042038   EGD                                    $2,961.00    $2,961.00   084020   LOS SURGERY REV
442047181   EGD INTERVENTN                         $3,179.00    $3,179.00   084020   LOS SURGERY REV
442047298   INJ IVP SNGL/INIT DRG                    $209.00      $209.00   084020   LOS SURGERY REV
442047299   INJECTION IM/SQ EA                       $196.00      $196.00   084020   LOS SURGERY REV
445044044   MAC/REG ADD 15M                          $408.00      $408.00   084020   LOS SURGERY REV
445044043   MAC/REG FIRST 30M                        $844.00      $844.00   084020   LOS SURGERY REV
442042084   S CATH BLN DILATE NOVSC A              $1,113.30    $1,113.30   084020   LOS SURGERY REV
442042085   S CATH BLN DILATE NOVSC B              $1,113.30    $1,113.30   084020   LOS SURGERY REV
442047129   S CATH BLN DILATE NOVSC D              $1,242.50    $1,242.50   084020   LOS SURGERY REV
442047134   S CATH BLN DILATE NOVSC E              $1,242.50    $1,242.50   084020   LOS SURGERY REV
442047135   S CATH BLN DILATE NOVSC F              $1,243.00    $1,243.00   084020   LOS SURGERY REV
442047136   S CATH BLN DILATE NOVSC G              $1,242.50    $1,242.50   084020   LOS SURGERY REV
442047148   S CATH BLN DILATE NOVSC H              $1,280.00    $1,280.00   084020   LOS SURGERY REV
442047138   S CATH DRAINAGE BLAKE 10                 $156.65      $156.65   084020   LOS SURGERY REV
442046091   S CATH DRAINAGE JP 10 FLT                 $63.00       $63.00   084020   LOS SURGERY REV
442045468   S CATH DRAINAGE JP 10 RND                 $77.00       $77.00   084020   LOS SURGERY REV
442047074   S CATH DRAINAGE JP 7 FLAT                 $69.15       $69.15   084020   LOS SURGERY REV
442045811   S CATH DRAINAGE JP 7 RND                  $77.30       $77.30   084020   LOS SURGERY REV
442047143   S CATH DRAINAGE SUMP 20                   $66.35       $66.35   084020   LOS SURGERY REV
442047141   S CATH DRAINAGE SUMP 24                   $66.35       $66.35   084020   LOS SURGERY REV
442047142   S CATH DRAINAGE SUMP 28                   $66.00       $66.00   084020   LOS SURGERY REV


7/11/2012                                                                                                          101
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442045896   S CATH DRAINAGE T TUBE 14                 $77.30       $77.30   084020   LOS SURGERY REV
442045912   S CATH DRAINAGE T TUBE 18                 $77.30       $77.30   084020   LOS SURGERY REV
442045069   S CATH URETERAL 4FR RND                  $252.00      $252.00   084020   LOS SURGERY REV
442045070   S CATH URETERAL 5FR RND                  $252.00      $252.00   084020   LOS SURGERY REV
442047273   S DVC RPR URN INCN SLNG                $6,197.00    $6,197.00   084020   LOS SURGERY REV
442045435   S IMP ACE BONE 4.5 SCREW                 $195.00      $195.00   084020   LOS SURGERY REV
442045434   S IMP ACE PLATE                        $1,199.00    $1,199.00   084020   LOS SURGERY REV
442045432   S IMP ACE SCREW ASSEMBLY               $1,710.00    $1,710.00   084020   LOS SURGERY REV
442047189   S IMP ACETAB COMPONENT                 $6,065.00    $6,065.00   084020   LOS SURGERY REV
442047240   S IMP ANCHOR MITEK                     $1,725.00    $1,725.00   084020   LOS SURGERY REV
442047224   S IMP FASCIA LATA                      $5,798.00    $5,798.00   084020   LOS SURGERY REV
442047279   S IMP FASTENER                           $747.12      $747.12   084020   LOS SURGERY REV
442047187   S IMP FEM COMPONENT                   $18,282.00   $18,282.00   084020   LOS SURGERY REV
442047188   S IMP FEM HEAD                         $2,654.45    $2,654.45   084020   LOS SURGERY REV
442047347   S IMP GUIDE WIRE 3.0                     $909.54      $909.54   084020   LOS SURGERY REV
442047191   S IMP HIP LINER                        $6,968.00    $6,968.00   084020   LOS SURGERY REV
442046035   S IMP KNEE COMPONENT                       $0.00        $0.00   084020   LOS SURGERY REV
442047195   S IMP KNEE COMPONENT                  $13,681.00   $13,681.00   084020   LOS SURGERY REV
442047008   S IMP KNOWLES PINS 3-6                   $314.00      $314.00   084020   LOS SURGERY REV
442045002   S IMP MOORE HIP PROSTH                 $3,710.00    $3,710.00   084020   LOS SURGERY REV
442047348   S IMP NAIL TIBIAL 10X28                $5,224.03    $5,224.03   084020   LOS SURGERY REV
442045439   S IMP NOCOR WODEL SYS TM               $1,047.95    $1,047.95   084020   LOS SURGERY REV
442047192   S IMP PAT DOME                         $2,547.00    $2,547.00   084020   LOS SURGERY REV
442046032   S IMP PATELLAR DOME                        $0.00        $0.00   084020   LOS SURGERY REV
442047208   S IMP RUSH ROD                           $532.50      $532.50   084020   LOS SURGERY REV
442047185   S IMP SLING KIT                        $3,733.10    $3,733.10   084020   LOS SURGERY REV
442047013   S IMP SM FRAGMENT PLATE                  $269.00      $269.00   084020   LOS SURGERY REV
442047280   S IMP STAPLE                             $513.24      $513.24   084020   LOS SURGERY REV
442047193   S IMP TIB ART SURFACE                  $4,425.00    $4,425.00   084020   LOS SURGERY REV
442047194   S IMP TIB INSERT                       $6,977.00    $6,977.00   084020   LOS SURGERY REV
442046034   S IMP TIBIAL INSERT                        $0.00        $0.00   084020   LOS SURGERY REV
442047190   S IMP TITAN SCREW                        $596.25      $596.25   084020   LOS SURGERY REV
442045199   S MESH IMPLANT 10X14                     $669.00      $669.00   084020   LOS SURGERY REV
442045358   S MESH IMPLANT 2X4                       $312.00      $312.00   084020   LOS SURGERY REV
442046071   S MESH IMPLANT 3X6                       $256.00      $256.00   084020   LOS SURGERY REV
442047349   S MESH IMPLANT 6X6                       $337.83      $337.83   084020   LOS SURGERY REV


