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					                                                     Northridge Hospital Medical Center
                                                                           June 1, 2005


Charge #Dept   CDM Description                                          Price
5800016   58   DIDANOSINE 100MG TAB                                               $7.10
5800024   58   NORTRIPTYLINE 10 MG CAP                                            $5.50
5800032   58   PROPAFENONE 150 MG TAB                                             $7.93
5800040   58   OMEPRAZOLE 20 MG CAP                                              $12.28
5800057   58   MEDROXYPROGESTERONE 5MG                                            $6.28
5800065   58   METHYLPRED DOSEPAK 4 MG                                           $32.40
5800073   58   ETODOLAC 300MG                                                     $7.21
5800081   58   PHOSLO TAB                                                         $5.19
5800099   58   OFLOXACIN 400 MG TAB                                              $14.45
5800107   58   CLONIDINE 0.2MG TAB                                                $5.32
5800115   58   PYRIDOSTIGMINE 180 MG TAB                                          $5.43
5800123   58   PYRIDOSTIGMINE 60 MG TAB                                           $5.10
5800131   58   NABUMETONE 500 MG TAB                                              $7.73
5800156   58   CLOMIPRAMINE 25MG CAP                                              $6.26
5800164   58   CINOXACIN 500MG CAP                                                $8.89
5800180   58   CEPHRADINE 500MG CAP                                               $6.63
5800198   58   AMOXICILLIN 250MG CAP                                              $5.36
5800206   58   AMPICILLIN 250MG CAP                                               $5.21
5800214   58   AMPICILLIN 500MG CAP                                               $5.36
5800222   58   CEFADROXIL 500MG CAP                                              $12.70
5800230   58   CARBENECILLIN 382MG TAB                                            $8.41
5800248   58   CEPHALEXIN 250MG CAP                                               $5.26
5800255   58   CEPHALEXIN 500MG CAP                                               $7.46
5800263   58   CEFACLOR 250MG CAP                                                 $8.76
5800271   58   CEFACLOR 500MG CAP                                                $12.60
5800289   58   CEPHRADINE 250MG CAP                                               $5.01
5800297   58   CHLORAMPHENICOL 250MG CAP                                          $5.39
5800305   58   CLINDAMYCIN 150MG CAP                                              $6.30
5800313   58   CLOXACILLIN 250MG CAP                                              $5.35
5800321   58   CLOXACILLIN 500MG CAP                                              $7.01
5800339   58   DECLOMYCIN 150MG TAB                                              $27.51
5800347   58   DECLOMYCIN 300MG TAB                                              $46.55
5800354   58   DICLOXACILLIN 250MG CAP                                            $5.46
5800362   58   DICLOXACILLIN 500MG CAP                                            $5.12
5800370   58   DOXYCYCLINE 50MG CAP                                               $5.19
5800388   58   DOXYCYCLINE 100MG CAP                                              $6.68
5800396   58   ERYTHROMYCIN 250MG TAB                                             $5.17
5800404   58   ERYTHROMYCIN 500MG TAB                                             $5.28
5800412   58   ERYTHROMYCIN 400MG TAB                                             $5.26
5800420   58   MINOCYCLINE 100 MG CAP                                            $12.38
5800438   58   ERYTHRO BASE 250MG TAB                                             $5.20
5800446   58   NALIDIXIC ACID 500 MG TAB                                          $5.13
5800453   58   NEOMYCIN 500 MG TAB                                                $5.45
5800461   58   OXACILLIN 250 MG CAP                                               $5.05
5800479   58   OXACILLIN 500 MG CAP                                               $6.72
5800487   58   PEN VK 250 MG TAB                                                  $5.13
5800495   58   PEN VK 500 MG TAB                                                  $5.26
5800503   58   TETRACYCLINE 250 MG CAP                                            $5.08
5800511   58   TETRACYCLINE 500 MG CAP                                            $5.17
5800529   58   AMOXICILLIN 500MG CAP                                              $4.92
5800537   58   AUGMENTIN 250MG TAB                                               $10.66
5800545   58   QUINACRINE 100 MG TAB                                              $5.35
5800552   58   PYRIMETHAMINE 25 MG TAB                                            $5.45
5800560   58   ERYTHROMYCIN 333MG TAB                                             $5.39


                                     Page 1 of 276
Charge #Dept   CDM Description                       Price
5800586   58   FLUCONAZOLE 100MG TAB                         $24.54
5800594   58   NORFLOXACIN 400 MG TAB                        $11.61
5800610   58   MINOCYCLINE 50 MG CAP                          $6.54
5800628   58   MACRODANTIN 25MG CAP                           $6.00
5800636   58   NAFCILLIN 250 MG CAP                           $6.52
5800644   58   CEFADROXIL 1GM CAP                            $17.91
5800651   58   ERYTHRO BASE 500MG TAB                         $5.45
5800669   58   VERAPAMIL 240 MG CAP                           $7.17
5800677   58   PRAZIQUANTEL 600 MG TAB                       $28.80
5800685   58   QUINAPRIL 20 MG TAB                            $7.17
5800693   58   FOSINOPRIL 10MG TAB                            $5.40
5800719   58   ACTIFED TAB                                    $5.07
5800735   58   SPIRONOLACTONE 25 MG TAB                       $5.43
5800743   58   METHYLDOPA 250 MG TAB                          $5.37
5800750   58   METHYLDOPA 500 MG TAB                          $5.01
5800768   58   METHYLDOPA 125 MG TAB                          $5.13
5800776   58   MEDROXYPROGEST 10MG TAB                        $5.26
5800784   58   ALDORIL - 15 TAB                               $4.88
5800792   58   ALDORIL - 25 TAB                               $4.85
5800800   58   AMINOCAPROIC ACID 500MG                        $8.10
5800818   58   METAPROTERENOL 10 MG TAB                       $5.16
5800826   58   METAPROTERENOL 20 MG TAB                       $5.21
5800834   58   COL-BENEMID                                    $5.27
5800842   58   PROCARBAZINE 50 MG CAP                         $5.04
5800859   58   AMINOPHYLLINE 100MG TAB                        $5.08
5800867   58   AMINOPHYLLINE 200MG TAB                        $5.10
5800875   58   DISULFIRAM 500MG TAB                           $5.38
5800883   58   MECLIZINE 12.5MG TAB                           $5.16
5800891   58   MECLIZINE 25MG TAB                             $5.18
5800909   58   HYDRALAZINE 25MG TAB                           $5.14
5800917   58   HYDRALAZINE 50MG TAB                           $5.17
5800925   58   NYLIDRIN 6 MG TAB                              $5.10
5800933   58   TRIHEXYPHENIDYL 2 MG TAB                       $5.19
5800941   58   HYDRALAZINE 10MG TAB                           $5.11
5800958   58   TRIHEXYPHENIDYL 5 MG TAB                       $5.32
5800966   58   TRIAMCINOLONE 4 MG TAB                         $5.08
5800982   58   ASCORBIC ACID 250MG TAB                        $5.05
5801006   58   ASCORBIC ACID 500MG TAB                        $5.09
5801014   58   AMOXAPINE 50MG TAB                             $6.76
5801022   58   ASCRIPTIN 5GR TAB                              $5.00
5801030   58   CLOFIBRATE 500MG CAP                           $5.26
5801055   58   SULFASALAZINE 500 MG TAB                       $5.14
5801063   58   BACLOFEN 10MG TAB                              $4.82
5801071   58   NORTRIPTYLINE 25 MG TAB                        $5.42
5801089   58   BASALJEL TAB                                   $5.20
5801097   58   DIPHENHYDRAMINE 25MG CAP                       $5.10
5801105   58   PROBENECID 500 MG TAB                          $5.47
5801113   58   DICYCLOMINE 10MG TAB                           $5.23
5801121   58   COMBIPRES 0.1MG TAB                            $6.01
5801139   58   DICYCLOMINE 20MG CAP                           $5.35
5801147   58   ACT CHAR SUSP 50GM                            $34.60
5801154   58   CAFERGOT TAB                                   $6.11
5801162   58   TERBUTALINE 2.5 MG TAB                         $5.39
5801170   58   TERBUTALINE 5 MG TAB                           $4.89
5801188   58   CORTISONE 25MG TAB                             $4.76
5801196   58   CAL GLUC 500MG TAB                             $5.25
5801204   58   CAL LAC 325MG TAB                              $5.07
5801212   58   CAL LAC 650MG TAB                              $5.03


                                     Page 2 of 276
Charge #Dept   CDM Description                       Price
5801220   58   CLONIDINE 0.3MG TAB                           $5.48
5801238   58   SULINDAC 150 MG TAB                           $5.31
5801246   58   SULINDAC 200 MG TAB                           $6.14
5801253   58   CAL CARB 650MG TAB                            $5.11
5801261   58   CYTOSPAZ TAB                                  $5.43
5801279   58   BENZTROPINE 2 MG TAB                          $5.32
5801287   58   DOCUSATE SOD 100MG CAP                        $5.11
5801295   58   PROCHLORPERAZINE 5 MG TAB                     $5.12
5801303   58   PROCHLORPERAZINE 10MG TAB                     $6.21
5801337   58   PLAQUENIL 200 MG TAB                          $7.78
5801345   58   BENZTROPINE 0.5MG TAB                         $5.26
5801352   58   DOCUSATE SOD 50MG CAP                         $5.09
5801360   58   COLCHICINE 0.6MG TAB                          $5.34
5801378   58   DANTROLENE 25MG CAP                           $6.04
5801386   58   CLEMASTINE-2 TAB                              $6.69
5801394   58   RAMIPRIL 2.5 MG CAP                           $5.37
5801402   58   PROCHLORPER SR 15 MG CAP                      $6.81
5801410   58   NADOLOL 40 MG TAB                             $6.90
5801436   58   DILTIAZEM 30MG TAB                            $4.83
5801444   58   DEXAMETHASONE 0.5MG TAB                       $5.24
5801451   58   DEXAMETHASONE 0.75MG TAB                      $5.33
5801469   58   DEXAMETHASONE 4MG TAB                         $4.93
5801477   58   WARFARIN 2 MG TAB                             $5.28
5801485   58   WARFARIN 2.5 MG TAB                           $5.32
5801493   58   VALPROIC ACID 250 MG CAP                      $6.65
5801501   58   CHLORPROPAMIDE 250MG TAB                      $5.04
5801519   58   DIALOSE PLUS TAB                              $5.22
5801527   58   ACETAZOLAMIDE 250MG TAB                       $5.18
5801535   58   WARFARIN 5 MG TAB                             $5.38
5801543   58   WARFARIN 10 MG TAB                            $6.54
5801550   58   WARFARIN 7.5 MG TAB                           $6.45
5801568   58   CTM 8MG SR TAB                                $5.11
5801576   58   PHENYTOIN 50 MG TAB                           $5.44
5801584   58   PHENYTOIN 100 MG CAP                          $5.38
5801592   58   OXYBUTYNIN 5 MG TAB                           $5.45
5801600   58   DONNATAL TAB                                  $5.18
5801618   58   LEVODOPA 250MG CAP                            $5.37
5801626   58   PENICILLAMINE 250 MG TAB                      $6.32
5801642   58   DIMENHYDRINATE 50MG TAB                       $5.08
5801659   58   DRIXORAL TAB                                  $5.34
5801667   58   BISACODYL 5MG TAB                             $5.08
5801675   58   DYAZIDE CAP                                   $5.40
5801683   58   TRIAMTERENE 100 MG CAP                        $5.40
5801691   58   DES 1MG TAB                                   $5.10
5801709   58   DES 5MG TAB                                   $5.26
5801717   58   CHLORPROPAMIDE 100MG TAB                      $5.34
5801725   58   ACETAZOLAMIDE 500MG CAP                       $5.15
5801733   58   AMITRIPTYLINE 10MG TAB                        $5.09
5801741   58   AMITRIPTYLINE 25MG TAB                        $5.14
5801758   58   AMITRIPTYLINE 50MG TAB                        $5.25
5801766   58   AMITRIPTYLINE 75MG TAB                        $5.42
5801782   58   SALSALATE 500 MG TAB                          $5.20
5801790   58   FERROUS GLUC 300MG TAB                        $5.10
5801808   58   FERROUS SULF 300MG TAB                        $5.05
5801816   58   METRONIDAZOLE 250 MG TAB                      $4.83
5801832   58   CARDIOQUIN 275MG TAB                          $6.89
5801840   58   FOLIC ACID 1MG TAB                            $5.16
5801857   58   NITROFURANTOIN 50 MG TAB                      $4.95


                                     Page 3 of 276
Charge #Dept   CDM Description                      Price
5801865   58   MACRODANTIN 100MG CAP                         $7.23
5801873   58   SULFAMETHOXAZOLE 500 MG                       $4.80
5801881   58   SULFAISOXAZOLE 500 MG                         $5.34
5801899   58   DOCUSATE SOD 250MG CAP                        $5.08
5801907   58   ACETOHEXAMIDE 250MG TAB                       $5.26
5801915   58   ASA GR 5 EC TAB                               $5.06
5801923   58   GAVISCON TAB                                  $5.08
5801931   58   HALOPERIDOL 1MG TAB                           $5.45
5801949   58   HALOPERIDOL 2MG TAB                           $4.90
5801956   58   HALOPERIDOL 5MG TAB                           $5.46
5801964   58   AMITRIPTYLINE 100MG TAB                       $4.77
5801972   58   AMITRIPTYLINE 150MG TAB                       $5.00
5801980   58   HALOPERIDOL 10MG TAB                          $7.28
5802004   58   HIPREX 1GM TAB                                $7.07
5802012   58   HYDERGINE 1MG TAB                             $6.01
5802020   58   HCTZ 50MG TAB                                 $5.09
5802053   58   CHLORTHALIDONE 100MG TAB                      $5.13
5802061   58   PROPRANOLOL 10 MG TAB                         $5.20
5802079   58   PROPRANOLOL 20 MG TAB                         $5.27
5802087   58   PROPRANOLOL 40 MG TAB                         $5.41
5802095   58   PROPRANOLOL 80 MG TAB                         $5.49
5802103   58   HALOPERIDOL 0.5MG TAB                         $5.29
5802111   58   DIHYDROTACHY 0.125MG TAB                      $6.35
5802129   58   LOPERAMIDE 2MG CAP                            $5.29
5802137   58   AZATHIOPRINE 50MG TAB                         $7.22
5802145   58   INDOMETHACIN 25MG CAP                         $5.40
5802152   58   INDOMETHACIN 50MG CAP                         $5.02
5802160   58   ISONIAZID 300MG TAB                           $5.15
5802178   58   ISOSOR DINIT 2.5 MGSLTAB                      $5.29
5802186   58   ISOSOR DINIT 40MG SR TAB                      $5.16
5802194   58   CHLORTHALIDONE 25MG TAB                       $5.18
5802202   58   CHLORTHALIDONE 50MG TAB                       $5.19
5802210   58   ISONIAZID 100MG TAB                           $5.11
5802228   58   POT CHL 20 MEQ PKT                            $7.41
5802244   58   K-LYTE 25MEQ TAB                              $6.73
5802251   58   DIGOXIN 0.125MG TAB                           $5.29
5802269   58   DIGOXIN 0.25MG TAB                            $5.29
5802277   58   GUANETHIDINE 10MG TAB                         $4.94
5802285   58   POT GLUC TAB                                  $5.04
5802293   58   FUROSEMIDE 20 MG TAB                          $5.17
5802301   58   FUROSEMIDE 40 MG TAB                          $5.20
5802319   58   CHLORAMBUCIL 2MG TAB                          $7.16
5802327   58   LIBRAX CAP                                    $5.06
5802335   58   LITH CARB 300MG TAB                           $5.26
5802343   58   BACID CAP                                     $5.28
5802350   58   METOPROLOL 50 MG TAB                          $5.31
5802368   58   LITH CARB 300MG SR TAB                        $5.18
5802376   58   FLUOXYMESTERONE 10MG TAB                     $10.34
5802384   58   MINOXIDIL 10 MG TAB                           $6.58
5802392   58   HYDROXYUREA 500MG CAP                         $6.84
5802400   58   MACRODANTIN 50MG CAP                          $5.35
5802418   58   METHENAMINE 500 MG TAB                        $5.39
5802426   58   PROBUCOL 250 MG TAB                           $5.03
5802434   58   METHYLPRED 4 MG TAB                           $6.53
5802442   58   METHYLPRED 16 MG TAB                          $9.36
5802459   58   MEGESTROL 40MG TAB                            $6.59
5802467   58   THIORIDAZINE 10 MG TAB                        $5.34
5802475   58   THIORIDAZINE 25 MG TAB                        $5.48


                                    Page 4 of 276
Charge #Dept   CDM Description                        Price
5802483   58   THIORIDAZINE 50 MG TAB                         $5.30
5802491   58   THIORDIAZINE 15 MG TAB                         $5.11
5802509   58   METHERGINE 0.2 MG TAB                          $5.11
5802517   58   PRAZOSIN 1 MG CAP                              $5.29
5802525   58   PRAZOSIN 2 MG CAP                              $5.38
5802533   58   IBUPROFEN 300MG TAB                            $5.20
5802541   58   IBUPROFEN 400MG TAB                            $5.22
5802558   58   PHYTONADIONE 5 MG TAB                          $4.98
5802566   58   MIDRIN CAP                                     $5.49
5802574   58   MULTIVIT                                       $5.05
5802582   58   ETHAMBUTOL 100MG TAB                           $4.85
5802590   58   MYLANTA TAB                                    $6.68
5802616   58   SIMETHICONE 80 MG TAB                          $5.15
5802624   58   PRAZOSIN 5 MG CAP                              $4.98
5802632   58   FENOPROFEN 300MG CAP                           $5.35
5802640   58   NAPROXEN 250 MG TAB                            $5.25
5802657   58   THIOTHIXENE 5 MG CAP                           $5.47
5802665   58   THIOTHIXENE 10 MG CAP                          $5.00
5802673   58   IBUPROFEN 600MG TAB                            $5.30
5802681   58   NIACIN 50 MG TAB                               $5.03
5802699   58   NIACIN 100 MG TAB                              $5.04
5802707   58   NTG 2.5 MG SR CAP                              $5.12
5802715   58   NTG 6.5 MG SR CAP                              $5.18
5802723   58   TAMOXIFEN 10 MG TAB                            $8.47
5802749   58   PRIMIDONE 250 MG TAB                           $5.49
5802764   58   NORGESIC TAB                                   $5.12
5802772   58   NORGESIC FORTE TAB                             $6.07
5802780   58   DISOPYRAMIDE 150MG CAP                         $5.40
5802798   58   DESIPRAMINE 25MG TAB                           $5.46
5802806   58   NORTRIPTYLINE 50 MG TAB                        $7.06
5802814   58   FENOPROFEN 600MG TAB                           $4.93
5802822   58   THIOTHIXENE 2 MG CAP                           $5.31
5802830   58   THIOTHIXENE 1 MG CAP                           $5.24
5802848   58   ORPHENADRINE 100 MG TAB                        $6.53
5802855   58   DISOPYRAMIDE 100MG TAB                         $5.35
5802863   58   TOLBUTAMIDE 500 MG TAB                         $5.29
5802889   58   OS CAL TAB                                     $5.09
5802897   58   PAPAVERINE 150 MG CAP                          $5.13
5802905   58   CHLORZOXAZONE 500MG TAB                        $5.49
5802913   58   PARNATE 10 MG TAB                              $5.26
5802921   58   ETHOTOIN 250MG TAB                             $5.17
5802939   58   DOCUSATE/CASANTH CAP                           $5.17
5802954   58   DIPYRIDAMOLE 25MG TAB                          $5.20
5802962   58   PREDNISONE 5 MG TAB                            $5.12
5802970   58   CYPROHEPTADINE 4MG TAB                         $5.18
5802988   58   PREDNISONE 20 MG TAB                           $5.17
5803002   58   CONJ ESTROGEN 1.25MG TAB                       $6.67
5803010   58   CONJ ESTROGEN 0.625MG TAB                      $6.22
5803051   58   PROCAINAMIDE 250 MG CAP                        $5.09
5803069   58   PROCAINAMIDE 375 MG CAP                        $5.13
5803077   58   PROCAINAMIDE 500 MG CAP                        $5.16
5803085   58   PHENAZOPYRIDINE 100MG TAB                      $5.11
5803093   58   PHENAZOPYRIDINE 200MG TAB                      $5.19
5803119   58   PREDNISONE 1 MG TAB                            $5.07
5803127   58   QUIN GLUC 324 MG SR TAB                        $4.92
5803135   58   QUESTRAN PKT                                   $8.74
5803143   58   QUINIDINE 200 MG TAB                           $5.18
5803150   58   QUINIDINE 300 MG TAB                           $5.34


                                      Page 5 of 276
Charge #Dept   CDM Description                       Price
5803168   58   PROCAINAMIDE 500MG SR TAB                     $5.28
5803176   58   RESERPINE 0.25 MG TAB                         $5.06
5803184   58   RIFAMPIN 300 MG CAP                           $8.80
5803192   58   METHOCARBAMOL 500 MG TAB                      $5.25
5803200   58   METHOCARBAMOL 750 MG TAB                      $5.28
5803218   58   CALCITRIOL 0.25MCG CAP                        $6.80
5803226   58   SENNA TAB                                     $5.03
5803234   58   TRIMETH/SULFA DS TAB                          $6.29
5803242   58   MESORIDAZINE 25MG TAB                         $6.43
5803259   58   RESERPINE 0.1 MG TAB                          $5.04
5803275   58   SINEMET 10/100 TAB                            $5.36
5803283   58   SINEMET 25/250 TAB                            $6.51
5803291   58   DOXEPIN 10MG CAP                              $5.32
5803309   58   DOXEPIN 25MG CAP                              $5.43
5803317   58   DOXEPIN 50MG CAP                              $4.85
5803325   58   DOXEPIN 75MG CAP                              $5.41
5803341   58   CARISOPRODOL 350MG TAB                        $4.90
5803358   58   MESORIDAZINE 10MG TAB                         $5.36
5803366   58   SINEMET 25/100 TAB                            $5.49
5803374   58   TRIFLUOPERAZINE 1 MG TAB                      $5.02
5803382   58   TRIFLUOPERAZINE 2 MG TAB                      $6.01
5803390   58   TRIFLUOPERAZINE 5 MG TAB                      $6.52
5803416   58   SOMA CMPD TAB                                 $8.00
5803424   58   PSEUDOEPHEDRINE 60 MG TAB                     $5.05
5803432   58   DOCUSATE CA 240MG CAP                         $5.11
5803440   58   LEVOTHYROXINE 0.1MG TAB                       $5.28
5803457   58   RITODRINE 10 MG TAB                           $9.12
5803465   58   MEDROXYPROGEST 2.5MG TAB                      $5.14
5803473   58   CONJ ESTROGEN 2.5MG TAB                       $7.60
5803481   58   PHAZYME - 95 TAB                              $5.15
5803499   58   PSEUDOEPHEDRINE 30 MG TAB                     $5.05
5803507   58   CIMETIDINE 300MG TAB                          $6.05
5803515   58   CARBAMAZEPINE 100MG CH TA                     $5.22
5803523   58   CARBAMAZEPINE 200MG TAB                       $5.36
5803531   58   AMANTADINE 100MG CAP                          $5.39
5803549   58   MULTI VIT THER/MIN TAB                        $5.08
5803556   58   THIAMINE 100 MG TAB                           $5.08
5803564   58   CHLORPROMAZINE 10MG TAB                       $5.39
5803572   58   CHLORPROMAZINE 25 MG TAB                      $4.80
5803580   58   CHLORPROMAZINE 50MG TAB                       $5.08
5803598   58   CHLORPROMAZINE 100 MG TAB                     $5.40
5803606   58   THYROID 30 MG TAB                             $5.25
5803614   58   TRIMETHOBENZAMIDE 250 MG                      $5.46
5803622   58   TITRALAC TAB                                  $5.04
5803630   58   NIFEDIPINE XL 30 MG TAB                       $7.10
5803648   58   TRIMEPRAZINE 2.5 MG TAB                       $5.03
5803655   58   TRIMEPRAZINE 5 MG CAP                         $6.43
5803663   58   TESSALON PERLE 100 MG CAP                     $6.45
5803671   58   TOLMETIN 200 MG TAB                           $5.13
5803689   58   TOLAZAMIDE 250 MG TAB                         $5.46
5803697   58   THIETHYLPERAZINE 10MG TAB                     $5.18
5803705   58   ETRAFON 2/25 TAB                              $6.35
5803713   58   ETRAFON 2/10 TAB                              $5.40
5803721   58   THEOPHYL ANH 100MG SR TAB                     $5.34
5803739   58   THEOPHYL ANH 200MG SR TAB                     $5.46
5803754   58   BETHANECHOL 10MG TAB                          $4.82
5803762   58   BETHANECHOL 25MG TAB                          $5.11
5803770   58   THIAMINE 50 MG TAB                            $5.06


                                     Page 6 of 276
Charge #Dept   CDM Description                       Price
5803788   58   FLAVOXATE 100MG TAB                            $6.86
5803804   58   HYDROXYZINE 25 MG TAB                          $5.42
5803812   58   HYDROXYZINE 50 MG TAB                          $5.35
5803820   58   IMIPRAMINE 10MG TAB                            $5.08
5803838   58   IMIPRAMINE 25MG TAB                            $5.11
5803846   58   IMIPRAMINE 50MG TAB                            $5.19
5803853   58   ALLOPURINOL 100MG TAB                          $5.22
5803861   58   ALLOPURINOL 300MG TAB                          $4.91
5803879   58   TOLAZAMIDE 100 MG TAB                          $5.23
5803887   58   ETRAFON 4/10 TAB                               $4.99
5803895   58   ETRAFON 4/25 TAB                               $6.55
5803903   58   TUSS ORNADE CAP                                $6.56
5803937   58   VIOKASE TAB                                    $5.29
5803945   58   PROPYLTHIOURACIL 50MG TAB                      $5.06
5803960   58   ZINC SULFATE 220 MG CAP                        $5.12
5803978   58   METOLAZONE 5 MG TAB                            $5.41
5803986   58   PERCOGESIC TAB                                 $5.08
5803994   58   LIDOCAINE 5% PATCH                            $10.65
5804000   58   PHENYLBUTAZONE 100 MG TAB                      $4.76
5804018   58   FUROSEMIDE 80MG TAB                            $4.79
5804026   58   PYRIDOXINE 50 MG TAB                           $5.05
5804042   58   METOPROLOL 100 MG TAB                          $6.80
5804059   58   CYCLIZINE 50MG TAB                             $5.24
5804067   58   METHOTREXATE 2.5 MG TAB                       $11.86
5804075   58   THEOPHYLL ANH 250 MG CAP                       $5.19
5804083   58   KETOCONAZOLE 200MG TAB                        $10.75
5804109   58   MAPROTILINE 25MG CAP                           $4.93
5804117   58   TIMOLOL 10 MG TAB                              $5.38
5804125   58   AMILORIDE 5MG TAB                              $5.41
5804141   58   MINOXIDIL 2.5 MG TAB                           $4.88
5804158   58   BELLERGAL S TAB                                $6.46
5804166   58   BROMPHENIRAMINE 4MG TAB                        $5.04
5804174   58   CHLOROTHIAZIDE 500MG TAB                       $5.25
5804182   58   DONNAZYME TAB                                  $5.43
5804190   58   EXCEDRIN TAB                                   $5.10
5804208   58   FLUDROCORTISONE 0.1MG TAB                      $5.32
5804216   58   GRISEOFULVIN 500MG TAB                         $7.19
5804232   58   GRISEOFULVIN 125MG TAB                         $4.91
5804240   58   BROMPHENIRAMINE 8MG SR                         $5.18
5804257   58   TRAZODONE 50 MG TAB                            $5.42
5804265   58   DANOCRINE 200MG CAP                           $13.54
5804281   58   NIFEDIPINE 10 MG CAP                           $4.90
5804299   58   CYCLOBENZAPRINE 10MG TAB                       $5.45
5804307   58   BACAMPICILLIN 400MG TAB                        $8.78
5804315   58   ALU CAP                                        $5.20
5804323   58   BROMOCRIPTINE 2.5MG TAB                       $11.31
5804349   58   ATENOLOL 50MG TAB                              $5.34
5804356   58   FERRO SEQUEL                                   $5.28
5804364   58   NADOLOL 80 MG TAB                              $6.89
5804372   58   DEXAMETHASONE 1.5MG TAB                        $5.39
5804380   58   DIALOSE CAP                                    $5.17
5804406   58   ISOSORBIDE DINIT 10MGTAB                       $5.20
5804414   58   ISOSORB DINIT 20MG TAB                         $5.30
5804422   58   CAPTOPRIL 25MG TAB                             $6.64
5804430   58   CAPTOPRIL 50MG TAB                             $8.53
5804448   58   SUCRALFATE 1 GM TAB                            $6.18
5804463   58   PYRIDOXINE 100 MG TAB                          $5.05
5804471   58   VERAPAMIL 120 MG TAB                           $4.94


                                     Page 7 of 276
Charge #Dept   CDM Description                        Price
5804489   58   ETHAMBUTOL 400MG TAB                            $7.78
5804497   58   DIFLUNISAL 500MG TAB                            $6.56
5804505   58   CALCET TAB                                      $5.07
5804513   58   MECLOMEN 50MG CAP                               $5.43
5804521   58   MITROLAN TAB                                    $5.18
5804539   58   METOLAZONE 2.5 MG TAB                           $5.27
5804547   58   ESTROPIPATE 1.25MG TAB                          $6.11
5804554   58   METOCLOPRAMIDE 10 MG TAB                        $5.29
5804562   58   TRAZODONE 100 MG TAB                            $5.10
5804570   58   ALBUTEROL 2MG TAB                               $5.32
5804588   58   NAPROXEN 375 MG TAB                             $6.13
5804596   58   CONJ ESTROGEN 0.3MG TAB                         $6.23
5804604   58   DIFLUNISAL 250MG TAB                            $6.07
5804612   58   FERO FOLIC 500TAB                               $5.41
5804620   58   DISOPYRAMIDE CR 100MG CAP                       $6.80
5804638   58   DISOPYRAMIDE CR 150MG CAP                       $7.29
5804653   58   OS-CAL 500 TAB                                  $5.08
5804661   58   NAPROXEN 500 MG TAB                             $6.60
5804679   58   CHLOROQUINE 500MG TAB                          $10.71
5804687   58   PROPRANOLOL LA 80 MG CAP                        $6.66
5804695   58   ALBUTEROL 4MG REPETAB                           $6.20
5804703   58   PINDOLOL 5 MG TAB                               $6.32
5804711   58   ATENOLOL 100MG TAB                              $6.99
5804729   58   VERAPAMIL 80 MG TAB                             $5.47
5804737   58   THYROGLOBULIN 130 MG TAB                        $5.16
5804745   58   LACTINEX GRANULES                               $4.83
5804752   58   LABETOLOL 200MG TAB                             $5.39
5804760   58   SIMVASTATIN 10 MG TAB                           $9.49
5804778   58   GLIPIZIDE 5MG TAB                               $5.43
5804786   58   DILTIAZEM 60MG TAB                              $5.05
5804802   58   ETHOSUXIMIDE 250MG CAP                          $6.41
5804810   58   BETHANECHOL 50MG TAB                            $6.74
5804828   58   METRONIDAZOLE 500 MG TAB                        $5.24
5804836   58   PROPRANOLOL 60 MG TAB                           $5.25
5804844   58   RANITIDINE 150 MG TAB                           $8.98
5804851   58   CIMETIDINE 200MG TAB                            $5.45
5804869   58   CLOMIPHENE 50MG TAB                            $21.57
5804893   58   CIMETIDINE 400MG TAB                            $7.39
5804901   58   ACYCLOVIR 200MG CAP                             $6.98
5804919   58   QUININE 260 MG CAP                              $5.19
5804927   58   QUININE 325 MG CAP                              $5.18
5804935   58   SPIRONOLACTONE 100 MG TAB                       $8.82
5804943   58   DIGOXIN 0.1 MG CAP                              $5.27
5804950   58   VITAMIN B COMPLEX                               $5.21
5804968   58   TOCAINIDE 400 MG TAB                            $5.40
5804976   58   TOCAINIDE 600 MG TAB                            $6.44
5804984   58   GLYBURIDE 1.25MG TAB                            $5.21
5805007   58   GLYBURIDE 2.5MG TAB                             $5.46
5805015   58   GLYBURIDE 5MG TAB                               $5.26
5805023   58   INDOMETHACIN 75MG SR CAP                        $6.38
5805031   58   LABETOLOL 300MG TAB                             $6.44
5805049   58   TAO 250 MG CAP                                  $6.65
5805056   58   INDAPAMIDE 2.5MG TAB                            $6.31
5805064   58   THEOPHYLL ANH 200 MG CAP                        $5.42
5805072   58   THEOPHYLL ANH 300 MG CAP                        $4.76
5805080   58   PENTOXIPHYLLINE 400MG TAB                       $5.31
5805098   58   DISULFIRAM 250MG TAB                            $5.07
5805106   58   TRIMETH/SULFA TAB                               $5.27


                                      Page 8 of 276
Charge #Dept   CDM Description                       Price
5805114   58   DIPYRIDAMOLE 50MG TAB                          $5.30
5805122   58   CLONIDINE 0.1MG TAB                            $5.24
5805130   58   EHTACRYNIC ACID 50 MG TAB                      $4.80
5805148   58   ALBUTEROL 4 MG TAB                             $5.47
5805155   58   PIROXICAM 10 MG CAP                            $6.90
5805163   58   PROCAINAMIDE 750MG SR TAB                      $5.39
5805171   58   THEOPHYLL ANH 125 MG CAP                       $5.38
5805189   58   PIROXICAM 20 MG CAP                            $9.44
5805197   58   ENTEX LA TAB                                   $6.26
5805205   58   MAXZIDE TAB                                    $5.41
5805213   58   TOLMETIN 400 MG CAP                            $6.49
5805221   58   DIPYRIDAMOLE 75MG TAB                          $4.95
5805239   58   PROCAINAMIDE 250MG SR TAB                      $5.17
5805247   58   MECLOMEN 100MG CAP                             $4.80
5805254   58   TRIAMTERENE 50 MG CAP                          $5.32
5805262   58   PROPRANOLOL LA 120 MG CAP                      $7.30
5805270   58   THEOPHYLL ANH 300MG SR TB                      $4.81
5805288   58   PRENATAL VIT                                   $5.04
5805296   58   LEVODOPA 100MG TAB                             $5.23
5805312   58   ANAPROXEN 275MG TAB                            $5.24
5805320   58   NACL 1 GM TAB                                  $5.07
5805338   58   ISOSORB DINIT 40 MG TAB                        $5.13
5805353   58   WIGRAINE TAB                                   $5.39
5805361   58   FLUORIDE 1MG TAB                               $5.01
5805379   58   HYDERGINE 1MG SL TAB                           $5.12
5805387   58   HYDERGINE 0.5MG SL TAB                         $5.38
5805403   58   KONSYL 5ML                                     $5.32
5805411   58   BROMPHENIRAMINE 12MG TAB                       $5.25
5805429   58   SENOKOT GRAN 2 OZ                             $29.42
5805437   58   TERAZOSIN 5 MG TAB                             $6.48
5805460   58   MAG SULF CRYTALS 120GM                        $21.56
5805486   58   NTG PATCH 0.4 MG/HR                            $6.48
5805494   58   NTG PATCH 0.6 MG/HR                            $6.72
5805502   58   AUGMENTIN 500MG TAB                           $13.81
5805510   58   DIPHENHYDRAMINE 50MG CAP                       $5.13
5805528   58   CITRUCEL PKT                                   $4.78
5805536   58   NICOTINE PATCH 21MG                           $12.12
5805544   58   PROMETHAZINE 25MG SUP                         $14.03
5805577   58   ANUSOL SUP                                     $5.39
5805585   58   ANUSOL HC SUP                                  $5.34
5805593   58   ASA 125MG SUP                                  $3.43
5805601   58   CAFERGOT SUP                                  $10.23
5805619   58   PROCHLORPERAZINE 5MG SUP                      $10.21
5805627   58   PROCHLORPERAZINE 25MG SUP                     $11.68
5805637   58   BISACODYL SUP                                  $5.40
5805643   58   GLYCERIN SUP                                   $3.40
5805650   58   NICOTINE PATCH 7 MG                           $11.31
5805668   58   TRIMETHOBENZAMDE 200MG SP                      $4.76
5805676   58   PREP H SUP                                     $5.48
5805684   58   TRIMETHOBENZAMIDE 100 SUP                      $5.43
5805692   58   THIETHYLPERAZINE 10MG SUP                      $7.34
5805700   58   ACETAMINOPHEN 325MG SUP                        $3.53
5805718   58   SCOPOLAMINE PATCH                             $22.50
5805734   58   ACETAMIN SUP 120MG                             $3.72
5805742   58   ESTRADERM 0.1MG PATCH                         $15.45
5805759   58   ESTRADERM 0.05MG PATCH                        $14.69
5805767   58   CLOTRIMAZOLE VAG TAB 7PAK                     $34.80
5805775   58   AVC VAG SUPP                                  $99.10


                                     Page 9 of 276
Charge #Dept   CDM Description                       Price
5805783   58   NTG PATCH 0.3 MG/HR                            $6.48
5805791   58   ACETAMIN SUP 650MG                             $5.39
5805809   58   CAFERGOT PB TAB                                $5.32
5805817   58   CATAPRES TTS 1 PATCH                          $37.08
5805825   58   CATAPRES TTS 2 PATCH                          $59.69
5805841   58   CATAPRES TTS 3 PATCH                          $81.26
5805858   58   NICOTINE PATCH 14 MG                          $11.71
5805866   58   WIGRAINE SUP                                   $7.89
5805874   58   ASA 600MG SUP                                  $3.47
5805882   58   NTG PATCH 0.1 MG/HR                            $6.24
5805890   58   NTG PATCH 0.2 MG/HR                            $6.24
5805908   58   CHLORPROMAZINE 25MG SUP                       $11.87
5805916   58   CHLORPROMAZINE 100MG SUP                      $13.96
5805924   58   PROMETHAZINE 12.5 MG SUP                      $12.75
5805932   58   ASA 300MG SUP                                  $3.45
5805940   58   VIT D 50,000 UN CAP                            $5.14
5805957   58   ACETAZOLAMIDE 125MG TAB                        $5.39
5805981   58   DONNATAL SR                                    $5.42
5806013   58   FLUPHENAZINE 5MG TAB                           $6.65
5806021   58   AURANOFIN 3MG CAP                              $6.87
5806039   58   CAPTOPRIL 12.5MG TAB                           $6.64
5806047   58   AMIODARONE 200MG TAB                          $11.34
5806054   58   MEXILETINE 150 MG CAP                          $6.13
5806062   58   MEXILETINE 200 MG CAP                          $6.54
5806070   58   FLECAINIDE 100MG TAB                           $6.69
5806088   58   ENALAPRIL 5MG TAB                              $6.36
5806096   58   ENALAPRIL 10MG TAB                             $6.48
5806104   58   ISOSORB DINIT 5MG SL TAB                       $5.07
5806120   58   CORTISONE 10MG TAB                             $5.42
5806138   58   CTM 4MG TAB                                    $5.19
5806146   58   CTM 12MG TAB                                   $5.36
5806153   58   LOVASTATIN 20MG TAB                            $9.37
5806179   58   METAMUCIL PKT                                  $5.13
5806203   58   ASA BUFF TAB                                   $5.04
5806211   58   DANOCRINE 100MG TAB                            $9.73
5806229   58   THYROID 60 MG TAB                              $5.22
5806237   58   THYROID 120 MG TAB                             $5.18
5806245   58   THYROID 180 MG TAB                             $5.47
5806252   58   TRIMETHOPRIM 100 MG TAB                        $5.46
5806260   58   PYRAZINAMIDE 500 MG TAB                        $6.41
5806278   58   PREDNISONE 2.5 MG TAB                          $5.11
5806286   58   KETOPROFEN 75MG CAP                            $6.62
5806294   58   PREDNISONE 10 MG TAB                           $5.13
5806302   58   PREDNISONE 50 MG TAB                           $5.34
5806310   58   NTG 0.4 MG SL TAB                             $29.08
5806328   58   NTG 0.6 MG SL TAB                             $27.32
5806336   58   BUSPIRONE 10MG TAB                             $7.05
5806344   58   LEVOTHYROXINE 0.15MG TAB                       $5.33
5806351   58   LEVOTHYROXINE 0.2MG TAB                        $5.41
5806369   58   LEVOTHYROXINE 0.3MG TAB                        $4.85
5806377   58   CLEMASTINE-1 TAB                               $5.31
5806385   58   IMIPRAMINE 75MG SR CAP                         $5.43
5806401   58   IBUPROFEN 200MG TAB                            $5.04
5806419   58   GLIPIZIDE 10MG TAB                             $5.19
5806427   58   CONT ESTROGENS 0.9MG TAB                       $6.67
5806435   58   QUESTRAN LIGHT PKT                             $7.96
5806443   58   GUANABENZ 4MG TAB                              $5.18
5806450   58   CHOLOXIN 2MG TAB                               $7.22


                                    Page 10 of 276
Charge #Dept   CDM Description                         Price
5806468   58   NOVAFED 120 MG SR CAP                            $5.32
5806476   58   BUSPIRONE 5MG TAB                                $5.31
5806500   58   NTG 0.3 MG SL TAB                               $27.32
5806518   58   LEVOTHYROXINE 0.075MG TAB                        $5.44
5806526   58   IBUPROFEN 800MG TAB                              $5.32
5806534   58   LEVOTHYROXINE 0.155MG TAB                        $5.32
5806542   58   PROMETHAZINE 25 MG TAB                           $5.09
5806559   58   LEVOTHYROXINE 0.05MG TAB                         $5.24
5806567   58   LABETOLOL 100MG TAB                              $4.99
5806575   58   LEVOTHYROXINE 0.025MG TAB                        $5.33
5806583   58   SPIRONOLACTONE 40 MG TAB                         $6.87
5806591   58   THYROID 15 MG TAB                                $5.12
5806609   58   NITROFURANTOIN 100 MG TAB                        $6.46
5806617   58   HCTZ 25MG TAB                                    $5.06
5806625   58   RANITIDINE 300 MG TAB                           $12.97
5806658   58   KCL 10MEQ SR TAB                                 $5.39
5806666   58   KCL 20MEQ SR TAB                                 $5.10
5806674   58   NIFEDIPINE 20 MG CAP                             $6.01
5806682   58   DIVALPROEX 250MG TAB                             $6.89
5806690   58   DEXAMETH 2MG TAB                                 $4.97
5806708   58   GUANFACINE 1MG TAB                               $6.21
5806716   58   MENEST 0.3MG TAB                                 $5.22
5806724   58   MENEST 0.625MG TAB                               $5.31
5806732   58   MENEST 1.25MG TAB                                $5.43
5806740   58   ENDURONYL TAB                                    $6.64
5806757   58   ETHIONAMIDE 250MG CAP                           $10.18
5806765   58   DEXAMETH 6MG TAB                                 $5.46
5806773   58   FENOPROFEN 200MG CAP                             $5.31
5806781   58   VERAPAMIL 240 MG SR TAB                          $7.52
5806799   58   B COMPLEX W/ C TAB                               $5.11
5806807   58   HYDROCORTISONE 10MG TAB                          $5.43
5806815   58   HYDROCORTISONE 20MG TAB                          $5.12
5806831   58   K-LYTE CL 25MEQ TAB                              $6.73
5806849   58   COMBIPRES 0.2MG TAB                              $6.69
5806856   58   DECONAMINE SR CAP                                $4.89
5806898   58   MISOPROSTOL 200 MCG TAB                          $7.22
5806906   58   DILTIAZEM 90MG TAB                               $6.43
5806922   58   CEFUROXIME 250MG TAB                            $15.30
5806930   58   CEFUROXIME 500MG TAB                            $24.60
5806955   58   KCL 8MEQ CAP                                     $5.25
5806963   58   PHENYTOIN 30 MG CAP                              $5.30
5806971   58   KCL 10MEQ SR CAP                                 $5.32
5806989   58   CHARCOAL TAB                                     $5.06
5807003   58   SLOW-MAG TAB                                     $5.16
5807011   58   PRIMIDONE 50 MG TAB                              $5.32
5807029   58   FLUOXETINE 20MG CAP                             $13.00
5807037   58   ERRERSYLIUM POWD 5ML                            $20.26
5807045   58   ERRERSYLIUM PKT                                  $5.01
5807052   58   QUINESTROL 100 MCG TAB                           $6.83
5807060   58   QUINIDINE 300 MG SR TAB                          $6.02
5807078   58   QUININE 200 MG CAP                               $5.15
5807110   58   SOD BICARB 650 MG TAB                            $5.09
5807128   58   NIZATIDINE 300 MG CAP                            $8.14
5807136   58   TERAZOSIN 1 MG TAB                               $6.48
5807144   58   CIMETIDINE 800MG TAB                             $9.99
5807151   58   VIT A 25,000 UN CAP                              $4.75
5807169   58   VIT E 400 U CAP                                  $5.06
5807177   58   CIPROFLOXACIN 250MG TAB                         $14.57


                                      Page 11 of 276
Charge #Dept   CDM Description                        Price
5807185   58   VERAPAMIL 180 MG SR TAB                          $7.35
5807193   58   THEO ANH 60 MG CAP                               $5.28
5807201   58   CIPROFLOXACIN 500MG TAB                         $16.35
5807219   58   NICARDIPINE 20 MG CAP                            $5.44
5807227   58   NICARDIPINE 30 MG CAP                            $5.04
5807235   58   CIPROFLOXACIN 750MG TAB                         $16.95
5807268   58   LISONOPRIL 10MG TAB                              $5.45
5807276   58   TUMS TAB                                         $5.04
5807284   58   DICLOFENAC 50MG TAB                              $6.75
5807292   58   DICLOFENAC 25MG TAB                              $5.06
5807300   58   ZIDOVUDINE 100 MG CAP                            $7.54
5807318   58   DICLOFENAC 75MG TAB                              $7.33
5807326   58   MAXZIDE-25 TAB                                   $5.48
5807334   58   NIZATIDINE 150 MG CAP                            $8.53
5807342   58   LISINOPRIL 5MG TAB                               $5.40
5807359   58   LISINOPRIL 20MG TAB                              $6.07
5807367   58   TERAZOSIN 2 MG TAB                               $6.48
5807375   58   DILTIAZEM SR 90MG CAP                            $6.10
5807383   58   DILTIAZEM SR 60MG CAP                            $5.37
5807391   58   DILTIAZEM SR 120MG CAP                           $6.73
5807409   58   NIMODIPINE 30 MG CAP                            $21.64
5807417   58   RIFAMPIN 150 MG CAP                              $7.39
5807425   58   FLURBIPROFEN 100MG TAB                           $7.67
5807433   58   FAMOTIDINE 20MG TAB                              $8.06
5807458   58   FAMOTIDINE 40MG TAB                             $11.84
5807466   58   SULFINPYRIZONE 200 MG CAP                        $5.26
5807482   58   ALU TAB                                          $5.18
5807490   58   BASALJEL CAP                                     $5.21
5807508   58   DI-GEL TAB                                       $5.05
5807516   58   MAGAN TAB                                        $4.85
5807524   58   NEUTRA PHOS POWD                                 $5.39
5807532   58   DIGOXIN 0.2MG CAP                                $5.32
5807540   58   NIACIN 125 MG SR CAP                             $5.06
5807557   58   THYROID 240 MG TAB                               $5.06
5807565   58   DIHYDRO TACHY 0.2MG TAB                          $6.29
5807573   58   NTG 9 MG SR CAP                                  $5.21
5807581   58   VIT A 10,000 UN CAP                              $5.02
5807599   58   FLUTAMIDE 125MG CAP                              $9.45
5807607   58   ESTROPIPATE 0.625MG TAB                          $5.13
5807615   58   NIFEDIPINE XL 60 MG TAB                          $9.80
5807631   58   ANAPROXEN DS 550MG                               $6.58
5807649   58   HYDROXYZINE 10MG TAB                             $5.36
5807714   58   LEVOTHYROXINE 0.175MG TAB                        $5.37
5807722   58   TICLODIPINE 250 MG TAB                           $8.49
5807730   58   KETOROLAC 10MG TAB                               $6.57
5807748   58   TRINALIN TAB                                     $6.89
5807763   58   MESALAMINE 500MG SUPP                           $11.81
5807771   58   MESALAMINE 4GM/60ML ENEMA                       $40.98
5807797   58   SERTRALINE 50 MG TAB                            $10.03
5807805   58   THEOPHYLL ANH 100MG SR CP                        $5.32
5807813   58   THEOPHYLL ANH 450MG SR TB                        $4.86
5807821   58   SINEMET - CR 50/200 TAB                          $8.02
5807839   58   CEFIXIME 400MG TAB                              $20.90
5807847   58   METHIMAZOLE 5 MG TAB                             $5.44
5807854   58   IODIN GLYCEROL 30MG CAP                          $5.15
5807862   58   OVRAL TAB                                        $9.17
5807870   58   OVRAL TAB - 21 PAK                             $118.66
5807888   58   PEPTO-BISMOL TAB                                 $5.11


                                     Page 12 of 276
Charge #Dept   CDM Description                       Price
5807912   58   FINASTERIDE 5MG TAB                           $10.39
5807920   58   PRAVASTATIN 10 MG TAB                          $8.59
5807938   58   NADOLOL 20 MG TAB                              $7.27
5807946   58   NEPHRO-VITE TAB                                $5.17
5807953   58   NIACIN 500 MG TAB                              $5.09
5807979   58   BENAZEPRIL 10MG TAB                            $6.34
5807987   58   BENAZEPRIL 20MG TAB                            $6.34
5807995   58   GALANTAMINE 4MG TAB                            $9.72
5808001   58   ISOSORB MONO 20 MG TAB                         $6.86
5808019   58   MACRO BID 100MG CAP                            $8.89
5808027   58   MAG-TAB SR                                     $5.16
5808035   58   METYRAPONE 250 MG TAB                          $9.13
5808043   58   MORICIZINE 200 MG TAB                          $6.30
5808050   58   MORICIZINE 250 MG TAB                          $6.74
5808068   58   MORICIZINE 300 MG TAB                          $7.12
5808076   58   ENTEX PSE TAB                                  $6.26
5808084   58   ESTRADIOL 1MG TAB                              $5.38
5808092   58   OFLOXACIN 300 MG TAB                          $13.90
5808100   58   GRISEOFULVIN 250MG                             $6.01
5808118   58   GRISEOFULVIN 330MG                             $7.03
5808126   58   PROPRANOLOL LA 60 MG                           $6.85
5808134   58   HYOSCYAMINE 0.125MG SL                        $35.36
5808142   58   HYOSCYAMINE 0.375MG SR                         $7.00
5808159   58   CLOFAZIMINE 50MG TAB                           $5.21
5808167   58   CLOFAZIMINE 100MG TAB                          $5.23
5808175   58   CYCLOSERINE 250MG CAP                         $12.37
5808183   58   DAPSONE 25MG TAB                               $5.20
5808191   58   PHENOXYBENZAMINE 10MG CAP                      $5.28
5808209   58   ISRADIPINE 2.5MG CAP                           $4.78
5808217   58   ISRADIPINE 5MG CAP                             $5.12
5808225   58   DILTIAZEM 120MG CD CAP                         $7.09
5808233   58   DILTIAZEM 180MG CD CAP                         $7.83
5808241   58   DILTIAZEM 240MG CD CAP                         $8.92
5808258   58   DILTIAZEM 300MG CD CAP                        $10.80
5808266   58   DOXAZOSIN 1MG TAB                              $6.62
5808274   58   DOXAZOSIN 2MG TAB                              $6.62
5808282   58   DOXAZOSIN 4MG TAB                              $6.75
5808308   58   CLONAZEPAM 0.5MG TAB                           $5.16
5808316   58   CLONAZEPAM 1MG TAB                             $5.32
5808324   58   CLONAZEPAM 2MG TAB                             $5.32
5808340   58   BEROCCA TAB                                    $5.41
5808357   58   CLARITHROMYCIN 250MG TAB                      $14.05
5808365   58   CLARITHROMYCIN 500MG TAB                      $14.05
5808373   58   THERMOTAB                                      $5.03
5808381   58   BUMETANIDE 1 MG TAB                            $5.47
5808399   58   BUMETANIDE 2MG TAB                             $5.14
5808407   58   BUMETANIDE 0.5MG TAB                           $5.33
5808415   58   TRIFLUOPERAZINE 10 MG                          $7.80
5808423   58   URSODIOL 300 MG CAP                            $9.73
5808431   58   QUINAPRIL 10 MG                                $6.85
5808449   58   CLOMIPRAMINE 50MG CAP                          $6.76
5808456   58   CLOMIPRAMINE 75MG CAP                          $8.02
5808464   58   AMLODIPINE 2.5MG TAB                           $6.51
5808472   58   ESTRADIOL 2MG TAB                              $6.39
5808480   58   ERYTHROMYCIN PCE 333MG                         $7.95
5808498   58   LEVODOPA 500MG TAB                             $4.96
5808506   58   PAROXETINE 20 MG TAB                          $10.51
5808514   58   LITH CARB 300MG CAP                            $5.21


                                    Page 13 of 276
Charge #Dept   CDM Description                         Price
5808522   58   LEVOTHYROXINE 0.112 MG                           $5.49
5808548   58   TRILISATE 750 MG TAB                             $5.33
5808555   58   CALCIUM GLUC 1GM TAB                             $5.12
5808563   58   FELODIPINE 5MG TAB                               $6.17
5808571   58   PAROXETINE 30 MG TAB                            $10.58
5808589   58   NIFEDIPINE XL 90 MG TAB                         $10.47
5808597   58   BENAZEPRIL 5MG TAB                               $6.34
5808639   58   MULTIVIT THER TAB (GENERI                        $5.07
5808654   58   KETOPROFEN 50MG                                  $6.46
5808662   58   CORTISONE 5MG TAB                                $5.23
5808670   58   PROTRIPTYLINE 5 MG TAB                           $4.80
5808688   58   DOXYCYCLINE 100 MG TAB                           $4.83
5808696   58   HYDROXYZINE 25MG CAP                             $5.44
5808704   58   HYDROXYZINE 50MG CAP                             $4.94
5808712   58   FIBERCON TAB                                     $5.01
5808720   58   FLUCONAZOLE 200MG TAB                           $37.61
5808746   58   METOCLOPRAMIDE 5 MG TAB                          $5.49
5808753   58   DESIPRAMINE 75MG TAB                             $4.96
5808761   58   ATOVAQUONE 250MG TAB                            $15.08
5808787   58   SALSALATE 750 MG TAB                             $5.28
5808795   58   WARFARIN 1 MG TAB                                $5.23
5808803   58   AMLODIPINE 5MG TAB                               $7.47
5808811   58   AMLODIPINE 10MG TAB                              $8.35
5808829   58   NICARDIPINE 30 MG SR CAP                         $5.10
5808837   58   NICARDIPINE 45 MG SR CAP                         $6.33
5808845   58   NICARDIPINE 60 MG SR CAP                         $6.79
5808886   58   GLYCOPYRROLATE 1MG TAB                           $4.94
5808902   58   MAGNESIUM GLUC 500MG TAB                         $5.16
5808936   58   ACEBUTOLOL 200MG CAP                             $8.21
5808951   58   AMOXAPINE 100MG TAB                              $8.72
5808977   58   INDOMETHACIN 50MG SUP                            $7.69
5808985   58   DOXEPIN 100MG CAP                                $6.66
5808993   58   FLUPHENAZINE 1MG TAB                             $4.94
5809009   58   FLUPHENAZINE 2.5MG TAB                           $5.36
5809017   58   TIMOLOL 5 MG TAB                                 $5.28
5809025   58   THIORIDAZINE 100 MG TAB                          $4.98
5809033   58   LOXAPINE 10MG CAP                                $6.27
5809041   58   LOXAPINE 5MG CAP                                 $5.35
5809066   58   HYDROXYZINE 100MG CAP                            $5.23
5809074   58   MAPROTILINE 50MG TAB                             $5.38
5809082   58   MULTI VITS/MIN/IRN TAB                           $5.04
5809090   58   CYCLANDELATE 200MG CAP                           $4.86
5809108   58   DESIPRAMINE 10MG TAB                             $5.40
5809116   58   DESIPRAMINE 50MG TAB                             $4.93
5809124   58   DEXAMETHASONE 1MG TAB                            $5.34
5809132   58   BUPROPION 75MG TAB                               $5.20
5809140   58   GUAIFENESIN SR 600MG TAB                         $5.43
5809165   58   SIMETHICONE 125 MG CAP                           $5.13
5809181   58   ZALCITABINE 0.375 MG TAB                         $8.54
5809199   58   LACTINEX TAB                                     $5.12
5809215   58   PROPANTHELINE 15 MG TAB                          $5.21
5809223   58   PHENELZINE 15 MG TAB                             $4.81
5809231   58   METHAZOLAMIDE 50 MG TAB                          $5.49
5809249   58   MOLINDONE 25 MG TAB                              $5.40
5809256   58   MEBENDAZOLE 100MG TAB                           $13.25
5809264   58   PERGOLIDE 0.05 MG TAB                            $5.18
5809272   58   PERGOLIDE 0.25 MG TAB                            $6.63
5809280   58   SERTRALINE 100 MG TAB                           $10.03


                                      Page 14 of 276
Charge #Dept   CDM Description                        Price
5809306   58   FLUCYTOSINE 500MG CAP                          $17.97
5809314   58   PERPHENAZINE 4 MG TAB                           $5.41
5809322   58   TOLBUTAMIDE 250 MG TAB                          $5.13
5809348   58   CHLORPROMAZINE 200MG TAB                        $6.32
5809421   58   TRILISATE 500 MG TAB                            $5.08
5809454   58   PANCREASE EC CAP                                $5.08
5809488   58   CEFUROXIME 125MG TAB                            $8.10
5809496   58   CHENODIOL 250MG TAB                             $6.16
5809520   58   CHLOROQUINE-PRIMAQUIN TAB                       $9.88
5809538   58   CHLOROTHIAZIDE 250MG TAB                        $5.15
5809553   58   CHLOROTRIANSENE 25MG CAP                        $7.79
5809603   58   BUTABARBITAL 30MG TAB                           $6.69
5809611   58   BUTABARBITAL 50MG TAB                           $7.50
5809629   58   ESGIC CAP                                       $7.49
5809645   58   ESGIC TAB                                       $6.90
5809652   58   CALCITRIOL 0.5MCG CAP                           $8.48
5809660   58   CALTRATE 600 W/VIT D TAB                        $5.10
5809686   58   CAPTOPRIL 100MG TAB                             $7.29
5809694   58   BETAXOLOL 10MG TAB                              $5.13
5809702   58   BETAXOLOL 20MG TAB                              $7.66
5809728   58   BROMOCRIPTINE 5MG CAP                          $15.15
5809744   58   BUPROPION 100MG TAB                             $6.14
5809751   58   BUSULFAN 2MG TAB                                $7.64
5809769   58   BUTABARBITAL 15MG TAB                           $4.89
5809793   58   BENZTROPINE 1MG TAB                             $5.26
5809801   58   PANCREASE MT 10 CAP                             $6.01
5809884   58   ASA 81MG EC TAB                                 $5.03
5809892   58   ALKA SELTZER BLUE TAB                           $5.17
5809918   58   ETRAFON 4/50 TAB                                $6.60
5809975   58   ACEBUTOLOL 400MG CAP                           $10.71
5810015   58   ACYCLOVIR 800MG TAB                            $14.06
5810031   58   ALTRETAMINE 50MG CAP                           $19.20
5810049   58   ETRETINATE 10MG CAP                             $8.73
5810056   58   ETRETINATE 25MG CAP                            $11.39
5810064   58   FELODIPINE 10MG TAB                             $7.71
5810080   58   FERROUS SULFATE 160MG TAB                       $5.17
5810106   58   FLUCYTOSINE 250MG CAP                          $11.02
5810122   58   FLUOXYMESTERONE 5MG TAB                         $8.46
5810130   58   FLUPHENAZINE 10MG TAB                           $7.41
5810148   58   FLURBIPROFEN 50MG TAB                           $5.34
5810155   58   FOSINOPRIL 20 MG TAB                            $5.50
5810171   58   GLYBURIDE 3MG TAB                               $6.52
5810189   58   HYDRALAZINE 100MG TAB                           $5.19
5810213   58   IMIPRAMINE 100MG CAP                           $10.41
5810221   58   ESTAZOLAM 1MG TAB                               $6.83
5810239   58   ESTRAMUSTINE 140MG CAP                         $12.04
5810247   58   ESTROPIPATE 2.5MG TAB                           $7.68
5810254   58   ETHACRYNIC ACID 25MG TAB                        $5.37
5810262   58   ETHINYL ESTRADIOL 0.02MG                        $5.42
5810270   58   ETHINYL ESTRADIOL 0.05MG                        $5.07
5810304   58   ISOCARBOXAZID 10MG TAB                          $5.06
5810312   58   ETIDRONATE 200MG TAB                           $10.99
5810320   58   ETIDRONATE 400MG TAB                           $17.97
5810379   58   GUANABENZ 8MG TAB                               $6.96
5810395   58   GUANETHIDINE 25MG TAB                           $6.15
5810429   58   LEVAMISOLE 50MG TAB                            $16.72
5810437   58   LEVOTHYROXINE 0.088MG TAB                       $5.42
5810460   58   THYROLAR 2 MG GR                                $5.29


                                     Page 15 of 276
Charge #Dept   CDM Description                       Price
5810478   58   TRIMIPRAMINE 25 MG CAP                         $5.28
5810486   58   IRON CPLX POLYSAC 150MG C                      $5.29
5810494   58   ISOSORBIDE DINIT 30MG TAB                      $6.66
5810502   58   ISOSORBIDE DINIT 5MG TAB                       $5.16
5810510   58   ISOTRETINOIN 10MG CAP                         $25.73
5810528   58   ISOTRETINOIN 20MG CAP                         $29.77
5810536   58   ISOTRETINOIN 40MG CAP                         $33.93
5810569   58   DIVALPROEX 500MG TAB                           $9.31
5810585   58   FLUOXETINE 10MG CAP                           $12.63
5810593   58   DOXEPIN 150MG CAP                              $7.29
5810601   58   DRONABINOL 2.5MG CAP                          $11.51
5810619   58   DRONABINOL 2.5MG(5MGCAP)                      $19.00
5810627   58   DRONABINOL2.5MG(10MGCAP)                      $33.87
5810635   58   ENALAPRIL 2.5 MG TAB                           $5.41
5810643   58   ENALAPRIL 20MG TAB                             $7.48
5810668   58   EPHEDRINE 25MG CAP                             $5.14
5810676   58   DIDANOSINE 150MG TAB                           $8.65
5810734   58   DIGOXIN 0.05MG CAP                             $5.25
5810759   58   DILTIAZEM 120 MG TAB                           $7.29
5810783   58   DEXTROAMPHETAMINE 5MG TAB                     $35.92
5810825   58   DIAZOXIDE 50MG CAP                             $6.93
5810833   58   DANOCRINE 50MG TAB                             $7.82
5810841   58   DANTROLENE 100MG CAP                           $8.44
5810858   58   DANTROLENE 50MG CAP                            $7.57
5810866   58   DAPSONE 100MG TAB                              $5.21
5810882   58   DESIPRAMINE 100 MG TAB                         $9.54
5810890   58   DESIPRAMINE 150MG TAB                         $12.03
5810916   58   CYANOCOBALAMIN 100MCG TAB                      $5.04
5810932   58   CYCLANDELATE 400MG CAP                         $5.18
5810940   58   CYCLOPHOSPHAMIDE 25MG TAB                      $8.52
5810957   58   COLCHICINE 0.5MG TAB                           $5.40
5811005   58   CLINDAMYCIN 300MG CAP                         $15.90
5811021   58   CLOZAPINE 100MG TAB                           $13.12
5811039   58   CLOZAPINE 25MG TAB                             $7.52
5811047   58   LIOTHYRONINE 25MCG TAB                         $4.76
5811054   58   MAGNESIUM OXIDE 400MG TAB                      $5.09
5811096   58   MELPHALAN 2MG TAB                              $8.37
5811104   58   MEPHENYTOIN 100MG TAB                          $5.35
5811112   58   MERCAPTOPURINE 50MG TAB                       $10.30
5811120   58   MESALAMINE 400MG TAB                           $6.20
5811138   58   MESORIDAZINE 100MG TAB                         $7.35
5811146   58   MESORIDAZINE 50MG TAB                          $6.27
5811161   58   METHIMAZOLE 10 MG TAB                          $5.14
5811211   58   METOLAZONE 10 MG TAB                           $5.45
5811229   58   MEXILETINE 250 MG CAP                          $6.23
5811237   58   LIOTHYRONINE 5MCG TAB                          $5.20
5811245   58   LITH CARB SR 450MG TAB                         $5.01
5811260   58   LOVASTATIN 40MG TAB                           $13.49
5811278   58   LOVASTATIN 10MG TAB                            $6.99
5811286   58   LOXAPINE 25MG CAP                              $7.35
5811294   58   LOXAPINE 50MG CAP                              $8.41
5811302   58   LYSINE 500MG TAB                               $5.04
5811310   58   ORAL CONTRACEPTIVE TAB                        $88.20
5811336   58   ILOPAN CHOLINE TAB                             $5.25
5811344   58   PAROMYCIN 250 MG CAP                           $9.25
5811377   58   PENICILLAMINE 125 MG CAP                       $5.22
5811385   58   RAMIPRIL 5 MG CAP                              $5.44
5811401   58   TRINSICON CAP                                  $5.49


                                    Page 16 of 276
Charge #Dept   CDM Description                        Price
5811419   58   PERPHENAZINE 8 MG TAB                            $6.29
5811427   58   PERPHENAZINE 2 MG TAB                            $5.03
5811450   58   PHENTERMINE 15 MG CAP                            $7.34
5811476   58   KCL 8MEQ SR TAB                                  $5.20
5811500   58   PRAVASTATIN 20 MG TAB                            $8.95
5811526   58   PRIMAQUINE TAB                                   $4.94
5811542   58   PROCAINAMIDE 1 GM SR TAB                         $6.42
5811583   58   PINDOLOL 10 MG TAB                               $7.08
5811641   58   PROMAZINE 25 MG TAB                              $5.45
5811674   58   PROPAFENONE 300 MG TAB                          $11.73
5811682   58   PROPANOLOL LA 160 MG TAB                         $8.32
5811690   58   PROTRIPTYLINE 10 MG TAB                          $5.13
5811724   58   QUINAPRIL 5 MG TAB                               $6.85
5811732   58   QUINAPRIL 40 MG TAB                              $6.57
5811740   58   RIFABUTIN 150 MG CAP                            $18.97
5811757   58   SCOPALAMINE 0.3 MG VIAL                         $37.20
5811781   58   SIMVASTATIN 20 MG TAB                           $13.57
5811807   58   SIMVASTATIN 5 MG TAB                             $8.09
5811815   58   MISOPROSTOL 100 MCG TAB                          $6.21
5811823   58   MOLINDONE 10 MG TAB                              $4.94
5811831   58   MOLINDONE 100 MG TAB                             $7.33
5811849   58   CISAPRIDE 10MG TAB                               $4.90
5811856   58   MOLINDONE 5 MG TAB                               $5.44
5811864   58   TRI VI FLOR 1 MG TAB                             $5.14
5811906   58   NALTEXONE 50 MG TAB                             $13.10
5811914   58   NEOSTIGMINE 15 MG TAB                            $4.94
5811955   58   NORTRIPTYLINE 75 MG CAP                         $19.66
5811963   58   OFLOXACIN 200 MG TAB                            $12.33
5812003   58   ONDANSETRON 8 MG TAB                            $80.51
5812029   58   TRAZADONE 150 MG TAB                             $6.94
5812037   58   SULFADIAZINE 500 MG TAB                          $6.61
5812086   58   THEOPHYLL ANH 50 MG CAP                          $5.17
5812094   58   THEOPHYLL ANH 50MG SR CAP                        $5.26
5812102   58   THEOPHYLL ANH 75 MG CAP                          $5.20
5812128   58   THEOPHYLL ANH 400MG SR TB                        $6.28
5812151   58   THIORIDAZINE 200 MG TAB                          $6.20
5812169   58   THIOTHIXENE 20 MG CAP                            $7.73
5812177   58   TIMOLOL 20 MG TAB                                $6.44
5812201   58   SOTALOL 80 MG TAB                               $10.57
5812219   58   VIT E 200 U CAP                                  $5.05
5812250   58   TRIMIPRAMINE 100 MG CAP                          $8.07
5812268   58   VERAPAMIL 40 MG TAB                              $5.32
5812276   58   TRIMIPRAMINE 50 MG CAP                           $6.80
5812318   58   LACTASE ENZYME TAB                               $5.18
5812326   58   VERAPAMIL 120 MG SR TAB                          $7.20
5812342   58   NYSTATIN ORAL TAB                                $7.22
5812383   58   ATENOLOL 25MG TAB                                $5.20
5812466   58   BACLOFEN 20MG TAB                                $6.76
5812490   58   LORATIDINE 10MG TAB                             $10.46
5812532   58   DIVALPROEX NA 125MG TAB                          $5.12
5812540   58   GUANFACINE 2MG TAB                              $11.42
5812557   58   MICONAZOLE 3 VAG SUP                           $109.66
5812565   58   PERPHENAZINE 16 MG TAB                           $7.07
5812581   58   ZALCITABINE 0.75 MG TAB                          $9.69
5812623   58   OXAPROZIN 600 MG TAB                             $8.60
5812649   58   GLYCERIN PED SUP                                $20.23
5812664   58   DES 50MG TAB                                     $7.68
5812698   58   MOLINDONE 50 MG TAB                              $6.51


                                     Page 17 of 276
Charge #Dept   CDM Description                        Price
5812706   58   TACRINE 10 MG CAP                               $7.06
5812714   58   TACRINE 20 MG CAP                               $6.20
5812763   58   METOPROLOL 50 MG SR TAB                         $5.41
5812771   58   ITRACONAZOLE 100MG CAP                         $24.62
5812797   58   RISPERIDONE 1 MG TABLET                        $11.81
5812805   58   ISOSORBIDE MONO 60MG TAB                        $8.73
5812847   58   RISPERIDONE 2 MG TABLET                        $16.23
5812854   58   RISPERIDONE 3 MG TABLET                        $18.36
5812862   58   RISPERIDONE 4 MG TABLET                        $23.29
5812870   58   MAALOX TABLET                                   $5.46
5812888   58   CYCLOSPORINE 25MG CAP                           $7.47
5812896   58   CYCLOSPORINE 100MG BRAND                       $17.87
5812912   58   VENLAFAXINE 25 MG TAB                           $7.81
5812920   58   VENLAFAXINE 37.5 MG TAB                         $7.77
5812938   58   VENLAFAXINE 50 MG TAB                           $7.72
5812946   58   VENLAFAXINE 75 MG TAB                           $7.94
5812953   58   VENLAFAXINE 100 MG TAB                          $8.36
5812961   58   GABAPENTIN 100MG CAP                            $5.08
5812979   58   GABAPENTIN 300MG CAP                            $7.40
5812987   58   GABAPENTIN 400MG CAP                            $7.94
5812995   58   CYCLOSPORINE M/EMUL 25MG                        $7.06
5813019   58   CYCLOSPORINE M/EMUL 100MG                      $16.21
5813043   58   TORSEMIDE 20 MG TAB                             $5.07
5813068   58   FLUVASTATIN 20MG CAP                            $8.38
5813092   58   FLUVASTATIN 40MG CAP                            $8.38
5813159   58   STAVUDINE 30 MG CAPSULE                        $16.63
5813167   58   STAVUDINE 40 MG CAPSULE                        $16.86
5813225   58   LORATADINE5MG/PSEUDO 120                        $7.64
5813233   58   FLUVOXAMINE 50MG TAB                           $10.66
5813241   58   FLUVOXAMINE 100MG TAB                          $10.88
5813258   58   NEFAZODONE 100 MG TAB                           $7.59
5813266   58   NEFAZODONE 150 MG TAB                           $6.48
5813274   58   NEFAZODONE 200 MG TAB                           $7.73
5813282   58   NEFAZODONE 250 MG TAB                           $7.80
5813357   58   VIT E 100 U CAP                                 $5.21
5813381   58   METHYSERGIDE 2 MG TAB                           $9.68
5813407   58   GANCICLOVIR 250MG CAP                          $12.23
5813415   58   LAMOTRIGINE 25MG TAB                            $7.31
5813423   58   LAMOTRIGINE 100MG TAB                           $8.37
5813431   58   LAMOTRIGINE 150MG TAB                           $8.59
5813449   58   LAMOTRIGINE 200MG TAB                           $8.81
5813456   58   NEVIRAPINE 200MG TAB                           $14.63
5813464   58   BETHANECHOL 5MG TAB                             $4.77
5813472   58   ERGOTAMINE 2MG TAB                             $15.35
5813589   58   METFORMIN 500MG TAB                             $5.39
5813597   58   METFORMIN 850MG TAB                             $4.99
5813605   58   METOPROLOL 100MG SR                             $6.83
5813613   58   TRAMADOL 50MG TAB                               $6.65
5813621   58   ZINC GLUCONATE 50MG TAB                         $5.03
5813639   58   GLIPIZIDE XL 5MG TAB                            $4.77
5813647   58   HYDROCORTISONE 5MG TAB                          $5.26
5813662   58   DIVALPROEX 125MG SPR CAP                        $5.13
5813704   58   DIDANOSINE 25MG TAB                             $5.36
5813712   58   DIDANOSINE 50MG TAB                             $5.08
5813738   58   DIDANOSINE 167MG PKT                           $11.30
5813746   58   DIDANOSINE 250MG PKT                           $14.93
5813787   58   LOSARTAN 25MG TAB                               $7.68
5813795   58   LOSARTAN 50 MG TAB                              $7.68