7/11/2012                                                                                              102
                                         d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442045276   S MESH IMPLANT KEY HOLE                   $338.00      $338.00   084020   LOS SURGERY REV
442046106   S MESH IMPLANT PLUG L                     $884.00      $884.00   084020   LOS SURGERY REV
442046105   S MESH IMPLANT PLUG M                     $884.00      $884.00   084020   LOS SURGERY REV
442046162   S MESH IMPLANT PLUG S                     $883.55      $883.55   084020   LOS SURGERY REV
442047251   S NSTRL BLANKET 300                        $51.00       $51.00   084020   LOS SURGERY REV
442047252   S NSTRL BLANKET 522                        $71.00       $71.00   084020   LOS SURGERY REV
442047220   S NSTRL COMBITUBE 37FR                    $495.45      $495.45   084020   LOS SURGERY REV
442047221   S NSTRL COMBITUBE 41FR                    $495.45      $495.45   084020   LOS SURGERY REV
442045283   S PCR 1 CHMBR RR                       $15,782.38   $15,782.38   084020   LOS SURGERY REV
442047276   S PORT INDWELLING 9 FR.                 $1,411.00    $1,411.00   084020   LOS SURGERY REV
442047357   S STNT NOCOR WDEL SYS TMPA                $823.26      $823.26   084020   LOS SURGERY REV
442047358   S STNT NOCOR WDEL SYS TMPB                $823.26      $823.26   084020   LOS SURGERY REV
442047350   S STRL 15X12 ELECTRODE                    $101.80      $101.80   084020   LOS SURGERY REV
442047218   S STRL 24 FR. LOOP                        $415.35      $415.35   084020   LOS SURGERY REV
442047217   S STRL 26 FR. LOOP                        $415.35      $415.35   084020   LOS SURGERY REV
442047219   S STRL 28 FR. KNIFE                       $447.30      $447.30   084020   LOS SURGERY REV
442047216   S STRL 28 FR. LOOP                        $415.00      $415.00   084020   LOS SURGERY REV
442046093   S STRL 6-0 PROLENE M8706                  $156.00      $156.00   084020   LOS SURGERY REV
442047302   S STRL ABLATION KIT                     $5,386.45    $5,386.45   084020   LOS SURGERY REV
442047281   S STRL ACL KIT                          $1,295.75    $1,295.75   084020   LOS SURGERY REV
442047250   S STRL AGG MENISCUS 4.0                   $491.67      $491.67   084020   LOS SURGERY REV
442047249   S STRL AGG MENISCUS 5.0                   $479.00      $479.00   084020   LOS SURGERY REV
442047257   S STRL AGG MENISCUS 5.5                   $492.00      $492.00   084020   LOS SURGERY REV
442045234   S STRL AP 200                             $260.85      $260.85   084020   LOS SURGERY REV
442042060   S STRL ARTHROSCOPY SET                    $331.00      $331.00   084020   LOS SURGERY REV
442045236   S STRL AUTO PURSTRING 65                  $312.70      $312.70   084020   LOS SURGERY REV
442047247   S STRL BARREL BUR                         $623.68      $623.68   084020   LOS SURGERY REV
442047254   S STRL BARREL BUR 5.0                     $521.00      $521.00   084020   LOS SURGERY REV
442047255   S STRL BARREL BUR 5.5                     $521.00      $521.00   084020   LOS SURGERY REV
442047210   S STRL BARREL BUR 5.6MM                   $466.00      $466.00   084020   LOS SURGERY REV
442047209   S STRL BARREL BUR 6.0MM                   $465.75      $465.75   084020   LOS SURGERY REV
442046059   S STRL BIPOLAR PROBE                    $1,190.10    $1,190.10   084020   LOS SURGERY REV
442047353   S STRL BLADE-LONG NARROW                  $257.08      $257.08   084020   LOS SURGERY REV
442042086   S STRL BLUNT TIP TROCAR                   $589.00      $589.00   084020   LOS SURGERY REV
442045848   S STRL BLUNTPORT                          $414.00      $414.00   084020   LOS SURGERY REV
442046085   S STRL BONE WAX                            $28.70       $28.70   084020   LOS SURGERY REV


7/11/2012                                                                                               103
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047286   S STRL BRONCHO CATH 37L                  $362.00      $362.00   084020   LOS SURGERY REV
442047289   S STRL BRONCHO CATH 37R                  $431.25      $431.25   084020   LOS SURGERY REV
442047287   S STRL BRONCHO CATH 39L                  $362.00      $362.00   084020   LOS SURGERY REV
442047290   S STRL BRONCHO CATH 39R                  $431.25      $431.25   084020   LOS SURGERY REV
442047288   S STRL BRONCHO CATH 41L                  $362.00      $362.00   084020   LOS SURGERY REV
442047291   S STRL BRONCHO CATH 41R                  $431.25      $431.25   084020   LOS SURGERY REV
442047259   S STRL BX FORCEP 15993                    $86.18       $86.18   084020   LOS SURGERY REV
442047114   S STRL BX FORCEP 240 CM                  $222.00      $222.00   084020   LOS SURGERY REV
442047113   S STRL BX FORCEP EGD                     $222.00      $222.00   084020   LOS SURGERY REV
442047212   S STRL BX. NEEDLE 15CM                   $325.65      $325.65   084020   LOS SURGERY REV
44706679    S STRL CANNULA 5X76                       $99.30       $99.30   084020   LOS SURGERY REV
442047262   S STRL CANNULA 5X76 MM                    $99.29       $99.29   084020   LOS SURGERY REV
442045718   S STRL CATH FOG BIL PRB 6                $326.15      $326.15   084020   LOS SURGERY REV
442045798   S STRL CAUTERY EXT                        $33.00       $33.00   084020   LOS SURGERY REV
442045670   S STRL CAUTERY NEEDLE                      $8.00        $8.00   084020   LOS SURGERY REV
442045379   S STRL CAUTERY PENCIL                    $111.00      $111.00   084020   LOS SURGERY REV
442047246   S STRL CHEST TUBE 32 FR                   $37.33       $37.33   084020   LOS SURGERY REV
442045471   S STRL CHOLANG CATH 6FR                  $171.70      $171.70   084020   LOS SURGERY REV
442045472   S STRL CHOLANG KIT 4FR                   $327.00      $327.00   084020   LOS SURGERY REV
442042066   S STRL CONSTAVAC                       $1,026.00    $1,026.00   084020   LOS SURGERY REV
442047151   S STRL CRE ESOPH DLTR                  $1,502.00    $1,502.00   084020   LOS SURGERY REV
442045286   S STRL C-SECTION PACK                    $488.00      $488.00   084020   LOS SURGERY REV
442047116   S STRL CURVED BUR 3.6MM                $1,198.00    $1,198.00   084020   LOS SURGERY REV
442047300   S STRL CUT FRCP CVD DISP               $1,292.85    $1,292.85   084020   LOS SURGERY REV
442047296   S STRL CUT-FORCEPS 10MM                $1,848.90    $1,848.90   084020   LOS SURGERY REV
442047295   S STRL CUT-FORCEPS 5MM                 $1,848.90    $1,848.90   084020   LOS SURGERY REV
442047238   S STRL DERMACARRIER                      $137.60      $137.60   084020   LOS SURGERY REV
442047237   S STRL DERMATOME BLADE                   $193.15      $193.15   084020   LOS SURGERY REV
442045980   S STRL DISP VEIN STRIP.                   $93.55       $93.55   084020   LOS SURGERY REV
442047070   S STRL DISSECT HOOK 5 MM                 $720.40      $720.40   084020   LOS SURGERY REV
442047265   S STRL EAR T-TUBE                        $150.76      $150.76   084020   LOS SURGERY REV
442047258   S STRL EGG BUR 5.5                       $624.00      $624.00   084020   LOS SURGERY REV
442047065   S STRL ELECT BALL E1564                   $96.00       $96.00   084020   LOS SURGERY REV
442047063   S STRL ELECT WIRE E1561                   $96.00       $96.00   084020   LOS SURGERY REV
442047064   S STRL ELECT WIRE E1567                   $96.45       $96.45   084020   LOS SURGERY REV
442047213   S STRL ELECTRODE 3.5X160               $1,186.00    $1,186.00   084020   LOS SURGERY REV


7/11/2012                                                                                              104
                                         d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047274   S STRL ELECTRODE BIPOLAR                $1,756.74    $1,756.74   084020   LOS SURGERY REV
442047263   S STRL ELECTRODE E1560                     $99.75       $99.75   084020   LOS SURGERY REV
442047303   S STRL ENDO CLIP ML                       $675.00      $675.00   084020   LOS SURGERY REV
442046153   S STRL ENDO DISSECT                       $475.00      $475.00   084020   LOS SURGERY REV
442047311   S STRL ENDO GIA 30 - 3.5                  $645.00      $645.00   084020   LOS SURGERY REV
442047327   S STRL ENDO GIA II STAPLER              $1,053.00    $1,053.00   084020   LOS SURGERY REV
442046072   S STRL ENDOCATCH 173050                   $501.00      $501.00   084020   LOS SURGERY REV
442046055   S STRL ENDOCLINCH II                      $470.00      $470.00   084020   LOS SURGERY REV
442047264   S STRL ENDO-KITTNER                        $93.23       $93.23   084020   LOS SURGERY REV
442046056   S STRL ENDORETRACT                        $618.50      $618.50   084020   LOS SURGERY REV
442046054   S STRL ENDOSHEARS                         $476.00      $476.00   084020   LOS SURGERY REV
442047097   S STRL ENDOSTASIS 10 FR                 $1,332.50    $1,332.50   084020   LOS SURGERY REV
442047256   S STRL EPI/SPINAL TRAY                    $274.00      $274.00   084020   LOS SURGERY REV
442046082   S STRL EPIDURAL 5270                      $210.00      $210.00   084020   LOS SURGERY REV
442046074   S STRL EPIDURAL CATH ADAP                  $55.50       $55.50   084020   LOS SURGERY REV
442046073   S STRL EPIDURAL CATH ASSM                  $52.00       $52.00   084020   LOS SURGERY REV
442045247   S STRL ESOPHAGEAL STETH                    $24.25       $24.25   084020   LOS SURGERY REV
442046031   S STRL ETHIBAND #5                         $98.20       $98.20   084020   LOS SURGERY REV
442047222   S STRL FEM CANAL BRUSH                    $126.00      $126.00   084020   LOS SURGERY REV
442047241   S STRL FIBERWIRE AR-7200                  $120.00      $120.00   084020   LOS SURGERY REV
442046103   S STRL FISH VISCERA RET                   $166.95      $166.95   084020   LOS SURGERY REV
442047161   S STRL FLEX POINT ELECT                   $875.00      $875.00   084020   LOS SURGERY REV
442047053   S STRL FOGARTY CLIP                        $39.60       $39.60   084020   LOS SURGERY REV
442046063   S STRL FOGARTY CV5071                     $170.00      $170.00   084020   LOS SURGERY REV
442047245   S STRL GASTRAS TUBE 28 FR                 $268.51      $268.51   084020   LOS SURGERY REV
442047046   S STRL GELFOAM 100                        $173.05      $173.05   084020   LOS SURGERY REV
442047337   S STRL GIA 80 STAPLER                   $1,092.00    $1,092.00   084020   LOS SURGERY REV
442047336   S STRL GIA 80 STPL LDNG                   $557.00      $557.00   084020   LOS SURGERY REV
442045334   S STRL GIGLI SAW WIRE                     $112.90      $112.90   084020   LOS SURGERY REV
442047267   S STRL GORETEX 6-0                        $137.04      $137.04   084020   LOS SURGERY REV
442047266   S STRL GORETEX 7-0                        $142.72      $142.72   084020   LOS SURGERY REV
442046149   S STRL GRASPING FORCEPS                 $1,113.00    $1,113.00   084020   LOS SURGERY REV
442046148   S STRL HELICAL STONE BKT                $1,047.95    $1,047.95   084020   LOS SURGERY REV
442047322   S STRL HERNIA 4.0 DLU CART                $275.40      $275.40   084020   LOS SURGERY REV
442047323   S STRL HERNIA 4.8 DLU CART                $275.00      $275.00   084020   LOS SURGERY REV
442047111   S STRL HOT BX FORCEP 1550                 $273.00      $273.00   084020   LOS SURGERY REV