                                     Page 18 of 276
Charge #Dept   CDM Description                        Price
5813811   58   MIDODRINE 5MG TAB                              $10.16
5813829   58   GEMFIBROZIL 300MG                               $5.42
5813837   58   GEMFIBROZIL 600MG                               $6.88
5813845   58   THEOPHYLL ANH 75MG SR CAP                       $5.29
5813852   58   TYROSINE 500 MG TAB                             $5.13
5813860   58   NOVOBIOCIN 250MG CAP                            $8.52
5813878   58   HYDROXYZINE 100MG TAB                           $6.46
5813886   58   ERYTHROMYCIN 250MG CAP                          $4.77
5813894   58   FISH OIL CAPSULE 500MG                          $5.16
5813910   58   FISH OIL CAPSULE 1000MG                         $5.06
5813936   58   CHLOROQUIN 250MG TAB                            $5.06
5813944   58   CHLORZOXAZONE 250MG TAB                         $5.15
5813969   58   CAL CARB 1250 MG TAB                            $5.17
5813985   58   MG-PLUS PROTEIN 133MG TAB                       $5.06
5814041   58   BREAST MILK FORT0.95GM                         $27.67
5814058   58   GLYBURIDE 1.5MG TAB                             $5.12
5814066   58   GLYBURIDE 6MG TAB                               $7.55
5814074   58   LECITHIN 1.2GM CAP/TAB                          $5.06
5814082   58   SELENIUM 50MCG TAB                              $5.03
5814108   58   ALENDRONATE 10MG TAB                            $9.74
5814116   58   ALENDRONATE 40MG TAB                           $16.94
5814124   58   BIOTIN 800MCG                                   $5.03
5814132   58   MESALAMINE 250MG SR                             $5.46
5814165   58   OS-CAL 500+VITD TAB                             $5.07
5814181   58   WARFARIN 4 MG TAB                               $5.33
5814215   58   TACROLIMUS 1MG CAP                              $7.90
5814223   58   TACROLIMUS 5MG CAP                             $10.38
5814231   58   MYCOPHENOLATE 250MG CAP                        $10.47
5814249   58   CARVEDILOL 6.25MG TAB                           $7.82
5814264   58   CARVEDILOL 25MG TAB                             $7.82
5814280   58   LAMIVUDINE 150MG TAB                           $15.57
5814298   58   SAQUINAVIR 200MG CAP                            $6.93
5814306   58   ACARBOSE 50MG TAB                               $5.30
5814322   58   LANSOPRAZOLE 15MG CAP                          $13.74
5814330   58   LANSOPRAZOLE 30MG CAP                          $13.92
5814348   58   RILUZOLE 50MG TAB                              $35.82
5814447   58   RITONAVIR 100MG CAP                            $11.42
5814470   58   SUMATRIPTAN 25MG TAB                           $46.15
5814488   58   SUMATRIPTAN 50MG TAB                           $43.18
5814504   58   PANCREASE MT 20 CAP                             $8.03
5814546   58   BISOPROLOL 5MG TAB                              $6.71
5814553   58   BISOPROLOL 10MG TAB                             $6.71
5814579   58   NICOTINE PATCH 11MG                            $13.99
5814587   58   NICOTINE PATCH 22MG                            $14.85
5814611   58   COLESTIPOL 1GM TAB                              $4.99
5814637   58   LEVOCARNITINE 330MG TAB                         $5.45
5814645   58   THYROLAR 1 GR                                   $5.17
5814652   58   THYROLAR 3 GR                                   $5.25
5814660   58   LIOTHYRONINE 50MCG TAB                          $5.16
5814686   58   OMEPRAZOLE 10MG CAP                            $11.42
5814702   58   SINEMET-CR 25/100TAB                            $6.20
5814744   58   GAVISCON - 2 CHEW TAB                           $5.16
5814793   58   ESTRADIOL 0.075MG PATCH                        $10.35
5814835   58   TERAZOSIN 1MG CAP                               $6.48
5814850   58   TERAZOSIN 5MG CAP                               $6.48
5814876   58   PERGOLIDE 1MG TAB                              $12.34
5814884   58   SELEGILINE 5MG CAP                              $9.40
5814918   58   GRANISETRON 1MG TAB                            $98.10


                                     Page 19 of 276
Charge #Dept   CDM Description                        Price
5814942   58   AUGMENTIN 875MG TAB                            $16.77
5814975   58   MEFLOQUINE 250MG TAB                           $29.86
5815006   58   OLANZAPINE 5MG                                 $20.80
5815022   58   OLANZAPINE 10MG                                $28.05
5815030   58   CREON CAPSULE                                   $4.77
5815048   58   TERBINAFINE 250MG TAB                          $25.55
5815055   58   TRIAM/HCTZ 50/25 CAP                            $5.32
5815089   58   ZAFIRLUKAST 20MG TAB                            $6.91
5815121   58   BENAZEPRIL 40MG TAB                             $6.34
5815139   58   CAFFEINE 100MG TAB                              $5.09
5815147   58   CAFFEINE 200MG TAB                              $5.08
5815170   58   TIZANIDINE 4MG TAB                              $7.26
5815188   58   TOPIRAMATE 100MG TAB                           $14.00
5815212   58   CABERGOLINE 0.5MG TAB                          $80.93
5815238   58   DONEPEZIL 5MG TAB                              $14.84
5815246   58   DONEPEZIL 10MG TAB                             $15.00
5815253   58   TOPIRAMATE 25MG TAB                             $7.67
5815261   58   FEXOFENADINE 60MG CAP                           $6.37
5815287   58   WARFARIN 3 MG TAB                               $5.49
5815295   58   WARFARIN 6 MG TAB                               $6.37
5815303   58   THEOPHYLL ANH 600MGSR TAB                       $6.60
5815337   58   MIRTAZAPINE 15MG TAB                           $10.59
5815345   58   MIRTAZAPINE 30MG TAB                           $10.79
5815394   58   ALBENDAZOLE 200MG TAB                           $7.29
5815402   58   ATORVASTATIN 10MG TAB                           $9.43
5815410   58   ATORVASTATIN 20MG TAB                          $11.09
5815436   58   BUPROPION 100MG SR TAB                          $8.22
5815444   58   BUPROPION 150MG SR TAB                          $6.71
5815451   58   INDINAVIR 200MG CAP                             $6.79
5815469   58   INDINAVIR 400MG CAP                            $10.34
5815493   58   CARBAMAZEPINE XR 100MG                          $5.26
5815501   58   CARBAMAZEPINE XR 200MG                          $4.89
5815527   58   DESMOPRESSIN 0.1MG TAB                         $10.71
5815576   58   NELFINAVIR 250MG TAB                            $8.51
5815584   58   VALSARTAN 80MG CAP                              $7.58
5815592   58   VALSARTAN 160MG CAP                             $7.85
5815600   58   DELAVIRDINE 100MG TAB                           $5.32
5815667   58   PRAMIPEXOLE 0.25MG TAB                          $6.63
5815683   58   PRAMIPEXOLE 1.5MG TAB                           $8.64
5815691   58   CARVEDILOL 3.125MG TAB                          $7.82
5815709   58   RISPERIDONE 0.5MG TAB                          $11.35
5815725   58   AZITHROMYCIN 250MG TAB                         $20.25
5815733   58   AZITHROMYCIN 600MG TAB                         $45.52
5815758   58   GLIMEPIRIDE 1MG TAB                             $5.45
5815881   58   PAROXETINE 10MG TAB.                           $10.12
5815907   58   TAMSULOSIN 0.4MG CAP                            $8.27
5815915   58   MAGNESIUM OXIDE 250MG TAB                       $5.02
5815923   58   LEVOFLOXACIN 500MG TAB                         $27.56
5815931   58   LEVOFLOXACIN 250MG TAB                         $24.58
5815964   58   DHEA 25MG CAP                                   $5.10
5815980   58   QUETIAPINE 25MG TAB                             $7.94
5815998   58   QUETIAPINE 100MG TAB                           $10.90
5816038   58   METHYLPRED 2MG TAB                              $4.98
5816046   58   MIBEFRADIL 50MG TAB                             $6.55
5816079   58   SEVELAMER 403MG CAP                             $5.15
5816087   58   TOLTERODINE 1MG TAB                             $7.94
5816111   58   TIAGABINE 4MG TAB                               $6.60
5816178   58   TESTOSTERONE PATCH 2.5MG                        $7.67


                                     Page 20 of 276
Charge #Dept   CDM Description                         Price
5816269   58   RALOXIFENE 60MG TAB                              $10.03
5816277   58   REPAGLINIDE 2MG TAB                               $6.58
5816285   58   TROVAFLOXACIN 100MG TAB                          $16.21
5816293   58   TROVAFLOXACIN 200MG TAB                          $18.78
5816319   58   CLOPIDOGREL 75MG TAB                             $13.36
5816335   58   ROPINIROLE 1MG TAB                                $7.25
5816343   58   TOLTERODINE 2MG TAB                               $8.05
5816368   58   MONTELUKAST 10MG TAB                             $10.56
5816376   58   PILOCARPINE 5MG TAB                               $7.60
5816384   58   PLACEBO CAPSULE                                   $5.38
5816400   58   DILTIAZEM ER 120MG                                $6.65
5816426   58   DILTIAZEM ER 180MG                                $7.18
5816434   58   DILTIAZEM ER 240MG                                $7.72
5816442   58   DILTIAZEM ER 300MG                                $9.83
5816459   58   ETODOLAC CR 400MG                                 $7.41
5816467   58   FOLIC ACID 0.4MG TAB                              $5.02
5816475   58   FOSFOMYCIN 3GM PKT                               $80.00
5816491   58   TOLCAPONE 100MG TAB                               $9.67
5816509   58   VENLAFAXINE XR 37.5MG                            $10.34
5816517   58   VENLAFAXINE XR 75MG                              $11.10
5816525   58   VITAMIN D 400 I.U.                                $5.02
5816541   58   CITRACAL                                          $5.07
5816558   58   CITRACAL+D                                        $5.11
5816616   58   DIVALPROEX ER 250MG TAB                           $6.71
5816624   58   VORICONAZOLE 200MG TAB                           $77.68
5816640   58   NAFAZODONE 50MG TAB                               $7.51
5816681   58   CITALOPRAM 20MG TAB                               $9.69
5816707   58   CELECOXIB 100MG CAP                               $7.99
5816715   58   EFAVIRENZ 200MG CAP                              $15.10
5816731   58   LEFLUNOMIDE 20MG TAB                             $37.48
5816756   58   MONTELUKAST 5MG TAB                              $23.68
5816806   58   LEVETIRACETAM 500MG TAB                           $9.16
5816822   58   CELECOXIB 200MG TAB                              $10.54
5816863   58   DIVALPROEX ER 500MG TAB                           $8.20
5816905   58   METFORMIN XR 500MG TAB                            $5.37
5816921   58   DOLASETRON 100MG TAB                            $156.48
5816939   58   HC CYPIONATE SUSP                                 $5.24
5816947   58   IRBESARTAN 150MG TAB                              $7.53
5816954   58   OXCARBAZEPINE 300MG TAB                           $8.59
5816988   58   GLIPIZIDE XL 2.5MG TAB                            $4.77
5816996   58   TOLTERODINE LA 2MG CAP                           $10.77
5817010   58   ARIPIPRAZOLE 5MG CAP                             $27.02
5817085   58   RISPERIDONE 1MG DSLV TAB                         $12.97
5817093   58   OPERAMIDE LIQ 2MG/10ML                           $20.93
5817101   58   EXCEDRIN EX STR TAB                               $5.07
5817119   58   LETROZOLE 2.5MG TAB                              $21.68
5817127   58   DITROPAN XL 5MG TAB                              $10.97
5817150   58   ZONISAMDIE 100MG CAP                              $8.60
5817176   58   VALACYCLOVIR 1GM TAB                             $15.30
5817184   58   MEMANTINE 5MG TAB                                 $8.88
5817242   58   MEMANTINE 10MG TAB                                $8.88
5817333   58   OLANZAPINE 15MG SL TABLET                        $30.86
5817358   58   ESCITALOPRAM 10MG TABLET                          $8.86
5817432   58   VITAMIN E 100I.U.CAP                              $5.02
5817440   58   TOPIRAMATE 15MG SPRK                              $7.47
5817507   58   REPAGLINIDE 1MG TAB                               $6.58
5817622   58   AGGRENOX 200/25 CAP                               $8.78
5817671   58   IVERMECTIN 3MG TAB                               $14.88


                                      Page 21 of 276
Charge #Dept   CDM Description                       Price
5817697   58   DUTASTERIDE 0.5MG CAP                           $9.97
5817804   58   METAXALONE 400MG TAB                            $6.81
5817879   58   LINEZOLID 600MG TAB                           $139.27
5817895   58   ROSIGLITAZONE 2MG TAB                           $8.40
5817903   58   ROSIGLITAZONE 4MG TAB                          $10.28
5817937   58   ABACAVIR 300MG TAB                             $19.55
5817978   58   RIBAVARIN 200MG CAP                            $13.52
5818018   58   ZIPRASIDONE 20MG CAP                           $14.27
5818026   58   PANTOPRAZOLE 40MG TAB                          $11.90
5818034   58   ALENDRONATE 70MG TAB                           $44.18
5818042   58   ANAGRELIDE 0.5MG TAB                           $17.03
5818059   58   RABEPRAZOLE 20MG TAB                           $13.65
5818067   58   TIAGABINE 2MG TAB                               $6.60
5818083   58   RIVASTIGIMINE 1.5MG TAB                         $9.77
5818109   58   VALACYCLOVIR 500MG TAB                         $14.49
5818166   58   ENTACAPONE 200MG TAB                            $8.23
5818224   58   TESTOST TRNSDRM PATCH 5MG                      $11.34
5818232   58   MONTELUKAST 4MG TAB                            $10.56
5818265   58   OSELTAMIVIR 75MG CAP                           $19.32
5818356   58   PIOGLITAZONE 15MG TAB                          $11.54
5818364   58   PIOGLITAZONE 30MG TAB                          $16.06
5818380   58   GATIFLOXACIN 200MG TAB                         $23.45
5818398   58   GATIFLOXACIN 400MG TAB                         $23.45
5818463   58   ARIPIPRAZOLE 10MG CAPSULE                      $27.02
5818471   58   TRIMETHOBENZ 300MG CAP                          $6.25
5819008   58   ROPINIROLE 0.25MF TAB                           $6.03
5819040   58   DULOXETINE 20MG CAP                            $10.35
5819057   58   DULOXETINE 30MG CAP                            $11.13
5819065   58   DULOXETINE 60MG CAP                            $11.13
5819073   58   EZETIMIBE 10MG TAB                              $9.70
5819081   58   EPLERENONE 25MG TAB                            $11.88
5819099   58   EPLERENONE 50MG TAB                            $11.88
5819107   58   SILDENAFIL 25MG TAB                            $26.33
5819123   58   VALSARTAN 40MG TAB                              $6.99
5820014   58   THALIDOMIDE 50MG CAP                           $20.43
5820022   58   CRANBERRY EXTRCT 400MG CP                       $5.10
5820030   58   GLUCOSAMINE 500MG CAP                           $5.23
5820048   58   CHROMAGEN FORTE TAB                             $5.05
5820055   58   RIBOFLAVIN 100MG TAB                            $5.04
5820063   58   TEGASEROD 6MG TAB                               $8.07
5820071   58   THIABENDAZOLE 500MG TAB                         $6.52
5820089   58   VALGANCICLOVIR 450MG TAB                       $70.10
5820097   58   OLANZAPINE SL 20MG TAB                         $49.59
5830005   58   MICONAZOLE2%PWDR 90GM                          $20.12
5830013   58   FURACIN CR 28GM                                $36.80
5830021   58   ELIMITE CRM 60GM                               $92.86
5830039   58   TRIAMCIN OINT 0.1% 80 GM                       $22.50
5830047   58   DIPROLENE GEL 15GM                            $105.62
5830054   58   PRAMASONE LOT 60ML                            $124.60
5830062   58   ULTRAVATE CR 0.05% 45 GM                       $87.20
5830070   58   NAFTIN CR 1% 30 GM                             $86.96
5830088   58   LOTRISONE CR 45GM                             $143.20
5830096   58   AVITENE 1GM                                   $728.12
5830104   58   LIDOCAINE 4% 50ML TOP SOL                      $28.32
5830112   58   TOPICORT 0.05% GEL 15 GM                       $50.20
5830120   58   THROMBIN 1000U VL                              $49.52
5830138   58   THROMBIN 5000U VL                             $104.76
5830153   58   GLY-OXIDE 15ML                                 $29.26


                                    Page 22 of 276
Charge #Dept   CDM Description                         Price
5830161   58   ORABASE PLAIN 5 GM                               $26.60
5830179   58   HURRICAINE SPR                                   $67.60
5830187   58   HC LOT 0.5% 60ML                                 $27.00
5830203   58   HC OITN 0.5% 30GM                                $23.20
5830211   58   PRAMEGEL 118 ML                                  $22.30
5830229   58   FLUOCINONIDE 0.05% OI 15G                        $52.82
5830237   58   MANTADIL CR 15GM                                 $57.88
5830245   58   MICONAZOLE-7 VAG TABS                            $35.70
5830252   58   NEO/POLY/BACI OINT 15 GM                         $23.60
5830278   58   HC 2.5% LOT 60ML                                $126.26
5830294   58   BACITRACIN OINT UD                                $5.08
5830302   58   A & D OINT 1.5OZ                                 $24.68
5830310   58   TOPICORT LP 0.05% CR 15GM                        $50.90
5830328   58   FURACIN CR 14GM                                  $25.82
5830344   58   BENZOIN TINC 60ML                                $21.20
5830351   58   CORTENEMZ 100MG                                  $26.34
5830369   58   TRIPLE SULFA VAG CRM                             $23.07
5830377   58   NYSTATIN VAG TAB 15 PAK                          $23.67
5830385   58   DEBRISAN 7X 4GM                                  $26.96
5830401   58   AMERICAINE SPRAY 60GM                            $27.40
5830419   58   NEOSPORIN OINT UD                                 $5.08
5830427   58   NEOSPORIN POWDER                                 $32.40
5830435   58   NEOSPORIN CRM 15 GM                              $27.34
5830443   58   CALAMINE LOT 120ML                               $23.58
5830450   58   ANUSOL HC CRM                                    $78.76
5830468   58   AVC CREAM                                        $91.72
5830476   58   BEN GAY 37GM GREASELESS                          $25.00
5830484   58   ANUSOL OINT                                      $27.92
5830492   58   CALADRYL LOT 6OZ                                 $26.52
5830500   58   DOMEBORO PKT                                      $5.05
5830518   58   CALADRYL LOT 75ML                                $25.36
5830526   58   CHLORASEPTIC SPRAY 6 OZ                          $27.50
5830534   58   CORTISPORIN OINT 15GM                            $96.66
5830542   58   DEBRISAN BEADS 60GM                             $108.68
5830559   58   DEBRISAN 14 X 4GM                                $10.72
5830567   58   CETACAINE SPRAY                                 $127.00
5830575   58   DERMOPLAST SPRAY                                 $26.92
5830583   58   DESITIN OINT 1OZ                                 $24.54
5830609   58   FURACIN DRESSING 28GM                            $29.14
5830617   58   FURACIN DRESSING 57GM                            $54.04
5830625   58   ELASE OINT 30GM                                  $84.90
5830633   58   ACYCLOVIR 5% OINT 15GM                          $105.60
5830641   58   CENTAMICIN CR 15GM                               $27.44
5830658   58   GELFOAM 12 X 7                                   $27.73
5830666   58   GELFOAM #100                                     $95.92
5830674   58   GRANULEX SPRAY                                   $40.55
5830690   58   MICONAZOLE-7 VAG CRM                             $35.70
5830724   58   TRIAMCIN OINT 0.1% 15GM                          $27.20
5830732   58   PROSTIN E2 GEL                                  $216.00
5830740   58   TRIAMCIN CRM 0.1% 80GM                           $20.10
5830757   58   FLUOCINONIDE 0.05% CR 15G                        $27.94
5830773   58   PETROLATUM OINT 30 GM                            $22.60
5830799   58   NYSTATIN CRM 15 GM                               $23.76
5830807   58   NYSTATIN/TRIAM 15 GM CRM                         $29.20
5830815   58   NYSTATIN/TRIAM 30 GM CRM                         $24.18
5830823   58   LINDANE LOT 60ML                                 $26.70
5830831   58   LINDANE SHAMPOO 60ML                             $28.10
5830849   58   NYSTATIN TOP POWD                                $71.02


                                      Page 23 of 276
Charge #Dept   CDM Description                         Price
5830856   58   NEO/POLY/BACI OINT 30 GM                         $25.20
5830864   58   NTG OINT 2% 30 GM                                $21.74
5830872   58   CLOTRIMAZOLE SOLN 10ML                           $38.58
5830880   58   DIBUCAINE OINT 30GM                              $23.56
5830898   58   POLY/BACI OINT 15 GM                             $25.20
5830906   58   SILVER SULFDIAZINE 400 GM                        $80.16
5830914   58   SILVER SULFADIAZINE 50 GM                        $20.50
5830930   58   FLUOCINOLONE CR .025 15GM                        $24.86
5830948   58   TOLNAFTATE CR 15 GM                              $24.80
5830955   58   TRAVASE OINT 15 GM                               $93.88
5830963   58   DESONIDE CR 15GM                                 $40.94
5830971   58   TUCKS PADS 40                                    $23.74
5830989   58   BETAMETH VAL 0.1% CR 15GM                        $22.12
5830997   58   CALCIPOTRIENE OINT30GM                          $108.14
5831003   58   BETAMETH VAL 0.1% CR 45GM                        $27.92
5831011   58   IODOCHL 3%/HYDRO 1%                             $143.50
5831029   58   LIDOCAINE JELLY                                  $51.26
5831037   58   ZN OXIDE OINT 30 GM                              $22.36
5831052   58   ETHYL CHLORIDE 4OZ                               $43.12
5831060   58   FLUOROURACIL CR 5%                              $214.26
5831078   58   ELASE/CHLORO 30GM                                $91.60
5831086   58   DIPROSONE OINT 0.05% 15GM                        $64.84
5831094   58   DOMEBORO TAB                                      $5.05
5831102   58   DIPROSONE CR 0.05% 15GM                          $68.78
5831110   58   CORDRAN TAPE 24"                                 $39.88
5831128   58   HC LOT 1% 60ML                                   $44.70
5831136   58   PROCTOFOAM HC                                    $91.56
5831144   58   PREP H OINT 30 GM                                $29.16
5831151   58   TETRACAINE SOL 2% 30 ML                          $56.76
5831169   58   LANACANE 30GM CR                                 $25.62
5831177   58   GENT VIO 1% 30ML                                 $27.16
5831193   58   HALCINONIDE CR 15GM                              $58.04
5831201   58   ADRENALIN TOP 30ML                               $45.38
5831219   58   TRIAMCIN SPRAY 63 GM                             $79.84
5831227   58   PREMARIN CR/APP                                 $161.88
5831235   58   ALPHA KERI OIL                                   $27.96
5831243   58   ALPHA KERI LOT 3.75OZ                            $29.60
5831250   58   HALCINONIDE CR 60GM                             $141.30
5831268   58   SELENIUM 1% SHAM 120 ML                          $26.60
5831276   58   NYSTATIN CR 30 GM                                $26.10
5831284   58   TOLNAFTATE SOLN 10 ML                            $26.00
5831292   58   CLOTRIMAZOLE VAG CR 45GM                         $76.74
5831300   58   TRETINOIN 0.05% LIQ 28 ML                       $182.62
5831318   58   AVEENO BATH 8 PKT                                 $4.95
5831334   58   TRIAMCIN LOT 0.1% 15 ML                          $37.44
5831342   58   TRIAMCIN CRM 0.025% 15 GM                        $26.00
5831359   58   LOTRISONE CR 15GM                                $71.86
5831367   58   FLUORIMETHANE SPRAY                              $73.77
5831375   58   BACITRACIN OINT 30GM                             $23.52
5831383   58   GELFOAM SZ 50                                    $67.48
5831391   58   LIDOCAINE 5% OINT                                $44.68
5831409   58   TCN 3% OINT 30 GM                                $32.22
5831417   58   MICONAZOLE CR 15 GM                              $24.72
5831425   58   RIMSO-50 50 ML VIAL                             $130.00
5831433   58   CORTISPORIN CR 7.5GM                             $73.36
5831466   58   HC OINT 1% 30GM                                  $23.84
5831474   58   KETOCONAZOLE CRM 30GM                            $80.58
5831482   58   HALCINONIDE OINT 15GM                            $58.04


                                      Page 24 of 276
Charge #Dept   CDM Description                        Price
5831490   58   NYSTATIN/TRIAM 30 GM OINT                       $24.18
5831508   58   NYSTATIN/TRIAM 15 GM OINT                       $29.20
5831516   58   GENTAMICIN OINT 15GM                            $27.44
5831524   58   HALCINONIDE OINT 60GM                          $141.30
5831532   58   HC CRM 0.5% 30GM                                $23.20
5831540   58   HC CRM 1% 30GM                                  $24.72
5831557   58   MAFENIDE CR 120GM                               $67.12
5831565   58   PHISODERM 150 ML                                $26.84
5831573   58   DIENESTROL CRM/APP                              $78.00
5831581   58   DESENEX POWDER 90GM                             $21.29
5831599   58   DESENEX OINT 30GM                               $24.80
5831607   58   DEXAMETH CRM 0.1% 15GM                          $33.50
5831615   58   SURGILUBE 60 GM                                 $22.60
5831623   58   SILVER NITRATE STICKS/10                        $22.21
5831631   58   CLOTRIMAZOLE 1% CRM 15GM                        $42.42
5831649   58   NYSTATIN OINT 15 GM                             $23.84
5831656   58   TRETINOIN 0.05% CRM 20 GM                      $141.88
5831664   58   TRIAMCIN LOT 0.025% 60ML                        $98.44
5831672   58   TRIAMCIN CRM 0.025% 80 GM                       $20.50
5831680   58   TRIAMCIN OINT 0.025% 15GM                       $22.70
5831698   58   TRIAMCIN CRM 0.1% 15 GM                         $27.20
5831706   58   TRIAMCIN OINT 0.025% 80GM                       $20.50
5831714   58   MOMETASONE OINT 45 GM                          $122.22
5831730   58   CLORPACTIN WCS-90 2GM                           $27.80
5831755   58   TOPICORT 0.25% CR 15 GM                         $56.30
5831763   58   TOPICORT 0.25% OINT 15 GM                       $55.88
5831771   58   CAPSAICIN 0.25% CR 45 GM                        $50.60
5831789   58   VIT E CRM 2 OZ                                  $27.58
5831797   58   TANNIC ACID 5% OINT 30 GM                       $22.00
5831805   58   CLOBETASOL 0.05% OIN 15GM                       $89.52
5831813   58   CLOBETASOL 0.05% OIN 30GM                      $120.04
5831821   58   CLOBETASOL 0.05% CR 15GM                        $89.52
5831839   58   CLOBETASOL 0.05% CR 30GM                       $120.04
5831847   58   TERCONAZOLE 7 VAG CR 45GM                       $52.60
5831862   58   THROMBIN 20,000 UNIT VIAL                      $275.96
5831870   58   SELENIUM 2.5% SHAM 120 ML                       $23.90
5831888   58   POLY/BACI POWDER 10 GM                          $32.40
5831896   58   KETOCONAZOLE SHAM 4OZ                           $71.76
5831904   58   LIDEX-E CR 30GM                                 $69.38
5831912   58   GELFILM 25X50MM                                 $92.58
5831920   58   GELFOAM POWDER 1GM                             $146.82
5831938   58   HC 2.5% TOP CR 60GM                            $134.52
5831946   58   TRIAM/DENTAL PASTE 5 GM                         $22.80
5831953   58   DUODERM 4X4- 5 PAK                              $63.32
5831961   58   DUODERM 8X8- 3 PAK                             $112.78
5831979   58   MOMETASONE 0.1% CR 15 GM                        $71.28
5831987   58   MOMETASONE 0.1% CR 45 GM                       $122.22
5832001   58   MOMETASONE 0.1% LOT 30 ML                       $76.40
5832019   58   MOMETASONE 0.1% OINT 15GM                       $71.28
5832035   58   TRIAMCIN LOT 0.1% 60 ML                         $29.48
5832043   58   NYSTATIN/TRIAM 60 GM CRM                        $34.12
5832068   58   COLLAGEN POWDER 1GM                            $161.25
5832076   58   PERMETHRIN 1% 60 ML SOLN                        $28.40
5832084   58   ECONAZOLE 1% 30GM                               $91.12
5832092   58   CAMPHO PHENIQUE GEL 0.5OZ                       $26.62
5832100   58   MENTHOLATUM 30GM                                $23.76
5832118   58   TOLNAFTATE CR 30 GM                             $26.90
5832124   58   LIDOCAINE JELLY URO-JET                         $29.24


                                     Page 25 of 276
Charge #Dept   CDM Description                        Price
5832159   58   EPSOM SALT GRAN                                 $22.34
5832183   58   BETAMETH DIP O 0.05% 45                         $60.92
5832217   58   BETAMETH VAL .1% OINT 15G                       $22.62
5832225   58   BETAMETH VAL .1% OINT 45G                       $29.56
5832233   58   STR IODINE SOLN 480 ML                          $21.03
5832241   58   CLINDA 1% TOP SOLN 30ML                         $66.68
5832290   58   POLY/BACI OINT 30 GM                            $23.34
5832332   58   CARRINGTON 90GM GEL                             $46.52
5832340   58   BUTACONAZOLE 28GM VAG CR                        $48.52
5832423   58   BENZOYL PEROX 10% GEL 45G                       $36.66
5832431   58   BENZOYL PEROX 5% GEL 45GM                       $36.12
5832456   58   BETAMETHASONE DIP 60ML LT                       $70.98
5832464   58   BETAMETHASONE VAL 60ML LT                       $36.26
5832506   58   FLUOCINOLONE AC .01% CRM                        $49.44
5832514   58   FLUOCINOL AC 0.01% 15GM                         $29.58
5832522   58   FLUOCINONIDE 0.05% 30GM C                       $36.04
5832548   58   FLUOCINONIDE 0.05% 30GM O                       $69.38
5832563   58   FLUOCINONIDE EMOL CRM 15G                       $52.82
5832571   58   FLUORURACIL 1% CRM 30GM                        $220.42
5832589   58   FLUOROURACIL 1% SOLN 30ML                      $161.22
5832597   58   CORDRAN SP 0.025%CR30GM                         $48.28
5832621   58   HYDROCORT 10% FOAM 20 GM                       $127.68
5832639   58   HC 2.5% CRM 30GM                                $87.90
5832654   58   HC LOT 1% 120ML                                 $27.50
5832688   58   ESTRADIOL VAG CRM 42.5GM                        $98.40
5832696   58   ESTROPIPATE VAG CRM 45GM                       $105.34
5832712   58   HALCINONIDE OINT 30GM                           $87.20
5832720   58   HALCINONIDE CRM 30GM                            $87.20
5832746   58   TROLAMINE CRM 10% 60 GM                         $26.50
5832779   58   MASSENGILL DOUCHE 6OZ                           $22.00
5832795   58   TRIAMCIN HP CRM 0.5% 15GM                       $77.72
5832829   58   TRIPLE DYE 0.5 ML                                $5.23
5832936   58   TUCKS CREAM 40 GM                               $27.78
5833124   58   EPIFOAM 10GM                                    $48.96
5833207   58   METRONIDAZOLE TOP GEL                          $169.00
5833223   58   MEPIVICAINE 1% 50ML VL                          $82.48
5833231   58   MEPIVICAINE 2% 20ML VL                          $25.46
5833249   58   MEPIVICAINE 2% 50ML VL                          $93.08
5833298   58   LIDOCAINE ORAL SPRAY                            $89.50
5833330   58   VIOFORM HC CRM 20 GM                            $20.02
5833355   58   CLOTRIMAZOLE LOT 30ML                           $72.12
5833363   58   CLOTRIMAZOLE 1% CRM 30GM                        $48.94
5833371   58   CLOTRIMAZOLE 1% SOL 30ML                        $49.72
5833397   58   COAL TAR 30% 180ML                              $78.29
5833413   58   ERYTHROMYCIN 2% 120ML TS                        $46.66
5833439   58   BENZAMYCIN GEL 23GM                            $139.68
5833496   58   CROTAMITON 10% CRM 60GM                         $36.72
5833504   58   CROTAMITON 10% LOT 60ML                         $38.48
5833512   58   EUCERIN CRM 120GM                               $22.77
5833553   58   TOPICORT .05% CRM 60 GM                         $94.16
5833587   58   DIPHENHYD 1% CRM 15GM                           $25.86
5833678   58   EMLA CREAM 5GM                                  $27.88
5833702   58   THROMBIN 10000 U VIAL                          $182.52
5833710   58   NTG OINT 1 GM PKT                                $5.00
5833736   58   A & D OINT 5GM PKT                               $5.12
5833744   58   CALMOSEPTINE OINT 71GM                           $5.00
5833769   58   FLUOCINONIDE 0.05%LOT60ML                       $54.74
5833827   58   CORDRAN 0.05% OINT 30GM                         $58.86


                                     Page 26 of 276
Charge #Dept   CDM Description                      Price
5833843   58   COLLAGENASE 15GM OINT                         $69.90
5833850   58   PRAMOXINE FOAM 15 GM                          $28.56
5833884   58   VIT E TOP OIL 30 ML                           $23.58
5833892   58   COLLODION 120ML                               $22.38
5833934   58   ELASE OINT 10GM                               $41.22
5833959   58   GLYCERIN 60ML                                 $23.00
5833967   58   KETOCONAZOLE 2% CRM 15GM                      $51.92
5833975   58   NYSTAT/TRIAM CR 1.5GM PKT                      $5.25
5834007   58   ANBESOL 9ML LIQ                               $29.80
5834015   58   CAPSAICIN HP CR 30GM                          $63.56
5834080   58   DIPHENHYDRAMINE 1% SPRAY                      $28.48
5834163   58   HC VALER 0.2% CRM 120GM                       $45.06
5834254   58   HIBICLENS IRR 0.025% 1L                       $40.03
5834312   58   SILVER NIT 0.25% IRR 1 L                      $20.10
5834320   58   PROCTO CREAM HC 1 OZ                          $92.08
5834387   58   EMLA CREAM 30GM                               $23.63
5834536   58   TERBINAFINE 1%CRM 15GM                        $26.30
5834569   58   DINOPROSTONE VAG INSERT                      $460.12
5834577   58   LEECH                                         $54.00
5834619   58   ALOE VERA GEL 4OZ                             $25.98
5834643   58   THIMEROSAL 120ML                              $34.23
5834650   58   DIPHENHYD 1% CRM 30GM                         $27.80
5834684   58   CORDAN 0.05% OINT 15GM                        $44.56
5834692   58   CORDAN 0.05% OINT 60GM                       $100.76
5834718   58   CORDAN 0.05% LOTION 60ML                      $80.86
5834726   58   CORDAN SP 0.05% CRM 30 GM                     $58.86
5834734   58   CORDAN SP 0.05% CRM 60GM                     $100.76
5834759   58   GELFOAM CONE SIZE 13                          $86.44
5834775   58   AQUAPHOR OINT 30GM                            $21.72
5834809   58   SURGILUBE PKT                                  $5.33
5834817   58   DESNEEX SPRAY 45GM                            $28.86
5834858   58   MINERAL OIL 2ML VIAL                           $8.18
5834866   58   NEOMYCIN 0.5% OINT 30GM                       $12.54
5834874   58   FLUCINOLONE AC0.025%OIN15                     $38.54
5834924   58   CLIOQUINOL 3% CRM 30GM                        $40.72
5834940   58   DIBUCAINE 0.5% CRM 45GM                       $26.52
5834957   58   BENZOYL PEROX10%WASH 15ML                     $44.29
5834965   58   BENZOYL PEROX10%LOT 30ML                      $25.58
5834973   58   BENZOYL PEROX 10%BAR SOAP                     $28.00
5834999   58   XENADERM OINTMENT 60GM                       $136.08
5835004   58   BENZOYL PEROX10%WASH 120M                     $29.82
5835012   58   BETAMTHASONE DIO 85GM AER                     $61.94
5835020   58   BLISTEX OINT 6GM                              $22.44
5835038   58   CAMPHO-PHENIQUE 45ML                          $20.08
5835053   58   CETAPHIL LOTION 240ML                         $22.24
5835061   58   COAL TAR 5% GEL 90GM                          $45.44
5835079   58   COMPOUND W 9.3 ML                             $21.44
5835087   58   AVEENO BAR                                    $23.12
5835111   58   BENZOYL PEROX5%LOT.30ML                       $24.20
5835129   58   BENZOYL PEROX 5% BAR SOAP                     $29.26
5835137   58   BENZOCAINE 20% OINT 30GM                      $24.60
5835152   58   ALCLOMETASONE0.05%CRM15GM                     $55.34
5835194   58   AVITENE WEB 70X35                            $203.75
5835228   58   CELLULOSE POWDER 60GM                         $26.26
5835244   58   AMMONIUM LACT.12%LOT150ML                     $20.39
5835251   58   LINDANE CRM 60GM                              $35.76
5835327   58   CLINDAMYCIN2%VAG CRM40GM                     $123.92
5835350   58   METRONIDAZOLE VAG GEL70GM                     $88.50


                                   Page 27 of 276
Charge #Dept   CDM Description                        Price
5835392   58   CIDOFOVIR 75MG/ML AMP                          $3,128.00
5835616   58   TALC STERILE PKT                                $230.00
5835681   58   AVEENO LOTION 240ML                               $29.65
5835699   58   PREP H CRM 27GM                                   $28.49
5835715   58   DIPHENHYD 2% CRM 30GM                             $27.34
5835764   58   DIFLORASONE0.05%CRM 30GM                        $143.48
5835822   58   SEBULEX SHAMPOO 120ML                             $29.12
5835954   58   CORDRAN 0.035%OINT 30GM                           $64.08
5836002   58   BUTT PASTE 105GM                                  $41.79
5836051   58   NEUTROGENA SHAM 255ML                             $20.86
5836069   58   TERCONAZOLE 3VT 3X80MG                          $110.08
5836101   58   TERCONAZOLE 3VAG OR 20GM                          $25.00
5836226   58   CAPSAICIN CR 60GM                                 $81.50
5836267   58   SUMMER'S EVE DOUCHE 4.5OZ                         $22.86
5836366   58   MALTODEXTRIN GEL 85GM                             $40.01
5836374   58   TOCOPHEROL CREAM 60GM                             $25.50
5836432   58   LACTIC ACID CRM 120GM                             $21.62
5836572   58   MUPIROCIN NAS OINT 1GM                             $7.58
5836580   58   MUPIROCIN CREAM 15GM                              $53.70
5836606   58   BETAMETH CRM.05%50GM                            $117.76
5836614   58   LANOLIN CREAM 30GM                                $20.15
5836622   58   NIVEA CREAM 40Z                                   $26.94
5836630   58   BECAPLERMIN GEL 15GM                           $1,129.62
5836648   58   UREA CRYSTALS 500GM                                $5.04
5836663   58   CORDRAN SP 0.05% 15GM                             $44.56
5836671   58   ULTRAVATE CRM 0.05% 15GM                          $82.40
5836689   58   ZINCON SHAMPOO 1%                                 $27.08
5836770   58   PRAMOXINE/HC1%CRM 30GM                            $98.22
5836788   58   PRAMOXINE/HC2.5%CRM30GM                         $109.90
5836903   58   MIRALAX 17GM PWD                                   $6.80
5836911   58   PAPAIN-UREA OINT 30GM                           $119.10
5838735   58   FLOSEAL MATRIX HEMOSTATIC                       $330.00
5840012   58   METAPROTERENOL0.65MG INH                          $26.50
5840020   58   BRONKOMETER 10ML                                  $75.46
5840038   58   ACETYLCYST 20% 4ML VIAL                           $17.20
5840046   58   TOBRADEX OPH OIN 3.5 GM                         $159.12
5840053   58   ACETYLCYST 20% 30ML VIAL                          $39.00
5840061   58   ISOETHARINE 10ML                                  $47.12
5840079   58   TERBUTALINE 7.5 ML INH                            $62.56
5840087   58   AEROBID INH                                     $171.60
5840095   58   IPRATROPIUM 18MCG/INH 14G                       $149.50
5840103   58   ALBUTEROL INH COMP                                $86.72
5840111   58   CROMOLYN 800MCG/PUFF INH                        $195.88
5840129   58   AMYL NITRITE 0.3ML                                 $4.95
5840137   58   METAPROTERENOL 0.3 ML UD                          $16.23
5840152   58   PIRBUTEROL25.6GM INH                            $111.04
5840160   58   TRIAMCINOLONE INH                               $202.86
5840178   58   DEXAMETHASONE INH                               $101.87
5840194   58   CIPROFLOXACIN 2.5ML OPSOL                       $120.76
5840202   58   REFRESH PM OPH OINT                               $26.82
5840210   58   CEPACOL LOZ 18 PAK                                 $5.08
5840244   58   MYCELEX TROCHE                                     $6.83
5840251   58   NICOTINE GUM 96X2MG                                $5.42
5840269   58   SUCRET LOZ 48 PAK                                  $5.12
5840277   58   CHLORAMPHENICOL OTIC SOLN                         $65.36
5840285   58   BETAGAN 0.5% 5ML OPSOL                            $40.94
5840293   58   PRED-FORTE 1% 5 ML OPTH                           $83.88
5840301   58   VISCOAT 0.5 ML INJ                              $229.69


                                     Page 28 of 276
Charge #Dept   CDM Description                        Price
5840319   58   SOD HYALURONATE 0.4 ML                         $304.38
5840327   58   HALOTHANE PER HOUR                              $30.00
5840335   58   VASOSULF OPH DROPS 5 ML                         $36.22
5840343   58   OTRIVIN NAS SPR 0.1% 20ML                       $28.52
5840350   58   AFRIN NAS SPR 15ML                              $29.56
5840368   58   SALINE NAS SPR 15 ML                            $24.44
5840376   58   ARTIFICIAL TEARS 15ML                           $24.88
5840384   58   BACITRACIN OPTH OINT                            $29.50
5840392   58   ATROPINE 1% OPTH SOL 2 ML                       $24.84
5840400   58   ATROPINE 1% OPTH SOL 5 ML                       $52.00
5840418   58   AURALGAN OTIC DROPS                             $49.72
5840426   58   BSS OPTH SOLN 15ML                              $23.88
5840434   58   BLEPHAMIDE OPH SUSP 10ML                       $150.38
5840442   58   SULFACET 10% OPH 5                             $104.62
5840459   58   PILOCARPINE 6% OPT SOL 15                       $61.12
5840467   58   CERUMENEX OTIC 6ML                              $67.78
5840475   58   PILOCARPINE 3% OPT SOL 15                       $42.26
5840483   58   CHLORAMPHENICOL .5% OP SN                       $27.00
5840491   58   CHLORAMPHENOCOL OPT OINT                        $25.94
5840509   58   COLISTIN OTIC SUSP                              $60.28
5840517   58   CORTISPORIN OPH SUSP                           $106.26
5840525   58   CORTISPORIN OTIC SOLN                           $26.60
5840533   58   CORTISPORIN OPTH OINT                           $73.90
5840541   58   CORTISPORIN OTIC SUSP                           $30.18
5840558   58   PILOCARPINE 2% OPT SOL UD                       $25.88
5840566   58   CYCLOMYDRIL OPT SOL 2ML                         $15.50
5840574   58   DACRIOSE 30ML                                   $12.40
5840582   58   DEBROX OTIC 15ML                                $28.90
5840590   58   DEXAMETH OPT SOL 5ML                            $90.38
5840608   58   FML OPH SUSP 0.1% 5ML                           $78.00
5840616   58   GENTAMICIN OPTH SOLN                            $26.40
5840624   58   GENTAMICIN OPTH OINT                            $41.50
5840632   58   DEXAMETH OPTH OINT                              $44.00
5840640   58   DDAVP NASAL SPRAY 5ML                          $252.52
5840657   58   HOMATROP 2% OPT SOL 1ML                          $8.02
5840665   58   HOMATROP 5% OPT SOL 1ML                          $9.88
5840673   58   MAXITROL OPTH OINT                             $141.88
5840681   58   LACRI-LUBE OPTH OINT                            $28.00
5840699   58   NEO/POLY/BACI OPTH OINT                         $29.06
5840707   58   NEO/POLY/GRAMI OPTH SOLN                        $55.40
5840715   58   VOSOL OTIC 15 ML                               $142.44
5840723   58   DEXAMETH TURBINAIRE                            $101.87
5840749   58   PHENYLEPH 10% OPT SOL 1ML                        $9.88
5840756   58   PHENYLEPH 2.5% OPT SL 5ML                       $27.46
5840764   58   SOD CHL 5% OPT SOL 15 ML                        $52.50
5840772   58   ERYTHROMYCIN OPTH OINT                          $21.46
5840780   58   SULFACET 10% OPTH OINT                         $102.58
5840798   58   IDOXURIDINE OPTH OINT                           $40.10
5840806   58   PREDNISOL 0.12% OS 10 ML                        $87.00
5840814   58   PILOCARPINE 1% 2ML OPT SL                       $25.88
5840822   58   PILOCARP 1% 15 ML OPT SOL                       $62.26
5840830   58   PILOCARP 2% 15 ML OPT SOL                       $63.38
5840848   58   PILOCARP 4% 15 ML OPT SOL                       $66.12
5840855   58   CETAPRED OPTH OINT                              $68.62
5840863   58   POLYSPORIN OPTH OINT                            $30.80
5840871   58   TETRACAINE 0.5% OPT 1 ML                        $25.88
5840889   58   HYPOTEARS 15ML                                  $26.54
5840897   58   TIMOLOL 0.5% OPT SOL 5 ML                       $54.20


                                     Page 29 of 276
Charge #Dept   CDM Description                        Price
5840905   58   TIMOLOL 0.25% OPT SOL 5ML                       $47.36
5840913   58   VASOCON A OPTH SOLN                             $36.64
5840921   58   BECLOMETHASONE INH                              $99.88
5840939   58   OPTHOCORT OPTH OINT                             $40.44
5840947   58   PROPARACAINE OPT SOL 15ML                       $64.38
5840954   58   VISINE OPTH SOLN                                $26.58
5840962   58   MAXITROL OPH SUSP                              $131.26
5840970   58   PHENYLEPH 1% NAS DROPS 15                       $27.90
5840988   58   ALBALON OPT SOL 15ML                            $57.30
5841002   58   DIPIVEFRIN OPT SOL 5ML                          $57.82
5841010   58   PHENYLEPH 10% 5ML OPTH SL                       $23.40
5841028   58   SULFACET 10% 5ML OPTH SOL                       $47.42
5841036   58   TOBRADEX 5 ML OPH SUSP                         $142.38
5841044   58   CYCLOPENTOLATE 0.5% 2ML                          $6.44
5841051   58   CYCLOPENTOLATE 1% 2ML                           $14.81
5841077   58   BECLOMETHASONE NASAL INH                       $124.20
5841093   58   VASOCIDIN OPTH SOLN 5 ML                        $50.10
5841101   58   PREDNISOL 0.1% OS 10 ML                         $64.06
5841119   58   PHENYLEPH NAS DROPS 0.25%                       $26.88
5841127   58   PHENYLEPH NAS SPR 0.25%                         $26.98
5841135   58   PHENYLEPH NAS DROPS 1/8%                        $26.88
5841143   58   PHENYLEPH NAS DROPS 0.5%                        $26.98
5841150   58   SYNTOCINON NAS SPR 5 ML                        $137.08
5841168   58   BETAXOLOL OPT SOLN 5ML                         $103.76
5841176   58   CYCLOPENTOLATE 2% 2ML                           $19.38
5841200   58   SOD HYALURON 0.85 ML                           $566.88
5841218   58   BETOPTIC S OPTH SOL 15ML                       $277.26
5841226   58   CARBOCHOL 1.5% OPSOL 15ML                       $86.12
5841234   58   ACETYLCHOL OPT SOL 2ML                          $54.04
5841259   58   SULFACET 10% OPTH OINT                          $42.50
5841267   58   ATROPINE 1% OPTH OINT                           $28.70
5841275   58   PILOCARPINE 4% OPTH SL 2M                       $24.84
5841283   58   FLURBIPROFEN OPT SOL 2.5                        $50.96
5841309   58   TOBREX OPTH SOLN 5 ML                           $76.88
5841317   58   TOBREX OPTH OINT                               $129.26
5841325   58   SULFACER 10% OPT SOL UD                         $25.88
5841333   58   BECLOMETHASONE AQ NASAL                        $171.60
5841341   58   VOSOL HC OTIC 10 ML                            $170.86
5841358   58   PROPARACAINE OPT SOL 2 ML                       $27.64
5841366   58   PILOCARPINE 4% GEL 5 GM                        $106.26
5841374   58   POLYTRIM OPH SOL 10 ML                          $79.10
5841382   58   TROPICAMIDE 1% 3 ML                             $13.81
5841390   58   CROMOLYN NASAL SOLN 13ML                        $57.24
5841408   58   CROMOLYN NASAL SOLN 26ML                        $96.56
5841416   58   FLUNISOLIDE NAS SOLN 25ML                      $101.20
5841424   58   TRIAM NASAL INH 10 GM                          $129.70
5841432   58   NAFARELIN NAS SOLN 10 ML                       $916.72
5841440   58   NAPHAZ 0.012% OS 15 ML                          $56.88
5841457   58   NAPHAZ 0.1% OS 15 ML                            $42.26
5841465   58   ETHRANE PER HOUR                                $94.01
5841473   58   ETHRANE EA ADDL 15 MIN                          $34.75
5841481   58   FORANE PER HOUR                                 $40.00
5841499   58   FORANE EA ADDL 15 MIN                           $21.25
5841507   58   HALOTHANE EA ADDL 15MIN                         $18.75
5841515   58   ALBUTEROL 2.5MG IN SOL UD                        $5.10
5841523   58   AFRIN NAS DROP 20ML                             $29.64
5841531   58   NTG LINGUAL AERO 14.5GM                         $72.44
5841556   58   OCEAN NASAL SPRAY 45 ML                         $24.20


                                     Page 30 of 276
Charge #Dept   CDM Description                        Price
5841572   58   CROMOLYN INH 20MG/2ML AMP                       $24.10
5841580   58   ACETYLCYST 10% 10ML VIAL                        $30.84
5841606   58   ISOPROTERENOL INH 10MG                          $78.88
5841614   58   AMMONIA VAPORELES                                $5.28
5841622   58   APRACLONIDINE OPT SOLN                         $164.76
5841648   58   SULFISOX OPH SOLN 15 ML                         $29.26
5841663   58   SALIVA SUBSTITUTE                               $29.64
5841705   58   CARBACHOL 3% 15ML OPT SOL                       $96.88
5841713   58   CARBACHOL .01% 1.5ML OPSO                       $71.26
5841747   58   BITOLTEROL INH                                 $101.74
5841754   58   BSS OPTH SOLN 500ML                             $58.50
5841762   58   ATROPINE 0.5% OPTH SOL 5M                       $31.88
5841770   58   ATROPINE 3% OPTH SOL 5ML                        $30.00
5841812   58   FLUORESCEIN 2% OP SOL 2ML                       $28.84
5841820   58   FML OPT SUSP 0.25% 5ML                          $52.82
5841846   58   HOMATROPINE 2% OP SOL 15M                       $46.24
5841853   58   HOMATROPINE 5% OP SOL 15M                       $80.00
5841861   58   GONIOSOL OPTSOL 15ML                            $42.32
5841879   58   VIDARABINE 3% OPT OINT                          $59.62
5841887   58   TRIFLURIDINE 1% OPT SOL                        $113.94
5841911   58   SULFACET 10% OPT SOL 15ML                       $30.62
5841929   58   SULFACET 30% OPT SOL 15ML                       $22.00
5841937   58   SULFACET 15% OPT SOL 5 ML                       $39.12
5841952   58   VASOCIDIN OPT SOL 10 ML                         $63.92
5841978   58   OPTHALMIC LUBRICANT                             $53.26
5841986   58   NAPHAZ .05% OS 20 ML                            $26.86
5841994   58   BUDESONIDE NEB AMP                              $14.38
5842018   58   NAPHCON A OPT SOL 15 ML                         $25.76
5842034   58   NEO DECADRON OPT SOL 5 ML                       $48.90
5842042   58   NEO DECADRON OPT UNG                            $23.12
5842059   58   POLY PRED OPT SUSP 5 ML                         $67.10
5842067   58   CELLUVISC 1% OPT SOL                             $5.32
5842075   58   SOD CHLORIDE .9% 3 ML UD                        $15.30
5842125   58   PILOCARP 0.5% OPT SOL                           $29.64
5842133   58   PILOCARP 10% OPT SOL                            $55.76
5842166   58   PREDNISOL 0.12% OS 5 ML                         $61.38
5842174   58   PRED-FORTE 1% 15 ML OS                         $158.58
5842190   58   PHENYLEPH 2.5% 2 ML OP SO                       $12.88
5842208   58   PHYSOSTIGMINE OPT OINT                          $36.88
5842216   58   PILOCARP 0.25% OPT SOL                          $39.50
5842240   58   METIPRANOLOL .3% OPT 5ML                        $25.00
5842257   58   METAPROTERENOL INH SOL                          $26.08
5842265   58   EPINEPHRINE 0.5% 15ML OPT                      $102.72
5842273   58   EPINEPHRINE 1% 15ML OPSOL                      $109.38
5842281   58   EPINEPHRINE 2% 15ML OPSOL                      $118.72
5842299   58   EPINEPHRINE INH SOL 15 ML                       $51.50
5842323   58   REFRESH OPTH SOLN .3 ML                         $20.48
5842380   58   EPINEPHRINE INHALER 15 ML                       $51.04
5842398   58   EPINEPHRINE 0.25% 15MLOPT                       $53.60
5842406   58   ECHOTHIOPHATE 0.06% OPT                         $73.16
5842414   58   ECHOTHIOPHATE 0.125% OPT                       $151.00
5842430   58   ISOPROTER 1:100 INH SOL                         $59.60
5842455   58   ISOPROTERENOL INHALER                           $66.16
5842489   58   LEVOBUNOLOL 0.5% 2ML OPSO                       $36.58
5842497   58   DICLOFENAC OPTH SOL 2.5ML                       $92.88
5842505   58   DESFLURANE PER HOUR                            $164.55
5842513   58   DESFLURANE EA ADDL 15 MIN                       $52.39
5842521   58   NEDOCROMIL INH 16.2 GM                         $149.72


                                     Page 31 of 276
Charge #Dept   CDM Description                       Price
5842562   58   CYCLOPENTOLATE 0.5% 5ML                          $34.50
5842612   58   HOMATROP 2% OPTH SOL 5 ML                        $56.00
5842620   58   HOMPTROP 5% OPTH SOL 5ML                         $62.88
5842646   58   ECHOTHIOPHATE 0.25% OPSOL                        $89.88
5842679   58   IPRATROPIUM 0.02% INH 2.5                         $5.15
5842687   58   BUTORPHANOL NAS SPR 2.5ML                        $26.86
5842711   58   EYESTREAM OPH IRR 120ML                          $49.26
5842760   58   NITROUS OXIDE 15 MIN                             $20.00
5842802   58   DEMECARIUM 0.125% OPH 5ML                        $42.56
5842810   58   DEMECARIUM O.25% OPH 5ML                         $44.92
5842836   58   SCOP OPH SOLN 0.25% 5ML                          $56.12
5842844   58   SOD HYALURON 10MG/ML0.55M                      $435.63
5842927   58   KETORALAC OPH SOL                              $153.06
5843057   58   DORZOLAMIDE2% OPH SOL 5ML                        $20.28
5843065   58   DORZOLAMIDE2% OPH SOL10ML                      $112.80
5843099   58   LEVALBUTEROL 1.25MG/3ML                           $2.90
5843156   58   OCUCOAT SOLN 15ML                              $152.00
5843172   58   IPRATROPIUM.06%NAS SPRAY                       $118.31
5843180   58   PRED-G OPH SUSP 10ML                           $120.38
5843198   58   HOMATROPINE 5% OP SOLN 2M                        $27.72
5843206   58   IDOXURIDINE 0.1%OP SOL15M                        $36.42
5843222   58   CYCLOPENTOLATE 0.5% 15ML                         $94.76
5843230   58   EPINEPHRINE 0.5%OPH SOL5M                        $21.78
5843255   58   DORNASE ALFA 2.5ML INH                         $206.90
5843305   58   PREDNISOL 0.125%OS 10ML                          $64.58
5843354   58   VANCOMYCIN OPH SOL15ML                           $66.44
5843362   58   IPRATROPIUM03%NAS SPRAY                        $136.34
5843388   58   SEVOFLURANE/HOUR                                 $96.00
5843396   58   SEVOFLURANE ADD'L 15MIN                          $35.00
5843420   58   TOBRAMYCIN OPH SOLN 15ML                         $41.44
5843438   58   CEFAZOLIN OPH SOL 15ML                           $25.00
5843529   58   SALIVART 25ML                                    $21.74
5843578   58   LATANOPROST 0.005% OPH                         $132.58
5843586   58   GANCICLOVIR4.5MGVITR IMPL                     $8,750.00
5843594   58   BECLOMETH DS INH 12.2GM                        $116.66
5843602   58   BRIMONIDINE 0.2% OPH SOL                         $82.56
5843610   58   CALCITONIN-SALMON NAS 3.7                        $60.06
5843628   58   FLUTICASONE ORAL INH                           $152.82
5843636   58   FLUTICASONE ORAL INH                           $201.22
5843644   58   FLUTICASONE ORAL INH                           $307.06
5843651   58   FLUORESCEIN 9MG STRIP EA                         $20.49
5843743   58   OFLOXACIN 0.3% 5ML O SOL                         $73.52
5843826   58   MOXIFLOXACIN 0.05% 3ML                         $123.92
5843867   58   LEVOBUNOLOL 0.25% 5ML                            $26.33
5843875   58   SODIUM CHLORIDE 2% 15ML                          $22.44
5843883   58   SUMATRIPTAN SPR 20MG                             $48.02
5843891   58   SUMATRIPTAN SPR 5MG                              $48.02
5843917   58   COMBIVENT INHALER 14.7GM                       $169.80
5844006   58   IPRATROP/ALBUT0.5/3MG 3ML                        $30.00
5844063   58   CIPRO HC OTIC 10ML                             $197.26
5844105   58   ADVAIR DISC 100/50                             $190.02
5844113   58   ADVAIR DISC 250/50                             $232.16
5845292   58   CADEXOMER IODINE GEL                           $118.68
5845847   58   LEVALBUTEROL 0.63MG/3ML                           $5.45
5850011   58   GASTROGRAFIN 20ML                                $23.92
5850029   58   RANITIDINE 150MG/10ML SOL                        $15.52
5850037   58   GASTROVIEW 120ML                                 $62.18
5850045   58   GASTROVIEW 20ML                                  $28.70


                                    Page 32 of 276
Charge #Dept   CDM Description                        Price
5850052   58   HYPAQUE SOD 120ML                              $48.22
5850078   58   ERYTHROMY SUC 200MG/5ML                         $5.25
5850086   58   ERYTHROMY SUC 400MG/5ML                         $6.56
5850094   58   TCN 125 MG/5 ML SUSP                           $20.18
5850110   58   AMOXICILLIN 125MG/5ML SUS                       $8.12
5850128   58   PEN VK 125MG/5ML 100ML SU                      $24.76
5850144   58   AMPICILLIN 250MG/5ML SUS                        $6.20
5850151   58   AMPICILLIN 125MG/5ML SUS                        $5.23
5850169   58   CEPHALEXIN 250MG SUSP                           $7.48
5850177   58   PEDIAZOLE 100 ML                               $45.50
5850185   58   PEN VK 250MG/5ML 100ML SU                      $26.48
5850193   58   ERYTHROMY EST 250MG/5ML                         $4.86
5850201   58   CEFACLOR 125/5ML SUS 75ML                      $41.28
5850219   58   TRIMETH/SULFA 20ML LIQ                          $5.38
5850235   58   CRITICARE HN 240ML                             $19.94
5850243   58   ISOCAL 240ML ORAL                              $13.94
5850284   58   SORBITOL 70% SOLN 30 ML                        $21.99
5850300   58   SUSTACAL HC 240 ML ORAL                        $13.98
5850318   58   TRAVASORB RENAL PKT                            $22.05
5850326   58   TRAVASORB HEPATIC PKT                          $27.03
5850342   58   ULTRACAL 240 ML ORAL                           $14.19
5850359   58   SUPLENA 240 ML ORAL                            $14.62
5850383   58   CIT OF MAG 300ML LIQ                           $23.36
5850391   58   DEXAMETH LIQ 5ML                                $5.24
5850409   58   DONNATAL LIQ 5ML                                $5.34
5850417   58   DOCUSATE SOD 50MG/ML ORAL                       $5.38
5850425   58   ACTIFED LIQ 5ML                                 $5.20
5850433   58   DIPHENHYDRAMINE LIQ 5ML                         $5.08
5850441   58   BENYLIN LIQ 5ML                                 $5.13
5850458   58   AQUASOL E 50U 12ML DROPS                       $59.44
5850466   58   DIMETANE LIQ 5ML                               $20.22
5850490   58   AMICAR LIQ 5ML                                 $13.77
5850508   58   EMETROL LIQ 30ML                               $21.30
5850524   58   SULFISOX LIQ 5 ML                               $5.41
5850532   58   IPECAC SYR 30ML                                 $8.00
5850540   58   KAOLIN/PECTIN LIQ 30ML                          $5.36
5850557   58   LIDOCAINE VISC LIQ 100ML                       $26.84
5850565   58   FURADANTIN LIQ 5ML                             $57.42
5850573   58   FEOSOL LIQ 5ML                                  $5.47
5850581   58   METAPROTERENOL LIQ 5 ML                         $5.16
5850599   58   NEO-CALGLUCON SYR 5 ML                          $5.31
5850607   58   LACTULOSE LIQ 30ML                              $9.88
5850649   58   MULTI VIT LIQ 5 ML                              $5.35
5850656   58   CASTOR OIL 30ML                                 $4.90
5850664   58   NOVAHISTINE DMX LIQ 5 ML                       $20.44
5850680   58   IODIN GLYCEROL LIQ 5ML                          $4.78
5850698   58   CYRPOHEPATDINE 2MG/5ML LI                       $5.36
5850706   58   PROMETHAZINE LIQ 5 ML                          $20.19
5850714   58   GUAIFEN/DM LIQ 5ML                             $20.54
5850722   58   GUAIFENESIN LIQ 10ML                            $5.33
5850748   58   GUAIFEN/DM LIQ 10ML                             $5.33
5850755   58   CIMETIDINE 300MG/5ML LIQ                        $4.95
5850763   58   TITRALAC PLUS 30 ML                             $5.34
5850771   58   ACETAMIN DROPS 15ML                            $29.32
5850789   58   AMINOPHYLLINE LIQ 5ML                           $5.18
5850805   58   NOVAHISTINE EXPT 5 ML                          $20.67
5850821   58   CHLOROTHIAZIDE SUSP 5ML                         $5.26
5850839   58   GO-LYTELY                                      $46.88


                                     Page 33 of 276
Charge #Dept   CDM Description                        Price
5850847   58   METOCLOPRAMIDE LIQ 10 ML                         $4.93
5850862   58   DONNAGEL LIQ 5ML                                 $5.15
5850888   58   HYDROXYZINE LIQ 5ML                              $5.08
5850896   58   SIMETHICONE DROPS 30 ML                         $24.10
5850912   58   METHYLDOPA LIQ 5 ML                              $5.04
5850946   58   ERGOCALCIFEROL DROPS                             $1.25
5850953   58   HYOSCYAMINE 15ML DROPS                          $89.92
5850979   58   CEFACLOR 250/5ML SUS 75ML                       $68.07
5851001   58   AL HYDROX GEL 30ML                               $5.40
5851019   58   POLY VI SOL DROPS 30 ML                          $5.26
5851027   58   PULMOCARE 240 ML ORAL                           $14.92
5851050   58   PREDNISONE LIQ 5 ML                             $22.02
5851068   58   RIOPAN LIQ 30 ML                                 $5.24
5851084   58   CASTOR OIL EMUL 120ML                           $23.32
5851092   58   NYSTATIN SUSP 5 ML                               $6.24
5851100   58   ACETAMIN LIQ 650MG                               $5.17
5851126   58   ACETAMIN LIQ 325MG                               $5.03
5851134   58   ALTERNAGEL 30ML                                  $4.82
5851159   58   GAVISCON 30ML                                   $20.98
5851183   58   KAYEXALATE 15GM/60ML LIQ                        $21.30
5851225   58   OSMOGLYN 220 ML ORAL                            $79.62
5851233   58   PEPTO-BISMOL LIQ 120 ML                         $24.30
5851241   58   PERDIEM 6 GM PKT                                 $7.82
5851258   58   PERDIEM 100 GM                                  $20.78
5851266   58   RIOPAN PLUS 30 ML                                $5.31
5851282   58   TRI VI FLOR DROPS 50 ML                          $5.24
5851290   58   PROMETHAZINE VC LIQ 5ML                         $20.18
5851308   58   LIDOCAINE VISCOUS 20ML                           $8.32
5851316   58   GASTROGRAFIN 120ML                              $93.54
5851324   58   MAGNACAL 250ML                                  $12.12
5851332   58   CYCLOSPORINE 100MG/ML-50M                       $17.47
5851340   58   MINERAL OIL 30 ML                                $8.58
5851357   58   ISOCAL HCN 240ML ORAL                           $14.22
5851365   58   KCL 10% 20MEQ/15ML SOLN                          $5.24
5851399   58   SUSTACAL PUDD                                   $13.72
5851407   58   SSKI DROPS 30 ML                                $34.20
5851415   58   CLINDA SUS 75MG/5ML 100ML                       $67.82
5851431   58   PSEUDOEPH SYR 30 MG/5 ML                        $24.80
5851449   58   CHLORHEX ORAL RINSE 16OZ                        $33.64
5851464   58   COLESTIPOL 5GM PKT                               $7.32
5851472   58   X-PREP 2.5 OZ LIQ                               $33.02
5851480   58   ACYCLOVIR SUSP 200MG/5ML                         $6.38
5851522   58   BOOSBERG SOLN 60ML                              $28.00
5851530   58   IBUPROFEN 100MG/5ML SUS                          $5.26
5851548   58   PEDIAZOLE 5 ML SUS                              $21.78
5851563   58   GLUCERNA 240ML                                  $26.56
5851571   58   PYRIDOSTIGMINE SYRUP 5 ML                        $5.13
5851589   58   GUAIFENISIN LIQ 5ML                              $5.30
5851613   58   NEPRO 240 ML ORAL                               $15.58
5851639   58   MCT OIL 15ML                                    $21.75
5851647   58   SOD CIT/CITRIC ACID 30ML                         $6.86
5851662   58   ACETAMIN LIQ 120ML                              $20.82
5851688   58   AMANTADINE 50MG/5ML LIQ                         $62.82
5851696   58   AUGMENTIN SUSP 125MG/5ML                       $104.53
5851704   58   AUGMENTIN SUSP 250MG/5ML                       $190.30
5851738   58   CEFADROXIL 250MG SUSP                           $92.48
5851761   58   CARBAMAZEPINE SUSP 100MG                         $5.48
5851803   58   PROCHLORPER LIQ 5 MG/5 ML                       $61.00


                                     Page 34 of 276
Charge #Dept   CDM Description                        Price
5851811   58   PHENERGAN DM EXPT 120 ML                        $20.22
5851837   58   PHENERGAN PL LIQ 120 ML                         $29.36
5851894   58   CHLORPROMAZ 30MG/ML 5ML                          $5.15
5851936   58   AUGMENTIN 125MG/5ML 75ML                        $58.26
5851951   58   AUGMENTIN 250MG/5ML 75ML                       $101.92
5851977   58   AMPICILLIN 250MG/5ML 100M                       $29.70
5851985   58   CEPHALEXIN 125MG/5ML 100M                       $25.30
5852009   58   CEPHALEXIN 250MG/5ML 100M                       $35.20
5852033   58   CHERRY FLAVORED LIQ                             $25.69
5852066   58   CEFACLOR 125MG/5ML 150ML                        $72.25
5852132   58   CALCIUM CARBONATE LIQ                           $20.05
5852199   58   MAALOX 148ML LIQ                                $24.65
5852207   58   AMOXICILLIN 125MG/5ML 150                       $28.22
5852215   58   AMOXICILLIN 250MG/5ML 150                       $22.18
5852256   58   FERRIC SUBSULFATE LIQ 500                       $21.36
5852264   58   FERROUS SULF LIQ 220MG/5M                        $5.06
5852272   58   FLUPHENAZINE 5MG/ML 120ML                       $11.71
5852306   58   HALOPERIDOL LAC LIQ 120ML                        $5.09
5852322   58   ETHOSUXIMIDE 250MG/5ML                          $20.53
5852330   58   COLD & COUGH PREP LIQ                            $5.03
5852348   58   ASCORBIC ACID 50ML LIQ                           $5.42
5852355   58   VIT A 50 MU/ML LIQ                             $107.48
5852371   58   TRIHEXYPHENIDYL 2MG/5ML                          $5.45
5852389   58   TRIMEPRAZINE 2.5MG/5ML LI                       $50.80
5852413   58   THIORIDAZINE 100MG/ML LIQ                        $7.07
5852421   58   THIORIDAZINE 30 MG/ML                            $4.95
5852447   58   THIOTHIXENE 5 MG/ML LIQ                         $82.89
5852470   58   NORTRIPTYLINE 10MG/5ML LQ                       $21.16
5852488   58   NAPROXEN 125MG/5ML LIQ                           $5.42
5852561   58   MINERAL OIL LIQ                                 $27.20
5852587   58   MOLINDONE 20 MG/ML LIQ                          $11.68
5852652   58   POLYCITRA K LIQ                                  $5.06
5852686   58   POT CHL 15 MEQ PKT                               $5.34
5852702   58   PRIMADONE 250MG/5ML LIQ                          $7.06
5852728   58   PREDNISOLONE 5MG/5ML LIQ                         $5.18
5852736   58   PERPHENAZINE 3 MG/ML LIQ                         $7.72
5852785   58   LITH CIT LIQ 300MG/5ML                           $5.08
5852793   58   LOXAPINE LIQ 25MG/ML                             $8.97
5852801   58   RIOPAN LIQ 12 OZ                                $29.34
5852827   58   MESORIDAZINE 25MG/ML LIQ                        $26.52
5852843   58   RIOPAN PLUS LIQ 12 OZ                           $29.62
5852959   58   ROBITUSSIN CF LIQ 120 ML                        $20.07
5852967   58   NOVAHISTINE DH LIQ                               $5.38
5852991   58   AZITHROMYCIN SUSP300MG/15                       $24.88
5853056   58   DIPHENHYDRAMINE LIQ 120ML                        $5.10
5853098   58   DOXEPIN 10MG/ML LIQ                              $6.53
5853106   58   DOXYCYCLINE 25MG/5ML LIQ                         $6.70
5853122   58   POLYCITRA 15 ML ORAL                             $5.19
5853130   58   DIGOXIN 0.25MG/5ML ELX                           $6.68
5853148   58   FUROSEMIDE 40 MG/5ML ORAL                        $4.96
5853163   58   KCL 40MEQ/30ML SOLN                              $5.28
5853197   58   ENSURE 240ML                                    $13.47
5853205   58   OSMOLITE 240 ML                                 $22.66
5853213   58   HALOPERIDOL 5MG/2.5ML SOL                        $6.56
5853247   58   HEPATIC AID 1 PKT                               $54.89
5853254   58   PEDIALYTE 240 ML                                $14.65
5853262   58   THIOTHIXENE 10MG/2ML SOL                         $5.10
5853304   58   DEXTROSE 40% GEL                                $23.30


                                     Page 35 of 276
Charge #Dept   CDM Description                       Price
5853346   58   THIORIDAZINE 30MG/ML 1ML                       $40.55
5853403   58   FLUPHENAZ 0.5MG/ML LIQ 60                       $5.45
5853411   58   MULTIVITS THER 5 ML                             $5.22
5853486   58   PREDNISOLONE 15MG/5ML LIQ                       $5.45
5853510   58   DIGOXIN 0.125MG/2.5ML ELX                       $6.68
5853528   58   MAALOX PLUS XSTR 150ML                         $26.22
5853601   58   PHENYTOIN 100 MG/4 ML LIQ                       $6.78
5853619   58   VALPROATE 250 MG/5 ML SYR                       $5.08
5853742   58   INDOMETHACIN 25MG/5ML                           $6.14
5853759   58   SUCRALFATE SUSP 10 ML                           $8.00
5853783   58   AMOX 125MG/5ML 100ML SUSP                      $27.12
5853858   58   VIVONEX PEDIATRIC PKT                         $121.00
5853882   58   ISONIAZID 50MG/5ML LIQ                          $5.28
5853916   58   CLARITHROMYCIN 125MG/ML                         $8.70
5853924   58   CLARITHROMYCIN 250MG/5ML                       $12.94
5853957   58   FLUOXETINE 20MG/5ML LIQ                        $20.35
5854104   58   MEGESTROL 400MG/10ML ORAL                      $17.33
5854146   58   AZITHROMYCIN SUSP 900MG                        $83.26
5854229   58   ALLOPURINOL6MG/MLSUSP30ML                      $21.20
5854252   58   DIHYDROTACHY 0.2MG/ML 30M                      $99.94
5854302   58   ATOVAQUONE 75OMG/5ML SUSP                      $40.80
5854526   58   AMPICILLIN 125MG/5ML200ML                      $28.40
5854534   58   AMPICILLIN 250MG/5ML200ML                      $41.28
5854575   58   TRI VI SOL DROPS 50ML                          $24.04
5854583   58   DIPHENHYDRAMINE LIQ 10ML                        $5.05
5854625   58   AMBENYL 5ML LIQ                                 $5.39
5854633   58   CISAPRIDE 10MG/10ML LIQ                         $6.62
5854641   58   ZIDOVUDINE 100MG/10MLORAL                       $7.54
5854658   58   COMPLEAT 250ML ORAL                            $15.86
5854674   58   POLYCOSE POWDER 350 GM                         $29.06
5854682   58   NUTRAMIGEN POWDER 454 GM                       $40.04
5854690   58   KINDERCAL 240ML ORAL                           $13.82
5854708   58   BICITRA 15ML ORAL                               $4.81
5854716   58   ROBITUSSIN CF LIQ 240ML                        $23.38
5854724   58   MERITENE POWDER 454GM                          $25.36
5854732   58   PREGESTIMIL POWDER 454 GM                      $41.83
5854757   58   IMPACT LIQUID 250ML                            $25.82
5854765   58   PROSOBEE POWDER 420GM                          $39.46
5854781   58   RIFAMPIN SUSP 150MG/15ML                       $51.81
5854799   58   NEOCATE 14OZ CAN                               $60.00
5855150   58   LEVOCARNITINE 100MG/ML                          $5.29
5855259   58   CEHRADINE 125/5ML SUSP                         $50.08
5855267   58   CEPHRADINE 250MG/5ML SUSP                      $50.66
5855275   58   MAG CHLOR 5% SOL 120ML                         $22.47
5855283   58   ALLOPURINOL 100MG/5ML                          $41.99
5855309   58   BAX SUSP 120ML                                 $23.99
5855317   58   GI COCKTAIL 400ML                              $44.32
5855358   58   RISPERIDONE 1MG/ML 1ML LQ                       $9.73
5855481   58   TRAUMACAL 240ML ORAL                           $25.84
5855515   58   ITRACONAZOLE LIQ 10MG/ML                        $5.47
5855523   58   PREGESTIMIL 20 30Z BTL                         $13.76
5855531   58   PREGESTIMIL 24 30Z BTL                         $13.76
5855549   58   GRISEOFULUIN 125MG/5ML                          $5.40
5855564   58   PROMOD PWDR 237GM                              $38.00
5855697   58   CEFUROXIME125MG/5ML SUS                        $43.56
5855713   58   SENOKOY SYRUP                                   $5.16
5855762   58   AUGMENTIN 400-57/5ML                          $184.30
5870019   58   PROPOXYPHENE 65 MG CAP                          $5.06


                                    Page 36 of 276
Charge #Dept   CDM Description                        Price
5870035   58   DARVON N 100 TAB                                $5.49
5870043   58   MEPROBAMATE 200MG TAB                           $5.26
5870050   58   TEMAZEPAM 30 MG CAP                             $5.24
5870068   58   TEMAZEPAM 15 MG CAP                             $5.22
5870092   58   CODEINE SULF 30MG TAB                           $4.78
5870118   58   METHADONE 5 MG TAB                              $5.38
5870126   58   MORPHINE SULF SR 30MG TAB                      $39.33
5870134   58   FLURAZEPAM 15MG CAP                             $5.32
5870159   58   HYDROMORPHONE 2 MG TAB                          $5.47
5870167   58   HYDROMORPHONE 4 MG TAB                          $5.08
5870175   58   MEPERIDINE 50MG TAB                            $36.98
5870183   58   PHENOBARBITAL 100 MG TAB                        $5.07
5870209   58   ASA W/CODEINE 15MG TAB                          $5.06
5870217   58   EQUAGESIC TAB                                   $6.15
5870225   58   FIORINAL TAB                                    $4.97
5870233   58   FIORINAL W/COD 30MG CAP                         $7.42
5870241   58   LEVORPHANOL 2MG TAB                             $5.13
5870258   58   CHLORDIAZEPOXIDE 5MG CAP                        $5.19
5870266   58   CHLORDIAZEPOXIDE 10MG CAP                       $5.22
5870274   58   CHLORDIAZEPOXIDE 25MG CAP                       $5.23
5870282   58   LOMOTIL 2.5MG TAB                               $5.07
5870290   58   SOMA CMPD W/CODEINE TAB                        $12.22
5870308   58   SYNALGOS DC CAP                                 $6.39
5870316   58   MEPROBAMATE 400MG TAB                           $5.34
5870324   58   PENTOBARBITAL 50 MG CAP                         $5.43
5870332   58   PENTOBARBITAL 100 MG CAP                        $4.87
5870340   58   PERCOCET TAB                                    $4.93
5870357   58   HYCODAN 5MG TAB                                 $5.17
5870365   58   PERCODAN TAB                                    $5.30
5870373   58   PHENOBARBITAL 15 MG TAB                         $5.07
5870381   58   PHENOBARBITAL 30 MG TAB                         $5.07
5870399   58   PHENOBARBITAL 60 MG TAB                         $5.06
5870407   58   ETHCHLORVYNOL 500MG CAP                         $7.05
5870415   58   METHYLPHENIDATE 5 MG TAB                        $5.30
5870423   58   METHYLPHENIDATE 10 MG TAB                       $5.43
5870431   58   METHYLPHENIDATE 20 MG TAB                       $4.94
5870449   58   SECOBARBITAL 100 MG CAP                         $5.28
5870456   58   ACETAMIN/CODEINE 15MG TAB                       $5.32
5870464   58   ACETAMIN/CODEINE 30MG TAB                       $5.36
5870472   58   ACETAMIN/CODEINE 60MG TAB                       $4.89
5870498   58   DIAZEPAM 2MG TAB                                $5.24
5870506   58   DIAZEPAM 5MG TAB                                $5.32
5870514   58   DIAZEPAM 10MG TAB                               $5.43
5870522   58   METHADONE 10 MG TAB                             $5.44
5870530   58   ASA W/CODEINE 60MG TAB                          $5.16
5870548   58   ASA W/CODEINE 30MG TAB                          $5.11
5870555   58   FLURAZEPAM 30MG CAP                             $5.38
5870563   58   FIORICET TAB                                    $5.23
5870571   58   DURAGESIC PTCH 50MCG                           $93.63
5870589   58   CHLORAZEPATE 7.5MG TAB                          $7.45
5870597   58   LORAZEPAM 1MG TAB                               $5.36
5870605   58   LORAZEPAM 2MG TAB                               $6.64
5870613   58   ALPRAZOLAM 0.25MG TAB                           $6.05
5870621   58   DARVOCET-N-100 TAB                              $4.84
5870639   58   OXAZEPAM 15 MG CAP                              $5.18
5870647   58   OXAZEPAM 30 MG CAP                              $7.27
5870654   58   PENTAZOCINE NX TAB                              $6.29
5870662   58   TALACEN TAB                                     $6.64


                                     Page 37 of 276
Charge #Dept   CDM Description                       Price
5870670   58   CLORAZEPATE 3.75MG TAB                          $6.79
5870688   58   VICODIN TAB                                     $4.76
5870696   58   ALPRAZOLAM 0.5MG TAB                            $5.10
5870704   58   ALPRAZOLAM 1MG TAB                              $5.42
5870712   58   PRAZEPAM 10 MG CAP                              $5.14
5870720   58   TRIAZOLAM 0.125 MG TAB                          $4.92
5870738   58   TRIAZOLAM 0.25 MG TAB                           $5.01
5870753   58   PRAZEPAM 5 MG CAP                               $4.99
5870761   58   WYGESIC TAB                                     $5.47
5870779   58   LORAZEPAM 0.5MG TAB                             $5.04
5870787   58   DURAGESIC PTCH 25MCG                           $67.08
5870795   58   OXYMORPHONE 5 MG SUP                           $13.17
5870803   58   OXAZEPAM 10 MG CAP                              $5.26
5870811   58   DURAGESIC PTCH 75MCG                          $124.44
5870829   58   DURAGESIC PTCH 100MCG                         $153.70
5870837   58   MORPHINE SULF SR 15 MG TB                      $37.09
5870845   58   VICODIN-ES TAB                                  $4.98
5870852   58   MEPHOBARBITAL 100MG TAB                         $5.10
5870886   58   MORPH SULF 15MG CAP                            $35.66
5870894   58   OXYCODONE 5MG TAB                              $35.66
5870902   58   OXYCODONE 10MG CR TAB                          $38.26
5870910   58   OXYCODONE 20MG CR TAB                          $41.24
5870928   58   OXYCODONE 40MG CR TAB                          $46.08
5870944   58   PEMOLINE 18.75 MG TAB                           $6.47
5870985   58   MEPERIDINE 100MG TAB                           $39.12
5871009   58   MEPHOBARBITAL 32MG TAB                          $5.38
5871017   58   MEPHOBARBITAL 50MG TAB                          $4.82
5871025   58   B & O 30MG SUPP                                $40.63
5871041   58   PENTOBARBITAL 120MG SUPP                       $13.72
5871058   58   QUAZEPAM 15 MG TAB                             $11.87
5871074   58   MORPHINE SULF SR 100MG TB                      $48.16
5871082   58   ZOLPIDEM 10 MG TAB                             $11.43
5871090   58   ZOLPIDEM 5 MG TAB                              $10.04
5871108   58   TEMAZEPAM 7.5 MG CAP                            $5.38
5871116   58   ESTAZOLAM 2MG TAB                               $7.15
5871132   58   CHL HYD 324 MG SUP                              $8.85
5871140   58   CHL HYD 648MG SUP                              $10.63
5871165   58   MORPH SULF 10 MG SOL TAB                       $20.29
5871173   58   MORPH SULF 15 MG TAB                           $35.73
5871199   58   MORPHINE SULF SR 60MG TAB                      $43.65
5871215   58   METHYLPHENIDTE 20MG SR TB                       $7.75
5871256   58   FIORICET W/COD 30MG                             $8.96
5871264   58   PEMOLINE 37.5MG TAB                             $5.33
5871322   58   FENFLURAMINE 20MG TAB                           $5.42
5871355   58   ATOMOXETINE 10MG TAB                            $7.45
5871371   58   DEXTROAMPHETAMINE 10MG CA                      $36.33
5871389   58   DEXTROAMPHETAMINE15MG CAP                      $36.70
5871504   58   NORCO TAB                                       $6.45
5871561   58   ADDERALL 5MG TAB                               $38.40
5871587   58   DIAZEPAM RECTAL GEL 10MG                      $215.70
5871595   58   DIAZEPAM RECTAL GEL 15MG                      $150.00
5871603   58   MODAFINIL 100MG TAB                            $44.32
5871611   58   FENTANYL 200MCG LOZ                            $55.27
5871637   58   FENTANYL 600MCG LOZ                            $66.47
5871652   58   FENTANYL 1200MCG LOZ                           $83.47
5880034   58   PAREGORIC 5 ML LIQ                              $6.98
5880042   58   PHENOBARBITAL 20MG/5ML EL                       $4.87
5880075   58   ROBITUSSIN AC 5 ML LIQ                          $5.46


                                    Page 38 of 276
Charge #Dept   CDM Description                        Price
5880083   58   ACTIFED C 5ML LIQ                               $21.05
5880091   58   B & O 60MG SUP                                  $41.04
5880109   58   CHLORAL HYDRATE 500MG/5ML                        $5.28
5880117   58   MORPH SULF 10MG/5ML LIQ                         $35.77
5880125   58   HYDROMORPHONE 3MG SUP                           $11.99
5880133   58   METHADONE 10 MG/5 ML LIQ                         $5.01
5880141   58   COCAINE 10% 4ML TOP SOLN                       $121.02
5880158   58   ACETAMIN/CODEINE 5ML LIQ                         $5.36
5880166   58   PENTOBARBITAL 60 MG SUP                         $14.42
5880174   58   MORPHINE SULF 20MG/ML SOL                       $36.38
5880182   58   COCAINE 4% 4ML TOP SOLN                         $85.36
5880190   58   MORPH SULF 20MG/5ML LIQ                         $35.26
5880208   58   LOMOTIL LIQ 5ML                                  $5.15
5880216   58   PARALDEHYDE LIQ 30 ML                           $20.98
5880232   58   HYCODAN LIQ 5ML                                  $5.23
5880240   58   DARVON-N SUSP 5ML                                $5.34
5880257   58   LOR TAB LIQ 5ML                                  $5.44
5880265   58   CASCARA FLUID EXTR 5ML                           $5.18
5880273   58   LORTAB ELIXIR 15ML                               $6.14
5880299   58   PHENERGAN VC/COD 120 ML                         $11.30
5880323   58   ACETAMIN/COD LIQ 12.5ML                          $4.86
5880331   58   HYCOTUSS LIQUID                                  $5.10
5880349   58   PHENERGAN/COD LIQ 120 ML                         $5.13
5880372   58   T.A.C. TOP SOL                                  $72.20
5880380   58   METHADONE 5MG/5ML LIQ                            $5.39
5880430   58   MEPERIDINE 50MG/5ML LIQ                         $35.51
5881115   58   LIDOCAINE/EPI/TETRA 5ML                         $17.60
5881123   58   MIDAZOLAM SYR 10MG/5ML                          $37.16
5890017   58   AMOBARBITAL 500MG VIAL                          $61.85
5890025   58   BREVITAL 500MG VIAL                             $79.56
5890033   58   CODEINE PHOS 30MG INJ                           $37.36
5890041   58   CODEINE PHOS 60MG INJ                           $37.52
5890058   58   MEPERIDINE 50MG INJ                             $36.08
5890066   58   MEPERIDINE 100MG INJ                            $36.12
5890074   58   HYDROMORPHONE 2MG INJ                           $37.66
5890082   58   HYDROMORPHONE 4MG INJ                           $38.38
5890090   58   METHADONE 10 MG INJ                             $38.94
5890108   58   INNOVAR 2ML INJ                                 $74.12
5890116   58   LEVORPHANOL 2MG INJ                             $42.92
5890132   58   MORPHINE SULF 10 MG INJ                         $36.58
5890140   58   MORPHINE 15 MG INJ                              $36.36
5890157   58   PENTOBARBITAL 100 MG INJ                        $40.02
5890165   58   OXYMORPHONE 1.5 MG INJ                          $10.96
5890173   58   PHENOBARBITAL 130 MG INJ                        $37.70
5890181   58   SECOBARBITAL 100 MG INJ                         $39.21
5890199   58   FENTANYL 2ML INJ                                $40.16
5890207   58   DIAZEPAM 10MG INJ                               $38.81
5890215   58   THIOPENTAL 500 MG INJ                           $70.40
5890223   58   PHENOBARBITAL 65 MG INJ                         $37.70
5890231   58   MIDAZOLAM 5MG/1ML VIAL                          $51.86
5890249   58   SUFENTANIL 2 ML INJ                             $86.96
5890256   58   MORPHINE SULF 4 MG INJ                          $36.82
5890280   58   MORPHINE SULF 2 MG INJ                          $36.82
5890306   58   ALFENTANIL 2ML INJ                              $51.18
5890322   58   MEPERIDINE PCA 500MG                            $76.98
5890330   58   MORPHINE SULF 300MG/20ML                        $66.80
5890355   58   PENTAZOCINE 60 MG INJ                           $45.52
5890363   58   LORAZEPAM 2MG INJ                               $64.33


                                     Page 39 of 276
Charge #Dept   CDM Description                       Price
5890371   58   LORAZEPAM 4MG INJ                                $68.20
5890389   58   MIDAZOLAM 2MG/2ML VIAL                           $37.80
5890413   58   MEPERIDINE 25MG INJ                              $35.04
5890421   58   MEPERIDINE 75MG INJ                              $35.04
5890439   58   PENTAZOCINE 30 MG INJ                            $40.19
5890447   58   FENTANYL 5ML AMP                                 $44.38
5890454   58   SUFENTAINL 5 ML AMP                            $142.96
5890462   58   ALFENTANIL 5ML INJ                               $64.02
5890470   58   FENTANYL 10ML INJ                                $39.14
5890488   58   HYDROMORPHONE 2MG/ML 20ML                        $62.52
5890538   58   MEPERIDINE 100MG/ML 20ML                         $90.02
5890553   58   PENTAZOCINE 30MG/ML 10 ML                        $40.38
5890579   58   MIDAZOLAM 5 MG/5 ML VIAL                         $39.96
5890611   58   MORPHINE PF 10MG/10ML INJ                        $53.46
5890645   58   MORPH SULF PCA 60 MG                             $58.10
5890660   58   MORPH SULF 250MG/10ML INJ                        $25.46
5890694   58   FENTANYL 20ML INJ                                $89.32
5890710   58   FENTANYL 50ML INJ                              $241.83
5890728   58   HYDROMORPHONE PCA 12MG                           $75.00
5890751   58   MORPHINE PF 500MG/10ML IN                        $57.50
5890785   58   MIDAZOLAM 50MG/10ML                            $144.48
5890793   58   MIDAZOLAM 10MG/10ML                              $51.86
5890827   58   PENTOBARB 50MG/ML 20ML                           $36.01
5900014   59   EPOETIN ALPHA 1000U(4000U                        $46.84
5900022   59   VECURONIUM 10 MG VIAL                          $120.08
5900030   59   DEZOCINE 10MG VIAL                               $61.58
5900048   59   PROTIRELIN 500MCG/ML INJ                       $199.76
5900055   59   SINOGRAFIN 10 ML VIAL                          $161.56
5900063   59   PROPOFOL 20 ML INJ                               $71.40
5900071   59   NESACAINE-MPF 2% 30 ML                           $91.20
5900089   59   NESACAINE-MPF 3% 30 ML                           $94.76
5900097   59   K PHOS 15MM/5ML                                  $28.85
5900113   59   INSULIN HUMAN UL 100U/ML                         $74.06
5900121   59   FILGRASTIM 300MCG INJ                          $598.55
5900139   59   LUPRON 2WK KIT                                $1,259.14
5900147   59   COCCI SKIN TEST                                  $39.50
5900162   59   PIPECURONIUM 10 MG VIAL                        $209.60
5900170   59   PYRIDOSTIGMINE 10MG/2 ML                         $37.69
5900188   59   INTERFERON ALPHA 2A 3MU                        $155.76
5900212   59   MUMPS SKIN TEST                                  $76.98
5900220   59   TB TINE TEST                                     $37.39
5900238   59   TRICHOPHYTON SKIN TEST                           $37.09
5900246   59   TB PPD 5U SKIN TEST                              $38.48
5900253   59   TB PPD 250 U SKIN TEST                           $46.47
5900261   59   TB PPD 1 U SKIN TEST                             $40.35
5900287   59   RIBAVIRIN 6 GM                                $2,649.20
5900303   59   LUPRON DEPOT 7.5MG                            $2,101.28
5900311   59   OCTREOTIDE 0.1 MG INJ                            $60.40
5900329   59   SALINE FLUSH                                     $25.34
5900337   59   ASCORBIC ACID 500MG INJ                          $38.72
5900345   59   ETHACRYNIC ACID 50MG INJ                       $110.80
5900352   59   HYDROCORTISONE 100MG INJ                         $39.03
5900360   59   PYRIDOXINE 100 MG VIAL                           $37.88
5900378   59   METHYLPRED 125 MG VIAL                           $25.49
5900386   59   METHYLPRED 40 MG VIAL                            $39.10
5900402   59   CHROMIC CHL 10ML 4MCG/ML                         $37.20
5900410   59   DEXAMETH 4MG/ML 1ML VIAL                         $28.83
5900436   59   POT ACETATE 40 MEQ VIAL                          $37.71


                                    Page 40 of 276
Charge #Dept   CDM Description                         Price
5900444   59   DEXAMETH 10MG/ML 1ML VIAL                          $38.34
5900451   59   THIAMINE 100 MG VIAL                               $29.00
5900469   59   MANGANESE 10ML VIAL                                $37.20
5900477   59   HYPAQUE 60 150ML                                 $101.24
5900485   59   HYPAQUE 60 50ML                                    $48.62
5900493   59   HYPAQUE 500ML                                      $43.06
5900527   59   ESTRADURIN 40MG INJ                              $168.24
5900535   59   HEP B IMM GLOB 0.5ML INJ                         $223.67
5900543   59   BUMETANIDE 1MG INJ                                 $39.60
5900568   59   ENALAPRIL 2ML INJ                                $153.72
5900576   59   DEXPANTHENOL 2ML INJ                               $43.63
5900584   59   TRIFLUPROMAZINE 20MG INJ                         $257.27
5900592   59   ZINC CL INJ 1MG/ML 10 ML                           $37.20
5900618   59   HEPARIN 5000U/ML 10ML VL                           $40.49
5900626   59   KETOROLAC 30MG INJ                                 $51.86
5900634   59   MAG SULF 50% 20ML VIAL                             $44.89
5900642   59   MAG SULF 50% 50ML VIAL                             $69.52
5900659   59   MAG SULF 50% 2ML VIAL                              $37.20
5900675   59   MESORIDAZINE INJ                                   $50.60
5900683   59   ACTIVASE 10MG(100MGVIAL)                        $6,834.56
5900691   59   STREPTOKINASE 250KU(600 V                        $720.00
5900709   59   VARICELLA ZOSTER GLOB INJ                        $457.50
5900717   59   ACTH 40U/ML 1 ML INJ                             $142.40
5900725   59   ACTH GEL 80U INJ                                 $131.84
5900733   59   METHYLDOPA 250 MG VIAL                             $40.38
5900741   59   AMINOCAPROIC ACID 20ML VI                          $37.68
5900758   59   DEPO TESTADIOL 1ML INJ                             $40.89
5900766   59   DIGOXIN 0.1MG AMP                                  $47.81
5900774   59   DEPO PROVERA 100MG INJ                             $60.73
5900782   59   ACTIVASE 10MG(20MGVIAL)                          $212.50
5900790   59   AMINOPHYLLINE 500 MG VIAL                          $28.98
5900808   59   AMM CHL 100MEQ VIAL                                $38.99
5900816   59   AMPHOTERICIN B 50MG VIAL                         $150.00
5900824   59   PHYSOSTIGMINE 2 ML AMP                             $61.67
5900832   59   PNEUMOVAX VACC                                     $69.44
5900840   59   CALCITONIN 400U INJ                              $206.90
5900857   59   ANTIVENIN-POLYVALENT                            $3,387.50
5900865   59   HYDRALAZINE 20MG INJ                               $63.88
5900873   59   PHYTONADIONE 10 MG AMP                             $45.61
5900899   59   IMM GLOB NON-LYOPH 1GM IV                        $542.06
5900907   59   METARIMINOL 10 ML VIAL                             $73.44
5900915   59   TRIAMCINOLONE 40 MG INJ                            $52.36
5900923   59   GLUCAGON 1ML (1ML)INJ                            $212.00
5900931   59   DROPERIDOL 2ML VIAL                                $40.31
5900949   59   ATROPINE 1MG PFS                                   $81.36
5900956   59   CYANOCOBALAMIN 1000MCG                             $28.81
5900956   59   CYANOCOBALAMIN 1000MCG                             $28.81
5900964   59   BAL IN OIL INJ                                   $281.66
5900972   59   DICYCLOMINE 20 MG INJ                              $39.20
5900980   59   METOCLOPRAMIDE 10 MG INJ                           $38.35
5901004   59   DIPHENHYDRAMINE 50MG INJ                           $39.21
5901012   59   BRETYLIUM 500MG INJ                              $115.00
5901020   59   TERBUTALINE 1 ML INJ                             $144.00
5901038   59   SOD BICARB 8.4% PFS 10ML                           $82.16
5901046   59   STREPTOKINASE 750M VIAL                         $1,093.03
5901053   59   CAL CHLOR 1GM PFS                                  $77.48
5901079   59   CELESTONE 6MG/ML 5ML INJ                         $141.56
5901087   59   BENZTROPINE 2MG INJ                                $56.99


                                      Page 41 of 276
Charge #Dept   CDM Description                        Price
5901095   59   PROCHLORPERAZINE 10MG INJ                       $40.64
5901103   59   COSYNTROPIN INJ                                 $96.80
5901111   59   DEXAMETH 4MG/ML 5ML VIAL                        $38.09
5901129   59   DELESTROGEN 20MG INJ                            $87.16
5901137   59   DEPO-MEDROL 40MG INJ                            $40.93
5901145   59   DEPO-MEDROL 80MG INJ                            $58.57
5901152   59   DEXTROSE 50% 50ML VIAL                          $37.14
5901160   59   DIGOXIN 0.5MG AMP                               $38.10
5901178   59   PHENYTOIN 100 MG INJ                            $46.46
5901186   59   PHENYTOIN 250 MG INJ                            $56.59
5901194   59   DOXAPRAM 20MG INJ                               $40.87
5901202   59   HYDROXYPROG 250MG INJ                           $39.30
5901210   59   DEPO TESTOSTERONE 100MG                         $47.92
5901228   59   DEXTROSE 50% 50ML SYRINGE                      $105.08
5901236   59   DIMENHYDRINATE 50MG INJ                         $39.73
5901244   59   DESFERAL INJ 500MG                              $88.00
5901251   59   DIP/TET AGE 7+ YRS INJ                          $54.34
5901269   59   DPT PED INJ                                     $60.49
5901277   59   DHE - 45 INJ                                    $63.61
5901285   59   ACETAZOLAMIDE 500 MG INJ                       $186.52
5901301   59   EPINEPHRINE 1MG/10ML SYR                        $79.72
5901319   59   EPHEDRINE 50MG INJ                              $37.60
5901327   59   STREPTOKINASE 250KU VIAL                       $506.15
5901335   59   FOLIC ACID INJ                                  $37.23
5901343   59   VERAPAMIL 5MG/2ML VIAL                          $37.03
5901350   59   FLUORESCITE 5ML AMP                            $118.24
5901368   59   HEP B IMM GLOB 5ML                             $660.08
5901376   59   HALOPERIDOL 5MG INJ                             $52.35
5901384   59   HEPARIN 10MU 1ML INJ                            $37.61
5901392   59   HEPARIN 1 MU/ML 10ML VIAL                       $37.56
5901400   59   HEPARIN 5000U IML INJ                           $37.23
5901418   59   IRON DEXTRAN 100MG INJ                         $159.84
5901426   59   HEPARIN LOCK 100U                               $28.89
5901434   59   PROPRANOLOL 1 MG INJ                            $48.13
5901442   59   INDIGO CARMINE 5ML AMP                          $60.50
5901459   59   INSULIN HUMAN R 100U/ML                         $26.41
5901467   59   DIAZOXIDE 300MG INJ                            $472.97
5901491   59   ISOPROTERENOL 1MG AMP                           $98.28
5901509   59   TET IMM GLOB 250 U INJ                         $113.76
5901517   59   FUROSEMIDE 40MG INJ                             $28.81
5901525   59   FUROSEMIDE 20MG INJ                             $28.75
5901533   59   FUROSEMIDE 100MG INJ                            $28.54
5901541   59   NOREPINEPHRINE 4 ML AMP                         $66.48
5901558   59   LIDOCAINE 2GM ADD PFS                           $92.52
5901566   59   KETAMINE 50MG/ML 10ML VIA                      $112.68
5901574   59   METH-ERGONOVINE 0.2MG AMP                       $43.31
5901582   59   MVI-12 10 ML VIAL                               $39.23
5901590   59   MYOCHRYSINE 50 MG INJ                           $64.24
5901608   59   MANNITOL 25% 50ML VIAL                          $38.03
5901616   59   NALOXONE 0.4 MG INJ                             $37.40
5901624   59   PHENYLEPHRINE 10 MG INJ                         $39.13
5901632   59   NITROPRUSSIDE 50 MG VIAL                        $48.13
5901640   59   NALBUPHINE 10 MG INJ                            $37.16
5901657   59   BUPIV/EPI 0.5% 30ML AMP                         $59.42
5901665   59   BUPIVACAINE 0.25% 30ML VL                       $43.72
5901673   59   BUPIVACAINE 0.5% 30ML VIA                       $45.88
5901681   59   PAPAVERINE 60 MG INJ                            $37.51
5901699   59   PANCURONIUM 4 MG/2ML VIAL                       $48.13


                                     Page 42 of 276
Charge #Dept   CDM Description                        Price
5901707   59   THIOTHIXENE 4 MG/2 ML INJ                         $37.94
5901715   59   ORPHENADRINE 60MG/2ML INJ                         $39.40
5901723   59   OXYTOCIN 10 U INJ                                 $28.98
5901731   59   VASOPRESSIN 20 U INJ                              $52.63
5901749   59   METHYLENE BLUE 10 ML INJ                          $67.00
5901756   59   K PHOS 45MM/15ML VIAL                             $37.39
5901764   59   PROCAINAMIDE 1 GM VIAL                            $67.76
5901772   59   CONJ ESTROGEN 25MG INJ                          $258.88
5901780   59   PROTAMINE 50 MG INJ                               $40.16
5901798   59   PHENTOLAMINE 5 MG INJ                           $232.98
5901806   59   RUBELLA VACC                                      $84.48
5901814   59   DANTROLENE 20MG VIAL                              $83.14
5901830   59   SOD BICARB 4.2% 10 ML                             $39.14
5901848   59   PROMAZINE 100 MG/2 ML VIA                         $51.86
5901855   59   QUIN GLUC 800MG/10ML VIAL                       $109.84
5901889   59   CIMETIDINE 300 MG VIAL                            $39.73
5901897   59   TET TOX 0.5 ML INJ                                $39.59
5901905   59   CHLORPROMAZ 25MG/1ML INJ                          $40.19
5901913   59   CHLORPROMAZ 50MG/2ML INJ                          $38.36
5901921   59   TRIMETHOBENZ 200 MG INJ                           $41.38
5901939   59   THIETHYLPERAZINE 10MG INJ                         $43.54
5901947   59   HYDROXYZINE 100MG/2ML INJ                         $39.30
5901954   59   BETHANECHOL 5MG INJ                               $45.29
5901970   59   GLYCOPYRROLATE 0.2MG INJ                          $28.58
5901988   59   EPINEPHRINE 1:1000 AMP                            $28.64
5902002   59   BUPIVAC 0.75% 30ML AMP                            $55.19
5902010   59   LIDOCAINE 2% 50ML VIAL                            $28.85
5902028   59   NA PHOS 45MM/15 ML VIAL                           $40.46
5902028   59   NA PHOS 45MM/15 ML VIAL                           $40.46
5902036   59   TRACE METALS 5 ML VIAL                            $37.89
5902044   59   METOCLOPRAMIDE 50 MG VIAL                         $49.52
5902051   59   EDETATE 5ML VIAL                                $213.40
5902069   59   INSULIN HUMAN L 100U/ML                           $74.06
5902077   59   PROMETHAZINE 50 MG INJ                            $41.00
5902085   59   TUBOCURA 3MG/ML 20ML VIAL                         $61.63
5902093   59   PROSTIN VR PED AMP                              $707.16
5902101   59   ATRACURIUM 50MG AMP                             $154.68
5902119   59   AZATHIOPRINE 100MG VIAL                         $417.57
5902127   59   INTERFERON ALPHA 2B 3MU                         $166.52
5902135   59   COLCHICINE 1MG INJ                                $39.26
5902143   59   UROKINASE 250 MU VIAL                          $1,909.23
5902150   59   UROKINASE 5 MU OPEN-CATH                        $365.52
5902168   59   BUMETANIDE 0.5 MG VIAL                            $38.15
5902176   59   COPPER CL 0.4MG/ML 10ML                           $37.20
5902184   59   CYANIDE ANTIDOTE KIT                            $552.25
5902200   59   DIP/TET <7 YRS INJ                                $44.08
5902218   59   EPOETIN ALPHA 1000U                               $79.65
5902226   59   DOPAMINE 200MG/5ML VIAL                           $28.84
5902234   59   CAL CHL 1GM VIAL                                  $28.73
5902242   59   POT CHLOR 40MEQ/20ML VIAL                         $25.34
5902259   59   LIDOCAINE 50MG PFS                                $68.56
5902267   59   HYDROCORTISONE 500MG VIAL                         $72.12
5902275   59   FLUPHENAZ DEC 25MG/ML 5ML                       $262.55
5902291   59   SINCALIDE 5 MCG VIAL                            $125.36
5902309   59   DDAVP 1MCG(40MCG) INJ                          $1,072.66
5902309   59   DDAVP 1MCG(40MCG) INJ                           $138.84
5902325   59   NALBUPHINE 20 MG INJ                              $37.28
5902333   59   IMM GLOB NONLYOPH 1GM 5GM                      $1,079.94


                                     Page 43 of 276
Charge #Dept   CDM Description                        Price
5902341   59   AMRINONE 100MG/20ML AMP                         $302.03
5902358   59   INDOMETHACIN IV 1MG VIAL                        $360.24
5902366   59   ESMOLOL 2.5GM AMP                               $215.13
5902374   59   NACL 4 MEQ/ML 30 ML VIAL                          $37.44
5902382   59   HYSKON 100ML VIAL                               $136.52
5902382   59   HYSKON 100ML VIAL                               $136.52
5902390   59   METOPROLOL 5 MG/5 ML INJ                          $63.20
5902408   59   ACTH GEL 40U/ML 1ML VIAL                          $85.08
5902416   59   ETOMIDATE 40MG/20ML PFS                         $145.60
5902424   59   CELESTONE SOL 3MG/ML 5ML                        $101.88
5902432   59   ATROPINE 0.4 MG VIAL 1 ML                         $25.43
5902440   59   BUMETANIDE 2.5MG/10ML VIA                         $60.68
5902457   59   ATROPINE 0.5MG PFS                                $79.44
5902465   59   EDROPHONIUM 150MG/15ML VL                         $63.00
5902473   59   ESTRADIOL VAL 40MG/ML 5ML                       $514.38
5902481   59   BUPIVAC 0.25% AMP 50ML                            $60.82
5902499   59   BUPIVAC 0.25% VIAL 10ML                           $39.07
5902507   59   SCOPOLAMINE 0.4 MG VIAL                           $37.20
5902515   59   DOPAMINE 400MG/10ML VIAL                          $94.68
5902523   59   LIDO/EPI 1.5% 30ML                                $49.93
5902531   59   BUPIVAC 0.5% VIAL 10ML                            $39.36
5902549   59   LIDOCAINE 1% 50ML VIAL                            $28.86
5902556   59   THYROTROPIN 10 UN INJ                           $720.67
5902564   59   BUPIVAC 0.75% VIAL 10ML                           $39.70
5902572   59   BUPIV/EPI 0.75% AMP 30ML                          $60.46
5902580   59   TESTOS ENAN 200MG/ML 10ML                       $188.40
5902598   59   BUPIV/EPI 0.25% AMP 50 ML                         $64.87
5902606   59   NESACAINE 1% 30 ML VIAL                         $107.56
5902614   59   NESACAINE 2% 30 ML VIAL                         $109.76
5902622   59   BUPIV/EPI 0.25% 10ML VIAL                         $39.54
5902630   59   ESTRONE 2MG/ML 10ML VIAL                          $99.20
5902648   59   TETRACAINE 1% AMP 2 ML                            $45.29
5902655   59   HEPARIN LOCK 10U                                  $28.79
5902663   59   BUPIV/EPI 0.5% 10ML VIAL                          $39.86
5902671   59   NALOXONE 2 MG/2 ML INJ                            $40.75
5902689   59   NA ACETATE 40 MEQ/20 ML                           $25.07
5902697   59   HYDROCORTISONE 250MG VL                           $40.00
5902705   59   ARISTOSPAN 20MG/ML 1ML VL                         $56.81
5902713   59   NEOSTIGMINE 0.5 MG/ML AMP                         $37.75
5902721   59   METHOCARBAMOL 10 ML VIAL                          $40.49
5902739   59   METHYLPRED 1 GM VIAL                              $37.30
5902747   59   CORTISONE 50MG/ML 10ML                            $38.65
5902754   59   SOD BICARB 8.4% 50ML VIAL                         $28.69
5902762   59   HYDROCORT 1GM VIAL                                $39.31
5902770   59   MAG SULF 50% 10ML VIAL                            $39.95
5902788   59   METHYLENE BLUE 1 ML INJ                           $51.50
5902796   59   LABETOLOL 100MG/20ML VIAL                       $201.40
5902804   59   DIGIBIND 40MG VIAL                             $1,809.59
5902812   59   PENTAGASTRIN 2 ML                               $169.40
5902820   59   ATRACURIUM 100MG VIAL                           $204.63
5902838   59   HEMABATE INJ                                    $145.84
5902846   59   ONDANSETRON 1MG(40MG)INJ                          $77.42
5902853   59   TRIAMCIN 10MG/ML 5 ML VL                          $61.81
5902861   59   CIMETIDINE 8ML VIAL                               $69.00
5902879   59   NITROGLYCERIN 50MG VIAL                           $65.00
5902887   59   FAMOTIDINE 20 MG VIAL                             $40.74
5902895   59   ESMOLOL 100MG/10ML VIAL                           $66.96
5902903   59   BUTORPHANOL 1MG INJ                               $57.94


                                     Page 44 of 276
Charge #Dept   CDM Description                       Price
5902911   59   IMMUNE SER GLOB 2ML VIAL                         $73.12
5902929   59   IMMUNE SER GLOB 10ML VIAL                      $124.20
5902937   59   RITODRINE 50MG/5ML                             $183.92
5902945   59   KETOROLAC 60MG INJ                               $53.48
5902952   59   ACTIVASE 50MG VIAL                            $3,429.78
5902994   59   MVI PED 5ML VIAL                                 $45.20
5903000   59   LIDO/EPI 2% 20ML VL                              $83.60
5903026   59   HYALURONIDASE 150MG VIAL                       $112.36
5903034   59   LEVOTHYROXINE 200MCG VL                        $159.76
5903042   59   LEVOTHYROXINE 500MCG VL                        $173.72
5903059   59   HEPATITIS B VACC 0.5ML                         $126.08
5903067   59   HYDELTRA TBA 20MG VIAL                           $44.03
5903075   59   PHYTONADIONE 1 MG INJ                            $46.64
5903083   59   CAL GLUC 4.8MEQ 10ML VL                          $28.89
5903091   59   MVI CONC 5 ML VL                                 $49.52
5903117   59   MEPIVICAINE 1.5% 30ML VL                         $64.76
5903125   59   ATENOLOL 5MG/10ML AMP                            $60.20
5903133   59   NEOSTIGMINE 1:1000 10 ML                         $59.38
5903141   59   NEOSTIGMINE 0.25 MG AMP                          $37.47
5903158   59   DEPO-ESTRADIOL 5ML VL                          $147.72
5903166   59   AMITRIPTYL 10MG/ML 10ML V                        $64.92
5903174   59   SUCCINYLCHOL 200 MG/10ML                         $37.14
5903182   59   SUCCINYLCHOL 1000 MG/10ML                        $40.04
5903190   59   BUPIVACAINE SPINAL 2ML                           $39.41
5903240   59   FLUMAZENIL 5ML INJ                             $196.40
5903257   59   FLUMAZENIL 10ML INJ                            $300.63
5903265   59   ADENOSINE THERAP 6MG INJ                       $160.00
5903273   59   LUPRON 4WK KIT                                $1,770.00
5903281   59   BERACTANT 200MG/8ML                           $2,837.43
5903299   59   MIVACURIUM 10 MG/5 ML                            $61.88
5903307   59   PAMIDRONATE 30 MG VIAL                         $876.63
5903323   59   DILTIAZEM 50MG/10ML VIAL                       $134.64
5903331   59   STREPTOKINASE 250KU(1.5VL                     $2,166.13
5903349   59   BUPIVAC 0.5% 30ML AMP                            $54.38
5903356   59   CALCITRIOL 1MCG/1ML AMP                          $74.00
5903364   59   METOCLOPRAMIDE 150MG VIAL                        $90.00
5903372   59   DIPYRIDAMOLE 10MG/2ML AMP                      $140.00
5903380   59   NTG 50 MG/250 ML RTU                             $36.35
5903398   59   HEPARIN 25000U/500ML RTU                         $43.18
5903430   59   RANITIDINE 150MG/6ML VIAL                        $61.67
5903455   59   SUMATRIPTAN 6 MG INJ KIT                       $317.92
5903489   59   LIDO/EPI 1% 20ML                                 $39.79
5903497   59   LIDO/EPI 1% 50ML                                 $47.81
5903513   59   PROGEST/OIL 50MG/1ML INJ                       $175.00
5903521   59   SARGRAMOSTIM 50MCG(500MCG                      $671.18
5903539   59   DEXAMETH 8GM/ML INJ                              $61.81
5903547   59   AUROTHIOGLUCOSE 50MG VIAL                        $87.08
5903562   59   ESTRADIOL VIAL 10MG/ML 5M                      $231.51
5903570   59   ETIDRONATE 50MG/ML 6ML                         $303.50
5903588   59   STER WAT FOR INJ 10 ML                           $25.43
5903604   59   SOD BICARB 8.4% PFS 50 ML                      $110.64
5903612   59   DEXTROSE 25% PFS                                 $81.20
5903620   59   LIDOCAINE 100MG PFS                              $70.84
5903646   59   POT CHLOR 20 MEQ VIAL                            $28.54
5903653   59   POT CHLOR 30 MEQ VIAL                            $28.66
5903661   59   ATROPINE 1MG VIAL                                $29.00
5903679   59   ATROPINE 0.4MG 20ML VIAL                         $28.75
5903703   59   SECRETIN INJ 75 UNITS                          $768.55


                                    Page 45 of 276
Charge #Dept   CDM Description                        Price
5903711   59   PROMETHAZINE 25 MG INJ                            $40.39
5903745   59   OFLOXACIN 400MG/10ML VIAL                       $130.40
5903760   59   RANITIDINE 50MG/2ML VIAL                          $39.99
5903786   59   PERPHENAZINE 5 MG INJ                             $53.80
5903794   59   CHOLERA VACC INJ                                  $63.61
5903802   59   BUPIVICAINE 0.5% 50ML                             $54.83
5903836   59   BCG VACCINE INJ                                 $196.47
5903851   59   ARGININE 10% 300ML INJ                          $377.00
5903877   59   AMINOPHYLLINE 250MG INJ                           $28.81
5903893   59   FAMOTIDINE 40MG/4ML VIAL                          $40.74
5903901   59   FLUORESCEIN 25% 2ML INJ                         $133.76
5903919   59   FLUPHENAZINE 2.5MG/ML INJ                         $39.33
5903927   59   HALOPERIDOL DEC 50MG INJ                        $214.56
5903943   59   HEPARIN 10U/ML 10ML INJ                           $39.88
5903950   59   HEPARIN 1000U/ML 30ML INJ                         $39.38
5903968   59   HEPARIN 1000U/ML 1ML INJ                          $28.99
5903976   59   HEPARIN 1000U/ML 10ML INJ                         $39.70
5903992   59   RSV IMMGLOB50MG-2.5GMVIAL                      $3,358.30
5904016   59   INDOCYANINE GREEN 25MG                          $110.60
5904024   59   INTERFERON ALPHA 2B 1M(10                       $617.71
5904032   59   HYDROXYZINE 25 MG/ML INJ                          $37.53
5904040   59   ETHYL ALCOHOL 100% 1ML                            $71.32
5904073   59   GOLD 500MG/10ML INJ                               $61.44
5904099   59   HAEMOPHILUS B VACCINE                             $23.35
5904107   59   TUBOCURA 3MG/ML 10 ML VL                          $47.00
5904123   59   VIT A 50,000 U/ML INJ                           $130.68
5904131   59   TRIAMCINOLONE FORTE INJ                           $51.50
5904164   59   TRIMETHAPHAN 500 MG INJ                         $134.40
5904172   59   TOLAZOLINE 25MG/ML INJ                            $86.04
5904198   59   SOTRADECOL 1% INJ                                 $79.92
5904206   59   LABETOLOL 20MG/4ML SYR                            $98.28
5904214   59   SODIUM THIOSUL 100MG/ML                           $53.75
5904222   59   SODIUM THIOSULFATE 25% IN                       $100.24
5904248   59   THIOTHIXENE 5 MG/ML INJ                           $39.54
5904263   59   TESTOSTERONE 100MG/ML INJ                         $37.61
5904289   59   BACT WAT FOR INJ 30ML                             $28.54
5904313   59   NALOXONE 10MG/10ML INJ                            $40.25
5904321   59   NANDROLONE DEC 100MG/ML                           $84.56
5904339   59   NANDROLONE DEC 200MG/ML                           $88.00
5904347   59   MUMPS VACC INJ                                  $110.92
5904354   59   SOD BICARB 4% 5 ML VL                             $39.78
5904362   59   SOD CHLOR FOR INJ 30ML VL                         $25.43
5904370   59   SOD CHOLR FOR INJ 10ML VL                         $25.34
5904396   59   LIDOCAINE 0.5% 50 ML VIAL                         $70.92
5904404   59   PROTAMINE 250 MG INJ                              $88.04
5904412   59   POLIOVIRUS VACCINE                                $62.28
5904420   59   POT CHLOR 10MEQ/50ML BAG                          $34.63
5904446   59   PROCAINE 1% 2 ML INJ                              $39.26
5904453   59   PROCAINE 1% 30 ML VL                              $79.96
5904479   59   PANCURONIUM 1MG/ML 10ML                           $37.75
5904487   59   LOXAPINE 50MG/ML INJ                              $71.30
5904495   59   METHOTREXATE 250 MG VL                          $140.96
5904503   59   METHOXAMINE 20 MG INJ                           $117.68
5904511   59   MMR VACCINE INJ                                 $209.04
5904537   59   LIDOCAINE 1% 20ML VIAL                            $38.99
5904545   59   LIDOCAINE 2% 20ML VIAL                            $44.80
5904545   59   LIDOCAINE 2% 20ML VIAL                            $25.39
5904552   59   LIDOCAINE 1.5% 20ML VL                            $66.60


                                     Page 46 of 276
Charge #Dept   CDM Description                       Price
5904578   59   LIDOCAINE 4% 5ML AMP                             $38.31
5904594   59   LIDOCAINE 1% 2ML AMP                             $37.58
5904610   59   LIDOCAINE-GLUCOSE 2ML AMP                        $60.56
5904636   59   CYCLOSPORINE 5ML INJ                             $46.24
5904644   59   FLUOGEN INJ                                      $43.25
5904651   59   DEXTROSE 10% 5ML INJ                             $38.30
5904677   59   EPINEPHRINE 1:1000 30ML                          $90.76
5904701   59   LIDOCAINE 1% 30ML                                $28.65
5904719   59   LIDOCAINE 2% 10ML VIAL                           $37.13
5904727   59   LIDOCAINE 1% 5ML AMP                             $38.94
5904735   59   CORTICOTROPINE 25U INJ                         $110.92
5904743   59   LIDO/EPI 2% 50ML VIAL                            $52.31
5904784   59   INS HUMAN UL 100U/ML 10ML                        $37.65
5904834   59   INS HUM 70/30 1.5ML PEN F                        $26.52
5904842   59   INS R HUM 1.5ML PEN FILL                         $26.52
5904859   59   INS NPH HUM 1.5ML PEN FIL                        $26.52
5904883   59   HEXABRIX 39% 50ML VL                           $254.08
5904891   59   HYPAQUE 50% 50ML VL                              $50.06
5904958   59   HALOPERIDOL 100MG 1ML INJ                      $332.34
5904966   59   ETHANOLAMINE 5% 2ML INJ                        $134.76
5904974   59   EDROPHON/ATR 5ML INJ                             $47.86
5904990   59   POT CHLOR 10MEQ VIAL                             $28.56
5905005   59   DEPO PROVERA 150MG INJ                         $236.62
5905021   59   MILRINONE 10MG/10 ML VL                        $349.56
5905039   59   DEPO-MEDROL 80MG/ML 5 ML                       $108.10
5905096   59   NALOXONE 0.4MG/ML 10 ML                        $179.52
5905112   59   DEPO-PROVERA 50MG(1GM)INJ                      $462.19
5905120   59   LUPRON DEPOT 3.75MG                           $1,562.21
5905146   59   TERIPARATIDE 20MCG INJ                           $89.91
5905161   59   FLUPHENAZINE DEC 25MG/ML                       $132.56
5905179   59   ISOPROTERENOL 2MG/10ML PF                        $84.44
5905229   59   PANCURONIUM 2 MG/ML 5 ML                         $38.63
5905237   59   GOSERELIN 3.6MG SYR                            $771.30
5905245   59   ENOXAPARIN 30MG SYRINGE                        $109.20
5905294   59   FILGRASTIM 480MCG VIAL                         $941.55
5905302   59   SARGRAMOSTIM 50MCG(250MCG                      $555.33
5905369   59   BUPIV/EPI 0.25% 30ML VIAL                        $47.27
5905377   59   INTERFERON ALPHA 2B 1M.5M                      $272.64
5905385   59   ISOPROTERENOL 0.2MG AMP                          $44.35
5905419   59   SOTRADECOL 3% INJ                              $123.00
5905427   59   ESTRADIOL VAL 40MG/ML 10M                      $202.72
5905443   59   TRACE METALS 1 ML                                $38.45
5905450   59   GRANISETRON 1MG/1ML VIAL                       $703.20
5905468   59   APROTININ INJ 100ML                           $1,038.82
5905476   59   APROTININ INJ 200ML                           $2,001.04
5905518   59   ROCURONIUM 50 MG VIAL INJ                        $86.56
5905567   59   KETAMINE 100MG/ML 5ML INJ                      $109.08
5905575   59   CAFFEINE/SOD BENZ 500MG                        $117.52
5905641   59   FAC VIII POWDER INJ 500U                      $1,420.00
5905666   59   ONDANSETRON 1MG(4MG/2ML)                       $130.84
5905690   59   ABCIXIMAB 10MG INJ                             $460.78
5905740   59   KETAMINE 10MG/ML 20ML VIA                        $69.88
5905799   59   VARICELLA VIRUS VAC 0.5ML                      $325.90
5905807   59   ALPROSTADIL10MCG.MLINJ                         $105.24
5905815   59   ETIDOCAINE 1% 30ML                             $106.36
5905831   59   ETIDOCAINE 1.5% W/EPI 20M                      $123.56
5905849   59   GONADORELIN 100MCG/2ML IN                      $429.22
5905898   59   BOTULINUM TOXIN 1U(100UV)                     $1,638.75


                                    Page 47 of 276
Charge #Dept   CDM Description                        Price
5905906   59   RISPIRAONDE CONSTA 25 MG                       $1,015.89
5906029   59   PRALIDOXIME 1GM INJ                             $116.00
5906185   59   ISOSULFAN BLUE 1% 5MLVIAL                       $164.00
5906342   59   AMIODARONE 150MG/3ML INJ                        $212.50
5906359   59   MESNA 400MG INJ BRAND                           $159.26
5906367   59   DEPO-MEDROL 40MG/ML 5ML                           $61.18
5906375   59   NALOXONE 0.02MG/ML 2ML                            $44.46
5906391   59   IMIPRAMINE 25MG/2ML AMP                           $38.42
5906417   59   EPINEPHRINE 1:200 INJ 0.3                         $44.98
5906425   59   EPINEPHRINE 1:200 INJ 5ML                       $174.00
5906433   59   IRON DEXTRAN 500MG INJ                          $212.72
5906441   59   CALCITONIN-HUMAN 0.5MGVIA                         $59.51
5906458   59   BACLOFEN INTRA 10MG/20ML                        $923.00
5906482   59   ATROPINE 0.3MG 1ML                                $28.93
5906490   59   BUPIVAC.25%VIAL 50ML                              $51.77
5906508   59   BUPIV/EPI0.25%VIAL50ML                            $56.59
5906516   59   BUPIV/EPI0.5%VIAL50ML                             $59.87
5906540   59   HEPATITIS A VACC0.5ML                           $101.60
5906557   59   HEPATITIS A VACC 1ML                            $259.89
5906565   59   BACLOFEN INTRA 10MG/5ML I                      $1,822.00
5906573   59   KETOROLAC 15MG INJ                                $51.73
5906581   59   FACTOR IXCOMPLEX1050U/VIA                       $410.78
5906599   59   ARGATROBAN 100U/ML 2.5ML                       $3,109.07
5906607   59   LYMPHOCYTE IMM GLOB250MG                        $938.58
5906623   59   SUCCINYL POWD/INJ500MG                            $61.40
5906706   59   IBUTILIDE 1MG/10ML VIAL                        $1,083.48
5906722   59   DEXRAZOXANE 500MG INJ                          $1,815.78
5906755   59   MENINGOCOCCAL VACC                              $189.60
5906847   59   PAMIDRONATE 30MG(60MGV)                        $1,521.40
5906854   59   PAMIDRONATE 30MG(90MGV)                        $2,958.60
5906888   59   CISATRACURIUM10MG/5ML                             $65.00
5906938   59   NICARDIPINE 25MG AMP                            $254.29
5906946   59   ZINC SULF INJ 1MG/ML 10ML                         $25.25
5906953   59   OCTREOTIDE.2MG/ 5ML VIAL                          $49.65
5906961   59   SUMATRIPTAN 6MG VIAL                            $250.76
5906979   59   CYSTEINE 50MG/ML 10ML                             $28.89
5906995   59   INSULIN LISPRO 100U/ML 10                       $159.76
5907001   59   INSULIN LISPRO 100U/ML 1M                         $24.98
5907043   59   HYDROCHLORIC ACIC37%INJ                           $25.02
5907118   59   ROPIVACAINE 1% 10MLVIAL                           $72.52
5907134   59   IMM GLOB NONLYOPH 1GM 5GM                       $405.00
5907142   59   FOSPHENYTOIN 150MG/2ML                          $117.80
5907167   59   RETEPLASE 10.8 IU INJ                          $5,504.00
5907175   59   ADENOSINE DX 90MG INJ                           $899.87
5907183   59   DEXAMETH 10MG/ML 10ML VI                          $43.40
5907209   59   INTERFERON BETA 1A 33MCG                        $799.10
5907217   59   INTERFERON BETA 1B 0.3MG                        $300.35
5907266   59   ENOXAPARIN 40MG SYRINGE                         $138.96
5907464   59   TORSEMIDE 20MG/2ML INJ                            $52.85
5907480   59   DALTEPARIN 2500UNIT INJ                           $95.36
5907498   59   DALTEPARIN 5000UNIT INJ                         $142.24
5907530   59   RHO-D IG 600IU/ML 2.5ML                         $915.00
5907548   59   RHO-D IMM GLOB IV 100IU                         $485.00
5907563   59   DOLASETRON 10MG(100MGV)                         $215.00
5907571   59   DOLASTRON 10MG(12.5MG)INJ                         $94.20
5907589   59   CEFEPIME IGM INJ                                  $86.24
5907670   59   FOMEPIZOLE 1GM/ML 1.5ML                        $4,004.57
5907688   59   HYALURONIDASE15500U VIAL                        $245.72


                                     Page 48 of 276
Charge #Dept   CDM Description                         Price
5907696   59   OCTREOTIDE 0.05MG INJ                           $64.91
5907704   59   OPRELVEKIN 5MG INJ                            $641.60
5907712   59   PALIVIZUMAB 100MG INJ                        $4,127.84
5907720   59   EPTIFIBATIDE 75MG INJ                         $888.14
5907738   59   EPTIFIBATIDE 20MG INJ                         $297.41
5907746   59   ENOXAPARIN 60MG SYRINGE                       $198.60
5907985   59   DROTRECOGIN 5MG/ML SDV                       $1,004.17
5907993   59   DROTRECOGIN 20MG/ML SDV                      $3,394.28
5908017   59   INSULIN GLARGINE 100U/ML                        $51.34
5908025   59   OLANZAPINE 10MG INJ                           $108.76
5908041   59   ENOXAPARIN 100MG SYRINGE                      $280.51
5908066   59   IMM GLOB LYOPHIL 1GM(6GM)                    $1,240.21
5908082   59   ZOLEDRONATE 1MG(4MG) INJ                     $1,692.82
5908157   59   BACLOFEN 50MCG/ML AMP                         $172.00
5908231   59   GLATIRAMER ACE 20MG INJ                       $158.46
5908249   59   INFLIXIMAB 10MG(100MGINJ)                    $2,440.64
5908272   59   DALETPARIN 10000U/ML                          $213.57
5908306   59   VALPROATK 500MG VIAL                            $83.36
5908348   59   TENECTEPLASE 50MG INJ                        $5,859.96
5908355   59   NESIRITIED 1.5MG INJ                         $1,874.76
5908363   59   PALIVIZUMB 50MG/0.5ML SDV                    $2,416.24
5908413   59   ENOXAPARIN 80MG SYRINGE                       $228.39
5908421   59   RABIES IMMUNGLOG150IU/ML                      $539.54
5908421   59   RABIES IMMUNGLOG150IU/ML                      $616.33
5908447   59   LEPIRUDIN 50MG INJ                            $627.70
5908470   59   TIROFIBAN 12.5MG/50ML                        $1,756.70
5908512   59   LINEZOLID 2MG/ML 300ML                        $319.04
5908553   59   ANTIVENOM CROFAB 1GM                         $7,268.00
5908561   59   PANTOPRAZOLE 40MG INJ                         $140.00
5908579   59   FENOLDAPAM 10MG/ML 1ML                        $506.30
5908587   59   FERRIC GLUC CMP 62.5MGINJ                     $192.00
5908595   59   ALLOPRUINOL 500MG INJ                        $2,252.34
5908686   59   FACTOR VIIA/1200MCG                          $4,460.00
5908694   59   FACTOR VII4800MCG                           $13,340.00
5908702   59   PORACTANT 1.5ML VIAL                         $1,166.60
5908710   59   PORACTANT 3ML VIAL                           $2,264.69
5908926   59   ADENOSINE THER 60MG INJ                         $59.34
5909791   59   LIDOCAINE 2%PF20MG/ML 2ML                       $38.74
5909908   59   ZIPRASIDONE 20MG/ML INJ                       $211.44
5909916   59   OCTREOTIDE DPT 1MG(20MG)                      $308.59
5909932   59   LANSOPRAZOLE 30MG INJ                         $129.96
5909940   59   ACETYLCYST 20%30ML INJ                        $493.58
5909957   59   OXYTOCIN 15 UNITS/D5W 250                       $93.00
5909973   59   OXYTOCIN 20U/1000ML D5L                         $93.00
5910005   59   CEFAZOLIN 250MG VIAL                            $37.33
5910013   59   VANCOMYCIN 1 GM VIAL                            $85.00
5910021   59   FLUCONAZ.200MG/100ML RTU                      $444.83
5910039   59   AMPICILLIN 125MG VIAL                           $37.58
5910047   59   AMPICILLIN 250 MG VIAL                          $37.62
5910054   59   AMPICILLIN 500MG VIAL                           $37.74
5910062   59   AMPICILLIN 1GM VIAL                             $38.36
5910070   59   AMPICILLIN 2GM VIAL                             $40.59
5910088   59   VIDARABINE 1000MG/5ML VIL                     $218.02
5910096   59   CEFOTAXIME 1GM VIAL                             $62.40
5910104   59   CEFOTAXIME 2GM VIAL                           $108.92
5910112   59   METRONIDAZOLE 500MG VIAL                      $140.68
5910120   59   AMIKACIN 500MG VIAL                           $157.04
5910138   59   TRIMETH/SULFA 5 ML VIAL                         $39.06


                                      Page 49 of 276
Charge #Dept   CDM Description                        Price
5910146   59   PIPERACILLIN 4 GM VIAL                         $121.60
5910153   59   PIPERACILLIN 3 GM VIAL                          $96.48
5910161   59   PIPERACILLIN 2 GM VIAL                          $70.96
5910179   59   BICILLIN CR 600 INJ                             $47.59
5910187   59   BICILLIN CR 1.2MU INJ                           $68.16
5910195   59   BICILLIN LA 1.2MU INJ                           $82.44
5910203   59   BICILLIN LA 600 INJ                             $60.55
5910211   59   BICILLIN LA 2.4MU INJ                          $203.19
5910237   59   CEFOXITIN 1GM VIAL                              $68.00
5910245   59   CEFOXITIN 2GM VIAL                             $115.36
5910252   59   CEFAZOLIN 0.5GM VIAL                            $37.14
5910260   59   CEFAZOLIN 1GM VIAL                              $49.07
5910278   59   CEFOTETAN 1GM VIAL                              $64.64
5910286   59   CEFOTETAN 2GM VIAL                             $107.60
5910294   59   CEFUROXIME 1.5GM VIAL                           $78.60
5910302   59   CLINDAMYCIN 300 MG VIAL                         $40.25
5910310   59   CLINDAMYCIN 600MG VIAL                          $40.29
5910328   59   COLISTIN 150MG VIAL                            $200.46
5910336   59   DOXYCYCLINE 100 MG VIAL                         $79.00
5910344   59   DOXYCYCLINE 200MG VIAL                         $154.76
5910351   59   ERYTHROMYCIN 1GM VIAL                           $54.43
5910369   59   ERYTHROMYCIN 500MG VIAL                         $40.09
5910377   59   GENTAMYCIN 80MG VIAL                            $37.88
5910385   59   KANAMYCIN 500MG VIAL                            $39.36
5910393   59   PRIMAXIN 250MG(500MG)INJ                       $137.20
5910401   59   METHICILLIN 1 GM VIAL                           $44.89
5910419   59   MINOCYCLINE 100 MG VIAL                        $211.76
5910435   59   KANAMYCIN 75MG VIAL                             $39.04
5910450   59   OXACILLIN 500 MG VIAL                           $37.37
5910468   59   OXACILLIN 1 GM VIAL                             $39.35
5910476   59   TIMENTIN 3.1 GM VIAL                            $84.04
5910484   59   PEN G K 1 MU VIAL                               $37.27
5910518   59   PEN G NA 5 MU VIAL                              $48.53
5910526   59   PRO PEN G 2.4 MU INJ                            $66.80
5910534   59   PRO PEN G 600 U INJ                             $39.30
5910542   59   PRO PEN G 1.2 MU INJ                            $44.71
5910559   59   STREPTOMYCIN 1 GM INJ                           $63.88
5910567   59   TOBRAMYCIN 80 MG VIAL                           $39.82
5910575   59   TOBRAMYCIN 60 MG SYRINGE                        $49.70
5910583   59   TICARCILLIN 3 GM VIAL                           $63.20
5910591   59   TETRACYCLINE 100 MG INJ                         $50.11
5910625   59   TICARCILLIN 6 GM VIAL                           $90.00
5910633   59   VANCOMYCIN 500 MG VIAL                          $59.24
5910641   59   CEFTRIAXONE 1GM VIAL                           $203.19
5910690   59   NAFCILLIN 500 MG VIAL                           $37.20
5910708   59   NAFCILLIN 1 GM VIAL                             $38.83
5910716   59   NAFCILLIN 2 GM VIAL                             $44.80
5910724   59   CLINDAMYCIN 900MG VIAL                          $58.29
5910740   59   OXACILLIN 2 GM VIAL                             $48.89
5910757   59   PENTAMIDINE 300 MG VIAL                        $208.80
5910765   59   RIFAMPIN 600 MG VIAL                           $189.98
5910799   59   CEFTAZIDIME 2GM VIAL                           $142.92
5910807   59   CEFTIZOXIME 2GM VIAL                           $103.60
5910815   59   UNASYN 1.5 GM VIAL                              $55.42
5910831   59   CEFTAZIDIME 1GM VIAL                            $76.91
5910856   59   AZTREONAM 1GM VIAL                              $95.56
5910864   59   MICONAZOLE 20 ML INJ                           $173.88
5910872   59   CIPROFLOXACIN 200MG VIAL                        $77.64


                                     Page 50 of 276
Charge #Dept   CDM Description                       Price
5910880   59   POLYMYXIN B 50 MG VIAL                         $43.94
5910906   59   UNASYN 3 GM VIAL                               $77.84
5910914   59   BACITRACIN 50MU VIAL                           $45.20
5910930   59   NEOSPORIN GU IRR 1ML AMP                        $6.18
5910948   59   ACYCLOVIR 50MG (500VIAL)                      $230.35
5910955   59   GANCICLOVIR 500MG VIAL                        $159.20
5910963   59   CEFTRIAXONE 250MG INJ                          $83.28
5910971   59   ISONIAZID 1000MG/10ML VL                      $101.04
5910989   59   CAPREOMYCIN 1GM VIAL                          $126.40
5910997   59   MEROPENEM 500MG VIAL                          $249.71
5911003   59   FLUCONAZOLE 200MG/D5W RTU                     $444.83
5911011   59   CEFAZOLIN 1GM/50ML RTU                         $45.65
5911029   59   CEFOXITIN 1 GM/50 ML RTU                       $75.72
5911037   59   CEFOXITIN 2 GM/50 ML RTU                      $119.04
5911045   59   CEFOTAXIME 1 GM/50 ML RTU                      $70.64
5911052   59   CEFTAZIDIME 1 GM/50ML RTU                      $87.72
5911060   59   CEFTRIAXONE 1 GM/50ML RTU                     $180.72
5911078   59   METRONIDZ 500MG/100ML RTU                      $81.36
5911086   59   CEFTAZIDIME 500MG VIAL                         $52.01
5911102   59   CEFTAZIDIME 2GM/50ML RTU                      $144.60
5911144   59   CEFUROXIME 1.5GM/50ML RTU                      $84.64
5911169   59   CEFUROXIME 750MG VIAL                          $62.57
5911185   59   CHLORAMPEN 1GM VIAL                            $49.30
5911185   59   CHLORAMPEN 1GM VIAL                            $39.50
5911219   59   AMIKACIN 100MG INJ                            $152.16
5911235   59   FOSCARNET 1GM(12GM INJ)                       $636.53
5911243   59   GENTAMICIN INTRATHEC 2ML                       $38.70
5911250   59   GENTAMICIN 80MG/100ML RTU                      $64.60
5911268   59   GENTAMICIN 100MG/100ML RT                      $63.12
5911276   59   KANAMYCIN 1GM VIAL                             $51.19
5911284   59   CEFOTAXIME 2GM/50ML RTU                       $105.04
5911292   59   CIPRO 400MG/200ML RTU                         $140.08
5911300   59   TOBRAMYCIN 20 MG VIAL                          $39.68
5911318   59   GENTAMICIN 20MG/2ML VIAL                       $28.78
5911367   59   FLUCONAZL 400MG/D5W RTU                       $640.90
5911375   59   CEFOTETAN 1 GM/50 ML RTU                       $66.88
5911425   59   ZOSYN 4.5 GM VIAL                             $110.90
5911433   59   ZOSYN 2.25 GM VIAL                             $67.85
5911441   59   ZOSYN 3.375 GM VIAL                            $91.75
5911458   59   AZTREONAM 2GM VIAL                            $163.56
5911466   59   AZTREONAM 500MG VIAL                           $62.35
5911482   59   CIPRO 200MG/100ML RTU                          $82.44
5911540   59   MEROPENEM 1GM VIAL                            $249.71
5911557   59   TOBRAMYCIN 1.2GM VIAL/SYR                     $402.41
5911565   59   ZIDOVUDINE 10MG/ML 20ML                        $28.96
5911573   59   PRIMAXIN 250MG VIAL                            $83.04
5911581   59   TRIMETH/SULF IV 10ML                           $88.96
5911599   59   VORICONAZOLE 200MG INJ                        $422.19
5911607   59   AMIKACIN 1000MG VIAL                          $256.99
5911615   59   AMPHO-B LIPO 100MG/20MG V                     $477.28
5911623   59   TRIMETREXATE 25MG INJ                         $597.50
5911656   59   AZITHROMYCIN 500MG VIAL                       $142.74
5911680   59   LEVOFLOXACIN 500MG VIAL                       $202.60
5911698   59   LEVOFLOXACIN 250MG RTU                        $111.32
5911706   59   LEVOFLOXACIN 500MG RTU                        $202.60
5911714   59   AMPHO-B LIPO 50MG/12.5MLV                     $706.88
5911722   59   DAPTOMYCIN 1MG(500MG)VIAL                     $643.70
5911730   59   GATIFLOXACIN 400MG/40ML                       $172.20