7/11/2012                                                                                               105
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047060   S STRL HYDROFLEX IRRIG                   $341.00      $341.00   084020   LOS SURGERY REV
442046052   S STRL INNER INSUF NDL                   $130.00      $130.00   084020   LOS SURGERY REV
442046050   S STRL INNERDYNE 10MM TRO                $459.00      $459.00   084020   LOS SURGERY REV
442046051   S STRL INNERDYNE 12MM TRO                $458.60      $458.60   084020   LOS SURGERY REV
442046049   S STRL INNERDYNE 5MM TROC                $426.00      $426.00   084020   LOS SURGERY REV
442046053   S STRL INNERDYNE SLEEVE                  $172.00      $172.00   084020   LOS SURGERY REV
442047243   S STRL IRRIG TUBING                      $122.60      $122.60   084020   LOS SURGERY REV
442046062   S STRL J-P RESERVOIR 7074                 $53.00       $53.00   084020   LOS SURGERY REV
442046123   S STRL LAP INSUFF. TUBING                 $76.00       $76.00   084020   LOS SURGERY REV
442045550   S STRL LAPAROSCOPY PACK                  $338.00      $338.00   084020   LOS SURGERY REV
442047044   S STRL LAPROLOADER                       $383.00      $383.00   084020   LOS SURGERY REV
442047071   S STRL LCS SHEARS CS150                $2,075.40    $2,075.40   084020   LOS SURGERY REV
442047109   S STRL LCSB5 SHEARS                    $1,886.65    $1,886.65   084020   LOS SURGERY REV
442047268   S STRL LECTRO/VAC                         $47.67       $47.67   084020   LOS SURGERY REV
442047160   S STRL LGE ROLLER ELECT                  $877.00      $877.00   084020   LOS SURGERY REV
442046068   S STRL LIVER BX 43-106                   $279.70      $279.70   084020   LOS SURGERY REV
442042103   S STRL LMA 3                             $186.00      $186.00   084020   LOS SURGERY REV
442042104   S STRL LMA 4                             $186.00      $186.00   084020   LOS SURGERY REV
442042080   S STRL LMA 5                             $223.65      $223.65   084020   LOS SURGERY REV
442047184   S STRL LOOP ELECTRODE                    $499.00      $499.00   084020   LOS SURGERY REV
442047081   S STRL MANIPUJECTOR                      $215.00      $215.00   084020   LOS SURGERY REV
442046141   S STRL MED SAW BLADE                     $278.90      $278.90   084020   LOS SURGERY REV
442047356   S STRL MICRO BLADE                       $257.08      $257.08   084020   LOS SURGERY REV
442047198   S STRL MICRO HEX SNARE                   $272.00      $272.00   084020   LOS SURGERY REV
442047196   S STRL MICRO MILL                        $924.00      $924.00   084020   LOS SURGERY REV
442047040   S STRL MICRO-MILL CUTTER                 $473.35      $473.35   084020   LOS SURGERY REV
442047301   S STRL MOD T-TUBE EAR                    $170.90      $170.90   084020   LOS SURGERY REV
442047325   S STRL MULTI GIA 60 - 3.8                $213.80      $213.80   084020   LOS SURGERY REV
442047110   S STRL MULTIBITE BX FORC                 $314.40      $314.40   084020   LOS SURGERY REV
442047137   S STRL NEEDLE 25 X 5                      $49.00       $49.00   084020   LOS SURGERY REV
442047091   S STRL NEEDLE SP 25X1 1/2                 $66.65       $66.65   084020   LOS SURGERY REV
442047355   S STRL NERVE STIMULATOR                  $265.67      $265.67   084020   LOS SURGERY REV
442047086   S STRL NIM-2 EMG ET 7.0                $1,332.50    $1,332.50   084020   LOS SURGERY REV
442047163   S STRL O TICRON SUTURE                   $161.15      $161.15   084020   LOS SURGERY REV
442045544   S STRL O.B. PACK                         $339.00      $339.00   084020   LOS SURGERY REV
442047144   S STRL OVAL SNARE 6230                   $214.00      $214.00   084020   LOS SURGERY REV