                                    Page 51 of 276
Charge #Dept   CDM Description                         Price
5911748   59   TROVAFLOXACIN 200MG/40ML                         $180.32
5911763   59   ITRACONAZOLE 250MG INJ                           $798.05
5911771   59   SYNERCID 500MG VIAL                              $442.12
5911789   59   GATIFLOXACIN 200MG/20ML                            $92.00
5911854   59   CASPOFUNGIN 5MG(70MG) INJ                       $1,876.93
5911862   59   CASPOFUNGIN 5MG(50MG) INJ                       $1,461.44
5911979   59   GENTAMICIN 60MG/100ML RTU                          $61.81
5917943   59   CILOSTAZOL 100MG TAB                                $8.05
5919493   59   TIOTROPIUM 18MCG INH CAP                           $12.00
5930011   59   MANNITOL 20% 500ML                                 $90.30
5930029   59   D5W/ALC 5% 1000ML                                  $36.60
5930037   59   HEPATAMINE 500ML                                 $423.03
5930045   59   THAM 500 ML                                      $225.45
5930052   59   D5W 25ML                                           $11.31
5930086   59   HESPAN 500ML                                     $198.68
5930094   59   FAT EMUL 20% 500ML                               $108.50
5930102   59   NSA 5% 50 ML                                     $180.00
5930110   59   NSA 25% 20 ML                                    $180.00
5930128   59   NSA 5% 250 ML                                    $282.50
5930136   59   NSA 25% 50 ML                                    $282.50
5930144   59   NSA 25% 100 ML                                   $650.00
5930151   59   PPF 250 ML                                       $226.06
5930177   59   PPF 50 ML                                        $115.00
5930185   59   SOD CHL 3% 500 ML                                  $60.00
5930185   59   SOD CHL 3% 500 ML                                  $73.70
5930193   59   FAT EMUL 10% 500ML                                 $80.75
5930227   59   FAT EMUL 20% 100ML                                 $56.77
5930235   59   RINGER'S INJ 1000 ML                               $60.00
5930268   59   D10W 1000ML                                        $35.00
5930276   59   D10W 250ML                                         $35.00
5930284   59   D10W 500ML                                         $35.00
5930326   59   D5/0.2NS 1000ML                                    $35.00
5930334   59   D5/0.2NS 250ML                                     $35.00
5930342   59   D5/0.2NS 500ML                                     $35.00
5930359   59   D5/0.45NS 1000ML                                   $35.00
5930367   59   D5/0.45NS 500ML                                    $35.00
5930417   59   D5/LR 1000ML                                       $35.00
5930425   59   D5/LR 500ML                                        $35.00
5930433   59   D5/NS 1000ML                                       $35.00
5930441   59   D5/NS 500ML                                        $35.00
5930458   59   D5/PLAS M 1000ML                                   $35.00
5930466   59   D5W 100ML                                          $35.00
5930474   59   D70W 500ML                                         $38.34
5930482   59   D5/RINGERS 1000ML                                  $35.00
5930490   59   D5W 150ML                                          $35.00
5930508   59   D5 RINGERS 500ML                                   $35.00
5930516   59   D5W 250ML                                          $35.00
5930532   59   D5W 500ML                                          $35.00
5930557   59   D5W 1000ML                                         $35.00
5930565   59   D5W 50ML                                           $35.00
5930573   59   LAC/RINGERS 1000ML                                 $35.00
5930581   59   NS 100 ML                                          $35.00
5930599   59   UREAPHIL 40 GM VIAL                              $331.08
5930607   59   NS 50 ML                                           $35.00
5930615   59   LAC/RINGERS 500ML                                  $35.00
5930623   59   NS 25 ML                                           $35.00
5930631   59   NS 1/2 NORM 500 ML                                 $35.00
5930649   59   NS 250 ML                                          $35.00


                                      Page 52 of 276
Charge #Dept   CDM Description                        Price
5930672   59   NS 1000 ML                                      $35.00
5930680   59   NS 1/2 NORM 1000 ML                             $35.00
5930698   59   NS 150 ML                                       $35.00
5930714   59   NS 500 ML                                       $35.00
5930730   59   AMINO ACID 5.4% 250ML IV                       $238.40
5930748   59   GENTRAN 40 10%/D5W 500ML                       $368.08
5930755   59   DEXTRAN 70 6%/NS 500ML                         $203.37
5930771   59   DOPAMINE 400MG/250ML RTU                        $60.00
5930797   59   D5/0.2 NACL KCL 20/L RTU                        $75.00
5930813   59   D5/0.45 NACL KCL 10/L RTU                       $75.00
5930821   59   D5/0.45 NACL KCL 20/L RTU                       $75.00
5930839   59   D5/0.45 NACL KCL 30/L RTU                       $75.00
5930847   59   D5/0.45 NACL KCL 40/L RTU                       $75.00
5930854   59   D5/NS KCL 20/L RTU                              $75.00
5930862   59   D5/NS KCL 40/L RTU                              $75.00
5930870   59   STER WATER INJ 1000 ML                          $30.00
5930896   59   EVACUATED BOTTLE 1000ML                         $28.77
5930912   59   EVACUATED BOTTLE 250ML                          $27.56
5930920   59   EVACUATED BOTTLE 500ML                          $27.80
5930938   59   GLYCINE 1.5% INJ 3000ML                         $15.60
5931019   59   D40W 500ML                                      $53.90
5931027   59   D5/.2NACL KCL 40/L RTU                          $75.00
5931043   59   PLASMALYTE A 1000ML INJ                         $30.00
5931050   59   D5W KCL 20/L RTU                                $75.00
5931068   59   D5W KCL 30/L RTU                                $75.00
5931076   59   D5W KCL 40/L RTU                                $75.00
5931118   59   D5/0.45 NS 250ML                                $35.00
5931159   59   DOBUTAMNE 500MG/250ML RTU                      $321.26
5931191   59   CARDIOPLEGIC SOLN                              $150.00
5931324   59   TROPHAMINE 6% 500ML                             $85.76
5931340   59   FAT EMUL 10% 100ML                              $49.85
5931357   59   FAT EMUL 10% 250ML                              $57.55
5931365   59   FAT EMUL 20% 250ML                              $73.70
5931431   59   NS KCL 20MEQ/L RTU                              $75.00
5931456   59   KCL 20MEQ/100ML RTU                             $35.00
5931555   59   KCL 40MEQ/100ML RTU                             $75.00
5931597   59   KCL 10MEQ/100ML RTU                             $35.00
5931605   59   LIDOCAINE 1GM/25OML RTU                         $25.07
5931613   59   KCL 20MEQ/50ML RTU                              $34.63
5932058   59   D5/0.2 NACL KCL20/L                             $75.00
5932066   59   D5/LR KCL 20/L                                  $75.00
5932074   59   D5/LR KCL 40/L                                  $75.00
5940010   59   NS 1000 ML IRR                                  $35.00
5940028   59   NS 500 ML IRR                                   $35.00
5940036   59   DAKIN'S SOLN 1/2 STR                            $28.06
5940077   59   ACETIC ACID 0.25% IRR 1L                        $51.40
5940085   59   STER WATER 1000 ML IRR                          $35.00
5940184   59   DAKIN'S SOLN 1/4 STR                            $28.06
5940283   59   RENACIDIN IRRIG BTL                             $26.06
5940309   59   NS 2000 ML IRR                                  $35.00
5940325   59   STER WATER 2L IRRIG BAG                         $35.00
5940341   59   SORBITOL 3% IRRIG                               $20.40
5940358   59   STER WATER 3000 ML IRRIG                        $35.00
5940374   59   NS 3000 ML IRRIG                                $35.00
5940382   59   LAC RING 3000ML IRRIG                           $35.00
5940390   59   ANTICOAG CIT/DEX SLN 500M                       $35.00
5940416   59   TRIPLE ANT SOLN 250 ML                          $74.00
5940432   59   BACITRACIN IRRIG                               $182.00


                                     Page 53 of 276
Charge #Dept   CDM Description                       Price
5940465   59   STER WATER 250ML IRRIG                           $35.00
5940663   59   BUNNELLS IRRIG SOLN 1L                           $66.00
5950001   59   TEMOZOLAMIDE 100MG CAP                         $352.52
5950019   59   THIOGUANINE 40 MG TAB                            $12.07
5950027   59   CYCLOPHOSPHAMIDE 25MG(50T                        $10.30
5950035   59   LEUCOVORIN 5MG TAB                               $10.50
5950043   59   LEUCOVORIN 25MG TAB                              $31.38
5950068   59   LOMUSTINE 10MG CAP                               $22.11
5950076   59   LOMUSTINE 40MG CAP                               $58.53
5950084   59   LOMUSTINE 100MG CAP                            $107.65
5950092   59   BICALUTAMIDE 50MG TAB                            $36.04
5950100   59   ETOPOSIDE 50MG CAP GENERI                      $131.55
5950118   59   TRETINOIN 10MG CAP                               $45.38
5950126   59   ANASTROZOLE 1MG TAB                              $15.60
5950134   59   TEMOZOLAMIDE 250MG CAP                         $875.32
5950167   59   IMATINIB 100MG TAB                               $51.28
5951249   59   CAPECITABINE 500MG TAB                           $24.83
5960018   59   MITHRAMYCIN 2500 MCG VIAL                      $289.88
5960026   59   CYCLOPHOSPHAMIDE 200MGINJ                      $291.72
5960034   59   IDARUBICIN 5MG(10MGVIAL)                      $1,609.26
5960042   59   IDARUBICIN 5MG VIAL                            $854.62
5960059   59   CARBOPLATIN 50MG(150VIAL)                     $1,123.92
5960067   59   IFEX 1GM VIAL                                  $416.64
5960075   59   MESNA 200MG INJ BRAND                          $129.64
5960083   59   DOXORUBICIN 10MG VIAL                          $207.28
5960091   59   DOXORUBICIN 10MG (50MGV)                       $478.52
5960109   59   CARMUSTINE 100MG VIAL                          $320.38
5960117   59   BLEOMYCIN 15U VIAL                            $1,043.61
5960125   59   DAUNORUBICIN 20MG VIAL                         $410.08
5960133   59   CYTARABINE 100MG INJ                           $117.96
5960141   59   CYTARABINE 500MG INJ                           $152.56
5960158   59   DACTINOMYCIN 0.5MG VIAL                        $129.20
5960166   59   CISPLATIN 10MG VIAL                            $166.56
5960174   59   CISPLATIN 10MG(50MGVIAL)                       $411.06
5960182   59   CYCLOPHOSPHAMIDE 100MG V                       $112.38
5960190   59   CYCLOPHOSPH 200MG INJ BRA                      $123.52
5960208   59   CYCLOPHOSPHAMID 500MG INJ                      $151.42
5960216   59   DACARBAZINE 100MG VIAL                         $127.64
5960224   59   DACARBAZINE 200MG VIAL                         $155.46
5960232   59   MITOMYCIN 5 MG VIAL                            $357.54
5960240   59   FLUOROURACIL 500MG VIAL                        $106.40
5960257   59   LEUCOVORIN 50MG INJ                            $106.12
5960265   59   VINCRISTINE (1MG)2MG INJ                       $176.50
5960273   59   METHOTREXATE 5M (50MG VIA                      $109.50
5960281   59   NITROGEN MUSTARD 10MG VIA                      $120.20
5960299   59   VINCRISTINE 1MG/ML 1ML IN                      $163.52
5960307   59   FUDR 0.5GM VIAL                                $372.76
5960315   59   ASPARGINASE 10MU VIAL                          $250.69
5960323   59   VINBLASTINE 1MG(10MGINJ)                       $166.26
5960331   59   STILPHOSTROL 5 ML INJ                            $80.68
5960349   59   THIOTEPA 15 MG VIAL                            $276.59
5960356   59   CYCLOPHOSPHAMIDE 1GM INJ                       $200.30
5960364   59   METHOTREXATE 5MG(200MG VL                      $133.44
5960372   59   METHOTREXATE 5MG(100MGVL)                      $117.00
5960380   59   MITOXANTRONE 5MG(25MG)                        $2,447.52
5960398   59   ETOPOSIDE 100MG/5ML VIAL                       $362.10
5960406   59   METHOTREXATE 5MG(20MG V)                       $105.56
5960414   59   MITOXANTRONE 5MG(20MGINJ)                     $1,978.08


                                    Page 54 of 276
Charge #Dept   CDM Description                        Price
5960422   59   MITOXANTRONE 5MG(30MG INJ                      $2,917.10
5960430   59   METHOTREXATE 5MG(1GMV)                          $222.88
5960448   59   MESNA 200MG(1GM)INJ BRAND                       $248.16
5960455   59   PACLITAXEL 30 MG/5 ML VL                        $450.70
5960463   59   CARBOPLATIN 50MG(450MGV)                       $3,171.80
5960471   59   CARBOPLATIN 50MG INJ                            $441.32
5960489   59   CISPLATIN 10MG(100MGVIAL)                      $1,060.00
5960497   59   MITOMYCIN 20 MG VIAL                            $969.74
5960505   59   CLADRIBINE 1MG(10MGVIAL)                       $2,626.38
5960513   59   MELPHALAN 50MG INJ                             $1,021.28
5960521   59   FLUDARABINE 50MG INJ                           $1,358.09
5960554   59   VINORELBINE 10 MG INJ                           $287.05
5960562   59   VINORELBINE 10MG(50MGINJ)                      $1,355.18
5960604   59   DOXORUBICIN-LIPOS10MG/20V                      $1,412.50
5960653   59   ALDESLEUKIN 22MU VIAL                          $2,552.05
5960661   59   DOCETAXEL 20MG(80MGVIAL)                        $876.10
5960679   59   IRINOTECAN 20MG(100MGVIAL                      $2,704.71
5960695   59   GEMCITABINE 200MG(1GMV)                        $1,491.62
5960703   59   TOPOTECAN 4MG VIAL                             $3,334.82
5960711   59   AMIFOSTINE 500MG VIAL                          $1,112.00
5960729   59   CYTARABINE LIPO 50MG INJ                       $4,660.00
5960745   59   RITUXIMAB 100MG INJ                            $1,940.14
5960752   59   GEMTUZUMAB 5MG INJ                             $5,510.00
5960760   59   FULVESTRANT 250MG/5ML INJ                      $2,067.32
5960810   59   RITUXIMAB 100MG(500MGINJ)                      $8,249.09
5960844   59   RASBURICASE 0.5MG(1.5MG)                       $1,430.15
5960885   59   EPIRUBICIN (2MG)50MG INJ                       $2,642.13
5960919   59   TRATUZUMAB 10MG(440MG V)                       $5,710.90
5960935   59   BORTEZOMIB 0.1MG INJ(3.5)                      $2,546.26
5970041   59   FLEET ENEMA                                       $22.00
5970074   59   FLEET OIL ENEMA                                   $23.62
5970124   59   CHEMSTRIP BG KIT                                   $6.02
5970140   59   ANA STING KIT                                   $153.64
5970165   59   FLEET PED ENEMA                                   $22.56
5970199   59   EVAC-Q-KIT                                        $30.66
5970207   59   INSPIREASE INH DEVICE                             $59.10
5970264   59   LAMINARIA MEDIUM                                  $18.00
5970702   59   MAGNI-GUIDE                                       $26.20
5980024   59   NEO CEFTAZADIME INJ                               $39.50
5980032   59   NEO FOLIC ACID ORAL                               $12.33
5980040   59   NEO AMINOPHYLLINE INJ                             $28.98
5980057   59   NEO CAFFEINE ORAL                                 $10.00
5980073   59   NEO HYDRALAZINE INJ                               $38.50
5980081   59   NEO HYDRALAZINE ORAL                               $2.50
5980099   59   NEO PHENOBARBITAL INJ                             $37.70
5980115   59   NEO DICLOXACILLIN ORAL                            $24.02
5980123   59   NEO GENTAMICIN INJ                                $28.75
5980131   59   NEO ACYCLOVIR 5MG(500MG)                        $215.80
5980156   59   NEO CEFUROXIME INJ                                $73.84
5980164   59   NEO CLINDAMYCIN INJ                               $40.25
5980172   59   NEO CEFOTAXIME INJ                                $42.55
5980180   59   NEO CEFTRIAXONE INJ                               $73.00
5980198   59   NEO NAFCILLIN INJ                                 $37.20
5980206   59   NEO AMPHOTERICIN B INJ                            $40.50
5980248   59   NEO DEXAMETHASONE INJ                             $28.83
5980271   59   NEO CHLOROTHIAZIDE ORAL                            $3.10
5980347   59   NEO METOCLOPRAMIDE ORAL                            $5.04
5980362   59   NEO TERBUTALINE INJ                               $17.44


                                     Page 55 of 276
Charge #Dept   CDM Description                       Price
5980388   59   NEO TOLAZOLINE INJ                            $86.04
5980412   59   NEO GLYCERIN CHIP                              $3.36
5980537   59   NEO METRONIDAZOLE ORAL                        $32.00
5980552   59   NEO PROPYLTHIOURACIL ORAL                      $5.50
5980677   59   NEO DIGOXIN INJ                               $29.00
5980685   59   NEO RANITIDINE INJ                            $39.99
5980750   59   NOE LYSINE ORAL                                $5.02
5981048   59   NEO VIT A 10,000U/ML SOLN                      $1.35
5981121   59   NEO VITAMIN B-12 INJ                          $25.00
5981154   59   CAFF CITRATE 60MG/3ML INJ                   $174.32
5981170   59   NEO SODIUM BICARB ORAL                         $5.20
0060517   00   NICU 2:1                                   $9,790.00
0090126   00   NURSERY,BOARDER BABY PEDS                  $1,320.00
0081315   00   ROOM & BOARD, CVU                          $3,795.00
0091314   00   ROOM & BOARD, CVU W/SIT                    $4,485.00
0014100   00   ROOM & BOARD FT4 MED SUR                   $2,295.00
0024109   00   ROOM & BOARD, FT4 MED SUR                  $2,080.00
0050336   00   R&B, REHAB/SEMI W/SITTER                   $2,405.00
0050443   00   ROOM & BOARD, PICU 2:1                    $10,775.00
0050518   00   NICU LEVEL IV 1:1                          $7,435.00
0051318   00   ROOM & BOARD, MED SURG 3G                  $2,225.00
0040337   00   R&B,REHAB/PRIV W/SITTER                    $2,620.00
0052225   00   ROOM & BOARD, CCC 2:1                      $9,890.00
0040378   00   ROOM & BORD,M/S W/SIT GT4                  $2,520.00
0040444   00   ROOM & BOARD, PICU 1:1                     $8,245.00
0040519   00   NICU LEVEL IV (1:2)                        $5,840.00
0060442   00   ROOM &BOARD,PICU W/SITTER                  $7,490.00
0050120   00   ROOM & BOARD, OB ON PEDS                   $2,405.00
0082222   00   ROOM & BOARD, PICU ON ICU                  $6,340.00
0074443   00   ROOM&BOARD,ORTHO W/SITTER                  $2,405.00
0080440   00   ROOM & BOARD,NICU 1:2 ISO                  $7,295.00
0073338   00   ROOM & BOARD, TELEMETRY                    $2,965.00
0090449   00   ROOM & BOARD,NICU 1:1 ISO                  $8,245.00
0092221   00   ROOM & BOARD, CCC 1:1                      $6,510.00
0093336   00   R&B, TELE W/SITTER                         $4,105.00
0062224   00   ROOM & BOARD,CCC W/SITTER                  $5,915.00
0075556   00   R&B, HI RISK ANTEPARTUM                    $3,335.00
0070441   00   ROOM&BD,NICU 1:2 ON PICU                   $5,840.00
0071316   00   ROOM & BOARD,MS ONC W/SIT                  $2,395.00
0072223   00   ROOM & BOARD, CVU                          $3,795.00
0017772   00   ROOM & BOARD, 2F M/S PRIV                  $2,295.00
0010447   00   ROOM & BOARD, PICU 1:2                     $6,980.00
0020123   00   ROOM & BOARD, PEDS SEMI                    $2,295.00
0020172   00   R&B PSYCH SEMI-PRIVATE                     $2,350.00
0020180   00   RM & BD, PSYCH ADOL SEMI                   $2,720.00
0010181   00   RM & BD, PSYCH ADOL PVT                    $2,720.00
0010124   00   ROOM & BOARD, PEDS PRIV                    $2,445.00
0010520   00   ROOM & BOARD,OBSTETRICS                    $2,405.00
0010173   00   RM & BD PSYCH PVT BLOCKED                  $2,720.00
0010330   00   ROOM&BOARD,REHAB/PRIVATE                   $2,295.00
0030189   00   RM & BD, PSYCH ADOL 3/4                    $2,720.00
0030445   00   ROOM & BOARD, PEDS ON PIC                  $2,445.00
0030510   00   NICU LEVEL III 1:3-4                       $5,290.00
0031310   00   ROOM & BOARD, TELEMETRY 3                  $2,965.00
0030171   00   RM & BD PSYCH SEMI 3/4                     $2,350.00
0040170   00   RM & BD, PSYCH INENSIVE                    $2,965.00
0040121   00   NICU 1:3-4 ON PEDS                         $5,290.00
0020339   00   ROOM & BOARD,REHAB/SEMI                    $2,080.00


                                    Page 56 of 276
Charge #Dept   CDM Description                       Price
0040188   00   RM & BD PSCYH ADOL INTENS                     $2,965.00
0010538   00   NEWBORN CARE                                  $1,210.00
0020370   00   ROOM & BOARD, MED/SUR GT4                     $2,080.00
0020446   00   ROOM & BOARD, CCC ON PIC                      $6,340.00
0020537   00   NURSERY,BOARDER BABY                          $1,320.00
0021311   00   ROOM & BOARD,MED SURG ONC                     $2,295.00
0022228   00   ROOM & BOARD, CCC 1:2                         $4,960.00
0023333   00   ROOM & BOARD, M/S ON TELE                     $2,455.00
0030122   00   ROOM &BOARD,PEDS SEMI 3/4                     $2,080.00
0027771   00   ROOM & BOARD, 2F M/S SEMI                     $2,080.00
0025551   00   ROOM & BOARD, LDP SINGLE                      $2,405.00
0024448   00   ROOM & BOARD, ORTHO SNGLE                     $2,080.00
0076018   00   ROOM & BOARD TELEMETRY A                      $2,965.00
0016022   00   ROOM & BOARD MED SUR SEMD                     $2,080.00
0045559   00   ROOM & BOARD, MED/SURG 5F                     $2,080.00
0016014   00   ROOM & BOARD MED SURG SEM                     $2,080.00
0070318   00   ROOM & BOARD, MED SURG ON                     $2,510.00
0060319   00   ROOM & BOARD, MED SURG ON                     $2,295.00
0037770   00   ROOM & BOARD OBSTETRICS                       $2,405.00
0120113   01   AMNIOTIC FLUID REDUCTION                       $330.00
0111039   01   CIRCUMCISION                                   $165.00
0111047   01   OP NON STRESS TEST                             $471.00
0100198   01   OB INJ RHO SQ/IM(PER VST)                      $338.00
0120105   01   AMNIOCENTESIS                                  $355.00
0102129   01   RECOVERY/MINUTE                                   $7.00
0100669   01   VERSION EXTERNAL                               $481.00
0100461   01   ANESTH/MIN REGIONAL                               $6.00
0105031   01   DELIVERY SERVICE(VAGINAL)                     $2,761.00
0100305   01   ANESTH/MIN GENERAL                               $13.00
0111997   01   OR TIME/OB/MINUTE                                $91.00
0107011   01   LACTATION CONSULT-INTERMD                      $111.00
0107151   01   AMNIOINFUSION                                  $574.00
0107045   01   LACTATION CONSULT-TELEPHO                        $28.00
0107029   01   LACTATION CONSULT-COMPREH                      $165.00
0107003   01   LACTATION CONSULT - BRIEF                        $64.00
0105304   01   STRESS TEST                                    $732.00
0107037   01   LACTATION CONSULT ADD 15M                        $37.00
0105205   01   NON STRESS TEST                                $471.00
0105403   01   ULTRASOUND, OB LIMITED                         $976.00
0204453   02   TRANSESOPHAGEAL ECHO/PACU                     $2,042.00
0203786   02   EVOKED RESP SSEP/TRK/HEAD                      $982.00
0203778   02   EVOKED RESP SSEP/LWR EXT                      $1,296.00
0203760   02   EVOKED RESP SSEP/UPR EXT                      $1,296.00
0200675   02   INJ TX/DX INTRAVENOUS                          $307.00
0200626   02   IV INFUSION THERAPY 1STHR                      $197.00
0200642   02   BLOOD TRANSFUSION SRVC                         $527.00
0201897   02   PACU/MIN INTENS (MAIN OR)                        $14.00
0200634   02   IV INFUS THER AD HR MAX 8                      $100.00
0200659   02   INJ TX/DX SUBQ IM                              $307.00
0200683   02   INJ ANTIBIOTIC IM                              $455.00
0200667   02   INJ TX/DX INTRA-ARTERIAL                       $307.00
0273797   02   ELECTROCONVULSIVE THERAPY                      $685.00
0204446   02   TRANSESOPHAGEAL ECHO/INTR                     $1,797.00
0270017   02   CARDIOVERSION, EXTERNAL                        $807.00
0202838   02   OR TIME/MINUTE                                 $140.00
0201871   02   PACU/MINUTE(MAIN OR)                             $14.00
0201830   02   SSU SPECIAL PROCEDURE RM                       $711.00
0203752   02   INTRAOPERATIVE SSEP/HOUR                       $446.00


                                    Page 57 of 276
Charge #Dept   CDM Description                       Price
0300640   03   ASC/PACU                                       $7.00
0360297   03   ASC SPECIAL PROCEDURE RM                    $671.00
0302315   03   OR TIME ASC/MINUTE                            $93.00
0400424   04   ANESTH-REGIONAL/MIN                            $6.00
0400325   04   ANESTH GEN/MINUTE                             $14.00
0562231   05   IMP FUSION HOOK                             $948.00
0562215   05   NEEDLE, BIOPSY OSTYCUT                      $287.00
0576298   05   TIP,APPLICATOR SURG ADHES                   $198.00
0558999   05   SYRINGE, CEMENT KYPHX                       $407.00
0555052   05   TAMP, BONE KYPHX                           $5,774.00
0548693   05   DEVICE, BONE FILL KYPHX                     $407.00
0546853   05   CATH, DELIVERY BETA                       $20,509.00
0522326   05   PUSHER, KNOT                                $153.00
0584235   05   NEEDLE, BRACHYTHERAPY                       $142.00
0576850   05   KIT, GALACTOGRAM DISP                       $232.00
0583682   05   HANDPIECE,TURBINAT SOMNUS                   $407.00
0576892   05   CANNULA, DUCTOGRAM                          $198.00
0555045   05   KIT, INTRODUCER KYPHX                      $5,031.00
0576744   05   NEEDLE, HAWKINS III                         $157.00
0576645   05   TRAY, STEREOTATIC DISP                      $232.00
0576595   05   PROBE MAMMOTOME                             $856.00
0576330   05   TIP,APP 27CM SURG ADHESIV                   $212.00
0577205   05   CATH, HSG                                   $198.00
0586743   05   MESH,COMPOSIX 12X12                        $6,348.00
0587360   05   CATH,IAB                                   $5,496.00
0587147   05   PORT,MRI DOUBLE                            $5,159.00
0587170   05   STENT,BILIARY NITINOL                      $6,704.00
0587162   05   IMP MESH HERNIA PATCH                      $5,005.00
0517920   05   IMPLANT, TENDON                            $4,081.00
0555250   05   NEEDLE, BIOPSY KYPHX                        $165.00
0587394   05   STENT,BILIARY WALL 8/10MM                  $6,904.00
0587337   05   GRAFT,VASCULAR                             $1,073.00
0510099   05   CAGE, STACKABLE                            $4,139.00
0509125   05   GRAFT, PATCH DURAL 4X5                     $5,597.00
0509091   05   GRAFT, PATCH DURAL 3X3                     $1,717.00
0509026   05   GRAFT, PATCH DURAL 1X3                      $825.00
0508895   05   GRAFT, PATCH DURAL 1X1                      $489.00
0505693   05   UNIT,COMPRESS/DIST ORTHO                   $1,002.00
0508523   05   RING, DYNA ORTHOFIX                         $666.00
0564476   05   WIRE DEFIB SYNCRUS                         $2,048.00
0579367   05   MODULE SCREW TEST                          $7,380.00
0590109   05   SPHINCTERTOME                               $490.00
0590299   05   IV SOLUTION PLASMALYTE                        $75.00
0579375   05   CATH CARDIAC ABLATION                     $11,624.00
0585638   05   PACEMAKER SING HI ENERGY                  $24,390.00
0585646   05   PACEMAKER DUAL HI ENERGY                  $29,593.00
0585653   05   LEAD DEFIB CS BIVEN                       $27,100.00
0585661   05   LEAD DEFIB SING                           $13,550.00
0590273   05   IV SOLUTION                                   $60.00
0585687   05   IMP DEFIG SINGLE                          $61,179.00
0564484   05   DEVICE ENDOMETRL ABLATION                  $3,483.00
0586172   05   IMP DEFIB DUAL                            $62,330.00
0586131   05   IMP DEFIB BIVEN                          $145,314.00
0586123   05   IMP DEFIB DUAL HI ENERGY                  $97,560.00
0537944   05   SURGIFOAM POWDER                            $413.00
0537746   05   KIT, GELPORT SEPARATOR                     $1,913.00
0537845   05   MODULE FEMORAL CONVERSION                  $7,111.00
0537902   05   SYSTEM, FEMORAL RECOVERY                   $9,068.00


                                    Page 58 of 276
Charge #Dept   CDM Description                       Price
0537894   05   STENT, TRANSNASAL EYE                       $546.00
0537886   05   HEAD, RADIAL MODULAR                       $9,068.00
0518639   05   GAS, INTRAOCULAR                            $590.00
0518647   05   GAS, PERFLUORON                            $1,506.00
0537928   05   KIT, PLEURAL CATH                          $1,293.00
0537829   05   CATH, MADDURI URETHROGRAM                   $413.00
0551184   05   ROD SIZER PENILE IMP                       $3,483.00
0537761   05   RETRIEVER, BILIARY STENT                    $546.00
0558650   05   BIOGLUE                                    $3,784.00
0537720   05   KIT, VARICARE WOUND MGMT                    $221.00
0537704   05   SUCTION IRRIGATOR                           $283.00
0537662   05   SHEATH, RETRIEVE BENT WIR                   $413.00
0537647   05   FILTER WIRE EMBOLIC PRTCT                  $8,418.00
0551200   05   SYSTEM MENISCAL REPAIR                      $900.00
0537787   05   CATH, BALLOON VENOGRAM                      $546.00
0500454   05   KIT, PLATELET SMARTPREP                    $3,430.00
0550053   05   URETHERAL DILATION, DISP                    $699.00
0550061   05   CRYOPROBE LIVER KIT DISP                  $35,750.00
0550079   05   CAST LONG LEG ADULT                         $259.00
0550087   05   CAST SHORT LEG ADULT                        $158.00
0550103   05   CAST LONG ARM ADULT                         $175.00
0550111   05   CAST SHORT ARM ADULT                          $94.00
0550129   05   CAST LONG LEG CHILD                         $115.00
0550145   05   CAST SHORT LEG CHILD                          $94.00
0558684   05   CATH IVUS LARGE                            $5,967.00
0558676   05   CATH IVUS                                  $4,738.00
0550152   05   CAST LONG ARM CHILD                         $115.00
0550160   05   CAST SHORT ARM CHILD                          $94.00
0550178   05   EXTRACTOR BLLN MULTISIZE                    $708.00
0558502   05   DRSG ABDOMINAL TRAC SYS                    $1,307.00
0558544   05   PROBE ABLATION 2-3CM                       $6,649.00
0558551   05   PROBE ABLATION 3.5-4CM                     $8,424.00
0558577   05   PROBE ABLATION 5CM                        $10,259.00
0558585   05   IMPLANT EYE GOLD                            $823.00
0558593   05   IMPLANT BONE STRUT                         $1,674.00
0558635   05   WIRE FIBER                                  $239.00
0558643   05   IMP DEFIB BIVEN MAX                      $210,565.00
0551218   05   PROBE BIPOLAR COAG                          $546.00
0500132   05   TIRE, OPTHALMIC                             $175.00
0500017   05   CATH,INTRACARDIAC 20 POLE                  $7,036.00
0503052   05   TRAY, MAMMOSITE                           $18,154.00
0503037   05   SEEDS, PRELOAD I-125                        $279.00
0500298   05   BLOCK, TIBIAL                              $3,412.00
0500280   05   BLOCK, INTERPORE                           $3,900.00
0500272   05   APPLICATOR, TRANSVAGINAL                   $4,518.00
0500264   05   APPLICATOR, PLATELET SPRY                   $413.00
0500256   05   APPLICATOR, PLATELET LIQ                    $259.00
0500249   05   PUMP CONTROL                              $17,550.00
0500231   05   CUFF, BELT                                 $7,800.00
0551176   05   SEAL PROXIMAL HARTSTRING                   $1,493.00
0584201   05   KIT PACEMAKER SERVICE                       $384.00
0532614   05   WIRE ROTOBLATOR                             $590.00
0530691   05   BURR ROTOBLATOR                            $5,651.00
0584219   05   HANDPIECE HARMONIC                         $1,676.00
0500108   05   RETRIEVER, SUTURE                           $280.00
0500116   05   GUIDE, GNAJAR                               $546.00
0500025   05   CATH,INTRACARDIAC 10 POLE                  $3,870.00
0534750   05   PAD HEMOSTASIS                              $384.00


                                    Page 59 of 276
Charge #Dept   CDM Description                          Price
0551150   05   KIT PLATELET SMARTPREP                        $3,430.00
0500447   05   STENT, PANCREATIC                              $355.00
0500421   05   STENT, WALL COLONIC                          $11,863.00
0520056   05   STENT, DRUG ELUTING                          $19,825.00
0500405   05   SET, FRONTALIS PTOSIS                          $355.00
0500033   05   PUSHER, STENT                                  $283.00
0500389   05   CATH, NEEDLE YUEH                              $221.00
0500371   05   SUPPORT, BATTEN NSL VLV                        $546.00
0500082   05   STENT, UTERINE BALLOON                         $221.00
0500348   05   KIT, RAP-PAC ACL                               $653.00
0500330   05   PROBE, CORONARY ARTERY                         $413.00
0500322   05   KIT, TISSUE REPAIR                             $546.00
0500306   05   STENT, WALL DUODENAL                         $10,238.00
0500066   05   STENT COBALT                                  $7,020.00
0500413   05   PUNCH, CORNEAL                                 $413.00
0500074   05   IMP STENT CORONARY BARE                       $7,652.00
0530246   05   BASKET, STONE ALL                              $595.00
0530170   05   BAND, ENCIRCLING                               $679.00
0530360   05   BLADE, DERMATONE                               $370.00
0530485   05   TOOL BLADE SAW DISP                            $142.00
0530469   05   BLADE, SAW GIGLI                               $157.00
0526681   05   SCRAPER,TANO                                   $486.00
0525972   05   PROBE, PH                                      $157.00
0525949   05   CATHETER,INFUS 5FR                             $486.00
0525881   05   STENT,ESOPHAGEAL                             $10,318.00
0525873   05   BALLOON,BILIARY                                $748.00
0525683   05   TUNNELER                                       $252.00
0525600   05   BANDS,ESOPHAGEAL                               $905.00
0530006   05   ADAPTER, CATHETER                              $157.00
0529966   05   SET,INTUBATION MIMI                            $370.00
0528489   05   TUBING,INSUFFLATOR                             $142.00
0528133   05   GRAFT,PATCH 6X8                                $844.00
0531285   05   CATHETER, IRRIGATION 4F-6                      $196.00
0531269   05   CATHETER, BROVIAC                              $540.00
0531228   05   CATH, VENTRIC                                  $486.00
0531541   05   CLIP, RANEY REFILL                             $142.00
0531442   05   CEMENT, BONE                                   $406.00
0531194   05   STAPLE, EPIPHYSEAL                             $264.00
0531558   05   BRUSH, FEMORAL CANAL                           $142.00
0530832   05   CLIP, ANUERYSM                                 $866.00
0530758   05   BAG,EXT DRAIN                                  $196.00
0531087   05   CATH, FOGERTY                                  $252.00
0531145   05   CATH, PERITONEAL                               $370.00
0530964   05   CATH,BALLOON DILAT                            $5,600.00
0523738   05   STRAP,ANKLE DISTRACTOR                         $252.00
0518514   05   PROBE,RF TUNA                                $10,525.00
0518621   05   STYLET,PACEMAKER                               $287.00
0518613   05   OIL,ADATOSIL                                  $1,430.00
0518498   05   SET,GEM TUBE                                   $232.00
0518472   05   SYSTEM,CABLE SWAGE                             $564.00
0518431   05   CRIMP,SS STERNAL                               $182.00
0518548   05   LEAD,VAG NERVE STIM                          $11,834.00
0521641   05   HEAD,HUMERAL                                  $5,802.00
0521765   05   ROTALINK ADVANCER                             $7,685.00
0521567   05   GRAFT,SOFT TISSUE                             $1,000.00
0520288   05   LINER,ACETABULAR                               $486.00
0518365   05   SUTURE, DERMABOND                              $196.00
0521781   05   SYSTEM.ATHERECTOMY                            $5,693.00


                                       Page 60 of 276
Charge #Dept   CDM Description                        Price
0517573   05   WIRE,ISOLA SPINAL                            $370.00
0517565   05   UNIT,FIXATOR COMP                            $877.00
0518381   05   HANDPIECE,HOLMIUM                           $1,096.00
0518167   05   SHEATH,FLEXOR                                $287.00
0518340   05   PROBE,MYOCARD NDLE                           $232.00
0518068   05   LINK,PEDICLE                                 $686.00
0517854   05   IMP PIN BUTTRESS                             $195.00
0522813   05   STYLET, COAXIAL DILATION                     $252.00
0522805   05   ADAPTER, TUOHY BORST                         $232.00
0522797   05   BAG AMBU                                     $142.00
0523050   05   CLAMP,RECONSTRUCTION                        $3,032.00
0523720   05   SET,IRRIG BIPOLAR                            $252.00
0523688   05   TOOL,TUNNEL VGL NRV                          $516.00
0522896   05   KIT, TRANSDUCER TRIPLE                       $252.00
0523225   05   TUBE,GASTROSTOMY                             $317.00
0522904   05   KIT, TRANSDUCER SINGLE                       $142.00
0523043   05   RAIL,RECONSTRUCTION                         $4,583.00
0523035   05   RING,RECONSTRUCTION                          $685.00
0522995   05   PROBE, RECTAL TEMP                           $142.00
0522920   05   KIT, I.C.P.POST CRANI                       $1,406.00
0522110   05   BUTTON GASTROSTOMY                           $377.00
0522102   05   DEVICE,ARTERIAL CLOSURE                     $1,910.00
0522060   05   DEVICE,MAGNET EXCHANGE                       $486.00
0522227   05   ELECTRODE RESECTOSCOPE                       $486.00
0522243   05   FORCEP,MICRO OPHTHALMIC                      $486.00
0522615   05   CAST, AIR                                    $232.00
0522672   05   HOLDER, WRIST                                $287.00
0522391   05   NEEDLE,COLLAGEN INJ                          $556.00
0522334   05   SYRINGE,COLLAGEN                             $661.00
0535195   05   CATH QUAD B                                 $1,372.00
0535179   05   SPIKE,SURETEC                                $667.00
0534644   05   SLING,ULTRA                                  $370.00
0536292   05   SCREW,CORTICAL                               $119.00
0536276   05   STRIP,PERI ENDO                              $486.00
0536060   05   AMBU BAG, DISP.                              $196.00
0536136   05   RINGS, FALLOPE                               $252.00
0536094   05   RESV, HICKHAM                                $486.00
0536623   05   SUCTION,KATIVAS                              $142.00
0536615   05   SHEETING, SILASTIC                           $824.00
0536607   05   SUCTION,COAGULATOR                           $193.00
0536599   05   SHEET, LIMB BILATERAL                        $142.00
0536052   05   STENT,URINARY DIVERSION                      $452.00
0535658   05   SPLINT,NASAL                                 $142.00
0535450   05   PROBE,LITHOTRYPTOR                           $486.00
0532333   05   SHUNT,VENOUS PERITONEAL                     $6,215.00
0532473   05   IMP STEM FEMORAL                           $10,856.00
0532465   05   DRESSING, EAR GLASSCOCK                      $142.00
0532531   05   ERASER,WET FIELD                             $252.00
0532200   05   DRAIN JACKSON PRATT                          $142.00
0531749   05   CONFORMERS,OCULAR                            $196.00
0532036   05   DERMA CARRIER                                $196.00
0532093   05   PROBE, ACUTOME                               $613.00
0531921   05   CUP, ACETABULAR ALL                         $6,850.00
0533729   05   KIT, CRANIOPLASTY                            $921.00
0533679   05   SEED.GOLD MARKER                               $55.00
0533547   05   INTRODUCER, PACER                            $309.00
0533521   05   INTRODUCER                                   $317.00
0534040   05   SHUNT,CSF                                   $1,370.00


                                     Page 61 of 276
Charge #Dept   CDM Description                       Price
0533992   05   SHELL/CUP ACETABULAR                       $1,607.00
0533752   05   BIT, DRILL                                  $196.00
0533034   05   RESERVOIR,VENTRICULAR                       $590.00
0532655   05   CATH, DUAL LUMEN                            $234.00
0533281   05   IMMOBILZER, KNEE                            $157.00
0540260   05   CATHETER, VENA CAVA                         $486.00
0540419   05   LEAD PACING SING                           $4,546.00
0540781   05   RESERVOIR, CARDIOTOMY                       $406.00
0540625   05   NEEDLE, AORTIC ROOT                         $196.00
0539221   05   VALVE, HEMOSTATIC ROTATE                    $452.00
0539171   05   CLAMP ENDO DISP                             $142.00
0540047   05   TOOL BLADE MICRO DISP                       $142.00
0539395   05   CELL SAVER SOFTWARE                        $1,478.00
0544338   05   FIBER,TURP ADD/STAT                        $7,458.00
0544429   05   CATH RF-B ABLATION                         $5,510.00
0544411   05   CATH RF-A ABLATION                         $4,940.00
0544387   05   VALVE,VP SHUNT                            $12,534.00
0544346   05   SHEARS,COAGULATING                         $1,112.00
0544312   05   TUBING,HYSTEROSCOPIC                        $486.00
0544296   05   CANNULA,ILLUMINATED                         $287.00
0544288   05   GUIDE,DRILL                                 $377.00
0544270   05   PROBE,LASER CVD                             $370.00
0544601   05   PASSER,CATH INTRATHECAL                     $486.00
0544593   05   CATH,INTRATHECAL                           $3,965.00
0544585   05   PUMP,INTRATHECAL                          $71,938.00
0544254   05   SEALANT,HEMOSTASIS                          $625.00
0540948   05   SUCTION, EXTRA CELL SAVER                   $142.00
0544221   05   KIT,CARTLIDGE BIOPSY                       $1,579.00
0544205   05   FIBER, ENDO LASER                           $567.00
0544197   05   CLAMP FIXATOR                               $532.00
0544171   05   SUTURE ASSIST                               $486.00
0544163   05   CORD, BIPOLAR                               $157.00
0543819   05   TRAY,THORA/PARACENTESIS                     $193.00
0542159   05   NEEDLE, VERRES DISP                         $196.00
0542092   05   TUBING, SIMPULSE                            $195.00
0541243   05   WIRE, TEMP PACING                           $142.00
0537613   05   TIP, SUCTION                                $142.00
0537415   05   STRIPPER, VEIN DISP                         $157.00
0537522   05   FILTER, GREENFIELD                          $486.00
0537977   05   TUBING, ARTHROSCOPY                         $370.00
0537852   05   TUBE, PE                                    $195.00
0537803   05   ORTHOFUSER                                  $486.00
0537407   05   ELECTRODE,LOOP                              $370.00
0537936   05   TUBE, T                                     $157.00
0536854   05   TRAY,SPINAL ANES                            $142.00
0536953   05   SPLINT, NASAL EXTERNAL                      $142.00
0536839   05   SPHERE,OCULAR                               $142.00
0537332   05   STIMULATOR, BONE                          $30,010.00
0537290   05   STENT, URETERAL                             $486.00
0537274   05   STENT "J" URETERAL                         $5,821.00
0537159   05   STAPLE, FIXATION                            $370.00
0538090   05   RESERVOIR,J-VAC                             $142.00
0538694   05   VALVE, MITRAL                             $37,074.00
0538942   05   SET, CARDIAC PERFUSION                     $6,340.00
0538934   05   CANNULAE,CORONARY PERFUSI                   $142.00
0539007   05   PUNCH,AORTIC                                $196.00
0538322   05   WIRE, GUIDE                                 $370.00
0538363   05   WIRE, STAPES HOUSE                          $264.00


                                    Page 62 of 276
Charge #Dept   CDM Description                        Price
0538173   05   CATH, AORTIC FOGERTY                         $672.00
0538165   05   VALVE, HOLTER                               $1,521.00
0539098   05   RETAINER, VISCERAL                           $196.00
0538454   05   STENT, PIGTAIL                               $377.00
0538397   05   PATCH,VASCULAR                               $673.00
0538371   05   CATH HICKMAN                                 $486.00
0556183   05   CANNULA,RETROPLEGIA                          $486.00
0556233   05   TUBING, ARTHRO FLOW                          $317.00
0556191   05   CATH OCCLUSION                               $252.00
0556449   05   WIRE, K                                        $66.00
0556290   05   FINGERTRAP,WRIST TOWER                       $232.00
0556357   05   STABILIZER,TISSUE                           $9,450.00
0556340   05   BARIUM                                         $39.00
0556316   05   STIMULATOR,SPINAL                          $10,457.00
0556407   05   TUBE, LASER ET                               $486.00
0554477   05   RECORDER,IMPLANTABLE                       $20,636.00
0554055   05   INFLATOR,LAVEEN                              $370.00
0555797   05   KIT, INFLATION DEVICE                        $486.00
0553263   05   STENT,BILIARY                               $4,447.00
0555433   05   GRAFT,HEMASHIELD STRAIGH                    $1,090.00
0555227   05   NEEDLE, SCLERO                               $252.00
0554485   05   AIRWAY,MASK LARYNGEAL                        $210.00
0557330   05   PAD,INSULATION CARDIAC                       $157.00
0557991   05   JELLY,UROJET                                 $142.00
0557405   05   DEVICE,INFLATION                             $790.00
0557215   05   ELECTRODE,MENISECTOMY                        $317.00
0557348   05   GRAFT,ACHILLES TENDON                       $5,805.00
0557249   05   SOLUTION,PROVISC                             $245.00
0559641   05   TACK,MACROPORE                               $195.00
0559310   05   SHEET,MACROPORE                             $3,796.00
0558270   05   GUIDEWIRE,ACUTRAK                            $157.00
0556670   05   PERFORATOR DISPOSABLE                        $486.00
0556647   05   MESH, TITANIUM                              $1,222.00
0557223   05   SOLUTION,VISCOAT                             $264.00
0556514   05   BONE DOWELS                                 $1,644.00
0556993   05   GRAFT,VERTI                                $11,860.00
0556787   05   INTERCEED                                    $486.00
0556779   05   ENDOCLIP                                     $486.00
0546051   05   CATH,PICC LINE                               $370.00
0546036   05   TOOL,DISSECTING                              $486.00
0546010   05   POST,CENTRALIZER                             $370.00
0546002   05   PIN,PLATE HOLDING                            $486.00
0545871   05   COMPONENT,FEMORAL                          $13,864.00
0545970   05   GUIDE,NEEDLE                                 $142.00
0545954   05   CLAMP,BURR HOLE                              $377.00
0545947   05   FORCEPS,DISSECTING DISP                      $486.00
0545897   05   COVER,HOLE THREADED                          $370.00
0545996   05   CONNECTOR,SHUNT                              $196.00
0546200   05   ROD,MOSS/MIAMI                              $1,183.00
0546416   05   SLEEVES, ATHROMBIC PUMP                      $196.00
0546309   05   IMP SLING G/U                               $6,817.00
0546291   05   IMP FIXATION CLAMP                          $8,624.00
0546283   05   ROD,SPINAL                                   $994.00
0546275   05   VALVE,STENTLESS                            $39,873.00
0546267   05   WASHER,EXT FIXATOR                           $317.00
0546234   05   CLIP,FIXATOR                                 $859.00
0546218   05   KIT,PENILE ASSY                              $960.00
0546176   05   ELECTRODE,CUTTING WIRE                       $486.00


                                     Page 63 of 276
Charge #Dept   CDM Description                         Price
0546150   05   PROBE,TEMP FOLEY                              $142.00
0546143   05   COMPONENT,TIBIAL                              $953.00
0546135   05   GRAFT,FASCIA LATA                            $1,644.00
0545863   05   PLATE,TIBIAL BASE                            $6,371.00
0546226   05   RESERVOIR,PENILE                             $6,621.00
0545608   05   TIP,NEEDLE COLORADO                           $317.00
0545582   05   TUBE,MEDULLARY                                $406.00
0545574   05   RETRACTOR,SPACE KEEPER                        $406.00
0545889   05   COMPONENT,PATELLAR                           $1,310.00
0545533   05   SURFACE ARTICULATOR                          $6,552.00
0545657   05   CATH QUAD A                                   $590.00
0545251   05   FELY,ORTHO                                    $157.00
0545541   05   SPACER,BONE                                 $16,294.00
0545731   05   NUT                                           $317.00
0545814   05   INTRODUCER,BIOTRONEK                          $406.00
0545798   05   CATH,IUP                                      $232.00
0545624   05   CANNULA,RAPID EXCHANGE                        $377.00
0545749   05   PROBE,GOLD 7FR                               $1,022.00
0545632   05   DEVICE,LOCKING RAPID EXCH                     $309.00
0545723   05   CAGE,BRANIGAN                               $13,957.00
0545707   05   SHEATH,PEEL AWAY                              $370.00
0545673   05   KIT,BONE LENGTHENING                         $5,759.00
0545756   05   PROBE,GOLD 10FR                               $655.00
0550996   05   INTRODUCER,FAST CATH                          $377.00
0552224   05   SET,MICORDEBRIDER                             $196.00
0551879   05   KNIFE,HOOK                                    $196.00
0547141   05   EXTENSION,STEM STR                           $1,283.00
0548420   05   FORCEPS, BIOPSY                               $486.00
0547224   05   PIN, ABSORBABLE                              $1,065.00
0547216   05   TIP,PHACO                                     $287.00
0549063   05   IMP STEM HUMERAL                            $13,098.00
0549139   05   REAMER,DISP                                   $370.00
0546622   05   PLUG,BONE TUNNEL                              $157.00
0550020   05   BAG, RESUSCITA INFANT/PED                     $157.00
0549394   05   FROCEP,CUTTING COAG                           $738.00
0549337   05   RETRIEVAL NET                                 $317.00
0549170   05   ROD,HIP                                       $701.00
0550186   05   CANNULA, CPAP                                 $252.00
0567966   05   SCULPS, CEMENT                                $232.00
0567941   05   CANNULA, AORTIC                               $232.00
0567818   05   CANNULA,UNIV                                  $142.00
0568287   05   PROGRAMMER, SPINAL STIM                      $8,155.00
0568246   05   BLADE, HARMONIC DISP                          $516.00
0568238   05   SCISSORS,MICRO ENDO                           $317.00
0567982   05   TROCAR, SPLIT                                 $370.00
0568121   05   TEMPLATE                                      $538.00
0565648   05   STENT, COOK/MICROVASIVE                       $382.00
0565630   05   STENT, BARD                                   $737.00
0565606   05   GUIDE ROD/PIN                                 $370.00
0565515   05   ABSORBER, FEMEROL                             $370.00
0565614   05   BALLOON DILATOR, PHANTOM                      $757.00
0565820   05   THORACOPORT                                   $252.00
0567248   05   PROBE,ENDO                                    $486.00
0566919   05   STENT,BILIARY WALL 7MM                       $7,675.00
0566729   05   KIT,CARDIOPLEGIA                              $377.00
0569467   05   REMOVER,CLIP                                  $252.00
0569541   05   CORD,IRR.MALIS                                $252.00
0569392   05   CATH,VASOVIEW                                $6,765.00


                                      Page 64 of 276
Charge #Dept   CDM Description                         Price
0569665   05   DRAIN,ORTHOFUSER                                 $157.00
0559815   05   KIT,ORTHOSPHERE                                  $815.00
0569657   05   DRAIN,BLAKE                                      $196.00
0569640   05   DIALATOR,UROMAX                                  $686.00
0569061   05   BLANKET,SPINE                                    $370.00
0569053   05   DIALATOR,URETERAL                                $252.00
0568949   05   STAPLER,LDS                                      $777.00
0568394   05   BAG, PRESSURE INFUS                              $317.00
0569327   05   CATH,LAP CHOLE                                   $317.00
0569087   05   KIT,ACL DISP                                     $780.00
0569244   05   CATH,AIRWAY EXCHANGE                             $252.00
0569137   05   BAG,ENDOCATH                                     $486.00
0565481   05   SUTURE PASSER, DISP                              $252.00
0569277   05   CATH,BONANNO                                     $370.00
0561936   05   DILATOR, ESOPH                                   $806.00
0562181   05   KIT,VITRECTOMY                                   $252.00
0564179   05   GUN, RANEY DISP                                  $370.00
0562942   05   CANNULA, ERCP                                    $370.00
0563494   05   STAPLER,ENDO                                    $1,118.00
0563486   05   BABCOCK, ENDO DISP                               $486.00
0563155   05   ILLUMINATOR,SHIELDED                             $309.00
0563122   05   PAIOLLATOME                                     $1,431.00
0563866   05   SCISSOR, ENDO                                    $377.00
0560193   05   FLUID,VISCOUS ACCURUS                            $370.00
0560169   05   TUBING,CARDIOPLEGIA                              $833.00
0559989   05   SNARES,POLYP                                     $157.00
0560185   05   HANDPIECE,PULSED LAVAGE                          $234.00
0560524   05   SET,LACRIMAL INTUB                               $486.00
0565267   05   PIN,FIXATOR                                      $195.00
0565259   05   IMP FIXATION ROD EXTERNAL                        $232.00
0565143   05   HANDPIECE,ARGON BEAM                             $794.00
0565127   05   WARMING BLANKET OR                               $142.00
0565424   05   KNIFE, SLIT/CRESCENT                             $232.00
0565291   05   HEAD, FEMORAL                                   $1,111.00
0564583   05   BRUSH,BIPOLAR                                    $142.00
0564781   05   GLIDEWIRE                                        $486.00
0564617   05   METER, PEAK FLOW                                 $157.00
0564567   05   BOOT,EQUALIZER                                   $317.00
0564344   05   TOOL BIOPSY DISP                                 $210.00
0565036   05   DISSECTOR, ENDO TIP                              $486.00
0565028   05   OCCLUDER, CORONARY                               $317.00
0564997   05   CANNULA,CLR                                      $232.00
0564948   05   TIP,CANAL IRRIG                                  $142.00
0564880   05   SET, MICROPUNCTURE                               $232.00
0564849   05   CATHETER, NEPHROSTOMY                            $486.00
0572784   05   VALVE,GLAUCOMA                                  $6,172.00
0572115   05   PROBE,TAC                                       $1,096.00
0572057   05   PROBE,CHISEL                                     $486.00
0572149   05   SET, FLUID WARMER                                $232.00
0571968   05   PROBE,ARTHROWAND                                 $486.00
0572123   05   TUBE,LARYNGECTOMY                                $274.00
0572131   05   TUBE,PISTIN WIRE                                 $309.00
0574269   05   PORT,MRI SINGLE                                 $1,406.00
0570333   05   MENISCUS ARROW                                   $486.00
0570259   05   LINE,CARIOPLEG SUCT                              $157.00
0570002   05   HANDPIECE,IRRIGATOR                              $252.00
0569996   05   GUIDE SCREW                                      $196.00
0569988   05   GRANULES,PRO-OSTEON                              $743.00


                                      Page 65 of 276
Charge #Dept   CDM Description                       Price
0570069   05   HOOK,ENDO                                   $613.00
0569871   05   ENDOBUTTON                                  $452.00
0569863   05   ELECTRODE,ROLLER                            $486.00
0570192   05   SET,IRR SUCTION                             $317.00
0570176   05   SET, NORMOTHERMIS IRR                       $309.00
0570168   05   SET, CANALICUL.INTUB                        $486.00
0571588   05   PIN,TROCAR                                  $370.00
0571547   05   PASSER,SHUNT                                $377.00
0571364   05   NEEDLE,ENDO                                 $157.00
0505214   05   CATHETER, GUIDING                           $486.00
0505180   05   CATH DIALYSIS                              $1,374.00
0505131   05   CATHETER, BILIARY                           $558.00
0505040   05   CATH XRA PIGTAIL WHITE                      $486.00
0505396   05   COLLAR,PHILADELPHIA                         $142.00
0505248   05   CATHETER,PERITONEAL                         $377.00
0504910   05   CATH XRA CERBRAL J                          $370.00
0504696   05   CATH, SWAN GANZ DBL LUMEN                   $245.00
0504795   05   CATH TROCAR                                 $157.00
0504779   05   CATH SWAN GANZ                              $179.00
0506162   05   ABUTMENT,HEALING                            $195.00
0505768   05   LEAD DEFIB DUAL                           $34,959.00
0505925   05   PACKING, WOUND DRAINAGE                     $122.00
0502815   05   CATHETER,SWAN GANZ OXIMET                   $634.00
0500173   05   BAG, ATS                                    $195.00
0501924   05   COLLAR, STIFF NECK                          $129.00
0501817   05   SHIELD,CORNEAL                              $317.00
0504076   05   CATH, FOLEY, COUNCIL                        $142.00
0504068   05   CATH FOGARTY EMBOLECTOMY                    $370.00
0504043   05   CATH FILIFORM                               $142.00
0504027   05   CATH DILATATION                            $1,090.00
0503946   05   CATH,VIP THERMODILUTION                     $317.00
0503789   05   CATH CORONARY                               $196.00
0503557   05   CATH BALLOON                               $7,785.00
0509489   05   GUIDE WIRE, WHOLEY                          $486.00
0509810   05   TRAY, DOUBLE LUMEN VENOUS                   $486.00
0509679   05   HEMOVAC, SOFT                               $232.00
0508820   05   NEEDLE BIOPSY, DISP                         $196.00
0508580   05   KIT, DRAINAGE                               $406.00
0508572   05   MANIPULATOR, UTERINE HUMI                   $232.00
0510487   05   PLEUREVAC                                   $252.00
0510917   05   SET, COLD INJECTATE                         $142.00
0510859   05   SET, CHECK FLO SHEATH                       $486.00
0509935   05   TRAY, TRIPLE LUMEN VENOUS                   $370.00
0510230   05   PILLOW,ABDUCTION                            $196.00
0506998   05   BOLT,ICP MONITOR                           $1,137.00
0508234   05   KIT, MANIFOLD 3 WAY                         $407.00
0508226   05   KIT, INTRODUCER PUCUTANEO                   $252.00
0508101   05   KIT, ARTERIAL LINE                          $157.00
0508135   05   KIT BROVIAC CATH REPAIR                     $377.00
0508267   05   KIT MONITORING                              $486.00
0508341   05   KIT, PERITONEAL LAVAGE                      $157.00
0508333   05   KIT, PERICAR DIOCENTESIS                    $406.00
0507541   05   GUIDE WIRE SBF BEATSON                      $486.00
0507616   05   GUIDE WIRE                                  $540.00
0507707   05   GUIDE WIRE TSF                              $142.00
0507897   05   INDEFLATOR                                  $845.00
0507871   05   IMMOBILIZER SHOULDER                        $157.00
0507962   05   MONITOR,ICP(IMPLANT)                       $1,302.00


                                    Page 66 of 276
Charge #Dept   CDM Description                       Price
0514638   05   TRAY VEIN CUTDOWN                              $564.00
0514653   05   TRAY VITAL SIGN                                $232.00
0514513   05   TRAY THORACENTESIS                             $157.00
0511089   05   SET, INTRODUCER                                $317.00
0515072   05   TUBE FEEDING                                   $142.00
0515049   05   GUIDE WIRE, GLIDE                              $370.00
0513986   05   TRAY INTUBATION                                $547.00
0513952   05   TRAY HYSTEROSALPINOGRAM                        $157.00
0513879   05   TRAY URINEMETER                                $157.00
0513812   05   TRAY EPIDURAL                                  $196.00
0513937   05   TRAY HEMODIALYSIS                              $252.00
0514232   05   TRAY PELVIC                                    $486.00
0514158   05   TRAY MYELOGRAM                                 $142.00
0514125   05   JAGWIRE,RAPID EXCHANGE                         $568.00
0516211   05   TREPHINE,DISP                                  $631.00
0516195   05   SET. INTRO CATH SUPRA                          $370.00
0516963   05   WRENCH,ALLEN FIXATOR                           $370.00
0516518   05   CATH,THERMODILUTION                            $788.00
0516450   05   CATHETER, V-PACING PROBE                       $452.00
0515312   05   TUBE TRACH                                     $317.00
0515445   05   URINEMETER                                     $232.00
0511345   05   SET SUTURE                                     $142.00
0511162   05   SET, NEPHROSTOMY                              $5,821.00
0513374   05   TRAY AMMIOCENTESIS                             $240.00
0513648   05   TRAY,CHEST TUBE                                $377.00
0513614   05   TRAY CATH FOLEY                                $142.00
0513523   05   TRAY, BONE MARROW                              $252.00
0513432   05   TRAY ANTHROGRAM                                $278.00
0513572   05   TRAY CATH CARDIAC                              $377.00
0512533   05   SURGICEL 4X8                                   $232.00
0512525   05   SURGICEL 2X3                                   $157.00
0512962   05   THERAPLAST                                     $157.00
0587212   05   CAUTERY BALL TIP                               $189.00
0595512   05   IMP STEM RADIAL                               $9,000.00
0595520   05   CATH FALLOPIAN TUBE                            $590.00
0595538   05   ENDO STITCH                                    $446.00
0595546   05   TOOL CAVERNOTOME DISP                         $1,024.00
0595553   05   CATH VASCULAR INTERVENTIO                     $4,690.00
0595579   05   KIT VASCULAR INTERVENTION                      $239.00
0595637   05   IMP CLAMP SPINAL FUSION                       $5,005.00
0595629   05   CATH VASCULAR ACCESS                          $1,765.00
0595587   05   IMP MICROSPHERES                               $941.00
0595595   05   KIT BONE ACCESS                               $1,554.00
0595603   05   KIT LIVER ACCESS                              $1,828.00
0595611   05   INTRODUCER VASCULAR ACCES                      $590.00
0595561   05   IMP EYE CAPSULAR TENSION                       $784.00
0587568   05   CATH ANGIOJET                                 $9,300.00
0593624   05   IMP FIXATION BLADE                            $1,810.00
0593632   05   KIT PIN PLUG PACMAKER                          $590.00
0587501   05   KIT DCR LACRIMAL DUCT                         $4,920.00
0587519   05   KIT DCP LACRIMAL DUCT                         $3,885.00
0587527   05   TOOL BLADE OSTEOTOME                           $590.00
0587535   05   TOOL BLADE RASP                                $590.00
0587188   05   IMP CABLE RECON/TRAUMA                        $1,384.00
0587550   05   CATH BALL DIL PERIPHERAL                      $1,035.00
0587204   05   COIL EMBOLIZATION                              $280.00
0587576   05   CATH ANGIOGRAPHIC                              $239.00
0587584   05   KIT AUTOTRANSFUSION DISP                       $619.00


                                    Page 67 of 276
Charge #Dept   CDM Description                       Price
0595496   05   KIT RADIOPACIFIER                           $590.00
0595504   05   KIT CEMENT DELIVERY                        $3,750.00
0587196   05   GRAFT DELIVERY SYSTEM                      $1,082.00
0593616   05   DILATOR RADIOLUCENT                         $590.00
0595645   05   IMP DBM/MARROW SYSTEM                      $3,885.00
0587543   05   CATH BARTHOLIN CYST                         $239.00
0591446   05   KIT RESERVOIR CSF                           $446.00
0595694   05   ENDO TROCAR                                 $446.00
0595686   05   IMP PATELLO-FEMORAL                       $36,750.00
0595678   05   IMP THREADED PEG                            $446.00
0595660   05   IMP AORTIC CONNECTOR                       $1,764.00
0591453   05   CLIP STIMULATION DYNAMIC                   $1,336.00
0583054   05   STENT HEPATIC                             $20,863.00
0595488   05   KIT, ANGIOJET PUMP                         $1,060.00
0595470   05   DEVICE VASC ACCESS US                       $608.00
0580233   05   HANDPIECE TRANSMURAL LESI                 $15,400.00
0588798   05   IMP VASCULAR EMBOLIZATION                   $590.00
0595702   05   PROBE MONOPOLAR COAG                        $306.00
0595652   05   TOME VALVULOTOME                           $4,025.00
0577684   05   IMP TISSUE BONE ARTIFICIA                  $9,100.00
0579763   05   KIT,PLATLT,APP,DBL.SNL                      $616.00
0577692   05   BALLOON, RETRIEVAL                          $569.00
0579748   05   KIT,PLATLT PROC SPINAL                     $3,779.00
0579730   05   KIT PLATLT PROC ENT                        $1,202.00
0578542   05   TRAY, PEG WIRE                              $535.00
0578534   05   BASKET, SOFT OR HARD                        $936.00
0575068   05   TURING, SUCTN HIGH VOLMNE                   $196.00
0576926   05   TUBE, JEJUNAL                               $486.00
0584169   05   PACEMAKER DUAL                            $21,588.00
0583849   05   PACEMAKER SINGLE                          $20,557.00
0583591   05   PEG,FEMORAL                                 $486.00
0583575   05   CAGE, SPINE                               $25,969.00
0583567   05   LEAD PACING DUAL                           $3,794.00
0584102   05   STENT,WALL ILIAC                           $5,754.00
0579755   05   KIT.PLATLT APPLIC SPINAL                    $486.00
0582940   05   CLIP,LOCKING TIBIAL                         $377.00
0583153   05   GRAFT,PATCH BOVINE                          $377.00
0583385   05   CATH BALLOON DILATION                       $672.00
0583377   05   STENT,WALL TRACHEOBRONCH                   $6,845.00
0583369   05   SCREW,PEDICLE                               $756.00
0583278   05   HANDPIECE,SOMNUS                           $1,208.00
0583229   05   KIT,HIP IMPLANT REMOVAL                    $4,392.00
0583211   05   GUIDEWIRE,NITEROL                           $309.00
0583179   05   CABLE,FIXATION                             $6,262.00
0586198   05   ILLUMINATOR,ENOD BULLET                     $317.00
0587063   05   LEAD,PISCES QUAD                          $10,315.00
0587055   05   STIMULATOR,ITREL                          $56,082.00
0587030   05   PROGRAMMER,STIMULATOR                      $6,384.00
0587014   05   EXTENSION,STIMULATOR                       $3,177.00
0586651   05   STANT,BILIARY PALMAZ                       $4,447.00
0587048   05   STIMULATOR,SYNERGY                        $87,760.00
0591412   05   RETRACTOR,FAN ENDO                          $486.00
0586388   05   STAPLE,ISOLA ANTERIOR                      $1,302.00
0586362   05   PIN,FIXATION SPINE                          $486.00
0586354   05   IMP FIXATION CAP                            $638.00
0586339   05   ROD,KANEDA                                  $652.00
0586321   05   PUMP,PAIN DISP                              $722.00
0586263   05   IMPLANT,EYE SPONGE                          $252.00


                                    Page 68 of 276
Charge #Dept   CDM Description                      Price
0586248   05   SHEATH,INTRO BRITE TIP                     $232.00
0586206   05   CATH,URETERAL DUAL LUMEN                   $309.00
0586552   05   BALLOON,ATHERECT.CUTTNG                   $5,595.00
0579987   05   MESH,SPINAL                              $13,434.00
0579904   05   BONE,SHAFT/SEGMENT                        $1,715.00
0579854   05   BRUSH,CSYTOLOGY                            $406.00
0579839   05   BURR, SHAVER                               $370.00
0581991   05   INSERT,FOGARTY                             $232.00
0582239   05   MENOCONCENTRATOR                           $590.00
0581363   05   RETRIEVAL BALLOON DISTAL                   $406.00
0641357   06   CARDIOLIPIN IGA AB                         $192.00
0641373   06   INFLUENZA A VIRUS AG, EIA                    $98.00
0641365   06   HERPES 1&2 IGM AB                          $197.00
0695023   06   18-HYDROXYCORTICOSTERONE                   $111.54
0690669   06   FETAL FIBRONECTIN ALF                      $200.00
0690255   06   PNEUMOCOCCAL SEROTYP-ARUP                     $2.70
0690248   06   N-TELOPEPTIDE, SERUM-ARUP                  $118.73
0690230   06   HIV-1 DRUG PHENO ADD ARUP                    $65.67
0690222   06   HIV-1 DRG PHNO 10 D-ARUP                   $656.70
0690214   06   S. CEREVISIALE AB-ARUP                       $27.00
0690271   06   ALPHA2 MACROGLOBULIN-ARUP                    $31.38
0694794   06   HELICOBACTER AB-ARUP                         $12.00
0690289   06   MTHFR EXTRACTION-ARUP                        $15.00
0695346   06   T.PALLIDUM AB, IGG ELISA                     $27.70
0695353   06   T.PALLIDUM AB, IGM ELISA                     $43.56
0695601   06   HIV-1 GENOTYPR ARUP                        $550.00
0695627   06   HYPERSENSITIVITY LNG-ARUP                     $5.00
0695643   06   PLT AB-HEPARIN IND- ARUP                   $150.00
0695668   06   CYTOGENETIC INTERP REPORT                    $35.00
0694653   06   PLATELET ASSOC AB DIRECT                     $21.71
0686295   06   FACTOR XI-ARUP                               $53.89
0686139   06   PORPHYRINS, URINE-ARUP                       $20.40
0686154   06   KAPPA LIGHT CHAIN-ARUP                       $17.52
0686170   06   LAMBDA LIGHT CHAIN-ARUP                      $17.52
0686162   06   FACTOR V-ARUP                                $24.00
0681940   06   FACTOR VII-ARUP                              $28.50
0686857   06   FACTOR VIII-ARUP                             $24.00
0690263   06   HEPARIN ANTI-XA LMWH-ARUP                  $104.46
0686527   06   FACTOR X-ARUP                                $28.50
0695809   06   MOLECULAR EXTRACTION ARUP                    $23.75
0686535   06   FACTOR XII-ARUP                              $53.95
0686550   06   FACTOR II-ARUP                               $42.00
0686873   06   SIROLIMUS-ARUP                               $69.00
0686303   06   EHRLICHIA AB-ARUP                            $12.60
0690313   06   MTHFR INTERP REPORT-ARUP                     $15.00
0690305   06   MTHFR NUCLEIC PROBE-ARUP                     $15.00
0690297   06   MTHFR AMPLIFICATION-ARUP                     $45.00
0686253   06   FACTOR IX-ARUP                               $51.12
0690529   06   MYCOPHENOLIC ACID ARUP                       $44.15
0696799   06   ECHOVIRUS (ENTERO)AB-ARUP                    $19.87
0631473   06   FETAL FIBRONECTIN                          $237.00
0695700   06   METHEMOGLOBIN-ARUP                           $38.57
0695726   06   CYTOKERATIN AB-ARUP                          $74.80
0695742   06   BERYLLIUM-ARUP                               $72.80
0696609   06   FECAL FAT,QUAL-ARUP                           $8.94
0695288   06   DNASE-B AB ARUP                              $11.18
0696641   06   OXCARBAZEPINE METAB-ARUP                     $61.00
0695270   06   CARDIOLIPIN AB IGA ARUP                      $22.50