7/11/2012                                                                                              106
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442042069   S STRL P.E.G. 20FR                       $409.55      $409.55   084020   LOS SURGERY REV
442045365   S STRL PACK, EENT                        $120.65      $120.65   084020   LOS SURGERY REV
442046130   S STRL PACK, MAJOR LAP                   $372.00      $372.00   084020   LOS SURGERY REV
442046131   S STRL PACK, MINOR LAP                   $313.00      $313.00   084020   LOS SURGERY REV
442046133   S STRL PACK, MINOR ORTHO                 $427.00      $427.00   084020   LOS SURGERY REV
442047297   S STRL PKS NEEDLE                      $1,104.45    $1,104.45   084020   LOS SURGERY REV
442046134   S STRL POLYP RETR COLON                  $332.00      $332.00   084020   LOS SURGERY REV
442046135   S STRL POLYP RETR EGD                    $315.00      $315.00   084020   LOS SURGERY REV
442042073   S STRL POLYP SNARE 6234                  $232.00      $232.00   084020   LOS SURGERY REV
442047354   S STRL RAD 40 BLADE                      $927.73      $927.73   084020   LOS SURGERY REV
442047122   S STRL RADENOID 60 4MM                   $726.00      $726.00   084020   LOS SURGERY REV
442047115   S STRL RADENOID BLADE 4.0                $654.80      $654.80   084020   LOS SURGERY REV
442047225   S STRL RAE ET TUBE 3.5                    $62.80       $62.80   084020   LOS SURGERY REV
442047226   S STRL RAE ET TUBE 4.0                    $63.00       $63.00   084020   LOS SURGERY REV
442047227   S STRL RAE ET TUBE 4.5                    $63.00       $63.00   084020   LOS SURGERY REV
442047228   S STRL RAE ET TUBE 5.0                    $63.00       $63.00   084020   LOS SURGERY REV
442047229   S STRL RAE ET TUBE 5.5                    $63.00       $63.00   084020   LOS SURGERY REV
442047230   S STRL RAE ET TUBE 6.0                    $63.00       $63.00   084020   LOS SURGERY REV
442047231   S STRL RAE ET TUBE 6.5                    $63.00       $63.00   084020   LOS SURGERY REV
442047242   S STRL RAE ET TUBE 7.0                    $63.00       $63.00   084020   LOS SURGERY REV
442047239   S STRL RAE ET TUBE 7.5                    $63.00       $63.00   084020   LOS SURGERY REV
442046136   S STRL RECIP BLADE LONG                  $355.00      $355.00   084020   LOS SURGERY REV
442045105   S STRL RESECT LOOP                       $305.65      $305.65   084020   LOS SURGERY REV
442046084   S STRL RETENTION BOLSTER                  $14.40       $14.40   084020   LOS SURGERY REV
442047183   S STRL ROLLER BALL ELECT                 $876.50      $876.50   084020   LOS SURGERY REV
442047253   S STRL ROUND BUR 4.0                     $520.78      $520.78   084020   LOS SURGERY REV
442047248   S STRL ROUND BUR 4.0                     $623.68      $623.68   084020   LOS SURGERY REV
442042054   S STRL SAGITIAL BLADE                    $343.00      $343.00   084020   LOS SURGERY REV
442047269   S STRL SAW BLADE LONG NAR                $257.08      $257.08   084020   LOS SURGERY REV
442046154   S STRL SCLEROTHERAPY NDL                 $273.00      $273.00   084020   LOS SURGERY REV
442047320   S STRL SHEA PARASOL TUBE                 $134.00      $134.00   084020   LOS SURGERY REV
442047319   S STRL SHEEHY EAR TUBE                    $48.00       $48.00   084020   LOS SURGERY REV
442047261   S STRL SHEEHY TUBE                        $71.02       $71.02   084020   LOS SURGERY REV
442047352   S STRL SHOULDER KIT 3583                 $314.25      $314.25   084020   LOS SURGERY REV
442047272   S STRL SHOULDER SUSP KIT                 $314.10      $314.10   084020   LOS SURGERY REV
442047271   S STRL SINUS BLADE 4.0                   $825.08      $825.08   084020   LOS SURGERY REV


7/11/2012                                                                                              107
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047329   S STRL SPEEDBAND #6500                 $1,436.85    $1,436.85   084020   LOS SURGERY REV
442046080   S STRL SPINAL BUPIVACAINE                $143.00      $143.00   084020   LOS SURGERY REV
442046079   S STRL SPINAL LIDOCAINE                  $132.00      $132.00   084020   LOS SURGERY REV
442045246   S STRL STAPLE 3M 35W                     $109.00      $109.00   084020   LOS SURGERY REV
442047343   S STRL STAPLE TA3035L                    $294.80      $294.80   084020   LOS SURGERY REV
442047346   S STRL STAPLE TA3048L                    $294.80      $294.80   084020   LOS SURGERY REV
442047342   S STRL STAPLE TA6035L                    $317.00      $317.00   084020   LOS SURGERY REV
442047345   S STRL STAPLE TA6048L                    $317.00      $317.00   084020   LOS SURGERY REV
442047341   S STRL STAPLE TA9035L                    $331.00      $331.00   084020   LOS SURGERY REV
442407205   S STRL STAPLE TA9048L                    $331.45      $331.45   084020   LOS SURGERY REV
442047344   S STRL STAPLE TA9048L                    $331.45      $331.45   084020   LOS SURGERY REV
442047340   S STRL STAPLER TA3035S                   $586.00      $586.00   084020   LOS SURGERY REV
442407200   S STRL STAPLER TA6035S                   $606.45      $606.45   084020   LOS SURGERY REV
442047339   S STRL STAPLER TA6035S                   $606.00      $606.00   084020   LOS SURGERY REV
442047338   S STRL STAPLER TA9035S                   $648.00      $648.00   084020   LOS SURGERY REV
442047308   S STRL STAPLES CEEA 25                 $1,560.40    $1,560.40   084020   LOS SURGERY REV
442047309   S STRL STAPLES CEEA 28                 $1,560.40    $1,560.40   084020   LOS SURGERY REV
442047310   S STRL STAPLES CEEA 31                 $1,560.00    $1,560.00   084020   LOS SURGERY REV
442047317   S STRL STAPLES LDS 15W                   $752.00      $752.00   084020   LOS SURGERY REV
442047270   S STRL STIMULATOR PROBE                  $544.42      $544.42   084020   LOS SURGERY REV
442047088   S STRL SUB DERMAL EMG                    $439.60      $439.60   084020   LOS SURGERY REV
442046160   S STRL SURGICAL STAYS                    $279.45      $279.45   084020   LOS SURGERY REV
442047333   S STRL SURGICLIP L 134048                $390.00      $390.00   084020   LOS SURGERY REV
442047332   S STRL SURGICLIP M 134051                $390.00      $390.00   084020   LOS SURGERY REV
442047331   S STRL SURGICLIP S 134046                $390.30      $390.30   084020   LOS SURGERY REV
442042052   S STRL SURGILAV IRR TIP                  $145.00      $145.00   084020   LOS SURGERY REV
442042051   S STRL SURGILAV TIB BRUSH                $145.00      $145.00   084020   LOS SURGERY REV
442046046   S STRL SURGINEEDLE 150MM                 $151.70      $151.70   084020   LOS SURGERY REV
442045082   S STRL SURGITIE                          $129.00      $129.00   084020   LOS SURGERY REV
442046158   S STRL SUTUPAK TIES                       $35.15       $35.15   084020   LOS SURGERY REV
442045327   S STRL SUTURE #1 - #6-0                   $27.00       $27.00   084020   LOS SURGERY REV
442045366   S STRL SUTURE C-R                         $85.00       $85.00   084020   LOS SURGERY REV
442045367   S STRL SUTURE MERSILENE                   $94.00       $94.00   084020   LOS SURGERY REV
442046156   S STRL SUTURE NOVAFIL                     $26.00       $26.00   084020   LOS SURGERY REV
442045368   S STRL SUTURE RETEN 470G                  $24.00       $24.00   084020   LOS SURGERY REV
442046157   S STRL SUTURE TICRON                      $33.00       $33.00   084020   LOS SURGERY REV