                                   Page 69 of 276
Charge #Dept   CDM Description                       Price
0690552   06   ANDROSTENEDIONE ARUP                           $20.40
0690560   06   PTH RELATED PEPTIDE ARUP                       $30.85
0690578   06   OROTIC ACID ARUP                              $168.30
0690586   06   PORPHYRINS, SERUM ARUP                         $15.00
0690602   06   HISTOPLASMA AG ARUP                           $110.00
0690628   06   LEUKEMIA LYMPH PHENO ARUP                      $23.61
0690651   06   NEUT OXIDATIVE BURST ARUP                      $75.00
0696617   06   SULFONYLUREA HYPOGLY-ARUP                      $82.70
0696690   06   B.PERTUSSIS PCR-ARUP                           $53.40
0681833   06   CHLORAMPHONICOL-ARUP                           $31.08
0695841   06   ENZYMATIC DIGESTION-ARUP                       $23.75
0696567   06   SEPARATE GEL ELECTRO-ARUP                      $23.75
0696583   06   AMPLIFICATION DNA-ARUP                         $55.00
0696591   06   MOLECULAR INTERP REPORT                        $23.75
0690024   06   ENTEROVIRUS BY RT-PCRARUP                     $164.96
0695296   06   PSEUDOCHOLINESTERASE ARUP                       $9.60
0696682   06   VIT B6(PYRIDOXINE)-ARUP                        $14.87
0695767   06   BETA2 GLYCOPROTEN AB ARUP                      $19.50
0696716   06   LAMOTRIGINE-ARUP                               $15.00
0696724   06   VW MULTIMERIC-ARUP                             $29.83
0696732   06   VZV AG DFA DETECT-ARUP                         $26.01
0651141   06   CAPILLARY BLOOD COLLECT                        $43.00
0695254   06   KEPPRA ARUP                                    $75.73
0695262   06   CLINDAMYCIN ARUP                               $85.72
0695619   06   CENTROMERE AB ARUP                             $15.00
0689885   06   METHOTREXATE-ARUP                              $24.41
0681908   06   LIVER-KIDNEY MICROAB-ARUP                      $15.53
0689976   06   BORRELIA B IGG,WESTN-ARUP                      $21.00
0689950   06   BORRELIA B IGM,WESTN-ARUP                      $21.00
0689943   06   BORRELIA BURG, PCR-ARUP                        $88.59
0689935   06   CYANIDE-ARUP                                   $31.06
0689927   06   FTA, CSF-ARUP                                  $49.84
0630749   06   CYCLOSPORINE A                                $148.00
0689893   06   RUBEOLA AG, IGM-ARUP                           $11.36
0630483   06   MICROALBUMIN, URINE                            $89.00
0689869   06   NITROBLUE TETRA(NBT)-ARUP                      $40.46
0689851   06   OXALATE, UR-ARUP                               $13.13
0680280   06   HEPATITIS C GENOTYPE-ARUP                     $245.00
0680298   06   CHOLINESTERASE-ARUP                             $9.60
0680348   06   GC DNA PROBE-ARUP                               $9.88
0680363   06   CHLAMYDIA DNA PROBE-ARUP                       $10.00
0680389   06   INSULIN LIKE GROWTH 1ARUP                      $19.50
0689919   06   H. PYLORI AG STOOL-ARUP                        $53.51
0620096   06   CULTURE TYPING, ANTISERUM                      $53.00
0650010   06   VENIPUNCTURE, ROUTINE                          $40.00
0680025   06   COMPLEMENT, TOTAL-ARUP                         $12.90
0680033   06   PHENYLALANINE NBS                              $15.40
0680041   06   TYROSINE NBS                                   $15.40
0680066   06   TRANSFERASE NBS                                $15.40
0680140   06   NEWBORN INIT SCRN-TSH NBS                      $15.40
0689984   06   BORRELIA BURG AB-ARUP                          $11.10
0680199   06   SPECIMEN COLLECTION NBS                         $6.00
0680439   06   BARTONELLA AB-ARUP                             $11.10
0640078   06   ANTI-NEUTROPH CYTO AB,IGG                     $118.00
0630103   06   HOMOCYSTINE, TOTAL                            $178.00
0630111   06   CA 125                                        $213.00
0630285   06   CA 27.29                                      $213.00
0630319   06   CA 15-3                                       $213.00


                                    Page 70 of 276
Charge #Dept   CDM Description                       Price
0630392   06   CA 19-9                                       $213.00
0630418   06   T3, FREE                                      $132.00
0680181   06   HGB CHROMATOGRAPHY NBS                         $15.40
0680538   06   TOPIRAMATE-ARUP                                $40.27
0681098   06   RETICULIN ABIGA TITR-ARUP                      $22.84
0681106   06   ORGANIC ACIDS,URINE-ARUP                       $84.67
0681114   06   FACTOR II MUT AMP-ARUP                         $28.50
0681197   06   FACTOR II MUT ISOLTE-ARUP                       $9.00
0681692   06   FACTOR II MUT PROBE-ARUP                        $9.00
0681726   06   FACTOR II MUT INTERP-ARUP                       $9.00
0680397   06   TACROLIMUS-ARUP                                $36.00
0631358   06   B NATRIURETIC PEPTIDE                         $178.00
0681023   06   IMMUNOFIXATION, UR-ARUP                        $40.00
0620146   06   ENZYME DETECTION                               $28.00
0681007   06   METHYLMALONIC ACID-ARUP                        $24.00
0681015   06   SOL TRANSFERRIN RECP-ARUP                      $18.00
0681767   06   WEST NILE VIRUS AB-ARUP                        $53.77
0620187   06   HEPARIN-INDUCED THROMBO                       $295.00
0681783   06   HEPARIN-INDUCED THROMB-SP                     $249.00
0696666   06   IRON, URINE-ARUP                              $123.00
0681759   06   FACTOR II MUT ANALY-ARUP                       $28.50
0680819   06   V WILLEBRAND FCTR AG-ARUP                      $75.31
0681882   06   C DIFFICILE TOX A&B-ARUP                       $16.50
0680447   06   PARVOVIRUS B19 AB-ARUP                         $11.10
0680488   06   TESTOSTERONE, TOTAL-ARUP                       $10.28
0680496   06   BNATRIURETIC PEPTIDE-ARUP                     $150.00
0680561   06   ANCA AB (MPO)-ARUP                             $15.60
0680587   06   ANCA AB (PR3)-ARUP                             $15.60
0680611   06   ANCA SCREEN TITER-ARUP                         $29.60
0681064   06   RETICULIN AB, IGA-ARUP                         $19.50
0680660   06   V WILLEBRAND FACTOR-ARUP                       $52.20
0681056   06   ORGANIC ACIDS,PLASMA-ARUP                     $225.00
0680835   06   PREGNENOLONE-ARUP                              $71.41
0680843   06   CF MUTATION EXTRACT-ARUP                       $23.75
0680868   06   CF MUTATION DIGEST-ARUP                        $23.75
0680884   06   CF MUTATION AMP-ARUP                          $100.00
0680942   06   CF MUTATION GEL SEP-ARUP                       $23.75
0680967   06   CF MUTATION INTERP-ARUP                        $23.75
0680413   06   LIPOPROTEIN A-ARUP                             $19.50
0680637   06   ANCA REFLEX PANEL-ARUP                         $21.91
0696625   06   SEX HORMONE BIND-ARUP                          $18.55
0690735   06   NUCLEIC ACID EXTRACT-ARUP                      $31.25
0690727   06   LDL, DIRECT-ARUP                               $12.90
0690123   06   MYCO PNEUMONIAE CULT-ARUP                      $23.39
0690818   06   VIRAL CULTURE-FOC                             $103.20
0690800   06   T3 REVERSE-ARUP                                $21.60
0690784   06   INFLUENZA A/B AG-ARUP                          $36.18
0690776   06   TRYPSINOGEN-ARUP                               $20.70
0690768   06   ARYLSULFATASE A, UR-ARUP                      $198.88
0690743   06   HIV 1 RNA-BDNA-ARUP                           $110.00
0690750   06   ANTI-PHOSPHATIDYL AB-ARUP                      $20.30
0690792   06   MYCO PNEUMONIAE PCR-ARUP                      $124.24
0690321   06   DRUG SCR-BENZODIAZEPINES                       $50.00
0610097   06   PTT CORRECTION STUDIES                        $124.00
0690032   06   FUNGAL MIC 1 DRUG-FOC                          $76.00
0690040   06   FUNGAL MIC 2 DRUG-FOC                         $122.40
0690057   06   FUNGAL MIC 3 DRUG-FOC                         $182.40
0690065   06   FUNGAL MIC 4 DRUG-FOC                         $242.40


                                    Page 71 of 276
Charge #Dept   CDM Description                      Price
0690073   06   QUINIDINE-ARUP                                $15.00
0690081   06   PROCAINAMIDE NAPA-ARUP                        $17.94
0690099   06   IMMUNOASSAY QNT-ARUP                          $17.15
0690107   06   CREATINE-ARUP                                 $64.75
0690115   06   C. DIFFICILE CYTOTXN-ARUP                     $15.92
0690172   06   CMV BY PCR-ARUP                               $71.85
0690131   06   METHANOL-ARUP                                 $23.28
0690180   06   MYCO. PNEUMONIAE AB-ARUP                      $10.50
0690164   06   VZV BY PCR-ARUP                               $72.66
0690412   06   INFLUENZA B AG, DFA-FOC                       $42.75
0640243   06   INFLUENZA B VIRUS AG, EIA                     $98.00
0690693   06   ASPERGILLUS AG, EIA-FOC                      $195.00
0690685   06   PARAINFLUENZA 3, DFA-FOC                      $38.70
0690677   06   PARAINFLUENZA 2, DFA-FOC                      $38.70
0690479   06   PARAINFLUENZA 1, DFA-FOC                      $38.70
0690016   06   OLIGOCLONAL BAND,CSF-ARUP                      $2.50
0690420   06   ADENOVIRUS AG, DFA-FOC                        $48.00
0690198   06   DRUG SCR-BARBITURATES                         $50.00
0690404   06   INFLUENZA A AG, DFA-FOC                       $42.75
0690388   06   DRUG SCR-TETRAHYDROCANNAB                     $50.00
0690354   06   DRGU SCR-PHENYCYCLIDINES                      $50.00
0690347   06   DRUG SCR-OPIATES                              $50.00
0690339   06   DRUG SCR-COCAINE                              $50.00
0690719   06   DIHYDROTESTOSTERONE-ARUP                      $22.50
0690453   06   FUNGAL ID-FOC                                 $81.00
0690149   06   OSMOTIC FRAGILITY-ARUP                        $68.71
0629931   06   CULTURE, PRESUMP BACT ID,                     $91.00
0629949   06   HOMOGENIZATION TISSUE                         $91.00
0629923   06   CULTURE URINE ID                              $91.00
0629915   06   MACROSCOPIC EXAM, PARASIT                     $92.00
0629907   06   MACRO EXAM ARTHROPOD                          $92.00
0629899   06   CULT ANAEROBIC DEF ID                         $91.00
0629881   06   CULT AEROBIC DEF ID                           $91.00
0629873   06   CULT FUNGUS ID MOLD                          $147.00
0629865   06   CULT FUNG ID YEAST EA                        $147.00
0629956   06   CULTURE, ENTEROPATH E. CO                     $59.00
0684696   06   HEPATITIS BE AG-ARUP                          $11.80
0684829   06   HEPATITIS D VIRUS AB-ARUP                     $11.84
0684811   06   HEPATITIS C RNA-ARUP                         $240.00
0684787   06   TISSUE CULT TISSUE-ALF                       $240.00
0684951   06   COCCI EIA IGM-KERN                            $10.00
0684662   06   HEPATITIS BE AB-ARUP                          $13.10
0684647   06   HEPATITIS B SURF AG CONF                      $26.09
0684621   06   HEMOGLOBIN,PLASMA-ARUP                        $11.98
0684613   06   HGB A2&F BY COLUMN-ARUP                       $11.76
0684605   06   HEMOGLOBIN EVAL-ARUP                          $15.00
0685289   06   HOMOCYSTINE,TOTAL-ARUP                        $21.67
0684746   06   HEPATITIS C(HCV)RNA-ARUP                      $91.67
0685115   06   ORGANIC ACIDS,UR-UCGL                        $242.00
0685263   06   HLA-B27-ARUP                                  $34.93
0685255   06   HLA-A EXTRACTION-ARUP                        $133.33
0685230   06   HIV1-ULTRA SEN RNA-ARUP                      $130.00
0685180   06   WESTERN BLOT HIV1-ARUP                        $35.28
0685172   06   AMINO ACID,PLASMA-UCGL                       $158.00
0685156   06   HISTO AB CF-ARUP                              $11.25
0684936   06   HERPES SIMPLEX CULT-ARUP                      $16.27
0685123   06   HISTAMINE,WB-ARUP                             $21.00
0684944   06   HERPES SIMPLEX DFA-ARUP                       $53.08


                                   Page 72 of 276
Charge #Dept   CDM Description                       Price
0685107   06   5-HIAA-ARUP                                    $13.00
0685073   06   COCCI CF-KERN                                   $8.00
0684977   06   COCCI IMUN DIFF-KERN                           $10.00
0685149   06   HISTONE AB,IGG-ARUP                            $15.60
0683896   06   TISSUE CULT LYMPH-ALF                         $116.00
0684050   06   FAT,FECAL,QUAN-ARUP                            $23.10
0684001   06   TISSUE CULT BLD-ALF                           $180.00
0683961   06   CHROMOSOME ANAL-ALF                           $180.00
0684118   06   PARATHYOID INT.MOLCU-ARUP                      $12.50
0683599   06   ESTROG RECEPT-ARUP                             $62.50
0684233   06   GASTRIN-ARUP                                   $13.75
0684407   06   GROWTH HORMONE-ARUP                            $10.60
0684340   06   ANTI-GBM AB,IGG-ARUP                           $45.00
0684316   06   COXSACKIE B VIRS2-ARUP                         $11.91
0684290   06   COXSACKIE B VIRUS1-ARUP                        $11.91
0684076   06   FLECAINIDE-ARUP                                $22.50
0684266   06   FV LEIDEN ENZYM DIG-ARUP                       $10.51
0684084   06   MYOGLOBIN,URINE-ARUP                           $12.90
0684209   06   GABAPENTIN-ARUP                                $20.00
0684183   06   CHROMOSOME ANAL/KARY-ALF                       $40.00
0684175   06   CHROMOSOME ANAL-ALF                           $195.00
0684134   06   FRUCTOSAMINE-ARUP                              $12.66
0685339   06   HOMOVANILLIC ACID-ARUP                         $15.00
0686733   06   PTT-ARUP                                       $10.96
0686840   06   GLIADIN AB,IGA-ARUP                            $14.70
0686832   06   MANGANESE-ARUP                                 $12.00
0686816   06   MAGNESIUM,UR-ARUP                              $11.92
0686790   06   LYSOZYME,BLD/FLUID-ARUP                        $13.80
0686774   06   LYME AB,IGG WST BLT-ARUP                       $21.00
0686758   06   LYME AB DETECT-ARUP                            $11.10
0686899   06   MEASLES(RUBEO)AB/IGG-ARUP                      $11.50
0686584   06   GLUCOSE-6-PD-ARUP                              $15.07
0686519   06   LEGIONELLA PCR-ARUP                           $199.68
0686493   06   LEAD-ARUP                                       $6.25
0686477   06   LEAD,URINE-ARUP                                $10.50
0687194   06   MICROALBUMIN,UE-ARUP                           $10.50
0687103   06   GLIADIN AB,IGG-ARUP                            $14.70
0687038   06   METANEPHRINE,UR-ARUP                           $22.80
0687004   06   MCURY,UR-ARUP                                  $10.50
0686931   06   MERCURY-ARUP                                   $10.50
0686915   06   MECONIUM CMP DRG PNL-ARUP                     $110.00
0686402   06   COXSACKIE B VIRUS 6-ARUP                       $11.91
0685560   06   HYDROXYPROGEST 17D-ARUP                        $20.75
0685859   06   INFLUENZA B AB-ARUP                            $13.60
0685800   06   INFLUENZA A VIR AB-ARUP                        $13.60
0685792   06   COXSACKIE B VIRUS 3-ARUP                       $11.91
0685735   06   IMMUNGLOBULIN D-ARUP                            $9.90
0685644   06   IMMUNOFIX ELECTROPH-ARUP                       $40.00
0685602   06   IMMUNE COMP RAJ-ARUP                           $84.37
0685578   06   IGG SUBCLASSES 1-ARUP                          $13.05
0685537   06   5-HIAA,UR-ARUP                                 $13.00
0685495   06   17-HYDROXY-STERIOD-ARUP                        $44.40
0685487   06   HPV,HI RISKDNA PROBE-ARUP                      $44.00
0685412   06   HTLV I/II AB(EIA)-ARUP                          $8.59
0685594   06   IMIPRAMINE FRACTION-ARUP                       $22.50
0686212   06   LEGIONELLA PNEU CULT-ARUP                      $29.98
0686360   06   COXSACKIE B VIRUS 5-ARUP                       $11.91
0686352   06   17-KETOSTERIOD,UR-ARUP                         $32.41


                                    Page 73 of 276
Charge #Dept   CDM Description                       Price
0686345   06   COXSACKIE B VIRUS 4-ARUP                       $11.91
0686311   06   17-KETOGEN STERIODS-ARUP                      $102.70
0686279   06   LEPTOSPIRA AB-ARUP                             $27.79
0685867   06   INSULIN ANTIBODIES-ARUP                        $39.17
0686238   06   LEGIONEALL PNEU DFA-ARUP                       $27.58
0685909   06   INSUKIN,RANDOM-ARUP                             $9.09
0686196   06   LEGIONEALL PNEUM AG-ARUP                       $16.50
0686055   06   ISLET CELL AB,IGG-ARUP                         $24.53
0686006   06   INTRIN FACT NBLOCK AB-AR                       $10.00
0683540   06   ANTI-THYROGLOBULIN RDL                         $25.00
0681403   06   PROTEIN,TOTAL-ARUP                              $5.40
0681460   06   DRVVT-ARUP                                     $10.80
0681452   06   PT-ARUP                                         $9.28
0681312   06   IGG SUBCLASS 4-ARUP                            $13.05
0681411   06   LD,TOTAL-ARUP                                   $7.65
0681395   06   IGM,SERUM-ARUP                                  $9.90
0681361   06   IGG SERUM-ARUP                                  $8.25
0681338   06   IGA,SERUM-ARUP                                  $9.90
0683573   06   ERYTHROPOIETIN-ARUP                            $18.33
0681619   06   POLIOVIRUS AB TYPE3-ARUP                       $26.88
0681510   06   IGG,CSF-ARUP                                    $8.25
0681585   06   POLIOVIRUS ABTYPE2-ARUP                        $26.88
0681577   06   ALBUMIN,SERUM-ARUP                              $5.83
0680785   06   CLOZAPINE-ARUP                                 $24.60
0681262   06   T-CELL CD19/CD3%-ARUP                          $24.00
0681221   06   T-CELL CD8/CD3-ARUP                            $24.00
0681205   06   PHENYTOIN TOTAL-ARUP                           $10.26
0681775   06   COCCIDIODES AB CF-ARUP                         $10.50
0681213   06   T-CELL CD4/CD3-ARUP                            $24.00
0682807   06   AMEBIASIS AB-ARUP                              $12.00
0682781   06   ARUG ANAL,URINE-ARUP                           $90.72
0682765   06   DRUG ANALYSIS-ARUP                             $83.09
0682757   06   DRUG ANAL,GASTRIC-ARUP                        $199.85
0681734   06   T-CELL CD16/CD56/CD3-ARUP                      $24.00
0682617   06   DHEA-ARUP                                      $22.95
0682542   06   DESIPRAMINE-ARUP                               $16.50
0682492   06   DIAZEPAM&METOBOLITE-ARUP                       $28.48
0682450   06   DEHYDROEPIAN.SULF-ARUP                         $15.90
0682625   06   11 DEOXYCORTISOL-ARUP                          $28.50
0683144   06   ANTI-SMOOTH MUSC. AB RDL                       $23.00
0683128   06   ANTI-PARIETAL CELL AB RDL                      $17.00
0683094   06   E.HISTOLYTICA AB-ARUP                          $12.00
0681874   06   COPPER-ARUP                                     $9.00
0682435   06   CYTOMEGALOVIRUS CULT-ARUP                      $52.22
0682021   06   CRYTPOCOCCUS AB-ARUP                           $52.40
0681957   06   CREATINE KINASE ISO-ARUP                       $19.80
0681932   06   COXSACK A SERO 7-ARUP                          $22.82
0682088   06   QFVR AB PHSE II IGG-ARUP                       $17.69
0681890   06   CORTISOL,UR FREE-ARUP                          $13.50
0682096   06   CRYPTOCOCCUS AG-ARUP                           $21.44
0681866   06   COMPLEMENT COMP 2-ARUP                         $34.51
0681858   06   COCCID AB IGM(EIA)-ARUP                        $10.50
0681825   06   T-CELL CD3-ARUP                                $24.00
0681817   06   COCCID AN IGG(EIA)-ARUP                        $10.50
0681791   06   COOCIDIODES AB CF-ARUP                         $10.50
0681742   06   COCCID AB PNL,CSF-ARUP                         $42.00
0682377   06   CYSTINE,UR,QUAN-ARUP                           $18.00
0682369   06   CYSTICER IGG,CSF-ARUP                          $64.20


                                    Page 74 of 276
Charge #Dept   CDM Description                        Price
0682344   06   CYCLOSPORINE A-ARUP                             $22.20
0682310   06   17-HYDROXYPREGNEN-ARUP                          $71.41
0682054   06   CRYPTOCOCCUS AG,CSF-ARUP                        $21.44
0687277   06   MITCHON M2 AB/IGG-ARUP                          $10.60
0688507   06   PROTEIN S FUNC.-ARUP                            $40.38
0688978   06   SCLERO(SCL-70),IGG_ARUP                         $10.80
0688879   06   RENIN ACTIVITY-ARUP                             $16.50
0688861   06   PYRUVIC ACID-ARUP                               $18.68
0688648   06   FV LEIDEN AMPLIF,PCR-ARUP                       $19.95
0688317   06   B.PERTUSSIS AB,IGM-ARUP                         $13.50
0689109   06   SMOOTH MUSC.AB-ARUP                              $7.02
0688457   06   PROTEIN ELECTROPH-ARUP                          $10.00
0688432   06   PROTEIN,TOT,CSF-ARUP                             $7.69
0688382   06   PROTEIN C,TOTAL-ARUP                            $14.10
0688374   06   PROTEIN C,FUNC-ARUP                             $24.13
0688606   06   PROTEIN S,TOTAL-ARUP                            $14.10
0689380   06   THYROID BIND GLOB-ARUP                          $16.50
0689372   06   TPO ANTIBODY-ARUP                                $9.00
0689349   06   THYROGLOBULIN AB-ARUP                           $13.50
0689331   06   THYROGLOBULIN-ARUP                              $24.66
0689323   06   THIOCYANATE-ARUP                                $23.62
0689307   06   TETANUS AB,IGG-ARUP                              $9.60
0689299   06   TESTOSTERONE,FREE-ARUP                          $15.60
0689240   06   T-CELL CD19/CD3-ARUP                            $24.00
0689026   06   SEROTONIN,WB-ARUP                               $37.50
0689232   06   STRIATED MUSC AB IGG-ARUP                       $16.50
0687491   06   MYELIN PROTEIN-ARUP                             $22.95
0687715   06   OLIGOCLONAL BANDING-ARUP                        $36.80
0687699   06   5'NUCLEOTIDASE-ARUP                             $15.00
0687624   06   NORTRIPTYLINE-ARUP                              $13.80
0687616   06   NICOTINE&COTIN METAB-ARUP                       $65.65
0688325   06   LEGION PNEUMO AB1-6-ARUP                        $11.10
0687509   06   MYOCARDIAL AB,IGG-ARUP                          $18.42
0687434   06   MYCOPLASMA HOM CX-ARUP                          $29.40
0687392   06   ANTI-STRIATED AB IGG-ARUP                       $16.50
0687384   06   MUMPS AB,IGM-ARUP                               $11.50
0687376   06   MUMPS AB,IGG-ARUP                               $11.50
0687517   06   MYOGLOBIN-ARUP                                  $12.90
0687954   06   PHENYTOIN,FREE-ARUP                             $11.57
0688226   06   PBG,URINE-ARUP                                  $28.37
0688184   06   POLIOVIRUS AB TYPE-1-ARUP                       $26.88
0688119   06   PLATLET AB DET.INDIR-ARUP                       $75.00
0688093   06   HEPATIT B DNA,QUANT-ARUP                        $82.00
0688044   06   PLASMINOGEN-ARUP                                $19.08
0688036   06   B.PERTUSSIS,DFA-ARUP                            $20.94
0687756   06   OSTEOCALCIN(GIA)-ARUP                           $30.00
0687962   06   PHOSPHOLIPIDS-ARUP                              $25.64
0687798   06   OXALATE-ARUP                                   $102.00
0687913   06   PENTOBARBITAL-ARUP                              $15.60
0687848   06   B.PERTUSSIS,CULT-ARUP                           $28.56
0687830   06   PARIETAL CELL AB IGG-ARUP                       $21.80
0687822   06   CALCIUM,TOTAL-ARUP                               $6.98
0689489   06   TRYPSIN,FECAL-ARUP                              $10.55
0687970   06   PHOSPHOROUS,UR-ARUP                              $6.91
0689463   06   TRAZODONE-ARUP                                  $24.76
0689604   06   VARIC-ZOSTER AB IGG-ARUP                        $10.50
0689752   06   VITAMIN C-ARUP                                  $13.76
0689687   06   VIT B1(THIAMINE)-ARUP                           $21.60


                                     Page 75 of 276
Charge #Dept   CDM Description                       Price
0689661   06   VITAMIN A-ARUP                                 $15.66
0689877   06   VITAMIN D,25-HYDROXY-ARUP                      $23.40
0689612   06   VARICEL-ZOSTR AB IGM-ARUP                      $10.50
0689554   06   VANILLYLMAN ACID,UR-ARUP                       $13.50
0689547   06   URIC ACID,UR-ARUP                               $6.74
0689513   06   UREA&MYCOPLASMA CULT-ARUP                      $29.40
0689505   06   TSH RECEPTOR AB-ARUP                           $24.64
0689646   06   VIRAL CULT-ARUP                                $38.52
0689471   06   TRIIODOTHYRONINE,FR-ARUP                       $15.00
0689844   06   VIT D,1,1-25DIHYDROX-ARUP                      $27.00
0689968   06   VITAMIN E-ARUP                                 $15.66
0622472   06   RSV ANTIGEN,EIA                               $214.00
0622415   06   FUNGUS CULT,SKN,NL,HR                         $147.00
0622399   06   FUNGUS,MOLD,ID DEF                            $147.00
0622373   06   ANAEROBIC BACTERIAL ID                         $91.00
0625178   06   CRYPTOCOCCAL AG TITER                         $231.00
0622407   06   ACID FAST CONCENTRATION                        $50.00
0630582   06   PHOSPHORUS, SERUM                             $114.00
0624098   06   CULTURE, CAMPYLOBACTER                         $59.00
0623603   06   FECAL WHITE CELLS                             $145.00
0622597   06   CULTURE, OTHER                                $313.00
0622605   06   SENSITIVITY,DISK METHOD                       $209.00
0623017   06   MICROSPORIDIUM STAIN                          $197.00
0622902   06   C DIFFICILE TOXIN                             $204.00
0622662   06   CULTURE, BETA STREP                           $173.00
0621565   06   VRE SCREEN                                    $161.00
0621482   06   FUNGUS CULTURE BLOOD                          $147.00
0621334   06   KOH PREPARATION                               $107.00
0629121   06   CLOTEST                                       $130.00
0630335   06   GLUCOSE, CSF/BODY FLUID                       $166.00
0630327   06   GLUCOSE, URINE                                $137.00
0630301   06   GLUCOSE BLOOD                                 $165.00
0630293   06   GGT                                           $161.00
0630277   06   PHENYTOIN (DILANTIN)                          $415.00
0630269   06   CREATININE CLEARANCE                          $301.00
0630251   06   CREATININE, URINE                             $137.00
0630137   06   CALCIUM, URINE                                $137.00
0630236   06   HAV AB, IGM                                   $155.00
0630368   06   GLUCOSE TOLERANCE, EA ADD                     $137.00
0630210   06   CPK                                           $193.00
0630202   06   HEPATITIS B CORE AB                           $212.00
0630194   06   CORTISOL, SERUM                               $219.00
0630186   06   CHOLESTEROL                                   $165.00
0630178   06   CHLORIDE, CSF/BODY FLUID                      $166.00
0630160   06   CHLORIDE, URINE                               $137.00
0630152   06   CHLORIDE, SERUM                               $137.00
0624171   06   ANAEROBIC CULTURE                             $122.00
0630244   06   CREATININE, SERUM                             $165.00
0630566   06   ALK PHOS, HEAT STABLE                         $244.00
0630558   06   ALKALINE PHOSPHATASE                          $161.00
0630541   06   ACID PHOSPHATASE                              $137.00
0630533   06   MAGNESIUM, URINE                              $137.00
0630525   06   MAGNESIUM, SERUM                              $145.00
0630517   06   TRANSFERRIN                                   $182.00
0630509   06   LITHIUM                                       $292.00
0630475   06   LIDOCAINE                                     $255.00
0630350   06   GTT 1ST 3 SPECIMEN                            $581.00
0630459   06   LDH, CSF/BODY FLUID                           $193.00


                                    Page 76 of 276
Charge #Dept   CDM Description                        Price
0630442   06   LDH, SERUM                                      $193.00
0630434   06   LACTIC ACID                                     $244.00
0630426   06   IRON BANDING CAPACITY                           $109.00
0630400   06   IRON, TOTAL                                     $104.00
0630129   06   CALCIUM, SERUM                                  $137.00
0630491   06   LIPASE                                          $193.00
0630145   06   CARBAMAZEPINE (TEGRETOL)                        $415.00
0629162   06   MRSA SCREEN                                     $161.00
0630087   06   BILIRUBIN, DIRECT                               $160.00
0630079   06   BILIRUBIN, TOTAL                                $145.00
0630061   06   CARBON DIOXIDE                                  $137.00
0630053   06   APT-FETAL HEMOGLOBIN                            $114.00
0630046   06   AMYLASE, URINE                                  $150.00
0630038   06   AMYLASE, SERUM                                  $193.00
0630020   06   ALCOHOL (ETHANOL), SERUM                        $379.00
0630004   06   ACETONE, SERUM                                  $126.00
0630012   06   ALBUMIN                                         $145.00
0610857   06   URINALYSIS W/MICRO                              $145.00
0611061   06   FDP (FSP)                                       $192.00
0611053   06   THROMBIN TIME                                   $160.00
0611046   06   FIBRINOGEN                                      $193.00
0611020   06   REPTILASE TEST                                  $145.00
0611012   06   PTT                                             $161.00
0611004   06   PROTHROMBIN TIME                                $156.00
0610576   06   VISCOSITY, SERUM                                $100.00
0611103   06   CIRCULATING ANTICOAGULANT                       $476.00
0610758   06   FACTOR II                                       $274.00
0610675   06   PLT AGGREG RISTOCETIN                           $216.00
0610667   06   PLT AGGREG ARACHIDONIC                          $216.00
0610592   06   PLATELET COUNT, AUTO                              $77.00
0611236   06   FACTOR IX                                       $401.00
0611293   06   FACTOR VIII, VW RIST CO                         $584.00
0611285   06   FACTOR VIII SCREEN                              $334.00
0611277   06   FACTOR XIII                                       $73.00
0611269   06   FACTOR XII                                      $274.00
0611087   06   CLOT RETRACTION                                   $55.00
0611244   06   FACTOR X                                        $274.00
0611228   06   FACTOR VIII,ONE STAGE                           $461.00
0611210   06   FACTOR VII                                      $231.00
0611202   06   FACTOR V                                        $274.00
0611152   06   D-DIMER                                         $137.00
0611137   06   PLATELET AGGREGATION                           $1,044.00
0611251   06   FACTOR XI                                       $274.00
0610188   06   SUCROSE HEMOLYSIS TEST                          $126.00
0610170   06   SICKLE CELL SCREEN                                $92.00
0610162   06   FETAL HGB, KLEIHAUER BETK                       $215.00
0610154   06   BLOOD SMEAR EXAM W/O DIFF                         $28.00
0610147   06   PROTEIN C ANTIGEN                               $372.00
0610584   06   PLATELET COUNT, MANUAL                          $118.00
0610121   06   UROBILINOGEN SCREEN                               $34.00
0610238   06   HEINZ BODIES                                      $65.00
0610071   06   NASAL SMEAR, EOSINOPHILS                          $59.00
0610063   06   DIFFERENTIAL, MANUAL                            $118.00
0610055   06   EOSINOPHIL COUNT                                $114.00
0610048   06   RETICULOCYTE COUNT                              $133.00
0610030   06   SED RATE RBC NON AUTO                           $120.00
0610022   06   SED RATE RBC NON AUTO                           $120.00
0610139   06   PROTEIN S,TOTAL                                 $417.00


                                     Page 77 of 276
Charge #Dept   CDM Description                       Price
0610410   06   SPERM COUNT                                   $161.00
0610535   06   WRIGHT STAIN                                  $161.00
0610519   06   HEMOGRAM                                      $140.00
0610501   06   CBC W/ AUTO DIFF                              $204.00
0610493   06   HEMATOCRIT                                     $64.00
0610477   06   PLATLET FUNCTION(ADP)                         $258.00
0610451   06   ANTITHROMBIN III ACTIVITY                     $270.00
0610220   06   LEUKOCYTE ALK PHOSPHATASE                     $152.00
0610402   06   SEMEN ANALYSIS, COMPLETE                      $292.00
0610394   06   PH, BODY FLUID                                 $88.00
0610303   06   CELL CT FLUID W/DIFF                          $161.00
0610295   06   PLT AGGREG COLLAGEN                           $216.00
0610279   06   URINE VOL. MEASUREMNT                          $33.00
0610469   06   PLATLET FUNCTION(EPI)                         $258.00
0620435   06   GIARDIA AG DETECTION                          $244.00
0620625   06   CULTURE, NOSE/THROAT                          $301.00
0620609   06   CULTURE, FECES                                $301.00
0620575   06   YEAST ID DEFINITIVE                           $147.00
0620567   06   RSV AG DETECT,DFA                             $104.00
0620559   06   PARAINFLU AD DETECT DFA                       $104.00
0620542   06   INFLUENZA A AG DETEC DFA                      $104.00
0611426   06   PT CORRECTION STUDIES                         $124.00
0620708   06   SCHLICTER TEST                                $250.00
0620427   06   YERSINIA CULTURE                              $111.00
0620419   06   MICROBIAL ID                                  $174.00
0620393   06   VIBRIO CULTURE                                $136.00
0620310   06   CRYPTOCOCCAL ANTIGEN                          $146.00
0620302   06   BETA STREP SCREEN, RAPID                       $38.00
0620252   06   CULTURE, GC SCREEN                            $161.00
0620211   06   BACTERIAL AG DETECT, SING                     $146.00
0620534   06   ADENOVIRUS AG DETECT DFA                      $104.00
0620872   06   PH, FECES                                      $59.00
0630590   06   PHOSPHORUS, URINE                             $116.00
0621029   06   ANAEROBIC SENSITIVITY                         $179.00
0620971   06   ROTAVIRUS AG, EIA                             $214.00
0620906   06   SENSITIVITY,AGAR DIF                          $209.00
0620880   06   REDUCING SUB FECES/URINE                       $59.00
0620856   06   AEROBIC BACTERIAL ID                           $91.00
0620179   06   FECAL FAT, QUALITATIVE                         $92.00
0612051   06   FAT, URINE                                     $38.00
0620203   06   MALARIAL STAIN                                $303.00
0612085   06   URINE MICROSCOPIC                              $18.00
0612044   06   HEMOSIDERIN, URINE                             $38.00
0612028   06   PREGNANCY TEST URINE                          $222.00
0612010   06   UA NONAUTO W/O MICRO                           $36.00
0612002   06   URINALYSIS                                    $126.00
0612077   06   OCCULT BLOOD, MISC FLUID                       $34.00
0620054   06   WET MOUNT                                     $145.00
0611434   06   PLATELET ADHESION TEST                        $418.00
0620161   06   OCCULT BLOOD, FECES                            $87.00
0620153   06   O&P, CONCENTRATE                              $158.00
0620120   06   ACID FAST STAIN                               $107.00
0620112   06   ACID FAST CULTURE                             $165.00
0620104   06   FUNGUS CULT,OTHER SOURCE                      $147.00
0620088   06   O & P TRICHROME STAIN                          $95.00
0620062   06   INDIA INK                                     $145.00
0620195   06   PINWORM PREP                                   $92.00
0620047   06   GRAM STAIN                                    $145.00


                                    Page 78 of 276
Charge #Dept   CDM Description                         Price
0620039   06   SUSCEPTIBILITY STUDIES,PL                       $248.00
0620021   06   CULTURE, URINE                                  $313.00
0620013   06   CULTURE, BLOOD                                  $363.00
0620005   06   PNEUMOCYSTIS CARINII,DFA                        $130.00
0614032   06   SP GRAVITY (OTH THAN UR)                         $41.00
0620070   06   CRYPTOSPORIDIUM AG-EIA                          $212.00
0643460   06   TOXOPLASMA ANTIBODY IGG                         $197.00
0643544   06   IMMUNOGLOBULIN M                                $121.00
0643536   06   IMMUNOGLOBULIN G                                $121.00
0643528   06   IMMUNOGLOBULIN D                                $121.00
0643510   06   IMMUNOGLOBULIN A                                $121.00
0643494   06   ANTI DNA TITER                                  $190.00
0643353   06   ANTI-SCL 70                                     $258.00
0643635   06   C4 COMPLEMENT                                   $167.00
0643452   06   RUBELLA ANTIBODY IGG                            $197.00
0643445   06   HERPES I, IGG                                   $182.00
0643437   06   ANTI DNA SCREEN                                 $190.00
0643429   06   CMV IGG ANTIBODY                                $197.00
0643411   06   ANA TITER                                       $168.00
0643403   06   ANA SCREEN                                      $168.00
0643775   06   SKIN TEST, MUMPS                                $201.00
0630574   06   OSMOLALITY, SERUM                               $105.00
0644179   06   GC, DNA PROBE                                   $270.00
0643809   06   SKIN TEST, ANERGY PANEL                         $302.00
0643619   06   TOTAL HEMO COMPLEMENT                           $269.00
0643783   06   SKIN TEST, TRICHOPHYTON                         $129.00
0643627   06   C3 COMPLEMENT                                   $167.00
0643767   06   SKIN TEST, HISTOPLASMOSIS                       $168.00
0643759   06   SKIN TEST, COCCIDIOMYCES                        $168.00
0643742   06   SKIN TEST, CANDIDA                              $201.00
0643734   06   SKIN TEST TB 250 TU                             $152.00
0643726   06   SKIN TEST, TB                                   $201.00
0643643   06   HCG SERUM QUAL                                  $222.00
0643346   06   ANTI-PCNA                                       $216.00
0643791   06   SKIN TEST,UNLISTED ANTIGE                       $152.00
0640367   06   FIBRIN MONOMER                                  $143.00
0643007   06   RPR                                              $78.00
0642652   06   RPR TITER                                       $175.00
0641514   06   EBV EARLY ANTIGEN                               $258.00
0641506   06   MYCOPLASMA AB,IGM                               $235.00
0643387   06   ANTI-SSB (LA)                                   $258.00
0640375   06   H. PYLORI AB                                    $241.00
0643064   06   MONOTEST TITER                                  $166.00
0640359   06   ACTIV PROTEIN C RESIST                          $159.00
0640342   06   RUSSELL VIPER VENOM, DILU                       $179.00
0640318   06   CARDIOLIPIN IGM AB                              $192.00
0640300   06   CARDIOLIPIN IGG AB                              $192.00
0640284   06   CHLAMYDIA, DNA PROBE                            $225.00
0641498   06   MYCOPLASMA AB IGG                               $235.00
0643338   06   ANTI-JO1                                        $216.00
0643320   06   ANTI-RNP                                        $258.00
0643304   06   HERPES II, IGG                                  $197.00
0643288   06   ANTI-SM                                         $258.00
0643262   06   ANTI-ENA OTHER                                  $216.00
0643247   06   ANTI-SSA (RO)                                   $258.00
0643221   06   CRYOGLOBULINS                                   $121.00
0643056   06   MONOTEST SCREEN                                 $161.00
0643130   06   FTA                                             $182.00


                                      Page 79 of 276
Charge #Dept   CDM Description                       Price
0643114   06   CSF VDRL, QUANT.                              $175.00
0643098   06   COLD AGGLUTININS                              $114.00
0643080   06   ASO, QUANTITATIVE                             $136.00
0643072   06   STREPTOZYME SCREEN                            $111.00
0631481   06   HAPTOGLOBIN                                   $177.00
0631655   06   ACETAMINOPHEN (TYLENOL)                       $415.00
0631648   06   PROCAINAMIDE-NAPA                             $296.00
0631630   06   DRUG SCR-AMPHETAMINES                          $59.00
0631614   06   TOBRAMYCIN                                    $217.00
0631598   06   HCG, QUANTITATIVE                             $248.00
0631333   06   THEOPHYLLINE                                  $310.00
0631564   06   HEP B SURFACE ANTIBODY                        $155.00
0631416   06   TESTOSTERONE                                  $250.00
0631408   06   PROGESTERONE                                  $244.00
0640276   06   DNA, EXTRACTION                                $70.00
0631580   06   GENTAMICIN                                    $310.00
0631820   06   COCAINE CONFIRMATION                          $182.00
0632018   06   PSA SCREEN                                    $246.00
0631994   06   CRP,HIGH SENSITIVE                            $177.00
0631986   06   GLUCOSE POST DOSE                             $275.00
0631861   06   PCP CONFIRMATION                              $182.00
0631853   06   AMPHETAMINE CONFIRMATION                      $182.00
0631838   06   THC CONFIRMATION                              $182.00
0631671   06   IMMUNOELECTRO, SERUM                          $286.00
0631812   06   FREE THYROXINE (T4)                           $132.00
0631804   06   ANTI-THROMBIN III                             $270.00
0631796   06   PROTEIN, URINE 24 HOUR                         $87.00
0631713   06   T3 TOTAL                                      $196.00
0631846   06   OPIATE CONFIRMATION                           $182.00
0630681   06   SALICYLATES                                   $239.00
0630798   06   UREA NITROGEN, URINE                          $147.00
0630780   06   UREA NITROGEN (BUN), SER                      $137.00
0630772   06   ALPHA-FETO PROTEIN                            $251.00
0630764   06   TRIGLYCERIDES                                 $145.00
0630731   06   SWEAT COLL IONTOPHOR                          $404.00
0630723   06   SODIUM, URINE                                 $137.00
0630715   06   SODIUM, SERUM                                 $137.00
0631341   06   VITAMIN B-12                                  $204.00
0630699   06   AST (SGOT)                                    $193.00
0630673   06   QUINIDINE                                     $199.00
0630665   06   PHENOBARBITAL                                 $346.00
0630657   06   PROTEIN ELECTRO, SERUM                        $286.00
0630640   06   PROTEIN, CSF/BODY FLUID                       $173.00
0630632   06   PROTEIN, URINE                                $192.00
0630624   06   PROTEIN, SERUM                                $173.00
0630616   06   POTASSIUM, URINE                              $137.00
0630608   06   POTASSIUM, SERUM                              $137.00
0630707   06   ALT (SGPT)                                    $161.00
0631127   06   T-UPTAKE (T3U)                                $126.00
0631317   06   HEPATITIS B SURF ANTIGEN                      $147.00
0631309   06   HBS AG NEUTRALIZATION                         $147.00
0631291   06   HDL CHOLESTROL                                $167.00
0631267   06   FOLIC ACID (FOLATE)                           $199.00
0631259   06   FERRITIN                                      $186.00
0631200   06   AMMONIA                                       $255.00
0631192   06   AMIKACIN                                      $244.00
0630806   06   URIC ACID, SERUM                              $165.00
0631135   06   T4 (THYROXIN)                                 $109.00


                                    Page 80 of 276
Charge #Dept   CDM Description                        Price
0630814   06   URIC ACID, URINE                               $116.00
0631010   06   DIGOXIN                                        $295.00
0630921   06   ELECTROLYTES                                   $216.00
0630897   06   OSMOLALITY, URINE                              $109.00
0630848   06   VANCOMYCIN                                     $303.00
0630830   06   VALPROIC ACID (DEPAKENE)                       $364.00
0631150   06   THYROID STIMULATING HORMO                      $225.00
0633941   06   TROPONIN I                                     $325.00
0634881   06   PRIMIDONE                                      $222.00
0635417   06   LH                                             $222.00
0633909   06   ESTRADIOL                                      $214.00
0633784   06   COMP. METABOLIC PANEL                          $493.00
0633776   06   PROSTATIC ACID PHOS                            $137.00
0633768   06   BASIC METABOLIC PANEL                          $378.00
0640060   06   TOXOPLASMA ANTIBODY IGM                        $200.00
0640235   06   IMMUNOGLOBULIN E                               $121.00
0640177   06   PREALBUMIN                                     $199.00
0640169   06   MEASLES (RUBEOLA) IGM                          $179.00
0640151   06   MEASLES (RUBEOLA) IGG                          $179.00
0640144   06   VARICELLA ZOSTER IGG                           $179.00
0640136   06   EBV, CAPSID ANTIGEN IGM                        $258.00
0640128   06   EBV, CAPSID ANTIGEN IGG                        $197.00
0640102   06   EBV, NUC ANTIGEN IGG                           $197.00
0635409   06   FSH                                            $222.00
0640052   06   HERPES II ANTIBODY IGM                         $197.00
0640045   06   HERPES I ANTIBODY IGM                          $197.00
0640037   06   CMV ANTIBODY IGM                               $282.00
0640029   06   RUBELLA ANTIBODY IGM                           $197.00
0640011   06   ANTI-ENA SCREEN                                $258.00
0635433   06   HEMOGLOBIN A1C                                 $141.00
0635425   06   PROLACTIN                                      $232.00
0633693   06   PROSTATE SPECIFIC AG                           $246.00
0640110   06   EBV, NUC ANTIGEN IGM                           $216.00
0633750   06   HEPATIC FUNCTION PNL                           $299.00
0632919   06   PROTEIN ELECTRO, CSF                           $329.00
0632901   06   PROTEIN ELECTRO, URINE                         $286.00
0632869   06   AMYLASE, BODY FLUID                            $140.00
0632935   06   IMMUNOELECTRO, CSF                             $286.00
0640268   06   DNA,AMPLIFICATION                               $70.00
0632844   06   HCV(HEP C VIRUS AB)                            $197.00
0632372   06   CKMB                                           $244.00
0633651   06   HEPATITIS PANEL                                $366.00
0633610   06   HTLV 1 ANTIBODY                                $126.00
0633578   06   HAV ANTIBODY, IGM                              $161.00
0633537   06   HAV ANTIBODY TOTAL                             $169.00
0633495   06   HB CORE AB, IGM                                $168.00
0633487   06   CANNABINOIDS SEMIQUANT                         $167.00
0633461   06   RA FACTOR,QUANT                                $177.00
0632927   06   IMMUNOELECTRO, URINE                           $286.00
0633412   06   ALCOHOL (ETHANOL), URINE                       $255.00
0633735   06   CEA                                            $251.00
0633024   06   LIPID PANEL                                    $443.00
0633453   06   HIV-1/HIV-2 AB SINGLE                          $196.00
0671776   06   ANIMOLELUV ACID,UR-ARUP                         $32.11
0671891   06   HEPATITIS C AB(RIBA)-ARUP                      $108.48
0671644   06   C.PSITTACI AB,IGG-ARUP                           $7.50
0672048   06   ANTI-GBM IFA-SPEC.LAB SPC                      $105.63
0671693   06   CARBAMAZEPINE,FREE-ARUP                         $12.49


                                     Page 81 of 276
Charge #Dept   CDM Description                       Price
0671677   06   HERPES SIMP1&2 AB IGM ARU                      $13.50
0672436   06   APOLIPOPROTEIN B100-ARUP                       $15.00
0672337   06   APOLIPOPROTEIN A1-ARUP                         $15.00
0672279   06   PSA,FREE-ARUP                                  $23.19
0672246   06   LYMPH ENUMER, BASIC SPC                       $130.00
0672212   06   INFLUENZA A/B AG-FOC                           $45.26
0672063   06   PSA,TOTAL-ARUP                                 $14.25
0671040   06   CHLAMYDIA DFA SMEAR FOC                         $9.00
0671024   06   ZINC,SERUN-ARUP                                $12.00
0670976   06   C.PNEUMON.AB,IGG-ARUP                           $7.50
0671065   06   HERPES SIMPLX VR DNA-ARUP                      $56.00
0671560   06   LD ISO-ARUP                                    $17.28
0671552   06   C.TRACHOMATIS AB,IGG-ARUP                       $7.50
0671313   06   ACTH-ARUP                                      $25.50
0674259   06   LYME AB IGM WST BLT-ARUP                       $21.00
0674085   06   HISTOPLASMA AB,ID-ARUP                         $10.50
0674077   06   IGF BINDING PROTEIN-ARUP                       $20.66
0674549   06   HLA-B AMPLIFICATION-ARUP                      $133.33
0674457   06   HLA-A ID-ARUP                                 $133.33
0674440   06   HLA-A AMPLIFICATION-ARUP                      $133.33
0674507   06   HLA-B EXTRACTION-ARUP                         $133.33
0672790   06   WEST EQ ENCEPH PNL-FOC                         $46.15
0672766   06   ANTI-MICHROSOMAL AB-ARUP                        $9.00
0672758   06   TOXO GONDII DNA,PCR-FOC                       $154.07
0672642   06   THYROID STIM IMMUNO-ARUP                       $69.60
0672899   06   PROGESTERONE RECEPT-ARUP                       $62.50
0672535   06   ESTRONE-ARUP                                   $19.80
0672527   06   ESTROGENS,SER FRACT-ARUP                       $29.80
0672485   06   HIV P24 ANTIGEN-ARUP                           $14.78
0672675   06   MYCO PNEUMO CULT-FOC                           $40.30
0673558   06   HISTO AB YEAST,CF-ARUP                         $11.25
0673483   06   M. AVIUM DRUG PANEL FOC                        $92.30
0673467   06   AFB RAPI GROWER DRUG FOC                       $60.45
0673459   06   AFB SECONDARY DRUGS FOC                        $63.00
0673434   06   AFB RAPID PRIM.DRUG FOC                        $72.15
0673418   06   MYCOBACT DNA PROBE FOC                         $35.91
0673400   06   MYCOBACTERIA ID FOC                            $33.00
0660647   06   FROZEN BLOOD THAW/PROCESS                     $732.00
0660589   06   HOLD CLOT                                      $47.00
0660563   06   ABSORPTION, AUTO WARM                         $129.00
0660514   06   RHIG HANDLING                                  $88.00
0660506   06   DONOR UNIT RETYPE                             $201.00
0660423   06   CRYOPPT HDLG-THAW/UNIT                         $78.00
0660407   06   FFP HANDLING-THAWING/UNIT                      $73.00
0670968   06   C.PSITTICI AB.IGM-ARUP                          $9.16
0660886   06   BLOOD ISSUE OR RETURN                         $201.00
0660811   06   ANTIBODY ID, SELECT CELLS                     $126.00
0660803   06   AB SCREEN, 2-STG COLD                         $104.00
0660787   06   ANTIBODY TITER                                $212.00
0660050   06   AB SCREEN,COOMBS INDIRECT                     $303.00
0660027   06   RA TYPE                                       $113.00
0660001   06   ABO GROUP                                     $120.00
0660191   06   ANTIBODY ABS, AUTO COLD                       $100.00
0660324   06   BLOOD SPLITTING                                $78.00
0660084   06   ANTIBODY ID PANEL                             $589.00
0660209   06   ANTIBODY ABS,DIFFERENTIAL                     $148.00
0660167   06   ANTIBODY ELUTION                              $276.00
0660142   06   ANTIGEN SCREEN                                 $91.00


                                    Page 82 of 276
Charge #Dept   CDM Description                      Price
0660126   06   COOMBS, DIRECT                               $113.00
0660118   06   RBC ENZYME TREATMENT                          $53.00
0660217   06   CROSSMATCH                                   $329.00
0670570   06   AEROBIC BACT.ID-FOC                           $60.00
0670612   06   BARTONELLA DNA,PCR-FOC                       $154.07
0670414   06   ADENOVIRUS 40-41 AG ARUP                      $10.50
0670406   06   C.PNEUMON.AB,IGM-ARUP                          $9.16
0670711   06   CHLAMYDIA DNA,PCR-FOC                        $152.10
0670927   06   CMV DNA,PCR-ARUP                              $71.85
0670877   06   C.TRACHOMATIS AB,IGM-ARUP                      $9.16
0670596   06   MIC/MBC 5 DRUGS FOC                          $186.00
0670729   06   ENDOMYSIAL AB,IGA-ARUP                        $11.40
0670604   06   MIC/MBC 6 DRUGS FOC                          $200.00
0670653   06   CANDIDA ANTIBODY(ID)-ARUP                     $11.76
0670646   06   XYLOSE ABSRB(25G DOSE)ARU                     $15.90
0670638   06   CAL ENCEPHPALITIS AB ARUP                     $12.00
0662221   06   FETAL SCREEN                                 $214.00
0661041   06   CROSSMATCH,IN VIVO                           $329.00
0661033   06   IMMUNE STUDY                                 $129.00
0661025   06   IRRADIATION FEE RED CROSS                     $60.00
0661017   06   IRRADIATION FEE - NHMC                       $165.00
0661009   06   RED CROSS CMV TESTING ARC                     $50.00
0670190   06   AFB TB COMP DNA/PCR-FOC                      $154.07
0667121   06   PLATELET POOLING                             $275.00
0667147   06   CRYOPRECIPITATE POOLING                      $652.00
0670000   06   REF LAB SPECIMEN HANDLING                     $24.00
0667204   06   PLATELETPHERESIS HDLG                        $137.00
0674671   06   HLA-B ID-ARUP                                $133.33
0678706   06   ALDOLASE-ARUP                                  $7.00
0678862   06   AMINO ACIDS,URINE-ARUP                       $105.00
0678854   06   AMINO ACIDS,PLASMA-ARUP                      $105.00
0678805   06   ALUMINUM,SERUN-ARUP                           $10.50
0678771   06   A-1 ANITRYP PHENO-ARUP                        $22.33
0678763   06   APLPHA-1ANTITIRPYSIN-ARUP                     $10.30
0678748   06   ALLERGENS TEST IND-ARUP                        $4.76
0678730   06   ALK PHOSPHATASE ISO-ARUP                      $11.25
0678540   06   HAM TEST-ARUP                                 $60.00
0678714   06   ALDOSTERONE,SERUM-ARUP                        $27.90
0678912   06   ANGIOTENSIN COV ENZ-ARUP                      $14.00
0678698   06   ALCOHOLS-ARUP                                 $23.28
0678680   06   ALBUMIN,CSF-ARUP                               $5.83
0678649   06   AFP(AMNIOTIC FLUID)ARUP                       $13.50
0678631   06   AFB MIC DRUG PANEL-ARUP                      $147.22
0678615   06   ADRENOCORTCO HORMONE-ARUP                     $25.50
0678607   06   ADRENAL ANTIBODY-ARUP                         $45.04
0678599   06   ADENOVIRUS AB-ARUP                            $11.94
0679332   06   BETA-2-MICROGLOBULIN-ARUP                     $13.25
0678722   06   ALDOSTERONE,URINE-ARUP                        $27.90
0679084   06   PARVOVIRUS IGG FOC                            $34.45
0674648   06   TREPONEMA AB,(MHA-TP)ARUP                     $15.82
0679308   06   MICROALBUMIN,URIN-ARUP                        $24.00
0679290   06   BENCE JONES PRO,QUAL-ARUP                     $40.00
0679274   06   ASPERGILLUS AB ID-ARUP                        $11.10
0679258   06   ARSENIC,URINE-ARUP                            $15.00
0679241   06   ARSENIC-ARUP                                  $15.00
0679191   06   ANTI-THROMBIII,ENZY-ARUP                      $24.29
0678870   06   AMIODARONE&METABOL-ARUP                       $24.76
0679092   06   PARVOVIRUS IGM-FOC                            $34.45


                                   Page 83 of 276
Charge #Dept   CDM Description                       Price
0678888   06   AMITRIP/NORTRIP FRAC-ARUP                      $24.00
0679076   06   PARVOVIRUS PNL-FOC                             $64.00
0679068   06   PARVOVIRUS IGM-FOC                             $46.00
0679050   06   PARVOVIRUS IGG-FOC                             $46.00
0679043   06   PARVOVIRUS PNL(ISA)-FOC                        $72.00
0679027   06   ANTINEUTRO CYTOABIGG-ARUP                      $21.91
0678961   06   ANTI-GBM AB,IGA-ARUP                           $45.00
0678532   06   ACETYL REC MOD AB-ARUP                         $28.50
0679183   06   ANTI THROMB III AG-ARUP                        $51.02
0677211   06   SALMONELAA O PARA B-ARUP                        $8.03
0677807   06   AMNIOTIC FLUID KARYO. UCC                     $360.00
0677492   06   COMA NL,BLD/URINE-PL                          $120.75
0677484   06   COMA PANEL,URINE-PL                            $89.25
0677476   06   DRUG CONF.,GCMS-PL                             $25.00
0677468   06   DRUG SCREEN,URINE-PL                           $12.00
0677252   06   SALMONELLA H GRP D-ARUP                         $8.03
0677245   06   SALMONELLA H PARA B-ARUP                        $8.03
0678581   06   ACT PROT C RESIST-ARUP                         $21.30
0677229   06   SALMONELLA O GRP D-ARUP                         $8.03
0677203   06   SALMONELLA O PARA A-ARUP                        $8.03
0677187   06   PROTEUS AG OX K-ARUP                            $8.03
0677179   06   PROTEUS AG OX2-ARUP                             $8.03
0677161   06   PROTEUS AG OX19-ARUP                            $8.03
0677153   06   BRUCELLA AB,IGM-ARUP                            $8.40
0677146   06   PROTEIN,TOT,UR-ARUP                             $5.40
0677138   06   FV LEIDEN PCR INT/RPT_ARU                      $10.51
0677120   06   FV LEIDEN NUC PROBE-ARUP                       $10.51
0677237   06   SALMONELLA H PARA A-ARUP                        $8.03
0678524   06   ACETYL RECEP BLOC AB-ARUP                      $28.50
0678516   06   ACETYL RECEPT BINDAB-ARUP                      $28.50
0678367   06   LACTIC ACID CSF ARUP                            $7.20
0678359   06   VIT B12 BIND CAP ARUP                          $16.50
0678342   06   HPV PNL,PARAFFIN ARUP                         $250.00
0678334   06   ACID PHOS,TOTAL ARUP                            $8.40
0677963   06   ANTI-GBM AB,IGG EIA-ARUP                       $24.52
0678144   06   CYSTINE URINE ARUP                             $18.00
0678136   06   CHLAMYDIA TRACH DFA ARUP                       $19.94
0678128   06   PRIMIDONE ARUP                                 $12.02
0678110   06   COCCIDIOIDES AB,CF FOC                         $31.20
0678102   06   COCCIDIODES AB,ID-ARUP                         $10.50
0678094   06   LIDOCAINE ARUP                                 $25.42
0679357   06   BILE ACIDS,TOTAL-ARUP                          $11.06
0678268   06   HALOPERIDOL ARUP                               $27.68
0680322   06   COXSACKIE A SERO16-ARUP                        $22.82
0680215   06   COXSACKIE A SERO10-ARUP                        $22.82
0680165   06   COXSACKIE A SERO9-ARUP                         $22.82
0679324   06   BETA2 MICROGLOB-ARUP                           $13.25
0680595   06   CLONAZEPAM-ARUP                                $24.05
0680694   06   CLORAZEPATE-ARUP                               $27.76
0680553   06   PTH MID REGION-END                             $91.00
0680512   06   QFVR AB,PHASE1,IGG-ARUP                        $17.69
0679472   06   CA 19-9 ARUP                                   $12.50
0679647   06   CARDIOLIP AB IGG-ARUP                          $19.50
0679639   06   CARBOXYHEMOGLOBIN-ARUP                         $38.57
0679621   06   CARBAMAZEPINE,TOT-ARUP                         $12.78
0679555   06   CALCIUM,URINE-ARUP                              $6.98
0679548   06   CALCIUM,IONIZED-ARUP                           $13.50
0679530   06   CALCITONIN-ARUP                                $24.00


                                    Page 84 of 276
Charge #Dept   CDM Description                        Price
0679522   06   CAFFEINE-ARUP                                   $26.88
0679480   06   CA 27-29 ARUP                                   $15.00
0679688   06   CATHECHOLAMINES,PL-ARUP                         $31.50
0679464   06   CA 15-3-ARUP                                    $15.00
0679456   06   CA-125-ARUP                                     $12.50
0679449   06   C1Q BINDING ASSAY-ARUP                          $15.00
0679415   06   C-PEPTIDE-ARUP                                  $15.60
0679407   06   C1 ESTERACE FUNC-ARUP                           $26.45
0679399   06   C-1 ESTERACE INHIB-ARUP                         $14.10
0679381   06   BRUCELLA AB,IGG-ARUP                             $8.40
0679373   06   BLASTOMYCES AB(ID)-ARUP                         $12.34
0679860   06   CHOLINESTERASE,RBC-ARUP                          $9.00
0680116   06   HAM TEST-ARUP                                   $60.00
0680074   06   CK ISO-ARUP                                     $19.80
0679654   06   CARNITINE FREE&TOTAL-ARUP                       $21.00
0679977   06   CITRIC ACID,UR-ARUP                             $13.50
0679662   06   CAROTENE,TOTAL-ARUP                             $13.06
0679837   06   CHLAMYDIA TRACH LCR ARUP                        $18.50
0679803   06   CHLAMYDIA CULTURE-ARUP                          $29.87
0679787   06   CHLAMYDIA AB PNL ARUP                           $50.00
0679753   06   CERULOPLASMIN-ARUP                              $10.50
0679720   06   HERPES AG DETECT,DFA FOC                        $23.94
0679704   06   CATECHOLAMIN,UR FR-ARUP                         $20.00
0675785   06   BORDETELLA PERTUSS.AB FOC                       $31.85
0675868   06   TYPHUS AB RICKETTSIA ARUP                       $15.60
0675843   06   TOXOPLASMOSIS,IFA FOC                           $69.55
0675819   06   CANDIDIASIS PANEL FOC                           $56.55
0675694   06   AFB PRIMARY DRUGS FOC                           $70.50
0675793   06   BORRELIA(RELAP.FEVER) FOC                       $96.85
0675777   06   B.PERT/PARA CUL/DFA-FOC                         $58.40
0675769   06   BORD PERT. CULT FOC-ARUP                        $40.62
0675728   06   INFLUENZA C,AB CF FOC                           $42.16
0677112   06   FV LEIDEN NUC.PROBE-ARUP                        $10.51
0675801   06   CALIF.ENCEPH IGG-FOC                            $36.03
0676015   06   CRYPTOCOCCUS AB. DET FOC                        $39.65
0676064   06   ANAEROBIC MIC FOC                               $48.10
0676049   06   AMPHOTERICIN B, MIC FOC                         $38.22
0675884   06   VARICELLA ZOSTER AB FOC                         $34.45
0676023   06   CRYSTICERCOSIS AB.IHA FOC                       $50.05
0675967   06   UREAPALSMA CULTURE FOC                          $38.35
0675934   06   COCCODIODES CF,CSF FOC                          $37.70
0675926   06   YERSINIA AB FOC                                 $58.50
0675918   06   WEST EQU ENCEP AB - ARUP                        $12.00
0676031   06   TOXOCARA AB, ELISA FOC                          $60.80
0674861   06   HPV,LO RISK DNAPROBE-ARUP                       $19.00
0674762   06   HLA-C ID-ARUP                                  $133.33
0674721   06   HLA-C AMPLIFICATION-ARUP                       $133.33
0674697   06   HLA-C EXTRACTION-ARUP                          $133.33
0680736   06   C DIFFICILE CULT-ARUP                           $31.82
0675678   06   AFB DIRECT RAPID PNL FOC                        $63.00
0675660   06   AFB SECONDARY PNL FOC                           $76.05
0675603   06   PI/PPT LECITHIN-FDL                             $60.00
0675561   06   PHOSPHATIDYL GLYC-FDL                           $60.00
0675520   06   L/S RATIO,AMNIOTIC-FDL                         $110.00
0675454   06   FOLATE,RBC-ARUP                                 $18.75
0675249   06   IGG SUBCLASS 2-ARUP                             $13.05
0675199   06   FV LEIDEN MLCLR EXT-ARUP                        $10.51
0676726   06   REOVIRUS AB,CF FOC                              $34.20


                                     Page 85 of 276
Charge #Dept   CDM Description                       Price
0676718   06   ECHINOCOCCUS AB ARUP                           $18.77
0676700   06   EAST.EQUINE ENCEPH.ABARUP                      $12.00
0676692   06   DIPHTHERIA ANTITOXOID,FOC                      $48.10
0676684   06   DENGUE FEVER AB,IFA FOC                        $58.50
0676668   06   COXSACKIE A AB PANEL,FOC                       $64.39
0676619   06   CHAGAS DISEASE AB,FOC                          $64.35
0676593   06   CARDIOLIPIN AB,IGM-ARUP                        $19.50
0676585   06   MENINGITIS PANEL AB FOC                       $203.45
0676577   06   EXANTHEMAS/ANANTHEMAS FOC                     $222.30
0676676   06   COXSACKIE B AB PANEL,FOC                       $64.39
0676874   06   MICONAZOLE,MIC FOC                             $38.35
0676973   06   MIC/MBC 2 DRUGS FOC                           $144.00
0676965   06   ADENOVIRUS AB,CF FOC                           $14.22
0676932   06   POLIOVIRUS T1-3 AB,CF FOC                      $35.53
0676767   06   RICKETTSIAL PANEL,IFA FOC                      $65.00
0676858   06   MUMPS AB PANEL,IFA FOC                         $47.45
0676791   06   SCHISTOSOMIASIS AB ARUP                        $60.80
0676783   06   ST.LOUIS ENCEPHAL.AB-ARUP                      $12.00
0676221   06   LEGIONELLA CULTURE FOC                         $17.00
0676569   06   PROTEIN,TOT,NEPHLO-ARUP                         $5.40
0676312   06   ENTERIC ADENOVIRUS FOC                         $43.55
0676270   06   MIC/MBC 3 DRUGS FOC                           $158.00
0676262   06   MIC/MBC 4 DRUGS FOC                           $173.00
0676338   06   EBV,EARLY ANTIGEN IFA FOC                      $38.35
0676239   06   CMV CULTURE ONLY FOC                           $44.85
0676346   06   EBV,VIRAL CAPSID FOC                           $40.95
0676213   06   HERPES CULTURE FOC                             $41.60
0676197   06   CHLAMYDIA CULTURE FOC                          $32.76
0676163   06   HISTO AB., CF FOC                              $35.10
0677104   06   B.PERTUSSIS AB,IGG-ARUP                        $13.50
0676445   06   IGG SUBCLASS 3-ARUP                            $13.05
0676510   06   LEPTOSPIRA CULTURE FOC                         $79.95
0676502   06   LEGIONELLA AB PANEL FOC                        $64.35
0676478   06   KETOCONAZOLE,MIC FOC                           $38.22
0676320   06   EBV,NUCLEAR ANTIGEN FOC                        $31.85
0676551   06   ALKALINE PHOS-ARUP                              $6.26
0676411   06   MYCOPLASMA CULT,MALE-FOC                       $44.65
0676403   06   LEGIONELLA AG DETECT FOC                       $15.84
0676395   06   MYCOPLASMA CULT,GENI FOC                       $68.25
0700476   07   IN SITU INTERP REPORT SJM                     $200.00
0700468   07   CYTO INTERPHASE IN SITU                        $90.00
0700450   07   CYTOGENETIC DNA PROBESJMC                      $61.00
0709600   07   ELECTRON MICRO DIAG CSLS                      $181.66
0709592   07   GROSS & MICRO LVL IV CSLS                      $69.23
0709618   07   TERM DEOXY TRANS CSLS                         $124.11
0710624   07   CYTOGEN IN SITU 25-99 ARU                      $40.00
0710657   07   CYTOGEN INTERP & RPT ARUP                      $35.00
0710640   07   CYTOGEN DNA PROBE EA ARUP                     $360.00
0710632   07   CYTOPATH CONC SMR&INT                          $25.00
0708628   07   BONE MARR CELL BLOCK                          $165.00
0708800   07   FNA; WITHOUT IMAGING                          $134.00
0708826   07   BLOOD SMEAR INTERPRET                          $32.00
0708842   07   FNA IMMEDIATE EVAL                            $134.00
0708503   07   FLUIDS, SMR FILTER W INTR                      $52.00
0710608   07   DNA IMAGE ANALYSIS-SJMC                        $74.00
0708040   07   CYTOLOGY, CELL BUTTON                          $84.00
0707067   07   GROSS/MICRO MAJOR LEV VI                      $172.00
0710616   07   HPV IN-SITU-SJMC                               $52.00


                                    Page 86 of 276
Charge #Dept   CDM Description                       Price
0710590   07   DNA ANALYSIS,FLOW-SJMC                         $104.00
0710582   07   IMMUNOHISTOCHEM-SJMC                             $62.00
0709584   07   GROSS/MICRO,COMP.LEVIV                         $165.00
0709428   07   CYTOMETRY-DNA ANALYSIS                         $137.00
0709410   07   FLOW CYTOMETRY                                 $137.00
0709402   07   HANDLING CHARGE                                  $37.00
0709071   07   PAP SMEAR                                        $30.00
0710566   07   FLOW CELL CYCLE/DNA SJMC                         $62.00
0705152   07   CRYSTAL IDENTIFICATION                           $43.00
0707034   07   GROSS/MICRO,STAND.LEVIII                         $92.00
0707026   07   GROSS/MICRO,SIM.LEVII                            $58.00
0707000   07   GROSS EXAM ONLY, LEVELI                          $31.00
0706556   07   OR CONSULT G/M EA ADD                            $77.00
0706515   07   OR CONSULT,GROSS&MICRO                         $123.00
0706499   07   OR CONSULT,GROSS ONLY                            $77.00
0705855   07   FNA INTERP. & REPORT                           $134.00
0705400   07   CYTOLOGY,OTHER FLUIDS                            $47.00
0704502   07   STAINS, GROUP I                                $264.00
0701565   07   PAP SMEAR THIN PREP                              $51.00
0701144   07   RENAL CALCULI ANALY-JL                           $40.00
0701086   07   CYTOLOGY,CONC SMR W INTER                        $70.00
0707059   07   GROSS/MICRO/COMPREH LEV V                      $158.00
0707646   07   BONE MARROW BIOP/INTERPRE                      $165.00
0707604   07   BONE MARROW SMEAR/INTERPR                        $36.00
0701078   07   FLUIDS, FILTER W INTERP                          $34.00
0707075   07   SURG CONSULT,OUTSIDE                           $118.00
0707174   07   SPECIAL STAIN 1 - CSLS                         $223.00
0707232   07   DECALCIFICATION                                  $15.00
0707356   07   SPECIAL STAIN CLASS II                         $113.00
0850016   08   SPIROMETRY(PRE&POST)                           $403.00
0850008   08   SPIROMETRY(SIMPLE)                             $373.00
0850024   08   BRONCHOSPASM EVAL                              $881.00
0850065   08   THORACIC GAS VOLUME                            $268.00
0850032   08   VITAL CAPACITY/PEAK FLOW                       $242.00
0850040   08   MVV(MAX VOL VENT)                              $157.00
0850057   08   FRC(FUNC RESIDUAL CAP)                         $268.00
0850115   08   PULM STRESS(COMPLEX)                           $403.00
0850081   08   CLOSING VOL(SNGL BREATH)                       $242.00
0850099   08   FLOW VOLUME LOOP                               $242.00
0850107   08   PULM STRESS TEST(SIMPLE)                       $268.00
0850206   08   ARTERIAL PUNCTURE                                $53.00
0850180   08   PH ANALYSIS(CORD PH)                           $155.00
0850172   08   BLOOD GAS W O2&HG                              $435.00
0850164   08   BLOOD GAS STUDY                                $389.00
0850156   08   PNEUMOGRAM PEDIATRIC                          $1,670.00
0850073   08   RESISITANCE AIRWAY                             $268.00
0850198   08   OXYGEN SATURATION                              $155.00
0850123   08   OXYGEN UPTAKE_COMPLETE                         $268.00
0850131   08   DIFFUSION CAPACITY TEST                        $410.00
0850214   08   PH MEASUREMENT(BODY FLUID                      $155.00
0853408   08   POLY SLEEP STAG 1-3                           $1,432.00
0853440   08   POLY SLEEP STAG.+                             $4,439.00
0856021   08   EMG CRANIAL NERVES                             $530.00
0856013   08   EMG SPECIFIC MUSCLES LTD                       $234.00
0801944   08   SODIUM(PF)                                       $43.00
0856096   08   EEG SLEEP ONLY MSLT                            $948.00
0856088   08   EOG-OCULOELECTROMYOGR.                         $309.00
0856070   08   HYPOXIC RESPONSE                               $312.00