7/11/2012                                                                                              108
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047130   S STRL SYRINGE GAUGE                     $257.00      $257.00   084020   LOS SURGERY REV
442047260   S STRL T TUBE 18FR                        $57.34       $57.34   084020   LOS SURGERY REV
442047359   S STRL T-GROMMET EAR TUBE                $174.41      $174.41   084020   LOS SURGERY REV
442047292   S STRL TRACH XLG 7.0                     $812.09      $812.09   084020   LOS SURGERY REV
442047293   S STRL TRACH XLG 8.0                     $812.09      $812.09   084020   LOS SURGERY REV
442047294   S STRL TRACH XLG 9.0                     $812.09      $812.09   084020   LOS SURGERY REV
442047118   S STRL TRICAT BLADE                      $711.00      $711.00   084020   LOS SURGERY REV
442047244   S STRL TRICUT BLADE                      $947.10      $947.10   084020   LOS SURGERY REV
442047351   S STRL T-TUBE 18 FR                       $57.34       $57.34   084020   LOS SURGERY REV
442045431   S STRL TUBE GASTROS 14FR                 $271.00      $271.00   084020   LOS SURGERY REV
442045356   S STRL TUBE GASTROS 22FR                 $271.00      $271.00   084020   LOS SURGERY REV
442045357   S STRL TUBE GASTROS 24FR                 $271.00      $271.00   084020   LOS SURGERY REV
442047235   S STRL TUOHY NEEDLE 17X6                  $90.25       $90.25   084020   LOS SURGERY REV
442047236   S STRL TUOHY NEEDLE 20X6                  $94.00       $94.00   084020   LOS SURGERY REV
442047154   S STRL TUR Y SET                          $58.00       $58.00   084020   LOS SURGERY REV
442047321   S STRL TURBINATE STENT                   $114.80      $114.80   084020   LOS SURGERY REV
442047062   S STRL ULTRACISION SHEARS              $1,640.65    $1,640.65   084020   LOS SURGERY REV
44706680    S STRL VAC COLLECTION SET                 $39.50       $39.50   084020   LOS SURGERY REV
442045795   S STRL VAC CURETTE 10 CVD                 $30.00       $30.00   084020   LOS SURGERY REV
442045285   S STRL VAC CURETTE 10 FL                  $29.55       $29.55   084020   LOS SURGERY REV
442045085   S STRL VAC CURETTE 12 CVC                 $30.00       $30.00   084020   LOS SURGERY REV
442045794   S STRL VAC CURETTE 8 CVD                  $30.00       $30.00   084020   LOS SURGERY REV
442047223   S STRL VAGINAL RETRACTOR                 $479.00      $479.00   084020   LOS SURGERY REV
442047326   S STRL VERSA 4.0 STAPLER                 $381.00      $381.00   084020   LOS SURGERY REV
442047335   S STRL VERSA GIA STAPLER                 $549.75      $549.75   084020   LOS SURGERY REV
442045340   S STRL VESSELOOPS                         $33.90       $33.90   084020   LOS SURGERY REV
442047232   S STRL WHITACRE SPINAL 22                 $42.00       $42.00   084020   LOS SURGERY REV
442047233   S STRL WHITACRE SPINAL 25                 $42.00       $42.00   084020   LOS SURGERY REV
442047234   S STRL WHITACRE SPINAL 27                 $42.00       $42.00   084020   LOS SURGERY REV
442046140   S STRL WIDE SAW BLADE                    $278.90      $278.90   084020   LOS SURGERY REV
442046097   S STRL WIRE GUIDE                        $623.45      $623.45   084020   LOS SURGERY REV
442047275   S TISSUE CONNCTV HUMAN P              $12,212.00   $12,212.00   084020   LOS SURGERY REV
442043028   SIGMOIDOSCOPY                          $1,575.00    $1,575.00   084020   LOS SURGERY REV
442043030   SIGMOIDOSCOPY INTERVENTN               $1,821.00    $1,821.00   084020   LOS SURGERY REV
445044040   STND GENRL ANES ADD 15M                  $432.00      $432.00   084020   LOS SURGERY REV
445044039   STND GENRL ANES FIRST 30M                $872.00      $872.00   084020   LOS SURGERY REV


7/11/2012                                                                                              109
                                        d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