                                    Page 87 of 276
Charge #Dept   CDM Description                      Price
0856062   08   CPAP-CONT.POS.AIR.PRESS.                      $447.00
0856054   08   RESISTANCE TO AIR FLOW                        $148.00
0856005   08   EEG SLEEP NOC                                 $738.00
0856039   08   ECG UP TO 12 HRS                              $490.00
0853457   08   POLY SLEEP STAG+4W/CPAP                      $5,082.00
0853960   08   SLEEP STUDY                                   $715.00
0853945   08   N P T STUDY NIGHT 3                          $1,432.00
0853804   08   N P T STUDY NIGHT 2                          $1,432.00
0853705   08   N P T STUDY NIGHT 1                          $2,565.00
0853671   08   MULTIPLE SLEEP LATENCY                       $2,246.00
0853549   08   EXTENS. CLIN. SLEEP INTAK                     $559.00
0853523   08   PSYCH & PMD SLEEP EVAL                        $653.00
0853507   08   NASAL CPAP                                    $415.00
0856047   08   PULSE OXIMETRY NON-INVAS.                    $1,016.00
0802066   08   CARBOXYHEMOGLOBIN(PF)                           $53.00
0802058   08   METHEMOGLOBIN(PF)                               $53.00
0801951   08   POTASSIUM(PF)                                   $43.00
0801977   08   CHLORIDE(PF)                                    $43.00
0801985   08   IONIZED CALCIUM(PF)                             $43.00
0801993   08   TATAL HEMOGLOBIN(PF)                            $14.00
0901579   09   ERCP W/ SPINCTEROTOMY                        $4,060.00
0901587   09   ERCP W/ LITHOTRYPTOR                         $4,060.00
0901595   09   UGI ENDOSCOPY W/SCLEROTH                     $2,334.00
0901694   09   FLEXIBLE SIG W/ BIOPSY                       $1,416.00
0901686   09   FLEX SIG W/ FORGN BDY REM                    $1,416.00
0901678   09   FLEX SIG W/CAUT OR SCLERO                    $1,416.00
0901652   09   FLEX SIG W/ POLYPECTOMY                      $1,416.00
0901470   09   UGI ENDOSCOPY W/CYTOLOGY                     $2,334.00
0901462   09   COLONOSCOPY W/FBR                            $2,921.00
0900233   09   GI LAB FLUID COLLECTION                       $128.00
0900670   09   UGI ENDOSCOPY W/REM TPL H                    $2,334.00
0900688   09   REM FECAL IMPCT/FB W/ANES                    $1,278.00
0900258   09   ERCP W/BIOPSY SNGL/MULTI                     $4,060.00
0900647   09   COLONOSCOPY W/HOT BIOPSY                     $2,921.00
0900654   09   UGI ENDOSCOPY W/BAND VARI                    $2,334.00
0904532   09   RECTAL BIOPSY                                $2,334.00
0900662   09   ERCP W/REM FB/CHG TB/STNT                    $4,060.00
0906552   09   COLONOSCOPY THRU STOMA DI                    $2,921.00
0905539   09   ENDOSCOPY SM INT W/JTUBE                     $2,334.00
0905547   09   ENDOSCOPY SM INT W/JTUBE                     $2,334.00
0905067   09   OFFICE VISIT, REMOVAL GTU                     $692.00
0906040   09   FLEX SIG W/DIR SUBMUC INJ                    $1,416.00
0905075   09   REM OF FECAL IMPACT/FB W/                    $1,278.00
0906032   09   ENDOSCPY SM INT INC IL BX                    $2,334.00
0906024   09   ENDOSCOPY SM INT INC ILEU                    $2,334.00
0906057   09   COLONOSCOPY W/DILATATION                     $2,921.00
0907824   09   ESOPH REFLUX TST NASAL CA                    $1,617.00
0907840   09   ESOPHAGEAL MOTILITY STUDY                    $1,617.00
0906578   09   UGI ENDOSCOPY W/INJECTION                    $2,334.00
0906560   09   UGI ENDOSCOPY W/ABLATION                     $2,334.00
0907832   09   ESOPH REFLX TST MUCOS TE                     $1,617.00
0900118   09   COLONOSCOPY W/BIOPSY                         $2,921.00
0900050   09   ERCP                                         $4,060.00
0900142   09   COLONOSCOPY W/POLYPECTOMY                    $2,921.00
0900035   09   COLONSCOPY COMPLEX                           $2,921.00
0902056   09   UGI ENDOSCOPY W/PEG                          $2,334.00
0901512   09   ERCP W/STONE REMOVAL                         $4,060.00
0904011   09   UGI ENDOSCOPY W/GW DIL                       $2,334.00


                                   Page 88 of 276
Charge #Dept   CDM Description                       Price
0903138   09   UGI ENDOSCOPY W/CAUTERY                       $2,334.00
0903112   09   UGI ENDOSCOPY W/BIOPSY                        $2,334.00
0903104   09   UGI ENDOSCOPY CMPLX                           $2,334.00
0902031   09   UGI ENDO W/GAS OUTLET DIL                     $2,334.00
0901769   09   UGI ENDOSCOPY W/J TUBE                        $2,334.00
0901660   09   IV TX/DX IV PER VISIT                          $194.00
0901546   09   ERCP W/BAL DIL AMPULLA                        $4,060.00
0901538   09   ERCP W/STENT PLACEMENT                        $4,060.00
0901520   09   ERCP W/NASAL BILIAR DRAIN                     $4,060.00
0924654   09   PROBE,ARGON PLASMA COAG                        $759.00
0907808   09   DESTRUCTION OF HEMORRHOID                     $1,278.00
0907790   09   REPLACMENT GASTRIC BUTTON                      $840.00
0906545   09   FLEXIBLE SIG W/ ABLATION                      $1,416.00
0906008   09   ILEOSCOPY VIA STOMA                           $2,334.00
0905059   09   REPLACEMENT PEG                                $840.00
0900324   09   CONVERSION PEG-PEJ                            $1,474.00
0900217   09   COLONOSCOPY W/ABLATION                        $2,921.00
0903146   09   UGI ENDOSCOPY W/POLYPECT                      $2,334.00
0900159   09   COLONOSC W/CAUT OR SCLERO                     $2,921.00
0901207   09   UGI ENDOSCOPY W/BANDING                       $2,334.00
0900480   09   PARACENTESIS                                   $719.00
0901256   09   UGI ENDOSCOPY W/STENT                         $2,334.00
0900571   09   ESOPH MOTILITY STDY W/RX                      $1,617.00
0900555   09   LIVER BIOPSY,NEEDLE,PERCU                     $2,921.00
0900548   09   UGI ENDOSCOPY W/FBR                           $2,334.00
0900522   09   UGI ENDOSCOPY W/BALLN DIL                     $2,334.00
0901272   09   ESOPH REFLUX TST PROLONG                      $1,617.00
0900506   09   GASTRIC LAVAGE                                 $692.00
0900589   09   FLEXIBLE SIGMOIDOSCOPY                        $1,216.00
1000165   10   RED CROSS SERUM ABSORPT                          $33.25
1000173   10   RED CROSS INCUBATE W/DRUG                      $110.00
1000181   10   RED CROSS MONOLAYER                            $550.00
1000199   10   RED CROSS PRESCREEN, UNIT                        $33.25
1000207   10   RED CROSS ANTIGEN TYPE,EA                        $50.00
1000215   10   RED CROSS AG NEG UNIT                          $300.00
1000157   10   RED CROSS TITRATION, EACH                        $56.00
1000231   10   RED CROSS PLT ASSOC IGG                        $105.00
1000223   10   RED CROSS PLT AB CROSS                         $206.00
1000140   10   RED CROSS SERUM INHIBITN                         $33.25
1000132   10   RED CROSS DILUTION, SERUM                        $33.25
1000249   10   RED CROSS HLA AB IDENT                         $230.00
1000108   10   RED CROSS ENZYME PRETREAT                        $16.50
1000116   10   RED CROSS AB ID, EA PANEL                        $28.00
1000082   10   RED CROSS DAT, EACH                               $8.75
1000074   10   RED CROSS RH PHENOTYPE                           $22.50
1000066   10   RED CROSS RH TYPE                                 $8.25
1000058   10   RED CROSS ABO TYPE                               $16.50
1000124   10   RED CROSS AB ELUTION, EA                         $56.00
1000090   10   RED CROSS AB SCREEN                              $22.50
1000363   10   RED CROSS RBC PHENOTYPE                          $13.50
1001676   10   APHERESIS, PLATELETS                          $1,050.00
1018068   10   ERYTHROCYTOPHERESIS                           $1,050.00
1018175   10   ALBUMIN (HUMAN) 5% 250ML                         $80.00
1018167   10   BLOOD PRODUCT, SPLIT UNIT                      $150.00
1016021   10   THERAPEUTIC PHLEBOTOMY                         $344.00
1018159   10   RC GRANULOCYTE PHERIS                         $2,000.00
1016005   10   AUTO DONOR REJECTED/SCREE                        $15.00
1018019   10   DEGLYCEROLIZED RED CELLS                       $677.00


                                    Page 89 of 276
Charge #Dept   CDM Description                      Price
1018001   10   RED CELLS,LR FROZEN,DEGLY                     $487.00
1018209   10   PLATELETPHERESIS                              $459.00
1005123   10   LEUKOREDUCED RBC PRODUCT                      $252.00
1002112   10   CRYOPRECIPITATE                                 $52.00
1002096   10   FRESH FROZEN PLASMA                           $107.00
1002005   10   WHOLE BLOOD PRODUCT                           $331.00
1002021   10   RED CROSS FEE WASHED RBC                      $450.00
1002013   10   PACKED RBC PRODUCT                            $237.00
1019132   10   APHERESIS, PLASMA                            $1,050.00
1000330   10   RC CRYOREDUCED FFP                              $80.00
1002054   10   PLATELET CONCENTRATE                            $69.00
1015163   10   RHOGAM-RH D IG                                  $82.00
1010313   10   APHERESIS IMMUNO COLUMN                      $2,270.00
1005644   10   RC HLA TYPING ARC                             $275.00
1005685   10   RC PLATLET AB SCREEN ARC                      $206.00
1011782   10   FFP PHERESIS                                  $107.00
1151034   11   DOPPLER,SPEC,LTD,FU                           $196.00
1151026   11   EVENT RECORD.POST SYMPTOM                     $737.00
1157858   11   DOPPLER SPECTRAL                              $393.00
1108174   11   STRESS ECHOCARDIOGRAM                        $1,720.00
1157296   11   PMKR EVAL 2CHMBR W/PROG                       $373.00
1157841   11   PCMKER PHONE ANALYS. DUAL                     $116.00
1157874   11   DOPPLER COLOR FLOW                            $201.00
1108166   11   TRANSESOPHAGEAL ECHOCARDI                    $2,175.00
1157833   11   PACEMAKER ANALYSIS DUAL                       $327.00
1101633   11   PERICARDIOCENT,SUBS                           $658.00
1101641   11   PERICARDIOCENT,INIT                          $1,318.00
1101658   11   TRASNESOPH ECHO/CONG                         $1,739.00
1101716   11   ECHO-2D CONGENITAL                           $1,678.00
1101724   11   ECHO CONGEN F/U OR LTD                        $936.00
1101732   11   ECHO 2D W/CONTRAST                           $1,830.00
1101757   11   EVNT RECORD PRESYMP TRANS                    $1,012.00
1107002   11   EKG                                           $462.00
1107044   11   TILT TABLE,CARDIO FUNC                       $1,147.00
1107036   11   SIGNAL AVERAGING ECG                          $481.00
1108158   11   EVNT RECORD.PRESYM HOOK                      $1,665.00
1107127   11   RHYTHM STRIP X1                               $131.00
1107358   11   PMKR EVAL 1CHMBR W/PROG                       $337.00
1107549   11   ECHOCARDIOGRAM, M-MODE &                     $2,098.00
1107531   11   ECHOCARDIOGRAM, LTD/FU                       $1,170.00
1107523   11   HOLTER SCANNING                               $488.00
1107341   11   PACEMAKER PH/CALL ANALYSI                     $146.00
1107333   11   PACEMAKER ANALYSIS F/UP                       $266.00
1107325   11   PACEMAKER ANALYSIS INITAL                     $348.00
1107267   11   CARDIOVASC STRESS TEST                       $1,720.00
1107507   11   HOLTER MONITOR 24 HR                         $2,336.00
1206085   12   NCV REPETETIVE STIM                           $346.00
1210293   12   NRV CONDUCT,MOTOR,SENSORY                     $288.00
1210392   12   H REFLX-GASTRO/SOLEUS MUS                     $346.00
1210194   12   NCV CNDCT/VEL-MOTOR,W/F-W                     $520.00
1206028   12   NEEDLE EMG - 3 EXTREMITY                      $956.00
1206002   12   NEEDLE EMG - 1 EXTREMITY                      $412.00
1206010   12   NEEDLE EMG - 2 EXTREMITY                      $935.00
1206036   12   NEEDLE EMG - 4 EXTREMITY                     $1,059.00
1300300   13   NEWBORN HEARING SCREENING                     $186.00
1318302   13   UROFLOW                                       $389.00
1307248   13   EVOKED RESP.SSEP LOW EXT                     $1,569.00
1307255   13   EVOKED RESP SSEP TRK/HEAD                    $1,046.00


                                   Page 90 of 276
Charge #Dept   CDM Description                       Price
1318104   13   CMG ABD PRESSURE                               $619.00
1318401   13   URETHRAL PRES PROFILE                          $551.00
1318609   13   EMG + CMG                                     $1,294.00
1307214   13   AUDITORY EVOKED POTENTIAL                     $1,293.00
1307081   13   ECS RECORDING                                  $540.00
1307099   13   EVOKED RESP SSEP UP EXT                       $1,569.00
1307107   13   24 HR EEG MONITOR                             $3,227.00
1307206   13   EEG-EXT MONITR OVER 1HR                       $1,054.00
1307131   13   VISUAL EVOKED POTENTIAL                       $1,293.00
1307198   13   EEG-EXT MON UP TO 1HR                          $908.00
1401090   14   IRS CATH PLACE THORC/BRAC                      $250.00
1440239   14   CATHERIZATION,AORTA,TRANS                     $1,012.00
1440221   14   CATH VEN ORGAN BLD SAMPLE                     $1,113.00
1400951   14   INTRO CATH LT 2ND ORDER                        $250.00
1400860   14   INTRO CATH RT RENAL 2ND O                      $250.00
1401132   14   INTRO CATH RT RENAL 1ST O                      $250.00
1401124   14   CATH PLC SLCT 3RD PULM LT                      $227.00
1401108   14   IRS CATH PL ABD/PEL/EXT 1                      $250.00
1440304   14   IR ANG CAROTID CEREBRL LT                     $2,584.00
1403526   14   INJ PROC SIALOGRAM                             $250.00
1403534   14   INJ PROC MYELOGRAM;SPINAL                      $300.00
1403542   14   IRS DISKOGRM LUMBAR EA LV                      $250.00
1403120   14   INJ PROC SHOULDER ARTHRO                       $250.00
1403138   14   INJ PROC ELBOW ARTHROGRAM                      $227.00
1403146   14   INJ HIP ARTHROGM W/O ANE                       $250.00
1401116   14   CATH PLC SLCT PULM LT                          $227.00
1441229   14   BONE MARROW BIOPSY                             $686.00
1440387   14   IR ANGIO CAROTID EXTERNAL                     $2,584.00
1440403   14   IR VENOGRAM VEN SINUS/JUG                      $850.00
1440312   14   IR ANGIO CAROTID EXTERNAL                     $3,526.00
1440247   14   IR VENOGRAM ADRENAL LT                         $850.00
1440270   14   IR ANGIO PULMONARY BIL                        $3,590.00
1403625   14   IRS REPL NONTUN CV CATH                        $237.00
1403500   14   INTRO NEEDLE/CATH VEIN                         $227.00
1403583   14   IRS CATH PLC THOR/BRCH 3R                      $250.00
1403351   14   ANGIO,ARCH,CAROTIC BILATE                     $2,842.00
1403377   14   ANGIO RENAL/UNI SELECT LT                     $2,101.00
1403393   14   ANGIO ADRENAL/UNI/SEL LT                      $2,245.00
1403336   14   INJ PROC URETHROCYSTO RET                      $227.00
1403419   14   ANGIO PULMONARY LT                            $1,737.00
1403328   14   INJ PROC CYSTOGRAPHY                           $250.00
1403427   14   INTRO CATH A/V SHUNT DIAL                      $300.00
1403435   14   INTRO NDL/CATH EXT ARTERY                      $250.00
1403443   14   INTRO NDL/CATH BRACH ART                       $250.00
1403450   14   INTRO NDL/CTH VER/CAR ART                      $227.00
1403468   14   INTRO CATH PUL ART 1ST OR                      $227.00
1403476   14   INTRO CATH IVC                                 $250.00
1403484   14   INJ PROC VENOGRAPHY EXT                        $250.00
1403211   14   INJ PROC ANKLE ARTHROGRAM                      $227.00
1403492   14   INJ PROC PERC TX EXT                           $227.00
1403575   14   IRS CATH PLACE THORC/BRAC                      $250.00
1441203   14   IRS BIOPSY TRANSCATH                           $686.00
1403344   14   INTRO TRANSCERV FALL CATH                      $300.00
1403203   14   INJ PROC KNEE ARTHROGRAM                       $250.00
1403195   14   INJ HIP ARTHROGRAM W/ANES                      $227.00
1403229   14   INJ CHOLANGIO EXIST CATH                       $300.00
1403237   14   INJ PERC TRANS CHOLANGRM                       $250.00
1403294   14   INJ PYELOGRAPHY TUBE/CATH                      $250.00


                                    Page 91 of 276
Charge #Dept   CDM Description                       Price
1403518   14   INJ DACRYOCYSTOGRPHY CONT                      $227.00
1403302   14   IRS URETEROGRAPHY INJ                          $250.00
1403310   14   INJ PROC VISUALIZE                             $227.00
1403559   14   INTRO CATH AORTA                               $250.00
1441070   14   DRAIN RETROPERITONEAL ABS                      $250.00
1440908   14   DISCOGRAPHY CERVICAL/THOR                      $952.00
1440510   14   CORE BX EA LESION W IMAG                       $310.00
1440874   14   INJ EPIDURAL/LOCAL C/T SP                      $250.00
1403666   14   XR FLUORO 4-5 HRS                              $985.00
1403658   14   XR FLUORO 3-4 HRS                              $937.00
1403641   14   XR FLUORO 2-3 HRS                              $914.00
1403633   14   XR FLUORO 1-2 HOUR                            $1,145.00
1440940   14   INJ SACRO ILIAC JOINT                          $227.00
1440916   14   FACET BLK INJ L SPN EA AD                      $250.00
1441195   14   INJ WRIST ARTHROGRAM                           $227.00
1441187   14   SACROILIAC JOINT ARTHROGR                      $714.00
1441161   14   INJ SACROILIAC ARTHROGRAM                      $227.00
1441146   14   INJ SINUS TRACK DIAGNOSTC                      $250.00
1403567   14   IRS CATH PLACE THORC/BRAC                      $250.00
1440528   14   IMAGING GUIDED BX. (VACC)                      $234.00
1440742   14   CLIP PLACEMENT                                 $232.00
1440684   14   BREAST LOC INITIAL LESION                      $234.00
1440676   14   BREAST LOC ADD LESION                          $234.00
1440668   14   INSERT GI TUBE                                 $250.00
1440601   14   IRS GASTROSTOMY TUBE PERC                      $267.00
1440882   14   VERTEBROPLASTY FLURO GUID                     $1,484.00
1440759   14   DILATION OF URETER/NEPHR                       $553.00
1440965   14   IRS REPAIR CV CTH WO PMP                      $1,608.00
1440585   14   BIL ENDO-PERC W/O STENT                        $929.00
1440841   14   IRS INTERRUPT IVC PARTIAL                      $755.00
1440833   14   THROMBECTOMY, AV SHUNT                         $755.00
1440825   14   PTA, VENOUS                                   $4,368.00
1440999   14   PNEUMONOST PERC ABSC/CYST                      $276.00
1422443   14   XR SM BWL V ENTEROCLYSIS                       $760.00
1432079   14   NEPHROSTOLITHOTOMY                             $293.00
1441542   14   IRS LUMBAR PUNC THERAP/DR                     $1,179.00
1441526   14   PUNC C1-C2 W INJ                              $1,179.00
1441518   14   INJ HYSTERO/SALPINGOGRAM                       $310.00
1447028   14   REMOVE FB ESOPH W BAL CTH                      $886.00
1422500   14   IR CAVERNOSOGRAM                               $980.00
1401140   14   INTRO CATH LT RENAL 1ST O                      $227.00
1422575   14   IR ANGIO CAROTID EXTERNAL                     $2,584.00
1422518   14   IR RENAL CYST STUDY TRANS                      $885.00
1422526   14   NEPHRO TB PLC REN/PELV BI                     $1,125.00
1425214   14   NEPHRO TUBE PLACE URET LT                     $2,522.00
1422534   14   NP/URET/URETHRA DIL RT                        $1,078.00
1422542   14   XR PELVIMETRY                                  $300.00
1422567   14   IR BRACHIAL ANGIO RETRO                        $262.00
1421700   14   XR BONE SURVEY LIMITED                         $435.00
1422583   14   IR CAROTID CEREB ANG RT                       $2,584.00
1422609   14   IR VENOGRAM ADRENAL RT                         $850.00
1441476   14   CYSTOURETHROSCOPY W CATH                       $227.00
1441484   14   CATH URETH W REM CALCULUS                      $227.00
1422559   14   IR AORTO THOR WO SERIALOG                     $1,476.00
1441328   14   ESOPHAGOSCOPY FB REMOVAL                       $376.00
1440353   14   IRS CATH PL ABD/PEL/EXT E                      $227.00
1440502   14   IRS ARTERIAL ACCES LINE I                      $344.00
1440551   14   CAN INSERT HEOMDIAL AV EX                      $237.00


                                    Page 92 of 276
Charge #Dept   CDM Description                       Price
1440627   14   CAN INSRT HEMO AV REV/CLS                      $237.00
1441278   14   TIPS INSERTION                                $1,608.00
1441286   14   TIPS REVISION                                 $1,289.00
1441500   14   INJ EPIDIYMOGRAM, VASOGRA                      $227.00
1441310   14   BX SALIVARY GLAND                              $227.00
1441427   14   ABD PARACENTESIS SUBSEQ                        $190.00
1441344   14   DILATION ESPHGSCPY <30MM                       $376.00
1441351   14   ERCP W OR WO SPEC COLLECT                      $376.00
1441369   14   DILAT ESOPHOGOSCOPY 30MM+                      $376.00
1441385   14   ENTEROCLYSIS                                   $227.00
1441393   14   CTH PLC JEJUNSTMY INTRAOP                      $227.00
1441401   14   BX,PANCREAS-PERC NEEDLE                        $274.00
1441302   14   INJ LYMPHANGIOGRAM                             $227.00
1440056   14   CATH PLC SLCT 3RD PUL RT                       $227.00
1432806   14   FINE NDL ASP W IMAG GUIDA                      $197.00
1441468   14   MANOMETRIC NPHYR/PYLO/URE                      $227.00
1441443   14   IRS BIOPSY RENAL NDL/TROC                      $391.00
1441435   14   INJ EVAL PERI VEN SHUNT                        $227.00
1432814   14   INJ ARTHROGRAM TMJ                             $227.00
1434133   14   IRS DISKO CERV/THOR EA LV                      $250.00
1440049   14   CATH PLC SLCT PULM RT                          $227.00
1440213   14   IRS CATH PL ABD/PEL/EXT 3                      $227.00
1440197   14   IRS CATH PL ABD/PEL/EXT 1                      $250.00
1440205   14   IRS CATH PL ABD/PEL/EXT 2                      $227.00
1422591   14   IR RENAL AORTO W FLUSH BI                     $1,910.00
1440031   14   TUBE INSERT-CHEST                              $250.00
1422468   14   CHOL/PANC INTRAOP ADD IR                       $214.00
1422237   14   XR CHEST SPECIAL VIEWS                         $365.00
1422211   14   XR CHEST 2VWS+OBLIQUES                         $481.00
1422203   14   XR CHEST 2VWS+APICAL LORD                      $481.00
1422450   14   XR THERA ENEMA TX OBSTR                        $782.00
1422229   14   XR MANDIBLE <4 VWS RT                          $345.00
1422252   14   XR FACIAL BONES <3 VWS                         $535.00
1422260   14   XR OPTIC FORAMINA LT                           $283.00
1422278   14   XR PACEMAKE INSRT W FLUOR                      $978.00
1422294   14   XR RIBS W/CHEST 4+ VIEWS                       $536.00
1422302   14   XR THORACOLUMBAR STANDING                      $455.00
1422310   14   XR T-SPINE 2 VIEWS                             $384.00
1422328   14   XR T-SPINE 4 VIEWS+                            $632.00
1422476   14   IR ERCP PANCREATIC DUCT                       $1,391.00
1422336   14   XR SACROILIAC JTS <3 VWS                       $277.00
1422427   14   XR UGI W BARIUM W KUB                          $760.00
1422435   14   XR UGI W BARIUM+SM BOWEL                      $1,097.00
1422401   14   XR LOW EXTREM INFANT 2+ V                      $200.00
1422393   14   XR KNEES-BILAT STAND AP                        $295.00
1422385   14   XR KNEE COMP MIN 4VWS RT                       $327.00
1422377   14   XR KNEE COMP MIN 4VWS LT                       $327.00
1422369   14   XR UP EXT-IN,MIN 2VW RT                        $277.00
1422344   14   XR UP EXT-IN MIN 2VW LT                        $277.00
1422484   14   IR ERCP BIL+PANC DUCT                         $1,391.00
1422419   14   XR LOW EXTREM INFANT 2+ V                      $200.00
1450568   14   VENOGRAM, EPIDURAL                             $850.00
1450535   14   VENOGRAM, ADRENAL BILAT                       $1,099.00
1450527   14   VEN/RENAL/BIL/SELECT                          $2,245.00
1450550   14   VENOGRAM,SPR SAGITTAL SNS                      $850.00
1450485   14   ANGIO, EXTREMITY, BILAT                       $3,169.00
1450576   14   TRANSHEP PORTO W/HEMO EVL                      $702.00
1450584   14   PORTOGRAPHY W/O HEMO EVAL                      $850.00


                                    Page 93 of 276
Charge #Dept   CDM Description                       Price
1450592   14   VENOGRAM HEPATIC W/HEMO                        $850.00
1450600   14   VENOGRAM,HEPATIC W/O HEMO                      $850.00
1450543   14   VENOGRAM,SINUS OR JUGULAR                      $850.00
1450519   14   ANGIO, INTERNAL MAMMARY                       $1,737.00
1450618   14   EMBOLIZATION                                  $2,437.00
1450493   14   ANGIO PELVIC/SELECT                           $1,737.00
1450444   14   T-TUBE CHOLANGIOGRAM                          $1,714.00
1450451   14   XR INTRALUM DIL OBSTRUCT                       $873.00
1450469   14   BILIARY DIL TRANS W/WO ST                     $1,416.00
1450477   14   ANGIO, SPINAL, SELECTIVE                      $1,998.00
1450501   14   ANGIO NONSELECTIVE PULMON                     $1,737.00
1422682   14   XR FLUORO 8-9 HRS                             $1,182.00
1422674   14   XR FLUORO 7-8 HRS                             $1,182.00
1422666   14   XR FLUORO 6-7 HRS                             $1,182.00
1450774   14   IRS INS TUN CV CATH WO>5                      $2,124.00
1450782   14   IRS INS TUNNEL CVAD W POR                     $1,769.00
1450790   14   IRS INS PICC WO PROT/P >5                     $1,769.00
1450808   14   INS PICC PERI W CONT PORT                     $1,769.00
1450816   14   IRS INS CVAD PERIPH W POR                     $1,769.00
1450824   14   IRS REPLACE PICC WO PORT                      $1,067.00
1450352   14   IRS URETERAL CATH/STN DRN                      $539.00
1450626   14   EXCH ART CTH FOR THRMB RX                     $2,409.00
1450410   14   FACET BLK INJ LSPINE E AD                      $250.00
1450709   14   PTA, VENOUS                                   $3,970.00
1450691   14   TRANSCATHETER BIOPSY                          $3,967.00
1450683   14   PERC/TRANSLUM/ANGIO ADD V                     $1,395.00
1450675   14   PERC/TRANSLUM/ANGIO/VISC                      $2,532.00
1450667   14   PERC/TRANSLUM/ANGIO/ADDP                      $1,573.00
1450659   14   PERC/TRANSLUM/ANGIO PERI                      $3,423.00
1450642   14   ENDOVASCULAR AORTIC RPR                       $3,423.00
1450634   14   ENDOVASCULAR AORTIC RPAIR                     $3,423.00
1450766   14   US GUIDED BIOPSY                              $1,172.00
1450881   14   IR REMOV PERICTH MATER                         $353.00
1450097   14   INFUSION FOR THROMBOLYSIS                      $351.00
1450089   14   IRS BIOPSY TRANSCATH                           $686.00
1450071   14   THROMBECTOMY, AV SHUNT                         $686.00
1450063   14   THROMBO DECLOT OF CTH PRT                     $1,608.00
1450048   14   CATHRZTION, AORTA, TRANSL                     $1,012.00
1450030   14   INJ ARTHROCENT MJR JOINT                         $82.00
1450022   14   BX,BONE TROC/NDL DEEP                          $318.00
1450014   14   BX,BNE-TRC/NDL, SUPER                          $239.00
1450832   14   IRS REM TUN CV DEV W PORT                      $834.00
1450840   14   IRS REMOV PERICATH MATER                       $532.00
1450857   14   IRS REMOV INTRACATH MATER                      $532.00
1450378   14   NEPHRO/PYELO TUBE CHANGE                       $173.00
1450873   14   IRS EPI INJ BLD/CLOT PATC                      $615.00
1450121   14   PLAC IVC FILTER S&I                            $755.00
1450907   14   IR FLUORO CV A DEV PLACE                      $1,067.00
1450923   14   US GUIDED VASCULR ACCESS                       $572.00
1403690   14   TPA PERC AORTIC                               $1,515.00
1403708   14   TPA PERC BRACH TRNK BR EA                      $740.00
1403716   14   TPA PERC FEMORAL POPLITEA                     $1,515.00
1403724   14   TPA PERC ILIAC ARTERY                         $1,515.00
1403732   14   TPA TIBIOPERIT TRUNK BRAN                     $1,515.00
1403740   14   INJ ARTHROCENT INTERM JT                       $227.00
1441153   14   INJ SINUS TRACK THERAPEUT                      $227.00
1420033   14   EYE FOREIGN BODY RT                            $242.00
1450865   14   IRS CYSTO WSTENT URET INS                     $2,071.00


                                    Page 94 of 276
Charge #Dept   CDM Description                       Price
1450253   14   IRS PERITONEAL ABCESS DRN                      $250.00
1450394   14   IRS TRANSVAG/REC PELVC AB                      $250.00
1450386   14   URETEROSTOMY TUBE CHANGE                       $174.00
1441237   14   IR ARTHROGRAM TMJ                              $714.00
1450360   14   INTR GD RNL PLVS-PERC DIL                      $502.00
1450345   14   CTH INTRO-RNL PLVS PERC                        $478.00
1450337   14   IRS RENAL CYST ASP/INJECT                      $280.00
1450329   14   IRS PERIRENAL/RENAL ABSCE                      $250.00
1450311   14   CONT INJ AB/CYST DRN CATH                      $250.00
1450303   14   XCHNG CTH, FRM ABCSS/CATH                      $227.00
1450295   14   BX,ABD/RETROPERI MASS-PRC                      $366.00
1450287   14   ABD PARACENTESIS-INITIAL                       $217.00
1450105   14   INFUSION,NON THROMBOLYTIC                     $1,038.00
1450261   14   IRS SUBDIAPH-PHRENIC ABSC                      $250.00
1450113   14   EXCHNG ART CTH THROMB RX                      $1,038.00
1450246   14   IRS PANCREAS PSEUDOCYST D                      $250.00
1450238   14   CHANGE PERC BIL DRAIN CTH                      $626.00
1450220   14   INTRPRC TRNSHP STNT-BIL D                     $1,507.00
1450212   14   INTR PRC TRNSHP CTH BIL D                     $1,298.00
1450204   14   PERC CHOLECYSTOSTOMY                           $376.00
1450196   14   TISSUE ABLATION TUMORS                         $686.00
1450188   14   IRS LIVER ABSCESS PERC D                       $250.00
1450170   14   BX LIVER-PERC NEEDLE                           $376.00
1451061   14   TRANSRECTAL DRN-PLVC ABS                       $506.00
1450154   14   INSERT GI TUBE                                 $250.00
1450147   14   GASTRIC TUBE REPOSITION                        $314.00
1450139   14   BX LYMPH NODE-SUPERFICIAL                      $227.00
1450402   14   IRS BIOPSY THYROID NEEDLE                      $251.00
1450279   14   IRS RETROPERITONL ABSCES                       $250.00
1450717   14   IR BILIARY DRAIN TRANSHEP                     $2,183.00
1445022   14   BRACHIOCEPHALIC ANGIO OPN                     $2,890.00
1445014   14   TRANSCATH STENT,OPN INIT                      $2,890.00
1400886   14   THROMBECT, OPEN, AV FIST                      $2,890.00
1400878   14   CREATE AV FSTLA, NONAUTO                      $2,890.00
1490341   14   TRANSCATH STENT, CCA W/EP                     $5,751.00
1490358   14   TRANSCATH STENT, CCA WO/E                     $5,751.00
1490366   14   IVUS NONCORONARY INIT'L V                     $4,783.00
1490374   14   IVUS NON-CORONARY ADD'T V                     $4,783.00
1490382   14   IS ILIAC VEIN LIGATE                          $4,154.00
1490390   14   IRS SPLENOPORTOGRAM INJTI                     $1,491.00
1490408   14   IRS APPENDIX ABSCES PERC                       $668.00
1490531   14   IR EPIDUROGRAM                                 $626.00
1490473   14   IRS OCCLU/EMBOLZ CNS PERM                     $3,514.00
1490465   14   IS OCCL/BALLOON EMBOLZ HD                     $3,514.00
1490457   14   IS THYROID CYST ASPIR/INJ                      $275.00
1490440   14   IS ABLATION RENAL TISS PE                      $208.00
1490432   14   IS BX BILIARY THRU TRACT                      $1,594.00
1490424   14   IS BX BILIARY BRUSH                           $1,594.00
1490416   14   IS ABLATION LIVER NON-RF                      $1,722.00
1490317   14   IS REPL TUN CVC W PORT SA                     $4,470.00
1490333   14   IS REPL PICC W PORT SAME                      $2,000.00
1490325   14   IS REPL TUN CVC W PUMP SA                     $4,470.00
1490754   14   IRS TUBE TRANSHEP REVIS/                      $1,565.00
1490598   14   IR PERIPHERAL ART ATHEREC                     $3,329.00
1490606   14   IR PERIPHERAL ATHERECT EA                     $3,329.00
1490614   14   IR RENAL ATHERECTOMY                          $3,329.00
1490622   14   IS ATHEREC VISCER PERC S                      $3,329.00
1490648   14   IS ATHEREC VISCER PERC S                      $3,329.00


                                    Page 95 of 276
Charge #Dept   CDM Description                        Price
1490721   14   IR RADIOPHARM PARTIC INTR                    $639.00
1490697   14   WADA EEG TEST                                $505.00
1490739   14   IRS ENDOVAS GRFT RPLC ILI                   $4,686.00
1490515   14   IRS ANES/STER EPI L/S SG                    $1,125.00
1490689   14   IS PLACE CLOSURE DEVIC VA                    $724.00
1490481   14   IRS OCCLU/EMBOLZ NON CNS                    $3,514.00
1490564   14   IR REMOV INTRACATH MAT C                     $380.00
1490556   14   IR VENOGRAM ORBITAL                         $1,131.00
1490549   14   IR SLENOPORTOGRAM                            $622.00
1490580   14   IVUS NON-CORONARY ADD'T V                    $428.00
1490523   14   IRS ANES/STER EPI L/S ADD                   $1,125.00
1490572   14   IVUS NON-CORONARY INITIAL                    $428.00
1490499   14   IRS ANES/STR EPI C/T SGL                    $1,125.00
1490507   14   IRS ANES/STR EPI C/T ADDL                   $1,125.00
1490705   14   IR ENDOVAS REPAIR ILIAC A                   $3,195.00
1490168   14   IS ABLATION LUNG TISSUE                      $534.00
1490309   14   IS REPL TUN CVC WO PP SAM                   $2,000.00
1490119   14   IS PUNCT/ASP ABSC/HEMAT/                     $251.00
1490127   14   IS ABLATION BONE TUMOR                      $7,881.00
1490135   14   IS KYPHOPLASTY                               $443.00
1490150   14   IS INS TUNNEL CATH PLEUR                     $534.00
1490176   14   IS ATHERECT RENAL/VISCER                    $6,106.00
1490184   14   VASCULAR INJECTION                           $534.00
1490192   14   IS ABLATION EXTREM VEIN 1                   $3,408.00
1490200   14   IS ABLATION EXTREM VEIN A                   $3,408.00
1490218   14   IS ABLATON LASR EXTRM VEI                   $3,408.00
1490226   14   IS ABLATON LASR EXTRM VEI                   $3,408.00
1490234   14   INSERT NONTUNNEL CV CATH                    $2,000.00
1490770   14   IRS CATH EPI/SUB C/T CONT                   $1,100.00
1490259   14   INSERT TUNNEL CVC W PUMP                    $4,470.00
1490267   14   IRS INS TUN CVAD 2 CATH                     $4,470.00
1490275   14   INS TUN CVAD 2 CATH W POR                  $15,176.00
1490283   14   IS RPR CVC/PICC W/PORT OR                    $770.00
1490291   14   IS REPLAC CVC/PICC CATH W                    $770.00
1490796   14   CATH PLCMT EPIDUR/SUBARAC                   $1,100.00
1490242   14   INS TUNNEL CVAD W PORT<5Y                   $4,470.00
1490143   14   IS PLEURODESIS, CHEMICAL                     $534.00
1490762   14   CHANGE OF BLADDER TUBE                      $1,565.00
1490713   14   IRS PORTAL VEIN CATH PER                     $213.00
1490747   14   IR SIALOGRAM W/DILATION                      $365.00
1401975   14   HAND 3RD DIGIT LT                            $220.00
1402064   14   WRIST LTD LT                                 $300.00
1402056   14   HAND 5TH DIGIT RT                            $220.00
1402049   14   HAND 4TH DIGIT RT                            $220.00
1402023   14   HAND 3RD DIGIT RT                            $220.00
1402015   14   HAND 2ND DIGIT RT                            $220.00
1402007   14   THUMB RT                                     $220.00
1401983   14   HAND 4TH DIGIT LT                            $220.00
1401967   14   HAND 2ND DIGIT LT                            $220.00
1402072   14   WRIST LTD RT                                 $300.00
1402163   14   FOOT 2ND DIGIT RT                            $220.00
1401959   14   THUMB LT                                     $220.00
1401942   14   HIP LTD RT                                   $220.00
1401991   14   HAND 5TH DIGIT LT                            $220.00
1402080   14   WRIST COMP LT                                $333.00
1402098   14   WRIST COMP RT                                $333.00
1402106   14   TOE GREAT LT                                 $220.00
1402114   14   FOOT 2ND DIGIT LT                            $220.00


                                     Page 96 of 276
Charge #Dept   CDM Description                        Price
1402213   14   FEMUR RT                                        $333.00
1402122   14   FOOT 3RD DIGIT LT                               $220.00
1402130   14   FOOT 4TH DIGIT LT                               $220.00
1402155   14   TOE,GREAT RT                                    $220.00
1402171   14   FOOT 3RD DIGIT RT                               $220.00
1402189   14   FOOT 4TH DIGIT RT                               $220.00
1402197   14   FOOT 5TH DIGIT RT                               $220.00
1402205   14   FEMUR LT                                        $333.00
1401934   14   HIP LTD LT                                      $220.00
1402148   14   FOOT 5TH DIGIT LT                               $220.00
1402221   14   KNEE <3 VIEWS LT                                $333.00
1401165   14   CATH,PERCLOSE                                   $763.00
1401173   14   CLIP,BIOPSY(MICROMARK)                          $396.00
1401637   14   DEXA STUDY HIP PELVIS SPI                       $688.00
1401736   14   XR MASTOIDS PER SIDE <3 V                       $447.00
1401785   14   HIP-OPERATIVE RT                                $283.00
1401926   14   HAND COMP RT                                    $333.00
1401819   14   SCAPULA COMP LT                                 $333.00
1401827   14   SCAPULA COMP RT                                 $333.00
1401835   14   HUMERUS LT                                      $315.00
1401843   14   HUMERUS RT                                      $315.00
1401850   14   RIBS LT                                         $408.00
1401868   14   RIBS RT                                         $408.00
1401876   14   XR RIBS W/CHEST 3+ VIEWS                        $590.00
1401884   14   XR RIBS W/CHEST 3+ VIEWS                        $590.00
1401892   14   HAND LTD LT                                     $300.00
1401900   14   HAND LTD RT                                     $300.00
1401918   14   HAND COMP LT                                    $333.00
1401777   14   HIP-OPERATIVE LT                                $283.00
1423482   14   CHEST-DECUBITUS LT                              $365.00
1424290   14   GALACTOGRAM                                     $703.00
1424035   14   IRS INS PICC WO PRT/PMP<5                      $1,769.00
1423888   14   MYELOGRAM T-SPINE                              $1,302.00
1422286   14   XR CYSTOGRAM 3+ VIEWS                           $442.00
1423938   14   DACRYOCYSTOGRAM                                 $985.00
1425222   14   NEPHRO TB PLACE URET RT                        $2,522.00
1432749   14   ARTHROGRAM WRIST RT                             $620.00
1424332   14   GASTRIC TUBE PLACEMENT                         $2,087.00
1424365   14   FLUORO GUIDE SPINE INJ PR                      $2,678.00
1421718   14   FALLOP TUBE CATH TRANSCER                      $3,514.00
1425248   14   NEPHROST TUBE PLC URE BIL                      $2,292.00
1421387   14   CONSULT OUTSIDE FLM                             $122.00
1421478   14   OSSEOUS SURVEY-INFANT                           $874.00
1421460   14   FLUOROSCOPY 1/2 HR                              $410.00
1421890   14   MAMMOGRAPHY EA ADDL VIEW                        $103.00
1421502   14   FLUORO/TUBE PL                                  $195.00
1421353   14   TOMOGRAPHY                                      $703.00
1421668   14   FLUORO GUIDED NDL PLACE                        $1,885.00
1421643   14   XR UGI W AIR CONTRAST WO                        $710.00
1421619   14   NON IONIC PHARM                                 $564.00
1421486   14   NEPHROSOGRAM                                    $789.00
1421544   14   ERCP PANCREATOGRAM                             $1,530.00
1425701   14   PERC BILIARY STONE EXTRAC                      $1,240.00
1421601   14   SINUS <3 VIEWS                                  $360.00
1432509   14   BLADDER ASP W/SUPPB CATH                        $442.00
1432483   14   NEPHOR/PYELO TUBE CHG                           $173.00
1432467   14   INTRO URETERAL CATH-PERC                        $593.00
1432426   14   BX,ABD/RETROPERIT MASS-PE                       $366.00


                                     Page 97 of 276
Charge #Dept   CDM Description                       Price
1432418   14   ABD PARACENTESIS-INIT                          $217.00
1432392   14   BIL DUC STN EXTRACT-PERC                       $968.00
1432384   14   BIL ENDO-PERC W/DIL/STNT                       $843.00
1432376   14   PERC BIL DRN CATH CHG                          $626.00
1432459   14   CATH INTR-RNL PELVIS PERC                      $478.00
1432632   14   VENOGRAM,UPPER EXT LT                         $1,123.00
1402239   14   KNEE <3 VIEWS RT                               $333.00
1432723   14   ARTHROGRAM ELBOW RT                            $620.00
1432715   14   ARTHROGRAM ELBOW LT                            $620.00
1432707   14   ARTHROGRAM KNEE RT                             $683.00
1432699   14   ARTHROGRAM KNEE LT                             $683.00
1432681   14   ARTHROGRAM SHOULDER RT                         $785.00
1432673   14   ARTHROGRAM SHOULDER LT                         $785.00
1432665   14   IR VENOGRAM RENAL RT                          $1,737.00
1432533   14   VENT PUNC-EXSTNG HOLE-INJ                      $289.00
1432640   14   VENOGRAM,UPPER EXT RT                         $1,123.00
1432541   14   SPINAL PUNC-LUMBAR DX                          $191.00
1432608   14   ANGIO,CAROTID CERV RT                         $2,584.00
1432590   14   ANGIO,CAROTID,CER LT                          $2,584.00
1432582   14   FLUOR<1HR PHY TIME                             $131.00
1432335   14   TRNSRCTL DRAIN-PELVIS ABS                      $506.00
1432657   14   IR VENOGRAM RENAL LT                          $1,737.00
1432103   14   BX,MUSCLE-PERC NDLE                            $215.00
1432046   14   ANGIO,ARCH,CAROT,CEREB,BI                     $4,232.00
1432012   14   IR ANGIO EA ADDL VESSEL                       $1,179.00
1432350   14   INTR PERC CATH-BIL DRN                        $1,428.00
1426055   14   ENTEROCLYSIS TUBE PLC PER                      $801.00
1425883   14   BABYGRAM                                       $503.00
1432228   14   PTA-BRACHIO TRUNK/BRNCH                       $1,668.00
1432327   14   GASTRIC TUBE REPOSITION                        $314.00
1432319   14   GASTROSTOMY TUBE CHANGE                        $148.00
1432301   14   PERC PLC-GASTROSTOMY TUBE                      $678.00
1432293   14   CTH PLC INTRVSC STNT-ADDL                      $570.00
1432285   14   CTH PLC INTRVSC STNT-INIT                     $1,143.00
1432277   14   TRANS CATH EMBOLIZATION                       $3,180.00
1432269   14   TRNSCATH RTRVL-INTRAVAS                        $755.00
1432251   14   IRS REPOSIT CV CATH W/FLR                      $162.00
1432129   14   BX,PELVIS/HIP-SPRFIC                           $340.00
1432236   14   PTA-VENOUS                                     $815.00
1432137   14   BX,PELVIS/HIP DEEP                            $1,035.00
1432210   14   PTA-FEMERAL-POPLITEAL                         $1,330.00
1432202   14   PTA-ILIAC                                     $1,113.00
1432194   14   PTA-AORTIC                                     $847.00
1432186   14   PTA-RENAL/VISCERAL                            $1,774.00
1432178   14   PTA-TIBIOPER TRUNK/BRANCH                     $1,549.00
1432160   14   PNEUMO.LUNG PUC FOR ASP                        $276.00
1432152   14   BX,PLEURAL-PERC NDL                            $256.00
1432244   14   IRS INS NONTUN CV CTH>5YR                      $262.00
1420132   14   XR SINUSES 3+ VIEWS                            $628.00
1420223   14   CHEST SINGL VW                                 $365.00
1420215   14   SIALOGRAPHY                                    $524.00
1420181   14   NECK SOFT TISSUE                               $288.00
1420173   14   TMJ                                            $501.00
1420165   14   XR SKULL 4+ VIEWS                              $646.00
1420140   14   SELLA TURCICA                                  $162.00
1420256   14   CHEST CP INC FL                                $325.00
1420124   14   XR OPTIC FORAMINA RT                           $283.00
1420116   14   NASAL BONES 3 VIEWS+                           $431.00


                                    Page 98 of 276
Charge #Dept   CDM Description                         Price
1420108   14   XR FACIAL BONES 3+ VIEWS                         $628.00
1420090   14   INT AUD MEATUS                                   $424.00
1420082   14   XR MASTOIDS 3+ VIEWS PER                         $466.00
1420074   14   XR MANDIBLE 4 VIEWS+ BIL                         $589.00
1420066   14   EYE FOREIGN BODY LT                              $242.00
1420157   14   SKULL <4 VIEWS                                   $460.00
1420439   14   THORACO LUMBAR 2 VIEWS                           $232.00
1420421   14   T-SPINE 3 VIEWS                                  $424.00
1420413   14   CERV FLXN/EXT                                    $708.00
1420405   14   C SPINE 4 VIEWS+                                 $650.00
1420397   14   C SPINE <4 VIEWS                                 $430.00
1420389   14   CERV LAT VIEW                                    $288.00
1420371   14   SPINE SURVY AP/LAT                               $654.00
1420363   14   XR STERNOCLAVIC JT(S) 3+                         $333.00
1420231   14   CHEST/TWO VWS                                    $507.00
1420348   14   RIBS BLTERAL                                     $492.00
1420249   14   XR CHEST 4+ VIEWS                                $530.00
1420272   14   CHEST 2 VIEWS+ FLUORO                           $1,076.00
1420355   14   XR STERNUM 2+ VIEWS                              $333.00
1402320   14   FOOT 2 VIEWS LT                                  $302.00
1402429   14   FOREARM LT                                       $305.00
1402411   14   ELBOW COMP RT                                    $333.00
1402403   14   ELBOW COMP LT                                    $333.00
1402395   14   ELBOW LTD RT                                     $300.00
1402387   14   ELBOW LTD LT                                     $300.00
1402361   14   XR SHOULDER 1 VIEW LT                            $274.00
1402353   14   XR SHOULDER 1 VIEW RT                            $274.00
1402338   14   FOOT 2 VIEWS RT                                  $302.00
1402452   14   CALCANEOUS RT                                    $274.00
1402312   14   ANKLE 3 VIEWS+ RT                                $333.00
1402304   14   ANKLE 3 VIEWS+ LT                                $333.00
1402296   14   ANKLE 2 VIEWS RT                                 $300.00
1402288   14   ANKLE 2 VIEWS LT                                 $300.00
1402270   14   TIB & FIB RT                                     $308.00
1402262   14   TIB & FIB LT                                     $308.00
1402254   14   KNEE 3 VIEWS RT                                  $360.00
1402247   14   KNEE 3 VIEWS LT                                  $360.00
1402536   14   XF MANDIBLE <4 VIEWS LT                          $345.00
1419415   14   AFTER BONE SCAN FILMS                            $478.00
1416940   14   KIT,ENTROCLYSIS                                  $340.00
1402841   14   XR BONE LENGTH STUDIES                           $584.00
1402825   14   KNEE WT BEARING LT                               $333.00
1402817   14   KNEE WT BEARING RT                               $333.00
1402809   14   FOOT WT BEARING LT                               $302.00
1402791   14   FOOT WT BEARING RT                               $302.00
1402437   14   FOREARM RT                                       $305.00
1402692   14   HIP COMP LT                                      $248.00
1402445   14   CALCANEOUS LT                                    $274.00
1402510   14   CLAVICLE RT                                      $333.00
1402502   14   CLAVICLE LT                                      $333.00
1402494   14   FOOT COMP RT                                     $333.00
1402486   14   FOOT COMP LT                                     $333.00
1402478   14   XR SHOULDER 2+ VIEWS RT                          $333.00
1402460   14   XR SHOULDER 2+ VIEWS LT                          $333.00
1420462   14   L SPINE 4 VIEWS +                                $695.00
1402700   14   HIP COMP RT                                      $248.00
1421056   14   UROGRAPHY W/INFUSION                             $628.00
1421023   14   UROGRAPHY                                        $847.00


                                      Page 99 of 276
Charge #Dept   CDM Description                        Price
1421015   14   CHOLANGIO PERC.TRANSHEP                         $887.00
1420991   14   XR FLUORO 5-6 HRS                              $1,300.00
1420447   14   SCOLIOSIS STUDY                                 $501.00
1421080   14   IVP W/TOMOGRAMS                                $1,215.00
1420959   14   CHOLANGIOGRAPHY INTRAOP                         $554.00
1420942   14   CHLCYSTGRPHY/GB                                 $455.00
1420934   14   COLON-BE W/AIR                                  $789.00
1420926   14   BARIUM ENEMA WO OR W KUB                        $674.00
1420918   14   SMALL BOWEL                                     $492.00
1420900   14   UGI W/SMALL BWL                                $1,207.00
1420892   14   UPPER GI W/KUB                                  $837.00
1420884   14   GASTROGRAPHIN CHRG                              $213.00
1421163   14   HYSTROSALPINGOGRAM                              $583.00
1432756   14   ARTHROGRAM HIP LT                               $943.00
1421262   14   XR BONE SURVEY COMPLETE                        $1,336.00
1421254   14   BONE LENGTH STUDY                               $442.00
1421247   14   BONE AGE                                        $449.00
1421239   14   JOINT SURVEY 1VW 2 OR>JTS                       $935.00
1421072   14   XR UROGRAM RETROGRADE                           $663.00
1421106   14   CYSTOGRAM VOIDING                               $625.00
1420850   14   ESOPHAGUS                                       $530.00
1420546   14   IR MYELOGRAM LUMBAR SPINE                      $1,113.00
1420876   14   HYPERTONIC DUODGRPHY                            $585.00
1420629   14   XR AC JOINTS W OR WO WTS                        $328.00
1420579   14   DISCOGRPHY L-SPINE                             $1,142.00
1420553   14   IR MYELOGRAM CERVICAL SPI                      $1,336.00
1420538   14   XR SACRUM AND COCCYX 2+ V                       $449.00
1420520   14   XR SACROILIAC JOINTS 3+ V                       $320.00
1420512   14   PELVIS 3 VIEWS+                                 $501.00
1420496   14   PELVIS <3 VIEWS                                 $216.00
1420488   14   LMBR BND VIEWS 4+                               $293.00
1420470   14   LMBOSACRL BNDNG                                 $718.00
1421288   14   FISTULA SINUS ABSCESS STD                       $628.00
1420561   14   MYLGRPHY FULL SPINE                            $1,633.00
1420454   14   L SPINE <4 VIEWS                                $501.00
1420835   14   ABD AP+ERECT+/DECU+CXR 1V                       $628.00
1420819   14   ABD AP+OBLIQUE+CONE                             $185.00
1420801   14   ABD SINGLE VIEW                                 $365.00
1420868   14   SWALLOW FUNCT W/OT                              $574.00
1420710   14   HIP/PELVIS F/CHL                                $256.00
1420702   14   HIPS BILAT COMPLETE                             $530.00
1420694   14   PELVIS/UNILAT HIP                               $248.00
1452432   14   IR AORTOGRAM THORACIC W S                      $2,245.00
1449065   14   ABD AP+ERECT+OR DECUB                           $442.00
1446178   14   TRANSCATH THER INF THROM                       $4,914.00
1443530   14   TRANSCATH/RETRIEVE PERC                        $2,245.00
1443712   14   NEPH/URETER/URETHR DIL LT                      $1,078.00
1443613   14   PERC/TRNSLUM/ANGIO/ADD V                       $1,535.00
1443746   14   IR IVC FILTER PLACEMENT                        $1,186.00
1443555   14   IR ANGIO A-V SHUNT                              $770.00
1443779   14   CHANGE/PERC DRAINAGE CATH                      $2,638.00
1443415   14   IR TRANSCATH ANGIO EXIST                       $3,323.00
1432731   14   ARTHROGRAM WRIST LT                             $620.00
1443738   14   BILIARY STENT PLACEMENT                        $3,423.00
1444090   14   SUBTRACTION W CONTRAST ST                       $100.00
1443811   14   GUIDED PERC DRAINAGE                           $1,737.00
1487446   14   STENT,WALL                                     $3,026.00
1487461   14   STENT,BILIARY                                   $429.00


                                    Page 100 of 276
Charge #Dept   CDM Description                        Price
1487479   14   CATHETER,BALLOON                                $683.00
1490010   14   DRAPE,BRACHIAL                                  $141.00
1490101   14   NEEDLE,YUEH                                     $160.00
1490093   14   SNARE,RETRIEVAL                                 $979.00
1490085   14   COIL,EMBOLIZATION                               $381.00
1490077   14   NEEDLE,MONOPY BX                                $233.00
1490069   14   CATH,SEL HYSTERO                                $383.00
1490051   14   CATH,SIALOGRAPHY                                $197.00
1490044   14   BARIUM,STERILE                                  $383.00
1487453   14   STENT,PALMAZ                                   $2,271.00
1490028   14   MARKER,Y SPOT                                      $9.00
1490002   14   DRAPE,PROBE                                       $77.00
1488824   14   CONSCIOUS SEDATION(ORAL)                        $560.00
1488816   14   CONSCIOUS SEDATION(IV)                          $740.00
1488808   14   FLUORO GUIDE TUBE REMOVAL                      $1,885.00
1487511   14   CATHETER,INFUSION                               $817.00
1487503   14   CATHETER,PICC LINE                              $431.00
1487495   14   CATHETER,PAS PORT                              $1,082.00
1490036   14   MARKER,BECKLEY SPOT                               $28.00
1436021   14   INF VENACAVA WITH SERIAL                       $1,624.00
1434000   14   ARTERIAL VENOUS SHUNT                          $1,017.00
1436070   14   VEN/EXT/BILATERAL                              $1,210.00
1440064   14   VERTEBROPLASTY THORACIC                        $1,496.00
1440072   14   VERTEBROPLASTY LUMBAR                          $1,496.00
1436005   14   SUP VENACAVA WITH SERIAL                       $1,912.00
1435007   14   ANGIO PULMONARY RT                             $1,737.00
1440635   14   IRS REM TUN CV CATH WO PO                      $1,132.00
1440619   14   ANGIO ADRENAL/UNI/SEL RT                       $2,245.00
1440411   14   ARCH CERVICOCEREBRAL                           $1,624.00
1440023   14   PERC VERTEBROPLASTY ADDL                       $1,133.00
1440361   14   PORTAL SYSTEMIC SHUNT                          $5,897.00
1440320   14   IRS INS TUN CV CTH WO PRT                      $2,124.00
1440148   14   IRS FACET JT C-T INJ ANES                      $2,678.00
1440130   14   FACET BLOCK-LUMBAR                             $1,405.00
1440122   14   INJECTION CEMENT                                $971.00
1440098   14   INJ EPIDURAL/LOC L SPINE                       $1,297.00
1440080   14   IRS FACET JT L-S INJ ANES                      $1,277.00
1433069   14   IR AORTOGRAM ABD W ILIOFE                      $2,638.00
1432939   14   THORACENT W/TUBE W WO WS                        $271.00
1432921   14   INJ ARTHROCNTSS MJR JOINT                         $82.00
1432913   14   BX,BONE TROC/NDL DEEP                           $318.00
1432780   14   ARTHROGRAM ANKLE RT                             $620.00
1432772   14   ARTHROGRAM ANKLE LT                             $620.00
1432764   14   ARTHROGRAM HIP RT                               $943.00
1433010   14   ANGIO, ABDOMINAL                               $2,442.00
1433259   14   NEPHROSTOGRM PERC LT                           $1,238.00
1433242   14   NEPHROSTOGRM PERC RT                           $1,238.00
1440577   14   ANGIO ADRENAL/BIL/SELECT                       $3,590.00
1433143   14   ANGIO EXT LT                                   $2,638.00
1433135   14   ANGIO EXT RT                                   $2,638.00
1433127   14   VENOGRAM LOW EXT LT                            $1,123.00
1433119   14   VENOGRAM LOW EXT RT                            $1,123.00
1442219   14   ANGIO VISCERAL/SELECT                          $1,910.00
1442201   14   IR ANGIO CAROTID CERVICAL                      $1,912.00
1442136   14   ANGIO RENAL/UNI/SELECT RT                      $2,101.00
1440643   14   IR VENOUS SAMPLE W OR WO                       $1,930.00
1442052   14   IR ANGIO EA ADDL VESSEL                         $644.00
1442003   14   IR AORTOGRAM THORACIC W S                      $2,397.00


                                    Page 101 of 276
Charge #Dept   CDM Description                      Price
1440817   14   IR AORTOGRAM THORACIC W S                    $3,100.00
1440718   14   IR STENT PLACEMENT NON CO                    $3,930.00
1440700   14   URETHROCSYTOGRM RETROGRAD                     $644.00
1441047   14   CHEST-DECUB-BILAT                             $530.00
1441575   14   IR ANGIO VERTEBRAL UNI CR                    $1,912.00
1500362   15   CT CHEST W&W/O CONTRAST                      $3,550.00
1511195   15   VENT PUNC-EXIST HOLE W/IN                     $289.00
1530419   15   CT UPPER EXT WO CONT BIL                     $1,985.00
1530443   15   CT LOWER EXT WO+W CONT BI                    $2,607.00
1511203   15   PUNC SPINE TX                                $1,179.00
1511211   15   INJ EPIDURAL/LOCAL L SPIN                    $1,179.00
1511187   15   BX PRST-NDL/PNCH,SNG/MULT                     $280.00
1530435   15   CT LOWER EXT W CONT BILAT                    $2,863.00
1511229   15   FACET BLK INJ L SPN 1ST                      $1,277.00
1511237   15   FACET BLK INJ LSPINE E AD                     $250.00
1530401   15   CT UPPER EXT WO+W CONT BI                    $2,011.00
1502160   15   FINE NDL ASP W IMAG GUIDA                     $197.00
1530427   15   CT UPPER EXT W CONT BIL                      $1,862.00
1540103   15   CT VERTEBROPLASTY 1 VERT                     $1,714.00
1500057   15   CT NEPHRO TUBE PLACE                         $1,125.00
1511112   15   IRS PANCREAS PSEUDOCYST D                     $250.00
1511146   15   ASP+OR INJ RENAL CYST/PEL                     $280.00
1511096   15   BX SFT TISS NCK OR THORAX                     $239.00
1511252   15   INJ EPIDURAL/LOC CT SPINE                    $1,179.00
1540095   15   CTA ABD W RUNOFF WO+W CON                    $4,119.00
1511104   15   BX,PLEURAL-PERC NDL                           $256.00
1511088   15   BX,MUSCLE-PERC NEEDLE                         $195.00
1511153   15   IRS URETERAL CATH/STN DRN                     $539.00
1511161   15   INJ PYELOGRAPHY TUBE/CATH                     $250.00
1511179   15   NEPHRO/PYELO TUBE CHANGE                      $173.00
1511120   15   IRS PARCENTESIS/LAVAGE SU                     $190.00
1500099   15   CT MAXILLOFACIAL WO+W CON                    $2,951.00
1511138   15   BX RENAL PERC                                 $391.00
1504646   15   INJ ARTHROCENT INTERM JT                      $227.00
1540111   15   CT VERTEBROPLST INJ ADDL                     $1,496.00
1540152   15   IRS VERTEBROPLT INJ THOR                     $1,496.00
1504620   15   FACET BLOCK INJ SPINE EA                      $227.00
1540137   15   CT THORACOST TUBE INSERT                      $250.00
1504638   15   FACET BLOCK INJ SPINE 1ST                    $1,277.00
1530344   15   CT UPPER EXT LT W/O CONT                     $2,184.00
1530336   15   CT PELVIS LTD W/CONT-HDR                     $1,376.00
1530328   15   CT PANCREAS W&W/O CONT                       $1,949.00
1530294   15   CT ABDOMEN-LTD                               $1,682.00
1530278   15   CT THORACENTESIS                              $187.00
1530260   15   CT BX LIVER PERC NDL                          $337.00
1530252   15   CT ABSCESS DRAIN COMPLEX                      $250.00
1530245   15   CT ABS DRAIN SIMPLE                           $120.00
1530237   15   CT GUIDED STEREO/PINPT                       $4,346.00
1530229   15   SPINAL PUNC LUMB-DX                           $144.00
1530211   15   CT CATH INTRO-RNL PLVS                        $478.00
1530203   15   CT BX PANCREAS-PERC NDL                       $274.00
1530047   15   CT PERIT ABCES DRAIN                          $637.00
1530187   15   CT CORON/SAG IMG RECON                        $590.00
1530377   15   CT UPPER EXT RT W/CONT                       $2,048.00
1530161   15   CT GUIDED PERC DRNG                          $3,419.00
1530153   15   CT PELVIS W&W/O CONTRAST                     $3,395.00
1530146   15   CT L-SPINE W&W/O CONT                        $3,183.00
1530138   15   CT L-SPINE W/O CONTRAST                      $3,183.00


                                  Page 102 of 276
Charge #Dept   CDM Description                       Price
1530120   15   CT T-SPINE W&W/O CONT                         $2,430.00
1530112   15   CT C-SPINE W&W/O CONT                         $3,227.00
1530104   15   CT SFT TISS NECK W&W/O CO                     $2,394.00
1530096   15   CT ORB/SLLA/FSSA/IAC W+WO                     $3,247.00
1530088   15   CT NEEDLE BX-BONE                             $4,480.00
1530070   15   CT BX BONE-SUPERFICIAL                         $239.00
1530054   15   CT SUBPHREN ABCESS-PERC                        $609.00
1530195   15   CT BX BONE TROC NDL DEEP                       $415.00
1540020   15   CT ANGIO CHEST WO&W CON                       $4,375.00
1500123   15   CT ORBIT/SELA/FOSA/IAC WO                     $2,303.00
1580679   15   CONSCOIUS SEDATION(ORAL)                       $560.00
1580661   15   CONSCIOUS SEDATION(IV)                         $672.00
1580653   15   CT SINUS INSTATRAK                             $184.00
1540087   15   CT ANGIO ABDOMEN WO&W CON                     $4,041.00
1540079   15   CT ANGIO LOW EXTREM WO&W                      $3,295.00
1540061   15   CT ANGIO LOW EXTREM WO&W                      $3,295.00
1540053   15   CT ANGIO UPP EXTREM WO&W                      $2,759.00
1530351   15   CT UPPER EXT RT W/O CONT                      $2,184.00
1540038   15   CT ANGIO PELVIS WO&W CON                      $4,381.00
1530369   15   CT UPPER EXT LT W/CONT                        $1,862.00
1540012   15   CT ANGIO NECK WO&W CONTRA                     $3,719.00
1540004   15   CT ANGIO HEAD WO&W CONTRA                     $3,719.00
1530559   15   CT RETROPER ABS DRAIN                          $571.00
1530534   15   CT LOW EXT RT W&W/O CON                       $2,245.00
1530526   15   CT LOW EXT LT W&W/O CONT                      $2,245.00
1530518   15   CT LOW EXT W/CONTRAST                         $2,751.00
1530500   15   CT LOW EXT W/CONTRAST                         $2,751.00
1530492   15   CT LOW EXT RT W/O CONT                        $2,184.00
1530484   15   CT LOWER EXT LT W/O CONT                      $2,184.00
1530393   15   CT UP EXT RT W&W/O CONT                       $2,011.00
1530385   15   CT UP EXT LT W&W/O CONT                       $2,011.00
1530286   15   CT PARACENTESIS INITIAL                        $170.00
1540046   15   CT ANGIO UPP EXTREM WO&W                      $2,759.00
1501063   15   C.T. CHEST W/O CONTRAST                       $2,750.00
1501550   15   CT CHEST SCREENING                             $485.00
1501386   15   CT STERNO-CLAV JNTS W/O                       $1,570.00
1501279   15   CT T-SPINE W/CONTRAST                         $2,026.00
1501261   15   CT L-SPINE W/CONTRAST                         $2,653.00
1501204   15   CT C-SPINE W/CONTRAST                         $2,959.00
1501154   15   CT PELVIS WO CON                              $2,161.00
1501113   15   C.T.THORACIC SP W/O CONT                      $2,674.00
1501105   15   CT C SPINE W/O CONTRAST                       $3,550.00
1501097   15   C.T. PELVIS CONTRAST                          $3,197.00
1502004   15   CT LOW EXT WO CONT BILAT                      $2,347.00
1501006   15   CT BODY SCAN-ABD W/O CS                       $2,036.00
1500131   15   RECONSTRUCTION/MULTIPL 3D                      $989.00
1500149   15   CT ORBIT/SELA/FOSA/IAC W                      $3,247.00
1530310   15   CT BRAIN-ANGIO W/CON                          $3,537.00
1500206   15   CT NECK SOFT TISSUE W/O                       $3,161.00
1501089   15   C.T. PELVISW/O CONT                           $2,608.00
1501071   15   CT CHEST W CONTRAST                           $3,382.00
1501014   15   CT BODY/ABD SCAN W/CONTST                     $3,838.00
1501022   15   CT BODY PRE AND POST CONT                     $3,051.00
1501048   15   CT FOSSA/PITUITARY W/O                        $2,356.00
1501055   15   POST. FOSSA/PIT./CONT                         $2,951.00
1500214   15   CT NECT SOFT TISSUE W/CS                      $3,161.00
1530039   15   CT NEEDLE BX MASS                             $4,289.00
1500164   15   CT NON IONIC PHARM                             $564.00


                                   Page 103 of 276
Charge #Dept   CDM Description                        Price
1530021   15   CT BX ABD MASS-PERC                             $404.00
1530005   15   CT BX LUNG-PERC NEEDLE                          $424.00
1511054   15   CT PITUITARY W/CONTRAST                        $3,248.00
1506302   15   CT LIMITED OR FOLLOW UP                         $593.00
1503960   15   CT PITUITARY W/O CONT                          $3,110.00
1502103   15   CT GUIDED RAD TX PLACEMNT                      $2,146.00
1530013   15   CT NEEDLE BX LUNG                              $5,662.00
1502020   15   CT GUIDANCE NEEDLE PLACE                       $4,480.00
1502285   15   CT GUIDED ABLATION                             $2,162.00
1502293   15   NEEDLE,ELECTRODE                               $1,388.00
1500107   15   CT I.A.C. CONT                                 $2,303.00
1500016   15   CT HEAD SCAN CONTRAST                          $2,631.00
1500024   15   CT HEAD PRE AND POST CONT                      $3,473.00
1500040   15   C.T. SINUS W/O CONTRAST                        $3,577.00
1500065   15   CT SINUS W CONTRAST                            $2,763.00
1500073   15   CT FACIAL BONES W/O CONT                       $3,450.00
1500081   15   C.T. INT. AUD. CANAL W/O                       $3,577.00
1500008   15   CT HEAD SCAN W/O CONTRAST                      $3,473.00
1670587   16   MYOCARD PERF/EJECT FRACT                       $1,593.00
1686062   16   GALLIUM(MCI)                                      $45.00
1629344   16   BLOOD POOLING IMAGING                          $1,023.00
1686054   16   SULFUR COLLOID TC99M                            $121.00
1686898   16   DISOFENIN                                         $59.00
1600717   16   LUNG QUANTIFICATION                            $1,261.00
1686146   16   ULTRA TAG                                       $183.00
1670579   16   MYOCARD PERF/WALL MOTION                       $1,593.00
1672070   16   RENOGRAM W/O PHARM                             $1,734.00
1670611   16   KIDNEY IMAG W VAS WO+W PH                       $572.00
1686088   16   CARDIOLITE > THAN 3000                          $185.00
1674258   16   GASTROESOPHAGEAL REFLUX                        $1,055.00
1685965   16   CHOLETEC, PER VIAL                              $125.00
1600030   16   THALLIUM (PER MCI)                                $49.00
1686872   16   TC99M PERTECHNETATE                               $32.00
1695790   16   TC99M MEDRO UP TO 30MCI                         $114.00
1686245   16   I-131 PER UCI(1-5 MCI)                          $136.00
1686039   16   TC99M MAA(MCI)                                  $930.00
1686013   16   DTPA, PER VIAL                                    $63.00
1686096   16   MAG3(MCI)                                       $477.00
1686880   16   ACU TC(TC99M APCL PER UN)                       $710.00
1674241   16   I-123 100 MCI                                     $46.00
1600626   16   BRAIN IMAGING W/VAS FLOW                       $1,690.00
1600618   16   BRAIN IMAGING LTD STATIC                       $1,419.00
1600584   16   PET W/BODY LUNG SNGL NOD                       $4,862.00
1600436   16   PET IMG MYOCARD VIABILITY                      $3,817.00
1600428   16   PET IMAG METABOLIC BRAIN                       $3,403.00
1600246   16   NM PET WB INITIAL LUNG CA                      $4,862.00
1600295   16   NM PET WB DX MELANOMA                          $4,051.00
1600113   16   TUMOR LOCALIZATION SPECT                        $999.00
1600121   16   SAMARIUM SM153 LEXI 50MCI                      $2,320.00
1600139   16   INDIUM 111 PENT(OST/3MCI)                      $2,320.00
1600238   16   PET IMAG W/BODY LUNG CA                        $4,862.00
1600410   16   PET IMG W/BDY ESOPH RESTG                      $3,683.00
1600253   16   PET IMG W/BDY RESTAG LUNG                      $4,862.00
1600683   16   I-131 RADIOPHARM 1-6MCI                         $517.00
1600261   16   NM PET WB DX COLORECTAL                        $4,420.00
1600287   16   PET IMG W/BDY RSTG COLOR                       $4,862.00
1600402   16   PET IMG W/BDY ESOPH INIT                       $3,683.00
1600303   16   PET IMG W/BDY MLNMA INIT                       $4,051.00