442047283   STND PACU LVL 1 ADD 15M                  $282.00      $282.00   084020   LOS SURGERY REV
442047282   STND PACU LVL 1 FIRST 30M                $614.00      $614.00   084020   LOS SURGERY REV
442047285   STND PACU LVL 2 ADD 15M                  $561.00      $561.00   084020   LOS SURGERY REV
442047284   STND PACU LVL 2 FIRST 30M              $1,135.00    $1,135.00   084020   LOS SURGERY REV
442047166   SURG LVL 1 ADD 15M                       $990.00      $990.00   084020   LOS SURGERY REV
442047165   SURG LVL 1 FIRST 30M                   $2,319.00    $2,319.00   084020   LOS SURGERY REV
442047168   SURG LVL 2 ADD 15M                     $1,173.00    $1,173.00   084020   LOS SURGERY REV
442047167   SURG LVL 2 FIRST 30M                   $2,921.00    $2,921.00   084020   LOS SURGERY REV
442047170   SURG LVL 3 ADD 15M                     $1,328.00    $1,328.00   084020   LOS SURGERY REV
442047169   SURG LVL 3 FIRST 30M                   $3,541.00    $3,541.00   084020   LOS SURGERY REV
442047172   SURG LVL 4 ADD 15M                     $1,410.00    $1,410.00   084020   LOS SURGERY REV
442047171   SURG LVL 4 FIRST 30M                   $4,152.00    $4,152.00   084020   LOS SURGERY REV
442047174   SURG LVL 5 ADD 15M                     $1,245.00    $1,245.00   084020   LOS SURGERY REV
442047173   SURG LVL 5 FIRST 30M                   $5,250.00    $5,250.00   084020   LOS SURGERY REV
467061451   CA ECHO 2D CMPL                        $1,675.00    $1,675.00   084143   LOS ULTRASOUND REV
467061453   CA ECHO 2D LTD                           $853.00      $853.00   084143   LOS ULTRASOUND REV
467061423   CA ECHO DPPLER CMPL                      $738.00      $738.00   084143   LOS ULTRASOUND REV
467061457   CA ECHO DPPLER COLOR FLOW              $1,167.00    $1,167.00   084143   LOS ULTRASOUND REV
467062463   NI DPPLER EXT VEINS BIL                $1,563.00    $1,563.00   084143   LOS ULTRASOUND REV
467050012   NI DUPLEX EXT LOW BIL                  $3,796.00    $3,796.00   084143   LOS ULTRASOUND REV
467080014   NI DUPLEX EXT UPP BIL                  $2,997.00    $2,997.00   084143   LOS ULTRASOUND REV
467061461   NI DUPLEX EXT VEINS UNI                $2,009.00    $2,009.00   084143   LOS ULTRASOUND REV
467061449   NI DUPLEX EXTRACRAN BIL                $3,109.00    $3,109.00   084143   LOS ULTRASOUND REV
467061415   US ABD CMPL                            $1,649.00    $1,649.00   084143   LOS ULTRASOUND REV
467062456   US BIO PROFILE W NONSTRES              $1,421.00    $1,421.00   084143   LOS ULTRASOUND REV
467061460   US BREAST UNI OR BIL                     $901.00      $901.00   084143   LOS ULTRASOUND REV
467061418   US ECHO ABD LTD                        $1,180.00    $1,180.00   084143   LOS ULTRASOUND REV
467061421   US ECHO RETROPE LTD                    $1,180.00    $1,180.00   084143   LOS ULTRASOUND REV
467061462   US EXT NONVASCULAR                     $1,180.00    $1,180.00   084143   LOS ULTRASOUND REV
467061410   US HEAD & NEC SFT TISSUE               $1,173.00    $1,173.00   084143   LOS ULTRASOUND REV
467062460   US OB 1ST TRI 1 GEST                   $1,796.00    $1,796.00   084143   LOS ULTRASOUND REV
467062461   US OB 1ST TRI EA GEST                    $982.00      $982.00   084143   LOS ULTRASOUND REV
467061424   US OB AFTR 1ST TRI 1 GEST              $1,846.00    $1,846.00   084143   LOS ULTRASOUND REV
467050005   US OB AFTR 1ST TRI EA GES              $1,952.00    $1,952.00   084143   LOS ULTRASOUND REV
467061426   US OB LTD 1/MORE FETUSES               $1,778.00    $1,778.00   084143   LOS ULTRASOUND REV
467061428   US PELV CMPL NONOB                     $1,283.00    $1,283.00   084143   LOS ULTRASOUND REV


7/11/2012                                                                                                 110
                                  d3df241e-f38d-4afd-b665-e6a6e9235a30.xls


467061419 US RETROPE CMPL                    $1,627.00    $1,627.00 084143   LOS ULTRASOUND REV
467061429 US TESTICULAR SCROTUM              $1,268.00    $1,268.00 084143   LOS ULTRASOUND REV
467062462 US TRANSVAGINAL                    $1,317.00    $1,317.00 084143   LOS ULTRASOUND REV




7/11/2012                                                                                         111
                                                                AB 1045 - List of 25 Common
                                                               Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




     Evaluation & Management Services (CPT Codes 99201-99499)                     2007 CPT Code   Average Charge
        Emergency Room Visit, Level 2 (low to moderate severity)                      99282                 $396.00
        Emergency Room Visit, Level 3 (moderate severity)                             99283                 $869.00
        Emergency Room Visit, Level 4 (high severity)                                 99284                $1,331.00
        Outpatient Visit, established patient, 15 minutes                             99213
     Laboratory & Pathology Services (CPT Codes 80048-89356)                      2007 CPT Code   Average Charge
        Basic Metabolic Panel                                                         80048                 $210.00
        Blood Gas Analysis, including 02 saturation                                   82805
        Complete Blood Count, automated                                               85027                 $159.00
        Complete Blood Count, with differential WBC, automated                        85025                 $191.00
        Comprehensive Metabolic Panel                                                 80053                 $261.00
        Creatine Kinase (CK), (CPK), Total                                            82550                 $159.00
        Lipid Panel                                                                   80061                 $523.00
        Partial Thromboplastin Time                                                   85730                 $147.00
        Prothrombin Time                                                              85610                  $96.00
        Thyroid Stimulating Hormone                                                   84443                 $425.00
        Troponin, Quantitative                                                        84484                 $242.00
        Urinalysis, without microscopy                                                81002                  $25.00
      URNALYSIS AUTO W/O MICRO                                                        81003                  $57.00
        Urinalysis, with microscopy                                                   81001                  $77.00
     Radiology Services (CPT Codes 70010-79999)                                   2007 CPT Code   Average Charge
        CT Scan, Abdomen, with contrast                                               74160
        CT Scan, Head or Brain, without contrast                                      70450
        CT Scan, Pelvis, with contrast                                                72193
        Mammography, Screening, Bilateral                                             77056
        MRI, Head or Brain, without contrast, followed by contrast                    70553
        Ultrasound, Abdomen, Complete                                                 76700
        Ultrasound, OB, 14 weeks or more, transabdominal                              76805
        X-Ray, Lower Back, four views                                                 72110
        X-Ray, Chest, two views                                                       71020
     Medicine Services (CPT Codes 90281-99602)                                    2007 CPT Code   Average Charge
        Cardiac Catheterization, Left Heart, percutaneous                             93510
        Echocardiography, complete                                                    93307
        Electrocardiogram, routine, with interpretation and report                    93000
        Inhalation Treatment, pressurized or nonpressurized                           94640                 $206.00
        Physical Therapy, Evaluation                                                  97001
        Physical Therapy, Gait Training                                               97116
        Physical Therapy, Therapeutic Exercise                                        97110