                                    Page 104 of 276
Charge #Dept   CDM Description                        Price
1600311   16   PET IMG W/BDY MLNMA RESTG                      $4,051.00
1600329   16   PET IMG W/BDY MLNMA NONCV                      $3,683.00
1600337   16   NM PET WB DX LYMPHOMA                          $4,420.00
1600345   16   PET IMG W/BDY LYMPH INIT                       $4,862.00
1600352   16   PET IMG W/BDY LYMPH RESTG                      $4,862.00
1600360   16   NM PET WB DX HEAD/NECK                         $4,420.00
1600378   16   PET IMG W/BDY HD/NCK INIT                      $4,862.00
1600386   16   PET IMG W/BDY HD/NCK RSTG                      $4,862.00
1600279   16   NM PET WB INITIAL COLORE                       $4,862.00
1600394   16   NM PET WB DX ESOPHAGEAL                        $3,683.00
1670421   16   NM MYOCARD INFARCT IMAG S                      $2,398.00
1670389   16   VENOUS THROMB IMAGE LT                         $1,023.00
1670371   16   VENOUS THROMBOSIS STUDY                        $1,210.00
1670363   16   BONE IMAGING 3D-SPECT                          $1,749.00
1670397   16   VENOUS THROMB IMAGE RT                         $1,023.00
1670355   16   LVR+SPLN IMG W VASC FLOW                       $1,297.00
1601624   16   PET IMAG W/BDY BRST CA RE                      $3,348.00
1670447   16   CARD BLDPL W VASC FLW MUL                      $1,962.00
1670454   16   BRAIN SCN CMPLT STATIC                         $1,536.00
1670405   16   NM MYOCARD PERF SPECT SI                       $1,194.00
1670348   16   LIVER SPECT                                    $1,297.00
1670330   16   LIVER IMAGING W VASC FLOW                      $1,419.00
1670322   16   LIVER IMAGING ONLY                             $1,191.00
1670314   16   THYROID METS UPTAKE                            $1,261.00
1670306   16   THYROID UPTAKE W MULTI SC                      $1,367.00
1670298   16   SURFACE APP OF RADIOACT S                       $120.00
1670678   16   ISOTOPE I-131 HYPERTHYROI                       $110.00
1670660   16   ISOTOPE I-131 DIAG CAP                          $110.00
1670652   16   ISOTOPE GASTRIC EMPTYING                        $110.00
1670645   16   INFLAM PROCESS LOC SPECT                       $1,616.00
1670439   16   NM CARDIAC BLOOD POOL PLN                      $2,398.00
1670462   16   BRAIN VASC FLOW ONLY                           $1,419.00
1670694   16   ISOTOPE MAA PER MCI                             $110.00
1601616   16   PET IMAD W/BODY BREAST CA                      $3,348.00
1601533   16   NM PET BREAST CA STAGIN/R                      $3,348.00
1670413   16   MYOCARD INFRCT IMG W EJEC                      $1,740.00
1670595   16   TUMOR LOCAL;WHL BODY                           $2,628.00
1670546   16   RENAL IMAGING STATIC ONLY                      $1,445.00
1670538   16   DACRYOCYSTOGRAPHY                              $1,261.00
1670520   16   CSF LEAK DETECT+LOCALIZAT                      $1,962.00
1670512   16   CSF FLOW SPECT                                 $1,536.00
1670702   16   ISOTOPE MDP                                     $110.00
1670736   16   ISOTOPE TAGGED RBC                              $110.00
1670728   16   ISOTOPE RED CELL MASS/MCI                       $110.00
1670710   16   ISOTOPE ONCOSCINT/DOSE                          $110.00
1670470   16   CEREBRAL VASC FLOW                             $1,419.00
1600444   16   PET IMAGING INITIAL DX CE                      $4,856.00
1670751   16   ISOTOPE TCO4 I-20 PER MCI                       $110.00
1670769   16   ISOTOPE XENON GAS 133                           $110.00
1670553   16   TUMOR LOCALIZATION;LIMITD                      $2,628.00
1670744   16   ISOTOPE TC PYP PER MCI                          $110.00
1670637   16   INFLAM PROC LOC LTD IND/G                      $2,628.00
1600469   16   PET IMAGING RESTAGE OVARI                      $4,856.00
1650456   16   NM LUNG VENT/PERFUS MULTI                      $1,261.00
1650464   16   NM BLADDER RESIDUAL URINA                      $1,410.00
1608199   16   IN-III PENTETATE/0.5MCI                         $507.00
1650449   16   NM BONE IMAGING MULTIPLE                       $1,749.00
1608181   16   TC 99M EXANETAZINE/DOSE                        $1,757.00


                                    Page 105 of 276
Charge #Dept   CDM Description                        Price
1608207   16   GALLIUM GA67/MCI                                  $48.00
1608215   16   IN-111 OXYQUINOLINE/0.5MC                       $843.00
1600451   16   PET IMAGING BRAIN ALZHEI                       $4,856.00
1608223   16   TC99 MERTIATIDE PER MCI                           $70.00
1608231   16   TC99M NA GLUCOHEPTON/VIAL                         $65.00
1675024   16   SALIVARY GLANDS                                 $589.00
1675065   16   THYROID METS IMAG WHOLBOD                      $2,300.00
1675545   16   G.I. BLEEDING STUDY                            $1,238.00
1675552   16   NM VENOUS THROMBOSIS PEPT                      $1,238.00
1675578   16   BRAIN SCAN COMPL STATIC W                       $606.00
1673029   16   LIVER SPLEEN SCN                               $1,310.00
1675586   16   NON CARDIAC VASC FLOW IMA                       $837.00
1675693   16   LIVER SPECT W VASC FLOW                        $1,419.00
1675560   16   MECKEL'S DIVERTICULUM                          $1,077.00
1673078   16   HEPATOBILIARY SCAN                             $2,891.00
1673060   16   LUNG VENT SCAN, SINGLE                         $1,388.00
1673045   16   PERFUSION LUNG SCAN                            $1,983.00
1672583   16   GASTRIC EMPTYING STUDY                         $1,804.00
1672054   16   VOIDING ISOTOPE CYSTOGRAM                      $1,410.00
1672039   16   KIDNEY IMAG W PHARM SNGL                        $439.00
1675701   16   MYOCARDIAL SC REST/STRS M                      $1,740.00
1680651   16   CONSCIOUS SEDATION(ORAL)                        $560.00
1672047   16   BONE SCAN LIMITED                              $1,082.00
1672021   16   RENOGRAM                                       $1,445.00
1670686   16   INDIUM FOR CIST(PER MCI)                       $1,644.00
1684992   16   MATERIAL SPECT BRAIN SCAN                      $1,126.00
1680636   16   CONSCIOUS SEDATION(IV)                          $560.00
1675719   16   CARDIOLITE UP TO 3000                           $253.00
1680099   16   NM TESTES W/ FLOW                              $1,333.00
1676584   16   NM TUMOR LOCALIZE LTD                          $1,899.00
1676519   16   MATERIAL MONOCLONAL SCAN                       $6,144.00
1675727   16   PERITONEAL SHUNT STUDY                         $1,443.00
1601665   16   I 131 1.0M CURIE EA ADD                           $55.00
1670074   16   BONE SCAN/WHOLE                                $1,924.00
1670033   16   THYRD SCANNING/IMGNG                            $706.00
1670025   16   NM THYROID SCAN W/UPTAKE                       $1,388.00
1670017   16   THY UPTK MULTI DET                              $391.00
1670009   16   THYROID UPTKE SGL DT                            $355.00
1650431   16   BRAIN SPECT                                    $1,561.00
1650407   16   SPECT PROCESSING                               $1,132.00
1600089   16   LYMPHO SYSTEM IMAGING                          $1,095.00
1670082   16   TUMOR LOCAL WHOLE BODY                         $2,891.00
1601657   16   ADRENAL IMAGING MIBG                           $1,457.00
1600220   16   FDG PHARM                                      $1,623.00
1600212   16   PET WHOLE BODY SCAN                            $6,177.00
1600204   16   PET HEART PERFUSION                            $4,408.00
1600196   16   PET HEART METABOLISM                           $4,408.00
1600188   16   PET BRAIN PERFUSION                            $3,929.00
1600170   16   PET BRAIN METABOLISM                           $4,322.00
1600097   16   CSF FLOW SHUNT EVAL                            $1,580.00
1671767   16   INDIUM WBC SCAN,0.5MCI                         $1,239.00
1670504   16   3 PHASE BONE SCAN                              $2,037.00
1670488   16   NM STRONT-89 THER/MCI BR                       $8,664.00
1670280   16   NM BONE MARROW MULTILTI                        $1,035.00
1670140   16   NM MYOCARD PERF SPECT MUL                      $2,639.00
1670108   16   CISTERNOGRAM                                   $1,328.00
1670132   16   NM MYOCARD PERF PLANAR SI                      $1,376.00
1672005   16   RENAL IMAG FLOW&STATICS                         $514.00


                                    Page 106 of 276
Charge #Dept   CDM Description                        Price
1670157   16   NM CARDIAC BLOOD POOL PLN                      $2,159.00
1670173   16   COMPUTER ASSISTANCE                             $765.00
1670181   16   COMPUTER PROCESS >30MIN                         $374.00
1670207   16   INDIUM WBC SCAN                                $1,777.00
1670215   16   NM PARATHYROID                                 $2,404.00
1670124   16   NM MYOCARDIAL INFARCT                          $1,194.00
1600485   16   NM PET RECUR/RESID THYR C                      $4,408.00
1670249   16   NM RADIOPHARM THRPY IV                          $771.00
1670231   16   NM RADIOPHARM THRPY ORAL                        $771.00
1600477   16   NM 'PET IMAGING ALZHEIMER                      $4,408.00
1850213   18   CPT INITIAL                                     $160.00
1850106   18   IPPB TREATMENT                                    $80.00
1850114   18   AEROSOL-MED CONT DEMO/EVL                       $213.00
1850122   18   AEROSOL-MED CONT/HR                             $106.00
1850130   18   AEROSOL HHN TX DEMO/EVAL                        $200.00
1850148   18   AEROSOL HHN TREATMENTS                          $100.00
1850155   18   AEROSOL-MDI DEMO/EVAL DAY                       $160.00
1850163   18   AEROSOL-MDI SUBSEQUENT                            $80.00
1850189   18   INHAL TX W/SPECIFIC GAS                           $80.00
1850098   18   IPPB DEMO/EVAL/DAY                              $160.00
1850205   18   SPUTUM INDUC TREATMENT                            $80.00
1850270   18   PULSE OX CHECK(MULTI DET)                       $590.00
1850221   18   CPT SUBSEQUENT                                  $133.00
1850239   18   INTUBATION                                      $781.00
1850262   18   PULSE OX SNGL DETERM                              $85.00
1850288   18   PULSE OX NOCTURNAL STUDY                        $813.00
1850197   18   SPUTUM INDUC DEMO/EVAL                          $160.00
1850049   18   VENT DAY INITIAL ADULT                         $3,043.00
1850056   18   VENT DAY SUBSEQUENT ADULT                      $2,352.00
1850072   18   CPAP DAY                                        $639.00
1850445   18   VENT DAY SUBSEQUENT NEONA                      $2,352.00
1850437   18   VENT DAY INIT OSCILLATOR                       $3,043.00
1850429   18   VENT DAY INIT DAY NEONATE                      $3,043.00
1850411   18   TRANSCUTE MONIT SUBSEQ                            $59.00
1850403   18   TRANSCUTE MONIT INITIAL                         $117.00
1850452   18   VENT DAY SUBSEQ OSCILLATR                      $2,352.00
1850395   18   ETCO2 SUBSEQUENT HR                               $49.00
1850387   18   ETCO2 INITIAL                                     $49.00
1850379   18   BIPAP SUBSEQUENT DAY                            $825.00
1850361   18   BIPAP INITIAL DAY                               $948.00
1850353   18   AEROSOL/DAY (BLAND)                             $435.00
1850346   18   VITAL CAPACITY SUBSEQUENT                         $49.00
1850338   18   VITAL CAPACITY INITIAL                            $98.00
1905207   19   PERITONEAL DIAL (BAG EXC)                       $301.00
1905066   19   HEMODIALYSIS PROCEDURE                         $1,520.00
1905041   19   OUTPT DIALYSIS PROCEDURE                       $1,520.00
2031227   20   MANUAL THERAPY 15MIN/MCR                          $83.00
2031532   20   COMMUN POOL GRP 30MIN/WC                           $3.00
2031607   20   INIT EVAL PED 45'                               $351.00
2031581   20   INIT EVAL PED 30'                               $234.00
2031573   20   INIT EVAL PED 15'                               $117.00
2031565   20   WC CARE SELECT DEBRID 30M                       $202.00
2031565   20   WC CARE SELECT DEBRID 30M                       $202.00
2031565   20   WC CARE SELECT DEBRID 30M                       $202.00
2031565   20   WC CARE SELECT DEBRID 30M                       $202.00
2031540   20   COMM POOL 15MIN ADD/WC                             $2.00
2031631   20   INITIAL EVAL PED 90'                            $703.00
2031524   20   THER PROC GRP 60MIN/MCR                         $256.00


                                    Page 107 of 276
Charge #Dept   CDM Description                         Price
2031516   20   THER PROC GRP 45MIN/MCR                         $192.00
2031482   20   AQUATIC GROUP 60MIN/MCR                         $298.00
2031250   20   INIT EVAL 90MIN                                 $648.00
2031714   20   MANUAL THER JOINT MOB/MC&                        $83.00
2032282   20   BFB TRAINING 45MIN                              $260.00
2032043   20   FUNCT CAPACITY 60MIN/WC                         $213.00
2031920   20   EVAL ESTAB/RE-EVAL30'                           $211.00
2031615   20   INITIAL EVAL PED 60MIN                          $469.00
2031623   20   INIT EVAL PED 75'                               $469.00
2031706   20   MASSAGE 30MIN/WC&MC                              $75.00
2031839   20   EVAL ESTAB/RE-EVAL 15MIN                        $105.00
2031219   20   INIT EVAL 60MIN                                 $431.00
2031243   20   INIT EVAL 75MIN                                 $540.00
2030062   20   INITIAL EVALUATION 30MIN                        $216.00
2030617   20   *HOT/COLD PACKS                                  $62.00
2030591   20   WC SELECT DEBRID 15MIN                           $81.00
2030591   20   WC SELECT DEBRID 15MIN                           $81.00
2030591   20   WC SELECT DEBRID 15MIN                           $81.00
2030591   20   WC SELECT DEBRID 15MIN                           $81.00
2030658   20   ELEC STIM/TENS UNATTEND                          $71.00
2030559   20   WHIRLPOOL,FULL BODY                             $166.00
2030534   20   WHIRLPOOL,EXTREMITY                             $115.00
2031201   20   INITIAL EVAL 45MIN                              $324.00
2031094   20   WORK HARDENING +1HR                              $35.00
2031086   20   WORK HARDENING INIT 2HR                         $178.00
2031078   20   AQUATIC GROUP 90MIN/MCR                         $447.00
2031060   20   THER PROC GRP 120MIN/MCR                        $511.00
2031052   20   THER PROC GRP 90MIN/MCR                         $307.00
2030641   20   MECHANICAL TRACTION                              $71.00
2030724   20   MASSAGE 15MIN/MCR                                $75.00
2030716   20   ELEC STIM/TENS ATT 15MIN                         $71.00
2030690   20   ULTRASOUND 15MIN                                 $71.00
2030682   20   IONTOPHORESIS 15MIN                              $71.00
2030666   20   VASOPNEUM DEVICE                                 $56.00
2030153   20   AQUATIC THERAPY 30'/WC&MC                       $186.00
2030211   20   AQUATIC GRP +15MIN/WC&MC                         $75.00
2030203   20   AQUATIC GROUP 30MIN                             $149.00
2030195   20   BFB TRNG 60'                                    $346.00
2030484   20   CASE CONF 15MIN ADD/MC                           $49.00
2030161   20   AQUATIC THERAPY 15MIN/MCR                        $94.00
2030278   20   THER EXER 30MIN/MC&WC                           $149.00
2030146   20   BIO FEEDBACK 15MIN ADD/MC                        $75.00
2030138   20   BIO FEEDBACK MEASUR 15MIN                        $75.00
2030120   20   ISOKINETIC MEASUR 15MIN                          $93.00
2030104   20   EVAL ESTAB/RE-EVALADD15MC                        $84.00
2030088   20   INITIAL EVALUATION 15MIN                        $109.00
2030351   20   ORTHOTIC FIT/TRNG 15MIN                          $83.00
2030435   20   THER PROC GRP 15MINADDL                          $64.00
2030427   20   THER PROC GRP INIT 30MIN                        $128.00
2030385   20   BFB TRAINING 30MIN                              $174.00
2030252   20   FUNC ACT 30MIN/MC&WC                            $149.00
2030369   20   KINETIC EXER 30MIN/MC&WC                        $141.00
2030260   20   FUNCT ACTIVITY 15MIN/MCR                         $75.00
2030344   20   ORTHOTIC FIT/TRNG 30'/MC                        $165.00
2030336   20   PROSTHETIC TRNG 15MIN                            $83.00
2030328   20   PROST TRAIN 30MIN/MC&WC                         $165.00
2030286   20   THER EXER 15MIN/MCR                              $75.00
2030377   20   KINETIC EX 15MIN/MCR                             $70.00


                                     Page 108 of 276
Charge #Dept   CDM Description                        Price
2032621   20   HOME MT(CHECK)30MIN/MC&WC                      $119.00
2032696   20   CASE CONFERENCE 30MIN/MC                        $98.00
2032688   20   MANUAL THER MYOFAS/MC&WC                        $83.00
2032670   20   MANUAL THER SFT TIS MOB                         $83.00
2032662   20   BFB TRNG 15MIN ADDL/MC                          $69.00
2032332   20   THER EX 15MIN ADD'L/MC&WC                       $75.00
2032506   20   WC SELECT DEBRID 45MIN                         $243.00
2032498   20   WHEELCHAIR TRNG/MGT 15MIN                       $60.00
2032480   20   FUNC ACT +15MIN/WC&MC                           $75.00
2032472   20   PROSTHEITC TRNG+15'/WC&MC                       $83.00
2032464   20   ORTHOTIC FIT/TRNG+15'/WC                        $83.00
2032647   20   PT PROC MOD COMBO 30MIN                        $149.00
2032365   20   NEUROMUSC RE-ED 30MIN                          $165.00
2032506   20   WC SELECT DEBRID 45MIN                         $243.00
2032340   20   WHIRLPOOL-FULL W/DEBRID                        $208.00
2032324   20   WHIRLPOOL-EXT W/DEB                            $115.00
2032316   20   EVAL ESTAB/RE-EVAL 60MIN                       $337.00
2032308   20   EVAL ESTAB/RE-EVAL 45MIN/                      $316.00
2032290   20   INIT EVAL PED 15MIN ADDL                       $117.00
2032373   20   INIT EVAL 15MIN ADDL/MC                        $109.00
2032431   20   AQUATIC THER 15MIN ADDL                         $94.00
2032548   20   WC NON SEL DEBRID 45MIN                        $224.00
2032639   20   HOME MGT(CHECK)+15MIN/WC                        $75.00
2032381   20   NEUROMUSC RE-ED 15MIN ADD                       $83.00
2032613   20   HOME MGT(CHECK)15MIN/MCR                        $60.00
2032605   20   BIO FEED MEASUR 60MIN/WC                       $298.00
2032597   20   BIO FEED MEASUR 30MIN/MC                       $149.00
2032571   20   ISOKIN MEASUR 60MIN/WC                         $371.00
2032506   20   WC SELECT DEBRID 45MIN                         $243.00
2032555   20   WC NON SEL DEBRID 60MIN                        $298.00
2032506   20   WC SELECT DEBRID 45MIN                         $243.00
2032530   20   WC NON SEL DEBRID 30MIN                        $186.00
2032522   20   WC NON SELECT DEB 15MIN                         $94.00
2032514   20   WC SELECT DEBRID 60MIN                         $324.00
2032514   20   WC SELECT DEBRID 60MIN                         $324.00
2032514   20   WC SELECT DEBRID 60MIN                         $324.00
2032514   20   WC SELECT DEBRID 60MIN                         $324.00
2032654   20   PT PROC COMBO+15'/MC                            $75.00
2032563   20   FUNC CAPACITY 15MIN/MCR                         $43.00
2032357   20   NEUROMUSC RE-ED 15MIN                           $83.00
2030765   20   ISOKINETIC MEAS 30MIN/WC                       $185.00
2030757   20   ISOKINETIC MEAS 15MIN/WC                        $93.00
2030773   20   ISOKINETIC MEAS 45MIN/WC                       $278.00
2030823   20   AQUATIC GROUP 45MIN                            $179.00
2031748   20   THER PROC GRP 150MIN/MCR                       $511.00
2031755   20   THER PROC GRP 180MIN/MCR                       $613.00
2031763   20   THER PROC GRP 210MIN/MCR                       $716.00
2030781   20   AQUATIC GROUP 15MIN MCR                         $60.00
2031771   20   THER PROC GRP 240MIN/MCR                       $818.00
2030799   20   AQUA GRP 30MIN MCR(DISTN)                      $119.00
2030807   20   THER PROC GRP 15MIN/MCR                         $51.00
2030815   20   THER PROC GRP 30MIN MCR                        $102.00
2037034   20   PT DEBR SELCT>20CM 30MIN                       $172.00
2036986   20   PT DEBR SELCT<20CM 15MIN                        $81.00
2036994   20   PT DEBR SELCT<20CM 30MIN                       $162.00
2037000   20   PT DEBR SELCT<20CM 45MIN                       $243.00
2037018   20   PT DEBR SELCT<20CM 60MIN                       $324.00
2037059   20   PT DEBR SELCT>20CM 60MIN                       $344.00


                                    Page 109 of 276
Charge #Dept   CDM Description                       Price
2037042   20   PT DEBR SELCT>20CM 45MIN                      $258.00
2037026   20   PT DEBR SELCT>20CM 15MIN                       $86.00
2112100   21   ORTHOTIC FIT/TRNG30'/WC                       $165.00
2112167   21   THER PROC GRP INITI 30MIN                     $128.00
2112019   21   INIT EVAL+15MIN/MC&WC                         $109.00
2112027   21   THER EXER 30MIN/MC&WC                         $149.00
2112035   21   THER EXER 15MIN/MCR                            $75.00
2112043   21   ADL TRNG 30MIN/MC&WC                          $149.00
2112050   21   ADL TRNG 15MIN/MCR                             $75.00
2112068   21   NEUROMUSC REED 30MIN/MC&W                     $165.00
2112076   21   NEUROMUSC REED 15MIN/MCR                       $83.00
2112084   21   COGNITIVE TRNG 30MIN/MC&W                     $149.00
2112092   21   COGNITIVE TRNG 15MIN/MCR                       $75.00
2112118   21   ORTHOTIC FIT/TRNG 15'/MCR                      $83.00
2112134   21   FUNC ACTIVITY 15MIN/MCR                        $75.00
2112126   21   FUNC ACTIVITY 30MIN/MC&WC                     $149.00
2112449   21   PARAFFIN                                       $71.00
2112431   21   *HOT/COLD PACK                                 $62.00
2112266   21   INITIAL EVALUATION 15MIN                      $109.00
2112142   21   COMMUN/WRK INTGR 30MIN/MC                     $149.00
2112159   21   COMMUN WROK/REINTER 15MIN                      $75.00
2112209   21   CASE CONF 15MIN/MC                             $49.00
2112175   21   THER PROC GRP+_15'/MC&WC                       $64.00
2112001   21   INITIAL EVALUATION 30MIN                      $216.00
2110393   21   INITIAL EVAL PED 60MIN                        $469.00
2165520   21   DPP ADL INTEN EVAL PR&WC                      $480.00
2165553   21   DPP ADL INTEN EVAL MCR                        $240.00
2165561   21   DPP ADL MOB EVAL15MIN/MCR                      $30.00
2165603   21   DPP TRAVEL TIME - 15MIN                        $13.00
2165587   21   DPP MOB PRACTICE 15MIN                         $24.00
2110419   21   INITIAL EVAL PED 75MIN                        $586.00
2110773   21   FUNC CAPACITY 60MIN/WC                        $170.00
2110609   21   WC SELECT DEBRID 15MIN                        $101.00
2110609   21   WC SELECT DEBRID 15MIN                        $101.00
2110617   21   WC SELECT DEBRID 30MIN                        $202.00
2110617   21   WC SELECT DEBRID 30MIN                        $202.00
2110617   21   WC SELECT DEBRID 30MIN                        $202.00
2110617   21   WC SELECT DEBRID 30MIN                        $202.00
2110633   21   MASSAGE 15MIN/MCR                              $75.00
2110641   21   MASSAGE 30MIN/MC&WC                            $60.00
2110658   21   PROSTH TRNG 15MIN/MCR                          $83.00
2110666   21   PROSTH TRNG 30MIN/MC&WC                       $132.00
2110609   21   WC SELECT DEBRID 15MIN                        $101.00
2110864   21   EVAL ESTAB/RE-EVAL 30MIN                      $211.00
2110930   21   WORK HARDENING ADDL 1HR                        $35.00
2110914   21   IONTOPHORESIS 15MIN                            $71.00
2110690   21   BFB MEASUR 15MIN/MCR                           $94.00
2110856   21   BFB TRAINING 60MIN                            $346.00
2110849   21   BFB TRAINING 30MIN                            $174.00
2110815   21   THER PROC GRP 120MIN/MCR                      $511.00
2110807   21   THER PROC GRP 90MIN/MCR                       $383.00
2110781   21   WORK HARDENING INIT 2HR                       $142.00
2110591   21   WHIRLPOOL,EXTREMITY                           $115.00
2110906   21   ULTRASOUND 15MIN                               $71.00
2111169   21   BFB TRAINING 45MIN                            $260.00
2110229   21   INITIAL EVALUATION 90MIN                      $648.00
2110245   21   THER PROC GRP 60MIN/MCR                       $256.00
2110278   21   INITIAL EVALUATION 45MIN                      $324.00


                                   Page 110 of 276
Charge #Dept   CDM Description                        Price
2110286   21   INITIAL EVALUATION 60MIN                       $431.00
2110294   21   INITIAL EVALUATION 75MIN                       $540.00
2110609   21   WC SELECT DEBRID 15MIN                         $101.00
2110476   21   ELEC STIM/TENS UNATTENDED                       $71.00
2110468   21   ELEC STIM/TENS ATT 15MIN                        $71.00
2110427   21   INITIAL EVAL PED 90MIN                         $703.00
2110385   21   INITIAL EVAL PED 45MIN                         $351.00
2110377   21   INITIAL EVAL PED 30MIN                         $234.00
2110369   21   INITIAL EVAL PED 15MIN                         $117.00
2110088   21   EVAL ESTAB/RE-EVAL 15MIN                       $105.00
2182285   21   COMMUN POOL GRP +15MIN/WC                        $4.00
2182236   21   *THER REC GROUP 60MIN*                         $245.00
2182228   21   *THER REC GROUP 45MIN*                         $184.00
2182210   21   *THER REC EVAL 60MIN*                          $421.00
2182202   21   *THER REC EVAL 45MIN*                          $252.00
2180834   21   *THER REC GROUP 120MIN                         $490.00
2180826   21   *THER REC GROUP 90MIN                          $367.00
2182152   21   COMMUN POOL GRP 30MIN/WC                        $10.00
2182137   21   *TR CASE CONF +15'/MC                           $49.00
2182095   21   *THER REC GRP 15MIN MC/WC                       $62.00
2182087   21   *THER REC GROUP 30MIN                          $122.00
2182079   21   *AQUATIC THER 15MIN/MCR*                        $72.00
2182053   21   *COMMUN SKILLS 15'MCR                           $72.00
2182046   21   *COMMUN SKILLS 30/MC&WC                        $144.00
2182038   21   *LEISURE SKILLS 15MIN/MCR                       $72.00
2182020   21   *LEISURE SKILLS 30MIN*                         $144.00
2182061   21   *AQUATIC THER 30MIN/MC&WC                      $145.00
2182004   21   *THER REC EVAL 30MIN*                          $211.00
2112886   21   MANUAL THERAPY 15MIN/MCR                        $83.00
2112894   21   ORTHOTIC FIT/TRNG+15'/MC                        $83.00
2112902   21   PROSTH TRNG+15MIN/MC&WC                         $83.00
2112910   21   FUNC ACT +15MIN/MC&WC                           $75.00
2112928   21   WC NON SELECT DEBRID 15'                        $94.00
2112936   21   WC NON-SEL DEBRID 30MIN                        $186.00
2112944   21   FUNC CAPACITY 15MIN/MCR                         $43.00
2112852   21   ISOKINETIC MEAS 15MIN                           $93.00
2112878   21   MANUAL THER MYOFAS/MC&WC                        $83.00
2112688   21   BFB MEASUR 30MIN/MC                            $186.00
2112993   21   AQUATIC THER+15'/MC&WC                          $94.00
2112696   21   BFB MEASUR 60MIN/WC                            $373.00
2112704   21   BFB MEASUR +15MIN/MC                            $94.00
2112712   21   HOME MGT(CHECK)15'/MCR                          $75.00
2112738   21   HOME MGT 15MIN ADDL/WC                          $75.00
2112753   21   COMMUN REINTEG+15MIN/MC                         $75.00
2112761   21   ADL TRNG+15MIN/MC&WC                            $75.00
2112597   21   SENSORY INTEGR 15MIN/MCR                        $75.00
2112605   21   SENSORY INTEGR 30'/MC&WC                       $119.00
2112845   21   ISOKINETIC MEASUR 60MIN                        $371.00
2112316   21   THER PROC GRP 45MIN/MCR                        $192.00
2113066   21   INIT EVAL PED+15MIN/MC                         $117.00
2113074   21   EVAL ESTAB/RE-EVAL 45MIN                       $252.00
2113082   21   EVAL ESTAB/RE-EVAL 60MIN                       $337.00
2113090   21   EVAL EST/RE-EVAL+15MIN                          $84.00
2113116   21   VASOPNEUMATIC DEVICE                            $56.00
2113124   21   FLUIDOTHERAPY                                   $56.00
2113132   21   KINETIC EX 15MIN/MCR                            $88.00
2113140   21   KINETIC EX 30MIN/MC&WC                         $141.00
2112860   21   MANUAL THER SFT TIS/MC&WC                       $83.00


                                    Page 111 of 276
Charge #Dept   CDM Description                        Price
2113041   21   NEUROMUSC REED+15'/MC&WC                        $83.00
2112613   21   SENSORY INTEG+15'/MC&WC                         $60.00
2113033   21   AQUATIC GRP 30MIN                              $119.00
2113025   21   AQUATIC GRP 60MIN/MCR                          $239.00
2112951   21   AQUATIC GRP 90MIN/MCR                          $358.00
2112969   21   AQUATIC GRP+15MIN/MC&WC                         $60.00
2112977   21   AQUATIC THERAPT 15MIN/MCR                       $94.00
2112985   21   AQUATIC THER 30MIN/MC&WC                       $186.00
2112746   21   BFB TRNG 15MIN AADL/MC                          $87.00
2113017   21   MANUAL THER-JNT MOB/MC&WC                       $83.00
2113157   21   THER EX 15MINADDL/MC&WC                         $75.00
2182327   21   *THER REC AQUATIC GRP 30'                      $115.00
2182384   21   *CASE CONF 30MIN/MC                             $98.00
2182376   21   *COMMUN SK +15MIN/MC&WC                         $72.00
2182368   21   *LEISURE SKILLS+15'/MC&WC                       $72.00
2182350   21   *AQUATIC THER+15MIN/MC&WC                       $72.00
2182335   21   *THER REC AQUAT GRP 60MIN                      $230.00
2112621   21   COGNITIVE TRNG +15'/MC&WC                       $75.00
2182319   21   *THER REC EVAL 15MIN/MC                         $84.00
2112720   21   HOME MGT 30MIN/MC&WC                           $149.00
2112639   21   CASE CONFERENCE 30MIN/MC                        $98.00
2182343   21   *TR AQUA GRP+15'/MC&WC                          $58.00
2165314   21   DPP COMMUNITY TRNG 15MIN                        $30.00
2165280   21   DPP ADL INTENS EVAL+15/MC                       $30.00
2165272   21   DPP ADL INTNS EVAL30'/MC                        $60.00
2165306   21   DPP MOB PRACT+15'/MC&WC                         $24.00
2165330   21   DPP COMMUN TRNG+15'/MC&WC                       $30.00
2165322   21   DPP COMMUN TRNG 30'/MC&WC                       $60.00
2165348   21   DPP TRAVEL TIME1WAY/ML/MC                        $2.00
2113165   21   WHIRLPOOL-EXT W/DEBRID                         $115.00
2165298   21   DPP MOB PRAC 30'/MC&WC                          $48.00
2110518   21   ISOKINETIC MEAS 15MIN/WC                        $93.00
2165611   21   DPP TRVL TIME-15MIN,2PEOP                       $26.00
2110534   21   IOSKINETIC MEAS 45MIN/WC                       $278.00
2110526   21   ISOKINETIC MEAS 30MIN/WC                       $185.00
2181113   21   *THER REC GRP 210MIN/MCR                       $686.00
2110955   21   THER PROC GRP 210MIN/MCR                       $716.00
2181121   21   *THER REC GRP 240MIN/MCR                       $784.00
2113199   21   AQUATIC GROUP 45MIN                            $179.00
2112324   21   THER PROC GROUP 180MIN                         $613.00
2112308   21   THER PROC GRP 30MIN MCR                        $102.00
2112282   21   THER PROC GRP 15MIN/MCR                         $51.00
2113181   21   AQUA GRP 30MIN MCR(DISTN)                      $119.00
2113173   21   AQUATIC GROUP 15MIN MCR                         $60.00
2180842   21   *THER REC GROUP 180MIN                         $588.00
2181105   21   *THER REC GRP 150MIN/MCR                       $490.00
2182418   21   *THER REC AQUATIC GRP 45                       $115.00
2110963   21   THER PROC GRP 240MIN/MCR                       $818.00
2110948   21   THER PROC GRP 150MIN/MCR                       $511.00
2113553   21   OT DEBR SELCT>20CM 15MIN                        $86.00
2113561   21   OT DEBR SELCT>20CM 30MIN                       $172.00
2113538   21   OT DEBR SELCT<20CM 15MIN                        $81.00
2113546   21   OT DEBR SELCT<20CM 30MIN                       $162.00
2200947   22   SPEECH EVAL PED 60MIN                          $469.00
2200921   22   SPEECH EVAL PED 30MIN                          $234.00
2200905   22   SPEECH GROUP 60MIN                             $256.00
2200715   22   SPEECH/LANG EVAL 90MIN                         $648.00
2200707   22   SPEECH/LANG EVAL 75MIN                         $540.00


                                    Page 112 of 276
Charge #Dept   CDM Description                        Price
2200665   22   SWALLOWING TREATMNT 60MIN                    $330.00
2200657   22   SWALLOWING TREATMNT 45MIN                    $248.00
2200632   22   SPEECH/LANG THERAPY 45MIN                    $224.00
2200616   22   SPEECH/LANG EVAL 60MIN                       $431.00
2200954   22   SPEECH EVAL PED 75MIN                        $586.00
2200582   22   SWALLOW EVAL VIDEO 60MIN                     $671.00
2200608   22   SPEECH/LANG EVAL 45MIN                       $324.00
2200640   22   SWALLOWING TREATMNT 30MIN                    $165.00
2200962   22   SPPECH EVAL PED 90MIN                        $562.00
2200913   22   SPEECH EVAL PED 15MIN                        $117.00
2200574   22   SWALLOW EVAL BEDSID 30MIN                    $234.00
2200061   22   AUDIO SCREEN                                   $75.00
2200095   22   SPEECH/LANG EVAL 30MIN                       $216.00
2200079   22   AUDIO-AIR AND BONE                           $218.00
2200046   22   SPEECH GROUP 45MIN                           $192.00
2200020   22   SPCH/LANG THER 15 MIN                          $75.00
2200012   22   SPCH/LANG/THER 30MIN                         $149.00
2200939   22   SPEECH EVAL PED 45MIN                        $351.00
2200541   22   SWALLOWING TREATMNT 15MIN                      $83.00
2200400   22   SPEECH/LANG EVAL 15MIN                       $109.00
2200038   22   SPEECH GROUP 30MIN                           $128.00
2200335   22   SPEECH/LANG THERAPY 60MIN                    $298.00
2201382   22   VOICE PROSTH TX 60MIN                        $298.00
2201325   22   SWALLOW EVAL VIDEO 75MIN                     $839.00
2201275   22   SWALLOW EVAL 45MIN                           $351.00
2201283   22   SWALLOW EVAL 60MIN(BED)                      $469.00
2201291   22   SWALLOW EVAL 75MIN(BED)                      $586.00
2200624   22   SWALLOW EVAL 90MIN (BED)                     $562.00
2201390   22   SPEECH GRP+15MIN/WC                            $64.00
2201374   22   VOICE PROSTH TX 45MIN                        $224.00
2201317   22   SWALLOW EVAL VIDEO 45MIN                     $504.00
2201366   22   VOICE PROSTH TX 30MIN                        $149.00
2201077   22   SWALLOW EVAL VIDEO 90MIN                    $1,006.00
2201309   22   SWALLOW EVAL VIDEO 30MIN                     $335.00
2201408   22   SPEECH GRP 15MIN/MCR                           $51.00
2201465   22   SPEECH GRP 240MIN/MCR                        $818.00
2201457   22   SPEECH GRP 210MIN/MCR                        $716.00
2201440   22   SPEECH GRP 180MIN/MCR                        $613.00
2201424   22   SPEECH GRP 120MIN/MCR                        $409.00
2201432   22   SPEECH GRP 150MIN/MCR                        $511.00
2201416   22   SPEECH GRP 30MIN(DISTINT)                    $102.00
2302156   23   ER CRITICAL CARE 30-74MIN                   $1,600.00
2302206   23   ER EMTALA MED SCRN EXAM                        $89.00
2302131   23   ER LEVEL 4                                   $711.00
2302164   23   ER LEVEL 1/ FOLLOWUP                         $134.00
2302149   23   ER LEVEL 5                                  $1,155.00
2302123   23   ER LEVEL 3                                   $415.00
2302115   23   ER LEVEL 2                                   $267.00
2302404   23   ER LEVEL 1                                   $178.00
2305589   23   ER LEVEL 1 / PMD                             $178.00
2306421   23   TIER I TRAUMA ACTIVATION                   $15,064.00
2301356   23   LR CPLX SC/ARM/LG ADD <5                     $178.00
2301349   23   AVULSION NAIL PLAT EA ADD                    $109.00
2301380   23   CHANGE GASTROSTOMY TUBE                      $303.00
2319465   23   REMOVAL FB FOOT SUBQ                         $587.00
2301406   23   I&D ABSC VULVA/PERINEAL                      $389.00
2301364   23   DRN ABSC FINGER SIMPLE                       $237.00
2301422   23   BLEPHARO DRN ABSC EYELID                     $459.00


                                    Page 113 of 276
Charge #Dept   CDM Description                       Price
2301398   23   I&D ABSC ISCHIO/PERIRECTL                     $1,890.00
2332278   23   INSERT NONTUN CV CATH <5                      $1,333.00
2332393   23   INSERT NONTUN CV CATH >5                      $1,333.00
2319457   23   TX DSLC JT I-P W/MAN CLSD                      $385.00
2319481   23   REMOVE CERUMEN IMPACTED                        $200.00
2319473   23   INSERT CATH BLADDER SMPL                         $89.00
2301414   23   I&D ABSC GLAND BARTHOLIN                       $389.00
2301372   23   TRANSFUS BLOOD/BLOOD COMP                      $527.00
2331924   23   REMOV/BIVALV CAST ARM/LEG                      $177.00
2331999   23   CNTRL NOSEBLEED POST SUBS                      $536.00
2331981   23   CNTRL NOSEBLEED POST INIT                      $357.00
2331973   23   CNTRL NOSEBLEED ANTR CPLX                      $536.00
2331965   23   CNTRL NOSEBLEED ANTR SMPL                      $357.00
2331957   23   REMOVAL FB NASAL                               $338.00
2331932   23   WINDOW CAST                                    $177.00
2331916   23   APPLY SPLINT SHORT LEG                         $421.00
2331908   23   APPLY SPLINT LONG LEG                          $421.00
2331890   23   APPLY CAST SHORT LEG WALK                      $421.00
2331882   23   APPLY CAST SHORT LEG                           $421.00
2331494   23   TX FX ANK DIST W/MAN CLSD                      $385.00
2331940   23   WEDGE CAST                                     $177.00
2332088   23   PERICARDIOCENTES INITIAL                       $877.00
2332161   23   ARTERIAL CATH/CANN PERC                          $59.00
2332153   23   ARTERIAL PUNCTURE                                $59.00
2332005   23   INTUBATION ENDOTRACHEAL                       $1,087.00
2332096   23   INSERT TEMP CARD ELECTROD                     $1,042.00
2332070   23   THORACOSTOMY TUBE                              $877.00
2332062   23   THORACENTESIS                                  $877.00
2332054   23   TRACHEOSTOMY EMERG CRICO                      $2,026.00
2332047   23   TRACHEOSTOMY EMERG TRANS                      $1,621.00
2331841   23   APPLY SPLINT FINGER STC                        $281.00
2332104   23   VENIPUNCTURE <3YR FEM/JUG                        $64.00
2331569   23   TX DISLC ANKLE CLOSED                          $385.00
2331635   23   TX FX METACARP W/MAN CLSD                      $385.00
2331627   23   TX FX METATARSAL CLOSED                        $385.00
2331601   23   TX FX TALUS W MANIP CLSD                       $350.00
2331544   23   TX DSLC TIBIOFIB JT CLSD                       $385.00
2331536   23   TX FX ANK TRIM W/MAN CLSD                      $385.00
2331528   23   TX FX ANKLE TRIMAL CLOSED                      $385.00
2331510   23   TX FX ANK BIML W/MAN CLSD                      $385.00
2331502   23   TX FX ANKLE BIMALL CLOSED                      $385.00
2331585   23   TX FX CALCANEAL CLOSED                         $385.00
2331833   23   APPLY SPLINT SHRT ARM STC                      $421.00
2331817   23   APPLY CAST HAND/FOREARM                        $421.00
2331783   23   TX DSLC JT INTERPHAL CLSD                      $385.00
2331767   23   TX DSLC JT METATARSO CLSD                      $385.00
2331643   23   TX FX GR TOE CLOSED                            $385.00
2331742   23   TX DSLC JT TARSOMETA CLSD                      $385.00
2331650   23   TX FX GR TOE W/MAN CLOSED                      $385.00
2331692   23   TX DSLC TARSAL BONE CLSD                       $385.00
2331676   23   TX FX PHAL W MANIP CLSD                        $264.00
2332195   23   CLOSE LAC MOUTH <2.5CM                         $587.00
2332179   23   ARTERIAL CATH/CANN CUTDWN                        $59.00
2332948   23   INJ ANTIBIOTIC IM                              $455.00
2332930   23   INJ TX/DX INTRAVENOUS                          $455.00
2332922   23   INJ TX/DX SUBQ/IM                              $455.00
2332252   23   PERITONEOCENTESIS INITIAL                      $877.00
2332336   23   INJ ANES NERVE PERIPHERAL                      $628.00


                                   Page 114 of 276
Charge #Dept   CDM Description                       Price
2332328   23   INJ ANES NERVE TRIGEMINAL                      $510.00
2332310   23   LUMBAR PUNCTURE DIAGNOSTC                      $723.00
2332302   23   VAGINAL DELIVERY                              $2,974.00
2332351   23   REM FB CONJUCTIV EMBEDDED                      $532.00
2332369   23   REM FB CORNEAL WO SLT LMP                      $639.00
2332245   23   ANOSCOPY DIAG                                    $75.00
2332237   23   ENUCLEA/EXCIS EXT HEMORHD                      $533.00
2332229   23   LR MOUTH/TONGUE POSTERIOR                      $705.00
2332211   23   LR MOUTH/TONGUE <2.5CM                         $587.00
2332203   23   CLOSE LAC MOUTH >2.5CM                        $1,061.00
2331809   23   APPLY CAST SHORT ARM                           $421.00
2332286   23   INSERT CATH BLADDER CPLX                       $178.00
2332443   23   GASTRIC INTUB/LAVAGE TMT                       $337.00
2332187   23   PLACE NDL INTRAOSSO INFUS                      $268.00
2332344   23   REM FB CONJUCTIV SUPERFIC                      $341.00
2332450   23   EMERG ROOM CPR                                $1,087.00
2332419   23   IV INFUS THER ADD HR MAX8                      $100.00
2332401   23   IV INFUSION THERPY 1ST HR                      $197.00
2332385   23   REM FB EXT AUD CANAL                           $251.00
2332377   23   REM FB CORNEAL W/SLT LMP                       $781.00
2332468   23   CARDIOVERSION                                 $1,087.00
2330579   23   LR INT NK/HND/FT 20-30CM                       $587.00
2330645   23   LR CPLX TRUNK 2-7.5CM                          $824.00
2330637   23   LR CPLX TRUNK 1-2.5CM                          $824.00
2330629   23   LR INT FACE/EAR 12-20CM                        $587.00
2330611   23   LR INT FACE/EAR 7.6-12CM                       $587.00
2330603   23   LR INT FACE/EAR 5-7.5CM                        $587.00
2330827   23   TX FX BONE NASAL CLSD WO                       $338.00
2330587   23   LR INT FACE/EAR <2.5CM                         $587.00
2330678   23   LR CPLX HD/HND/FT 1-2.5CM                      $705.00
2330561   23   LR INT NK/HND/FT 12-20CM                       $587.00
2330553   23   LR INT NK/HND/FT 7-12CM                        $587.00
2330546   23   LR INT NK/HND/FT 2-7CM                         $587.00
2331486   23   TX FX ANKLE DIST CLOSED                        $385.00
2330520   23   LR INT SCLP/TRNK 20-30CM                       $587.00
2331825   23   APPLY SPLINT LONG ARM                          $421.00
2330595   23   LR INT FACE/EAR 2-5CM                          $587.00
2330736   23   DRESS/DEBR BURN SMALL                          $427.00
2330819   23   ARTHROCENT JT MAJOR                            $510.00
2330801   23   ARTHROCENT INT JT/BURSA                        $415.00
2330793   23   ARTHROCENT SM JT/BURSA                         $344.00
2330769   23   REM FB MUSC/TENDON SMPL                        $587.00
2330652   23   LR CPLX SC/ARM/LG 1-2.5CM                      $705.00
2330744   23   DRESS/DEBR BURN MEDIUM                         $243.00
2330660   23   LR CPLX SC/ARM/LG 2-7.5CM                      $705.00
2330728   23   TX BURN 1ST DEG INITIAL                        $341.00
2330710   23   LR CPLX EYE/N/EAR 2-7.5CM                      $824.00
2330702   23   LR CPLX EYE/N/EAR 1-2.5CM                      $705.00
2330694   23   LR CPLX EYE/N/EAR <1.0CM                       $824.00
2330686   23   LR CPLX HD/HND/FT 2-7.5CM                      $705.00
2330488   23   LR INT SCLP/TRNK <2.5CM                        $587.00
2330751   23   DRESS/DEBR BURN LARGE                          $427.00
2330231   23   I&D CYST PILONIDAL SIMPLE                      $482.00
2330504   23   LR INT SCLP/TRNK 7-12CM                        $587.00
2330306   23   DEBR SKIN FULL THICKNESS                       $341.00
2330298   23   DEBR SKIN PART THICKNESS                       $289.00
2330280   23   ASP ABSC/HEMA/CYST/BULLA                       $251.00
2330272   23   I&D HEMATOMA/SEROMA/FLUID                     $1,333.00


                                   Page 115 of 276
Charge #Dept   CDM Description                         Price
2330264   23   I&R FB SUBQ COMPLEX                             $1,256.00
2330322   23   AVULSION NAIL PLATE SNGLE                        $184.00
2330249   23   I&D CYST PILONIDAL CPLX                         $1,333.00
2330330   23   EVAC HEMATOMA SUBUNGAL                           $178.00
2330223   23   I&D ABSCESS COMPLEX                              $482.00
2330215   23   I&D ABSCESS SIMPLE                               $385.00
2329159   23   TRAUMA CONSULT/EVAL                             $3,974.00
2329142   23   TIER II TRAUMA ACTIVATION                       $7,531.00
2330256   23   I&R FB SUBQ SIMPLEY                              $482.00
2330405   23   LR SMPL TRNK/NECK 12-20CM                        $468.00
2330538   23   LR INT NK/HND/FT <2.5CM                          $587.00
2330470   23   LR SMPL FACE/EAR 12-20CM                         $504.00
2330462   23   LR SMPL FACE/EAR 7-12CM                          $504.00
2330454   23   LR SMPL FACE/EAR 5-7CM                           $504.00
2330447   23   LR SMPL FACE/EAR 2-5CM                           $504.00
2330439   23   LR SMPL FACE/EAR <2.5CM                          $587.00
2330314   23   DEBR SKIN/SUBQ TISSUE                            $628.00
2330413   23   LR SMPL TRNK/NECK 20-30CM                        $468.00
2330496   23   LR INT SCLP/TRNK 2-7CM                           $587.00
2330397   23   LR SMPL TRNK/NECK 7-12CM                         $468.00
2330389   23   LR SMPL TRNK/NECK 2-7CM                          $468.00
2330371   23   LR SMPL TRNK/NECK <2.5CM                         $468.00
2330363   23   EXC SKIN NAIL FOLD                               $341.00
2330355   23   EXC NAIL & MATRIX                                $587.00
2330348   23   REPAIR NAIL BED                                  $587.00
2330421   23   LR SMPL TRNK/NECK >30CM                          $468.00
2331239   23   TX FX ULNAR STYLOID CLSD                         $385.00
2331304   23   TX DSLC HAND W/MAN CLSD                          $385.00
2331288   23   TX DSLC THUMB W/MAN CLSD                         $385.00
2331270   23   TX FX METACARP W/MAN CLSD                        $385.00
2331262   23   TX FX METACARPAL CLOSED                          $385.00
2331163   23   TX FX RADIUS/ULNA CLOSED                         $385.00
2331247   23   REPAIR HAND EXTENSOR                            $2,295.00
2331221   23   TX FX CARPAL W/MAN CLOSED                        $385.00
2331205   23   TX FX NAVICULAR CLOSED                           $385.00
2331197   23   TX FX DIST RAD W/MAN CLSD                        $385.00
2331189   23   TX FX DISTAL RADIAL CLSD                         $385.00
2331171   23   TX FX DIST RAD W/MAN CLSD                        $385.00
2331254   23   REPAIR FINGER EXTENSOR                          $2,295.00
2331395   23   TX FX PHAL DIS W/MAN CLSD                        $385.00
2331478   23   TX FX FIB SHFT W/MAN CLSD                        $385.00
2330512   23   LR INT SCLP/TRNK 12-20CM                         $587.00
2331452   23   TX FX ANK MALL W/MAN CLSD                        $385.00
2331437   23   TX FX TIB SHFT W/MAN CLSD                        $385.00
2331429   23   TX FX TIBIAL SHAFT CLOSED                        $385.00
2331320   23   TX DSLC MP W/MAN CLOSED                          $385.00
2331387   23   TX FX PHALANX DIST CLOSED                        $385.00
2331379   23   TX FX JT MP/IP W/MAN CLSD                        $385.00
2331361   23   TX FX JT M-P/I-P CLOSED                          $385.00
2331353   23   TX FX PHALANX W/MAN CLSD                         $385.00
2331346   23   TX FX PHALANX CLOSED                             $385.00
2331445   23   TX FX ANKLE MALL CLOSED                          $385.00
2331411   23   TX DSLC PATELLAR CLOSED                          $385.00
2330900   23   TX DSLC SHLDR W/MAN CLSD                         $385.00
2330983   23   TX FX HUM SUPR/TRAN CLSD                         $385.00
2330975   23   TX FX HUM SHFT W/MAN CLSD                        $385.00
2330967   23   TX FX HUMER SHAFT CLOSED                         $385.00
2330959   23   I&D UP ARM,ELB; BURSA                            $989.00


                                     Page 116 of 276
Charge #Dept   CDM Description                        Price
2330934   23   TX DLSC SHLDR W/MAN CLSD                        $385.00
2330991   23   TX FX HUM S-T W/MAN CLSD                        $385.00
2330868   23   TX FX CLAVICLE W/MAN CLSD                       $385.00
2330892   23   TX FX HUMER GR TUBER CLSD                       $385.00
2330876   23   TX FX HUMER PROX CLOSED                         $385.00
2330850   23   TX FX CLAVICLE CLOSED                           $385.00
2331155   23   TX FX ULNA W/MAN CLOSED                         $385.00
2331460   23   TX FX FIB SHFT PROX CLSD                        $385.00
2330926   23   TX DSLC/FX G-T W/MAN CLSD                       $385.00
2331106   23   TX FX ULNA PRX W/MAN CLSD                       $385.00
2331148   23   TX FX ULNA CLOSED                               $385.00
2331007   23   TX FX HUMER EPICOND CLSD                        $385.00
2331114   23   RPR FOREARM TENDN/MUSCL                        $2,526.00
2331130   23   TX FX RAD SHAFT DSLC CLSD                       $385.00
2331098   23   TX FX ULNA PROX CLOSED                          $350.00
2331080   23   TX FX RAD HD/NK W/MAN CLD                       $385.00
2331072   23   TX FX RADIAL HD/NCK CLSD                        $385.00
2331064   23   TX ELBOW CHILD W/MAN CLSD                       $385.00
2331056   23   TX FX ELBOW W/MAN CLOSED                        $385.00
2331049   23   TX DSLC ELBOW CLOSED                            $385.00
2331031   23   TX FX HUMER W/MAN CLOSED                        $385.00
2331023   23   TX FX HUMER CLOSED                              $385.00
2331015   23   TX FX HUM EPIC W/MAN CLSD                       $385.00
2331122   23   TX FX RADIAL SHAFT CLOSED                       $385.00
2333557   23   TX DIST FEM SEP CLOSED                          $325.00
2333391   23   REM FB ARM/ELBOW SUBQ                           $495.00
2333383   23   TX FX HUM G-T W/MAN CLSD                        $325.00
2333375   23   TX FX HUM PROX W/MAN CLSD                       $325.00
2333367   23   TX FX SCAPULA W/MAN CLSD                        $325.00
2333359   23   TX FX SCAPULA CLOSED                            $325.00
2333342   23   TX DSLC A-CLAV W/MAN CLSD                       $325.00
2333326   23   TX DSLC S-CLAV W/MAN CLSD                       $325.00
2333425   23   TX FX NAVICULR W/MAN CLSD                       $325.00
2333318   23   TX DSLC STERNOCLAV CLOSED                       $325.00
2333300   23   REMOVAL FB SHOULDER SUBQ                        $895.00
2333292   23   TX DSLC JAW CLOSED                              $325.00
2333284   23   TX FX MANDIB FIX CLOSED                        $1,495.00
2333276   23   TX FX MANDIB W/MANIP                            $695.00
2333334   23   TX DSLC ACROMIOCLAV CLSD                        $325.00
2333466   23   TX DSLC TRN-SC W/MAN CLSD                       $325.00
2333029   23   DEBR/REM FB SKIN/MUS/BONE                       $495.00
2333524   23   TX FX FEM SUPR/TRAN CLSD                        $325.00
2333516   23   TX FX FEMORAL SHAFT CLSD                        $325.00
2333508   23   REM FB PELVIS/HIP SUBQ                          $895.00
2333490   23   TX FX METACARPAL FIX CLSD                       $325.00
2333409   23   TX FX RAD SHFT W/MAN CLSD                       $325.00
2333474   23   TX DSLC LUNATE W/MAN CLSD                       $325.00
2333417   23   TX FX RAD/ULNA W/MAN CLSD                       $325.00
2333532   23   TX FX FEM SHFT W/MAN CLSD                       $325.00
2333458   23   TX DSLC RADULN W/MAN CLSD                       $325.00
2333540   23   TX FX FEM S-T W/MAN CLSD                        $325.00
2333441   23   TX DSLC CARPAL W/MAN CLSD                       $325.00
2333433   23   TX FX CARPAL CLOSED                             $325.00
2333268   23   TX FX MANDIB CLOSED                             $325.00
2333482   23   DRN ABSC FINGER COMPLEX                        $1,125.00
2332989   23   DEBR SKIN 10% SURFACE                           $301.00
2333078   23   LR SMPL FACE/EAR 20-30CM                        $495.00
2333060   23   EXC NAIL MATRIX REM PHAL                        $120.00


                                    Page 117 of 276
Charge #Dept   CDM Description                        Price
2333052   23   DEBRIDE NAIL 6 OR MORE                          $212.00
2333037   23   DEBR SKIN/SUBQ/MUSCLE                           $580.00
2333011   23   DEBR/REM FB SKIN/MUSCLE                         $495.00
2333045   23   DEBRIDE NAIL UP TO 5                            $169.00
2332997   23   DEBR SKIN EA ADD 10%                              $92.00
2333102   23   PACK WOUND DEHISCENCE                           $200.00
2332971   23   I&D WOUND POSTOP COMPLEX                       $1,125.00
2332963   23   ASP FINE NDL W/ IMAGING                         $301.00
2332955   23   ASP FINE NDL W/O IMAGING                        $212.00
2331718   23   ER EVIDENTIARY EXAM                             $865.00
2333565   23   TX DIS FEM SEP W/MAN CLSD                       $325.00
2322006   23   DEBR/REM FB SKIN/SUBQ                           $495.00
2333169   23   LR CPLX HD/HND/FT ADD <5                        $150.00
2333243   23   TX FX PALATAL/MAXILL FIX                        $325.00
2333235   23   TX FX ORBIT W/MANIP CLSD                       $1,495.00
2333227   23   TX FX ORBIT CLOSED                              $695.00
2333219   23   TX FX NASOMAXILLARY CLSD                        $325.00
2333201   23   TX FX NASAL SEPT CLOSED                        $1,495.00
2333193   23   INC ABS SOFT TISS SUPERFC                       $407.00
2333086   23   LR SMPL FACE/EAR >30CM                          $495.00
2333177   23   LR CPLX EYE/N/EAR ADD <5                        $150.00
2333094   23   CLOSE SMPL WOUND DEHISC                         $200.00
2333151   23   LR CPLX TRUNK ADD <5CM                          $150.00
2333144   23   LR INT FACE/EAR >30CM                           $695.00
2333136   23   LR INT FACE/EAR 20-30CM                         $495.00
2333128   23   LR INT NK/HND/FT >30CM                          $695.00
2333110   23   LR INT SCLP/TRNK >30CM                          $695.00
2333250   23   TX FX MANDIB/MAXILL CLSD                        $325.00
2333185   23   CLOSE WOUND LATE COMPLEX                       $1,495.00
2334670   23   CONSC SEDATION IV/IM/INH                        $526.00
2334548   23   SUTURE WND EYELID PAR THK                      $1,595.00
2334555   23   SUTURE WND EYELID FUL THK                      $1,695.00
2334563   23   REMOVAL FB EYELID EMBEDED                       $288.00
2334571   23   I&D LACRIMAL GLAND                              $387.00
2334589   23   I&D LACRIMAL SAC                               $1,495.00
2334597   23   DRN ABS/HEMA EXT EAR SMPL                       $200.00
2334605   23   DRN ABS/HEMA EXT EAR CPLX                      $1,125.00
2334613   23   DRN ABSC EXT AUD CANAL                          $200.00
2334621   23   ADMIN OTHER IMMUN VAC ONE                       $150.00
2334639   23   ADMIN OTHER IMMUN VAC ADD                         $75.00
2334647   23   INJ TX/DX INTRA-ARTERIAL                        $384.00
2334142   23   DRN ABSC PALATE/UVULA                           $288.00
2334662   23   DEBR NON-SELECTIV SESSION                       $975.00
2333854   23   VENIPUNCT >3YR PHY SKILL                          $54.00
2334688   23   CONSC SED ORAL/RECTL/NASL                       $526.00
2334266   23   CTRL NASOPH HEMR SMPL                           $301.00
2334258   23   CNTRL OROPHARY HEMR SMPL                        $301.00
2334241   23   SUTUR WOUND/INJUR PHARYNX                       $895.00
2334233   23   REMOVAL FB PHARYNX                              $285.00
2334225   23   I&D ABSC PERITONSILLAR                          $288.00
2334217   23   DRN ABSC SUBMAX EXTERNAL                        $288.00
2334522   23   LR CONJUNCT W/MOBIL/REARG                      $1,495.00
2334191   23   DRN ABSC PAROTID COMPLEX                       $1,495.00
2334167   23   LR PALATE >2CM                                 $1,495.00
2334159   23   LR PALATE <2CM                                  $495.00
2334381   23   INS PERITL CATH/CANN TEMP                      $1,300.00
2334514   23   LR CONJUNC DIRECT CLOSE                        $1,595.00
2334506   23   LUMBAR PUNCTURE THERA                           $610.00


                                    Page 118 of 276
Charge #Dept   CDM Description                        Price
2334498   23   DELIVERY OF PLACENTA                           $2,510.00
2334480   23   EPISIOTOMY VAGINAL REPAIR                      $1,495.00
2334472   23   REMOVE IUD                                      $208.00
2334464   23   I&D HEMOTOMA VAG NON-OB                        $1,125.00
2334456   23   I&D HEMOTOM VAG OB/POSTOB                      $1,125.00
2334449   23   COLPOCENTESIS                                   $328.00
2334423   23   CHG CYSTOSTOMY TUBE CPLX                        $950.00
2334431   23   DRN ABSC/CYST SKENE GLAND                      $1,495.00
2334415   23   CHG CYSTOSTOMY TUBE SMPL                        $256.00
2334530   23   LR CORNEA                                      $1,495.00
2334399   23   IRRIG/LAV/INSTL BLADDER                         $250.00
2333573   23   TX FX PATELLAR CLOSED                           $325.00
2334373   23   ANOSCOPY W/REMOVAL FB                          $1,250.00
2334365   23   HEMORRHOIDECTOMY SIMPLE                         $450.00
2334357   23   INC HEMORRHOID EXTERNAL                         $450.00
2334340   23   I&D ABSC PERIANAL SUPERFC                       $450.00
2334332   23   SIGMOIDOSCOPY W/REMOV FB                        $695.00
2334324   23   SIGMOIDOSCOPY FLEX                              $595.00
2334316   23   PROCTOSIGMOID W/REMOV FB                        $695.00
2334308   23   PROCTOSIGMOID RIGID                             $595.00
2334290   23   I&D ABSC RECTUM SUBMUCOSL                       $450.00
2334282   23   DRN ABSC PELVIC TRANSRCTL                       $450.00
2334274   23   PLACE NASO/OROGAS TUBE                          $256.00
2334183   23   DRN ABSC PAROTID SIMPLE                        $1,495.00
2334407   23   INSERT CATH BLADDER                               $75.00
2333797   23   WEDGE CLUBFOOT CAST                             $149.00
2333672   23   STRAPPING SHOULDER                              $237.00
2333607   23   TX DSLC KNEE CLOSED                             $325.00
2333615   23   TX FX CALCANEL W/MAN CLSD                       $325.00
2333862   23   VENIPUNCTURE VENOUS                               $30.00
2334134   23   REM FB BONE DENTOALVEOLAR                      $1,495.00
2333623   23   APPLY CAST LONG ARM                             $355.00
2334209   23   DRN ABSC SUBMAX INTRAORAL                       $288.00
2333631   23   APPLY CAST FINGER                               $237.00
2333839   23   VENIPUNCTURE <3YR SCALP                           $54.00
2333649   23   APPLY SPLINT FINGER DYN                         $237.00
2333821   23   INTRO NEEDLE VEIN                                 $30.00
2333896   23   VENIPUNCT CUTDOWN > AGE 1                         $50.00
2333805   23   THORACENTESIS INSRT TUBE                        $740.00
2333904   23   INS TUN CV CATH WO PORT<5                      $1,125.00
2333789   23   STRAP DENIS-BROWN SPLINT                        $237.00
2333755   23   STRAPPING UNNA BOOT                             $237.00
2333748   23   STRAPPING TOES                                  $237.00
2333656   23   STRAPPING THORAX                                $237.00
2333664   23   STRAPPING LOW BACK                              $237.00
2333730   23   STRAPPING ANKLE &/OR FOOT                       $237.00
2333722   23   STRAPPING KNEE                                  $237.00
2333714   23   STRAPPING HIP                                   $237.00
2333680   23   STRAPPING ELBOW OR WRIST                        $237.00
2333706   23   APPLY SPLINT SHRT ARM DYN                       $355.00
2333698   23   STRAPPING HAND OR FINGER                        $237.00
2333813   23   INS/REPL TEMP DUAL ELECTR                       $879.00
2334027   23   RPR LIP UP 1/2 VERTICAL                         $895.00
2324135   23   REM FB SOFT TISS DENTOALV                       $325.00
2334126   23   DRN ABSC DENTOALVEOLAR                          $288.00
2334118   23   LR MOUTH/TONGUE >2.6CM                          $895.00
2333581   23   TX FX TIBIAL PROX CLSD                          $325.00
2334100   23   I&D EXTRAORAL SUBLINGUAL                        $288.00


                                    Page 119 of 276
Charge #Dept   CDM Description                        Price
2334092   23   I&D INTRAORAL SUBLINGUAL                     $288.00
2334084   23   I&D INTRAORAL LINGUAL                       $1,495.00
2334076   23   REM FB EMBED MOUTH CPLX                      $895.00
2334068   23   REM FB EMBED MOUTH SMPL                      $285.00
2334050   23   DRN ABSC/CYST MOUTH CPLX                     $895.00
2333888   23   VENIPUNCT CUTDOWN < AGE 1                      $50.00
2334035   23   RPR LIP COMPLEX                              $895.00
2333847   23   VENIPUNCTURE <3YR VEIN                         $54.00
2334019   23   RPR LIP FULL THICK                           $895.00
2333599   23   TX FX SPINE INTERCND CLSD                    $325.00
2334001   23   REPL PICC WO PORT                           $1,125.00
2333995   23   REPL NOTUN CV CATH WO PRT                   $1,125.00
2333987   23   INS PICC WO PORT/PUMP>5YR                   $1,125.00
2333979   23   INS PICC WO PORT/PUMP<5YR                   $1,125.00
2333961   23   INS TUN CVAD 2CATH W PORT                   $1,125.00
2333953   23   INS TUN CVAD 2CATH WO PRT                   $1,200.00
2333946   23   INS TUNNEL CVAD W PUMP                      $1,200.00
2333938   23   INS TUNNEL CVAD W PORT>5                    $1,200.00
2333920   23   INS TUNNEL CVAD W PORT<5                    $1,200.00
2333912   23   INS TUN CV CATH WO PORT>5                   $1,125.00
2334043   23   DRN ABSC/CYST MOUTH SMPL                     $395.00
2800811   28   PULMONARY VALVE PLASTY                      $7,768.00
2800985   28   ICD LEAD EVAL @ IMPLANT                     $1,590.00
2800878   28   RTLT HRT CATH EXIST SEPTL                   $5,609.00
2800894   28   RT&LT HRT CTH CONGEN ANAM                   $5,609.00
2800910   28   PA ANGIO INJECTION                           $363.00
2800928   28   RV OR RA INJECTION                           $363.00
2800936   28   IC DOPPLER INITIAL VESSEL                    $363.00
2800944   28   IC DOPPLER, ADD VESSEL                       $363.00
2800951   28   INTRATRL CMM CLSR PERCUT                    $5,797.00
2800860   28   LHC VIA LT VENT PUNCTURE                    $5,609.00
2800977   28   3D MAPPING OF TACHYCARDIA                   $1,640.00
2800886   28   RHC/CONGENITAL ANOMALY                      $5,609.00
2801009   28   ICD LD&GEN EVAL @ IMPLANT                   $1,590.00
2801017   28   TILT TABLE TEST                              $584.00
2801025   28   INTRACARDIAC ECG DUR EPS                    $4,189.00
2801033   28   PCR/DUAL CHAMB ANAL&REPRO                    $366.00
2801041   28   CARDIOVAS PROC, UNLISTED                    $1,304.00
2801058   28   CLSR DEVICE POST INTERVNT                    $481.00
2801066   28   RENAL ANGIO W/CATH                           $869.00
2801074   28   ILIAC ANGIO W/CATH                           $869.00
2801082   28   DES SINGLE VESSEL(MCARE)                   $10,753.00
2801090   28   DES ADD VESSEL(MCARE)                        $577.00
2800969   28   VSD CLSR(CONGEN)PERCUTAN                    $5,797.00
2800738   28   CARDIAC SURGERY, UNLISTED                   $1,304.00
2800654   28   PCR/ICD RARV LD REPOSITN                    $3,312.00
2800662   28   VNT LD PLACE(LT) EXIST GN                   $2,324.00
2800670   28   VNT LD PLACE(LT) GEN INS                    $2,981.00
2800688   28   VENT LEAD REPOSITION (LT)                   $2,485.00
2800696   28   ICD AND LEAD INSERT                         $7,452.00
2800704   28   IMPLANT LOOP RECORDER                       $4,969.00
2800712   28   REMOVE LOOP RECORDER                        $2,485.00
2800902   28   RHC & TRANSEPTAL LHC                        $5,609.00
2800720   28   IABP REMOVAL                                $2,718.00
2800852   28   COR ARTERIOGRAM W/O LHC                     $2,718.00
2800795   28   AORTIC VALVE PLASTY                         $7,768.00
2800845   28   TEE REAL-TIME MONITORING                    $1,007.00
2800837   28   PA ANGIOPLASTY ADD VESSEL                   $3,013.00