Office of Statewide Health Planning and Development                                                                    AB 1045 (May 2007)
                                                                 AB 1045 - List of 25 Common
                                                                Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007

     Surgery Services (CPT Codes 10021-69990)                                                   2007 CPT Code             Average Charge
        Arthroscopy, Knee, with meniscectomy (medial or lateral)                                     29881
        Arthroscopy, Shoulder, with partial acromioplasty                                            29826                        $17,022.74
        Carpal Tunnel Surgery                                                                        64721
        Cataract Removal with Insertion of Intraocular Lens, 1 Stage                                 66984
        Colonoscopy, diagnostic                                                                      45378                         $4,913.50
        Colonoscopy, with biopsy                                                                     45380                         $5,687.73
        Colonoscopy, with lesion removal, by snare technique                                         45385
        Discission, secondary membranous cataract, laser surgery                                     66821
        Endoscopy, Upper GI, diagnostic                                                              43235                         $4,394.19
        Endoscopy, Upper GI, with biopsy                                                             43239                         $6,263.42
        Excision, Breast Lesion                                                                      19120                         $7,326.45
        Hernia Repair, Inguinal, 5 years and older                                                   49505                        $13,082.18
        Injection, Anesthetic or Steroid, transforaminal epidural                                    64483
        Injection, Diagnostic or Therapeutic substance, epidural                                     62311
        Laparoscopic Cholecystectomy                                                                 47562                        $16,564.40
        Tonsillectomy with Adenoidectomy, less than 12 years old                                     42820
        Tympanostomy (insert ventilating tube, general anesthesia)                                  69436
     Other Common Outpatient Procedures (list as needed)                                        2007 CPT Code             Average Charge




        Count of Reported Procedures (minimum 25 required)
     Instructions for Completing AB 1045 Common Outpatient Procedure Form
     1. Enter Hospital Name and OSHPD Facility Number. Revise Effective Date of Charges, if necessary.
     2. Enter Average Charge for at least 25 commonly performed outpatient procedures. For Evaluation & Management
       Services, do not include related ancillary charges. For all other procedures, include related ancillary charges.
       NOTE: The CPT codes are included on this form to help identify the listed procedures based on the principal
      procedure appearing on the patient's medical record. The average charge for all related services and procedures
       (e.g., supplies, drugs, lab, use of operating room, etc.) should be included in the average charge for that procedure.
     3. Do not change procedure descriptions or CPT code references. Use "Other Common Outpatient Procedures"
       (rows 62-71) if you are unable to select procedures from list.
     4. Submit completed form as Excel (.xls) file, along with chargemaster and percent change in gross revenue
       calculation, by e-mail to chargemaster@oshpd.ca.gov or by standard mail on CD.




Office of Statewide Health Planning and Development                                                                                            AB 1045 (May 2007)
                                                       AB 1045 - List of 25 Common
                                                      Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




Office of Statewide Health Planning and Development                                    AB 1045 (May 2007)
                                                       AB 1045 - List of 25 Common
                                                      Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




Office of Statewide Health Planning and Development                                    AB 1045 (May 2007)
                                                       AB 1045 - List of 25 Common
                                                      Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




Office of Statewide Health Planning and Development                                    AB 1045 (May 2007)
                                                       AB 1045 - List of 25 Common
                                                      Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




Office of Statewide Health Planning and Development                                    AB 1045 (May 2007)
                                                       AB 1045 - List of 25 Common
                                                      Outpatient Procedures for 2007


     Hospital Name: Memorial Hospital of Los Banos
     OSHPD Facility No: 106240924
     Effective Date of Charges: June 1, 2007




Office of Statewide Health Planning and Development                                    AB 1045 (May 2007)
MHLB
High Level Summary                               Current           Current             Current
FINAL                                            For 2007          For 2007            For 2007          Diff Between
                             (12 Months)                                              Combined            New Price +
                                Actual       PRICE Impact      Volume Impact         New Price &        New Volume VS      Price    Volume     Total
Gross Revenue                  06/30/06         ONLY               Only              New Volume         CURRENT PRICE     Impact    Impact    Impact

Routine                  $      16,605,100   $    20,244,580   $      (574,841) $      19,669,739   $           582,144      6.1%     -3.0%      3.0%
Inpatient Ancillary      $      39,525,681   $    42,966,162   $      (341,694) $      42,624,468   $         1,854,187      5.4%     -0.8%      4.5%
Outpatient               $      69,803,060   $    77,024,342   $       978,711 $       78,003,053   $         5,635,417      6.4%      1.4%      7.8%
VNA                      $             -                                        $             -     $               -
Gould MRI (outpatient)   $             -                                        $             -     $               -

Total Gross              $     125,933,841   $   140,235,084   $        62,176   $    140,297,260   $         8,071,748      6.1%      0.0%      6.1%

								
To top