                                    Page 120 of 276
Charge #Dept   CDM Description                       Price
2800829   28   PA ANGIOPLASTY, INIT VESS                  $4,198.00
2800803   28   MITRAL VALVE PLASTY                        $7,768.00
2800787   28   IVUS, ADD VESSEL                           $3,013.00
2800779   28   IVUS, INITIAL VESSEL                       $4,198.00
2800761   28   IV INFUSION, THROMBOLYSIS                   $869.00
2800753   28   BRACHYTHERAPY, CORONARY                    $5,797.00
2800746   28   THROMBECTOMY, CORONARY                     $1,304.00
2820074   28   COR ATHEREC SNGL VSL LD                    $7,768.00
2820066   28   COR ATHEREC SNGL VSL LC                    $7,768.00
2820041   28   PTCA EA ADDL VESSEL LD                      $602.00
2820033   28   PTCA EA ADDL VESSEL LC                      $602.00
2820058   28   PTCA EA ADDL VESSEL RC                      $602.00
2820082   28   COR ATHEREC SNGL VSL RC                    $7,768.00
2820090   28   COR ATHER EA ADD VSL LC                     $481.00
2820108   28   COR ATHEREC ADDL VSL LD                     $481.00
2820116   28   COR ATHEREC EA VSL RC                       $481.00
2820124   28   IC STENT PLC SNG VSL LC                   $14,663.00
2820025   28   PTCA SINGLE VESSEL RC                      $9,710.00
2820165   28   IC STENT PLC EA ADDL LD                     $577.00
2803450   28   IMAGE S&I REPORT CARD CAT                   $750.00
2820132   28   IC STENT PLC SGL VSL LD                   $14,663.00
2804011   28   LEFT VENT ANGIO INJECT                      $295.00
2820330   28   HYPAQUE 60-50ML BTL                         $122.00
2803666   28   CORONARY THROMBOLYSIS                      $1,040.00
2803955   28   CORONARY,SELECTIVE ANGIO                    $729.00
2820017   28   PTCA SINGLE VESSEL LD                      $9,710.00
2804235   28   CARDIAC OUTPUT SUBSEQUENT                   $162.00
2804243   28   TEMP TRANSCUTANOUS PACING                   $356.00
2804318   28   CARD OUTPUT THERMAL                         $372.00
2804482   28   PERICARDIOCENTESIS                         $3,399.00
2812428   28   CARDIOVERSION, EXTERNAL                    $1,087.00
2820009   28   PTCA SINGLE VESSEL LC                      $9,710.00
2803468   28   IMAGE S&I REPORT VESSELS                   $1,189.00
2820496   28   COMP EPS W/LT VENT RECORD                  $3,351.00
2820314   28   REPOS/REPLC DUAL LEAD                      $2,981.00
2820421   28   REMOVAL AICD GENERATOR                     $2,485.00
2820447   28   REMOVE AICD SYSTM NONTHOR                  $3,312.00
2820454   28   INSERT AICD LEAD NONTHORO                  $3,312.00
2820405   28   PACER ELEC REMOV DUAL                      $2,981.00
2820488   28   COMP EPS W/LT ATR RECORD                   $3,351.00
2820389   28   PACER ELEC REMOV SNGL                      $2,485.00
2820504   28   STIM/OACE POST IV DRG INF                  $2,317.00
2820512   28   EPS DEFIB EVALUATION                       $1,988.00
2830396   28   LEFT HEART CATH/CUTDWN                     $5,609.00
2820140   28   IC STENT PLC SGL VSL RC                   $14,663.00
2820470   28   INSERT PACER FLUORO S&I                     $414.00
2820298   28   PACER SYSTEM UPGRADE                       $7,452.00
2820223   28   INSERT PERM PACER ATRIAL                   $7,452.00
2820231   28   INSERT PERM PACER VENT                     $9,316.00
2820249   28   INSERT PERM PACE ATR/VENT                 $10,972.00
2820256   28   INSERT TEMP PACER SINGLE                   $1,042.00
2820264   28   INSERT TEMP PACER DUAL                     $1,077.00
2820413   28   INSERT/REPLACE AICD GEN                    $9,316.00
2820280   28   INSERT PACER GENERTR DUAL                  $5,797.00
2820215   28   CPR                                        $1,087.00
2820306   28   INSERT/REPLAC ELEC SGL                     $3,107.00
2820322   28   REPAIR PMKR ELEC SNGL                      $2,485.00
2820348   28   REPAIR PACER ELECTRD DUAL                  $2,485.00


                                   Page 121 of 276
Charge #Dept   CDM Description                        Price
2820355   28   REVISE/RELOC PACER POCKET                   $2,485.00
2820363   28   REVISE/RELOC AICD POCKET                    $2,485.00
2820371   28   PACER PULS GEN REMOV                        $3,107.00
2820272   28   INSERT PACER GENERATR SGL                   $4,969.00
2800589   28   EP RT VENT RECORDING                         $409.00
2800415   28   EP COMPLETE W/INDUCT                        $9,963.00
2800464   28   STENT ADDL VESSEL                            $506.00
2800522   28   EP COMPLETE,NO INDUCTION                    $4,425.00
2800530   28   EP ABLATION,AVN                             $7,945.00
2800209   28   CORON ANGIO EA ADD VESSEL                    $506.00
2800571   28   EP INTRA A MAPPING                           $327.00
2800175   28   AORTOGRAPHY                                  $295.00
2800597   28   EP INTRA VENT PACING                         $570.00
2800605   28   EP HIS BUNDLE RECORDING                      $956.00
2800613   28   EP LT VENT RECORDING                         $409.00
2800621   28   EP FOLLOWUP DRUG TEST                       $3,184.00
2800639   28   EP INTRA ATRIAL PACING                       $570.00
2800647   28   EP EVAL,AICD                                $2,050.00
2800555   28   EP ABLATION,VT                             $12,837.00
2820173   28   IC STENT PLC EA ADDL RC                      $722.00
2800019   28   RT&LT HEART CATH                            $9,459.00
2800027   28   LEFT HEART CATH                             $5,273.00
2800407   28   STENT PLACEMENT TRANSCATH                  $13,441.00
2800563   28   EP INTRA A/V MAPPING                       $11,003.00
2800084   28   LEFT HEART CATH                             $8,414.00
2800118   28   PERC ATHERECT ADD VESSEL                     $404.00
2800126   28   PERC COR ATHERECTOMY                       $10,682.00
2800159   28   CORONARY ANGIOPLASTY                       $10,682.00
2800035   28   RIGHT HEART CATH                            $3,399.00
2801462   28   VISIPAQUE-320 50ML                           $385.00
2801470   28   VISIPAQUE-320 100ML                          $512.00
2801488   28   VISIPAQUE-320 150ML                          $512.00
2801496   28   VISIPAQUE-320 200ML                          $552.00
2803013   28   SWAN GANZ PLACEMENT                         $1,360.00
2801454   28   CONRAY-60 50ML                               $104.00
2801207   28   HEXABRIX - 320 50ML                          $352.00
2803039   28   TRANSEPT/RETRO LT HT CATH                   $5,609.00
2800548   28   EP ABLATION,SVT                            $11,003.00
2803104   28   OPACIFICATION OF IMA                         $454.00
2803112   28   GRAFT STUDY                                  $729.00
2803021   28   ENDOMYOCARDIAL BIOPSY                       $3,399.00
2801249   28   OMNIPAQUE 350 - 2500ML                       $598.00
2803054   28   INSERTION IAPB CATH                         $3,399.00
2801447   28   OPTIRAY-350 150ML                            $468.00
2801215   28   OMNIPAQUE - 350 50ML                         $212.00
2801231   28   OMNIPAQUE-350 150ML                          $583.00
2801306   28   HEXABRIX-320 150ML                           $562.00
2801421   28   OPTIRAY-350 50ML                             $357.00
2801314   28   HEXABRIX-320 100ML                           $468.00
2801223   28   OMNIPAQUE-350 100ML                          $421.00
2801439   28   OPTIRAY-350 100ML                            $562.00
2820520   28    IC STENT PLACEMENT EA AD                    $290.00
2820553   28   PTA-FEMORAL-POPLITEAL                       $1,249.00
2820561   28   PTA-BRACHIOCEPH TRUNK/BRA                   $1,566.00
2820579   28   THROMBECTOMY OF GRAFT                       $4,491.00
2820587   28   CTH PLC INTRVSC STNT-INIT                   $1,073.00
2820603   28   CTH PLC INTRVSC STNT-ADD'                    $535.00
2820611   28   IVUS NON-CORONARY ADD'T V                   $2,245.00


                                    Page 122 of 276
Charge #Dept   CDM Description                         Price
2820629   28   PLAC IVC FILTER                                  $644.00
2820546   28   PTA-ILIAC                                       $1,045.00
2820538   28   PTA-RENAL/VISCERAL                              $1,666.00
2820595   28   IVUS NONCORONARY INIT'L V                       $4,491.00
2902153   29   CARDIAC INIT EVAL OP 120M                        $383.00
2902112   29   CARDIAC INPT EVAL                                $275.00
2902120   29   DISCHG W/HOME PRGM EVAL                          $412.00
2905099   29   GRP MONITORED THER EX 60'                        $167.00
2904019   29   CARDIAC FINAL EVAL W/RPT                         $137.00
2905008   29   CARDIAC INIT EVAL OP 90MI                        $329.00
2904936   29   CARDIAC INIT EVAL O/P 30                         $137.00
2904910   29   CARDIAC INIT EVAL O/P 60                         $275.00
2904027   29   CARDIAC INTERIM EVAL                             $137.00
4100301   41   DAY TX PHP FULL DAY/ADULT                        $300.00
4102182   41   O.T. PHP ADULTHERAPY                               $64.00
4102190   41   GROUP TX PHP ADULT                               $168.00
4100319   41   DAY TRT PHP 1/2DAY ADULT                         $150.00
4100095   41   FAMILY TX PHP ADULT                              $106.00
4100038   41   PHARMACOLOGIC MGT ADULT                            $69.00
4100020   41   IND TX PHP 30MIN ADULT                             $65.00
4100012   41   IND TX PHP 1HR ADULT                               $90.00
4150108   41   CONJOINT/FAMILY ADOL OPT                           $90.00
4150512   41   ADOLESCENT HALF DAY PHP                          $150.00
4150405   41   MULTI FAMILY GROUP ADOL                            $30.00
4155818   41   ADOLESCENT FULL DAY PHP                          $300.00
4155115   41   GROUP TX OPT 60MIN ADOL                            $24.00
4105292   41   ACT.THERAPY ADULT OPT                            $275.00
4105284   41   EDUCATION TRNG ADULT OPT                         $275.00
4105177   41   ED TRAINING PHP(ADULT)                           $275.00
4105144   41   ACTIVITY TX PHP ADULT                              $70.00
4105102   41   DIAGNOSTIC INTERVIEW ADU                         $260.00
4105110   41   IND TX OPT30 MIN.ADULT                             $65.00
4105037   41   GROUP TX OPT 60MIN ADULT                         $196.00
4105029   41   GRP TX OPT 90MIN ADULT                             $95.00
4105011   41   IND TX OPT 50MIN ADULT                             $90.00
4105094   41   CONJOINT/FAM TX OPT/ADUL                           $90.00
4400081   44   ED CRISIS TM CNSLT 80MIN                         $326.00
4400065   44   ED CRISIS TM CNSLT 40MIN                         $178.00
4400024   44   CRISIS TEAM CONSULT 40MIN                        $178.00
4400032   44   CRISIS TEAM CONSULT 60MIN                        $249.00
4400073   44   ED CRISIS TM CNSLT 60MIN                         $249.00
4400057   44   ED CRISIS TM CNSLT 30MIN                         $118.00
4400016   44   CRISIS TEAM CONSULT 30MIN                        $118.00
4400040   44   CRISIS TEAM CONSULT 80MIN                        $326.00
4510293   45   O/P GROUP THERAPY 75MIN                          $210.00
4500294   45   GROUP THERAPY 75MIN                              $210.00
4510608   45   O/P PSYCH TESTING 30MIN                          $139.00
4510558   45   O/P PSYCH TESTING 60MIN                          $278.00
4510475   45   O/P PSYCH EVAL 30MIN                             $130.00
4510459   45   O/P PSYCH EVALUATON 60MIN                        $260.00
4510301   45   O/P GROUP THERAPY 60MIN                          $168.00
4510277   45   O/P CONJOINT THER 30MIN                          $105.00
4510202   45   O/P FAMILY THERAPY 60MIN                         $210.00
4510103   45   O/P INDIVID THER 20-30MIN                        $105.00
4510251   45   O/P CONJOINT THER 60MIN                          $210.00
4510152   45   O/P INDIVID THERAPY 50MIN                        $210.00
4500179   45   INDIVIDUAL THERAPY 15MIN                           $53.00
4500328   45   GROUP THERAPY 30MIN                                $84.00


                                     Page 123 of 276
Charge #Dept   CDM Description                        Price
4500302   45   GROUP THERAPY 60MIN                            $168.00
4500286   45   CONJOINT THERAPY 15MIN                          $53.00
4500252   45   CONJOINT THERAPY 60MIN                         $210.00
4500450   45   PSYCH EVAL 60MIN                               $260.00
4500203   45   FAMILY THERAPY 60MIN                           $210.00
4500278   45   CONJOINT THERAPY 30MIN                         $105.00
4500153   45   INDIVIDUAL THERAPY 50MIN                       $210.00
4500104   45   INDIVIDUAL THER 20-30MIN                       $105.00
4500229   45   FAMILY THERAPY 30MIN                           $105.00
4500237   45   FAMILY THERAPY 15MIN                            $53.00
4500476   45   PSYCH EVAL 30MIN                               $130.00
4510228   45   O/P FAMILY THERPAY 30MIN                       $105.00
4500609   45   PSYCH TESTING 30MIN                            $139.00
4500559   45   PSYCH TESTING 60MIN                            $278.00
4500542   45   NEUROPSYCH TESTING 30MIN                       $147.00
4500534   45   NEUROPSYCH TESTING 60MIN                       $294.00
5180054   51   EH E/M ESTAB PT FU MOD                         $110.00
5180021   51   EH E/M NEW PT LIMITED                           $95.00
5180070   51   PRE-PLACEMENT PHYSICAL                          $50.00
5180047   51   EH E/M ESTAB PT FU LIMIT                        $95.00
5180039   51   EH E/M NEW PT MODERATE                         $110.00
5180096   51   FIT FOR LIFE - INITIAL                          $20.00
5180104   51   FIT FOR LIFE - FOLLOW UP                        $10.00
5180013   51   EMPLOYEE-WOUND CHECK                            $70.00
5180062   51   EMPLOYEE-RECHECK                                $91.00
5180088   51   EMPLOYEE-INIT CHECK                            $110.00
5180112   51   WORK CAP EVAL-4HRS                             $600.00
5180120   51   WORK CAP EVAL-DAY 2                            $325.00
5180138   51   REPORT FEE                                     $150.00
5180146   51   CANCELLATION FEE                               $225.00
5180153   51   WORK CAP EVAL-6TO8HRS                          $800.00
5180294   51   ERGONOMIC EVAL INIT HR                         $110.00
5180302   51   ERGONOMIC EVAL ADD 15MIN                        $28.00
5180310   51   ERGONOMIC RPT INIT HR                           $83.00
5180328   51   ERGONOMIC RPT ADD 15MIN                         $44.00
5180336   51   TRAVEL 30 MINUTES                               $28.00
5700539   57   DIAB.EDUC CLASS SERIES                         $604.00
5700521   57   GROUP CLASS SESSION O/P                         $92.00
5702006   57   PSYCHOSOCIAL EVAL II                           $164.00
5700513   57   SURVIVAL SKILLS CLASS                          $462.00
5701008   57   NUTRITION CONSULT,COMP I                       $220.00
5701024   57   NUTRITIONAL CONSULT II                          $96.00
5702014   57   PSYCHOSOCIAL EVAL I                            $134.00
5702022   57   COUNSELING INDIVIDUAL II                       $134.00
5702030   57   COUNSELING INDIVIDUAL I                         $92.00
5701016   57   NUTRITIONAL CONSULT III                        $129.00
5700190   57   INSULIN ADMIN&HYPOGLYCEMI                      $220.00
5702055   57   COUNSELING CPL/FAMILY II                       $134.00
5702063   57   COUNSELING COUPLE/FAM I                         $92.00
5700133   57   FOLLOW-UP VISIT                                $106.00
5700141   57   BRIEF DIAB F/U VISIT                            $66.00
5700158   57   STRESS MGMT TRAINING OTHE                      $111.00
5700208   57   POST DISCHARGE F/U VISIT                        $96.00
5700216   57   BRIEF NUT FOLLOW-UP VISIT                       $52.00
5700224   57   LAST RESORT BEFRE INS CLS                      $348.00
5700232   57   BEGINNING INSULIN CLASS                        $303.00
5700323   57   COMP. INIT NURSG CONSULT                       $220.00
5700331   57   EXTENDED NURSING CONSULT                       $113.00


                                    Page 124 of 276
Charge #Dept   CDM Description                        Price
5700349   57   INTERMED NURSING CONSULT                        $129.00
5700166   57   BLOOD GLUCOSE TRAINING                          $148.00
5703079   57   DIABETES/PREG COUPLE COUN                       $134.00
5702048   57   COUNSELING CPL/FAMILY III                       $193.00
5703061   57   DIABETES/PREG FOLLOW-UP                           $77.00
5703053   57   DIAB/PREG NUTRIT INTERMED                       $111.00
5703046   57   DIAB/PREG NUTRITIONAL III                       $134.00
5703038   57   DIABETES/PREG NUTRITION I                       $220.00
5703020   57   DIABETES/PREG INTER CNSLT                       $111.00
5703012   57   DIABETES/PREG EXT CONSULT                       $134.00
5703004   57   DIABETES/PREG INIT CONSLT                       $164.00
5702071   57   PSYCHOSOCIAL EVAL III 30"                         $92.00
6714703   67   ABSESS DRAIN.SUPPLIES                          $1,161.00
6714513   67   CT INJECTION SUPPLIES                             $64.00
7195100   71   E/M CONSULT FOCUSED(2ND)                        $750.00
7195266   71   EXCISION 0.6-1.0CM                             $1,275.00
7195175   71   BIOPSY SKIN SQ                                  $360.00
7195183   71   ECC                                             $525.00
7195191   71   COLPOSCOPY                                      $968.00
7195209   71   CATHETERIZATION-SIMPLE                          $375.00
7195217   71   CATHETERIZATION-COMP                            $555.00
7195225   71   DRAIN LYMPH-SIMPLE                              $750.00
7195233   71   E/M FOCUSED EXAM(EST PT)                          $45.00
7195084   71   E/M COMP EX MOD(CNSLT)                         $1,049.00
7195258   71   EXCISION UP TO 0.5CM                            $870.00
7195142   71   BIOPSY CERVICAL                                 $360.00
7195274   71   EXCISION 1.1-2.2CM                             $1,950.00
7195282   71   EXCISION >2.O CM                               $3,600.00
7195290   71   BX ABD/RETRO PERC NDL                          $1,050.00
7195308   71   E/M DETAIL EXAM(EST PT)                         $162.00
7195316   71   E/M EXPAND EXAM(EST PT)                           $86.00
7195324   71   E/M COMP EXAM(EST PT)                           $269.00
7195241   71   BIOPSY ENDOMETRIAL                              $525.00
7195001   71   E/M FOCUSED EXAM(NEW PT)                          $90.00
7195019   71   E/M EXPANDED EXAM(NEW PT)                       $189.00
7195027   71   E/M DETAILED EXAM(NEW PT)                       $275.00
7195167   71   BIOPSY VULVA                                    $360.00
7195043   71   E/M COMP EXAM COMP(NEW PT                       $726.00
7195159   71   BIOPSY VAGINAL SMPLE                            $360.00
7195332   71   DRAIN LYMPH-EXT                                $1,950.00
7195068   71   E/M EXP EXAM(CONSULT)                           $450.00
7195076   71   E/M DETAILED EX(CNSLT)                          $645.00
7195092   71   E/M COMP EX COMP(CNSLT)                        $1,371.00
7195118   71   E/M CONSULT DETAILED(2ND)                       $975.00
7195126   71   E/M CONSULT COMP MOD(2ND)                      $1,125.00
7195134   71   E/M CONSULT COMP COM(2ND)                      $1,275.00
7700990   77   GUEST TRAY                                        $20.00
7700065   77   DIABETES&PREG. ED                               $276.00
7700057   77   O/P NUTR.CONSULT FL/UP                            $91.00
7700016   77   O/P NUTR.CONSULT INIT                           $194.00
8040446   80   NEUROMUSC RE-ED 30" MC&WC                       $132.00
8040453   80   NEUROMUSC RE-ED 15" ADD                           $66.00
8040461   80   THER PROC GRP INIT 30MIN                        $112.00
8040933   80   BIO FEEDBACK 15MIN ADD/MC                         $75.00
8040479   80   THER PROC GRP ADD 15MIN                           $51.00
8040529   80   THER PROC GRP 120MIN/MCR                        $447.00
8040511   80   THER PROC GRP 90MIN/MCR                         $307.00
8040495   80   THER PROC GRP 60MIN/MCR                         $224.00


                                    Page 125 of 276
Charge #Dept   CDM Description                        Price
8040438   80   NEUROMUSCUL RE-ED 15" MCR                       $75.00
8040370   80   KINETIC EXER 15MIN/MCR                          $70.00
8040487   80   THER PROC GRP 45MIN/MCR                        $168.00
8040537   80   THER PROC GRP 240MIN/MCR                       $895.00
8040313   80   VASOPNEUMATIC DEVICE                            $56.00
8040198   80   EVAL ESTAB/RE-EVAL 30MIN                       $168.00
8040255   80   EVAL EST/REEVAL 45" MCRWC                      $252.00
8040263   80   EVAL EST/REEVAL 60" MCRWC                      $337.00
8040271   80   EVAL EST/REEVAL 15"ADD MC                       $84.00
8040982   80   BIO FEEDBACK TRNG 45MIN                        $208.00
8040974   80   BIO FEEDBACK TRNG 30MIN                        $138.00
8040966   80   HOME MGT(CHECK)15 ADD/WC                        $60.00
8040958   80   HOME MGT(CHECK)30MIN/MCWC                      $119.00
8040289   80   *HOT/COLD PACKS                                 $62.00
8040396   80   THER EXER 15MIN/MCR                             $68.00
8040305   80   ELEC STIM/TENS UNATTENDED                       $71.00
8040420   80   THER EXER 15MIN ADD/MC&WC                       $60.00
8040321   80   WHIRLPOOL, EXTREMITY                            $92.00
8040941   80   HOME MGT(CHECK) 15MIN/MCR                       $60.00
8040339   80   WHIRLPOOL EXT W/DEBRIDE                        $109.00
8040347   80   ELEC STIM/TENS ATT 15MIN                        $71.00
8040354   80   IONTOPHORESIS 15MIN                             $71.00
8040362   80   ULTRASOUND 15MIN                                $71.00
8040834   80   WOUND CARE SEL DEBRID 30"                      $162.00
8040388   80   KINETIC EXER 30MIN MC&WC                       $141.00
8040925   80   BIO FEEDBK MEASUR 60" WC                       $298.00
8040412   80   THER EXER 30MIN/MC&WC                          $119.00
8040297   80   MECHANICAL TRACTION                             $71.00
8040727   80   ORTHOTIC FIT/TRN 30" MCWC                      $132.00
8040842   80   WOUND CA NON-SEL DEB 15"                        $75.00
8040792   80   WHEELCHAIR TRN/MGT 15"MCR                       $60.00
8040784   80   FUNC ACT 15MIN ADD MC&WC                        $60.00
8040776   80   FUNC ACTIVITY 30MIN/MC&WC                      $119.00
8040743   80   FUNCTION ACTIVITY 15" MCR                       $75.00
8040586   80   AQUATIC THERAPY 15MIN/MCR                       $94.00
8040560   80   AQUATIC GRP 60MIN/MCR                          $298.00
8040735   80   ORTHOTIC FIT/TRN 15" ADD                        $66.00
8040552   80   AQUATIC GRP 30MIN                              $149.00
8040719   80   ORTHOTIC FIT/TRN 15" MCR                        $75.00
8040701   80   MANUAL THERAPY 15MIN/MCR                        $83.00
8040693   80   MASSAGE 30MIN/MC&WC                             $60.00
8040685   80   MASSAGE 15MIN/MCR                               $75.00
8040677   80   AQUATIC THER 15 ADD MC&WC                       $75.00
8050221   80   *THER REC LEISR SKL 30MIN                      $115.00
8040180   80   INITIAL EVAL 15MIN ADD/MC                       $86.00
8040594   80   AQUATIC THER 30MIN/MC&WC                       $149.00
8040834   80   WOUND CARE SEL DEBRID 30"                      $162.00
8040909   80   BIO FEEDBK MEAS 15"/MCR                         $75.00
8040891   80   ISOKINETIC MEASURMENT WC                       $371.00
8040883   80   ISOKINETIC MEASURMNT 15"                        $93.00
8040875   80   FUNCTIONAL CAPACITY/WC                         $170.00
8040867   80   FUNCT CAPACITY 15MIN MCR                        $43.00
8040859   80   WOUND CR NON-SEL DEB 30"                       $149.00
8040578   80   AQUATIC GRP 15"ADD MC&WC                        $60.00
8040834   80   WOUND CARE SEL DEBRID 30"                      $162.00
8040917   80   BIO FEEDBK MEAS 30MIN/MC                       $149.00
8040826   80   WOUND CARE SEL DEBRID 15"                       $81.00
8040826   80   WOUND CARE SEL DEBRID 15"                       $81.00


                                    Page 126 of 276
Charge #Dept   CDM Description                        Price
8040826   80   WOUND CARE SEL DEBRID 15"                         $81.00
8040545   80   THER PROC GRP - FULL DAY                       $1,227.00
8040826   80   WOUND CARE SEL DEBRID 15"                         $81.00
8040818   80   WORK HARDENING ADD 1HR                            $35.00
8040800   80   WORK HARDENING INIT 2HR                         $142.00
8040834   80   WOUND CARE SEL DEBRID 30"                       $162.00
8020927   80   DPP COMM TRAIN 15"AD MCWC                         $30.00
8030348   80   SWALLOWING TREATMNT 45MIN                       $198.00
8030355   80   SWALLOWING TREATMNT 60MIN                       $264.00
8020828   80   DPP ADL INTENS EVAL PR&WC                       $480.00
8020836   80   DPP ADL INTENS EVAL MCR                         $240.00
8020844   80   DPP ADL MOBIL EVAL 15/MCR                         $30.00
8020851   80   DPP ADL INTEN EVAL 30/MC                          $60.00
8020869   80   DPP ADL INTN EVL 15ADD/MC                         $30.00
8020877   80   DPP MOBILITY PRACT 15MIN                          $24.00
8020885   80   DPP MOBIL PRA 30MIN MC&WC                         $48.00
8020893   80   DPP MOBIL PRAC 15ADD MCWC                         $24.00
8050098   80   *THER REC GRP 90MIN                             $294.00
8020919   80   DPP COMM TRAIN 30" MC&WC                          $60.00
8020935   80   DPP TRAVEL TIME 15MIN                             $13.00
8050247   80   *THER REC COMM SKL 15 MCR                         $66.00
8050031   80   *THER REC EVAL 45MIN                            $252.00
8040172   80   INITIAL EVAL 120MIN                             $660.00
8050056   80   *THER REC EVAL 15" ADD MC                         $84.00
8050064   80   *THER REC GRP 30MIN                             $112.00
8050072   80   *THER REC GRP 45MIN                             $168.00
8050080   80   *THER REC GRP 60MIN                             $224.00
8020901   80   DPP COMMUNITY TRAIN 15MIN                         $30.00
8030173   80   SPEECH GROUP 60MIN                              $224.00
8040990   80   BIO FEEDBACK TRNG 60MIN                         $314.00
8030017   80   SPEECH/LANG EVAL 30MIN                          $165.00
8030025   80   SPEECH/LANG EVAL 45MIN                          $259.00
8030033   80   SPEECH/LANG EVAL 60MIN                          $330.00
8030041   80   SPEECH/LANG EVAL 75MIN                          $431.00
8030066   80   SPEECH/LANG EVAL 90MIN                          $518.00
8030082   80   SPEECH/LANG EVAL 120 MIN                        $660.00
8030090   80   SPEECH/LANG THERAPY 15MIN                         $68.00
8030124   80   SPEECH/LANG THERAPY 30MIN                       $136.00
8030132   80   SPEECH/LANG THERAPY 45MIN                       $204.00
8030140   80   SPEECH/LANG THERAPY 60MIN                       $272.00
8030330   80   SWALLOWING TREATMNT 30MIN                       $132.00
8030165   80   SPEECH GROUP 45MIN                              $168.00
8030322   80   SWALLOWING TREATMT 15MIN                          $66.00
8030181   80   SPEECH GROUP 120MIN/MCR                         $409.00
8030199   80   SPEECH GROUP 240MIN/MCR                         $818.00
8030207   80   SPEECH GROUP FULL DAY                          $1,227.00
8030223   80   SPEECH GRP 15MIN ADD'L/WC                         $51.00
8030231   80   SWALLOW EVAL VIDEO 30MIN                        $268.00
8030249   80   SWALLOW EVAL VIDEO 45MIN                        $403.00
8030256   80   SWALLOW EVAL VIDEO 60MIN                        $537.00
8030264   80   SWALLOW EVAL VIDEO 75MIN                        $671.00
8030272   80   SWALLOW EVAL VIDEO 90MIN                        $805.00
8050049   80   *THER REC EVAL 60MIN                            $320.00
8030157   80   SPEECH GROUP 30MIN                              $112.00
8050189   80   *THER REC AQUA THR 15 MCR                         $91.00
8040131   80   INITIAL EVAL 45MIN                              $248.00
8040123   80   INITIAL EVAL 30MIN                              $173.00
8050288   80   *THER REC COMM SKL 15 ADD                         $58.00


                                    Page 127 of 276
Charge #Dept   CDM Description                       Price
8050254   80   *THER REC COMM SK 30 MCWC                      $115.00
8050239   80   *THER REC LEIS SKL 15ADD                         $58.00
8050213   80   *THER REC LEISURE SK 15"                         $66.00
8040149   80   INITIAL EVAL 60MIN                             $330.00
8050197   80   *THER REC AQUA THER 30MIN                      $145.00
8050171   80   *THER REC AQUA GP 15 ADD                         $58.00
8050163   80   *THER REC AQUA GRP 60MIN                       $288.00
8050155   80   *THER REC AQUA GRP 30MIN                       $115.00
8050148   80   *THER REC GRP 15 ADD MCWC                        $49.00
8050130   80   *THER PROC GRP FULL DAY                       $1,176.00
8050122   80   *THER PROC GRP 240MIN/MCR                      $895.00
8050106   80   *THER REC GRP 120MIN                           $447.00
8050023   80   *THER REC EVAL 30MIN                           $160.00
8050205   80   *THER REC AQU THER 15 ADD                        $72.00
8040164   80   INITIAL EVAL 90MIN                             $518.00
8040156   80   INITIAL EVAL 75MIN                             $431.00
8041022   80   MANUAL THER SFT TIS MOB                          $66.00
8020786   80   COGNITIVE TRN 15"ADD/MCWC                        $60.00
8020778   80   COGNITIVE TRN 30"/MC&WC                        $119.00
8041014   80   MANUAL THER-JNT MOB/MC&WC                        $66.00
8041030   80   MANUAL THER MYOFASC REL                          $66.00
8020760   80   COGNITIVE TRNG 15MIN/MCR                         $75.00
8020737   80   ADL TRNG 15MIN/MCR                               $68.00
8020752   80   ADL TRNG 15MIN ADD/MC&WC                         $60.00
8020646   80   HOME MGT(CHECK)30"/MC&WC                       $119.00
8020745   80   ADL TRNG 30MIN/MC&WC                           $119.00
8020513   80   WOUND CARE SEL DEBRID 15"                        $81.00
8020489   80   FUNC ACT 15MIN ADD/MC&WC                         $68.00
8020497   80   WORK HARDENING INIT 2HR                        $142.00
8020505   80   WORK HARDENING 1HR ADD                           $35.00
8020257   80   THER EXER 15MIN ADD/MC&WC                        $60.00
8020240   80   THER EXER 30MIN/MC&WC                          $136.00
8020166   80   WHIRLPOOL-EXTREMITY                            $115.00
8020513   80   WOUND CARE SEL DEBRID 15"                        $81.00
8020547   80   WOUND CR NON-SEL DEBR 30"                      $149.00
8041006   80   BIO FEEDBK TRN 15"ADD/MC                         $69.00
8020455   80   ORTHO FIT/TRN 15"ADD MCWC                        $66.00
8020521   80   WOUND CARE SEL DEBRID 30"                      $162.00
8040099   80   THER PROC GRP 180MIN/MCR                       $613.00
8030363   80   THER PROC GRP 180MIN                           $613.00
8020976   80   THER PROC GRP 180MIN/MCR                       $613.00
8020521   80   WOUND CARE SEL DEBRID 30"                      $162.00
8020521   80   WOUND CARE SEL DEBRID 30"                      $162.00
8020521   80   WOUND CARE SEL DEBRID 30"                      $162.00
8020539   80   WOUND CR NON-SEL DEB 15"                         $75.00
8020513   80   WOUND CARE SEL DEBRID 15"                        $81.00
8020364   80   THER PROC GRP - FULL DAY                      $1,342.00
8020265   80   NEUROMUSC RE-ED 15MIN/MCR                        $75.00
8020273   80   NEUROMUSC RE-ED 30"/MC&WC                      $132.00
8020281   80   NEUROMUSC RE-ED ADD/MC&WC                        $66.00
8020299   80   THER PROC GRP INIT 30MIN                       $112.00
8020307   80   THER PROC GRP 15"ADD/MCWC                        $51.00
8020315   80   THER PROC GRP 45MIN/MCR                        $168.00
8020323   80   THER PROC GRP 60MIN/MCR                        $224.00
8020331   80   THER PROC GRP 90MIN/MCR                        $307.00
8020471   80   FUNC ACTIVITY 30MIN/MC&WC                      $136.00
8020356   80   THER PROC GRP 240MIN/MCR                       $895.00
8020463   80   FUNC ACTIVITY 15MIN/MCR                          $75.00


                                   Page 128 of 276
Charge #Dept   CDM Description                        Price
8020372   80   MANUAL THER-JNT MOB MC&WC                       $66.00
8020380   80   MANUAL THER SFT TIS/MC&WC                       $66.00
8020398   80   MANUAL THER MYOFASC REL                         $66.00
8020406   80   MASSAGE 15MIN/MCR                               $75.00
8020414   80   MASSAGE 30MIN/MC&WC                             $60.00
8020422   80   MANUAL THERAPY 15MIN/MCR                        $83.00
8020430   80   ORTHOTIC FIT/TRN 15"/MCR                        $66.00
8020448   80   ORTHOTIC FIT/TRN 30"/MCWC                      $132.00
8020513   80   WOUND CARE SEL DEBRID 15"                       $81.00
8020349   80   THER PROC GRP 120MIN/MCR                       $447.00
8020075   80   INITIAL EVAL 15MIN ADD/MC                       $86.00
8020125   80   *HOT/COLD PACK                                  $62.00
8020117   80   EVAL EST/RE-EV 15" ADD/MC                       $84.00
8020109   80   EVAL EST/RE-EV 60"/MCR&WC                      $337.00
8020091   80   EVAL EST/RE-EV 45"/MCR&WC                      $252.00
8020661   80   BIO FEEDBACK TRNG 30MIN                        $138.00
8020679   80   BIO FEEDBACK TRNG 45MIN                        $208.00
8020554   80   FUNC CAPACITY 15MIN/MCR                         $43.00
8020695   80   BIO FEEDBK TRN 15"ADD/MC                        $69.00
8020133   80   ELEC STIM/TENS UNATTENDED                       $71.00
8020083   80   EVAL ESTAB/RE-EVAL 30MIN                       $168.00
8020687   80   BIO FEEDBACK TRNG 60MIN                        $314.00
8020067   80   INITIAL EVALUATION 120MIN                      $660.00
8020059   80   INITIAL EVALUATION 90MIN                       $518.00
8020042   80   INITIAL EVALUATION 75MIN                       $413.00
8020034   80   INITIAL EVALUATION 60MIN                       $330.00
8020026   80   INITIAL EVALUATION 45MIN                       $259.00
8020018   80   INITIAL EVALUATION 3OMIN                       $165.00
8020729   80   COMM WORK REINT 15"ADD/MC                       $60.00
8020711   80   COMM WORK/REINTEG 30"/MC                       $119.00
8020596   80   BIO FEEDBK MEAS 15MIN/MCR                       $75.00
8020562   80   FUNC CAPACITY/WC                               $170.00
8020703   80   COMM/WORK REINTEG 15"/MCR                       $68.00
8020588   80   ISOKINETIC MEASUREMENT/WC                      $371.00
8020141   80   VASOPNEUMATIC DEVICE                            $56.00
8020232   80   THER EXER 15MIN/MCR                             $68.00
8020224   80   KINETIC EXER 30MIN/MC&WC                       $141.00
8020216   80   KINETIC EXER 15MIN/MCR                          $70.00
8020208   80   FLUIDOTHERAPY                                   $56.00
8020190   80   ULTRASOUND 15MIN                                $71.00
8020182   80   IONTOPHORESIS 15MIN                             $71.00
8020604   80   BIO FEEDBK MEAS 30MIN/MC                       $149.00
8020174   80   ELEC STIM/TENS ATTEN 15"                        $71.00
8020570   80   ISOKINETIC MEASURE 15MIN                        $93.00
8020612   80   BIO FEEDBK MEAS 60MIN/WC                       $298.00
8020158   80   PARAFFIN                                        $71.00
8020620   80   BIO FEEDBK MEAS 15"ADD MC                       $75.00
8020653   80   HOME MGT(CHECK)15" ADD/WC                       $60.00
8020638   80   HOME MGT(CHECK) 15MIN/MCR                       $75.00
8001000   80   FULL DAY CANCELLATION                          $244.00
8001018   80   HALF DAY CANCELLATION                          $103.00
8010001   80   SOC SERV GP THER 60MIN                         $224.00
8010100   80   SOC SERV GP THER 30MIN                         $112.00
8010258   80   SOC SERV IND THER 60MIN                        $261.00
8010407   80   SOC SERV IND THER 30MIN                        $115.00
8010506   80   SOC SVC PSYCH EVAL 60MIN                       $337.00
8010605   80   SOC SVCS PSYCH EVAL 30MIN                      $168.00
8000572   80   NEUROPSYCH TESTING 60MIN                       $392.00


                                    Page 129 of 276
Charge #Dept   CDM Description                        Price
8000010   80   PSY REHAB GP THER 50MIN                         $224.00
8000069   80   PSY REHAB GP THER 25MIN                         $112.00
8000119   80   PSYCH IND TX 50MIN                              $280.00
8000218   80   PSYCH IND TX 20-30MIN                           $141.00
8000416   80   PSYCH EVAL 60MIN                                $346.00
8040768   80   BIOFEED TRNG 60'                                $277.00
8000754   80   PSYCH FAMILY THERAP 30MIN                       $141.00
8000762   80   PSYCH FAMILY THERAP 60MIN                       $280.00
8000770   80   PSYCH CO-JOINT THER 30MIN                       $141.00
8000788   80   PSYCH CO-JOINT THER 60MIN                       $280.00
8000515   80   PSYCH EVAL 30MIN                                $174.00
8031254   80   ADDITIONAL EVAL 25MIN                           $161.00
8000226   80   BIDT HALF DAY                                      $1.00
8041071   80   AQUATIC GRP 45MIN                               $179.00
8050320   80   *THER REC AQUATIC GRP 45                        $173.00
8000234   80   BIDT FULL DAY                                      $1.00
8023962   80   OT DEBR SELCT>20CM 30MIN                        $172.00
8023954   80   OT DEBR SELCT>20CM 15MIN                          $86.00
8042293   80   PT DEBR SELCT>20CM 30MIN                        $172.00
8042285   80   PT DEBR SELCT>20CM 15MIN                          $86.00
8023947   80   OT DEBR SELCT<20CM 30MIN                        $162.00
8023939   80   OT DEBR SELCT<20CM 15MIN                          $81.00
8042277   80   PT DEBR SELCT<20CM 30MIN                        $162.00
8042269   80   PT DEBR SELCT<20CM 15MIN                          $81.00
8200073   82   LAYRNGOSCOPY; DIRECT                            $216.00
8200263   82   SIGMOIDOSCOPY, RIGID                           $1,207.00
8200081   82   LARYNGOSCOPY; FLEX                                $88.00
8200099   82   FLEXIBLE SIGMOIDOSCOPY                          $773.00
8200412   82   BIOPSY PROSTATE NDL INTRO                       $108.00
8200461   82   INTENSITY MOD RADIO PLAN                       $6,821.00
8200453   82   INTENSITY MOD TX DELIVERY                      $1,019.00
8205734   82   NM BRACHY SEED IR-192 HDR                       $196.00
8205205   82   RAD TX COMPLEX 6 MEV                            $490.00
8205700   82   IV INFUSION ADD'L HR                            $100.00
8205692   82   IV INFUSION 1 HR                                $197.00
8205684   82   EXAM/TX PREPARATION                             $130.00
8205320   82   SIMULATION - 3D                                $5,836.00
8205312   82   INFUSION RADIOELEMENT                           $255.00
8205239   82   RAD TX COMPLEX 25 MEV                           $490.00
8205221   82   RAD TX INTERMED 25 MEV                          $362.00
8205213   82   RAD TX SIMPLE 25 MEV                            $372.00
8230070   82   NEW PATIENT COMPREHENSIVE                       $207.00
8200057   82   EB THERAPY 6-10 MEV                             $490.00
8280778   82   TREATMENT ROOM                                  $390.00
8280760   82   FNA BX PATH IN RAD ONC                          $197.00
8280752   82   CONSCIOUS SEDATION(ORAL)                        $560.00
8280745   82   CONSCIOUS SEDATION(IV)                          $560.00
8230138   82   EST PT COMPREHEN EXAM HX                        $207.00
8230120   82   EST PT DETAILED EXAM HX                         $207.00
8230112   82   EST PT EXPANDED EXAM HX                         $126.00
8230104   82   EST PT-FOCUS EXAM HX                            $122.00
8230088   82   NEW PATEINT COMPL/COMP                          $207.00
8230062   82   NEW PATIENT DETAILED                            $126.00
8230054   82   NEW PATIENT EXPANDED                            $102.00
8230047   82   NEW PT FOCUSED                                  $122.00
8230096   82   ESTAB PT MIN                                    $122.00
8200305   82   HDR 1-4 SOURCE POSITIONS                       $4,239.00
8201600   82   INTRACAVITARY IMP INTERM                        $573.00


                                    Page 130 of 276
Charge #Dept   CDM Description                       Price
8201501   82   INTRACAVITARY IMP COMPLEX                   $714.00
8201303   82   CONTINUING MED PHYSICS                      $624.00
8201006   82   BASIC RAD DOSIMETRY CALC                    $281.00
8200404   82   EB THERAPY >20 MEV                          $490.00
8200396   82   BLOOD PRODUCT IRRIDATION                    $163.00
8200362   82   SPECIAL TX PROCEDURE                       $2,326.00
8200354   82   SPEC TELETHER PORT PLANS                    $846.00
8200313   82   HDR 5-8 SOURCE POSITIONS                   $3,211.00
8200347   82   SPECIAL PHYSICS CONSULT                     $730.00
8200255   82   ISODOSE PLAN - SIMPLE                       $390.00
8200248   82   ISODOSE PLAN-INTERMEDIATE                   $490.00
8200230   82   ISODOSE PLAN - COMPLEX                      $556.00
8200123   82   EB THERAPY <5 MEV                           $371.00
8205197   82   RAD TX INTERM 6 MEV                         $362.00
8200065   82   EB THERAPY 11-19 MEV                        $490.00
8200339   82   HDR >12 SOURCE POSITIONS                   $4,239.00
8202368   82   SPECIAL DOSIMETRY                           $104.00
8204968   82   PORT FILMS                                  $126.00
8203515   82   SIMULATION - INTERMEDIATE                   $894.00
8203358   82   SIMULATION - COMPLEX                       $1,359.00
8203333   82   SIMULATION - SIMPLE                         $725.00
8203127   82   INTERSTITIAL IMP COMPLEX                   $1,076.00
8203119   82   INTERSTITIAL IMP INTERM                     $672.00
8203101   82   INTERSTITIAL IMP SIMPLE                     $346.00
8202905   82   TREATMENT DEVICES-SIMPLE                    $281.00
8202806   82   TREATMENT DEVICES - INTER                   $396.00
8202707   82   TREATMENT DEVICES -COMPLX                   $679.00
8201709   82   INTRACAVITARY IMP SIMPLE                    $438.00
8200321   82   HDR 9-12 SOURCE POSITIONS                  $4,239.00
8202301   82   SURFACE APPL SR-90                          $120.00
8202277   82   BRACHYTHERAPY CALC INTERM                   $725.00
8202269   82   BRACHYTHERAPY CALC COMPLX                  $1,038.00
8202202   82   SPRVSN & HDLG OF RADIOELE                   $104.00
8201923   82   NDL, PROSTATE SEED                            $26.00
8201824   82   SET, STABILIZING NEEDLE                     $174.00
8205189   82   RAD TX SIMPLE 6 MEV                         $372.00
8202434   82   BRACHYTHERAPY CALC-SIMPLE                   $374.00
8290082   82   THERAP RADIOLOGY TREAT PL                   $780.00
8290041   82   SRS DELIVERY (STANDARD)                   $34,000.00
8205346   82   BREAST INTERS RAD TX DELY                  $6,922.00
8205338   82   BREAST INTERS RADTX IMMED                  $5,868.00
8200115   82   BRACHY SEED I-125 EA                          $60.00
8200032   82   CHEMO INFUSION 1ST HR                       $391.00
8290009   82   STEROTACT RADIOSURG 1 OR                  $37,000.00
8290017   82   SRS PLANNING (STANDARD)                    $8,000.00
8290108   82   3-D SIMULATION PLANNING                    $5,836.00
8290033   82   SRS PLANNING (COMPLEX)                    $12,000.00
8200040   82   CHEMO INFUS ADD HR MAX 8                    $130.00
8290058   82   SRS DELIVERY INTERMEDIATE                 $34,000.00
8290066   82   SRS DELIVERY (COMPLEX)                    $38,000.00
8290074   82   3-D SIMULATION PLANNING                    $5,480.00
8290090   82   RADIATION MGT CEREBRAL LE                  $1,350.00
8290116   82   RADIATION MGT CEREBRAL LE                  $1,438.00
8290124   82   THERAPEUTIC RADIOLOGY TRE                   $831.00
8290025   82   SRS PLANNING (INTERMEDIAT                 $10,000.00
8220212   82   CHEMO ADMN CNS W/ SPINAL                    $210.00
8400236   84   MRI CONTRAST MATERIAL                       $707.00
8411894   84   MRI UPPER EXT W CONT BIL                   $2,140.00


                                   Page 131 of 276
Charge #Dept   CDM Description                       Price
8411928   84   MRI UP EXT WO+W CONT BIL                      $2,140.00
8411936   84   MRI UPPER JNT WO CONT BIL                     $1,883.00
8411852   84   MRI UPPER EXT W CONT RT                       $2,117.00
8411993   84   MRI UPPER JNT W CONT LT                       $2,117.00
8412009   84   MRI UPPER JOINT W CONT RT                     $2,117.00
8412017   84   MRI UP JNT WO+W CONT BIL                      $2,839.00
8412041   84   MRI LWR EXT WO CONT BIL                       $2,305.00
8412058   84   MRI LOWER EXT W CONT BIL                      $2,697.00
8412074   84   MRI LWR EXT WO+W CONT BIL                     $3,106.00
8412082   84   MRI LWR JNT WO CONT BIL                       $2,305.00
8412090   84   MRI LWR JNT W CONT BIL                        $2,697.00
8412108   84   MRI LWR JNT WO+W CONT BIL                     $3,106.00
8411969   84   MRI UP JOINT W CONT BIL                       $2,140.00
8412900   84   MRI CARDIAC MORPH WO CONT                     $3,106.00
8412918   84   MRI CARDIAC MORPH W CONT                      $3,427.00
8412926   84   MRI CARDIAC FUNCT LIMITED                     $3,321.00
8406381   84   MR L SPINE W CONTRAST                          $453.00
8411571   84   MR BREAST WO&W CON RTCONT                     $2,415.00
8411845   84   MRI UPPER EXT W CONT LT                       $2,117.00
8411597   84   MR SPECTROSCOPY                               $3,408.00
8411589   84   MRI BREAST W +/OR WO CONT                     $2,415.00
8412801   84   MR FACE NECK ORBITS W CON                     $2,914.00
8406324   84   MR C SPINE W CONTRAST                         $3,395.00
8406456   84   MR T SPINE W CONTRAST                         $3,395.00
8411837   84   MRI UPPER EXT W0 CON BIL                      $2,032.00
8412934   84   MRI CARDIAC FLOW MAPPING                      $3,427.00
8411340   84   MRI ANKLE W/O CONT LT                         $2,536.00
8411225   84   MRI UPPER EXT W&W/O LT                        $2,140.00
8411233   84   MRI UPPER EXT W&W/O RT                        $2,140.00
8411241   84   MRI SHOULDER W/O CONT LT                      $2,536.00
8411258   84   MRI SHOULDER W/O CONT RT                      $2,536.00
8411266   84   MRI ELBOW W/O CONT LT                         $2,071.00
8411274   84   MRI ELBOW W/O CONT RT                         $2,071.00
8411282   84   MRI WRIST W/O CONT.LT                         $2,229.00
8411290   84   MRI WRIST W/O CONT RT                         $2,229.00
8411308   84   MRA UPPER EXT LT                              $3,776.00
8411316   84   MRA UPPER EXT RT                              $3,776.00
8411332   84   MRI LOWER EXT W&W/O RT                        $2,604.00
8411357   84   MRI ANKLE W/O CONT RT                         $2,536.00
8411365   84   MRI HIP W/O CONT LT                           $2,536.00
8411373   84   MRI HIP W/O CONT RT                           $2,536.00
8411381   84   MRI KNEE W/O CONT LT                          $2,536.00
8411399   84   MRI KNEE W/O CONT RT                          $2,536.00
8411407   84   MRA LOW EXT WO+W LT                           $4,532.00
8411415   84   MRA LOWER EXT WO+W RT                         $4,532.00
8411456   84   MRI HAND W&W/O CONT RT                        $2,140.00
8411324   84   MRI LOWER EXT W&W/O LT                        $2,604.00
8408569   84   MRI BRAIN PRE&POST CONTR.                     $3,852.00
8408585   84   MRI PITUITARY W&W/O CONT                      $3,852.00
8408643   84   MRI IAC'S PRE/POST CONTR.                     $4,623.00
8408650   84   MRI C-SPINE PRE/POST CONT                     $3,303.00
8408668   84   MRI T-SPINE PRE/POST CONT                     $3,303.00
8408676   84   MRI L-SPINE PRE/POST CONT                     $3,303.00
8408064   84   MRI/MRA CONTRAST                               $849.00
8408742   84   MRI SALIV.GLAND W&WO CONT                     $3,046.00
8411183   84   MRI BRAIN-DIFF W/O CONT                       $3,852.00
8409096   84   MRI BRAIN W/CONTR.                            $2,918.00
8411001   84   MRA HEAD W/O CONTRAST                         $3,461.00


                                   Page 132 of 276
Charge #Dept   CDM Description                        Price
8411019   84   MRA HEAD W&W/O CONTRAST                        $4,483.00
8411027   84   MRA HEAD W/CONTRAST                            $4,050.00
8411068   84   MRI SHOULDER W&W/O LT                          $3,124.00
8411076   84   MRI SHOULDER W&W/O RT                          $3,124.00
8411126   84   MRI ANKLE W&W/O CONT LT                        $2,366.00
8411134   84   MRI ANKLE W&W/O CONT RT                        $2,366.00
8412439   84   MRI FOREARM W/O CONT RT                        $1,863.00
8412306   84   MRI FEMUR W/O CONT LT                          $2,536.00
8412314   84   MRI FEMUR W/O CONT RT                          $2,536.00
8412322   84   MRI LOW EXT W/CONT LT                          $2,484.00
8412330   84   MRI KNEE W&W/O CONT LT                         $3,124.00
8412348   84   MRI KNEE W&W/O CONT RT                         $3,124.00
8412355   84   MRI LOW EXT W/O CONT RT                        $2,536.00
8412363   84   MRI FOOT W/CONT LT                             $2,733.00
8412371   84   MRI FOOT W/CONT RT                             $2,733.00
8412389   84   MRI FOOT W/O CONT LT                           $2,060.00
8412397   84   MRI FOOT W/O CONT RT                           $2,060.00
8412405   84   MRI WRIST W&W/O CONT LT                        $2,134.00
8412421   84   MRI FOREARM W/O CONT LT                        $2,235.00
8412272   84   MRA NECK W/O CONTRAST                          $2,175.00
8412447   84   MRI HAND W/O CONT LT                           $2,235.00
8412454   84   MRI ABDOMEN W/CONTRAST                         $3,573.00
8412462   84   MRI HUMERUS W/O CONT LT                        $2,235.00
8412470   84   MRI HUMERUS W/O CONT RT                        $2,235.00
8412488   84   MRI UP EXT W/O CONT LT                         $2,235.00
8412496   84   MRI UP EXT W/O CONT RT                         $1,857.00
8412512   84   MR ORBIT/FACE/NECK WO&W C                      $3,950.00
8412538   84   MRI ABDOMEN W/O CONT                           $2,985.00
8412546   84   MRI HAND W/O CONT RT                           $2,235.00
8412553   84   MRI ABDOMEN W&W/O CONT                         $4,163.00
8412413   84   MRI WRIST W&W/O CONT RT                        $2,134.00
8411977   84   MRI FOOT W&W/O CONT LT                         $3,124.00
8411605   84   MRI HUMERUS W&W/O CONT RT                      $2,140.00
8411613   84   MRI HUMERUS W&W/O CONT LT                      $2,140.00
8411720   84   MRI FEMUR W&W/O CONT LT                        $2,839.00
8411738   84   MRI FEMUR W&W/O CONT RT                        $2,366.00
8411811   84   MRI FOREARM W&W/O CONT LT                      $2,140.00
8411829   84   MRI FOREARM W&W/O CONT RT                      $2,140.00
8412298   84   MRI CHEST W&W/O CONTRAST                       $3,124.00
8411951   84   MRI TIB-FIB W&W/O CONT RT                      $2,366.00
8412280   84   MRI CHEST W/CONTRAST                           $2,484.00
8411985   84   MRI FOOT W&W/O CONT RT                         $3,124.00
8412157   84   MRI ELBOW W&W/O CONT LT                        $2,015.00
8412165   84   MRI ELBOW W&W/O CONT RT                        $2,015.00
8412173   84   MRI HIP W/CONT LT                              $2,277.00
8412181   84   MRI HIP W/CONT RT                              $2,069.00
8412199   84   MRI HIP W&W/O CONT LT                          $2,604.00
8412207   84   MRI HIP W&W/O CONT RT                          $3,124.00
8412215   84   MRI ANKLE W/CONT LT                            $2,277.00
8412223   84   MRI ANKLE W/CONT RT                            $2,277.00
8412256   84   MRA NECK W&W/O CONTRAST                        $3,395.00
8411944   84   MRI TIB-FIB W&W/O CONT LT                      $2,366.00
8403156   84   MRI CARDIAC FUNCTION COMP                      $3,417.00
8403701   84   RECONSTRUCTION MULTI 3D                         $708.00
8402745   84   MRI PELVIS W/CON                               $3,165.00
8406043   84   MRI BRAIN W/O CONTRAST                         $3,852.00
8406175   84   MR ORBIT/FACE/NECK WO&W C                      $3,502.00
8400400   84   MRI BREAST BIL W +/OR WO                       $2,657.00


                                    Page 133 of 276
Charge #Dept   CDM Description                        Price
8401606   84   MRI CHEST W/O CONTRAST                         $2,536.00
8406241   84   MRI INT AUD CANALS                             $2,793.00
8407322   84   MRI ORBITS, FCE & NCK WO                       $2,995.00
8407520   84   MRI TMJ'S                                      $3,584.00
8406316   84   MRI C-SPINE W/O CONT                           $3,303.00
8412561   84   MRI PELVIS W/O CONTRAST                        $2,995.00
8406373   84   MRI L-SPINE W/O CONTRAST                       $3,107.00
8406449   84   MRI T-SPINE W/O CONTRAST                       $3,303.00
8406803   84   MRI HAND WO+W CONT BIL                         $1,693.00
8412579   84   MRI PELVIS W&W/O CONT                          $2,986.00
8480923   84   CONSCIOUS SEDATION(ORAL)                        $560.00
8480915   84   CONSCIOUS SEDATION(IV)                          $740.00
8450082   84   MRA SPINE W OR WO CONT                         $3,735.00
8450074   84   MRA PELVIS W + WO CONT                         $3,365.00
8450066   84   MRA NECK W/CONT                                $4,286.00
8412603   84   MRI TIB-FIB W/O CONT RT                        $2,536.00
8450041   84   MRA UPPER EXTREMITY BIL                        $3,611.00
8412595   84   MRI TIB-FIB W/O CONT LT                        $2,536.00
8412637   84   MRI LOW EXT W/CONT RT                          $2,484.00
8450025   84   MRA CHEST W OR WO CONT                         $3,735.00
8441149   84   MRI HAND W&W/O CONT LT                         $2,140.00
8450017   84   MRA ABDOMEN W/O, W CONT                        $3,573.00
8412645   84   MRI LOW EXT W/O CONT LT                        $2,536.00
8450033   84   MRA LOWER EXT WO+W BIL                         $4,473.00
8412819   84   MR ABLATION VISCERAL TISS                      $1,105.00
8501116   85   INJ HYSTEROSON/SALPINGOG                        $310.00
8501132   85   ARTERIAL DUPLEX SCAN LELT                       $649.00
8501157   85   UNILATERAL MAMMOGRAPHY                          $103.00
8580524   85   DUCTO/GALACTOGRM MULTI RT                       $644.00
8501124   85   AMNIOCENTESIS; DIAGNOSTIC                       $226.00
8501140   85   ARTERIAL DUP UPPR EXT LT                        $979.00
8501108   85   INJ FOR GLACTOGRAM                              $226.00
8501835   85   US GUIDE NDL PLACE BR LT                        $918.00
8550576   85   US UP EXT ART DOPPLER BIL                      $1,175.00
8550634   85   US DUPLX HEMODIALYSIS ACC                       $474.00
8550543   85   INTRACRANIAL ART DOPP LIM                       $889.00
8550568   85   US LWR EXT ART DOPPLER BI                       $980.00
8524035   85   BX SKIN, SINGLE LESION                          $383.00
8580557   85   ASPIRATION CYST BRST 1ST                        $116.00
8550667   85   CONSCIOUS SEDATION(IV)                          $672.00
8550527   85   EXTRACRANIAL ART DOPP BIL                      $1,606.00
8524076   85   BREAST LOC INITIAL LESION                       $234.00
8511388   85   US GUIDE INTER RADIOTHERA                      $1,645.00
8550642   85   US LWR EXT VEN DOPP BIL                        $1,349.00
8550659   85   US UP EXT VENOUS DOPP BIL                      $1,349.00
8550584   85   US UP EXT VEN DUPLEX BIL                        $889.00
8511370   85   US GUIDED TIPS REVISION                         $724.00
8550600   85   DUPLX ART/VN VISC/PLV LTD                      $1,052.00
8550626   85   DUP ARTA,IVC,IL,GRFT LTD                       $1,159.00
8580565   85   ASPIRATION CYST BRST ADDL                         $69.00
8511255   85   OB 1ST TRI EA ADD FETUS                         $473.00
8511354   85   US GUIDED BX SOFT TISSUE                       $1,404.00
8511347   85   IRS PNEUMONOSTOMY W/DRAIN                       $276.00
8511339   85   US GUIDE NDL PLACE BRS RT                       $918.00
8511321   85   US PRST VOL BRACHYTHERAPY                      $1,029.00
8511289   85   OB TRANSVAGINAL, US                             $760.00
8550535   85   INTRACRANIAL ART DOP COMP                      $1,175.00
8511263   85   US OB+DTL FTL ANTMY SGL F                       $879.00


                                    Page 134 of 276
Charge #Dept   CDM Description                        Price
8550618   85   DUPLX ARTA,IVC,IL GRF CMP                      $1,278.00
8511248   85   US SPINAL CANAL                                 $731.00
8511230   85   US RENAL TRANSPLANTED                           $914.00
8511222   85   US RETROPERITONEAL                              $914.00
8511214   85   US GUIDED TISSUE ABLATION                      $2,982.00
8580540   85   DUCTOGRAM/GALACT SNGLE RT                       $703.00
8580532   85   DUCTOGRAM/GALACT SNGL LT                        $703.00
8511271   85   OB+DTL FTL AN EA ADD FTS,                       $473.00
8524126   85   BX SFT TISS NCK OR THORAX                       $239.00
8524175   85   BX EPIDIDYMIS, NEEDLE                           $227.00
8579955   85   US LOW EXT VENOUS DUPL BI                      $2,577.00
8524167   85   US PARACENTESIS SUBSEQ                          $391.00
8524159   85   BX,PANCREAS-PERC NEEDLE                         $274.00
8550592   85   DUPLX ART/VEN VSC/PEL CMP                      $1,172.00
8524183   85   INJ EPIDURAL/LOC CT SPINE                      $1,179.00
8524134   85   BX,PLEURAL-PERC NDL                             $256.00
8524118   85   BIOPSY,BONE                                     $318.00
8524100   85   BX,BNE-TROC/NDL,SUPER                           $239.00
8524092   85   BX,MUSCLE-PERC NEEDLE                           $195.00
8524191   85   INJ EPIDURAL/LOCAL L SPIN                      $1,179.00
8524084   85   BREAST LOC ADD LESION                           $234.00
8524142   85   BX LYMPH NODE-SUPERFICIAL                       $227.00
8524209   85   INJ ARTHROCENTESIS MJ JT                          $82.00
8523516   85   BX RENAL PERC                                   $391.00
8580417   85   US BREASTS BIL(W CTR)                           $399.00
8500217   85   CAPILLARY PUNCTURE                                $43.00
8570236   85   ARTERIAL DUPLEX UP EXT RT                       $649.00
8570228   85   ART DUP SCAN UP EXY BILAT                      $1,293.00
8570210   85   ART PROFL W/ EXERCISE                          $1,660.00
8570061   85   US LO EXT ART DOP MLT BIL                      $1,406.00
8550501   85   US INFANT HIP RT                               $1,226.00
8550519   85   US INFANT HIP LT                               $1,226.00
8580003   85   MAMMOGRAM DIAG RT                               $318.00
8580078   85   US CHEST                                        $593.00
8550493   85   US SHOULDER LT                                 $1,031.00
8570046   85   ART DUP SCAN LO EXT-BIL                        $1,293.00
8580011   85   MAMMOGRAM DIAG LT                               $318.00
8580029   85   MAMMOGRAM DIAG BILAT                            $439.00
8580037   85   US BREAST LT NDL LOCAL                          $759.00
8580045   85   MAMMOGRAPHY ADD'L (W.CTR)                       $136.00
8580060   85   MAMMAGRAM SCREENING BIL                         $197.00
8580086   85   US SOFT TISSUE HEAD + NEC                       $790.00
8580094   85   US BLADDER(W.CTR)                               $490.00
8550485   85   US SHOULDER RT                                 $1,031.00
8550345   85   ART DUPLEX BILAT LOW EXT                        $889.00
8580052   85   BREAST BIOPSY SPECIMEN/WC                       $266.00
8550386   85   US BREAST RT                                    $266.00
8550279   85   US GUIDED FNA THYROID W I                       $197.00
8550287   85   US UPPER EXT ART DOPL BIL                      $1,278.00
8580235   85   US RENAL LTD(W.CTR)                             $348.00
8550477   85   US UP EXT VEN DOP LT                            $994.00
8550394   85   US BREAST LT                                    $266.00
8550402   85   US OCCULAR RT                                   $534.00
8550410   85   US OCCULAR LT                                   $534.00
8550428   85   US EXTREM NON VASC RT                           $790.00
8550436   85   US EXTREM NON VASC LT                           $790.00
8550444   85   US LOW EXT VEN DOP RT                          $1,485.00
8550451   85   US LOW EXT VEN DOP LT                          $1,485.00


                                    Page 135 of 276
Charge #Dept   CDM Description                       Price
8550469   85   US UP EXT VEN DOP RT                           $994.00
8580466   85   US EXTREM NON VASC RT                          $790.00
8580219   85   US OB 2&3 TRIMES(W.CTR)                       $1,254.00
8580367   85   US THORACEN PUNC(W.CTR)                        $322.00
8580375   85   US THYROID NDL BX(W.CTR)                       $190.00
8580383   85   US THYROID BIOPSY(W.CTR)                       $906.00
8580391   85   MA MAMMO PLACE NDL BRST R                      $759.00
8580409   85   MA MAMMO PLACE NDL BRST L                      $759.00
8580425   85   US BREAST RT(W.CTR)                            $266.00
8580433   85   US BREAST LT(W.CTR)                            $266.00
8580342   85   US BONE DENSITY(W.CTR)                         $246.00
8580334   85   DEXA RADIUS WRIST OR HEEL                      $757.00
8580474   85   US EXTREM NON VASC LT                          $790.00
8580482   85   US LO EXT DOP RT(W.CTR)                       $1,485.00
8580490   85   US LOW EXT DOP LT(W.CTR)                      $1,485.00
8580508   85   US UP EXT DOP RT(W.CTR)                        $994.00
8580516   85   US UP EXT DOP LT(W.CTR)                        $994.00
8580227   85   US RENAL(W.CTR)                               $1,005.00
8580128   85   US THORACENTESIS(W.CTR)                        $773.00
8580136   85   US APPENDIX(W.CTR)                            $1,015.00
8580144   85   US ABDOMINAL COMPLETE                         $1,047.00
8580151   85   US ABD LTD(W.CTR)                              $606.00
8580177   85   US AORTA(W.CTR)                               $1,015.00
8580185   85   US OB 1ST TRI SNGL FETUS                      $1,015.00
8580193   85   US OB LTD 1 OR MORE FETUS                      $521.00
8580359   85   US OB 2ND/3RD EACH ADD'L                       $879.00
8550261   85   US GUIDED FNA BREAST W IM                      $197.00
8580276   85   BREAST LOC 2ND LES(W.CTR)                      $678.00
8580243   85   US BIOPSY GUIDED(W.CTR)                       $1,289.00
8580250   85   US LOCALIZATION(W.CTR)                         $507.00
8580268   85   STEREOTAC BRST BX LOC                         $1,788.00
8580284   85   DUCTO/GALACTOGRM MULTI LT                      $773.00
8580300   85   US GUIDED CYST ASP(W.CTR)                      $837.00
8580318   85   US PARACENTESIS(W.CTR)                         $634.00
8580326   85   US GUIDED ABLATION(W.CTR)                     $1,965.00
8580201   85   US DOPPLER ADJUNCT(W.CTR)                      $471.00
8502197   85   NEEDLE,ELECTRODE(ABLAT)                       $1,666.00
8502213   85   US BONE DENSITY                                $246.00
8511008   85   US ABDOMINAL COMPLETE                         $1,047.00
8511305   85   US AORTA                                      $1,015.00
8501603   85   US INTRAOPERATIVE                             $1,544.00
8501587   85   US TRANSVAGINAL                                $837.00
8522468   85   US VAS DPLX VENOUS EXTREM                      $621.00
8580292   85   US HYSTEROSONOGRAM(W.CTR)                     $1,132.00
8550253   85   US GUID PERC ABSCES DRNG                       $834.00
8500019   85   US CHEST                                       $653.00
8500035   85   ARTERIAL DUPLEX SCAN LERT                      $649.00
8500209   85   US SOFT TISS HEAD + NECK                       $790.00
8500316   85   US BLADDER                                     $490.00
8501611   85   DUPLEX SCAN PENILE VES CO                      $768.00
8500332   85   US SUPERFICIAL MASS                            $557.00
8500506   85   US HEAD                                        $944.00
8500704   85   US BIOPHYSICAL PROFILE                        $1,088.00
8501355   85   US THORACENTESIS                              $1,021.00
8501363   85   CAROTID DUPLEX SCAN BILAT                     $1,767.00
8501496   85   US APPENDIX                                   $1,015.00
8501538   85   US PROSTATE BIOPSY                             $923.00
8500324   85   US PELVIC MALE                                 $583.00


                                   Page 136 of 276
Charge #Dept                CDM Description                                                                        Price
8550147      85            FNA W/WO SMEAR-SUPER                                                                               $197.00
8550030      85            US THORACENTESIS                                                                                   $322.00
8550048      85            US PARACENTESIS INITIAL                                                                            $288.00
8550055      85            BX BREAST PERC NDL CORE                                                                            $215.00
8550063      85            US LIVER-PERC NDL BX                                                                               $497.00
8550071      85            US LIVER BIOPSY                                                                                   $1,174.00
8550089      85            US PROSTATE BX SNGL/MULTI                                                                          $371.00
8550097      85            US THYROID,NDL BX                                                                                  $251.00
8550113      85            US THYROID BIOPSY                                                                                  $906.00
8550139      85            US ABSCESS I&D COMP/MLT                                                                            $250.00
8550154      85            US GUIDE ASPIR BREAST 1ST                                                                          $116.00
8523003      85            US TESTICULAR SCAN                                                                                 $881.00
8550162      85            US PUNC ASP + CYST BREAST                                                                            $69.00
8511107      85            US ABDOMINAL LTD                                                                                   $726.00
8550188      85            US CATH INTR RNL PLVS PER                                                                          $478.00
8550196      85            US ASPIRAT OF CYST-SNG                                                                             $182.00
8550212      85            US ASPIRAT OF CYST MULTI                                                                           $250.00
8550238      85            US BREAST LT NDL LOCALIZ                                                                           $690.00
8550121      85            US ABSCESS I&D SMPL/SNG                                                                            $137.00
8524027      85            US GUIDED BIOPSY                                                                                  $1,289.00
8523409      85            US OB 2&3 TRI SNGL FETUS                                                                          $1,254.00
8523417      85            US BREAST BIL                                                                                      $399.00
8523508      85            US RENAL                                                                                          $1,005.00
8523607      85            US LTD RENAL                                                                                       $417.00
8550014      85            US OB 2ND/3RD EACH ADD'L                                                                           $967.00
8524019      85            US TRANSRECTAL                                                                                     $872.00
8524068      85            US GUIDED NEEDLE PLACE                                                                             $607.00
8550170      85            US RENAL/PLVC ASP-NDLPERC                                                                          $280.00
8530487      85            US PELVIC                                                                                         $1,015.00
8523102      85            US AMNIOCENTESIS                                                                                   $700.00
8540015      85            US HYSTEROSONOGRAM                                                                                $1,029.00
8540114      85            US GUIDED RAD THER PLCT                                                                           $1,730.00
8540304      85            US GUIDED PERC DRAINAGE                                                                            $837.00
8540403      85            US GUIDED PARACENTESIS                                                                             $837.00
8580607      85            US VASO/EPIDIDYMOGRAM                                                                              $539.00
8580631      85            MA MAMMO PLACE NDL BREAST                                                                          $296.00
8580706      85            MA MAMMO PLACE NDL BREAST                                                                          $296.00
8580581      85            US GUIDE NDL PLACE(BX/AS                                                                           $227.00
8580573      85            US GUIDED COMPRESSION RE                                                                           $227.00
9500091      95            OBSERVATION HOUR/LABOR                                                                             $100.00
9500018      95            OBSERVATION HR/TELEMETRY                                                                           $125.00
9500026      95            OBSERVATION HOUR/CVU                                                                               $160.00
9500034      95            OBSERVATION HR/MS GT4                                                                                $85.00
9500042      95            OBSERVATION HR/MEDSURG 2F                                                                            $95.00
9500059      95            OBSERVATION HOUR/ONCOLOGY                                                                            $95.00
9500083      95            OBSERVATION HOUR/PEDS                                                                                $95.00
9500067      95            OBSERVATION HOUR/ORTHO                                                                               $95.00
9541004      95            OBSERVATION HOUR/4FT MED                                                                             $85.00




This charge description master (CDM) is made available for your inspection based on Chapter 2 of Division 2, commencing with Section 1339.50
of the California Health and Safety Code.
Many charges contained in this chargemaster are subject to various periodic changes in the cost of items subject to vendors, manufacturers and
others that supply these items to Northridge Hospital Medical Center The information provided herein, was effective on June 1, 2005 . These
charges may have changed since this date due to new technology, added or eliminated services, goods and/or procedures, etc. According to
Health and Safety Code Section 1339.51, this chargemaster again will be updated July 1, 2006. The information contained in this CDM is specific
to this facility.


                                                             Page 137 of 276
Charge #Dept                 CDM Description                                                                              Price
The charges contained in this document are the same for all patients of this facility regardless of insurance program or coverage. However, the
charges contained in this document do not reflect expected reimbursement, since health plans negotiate reimbursement rates based on a
number of factors. Other issues affecting actual reimbursement could include whether a procedure was done on an inpatient or outpatient basis,
physician orders, comorbidities and complications, medical necessity the patient, are the key components to which services and procedures are
The physician orders, based on his/her examination and treatment of
charged to an individual patient. There are many components that comprise one hospital bill. For example, one short hospital inpatient stay
could include surgical procedures, treatment in the emergency department, supplies, pharmaceuticals, numerous tests (i.e., x-rays, laboratory),
room and board, respiratory and physical therapy and so forth (all based on a physician’s orders). Therefore, this document should not be used
to accurately estimate the final patient cost of a given hospital-stay. It is provided for information only. Descriptions and charges contained in this


This hospital provides discounted care to low-income uninsured patients. Please contact our financial aid department at phone # 818-885-8500,
ext 3751 for more information on programs and eligibility




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